bluuebunny/crossref_metadata_2025 huggingface dataset:
The Mediating Effect of Unhealthy Behaviors and Body Mass Index in the Relation Between High Physical Workload and Self-Rated Poor Health in Male Construction Workers
Authors: Proper Karin I. , Cillekens Bart , Twisk Jos W.R. , Coenen Pieter , Robroek Suzan J.W. , van Oostrom Sandra H.
Published: June 2020

Objectives:

To examine the mediating role of unhealthy behaviors and body mass index (BMI) in the relation between high physical workload and self-rated health in male construction workers.

Methods:

Longitudinal data over 2010 to 2018 were used of 30,224 male construction workers in The Netherlands. Smoking, lack of physical activity, and alcohol consumption were self-reported. BMI was based on measured body weight and height. Multilevel modeling path analyses were used to determine the mediating role of unhealthy behaviors in the relation between physical workload and poor health.

Results:

A direct effect of high physical workload on poor health adjusted for unhealthy behaviors and BMI was found (odds ratio [OR] 1.49, 95% confidence interval [CI] 1.38 to 1.68). Indirect effects of the unhealthy behaviors and BMI in the relation between high physical workload and poor health were small (OR varying from 0.96 to 1.04).

Conclusion:

The pathway of high physical workload and poor health through unhealthy behaviors and BMI was not supported.
Mental Health Stigma and Wellbeing Among Commercial Construction Workers
Authors: Eyllon Mara , Vallas Steven P. , Dennerlein Jack T. , Garverich Suzanne , Weinstein Daniel , Owens Kathleen , Lincoln Alisa K.
Published: June 2020

Objective:

The aim of this study was to understand the relationship between mental health stigma and wellbeing in a sample of commercial construction workers.

Methods:

A sequential quantitative to qualitative mixed methods study was conducted. First, 264 workers were surveyed and logistic regression examined the associations between mental health stigma and psychological distress, substance abuse, and sleep; then, data from eight key informant interviews and six focus groups with workers were analyzed thematically.

Results:

Stigma was significantly associated with psychological distress and impaired sleep, but not with substance abuse. Key informants and workers discussed the prominence of stigma on worksites and how the masculine culture of the industry and job insecurity contributed to stigma.

Conclusion:

Stigma poses a barrier to addressing mental health among workers; peer support and improved human resources may be promising.
Surgical treatment of non-functioning pancreatic neuroendocrine tumors: current controversies and challenges
Authors: Memeh Kelvin O. , Vaghaiwalla Tanaz , Keutgen Xavier M.
Published: June 2020

There has been a rising trend in the incidence and prevalence of non-functioning pancreatic neuroendocrine tumors (NFPanNETs). While a significant number of the newly diagnosed NFPanNETs are asymptomatic, a majority of patients will present with liver metastasis (LM) at the time of diagnosis. Surgical resection remains the only curative treatment, especially for localized NFPanNETs. While a majority of small NFPanNETs are indolent, some are not. This heterogeneity in tumor biology presents the surgeon with the unique challenge of determining which patient will benefit from surgery, given the morbidity of pancreatic surgery. There has been a recent push for a more aggressive approach to the care of these patients, given the emergence of data supporting such measures. However, the risk of over or under treatment has generated immense debate amongst experts in the field. The heterogeneity of current practice guidelines and institutional practices around the world is a reflection of the disparate opinion on the management of NFPanNET. In this review, we set out to examine the evidence regarding some of the most controversial and challenging aspects of the surgical treatment of NFPanNET. We evaluate the following questions; should patients with small NFPanNETs ≤ 2 cm in size be resected; should patients with metastatic NFPanNETs undergo surgical debulking, and should there be resection of the primary tumor in the setting of non-resectable metastatic disease?

Although there are currently no Level 1 data to answer these questions conclusively, we believe that the current literature supports a more aggressive approach to the management of NFPanNET.
Efficacy of Ankle Supports on Dynamic Postural Control in Patients with Chronic Ankle Instability
Authors: Hassanpour Samira , Daryabor Aliyeh , Jamshidi Aliashraf , Rezaei Mehdi
Published: June 2020

Introduction

The chronic ankle instability (CAI) that results from a lateral ankle sprain causes balance deficits during quiet standing. Dynamic postural control in patients with CAI can be improved using soft and semirigid braces.

Objective

This study was aimed at investigating the effects of soft and semirigid ankle supports on dynamic postural stability in subjects with CAI.

Materials and Methods

Fifteen subjects with unilateral CAI as the CAI group and 15 healthy control subjects as the control group were recruited for participation in the study. Stability indexes (SIs), including overall SI, anteroposterior SI, and mediolateral SI, were determined using the Biodex Balance System (BBS), and lower-limb reach was ascertained using the Star Excursion Balance Test (SEBT). These indicators were measured under three conditions: without orthosis, with soft orthosis, and with semirigid orthosis.

Results

Significant differences in overall SI were found between the affected and healthy feet of the CAI group (P = 0.009) and between the affected feet of the CAI group and the healthy feet of the control group (P = 0.031). The SEBT revealed significant differences between the injured and uninjured sides of the CAI group in the anterior, anterior-medial, and anterior-lateral directions. With the use of soft ankle supports, no significant differences were found between the affected and unaffected limbs of the CAI group in the overall and mediolateral SIs of BBS test and the anterior-medial (P = 0.057) and anterior-lateral (P = 0.07) directions of SEBT.

Conclusions

The soft ankle support has more effect on the balance of the CAI patients in comparison with the semirigid orthosis.
Prevalence and determinants of masked hypertension among obese individuals at the Yaoundé Central Hospital: a cross-sectional study in sub-Saharan Africa
Authors: Hamadou Bâ , Amougou Sylvie Ndongo , Tchuendem Yolande , Nganou-Gnindjio Chris Nadège , Mfeukeu-Kuate Liliane , Foka Audrey Joyce , Tankeu Aurel T. , Jingi Ahmadou Musa , Menanga Alain Patrick , Kingue Samuel
Published: June 2020

Objectives

The aim of this study was to investigate the prevalence and associated factors of masked hypertension in obese patients in Yaounde.

Methods

We carried out a cross-sectional study from January to September 2017 at the National Obesity Center of the Yaounde Central Hospital. Masked hypertension was defined when the mean 24 h SBP was greater than or equal to 130 mmHg and/or the mean 24 h DBP was greater than or equal to 80 mmHg with normal office blood pressure (SBP/DBP) <140/90 mmHg. Logistic regression was used to examine the relationship of masked hypertension with associated factors.

Results

Among the 90 participants included, 67.8% were females. The mean age (±SD) was 46 (±8) years. The mean clinical measurements were 120 ± 9.4 mmHg and 75.5 ± 7.9 mmHg, respectively, for the SBP and the DBP. On 24 h ambulatory measurement, the mean was 123.9 ± 14.4/74.7 ± 8.9 mmHg, respectively, for the SBP/DBP. The prevalence of masked hypertension was 33.3%. Masked hypertension was significantly associated with high-normal office blood pressure [odds ratio (OR) = 2.90, P = 0.02] and to dyslipidemia (OR = 3.60, P = 0.01), but not to the male sex, diabetes, physical activity, and tobacco/alcohol.

Conclusion

Our findings suggest that the prevalence of masked hypertension is high and that physicians should consider ambulatory blood pressure monitoring for obese individuals with high-normal office blood pressure or dyslipidemia.
Dynamics of liver stiffness-based risk prediction model during antiviral therapy in patients with chronic hepatitis B
Authors: Chon Hye Yeon , Seo Yeon Seok , Lee Jung il , Kim Byung Seok , Jang Byoung Kuk , Kim Sang Gyune , Suk Ki Tae , Kim In Hee , Lee Jin-Woo , Chon Young Eun , Kim Moon Young , Jeong Soung Won , Lee Han Ah , Yim Sun Young , Um Soon Ho , Lee Hyun Woong , Lee Kwan Sik , Song Jeong Eun , Lee Chang Hyeong , Chung Woo Jin , Hwang Jae Seok , Yoo Jeong-Ju , Kim Young Seok , Kim Dong Joon , Lee Chang Hun , Yu Jung Hwan , Ha Yeon Jung , Kim Mi Na , Lee Joo Ho , Hwang Seong Gyu , Kang Seong Hee , Baik Soon Koo , Jang Jae Young , Suh Sang Jun , Jung Young Kul , Kim Beom Kyung , Park Jun Yong , Kim Do Young , Ahn Sang Hoon , Han Kwang-Hyub , Yim Hyung Joon , Kim Seung Up
Published: June 2020

Objective

The liver stiffness-based risk prediction models predict hepatocellular carcinoma (HCC) development. We investigated the influence of antiviral therapy (AVT) on liver stiffness-based risk prediction model in patients with chronic hepatitis B (CHB).

Methods

Patients with CHB who initiated AVT were retrospectively recruited from 13 referral Korean institutes. The modified risk estimation for hepatocellular carcinoma in chronic hepatitis B (mREACH-B) model was selected for the analysis.

Results

Between 2007 and 2015, 1034 patients with CHB were recruited. The mean age of the study population (639 men and 395 women) was 46.8 years. During AVT, the mREACH-B score significantly decreased from the baseline to 3 years of AVT (mean 9.21 → 7.46, P < 0.05) and was maintained until 5 years of AVT (mean 7.23, P > 0.05). The proportion of high-risk patients (mREACH-B score ≥11) was significantly reduced from the baseline to 2 years of AVT (36.4% → 16.4%, P < 0.001) and was maintained until 5 years of AVT (12.2%, P > 0.05). The mREACH-B scores at baseline and 1 year of AVT independently predicted HCC development (hazard ratio = 1.209–1.224) (all P < 0.05). The cumulative incidence rate of HCC was significantly different at 5 years of AVT among risk groups (high vs. high-intermediate vs. low-intermediate vs. low) from baseline (4.5% vs. 3.2% vs. 1.5% vs. 0.8%) and 1 year (11.8% vs. 4.6% vs. 1.8% vs. 0.6%) (all P < 0.05, log-rank tests).

Conclusions

The mREACH-B score was dynamically changed during AVT. Thus, repeated assessment of the mREACH-B score is required to predict the changing risk of HCC development in patients with CHB undergoing AVT.
Analysis of risk factors for gallbladder polyp formation – A retrospective study based on serial ultrasounds
Authors: Yao Guibin , Bai Xuesong , Yang Changlin , Liu Liwei , Zhou Zhen , Huang Yue , Zheng Yamin
Published: June 2020

Aim

To evaluate gallbladder polyp (GBP) formation related risk factors based on serial ultrasounds (US).

Methods

Risk factors related GBP formation were retrospectively investigated among participants, who had US reexamination and interval >180 days in 5 years. After groups were divided based on US, we compared final data and initial data in GBP new incidence group. Then compared the data in GBP new incidence group and GBP(−) group.

Results

Overall 20 447 participants were recruited, including 18 243 in GBP (−) group and 2204 in GBP group. The mean diameters of polyps were 0.455 ± 0.198 mm in initial and 0.420 ± 0.180 mm in final examination. GBP new incidence group included 797 participants. Percentage of GBP new incidence participants was higher than GBP resolved (36.16% vs. 11.71%). Participants in middle age were more likely have GBP size increase or new incidence, and participants in old age (≥60 years old) were with GBP size decrease or resolved. In GBP new incidence group, participants in final US showed higher FBG, higher LDL, lower HDL, higher ALT and higher AST than initial US. Compared with GBP (−) group and, same risk factors, in addition with age, were shown in GBP new incidence group, Logistic regression analysis show that higher LDL, lower HDL and higher AST were risk factors for GBP formation.

Conclusion

Participants in middle age were more likely to have GBP new incidence. Higher LDL, lower HDL and higher AST were independently risk factors for GBP formation.
A Multimodal Approach for the First-Line Treatment of Infected Pancreatic Necrosis
Authors: Ocampo Carlos , Zandalazini Hugo , Alonso Facundo , Canullan Carlos , Stagnaro Gabriel , Leyton Vanina , Chiappetta Luis
Published: June 2020

Objectives

Because infected pancreatic necrosis (IPN) has multiple presentations, not all patients are likely to benefit from the same first-line treatment. Our objective was to evaluate morbidity and mortality in a series of patients treated with a multimodal therapeutic approach.

Methods

Between May 2012 and May 2019, 51 patients diagnosed with IPN were treated. The 5 initial treatment alternatives were as follows: percutaneous drainage, minimally invasive necrosectomy, antibiotics alone, transgastric necrosectomy, and temporizing percutaneous/endoscopic drainage. Initial treatment selection depended on evolution, clinical condition, and extension of pancreatic necrosis. Success, morbidity, and mortality rates were determined.

Results

In terms of determinant-based classification, 37 were classified as severe, and 14 as critical. Percutaneous, temporizing drainage, minimally invasive necrosectomy, antibiotics alone and transgastric necrosectomy approaches were used in 21, 10, 11, 4, and 5 patients, respectively. Necrosectomy was not required in 18 patients (35%). There were no significant differences in mortality among the different treatment approaches (P < 0.45). Overall success, morbidity, and mortality rates were 68.6%, 52.9%, and 7.8%, respectively.

Conclusions

The multimodal approach seems to be a rational and efficient strategy for the initial treatment of IPN.
Alterations in Enteroendocrine Hormones After Total Pancreatectomy With Islet Autotransplantation
Authors: McEachron Kendall R. , Yang Yi , Hodges James S. , Beilman Gregory J. , Pruett Timothy L. , Kirchner Varvara A. , Dunn Ty B. , Freeman Martin L. , Trikudanathan Guru , Mulier Kristine E. , Ptacek Peggy , Bellin Melena D.
Published: June 2020

Objective

When total pancreatectomy with islet autotransplantation (TPIAT) is performed for chronic pancreatitis, the pancreas and most of the duodenum are removed, with Roux-en-Y reconstruction of the gastrointestinal tract. Enteroendocrine cells in the intestines and pancreas secrete hormones coordinating digestion and motility, but anatomic reconstruction alters transit of nutrients to these cells. We hypothesized that TPIAT leads to changes in enteroendocrine hormones.

Methods

Glucagon-like peptide 1 (GLP-1), peptide YY (PYY), and pancreatic polypeptide (PP) were measured from mixed-meal tolerance tests of 34 clinical trial participants before and 18 months after TPIAT. Area under the curve of GLP-1 and PYY-stimulated responses were calculated by trapezoidal method, and the PP response was measured as the stimulated max minus baseline (ΔPP).

Results

Area under the curve of GLP-1 and PYY increased significantly after TPIAT (GLP-1 average +553.1 pg/mL per minute, P = 0.004; PYY average +4647.9 pg/mL per minute, P = 0.02). ΔPP trended toward lower after TPIAT (average, −52.2 pg/mL, P = 0.06).

Conclusions

In this novel study of enteroendocrine hormones in TPIAT patients, stimulated levels of GLP-1 and PYY were significantly higher after versus before TPIAT. ΔPP was lower after TPIAT, but not significantly. These hormone changes have potential clinical implications that warrant further research.
Characterization of Esophageal Motility in Children With Operated Esophageal Atresia Using High‐resolution Impedance Manometry and Pressure Flow Analysis
Authors: Courbette Olivier , Omari Taher , Aspirot Ann , Faure Christophe
Published: June 2020

Objectives:

Esophageal dysmotility is common in patients with esophageal atresia (EA). High‐resolution impedance manometry and pressure flow analysis (PFA) allow characterization of biomechanical events that drive bolus flow. The aims were to assess esophageal motility in children with EA, using PFA, and to test whether there is a correlation between PFA parameters and symptoms or endoscopic/histologic findings.

Methods:

High‐resolution impedance manometry was performed in 16 children with EA (median age 11 years), compared with 13 patient controls (median age 14 years; P = NS vs patients). Wet swallows were analyzed using PFA. Medical charts were reviewed for symptoms and pathology results of the attendant esophagoscopy. Patients with EA were arbitrarily subgrouped according to their motility pattern: group A with presence of distal contraction in ≥50% of the swallows and group B with presence of distal contractions in <50% of the swallows.

Results:

Esophageal peristaltic motor patterns were abnormal in all patients with EA. Bolus transport was impaired as shown by the higher impedance ratio in EA than in controls (0.47 vs 0.22; P < 0.001). Impedance ratio was also higher in group B (n = 8) versus group A (n = 8) (P < 0.001). Symptoms of dysphagia were not correlated with the PFA measures. Contractile segment impedance, a marker of mucosal integrity, was significantly lower in the EA group.

Conclusions:

Bolus transport was severely altered in patients with EA but was not predictive of symptoms. The presence of residual distal contractions is associated with a more efficient bolus propulsion.
Who's at Risk? A Prognostic Model for Severity Prediction in Pediatric Acute Pancreatitis
Authors: Farrell Peter R. , Hornung Lindsey , Farmer Peter , DesPain Angelica W. , Kim Esther , Pearman Ryan , Neway Beemnet , Serrette Ashley , Sehgal Sona , Heubi James E. , Lin Tom K. , Nathan Jaimie D. , Vitale David S. , Abu‐El‐Haija Maisam
Published: June 2020

Objectives:

The aim of the study was to validate and optimize a severity prediction model for acute pancreatitis (AP) and to examine blood urea nitrogen (BUN) level changes from admission as a severity predictor.

Study Design:

Patients from 2 hospitals were included for the validation model (Children's Hospital of the King's Daughters and Children's National Hospital). Children's Hospital of the King's Daughters and Cincinnati Children's Hospital Medical Center data were used for analysis of BUN at 24 to 48 hours.

Results:

The validation cohort included 73 patients; 22 (30%) with either severe or moderately severe AP, combined into the all severe AP (SAP) group. Patients with SAP had higher BUN (P = 0.002) and lower albumin (P = 0.005). Admission BUN was confirmed as a significant predictor (P = 0.005) of SAP (area under the receiver operating characteristic [AUROC] 0.73, 95% confidence interval [CI] 0.60–0.86). Combining BUN (P = 0.005) and albumin (P = 0.004) resulted in better prediction for SAP (AUROC 0.83, 95% CI 0.72–0.94). A total of 176 AP patients were analyzed at 24–48 hours; 39 (22%) met criteria for SAP. Patients who developed SAP had a significantly higher BUN (P < 0.001) after 24 hours. Elevated BUN levels within 24 to 48 hours were independently predictive of developing SAP (AUROC: 0.76, 95% CI: 0.66–0.85). Patients who developed SAP had a significantly smaller percentage decrease in BUN from admission to 24 to 48 hours (P = 0.002).

Conclusion:

We externally validated the prior model with admission BUN levels and further optimized it by incorporating albumin. We also found that persistent elevation of BUN is associated with development of SAP. Our model can be used to risk stratify patients with AP on admission and again at 24 to 48 hours.
Introducing Nurse-Led Patient Education Visits
Authors: Goodman Kassandra J. , Dougan Brian M. , Stevens Dawn M. , Smith Jessica R. , Mikhail Michael A. , Majka Andrew J.
Published: June 2020

Background:

The literature includes multiple descriptions of successful nurse-led interventions, but the effects of nurse-led education on nurse and patient satisfaction in an executive health program are unknown.

Local Problem:

Nursing staff desire to practice more fully within their scope of licensure. Increased practice demands raised questions about whether nurse-led education would improve staff and patient satisfaction.

Methods/Interventions:

A structured quality improvement process was used to design a nurse-led patient education program. Pilot measures included 5-point Likert scale patient and staff satisfaction surveys. Nurse burnout was also measured before and after the pilot.

Results:

Patient satisfaction was high; 96% reported favorable satisfaction during the pilot, with sustained results over the following 3 years. Nurses' sense of achievement improved by 12 percentage points, and perception of making good use of skills and abilities increased by 39 percentage points.

Conclusions:

A nurse-led patient education intervention contributed to improved staff satisfaction while sustaining a positive patient experience.
Distorted Time Perspective in Adolescent Afghan and Syrian Refugees Is Associated With Psychological Distress
Authors: Walg Marco , Eder Lara L. , Martin Alexandra , Hapfelmeier Gerhard
Published: June 2020

Young refugees are a high-risk group for mental disorders, particularly for posttraumatic stress disorder (PTSD). Individuals with PTSD suffer from an altered time perspective with a focus on negative experiences in the past and a disregard for positive life events and the future. This study investigates time perspectives and psychological distress in 30 adolescent refugees from Syria and Afghanistan in Germany. Time perspective was assessed using the Zimbardo Time Perspective Inventory. The refugees exhibited a distorted time perspective that is common for individuals with PTSD: a high orientation toward the negative past and a low orientation toward the positive past and future. A high orientation toward the negative past was associated with high levels of general psychological distress, PTSD symptoms, and depression. A low orientation toward the future was related to high levels of anxiety. Taking time perspective and corresponding beliefs into consideration may be advantageous when treating refugees with trauma-related disorders.
Clinical Demonstration of the Potential of Parental Feedback in Reducing Deterioration During Group Psychotherapy With Children
Authors: Tzur Bitan Dana , Zilcha-Mano Sigal , Asper Ariel , Bloch Yuval
Published: June 2020

In recent years, great efforts have been exerted to minimize the rates of deterioration in clinical practice, especially in child psychotherapy. The present study explored the potential effect of routine outcome monitoring (ROM) with parents as a preventive intervention to reduce deterioration in children. Twenty-five children receiving treatment for emotional problems were randomized to parent-based, ROM-assisted group psychotherapy or to treatment as usual (TAU). A mixed-methods approach was utilized, with the number of deteriorating cases compared at the group level and two case illustrations assessed at the individual level. At the group level, there were fewer cases of deterioration in child's anxiety, parental stress, and quality of parent's alliance in the ROM-assisted group, compared with TAU. Case studies illustrated how ROM can be used as a tool to communicate with parents to prevent deterioration. Routine outcome monitoring in child psychotherapy may thus benefit therapy process and outcome. Limitations and directions for future research are discussed.
Homicide-Suicide
Authors: Loughney Elizabeth , Kemp Walter L.
Published: June 2020

Strangulation is commonly associated with certain findings at autopsy, including petechial hemorrhages in the conjunctiva and oral mucosa, contusions or abrasions of the neck, hemorrhage within the anterior and posterior neck musculature, and fractures of the hyoid bone or thyroid cartilage. We present the case of a 68-year-old woman who was found dead in her bedroom, with her husband being found dead in the garage. Her husband had shot himself, and the woman, who was lying partially on her side, had blood coming from her ear that was facing upward and was, at the scene, also believed to have been shot. Autopsy revealed no gunshot wound, but instead florid petechial hemorrhages of the face and conjunctivae, a few contusions of the left and right sides of the neck, a laceration of the lower lip, oral mucosal petechiae, focal hemorrhage in the soft tissue around the hyoid bone, and focal hemorrhages in the left and right sternohyoid muscle. The tongue had multiple contusions. Her cause of death was certified as homicidal asphyxiation, including probable strangulation. Extensive contusions of the tongue are not routine findings with strangulation but occur in about 25% of cases, especially those involving the elderly, and hemorrhage from the ear is rarely reported. This case illustrates uncommon and rare autopsy findings for strangulation, which under the right circumstances, deceived investigators into thinking that a gunshot wound had occurred.
Epstein-Barr Virus Negative Lymphoepithelioma-Like Cholangiocarcinoma in a Patient of European Descent: A Report of a Case
Authors: Tankel James , Haim Menahem Ben , Dagan Amir , Reissman Petachia , Doviner Victoria
Published: June 2020

Lymphoepithelioma-like carcinoma in the setting of cholangiocarcinoma in the absence of underlying Epstein-Barr virus is an incredibly rare entity. However, all of the reports that exist, which are few and far between, describe this vignette in patients of Far Eastern origin. We present the first case report of Epstein-Barr virus–negative lymphoepithelioma-like carcinoma–associated cholangiocarcinoma occurring in a patient of European descent. The 62-year-old woman described here presented with nonspecific symptoms of lethargy, low-grade pyrexia, and raised white blood cell count. Subsequent investigations revealed a large hepatic mass with subsequent hepatectomy yielding a large tumor containing poorly differentiated adenosquamous cholangiocarcinoma alongside a rich infiltrate of lymphocytes and lymphoplasmacytic inflammatory infiltrate. Epstein-Barr virus in situ hybridization was negative in both the malignancy and surrounding tissues. Reflecting its rarity, the pathogenesis of this specific malignancy is poorly understood, as also are the treatment and prognosis.
Role of Troponin Determination to Diagnose Chest Pain in the Pediatric Emergency Department
Authors: Brancato Federica , De Rosa Gabriella , Gambacorta Alessandro , Nunziata Alessia , Ferrara Pietro , Buonsenso Danilo , Covino Marcello , Chiaretti Antonio
Published: June 2020

Objectives

Chest pain is a common cause to admission to the pediatric emergency department and often leads to an extensive cardiac evaluation. The objective of this study was to evaluate the usefulness of the troponin (TN) plasma level determination in the initial phase of the differential diagnosis of chest pain in children.

Methods

This is a retrospective observational study on 107 patients, aged 0 to 19 years, admitted for chest pain to the pediatric emergency department of our institution. Demographics, clinical data, and patient outcomes were analyzed. Troponin values of >0.03 ng/mL but <0.1 ng/mL were considered suspected for cardiac pathology, whereas levels of >0.1 ng/mL were indicative of cardiac pathology. In these latter patients, an echocardiographic examination was also performed.

Results

Only 99 patients were evaluated with electrocardiogram (ECG). In 91 of 99 patients of our series, both TN determination and ECG recording were performed. Troponin was higher than the cutoff value (0.03 ng/mL) in 9 patients (9.1%). Only 2 of the 9 patients who presented high TN values showed a nonpathological ECG, whereas 16 (17.5%) of 91 patients in whom both ECG and TN determination were performed had ECG abnormalities without a simultaneous elevation of TN. Of the 26 patients who had medical history and suggestive targets of cardiac pathology, only in 6 (23.1%) of them the diagnosis was confirmed. The final diagnosis of the 99 patients was idiopathic chest pain in 45.4% of cases.

Conclusions

Even with the low cost and the relatively easiness for the plasma level determination, TN should be measured only in children with chest pain associated to familiar history suggestive of cardiovascular disease and/or clinical symptoms and/or ECG alterations.
Implementation of Pediatric Emergency Care Applied Research Network Guidelines for Traumatic Brain Injury in a Rural Tertiary Care Center
Authors: Tsao Jackie , Hook Marcus , Shah Purvi , Bingham Peter M.
Published: June 2020

Objectives

To evaluate changes in imaging practices for pediatric head trauma after publication of the Pediatric Emergency Care Applied Research Network (PECARN) guidelines, explore areas for quality improvement regarding neuroradiology referrals. We also sought to determine the prevalence of incidental findings discovered on computed tomographies (CTs) attained for minor head trauma and ascertain disposition in these cases.

Methods

This retrospective study was conducted at a rural academic center and included 156 children who received CTs for head trauma between 2005 and 2015. Subjects were divided into 2 groups: pre-PECARN publication and post-PECARN publication. Electronic medical records were reviewed to determine whether or not head CTs were obtained according to PECARN guidelines. The proportion of scanned cases and incidental findings in each group was then compared.

Results

Significantly more subjects met PECARN criteria for head CT during the pre-PECARN period (67.1% vs 50.6%,P= 0.04). Among those who met PECARN criteria, severe mechanism of injury was the most common criterion met in both groups (43.8% pre-PECARN and 26.5% post-PECARN). Nine (5.7%) subjects had incidental findings (similar for both study periods), of which 3 prompted additional diagnostic testing or invasive intervention. Among those who did not meet PECARN criteria, the most common mechanism of injury was fall (<3 ft).

Conclusions

Implementation of PECARN guidelines at our center remained limited in the 5 years after publication of this practice guide. Clinically insignificant incidental findings were often detected and may heighten patient anxiety.
Pediatric Intentional Self-poisoning Evaluated in the Emergency Department
Authors: Gonzalez-Urdiales Paula , Kuppermann Nathan , Dalziel Stuart R. , Prego Javier , Benito Javier , Mintegi Santiago
Published: June 2020

Background

Suicide is a growing public health problem during late childhood and adolescence. The leading method of suicide attempts in this age group is intentional self-poisoning. A first self-poisoning episode is a strong predictor of subsequent suicide and premature death. The objective of this study was to analyze the presentation and management of children younger than 18 years with intentional self-poisonings admitted to an emergency department (ED) in a global research network of pediatric EDs.

Methods

We performed a secondary analysis of a large, international, multicenter, cross-sectional prospective registry of childhood poisoning presentations to 105 EDs in the Pediatric Emergency Research Networks (PERN) network. Data collection started at each ED between January and September 2013 and continued for 1 year.

Results

During the study period, we included 1688 poisoning exposures. Of these, 233 (13.8%) were intentional self-poisonings, with significant variation between regions. Female/male ratio was 4.7/1 and most occurred at home. The most common toxicants were therapeutic drugs, mainly psychotropics and analgesics. Ninety patients (38.6%) gave a history of a previous episode of intentional self-poisoning. Sixty-three children (27.0%) were not assessed by a psychiatric service nor transferred to a psychiatric inpatient facility. No patient died. There was significant variation in the involved toxicants and interventions among EDs in different global regions.

Conclusions

Most intentional self-poisoning presentations to pediatric EDs globally are related to intentional ingestions of therapeutic drugs at home by females. Best practices have to be translated into care to guarantee the best outcomes of these patients.
Effect of Comorbid Chronic Low Back Pain on Patient-Reported Outcome and Gait Parameters in Patients With Symptomatic Knee Osteoarthritis
Authors: Lee Se Won , Patel Jasal , Napatkamon Ayutyanont , Aguilla Eric , Hill Joseph , Bartels Matthew N.
Published: June 2020

Knee osteoarthritis and chronic low back pain are common and often coexist. There are limited studies on the impact of coexisting musculoskeletal disorders on gait parameters and its association with self-assessed functional outcome. This study compared gait parameters, self-assessed functional outcome measurements, and quality-of-life scales between patients with knee osteoarthritis against those with coexisting knee osteoarthritis and chronic low back pain using gait analysis, Western Ontario and McMaster Osteoarthritis Index, and Short Form-36. Three hundred sixty-seven patients underwent gait analysis after the question-based functional outcome measurement. Pain, function, and quality of life were worse in the coexisting knee osteoarthritis and chronic low back pain group (n = 197) compared with the knee osteoarthritis only group (n = 170, P = 0.017, P = 0.004, P < 0.001, P = 0.004, respectively). The coexisting knee osteoarthritis and chronic low back pain group had significantly lower gait velocity and cadence than the knee osteoarthritis group (P = 0.028 and P = 0.003). The Western Ontario and McMaster Osteoarthritis Index Pain subscore was associated with gait velocity (P < 0.001) in the knee osteoarthritis group, whereas Short Form-36 physical composite was associated with gait velocity (P < 0.001) in the coexisting knee osteoarthritis and chronic low back pain group. Comorbid chronic low back pain in patients with knee osteoarthritis was associated with worse pain, function, quality of life, gait velocity, and cadence. Compared with the Western Ontario and McMaster Osteoarthritis Index, Short Form-36 may be a more suitable tool to track mobility outcome measure, such as gait velocity, in the management of the coexisting knee osteoarthritis and chronic low back pain.
Stress Reactivity as a Contributor to Racial and Socioeconomic Disparities: Rationale and Baseline Results From the Richmond Stress and Sugar Study
Authors: Mezuk Briana , Lexima Evanise , Kalesnikava Viktoryia A. , Fleming Jacinda , Montgomery Joshua , Tuktur Wanderimam , Winston Jason , Perrin Paul B. , Green Tiffany , Wheeler David C.
Published: June 2020

Objective

There are pronounced racial and socioeconomic disparities in type 2 diabetes. Although “stress” as a general phenomenon is hypothesized to contribute to these disparities, few studies have objective measures of stress reactivity in diverse samples to test hypotheses about purported mechanisms. This study describes the rationale and baseline characteristics of a cohort designed to address the question: how does stress contribute to disparities in diabetes risk?

Methods

The Richmond Stress and Sugar Study recruited 125 adults at elevated risk of type 2 diabetes using a two-by-two sampling frame wherein non-Hispanic whites and African Americans (AAs) were each recruited from neighborhoods of higher and lower socioeconomic status (SES). Stress reactivity was assessed using the Trier Social Stress Test (TSST) and salivary cortisol. Analyses of variance and multilevel modeling were used to examine how stress reactivity varied both within and across race and neighborhood SES.

Results

The mean (SD) age was 57.4 (7.3) years, 49% were female, 54% were AA or another racial/ethnic minority, and mean hemoglobin A1c level was in the prediabetes range (5.8%; range, 5.50%–5.93%). Living in a lower-SES neighborhood was associated with 16% (95% confidence interval [CI] = −0.04 to 34) higher pre-TSST cortisol, 8.4% (95% CI = −14 to −3) shallower increase in response to the TSST, and 1% (95% CI = 0.3 to 1.7) steeper decline post-TSST than living in the higher neighborhood SES. Post-TSST cortisol decline was 3% greater among AA compared with non-Hispanic whites. Race-by-SES interaction terms were generally small and nonsignificant.

Conclusions

SES is associated with stress reactivity among adults at high risk of diabetes.
The Discrepancy Between Perceived Importance and Actual Delivery of Business Education in Residency
Authors: Patrinely J. Randall , Davis Matthew J. , Abu-Ghname Amjed , Reece Edward M. , Perdikis Galen
Published: June 2020

Background

In the contemporary healthcare environment, there is a need for physicians to understand business fundamentals. Nonsurgical residencies have implemented formal business education, but surgical training programs have been slower to adapt. Further research is needed to evaluate the status of business education in plastic surgery residency.

Methods

A 12-question survey was created. Ninety program director (PD) e-mails were obtained and the survey was distributed using SurveyMonkey. The survey evaluated program demographics and current resources, commitments, and attitudes toward business training. The survey also identified the most important topics to include in a business curriculum.

Results

Thirty-six surveys were completed (response rate = 40%). Whereas most PDs agreed that business education in plastic surgery residency was important (78%) and that their programs should have more business training (73%), only 39% currently offered business training. Only 42% of PDs believed that their chief residents were competent to handle the business aspects of plastic surgery upon graduation. No programs offered a formal gap year to pursue a professional business degree. The most important topics identified for a business curriculum were economics and finance (83.3%), management (64%), and marketing (53%).

Conclusions

There is disconnect between perceived importance and resources available for plastic surgery residents to receive business education. Increased attention is needed to resolve this discrepancy to ensure that future plastic surgeons are equipped to excel in their personal careers and stimulate the advancement of the field. Future research should aim to outline a business curriculum for plastic surgery trainees.
Endoscopic “Quick” Septoplasty in Preservation Rhinoplasty
Authors: D'Ascanio Luca , Ori Michele , Finocchi Valerio , Vione Nicola , Capalbo Maria , Ricci Giampietro
Published: June 2020

Background

Preservation rhinoplasty (PR) is revolutionizing rhinoplasty surgery, based on new anatomical studies, advanced tip suture techniques, and refinement of surgical techniques. Septal surgery is a fundamental preparatory stage during PR, especially for the dorsal preservation let/push-down procedure. To increase the predictability of the septoplasty aesthetic effects on the nasal dorsum and further extend the principles of PR to septal surgery, we applied the endoscopic technology to the “quick” septoplasty technique we had already developed in the past decades.

Methods

One hundred sixty-six patients (41 males, 125 females; mean age, 39.7 years; age range, 18–61 years) were submitted to endoscopic “quick” septoplasty for septal deviation during PR procedure. Preoperative evaluation of the nasal dorsum included external examinations of the size, shape, and orientation of the dorsum. Anterior active rhinomanometry was performed in all patients to determine nasal flow resistance preoperatively and 6 months after surgery. Preoperative and postoperative patients' scores on the Nasal Obstruction Septoplasty Effectiveness questionnaire were compared to assess the improvement of nasal symptoms after surgery. The duration of the septoplasty procedure was measured for all the patients. Standard nasal photographic assessment was performed before and 6 months after surgery.

Results

Postoperatively, 98.8% of our patients displayed an improvement of their nasal breathing function. No complication in terms of septal perforation, nasal infection, or bleeding was noticed. No case of turbinoseptal synechiae or cerebrospinal fluid leak was recorded. The dorsum preservation rhinoplasty procedure was successfully completed in all patients. The mean septoplasty operative time, excluding local anesthesia injection and other surgical procedures associated with septal surgery such as turbinoplasty and rhinoplasty, was 11.41 ± 6.23 minutes (range, 9–31 minutes).

Conclusions

Our results show that a short surgical time is needed to perform the proposed endoscopic septoplasty procedure. Such a short operative time allows the physician to both correct septal deviations quickly and correct/reduce the cartilaginous hump, thus representing a fundamental element of PR. In addition, the minimal tissue dissection reduces intraoperative nasal edema, favoring intraoperative aesthetic evaluation.
In-Depth Volumetric Analysis of Alveolar Cleft Defects Using Three-Dimensionally Printed Models
Authors: Chen Shuxiu , Liu Bing , Yin Ningbei , Wang Yongqian
Published: June 2020

Presurgical evaluation of the alveolar cleft defect is an essential and crucial step for procedural success. In this study, three-dimensionally printed models derived from computed tomography scans were used to measure the alveolar defect volume before bone grafting. The authors also explored the influence of cleft type, age, and gender on alveolar bone defect volume. Ninety-four patients with unilateral alveolar cleft were enrolled in this study. One-way analysis of variance and multivariate analysis were used to investigate the influence of age (8–14 years), gender, and cleft type on the outcome of alveolar bone defect volume. The mean volume of the alveolar cleft defect in all patients was 1.40 ± 0.37 ml, and the average age of the patients was 10.33 ± 1.75 years. One-way analysis of variance showed that alveolar defect volume was not influenced by age (P = 0.24 > 0.05). Multivariate analysis indicated that gender (P = 0.001 < 0.05) and cleft type (P = 0.028 < 0.05) had a statistically significant influence on alveolar defect volume. This study validates our clinical experience and further proves the importance of individualized presurgical volumetric assessment in achieving optimal therapeutic outcomes.
Saliva as a Potential Diagnostic Specimen for COVID-19 Testing
Authors: Harikrishnan Pandurangan
Published: June 2020

The current outbreak of the highly contagious, animal origin SARS-CoV-2 virus causes the disease COVID-19. The disease is globally pandemic and as per World Health Organization (WHO) has spread to 235 countries. There is global lockdown for containment of the virus transmission. Testing of symptomatic patients, healthcare workers and suspected individuals and mass screening is vital. WHO recommends nasopharyngeal (NP) and oropharyngeal (OP) swab for the quantitative assessment of SARS-CoV-2 RNA level through real-time reverse transcription polymerase chain reaction (rRT-PCR). The virus is shown to be consistently present in saliva and rRTPCR of saliva specimens and have advantages over NP and OP swabs such as self-collection of saliva, avoidance of healthcare workers for specimen collection, cost-effectiveness, etc. This article explores the current literature and suggests saliva as an emerging potential diagnostic specimen for COVID-19 testing.
Linguistic Validation of the Debriefing Assessment for Simulation in Healthcare in Spanish and Cultural Validation for 8 Spanish Speaking Countries
Authors: Muller-Botti Sacha , Maestre Jose M. , del Moral Ignacio , Fey Mary , Simon Robert
Published: June 2020

Introduction

Debriefing Assessment for Simulation in Healthcare (DASH) is an instrument to assist in developing and evaluating faculty debriefing and instructional skills that, in the context of trained raters, yields reliable data and internal consistency. Support for its validity is grounded in both its content and the scores arising from its use. The utilization of this and other assessment tools, guidelines, and protocols is expanding internationally, but most of them are available only in English and there is not a single established methodology for translation. The objectives of this study were to demonstrate a translation technique and conduct a linguistic validation of the translation of the DASH from English to Spanish and to demonstrate and conduct a cultural validation across 8 Spanish-speaking countries.

Methods

A forward translation and review of the DASH score sheets and Rater's Handbook defined the consensus harmonized version. A backward translation was reviewed by the original authors and discussed with the translators to produce the approved harmonized version. This was then tested through a questionnaire to assess clarity, comprehensiveness, appropriateness, and cultural relevance among 5 monolingual subjects from 8 Spanish-speaking countries.

Results

During the forward translation, 16 discrepancies were detected in the Spanish DASH. Sixty-two participants were sent the Spanish cultural questionnaire and 48% responded. A total of 82 different interpretations and 57 extra recommendations (42% terms, 16% concepts, and 42% syntax) were made. Twenty-seven percent of them were applied.

Conclusions

The translated DASH has undergone a linguistic validation into Spanish, and a cultural validation across 8 Spanish-speaking countries. It may be used to assess debriefings in healthcare settings in these countries. The methodology used is applicable for translating and assessing a cross-cultural validation of assessment instruments.
Age, Not Sex, Modifies the Effect of Frailty on Long-term Outcomes After Cardiac Surgery
Authors: Sun Louise Y. , Spence Stewart D. , Benton Samantha , Beanlands Rob S. , Austin Peter C. , Bader Eddeen Anan , Lee Douglas S.
Published: June 2020

Objective:

To examine the prevalence of frailty in surgical patients and determine whether age and sex modify the relationship between frailty and long-term mortality.

Background:

Frailty is a complex and prevalent clinical syndrome. The cardiac surgery literature consists mostly of small, single-center studies, and the epidemiology of frailty remains to be fully elucidated in a real-world surgical population.

Methods:

This retrospective cohort study included patients who underwent coronary artery bypass grafting, and/or aortic, mitral or tricuspid valve surgery in Ontario, Canada, between 2008 and 2016. The primary outcome was all-cause mortality. Survival probabilities were calculated using the Kaplan-Meier method, and the association of covariates with the hazard of death was assessed using multivariable Cox proportional hazard models. Frailty was assessed using the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnoses indicator.

Results:

Of 72,824 patients, 11,685 (16%) were frail. At median 5 ± 2 years of follow-up, 2921 (25.0%) frail patients and 8637 (14.1%) non-frail patients had died [adjusted hazard ratio 1.60; 95% confidence interval (CI), 1.53–1.68]. The adjusted hazard ratio was highest in patients who underwent isolated mitral (2.18; 95% CI, 1.71–2.77) and mitral + aortic valve surgery (1.85; 95% CI, 1.33–2.58) and lowest after coronary artery bypass grafting + mitral valve surgery (1.38; 95% CI, 1.11–1.70). Age, but not sex, modified the effect of frailty on mortality; such that the rate of death decreased linearly with increasing patient age.

Conclusions:

We observed a high prevalence of frailty in patients undergoing cardiac surgery, and a statistically significant association between frailty and long-term mortality after cardiac procedures. Importantly, the rate of death was inversely proportional to age, such that frailty had a stronger adverse impact on younger patients. Our findings highlight the need to incorporate frailty into the preoperative risk stratification and investigate strategies to support younger patients who are frail.