bluuebunny/crossref_metadata_2025 huggingface dataset:
Combating insulin resistance with the paleo diet
Authors: Olivieri Chrystyne
Published: January 2019

Lifestyle changes that include adopting a healthy diet, such as the paleo diet, can help prevent prediabetes and T2DM. This article explores the potential benefits of replacing low-calorie diets with the paleo diet. As primary care providers, NPs are positioned to help inform patients, particularly those with prediabetes and T2DM, about healthy lifestyle choices and provide them with resources to achieve weight loss success.
Contributions of innate lymphocytes to allergic responses
Authors: Inclan-Rico Juan M. , Ponessa John J. , Siracusa Mark C.
Published: January 2019

Purpose of review

Allergic diseases represent a growing global health concern, especially among pediatric populations. Current strategies for the treatment of allergies and asthma focus on limiting the severity of the symptoms; however, additional research investigating the mechanisms promoting inflammation in the context of allergic reactions may lead to the development of more effective therapeutic strategies.

Recent findings

Novel studies have highlighted the contributions of innate lymphocytes to the induction of inflammatory responses to allergens. Remarkably, neuron-derived signals, hormones, and even vitamins have been suggested to modulate the activity of innate lymphocytes, opening new windows of opportunity for the treatment of allergic inflammation.

These studies highlight the complex interactions of the nervous, endocrine, and immune system that promote pathology in the context of allergic inflammation. Further studies are required to understand these interactions in order to aid in the development of novel and much-needed therapies to treat allergic conditions.
Predicting Ambulatory Function Based on Infantile Lower Extremity Posture Types in Amyoplasia Arthrogryposis
Authors: Donohoe Maureen , Pruszcynski Blazej , Rogers Kenneth , Bowen James Richard
Published: January 2019

Background:

Arthrogryposis multiplex congenita (AMC) is a nonprogressive syndrome with multiple rigid joints, fibrotic periarticular tissue, and muscular fibrosis. The most common subgroup is amyoplasia. Ambulation is one of the most significant functions of the lower extremities as it translates to increased functionality and independence in adulthood. There is no predicative scale to determine ambulation at maturity for the infant with amyoplasia. It is believed lower extremity resting position of infants with amyoplasia potentially correlates with ambulation at maturity. The purpose of this study was to classify the infantile position of lower extremities and muscle strength to predict ambulation potential at maturity.

Methods:

Children with amyoplasia were retrospectively reviewed and classified into groups based on infantile position of hip-knee alignment and limb muscle function. Sitting, standing, and walking skills from infancy into adulthood were evaluated. The ambulation function was correlated with the infantile position of the lower extremities.

Results:

Amyoplasia cases were sorted into 5 types and correlated with ambulatory potential. Type I: mild ambulatory impairment with infantile position of flexed knees and hips but full range of motion. At maturity, all were community ambulators. Type II: moderate ambulatory impairment having infantile position of hip flexion, hip external rotation, and knee flexion contractures. Hip abductors and external rotators had antigravity strength. All stood and walked during the first decade of life with knee ankle foot orthoses. Type III: severe ambulatory impairment having infantile position of hip flexion, abduction, external rotation, and knee flexion contractures but lacked hip muscle recruitment. All used wheelchairs at maturity. Type IV: mild ambulatory impairment with infantile position of extended knees and flexed dislocated hips. At maturity, 90% were community ambulators. Type V: variable ambulatory impairment having asymmetric hip and knee alignment with unilateral hip dysplasia with extended knee and opposite limb flexed. Ambulation skill varied at maturity with 27% full-time wheelchair users.

Conclusions:

Amyoplasia can be sorted by infantile position of lower extremities and muscle strength into 5 types to predict ambulatory function.

Level of Evidence:

Level III—Prognostic Study.
Respiratory Variability of Pulmonary Velocity-Time Integral As a New Gauge of Fluid Responsiveness For Mechanically Ventilated Patients in the ICU*
Authors: Gavaud Ariane , Nguyen Lee S. , Caubel Antoine , Grillet Guillaume , Donal Erwan , Belliard Guillaume
Published: January 2019

Objectives:

To evaluate reliability and feasibility of the respiratory variability of pulmonary velocity-time integral as a new dynamic marker of fluid responsiveness in mechanically ventilated patients.

Design:

Prospective observational study.

Setting:

Medical-surgical ICU of a general hospital.

Patients:

Fifty mechanically ventilated patients with acute circulatory failure.

Interventions:

Transthoracic echocardiography was performed at inclusion (transthoracic echocardiography baseline). Fluid therapy was prescribed to patients exhibiting one value greater than or equal to 13% among commonly used variables of fluid responsiveness: respiratory variability of aortic velocity-time integral, respiratory variability of inferior vena cava diameter, or pulse pressure variation.

Measurements and Main Results:

Respiratory variability of pulmonary velocity-time integral was assessed at baseline. Respiratory variability of pulmonary velocity-time integral was significantly greater in patients who received fluid therapy (26.9 ± 12.5% vs 6.2 ± 4.3%; p < 0.0001). Respiratory variability of pulmonary velocity-time integral was correlated with respiratory variability of aortic velocity-time integral (r = 0.75; p < 0.0001), respiratory variability of inferior vena cava diameter (r = 0.42; p < 0.01), and pulse pressure variation (r = 0.87; p < 0.0001) at baseline and with the relative increase in cardiac output after fluid therapy (r = 0.44; p = 0.019). Fluid responsiveness was defined as a 10% increase in cardiac output after fluid therapy, assessed by a second transthoracic echocardiography. Respiratory variability of pulmonary velocity-time integral was associated with fluid responsiveness (adjusted odds ratio, 1.58; 95% CI, 1.08–2.32; p = 0.002). Area under the receiver operating characteristics curve was 0.972, and a value of respiratory variability of pulmonary velocity-time integral greater than or equal to 14% yielded a sensitivity of 92% and specificity of 87% to predict fluid responsiveness. Interobserver reproducibility was excellent (intraclass correlation coefficient = 0.94).

Conclusions:

Respiratory variability of pulmonary velocity-time integral is a simple and reliable marker of fluid responsiveness for ventilated patients in ICU.
Cetuximab as a Component of Multimodality Treatment of High-Risk Cutaneous Squamous Cell Carcinoma: A Retrospective Analysis From a Single Tertiary Academic Medical Center
Authors: Trodello Cameron , Higgins Shauna , Ahadiat Omeed , Ragab Omar , In Gino , Hawkins Makenzie , Wysong Ashley
Published: January 2019

BACKGROUND

Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer and has potential for regional or distant metastasis. Despite the standardization of features associated with high-risk cSCC, an advanced subset of cSCC, there is no established consensus regarding proper management of this tumor.

OBJECTIVE

To evaluate the efficacy of cetuximab, add to existing management options, and aid in the development of standardized treatment for this tumor.

MATERIALS AND METHODS

Medical records were searched using Current Procedural Terminology codes for cetuximab and cSCC. Demographic data and tumor characteristics, along with treatment regimens and follow-up times, were collected. A total of 20 cases were examined.

RESULTS

Of the 20 cases, 3 experienced a complete response and 7 experienced a partial response, yielding an overall response of 50% and a combined median disease-free survival of 6.35 months (range 1–46.8 months).

CONCLUSION

As most of the patients who experienced a response received cetuximab as part of a multimodality treatment approach, cetuximab may be most efficacious when administered with concurrent therapies such as surgery or radiation. Further larger prospective studies to determine the optimal dosing and frequency of cetuximab and the utility of concurrent therapies are warranted.
Comparison of Surgical Outcomes of Rectangular Lid Excision Versus Elliptical Excision for the Treatment of Epidermal Cysts
Authors: Kwon Soon‐Hyo , Kim Minsu , Shin Jung‐Won , Na Jung‐Im , Huh Chang‐Hun
Published: January 2019

BACKGROUND

Elliptical excision (EE) has been the standard surgical technique for the removal of epidermal cysts. However, it produces to create a long, linear wound causing cosmetic concerns.

OBJECTIVE

The purpose of the study was to evaluate the cosmetic outcomes and postoperative complications of rectangular lid excision (LE) compared with EE in epidermal cyst removals.

METHODS

Medical records of patients who received surgical excision for epidermal cysts were retrospectively reviewed. Three dermatologists evaluated the postoperative photographs using 4-scale investigator's global assessment.

RESULTS

Of the 123 lesions, EE and LE were performed in 58 and 65 lesions, respectively. Although the mean diameter of cysts was significantly greater in the LE group than in the EE group, the number of postoperative complications was not different between the 2 groups. A photographic assessment was performed in 11 lesions in the LE group and 11 lesions in the EE group. Although the mean diameter of cysts was greater in the LE group than in the EE group, the cosmetic outcome was significantly better in the LE group.

CONCLUSION

The LE technique was shown to have a superior cosmetic outcome than the EE technique. Hence, it is a viable alternative for the removal of epidermal cysts.
Cardiovascular reactivity and psychological hyperarousal in hot flash-associated insomnia disorder
Authors: Bertisch Suzanne M. , Wiley Aleta , McCormick Kathleen , Muresan Cristen , Camuso Julie , Albert Kimberly , Crawford Sybil L. , Newhouse Paul , Taylor J. Andrew , Joffe Hadine
Published: January 2019

Objectives:

Given the neurocognitive hyperarousal observed in patients with insomnia disorder and associations of nocturnal hot flashes with cardiovascular disease risk, we examined whether women with hot flash-associated insomnia disorder demonstrate exaggerated cardiovascular responsivity to acute stressors, and also a profile of psychological hyperarousal.

Methods:

Peri and postmenopausal women with and without hot flash-associated insomnia disorder underwent assessments of cardiovascular autonomic responsivity to acute stress paradigms and psychological hyperarousal. Hemodynamic responses (heart rate, blood pressure) to nociceptive, social-evaluative, and cognitive stress paradigms were measured in the morning. Psychological hyperarousal was evaluated using questionnaires assessing daytime and presleep hyperarousal, anxiety, and sleep-related cognitions.

Results:

Women (25 with and 15 without hot flash-associated insomnia) aged 53.4 ± 4.8 years reported a range of insomnia symptoms. Resting-state hemodynamics were similar between groups. Heart rate and blood pressure responses to stress paradigms did not differ by group nor did they correlate with insomnia severity. Women with insomnia disorder had higher generalized anxiety disorder scores (mean 2.7 ± 3.0 vs 1.0 ± 1.4; P = 0.05) and sleep-related cognitions than those without insomnia (P ≤ 0.05). Insomnia symptom severity was moderately correlated with presleep and daytime hyperarousal, anxiety, and sleep-related cognition (all r ≥ 0.43).

Conclusions:

Though hot flash-associated insomnia is characterized by psychological hyperarousal before sleep and during the daytime, it does not relate to cardiovascular responsiveness to acute stressors. Our findings do not support the hypothesis that altered cardiovascular control is a potential mechanism by which hot flash-associated insomnia confers higher cardiovascular disease risk.
How teams impact patient satisfaction: A review of the empirical literature
Authors: Hoff Timothy , Prout Kathryn , Carabetta Shannon
Published: January 2019

Background

The increased use of health care teams merits further investigation in terms of their impact on patient satisfaction. Patient satisfaction and patient experience generally have come front-and-center given trends within the health care industry around “patient-centered care” and “consumer engagement.”

Purpose

This review examines research published between 2000 and 2017 that includes analysis of potential team–patient satisfaction linkages, taking the conceptual perspective that both the mere presence of health care teams and specific team features like cohesion may each be impactful.

Methods

A systematic, PRISMA-guided literature review across four databases (PubMed, CINAHL, Business Source Complete, and ScienceDirect) to examine potential team–patient satisfaction linkages in the existing team literature was performed.

Results

In-depth review of 24 relevant studies found the following: (a) The extant literature examining the team–patient satisfaction relationship currently suffers from limitations around study design, construct definition, and variable operationalization, which render less confidence overall in the body of work, and (b) despite the limitations, extant work does suggest that there may be instances where the presence of a health care team does favorably impact patient satisfaction.

Practice Implications

Future research should attend to several issues related to study design improvements, more precise operationalization and measurement of both teams and patient satisfaction, expansion of focus beyond patient satisfaction within the same study, and inclusion of more ambulatory care delivery settings in team–satisfaction research.
Influence of Lens Status on Outcomes of Descemet Membrane Endothelial Keratoplasty
Authors: Godin Morgan R. , Boehlke Christopher S. , Kim Terry , Gupta Preeya K.
Published: January 2019

Purpose:

To evaluate whether lens status influences clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) in patients who underwent DMEK in phakia, pseudophakia, or combined with cataract surgery (triple).

Methods:

A retrospective review of 139 eyes (107 patients) with symptomatic Fuchs' dystrophy or secondary corneal edema was performed. Patients were divided into 3 groups: 1) DMEK + cataract surgery, 2) DMEK in pseudophakia, and 3) DMEK in phakia.

Results:

Of 139 DMEK surgeries, 61 were DMEK triple (43.9%), 55 pseudophakic DMEK (39.6%), and 23 phakic DMEK (16.5%) procedures. Rebubble occurred in 31 of 134 eyes (23.1%), of which 17 were in eyes after DMEK triple (28.3%), 10 after pseudophakic DMEK (19.6%), and 4 after phakic DMEK (17.4%). There was no statistically significant difference in rebubble rates depending on lens status (P = 0.548). There was no statistically significant difference in best corrected visual acuity (BCVA) between eyes that underwent rebubble versus not (P = 0.854). BCVA in patients post-DMEK was 20/25 or better in 81% of cases, and mean BCVA was 20/23. Donor age (P = 0.889), graft cell count (P = 0.525), and graft preparation technique (P = 0.769) were not predictive of rebubbling.

Conclusions:

Our study demonstrates no difference in DMEK outcome with regard to rebubble rate whether the procedure is performed in combination with cataract surgery, in pseudophakia, or in phakia. Furthermore, donor age, initial graft cell count, and graft preparation technique did not impact rebubble rate. BCVA was also not affected by the need for rebubbling.
High Levels of HIV-1 Drug Resistance in Children Who Acquired HIV Infection Through Mother to Child Transmission in the Era of Option B+, Haiti, 2013 to 2014
Authors: Louis Frantz Jean , Segaren Nathanael , Desinor Olbeg , Beard R. Suzanne , Jean-Louis Reginald , Chang Joy , Boisson Sylvie , Hulland Erin N. , Wagar Nick , DeVos Joshua , François Kesner , Buteau Josiane , Boncy Jacques , Marston Barbara J. , Domerçant Jean Wysler , Yang Chunfu , Charles Macarthur
Published: January 2019

Background:

The main objective of this study was to determine the frequency and patterns of HIV drug resistance–associated mutations among children under 18 months of age born to HIV-1–positive mothers enrolled in the prevention of mother-to-child transmission services in Haiti.

Methods:

Between January 1, 2013 and December 31, 2014, HIV-positive remnant dried blood spots collected from children under 18 months of age for Early Infant Diagnosis at the National Public Health Laboratory were used for HIV-1 genotyping. HIV drug resistance mutations were analyzed using the Stanford Drug Resistance HIVdb program.

Results:

Of the 3555 dried blood spots collected for Early Infant Diagnosis, 360 (10.1%) were HIV-positive and 355 were available for genotyping. Of these, 304 (85.6%) were successfully genotyped and 217 (71.4%) had ≥1 drug resistance mutation. Mutations conferring resistance to nucleoside reverse transcriptase inhibitor (NRTIs) and non-NRTIs were present in 40.5% (123) and 69.1% (210), respectively. The most frequent mutations were K103N/S (48.0%), M184V (37.5%), G190A/S (15.1%), and Y181C/G/V (14.1%). Predicted drug resistance analysis revealed that 68.8% of the children had high-level resistance to non-NRTIs and 11.5% had intermediate to high-level resistance to abacavir.

Conclusions:

This study showed high rates of resistance to NRTIs and non-NRTIs among newly HIV-diagnosed children in Haiti, suggesting that in the era of “Option B+” (initiation of lifelong combination antiretroviral therapy to pregnant women with HIV), the majority of children who acquire HIV infection through mother-to-child transmission of HIV have resistant HIV. These results have led the National HIV Program to revise the pediatric guidelines to include protease inhibitors in first-line regimens for all HIV-positive newborns.
Burden of Respiratory Syncytial Virus Disease and Mortality Risk Factors in Argentina: 18 Years of Active Surveillance in a Children’s Hospital
Authors: Gentile Angela , Lucion María Florencia , Juarez María del Valle , Areso María Soledad , Bakir Julia , Viegas Mariana , Mistchenko Alicia
Published: January 2019

Background:

Respiratory syncytial virus is the leading cause of acute lower respiratory infection in children. We aimed to describe the clinical-epidemiologic pattern and risk factors for mortality associated with RSV infection.

Methods:

This is a prospective, cross-sectional study of acute lower respiratory infection in children admitted to the Children’s Hospital during 2000 to 2017. Viral diagnosis was made by fluorescent antibody techniques or real-time-polymerase chain reaction. We compared clinical-epidemiologic characteristics of RSV infection in nonfatal versus fatal cases. Multiple logistic regression was used to identify independent predictors of mortality.

Results:

Of 15,451 patients with acute lower respiratory infection, 13,033 were tested for respiratory viruses and 5831 (45%) were positive: RSV 81.3% (4738), influenza 7.6% (440), parainfluenza 6.9% (402) and adenovirus 4.3% (251). RSV had a seasonal epidemic pattern coinciding with months of lowest average temperature. RSV cases show a case fatality rate of 1.7% (82/4687). Fatal cases had a higher proportion of prematurity (P < 0.01), perinatal respiratory history (P < 0.01), malnourishment (P < 0.01), congenital heart disease (P < 0.01), chronic neurologic disease (P < 0.01) and pneumonia at clinical presentation (P = 0.014). No significant difference between genders was observed. Most deaths occurred among children who had complications: respiratory distress (80.5%), nosocomial infections (45.7%), sepsis (31.7%) and atelectasis (13.4%). Independent predictors of RSV mortality were moderate-to-severe malnourishment, odds ratio (OR): 3.69 [95% confidence interval (CI): 1.98–6.87; P < 0.0001]; chronic neurologic disease, OR: 4.14 (95% CI: 2.12–8.08; P < 0.0001); congenital heart disease, OR: 4.18 (95% CI: 2.39–7.32; P< 0.0001); and the age less than 6 months, OR: 1.99 (95% CI: 1.24–3.18; P = 0.004).

Conclusions:

RSV showed an epidemic pattern affecting mostly young children. Malnourishment, chronic neurologic disease, congenital heart disease and the age less than 6 months were the independent risk factors for RSV mortality.
Prevalence of Functional GI Diseases and Pelvic Floor Symptoms in Marfan Syndrome and Ehlers-Danlos Syndrome
Authors: Nee Judy , Kilaru Saikiran , Kelley John , Oza Sveta S. , Hirsch William , Ballou Sarah , Lembo Anthony , Wolf Jacqueline
Published: January 2019

Background and Aims:

Prior studies have shown a high prevalence of gastrointestinal (GI) symptoms, diagnoses of functional GI diseases (FGIDs), and pelvic floor symptoms associated with Ehlers-Danlos syndrome (EDS). It is unclear if Marfan syndrome (MFS), another common hereditary noninflammatory connective tissue disorder, is also associated these symptoms. This study evaluates the prevalence of and compares FGIDs and pelvic floor symptoms in a national cohort of EDS and MFS patients.

Methods:

A questionnaire was sent to members of local and national MFS and EDS societies. The questionnaire evaluated the presence of GI and pelvic floor symptoms and diagnoses. The presence of FGIDs was confirmed using Rome III criteria. Quality of life was evaluated and scored with the CDC quality of life.

Key Results:

Overall, 3934 patients completed the questionnaire, from which 1804 reported that they had some form of EDS and 600 had MFS. In total, 93% of patients with EDS complained of GI symptoms and qualified for at least one FGID compared with 69.8% of patients with MFS. When comparing EDS prevalence of upper and lower GI symptoms as well as FGIDs, subjects with EDS reported significantly higher prevalence of Rome III FGIDs as compared with those with MFS. Irritable bowel syndrome (57.8% vs. 27.0%, P<0.001), functional dyspepsia (FD) (55.4% vs. 25.0%, P<0.001), postprandial distress (49.6% vs. 21.7%, P<0.001), heartburn (33.1% vs. 16.8%, P<0.001), dysphagia (28.5% vs. 18.3%, P<0.001), aerophagia (24.7% vs. 12.3%, P<0.001), and nausea (24.7% vs. 7.2%, P<0.001) were all significantly greater in the EDS population compared with MFS population. The prevalence of FGIDs was similar across subtypes of EDS. In general, participants with EDS were more likely to have nearly all pelvic floor symptoms as compared with participants with MFS.

Conclusions:

The prevalence of FGIDs and pelvic floor symptoms in EDS is higher than that found in MFS. The prevalence of FGIDs were similar across EDS subtypes. This study supports the mounting evidence for FGIDs in those with connective tissue diseases, but more specifically, in EDS.
Narcissism and Attachment
Authors: Cramer Phebe
Published: January 2019

Research often shows that narcissism and attachment style are related. The present research examines the question of whether early parenting style contributes to adult attachment style, beyond the relation between narcissism and attachment. Parents reported on their parenting style at age 3, and offspring were assessed for attachment style and narcissism at age 23. The results indicated that early parenting style was not directly related to narcissism, but along with narcissism added to the prediction of attachment style. In combination with vulnerable narcissism, authoritarian parenting was positively related to secure attachment, and negatively related to preoccupied attachment, whereas permissive and responsive parenting were negatively related to secure attachment and positively related to preoccupied attachment.
Cognitive Deficits in Euthymic Patients With Bipolar Disorder
Authors: Srivastava Chhitij , Bhardwaj Anupam , Sharma Mukul , Kumar Sanjay
Published: January 2019

Cognitive deficits have been demonstrated in people in the euthymic phase of bipolar disorder. This cross-sectional study compared euthymic bipolar disorder patients (n = 30) with never psychiatrically ill controls (n = 30) on a neuropsychological test battery containing tasks of executive function, the Wisconsin Card Sorting Test (WCST), attention and working memory, digits forward and backward, and speed of information processing digit symbol. Scores on the Mini-Mental State Examination (MMSE) and vocabulary test did not differ between the groups. The bipolar group was significantly impaired compared with controls on various indices of executive function on the WCST and on the digit tests. The impaired performance on the digit tests, but not the WCST, was significantly associated with medication status, notably prescribed benzodiazepines. There was no significant effect of severity or course of illness on performance. The findings support the hypothesis that impairments in executive function are present between illness episodes in bipolar disorder, and so they are not simply state markers.
Predicting Planned Suicide Attempts With the Columbia-Suicide Severity Rating Scale
Authors: Park C. Hyung Keun , Kim Hyeyoung , Kim Bora , Kim Eun Young , Lee Hyun Jeong , Kim Daewook , Ahn Yong Min
Published: January 2019

Identifying predictors of planned suicide attempts (PSA) is critical because these are associated with grave consequences. Using data of suicide attempters visiting emergency departments, we investigated whether the Columbia-Suicide Severity Rating Scale (C-SSRS) subscales, by retrospectively evaluating ideation before an attempt, could predict the occurrence of PSA versus unplanned suicide attempts using logistic regression analyses. The severity subscale was used as a continuous (model A) and a categorical (model B) variable. In model A, higher scores on each subscale were associated with increased risk of PSA. In model B, the highest score on the severity subscale and a higher intensity subscale score predicted PSA. The severity and intensity subscales had areas under receiver operating curves of 0.712 and 0.688 with optimum cutoff points of 4/5 and 15/16, respectively. In addition, being aged 30 to 49 and 50 to 69 years, being male, interpersonal stress, and depressive and adjustment disorders increased PSA risk. The C-SSRS subscales, along with sociodemographic and clinical risk factors, can predict PSA.
Clinicians' Empathy and Professional Quality of Life
Authors: Laverdière Olivier , Ogrodniczuk John S. , Kealy David
Published: January 2019

Psychotherapists can experience emotional drain as a result of their work with distressed and traumatized patients. It has been suggested that psychotherapists' empathy, which is central to clinical work, may be an important risk factor in the development of burnout or secondary traumatic stress. This apparent contradiction is thought provoking, especially given the complexity of empathic response. The current study aimed to explore the relationship of empathy to compassion satisfaction, burnout, and secondary traumatic stress, while also considering the influence of important work conditions. To do so, 240 psychotherapists described their current practice and reported their levels of empathy and their professional quality of life. Results revealed various relationships between dimensions of empathy and professional quality of life, and the moderating role of empathy regarding the impact of work conditions on professional quality of life. Results highlight the importance of a multidimensional assessment of empathy and the importance of different training and supervision strategies that could help psychotherapists to be more resilient in their work.
Improving Student Engagement in Community Disaster Preparedness
Authors: Shannon Crystal
Published: January 2019

Background

Recent events continue to demonstrate the need for effective community-level disaster preparedness. Nurses remain key figures in supporting local response efforts and disaster education for unexpected events.

Problem

Although improved efforts have promoted disaster nursing practice knowledge, nursing education remains challenged in engaging students in disaster management efforts.

Approach

Students collaborated over 4 semesters to assess and deliver a variety of disaster-related interventions to the community.

Outcomes

The multisemester project improved students' understanding of disaster nursing, the nursing program's engagement with community partners, and community members' knowledge and ability for emergency preparedness.

Conclusion

The project was instrumental in improving the community's awareness and engagement of the regional nursing programs in community-based emergency response. The details of the project are provided for replication by other faculty and nursing programs.
The Application of FOXO1A Expression Predicts Aggressive Behavior and Poor Prognosis in Gliomas
Authors: Huang Zheng-Yi , Hueng Dueng-Yuan , Tsai Wen-Chiuan
Published: January 2019

Forkhead box, class O, 1A (FOXO1A) is an important factor related to some human malignancies. We tested the association between FOXO1A cytoplasmic expression and World Health Organization grading system in primary brain tumors (PBTs). First of all, Western blot analysis was also performed in normal brain tissue and U87MG, LN229, GBM8401, and U118MG glioma cell lines protein lysates. Then, in order to realize FOXO1A gene expression in gliomas, U87MG, LN229, GBM8401 mRNA were applied to performed quantitative reverse transcription polymerase chain reaction (RT-PCR). At last, the immunohistochemical (IHC) analysis of FOXO1A was performed in 8 non-neoplastic brain tissues and 126 PBTs. The immunostain scores were obtained as the degree of cytoplasmic FOXO1A intensity multiplied by the percentage of positively stained tumor area. On the basis of the results of these in vitro studies, marked increase FOXO1A protein and mRNA expressions in glioma cell lines than in normal human tissue. On the view point of IHC stains, the average immunostain score of FOXO1A in all PBTs was significantly higher than non-neoplastic brain tissues. In addition, the immunostain scores of FOXO1A in high grade were higher than low-grade gliomas. Furthermore, higher cytoplasmic expression of FOXO1A might indicate the shorter overall survival rate in gliomas. Furthermore, FOXO1A expression was associated with isocitrate dehydrogenase I /2, ATRX, and p53 mutation by IHC staining. Therefore, the application of FOXO1A IHC stain might have some benefits to improve diagnostic accuracy, predict tumor progression, and evaluate survival time in glioma patients.
A Comparison of E6H4 and G175-405 p16-specific Monoclonal Antibodies in Oropharyngeal Squamous Cell Carcinoma
Authors: Ennis Chad M. , Rohrbach Marc R. , Schwalbe Michael , Mahajan Aparna , Hartig Gregory K.
Published: January 2019

The purpose of this investigation is to directly compare G175-405 and E6H4 p16-specific antibodies as immunomarkers of HPV-driven oropharyngeal carcinoma. The investigators designed a retrospective analysis using specimens from an archived tissue bank with known in situ hybridization and polymerase chain reaction status for HPV DNA. Fifty randomly selected oropharyngeal specimens were evaluated with both the G175-405 and E6H4 p16-specific monoclonal antibodies. Two pathologists, blinded to the HPV-specific testing status, evaluated p16 positivity for both antibody clones. Interrater agreement was determined using a Cohen κ coefficient. Sensitivity and specificity values were calculated using a standard 2×2 contingency table, then compared using McNemar test. Interrater agreement for interpretation of p16 expression was 92% (κ=0.84) for the G175-405 clone and 100% for the E6H4 clone (κ=1.0). The G175-405 stain had a sensitivity of 0.917 and specificity of 0.846. The E6H4 stain had a sensitivity of 1.000 and specificity of 0.769. Using McNemar test, there were no significant differences found for sensitivity (P=0.480) or specificity (P=0.480) values. The results of this study suggest that though both G175-405 and E6H4 antibody stains are statistically comparable immunomarkers for HPV-driven oropharyngeal carcinoma, the E6H4 clone offers improved interobserver reliability.
The Association of Hospital Rate of Delayed Epinephrine Administration With Survival to Discharge for Pediatric Nonshockable In-Hospital Cardiac Arrest
Authors: Raymond Tia T. , Praestgaard Amy , Berg Robert A. , Nadkarni Vinay M. , Parshuram Chris S.
Published: January 2019

Objectives:

To evaluate the variation of hospital rates of delayed epinephrine administration in pediatric patients with nonshockable in-hospital cardiac arrest, and the association of those rates with event, 24-hour, and overall survival to hospital discharge.

Design:

A retrospective evaluation was performed. Delayed epinephrine was defined as greater than 5 minutes between the time the need for chest compressions was identified and epinephrine was administered. The main outcome was the association of hospital rate of delayed epinephrine administration with survival to hospital discharge. Secondary outcomes were event and 24-hour survival. Evaluation used hierarchical logistic regression and included 13 patient/event-level and seven hospital-level factors.

Setting:

Hospitals with greater than 6 months data in the American Heart Association’s Get With the Guidelines—Resuscitation registry (2000–2016) and greater than or equal to five total pediatric cardiac arrests with nonshockable rhythm.

Patients:

Children less than 18 years old with index nonshockable in-hospital cardiac arrest treated with greater than or equal to one epinephrine dose.

Interventions:

None.

Measurements and Main Results:

One-thousand four-hundred sixty-two patients at 69 hospitals were included: 218 patients (14.9%) had epinephrine delay rates ranging from 0% to 80% of events (median, 15.6%; interquartile range, 7–25%). The median and interquartile range of hospital level delay was 16% (7–25%). Patient/event-level predictors of delayed epinephrine were asystole (odds ratio, 1.54 [95% CI, 1.10–2.16]) and insertion of an endotracheal tube (odds ratio, 1.86 [95% CI, 1.27–2.73]). Hospital size less than 200 compared with greater than or equal to 500 beds (odds ratio, 3.07 [95% CI, 1.22–7.73]) and ICU location (odds ratio, 0.51 [95% CI, 0.36–0.74]) were associated with epinephrine delay rates. After adjustment, increasing quartiles of epinephrine delay were associated with lower patient and hospital-level return of spontaneous circulation (p = 0.019, p = 0.006) and 24-hour survival (p = 0.018, p = 0.002) respectively, but not survival to discharge (p = 0.20, p = 0.24).

Conclusions:

Delayed epinephrine administration following pediatric nonshockable in-hospital cardiac arrest varies significantly between hospitals. Hospitals with higher rates of delayed epinephrine administration had worse patient- and hospital-level outcomes after adjusting for multiple patient- and hospital-level factors. Delayed epinephrine administration may directly contribute to increased mortality risk and/or may be a marker of unmeasured elements of hospital resuscitation performance.
Asthma-Related Emergency Department Visits Among Low-Income Families With Young Children by Race/Ethnicity and Primary Language
Authors: Aratani Yumiko , Nguyen Hong-An , Sharma Vrinda
Published: January 2019

Objective

The aim of this study was to examine the existence of racial/ethnic and language disparities in asthma-related emergency department (ED) initial and return visits among young children in low-income families in California.

Methods

Children younger than 6 years with at least 1 asthma-related ED visit recorded in the California Office of Statewide Health Planning and Development data set between January 1, 2009, and December 31, 2013, and on Medicaid (Medi-Cal) were assessed. Primary outcomes were hospitalization at the first asthma-related ED visit and a return asthma-related ED visit within 12 months. Data were analyzed using multivariate logistic regression.

Results

Among 47,657 children, approximately 55% were Hispanic, 20% were black, and 2.7% were Asian/Pacific Islander. For non–English-speaking families, 82% were Hispanic. Among English-speaking families, blacks were less likely to be hospitalized at the first ED visit (odds ratio [OR], 0.787; 95% confidence interval [CI], 0.715–0.866) but more likely to return to the ED (OR, 1.291; 95% CI, 1.205–1.383) compared with whites. Conversely, Asian/Pacific Islanders whose primary language was English were more likely to be hospitalized (OR, 2.150; 95% CI, 1.827–2.530) compared with whites. Among families whose primary language was not English, Hispanic and Asian/Pacific Islanders are more likely to be hospitalized at the first ED visit and all groups are less likely to return to the ED compared with English-speaking whites.

Conclusions

The findings suggest that racial/ethnic and language disparities exist in eventual asthma-related hospitalizations and repeat ED visits. Continued research is needed to understand the existence of these differences and to inform future comprehensive and linguistically appropriate asthma interventions for children in low-income families.
Universal Intimate-Partner Violence Assessment in the Pediatric Emergency Department and Urgent Care Setting
Authors: Litzau Megan , Dowd M. Denise , Stallbaumer-Rouyer Jennifer , Miller Melissa K. , Randell Kimberly A.
Published: January 2019

Objective

The aim of this study was to examine universal intimate-partner violence (IPV) assessment in the pediatric acute care setting.

Methods

We reviewed universal IPV assessment over 1 year in 2 emergency departments and 3 urgent care centers within a children's hospital system. Written IPV assessment used 2 questions (ie, safety concerns at home, information desired); “yes” to either was considered positive. We identified positive assessments via preexisting quality report. We collected demographics, resource utilization, and reason for positive screen by chart review. Positive assessment for IPV was determined by chart documentation.

Results

Intimate-partner violence assessment was documented in 169,399 visits (96% of all visits); 511 (0.3%) were positive. Four hundred ninety cases were reviewed; 21 cases were excluded (incomplete data). One hundred twenty positive assessments were classified as misunderstood (“yes” marked in error); these were associated with nonwhite race (P < 0.001). We identified IPV in 169 (46%) of the remaining 370 positive assessments. Intimate-partner violence identification was associated with white race (P = 0.004), female caregiver (P < 0.001), and English as primary home language (P = 0.045). Non-IPV concerns triggered 239 positive assessments; concerns included child maltreatment (n = 125), mental/behavioral health (n = 46), other violence (n = 33), and parenting (n = 21). Intimate-partner violence was identified by social work in 82 cases triggered by non-IPV concerns. Resources utilized included social work (99%), non-IPV resources (59%), IPV advocate (21%), law enforcement (0.8%), and child protective services (1.6%).

Conclusions

Universal IPV assessment in the pediatric acute care setting is feasible and may enable resource provision for IPV and non-IPV concerns.
A Novel Pediatric Emergency Department Intervention to Improve Adolescent Sexual Health Care
Authors: Jayamaha Dharshinie , Finocchario-Kessler Sarah , Giovanni Joan , Michael Jeffrey , Moffatt Mary E. , Sherman Ashley K. , Miller Melissa K.
Published: January 2019

Objective

The aim of this study was to evaluate a novel educational intervention for physician trainees to improve sexual health care provision, including condom distribution, in the pediatric emergency department.

Methods

Resident physicians and medical students in an urban pediatric emergency department viewed an evidence-based educational video on sexual health care provision. It featured role-plays and a description of the condom distribution process, and targeted trainees who provide health care to patients aged 14 years or more with potential genitourinary complaints. Trainees completed pre- and postintervention surveys to assess attitudes, motivation, and confidence for 4 recommended practices (Likert scale, 1 = not at all to 4 = extremely). We used Wilcoxon signed rank tests to assess differences in paired responses to motivation and confidence statements. A subset of 33 trainees completed a brief survey to assess condom distribution during emergency department clinical encounters.

Results

Of 56 trainees, 51 (91%) participated: 53% female, 58% from pediatrics. At baseline, participants reported high levels of confidence and motivation to provide sexual health care. Postintervention, there were significant increases in the proportion of participants who reported greater motivation and confidence to (1) ask a parent to step out of the room, (2) obtain sexual history, (3) discuss condom use, and (4) offer condoms (all P < 0.05). Postintervention, fewer participants “agreed/strongly agreed” that there is inadequate time to obtain sexual histories (22% vs 45%; P < 0.05). Most (60%) sexually active patients accepted condoms during clinical care.

Conclusion

In this pediatric emergency department, a low-cost intervention showed promise to improve trainee attitudes, motivation, and confidence toward adolescent sexual health care provision. These data may inform strategies to improve access to care for this population.
Sudden Diplopia at a Pediatric Emergency Department
Authors: Brambilla Alice , Pasti Mattia , Parri Niccolò
Published: January 2019

Objective

Otitis media, facial pain in trigeminal region, and ipsilateral abducens nerve palsy clinically define Gradenigo syndrome, a rare but serious complication of suppurative middle ear infection. Radiological investigation is required to confirm petrous apex involvement and to exclude further consequences as sinus thrombosis, meningitis, and intracranial abscess.

Methods/Results

We report the case of an 8-year-old child referred to our emergency department for recurrent headache and sudden strabismus. Clinical evidence of suppurative otitis media raised the suspicion for Gradenigo syndrome, definitively confirmed at computed tomography and magnetic resonance imaging scans. Conservative treatment alone enabled complete clinical and radiological remission, without long-term sequelae.

Conclusions

Despite being a rare condition, Gradenigo syndrome should be taken into account as potential differential diagnosis in children referred to emergency department for recurrent headache and strabismus. An accurate anamnesis to document recent ear infection is mandatory to orientate the diagnosis and focus radiological investigations. Early recognition and timely intervention may allow conservative management to succeed, avoiding the need for surgery and serious sequelae.
Timing of Button Battery Removal From the Upper Gastrointestinal System in Children
Authors: Al Lawati Tawfiq Taki , Al Marhoobi Reem Mohammed
Published: January 2019

Objective

The aim of the study was to investigate the appropriate time of removal of button batteries (BB) from the esophagus and stomach in children.

Methods

This is a retrospective descriptive single-center study reviewing the medical records of all children with BB ingestion seen in the Royal Hospital between January 1, 2011, and December 31, 2014. All children younger than 13 years with a history of BB ingestion were included. Biodemographic data including age and sex were obtained. In addition, time of ingestion of BB, location of BB, time of endoscopic removal, and any complications were recorded.

Results

Forty-six patients with BB ingestion were identified out of 385 who presented with foreign body ingestion (12%) during the study period. Twenty four (52%) were boys and 22 (48%) were girls. All children had BB of 20 mm in diameter. Two children had the BB in the esophagus, whereas 13 children had the BB in the stomach up on presentation. The mean time of presentation of children with BB in the esophagus was 1.75 hours after ingestion, whereas those with BB in the stomach presented on average 19.4 hours after ingestion (P < 0.035). An endoscopic intervention was done in only 8 of the 46 children. Two children had the BB in the esophagus and 6 children in the stomach. One child required intensive care unit with subsequent esophageal strictures. The mean time of esophageal BB removal was 1.7 hours from ingestion, whereas removal from the stomach was on average 27 hours after ingestion. Endoscopic injuries were noted in 87.5% of the children with BB in the esophagus or the stomach. No mortality occurred during the study period.

Conclusions

Button batteries ingestion is a common problem with variable time of presentation to the emergency department. Esophageal BB presents the highest risk of injury even in as short time as 2 hours. Gastric mucosal injury can occur within 10 hours of ingestion. Button batteries of 20-mm diameter need to be urgently removed from the esophagus and be considered for removal earlier than 24 hours if in the stomach.
Etiology, Management, and Outcome of Pediatric Epistaxis
Authors: Send Thorsten , Bertlich Mattis , Eichhorn Klaus Wolfgang , Ganschow Rainer , Schafigh Darius , Horlbeck Fritz , Bootz Friedrich , Jakob Mark
Published: January 2019

Objective

Epistaxis in children is one of the most common causes for seeking professional medical help. Patients may be treated by several disciplines with various approaches to pediatric epistaxis. We reviewed cases of pediatric epistaxis from an otorhinolaryngologist's point of view.

Methods

A retrospective chart review was performed on all patients younger than 18 years presenting with epistaxis to the Department of Otorhinolaryngology at the University of Bonn, Germany.

Results

Sixty episodes of epistaxis in 58 patients were included in the study. Mean age was 10.1 ± 4.5 years. In terms of risk factors, 3 patients had a hemorrhagic diathesis, 3 had taken medication that interfered with hemostasis, and 8 had a history of previous trauma, most of which was digital manipulation. Twenty-six patients did not need invasive therapy. Twenty-six patients received cauterization to control the bleeding, and 4 patients needed surgery. The necessity for surgery was mainly noncooperation.

Conclusions

Epistaxis in children is seldom serious. However, hemorrhagic diathesis needs to be kept in mind as a potential cause of epistaxis. In most cases, careful instruction of the patients and the relatives concerning nasal mucosal care is sufficient. If cauterization is necessary, silver nitrate coagulation should be preferred over electrocoagulation.
Focused Cardiac Ultrasound in Pediatric Pulmonary Hypertension
Authors: Noorbakhsh Kathleen A. , Bell-Cheddar Yolandee R. , Marin Jennifer R.
Published: January 2019

We present 2 cases of pediatric pulmonary hypertension presenting with respiratory distress. Focused cardiac ultrasound revealed findings consistent with right ventricular dilatation and elevated right ventricular pressure. These findings, in conjunction with the clinical presentation, allowed for early identification and rapid evaluation of a pathologic process that can often go unidentified. In this report, we review the relevant aspects of focused cardiac ultrasound in the setting of pulmonary hypertension.