bluuebunny/crossref_metadata_2025 huggingface dataset:
Socio-demographic and clinical determinants of late presentation among patients newly diagnosed with HIV in the Eastern Cape, South Africa
Authors: Sogbanmu Olufunso O. , Goon Daniel T. , Obi Larry C. , Iweriebor Ben C. , Nwodo Uchechukwu N. , Ajayi Anthony I. , Okoh Anthony I.
Published: February 2019

South Africa recently implemented the ‘test and treat’ strategy for all HIV-infected individuals receiving diagnosis at the health facility level. However, the impact of this programme in terms of the prevention of HIV transmission, morbidity and mortality associated with HIV can only be maximized if patients are diagnosed early. This study determines the prevalence of late presentation among newly diagnosed HIV-infected individuals and also examines the socio-demographic and clinical determinants for late presentation in health facilities in the Eastern Cape Province, South Africa.

In this cross-sectional study, a total of 335 newly diagnosed patients were recruited consecutively between August 2016 and July 2017. Late presenter for HIV care was defined in accordance with the European Late Presenter Consensus working group as a patient who reports for care when the CD4 count is below 350 cells/μL and/or when there is an established AIDS-defining clinical condition, irrespective of CD4 count. Adjusted and unadjusted logistic regression analysis was used to examine the determinants of late HIV diagnosis.

Participants’ mean age was 33.6 (SD: 10.6). Almost 96% of the participants believed their route of HIV infection was heterosexual sex. Most newly diagnosed HIV-infected patients (60%) were late presenters (CD4+ count ≤350 cells/μL and/or having an AIDS-defining illness in World Health Organisation (WHO)-defined stage III/IV), with 35% presenting with Acquired Immune Deficiency Syndrome (AIDS)-related complications. In the adjusted model, only male sex (AOR: 2.81; CI: 1.51–5.23), no formal education (AOR: 5.63; CI: 1.68–18.85), and overweight body mass category (AOR: 2.45; CI: 1.04–5.75) were independently associated with late HIV diagnosis.

The majority of newly diagnosed HIV-infected individuals were late presenters. To maximize the impact of the ‘test and treat’ policy aimed at reducing new HIV transmissions and preventing the morbidity and mortality associated with HIV, there is a need for programmes to improve early detection of HIV in the study settings. This programme should target males and individuals with no formal education for maximum impact.
In-hospital, short-term and long-term adverse clinical outcomes observed in patients with type 2 diabetes mellitus vs non-diabetes mellitus following percutaneous coronary intervention
Authors: Zhuo Xiaojun , Zhang Chuanzeng , Feng Juan , Ouyang Shenyu , Niu Pei , Dai Zhaohui
Published: February 2019

Background:

Several studies have shown that patients with type 2 diabetes mellitus (T2DM) have worse clinical outcomes in comparison to patients without diabetes mellitus (DM) following Percutaneous Coronary Intervention (PCI). However, the adverse clinical outcomes were not similarly reported in all the studies. Therefore, in order to standardize this issue, a meta-analysis including 139,774 patients was carried out to compare the in-hospital, short-term (<1 year) and long-term (≥1 year) adverse clinical outcomes in patients with and without T2DM following PCI.

Methods:

Electronic databases including MEDLINE, EMBASE, and the Cochrane Library were searched for Randomized Controlled Trials (RCTs) and observational studies. The adverse clinical outcomes which were analyzed included mortality, myocardial infarction (MI), major adverse cardiac events (MACEs), stroke, bleeding, target vessel revascularization (TVR), target lesion revascularization (TLR), and stent thrombosis. Risk Ratios (RR) with 95% confidence intervals (CI) were used to express the pooled effect on discontinuous variables and the analysis was carried out by RevMan 5.3 software.

Results:

A total number of 139,774 participants were assessed. Results of this analysis showed that in-hospital mortality and MACEs were significantly higher in patients with T2DM (RR 2.57; 95% CI: 1.95–3.38; P = .00001) and (RR: 1.38; 95% CI: 1.10–1.73; P = .005) respectively. In addition, majority of the short and long-term adverse clinical outcomes were also significantly higher in the DM group as compared to the non-DM group. Stent thrombosis was significantly higher in the DM compared to the non-DM group during the short term follow-up period (RR 1.59; 95% CI: 1.16–2.18;P = .004). However, long-term stent thrombosis was similarly manifested.

Conclusion:

According to this meta-analysis including a total number of 139,774 patients, following PCI, those patients with T2DM suffered more in-hospital, short as well as long-term adverse outcomes as reported by most of the Randomized Controlled Trials and Observational studies, compared to those patients without diabetes mellitus.
Characteristics of the modern-day physician house call
Authors: Fortin Ensign Shannon , Baca-Motes Katie , Steinhubl Steven R. , Topol Eric J.
Published: February 2019

Many barriers to primary healthcare accessibility in the United States exist including an increased opportunity cost associated with seeking primary care. New models of healthcare delivery aimed at addressing these problems are emerging. The potential impact that on-demand primary care physician house calls services can have on healthcare accessibility, patient care, and satisfaction by both patients and physicians is poorly characterized.

We performed a retrospective observational analysis on data from 13,849 patients who utilized Heal, Inc, an application (app)-based, on-demand house calls platform between August 2016 and July 2017. We assessed house call wait time and visit duration, diagnoses by International Classification of Diseases, tenth revision, Inc (ICD10) codes, and house call outcomes by post-visit prescription and lab requests, and patient satisfaction survey.

Patients who utilized this physician house call service had a bimodal age distribution peaking at age 1 year and 36 years. Same day acute sick exams (93.9% of pediatric (Ped) and 66.9% of adult requests) for fever and/or acute upper respiratory infection represented the most common use. The mean wait time for as soon as possible house calls were 96.1 minutes, with an overall mean house call duration of 27.1 minutes. A house call was primarily chosen over an Urgent Care Clinic or Doctor's office (46.2% and 41.6% of respondents, respectively), due to convenience or fastest appointment available (69.6% and 33.8% of respondents, respectively). Most survey respondents (94.2%) would schedule house calls again.

On-demand physician house calls programs can expand access options to primary healthcare, primarily used by younger individuals with acute illness and preference for a smartphone app-based home visit.
A retrospective observational study of early experiences of vedolizumab treatment for inflammatory bowel disease in the UK
Authors: Cummings Fraser , Gaya Daniel R. , Levison Scott , Subramanian Sreedhar , Owen Glynn , Rathmell Anna , Glen Fiona , Demuth Dirk , Meadowcroft Simon , Irving Peter M.
Published: February 2019

Results from clinical trials show that vedolizumab is an efficacious treatment for inflammatory bowel disease, namely Crohn's disease (CD) and ulcerative colitis (UC). However, there is limited evidence from real-world clinical practice, especially on early clinical experiences in the UK.

To describe real-world early experiences of vedolizumab to treat CD and UC in the UK.

A retrospective, chart review study of patients with CD or UC treated with vedolizumab across 5 UK hospitals. All eligible adults (≥18 years at initiation) with a diagnosis of CD and ≥14 weeks of data or UC and ≥10 weeks of data available following vedolizumab initiation were included.

Data were analyzed for 112 patients (CD: 66; UC: 46). Patients with CD had a median of 7.4 (interquartile range 5.7–9.4) months follow-up and patients with UC had a median of 7.4 (5.6–10.2) months follow-up post-vedolizumab initiation. Most patients, 80% (53/66) with CD and 89% (41/46) with UC, remained on vedolizumab treatment at the time of data collection. No new safety signals were identified during the study.

These results add to the body of evidence supporting vedolizumab as an effective and well-tolerated treatment for CD and UC in real-world clinical practice.
Responses of lung cancer survivors undergoing gamma knife surgery to supportive group psychotherapy
Authors: Peng Wanxiu , Zhang Hui , Li Zhongguo
Published: February 2019

An increasingly important concern for clinicians who care for patients with cancers is their psychological problems and quality of life. The present study examined the efficacy of supportive group psychotherapy (SGP) on anxiety, depression and overall quality of life in patients with lung cancer undergoing gamma knife surgery (GKS).

160 patients with lung cancer undergoing GKS were randomly divided into SGP group (n = 82) and care as usual (CAU) group (n = 78). Patients in SGP group received 90 minutes’ group psychotherapy intervention once a week for 8 weeks, while patients in CAU group received usual care. Outcome measures were administered before and after the intervention and at 3-months follow-up. The primary outcome measures were the 14-item Hospital Anxiety and Depression Scale (HADS) and the secondary outcome measures were the 30-item European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30).

Demographic characteristics between SGP and CAU groups showed no difference in sex, age, course of disease, years of education, marital status and profession. Psychological characteristics evaluated by HADS revealed that levels of both depression and anxiety in SGP group were significantly improved compared with that in CAU group at the end of the treatment and the improvement remained at the 3-months follow-up. In addition, EORTC QLQ-C30 demonstrated that functional scales including emotion, cognition and society in SGP group were significantly higher than that in CAU group at the end of the treatment and maintained till 3-months follow-up. EORTC QLQ-C30 also showed that symptom scales including fatigue, nausea/vomiting, pain, syspnea, insomnia, loss of appetite and financial problems in the former group were significantly lower than that in the latter group and maintained till 3-months follow-up. Furthermore, compared with that in SGP group before treatment, these variables in both HADS and EORTC QLQ-C30 showed obvious improvement in the same group after treatment and at the 3-months follow-up.

The results suggested that SGP can alleviate anxiety and depression in patients with lung cancer following GKS and improve the overall quality of life.
Early characteristics of fulminant myocarditis vs non-fulminant myocarditis
Authors: Wang Zicheng , Wang Yanwei , Lin Haiyan , Wang Shengjie , Cai Xianlei , Gao Da
Published: February 2019

Background:

Fulminant myocarditis (FM) is a sub-category myocarditis. Its primary characteristic is a rapidly progressive clinical course that necessitates hemodynamic support. FM can be difficult to predict at the onset of myocarditis. The aim of this meta-analysis was to identify the early characteristics in FM compared to those of non-fulminant myocarditis (NFM).

Methods:

We searched the databases of MEDLINE, EMBASE, CENTRAL, for studies comparing FM with acute NFM from January 1, 2000 to June 1, 2018. The baseline variables were compared in each study. Mean differences (MD) and relative ratios (RR) were calculated.

Results:

Seven studies (158 FM patients and 388 NFM patients) were included in the analysis. The FM group had significantly lower systolic blood pressure (SBP), higher creatine kinase (CK), wider QRS duration, lower left ventricular ejection fraction (LVEF), thicker left ventricular posterior wall diameter (LVPWd), higher incidence of ST depression, ventricular tachycardia/ventricular fibrillation (Vt/Vf) and syncope, less incidence of chest pain than the NFM groups. There was no difference in terms of heart rate (HR), c-reactive protein (CRP), fever, dyspnea, white blood cells (WBC), atrioventricular block (AVB), Q waves, ST elevation, interventricular septum diameter (IVSd), or end-diastolic left ventricular diameter (LVEDd) between FM and NFM.

Conclusion:

We found that the lower SBP, higher CK, wider QRS duration, lower LVEF, thicker LVPWd, higher incidence of ST depression, Vt/Vf and syncope as well as lower incidence of chest pain were early characteristics of FM.
Effectiveness and safety of Xuefu Zhuyu decoction for treating coronary heart disease angina
Authors: Yang Tao , Li Xiao , Lu Ziwen , Han Xiaowan , Zhao Mingjing
Published: February 2019

Background:

Coronary heart disease angina is a very common cardiovascular disease, which not only causes personal health problems, but also a serious burden on the social economy. Xuefu Zhuyu Decoction (XFZYD) has been widely adapted to clinical practice for people with coronary heart disease angina. At present, it is necessary to update the existing research, re-evaluate the effectiveness and safety of XFZYD, and provide the latest evidence for coronary heart disease angina.

Methods and analysis:

The purpose of this study was to search the electronic database for XFZYD in the treatment of coronary heart disease angina. The database includes PubMed, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure database (CNKI), Wanfang database, Chinese Biomedical Literature database (CBM), Chinese Scientific Journal database (VIP). In addition, ongoing trials will be retrieved from the WHO ICTRP Search Portal, the Chinese Clinical Trial Register and The Clinical Trials Register. We will assess all the documents from the database establishment to January 31, 2019. The RevMan V.5.3 software will be used to calculate the data synthesis and perform a meta-analysis when the literature is appropriate.

Results:

The study will provide a high-quality synthesis of current evidence of XFZYD for coronary heart disease angina from the various comprehensive assessment, including Significantly effective, Effective, Invalid, Aggravation, which based on the “Guidelines for Clinical Research of New Chinese Medicine”. Adverse events are also included.

Conclusion:

The systematic review will provide evidence for assessing the effectiveness and safety of XFZYD in the treatment of coronary heart disease angina.

PROSPERO registration number:

PROSPERO CRD42019122003.
Circulating uPA as a potential prognostic biomarker for resectable esophageal squamous cell carcinoma
Authors: He Xiao , Xu Xiaoling , Zhu Guanxia , Ye Hong
Published: February 2019

Previous research showed that the 4 genes of matrix metallopeptidase 9 (MMP9), cyto-keratin 20 (CK20), cyto-keratin 19 (CK19) and urokinase type plasminogen activator (uPA) are detectable in the peripheral blood. All the 4 genes are related to tumor invasion and metastasis. However, whether their expression is associated with clinicopathologic factors and the prognosis of patients with esophageal squamous cell carcinoma (ESCC) is still confused. Expression levels of MMP9, CK20, CK19, and uPA were evaluated by quantificational real-time polymerase chain reaction (qRT-PCR) in peripheral blood of 205 ESCC patients who received radical resection. The cut-off value was 1000 copy numbers. Their impacts on clinicopathologic factors and survival were investigated. The uPA expression positively correlated with gender (P 
= .046) and tumor size (P = .046). Meanwhile, CK19 expression positively correlated with tumor size (P = .029), vascular invasion (P = .024), and CK20 expression positively correlated with tumor size (P = .035) and degrees of differentiation (P = .032). Moreover, the overexpression of MMP9 has a correlation with postoperative radiotherapy (P = .041) and chemotherapy (P = .012). Among the 4 genes, only uPA is a prognostic indicator for disease-free survival and overall survival both in univariate analysis and multivariate analysis (P = .015). This study suggests that circulating uPA mRNA in peripheral blood can serve as a potential unfavorable prognosis biomarker in ESCC. Further perspective, multi-center and large-scale study is still needed.
The effects of aromatherapy massage on improvement of anxiety among patients receiving palliative care
Authors: Hsu Chia-Hsien , Chi Ching-Chi , Chen Pei-Shih , Wang Shu-Hui , Tung Tao-Hsin , Wu Shih-Chung
Published: February 2019

Background:

Anxiety in patients receiving palliative care is a noteworthy concern because it may affect their quality of life. Aromatherapy has been widely utilized to improve anxiety among patients receiving palliative care.

Objective:

To investigate the effectiveness of anxiety improvement in patients receiving palliative care by comparing the intervention group (aromatherapy massage) with the control group (common massage alone).

Methods:

A literature search was performed using PubMed, Cochrane Library, Embase, MEDLINE, and CINAHL for all related studies from inception through November 30, 2018 without restriction on language. A quantitative synthesis of randomized controlled trials (RCTs) was conducted to compare the difference in effectiveness scores between the aromatherapy massage and only common massage groups by employing a random-effect model.

Results:

We included three RCTs with a total of 160 participants (81 in the intervention group and 79 in the control group) in our systematic review and conducted a quantitative synthesis. The secondary data from the reviewed trials were then pooled using a random-effect model. Anxiety (mean difference = −2.60 [95% confidence interval: −7.82, 2.63], P = .33) was assessed using anxiety scores from the State-Trait Anxiety Inventory.

Conclusion:

Compared with common massage alone, aromatherapy massage does not provide significant effectiveness of anxiety improvement among patients receiving palliative care.
Spontaneous reduction of an incarcerated gravid uterus after myomectomy in the second trimester
Authors: Tong Chun , Wang Yan , Liu Zhaohui , Zhao Yangyu , Xu Yan , Wang Wei
Published: February 2019

Rationale:

During a normal pregnancy, in the 1st trimester uterus lies in pelvis and enlarges in size as the pregnancy advances. By 14 weeks of gestation, the gravid uterus transforms from a pelvis to an abdominal organ and a retroverted uterus will correct as the fundus rises out of the pelvis and falls forward to its normal anatomical position. If the uterus remains in the pelvic cavity after 14 weeks of gestation, it is referred to as an incarcerated uterus.

Patient concerns:

A 31-year-old gravida 3 para 0 woman was admitted to our obstetrics unit at 20 weeks’ gestation with the complaint of severe persistent upper abdominal pain for over 12 hours.

Diagnosis and interventions:

A diagnosis of fibroid degeneration was made through ultrasound and magnetic resonance imaging. The patient was hospitalized with conservative treatment. An abdominal myomectomy was performed at 22 weeks’ gestation because her condition had deteriorated. Incarcerated uterus was not suspected even at the time of myomectomy. But within 24 hours after myomectomy, diagnosis of incarcerated gravid uterus was made by ultrasound.

Outcomes:

Incarcerated gravid uterus was found spontaneously reduced three weeks after myomectomy by ultrasound. A transverse Cesarean incision was performed at 32 weeks’ gestation. A male infant weighing 2120 g was delivered with Apgar scores of 10 and 10 at 1 and 5 minutes, respectively. Postoperative course was uneventful.

Lessons:

Incarceration of the gravid uterus is relatively rare and it is difficult to diagnose. This patient's findings suggested the incarceration of gravid uterus can be a transient abnormal position. The results of this study indicates that the incarcerated uterus when associated with fibroid is spontaneously reduced after removal of the fibroid.
Preoperative prealbumin and transferrin
Authors: Takemoto Erin , Yoo Jung , Blizzard Sabina R. , Shannon Jackilen , Marshall Lynn M.
Published: February 2019

Summary of Background Data:

There is growing interest in identifying nutritional biomarkers associated with poor outcomes of elective spine surgery. Prealbumin and transferrin are both biomarkers of nutritional status that can be obtained from clinical laboratories. However, associations of preoperative measures of these nutritional biomarkers across their range with risk of complications from spine surgery have not been fully investigated.

Objective:

Determine associations of preoperative prealbumin and transferrin levels with 30-day risk of complication among elective spine surgery patients.

Study Design:

Cohort study with preoperative prealbumin and transferrin collected as standard of care.

Outcome Measures:

30-day risk of medical complication.

Methods:

Data were obtained from medical records of 274 consecutive adult patients ages ≥50 years who underwent elective spine surgery from June 2013 to June 2014. Prealbumin (mg/dL), serum transferrin (mg/dL), and preoperative factors were abstracted from medical records. Prealbumin and transferrin levels were categorized into quartiles and as below versus median or higher. The primary outcome measure was 30-day risk of medical complication, such as renal failure or infections. Associations of the biomarkers with outcome risk were assessed with chi-square tests and with risk ratios (RR) and 95% confidence intervals (CI) estimated with multivariable log-binomial regression.

Results:

The 274 adults studied had a median prealbumin level of 27.4 mg/dL and a median transferrin level of 265.0 mg/dL. The 30-day risk of complication was 12.8% (95% CI: 8.8%–16.7%). Risk of complication did not vary by quartile for either prealbumin (P = .26) or transferrin (P = .49) and was not associated either with prealbumin (below median, RR = 1.1, 95% CI: 0.8, 1.5) or transferrin (below median, RR = 1.1, 95% CI: 0.8, 1.6).

Conclusions:

Among adults undergoing elective spine surgery, the 30-day risk of complication was not associated with prealbumin or transferrin. Nutrition status, as measured by prealbumin and transferrin, does not appear to be associated with complication risk.

Level of evidence: Level III.
Solvent-based paclitaxel or nab-paclitaxel for heavily treated relapsed/refractory small cell lung cancer
Authors: Sugiyama Keiji , Kogure Yoshihito , Torii Atsushi , Shiraishi Kazuhiro , Yamada Arisa , Ishida Akane , Shigematsu Fumie , Nozawa Kazuki , Niwa Hideyuki , Oka Saori , Nakahata Masashi , Kitagawa Chiyoe , Oki Masahide , Saka Hideo
Published: February 2019

Treatment options for patients with relapsed/refractory small cell lung cancer (R/R SCLC) are limited, and the efficacy of salvage therapies for heavily treated patients should be assessed. Here, we evaluated the efficacy of paclitaxel (PTX) in R/R SCLC patients.

A single-institute retrospective chart review was conducted. The primary endpoint was overall survival (OS), whereas the secondary endpoints were progression-free survival (PFS), overall response rate, disease control rate (DCR), and safety.

Thirty-one patients (median age, 69 [range, 56–80] years) were analyzed. The median follow-up period was 122 (range, 28–1121) days. The median OS and PFS were 4.4 and 2.2 months, respectively. Adverse events of grade 3 or higher, other than hematological toxicity, were febrile neutropenia and neuropathy. Multivariate analyses identified the following independent predictors of poor OS: performance status and lactate dehydrogenase at the upper limit of normal.

PTX monotherapy showed moderate efficacy with acceptable toxicity in heavily treated patients with R/R SCLC patients.
Understanding the Economic Impact of Health Care-Associated Infections: A Cost Perspective Analysis
Authors: Scott R. Douglas , Culler Steven D. , Rask Kimberly J.
Published: February 2019

The economic impacts from preventing health care-associated infections (HAIs) can differ for patients, health care providers, third-party payers, and all of society. Previous studies from the provider perspective have estimated an economic burden of approximately $10 billion annually for HAIs. The impact of using a societal cost perspective has been illustrated by modifying a previously published analysis to include the economic value of mortality risk reductions. The resulting costs to society from HAIs exceed $200 billion annually. This article describes an alternative hospital accounting framework outlining the cost of a quality model which can better incorporate the broader societal cost of HAIs into the provider perspective.
Missed Opportunities
Authors: Hessels Amanda J. , Weaver Susan H.
Published: February 2019

Standard precautions are a recommended set of actions health care workers should take to prevent health care-associated infections and potentially infectious exposures. However, they are not reliably practiced, many opportunities are missed, and a substantial discrepancy between workers' stated performance and actual performance exists. This article presents findings from developing and testing standard precaution case scenarios to enhance nursing knowledge. Infusion nursing is high risk and entails highly complex care in dynamic settings. Challenges may exist when integrating this advanced care with fundamental standard precaution requirements. For this reason, findings from this study have implications for infusion nursing practice.
Clown Intervention on Psychological Stress and Fatigue in Pediatric Patients With Cancer Undergoing Chemotherapy
Authors: Lopes-Junior Luis C. , Silveira Denise S. C. , Olson Karin , Bomfim Emiliana O. , Veronez Luciana C. , Santos Jéssica C. , Alonso Jonas B. , Nascimento Lucila C. , Pereira-da-Silva Gabriela , Lima Regina A. G.
Published: February 2019

Background

Clown intervention has been shown to enhance emotional and behavioral processes, but few studies have comprehensively examined the effectiveness of this practice using biomarkers.

Objective

The aim of this study was to evaluate the effect of a clown intervention on the levels of psychological stress and cancer-related fatigue in pediatric patients with cancer undergoing chemotherapy.

Methods

Sixteen patients who met all criteria from a pediatric oncology inpatient unit in a Brazilian comprehensive cancer care hospital participated in this quasi-experimental study. Eight saliva samples were collected, comprising 4 at baseline and 4 after clown intervention (+1, +4, +9, and +13 hours after awakening). Salivary cortisol and α-amylase levels were determined using high-sensitivity enzyme-linked immunosorbent assay kits. Stress and fatigue were measured by the Child Stress Scale-ESI and the PedsQL Multidimensional Fatigue Scale, respectively. Relationships among stress, fatigue, and biomarker levels were investigated using nonparametric statistics.

Results

In comparison with baseline measurements, the total psychological stress and fatigue levels improved after the clown intervention at the collection time point +4 hours (P= .003 andP= .04, respectively). Salivary cortisol showed a significant decrease after clown intervention at the collection time points +1, +9, and +13 hours (P< .05); however, α-amylase levels remained unchanged.

Conclusion

These findings provide preliminary evidence that clown intervention merits further study as a way to reduce stress and fatigue in pediatric cancer inpatients, and that self-report and biomarker measures are feasible to collect in this patient group.

Implications for Practice

Clown intervention as a nonpharmacological intervention may improve stress and fatigue levels in pediatric inpatients with cancer undergoing chemotherapy.
Content Validation of Quality and Safety Education for Nurses Prelicensure Clinical Evaluation Instruments
Authors: Altmiller Gerry
Published: February 2019

Background

Clinical evaluation is a high-stakes assessment that requires valid and reliable instruments that are understandable to faculty and students.

Purpose

This article describes the development of Quality and Safety Education for Nurses (QSEN)–based clinical evaluation instruments to measure competency in prelicensure clinical courses. The goal was to establish content validation for the items included on each and appropriately level requisite behaviors to demonstrate increasing progression in clinical performance expectation from fundamentals to senior nursing clinical courses.

Methods

Based on their area of expertise, nurse educators were recruited into panels of 5 to 7 members each to review and rate items for relevance for each course-specific clinical evaluation instrument using the Content Validity Index.

Results

Two rounds of rigorous review yielded 6 content-validated instruments.

Conclusions

The QSEN-based clinical evaluation instruments provide standardized language framed in quality and safety that demonstrate evolving sophistication, complexity, and expectation in student clinical performance.
Innovative Model to Recognize Previous Military Training of BSN Students
Authors: McLain Rhonda M. , Moore Randy , Hites Lisle
Published: February 2019

Background

Many of our military transitioning to civilian life are expertly trained medics, corpsmen, and health care specialists.

Problem

The medical training of these veterans does not follow traditional degree granting academic protocols. These individuals seeking formal academic credentials to work in the nonmilitary sector are often forced to start their health education over from the beginning.

Approach

An innovative model was developed for waiving the requirements for specific nursing courses for veteran-students. Using a skills self-assessment tool and a validation process, veteran-students are able to demonstrate their knowledge, training, and experience.

Outcomes

As part of the program, 32 veteran-students have validated out of 65 courses for 115 credit hours. All students have successfully progressed through the BSN program.

Conclusion

This skills validation model represents a model that can be implemented for students entering a nursing program with a variety of health care backgrounds.
Stroke Characteristics, Risk Factors, and Outcomes in Transgender Adults
Authors: LaHue Sara C. , Torres Dolores , Rosendale Nicole , Singh Vineeta
Published: February 2019

Objectives:

To describe the clinical characteristics and risk factors of male-to-female transgender (transwomen) patients with acute stroke.

Methods:

The study population included all patients admitted for stroke at San Francisco General Hospital from October 1, 2010 through August 31, 2017 who self-identified as transwomen. Patient charts were reviewed by the study coauthors for demographics, stroke risk factors, stroke characteristics, and clinical outcomes. Means, percentiles, and ranges were calculated.

Results:

Eight transwomen (average age, 50±9 y; range, 38 to 61 y) were admitted for stroke (average NIHSS, 8; range, 0 to 27). The majority of patients presented subacutely. The most common type of stroke was ischemic stroke (4, 50%), followed by intracerebral hemorrhage (2, 22%), transient ischemic attack (1, 13%), and concurrent ischemic stroke with subarachnoid hemorrhage (1, 13%). While traditional stroke risk factors were present, these patients also disproportionally had alternative risk factors: stimulant use (5, 63%), tobacco use (5, 63%), hepatitis C (5, 63%), human immunodeficiency virus (3, 38%), and prior stroke or transient ischemic attack (2, 25%). Six patients (75%) used estradiol (oral or injection) or conjugated estrogen as part of gender-affirming treatment at the time of stroke; one patient used estrogen remotely. Only 2 patients (33%) were prescribed their hormone therapy on discharge.

Conclusions:

Understanding unique vulnerabilities of the transgender community for cerebrovascular events is essential to provide culturally appropriate counseling for harm reduction.
Case Report: Focal Choroidal Excavation Underlying Combined Hamartoma of the Retina and Retinal Pigment Epithelium
Authors: Wang Qian , Liu Jing Hua , Jiao Xuan , Wei Wen Bin , Lu Hai
Published: February 2019

SIGNIFICANCE

There are few reports of focal choroidal excavation (FCE) in combined hamartoma of the retina and retinal pigment epithelium (CHRRPE). This report documents a case of this rare condition and suggests that there might be a relationship between FCE and CHRRPE.

PURPOSE

The purpose of this study was to describe a case of FCE underlying CHRRPE.

CASE REPORT

A 6-year-old Chinese boy presented with a 2-month history of decreased vision in his left eye. Fundus examination of the left eye showed an elevated fibrotic mass in the macular area with pigment disturbance. Optical coherence tomography revealed a cup-shaped FCE in the macula with thickening and disorganization of multiple retinal layers and overlying epiretinal proliferation in the left eye. A diagnosis of FCE within CHRRPE was made, and periodic review was recommended.

CONCLUSIONS

There may be an association or a causal relationship between CHRRPE and FCE. It is plausible that FCE in the setting of CHRRPE is a developmental abnormality that occurs after birth because of a weakening of the retinal pigment epithelium and thinning of the choroid beneath the tumor. Continued monitoring for FCE progression and potential choroidal neovascularization is indicated.
The Effect of Microblepharon Exfoliation on Clinical Correlates of Contact Lens Discomfort
Authors: Siddireddy Jaya Sowjanya , Tan Jacqueline , Vijay Ajay Kumar , Willcox Mark D. P.
Published: February 2019

SIGNIFICANCE

Microblepharon exfoliation improved eyelid signs and tear film characteristics after a single in-office treatment in symptomatic contact lens wearers.

PURPOSE

The purpose of this study was to assess the effect of two eyelid hygiene treatments—microblepharon exfoliation and a hypoallergenic foam cleanser (LidHygenix)—on clinical signs of the eyelids, meibomian glands, and tear film in contact lens discomfort.

METHODS

A randomized, interventional, unmasked, crossover trial was conducted on 30 experienced daily-wear soft contact lens wearers. Assessment of clinical signs of the eyelid margin, meibomian gland morphology and secretion, and tear film biophysical properties was performed (baseline 1), and participants were randomly assigned to receive one of the two treatments (microblepharon exfoliation or foam cleansing using LidHygenix) as a single in-office procedure. Symptoms were evaluated using the Contact Lens Dry Eye Questionnaire-8 immediately after treatment, and assessment of all the study variables was repeated at the follow-up visit 7 to 10 days after treatment. After 28 to 30 days of washout, participants returned for reassessment of the study variables (baseline 2) and were crossed over to receive the alternate treatment. Follow-up was repeated 7 to 10 days after the second treatment.

RESULTS

Seven to 10 days after treatment with microblepharon exfoliation, symptomatic wearers showed significant improvement in anterior blepharitis (mean difference, 0.60; P = .04), lid wiper staining (0.50; P = .06), and lid-parallel conjunctival folds (0.68, P = .02) along with orifice capping (median difference, 0.65; P < .001), foam (0.90; P < .001), secretion volume (0.69; P < .001), quality (0.74; P < .001), and expressibility (0.49; P = .002), which were also clinically significant changes. However, in tear properties, significant improvements were observed in tear volume (LidHygenix, −1.25 mm; microblepharon exfoliation, −1.62 mm), break-up time (−0.14 seconds; −0.14 seconds), tear evaporation rate without contact lenses (21.52 g m−2 h; 45.43 g m−2 h), and lipid layer thickness (−20.61 nm; −25.13 nm) after both treatments but in symptomatic lens wearers only (P < .05).

CONCLUSIONS

Microblepharon exfoliation improved eyelid signs and tear film characteristics in symptomatic contact lens wearers after a single in-office treatment.
CRISPR/Cas9-Mediated BRCA1 Knockdown Adipose Stem Cells Promote Breast Cancer Progression
Authors: Zhao Ruya , Kaakati Rayan , Liu Xinjian , Xu Lingfan , Lee Andrew K. , Bachelder Robin , Li Chuan-Yuan , Hollenbeck Scott T.
Published: February 2019

Background:

The tumor microenvironment within the breast is rich in adipose elements. The interaction between adipose cells and breast cancer is poorly understood, particularly as it pertains to patients with genetic susceptibility to breast cancer. This study focuses on the phenotype of human adipose-derived stem cells with the BRCA1 mutation and the effect they may have on breast cancer cell behavior.

Methods:

CRISPR/Cas9 was used to generate de novo BRCA1-knockdown human adipose-derived stem cells. The effect of the BRCA1 knockdown on the adipose-derived stem cell phenotype was compared to wild-type adipose-derived stem cells and patient-derived breast adipose-derived stem cells with known BRCA1 mutations. Interactions between adipose-derived stem cells and the MDA-MB-231 breast cancer cell line were evaluated.

Results:

BRCA1-knockdown adipose-derived stem cells stimulated MDA-MB-231 proliferation (1.4-fold increase on day 4; p = 0.0074) and invasion (2.3-fold increase on day 2; p = 0.0171) compared to wild-type cells. Immunofluorescence staining revealed higher levels of phosphorylated ataxia telangiectasia-mutated activation in BRCA1-knockdown cells (72.9 ± 5.32 percent versus 42.9 ± 4.97 percent; p = 0.0147), indicating higher levels of DNA damage. Beta-galactosidase staining demonstrated a significantly higher level of senescence in BRCA1-knockdown cells compared with wild-type cells (7.9 ± 0.25 percent versus 0.17 ± 0.17 percent; p < 0.0001). Using quantitative enzyme-linked immunosorbent assay to evaluate conditioned media, the authors found significantly higher levels of interleukin-8 in BRCA1-knockdown cells (2.57 ± 0.32-fold; p = 0.0049).

Conclusions:

The authors show for the first time that the BRCA1 mutation affects the adipose-derived stem cell phenotype. Moreover, CRISPR/Cas9-generated BRCA1-knockdown adipose-derived stem cells stimulate a more aggressive behavior in breast cancer cells than wild-type adipose-derived stem cells. This appears to be related to increased inflammatory cytokine production by means of a DNA damage-mediated cell senescence pathway.
The Ideal Nipple Reconstruction Shield
Authors: Staruch Robert M. T. , Din Asmat H. , See Marlene S. , Mohanna Pari-Naz
Published: February 2019

Reconstruction of the nipple-areola complex is the culmination of a long road for patients who have suffered breast cancer. The postoperative dressing of the reconstructive nipple must protect it from mechanical forces, trauma, and infection. A broad array of dressings has been used for the reconstructed nipple. The authors propose the use of a readily available adhesive eye protector as a simple and cost-effective dressing for the reconstructed nipple-areola complex.
Theories of Etiopathogenesis of Breast Implant–Associated Anaplastic Large Cell Lymphoma
Authors: Rastogi Pratik , Riordan Edward , Moon David , Deva Anand K.
Published: February 2019

Breast implant–associated anaplastic large cell lymphoma is a malignancy of T lymphocytes that is associated with the use of textured breast implants in both esthetic and reconstructive surgeries. Patients typically present with a delayed seroma 8–10 years following implantation or—less commonly—with a capsular mass or systemic disease. Current theories on disease pathogenesis focus on the interplay among textured implants, Gram-negative bacteria, host genetics, and time. The possible roles of silicone leachables and particles have been less well substantiated. This review aims to synthesize the existing scientific evidence regarding breast implant–associated anaplastic large cell lymphoma etiopathogenesis.
Patient Registry and Outcomes for Breast Implants and Anaplastic Large Cell Lymphoma Etiology and Epidemiology (PROFILE): Initial Report of Findings, 2012–2018
Authors: McCarthy Colleen M. , Loyo-Berríos Nilsa , Qureshi Ali A. , Mullen Erin , Gordillo Gayle , Pusic Andrea L. , Ashar Binita S. , Sommers Katie , Clemens Mark W.
Published: February 2019

Background:

In January of 2011, the US Food and Drug Administration released a safety communication regarding the potential association between breast implants and anaplastic large cell lymphoma (ALCL). In August of 2012, the American Society of Plastic Surgeons, The Plastic Surgery Foundation, and the Food and Drug Administration signed a cooperative research and development agreement to develop a patient registry entitled the “Patient Registry and Outcomes for Breast Implants and Anaplastic Large Cell Lymphoma Etiology and Epidemiology” (PROFILE).

Methods:

The first report of the registry findings is presented here.

Results:

From August of 2012 to March of 2018, a total of 186 distinct cases of breast implant–associated ALCL (BIA-ALCL) in the United States were reported to PROFILE. At the time of this present analysis, complete detailed case report forms have been received for 89 (48%) cases. Median time from implantation of any device to BIA-ALCL diagnosis was 11.0 years (range = 2–44 years; n = 89). At the time of presentation, 96% of cases had local symptoms and 9% had concurrent systemic symptoms. The most common local symptom was a periprosthetic fluid collection seen in 86% of patients. All patients had a history of a textured device; there were no patients who had a smooth-only device history. At the time of initial case report submission, 3 deaths were reported.

Conclusions:

The PROFILE Registry has shown to be an essential tool in unifying the collection of data pertaining to BIA-ALCL. These data have broadened our understanding of the disease and emphasize the critical importance of detailed tracking of BIA-ALCL cases.
Exploratory Investigation of a Brief Cognitive Behavioral Intervention and Transcranial Direct Current Stimulation on Odor Sensitivity
Authors: Houghton David C. , Uhde Thomas W. , Borckardt Jeffrey J. , Cortese Bernadette M.
Published: February 2019

Objective

Enhanced odor sensitivity is a phenomenon that potentially underlies conditions such as multiple chemical sensitivity (MCS). Currently, there are no treatments that have been shown to effectively decrease odor sensitivity. Given similarities of odor hypersensitivity/MCS to pain sensitization disorders such as fibromyalgia, there may be a potential for interventions that improve pain tolerance to modulate odor sensitivity.

Methods

This exploratory study randomized 72 healthy community adult volunteers to receive one of six treatments in between two assessments of thermal pain tolerance and odor threshold. Participants were randomized to receive either cathodal, anodal, or sham transcranial direct current stimulation (tDCS) aimed at dorsolateral prefrontal cortex. In addition, participants were provided a brief cognitive behavioral intervention (CBI) for pain consisting of task framing, cognitive restructuring, and distraction technique training, or a control intervention consisting of information about pain.

Results

Persons who received a brief CBI showed significantly increased odor thresholds (reduced sensitivity) during intervention (F (1,62) = 7.29, p = .009, ηp
2 = .11), whereas the control intervention was not associated with altered odor thresholds. Moreover, in those who received brief CBI, more severe anxiety associated with larger reductions in odor sensitivity (ρ = .364, p = .035). There was no effect of tDCS (F (2,62) = .11, p = .90) nor interaction between tDCS and CBI (F (2,62) = .32, p = .73).

Conclusions

Given the connection between anxiety and MCS, results suggest that CBT techniques for somatic processes may show promise in treating conditions characterized by increased sensitivity to odors (e.g., MCS).
A Mixed-Method Study of Practitioners' Perspectives on Issues Related to EHR Medication Reconciliation at a Health System
Authors: Rangachari Pavani , Dellsperger Kevin C. , Fallaw David , Davis Ian , Sumner Michael , Ray Walter , Fiedler Shashana , Nguyen Tran , Rethemeyer R. Karl
Published: February 2019

Background:

In an effort to reduce medication discrepancies during transitions of care and improve accuracy of the patient's medication list, AU Health conducted a study to identify a comprehensive set of issues related to electronic health record (EHR) medication reconciliation (MedRec) from the perspective of practitioners directly involved in the EHR MedRec process.

Methods:

An exploratory mixed-method design was used. The 2-round study included 15 individual interviews, followed by a survey of 200 practitioners (ie, physicians, nurses, and pharmacists) based in the outpatient and inpatient medicine service at AU Health.

Results:

Thematic analysis of interview data identified 55 issue items related to EHR MedRec under 9 issue categories. The survey sought practitioners' importance rating of all issue items identified from interviews. A total of 127 (63%) survey responses were received. Factor analysis served to validate the following 6 of the 9 issue categories, all of which were rated “important” or higher (on average), by over 70% of all respondents: (1) care coordination (CCI); (2) patient education (PEI); (3) ownership and accountability (OAI); (4) processes-of-care (PCI); (5) IT-related (ITRI); and (6) workforce training (WTI). Significance testing of importance rating by professional affiliation revealed no statistically significant differences for CCI and PEI, and some statistically significant differences for OAI, PCI, ITRI, and WTI.

Conclusion:

There were 2 key gleanings from the issues related to EHR MedRec unearthed by this study: (1) there was an absence of shared understanding among practitioners, of the value of EHR MedRec in promoting patient safety, which contributed to workarounds, and suboptimal use of the EHR MedRec system; and (2) there was a sociotechnical dimension to many of the issues, creating an added layer of complexity. These gleanings, in turn, provide insights into best practices for managing both (1) clinical transitions of care in the EHR MedRec process and (2) sociotechnical challenges encountered in EHR MedRec implementation.
Evaluation of Adaptive Statistical Iterative Reconstruction-V Reconstruction Algorithm vs Filtered Back Projection in the Detection of Hypodense Liver Lesions: Reader Performance and Preferences
Authors: Dimmitt Amanda M. , Pelz Jessica A. , Albertson Megan E. , Samson Kaeli K. , Muinov Lyudmila M. , Oliveto Jennifer M. , Hansen Neil J.
Published: February 2019

Objective

The aim of the study was to evaluate diagnostic accuracy and readers' experience in the detection of focal liver lesions on computed tomography with Adaptive Statistical Iterative Reconstruction-V (ASIR-V) reconstruction compared with filtered back projection (FBP) scans.

Methods

Fifty-five patients with liver lesions had FBP and ASIR-V scans. Two radiologists independently reviewed both sets of computed tomography scans, identifying and characterizing liver lesions.

Results

Adaptive Statistical Iterative Reconstruction-V scans had a reduction in dose length product (P < 0.0001) with no difference in image contrast (P = 0.1805); image noise was less for the ASIR-V scans (P < 0.0001) and contrast-to-noise ratio was better for ASIR-V (P = 0.0002). Both readers found more hypodense liver lesions on the FBP (P = 0.01) scans. Multiple subjective imaging scores were significantly less for the ASIR-V scans for both readers.

Conclusions

Although ASIR-V scans were objectively better, our readers performed worse in lesion detection on them, suggesting a need for better education/experience with this technology during implementation.