bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Cannabis Use in Suicidal Ideation Among Patients With Opioid Use Disorder
Authors: Naji Leen , Rosic Tea , Sanger Nitika , Dennis Brittany , Worster Andrew , Paul James , Thabane Lehana , Samaan Zainab
Published: December 2020

Objectives:

Cannabis use is associated with suicide risk in the general population; however, it is unknown if this association is also present in patients with opioid use disorder (OUD). The purpose of this study is to investigate the association between cannabis use and suicidal ideation in patients with OUD.

Methods:

We conducted a multivariable logistic regression analysis to assess the association between cannabis use and suicidal ideation, amongst a large cohort of patients with OUD. Current cannabis use and suicidal ideation over the past 30 days were obtained by self-report.

Results:

Cross-sectional data from 2335 participants with OUD were included in the analysis, of whom 51% report current cannabis use. We found a positive association between cannabis use and suicidal ideation (OR = 1.41, 95% CI 1.11, 1.80, P = 0.005). We found that men (OR = 1.84, 95% CI 1.44, 2.35, P < 0.001), younger individuals (OR = 1.02, 95% CI 1.01, 1.03), P = 0.004), and that those with more symptoms of anxiety or depression (OR = 1.16, 95% CI 1.15, 1.18, P < 0.001) were more likely to report suicidal ideation.

Conclusions:

Cannabis use is associated with a heightened propensity for suicidal ideation amongst patients with OUD, who are already a high-risk population. Further research into the potential harms of cannabis use in this population is required given the prevalence of its use and potential benefits in mitigating opioid withdrawal.
Clinical Efficacy of Pulsed Radiofrequency Treatment Targeting the Mid-cervical Medial Branches for Intractable Cervicogenic Headache
Authors: Park Mu Seung , Choi Hyuk Jai , Yang Jin Seo , Jeon Jin Pyeong , Kang Suk Hyung , Cho Yong Jun
Published: December 2020

Objective:

Cervicogenic headache has been known to originate from the convergence of the upper 3 cervical and trigeminal afferents. The administration of conservative treatments, interventional procedures, and more recently, pulsed radiofrequency, has been used to relieve cervicogenic headache. In this study, the authors evaluated the clinical efficacy and safety of pulsed radiofrequency targeting the mid-cervical medial branches.

Materials and Methods:

From September 2012 until December 2017, 395 patients were diagnosed with cervicogenic headache based on the third edition of the International Classification of Headache Disorders. The authors treated them conservatively at first, and those patients with nonresolution of pain were treated with mid-cervical medial branches block applied from C3 to C5 twice. Subsequently, if any patient continued to experience persistent pain, the authors classified them as having intractable cervicogenic headache and performed pulsed radiofrequency treatment targeting the mid-cervical medial branches from C3 to C5 bilaterally. The authors analyzed their demographics and used a Visual Analogue Scale to assess their pain for 12 months.

Results:

Fifty-seven patients were enrolled in this study. The mean age was 49.8 years, and the mean duration of symptoms was 47.7 months. The mean Visual Analogue Scale score was 6.21 before pulsed radiofrequency treatment, and it improved to 1.54 immediately after the procedure without the symptoms recurring for a minimum of 12 months. There were no severe complications, such as vascular or nerve injuries.

Conclusions:

In patients with intractable cervicogenic headache, pulsed radiofrequency treatment targeting the mid-cervical medial branches resulted in a satisfactory, long-lasting outcome without serious complications.
Biomechanical Contributions of Spinal Structures with Different Degrees of Disc Degeneration
Authors: Cornaz Frédéric , Widmer Jonas , Farshad-Amacker Nadja A. , Spirig José Miguel , Snedeker Jess G. , Farshad Mazda
Published: December 2020

Study Design.

Biomechanical cadaveric study.

Objective.

The aim of this study was to evaluate the effect of degeneration on biomechanical properties of the passive structures of the lumbar spine.

Summary of Background Data.

Although the load apportionment among the passive structures in healthy spines follows well-defined contribution patterns, it remains unknown how this load distribution and sagittal preload changes by degenerative processes of the intervertebral disc (IVD).

Methods.

Fifty lumbar spinal segments were tested in a displacement-controlled stepwise reduction study in flexion, extension, axial rotation, lateral bending, anterior, posterior and lateral shear. The intertransverse ligaments (ITLs), supraspinous and interspinous ligaments (ISL&SSL), facet joint capsules (FJC), facet joints (FJ), ligamentum flavum (LF), posterior longitudinal ligament (PLL), anterior longitudinal ligament (ALL), and spondylophytes were subsequently reduced. The results were set in relation to IVD-degeneration, quantified with Pfirrmann classification.

Results.

In flexion, a load redistribution from LF (−28% n.s.) and PLL (−13% n.s.) towards the IVD (+9%, n.s.) is observed comparing grade 2 to 5 IVD degeneration, whereas in all other loading directions, a reduction of IVD-contribution from −12% to −53% is recorded. In axial rotation, anterior and lateral shear, more load is shared by the FJ (+4% n.s., +23% ∗, +13% n.s.). The preload of the ALL, LF, PLL, and IVD is reduced ranging from −0.06 Nm to −0.37 Nm.

Conclusion.

IVD degeneration is related to notable load-redistributions between the passive spinal structures. With further degeneration, reduced contribution of the LF and PLL and higher loads on the IVD are observed in flexion. In the other tested loading directions, the relative load on the IVD is reduced, whereas higher FJ-exposure in axial rotation, anterior and lateral shear is observed. Furthermore, the preload of the spinal structures is reduced. These observations can further the understanding of the degenerative cascade in the spine.

Level of Evidence: N/A
An Analysis of Eating Disorders in Adolescent Idiopathic Scoliosis: A Prospective Cross-sectional Study in a Female Population
Authors: Cantele Francesca , Maghini Irene , Tonellato Michele , Meneguzzo Paolo , Favaro Angela , Masiero Stefano
Published: December 2020

Study Design.

Prospective cross-sectional study.

Objective.

We designed this study to investigate whether adolescent girls with idiopathic scoliosis show a predisposition for eating disorders (EDs) and alterations of the quality of life and body image self-perception, compared to same-age healthy females.

Summary of Background Data.

Idiopathic scoliosis is the most common spinal deformity of adolescence. Recent findings about the impairment of the self-body image in adolescents with idiopathic scoliosis provide a common trait of scoliosis and EDs and could lead to the suspicion of an association between these two pathological conditions. Despite this, current literature shows the lack of evident results about the impact of adolescent idiopathic scoliosis (AIS) on the possibility to develop of EDs.

Methods.

One hundred forty-four females with diagnosis of AIS (aged 10–18 years) formed the scoliosis group. One hundred forty-six same-age healthy girls were enrolled in the control group. For all subjects, we considered sport practice. Only for Scoliosis Group, we also considered the severity of scoliosis, the use of brace and the practice of physiotherapy scoliosis-specific exercises. The participants were asked to answer to the Scoliosis Research Society-22 revised Patient Questionnaire (SRS-22r) and the Eating Disorders Inventory (EDI).

Results.

In the scoliosis group, significantly lower scores on the SRS-22r total and in the self-image domain were detected. The two groups showed differences in the total EDI score and in the body dissatisfaction EDI's domain. Severity of scoliosis was correlated with worse SRS-22r total score and SRS-22r self-image domain score. There were no differences in the scores of the SRS-22r and EDI between braced and nonbraced subjects. Lower scores in SRS-22r total and self-image domain were found in girls who practiced physiotherapy exercises. Subjects who practiced a sport showed higher SRS-22r total scores.

Conclusion.

The AIS cohort in our study demonstrated lower levels of eating psychopathology than healthy controls. Surprisingly, eating behavior does not seem to be affected by orthotic management. However, quality of life and self-body image could be impaired in scoliotic girls, especially when they practice physiotherapy exercises, whereas those who practice sport seem to be preserved in this regard.

Level of Evidence: 4
Characteristics and Trends of the Most Cited Spine Publications
Authors: Donnally Chester J. , Lugo-Pico Julian G. , Bondar Kevin J. , Chen Clark J. , McCormick Johnathon R. , Errico Thomas J.
Published: December 2020

Study Design.

Bibliometric literature review.

Objective.

The aim of this study was to recognize and analyze the most frequently cited manuscripts published in the journal Spine.

Summary of Background Data.

Although the journal Spine is considered a premiere location for distributing influential spine research, no previous study has evaluated which of their publications have had the most impact. Knowledge and appreciation of the most influential Spine publications can guide and inspire future research endeavors.

Methods.

Using the Scopus database, the 100 most cited articles published in Spine were accessed. The frequency of citations, year of publication, country of origin, level-of-evidence (LOE), article type, and contributing authors/institutions were recorded. The 10 most cited articles (per year) from the past decade were also determined.

Results.

“Guidelines For The Process Of Cross-Cultural Adaptation Of Self-Report Measures” by Beaton DE was the most cited article with 2960 citations. 2000 to 2009 (n = 46) was the most productive period. A LOE of III (n = 35) followed by II (n = 34) were the most common. Deyo RA (n = 8), Bombardier C (n = 6), and Waddell G (n = 6) produced the most articles. University of Washington (n = 8) and University of Toronto (n = 8) ranked first for institutional output. Clinical Outcome (n = 28) was the most recurring article topic. The United States (n = 51) ranked first for country of origin.

Conclusion.

Using citation analysis as an objective proxy for influence, certain publications can be distinguished from others due to their lasting impact and recognition from peers. Of the top cited Spine publications, many pertained to clinical outcomes (28%) and had a LOE of I, II, or III (60%). Although older publications have had longer time to accrue citations, those in the most recent decade comprise this list almost 2:1. Knowledge of these “classic” publications allows for a better overall understanding of the diagnosis, management, and future direction of spine health care.

Level of Evidence: 3
Improvement in SRS-22R Self-Image Correlate Most with Patient Satisfaction after 3-Column Osteotomy
Authors: Gum Jeffrey L. , Shasti Mark , Yeramaneni Samrat , Carreon Leah Y. , Hostin Richard A. , Kelly Michael P. , Lafage Virginie , Smith Justin S. , Passias Peter G. , Kebaish Khaled , Shaffrey Christopher I. , Burton Douglas L. , Ames Christopher P. , Schwab Frank J. , Protopsaltis Themistocles , Bess R. Shay
Published: December 2020

Study Design.

Longitudinal cohort.

Objectives.

The aim of this study was to examine the relationship between patient satisfaction, patient-reported outcome measures (PROMs) and radiographic parameters in adult spine deformity (ASD) patients undergoing three-column osteotomies (3CO).

Summary of Background Data.

Identifying factors that influence patient satisfaction in ASD is important. Evidence suggests Scoliosis Research Society-22R (SRS-22R) Self-Image domain correlates with patient satisfaction in patients with ASD.

Methods.

This is a retrospective review of ASD patients enrolled in a prospective, multicenter database undergoing a 3CO with complete SRS-22R pre-op and minimum 2-years postop. Spearman correlations were used to evaluate associations between the 2-year SRS Satisfaction score and changes in SRS-22R domain scores, Oswestry Disability Index (ODI), and radiographic parameters.

Results.

Of 135 patients eligible for 2-year follow-up, 98 patients (73%) had complete pre- and 2-year postop data. The cohort was mostly female (69%) with mean BMI of 29.7 kg/m2 and age of 61.0 years. Mean levels fused was 12.9 with estimated blood loss of 2695 cc and OR time of 407 minutes; 27% were revision surgeries. There was a statistically significant improvement between pre- and 2-year post-op PROMs and all radiographic parameters except Coronal Vertical Axis. The majority of patients had an SRS Satisfaction score of ≥3.0 (90%) or ≥4.0 (68%), consistent with a moderate ceiling effect. Correlations of patient satisfaction was significant for Pain (0.43, P < 0.001), Activity (0.39, P < 0.001), Mental (0.38, P = 0.001) Self-Image (0.52, P < 0.001). ODI and Short-Form-36 Physical component summary had a moderate correlation as well, with mental component summary being weak. There was no statistically significant correlation between any radiographic or operative parameters and patient satisfaction.

Conclusion.

There was statistically significant improvement in all PROMs and radiographic parameters, except coronal vertical axis at 2 years in ASD patients undergoing 3CO. Improvement in SRS Self-Image domain has the strongest correlation with patient satisfaction.

Level of Evidence: 3
Coronavirus Disease 2019 Calls for Predictive Analytics Monitoring—A New Kind of Illness Scoring System
Authors: Davis John P. , Wessells Dustin A. , Moorman J. Randall
Published: December 2020

Coronavirus disease 2019 can lead to sudden and severe respiratory failure that mandates endotracheal intubation, a procedure much more safely performed under elective rather than emergency conditions. Early warning of rising risk of this event could benefit both patients and healthcare providers by reducing the high risk of emergency intubation. Current illness severity scoring systems, which usually update only when clinicians measure vital signs or laboratory values, are poorly suited for early detection of this kind of rapid clinical deterioration. We propose that continuous predictive analytics monitoring, a new approach to bedside management, is more useful. The principles of this new practice anchor in analysis of continuous bedside monitoring data, training models on diagnosis-specific paths of deterioration using clinician-identified events, and continuous display of trends in risks rather than alerts when arbitrary thresholds are exceeded.
Efficacy of Early Prophylaxis Against Catheter-Associated Thrombosis in Critically Ill Children: A Bayesian Phase 2b Randomized Clinical Trial*
Authors: Faustino E. Vincent S. , Shabanova Veronika , Raffini Leslie J. , Kandil Sarah B. , Li Simon , Pinto Matthew G. , Cholette Jill M. , Hanson Sheila J. , Nellis Marianne E. , Silva Cicero T. , Chima Ranjit , Sharathkumar Anjali , Thomas Kimberly A. , McPartland Tara , Tala Joana A. , Spinella Philip C.
Published: December 2020

OBJECTIVES:

We obtained preliminary evidence on the efficacy of early prophylaxis on the risk of central venous catheter-associated deep venous thrombosis and its effect on thrombin generation in critically ill children.

DESIGN:

Bayesian phase 2b randomized clinical trial.

SETTING:

Seven PICUs.

PATIENTS:

Children less than 18 years old with a newly inserted central venous catheter and at low risk of bleeding.

Intervention:

Enoxaparin adjusted to anti-Xa level of 0.2–0.5 international units/mL started at less than 24 hours after insertion of central venous catheter (enoxaparin arm) versus usual care without placebo (usual care arm).

MEASUREMENTS AND MAIN RESULTS:

At the interim analysis, the proportion of central venous catheter-associated deep venous thrombosis on ultrasonography in the usual care arm, which was 54.2% of 24 children, was significantly higher than that previously reported. This resulted in misspecification of the preapproved Bayesian analysis, reversal of direction of treatment effect, and early termination of the randomized clinical trial. Nevertheless, with 30.4% of 23 children with central venous catheter-associated deep venous thrombosis on ultrasonography in the enoxaparin arm, risk ratio of central venous catheter-associated deep venous thrombosis was 0.55 (95% credible interval, 0.24–1.11). Including children without ultrasonography, clinically relevant central venous catheter-associated deep venous thrombosis developed in one of 27 children (3.7%) in the enoxaparin arm and seven of 24 (29.2%) in the usual care arm (p = 0.02). Clinically relevant bleeding developed in one child randomized to the enoxaparin arm. Response profile of endogenous thrombin potential, a measure of thrombin generation, was not statistically different between trial arms.

CONCLUSIONS:

These findings suggest the efficacy and safety of early prophylaxis that should be validated in a pivotal randomized clinical trial.
Dermal Filler Injections in Patients With Autoimmune and Inflammatory Rheumatic Diseases—The Patients' Perspective
Authors: Koren Amir , Sarbagil-Maman Hagit , Litinsky Irina , Furer Victoria , Artzi Ofir
Published: December 2020

BACKGROUND

Injecting dermal fillers in patients with autoimmune inflammatory rheumatic diseases (AIIRDs) is controversial.

OBJECTIVE

To evaluate the attitudes of patients with AIIRDs regarding the use of dermal fillers and the side effects of those who underwent them.

METHODS

Patients with AIIRDs who attended a rheumatology outpatient clinic between 2016 and 2018 filled in a questionnaire about their attitudes toward dermal filler injections. The questionnaire evaluated information received from professionals and the factors that influenced their decision of whether or not to undergo the procedures.

RESULTS

Overall, 194 patients with AIIRDs (mean age 56.5 ± 14.0, 99% women) responded. Forty-two of them had previously undergone the injections and intended to repeat them (Group A), 37 had not received filler injections but intended to do so (Group B), and 114 who had never undergone them did not intend to undergo them. The major motivation for undergoing filler injections was social. Patients treated with dermal fillers refrained from informing their rheumatologist about their injections. They were, however, highly satisfied with the procedure and reported negligible side effects.

CONCLUSION

The use of dermal fillers was apparently safe and well received by patients with AIIRDs. Physicians' recommendations to refrain from injecting them with dermal fillers should be reconsidered and evaluated in clinical studies.
Inference of Naturally Acquired Immunity Using a Self-matched Negative-Control Design
Authors: Northrup Graham R. , Qian Lei , Bruxvoort Katia , Marx Florian M. , Whittles Lilith K. , Lewnard Joseph A.
Published: December 2020

Host adaptive immune responses may protect against infection or disease when a pathogen is repeatedly encountered. The hazard ratio of infection or disease, given previous infection, is typically sought to estimate the strength of protective immunity. However, variation in individual exposure or susceptibility to infection may introduce frailty bias, whereby a tendency for infections to recur among individuals with greater risk confounds the causal association between previous infection and susceptibility. We introduce a self-matched “case-only” inference method to control for unmeasured individual heterogeneity, making use of negative-control endpoints not attributable to the pathogen of interest. To control for confounding, this method compares event times for endpoints due to the pathogen of interest and negative-control endpoints during counterfactual risk periods, defined according to individuals’ infection history. We derive a standard Mantel-Haenszel (matched) odds ratio conveying the effect of prior infection on time to recurrence. We compare performance of this approach to several proportional hazards modeling frameworks and estimate statistical power of the proposed strategy under various conditions. In an example application, we use the proposed method to reestimate naturally acquired protection against rotavirus gastroenteritis using data from previously published cohort studies. This self-matched negative-control design may present a flexible alternative to existing approaches for analyzing naturally acquired immunity, as well as other exposures affecting the distribution of recurrent event times.
Safety and Efficacy of Pharmaco-invasive Approach Using Streptokinase Compared With Primary Percutaneous Coronary Angiography
Authors: Sultan El-Zahraa M. , Elberry Ahmed A. , Rabea Hoda , Mahmoud Hesham B.
Published: December 2020

Background:

Fibrin-specific fibrinolytics are preferred when they used in STEMI patients (pharmaco-invasive approach). However, streptokinase is still the most common used thrombolytic agent in Egypt because of its cheaper cost.

Methods:

266 STEMI patients were randomly assigned to undergo PPCI or pharmacoinvasive (using streptokinase). Primary end point (death, shock, congestive heart failure, or reinfarction up to 30 d) and secondary end point (ischemic stroke, intracranial hemorrhage, or nonintracranial bleeding) were followed for 30 days after reperfusion. In pharmaco-invasive arm, urgent coronary angiography was performed in case of failed reperfusion. Based on the reperfusion time from symptoms onset, patients in both arms were divided into; early (≤3 hrs) and late reperfusion (>3 hrs).

Results:

No statistical significant difference regarding left ventricular ejection fraction, end diastolic and end systolic diameter in both arms. Early PPCI (≤3 hrs) had highest ejection fraction values (56.9 ± 7.5). Myocardial wall preservation was best achieved in early pharmaco-invasive (≤3 hrs).There was no statistical significant difference in TIMI flow results between all subgroups (early and late of both arms) (P = 0.750). Suction devices and IV Eptifibatide were less frequently used in the pharmaco-invasive comparing to PPCI arm; (P = 0.000 and P = 0.006) subsequently. No statistical significant difference regarding complication incidence in both arms (P = 0.518). Radial access was more commonly used in the pharmaco-invasive arm (P = 0.015).

Conclusion:

Utilizing streptokinase in early re-perfused patients by PI approach (≤3 hrs) seems safe and efficient when PPCI delay (>120 min from symptom onset) is the other option.
New Freeware for Image Analysis of Lissamine Green Conjunctival Staining
Authors: Courrier Emilie , Renault Didier , Dib Elian , Urrea Caroline , Kaspi Mathilde , Fournier Corinne , Lépine Thierry , Chiambaretta Frédéric , Hor Guillaume , He Zhiguo , Garcin Thibaud , Thuret Gilles , Gain Philippe
Published: December 2020

Purpose:

Lissamine green (LG) is often used in addition to fluorescein to assess the severity of conjunctival damage in dry eye syndrome, which is graded manually. Our purpose was to describe an algorithm designed for image analysis of LG conjunctival staining.

Methods:

Twenty pictures of patients suffering from dry eye with visible LG conjunctival staining were selected. The images were taken by 2 different digital slit lamps with a white light source and a red filter transmitting over the wavelengths absorbed by LG. Conjunctival staining appeared in black on a red background. The red channel was extracted from the original image. Stained areas were then detected using a Laplacian of Gaussian filter and applying a threshold whose value was determined manually on a subset of images. The same algorithm parameters remained constant thereafter. LG-stained areas were also drawn manually by 2 experts as a reference.

Results:

The delineation obtained by the algorithm closely matched the actual contours of the punctate dots. In 19 cases of 20 (95%), the algorithm found the same Oxford grade as the experts, even for confluent staining that was detected as a multitude of dots by the algorithm but not by the experts, resulting in a high overestimation of the total number of dots (without mismatching the Oxford grade estimated by the experts). The results were similar for the 2 slit-lamp imaging systems.

Conclusions:

This efficient new image-analysis algorithm yields results consistent with subjective grading and may offer advantages of automation and scalability in clinical trials.
Use of Telepresence Robots in Glaucoma Patient Education
Authors: Ooms Ashley , Shaikh Ibraheem , Patel Nishant , Kardashian-Sieger Thomas , Srinivasan Nivetha , Zhou Benjamin , Wilson Logan , Szirth Bernard , Khouri Albert S.
Published: December 2020

Précis:

Telepresence robots (TR) present the versatility to effectively provide remote educational sessions for patients affected by glaucoma to improve disease knowledge. Given COVID-19’s effect on clinical practice, TR can maintain social distancing when educating patients.

Purpose:

TR are devices that allow remote users to have a mobile presence anywhere. We compared the effect of an education session given by an in-person educator versus a TR on glaucoma knowledge and identified factors that impact patient education.

Methods:

Eighty-five glaucoma patients were split into control, human, and TR groups. We measured glaucoma knowledge scores (KS) using the National Eye Institute’s Eye-Q Test. Human and TR groups had the education session with a human or TR followed by the questionnaire. The control group was administered the questionnaire without an education session. Treatment regimen recall (RR) >90% was considered a success. We used linear regression and binary logistic regression to determine variables that affect KS and RR, respectively.

Results:

Mean age was 58.3±2.8 years. 49% were female. Mean KS were 5.8±0.7 in the control group (n=31), 7.9±0.5 in the TR group (n=26), and 8.4±0.5 in the human group (n=28). Control participants had a lower mean KS than the human or TR groups (P<0.001). Having the education session (2.5, P<0.001), education greater than high school (0.8, P=0.016), and diabetes (−0.7, P=0.037) affected KS. Having diabetes (odds ratio=0.14, P=0.014) negatively affected RR. Having the education session may affect RR (odds ratio=5.47, P=0.07), warranting additional studies.

Conclusions:

Education sessions with a human and TR improved patients’ glaucoma KS. TRs may serve as an alternative to in-person education sessions and allow educators to safely and effectively educate patients remotely to adhere to COVID-19 social distancing guidelines.
IFSI-guideline on chronic prurigo including prurigo nodularis
Authors: Ständer Sonja , Pereira Manuel P. , Berger Timothy , Zeidler Claudia , Augustin Matthias , Bobko Svetlana , Brenaut Emilie , Chen Suephy C. , Chisolm Sarah , Dalgard Florence J. , Elberling Jesper , Elmariah Sarina B. , Evers Andrea W.M. , Garcovich Simone , Gonçalo Margarida , Halvorsen Jon A. , Kim Brian S. , Kupfer Jörg , Lambert Julien , Legat Franz J. , Lerner Ethan A. , Leslie Tabi A. , Lönndahl Louise , Lvov Andrey , Metz Martin , Misery Laurent , Papadavid Evangelia , Potekaev Nikolay N. , Reich Adam , Savk Ekin , Schneider Gudrun , Schut Christina , Serra-Baldrich Esther , Ständer Hartmut F. , Streit Markus , Szepietowski Jacek C. , Tharp Michael D. , Wallengren Joanna , Nast Alexander , Weisshaar Elke , Yosipovitch Gil
Published: December 2020

Chronic prurigo (CPG) is a highly burdensome pruritic disease characterized by chronic itch, a prolonged scratching behavior and the development of localized or generalized hyperkeratotic pruriginous lesions. Neuronal sensitization and the development of an itch-scratch cycle contribute to the augmentation of pruritus and the chronicity of the disease. We provide here the first international guideline for a rational diagnostic and therapeutic approach for CPG. Recommendations are based on available evidence and expert opinion. The diagnosis of CPG is made clinically. A detailed medical history together with laboratory and radiological examinations are advised in order to determine the severity of CPG, identify the underlying origin of the itch and assist in the elaboration of a treatment plan. Therapeutically, it is advised to adopt a multimodal approach, including general strategies to control itch, treatment of the underlying pruritic conditions, and of the pruriginous lesions. Topical (corticosteroids, calcineurin inhibitors, capsaicin) and systemic antipruritic agents (eg, gabapentinoids, immunosuppressants, and opioid modulators) as well as physical treatment modalities (phototherapy, cryotherapy) should be employed in a step-wise approach. Psychosomatic or psychological interventions may be recommended in CPG patients with signs of psychiatric/psychological comorbidities.
Association between the clinical and demographic characteristics of patients undergoing cataract surgery and their prevalence of conjunctival bacteria
Authors: Fernández-Rubio María-Elisa , Urcelay-Segura José-Luis , Bellón-Cano José-María , Cuesta-Rodríguez Teresa
Published: December 2020

Purpose:

To identify characteristics of patients undergoing cataract surgery associated with pathogenic and antibiotic-resistant conjunctival bacteria.

Setting:

Spanish tertiary hospital.

Design:

Retrospective cross-sectional study.

Methods:

Records of consecutive patients undergoing cataract surgery between July 2005 and September 2014, contained data on patient characteristics and conjunctival bacteria systematically identified with preoperative tests and anesthetic evaluation. A multivariate logistic regression associated 12 bacterial groups with every category of 17 characteristics. Odds ratio (OR), 95% CIs expressed colonization risk.

Results:

In 14883 patients, categories associated with pathogenic bacteria were age older than 79 years with nonfermentative gram-negative bacilli (NFGNB) (OR 1.74, 1.12-2.71), enterococci (OR 1.90, 1.36-2.65), Enterobacteriaceae (OR 2.17, 1.65-2.87), and Staphylococcus aureus (OR 1.37, 1.16-1.62); obesity with S aureus (OR 1.52, 1.30-1.78), enterococci (OR 1.99, 1.47-2.68), and Enterobacteriaceae (OR 2.17, 1.70-2.77); dacryocystorhinostomy history with S aureus (OR 1.90, 1.48-2.44), Haemophilus spp. (OR 2.06, 1.37-3.11), Streptococcus pneumoniae (OR 3.14, 2.14-4.62), NFGNB (OR 2.23, 1.28-3.88), and enterococci (OR 1.80, 1.16-1.81); diabetes with S aureus (OR 1.27, 1.13-1.44), enterococci (OR 1.49, 1.19-1.87), and Enterobacteriaceae (OR 1.27, 1.04-1.54); smoking habit with Enterobacteriaceae (OR 2.11, 1.56-2.86); autumn with NFGNB (OR 2.0, 1.35-3.0); hot weather with S aureus (OR 1.23, 1.03-1.47); and lung, renal, and some heart insufficiencies with S aureus. Other staphylococci, highly antibiotic-resistant, were associated with old age, obesity, and hot weather.

Conclusions:

Old age, obesity, diabetes, dacryocystorhinostomy history, smoking habit, and autumn and summer seasons increased the prevalence of enterococci, staphylococci, Enterobacteriaceae, and/or NFGNB. Obesity and humid-warm weather are key for choosing a cataract surgery prophylaxis.
Guideline Adherence of Monitoring Antipsychotic Use for Nonpsychotic Indications in Children and Adolescents
Authors: Dinnissen Mariken , Dietrich Andrea , van der Molen Judith H. , Verhallen Anne M. , Buiteveld Ynske , Jongejan Suzanne , Troost Pieter W. , Buitelaar Jan K. , van den Hoofdakker Barbara J. , Hoekstra Pieter J.
Published: December 2020

Background

Antipsychotics are frequently prescribed to children and adolescents for nonpsychotic indications. Guidelines recommend regularly assessing treatment response and adverse effects and the ongoing need for their use. We aimed to assess adherence to recommendations of available guidelines regarding monitoring antipsychotic use and to test the influence of children's age, sex, intelligence quotient, and diagnosis on adherence.

Methods

We reviewed 426 medical records from 26 centers within 3 large Dutch child and adolescent psychiatry organizations, excluding children with schizophrenia, psychosis, mania, or an intelligence quotient below 70. We investigated whether there was regular assessment of treatment response, adverse events (physical and laboratory), and at least annual discussion of the need of continued use.

Results

On average, treatment response was assessed in 69.3% of the recommended treatment periods, height in 25.6%, weight in 30.6%, blood pressure in 20.6%, evaluation of adverse events in 19.4%, and cardiometabolic measures in 13.7%; discontinuation and/or continued need was discussed at least annually in 36.2%. Extrapyramidal and prolactin-related adverse effects, waist circumference, glucose, and lipids were rarely investigated. Higher age was associated with lower rates of assessment of treatment response. Most antipsychotics were prescribed long-term. In those children with sufficient documentation of the course of treatment, 57.7% was still using an antipsychotic 3 years after initiation.

Conclusions

Our findings indicate insufficient adherence to guideline recommendations for monitoring antipsychotic use in children and adolescents, as well as long duration of use in the majority of children. Especially, older children are at higher risk of receiving suboptimal care.
Subject Matter Experts Identify Health Equity Concerns in Breastfeeding for African American Women
Authors: Hinson Tyonne D. , Skinner Asheley Cockrell , Spatz Diane L.
Published: December 2020

Although the rate of breastfeeding initiation in the United States has continued to rise since 1972, African American mothers continue to experience a significant disparity in initiation. The aim of this study was to explore the perceptions of the facilitators and barriers of breastfeeding initiation among African American mothers from the perspective of subject matter experts (SMEs). This study was part of a larger study that also involved focus group methodology with African American women. The purpose of this article is to describe the opinions, knowledge, and perceptions of SMEs who work with African American mothers. A semistructured interview guide was used to interview 7 SMEs at which point no new themes emerged from the data. SMEs highlighted the significance of modifiable factors in breastfeeding initiation decisions and validated many perceptions of African American mothers. SMEs identified many critical issues foundational to community perspective and shaping future success in raising breastfeeding initiation rates. To increase breastfeeding initiation rates among African American mothers, strategies beyond the individual level are necessary. SMEs recognize the importance of addressing fundamental issues related to historical perspectives, normalization, education, and disparities in breastfeeding as critical.
The Feasibility of Magnetic Resonance Imaging for the Differentiation of Cerebrospinal Fluid Leak From Middle Ear Effusion: A Quantitative Analysis
Authors: Raghavan Arun M. , Breen Joseph T.
Published: December 2020

Objective:

Assess quantitatively whether magnetic resonance imaging (MRI) signal intensity can be used to distinguish cerebrospinal fluid (CSF) leaks in the temporal bone from middle ear effusions.

Study Design:

Retrospective case review.

Setting:

Tertiary referral center.

Patients:

Forty-nine patients, 18 with middle ear effusions (MEE), 30 with CSF leaks, and 1 with an MEE on one side and a CSF leak on the other, were evaluated in the study. Primary inclusion criteria for CSF leak patients were operative management of CSF leak with confirmatory diagnosis in follow-up. Primary inclusion criteria for MEE patients were electronic medical record documentation of an effusion with subsequent resolution on follow-up. For all patients, inclusion criteria included MRI imaging with 3D-T2 weighted sequences (3DT2) and fluid-attenuated inversion recovery (FLAIR) sequences performed within 1 year of diagnosis code entry.

Intervention:

Computational analysis of signal intensity of fluid collections in MRI imaging.

Main Outcome Measures:

Sensitivity and specificity of 3DT2 and FLAIR signal intensity in the detection of CSF leak.

Results:

For 3DT2 sequences with a chosen normalized signal intensity threshold (CSF leak if ≥ 0.5), sensitivity was 100% (95% CI: 86.3–100) and specificity was 83.3% (95% CI: 51.6–97.9). For FLAIR sequences with a threshold of 1.0 (CSF leak if < 1.0), sensitivity was 77.4% (95% CI: 58.9–90.4) and specificity was 85.7% (95% CI: 63.6–97.0). For a combined test in which a fluid collection was considered CSF if both 3DT2 ≥ 0.5 and FLAIR < 1.0, sensitivity was 76% (95% CI: 54.9–90.6) and specificity was 100% (95% CI: 73.5–100).
Prevalence of Depression and Anxiety in Adolescents With Hearing Loss
Authors: Cejas Ivette , Coto Jennifer , Sanchez Chrisanda , Holcomb Meredith , Lorenzo Nicole E.
Published: December 2020

Objective:

To develop and implement a universal screening protocol for depression and anxiety in adolescents serviced in an otology and audiology practice and to estimate the prevalence of depression and anxiety in adolescents with hearing loss, while also comparing rates by degree of hearing loss and type of hearing device used.

Study Design:

Cross-sectional.

Setting:

University tertiary medical center.

Patients:

One hundred four adolescents 12- to 18-years-old who attended an otology clinic in a large metropolitan hospital in the southeastern United States.

Main Outcome Measure:

(s): Depression (PHQ-8), anxiety (GAD-7), degree of hearing loss, type of hearing loss, and type of hearing device utilized.

Results:

Twenty-five percent of adolescents scored above the clinical cutoff on at least one of the depression and/or anxiety measures, with 10% scoring in the elevated range on both measures. Specifically, 17% scored above the cutoff on the PHQ-8 and 16% scored in the clinically significant range for the GAD-7. An additional 30 and 21% scored in the at-risk range for depression and anxiety, respectively. Older adolescents were more likely to score within the elevated range for depression (r = 0.232, p = 0.026). Also, adolescents with severe to profound hearing loss had higher rates of depression and anxiety.

Conclusions:

Integration of mental health screening is needed in otology and audiology practices both to identify those who require psychological support and to provide appropriate treatment to reduce long-term impact of hearing loss on quality of life and mental health functioning in adolescents.
Current Trends and Predictors of Case Outcomes for Malpractice in Colonoscopy in the United States
Authors: Patel Krishan S. , Kothari Pooja , Gantz Owen , Prabhu Arpan , Ayyaswami Varun , Kono Janelle , Ahlawat Sushil
Published: December 2020

Background:

Over 14 million colonoscopies are performed annually, and this procedure remains the largest contributor to malpractice claims against gastroenterologists. The aim of this study was to evaluate reasons for litigation and predictors of case outcomes.

Materials and Methods:

Cases related to colonoscopy were reviewed within the Westlaw legal database. Patient demographics, reasons for litigation, case payouts, and verdicts were assessed. Multivariate regression was used to determine predictors of defendant verdicts.

Results:

A total of 305 cases were included from years 1980 to 2017. Average patient age was 54.9 years (range, 4 to 93) and 52.8% of patients were female. Juries returned defendant and plaintiff verdicts in 51.8% and 25.2% of cases, respectively, and median payout was $995,000. Top reasons for litigation included delay in treatment (65.9%) and diagnosis (65.6%), procedural error (44.3%), and failure to refer (25.6%). Gastroenterologists were defendants in 71% of cases, followed by primary care (32.2%) and surgeons (14.8%). Cases citing informed consent predicted defendant verdict (odds ratio, 4.05; 95% confidence interval, 1.90-9.45) while medication error predicted plaintiff verdict (odds ratio, 0.18; 95% confidence interval, 0.04-0.59). Delay in diagnosis (P=0.060) and failure to refer (P=0.074) trended toward plaintiff verdict but did not reach significance. Most represented states were New York (21.0%), California (13.4%), Pennsylvania (13.1%), Massachusetts (12.5%).

Conclusions:

Malpractice related to colonoscopy remains a significant and has geographic variability. Errors related to sedation predicted plaintiff verdict and may represent a target to reduce litigation. Primary care physicians and surgeons were frequently cited codefendants, underscoring the significance of interdisciplinary care for colonoscopy.
Treatment Satisfaction With Current Medications for Chronic Constipation
Authors: Hayashi Toshihiro , Miwa Hiroto
Published: December 2020

Goals:

This survey aims to determine relevant patient characteristics, treatment satisfaction, and bothersome symptoms in Japanese patients with chronic constipation (CC) treated at medical institutions.

Background:

Epidemiological surveys of Japanese patients with CC are limited.

Study:

This internet survey, conducted in 2017, included 500 adults (selected from 589 respondents to match age composition ratio in Japan) who experienced constipation-like symptoms for ≥6 months, were treated at medical institutions for symptoms, and were taking any prescribed medication.

Results:

Of 500 patients, 65.6% were female and 62.6% had experienced constipation for >10 years. Abdominal bloating, infrequent bowel movement, hard consistency of stool, and difficulty of defecation were the most frequently reported and most bothersome symptoms in males and females. Overall, 29% of patients were satisfied with treatment (36% of males, 26% of females); the individual major CC symptom with the highest level of treatment satisfaction was infrequent bowel movement (31% of total, 45% of males, 26% of females). The level of treatment satisfaction for most individual major CC symptoms was lower in females than in males, and overall treatment satisfaction by therapeutic categories ranged from 16% to 46%. Mean overall treatment satisfaction, as well as mean treatment satisfaction for each major symptom, decreased with increasing number of treatments.

Conclusions:

The survey results suggest that conventional treatment options were not effective enough to improve bothersome symptoms or treatment satisfaction. Treatment selection that is tailored to individual symptoms and takes patient characteristics into consideration may be key to improving patients’ treatment satisfaction.
Moderate‐to‐severe Endoscopic Inflammation is Frequent After Clinical Remission in Pediatric Ulcerative Colitis
Authors: Sarbagili‐Shabat Chen , Weiner Dror , Wardi Joram , Abramas Lee , Yaakov Michal , Levine Arie
Published: December 2020

Objectives:

Pediatric ulcerative colitis (UC) is characterized by low sustained remission rates and frequent extension of disease even if clinical remission is obtained with therapy. Moderate‐to‐severe endoscopic activity is a risk factor for relapse while prospective evidence regarding early mucosal healing or persistence of inflammation after remission in children is not available. Our aim was to evaluate if significant inflammation is common after clinical remission and could explain the high relapse rate in pediatric UC.

Methods:

Pediatric UC patients with clinical remission, defined as pediatric UC activity index (PUCAI) scores <10, were prospectively assessed for mucosal healing by endoscopy 3 to 5 months after remission was documented. Mayo score was assessed for each segment by a blinded adult gastroenterologist using central reading. Symptomatic patients before sigmoidoscopy were excluded. Sustained remission was assessed retrospectively at 18 months follow‐up.

Results:

Forty‐two children were screened, 28 children in continuous clinical remission at time of sigmoidoscopy were included. Mayo 0 was present in 12/28 (42.86%), Mayo 1 in 2/28 (7.1%) and Mayo 2 to 3 in 14/28 (50.0%) endoscopies. Among 23 patients with follow‐up through 18 months, remission was sustained in 6/12 (50.0%) with Mayo score 0 to 1 versus 2/11 (18.18%) of patients with Mayo 2 and 3.

Conclusions:

Over 50% of children assessed for mucosal healing 3 to 5 months after clinical remission is obtained, have endoscopic disease, primarily moderate‐to‐severe Mayo 2 to 3 inflammation, which was associated with lower sustained remission.
Management of Gastrointestinal and Nutritional Problems in Children With Neurological Impairment
Authors: Romano Claudio , Dipasquale Valeria , Van Winckel Myriam , Hulst Jessie , Broekaert Ilse , Bronsky Jiri , Dall'Oglio Luigi , Mis Nataša Fidler , Hojsak Iva , Orel Rok , Papadopoulou Alexandra , Schaeppi Michela , Thapar Nikhil , Wilschanski Michael , Sullivan Peter , Gottrand Frédéric
Published: December 2020

Objectives:

The main aim of this study was to determine the impact on clinical practice of the first European Society of Gastroenterology, Hepatology, and Nutrition (ESPGHAN) position paper on the diagnosis and management of nutritional and gastrointestinal problems in children with neurological impairment (NI).

Methods:

In this pilot‐study, a web‐based questionnaire was distributed between November, 2019 and June, 2020, amongst ESPGHAN members using the ESPGHAN newsletter. Fifteen questions covered the most relevant aspects on nutritional management and gastrointestinal issues of children with NI. A descriptive analysis of responses was performed.

Results:

A total of 150 health professionals from 23 countries responded to the survey. A considerable variation in clinical practice concerning many aspects of nutritional and gastrointestinal management of children with NI was observed. The most frequently used method for diagnosing oropharyngeal dysfunction was the direct observation of meals with or without the use of standardised scores (n = 103). Anthropometric measurements were the most commonly used tools for assessing nutritional status (n = 111). The best treatment for gastroesophageal reflux disease (GERD) was considered to be proton pump inhibitor therapy by most (n = 116) participants. Regarding tube feeding, nearly all respondents (n = 114) agreed that gastrostomy is the best enteral access to be used for long‐term enteral feeding. Fundoplication was indicated at the time of gastrostomy placement especially in case of uncontrolled GERD.

Conclusions:

More studies are required to address open questions on adequate management of children with NI. Identifying knowledge gaps paves the way for developing updated recommendations and improving patient care.
Actinomyces in Forensic Practice
Authors: Olds Kelly L. , Gilbert John D. , Byard Roger W.
Published: December 2020

A 19-year-old woman in septic shock with recent computed tomography findings of a loculated hepatic abscess was transferred to an intensive care unit where she went into asystolic cardiac arrest. After resuscitation, surgical exploration revealed a purulent pericardial effusion with tamponade and a liver abscess. Microbiological analyses from both sites were negative. Shortly after surgical exploration, she developed multiorgan failure and died. At autopsy, pus was observed both within the pericardial cavity and around the left lobe of the liver. Green “sulfur granules” suggestive of infection with Actinomyces spp. were able to be extruded from the liver during the postmortem examination and cultures returned positive for Actinomyces israelii. This case is a rare example of primary hepatic actinomycosis infection that resulted in the death of a young woman. Nonspecific clinical manifestations may delay diagnosis; however, the finding of “sulfur granules” in areas of abscess formation at autopsy should be taken as an indication of possible underlying Actinomyces infection.