bluuebunny/crossref_metadata_2025 huggingface dataset:
DECREASED RETINAL CAPILLARY DENSITY IS ASSOCIATED WITH A HIGHER RISK OF DIABETIC RETINOPATHY IN PATIENTS WITH DIABETES
Authors: Czakó Cecília , Sándor Gábor , Ecsedy Mónika , Récsán Zsuzsa , Horváth Hajnalka , Szepessy Zsuzsanna , Nagy Zoltán Zsolt , Kovács Illés
Published: June 2018

Purpose:

To quantify retinal microvascular alterations using optical coherence tomography angiography in diabetic patients, and to evaluate the accuracy of decreased vessel density (VD) in predicting early diabetic retinopathy (DR).

Methods:

One hundred and two eyes of 51 diabetic patients and 92 eyes of 46 individuals without diabetes were examined. Duration of diabetes, insulin therapy, blood pressure, HbA1C, dyslipidemia, axial length, and the presence of DR were recorded. Retinal VD was measured using optical coherence tomography angiography. The effect of risk factors on VD and on DR was assessed using multivariable regression analyzes.

Results:

Compared with controls, VD was lower in diabetic patients (P < 0.05) and correlated with diabetes duration (P = 0.02). Decreased VD was associated with a higher risk of DR (odds ratio: 1.24, P = 0.009) after controlling for systemic and ocular confounding variables. Eyes with a VD of <50% had an odds ratio of 4.55 (P = 0.003) for DR and an odds ratio of 3.22 (P = 0.03) for decreased visual acuity (<20/25) after controlling for systemic and ocular confounding factors.

Conclusion:

The risk of DR and vision loss is substantially higher in eyes with lower VD, suggesting that optical coherence tomography angiography metrics may serve as prognostic biomarkers for the prediction of early onset DR.
Analysis of SmartPlug Insertion–Related Complications
Authors: Huang Chien-Jung , Lu Chia-Ju , Tu Wen-Hui , Hou Yu-Chih , Wang I-Jong , Hu Fung-Rong , Chen Wei-Li
Published: June 2018

Purpose:

To evaluate the complications and the treatment results of SmartPlug-related complications.

Methods:

Retrospective review of all patients from a single medical hospital who received SmartPlug (Medennium, Inc., Irvine, CA) insertions from October 2007 to February 2014. All patients who developed SmartPlug-related canaliculitis and pyogenic granuloma were analyzed. Lacrimal irrigation with antibiotics was performed in most patients.

Results:

Six hundred thirty-one eyes received SmartPlug insertion and 18 eyes developed SmartPlug-related complications (14 canaliculitis and 4 pyogenic granuloma). The mean time interval from insertion to development of the complications is 3.0 (0.5–6.9) years. Sixteen eyes received lacrimal irrigation with antibiotics, and all the eyes showed improvement without recurrence. The other two eyes had recurrence of granuloma pyogenica only after surgical excision.

Conclusions:

SmartPlug-related complications, including canaliculitis and granuloma pyogenica, required long-term follow-up. Most of the complications can be cured by lacrimal irrigation of antibiotics.
Is Sesamol Effective in Corneal Neovascularization?
Authors: Kaya Hüseyin , Pekel Gökhan , Yörükoğlu Aygün , Hiraali Mehmet Can , Şahin Barbaros
Published: June 2018

Objectives:

To evaluate the effects of topically and subconjunctivally administered sesamol on experimentally induced corneal neovascularization in rats.

Methods:

Fifty-six right eyes of 56 Wistar Albino rats were chemically cauterized to induce corneal neovascularization in this experimental and comparative study. The subjects were divided into eight groups: topical sesamol (group 1), subconjunctival sesamol (group 2), topical bevacizumab (group 3), subconjunctival bevacizumab (group 4), topical bevacizumab+ sesamol (group 5), subconjunctival bevacizumab+ sesamol (group 6), topical Tween 80 (group 7), and control (group 8). The amount of subconjunctivally injected sesamol and bevacizumab was 1.25 mg each. Topical groups were administered 10 mg/mL drops twice daily. The control group was left untreated. To evaluate the degree of corneal neovascularization, digital photographs and corneal sections stained with hematoxylin–eosin and CD31 were used.

Results:

When photographs of neovascularization areas were examined, all treatment groups showed statistically significant differences when compared with the control group (P<0.001). Topical sesamol was found to be more effective when compared with subconjunctival sesamol (P=0.003). Topical sesamol+ bevacizumab was found to be more effective when compared with topical bevacizumab (P=0.018). The numbers of new corneal vessels were as follows: 12.28±6.29 in group 1, 36.85±12.8 in group 2, 18.85±7.71 in group 3, 16.85±8.70 in group 4, 19.57±8.56 in group 5, 22.57±7.43 in group 6, 45.00±11.29 in group 7, and 51.16±5.91 in group 8 (P<0.001).

Conclusions:

The outcomes of this study suggest antiangiogenic effects of sesamol. The use of topical sesamol monotherapy or sesamol combined with bevacizumab may be options for the prevention of corneal neovascularization.
Response of the Aging Eye to First Day of Modern Material Contact Lens Wear
Authors: Lafosse Edouard , Martínez-Albert Noelia , Wolffsohn James S. W. , Cerviño Alejandro , García-Lázaro Santiago
Published: June 2018

Objectives:

To investigate the ocular surface of an aged population wearing a daily disposable contact lens (CL) over their 1st day of wear.

Methods:

Forty eyes from 40 presbyopic subjects were fitted a daily CL (Delefilcon A). Tear osmolarity, tear meniscus area (TMA), and ocular surface aberrations (total higher-order root mean square [RMS]) were assessed at baseline (t0), at 20 min (t1) and after 8 hr (t2) of wear. Fluorescein corneal and conjunctival staining and tear breakup time (TBUT) were performed at t0and t2.

Results:

No statistically significant changes were found between t0, t1, and t2for TMA and between t0and t2for fluorescein corneal and conjunctival staining. Tear breakup time worsened by the end of the day from 10.4±0.4 sec t0to 9.0±0.3 sec t2(P<0.05). Osmolarity showed significant changes between t0306.9±2.3 mOsm/L and t1312.4±2.4 mOsmol/L (P=0.02) but returned to baseline values at 8 hr (310.40±2.26 mOsm/L;P=0.09). Total higher-order RMS showed significant changes between t00.38±0.02 μm and t10.61±0.04 μm (P≤0.001) and between t0and t20.64±0.41 μm (P≤0.001).

Conclusions:

Delefilcon A may induce measures changes (osmolarity and TBUT values) in a presbyopic population; however, TMA and vital staining were maintained at the baseline level over the day.
Polymicrobial Keratitis With Cryptococcus curvatus, Candida parapsilosis, and Stenotrophomonas maltophilia After Penetrating Keratoplasty: A Rare Case Report With Literature Review
Authors: Ting Darren Shu Jeng , Bignardi Giuseppe , Koerner Roland , Irion Luciane D. , Johnson Elizabeth , Morgan Stephen J. , Ghosh Saurabh
Published: June 2018

Objectives:

To report the first case of fungal keratitis caused by Cryptococcus curvatus after penetrating keratoplasty (PK) in an immunocompetent patient and to describe its therapeutic challenge and long-term outcome.

Methods:

An interventional case report.

Results:

A 54-year-old female patient underwent right PK for lattice dystrophy. At 5-year post-PK, she developed a polymicrobial keratitis caused by Candida parapsilosis, and Stenotrophomonas maltophilia at the peripheral graft, which was successfully treated with topical antibiotic and antifungal drops. One year later, another fungal keratitis occurred which apparently resolved with antifungal treatment but recurred in an unusual fashion and required a repeat PK revealing the diagnosis of C. curvatus keratitis. This was confirmed by microbiological culture on Sabouraud dextrose agar, nuclear ribosomal repeat regional sequencing of the D1-D2 and internal transcribed spacer regions, and histopathological examination. Various topical, intracorneal, and systemic antifungal treatments had been attempted but failed to resolve the infection completely, necessitating a subsequent third PK. A further recurrence was noted 16-month post-third PK, which was eradicated with multiple topical and intracorneal antifungal treatment, and direct cryotherapy to the corneal abscess. No further recurrence of C. curvatus was noted at 4-year follow-up.

Conclusions:

Cryptococcus curvatus should be added to the known list of organisms capable of causing fungal keratitis. Our experience suggests that this type of organism could cause low-grade, grumbling infection, which may however be exceptionally difficult to treat. Long-term eradication of this rare fungal keratitis could be potentially achieved by intensive ocular and systemic antifungal treatment, repeat therapeutic keratoplasties, and focal cryotherapy.
Vision Improvement and Compliance With the Use of Orthokeratology Lenses in School Children: A Sample From Five Primary Schools in Northern Taiwan
Authors: Chang Li-Chun , Liao Li-Ling
Published: June 2018

Purpose:

To assess the visual acuity and compliance with the use of orthokeratology lenses (OrthoK) in school children.

Methods:

A retrospective study was conducted to determine the education-related factors influencing the improvement in visual acuity in myopic students using OrthoK in five primary schools in Taiwan.

Results:

Of the 5,173 eligible students from five primary schools, 1906 (36.8%) students were diagnosed with myopia. Among 201 (10.6%) students wearing OrthoK, 69.7% had used them for at least 1 year, 53.2% achieved visual acuity greater than 0.8 (6/7.5, log of minimal angle of resolution 0.1) in school, and 49.8% had received health education related to OrthoK care. Multiple logistic regression analysis showed that a higher possibility to achieve visual acuity greater than 0.8 was associated with more than 1-year use of OrthoK, good compliance, and receiving health education from an ophthalmologist.

Conclusion:

It is important that children wearing OrthoK receive education and comply with the use of OrthoK for visual acuity improvement.
Scleral Lens Issues and Complications Related to a Non-optimal Fitting Relationship Between the Lens and Ocular Surface
Authors: Fadel Daddi
Published: June 2018

Introduction:

The advent of high oxygen permeability (Dk) of rigid contact lens materials has reduced complications related to hypoxia when using scleral contact lenses (ScCLs). However, new issues and complications have emerged. Some of these issues and complications are caused by the nonoptimal fitting relationship with the underlying ocular surface, which may pose a challenge in their management.

Method:

PubMed searches using different keywords and an investigation into the issues and complications etiology were conducted. Detailed guidelines for their management are provided.

Results:

The literature provides a few reports of severe adverse reactions to ScCLs. The most common issues, unique to ScCL wear, have been described. Likewise, other anomalies in ScCL fitting may affect patient satisfaction and lead to drop out, promoting eye surgery or dramatic psychological effects. The management of these issues and complications may be also frustrating for clinicians who will, in turn, rarely, or not at all, prescribe them.

Conclusion:

Scleral contact lenses intimidate practitioners because of their large diameter and the lack of knowledge in regard to the fitting process but especially because of the challenging management of issues and complications that may occur relating to the lens fitting relationship with the underlying ocular surface. A detailed description of the etiology and management of these anomalies will allow practitioners to gain more confidence in fitting ScCLs and prescribe them more often. Patients are the primary beneficiaries from wearing these large rigid lenses; ScCLs represent a life-changing event for many patients.
Stabilization Time of Anterior Segment Parameters After Trabeculectomy Surgery
Authors: Simsek Mert , Elgin Ufuk , Uzel Mehmet Murat , Sen Emine , Yilmazbas Pelin
Published: June 2018

Objectives:

To investigate the postoperative changes in the anterior segment parameters by Scheimpflug imaging method in patients undergoing trabeculectomy surgery.

Methods:

This prospective study included 38 phakic eyes of 38 patients with primary open-angle glaucoma who underwent trabeculectomy. Anterior chamber angle (ACA), anterior chamber depth (ACD), anterior chamber volume (ACV), and central corneal thickness (CCT) of the eyes were measured by performing Scheimpflug imaging in preoperative (baseline) and postoperative periods (1st week and 1st, 3rd, and 6th months after the surgery).

Results:

Significant differences were observed in all the anterior segment parameters during the postoperative period (P<0.001 for ACA, ACD, and CCT; P=0.001 for ACV). Compared with preoperative values, ACA, ACD, and ACV values decreased and CCT value increased in the 1st postoperative week (P<0.001 for all the parameters). Compared with the 1st postoperative-week values, ACA, ACD, and ACV values significantly increased and CCT value significantly decreased in the 1st postoperative month (P=0.002 for ACV; P<0.001 for ACA, ACD, and CCT). However, no significant differences were observed between the baseline and 1st postoperative-month values (P>0.05 for all the parameters). Moreover, the changes in the anterior segment parameters were not statistically significant after the 1st postoperative month.

Conclusions:

Our results showed that the changes in the anterior segment parameters observed in the early postoperative period after trabeculectomy returned to their baseline values after approximately 1 month after the surgery and remained stable thereafter.
Concussion Rates Differ by Practice Type and Equipment Worn in an Autonomy Five Collegiate Football Conference
Authors: Wasserman Erin B. , Coberley Mark , Anderson Scott , Grant Murphy , Hardin James Allen
Published: June 2018

Objective:

Evaluate the rate of concussions across Big 12 Conference football programs based on (1) equipment worn, (2) contact level, (3) preseason practice versus in-season practice versus games, and (4) mechanism of injury for concussion.

Design:

Descriptive epidemiology study.

Setting:

Big 12 Conference football practices and competitions.

Patients (or Participants):

Big 12 Conference football teams.

Assessment of Risk Factors:

All Big 12 Conference institutions collected data on practice types, equipment worn, practice and game participation, and concussions during the fall, preseasons and regular seasons, from 2013 to 2016.

Main Outcome Measures:

Injury rates and injury rate ratios were reported with 95% confidence intervals (CIs).

Results:

From 2013 to 2016, there were 375 concussions reported [0.98/1000 athlete exposures (AEs) (95% CI, 0.88-1.08)], an average of approximately 9 concussions per team per year. Concussion rates were highest in games (5.73/1000 AE), but among practices, concussion rates were highest in full-pad (1.18/1000 AEs) and live-contact (1.28/1000 AEs) practices. Concussion rates increased with increasing contact and equipment worn. Concussion rates were higher in the preseason than in the regular season, even when stratifying by contact level and equipment worn.

Conclusions:

Practice concussion rates are highest during fully padded and live-contact practices, supporting limitations on practice contact and equipment worn to reduce the risk associated with head-impact exposure. Higher concussion rates in the preseason and during games indicate an effect of play intensity on concussion risk, and further research is needed to evaluate the direct effect of practice contact level and equipment guidelines and restrictions on concussion incidence.
Novel Factors Associated With Analgesic and Anti-inflammatory Medication Use in Distance Runners: Pre-race Screening Among 76 654 Race Entrants—SAFER Study VI
Authors: Rotunno Adrian , Schwellnus Martin P. , Swanevelder Sonja , Jordaan Esme , Janse Van Rensburg Dina C. , Derman Wayne
Published: June 2018

Objective:

Analgesic/anti-inflammatory medication (AAIM) increases the risk of medical complications during endurance races. We determined how many runners use AAIM before or during races, AAIM types, and factors associated with AAIM use.

Design:

Cross-sectional study.

Setting:

21.1-km and 56-km races.

Participants:

Seventy-six thousand six hundred fifty-four race entrants.

Methods:

Participants completed pre-race medical screening questions on AAIM use, running injury or exercise-associated muscle cramping (EAMC) history, and general medical history.

Main Outcome Measures:

Analgesic/anti-inflammatory medication use, types of AAIM (% runners; 95% confidence interval), and factors associated with AAIM use (sex, age, race distance, history of running injury or EAMC, and history of chronic diseases) [prevalence ratio (PR)].

Results:

Overall, 12.2% (12.0-12.5) runners used AAIM 1 week before and/or during races (56 km = 18.6%; 18.0-19.1, 21.1 km = 8.3%; 8.1-8.6) (P < 0.0001). During races, nonsteroidal anti-inflammatory drugs (NSAIDs) (5.3%; 5.1-5.5) and paracetamol (2.6%; 2.4-2.7) were used mostly. Independent factors (adjusted PR for sex, age, and race distance; P < 0.0001) associated with AAIM use were running injury (2.7; 2.6-2.9), EAMC (2.0; 1.9-2.1), cardiovascular disease (CVD) symptoms (2.1; 1.8-2.4), known CVD (1.7; 1.5-1.9), CVD risk factors (1.6; 1.5-1.6), allergies (1.6; 1.5-1.7), cancer (1.3; 1.1-1.5), and respiratory (1.7; 1.6-1.8), gastrointestinal (2.0; 1.9-2.2), nervous system (1.9; 1.7-2.1), kidney/bladder (1.8; 1.6-2.0), endocrine (1.5; 1.4-1.7), and hematological/immune (1.5; 1.2-1.8) diseases.

Conclusions:

12.2% runners use AAIM before and/or during races, mostly NSAIDs. Factors (independent of sex, age, and race distance) associated with AAIM use were history of injuries, EAMC, and numerous chronic diseases. We suggest a pre-race screening and educational program to reduce AAIM use in endurance athletes to promote safer races.
Sorafenib for Treatment of Hepatocellular Carcinoma
Authors: Leathers James S. , Balderramo Domingo , Prieto John , Diehl Fernando , Gonzalez-Ballerga Esteban , Ferreiro Melina R. , Carrera Enrique , Barreyro Fernando , Diaz-Ferrer Javier , Singh Dupinder , Mattos Angelo Z. , Carrilho Flair , Debes Jose D.
Published: June 2018

Goals:

We aim to describe the efficacy, safety profile, and variables associated with survival in patients with hepatocellular carcinoma (HCC) treated with sorafenib in South America.

Background:

Sorafenib has been shown to improve survival in patients with advanced HCC. There are few data on sorafenib use for HCC in South America.

Study:

We performed a retrospective analysis of HCC cases treated with sorafenib from 8 medical centers in 5 South American countries, between January 2010 and June 2017. The primary endpoint was overall survival (OS), which was defined as time from sorafenib initiation to death or last follow-up. Risk factors for decreased OS were assessed using Cox proportional hazard regression and log-rank tests.

Results:

Of 1336 evaluated patients, 127 were treated with sorafenib and were included in the study. The median age of individuals was 65 years (interquartile range, 55 to 71) and 70% were male individuals. Median OS in all patients was 8 months (interquartile range, 2 to 17). Variables associated with survival on multivariate analysis were platelets >/<250,000 mm3 (2 vs. 8 mo, P=0.01) and Barcelona Clinic Liver Cancer (BCLC) stage (A/B, 13 vs. C/D, 6 mo; P=0.04). In a subanalysis of patients with BCLC stage C, platelets >/<250,000 mm3 were also independently associated with survival (2 vs. 5.5 mo, P=0.03). Patients lived longer if they experienced any side effects from sorafenib use (11 vs. 2 mo, P=0.009). Patients who stopped sorafenib because of side effects had shorter survival compared with patients who were able to tolerate side effects and continue treatment (7.5 vs. 13 mo, P=0.01).

Conclusions:

Pretreatment elevation of platelets and advanced BCLC stage were independently associated with poor survival on sorafenib in a South American cohort.
Polyethylene Glycol Maintenance Treatment for Childhood Functional Constipation
Authors: Modin Line , Walsted Anne Mette , Dalby Kasper , Jakobsen Marianne Skytte
Published: June 2018

Objective:

The aim of this study was to investigate the long‐term efficacy of polyethylene glycol (PEG) during maintenance treatment of childhood functional constipation (FC) in a randomized, double‐blinded, placebo‐controlled trial.

Methods:

Children (2–16 years) with FC according to the Rome III criteria were randomly assigned to maintenance treatment with PEG or placebo for 24 weeks. Children reporting treatment failure before 24 weeks were switched to conventional treatment. Primary outcome was successful treatment, defined as absence of any Rome III criteria with or without use of medication after 24 weeks.

Results:

A total of 102 children were included: PEG/placebo: 49/53. At 24 weeks, significantly more patients in the PEG group, compared to the placebo group, were successfully treated (33 [67%] vs 19 [36%] hazard ratio (95% confidence intervals) = 3.21 [1.73–5.94]). Significantly fewer children in the PEG group switched to rescue medication (2 [4%] vs 30 [57%], P < 0.001). Time before the change to rescue medication was 13 and 27 days, respectively, for each of the 2 children in the PEG group who required rescue medication. Median time to shift to rescue medication was 27 days (range: 3–64 days) in the placebo group. At 24 weeks after initiation of treatment, 33 children (67%) in the PEG group were successfully treated, compared to 19 children (32%) in the placebo group (hazard ratio (95% confidence intervals) = 3.21 [1.73–5.94]). No serious adverse event related to use of the medication was registered.

Conclusions:

Maintenance treatment with PEG is significantly more effective than placebo in preventing relapse of constipation symptoms during long‐term maintenance treatment in childhood FC. We therefore recommend that maintenance treatment commence after disimpaction.
Evaluation of Epicardial Fat Thickness in Young Patients With Embolic Stroke of Undetermined Source
Authors: Gürdal Ahmet , Keskin Kudret , Orken Dilek N. , Baran Gözde , Kiliçkesmez Kadriye
Published: June 2018

Objectives:

Epicardial adipose tissue is metabolically active and is an important predictor of metabolic and cardiovascular diseases. This study investigated the echocardiographic epicardial adipose tissue measurement in young patients with embolic stroke of undetermined source (ESUS).

Materials and Methods:

We studied 77 volunteers, including 40 patients with ESUS (mean age 43±8 y, 16 female patients) and 37 healthy subjects (mean age 38±7 y, 20 female subjects). All necessary biochemical parameters were analyzed, and epicardial fat thickness (EFT) was measured by echocardiography in all subjects. Additional related diagnostic work-up was conducted in each patient, according to the patients’ clinical presentation.

Results:

The patients with ESUS had a significantly higher EFT than the control group (5.51±0.82 vs. 3.96±0.51; P<0.01). Furthermore, there was a positive correlation between EFT and serum C-reactive protein levels (r=0.284; P<0.05). As an optimal cut-off point, a high-risk EFT value of 4.6 mm was determined to predict ESUS, with an 87.5% sensitivity and an 81.1% specificity.

Conclusion:

We found that echocardiographic EFT was significantly higher in young patients with ESUS than in healthy individuals. Increased EFT might be a novel risk factor in these patients
Acute Right Middle Cerebral Artery Occlusion Resulting in Acute Systolic Heart Failure, Cerebral T-Waves, and QTc Prolongation
Authors: Blech Benzion , O’Carroll Cumara
Published: June 2018

Introduction:

Acute cerebral injuries, such as cerebral ischemic or hemorrhagic events, have been repeatedly correlated with sudden electrocardiogram (ECG) changes, such as cardiac arrhythmias, QT prolongation, and T-wave inversion (the “cerebral T-wave”). Injuries to the insular cortex have been reported in the literature to result in such changes, possibly due to increased sympathetic tone to the cardiac system.

Case Report:

A 65-year-old gentleman presented with an acute right middle cerebral artery territory infarction, and was found to have ECG abnormalities and left ventricular dysfunction, which improved after the acute phase of the stroke.

Conclusions:

Acute ischemic infarcts, particularly to the right insular cortex, can result in ECG abnormalities, such as QT prolongation and T-wave inversion, as well as acute systolic heart failure; all of which may be reversible after the acute phase of the stroke.
Therapy With Mesenchymal Stem Cells in Parkinson Disease
Authors: Mendes Filho Daniel , Ribeiro Patrícia d.C. , Oliveira Lucas F. , de Paula Diógenes R.M. , Capuano Vanessa , de Assunção Thaís S.F. , da Silva Valdo J.D.
Published: June 2018

Background:

Parkinson disease (PD) is a neurodegenerative disorder affecting the basal nuclei, causing motor and cognitive disorders. Bearing in mind that standard treatments are ineffective in delaying the disease progression, alternative treatments capable of eliminating symptoms and reversing the clinical condition have been sought. Possible alternative treatments include cell therapy, especially with the use of mesenchymal stem cells (MSC).

Review Summary:

MSC are adult stem cells which have demonstrated remarkable therapeutic power in parkinsonian animals due to their differentiation competence, migratory capacity and the production of bioactive molecules. This review aims to analyze the main studies involving MSC and PD in more than a decade of studies, addressing their different methodologies and common characteristics, as well as suggesting perspectives on the application of MSC in PD.

Conclusions:

The results of MSC therapy in animal models and some clinical trials suggest that such cellular therapy may slow the progression of PD and promote neuroregeneration. However, further research is needed to address the limitations of an eventual clinical application.
Human Immunodeficiency Virus/Sexually Transmitted Infection Counseling and Testing Services Received by Gay and Bisexual Men Using Preexposure Prophylaxis at Their Last PrEP Care Visit
Authors: Parsons Jeffrey T. , John Steven A. , Whitfield Thomas H.F. , Cienfuegos-Szalay Jorge , Grov Christian
Published: June 2018

Background

Preexposure prophylaxis (PrEP) reduces risk of human immunodeficiency virus infection for many gay and bisexual men (GBM); however, bacterial sexually transmitted infections associated with decreasing condom use among users is of concern. Center for Disease Control and Prevention's guidelines for PrEP use recommend bacterial sexually transmitted infection screening every 6 months. We sought to investigate comprehensive PrEP care, defined as: (1) discussion of sexual behavior, (2) blood sample, (3) urine sample, (4) rectal sample (rectal swab), and (5) throat sample (throat swab), provided at the user's last PrEP appointment.

Methods

The PrEP-using GBM in New York City (n = 104) were asked about their last PrEP care visit. We examined associations of demographics (age, race/ethnicity, and education), recent number of condomless anal sex events, time on PrEP, and health care provider type on receiving comprehensive care at last visit using fully adjusted binary logistic regression.

Results

At their last visit, nearly all men (94%) gave blood for testing, 88% provided a urine sample, and 77% discussed sexual behavior with their provider. However, only 51% reported having a rectal swab, and 48% an oral swab. Only 32% of men received comprehensive PrEP care at their last PrEP visit. Odds of receiving comprehensive care were significantly higher among younger men, men with a bachelor's degree or more education, and those who reported more condomless anal sex.

Conclusions

Less than one third of GBM received comprehensive human immunodeficiency virus/sexually transmitted infection counseling and testing at their last visit. These findings indicate further efforts are needed to prepare health care providers for prescribing and managing patients on PrEP.
Condom Use, Multiple Rounds of Sex, and Alcohol Use Among South African Women Who Use Alcohol and Other Drugs: An Event-Level Analysis
Authors: Zule William A. , Speizer Ilene S. , Browne Felicia A. , Howard Brittni N. , Wechsberg Wendee M.
Published: June 2018

Background

High rates of alcohol and other drug use contribute to the ongoing generalized human immunodeficiency virus epidemic in South Africa. Despite the general link between alcohol use and condomless sex, findings from event-level studies of the relationship between alcohol use and condomless sex during the same encounter have been inconsistent.

Methods

We conducted event-level analyses of the most recent sexual encounter reported by 636 women who use substances in Pretoria. Data were collected via a questionnaire that included questions about the number of rounds of vaginal and anal sex and condom use during each round. We used multiple logistic regression analyses to model the associations between alcohol use by both partners and having multiple rounds of sex, and alcohol use and condom use during all rounds of sex.

Results

Over 50% of encounters involved multiple rounds of vaginal or anal sex. Encounters that involved multiple rounds of sex were associated with inconsistent condom use. Encounters in which both partners drank alcohol were more likely to involve condomless sex, as compared with encounters in which one or neither partner drank alcohol.

Conclusions

These findings raise the possibility that prior event-level studies, which do not ask about multiple rounds of sex, may underestimate the prevalence of condomless sex. The association between alcohol use by both partners and condomless sex may partially explain inconsistent associations between alcohol use and condom use in event-level studies that did not assess the number of partners drinking.
Impact of Providing Preexposure Prophylaxis for Human Immunodeficiency Virus at Clinics for Sexually Transmitted Infections in Baltimore City: An Agent-based Model
Authors: Kasaie Parastu , Berry Stephen A. , Shah Maunank S. , Rosenberg Eli S. , Hoover Karen W. , Gift Thomas L. , Chesson Harrell , Pennington Jeff , German Danielle , Flynn Colin P. , Beyrer Chris , Dowdy David W.
Published: June 2018

Background

Preexposure prophylaxis (PrEP) greatly reduces the risk of human immunodeficiency virus (HIV) acquisition, but its optimal delivery strategy remains uncertain. Clinics for sexually transmitted infections (STIs) can provide an efficient venue for PrEP delivery.

Methods

To quantify the added value of STI clinic–based PrEP delivery, we used an agent-based simulation of HIV transmission among men who have sex with men (MSM). We simulated the impact of PrEP delivery through STI clinics compared with PrEP delivery in other community-based settings. Our primary outcome was the projected 20-year reduction in HIV incidence among MSM.

Results

Assuming PrEP uptake and adherence of 60% each, evaluating STI clinic attendees and delivering PrEP to eligible MSM reduced HIV incidence by 16% [95% uncertainty range, 14%–18%] over 20 years, an impact that was 1.8 (1.7–2.0) times as great as that achieved by evaluating an equal number of MSM recruited from the community. Comparing strategies where an equal number of MSM received PrEP in each strategy (ie, evaluating more individuals for PrEP in the community-based strategy, because MSM attending STI clinics are more likely to be PrEP eligible), the reduction in HIV incidence under the STI clinic-based strategy was 1.3 (1.3–1.4) times as great as that of community-based delivery.

Conclusions

Delivering PrEP to MSM who attend STI clinics can improve efficiency and effectiveness. If high levels of adherence can be achieved in this population, STI clinics may be an important venue for PrEP implementation.
A Comparison of Syphilis Partner Notification Outcomes by Reported Use of Internet-based Apps to Meet Sex Partners in North Carolina, 2013–2016
Authors: Mobley Victoria , Cope Anna , Dzialowy Nicole , Maxwell Jason , Foust Evelyn , Samoff Erika
Published: June 2018

Background

Partner notification services (PNS) remain the backbone of syphilis control. The popularity of Internet-based apps to meet sex partners among early syphilis (ES) patients may hinder the success of PNS if partners cannot be located.

Methods

We compared demographic and clinical characteristics between male ES patients indicating sex with men (MSM) and reported in North Carolina between 2013 and 2016 by reported use of an Internet-based app to meet sex partners (app user). We used multivariable log-binomial regression to assess the association between app usage and ES exposure notification of 1 or more sex partner.

Results

Among 3414 MSM ES patients, 58.6% were app users. App users were more frequently white (33.2% vs 27.3%; P = 0.003), younger (median, 28 years vs 30 years; P = 0.0002) and less frequently human immunodeficiency virus coinfected (54.1% vs 58.2%; P = 0.02) compared to non-app users. Overall, 94.9% of app users and 89.6% of non-app users reported 1 or more sex partner. App users reported 2.5 times more locatable and 2.7 times more unlocatable sex partners than non-app users. Similar proportions of app (23.6%) and non-app users (25.0%) reported only unlocatable partners (P = 0.4). App usage was not associated with ES exposure notification of 1 or more sex partner (adjusted risk ratio, 0.99; 95% confidence interval, 0.87–1.13).

Conclusions

We observed no difference in the proportion of locatable partners or likelihood of notifying 1 or more sex partner of exposure among MSM ES patients, by reported use of Internet-based apps to meet sex partners. Partner notification services continues to be an important mechanism to locate and assure treatment for sex partners in this population.
Implementing Lean in Academic Primary Care
Authors: Daaleman Timothy P. , Brock Dawn , Gwynne Mark , Weir Sam , Dickinson Iris , Willis Beth , Reid Alfred
Published: June 2018

Background:

Lean is emerging as a quality improvement (QI) strategy in health care, but there has been minimal adoption in primary care teaching practices. This study describes a strategy for implementing Lean in an academic family medicine center and provides a formative assessment of this approach.

Methods:

A case study of the University of North Carolina Family Medicine Center that used the Consolidated Framework for Implementation Research to guide a formative evaluation. The implementation strategy included partnering with Lean content experts and creating a leadership team; planning and completing QI events and Lean training modules; and evaluating and reporting activities related to QI and training.

Results:

During the initial period of Lean implementation, there was (1) minimal to no change in the quality of care as determined by the Preventive Care Index (46-48); (2) a decrease patient appointment cycle time from 89 minutes to 65 minutes; (3) an increase in overall practice productivity from $8144 to $9160; (4) a decrease in patient satisfaction from 94% to 91%; and (5) an increase in monthly visit volume from 4112 to 5076.

Conclusion:

Lean had an uneven effect on QI in an academic primary care practice during the first year of implementation.
Quality Reporting by Payers: A Mixed-Methods Study of Provider Perspectives and Practices
Authors: Garabedian Laura F. , Sinaiko Anna D. , Ross-Degnan Dennis , Abu-Jaber Tariq , Hoefer Martha , Oddleifson Stephanie , Wagner Anita K.
Published: June 2018

Background:

Providers need timely, clinically meaningful, and actionable information to improve quality of care. Payers may play an important role in providing such information in ambulatory care settings. We sought to learn about providers' use and perceptions of quality reports from insurers.

Methods:

We employed a mixed-methods study design. We analyzed the performance of 118 provider groups on 21 HEDIS measures included in one New England insurer's quality reporting program and evaluated how a subset of provider groups (n = 55) accessed the reports. We also conducted 14 semistructured interviews with providers and administrators to assess their perspectives about quality reports from insurers in general.

Results:

Performance on quality measures varied greatly across provider groups and by metric. Only 20% of provider groups accessed the quality reports during the study period. While providers reported that payer information on quality has the potential to be useful, respondents suggested important reasons why insurer quality reports were not widely accessed, including information overload, conflicts with other sources of information, and the significant provider effort required to make the reports actionable.

Conclusions:

Payer-provider collaborations are needed to improve the usefulness of payers' quality measurement reports, and coordination among payers is needed to streamline reported measures.
Implementing a Comprehensive Unit-Based Safety Program (CUSP) to Enhance a Culture of Patient Safety and Improve Medication Safety in a Regional Home Care Program
Authors: Ganaden Rachel E. , Mitchell Lori
Published: June 2018

Objective:

To determine whether a Comprehensive Unit-based Safety Program could be used to enhance a culture of patient safety and improve medication safety at 1 pilot site.

Methods:

The Canadian Patient Safety Culture Survey tool was used to assess the culture of patient safety and drill down on the key factors contributing to medication errors. Based on staff input and site improvement team investigations, solutions were developed to address medication safety issues. The main outcome measure was pre-/postintervention Canadian Patient Safety Culture scores. Change in frequency of occurrence reporting and staff's overall project experience were also measured.

Results:

Overall perceptions of patient safety culture improved from 70% preintervention to 76.8% postintervention, representing a 9.7% change. Volume of occurrence reporting showed a marked increase postintervention. The project was well received by staff, with 84% rating their experience as “Good” to “Excellent.” Finally 100% of participants reported that they learned something new and that this information could be applied to improve their day-to-day work.

Conclusion:

Implementing a Comprehensive Unit-based Safety Program improved staff's perceptions of patient safety, contributing to improved medication safety. To our knowledge, this is the first application of Comprehensive Unit-based Safety Program to successfully enhance patient safety in the home care setting.
Identification of Children as Relatives With a Systematic Approach; a Prerequisite in Order to Offer Advice and Support
Authors: Andersson Ann-Christine , Melke Anna , Andersson Gäre Boel , Golsäter Marie
Published: June 2018

The purpose of this study was to elucidate conditions at all system levels in a specific health care service to develop practices for identification of children as relatives. An interactive research approach with the intention to create mutual learning between practice and research was used. The participating health care service cared for both clinic in- and outpatients with psychiatric disorders. Health care professionals from different system levels (micro, meso, macro) participated, representing different professions. At the first project meeting, it was obvious that there was no systematic approach to identify children as relatives. At the micro level, activities such as a pilot survey and an open house activity were carried out. At the meso level, it was discussed how to better support collaboration between units. At the management (macro) level, it was decided that all units should appoint at least one child agent, with the aim to increase collaboration throughout the whole health care service. To change focus, in this case from only parents to inclusion of children, is an important challenge faced by health care services when forced to incorporate new policies and regulations. The new regulations contribute to increased complexity in already complex organizations. This study highlights that such challenges are underestimated.
Physician Engagement With Metrics in Lean Primary Care Transformation
Authors: Gray Caroline P. , Yakir Maayan , Hung Dorothy Y.
Published: June 2018

Objective:

Data and metrics play important roles in quality and process improvement efforts. For one specific process improvement method, Lean or Lean health care, data and metrics are central components, allowing users to identify areas that need improvement and to assess the degree to which improvements have been realized. This article explores the role that metrics and measurement played in a wide-reaching “Lean”-based continuous quality improvement effort carried out in the primary care departments of a large, ambulatory care health care organization.

Methods:

This article is based on qualitative data collected through in-depth interviews with physicians, staff, and health care leaders.

Results:

Suggestions for improving the ways that metrics may be optimally used, presented, and approached while carrying out health care improvement efforts include having accurate and compelling data throughout the improvement process, ensuring that metrics are professionally meaningful to physicians, and presenting metrics in a manner that increases the likelihood that they will be digested and ultimately used to improve health care.

Conclusions:

Effective strategies for selecting and presenting metrics to practicing physicians are an important part of a successful quality improvement effort.
Multireader Study on the Diagnostic Accuracy of Ultrafast Breast Magnetic Resonance Imaging for Breast Cancer Screening
Authors: van Zelst Jan C.M. , Vreemann Suzan , Witt Hans-Joerg , Gubern-Merida Albert , Dorrius Monique D. , Duvivier Katya , Lardenoije-Broker Susanne , Lobbes Marc B.I. , Loo Claudette , Veldhuis Wouter , Veltman Jeroen , Drieling Daniel , Karssemeijer Nico , Mann Ritse M.
Published: June 2018

Objectives

Breast cancer screening using magnetic resonance imaging (MRI) has limited accessibility due to high costs of breast MRI. Ultrafast dynamic contrast-enhanced breast MRI can be acquired within 2 minutes. We aimed to assess whether screening performance of breast radiologist using an ultrafast breast MRI-only screening protocol is as good as performance using a full multiparametric diagnostic MRI protocol (FDP).

Materials and Methods

The institutional review board approved this study, and waived the need for informed consent. Between January 2012 and June 2014, 1791 consecutive breast cancer screening examinations from 954 women with a lifetime risk of more than 20% were prospectively collected. All women were scanned using a 3 T protocol interleaving ultrafast breast MRI acquisitions in a full multiparametric diagnostic MRI protocol consisting of standard dynamic contrast-enhanced sequences, diffusion-weighted imaging, and T2-weighted imaging. Subsequently, a case set was created including all biopsied screen-detected lesions in this period (31 malignant and 54 benign) and 116 randomly selected normal cases with more than 2 years of follow-up. Prior examinations were included when available. Seven dedicated breast radiologists read all 201 examinations and 153 available priors once using the FDP and once using ultrafast breast MRI only in 2 counterbalanced and crossed-over reading sessions.

Results

For reading the FDP versus ultrafast breast MRI alone, sensitivity was 0.86 (95% confidence interval [CI], 0.81–0.90) versus 0.84 (95% CI, 0.78–0.88) (P = 0.50), specificity was 0.76 (95% CI, 0.74–0.79) versus 0.82 (95% CI, 0.79–0.84) (P = 0.002), positive predictive value was 0.40 (95% CI, 0.36–0.45) versus 0.45 (95% CI, 0.41–0.50) (P = 0.14), and area under the receiver operating characteristics curve was 0.89 (95% CI, 0.82–0.96) versus 0.89 (95% CI, 0.82–0.96) (P = 0.83). Ultrafast breast MRI reading was 22.8% faster than reading FDP (P < 0.001). Interreader agreement is significantly better for ultrafast breast MRI (κ = 0.730; 95% CI, 0.699–0.761) than for the FDP (κ = 0.665; 95% CI, 0.633–0.696).

Conclusions

Breast MRI screening using only an ultrafast breast MRI protocol is noninferior to screening with an FDP and may result in significantly higher screening specificity and shorter reading time.
Combined External, Endoscopic, Endonasal-Assisted En Bloc Resection of Malignant Tumors From the Lacrimal Drainage System
Authors: Shi Jieliang , Tu Yunhai , Wu Wencan
Published: June 2018

Purpose:

The aim of this study is to describe a minimally invasive technique of en bloc resection of malignant tumors from lacrimal drainage system (LDS).

Methods:

This was a noncomparative, retrospective chart review of the clinical and pathologic findings of patients presenting with a LDS malignant tumor who underwent endoscopic prelacrimal recess approach with a small external incision for en bloc excision of the LDS.

Results:

A total of 12 patients from April 2010 to July 2017 were reviewed in this study. Of the 12 patients, 7 were males. The mean age was 51 years (range, 38–66 years), and all cases were unilateral. Histopathology revealed 3 adenoid cystic carcinomas, 2 squamous cell carcinomas, 2 melanomas, and 1 each of papilloma with carcinoma, papillary squamous cell carcinoma, mucoepidermoid carcinoma, B-cell lymphoma, and natural killer/T-cell lymphoma. Epiphora and a mass were the most common presentations. Adjuvant radiotherapy was given in 6 cases after surgery. Eleven patients remain alive and mean disease-free survival time was 25 months (range, 3–78 months). Two cases with malignant melanoma showed recurrence and 1 patient died of metastatic involvement.

Conclusion:

Endoscopic endonasal approach combined with a small external incision is efficient method for the management of tumors arising from the LDS.
Efficacy of Photocoagulation of Vascular Malformations in the Oral Mucosa Using Nd: YAG Laser
Authors: Cadavid Ana Maria Hoyos , de Campos Wladimir Gushiken , Aranha Ana Cecília Correa , Lemos-Junior Celso Augusto
Published: June 2018

The purpose of this study was to analyze the effectiveness of Nd: YAG laser photocoagulation in the treatment of vascular malformations in the oral and perioral area; 93 patients (104 lesions) were evaluated in an Ambulatory of Oral Medicine (2006–2013). The sample consisted of 57 women (61%) and 36 men (39%), aged 8 to 85 years. The lesion size was smaller than 3 cm in most patients. The lesions were located on the lips, jugal mucosa, tongue, palate, gingiva, and retromolar trigone. All patients were treated on an outpatient basis using local anesthesia and Nd: YAG laser (Power Laser C ) with a wavelength of 1064 nm and a fiber optic diameter of 400 μm. After treatment no patients had complications, however, in patients of deep lesions, 2 or more irradiations were required to treat the lesions. Finally, the authors conclude that the clinical and aesthetic satisfactory results of the 93 patients treated with Nd: YAG laser suggest that this type of laser is effective and safe in the treatment of oral and perioral vascular malformations.
Successful Treatment of Pneumocephalus Using a Free-Style Chimeric Free Flap From a Scarred Thigh
Authors: Visconti Giuseppe , Pagliara Domenico , Bianchi Alessandro , La Rocca Giuseppe , Olivi Alessandro , Salgarello Marzia
Published: June 2018

Pneumocephalus is an air collection in cranial cavity caused by accidental exposition of intracranial compartment after trauma or surgery. Skull base reconstruction with free flap is a useful surgical tool to avoid cerebral herniation or intracranial infection. The authors describe a patient of pneumocephalus following anterior skull base meningioma resection, unsuccessfully treated with 2 attempts of fascia lata grafts harvested from both thighs. A free-style chimeric anterolateral thigh free flap was performed using middle third of rectus femoris muscle to fill the planum spheno-ethmoidalis defect and adipocutaneous paddle for postoperative monitoring and for favoring a tension free skin closure. Free-style dissection with limited undermining in the previously scarred thigh was performed to avoid donor-site complication. Postoperative course was uneventful with complete resolution of the pneumocephalus.