bluuebunny/crossref_metadata_2025 huggingface dataset:
Neonatal Admission and Its Relationship to Maternal Pain
Authors: Cooper Alannah L. , Brown Janie A. , Kelly Suzanne , Eccles Siobhan P. , Parsons Richard , Osseiran-Moisson Rebecca
Published: January 2020

The aim of this study was to determine whether postnatal women whose babies required neonatal intensive care unit (NICU) admission self-reported lower pain scores and required less analgesia than women whose babies remained with them. A prospective matched audit comparing pain scores and analgesia requirements where every woman with a baby admitted to the NICU was matched to 2 women whose babies remained on the ward was undertaken. Matches were based on age, number of previous births, type of birth, episiotomy, and epidural or spinal analgesia use. Data were collected on pain scores and analgesia administered in the first 72 hours postbirth. A total of 150 women were recruited and matched from November 2015 to May 2017. No statistically significant differences were found between the 2 groups for opiate analgesia use (P = .91) or pain scores (P = .89). Regardless of NICU admission, significantly higher pain scores were reported in participants who had episiotomies (P = .03). Birth via cesarean birth resulted in significantly higher pain scores (P < .01) and greater opiate administration (P < .01). This study found no statistically significant difference between pain scores or analgesia use of mothers whose babies required NICU admission and mothers whose babies remained with them.
Additional Effects of Shank Adaptations in Children with Bilateral Spastic Cerebral Palsy
Authors: Schwarze Martin , Horoba Laura , Block Julia , Putz Cornelia , Alimusaj Merkur , Salami Firooz , Wolf Sebastian I. , Dreher Thomas
Published: January 2020

Introduction

Conservative therapy for bilateral spastic cerebral palsy (BSCP) regularly includes a modular orthosis setup with dynamic ankle-foot orthosis (DAFO) and modular shank supply (MSS). Additional effects by this modular supply have not been studied so far.

The goal was thus an exploratory investigation of what effects can be expected by supplementing a DAFO with an additional MSS.

Materials and Methods

Ten children with BSCP were fitted with DAFO and MSS. Dynamic elastic shank adaptations (DESAs) and ground reaction force AFOs (GRAFOs) were used, depending on the participants' individual needs.

Participants underwent a gait analysis after supply and 3 months later. Data analysis included a descriptive analysis and further statistical testing using a Friedman test and post hoc Wilcoxon rank test.

Results

The Gillette Gait Index (GGI) improved significantly with MSS compared with barefoot and DAFO, the Gait Deviation Index (GDI) only comparing DAFO to MSS. However, no further changes had occurred at follow-up, and for the Gait Profile Score (GPS), not at all. Step length, velocity, cadence, stance duration, and step width changed significantly after supply. Kinematic changes developed at ankle, knee, hip, and trunk. However, only minor changes had occurred at follow-up.

Conclusions

DAFOs and MSS show positive effects, as observed in spatiotemporal parameters, gait indices, and kinematic data. Most kinematic effects occur at the ankle and knee joint. MSS produces additional effects, with a particular emphasis on the extending effect on the knee in terminal stance. Only minor beneficial effects on kinematic parameters of knee and trunk during swing phase occur after a familiarization phase. The changes in the spatiotemporal parameters imply a slight deterioration.
Temozolomide plus whole brain radiotherapy for the treatment of non-small-cell lung cancer patients with brain metastases
Authors: Duan Hua , Zheng Shu-Yue , Zhou Tian , Cui Hui-Juan , Hu Kai-Wen
Published: January 2020

Introduction:

Whole brain radiotherapy (WBRT) has been the mainstay treatment of brain metastases (BM) in non-small cell lung cancer (NSCLC) patients for years. Temozolomide (TMZ) could penetrate the blood–brain barrier and some studies showed that TMZ plus MBRT may improve clinical effectiveness. This meta-analysis is aim to evaluate the clinical effectiveness and safety of TMZ plus MBRT in the NSCLC patients with BM.

Methods and analysis:

We systematically searched databases including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and four Chinese databases (Chinese Biomedical Database, China National Knowledge Infrastructure, Wanfang Database and Chinese Scientific Journal Database) without language restrictions from inception until July 26, 2019. Randomized controlled trials (RCTs) which compared TMZ plus WBRT with single WBRT in the advanced NSCLC patients with BM were included. The outcomes analysis reported objective response rate (ORR), disease control rate (DCR), overall survival (OS), progression-free survival (PFS), quality of life (QOL), and adverse effects. Two reviewers will independently extract data from the selected studies and assess the quality of studies. Statistical analyses will be performed using Review manager 5.3 software. Random-effects or fixed models were used to estimate pooled hazard ratio and relative risk.

Results:

This systemic review and meta-analysis will evaluate the effects of TMZ plus MBRT in the NSCLC patients with BM in RCTs.

Conclusion:

Our study will provide evidence to judge if TMZ plus MBRT are effective treatment for NSCLC patients with BM.
Pain assessment of a new bloodletting device
Authors: Ryu Hwa Yeon , Kang Jae Hui
Published: January 2020

Background:

The bloodletting device has been used by many institutions for about 100 years. Many patients feel fear from the pain caused by applying the bloodletting device for treatment. We used bloodletting device using the principle of “prestimulation neurodisturbance,” which can mask the subject undetectable for pain. In this study, we will investigate pain of bloodletting device during blood collection and will identify the safety of the device.

Methods:

This study will be a randomized, controlled, double-blind, and matched-paired-designed clinical trial. Four groups, RTLC, LTRC, RCLT, and LCRT (T = test device, C = control device, L = left, R = right), will be randomly allocated. Total duration of the clinical trial will be 3 months. The subjects will be performed from 1 to 3 times only on the day of the procedure. The primary outcomes will be measured using pain visual analog scale score and the secondary outcomes will include verbal rating scale and the time at which the pain disappears after blood collection (second), the total number of “nonbleeding” cases and subjects, the number of “blood collection failure” and subjects, the presence of “delayed hemostasis,” and the number of subjects. Repeated-measure analysis will be used to measure primary efficacy based on full analysis set.

Discussion:

This study has limited inclusion and exclusion criteria and a well-controlled intervention, and it will be the first randomized controlled trial to investigate pain of bloodletting device using the principle of “prestimulation neurodisturbance.” This study provides insights into the underlying mechanisms of the pain-reducing effect of the developed bloodletting device and will lay the groundwork for further studies.
Kushenin combined with entecavir for chronic hepatitis B
Authors: Wang Yunxia , Zhang Jiayuan , Jin Yuxia , Xiao Xiao , Zhang Qi
Published: January 2020

Background:

A recent study has reported that there are >240 million patients infected with chronic hepatitis B (CHB) worldwide. Once patients with CHB start antiviral treatment, they need to take antiviral drugs for a long period, which may lead to a series of side effects, and the resistance to the antiviral drugs may also emerge. We aim to evaluate the efficacy and safety of kushenin (KS) combined with entecavir (ETV) for chronic hepatitis B.

Methods:

Randomized controlled trials (RCTs) of KS combined with ETV for CHB will be identified from PubMed, EMBASE, Web of Science, The Cochrane Library, Chinese Biomedical Database, China National Knowledge Infrastructure, Chongqing VIP, Wangfang Data. Literature screening and data extraction will be independently performed by 2 researchers. The cochrane collaboration tool for assessing risk of bias will be applied to evaluate the risk of bias of the RCTs included. The extracted data will be analyzed by Rev-man 5.3.0 software.

Results:

A high-quality synthesis of current evidence on the efficacy and safety of KS combined with ETV for CHB will be provided in this study.

Conclusion:

This systematic review will aim to evaluate the efficacy and safety of KS combined with ETV for CHB.

PROSPERO registration number:

CRD42019124790.
Auricular acupuncture for migraine
Authors: Zhang Feng , Shen Yifeng , Fu Hongjuan , Zhou Hao , Wang Chao
Published: January 2020

Background:

Previous reviews indicate that the effect of auricular acupuncture on migraine. However, a systematic review is not available. Therefore, this protocol was conducted to evaluate the efficacy and safety of auricular acupuncture on migraine, by conducting a systematic review and meta-analysis.

Methods:

The following databases will be searched from their inception to October 2019: Chinese National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Wan Fang Database, the Chongqing VIP Chinese Science and Technology Periodical Database (VIP), Cochrane Library, EMBASE, EBSCO, PubMed. The randomized controlled trials (RCTs) in English or Chinese associated with auricular acupuncture for migraines will be included. Eligible study conference abstracts and reference lists of manuscripts will be searched. The data collection and analysis will be conducted independently by 2 reviewers. Meta-analysis will be performed using Rev Man V.5.3.5 statistical software.

Results:

This systematic review will be conducted to evaluate the efficacy and safety of auricular acupuncture in the treatment of migraine. Therefore, auricular acupuncture in the treatment of migraine needs to be further clarified.

Conclusions:

In summary, this review will determine whether the impact of auricular acupuncture for intelligence on the treatment of migraines. A better approach may be established for migraine base on this review. It provides reliable evidence for its extensive application.

Ethics and dissemination:

The private information from individuals will not publish. This systematic review also will not involve endangering participant rights. Ethical approval is not available. The results may be published in a peer-reviewed journal or disseminated in relevant conferences.

OSF REGISTRATION NUMBER:

DOI 10.17605/OSF.IO/7ZR8Q
An analysis of factors related to the development of in-stent restenosis after percutaneous coronary intervention: Retracted
Authors: Zhang Gai , Li Shufang , Lin Ping , Chen Yumei
Published: January 2020

To investigate the relationship between life style, medication adherence and the development of in-stent restenosis after percutaneous coronary intervention.

A total of 230 patients with coronary heart disease were recruited and investigated with semi-quantitative food frequency questionnaire, international physical activity questionnaire, screening tool for psychological and Morisky questionnarie. Logistic regression was used for statistical analysis.

Logistic regression analysis revealed that there was positive correlation between Morisky score (OR = 1.503), anger (OR = 1.135) and restenosis; and there was negative correlation between physical activity (OR = 0.346), folate intake (OR = 0.926), Vitamin C ingestion (OR = 0.881) and restenosis.

The lifestyle and medication adherence of patients after percutaneous coronary intervention are predictors of restenosis, suggesting that it is necessary to strength intervention program to reduce restenosis.
Differential role of triggering receptors expressed on myeloid cells 2 R47H in 3 neurodegenerative diseases based on a systematic review and meta-analysis
Authors: Zhang Bin , Li Rui , Zhang Yufan , Gao Xia
Published: January 2020

Background:

Recent studies have suggested that the potential functional polymorphism R47H in triggering receptors expressed on myeloid cells 2 (TREM2) is associated with several neurodegenerative diseases, however, the results remain inconclusive. This meta-analysis aimed to investigate the association between TREM2 R47H and the risk for 3 typical neurodegenerative diseases: Alzheimer disease (AD), Parkinson disease (PD), and amyotrophic lateral sclerosis (ALS).

Methods:

A literature review was carried out using PubMed, Medline, and Embase. Data analysis was conducted using Stata 15.0 software. The pooled odds ratio (ORs) and 95% confidence interval (CIs) were calculated.

Results:

A total of 35 articles were identified as eligible: 22 on AD, 3 on ALS, 7 on PD, 2 on AD and ALS, and 1 on ALS and PD. The AD set included 23,092 cases and 30,920 controls, the ALS set included 7391 cases and 12,442 controls, and the PD set included 8498 patients and 9161 controls. We found that R47H was associated with an increased risk of AD in the total pooled population (P < .001, OR = 4.02, 95% CI = 3.15–5.13). However, this significant difference existed for Caucasian people (OR = 4.16, 95% CI = 3.24–5.33) but not for Asian or African people. Moreover, we did not find any significant differences in minor allele frequency distribution between the PD and control groups or between the ALS and control groups, not only for the total pooled population but also for the subgroups of different ethnicities.

Conclusion:

Our study suggested that R47H in the TREM2 gene leads to an increased risk for developing AD, but not for ALS and PD, which adds evidence to the notion that diverse pathogenesis may be involved in different neurogenerative diseases.
Bronchoscopic lung volume reduction procedures for emphysema
Authors: Xu Wu , Wang Junyi , He Xiang , Wang Junlan , Wu Dehong , Li Guoping
Published: January 2020

Bronchoscopic lung volume reduction (BLVR) offers alternative novel treatments for patients with emphysema. Comprehensive evidence for comparing different BLVR remains unclear. To estimate the effects of different BLVR on patients with emphysema. PubMed, EMBASE, Cochrane Library, and Web of Science databases from January 2001 to August 2017 were searched. Randomized clinical trials evaluated effects of BLVR on patients with emphysema. The relevant information was extracted from the published reports with a predefined data extraction sheet, and the risk of bias was assessed with the Cochrane risk of bias tools. Pair-wise metaanalyses were made using the random-effects model. A random-effects network meta-analysis was applied within a Bayesian framework. The quality of evidence contributing to primary outcomes was assessed using the GRADE framework. 13 trials were deemed eligible, including 1993 participants. The quality of evidence was rated as moderate in most comparisons. Medical care (MC)was associated with the lowest adverse events compared with intrabronchial valve (IBV)(-2.5,[-4.70 to -0.29]), endobronchial valve (EBV) (-1.73, [-2.37 to -1.09]), lung volume reduction coils (LVRC) (-0.76, [-1.24 to -0.28]), emphysematous lung sealant (ELS) (-1.53, [-2.66 to -0.39]), and airway bypass(-1.57, [-3.74 to 0.61]). Adverse events in LVRC were lower compared with ELS (-0.77,[-2.00 to 0.47]). Bronchoscopic thermal vapor ablation (BTVA) showed significant improvement in FEV1 compared with MC (0.99, [0.37 to 1.62]), IBV (1.25, [0.25 to 2.25]), and LVRC (0.72, [0.03 to 1.40] ). Six  minute walking distance (6 MWD) in ELS was significantly improved compared with other four BLVR, sham control, and MC (-1.96 to 1.99). Interestingly, MC showed less improvement in FEV1 and 6MWDcompared with EBV (-0.45, [-0.69 to -0.20] and -0.39, [-0.71 to -0.07], respectively). The mortality in MC and EBV was lower compared with LVRC alone (-0.38, [-1.16 to 0.41] and -0.50, [-1.68 to 0.68], respectively). BTVA and EBV led to significant changes in St George's respiratory questionnaire (SGRQ) compared with MC alone (-0.74, [-1.43 to -0.05] and 0.44, [0.11 to 0.78], respectively). BLVR offered a clear advantage for patients with emphysema. EBV had noticeable beneficial effects on the improvement of forced expiratory volume 1, 6MWD and SGRQ, and was associated with lower mortality compared with MC in different strategies of BLVR.
A pilot study exploring the efficacy and safety of herbal medicine on Korean obese women with metabolic syndrome risk factors
Authors: Kim Hyun-ju , Ko Youme , Kim Hojun , Cha Yun-Yeop , Jang Bo-Hyoung , Song Yun-Kyung , Ko Seong-Gyu
Published: January 2020

Background:

Obesity is associated with metabolic syndrome, a condition that increases one's risk for heart disease and other conditions. The prevalence of obesity and associated diseases have steadily increased among Korean adults. The effect of the herbal medicines Daesiho-tang (DSHT) and Chowiseungcheng-tang (CST) on obesity have been reported. The purpose of this study is to evaluate the efficacy and safety of Daesiho-tang and Chowiseungcheng-tang on obese Korean women with high risk for metabolic syndrome.

Methods/design:

This study is a randomized, double-blinded, placebo-controlled, multi-center, 3-arm, parallel group clinical trial. A total of 120 participants will be enrolled and randomly assigned to the Daesiho-tang group, the Chowiseungcheng-tang group, or the placebo group in a 1:1:1 ratio using an internet-based randomization system at visit 2. Each group will be administered DSHT, CST, or placebo 3 times per day for 12 weeks. The primary outcome is to evaluate the changes in mean body weight of participants in the DSHT and CST groups and compare with those in the placebo group, and determine their statistical significance, if any, after 12 weeks. The secondary outcomes are the following: changes in body fat percentage and body fat mass, changes in waist circumference, waist-to-hip ratio, and body mass index, changes in serum lipids, fasting blood sugar, blood pressure, and C-reactive proteins (CRP) levels between visit 1 and visit 5 measurements. Changes in visceral fat volume determined through abdominal computed tomography, patient-reported health outcomes surveys—the Korean version of the Obesity-related Quality of Life and the Korean version of Eating Attitudes Test.

Discussion:

This study will provide research methodologies for evaluating the efficacy and safety of Daesiho-tang and Chowiseungcheng-tang on obese Korean women with high risk for metabolic syndrome.

Trial registration: ClinicalTrials.gov, NCT02651454. Registered on 11 January 2016.

Protocol version: The final approved version of the trial protocol is V1.3.(2017.11.10).
Apremilast for the treatment of hidradenitis suppurativa associated with psoriatic arthritis in multimorbid patients
Authors: Garcovich Simone , Giovanardi Giulia , Malvaso Dalma , De Simone Clara , Peris Ketty
Published: January 2020

Introduction:

Hidradenitis suppurativa is a complex, chronic, difficult to treat condition belonging to the spectrum of cutaneous immune-mediated inflammatory diseases. Systemic treatment options for moderate-severe disease are limited to TNF-alpha antagonists and other biologic agents, with limited clinical evidence.

Patient concerns:

We report two adult patients with severe hidradenitis suppurativa presenting concomitant psoriatic arthritis and multiple medical comorbidities. Both were ineligible or resistant to adalimumab, the only biologic drug approved for the treatment of hidradenitis.

Diagnosis:

Both patients were diagnosed with severe Hurley III-stage disease and psoriatic arthritis, showing resistance to first-line systemic treatments and a complex comorbidity profile.

Interventions:

Patients underwent treatment with apremilast, an oral phosphodiesterase-4 inhibitor, approved for the treatment of psoriatic arthritis.

Outcomes:

After 16 weeks of treatment, a clinically relevant improvement of inflammatory lesions, skin- and arthritis-related pain, and patient-reported outcomes was achieved in both patients. Apremilast was well tolerated and continued up to 48 weeks of treatment.

Conclusion:

We report the “real-life” use of apremilast in the treatment of multimorbid patients with hidradenitis suppurativa and review its potential role in the management of this severe condition.
Identifying the insulin resistance index in nondiabetic Chinese subjects
Authors: Tuo Xiu , Yuan Jing , Wang Xu-Hong , Xin Zhong
Published: January 2020

In the present study, the performance of anthropometric parameters, lipid and glucose indexes, and the combination of anthropometric parameters with the TyG (triglycerides × fasting plasma glucose) metabolic index, was compared in detecting insulin resistance (IR) to evaluate the optimal cut-off points in nondiabetic Chinese individuals. A total of 1067 nondiabetics underwent oral glucose tolerance test, blood lipid, and fasting insulin measurements. The clinical usefulness of various parameters— body mass index (BMI), waist circumference (WC), TyG, triglycerides/ high density lipoprotein cholesterol ratio, and TyG with adiposity status (TyG-BMI [TyG × BMI] and TyG-WC)—was analyzed to identify IR. Spearman correlation and receiver-operating characteristic curve analyses were used to compare the predictive efficacy of different indicators. All indicators showed a positive correlation with IR in both normal glucose and all subjects. However, the correlation between BMI and homeostasis model assessment of IR index was higher than other indicators as assessed by Spearman correlation test (P < .05). Furthermore, BMI and TyG-BMI were better indicators than others as determined by comparing the area under the receiver-operating characteristics curves (P < .05) in detecting IR. BMI is a simple and accurate measure for detecting IR in Chinese subjects. The 27 kg/m2threshold was the optimal BMI cut-off point for detecting IR in both normal glucose and all glucose categories subjects.
Epithelial-myoepithelial carcinoma originating from a minor salivary gland in the nasal septum
Authors: Lee Young Sub , Ha Sun Mok , Paik Seung Won , Yang Hui Joon , Jeon Hyun Jong , Park Dong-Joon , Hwang Chi Sang
Published: January 2020

Rationale:

Epithelial-myoepithelial carcinoma is an extremely rare, malignant neoplasm that occurs most frequently in the major salivary glands and accounts for approximately 1% of all salivary gland neoplasms. Few reports have described the presence of epithelial-myoepithelial carcinoma in the sinonasal region; hence, the treatment guideline and prognosis remain unclear.

Patient concerns:

We reported a case of a 75-year-old woman with complaint of nasal obstruction and frequent epistaxis for 3 years. During the nasal endoscopic examination, a mass in the left nasal cavity originating from the left nasal septum that caused bleeding on touch was observed.

Diagnoses:

A diagnosis of epithelial-myoepithelial carcinoma was made based on the features of histopathology and immunohistochemistry of the surgical specimens. The patient was treated by surgical removal of the septal mass using the endonasal endoscopic approach.

Outcomes:

In the serial follow-up paranasal sinus imaging and endoscopic inspection, evidence of recurrence was absent for 18 months after surgery.

Lessons:

This report highlights a case of epithelial-myoepithelial carcinoma originating from a minor salivary gland in the nasal septum, one of the most unusual locations. Diagnosis of epithelial-myoepithelial carcinoma should be made based on the findings of immunohistochemistry of the operative specimen. Clinicians should consider complete surgical resection as the effective treatment of choice.
A Prolonged Activated Partial Thromboplastin Time in a Child With Hodgkin Lymphoma
Authors: Kara Buket , Kart Kubilay K. , Koksal Yavuz
Published: January 2020

A 3-year-old girl presented with fever and left-sided neck mass that did not resolve despite antibiotic treatment. Physical examination was normal except lymphadenopathy in the left cervical region. Complete blood count was Hb: 8.01 g/dL, leukocyte count: 4034/mm3, platelet count: 286,000/mm3. On preoperative period, coagulation studies revealed a prolonged activated partial thromboplastin time (aPTT, 46.1 s [N: 21 to 36]), corrected mixing test for aPTT. The prothrombin time and international normalized ratio were in normal limits. Factor VIII levels, von Willebrand factor antigen, and ristocetin cofactor were normal. After the patient was given fresh frozen plasma, lymph node excision was performed. As a result of pathologic examination, Hodgkin lymphoma was diagnosed as classic type. The patient was instituted ABVD chemotherapy protocol for Hodgkin lymphoma. The aPTT at the sixth day of treatment was within normal limits. Coagulation test abnormalities are extremely rare in Hodgkin lymphoma. To our knowledge, this is the first report of prolonged aPTT in a child with Hodgkin lymphoma.
Overhauling Nutrition Assistance Programs to Provide Comprehensive Nutrition Support for Older Adults
Authors: Bergia Robert E. , Jun Shinyoung , Byers Adam , Savaiano Dennis
Published: January 2020

Older adults want to “age in place,” but the currently fragmented and inadequate nutrition assistance environment is at odds with this goal. Given the substantial gap between resources needed to make the “Aging in Place” dream a reality and current level of support, investigation into mechanisms of an overhaul to nutrition assistance for older adults is warranted. In this article, we assess the need for comprehensive nutrition support for older adults, review the current federal nutrition support, provide rationales for legislation supporting nutrition support integration and expansion (with an emphasis on home nutrition support for older adults), and introduce operational approaches for an expansion. Older adults face unique challenges to maintaining adequate nutrition. Upwards of 19% of older adults with low incomes (those living in households below 185% of the poverty threshold) were food insecure, and approximately 90% of these individuals did not receive meal services. Fragmentation of federal services across the US Department of Agriculture and Department of Health and Human Services, mobility, technology use, and stigma surrounding assistance programs all but guarantee that older adults do not derive maximal benefit from available services. In light of the complementary nature of different nutrition policies and programs, leading policy experts have called for integrated, multicomponent government strategies that adapt and streamline existing structures and systems. We urge the US Department of Agriculture and the Department of Health and Human Services to conduct pilot studies granting states joint waiver authority for SNAP, Medicaid, Medicare Advantage, and the Older Americans Act Nutrition Program. Leveraging resources and information across parallel programs can allow more older adults to manifest their right to “age in place.”
The Emergence of the Term “Ultraprocessed” Foods in Nutrition Research
Authors: Ivens Barbara J.
Published: January 2020

“Ultraprocessed” is a relatively new term used to categorize foods. The purpose of this article is to document the emergence of the term in nutrition research literature for the past decade. A PubMed search for “ultraprocessed” in the title or abstract was conducted to document the term's use, frequency, and geographic origin. The term, which initially appeared in articles published by Brazilian researchers, is now widely used by the international research community. Because words matter, especially in nutrition education and food selection recommendations, it is important to track the use of terms such as “ultraprocessed” food. Consumer-focused research is needed that documents the understanding of such terms as aids in the selection of nutrient-dense foods as components of a balanced diet.
The Relationship of Injury and Complaints of Police Use of Excessive Force
Authors: Strote Jared , Hickman Matthew J.
Published: January 2020

Use of excessive force (UOEF) is an important and controversial topic but little is known about how injury severity is related to allegations of UOEF. We hypothesized that such complaints would be associated with more significant traumatic injuries. Emergency department records were searched for all individuals making UOEF complaints against an urban police department from 2010 to 2012. Demographic, diagnosis, and other medical data, including Injury Severity Score, were obtained. From police records, force used, suspect resistance and threat, and other call data were obtained. The same data were collected for a control group randomly chosen from all use-of-force events identified during the study period. Of the 235 complaints filed, 42 (18%) subjects had medical evaluation. The control group was significantly younger and more likely to be male; there was no significant difference in race or income. Major injuries were infrequent. No significant difference was found in Injury Severity Score or other medical variables between the 2 groups. Among the law enforcement variables, the only significant difference was a higher likelihood of psychiatric-related calls in the control group. The majority of patients alleging UOEF did not require immediate medical attention, and we found no relationship between injury severity and UOEF complaints.
The HIV Continuum of Care for Adolescents and Young Adults Attending 13 Urban US HIV Care Centers of the NICHD-ATN-CDC-HRSA SMILE Collaborative
Authors: Kapogiannis Bill G. , Koenig Linda J. , Xu Jiahong , Mayer Kenneth H. , Loeb Jacqueline , Greenberg Lauren , Monte Dina , Banks-Shields Marinna , Fortenberry J. Dennis ,   the Adolescent Medicine Trials Network for HIV/AIDS Interventions
Published: January 2020

Background:

Almost one-quarter of all new HIV diagnoses in the United States occur among persons aged 13–24 years. These youths have the poorest HIV care continuum (HCC) outcomes, yet few empirical youth-specific data are available.

Methods:

The Strategic Multisite Initiative for the Identification, Linkage, and Engagement in Care of HIV-infected youth (SMILE) helped HIV-infected (mostly newly diagnosed) youth, aged 12–24 years, link to youth-friendly care, and evaluated each milestone of the HCC (October 2012–September 2014). Numbers of HIV-infected youth referred, linked, engaged, and retained in care were recorded, along with sociodemographics. Viral suppression (VS) was defined as ≥1 HIV viral load (VL) below the level of detection on study. Correlates of VS were examined using Cox proportional hazards models.

Results:

Among 1411 HIV-infected youth, 1053 (75%) were linked, 839 (59%) engaged, and 473 (34%) retained in care at adolescent health care sites. Antiretroviral therapy was initiated among 474 (34%), and 166 (12%) achieved VS. Predictors of VS included lower VL at baseline [aHR 1.56 (95% CI: 1.32–1.89), P < 0.0001], recent antiretroviral therapy receipt [aHR 3.10 (95% CI: 1.86–5.18), P < 0.0001], and shorter time from HIV testing until referral to linkage coordinator [aHR 2.52 (95% CI: 1.50–4.23), P = 0.0005 for 7 days to 6 weeks and aHR 2.08 (95% CI: 1.08–4.04), P = 0.0294 for 6 weeks to 3 months compared with >3 months].

Conclusions:

Although this large national sample of predominately newly diagnosed youths linked to care at similar rates as adults, they achieved disproportionately lower rates of VS. Prompt referral to youth-friendly linkage services was an independent predictor of VS. Youth-focused interventions are urgently needed to improve their HCC outcomes.
Sjögren Syndrome in the Intensive Care Unit
Authors: Ruiz-Ordoñez Ingrid , Aragón Cristian C. , Padilla-Guzmán Alejandro , Rosero Felipe , Gallego Anggie , Quintana Jhon H. , Suárez-Avellaneda Ana , Tobón Gabriel J.
Published: January 2020

Background/Objective

Studies on the clinical characteristics, prognosis, and factors associated with mortality in patients with Sjögren syndrome (SS), particularly those in the intensive care unit (ICU), are limited. The present study aimed to describe clinical and immunological variables associated with mortality in patients with SS admitted to ICU at a single center in Cali, Colombia.

Methods

An observational, medical records review study was performed between 2011 and 2019 by reviewing the clinical records of patients with SS admitted to ICU at a high-complexity center.

Results

Seventy-two patients were included with a total of 117 ICU admissions (17 cases required readmission and 1 case required 17 readmissions): 103 (86.32%) were attributable to medical issues, and 14 corresponded to surgical admissions. Major causes of ICU medical admission were infection (44/103) followed by organ involvement. Only 5 admissions were related to SS due to neurological involvement. The APACHE (Acute Physiology, Age, and Chronic Health Evaluation) score was 10 (interquartile range [IQR], 7–16), the SOFA (Sequential Organ Failure Assessment) score was 2 (IQR, 0–14), and the EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) score was 0 (IQR, 0–12) with higher values in the nonsurvivor group. Intensive care unit mortality was 12/72 (16.67%).

Conclusions

The main cause of ICU admission was infection. Patients with increased medical requirements, such as mechanical ventilation and vasopressor support, and with higher APACHE, SOFA, and ESSDAI scores were more susceptible to poor outcomes. Moreover, 50% of deaths were attributable to SS and 25% to infection.
Effects of Video Discharge Instructions on Patient Understanding
Authors: Wilkin Zebulon L.
Published: January 2020

Previous studies demonstrated that patients have difficulty understanding and retaining discharge instructions due to the lack of time spent counseling patients and low health literacy rates. The purpose of this study was to evaluate the effects of video instructions on patient understanding of their discharge instructions. This was a prospective, randomized, controlled trial of a convenience sample conducted in a military hospital emergency department. Adult patients with a diagnosis of upper respiratory tract infection, pharyngitis, or gastroenteritis were included into the study. Investigators randomized subjects to either standard discharge procedures or standard discharge procedures plus video discharge instructions, using a random number generator. Ten minutes after receiving one of these 2 discharge education methods, subjects demonstrated their knowledge of their discharge instructions using a predefined 5-question, multiple-choice questionnaire. From October 1, 2015, to January 8, 2016, a total of 60 subjects volunteered to participate in the study. Zero subjects were excluded, and all subjects completed the study protocol. Baseline characteristics between groups were not significantly different (30 video discharge instructions and 30 standard discharge instructions). We found a significant difference between groups with respect to discharge instructions knowledge in favor of the video discharge instructions group (4.53 vs. 4; p = 0.009). Video discharge instructions, used as an adjunct to standard verbal and written discharge methods, improved patient understanding and retention of their discharge instructions.
Improved Concussion Discharge Instructions in a Pediatric Emergency Department
Authors: Keenan Ryan P. , Lovanio Kathleen , Lapidus Garry , Chenard Danielle , Smith Sharon
Published: January 2020

Pediatric concussions are common and many children seek care in emergency departments. Providing concussion discharge instructions to patients and families is part of routine standard of care. The objective of this study was to determine whether the use of the Acute Concussion Evaluation-Emergency Department Discharge Instructions (ACE-ED DI) improves the caregiver's knowledge of injury management, specifics about returning to school and sports activities, and outpatient follow-up. This was a quasi-experimental study conducted in an urban Level 1 trauma center pediatric emergency department (PED). A convenience sample of caregivers of children aged 5–18 years who presented to the PED with a concussion was recruited and consented to participate. Caregivers completed a 16-item survey to assess overall understanding of concussion management after instructions were given. Caregivers received the standard discharge instructions (SDIs) in Phase 1 and SDIs plus the ACE-ED DI in Phase 2. Descriptive statistics were used for demographic variables and t-test to compare groups. Sixty-three of 68 (93%) caregivers participated; 30 in the SDI group and 33 in the SDI plus ACE-ED DI group. Demographic characteristics were similar between groups. Caregivers who received the ACE-ED DI reported a 24% increase in helpfulness of written materials (p < 0.001), a 25% increase in perceived understanding about concussion injury and management (p < 0.001), a 23% increase in understanding about returning to school activities (p < 0.001), and were 17% more likely to follow up with their primary care provider (p < 0.001). The ACE-ED DI used in a PED was found to be more effective at increasing caregivers' perceived knowledge of concussion management, specifics about returning to school and sports activities, and outpatient follow-up.
Marijuana Use
Authors: Abrams Tara , Gantioque Raymund
Published: January 2020

There is an emerging subset of patients who present to the emergency department (ED) with cannabinoid hyperemesis syndrome (CHS). Cannabinoid hyperemesis syndrome is a relatively new clinical condition and despite a long documented marijuana use in humans, little is known about the pathophysiology of this emerging problem. The focus of this article is to present a patient who presented with CHS. The clinical presentation, diagnostics, and treatment for this patient will be discussed. The nurse practitioner can anticipate high utilization of patients presenting to the ED with CHS. Nurse practitioners need to provide early recognition and careful management of patients who present with this condition.
Management of Acute Idiopathic (Viral) Pericarditis in the Emergency Department
Authors: Schwier Nicholas C. , Cannedy J. Jacob , Skrepnek Grant H.
Published: January 2020

Acute pericarditis is an inflammatory disorder that contributes to chest pain admissions in the emergency department (ED). Nursing professionals can play a vital role in the differential, triage and management of acute pericarditis in the ED. First-line pharmacotherapy to specifically treat acute pericarditis of viral or idiopathic origin is paramount in improving patients' quality of life and reducing the risk of further recurrences of pericarditis and consists of combination therapy with aspirin (acetylsalicylic acid [ASA]) or a nonsteroidal anti-inflammatory drug (NSAID), in combination with colchicine. Corticosteroids should not be initiated as first-line therapy in idiopathic (viral) pericarditis, as they increase the risk of recurrences. Nursing professionals are also pivotal in monitoring pharmacotherapy with respect to safety and efficacy. Overall, the nursing professional can facilitate timely administration and monitoring of medications, provide patient education, promote adherence, and assist in transitions of care for patients diagnosed with acute idiopathic (viral) pericarditis in the ED.
Fibromatosis Colli
Authors: Valentino Katie , Tothy Alison S.
Published: January 2020

Fibromatosis colli is a rare, usually self-limiting condition caused by a benign tumor in the sternocleidomastoid muscle. The tumor occurs most often during infancy and can be clinically associated with torticollis. Accurate diagnosis of fibromatosis colli is important to avoid unnecessary invasive interventions. Radiographic imaging is fundamental to differentiating this benign tumor from other causes of neck masses/swelling in infants. In this article, we discuss the case of a 4-month old child who presented with a head tilt and had imaging that favored a diagnosis of fibromatosis colli.
Acute Treatment of Pediatric Migraine
Authors: Cook Calli
Published: January 2020

The purpose of the Research to Practice column is to review and critique current research articles that directly affect the practice of the advanced practice nurse (APN) in the emergency department. This review examines the findings of M. Oskoui et al. (2019) from their article, “Practice guideline update summary: Acute treatment of migraine in children and adolescents: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society.” The authors completed an extensive literature review and created eight recommendations for the acute treatment of pediatric migraine focusing on medication selection, dosing, patient education, and patient counseling. By applying the evidence-based guidelines presented in this study, the urgent care or emergency department APN can confidently recognize and treat acute migraine symptoms and reduce patient risks from unnecessary testing and overuse of acute migraine medications.
Different Severity of Clinical Outcomes Between the 2 Subgroups of Stage 1 Acute Kidney Injury After Liver Transplantation
Authors: Lee Ho-Jin , Kim Won Ho , Jung Chul-Woo , Suh Kyung-Suk , Lee Kook Hyun
Published: January 2020

Background.

Although the Kidney Disease: Improving Global Outcomes (KDIGO) criteria is used to define acute kidney injury (AKI) after liver transplantation, the criteria was criticized for including 2 heterogeneous groups of different serum creatinine (sCr) criteria together in AKI stage 1. We investigated whether there are significant differences in clinical outcomes between 2 subgroups of patients within AKI stage 1.

Methods.

A total of 1440 cases were reviewed. The AKI stage 1 (n = 443) were divided into 2 subgroups based on changes in sCr level (stage 1a: ≥0.3 mg/dL of absolute sCr increase, n = 251; stage 1b: ≥50% relative sCr increase, n = 192). Propensity score analysis was performed between stage 1a and 1b groups, yielding 157 matched pairs. We compared the length of hospital stay, early allograft dysfunction, and 5-year all-cause mortality between these subgroups after matching. Kaplan–Meier analyses were performed to compare the graft or overall survival between the subgroups after matching. Sensitivity analysis for Acute Kidney Injury Network (AKIN) criteria was performed.

Results.

Length of hospital stay and 5-year all-cause mortality was significantly worse in patients with stage 1b compared to stage 1a after matching. Five-year graft or patient survival was significantly worse in patients with stage 1b compared to stage 1a after matching (Log-rank test P = 0.022 and P = 0.027, respectively). These results were the same regarding AKIN criteria.

Conclusions.

The KDIGO criteria for AKI stage 1 could be further divided into 2 substages with different severity of clinical outcomes. This modified criteria could give additional prognostic information in patients undergoing liver transplantation.
Uncontrolled Donation After Circulatory Death: A Unique Opportunity
Authors: Coll Elisabeth , Miñambres Eduardo , Sánchez-Fructuoso Ana , Fondevila Constantino , Campo-Cañaveral de la Cruz José Luis , Domínguez-Gil Beatriz
Published: January 2020

Uncontrolled donation after circulatory death (uDCD) refers to donation from persons who die following an unexpected and unsuccessfully resuscitated cardiac arrest. Despite the large potential for uDCD, programs of this kind only exist in a reduced number of countries with a limited activity. Barriers to uDCD are of a logistical and ethical-legal nature, as well as arising from the lack of confidence in the results of transplants from uDCD donors. The procedure needs to be designed to reduce and limit the impact of the prolonged warm ischemia inherent to the uDCD process, and to deal with the ethical issues that this practice poses: termination of advanced cardiopulmonary resuscitation, extension of advanced cardiopulmonary resuscitation beyond futility for organ preservation, moment to approach families to discuss donation opportunities, criteria for the determination of death, or the use of normothermic regional perfusion for the in situ preservation of organs. Although the incidence of primary nonfunction and delayed graft function is higher with organs obtained from uDCD donors, overall patient and graft survival is acceptable in kidney, liver, and lung transplantation, with a proper selection and management of both donors and recipients. Normothermic regional perfusion has shown to be critical to achieve optimal outcomes in uDCD kidney and liver transplantation. However, the role of ex situ preservation with machine perfusion is still to be elucidated. uDCD is a unique opportunity to improve patient access to transplantation therapies and to offer more patients the chance to donate organs after death, if this is consistent with their wishes and values.
Structure and Function of Porcine Arteries Are Preserved for up to 6 Days Using the HypoRP Cold-storage Solution
Authors: Dréau Didier , Wang Shangping , Clemens Mark , Elliott Gloria D.
Published: January 2020

Background.

Maintaining functional vessels during preservation of vascularized composite allografts (VCAs) remains a major challenge. The University of Wisconsin (UW) solution has demonstrated significant short-term benefits (4–6 h). Here we determined whether the new hypothermic resuscitation and preservation solution HypoRP improves both structure, survival, and function of pig arteries during storage for up to 6 days.

Methods.

Using porcine swine mesenteric arteries, the effects of up to 6-day incubation in a saline (PBS), UW, or HypoRP solution on the structure, cell viability, metabolism, and function were determined.

Results.

After incubation at 4°C, for up to 6 days, the structures of the arteries were significantly disrupted, especially the tunica media, following incubation in PBS, in contrast with incubation in the HypoRP solution and to a lesser extent, in UW solution. Those disruptions were associated with increased active caspase 3 indicative of apoptosis. Additionally, while incubation in PBS led to a significant decrease in the metabolic activity, UW and HypoRP solutions allowed a stable to increased metabolic activity following 6 days of cold storage. Functional responsiveness to phenylephrine (PE) and sodium nitroprusside (SNP) decreased over time for artery rings stored in PBS and UW solution but not for those stored in HypoRP solution. Moreover, artery rings cold-stored in HypoRP solution were more sensitive to ATP.

Conclusions.

The HypoRP solution improved long-term cold storage of porcine arteries by limiting structural alterations, including the collagen matrix, reducing apoptosis, and maintaining artery contraction-relaxation functions for up to 6 days.
Updates in the Management of Cryptogenic Stroke and Patent Foramen Ovale
Authors: Stone David K. , Buchwald Natalie , Wilson Christina A.
Published: January 2020

Background:

Stroke is a common neurological disorder and may present with visual symptoms. A thorough workup is warranted to determine the underlying cause of stroke to optimize secondary prevention. Despite a full workup, a high-risk mechanism may not be identified. Optimal treatment in this patient population has been the subject of recent research, particularly with regard to low-risk stroke mechanisms such as patent foramen ovale (PFO).

Evidence acquisition:

Using PubMed and published stroke guidelines, an evidence-based literature review was performed.

Results:

In this review, we compare cryptogenic stroke with the newer concept of embolic stroke of undetermined source, summarize the most common causes presumed to underlie these strokes, and review the evidence for optimal antithrombotic management. We also review recent clinical trials demonstrating a benefit for percutaneous closure of PFO for secondary stroke prevention in select patients.

Conclusions:

Stroke management is based on evaluation of individual patient-risk factors. Evaluation and treatment is ideally directed by a vascular neurologist to ensure optimal secondary prevention, especially in cases where an underlying etiology is not identified on initial workup.