bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Stromal Herpes Simplex Virus Keratitis With Epithelial Ulceration Using Optical Coherence Tomography–Generated Corneal Thickness Maps
Authors: Lu Louise , Palioura Sotiria
Published: July 2020

Purpose:

To report 2 cases of herpes simplex virus (HSV) stromal keratitis with epithelial ulceration that were managed using optical coherence tomography–generated pachymetric and corneal epithelial thickness maps.

Methods:

Two patients with a history of HSV keratitis with nonhealing epithelial defects were referred to the Athens Vision Eye Institute. Anterior segment optical coherence tomography–generated pachymetric and corneal epithelial thickness maps showed subclinical stromal edema and irregular epithelium, thus indicating diagnoses of HSV stromal keratitis with epithelial ulceration. The patients were administered topical preservative-free dexamethasone and oral antiviral therapy. Steroid tapering was guided by pachymetric and corneal epithelial thickness maps at each follow-up visit.

Results:

Both patients experienced initial healing of the epithelium and resolution of stromal inflammation. One patient had a recurrence of HSV stromal keratitis with epithelial defect 3 months after initial improvement, with pachymetric and corneal epithelial thickness maps indicating subclinical stromal edema. He was reintroduced to topical steroid therapy, and the stromal edema and epithelial defect subsequently resolved. Both patients have had no recurrences in the past year.

Conclusions:

Pachymetric and corneal epithelial thickness maps provide an objective assessment of stromal inflammation and the following 2 clinical advantages in the management of HSV stromal keratitis with epithelial ulceration: (1) they help differentiate it from HSV epithelial keratitis with geographic ulceration and neurotrophic keratopathy and (2) offer objective measurements to guide management with topical corticosteroids until resolution of stromal edema. Thus, treatment can be initiated in a timely manner, and the blinding complications of HSV stromal keratitis can be avoided.
Predictors of Vision-Related Quality of Life After Endothelial Keratoplasty in the Descemet Endothelial Thickness Comparison Trials
Authors: Pickel Julia , Chamberlain Winston D. , Lin Charles C. , Austin Ariana , Clover Jameson , Lietman Thomas M. , Rose-Nussbaumer Jennifer
Published: July 2020

Purpose:

To determine which baseline characteristics are associated with vision-related quality of life (QOL) after endothelial keratoplasty.

Methods:

A patient- and outcome-masked randomized clinical trial. Consecutive patients presenting with isolated endothelial disease requiring endothelial keratoplasty at Oregon Health Sciences University and Stanford University. Study eyes randomized to one of the 2 types of endothelial keratoplasty were given the national eye institute vision function questionnaire 25 at baseline and 12 months. In this prespecified secondary outcome, we assessed the role of recipient and donor characteristics as predictors of the 12-month national eye institute vision function questionnaire 25 change score.

Results:

The mean vision function questionnaire (VFQ) score was 74 (SD 14) at baseline and increased to 82 (SD 12) at 3 months and 87 (SD 10) at 12 months. We were unable to find a difference in vision-related QOL in study participants who underwent Descemet membrane endothelial keratoplasty compared with ultrathin Descemet stripping endothelial keratoplasty [coef −0.98, 95% confidence interval (CI) −9.27 to 7.31; P = 0.82]. In multivariable analysis, patients who underwent endothelial keratoplasty in 2 eyes had approximately 8 points higher VFQ at 12 months after the second eye than those who had only one eye enrolled (95% CI 0.10–15.72; P = 0.047). Posterior densitometry produced an approximately 1-point increase each in the VFQ change score for each 1 grayscale unit increase at baseline (95% CI 0.26–1.81; P = 0.009). Although the sample size was small, a diagnosis of pseudophakic bullous keratopathy had approximately 19-points more improvement on average compared with Fuchs (95% CI 7.68–30.00; P = 0.001).

Conclusions:

Bilateral endothelial keratoplasty resulted in higher vision-related QOL compared with unilateral. Baseline densitometry, objective measure of corneal haze that predicts vision-related QOL, may play a role in monitoring disease progression.
Recipient Factors Associated With Graft Detachment of a Subsequent Eye in Sequential Descemet Membrane Endothelial Keratoplasty
Authors: Kim Kyeong Hwan , Tijunelis Marius A. , Zhou Yunshu , Musch David C. , Hood Christopher T. , Tannen Bradford L. , Mian Shahzad I.
Published: July 2020

Purpose:

To evaluate the recipient factors associated with graft detachment in the subsequent eye of patients who underwent sequential Descemet membrane endothelial keratoplasty (DMEK).

Methods:

A retrospective, consecutive case series with 158 eyes of 79 patients who underwent DMEK surgeries in both eyes between October 2013 and April 2019 for treatment of Fuchs endothelial dystrophy. The main outcome measure was the presence of graft detachment (any amount of detachment) at postoperative 1 week in the subsequent eye. Preoperative, intraoperative, and postoperative factors were evaluated for association with graft detachment.

Results:

Of 79 patients (158 eyes) with a mean follow-up of 11.7 ± 8.4 months, 18 patients (36 eyes) developed graft detachment in both eyes 1 week postoperatively. The risk of detachment in the subsequent eye was increased when the first eye had any amount of detachment [odds ratio = 2.8; 95% confidence interval (CI) = 1.1–7.3; P = 0.037]. When the first eye had a clinically significant detachment (>30% detached), the risk of detachment occurring in the subsequent eye was greater (odds ratio = 15.7; 95% CI = 1.8–134.5; P = 0.012). This risk of graft detachment in the subsequent eye increased 33% for every 5% increase in the detachment percentage in the first eye (odds ratio = 1.3; 95% CI = 1.1–1.6; P = 0.008).

Conclusions:

The presence of graft detachment after DMEK increases the risk of graft detachment in subsequent DMEK in the contralateral eye. Modification in perioperative care and surgical technique in the contralateral eye, such as a larger gas bubble, use of SF6 20%, and combining cataract surgery, may be needed when graft detachment occurs after DMEK in the first eye.
Cyanoacrylate Tissue Adhesive for the Treatment of Corneal Thinning and Perforations: A Multicenter Study
Authors: Anchouche Sonia , Harissi-Dagher Mona , Segal Laura , Racine Louis , Darvish-Zargar Mahshad , Robert Marie-Claude
Published: July 2020

Purpose:

To examine the outcomes of cyanoacrylate tissue adhesive (CTA) application for impending or frank corneal perforations and assess for predictors of treatment response.

Methods:

A multicenter cohort study was conducted to assess the clinical outcomes of adult patients who underwent CTA gluing for impending or frank corneal perforations between 2013 and 2018. The primary outcome was the proportion of successful CTA applications, defined as tectonic stability of the globe without subsequent keratoplasty (KP). Secondary outcomes included visual acuity and success of subsequent surgical interventions, if performed.

Results:

Fifty-three eyes of 52 patients were included in this study [56% women; mean age at presentation 70 ± 13 years; median length of follow-up of 387 days (interquartile range: 191–704)]. Medical comorbidities were present in 62% of patients. The most common etiologies for perforations included infections (43%) and Sjogren disease (9%). Of the CTA-treated eyes, 22% had a complete resolution of the corneal lesion. Fifty-four percent of patients underwent KP. Longer duration of CTA treatment was associated with CTA success (P = 0.04). For patients requiring KP, 71% were successful and 29% failed. There is no significant difference in the median time delay between patients with successful and failed KPs (P = 0.4).

Conclusions:

CTA may be considered a stand-alone treatment for corneal perforations. It yielded a success rate of 22%. Failed CTA treatment occurred quickly, largely because of the severity of presentation. In cases requiring KP, the delay between glue application and surgery did not influence the PK success.
Longitudinal Corneal Endothelial Cell Changes in Patients Undergoing Hematopoietic Stem Cell Transplantation
Authors: Pellegrini Marco , Giannaccare Giuseppe , Bernabei Federico , Moscardelli Fabiana , Sessa Mariarosaria , Arpinati Mario , Bonifazi Francesca , Versura Piera
Published: July 2020

Purpose:

To evaluate longitudinally corneal endothelial cell changes in patients undergoing hematopoietic stem cell transplantation (HSCT) and to further investigate possible correlations with hematological and ocular characteristics.

Methods:

Prospective observational study conducted at a single center. All patients underwent a comprehensive ophthalmological examination, before and after HSCT, including slitlamp examination, Schirmer test, tear breakup time, ocular surface staining, specular microscopy of corneal endothelium, and Ocular Surface Disease Index questionnaire.

Results:

Twenty-five patients undergoing HSCT and 25 age- and sex-matched controls were included. At baseline, hematological patients showed significantly lower values of endothelial cell density (ECD) compared with those of controls (2514.5 ± 390.2 vs. 2723.7 ± 298.0 cells/mm2, P = 0.038). After HSCT, ocular surface disease index score significantly increased (P = 0.020) and tear breakup time significantly decreased (P = 0.036). Conversely, no significant changes were found in Schirmer test and corneal fluorescein staining (always P > 0.05). Eight patients (32%) developed ocular graft-versus-host disease (GVHD). ECD values significantly decreased after HSCT (from 2514.5 ± 390.2 to 2409.5 ± 330.9 cells/mm2, P = 0.009). The decrease in ECD values after HSCT was more pronounced in patients with ocular GVHD compared with those without (231.1 ± 188.8 vs. 45.6 ± 156.5, P = 0.016). No significant correlations between the changes in ECD and hematological and ocular characteristics were found (always P > 0.05).

Conclusions:

Hematological patients showed a lower endothelial cell count already before HSCT, compared with controls. After HSCT, the endothelial cell count further significantly decreased, particularly in patients who developed ocular GVHD.
Impact of On-Site Hospital Medicine Curriculum on Preceptor Perception of Rotation
Authors: Sharma Poonam , Brooks Megan , Roomiany Pahresah , Verma Lalit , Criscione-Schreiber Lisa
Published: July 2020

Purpose

To assess the feasibility of an on-site, case-based curriculum delivered by preceptors and to assess preceptors' perceptions of the impact of the curriculum on rotation performance and ability to teach.

Methods

Hospital medicine preceptors were surveyed before and after curriculum deployment using a previously developed survey.

Results

Preceptors had positive perceptions of the impact of the curriculum. Rotation performance for health care systems topics had the greatest increase.

Conclusions

Curriculum delivery through on-site, case-based teaching might be well received by preceptors. Despite increased demands on preceptor time, preceptor response to the introduction of a structured curriculum during the second-year internal medicine rotation was positive. Use of preceptor-delivered, preprepared, case-based curricular content might be a tool worth testing in further contexts.
Endoscope infection transmission state-of-the-art: beyond duodenoscopes to a culture of infection prevention
Authors: Hutfless Susan
Published: July 2020

Purpose of review

The elevator mechanism of the duodenoscope was the focus of endoscopically transmitted infections prior to the COVID-19 pandemic. Since that time, the ‘suspicious suspects’ in the endoscopy unit have grown in number in the eyes of both patients and endoscopists.

Recent findings

This review summarizes the existing guidelines related to infection control in the endoscopy unit and emerging technologies to address gaps, identifies recommendations proposed during the COVID-19 pandemic, and reminds the reader that infection prevention has not changed since the emergence of COVID-19, only the importance of infection prevention has increased in visibility.

Infection prevention has been and will always be necessary in the gastrointestinal endoscopy unit. Although outbreaks of antibiotic-resistant organisms and infectious diseases like COVID-19 raise the profile of infection control, there have been no major changes to infection control practice recommendations because of the global pandemic. The history of lapses in infection control, persistent contamination of reprocessed endoscopes, and failure of many endoscopy units to identify certain endoscopic procedures as aerosol-generating procedures prior to the pandemic emphasize the need for better knowledge and implementation of infection control practices within endoscopy units.
Prostate-specific membrane antigen targeted PET imaging for prostate cancer recurrence
Authors: Ferdinandus Justin , Fendler Wolfgang Peter , Hadaschik Boris , Herrmann Ken
Published: July 2020

Purpose of review

Prostate-specific membrane antigen targeted PET imaging (PSMA PET) of biochemically recurrent prostate cancer (BCR) is implemented in routine management in many countries and recommended in European Association of Urology (EAU) and American Society of Clinical Oncology (ASCO) guidelines. Purpose of this review is to summarize recently published evidence of accuracy, management impact, and clinical benefit of PSMA PET in this setting and to state our opinion on the role of PSMA PET in future trials and clinical routine to improve patient outcomes.

Recent findings

The past two years saw an increase of evidence supporting superior detection rates and accuracy of PSMA PET versus standard imaging and other PET radiotracers in the localization of BCR. Systematic reviews, prospective trials and large-scale retrospective studies establish PSMA PET as a new benchmark imaging in this setting and demonstrate considerable impact on therapeutic and diagnostic management. Multiple studies have highlighted pitfalls of PSMA PET imaging warranting attention while interpreting these scans.

PSMA PET is the new imaging method of choice in BCR. Recent evidence shows unprecedented accuracy and high detection rates along with translation into management changes in a majority of patients. However, improvement of oncologic outcome has not been assessed yet. Implementation of PSMA PET into clinical trials and management of BCR will be crucial to demonstrate outcome improvement.
Volume outcome relationship in penile cancer: a systematic review
Authors: Quhal Fahad , Pradere Benjamin , Mori Keiichiro , Shariat Shahrokh F.
Published: July 2020

Purpose of review

Penile cancer is a rare disease with significant morbidity. Because of the low volume of cases, it has been suggested that its treatment should be centralized in order to improve outcomes through better management of both the primary tumor and distant disease. We reviewed and summarized the most relevant recent publications regarding centralization of penile cancer management.

Recent findings

Management of penile cancer in academic and supra-regional centers was associated with better survival outcomes. Moreover, reports from population-based studies showed more adherence to guidelines recommendations in academic centers with higher utilization of organ sparing treatments and invasive inguinal lymph node staging.

The optimal management of penile cancer remains a major therapeutic challenge. Patients with invasive tumors are less adequately managed in lower volume nonspecialized centers. The data convincingly support efforts to centralize penile cancer care and to promote the development of centers of expertise in order to achieve the best possible outcomes for each patient.
Patient Transfer for Hand and Upper Extremity Injuries: Diagnostic Accuracy at the Time of Referral
Authors: Amador Ricardo O. , Wilkens Suzanne , Gottlieb Rachel , Sood Ravi F. , Cetrulo Curtis L. , Chen Neal C. , Eberlin Kyle R.
Published: July 2020

Background:

Local health care facilities are often unequipped to treat complex upper extremity injuries, and patients are therefore transferred to designated trauma centers. This study describes the characteristics of patients transferred to a Level I trauma center for hand and upper extremity injuries and to investigate the accuracy of the provided diagnosis at the time of referral.

Methods:

Adult patients transferred from outside facilities to the authors’ Level I trauma center by means of direct contract with the on-call fellow for the care of hand and upper extremity injuries were identified. Patient- and injury-related information was prospectively collected at the time of referral before patient transfer, and again following diagnostic evaluation by a hand surgeon at the authors’ institution.

Results:

Sixty-three patients were transferred to the authors’ hand surgery service from outside facilities after direct contact with the on-call fellow. Most patients were referred by emergency medicine physicians [n = 47 (76 percent)], followed by midlevel emergency department providers (physician assistant or nurse practitioner) [n = 12 (19 percent)] or hand surgeons [n = 3 (5 percent)]. Six patients were transferred directly from a Level I trauma center. Twenty-one transferred patients (33 percent) had an inaccurate diagnosis at the time of referral. Factors associated with an inaccurate diagnosis included trauma level of the referring hospital and diagnoses of infection or dysvascularity.

Conclusions:

The diagnostic accuracy for hand injuries transferred from outside facilities by means of provider-to-provider communication is imperfect, and some injuries are misdiagnosed. Hand surgeons should continue to improve the triage and transfer process for patients with acute hand surgery injuries.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Diagnostic, IV.
Nonsyndromic Craniosynostosis Is Associated with Increased Risk for Psychiatric Disorders
Authors: Tillman Karin K. , Höijer Jonas , Ramklint Mia , Ekselius Lisa , Nowinski Daniel , Papadopoulos Fotios C.
Published: July 2020

Background:

Craniosynostosis is one of the most common craniofacial malformations demanding surgical treatment in infancy. Data on overall psychiatric morbidity among children with nonsyndromic craniosynostosis remain limited. This study investigated the risk of psychiatric disorders in nonsyndromic craniosynostosis.

Methods:

The authors reviewed a register-based cohort of all individuals born with nonsyndromic craniosynostosis in Sweden between 1973 to 1986 and 1997 to 2012 (n = 1238). The nonsyndromic craniosynostosis cohort was compared with a matched community cohort (n = 12,380) and with unaffected full siblings (n = 1485). The authors investigated the risk of psychiatric disorders, suicide attempts, and suicides by using Cox regression adjusted for perinatal and somatic factors, season and birth year, sex, parental socioeconomic factors, and parental psychiatric disorders.

Results:

Children with nonsyndromic craniosynostosis had a higher risk of any psychiatric disorder (adjusted Cox-derived hazard ratio, 1.70; 95 percent CI, 1.43 to 2.02), including intellectual disability (adjusted Cox-derived hazard ratio, 4.96; 95 percent CI, 3.20 to 7.70), language disorders (adjusted Cox-derived hazard ratio, 2.36; 95 percent CI, 1.57 to 3.54), neurodevelopmental disorders (adjusted Cox-derived hazard ratio, 1.30; 95 percent CI, 1.01 to 1.69), and other psychiatric disorders (adjusted Cox-derived hazard ratio, 1.43; 95 percent CI, 1.11 to 1.85). Full siblings with nonsyndromic craniosynostosis were more likely, in the crude analyses, to be diagnosed with any psychiatric disorder, including intellectual disability, language disorders, and neurodevelopmental disorders compared with nonaffected siblings. The higher risk for any psychiatric disorder and intellectual disability remained after adjusting for confounders.

Conclusions:

Children with nonsyndromic craniosynostosis demonstrated higher risks of any psychiatric disorder compared with children without nonsyndromic craniosynostosis. This risk cannot fully be explained by familial influences (i.e., genetic or environmental factors).

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
A Comprehensive Review of Surgical Treatment of Migraine Surgery Safety and Efficacy
Authors: Hatef Daniel A. , Gutowski Karol A. , Culbertson Gary R. , Zielinski Marta , Manahan Michele A.
Published: July 2020

Background:

Recent clinical experience with migraine surgery has demonstrated both the safety and the efficacy of operative decompression of the peripheral nerves in the face, head, and neck for the alleviation of migraine symptoms. Because of the perceived novelty of these procedures, and the paranoia surrounding a theoretical loss of clinical territory, neurologists have condemned the field of migraine surgery. The Patient Safety Subcommittee of the American Society of Plastic Surgeons ventured to investigate the published safety track record of migraine surgery in the existing body of literature.

Methods:

A comprehensive review of the relevant published literature was performed. The relevant databases and literature libraries were reviewed from the date of their inception through early 2018. These articles were reviewed and their findings analyzed.

Results:

Thirty-nine published articles were found that demonstrated a substantial, extensively replicated body of data that demonstrate a significant reduction in migraine headache symptoms and frequency (even complete elimination of headache pain) following trigger-site surgery.

Conclusions:

Migraine surgery is a valid method of treatment for migraine sufferers when performed by experienced plastic surgeons following a methodical protocol. These operations are associated with a high level of safety. The safety and efficacy of migraine surgery should be recognized by plastic surgeons, insurance companies, and the neurology societies.
Low Complication Rates Using Closed-Incision Negative-Pressure Therapy for Panniculectomies: A Single-Surgeon, Retrospective, Uncontrolled Case Series
Authors: Patel Ashraf A. , Wilcox Kailyn , Bhinder Jasmine , Reiser Julia , Upadhyaya Prashant
Published: July 2020

Background:

Panniculectomies are associated with high complication rates (43 to 70 percent), particularly in patients with obesity, smoking, and diabetes mellitus. Closed-incision negative-pressure therapy can be used postoperatively to support healing by promoting angiogenesis and decreasing tension. The authors hypothesized that using it with panniculectomies would minimize complications, and that a longer duration of therapy would not increase the incidence of complications. The authors also evaluated whether closed-incision negative-pressure therapy malfunction was associated with complications.

Methods:

This retrospective, uncontrolled case series analyzed 91 patients who underwent panniculectomies managed with closed-incision negative-pressure therapy performed by a single surgeon from 2014 to 2018. Patients were followed for 6 months; therapy duration and malfunction were recorded. Patients were placed into therapy duration groups (2 to 7, 8 to 10, or >10 days). Complications managed conservatively were minor and major if they required intervention. Odds ratios were performed with 95 percent confidence intervals and p values.

Results:

Mean follow-up was 225.1 days and mean closed-incision negative-pressure therapy duration was 10.5 days. Major complications were reported in five patients (5.5 percent), infections in four (4.4 percent), dehiscence in two (2.2 percent), and seroma in four (4.4 percent). Patients with malfunction [n = 16 (17.6 percent)] were more likely to experience complications (OR, 3.3; p = 0.043). No significant increase in complications was found with therapy duration longer than 10 days, but potentially there is an increased risk of infection (OR, 4.0; p = 0.067).

Conclusions:

Although high complication rates have been associated with panniculectomies, the authors’ results show that low complication rates can be achieved with closed-incision negative-pressure therapy. Randomized controlled trials need to be conducted evaluating different therapy systems and the optimal duration of therapy with panniculectomies.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Development and Evaluation of the Taxonomy of Trauma Leadership Skills–Shortened for Observation and Reflection in Training
Authors: Leenstra Nico F. , Jung Oliver C. , Cnossen Fokie , Jaarsma A. Debbie C. , Tulleken Jaap E.
Published: July 2020

Introduction

Trauma leadership skills are increasingly being addressed in trauma courses, but few resources are available to systematically observe and debrief trainees' performances. The authors therefore translated their previously developed, extensive Taxonomy of Trauma Leadership Skills (TTLS) into a practical observation tool that is tailored to the vocabulary of clinician instructors and their workflow and workload during simulation-based training.

Methods

In 2016 to 2018, the TTLS was subjected to practical evaluation in an iterative process of 2 stages. In the first stage, testing panels of trauma specialists observed excerpts from videotaped simulations and indicated from the list of elements which behaviors they felt were being shown. Any ambiguities or redundancy were addressed by rephrasing or combining elements. In the second stage, iterations were used in actual scenario training to observe and debrief trainees' performances. The instructors' recommendations resulted in further improvements of clarity, ease of use, and usefulness, until no new suggestions were raised.

Results

The resultant “TTLS–Shortened for Observation and Reflection in Training” was given a simpler structure and more concrete and self-explanatory benchmarks. It contains 6 skill categories for evaluation, each with 4 to 6 benchmark behaviors.

Conclusions

The TTLS–Shortened for Observation and Reflection in Training is an important addition to other trauma assessment tools because of its specific focus on leadership skills. It helps set concrete performance expectations, simplify note taking, and target observations and debriefings. One central challenge was striking a balance between its conciseness and specificity. The authors reflected on how the decisions for the resultant structure ease and leverage the conduct of observations and performance debriefing.
Facilitating Client Ability to Communicate in Palliative End-of-Life Care
Authors: Pollens Robin
Published: July 2020

The client's ability to communicate is key to providing quality palliative end-of-life care. A speech–language pathologist (SLP) can facilitate the patient's ability to communicate concerns or preferences in order to (1) improve the health care team's ability to manage symptoms and engage in end-of-life discussions, and (2) support the patient and family's ability to maintain social connectivity. This article describes methods for implementing speech–language pathology communication consults in palliative or end-of life care. The information is illustrated with patient vignettes and supported by literature resources. Specific participation goals and outcomes illustrate the impact of the SLP treatment on the interprofessional team palliative care outcomes. Approaches to advocating for speech–language pathology communication consults in palliative end-of-life care are highlighted. Ongoing research and advocacy may result in valuable skilled speech–language pathology services for patients with communication barriers in palliative or end-of-life care.
Nonfluent Primary Progressive Aphasia
Authors: Mahendra Nidhi , Tadokoro Ashlyn
Published: July 2020

Purpose:

Nonfluent primary progressive aphasia (nfvPPA) is an established language-led dementia and a known variant of frontotemporal degeneration. The purpose of this article is to report the trajectory of a single case, AC, diagnosed with nfvPPA. We describe a range of interventions offered to AC over 3 years that aimed to support her communicative function, social participation, sense of identity, and emotional well-being. We offer reflections on how these interventions align with palliative care principles, highlighting their value for guiding communication and life participation interventions for persons with nfvPPA.

Method:

This study used a longitudinal analysis of impairment progression, traditional outcome measures, patient-reported outcome measures, and narrative description to report on patient and family response to interventions.

Results:

Individual and group interventions are critical for addressing the progressive communication impairments and life participation restrictions for persons affected by nfvPPA. Palliative care principles have intuitive appeal for informing the selection of intervention approaches while focusing on managing symptoms, upholding patient autonomy and dignity, and enhancing quality of life throughout the course of rapidly progressive conditions like primary progressive aphasia.

Discussion/Conclusion:

Speech–language pathologist-led interventions, grounded in palliative care principles, can optimize communicative function and quality of life for persons with nfvPPA.
Frequency of Opioid Prescribing for Acute Low Back Pain in a Rural Emergency Department
Authors: Jauregui Jean E. , Nutt Rita J. , Margolis Asa M.
Published: July 2020

National guidelines created by the Agency for Healthcare Research and Quality (AHRQ), the American College of Emergency Physicians (ACEP), and the American College of Physicians (ACP) support the use of nonsteroidal anti-inflammatory drugs (NSAIDs) over opioids when treating acute low back pain (AHRQ, 2016
;
Harrison, 2017
;
Qaseem, Wilt, McLean, Forciea, & Clinical Guidelines Committee of the American College of Physicians, 2017). Opioids not only have many more side effects than NSAIDs but also carry the risk of opioid abuse and overdose (Qaseem et al., 2017). The purpose of this study was to determine whether emergency department (ED) providers, including physicians, nurse practitioners, and physician assistants, are following evidence-based low back pain management guidelines by assessing the measurement of opioid versus NSAID prescribing. A retrospective chart review including data from January through June 2017 was conducted at a rural ED. Subject inclusion criteria were as follows: older than 18 years, had experienced new-onset low back pain within the last 1 month, and had been given an ICD-10 (International Classification of Diseases, Tenth Revision) code of M54.5. Data regarding the type of provider seen, the treatment the provider prescribed, and demographics were collected. Inclusion criteria were met by 162 subjects. While 52.5% of subjects were prescribed an NSAID at discharge, 53.7% were prescribed an opioid at discharge. Subjects whose injury was work related were less likely to receive an opioid prescription (p = 0.027, 95% CL). Subjects whose pain started within 3 days were more likely to receive an opioid prescription than those whose pain had started more than 3 days before being seen (p = 0.018, 95% CL). Despite the current evidence-based guidelines by the AHRQ, ACEP, and ACP against opioid prescribing for acute low back pain, more subjects received an opioid prescription at discharge than a prescription for an NSAID. This retrospective chart review determined the need for increased ED provider education regarding treatment modalities for acute low back pain.
Are Antibiotics Useful in Acute Chronic Obstructive Pulmonary Disease Exacerbations? Implications for APRN Practice
Authors: Safier Frenkel Tova , Evans Dian Dowling
Published: July 2020

The Research to Practice column aims to provide advanced practice registered nurses (APRNs) with an analysis of current research topics with implications for practice change within emergency care settings. The article, “Antibiotics for Exacerbations of Acute Chronic Obstructive Pulmonary Disease?” conducted by D. Vollenweider, A. Frei, C. Streurer-Stey, J. Garcia-Aymerich, and M.A. Puhan (2018), examines a Cochrane systematic review and meta-analysis of randomized controlled trials. The investigators evaluate the findings that compare clinical outcomes including adverse events, re-exacerbation, treatment failure, and mortality among intensive care unit patients, inpatient, and outpatient populations treated with antibiotics or placebo medications for acute chronic obstructive pulmonary disease (COPD) exacerbations. The findings are discussed in the context of narrowing the evidence gap to improve clinical recommendations. Their findings have implications for APRN practice, including the signs and symptoms associated with an underlying bacterial triggered COPD exacerbation and the patient populations most likely to benefit from antibiotic therapy.
Equal fitness among alternative mating strategies in a harem polygynous insect
Authors: Nason Sarah E. , Kelly Clint D.
Published: July 2020

Alternative mating strategies are widespread among animal taxa, with strategies controlled by a genetic polymorphism (Mendelian strategy) being rarer in nature than condition-dependent developmental strategies. Mendelian strategies are predicted to have equal average fitnesses and the proportion of offspring produced by a strategy should equal the equilibrium proportion of individuals representing the strategy in a population. Developmental strategies are not expected to produce offspring in equilibrium proportions; however, whether the alternative phenotypes should have equal average fitness is debated. The Wellington tree wētā (
Hemideina crassidens
) (Orthoptera: Anostostomatidae) is a harem polygynous insect in which intense sexual competition has favoured the evolution of three alternative mating strategies that differ in weapon size and the ability to fight for control of harems. Here, we use molecular genotyping to test the hypothesis that the alternative strategies in this species are maintained by having equal relative fitness and that morphs produce offspring in equilibrium proportions. As expected, the average relative fitness of the three strategies did not significantly differ and the proportion of offspring produced by each morph is equal to the frequency of that morph in the population. Our results support the hypothesis that the alternative male morphs in
H. crassidens
represent Mendelian strategies.
Frictional internal work of damped limbs oscillation in human locomotion
Authors: Minetti Alberto E. , Moorhead Alex P. , Pavei Gaspare
Published: July 2020

Joint friction has never previously been considered in the computation of mechanical and metabolic energy balance of human and animal (loco)motion, which heretofore included just muscle work to move the body centre of mass (external work) and body segments with respect to it. This happened mainly because, having been previously measuredex vivo, friction was considered to be almost negligible. Present evidences ofin vivodamping of limb oscillations, motion captured and processed by a suited mathematical model, show that: (a) the time course is exponential, suggesting a viscous friction operated by the all biological tissues involved; (b) during the swing phase, upper limbs report a friction close to one-sixth of the lower limbs; (c) when lower limbs are loaded, in an upside-down body posture allowing to investigate the hip joint subjected to compressive forces as during the stance phase, friction is much higher and load dependent; and (d) the friction of the four limbs during locomotion leads to an additional internal work that is a remarkable fraction of the mechanical external work. These unprecedented results redefine the partitioning of the energy balance of locomotion, the internal work components, muscle and transmission efficiency, and potentially readjust the mechanical paradigm of the different gaits.
Modeling Control, Lockdown & Exit Strategies for COVID-19 Pandemic in India
Authors: Barman Madhab , Nayak Snigdhashree , Yadav Manoj K. , Raha Soumyendu , Mishra Nachiketa
Published: July 2020

COVID-19–a viral infectious disease–has quickly emerged as a global pandemic infecting millions of people with a significant number of deaths across the globe. The symptoms of this disease vary widely. Depending on the symptoms an infected person is broadly classified into two categories namely, asymptomatic and symptomatic. Asymptomatic individuals display mild or no symptoms but continue to transmit the infection to other-wise healthy individuals. This particular aspect of asymptomatic infection poses a major obstacle in managing and controlling the transmission of the infectious disease. In this paper, we attempt to mathematically model the spread of COVID-19 in India under various intervention strategies. We consider SEIR type epidemiological models, incorporated with India specific social contact matrix representing contact structures among different age groups of the population. Impact of various factors such as presence of asymptotic individuals, lockdown strategies, social distancing practices, quarantine, and hospitalization on the disease transmission is extensively studied. Numerical simulation of our model is matched with the real COVID-19 data of India till May 15, 2020 for the purpose of estimating the model parameters. Our model with zone-wise lockdown is seen to give a decent prediction for July 20, 2020.
SARS-CoV-2, SARS-CoV-1 and MERS-CoV viral load dynamics, duration of viral shedding and infectiousness – a living systematic review and meta-analysis
Authors: Cevik Muge , Tate Matthew , Lloyd Ollie , Maraolo Alberto Enrico , Schafers Jenna , Ho Antonia
Published: July 2020

Background

Viral load kinetics and the duration of viral shedding are important determinants for disease transmission. We aim i) to characterize viral load dynamics, duration of viral RNA, and viable virus shedding of SARS-CoV-2 in various body fluids and ii) to compare SARS-CoV-2 viral dynamics with SARS-CoV-1 and MERS-CoV.

Methods

Medline, EMBASE, Europe PMC, preprint servers and grey literature were searched to retrieve all articles reporting viral dynamics and duration of SARS-CoV-2, SARS-CoV-1 and MERS-CoV shedding. We excluded case reports and case series with < 5 patients, or studies that did not report shedding duration from symptom onset. PROSPERO registration: CRD42020181914.

Findings

Seventy-nine studies on SARS-CoV-2, 8 on SARS-CoV-1, and 11 on MERS-CoV were included. Mean SARS-CoV-2 RNA shedding duration in upper respiratory tract, lower respiratory tract, stool and serum were 17.0, 14.6, 17.2 and 16.6 days, respectively. Maximum duration of SARS-CoV-2 RNA shedding reported in URT, LRT, stool and serum were 83, 59, 35 and 60 days, respectively. Pooled mean duration of SARS-CoV-2 RNA shedding was positively associated with age (p=0.002), but not gender (p = 0.277). No study to date has cultured live virus beyond day nine of illness despite persistently high viral loads. SARS-CoV-2 viral load in the upper respiratory tract appears to peak in the first week of illness, while SARS-CoV-1 and MERS-CoV peak later.

Conclusion

Although SARS-CoV-2 RNA shedding in respiratory and stool can be prolonged, duration of viable virus is relatively short-lived. Thus, detection of viral RNA cannot be used to infer infectiousness. High SARS-CoV-2 titers are detectable in the first week of illness with an early peak observed at symptom onset to day 5 of illness. This review underscores the importance of early case finding and isolation, as well as public education on the spectrum of illness. However, given potential delays in the isolation of patients, effective containment of SARS-CoV-2 may be challenging even with an early detection and isolation strategy.

Funding

No funding was received.
A Bayesian Framework for Estimating the Risk Ratio of Hospitalization for People with Comorbidity Infected by the SARS-CoV-2 Virus
Authors: Gao Xiang , Dong Qunfeng
Published: July 2020

Estimating the hospitalization risk for people with certain comorbidities infected by the SARS-CoV-2 virus is important for developing public health policies and guidance based on risk stratification. Traditional biostatistical methods require knowing both the number of infected people who were hospitalized and the number of infected people who were not hospitalized. However, the latter may be undercounted, as it is limited to only those who were tested for viral infection. In addition, comorbidity information for people not hospitalized may not always be readily available for traditional biostatistical analyses. To overcome these limitations, we developed a Bayesian approach that only requires the observed frequency of comorbidities in COVID-19 patients in hospitals and the prevalence of comorbidities in the general population. By applying our approach to two different large-scale datasets in the U.S., our results consistently indicated that cardiovascular diseases carried the highest hospitalization risk for COVID-19 patients, followed by diabetes, chronic respiratory disease, hypertension, and obesity, respectively.

Significance Statement

We developed a novel Bayesian approach to estimate the hospitalization risk for people with comorbidities infected with the SARS-CoV-2 virus. Our results indicated that cardiovascular diseases carried the highest hospitalization risk for COVID-19 patients, followed by diabetes, chronic respiratory disease, hypertension, and obesity, respectively.
30-day mortality and morbidity in COVID-19 versus influenza: A population- based study
Authors: Nersesjan Vardan , Amiri Moshgan , Christensen Hanne , Benros Michael E. , Kondziella Daniel
Published: July 2020

Background

As of July 2020, COVID-19 has caused 500,000 deaths worldwide. However, large-scale studies of COVID-19 mortality and new-onset comorbidity compared to influenza and individuals tested negative for COVID-19 are lacking. We aimed to investigate COVID-19 30-day mortality and new-onset comorbidity compared to individuals with negative COVID-19 test results and individuals tested for influenza.

Methods and findings

This population-based cohort study utilized electronic health records covering roughly half (n=2,647,229) of Denmark’s population, with nationwide linkage of microbiology test results and death records. All individuals ≥18 years tested for COVID-19 and individuals tested for influenza were followed from November 1, 2017 to June 30, 2020. The main outcome was 30-day mortality after a test for either COVID-19 or influenza. Secondary outcomes were major comorbidity diagnoses 30-days after the test for either COVID-19 or influenza. In total, 224,639 individuals were tested for COVID-19. Among inpatients positive for COVID-19, 356 of 1657 (21%) died within 30 days, which was a 3.0 to 3.1-fold increased 30-day mortality rate, when compared to influenza and COVID-19-negative inpatients (all p<0.001). For outpatients, 128 of 6,263 (2%) COVID-19-positive patients died within 30 days, which was a 5.5 to 6.9-fold increased mortality rate compared to influenza and COVID-19-negative patients, respectively (all p<0.001). Compared to hospitalized patients with influenza, new-onset ischemic stroke, diabetes and nephropathy occurred more frequently in inpatients with COVID-19 (all p<0.05).

Conclusions

In this population-based study comparing COVID-19 with influenza, COVID-19 was associated with increased rates of major systemic and vascular comorbidity and substantially higher mortality, which is likely even higher than the stated 3.0 to 5.5-fold increase owing to more extensive testing for COVID-19.
Association of olfactory dysfunction with hospitalization for COVID-19: a multicenter study in Kurdistan
Authors: Zobairy Hosna , Shamsoddin Erfan , Rasouli Mohammad Aziz , Khodlan Nasrollah Veisi , Moradi Ghobad , Zareie Bushra , Teymori Sara , Asadi Jalal , Sofi-Mahmudi Ahmad , Sedaghat Ahmad R
Published: July 2020

Objective

To evaluate the association of olfactory dysfunction (OD) with hospitalization for COVID-19.

Study Design

Multi-center cohort study.

Setting

Emergency departments of thirteen COVID-19-designed hospitals in Kurdistan province, Iran.

Subjects and Methods

Patients presenting with flu-like symptoms who tested positive by RT-PCR for COVID-19 between May 1st and 31st, 2020. At the time of presentation and enrollment, patients were asked about the presence of OD, fever, cough, shortness of breath, headache, rhinorrhea and sore throat. The severity of OD was assessed on an 11-point scale from 0 (none) to 10 (anosmia). Patients were either hospitalized or sent home for outpatient care based on standardized criteria.

Results

Of 203 patients, who presented at a mean of 6 days into the COVID-19 disease course, 25 patients (12.3%) had new OD and 138 patients (68.0%) were admitted for their COVID-19. Patients admitted for COVID-19 had a higher prevalence of all symptoms assessed, including OD (p<0.05 in all cases), and OD identified admitted patients with 84.0% sensitivity and 34.3% specificity. On univariate logistic regression, hospitalization was associated with OD (odds ratio [OR] = 2.47, 95%CI: 1.085–6.911, p=0.049). However, hospitalization for COVID-19 was not associated with OD (OR=3.22, 95% CI: 0.57–18.31, p=0.188) after controlling for confounding demographics and comorbidities.

Conclusion

OD may be associated with hospitalization for (and therefore more severe) COVID-19. However, this association between OD and COVID-19 severity is more likely driven by patient characteristics linked to OD, such as greater numbers of COVID-19 symptoms experienced or high-risk comorbidities.
Does sampling saliva increase detection of SARS-CoV-2 by RT-PCR? Comparing saliva with oro-nasopharyngeal swabs
Authors: Akgun Dogan Ozlem , Kose Betsi , Agaoglu Nihat Bugra , Yildiz Jale , Alkurt Gizem , Demirkol Yasemin Kendir , Irvem Arzu , Dinler Doganay Gizem , Doğanay Levent
Published: July 2020

The gold standard method in the diagnosis of SARS-CoV-2 infection is the detection of viral RNA in nasopharyngeal sample by RT-PCR. Recently, saliva samples has been suggested as an alternative due to being fast, reliable and non-invasive, rather than nasopharyngeal samples. We compared RT-PCR results in nasopharyngeal, oro-nasopharyngeal and saliva samples of COVID-19 patients. 98 of 200 patients were positive in RT-PCR analysis performed before the hospitalization. In day 0, at least one sample was positive in 67% of 98 patients. Positivity rate was 83% for both oro-nasopharyngeal and nasopharyngeal samples, while it was 63% for saliva samples (p<0.001). On day 5, RT-PCR was performed in 59 patients, 34% had at least one positive result. The positivity rate was 55% for saliva and nasopharyngeal samples, while it was 60% for oro-nasopharyngeal samples. Our study shows that the sampling saliva does not increase the sensitivity of RT-PCR tests at early stages of infection. However, on 5th day, viral RNA detection rates in saliva were similar to nasopharyngeal and oro-nasopharyngeal samples. In conclusion, we suggest that, in patients receiving treatment, virus presence in saliva, in addition to the standard samples, is important to determine the isolation period and to control the transmission.