bluuebunny/crossref_metadata_2025 huggingface dataset:
An Update on the Use of Massive Transfusion Protocols in Obstetrics
Authors: Pacheco Luis D. , Saade George R. , Costantine Maged M. , Clark Steven L. , Hankins Gary D. V.
Published: February 2017

(Am J Obstet Gynecol. 2016;214(3):340–344)

Peripartum hemorrhage due to increased cesarean deliveries and placental anomalies is a significant cause of maternal mortality worldwide. Alternate pathways have been suggested to play an important role in the pathophysiology of massive hemorrhage. Research evidence suggests that hemostatic resuscitation can improve outcomes compared with traditional resuscitation protocols. Massive transfusion protocols administer blood products early in the resuscitation process and have been adopted widely in the United States for severe hemorrhage treatment. This review aimed to address updates on the use of massive transfusion protocols for obstetrical hemorrhage.
Uterine Rupture: Trends Over 40 Years
Authors: Al-Zirqi I. , Stray-Pedersen B. , Forsén L. , Daltveit A.K. , Vangena S.
Published: February 2017

(BJOG. 2016;123:780–787)

An increasing trend in the use of cesarean section worldwide implies a consequent increase in the rate of uterine rupture. The objectives of this study were to determine the trends in incidence, risk factors, and outcomes of uterine rupture over a period of 40 years in Norway.
Seeing Double: A Nation of Twins From Sea to Shining Sea
Authors: Adashi Eli Y.
Published: February 2017

(Am J Obstet Gynecol. 2016;214(3):311–313)

Twin birth rates in the United States have constantly been on the rise (33.9 per 1000 live births in 2014) as reported by the Division of Vital Statistics of the National Centers for Health Statistics. The adverse consequences of an increasing national twin birth rate include babies that are born “very preterm” (<32 completed weeks of gestation) or “preterm” (<37 completed weeks of gestation), and babies born with “very low birthweight” (<1500 g) or “low birthweight” (<2500 g). This commentary aimed to explain the ontogeny of the twin births “epidemic,” to describe the factors contributing to it, and to propose potential remedies for it. The basal/naturally occurring national twin birth rate was 20.1 per 1000 live births from 1949 to 1966. The first fertility-promoting drug (clomiphene citrate) was introduced in 1967 at which time the incidence of twin births gradually started to rise. The national twin birth rate grew steadily from 1986 as the in vitro fertilization (IVF) venture was just in progress. With the increasing utilization of IVF and the emergence of superovulation and subsequent intrauterine insemination (IUI), the national twin birth rate reached 25 per 1000 live births after a decade. The national twin birth rate had crossed the 30 per 1000 live births barrier by 2001 and had thereby resulted in an overall 1.7-fold increase compared with its baseline rate, with the rising trend yet to be reversed.
Wide Differences in Mode of Delivery Within Europe: Risk-stratified Analyses of Aggregated Routine Data from the Euro-Peristat Study
Authors: Macfarlane A.J. , Blondel B. , Mohangoo A.D. , Cuttini M. , Nijhuis J. , Novak Z. , Ólafsdóttir H.S. , Zeitlin J.
Published: February 2017

(BJOG. 2016;123:559–568)

Cesarean section rates have been on the rise in many developed countries over the past few decades. Cesarean section is a necessity in some high-risk conditions like placenta previa or fetal distress. Performance of the surgery is often governed by factors like parity, previous cesarean section, fetal presentation and multiplicity. The objectives of this study were two-fold: first to use aggregated population-based data from routine sources to review and understand the differences between obstetric intervention rates for European countries, and second to analyze the extent to which clinicians were likely to intervene in high-risk situations in countries with high overall cesarean rates.
Finding NEMO in Preeclampsia
Authors: Sakowicz Agata , Hejduk Paulina , Pietrucha Tadeusz , Nowakowska Magdalena , Płuciennik Elżbieta , Pospiech Karolina , Gach Agnieszka , Rybak-Krzyszkowska Magda , Sakowicz Bartosz , Kaminski Marek , Krasomski Grzegorz , Biesiada Lidia
Published: February 2017

(Am J Obstet Gynecol. 2016;214:538.e1–538.7)

Research has shown that 5% to 7% of low-risk nulliparous women are affected by preeclampsia (PE).
Nifedipine Versus Atosiban for Threatened Preterm Birth (APOSTEL III): A Multicentre, Randomized Controlled Trial
Authors: van Vliet Elvira O.G. , Nijman Tobias A.J. , Schuit Ewoud , Heida Karst Y. , Opmeer Brent C. , Kok Marjolein , Gyselaers Wilfried , Porath Martina M. , Woiski Mallory , Bax Caroline J. , Bloemenkamp Kitty W.M. , Scheepers Hubertina C.J. , Jacquemyn Yves , van Beek Erik , Duvekot Johannes J. , Franssen Maureen T.M. , Papatsonis Dimitri N. , Kok Joke H. , van der Post Joris A.M. , Franx Arie , Mol Ben W. , Oudijk Martijn A.
Published: February 2017

(Lancet. 2016;387:2117–2124)

Research has shown that preterm birth accounts for 50% of neonatal morbidity and 50% to 75% of neonatal mortality worldwide.
Persistent Paralysis After Spinal Anesthesia for Cesarean Delivery
Authors: Zaphiratos V. , McKeen D.M. , Macaulay B. , George R. B.
Published: February 2017

(J Clin Anesth. 2015;27(1):68–72)

The increased use of neuraxial anesthesia during cesarean delivery has greatly decreased the rate of maternal mortality.
Transforming Medical Assessment: Integrating Uncertainty Into the Evaluation of Clinical Reasoning in Medical Education
Authors: Cooke Suzette , Lemay Jean-Francois
Published: February 2017

In an age where practicing physicians have access to an overwhelming volume of clinical information and are faced with increasingly complex medical decisions, the ability to execute sound clinical reasoning is essential to optimal patient care. The authors propose two concepts that are philosophically paramount to the future assessment of clinical reasoning in medicine: assessment in the context of “uncertainty” (when, despite all of the information that is available, there is still significant doubt as to the best diagnosis, investigation, or treatment), and acknowledging that it is entirely possible (and reasonable) to have more than “one correct answer.” The purpose of this article is to highlight key elements related to these two core concepts and discuss genuine barriers that currently exist on the pathway to creating such assessments. These include acknowledging situations of uncertainty, creating clear frameworks that define progressive levels of clinical reasoning skills, providing validity evidence to increase the defensibility of such assessments, considering the comparative feasibility with other forms of assessment, and developing strategies to evaluate the impact of these assessment methods on future learning and practice. The authors recommend that concerted efforts be directed toward these key areas to help advance the field of clinical reasoning assessment, improve the clinical care decisions made by current and future physicians, and have positive outcomes for patients. It is anticipated that these and subsequent efforts will aid in reaching the goal of making future assessment in medical education more representative of current-day clinical reasoning and decision making.
Causes and consequences of fatigue in rheumatoid arthritis
Authors: Katz Patricia
Published: February 2017

Purpose of review

To review current information on the causes, treatments, and consequences of fatigue in rheumatoid arthritis.

Recent findings

Disease activity (inflammation, pain, joint symptoms) is associated with greater fatigue. However, disease activity per se accounts for only a small portion of fatigue, and rheumatoid arthritis medications that reduce disease activity have small effects on fatigue. Instead, factors outside the direct effects of rheumatoid arthritis, such as obesity, physical inactivity, sleep disturbance, and depression, explain the majority of variation in fatigue. Some of these factors may be indirect effects of disease (e.g. pain can lead to sleep disturbance). Rheumatoid arthritis has significant effects on the quality of life of individuals with rheumatoid arthritis. The most effective approaches to reducing rheumatoid arthritis fatigue appear to be behavioral, such as increasing physical activity, or cognitive, such as cognitive behavioral interventions.

Fatigue in rheumatoid arthritis appears to be largely because of factors outside the direct effects of the disease, such as behavioral and psychological factors. In spite of the tremendous impact of fatigue on patient health and quality of life, effective treatments remain elusive, but existing data show that behavioral and cognitive approaches may be most effective.
Superior Outcomes After Operative Fixation of Patella Fractures Using a Novel Plating Technique: A Prospective Cohort Study
Authors: Lorich Dean G. , Fabricant Peter D. , Sauro Gina , Lazaro Lionel E. , Thacher Ryan R. , Garner Matthew R. , Warner Stephen J.
Published: February 2017

Objective:

The purpose of this prospective cohort study was to determine if a new patella fracture fixation construct resulted in improved outcomes compared with traditional tension band techniques.

Design:

Comparative cohort study.

Setting:

Academic level I trauma center.

Patients/Participants:

Patients with isolated, unilateral patellar fractures were enrolled prospectively. From 2012 to 2014, 33 patients underwent fixation with a novel plate construct that spans half of the patella circumference laterally and provides multiplanar fixation through a low-profile plate. A comparison cohort was drawn from 25 patients treated from 2008 to 2012, where treatment consisted of traditional tension band fixation techniques.

Intervention:

Surgical fixation of patella fractures was performed with either a tension band or novel plate construct.

Main Outcome Measurements:

Subjective postoperative clinical outcomes and objective functional and strength measurements were subsequently collected.

Results:

The 2 cohorts had similar baseline characteristics. Patients with the plate construct had clinically and statistically significantly superior Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS) scores throughout the study period (P < 0.001). Functional testing also demonstrated significant improvements in patients with plate constructs compared with tension band constructs at 12 months. Patients in the plate cohort had significantly increased thigh circumferences (P = 0.003) and decreased anterior knee pain (P < 0.0001) compared with the tension band cohort.

Conclusions:

In this prospective cohort study, the use of a novel fixation construct with multiplanar and interfragmentary fixation and minimal disruption of patellar vascularity enables improved clinical outcomes and functional performance.

Level of Evidence:

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Precise Measurement of the Outer Diameters of Antibiotic-Laden Cement Nails Produced by Various Sized Thoracostomy Catheter Molds
Authors: Czajka Cory M. , Bauer Ian N. , Warner Stephen J. , Goytia Robin N. , Brinker Mark R.
Published: February 2017

Objectives:

At our institution, custom-made antibiotic-laden cement nails (ACNs) fabricated during surgery using a thoracostomy catheter as a mold are commonly used to treat long-bone infection. As the outer diameter of the nails produced has not previously been described, we designed a study to measure the outer diameter of ACNs fashioned using commercially available and commonly utilized thoracostomy catheters of various sizes.

Methods:

Six thoracostomy catheters from 2 different manufactures (Argyle PVC Thoracic Catheters; Covidien Ltd and Atrium PVC Thoracic Catheters; Atrium Medical Corporation), ranging from 20 French to 40 French, were utilized in this study. Each catheter was filled with antibiotic-laden cement, and the most proximal segment (largest outer diameter) and most distal segment (smallest outer diameter) were detached for study. Once the cement was cured, the thoracostomy catheters were cut away and the segments were measured using a calibrated digital caliper (Mitutoyo Corp, Aurora, IL). Because the ACNs produced using the technique taper from proximal to distal according to the shape of the thoracostomy catheter design, data were recorded as a maximum and minimum outer diameter for each ACN produced by each of the 6 thoracostomy catheter sizes studied. All measurements were in millimeters and were rounded to the nearest one-tenth of a millimeter.

Results:

The ACNs produced using the various sized thoracostomy catheters had segments with outer diameters ranging from 4.2 mm to 11.2 mm. Both brands of catheters produced nails with similar distal diameters. Specifically, the mean distal diameter measurements were 4.2 mm for a 20 French catheter, 5.5 mm for a 24 French catheter, 6.6 mm for a 28 French catheter, 7.7 mm for a 32 French catheter, 8.4 mm for a 36 French catheter, and 9.9 mm for a 40 French catheter. The Argyle brand catheters produced nails with proximal diameters that increased with the catheter's size, from 7.1 mm for a 20 French catheter to 11.2 mm for a 40 French catheter. The Atrium brand catheters produced nails with a much tighter range of proximal diameters ranging from 9.4 mm to 11.1 mm.

Conclusions:

Thoracostomy catheters are commonly utilized to produce ACNs. The results of our study confirm that the fabricated nails taper in diameter from proximal to distal. Knowledge of the specific dimensions of the ACN produced by each size thoracostomy catheter will aid the orthopaedic surgeon in selecting the right size based on the diameter of the medullary canal being treated.
Presence of Failed Fracture Implants in Association With Lower Extremity Long Bone Nonunion Does Not Portend Worse Outcome After Nonunion Repair
Authors: Regan Deirdre K. , Davidovitch Roy I. , Konda Sanjit , Manoli Arthur , Leucht Philipp , Egol Kenneth A.
Published: February 2017

Objective:

The purpose of this study was to determine whether the finding of failed fracture implants in association with lower extremity long bone fracture nonunion portends worse clinical or functional outcome after surgical nonunion repair.

Design:

Retrospective analysis of prospectively collected data.

Setting:

Academic Medical Center.

Patients:

One hundred eighty-one patients who presented to our institution over a 10-year period and underwent surgical repair of a lower extremity fracture nonunion.

Intervention:

Surgical repair of lower extremity fracture nonunion.

Main Outcome Measurements:

Time to union, postoperative complications, visual analog scale pain scores, and Short Musculoskeletal Function Assessment scores after lower extremity nonunion repair. Data were analyzed to assess for differences in postoperative outcomes based on the integrity of fracture implants at the time of nonunion diagnosis. Implant integrity was defined using 3 groups: broken implants (BI), implants intact (II), and no implants (NI).

Results:

There was no significant difference in time to union after surgery between the BI, II, or NI groups (mean 8.1 months vs. 7.6 months vs. 6.2 months, respectively). Fourteen patients (7.7%) failed to heal, including 5 BI patients, 7 II patients, and 2 NI patients. One tibial nonunion patient in each of the 3 groups underwent amputation for persistent nonunion after multiple failed revision attempts at a mean of 4.8 years after initial injury. There was no difference in postoperative pain scores, the rate of postoperative complications, or functional outcome scores identified between the 3 groups.

Conclusions:

The finding of failed fracture implants at the time of lower extremity long bone nonunion diagnosis does not portend worse clinical or functional outcome after surgical nonunion repair. Patients who present with failed fracture implants at the time of nonunion diagnosis can anticipate similar time to union, complication rates, and functional outcomes when compared with patients who present with intact implants or those with history of nonoperative management.

Level of Evidence:

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
What Are the Indications for Spinal Fusion Surgery in Scheuermann Kyphosis?
Authors: Polly David W. , Ledonio Charles G.T. , Diamond Beverly , Labelle Hubert , Sucato Daniel J. , Hresko M. Timothy , Emans John B. , Vitale Michael G. , Erickson Mark A. , Larson A. Noelle
Published: February 2017

Background:

Surgical indications for Scheuermann kyphosis are variable. We sought to evaluate the characteristics of patients undergoing operative versus nonoperative treatment of Scheuermann kyphosis to better understand current practices and the factors which contribute to the decision for surgical management.

Methods:

Multicenter prospective cohort study. We evaluated consecutive patients presenting with Scheuermann kyphosis. Patients underwent either surgical or nonoperative management according to surgeon and patient discretion. Preoperative patient-reported outcome measures (Scoliosis Research Society and Spinal Appearance Questionnaire scores), demographics, and radiographic characteristics were assessed.

Results:

Overall, 150 patients with Scheuermann kyphosis were enrolled, with 77 choosing nonoperative treatment and 73 treated operatively. Compared with the nonoperative cohort, patients treated operatively were older (16.3±2.0 vs. 15.1±2.2, P=0.0004), and had higher body mass index (26.3±7.2 vs. 22.7±6.5, P=0.003), had greater T2-T12 kyphosis (71±14 degrees vs. 61±12 degrees, P<0.001), increased pelvic incidence (46 vs. 41 degrees, P=0.03) and pelvic tilt (10 vs. 3 degrees, P=0.03). There was no detected difference in maximal sagittal Cobb angle in the operative versus nonoperative patients (73±11 vs. 70±12 degrees, P=0.11). Functionally, the operative patients had worse Scoliosis Research Society pain scores (3.7±0.9 vs. 4.1±0.7, P=0.0027) and appearance scores (2.9±0.7 vs. 3.4±0.8, P <0.0001).

Conclusions:

Patients undergoing surgical management of Scheuermann disease were more likely to have large body mass index and worse pain scores. Other factors beyond radiographic measurement likely contribute to the decision for surgical management of Scheuermann kyphosis.

Level of Evidence:

Level II.
Clubfoot and Tethered Cord Syndrome: Results of Treatment With the Ponseti Method
Authors: Jackson Trevor , Jones Alexander , Miller Nancy , Georgopoulos Gaia
Published: February 2017

Background:

The Ponseti technique has demonstrated high success rates worldwide for the treatment of idiopathic clubfoot. The purpose of this study was to determine whether clubfoot associated with tethered cord syndrome (TCS) was more resistant to Ponseti treatment than isolated clubfoot.

Methods:

An IRB-approved retrospective cohort study of subjects undergoing Ponseti treatment of clubfoot between 2002 and 2013 was conducted. Subjects with TCS were matched to subjects with isolated clubfoot (1:2) on the basis of laterality, date of birth, sex, and age at presentation. Subject demographics, number of casts placed (pretenotomy and posttenotomy), and recurrence data were collected. Generalized logistic regression and linear mixed model regression analyses were used to compare recurrence within 2 years of the initiation of casting and the log number of casts needed to achieve an acceptable correction, respectively.

Results:

Data from 24 subjects (16 isolated clubfeet, 8 with TCS) with clubfoot (12 bilateral, 12 unilateral) were analyzed. The isolated clubfoot group was the same age at presentation on average (21.9±4.7 d) as the TCS group (28.3±9.6 d) (P=0.55). The number of casts required to achieve an acceptable correction was 54% higher (95% CI, 7.8%-120.3%; P=0.0217) in the TCS group compared with the isolated clubfoot group. The cumulative crude incidence of deformity recurrence within the first 2 years after casting initiation was 8% in the isolated clubfoot group compared with 42% in the TCS group. The odds of deformity recurrence in the TCS group were 5.6 (95% CI, 0.7-45.2; P=0.1054) times the odds of deformity recurrence in the isolated clubfoot group. Furthermore, the incidence of deformity recurrence was higher among subjects who had a tethered cord release posttenotomy (56%, 5/9) as compared with pretenotomy (0%, 0/3).

Conclusion:

Clubfoot associated with TCS required more casts to achieve an acceptable correction. Subjects with tethered cord were also at an increased risk of deformity recurrence compared with subjects with isolated clubfoot.

Level of Evidence:

Level II—retrospective prognostic study.
Biomechanical Analysis of Retrograde Flexible Intramedullary Nail Constructs in a Simulated Pediatric Femur Fracture Model
Authors: Bland Daniel C. , Black Sheena R. , Pierce William A. , Wimberly Robert L. , Riccio Anthony I.
Published: February 2017

Background:

Various flexible intramedullary nail (FIMN) constructs for pediatric femur fractures are described; however, no biomechanical study has compared stability of medial-lateral entry versus all-lateral entry retrograde nailing. Our purpose is to compare the rotational and bending stiffness of 2 different FIMN constructs and 2 different materials in a simulated pediatric femur fracture model.

Methods:

Eighty adolescent-sized composite femurs were used to simulate transverse (40 femurs) and oblique (40 femurs) mid-diaphyseal fractures. Retrograde FIMN of the femurs was performed using either 3.5 mm titanium (Ti) or 3.5 mm stainless-steel (SS) flexible nails in 2 configurations: 2 “C”-shaped nails (CC) placed through medial and lateral entry sites or 1 “C”-shaped nail and 1 “S”-shaped nail (CS) placed through a single lateral entry site. Models were first tested in 10 cycles of axial rotation to ±1 N m of torque at a rate of 0.5 degrees/s under 36 kg of compression. Axial compression was performed and bending stiffness defined as the force required to achieve 10 degrees varus at the fracture site.

Results:

No differences were noted in rotational stiffness comparing Ti and SS nails regardless of nail configuration or fracture pattern. Comparable rotational stability was found for CC and CS configurations with SS implants for both fracture patterns. The CS construct (0.60 N m/degree) was stiffer in rotation than the CC construct (0.41 N m/degree) with Ti implants in the transverse fracture model (P<0.005). SS nails provided greater bending stiffness than Ti nails in both oblique and transverse fracture patterns, regardless of nail construct. The all-lateral entry (CS) construct demonstrated statistically significant greater bending stiffness regardless of implant material or fracture pattern (P<0.03).

Conclusions:

An all-lateral entry (CS) FIMN construct demonstrated greater bending stiffness in both fracture patterns and materials. Ti and SS implants have comparable rotational stiffness in all fracture patterns and materials; however, SS nails were superior at resisting bending forces in both fracture patterns. CS nail configuration and SS implants demonstrated superior bending stiffness and rotational stiffness when compared with the more commonly used CC construct and Ti implants.

Level of Evidence:

NA (biomechanical study).
Characterization of melanoma susceptibility genes in high-risk patients from Central Italy
Authors: Pellegrini Cristina , Maturo Maria Giovanna , Martorelli Claudia , Suppa Mariano , Antonini Ambra , Kostaki Dimitra , Verna Lucilla , Landi Maria Teresa , Peris Ketty , Fargnoli Maria Concetta
Published: February 2017

Genetic susceptibility to cutaneous melanoma has been investigated in Italian high-risk melanoma patients from different geographical regions. CDKN2A,CDK4, andMC1Rgenes have been screened in most studies,MITFandPOT1were screened in only one study, and none analyzed theTERTpromoter. We carried out a mutational analysis ofCDKN2A,CDK4exon 2,POT1p.S270N,MITFexon 10,MC1R, and theTERTpromoter in 106 high-risk patients with familial melanoma (FM) and sporadic multiple primary melanoma (spMPM) from Central Italy and evaluated mutations according to the clinicopathological characteristics of patients and lesions. In FM,CDKN2Amutations were detected in 8.3% of the families, including one undescribed exon 1β mutation (p.T31M), and their prevalence increased with the number of affected relatives within the family.MC1Rvariants were identified in 65% of the patients and theTERTrs2853669 promoter polymorphism was identified in 58% of the patients. A novel synonymous mutation detected inMITFexon 10 (c.861A>G, p.E287E), although predicted as a splice site mutation by computational tools, could not functionally be confirmed to alter splicing. For spMPM, 3% carriedCDKN2Amutations, 79% carriedMC1Rvariants, and 47% carried theTERTrs2853669 promoter polymorphism.MC1Rvariants were associated with fair skin type and light hair color both in FM and in spMPM, and with a reduction of age at diagnosis in FM patients. Mutations inCDK4exon 2 and thePOT1p.S270N mutation were not detected. A low frequency ofCDKN2Amutations and a high prevalence ofMC1Rvariants characterize high-risk melanoma patients from Central Italy.
Lymph nodes’ capsular naevi are associated with high naevus count in melanoma patients: a case–control study
Authors: Ribero Simone , Longo Caterina , Specchio Francesca , Piana Simonetta , Castagnetti Fabio , Moscarella Elvira , Lallas Aimilios , Alfano Roberto , Argenziano Giuseppe
Published: February 2017

Capsular naevi (CNs) in lymph nodes (LNs) are relatively common, occurring in 3–22% of patients who undergo LN surgery for melanoma. Naevus count is one of the principal risk factors for melanoma, as well as a prognostic factor in melanoma patients. However, little is known about the occurrence of CN in melanoma patients on the basis of their naevus count. A case–control study was performed, to look at the naevus count differences between CN-positive and CN-negative melanoma patients. Cases (CN positive) were matched for age, sex and Breslow thickness with controls (CN negative). Total naevus count was recorded at diagnosis and compared between the two groups. This study was conducted in a tertiary referral academic centre for skin cancer. Twenty-two positive CN patients were matched with 22 negative CN patients. The mean Breslow thickness was 2.66 mm (range: 0.6–9). Positive CN patients were significantly associated with an increasing naevus count on their skin (P=0.02). Patients with more than 100 naevi reported an odds ratio of 7.78 on having a CN compared with patients with fewer than 50 naevi on their skin (P=0.02). An increased melanocytic migration to LNs might be the reason for the association between CNs and a high number of melanocitic naevi on the skin. This could shed some light on the physiology of melanocytes and could be an easy way to predict patients at greater risk of having CNs.
Psychological characteristics of early-stage melanoma patients: a cross-sectional study on 204 patients
Authors: Tesio Valentina , Ribero Simone , Castelli Lorys , Bassino Stefania , Leombruni Paolo , Caliendo Virginia , Grassi Marcella , Lauro Danilo , Macripò Giuseppe , Torta Riccardo G.V.
Published: February 2017

The presence of psychological distress has a negative impact not only on cancer patients’ quality of life but also on the course of the disease, with slower recovery and increased morbidity. These issues are of particular importance in melanoma patients (MP), who remain at risk of disease progression for many years after diagnosis. This study aimed to investigate psychological distress, coping strategies, and their possible relationships with demographic–clinical features in patients with early-stage melanoma in follow-up. The investigation focused in particular on whether the psychological profile differed between patients at different melanoma stages. Data of 118 patients with melanoma in the Tis-Ia stages (MP_Tis-Ia) and 86 patients with melanoma in the Ib–IIa–IIb stages (MP_Ib–II) were gathered through a self-administered survey and compared using a cross-sectional design. The results evidenced a high percentage of anxiety (25%) and distress symptoms (44%), whereas depressive symptoms seemed less frequent (8%). Psychological distress was higher in women than in men, and in patients with a higher educational level. Nevertheless, no significant differences were found between MP_Tis-Ia and MP_Ib–II. With respect to coping style, the patients in this sample adopted predominantly positive and active strategies. Correlational analyses showed that maladaptive coping strategies such as behavioral disengagement, denial, self-distraction, and self-blame were most strongly related to increased levels of psychological distress. The high presence of anxiety and distress symptoms, their relationship, and the use of negative coping strategies underline the importance of psychological distress screening also in early-stage MP, including at long-term follow-up.
Correlates of Health Literacy and Its Impact on Illness Beliefs for Emergency Department Patients With Acute Heart Failure
Authors: Kumar Vijaya Arun , Albert Nancy M. , Medado Patrick , Mango Lynn Marie , Nutter Benjamin , Yang Dongsheng , Levy Phillip
Published: February 2017

Objectives:

To study the relationship between health literacy (HL) and socioeconomic, demographic factors and disease-specific illness beliefs among patients who present to the emergency department with heart failure (HF).

Background:

Maintenance of well-being for patients with HF is partially dependent on appropriate self-care behaviors, which, in turn, are influenced by underlying illness beliefs. HL is a potential modifier of the interaction between behaviors and beliefs. There have been limited investigations studying this relationship among individuals with acute HF.

Methods:

A cross-sectional study of patients with hemodynamically stable acute HF was conducted. Demographic, education, and social support data were obtained from all patients along with self-reported responses to the 36-item STOFHLA survey, a 14 item HF-specific illness belief questionnaire, and a 5-item self-care adherence survey. General association was assessed using the χ2 or Fisher exact test, and comparisons were made using the Kruskal–Wallis test.

Results:

A total of 100 patients (51 females and 49 males) were included, 94% of whom were African-American (mean age [SD]: 57.5 [13.2] years). Inadequate, marginal, and adequate health literacy were present in 35%, 17%, and 48%, respectively, with increasing adequacy among the higher educated (P < 0.001). Overall, HF illness beliefs were considered to be “inaccurate” (mean score [SD] on a 4-point Likert scale: 2.8 [0.3]) but did correlate positively with improved HL (r = 0.26; P = 0.008).

Conclusion:

In this cohort of relatively young, predominantly African-American patients with acute HF, HL was positively correlated with level of education and negatively associated with age and was an important determinant of disease-specific illness beliefs.
Care for Vulnerable Elderly in Cardiology: A Program for Daily Practice
Authors: Wit Mirjam A. M. , Bos-Schaap Annet J. C. M. , Umans Victor A. W. M.
Published: February 2017

Background:

The percentage of cardiac patients aged ≥75 has increased considerably over the past decades. To optimize multidisciplinary care for these frail elderly, a program of intensive medical and nursing care was started at Noord West Ziekenhuisgroep department of cardiology.

Methods:

Patients over 70 years of age, admitted to the department of cardiology, were included and treated by the advanced practice nurse according to a redesigned care process that focused on expedite mobilization and care by an advanced practice nurse-headed team including the first outpatient visit.

Results:

A total of 951 patients over 70 years were included in the frail elderly project. The average length of stay of the frail elderly was 6 days (SD 5). In the first 30 days, after discharge, 12% of these patients were readmitted with heart failure and 2% with dehydration. Mortality during admission was 3%, and 11% died within 3 months after discharge.

Conclusions:

This observational study shows, during a 4-year period, the vulnerability of aged cardiac patients. They were mainly admitted for (diastolic) heart failure, usually in combination with atrial fibrillation and hypertension. Their length of stay was on average 6 days with 11% mortality at 90 days follow-up.
Reliability of Videoconferencing Administration of a Communication Questionnaire to People With Traumatic Brain Injury and Their Close Others
Authors: Rietdijk Rachael , Power Emma , Brunner Melissa , Togher Leanne
Published: February 2017

Objectives:

To compare in-person with videoconferencing administration of a communication questionnaire for people with traumatic brain injury (TBI) and their close others.

Design:

Repeated-measures design with randomized order of administration.

Participants:

Twenty adults with severe TBI and their close others.

Methods:

Both participants with TBI and their close others completed the La Trobe Communication Questionnaire (LCQ) via interview with a clinician, once via Skype and once during a home visit.

Measures:

Total LCQ score and time taken for completion.

Results:

There were no significant differences between videoconferencing and in-person conditions in the total scores or time taken to complete the questionnaire.

Conclusions:

Videoconferencing-based administration of the LCQ is as reliable and efficient as in-person administration.
Assessment of Oculomotor Function in Patients With Postconcussion Syndrome: A Systematic Review
Authors: Taghdiri Foad , Varriano Brenda , Tartaglia Maria Carmela
Published: February 2017

Background:

Concussion and its associated sequel, postconcussion syndrome (PCS), have a debilitating impact on the lives of concussed patients. However, a diagnostic biomarker for this condition is lacking. Recently, there has been a surge of interest in using oculomotor function testing as an objective assessment of patients with PCS.

Objectives:

To systematically synthesize, appraise, and summarize all published empirical studies that have assessed alteration of oculomotor functions in patients with PCS.

Methods:

Medline, Embase, PsychINFO, and CINAHL databases searched up to July 2016 for studies that used oculomotor function assessment in patients with postconcussion symptoms.

Results:

The search identified 1637 citations, and finally 8 case-control studies were included. Of these, 5 studies used a similar task with a target moving in a circular trajectory. Three other studies measured conventional oculomotor tasks such as saccade, vergence, and smooth pursuit eye movements.

Conclusions:

Currently, there is limited support for the recommendation of oculomotor function assessments for diagnosis and identification of patients with PCS following head trauma. Therefore, more rigorous studies assessing oculomotor function changes in patients with PCS are warranted.
Test-Retest Reliability of Traumatic Brain Injury Outcome Measures: A Traumatic Brain Injury Model Systems Study
Authors: Bogner Jennifer A. , Whiteneck Gale G. , MacDonald Jessica , Juengst Shannon B. , Brown Allen W. , Philippus Angela M. , Marwitz Jennifer H. , Lengenfelder Jeannie , Mellick Dave , Arenth Patricia , Corrigan John D.
Published: February 2017

Objective:

Evaluate the test-retest reliability of measures that comprise the Traumatic Brain Injury Model Systems follow-up data set.

Participants:

A total of 224 persons with a moderate-severe traumatic brain injury (TBI) enrolled in the Traumatic Brain Injury Model Systems National Database.

Design:

Following standard administration of the follow-up interview, a second interview was administered 14 to 28 days later using the same interviewer and the same mode of administration.

Main Measures:

Traumatic Brain Injury Model Systems follow-up interview that includes 66 variables comprised (a) single item measures of demographics; employment; general health as well as specific health conditions; rehospitalization; tobacco, alcohol, and other drug use; transportation; and mental health and (b) multi-item instruments: FIM; Participation Assessment With Recombined Tools-Objective; Disability Rating Scale; Glasgow Outcome Scale—Extended; Supervision Rating Scale; Satisfaction With Life Scale; TBI Quality of Life Anxiety and Depression items; and The Ohio State University TBI Identification Method.

Results:

Intraclass correlation coefficient values ranged from 0.65 to 0.99, weighted kappa values ranged from 0.54 to 0.99, and kappa values ranged from 0.43 to 1.00. Four kappa/weighted kappa estimates fell below 0.60: arrested, psychiatric hospitalization, number of days not in good physical health, and rating of general emotional health.

Conclusions:

With few exceptions, good to excellent test-retest reliability estimates were obtained. The findings support the use of these measures in prior and future studies and indicate that persons with moderate-severe TBI can provide reliable self-report.
Treatment Charges for Traumatic Brain Injury Among Older Adults at a Trauma Center
Authors: Albrecht Jennifer S. , Slejko Julia F. , Stein Deborah M. , Smith Gordon S.
Published: February 2017

Objective:

To provide charge estimates of treatment for traumatic brain injury (TBI), including both hospital and physician charges, among adults 65 years and older treated at a trauma center.

Methods:

We identified older adults treated for TBI during 2008–2012 (n = 1843) at Maryland's Primary Adult Resource Center and obtained hospital and physician charges separately. Analyses were stratified by sex and all charges were inflated to 2012 dollars. Total TBI charges were modeled as a function of covariates using a generalized linear model.

Results:

Women comprised 48% of the sample. The mean unadjusted total TBI hospitalization charge for adults 65 years and older was $36 075 (standard deviation, $63 073). Physician charges comprised 15% of total charges. Adjusted mean charges were lower in women than in men (adjusted difference, −$894; 95% confidence interval, −$277 to −$1512). Length of hospital and intensive care unit stay were associated with the highest charges.

Conclusions:

This study provides the first estimates of hospital and physician charges associated with hospitalization for TBI among older adults at a trauma center that will aid in resource allocation, triage decisions, and healthcare policy.
INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR MACULAR HOLE SURGERY WITHOUT EXTRA MANIPULATION OF THE FLAP
Authors: Casini Giamberto , Mura Marco , Figus Michele , Loiudice Pasquale , Peiretti Enrico , De Cillà Stefano , Fuentes Taiusha , Nasini Francesco
Published: February 2017

Purpose:

To determine whether surgical manipulation steps of the internal limiting membrane (ILM) flap, such as ILM trimmed, ILM tuck inside the hole, ILM massage, are mandatory to obtain satisfactory outcomes for the repair of large stage IV idiopathic macular hole using the inverted ILM flap technique.

Methods:

In this interventional comparative prospective single-masked study, 81 eyes were randomized into 2 treatments groups. In Group 1 (41 eyes), the classic inverted ILM flap technique was performed. In Group 2 (40 eyes), a modified procedure was used: after ILM peeling, no extra flap manipulation was performed. The macular hole was covered by the inverted ILM flap because of the air pressure at the time of the fluid–air exchange.

Results:

At 12 months, macular hole closure was observed in 40 eyes (97.6%) in Group 1 and in 39 eyes in Group 2 (97.5%). U-shape closure rate, ellipsoid zone defects, and external limiting membrane defects were similar in both groups. The results indicate no statistical difference in anatomical and functional success between both groups.

Conclusion:

The macular hole closure rate, improved visual acuity, and no extra complications indicate noninferiority of the modified inverted ILM technique. Internal limiting membrane finishing, tucking, and massage may not be required to obtain surgical success.
LONGITUDINAL CHANGES IN THICKNESSES OF THE MACULA, GANGLION CELL–INNER PLEXIFORM LAYER, AND RETINAL NERVE FIBER LAYER AFTER VITRECTOMY
Authors: Lim Hyung-Bin , Lee Min-Woo , Kwak Baek-Soo , Jo Young-Joon , Kim Jung-Yeul
Published: February 2017

Purpose:

To analyze longitudinal changes in the thicknesses of the macula, ganglion cell–inner plexiform layer (GC-IPL), and peripapillary retinal nerve fiber layer (RNFL) after vitrectomy.

Methods:

Thirty-eight patients diagnosed with intraocular lens (IOL) dislocation without evidence of other vitreoretinal diseases were included. They underwent conventional vitrectomy and IOL transscleral fixation, with a follow-up of 12 months. Using spectral domain optical coherence tomography, the thicknesses of the macula, GC-IPL, and peripapillary RNFL in the vitrectomized and fellow control eyes were measured. Various optic nerve head parameters were also determined.

Results:

Optical coherence tomography showed that there were no significant differences in postoperative central macular thickness compared with baseline values. The average GC-IPL thickness increased 1 month after surgery from baseline (P = 0.038). The average RNFL thickness increased from baseline at 1 month (P = 0.001) and 3 months (P = 0.011) after vitrectomy. The mean foveal, GC-IPL, and RNFL thicknesses of the study eyes compared with the fellow control eyes increased at 1 month (P = 0.034), 1 month (P = 0.048), and 1 month (P = 0.013) to 3 months (P = 0.038), respectively, after surgery. However, no significant differences were found in intraocular pressure or optic nerve head parameters between the study and fellow control eyes at 12 months after surgery.

Conclusion:

Transient increases in the thickness of the macula and GC-IPL were observed at 1 month after vitrectomy, and the postoperative RNFL thickness increased until 3 months after surgery, after which it returned to preoperative levels. There was no significant change in intraocular pressure or optic nerve head parameters before and after surgery.
METAMORPHOPSIA AND OUTER RETINAL MORPHOLOGIC CHANGES AFTER SUCCESSFUL VITRECTOMY SURGERY FOR MACULA-OFF RHEGMATOGENOUS RETINAL DETACHMENT
Authors: Okuda Tetsuhiko , Higashide Tomomi , Sugiyama Kazuhisa
Published: February 2017

Purpose:

To evaluate the correlation between metamorphopsia and outer retinal morphologic changes after successful vitrectomy for rhegmatogenous retinal detachment (RRD).

Methods:

Forty eyes from 40 patients with macula-off (26 eyes) or macula-on (14 eyes) RRDs that underwent pars plana vitrectomy were included. Metamorphopsia was quantified with M-CHARTS. The relationship between the integrity of the outer retinal layers examined by spectral domain optical coherence tomography and metamorphopsia at 6 and 12 months postoperatively was evaluated.

Results:

Metamorphopsia was significantly more frequent in eyes with macula-off RRD (88%) than in eyes with macula-on RRD (21%) at 6 months postoperatively (P < 0.001) and became significantly less frequent in macula-off RRD eyes from 6 months to 12 months (64%) postoperatively (P = 0.041). Horizontal metamorphopsia scores in eyes with continuous interdigitation zone and ellipsoid zone bands were significantly smaller than in eyes with a disrupted interdigitation zone band and a continuous ellipsoid zone band or in eyes with disrupted ellipsoid zone and interdigitation zone bands (P = 0.003 and P <0.001, respectively), which was consistent with the results of vertical metamorphopsia scores.

Conclusion:

Restoration of both the ellipsoid zone and interdigitation zone bands seems to be an important factor for the reduction of metamorphopsia after successful vitrectomy for macula-off RRD.
ACUTE ZONAL OCCULT OUTER RETINOPATHY
Authors: Duncker Tobias , Lee Winston , Jiang Fan , Ramachandran Rithambara , Hood Donald C. , Tsang Stephen H. , Sparrow Janet R. , Greenstein Vivienne C.
Published: February 2017

Purpose:

To assess structure and function across the transition zone (TZ) between relatively healthy and diseased retina in acute zonal occult outer retinopathy.

Methods:

Six patients (6 eyes; age 22–71 years) with acute zonal occult outer retinopathy were studied. Spectral-domain optical coherence tomography, fundus autofluorescence, near-infrared reflectance, color fundus photography, and fundus perimetry were performed and images were registered to each other. The retinal layers of the spectral-domain optical coherence tomography scans were segmented and the thicknesses of two outer retinal layers, that is, the total receptor and outer segment plus layers, and the retinal nerve fiber layer were measured.

Results:

All eyes showed a TZ on multimodal imaging. On spectral-domain optical coherence tomography, the TZ was in the nasal retina at varying distances from the fovea. For all eyes, it was associated with loss of the ellipsoid zone band, significant thinning of the two outer retinal layers, and in three eyes with thickening of the retinal nerve fiber layer. On fundus autofluorescence, all eyes had a clearly demarcated peripapillary area of abnormal fundus autofluorescence delimited by a border of high autofluorescence; the latter was associated with loss of the ellipsoid zone band and with a change from relatively normal to markedly decreased or nonrecordable visual sensitivity on fundus perimetry.

Conclusion:

The results of multimodal imaging clarified the TZ in acute zonal occult outer retinopathy. The TZ was outlined by a distinct high autofluorescence border that correlated with loss of the ellipsoid zone band on spectral-domain optical coherence tomography. However, in fundus areas that seemed healthy on fundus autofluorescence, thinning of the outer retinal layers and thickening of the retinal nerve fiber layer were observed near the TZ. The TZ was also characterized by a decrease in visual sensitivity.
CHOROIDAL THICKNESS IN DIABETIC RETINOPATHY ASSESSED WITH SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY
Authors: Laíns Inês , Talcott Katherine E. , Santos Ana R. , Marques João H. , Gil Pedro , Gil João , Figueira João , Husain Deeba , Kim Ivana K. , Miller Joan W. , Silva Rufino , Miller John B.
Published: February 2017

Purpose:

To compare the choroidal thickness (CT) of diabetic eyes (different stages of disease) with controls, using swept-source optical coherence tomography.

Methods:

A multicenter, prospective, cross-sectional study of diabetic and nondiabetic subjects using swept-source optical coherence tomography imaging. Choroidal thickness maps, according to the nine Early Treatment Diabetic Retinopathy Study (ETDRS) subfields, were obtained using automated software. Mean CT was calculated as the mean value within the ETDRS grid, and central CT as the mean in the central 1 mm. Diabetic eyes were divided into four groups: no diabetic retinopathy (No DR), nonproliferative DR (NPDR), NPDR with diabetic macular edema (NPDR + DME), and proliferative DR (PDR). Multilevel mixed linear models were performed for analyses.

Results:

The authors included 50 control and 160 diabetic eyes (n = 27 No DR, n = 51 NPDR, n = 61 NPDR + DME, and n = 21 PDR). Mean CT (ß = −42.9, P = 0.022) and central CT (ß = −50.2, P = 0.013) were statistically significantly thinner in PDR eyes compared with controls, even after adjusting for confounding factors. Controlling for age, DR eyes presented a significantly decreased central CT than diabetic eyes without retinopathy (β = −36.2, P = 0.009).

Conclusion:

Swept-source optical coherence tomography demonstrates a significant reduction of CT in PDR compared with controls. In the foveal region, the choroid appears to be thinner in DR eyes than in diabetic eyes without retinopathy.