bluuebunny/crossref_metadata_2025 huggingface dataset:
Pelvic Trauma: What the Radiologist Needs to Know
Authors: Schuchardt Philip , Yasin Junaid , Davis Ryan M. , Thimmappa Nanda , Bhat Ambarish P.
Published: October 2019

Pelvic trauma, especially in the setting of hemodynamic instability, results in high rates of morbidity and mortality. Proper management requires rapid identification of injured structures via appropriate diagnostic studies. This review primarily focuses on the initial evaluation of pelvic trauma, the vascular territories within the pelvis, angiographic and imaging findings of vascular pelvic injury, classification of pelvic injuries, and treatment of pelvic trauma.
Overview of Ground-Glass Opacity on CT: A Must for the Diagnostic Radiologist
Authors: Baxi Ameya J. , Mumbower Amy L. , Restrepo Carlos S.
Published: October 2019

Ground-glass opacity is a commonly encountered, nonspecific finding in the lung parenchyma on chest CT. Because of increasing and widespread use of CT, an improved understanding of ground-glass opacity will contribute to optimized patient care.1–3 Ground-glass opacity has been described as a potential finding in virtually all pulmonary neoplastic, infectious, and inflammatory conditions; thus, the specificity of this finding in a given case is limited. Even when correlating with the clinical setting, a wide differential diagnosis often is applicable.1–4 Thus, it is important for the radiologist to have a systematic approach and review all relevant data, both imaging and clinical, in order to best assist the referring physician for care of the patient. The objectives of this article are to discuss the etiopathogenesis and characteristic CT imaging appearance of ground-glass opacity; suggest and review methods to classify ground-glass opacity based on distribution, acuity, and cause (to provide the most concise differential diagnosis); and provide an overview of the more frequently encountered and well-known causes of ground-glass opacity in daily radiologic practice.
Perceived Self-Efficacy of Teaching for Creativity Among Nurse Faculty in Taiwan: A Preliminary Study
Authors: Liu Hsing-Yuan , Wang I-Teng , Han Hui-Mei , Huang Ding-Hau , Hsu Ding-Yang
Published: October 2019

Many health care education programs, particularly those in Taiwan, have begun offering capstone product-based curricula, not only to improve nursing students’ problem-solving skills but also to foster creativity and innovation regarding health care issues. This study used a cross-sectional quantitative design to explore the efficacy of teaching for creativity among nurse faculty in Taiwan. Results showed knowledge of intellectual property rights was low, as was ability to creatively evaluate trademark and patent designs. Curiosity was the main predictor associated with self-efficacy of teaching for creativity.
The CARE approach
Authors: McCarthy Jessica , Bianchi Ann
Published: October 2019

Disclosing abuse for the first time transfers power back to the patient as she begins to move toward safety. Nurses can consider, acknowledge, respond, and empower while building a trusting relationship during routine screening.
Acute acetaminophen toxicity in adults
Authors: Saccomano Scott J.
Published: October 2019

When taken in the recommended dosage, acetaminophen is a safe and effective analgesic and antipyretic agent. Its wide availability and easy accessibility make accidental or intentional overdose, leading to hepatotoxicity, a common occurrence. To prevent morbidity and mortality, prompt recognition of acetaminophen toxicity is essential. This article covers the stages of acetaminophen toxicity, recommended treatments, and NP considerations, including patient education recommendations.
Wound Care 101
Authors: Cox Jill
Published: October 2019

The clinical nurse may be the first caregiver to assess changes in a patient's skin and initiate wound care. This article provides practical guidelines that any nurse can implement.
Attitudes of Trainees in Obstetrics and Gynecology Regarding the Structure of Residency Training
Authors: Alston Meredith J. , Autry Amy (Meg) , Wagner Sarah A. , Kohl-Thomas Belinda M. , Ehrig Jessica , Allshouse Amanda A. , Gottesfeld Marshall , Stephenson-Famy Alyssa
Published: October 2019

OBJECTIVE:

To measure future and current resident perspectives on obstetrics and gynecology residency training structure and possible future models.

METHODS:

Medical students invited for obstetrics and gynecology residency interviews and residents (postgraduate year [PGY]-1–4) at the University of Colorado, the University of Washington, the University of California San Francisco, Loyola University, Saint Joseph's Hospital, and Texas A&M in 2017–2018 received a voluntary, electronic survey regarding possible models for restructuring residency training. Student and resident responses were compared using χ2 test for categorical and two-sample t-test for continuous items.

RESULTS:

Applicants (63%, 280/444) and residents (66%, 101/153) had similar response rates (overall response rate 64%). Applicants (24%) and residents (29%) reported having concerns about the current structure of residency training. The ideal residency duration was reported as 4 years by 72% of applicants and 85% of residents. Lack of gynecologic surgical volume was the most frequently reported concern among applicants (75%) and residents (72%). Fourth-year tracking (focusing on training aligned with postgraduation career path) was preferred by 90% of applicants and 77% of residents (P=.002) and 92% among respondents planning fellowship. Most applicants (68%) and residents (75%) preferred not starting fellowship training after the 3rd year of residency.

DISCUSSION:

The majority of learners surveyed support a 4-year training structure but likewise support individualizing training in PGY-4. It is imperative that obstetrics and gynecology leadership consider this and other feedback from learners when considering modifications to the current training paradigm.
Resection arthroplasty of the shoulder and hemiarthoplasty in the setting of infection: A narrative review
Authors: Alyea Eric Gordon , Burkhead Wayne Z.
Published: October 2019

Failure after anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA) leaves few options secondary to loss of bone stock and derangement of the soft tissues. Treatment modalities for prosthetic joint infection are as diverse as their efficacy and morbidity. Single- or two-stage revision arthroplasty is an option for treating prosthetic joint infections in patients who can be treated surgically. The use of an antibiotic cement spacer as definitive treatment also has been shown in recent literature to be a viable treatment in medically tenuous patients or in patients with infections. The utility of a hemiarthroplasty with an antibiotic-coated stem (functional spacer) has been shown to provide good pain relief in over half of patients, and conversion of a hemiarthroplasty to a reverse TSA can be performed with improvement in both motion and function. Two-stage revision methods have the highest likelihood of restoring function, with a reported 60% to 90% success rate. While arthrodesis and amputation are options in life-threatening infections or the severely ill patient, resection arthroplasty remains an option as a limb and limited motion-sparing alternative.
Locking Hole Inserts: Effect of Insertion Torque on Fatigue Performance and Insert Loosening in Locking Plates
Authors: Zhang Joanne Y. , Tornetta Paul , Jones Bob , Zheng Yanming , Whitten Andy , Cartner Jacob , Ricci William M.
Published: October 2019

Objectives:

To evaluate the effect of locking hole inserts (LHIs) and their insertion torque on locking plate fatigue life.

Methods:

Eighteen standard 3.5-mm locking plates were instrumented with LHIs (Smith & Nephew, Memphis, TN) of 1.70 or 3.96 Nm insertion torque, or without LHIs, whereas eleven 4.5-mm locking plates were instrumented with LHIs at 3.96 Nm insertion torque or without LHIs. Plates were cyclically loaded to failure (ie, plate fracture) in four-point bending. Number of cycles to plate failure were measured.

Results:

The 3.5-mm plates with 1.70 Nm LHI insertion torque had a 52% increase in cycles to failure compared with plates without LHIs (114,300 ± 23,680 vs. 75,487 ± 15,746 cycles; P = 0.01). Increasing insertion torque to 3.96 Nm led to a further increase of 36% in fatigue life (155,177 ± 32,493 cycles; P = 0.02) and a 106% increase compared with plates without LHIs (P = 0.001). The 4.5-mm plates with 3.96 Nm insertion torque had a 48% increase in cycles to failure when compared with plates without LHIs (74,369 ± 10,181 vs. 50,214 ± 5544 cycles; P = 0.001).

Conclusions:

LHIs significantly extend plate fatigue length, which would be advantageous in the setting of delayed fracture healing. We recommend the use of LHIs in round locking holes over bony gaps whenever possible; however, we recognize that these findings are limited to implants manufactured by Smith & Nephew.
Apparent Proximal Ulna Dorsal Angulation Variation Due to Ulnar Rotation
Authors: Jarvie Geoff C. , Kilb Brett , Willing Ryan , King Graham J. , Daneshvar Parham
Published: October 2019

Objective:

To investigate the effect of ulna rotation on the apparent proximal ulna dorsal angulation (PUDA).

Methods:

Computed tomography images of 59 ulnas were included in this study, 48 being bilateral specimens and the remaining 11 were unilateral. Three-dimensional models of the entire ulna were obtained, and the ulnas were rotated in 5-degree increments in internal rotation or external rotation from neutral. PUDA, PUDA apex, varus angulation, and varus apex were measured on each ulna.

Results:

With the ulna in neutral rotation, the mean (95% CI) PUDA was 3.7 (2.9–4.5) degrees, whereas the mean varus angle was 10.5 (9.8–11.1) degrees. The varus angle apex and PUDA apex were 28.9 (27.5–30.2)% and 19.6 (18.7–20.6)% along the total length of the ulna, respectively. As the ulna was rotated externally by 5, 10, and 15 degrees, the PUDA increased by 0.7 (0.5–0.9) degrees, 1.2 (0.9–1.4) degrees, and 1.4 (1.1–1.8) degrees, respectively. Conversely, with internal rotation of 5, 10, and 15 degrees, the PUDA decreased by 0.9 (0.8–1.1) degrees, 2.0 (1.8–2.3) degrees, and 3.3 (2.7–3.9) degrees, respectively.

Conclusions:

This study demonstrates that small degrees of ulna rotation result in a statistically significant change in the apparent PUDA; however, this may not represent a clinically significant difference. Because of the anatomic variation between patients, it is important to obtain a contralateral film to determine the PUDA for anatomic reduction of the ulna in complex cases. When using a contralateral image, it is important to obtain a true lateral film or consider using 3-dimensional imaging for preoperative planning.
Precontoured Quadrilateral Surface Acetabular Plate Fixation Demonstrates Increased Stability When Compared With Pelvic Reconstruction Plates: A Biomechanical Study
Authors: Ryan Weston , Alfonso Nicholas A. , Baldini Todd , Kumparatana Pam , Reiter Michael , Joyce Christopher , Wei Chen , Zhang Yingzhe , Mauffrey Cyril
Published: October 2019

Objective:

To compare the stability of 3 fixation strategies for a transverse acetabular fracture: a reconstruction plate with anterior and posterior column screws (group A); an infrapectineal precontoured quadrilateral surface buttress (iPQSB) plate alone (group B); and an anterior column lag-screw and iPQSB plate (group C).

Methods:

A transverse acetabular fracture was created in 18 synthetic hemipelvises. Six were fixed by each of the 3 methods described. Specimens underwent cyclic axial compressive loading to 1700N for 42,000 cycles while anterior and posterior column displacements were measured, followed 4800N for 50 cycles. Displacement and stiffness data were analyzed with analysis of variance and Tukey HSD. A Cox proportional hazards regression model was used to determine survival rate. P values < 0.05 were considered significant.

Results:

Group C had significantly less posterior column displacement (0.16 ± 0.06 mm) compared with group B (0.38 ± 0.37 mm, P < 0.0001) and group A (0.38 ± 0.37 mm, P < 0.0001). In addition, group A had significantly more anterior column displacement (0.28 ± 0.11 mm) than group B (0.22 ± 0.14 mm, P = 0.0310) and group C (0.18 ± 0.09 mm, P = 0.0001). Group C was 10.5% stiffer than group A (P = 0.0037). Group B had a 7.27x greater rate of failure than group C (95% confidence interval, 1.6–33.2).

Discussion and Conclusion:

Under anatomical loading, iPQSB plates with anterior column lag-screw fixation demonstrate increased stability in a synthetic bone transverse acetabular fracture model. Based on our data, we support additional evaluation of early weight-bearing after transverse acetabular fracture fixation in patients with healthy bone when an anterior column screw-iPQSB plate construct is used.
Long-Term Treatment Effect and Predictability of Spinopelvic Alignment After Surgical Correction of Adult Spine Deformity With Patient-Specific Spine Rods
Authors: Kleck Christopher J. , Calabrese David , Reeves Bradley J. , Cain Christopher M.J. , Patel Vikas V. , Noshchenko Andriy , Burger-Van der Walt Evalina L.
Published: October 2019

Study Design.

Retrospective case series.

Objective.

To evaluate the short- and long-term treatment effect (TE) of spinopelvic parameters after surgical correction of adult spine deformity (ASD) utilizing preoperative planning and patient-specific spine rods (PSSRs), and to assess the correspondence between planned and real outcomes.

Summary of Background Data.

PSSR have been used in ASD correction for the last decade. However, a TE and predictability of spinopelvic alignment at long-term follow-up has not been studied.

Methods.

Inclusion criteria: male or female; age more than 20 years; correction of ASD with PSSR; 24-month follow-up (or revision surgery). Studied parameters: sagittal vertical axis; lumbar lordosis (LL); pelvic tilt (PT); sacral slope; pelvic incidence (PI); and PI-LL. The measurement error, TE (the differences between postoperative and preoperative values), standardized TE, and predictability of the studied parameters assessed. The variables included categorical (optimal/nonoptimal) and continuous obtained by direct measurements and weighted by individual optimal values. Statistical significance was set at P ≤ 0.05.

Results.

Thirty-four patients were included: 56% women; the mean age, 63.4 (standard deviation, 12.7); at each follow-up: 32 at 1 to 3 months, 34 at 11 to 13, and 14 at 23 to 25 with 9 followed to the revision surgery. Strong or moderate TE was shown for sagittal vertical axis, LL, and PI-LL. The TE of PT and sacral slope was less significant and lower than planned. PI was not stable in 18%. The changes of continuous variables were more prominent and statistically significant then categorical. The mean values did not show significant differences between planned and postoperative outcomes except for PT. However, the individual deviations were substantial for all parameters. Significant predictability was shown only for LL and PI.

Conclusion.

Use of PSSR showed strong and relatively stable TE in ASD during 2 postoperative years. However, improvement of the planning accuracy may contribute to further enhancement of the method's efficacy.

Level of Evidence: 4.
Quantitation Analysis of PCDH10 Methylation in Adolescent Idiopathic Scoliosis Using Pyrosequencing Study
Authors: Shi Benlong , Mao Saihu , Xu Liang , Li Yang , Sun Xu , Liu Zhen , Zhu Zezhang , Qiu Yong
Published: October 2019

Study Design.

A retrospective and comparative study.

Objective.

To evaluate the difference of DNA methylation in protocadherin10 (PCDH10) genes between adolescent idiopathic scoliosis (AIS) and normal controls, and to assess the association between DNA methylation and the etiology of AIS.

Summary of Background Data.

The PCDH10 gene showed abnormal expression in AIS. However, the mechanism was still unclear. DNA methylation was an important epigenetic mechanism at the interface between genetics and environmental phenotype, seeming to be a suitable epigenetic mark for the abnormal expression of PCDH10 in AIS.

Methods.

There were 50 AIS patients and 50 healthy controls included in the study. The peripheral blood sample of each participant was taken. The pyrosequencing assay was used to assess the methylation status of PCDH10 promoter and real time PCR (RT-PCR) was used to detect the PCDH10 gene expression. The comparison analysis was performed using independent t test and 2-tailed Pearson coefficients was calculated for the correlation analysis.

Results.

The average methylation level was 4.32 ± 0.73 in AIS patients and 3.14 ± 0.97 in healthy controls (P < 0.001). The PCDH10 gene expression was 0.23 ± 0.04 in AIS patients and 0.36 ± 0.08 in normal controls (P < 0.0001). Statistically significant linear correlation was found between PCDH10 gene methylation level and Cobb angle of major curve (P < 0.001). Besides, a significant negative correlation between PCDH10 methylation and PCDH10 gene expression was found (P < 0.001).

Conclusion.

AIS patients were associated with high DNA methylation level and low gene expression of PCDH10 gene rather than normal controls. The high methylation level indicated high Cobb angle of major curves in AIS. The abnormal DNA methylation may widely exist and serve as a potential mechanism for AIS.

Level of Evidence: 3
Best Practices and Evolving Techniques for Preventing Infection After Fracture Surgery
Authors: Joshi Manjari
Published: October 2019

Orthopedic trauma-related infections remain one of the major complications in modern trauma and orthopedic surgery. Despite current preventive practices, infection rates range from ~1% after operative fixation of closed low-energy fractures to >30% in complex open tibia fractures. Fracture-related infections negatively impact clinical outcome with lifelong functional impairment and significantly increase health care expenditure. In addition, the escalating issue of antimicrobial resistance continues to pose a challenge to clinicians. Unfortunately, in orthopedic trauma, only a few preventive measures are strongly supported by past studies and for most measures, there are insufficient data. Surgical site infection prevention guidelines established by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) are generalized for all surgical disciplines and do not take into account the specifics of fracture-related infections. The most important difference in orthopedic trauma patients from the other surgical disciplines is the ability of skin colonizers and contaminating organisms to establish infection on implants and form biofilms. The bacteria can then resist conventional infection control measures and prophylactic antibiotic therapy. To effectively decrease fracture-related infections, there needs to be a multidisciplinary clinical approach, which should recognize the unique aspects of such infections and develop strategies on the basis of these specific needs. There is also a dire need for future research for prevention of infections focusing on specifics of musculoskeletal trauma. This review highlights the established practices for infection prevention in fractures and discusses the emerging strategies still under investigation.
Very Low Density Lipoprotein Receptor Sequesters Lipopolysaccharide Into Adipose Tissue During Sepsis
Authors: Shimada Tadanaga , Topchiy Elena , Leung Alex K. K. , Kong HyeJin J. , Genga Kelly R. , Boyd John H. , Russell James A. , Oda Shigeto , Nakada Taka-aki , Hirasawa Hiroyuki , Walley Keith R.
Published: October 2019

Objectives:

Obese patients have lower sepsis mortality termed the “obesity paradox.” We hypothesized that lipopolysaccharide, known to be carried within lipoproteins such as very low density lipoprotein, could be sequestered in adipose tissue during sepsis; potentially contributing a survival benefit.

Design:

Retrospective analysis.

Setting:

University research laboratory.

Subjects and Patients:

Vldlr knockout mice to decrease very low density lipoprotein receptors, Pcsk9 knockout mice to increase very low density lipoprotein receptor, and Ldlr knockout mice to decrease low density lipoprotein receptors. Differentiated 3T3-L1 adipocytes. Caucasian septic shock patients.

Interventions:

We measured lipopolysaccharide uptake into adipose tissue 6 hours after injection of fluorescent lipopolysaccharide into mice. Lipopolysaccharide uptake and very low density lipoprotein receptor protein expression were measured in adipocytes. To determine relevance to humans, we genotyped the VLDLR rs7852409 G/C single-nucleotide polymorphism in 519 patients and examined the association of 28-day survival with genotype.

Measurements and Main Results:

Lipopolysaccharide injected into mice was found in adipose tissue within 6 hours and was dependent on very low density lipoprotein receptor but not low density lipoprotein receptors. In an adipocyte cell line decreased very low density lipoprotein receptor expression resulted in decreased lipopolysaccharide uptake. In septic shock patients, the minor C allele of VLDLR rs7852409 was associated with increased survival (p = 0.010). Previously published data indicate that the C allele is a gain-of-function variant of VLDLR which may increase sequestration of very low density lipoprotein (and lipopolysaccharide within very low density lipoprotein) into adipose tissue. When body mass index less than 25 this survival effect was accentuated and when body mass index greater than or equal to 25 this effect was diminished suggesting that the effect of variation in very low density lipoprotein receptor function is overwhelmed when copious adipose tissue is present.

Conclusions:

Lipopolysaccharide may be sequestered in adipose tissue via the very low density lipoprotein receptor and this sequestration may contribute to improved sepsis survival.
Intrapatient Molecular and Histologic Heterogeneity After First-generation or Second-generation TKI Therapy of NSCLC Patients
Authors: Iacono Daniela , Osman Giorgia A. , Migliorino Maria R. , Grillo Lucia , Remotti Daniele , Nunnari Josè , Ricciardi Serena , Rossi Antonio , Mancuso Andrea , Graziano Paolo , Di Lorenzo Angela , Bronzini Monica , Signora Mauro , Leone Alvaro
Published: October 2019

Objectives:

The discovery of tyrosine kinase inhibitors (TKI) has remarkably improved the clinical course of patients with non–small cell lung cancer driven by Epidermal Growth Factor Receptor (EGFR) mutations. However, virtually in all cases, the disease resurfaces in a TKI-resistant form that is mainly linked to an acquired EGFR-T790M mutation, a MET amplification, or small cell lung cancer (SCLC) transformation. Third-generation TKIs are able to block tumor growth through an irreversible binding to the T790M-mutated receptor. Such new treatments require the diagnostic analysis of new pathologic tissue or a liquid biopsy to detect the presence of the T790M mutation.

Materials and Methods:

Pre-TKI and post-TKI biopsies from 27 patients with an activating EGFR mutation were collected and analyzed for EGFR-T790M mutation, MET amplification, and SCLC transformation.

Results:

The T790M mutation was found in 16 patients (59%) whereas MET gene amplification was found in 2 (10.5%) of 19 evaluated cases. The histologic transformation from adenocarcinoma (ADC) to SCLC was identified in 3 patients (11%). In one of them reversal from SCLC back to adenocarcinoma was observed. One patient had the T790M mutation concordantly detected in 2 synchronous lesions whereas another patient showed T790M positivity only in one of 2 specimens. In 4 patients longitudinal biopsies revealed T790M gains and losses not always according to biological expectations.

Conclusions:

Intrapatient molecular or histologic heterogeneity may be frequently found during routine treatment of non–small cell lung cancer patients. This biological aspect may have profound repercussions on subsequent therapeutic decisions, and therefore requires in-depth investigation.
An Update to Changing Patterns of Anal Carcinoma in the United States
Authors: Mahal Amandeep R. , Johung Kimberly L. , Mahal Brandon A. , Nguyen Paul L. , Yu James B.
Published: October 2019

Objectives:

Approximately 8,300 new cases of anal carcinoma will be diagnosed in the United States in 2019. Anal squamous cell carcinoma (SCC) accounts for about 70% of all anal cancers. As cancer prevention and treatments have evolved over time, medical management of human immunodeficiency virus has improved, and sexual behaviors have changed, anal carcinoma incidence rates (IRs) may have also changed.

Methods:

The 9 oldest Surveillance, Epidemiology, and End Results registries were used to identify and determine IR of carcinoma in situ (CIS) and invasive SCC for 9757 patients below 65 years diagnosed with anal SCC/CIS from 1973 to 2014. Joinpoint regression models identified time points at which incidence trends changed.

Results:

The incidence of CIS decreased since 2010 (age-adjusted IR annual percent change [APC]: −5.65, 95% CI: −10.0 to −1.1), especially for men (APC: −8.30, 95% CI: −12.6 to −3.8). In contrast, the incidence of SCC increased since 2007 (APC: 2.59, 95% CI: 0.1-5.2). During 2010-2014, men were more likely to present with CIS (incidence rate ratio [IRR]: 3.234, 95% CI: 3.000-3.489) but less likely to present with localized (IRR: 0.827, 95% CI: 0.754-0.906), regional (IRR: 0.603, 95% CI: 0.537-0.676), and distant SCC (IRR: 0.751, 95% CI: 0.615-0.915) compared with women.

Conclusions:

The previously observed rise in anal SCC/CIS incidence slowed in 2010, largely due to a decline in CIS rates. Patients were more likely to present with CIS than SCC at any stage. Future studies are necessary to determine if this decline in CIS precedes a decline in invasive SCC.
Multimorbidity patterns in people with HIV
Authors: De Francesco Davide , Sabin Caroline A. , Reiss Peter
Published: October 2019

Purpose of review

With the progressive aging of populations of people with HIV (PWH), multimorbidity is increasing. Multimorbidity patterns, that is groups of comorbidities that are likely to co-occur, may suggest shared causes or common risk factors. We review the literature regarding multimorbidity patterns identified with data-driven approaches and discuss the methodology and potential implications of the findings.

Recent findings

Despite the substantial heterogeneity in the methods used to identify multimorbidity patterns, patterns of mental health problems, cardiovascular diseases, metabolic disorders and musculoskeletal problems are consistently reported in the general population, with patterns of mental health problems, cardiovascular diseases or metabolic disorders commonly reported in PWH. In addition to these, patterns of lifestyle-related comorbidities, such as sexually transmitted diseases, substance use (alcohol, recreational drugs and tobacco smoking) or their complications, seem to occur among PWH.

Multimorbidity patterns could inform the development of appropriate guidelines for the prevention, monitoring and management of multiple comorbidities in PWH. They can also help to generate new hypotheses on the causes underlying previously known and unknown associations between comorbidities and facilitate the identification of risk factors and biomarkers for specific patterns.
Serum uric acid and fatal myocardial infarction: detection of prognostic cut-off values: The URRAH (Uric Acid Right for Heart Health) study
Authors: Casiglia Edoardo , Tikhonoff Valérie , Virdis Agostino , Masi Stefano , Barbagallo Carlo M. , Bombelli Michele , Bruno Bernardino , Cicero Arrigo F.G. , Cirillo Massimo , Cirillo Pietro , Desideri Giovambattista , D’Elia Lanfranco , Ferri Claudio , Galletti Ferruccio , Gesualdo Loreto , Giannattasio Cristina , Iaccarino Guido , Lippa Luciano , Mallamaci Francesca , Maloberti Alessandro , Mazza Alberto , Muiesan Maria Lorenza , Nazzaro Pietro , Palatini Paolo , Parati Gianfranco , Pontremoli Roberto , Quarti-Trevano Fosca , Rattazzi Marcello , Rivasi Giulia , Salvetti Massimo , Tocci Giuliano , Ungar Andrea , Verdecchia Paolo , Viazzi Francesca , Volpe Massimo , Grassi Guido , Borghi Claudio
Published: October 2019

Objective:

The Working Group on Uric Acid and Cardiovascular Risk of the Italian Society of Hypertension conceived and designed an ad-hoc study aimed at searching for prognostic cut-off values of serum uric acid (SUA) in predicting fatal myocardial infaction (MI) in women and men.

Methods:

The URic acid Right for heArt Health study is a nationwide, multicentre, observational cohort study involving data on individuals aged 18–95 years recruited on a regional community basis from all the territory of Italy under the patronage of the Italian Society of Hypertension with a mean follow-up period of 122.3 ± 66.9 months.

Results:

A total of 23 467 individuals were included in the analysis. Cut-off values of SUA able to discriminate MI status were identified by mean of receiver operating characteristic curves in the whole database (>5.70 mg/dl), in women (>5.26 mg/dl) and in men (>5.49 mg/dl). Multivariate Cox regression analyses adjusted for confounders (age, arterial hypertension, diabetes, chronic kidney disease, smoking habit, ethanol intake, BMI, haematocrit, LDL cholesterol and use of diuretics) identified an independent association between SUA and fatal MI in the whole database (hazard ratio 1.381, 95% confidence intervals, 1.096–1.758,P = 0.006) and in women (hazard ratio 1.514, confidence intervals 1.105–2.075,P < 0.01), but not in men.

Conclusion:

The results of the current study confirm that SUA is an independent risk factor for fatal MI after adjusting for potential confounding variables, and demonstrate that a prognostic cut-off value associated to fatal MI can be identified at least in women.
Assessment of Surgical Antibiotic Prophylaxis Compliance in Pediatrics: A Pre–post Quasi-experimental Study
Authors: Lombardi Juliana , Nguy Philippe , Robichaud Ducharme Antoine , Thompson-Desormeaux Félix , Ruo Ni , Girard Gabrielle , Schnitzer Mireille E. , Thirion Daniel J. G. , Papenburg Jesse , Longpré Audrey-Anne
Published: October 2019

Objective:

Data from rigorous evaluations of the impact of interventions on improving surgical antibiotic prophylaxis (SAP) compliance in pediatrics are lacking. Our objective was to assess the impact of a multifaceted intervention on improving pediatric SAP compliance in a hospital without an ongoing antimicrobial stewardship program.

Study Design:

A multidisciplinary team at the Montreal Children’s Hospital performed a series of interventions designed to improve pediatric SAP compliance in June 2015. A retrospective, quasi-experimental study was performed to assess SAP compliance before and following the interventions. Our study included patients under 18 years old undergoing surgery between April and September in 2013 (preintervention) and in 2016 (postintervention). A 10-week washout period was included to rigorously assess the persistence of compliance without ongoing interventions. SAP, when indicated, was qualified as noncompliant, partially compliant (adequate agent and timing) or totally compliant (adequate agent, dose, timing, readministration, duration).

Results:

A total of 982 surgical cases requiring SAP were included in our primary analysis. The composite partial and total compliance increased from 51.4% to 55.8% [adjusted odds ratio 1.3; 95% confidence interval: 1.0–1.8; P = 0.06]. Although improvements in correct dose and readministration were significant, there was no significant improvement in correct timing, agent selection or duration.

Conclusion:

Our study demonstrated that overall SAP compliance did not significantly improve following a washout period, illustrating the importance of ongoing surveillance and feedback from an antimicrobial stewardship program. Our strict approach in evaluating the timing criterion may also explain the lack of a significant impact on SAP compliance.
Epidemiology of Respiratory Syncytial Virus–related Hospitalizations and the Influence of Viral Coinfections in Southern Austria in a 7-year Period
Authors: Resch Bernhard , Puchas Claudia , Resch Elisabeth , Urlesberger Berndt
Published: October 2019

Objective:

The aim of this study was to determine the respiratory syncytial virus (RSV) epidemiology and to analyze the influence of risk factors and coinfections over the last years.

Methods:

Retrospectively all infants, children and adolescents hospitalized due to respiratory disease with positive RSV test [hospitalized for RSV infection (RSV-H)] between January 1, 2009, and December 31, 2015, at a tertiary care center in the southern part of Austria were included for analysis. Patients were all identified by a search via International Classification of Diseases and Related Health Problems, 10th Edition codes, and all medical data were collected from the local electronic databases called openMedocs. RSV tests had to prove true infection case definition.

Results:

During a 7-year study period, 745 infants, children and adolescents exhibited RSV-H. Main diagnosis was bronchiolitis (70%). Nearly half of all cases (44%) were born during the first half of the RSV season (November–January), and seasonal peak of RSV-H was in January. Predominant underlying condition was history of prematurity in 15% followed by neurologic impairment (3.5%) and hemodynamically significant congenital heart disease (2.95%). Age ≤2 months and underlying conditions/morbidities were associated with more severe disease. The majority of cases (96%) had an age below 24 months, and 91% below 12 months. Viral coinfection (most common influenza virus, adenovirus and rhinovirus) was diagnosed in 37 cases (5%) resulting in a more severe course of disease. Main risk factors of coinfection were siblings and crowding. Mortality was 0.27% (2/745). Both children had coinfection with influenza A virus and were multihandicapped (15 and 20 years of age, respectively).

Conclusions:

Prematurity and underlying morbidities play a marked role in RSV-H. Viral coinfections aggravated disease with death in 2 multihandicapped adolescents.
The Effects of Session Standardization and Template Optimization on Improving Access to High-Demand Pediatric Subspecialty Care
Authors: Volk Angela S. , Hollier Larry H. , Karon Grace N. , Bank David E.
Published: October 2019

A major focus of US health care systems is ensuring timely patient access to subspecialty care. This article describes the experiences of a large children's hospital after implementation of clinic session standardization and template optimization. Outpatient specialty clinic sessions were standardized to 4-hour periods, and all unfilled complex appointment slots were made available for any appointment type within 72 hours of the clinic date. Three high-demand outpatient clinical services achieved increased aggregate potential and completed outpatient appointments over a 2-year period. These improvements were mostly due to an increase in providers and were not always coupled to shorter patient lag times.
The Shared Subjective Frames of Interdisciplinary Practitioners Involved in Function-Focused Care in a Nursing Home: Q-Methodology
Authors: KIM Mi So , KIM Gyu-Tae , LEE Su Jung , PARK Min Sun , JEONG Eun-hye , CHANG Sung Ok
Published: October 2019

Background

An interdisciplinary team-based approach in nursing homes has been suggested in the literature as a strategy for delaying functional decline in residents. Function-focused care is a philosophy-based approach in which interdisciplinary practitioners assess functional capacity and help older adults to optimize and maintain their remaining abilities.

Purpose

This study explored and described the shared subjective frames of interdisciplinary practitioners as regards function-focused care for nursing home residents.

Methods

Q-methodology was used to analyze the subjectivity of each factor of function-focused care for nursing home residents. Data were collected from August to September 2016. Thirty-four Q-statements were selected and scored by the 30 interdisciplinary practitioners on a 9-point scale with a normal distribution. Data were analyzed using the PQ Method 2.33 program.

Results

The results revealed four factors of function-focused care, including (a) using a wait-and-see approach to encourage self-care, (b) maintaining interactive communications to identify and respond to changes, (c) reinforcing residents' inner and outer strengths for homeostasis, and (d) using a tailored approach based on comparisons between the past and the present. Shared subjectivity may provide an important collaborative framework to identify and solve complex problems related to the functional needs of nursing home residents.

Conclusions

The results of this study elucidate the subjectivities of interdisciplinary practitioners and better enable their provision of effective care in support of the remaining functional abilities of older adults living in nursing homes. The findings may be used as a reference to establish communication methods and shared documentation for interdisciplinary practitioners in nursing homes and construct interdisciplinary function-focused care practice guidelines.
Work Productivity Losses and Associated Risk Factors Among University Employees in the CAMMPUS Wellness Program
Authors: Zhang Wei , Li Kathy H. , Gobis Barbara , Zed Peter J. , Lynd Larry D.
Published: October 2019

Objective:

The aim of this study was to comprehensively measure work productivity losses of employees enrolled in a pharmacist-led wellness program and assess associated risk factors.

Methods:

The study sample was employees at least 18 years old with a Framingham Risk Score (FRS) at least 10% or 1+ medication-modifiable cardiovascular risk factor (196 participants at baseline and 166 at 12-month endpoint). Total work hour losses (WHL) were measured using the Valuation of Lost Productivity questionnaire. The factors anticipated to be associated with WHL included work habits, FRS, body mass index (BMI), physical activity, and health-related quality of life (HRQoL).

Results:

Sedentary work habits, higher BMI, and lower HRQoL were significantly associated with more WHL for males. Among females, only a lower HRQoL was significantly associated with more WHL.

Conclusions:

Our findings help identify employees at greater risk for WHL and provide insights on how workplace wellness programs can be modified.
Preadmission Exposure to Air Pollution and 90-Day Mortality in Critically ill Patients
Authors: Im Chami , Kim Dong Hyun , Oh Tak Kyu
Published: October 2019

Objective:

We investigated the association between preadmission exposure to air pollutants and 90-day mortality in critically ill patients.

Methods:

This retrospective cohort study analyzed the medical records of adult patients (more than or equal to 18 years) admitted to the intensive care unit of a tertiary academic hospital from 2015 to 2016.

Results:

Four air pollutants were not significantly associated with 90-day mortality and pulmonary disease-related 90-day mortality (P > 0.05). In patients with preadmission chronic obstructive lung disease (COPD), a 1 ppm increase in ozone (O3) and carbon monoxide (CO) was associated with a 1.04-fold and 5.99-fold increase in pulmonary disease-related 90-day mortality, respectively.

Conclusions:

Preadmission exposure to air pollution was not associated with 90-day mortality in critically ill patients. However, a higher concentration of CO and O3 was associated with an increase in pulmonary disease-related 90-day mortality in patients with preadmission COPD.
Barriers to Weight Management Among Overweight and Obese Firefighters
Authors: Muegge Carolyn M. , Zollinger Terrell W. , Song Yiqing , Wessel Jennifer , Monahan Patrick O. , Moffatt Steven M.
Published: October 2019

Objective:

To examine barriers to weight management among firefighters.

Methods:

Health risk data collected on 2373 overweight firefighters were used for this cross-sectional study. Barriers to weight management were the dependent variables and demographic characteristics, readiness for change, and health risk factors were the correlates in the multivariate-adjusted logistic models.

Results:

Overweight firefighters who were ready to begin a weight management program were more likely to identify “lack of knowledge about weight management,” “lack of access to exercise opportunities,” and “eating helps me cope with stress” and report a greater number of barriers toward weight management. Older firefighters were less likely to identify or report one or more barriers to weight management.

Conclusion:

Understanding barriers, readiness for change, and age may be useful in planning interventions to help firefighters better manage their weight.
The Experiences of Parents in the Neonatal Intensive Care Unit
Authors: Loewenstein Kristy , Barroso Julie , Phillips Shannon
Published: October 2019

Having a child hospitalized in the neonatal intensive care unit (NICU) is a deviation from the norms expected for pregnancy and childbirth. A NICU admission may be traumatic for some parents, causing psychological distress and altered parenting roles. The aim of this integrative review is to examine the experiences and perceptions of a NICU hospitalization from the perspective of both parents to inform clinical practice and future research. A systematic search of 3 databases was conducted and included studies were evaluated by the Critical Skills Appraisal Programme checklist for qualitative studies. The Whittemore and Knafl integrative review methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology were followed to provide a structure for searching and reporting findings. There were 248 participants (153 mothers and 95 fathers) from 9 countries and of varying socioeconomic backgrounds in the 16 primary qualitative studies included in this review. The resulting major themes included panic sequence, emotional upheaval, social support, faith, and adjusting. Interventions directed at managing parents' emotions, supporting their spiritual needs, facilitating parenting skills and infant attachment, and adapting the environment to parents' needs can help improve the NICU experience.
Complement Activation During Early Pregnancy and Clinical Predictors of Preterm Birth in African American Women
Authors: Dunn Alexis B. , Dunlop Anne L. , Miller Andrew H. , Hogue Carol J. , Crofton Jordan M. , Corwin Elizabeth J.
Published: October 2019

Complement activation is essential for select physiologic processes during pregnancy; however, excess activation has been associated with an increased risk for preterm birth (PTB). African American (AA) women experience disproportionately higher rates of inflammation-associated PTB than other groups of women; thus, the purpose of this study was to explore the relationship between complement activation and perinatal outcomes among AA women. A plasma sample was collected between 8 and 14 weeks' gestation from a cohort of healthy AA women (N = 144) enrolled in a larger PTB cohort study. Medical record review was conducted to collect information on clinical factors (cervical length, health behaviors, gestational age at delivery). Multiple regression analysis was used to explore the relationships between complement marker (C3a/Bb) concentrations and the outcomes of interest after adjusting for baseline characteristics. C3a/Bb concentrations were not significant predictors of the gestational age at delivery, cervical length, or behavioral risk factors for PTB in this sample. Complement markers may not influence pregnancy outcomes among AA women in the same way as in predominantly white populations; however, more studies are needed to define complement dysregulation and the relationship with outcomes among AA women.
Effectiveness of a Short Education Series to Reduce Anxiety for Health Professions Graduate Students: A Pilot Study
Authors: Shearin Staci M. , Brewer-Mixon Karen
Published: October 2019

In college and graduate programs across the United States, educators have become aware that the psychological well-being of the current generation of students (often referred to as “Millennials”) needs to be an important area of focus. In 2007, 50.7% of American college students met the clinical criteria for a depressive or anxiety disorder. In the 2010 American College Health Survey, 48% of college and university respondents felt overwhelming anxiety at least once in the preceding year. These data make it clear that there is a need for effective interventions to help students reduce the emotional distress they experience. This pilot study examined the effects of an educational intervention on anxiety in graduate students. The intervention included cognitive behavioral therapy (CBT) and mindfulness training, in addition to education about lifestyle health behaviors and study habits. First year graduate students in the UT Southwestern School of Health Professions were recruited for the pilot study. The study design included 4 educational sessions to provide education/training in CBT, mindfulness, lifestyle, and study habits. Subjects completed outcome measures before and after the intervention including the Depression Anxiety Stress Scale-21 (DASS-21) and a survey about subjects' behaviors in the domains targeted in the study. Results indicated a decrease in student distress in DASS-21 overall and individual subtest scores. The results suggest that a comprehensive intervention was successful in impacting the depression, anxiety, and overall stress levels of the involved students.
Ultrasound Evaluation of Hemidiaphragm Function Following Thoracentesis
Authors: Skaarup Søren H. , Lonni Sara , Quadri Federico , Valsecchi Alberto , Ceruti Paolo , Marchetti Giampietro
Published: October 2019

Background:

Dyspnea is the major symptom caused by pleural effusion. The pathophysiological pathways leading to dyspnea are poorly understood. Dysfunction of respiratory mechanics may be a factor. We aimed to study the change in diaphragmatic function following thoracentesis.

Methods:

Patients undergoing thoracentesis at a highly specialized pleural center, underwent ultrasound evaluation of hemidiaphragm movement, before and after thoracentesis was performed. The change was compared to the reduction of dyspnea measured at the modified Borg scale.

Results:

Thirty-two patients were included. Dyspnea was reduced from 5.01 [95% confidence interval (CI): 4.12-6.04] to 2.6 (95% CI: 1.87-3.4, P<0.0001). Low hemidiaphragmatic movement before thoracentesis on the side of pleural effusion was improved by 17.4 cm2 (95% CI: 13.04-21.08), equalizing movement to the side without pleural effusion. On average, 1283 mL (SD: 469) fluid was drained. Multiple linear regression analysis showed that prethoracentesis ultrasound evaluation of hemidiaphragmatic function was correlated with successful thoracentesis.

Conclusion:

Hemidiaphragm function is reduced on the side of pleural effusion, and thoracentesis restores function. Improvement in diaphragm movement is related to a reduction in dyspnea.