bluuebunny/crossref_metadata_2025 huggingface dataset:
Communication During Palliative Care and End of Life
Authors: Montgomery Kathleen E. , Sawin Kathleen J. , Hendricks-Ferguson Verna
Published: April 2016

Background:

Communication between patients, families, and healthcare providers is a central component of end-of-life care. Nurse communication during palliative care (PC) and end of life (EOL) is a phenomenon with limited research. It is unclear how the level of nursing experience influences the perspectives of nurses communicating during EOL.

Objective:

The aim of this study is to describe the commonalities of experienced nurses’ perceptions of communicating during PC and EOL and perceptions of barriers and facilitators to effective communication.

Methods:

This study was part of a larger multisite study that used a qualitative, empirical phenomenology design and represents focus group data gathered from pediatric oncology nurses with more than 5 years of experience or who were advanced practice nurses not involved in the direct evaluation of other nurses.

Results:

Five core themes with corresponding themes and subthemes were identified. The core themes included (a) Evolution of PC/EOL, (b) Skill of Knowing, (c) Expanded Essence of Caring, (d) Experienced Nurse as Committed Advocate, and (e) Valuing Individual Response to Grief.

Conclusions:

Findings reflect how the concept of experience transcended the 5 core themes and captured how experience provided nurses the know-how to fulfill the roles of communication, caring, and advocacy for children and families.

Implications for Practice:

Enhancing nurse communication skills during EOL requires opportunities to gain experience coupled with clinical strategies, such as standardized curricula, simulation, competency-based orientation programs, mentorship, and peer support.
Patients’ Vulnerability in Follow-up After Colorectal Cancer
Authors: Thomsen Thora G. , Hølge-Hazelton Bibi
Published: April 2016

Background:

In the transition between being a hospitalized patient with cancer and resuming “normal” life, many patients experience physical, mental, and social challenges. Scientifically, as well as politically, it is therefore recommended to undertake research with a focus on rethinking and reorganizing follow-up after cancer treatment.

Objective:

The aim of this study was to identify the perspectives of fast-track colorectal cancer surgery patients on challenges experienced in the transition from being a hospitalized patient with cancer to being a cancer survivor.

Methods:

The current article represents phase 1 in an ongoing action research project. Data were analyzed by using the “interpretive description” method.

Results:

Twelve patients (6 male and 6 female patients; mean age, 72.4 years) participated in the study. The analyses show that the patients physically experienced readiness to leave hospital after a few days; however, shortly after returning home, most of them became mentally overwhelmed by the feeling of vulnerability that was closely related to the feeling of being handed over the responsibility for a newly cancer-operated body and a fragile life situation. Four issues that challenged the patients emerged from the analysis: restore an everyday life, participate in a follow-up program, get relevant information, and manage contact with relevant health professionals.

Conclusions:

The study indicates that the transition to restoring a normal life after cancer surgery had been an experience characterized by more vulnerability than expected by the patients in the study.

Implications for Practice:

The findings provide 4 well-defined themes, each of which constitutes a point of departure related to focused patient-centered interventions related to follow-up after cancer surgery.
Improving the Transition to Palliative Care for Patients With Acute Leukemia
Authors: Hopkins Bianca , Gold Michelle , Wei Andrew , Grigoriadis George
Published: April 2016

Background:

Currently, there is little guidance available for documenting and executing the change in management goals in the context of incurable hematologic disease.

Objective:

The aim of this study was to improve the transition to palliative care for patients with acute myeloid leukemia (AML) through the development and implementation of a coordinated care plan program.

Methods:

Twenty-three patients with AML who were no longer being treated with curative intent from March 2011 through September 2012 had hematology supportive care plans developed. Patients (n = 7) completed post–care plan implementation questionnaires to determine their level of understanding in relation to the change in treatment intent. Staff completed pre– (n = 26) and post– (n = 19) care plan implementation questionnaires to determine the communication, challenges, and accessibility of changed management goals.

Results:

Seventy-seven percent of patients understood palliative care to be the primary team managing their symptoms, with 75% of patients viewing symptom control as the main goal of treatment. Staff findings demonstrated a significant improvement in the communication of treatment goals (53% preimplementation vs 86% postimplementation). Early timing of referrals remains a significant issue.

Conclusions:

Implementing the individualized care plan program was associated with better communication and accessibility of documented palliative treatment goals for patients with AML.

Implications for Practice:

This study establishes a model of care that addresses symptom and disease burden in end-stage AML and provides valuable insight into the patient and family understanding of treatment intent during this terminal phase.
The Role of Hair Loss in Cancer Identity
Authors: Trusson Diane , Pilnick Alison
Published: April 2016

Background:

The trauma of chemotherapy-induced alopecia is well documented. However, less is known about how the stereotypical cancer identity affects social interactions.

Objective:

The aim of this study is to explore women’s experiences of hair loss resulting from breast cancer treatment, from a sociological perspective.

Methods:

Twenty-four women who had been treated for early-stage breast cancer or ductal carcinoma in situ were interviewed. References to hair (loss) were isolated from their narratives.

Results:

Findings confirm previous research that hair loss can be traumatic. The stigma attached to both having a cancer patient identity and nonconformity with norms of appearance means that women must decide how much to reveal and to whom. An unexpected finding was that distressing experiences were reported by some women who had not lost their hair.

Conclusions:

Hair is important to identity; therefore, there are implications for social interactions whether women decide to disguise their hair loss or not. There may also be implications for women who do not lose their hair because they fail to conform to the stereotypical appearance of the bald cancer patient. Future research should consider the role of stereotypes in patient experiences.

Implications for Practice:

Nurses should provide sufficient information and support to prepare patients for the impact on self-perception and social interactions when facing hair loss. Also, patients should be forewarned about the possible implications of not conforming to the cancer stereotype. In addition, greater education among the wider population about the possible side effects of cancer treatments may prevent women feeling stigmatized while already undergoing a stressful experience.
Sick Leave and Disability Across Three Decades After a Major Disaster
Authors: Holgersen Katrine Høyer , Klöckner Christian A. , Bøe Hans Jakob , Holen Are
Published: April 2016

Extended functional impairment characterized by sick leave and disability after a single disaster has not been documented before. This prospective, longitudinal, case–control study applied growth mixture modeling to predict trajectories of functional impairment in oil rig workers, survivors (n= 68) and a matched comparison group (n= 84), over 27 years after the 1980 North Sea oil rig disaster. In the initial 12 years post-disaster, survivors displayed higher rates of functional impairment than the comparison group. A minor group of survivors (n= 8, 11.8%) demonstrated persistent functional impairment from the start and remained unable to work during the subsequent three decades. Long-term sick leave and disability were related to perceived peritraumatic death threat and a propensity towards social withdrawal. Most survivors (n= 60) revealed no major functional impairment. The study indicates that functional impairment should be counteracted in the early support after a single disaster.
A Randomized, Controlled Pilot Study of a Single-Session Psychoeducation Treatment for Urban, Culturally Diverse, Trauma-Exposed Adults
Authors: Ghafoori Bita , Fisher Dennis , Korosteleva Olga , Hong Madelyn
Published: April 2016

This randomized pilot study aimed to determine whether a single session of psychoeducation improved mental health outcomes, attitudes toward treatment, and service engagement among urban, impoverished, culturally diverse, trauma-exposed adults. Sixty-seven individuals were randomly assigned to a single-session psychoeducation treatment or a delayed treatment comparison control group. The control group was found to be superior to the treatment group at posttest with respect to symptoms of posttraumatic stress disorder, anxiety, and occupational and family disability. At follow-up, all participants had completed the psychoeducation treatment, and a mixed-effects model indicated significant improvements over time in symptoms of posttraumatic stress disorder, anxiety, depression, somatization, and attitudes toward treatment. Ninety-eight percent of the participants reported the psychoeducation was helpful at follow-up. Participants also reported a 19.1% increase in mental health service utilization at follow-up compared with baseline. Implications for treatment and future research are discussed.
Association of Spirituality With Mental Health Conditions in Ohio National Guard Soldiers
Authors: Ganocy Stephen J. , Goto Toyomi , Chan Philip K. , Cohen Gregory H. , Sampson Laura , Galea Sandro , Liberzon Israel , Fine Thomas , Shirley Edwin , Sizemore James , Calabrese Joseph R. , Tamburrino Marijo B.
Published: April 2016

Research exploring spirituality in military populations is a relatively new field with limited published reports. This study used the Spiritual Well-Being Scale to examine the association of spiritual well-being with suicidal ideation/behavior, posttraumatic stress disorder (PTSD), and depression and alcohol use disorders in a randomized sample of Ohio Army National Guard soldiers. The participants were 418 soldiers, mostly white and male, with nearly three-quarters indicating that they had been deployed at least once during their careers. Higher spirituality, especially in the existential well-being subscale, was associated with significantly less lifetime PTSD, depression, and alcohol use disorders and with less suicidal ideation over the past year. Future research in this area may benefit from a longitudinal design that can assess spirituality and mental health behaviors in addition to diagnoses at different time points, to begin to explore spirituality in a larger context.
Optical Characterization Method for Tilted or Decentered Intraocular Lenses
Authors: Bonaque-González Sergio , Bernal-Molina Paula , Marcos-Robles Manuel , López-Gil Norberto
Published: April 2016

Purpose

To test and validate a method for measuring the optical quality and optical power of monofocal intraocular lenses (IOLs) in the presence of a tilt or a decentration as well as its optical power.

Methods

The experimental system consists of an artificial eye (wet-cell) and a commercial aberrometer with a Shack-Hartmann sensor. Optical image quality parameters such as point spread function (PSF), modulation transfer function (MTF), and the simulations of the retinal image of an extended object are computed from the in vitro wavefront data of an IOL. Repeatability and reproducibility of the system are tested. Mathematical and ray-tracing simulations are used to ascertain the precision and accuracy of the method. Comparison with a standard single-pass method of measurement is also made. Optical properties of four commercial monofocal IOLs are measured under tilts of 0°, 2°, and 4°, and vertical decentrations of 0, 0.2, and 0.4 mm; the results of such measurements are compared with a ray-tracing simulation.

Results

Precision and accuracy of the system are in good agreement with theoretical calculations. Reproducibility and repeatability are within standard ISO norms. MTFs obtained with this method and with the standard method are very similar. The precision of the estimation of the IOL’s optical power is higher than 98.6%. Commercially tested IOLs show a decrease of optical quality in the presence of decentrations and tilts, and their susceptibility to tilts and decentrations depends on the asphericity. These results are in concordance with the results obtained by ray-tracing simulation.

Conclusions

A simple wavefront-based method for in vitro measurements of the wavefront aberrations and power of an IOL is proposed and tested showing accurate and precise results.
Prevalence of Diabetic Retinopathy in a Clinic Population from Puerto Rico
Authors: Rodriguez Neisha M. , Aguilar Stephanie
Published: April 2016

Purpose

Diabetic retinopathy (DR) is a preventable or treatable cause of blindness in the adult population. The prevalence of diabetes mellitus (DM) in Puerto Ricans is the highest among Hispanics. This study evaluated the prevalence of DR in a screening program of DM subjects in a clinic system in Puerto Rico.

Methods

A retrospective cross-sectional health records study of DM patients referred by primary care physicians for dilated retinal evaluation to the Inter American University of Puerto Rico School of Optometry Juana Diaz Eye Institute Clinic between 2001 and 2009 was performed. All subjects underwent a complete eye evaluation including fundus photography. Photographs were graded following the Early Treatment Diabetic Retinopathy Study protocols.

Results

A total of 411 randomly selected health records of DM subjects older than 30 years were included. The estimated prevalence of DR among all subjects is 37.7%. DR was more common in males (47.2%) than females (33.7%). The age range with higher frequency of DR is among ages 60 to 69 (34.8%) and the lowest between ages 30 and 39 (3.9%). The average number of years since initial DM diagnosis was 12.48. Probability of developing DR increases with longer duration of DM (p < 0.05). The most common stage was mild non-proliferative DR (22.6%).

Conclusions

Our data revealed that prevalence of DR was high among Puerto Ricans. Mild stage retinopathy was most prevalent and there exists an increase in probability to develop DR with duration of DM. The prevalence of DR in total population may be different than the findings presented in this paper. Comprehensive studies are needed to understand and estimate the progression and impact of DR in this population.
Clicking Eyelids: A New Finding of Prostaglandin-Associated Periorbitopathy
Authors: Skorin Leonid , Dailey Kathryn H.
Published: April 2016

Purpose

To present and discuss a case representing both a new sign and symptom of prostaglandin-associated periorbitopathy.

Case Report

An 83-year-old female patient presented for a 6-month glaucoma follow-up in July 2013 with no specific visual or comfort complaints. The patient had a 14-year history of bilateral primary open angle glaucoma and a 13-year history of once daily bimatoprost use in both eyes. Evaluation at previous examinations revealed long eyelashes, tight eyelids, small palpebral fissures, and deepening of the upper eyelid sulcus. During slit-lamp examination of the anterior segment, it was noted that the patient’s eyelids clicked intermittently when she blinked. The patient had not previously noticed the clicking and it was determined to be present in each eye individually. The eyelid clicking has been noted to be present in every follow-up examination since it was discovered in July 2013.

Conclusions

Prostaglandin-associated periorbitopathy and the resulting cosmetic effects noticed visually by patients are well documented. Our case represents a new audible sign and symptom that may be found with prostaglandin-associated periorbitopathy but has not to our knowledge been reported in the literature.
Pediatric Patient With Altered Mental Status and Hypoxemia
Authors: Root Jeremy M. , Vargas Marcela , Garibaldi Luigi R. , Saladino Richard A.
Published: April 2016

Childhood cases of myxedema coma are extremely rare. We report a case of a 5-year-old girl transferred to a tertiary care pediatric emergency department with hypoxemia and altered mental status and diagnosed with severe hypothyroidism and myxedema coma in the setting of acute influenza infection. Although it is rare, myxedema coma must remain in the differential diagnosis for altered mental status and organ dysfunction in the pediatric population.
Leukocyte-Reduced Platelet-Rich Plasma Alters Protein Expression of Adipose Tissue–Derived Mesenchymal Stem Cells
Authors: Loibl Markus , Lang Siegmund , Hanke Alexander , Herrmann Marietta , Huber Michaela , Brockhoff Gero , Klein Silvan , Nerlich Michael , Angele Peter , Prantl Lukas , Gehmert Sebastian
Published: April 2016

Background:

Application of platelet-rich plasma and stem cells has become important in regenerative medicine. Recent literature supports the use of platelet-rich plasma as a cell culture media supplement to stimulate proliferation of adipose tissue–derived mesenchymal stem cells. The underlying mechanism of proliferation stimulation by platelet-rich plasma has not been investigated so far.

Methods:

Adipose tissue–derived mesenchymal stem cells were cultured in α-minimal essential medium supplemented with platelet-rich plasma or fetal calf serum. Cell proliferation was assessed with cell cycle kinetics using flow cytometric analyses after 48 hours. Differences in proteome expression of the adipose tissue–derived mesenchymal stem cells were analyzed using a reverse-phase protein array to quantify 214 proteins. Complementary Ingenuity Pathways Analysis and gene set enrichment analysis were performed using protein data, and confirmed by Western blot analysis.

Results:

A higher percentage of adipose tissue–derived mesenchymal stem cells in the S phase in the presence of platelet-rich plasma advocates the proliferation stimulation. Ingenuity Pathways Analysis and gene set enrichment analysis confirm the involvement of the selected proteins in the process of cell growth and proliferation. Ingenuity Pathways Analysis revealed a participation in the top-ranked canonical pathways PI3K/AKT, PTEN, ILK, and IGF-1. Gene set enrichment analysis identified the authors’ protein set as being part of significantly regulated protein sets with the focus on cell cycle, metabolism, and the Kyoto Encyclopedia of Genes and Genomes transforming growth factor-β signaling pathway.

Conclusions:

The present study provides evidence that platelet-rich plasma stimulates proliferation and induces a unique change in the proteomic profile of adipose tissue–derived mesenchymal stem cells. The interpretation of altered expression of regulatory proteins represents a step forward toward achieving good manufacturing practice–compliant criteria for cell-based strategies.
Evidence for Extending the Duration of Chemoprophylaxis following Free Flap Harvest from the Lower Extremity: Prospective Screening for Deep Venous Thrombosis
Authors: Rau Aline S. , Harry Brian L. , Leem Ted H. , Song John I. , Deleyiannis Frederic W.-B.
Published: April 2016

Background:

The purpose of this study was to investigate the incidence of symptomatic and asymptomatic deep venous thrombosis in patients undergoing harvest of a free flap from the lower extremity who were receiving standard chemoprophylaxis while hospitalized.

Methods:

A retrospective review of 65 consecutive patients undergoing surgery between 2011 and 2013 was performed to determine the incidence of symptomatic deep venous thrombosis. These patients were screened for deep venous thrombosis based on development of symptoms. Prospective evaluation of a similar consecutive population of 37 patients between 2014 and 2015 was then performed to determine the incidence of asymptomatic deep venous thrombosis. These patients underwent routine duplex ultrasonography of both legs at postoperative weeks 1 and 4.

Results:

Symptomatic deep venous thrombosis occurred in 2.9 percent of all patients. In the prospective cohort, 8.1 percent of the patients were found to have an acute deep venous thrombosis by postoperative week 1. At postoperative week 4, 16.7 percent of the patients developed a new, acute deep venous thrombosis. The estimated costs of screening and treating deep venous thrombosis in the retrospective group and the prospective group were $222 and $2259, respectively. The cost of routine chemoprophylaxis without duplex screening for an additional 14 days after discharge was $125 per patient.

Conclusions:

The rate of asymptomatic deep venous thrombosis may be much higher than previously appreciated in this population of very high-risk patients, especially during the 2 weeks after discharge. Extending the duration of chemoprophylaxis to 4 weeks after surgery may be warranted.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Persons Living With HIV in the United States: Fewer Than We Thought
Authors: Xia Qiang , Braunstein Sarah L. , Wiewel Ellen W. , Eavey Joanna J. , Shepard Colin W. , Torian Lucia V.
Published: April 2016

Objectives:

To estimate the number of persons living with HIV (PLWH) in the United States and to describe their care status.

Methods:

Estimates of diagnosed PLWH in New York City and other 19 jurisdictions based on HIV case reporting were compared with those based on HIV laboratory reporting. A revised HIV care continuum was constructed based on previously published data.

Results:

The estimate of PLWH based on HIV case reporting was 25.6% higher than that based on HIV laboratory reporting data in New York City. There were 819,200 PLWH in the United States at the end of 2011 (plausible range: 809,800–828,800), of whom 86% were diagnosed, 72% were retained in care (≥1 care visit in 2011), 68% were on antiretroviral therapy, and 55% were virally suppressed (≤200 copies/mL).

Conclusions:

The current method based on HIV case reporting may have overestimated PLWH in the United States. While we continue cleaning HIV case reporting data to improve its quality, we should take the opportunity to use comprehensive HIV laboratory reporting data to estimate PLWH at both the national and local levels.
Geriatric Assessments and Association With VACS Index Among HIV-Infected Older Adults in San Francisco
Authors: John Malcolm D. , Greene Meredith , Hessol Nancy A. , Zepf Roland , Parrott Amanda Hutton , Foreman Cameron , Bourgeois James , Gandhi Monica , Hare C. Bradley
Published: April 2016

Objectives:

To perform geriatric assessments in older HIV-infected adults in San Francisco and examine the association with age and the Veterans Aging Cohort Study (VACS) index scores.

Methods:

A cross-sectional study was conducted from 2012 to 2014 among HIV-infected patients ≥50 years at 2 San Francisco-based HIV clinics. We evaluated 4 health domains: (1) physical health and function (activities of daily living), instrumental activities of daily living (IADL), falls, gait speed, (2) social support (physical and perceived support, loneliness), (3) mental health (depression, anxiety, posttraumatic stress disorder) and cognition, and (4) behavioral and general health (antiretroviral adherence and quality of life). Contingency table and rank-sum analyses examined associations between these domains with age and VACS index scores.

Results:

Three hundred fifty-nine patients completed assessments (median age 57; 85% male; 57% white; 72% >high school education). On functional assessment, 39% reported dependence with ≥1 IADL, and 40% reported falls in the previous year. Fifty-eight percent experienced loneliness, 60% the lowest levels of perceived social support, 55% depression, and 12% posttraumatic stress disorder. Forty percent had possible mild cognitive impairment. Thirty percent reported poor or fair quality of life. Older age was associated with lower CD4 counts, balance problems, slower gait, lower anxiety, poorer general health, and higher antiretroviral adherence. VACS Index score was associated with dependence in ≥1 IADL and antiretroviral adherence.

Conclusion:

In a large sample of older HIV-infected adults, multiple significant aging-related conditions were identified. Integrating geriatric assessment tools into HIV/AIDS clinical care may help target interventions to optimize clinical care and quality of life for older HIV-infected individuals.
HIV stigma trends in the general population during antiretroviral treatment expansion: analysis of 31 countries in sub-Saharan Africa, 2003–2013
Authors: Chan Brian T. , Tsai Alexander C.
Published: April 2016

Background:

HIV-related stigma is associated with increased risk-taking behavior, reduced uptake of HIV testing, and decreased adherence to antiretroviral therapy (ART). Although ART scale-up may reduce HIV-related stigma, the extent to which levels of stigma in the general population have changed during the era of ART scale-up in sub-Saharan Africa is unknown.

Methods:

Social distance and anticipated stigma were operationalized using standard HIV-related stigma questions contained in the Demographic and Health Surveys and AIDS Indicator Surveys of 31 African countries between 2003 and 2013. We fitted multivariable linear regression models with cluster-correlated robust standard errors and country fixed effects, specifying social distance or anticipated stigma as the dependent variable and year as the primary explanatory variable of interest.

Results:

We estimated a statistically significant negative association between year and desires for social distance (b = −0.020; P < 0.001; 95% confidence interval: −0.026 to −0.015) but a statistically significant positive association between year and anticipated stigma (b = 0.023; P < 0.001; 95% confidence interval: 0.018 to 0.027). In analyses stratified by HIV prevalence above or below the sample median, declines in social distancing over time were more pronounced among countries with a higher HIV prevalence.

Conclusions:

Concomitant with ART scale-up in sub-Saharan Africa, anticipated stigma in the general population increased despite a decrease in social distancing toward people living with HIV. Although ART scale-up may help reduce social distancing toward people living with HIV, particularly in high-prevalence countries, other interventions targeting symbolic or instrumental concerns about HIV may be needed.
Narrowing the Gap in Life Expectancy Between HIV-Infected and HIV-Uninfected Individuals With Access to Care
Authors: Marcus Julia L. , Chao Chun R. , Leyden Wendy A. , Xu Lanfang , Quesenberry Charles P. , Klein Daniel B. , Towner William J. , Horberg Michael A. , Silverberg Michael J.
Published: April 2016

Background:

It is unknown if a survival gap remains between HIV-infected and HIV-uninfected individuals with access to care.

Methods:

We conducted a cohort study within Kaiser Permanente California during 1996–2011, using abridged life tables to estimate the expected years of life remaining (“life expectancy”) at age 20.

Results:

Among 24,768 HIV-infected and 257,600 HIV-uninfected individuals, there were 2229 and 4970 deaths, with mortality rates of 1827 and 326 per 100,000 person-years, respectively. In 1996–1997, life expectancies at age 20 for HIV-infected and HIV-uninfected individuals were 19.1 and 63.4 years, respectively, corresponding with a gap of 44.3 years (95% confidence interval: 38.4 to 50.2). Life expectancy at age 20 for HIV-infected individuals increased to 47.1 years in 2008 and 53.1 years by 2011, narrowing the gap to 11.8 years (8.9–14.8 years) in 2011. In 2008–2011, life expectancies at age 20 for HIV-infected individuals ranged from a low of 45.8 years for blacks and 46.0 years for those with a history of injection drug use to a high of 52.2 years for Hispanics. HIV-infected individuals who initiated antiretroviral therapy with CD4 ≥500 cells per microliter had a life expectancy at age 20 of 54.5 years in 2008–2011, narrowing the gap relative to HIV-uninfected individuals to 7.9 years (5.1–10.6 years). For these HIV-infected individuals, the gap narrowed further in subgroups with no history of hepatitis B or C infection, smoking, drug/alcohol abuse, or any of these risk factors.

Conclusions:

Even with early treatment and access to care, an 8-year gap in life expectancy remains for HIV-infected compared with HIV-uninfected individuals.
Barriers to Viral Suppression Among Female Sex Workers: Role of Structural and Intimate Partner Dynamics
Authors: Duff Putu , Goldenberg Shira , Deering Kathleen , Montaner Julio , Nguyen Paul , Dobrer Sabina , Shannon Kate
Published: April 2016

Objective:

Despite global evidence that sex workers (SWs) are disproportionately impacted by HIV, data on HIV treatment outcomes among SWs living with HIV remains sparse. This study examined the correlates of undetectable plasma viral load (pVL) among street- and off-street SWs living with HIV and on antiretroviral therapy (ART) in Metro Vancouver, Canada.

Methods:

Analyses drew on data (2010–2014) from a longitudinal cohort of SWs (An Evaluation of Sex Workers Health Access) and confidential linkages with the Drug Treatment Program (DTP) data on ART dispensation and outcomes. Bivariate and multivariable generalized linear mixed-effects models were used to identify longitudinal correlates of undetectable pVL (<50 copies/mL).

Results:

Of the 72 SWs living with HIV who had ever used ART, 38.9% had an undetectable pVL at baseline. Although 84.7% had undetectable pVL at least once over the study period, 18.1% exhibited sustained undetectable pVL. In multivariable generalized linear mixed-effects model analyses, ≥95% pharmacy refill adherence (adjusted odds ratio (AOR) = 4.21; 95% confidence interval (CI) 2.16 to 8.19) and length of time since diagnosis (AOR = 1.06; 95% CI: 1.00 to 1.13) were positively correlated with undetectable pVL. Having an intimate male partner (AOR = 0.35; 95% CI: 0.16 to 0.78) and being homelessness were negatively correlated with undetectable pVL (AOR = 0.22; 95% CI: 0.10 to 0.47).

Discussion/Conclusions:

There is a need to more closely consider the social and structural contexts that shape SWs' experiences on ART and impact treatment outcomes, including the gendered power dynamics within intimate partnerships. Future research on HIV care among SWs is urgently needed, alongside structural and community-led interventions to support SWs' access to and retention in care.
Difference in Aortic Stiffness Between Treated Middle-Aged HIV Type 1–Infected and Uninfected Individuals Largely Explained by Traditional Cardiovascular Risk Factors, With an Additional Contribution of Prior Advanced Immunodeficiency
Authors: Kooij Katherine W. , Schouten Judith , Wit Ferdinand W. N. M. , van der Valk Marc , Kootstra Neeltje A. , Stolte Ineke G. , van der Meer Jan T. M. , Prins Maria , Grobbee Diederick E. , van den Born Bert-Jan H. , Reiss Peter ,   on behalf of the AGEhIV Cohort Study Group
Published: April 2016

Background:

Patients with HIV, even with suppressed viremia on combination antiretroviral therapy, are at increased risk for cardiovascular disease. The underlying pathophysiology remains to be clarified. Aortic stiffness, known to be associated with cardiovascular disease in the general population, was investigated in a cohort of HIV type 1 (HIV 1)–infected and similar but uninfected individuals.

Methods:

Aortic stiffness was assessed by measuring pulse wave velocity (PWV) with an Arteriograph. Five hundred seven HIV-uninfected and 566 HIV 1–infected individuals, predominantly with suppressed viremia on combination antiretroviral therapy, aged ≥45 years, participating in the ongoing AGEhIV Cohort Study were included in the analysis. Multivariable linear regression was used to investigate whether HIV was independently associated with aortic stiffness, adjusting for traditional cardiovascular risk factors.

Results:

Study groups were comparable in demographics; smoking and hypertension were more prevalent in HIV-infected participants. PWV was higher in the HIV-infected group (7.9 vs. 7.7 m/s, P = 0.004). After adjustment for mean arterial pressure, age, gender, and smoking, HIV status was not significantly associated with aortic stiffness. In HIV-infected participants, having a nadir CD4+ T-cell count ≤100 cells per cubic millimeter was independently associated with a higher PWV.

Conclusions:

The increased aortic stiffness in HIV-infected participants was largely explained by a higher prevalence of traditional cardiovascular risk factors, particularly smoking. Although HIV itself was not independently associated with higher aortic stiffness, a prior greater degree of immunodeficiency was. This suggests a detrimental effect of immunodeficiency on the aortic wall, possibly mediated by inflammation.
Brief Report: Cumulative Tenofovir Disoproxil Fumarate Exposure is Associated With Biomarkers of Tubular Injury and Fibrosis in HIV-Infected Men
Authors: Jotwani Vasantha , Scherzer Rebecca , Estrella Michelle M. , Jacobson Lisa P. , Witt Mallory D. , Palella Frank , Macatangay Bernard , Bennett Michael , Parikh Chirag R. , Ix Joachim H. , Shlipak Michael
Published: April 2016

Tenofovir disoproxil fumarate (TDF) can cause kidney damage, but current clinical tests are insensitive for detecting toxicity. Among 884 HIV-infected men enrolled in the Multicenter AIDS Cohort Study, we measured urine biomarkers specific for tubular damage (interleukin-18, kidney injury molecule-1, procollagen type III N-terminal propeptide) and albuminuria. In adjusted analyses, each year of TDF exposure was independently associated with 3.3% higher interleukin-18 (95% CI: 0.8% to 5.8%), 3.4% higher kidney injury molecule-1 (1.1% to 5.7%), and 3.1% higher procollagen type III N-terminal propeptide (0.8% to 5.5%), but not with albuminuria (2.8%; −0.6% to 6.2%). Biomarkers of tubular damage may be more sensitive than albuminuria for detecting toxicity from TDF and other medications.
Nondiagnostic Computed Tomography–guided Percutaneous Lung Biopsies Are More Likely When Infection Is Suspected
Authors: Haas Brian M. , Elicker Brett M. , Nguyen Janet , Ordovas Karen G. , Jones Kirk D. , Henry Travis S. , Naeger David M.
Published: April 2016

Purpose:

The purpose of this study was to assess the incidence of nondiagnostic computed tomography–guided lung biopsy results, stratified by biopsy indication, and determine the final diagnosis in such cases.

Materials and Methods:

Following institutional review board approval, pathology results from CT-guided lung biopsies over a 5-year period at 2 institutions were categorized as diagnostic or nondiagnostic. Each biopsy’s indication was categorized as being for a lesion considered likely to be cancer, infection, or uncertain. For all nondiagnostic biopsies, the medical chart was reviewed to determine the final clinical diagnosis.

Results:

A total of 660 biopsies were evaluated, 139 (21%) of which were nondiagnostic. Of these 139 patients, the final clinical diagnosis was infection in 37%, cancer in 30%, and a benign noninfectious diagnosis in 10%; 23% remained undiagnosed at last available follow-up. Among the patients in whom there was a high pretest suspicion for cancer, 13% were nondiagnostic, 45% of which were cancer and 27% were infection. Among biopsies of lesions with pretest probability for both cancer and infection, 51% were nondiagnostic; on clinical follow-up these were determined to be infection in 34% and cancer in 14%. When there was high pretest suspicion for infection, 73% were nondiagnostic, of which 13% were cancer on clinical follow-up, and 88% were infection. The rate of nondiagnostic biopsies was statistically significantly different (P<0.001) among the 3 groups.

Conclusions:

Nondiagnostic biopsies are common and occur most frequently when there is a moderate or high pretest suspicion for infection. Among all nondiagnostic biopsies, regardless of indication, cancer and infection were diagnosed on follow-up in similar proportions.
Can Chest Computed Tomography Be Replaced by Lung Ultrasonography With or Without Plain Chest Radiography in Pediatric Pneumonia?
Authors: Hajalioghli Parisa , Nemati Masoud , Dinparast Saleh Leila , Fouladi Daniel F.
Published: April 2016

Purpose:

The purpose of this study was to answer the following question: can chest computed tomography (CT) requested by pediatricians be replaced by lung ultrasonography (US) with or without chest radiography in pediatric pneumonia?

Materials and Methods:

A total of 98 children with suspected pneumonia who were referred by pediatricians for CT examinations were prospectively studied. Levels of agreement between CT findings and plain radiography, lung US, and chest radiography plus lung US results were investigated.

Results:

CT defined pneumonia in 84 patients, among which 26 cases were complicated. κ values between radiography and CT findings were 0.82 in complicated cases, 0.67 in uncomplicated cases, and 0.72 overall. The corresponding values between US and CT findings were 1, 0.52, and 0.62, respectively, and between radiography plus US and CT findings were 1, 0.86, and 0.88, respectively.

Conclusions:

CT can be replaced by US when complex effusions are present in children with pneumonia. In case of an ambiguous diagnosis of pediatric pneumonia with or without complex effusions, a combination of chest radiography and US is a reliable surrogate for chest CT.
Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET)/MRI for Lung Cancer Staging
Authors: Ohno Yoshiharu , Koyama Hisanobu , Lee Ho Yun , Yoshikawa Takeshi , Sugimura Kazuro
Published: April 2016

Tumor, lymph node, and metastasis (TNM) classification of lung cancer is typically performed with the TNM staging system, as recommended by the Union Internationale Contre le Cancer (UICC), the American Joint Committee on Cancer (AJCC), and the International Association for the Study of Lung Cancer (IASLC). Radiologic examinations for TNM staging of lung cancer patients include computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography with 2-[fluorine-18] fluoro-2-deoxy-D-glucose (FDG-PET), and FDG-PET combined with CT (FDG-PET/CT) and are used for pretherapeutic assessments. Recent technical advances in MR systems, application of fast and parallel imaging and/or introduction of new MR techniques, and utilization of contrast media have markedly improved the diagnostic utility of MRI in this setting. In addition, FDG-PET can be combined or fused with MRI (PET/MRI) for clinical practice. This review article will focus on these recent advances in MRI as well as on PET/MRI for lung cancer staging, in addition to a discussion of their potential and limitations for routine clinical practice in comparison with other modalities such as CT, FDG-PET, and PET/CT.
Standardized Patient Encounters
Authors: Turner T. Robert , Scerbo Mark W. , Gliva-McConvey Gayle A. , Wallace Amelia M.
Published: April 2016

Introduction

Standardized patients are a beneficial component of modern healthcare education and training, but few studies have explored cognitive factors potentially impacting clinical skills assessment during standardized patient encounters. This study examined the impact of a periodic (vs. traditional postencounter) evaluation approach and the appearance of critical verbal and nonverbal behaviors throughout a standardized patient encounter on scoring accuracy in a video-based scenario.

Methods

Forty-nine standardized patients scored either periodically or at only 1 point in time (postencounter) a healthcare provider’s verbal and nonverbal clinical performance during a videotaped standardized patient encounter. The healthcare provider portrayed in this study was actually a standardized patient delivering carefully scripted verbal and nonverbal behaviors in their portrayal of an actual physician. The encounter itself was subdivided into 3 distinct segments for the purpose of supporting periodic evaluation, with the expectation that both verbal and nonverbal cues occurring in the middle segment would be more challenging to accurately report for participants in the postscenario evaluation group as a result of working memory decay.

Results

Periodic evaluators correctly identified a significantly greater number of critical verbal cues midscenario than postencounter evaluators (P < 0.01) and correctly identified a significantly greater number of critical nonverbal cues than their postscenario counterparts across all 3 scenario segments (P < 0.001). Further, postscenario evaluations exhibited a performance decrement in terms of midscenario correct identifications that periodic evaluators did not (P < 0.01). Also, periodic evaluators exhibited fewer verbal cue false-positives during the first segment of the scenario than postscenario evaluators (P < 0.001), but this effect did not extend to other segments regardless of the cue type (ie, verbal or nonverbal).

Discussion

Pausing lengthier standardized patient encounters periodically to allow for more frequent scoring may result in better reporting accuracy for certain clinical behavioral cues. This could enable educators to provide more specific formative feedback to individual learners at the session’s conclusion. The most effective encounter design will ultimately depend on the specific goals and training objectives of the exercise itself.
Improvement in Trainees’ Attitude and Resuscitation Quality With Repeated Cardiopulmonary Resuscitation Training
Authors: Kim Jong Won , Lee Jeong Hun , Lee Kyeong Ryong , Hong Dae Young , Baek Kwang Je , Park Sang O
Published: April 2016

Introduction

This study investigated the effect of increasing numbers of training sessions in cardiopulmonary resuscitation (CPR) on trainees’ attitude and CPR quality.

Methods

Cardiopulmonary resuscitation training for hospital employees was held every year from 2006 to 2010. Participants were recruited among the trainees in 2010. The trainees’ attitudes toward CPR were surveyed by questionnaire, and the quality of their CPR was measured using 5-cycle 30:2 CPR on a manikin. Participants were categorized according to the number of consecutive CPR training sessions as T1 (only 2010), T2 (2009 and 2010), T3 (from 2008 to 2010) and T4–5 (from 2006 or 2007 to 2010). The trainee attitude and CPR quality were compared among the 4 groups.

Results

Of 923 CPR trainees, 267 were enrolled in the study. There was significant increase in willingness to start CPR and confidence in chest compression and mouth-to-mouth ventilation (MTMV) with increasing number of CPR training sessions attended (especially for ≥ 3 sessions). There was a significant increase in mean compression depth and decrease in percentage of chest compressions with depth of less than 38 mm in the T3 and T4–5 compared with the T1 and T2. No-flow time decreased significantly, and the percentage of MTMV with visible chest rise increased, as the number of training sessions increased.

Conclusions

Repeated CPR training improved trainees’ attitude and CPR quality. Because the number of training sessions increased (≥3), the willingness to start CPR and the confidence in skills increased significantly, and chest compression depth, no-flow time, and MTMV improved.
Comparison of 4 Laryngoscopes in 2 Difficult Airway Scenarios
Authors: Altun Demet , Ozkan-Seyhan Tulay , Orhan-Sungur Mukadder , Sivrikoz Nukhet , Camci Emre
Published: April 2016

Introduction

The performance of laryngoscopes that have been developed for difficult airways can vary widely. The aim of the study was to compare Macintosh, McCoy, McGrath MAC, and C-MAC laryngoscopes in cervical immobilization and tongue edema scenarios in a mannequin, primarily to evaluate the time to intubation.

Methods

In this randomized crossover study, 41 anesthesiology residents used 4 laryngoscopes in a mannequin (SimMan 3G) in 2 different scenarios. Intubation time (insertion of the blade between the teeth, to placement of the endotracheal tube into the trachea) longer than 120 seconds or inability to successfully place the endotracheal tube into the trachea after 5 or more attempts was defined as intubation failure. Besides intubation time, laryngoscopic view, number of intubation attempts, presence of esophageal intubation, need for stylet, difficulty of intubation, and success rate were recorded as secondary outcomes.

Results

Intubation time was observed from longest to shortest as McGrath > McCoy > C-MAC > Macintosh in both scenarios. Laryngeal view was better with C-MAC laryngoscope. McGrath laryngoscope performed poorly specifically in tongue edema scenarios, which resulted in higher number of intubation attempts, esophageal intubation, need for intubation stylets, and overall intubation failure.

Conclusions

The short intubation time observed with the Macintosh underlines the necessity of familiarity in success. Tongue edema is a more challenging scenario for simulated difficult airway and the McGrath may not be a good choice for such a scenario.
The Design of a Randomized Trial of Vaginal Surgery for Uterovaginal Prolapse: Vaginal Hysterectomy With Native Tissue Vault Suspension Versus Mesh Hysteropexy Suspension (The Study of Uterine Prolapse Procedures Randomized Trial)
Authors: Nager Charles W. , Zyczynski Halina , Rogers Rebecca G. , Barber Matthew D. , Richter Holly E. , Visco Anthony G. , Rardin Charles R. , Harvie Heidi , Wallace Dennis , Meikle Susan F.
Published: April 2016

Objectives

We present the rationale for and design of a randomized controlled superiority trial comparing 2 vaginal surgical approaches for the treatment of uterovaginal prolapse. The Study of Uterine Prolapse Procedures Randomized Trial (SUPeR) trial compares the efficacy and safety of native tissue repair with vaginal hysterectomy and suture apical suspension versus uterine conservation with mesh hysteropexy through 36 to 60 months postoperatively for primary repair of uterovaginal prolapse.

Methods

The selection of the primary outcome measure, timing of randomization, patient and evaluator masking to surgical intervention, collection and adjudication of adverse events, cost effectiveness evaluations, partnering with industry, and surgeon certification of competency to perform the 2 procedures is described. A composite primary outcome of success defined as no prolapse symptoms, no objective prolapse beyond the hymen, and no retreatment of prolapse, with a minimum of 36 months postsurgery follow-up using survival analyses is planned. Secondary outcomes measured at baseline and every 6 months postsurgery include validated condition-specific and general quality of life assessments, global impression of improvement, body image, and sexual function measures. Unique challenges during the trial design include maintenance of patient masking to the intervention with routine gynecologic health maintenance and maintenance of evaluator masking.

Results

Recruitment and randomization of 180 participants is complete, and participants are currently in the follow-up phase.

Conclusions

This trial will provide information to help surgeons counsel patients and contribute evidence-based information regarding risks and benefits of 2 approaches for the treatment of uterovaginal prolapse.