bluuebunny/crossref_metadata_2025 huggingface dataset:
Abortion Policies in U.S. Teaching Hospitals
Authors: Zeldovich Varvara B. , Rocca Corinne H. , Langton Callie , Landy Uta , Ly Elizabeth S. , Freedman Lori R.
Published: May 2020

OBJECTIVE:

To evaluate the prevalence and features of policies regulating abortion in U.S. teaching hospitals.

METHODS:

In this mixed-methods study, we conducted a national survey of obstetrics and gynecology teaching hospitals (2015–2016) and qualitative interviews (2014 and 2017) with directors at obstetrics and gynecology residency programs. We asked participants about hospital regulations on abortion and their perceptions of the nature and enforcement of these policies. Interview analysis was conducted with a grounded theoretical approach and informed development of the survey. The prevalence of policies was described using survey data; differences in policy structures by region were analyzed using a series of logistic regression models.

RESULTS:

Directors from 169 of 231 eligible training programs responded to the survey (73%). Institutional policies limited abortion beyond state law in 57% of teaching hospitals, most commonly in the Midwest and South (odds ratio [OR] 4.3, P<.01 for Midwest; OR 4.0, P=.001 for South vs Northeast). Policies varied in form (written and unwritten) and restricted abortion based on the indication for the procedure and gestational age. Nonmedically indicated, or “elective” procedures were more commonly restricted (48% of sites reporting any policy and 25% prohibiting these abortions altogether) than medically indicated ones (28% of sites reporting any policy.) Policies were created by those with institutional power, including hospital leadership and obstetrics and gynecology department chairs, and were perceived to be motivated by personal beliefs and a desire to avoid controversy. Rules were commonly enforced by medical specialists, hospital ethics committees, and department chairs. Qualitative data highlighted the convoluted nuances of these policies, which often put clinicians at odds with their professional mandates.

DISCUSSION:

Reportedly driven by broader institutional interests, obstetrics and gynecology teaching hospital policies often restricted abortion beyond state law to the detriment of abortion access and training opportunities. Vague or unwritten abortion policies, although difficult to navigate, gave health care providers some agency and flexibility over their practices.
Acute Respiratory Distress Syndrome in a Preterm Pregnant Patient With Coronavirus Disease 2019 (COVID-19)
Authors: Blauvelt Christine A. , Chiu Catherine , Donovan Anne L. , Prahl Mary , Shimotake Thomas K. , George Ronald B. , Schwartz Brian S. , Farooqi Naghma A. , Ali Syed S. , Cassidy Arianna , Gonzalez Juan M. , Gaw Stephanie L.
Published: May 2020

BACKGROUND:

Data suggest that pregnant women are not at elevated risk of acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or developing severe disease compared with nonpregnant patients. However, management of pregnant patients who are critically ill with coronavirus disease 2019 (COVID-19) infection is complicated by physiologic changes and other pregnancy considerations and requires balancing maternal and fetal well-being.

CASE:

We report the case of a patient at 28 weeks of gestation with acute respiratory distress syndrome (ARDS) from COVID-19 infection, whose deteriorating respiratory condition prompted delivery. Our patient's oxygenation and respiratory mechanics improved within hours of delivery, though she required prolonged mechanical ventilation until postpartum day 10. Neonatal swabs for SARS-CoV-2 and COVID-19 immunoglobulin (Ig) G and IgM were negative.

CONCLUSION:

We describe our multidisciplinary management of a preterm pregnant patient with ARDS from COVID-19 infection and her neonate.
Taylor Spatial Frame or Reamed Intramedullary Nailing for Closed Fractures of the Tibial Shaft: A Randomized Controlled Trial
Authors: Frihagen Frede , Madsen Jan E. , Sundfeldt Mikael , Flugsrud Gunnar B. , Andreassen Joakim S. , Andersen Mette R. , Andreassen Geir S.
Published: May 2020

Objectives:

To compare a modern ring fixator [Taylor Spatial Frame (TSF)] and reamed intramedullary nailing (IMN) for the treatment of closed tibial shaft fractures.

Design:

Randomized controlled trial.

Setting:

Two university hospitals.

Patients:

Patients between 18 and 70 years of age surgically treated for an acute tibial shaft fracture.

Intervention:

TSF (n = 31) versus a reamed intramedullary nail (n = 32). The patients were followed up for 2 years.

Main Outcome Measurements:

The physical component summary of Short Form 36 (SF-36) at 2 years was the primary outcome measure. Secondary outcomes included the other components of the SF-36, pain assessed by a visual analogue scale (VAS), complications, and resource consumption.

Results:

The mean age was 43 years (SD 14.0), and 42 (67%) were men. The physical component summary at 2 years was 52.4 (SD 6.3) in the TSF group and 53.3 (SD 8.0) in the IMN group (P = 0.35). There were modest differences in the other SF-36 scores during the follow-up period. Up to and including 12 months, the TSF group had less knee pain [at 12 months: VAS 0.5 (SD 1.2) vs. VAS 2.4 (SD 2.2; P < 0.001)], but this was not statistically significant at 24 months [VAS 0.7 (SD 1.4) vs. VAS 1.5 (SD 2.0; P = 0.11)]. Superficial skin infections were more frequent in the TSF group [22 (71%) vs. 4 (13%); P < 0.001]. The number of other complications was similar between the groups.

Conclusions:

Both TSF and IMN provided good clinical results. TSF had more pin-track infections but less knee pain the first year.

Level of Evidence:

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Distance Between Reproductive Structures and the Insertion Point of the Retrograde Pubic Ramus Screw
Authors: Luksameearunothai Kitchai , Amin Raj M. , Shafiq Babar , Hasenboehler Erik A.
Published: May 2020

Objective:

To identify the distance between the guidewire for a retrograde pubic ramus screw and critical reproductive structures in men and women.

Methods:

Twenty hemipelves from 10 fresh-frozen cadavers (pelvis to distal femur) were studied. The mean (±SD) age was 77 ± 6 years for the 5 male cadavers and 71 ± 9 years for the 5 female cadavers. A 2.8-mm guidewire for a cannulated screw was inserted from the parasymphyseal bone using fluoroscopic guidance. The soft tissue was dissected and measurements performed by the first author. In men, we measured the closest distances from the guidewire entry point to the contralateral spermatic cord and corpus cavernosum. In women, we measured the closest distances from the guidewire entry point to the base of the clitoral body and clitoral glans.

Results:

In male cadavers, mean distances were 8.8 ± 4.2 mm to the spermatic cord and 13 ± 6.7 mm to the corpus cavernosum. The guidewire did not penetrate these structures in any specimen. In female cadavers, mean distances were 12 ± 5.7 mm to the base of the clitoral body and 40 ± 8.2 mm to the clitoral glans. The guidewire also did not penetrate these structures.

Conclusions:

The contralateral spermatic cord and corpus cavernosum in men and the base of the clitoral body in women are close to the pathway of the retrograde ramus screw guidewire. Careful identification of the entry point and avoidance of multiple attempts of guidewire insertion may reduce the risk of injury to these structures.
Guided Growth for Ankle Valgus Deformity: The Challenges of Hardware Removal
Authors: Westberry David E. , Carpenter Ashley M. , Thomas Jonathan T. , Graham George D. , Pichiotino Erin , Hyer Lauren C.
Published: May 2020

Background:

Ankle valgus deformity is associated with conditions such as clubfoot, cerebral palsy, and myelodysplasia. Guided growth strategies using a transphyseal screw provide effective correction of ankle valgus deformity. When correction occurs before skeletal maturity, screw removal is required to prevent overcorrection in the coronal plane. In this study, we reviewed the outcomes of guided growth procedures for correction of ankle valgus and related difficulty with hardware extraction.

Methods:

A retrospective review of patients with ankle valgus managed with transphyseal screw placement was performed. Clinical and radiographic data, including the lateral distal tibial angle (LDTA), type of screw placed, and time to correction was recorded. At hardware removal, we reviewed elements associated with difficult extraction defined as requiring the use of specialized screw removal/extraction sets or inability to remove the entirety of the screw.

Results:

One hundred nineteen patients (189 extremities) with a mean age of 11.7 years at time of screw placement met study inclusion criteria. Following correction of the valgus deformity, hardware removal occurred at an average of 18.4 months after placement of the screw. Preoperatively, the mean LDTA for the entire cohort was 81.3 degrees, and was corrected to a mean LDTA of 91.1 degrees. Complicated hardware removal occurred in 69 (37%) extremities. These 69 extremities had hardware in place an average of 1.8 years compared with an average of 1.4 years in extremities without difficult extraction (P<0.01). Six (9%) screws were unable to be removed in their entirety. Rebound valgus deformity occurred in 5 extremities (3%).

Conclusions:

Extraction of transphyseal screws in the correction of ankle valgus can be problematic. Specialized instrumentation was required in approximately one third of cases. Longevity of screw placement may be a factor that affects the ease of extraction. Additional exposure, access to specialized instrumentation, and additional operative time may be required for extraction.

Level of Evidence:

Level IV—case series.
Two-level Posterior Lumbar Interbody Fusion at the Lumbosacral Segment has a High Risk of Pseudarthrosis and Poor Clinical Outcomes
Authors: Fujimori Takahito , Sakaura Hironobu , Ikegami Daisuke , Sugiura Tsuyoshi , Mukai Yoshihiro , Hosono Noboru , Tateishi Kosuke , Fuji Takeshi
Published: May 2020

Study Design:

This was a retrospective study.

Objectives:

The purposes of this study were to investigate the fusion rate and clinical outcomes of 2-level posterior lumbar interbody fusion (PLIF).

Summary of Background Data:

PLIF provides favorable clinical outcomes and a high fusion rate. However, most extant studies have been limited to the results of single-level PLIF. Clinical outcomes and fusion rate of 2-level PLIF are unknown.

Materials and Methods:

In total, 73 patients who underwent 2-level PLIF below L3 between 2008 and 2016 (follow-up period >2 y) were included. Patients were divided into the 2 groups on the basis of surgical level. The lumbar group included 48 patients who underwent L3/4/5 PLIF, and the lumbosacral group included 25 patients who underwent L4/5/S PLIF. Fusion rate and clinical outcomes were compared. The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and a visual analog scale were used for evaluation.

Results:

Fusion rate was significantly lower in the lumbosacral group (lumbar 96% vs. lumbosacral 64%; P<0.001). Eight of 9 cases of pseudarthrosis occurred at the lumbosacral segment. Improvement in the mental health domain of the JOAPEQ was significantly lower in the lumbosacral group (lumbar 16 vs. lumbosacral 10; P=0.02). The VAS data showed that improvements in the following variables were significantly lower in the lumbosacral group than in the lumbar group: pain in low back (lumbar −38 vs. lumbosacral −23; P=0.004), pain in buttocks or lower leg (lumbar −48 vs. lumbosacral −29; P=0.04), and numbness in buttocks or lower leg (lumbar −44 vs. lumbosacral −33; P=0.04).

Conclusions:

Two-level PLIF at the lumbosacral segment demonstrated a significantly lower fusion rate and poorer clinical outcomes than that at the lumbar-only segments. Some reinforcement for the sacral anchor is recommended to improve fusion rate, even for short fusion like 2-level PLIF, if the lumbosacral segment is included.

Level of Evidence:

Level III.
Do Temporal Changes in Facial Expressions Help Identify Patients at Risk of Deterioration in Hospital Wards? A Post Hoc Analysis of the Visual Early Warning Score Study
Authors: Madrigal-Garcia Maria Isabel , Archer Dawn , Singer Mervyn , Rodrigues Marcos , Shenfield Alex , Moreno-Cuesta Jeronimo
Published: May 2020

Objectives:

To determine whether time-series analysis and Shannon information entropy of facial expressions predict acute clinical deterioration in patients on general hospital wards.

Design:

Post hoc analysis of a prospective observational feasibility study (Visual Early Warning Score study).

Setting:

General ward patients in a community hospital.

Patients:

Thirty-four patients at risk of clinical deterioration.

Interventions:

A 3-minute video (153,000 frames) for each of the patients enrolled into the Visual Early Warning Score study database was analyzed by a trained psychologist for facial expressions measured as action units using the Facial Action Coding System.

Measurements and Main Results:

Three-thousand six-hundred eighty-eight action unit were analyzed over the 34 3-minute study periods. The action unit time variables considered were onset, apex, offset, and total time duration. A generalized linear regression model and time-series analyses were performed. Shannon information entropy (Hn) and diversity (Dn) were calculated from the frequency and repertoire of facial expressions. Patients subsequently admitted to critical care displayed a reduced frequency rate (95% CI moving average of the mean: 9.5–10.9 vs 26.1–28.9 in those not admitted), a higher Shannon information entropy (0.30 ± 0.06 vs 0.26 ± 0.05; p = 0.019) and diversity index (1.36 ± 0.08 vs 1.30 ± 0.07; p = 0.020) and a prolonged action unit reaction time (23.5 vs 9.4 s) compared with patients not admitted to ICU. The number of action unit identified per window within the time-series analysis predicted admission to critical care with an area under the curve of 0.88. The area under the curve for National Early Warning Score alone, Hn alone, National Early Warning Score plus Hn, and National Early Warning Score plus Hn plus Dn were 0.53, 0.75, 0.76, and 0.81, respectively.

Conclusions:

Patients who will be admitted to intensive care have a decrease in the number of facial expressions per unit of time and an increase in their diversity.
Personalized Ventilation to Multiple Patients Using a Single Ventilator: Description and Proof of Concept
Authors: Han Jay S. , Mashari Azad , Singh Devin , Dianti Jose , Goligher Ewan , Long Michael , Ng William , Wasowicz Marcin , Preiss David , Vesely Alex , Kacmarek Robert , Keshavjee Shaf , Brochard Laurent , Fisher Joseph A. , Slutsky Arthur S.
Published: May 2020

Objectives:

To design and test a ventilator circuit that can be used for ventilation of two or more patients with a single ventilator, while allowing individualization of tidal volume, fractional concentration of oxygen, and positive end-expiratory pressure to each patient, irrespective of the other patient’s respiratory system mechanics.

Design:

Description and proof of concept studies.

Settings:

Respiratory therapy laboratory.

Subjects:

Ventilation of mechanical test lungs.

Interventions:

Following a previously advocated design, we used components readily available in our hospital to assemble two “bag-in-a-box” breathing circuits. Each patient circuit consisted of a flexible bag in a rigid container connected via one-way valve to a test lung, along with an inline positive end-expiratory pressure valve, connected to the ventilator’s expiratory limb. Compressed gas fills the bags during “patient” exhalation. During inspiration, gas from the ventilator, in pressure control mode, enters the containers and displaces gas from the bags to the test lungs. We varied tidal volume, “respiratory system” compliance, and positive end-expiratory pressure in one lung and observed the effect on the tidal volume of the other.

Measurements and Main Results:

We were able to obtain different tidal volume, dynamic driving pressure, and positive end-expiratory pressure in the two lungs under widely different compliances in both lungs. Complete obstruction, or disconnection at the circuit connection to one test lung, had minimal effect (< 5% on average) on the ventilation to the co-ventilated lung.

Conclusions:

A secondary circuit “bag-in-the-box” system enables individualized ventilation of two lungs overcoming many of the concerns of ventilating more than one patient with a single ventilator.
The effects of a new, improved Chinese medicine, Gengnianchun formula granules, on hot flushes, depression, anxiety, and sleep in Chinese peri- and postmenopausal women: a randomized placebo-controlled trial
Authors: Zhang Yang , Cao Yuankui , Wang Li
Published: May 2020

Objective:

The aim of the study was to investigate the effectiveness and safety of a new, improved herbal formula of a traditional Chinese medicine, improved Gengnianchun (I-GNC), on hot flushes, depression, anxiety, and sleep in peri- and postmenopausal women in China.

Methods:

A randomized, single-blind, placebo-controlled trial of peri- and postmenopausal women with Kupperman Index (KMI) scores of 15 or higher was conducted for 12 weeks. Hot flush frequencies, KMI scores, Hamilton depression scale scores, Hamilton anxiety scale scores, and Pittsburgh Sleep Quality Index scores were evaluated. Each outcome was evaluated every 4 weeks.

Results:

Ninety-eight participants completed the study. The I-GNC formula significantly reduced the mean (SD) frequency of hot flushes from 7 (4.554) to 1.2 (1.675) in the I-GNC group and from 6.74 (3.43) to 3.66 (2.635) in the placebo group (P < 0.01). The KMI (P < 0.01), Hamilton depression scale (P < 0.01), and Hamilton anxiety scale (P < 0.01) scores decreased in both groups after treatment, and significant differences were observed between the two groups (P < 0.01); however, no significant difference in the Pittsburgh Sleep Quality Index score was observed. I-GNC had no effect on serum follicle-stimulating hormone or E2 levels. There were no obvious adverse effects.

Conclusions:

The traditional Chinese medicine herbal formula I-GNC can alleviate the symptoms of menopausal syndrome and improve quality of life among peri- and postmenopausal women. I-GNC is safe and has no notable adverse effects.
A practical approach to switch from a multiple pill therapeutic strategy to a polypill-based strategy for cardiovascular prevention in patients with hypertension
Authors: Coca Antonio , Kreutz Reinhold , Manolis Athanasios J. , Mancia Giuseppe
Published: May 2020

Pharmacological treatment recommended by guidelines for very high-risk patients with established cardiovascular disease (CVD) includes lipid-lowering drugs, antihypertensive agents and antiplatelet therapy. Depending on the associated comorbidities, this baseline regimen has to be complemented with other drugs. Therefore, the number of pills to be taken is usually high and adherence to these multiple pill therapeutic regimens and long-term persistence on treatment is low, being the main factor for insufficient control of cardiovascular risk factors. The CNIC (Centro Nacional de Investigaciones Cardiovasculares, Ministerio de Ciencia e Innovación, España) polypill is the only polypill containing low-dose aspirin approved by the EMA and marketed in Europe, and has demonstrated to improve adherence. For this reason, guidelines recommend its use for secondary prevention of CVD, and also for primary prevention of cardiovascular events in patients with multiple cardiovascular risk factors and advanced atherosclerotic process at high risk of thrombosis and low risk of bleeding. This article pretends to simplify the steps that clinicians may follow to switch from any baseline regimen to the polypill with the use of several algorithms and tables showing the equivalent effective daily doses of different angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and statins to facilitate switching, as well as the steps to be followed depending of the initial levels of BP and LDL-cholesterol values to achieve BP and lipid control with the association to the polypill of other BP-lowering or lipid-lowering drugs whenever needed.
Difference in the Cesium Body Contents of Affected Area Residents Depending on the Evacuation Timepoint Following the 2011 Fukushima Nuclear Disaster
Authors: Igarashi Yu , Kim Eunjoo , Hashimoto Shozo , Tani Kotaro , Yajima Kazuaki , Iimoto Takeshi , Ishikawa Tetsuo , Akashi Makoto , Kurihara Osamu
Published: May 2020

Estimating the internal thyroid dose received by residents involved in the 2011 Fukushima Daiichi Nuclear Power Plant (FDNPP) accident has been a challenging task because of the shortage of direct human measurements related to the largest contributing radioisotope to the dose, 131I. In a previous dose estimation, we used the results of whole-body counter (WBC) measurements targeting 134Cs and 137Cs, based on the assumption that these radioisotopes were incorporated at the same time as 131I in the early phase of the accident. The main purpose of this study was to clarify whether the trace of the early intake remained in the WBC measurements that were started several months after the accident. In the present work, WBC data of 1,639 persons from Namie town, one of the heavily contaminated municipalities, were analyzed together with their evacuation behavior data. The results demonstrated that the cesium detection rate in the WBC results was several times higher in the late evacuees [who evacuated outside the 20-km radius of the FDNPP at 3:00 p.m. (Japanese Local Time) on 12 March or later] compared to the prompt evacuees (who evacuated before 3:00 p.m. on 12 March). Among the adults, the cesium detection rates (and the 90th percentile values of the 137Cs intake) of the prompt and late evacuees were about 20% (5.4 × 103 Bq) and 60% (1.6 × 104 Bq), respectively. Approximately 20% of the individuals analyzed were categorized as late evacuees. These differences in cesium would be caused by exposure to the radioactive plume in the afternoon on 12 March, which was likely to influence the late evacuees. On the other hand, the intake on 15 March, when the largest release event occurred, was expected to be relatively small for Namie town's residents. In conclusion, the trace of the early intake remained in the WBC measurements, although this would not necessarily be true for all subjects. The results obtained from this study would provide useful information for the reconstruction of the early internal thyroid doses from radioiodine in the future.
MSC-Derived Extracellular Vesicles: New Emergency Treatment to Limit the Development of Radiation-Induced Hematopoietic Syndrome?
Authors: Cavallero Sophie , Riccobono Diane , Drouet Michel , François Sabine
Published: May 2020

Nuclear accidents or acts of terrorism involving radioactive sources might lead to mass casualties irradiation. The hematopoietic system is one of the most critical and radiation-sensitive tissues because the limited life span of blood cells requires the continuous division of hematopoietic stem cells (HSCs) into the bone marrow. The radiation-induced hematopoietic syndrome, RI-HS, is an impairment of the hematopoiesis that will result in pancytopenia of various degrees. In fact, treatment with granulocyte-colony stimulating factor (G-CSF) is considered as a valuable adjunct to treatment controls in some irradiated patients. Nevertheless, these overexposed patients with bone marrow suppression have minimal medullary territories that do not allow complete recovery of hematopoiesis but lead to significant immunoreactivity following allogeneic hematopoietic stem cell transplantation (HSCT). The high morbidity and mortality of these overexposed patients is a reminder of the lack of effective treatment for hematopoietic syndrome. During the last 20 y, a therapeutic approach for mesenchymal stem cells (MSC) has been proposed for the management of accidentally irradiated victims. Many preclinical animal studies have shown that MSC, mainly by their secretory activity, in particular extracellular vesicles (EVs), contribute to the control of inflammation and promote regeneration of tissues by accelerating angiogenesis and re-epithelialization processes. Therefore, we investigated the potential effect of EVs on the reduction of early bone marrow ionization toxicity, early anti-apoptotic therapy, and vascular protection in the RI-HS model. The main purpose is to propose an innovative treatment of non-patient-specific RI-HS emergency treatment in order to limit allogeneic HSC.
RETAINED, NONDISSOLVING, TUBULAR FOREIGN BODIES IN THE VITREOUS CAVITY AFTER INTRAVITREAL DEXAMETHASONE (OZURDEX) IMPLANTATION
Authors: Han Ian C. , Critser D. Brice , Amram Alec L. , Folk James C.
Published: May 2020

Purpose:

To describe the retention of large, tubular, nondissolving foreign bodies because of a complication of the intravitreal dexamethasone implant (Ozurdex).

Methods:

This is a single-center, retrospective chart review of patients who were found to have retained, nondissolvable tubular foreign bodies in the vitreous cavity for more than 6 months (the expected dissolution time of the implants) after Ozurdex injections. Ocular symptomatology and multimodal imaging were reviewed.

Results:

Five patients had retained, nondissolvable tubular foreign bodies in the vitreous that persisted for months (mean 28.2 months, range 9–67 months) after intravitreal injection of Ozurdex. Two patients were symptomatic due to the foreign bodies and chose alternate local therapy, but none of the patients opted for surgical explantation.

Conclusion:

Persistent, nondissolving, tubular foreign bodies can be seen in the vitreous cavity for years after injection of the Ozurdex implant. Clinicians should be aware of this complication that has the potential to cause visual symptoms and ocular morbidity.
Usefulness of Optical Coherence Tomography Angiography in the Differential Diagnosis Between Superior Segmental Optic Hypoplasia and Normal-tension Glaucoma
Authors: Lee So Yeon , In Jung Hee , Kim Chang Hwan , Hong Young Jae
Published: May 2020

Purpose:

The differential diagnosis of superior segmental optic hypoplasia (SSOH) and normal-tension glaucoma (NTG) is an issue in the ophthalmologic field. To date, several modalities have been developed to solve this issue; however, no standard methods have been established. Recently, optical coherence tomography angiography (OCTA) has been introduced to better evaluate the volumetric angiography images. Therefore, in this study, we investigated the usefulness of OCTA in differentiating between SSOH and NTG.

Materials and Methods:

In this retrospective study, we included 26 patients with SSOH who had definite visual field defects and 40 patients with NTG who had only inferior visual field defects. Age, sex, intraocular pressure, refractive error, retinal nerve fiber layer thickness, and visual field defects were compared between the groups. In addition, we analyzed and compared the peripapillary vessel density (VD) measured on OCTA between the groups. The area under the receiver operating characteristic curves were obtained for each parameter.

Results:

On Cirrus HD-OCT, the retinal nerve fiber layer in patients with SSOH was thinner in the superonasal segment and thicker in the superotemporal segment compared with patients with NTG. In the analysis of OCTA, the peripapillary VD of the superonasal segment was significantly lower in the SSOH group than in the NTG group, while it was significantly higher in the superotemporal segment in the SSOH group than in the NTG group. The optimal superonasal-to-superotemporal ratio cutoff was 0.8828, with a sensitivity of 95% and specificity of 92.3%, for the diagnosis of SSOH (area under the receiver operating characteristic curve=0.962).

Conclusions:

Our findings suggest that the superonasal-to-superotemporal VD ratio measured on OCTA may be used to distinguish between SSOH and NTG. However, further large-scale studies are required to verify our findings.
Transient Myopia Secondary to Supraciliary Effusion: Unusual Complication After an Uneventful Prolene Gonioscopy-assisted Transluminal Trabeculotomy
Authors: Aktas Zeynep , Ucgul Ahmet Y. , Segawa Asadu
Published: May 2020

Purpose:

The purpose of this study was to report 2 cases experiencing a transient decrease in their vision due to the development of acute myopia after an uneventful prolene gonioscopy-assisted transluminal trabeculotomy (GATT) surgery.

Methods:

A 52-year-old woman with primary open-angle glaucoma and an 8-year-old boy with juvenile glaucoma underwent uneventful GATT surgery.

Results:

On the postoperative first day, both patients had mild shallow anterior chamber and intraocular pressures measured as 19 and 16 mm Hg, respectively. Both patients had myopia measured as −4.5 and −6.0 D, respectively. Fundus examination was unremarkable in the first patient, whereas it showed bilateral optic disc cupping and retinal nerve fiber layer atrophy in the second patient. In the first patient, supraciliary effusion was detected by using ultrasound biomicroscopy. Ultrasound biomicroscopy could not be performed in the second patient, but ocular ultrasonography revealed a thin layer of suprachoroidal fluid. Myopia was completely regressed, and visual acuity increased within 1 week of the follow-up in both patients. At the sixth month of the follow-up, intraocular pressures in both patients were under control without any antiglaucoma medications.

Conclusion:

Transient decrease in vision after the GATT surgery might occur secondary to supraciliary effusion leading to acute, transient myopia.
Update on Micropulse Transscleral Cyclophotocoagulation
Authors: Sanchez Facundo G. , Peirano-Bonomi Juan C. , Brossard Barbosa Natalie , Khoueir Ziad , Grippo Tomas M.
Published: May 2020

Micropulse transscleral cyclophotocoagulation is a promising and relatively new technique that uses repetitive micropulses of diode laser energy, delivered with the Cyclo G6 Glaucoma Laser System (Iridex Corporation), in an off-and-on cyclical manner. This review article provides an update on the latest data available for this technique, including a discussion of the aspects in which there is still limited data, such as the precise mechanism of action, the ideal laser parameters based on total energy levels, as well as an overview of other potentially relevant variables that may be playing an important role in outcomes.
Neonates With Urinary Tract Infection
Authors: Hernández-Bou Susanna , Trenchs Victoria , Cano Iván , Girona Mònica , Luaces Carles
Published: May 2020

Background:

Our objectives were to determine the prevalence of and to identify risk factors for coexisting bacterial meningitis (BM) in neonates with urinary tract infection (UTI).

Methods:

A cross-sectional study was conducted at pediatric emergency department of a tertiary teaching hospital from 2001 to 2017. Infants <29 days of age with UTI (≥10,000 colony-forming units/mL of a single pathogen from a catheterized specimen in association with positive urinalysis) were included. Definite BM was defined as growth of a single bacterial pathogen from a cerebrospinal fluid (CSF) sample and probable BM as (1) positive blood culture with CSF pleocytosis and treatment consistent with BM or (2) antibiotic pretreatment before lumbar puncture, CSF pleocytosis and treatment consistent with BM. Univariate testing was used to identify possible risk factors associated with BM. Receiver operating characteristics curves were constructed for the laboratory markers associated with BM.

Results:

Three hundred seventy-one infants were included. Five [1.3%; 95% confidence interval (CI): 0.6%–3.1%] had BM: 4 definite BM and 1 probable BM. Risk factors detected for BM were classified as not being well-appearing and a procalcitonin value ≥0.35 ng/mL [sensitivity of 100% (95% CI: 56.6%–100%) and negative predictive value of 100% (95% CI: 96.1%–100%)].

Conclusions:

Coexisting BM occurs uncommonly in neonates with UTI. Well-appearing neonates with UTI and procalcitonin value <0.35 ng/mL were at very low risk for BM; avoiding routine lumbar puncture in these patients should be considered.
Scale for Measuring Role Strain in Women With Diabetes
Authors: Huang Chiu-Ling , Chen Shi-Yu , Hsu Hui-Chun , Wang Ruey-Hsia
Published: May 2020

Background

Women with diabetes (type 1 and type 2) have excessive risk of developing cardiovascular disease compared with men with diabetes, so optimizing diabetes control is crucial for women to reduce this risk. Women with diabetes experience role strain, and a scale to measure role strain in the context of diabetes control could help healthcare providers improve diabetes control in women with diabetes.

Objective

The aims of the study were to develop a short-form scale for measuring role strain in Taiwanese women with diabetes and test its psychometric properties.

Methods

This study was conducted from October 2018 to May 2019 and used a cross-sectional design. Based on literature reviews and results of focus groups, a 28-item role strain scale was developed and administered to 519 women with diabetes in Taiwan. Item analysis, exploratory factor analysis, confirmatory factor analysis, concurrent validity, and reliability testing were used to examine the psychometric characteristics of the scale.

Results

A 9-item role strain scale including subscales for role guilt and role conflict, supported by exploratory factor analysis and confirmatory factor analysis, was produced. High role strain significantly correlated with high depression (r = 0.399, P < .001) and high hemoglobin A1c levels (r = 0.169, P < .001). The overall and subscale Cronbach's α ranged between 0.78 and 0.86, with test-retest reliability ranging between 0.64 and 0.81.

Conclusions

The role strain scale for women with diabetes is reliable and valid and can be used to evaluate role strain in women with diabetes.
Implementation of the Mental Health Nurse Practitioner Role in Forensic Settings: A Case Report
Authors: Paradis-Gagné Etienne , Guimond Valérie
Published: May 2020

This is a case report about the implementation of the mental health nurse practitioner role in forensic psychiatric settings. We will present its implementation and issues encountered during this process, such as a lack of understanding of the role in staff teams, scope of practice limitations, tension stemming from the conflict between treatment and punishment approaches, and the risk of medicalization of nursing. This case report, based on the authors' experiences, represents an early contribution to research on advanced nursing practice in forensic psychiatry, an area that has yet to receive much attention in the literature.
Comparing quality of care in medical specialties between nurse practitioners and physicians
Authors: Carranza Ashley N. , Munoz Pamela J. , Nash Angela J.
Published: May 2020

Background:

The American health care system is facing a growing health care provider shortage in primary and specialty care settings. Research has established that nurse practitioners (NPs) match or exceed their physician colleagues in providing quality care in primary care settings.

Objective:

This systematic review aimed to compare the quality of NP versus physician-led care in outpatient specialty care setting for clinical outcomes patient satisfaction.

Data sources:

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guided the literature search (CINAHL, PubMed, and Cochrane Library) and interpretation of findings. Of the 228 articles that met the inclusion/exclusion criteria, 11 were selected for further review.

Conclusions:

Studies were conducted from 1995 to 2016 across four countries and spanned 10 distinct medical specialties. As a whole, these studies demonstrated that NPs in specialty settings perform as well as physicians terms of clinical safety and positive patient outcomes. Nurse practitioners matched or exceeded their physician counterparts in patient education and satisfaction.

Implications for practice:

Nurse practitioners are a feasible option for addressing specialty care shortages. Further research should investigate whether NPs and physicians are equally prepared to provide equivalent care immediately following their respective postbaccalaureate programs. If not, studies should explore specific training duration and elements NPs require to provide equivalent care.
Physical activity is more related to adiposity in hypertensive than nonhypertensive middle-aged and older adults
Authors: Tebar William R. , Ritti-Dias Raphael M. , Saraiva Bruna T.C. , Scarabottolo Catarina C. , Canhin Daniel S. , Damato Tatiana M.M. , Aguilar Beatriz A.S. , Christofaro Diego G.D.
Published: May 2020

Objective

Adiposity is the main risk factor for hypertension and is negatively related to physical activity. However, it is not clear if this relationship is different according to hypertension. The present study aimed to analyze the relationship of physical activity in different domains with adiposity in hypertensive and nonhypertensive adults.

Participants and methods

A sample of 843 adults (61.6% of female) was randomly selected, with a mean age of 56.6 (±18.3) years. Diagnosed hypertension and the use of medicines were self-reported. Physical activity was assessed by questionnaire and blood pressure was measured by the oscillometric device. Adiposity indicators were as follows: BMI, waist circumference, and waist-to-height ratio (WHtR).

Results

Hypertension was reported by 44.7% of sample, being higher among older-aged, obese, elevated waist circumference and WHtR, and low physical activity groups. Physical activity was negatively related to BMI (leisure-time physical activity β = −0.070, total physical activity β = −0.082), waist circumference (leisure-time physical activity β = −0.031, total physical activity β = −0.037), and WHtR (leisure-time physical activity β = −4.917, total physical activity β = −5.996) in hypertensive adults. Hypertensive adults who had obesity were more likely to be less active at leisure physical activity [odds ratio (OR) = 2.25] and in total physical activity (OR = 2.46) than hypertensive adults with normal weight. Hypertensive adults with elevated waist circumference and elevated WHtR were more likely to be less active in total physical activity than those hypertensive adults with normal values (OR = 2.34 and 3.33, respectively).

Conclusion

Leisure time and total physical activity were related to adiposity only in hypertensive adults. Higher physical activity levels could be important to adiposity control in hypertensive population.
Limited correction of lumbar lordosis in the treatment of degenerative scoliosis
Authors: Liang Yan , Tang Xiangyu , Zhao Yongfei , Song Kai , Mao Keya , Liu Haiying , Wang Zheng
Published: May 2020

Background:

Patients suffering from degenerative scoliosis (DS) were commonly associated with coronal and sagittal imbalance which made deformity correction surgery necessary. The study aimed to explore the efficacy and feasibility of the limited correction of lumbar lordosis (LL) in the treatment of patients with DS.

Methods:

This was a retrospective study including 58 DS patients who underwent spinal deformity correction surgery and were followed up at least 2 years between January 2013 and January 2017. According to the difference of postoperative LL, the patients were divided into 2 groups: the limited correction group: Pelvic incidence(PI)–18°≤ LL<PI–9° and the control group: PI–9°≤ LL<PI+9°. There were 31 patients in the limited group, and 27 patients in the control group. The clinical and radiographic outcomes were compared preoperatively and at the last follow-up evaluation.

Results:

There was no significant difference between the 2 groups preoperatively (P > .05). In terms of surgery, the limited group had less intra-operative blood loss and operation time (P < .05). At the last follow-up, significant differences were found in terms of LL(−38.2 ± 4.7° and -46.9 ± 4.7°), PT (18.8 ± 5.2° and 11.1 ± 3.6°), sacrum slope (33.7 ± 7.0° and 41.4 ± 6.1°) (P < .05), while there were no significant differences in terms of lumbar Cobb angle (10.5 ± 9.3°and 8.3 ± 6.7°), Oswestry Disability Index scores (25.6 ± 10.2 and 26.4 ± 12.1), and JOA scores (23.6 ± 5.2 and 22.3 ± 5.7) (P > .05).

Conclusion:

Limited correction of LL in the treatment of DS patients can achieve favorable clinical outcomes including effective Cobb angle correction with less blood loss and operative time.
The effectiveness and safety of extracorporeal shock wave lithotripsy for the management of kidney stones
Authors: Qiang Yong-chun , Guo Yu-ge , Wang Yun-qi
Published: May 2020

Background:

This study will assess the effectiveness and safety of extracorporeal shock wave lithotripsy (ESWL) for patients with kidney stones (KS).

Methods:

A comprehensive and systematic literature records search for studies will be conducted in MEDLINE, EMBASE, Cochrane Library, WANGFANG, VIP, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All these databases will be searched from inception to the present without language limitation. Cochrane risk of bias tool will be used to assess the methodological quality for all included studies. Statistical analysis is performed using RevMan 5.3 software.

Results:

This study will provide synthesis of current evidence of ESWL for patients with KS through assessing primary outcomes of overall stone-free rate, and secondary outcomes of mean stone size (mm), pain intensity, urinary biochemical variables, mean hospital stay (day), quality of life, and adverse events.

Conclusion:

This study will provide recommendations for the effectiveness and safety of ESWL for patients with KS, which may help to guide clinician.

PROSPERO registration number:

PROSPERO CRD42019157243.
Contrast-enhanced ultrasound evaluation of the prostate before transrectal ultrasound-guided biopsy can improve diagnostic sensitivity
Authors: Liu Guangqing , Wu Size , Huang Li
Published: May 2020

To conduct a STARD-compliant validity that the contrast-enhanced ultrasound (CEUS) evaluation of prostate for the improvement of positive rate of biopsy and diagnostic efficiency of prostate carcinoma (PCa).

Data of 137 patients with suspected PCa who underwent relevant examinations and treatment were reviewed, and 82 of 137 patients were finally included. The patients consisted of Group 1 (26 patients) and Group 2 (42 patients) according to which they underwent transrectal ultrasound (TRUS) biopsy selected from CEUS evaluation of the prostate and who underwent TRUS-guided biopsy directly. A systematic 12-core biopsy was performed at first, and additional 1 to 2 cores biopsy was made in the suspected target area where CEUS had showed abnormal enhancement. The assumed diagnoses were compared with pathological findings.

There were 37 patients with PCa and 31 patients with benign lesions; and 14 patients without biopsy after CEUS did not find PCa emerging in follow-up (18–47 months). The positive rates of biopsy-malignant lesions were 73.1% and 42.8% in Group 1 and Group 2, respectively. The positive rate of biopsy in Group 1 was significantly higher than that in Group 2 (P = .024). The sensitivity and accuracy of TRUS biopsy and a combination of TRUS biopsy after transrectal CEUS for the evaluation of prostate benign and malignant lesion were 60% and 66.7% (P=0.0139), and 94.4% and 88.5% (P=0.0453), respectively.

CEUS evaluation of the prostate of PSA-elevated patient before biopsy can help select target patient with high risk of PCa, reduce unnecessary biopsy, increase detection rate of PCa, and improve diagnostic sensitivity and accuracy.
Occurrence of lymphoplasmacytic lymphoma in a chronic myeloid leukemia patient following long-term treatment with tyrosine kinase inhibitors
Authors: Lee Chang-Hoon , Jeon So Yeon , Yhim Ho-Young , Jang Kyu Yun , Kwak Jae-Yong
Published: May 2020

Introduction:

After tyrosine kinase inhibitors (TKIs) targeting BCR-ABL1 were introduced for the treatment of chronic myeloid leukemia, clinical outcomes have improved dramatically. However, together with the increase in the survival rate, a more frequent occurrence of secondary malignancies has been observed as well. TKIs have been demonstrated to be a risk factor of malignancies such as non-Hodgkin lymphoma, prostate cancer, and skin cancer. However, lymphoplasmacytic lymphoma (LPL) has never been reported as a secondary malignancy after TKI treatment in chronic myeloid leukemia (CML).

Patient concerns:

An 81-year-old male patient diagnosed with CML and treated with TKIs for a long period (15 years) was admitted due to a chief complaint of abdominal pain. A large abdominal mass was detected by imaging that included computed tomography.

Diagnosis:

LPL was confirmed from biopsies after ultrasonography and sigmoidoscopy. Serum IgM level was increased and M protein and monoclonal gammopathy, IgM_kappa light chain type were detected.

Interventions:

The patient received six cycles of R-CHOP chemotherapy.

Outcomes:

After chemotherapy, he showed response. The sizes of the abdominal mass and lymph nodes decreased; moreover, serum M protein and IgM levels decreased, as well.

Conclusion:

Herein, for the first time, we describe a patient who developed LPL as a secondary malignancy after administration of TKIs for the treatment of CML. Our observations indicate the importance of awareness of this secondary malignancy that can develop in CML patients treated with TKIs.
Moxibustion for treating knee osteoarthritis
Authors: Wang Xue , Jiang Yunfeng , Xiong Jun , Yuan Ting , Yang Jun , Zhou Xiaohong , Liao Kai , Xu Lingling
Published: May 2020

Background:

Knee osteoarthritis (KOA) is a significant health issue because it causes pain and functional limitation. Many studies have reported that moxibustion, a treatment in traditional Chinese medicine, is effective in treating KOA. The aim of this overview is to synthesize and assess the reliability of evidence generated from these systematic reviews of the effectiveness of moxibusition for KOA.

Methods:

This is a protocol for a systematic overview of reviews. We will search 7 databases: PubMed, Embase, Cochrane Library, Chinese Biomedical Literatures Database, China National Knowledge Infrastructure, WangFang Database, Chinese Scientific Journal Database from their inception to April 2020. We will consider systematic reviews and meta-analysis of randomized controlled trials evaluating the effectiveness of moxibustion for KOA. Independent reviewers will sift, perform data extraction in duplicate, and assess the quality of the reviews using the Change MeaSurement Tool to Assess Systematic Reviews-2 to Assessment of Multiple Systematic Reviews-2 and the Preferred Reporting Item for Systematic Review and Meta-Analysis statement. The outcomes of interest include: quality of life, knee function, and pain relief outcomes prioritized in the individual reviews. The evidence will be synthesized where appropriate by patient subgroups, intervention type, context, and outcome. Revman 5.3 software will be used to conduct meta-analysis and calculate the risk ratio for dichotomous data. Weighted mean difference or standard mean difference will be calculated for continuous data. The quality of evidence was assessed according to Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) considering the methodological quality of the randomized controlled trials and meta-analysis.

Results:

The results of this study will be published in a peer-reviewed journal.

Conclusions:

We expect to compile evidence from multiple systematic reviews of symptomatic improvement in patients with KOA in an accessible and useful document.

Trial registration number:

CRD42019141029 in PROSPERO 2019.