bluuebunny/crossref_metadata_2025 huggingface dataset:
Severe peripheral arterial diseases in hemodialysis patient
Authors: Li Jiali , Yan Mingming , Qin Jiao , Liu Jun , Wen Rui
Published: January 2020

Rationale:

Peripheral arterial diseases (PADs) is defined as a systemic arterial disorders involving the lower extremity arteries, iliac, and carotid, which is developed more common in patients with chronic kidney disease (CKD) than individual with normal renal function. Concurrence of mesenteric artery disease and lower extremity artery disease (LEAD) is rare. The presence of PADs in patients receiving hemodialysis leads to a dramatic increase in risk of cardiovascular mortality. However, the early diagnosis of PADs in patient with CKD remains a challenge to nephrologists, which adds an adverse effect on prognosis.

Patient concerns:

A 48-year-old man received regular hemodialysis due to end-stage renal failure caused by type 2 diabetes mellitus (T2DM) for 7 years, who was admitted into hospital for acute, severe rest pain of the right lower extremity at the first time. The computed tomography angiography showed severe, diffuse stenosis of the distal third of femoral artery. After discharged, he was readmitted into hospital for abdominal pain and the recurred right lower limb pain. A diagnostic angiography confirmed the initial occlusion of superior mesenteric artery, severe obstruction of the distal segment of femoral artery and diffuse, irregular stenosis of arteria peronea and arteria tibialis posterior.

Diagnosis:

The patient was diagnosed as PADs including LEAD and mesenteric artery disease.

Interventions:

The percutaneous transulminal angioplasty (PTA) combined with antiplatelet therapy and beraprost were performed. Moreover, the cinacalcet and lanthanum carbonate were prescribed to control calcium-phosphorus- parathyroid hormone metabolism.

Outcomes:

The patient was free of abdominal pain and partly relieved from the ache of lower limb after PTA. However, he finally succumbed to acute myocardial infarction.

Lessons:

The incidence of PADs is higher in dialysis patients due to a unique set of biochemical and endocrine abnormalities. As there is a high uremic status and PADs burden in patients with hemodialysis, the short term risk of cardiovascular disesase mortality markedly increases. There is a need for nephrologists and cardiovascular physicians to identify these patients and then provide early and proper treatment.
Effectiveness of a multicomponent treatment versus conventional treatment in patients with fibromyalgia
Authors: Araya-Quintanilla Felipe , Gutiérrez-Espinoza Héctor , Muñoz-Yánez María Jesús , Cavero-Redondo Iván , Álvarez-Bueno Celia , Martinez-Vizcaíno Vicente
Published: January 2020

Background:

Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread musculoskeletal pain and multiple symptoms. It is a common clinical condition whose etiology is unclear. Currently, there is no gold standard treatment for FM. Management of this condition is therefore aimed at reducing symptoms and maintaining the individual's ability to function optimally. Based on the principal symptoms and characteristics of individuals with FM, we hypothesized that the implementation of a multicomponent treatment (with physical exercise, cognitive behavioral therapy adding to a graded motor imagery program, and therapeutic neuroscience education) would be more effective than conventional treatment in women with FM. This paper describes the rationale and methods of study intended to test the effectiveness of multicomponent treatment versus conventional treatment in patients with FM.

Method/Design:

Fifty-six female individuals between 18 and 65 years of age, who were referred to the physical therapy department of the Rehabilitar Center in Chile, will be randomized into two treatment arms. The intervention group will receive a multicomponent treatment program for duration of 12 weeks. The control group will receive a conventional treatment for this condition for 12 weeks. The primary outcome measure will be the pain intensity score, measured by the numeric pain rating scale (NPRS), and the secondary outcomes will be the FM Impact Questionnaire (FIQ), and affective components of pain, such as catastrophizing using the Pain Catastrophizing Scale (PCS), fear of movement using the Tampa Scale Kinesiophobia (TSK), and sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI).

Discussion:

This paper reports the design of a randomized clinical trial aimed at assessing the effectiveness of the multicomponent treatment versus conventional treatment in women with FM.

Trial registration:

Brazilian registry of clinical trials UTN number U1111-1232-0862. Registered 22 April 2019.
A systematic review and meta-analysis of the effects of early mobilization therapy in patients after cardiac surgery
Authors: Chen Bin , You Xiaofang , Lin Yuan , Dong Danyu , Xie Xuemin , Zheng Xinyi , Li Dong , Lin Wanqing
Published: January 2020

Background:

Prolonged hospitalization and immobility of critical care patients elevates the risk of long-term physical and cognitive impairments. However, the therapeutic effects of early mobilization have been difficult to interpret due to variations in study populations, interventions, and outcome measures. This systematic review and meta-analysis aims to assess the effects of early mobilization therapy for non-emergency cardiac surgery patients in the intensive care unit (ICU).

Methods:

The following databases will be used to search for relevant keywords: PubMed, Embase, CINAHL, PEDro, and the Cochrane Library from inception to September 2018 by 2 researchers independently. Randomized controlled trials (RCTs), will be included if patients are adults (≥18 years) admitted to any ICU for cardiac surgery due to cardiovascular disease and who are treated with experimental physiotherapy initiated in the ICU (pre, post, or perioperative). The Review Manager 5.3 will be used for meta-analysis and the evidence level will be assessed by using the method for Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Continuous outcomes will be presented as the weighted mean difference (WMD) or standardized mean difference (SMD) with 95% confidence interval (CI), while dichotomous data will be expressed as relative risk (RR) with 95% CI. If the included studies have existing heterogeneity (P < 0.1), a random-effects model will be used. Otherwise, we will calculate using a fixed effects model.

Results:

This review will evaluate the effects of early mobilization on length of ICU and hospital stay, physical function and adverse events in patients with cardiac surgery patients in the ICU.

Conclusion:

This systematic review will comprehensively provide conclusive evidence of the therapeutic effect of early mobilization on cardiac surgery patients in the ICU.

PROSPERO Research registration identifying number: CRD42019135338.
Analysis of inpatients’ characteristics and spatio-temporal distribution of liver cancer incidence in Wuwei, Gansu Province, from 1995 to 2016
Authors: Zhang Yang , li Zhao , Shao Zhongjun , Liu Kun , Ji Zhaohua
Published: January 2020

This long-term span retrospective study aimed to determine the incidence and spatial-temporal trends of liver cancer in Wuwei city from 1995 to 2016 to provide scientific knowledge on the prevention and treatment of liver cancer.

Data from the medical records of liver cancer patients treated in 12 sentinel hospitals in Wuwei city were extracted. SAS and Joinpoint software were used for data analysis, ArcGIS 10.2 software was used to make geographical distribution map, and SaTScan 9.4 software was used for clustering area detection.

Of 2271 patients with liver cancer (average age, 58.73 years), 17.7% were 60 to 64 years of age. Majority were males (1680, 74%), with a sex ratio of 2.84. Joinpoint regression analysis from 1995 to 2016 revealed that the standardized liver cancer rate increased [annual average rate of change (AAPC) = 12.80% (95% CI: 9.5%–16.7%)], with a joinpoint in 2009. From 1995 to 2009, the change in overall APC was statistically significant [APC = 16.7 (95% CI: 12.3%–21.3%)]. The average incidence was the highest in Hongshagang Town. After 2005, the incidence gradually increased in each township. Five clusters of liver cancer were noted in Wuwei, including 37 townships.

Males had a higher standardized liver cancer rate. After 2009, increase in the incidence of liver cancer was less rapid. The incidence of liver cancer in townships of Wuwei city was non-random, with certain spatial aggregations, covering 37 townships.
Peripheral monocyte count is an independent predictor of all-cause mortality in type 2 diabetes with macro-vascular complications
Authors: Yang Lina , Hu Jinbo , Wang Zhihong , Chen Xiangjun , Wang Yue , Yang Shumin , Luo Ting , Mei Mei , Cheng Qingfeng , Xu Zhixin , Du Zhipeng , Gong Lilin , Luo Rong , Li Qifu
Published: January 2020

The relationship between monocyte count and mortality seemed to be varied in different diseases, and it remains unclear in type 2 diabetes (T2D). We conducted a prospective study to investigate whether monocyte count predict all-cause mortality in patients with T2D.

In this prospective study, a total of 1073 patients with T2D were enrolled at baseline and 880 patients completed the follow up. The median follow-up time was 47 months. At baseline, clinical characteristics including height, weight, waist circumference, blood pressure were recorded. Biochemical parameters including counts of white blood cells (WBCC), neutrophil (NC) and monocyte (MC), lipid profiles, glycated hemoglobin (HbA1c), serum creatinine were measured. Charlson comorbidity index (CCI) was calculated based on age and comorbidities. Participants were stratified into low, median, and high tertiles according to the baseline MC. Regression models were used to analyze the associations of peripheral MC and the all-cause mortality.

Compared to the survived subjects, the baseline MC was significantly higher in patients who deceased during the follow-up (0.45 ± 0.16 vs 0.37 ± 0.15 × 109/L, P = .003). In the multivariate Cox hazard models, subjects in higher MC tertile showed higher risks of all-cause mortality (low tertile as the reference, hazard ratio [HR] 95%CI 2.65 [0.84,8.31] and 3.73 [1.14,12.24] for middle and high MC tertile, respectively) after adjusted for gender, body mass index, CCI, duration of T2D, history of hypertension and metabolic syndrome, drugs, levels of high-sensitivity C-reactive protein, systolic blood pressure, HbA1c, WBCC, and NC. In T2D patients with macro-vascular complications at baseline, 1-SD increment of MC resulted in 1.92-fold higher risk of all-cause mortality. However, the relationship disappeared in subjects without macro-vascular complications at baseline (1.13 [0.72, 1.78], P = .591).

Peripheral monocyte count is an independent predictor of all-cause mortality in T2D, especially for subjects with macro-vascular complications.
Orbital myiasis
Authors: Huang Yan-Ling , Liu Lu , Liang Hao , He Jian , Chen Jun , Liang Qiao-Wen , Jiang Zhi-Yuan , He Jian-Feng , Huang Min-Li , Du Yi
Published: January 2020

Rationale:

Myiasis is a parasitic disease caused by fly larvae of the Diptera order that infest human and other vertebrate animal tissues. Orbital myiasis is a potentially destructive infestation of the orbital tissues, which may affect individuals with previous ocular diseases or disorders of consciousness.

Patient concerns:

A 72-year-old man presented with a complaint of repeated pain for two years after trauma to his right eyelid and aggravated symptoms with larvae wriggling out for 2 days. An orbital computed tomography scan revealed right eyeball protrusion and periocular soft tissue edema. Two days later, magnetic resonance imaging showed that the shape of the right eyeball was changed and that the normal structure of the eyeball could not be identified.

Diagnoses:

Due to the patient's symptoms and imaging examination results, the diagnosis of orbital myiasis was made.

Interventions:

The patient was treated by exenteration of the right orbit, and all necrotic tissues and larvae were removed. The defect was repaired via reconstruction with a pedicled musculocutaneous flap from the forehead region. Antibiotics and tetanus toxoid therapy were utilized to prevent potential bacterial infection.

Outcomes:

The patient recovered well postoperatively and was discharged uneventfully. During the 6-month follow-up period, the wound healed well.

Lessons:

Advanced age and untreated eye trauma are risk factors for orbital myiasis. Timely removal of larvae and elimination of infections are important measures for protecting the eyeball.
A retrospective comparative study of infection control rate and clinical outcome between open debridement using antibiotic-impregnated cement beads and a two-stage revision in acute periprosthetic knee joint infection
Authors: Chang Moon Jong , Lee Seung Ah , Kang Seung-Baik , Hwang Keum Min , Park Hyung Jun , Lee Kyoung Hwan , Seo Jai Gon , Chang Chong Bum
Published: January 2020

The aim of this study was to determine whether the infection control rate of a modified debridement, antibiotics, and implant retention (DAIR) protocol (DAIR with antibiotic-impregnated cement beads) is comparable to that of 2-stage revision for acute periprosthetic joint infection (PJI) after total knee arthroplasty (TKA). We also aimed to determine whether this modified DAIR technique produced better clinical results than those obtained using 2-stage revision in terms of functional outcome, range of motion (ROM), and patient satisfaction at 2 years after surgery.

This retrospective comparative study included patients who underwent modified DAIR (7 patients, 9 knees) or 2-stage revision (8 patients, 9 knees) for acute PJI of the knee joint. Infection control rate, functional outcome measured using Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, ROM and patient satisfaction were compared between the two groups.

There was no difference in infection control rates between the modified DAIR and 2-stage revision groups (78% vs 78%, respectively). In contrast, surgical outcome in the modified DAIR group was tended to be better than 2-stage revision group, but it did not reach statistical significance. Median maximal range of flexion was 103° in the modified DAIR group and it was 90° in the 2-stage group (P = .191). In addition, the median WOMAC function score was 24 in the modified DAIR group and it was 30 in the 2-stage group (P = .076). Median patient satisfaction measured using visual analogue scale was 8 in the modified DAIR group and 5 in the 2-stage group (P = .069).

The infection control rates of the modified DAIR protocol and 2-stage revision protocol were similar for the treatment of acute PJI of the knee joint. However, the modified DAIR protocol could not provide substantially increased functional outcomes and patient satisfaction compared to 2-stage revision. Therefore, the modified DAIR technique should be considered to be of limited use in patients with high surgical morbidity.
Application of point-of-care ultrasound for different types of esophageal foreign bodies: three case reports
Authors: Ahn Jung Hwan , Sohn Youdong
Published: January 2020

Rationale:

Esophageal point-of-care ultrasound (POCUS) has recently been reported as a useful, quick, safe, and simple technique to detect esophageal foreign bodies (FBs). However, case series to detect esophageal FB using POCUS have been rarely reported. Chicken bones and pills, especially, have not yet been reported as esophageal FBs. The objective of this case series was to describe the POCUS findings of 3 different materials—food, pill, and chicken bone.

Patient concerns:

Case 1, a 75-year-old woman with odynophagia and neck pain occurring 30 min after eating chicken porridge; Case 2, a 32-year-old woman with neck discomfort occurring 2 h after taking a pill; Case 3, a 29-year-old woman reporting FB sensation in the neck that occurred 1 h after eating sausage and rice soup.

Diagnosis:

Case 1. Cervical esophageal FB (chicken bone), Case 2. Cervical esophageal FB (oral pill), Case 3. Cervical esophageal FB (food).

Interventions:

Case 1. POCUS, urgent esophagogastroduodenoscopy (EGD) with alligator forceps. POCUS findings; hyperechoic material (suspected FB) that did not disappear by swallowing and esophageal dilatation with pooling of secretions. Case 2. POCUS. POCUS findings; hypoechoic material (suspected FB) that did not disappear by swallowing, and esophageal bulging above the FB, especially observed in the longitudinal view. Case 3. POCUS. POCUS findings; hyperechoic material (suspected FB) with reverberation artifact that did not disappear with swallowing efforts. Prior FB esophageal bulging with persistent air-fluid level was especially observed in the longitudinal view.

Outcomes:

Case 1. FB was removed by EGD with alligator forceps. Case 2. Symptoms disappeared under observation without EGD. Follow-up POCUS revealed normalized bulging esophagus. Case 3. These symptoms improved after vomiting a large piece of food material. Three patients were discharged without complications.

Lessons:

In this case series, the impacted materials were chicken bone, pill, and food. However, POCUS findings were similar (esophageal dilation, hyperechoic or hypoechoic lesion with mixed echogenic contents in food or secretion, and no change with swallowing efforts). A longitudinal view was useful to assume the presence of cervical esophageal FB in all three cases. Thus, POCUS findings could be indirect signs of a FB in the esophagus.
Moxibustion for the treatment of primary dysmenorrhea
Authors: Wang Xue , Xiong Jun , Yang Jun , Yuan Ting , Fan Hao , Jiang Yunfeng , Zhou Xiaohong , Liao Kai , Xu Lingling
Published: January 2020

Background:

Primary dysmenorrhea (PD) is a common gynecological disease, it refers to spasmodic pain in the lower abdomen before, after or during menstruation, accompanied by general discomfort, In severe cases, fainting may occur due to severe pain, reducing the quality of patients’ life and imposing a heavy burden on social medical security system. There are many ways to treat primary dysmenorrhea, including western medicine and traditional Chinese medicine. Moxibustion is one of the traditional Chinese medicine treatments for primary dysmenorrhea, especially popular in China. Therefore, our overview aims at evaluating the methodological bias and the reliability of the conclusions of systematic reviews (SRs) about moxibustion for primary dysmenorrhoea, and help clinical decision makers translate this research into clinical policy and practice.

Methods:

We will search electronic databases including PubMed, Embase, Cochrane Library, Chinese Biomedical Literatures Database (CBM), China National Knowledge Infrastructure (CNKI), WangFang Database (WF), Chinese Scientific Journal Database (VIP) from inception to February 2017. We will consider systematic reviews and meta-analysis of randomized controlled trials evaluating the effect of moxibustion for PD. Two reviewers will identify relevant studies, extract data information, and then assess the methodological quality by Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) tool. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) report checklist to assess the quality of reports included in the study. We will use the evaluations of the Classification of Recommendations, Evaluation, Development and Evaluation (GRADE) of the authors of the included systematic reviews. The screening of systematic reviews, eligibility evaluation, data extraction, methodological quality, and quality of evidence will be conducted by independent reviewers in pairs. The outcomes of interest include: total effective rate, visual analog scale scores (VAS), Cox Menstrual Symptom Scale (CMSS), Dysmenorrhea symptom score and adverse events outcomes prioritized in the individual reviews. We will extract data onto a predefined form designed to summarize the key characteristics of each review. The evidence will be a narrative synthesis organized around the type and content of the intervention and the results reported.

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 primary dysmenorrhea in an accessible and useful document.

Registration number PROSPERO:

CRD42019141130
Is high tibial osteotomy better than proximal fibula osteotomy for treating knee osteoarthritis? A protocol for a systematic review and meta-analysis of clinical controlled trials
Authors: Huang Hetao , Huang Sicong , Liang Guihong , Zeng Lingfeng , Pan Jianke , Yang Weiyi , Chen Hongyun , Liu Jun , Pan Biqi
Published: January 2020

Background:

Knee osteoarthritis (KOA) is a common disease in the elderly, which seriously reduces the quality of life of patients and increases the social burden. proximal fibula osteotomy (PFO) and high tibial osteotomy (HTO) are effective methods to treat KOA. However, it is not entirely clear which method has the advantage. Therefore, we evaluated the efficacy and safety of HTO and PFO in the treatment of KOA.

Methods:

Randomized controlled trials from online databases including PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journal Database, Wanfang Data and Chinese Biomedical Literature Database that compared the efficacy of HTO and PFO in the treatment of KOA were retrieved. The main outcomes included hospital for special surgery (HSS) knee scores, knee society knee scoring system (KSS) score, visual analog scale (VAS) knee pain scores, western ontario and McMaster universities osteoarthritis index score, operation time, intraoperative bleeding volume, hospitalization time, complications. The Cochrane risk of bias tool was used to assess methodological quality.

Results:

The literature will provide a high-quality analysis of the current evidence supporting HTO for KOA based on various comprehensive assessments including HSS scores, KSS score, VAS scores, western Ontario and McMaster universities osteoarthritis index score, operation time, intraoperative bleeding volume, hospitalization time, and complications.

Conclusion:

This proposed systematic review will provide up-to-date evidence to assess the effect of HTO in the treatment for patients with KOA.
Moxibustion as an adjunct for lower urinary tract symptoms associated with benign prostate enlargement
Authors: Lee Hye-Yoon , Bae Go-Eun , Lee Sang-Don , Nam Jong-Kil , Yun Young-Ju , Han Ji-Yeon , Lee Dong-Hoon , Choi Jun-Young , Park Seong-Ha , Kwon Jung-Nam
Published: January 2020

Background:

Benign prostatic enlargement (BPE) causes discomfort in daily life, including lower urinary tract symptoms (LUTSs) caused by the enlarged prostate, and requires long-term management as a chronic, irreversible disease. To improve LUTS, certain complementary therapies have been used with or without doctors’ directions. Conventional treatments and complementary therapies tend to be combined unsystematically, depending on patient preference; thus, research for safe and efficient combination therapy is warranted.

Methods:

Twenty-nine participants were randomly assigned to an integrative group (IG, n = 15) or a conventional group (CG, n = 14). The IG received moxibustion (twice weekly for 4 weeks, at the acupuncture points SP6, LR3, and CV4) and conventional medication for 4 weeks, followed by conventional medication alone for 8 weeks. The CG received conventional medication alone for 12 weeks. The outcome measures were International Prostate Symptom Score (IPSS), patient's global impression of changes (PGIC), maximum urinary flow rate (Q
max), postvoid residual urine volume (PVR), and frequency-volume chart.

Results:

Total IPSS (IG, −2.4 ± 4.2; CG, 0.9 ± 4.0; P = .039), PGIC-A (IG, 3.5 ± 1.0; CG, 2.2 ± 1.0; P = .001), and PGIC-B (IG, 3.5 ± 0.1; CG, 4.7 ± 0.6; P = .004) were significantly improved in the IG compared with the CG, 4 weeks after baseline. Among the IPSS items, incomplete emptying (IG, −0.6 ± 0.7; CG, 0.4 ± 1.2; P = .019), straining (IG, −0.6 ± 0.8; CG, 0.2 ± 1.2; P = .046), and nocturia (IG, −0.8 ± 1.4; CG, 0.1 ± 1.0; P = .045) showed significant differences. The Q
max and PVR volume did not differ significantly at 12 weeks after the baseline.

Conclusion:

Moxibustion can be considered an adjunct therapy to improve LUTS in BPE patients. A full-sized randomized controlled trial would be feasible with comparator modifications and an extended study period. The study design should include a placebo group and narrow the eligibility to subjects who do not respond well to conventional treatments.
Depressed sympathovagal modulation indicates sepsis in patients with suspected infection
Authors: Hsu Ching-Tang , Tai Henry Chih-Hung , Chung Jui-Yuan , Chen Jiann-Hwa , Chen Wei-Lung
Published: January 2020

This study explored whether sympathovagal modulation assessed through frequency domains of heart rate variability (HRV) can indicate sepsis in patients with suspected infection.

In total, 370 consecutive adult patients with suspected infection admitted to the emergency department were enrolled in this single-center cohort study. A continuous 10-minute electrocardiography for HRV analysis was recorded immediately for these patients after inclusion. Patients were stratified into non-sepsis and sepsis groups based on a sepsis-related organ failure assessment score of ≥2 that met the Third International Consensus Definitions for Sepsis. Seven frequency domains of HRV were compared between these 2 groups.

Compared with the non-sepsis group (n = 98), the sepsis group (n = 272) had a significantly lower incidence of respiratory tract infection, higher total power, higher very-low-frequency component, higher high-frequency (HF) component, higher normalized HF component, lower normalized low-frequency (LF) component, and lower LF component/HF component ratio (LF/HF). Multiple logistic regression model identified HF component (odds ratio [OR] = 0.994; 95% confidence interval [CI], 0.990–0.999) and LF/HF (OR = 0.494; 95% CI, 0.423–0.578) as significant variables associated with sepsis. The area under receiver operating characteristic curves of HF component and LF/HF was 0.741 (95% CI, 0.685–0.797) and 0.930 (95% CI, 0.900–0.960), respectively, in identifying sepsis in patients with suspected infection.

Tilted sympathovagal balance toward increased vagal activity and depressed sympathetic modulation, assessed by the HF component and LF/HF, may indicate sepsis in patients with suspected infection.
Epidural anesthesia for emergency cesarean section in a woman with Fontan circulation
Authors: Wu Pin , Zhu Sheng-Mei , Yao Yong-Xing
Published: January 2020

Rationale:

Anesthetic management of pregnant women with Fontan circulation remains challenging. There are few reports that describe the anesthetic management of cesarean section after Fontan surgery. Here, we present a case of successful epidural anesthesia in a woman with Fontan circulation who required emergency cesarean section.

Patient concerns:

A 29-year-old woman at gestational week 28 was scheduled for emergency cesarean section because of fetal distress. Her past medical history was significant for congenital transposition of the great arteries that had been treated by Fontan surgery 26 years earlier. Her postoperative course had been uneventful and she had reached a near normal level of activity with no arrhythmias or thrombotic complications. On presentation, her oxygen saturation was approximately 84% and she had digital clubbing. Arterial blood gas analysis showed a PCO2 of 35 mmHg, PO2 of 55.5 mmHg, and hemoglobin of 16.3 g/dL. Her blood coagulation parameters were within normal limits except for a high fibrinogen concentration (4.55 g/L).

Diagnosis:

The diagnosis was pregnancy requiring emergency cesarean section because of fetal distress.

Interventions:

Before anesthesia, a radial artery line was established for continuous measurement of blood pressure. An air pressure pump was placed on the patient's lower limbs and a low-dose dobutamine infusion was started. Next, epidural anesthesia was successfully performed at L2–3. Five milliliters of 2% lidocaine followed by 10 mL of 0.75% ropivacaine were injected. Dobutamine was infused to maintain a target blood pressure of 100–120/60–70 mmHg.

Outcomes:

The procedure was uneventful with the patient maintaining a stable heart rate of 80 to 90 beats/min and an oxygen saturation of 90% to 94%. A male infant weighing 840 g was delivered. The Apgar score was 9 at 1 and 5 minutes. The patient was transferred to the intensive care unit for 20 hours of monitoring and discharged 9 days later. The neonate was discharged after 2 months of specialist neonatal treatment.

Lessons:

Epidural anesthesia may be used in women with Fontan circulation undergoing emergency cesarean section. Knowledge of the physiology of the heart lesion and that of pregnancy are critical to the outcome.
Kangaroo Care for Hospitalized Infants with Congenital Heart Disease
Authors: Lisanti Amy Jo , Buoni Alessandra , Steigerwalt Megan , Daly Michelle , McNelis Stephanie , Spatz Diane L.
Published: January 2020

Background:

Kangaroo care (KC), or skin-to-skin care, occurs when an infant is dressed in a diaper and held to a parent's bare chest. This form of holding has been shown to have many benefits for hospitalized infants and has been shown to be a safe and feasible intervention to support infants with congenital heart disease. Despite known benefits, KC was not implemented routinely and consistently in our cardiac center for infants with congenital heart disease. The purpose of this project was to support use of KC as a nursing intervention for hospitalized infants with congenital heart disease and their parents.

Methods:

A KC quality improvement committee formed to develop strategies to increase frequency of KC, including the creation of a new nursing policy and procedure on KC for infants, adaptation of the electronic health record to facilitate KC documentation, education, and supporting translation of KC into practice through the cardiac center's first Kangaroo-A-Thon.

Results:

Twenty-six nurses initiated KC 43 times with 14 patients over the 8-week period for the Kangaroo-A-Thon. No adverse events were reported as a result of infants being held by their parents in KC.

Conclusion:

Our local initiative provided preliminary evidence that KC can be safely integrated into standard care for hospitalized infants with congenital heart disease. Formal standards and procedures, along with creative initiatives such as a Kangaroo-A-Thon, can be a first step toward fostering the translation of KC into practice.
The (Slow) Depathologizing of Gender Incongruence
Authors: Davies Robert D. , Davies Madeline E.
Published: January 2020

Psychiatric nosology has at times mirrored cultural mores and societal values, pathologizing behaviors seen at the time to be either immoral or outside the norm. This has been particularly true when it comes to issues related to sexuality and gender. Such pathologizing has resulted in further stigmatization and discrimination in society. Gender incongruence, the experience of an individual whose internal sense of gender is at odds with the sex they were assigned at birth, has long been pathologized. This article will compare the history of the psychiatric depathologizing of homosexuality to the current process of depathologizing gender incongruence.
Association Between Alexithymia and Immature Coping Styles Is Mediated by Self-Inconsistency and Is Correlated to Obsessive-Compulsive Symptoms
Authors: Wu Chao , Shi Chuan , Dong Wentian , Li Bing , Wu Rengang
Published: January 2020

This study aimed to investigate whether a multivariate association between alexithymia and coping styles is affected by self-inconsistency and whether the association contributed to obsessive-compulsive symptoms in 34 patients with obsessive-compulsive disorder (OCD) and 53 healthy participants. Alexithymia, coping styles, self-inconsistency, and obsessive-compulsive symptoms were evaluated using the Toronto Alexithymia Scale-20, the Coping Style Questionnaire, the Self-Consistency and Congruence Scale, and the Vancouver Obsessive-Compulsive Inventory, respectively. We found that self-inconsistency partially mediated the association between alexithymia and immature coping styles in the OCD patients but fully mediated the association in the healthy participants. Moreover, in the two groups, the alexithymia-coping coupling was related to contamination, obsession, indecisiveness, and ritualization, but not the checking symptom dimension. The findings suggest that the disturbance in identifying and describing feelings is associated with immature coping styles through disharmony between self-recognition and experience. The mechanism of the checking symptom seems to be distinct from other obsessive-compulsive symptoms.
Well-Being and Self-Disorders in Schizotypal Disorder and Asperger Syndrome/Autism Spectrum Disorder
Authors: Nilsson Maria , Handest Peter , Carlsson Jessica , Nylander Lena , Pedersen Lennart , Mortensen Erik Lykke , Arnfred Sidse
Published: January 2020

We explored subjective well-being in two groups of young adult participants diagnosed with either schizotypal disorder (Sd) (n = 29) or Asperger syndrome/autism spectrum disorder (As/ASD) (n = 22). Well-being was impaired in both groups and was lower in the Sd group than in the As/ASD group. Furthermore, there was a negative correlation between well-being and the presence of self-disorders. The negative effect of self-disorders on well-being was still significant when adjusted for diagnosis, age and gender, and level of function. The present findings point toward clinically important disorder-specific differences in the nature of impaired well-being between the Sd group and the As/ASD group, as there seems to be a self-disorder–driven additional contribution to impaired subjective well-being within the schizophrenia spectrum. These findings further nuance the understanding of fundamental and clinically important qualitative differences between the schizophrenia spectrum and the autism spectrum.
Transition to Practice
Authors: Urban Regina Wilder , Barnes Donelle M.
Published: January 2020

This qualitative study is based on individual interviews with 15 new graduate nurses during their first few months of independent practice. Three themes emerged from the data that reflected their lived experience: feeling overwhelmed, navigating work-based relationships, and finding their flow. Nursing professional development specialists who work with these newly independent nurses are uniquely situated to offer ongoing educational support and to conduct evidence-based conversations with them about the transition to practice.
Development and Psychometric Analysis of the Patient Preferences for Engagement Tool
Authors: Jerofke-Owen Teresa A. , Garnier-Villarreal Mauricio
Published: January 2020

Background

Assessing patients’ preferences for engaging in healthcare is needed to inform the planning and delivery of individualized healthcare. Unfortunately, patients are often not engaged in their care to the extent that they would like, leading to patient feelings of disempowerment and frustration.

Objectives

The purpose of this study was to (a) develop and (b) psychometrically test the Patient Preferences for Engagement Tool (PPET), a clinical assessment tool that can be used by nursing staff to identify patient preferences for engagement in healthcare. The usability of the PPET was also examined for both nurses and patients participating in the study.

Methods

The psychometric evaluation design used content and construct validity testing (exploratory and confirmatory factor analysis, known groups comparisons) and reliability estimation using Cronbach’s alpha coefficient. The sample consisted of 308 adult patients aged 18–101 years from a Midwestern U.S. Magnet-designated academic medical center.

Results

Content validity index was at least 0.8 for all but one item. Using a split sample, a six-factor solution was first identified using exploratory factor analysis and then confirmed using confirmatory factor analysis. Demographic and illness factors were not significant predictors of factor scores. Cronbach’s alpha coefficients of all six factors were >0.7. Both patients and nurses gave high ratings to the tool on effectiveness, efficiency, and satisfaction with use.

Discussion

The PPET demonstrated acceptable validity and reliability estimates. Assessing patient preferences for engagement gives value to the patient voice and provides an opportunity to have discussions with patients about various ways they can engage in their healthcare. Future research will focus on reducing the number of items on the PPET to construct a clinically useful resource for providers to use to assess patient preferences for healthcare engagement, leading to the development of more personalized care delivery methods.
Preoperative Education for Total Knee Replacement
Authors: Causey-Upton Renee , Howell Dana M. , Kitzman Patrick H. , Custer Melba G. , Dressler Emily V.
Published: January 2020

BACKGROUND:

Preoperative education aids in reducing the incidence of poor outcomes after total knee replacement (TKR) and increasing patient readiness for discharge home but is not well described in the literature.

PURPOSE:

The purpose of the study is to describe the current design of preoperative education for TKR across the United States.

METHODS:

A large, national sample of orthopaedic nurses completed an online survey to describe preoperative education at their facilities.

RESULTS:

Most participants provided preoperative education as part of interprofessional teams in either a group format or combined group and individual education. Verbal instruction was the most common educational delivery method, followed by written instruction. Education typically lasted between 1 and 1.5 hours, was delivered in a single session, and included a variety of topics.

CONCLUSION:

Results of this study describe preoperative educational practices and can support future research to improve patient outcomes following TKR surgery.
Induction of Labor: An Overview of Guidelines
Authors: Tsakiridis Ioannis , Mamopoulos Apostolos , Athanasiadis Apostolos , Dagklis Themistoklis
Published: January 2020

Importance

Induction of labor (IOL) is a common obstetric intervention that stimulates the onset of labor using artificial methods.

Objective

The aim of this study was to summarize and compare recommendations from 4 national or international medical societies on the IOL.

Evidence Acquisition

A descriptive review was conducted of major published guidelines on IOL: the American College of Obstetricians and Gynecologists' “Induction of Labor” and “Management of Late-Term and Postterm Pregnancies,” the guidelines of the Society of Obstetricians and Gynaecologists of Canada (SOGC) on “Induction of Labour,” those of the National Institute for Health and Care Excellence (NICE) on “Inducing Labour,” and the World Health Organization's (WHO's) “Recommendations for Induction of Labour” and “WHO Recommendations: Induction of Labour at or Beyond Term.” These guidelines were compared in terms of their recommendations on clinical indications and methods.

Results

Many similar indications and contraindications to IOL are identified between American College of Obstetricians and Gynecologists and SOGC, whereas NICE and WHO do not mention any contraindications. The timing of IOL in postterm pregnancies also differs among the guidelines. Regarding the methods of induction, all the medical societies recommend the use of membrane sweeping, mechanical methods, prostaglandins, and oxytocin, whereas NICE argues against the use of misoprostol for IOL. The American College of Obstetricians and Gynecologists and SOGC consider amniotomy a method of IOL, whereas NICE and WHO do not recommend it. All the guidelines also make similar recommendations regarding the management of uterine tachysystole in cases of IOL.

Conclusions

The World Health Organization seems to be the most evidence-based guideline with recommendations based mainly on Cochrane reviews. The variation in the clinical indications and methods of IOL highlights the need to adopt an international consensus, which may help to optimize the quality of obstetric care and further promote evidence-based medicine.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After participating in this activity, the learner should be better able to identify the appropriate indications for induction of labor; explain the effectiveness and associated risks of using prostaglandins, misoprostol, oxytocin, and amniotomy for induction of labor; and assess the definition and alternatives of failure of induction of labor.
Effect of Vaginal Mesh Hysteropexy Versus Vaginal Hysterectomy With Uterosacral Ligament Suspension on Treatment Failure in Women With Uterovaginal Prolapse: A Randomized Clinical Trial
Authors: Nager Charles W. , Visco Anthony G. , Richter Holly E. , Rardin Charles R. , Rogers Rebecca G. , Harvie Heidi S. , Zyczynski Halina M. , Paraiso Marie Fidela R. , Mazloomdoost Donna , Grey Scott , Sridhar Amaanti , Wallace Dennis
Published: January 2020

(Abstracted from JAMA 2019;322:1054–1065)

Two surgical options for patients with uterovaginal prolapse are vaginal hysterectomy with suture apical suspension or transvaginal mesh hysteropexy, a uterine preservation procedure. An analysis of a US database from 2007 to 2011 estimated that 13% of women underwent pelvic organ prolapse surgery by the age of 80 years.
Gross and Histopathological Findings in the First Reported Vaping-Induced Lung Injury Death in the United States
Authors: Youmans Amanda J. , Harwood Jamie
Published: January 2020

The popularity of e-cigarettes (vaping) has been on the rise in recent years, but the adverse effects of vaping have been greatly unknown. In 2019, the use of vaping products has been linked to an outbreak of severe lung disease, some cases of which have progressed to death. One death attributed to vaping is presented with emphasis on the gross and histopathological findings from the autopsy. These findings were correlated with the patient's clinical course and medicolegal investigation to determine the cause of death. To our knowledge, this is the first confirmed death in the United States that was directly attributed to the use of vaping.
Attending-Provider Handoffs and Pediatric Emergency Department Revisits
Authors: Lyons Todd W. , Michelson Kenneth A. , Nigrovic Lise E. , Perron Catherine E. , Fine Andrew M.
Published: January 2020

Objective

The objective of this study was to determine if intradepartment attending-provider transitions of care (handoffs) during a pediatric emergency department (ED) encounter were associated with return ED visits resulting in hospitalization.

Methods

We analyzed ED encounters for patients younger than 21 years discharged from a single pediatric ED from January 2013 to February 2017. We classified an encounter as having a handoff when the initial attending and discharging attending differed. Our primary outcome was a revisit within 72 hours resulting in hospitalization. Our secondary outcomes were any revisit within 72 hours and revisits resulting in hospitalization with potential deficiencies in care. We compared outcome rates for ED encounters with and without provider handoffs, both with and without adjustment for demographic, clinical, and visit characteristics.

Results

Of the 177,350 eligible ED encounters, 1961 (1.1%) had a return visit resulting in hospitalization and 6821 (3.9%) had any return visit. In unadjusted analyses, handoffs were associated with an increased likelihood of a return visit resulting in hospitalization (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.26–1.70) or any return visit (OR, 1.20; 95% CI, 1.10–1.31). However, after adjustment, provider handoffs were not associated with return ED visits resulting in hospitalization (OR, 0.96; 95% CI, 0.81–1.13) or any return ED visits (OR, 1.00; 95% CI, 0.90–1.10).

Conclusions

Provider handoffs in a pediatric ED did not increase the risk of return ED visits or return ED visits with deficiencies in care after adjustment for demographic, clinical, and visit factors.
Pediatric Emergency Department Return Visits
Authors: Ostrow Olivia , Zelinka Alena , Shim Andrea , Azmat Syed Khurram , Masood Sameer , Chartier Lucas B.
Published: January 2020

Objectives

Emergency department (ED) return visits (RVs) leading to hospital admission are a quality measure that can potentially signal gaps in patient care. Systematic capture and investigation of RVs at a case level can provide an understanding of patient- and visit-level factors associated with RVs, and thus inform system-level quality improvement (QI) opportunities. Our objective is to describe the development of a database that enables tracking and analyzing of all pediatric ED RVs, to understand recurring themes and inform QI initiatives.

Methods

A single-center retrospective cohort study was conducted at a quaternary care children's hospital during a 3-year period (December 2013 to November 2016). All 72-hour RVs were audited for patient- and visit-level variables and clinicians completed root-cause analyses of their RVs. Using descriptive statistics, variables associated with RVs and system-level quality themes were identified.

Results

Of 214,047 ED patient visits, 1546 (0.7%) patients returned within 72 hours and were admitted. The RV patients had higher acuity scores on both visits compared with all ED visits, and the RV group had a higher proportion of children younger than 12 months than the overall ED visit group (25.0% vs 16.2%). The underlying cause for the majority of RVs was determined to be natural disease progression (63%), whereas 9% were callbacks for positive blood cultures or discrepant radiology results, and 6% were categorized as misdiagnoses. Several successful QI initiatives were completed as a result of the program.

Conclusions

Systematic monitoring and investigation of all ED RVs provides an innovative and effective approach to seeking provider- and system-level improvement opportunities.
Epidemiology of Headache in Children in a Community Emergency Department
Authors: Klim Sharon , Kelly Anne-Maree , Krieser David
Published: January 2020

Objective

This study aimed to describe the epidemiology of headache in children attending a community mixed adult-pediatric emergency department (ED) in Australia with a view to providing scoping data for future headache-related projects for the pediatric ED research networks.

Methods

This is a retrospective cohort study by medical record review. Participants were children aged 2 to 16 years who presented to the ED between January 1, 2016, and December 31, 2016, with a major symptom of headache. Exclusion criteria were a history of recent head trauma, a ventriculoperitoneal shunt in situ, or known intracranial conditions associated with headache. Data collected included demographics, clinical features, investigations, diagnosis, disposition, and outcome. The primary outcomes of interest were the proportion of children with a serious ED diagnosis, the distribution of ED diagnoses, investigation ordering patterns, treatments provided, and clinical outcome.

Results

A total of 225 children were studied, with a median age of 9 years (interquartile range, 6–13 years). The most common associated symptoms were fever (47%) and vomiting (42%). The most common examination feature was fever (21%). Abnormal neurological findings were very uncommon. Few children underwent advanced neuroimaging (7 patients; 3%), and no intracranial abnormalities were detected. Seven children had a serious diagnosis (7/225 [3%]; 95% confidence interval, 2%–6%). Six of these 7 were viral meningitis, and there was 1 case of bacterial meningitis.

Conclusions

In a community teaching hospital cohort of children with headache, intercurrent viral illness is the most common cause. Serious causes were very uncommon. The rate of bacterial meningitis, tumor, or abscess was <1%. This has implications for the planning of research projects.