bluuebunny/crossref_metadata_2025 huggingface dataset:
Changing the Game: College Dance Training for Well-Being and Resilience Amidst the COVID-19 Crisis
Authors: Bohn Joe , Hogue Stephanie
Published: October 2020

The COVID-19 pandemic has disrupted all aspects of life, from health to financial to social. College students in particular have faced difficulties adjusting to an entirely virtual atmosphere, compounding the normal stressors that come with full class loads and transitioning into more independent adult lives. In response to the onset of the COVID-19 crisis, a faculty member at the University of South Florida’s College of Public Health designed impromptu, free dance lessons offered through a virtual video platform to the college and broader community. The lessons were offered with the intent of providing a healthy and engaging environment to help students and others in the community cope with lockdown stress, depression, and anxiety throughout spring and summer 2020. This article summarizes the structure of the intervention, lessons learned throughout implementation, and the broader practice potential during the COVID-19 pandemic and beyond.
A Multiscale Approach for Whole-Slide Image Segmentation of five Tissue Classes in Urothelial Carcinoma Slides
Authors: Wetteland Rune , Engan Kjersti , Eftestøl Trygve , Kvikstad Vebjørn , Janssen Emiel A. M.
Published: October 2020

In pathology labs worldwide, we see an increasing number of tissue samples that need to be assessed without the same increase in the number of pathologists. Computational pathology, where digital scans of histological samples called whole-slide images (WSI) are processed by computational tools, can be of help for the pathologists and is gaining research interests. Most research effort has been given to classify slides as being cancerous or not, localization of cancerous regions, and to the “big-four” in cancer: breast, lung, prostate, and bowel. Urothelial carcinoma, the most common form of bladder cancer, is expensive to follow up due to a high risk of recurrence, and grading systems have a high degree of inter- and intra-observer variability. The tissue samples of urothelial carcinoma contain a mixture of damaged tissue, blood, stroma, muscle, and urothelium, where it is mainly muscle and urothelium that is diagnostically relevant. A coarse segmentation of these tissue types would be useful to i) guide pathologists to the diagnostic relevant areas of the WSI, and ii) use as input in a computer-aided diagnostic (CAD) system. However, little work has been done on segmenting tissue types in WSIs, and on computational pathology for urothelial carcinoma in particular. In this work, we are using convolutional neural networks (CNN) for multiscale tile-wise classification and coarse segmentation, including both context and detail, by using three magnification levels: 25x, 100x, and 400x. 28 models were trained on weakly labeled data from 32 WSIs, where the best model got an F1-score of 96.5% across six classes. The multiscale models were consistently better than the single-scale models, demonstrating the benefit of combining multiple scales. No tissue-class ground-truth for complete WSIs exist, but the best models were used to segment seven unseen WSIs where the results were manually inspected by a pathologist and are considered as very promising.
CBT for Anxiety Related to Parenting a Child with a Life-Limiting Neuromuscular Condition: A Single Case Study
Authors: Birdsey Nicola
Published: October 2020

Caring for a child with a neuromuscular condition such as Duchenne muscular dystrophy (DMD) presents many challenges, including managing the emotional impact of the diagnosis, managing extended periods of profound uncertainty, navigating the complexities of the healthcare system, managing the child’s physical symptoms, and supporting their emotional needs. Although it is encouraging that there is a growing body of research seeking to better understand the medical and treatment needs of those with DMD, the psychosocial needs of individuals and their families have traditionally been considered as ancillary to the child’s physical health needs. Consequently, there is limited research investigating the psychological wellbeing of those with DMD, and even less is known about the psychological wellbeing and needs of caregivers, who play a critical role in supporting their child. Caregivers experience multiple stressors and often encounter caring burden and high prevalence rates of anxiety and depression. This paper aims to explore the use of cognitive behavioral therapy (CBT) for comorbid anxiety and low mood in a parent of a child with DMD using a single case design. Results suggest that in the context of multiple stressors and significant life events, CBT was effective in improving mood and reducing symptoms of anxiety. This case highlights the value in offering support to parents of children with DMD and may have clinical implications for other neuromuscular and life-limiting conditions.
Electronic Moxibustion for Breast Cancer-Related Lymphedema: A Pilot Clinical Trial
Authors: Han Kyungsun , Kwon Ojin , Park Hyo-Ju , Kim Ae-Ran , Lee Boram , Kim Mikyung , Kim Joo-Hee , Yang Chang-sup , Yoo Hwa-Seung
Published: October 2020

This is a preliminary study to investigate the feasibility of electronic moxibustion in breast cancer patients with upper limb lymphedema. As current treatment options for lymphedema are unsatisfactory and time consuming, there have been attempts to manage symptoms using integrative treatments. Electronic moxibustion was developed to compensate for the shortcomings of conventional moxibustion and is widely used in clinical practice. However, there have been no studies on using electronic moxibustion in breast cancer-related lymphedema. To investigate the feasibility of electronic moxibustion in treating breast cancer-related lymphedema, this study included subjects who completed primary cancer treatment at least 6 months ago and had more than 10 mm difference in arm circumference of upper limbs. All subjects were assigned to the treatment group. Subjects were treated with 16 sessions (30 minutes/session) of electronic moxibustion for 8 weeks followed by 4 weeks of follow-up. For outcome measures, upper limb circumferences, shoulder range of motion, bioimpedance analysis, and quality of life questionnaire were assessed. All 10 subjects completed the study. The effective index showed 38.21% reduction after treatment ( P = .0098) and 29.35% ( P = .0039) after 4 weeks of follow-up compared to the baseline. The reduction of lymphedema was most prominent at 10 cm above the elbow crease, where the mean reduction of circumference difference was 7.5 mm ( P = .0430) and continued to improve after treatment (mean reduction of 8.3 mm, P = .0156). There was significant improvement in shoulder range of motion only in flexion and internal rotation at week 9. There were 7 adverse events, and most were irrelevant to the treatment. Only 1 participant had a mild burn on the acupuncture point. Here, we demonstrate for the first time that electronic moxibustion treatment is a feasible treatment for breast cancer-related lymphedema. Electronic moxibustion may reduce differences in upper limb circumference and improve shoulder range of motion. A future comparative clinical trial is needed to confirm the clinical efficacy of this treatment.
Lateralized Rhythmic Delta Activity in Patients With Infectious or Autoimmune Insular Lesions
Authors: Husari Khalil S. , Ritzl Eva K.
Published: October 2020

Introduction

Lateralized rhythmic delta activity (LRDA) is a rare pattern on the ictal-interictal continuum (IIC) encountered in critically ill patients. Its association with acute seizures is yet to be fully explored. Insular involvement is a common finding in patients with infectious and autoimmune encephalitis. The association between acute insular lesions and the ictal-interictal continuum, particularly LRDA, has not been explored before.

Methods

A case series of 4 patients with either herpetic or autoimmune encephalitis and prominent insular cortex involvement who had LRDA when monitored on continuous EEG is being presented.

Results

Two patients had herpetic encephalitis and 2 patients had autoimmune encephalitis. All patients had either clinical or electrographic seizures with 1 patient progressing into new-onset refractory status epilepticus.

Conclusion

LRDA can be seen in patients with insular cortex acute inflammation. In this group of patients, LRDA may be associated with a higher risk of acute seizures. The presence of this otherwise not clearly epileptiform pattern should raise the clinical suspicion for the development of acute seizures. Patients with LRDA and ipsilateral insular lesions should be carefully monitored for the development of recurrent electrographic or electroclinical seizures and status epilepticus.
Nonoperative Management of Olecranon Fractures in Elderly Patients: A Systematic Review
Authors: Alvara Christina A. , Biedron Griffin , Dunn John C.
Published: October 2020

Background:

Despite increased utilization of conservative measures for displaced olecranon fractures in elderly patients, in whom operative fixation may be complicated by coexisting comorbidities and declining bone quality, the noninferiority of nonoperative management has yet to be proven. The purpose of this study was to review nonoperative management of displaced olecranon fractures in the elderly patient population.

Methods:

A literature search of the PubMed database was performed using the term olecranon fracture. Papers included those with results for patients aged 65 years and older published between 1990 and 2018 in the English language. Data were pooled to analyze outcomes and complications of nonoperative management of olecranon fractures in the elderly patient population.

Results:

Four eligible studies combined for a total of 69 patients with 70 fractures with an average age of 83.8 years (71-95 years), female predominance of 88%, and a mean follow-up of 12.4 months who underwent nonoperative management of displaced olecranon fractures. While only 25% of fractures went on to radiographic union, the mean Disabilities of the Arm, Shoulder, and Hand score was 16.9 (0-59.6), the mean arc of motion was 138°, and 92% of patients achieved excellent results. One-quarter (26%) of the patients experienced complications: radial head subluxation (1), skin sore (1), degenerative arthropathy (1), pain on movement (2), click in movement of the elbow (5), and local pain (8).

Conclusion:

Displaced olecranon fractures in patients aged older than 70 years may be effectively managed with nonoperative measures to produce high satisfaction and functional range of motion.
Radiographic Predictors of Delayed Carpal Tunnel Syndrome After Distal Radius Fracture in the Elderly
Authors: Kim Kevin H. , Duell Bryan , Munnangi Swapna , Long Mitchell , Morrison Elizabeth
Published: October 2020

Background

Delayed-onset carpal tunnel syndrome (DCTS) can develop weeks and months after distal radius fracture (DRFx). A better understanding of the risk factors of DCTS can guide surgeon’s decision making regarding the management of DRFx and also provides another discussion point to be had with elderly patients when discussing outcomes of nonoperative management.

Methods

We reviewed 216 nonoperatively managed DRFx between June 2015 and January 2019 at a single level 1 trauma center and senior author’s office. We identified 26 patients who developed DCTS at a minimum of 6 weeks after DRFx, which constituted our case group. The remaining 190 patients served as the control group (non–carpal tunnel syndrome [CTS]). Differences between case and control group were evaluated through univariate and multivariate analyses.

Results

The prevalence of DCTS among nonoperatively managed DRFx was 12%. In univariate analysis, volar tilt (VT) and teardrop angle (TDA) were significant independent predictors of development of DCTS. Multivariate logistic regression analysis determined that the odds of developing CTS increased by 12% and 24% for each degree of decrease in VT and TDA, respectively. No other significant risk factors were identified.

Conclusions

Decreasing VT and TDA are the most significant risk factors associated with DCTS in nonoperatively managed DRFx. These are simple and reliable radiographic measurements that provide significant prognostic value. These parameters can be used to guide surgeon decision making regarding management of DRFx in the elderly while aiding patient expectations and outcomes following nonoperative management of DRFx.
Adherence to Low-Fat, Vegan Diets in Individuals With Type 2 Diabetes: A Review
Authors: Storz Maximilian Andreas
Published: October 2020

Low-fat, vegan diets seem to be particularly effective for glycemic control and may significantly lower hemoglobin A1c levels in individuals with type 2 diabetes. However, health care providers report low levels of practice and argue that this diet is hard to follow. This controversy on the acceptability of low-fat vegan diets appears to be a significant barrier to its broader clinical implementation. This review investigated dropout and adherence rates in intervention studies using a low-fat vegan diet in individuals with type 2 diabetes. In contrast to the common belief that this diet is poorly accepted, this review suggests different findings. Dietary adherence appears to be good with approximately 50% of individuals meeting the criteria for high adherence in most studies. Adherence to a low-fat vegan diet was higher than adherence to conventional diets in several studies. Group support and regular supervision improve adherence. Moreover, relatively low dropout rates were found—indirectly indicating good acceptance and high patient interest in this particular dietary modification. Although this review has several important limitations, it appears inappropriate to associate low-fat, vegan diets with poor adherence in individuals with type 2 diabetes. With good and regular support, adherence rates are more than solid and physicians should advocate for this diet more frequently.
Psychological impact of caring for critically ill patients during the Covid-19 pandemic and recommendations for staff support
Authors: Bates Andrew , Ottaway Julia , Moyses Helen , Perrrow Marcie , Rushbrook Sophie , Cusack Rebecca
Published: October 2020

Background

Reports of significant psychological stress among frontline healthcare workers are emerging from the Covid-19 outbreak in China. Concerningly, these match findings from previous infective outbreaks, which resulted in long-term psychological pathology.

Methods

During the Covid-19 pandemic, a multi-disciplinary cohort of Intensive Care staff completed an online survey of psychological well-being and rated the perceived usefulness of supportive interventions.

Results

Sixty per cent of invited staff responded. Seventy-seven per cent reported normal/high level of resilience. Thirty-two staff (35%) reported anxiety of a level at which formal psychological assessment is recommended. Sixteen (14%) staff members reported symptomology suggestive of post-traumatic stress disorder (PTSD). Multiple regression analysis revealed a significant relationship between job-related well-being, anxiety (p = 0.003) and PTSD (p = 0.005). Nurses were seven times more likely than doctors to score higher anxiety (OR = 6.8; p = 0.01). Preferred supportive interventions were adequate personal protective equipment, rest facilities and regular breaks. In the subgroup with high anxiety, psychological support was perceived as significantly more useful, with significant reductions reported for rest facilities and PPE.

Discussion

We report concerning levels of anxiety and post-traumatic stress symptomology among intensive care staff during the Covid-19 crisis, significantly impacting job-related well-being. Nurses are disproportionately affected. Overall, physiologically protective supportive interventions were preferred by staff; however, staff with established anxiety desire professional psychological help. Our findings match reports from SARS 2003 and China 2019. To mitigate long-term psychological consequences of caring for patients during a pandemic, easily deliverable protective strategies should be instigated, supported by formal and longer-term psychological support. Particular attention should be paid to developing strategies which support nursing staff.
Myeloid-derived suppressor cell cytokine secretion as prognostic factor in myelodysplastic syndromes
Authors: Han Dong , Tao Jinglian , Fu Rong , Shao Zonghong
Published: October 2020

Myeloid-derived suppressor cells (MDSCs) are a heterogeneous population of immature myeloid cells that play a critical immunosuppressive role in the tumour micro-environment. Although biological research on MDSCs has made progress, the relationship between the secretion of cytokines by MDSCs and poor prognosis is not clear, and there are no criteria to measure the functional status of MDSCs. Here, we detected the mRNA expression of IL-10, IL-12, TGF-β and TNF-α in MDSCs and the levels of these cytokines in MDSC culture supernatants of patients with myelodysplastic syndromes, and quantified the functional status of MDSCs by IL-10/IL-12 ratio and TGF-β/TNF-α ratio. We found that the ratio of IL-10/IL-12 and TGF-β/TNF-α was significantly higher in higher-risk MDS than in lower-risk MDS and normal control groups. The TGF-β/TNF-α ratio in MDSCs was positively correlated with the percentage of blast cells and was negatively correlated with the percentage of CD3+CD8+ T lymphocytes. Meanwhile, the TGF-β/TNF-α ratio was higher in patients with a lower absolute neutrophil count. It suggested that MDSCs in higher-risk MDS have a stronger immunosuppressive effect and might be related to poor prognosis. Quantifying the functional status of MDSCs with IL-10/IL-12 and TGF-β/TNF-α ratio might help to evaluate the balance of cellular immunity of MDSCs in MDS.
Use of monoclonal antibodies for allergic bronchopulmonary aspergillosis in patients with asthma and cystic fibrosis: literature review
Authors: Eraso Isabel C. , Sangiovanni Saveria , Morales Eliana I. , Fernández-Trujillo Liliana
Published: October 2020

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction (HR) mediated by antigens to Aspergillus fumigatus. It is estimated that 2–15% of patients with cystic fibrosis (CF) and between 1% and 5% of asthmatics develop ABPA, affecting approximately 4.8 million people worldwide. The goals of treatment are controlling inflammation, reducing the number of exacerbations and limiting the progression of lung damage. Systemic steroids are therefore used as the mainstay therapy, along with antifungal medications. However, many patients do not respond or develop side effects to treatment. In this scenario, biological drugs such as Omalizumab, Mepolizumab, Benralizumab and Dupilumab have been implemented in clinical practice, even though there is a lack of scientific evidence to support their use. We performed a literature review of the studies carried out which analyzed biologics for the management of ABPA in adult populations with asthma and CF. To our knowledge this is the first literature review that included all biologics. We included a total of 32 studies, all but one were descriptive studies, and the vast majority evaluated the use of Omalizumab. Biologics appeared to have more benefit for patients with ABPA and asthma than CF, specifically at decreasing the frequency of acute exacerbations and by having a steroid-sparing effect. Although a decrease in serum IgE level is considered a measure of therapy success, values may not decline as expected in the context of a significant clinical improvement, highlighting the importance of measuring patient-oriented outcomes. As evidence comes mainly from case series and case reports, randomized controlled trials are needed to evaluate further the safety and efficacy of biologics in ABPA.

The reviews of this paper are available via the supplemental material section.
An experimental study on granular dissipation for the vibration attenuation of skis
Authors: Bajkowski Jacek M , Dyniewicz Bartłomiej , Bajer Czesław I , Bajkowski Jerzy
Published: October 2020

Due to the continuous deformations and irregularities of the surface of snow, alpine skis exhibit dynamic excitation, leading to drastic vibrations and decreased manoeuvrability. Therefore, attenuating these unwanted vibrations, while ensuring that the ski experience is not compromised, is an important challenge. The possibility of using granular material in a damping device is studied in this paper. A container that was partially filled with loose granules was fixed at the tip of an alpine ski to suppress vibrations by dissipating energy through collisions. The performance was verified experimentally by studying the transient response of a ski mounted in a horizontal cantilever orientation. Moreover, on-snow tests were performed. Different numbers of plastic granules were used as a dissipating material. To identify the nonlinear damping characteristics of the system, a Hilbert transform was used. In the laboratory test, the displacement amplitude decay was up to 16 percentage points higher when a granular dissipator was attached to the ski than without the damper. During field testing, acceleration amplitudes were 9% lower compared to the ski without the dissipator. This solution could possibly be adapted to other boardsports on a wide variety of terrain, including ground, water and snow.
ECHO Telementoring Applied to Managing Students With Seizures: The Benefits for School Nurses
Authors: McPhillips Angela M. , Schultz Rebecca J. , Nasuta Mary , Shafer Patricia O.
Published: October 2020

Project ECHO (Extension for Community Healthcare Outcomes) is an evidence-based telementoring approach to connect often siloed school nurses with a network of expert clinical and academic faculty, as well as school nurse colleagues throughout the country by engaging in case-based learning. Managing Students with Seizures ECHO: The Importance of School Nurses (MSwS ECHO) provided two cohorts of school nurses with an interactive, bidirectional educational program focused on various aspects of seizures and epilepsy relevant to school nurse practice. MSwS ECHO enhanced school nurses’ confidence in caring and advocating for students with seizures and epilepsy, expanded school nurses’ access to resources and professional networks, and provided the opportunity to collaborate with experts and colleagues to problem solve challenging real-life cases. The ECHO Model is a unique and effective teaching modality that can be applied to a variety of school health topics and chronic conditions. School nurses are encouraged to participate in forthcoming ECHO-based learning opportunities.
Collective Narcissism, In-Group Satisfaction, and Solidarity in the Face of COVID-19
Authors: Federico Christopher M. , de Zavala Agnieszka Golec , Baran Tomasz
Published: October 2020

The present study explored the antecedents of solidarity amid the COVID-19 pandemic. Given that solidarity during mass emergencies involves the development of a social identity encompassing those facing a common fate, we examined how national in-group satisfaction (IS, a belief that the national in-group and one’s membership in it are of high value) versus national collective narcissism (CN, a belief that the national in-group is exceptional and entitled to privileged treatment but not sufficiently recognized by others) predicted solidarity with those affected by the pandemic in Poland. The results of cross-sectional and dynamic analyses from a panel study on a representative sample of Polish adults indicate that IS predicted greater COVID-19 solidarity, whereas CN predicted reduced COVID-19 solidarity.
Advancements in therapeutic drugs targeting of senescence
Authors: Zhu Mingsheng , Meng Ping , Ling Xian , Zhou Lili
Published: October 2020

Aging leads to a high burden on society, both medically and economically. Cellular senescence plays an essential role in the initiation of aging and age-related diseases. Recent studies have highlighted the therapeutic value of senescent cell deletion in natural aging and many age-related disorders. However, the therapeutic strategies for manipulating cellular senescence are still at an early stage of development. Among these strategies, therapeutic drugs that target cellular senescence are arguably the most highly anticipated. Many recent studies have demonstrated that a variety of drugs exhibit healthy aging effects. In this review, we summarize different types of drugs promoting healthy aging – such as senolytics, senescence-associated secretory phenotype (SASP) inhibitors, and nutrient signaling regulators – and provide an update on their potential therapeutic merits. Taken together, our review synthesizes recent advancements in the therapeutic potentialities of drugs promoting healthy aging with regard to their clinical implications.
High plasma C-terminal FGF-23 levels predict poor outcomes in patients with chronic kidney disease superimposed with acute kidney injury
Authors: Chang Yu-Hsing , Wu Che-Hsiung , Chou Nai-Kuan , Tseng Li-Jung , Huang i-Ping , Wang Chih-Hsien , Wu Vin-Cent , Chu Tzong-Shinn
Published: October 2020

Background:

Elevated plasma C-terminal fibroblast growth factor-23 (cFGF-23) levels are associated with higher mortality in patients with chronic kidney disease (CKD) and acute kidney injury (AKI). Our study explored the outcome forecasting accuracy of cFGF-23 in critically ill patients with CKD superimposed with AKI (ACKD).

Methods:

Urine and plasma biomarkers from 149 CKD patients superimposed with AKI before dialysis were checked in this multicenter prospective observational cohort study. Endpoints were 90-day mortality and 90 days free from dialysis after hospital discharge. Associations with study endpoints were assessed using hierarchical clustering analysis, the generalized additive model, the Cox proportional hazard model, competing risk analysis, and discrimination evaluation.

Results:

Over a median follow up of 40 days, 67 (45.0%) patients died before the 90th day after hospital discharge and 39 (26.2%) progressed to kidney failure with replacement therapy (KFRT). Hierarchical clustering analysis demonstrated that cFGF-23 levels had better predictive ability for 90-day mortality than did other biomarkers. Higher serum cFGF-23 levels were independently associated with greater risk for 90-day mortality [hazard ratio (HR): 2.5; 95% confidence interval (CI) 1.5–4.1; p < 0.001]. Moreover, adding plasma cFGF-23 to the Demirjian AKI risk score model substantially improved risk prediction for 90-day mortality than the Demirjian model alone (integrated discrimination improvement: 0.06; p < 0.05; 95% CI 0.02–0.10). The low plasma cFGF-23 group was predicted having more weaning from dialysis in surviving patients (HR = 0.53, 95% CI, 0.29–0.95, p = 0.05).

Conclusions:

In patients with ACKD, plasma cFGF-23 levels are an independent risk factor to forecast 90-day mortality and 90-day progression to KFRT. In combination with the clinical risk score, plasma cFGF-23 levels could substantially improve mortality risk prediction.
Oral Lichen Planus
Authors: Ion Daniela I , Setterfield Jane F
Published: October 2020

Lichen planus (LP) is a relatively common autoimmune T-cell-mediated disease of unknown aetiology affecting the mucous membranes, skin and nails. Its prevalence varies between 0.5 and 2.2% of the population in epidemiological studies with a peak incidence in the 30–60 years range and with a female predominance of 2:1.1 Mucosal lichen planus tends to follow a chronic course with acute exacerbations. Spontaneous remission of oral lichen planus (OLP) is uncommon, and indeed mucosal LP may become worse with time. In contrast, cutaneous lichen planus may follow a milder clinical course though some variants may be severe such as those affecting the palms and soles and the scalp and the genital tract in females (vulvovaginal gingival LP) where scarring leads to significant complications.

It is important to identify those cases that may be drug induced or be associated with a contact allergic or irritant reaction (lichenoid reaction) or the rarer oral presentation of discoid lupus erythematosus. There is a very small risk of malignancy (approximately 1:200 patients/year) associated with oral lichen planus; thus patients should be informed that long term monitoring via their general dental practitioner is appropriate. This review will focus on the clinical presentation and management of oral lichen planus.
Early Detection of Oral Cancer
Authors: Lenouvel Daniel , Warnakulasuriya Saman
Published: October 2020

Oral cancer continues to present in the late stages of disease, with approximately 50% of cases being diagnosed with advanced disease. Early detection means less invasive treatment, a higher quality of life and ultimately an increased survival of disease. Oral cancer may develop in patients with pre-existing disorders that can be detected during routine mouth examinations.1 Late diagnosis leads to complex and costly treatment with poor outcomes.2 This article will examine the latest data on oral cancer in the UK and how the dental team should be involved in the early detection of disease.
Update on Orofacial Granulomatosis
Authors: Hullah Esther A , Escudier Michael P
Published: October 2020

Orofacial granulomatosis (OFG) is a condition manifesting clinically with chronic swelling of the mouth and/or face, notably with swelling of the lips and oral mucosa, a full-thickness, erythematous gingivitis and mucosal ulceration of various clinical types.1 Some patients may also present with neurological findings, for example facial palsy. Biopsy of affected tissue shows lymphoedema, with or without granulomatous inflammation. The oral lesions in OFG are histologically indistinguishable from the oral lesions in Crohn's disease (CD) and other systemic granulomatous disorders. It is a condition which may respond to the exclusion of certain food-related chemicals from the diet in up to 60% of patients and, as such, is distinct from gastrointestinal CD.2 CD is a relapsing systemic inflammatory disease which predominantly affects the gut, and patients suffering from this disease frequently present with abdominal pain, fever and altered bowel habit.3 A proportion of patients with clinical OFG (without other systemic disease) may have asymptomatic gastrointestinal involvement or go on to develop gut CD2,4 suggesting an association between the two diseases. It is estimated that 1% of CD sufferers may have a diagnosis of OFG, but the majority of patients in specialist OFG clinics do not have gut symptoms.2
Direct Placement Composite: The Treatment Modality of Choice to Restore the Worn or Eroded Dentition in Primary Dental Care
Authors: Milosevic Alex
Published: October 2020

Tooth wear is increasing in severity and prevalence, partly because of an ageing population and partly because of modern lifestyles. Management of the worn dentition with ‘full mouth rehabilitation’ is outmoded. This clinical paper aims to review the literature on composite restorations and give general dental practitioners the confidence to restore the worn dentition with dental composite. Composite is a versatile and widely available material that can be successfully applied within the existing occlusal vertical dimension (OVD) or at an increased OVD using a Dahl approach. Cases illustrate what is achievable, and clinical tips will help dentists optimise their results.
Worning: Tooth Wear Ahead
Authors: Slater Lucy , Eder Andrew , Wilson Nairn
Published: October 2020

While caries, periodontal disease and tooth wear are all largely preventable, current national guidelines on a preventive approach to oral healthcare provision are limited to advice on the prevention of caries and periodontal disease. Unfortunately, there is not yet a large enough body of evidence to develop guidelines on the prevention of tooth wear. As with caries, it is important to distinguish between ‘active’ and ‘arrested’ wear both in assessment and care planning. The aim of this article is to highlight the growing importance of early identification of patients who may be at risk of pathological tooth wear, provide an overview of known tooth wear markers, and suggest the development of a system to assess susceptibility to tooth wear.
Adult Dental Trauma: What Should the Dental Practitioner Know?
Authors: Chauhan Ravi , Rasaratnam Lakshmi , Alani Aws , Djemal Serpil
Published: October 2020

The management of adult dental trauma can be a daunting challenge for practitioners at any level. Like medical emergencies, initial management can have a large influence on prognosis. It is important that practitioners understand the basic principles of managing the acute presentations of dental trauma. This article aims to illustrate a step-by-step approach in order to improve the management within general dental practice for better outcomes for patients.
The Impact of Dementia on Oral Health and Dental Care, Part 1: Setting the Scene for Dental Care Provision
Authors: Kerr Kathryn , Curl Charlotte , Geddis-Regan Andrew
Published: October 2020

There are over 850,000 people living with dementia in the UK and this figure is expected to rise to over a million by 2021. Increasingly, oral healthcare professionals in primary care will see more patients affected by dementia at varying stages of the disease, and it is therefore crucial that they have a basic understanding of the disease and how these patients can be managed in a primary care environment. The first article in this series of two provides a definition of dementia and describes the symptoms of the disease along with the key issues related to oral health, such as oral pain. Oral pain can have far reaching consequences, but identifying it can be problematic, particularly in the latter stages of the disease. This article will therefore cover how to diagnose pain in patients with dementia. Information is also provided about how to make dental surgeries more ‘dementia friendly’.
The Impact of Dementia on Oral Health and Dental Care, Part 2: Approaching and Planning Treatment
Authors: Geddis-Regan Andrew , Kerr Kathryn , Curl Charlotte
Published: October 2020

Dementia has been described as the biggest health and social care challenge of this century; its impact on dental care cannot be ignored. Dementia affects cognitive ability and decision making, so it is important that oral healthcare professionals are conversant with current mental capacity legislation and issues that may be raised when treatment planning for patients living with the condition. This second article in the series considers the impact of dementia on dental care provision and covers a range of issues which are relevant to both general and specialist practice. These include assessment of capacity, use of different treatment modalities, such as sedation and general anaesthesia, and the factors that may be relevant when deciding to offer treatment or to refer to a secondary care setting for dental treatment. Advanced care planning is detailed to support general dental practitioners considering the longer-term wishes of their patients with an early diagnosis of dementia.
Dental Management of Patients With Acquired and Congenital Bleeding Disorders
Authors: Moosajee Sukina , Rafique Sobia
Published: October 2020

In an age when people are living longer and medical interventions are continually becoming more advanced, clinicians will need to be aware of systemic disorders and treatments that may cause complications in the dental setting. The Office for National Statistics’ projections state that 26% of the UK population will be aged over 65 years by 2041.1 Therefore, clinicians may often encounter patients who complain of prolonged bleeding following certain procedures, most commonly dental extractions. In the majority of cases, the cause is often a local one, which can be managed using simple local measures. However, poor management can lead to potentially fatal consequences.

The aim of this paper is to update clinicians on the dental management of patients with acquired or congenital bleeding disorders, and on how to decide the most appropriate setting for safe dental care. Patient safety in the NHS is a national priority with ever greater measures being put into place to avoid patient harm. Whilst most patients can be successfully treated in primary care, for the provision of safe dental treatment, the clinician may need to make a decision regarding referral to specialist services for all dental treatment, or share care between primary care and specialist services for selected procedures.
Sedation or General Anaesthetic for Special Care Patients?
Authors: Boyle Carole A , Lane Helen
Published: October 2020

When faced with an anxious patient with complex needs who requires dental care, it can be difficult to decide on the most appropriate method to manage their pain and anxiety. There are a range of conscious sedation techniques that may be used, and on some occasions, general anaesthesia may be required.

This paper describes the methods available and the factors influencing the decision-making process. The general dental practitioner (GDP) may not be able to offer care in their setting, but knowing more about the decision-making process and the information required to make that decision can help them guide patients and their families.
Removing Barriers to Dental Care for Individuals With Disability
Authors: Prasad Ria , Edwards Julie
Published: October 2020

This article outlines the role of oral healthcare professionals in treating individuals with disability and looks at the legislation around treatment of these patients, the different centres of care, and the role of the general dental team in supporting access for this group of patients. Practical tips for the dental team on current legislation to improve quality of care for these vulnerable patients along with issues relating to consent safeguarding and the Mental Capacity Act are also addressed in this article.
Functionally Orientated Tooth Replacement for Older Patients
Authors: McKenna Gerry , Jawad Sarra , Darcey James
Published: October 2020

Across the globe the population is ageing. In addition, older patients are retaining increasing numbers of natural teeth into old age. Therefore, clinicians are faced with the challenges of managing chronic dental diseases, including caries and periodontal disease, alongside replacing missing units. A number of treatment options are available to replace missing teeth for such patients with large numbers currently receiving removable partial dentures. Alternative approaches to treatment should be considered for this population group, including functionally orientated tooth replacement according to the principles of the shortened dental arch concept. In correctly chosen cases, this approach can provide patients with an acceptable, functional and aesthetic reduced dentition. Additionally, evidence suggests that such an approach can significantly reduce the maintenance burden for patients and clinicians which can ultimately deliver a more cost effective solution compared to removable alternatives.
Incorporating intra-lesional injection of mitomycin C in the management algorithm for bladder neck contractures and vesicourethral anastomotic strictures
Authors: Yao Henry H , Sengupta Shomik , Chee Justin
Published: October 2020

Objective:

This study aims to describe the experience of a single-surgeon series with the use of intra-lesional mitomycin C (MMC) in the treatment of bladder neck contracture (BNC) and vesicourethral anastomotic stenosis (VUAS).

Patients and methods:

From July 2014 to January 2019, patients who underwent bladder neck incision (BNI) and intra-lesional MMC injection performed by a single surgeon were included in this retrospective study. Clinico-pathological data were extracted from medical records. The primary outcome was recurrence rate following BNI and MMC injection.

Results:

Ten patients were included in the study. The median age was 68 years. The cause of BNC or VUAS was secondary to radical prostatectomy in eight patients and to endoscopic prostatectomy in two patients. The median follow-up was 16.4 months. The success rate was 70% after first treatment with BNI and MMC injection, and 80% after repeated treatment. There were no serious adverse events or complications related to the MMC injection.

Conclusion:

BNI and intra-lesional MMC injection is a minimally invasive treatment for refractory bladder neck contractures with a good success rate and minimal risk of side effects when a low dose of MMC is used. Further prospective multicentre study is warranted.

Level of evidence:

Level 4.
Engagement with Manage My Pain mobile health application among patients at the Transitional Pain Service
Authors: Slepian P Maxwell , Peng Michael , Janmohamed Tahir , Kotteeswaran Yuvaraj , Manoo Varuna , Blades Alexander McLaren , Fiorellino Joseph , Katznelson Rita , Tamir Diana , McRae Karen , Kahn Michael , Huang Alexander , Kona Sharath , Thaker Sonalben , Weinrib Aliza , Katz Joel , Clarke Hance
Published: October 2020

Objective

Mobile health platforms have become an important component of pain self-management programs and hundreds of mobile applications are commercially available for patients to monitor pain. However, few of these applications have been developed in collaboration with healthcare professionals or have been critically evaluated. Manage My Pain is a user-driven mobile health platform developed by ManagingLife in collaboration with clinician researchers. Manage My Pain allows patients to keep a “pain record” and supports communication of this information with clinicians. The current report describes a user engagement study of Manage My Pain among patients at the Transitional Pain Service (TPS) at Toronto General Hospital, a multidisciplinary clinic for patients at high risk of developing postsurgical pain.

Methods

Patients at the TPS were encouraged to register on Manage My Pain as one component of a larger, non-randomized prospective study of treatment predictors and treatment enhancement. Uptake of the application and rates of registration, use, and retention were tracked for 90 days.

Results

Of the 196 patients who consented to the larger study, 132 (67%) also provided consent to the Manage My Pain component, indicating that they found this to be an acceptable treatment adjunct, and 119 (61%) completed registration. Of those who used the app, 67.9% and 43.2% continued to use Manage My Pain beyond 30 and 90 days, respectively. On average, users engaged with the app for 93.14 days (SD = 151.9 days) logged an average of 47.39 total records (SD = 136.1).

Conclusions

Manage My Pain was found acceptable by a majority of patients at an academic pain management program. Rates of user registration and retention were favorable compared to those reported by other applications. Further research is needed to develop strategies to retain users and maximize patient benefit.
Trends Over Time in Emerging Adults’ Self-Reports of Attachment Styles
Authors: Sprecher Susan
Published: October 2020

Recent trend analyses have documented changes over the past decades in psychological and relational variables (e.g., social interaction, empathy, loneliness) for emerging adults. With one exception), however, little research has examined how attachment styles may have changed over time. The present study, which involved data collected from 1997 to 2019 within one university setting, examined whether young adults’ selection of the attachment style that best described them from Bartholomew and Horowitz’s) four-category attachment measure changed over time, controlling for several sociodemographic variables. Results indicated that the probability of selecting an insecure attachment style (and particularly the dismissing attachment style) increased over time, controlling for sociodemographic variables. The results are consistent with those of Konrath et al.
Single-Stage Posterior Vertebral Column Resection With Circumferential Reconstruction for Thoracic/Thoracolumbar Burst Fractures With or Without Neurological Deficit: Clinical Neurological and Radiological Outcomes
Authors: Hamzaoglu Azmi , Elsadig Mustafa , Karadereler Selhan , Mutlu Ayhan , Akman Yunus Emre , Ozturk Huseyin , Aslantürk Okan , Sanlı Tunay , Kahraman Sinan , Enercan Meric
Published: October 2020

Study Design:

Retrospective study.

Objective:

The aim of this study is to evaluate the clinical, neurological, and radiological outcomes of posterior vertebral column resection (PVCR) technique for treatment of thoracic and thoracolumbar burst fractures.

Methods:

Fifty-one patients (18 male, 33 female) with thoracic/thoracolumbar burst fractures who had been treated with PVCR technique were retrospectively reviewed. Preoperative and most recent radiographs were evaluated and local kyphosis angle (LKA), sagittal and coronal spinal parameters were measured. Neurological and functional results were assessed by the American Spinal Injury Association (ASIA) Impairment Scale, visual analogue scale score, Oswestry Disability Index, and Short Form 36 version 2.

Results:

The mean age was 49 years (range 22-83 years). The mean follow-up period was 69 months (range 28-216 months). Fractures were thoracic in 16 and thoracolumbar in 35 of the patients. AO spine thoracolumbar injury morphological types were as follows: 1 type A3, 15 type A4, 4 type B1, 23 type B2, 8 type C injuries. PVCR was performed in a single level in 48 of the patients and in 2 levels in 3 patients. The mean operative time was 434 minutes (range 270-530 minutes) and mean intraoperative blood loss was 520 mL (range 360-1100 mL). The mean LKA improved from 34.7° to 4.9° (85.9%). For 27 patients, the initial neurological deficit (ASIA A in 8, ASIA B in 3, ASIA C in 5, and ASIA D in 11) improved at least 1 ASIA grade (1-3 grades) in 22 patients (81.5%). Solid fusion, assessed with computed tomography at the final follow-up, was achieved in all patients.

Conclusion:

Single-stage PVCR provides complete spinal canal decompression, ideal kyphosis correction with gradual lengthening of anterior column together with sequential posterior column compression. Anterior column support, avoidance of the morbidity of anterior approach and improvement of neurological deficit are the other advantages of the single stage PVCR technique in patients with thoracic/thoracolumbar burst fractures.