bluuebunny/crossref_metadata_2025 huggingface dataset:
Healthcare Providers' Perceptions of Single-Room Versus Traditional Maternity Models
Authors: Hall Marc , Nowell Lorelli , Castrogiovanni Nina , Palacios-Derflingher Luz , Norris Jill M. , White Deborah E.
Published: May 2019

While many hospitals have transitioned from traditional maternity care to a single-room maternity model, little is known about how healthcare providers' practice differs between the models. This mixed-methods study compared healthcare providers' job satisfaction and team collaboration between traditional and single-room maternity care and explored how each model shaped providers' practice. Data were collected via questionnaires and interviews with healthcare providers from 2 hospitals. Independent t tests, Mann-Whitney U tests, and thematic analysis were used in analysis; findings were then triangulated. No difference was found in team collaboration and job satisfaction scores between single-room (n = 84) and traditional (n = 42) maternity care; however, providers described different means toward satisfaction and collaboration in the interviews (n = 18). Single-room maternity care providers valued interprofessional teamwork, patient/family involvement, and continuity of care. Traditional maternity care providers enjoyed specialization but described teamwork as uniprofessional and disconnected across professions; transfers between units weakened communication and fragmented care. While single-room maternity care providers described less tension and a more holistic patient-family journey, further research must be undertaken to examine whether and how interprofessional collaboration and communication impact patient and health system outcomes.
Grit
Authors: Tyer-Viola Lynda A.
Published: May 2019

Natural and man-made disasters have increased dramatically over time, requiring healthcare systems to develop and sustain emergency preparedness plans. Nurse leaders and frontline clinical nurses are often the first and long-term responders during these traumatic events. Emergency preparedness requires nurses exceed expectations beyond the daily level of performance in caring for patients in the presence of obstacles. A disaster creates additional burdens on nurses psychosocially due to work and home demands. Despite this adversity, nurses are able to work under harsh conditions and make critical clinical decisions. This commitment is often described as being resilient. A deeper reason why nurses perform during disasters is that they possess the personality trait known as grit. Grit motivates them to endure challenges and be successful over time. The critical attributes of grit are passion and perseverance. Cultivating grit among nurse leaders and clinical nurses is essential to sustaining interest in emergency preparedness and ensuring the needs of patients and caregivers are met when a disaster occurs.
The Female Genital Self-image Scale in Adult Women With Vulvar Lichen Sclerosus
Authors: Hodges Kelly R. , Wiener Courtney E. , Vyas Anuja S. , Turrentine Mark A.
Published: May 2019

Objective

There is no agreed upon standard way to measure vulvar lichen sclerosus disease severity. The Female Genital Self-Image Scale (FGSIS) is a validated survey tool assessing female genital self-image and is positively correlated with women's sexual function. A lower score represents a negative genital self-image. We evaluated the FGSIS in women with vulvar lichen sclerosus.

Methods

Women with biopsy-proven lichen sclerosus and women presenting for routine gynecologic care without lichen sclerosus matched by age were surveyed with the 7-item FGSIS. National surveys of healthy women in the United States have shown the mean 7-item FGSIS score is 21. To detect one standard deviation (20% absolute difference) between groups with a power of 80% at p < .05, 15 women would are needed in each group.

Results

Sixteen women with lichen sclerosus and 16 matched controls were surveyed between February and July 2018. The mean ± SD age of women with lichen sclerosus was 56.8 ± 13.5 years, 94% were white, 69% married, 81% college educated, 69% postmenopausal, and 18% on hormone replacement therapy. None of these differences were statistically different from control women. Women with vulvar lichen sclerosus had a significantly lower median 7-item FGSIS when compared with control subjects, 18 (interquartile range = 16–21) versus 25 (interquartile range = 23–27), respectively, Mann–Whitney U test, p < .001.

Conclusions

Women with vulvar lichen sclerosus have a lower score on the 7-item Female Genital Self-Image Scale compared with healthy controls.
Management of Acute Mastoiditis With Immediate Needle Aspiration for Subperiosteal Abscess
Authors: Bartov Noam , Lahav Yonatan , Lahav Gil , Zloczower Elchanan , Katzenell Udi , Halperin Doron , Hilly Ohad , Shoffel-Havakuk Hagit
Published: May 2019

Objectives:

The management of children with acute mastoiditis (AM) is still debated. Some advocate computed tomography (CT) and cortical mastoidectomy (CM) for all cases while others favor a more conservative management. This study assesses the safety and outcome of a conservative management scheme, with immediate myringotomy and postauricular needle aspiration (PANA) of a subperiosteal abscess (SPA).

Methods:

A retrospective cohort of children with AM younger than 12 years admitted to our institute between 1999 and 2017. Data collection includes patient characteristics, signs and symptoms, physical examination, laboratory tests, treatment regime, imaging findings, and long-term outcomes.

Results:

The study included 283 children. Ninety-eight children (34.6%) had a suspected SPA on admission and underwent a trial of immediate PANA, and 56.1% (55 cases) were positive. Of these 55, 83.6% (46) did not require CM. Twenty-four additional children had an SPA, proven by CT or during surgery, bringing the total SPA cases to 79 (27.9%). Of all children with proven SPA, 70.9% (56) did not require CM, with the practiced conservative management sufficing. Intracranial complication rates were 4.9% (14) and 8.8% (25) underwent CM. Long-term follow-up was available for 250 children. One child had hearing loss with a bilateral mixed hearing loss (50 decibels). There were no cases of neurological sequela.

Conclusions:

Conservative management of AM, involving prompt myringotomy for all patients and PANA for SPA, is safe and effective, and reduces the need for CT and CM. Conservative management obviates unnecessary radiation, general anesthesia, and surgery, without increasing the risk of immediate or long-term complications.
Evaluating the Long-Term Hearing Outcomes of Cochlear Implant Users With Single-Sided Deafness
Authors: Távora-Vieira Dayse , Rajan Gunesh P. , Van de Heyning Paul , Mertens Griet
Published: May 2019

Objectives:

To investigate the long-term outcomes of cochlear implantation in individuals with single-sided deafness (SSD) in terms of speech perception, subjective hearing performance, and sound localization.

Methods:

Thirty-four subjects with SSD were recruited across two large cochlear implant (CI) centers (Antwerp, Belgium and Perth, Australia). The long-term hearing outcomes (between 4 and 10 years of CI use) were evaluated using speech in noise tests, a subjective hearing performance questionnaire (Speech, Spatial and Qualities Questionnaire [SSQ12]), and sound localization tests.

Results:

Statistically significant improvements were observed in speech perception in noise and sound localization results postoperatively with the use of a CI in comparison to preoperative measurements. Subjective hearing abilities also significantly improved after long-term CI use.

Conclusion:

Access to binaural hearing is important for subjects with SSD. CI users with SSD experience long-term benefits in speech understanding, sound localization, and quality of life.
Comprehensive Analysis of Factors Leading to Poor Performance in Prelingual Cochlear Implant Recipients
Authors: Panda Smriti , Sikka Kapil , Singh Vishwajeet , Agarwal Shivani , Kumar Rakesh , Thakar Alok , Sharma Suresh C.
Published: May 2019

Objective:

To comprehensively analyze the prognostic factors responsible for affecting outcomes following cochlear implantation in prelinguals.

Study Design:

Retrospective cohort study from June 2004 to November 2015.

Setting:

Tertiary care center.

Patients:

Patients who had undergone cochlear implantation during June 2004 to November 2015 for prelingual sensorineural hearing loss with a minimum follow-up of 2 years.

Intervention:

Patients were evaluated for the presence of 20 risk factors possibly influencing postimplantation outcomes using a questionnaire.

Main Outcome Measures:

Assessment for speech and auditory function was done at the last follow-up with speech intelligibility ratings (SIR) and categories of auditory performance (CAP) scores, respectively.

Results:

One hundred fifty-one patients were included in this study. On univariate analysis for CAP, age at implantation, noncompliance to pre and postimplantation auditory and speech habilitation, poor parental motivation, socioeconomic status and literacy were found to be associated with lower scores (p < 0.05). Whereas, for SIR, additionally, attention deficit hyperactivity disorder and inner ear malformation were statistically significant negative predictors on univariate analysis. Finally, factors responsible for low CAP scores on multivariate analysis were poor parental literacy, poor socioeconomic status, irregular pre/postimplantation rehabilitation, and attention deficit hyperactivity disorder. While for SIR, additionally age at implantation was also a significant negative predictor. Increasing IQ and duration of implant use were associated with higher CAP (univariate) and SIR scores (univariate and multivariate) (p < 0.05).

Conclusion:

We were able to demonstrate negative impact of higher age at implantation, minimal cognitive disorder, adverse parental/socioeconomic profile, and poor compliance to pre/postimplantation auditory verbal habilitation on auditory and speech outcomes.
Episodic Vestibular Symptoms in Children With a Congenital Cytomegalovirus Infection: A Case Series
Authors: Dhondt Cleo , Maes Leen , Oostra Ann , Dhooge Ingeborg
Published: May 2019

Objective:

Congenital cytomegalovirus (cCMV) infection is the most common non-genetic cause of sensorineural hearing loss in children. Although cCMV-induced vestibular loss is demonstrated in several studies, the occurrence of vertigo has been described in only two cases to date. The aim of this paper is to discuss the underlying pathophysiology of recurrent vestibular symptoms in children with cCMV, based on five cases investigated in our center and an extensive research of the literature.

Study Design:

Retrospective case series.

Setting:

Tertiary referral center.

Patients:

This case series describes five pediatric cCMV-patients (three boys, two girls). Four of them were symptomatic at birth, one was asymptomatic. Three patients underwent cochlear implantation. The age of onset of the vestibular symptoms varied from 2;0 to 7;3 years of age.

Intervention:

None.

Main Outcome Measures:

Details regarding the patient history and results of cranial imaging, audiological, vestibular, and neurological assessments were collected retrospectively.

Results:

The selected cases suffered from recurrent vestibular symptoms. All patients had delayed onset, fluctuating, and/or progressive hearing loss. In all cases, the attacks were accompanied with nausea and vomiting and occurred without clear-cut trigger. Migraine and epilepsy often were proposed as first diagnosis, although they could not be confirmed eventually. Four out of five patients were diagnosed with a peripheral vestibular deficit.

Conclusions:

Diagnosis of vestibular symptoms in children with cCMV is complex, given the multiple morbidities than can occur. Peripheral vestibular causes should be considered in the diagnosis, as important vestibular deficits are demonstrated in this population.
Datalogging Statistics and Speech Recognition During the First Year of Use in Adult Cochlear Implant Recipients
Authors: Schvartz-Leyzac Kara C. , Conrad Chelsea A. , Zwolan Teresa A.
Published: May 2019

Objective:

To examine device datalogging characteristics and postoperative speech recognition performance in adult cochlear implant (CI) recipients.

Study Design:

Retrospective study examining datalogging characteristics throughout the first year of device use and postoperative speech recognition outcomes measured at 1 year.

Patients:

One hundred seventy-seven adults who received a Cochlear CI.

Main Outcome Measures:

Average values for environmental scene classification (hours of device use per day, and percent of hours per day in quiet, noise, and speech) as reported by Cochlear datalogging over the first year of device use. Speech recognition was assessed at 1 year postactivation.

Results:

During the first year of devices use, CI listeners >80 years of age used their device significantly less (average = 10.97 h/d) than the youngest adult listeners (18–30 yrs), who used their device an average of 13.29 hours/d. There was no consistent effect of age on the number of hours a CI user listened to speech in noise each day. Correlational and regression analyses suggest that the number of average hours of device use is the primary factor that accounts for variance observed in postoperative consonant-nucleus-consonant word scores.

Conclusion:

Results suggest that the average number of hours listening to speech in noise is not related to postoperative performance, but the average number of hours of device use per day is correlated with postoperative performance. Further research is needed to determine if these findings are merely correlational or causal in nature.
Bilateral Posterior Canal Benign Paroxysmal Positional Vertigo Tends to Reoccur
Authors: Pollak Lea , Michael Tal
Published: May 2019

Objective:

We analyzed the clinical characteristics of quite a large cohort of patients with bilateral posterior canal benign paroxysmal positional vertigo (bil-BPPV) with respect to the rate and types of recurrence.

Study Design:

Retrospective case review.

Setting:

Outpatient dizziness clinic.

Patients:

About 2,050 patients diagnosed with BPPV during the years 2003 to 2018 were reviewed.

Results:

Sixty (2.9%) were diagnosed with bil-BPPV. Fifty three (88%) were idiopathic and seven (12%) posttraumatic. Multiple BPPV episodes were encountered in 28 (47%) patients. Patients with bil-BPPV and multiple BPPV episodes were comparable with patients with a single attack of bil-BPPV except for older age and longer follow up. The most frequent type of recurrence following a bil-BPPV episode was posterior canal canalolithiasis (37.5%) and bil-BPPV (31.3%). Combined (posterior and horizontal) BPPV was encountered in 12.5% while horizontal canal involvement was found in only 7% of recurrences.

Conclusions:

The prevalence of bil-BPPV amongst all BPPV patients was lower than previously reported possibly due to stricter selection criteria. Older age and longer follow up of patients with multiple BPPV episodes than those with a single episode of bil-BPPV is in accordance with the theory of degenerative otoconia loosening. In contrast to the general consensus regarding random recurrences of BPPV side and subtypes, bil-BPPV recurred more frequently than expected. This might be the consequence of individual vulnerability to head movements, increased bone metabolism or an underlying vestibular pathology.
Easy Stapes Subluxation in 22q11.2 Deletion Syndrome: A Clinical Capsule and Literature Review
Authors: Kennel Christopher E. , Cousins Joseph P. , Rivera Arnaldo L.
Published: May 2019

Objectives:

This report describes iatrogenic stapes subluxation in a 22q11 deletion syndrome patient and reviews the human and murine literature for evidence that these patients have stapes malformations. We aim to alert otologic surgeons regarding the possibility of stapes footplate abnormalities in 22q11 deletion patients.

Patient:

An adult woman with known 22q11 deletion syndrome. Additionally, the literature review focused on other patients with 22q11 deletion syndrome as well as mouse models of this disorder.

Interventions:

A combination of diagnostic and therapeutic interventions were conducted consisting of middle ear exploration, removal of ossicular chain adhesions, and ultimately ossicular reconstruction.

Results:

The stapes footplate was poorly attached to the oval window in our patient. During removal of ossicular adhesions, the entire stapes subluxed requiring placement of a stapes prosthesis. The postoperative audiogram was similar to the preoperative audiogram. Literature review identified one other case of stapes subluxation in a patient with 22q11 deletion syndrome, and mouse models suggest that the stapes footplate has an abnormal connection to the oval window in those affected by 22q11 deletion syndrome.

Conclusions:

Patients with 22q11 deletion syndrome have chronic middle ear pathology, and if middle ear exploration is undertaken, the surgeon should be aware that the stapes may have a weak attachment to the oval window. This could put the stapes at risk of injury and contribute to conductive hearing loss.
Angular Electrode Insertion Depth and Speech Perception in Adults With a Cochlear Implant: A Systematic Review
Authors: Heutink Floris , de Rijk Simone R. , Verbist Berit M. , Huinck Wendy J. , Mylanus Emmanuel A. M.
Published: May 2019

Objective:

By discussing the design, findings, strengths, and weaknesses of available studies investigating the influence of angular insertion depth on speech perception, we intend to summarize the current status of evidence; and using evidence based conclusions, possibly contribute to the determination of the optimal cochlear implant (CI) electrode position.

Data Sources:

Our search strategy yielded 10,877 papers. PubMed, Ovid EMBASE, Web of Science, and the Cochrane Library were searched up to June 1, 2018. Both keywords and free-text terms, related to patient population, predictive factor, and outcome measurements were used. There were no restrictions in languages or year of publication.

Study Selection:

Seven articles were included in this systematic review. Articles eligible for inclusion: (a) investigated cochlear implantation of any CI system in adults with post-lingual onset of deafness and normal cochlear anatomy; (b) investigated the relationship between angular insertion depth and speech perception; (c) measured angular insertion depth on imaging; and (d) measured speech perception at, or beyond 1-year post-activation.

Data Extraction and Synthesis:

In included studies; quality was judged low-to-moderate and risk of bias, evaluated using a Quality-in-Prognostic-Studies-tool (QUIPS), was high. Included studies were too heterogeneous to perform meta-analyses, therefore, effect estimates of the individual studies are presented. Six out of seven included studies found no effect of angular insertion depth on speech perception.

Conclusion:

All included studies are characterized by methodological flaws, and therefore, evidence-based conclusions regarding the influence of angular insertion depth cannot be drawn to date.
Epidemiology and Diagnosis of Gastroparesis in the United States
Authors: Syed Aslam R. , Wolfe Michael M. , Calles-Escandon Jorge
Published: May 2019

Goals:

We aimed to establish the epidemiological characteristics and documentation of diagnostic workup for gastroparesis (GP).

Background:

No study has used a national database to evaluate the prevalence, demographics, and associated comorbid conditions of GP, and document rates of proper diagnosis.

Materials and Methods:

This was a cross-sectional population-based study using the Explorys Platform to determine the prevalence of GP in a large and diverse population highly representative of the US population and to examine the diagnostic approach of GP. Data collected were individual characteristics from electronic medical records (EMRs) included age, ethnicity/race, sex, diagnostic report for esophagogastroduodenoscopy (EGD) and gastric emptying study (GES).

Results:

A total of 43,827,910 medical records were surveyed (1999 to 2014), of which 69,950 had a diagnosis of GP, yielding an overall prevalence of 0.16%. We identified 249,930 EMRs with type 1 diabetes mellitus (T1DM), and 2,940,280 EMR’s with type 2 diabetes mellitus (T2DM), of which 11,470 (4.59%) and 38,670 (1.31%) EMR’s had concurrent GP, respectively. The remainder 19,810 EMRs with a diagnosis of GP were classified as having idiopathic GP. In all three subgroups, women and Caucasians had the highest prevalence of GP. The diagnosis of GP was confirmed by both GES and EGD in 9,950 of patients (14.22%). For patients with T1DM, T2DM, or idiopathic GP, GP was confirmed by both diagnostic tests in 16.8%, 14.0%, and 13.2%, respectively.

Conclusions:

Our estimated rates of prevalence of GP in T1DM and T2DM indicate that GP is not a common clinical complication in these populations. Majority of EMRs that indicated a diagnosis of GP did not include any documentation of definitive diagnostic testing (EGD and/or GES).
Fibroscan and low-density lipoprotein as determinants of severe liver fibrosis in diabetic patients with nonalcoholic fatty liver disease
Authors: Jaafar Rola F. , Hajj Ali Adel M. , Zaghal Ahmad M. , Kanso Mariam , Habib Salim G. , Halaoui Adham F. , Daniel Fady , Mokaddem Farah , Khalife Mohamad J. , Mukherji Deborah M. , Faraj Walid G.
Published: May 2019

Background

Fibroscan is an effective and noninvasive tool to quantify fibrosis and steatosis in liver diseases including nonalcoholic fatty liver disease (NAFLD). Type-2-diabetes is a known risk factor for worse prognosis in NAFLD. In this study, we compare liver status in NAFDL diabetic and nondiabetic patients, identify potential risk factors, and determine the usefulness of Fibroscan in this population.

Patients and methods

The charts of all patients with NAFLD who underwent Fibroscan at our institution were reviewed. Fibroscan results, demographics, and clinical data were collected and analyzed using SPSS software.

Results

Of the 248 NAFLD patients, 73 (29.4%) were diabetic and 175 (70.6%) were nondiabetic. As detected by the NAFLD’ liver stiffness measure, 35 (47.94%) diabetic patients had severe liver fibrosis (F4) in contrast to only 46 (26.3%) nondiabetics. Diabetic patients also presented more with hypertension, dyslipidemia, coronary artery disease, and chronic kidney disease. Liver steatosis, liver function tests, and noninvasive scores did not vary significantly between the two groups, except for γ-glutamyltransferase, prothrombin time-international normalized ratio, and BMI-alanine aminotransferase ratio-diabetes score. Diabetic patients had significantly lower high-density lipoproteins and low-density lipoproteins.

Conclusion

Fibroscan results and low-density lipoprotein are potential diagnostic factors of liver fibrosis in diabetic patients with NAFLD. Further studies are necessary to verify liver fibrosis diagnostic tools and prognostic and genetic markers in diabetic patients.
Update on low-density lipoprotein cholesterol quantification
Authors: Chung Soie
Published: May 2019

Purpose of review

β-Quantification is considered the reference measurement procedure for low-density lipoprotein cholesterol (LDL-C). However, this technique is time-consuming and thus is inappropriate for routine clinical practice. Therefore, the Friedewald equation or homogeneous assays have been widely utilized. As several pitfalls exist with these two methods, a novel method for estimating LDL-C was developed by Martin et al.

Recent findings

Martin's method uses a strata-specific median for the triglycerides/very low-density lipoprotein cholesterol (VLDL-C) ratio on the basis of triglycerides and non-HDL-C concentrations. Recent studies show that Martin's method better correlates with β-quantification or homogeneous assays compared with the Friedewald equation, especially with values of triglycerides at least 150 mg/dl and/or LDL-CD less than 70 mg/dl. Such findings have also been demonstrated in other ethnic groups (Japanese and Korean) and disease populations, including diabetes and cardiovascular disease, in which the triglycerides/VLDL-C ratio can be affected.

For the current therapeutic goal of LDL-C values below 70 mg/dl in high-risk patients, accurate assessment of LDL-C levels at very low levels is required. Martin's method could overcome pitfalls such as underestimation of the Friedewald equation at this level. Further evaluation of the triglycerides/VLDL-C ratio in participants with diverse ethnic backgrounds or clinical conditions would expand the implementation of this novel method.
Epitope matching in kidney transplantation: recent advances and current limitations
Authors: Larkins Nicholas G. , Wong Germaine , Taverniti Anne , Lim Wai H.
Published: May 2019

Purpose of review

Evolution of human leukocyte antigen (HLA) molecular typing techniques has progressively enabled more accurate determination of the three-dimensional building blocks that form the antibody accessibility and binding sites of each HLA allele. These immunogenic HLA regions known as epitopes are composed of polymorphic sequences of amino acid residues termed eplets. This review provides a critical appraisal of the current understanding of epitope compatibility in kidney transplantation.

Recent findings

There is a tendency to suggest that epitope matching is likely to be superior to broad antigen HLA matching such that the allocation of donor kidneys to patients with a more favorable epitope compatibility profile may lead to better allograft outcomes. A growing body of work has highlighted the association between a greater number of eplet mismatches and adverse allograft outcomes, and approaches using eplet matching have been successfully implemented in organ allocation programs. However, our understanding of epitope compatibility remains in its infancy, requiring further and more in-depth evaluation. Critically, it remains unclear how best to translate findings derived at the population level to the care of individual patients. Questions that need to be answered include a lack of consensus in the definition and interpretation of epitope compatibility, are class I and II compatibility of similar clinical importance, how best to define predetermined mismatch thresholds for utilization in organ allocation, and whether other properties such as differences in electrostatic potential between donor and recipient HLA alleles are also important in determining immunological compatibility.

Epitope matching likely represents a valid progression in understanding donor–recipient HLA compatibility. However, more clinical data and a better understanding about differences in methods to determine epitope compatibility are required before the approach can be widely applied in clinical practice.
A diagnostic ‘C’ saw: the ups and downs of C1q testing
Authors: Gebel Howard M. , Bray Robert A.
Published: May 2019

Purpose of review

The present review will focus on recently published data of solid organ allograft recipients reporting that patients with de-novo donor-specific HLA antibodies (DSA) that fix complement in vitro have a significantly higher risk for antibody-mediated rejection (AMR) and/or graft loss compared to patients whose de-novo DSA do not fix complement or patients who present with preexisting complement fixing DSA.

Recent findings

HLA DSAs that fix complement in vitro appear to be a key indicator for rejection and failure of kidney, heart, and lung allografts from studies performed around the world. The majority of these studies are population based and retrospective in nature. Although these studies seemingly indicate that in-vitro complement activating DSAs represent a higher clinical risk than noncomplement fixing DSAs, the majority have not accounted for false-negative reactions attributable to the so-called prozone/interference phenomenon. In the limited number of published studies addressing that concern, high mean fluorescence intensity (MFI) value noncomplement fixing DSAs correlate as well as complement fixing DSAs with AMR and graft loss. Combined with the cost of additional testing, these observations bring into question whether there is sufficient clinical applicability to warrant routine testing for complement fixing antibodies.

Complement fixing DSAs are clearly associated with AMR and/or loss of transplanted allografts. However, under appropriate testing conditions, complement fixing capability typically correlates with MFI values of the DSAs. As such, the routine implementation of in-vitro assays to determine whether DSAs fix complement is of questionable value especially when considering additional issues such as cost of testing, logistics, and whether the test results factor into individualized patient care.
Elevated International Normalized Ratio (INR) is Associated With an Increased Risk of Intraventricular Hemorrhage in Extremely Preterm Infants
Authors: Glover Williams Alessandra , Odd David , Bates Sarah , Russell Geoff , Heep Axel
Published: May 2019

Introduction:

The international normalized ratio (INR), a standardized method of reporting the prothrombin time, can be a surrogate marker of the vitamin K-dependent coagulation pathways.

Objective:

To evaluate the relationship between INR measurements in the first 48 hours of life and subsequent development of intraventricular hemorrhage (IVH) in extremely preterm infants.

Materials and Methods:

A single-center retrospective, observational cohort study of infants born at <28 weeks gestation. The main outcome measure was defined as the degree of IVH seen on cranial ultrasound examinations at day 7 postnatal age.

Results:

Of 200 infants, 109 (mean gestational age, 25.2 wk [SD, 1.27]) had coagulation results available. Of 109, 26 developed IVH. Elevated INR was associated with increased risk of a severe IVH (odds ratio [OR] 6.50; 95% confidence interval [CI], 1.65-25.62; P=0.008) adjusted for gestation, birth weight, and sex. INR was significantly associated with severe IVH in infants who did not receive blood products (OR, 64.60; 95% CI, 1.35-3081.25; P=0.035), but not in those who did (OR, 2.93; 95% CI, 0.67-12.71; P=0.151) (P
interaction=0.086).

Conclusion:

An elevated INR in the first 48 hours of life may be useful to identify preterm infants at risk of severe IVH and may guide strategies to prevent the development, or limit the extension, of IVH.
Clinical and Prognostic Role of 18F-FDG PET/CT in Pediatric Ewing Sarcoma
Authors: Albano Domenico , Dondi Francesco , Schumacher Richard Fabian , D’Ippolito Carmelita , Porta Fulvio , Giubbini Raffaele , Bertagna Francesco
Published: May 2019

Ewing sarcoma (ES) is one of the most common pediatric solid tumors with aggressive behavior and unfavorable survival. In this study, we evaluated the diagnostic accuracy of baseline and restaging fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) scans and their possible prognostic role in pediatric ES. We evaluated 17 patients who underwent a total of 27 18F-FDG-PET/CT scans (10 for staging and 17 for restaging). The PET images were analyzed visually and semiquantitatively by measuring SUVmean, SUVmax, SUVlbm, SUVbsa, MTV, and TLG. Moreover, PET/CT results were compared with other conventional imaging (CI) results. Among 10 baseline PET/CT scan results, 9 were positive and 1 not valuable by interference; baseline PET/CT and CI were concordant in 7 cases and discordant in 2, with pulmonary micrometastases not detected by PET/CT. Among 17 restaging PET/CT scan results, 9 were positive and 8 negative; CI and restaging PET/CT were concordant in 9 cases and discordant in 8. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of restaging 18F-FDG-PET/CT were 73%, 83%, 89%, 62.5%, and 76%, respectively. After a median follow-up of 20 months, relapse/progression occurred in 8 patients and death in 5. A positive 18F-FDG-PET/CT at restaging was significantly associated with shorter overall survival compared with unremarkable PET/CT at the same timepoint, but not with progression-free survival. Instead, metabolic PET/CT features were not correlated with outcome. 18F-FDG-PET/CT showed a good diagnostic performance in pediatric ES; except for pulmonary micrometastases, PET/CT was better than CI at restaging. Only restaging PET/CT result was significantly correlated with overall survival.
Another Look at Differentiating Nursing Practice
Authors: Boston-Fleischhauer Carol
Published: May 2019

Designing and improving efficient, effective staffing models remain a top priority for chief nurse executives (CNEs). However, market forces are pushing the need for staffing model innovation. Both innovative and widely debated in professional and academic circles, differentiated nursing practice has yet to be widely adopted. CNEs are challenged to revisit new realities and confront organizational, professional, and culture barriers that are impeding this staffing model innovation.
Exploring Inpatient Medication Patterns
Authors: Loresto Figaro L. , Welton John , Grim Stephanie , Valdez Carolyn , Eron Kathryn
Published: May 2019

PURPOSE

Exploratory study to examine inpatient medication administration patterns.

METHODS

Data from multiple sources were utilized for this study. The outcome was time difference between medication schedule and administration. A 3-level hierarchical linear regression approach, both unadjusted and adjusted, was considered for this study where medication administration events are nested within patients nested within nurses or units. Intraclass correlation coefficients (ICCs) were calculated and compared.

RESULTS

On average, medications were delayed by 12 (SD, 48.8) minutes. From the full model, patient ICCs decreased when “unit” replaced “nurse” as the 3rd level (0.541 vs 0.444). Patients who spoke Spanish had a significant 2.3- to 4.2-minute delay in medication administration. Certified nurses significantly give medications earlier compared with noncertified nurses by 1.6 minutes.

DISCUSSION

Optimal medication administration is a multifactorial concern with nurses playing a role. Nursing leaders should also consider patient demographics and unit conditions, such as culture, for medication administration optimization.
Accreditation of Transition to Practice Programs
Authors: Church Cory D. , Cosme Sheri , O’Brien Morgan
Published: May 2019

Accreditation of transition to practice (TTP) programs are rapidly increasing. A review was completed on 13 TTP programs, accredited by the American Nurses Credentialing Center Practice Transition Accreditation Program. The review found six benefits of TTP accreditation that can translate into value for organizations. Nursing professional development practitioners should seek accreditation for TTP programs to elevate the potential for funding from national agencies.
Improving Perioperative Knowledge, Self-Efficacy, and Performance in Labor and Delivery Nurses
Authors: Melendez Christian T. , March Alice L. , Cunningham Craig
Published: May 2019

The obstetrical unit utilized a training product (Periop 101: A Core Curriculum OB) to enhance the knowledge, self-efficacy, and performance of nurses circulating for cesarean births. Knowledge was measured using product provided testing. Self-efficacy was assessed using a modified perioperative self-efficacy scale, and performance was evaluated by analyzing documentation accuracy and incident reports. Results demonstrated improvements in perioperative knowledge, self-efficacy, and documentation as well as a reduction in incident reports.
Against All Odds: RNA Extraction From Different Protocols Adapted to Formalin-fixed Paraffin-embedded Tissue
Authors: Guerra Juliana M. , Monteiro Raquel L. , Gonzalez Lorenzo , Kimura Lidia M. , Cirqueira Cinthya d.S. , de Araújo Leonardo J.T.
Published: May 2019

For the preservation of tissue samples, formalin fixation followed by paraffin embedding (FFPE) has been the method of choice for decades, mainly because it maintains the morphologic characteristics of the original tissue particularly preserved, as well as its genetic material. FFPE cells can be used to perform molecular tests, such as conventional (c) or quantitative (q) reverse transcriptase polymerase chain reaction (RT-PCR), in retrospective investigations. However, extracting RNA from archived FFPE tissues is a challenging procedure, as it requires time and the use of complex extraction methods. As specific FFPE extraction methods are not always available in the laboratories, the objective of this study was to evaluate the performance of a method based on phenol-chloroform (PC) and 2 commercial methods for RNA extraction, adapting their protocols for FFPE tissues. For this study, a pool of FFPE tissues underwent RNA extraction by PC, QIAmp Viral RNA Mini, and RNeasy Mini Kit. Both the RT-cPCR and the RT-qPCR results were favorable, demonstrating the viability of the RNA. As these results expanded the alternatives for low-budget FFPE extraction, the choice of the ideal method to be used will depend on the availability of reagents and kits.
Chromogenic and Silver in Situ Hybridization for Identification of HER 2 Overexpression in Breast Cancer Patients: A Systematic Review and Meta-Analysis
Authors: Grazziotin Luiza R. , Dada Bukky R. , de la Rosa Jaimes Carolina , Cheung Winson Y. , Marshall Deborah A.
Published: May 2019

Introduction:

This systematic review has the purpose to characterize the accuracy of chromogenic in situ hybridization (CISH) and silver in situ hybridization (SISH), in comparison to fluorescence in situ hybridization (FISH) in the identification of human epidermal growth factor receptor-2 (HER2) overexpression and to inform decisions about test selection.

Materials and Methods:

We searched MEDLINE and EMBASE databases using these eligibility criteria: studies evaluating invasive breast cancer samples which examined agreement between CISH or SISH, and FISH, and reported sensitivity, specificity, or concordance. We performed a bivariate meta-analysis of sensitivity and specificity using a generalized linear mixed model. We used likelihood ratio tests from meta-regression to compare accuracy between HER2 tests.

Results:

The search identified 4475 articles, of which 32 were included. The summary estimates for sensitivity and specificity were 0.91 [95% confidence interval (CI), 0.85-0.95], and 0.97 (95% CI, 0.93-0.99) for SISH; 0.97 (95% CI, 0.83-1.00) and 0.99 (95% CI, 0.96-1.00) for single-probe CISH; and, 0.98 (95% CI, 0.92-0.99) and 0.98 (95% CI, 0.91-0.99) for dual-probe CISH. Significantly higher sensitivity was reported for dual-CISH than SISH (χ2: 5.36; P=0.02) when compared with the reference test FISH.

Conclusions:

The agreement between new bright field tests (SISH and CISH) and FISH is high (≥92%). Indirect comparison of HER2 tests indicated that overall CISH performance exceeds that of SISH. The pooled estimates from this meta-analysis summarize the current published literature and, in addition to other factors such as costs differentials, can help inform future HER2 test selection decisions.
PD-L1 Expression in Urothelial Carcinoma With Predominant or Pure Variant Histology
Authors: Reis Henning , Serrette Rene , Posada Jennifer , Lu Vincent , Chen Ying-bei , Gopalan Anuradha , Fine Samson W. , Tickoo Satish K. , Sirintrapun Sahussapont J. , Iyer Gopa , Funt Samuel A. , Teo Min Yuen , Rosenberg Jonathan E. , Bajorin Dean F. , Dalbagni Guido , Bochner Bernard H. , Solit David B. , Reuter Victor E. , Al-Ahmadie Hikmat A.
Published: May 2019

The introduction of immune checkpoint blockade (ICB) therapy has transformed the management of advanced bladder cancer (BC). Despite its limitations, PD-L1 immunohistochemistry may serve as a predictive biomarker of anti-PD-L1/PD1 therapy. While urothelial carcinoma (UC) patients with predominant or pure variant histology (UCV) account for up to one-third of advanced cases, to date, most ICB BC studies have excluded patients with such histologies. To assess the potential utility of ICB in patients with UCV, we analyzed PD-L1 expression in UCV and compared 3 commonly used and commercially available PD-L1 antibodies. Full sections from 84 UCV cases were stained with clones SP263, 22C3, and SP142, all of which are considered predictive assays to identify UC patients who are more likely to respond to anti-PD-1/PD-L1 inhibitors durvalumab, pembrolizumab, and atezolizumab, respectively. Expression on tumor cells (TC) and tumor-infiltrating immune cells (IC) was assessed. Staining extent and characteristics were evaluated, and concordance among the 3 clones was determined at various cutoff points as used in previous studies in BC. We found that PD-L1 was expressed in a significant percentage of UCV cases at different cutoff points (cutoff 1% TC: 37% to 54%, cutoff 5% TC: 23% to 37%), with the highest expression in UC with squamous differentiation. These figures are equal to or higher than those for classic/pure UC (4% to 30%). The results suggest that patients with UCV may benefit from anti-PD-1/PD-L1 therapy and argue against the exclusion of UC with predominant or pure variant histology from clinical ICB studies. The highest expression in both TC and IC was observed with clone SP263, followed by 22C3 and SP142, and all clones showed strong agreement in a pairwise comparison, both in TC and IC (R-values: 0.780 to 0.901), which indicates that all 3 clones are potentially useful in the evaluation of PD-L1 expression in UCV.
Autoimmune Pancreatitis Type 2
Authors: Gupta Rajib , Neyaz Azfar , Chougule Abhijit , Akita Masayuki , Zen Yoh , Forcione David , Castillo Carlos Fernandez-Del , Ferrone Cristina R. , Deshpande Vikram
Published: May 2019

Background:

Autoimmune pancreatitis (AIP) encompasses a heterogenous disease group that includes IgG4-related type 1 AIP and non–IgG4-related type 2 AIP. Clinically and on imaging, type 2 AIP mimics type 1 AIP, other forms of chronic pancreatitis and pancreatic ductal adenocarcinoma (PDAC); therefore, discriminatory markers may aid proper diagnosis. Herein, we examine the expression of PD-L1 and indoleamine 2,3-dioxygenase (IDO1) as a diagnostic tool to distinguish type 2 AIP from other forms of pancreatitis and PDAC.

Design:

We evaluated 35 pancreatectomy specimens diagnosed with type 2 AIP and potential mimics of this disease including type 1 AIP (n=14), chronic pancreatitis-not otherwise specified (n=10), groove pancreatitis (n=14), and PDAC (n=278). We scored inflammatory infiltrates, fibrosis and atrophy and performed immunohistochemical staining for PD-L1 and IDO1. We validated our findings on a series of endoscopic ultrasound–guided biopsies from patients with suspected type 2 AIP and inflammatory and neoplastic mimics of this disease (n=37).

Results:

The mean age of patients with type 2 AIP was 50 years with a F:M ratio of 1.2:1. Patients with type 2 AIP showed pancreatic ductal staining for PD-L1 and IDO1 in 69% (24/35) and 60% (15/25) of cases, respectively. PD-L1 reactivity was noted in 3% of patients with other forms of chronic pancreatitis and 3% of PDACs; notably, peritumoral ducts and acini were negative. Eight of 9 endoscopic ultrasound–guided biopsies with pancreatic ductal epithelium from patients with type 2 AIP were positive for PD-L1, while the inflammatory and neoplastic mimics were negative. Collectively, the sensitivity and specificity of PD-L1 as a marker of type 2 AIP was 70% and 99%, respectively.

Conclusions:

Ductal PD-L1 reactivity has the potential to distinguish type 2 AIP from other forms of pancreatitis and PDAC.
Cutaneous Syncytial Myoepithelioma Is Characterized by Recurrent EWSR1-PBX3 Fusions
Authors: Jo Vickie Y. , Antonescu Cristina R. , Dickson Brendan C. , Swanson David , Zhang Lei , Fletcher Christopher D.M. , Demicco Elizabeth G.
Published: May 2019

Cutaneous syncytial myoepithelioma (CSM) is a rare but distinctive benign variant in the family of myoepithelial neoplasms of skin and soft tissue. CSM has unique morphologic and immunohistochemical features, characterized by intradermal syncytial growth of spindled, ovoid, and histiocytoid cells and consistent staining for S-100 protein and EMA, and differs from other myoepithelial tumors by showing only infrequent keratin staining. Rearrangement of theEWSR1gene is now known to occur in up to half of all skin and soft tissue myoepithelial tumors, with a wide family of documented fusion partners. In 2013, we reported frequent (80%)EWSR1rearrangements in CSM, but were unable to identify the fusion partner using available studies at that time. After recent identification of an index case of CSM harboring anEWSR1-PBX3fusion, we used a combination of targeted RNA sequencing and fluorescence in situ hybridization (FISH) studies to investigate the genetic features of a cohort of CSM. AnEWSR1-PBX3fusion was identified in all 13 cases successfully tested. RNA sequencing was successful in 8/13 cases, all of which were found to have identical breakpoints fusing exon 8 ofEWSR1to exon 5 ofPBX3. FISH confirmed bothEWSR1andPBX3rearrangements in 9/9 cases tested, which included 4 confirmed to haveEWSR1-PBX3fusion by RNA-Seq, 3 cases that failed RNA-Seq, and 2 cases examined by FISH alone. Two cases failed RNA sequencing but had no additional tissue remaining for FISH studies. Our findings demonstrate thatEWSR1-PBX3fusions occur in most (and possibly all) cases of CSM.
Papillary Renal Neoplasm With Reverse Polarity
Authors: Al-Obaidy Khaleel I. , Eble John N. , Cheng Liang , Williamson Sean R. , Sakr Wael A. , Gupta Nilesh , Idrees Muhammad T. , Grignon David J.
Published: May 2019

We evaluated the clinicopathologic and chromosomal characteristics of a distinct subset of papillary renal tumors and compared them to a control series of papillary renal cell carcinoma types 1 and 2. Of the 18 patients, 9 were women and 9 were men, ranging in age from 46 to 80 years (mean, 64 y; median, 66 y). The tumors ranged in diameter from 0.6 to 3 cm (mean, 1.63 cm; median, 1.4 cm). Fourteen tumors were WHO/ISUP grade 2 and 4 were grade 1. All were stage category pT1. The tumors had branching papillae with thin fibrovascular cores, covered by cuboidal to columnar cells with granular eosinophilic cytoplasm, smooth luminal borders, and mostly regular and apically located nuclei with occasional nuclear clearing and inconspicuous nucleoli. Tubule formation and clear cytoplasmic vacuoles were observed in 5 and 9 tumors, respectively. Ten tumors had pseudocapsules. Psammoma bodies, necrosis, mitotic figures and intracellular hemosiderin are absent from all tumors. In contrast, papillary renal cell carcinoma type 1 consisted of delicate papillae covered by a single layer of cells with scanty pale cytoplasm with nuclei generally located in a single layer on the basement membrane of the papillary cores, while type 2 tumors had broad papillae covered by pseudostratified cells with eosinophilic cytoplasm and more randomly located nuclei. Both had occasional psammoma bodies, foamy macrophages and intracellular hemosiderin. Immunohistochemically, all were positive for pancytokeratin AE1/AE3, epithelial membrane antigen, MUC1, CD10, GATA3, and L1CAM. Cytokeratin 7 was positive in 16 tumors (1 had <5% positivity). CD117 and vimentin were always negative. α-methylacyl-CoA-racemase (AMACR/p504s) showed variable staining (range, 10% to 80%) in 5 tumors. However, all tumors in the control group were negative for GATA3 and positive for AMACR/p504s and vimentin immunostains. Fluorescence in situ hybridization analysis of the study group demonstrated chromosome 7 trisomy in 5 tumors (33%), trisomy 17 in 5 tumors (33%), and trisomy 7 and 17 in 3 tumors (20%). Chromosome Y deletion was found in 1 of 7 male patients and chromosome 3p was present in all tumors. No tumor recurrence or metastasis occurred. In summary, we propose the term papillary renal neoplasm with reverse polarity for this entity.