bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Peer Support on Colorectal Cancer Patients’ Adherence to Guideline-Concordant Multidisciplinary Care
Authors: Kanters Arielle E. , Morris Arden M. , Abrahamse Paul H. , Mody Lona , Suwanabol Pasithorn A.
Published: May 2018

BACKGROUND:

Multidisciplinary care is critical for the successful treatment of stage III colorectal cancer, yet receipt of adjuvant chemotherapy remains unacceptably low. Peer support, or exposure to others treated for colorectal cancer, has been proposed as a means to improve patient acceptance of cancer care.

OBJECTIVE:

The purpose of our study was to evaluate the effect of peer support on the attitudes of patients with colorectal cancer toward chemotherapy and their adherence to it.

DESIGN:

We conducted a population-based survey of patients with sage III colorectal cancer and compared demographics and adjuvant chemotherapy adherence after patient-reported exposure to peer support.

SETTINGS:

Patients were identified by using Surveillance, Epidemiology, and End Results Program cancer registries and were recruited 3 to 12 months after cancer resection.

PATIENTS:

All patients with stage III colorectal cancer who underwent colorectal resection between 2011 and 2013 and were located in the Detroit and Georgia regions were included.

MAIN OUTCOME MEASURES:

The main outcome measure was adjuvant chemotherapy adherence. Exposure to peer support was an intermediate outcome.

RESULTS:

Among 1301 patient respondents (68% response rate), 48% reported exposure to peer support. Exposure to peer support was associated with younger age, higher income, and having a spouse or domestic partner. Exposure to peer support was significantly associated with receipt of adjuvant chemotherapy (OR, 2.94; 95% CI, 1.89–4.55). Those exposed to peer support reported positive effects on attitudes toward chemotherapy.

LIMITATIONS:

This study has limitations inherent to survey research including the potential lack of generalizability and responses that are subject to recall bias. Additionally, the survey results do not allow for determination of the temporal relationship between peer support exposure and receipt of chemotherapy.

CONCLUSION:

Our study demonstrates that exposure to peer support is associated with higher adjuvant chemotherapy adherence. These data suggest that facilitated peer support programs could positively influence patient expectations and coping with diagnosis and treatment, thereby affecting the uptake of postoperative chemotherapy. See Video Abstract at http://links.lww.com/DCR/A587.
A Population-Based Cohort Analysis of Chemoradiation Versus Radiation Alone for Definitive Treatment of Stage I Anal Cancer in Older Patients
Authors: Buckstein Michael , Arens Yotam , Wisnivesky Juan , Gaisa Michael , Goldstone Stephen , Sigel Keith
Published: May 2018

BACKGROUND:

Although the benefit of chemoradiation over radiation therapy alone has been shown in randomized trials for stage II to III squamous cell of the anus, this benefit is not clear for patients with stage I cancer. Nevertheless, most societal recommendations endorse chemoradiation for patients with stage I squamous cell carcinoma of the anus despite the lack of proven benefit and potential increase in toxicity.

OBJECTIVE:

The purpose of this study was to determine whether outcomes are improved with the addition of chemotherapy versus radiation alone for stage I squamous cell carcinoma of the anus.

DESIGN:

This was a cohort analysis using Surveillance, Epidemiology and End Results registry linked to Medicare from 1996 to 2011. Propensity-score methods were used to control for potential confounding.

SETTINGS:

This was a population-based study.

PATIENTS:

Medicare eligible patients (age >65 y or with an eligible disability) with stage I squamous cell carcinoma of the anus treated with either definitive radiation alone or chemoradiation were included.

INTERVENTIONS:

Radiation or chemoradiation was the intervention.

MAIN OUTCOME MEASURES:

Overall survival, disease-free survival, cause-specific survival, colostomy-free survival, and acute or late toxicities were measured.

RESULTS:

A total of 200 patients with squamous cell carcinoma of the anus were identified who received chemoradiation versus 99 treated with lone radiotherapy. Median age was 72 years and did not differ by treatment (p = 0.6). Patients receiving chemoradiation had improved unadjusted overall survival compared with lone radiotherapy, but after adjustment using propensity-score methods there was no difference in overall survival (HR = 0.7 (95% CI, 0.4–1.0)), cause-specific survival (HR = 0.7 (95% CI, 0.3–1.6)), colostomy-free survival (HR = 1.1 (95% CI, 0.5–2.5)), or disease-free survival (HR = 0.9 (95% CI, 0.6–1.4)). Chemoradiation was associated with an increased risk of select early and late toxicities.

LIMITATIONS:

This is a retrospective series from an anonymous database. The data might not be relevant for younger, healthier patients.

CONCLUSIONS:

Lone radiation may be associated with adequate oncologic outcomes when used to treat older and sicker patients with stage I anal cancer. Physicians should discuss the potential benefits and harms of adding chemotherapy for the treatment of these patients. See Video Abstract at http://links.lww.com/DCR/A628.
Endovenous Thermal Ablation of Recurrent Varicose Veins due to Residual Great Saphenous Venous Insufficiency After Saphenous Venous Surgery: A Comparative Study
Authors: Hwang Jin Ho , Park Sang Woo , Chang Il Soo , Kim Ki Hyun , Kang Ji Hun
Published: May 2018

BACKGROUND

Redo surgery for recurrent varicose veins of the great saphenous vein (GSV) is technically more challenging than the initial surgery.

OBJECTIVE

To compare 980 and 1,470-nm endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) for the treatment of residual GSV insufficiency after saphenofemoral ligation ± stripping.

MATERIALS AND METHODS

Thirty-seven limbs in 29 patients with recurrent varicose veins were retrospectively evaluated. Patients were divided into 3 groups: 980-nm EVLA (group A), 1,470-nm EVLA (group B), and RFA (group C). Duplex ultrasonography, Venous Clinical Severity Score (VCSS), and adverse events were examined at intervals of 1 week, 1, 3, 6, and 12 months.

RESULTS

Complete closure was achieved in 35 (94.6%) limbs at 12 months. Venous Clinical Severity Score decrease in group C (3.6 ± 0.5) was significantly (p < .017) greater compared with that of group A (2.6 ± 0.9). Ecchymosis grade was significantly (p < .017) lower in group C (0.1 ± 0.3) than that in group A (1.6 ± 1.5).

CONCLUSION

Endovenous thermal ablation using EVLA or RFA is safe and effective for treatment of recurrent varicose veins resulting from residual GSV insufficiency after saphenous venous surgery. The RFA is superior to 980-nm EVLA in terms of postprocedural ecchymosis and improvement in VCSS.
Childhood Asthma Disparities in Chicago
Authors: Martin Molly A. , Kapheim Melissa Gutierrez , Erwin Kim , Ignoffo Stacy , McMahon Kate , O'Rourke Amy , Gerald Lynn B. , Barrett Meredith , Press Valerie G. , Darabi Houshang , Krishnan Jerry A.
Published: May 2018

We conducted a needs assessment to develop an evidence-based, locally tailored asthma care implementation plan for high-risk children with asthma in Chicago. Our team of health policy experts, clinicians, researchers, and designers included extensive stakeholder engagement (N = 162) in a mixed-methods community needs assessment. Results showed the lines of communication and collaboration across sectors were weak; caregivers were the only consistent force and could not always manage this burden. A series of recommendations for interventions and how to implement and measure them were generated. Cooperative, multidisciplinary efforts grounded in the community can target wicked problems such as asthma.
The Role of Family of Origin in Current Lifestyle Choices
Authors: Fonseca Ana Laura , Koyama Jill , Butler Emily A.
Published: May 2018

Many Americans are in poor health. This is acute for racial/ethnic minorities compared with the Non-Hispanic white population. A grounded theory approach was used to analyze semistructured qualitative interviews to identify perceptions of family-of-origin lifestyle choices in same-race and interracial couples. Several central themes emerged from the data including influence of family-of-origin eating patterns, lack of family-of-origin importance for physical activity, and romantic partner influence in eating and exercise. Findings provide evidence for the socialization of family of origin on lifestyle choices into adulthood and also suggest promising changes due to romantic partner.
A Review of Objective Measurement of Flap Volume in Reconstructive Surgery
Authors: Azzi Alain Joe , Hilzenrat Roy , Viezel-Mathieu Alex , Hemmerling Thomas , Gilardino Mirko
Published: May 2018

Background:

The utility and efficacy of 3-dimensional representation have been proven in bony reconstruction; however, its role in soft-tissue reconstruction remains limited. There is currently no reliable gold standard to objectively measure flap volume. This systematic review aims to summarize the available techniques used to objectively measure flap volume in reconstructive surgery.

Methods:

A systematic literature search was performed to identify all relevant articles describing objective techniques to quantify flap volume. The search included published articles in 3 electronic databases—Ovid MEDLINE, EMBASE, and PubMed.

Results:

A total of 16 studies were included. Flap volume was calculated using the following techniques: magnetic resonance imaging, computed tomography, 3-dimensional imaging and modeling, material templates, ultrasound, and weighing scales. Techniques and results of the included studies are summarized.

Conclusions:

This systematic review provides a summary of various published techniques for objective pre- or intraoperative quantification of flap volume in reconstructive surgery. The preliminary results from this review are promising, and we believe that 3-dimensional representation and objective quantification is the future of reconstructive flap surgery. More studies are needed to study the clinical relevancy and impact of the various imaging modalities reviewed and to develop automated volumetric measurement technology with improved accuracy, efficacy, and reproducibility.
Closed Posterior Levator Advancement in Severe Ptosis
Authors: Oh Lawrence J. , Wong Eugene , Bae Sol , Tsirbas Angelo
Published: May 2018

Background:

Repair of blepharoptosis from the posterior eyelid approach has usually been done utilizing a Müller’s muscle-conjuctival resection (MMCR) or an “open sky” technique. We present a new technique to advance the levator muscle from the posterior-approach in a closed fashion that can be used in patients with severe involutional ptosis.

Methods:

A retrospective chart review was performed for consecutive patients with severe involutional blepharoptosis during a 6-year period treated by a single surgeon with a Closed Posterior Levator Advancement. The inclusion criteria were good levator function (≥ 10 mm), graded response to phenylephrine (change in lid height, 0–5 mm), and no concomitant procedures. Severe involutional blepharoptosis was defined as a margin-to-reflex-distance-1 (MRD1) of ≤ 1.5 mm. Follow-up for all patients was a minimum of 9 months. The main outcome variables were MRD1, upper eyelid contour, intereye symmetry, and reoperation rates.

Results:

Three hundred three eyes from 192 patients, with severe ptosis were identified. The average age was 65 years, and the mean preoperative MRD1 was 0.3 mm. Postoperatively, mean MRD1 was 3.5 mm with a median improvement of 3.2 mm. The upper eyelid contour was deemed to be satisfactory by patient and surgeon in 98.3% of eyes. Intereye symmetry was excellent in 96% of our cohort. An overall revision rate of 1.8% was found.

Conclusions:

We present a new technique that involves an advancement of the levator muscle in a closed posterior eyelid approach. The technique has produced satisfactory outcomes in our cohort of patients with severe ptosis with a low revision rate.
Extended Use of Systemic Menopausal Hormone Therapy
Authors: KAUNITZ ANDREW M.
Published: May 2018

Because clinical trial data assessing more than 10 years of hormone therapy (HT) use are not available, providing guidance to menopausal women regarding duration of systemic HT is controversial. However, clinicians routinely encounter this issue in practice. Using available evidence and clinical experience, this chapter provides guidance for clinicians who care for patients who may be candidates for extended use of systemic HT.
A New Dual-purpose Quality Control Dosimetry Protocol for Diagnostic Reference-level Determination in Computed Tomography
Authors: Sohrabi Mehdi , Parsi Masoumeh , Sina Sedigheh
Published: May 2018

A diagnostic reference level is an advisory dose level set by a regulatory authority in a country as an efficient criterion for protection of patients from unwanted medical exposure. In computed tomography, the direct dose measurement and data collection methods are commonly applied for determination of diagnostic reference levels. Recently, a new quality-control-based dose survey method was proposed by the authors to simplify the diagnostic reference-level determination using a retrospective quality control database usually available at a regulatory authority in a country. In line with such a development, a prospective dual-purpose quality control dosimetry protocol is proposed for determination of diagnostic reference levels in a country, which can be simply applied by quality control service providers. This new proposed method was applied to five computed tomography scanners in Shiraz, Iran, and diagnostic reference levels for head, abdomen/pelvis, sinus, chest, and lumbar spine examinations were determined. The results were compared to those obtained by the data collection and quality-control-based dose survey methods, carried out in parallel in this study, and were found to agree well within approximately 6%. This is highly acceptable for quality-control-based methods according to International Atomic Energy Agency tolerance levels (±20%).
POSTERIOR SCLERAL CONTRACTION TO TREAT RECURRENT OR PERSISTENT MACULAR DETACHMENT AFTER PREVIOUS VITRECTOMY IN HIGHLY MYOPIC EYES
Authors: Zheng Linyan , Pan Anpeng , Zhu Shuangqian , Wu Yue , Dong Liang , Xue Anquan
Published: May 2018

Purpose:

To determine the efficacy of posterior scleral contraction (PSC) to treat recurrent or persistent macular detachment after previous vitrectomy in highly myopic eyes.

Methods:

We reviewed the medical records of patients with high myopia and recurrent or persistent macular detachment after previous vitrectomy treated with PSC at our hospital between April 2013 and March 2017. Fourteen eyes (14 patients; mean age, 58.93 ± 11.08 years) were included. Sclera cross-linked with genipin was used for PSC. The desired axial length decrease was 0.1-fold. The reattachment rate, best-corrected visual acuity, and axial length changes were evaluated.

Results:

The macular reattachment rate was 100%. In seven eyes with a silicone oil tamponade, the oil was successfully removed 2 weeks to 4 months after surgery. The best-corrected visual acuity improved significantly postoperatively (Snellen acuity improved from 20/1,000–20/400) (1.75 ± 0.90 vs. 1.34 ± 0.58 logarithm of the minimal angle of resolution; P < 0.05). Eight eyes (57.14%) improved; six eyes (43.86%) remained stable. The axial length decreased significantly postoperatively (31.32 ± 3.04 vs. 29.08 ± 3.05 mm; P < 0.05).

Conclusion:

Posterior scleral contraction is safe and effective for recurrent and persistent macular detachment after previous vitrectomy in highly myopic eyes. The silicone oil is removed after PSC, and vision can be preserved in these refractory cases.
ACCELERATED ONSET OF RETINAL TOXICITY FROM HYDROXYCHLOROQUINE USE WITH CONCOMITANT BREAST CANCER THERAPY
Authors: Sharma Aman , Maiz Alejandra M. , Tucker William R. , Cukras Catherine
Published: May 2018

Purpose:

To report a case of accelerated retinal toxicity due to hydroxychloroquine (HCQ) use for treatment of Sjögren syndrome in a patient treated with concomitant chemotherapy for breast cancer.

Methods:

Observational case report.

Results:

A 56-year-old white woman using 400 mg HCQ (7.1 mg/kg real body weight) daily for a total of 2 years and 10 months for treatment of Sjögren syndrome with concomitant use of docetaxel and cyclophosphamide therapy (21-day cycle, 4 cycles) followed by anastrozole for breast cancer, presented with visual complaints and findings of severe HCQ toxicity.

Conclusion:

Concomitant breast cancer therapy may have a synergistic effect with HCQ leading to accelerated retinal toxicity. As such potential acceleration is poorly understood, patients on HCQ who are treated with concomitant chemotherapy should be considered for more frequent retinal screenings to maximize safety and preservation of vision.
A Case of Corneal Neovascularization Misdiagnosed as Total Limbal Stem Cell Deficiency
Authors: Le Qihua , Samson C. Michael , Deng Sophie X.
Published: May 2018

Purpose:

To report a case of corneal neovascularization misdiagnosed as total limbal stem cell deficiency (LSCD).

Methods:

This is a case report of a 61-year-old woman who has a history of bilateral idiopathic scleritis, keratitis, and uveitis for more than 20 years. She was diagnosed with total LSCD in her left eye based on clinical presentation alone and was confirmed as a candidate for limbal transplantation at several major tertiary eye care centers in the United States. After referral to the Stein Eye Institute, in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) were performed to clarify the diagnosis.

Results:

Slit-lamp examination of the left eye revealed 360-degree severe thinning at the limbus and peripheral corneal pannus and neovascularization that spared the central cornea, a smooth epithelium without fluorescein staining at the central cornea, an uneven surface, and pooling of fluorescein at the peripheral cornea accompanied by minimal fluorescein staining of the sectoral peripheral epithelium. IVCM showed that epithelial cells in the central cornea exhibited a corneal phenotype and that the morphology of the epithelium in all limbal regions except the nasal limbus was normal. Epithelial cellular density and thickness were within the normal range. AS-OCT showed severe thinning in the limbus and a normal epithelial layer in the cornea and limbus. Based on the findings of IVCM and AS-OCT, we concluded that the patient had minimal LSCD, and limbal stem cell transplantation was not recommended.

Conclusions:

Clinical presentation alone is insufficient to correctly diagnose LSCD in complex cases. Additional diagnostic tests, such as IVCM, are necessary to confirm the diagnosis before any surgical intervention.
Interface Fungal Keratitis After Descemet Stripping Automated Endothelial Keratoplasty: A Review of the Literature With a Focus on Outcomes
Authors: McElnea Elizabeth , Power Billy , Murphy Conor
Published: May 2018

Purpose:

To examine the management and associated outcomes of reported cases of interface fungal infection after Descemet stripping automated endothelial keratoplasty (EK).

Methods:

A literature review identified reports of interface fungal infection after Descemet stripping automated EK. Data retrieved from the same included patient demographics, surgical procedure undertaken, donor rim culture result, clinical course, and outcome. A review of the relevant literature was also conducted.

Results:

Twenty-four cases of interface fungal infection after Descemet stripping automated EK were analyzed. Mean age of those affected was 66 years with range 52 to 85 years. Interface fungal infection after Descemet stripping automated EK was noted at a mean of 49.2 days postoperatively. Candida species were the causative infection in 79% cases. Penetrating keratoplasty was eventually performed in 79% of cases. The mean posttreatment best-corrected visual acuity was 0.44 logMAR.

Conclusions:

Penetrating keratoplasty is frequently required to eliminate interface fungal infection after Descemet stripping automated EK. A satisfactory visual outcome is usually achieved.
Radiotherapy for Active Thyroid Eye Disease
Authors: Godfrey Kyle J. , Kazim Michael
Published: May 2018

Purpose:

To critically review the published literature on orbital radiotherapy as a treatment modality for thyroid eye disease (TED).

Methods:

A systematic review and analysis of the relevant published literature was performed.

Results:

Thyroid eye disease is an autoimmune condition that is amenable to treatments that modulate the immune response, including orbital radiotherapy (ORT). Ideal candidates for ORT are patients in the early, active phase of TED with moderate to severe, or rapidly progressive, disease, including patients with significant motility deficits and compressive optic neuropathy. Patients with progressive strabismus may also benefit. Patients with mild or inactive disease will not benefit from ORT when compared with the natural history of the disease. Orbital radiotherapy should generally be used in conjunction with corticosteroid therapy, with response to corticosteroids demonstrating the immunomodulatory therapeutic potential of ORT. When treating TED-compressive optic neuropathy, ORT may help obviate the need for urgent surgical decompression, or postpone it until the stable, inactive phase of the disease. Orbital radiotherapy treatment doses should approach 20 Gy in most cases, but lower doses may be considered in younger patients without significant dysmotility. The safety profile of ORT is well established, and side effects are minimal in appropriately selected patients.

Conclusions:

Radiotherapy is a safe and effective treatment for active TED in appropriately selected patients.
Anatomic Variations of the Infraorbital Foramen in Caucasian Versus African American Skulls
Authors: Zhang Kevin R. , Blandford Alexander D. , Hwang Catherine J. , Perry Julian D.
Published: May 2018

Purpose:

The infraorbital foramen (IOF) represents a highly conserved structure but demonstrates morphologic variability. The purpose of this study is to describe the IOF location, size, and supernumerary foramina in an African American population and compare it with a Caucasian population.

Methods:

Sixty African American and 60 Caucasian skulls from the Hamann-Todd collection of the Cleveland Museum of Natural History were studied. The primary outcome was the number of accessory IOF and measurements of the location, size, shape, and direction of each foramen. Pearson chi-square, t tests, Fisher exact test, and Wilcoxon rank sum tests were used to analyze the data.

Results:

The African American population had a smaller vertical IOF diameter (mean = 2.81 mm) compared with the Caucasian population (mean = 3.08 mm) on the right side (p < 0.01). The distance from the IOF to the anterior nasal spine on the left side was greater in the African American population (mean = 33.93 mm) compared with the Caucasian population (Caucasian mean = 32.84 mm, p = 0.03). The distance from the IOF to the zygomaticomaxillary suture was significantly shorter in the African American population (mean = 11.85 mm) compared with the Caucasian population (mean = 13.21 mm) on the left side (p = 0.01). Accessory foramina were found in 13 Caucasian skulls (21.7%) and 6 African American skulls (10%; p = 0.08). Two distinct types of IOF existed in each population, one close to the main foramen and one within the sutura notha.

Conclusions:

The IOF is smaller and exits more laterally, with a lower proportion of accessory foramina in an African American population compared with a Caucasian population. Both groups exhibit 2 distinct types of IOF. These morphologic differences should be noted during surgeries and anesthetic planning to avoid neurovascular complications.
Health Outcomes of Youth in the United States Exposed to Parental Incarceration: An Integrative Review
Authors: Boch Samantha J. , Ford Jodi L.
Published: May 2018

In the United States, parental incarceration (PI) has been increasingly recognized as an understudied adverse childhood experience. In response, a rapidly expanding body of research has begun to investigate the effects of PI on youth mental and physical health outcomes.

Objective:

The purpose of this integrative review was to synthesize recent quantitative evidence investigating the effects of PI on youths' mental and physical health outcomes.

Design and Measures:

Electronic strategies were used to find relevant quantitative articles published between September 2006 and 2016 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses–Equity guidelines. Articles in the review (N = 17) varied in study design and methodologic rigor, complicating the analysis.

Results:

In general, U.S. youth exposed to PI are more likely than their unexposed peers to exhibit internalizing and externalizing behavioral difficulties. There is substantially less evidence on the associations between PI and the physical health of youth, in addition to the proposed linkages between exposure to PI and poor health. Overall, there is limited inclusion of contextual specifics of PI (e.g., type and duration of incarceration, relationship quality), which hampers generalizability.

Conclusion:

Future research could investigate the biological and social linkages between PI and health outcomes. Forensic nurses could help build supportive environments and meaningful behavioral health interventions to assist the health of those youth with a parent incarcerated.
Human Trafficking: How Nurses Can Make a Difference
Authors: Scannell Meredith , MacDonald Andrea E. , Berger Amanda , Boyer Nichole
Published: May 2018

Human trafficking is a human rights violation and a global health problem. Victims of human trafficking have medical and mental health sequelae requiring specific healthcare interventions. Healthcare professionals may be the initial contact that these victims make outside the world of trafficking. Healthcare professionals are key agents in the identification of human trafficking, which is essential in eliminating this public health problem. Unfortunately, healthcare professionals are not always able to detect signs of human trafficking. Failure to detect results in missed opportunities to assist victims. This is a case report of a victim of human trafficking who presented to an emergency department with medical and mental health issues. Despite numerous encounters with different healthcare professionals, signs and symptoms of human trafficking were not identified. Skilled assessment made by a forensic nurse alerted the healthcare team to clear features of human trafficking associated with this person. Through this case report we illustrate the key role the nurse played in identifying signs of human trafficking. Improvement of human trafficking educational programs is highlighted as a key adjunct to improving detection and facilitating the proper treatment of victims.
Injectable Nonsteroidal Anti-Inflammatory Drugs in Sport
Authors: Matava Matthew J.
Published: May 2018

Objective:

The primary objective of this article is to review the basic science of nonsteroidal anti-inflammatory drugs (NSAIDs), their clinical effects, indications, potential complications, and ethical issues associated with the use of injectable NSAIDs in the treatment of athletes. These objectives are presented taking into consideration the contemporaneous issues associated with the treatment of amateur and professional athletes.

Data Sources:

A nonformal review of the published medical literature and lay media focusing on the use of injectable NSAIDs in athletes was used for this article.

Main Results:

All NSAIDs work through the inhibition of the cyclooxygenase (COX) pathway (either one or both subtypes) to reduce inflammation and inhibit pain by reducing prostaglandin and thromboxane synthesis. Complications related to NSAID use involve primarily the gastrointestinal, renal, and cardiovascular systems through this COX pathway inhibition. Ketorolac is the only NSAID currently available in an injectable form. Despite its analgesic efficacy comparable with opioid medication, injectable ketorolac has the potential to cause bleeding in collision athletes resulting from impaired hemostasis.

Conclusions:

Nonsteroidal anti-inflammatory drug medications are currently used at every level of competition. Injectable ketorolac is an effective analgesic and anti-inflammatory drug. However, its potential effectiveness must be weighed against the risk of potential complications in all athletes, especially those who participate in contact/collision sports. The team physician must balance the goal of treating pain and inflammation with the ethical implications and medical considerations inherent in the administration of injectable medications solely to prevent pain and/or return the athlete to competition.
Endobronchial Ultrasound-guided Transbronchial Needle Aspiration With a 19-G Needle Device
Authors: Tremblay Alain , McFadden Seamus , Bonifazi Martina , Luzzi Valentina , Kemp Samuel V. , Gasparini Stefano , Chee Alex , MacEachern Paul , Dumoulin Elaine , Hergott Christopher A. , Shah Pallav L.
Published: May 2018

Background:

Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration is a well-established first-line minimally invasive modality for mediastinal lymph node sampling. Although results are excellent overall, the technique underperforms in certain situations. We aimed to describe our results using a new 19-G EBUS-guided transbronchial needle aspiration device to determine safety and feasibility of this approach.

Methods:

We completed a retrospective chart review of all cases performed to the time of data analysis at each of 3 study sites.

Results:

A total of 165 procedures were performed with a total of 297 individual lymph nodes or lesions sampled with the 19-G device by 10 bronchoscopists. Relatively large targets were selected for sampling with the device (mean lymph node size: 20.4 mm; lung lesions: 33.5 mm). A specific diagnosis was obtained in 77.3% of cases with an additional 13.6% of cases with benign lymphocytes, for a procedural adequacy rate of 90.9%. Procedure sample adequacy was 88.6% in suspected malignant cases, 91.0% in suspected sarcoidosis/lymphadenopathy cases, and 85.7% of cases with suspected lymphoma. On a per-node basis, a specific diagnosis was noted in 191/280 (68.2%) of samples, with an additional 61 showing benign lymphocytes for a per-node sample adequacy rate of 90%. One case (0.6%) of intraprocedure bleeding was noted.

Conclusions:

A new flexible 19-G EBUS needle was successfully and safely applied in a large patient cohort for sampling of lung and enlarged mediastinal lesions with high diagnostic rates across clinical indications.
Changes in Psychiatric and Medical Conditions and Health Care Utilization Following a Diagnosis of Sexual Assault
Authors: Young-Wolff Kelly C. , Sarovar Varada , Klebaner Daniella , Chi Felicia , McCaw Brigid
Published: May 2018

Introduction:

Sexual assault (SA) is alarmingly common and is associated with higher prevalence of psychiatric and medical conditions. However, many prior studies are limited to cross-sectional designs. Health care systems with electronic health records provide unique longitudinal data to examine whether SA is associated with changes in health and health care utilization.

Methods:

The sample included 1350 Kaiser Permanente Northern California adult female patients with a SA diagnosis from 2009 to 2015 and 4050 adult female patients without a SA diagnosis, matched on age, medical facility, and continuous enrollment during the study period. Using a retrospective cohort design, we tested whether a SA diagnosis was associated with 12-month changes in psychiatric and medical comorbidities and health care utilization using difference-in-difference models. Analyses were conducted in 2017.

Results:

Patients with a SA diagnosis had a higher prevalence of psychiatric and medical comorbidities and greater health care utilization than matched patients without SA in the 12 months before the SA diagnosis, and greater increases in the prevalence of psychiatric disorders and stress-related somatic conditions, and psychiatry and obstetrics/gynecology utilization (all P<0.001), 12 months after the SA diagnosis, relative to matched non-SA patients during this time.

Discussion:

SA is associated with increases in psychiatric disorders and stress-related somatic conditions as well as increases in utilization of psychiatry and obstetrics/gynecology. Clinicians should be trained in how to inquire about, respond to, and refer women who have experienced SA.
A Therapeutic Strategy for Resectable Pancreatic Cancer Based on Risk Factors of Early Recurrence
Authors: Kurahara Hiroshi , Maemura Kosei , Mataki Yuko , Sakoda Masahiko , Iino Satoshi , Kawasaki Yota , Arigami Takaaki , Mori Shinichiro , Kijima Yuko , Ueno Shinichi , Shinchi Hiroyuki , Natsugoe Shoji
Published: May 2018

Objectives

The aim of this study was to identify risk factors for early recurrence and assess the prognostic benefit of neoadjuvant therapy (NAT) for resectable pancreatic cancer.

Methods

Patients with radiographically resectable pancreatic cancer according to the National Comprehensive Cancer Network guidelines were enrolled. We regarded recurrence within 6 months after surgery as early recurrence.

Results

This study involved 115 patients (80 who underwent upfront surgery and 35 who received NAT). Serum carbohydrate antigen 19-9 greater than 85 U/mL and p53 expression in 0 or more than 80% of tumor cells were independent risk factors for early recurrence after upfront surgery. We classified patients into a high-risk group (1 or 2 risk factors) and a low-risk group (no risk factors). In the high-risk group, the median overall survival time of patients with NAT was significantly longer than that of patients without NAT (P = 0.028). By contrast, the median overall survival time was not different according to NAT in the low-risk group.

Conclusions

Serum carbohydrate antigen 19-9 and p53 expression of the primary tumor could be predictors of early recurrence in patients with resectable pancreatic cancer. The prognosis of patients with a high risk of early recurrence may be improved using NAT.
Neurophysiological Response to Olfactory Stimuli in Combat Veterans With Posttraumatic Stress Disorder
Authors: Bedwell Jeffrey S. , Bohil Corey J. , Neider Mark B. , Gramlich Michael A. , Neer Sandra M. , O'Donnell John P. , Beidel Deborah C.
Published: May 2018

There is a need for a better understanding of underlying pathology in posttraumatic stress disorder (PTSD) to develop more effective treatments. The late positive potential (LPP) amplitude from electroencephalogram has been used to assess individual differences in emotional reactivity. There is evidence that olfaction is particularly important in emotional processing in PTSD. The current study examined LPP amplitudes in response to olfactory stimuli in 24 combat veterans with PTSD and 24 nonmilitary/non-PTSD controls. An olfactometer delivered three negatively valenced odorants, with 12 trials of each delivered in a random order. The groups did not differ in LPP amplitude across odorants. However, within the PTSD group, higher Clinician-Administered PTSD Scale scores related to an increased LPP amplitude after diesel fuel and rotten egg, but not n_butanol, odorants. Results provide specific targets and theory for further research into clinical applications such as selection of idiographic odorants for use in virtual-reality exposure therapy.
Using a Clinician-Administered Interview to Examine the Overlap in Posttraumatic Stress Disorder Criteria D and E
Authors: Franklin C. Laurel , Raines Amanda M. , Walton Jessica L. , Chambliss Jessica L. , Maieritsch Kelly P.
Published: May 2018

Although the diagnosis of posttraumatic stress disorder (PTSD) is often criticized for including symptoms that overlap with one another, only one study has explored the impact of symptom reporting. Using a clinician-rated interview for PTSD (N = 558), the current study examined overlap between PTSD criteria D1, D2, and D3 (“target D symptoms”) and criterion E symptoms of similar content (i.e., E1 and E3). Furthermore, their impact on meeting criterion and disorder cutoffs was examined. Results revealed that target symptoms were endorsed in conjunction more than half the time. Criteria D and E also were often coded together. Removal of target D symptoms resulted in 24.7% of participants no longer meeting criterion D, but no reduction in the diagnosis of PTSD. This article is one of the first to report the functioning of the new criterion D symptoms, and the results have diagnostic implications for research and clinical work.
Burnout Among US Military Behavioral Health Providers
Authors: Stearns Shaun , Shoji Kotaro , Benight Charles C.
Published: May 2018

The present study investigated the prevalence of burnout among US military behavioral health providers (BHPs) and tested a mechanism of developing burnout in a job demands–resources model. Surveys were sent to BHPs working with US military populations globally (T1). Six months after, surveys were collected again at T2. In total, 271 providers completed T1, and 116 completed T2. The job demands–resources model showed that T1 burnout self-efficacy and support predicted T2 burnout and work engagement. T1 job demands predicted T2 burnout. To provide a deeper comparison of our findings, we included a meta-analysis, which indicated burnout among BHPs working on a military installation was equivalent with other professions. Providers working with military clients within the community reported lower burnout than other professionals. Findings suggest BHPs working on a military installation might be at greater risk of developing burnout. Burnout might be preventable by increasing job resources and decreasing job demands.
Self-esteem and Symptoms in Individuals at Clinical High Risk for Psychosis
Authors: Benavides Caridad , Brucato Gary , Kimhy David
Published: May 2018

Individuals with psychotic symptoms often report low global self-esteem (GSE). However, it remains unclear whether the low GSE is linked to the presence of psychotic symptoms or it is present before the onset of psychosis. In addition, the specific subdomains of GSE in these populations are unknown. To address this question, we conducted a cross-sectional study comparing global and SE elements among individuals at clinical high risk for psychosis (CHR; n = 36), individuals with schizophrenia (SCZ; n = 43), and healthy controls (HCs; n = 40). We then examined among CHR individuals the association between GSE, subdomains, and symptoms. CHR individuals displayed significantly lower GSE compared to HCs, at a level comparable with those for individuals with SCZ. The low GSE was driven primarily by self-perceptions of work and interpersonal relationships abilities. Lower GSE was associated with overall negative and disorganized symptoms severity, but not positive ones. The authors discuss the implications of the findings to intervention development.
Recovery From Schizophrenia
Authors: Santos Maria M. , Kopelowicz Alex , López Steven R.
Published: May 2018

This study examined the views about the future of persons with schizophrenia and their caregivers to understand what is at stake in engaging in recovery. The views of 60 Mexican-origin consumer-caregiver dyads were coded by three independent raters using a recovery literature-based coding system of recovery components: social relations, caregiving burden relief, independence, self-responsibility, and empowerment. General recovery expectations were also rated. Interrater reliability, component frequency, and congruence between the consumers and caregivers' expectations were statistically examined. Dominant recovery components for consumers and caregivers were independence (72.5%), general expectations for recovery (51%), and social relations (43%). Relatives differed in two important ways. Consumers held significantly greater expectations for independence (p < 0.01), whereas caregivers focused more on general recovery (p < 0.001). What matters for recovery for this sample of Mexican-origin consumers and caregivers differs. Addressing differences in views may facilitate person-centered treatment that considers the views of consumers and caregivers.
Bipolar Disorder Is Associated With an Increased Risk of Sexually Transmitted Infections: A Nationwide Population-based Cohort Study
Authors: Chen Shih-Fen , Wang Ling-Yi , Chiang Jen-Huai , Shen Yu-Chih
Published: May 2018

Background

Previous studies have suggested that sexually transmitted infections (STI) tend to increase in patients with bipolar disorder during a manic or hypomanic episode. However, in the long-term course of this disease, it is unclear whether patients with bipolar disorder have a higher risk of incident STI.

Methods

Using the National Health Insurance Research Database of Taiwan, 3721 patients with bipolar disorder and 14,884 controls without bipolar disorder matched by gender and age were enrolled between 2000 and 2010 and followed up until the end of 2013. Participants who developed any STI (human immunodeficiency virus [HIV], syphilis, genital warts, gonorrhea, chlamydial infection, and trichomoniasis) during the follow-up period were identified. Cox regression analysis was performed to examine the risk of STI between patients with bipolar disorder and comparative controls.

Results

Patients with bipolar disorder were prone to develop STI (hazard ratio [HR], 1.67, 95% confidence interval [95% CI], 1.27–2.18) especially for HIV (HR, 3.59; 95% CI, 1.16–11.08) and syphilis (HR, 2.26; 95% CI, 1.06–4.85). In addition, this study found that the incidence of STI was higher among women than men (HR, 1.83; 95% CI, 1.41–2.39).

Conclusions

This study shows that bipolar disorder is associated with an increased risk of developing STI, which has direct implications for the development of targeted prevention interventions or regular sexual health screening in mental health clinics to reduce the disproportionate burden of HIV and other STI in patients with bipolar disorder.
Performance of the Atlas Genetics Rapid Test for Chlamydia trachomatis and Women's Attitudes Toward Point-Of-Care Testing
Authors: Widdice Lea E. , Hsieh Yu-Hsiang , Silver Barbara , Barnes Mathilda , Barnes Perry , Gaydos Charlotte A.
Published: May 2018

Purpose

This study compared performance of the Atlas io polymerase chain reaction–based, point-of-care (POC) assay for Chlamydia trachomatis (CT), to Aptima Combo 2, a standard of care nucleic acid amplification assay, and evaluated patient attitudes toward POC testing.

Methods

Women 14 years or older undergoing CT screening/testing were recruited from Teen Health Center and a sexually transmitted disease clinic. Participants provided self-obtained vaginal swabs for testing with the Atlas io and Aptima Combo 2, and completed questionnaires assessing attitudes toward POC testing.

Results

Of 296 women recruited, 284 (192 from sexually transmitted disease clinic, 92 from Teen Health Center) had Aptima Combo 2 and Atlas io results available; 273 completed the questionnaire. Average age was 27.4 years (SD, 10.8 years). Sensitivity and specificity of the Atlas io test were 83.9% (26/31 specimens; 95% confidence interval [CI], 70.9–96.8%) and 98.8% (250/253 specimens; 95% CI, 97.5–100%), respectively. When specimens with discrepant results were included in the analyses, adjudicated sensitivity and specificity were 92.9% (26/28 specimens; 95% CI, 83.3 to 100%) and 98.8% (253/256 specimens; 95% CI, 97.5 to 100%), respectively.

A majority (70%) of women preferred to collect vaginal self-swab if a POC test were available. Most (61%) were willing to wait up to 20 minutes, and 26% were willing to wait up to 40 minutes for results, if they could be treated before leaving clinic.

Conclusions

A POC polymerase chain reaction test detecting CT had high sensitivity and specificity when testing prospective, vaginal swab samples. Availability of CT results during patients' visits may decrease time to treatment.
The Causality Nexus Between the Tako-tsubo Syndrome and an Assault
Authors: Zribi Malek , Manoubi Syrine Azza , Karray Narjes , Charfeddine Salma , Benamar Wiem , Hammami Zouhir , Kammoun Samir , Maatoug Samir
Published: May 2018

“Tako-tsubo” cardiomyopathy, also known as “broken heart syndrome,” is one of the rarest types of stress-induced cardiomyopathy. It frequently mimics acute coronary syndrome, characterized by transient left ventricular dysfunction, electrocardiographic changes, and release of myocardial enzymes. After treatment, the patients are cured in most cases without sequelae. Tako-tsubo syndrome is rarely considered as a reason for consultation in the forensic department.

Herein, we report a case of a 68-year-old woman who was assaulted by her police officer neighbor. The latter punched her in the arms and kneed her in the gut without causing any intrathoracic or abdominal injury. The victim was urgently hospitalized in the cardiology department for chest pain and dyspnea accompanied by ST-segment elevation and high troponin level.

Tako-tsubo cardiomyopathy diagnosis was based on clinical findings, echocardiography, coronary angiography, and magnetic resonance imaging findings. A forensic medicine consult was initially solicited for the drafting of an initial medical certificate and for evaluating the total transitory disability rate. A second consultation was then sought to evaluate the permanent partial disability.

We report this work to discuss the conduct of the forensic pathologist and to prove the causality relationship between the assault and the physical injuries.
A Fatal Outcome of Pica Syndrome
Authors: Bogdanovic Milenko , Alempijevic Djordje , Curcic Djordje , Durmic Tijana
Published: May 2018

We present the case of a 42-year-old man, with a medical history of schizophrenic psychosis, who was found dead on the floor of his bedroom. At the autopsy, a bottle lid with a notched edge was found in the lower pharynx, partially obstructing the larynx and thus keeping the epiglottis in an open position. Airway obstruction was caused by edema and inflammation of the surrounding tissue. After removal of the foreign body, the tissue of the larynx was left with an impression of the bottle lid. The adjacent mucosa was swollen, hyperemic, partly necrotic, and covered with fibrin deposits. Also, foreign bodies were found in the stomach. The histological analysis of the hypopharynx showed severe nonspecific inflammation and necrosis of epithelium. The cause of death was a complication of subacute laryngeal obstruction caused by a foreign body.