bluuebunny/crossref_metadata_2025 huggingface dataset:
Barriers to Collaborative Anesthetic Care Between Anesthesiologists and Nurses on the Labor and Delivery Unit: A Study Using Modified Delphi Technique
Authors: Fung L.Y. , Downey K. , Watts N. , Carvalho J.C.A.
Published: May 2018

(Can J Anaesth. 2017;64(8):836–844)

Teamwork between anesthesiologists and nurses is very important for patient safety and effective care, particularly in obstetric care. Barriers to effective teamwork between nurses and physicians are varied and can be difficult to identify, but may include lack of role clarity, intimidation and bullying, linguistic or cultural barriers, dependence on electronic systems, poor communication and hesitation to challenge the authority of the physician. The Delphi technique is a survey method used to minimize bias in group interviews and acquire a consensus of ideas from experts. This study uses a modified Delphi technique to gain consensus on the perceived barriers to collaboration between perinatal registered nurses and anesthesiologists in a tertiary labor and delivery unit.
Posttraumatic Stress Symptoms in Swedish Obstetricians and Midwives After Severe Obstetric Events: A Cross-sectional Retrospective Survey
Authors: Wahlberg Å. , Andreen Sachs M. , Johannesson K. , Hallberg G. , Jonsson M. , Skoog Svanberg A. , Högberg U.
Published: May 2018

(BJOG. 2017;124(8):1264–1271)

Health care professionals may experience psychological reactions such as posttraumatic stress disorder (PTSD) after encountering a severe obstetric incident. The term “second victim” has been used to refer to the distress reported by health care providers after involvement in a medical error or poor patient outcome. This can be detrimental to both the provider and their future patients. This current cross-sectional retrospective study assessed the traumatic experiences reported by obstetricians and midwives following a severe obstetric event, the risk factors for developing PTSD, and the short-term and long-term professional consequences following such severe events.
The Effect of a Multidisciplinary Obstetric Emergency Team Training Program, the in Time Course, on Diagnosis to Delivery Interval Following Umbilical Cord Prolapse: A Retrospective Cohort Study
Authors: Copson S. , Calvert K. , Raman P. , Nathan E. , Epee M.
Published: May 2018

(Aust N Z J Obstet Gynaecol. 2017;57(3):327–333)

Although the overall incidence of cord prolapse is 0.1% to 0.6%, it often appears in perinatal mortality inquiries, with a perinatal mortality rate of 91 in 1000 in the setting of cord prolapse. Cord prolapse is also significantly associated with spastic quadriplegic or dyskinetic cerebral palsy in both term and preterm infants. In order to optimize perinatal outcome in cases of cord prolapse where there is evidence of fetal distress, a diagnosis to delivery interval (DDI) of <30 minutes has been recommended, but there is no evidence that demonstrates an association between a more rapid DDI and improved neonatal outcomes below this 30-minute interval. On the basis of previous studies, it has also been recommended that all staff involved in maternity care receive training in the management of cord prolapse, in order to avoid the poor communication and confusion about roles and responsibilities shown to be associated with poor outcomes.
Reliability of Pressure Waveform Analysis to Determine Correct Epidural Needle Placement in Laboring Women
Authors: Al-Aamri I. , Derzi S.H. , Moore A. , Elgueta M.F. , Moustafa M. , Schricker T. , Tran D.Q.
Published: May 2018

(Anaesthesia. 2017;72(7):840–844)

Epidural failure is a significant problem in obstetric anaesthesia with one survey of parturients reporting a failure rate of 23%. There can be many causes of epidural failure, including technical failure due to misidentification of the epidural space. A false loss-of-resistance during epidural needle advancement is a common cause of misidentification. Pressure waveform analysis has been used to provide confirmation of correct epidural needle position when the loss-of-resistance technique was used to identify the epidural space during thoracic epidural procedures. Accurate needle placement is confirmed if a pulsatile waveform synchronized with arterial pulsations is seen. In one study, the failure rate decreased from 24% with loss-of-resistance only to 2% with the addition of pressure waveform analysis. However, the reliability of this technique for lumbar epidural analgesia for labor is unclear. This observational study was performed to determine the reliability of pressure waveform analysis in identifying accurate epidural needle placement during lumbar epidural insertion for labor analgesia.
Patient Selection for Later Delivery Timing With Suspected Previa-accreta
Authors: Perlman N.C. , Little S.E. , Thomas A. , Cantonwine D.E. , Carusi D.A.
Published: May 2018

(Acta Obstet Gynecol Scand. 2017;96(8):1021–1028)

There is a lack of agreement among organizations regarding the recommended timing of delivery for patients with placenta previa-accreta. The American Congress of Obstetricians and Gynecologists and The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) suggest scheduled delivery at 34 weeks and 34 to 356/7 weeks, respectively, while the Royal College of Obstetricians and Gynaecologists does not recommend delivery before 36 to 37 weeks’ gestation for asymptomatic women. Avoiding emergency hemorrhage and other forms of maternal morbidity is an argument for early delivery, but alternatively, there have been findings of adverse neonatal outcomes when women with placental implantation abnormalities deliver prematurely. This study aimed to provide guidance for individualized patient care, hypothesizing that as maternal morbidity in these patients is driven by unscheduled delivery, hemorrhage due to hypervascularity and placental invasion, and surgical complexity, patients at high risk of these outcomes may benefit from earlier planned delivery while those at lower risk may have later deliveries.
Pregnancy Outcomes in Women With Mechanical Prosthetic Heart Valves: A Prospective Descriptive Population-based Study Using the United Kingdom Obstetric Surveillance System (UKOSS) Data Collection System
Authors: Vause S. , Clarke B. , Tower C.L. , Hay C. , Knight M.
Published: May 2018

(BJOG. 2017;124(9):1411–1419)

Because pregnancy is considered a thrombogenic state, it is a time of significant risk for women with mechanical prosthetic heart valves (MPHVs). While the number of women with MHPVs becoming pregnant is believed to be on the rise, a lack of good quality data on maternal mortality and complications in this patient population impedes optimal clinical management. This current study was undertaken to determine how many women with MPHVs become pregnant each year in the United Kingdom, the incidence of fetal and maternal complications, and any association between the risk of complications and the type of anticoagulation regimen used.
Finding the Breech: Influence of Breech Presentation on Mode of Delivery Based on Timing of Diagnosis, Attempt at External Cephalic Version, and Provider Success With Version
Authors: Andrews S. , Leeman L. , Yonke N.
Published: May 2018

(Birth. 2017;44(3):222–229)

Breech presentation accounts for 10% to 15% of cesarean deliveries in the United States. Cesarean delivery presents maternal risks and risk for future pregnancies. External cephalic version has a 60% success rate and is effective in decreasing cesarean deliveries. Optimal timing for external cephalic version is 36 to 37 weeks. At a later gestational age, advanced labor or rupture of membranes may prevent external cephalic version. This study investigated the connection between gestational age when breech presentation is diagnosed and the likelihood of a vaginal delivery, hypothesizing that the likelihood of vaginal delivery and external cephalic version would decrease if there was a failure to diagnose breech presentation before 38 weeks’ gestation.
The Effect of Ondansetron on Acute Opioid Tolerance in Patients Receiving Intrathecal Opioids Before Cesarean Delivery
Authors: Greer K.C. , Terkawi A.S. , Tsang S. , Singla P. , Durieux M.E. , Tiouririne M.
Published: May 2018

(Reg Anesth Pain Med. 2017;42(5):669–673)

Acute opioid tolerance (AOT) and opioid-induced hyperalgesia have recently been raised as concerns associated with the use of opioids as an adjunct to local anesthetics in subarachnoid block for cesarean delivery. Ondansetron has been shown in animal studies to significantly prevent and reverse AOT and opioid-induced hyperalgesia. Such effects have not yet been examined in humans, so this study aimed to investigate whether intravenous (IV) ondansetron would attenuate opioid-induced AOT. The study hypothesized that patients receiving IV ondansetron prior to cesarean delivery would require fewer opioids and have better postoperative pain scores compared with those who did not receive IV ondansetron.
Effect of Intravenous Dexmedetomidine During General Anesthesia on Acute Postoperative Pain in Adults
Authors: Wang Xiuqin , Liu Naifu , Chen Jinlong , Xu Zan , Wang Fumei , Ding Chuan
Published: May 2018

Background:

Dexmedetomidine has been shown to have an analgesic effect. However, no consensus was reached in previous studies.

Methods:

Electronic databases such as PubMed, Embase, and Cochrane Central were searched for relevant randomized controlled trials. The relative risk and weighted mean difference (WMD) were used to analyze the outcomes. Random-effects model was used for meta-analysis.

Results:

Compared with the normal saline group, patients using DEX showed a significantly decreased pain intensity within 6 hours [WMD=−0.93; 95% confidence interval (CI), −1.34 to −0.53) and at 24 hours after surgery (WMD=−0.47; 95% CI, −0.83 to −0.11). DEX usage significantly reduced the cumulative opioids consumption at 24 hours after surgery (WMD=−6.76; 95% CI, −10.16 to −3.35), decreased the rescue opioids consumption in postanesthesia care unit (WMD=−3.11; 95% CI, −5.20 to −1.03), reduced the risk of rescue analgesics (relative risk=0.49; 95% CI, 0.33-0.71), and the interval to first rescue analgesia was prolonged (WMD=34.93; 95% CI, 20.27-49.59).

Conclusions:

Intravenous DEX effectively relieved the pain intensity, extended the pain-free period, and decreased the consumption of opioids during postoperative recovery of adults in general anesthesia.
Dynamic Contrast-Enhanced Ultrasound Identifies Microcirculatory Alterations in Sepsis-Induced Acute Kidney Injury
Authors: Lima Alexandre , van Rooij Tom , Ergin Bulent , Sorelli Michele , Ince Yasin , Specht Patricia A. C. , Mik Egbert G. , Bocchi Leonardo , Kooiman Klazina , de Jong Nico , Ince Can
Published: May 2018

Objectives:

We developed quantitative methods to analyze microbubble kinetics based on renal contrast-enhanced ultrasound imaging combined with measurements of sublingual microcirculation on a fixed area to quantify early microvascular alterations in sepsis-induced acute kidney injury.

Design:

Prospective controlled animal experiment study.

Setting:

Hospital-affiliated animal research institution.

Subjects:

Fifteen female pigs.

Interventions:

The animals were instrumented with a renal artery flow probe after surgically exposing the kidney. Nine animals were given IV infusion of lipopolysaccharide to induce septic shock, and six were used as controls.

Measurements and Main Results:

Contrast-enhanced ultrasound imaging was performed on the kidney before, during, and after having induced shock. Sublingual microcirculation was measured continuously using the Cytocam on the same spot. Contrast-enhanced ultrasound effectively allowed us to develop new analytical methods to measure dynamic variations in renal microvascular perfusion during shock and resuscitation. Renal microvascular hypoperfusion was quantified by decreased peak enhancement and an increased ratio of the final plateau intensity to peak enhancement. Reduced intrarenal blood flow could be estimated by measuring the microbubble transit times between the interlobar arteries and capillary vessels in the renal cortex. Sublingual microcirculation measured using the Cytocam in a fixed area showed decreased functional capillary density associated with plugged sublingual capillary vessels that persisted during and after fluid resuscitation.

Conclusions:

In our lipopolysaccharide model, with resuscitation targeted at blood pressure, contrast-enhanced ultrasound imaging can identify renal microvascular alterations by showing prolonged contrast enhancement in microcirculation during shock, worsened by resuscitation with fluids. Concomitant analysis of sublingual microcirculation mirrored those observed in the renal microcirculation.
Tiny Moments Matter: Promoting Professionalism in Everyday Practice
Authors: Bernabeo Elizabeth C. , Chesluk Benjamin , Lynn Lorna
Published: May 2018

Introduction:

Professionalism rests upon a number of individual, environmental, and societal level factors, leading to specific professional behavior in specific situations. Focusing on professional lapses to identify and remediate unprofessional physicians is incomplete. We explored professionalism in practicing internal medicine physicians in the context of everyday practice, to highlight how typical experiences contribute to positive, yet often unnoticed, professional behavior.

Methods:

In-depth interviews were used to uncover 13 physicians' most meaningful experiences of professionalism. Data were collected and analyzed using a grounded theory approach.

Results:

Results revealed several themes around which physicians embody professionalism in their daily lives. Physicians feel most professional when they are able to connect and establish trust with patients and colleagues and when they serve as positive role models to others. Physicians conceptualize professionalism as a dynamic and evolving competency, one that requires a lifelong commitment and that provides opportunities for lifelong learning.

Discussion:

Focusing on actual perceptions of experiences in practice offers important insights into how physicians think about professionalism beyond a traditional remediation and lapses perspective. Physicians often go out of their way to connect with patients and colleagues, serving and modeling for others, often at the expense of their own work-life balance. These moments help to infuse energy and positivity into physician practices during a time when physicians may feel overburdened, overscheduled, and overregulated. Understanding professionalism as developmental helps frame professionalism as a lifelong competency subject to growth and modification over time.
Plexiform Atypical Spitz Tumor With Rosette-Like Giant Cells: A Histologic and Immunohistochemical Study on a Case Suggesting Ganglioneuroblastic Differentiation: Review of the Literature and Considerations on Histogenesis
Authors: Castelli Elena , Orlando Elisabetta , Pistone Giuseppe , Bongiorno Maria R.
Published: May 2018

Spitz nevi, atypical Spitz tumors and Spitzoid melanoma, the three clinicopathologic forms that constitute the spectrum of the Spitz-type melanocytic lesions, share a histologic picture characterized by large spindle and/or epithelioid ganglion-like cells, with various admixtures of multinucleate bizarre cells. This remarkable cytology has always been interpreted as an unusual, as well as unexplained form of atypia. We report a case of atypical Spitz tumor with Homer Wright–like rosettes, a feature characteristic of ganglioneuroblastic proliferation. Furthermore, the ganglion-like cells of the tumor showed basophilic punctuation in the cytoplasm, reminiscent of Nissl substance, and a few cells, whether spindled or epithelioid, were positive to neuron-specific enolase and glial fibrillary acid protein. Based on our findings, we hypothesize that the outstanding similarity of the ganglion-like cells of Spitz tumors to the normal parasympathetic ganglion cells and to the cells of ganglioneuroma and ganglioneuroblastoma may not be fortuitous. Instead, it may represent the expression of a specific pattern of melanocytic differentiation, analogous to the neurotization of common and cellular blue nevi, although in this case, it would privilege the parasympathetic lineage over the Schwannian, perineural, or endoneural pathway. Our hypothesis is supported by the literature reports of rosette formation and frank ganglioneuroblastic differentiation in Spitz tumors and melanoma and by the demonstration that parasympathetic neurons take origin from the same tracts of the neural crest as other neural and melanocytic cells.
Heavily Pigmented Epithelioid Melanoma With Loss of Protein Kinase A Regulatory Subunit-α Expression
Authors: Cohen Jarish N. , Spies Jessica A. , Ross Fawn , Bohlke Angela , McCalmont Timothy H.
Published: May 2018

Heavily pigmented melanocytic neoplasms are genotypically and phenotypically diverse. Recently, a subset of this histopathologic spectrum was shown to harbor recurrent genetic alterations in the gene-encoding protein kinase A regulatory subunit-α (PRKAR1A). To date, no histopathologic descriptions of melanomas arising from this pathway have been described. We present a case of a darkly pigmented papule arising on the posterior neck of a 28-year-old man. Microscopically, the heavily pigmented compound melanocytic proliferation was centered in the dermis with permeation into the superficial subcutis. Tumor cells were arranged in large confluent nests and fascicles and lacked maturation with descent. The epithelioid melanocytes were characterized by enlarged vesicular nuclei with prominent nucleoli, nuclear pleomorphism, and plentiful gray-brown granular cytoplasm. Mitotic figures were readily identified. By immunohistochemistry, melanocytes were positive for mutant BRAF V600E and showed loss of Prkar1α and p16 expression. A multiplex MART-1/tyrosinase/phosophohistone-H3 immunostain demonstrated an increased mitotic index in melanocytes. The combination of highly atypical cytomorphology and architecture, increased mitoses, and p16 expression loss compelled the diagnosis of melanoma. Overall, we present the first clinicopathologic description of a PRKAR1A-inactivated melanoma to highlight morphological features and discuss mimics that may enter the differential diagnosis.
Early Self-Regulation, Early Self-Regulatory Change, and Their Longitudinal Relations to Adolescents' Academic, Health, and Mental Well-Being Outcomes
Authors: Howard Steven J. , Williams Kate E.
Published: May 2018

Objective:

To evaluate the extent to which early self-regulation and early changes in self-regulation are associated with adolescents' academic, health, and mental well-being outcomes.

Methods:

Data were collected from 1 of the cohorts in a large dual-cohort cross-sequential study of Australian children. This cohort consisted of a nationally representative data set of 4983 Australian children assessed at 4 to 5 years of age, who were followed longitudinally to 14 to 15 years of age. Using regression within a path analysis framework, we first sought to investigate associations of early self-regulation (at 4–5 years and 6–7 years of age) with a broad range of academic, health, and mental well-being outcomes in adolescence (at 14–15 years). We next investigated the extent to which an early change in self-regulation (from 4 to 7 years of age) predicted these adolescents' outcomes.

Results:

Early self-regulation predicted the full range of adolescents' outcomes considered such that a 1-SD increase in self-regulation problems was associated with a 1.5- to 2.5-times greater risk of more-negative outcomes. An early positive change in self-regulation was associated with a reduced risk of these negative outcomes for 11 of the 13 outcomes considered.

Conclusion:

These results suggest the potential of early self-regulation interventions, in particular, in influencing long-term academic, health, and well-being trajectories.
Preemptive Analgesia Decreases Pain Following Anorectal Surgery: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Trial
Authors: Van Backer Justin T. , Jordan Matthew R. , Leahy Danielle T. , Moore Jesse S. , Callas Peter , Dominick Timothy , Cataldo Peter A.
Published: May 2018

BACKGROUND:

Postoperative pain is a frequent cause for delayed discharge following outpatient procedures, including anorectal surgery. Both central and peripheral pain receptor sensitization are thought to contribute to postoperative pain. Blocking these receptors and preempting sensitization prevents hyperalgesia leading to lower pain medication requirements. Studies in the orthopedic, urologic, and gynecologic literature support this practice, but the use of preemptive analgesia in anorectal surgery is understudied.

OBJECTIVE:

This study aimed to evaluate the effectiveness of preemptive analgesia in decreasing postoperative pain.

DESIGN:

This is a randomized, double-blinded, placebo-controlled trial.

SETTING:

This study was conducted at the University of Vermont Medical Center, a tertiary care referral center in Burlington, Vermont.

PATIENTS:

Patients who were over 18 years of age, ASA Physical Status Classes I, II, or III, and undergoing surgery for anal fissure, fistula or condyloma or hemorrhoids were selected.

INTERVENTIONS:

Preoperative oral acetaminophen and gabapentin followed by intravenous ketamine and dexamethasone were given before incision compared with oral placebos.

MAIN OUTCOME MEASURES:

The primary outcomes measured were postoperative pain scores, percentage of patients utilizing breakthrough narcotics, and rates of side effects.

RESULTS:

Ninety patients were enrolled. Because of patient withdrawal, screen failures, and loss to follow-up, 61 patients were analyzed (30 in the preemptive analgesia group and 31 in the control group). Patients in the active group had significantly less pain in the postanesthesia care unit and at 8 hours postoperatively. Significantly fewer participants in the active group used narcotics in the postanesthesia care unit and at 8 hours postoperatively. Average pain scores were excellent for both groups. There was no difference in the number of medication-related side effects between the 2 groups.

LIMITATIONS:

This study was limited by the small sample size and excellent pain control in both groups.

CONCLUSIONS:

Preemptive analgesia is safe and results in decreased pain in the early postoperative period following anorectal surgery. It should be implemented by surgeons performing these procedures. See Video Abstract at http://links.lww.com/DCR/A588.
Outcomes of Community-Based Prenatal Education Programs for Pregnant Women in Rural Texas
Authors: Ramsey Joseph , Mayes Brandii
Published: May 2018

A prenatal, evidenced-based education program was implemented in 7 rural counties and provided by trained staff at the Texas Department of State Health Services. This was implemented to address health disparities, in regard to birth outcomes, in rural minorities of Southeast Texas. The participants were given a preassessment (N = 382) and a postassessment (N = 326) of relevant health knowledge and a follow-up assessment (N = 149) to document the outcomes of their birth as well as health practices they were employing as new parents. The assessment results were analyzed to determine the effectiveness of the programs on improving health outcomes and knowledge.
Health Self-Empowerment Theory
Authors: Tucker Carolyn M. , Roncoroni Julia , Wippold Guillermo M. , Marsiske Michael , Flenar Delphia J. , Hultgren Kristin
Published: May 2018

Health Self-Empowerment Theory asserts that 5 controllable psychological variables predict engagement in health-promoting behaviors. This study tests the theoretical integrity of Health Self-Empowerment Theory and its usefulness in predicting health-promoting behaviors and body mass index. Results from surveying 189 predominantly low-income, overweight/obese, and culturally diverse adults showed that most Health Self-Empowerment Theory variables were positively correlated. Structural equation modeling showed that 4 variables significantly predicted engagement in health-promoting behaviors, which mediated the relationships between body mass index and (a) motivation, (b) health self-efficacy, and (c) self-praise. Results support creating psychologically informed interventions to increase engagement in health-promoting behaviors and decrease body mass index among low-income adults, particularly racial/ethnic minorities, at risk for obesity-related health problems.
Trapeziectomy with Interpositional Arthroplasty using Acellular Dermal Matrix: Description of Technique and Early Outcomes
Authors: Cockcroft April C. , Markelov Alexey M.
Published: May 2018

Background:

Trapeziectomy with interpositional arthroplasty using Repriza acellular dermal matrix is a novel technique to treat primary and secondary carpometacarpal joint arthritis. Early studies with nonautograft interposition indicate promising post-trapeziectomy space maintenance with results similar to ligament reconstruction with tendon interposition, without the potential risks and increased operating time of harvesting a tendon autograft.

Methods:

Eleven patients in a retrospective cohort were followed for a minimum of 6 weeks (mean, 12). Subjective and objective data were collected to assess pain, subjective improvement of symptoms, radiographic measurements of first metacarpal subsidence, key pinch strength, grip strength, and range of motion.

Results:

Early outcomes in our cohort compare favorably to other treatment series. On average, patients received a significant pain reduction of 63%, with 36% of patients admitting to complete pain resolution. One hundred percentage of patients admitted to overall subjective improvement in symptoms. Ninety-one percentage of patients achieved postoperative opposition of the thumb and fifth digit. Comparison with preoperative x-rays showed mean thumb metacarpal subsidence of 27%. Zigzag deformity and extra-articular acellular dermal matrix migration, due to lack of patient compliance with splint, were observed complications. Only 8.3% subsidence was observed with an impressive 45% pain reduction, in a salvage patient after revision surgery for a NuGrip implant.

Conclusions:

In conclusion, this is a safe and effective primary or salvage technique for Eaton grades III and IV thumb carpometacarpal arthritis with a mean subsidence within the range observed with ligament reconstruction with or without tendon interposition. Long-term study with a larger sample size is needed to investigate this technique further.
Does Sensory Retraining Improve Subjective Rating of Sensory Impairment after Bilateral Sagittal Split Osteotomy?
Authors: Yang Yea-Ling , Wen-Ching Ko Ellen , Chen Yu-Ray , Huang Chiung Shing
Published: May 2018

Background:

Sensory retraining could ameliorate neurosensory disturbance (NSD) resulting from the injury of the inferior alveolar nerve after a bilateral sagittal split osteotomy (BSSO). The aim of this study was to measure the effects of sensory retraining on NSD.

Methods:

A randomized, prospective, single-blinded clinical trial was conducted on consecutive patients with NSD resulting from a BSSO to correct skeletal class III malocclusion. The outcome measurement of sensory recovery was performed using a patient-centered survey assessed by the total score of questionnaire (TSQ) and visual analogue scale (VAS) at preoperation (T0), 1 week after surgery (T1), each month from 1 to 6 months after surgery (T2–T7), and 1 year after surgery (T8).

Results:

In total, 115 consecutive patients were randomized into a control group (56 patients without sensory retraining) or study group (59 patients with sensory retraining). TSQ and VAS values continually decreased from T1 to T8 in both groups. The study group tended to have lower, but not significantly lower, TSQ and VAS values than the control group at each postoperative time point. Women and men responded similarly to sensory retraining at each time point. The oldest patients did not respond well to sensory retraining, compared with the youngest patients, from T1 to T8, and this age effect evaluated by the VAS reached a significant difference at T7 and T8.

Conclusion:

NSD, assessed by the TSQ and VAS, continually decreased over time after the BSSO. Sensory retraining could improve NSD, but not significantly.
Primary Double Eyelid Surgery—Trapezoidal Debulking of Upper Eyelid Tissues
Authors: Chen William P. D.
Published: May 2018

The video illustrates the steps of Asian blepharoplasty of the upper eyelids, using the author's principle of beveled approach and trapezoidal debulking of preaponeurotic platform to allow safe access, minimization of wound injury, and creating a physiologically dynamic crease, without resorting to the use of buried sutures.
LONG-TERM PROGNOSTIC FACTORS FOR VISUAL IMPROVEMENT AFTER EPIRETINAL MEMBRANE REMOVAL
Authors: Jeon Sohee , Jung Byungju , Lee Won Ki
Published: May 2018

Purpose:

To identify prognostic factors that may predict the amount of long-term visual improvement after idiopathic epiretinal membrane removal.

Methods:

A retrospective study of 114 patients who underwent epiretinal membrane removal was performed. The central foveal thickness, inner retinal layer thickness, inner retinal irregularity index, length of the cone outer segment tip line defect, and length of the ellipsoid zone defect were measured. The optical coherence tomography parameters that were associated with the amount of visual improvement were determined at 24 months postoperatively.

Results:

Central foveal thickness and inner retinal irregularity index were not associated with best-corrected visual acuity at 24 months (P = 0.227 and P = 0.544, respectively), whereas the lengths of cone outer segment tip line defect and ellipsoid zone defect were associated with worse best-corrected visual acuity at 24 months (P = 0.015 and P < 0.001, respectively). Univariate regression analysis indicated that central foveal thickness and inner retinal irregularity index were associated with visual improvement (P = 0.011 and P < 0.001, respectively). Multivariate regression analysis indicated that inner retinal irregularity index, a marker of the inner retinal deformation, was associated with visual improvement after adjusting for age, gender, and other optical coherence tomography findings (P < 0.001).

Conclusion:

Patients with preoperative inner retinal deformation were found to have significantly improved long-term visual outcomes after epiretinal membrane removal.
Femtosecond Laser–Assisted Graft Preparation for Descemet Membrane Endothelial Keratoplasty
Authors: McKee Hamish D. , Jhanji Vishal
Published: May 2018

Purpose:

To describe a technique of using a femtosecond laser to assist with graft preparation for Descemet membrane endothelial keratoplasty (DMEK).

Methods:

A femtosecond laser was used to assist in graft preparation for 3 DMEK procedures. The donor cornea is mounted on a proprietary artificial anterior chamber. A partial thickness deep circular cut is made with the femtosecond laser through the endothelium, Descemet membrane, and posterior stroma. Graft preparation is then completed without the use of a corneal trephine.

Results:

In all cases, graft preparation was successfully completed. Pterygium on a donor cornea resulted in an incomplete cut in 1 case that was finished manually. Subsequent keratoplasties resulted in clear corneas with endothelial cell counts within the expected range.

Conclusions:

The femtosecond laser may be a useful adjunct in graft preparation for DMEK.
Ocular Findings in Exfoliation Syndrome
Authors: Ritch Robert
Published: May 2018

Exfoliation syndrome is characterized by numerous ocular manifestations, the most important of these being glaucoma and cataract. Its ocular manifestations affect all of the structures of the anterior segment as well as conjunctiva and orbital structures. Exfoliation material is seen most prominently as characteristic white deposits on the anterior surface of the lens and the pupillary border of the iris. Both open-angle and angle-closure glaucoma are intimately associated with exfoliation syndrome. Other findings include zonular disruption, iris sphincter fibrosis, keratopathy, ocular surface disease, and retinal vein occlusion.
Deep-learning Classifier With an Ultrawide-field Scanning Laser Ophthalmoscope Detects Glaucoma Visual Field Severity
Authors: Masumoto Hiroki , Tabuchi Hitoshi , Nakakura Shunsuke , Ishitobi Naofumi , Miki Masayuki , Enno Hiroki
Published: May 2018

Purpose:

To evaluate the accuracy of detecting glaucoma visual field defect severity using deep-learning (DL) classifier with an ultrawide-field scanning laser ophthalmoscope.

Methods:

One eye of 982 open-angle glaucoma (OAG) patients and 417 healthy eyes were enrolled. We categorized glaucoma patients into 3 groups according to the glaucoma visual field damage (Humphrey Field Analyzer 24-2 program) [early; −6 dB (mean deviation) or better, moderate; between −6 and −12 dB, and severe as mean deviation of −12 dB or worse]. In total, 558 images (446 for training and 112 for grading) from early OAG patients, 203 images (162 for training and 41 for grading) from moderate OAG patients, 221 images (176 for training and 45 for grading) from severe OAG patients and 417 images (333 for training and 84 for grading) from normal subjects were analyzed using DL. The area under the receiver operating characteristic curve (AUC) was used to evaluate the accuracy after 100 trials.

Results:

The mean AUC between normal versus all glaucoma patients was 0.872, the sensitivity was 81.3% and the specificity was 80.2%. In normal versus early OAG, mean AUC was 0.830, the sensitivity was 83.8% and the specificity was 75.3%. In normal versus moderate OAG, mean AUC was 0.864, sensitivity was 77.5%, and specificity was 90.2%. In normal versus severe OAG glaucoma mean AUC was 0.934, sensitivity was 90.9%, and specificity was 95.8%.

Conclusions:

Despite using an ultrawide-field scanning laser ophthalmoscope, DL can detect glaucoma characteristics and glaucoma visual field defect severity with high reliability.
Influence of Sociodemographic Factors on Disease Characteristics and Vision-related Quality of Life in Primary Open-angle Glaucoma Patients: The Italian Primary Open Angle Glaucoma Study (IPOAGS)
Authors: Riva Ivano , Legramandi Lorenzo , Katsanos Andreas , Oddone Francesco , Rulli Eliana , Roberti Gloria , Quaranta Luciano
Published: May 2018

Purpose:

The purpose of this article was to evaluate the potential association between sociodemographic factors with clinical characteristics, vision-related quality of life (QoL), and glaucoma-related symptoms scores in a large cohort of primary open-angle glaucoma patients.

Materials and Methods:

Multicenter, cross-sectional study involving academic and nonacademic centers. Previously diagnosed primary open-angle glaucoma patients aged >18 years were enrolled. At baseline, information on demographic characteristics, social, medical and ocular history, clinical presentation and treatments was collected. Vision-related QoL was evaluated by means of the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25), while glaucoma-related symptoms were evaluated using the Glaucoma Symptom Scale (GSS) questionnaire. The associations between sociodemographic factors with clinical characteristics (mean deviation, pattern standard deviation, best-corrected visual acuity), NEI-VFQ-25, and GSS scores were evaluated by means of univariate and multivariate general linear models.

Results:

A total of 3227 patients were enrolled. Older age and male sex were significantly associated with lower mean deviation (P<0.01) and higher pattern standard deviation (P<0.01), whereas older age was associated with lower best-corrected visual acuity (P<0.01). The composite GSS score was related to age (P=0.02), sex (P<0.01), employment (P=0.01), and profession (P=0.04), while the total NEI-VFQ-25 score was associated with sex (P<0.01), marital status (P=0.02), and employment (P=0.02).

Conclusions:

Age and sex were significantly associated with almost all indicators of glaucoma severity at baseline. Other variables, such as employment, profession, and marital status were significantly associated with vision-related QoL scores.
Thyroid Stimulating Hormone Receptor Antibodies in Thyroid Eye Disease—Methodology and Clinical Applications
Authors: Diana Tanja , Kahaly George J.
Published: May 2018

Background:

Thyroid stimulating hormone receptor antibodies (TSHR-Ab) cause autoimmune hyperthyroidism and are prevalent in patients with related thyroid eye disease (TED).

Purpose:

To provide a historical perspective on TSHR-Ab and to present evidence-based recommendations for clinical contemporary use.

Methods:

The authors review the recent literature pertaining to TSHR-Ab in patients with TED and describe the various immunoassays currently used for detecting TSHR-Ab and their clinical applications.

Results:

We provide a historical summary and description of the various methods used to detect TSHR-Ab, foremost, the functional TSHR-Ab. Increasing experimental and clinical data demonstrate the clinical usefulness of cell-based bioassays for measurements of functional TSHR-Ab in the diagnosis and management of patients with autoimmune TED and in the characterization of patients with autoimmune-induced hyperthyroidism and hypothyroidism. Thyroid stimulating hormone receptor antibodies, especially the functional stimulating antibodies, are sensitive, specific, and reproducible biomarkers for patients with autoimmune TED and correlate well with clinical disease activity and clinical severity. Unlike competitive-binding assays, bioassays have the advantage of indicating not only the presence of antibodies but also their functional activity and potency.

Conclusions:

Measurement of TSHR-Ab (especially stimulating antibodies) is a clinically useful tool for the management of patients with TED.
Orbital Decompression for Thyroid-Related Orbitopathy During the Quiescent Phase
Authors: Ediriwickrema Lilangi S. , Korn Bobby S. , Kikkawa Don O.
Published: May 2018

Purpose:

To describe historical and modern surgical approaches to orbital decompression in patients with thyroid-related orbitopathy in the quiescent phase.

Methods:

A literature review of published techniques using the National Institutes of Health PubMed database.

Results:

Historically, orbital decompression has been accomplished via transantral, transcranial, transnasal, and orbital approaches. Current techniques use predominately periocular incisions to achieve effective decompression and proptosis reduction. Based on exophthalmometry and desired proptosis reduction, the authors propose a graded surgical approach to decompression for thyroid orbitopathy beginning with fat reduction, followed by deep lateral orbit via a superior eyelid crease incision, then medial wall by retro-caruncular approach, then posterior medial orbital floor either via transconjunctival or swinging eyelid approach, and finally with lateral orbital rim removal by superior eyelid crease incision as needed. These approaches can result in a range of proptosis reduction of up to 10 mm.

Conclusions:

A structured approach to orbital decompression results in predictable and effective outcomes in proptosis reduction.
Impacts of the Affordable Care Act on Community Health Centers
Authors: Hatch Brigit , Smith Ning , McBurnie Mary Ann , Quach Thu , Mayer Kenneth H. , Dunne Mary J. , Cottrell Erika
Published: May 2018

The aim of this study was to assess the impact of the Affordable Care Act (ACA) on community health centers (CHCs). Using electronic health records from the Community Health Applied Research Network, we assessed new patient characteristics, office visit volume, and payer distribution among CHC patients before and after ACA implementation, 2011-2014 (n = 442 455). New patients post-ACA were younger, more likely to be female and have chronic health conditions, and utilized more primary care (P < .05 for each). Post-ACA, clinics delivered 19% more office visits and more visits were reimbursed by Medicaid. The support of CHCs is needed to meet increased demand post-ACA.
Multiple Chronic Conditions and Disparities in 30-Day Hospital Readmissions Among Nonelderly Adults
Authors: Basu Jayasree , Hanchate Amresh , Koroukian Siran
Published: May 2018

This study examines the patterns of 30-day hospital readmissions by race/ethnicity and multiple chronic conditions (MCC) burden among nonelderly adult patients. We used hospital discharge data of patients in the 18- to 64-year age group in 5 US states, California, Florida, Missouri, New York, and Tennessee, for 2009 from the Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) of the Agency for Healthcare Research and Quality, linked to contextual and provider data from the Health Resources and Services Administration. A multilevel logistic regression model was used for data pooled over 5 states, adjusting for patient, hospital, and community characteristics. Controlling for other covariates, the study found that a higher MCC burden was associated with a higher all-cause 30-day readmission risk. We found considerable heterogeneity in levels of readmission risk among racial/ethnic subgroups stratified by chronic conditions. Among patients with a lowest MCC burden, African Americans had the highest risk of readmission, but with a higher MCC burden, the risk of readmission increased most for Hispanics.
Infusing Social Justice in Undergraduate Nursing Education: Fostering Praxis Through Simulation
Authors: Caldwell Robyn , Cochran Courtney
Published: May 2018

Scope of the Problem:

Forensic clinical experiences are often inconsistent in undergraduate nursing education. Nursing students are not included in the process of forensic evidence collection, often because of the sensitive nature of the situation. Unfortunately, nursing students are forced to rely on theoretical knowledge provided by the nurse educator to understand the complexities of forensic nursing care. Nursing students must be able to identify and provide appropriate nursing care for individuals in all forensic situations.

Social Justice in Clinical Nursing Education:

Comprehensive clinical laboratory experiences should be provided through active teaching–learning strategies, which replicate nursing care of the forensic patient. Simulated patient experiences provide a unique opportunity to explore the sensitive nature of sexual trauma in a safe learning environment. This strategy facilitates the application of theoretical forensic principles by utilizing live actors or high-fidelity manikins in laboratory settings.

Conclusion:

The application of theory to each simulated patient infuses conceptual knowledge at the point of care. Change in social consciousness begins at the bedside. The moral imperative of nursing continues to be the preparation of socially responsible, professional nurses who strive to end social injustices.
An Ecological Approach Toward Prevention and Care of Victims of Domestic Minor Sex Trafficking
Authors: Sanchez Rosario V. , Pacquiao Dula F.
Published: May 2018

Sex trafficking is a widespread form of human trafficking that exists globally. The forced sexual exploitation of young women for profit at the hands of traffickers is a human rights violation. Sex trafficking is a form of modern-day slavery where youths are sold as a commodity. It is difficult to determine the wide range of negative health outcomes associated with domestic minor sex trafficking due to the hidden nature of the crime and its lack of statistical data to determine prevalence. Viewing domestic minor sex trafficking through an ecological lens assists in the understanding of the multiple complex interactions between victims, their relationships, and environments that influence their health. Forensic nurses are poised as experts in the healthcare of vulnerable populations and possess the knowledge to understand that social determinants of vulnerability depend on the distinct setting or environment where victims of sex trafficking reside and how different factors affect their victimology, resilience, and well-being.
Musculoskeletal Injury in Paddle Sport Athletes
Authors: Griffin Andrew R. , Perriman Diana M. , Neeman Teresa M. , Smith Paul N.
Published: May 2018

Introduction:

Kayak racing has been an Olympic sport since 1936. The sport is evolving with the introduction of ocean skis and stand-up-paddle boards (SUP). Musculoskeletal injury incidence surveys have been conducted for ultra-marathon events, but no data have been published for other racing formats.

Objective:

To identify and compare the rates and types of injuries sustained by paddling athletes as a function of discipline and training parameters in Sprint, Marathon, Ultra-Marathon, and Ocean events.

Methods:

Competitors from 6 kayak and/or ocean surf-ski races in Australia were surveyed. Before each race, competitors were asked to complete a questionnaire. The questionnaire investigated paddling-related injuries over the previous 5 years, athlete morphology, flexibility, equipment and its setup, training volume, and environment.

Results:

Five hundred eighty-three competitors were surveyed. Disciplines included 173 racing-kayak (K1), 202 touring-kayak, 146 ocean-skis, 42 SUP, and 20 other. The top 5 paddling-related injuries were shoulder (31%), low back (23.5%), wrist (16.5%), neck (13.7%), and elbow (11.0%). The highest percentage of injury was found in K1 paddlers for shoulder (40.5%), SUP for low back (33.3%), and ocean-ski for wrist (22.6%). After controlling for on-water training hours, the relative risk (RR) of wrist injury was significantly increased in ocean-ski paddlers (1.86) and in paddlers with decreased flexibility (1.53-1.83). Relative risk of shoulder and low-back injury was significantly increased in athletes with lower training volumes (1.82-2.07). Younger athletes had lower RR of wrist and shoulder injury (0.58-0.62).
Novel Interventions for Recalcitrant Achilles Tendinopathy: Benefits Seen Following High-Volume Image-Guided Injection or Extracorporeal Shockwave Therapy—A Prospective Cohort Study
Authors: Wheeler Patrick C. , Tattersall Chloe
Published: May 2018

Objective:

To compare the outcomes for patients with chronic noninsertional Achilles tendinopathy following extracorporeal shockwave therapy (ESWT) and high-volume image-guided injection (HVIGI).

Design:

Prospective cohort study.

Setting:

Hospital-based Sports Medicine Outpatient Clinic.

Patients:

Sixty-three consecutive patients with chronic noninsertional Achilles tendinopathy, treated with ESWT (n = 22) or HVIGI (n = 41), with minimum 3-month follow-up. Mean age was 51.2 years, and mean duration of symptoms was 27.8 months.

Interventions:

Patients received either 3 sessions of ESWT (1 session per week) or a single ultrasound-guided HVIGI (10 mL of 1% lidocaine and 40 mLs of sterile saline). All patients received standardized aftercare, including continuation of a structured home exercise program of flexibility and eccentric strengthening exercises.

Main Outcome Measures:

Zero to 10 visual analog scale (VAS) for self-reported “average pain” and “average stiffness” values. In addition, Victoria Institute of Sport—Achilles questionnaire, (VISA-A), and Manchester-Oxford Foot Questionnaire (MOXFQ).

Results:

This study demonstrated statistically significant improvements in self-reported measures of pain and stiffness following either procedure. At 3 months, VAS (pain) was improved from 6.74 ± 1.31 to 3.57 ± 2.37 (P < 0.001) following HVIGI and from 6.57 ± 1.61 to 4.35 ± 2.55 (P = 0.002) following ESWT. At 3 months, VISA-A improved from 35% ± 17% to 51% ± 22% (P < 0.001) following HVIGI and from 34% ± 15% to 49% ± 15% (P < 0.001) following ESWT. Statistically significant improvements were only recorded at 6 weeks for ESWT and at 3 months for HVIGI using MOXFQ. No statistically significant differences were seen between the groups at any period studied.

Conclusions:

Patients improved to statistically significant extent following either a HVIGI or ESWT procedure, with no significant differences seen between the groups. The small sample sizes in this pragmatic study are noted, which limit interpretation, and larger more robust studies are required to investigate this further.

Clinical Relevance:

This pragmatic prospective cohort study demonstrates improvements following either ESWT or HVIGI procedures, with no significant differences seen between the groups.