bluuebunny/crossref_metadata_2025 huggingface dataset:
Inpatient Ordering of Home Hydroxyurea by Residents for Hospitalized Patients With Sickle Cell Disease
Authors: Shaw Rebekah , Kappa Sarah , Nickel Robert S.
Published: November 2019

Background:

Hydroxyurea is a well-established disease-modifying medication for sickle cell disease (SCD). At some institutions, hydroxyurea can only be ordered by “chemotherapy-certified” providers which may not include pediatric resident physicians.

Methods:

We conducted a survey of 39 American pediatric hospitals regarding their policy on resident hydroxyurea ordering for SCD. Our institution changed its policy in June 2016 to allow residents to order hydroxyurea for hospitalized patients with SCD who were already on hydroxyurea at home. We conducted a retrospective review of the medical records of a random sample of patients with SCD on hydroxyurea admitted the year before and the year after this policy change.

Results:

In our national survey, 51% of surveyed hospitals allowed residents to order hydroxyurea, 19% required a second signature, and 30% did not allow residents to order hydroxyurea. In our institutional study, patients after the policy change were significantly more likely to have received their home hydroxyurea by hospital day 1: before 62/90 (69%) versus after 105/119 (88%),P=0.0005. The proportion of patients who inappropriately received hydroxyurea was very low in both groups: before 1/91 (1%) versus after 3/126 (2%),P=0.64, with no serious adverse clinical events due to inappropriate hydroxyurea administration.

Conclusions:

Considerable national variation in practice currently exists in regards to resident hydroxyurea ordering hospital policies. A policy allowing residents to order hydroxyurea significantly increased the likelihood of a patient receiving hydroxyurea while hospitalized with no significant increase in inappropriate hydroxyurea administration. Resident hydroxyurea ordering seems safe and beneficial.
FLAG With Bortezomib in Childhood Relapsed/Refractory Leukemia: Remission Induction With Limited Toxicity in the Era of Multidrug-resistant Bacteria
Authors: Ravichandran Nikila , Uppuluri Ramya , Swaminathan Venkateswaran V. , Patel Shivani , Ramanan Kesavan M. , Jayakumar Indira , Ramakrishnan Balasubramaniam , Raj Revathi
Published: November 2019

We present our experience on the use of fludarabine, cytarabine, granulocyte colony-stimulating factor in combination with Bortezomib. In total, 13 children with relapsed/refractory leukemia (acute lymphoblastic leukemia=9 and acute myeloid leukemia=4) were included from January 2018 to May 2019. Culture-positive sepsis and intensive care unit admission rates were 38% and 30%, respectively, with no postchemotherapy mortality in this cohort. Morphologic remission was documented in 92% and negative minimal residual disease was achieved in 61%, with 100% remission in those with acute myeloid leukemia. These results bear significant relevance in developing countries where multidrug-resistant sepsis is on the rise.
A Spontaneously Necrotic Wilms’ Tumor Mimicking Renal Abscess: A Tricky Diagnosis not to Miss
Authors: Sevrin François , Rocourt Nathalie , Leroy Xavier , Coulomb-L’Hermine Aurore , Sudour-Bonnange Hélène
Published: November 2019

Wilms’ tumor (WT) is the most common renal malignancy in children. Its clinical and radiologic presentation may mimic other pediatric renal diseases, including pyonephrosis or renal abscess. The authors report a case of a 3-year-old girl presenting with pyelonephritis and right renal mass suggestive of a renal abscess, not responding to antibiotics. Further investigations were conducted, including a percutaneous renal needle core biopsy. A stage I fully necrotic WT was finally diagnosed. This amazing case of a fully necrotic WT at diagnosis demonstrates the importance of anatomopathologic analyses in pediatric renal masses, even when the infection is suspected.
Goal-oriented attentional self-regulation training in individuals with acquired brain injury in a subacute phase: a pilot feasibility study
Authors: Cizman Staba Ursa , Vrhovac Suzana , Mlinaric Lesnik Vesna , Novakovic-Agopian Tatjana
Published: November 2019

The primary aim of this prospective pilot study was to assess feasibility of implementing goal-oriented attentional self-regulation (GOALS) training in Slovenia with patients with multiple cognitive deficits after acquired brain injury in acute phase of recovery. Seven patients with acquired brain injury (i.e. stroke, traumatic brain injury, and subarachnoid hemorrhage) with a mean postinjury time of 4.3 months (SD = 1.25) and mean age of 34.5 years (SD = 18.6) were recruited for the study. The group program consisted of 10 sessions twice a week and included cognitive strategy training, social skills training, and psychoeducation. Structured interviews and neuropsychological tests were used before and after the training to determine the influence of the interventions on daily life tasks and attentional networks performance involving cognitive and behavioral domains. GOALS influenced self-reports of positive effect on the individual goals set by the patients. Training had a positive influence on executive control and memory. The results from the present study suggest that it is feasible to implement GOALS manualized executive function training in Slovenia, with the patients in a somewhat more acute stage than in previous studies, and that GOALS training may be a promising nonpharmacological treatment for cognitive and behavioral difficulties after acquired brain injury. Further research is needed to extend these findings in a larger sample.
International classification of diseases/disorders diagnosis and International Classification of Functioning, Disability and Health activity/participation limitation among psychiatric patients: a cross-sectional and exploratory study
Authors: Wciórka Jacek , Anczewska Marta , Jahołkowski Piotr , Świtaj Piotr
Published: November 2019

To explore the relationships between international classification of diseases/disorders (ICD)-10 diagnoses and International Classification of Functioning, Disability and Health (ICF) disability dimensions – activity and participation restriction among mental health service users. Three hundred sixty patients from different health services diagnosed with diverse mental disorders (ICD-10) participated in the study. Functioning restrictions were evaluated by use of the Mini-ICF-APP. Selected sociodemographic and clinical variables were also analysed. The Mini-ICF-APP scores correlated positively with the clinical impression of disease severity and negatively with general functioning. As independent factors determining the Mini-ICF-APP score, regression analysis suggests diagnosis and severity of disorder but also contextual factors such as general functioning and active occupation. Percentage and percentile distributions of activity and participation restrictions in diagnostic sections and categories revealed noticeable variability regardless of diagnosis-related differences. The diagnosis determines them neither in an ambiguous nor an absolute manner. There is a need to further explore the covariability between clinical diagnosis and ICF activity and participation restriction, particularly in regard the rationalization of social welfare benefits.
The Use of Home Telemonitoring for Heart Failure Management Among Hispanics, Non-Hispanic Blacks, and Non-Hispanic Whites
Authors: Cabán Priscilla Liza
Published: November 2019

Heart failure (HF) is ranked as one of the leading causes of hospitalizations and mortality among adults of all racial/ethnic groups in the United States. Telemonitoring, as a home care intervention for HF management, has been used across all groups although the benefit for Hispanics has not been established. The purpose of this retrospective, quantitative study was to determine the differences in hospital readmission between Hispanic, non-Hispanic Black, and non-Hispanic White patients with HF who either received or did not receive home telemonitoring services from a home care agency in Connecticut. A purposive sample of 138 records of patients admitted between January 1, 2012, and June 30, 2017, with a diagnosis of HF provided the data for the study. Data were analyzed by conducting simple and multiple logistic regression analyses. The key findings showed that Hispanics who used telemonitoring were almost four times less likely to be readmitted to the hospital compared with Hispanics who did not use telemonitoring (p= .04). Race, age, gender, and insurance were not significant predictors of readmissions (p> .05). The findings from this study may provide healthcare providers with a better understanding of the outcomes of home telemonitoring for treating adult Hispanic patients with HF.
Informal Caregiver Decision-Making Factors Associated With Technology Adoption and Use in Home Healthcare
Authors: Woo Kyungmi , Tark Aluem , Baik Dawon , Dowding Dawn
Published: November 2019

Technology systems to alleviate the burden of caregiving are increasing in use. The home is a unique place where chronic disease management is often performed by informal caregivers, yet how caregivers make decisions about adopting a specific technology has not been thoroughly explored. This systematic scoping review mapped evidence on decision-making factors associated with technology adoption and use by caregivers of patients receiving care at home. We followed the recommendations developed by members of the Joanna Briggs Institute. Four electronic databases (PubMed, Medline, CINAHL, and Embase) were searched using both medical subject headings (MeSH terms) and key words. A total of six papers were included for data synthesis. Factors such as information, comprehension, motivation, time, perceived burden, and perceived caregiving competency were found to affect adoption of technology. There are other factors uniquely springing from the patient and technology, as well as shared issues between caregivers and patient, and caregivers and technology. Although some factors depend on technology type and patient diagnosis, there were some common factors across the research. Those factors can be carefully considered in referring technology use for caregivers. More focused study in this underinvestigated area is much needed.
Tenecteplase Averting Mechanical Thrombectomy in Emergent Large Vessel Occlusion
Authors: Psychogios Klearchos , Kargiotis Odysseas , Safouris Apostolos , Magoufis Georgios , Liakakis Georgios , Stamboulis Eleftherios , Tsivgoulis Georgios
Published: November 2019

Introduction:

Tenecteplase has recently been studied as an alternative thrombolytic agent in acute stroke, with a possible superior effect in achieving reperfusion of large intracranial vessels.

Case Report:

A 90-year-old female patient was admitted to our stroke unit because of acute onset of dysarthria, left-sided neglect, and hemiparesis. Brain computed tomography (CT) coupled with CT angiography and CT perfusion (postprocessed with the use of RAPID software) demonstrated right proximal middle cerebral artery occlusion with a large penumbra/small ischemic core pattern. The patient was subsequently treated with bolus tenecteplase infusion (0.25 mg/kg). Mechanical thrombectomy was abandoned because the patient has rapidly improved. The patient was discharged to her own home 4 days later with no neurological deficit and functionally independent (modified Rankin scale of 0).

Conclusion:

This case exemplifies the potential of tenecteplase in achieving swift reperfusion in patients with large vessel occlusion associated with a substantial mismatch penumbral pattern.
Relationship Between Sleep Characteristics and Sudden Unexplained Death Risk in Epilepsy
Authors: Dede Hava Ö. , Bebek Nerses , Oğuz Akarsu Emel , Samanci Bedia , Karbay Merih , Gürses Candan , Baykan-Baykal Betül , Karadeniz Derya , Gökyiğit Ayşen
Published: November 2019

Background:

Sleep disorders and disturbances are generally underestimated in patients with epilepsy. The aim of this study is to determine the frequency of sleep disturbances and the comorbidity of sleep disorders in people with epilepsy without any complaints about sleep and their relation of sudden unexplained death in epilepsy (SUDEP) risk.

Methods:

Sleep complaints and the presence of sleep disorders were assessed with 4 questionnaires in 139 patients with epilepsy. Subjective sleep features were evaluated with Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Berlin Questionnaire for sleep apnea, and restless legs syndrome with International Restless Legs Syndrome Study Group (IRLSSG) severity scale. The presence of rapid eye movement/nonrapid eye movement parasomnia was asked to the patients and their relatives who share the same house. The patients’ SUDEP-7 scores were also determined and associations with sleep problems were investigated statistically.

Results:

Ninety-two patients with focal and 47 patients with generalized epilepsy were evaluated after their consent. The daily sleep quality was poor in 34 (24.5%) patients with PSQI. Daily sleepiness was present in 7 (5%) patients with ESS. Twenty-five patients (18%) had severe sleep apnea risk with the Berlin Questionnaire. Mild or severe RLS was detected in 24 patients (17.2%). There were no significant differences between focal or generalized epilepsy groups’ scores. No statistically significant relationship was identified between SUDEP-7 scores and sleep quality or sleep-related disorders.

Conclusion:

Our results emphasized a remarkable magnitude of the comorbidity of sleep disorders in patients with epilepsy, even for those who do not have complaints about sleep. As SUDEP cases are frequently seen during sleep, it is important to evaluate sleep in patients with epilepsy.
“I'll Just Pick It Up…”: Women's Acceptability of Self-Sampling Methods for Sexually Transmitted Infection Screening
Authors: Griner Stacey B. , Vamos Cheryl A. , Puccio Joseph A. , Perrin Karen M. , Beckstead Jason W. , Daley Ellen M.
Published: November 2019

Background

Rates of sexually transmitted infection (STI) screening are suboptimal among college women. Self-sampling methods (SSMs) may improve STI screening rates, but critical gaps remain regarding the influential characteristics of SSM to prioritize in intervention development. The purpose of this study was to explore intervention characteristics influencing the decision to adopt SSM among college women.

Methods

In-depth interviews (n = 24) were conducted with sexually active college women aged 18–24 years to explore preferred intervention characteristics of SSM. Interviews were stratified by screening status (screened or not screened). The instrument was guided by constructs from the Diffusion of Innovation theory and included characteristics of SSM, such as relative advantage, compatibility, complexity, adaptability, and risk and uncertainty.

Results

Overall, women felt that the SSM was not complex and that the instructions were straightforward. Participants discussed their strong preference for receiving their results via text or e-mail rather than via telephone. In addition, women described their concerns about mailing their sample and described their concern about potential contamination and tampering. The most salient advantage to use of SSM was avoiding an interaction with a health care provider.

Conclusions

This study contributes to an understanding of the salient intervention characteristics influencing the use of SSM for STI screening, which can be leveraged to improve the health of students and improve rates of screening. Findings can be used to inform the development of a future innovative, theory-based intervention that promotes the use of SSM to improve STI screening rates, and ultimately decrease the burden of STI-related disease.
Patients Are Willing to Wait for Rapid Sexually Transmitted Infection Results in a University Student Health Clinic
Authors: Gettinger Jesse , Van Wagoner Nicholas , Daniels Brice , Boutwell Alexander , Van Der Pol Barbara
Published: November 2019

We examined the acceptability and feasibility of using a 30-minute chlamydia/gonorrhea test in a student health clinical setting. One hundred eight students were enrolled and 89.4% were willing to wait up to 20 minutes beyond the conclusion of their routine visit. The average amount of time added per clinic visit was less than 11 minutes. Patient and staff satisfaction were high.
Safety and Effectiveness of Same-Day Chlamydia trachomatis and Neisseria gonorrhoeae Screening and Treatment Among Gay, Bisexual, Transgender, and Homeless Youth in Los Angeles, California, and New Orleans, Louisiana
Authors: Keizur Erin M. , Goldbeck Cameron , Vavala Gabriella , Romero-Espinoza Adriana , Ocasio Manuel , Fournier Jasmine , Lee Sung-Jae , Abdalian Sue-Ellen , Rotheram Mary Jane , Klausner Jeffrey D.
Published: November 2019

Background

Gay, bisexual, transgender, and homeless youth are at risk of sexually transmitted infections. As part of an adolescent human immunodeficiency virus prevention study, we provided same-day Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing and treatment. We aimed to evaluate the feasibility and effectiveness of same-day CT and NG treatment on the proportion of participants receiving timely treatment.

Methods

We recruited adolescents with high sexual risk behaviors aged 12 to 24 years from homeless shelters, lesbian, gay, bisexual, and transgender organizations, and community health centers in Los Angeles, California, and New Orleans, Louisiana from May 2017 to June 2019. Initially, participants were offered point-of-care pharyngeal, rectal, and urethral/vaginal CT and NG testing and referral to another clinic for treatment. After March 2018 in Los Angeles and November 2018 in New Orleans, we provided same-day treatment (and partner treatment packs) for study participants. We measured the proportion of participants who received same-day treatment and the median time to treatment. We collected frequency of partner treatment and any reported adverse treatment-related events.

Results

The proportion of participants receiving same-day CT and NG treatment increased from 3.6% (5/140) to 21.1% (20/95; Δ17.5%; 95% confidence interval, 9.2%–26.9%) after implementation of same-day testing and treatment. The median time to treatment decreased from 18.5 to 3 days. Overall, 36 participants took a total of 48 partner treatment packs. There were no reported treatment-related adverse events.

Conclusions

Providing sexually transmitted infection treatment to adolescents at the same visit as testing is feasible and safe, and can increase the proportion of individuals receiving timely treatment.
Religion, Culture, and Autopsy
Authors: Avşar Abdullah , Okdemir Erdem , Keten Alper , Kaya Ömer
Published: November 2019

The autopsy maintains its significance both forensically and medically despite enormous developments in antemortem and postmortem diagnostic methods. The present study probes the knowledge, attitude, and behavior of religious officials in our city toward autopsy and make an evaluation of how religion and culture affect those factors.

The study consists of 219 Imams (male) and 69 Quran instructors (female) who serve in urban and rural regions of Kahramanmaras and approved informed consent forms.

Two hundred thirty (79%) of the participants stated that the autopsy was an appropriate process according to Islam; 1 (0.3%) stated that it was inappropriate, whereas 57 (19.8%) were observed to have no idea regarding its appropriateness.

The mean knowledge score that participants had about autopsy was determined to be 7.45 ± 1.73 (min = 1, max = 10).

On the other hand, 240 participants (83.3%) stated that it was important for the religious officials to inform the society about the autopsy.

The negative attitude toward autopsy stems from the lack of knowledge and traditions. The religious officials could help the doctors to change the negative attitude stemming from tradition toward the autopsy.
Identification of CD5/Cyclin D1 Double-negative Pleomorphic Mantle Cell Lymphoma
Authors: Chuang Wen-Yu , Chang Sheng-Tsung , Yuan Chang-Tsu , Chang Gwo-Jyh , Chang Hung , Yeh Chi-Ju , Ueng Shir-Hwa , Kao Hsiao-Wen , Wang Tong-Hong , Wan Yung-Liang , Shih Lee-Yung , Chuang Shih-Sung , Hsueh Chuen
Published: November 2019

Pleomorphic mantle cell lymphoma (PMCL) can closely mimic diffuse large B-cell lymphoma (DLBCL) morphologically, and expression of CD5 and cyclin D1 is helpful for differential diagnosis. To date, no cases of CD5/cyclin D1 double-negative PMCL have been reported. Four cases of B-cell lymphoma with an immunophenotype of CD5(−) cyclin D1(−) SOX11(+) and morphologic features compatible with DLBCL were included. Two were previously identified, and the other 2 were screened from 500 cases of B-cell lymphoma. We analyzed their clinicopathologic, immunophenotypic, genetic, and gene expression features. Cases of cyclin D1-positive PMCL, cyclin D1-negative PMCL, germinal center B-cell (GCB) DLBCL, and activated B cell (ABC) DLBCL were also studied for comparison. Similar to other PMCL cases, these 4 patients were mainly elderly male individuals with an aggressive clinical course. None of these tumors had detectable translocations involving CCND1, CCND2, CCND3, CCNE1, CCNE2, MYC, BCL2, or BCL6. The genome-wide copy number profile of these 4 cases was similar to that of cyclin D1-negative PMCL. None of these tumors had high expression of cyclin D1, cyclin D2, or cyclin D3. Similar to cyclin D1-negative PMCL, these cases had higher expression of cyclin E1 and cyclin E2 compared with cyclin D1-positive PMCL. The gene expression pattern of these tumors was also similar to that of cyclin D1-negative PMCL. Here we report for the first time 4 cases of CD5/cyclin D1 double-negative PMCL. SOX11 positivity is useful to identify these rare tumors, and further genetic and gene expression analysis can be used to confirm the diagnosis.
A Call to Restore Your Calling
Authors: Miller Elissa G. , Mull Colette C.
Published: November 2019

Many aspects of our health care system in the United States can lead to physicians feeling helpless—an inability to save a dying child, an inability to protect an immunocompromised child from a vaccine-preventable illness because of waning herd immunity, and a burdensome new electronic medical record system that your employer insists you must use. The cumulative effect of these experiences can lead to moral distress and ultimately moral injury. We discuss helplessness, moral distress, and moral injury in the setting of today's practice of emergency medicine and provide concrete recommendations to help providers cope with their own reactions to distressing clinical situations.
Public Health Graduates and Employment in Governmental Public Health: Factors That Facilitate and Deter Working in This Setting
Authors: Yeager Valerie A. , Beitsch Leslie M. , Johnson Sarah M. , Halverson Paul K.
Published: November 2019

Objectives:

Previous surveys of public health graduates examine where they work; however, little is known about public health graduates' employment decisions or the factors that facilitate interest or deter interest in working in governmental public health settings. The purpose of the current pilot study was to build on the information previously collected in graduate surveys by expanding questions to undergraduates and asking about decisions and factors that influence choices of employment.

Methods:

A pilot survey of graduates of public health programs was conducted. Respondents provided information about their degree programs, year of graduation, and current employment. Questions asked where they applied for jobs, factors they considered, experiences with the application processes, and so forth. Descriptive statistics were calculated using frequencies and proportions. Open-ended responses were qualitatively reviewed and general themes were extracted.

Results:

Employment preferences were ranked the highest for not-for-profit organizations (ranked first among 21 of 62, 33.9%), followed by governmental public health agencies (ranked first among 18 of 62, 29.0%). Among master of public health graduates, 54.7% sought employment within this setting, although only 17.0% of those employed full time at the time of the survey were employed within a governmental public health agency. Job security (84.7%), competitive benefits (82.2%), identifying with the mission of the organization (82.2%), and opportunities for training/continuing education (80.6%) were the most influential, positive factors garnering interest in working in governmental public health. Factors that were the biggest deterrents included the ability to innovate (19.2%), competitive salary (17.8%), and autonomy/employee empowerment (15.3%).

Conclusions:

Approximately half of the respondents applied for a job within governmental public health in anticipation of or since graduating. However, only a quarter of employed respondents are currently working within governmental public health, suggesting a missed opportunity for recruiting the other quarter who applied and were interested in governmental positions.
Assessing the Walkability Environments of Churches in a Rural Southeastern County of the United States
Authors: Bernhart John A. , Wende Marilyn E. , Kaczynski Andrew T. , Wilcox Sara , Dunn Caroline G. , Hutto Brent
Published: November 2019

Context:

Churches can serve as important health promotion partners, especially in rural areas. However, little is known about the built environment surrounding churches in rural areas, including how these environments may impact opportunities for physical activity (PA) and may differ by neighborhood income levels.

Objective:

This study described walkability around churches in a rural county and examined differences in church walkability between high-, medium-, and low-income neighborhoods.

Design:

As part of the Faith, Activity, and Nutrition study, trained data collectors conducted a windshield survey of adjacent street segments within a half-mile of churches.

Setting:

Churches (N = 54) in a rural southeastern county in the United States.

Main Outcome Measure:

A summary walkability score (eg, presence of sidewalks, safety features, low traffic volume) was created with a possible range from 0 to 7. Analysis of variance was used to assess differences in walkability of churches by neighborhood income levels.

Results:

Walkability scores ranged from 0 to 6 (M = 2.31, SD = 1.23). Few churches had sidewalks, shoulders or buffers, or amenities nearby. In contrast, most churches had low traffic volume and no environmental incivilities. While not statistically significant, churches in low-income neighborhoods scored higher for walkability than churches in medium- and high-income neighborhoods.

Conclusions:

This study used low-cost environmental audits to analyze walkability in a sample of churches in a rural area and examined differences by neighborhood income. While churches may improve reach of people living in underserved and rural communities, a lack of environmental supports may limit effective PA promotion activities. Partnerships focused on improving existing areas or providing alternative PA opportunities for church and community members may be needed, especially in African American communities.
Life in Data Sets: Locating and Accessing Data on the Health of Americans Across the Life Span
Authors: King Jaron Hoani , Hall Mary Ann K. , Goodman Richard A. , Posner Samuel F.
Published: November 2019

Context:

The US government manages a large number of data sets, including federally funded data collection activities that examine infectious and chronic conditions, as well as risk and protective factors for adverse health outcomes. Although there currently is no mature, comprehensive metadata repository of existing data sets, US federal agencies are working to develop and make metadata repositories available that will improve discoverability. However, because these repositories are not yet operating at full capacity, researchers must rely on their own knowledge of the field to identify available data sets.

Program or Policy:

We sought to identify and consolidate a practical and annotated listing of those data sets.

Implementation and/or Dissemination:

Creative use of data resources to address novel questions is an important research skill in a wide range of fields including public health. This report identifies, promotes, and encourages the use of a range of data sources for health, behavior, economic, and policy research efforts across the life span.

Evaluation:

We identified and organized 28 federal data sets by the age-group of primary focus; not all groups are mutually exclusive. These data sets collectively represent a rich source of information that can be used to conduct descriptive epidemiologic studies.

Discussion:

The data sets identified in this article are not intended to represent an exhaustive list of all available data sets. Rather, we present an introduction/overview of the current federal data collection landscape and some of its largest and most frequently utilized data sets.
Multidisciplinary Team Reviews of Drug Overdose Deaths and the Use of Minigrants to Advance Recommendations: A Statewide Pilot in Rhode Island
Authors: Hackman H. Holly , Koziol Jennifer A. , McCormick Meghan , McDonald James V. , Green Traci C.
Published: November 2019

Context:

Rhode Island has been significantly impacted by the opioid epidemic, ranking 11th in unintentional drug overdose rates in the United States in 2017. Illicit fentanyl was involved in the majority of these deaths.

Program:

To enhance surveillance of this epidemic, the RI Department of Health piloted in-depth, multidisciplinary, and multiagency team reviews of drug overdose deaths. The goals were to identify gaps in policies and programming and develop recommendations to prevent future deaths. Time-sensitive minigrants were offered to nonprofit organizations as a novel way to further the recommendations put forth from these reviews.

Implementation:

Legal agreements between select state agencies and institutions enabled broad team representation and the sharing of information during each meeting. Reviews, revolving around a common theme, were conducted for up to 10 deaths each quarter. Recommendations for prevention were generated by the team and summarized in a report to the Governor's Overdose Prevention and Intervention Task Force and the public within 1 month of each meeting. Announcements of minigrant opportunities and funding to advance the community-specific recommendations were paired with each meeting.

Evaluation:

From November 2016 through May 2018, the pilot team convened 7 times, generated 78 recommendations, and distributed 31 minigrants. Early process evaluations of these grants have shown positive impact within local environments. Following the pilot phase, state legislation for these reviews was passed in June 2018.

Discussion:

The RI Department of Health was able to successfully pilot a multidisciplinary review process for overdose deaths and has recently institutionalized this process through legislation. The successful implementation of many of the team's community-oriented recommendations, supported through a minigrant process, highlights the impact that small financial investments can have to address the opioid epidemic and may be a model for other jurisdictions seeking to advance recommendations from these types of reviews.
Chronic Disease Surveillance Using Electronic Health Records From Health Centers in a Large Urban Setting
Authors: Figgatt Mary , Chen Jessica , Capper Gillian , Cohen Suzanne , Washington Raynard
Published: November 2019

Objectives:

To assess the validity of electronic health records (EHRs) from a network of health centers for chronic disease surveillance among an underserved population in an urban setting.

Design:

EHRs from a network of health centers were used to calculate the prevalence of chronic disease among adult and child patient populations during 2016. Two population-based surveys with local estimates of chronic disease prevalence were compared with the EHR prevalences.

Setting:

A network of health centers that provides health care services to an underserved population in a large urban setting.

Participants:

A total of 187 292 patients who had at least 1 health care visit recorded in the Philadelphia health center network.

Main Outcome Measure:

Chronic disease indicator (CDI) prevalence of adult obesity, adult smoking, adult diabetes, adult hypertension, child obesity, and child asthma. Health center CDI proportions were compared with survey estimates.

Results:

Overall consistency between the health center estimates and surveys varied by CDI. With the exception of childhood obesity, all health center CDI proportions fell within the 95% CI for at least 1 comparison survey estimate. Statistically significant differences were observed and varied by CDI.

Conclusions:

This analysis presents a novel use of existing EHR data to estimate chronic disease prevalence among underserved populations. With the increased use of EHRs in health centers, data from health center networks may supplement chronic disease surveillance efforts, if used appropriately.
Practice-Based Evidence Supporting Healthy Eating and Active Living Policy and Environmental Changes
Authors: Kelly Cheryl , Clennin Morgan N. , Barela Breanne A. , Wagner Andrea
Published: November 2019

Context:

Policy and environmental strategies have been recommended as evidence-based strategies to improve opportunities for healthy eating and active living.

Program:

A cohort of 6 coalitions in Colorado representing 5 communities was funded to implement policy and environmental strategies that support healthy eating and active living. Coalitions prioritized built environment to support active living and healthy food and beverage strategies.

Implementation:

Built environment coalitions prioritized the adoption of policies and implementation of infrastructure enhancements to improve access to walking, biking, and other physical activity at the institutional, regional, county, and/or municipal levels. Healthy food and beverage coalitions aimed to support the consumption of healthy foods and beverages in government settings, hospitals, and other public venues via policy, practice, or procedural changes.

Evaluation:

Built environment coalitions implemented change at 61 sites by implementing 16 policies and plans and 44 environmental changes. Healthy food and beverage coalitions implemented changes at 66 sites by passing 31 policies and plans and 44 environmental and practice changes. It is estimated that more than 70 000 individuals were likely exposed to these policy and environmental changes.

Discussion:

All community coalitions were successful in driving policy and environmental changes to promote healthy eating and active living. This program contributes to the practice-based evidence to demonstrate that with funding and resources, local public health coalitions and practitioners can drive policy and environmental changes in their communities. Providing funding to a dedicated coalition or group of partners can give coalitions the resources they need to drive these changes.
Role of Instruction Adherence During Highly Structured Robotic Arm Training on Motor Outcomes for Individuals After Chronic Stroke
Authors: Kim Grace J. , Chen Peii
Published: November 2019

The aim of this study was to examine the effects of instruction adherence on upper limb motor outcomes after highly structured intervention. A secondary data analysis was completed using mixed linear modeling design. Thirty chronic stroke survivors with moderate-to-severe arm impairment were assigned explicit movement instructions and completed 12 robotic therapy sessions for 4 wks. Instruction adherence was measured weekly using the Manipulation Check Questionnaire. Motor outcomes were measured at baseline, discharge, and at 4-wk follow-up using the Fugl-Meyer Assessment–Upper Extremity and Wolf Motor Function Test–Functional Ability Scale. There were no effects of adherence-related variables on upper limb motor outcomes (P > 0.2). Participant scores improved for both Fugl-Meyer Assessment–Upper Extremity and Wolf Motor Function Test–Functional Ability Scale from baseline to follow-up (P < 0.001). Participants improved motor function after 12 wks of robotic training; however, instruction adherence did not affect motor improvement. Adherence to explicit information may play a limited role in motor learning for stroke survivors with moderate-to-severe arm impairment during highly structured training protocols.
Disparities in Health Care for Hispanic Patients in Physical Medicine and Rehabilitation in the United States
Authors: Flores Laura E. , Verduzco-Gutierrez Monica , Molinares Diana , Silver Julie K.
Published: November 2019

In the United States, the number of people with Hispanic backgrounds is rapidly increasing. This growth, along with other factors, may put them at increased risk for healthcare disparities. Thus, physical medicine and rehabilitation should evaluate disparities in health services through the lens of the evidence base. To our knowledge, this is the first review describing the literature on healthcare disparities for Hispanic patients in the field of physical medicine and rehabilitation. This review explores healthcare utilization, risk factors, access, and health conditions specific to Hispanic populations. Articles used in this narrative review were collected for a 10-yr span (2009–2018) from online databases.

Our findings highlight disparities across common conditions and injuries in the physical medicine and rehabilitation literature, including poststroke rehabilitation, hip fracture treatment and rehabilitation, spinal cord injury, and traumatic brain injury. Our review suggests that Hispanic patients may be at risk for worse outcomes after these conditions, because of low access to rehabilitation services and disparities in the referral process. Similar results are reported for pain management and Parkinson disease. As we strive to provide optimal care to an increasingly diverse patient population, researchers and clinicians must consider effects of race and ethnicity on access to and utilization of rehabilitation services.
Comparison of Effective Cost and Complications after Abdominoperineal Resection: Primary Closure versus Flap Reconstruction
Authors: Billig Jessica I. , Hsu Jessica J. , Zhong Lin , Wang Lu , Chung Kevin C. , Kung Theodore A.
Published: November 2019

Background:

Flap reconstruction is recommended for select patients undergoing abdominoperineal resection to mitigate complications. However, the clinical effectiveness and financial implications of flap reconstruction remain unknown. The authors aim to compare the costs and complications for patients undergoing abdominoperineal resection with and without flap reconstruction.

Methods:

The Truven MarketScan Databases (2009 to 2016) were used to perform retrospective population-based analysis of colorectal carcinoma patients who underwent abdominoperineal resection with and without flap reconstruction. Univariate and multivariable logistic regressions were used to study effective cost (cumulative cost/number of healthy days) and complications.

Results:

Of 2557 total abdominoperineal resection patients, 194 patients underwent flap reconstruction. Patients undergoing flap reconstruction had a higher Elixhauser Comorbidity Index (p = 0.004) and were more likely to have local invasion (p < 0.001). At 6 months postoperatively, there were no differences in complications between the two groups (p = 0.116). Flap reconstruction was protective against intraabdominal infections (OR, 0.4; 95 percent CI, 0.2 to 0.9; p = 0.033) but conferred an increased risk of wound complications (OR, 1.5; 95 percent CI, 1.0 to 2.3; p = 0.039). Total median cost of care was similar (abdominoperineal resection alone, $40,050; abdominoperineal resection with flap, $41,380; p = 0.456). Effective cost was greater for abdominoperineal resection alone ($259/healthy day) than abdominoperineal resection with flap ($186/healthy day) but was not statistically significant (p = 0.17).

Conclusions:

Patients with flap reconstruction displayed a higher comorbidity score and more extensive disease, but these unfavorable factors did not result in a higher complication rate, total cost, or effective cost. Therefore, flap reconstruction for complex perineal defects confers a benefit in select patients and is a judicious use of health care resources.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Mortality Risk Associated With Personality Facets of the Big Five and Interpersonal Circumplex Across Three Aging Cohorts
Authors: Chapman Benjamin P. , Elliot Ari , Sutin Angelina , Terraciano Antonio , Zelinski Elizabeth , Schaie Warner , Willis Sherry , Hofer Scott
Published: November 2019

Objective

To address the common reliance on the global Big Five domains in the personality and longevity literature, the present study examined mortality risk associated with subdimensions of Big Five domains as well as specific traits within the interpersonal circumplex (IPC) model of personality.

Methods

Data were drawn from three major longitudinal studies of aging that administered the NEO Personality Inventory-Revised, a comprehensive measure of the Big Five, and comprised a total of 4223 participants. Item Response Theory models were used to generate latent trait scores for each of the 30 Big Five facets and eight scales from the IPC. Pooled mortality risk estimates were obtained from demographic-adjusted Cox regression models within each study.

Results

With a high degree of consistency, the vulnerability facet of neuroticism was associated with higher mortality risk and the activity facet of extraversion, with lower risk. None of the openness or agreeableness facets were associated with mortality, although the IPC scales submissiveness and hostile submissiveness were linked with elevated risk. All but one of the facets in the conscientiousness domain were robustly and consistently associated with lower mortality risk.

Conclusions

Findings indicate that specific facets of neuroticism and extraversion carry greater or lesser mortality risk. Broad composite scales averaging across all facets mask important personality risk factors. In contrast, nearly all facets within the conscientiousness domain confer protection against mortality. Finally, the IPC model may capture more nuanced interpersonal risk factors than the facets of Big Five agreeableness or extraversion. Understanding of the role of personality in longevity requires a more precise approach to conceptualization and measurement than broad, composite constructs usually provide.
Azole antifungals and new targeted therapies for hematological malignancy
Authors: Lindsay Julian , Teh Benjamin W. , Micklethwaite Ken , Slavin Monica
Published: November 2019

Purpose of review

With the introduction of new targeted therapies for hematological malignancies comes the challenges of both assessing the risk of developing an IFD while being treated with these agents, as well as managing the drug--drug interactions between azole antifungals and the agents.

Recent findings

New targeted therapies for hematological malignancy include chimeric antigen receptor T cells (CAR T cells), Bi-specific T-cell Engager (BiTE) blinatumomab, and the antibody–drug conjugate (ADC) of calicheamicin inotuzumab ozogamicin for acute lymphoblasic leukemia (ALL) and lymphoma; the Bruton's tyrosine kinase (BTK) inhibitor ibrutinib and phosphatidylinositol 3-kinase (PI3Kδ) inhibitor idelalisib for lymphoma and graft-versus-host disease (GVHD); FMS-like tyrosine kinase 3 (FLT3) inhibitors, such as midostaurin, sorafenib and gilteritinib for acute myeloid leukemia (AML); and the BCL-2 inhibitor venetoclax for a range of hematological malignancies including lymphoma and leukemia. This review summarizes recommendations for IFD prophylaxis using these therapies and evidence for managing concomitant azole administration.

Whilst some evidence exists to guide IFD prophylaxis using new targeted therapies for hematological malignancies, there is an overall lack of descriptive, robust studies specifically describing IFD risk and management. With the emergence of novel agents, clinical judgment must be used to assess the risk of developing an IFD. Care must also be taken when administering azoles with drug--drug interactions, often requiring dose adjustment of the cancer therapies.
Structural Retinal Assessment Using Optical Coherence Tomography and Fundus Fluorescein Angiography in Systemic Lupus Erythematosus Patients
Authors: Fouad Shawky A. , Esmat Mahmoud Ali Soheir M. , Rezk Alnaggar Alshaimaa Rezk Lotfy , Mahfouz Safaa , Essam Mervat , El-Gendy Hala
Published: November 2019

Background

Ocular manifestations in systemic lupus erythematosus (SLE) can be the presenting symptom of the disease or a sight-threatening complication.

Objectives

To detect different structural retinal changes in patients with SLE who had no ophthalmological symptoms and investigate the relationship between different retinal changes and the disease activity assessed by the Systemic Lupus Erythromatosus Disease Activity Index score.

Study Design

A descriptive pilot study from January 2016 to January 2017.

Methods

Fifty-two eyes of 26 patients diagnosed to have SLE were examined using visual acuity assessment, fundus examination, optical coherence tomography (OCT), and fundus fluorescein angiography (FFA).

Results

Fundus fluorescein angiography showed different changes in the form of venular occlusion and optic nerve leakage. There were also degenerative changes in the form of alternating hyperfluorescent and hypofluorescent areas outside the arcades as well as peripapillary areas and capillary dropout. Optical coherence tomography detected signs of degenerative thinning, incomplete posterior vitreous detachment, and epiretinal membrane. A significant correlation was found between SLE activity and the changes detected by FFA (p = 0.017). However, there was no significant correlation between disease activity and changes detected by OCT. Optical coherence tomography changes were significantly correlated with the duration of hydroxychloroquine use of more than 5 years (p = 0.032). There was no correlation between FFA or OCT changes and proteinuria or antiphospholipid antibodies.

Conclusions

Fundus fluorescein angiography is more sensitive in detecting early subclinical retinal changes in patients with SLE, which correlates with disease activity, whereas OCT is more sensitive in detecting changes resulting from hydroxychloroquine use.
Patient Repositioning Reveals a Malignant Pleura Effusion Initially Mistaken as a Bone Metastasis on 18FDG PET/CT
Authors: Kirchner Julian , Riedl Christopher C. , Ulaner Gary A.
Published: November 2019

A 70-year-old woman with breast cancer underwent 18F-FDG PET/CT for restaging. An FDG-avid focus corresponding to a rib on CT images was identified and interpreted as suggestive of an osseous metastasis. A PET/CT-guided biopsy was planned with the patient in prone position. Prone images demonstrated the FDG focus “moved” to the anterior chest and corresponding to pleural fluid. The diagnosis was altered from osseous metastases to pleural malignancy, and the bone biopsy was not performed. This case not only emphasizes the sensitivity of PET in the detection of malignancy, but also highlights the difficulty localizing small, mobile, FDG-avid foci.
177Lu-PSMA and 177Lu-DOTATATE Therapy in a Patient With Metastatic Castration-Resistant Prostate Cancer and Neuroendocrine Differentiation
Authors: Assadi Majid , Pirayesh Elahe , Rekabpour Seyed Javad , Zohrabi Farshad , Jafari Esmail , Nabipour Iraj , Esmaili Abdolhamid , Amini Abdullatif , Ahmadzadehfar Hojjat
Published: November 2019

We presented a promising result of radionuclide therapy using 177Lu-PSMA and 177Lu-DOTATATE in a patient with prostatic adenocarcinoma and neuroendocrine differentiation. Functional imaging of somatostatin receptors in patients with metastatic castration-resistant prostate cancer may pave the way toward implementation of novel radionuclide targets for the treatment of this aggressive subtype of prostate cancer.