bluuebunny/crossref_metadata_2025 huggingface dataset:
804 A Multidisciplinary Approach to Investigating Sleep Practices and Sleep Disturbances on an Inpatient Neurology Unit
Authors: Kadura Sullafa , Lin Jennifer , Poulakis Alexander , Ibarra Michael , Cai Xueya , Roberts Debra
Published: May 2021

Introduction

Minimizing nightly disruptions in the inpatient setting requires a multidisciplinary, collaborative approach. Our aim was to assess staff perceptions and practices of sleep during hospitalization to help identify and prioritize improvement initiatives.

Methods

An online survey was distributed to inpatient staff (nurses, residents, attendings, APPs) on a neurology unit at an academic medical center. The survey assessed sleep disturbances, sleep knowledge and sleep practices. Responses across groups were analyzed using Cochran Armitage tests. Cumulative logit model was also performed.

Results

Among the 49 respondents, 75% reported not having the training to diagnose and treat sleep disorders. 51.2% rarely or never asked about sleep quality or duration prior to admission. 29.6% rarely or never tracked the amount and quality of sleep during hospitalization. Reasons for not tracking or considering sleep included “not being a priority”, “no place to document” and “not being there at night.” Overall, staff ranked noise, testing and vital sign checks as most disruptive to sleep quality and temperature as least disruptive. However, nurses perceived medication administration (p=0.0001) and testing (p=0.0296) more disruptive than the ordering providers. Multivariable analysis showed nurses ranked medication administration higher than providers when shift differences were controlled (p< 0.01). Evening/night shift workers ranked pain (p=0.0324) and anxiety (p=0.0360) higher than day shift workers. Those comfortable with diagnosing and treating sleep disorders were more likely to track sleep during admission (p=0.009), allow patients to sleep during medication administration times (p=0.0189) and allow sleep during scheduled lab draws (p=0.0189).

Conclusion

Our findings indicate that differences in sleep knowledge and sleep perspectives exist across the healthcare team. Possible explanations include training differences, ordering providers not knowing what time medications are administered or when tests are done, teams not clarifying whether nighttime orders are critical and nurses lacking empowerment to notify providers that sleep is being disrupted. Hand offs may need optimization with regards to pain and anxiety. A multidisciplinary approach, particularly between providers/nurses and night/day teams is critical to improve sleep on inpatient units. Our next steps include surveying patients, tracking nightly disruptions using EMR and decreasing unnecessary overnight orders using a team based approach.

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823 Apparent seizure activity in a 9 year old female presenting as hypnopompic hallucinations
Authors: Rakita Jason , Judd Brooke
Published: May 2021

Introduction

The presence of hypnopompic hallucinations raises concerns for narcolepsy. However, sleep-related hallucinations may occur in other settings. Dreams at sleep-wake transitions may be difficult for patients to differentiate from sleep-related hallucinations. Sleep-related hallucinations are predominantly visual, although they can be auditory, tactile and/or kinetic. However, they are generally not olfactory in nature.

Report of case(s)

Here we present a case of a 9-year-old female with a history of tonsillectomy and adenoidectomy, ADHD, ODD, nocturnal enuresis, nocturia, aggressive behaviors and emotional outbursts who presented with EDS, frequent nocturnal awakenings, involuntary dozing, prolonged naps and a one year duration of hypnopompic hallucinations. Initially, the hallucinations occurred 2–3 times per week, but then decreased in frequency to 2–3 times per month. The frequency of episodes apparently decreased after tonsillectomy. She states that she wakes up and sees dots, and “she looks scary” when she looks at herself. She describes a variety of hallucinations including: seeing dots (including her mother being covered in dots), a cupcake, a strange woman walking, her hands looking strange--they had enlarged or hearing noises (a single loud bang). Pertinent physical exam findings included: BMI 66th percentile, Mallampati score 2/4, and a mildly enlarged tongue. The polysomnogram demonstrated mild obstructive sleep apnea by pediatric criteria, and, most notably, demonstrated an EEG with spike and wave formations in the central and frontal leads bilaterally. These were seen during NREM sleep and most prominently during sleep-wake transitions. There was also a more focal brief run of a regular 2 Hz rhythm in the central and frontal leads bilaterally. A referral was placed to Pediatric Neurology who ordered a full EEG which is pending at this time.

Conclusion

Sleep-related hallucinations may occur in narcolepsy, other sleep disorders, a mental disorder, a medical disorder, a medication effect or secondary to substance use. This case suggests that seizure activity may present as hypnopompic hallucinations as well.

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827 Central Sleep Apnea in a patient with Multiple Sclerosis
Authors: Dasgupta Rahul , Schütz Sonja , Braley Tiffany
Published: May 2021

Introduction

Sleep-disordered breathing is common in persons with multiple sclerosis (PwMS), and may contribute to debilitating fatigue and other chronic MS symptoms. The majority of research to date on SDB in MS has focused on the prevalence and consequences of obstructive sleep apnea; however, PwMS may also be at increased risk for central sleep apnea (CSA), and the utility of methods to assess CSA in PwMS warrant further exploration. We present a patient with secondary progressive multiple sclerosis who was found to have severe central sleep apnea on WatchPAT testing.

Report of case(s)

A 61 year-old female with a past medical history of secondary progressive multiple sclerosis presented with complaints of fragmented sleep. MRI of the brain, cervical spine, and thoracic spine showed numerous demyelinating lesions in the brain, brainstem, cervical, and thoracic spinal cord. Upon presentation, the patient noted snoring, witnessed apneas, and daytime sleepiness. WatchPAT demonstrated severe sleep apnea, with a pAHI of 63.3, and a minimum oxygen saturation of 90%. The majority of the scored events were non-obstructive in nature (73.1% of all scored events), and occurred intermittently in a periodic fashion.

Conclusion

The differential diagnosis of fatigue in PwMS should include sleep-disordered breathing, including both obstructive and central forms of sleep apnea. Demyelinating lesions in the brainstem (which may contribute to impairment of motor and sensory networks that control airway patency and respiratory drive), and progressive forms of MS, have been linked to both OSA and CSA. The present data illustrate this relationship in a person with progressive MS, and offer support for the WatchPAT as a cost-effective means to evaluate for both OSA and CSA in PwMS, while reducing patient burden. PwMS may be at increased risk for CSA. Careful clinical consideration should be given to ordering appropriate sleep testing to differentiate central from obstructive sleep apnea in PwMS, particularly for patients with demyelinating lesions in the brainstem.

Support (if any)

1. Braley TJ, Segal BM, Chervin RD. Obstructive sleep apnea and fatigue in patients with multiple sclerosis. J Clin Sleep Med. 2014 Feb 15;10(2):155–62. doi: 10.5664/jcsm.3442. PMID: 24532998; PMCID: PMC3899317.
840 Obstructive to Central: A switch in sleep apnea type after arteriovenous malformation rupture
Authors: Greer Meredith , Trotti Lynn Marie , Collop Nancy
Published: May 2021

Introduction

Sleep apnea and stroke have long been shown to be linked, with sleep apnea increasing the risk for stroke and stroke leading to sleep apnea. When the latter occurs, it can present as central sleep apnea (CSA), often in the form of Cheyne-Stokes breathing (CSB), and has been shown to resolve over time. We present a patient with persistent CSA after severe hemorrhagic stroke secondary to rupture of a temporal/thalamic arteriovenous malformation (AVM).

Report of case(s)

A 33-year-old man with a history of obstructive sleep apnea (OSA) presented to our clinic for re-evaluation of his disease. He was diagnosed with OSA in 2006 at which time he was 270 pounds with a body mass index (BMI) of 36.7, thus the OSA was thought to be secondary to obesity. When he presented to our clinic 10 years later, he had lost approximately 80 pounds after suffering multiple strokes. In 2014, he had a left temporal lobe hemorrhage due to rupture of a left temporal/thalamic AVM and required decompressive hemicraniectomy. In 2015, he had a re-bleed of this AVM, with new hemorrhage extending inferiorly into the left cerebral peduncle and pons, and superiorly into the left parietal periventricular white matter anteriorly along the optic tract. Ultimately, he was treated with stereotactic radiotherapy to the AVM nidus with no residual AVM. However, he has chronic encephalomalacia of the left basal ganglia, thalamus, temporal, parietal, and occipital lobes with extension into the left cerebral peduncle and changes consistent with radiation necrosis. His residual symptoms are aphasia and right-sided hemiplegia and although his snoring resolved with weight loss, his mother noticed pauses in his breathing overnight. A repeat sleep study done in 2016 showed 27 central apneas and 0 obstructive apneas with an AHI of 5.4 events/hour. He was subsequently studied on ASV with residual AHI of 0.4 events/hour.

Conclusion

Although patients with OSA may be at higher risk for stroke, it is important to re-evaluate their sleep apnea after such an event to ensure appropriate diagnosis and treatment going forward.

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851 Self-Medication with Caffeine for 31 Years: A Case of Undiagnosed Childhood Narcolepsy Type II
Authors: Seydou Moustapha Doulaye , Karime Christian , Wyrick Brenda , Khan Amir
Published: May 2021

Introduction

Narcolepsy represents a relatively rare chronic neurological sleep disorder. While peak incidence occurs in adolescence and early-adulthood, reports indicate a substantial number of children under 10 remain undiagnosed or are misdiagnosed. The present case describes a female with undiagnosed narcolepsy type II self-medicating with caffeinated beverages from the age of 7.

Report of case(s)

A 40-year-old female presented at our clinic with excessive daytime fatigue and hypersomnolence despite adequate sleep (Epworth sleepiness scale= 16/24). The patient denied snoring, sleep paralysis, catalepsy, and hypnagogic/hypnopompic hallucinations. Symptoms began at the age of 7 and steadily worsened, with teachers reporting significant concentration difficulties and multiple episodes of unintentional sleep onset in the classroom. The patient reported heavily relying on caffeinated beverages from the age of 7 to remain awake and focused on classroom activities. Starting at the age of 7, the patient consumed on average a caffeine-equivalent of 1 espresso shot/day (64mg caffeine/day). This increased to 4–6 espresso shots/day (256-384mg caffeine/day) by the age of 12 and 5–9 espresso shots/day (320-576mg caffeine/day) by the age of 18. At the age of 25, the patient developed severe anxiety with panic attacks and episodes of suicidal ideation. With multiple episodes of sleep onset while operating a motor vehicle, a near-accident prompted medical evaluation. Diagnosed with general anxiety disorder and idiopathic hypersomnolence, escitalopram and armodafinil were started with limited effect. The patient continued self-medicating with caffeinated beverages until age 38 when she was diagnosed with narcolepsy type II. Sodium oxybate was subsequently added to her treatment plan with initial sleep benefit and caffeine reduction. A repeat mean sleep latency test confirmed narcolepsy type II (mean sleep latency= 3 minutes, mean rapid eye movement [REM] sleep latency= 3 minutes). Polysomnography was later performed due to non-resolving symptoms, revealing mild obstructive sleep apnea (REM apnea-hypopnea index= 13.5/hour). Continuous positive airway pressure was added to the treatment regime with significant sleep benefit.

Conclusion

We describe a case of undiagnosed childhood narcolepsy type II necessitating significant caffeine consumptions in order to maintain classroom performance. With known anxiety-provoking effects of caffeine, the case highlights the importance of addressing childhood narcolepsy.

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857 Too sleepy: A pediatric case of Prader Willi Syndrome and Narcolepsy
Authors: Lam Elizabeth , Malhotra Sonal , Glaze Daniel
Published: May 2021

Introduction

Prader Willi syndrome (PWS) is a genetic disorder due to deletion of the paternal copies of genes within the chromosome region 15q11-q13. Individuals with PWS are commonly seen with obesity, sleep disordered breathing, and excessive daytime sleepiness (EDS). While the exact cause of EDS in individuals with PWS is not fully understood, there have been reports of PWS with narcolepsy-like syndrome. We report a case of a patient with PWS with findings suggesting the diagnosis of Narcolepsy Type 2.

Report of case(s)

Our patient is a 12-year-old male with PWS and 2nd degree heart block who was evaluated in our pediatric sleep center. He has a previous diagnosis of mild obstructive sleep apnea (OSA) with an apnea hypopnea index (oAHI) of 3.2. At 12 years of age, mother and patient reported that he had increased snoring, weight gain, EDS with a Pediatric Daytime Sleepiness Score (PDSS) of 10 and frequent refreshing naps during the daytime. Patient denied cataplexy during that visit. Subsequently, 2-week actigrapghy was performed which demonstrated an average total night sleep of 8 hours and 8 minutes. Overnight PSG with Multiple Sleep Latency Test (MSLT) demonstrated an oAHI of 4.8, total sleep time of 6.88 hours. During the MSLT, the mean sleep latency was 6.2 minutes and 5 sleep onset REM periods were observed over 5 nap opportunities. At his follow-up visit, methylphenidate was initiated after clearance by his cardiologist. Patient and mother opted for medical management of his mild OSA with Fluticisone and Montelukast. At his follow-up appointment, the patient had improvement in daytime sleepiness with a PDSS of 2 despite taking his Methylphenidate at night. Patient was instructed to switch to morning Methylphenidate dosing to optimize treatment of his EDS.

Conclusion

EDS is a common complaint seen in patients with PWS, however the etiology of it is not entirely understood. It is thought to be centrally mediated with components of hypersomnia and narcolepsy like-symptoms. More research is needed to better understand, diagnose and adequately treat patients with PWS and EDS.

Support (if any):
Sleep deprivation impairs binding of information with its context
Authors: Kurinec Courtney A , Whitney Paul , Hinson John M , Hansen Devon A , Van Dongen Hans P A
Published: May 2021

Binding information to its context in long-term memory is critical for many tasks, including memory tasks and decision making. Failure to associate information to its context could be an important aspect of sleep deprivation effects on cognition, but little is known about binding problems from being sleep-deprived at the time of encoding. We studied how sleep deprivation affects binding using a well-established paradigm testing the ability to remember auditorily presented words (items) and their speakers (source context). In a laboratory study, 68 healthy young adults were randomly assigned to total sleep deprivation or a well-rested control condition. Participants completed an affective item and source memory task twice: once after 7-hour awake during baseline and again 24 hours later, after nearly 31 hours awake in the total sleep deprivation condition or 7 hours awake in the control condition. Participants listened to negative, positive, and neutral words presented by a male or female speaker and were immediately tested for recognition of the words and their respective speakers. Recognition of items declined during sleep deprivation, but even when items were recognized accurately, recognition of their associated sources also declined. Negative items were less bound with their sources than positive or neutral items, but sleep deprivation did not significantly affect this pattern. Our findings indicate that learning while sleep-deprived disrupts the binding of information to its context independent of item valence. Such binding failures may contribute to sleep deprivation effects on tasks requiring the ability to bind new information together in memory.
High light-induced photoinhibition is not limiting seedling establishment at abrupt treeline ecotones in New Zealand
Authors: Döweler Fabian , Case Bradley S , Buckley Hannah L , Bader Martin K-F
Published: May 2021

Seedlings of New Zealand’s treeline-forming Fuscospora cliffortioides (Hook.f.) perform poorly beyond the established canopy, limiting treeline advance. To test the long-standing assumption that photoinhibition impairs regeneration in the subalpine belt of New Zealand’s Southern Alps, we assessed photosystem II (PSII) performance of seedling-sized individuals and microclimate variation. We performed diurnal, non-invasive chlorophyll-a-fluorescence measurements on exposed and canopy-sheltered individuals at two sites in New Zealand’s Southern Alps during summer and winter. Diurnal recordings of the effective (ΦPSII) and optimal (Fv/Fm) photosynthetic quantum yield were supplemented with light response curves and micro-temperature recordings. ΦPSII returned to near-optimal values around 0.8 after 30 min of shading, which rules out accumulative or long-term photoinhibition effects. The maximum electron transport rate derived from rapid light curves was significantly higher (+12%) in exposed compared with canopy-shaded individuals. Summer temperature fluctuated widely on the scree (−0.5 to 60.5 °C) and near seedlings (−2 to 26.5 °C). Our results revealed a remarkable level of light adaptation and contradict previous studies hinting at high light-induced photoinhibition as a treeline-limiting factor in the Southern Alps. By linking low ΦPSII on winter mornings, and large, sudden temperature drops in summer, we suspect that cold-induced photoinhibition might occur but the rapid recovery of ΦPSII seen across a wide temperature range makes lethal photo-oxidative damage rather unlikely. Given the demonstrably low summer frost tolerance of F. cliffortioides, cold-related damage resulting from frost events during the growing season or embolism induced by frost drought may offer more plausible explanations for the poor seedling establishment. Duration and frequency of these events could diminish with global warming, which may promote treeline advance.
Rotavirus Diarrhoea among Children Aged <5 Years in Hospital Setting in Dar Es Salaam, Tanzania
Authors: Nalitolela Neema , Kisenge Rodrick , Mkopi Namala Patrick , Manji Karim
Published: May 2021

Background

Diarrhoea remains among the highest causes of death in children under 5 years of age in developing countries. Before the introduction of rotavirus vaccine in Tanzania, rotavirus infection was the leading cause of severe diarrhoea in children below the age of 5 years but there is a paucity of studies reporting the severity of this infection after the introduction of rotavirus vaccine. This hospital-based study reports the proportion of children with rotavirus-associated diarrhoea in Dar es Salaam, its severity and associated factors.

Methods

A hospital-based cross-sectional study was conducted at the inpatient and outpatient paediatrics departments of the selected health facilities from September 2018 to February 2019. A total of 314 children meeting inclusion criteria were enrolled into the study. A structured questionnaire was used to collect demographic and medical history, anthropometric measurements were taken and a stool sample was collected from each patient for rotavirus antigen detection using CTK Biotech Onsite rotavirus antigen rapid test

Results

A total of 314 children were included in the study with age range between 2 and 59 months. The median age was 12 months with an interquartile range of 8–19 months. Symptoms of rotavirus diarrhoea were vomiting (p-value = 0.018) and severe dehydration (p-value = 0.000). Independent associated factors of rotavirus diarrhoea included: age of mother between 35 and 49 years (AoR 4.1, 95% CI 1.0–17.1, p-value = 0.05), geographical distribution (Ilala District, AoR 4.0, 95% CI 1.1–10.4, p-value = 0.039), poor hand hygiene (AoR 8.5, 95% CI 2.6–28.1, p-value = 0.000) and drinking bottled/home-treated water (AoR 5.4, 95% CI 1.3–22.7, p-value = 0.02).

Conclusion

Rotavirus infection is still prevalent and severe among children with diarrhoea. The difference in prevalence among the districts is also of concern and hence larger community-based cohort studies are needed to assess the association of rotavirus diarrhoea with the geographical variation across districts and regions. Improving sanitation and hygiene through health education amongst households is crucial for disease prevention.
Mineralized-tissue histology reveals protracted life history in the Pliocene three-toed horse from Langebaanweg (South Africa)
Authors: Nacarino-Meneses Carmen , Chinsamy Anusuya
Published: May 2021

We studied the bone and dental histology of the tri-dactyl equid Eurygnathohippus hooijeri, one of the most iconic mammals found at the world-renowned Pliocene site of Langebaanweg, South Africa, to reconstruct important features of its life history. Our results show that key life-history events, such as weaning, skeletal maturity and reproductive maturity, occurred later in this African hipparionine compared with European three-toed equids and several extant Equus. Its late life-history schedule agrees with an ecological context of low adult extrinsic mortality and low juvenile survival rates. We also observed high rates of bone growth in Eu. hooijeri that were probably achieved through a high-quality diet and plentiful available water. Our research highlights the significance of combining bone and dental histology in the same taxon to obtain refined palaeobiological information about extinct vertebrates.
A Pilot Prospective Observational Study of Cerebral Autoregulation and 12-Month Outcomes in Children With Complex Mild Traumatic Brain Injury: The Argument for Sufficiency Conditions Affecting TBI Outcomes
Authors: Thamjamrassri Thanyalak , Watanitanon Arraya , Moore Anne , Chesnut Randall M. , Vavilala Monica S. , Lele Abhijit V.
Published: May 2021

Background:

The relationship between cerebral autoregulation and outcomes in pediatric complex mild traumatic brain injury (TBI) is unknown, and explored in this study.

Methods:

We conducted a prospective observational study of patients aged 0 to 18 years hospitalized with complex mild TBI (admission Glasgow Coma Scale score 13 to 15 with either abnormal computerized tomogram of the head or history of loss of consciousness). Cerebral autoregulation was tested using transcranial Doppler ultrasonography, and impaired autoregulation defined as autoregulation index<0.4. We collected Glasgow Outcome Scale Extended-Pediatrics score and health-related quality of life data at 3, 6, and 12 months after discharge.

Results:

Twenty-four patients aged 1.8 to 16.6 years (58.3% male) with complete 12-month outcome data were included in the analysis. Median admission Glasgow Coma Scale score was 15 (range: 13 to 15), median injury severity score was 12 (range: 4 to 29) and 23 patients (96%) had isolated TBI. Overall, 10 (41.7%) patients had impaired cerebral autoregulation. Complete recovery was observed in 6 of 21 (28.6%) children at 3 months, in 4 of 16 (25%) children at 6 months, and in 8 of 24 (33.3%) children at 12 months. There was no difference in median (interquartile range) Glasgow Outcome Scale Extended-Pediatrics score (2 [2.3] vs. 2 [interquartile range 1.3]) or health-related quality of life scores (91.5 [21.1] vs. 90.8 [21.6]) at 12 months between those with intact and impaired autoregulation, respectively. Age-adjusted hypotension occurred in 2/24 (8.3%) patients.

Conclusion:

Two-thirds of children with complex mild TBI experienced incomplete functional recovery at 1 year. The co-occurrence of hypotension and cerebral autoregulation may be a sufficiency condition needed to affect TBI outcomes.
Neurodevelopmental Outcomes Associated With Intravitreal Bevacizumab Injections for Retinopathy of Prematurity
Authors: Webb Alexandra R.
Published: May 2021

Background:

Retinopathy of prematurity (ROP) is a common disorder among premature infants associated with significant morbidity. The current standard of care includes laser ablation therapy when needed. While intravitreal bevacizumab (IVB) injections have emerged as a new therapy for ROP, so have concerns about the systemic effects of the bevacizumab (Avastin), specifically on neurodevelopmental outcomes.

Purpose:

To review the current literature on the impact of IVB on neurodevelopmental outcomes in neonates with ROP to inform nurses' knowledge and practice.

Methods:

A literature search was performed in the PubMed, CINAHL, and Embase databases. Eleven primary studies examining neurodevelopmental outcomes related to IVB were identified and reviewed.

Results:

Limitations of current studies, including small sample sizes, retrospective analysis subject to selection bias, and confounding factors such as sedation/anesthesia exposure, prevent robust conclusions from being drawn. However, there is not currently any clear evidence of negative neurodevelopmental impacts associated with IVB despite a sound theoretical basis for concern.

Implications for Practice:

Nurses should include all known and potential risks and benefits when counseling families and developing individualized plans of care for their neonatal patients with ROP.

Implications for Research:

Well-designed, prospective studies examining neurodevelopmental outcomes at later time points are needed to conclusively support or disprove results of IVB therapy for ROP in the context of potential adverse effects.
Does a medial mini-incision decrease the risk of iatrogenic ulnar nerve injury in pediatric supracondylar humeral fractures treated with closed reduction and percutaneous pinning? A retrospective cohort study
Authors: Al Habsi Salim , Al Hamimi Suliman , Al Musawi Hashim , Rao Kaza S.V. , AL Ajemi Abdulla , Sharaby Mohamed M.F.
Published: May 2021

Background:

The authors compared two techniques for safe medial pin placement during fixation of supracondylar humeral fractures, namely closed pinning and mini-open pinning of medial wire insertion, and their effectiveness in protection against iatrogenic ulnar nerve injury.

Methods:

One hundred and nineteen patients with type 2 and 3 Gartland supracondylar humeral fractures (AO Foundation/Orthopaedic Trauma Association [AO/OTA] 13-M/3.1 II, III and IV) were included in this study after applying the exclusion criteria. All patients were managed with cross pinning with identification of two groups. The first group was for percutaneous pinning (N=63), and the second group for patients with medial open incision during medial wire insertion (N=56). All patients were evaluated for the incidence of nerve injury after surgery.

Results:

Nerve injury occurred in 12 of 119 patients. The estimated duration of follow-up was 43.6±10.2 wk. The results revealed nine patients who had ulnar nerve injury among both groups (group 1, N=8, group 2, N=1), with statistically better results in group 2 (P=0.02). The incidence of nerve injury was not found to be correlated with other variables, which included age, gender, type of fracture, number of Kirschner wires that were inserted, and the level of the surgeon.

Conclusions:

A medial mini-open incision decreased the risk of ulnar nerve injury during cross pin fixation in the treatment of displaced supracondylar humeral fractures, without additional morbidity.

Level of Evidence:

Level III.
Endoscopic Carpal Tunnel Release Without Invading the Tunnel: A New Transretinacular Technique
Authors: Tarfusser Ivo , Mariacher Markus , Berger Wilhelm , Tarfusser Thomas , Nienstedt Frank
Published: May 2021

Established endoscopic carpal tunnel release (ECTR) techniques carry a not entirely eludible risk of iatrogenic complications, mainly because of incomplete view of the cutting blade and intraoperative pressure increase inside the carpal tunnel (CT). We describe a novel single-portal ECTR method, conceived to reduce these risks, by optimizing visual control and avoiding dilatation of the CT. After incising the well exposed proximal third of the transverse carpal ligament (TCL), transection of the remainder is completed using a pediatric urethrotome. This small caliber instrument is moved in the plane of the TCL, without invading the tunnel, and provides detailed view of the TCL and any crossing anatomical structures at any given moment. We present the technique and the results of a retrospective case series of 33 patients with CT syndrome who underwent the procedure, after failing to respond to conservative treatment. Because of improved view and the avoidance of intraoperative pressure trauma to structures passing through the CT, the described approach may contribute to prevent iatrogenic complications and represent a valid improvement over conventional ECTR procedures.
User Engagement Using an Etextbook
Authors: Verkuyl Margaret , Atack Lynda , Lapum Jennifer L. , Hughes Michelle , St-Amant Oona , Petrie Paul
Published: May 2021

Engagement is an integral pedagogical component underpinning effective educational activities and is of importance for educators using online platforms. Carefully designed, technology-enabled learning resources can increase student engagement. We developed an open educational resource etextbook on vital sign measurement using an interactive and multimodal platform to facilitate student learning. The etextbook design was informed by experiential teaching-learning theory. Students progressed through the etextbook at their own pace, following pedagogy informed by the iterative process of read, observe, practice, and test, commonly used in nursing education. The etextbook was introduced as a required reading in a first-year health assessment course at one university and two colleges. In this project, we explored the level of engagement experienced by users of the etextbook. We conducted a descriptive study using the User Engagement Scale to measure students' degree of engagement using the etextbook. Results from participants (N = 455) who used the etextbook in the study indicated a high level of engagement. The responses to an open-ended item on the survey provided context to the results and shed light on effective design practices. Several recommendations for best practices in developing etextbooks are identified for educators to consider.
Measuring Nurses' Transition to Electronic Handover
Authors: Lee Chia-Lun , Lin Shu-Yuan
Published: May 2021

The transition from traditional handover methods to electronic handover is extremely stressful to nurses. This psychometric evaluation study tested the validity and reliability of the perception and adaptation readiness of electronic handover system scales for hospital nurses. A total of 253 Taiwanese nurses from a medical center participated in this study from January to March 2018. The perception and adaptation readiness of electronic handover system scales were self-developed, and content validity was tested via content validity index of the scale. Exploratory factor analysis and confirmatory factor analysis were utilized to test construct validity, while reliability was tested by Cronbach's α coefficient. Four factors explained 50.77% of the total variance in the perception of electronic handover system scale. Three factors accounted for 53.43% of the total variance in the adaptation readiness of electronic handover system scale. The confirmatory factor analysis results indicated a three-factor construct for both scales. Cronbach's α coefficients were 0.83 and 0.91 for the perception and adaptation readiness of the electronic handover system scale, respectively. The scales could be used to assess nurses' perceptions and adaptation readiness of electronic handover, while the assessing result serves as a reference for implementing educational and supportive interventions to facilitate adaptation in nurses.
Spinal versus general anesthesia during retrograde intra-renal surgery: A propensity score matching analysis
Authors: Olivero Alberto , Ball Lorenzo , Fontaneto Carlotta , Mantica Guglielmo , Bottino Paolo , Pelosi Paolo , Terrone Carlo
Published: May 2021

Background:

The indications for retrograde intra-renal surgery (RIRS) have greatly increased, however, there is still no consensus on the use of spinal anesthesia (SA) during this procedure. The aim of this study was to evaluate the comparability of surgical conditions and outcomes with RIRS performed under SA versus general anesthesia (GA) for renal stones.

Materials and methods:

This was a prospective, observational study in patients scheduled for RIRS in a single teaching hospital in Italy. Inclusion criteria were age >18 years and the presence of single or multiple renal stones. We recorded information concerning the site of lithiasis, the number of calculi, total stone burden, and the presence of concomitant ureteral stones or hydronephrosis. A propensity score-matched analysis was performed to evaluate the results in terms of surgical outcome, intraoperative and postoperative complications, and analgesia demand balanced for confounding factors. Patients were followed-up until day 90 from discharge.

Results:

We included 120 patients, the propensity score-matched cohort included 40 patients in the SA and 40 in the GA groups. The stone-free rate was 67.5% in the GA group and 70.0% in the SA group (p = 0.81). The use of auxiliary procedures within 90 days did not differ between groups (25.0% vs. 22.5%, p = 0.79). No cases of conversion from SA to GA were recorded. We did not find any differences in intraoperative bleedings, perforations, and abortions. Complication rates were similar in the 2 groups (10.0% in GA vs. 5.0% in SA, p = 0.64).

Conclusions:

In our cohort, RIRS performed under SA and GA was equivalent in terms of surgical results and complications.
Effects of Hot Nights on Mortality in Southern Europe
Authors: Royé Dominic , Sera Francesco , Tobías Aurelio , Lowe Rachel , Gasparrini Antonio , Pascal Mathilde , de’Donato Francesca , Nunes Baltazar , Teixeira Joao Paulo
Published: May 2021

Background:

There is strong evidence concerning the impact of heat stress on mortality, particularly from high temperatures. However, few studies to our knowledge emphasize the importance of hot nights, which may prevent necessary nocturnal rest.

Objectives:

In this study, we use hot-night duration and excess to predict daily cause-specific mortality in summer, using multiple cities across Southern Europe.

Methods:

We fitted time series regression models to summer cause-specific mortality, including natural, respiratory, and cardiovascular causes, in 11 cities across four countries. We included a distributed lag nonlinear model with lags up to 7 days for hot night duration and excess adjusted by daily mean temperature. We summarized city-specific associations as overall-cumulative exposure–response curves at the country level using meta-analysis.

Results:

We found positive but generally nonlinear associations between relative risk (RR) of cause-specific mortality and duration and excess of hot nights. RR of duration associated with nonaccidental mortality in Portugal was 1.29 (95% confidence interval [CI] = 1.07, 1.54); other associations were imprecise, but we also found positive city-specific estimates for Rome and Madrid. Risk of hot-night excess ranged from 1.12 (95% CI = 1.05, 1.20) for France to 1.37 (95% CI = 1.26, 1.48) for Portugal. Risk estimates for excess were consistently higher than for duration.

Conclusions:

This study provides new evidence that, over a wider range of locations, hot night indices are strongly associated with cause-specific deaths. Modeling the impact of thermal characteristics during summer nights on mortality could improve decisionmaking for preventive public health strategies.
Estimating the Cumulative Incidence of SARS-CoV-2 Infection and the Infection Fatality Ratio in Light of Waning Antibodies
Authors: Shioda Kayoko , Lau Max S.Y. , Kraay Alicia N.M. , Nelson Kristin N. , Siegler Aaron J. , Sullivan Patrick S. , Collins Matthew H. , Weitz Joshua S. , Lopman Benjamin A.
Published: May 2021

Background:

Serology tests can identify previous infections and facilitate estimation of the number of total infections. However, immunoglobulins targeting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported to wane below the detectable level of serologic assays (which is not necessarily equivalent to the duration of protective immunity). We estimate the cumulative incidence of SARS-CoV-2 infection from serology studies, accounting for expected levels of antibody acquisition (seroconversion) and waning (seroreversion), and apply this framework using data from New York City and Connecticut.

Methods:

We estimated time from seroconversion to seroreversion and infection fatality ratio (IFR) using mortality data from March to October 2020 and population-level cross-sectional seroprevalence data from April to August 2020 in New York City and Connecticut. We then estimated the daily seroprevalence and cumulative incidence of SARS-CoV-2 infection.

Results:

The estimated average time from seroconversion to seroreversion was 3–4 months. The estimated IFR was 1.1% (95% credible interval, 1.0%, 1.2%) in New York City and 1.4% (1.1, 1.7%) in Connecticut. The estimated daily seroprevalence declined after a peak in the spring. The estimated cumulative incidence reached 26.8% (24.2%, 29.7%) at the end of September in New York City and 8.8% (7.1%, 11.3%) in Connecticut, higher than maximum seroprevalence measures (22.1% and 6.1%), respectively.

Conclusions:

The cumulative incidence of SARS-CoV-2 infection is underestimated using cross-sectional serology data without adjustment for waning antibodies. Our approach can help quantify the magnitude of underestimation and adjust estimates for waning antibodies.
Preliminary Thermoluminescent Dosimeter Glow Curve Analysis with Automated Glow Peak Identification for LiF:Mg,Ti
Authors: Thiesen Jack H. , Hepker Jeremy M. , Yu Wenjin , Pombier Keegan D. , Kearfott Kimberlee J.
Published: May 2021

When appropriately analyzed, thermoluminescent dosimeter glow curve analysis allows for improved quantification of thermoluminescent material behavior while flagging abnormalities. The mathematical separation of a glow curve into contributions from energetically unique trap states, or glow curve analysis, may be used to remove undesired effects of signal fading for complex materials. A generalized glow curve analysis software for the separation of glow curves is presented in this paper. Written in C++, the software uses the first-order kinetics model with automatic peak identification. The automatic identification of peaks is achieved through a unique peak-finding algorithm. The program was performance tested using experimental glow curve data from LiF:Mg,Ti, and comparative results are presented.
Long-Term Outcome of Descemet Membrane Endothelial Keratoplasty in Eyes With Fuchs Endothelial Corneal Dystrophy Versus Pseudophakic Bullous Keratopathy
Authors: Zwingelberg Sarah B. , Büscher Frederike , Schrittenlocher Silvia , Rokohl Alexander C. , Loreck Niklas , Wawer-Matos Philomena , Fassin Anne , Schaub Friederike , Roters Sigrid , Matthaei Mario , Heindl Ludwig M. , Bachmann Björn O. , Cursiefen Claus
Published: May 2021

Purpose:

The aim of this study was to compare the long-term outcome of Descemet membrane endothelial keratoplasty (DMEK) in patients with Fuchs endothelial corneal dystrophy (FECD) and pseudophakic bullous keratopathy (PBK).

Methods:

Records of consecutive DMEK surgeries performed between 2015 and 2016 at the Department of Ophthalmology, Cologne, Germany, were retrospectively reviewed from the prospective Cologne DMEK Database. Eyes with either PBK or FECD with a complete 3-year follow-up were enrolled. Main outcome parameters included central corneal thickness (CCT), peripheral corneal thickness (PCT), best spectacle-corrected visual acuity (BSCVA, logarithm of the Minimum Angle of Resolution), and endothelial cell count (ECC) before and after DMEK.

Results:

Four hundred two eyes from 402 patients were included (FECD n = 371, PBK n = 31). Preoperatively, CCT (FECD: 681.91 ± 146.78 μm; PBK: 932.25 ± 319.84 μm) and PCT (FECD: 732.26 ± 98.22 μm; PBK: 867.54 ± 88.72 μm) were significantly higher in the PBK group (P < 0.01). Three years after DMEK, CCT (FECD: 526.56 ± 27.94 μm; PBK 663.71 ± 132.36 μm) was significantly lower in both groups compared with the preoperative values (P < 0.01), whereas PCT showed no significant difference. PCT increased during the course in the PBK group from month 12 after DMEK (12 mo: 783.73 ± 127.73 μm; 24 mo: 837.50 ± 110.19 μm; 36 mo: 857.79 ± 140.76 μm). The increase in PCT correlated with an accelerated ECC loss starting 12 months after DMEK (P = 0.036). Before DMEK, BSCVA in FECD was significantly higher (P < 0.001) compared with that in PBK. After 3 years, BSCVA improved in FECD and PBK eyes without significant difference (P = 0.239).

Conclusions:

Visual acuity after DMEK in PBK and FECD seems to be comparable during the long-term follow-up. Peripheral and central corneal edema seems to recur faster in eyes with PBK than in those with FECD. Therefore, using a donor graft with higher ECC or possibly a larger graft could be a promising approach for PBK patients.
Comparative Efficacy and Safety of Standard Versus Accelerated Corneal Crosslinking for Keratoconus: 1-Year Outcomes From the Save Sight Keratoconus Registry Study
Authors: Kandel Himal , Nguyen Vuong , Ferdi Alex C. , Gupta Aanchal , Abbondanza Marco , Sullivan Laurence , Apel Andrew , Watson Stephanie L.
Published: May 2021

Purpose:

The aim of this study was to compare the efficacy and safety of standard [Ultraviolet (UV) light power: 3 mW/cm2, duration: 30 minutes] versus accelerated (UV power: 9 mW/cm2, duration: 10 minutes) corneal crosslinking (CXL) for stabilizing keratoconus.

Methods:

A total of 684 eyes (555 patients; mean age ± SD, 25.0 ± 7.9 years; women, 30.6%) from 24 international sites with epithelium-off CXL for keratoconus had follow-up data at 1-year and met the inclusion criteria. Two hundred sixty-six eyes (228 patients) had undergone standard CXL, and 418 eyes (327 patients) had undergone accelerated CXL. The outcome measures included changes in visual acuity, keratometry, minimum corneal thickness, and frequency of adverse events. The outcomes were compared using mixed-effects regression models adjusted for age, sex, visual acuity, keratometry, pachymetry, doctor, practice, and eye laterality.

Results:

The adjusted mean changes (95% confidence interval) in outcomes were similar in standard and accelerated CXL in visual acuity [6.5 (2.0, 11.1) versus 5.5 (0.4, 10.6) logMAR letters, respectively], Kmax [−0.9 (−1.4, −0.3) D versus −1.2 (−1.9, −0.4) D, respectively], K2 [−0.4 (−0.9, 0.2) D versus −0.4 (−1.1, 0.3), D respectively], or minimum corneal thickness [−13.3 (−20.3, −6.3) μm versus −16.6 (−24.5, −8.6) μm, respectively] (all P > 0.05). The frequency of adverse events at the 12-month visit was also similar between the CXL groups (standard, 8.3% vs. accelerated, 5.5%; P = 0.21).

Conclusions:

This real-world observational study found that both standard and accelerated CXL were similarly safe and effective in stabilizing keratoconus at 1-year postsurgery in the real-world setting. The findings support the adoption of accelerated CXL for time and convenience.
Catheter-Associated Blood Stream Infection Caused by Acinetobacter oleivorans
Authors: Matsukawa Masanori , Aoki Kotaro , Ishii Yoshikazu , Murakami Keiji
Published: May 2021

A man in his late 70s developed a catheter-associated bloodstream infection caused by Acinetobacter oleivorans after endoscopic resection of colon adenomas. Bacteremia persisted despite of treatment with a series of effective antibacterial agents. After removal of the central venous catheter, his symptoms promptly resolved and blood culture turned negative. This is the case of A. oleivorans as a human pathogen firstly characterized by whole-genome sequencing.
Comparative Effectiveness of Behavioral Interventions for Cardiovascular Risk Reduction in Latinos
Authors: Estrada Leah V. , Solano Jasmine , Reading Turchioe Meghan , Cortes Yamnia I. , Caceres Billy A.
Published: May 2021

Background

Latinos, the fastest growing ethnic minority group in the United States, are at a high risk for cardiovascular disease (CVD). However, little is known about effective strategies to reduce CVD risk in this population.

Objective

The aim of this study was to systematically review and synthesize evidence from randomized controlled trials that examined the effectiveness of behavioral interventions to reduce CVD risk in Latinos living in the United States.

Methods

Four electronic databases were searched for relevant peer-reviewed English- and Spanish-language articles published between January 1, 2000, and December 31, 2019. Four reviewers independently completed article screening, data abstraction, and quality appraisal. At least 2 reviewers completed data abstraction and quality appraisal for each article, and a third reviewer was assigned to settle disagreements. Data on study characteristics and outcomes were abstracted.

Results

We retrieved 1939 articles. After applying inclusion/exclusion criteria, 17 articles were included. Most interventions were led by community health workers (n = 10); 2 family-based interventions were identified. None of the included studies was nurse led. Behavioral factors were assessed across all included studies, whereas only 4 studies reported on psychosocial outcomes. Improvements were observed in dietary habits and psychosocial outcomes. Findings for physical activity and biological outcomes were mixed. We identified no differences in outcomes based on intervention modalities used or the role of those who led the interventions.

Conclusion

Existing evidence is mixed. Future research should assess the effectiveness of understudied treatment modalities (including nurse-led, mobile health, and family-based interventions) in reducing CVD risk in Latinos.
Sharply Demarcated Yellow Hued Plaque on the Upper Eyelid
Authors: Corzano Renzo , Jacob Sharon E.
Published: May 2021

Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a case of yellow lesions on the upper eyelid.