bluuebunny/crossref_metadata_2025 huggingface dataset:
Novel Stereoscopic Optical System for Objectively Measuring Above-Surface Scar Volume—First-Time Quantification of Responses to Various Treatment Modalities
Authors: Salameh Fares , Koren Amir , Sprecher Eli , Artzi Ofir
Published: December 2017

BACKGROUND

Current approaches use subjective semiquantitative or cumbersome objective methodologies to assess physical characteristics of hypertrophic and keloid scars.

OBJECTIVE

This pilot study aimed to evaluate the accuracy and feasibility of a new stereoscopic optical and high-resolution 3-dimensional imaging system, for objectively measuring changes in above-surface scar volume after various interventions.

METHODS

Feasibility and accuracy were assessed by monitoring the above-surface scar volume of 5 scars in 2 patients for 5 successive months. Above-surface scar volume and Vancouver Scar Scale scores and the investigator and patient volume improvement assessment scores were assessed before and 12 weeks after last intervention.

RESULTS

Scar volume measured by the imaging system correlated significantly with the gold standard (actual weight). The greatest volume reduction followed a combination of cryotherapy and intralesional triamcinolone acetonide and 5-fluorouracil injections in Patient 1 and a combination of pulse dye laser and intralesional triamcinolone acetonide injections in Patient 2.

CONCLUSION

The new stereoscopic optical system is a valid, accurate, and practical objective method for assessing scar volume and for monitoring treatment response. It is more sensitive and accurate than semiquantitative objective scales. Further studies with a higher number of patients and scars are required to increase the measurement validity of the system.
Palliative care in gynecologic oncology
Authors: Karlin Daniel , Phung Peter , Pietras Christopher
Published: December 2017

Purpose of review

Patients with gynecologic malignancies face many difficult issues in the course of their diseases, ranging from physical symptoms to advance care planning in light of a poor prognosis. This review examines the evidence supporting integration of palliative care early in the course of disease and symptom management, and provides a framework for difficult conversations.

Recent findings

Palliative care has been demonstrated to improve quality of life and promote survival if integrated early in the course of disease. An evidence-based approach should guide symptom management, such as pain and nausea. Advance care planning and goals of care discussions are enhanced by a framework guiding discussion and the incorporation of empathetic responses.

Palliative care is a diverse multidisciplinary field that can provide significant benefit for patients with gynecologic malignancies.
Alternative facts and morcellation
Authors: Olive David L.
Published: December 2017

Purpose of review

Since the recent black-box warning regarding the use of electromechanical morcellation, there has been a hesitancy to utilize the product and even to perform other types of morcellation by gynecologists. Unfortunately, this Food and Drug Administration action and the continued public criticisms of this procedure are grounded in poor data and faulty reasoning. To truly perform informed consent to patients considering procedures involving morcellation, a thorough review of the facts, not alternative facts, must be communicated.

Recent findings

Misrepresentation of the ethics surrounding this procedure, the role of informed consent and the risks and benefits as determined by evidence-based medicine have led to confusion and poor public policy. Today's evidence suggests that the procedure is indeed ethical when full disclosure of the risks and benefits is presented via informed consent. Risks of the procedure have been exaggerated significantly, and little attention has been paid to the risks of denying morcellation procedures to patients. Attempts to condemn gynecologists as acting contrary to established surgical principles do not coincide with facts.

Morcellation is a controversial technique which undoubtedly has a role as well as limitations. To appropriately determine if the procedure is indicated and acceptable to the patient, full disclosure of the best available evidence is necessary.
SEVERE IMMUNE-MEDIATED THROMBOCYTOPENIA AFTER INTRAVITREAL BEVACIZUMAB INJECTION
Authors: Li Tianyi , Witteman Derek T. , Weber Eric D. , Alexander Warren L. , Schaber John D.
Published: December 2017

Purpose:

To report a case of severe immune-mediated thrombocytopenia after intravitreal bevacizumab administration.

Methods:

A 77-year-old man with right-sided macular degeneration received intravitreal bevacizumab. After his third treatment dose, he was hospitalized for symptomatic thrombocytopenia (platelet count of 3 k/μL) and underwent testing to determine the etiology.

Results:

Initial platelet counts on admission were 3 k/μL, down from 238 k/μL 3 months before. A peripheral smear, coagulation studies, and an abdominal CT were unremarkable. A bone marrow biopsy revealed hypercellular marrow with megakaryocytic hyperplasia. Serum antiplatelet antibody testing identified antibodies against glycoprotein IV and human leukocyte antigens. A total of 13 units of platelets were administered and resulted in no significant response. Treatment with rituximab, romiplostim, and human leukocyte antigen–matched platelets resulted in slow recovery and normalization of platelet counts.

Conclusion:

The case presented shows apparent severe immune-mediated thrombocytopenia after intravitreal bevacizumab administration.
Eyelid Changes Related to Meibomian Gland Dysfunction in Early Middle-Aged Patients Using Topical Glaucoma Medications
Authors: Kim Ji Hong , Shin Yong Un , Seong Mincheol , Cho Hee Yoon , Kang Min Ho
Published: December 2017

Purpose:

To investigate the relationship between topical glaucoma medications and meibomian gland dysfunction (MGD) in early middle-aged patients with glaucoma.

Methods:

In this cross-sectional study, 50 patients with glaucoma younger than 50 years who had used topical glaucoma medications for more than 6 months and 40 normal controls of similar age were included. Patients in each group were graded for MGD (0–4) using slit-lamp microscopy. Tear film breakup time (BUT), ocular surface staining, and Marx line scores were also evaluated. Differences between both groups were analyzed statistically.

Results:

The prevalence of MGD was 82% in the group using topical glaucoma medications and 52.5% in the control group. The average period of topical glaucoma medication use was 27.4 months. There were significant differences in the breakup time and Marx line score according to the presence of MGD. Although the duration of topical glaucoma medication use and the severity of MGD did not show a significant correlation, the degree of MGD and the Marx line score were significantly correlated.

Conclusions:

Glaucoma eye drops may be one factor affecting the eyelid changes associated with MGD. The Marx line score may be used as an index to evaluate MGD in patients with glaucoma.
Epidemiology of Persistent Dry Eye-Like Symptoms After Cataract Surgery
Authors: Iglesias Eugenia , Sajnani Ravin , Levitt Roy C. , Sarantopoulos Constantine D. , Galor Anat
Published: December 2017

Purpose:

To evaluate the frequency and risk factors for persistent postsurgical pain (PPP) after cataract surgery, defined as mild or greater dry eye (DE)-like symptoms 6 months after surgery.

Methods:

This single-center study included 86 individuals who underwent cataract surgery between June and October 2016 and had DE symptom information available 6 months after surgery. Patients were divided into 2 groups: controls were defined as those without DE symptoms 6 months after surgery (defined by a Dry Eye Questionnaire 5 (DEQ5) score <6), cases were defined as those with mild or greater DE-like symptoms 6 months after surgery (DEQ5 ≥6).

Results:

Mean age of the study population was 71 ± 8.6 years; 95% (n = 82) were men. DE-like symptoms were reported in 32% (n = 27) of individuals 6 months after cataract surgery; 10% (n = 8) reported severe symptoms (DEQ5 ≥12). Patients with DE-like symptoms after cataract extraction also had higher ocular pain scores and specific ocular complaints (ocular burning, sensitivity to wind and light) compared with controls with no symptoms. A diagnosis of nonocular pain increased the risk of DE-like symptoms after cataract surgery (odds ratio 4.4, 95% confidence interval 1.58–12.1, P = 0.005).

Conclusions:

Mild or greater PPP occurred in approximately 1/3 of individuals after cataract surgery. Prevalence of severe PPP is in line with that of refractive surgery, dental implants, and genitourinary procedures.
Psychiatric Disorders, Antiretroviral Medication Adherence and Viremia in a Cohort of Perinatally HIV-Infected Adolescents and Young Adults
Authors: Bucek Amelia , Leu Cheng-Shiun , Benson Stephanie , Warne Patricia , Abrams Elaine J. , Elkington Katherine S. , Dolezal Curtis , Wiznia Andrew , Mellins Claude Ann
Published: December 2017

Background:

Perinatally HIV-infected (PHIV+) adolescents and young adults (AYA) are at risk for suboptimal antiretroviral therapy (ART) adherence and mental health and substance use problems that, in HIV-infected adults, predict nonadherence. Studies on the relationship between psychiatric and substance use disorders (SUD) and adherence among PHIV+ AYA are limited, but may be important for informing evidence-based interventions to promote adherence.

Methods:

Data were analyzed from 3 annual follow-up interviews (FU2–FU4, N = 179) in a longitudinal study of PHIV+ AYA. Psychiatric disorders (anxiety, disruptive behavior, mood and SUD) were assessed with the Diagnostic Interview Schedule for Children. Adherence was self-reported missed ART doses within the past week. Viral load (VL) results were abstracted from medical charts. Multiple logistic regression analyzed cross-sectional associations between psychiatric disorders and (1) missed ART dose and (2) VL > 1000 copies/mL. Multiple linear regression assessed associations between psychiatric disorders and proportion of VL values >1000 copies/mL over time.

Results:

At FU2, 53% of PHIV+ AYA had any psychiatric disorder, 35% missed an ART dose in the past week and 47% had a VL > 1000 copies/mL. At FU2, behavioral disorders were associated with missed dose (P = 0.009) and VL > 1000 (P = 0.019), and mood disorders were associated with missed dose (P = 0.041). At FU4, behavioral disorders were associated with missed dose (P = 0.009). Behavioral disorders (P = 0.041), SUD (P = 0.016) and any disorder (P = 0.008) at FU2 were associated with higher proportion of VLs >1000 across FU2–FU4.

Conclusions:

Addressing psychiatric disorder and SUD among PHIV+ AYA may improve ART adherence outcomes in this population. Targeted interventions should be developed and tested.
Population Pharmacokinetics of Lopinavir in Severely Malnourished HIV-infected Children and the Effect on Treatment Outcomes
Authors: Archary Moherndran , Mcllleron Helen , Bobat Raziya , Russa Phillip La , Sibaya Thobekile , Wiesner Lubbe , Hennig Stefanie
Published: December 2017

Background:

In developing countries, malnutrition remains a common clinical syndrome at antiretroviral treatment (ART) initiation. Physiologic changes because of malnutrition and during nutritional recovery could affect the pharmacokinetics of antiretroviral drugs.

Methods:

HIV-infected children admitted with severe acute malnutrition were randomized to early or delayed initiation of lopinavir (LPV)/ritonavir, abacavir and lamivudine using World Health Organization weight band dosage charts. LPV concentrations were measured on day 1 and day 14. Thereafter, patients were followed-up to week 48. The population pharmacokinetics of LPV was described using NONMEM v7.3. Covariates were screened to assess their influence on the pharmacokinetics of LPV, and the relationship between pharmacokinetic variability and treatment outcomes were assessed.

Results:

Five hundred and two LPV concentrations were collected from 62 pediatric patients 0.1–3.9 years of age (median: 0.9 years). Rifampin-based antituberculosis treatment and “super-boosted” LPV/ritonavir were prescribed in 20 patients. LPV disposition was well described by a one-compartment model with first-order elimination. Neither randomization to early or delayed ART, tuberculosis comedications nor anthropometrical measurements explained the pharmcokinetic variability. Allometrically scaled fat-free mass influenced apparent clearance (CL/F) and volume of distribution (V
d/F). Pharmacokinetic exposure did not correlate with virologic outcomes or death at 12 or 48 weeks.

Conclusions:

LPV pharmacokinetics was influenced by fat-free mass and not by timing of ART initiation or tuberculosis comedication in severely malnourished HIV-infected children. LPV pharmacokinetics was found to be highly variable and bioavailability greatly reduced, resulting in a high CL estimate in this population. The role of LPV dose adjustment should be further evaluated in severely malnourished children initiating ART.
Hearing Loss in Pediatric Patients With Cerebral Palsy
Authors: Weir Forest W. , Hatch Jonathan L. , McRackan Theodore R. , Wallace Sarah A. , Meyer Ted A.
Published: December 2017

Objective:

This study evaluates the prevalence, type, and severity of hearing impairment in children with cerebral palsy (CP) and to analyze audiologic and otologic outcomes in these patients.

Study Design:

Retrospective analysis of the AudGen Database.

Setting:

Tertiary academic referral center.

Patients:

Pediatric patients in AudGen Database with a diagnosis of cerebral palsy. Appropriate audiologic, otologic, and demographic data were recorded.

Nine hundred forty patients met inclusion criteria. Hearing loss (HL) was defined as greater than 15 dB HL at any threshold by pure tone or greater than 20 dB HL by soundfield audiometry. Other available otologic and medical conditions were documented.

Results:

Of 940 patients, 367 (39%) had hearing loss. Of the 1,629 individual ears with HL, 782 (48%) had conductive, 63 (4%) had sensorineural, 410 (25%) had mixed, and 374 (23%) had unspecified hearing loss. Patients with mixed type 1 hearing loss had significantly worse PTAs.

Interpretation:

Hearing loss in CP has a large degree of sensorineural loss, with a predisposition to be bilateral. The severity of hearing loss was correlated with the degree of the motor and neurologic disability in these patients.
Meta-analysis of Cochlear Implantation Outcomes Evaluated With General Health-related Patient-reported Outcome Measures
Authors: McRackan Theodore R. , Bauschard Michael , Hatch Jonathan L. , Franko-Tobin Emily , Droghini Harris Richard , Velozo Craig A. , Nguyen Shaun A. , Dubno Judy R.
Published: December 2017

Objective:

Determine the change in general health-related quality of life (HRQOL) after cochlear implantation and association with speech recognition.

Study Design:

Meta-analysis.

Methods:

Search was performed following the PRISMA statement using PubMed, Medline, Scopus, and CINAHL. Studies on adult cochlear implant (CI) patients measuring HRQOL before and after cochlear implantation were included. Standardized mean difference (SMD) for each measure and pooled effects were determined. A meta-analysis of correlations was also performed between all non-disease-specific patient-reported outcome measures (PROMs) and speech recognition after cochlear implantation.

Results:

Twenty-two articles met criteria for meta-analysis of HRQOL improvement, but 15 (65%) were excluded due to incomplete statistical reporting. From the seven articles with 274 CI patients that met inclusion criteria, pooled analyses showed a medium positive effect of cochlear implantation on HRQOL (SMD = 0.79). Subset analysis of the HUI-3 measure showed a large effect (SMD = 0.84). Nine articles with 550 CI patients met inclusion criteria for meta-analysis of correlations between non-disease specific PROMs and speech recognition after cochlear implantation. Pooled analysis showed a low correlation between non-disease-specific PROMs and word recognition in quiet (r = 0.35), sentence recognition in quiet (r = 0.40), and sentence recognition in noise (r = 0.32).

Conclusion:

Although regularly used, HRQOL measures are not intended to measure nor do they accurately reflect the complex difficulties facing CI patients. Only a medium positive effect of cochlear implantation on HRQOL was observed along with a low correlation between non-disease-specific PROMs and speech recognition. The use of such instruments in this population may underestimate the benefit of cochlear implantation.
Mobile Hearing Testing Applications and the Diagnosis of Sudden Sensorineural Hearing Loss: A Cautionary Tale
Authors: Sethi Rosh K. V. , Ghanad Iman , Kanumuri Vivek , Herrmann Barbara , Kozin Elliott D. , Remenschneider Aaron K.
Published: December 2017

Objective:

Mobile hearing applications (apps) are available for hearing testing, personal sound amplification, as well as hearing aid modulation. Hearing testing apps are gaining popularity, especially in resource-limited settings. The reliability of mobile hearing testing apps, however, is not well characterized.

Patients/interventions:

A case study of a single patient with a complaint of sudden hearing loss presenting to a tertiary-care hospital.

Main Outcome Measure:

Comparison of a mobile hearing testing app results with standard audiogram.

Results:

A commercially available mobile hearing testing app was used after hours to determine if a patient's hearing complaints were consistent with sudden sensorineural hearing loss. The hearing app produced a rudimentary audiogram that was consistent with unilateral SSNHL. Given contraindications to oral treatment, preparations for possible intratympanic dexamethasone after a full audiometric evaluation were completed. Confirmatory audiogram the following day demonstrated normal hearing without evidence of hearing loss. Steroid treatment was aborted and appropriate counseling provided.

Conclusion:

While mobile hearing testing apps offer improved access to hearing screening in resource-limited settings, caution must be exercised when interpreting data and making clinical decisions based upon results. The role of professional audiologists remains critical. Further testing and validation of specific apps is required.
Photopolymerized Microfeatures Guide Adult Spiral Ganglion and Dorsal Root Ganglion Neurite Growth
Authors: Xu Linjing , Seline Alison E. , Leigh Braden , Ramirez Mark , Guymon C. Allan , Hansen Marlan R.
Published: December 2017

Hypothesis:

Microtopographical patterns generated by photopolymerization of methacrylate polymer systems will direct growth of neurites from adult neurons, including spiral ganglion neurons (SGNs).

Background:

Cochlear implants (CIs) provide hearing perception to patients with severe to profound hearing loss. However, their ability to encode complex auditory stimuli is limited due, in part, to poor spatial resolution caused by spread of the electrical currents in the inner ear. Directing the regrowth of SGN peripheral processes towards stimulating electrodes could help reduce current spread and improve spatial resolution provided by the CI. Previous work has demonstrated that micro- and nano-scale patterned surfaces precisely guide the growth of neurites from a variety of neonatal neurons including SGNs. Here, we sought to determine the extent to which adult neurons likewise respond to these topographical surface features.

Methods:

Photopolymerization was used to fabricate methacrylate polymer substrates with micropatterned surfaces of varying amplitudes and periodicities. Dissociated adult dorsal root ganglion neurons (DRGNs) and SGNs were cultured on these surfaces and the alignment of the neurite processes to the micropatterns was determined.

Results:

Neurites from both adult DRGNs and SGNs significantly aligned to the patterned surfaces similar to their neonatal counterparts. Further DRGN and SGN neurite alignment increased as the amplitude of the microfeatures increased. Decreased pattern periodicity also improved neurite alignment.

Conclusion:

Microscale surface topographic features direct the growth of adult SGN neurites. Topographical features could prove useful for guiding growth of SGN peripheral axons towards a CI electrode array.
Cochlear Implantation in Chronic Otitis Media With Cholesteatoma and Open Cavities: Long-term Surgical Outcomes
Authors: Vashishth Ashish , Fulcheri Andrea , Prasad Sampath Chandra , Dandinarasaiah Manjunath , Caruso Antonio , Sanna Mario
Published: December 2017

Objectives:

To evaluate the long-term surgical outcomes of cochlear implantation (CI) in chronic otitis media (COM) with cholesteatoma and open cavities using subtotal petrosectomy (STP). To review device explantation (DE) patients and reimplantation considerations.

Study Design:

Retrospective review.

Setting:

Otology and skull base center.

Patients and Methods:

Charts of 35 patients (36 ears) with COM with cholesteatoma, including open cavities, who underwent CI were reviewed for surgical outcomes and DE. Patient demographics, pathologies, previous surgeries, staging of implantation, salient intraoperative findings at the time of implantation and follow-up were evaluated. Details of patients with DE were evaluated for cause, operative findings, and reimplantation considerations.

Results:

Mean age of patients was 65.94 years. Nineteen open cavities, 11 primary cholesteatomas, 3 petrous bone cholesteatomas, and 3 atelectatic middle ears represented the pathologies with 31 patients of CI with concurrent STP and 5 patients where implantation was staged. The mean follow-up was 7.16 years ranging from 2 to 13 years. Four patients (11%) had DE due to extrusion and cavity infection with three reimplanted in same or contralateral ear. All explantations occurred within 24 months of primary implantation. No residual or recurrent cholesteatoma was observed in any of the patients during follow-up.

Conclusion:

CI is feasible in COM with cholesteatoma and open cavities with the use of STP and single-stage implantation can be performed in the absence of purulence. Despite low risk of residual cholesteatoma post meticulous disease removal, risk of DE remains, particularly in open cavity patients, and is higher than standard implantation. Reimplantation is often possible with careful considerations.
Heat Shock Proteins in Human Perilymph: Implications for Cochlear Implantation
Authors: Schmitt Heike , Roemer Ariane , Zeilinger Carsten , Salcher Rolf , Durisin Martin , Staecker Hinrich , Lenarz Thomas , Warnecke Athanasia
Published: December 2017

Objective:

Biomarkers reflecting the etiology and pathophysiology of inner ear diseases are limited. Evaluation of proteins in the perilymph may improve our understanding of inner ear disease. Heat shock proteins (HSP) belong to a superfamily of stress proteins and promote refolding of denatured proteins. The aim of the study was to analyze HSP in human perilymph and to identify possible correlation with audiological and etiologic data.

Methods:

Sampling of the perilymph was performed during cochlear implantation and vestibular schwannoma removal. Individual proteins were identified by a shot-gun proteomics approach by orbitrap mass spectrometry. Expression of HSP genes was determined in human cochlear tissue that was obtained during transcochlear surgeries.

Results:

Ten subgroups of HSP were identified in human perilymph samples. Increased levels of HSP were detected in a higher percentage in the perilymph of patients with residual hearing when compared with patients with no residual hearing in cochlear implantation. In patients with complete preservation of residual hearing, HSP 90 is identified in a lower percentage whereas HSP 70 1A/1B and 6 was identified in all the samples. Constitutive expression of HSP family members was verified in normal cochlear tissue.

Conclusion:

The 10 HSP variants are not identified in all the perilymph samples, but in a higher proportion in patients with residual hearing compared with patients with no residual hearing. In-depth proteome analysis of perilymph samples in correlation to patients’ audiogram data shows an increased concentration of HSP in patients with residual hearing. An increase in specific HSP in patients with loss of residual hearing after cochlear implantation was not observed.
High Resolution Three-Dimensional Delayed Contrast MRI Detects Endolymphatic Hydrops in Patients With Vertigo and Vestibular Schwannoma
Authors: Moayer Roxana , Ishiyama Gail P. , Karnezis Stellios , Sepahdari Ali R. , Ishiyama Akira
Published: December 2017

Objective:

Advances in high resolution magnetic resonance imaging (MRI) have enabled the detection of endolymphatic hydrops (EH), a pathological ballooning of the endolymphatic fluid system, known to be associated with Menière's disease. When a patient has a known diagnosis of vestibular schwannoma and develops recurrent episodic vertigo spells, many surgeons recommend surgical intervention, attributing the vestibular symptoms to the vestibular schwannoma. The aim of this study is to evaluate the clinical outcome in patients with vestibular schwannoma and EH, treated medically, for recurrent spells of vertigo.

Patients:

Two patients with EH and vestibular schwannoma who presented with recurrent spells of vertigo are included. Both had characteristic low frequency hearing loss ipsilateral to the schwannoma.

Intervention:

MRI sequences with 3T scanner (Skyra, Siemens Healthcare, Erlangen, Germany) using high resolution three-dimensional delayed postcontrast protocol included “cisternographic” T2 and delayed intravenous-enhanced three-dimensional fluid-attenuation inversion recovery (DIVE-3D-FLAIR) sequences, performed with 2350 ms (bright perilymph) and 2050 ms (bright endolymph) inversion times and with subtracted images.

Main Outcome Measure:

MRI FLAIR evaluation of EH and presence or absence of vestibular symptoms.

Results:

Both patients had resolution of the disabling vertigo spells with a diuretic, and Patient 1 had unchanged EH, while Patient 2 had partial resolution of the EH and the FLAIR hyperintensity.

Conclusion:

When EH coexists with vestibular schwannoma in a patient presenting with recurrent vertigo spells, medical treatments for EH may alleviate the vestibular symptoms. We recommend that patients with small vestibular schwannomas who present with vertigo spells undergo high resolution MRI to evaluate for EH and undergo a trial of medical treatment with diuretics.
Cartilage Conduction Hearing Aids for Severe Conduction Hearing Loss
Authors: Nishimura Tadashi , Hosoi Hiroshi , Saito Osamu , Shimokura Ryota , Yamanaka Toshiaki , Kitahara Tadashi
Published: December 2017

Objective:

To assess the benefits of a new type of hearing aid using cartilage conduction (CC) in patients with severe conduction hearing loss and evaluate its potential for practical use.

Study Design:

Consecutive, prospective case series.

Patients:

Forty-one subjects (21 with bilateral aural atresia; 15 with unilateral aural atresia; and 5 others) participated in this study.

Intervention:

Fitting and gain adjustments of the CC hearing aids were performed to the ear(s) with conduction hearing loss.

Main Outcome Measures:

The function gains were measured. Evaluation of the measurements of speech performance-intensity functions, speech recognition scores, tolerance of environmental noise, and subject questionnaires were also performed, and judged according to the “Guidelines for the evaluation of hearing aid fitting” established by the Japan Audiological Society.

Results:

The thresholds were significantly improved by CC hearing aids. The functional gains for CC hearing aids were nearly equivalent to that for their previously used hearing aids. The style of the transducer fixation and the type of aural atresia had no significant influence on the functional gains. Most of the assessment results were judged to be sufficient. Before the trial, bone conduction hearing aids had been used most frequently by bilateral aural atresia subjects. However, after the trial, most subjects continued to use CC hearing aids instead of reverting back to their original device. Overall, 39 subjects continued use of the CC hearing aids. No severe adverse effects were noted in the trial.

Conclusion:

Cartilage conduction hearing aids could be an additional and beneficial option for severe conduction hearing loss from aural atresia.
Early Outcomes With a Slim, Modiolar Cochlear Implant Electrode Array
Authors: McJunkin Jonathan L. , Durakovic Nedim , Herzog Jacques , Buchman Craig A.
Published: December 2017

Objective:

To describe outcomes from cochlear implantation with a new, slim modiolar electrode array.

Study Design:

Retrospective cohort study.

Setting:

Tertiary referral centers.

Patients:

Adult cochlear implant candidates.

Interventions:

Cochlear implantation with CI532 (Cochlear Corp).

Main Outcome Measures:

Pre- and postoperative speech perception scores, operative details, and postoperative computed tomography (CT) reconstructions of array location.

Results:

One hundred seventeen patients are implanted to date. There were eight tip rollovers identified with intraoperative x-ray and resolved with reinsertion. An additional rollover was identified on postoperative CT. CT reconstructions in 17 of 23 patients showed complete scala tympani placement with a wrap factor of 58% (range 53–64%) and a mean insertion angle of 406 degrees (range 360–452 degrees). Three implants demonstrated array translocation with electrodes in the scala vestibuli. Consonant-nucleus-consonant word scores improved from 10% preoperatively to 48% at 3 months postoperatively. Pure-tone thresholds were preserved postoperatively in 37 to 52% of patients across frequencies from 250 to 4000 Hz. Functional pure-tone thresholds (≤80 dB) were recorded in 9 to 25% of patients.

Conclusion:

CI532 array insertion results in consistent scala tympani location and provides expected audiologic performance. Initial hearing preservation results are not consistent with current electro-acoustic arrays.
Effect of nutritional risk on short-term outcomes after laparoscopic-assisted gastrectomy: a prospective study from two centers
Authors: Chen Wei-Zhe , Chen Xi-Yi , Zhang Feng-Min , Dong Qian-Tong , Ji Yan-Bin , Chen Xiao-Lei , Zhuang Cheng-Le , Chen Xiao-Xi
Published: December 2017

Background/aim

The aim of this prospective double-center study was to explore the effect of nutritional risk on short-term outcomes in the patients who had gastric cancer and underwent a laparoscopic-assisted gastrectomy.

Patients and methods

We conducted a study of patients who underwent laparoscopic-assisted gastrectomy in two large centers between June 2014 and April 2017. Patients’ demographic and clinical characteristics and postoperative short-term outcomes were prospectively analyzed. Patients were divided into two groups depend on the preoperative presence of nutritional risk. Clinical variables were compared. Univariate analyses and multivariate logistic regression analyses evaluating the risk factors for postoperative complications were performed.

Results

A total of 256 patients, comprising 187 males and 69 females, met the inclusion criteria and were included in this study. The mean age was 61.81 years, the average BMI was 22.44 kg/m2, and the average preoperative serum albumin was 39.42 g/l. Older age (P=0.001), higher tumor stage (P=0.047), lower BMI (P<0.001), lower preoperative serum albumin (P=0.005), and lower hemoglobin (P=0.013) were more common in the nutritional risk group. There were no significant differences in the short-term postoperative outcomes between nutritional risk and non-nutritional risk groups. Advanced age (P=0.024) and hypoalbuminemia (P=0.004) were independent risk factors for postoperative complications after laparoscopic-assisted gastrectomy.

Conclusion

Nutritional risk may not be a clinical predictor of short-term outcomes after laparoscopic-assisted gastrectomy. Advanced age and preoperative hypoalbuminemia were independent risk factors for grade II or more postoperative complications.
A systematic review and meta-analysis of second-line immunosuppressants for autoimmune hepatitis treatment
Authors: De Lemos-Bonotto Michele , Valle-Tovo Cristiane , Costabeber Ane M. , Mattos Angelo A. , Azeredo-da-Silva André L.F.
Published: December 2017

Introduction

The gold-standard treatment for autoimmune hepatitis (AIH) is a prednisone/azathioprine combination. However, subgroups of patients may be unresponsive to this treatment. The aim of this study is to evaluate the efficacy of second-line immunosuppressive therapies for AIH through a systematic review and meta-analysis in adult patients.

Patients and methods

The systematic review was registered at the PROSPERO platform under number 42015019831. Databases MEDLINE (PubMed), Lilacs, Cochrane, and Scielo were searched. The keywords used were ‘Hepatitis, Autoimmune’ and descriptors terms (MeSH and DeCS). These terms were linked with each immunosuppressant of interest.

Results

A total of 1532 studies were identified. Of these, 1492 were excluded on the basis of title and abstract reading. Among the 40 studies retrieved for detailed full-text analysis, a total of 15 fulfilled the inclusion criteria for the analysis. The most studied second-line immunosuppressive was mycophenolate mofetil (MM). The mean reduction of aminotransferases was observed in 94.3% with tacrolimus/prednisone, 91.3% for cyclosporine/prednisone, 85.5% for budesonide, and 78.7% MM/prednisone. For MM/prednisone, the mean rate of histological remission was 88.6%, liver transplantation was indicated in 11.4%, and the mortality rate was 7.2%. Limitations were also present, such as the lack of randomized-controlled trials and prospective studies, the small number of patients, and the heterogeneity between remission criteria.

Conclusion

This is the first systematic review and meta-analysis to compare the second-line imunossupressant therapy for AIH. The most studied second-line immunosuppressive is the MM, with a reasonable histological remission. The use of combined tacrolimus/prednisone was the most effective for the normalization of aminotransferases.
Total bile acid levels are associated with left atrial volume and cardiac output in patients with cirrhosis
Authors: Voiosu Andrei M. , Wiese Signe , Voiosu Theodor A. , Hove Jens , Bendtsen Flemming , Møller Søren
Published: December 2017

Background and aims

Bile acids (BAs) are potent signaling molecules involved in the regulation of several metabolic and functional aspects of cardiovascular homeostasis. BA pool alteration in cirrhosis may contribute toward the development of hemodynamic and cardiac disturbances. We aimed to investigate the association between total BA levels and echocardiographic and biochemical markers of cardiac dysfunction in cirrhotic patients.

Methods

Cirrhotic patients were enrolled prospectively in this hypothesis-generating study and evaluated for cardiac and hemodynamic dysfunction through clinical, echocardiographic, and biochemical means. Associations between total serum BA concentrations and markers of systolic or diastolic dysfunction and the presence of cirrhotic cardiomyopathy were tested through univariate and multivariate analyses.

Results

Fifty-eight patients with cirrhosis were assessed in this monocentric study. 49 (85%) patients had decompensated cirrhosis according to the Child class. The median total BA level was 45 µmol/l. There was no correlation between BA levels and the etiology of cirrhosis (P=0.2), current alcohol use (P=0.8), sex (P=0.1), smoking status (P=0.2), age, or BMI. Systolic and diastolic dysfunction were rare in the cohort. Total BA levels associated with several echocardiographic parameters of the hyperdynamic syndrome in univariate analysis but only with left atrial volume in multivariate analysis (P=0.007). BA concentrations did not differ according to the presence of echocardiographically diagnosed cirrhotic cardiomyopathy in the two models tested.

Conclusion

Total serum BA levels are associated with enlarged left atrial volume and markers of the hyperdynamic circulation in patients with cirrhosis irrespective of the etiology or the severity of liver disease.
Sudden Intracranial Hemorrhage in a Patient With Atypical Chronic Myeloid Leukemia in Chronic Phase
Authors: Kouzuki Kagehiro , Umeda Katsutsugu , Saida Satoshi , Kato Itaru , Hiramatsu Hidefumi , Funaki Takeshi , Kanda Kenji , Muramatsu Hideki , Yoshida Kenichi , Ogawa Seishi , Adachi Souichi
Published: December 2017

A 16-year-old boy was incidentally found to have hyperleukocytosis during a school physical examination. He was diagnosed with atypical chronic myeloid leukemia in chronic phase. Although treatment with hydoxyurea was started, his white blood cell count increased and he eventually developed lethal intracranial hemorrhage. Although very rare, intracranial hemorrhage should be considered as a possible complication in patients with atypical chronic myeloid leukemia, even in chronic phase, if they have hyperleukocytosis and thrombocytopenia.
Physician and Nurse Perceptions of Gentle Cesarean Birth
Authors: Mercier Rebecca J. , Durante Julia C.
Published: December 2017

Background:

Protocols for neonatal care and mother–baby interaction at cesarean birth frequently differ from those at vaginal birth. There is increasing interest in adopting family-friendly or gentle protocols for women having cesarean birth. Current evidence suggests challenges in achieving interdepartmental cooperation and consensus are potential barriers to implementing gentle cesarean protocols.

Purpose:

To describe how care providers' professional role and characteristics may affect perception about gentle cesarean birth techniques and inform specific concerns about protocol changes.

Study Design and Methods:

A cross-sectional survey with mixed-methods analysis incorporating quantitative and qualitative conventional content analysis was used. A structured survey was distributed via email to all care providers on the labor and birth unit, including attending physicians, resident physicians in training, fellows, labor nurses, respiratory therapists, and operating room technicians. Quantitative responses were analyzed with bivariable tests and logistic regression to describe associations between provider attitudes and provider characteristics. Open-ended responses were analyzed with conventional content analysis to develop a model describing influences on overall provider attitudes.

Results:

Physicians and nurses generally have positive attitudes on benefits of gentle cesarean techniques. Their perceptions overall are informed by the balance of concerns about patient safety and logistical challenges versus perceived benefits of the techniques. On an individual level, care provider demographic and professional characteristics of gender and prior experience affected attitudes more than their specific role in patient care.

Clinical Implications:

Most labor and birth care providers have positive attitudes about gentle cesarean birth. Implementation of such programs should prioritize patient safety, educate physician and nurses about potential benefits for patients, and use experienced physicians and nurses as ambassadors to increase acceptance.
Incivility in the Emergency Department
Authors: Garth Katy , Todd Dana , Byers Dina , Kuiper Betty
Published: December 2017

Uncivil behavior leads to low self-esteem, anxiety, sleep disturbance, recurrent nightmares, and depression. This article looks at the perception of incivility among emergency department nurses and the leadership required to implement evidence-based strategies to address this growing problem.
The Implementation of a Structured Nursing Leadership Development Program for Succession Planning in a Health System
Authors: Ramseur Priscilla , Fuchs Mary Ann , Edwards Pamela , Humphreys Janice
Published: December 2017

Preparing future nursing leaders to be successful is important because many current leaders will retire in large numbers in the future. A structured nursing leadership development program utilizing the Essentials of Nurse Manager Orientation online program provided future nursing leaders with content aligned with nursing leadership competencies. Paired with assigned mentors and monthly leadership sessions, the participants increased their perception of leadership competence.
Characteristics of the Nursing Practice Environment Associated With Lower Unit-Level RN Turnover
Authors: Nelson-Brantley Heather V. , Park Shin Hye , Bergquist-Beringer Sandra
Published: December 2017

OBJECTIVE

The aim of this study is to examine characteristics of the nursing practice environment associated with lower RN turnover.

BACKGROUND

Identifying characteristics of the practice environment that contribute to lower RN turnover is important for meeting the national quality strategy priority of reducing healthcare costs.

METHODS

Data from 1002 adult care units in 162 National Database of Nursing Quality Indicators participating hospitals were analyzed using multivariate linear regression. The Practice Environment Scale of the Nursing Work Index was used to measure practice environment characteristics. RN turnover was measured at the unit level.

RESULTS

Nursing units with higher overall ratings of the nursing practice environment had lower rates of RN turnover. Units with higher RN perceived staffing and resource adequacy experienced significantly lower RN turnover.

CONCLUSIONS

Unit managers and hospital administrators should consider RN perception of staffing and resource adequacy and the overall practice environment when developing targeted strategies for decreasing RN turnover.
A Thematic Analysis of Self-described Authentic Leadership Behaviors Among Experienced Nurse Executives
Authors: Alexander Catherine , Lopez Ruth Palan
Published: December 2017

OBJECTIVE

The aim of this study is to understand the behaviors experienced nurse executives use to create healthy work environments (HWEs). The constructs of authentic leadership formed the conceptual framework for the study.

BACKGROUND

The American Association of Critical-Care Nurses recommends authentic leadership as the preferred style of leadership for creating and sustaining HWEs. Behaviors associated with authentic leadership in nursing are not well understood.

METHODS

A purposive sample of 17 experienced nurse executives were recruited from across the United States for this qualitative study. Thematic analysis was used to analyze the in-depth, semistructured interviews.

RESULTS

Four constructs of authentic leaders were supported and suggest unique applications of each including self-awareness (a private and professional self), balanced processing (open hearted), transparency (limiting exposure), and moral leadership (nursing compass).

CONCLUSIONS

Authentic leadership may provide a sound foundation to support nursing leadership practices; however, its application to the discipline requires additional investigation.
Practical Application of High-Reliability Principles in Healthcare to Optimize Quality and Safety Outcomes
Authors: Oster Cynthia A. , Deakins Sherilyn
Published: December 2017

Application of high-reliability (HR) principles into daily healthcare processes can drive culture change, safety, and quality outcomes. Understanding foundational practices to full HR principle integration in an organization's quality and safety programs strengthens evidence-based practices, reduces clinical variation, and improves nurse-sensitive patient outcomes. Quantifying the cost impact of reduction in preventable harm and improved nurse-sensitive patient outcomes is an initial attempt to formulate an empiric measure of nursing value.
The Effect of Acetaminophen on Temperature in Critically Ill Children: A Retrospective Analysis of Over 50,000 Doses
Authors: Ray Samiran , Rogers Libby , Brown Katherine L. , Peters Mark J.
Published: December 2017

Objectives:

Acetaminophen is widely used in PICUs. Although randomized controlled trials suggest that acetaminophen significantly reduces body temperature in adults, the effect of acetaminophen on temperature in critically ill children has not been previously quantified.

Design:

Retrospective observational cohort study.

Setting:

Single-center general and cardiac PICU in a specialist children’s hospital.

Patients:

All children who received acetaminophen or had a fever (temperature ≥ 38°C) while on the ICU over a 40-month period (September 2012 to December 2015).

Interventions:

None.

Measurements and Main Results:

In total, 58,177 doses of acetaminophen were administered, with temperature data available for analysis for 54,084 doses. Temperature decreased by 0.11°C (95% CI, 0.09–0.14°C) 4 hours post acetaminophen dose, after adjustment for weight and illness severity. In children who had a fever and were given acetaminophen, temperature decreased by 0.78°C (95% CI, 0.74–0.82°C). Temperature decreased by 0.88°C (95% CI, 0.85–0.92°C) in children who had fever but did not receive acetaminophen. The change in temperature associated with fever was significantly different between those who did and did not receive acetaminophen (likelihood ratio statistic 246.06; p < 2.2 × 10–16).

Conclusions:

Acetaminophen is associated with a significant decrease in temperature in children with fever. However, temperature may decrease following fever without acetaminophen in the PICU. The threshold to use acetaminophen must be understood to determine the true effect on temperature in any future trials.
Rurality, Quality Improvement Maturity, and Accreditation Readiness: A Comparison Study of Colorado, Kansas, and Nebraska Local Health Departments
Authors: Gregg Abbey , Bekmuratova Sarbinaz , Palm David , VanRaemdonck Lisa , Pezzino Gianfranco , Chen Li-Wu , Manetta Peter
Published: December 2017

Objective:

To compare local health department (LHD) accreditation readiness (AR) and quality improvement (QI) maturity in 3 states, between LHDs with varying levels of rurality, and across an LHD staffing-level continuum.

Design:

This was a cross-sectional comparative study that included an online survey administered to LHD directors in Colorado, Kansas, and Nebraska. The survey included 10 questions assessed on a 5-point Likert scale covering 3 QI domains and 13 questions covering 5 AR domains. The median score for both QI maturity and AR was calculated by each state, by the number of full-time equivalent staff employed at the LHD, and by a measure of rurality and population density.

Setting and Participants:

A total of 156 LHDs from the states of Colorado, Kansas, and Nebraska.

Main Outcome Measure(s):

QI maturity and AR scores.

Results:

A majority (59%) of the surveyed LHDs plan to apply or have already applied for Public Health Accreditation Board (PHAB) accreditation. The overall QI maturity and AR scores were highest in Nebraska, as was the intent to seek PHAB accreditation and current use of PHAB standards. Across levels of rurality and staffing, LHD QI maturity scores were similar; however, AR scores improved as LHD staffing levels increased and rurality decreased.

Conclusions:

Small LHDs and rural LHDs have QI maturity levels that are comparable to larger, less rural LHDs, but their AR is much lower. As accreditation has been found to have positive benefits, it is important that all LHDs have the capacity and resources to meet the performance standards required of accredited LHDs. Small, rural LHDs may need additional resources and support in order to improve their ability to be accredited and/or certain accreditation requirements may need modification to make accreditation more accessible to small LHDs.