bluuebunny/crossref_metadata_2025 huggingface dataset:
Using CAT to understand and work with complex trauma
Authors: Wilson Claire
Published: September 2022

This chapter explores the application of cognitive analytic therapy (CAT) in working with asylum seeker and refugees, considering both the utility (and limitations) within an individual psychotherapy approach, and to aid reflection on broader political and societal issues impacting this client group. Specific challenges are discussed including working with interpreters and providing therapeutic work within a context of ongoing trauma, loss, and uncertainty. This chapter considers the potential of CAT or CAT informed work to both discuss and formulate these issues within the therapy setting, and how the use of CAT concepts can guide and facilitate consideration of these multiple facets of the client’s experience. Relevant concepts explored include: the theory of the socially developed self; issues around culture, social inequality and power; and the capacity of using CAT to understand the individual’s unique constructions and expressions of emotional distress and the multiple influences on this.
Relational supervision in CAT
Authors: Stevens Yvonne J. , Dudley Jay
Published: September 2022

In this chapter we seek to describe aspects of cognitive analytic therapy (CAT) supervision that we have found useful in our practice as supervisors. We offer an account of the key aspects of the integrated theoretical models that contribute to the practice of CAT supervision and training of CAT supervisors. We consider the importance of a relational and dialogic application of this theory to practice in the supervisory space. We define the over-arching principles of governance and risk-management; the maintenance of ethical practice through supervision; and ensuring that inclusivity, equality, and diversity are embedded within all aspects of supervision. We will review the expectations of the skills, knowledge, and experience required of CAT supervisors and how a competency framework for supervision has been developed to support this aim. We will describe the process of training to be accredited as a CAT supervisor.
Reformulation
Authors: Jenaway Alison
Published: September 2022

The process of reformulation in cognitive analytic therapy (CAT) is described as a collaborative exercise, between therapist and client, ending with a written narrative description and a visually distinctive diagram. The focus is on finding a shared language and a way to explore difficulties while keeping sight of strengths and achievements. The chapter discusses the innovations in writing reformulation letters, such as inviting clients to write back or writing the letter together. It also describes creative homework tasks, in addition to the typical psychotherapy file, genogram, and timeline, which aid self-reflection and self compassion. An example reformulation letter is provided with annotations to show the core contents. It explains co-creation of diagrams in CAT and suggests the use of templates for drawing diagrams, particularly for trainees. Potential negative aspects of reformulation are referenced, as well as ways to reduce the likelihood of harm.
Financing vaccine equity: funding for day-zero of the next pandemic
Authors: Agarwal Ruchir , Reed Tristan
Published: September 2022

A lack of timely financing for purchases of vaccines and other health products impeded the global response to the Covid-19 pandemic. Based on analysis of contract signature and delivery dates in Covid-19 vaccine advance purchase agreements, this paper finds that 60–75 per cent of the delay in vaccine deliveries to low- and middle-income countries is attributable to their signing purchase agreements later than high-income countries, which placed them further behind in the delivery line. A pandemic Advance Commitment Facility with access to a credit line on day-zero of the next pandemic could allow low- and middle-income countries to secure orders earlier, ensuring a much faster and equitable global response than during Covid-19. The paper outlines four options for a financier to absorb some or all of the risk associated with the credit line and discusses how the credit would complement other proposals to strengthen the financing architecture for pandemic preparedness, prevention, and response.
Le retour en classe et le port du masque pendant la pandémie de COVID-19 : le point de vue des élèves d’après une étude de simulation scolaire
Authors: Coelho Sophie G , Segovia Alicia , Anthony Samantha J , Lin Jia , Pol Sarah , Crosbie Jennifer , Science Michelle , Matava Clyde T , Parekh Rulan S , Caldeira-Kulbakas Monica , Carroll Stacie , Greenwood Jodi L , Panzera Giovanna , Imgrund Ryan , Osokin Konstantin , Korczak Daphne J
Published: September 2022

Objectifs

La présente étude s’est penchée sur le point de vue des enfants relativement au retour en classe après le confinement imposé par la pandémie, sur le port du masque en classe et sur la santé mentale des enfants et des parents pendant la pandémie.

Méthodologie

La présente étude transversale a fait partie d’un exercice de simulation scolaire de deux jours au cours duquel les élèves ont été répartis au hasard entre diverses recommandations sur le port du masque. Au moyen d’analyses régression multiple, les chercheurs ont analysé le compte rendu des parents sur la santé mentale et, après la simulation, celui des élèves sur l’anxiété liée à la COVID-19 et le port du masque. Les élèves plus âgés ont participé à des groupes de travail semi-structurés pour compléter les données du questionnaire.

Résultats

Sur les 190 élèves de la présente étude, 31 % ne dépassaient pas la quatrième année et 95 % avaient hâte de rentrer en classe. La plus grande anxiété des parents ou des proches (β= 0,67; p<0,001) et leur niveau de scolarité plus bas (β=1,86; p<0,002) étaient prédicteurs d’une plus grande anxiété des enfants à l’égard de la COVID-19. Les élèves plus âgés étaient plus susceptibles de trouver le port du masque nuisible aux interactions avec leurs camarades que les plus jeunes (χ2[1]=31,16; p<0,001) et pour leur capacité à comprendre l’enseignant (χ2[1]=13,97; p<0,001). Les élèves du groupe sans masque étaient plus susceptibles de craindre de contracter la COVID-19 à l’école (χ2[1]=10,07; p<0,05) que ceux du groupe qui le portaient, et d’anticiper éprouver de la difficulté à le porter (χ2[1]=18,95; p<0,001).

Conclusions

Chez les enfants anxieux à cause de la COVID-19, l’anxiété des parents et l’information sur la COVID-19 pourraient être des cibles d’intervention. De futures recherches devraient porter sur les effets de la mise en œuvre prolongée de mesures sanitaires d’atténuation des risques sur la réussite scolaire et la santé mentale des enfants.
Les effets de la pandémie de COVID-19 sur la santé mentale et physique des enfants inscrits à une clinique pédiatrique de gestion du poids
Authors: Agatha Nsamenang Sheri , Anne Gutierrez Carline , Manayathu Jones Jane , Jenkins Glenn , Anne Tibelius Stephanie , Maria DiGravio Anna , Chamas Basma , Efua Ewusie Joycelyne , Geddie Hannah , Punthakee Zubin , Constantine Samaan M , Wahi Gita , Morrison Katherine M
Published: September 2022

Historique

L’obésité est un problème sanitaire mondial. Étant donné la perturbation généralisée causée par la pandémie de COVID-19, il est important d’en évaluer l’effet chez les enfants ayant des troubles de santé chroniques. La présente étude évalue la santé des patients pédiatriques obèses inscrits à un programme de gestion du poids d’un hôpital de soins tertiaires avant la pandémie de COVID-19, puis un an après le début de la pandémie.

Méthodologie

Les chercheurs ont mené une analyse rétrospective des dossiers de patients de deux à 17 ans inscrits à une clinique pédiatrique de gestion du poids. Ils ont comparé les effets en matière de santé mentale (nouvelles orientations en psychologie, en travail social, dans un programme de troubles alimentaires, incidence de dysrégulation de l’alimentation, idéation suicidaire ou automutilation) et de santé physique (mesures anthropométriques) avant la pandémie, puis un an après le début de la pandémie.

Résultats

Chez les 334 enfants vus pendant l’une ou l’autre période, le nombre d’orientations en psychologie (12,4 % par rapport à 26, 5 %; p=0,002) et le résultat composite sur la santé mentale (17,2 % par rapport à 30,2 %; p=0,005) se sont creusés pendant la pandémie comparativement à auparavant. Dans un sous-groupe d’enfants (n=30) dont ils connaissaient les mesures anthropométriques au cours des deux périodes, le taux de diminution du score z de l’indice de masse corporelle était plus faible (−1,5 [2,00] par rapport à −0,3 [0,73]/année; p=0,002) et l’adiposité, plus élevée (−0,8 [4,64] par rapport à 2,7 [5,54] %/année; p=0,043) pendant la pandémie.

Exposé

La pandémie a influé sur la santé mentale et physique des enfants obèses inscrits à une clinique de gestion du poids. L’étude démontre un effet négatif sur la santé mentale et une amélioration moins marquée des mesures anthropométriques, mais les futures recherches, lorsque les patients auront repris les soins en clinique, permettront d’examiner nos résultats à la lumière de nouvelles mesures objectives.
St. John’s Wort Exacerbates Acetaminophen-Induced Liver Injury by Activation of PXR and CYP-Mediated Bioactivation
Authors: Jiang Yiming , Zhou Yanying , Song Shaofei , Fan Shicheng , Gao Yue , Li Yuan , Huang Min , Bi Huichang
Published: September 2022

St. John’s wort (SJW) is a medicinal herb remedy for mild depression. However, long-term use of SJW has raised safety concerns in clinical practice because of drug-drug interactions. Excessive use of acetaminophen (APAP) causes severe hepatotoxicity, but whether SJW modulates APAP-induced liver injury remains unclear. In this study, the effect of long-term SJW administration on APAP-induced acute hepatotoxicity and the involved mechanisms were investigated. Morphological and biochemical assessments clearly demonstrated that SJW exacerbates APAP-induced toxicity. Moreover, SJW markedly promoted glutathione depletion and increased the levels of the APAP-cysteine and APAP-N-acetylcysteinyl adducts in mice, which enhanced APAP metabolic activation and aggravated APAP-induced liver injury. To further elucidate APAP metabolic activation in liver injury induced by SJW, the activities and expression levels of CYP2E1 and CYP3A were measured. The results showed that the activities and expression levels of CYP2E1 and CYP3A were increased after SJW treatment. Furthermore, the PXR-CYP signaling pathway was activated by SJW, and its downstream target genes were upregulated. Collectively, this study demonstrated that the long-term administration of SJW extract led to the metabolic activation of APAP and significantly exacerbated APAP-induced liver injury, which may suggest caution for the clinical use of SJW and APAP.
A comparative atlas of selected skeletal elements of European urodeles (Amphibia: Urodela) for palaeontological investigations
Authors: Macaluso Loredana , Wencker Lukardis C M , Castrovilli Maria , Carnevale Giorgio , Delfino Massimo
Published: September 2022

The osteology of European urodeles was studied extensively in the past, but comparative analyses of isolated bones are rare, despite being the most useful tool for the identification of fossil remains. The present work is focused on the most robust skeletal elements (therefore, common in the fossil record: otic–occipitum complexes and vertebrae) and provides taxonomically significant diagnostic characters at the genus level for European genera of urodeles, including some taxa whose osteology was poorly known (e.g. Euproctus and Calotriton). Characters subject to wide variability are identified, and their use is discouraged for diagnoses of extinct species. A selection of diagnostic characters is used herein to build an identification key for each studied skeletal element and for a phylogenetic analysis to understand whether these osteological elements can convey a genuine signal. The analysis under Bayesian inference resulted in a well-supported Salamandridae clade and Pleurodelinae tribe. Salamandrina was recovered as part of the Pleurodelinae, in agreement with previous morphological phylogenetic analyses, but in contrast to the conclusion of molecular studies.
Women With a History of Primary Infertility and Increased Rates of Bilateral Oophorectomy
Authors: Ainsworth Alessandra J. , Sadecki Emily , Zhao Yulian , Weaver Amy L. , Stewart Elizabeth A.
Published: September 2022

OBJECTIVE:

To evaluate the association of primary infertility with subsequent bilateral oophorectomy and hysterectomy, using a population-based cohort of women with primary infertility and age-matched women in a referent group.

METHODS:

The Rochester Epidemiology Project record-linkage system was used to assemble a population-based cohort of women with primary infertility diagnosed between 1980 and 1999 (index date). Women were age-matched (±1 year) 1:1 to women without a history of infertility or hysterectomy at the index date (referent group). Cox proportional hazards models were fit to compare long-term risks of bilateral oophorectomy and hysterectomy, respectively, between women with infertility and women in the referent group.

RESULTS:

Among both groups of 1,001 women, the mean age at the index date was 29.2±4.4 years. Median duration of follow-up was 23.7 years for both groups. Women with primary infertility were 1.7 times (adjusted hazard ratio [aHR] 1.69, 95% CI 1.22–2.33) more likely to undergo bilateral oophorectomy compared with women in the referent group. In a sensitivity analysis that excluded women with a diagnosis of infertility related to endometriosis and their matched referent group participants, this association persisted (aHR 1.50, 95% CI 1.06–2.14). Women with primary infertility did not have a significant increased risk of hysterectomy (aHR 0.98, 95% CI 0.79–1.23). However, risk of hysterectomy was increased in those with primary infertility related to endometriosis (aHR 1.94, 95% CI 1.12–3.34). We observed that women with primary infertility were more likely to undergo hysterectomy with bilateral oophorectomy. Women in the referent group were more likely to undergo hysterectomy with ovarian conservation. Few women in either group had isolated bilateral oophorectomy.

CONCLUSION:

Primary infertility, with and without a diagnosis of endometriosis, is associated with an increased risk of bilateral oophorectomy. In women with endometriosis-related infertility, there is an association with future hysterectomy. These findings represent important confounders in the evaluation of long-term health outcomes related to primary infertility.
Enrollment of Individuals From Racial and Ethnic Minority Groups in Gynecologic Cancer Precision Oncology Trials
Authors: Mattei Larissa H. , Robb Lauren , Banning Kaitlyn , Polan Rosa M. , Cote Michele L.
Published: September 2022

OBJECTIVE:

To characterize whether enrollment patterns in precision oncology clinical trials for gynecologic cancers reflect the racial and ethnic diversity of patients with gynecologic cancers in the United States.

METHODS:

ClinicalTrials.gov was queried to perform this cross-sectional review. We included precision oncology trials—defined as trials using molecular profiling of a tumor or the patient genome to identify targetable alterations to guide treatment—of ovarian, uterine, cervical, and vulvar cancers in the United States. National Cancer Institute Surveillance, Epidemiology, and End Results and United States Census Bureau data were used to estimate cancer burden and the expected number of trial participants by race and ethnicity for each gynecologic cancer. The ratio of actual-to-expected participants was calculated. A ratio greater than 1 signified overenrollment. A random effects meta-analysis was performed to assess the relative weights of individual trials.

RESULTS:

We identified 493 trials, 61 of which met inclusion criteria. There were 2,573 patients enrolled in ovarian cancer trials, 1,197 in uterine cancer trials and 162 in cervical cancer trials. Non-Hispanic White women were overrepresented overall (enrollment ratio 1.26, 95% CI 1.20–1.32) and across all cancer types on subgroup analysis. Asian women, non-Hispanic Black women, and Hispanic women were underrepresented overall (enrollment ratios 0.63, 95% CI 0.41–0.86; 0.51, 95% CI 0.36–0.66 and 0.30, 95% CI 0.23–0.36, respectively). In subgroup analyses, Asian women and non-Hispanic Black women were underrepresented in ovarian and uterine cancer trials and Hispanic women were underrepresented across all cancer types.

CONCLUSION:

Non-Hispanic Black women, Asian women, and Hispanic women with gynecologic cancers are underrepresented in precision oncology trials. Few U.S.-based precision oncology trials exist for uterine and cervical cancers, which have a high burden of morbidity and mortality among racial and ethnic minority groups. Failure to equitably enroll patients who belong to racial and ethnic minority groups may perpetuate existing disparities in gynecologic cancer outcomes.
Using Prophylactic Antihemorrhagic Medications in Second-Trimester Surgical Abortions
Authors: Fairchild Kelly , Altinok Morgan , Kram Jessica J. F. , Heslin Kayla , Montgomery Michelle , Michelson Elizabeth Dickson , Dorton Benjamin
Published: September 2022

We aimed to estimate the association of prophylactic antihemorrhagic medication use during dilation and evacuation (D&E) with operative hemorrhage and estimated blood loss (EBL). Records for all pregnant patients between 14 and less than 22 weeks of gestation who had a D&E procedure from January 2012 to December 2019 were retrospectively reviewed. Prophylactic antihemorrhagic medication use was defined as receiving vasoconstrictors, uterotonics, or both before identification of hemorrhage during a D&E procedure. Overall, 147 D&E procedures were completed at a mean of 16.4 (±2.2) weeks of gestation. Prophylactic medications were used in 72.1% (n=106) of D&E procedures. Prophylactic medication use was associated with lower operative hemorrhage (21.7% vs 51.2%, P<.01) and lower EBL (336.9 mL vs 551.3 mL, P<.01).
Clinical Correlates of Placenta Accreta Spectrum Disorder Depending on the Presence or Absence of Placenta Previa
Authors: Hessami Kamran , Salmanian Bahram , Einerson Brett D. , Carusi Daniela A. , Shamshirsaz Amir A. , Shainker Scott A. , Subramaniam Akila , Shrivastava Vineet K. , Nieto-Calvache Albaro José , Gilner Jennifer B. , Khandelwal Meena , Backer-Meurke Sean , Cimic Adela , Aalipour Soroush , Grace Matthew R. , Fox Karin A. , Lyell Deirdre J. , Belfort Michael A. , Silver Robert M. , Shamshirsaz Alireza A.
Published: September 2022

OBJECTIVE:

To evaluate whether there are differences in risk factors and maternal outcomes of pregnancies complicated by placenta accreta spectrum depending on the presence or absence of placenta previa.

DATA SOURCES:

We performed a systematic search in Medline, EMBASE, ClinicalTrials.gov, and Web of Science from inception through April 25, 2022, without language or date restrictions. Search strategy included the key words “placenta accreta,” “placenta increta,” “placenta percreta,” “adherent placenta,” “invasive placenta,” “abnormal placent*,” “placenta previa,” and “marginal placent*.”

METHODS OF STUDY SELECTION:

Of the 1,122 articles screened, seven studies were included in the final review. Studies were included if they compared the risk factors and maternal outcomes of pregnancies complicated by placenta accreta spectrum depending on the presence or absence of placenta previa.

TABULATION, INTEGRATION, AND RESULTS:

A random-effects model was used to pool the mean differences or odds ratios (OR) and the corresponding 95% CIs using RevMan software. A total of 3,342 pregnancies complicated by placenta accreta spectrum were included in the meta-analysis (2,365 without previa and 977 with previa). Pregnancies complicated by placenta accreta spectrum without previa were more likely to have been conceived by in vitro fertilization (IVF) (OR 3.11, 95% CI 1.93–5.02, P<.001, I2=52.0%) and to be associated with prior dilation and curettage (D&C) (OR 1.60, 95% CI 1.15–2.22, P=.005, I2=0.0%) and myomectomy (OR 2.47, 95% CI 1.31–4.66, P=.005, I2=0.0%), but they were less likely to be associated with prior cesarean delivery (OR 0.15, 95% CI 0.06–0.37, P<.001, I2=87.0%). Placenta accreta spectrum without previa was less likely to be diagnosed antenatally (OR 0.07, 95% CI 0.04–0.11, P<.001, I2=38.0%). Also, women with pregnancies without previa had lower rates of red blood cell transfusion, intensive care unit admission, risk of hysterectomy, unscheduled delivery, and intraoperative bowel or bladder injuries.

CONCLUSION:

Pregnancies complicated by placenta accreta spectrum without previa had a more prominent association with IVF and prior D&C and myomectomy but were much less likely to be associated with prior cesarean delivery. Further, placenta accreta spectrum without previa was less likely to be diagnosed antenatally, although it had better maternal outcomes as compared with placenta accreta spectrum with previa.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42022307637.
Progression to Severe Chronic Hypertension 5–7 Years After a Pregnancy With Mild Chronic Hypertension
Authors: Oben Ayamo , Szychowski Jeff M. , Ketch Peter , Elkins Cooper , Sinkey Rachel , Andrews William W. , Oparil Suzanne , Tita Alan
Published: September 2022

OBJECTIVE:

To estimate the incidence of severe chronic hypertension (cHTN) within 5–7 years after a pregnancy complicated by mild cHTN.

METHODS:

This was a retrospective cohort study of women with mild cHTN during an index pregnancy between 2012 and 2014. Women were included if they received prenatal care at a single academic center and had mild cHTN during their pregnancy. Women with severe cHTN, type 1 diabetes, systemic lupus erythematosus, cardiomyopathy, proteinuria, or creatinine level greater than 1.1 mg/dL before 23 weeks of gestation at baseline were excluded. The primary outcome was a composite of severe cHTN (defined as new-onset of two or more severe blood pressures) or new-onset cardiovascular disease complications more than 12 weeks after the index delivery.

RESULTS:

A total of 647 women with mild cHTN met inclusion criteria. Of these, 236 (36.5%, 95% CI 32.8–40.2%) women experienced the primary composite outcome of severe cHTN within 5–7 years of the index pregnancy. Black women progressed more rapidly than White women (adjusted hazard ratio [aHR] 1.99, 95% CI 1.43–2.76). Smoking tobacco was also associated with more rapid progression to severe cHTN (aHR 1.47, 95% CI 1.13–1.90).

CONCLUSION:

In this cohort, one in three women with mild cHTN in an index pregnancy progressed to severe cHTN within 5–7 years. Prospective studies to validate this finding are needed.
Malignancy Assessment Using Gene Identification in Captured Cells Algorithm for the Prediction of Malignancy in Women With a Pelvic Mass
Authors: Moore Richard George , Khazan Negar , Coulter Madeline Ann , Singh Rakesh , Miller Michael Craig , Sivagnanalingam Umayal , DuBeshter Brent , Angel Cynthia , Liu Cici , Seto Kelly , Englert David , Meachem Philip , Kim Kyu Kwang
Published: September 2022

OBJECTIVE:

To evaluate the detection of malignancy in women with a pelvic mass by using multiplexed gene expression analysis of cells captured from peripheral blood.

METHODS:

This was an IRB-approved, prospective clinical study. Eligible patients had a pelvic mass and were scheduled for surgery or biopsy. Rare cells were captured from peripheral blood obtained preoperatively by using a microfluidic cell capture device. Isolated mRNA from the captured cells was analyzed for expression of 72 different gene transcripts. Serum levels for several commonly assayed biomarkers were measured. All patients had a tissue diagnosis. Univariate and multivariate logistic regression analyses for the prediction of malignancy using gene expression and serum biomarker levels were performed, and receiver operating characteristic curves were constructed and compared.

RESULTS:

A total of 183 evaluable patients were enrolled (average age 56 years, range 19–91 years). There were 104 benign tumors, 17 low malignant potential tumors, and 62 malignant tumors. Comparison of the area under the receiver operating characteristic curve for individual genes and various combinations of genes with or without serum biomarkers to differentiate between benign conditions (excluding low malignant potential tumors) and malignant tumors showed that a multivariate model combining the expression levels of eight genes and four serum biomarkers achieved the highest area under the curve (AUC) (95.1%, 95% CI 92.0–98.2%). The MAGIC (Malignancy Assessment using Gene Identification in Captured Cells) algorithm significantly outperformed all individual genes (AUC 50.2–65.2%; all P<.001) and a multivariate model combining 14 different genes (AUC 88.0%, 95% CI 82.9–93.0%; P=.005). Further, the MAGIC algorithm achieved an AUC of 89.5% (95% CI 81.3–97.8%) for stage I–II and 98.9% (95% CI 96.7–100%) for stage III–IV patients with epithelial ovarian cancer.

CONCLUSION:

Multiplexed gene expression evaluation of cells captured from blood, with or without serum biomarker levels, accurately detects malignancy in women with a pelvic mass.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02781272.

FUNDING SOURCE:

This study was funded by ANGLE Europe Limited (Surrey Research Park, Guildford, Surrey, United Kingdom).
Pregnancy-Associated Homicide and Suicide
Authors: Modest Anna M. , Prater Laura C. , Joseph Naima T.
Published: September 2022

OBJECTIVE:

To analyze differences in the demographic and social factors associated with pregnancy-associated violent deaths due to homicide compared with suicide by pregnancy timing.

METHODS:

This was a retrospective cohort study using the Centers for Disease Control and Prevention's National Violent Death Reporting System from 2008 to 2019. We included females aged 15–44 years who died by suicide, defined as intentional self-harm, or homicide. Pregnancy-associated deaths were defined as those that occurred during or within 1 year of pregnancy.

RESULTS:

Of 38,417 female victims aged 15–44 years identified in the data set, 10,411 had known pregnancy status; 1,300 of those deaths were pregnancy associated. Of all deaths with known pregnancy status, 3,203 were by homicide (30.8%) and 7,208 (69.2%) were by suicide. Pregnancy-associated homicide deaths made up 20.6% of all homicide deaths, and pregnancy-associated suicide deaths made up 8.8% of all suicide deaths. Individuals who died by homicide were younger (29.4±8.2 years vs 31.5±8.6 years), more likely to be single or never married (61.0% vs 50.0%), and had a higher proportion of associate’s degree–level education or less as compared with individuals who died by suicide (28.1% vs 43.9%). Of individuals who died by homicide, 37.7% were Black or African American, 13.4% were Hispanic, and 56.0%% were White. In comparison, 6.9% of individuals who died by suicide were Black or African American, 8.0% were Hispanic, and 85.0% were White. Having a mental health problem and any substance use were significantly more often associated with suicide deaths compared with homicide deaths (77.4% vs 7.2%, P<.001 for mental health, 33.3% vs 12.8%, P<.001 for substance use, respectively). Intimate partner violence was prevalent in both groups, although significantly higher in homicide deaths (57.3% vs 37.1%, P<.001). This pattern persisted when stratified by pregnancy status.

CONCLUSION:

Mental health problems, substance use disorder, and intimate partner violence are preceding circumstances to pregnancy-associated suicide and homicide.
An Extractor for the Management of Shoulder Dystocia
Authors: Gherman Robert B. , Patel Rajnish
Published: September 2022

BACKGROUND:

The Yaari Extractor is intended to wrap around and guide the fetal shoulder to facilitate vaginal delivery in cases of shoulder dystocia.

INSTRUMENT:

The Yaari Extractor is a single-use device for fetal shoulder extraction. The device consists of two curved, rigid plastic–coated metal arms with handles and an elastic engagement element that includes two hollow sleeves that cover the portion of the device that enters the vagina and contacts the fetus.

EXPERIENCE:

The device has been used in three cases of shoulder dystocia. In all three cases, the shoulder dystocia was resolved without the need for ancillary obstetric maneuvers, and there was no reported maternal or fetal injury.

CONCLUSION:

The Yaari Extractor is a novel technology that can be used to successfully resolve shoulder dystocia.
Serotonin Syndrome After Treatment of Nausea and Vomiting in Pregnancy
Authors: Wiseman Daniel , Samoukovic Gordan , Durcan Liam , Malhamé Isabelle
Published: September 2022

BACKGROUND:

Nausea and vomiting in pregnancy often require pharmacotherapy for symptom management. Serotonin syndrome is a rare clinical entity that can be precipitated by the medications used to treat nausea and vomiting in pregnancy.

CASE:

A 35-year-old pregnant individual with a history of hyperemesis gravidarum in an earlier pregnancy requiring prolonged hospitalization presented with nausea and vomiting at 7 weeks of gestation. She was incidentally found to have severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection when she was universally screened at the time of admission. She required pharmacotherapy, including prochlorperazine and ondansetron for treatment of nausea as well as sumatriptan for migraine. She developed acute spasticity, autonomic dysfunction, and temperature rise, precipitated by antiemetic therapy, consistent with serotonin syndrome. The syndrome resolved with supportive care and benzodiazepines.

CONCLUSION:

Serotonin syndrome is a serious clinical entity that can be provoked by the pharmacotherapy given to treat nausea and vomiting in pregnancy. This medical emergency requires early recognition and prompt management.
Improving the cosmetic outcome of Salter osteotomy through the modification of iliac crest graft harvesting site: a pilot clinical study
Authors: Yeganeh Ali , Moghtadaei Mehdi , Farahini Hossein , Amiri Shayan , Mahmoudi Mani , Hamidpour Yasaman , Hajializade Mikaiel
Published: September 2022

Background:

The conventional graft harvesting site in a Salter osteotomy might impair the cosmetic appearance of patients with developmental dysplasia of the hip (DDH). The authors evaluated if an alternative graft donor site on the iliac bone could eliminate this concern.

Methods:

In a prospective study, 23 patients who had DDH with an indication for Salter osteotomy were included. In 10 patients (study group), the vertical triangular graft was harvested from the one-third anterolateral section of the iliac wing. In the remaining 13 patients (control group), the graft was harvested from the conventional site. The radiographic measures, including acetabular index and center edge angle, Severin criteria, clinical outcomes (McKay criteria), and complication rates of the two groups were compared.

Results:

The clinical outcome, acetabular index, center-edge angle, and Severin criteria of the patients of the two groups were statistically comparable. Union of harvested sites was seen in all patients. The mean duration of surgery and blood loss were statistically comparable (P=0.49 and P=0.33, respectively). The rate of osteonecrosis was similar in the two groups. The only graft site morbidity was the anterior superior iliac spine (ASIS) asymmetry that was seen in all patients of the control group and no patients of the study group; a mean horizontal level difference of 2.2±0.5 cm was observed between the affected and unaffected ASIS of the control group.

Conclusions:

Vertical triangular graft harvest from the one-third anterolateral section of iliac wing in Salter osteotomy improves the cosmetic outcome through the reduction of pelvic deformity.

Level of Evidence:

Level III.
Diagnostic Utility of Endocervical Curettage During Colposcopy Among Patients of Varying Risk Factors
Authors: Wang Stephanie M. , Hoeppner Catherine , Kazma Jamil , Keegan Emma , Werner Logan , Chappell Nicole P.
Published: September 2022

Objective

Endocervical curettage (ECC) during colposcopy is recommended in certain circumstances; however, diagnostic use remains unclear. We evaluate the utility of ECC among patients with non-fully visualized squamocolumnar junction (SCJ) and certain patient socioeconomic factors.

Methods

Retrospective chart analysis was completed for patients aged older than 21 years who underwent a colposcopy at 2 study sites between 2012 and 2021. Demographics and histopathologic results were analyzed.

Results

A total of 1,516 colposcopies were reviewed; 73.8% (n = 1,119) had an ECC with colposcopy. Of those, 92.1% (n = 1,031) had benign ECC whereas 13.9% (n = 156) had a positive ECC at time of colposcopy. Most patients with benign ECC had benign/low-grade squamous intraepithelial lesion pathology on colposcopy biopsy (82.3%; n = 914; p < .001), and most patients with high-grade squamous intraepithelial lesion (HSIL) on ECC had HSIL on colposcopy biopsy (63.4%; n = 52; p < .001) However, when looking at patients with high-grade pathology on colposcopy biopsy, it was seen that most had benign or low-grade squamous intraepithelial lesion on ECC (79.5%; n = 205; p < .001). Most patients with adequately visualized SCJ on colposcopy were noted to have HSIL on biopsy and negative ECC (73%; n = 81; p < .001). This result was similar in patients with non-fully visualized SCJ, although not statistically significant. When stratified by socioeconomic status, most patients with high-grade lesions had a benign ECC.

Conclusions

Endocervical curettage has been described to increase the identification of high-grade lesions at time of colposcopy. This descriptive study shows that many high-grade lesions at time of excisional procedure had a benign ECC on colposcopy, with no demonstrated clear additional utility in high-risk groups.
Combined Arterial and Venous Phase Computed Tomographic Imaging of the Skull Base in Pulsatile Tinnitus
Authors: Formeister Eric J. , Xiao Grace , Clark James , Carey John P. , Hui Ferdinand , Agrawal Yuri , Sun Daniel Q.
Published: September 2022

Objective

To describe the demographic, clinical, and radiologic findings in a consecutive series of patients presenting with a chief complaint of pulsatile tinnitus (PT).

Study Design

Retrospective review of 157 patients undergoing a combined arterial/venous phase computed tomographic (CT) imaging study.

Setting

Tertiary referral center.

Patients

Adult patients referred to neurotology faculty for evaluation of PT between 2016 and 2020.

Interventions

Triple phase high-resolution arteriography/venography/temporal bone CT.

Main Outcome Measures

Prevalence of osseous, venous, and/or arterial pathology, clinicodemographic characteristics.

Results

One hundred fifty-seven adults (mean age, 52 years; 79.6% female) were evaluated. A history of migraine headaches was common (19.7%). The average body mass index was 30.0 (standard deviation, 6.8), and 17.2% of subjects had a diagnosis of obstructive sleep apnea. Idiopathic intracranial hypertension was diagnosed by elevated opening pressure on lumbar puncture in 13.4%. Comorbid depression and anxiety were common (25.5% and 26.1%, respectively). Overall, abnormalities were found in 79.0% of scans, with bilateral transverse sinus stenosis (TSS) seen in 38.9% and unilateral TSS found in 20.4%. Fifteen subjects (9.6%) had evidence of osseous etiologies, including superior canal dehiscence or thinning in 8.9% and sigmoid sinus dehiscence in one subject. There were 3 dural arteriovenous fistulae identified. Unilateral PT was ipsilateral to the side of TSS in 84.4% of subjects with unilateral TSS.

Conclusion

In a large consecutive series of patients with PT referred for CT venography/arteriography, transverse sinus stenosis was the most common finding at 59%. Venous etiologies for PT should be suspected when patients are referred to neurotologists for evaluation.
Quality-of-Life Outcomes After Modified Subtotal Petrosectomy With Ear Canal Closure for Chronic Otitis Media
Authors: Macielak Robert J. , Lohse Christine M. , Tuchscherer Amy M. , Carlson Matthew L.
Published: September 2022

Objective

To assess quality-of-life (QoL) outcomes after modified subtotal petrosectomy with ear canal closure (mSTP) for chronic otitis media.

Study Design

Survey study.

Setting

Tertiary referral center.

Patients

Patients with chronic otitis media.

Interventions

mSTP.

Main Outcome Measures

Survey results from enrolled patients on the validated disease-specific Chronic Ear Survey (CES) and Chronic Otitis Media Outcome Test-15 (COMOT-15) regarding their current state of health and, if surgery was performed within 3 years of enrollment, their state of health before mSTP.

Results

A total of 23 patients were studied, including 19 who underwent surgery within 3 years of enrollment. Postoperatively, mean total CES scores were 80 and COMOT-15 scores were 41, with a higher CES and a lower COMOT-15 indicating better QoL. There were statistically significant improvements after mSTP in the CES activity restriction (25% difference; p = 0.008), symptom (17% difference; p = 0.007), and medical resource (13% difference; p = 0.03) domain and total (18% difference; p = 0.006) scores. In addition, there were statistically significant improvements in the COMOT-15 ear symptom (−22% difference; p < 0.001) domain and total (−16% difference; p = 0.01) scores; however, improvements in the hearing function and mental health domains did not achieve statistical significance. Postoperative COMOT-15 total scores were significantly better for patients who underwent aural rehabilitation compared to those who did not (−17% difference; p < 0.001).

Conclusion

Modified subtotal petrosectomy with ear canal closure is a useful intervention for patients with recalcitrant chronic otitis media, offering improved QoL in appropriately selected patients. Aural rehabilitation, when feasible, provides the potential for further QoL improvement.
Further Evidence for Individual Ear Consideration in Cochlear Implant Candidacy Evaluation
Authors: Patro Ankita , Lindquist Nathan R. , Holder Jourdan T. , Tawfik Kareem O. , O'Malley Matthew R. , Bennett Marc L. , Haynes David S. , Gifford René , Perkins Elizabeth L.
Published: September 2022

Objective

To report speech outcomes after cochlear implantation (CI) for asymmetric hearing loss (AHL) and assess the influence of contralateral hearing.

Study Design

Retrospective review.

Setting

Tertiary referral center.

Patients

One hundred eighty-eight adults (mean age, 70 yr) undergoing CI for AHL from 2015 to 2020. Candidacy included pure-tone average (PTA) at least 70 dB hearing level and AzBio in quiet 60% or less in the implanted ear and AzBio in quiet greater than 40% in the contralateral ear.

Main Outcome Measures

PTA; Consonant-Nucleus-Consonant (CNC) word, AzBio sentences scores; Speech, Spatial, and Qualities of Hearing Scale (SSQ).

Results

Mean preoperative PTA and AzBio in the implanted and contralateral ears were 85.2 and 68.1 dB hearing level and 24.7% and 69.2%, respectively. Mean CNC in the implanted ear increased from 18.3% preoperatively to 44.4% (p < 0.0001) at 6 months and 49.3% (p < 0.0001) at 12 months. Mean AzBio in the implanted ear improved from 24.7% preoperatively to 60.3% (p < 0.0001) at 6 months and 64.3% (p < 0.0001) at 12 months. Patients demonstrated significant improvement in all SSQ domains at 6 and 12 months. When comparing patients with preoperative contralateral AzBio greater than 60% versus 41% to 60%, no significant differences existed in postoperative CNC scores (6-mo: 47% versus 41%, p = 0.276; 12-mo: 51% versus 47%, p = 0.543). There were no significant differences in 6-month (p = 0.936) or 12-month (p = 0.792) CNC scores between patients with AHL (contralateral ear AzBio >40%) and 169 unilateral CI patients meeting the traditional Medicare criteria (contralateral ear AzBio ≤40%).

Conclusion

CI recipients with AHL derive significant speech improvements, supporting individual ear consideration for CI candidacy and patient benefit outside of current Medicare criteria.
Unidirectional Vertical Vestibuloocular Reflex Adaptation in Humans Using 1D and 2D Scenes
Authors: Todd Christopher J. , Schubert Michael C. , Rinaudo Carlo N. , Migliaccio Americo A.
Published: September 2022

Hypothesis

The vertical vestibuloocular reflex (VOR) in response to pitch head impulses can be optimally trained to increase in one direction using a two-dimensional (2D) visual training target with minimal effect on the horizontal VOR.

Background

We modified the incremental VOR adaptation (IVA) technique, shown to increase the horizontal VOR in patients with vestibular hypofunction, to drive vertical VOR adaptation in healthy control subjects.

Methods

We measured the horizontal and vertical active (self-generated) and passive (imposed) head impulse VOR gains (eye velocity/head velocity) before and after 15 minutes of unidirectional downward IVA training. IVA training consisted of two sessions, one using a single-dot one-dimensional (1D) target, the other a grid-of-dots 2D target.

Results

The downward head impulse VOR gain significantly increased because of training by 13.3%, whereas the upward VOR gain did not change. The addition of extraretinal (2D) feedback did not result in greater adaptation, i.e., 1D and 2D gain increases were 15.5% and 10.6%, respectively. The vertical VOR gain increase resulted in a 3.2% decrease in horizontal VOR gain.

Conclusion

This preliminary study is the first to show that physiologically relevant (high frequency) unidirectional increases in vertical VOR gain are possible with just 15 minutes of training. This study sets the basis for future clinical trials examining vertical IVA training in patients, which may provide the first practical rehabilitation treatment to functionally improve the vertical VOR.
Injury severity score as a predictor of mortality in adult trauma patients by injury mechanism types in the United States: A retrospective observational study
Authors: Colnaric Jure M. , El Sibai Rayan H. , Bachir Rana H. , El Sayed Mazen J.
Published: September 2022

Injury severity score (ISS) is commonly used in trauma registries to describe injury severity and to predict outcomes in trauma patients regardless of injury mechanism. This study examined the correlation between ISS and mortality in adult trauma patients presenting to emergency departments in the United States with different mechanisms of injury.

A retrospective observational study was conducted using the 2014 Nationwide Emergency Department Sample. Patients’ characteristics were stratified by mortality. Receiver operating characteristic (ROC) curves were generated for death against ISS for each mechanism of injury. A logistic regression model was conducted for each mechanism of injury to determine whether ISS (≥16 vs <16) is a predictor of mortality.

The study sample consisted of 16,147,058 weighted adult trauma patients. Median age was 46 years. Slightly over half were females (51.9%). Falls, motor vehicle accidents and being struck by or against, were the most commonly reported mechanisms of injury (44.6%, 18.1%, and 15.3%, respectively). The overall mortality in the study population was 0.4%. The area under the ROC curve was highest in injuries sustained in accidents involving machinery (0.947; 95% confidence intervals [CI], 0.896-0.998), followed by motor vehicle traffic (MVA) (0.788; 95% CI, 0.775-0.801) and cutting or piercing (0.746; 95% CI, 0.701-0.791). Deceased patients were accurately identified by ISS 65.2% in injury by machinery, 47.7% in injury involving MVA, 39.7% in injury by firearm and 31.4% in injury by assault. After adjusting for confounders, the multivariate models in which ISS was the main independent factor performed best in predicting mortality from firearm and machinery mechanism of injuries.

Although the ROC curve analysis demonstrated a moderate or high discriminatory ability to identify deceased patients in 6 out of twelve mechanisms, and the multivariate analysis revealed that ISS was a significant predictor of mortality in 9 out of 12 injury mechanisms, the sensitivities of all logistic regression models were poor. The ISS ≥ 16 threshold alone therefore should not be used to identify patients with high-mortality risk. The mortality risk assessment should be done individually and be based on clinical evaluation.
Ambulatory Nurse Leadership
Authors: Hughes Patty
Published: September 2022

This article discusses the role of and need for nursing leadership in ambulatory care spaces. Challenges within health care and increasing complexity of patients exist, regardless of whether a nurse leader works in a traditional hospital setting or outside of that setting. Regardless of setting, nurse leaders want the same things for their patients and staff. The required skill set and characteristics for nurse leaders are the same, just used in a different venue. Traditional hospital nurse leaders must collaborate with nurse leaders in ambulatory to ensure each patient navigates through the continuum with as little disruption as possible. Nurse leaders in ambulatory can offer hospital leaders a fresh perspective on leadership, highlighting the value they bring to the table and how transferrable their skill set is to this setting, given the same support for success that is fundamental in the hospital setting. Strong nurse leadership is critical for driving innovation and inspiring transformative change in ambulatory settings.
Posttraumatic Stress Disorder Among Health Care Workers During the COVID-19 Pandemic
Authors: Bayazit Huseyin , Ozel Mehmet , Arac Songul , Dulgeroglu-Bayazit Dilruba , Joshi Astik
Published: September 2022

Background:

Coronavirus disease 2019 (COVID-19) has taken a significant toll on people worldwide, and in particular, on the health care workers (HCWs) who have worked on the frontlines in the fight against the pandemic. The goal of this study was to investigate the prevalence of posttraumatic stress disorder (PTSD) and related factors in HCWs in the era of COVID-19.

Methods:

This cross-sectional survey study was conducted between September 15, and October 15, 2020, among HCWs in Turkey. The survey consisted of self-administered questionnaires, which included questions about sociodemographic variables, experiences caring for patients with COVID-19, and the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), a trauma screening tool. The online survey was completed by 1833 HCWs. Univariate and multivariate logistic regression analyses were used to identify independent predictors of PTSD.

Results:

The mean age of the participants was 32.7±7.0 years; 81.9% were physicians, and 56.5% were female. The rates of COVID-19 history in the respondents, a family member, or a coworker were 13.6%, 32.3%, and 12.6%, respectively. Among the HCWs who participated, 39.9% met the criteria for PTSD. Compared with the physicians, the nonphysician HCWs had a higher rate of PTSD (49.5% vs. 36%) (P<0.001) and higher PCL-5 scores (53.31±19.6 vs. 42.5±20.3) (P<0.001). In addition, 9.7% of the surveyed HCWs reported having suicidal ideation during the COVID-19 pandemic. Independent predictors of PTSD in HCWs were working on a COVID-19 unit, feeling isolated, suicidal ideation, being a nonphysician HCW, fear of spreading coronavirus to family, female sex, and a history of having COVID-19.

Conclusions:

HCWs were at risk for impairment in mental well-being in the era of COVID-19, with a significant number experiencing PTSD as well as suicidal ideation. Therefore, HCWs, especially those who are working on a COVID-19 unit and are female, should be monitored regularly for PTSD.