bluuebunny/crossref_metadata_2025 huggingface dataset:
Strategies for Successful Recruitment of Pregnant Patients Into Clinical Trials
Authors: Sutton Elizabeth F. , Cain Loren E. , Vallo Porsha M. , Redman Leanne M.
Published: February 2017

Clinical research in the pregnant population allows for delivery of quality, evidence-based care in obstetrics. However, in recent years, the field of obstetrics has faced severe challenges in the recruitment of the pregnant population into clinical trials, a struggle also shared by several other medical disciplines. We candidly describe our failure to recruit a healthy population of overweight and obese pregnant women in their first trimester. We were then able to glean unsuccessful and successful recruitment approaches and improve our recruitment effort by autopsy of failed strategies and with guidance from a survey disseminated to improve our understanding of community feelings about participating in research while pregnant. These “lessons learned” taught us that active recruitment within this population is a necessity; that is, direct (face-to-face discussions at obstetric appointments) compared with indirect (flyers and general emails) modalities and that prenatal care provider support of the proposed research study is vital to a patient's willingness to participate. By implementation of “lessons learned,” we describe how we successfully recruited a similar pregnant population 1 year later. The Clinical Trials related to our article are as follows: 1) Expecting Success: NCT01610752, https://clinicaltrials.gov/ct2/show/NCT01610752; 2) MomEE: NCT01954342, https://clinicaltrials.gov/ct2/show/NCT01954342; and 3) Participate While Pregnant Survey: NCT02699632, https://clinicaltrials.gov/ct2/show/NCT02699632.
Minimally invasive techniques for pain palliation in extraspinal bone metastases: a review of magnetic resonance imaging-guided focused ultrasound (MRgFUS) and series conclusion
Authors: Mesko Nathan W. , Lawrenz Joshua M. , Joyce Michael J. , Ilaslan Hakan , Winalski Carl S.
Published: February 2017

Minimally invasive techniques are an effective primary or alternative modality for pain palliation in extraspinal bone metastases, particularly when conventional therapies, such as localized radiation therapy, leave a subset of patients with refractory pain. Previous issues in this series have reviewed outcome literature demonstrating the efficacy and safety profile of cryoablation, cementoplasty, radiofrequency ablation, embolization, laser photocoagulation, ethanol ablation, and microwave ablation. The newest technique, magnetic resonance imaging-guided focused ultrasound (MRgFUS), delivers nonionizing ultrasound energy in a noninvasive manner to produce thermal damage to the periosteum of bone metastases. This technique has previously demonstrated success in the treatment of uterine fibroids, movement disorders, solid tumors, desmoid tumors, and benign bone tumors. In extraspinal bone metastases, substantial pain relief has been achieved within 3 days and up to 12 mo after treatment, and this technique has shown success in lytic, blastic, and mixed lesions. The most common adverse effects are transient, short-lived procedural pain and minor skin burns. There is also promising evidence supporting its ability to reduce tumor volume. Future investigations will likely include evaluating its role in local tumor control and comparing it to localized radiation therapy. For all of these minimally invasive techniques, the majority of reported series are retrospective and small. Future multicenter, prospective, randomized trials are needed to compare the efficacy of these treatments to each other, and to conventional therapies.
Stemless shoulder replacement: a new concept for shoulder arthritis
Authors: Cruickshank David W. , Bicknell Ryan T.
Published: February 2017

Stemless shoulder arthroplasty implants allow a surgeon to more accurately recreate a patient’s normal anatomy because the implant is contained solely within the proximal humeral metaphysis. As well, this has the potential to avoid humeral stem-related complications, such as intraoperative fracture, periprosthetic fracture, and difficulties with revisions and stem extraction. Canal sparing shoulder arthroplasty implants have been used since 2004, and currently six manufacturers have designs available. Short-term to mid-term results are promising, with low rates of loosening and revision, similar to stemmed implants. However, long-term outcomes are not yet available. Stemless reverse shoulder arthroplasty offers the same potential benefits as anatomic stemless designs. Some implants are a convertible design that allows conversion from an anatomic to a reverse humeral component while leaving the metaphyseal implant in place. Short-term to mid-term outcomes are available only for one implant and are promising. Long-term outcomes of stemless reverse shoulder implants are not known.
Automated Bone Screw Tightening to Adaptive Levels of Stripping Torque
Authors: Reynolds Karen J. , Mohtar Aaron A. , Cleek Tammy M. , Ryan Melissa K. , Hearn Trevor C.
Published: February 2017

Objective:

To use relationships between tightening parameters, related to bone quality, to develop an automated system that determines and controls the level of screw tightening.

Methods:

An algorithm relating current at head contact (IHC) to current at construct failure (Imax) was developed. The algorithm was used to trigger cessation of screw insertion at a predefined tightening level, in real time, between head contact and maximum current. The ability of the device to stop at the predefined level was assessed.

Results:

The mean (±SD) current at which screw insertion ceased was calculated to be [51.47 ± 9.75% × (Imax − IHC)] + IHC, with no premature bone failures.

Conclusions:

A smart screwdriver was developed that uses the current from the motor driving the screw to predict the current at which the screw will strip the bone threads. The device was implemented and was able to achieve motor shut-off and cease tightening at a predefined threshold, with no premature bone failures.
Safety and Accuracy of Freehand Versus Navigated Iliac Screws
Authors: Hlubek Randall J. , Almefty Kaith K. , Xu David S. , Turner Jay D. , Kakarla Udaya Kumar
Published: February 2017

Study Design.

Retrospective review.

Objective.

To compare the safety and accuracy of the freehand technique versus stereotactic navigation for placement of iliac screws.

Summary of Background Data.

Iliac screw fixation is often used to augment lumbosacral reconstruction in advanced spine disease to increase the likelihood of successful arthrodesis. Iliac screws can be placed with image guidance, using either intraoperative fluoroscopy or computed tomography (CT) to guide navigation. However, these imaging modalities add radiation exposure and can disrupt workflow. The freehand technique is an alternative strategy that decreases radiation exposure and workflow disruption but may compromise safety and accuracy.

Methods.

A retrospective review was performed for a consecutive series of adult patients with degenerative spine conditions who underwent posterior reconstruction with iliac screw placement between 2011 and 2016. Clinical and radiographic data were collected and analyzed. The accuracy of iliac screw placement was determined with either intraoperative/postoperative CT imaging or anteroposterior/lateral radiography when CT was not performed.

Results.

Bilateral iliac screws were placed in all 111 patients, for a total of 222 iliac screws. Eighty screws were placed with the freehand technique and 142 with the intraoperative navigation technique. CT imaging was used to assess placement accuracy of 124 screws (46 freehand [37%], 78 navigated [63%]). Accuracy was similar for the freehand group (89%, 41/46) and the navigated group (96%, 75/78) (P = 0.12). For patients without intraoperative/postoperative CT imaging, radiography was used to assess placement accuracy of 98 screws (34 freehand, 64 navigated) and the placement accuracy rate for the freehand group (100%, 34/34) was comparable to that for the navigated group (98%, 63/64) (P = 0.46). No complications attributable to iliac screw placement occurred in either group.

Conclusion.

Overall, there was no difference in the safety and accuracy between the freehand and navigated techniques.

Level of Evidence: 4
A Modified Dual-plane Technique Using the Serratus Anterior Fascia in Primary Breast Augmentation
Authors: Hwang Dong Yeon , Park Sang Hoon , Kim Sang Wha
Published: February 2017

Background:

Breast augmentations are commonly performed aesthetic surgical procedures. As the breast is a changeable structure, the ideal location of an implant would be a plane that can adjust to the dynamic changes of the breast. We present a modified dual-plane technique for breast augmentation using the fascia for thin patients.

Methods:

Between June 2014 and June 2015, 27 patients with small breasts underwent breast augmentation using the modified dual-plane technique. The average age was 29.4 years (range, 20–41 y). The mean body mass index was 18.9 kg/m2 (range, 17.6–20.4 kg/m2).

Results:

The mean size of the implant was 288.9 ml (range, 255–360 ml) on the right side and 281.6 ml (range, 255–360 ml) on the left side. All the patients returned to daily-life activities within 1 week. There have been no complications during minimum follow-up periods of 18 months. The mean follow-up was 25.6 months (range, 18–36 mo).

Conclusions:

Visible, palpable implants and rippling after breast augmentation with implants are relatively common problems. Our modified dual-plane technique with the serratus anterior fascia can reduce visible rippling and yields a natural-looking breast, especially in thin patients.
The Telemark Breast Score: a Valid Method for Evaluation of Outcome after Breast Surgery
Authors: Begic Anadi , Stark Birgit
Published: February 2017

Background:

“Telemark Breast Score” (TBS) has been developed at Telemark Hospital in Norway for evaluation of results after breast surgery based on standardized patients’ photographs taken as a part of daily routine. Its reliability has recently been tested and approved. The external validity of the TBS was assessed by matching its data against the internationally recognized Breast-Q (BQ) questionnaire as a further step to study the validity of this new tool.

Methods:

The ideal distribution of breast volume is 45% of the total volume above and 55% below the nipple, and a 40° slope line at the upper pole. TBS makes the evaluation of these parameters of breast aesthetics more explicit. The method has been tested on photographs from 31 patients operated on for breast cancer with the Deep Inferior Perforator Flap. The evaluation was done by an independent experienced plastic surgeon earlier participating in the test–retests. The external validity of TBS was investigated against domains 1 and 3 of the BQ reconstruction module. The concordance between ratings was analyzed.

Results:

Concordance between TBS items and BQ domain 1 items regarding patient satisfaction, and between TBS items and BQ domain 3 items regarding how the patient experienced the outcome of breast reconstruction was relatively high except for 6 comparisons where we could not statistically ensure that more pairs were concordant than discordant. A total of 178 comparisons appeared to be concordant. This means that for all other comparisons, there was a preponderance of pairs of concordant observations, which indicates that measurements from the 2 instruments follow each other.

Conclusion:

The present data indicate that the TBS can be recommended as a valid tool to professionals for assessment of the outcome after breast reconstruction.
Functional and Aesthetic Thorax Reconstruction after Desmoid Tumor Resection
Authors: Olvera-Caballero Carlos , Acosta-Ponce de Leon Eric , Sanchez-Sosa Sergio
Published: February 2017

This study describes a case report of a 31-year-old patient who presented with a left thoracic tumor on costal cartilages 5 and 6 that was diagnosed as a desmoid tumor 3 years after receiving retropectoral breast implants for cosmetic reasons. The integral reconstruction of the thoracic wall, functional and aesthetic, was planned for a single surgical period. The defect secondary to the tumor resection, which left the pericardium and lung exposed, was closed using the pectoral muscle as a “pre-expanded” flap by the breast implant, and the breast aesthetic was treated bilaterally with new implants in the retromammary position. After 12 months, the patient remained free from tumor recurrence and had a satisfactory aesthetic result.
Attention Deficit Hyperactivity Disorder, Aggression, and Illicit Stimulant Use
Authors: Odell Annie P. , Reynolds Grace L. , Fisher Dennis G. , Huckabay Loucine M. , Pedersen William C. , Xandre Pamela , Miočević Milica
Published: February 2017

This study compares adults with and without attention deficit hyperactivity disorder (ADHD) on measures of direct and displaced aggression and illicit drug use. Three hundred ninety-six adults were administered the Wender Utah Rating Scale, the Risk Behavior Assessment, the Aggression Questionnaire (AQ), and the Displaced Aggression Questionnaire (DAQ). Those with ADHD were higher on all scales of the AQ and DAQ, were younger at first use of amphetamines, and were more likely to have ever used crack and amphetamines. A Structural Equation Model found a significant interaction in that for those with medium and high levels of verbal aggression, ADHD predicts crack and amphetamine. Follow-up logistic regression models suggest that blacks self-medicate with crack and whites and Hispanics self-medicate with amphetamine when they have ADHD and verbal aggression.
Approach to Human Immunodeficiency Virus/Sexually Transmitted Infection Testing for Men at an Urban Urgent Care Center
Authors: Schechter Sarah B. , Romo Dina L. , Cohall Alwyn T. , Neu Natalie M.
Published: February 2017

Background and Objectives

Sexually transmitted infection (STI) rates have increased among men. Urgent care centers are increasingly common sites for medical care. The objectives of this study are to describe practices surrounding STI testing at an urban urgent care center.

Methods

Electronic medical record data were analyzed for men ages 20 to 55 years seen at the urgent care center of a large urban hospital from June 7, 2011, to April 30, 2015 (n = 10,983). A subset of charts was reviewed to assess sexual history documentation (n = 906). Chief complaints relevant to STIs were defined as genitourinary or sexual complaints. Odds ratios and χ2 analyses were used to assess association between STI testing, chief complaint, and sexual history.

Results

Of the 10,983 visits, 10% (n = 1118) had a complaint relevant to STIs, and 5% (n = 505) had STI testing ordered. Of these tests, 4% were positive for syphilis (n = 11), 13% for chlamydia (n = 29), 6% for gonorrhea (n = 13), and 0.5% for human immunodeficiency virus (n = 1). Sexually transmitted infection testing was more likely to be ordered for STI-relevant chief complaints than unrelated complaints (odds ratio, 16.2, P < 0.01). Sexual history was documented for 8% of visits (n = 72) and was associated with STI testing (P <0.01).

Discussion

Sexually transmitted infections are diagnosed in men seen at urgent care centers more often when clients present with relevant symptoms. However, given the low rates of sexual history taking and the asymptomatic nature of most STIs, concern is raised about missing opportunities to identify, treat, and lower community burden of disease. Urgent care visits may represent opportunities for increased testing and treatment of STIs.
Haemophilus influenzae Isolated From Men With Acute Urethritis: Its Pathogenic Roles, Responses to Antimicrobial Chemotherapies, and Antimicrobial Susceptibilities
Authors: Ito Shin , Hatazaki Kyoko , Shimuta Ken , Kondo Hiromi , Mizutani Kosuke , Yasuda Mitsuru , Nakane Keita , Tsuchiya Tomohiro , Yokoi Shigeaki , Nakano Masahiro , Ohinishi Makoto , Deguchi Takashi
Published: February 2017

Background

There have been few comprehensive studies on Haemophilus influenza–positive urethritis.

Methods

In this retrospective study, we enrolled 68 men with H. influenzae–positive urethritis, including coinfections with Neisseria gonorrhoeae, Chlamydia trachomatis, and/or genital mycoplasmas: 2, 3, 20, and 43 treated with ceftriaxone, levofloxacin, sitafloxacin, and extended-release azithromycin (azithromycin-SR), respectively. We assessed microbiological outcomes in 54 men and clinical outcomes in 46 with H. influenzae–positive monomicrobial nongonococcal urethritis. We determined minimum inhibitory concentrations (MICs) of 6 antimicrobial agents for 59 pretreatment isolates.

Results

H. influenzae was eradicated from the men treated with ceftriaxone, levofloxacin, or sitafloxacin. The eradication rate with azithromycin-SR was 85.3%. The disappearance or alleviation of urethritis symptoms and the decreases in leukocyte counts in first-voided urine were significantly associated with the eradication of H. influenzae after treatment. For the isolates, ceftriaxone, levofloxacin, sitafloxacin, azithromycin, tetracycline, and doxycycline MICs were ≤0.008–0.25, 0.008–0.5, 0.001–0.008, 0.12–1, 0.25–16, and 0.25–2 μg/mL, respectively. The azithromycin MICs for 3 of 4 strains persisting after azithromycin-SR administration were 1 μg/mL. H. influenzae with an azithromycin MIC of 1 μg/mL increased chronologically.

Conclusions

H. influenzae showed good responses to the chemotherapies for urethritis. The significant associations of the clinical outcomes of the chemotherapies with their microbiological outcomes suggested that H. influenzae could play pathogenic roles in urethritis. All isolates, except for one with decreased susceptibility to tetracyclines, were susceptible to the examined agents. However, the increase in H. influenzae with an azithromycin MIC of 1 μg/mL might threaten efficacies of azithromycin regimens on H. influenzae–positive urethritis.
Faster and Riskier? Online Context of Sex Seeking Among Men Who Have Sex With Men in China
Authors: Cao Bolin , Liu Chuncheng , Stein Gabriella , Tang Weiming , Best John , Zhang Ye , Yang Bin , Huang Shujie , Wei Chongyi , Tucker Joseph D.
Published: February 2017

Background

Many men who have sex with men (MSM) seek sex partners online, creating barriers and opportunities for human immunodeficiency virus prevention. The purpose of this study was to examine the characteristics of MSM and the risks associated with seeking sex through websites, gay apps, and both platforms in China.

Methods

Data were collected through a cross-sectional online survey from September through October 2014 from 3 large gay Web portals. Sociodemographic information, sexual behaviors, and online sex seeking behaviors were measured. Multinomial logistic regression was performed to compare sexual risk behaviors among website users, gay app users, and men who used both platforms.

Results

Of the 1201 participants, 377 (31.4%) were website-only users, 487 (40.5%) were gay app-only users, and 337 (28.0%) were men who used both platforms. These 3 MSM subgroups have distinct sociodemographic characteristics. Overall, 57.6% of participants reported having engaged in condomless anal sex with their last male partner in the past 6 months, but there was no significant difference in condomless sex between the 3 groups. Men who used both platforms viewed more sexually transmitted disease-related messages than website-only users (adjusted odds ratio, 2.19; 95% confidence interval, 1.57–3.05).

Conclusions

Condom usage behaviors were unaffected by the medium through which sexual partners were found. However, the high frequency of condomless sex suggests that websites and gay apps are both risk environments. This study suggests using multiple platforms for human immunodeficiency virus/sexually transmitted disease social media interventions may be useful.
Treatment Outcomes for Rectal Lymphogranuloma Venereum in Men Who Have Sex with Men Using Doxycycline, Azithromycin, or Both: A Review of Clinical Cases
Authors: Leeyaphan Charussri , Ong Jason J. , Chow Eric P.F. , Dimovski Karolina , Kong Fabian Y.S. , Hocking Jane S. , Howden Ben , Bissessor Melanie , Fairley Christopher K. , Bradshaw Catriona , Read Timothy , Chen Marcus
Published: February 2017

Background: Treatment for rectal lymphogranuloma venereum where doxycycline 100 mg twice daily for 21 days was used—either alone or together with azithromycin 1 g single dose—resulted in microbiological cure of 97%. These data support doxycycline 100 mg twice daily for 21 days as the preferred treatment for rectal lymphogranuloma venereum.
Benefits and Potential Harms of Human Immunodeficiency Virus Self-Testing Among Men Who Have Sex With Men in China: An Implementation Perspective
Authors: Qin Yilu , Tang Weiming , Nowacki Amy , Mollan Katie , Reifeis Sarah A. , Hudgens Michael G. , Wong Ngai-Sze , Li Haochu , Tucker Joseph D. , Wei Chongyi
Published: February 2017

Background

Human immunodeficiency virus self-testing (HIVST) holds great promise for reaching high-risk key populations who do not access facility-based services. We sought to characterize unsupervised HIVST implementation among men who have sex with men in China.

Methods

We conducted a nationwide online survey in China. Eligible men were at least 16 years, had anal sex with a man, and had recent condomless sex. We assessed benefits (first-time testing, increased testing frequency, confirmatory testing) and potential harms (coercion, violence, suicidality) of HIVST. Among men who have sex with men who reported ever testing for human immunodeficiency virus (HIV), we identified correlates of HIVST as first-time HIV test being a self-test using multivariable logistic regression.

Results

Among 1610 men who met the eligibility criteria and started the survey, 1189 (74%) completed it. Three hundred forty-one (29%) of 1189 reported ever self-testing for HIV. Human immunodeficiency virus prevalence was 7% (24/341) among self-testers and 5% (15/306) among non–self-testers. Two hundred (59%) of 341 men who self-tested reported HIVST as a first-time HIV test. Thirty-one (9%) men experienced coercion with HIVST. Thirty-one (78%) of 40 men with positive HIV self-tests sought confirmation. Multivariable analysis revealed that HIVST as first-time HIV test was associated with younger age (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.92–0.99), not being “out” (OR, 2.28; 95% CI, 1.60–3.28), not using the internet to meet sex partners (OR, 0.39; 95% CI, 0.22–0.69), and group sex (OR, 1.74; 95% CI, 1.02–2.9).

Conclusions

Human immunodeficiency virus self-testing reached high-risk individuals that had never received facility-based testing. Further implementation research is needed to better understand HIVST outside of research programs.
Insurance Coverage and Utilization at a Sexually Transmitted Disease Clinic in a Medicaid Expansion State
Authors: Montgomery Madeline C. , Raifman Julia , Nunn Amy S. , Bertrand Thomas , Uvin A. Ziggy , Marak Theodore , Comella Jaime , Almonte Alexi , Chan Philip A.
Published: February 2017

Background

In Rhode Island, the Patient Protection and Affordable Care Act has led to over 95% of the state's population being insured. We evaluated insurance coverage and barriers to insurance use among patients presenting for services at the Rhode Island sexually transmitted disease (STD) clinic.

Methods

We analyzed factors associated with insurance coverage and utilization among patients presenting for STD services between July and December 2015.

Results

A total of 692 patients had insurance information available; of those, 40% were uninsured. Patients without insurance were more likely than those with insurance to be nonwhite (50% among uninsured, compared with 40% among insured; P = 0.014) and Hispanic or Latino/a (25%, compared with 16%; P = 0.006), and less likely to be men who have sex with men (27%, compared with 39%; P = 0.001). Of those with health insurance, 26% obtained coverage as a result of the Affordable Care Act, and 56% of those were previously uninsured. Among uninsured individuals, barriers to obtaining health insurance included cost and unemployment. Among those with insurance, 43% reported willingness to use insurance for STD services. Barriers to insurance use included concerns about anonymity and out-of-pocket costs.

Conclusions

Despite expanded insurance access, many individuals presenting to the Rhode Island STD Clinic were uninsured. Among those who were insured, significant barriers still existed to using insurance. STD clinics continue to play an important role in providing safety-net STD services in states with low uninsured rates. Both public and private insurers are needed to address financial barriers and optimize payment structures for services.
Suicides by Jumping Off Istanbul Bridges Linking Asia and Europe
Authors: Yurtseven Ayşe , Üzün İbrahim , Arslan Murat Nihat
Published: February 2017

Aim

The aim of this study was to determine the injury spectrum and characteristics of people who committed suicide by jumping into water from the July 15th Martyrs Bridge and Fatih Sultan Mehmet Bridges in Istanbul, Turkey.

Methods

This study included all of the jumpers from the July 15th Martyrs Bridge and Fatih Sultan Mehmet Bridge who were autopsied by the Council of Forensic Medicine, Istanbul Morgue Department, between 2000 and 2013. All of the data were collected from archived case files. Trauma scores were calculated from the traumatic findings of the autopsy reports using the New Injury Severity Score (NISS).

Results

A total of 80 jumping suicides were identified. The male-to-female ratio was 9:1, and the mean age was 34.06 ± 9.6 years. Most suicides occurred in 2009. The suicide rates were higher in the winter, particularly in December. The most frequent injuries were skin lesions, rib fractures, and lung lacerations. In 12% of the cases, the trauma was minor (NISS range, 0–14; mean, 7 ± 5.67), and in 88% of the cases, it was major (NISS range, 17–66; mean NISS, 44.5 ± 12.46).

Conclusion

The sociodemographic features of the jumpers who committed suicide were quite similar to those reported in previous studies. Preventative measures (installation of barriers or banning pedestrian access to bridges) reduced the suicide rate but were not completely effective. Establishing early warning systems and rescue strategies could save the lives of jumpers who have minor trauma.
Validating Fall Prevention Icons to Support Patient-Centered Education
Authors: Leung Wai Yin , Adelman Jason , Bates David W. , Businger Alexandra , Dykes John S. , Ergai Awatef , Hurley Ann , Katsulis Zachary , Khorasani Sarah , Scanlan Maureen , Schenkel Laura , Rai Amisha , Dykes Patricia C.
Published: February 2017

Introduction

Falls with injury are the most prevalent hospital adverse event. The objective of this project was to refine fall risk and prevention icons for a patient-centric bedside toolkit to promote patient and nurse engagement in accurately assessing fall risks and developing a tailored fall prevention plan.

Methods

Eighty-eight patients and 60 nurses from 2 academic medical centers participated in 4 iterations of testing to refine 6 fall risk and 10 fall prevention icons. During individual interviews, participants rated their satisfaction with the degree to which that icon represented the concept on a 4-point Likert scale, enabling computation of a Content Validity Index (CVI), and provided comments and suggestions for improvement. After reviewing CVI scores and feedback, the research team consulted with the illustrator to revise the icons.

Results

Content Validity Index scores improved after icon modifications. Icons that depicted multiple concepts required further iterations to be acceptable.

Discussion

Using icons to depict an accurate and easy-to-interpret fall risk assessment and intervention plan for all care team members including patients and family to follow should lead to improved adherence with that plan and decreased falls.

Conclusions

All 16 icons were refined and used to form the basis for a bedside fall prevention toolkit.
Suicide and Suicide Attempts on Hospital Grounds and Clinic Areas
Authors: Mills Peter D. , Watts Bradley V. , Hemphill Robin R.
Published: February 2017

Objectives

The goal of this study was to describe suicide and suicide attempts that occurred while the patient was on hospital grounds, common spaces, and clinic areas using root cause analysis (RCA) reports of these events in a national health care organization in the United States.

Method

This is an observational review of all RCA reports of suicide and suicide attempts on hospital grounds, common spaces, and clinic areas in our system between December 1, 1999, and December 31, 2014. Each RCA report was coded for the location of the event, method of self-harm, if the event resulted in a death by suicide, and root causes.

Results

We found 47 RCA reports of suicide and suicide attempts occurring on hospital grounds, common spaces, or clinic areas. The most common methods were gunshot, overdose, cutting, and jumping, and we have seen an increase in these events since 2011. The primary root causes were breakdowns in communication, the need for improved psychiatric and medical treatment of suicidal patients, and problems with the physical environment.

Conclusions

Hospital staff should evaluate the environment for suicide hazards, consider prohibiting firearms, assist patients with no appointments, and promote good communication about high-risk patients.
Essential and Nonessential Blood Testing in the Clinical Teaching Unit
Authors: Sherren Cody , Day Andrew , Ilan Roy
Published: February 2017

Objectives

The aim of the study was to evaluate the essential and nonessential blood tests ordered on the internal medicine clinical teaching units (CTUs) at Kingston General Hospital. Our aim was to establish a baseline performance measure identifying appropriate use of laboratory tests that could be used to inform improvement over time.

Methods

For an 8-week period, 14 CTU attending physicians at Kingston General Hospital were surveyed. They were asked for each of their patients, “What blood tests do you consider to be essential for tomorrow morning to maintain appropriate care for this patient?” The following day, blood tests that were ordered were compared with the “essential” list previously given by the attending physicians.

Results

Of 291 processed blood tests, 148 (51%) had not been considered essential by attending physicians; of the 203 tests considered essential, 60 (30%) were not ordered. Total agreement between “essential” and processed tests was poor (κ = 0.51; confidence interval, 0.45–0.56).

Conclusions

Inadequate use of blood tests for CTU patients is common. Quality improvement initiatives should aim to address the lack of observed consensus between attending physicians' views and the ordered tests and to streamline decision-making and the ordering/communication processes. Clinical standards and guidelines regarding ordering of laboratory tests should be clearly defined.
Evaluating the Impact of Radio Frequency Identification Retained Surgical Instruments Tracking on Patient Safety: Literature Review
Authors: Schnock Kumiko O. , Biggs Bonnie , Fladger Anne , Bates David W. , Rozenblum Ronen
Published: February 2017

Background

Retained surgical instruments (RSI) are one of the most serious preventable complications in operating room settings, potentially leading to profound adverse effects for patients, as well as costly legal and financial consequences for hospitals. Safety measures to eliminate RSIs have been widely adopted in the United States and abroad, but despite widespread efforts, medical errors with RSI have not been eliminated.

Objective

Through a systematic review of recent studies, we aimed to identify the impact of radio frequency identification (RFID) technology on reducing RSI errors and improving patient safety.

Methods

A literature search on the effects of RFID technology on RSI error reduction was conducted in PubMed and CINAHL (2000–2016). Relevant articles were selected and reviewed by 4 researchers.

Results

After the literature search, 385 articles were identified and the full texts of the 88 articles were assessed for eligibility. Of these, 5 articles were included to evaluate the benefits and drawbacks of using RFID for preventing RSI-related errors. The use of RFID resulted in rapid detection of RSI through body tissue with high accuracy rates, reducing risk of counting errors and improving workflow.

Conclusions

Based on the existing literature, RFID technology seems to have the potential to substantially improve patient safety by reducing RSI errors, although the body of evidence is currently limited. Better designed research studies are needed to get a clear understanding of this domain and to find new opportunities to use this technology and improve patient safety.
The Role of the Surgeon on Outcomes of Vaginal Prolapse Surgery With Mesh
Authors: Eilber Karyn S. , Alperin Marianna , Khan Aqsa , Wu Ning , Pashos Chris L. , Clemens J. Quentin , Anger Jennifer T.
Published: February 2017

Introduction

Adverse outcomes after surgery for pelvic organ prolapse (POP) with mesh are often attributed to the mesh material with little attention paid to the influence of surgeon factors. We used a national data set to determine whether surgeon case volume and specialty influenced vaginal prolapse surgery outcomes with mesh.

Materials and Methods

Public Use File data on a 5% random national sample of female Medicare beneficiaries were obtained from the Centers for Medicare and Medicaid Services. Women with a diagnosis of POP who underwent surgery with mesh between 2007 and 2008 were identified by relevant International Classification of Diseases, 9th Revision, Clinical Modification and Current Procedural Terminology, 4th Edition procedure codes. Outcomes were compared by surgeon case volume and specialty.

Results

From 2007 to 2008, 1657 surgeries for POP were performed with mesh. Low-, intermediate-, and high-volume surgeons performed 881 (53%), 408 (25%), and 368 (22%) of the cases with mesh, respectively. The cumulative reoperation rates for low-, intermediate-, and high-volume providers were 6%, 2%, and 3%, respectively. The difference in reoperation rates between low and intermediate and low- and high-volume surgeons was statistically significant (P = 0.007 and 0.003, respectively). There was no significant difference in reoperation rates between gynecologists and urologists when vaginal mesh was implanted for POP surgery.

Conclusions

Low-volume surgeons performed most of the vaginal prolapse repairs with mesh and had significantly higher reoperation rates. Surgeon experience must be a consideration when reporting mesh-related complications of POP surgery.
Barriers to Pelvic Floor Physical Therapy Regarding Treatment of High-Tone Pelvic Floor Dysfunction
Authors: Zoorob Dani , Higgins Margaret , Swan Kimberly , Cummings Jennifer , Dominguez Sarah , Carey Erin
Published: February 2017

Objective

Chronic pelvic pain is a prevalent and debilitating condition with a wide range of etiologies. An estimated 30% to 70% of chronic pelvic cases involve musculoskeletal component pain including high-tone pelvic floor dysfunction (HTPFD). Pelvic floor physical therapy has been shown to be a beneficial treatment for HTPFD, yet many patients do not have access to this treatment. The objective of this study was to identify the barriers preventing patients from following through with the first-line management, physical therapy.

Methods

Participants with a diagnosis of HTPFD (n = 154) were identified from the list of referrals sent from the obstetrics and gynecology department to an affiliated PFPT center. Participants were contacted and asked to complete a phone survey addressing demographics and perceived barriers to care. Responses were collected in REDCap. Univariate and bivariate analyses were performed using a statistical analysis software.

Results

Seventy surveys were completed. The top barriers identified by participants were financial constraints (51.4%), perceived lack of utility (37.1%), time constraints (30.0%), and travel issues (18.6%); 84.4% of participants had 1 or more comorbid pain condition. Whereas 51.4% expressed some level of anxiety regarding the PFPT option, only 9.6% of participants did not start treatment because of fear of treatment.

Conclusions

The majority of treatment barriers identified were concrete restraints, with insurance noncoverage and time constraints being the top issues. A fair number of participants expressed anxiety about the treatment or felt they received unclear explanations of the treatment. These are areas in which providers can potentially alleviate some barriers to care.
Outcomes of Transvaginal High Uterosacral Ligaments Suspension: Over 500-Patient Single-Center Study
Authors: Milani Rodolfo , Frigerio Matteo , Cola Alice , Beretta Carlo , Spelzini Federico , Manodoro Stefano
Published: February 2017

Background

Uterosacral ligament (USL) suspension is a safe and effective procedure in terms of anatomical, functional, and subjective outcomes for primary surgical treatment of prolapse.

Objectives

There has been a renewed interest toward native tissue prolapse repair by vaginal route because of low cost and lack of mesh-related complications. Uterosacral ligaments are considered safe, effective, and durable as suspending structures for primary surgical repair of the apical compartment. Our aim was to evaluate complications, anatomical, functional and subjective outcomes of high USL suspension for primary prolapse repair.

Methods

Data of patients who underwent vaginal hysterectomy followed by high USL suspension for pelvic organ prolapse were retrospectively analyzed. Operative data, as well as complications, were recorded. Anatomical recurrence was defined as descent of any compartment stage II or greater according to the Pelvic Organ Prolapse Quantification system. Functional outcomes focused on urinary, bowel, and sexual dysfunctions. International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form, Wexner, and Patient Global Impression of Improvement questionnaires were collected.

Results

Data of 533 women were analyzed. Mean follow-up was 32 (SD, 19) months (dropout rate, 2.6%). Most frequent complication was ureteral kinking (2.6%). Total recurrence rate was 13.7%, with anterior compartment being the most frequent (9.4%), whereas reoperation for symptomatic prolapse recurrence was required in only 1% of patients. Improvement of urinary incontinence, voiding dysfunction, constipation, and dyspareunia was observed. Overall subjective satisfaction was high (Patient Global Impression of Improvement score, 1.3), ranging from “much improved” to “very much improved.”

Conclusions

Uterosacral ligament suspension is a safe and effective procedure in primary surgical treatment of pelvic organ prolapse. Anatomical, functional, and subjective outcomes were very satisfactory, and reoperation rate for recurrence was only 1%.
Autoimmune encephalitis in children: clinical phenomenology, therapeutics, and emerging challenges
Authors: Dale Russell C. , Gorman Mark P. , Lim Ming
Published: February 2017

Purpose of review

Auto-antibodies that bind to conformational extracellular epitopes of neuronal receptors or synaptic proteins have provided clinicians with essential biomarkers in acute neurology. This review summarizes the current status and challenges in the field.

Recent findings

In children, anti-N-methyl-D-aspartate receptor encephalitis remains the most identifiable autoimmune encephalitis, although many patients have a clinical syndrome of brain inflammation in which no antibodies are identified. Anti-myelin oligodendrocyte glycoprotein antibody associated demyelination is now recognized as a major cause of monophasic and relapsing demyelination, often presenting with encephalopathy. We discuss the importance of auto-antibody detection methodology and the possible influence of intrathecal antibody synthesis on the speed of recovery and response to immune therapy. The current, often pragmatic rather than evidence-based therapeutic pathway will be discussed, highlighting key challenges such as the timing of second-line therapy, monitoring of disease activity, and identifying the patient who is responding poorly to treatment.

Although there have been significant developments, future priorities include the need for paediatric-specific consensus definitions for seronegative suspected autoimmune encephalitis, novel tools for monitoring patients with autoimmune encephalitis, consensus treatment recommendations, and neuroprotective strategies.
Detecting synaptic autoantibodies in psychoses: need for more sensitive methods
Authors: Masdeu Joseph C.
Published: February 2017

Purpose of review

Schizophrenic psychosis affects near 1% of the population. It typically starts in the first three decades of life, leading most often to chronic disability: antipsychotic treatment is palliative, not curative. The neurobiological abnormalities underlying psychoses are likely to differ across patients, ranging from autosomal dominant genetic disease to substance abuse, but a decreased function of the N-methyl-D-aspartate (NMDA) receptor seems to be a common theme. Emerging evidence suggests that decreased NMDA receptor function may be caused by auto-antibodies against this receptor in some patients currently being diagnosed as having schizophrenia.

Recent findings

Studies searching for antibodies against the NMDA receptor in the sera of patients with schizophrenia have been either negative or found them in a very small minority of patients. Furthermore, similar antibodies have been detected in the general population. From these findings, however, it cannot be concluded that relevant auto-antibodies are not responsible for a subgroup of psychoses. Shortcomings in current antibody detection methodology may be responsible for the negative studies.

Given the high probability that a considerable proportion of patients with psychosis may have auto-antibodies not detectable with current methods and therefore harbour a potentially treatable disease, research to increase antibody detection sensitivity is urgently needed.
Accelerated simulation of evolutionary trajectories in origin-fixation models
Authors: Teufel Ashley I. , Wilke Claus O.
Published: February 2017

We present an accelerated algorithm to forward-simulate origin-fixation models. Our algorithm requires, on average, only about two fitness evaluations per fixed mutation, whereas traditional algorithms require, per one fixed mutation, a number of fitness evaluations of the order of the effective population size,Ne. Our accelerated algorithm yields the exact same steady state as the original algorithm but produces a different order of fixed mutations. By comparing several relevant evolutionary metrics, such as the distribution of fixed selection coefficients and the probability of reversion, we find that the two algorithms behave equivalently in many respects. However, the accelerated algorithm yields less variance in fixed selection coefficients. Notably, we are able to recover the expected amount of variance by rescaling population size, and we find a linear relationship between the rescaled population size and the population size used by the original algorithm. Considering the widespread usage of origin-fixation simulations across many areas of evolutionary biology, we introduce our accelerated algorithm as a useful tool for increasing the computational complexity of fitness functions without sacrificing much in terms of accuracy of the evolutionary simulation.
The benefit of a tough skin: bullet holes, weathering and the preservation of heritage
Authors: Mol Lisa , Gomez-Heras M. , Brassey C. , Green O. , Blenkinsop T.
Published: February 2017

Projectile damage to building stone is a widespread phenomenon. Sites damaged 100 years ago during the First World War still see daily use, while in a more contemporary setting numerous reports show the damage to buildings in Babylon, Mosul and Palmyra. While research has been carried out on the long-term effects of conflict such as fire damage, little is known about the protracted damage sustained through the impact of bullets, shrapnel and other metal projectiles outside of the field of engineering focused on ceramics and metals. To investigate alterations to mineral structure caused by projectile damage, impacts were created in medium-grained, well-compacted, mesoporous sandstone samples using 0.22 calibre lead bullets shot at a distance of 20 m. Half these samples were treated with a surface consolidant (Wacker OH 100), to mimic natural cementation of the rock surface. These samples were then tested for changes to surface hardness and moisture movement during temperature cycles of 15–65°C. Petrographic thin section analysis was carried out to investigate the micro-scale deformation associated with high-speed impact. The results surprisingly show that stress build-up behind pre-existing cementation of the surface, as found in heritage sites that have been exposed to moisture and temperature fluctuations for longer periods of time, can be alleviated with a bullet impact. However, fracture networks and alteration of the mineral matrices still form a weak point within the structure, even at a relatively low impact calibre. This initial study illustrates the need for geomorphologists, geologists, engineers and heritage specialists to work collectively to gain further insights into the long-term impact of higher calibre armed warfare on heritage deterioration.
Threshold effect of growth rate on population variability of
Escherichia coli
cell lengths
Authors: Gangan Manasi S. , Athale Chaitanya A.
Published: February 2017

A long-standing question in biology is the effect of growth on cell size. Here, we estimate the effect of
Escherichia coli
growth rate (
r
) on population cell size distributions by estimating the coefficient of variation of cell lengths (CV
L
) from image analysis of fixed cells in DIC microscopy. We find that the CV
L
is constant at growth rates less than one division per hour, whereas above this threshold, CV
L
increases with an increase in the growth rate. We hypothesize that stochastic inhibition of cell division owing to replication stalling by a RecA-dependent mechanism, combined with the growth rate threshold of multi-fork replication (according to Cooper and Helmstetter), could form the basis of such a threshold effect. We proceed to test our hypothesis by increasing the frequency of stochastic stalling of replication forks with hydroxyurea (HU) treatment and find that cell length variability increases only when the growth rate exceeds this threshold. The population effect is also reproduced in single-cell studies using agar-pad cultures and ‘mother machine’-based experiments to achieve synchrony. To test the role of RecA, critical for the repair of stalled replication forks, we examine the CV
L
of
E. coli ΔrecA
cells. We find cell length variability in the mutant to be greater than wild-type, a phenotype that is rescued by plasmid-based RecA expression. Additionally, we find that RecA-GFP protein recruitment to nucleoids is more frequent at growth rates exceeding the growth rate threshold and is further enhanced on HU treatment. Thus, we find growth rates greater than a threshold result in increased
E. coli
cell lengths in the population, and this effect is, at least in part, mediated by RecA recruitment to the nucleoid and stochastic inhibition of division.