bluuebunny/crossref_metadata_2025 huggingface dataset:
Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Series of 60 Cases
Authors: Link Thomas W , Boddu Srikanth , Paine Stephanie M , Kamel Hooman , Knopman Jared
Published: October 2018

BACKGROUND

Chronic subdural hematoma (SDH) is a particularly challenging pathology due to high recurrence rates (2%-37%) and complex medical comorbidities that tend to afflict the patient population. Recently, there have been several case series published describing the use of middle meningeal artery (MMA) embolization as an alternative to surgery for treatment of new or recurrent chronic SDH.

OBJECTIVE

To describe our first 60 cases of MMA embolization for chronic SDH.

METHODS

MMA embolization was performed using angiography, selective microcatheterization of the MMA, and infusion of polyvinyl alcohol particles. Outcomes were assessed clinically and with interval imaging studies at 1 d, 2 wk, and 6 wk postprocedure, and additional intervals as indicated.

RESULTS

MMA embolization was performed successfully on 60 total SDHs in 49 patients. This includes upfront treatment for new (not previously treated) SDH in 42, for recurrence in 8, and prophylaxis (soon after surgical evacuation) in 10. There were 3 mortalities (unrelated to the procedure), and no procedural complications. Of the 50 nonprophylactic cases, there were 4 (8.9%) cases of recurrence requiring surgical evacuation, and 31 (68.9%) that had resolution or reduction in size >50% of SDH at longest follow-up. Overall, 41 (91.1%) were stable or decreased in size and able to avoid surgery.

CONCLUSION

MMA embolization may represent a minimally-invasive alternative to surgery for new or recurrent chronic SDH, or as prophylaxis to reduce the risk of recurrence after surgery. Given our encouraging results with a 91% long-term success rate, a large scale clinical trial is warranted.
Long-Term Survivorship Care After Cancer Treatment: A New Emphasis on the Role of Rehabilitation Services
Authors: Stout Nicole L , Silver Julie K , Alfano Catherine M , Ness Kirsten K , Gilchrist Laura S
Published: October 2018

In May 2018, the National Cancer Policy Forum (NCPF) of the National Academies of Sciences, Engineering, and Medicine (formerly the Institute of Medicine) released a report, Long-Term Survivorship Care After Cancer Treatment: Proceedings of Workshop. NCPF-published reports have historically played a significant role in driving policy and payment model changes in oncology care, in addition to raising awareness about the needs of individuals with cancer. This 2018 report provides a specific set of recommendations for improving symptom management and rehabilitation that suggest the integration of rehabilitation services at the point of cancer diagnosis and throughout the continuum of cancer care to effectively screen for and manage the anticipated functional morbidity associated with cancer treatment. The specificity of these recommendations is of significant relevance to the physical therapy profession and should encourage bold steps to effectively increase the presence of physical therapists as members of interdisciplinary cancer care teams. The profession must act to implement models of prospective care, develop targeted education and training initiatives to assure the knowledge and skills of our workforce for this complex population, and augment the current evidence base with greater attention to health services research aiming to understand the effectiveness of rehabilitation services in improving costs, utilization, and meaningful functional outcomes.
Self-Measured Arm Circumference in Women With Breast Cancer Is Reliable and Valid
Authors: Rafn Bolette S , McNeely Margaret L , Camp Pat G , Midtgaard Julie , Campbell Kristin L
Published: October 2018

Background

Prospective surveillance by physical therapists enables early detection and treatment of breast cancer–related lymphedema (BCRL). Strategies to increase access to prospective surveillance could reduce the burden of BCRL on patients and the health system. One potential solution is self-managed surveillance that does not require in-person assessment by a specialized physical therapist.

Objective

The objective was to develop and test the reliability and validity of a written and video-supported protocol for women with breast cancer to self-measure arm circumference.

Design

This was a cross-sectional reliability and validity study.

Results

The intrarater reliability between CIRself_home and CIRself_lab and the interrater reliability between CIRself_lab and CIRther was high to excellent for both arms in both groups (intraclass correlation coefficient ≥0.86). VOLself_lab correlated strongly with VOLper (r ≥ 0.95), demonstrating excellent validity. Participants reported strong intention, self-efficacy, and positive attitude toward the performance of self-managed surveillance for BCRL, which was not perceived to increase worry about having or getting BCRL.

Methods

Participants with (n = 20) and without (n = 21) BCRL completed self-measurement of arm circumference on both arms at home (CIRself_home) and at the lab (CIRself_lab) (intrarater reliability). The CIRself_lab was subsequently compared to measures performed by a specialized physical therapist (CIRther) (interrater reliability). To test validity, arm volume calculated from the self-measurements (VOLself_lab) was compared to perometry measurements (VOLper). Participants completed a questionnaire to assess attitudes for performing self-managed surveillance for BCRL.

Limitations

These findings need to be replicated in a clinical setting to confirm the reliability and acceptability of self-managed surveillance for BCRL among women newly diagnosed with breast cancer.

Conclusions

Self-measured arm circumference is reliable and valid among women with and without BCRL. Self-managed surveillance for BCRL can support self-efficacy without increasing anxiety.
Work-Related Upper Limb Symptoms in Hand-Intensive Health Care Occupations: A Cross-Sectional Study With a Health and Safety Perspective
Authors: Greiner Birgit A , Nolan Sheilah , Hogan Dervla A M
Published: October 2018

Background

Research with physical therapists reveals high rates of work-related musculoskeletal injuries, especially low back pain, with early career onset. Less focus has been given to upper limb disorders (ULDs) in these professionals, who frequently perform repetitive arm/hand and precision finger motions during work.

Objective

The objective was to estimate prevalence of body-site–specific upper limb (UL) symptoms and diagnosed ULDs in Irish chartered physical therapists, physiotherapists, and athletic therapists, with adjustment for leisure time injury, and document first onset of specific UL symptoms.

Design

The design was a cross-sectional survey (N = 347) using random sampling (physiotherapists in private practice), proportionate cluster sampling (hospital-based physiotherapists), and all-population sampling (physical therapists and athletic therapists).

Methods

The methods used were a postal questionnaire with annual, current, and incapacitating UL symptoms (neck, shoulders, elbows, wrists, fingers, thumbs) (Nordic Questionnaire); symptom onset; diagnosed UL disorders; and sociodemographics; prevalence with 95% CIs, and adjusted prevalence (general linear modeling).

Results

Adjusted annual prevalence of UL symptoms in at least 1 body site was 78.1% (95% CI = 71.4–82.2), and of incapacitating symptoms was 21.0% (95% CI = 16.4–27.0). Shoulder (53.2%, 95% CI = 47.9–58.7), neck (49.4%, 95% CI = 44.2–55.0), and thumbs (46.1%, 95% CI = 40.7–51.5) were mostly affected. Hospital-based therapists had a significantly higher prevalence of incapacitating symptoms compared with others (35.7% vs 23.3%). Respondents totaling 28.2% had at least 1 lifetime diagnosis of ULD, most commonly shoulder tendonitis (12.5%, 95% CI = 8.4–15.3) and overuse syndrome (11.8%, 95% CI = 8.4–15.3). First onset was mostly after 5 years working as a therapist; however, this differed by anatomical site.

Limitations

A cross-sectional study design limited interpretation of symptoms as work-related causes.

Conclusions

The high prevalence of ULD and symptoms warrants attention from occupational health and safety personnel. Training in injury prevention and risk assessment should be provided during education and as part of continuing education.
Impaired Physical Performance Predicts Hospitalization Risk for Participants in the Program of All-Inclusive Care for the Elderly
Authors: Falvey Jason R , Burke Robert E , Levy Cari R , Gustavson Allison M , Price Lisa , Forster Jeri E , Stevens-Lapsley Jennifer E
Published: October 2018

Background

Medicaid spending on the Program of All-Inclusive Care for the Elderly (PACE) has grown rapidly over the last 5 years. Reducing hospitalization rates is a major goal for PACE. However, there is a paucity of research evaluating the relationship between impaired physical performance and hospitalizations in PACE.

Objective

This study tested whether physical therapist–assessed physical performance, measured by the Short Physical Performance Battery (SPPB), can be used to identify participants in PACE at risk for all-cause hospitalizations or potentially avoidable hospitalizations (PAH).

Design

This was a retrospective cohort study of 1093 participants in PACE facilities in the Denver, Colorado, area.

Methods

Data were acquired from linked electronic medical record data and hospitalization claims. Unadjusted and adjusted Cox proportional hazards regression models were used to evaluate the relationship between SPPB scores and the probabilities of both all-cause hospitalizations and PAH.

Results

The unadjusted likelihood of hospitalization increased with greater physical performance impairment (for SPPB scores ≥8/12: 12.2%; for SPPB scores of 4/12 to 7/12: 15.7%; for SPPB scores <4/12: 21.1%). Compared with participants with SPPB scores ≥8/12, participants with SPPB scores <4/12 had nearly double the unadjusted hazard for hospitalization (hazard ratio = 1.99; 95% CI = 1.34–2.96). In adjusted Cox regression models, participants with SPPB scores <4/12 remained significantly more likely to be hospitalized (hazard ratio = 1.87; 95% CI = 1.24–2.84). Similar relationships were observed for PAH.

Limitations

The use of data from a single network of PACE facilities might limit generalizability to states with different Medicaid guidelines.

Conclusions

The findings suggest that impaired physical performance is an independent risk factor for hospitalization among participants in PACE. These findings could help guide the development of PACE program modifications for measuring and intervening on impairments in physical function.
Influenza
Authors: Perkins Amanda
Published: October 2018

We give you the information you need to conquer the 2018-2019 flu season.
Gabapentin for the Treatment of Vulvodynia: A Randomized Controlled Trial
Authors: Brown Candace S. , Bachmann Gloria A. , Wan Jim , Foster David C.
Published: October 2018

(Abstracted from Obstet Gynecol 2018;131:1000–1007)

Vulvodynia is a chronic pain syndrome with a lifetime prevalence of 7% to 16%. Only a small number of randomized clinical trials (RCTs) have been conducted on vulvodynia.
Survival After Secondary Cytoreductive Surgery and Chemotherapy Compared With Chemotherapy Alone for First Recurrence in Patients With Platinum-Sensitive Epithelial Ovarian Cancer and No Residuals After Primary Treatment. A Registry-Based Study
Authors: Szczesny Witold , Langseth Hilde , Myklebust Tor Å. , Kærn Janne , Tropé Claes , Paulsen Torbjørn
Published: October 2018

(Abstracted from Acta Obstet Gynecol Scand 2018; doi: 10.1111/aogs.13361)

Standard treatment for women with epithelial ovarian cancer (EOC) generally is primary surgery (with the aim of complete cytoreduction) followed by 6 cycles of carboplatin and taxanes every 3 weeks.
Birth Outcomes for Pregnant Women With HIV Using Tenofovir-Emtricitabine
Authors: Rough Kathryn , Seage George R. , Williams Paige L. , Hernandez-Diaz Sonia , Huo Yanling , Chadwick Ellen G. , Currier Judith S. , Hoffman Risa M. , Barr Emily , Shapiro David E. , Patel Kunjal
Published: October 2018

(Abstracted from N Engl J Med 2018;378:1593–1603)

Three-drug antiretroviral therapy (ART) during pregnancy has reduced the risk of perinatal transmission of HIV to less than 1% and has become the global standard of care. The Promoting Maternal and Infant Survival Everywhere (PROMISE) trial recently found that pregnant women in multiple sites of sub-Saharan Africa and India receiving tenofovir, disoproxil fumarate, emtricitabine, and ritonavir-boosted lopinavir (TDF-FTC-LPV/r) were more than twice as likely to deliver very prematurely (<34 weeks of gestation), at very low birth weight (<1500 g), and were significantly more likely to have infants that died within 14 days after delivery compared with those assigned to receive zidovudine, lamivudine, and ritonavir-boosted lopinavir (ZDV-3TC-LPV/r).
Canada’s Universal Health-Care System: Achieving Its Potential
Authors: Martin Danielle , Miller Ashley P. , Quesnel-Vallée Amélie , Caron Nadine R. , Vissandjée Bilkis , Marchildon Gregory P.
Published: October 2018

(Abstracted from Lancet 2018;391:1718–1735)

Canada’s universal publicly funded health care system, known as Medicare, was founded on the principle that access should be determined by need rather than ability to pay. Medicare is an importance source of collective pride in Canada as a universal health coverage model that provides access to physicians and hospital services through 13 tax-funded insurance plans.
Effect of Glyburide vs Subcutaneous Insulin on Perinatal Complications Among Women With Gestational Diabetes: A Randomized Clinical Trial
Authors: Sénat Marie-Victoire , Affres Helene , Letourneau Alexandra , Coustols-Valat Magali , Cazaubiel Marie , Legardeur Helene , Jacquier Julie Fort , Bourcigaux Nathalie , Simon Emmanuel , Rod Anne , Héron Isabelle , Castera Virginie , Sentilhes Loic , Bretelle Florence , Rolland Catherine , Morin Mathieu , Deruelle Philippe , De Carne Celine , Maillot François , Beucher Gael , Verspyck Eric , Desbriere Raoul , Laboureau Sandrine , Mitanchez Delphine , Bouyer Jean
Published: October 2018

(Abstracted from JAMA 2018;319(17):1773–1780)

Gestational diabetes continues to increase nationally and globally. The American Diabetes Association currently recommends insulin, the only Food and Drug Administration–approved pharmacologic agent, as first-line treatment for women with gestational diabetes mellitus requiring medications.
Cystourethroscopy Following Midurethral Slings: Is It Always Necessary?
Authors: Melon Jerome , Kelly Erin C. , van Delft Kim W. M.
Published: October 2018

(Abstracted from Int Urogynecol J 2018;29:789–793)

Synthetic midurethral slings (MUSs) have been the most prevalent surgical intervention for the treatment of stress urinary incontinence. However, their use for stress urinary incontinence has deceased in recent years, most likely the result of concerns over the safety of mesh implants by the US Food and Drug Administration, as well as a large number of class-action lawsuits.
Marijuana Use in Pregnancy and While Breastfeeding
Authors: Metz Torri D. , Borgelt Laura M.
Published: October 2018

The prevalence and perceived safety of marijuana use in pregnancy are increasing with expanding legalization. Marijuana crosses the placenta and passes into breast milk, resulting in fetal and neonatal exposure. Many women cite medical reasons for prenatal marijuana use such as nausea and vomiting of pregnancy, anxiety, and chronic pain. The scientific literature regarding marijuana in pregnancy is mixed, resulting in confusion among practitioners as to how to counsel women about risks of use. In addition, there is a paucity of literature related to marijuana use and breastfeeding. Existing pregnancy studies are predominantly retrospective cohorts with a reliance on self-report for ascertainment of exposure, which underestimates use. Many studies fail to adjust for important confounding factors such as tobacco use and sociodemographic differences. Despite the limitations of the existing evidence, there are animal and human data suggesting potential harm of cannabis use. The harms are biologically plausible given the role of the endocannabinoid system in pregnancy implantation, placentation, and fetal neurologic development. Two recent systematic reviews and meta-analyses found an association between marijuana use and adverse perinatal outcomes, especially with heavy marijuana use. In addition, three longitudinal cohort studies demonstrate a possible effect of prenatal marijuana exposure on long-term neurobehavioral outcomes. Marijuana use may be associated with growth restriction, stillbirth, spontaneous preterm birth, and neonatal intensive care unit admission. Therefore, women should be advised to refrain from using marijuana during pregnancy and lactation.
Flexible Fixation Treatment Strategies for Low-energy Lisfranc Injuries
Authors: Heyrani Nasser , Hopkins Justin N. , Ngyuyen Kevin N. , Kreulen Christopher , Giza Eric
Published: October 2018

Ligamentous Lisfranc injuries are characterized by disruption between the articulation of the medial cuneiform and base of the second metatarsal. Ligamentous injuries can be either subtle or obvious and can also occur with tarsometatarsal subluxations or dislocations. These injuries typically happen in athletic activity and are also seen lower-energy falls. Conventional use of transarticular screws to repair Lisfranc ligament injuries has provided good outcomes; however, the screws are also believed to decrease the natural physiological movement of the Lisfranc joint. As treatment options for ligamentous Lisfranc injuries move away from transarticular screws and toward bridge plating and motion-preserving fixation techniques, the goal of stable fixation is still important for optimizing long-term results. This article will focus on the technique of using a suture button device, and also introduce the technique of Lisfranc InternalBrace fixation. The internal brace technique allows for less bone loss from drilling, allows for collagen ingrowth, and can be used in conjunction with bridge plating techniques.

Level of Evidence: Diagnostic Level 4. See Instructions for Authors for a complete description of levels of evidence.
Implementation of the Smart Use of Antibiotics Program to Reduce Unnecessary Antibiotic Use in a Neonatal ICU: A Prospective Interrupted Time-Series Study in a Developing Country
Authors: Lu Chunmei , Liu Qing , Yuan Hao , Wang Laishuan
Published: October 2018

Objectives:

We aimed to implement our Smart Use of Antibiotics Program to ensure the proper use of antimicrobials, improve patient care and outcomes, and reduce the risks of adverse effects and antimicrobial resistance.

Design:

We compared the time periods before (baseline) and after (intervention) the implementation of an antibiotic protocol by performing surveillance and assessments of all antibiotic use during a 29-month interrupted period.

Setting:

Level 3–4 neonatal ICU in one referral center.

Patients:

All 13,540 infants who received antibiotics during their hospital stay from 2015 to 2017.

Interventions:

Prospective audit of targeted antibiotic stewardship program.

Measurements and Main Results:

The primary outcome was the change in total antibiotic days of therapy per 1,000 patient-days between the baseline and intervention periods. The secondary outcomes included readmissions for infection, late-onset sepsis (length of stay), necrotizing enterocolitis, or death in infants at 32 weeks of gestation or younger and the prevalence of multidrug-resistant organism colonization. No differences in safety outcomes were observed between the intervention and baseline periods. Following the implementation of our Smart Use of Antibiotics Program, the total quantity of antibiotics in the intervention phase was significantly decreased from 543 days of therapy per 1,000 patient-days to 380 days of therapy/1,000 patient-days compared with that of baseline (p = 0.0001), which occurred in parallel with a reduction in length of stay from 11.4% during the baseline period to 6.5% during the intervention period (p = 0.01). A reduced multidrug-resistant organism rate was also observed following Smart Use of Antibiotics Program implementation (1.4% vs 1.0%; p = 0.02). The overall readmission rate did not differ between the two periods (1.2% vs 1.1%; p = 0.16).

Conclusions:

Smart Use of Antibiotics Program implementation was effective in reducing antibiotic exposure without affecting quality of care. Antibiotic stewardship programs are attainable through tailoring to special stewardship targets even in a developing country.
Improving Charting Skills of Physicians in Monitored Practice
Authors: Wenghofer Elizabeth , Boal Peter , Floyd Nathanial , Lee Joan , Woodard Robert , Norcross William
Published: October 2018

Introduction:

The Physician Enhancement Program (PEP) is an in-practice monitoring program for physicians with potential dyscompetency issues. One component of PEP is a monthly chart audit. The purpose of our study was to determine if physicians' charting skills improve through their participation in PEP.

Methods:

The sample included physicians who participated in PEP for at least 6 months regardless of specialization, age, or gender (n = 77). PEP chart audits evaluate seven different aspects of chart and care quality, including legibility, organization, history, assessment/formulation, treatment, physical examination, and overall chart quality. Each aspect of charting is scored on a Likert-type scale from a score of 1 to 9. We conducted pair-matched t tests of the mean item scores for the 1st versus 6th, 12th, 18th, and 24th month in PEP for all chart elements except legibility. We also compared the size of the paired differences by month 1 scores for overall chart quality mean score to determine if the magnitude of change varied by starting point.

Results:

There was significant improvement (P < .002) across the 6 chart quality elements per physician at months 6, 12, 18, and 24. Physicians who started below Q1 for overall chart quality mean showed most improvement, whereas those who started above Q3 had insignificant change as they had little room to improve.

Discussion:

PEP participants demonstrated improved charting skills for each chart quality element evaluated. PEP is an effective form of physician education resulting in physician behavior changes, especially for those physicians who need it the most.
Dietary Micronutrient Intake of Participants in a “Partners Together in Health” Cardiac Rehabilitation Intervention
Authors: Jensen Sara Kvien , Yates Bernice , Lyden Elizabeth , Krogstrand Kaye Stanek , Hanson Corrine
Published: October 2018

Purpose:

Current guidelines for cardiovascular health emphasize a “dietary pattern” approach that could be expected to increase intakes of micronutrients in addition to altering the macronutrient profile. However, the effect of interventions such as cardiac rehabilitation on the micronutrient quality of the diet has not been evaluated. Therefore, the goal of this study was to investigate changes in micronutrient intake of cardiac rehabilitation participants over time.

Methods:

This was a secondary analysis of data from a randomized clinical trial that assessed the effects of the Partners Together in Health intervention on physical activity and healthy eating behaviors. The intake of 9 micronutrients important in cardiovascular health was assessed using 3-d food records. A micronutrient adequacy score was evaluated at 3 time points (baseline, 3 and 6 mo). Changes over time in micronutrient intake were assessed using a general linear model.

Results:

Sixty-eight participants who were enrolled in the Partners Together in Health interventional trial completed the study. There was no significant difference in the mean micronutrient score at any time point. Intake of individual micronutrients did not improve over the 6-mo time frame with the exception of vitamin E, (8.7 mg vs 6.5 mg for at 6 vs 3 mo, P = .02). The proportion of participants with intakes meeting the Dietary Recommended Intake for each nutrient also remained the same over time.

Conclusion:

Although cardiac rehabilitation programs may be effective in altering the macronutrient composition, improvements to overall diet quality may be tempered by a lack of improvement in intake of micronutrients.
The Effects of Cardiac Rehabilitation on Mortality and Morbidity in Women
Authors: Ghisi Gabriela Lima de Melo , Chaves Gabriela Suéllen da Silva , Bennett Amanda , Lavie Carl J. , Grace Sherry L.
Published: October 2018

Purpose:

Cardiac rehabilitation (CR) is associated with significant reductions in mortality and morbidity, but few women are included in trials. Therefore, a meta-analysis of the effects of CR in women is warranted.

Methods:

Randomized controlled trials from recent systematic reviews that included women attending comprehensive CR and reporting the outcomes of mortality and morbidity (hospitalization, myocardial infarction, bypass surgery, percutaneous coronary intervention) were considered for inclusion. An updated search of the literature was performed from the end date of the last search, based on the Cochrane strategy. Authors were contacted to provide results on women where none were reported.

Results:

On the basis of 2 recent systematic reviews, 80 trials were identified. Fifty (62.5%) were excluded, most commonly due to lack of inclusion of women (n = 18; 22.5%). One trial was identified through the search update. Of 31 potential trials meeting inclusion criteria, 1 reported results on women and many were old, and hence data by sex were no longer available. Ultimately, data for women were available in 2 trials. Therefore, it was deemed inappropriate to undertake this meta-analysis.

Conclusions:

This review corroborates the dearth of data on CR in women despite the fact that cardiovascular disease is the leading cause of death in women. Given the totality of evidence, including reductions in mortality and morbidity in nonrandomized studies, and evidence of benefit for other important outcomes such as functional capacity and quality of life, women should continue to be referred to CR.
Participation in Pulmonary Rehabilitation by Veterans Health Administration and Medicare Beneficiaries After Hospitalization for Chronic Obstructive Pulmonary Disease
Authors: Vercammen-Grandjean Christopher , Schopfer David W. , Zhang Ning , Whooley Mary A.
Published: October 2018

Background:

Hospitalization with acute exacerbation of chronic obstructive pulmonary disease (COPD) is common and costly to the health care system. Pulmonary rehabilitation (PR) can improve symptom burden and morbidity associated with COPD. The use of PR among Medicare beneficiaries is poor, and the use by Veterans Health Administration (VHA) beneficiaries is unknown. We sought to determine whether participation in PR was similarly poor among eligible veterans compared with Medicare beneficiaries.

Methods:

We performed a retrospective study using national VHA and Medicare data to determine the proportion of eligible patients who participated in PR after hospitalization for an acute exacerbation of COPD between January 2007 and December 2011. We also evaluated patient characteristics including demographic factors and comorbid medical history associated with participation.

Results:

Over the 5-year study period, 485 (1.5%) of 32 856 VHA and 3199 (2.0%) of 158 137 Medicare beneficiaries hospitalized for COPD attended at least 1 session of PR. Among both VHA and Medicare beneficiaries, participation was higher in those who had had comorbid pneumonia or pulmonary hypertension and was lower in older patients. Although participation increased in both groups over time, it remained exceedingly low overall.

Conclusion:

Pulmonary rehabilitation is significantly underused in both the VHA and Medicare populations. Although comorbid pulmonary disease is associated with higher use, the proportion of eligible patients who participate remains extremely low.
Physiological Responses and Prognostic Value of Common Exercise Testing Modalities in Idiopathic Pulmonary Fibrosis
Authors: Vainshelboim Baruch , Myers Jonathan , Oliveira Jose , Izhakian Shimon , Unterman Avraham , Kramer Mordechai Reuven
Published: October 2018

Purpose:

This pilot study aimed to compare physiological responses between cycle cardiopulmonary exercise tests (CPETs) and 6-min walk tests (6MWTs) and to assess their prognostic value among patients with idiopathic pulmonary fibrosis (IPF).

Methods:

Thirty-four patients with IPF (68 ± 8 yr) underwent CPETs and 6MWTs and were followed up for 40 mo. Differences, levels of agreement, and relative risks for mortality were analyzed between measured and estimated peak responses for the 2 tests.

Results:

Compared with the CPET, oxygen uptake (

JOURNAL/jcprh/04.03/01273116-201905000-00010/10FSM1/v/2023-09-11T074705Z/r/image-gif

o
2), heart rate (HR), and the nadir of SpO
2 were lower during the 6MWT, whereas work rate (WR) was higher. Mean differences were as follows:

JOURNAL/jcprh/04.03/01273116-201905000-00010/10FSM1/v/2023-09-11T074705Z/r/image-gif

o
2 =−1.9 mL/kg/min, 95% CI, −1.1 to −2.7, P < .001; HR =−9 beats/min, 95% CI, −4 to −14, P = .002; SpO
2 =−6%, 95% CI, −4 to −7, P < .001; and WR = 9 W/min, 95% CI, 3 to 16, P = .008. Interclass correlations ranged from 0.84 to 0.90 and both tests demonstrated prognostic value for mortality.

Conclusions:

Significant differences and variation in peak physiological responses were observed between cycle CPETs and 6MWTs in patients with IPF. However, good agreement was evident, suggesting that both tests provide value for clinical and research settings. Future studies should compare the physiological responses between treadmill CPETs and 6MWTs for prognostic utility in IPF.
Efficacy of Neulasta or Neupogen on H-ARS and GI-ARS Mortality and Hematopoietic Recovery in Nonhuman Primates After 10-Gy Irradiation With 2.5% Bone Marrow Sparing
Authors: Farese Ann M. , Bennett Alexander W. , Gibbs Allison M. , Hankey Kim G. , Prado Karl , Jackson William , MacVittie Thomas J.
Published: October 2018

A nonhuman primate model of acute, partial-body, high-dose irradiation with minimal (2.5%) bone marrow sparing was used to assess endogenous gastrointestinal and hematopoietic recovery and the ability of Neulasta® (pegylated granulocyte colony-stimulating factor) or Neupogen® (granulocyte colony-stimulating factor) to enhance recovery from myelosuppression when administered at an increased interval between exposure and initiation of treatment. A secondary objective was to assess the effect of Neulasta or Neupogen on mortality and morbidity due to the hematopoietic acute radiation syndrome and concomitant gastrointestinal acute radiation syndrome. Nonhuman primates were exposed to 10.0 Gy, 6 MV, linear accelerator-derived photons delivered at 0.80 Gy min−1. All nonhuman primates received subject-based medical management. Nonhuman primates were dosed daily with control article (5% dextrose in water), initiated on day 1 postexposure; Neulasta (300 μg kg−1), administered on days 1, 8, and 15 or days 3, 10, and 17 postexposure; or Neupogen (10 μg kg−1), administered daily postexposure following its initiation on day 1 or day 3 until neutrophil recovery (absolute neutrophil count ≥1,000 cells μL−1 for 3 consecutive days). Mortality in the irradiated cohorts suggested that administration of Neulasta or Neupogen on either schedule did not affect mortality due to gastrointestinal acute radiation syndrome or mitigate mortality due to hematopoietic acute radiation syndrome (plus gastrointestinal damage). Following 10.0 Gy partial-body irradiation with 2.5% bone marrow sparing, the mean duration of neutropenia (absolute neutrophil count <500 cells μL−1) was 22.4 d in the control cohort vs. 13.0 and 15.3 d in the Neulasta day 1, 8, 15 and day 3, 10, 17 cohorts, relative to 16.2 and 17.4 d in the Neupogen cohorts initiated on day 1 and day 3, respectively. The absolute neutrophil count nadirs were 48 cells μL−1 in the controls; 117 cells μL−1 and 40 cells μL−1 in the Neulasta days 1, 8, and 15 or days 3, 10, and 17 cohorts, respectively; and 75 cells μL−1 and 37 cells μL−1 in the Neupogen day 1 and day 3 cohorts, respectively. Therefore, the earlier administration of Neulasta or Neupogen was more effective in this model of marginal 2.5% bone marrow sparing. The approximate 2.5% bone marrow sparing may approach the threshold for efficacy of the lineage-specific medical countermeasure. The partial-body irradiation with 2.5% bone marrow sparing model can be used to assess medical countermeasure efficacy in the context of the concomitant gastrointestinal and hematopoietic acute radiation syndrome sequelae.
Idiopathic Acquired Lacrimal Canalicular Obstruction
Authors: Satchi Khami , McNab Alan A.
Published: October 2018

Purpose:

Acquired lacrimal canalicular obstruction has a variety of causes. In a small proportion of patients, no cause can be identified. This article describes a cohort of 27 patients with idiopathic acquired lacrimal canalicular obstruction encountered over a 28-year period.

Methods:

The diagnostic database of the senior author was analyzed to identify all cases of idiopathic acquired lacrimal canalicular obstruction seen from 1990 to 2017. Demographic, clinical, and treatment details were analyzed. Patients with primary lacrimal punctal stenosis or closure were excluded from the analysis.

Results:

The authors encountered 27 patients with idiopathic acquired lacrimal canalicular obstruction (17 female, 63%) aged 34 to 91 years (median: 65 years). The level of canalicular obstruction ranged from 1 to 10 mm from the punctum. Canalicular obstruction involved 1 canaliculus in 4 patients, 2 in 14 (ipsilateral in all except one), 3 in 3, and all 4 in 6. One patient who presented with ipsilateral upper and lower canalicular obstructions developed contralateral upper and lower obstructions several years later, and another patient redeveloped obstructions after initial successful surgical repair. In all cases, there were no features on history or examination to suggest a cause for the canalicular obstruction. Follow up ranged from 1 to 260 months (mean: 39 months). Sixteen patients underwent surgical repair, 11 with a dacryocystorhinostomy and placement of a Lester Jones glass bypass tube, 2 had a canaliculo-dacryocystorhinostomy (anastomosis of the canaliculus to the nose), 2 had dacryocystorhinostomy and trephination of the canalicular obstruction with silicone intubation, and 1 had a dacryocystorhinostomy alone to try and improve drainage through a single patent canaliculus.

Conclusion:

Idiopathic acquired lacrimal canalicular obstruction is uncommon and occurs more frequently in older women. The condition may be slowly progressive and can affect one or more canaliculi at any level. Treatment is the same as for any other cause of acquired lacrimal canalicular obstruction.
Morbihan Disease Treatment: Two Case Reports and a Systematic Literature Review
Authors: Boparai Ranjodh S. , Levin Ariana M. , Lelli Gary J.
Published: October 2018

Purpose:

To assess the effectiveness of treatments for Morbihan disease.

Methods:

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the literature was performed on April 1, 2018, using PubMed, Google Scholar, and Excerpta Medica dataBASE with terms used to describe Morbihan disease, including “Morbihan Disease,” “Morbihan Syndrome,” “lymphedema rosacea,” and “lymphedematous rosacea”. Case reports or case series were included if they fulfilled the following criteria: published in English, peer-reviewed, and reported Morbihan disease.

Results:

A total of 89 patients—87 patients from 49 articles and 2 cases from the authors’ institution—were included in the final analysis. The median age of patients was 51 years (range: 14–79), and 66 of 89 (74%) patients were men. Male gender correlated with lack of complete response to treatment (odds ratio: 0.25; 95% confidence interval: 0.06–0.97;p= 0.02), while presence of papules or pustules correlated with complete response to treatment (odds ratio: 4.07; 95% confidence interval: 1.04–17.68;p= 0.03). Longer antibiotic duration correlated with response to treatment (p= 0.03), favoring complete over partial response (p= 0.02). Mean antibiotic duration in patients who responded was 4.43 months (standard deviation: 3.49), with complete responders requiring 6.50 months (standard deviation: 4.57). Oral corticosteroids, isotretinoins, and combination therapies did not correlate with treatment response.

Conclusions:

The presence of papules and pustules correlates with a complete response to treatment, while male gender correlates with a partial response. Patients may benefit from 4- to 6-month duration of tetracycline-based antibiotics. Prospective studies are needed to assess the impact of antibiotic and isotretinoin dose and duration on treatment response.
Light Perception Vision Recovery After Treatment for Calcium Hydroxylapatite Cosmetic Filler–Induced Blindness
Authors: Vu Priscilla Q. , Grob Seanna R. , Tao Jeremiah P.
Published: October 2018

A 51-year-old woman presented with no light perception vision of the right eye 12 hours after another provider injected calcium hydroxylapatite into the glabella and dorsum of the nose. Exam and fluorescein angiography demonstrated optic nerve edema and choroidal hypoperfusion consistent with ischemia of the posterior ciliary circulation. The central retinal circulation appeared intact. One thousand two hundred units of retrobulbar hyaluronidase were injected urgently in several boluses. Oral prednisone and aspirin also were administered. Ocular massage was also initiated. One day later, visual acuity improved to light perception that remained stable at 3 months. Retrobulbar hyaluronidase injection, ocular massage, prednisone, and aspirin were correlated to recovery of light perception vision in this case of calcium hydroxylapatite filler embolization to the choroidal circulation. The mechanism for the recovery of some vision and the role of hyaluronidase and other medications remain uncertain. Further research in treatments for ophthalmic complications of facial fillers is warranted.
Incidence Risk Level and Severity of Orthopedic Surgical Site Infection in Jordan
Authors: Hassan Zeinab M. , Najjar Yahya W. , Saleh Mohammad Y. , Hamdan Mohammad
Published: October 2018

Background

Orthopedic surgical site infections are higher in developing countries compared with developed countries.

Purpose

This study aimed to determine the following: incidence rate of infection, levels of risk of infection, the severity of orthopedic infection, and the relationship between risk level of and severity level of orthopedic infection.

Methods

The study used a prospective approach to collect data about orthopedic surgery patients through assessing their health status and reviewing their medical records and monitoring for the occurrence of surgical site infection within 90 days after the operation. A total of 286 patients met the eligibility criteria from 18 hospitals. The severity of wound infection was assessed using the Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissues, isolation of bacteria, and duration of inpatient Stay wound scoring scale, and the levels of risk were assessed using the National Nosocomial Infection Surveillance risk index score.

Results

The incidence rate of orthopedic surgical site infection was (n = 8; 2.8%). Five patients (62.5%) had a moderate-risk level of infection, and 2 patients (25%) had a high-risk level. Most patients (n = 278; 97.2%) had satisfactory healing level. Both risk levels and severity levels of orthopedic surgical site infection were significantly correlated with each other.

Conclusion

Appropriate risk level and severity level assessment tools should be used to aid in the assessment of orthopedic surgical site infection.
Interrater Reliability of the Functional Status Score for the Intensive Care Unit
Authors: Hiser Stephanie , Toonstra Amy , Friedman Lisa Aronson , Colantuoni Elizabeth , Connolly Bronwen , Needham Dale M.
Published: October 2018

Background:

A decline in physical functioning is common during an intensive care unit (ICU) stay. The Functional Status Score for the Intensive Care Unit (FSS-ICU) is a performance-based measure designed to evaluate aspects of physical functioning in the ICU setting. While existing data support validity of the FSS-ICU, further investigation is needed regarding its interrater reliability.

Objective:

Evaluate interrater reliability of the FSS-ICU when completed by physical therapists (PTs), as part of routine clinical practice, across a wide range of patients with critical illness.

Design:

Prospective observational evaluation.

Methods:

Across patients in surgical, medical, and neurological ICUs, 8 PTs with 6 months of experience or more using the FSS-ICU (median [range] years of ICU experience = 2 [1-3]) administered the FSS-ICU. One of 2 reference rater PTs observed the FSS-ICU evaluation, and simultaneously scored it, with a minimum of 10 assessments per clinical PT. Reference rater and clinical PTs were blinded to each other's scores. Bland-Altman plots were constructed and intraclass correlation coefficients were computed using a random intercept (PT session and rater) model.

Results:

Eighty-one assessments on 76 different patients were observed by a reference rater PT. Bland-Altman plots revealed a mean difference in FSS-ICU scoring of 0.0 (95% limits of agreement: −4.0 to +4.0), with an intraclass correlation coefficient (95% confidence interval) of 0.985 (0.981-0.987). The intraclass correlation coefficients for patients in surgical, medical, and neurological ICUs were very similar: 0.984 (0.973-0.988), 0.987 (0.979-0.990), and 0.977 (0.963-0.983), respectively.

Limitations:

Single-center evaluation.

Conclusions:

The FSS-ICU evaluations, performed by PTs as part of routine clinical care across a variety of patients with critical illness, have excellent reliability compared with reference rater PTs.
Wavelet Decomposition–Based Speckle Reduction Method for Ultrasound Images by Using Speckle-Reducing Anisotropic Diffusion and Hybrid Median
Authors: Elsharif Razan I. , Ibraheem Banazier A. , Mustafa Zeinab A. , Abass Sahar K. , Fadl allah Manal M.
Published: October 2018

Ultrasound imaging is considered as a common facility of imaging techniques used in medical field because of its benefits, but the quality of ultrasound image is affected and degraded by the type of noise generated by the backscattered signals that interfere with each other and introduce a random interference pattern. This pattern is called speckle. In this article, we develop a new denoising method by introducing a speckle-reducing anisotropic diffusion filter into 4 sub-band images gained by using 2-dimensional wavelet decomposition. Moreover, according to frequency content on each sup band, we use hybrid median filter to get a full advantage of using nonlinear filtering in speckle noise. Finely to improve the quality of image and the overall performance, total variation is used in view of it is capability of brightness equality and edges preserving. The experimental result shows that the proposed method is highly effective in noise separation as well as edges preserving based on compression between linear scaling of the gray-level values despeckle filter, speckle-reducing anisotropic diffusion, median, hybrid median filter, and wavelet filters using image quality evaluation metrics.
Postpartum Mothers' Experiences With Newborn Weight Checks in the Home
Authors: DiTomasso Diane , Roberts Mary , Parker Cotton Brandi
Published: October 2018

Few researchers have examined the perspectives of breastfeeding mothers about using a pediatric scale in the home to monitor infant weight. A cross sectional design was used to measure helpfulness, impact on newborn feeding, and confidence among mothers who used a digital scale to monitor newborn weight. Women (N = 69) who had given birth in a community hospital in the Northeast region of the United States used a pediatric scale in the home daily for 2 weeks after birth. An online survey determined helpfulness of the scale, if use of the scale impacted feedings, and confidence in breastfeeding. Using a pediatric scale to monitor newborn weight was very helpful (n = 49; 71%); it was most helpful for primiparous women (P < .016). Feeding frequency often changed on the basis of neonatal weight (n = 27; 39%) but only 9% (n = 6) changed the type of milk fed. Confidence in breastfeeding increased in 90% (n = 62) of participants. A pediatric scale used in the home to monitor newborn weight is helpful for breastfeeding, especially for primiparous women. Use of the scale may increase maternal confidence in breastfeeding and help guide decisions about feeding frequency.
Data-driven Decision Making in Doctor of Physical Therapy Curricula Part I: Program-level Analysis
Authors: Roller Dawn , Wininger Michael , Leard John , Crane Barbara
Published: October 2018

Background and Purpose.

We describe a data-driven internal curricular review process for professional (entry-level) physical therapist education programs. Using National Physical Therapy Exam (NPTE) performance as an outcome measure, we test the ability of individual courses, as well as summary grade point averages (GPAs), to identify students at risk for failure in the first attempt of the NPTE.

Methods.

National Physical Therapy Exam score was modeled in a simple univariate linear regression on 2 sets of predictor variables: individual course final grades and summary GPAs. First-time NPTE performance was configured in 2 measures: a continuous measure of exam score and a dichotomous pass–fail index. For NPTE score as a continuous measure, linear regression was used to test for association. For pass–fail, we tested for optimal grade or GPA benchmark by systematic thresholding across a range of numerical grades (70–95%) or grade points (1.5–4.0). Methods were demonstrated in the setting of a dataset collected from a single graduate cohort (N = 36), among whom 26 first-time NPTE scores were available. Exploratory analyses tested the sensitivity of this analysis to datasets containing letter grades, and repeatability across 5 cohorts.

Outcomes.

Grade distributions in individual courses (n = 12) were weak to moderate predictors of NPTE score (range: 0.00 < R
2 < 0.60); curricular GPA distributions (n = 6) were moderate to fair predictors (0.4 < R
2 < 0.7). Overall undergraduate GPA and GPA in prerequisite science courses were found to not predict first-time NPTE score whatsoever. Optimal grade criterion within the classes ranged from 79 to 93 points; optimal GPA criteria ranged from 2.6 to 3.4. At-risk students were identifiable as early as the end of the first semester. Model consistency varied somewhat when replicated across 5 cohorts but showed general consistency in maintaining relative strengths of measured associations. This method showed robustness to conversion to letter-grade format.

Discussion and Conclusion.

Risk for failure in first-attempt NPTE is a parameter that can be measured, and at-risk students can be identified early in their physical therapist education programs. Internal policy making should be guided by program experience and use data at the per-course or per-semester level.