bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating the Development Processes of Consumer mHealth Interventions for Chronic Condition Self-management
Authors: Woods Leanna , Duff Jed , Cummings Elizabeth , Walker Kim
Published: May 2019

Innovative, patient-centered mHealth interventions have the potential to help with the burden of chronic conditions. This review aims to describe the development of consumer mHealth interventions for chronic condition self-management. A scoping review methodology was used to search medical databases for eligible reports, published between January 1, 2010, and December 31, 2017, that provided information on consumer mHealth interventions for respiratory disease, cancer, diabetes, and cardiovascular disease. Twenty-one reports were included, representing the development of 14 mHealth interventions. Most were developed collaboratively, using user-centered and participatory design processes. Predesign work involved a thorough needs assessment, and redesign processes were described as iterative, engaging with usability testing and design improvements. Tensions from competing priorities between patients and healthcare professionals were uncovered, with the intention to develop a useful product for the patient while ensuring clinical relevance. This review provides clear evidence that consumer mHealth interventions are developed inconsistently even when engaging with participatory or user-centered design principles, sometimes without direct involvement of patients themselves. Further, the incomplete description of the development processes presents challenges to furthering the knowledge base as healthcare professionals need timely access to quality information on mHealth products in order to recommend safe, effective consumer mHealth interventions.
eHealth Services in the Near and Distant Future in Swedish Home Care Nursing
Authors: Rydenfält Christofer , Persson Johanna , Erlingsdottir Gudbjörg , Johansson Gerd
Published: May 2019

Sweden and other developed countries are putting deliberate efforts into eHealth and digitalization of home care nursing. eHealth services have big potential in this area because they can provide mobile access to healthcare information. This study explores the eHealth services that home care nursing providers in Sweden currently use, plan to use, and have discarded. It also investigates their eHealth visions for the future. We sent a survey to the 264 Swedish municipalities responsible for home care nursing and received 144 responses (55%). The results show a large diversity of eHealth services in use. A few can be considered core services since they are broadly implemented or will be in the near future. Trials are also being carried out with more specialized services. The respondents envision more automation and remote monitoring services, while technical and usability issues are the main obstacles to implementation today. Much knowledge can be gained from proper evaluation of the ongoing work. More research is needed regarding (1) what eHealth can offer home care nursing, (2) the effects of using eHealth in home care nursing, and (3) if and how home care nursing organizations need to adapt to best make use of eHealth.
Current Trends in Robotics in Nursing Patents—A Glimpse Into Emerging Innovations
Authors: Frazier Rachel M. , Carter-Templeton Heather , Wyatt Tami H. , Wu Lin
Published: May 2019

The purpose of this study was to describe the current evidence found through a patent search about robotics used to assist nurses in providing care. The authors used a modified seven-step strategy of searching patents according to the US Patent and Trademark Office guidelines. The nursing robotic search was performed in four databases including the US Patent and Trademark Office issued patent database, the US Patent and Trademark Office published patent application database, the European Patent Office database, and Relecura. Keywords reflecting the scope of the term “robot” were defined for the purposes of this specific search. This broad search yielded large numbers of patents germane to nursing care. These results were narrowed using keywords and the Cooperative Patent Classification schemes to determine relevance, ensure rigor, and capture the most relevant results. This review of patents suggests robots for nursing care are proliferating. The opportunity for robotics in nursing is emerging in industry. Although nursing will likely benefit from robotics, we must determine the appropriate place to include robots in nursing care delivery.
Diagnostic and prognostic value of glucose transporters in melanocytic lesions
Authors: Ruby Kristen N. , Liu Catherine L. , Li Zhongze , Felty Cameron C. , Wells Wendy A. , Yan Shaofeng
Published: May 2019

We have previously reported increased glucose transporter 1 (GLUT1) expression in melanoma compared to benign nevi, associated with a significantly lower survival rate. GLUT1 upregulation was highly specific for distinguishing melanoma from benign nevi, yet poorly sensitive, likely because of expression of other GLUT isoforms. The purpose of this study was to evaluate GLUT2 and GLUT3, as melanoma biomarkers. A tissue microarray, consisting of 91 primary melanomas, 18 melanoma metastases, and 56 nevi, was examined using GLUT2 and GLUT3 immunohistochemistry. A semiquantitative scoring method was used to determine the percentage of positive tumor cells and staining intensity. GLUT2 was negative in all melanomas and benign nevi examined. Increased GLUT3 expression was more frequent in melanoma than in nevi (P < 0.0001), and in metastatic melanoma than in primary melanomas (P < 0.001). Of melanoma cases, 85.3% expressed either GLUT1 or GLUT3 or both, 39.4% of melanoma cases coexpressed GLUT1 and GLUT3, 17.4% of melanoma cases only expressed GLUT1, 28.4% of melanoma cases only expressed GLUT3, and 14.7% of melanoma cases were negative for both markers. Patients whose melanoma exhibited a high level of GLUT3 had significantly lower survival rates than those with low GLUT3 expression (P = 0.002). Evaluating both GLUT1 and GLUT3 increased the diagnostic value by increasing the sensitivity while the specificity remained high. In conclusion, GLUT2 was not expressed in melanocytes. GLUT3 expression was upregulated in melanoma compared with nevi, especially in those with worse prognosis. Similar to GLUT1, GLUT3 may serve as a useful diagnostic and prognostic marker.
Non-GNE Quadriceps Sparing Distal Myopathy in an Iranian Jewish Patient
Authors: Mishra Shri K. , Valles-Ayoub Yadira , Darvish Daniel , Khosa Shaweta , Moheb Negar , Trikamji Bhavesh , Rafiei Nastaran , Freundlich Robert
Published: May 2019

GNE myopathy is an autosomal-recessive distal myopathy. It is caused by a hypomorphic GNE gene, encoding the rate-limiting enzyme in sialic acid synthesis. This myopathy is prevalent in the Iranian Jewish (IJ) descendants because of a founder mutation GNE: p. M712T. We report a 52-year-old IJ woman who presented with a 20-year history of progressive distal muscle weakness. Physical examination and magnetic resonance imaging revealed lower-extremity weakness and atrophy. Electromyography confirmed myopathy. Genetic testing showed no mutations on the GNE gene. Muscle histochemistry demonstrated no rimmed vacuoles. The analysis of polysialylated neural cell adhesion molecule Western blot pattern was negative. Non-GNE myopathy with quadriceps sparing presentation has been previously described in a few cases of non-IJ descents. To the best of our knowledge, this is the first case of an IJ patient, presenting with quadriceps sparing myopathy, without associated GNE mutations and/or tubule-filamentous inclusions.
Clinical Opioid Withdrawal Scale (COWS)
Authors: Canamo Lilian J. , Tronco Nicole B.
Published: May 2019

The opioid crisis has shown evidence worldwide and locally. There was no protocol to detect opioid withdrawal at this organization. The purpose of this project was to develop a nursing-driven opioid withdrawal management tool using the validated Clinical Opioid Withdrawal Scale (COWS) to address an increase in opioid-addicted patients. Evidence-based practice change was executed using the San Diego 8A's method for adult trauma step-down patients experiencing opioid withdrawal with the COWS tool affecting frequency of nursing attempts at managing opioid withdrawal over an 8-week period. Training was provided to 45 nurses on COWS use in opioid-positive patients exhibiting withdrawal symptoms. Nurses were tested and retested to establish reliability. Nursing management included communication with MDs, safe opioid use education, social work consultation, use of nonopioid pain relief, or other symptomatic medication management. Nursing withdrawal management: pre-COWS = 25%; post-COWS = 96%. There was a statistically significant increase in the percentage of patients evaluated correctly following COWS initiation (n = 28, χ2 = 29, P < .0001, 95% CI, 47.71-83.74). Data were collected on a matched cohort of symptomatic toxicology-positive patients before and after change (n = 28 pre-COWS and n = 28 post-COWS). Use of the COWS tool with corresponding interventions by trauma nurses is feasible and results in improved withdrawal management.
Patient Survival and Length of Stay Associated With Delayed Rapid Response System Activation
Authors: Padilla Ricardo M. , Mayo Ann M.
Published: May 2019

The objective of this study was to investigate the difference in mortality and length of stay between patients who experienced a delay in rapid response system (RRS) activation and those who did not. A retrospective comparative cohort study investigated all adult inpatient cases that experienced an RRS activation from January 1, 2017, through January 1, 2018. Cases experiencing a delay in RRS activation were compared with cases without delay. During the study period a total of 3580 RRS activations that took place and 1086 RRS activations met inclusion criteria for analysis. Delayed RRS activations occurred in 325 cases (29.8%) and nondelayed RRS activations occurred in 766 cases (70.2%). The mean age was roughly the same for both groups (60 years old) and both groups consisted of approximately 60% males. Delay in activation was significantly associated with an increase in length of hospitalization (19.9 days vs 32.4 days; P < .001) and also a higher likelihood of not surviving hospitalization (hazard ratio = 2.70; 95% confidence interval, 1.96-3.71; P < .001). This study demonstrates that delayed RRS activation occurs frequently and exposes patients to higher mortality and longer length of hospitalization.
Nurses' Use of Evidence-Based Practice at Point of Care
Authors: McKinney Ivy , DelloStritto Rita A. , Branham Steve
Published: May 2019

The article reports results of an interrogative literature review designed to study the acquisition of research-based knowledge among practicing nurses who provide direct patient care for decision making at the point of care. Findings reveal that despite the amount of research done on the use of evidence-based practice among nurses, gaps continue to exist between what is known and what is done in practice. Nurses often cite the lack of time and support and the lack of knowledge as predominant factors that keep them from using evidence-based practice at the point of care. The past research has primarily been completed using a retrospective approach. There is a paucity of research that evaluates specific nursing behaviors that support evidence-based practice in daily patient care.
The Meaning of Comfort in the Intensive Care Unit
Authors: Olausson Sepideh , Fridh Isabell , Lindahl Berit , Torkildsby Anne-Britt
Published: May 2019

Providing comfort in an intensive care unit (ICU) setting is often related to pain relief and end-of-life care; environmental factors are often neglected, despite the major role of the environment on the patients' well-being and comfort. The aim of this article was to explore the meanings of comfort from a theoretical and empirical perspective to increase the understanding of what comfort means in ICU settings. A lexical analysis and serials of workshops were performed, and data were analyzed using a qualitative content analysis. The findings from the theoretical analysis show that comfort has a broad range of synonyms related to both subjective experiences and objective and physical qualities. The findings from the empirical part reveal 4 themes: comfort in relation to nature, comfort in relation to situation and people, comfort in relation to place, and comfort in relation to objects and material. Materiality, functionality, memory, culture, and history stipulate comfort. It is challenging to discern what comfort is when it comes to function and emotions. We also found that comfort is closely linked to nature and well-being.
Palliative Care
Authors: Riahi Shadan , Khajehei Marjan
Published: May 2019

The authors conducted an integrative review to determine evidence-based and most efficient strategies for improving the palliative care of patients at the end-of-life stage. Thirteen articles that met the overall inclusion criteria were evaluated. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart approach was used for the screening process. The Critical Appraisal Skill Program and the Mixed-Methods Appraisal Tool were also used for the critical appraisal of the data. Full reports of relevant articles were retrieved, and data were extracted by 2 reviewers independently. The quality of studies was appraised in reference to Consolidated Criteria for Reporting Qualitative Research guidelines. Key aspects included communication and coordination among the team members—patient-centered approach. The major theme was the application of a holistic approach to palliative care consisting of providing comfort to the dying patient. It was identified that relationships, which were identified as spiritual needs, are also crucial to the improvement of palliative care. Improving nursing education in this area, undertaking appropriate curriculum development, and providing coordination among training programs will help knowledgeable health care providers deliver compassionate, affordable, sustainable, and high-quality care to a growing population of aging patients facing the end of their lives.
Confrontation
Authors: Priddy Margaret M.
Published: May 2019

The critical care environment is rife with stressors for patients, families, and health care providers, which can act as causative and contributing factors to miscommunication and conflict. This article reviews the adverse effect of the stress response on cognitive functioning, along with tools to mitigate the stress response and respond using appropriate communication tools. The author presents resources for self-care and techniques for resilience in assessing and responding to a challenging situation in a therapeutic manner.
Is There an Association Between Prophylactic Femur Stabilization and Survival in Patients with Metastatic Bone Disease?
Authors: Philipp Travis C. , Mikula Jacob D. , Doung Yee-Cheen , Gundle Kenneth R.
Published: May 2019

Background

The femur is the most common site of metastasis in the appendicular skeleton, and metastatic bone disease negatively influences quality of life. Orthopaedic surgeons are often faced with deciding whether to prophylactically stabilize an impending fracture, and it is unclear if prophylactic fixation increases the likelihood of survival.

Questions/purposes

Is prophylactic femur stabilization in patients with metastatic disease associated with different overall survival than fixation of a complete pathologic fracture?

Methods

We performed a retrospective, comparative study using the national Veterans Administration database. All patient records from September 30, 2010 to October 1, 2015 were queried. Only nonarthroplasty procedures were included. The final study sample included 950 patients (94% males); 362 (38%) received prophylactic stabilization of a femoral lesion, and 588 patients (62%) underwent fixation of a pathologic femur fracture. Mean followup duration was 2 years (range, 0-7 years). We created prophylactic stabilization and pathologic fracture fixation groups for comparison using Common Procedural Terminology and ICD-9 codes. The primary endpoint of the analysis was overall survival. Univariate survival was estimated using the Kaplan-Meier method; between-group differences were compared using the log-rank test. Covariate data were used to create a multivariate Cox proportional hazards model for survival to adjust for confounders in the two groups, including Gagne comorbidity score and cancer type.

Results

After adjusting for comorbidities and cancer type, we found that patients treated with prophylactic stabilization had a lower risk of death than did patients treated for pathologic femur fracture (hazard ratio = 0.75, 95% CI, 0.62–0.89; p = 0.002).

Conclusions

In the national Veterans Administration database, we found greater overall survival between patients undergoing prophylactic stabilization of metastatic femoral lesions and those with fixation of complete pathologic fractures. We could not determine the cause of this association, and it is possible, if not likely, that patients treated for fracture had more aggressive disease causing the fracture than did those undergoing prophylactic stabilization. Currently, most orthopaedic surgeons who treat pathological fractures stabilize the fracture prophylactically when reasonable to do so. We may be improving survival in addition to preventing a pathological fracture; further study is needed to determine whether the association is cause-and-effect and whether additional efforts to identify and treat at-risk lesions improves patient outcomes.

Level of Evidence

Level III, therapeutic study.
Executive Function Profiles at Home and at School in 11-Year-Old Very Low Birth Weight or Very Low Gestational Age Children
Authors: Nyman Anna , Munck Petriina , Koivisto Mari , Hagelstam Camilla , Korhonen Tapio , Lehtonen Liisa , Haataja Leena ,   on behalf of the PIPARI Study Group
Published: May 2019

Objective:

Executive function (EF) problems of children born at very low birth weight (VLBW; ≤1500 g) or very low gestational age (VLGA; <32 gestational weeks) may present differently at school compared to the home environment. Ecological assessment of EF including parent- and teacher-rated profiles and associated risk factors of 11-year-old children born at VLBW or VLGA was evaluated.

Methods:

A total of 125 VLBW or VLGA children and 132 controls were assessed using the Behavior Rating Inventory of EF, which includes 8 subscales that form the Behavioral Regulation and Metacognition Indexes. For VLBW or VLGA children, full-scale intelligence quotient (IQ) was assessed using the Wechsler Intelligence scale for Children, Fourth Edition. Neonatal data were collected systematically.

Results:

VLBW or VLGA children with full-scale IQ ≥ 70 had clinically significant problems in the Working Memory subscale at school. Although they had clinically significant problems at home in the Behavioral Regulation Index, the difference disappeared when adjusted for paternal education. Lower gestational age, lower birth weight z-score, surgical necrotizing enterocolitis, low paternal and maternal education, and lower full-scale IQ were identified to be risk factors for higher scores in ecological assessment of EF.

Conclusion:

VLBW or VLGA children in this cohort exhibit fewer EF problems in ecological assessment of EF compared to previous literature. EF problems of this study population vary by home and school setting and are emphasized in working memory at school. Screening for EF problems in school environment is recommended to target the support.
Optimizing surgical management of patients who decline blood transfusion
Authors: Han Esther S. , Arora Chetna , Kim Jin Hee , Hur Hye-Chun , Advincula Arnold P.
Published: May 2019

Purpose of review

This review highlights the complexity of caring for gynecologic patients who refuse blood transfusion and discusses the importance of early, targeted perioperative and intraoperative medical optimization. We review alternative interventions and the importance of medical management to minimize blood loss and maximize hematopoiesis, particularly in gynecologic patients who may have significant uterine bleeding. The review also focuses on intraoperative interventions and surgical techniques to prevent and control surgical blood loss.

Recent findings

With improvements in surgical technique, greater availability of minimally invasive surgery, and increased use of preop UAE and cell salvage, definitive surgical management can be safely performed. New technologies have been developed that allow for safer surgeries or alternatives to traditional surgical procedures. Many medical therapies have been shown to decrease blood loss and improve surgical outcomes. Nonsurgical interventions have also been developed for use as adjuncts or alternatives to surgery.

The care of a patient who declines blood transfusion may be complex, but gynecologic surgeons can safely and successfully offer a wide variety of therapies depending on the patient's goals and needs. Medical management should be implemented early. A multidisciplinary team should be mobilized to provide comprehensive and patient-centered care.
What makes health services usable?: Insights from a qualitative study of caregivers of children with disabilities
Authors: Hilligoss Brian , Tanenbaum Sandra J. , Paul Marika H. , Ferrari Renée M. , Song Paula H.
Published: May 2019

Background

The concept of usability from the field of user-centered design addresses the extent to which a system is easy to use, including under extreme conditions. Apart from applications to technologies, however, little attention has been given to understanding what shapes usability of health services more generally. Health service usability may impact the extent to which patients avail themselves of and benefit from those services.

Purpose

The aim of the study was to develop the concept of usability as it applies to health services, particularly for a high-need, complex patient population.

Approach

We conducted interviews and focus groups with 66 caregivers of children with disabilities and analyzed data through inductive coding and constant comparison.

Results

We find that before health services can be rendered usable for patients with complex health conditions, work is often required to develop trusting relationships with individual providers and to manage time demands and attendant challenges of physical access. In addition, our findings show that actions crucial to receiving benefits from one service often entail difficult tradeoffs either with other services or with other important features in the patient’s life-world. Finally, we propose the concept of configuration to capture the complex interdependent arrangement of connections to multiple health services, often for multiple household members, and other life-world factors (e.g., employment, transportation, living conditions). These configurations are dynamic, fragile, and vulnerable to shocks—events that destabilize them, often negatively impacting the relative usability of services and of the entire configuration. Collectively, these findings illustrate health service usability as a relational, situated, emergent property rather than an inherent feature of the service itself.

Practice Implications

System-centered design perspectives produce services that are usable for the mythical “ideal” user. To be truly “patient centered,” designs must “decenter” the health service and recognize it as one component of the patient’s life-world configuration.
Mini-Descemet Membrane Endothelial Keratoplasty for the Early Treatment of Acute Corneal Hydrops in Keratoconus
Authors: Bachmann Björn , Händel Alexander , Siebelmann Sebastian , Matthaei Mario , Cursiefen Claus
Published: May 2019

Purpose:

To describe a new surgical option for the treatment of acute corneal hydrops in keratoconus and to present the first results.

Methods:

This is a retrospective analysis of 3 patients who presented to our clinic with a massive corneal hydrops in acute keratoconus and were treated by mini-Descemet membrane endothelial keratoplasty (DMEK). According to the size and the shape of the gap in the patient's Descemet membrane (DM), 1 DMEK graft was trephined with a round 5-mm punch. The other grafts were trimmed with a razor blade to a width of about 3 mm and a length adjusted to the length of the defect of the recipients' DM. The graft was inserted with a regular intraocular lens shooter. Correct unfolding of the graft was controlled by using intraoperative optical coherence tomography. At the end of the surgery, the graft was attached to the posterior corneal surface by a small air bubble. Thereafter, the complete anterior chamber was filled with 20% SF6 gas.

Results:

All 3 patients (age 32 ± 3 years on average) showed a rapid increase in uncorrected visual acuity from the logarithm of the minimum angle of resolution (LogMAR) 1.66 (±0.46) before mini-DMEK to the LogMAR 1.2 (±0.3) within 6 to 8 weeks after mini-DMEK. The thickest corneal point within the edematous cornea decreased in all 3 patients (1088 ± 280 μm before surgery vs. 630 ± 38 μm 1 week after surgery). One mini-DMEK failed in a first attempt. In this patient, the recipient DM was under strong tension and showed a pronounced dehiscence. Therefore, a small part of the recipient's DM around the preexisting gap in DM was removed before a second mini-DMEK graft was placed successfully. The other 2 patients developed partial graft detachment within 1 to 2 weeks after surgery. However, the corneas of these patients were dehydrated to physiological levels after mini-DMEK, and despite partial detachment, there was no relapse of the hydrops.

Conclusions:

Mini-DMEK could be helpful in patients with larger defects and detachments of DM in very ectatic corneas in the acute phase of corneal hydrops in acute keratoconus. These patients may not be successfully treated by intracameral gas application alone or in combination with pre-Descemetal sutures. Further investigations are needed to identify factors helping to decide on the best surgical approach in hydrops in acute keratoconus.
Effect of Scleral Lenses on Corneal Topography in Keratoconus: A Case Series of Cross-Linked Versus Non–Cross-Linked Eyes
Authors: Severinsky Boris , Fadel Daddi , Davelman Jenya , Moulton Eric
Published: May 2019

Purpose:

To evaluate the changes in anterior corneal topography induced by short-time wear of scleral contact lenses (SLs) in keratoconic subjects with and without a history of corneal cross-linking (CXL).

Methods:

Nine keratoconic patients (14 eyes) were fitted with 18.5 mm SLs for optical rehabilitation. Subjects were divided into 2 groups: 7 eyes without a history of CXL (Non-CXL group) and 7 with a history of CXL (CXL group). Corneal topography was performed at baseline and after 2 and 5 hours of lens wear. The differences for simulated flat (Kflat), steep (Ksteep) and maximal (Kmax) corneal curvatures, central corneal astigmatism (CCA), and central cornea thickness were evaluated.

Results:

No statistically significant difference was detected between Non-CXL and CXL groups in any of these measures. Statistically significant flattening was detected in Ksteep Repeated measures analysis of variance ([RM-ANOVA), F (2,24) = 11.32, P < 0.0001], CCA [RM-ANOVA, F (2,24) = 15.34, P < 0.0001], and Kmax [RM-ANOVA, F (2,24) = 19.10, P < 0.0001). From baseline to 5 hours of SL wear, Ksteep decreased on average from 53.1 to 52.4 D, Kmax decreased from 56.7 to 55.8 D, and CCA decreased from 7.2 to 6.3 D. Kmax showed a trend toward more flattening in the Non-CXL group. Central cornea thickness showed significant thickening over time from baseline (451 μm) to 5 hours (458 μm) of SL wear [RM-ANOVA, F (1,12) = 319.3, P < 0.0001].

Conclusions:

Short-term scleral lens wear in keratoconic patients may cause flattening of the anterior cornea. A history of CXL treatment does not guarantee corneal shape stability after scleral lens wear. Practitioners should be aware of these changes because scleral lens wear may mask the signs of keratoconus progression.
Progressive High Hypermetropic Shift as a Refractive Surprise Following Glaucoma Filtration Surgery in a Phakic Child With Early-Onset Childhood Glaucoma Associated With Axenfeld-Rieger Anomaly
Authors: Kumar Praveen , Senthil Sirisha
Published: May 2019

Purpose:

We report a case of progressive high hypermetropia following glaucoma filtration surgery in a child with Axenfeld-Rieger syndrome and congenital glaucoma.

Methods/Results:

We report a case of a 4-day-old female child presented as a case of Axenfeld-Rieger anomaly with secondary glaucoma in both eyes (OU), who underwent combined trabeculotomy with trabeculectomy in OU at the age of 3 weeks. On postoperative third month, cornea cleared and posterior embryotoxon was noted in OU with Habb’s striae in OS. Intraocular pressure (IOP) was controlled and fundus was normal in OU. Refraction was +2.00 D sph. in OD and 3.00D sph. in OS and was observed. On postoperative eighth month, IOP was controlled in OU, whereas retinoscopy showed refraction of +4.00D sph./−2.00D cyl at 30 degrees in OD and +10.00 D sph/−3.00 cyl at 120 degrees in OS, glasses were prescribed and was asked to review. After 4 years, the patient presented with blurring of vision, the best-corrected visual acuity noted was 20/100 in OD and 20/320 in OS. IOP was 28 and 14 mm Hg in OD and OS, respectively, but with healthy optic disc in OU. Refractive error had increased and was +5.50D sph in OD and +14.00D sph/−5.00 D cyl at 90 degrees in OS. Corneal topography showed cornea plana in OU, which was more in OS (K1: 32.6D and K2: 38.9D) compared with OD (K1: 38.7D and K2: 40.1D). The patient was started on glaucoma medications in OD. Four months later, IOP was controlled and refraction was stable in OU.

Conclusions:

Present case is the first to describe the unusual presentation of progressive high hypermetropia in a child with Axenfeld- Rieger anomaly with congenital glaucoma after surgical intervention for glaucoma. Childhood glaucoma is classically associated with myopic shift in refraction and refraction is one of the most important clinical parameter measured at every follow-up visit. Although progressive hypermetropic shift is a rare occurrence, clinicians should be aware of this possibility. Keratomerty should be performed when such refractive surprises arise, which may help detect the clinical condition and the etiology for such presentation.
Neglected Congenital Glaucoma With Lens Coloboma
Authors: Dhingra Deepika , Tekchandani Uday , Pandav Surinder S. , Kaushik Sushmita
Published: May 2019

Purpose:

To report a case of lens coloboma in a case of neglected primary congenital glaucoma.

Materials and Methods:

A 5-year-old boy was brought by the parents with complaints of diminution of vision in both eyes noticed for 8 months. There was a history of enlargement of eyes since 1 year of age.

Results:

Clinical examination revealed bilateral large eyes with limbal stretching and Haab striae and lens coloboma in the right eye. Dilated examination revealed scalloped border of the crystalline lens superotemporally with broken zonules and lens coloboma in inferotemporal quadrant with absent zonules. There was advanced optic nerve head cupping in both eyes. This lens coloboma is likely an acquired condition due to extensive stretching of the lens and zonules secondary to globe enlargement in neglected buphthalmos.

Conclusion:

A neglected case of congenital glaucoma can lead to lens subluxation along with lens coloboma.
Do Hospitalizations Disrupt Loyalty to Ambulatory Care Providers?
Authors: Gingras Laura , Chester Jennifer G. , Rajan Mangala , Sinha Sanjai , Kern Lisa M.
Published: May 2019

We sought to determine whether hospitalizations affect where patients seek ambulatory care. We conducted a retrospective cohort study of 569 adults who were attributed by a commercial payer to a large physician organization (PO) and hospitalized in 2015. Approximately half of the patients (55%) were admitted to the hospital affiliated with the PO; the rest were hospitalized elsewhere. Patients hospitalized elsewhere were significantly less likely to be seen by a PO provider in the 6 months posthospitalization than those hospitalized at the affiliated hospital (adjusted odds ratio = 0.29; 95% confidence interval = 0.17-0.48). These results have important implications for population management.
Right postoperative pleural effusion and pulmonary embolism following laparoscopic gynecological surgery: A rare case report and PRISMA-driven systematic review
Authors: Chao Wei-Ting , Jiang Ling-Yu , Chen Guan-Yeu , Wang Peng-Hui , Wu Hua-Hsi , Chen Yi-Jen
Published: May 2019

The incidence of postlaparoscopic pleural effusion and pulmonary embolism were rare. However, it might be life-threatening. Therefore, confirming the risk factor and management is important. We present a 53-year-old woman with ovarian endometriosis arranged for laparoscopic surgery. However, desaturation was noted on postoperation day 1. Chest radiograph and chest computed tomography showed pleural effusion and pulmonary embolism. Pleural pigtail insertion was performed and anticoagulant medication, albumin, and lasix were given. The patient’s recovery was uneventful. Several factors have been advanced to explain including the prolonged duration of the operation. Management options include supplemental oxygen therapy, and pigtail catheter insertion. Mechanical prophylaxis (sequential compression devices and graduated compression stockings) is sufficient for venous thromboembolism prevention.
Regional Adoption of Primary Care—Mental Health Integration in Veterans Health Administration Patient-Centered Medical Homes
Authors: Leung Lucinda B. , Rose Danielle , Stockdale Susan , McGowan Michael , Yano Elizabeth M. , Graaff A. Laurie , Dresselhaus Timothy R. , Rubenstein Lisa V.
Published: May 2019

Introduction:

Behavioral health integration is important, yet difficult to implement, in patient-centered medical homes. The Veterans Health Administration (VA) mandated evidence-based collaborative care models through Primary Care–Mental Health Integration (PC-MHI) in large PC clinics. This study characterized PC-MHI programs among all PC clinics, including small sites exempt from program implementation, in one VA region.

Methods:

Researchers administered a cross-sectional key informant organizational survey on PC-MHI among VA PC clinics in Southern California, Arizona, and New Mexico (n = 69 distinct sites) from February to May 2018. Researchers analyzed PC clinic leaders' responses to five items about organizational structure and practice management.

Results:

Researchers received surveys from 65 clinics (94% response rate). Although only 38% were required to implement on-site PC-MHI programs, 95% of participating clinics reported providing access to such services. The majority reported having integrated, colocated, or tele-MH providers (94%) and care management (77%). Most stated same-day services (59%) and “warm” handoffs (56%) were always available, the former varying significantly based on clinic size and distance from affiliated VA hospitals.

Conclusions:

Regional adoption of PC-MHI was high, including telemedicine, among VA patient-centered medical homes, regardless of whether implementation was required. Small, remote PC clinics that voluntarily provide PC-MHI services may need more support.
An Investigation of Professional Networks and Scholarly Productivity of Early Career Physical Therapy Faculty
Authors: Becker Betsy J. , Sayles Harlan , Woehler Meredith , Rost Tony , Willett Gilbert M.
Published: May 2019

Introduction and Review of the Literature.

Physical therapy (PT) faculty must retain a scholarly agenda. Active engagement and dissemination are challenging, especially for new faculty. Evidence suggests that faculty professional networks can improve performance and innovation. The aim of this study was to determine an effective network structure and composition for scholarly activity of early career PT faculty.

Subjects.

Early career faculty (less than 5 years of experience) with primary teaching and service/administrative duties who worked in accredited entry-level PT programs from institutions of varying Carnegie Classification levels. Data from 50 faculty were analyzed.

Methods.

Subject questionnaires gathered data for social network analysis (visualization and calculation of network structure and composition). Participants' scholarly activity was determined by curriculum vitae analyses. Multivariable ordinary least squares regression models were developed to determine associations between networks and scholarly productivity.

Results.

The results show evidence that a more open, less interconnected (ie, low density) network is associated with higher scholarly activity when controlling for the duration as a faculty member and whether the individual has an academic doctoral degree.

Discussion and Conclusion.

Key implications from this study include 1) faculty can be productive in their first 5 years regardless of their institution's Carnegie Classification, days on the job, and achievement of an academic doctoral degree; 2) an effective network for scholarly productivity is one that is open and less densely interconnected; and 3) there are practical strategies faculty and their mentors can take to make networks more effective.
From Mid 16th Century French Court to End 18th Century Danish Court: The Fatal Power of the Mammillary Process
Authors: Mudry Albert
Published: May 2019

Objectives/Hypothesis:

Two Royal events marked the history of the mastoid process between the 16th and 18th centuries. The first was the death of François II, King of France, following a complication of a chronic running left ear at the age of 16 years, and the second the death of Justus von Berger, Court physician of Christian VII, King of Denmark, after a trepanation of the mastoid process to heal his right-sided deafness at the age of 68 years. The aim of this study is to analyze these two events again with only original references and to replace them in their historical context.

Method:

Historical review of original literature dealing with the subject.

Results/Conclusion:

These two Royal events marked the history of the mastoid process, but they were unlikely to have been avoided during their specific era. Medical knowledge was insufficient to avoid these fatal outcomes. Because of their societal impact, they were known of and largely discussed, notably in the medical world, leading to the eventual modification of medical practice during that time. François II's death had no medical impact but von Berger's death practically stopped, for more than a half century, the development of mastoid surgery.
Vestibular Deficits Correlating to Dizziness Handicap Inventory Score, Hearing Loss, and Tumor Size in a Danish Cohort of Vestibular Schwannoma Patients
Authors: Kjærsgaard Jonas Bruun , Szeremet Marcin , Hougaard Dan Dupont
Published: May 2019

Objective:

To test the degree of vestibular end-organ dysfunction by means of contemporary vestibular testing and examine to which extend these findings correlate to the hearing loss, tumor size, and dizziness handicap registered in vestibular schwannoma patients.

Setting:

Tertiary referral center.

Patients:

Eighty-nine patients diagnosed with unilateral vestibular schwannoma.

Intervention(s):

Patients were evaluated by means of the Dizziness Handicap Inventory (DHI), magnetic resonance imaging scan as well as an extensive audiovestibular test-battery including pure-tone audiometry, ocular vestibular evoked myogenic potentials, cervical vestibular evoked myogenic potentials, and video head impulse test of all six semicircular canals.

Main Outcome Measure(s):

Patients were divided into four groups according to their number of dysfunctional vestibular end-organs. These groups were subsequently analyzed for differences in DHI score, pure-tone average, and tumor size. The group of patients with zero abnormal vestibular test results was used as index group.

Results:

For the group with three or more abnormal vestibular test results it was possible to find a statistical significant increase in both DHI score, pure-tone average, and tumor size. This was only found for the latter two parameters in the group with dysfunction of two vestibular end-organs. It was not possible to detect any statistical significant differences in the group with only one dysfunctional end-organ.

Conclusions:

Substantial loss of vestibular function is correlated to a higher degree of dizziness-induced handicap, hearing loss, and tumor size in vestibular schwannoma patients. Tumor size and audiometry may potentially be used as rough markers of residual vestibular function.
The Effect of Cochlear Implant Interval on Spoken Language Skills of Pediatric Bilateral Cochlear Implant Users
Authors: Wenrich Kaitlyn A. , Davidson Lisa S. , Uchanski Rosalie M.
Published: May 2019

Objective:

To examine the effects of cochlear implant (CI) interval (time between CI surgeries) on receptive vocabulary and receptive language skills for children with bilateral CIs.

Study Design:

A prospective cross-sectional study design.

Setting:

Participants were recruited from, and tested at, oral schools for the deaf and pediatric audiology clinics across the United States.

Patients:

Eighty-eight children, 4 to 9 years of age, with bilateral CIs and known hearing histories. Twenty-three participants received CIs simultaneously and 65 received CIs sequentially. Of those implanted sequentially, 86% wore a hearing aid (HA) on the non-implanted ear during the CI interval.

Intervention:

Bilateral cochlear implantation.

Main Outcome Measures:

Receptive vocabulary was measured via the Peabody Picture Vocabulary Test (PPVT). Receptive language skills were measured via the Clinical Evaluation of Language Fundamentals (CELF).

Results:

Multiple linear regression models indicate better receptive vocabulary and receptive language skills are associated with earlier ages at first CI (CI 1), but not with shorter CI intervals.

Conclusions:

Early cochlear implantation (i.e., age at CI 1) is critical for better receptive vocabulary and receptive language skills. Shorter CI intervals are not associated with better receptive vocabulary and receptive language skills for these 88 children, who nearly all used bimodal hearing during the interval. Use of a HA at the non-implanted ear, before receipt of a second CI (CI 2), may mitigate the effects of early bilateral auditory deprivation.
Application of Kaizen Principles to a Large Cochlear Implant Practice: A Continuous Quality Improvement Initiative at Mayo Clinic
Authors: Sladen Douglas P. , Olund Amy P. , Schmitt Matthew , Benson Barbara , DeJong Melissa D. , Dowling Brittany P. , Carlson Matthew L.
Published: May 2019

Objective:

To remove barriers and improve access for patients seeking cochlear implantation.

Study Design:

Prospective quality improvement study at a large tertiary academic care center.

Methods:

A Kaizen quality improvement model was applied over the course of a year. Four weeklong meetings were used to identify areas for improvement and remediation. Data were collected at baseline, 90-days, and 1-year postcompletion of the project. Outcome measures included lead times, defined as the wait time between first contact with the clinic and the first appointment, and the wait time between surgery and activation, and cycle times defined as the total test time needed to determine cochlear implant candidacy, and total time needed to complete initial activation. The total inventory kept as clinic stock was also calculated

Results:

Kaizen team members collected data for each outcome measure. After the Kaizen principles were applied, the following outcomes were observed: median lead times between first contact with the clinic to candidacy testing, candidacy testing to surgery, and surgery to activation of the implant remained stable from baseline to 1-year follow-up. Median cycle time for candidacy testing decreased from 7.3 hours at baseline to 3.0 hours at 1-year follow-up. Cycle times for initial activation of the device did not change over time. The total inventory of clinic stock was reduced by 31%.

Conclusions:

Though outcomes for lead and cycle times varied, implementation of Kaizen principles was found to be an effective method for completing this quality improvement project at a large cochlear implant program overall.

Level of Evidence: 3a
Quality of Life in Jugular Paraganglioma Following Radiosurgery
Authors: Patel Neil S. , Link Michael J. , Tombers Nicole M. , Pollock Bruce E. , Carlson Matthew L.
Published: May 2019

Objective:

The treatment paradigm for jugular paraganglioma (JP) has changed considerably over time with the wider adoption of stereotactic radiosurgery (SRS). To the best of the authors’ knowledge, there are no published studies that use validated patient-reported outcome measures to ascertain quality of life (QoL) outcomes following SRS for JP when used in single or combined modality treatment regimens.

Study Design:

Cross-sectional survey.

Setting:

Tertiary referral center.

Patients:

Adult patients with JP treated with primary SRS or SRS following primary surgery between 1990 and 2017.

Interventions(S):

Surgery and/or Gamma Knife SRS.

Main Outcome Measures:

Global and treatment-related QoL and differences in QoL based on treatment approach.

Results:

Sixty-nine surveys were distributed and a total of 26 completed surveys were received (38% response rate). Among respondents, the median age at SRS was 53 years and 16 of the 26 patients (62%) were female. Median follow-up was 97 months. Nineteen patients (73%) were treated with primary SRS or staged SRS following intentional subtotal resection (STR; hereafter referred to as “staged SRS”), while the remainder (n = 7, 27%) were treated with SRS for recurrent JP. Median physical and mental health QoL PROMIS-10 T-scores regardless of treatment strategy were 39.8 and 38.8, respectively, while median SF36 physical and mental component subscores were similar to national averages and non-tumor controls. When comparing general physical and mental health QoL scores, there was no significant difference between patients treated with primary or staged SRS and those treated with SRS for recurrent JP. However, age-adjusted swallowing function among patients treated with primary or staged SRS was better than in those patients treated with SRS for recurrent JP (p = 0.05).

Conclusions:

Patients treated with primary or staged SRS for JP tend to exhibit better swallowing outcomes than those treated with SRS for recurrent JP. However, the majority of overall and disease-specific quality of life measures were not different between groups. Based on the low incidence of new cranial neuropathy following SRS, it is likely that initial surgical morbidity is the primary contributor to this outcome. Disease-specific overall quality of life measures, akin to those already used for other benign skull base tumors, are necessary to better gauge physical and mental health outcomes following treatment for JP. Though limited by small sample size, this represents the first study to gauge QoL outcomes following treatment for JP.