bluuebunny/crossref_metadata_2025 huggingface dataset:
The Wiley Spinal Catheter-Over-Needle System for Continuous Spinal Anesthesia: A Case Series of 5 Cesarean Deliveries Complicated by Paresthesias and Headaches
Authors: McKenzie Christine P. , Carvalho Brendan , Riley Edward T.
Published: February 2017

(Reg Anesth Pain. Med 2016;41:405)

Two of the most effective methods used for providing intrapartum pain relief are epidural analgesia and combined spinal-epidural analgesia. Some of the advantages that spinal analgesia has over epidural analgesia include more rapid onset, a definitive endpoint for placement, usage of lower doses of local anesthetic/opioid, and superior sacral coverage. A continuous spinal analgesia technique offers the advantages of being able to prolong the duration of intrathecal analgesia, titrate the dose to effect, and rapidly convert a labor analgesic to a surgical anesthetic in case of a cesarean delivery.
Intrathecal Hydromorphone and Morphine for Postcesarean Delivery Analgesia: Determination of the ED90 Using a Sequential Allocation Biased-Coin Method
Authors: Sviggum Hans P. , Arendt Katherine W. , Jacob Adam K. , Niesen Adam D. , Johnson Rebecca L. , Schroeder Darrell R. , Tien Michael , Mantilla Carlos B.
Published: February 2017

(Anesth Analg. 2016;123:690–697)

The gold standard for pain control is intrathecal (IT) morphine, with an optimal dose for postcesarean analgesia ranging from 0 to 500 μg. However, there have been national shortages of preservative-free morphine, and dose-dependent opioid-induced side effects (nausea, pruritus, sedation, and respiratory depression) do occur. IT hydromorphone is a potential alternative for providing postcesarean analgesia. The authors of the present study thus identified dosages of IT hydromorphone that provided effective analgesia in 90% (ED90) of patients.
Heparin-induced Thrombocytopenia in Pregnancy: An Interdisciplinary Challenge: A Case Report and Literature Review
Authors: Mauermann E. , Vökt C. , Tsakiris D.A. , Tobler D. , Girard T.
Published: February 2017

(Int J Obstet Anesth. 2016;26:79–82)

Heparin-induced thrombocytopenia (HIT) occurs seldom during pregnancy (<0.1%) but may lead to thrombosis when untreated.
Early Postpartum Mitral Valve Thrombosis Requiring Extra Corporeal Membrane Oxygenation before Successful Valve Replacement
Authors: Halldorsdottir H. , Nordstrom J. , Brattstrom O. , Sennstrom M.M. , Sartipy U. , Mattsson E.
Published: February 2017

(Int J Obstet Anesth. 2016;26:75–78)

Patients with mechanical heart valves are at an increased risk of valve thrombosis during pregnancy.
Acute Vision Loss Secondary to Epidural Blood Patch: Terson Syndrome
Authors: Pagani-Estévez Gabriel L. , Chen John J. , Watson James C. , Leavitt Jacqueline A.
Published: February 2017

(Reg Anesth Pain Med. 2016;41(2):164–168)

Postdural puncture headache is commonly treated by lumbar epidural blood patch (EBP). A case study of vision loss that immediately occurred after an EBP is presented.
A Reliability Study Using a Long-Wave Infrared Thermography Device to Identify Relative Tissue Temperature Variations of the Body Surface and Underlying Tissue
Authors: Langemo Diane K. , Spahn James G.
Published: February 2017

OBJECTIVE:

This study assesses the ability of the Scout (WoundVision LLC, Indianapolis, Indiana), an FDA-approved visual and thermal imaging device and software analysis tool, to provide clinicians with a reliable and reproducible way to incorporate long-wave infrared thermography and relative temperature differential into clinical wound assessment by consistently identifying control areas against which to measure wound temperature.

METHODS:

This laboratory-based study utilized 3 adult wound care professionals experienced in control area selection. Twenty-six previously collected wound images were used for the study. The 3 readers placed a control area on each of the 26 wounds 3 different times (n = 78 independent placements) to establish within-reader agreement. To establish between-reader agreement, the readers again placed a control area on each of the 26 wounds (n = 26 independent placements).

OUTCOME MEASURES:

This study evaluates 2 aspects of the Scout device’s reliability: (1) within- and between-reader agreement of initial patient encounter control area images and (2) between-reader agreement of follow-up encounter control area images.

RESULTS:

The control area measurements were very consistent both within (percent coefficient of variation [%CV] approximately 1%) and between readers (%CV approximately 2%). The average maximum temperature within-reader %CV was 1.14% and the between-reader variation was %CV 1.97%. The average minimum temperature had a within-reader %CV of 1.1% and the between-reader coefficient of variation was 2.01%. The within- and between-reader average difference in mean temperature was 0.14° C and 0.29° C, respectively. The largest mean temperature difference observed within-readers was 0.68° C, and the smallest difference was 0.01° C. The largest difference observed in between-reader mean temperature was 0.96° C, and the smallest was 0.03° C.

CONCLUSIONS:

This study demonstrates that clinicians can repeatedly and reliably perform a relative temperature differential analysis using the Scout device to determine an appropriate control area for wound temperature assessment.
Trends in the Use of Neoadjuvant Chemotherapy for Advanced Ovarian Cancer in the United States
Authors: Melamed Alexander , Hinchcliff Emily M. , Clemmer Joel T. , Bregar Amy J. , Uppal Shitanshu , Bostock Ian , Schorge John O. , del Carmen Marcela G. , Rauh-Hain J. Alejandro
Published: February 2017

(Abstracted from Gynecol Oncol 2016;143:236–240)

The historic standard of care for women with advanced ovarian cancer has been primary cytoreductive surgery followed by adjuvant chemotherapy. In the past decade, however, treatment with neoadjuvant chemotherapy (NACT) followed by interval debulking surgery has emerged as an alternative treatment modality for patients with advanced disease.
When Love Hurts. A Systematic Review on the Effects of Endometriosis Surgical and Pharmacological Treatments on Female Sexual Functioning
Authors: Barbara Giussy , Facchin Federica , Meschia Michele , Berlanda Nicola , Frattaruolo Maria Pina , Vercellini Paolo
Published: February 2017

(Abstracted from Acta Obstet Gynecol Scand 2016; doi: 10.1111/aogs.13031)

Endometriosis occurs in 5% to 10% of women of reproductive age. Approximately two-thirds of women with this chronic disease experience some type of sexual dysfunction, such as dyspareunia, low satisfaction, low arousal, lack of desire, and orgasm difficulties.
Word Catheter and Marsupialisation in Women With a Cyst or Abscess of the Bartholin Gland (WoMan-Trial): A Randomised Clinical Trial
Authors: Kroese J. A. , van der Velde M. , Morssink L. P. , Zafarmand M. H. , Geomini P. , van Kesteren P. J. M. , Radder C. M. , van der Voet L. F. , Roovers J. P. W. R. , Graziosi G. C. M. , van Baal W. M. , van Bavel J. , Catshoek R. , Klinkert E. R. , Huirne J. A. F. , Clark T. J. , Mol B. W. J. , Reesink-Peters N.
Published: February 2017

(Abstracted from BJOG 2017;124:243–249)

There is a 2% lifetime risk among women of developing a cyst or abscess of the Bartholin gland. These usually occur during reproductive ages; both can limit activity, and an abscess can also cause extreme pain.
Antenatal Corticosteroids for Maturity of Term or Near-Term Fetuses: Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Saccone Gabriele , Berghella Vincenzo
Published: February 2017

(Abstracted from BMJ 2016;355:i5044)

One of the significant causes of early neonatal morbidity and mortality in the United States is respiratory distress syndrome (RDS). Prophylactic corticosteroids in singleton preterm pregnancies are known to hasten lung maturation and decrease the occurrence of RDS.
Hospital-Affiliated Outpatient Birth Centers: A Possible Model for Helping to Achieve the Triple Aim in Obstetrics
Authors: Woo Victoria G. , Milstein Arnold , Platchek Terry
Published: February 2017

(Abstracted from JAMA 2016;316(14):1441–1442)

Births account for a substantial portion of increasing health care costs in the United States. Despite the high costs of deliveries, birth outcomes are relatively poor; the United States ranks 48th in maternal mortality and 57th in infant mortality in the world.
Evaluation of Intra-articular Fracture Extension After Gunshot Wounds to the Lower Extremity: Plain Radiographs Versus Computer Tomography
Authors: Hwang John S. , Koury Kenneth L. , Gorgy George , Sirkin Michael S. , Reilly Mark C. , Lelkes Valdis , Adams Mark R.
Published: February 2017

Objective:

This study was to compare the use of computer tomography with plain radiographs for the evaluation of intra-articular extension of long bone fractures in the lower extremity after low-energy gunshot wounds.

Design:

Retrospective chart and radiographic review.

Setting:

Level 1 Trauma Center.

Patients/Participants:

Data were collected from a single institution from 2000 to 2014. Inclusion criteria consisted of patients greater than 17 years of age, low-velocity gunshot injuries causing fracture of the femur or tibia, plain radiographs with adequate films, and computed tomography (CT) imaging of the fracture. This consisted of 133 patients with 140 fractures.

Intervention:

Intra-articular fracture extension was evaluated on initial plain radiographs and CTs.

Main Outcome Measures:

Comparison of “gold standard” CT with all reviewers' evaluation of plain radiographs.

Results:

There were 140 total fractures; 108 were femoral fractures and 32 were tibial fractures. By comparing plain radiographs with the gold standard CT, the reviewers demonstrated correct diagnosis in 85% of intra-articular fractures and 96% of non–intra-articular fractures. In addition, the reviewers accurately diagnosed 70.8% of intra-articular extensions in the diaphysis and 70.5% in the metaphysis. The sensitivity and specificity for plain radiographs were 85.3% and 96.0%, respectively, for all locations. Metaphyseal and diaphyseal fractures demonstrated the poorest sensitivity at 80.7% and 82.1%, respectively.

Conclusions:

Low-energy gunshot wounds with fractures in the diaphyseal of the distal femur and all metaphyseal fractures warrant CT evaluation to better examine for intra-articular fracture extension.

Level of Evidence:

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Proximity and Risks of the Anterior Neurovascular and Tendinous Anatomy of the Distal Leg Relative to Anteriorly Applied Distal Locking Screws for Tibia Nailing: A Plea for Open Insertion
Authors: Mitchell Phillip M. , Collinge Cory A. , Barcak Eric , Perez Edward , Triantafillou Kostas
Published: February 2017

Purpose:

To determine the proximity and potential risks to distal leg anatomy from anterior to posterior (A-P) applied distal tibia locking screws for tibial nailing.

Design:

Retrospective.

Setting:

ACS level I trauma center.

Patients/Participants:

Twenty consecutive adult patients undergoing computed tomograms with intravenous contrast (computed tomography angiograms) on uninjured legs.

Main Outcome Measurements:

Simulated 5-mm distal interlocking screws placed in the A-P axis of an ideally placed tibial nail at 10-mm increments from the tibial plafond (10–40 mm) were studied in relation to the distal leg's anterior anatomy.

Results:

All A-P screws (80/80, 100%) impacted the tibialis anterior tendon, extensor hallucis longus tendon, and/or anterior tibial neurovascular (NV) bundle between 10 and 40 mm cranial to the plafond. The NV bundle was impacted in 53% of cases. The medial extent of the tibialis anterior tendon was greatest 10 mm cranial to the plafond and averaged 27 degrees (95% confidence interval, 22–33 degrees) medial to the A-P line. The maximum lateral border of the foot's common extensors, found 40 mm cranial to the plafond, averaged 71 degrees (95% confidence interval, 62–80 degrees) lateral to the A-P line.

Discussion:

The anterior tibial NV bundle and foot and ankle extensor tendons are at high risk from A-P–directed distal locking screws. The tendinous anatomy of the distal leg is at risk between 33 degrees medial and 80 degrees lateral to the A-P axis of a tibial nail. Distal locking screws placed from the A-P direction should be thoughtfully applied and an open approach should be strongly considered.
Sustained Responses to Measles Revaccination at 24 Months in HIV-infected Children on Antiretroviral Therapy in Kenya
Authors: Newman Laura P. , Njoroge Anne , Magaret Amalia , Chohan Bhavna H. , Gitomea Veronicah W. , Wald Anna , Gorstein Jonathan , Overbaugh Julie , Wamalwa Dalton , Maleche-Obimbo Elizabeth , Nduati Ruth , Farquhar Carey
Published: February 2017

Background:

There are limited data on whether HIV-infected children in resource-limited countries who are receiving antiretroviral therapy (ART) are able to produce sustained, protective levels of measles antibody after multiple measles vaccinations.

Methods:

We administered an additional measles vaccine to HIV-infected children 15 months to 12 years of age receiving ART in Nairobi, Kenya. Measles antibody concentrations were determined by enzyme-linked immunosorbent assay at enrollment, 1 month, 12 months and 24 months post revaccination.

Results:

At enrollment, 125 (54%) of 232 study participants had protective concentrations of measles antibody. Measles seropositivity increased to 98% of all children at 1 month post revaccination but decreased to 71% at 12 months and 60% at 24 months post revaccination. Measles seroconversion and sustained measles seropositivity among those who were measles seronegative at enrollment was 25% at 24 months post revaccination. In this group, 39% of children with <50 copies/mL plasma HIV RNA measles seroconverted compared to 4% of children with plasma HIV RNA ≥1000 copies/mL (P = 0.018).

Conclusions:

Measles revaccination can result in a sustained antibody response in a subset of HIV-infected children receiving ART, especially among those with HIV suppression.
High Rates of Baseline Drug Resistance and Virologic Failure Among ART-naive HIV-infected Children in Mali
Authors: Crowell Claudia S. , Maiga Almoustapha I. , Sylla Mariam , Taiwo Babafemi , Kone Niaboula , Oron Assaf P. , Murphy Robert L. , Marcelin Anne-Geneviève , Traore Ban , Fofana Djeneba B. , Peytavin Gilles , Chadwick Ellen G.
Published: February 2017

Background:

Limited data exist on drug resistance and antiretroviral treatment (ART) outcomes in HIV-1–infected children in West Africa. We determined the prevalence of baseline resistance and correlates of virologic failure (VF) in a cohort of ART-naive HIV-1–infected children <10 years of age initiating ART in Mali.

Methods:

Reverse transcriptase and protease genes were sequenced at baseline (before ART) and at 6 months. Resistance was defined according to the Stanford HIV Genotypic Resistance database. VF was defined as viral load ≥1000 copies/mL after 6 months of ART. Logistic regression was used to evaluate factors associated with VF or death >1 month after enrollment. Post hoc, antiretroviral concentrations were assayed on baseline samples of participants with baseline resistance.

Results:

One-hundred twenty children with a median age 2.6 years (interquartile range: 1.6–5.0) were included. Eighty-eight percent reported no prevention of mother-to-child transmission exposure. At baseline, 27 (23%), 4 (3%) and none had non-nucleoside reverse transcriptase inhibitor (NNRTI), nucleoside reverse transcriptase inhibitor or protease inhibitor resistance, respectively. Thirty-nine (33%) developed VF and 4 died >1 month post-ART initiation. In multivariable analyses, poor adherence [odds ratio (OR): 6.1, P = 0.001], baseline NNRTI resistance among children receiving NNRTI-based ART (OR: 22.9, P < 0.001) and protease inhibitor–based ART initiation among children without baseline NNRTI resistance (OR: 5.8, P = 0.018) were significantly associated with VF/death. Ten (38%) with baseline resistance had detectable levels of nevirapine or efavirenz at baseline; 7 were currently breastfeeding, but only 2 reported maternal antiretroviral use.

Conclusions:

Baseline NNRTI resistance was common in children without reported NNRTI exposure and was associated with increased risk of treatment failure. Detectable NNRTI concentrations were present despite few reports of maternal/infant antiretroviral use.
Serologic Responses After Hepatitis B Vaccination in Preterm Infants Born to Hepatitis B Surface Antigen–Positive Mothers
Authors: Tan Christelle Xian-Ting , Chan Si-Min , Lee Le-Ye , Ong Christina , Phua Kong-Boo , Aw Marion Margaret , Saw Sharon , Lee Guan-Huei , Wong Franco , Thoon Koh-Cheng
Published: February 2017

Background:

The Advisory Committee on Immunization Practices (ACIP) recommends a 4-dose vaccination schedule for preterm low birth weight infants (<2 kg) and a 3-dose vaccination schedule for preterm infants (≥2 kg) born to hepatitis B surface antigen (HBsAg)-positive mothers. However, data remain limited for these high-risk infants, and the optimal dosing schedule in Asia is not well established.

Aim:

The aim of this study was to evaluate the serologic vaccine responses in preterm infants born to HBsAg-positive mothers using current vaccination guidelines.

Methods:

Preterm babies of gestation less than 37 completed weeks born to HBsAg-positive mothers were prospectively recruited during 6 years (June 2009 to December 2015) and retrospectively recruited via convenience sampling in 2 years (June 2013 to April 2015) in 2 tertiary pediatric centers. The preterm infants were given 4 or 3 vaccine doses as per ACIP 2005 guidelines. Vaccine response was defined as achieving hepatitis B surface antibody values of >10 IU/L [Abbott Architect (Abbott Laboratories, Chicago, IL)] at 9 months of chronologic age.

Results:

A total of 24 preterm infants were recruited. Four had a birth weight <2 kg. Of 23 surviving infants, all were negative for HBsAg. One baby (4.5%) did not achieve adequate vaccine response. All 4 infants with birth weight <2 kg achieved seroprotective values.

Conclusion:

The current ACIP-recommended vaccination schedule results in adequate antibody responses in preterm infants of HBsAg-positive mothers.
Influenza Vaccination Rate and Reasons for Nonvaccination in Children With Cardiac Disease
Authors: Livni Gilat , Wainstein Alina , Birk Einat , Chodick Gabriel , Levy Itzhak
Published: February 2017

Background:

Influenza is a major cause of respiratory morbidity worldwide. It poses a risk of complications in children with cardiac disease. Influenza vaccine is considered the most effective and safe means of preventing the disease. The aims of this study were to determine the rate of influenza vaccination in children with cardiac disease and to identify the reasons for failure to vaccinate in this patient population.

Methods:

The study group included 186 children and their parents who attended the cardiology institute of a tertiary pediatric medical center between September and October 2012. Parents were asked to complete a questionnaire covering demographics, clinical features, influenza vaccination, receipt of advice from medical professionals regarding vaccination and personal knowledge about and attitude toward the influenza vaccine.

Results:

Median age of the children was 7.6 years. Thirty-six percent had been vaccinated in the previous influenza season. Vaccination was unrelated to the child’s age or sex or the parents’ education. Factors significantly affecting the decision of the parents to have their child vaccinated were their knowledge, beliefs and conceptions about the vaccine and their receipt of a recommendation to do so from the pediatrician or cardiologist (P < 0.001).

Conclusions:

The rate of vaccination against influenza is low in children with heart disease. Major factors encouraging vaccination are proper parental knowledge and the recommendation of the primary physician or cardiologist. Medical professionals caring for this patient population should be alerted to the need to routinely counsel parents on the importance of influenza vaccination.
The Chronic Otitis Media Benefit Inventory (COMBI): Development and Validation of a Dynamic Quality of Life Questionnaire for Chronic Ear Disease
Authors: Phillips John S. , Haggard Mark , Spencer Helen , Yung Matthew
Published: February 2017

Objective:

This study introduces a change-oriented short-form health-related quality of life questionnaire suited to symptoms of adult chronic middle ear disease and its consequences, and describes its properties.

Study Design:

Two-centre prospective correlational study primarily for instrument development.

Setting:

Two otology secondary care centers in England.

Patients:

Fifty-two consecutive adult patients with active chronic otitis media undergoing surgery.

Methods:

The 12 items for the chronic otitis media benefit inventory (COMBI) were appraised chiefly for internal consistency of resulting score and for factor structure (exploratory factor analysis).

Results:

The internal consistency of the COMBI was high within our cohort of patients, with a Cronbach's alpha value of 0.907. The three-factor solution from factor analysis explaining 73.6% of the variance was readily interpretable in terms of the intended item content: changes in hearing, ear symptoms, and daily activities plus healthcare uptake.

Conclusions:

The COMBI has suitable properties for the dynamic assessment of active chronic otitis media. Initial psychometric appraisal confirms its suitability for early adoption to acquire more comprehensive large-sample information with it and on it, for future refinement and application.
Blood pressure control for acute severe ischemic and hemorrhagic stroke
Authors: Bösel Julian
Published: February 2017

Purpose of review

Severe ischemic or hemorrhagic stroke is a devastating cerebrovascular disease often demanding critical care. Optimal management of blood pressure (BP) in the acute phase is controversial. The purpose of this review is to display insights from recent studies on BP control in both conditions.

Recent findings

BP control in acute ischemic stroke has recently been investigated with regard to endovascular recanalizing therapies. Decreases from baseline BP and hypotension during the intervention have been found detrimental. Overall, a periinterventional SBP between 140 and 160 mmHg appeared favorable in several studies. In acute hemorrhagic stroke, the recently completed Antihypertensive Treatment of Acute Cerebral Hemorrhage II trial confirmed feasibility of early aggressive BP reduction but failed to demonstrate a reduction in hematoma growth or a clinical benefit.

Recent findings do not support benefits of intensive BP lowering in both acute hemorrhagic and ischemic stroke, with the possible exception of the postinterventional phase after successful endovascular recanalization of large-vessel occlusions. Although optimal ranges of BP values remain to be defined, high BP should still be treated according to guidelines. As stroke patients requiring critical care are underrepresented in most studies on BP, caution in transferring these findings is warranted and prospective research in that patient population needed.
Time trends in the epidemiology and outcome of perianal fistulizing Crohn’s disease in a population-based cohort
Authors: Göttgens Kevin W.A. , Jeuring Steven F.G. , Sturkenboom Rosel , Romberg-Camps Mariëlle J.L. , Oostenbrug Liekele E. , Jonkers Daisy M.A.E. , Stassen Laurents P.S. , Masclee Ad A.M. , Pierik Marieke J. , Breukink Stéphanie O.
Published: February 2017

Objective

Perianal disease is a debilitating condition that frequently occurs in Crohn’s disease (CD) patients. It is currently unknown whether its incidence has changed in the era of frequent immunomodulator use and biological availability. We studied the incidence and outcome of perianal and rectovaginal fistulas over the past two decades in our population-based Inflammatory Bowel Disease South-Limburg cohort.

Patients and methods

All 1162 CD patients registered in the Inflammatory Bowel Disease South-Limburg registry were included. The cumulative probabilities of developing a perianal and rectovaginal fistula were compared between three eras distinguished by the year of CD diagnosis: 1991–1998, 1999–2005 and 2006–2011. Second, clinical risk factors and the risk of fistula recurrence were determined.

Results

The cumulative 5-year perianal fistula rate was 14.1% in the 1991–1998 era, 10.4% in the 1999–2005 era and 10.3% in the 2006–2011 era, P=0.70. Colonic disease was associated with an increased risk of developing perianal disease, whereas older age was associated with a decreased risk (both P<0.01). Over time, more patients were exposed to immunomodulators or biologicals before fistula diagnosis (18.5 vs. 32.1 vs. 52.1%, respectively, P=0.02) and started biological therapy thereafter (18.6 vs. 34.1 vs. 54.0%, respectively, P<0.01). The cumulative 5-year perianal fistula recurrence rate was not significantly different between eras (19.5 vs. 25.5 vs. 33.1%, P=0.28). In contrast, the cumulative 5-year rectovaginal rate attenuated from 5.7% (the 1991–2005 era) to 1.7% (the 2006–2011 era), P=0.01.

Conclusion

Over the past two decades, the risk of developing a perianal fistula was stable, as well as its recurrence rate, underlining the lasting need for improving treatment strategies for this invalidating condition.
SR-B1 and PDZK1: partners in HDL regulation
Authors: Trigatti Bernardo L.
Published: February 2017

Purpose of review

To outline the roles of SR-B1 and PDZK1 in hepatic selective HDL cholesterol uptake and reverse cholesterol transport and the consequences for atherosclerosis development.

Recent findings

Much of our understanding of the physiological roles of SR-B1 and PDZK1 in HDL metabolism and atherosclerosis comes from studies of genetically manipulated mice. These show SR-B1 and PDZK1 play key roles in HDL metabolism and protection against atherosclerosis. The recent identification of rare loss of function mutations in the human SCARB1 gene verifies that it plays similar roles in HDL metabolism in humans. Other rare mutations in both the human SCARB1 and PDZK1 genes remain to be characterized but may have potentially devastating consequences to SR-B1 function.

Identification of carriers of rare mutations in human SCARB1 and PDZK1 that impair the function of their gene products and characterization of the effects of these mutations on HDL cholesterol levels and atherosclerosis will add to our understanding of the importance of HDL function and cholesterol flux, as opposed to HDL-cholesterol levels, per se, for protection against cardiovascular disease.
Health‐related Quality of Life in Pediatric Patients With Chronic Hepatitis B Living in the United States and Canada
Authors: Schwarzenberg Sarah Jane , Ling Simon C. , Cloonan Yona Keich , Lin Hsing‐Hua S. , Evon Donna M. , Murray Karen F. , Rodriguez‐Baez Norberto , Rosenthal Philip , Teckman Jeffrey , Schwarz Kathleen B. ,   Hepatitis B Research Network
Published: February 2017

Objectives:

The aim of the study was to determine whether selected sociodemographic and hepatitis B virus (HBV)‐specific clinical factors are associated with health‐related quality of life (HRQoL) among pediatric patients chronically infected with HBV.

Methods:

Children with chronic HBV enrolled in the Hepatitis B Research Network completed the Child Health Questionnaire at study entry. Caregivers of children 5 to <10 years completed the parent‐reported form (CHQ‐Parent Report Form); youth 10 to <18 years completed the child‐reported CHQ‐Child Report Form. We examined univariable associations of the Child Health Questionnaire scores with selected independent variables: sex, adoption status, maternal education, alanine aminotransferase (U/L), aspartate aminotransferase‐to‐platelet ratio index, and HBV‐specific symptom count.

Results:

A total of 244 participants (83 young children 5–<10 years, 161 youth 10–<18 years) were included, all HBV treatment‐naïve. Among young children, increased alanine aminotransferase level was negatively associated with CHQ‐Parent Report Form psychosocial summary t score (r = −0.28, P = 0.01). No other subscale comparisons for young children were statistically significant. Among youth, adoption was associated with better physical functioning and general health (P < 0.01). Higher maternal education was associated with better role/functioning‐physical and ‐emotional scores (P < 0.05). Maternal education and adoption status were linked with adoption associated with higher maternal education. Increased symptom count in youth was associated with worse HRQoL in subscales measuring bodily pain, behavior, mental health, and self‐esteem (P < 0.01).

Conclusions:

Although overall HRQoL is preserved in children with chronic HBV, some sociodemographic and HBV‐related clinical factors were associated with impaired HRQoL in our pediatric patients at baseline. Measurement of HRQoL can focus resources on education and psychosocial support in children and families most in need.
Nutritional Assessment and Status of Hospitalized Infants
Authors: Matsuyama Misa , Bell Kristie , White Melinda , Lawson Karen , David Michael , Doolan Annabel , Todd Alwyn
Published: February 2017

Objectives:

Malnutrition during infancy has long‐term adverse consequences for both physical and psychological development. Early detection of malnutrition among hospitalized infants is essential to provide optimal nutrition support. The primary aim of the present study was to investigate the nutritional status of hospitalized infants using 2 methods: the Subjective Global Nutritional Assessment (SGNA) and anthropometric measurement. We also investigated diagnostic category associated with nutritional status, the mean anthropometric z scores, and explored the association between malnutrition and nutrition focused variables.

Methods:

Nutritional status of 110 hospitalized infants ages 31 days to 12 months was investigated using the SGNA and anthropometric measurements converted to z scores.

Results:

Utilizing the SGNA, 78 (70.9%) infants were classified as having normal nutritional status, 30 (27.3%) were moderately malnourished, and 2 (1.8%) were severely malnourished. The proportion of infants with acute malnutrition (weight‐for‐length z score <−2) was 16.4%, and chronic malnutrition (length‐for‐age z score <−2) was 3.6%. The mean anthropometric z scores of infants were significantly lower in infants identified as moderately and severely malnourished using the SGNA. Decrease in serial weight (odds ratio [OR] 44.4; 95% confidence interval [CI]: 4.3–451.5), having prolonged gastrointestinal symptoms (OR 18.8; 95% CI: 1.5–234.7), and reduced nutrition‐related functional capacity (OR 27.6; 95% CI 2.5–301.7) were associated with malnutrition after adjusting for sex, age, and length of hospital stay.

Conclusions:

Regardless of the method applied, cases of malnutrition amongst hospitalized infants were identified. The SGNA is a comprehensive approach to identifying malnutrition in hospitalized infants.
Frequency of Severe Infusion Reactions Associated With Outpatient Infusion of Infliximab Without Premedications
Authors: Hutsell Stephanie Q. , Wu May , Park K.T.
Published: February 2017

In this report, we describe incremental changes, during a 2‐year period at a single center with the administration of maintenance infliximab infusions. Given practice‐driven changes consisting of 1‐hour infusions and omission of premedications, we aimed to investigate if these changes contributed to severe infusion reactions. We reviewed approximately 900 infliximab infusions in a pediatric ambulatory infusion center from January 1, 2014, to December 31, 2015, for severe adverse reactions requiring either rescue epinephrine or a code blue or “rapid response” activation. In 2015, these practice changes resulted in a 51% decrease in total infusion hours (1281 to 630 infusion hours), despite a 9% increase in total number of infusions. No increase in severe adverse events associated with either rapid 1‐hour infusion or omission of premedications. Our findings highlight a quality‐improvement opportunity to standardize infliximab infusions to streamline care in an ambulatory setting.
Breast‐feeding and Infant Hospitalization for Infections
Authors: Størdal Ketil , Lundeby Karen M. , Brantsæter Anne L. , Haugen Margaretha , Nakstad Britt , Lund‐Blix Nicolai A. , Stene Lars C.
Published: February 2017

Objectives:

Breast‐feeding may protect against infections, but its optimal duration remains controversial. We aimed to study the association of the duration of full and any breast‐feeding with infections the first 18 months of life.

Methods:

The Norwegian Mother and Child study (MoBa) is a prospective birth cohort which recruited expecting mothers giving birth from 2000 to 2009. We analyzed data from the full cohort (n = 70,511) and sibling sets (n = 21,220) with parental report of breast‐feeding and infections. The main outcome measures were the relative risks (RRs) for hospitalization for infections from 0 to 18 months by age at introduction of complementary foods and duration of any breast‐feeding.

Results:

Although we found some evidence for an overall association between longer duration of full breast‐feeding and lower risk of hospitalizations for infections, 7.3% of breast‐fed children who received complementary foods at 4 to 6 months of age compared to 7.7% of those receiving complementary foods after 6 months were hospitalized (adjusted RR 0.95, 95% confidence interval 0.88–1.03). Higher risk of hospitalization was observed in those breast‐fed 6 months or less (10.0%) compared to ≥12 months (7.6%, adjusted RR 1.22, 95% confidence interval 1.14–1.31), but with similar risks for 6 to 11 months versus ≥12 months. Matched sibling analyses, minimizing the confounding from shared maternal factors, showed nonsignificant associations and were generally weaker compared with the cohort analyses.

Conclusions:

Our results support the recommendation to fully breast‐feed for 4 months and to continue breast‐feeding beyond 6 months, and suggest that protection against infections is limited to the first 12 months.
Feed‐induced Dystonias in Children With Severe Central Nervous System Disorders
Authors: Mordekar Santosh R. , Velayudhan Manjula , Campbell David I.
Published: February 2017

Dystonias can arise from any painful stimuli in neurologically disabled children. Classically, feed‐induced dystonias from mediastinal pain due to severe gastroesophageal reflux disease are described as Sandifer spasm. We report a case series of 12 severely neurologically impaired children with enteral feed–induced dystonias. Intestinal dysmotility was demonstrated in several. Improvements are seen with jejunal feeds or gut rest with total parenteral nutrition. Use of parenteral nutrition in children with severe neurodisability requires thorough discussion with patient groups and commissioners to give clinicians guidelines to standardize care.
Temporal Trend of Pediatric Inflammatory Bowel Disease
Authors: Ishige Takashi , Tomomasa Takeshi , Hatori Reiko , Tatsuki Maiko , Igarashi Yoshiko , Sekine Kazuhiko , Arakawa Hirokazu
Published: February 2017

Increased incidence and prevalence of pediatric inflammatory bowel disease (IBD) have been reported in Western countries. Changes in the prevalence of pediatric IBD in Asian countries, however, remain unclear. We evaluated the changes in the prevalence of IBD among Japanese adults and children from 2004 to 2013, by using the Japanese national registry data of patients receiving financial aid. Data from children (ages 0–19 years) were compared with those from young adults (ages 20–39 years). In 2004, age‐standardized prevalences of Crohn disease (CD) and ulcerative colitis (UC) among children were 4.2 of 100,000 and 11.0 of 100,000, respectively. The corresponding prevalences among young adults were 41.0 of 100,000 and 89.8 of 100,000, respectively. In 2013, age‐standardized prevalences of pediatric CD and UC were 7.2 of 100,000 and 15.0 of 100,000, respectively. During this period, prevalence of pediatric CD increased by 73.8% among children and by 49.0% in young adults. The prevalence of UC increased by 45.0% among children, and by 73.7% among young adults.
Niraparib Maintenance Therapy in Platinum-Sensitive, Recurrent Ovarian Cancer
Authors: Mirza Mansoor R. , Monk Bradley J. , Herrstedt Jørn , Oza Amit M. , Mahner Sven , Redondo Andrés , Fabbro Michel , Ledermann Jonathan A. , Lorusso Domenica , Vergote Ignace , Ben-Baruch Noa E. , Marth Christian , Mądry Radoslaw , Christensen René D. , Berek Jonathan S. , Dørum Anne , Tinker Anna V. , du Bois Andreas , González-Martín Antonio , Follana Philippe , Benigno Benedict , Rosenberg Per , Gilbert Lucy , Rimel Bobbie J. , Buscema Joseph , Balser John P. , Agarwal Shefali , Matulonis Ursula A.
Published: February 2017

(Abstracted from N Engl J Med 2016;375(22):2154–2164)

The initial response rate to platinum and taxane treatment in patients with advanced ovarian cancer is high. However, the effectiveness of this regimen diminishes over time, and most patients relapse; with retreatment, relapses occur at shorter intervals until patient death.
Gynecologic Outcomes After Hysteroscopic and Laparoscopic Sterilization Procedures
Authors: Perkins Rebecca B. , Morgan Jake R. , Awosogba Temitope P. , Ramanadhan Shaalini , Paasche-Orlow Michael K.
Published: February 2017

(Abstracted from Obstet Gynecol 2016;128:843–852)

The contraceptive method chosen by nearly 10 million US women is female tubal sterilization. This procedure can be performed either laparoscopically or hysteroscopically.
Nitrofurantoin vs Other Prophylactic Agents in Reducing Recurrent Urinary Tract Infections in Adult Women: A Systematic Review and Meta-analysis
Authors: Price Jameca Renee , Guran Larissa A. , Gregory W. Thomas , McDonagh Marian S.
Published: February 2017

(Abstracted from Am J Obstet Gynecol 2016;215(5):548–560)

Infections of the bladder in women are among the most common bacterial infections seen in general practice. Up to 50% of women will have at least 1 episode of uncomplicated urinary tract infection (UTI) during their lifetime, and 20% to 30% will have a recurrent episode.
Prenatal Ultrasound and Childhood Autism: Long-Term Follow-Up After A Randomized Controlled Trial of First- Versus Second-Trimester Ultrasound
Authors: Höglund Carlsson L. , Saltvedt S. , Anderlid B.-M. , Westerlund J. , Gillberg C. , Westgren M. , Fernell E.
Published: February 2017

(Abstracted from Ultrasound Obstet Gynecol 2016;48:285–288)

Prenatal ultrasound has its pros and cons, the pros being an effective means to assess gestational age and to identify fetal anomalies, whereas the cons are the potential risks associated with exposure to ultrasound, especially with increasing exposure times. Autism spectrum disorder (ASD) is caused by several factors, including infections and toxins.
Glucocorticoid Receptor Polymorphisms and Outcomes in Pediatric Septic Shock*
Authors: Cvijanovich Natalie Z. , Anas Nick , Allen Geoffrey L. , Thomas Neal J. , Bigham Michael T. , Weiss Scott L. , Fitzgerald Julie , Checchia Paul A. , Meyer Keith , Quasney Michael , Gedeit Rainer , Freishtat Robert J. , Nowak Jeffrey , Raj Shekhar S. , Gertz Shira , Grunwell Jocelyn R. , Opoka Amy , Wong Hector R.
Published: February 2017

Objective:

Polymorphisms of the glucocorticoid receptor gene are associated with outcome and corticosteroid responsiveness among patients with inflammatory disorders. We conducted a candidate gene association study to test the hypothesis that these polymorphisms are associated with outcome and corticosteroid responsiveness among children with septic shock.

Design:

We genotyped 482 children with septic shock for the presence of two glucocorticoid receptor polymorphisms (rs56149945 and rs41423247) associated with increased sensitivity and one glucocorticoid receptor polymorphism (rs6198) associated with decreased sensitivity to corticosteroids. The primary outcome variable was complicated course, defined as 28-day mortality or the persistence of two or more organ failures 7 days after a septic shock diagnosis. We used logistic regression to test for an association between corticosteroid exposure and outcome, within genotype group, and adjusted for illness severity.

Setting:

Multiple PICUs in the United States.

Interventions:

Standard care.

Measurements and Main Results:

There were no differences in outcome when comparing the various genotype groups. Among patients homozygous for the wild-type glucocorticoid receptor allele, corticosteroids were independently associated with increased odds of complicated course (odds ratio, 2.30; 95% CI, 1.01–5.21; p = 0.047).

Conclusions:

Based on these glucocorticoid receptor polymorphisms, we could not detect a beneficial effect of corticosteroids among any genotype group. Among children homozygous for the wild-type allele, corticosteroids were independently associated with increased odds of poor outcome.
Pediatric Acute Respiratory Distress Syndrome in Pediatric Allogeneic Hematopoietic Stem Cell Transplants: A Multicenter Study*
Authors: Rowan Courtney M. , Smith Lincoln S. , Loomis Ashley , McArthur Jennifer , Gertz Shira J. , Fitzgerald Julie C. , Nitu Mara E. , Moser Elizabeth A. S. , Hsing Deyin D. , Duncan Christine N. , Mahadeo Kris M. , Moffet Jerelyn , Hall Mark W. , Pinos Emily L. , Tamburro Robert F. , Cheifetz Ira M.
Published: February 2017

Objective:

Immunodeficiency is both a preexisting condition and a risk factor for mortality in pediatric acute respiratory distress syndrome. We describe a series of pediatric allogeneic hematopoietic stem cell transplant patients with pediatric acute respiratory distress syndrome based on the recent Pediatric Acute Lung Injury Consensus Conference guidelines with the objective to better define survival of this population.

Design:

Secondary analysis of a retrospective database.

Setting:

Twelve U.S. pediatric centers.

Patients:

Pediatric allogeneic hematopoietic stem cell transplant recipients requiring mechanical ventilation.

Interventions:

None.

Measurements and Main Results:

During the first week of mechanical ventilation, patients were categorized as: no pediatric acute respiratory distress syndrome or mild, moderate, or severe pediatric acute respiratory distress syndrome based on oxygenation index or oxygen saturation index. Univariable logistic regression evaluated the association between pediatric acute respiratory distress syndrome and PICU mortality. A total of 91.5% of the 211 patients met criteria for pediatric acute respiratory distress syndrome using the Pediatric Acute Lung Injury Consensus Conference definition: 61.1% were severe, 27.5% moderate, and 11.4% mild. Overall survival was 39.3%. Survival decreased with worsening pediatric acute respiratory distress syndrome: no pediatric acute respiratory distress syndrome 66.7%, mild 63.6%, odds ratio = 1.1 (95% CI, 0.3–4.2; p = 0.84), moderate 52.8%, odds ratio = 1.8 (95% CI, 0.6–5.5; p = 0.31), and severe 24.6%, odds ratio = 6.1 (95% CI, 2.1–17.8; p < 0.001). Nonsurvivors were more likely to have multiple consecutive days at moderate and severe pediatric acute respiratory distress syndrome (p < 0.001). Moderate and severe patients had longer PICU length of stay (p = 0.01) and longer mechanical ventilation course (p = 0.02) when compared with those with mild or no pediatric acute respiratory distress syndrome. Nonsurvivors had a higher median maximum oxygenation index than survivors at 28.6 (interquartile range, 15.5–49.9) versus 15.0 (interquartile range, 8.4–29.6) (p < 0.0001).

Conclusion:

In this multicenter cohort, the majority of pediatric allogeneic hematopoietic stem cell transplant patients with respiratory failure met oxygenation criteria for pediatric acute respiratory distress syndrome based on the Pediatric Acute Lung Injury Consensus Conference definition within the first week of invasive mechanical ventilation. Length of invasive mechanical ventilation, length of PICU stay, and mortality increased as the severity of pediatric acute respiratory distress syndrome worsened.
Medication Reconciliation Failures in Children and Young Adults With Chronic Disease During Intensive and Intermediate Care
Authors: DeCourcey Danielle D. , Silverman Melanie , Chang Esther , Ozonoff Al , Stickney Carolyn , Pichoff Darla , Oldershaw Alexandra , Finkelstein Jonathan A.
Published: February 2017

Objectives:

Although medication reconciliation has become standard during hospital admission, rates of unintentional medication discrepancies during intensive care of pediatric patients with chronic disease are unknown. Such discrepancies are an important cause of adverse drug events in adults with chronic illness and are associated with unintentional discontinuation of chronic medications. We sought to determine the rate, type, timing, and predictors of potentially harmful unintentional medication discrepancies in children and young adults with chronic disease.

Design:

Prospective observational cohort study.

Setting:

Patients discharged from the intensive and intermediate care units at a tertiary care children’s hospital from September 2013 to May 2014.

Patients:

Consecutive sample of 308 patients less than 25 years old with chronic disease defined by prescription of at least one predetermined class of chronic medication prior to hospitalization.

Measurements and Main Results:

The number of unintentional medication discrepancies with the potential for harm, as well as patient and medication-related factors predisposing patients to these errors were assessed. Two thousand seven hundred thirty-nine medication discrepancies were identified; 284 (10%) were unintentional and had the potential for harm (0.9/patient). Of these, 128 (45%) were due to errors in taking the preadmission medication history, whereas 156 (55%) were due to errors reconciling the medication history with orders. Most events occurred at admission (66%) and were dosing errors (45%). In multivariable negative binomial regression analyses (adjusted rate ratios [95% CI]), each additional preadmission medication (1.07 [1.04–1.10]), chronic respiratory medications (1.51 [1.01–2.28]), and chronic noninvasive ventilation (1.53 [1.07–2.19]) were associated with increased risk of a discrepancy.

Conclusions:

Unintentional medication discrepancies with the potential for harm are common among children and young adults with chronic disease during critical care admission due to both failure to obtain an accurate medication history and errors in reconciling the history with patient orders. The use of current medication reconciliation processes is insufficient to prevent errors in this high-risk population.