bluuebunny/crossref_metadata_2025 huggingface dataset:
Adherence to the Mediterranean Diet and Physical Resilience in Older Adults: The Seniors-ENRICA Cohort
Authors: Sotos-Prieto Mercedes , Ortolá Rosario , López-García Esther , Rodríguez-Artalejo Fernando , García-Esquinas Esther
Published: November 2020

Background

No prior studies have studied the association between diet and physical resilience, thus our aim was to assess the association between the adherence to the Mediterranean diet and other healthy dietary patterns and physical resilience, assessed empirically as a trajectory through exposure to chronic and acute stressors, in older adults participating in the Seniors-ENRICA (The Study on Nutrition and Cardiovascular Risk in Spain) cohort.

Methods

Data were assessed from 1301 individuals aged 60 and older, participating in the ENRICA prospective cohort study and recruited in 2008–2010 and followed up to 2012 (trial registration: NCT02804672). A Mediterranean Diet Adherence Screener score and the Alternate Healthy Eating Index 2010 were derived at baseline from a validated diet history. Health status was assessed at baseline and at the end of follow-up with a 52-item health Deficit Accumulation Index (DAI) including 4 domains (physical and cognitive function, mental health, self-rated health/vitality, and morbidity); higher DAI values indicate worse health. Physical resilience was defined as accumulating fewer health deficits than the expected age-related increase in DAI over follow-up, despite exposure to chronic and acute stressors.

Results

Over a 3.2-year follow-up, 610 individuals showed physical resilience. In multivariate analyses, the odds ratio (95% confidence interval) of physical resilience for the highest versus lowest tertile (lowest adherence) of the Mediterranean Diet Adherence Screener score was 1.47 (1.10–1.98). The association held for those maintaining or improving the DAI over follow-up (over-resilience): 1.58 (1.10–2.26). Results were consistent in those with unintentional weight loss (2.21 [1.10–4.88]) or hospitalization (2.32 [1.18, 4.57]) as acute stressors.

Conclusion

In older adults, a higher adherence to the Mediterranean diet is associated with a greater likelihood of physical resilience.
Social Isolation Among Spousal and Adult-Child Caregivers: Findings From the Canadian Longitudinal Study on Aging
Authors: Li Lun , Wister Andrew V , Mitchell Barbara
Published: November 2020

Objectives

The caregiving outcomes of spousal and adult-child caregivers are widely studied since they are the most common source of support provided to adults. However, the literature on social isolation among spousal and adult-child caregivers is very limited. In order to further elaborate and specify unique caregiving outcomes, this study focuses on social isolation, both longitudinally and comparatively between spousal and adult-child caregivers.

Methods

This study was based on the Baseline and Follow-up 1 data from the Canadian Longitudinal Study on Aging. A total of 5,226 participants (1,293 spousal caregivers and 3,933 adult-child caregivers) were selected. The Linear mixed models were used to examine the effect of caregiver type and caregiving intensity on social isolation over the course of survey.

Results

Spousal and adult-child caregivers reported greater social isolation over time, and spousal caregivers exhibited a steeper increase in social isolation from Baseline to Follow-up 1 than adult-child caregivers. Also, an increase in caregiving hours resulted in greater social isolation. Finally, male spousal or adult-child caregivers were more likely to be socially isolated over time than their female counterparts.

Discussion

The findings of this study contribute to the existing literature on caregiving outcomes by demonstrating an association between family caregiving and social isolation. The results indicate a strong need for intervention programs that aim to enhance social connectedness among family caregivers, and especially for those who perform intensive caregiving, are older age, and are from a lower socioeconomic status.
Trajectories of Depressive Symptoms Experienced by Older People: Effects of Time, Hurricane Sandy, and the Great Recession
Authors: Pruchno Rachel , Wilson-Genderson Maureen , Heid Allison , Cartwright Francine
Published: November 2020

Objectives

To examine depressive symptom trajectories as a function of time and exposure to Hurricane Sandy, accounting for the effects of the Great Recession.

Methods

We analyzed 6 waves of data from a 12-year panel using latent class growth models and multinomial logistic regression.

Results

We identified 4 groups of people experiencing different trajectories of depressive symptoms. The groups differed on baseline characteristics (gender, age, education, income, race), history of diagnosed depression, and initial level of depressive symptoms. The group with the highest levels of depressive symptoms reported greater levels of peri-traumatic stress exposure to Hurricane Sandy.

Discussion

Depressive symptoms increased as a function of the Great Recession, but exposure to Hurricane Sandy was not associated with subsequent increases in depressive symptoms for any of the 4 groups. People who consistently experienced high levels of depressive symptoms over time reported the highest levels of peri-traumatic stress during Hurricane Sandy. Findings highlight the importance of accounting for historical trends when studying the effects of disaster, identify people likely to be at risk during a disaster, and provide novel information about the causal relationship between exposure to disaster and depressive symptoms.
Healthwashing in high-sugar food advertising: the effect of prior information on healthwashing perceptions in Austria
Authors: Heiss Raffael , Naderer Brigitte , Matthes Jörg
Published: November 2020

In the context of exceeding levels of sugar consumption, some food companies advertise high-sugar products using inappropriate and misleading health claims (i.e. healthwashing). To reduce sugar consumption, consumers need to recognize what these healthwashed claims are. This study investigates how prior sugar-related health information moderates the effect of exposure to healthwashed advertisements (ads) on healthwashing perceptions and how such perceptions are related to attitudes towards product consumption. We conducted a 2 × 2 online experiment with 292 adult participants in Austria. We manipulated the presence of healthwashing and participants’ prior sugar-related health information. The results indicated that exposure to healthwashed ads increased healthwashing perceptions only when the participants received additional health information prior to ad exposure, whereas no significant effect was found when the participants did not receive such prior health information. Healthwashing perceptions were then negatively related to individuals’ attitudes towards product consumption. Based on these results, the study suggests that public access to health-related information might play an important role in empowering consumers to detect inappropriate health claims and become more critical towards food companies’ underlying strategies in ads.
Individual and contextual factors associated with barriers to accessing healthcare among women in Papua New Guinea: insights from a nationwide demographic and health survey
Authors: Seidu Abdul-Aziz , Agbaglo Ebenezer , Dadzie Louis Kobina , Ahinkorah Bright Opoku , Ameyaw Edward Kwabena , Tetteh Justice Kanor
Published: November 2020

Background

This study sought to assess the individual and contextual factors associated with barriers to accessing healthcare among women in Papua New Guinea.

Methods

The study was conducted among 14 653 women aged 15–49 y using data from the 2016–2018 Papua New Guinea Demographic and Health Survey. The outcome variable was barriers to accessing healthcare. Descriptive and multilevel logistic regression analyses were conducted. Statistical significance was declared at P < 0.05.

Results

Women aged 15–19 y were more likely to experience at least one barrier compared with those aged 40–49 y (adjusted OR [AOR]=1.48; 95% CI 1.18 to 1.86). Women with secondary/higher education (AOR=0.68; 95% CI 0.57 to 0.81), women in the richest wealth quintile (AOR=0.36; 95% CI 0.28 to 0.46) and those in the least disadvantaged socioeconomic status (AOR=0.46; 95% CI 0.33 to 0.64) had lower odds of having challenges with at least one barrier to healthcare. However, living in rural areas increased the odds of facing at least one barrier to healthcare (AOR=1.87; 95% CI 1.27 to 2.77).

Conclusions

This study has demonstrated that both individual and contextual factors are associated with barriers to healthcare accessibility among women in Papua New Guinea. To enhance the achievement of the Sustainable Development Goals 3.1, 3.7 and 3.8, it is critical to deem these factors necessary and reinforce prevailing policies to tackle barriers to accessing healthcare among women in Papua New Guinea.
Digital Storytelling Project as a Way to Engage Students in Twenty-First Century Skills Learning
Authors: Lazareva Aleksandra , Cruz-Martinez Gibran
Published: November 2020

This paper is focused on the implications of a collaborative digital storytelling project on student engagement in the higher education context. The empirical study is conducted with an interdisciplinary group of bachelor students in a Nordic University (N = 22) and a university in Southern Europe (N = 21), and the data are collected through an online student survey. The results demonstrate that the digital storytelling project supported students’ behavioral, emotional, and cognitive engagement. In general, the students had positive emotional experiences with the project. This assignment format was found less stressful than a frontal presentation in the classroom, allowing the students to express their perspectives more freely and confidently. The digital storytelling format also opened up for more creative ways to approach the task. It was important for the participants to have the project assignment split up in several checkpoints with feedback from the instructor. At the same time, the students suggested several areas for further improvement. Those are mainly related to the guidance on the use of technology and scripting the learning process within the small groups. Based on the results of the study, a range of practical implications for teaching practice is formulated.
Vietnam’s Regulations to Prevent Pollution from Plastic Waste: A Review Based on the Circular Economy Approach
Authors: Dang Vu Hai , Gam Pham Thi , Xuan Son Nguyen Thi
Published: November 2020

There is a big challenge in policymaking relating to plastic management in Vietnam: Vietnam is the one of the biggest global dischargers of plastic waste into the ocean, but the country also has a high demand for plastic for economic development. Recently, Vietnam has adopted the National Action Plan for the Management of Marine Plastic Litter by 2030. According to this Plan, Vietnam would take a circular economy approach in dealing with plastic. This article reviews Vietnamese regulations to prevent the pollution from plastic waste to see whether they support the implementation of the circular economy approach in plastic management and whether they are effective in preventing plastic waste pollution. Based on the review, recommendations are made to strengthen Vietnam’s legal retgime for the prevention of pollution from plastic waste.
Understanding How Perfectionism Impacts Intensive Interdisciplinary Pain Treatment Outcomes: A Nonrandomized Trial
Authors: Randall Edin T , Cole-Lewis Yasmin C , Petty Carter R , Jervis Kelsey N
Published: November 2020

Objective 

Several factors are known to impact response to the intensive interdisciplinary pain treatment (IIPT) program described in this study, yet no research has explored the role of perfectionism. This secondary data analysis explored direct and indirect relations between perfectionism and functional disability (primary outcome) and pain severity (secondary outcome) after IIPT, with pain catastrophizing and fear of pain as mediators.

Methods 

Youth (N = 253) aged 8–21 with chronic pain and associated disability completed pre- and post-IIPT measures of self-oriented perfectionism (SOP), socially prescribed perfectionism (SPP), pain catastrophizing, fear of pain, functional disability, and pain characteristics for routine clinical care and this nonrandomized trial. Eight mediated models were run for the two predictors, two mediators, and two outcomes.

Results 

Pretreatment perfectionism (SOP and SPP) led to greater reductions in pain catastrophizing over the course of IIPT, which resulted in lower pain severity (β = −.02 [CI = −0.07, −0.01] for SOP and β = −.02 [CI = −0.06, −0.003] for SPP) and less functional disability (β = −.06 [CI = −0.13, −0.01] for SOP and β = −.06 [CI = −0.14, −0.01] for SPP). Independent of pain catastrophizing, pretreatment SPP was directly associated with more posttreatment functional disability (β = .16 [CI = 0.05, 0.27]). Fear of pain was not a mediator.

Conclusions 

Findings suggest perfectionism has the potential to negatively impact IIPT outcomes. However, when perfectionistic youth with chronic pain learn to manage pain-related distress, they benefit. Results highlight the importance of assessing for and treating perfectionism and pain-related distress in youth with chronic pain.
A patient with chronic fingertip pain
Authors: Geoghegan Luke , Knowles Billie-Georgina , Nikkhah Dariush
Published: November 2020

Isolated chronic fingertip pain is an uncommon presentation with a broad differential diagnosis, including but not limited to, subungal neuroma, subungal haematoma, subungal exostosis and glomus tumour. We present an interesting case of a young lady with debilitating chronic fingertip pain diagnosed with a glomus tumour of her right index finger. Surgical excision provided complete resolution from pain, return to work and restoration of quality of life. Here we discuss clinical and radiological features of this rare benign neoplasm.
2D kinematics of massive stars near the Galactic Centre
Authors: Libralato Mattia , Lennon Daniel J , Bellini Andrea , van der Marel Roeland , Clark Simon J , Najarro Francisco , Patrick Lee R , Anderson Jay , Bedin Luigi R , Crowther Paul A , de Mink Selma E , Evans Christopher J , Platais Imants , Sabbi Elena , Sohn Sangmo Tony
Published: November 2020

The presence of massive stars (MSs) in the region close to the Galactic Centre (GC) poses several questions about their origin. The harsh environment of the GC favours specific formation scenarios, each of which should imprint characteristic kinematic features on the MSs. We present a 2D kinematic analysis of MSs in a GC region surrounding Sgr A* based on high-precision proper motions obtained with the Hubble Space Telescope. Thanks to a careful data reduction, well-measured bright stars in our proper-motion catalogues have errors better than 0.5 mas yr−1. We discuss the absolute motion of the MSs in the field and their motion relative to Sgr A*, the Arches, and the Quintuplet. For the majority of the MSs, we rule out any distance further than 3–4 kpc from Sgr A* using only kinematic arguments. If their membership to the GC is confirmed, most of the isolated MSs are likely not associated with either the Arches or Quintuplet clusters or Sgr A*. Only a few MSs have proper motions, suggesting that they are likely members of the Arches cluster, in agreement with previous spectroscopic results. Line-of-sight radial velocities and distances are required to shed further light on the origin of most of these massive objects. We also present an analysis of other fast-moving objects in the GC region, finding no clear excess of high-velocity escaping stars. We make our astro-photometric catalogues publicly available.
The role of mergers and interactions in driving the evolution of dwarf galaxies over cosmic time
Authors: Martin G , Jackson R A , Kaviraj S , Choi H , Devriendt J E G , Dubois Y , Kimm T , Kraljic K , Peirani S , Pichon C , Volonteri M , Yi S K
Published: November 2020

Dwarf galaxies (M⋆ < 109 M⊙) are key drivers of mass assembly in high-mass galaxies, but relatively little is understood about the assembly of dwarf galaxies themselves. Using the NewHorizon cosmological simulation (∼40 pc spatial resolution), we investigate how mergers and fly-bys drive the mass assembly and structural evolution of around 1000 field and group dwarfs up to z = 0.5. We find that, while dwarf galaxies often exhibit disturbed morphologies (5 and 20 per cent are disturbed at z = 1 and z = 3 respectively), only a small proportion of the morphological disturbances seen in dwarf galaxies are driven by mergers at any redshift (for 109 M⊙, mergers drive under 20 per cent morphological disturbances). They are instead primarily the result of interactions that do not end in a merger (e.g. fly-bys). Given the large fraction of apparently morphologically disturbed dwarf galaxies which are not, in fact, merging, this finding is particularly important to future studies identifying dwarf mergers and post-mergers morphologically at intermediate and high redshifts. Dwarfs typically undergo one major and one minor merger between z = 5 and z = 0.5, accounting for 10 per cent of their total stellar mass. Mergers can also drive moderate star formation enhancements at lower redshifts (3 or 4 times at z = 1), but this accounts for only a few per cent of stellar mass in the dwarf regime given their infrequency. Non-merger interactions drive significantly smaller star formation enhancements (around two times), but their preponderance relative to mergers means they account for around 10 per cent of stellar mass formed in the dwarf regime.
Using Smartphone-Based Accelerometer Data to Objectively Assess Outcomes in Spine Surgery
Authors: Basil Gregory W , Sprau Annelise C , Eliahu Karen , Borowsky Peter A , Wang Michael Y , Yoon Jang W
Published: November 2020

BACKGROUND

In order to deliver optimal patient care, spine surgeons must integrate technological changes to arrive at novel measures of functional outcomes. Historically, subjective patient-reported outcome (PRO) surveys have been used to determine the relative benefit of surgical treatments. Using smartphone-based accelerometers, surgeons now have the ability to arrive at objective outcome metrics.

OBJECTIVE

To use Apple Health (Apple Inc, Cupertino, California) data to approximate physical activity levels before and after spinal fusion as an objective outcome measurement.

METHODS

Personal activity data were acquired retrospectively from the cellphones of consenting patients. These data were used to measure changes in activity level (daily steps, flights climbed, and distance traveled) before and after patients underwent spine surgery at a single institution by a single surgeon. After data collection, we investigated the demographic information and daily physical activity pre- and postoperatively of participating patients.

RESULTS

Twenty-three patients were included in the study. On average, patients first exceeded their daily 1-yr average distance walked, flights climbed, and steps taken at 10.3 ± 14, 7.6 ± 21.1, and 8 ± 9.9 wk, respectively. Mean flights climbed, distance traveled, and steps taken decreased significantly from 6 mo prior to surgery to 2 wk postoperatively. Distance traveled and steps taken significantly increased from 6 mo prior to surgery to 7 to 12 mo postoperatively.

CONCLUSION

We demonstrated a valuable supplement to traditional PROs by using smartphone-based activity data. This methodology yields a rich data set that has the potential to augment our understanding of patient recovery.
Fresh street: the development and feasibility of a place-based, subsidy for fresh fruit and vegetables
Authors: Relton C , Crowder M , Blake M , Strong M
Published: November 2020

Background

Many UK communities experience food insecurity, and consume diets high in energy-dense, nutrient poor, processed foods and low in fruit and vegetables (FV). We explored a novel area-based approach to promote FV consumption and healthy eating in one such community.

Methods

We developed a weekly subsidy scheme for fresh FV with key local stakeholders in an area of socioeconomic deprivation in Northern England. The scheme (Fresh Street) offered five £1 vouchers to every household, regardless of income or household type. Vouchers were redeemable with local suppliers of fresh FV (not supermarkets). The feasibility of the scheme was assessed in four streets using rapid ethnographic assessment and voucher redemption information.

Results

Local councillors and public health teams were supportive of the scheme. Most eligible households joined the scheme (n = 80/97, 83%), and 89.3% (17 849/19 982) of vouchers issued were redeemed. Householders reported that the scheme made them think about what they were eating, and prompted them to buy and eat more FV.

Conclusions

This feasibility study reported high levels of acceptance for a place-based, household-level weekly FV subsidy scheme. Further research is required to evaluate the effectiveness of this approach to creating healthy diets, eating behaviours and food systems.
The role of interleukin-6 trans-signalling on cardiovascular dysfunction in inflammatory arthritis
Authors: Davies Ruth , Williams Jessica , Sime Katie , Jin Hyun-Sun , Thompson Charlotte , Jordan Lauren , Lang Derek , Halcox Julian P , Ellins Elizabeth , Jones Gareth W , Jones Simon A , Rose-John Stefan , Williams Anwen , Choy Ernest
Published: November 2020

Objectives

Cardiovascular (CV) mortality in RA patients is 50% higher than in the general population. There is increasing recognition that systemic inflammation is a major driver of this. IL-6 is implicated in cardiovascular disease (CVD) in the general population but its role in CVD in RA is undefined. Of the two modes of IL-6 signalling, trans-signalling is pro-inflammatory whereas classical signalling is linked with inflammation resolution. This study examines the role of IL-6 trans-signalling in CVD in a mouse model and patients with RA.

Methods

Myography determined the effect of IL-6 trans-signalling blockade, using sgp130Fc, on aortic constriction in murine collagen-induced arthritis. Serum CCL2 and sVCAM-1 as soluble biomarkers of sIL-6R trans-signalling were investigated in a human cross-sectional study. An observational longitudinal study investigated the association between these biomarkers and progression of subclinical atherosclerosis in early RA by measuring carotid intima-media thickness (CIMT).

Results

sgp130Fc reduced arthritis severity, serum CCL2 and sVCAM-1 and restored vascular function in collagen-induced arthritis (CIA). In established RA, sVCAM-1 correlated with the 28-joint DAS (DAS28) and CV risk. In early RA, baseline DAS28 was associated with CIMT change at 6 months. CIMT ‘rapid progressors’ at 12 months had higher baseline sVCAM-1, haemoglobin A1c, cholesterol:high-density lipoprotein cholesterol ratio and LDL cholesterol.

Conclusions

IL-6 trans-signalling plays a pivotal role in vascular dysfunction in CIA. In early RA, sVCAM-1 was associated with progression of subclinical atherosclerosis. Inflammation from RA onset in CVD-susceptible individuals may accelerate atherosclerosis. IL-6 trans-signalling blockade may be beneficial to RA patients and perhaps for atherosclerosis in the general population.
Measuring disease activity in psoriatic arthritis: PASDAS implementation in a tightly monitored cohort reveals residual disease burden
Authors: Mulder Michelle L M , van Hal Tamara W , van den Hoogen Frank H J , de Jong Elke M  G  J   , Vriezekolk Johanna E , Wenink Mark H
Published: November 2020

Objectives

We aimed to investigate the disease activity and overall disease burden of (subgroups of) patients with PsA using the Psoriatic Arthritis Disease Activity Score (PASDAS) in an already tightly monitored cohort.

Methods

This is a cross-sectional study evaluating data from the first visit of 855 PsA patients after implementation of the PASDAS in our tightly monitored cohort [e.g. DAS 28 (DAS28) was provided as an anchor]. Differences in clinical outcomes between subgroups of patients using established cut-offs for disease activity status [i.e. very low (VLDA), low (LDA), moderate (MDA), and high disease activity (HDA)] were examined.

Results

Based on the PASDAS, 53.1% of patients were in VLDA/LDA. 29.5% of patients had ≥1 swollen joint, 20.6% had ≥1 enthesitis index point and 3.0% had active dactylitis. Based on DAS28, 77.5% of the patients were in VLDA/LDA. Patients reaching both DAS28 VLDA/LDA status and PASDAS VLDA/LDA status [N = 445 (52.0%)] were compared with patients reaching only DAS28 VLDA/LDA status [N = 218 (25.5%)]. For these latter patients, significantly worse scores on separate parameters were found in measures used for PASDAS/DAS28 calculation (e.g. swollen and tender joint count and patient’s visual analogue scale global disease activity) as well as other disease measures (e.g. function and inflammatory back pain). This result remained, even when the stricter VLDA cut-off was used for the DAS28.

Conclusion

PASDAS implementation uncovered relevant residual disease activity in a quarter of patients previously assessed as being in DAS28 VLDA/LDA, underscoring the potential value of PASDAS measurements in PsA clinical care.
Alternate Dosing Protocol for Magnesium Sulfate in Obese Women With Preeclampsia
Authors: Brookfield Kathleen F. , Tuel Kierstyn , Rincon Monica , Vinson Abbie , Caughey Aaron B. , Carvalho Brendan
Published: November 2020

OBJECTIVE:

To evaluate whether obese women need greater doses of magnesium sulfate to obtain therapeutic serum concentrations for eclamptic seizure prevention.

METHODS:

Women with preeclampsia and a body mass index (BMI) of 35 or higher were randomly allocated to either the Zuspan regimen of magnesium sulfate (4-g intravenous [IV] loading dose, then a 1-g/h infusion) or to alternate dosing (6-g IV loading dose, then a 2-g/h infusion). Women had serum magnesium concentrations obtained at baseline, as well as after administration of magnesium sulfate at 1 hour, 4 hours, and delivery. The primary outcome was the proportion of women who had subtherapeutic serum magnesium concentrations (less than 4.8 mg/dL) 4 hours after administration. A sample size of 18 women per group was planned to compare the proportion of women with subtherapeutic serum magnesium concentrations in each group.

RESULTS:

From July 12, 2016, to March 14, 2019, 89 women with preeclampsia were screened and 37 were enrolled: 18 to the Zuspan regimen and 19 to the alternate regimen. A significantly greater proportion of women administered the Zuspan regimen had subtherapeutic serum magnesium concentrations at 4 hours (100% [95% CI 59–100] vs 63% [95% CI 41–81]; P=.01) compared with women administered the alternate higher dose regimen. At 4 hours, mean concentrations were significantly higher in the alternate regimen group (3.53 mg/dL±0.3 [Zuspan regimen] vs 4.41±0.5 [alternate regimen]; P<.01).

CONCLUSION:

The alternate dosing regimen of a 6-g IV loading dose followed by a 2-g/h IV maintenance dose more reliably achieves therapeutic serum magnesium concentrations (as defined by a concentration of at least 4.8 mg/dL) in obese women with preeclampsia.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02835339.
Private Equity Investments in Women's Health and Obstetrics and Gynecology Practices
Authors: Reddy Rajesh
Published: November 2020

Private equity has evolved into a major force in health care, with deal values and volumes rising year-over-year as these firms purchase hospital systems and physician groups. Historically, these investors have played an outsized role in highly reimbursed specialties such as dermatology and anesthesia. Private equity is relatively new to women's health; when it has invested in this sector, it has typically done so in fertility services. In recent years, however, private equity firms have ventured into general obstetrics and gynecology, drawn by its promise of steady returns, its fragmented landscape, and the potential to integrate related laboratory, ultrasound, and fertility services into obstetric care. Obstetrics and gynecology practices may soon face the prospect of acquisition by private equity firms offering professional management, centralized back-office functions, streamlined customer service, and the capital needed to reach a broader patient base. However, physicians may have concerns about the tradeoffs that accompany private equity acquisitions. Private equity–owned practices have been known to increase the use of lucrative services, deploy advanced practice professionals in place of physicians, and circumvent conflict-of-interest laws, potentially distorting clinical care and driving up costs for consumers. Furthermore, firms generally aim to exit their investment within a 3- to 7-year timeframe, and short-term growth plans may leave physician-owners with uncertain long-term management. As private equity makes headway into women's health, physicians and policymakers must pay closer attention to how this activity can change practice patterns and transform local health care markets while also demanding transparency in the process.
Safety and Feasibility of Discharge Without an Opioid Prescription for Patients Undergoing Gynecologic Surgery
Authors: Margolis Benjamin , Andriani Leslie , Baumann Katherine , Hirsch Anna M. , Pothuri Bhavana
Published: November 2020

OBJECTIVE:

To implement a quality-improvement intervention aimed at reducing unnecessary opioid prescriptions for patients who are undergoing gynecologic surgery.

METHODS:

This was a retrospective cohort study that included data from the pre– and post–quality-improvement initiative cohorts. Patients at an urban, tertiary academic medical center who were undergoing scheduled minimally invasive surgery and open abdominal surgery by a gynecologic oncologist were included. Patients underwent preoperative counseling, standardization of perioperative analgesia, and a postoperative opioid prescribing algorithm. Descriptive statistics were calculated for demographic and perioperative characteristics, process measures, and outcome measures.

RESULTS:

A total of 532 abdominal surgeries were analyzed. The total percentage of patients discharged with an opioid prescription decreased from 82.7% (n=229/276) to 23.1% (n=59/256) (P<.001) and was significantly reduced for all routes of surgery. The mean number of opioid tablets prescribed for all patients was significantly reduced from 7.2 tablets (SD=5.7) to 1.8 tablets (SD=4.3) (P<.001). Eighty-three percent of patients (n=97/117) who underwent minimally invasive hysterectomy and were discharged on postoperative day 0 or day 1 were not provided an opioid prescription. Fifty-one percent of patients who underwent laparotomy were discharged without an opioid prescription. The percentage of patients who required an opioid refill or new prescription in the preintervention and postintervention cohorts remained constant (6.5%, n=18/276 vs 5.9%, n=15/256, P=.75), as did postoperative calls for pain (8.3%, n=23/276 vs 10.9%, n=33/256).

CONCLUSION:

Patients who are undergoing scheduled abdominal gynecologic surgery can be safely discharged without opioid prescriptions with appropriate education and perioperative analgesia prescribing practices. These protocols and prescribing practices profoundly limit opioid prescriptions, which is an important factor in combating the ongoing opioid crisis.
Effect of Fasting on Total Bile Acid Levels in Pregnancy
Authors: Smith Devin D. , Kiefer Miranda K. , Lee Alan J. , Davis Sarah B. , Summerfield Taryn L. , Landon Mark B. , Rood Kara M.
Published: November 2020

OBJECTIVE:

To evaluate differences between fasting and nonfasting bile acid levels in asymptomatic and symptomatic pregnant women.

METHODS:

This is a report of two prospective cohort studies describing bile acid levels in the fasting and nonfasting state in pregnancy. The first cohort included asymptomatic women with singleton pregnancies. Women with a diagnosis of cholestasis, symptoms of cholestasis, or intolerance to components of a standardized meal were excluded. Bile acid levels were measured during the second and third trimesters after fasting and again 2 hours after a standardized meal. The second cohort included symptomatic women with singleton pregnancies in whom fasting and nonfasting bile acid levels were measured at the time of symptom evaluation. A cutoff of 10 micromoles/L was used for diagnosis.

RESULTS:

A total of 27 women were included in the asymptomatic cohort. Median [interquartile range] fasting bile acid levels were significantly lower than nonfasting levels in both the second trimester (4.65 micromoles/L [1.02–29.57] vs 13.62 micromoles/L [2.03–40.26]; P<.001) and third trimester (8.31 micromoles/L [1.14–51.26] vs 17.35 micromoles/L [1.77–62.93]; P<.001). Bile acid levels exceeded 10 micromoles/L in 21% of the fasting samples and in 58% of the nonfasting samples in the third trimester. A total of 26 women were included in the symptomatic cohort. Median [interquartile range] fasting bile acid levels were significantly lower than nonfasting values (11.5 micromoles/L [7–56] vs 13.5 micromoles/L [9–142]; P<.001). Six patients in the symptomatic cohort (23%) had nonfasting bile acid levels greater than 10 micromoles/L that dropped below 10 micromoles/L when fasting.

CONCLUSION:

Fasting bile acid levels are significantly lower when compared with nonfasting values in both asymptomatic and symptomatic pregnant women. In asymptomatic women, nonfasting bile acid levels often exceeded 10 micromoles/L whereas fasting values did not. In symptomatic women, fasting bile acid levels resulted in 23% fewer diagnoses of cholestasis when compared with nonfasting values. These findings suggest that fasting evaluation of bile acid levels or a higher threshold for diagnosis of cholestasis should be considered.
Fertility-Sparing Treatment for Early-Stage Cervical, Ovarian, and Endometrial Malignancies
Authors: Nitecki Roni , Woodard Terri , Rauh-Hain J. Alejandro
Published: November 2020

Approximately 20% of gynecologic malignancies are diagnosed in reproductive-aged women, and standard-of-care surgical treatment often precludes future fertility. In early-stage disease, shared decision making about fertility-sparing medical and surgical approaches may give well-selected patients the opportunity to pursue their family-building goals without compromising long-term survival. Although future fertility is an important consideration for young women with cancer, rates of fertility-sparing procedures remain low. Moreover, because data on pregnancy rates and outcomes after fertility-sparing treatments are limited, it is challenging to counsel patients on realistic expectations. This review examines the critical oncologic outcomes of fertility-sparing approaches in early-stage gynecologic malignancies and highlights pregnancy outcomes in this population.
Cesarean Delivery and Gender of Delivering Physicians
Authors: Hoxha Ilir , Sadiku Fitim , Lama Arber , Bunjaku Genta , Agahi Riaz , Statovci Jeta , Bajraktari Ilirjana
Published: November 2020

OBJECTIVE:

To assess the association of the gender of the delivering physician and the odds of performing cesarean delivery.

DATA SOURCES:

CINAHL, ClinicalTrials.gov, Cochrane Library, PubMed, Scopus and Web of Science from the first year of records through May 2020.

METHODS OF STUDY SELECTION:

We included studies that reported odds ratios (OR), or data allowing the calculation of ORs, for cesarean delivery performed by female and male delivering physicians. We also included studies that reported the preference of physicians for performing cesarean deliveries.

TABULATION, INTEGRATION, AND RESULTS:

Independent data extraction was carried out by at least two researchers. Standard inverse-variance random effects meta-analysis was used to generate overall ORs. Finally, in two separate meta-analyses, we analyzed 15 studies containing clinical data for 1,269,625 births, and 11 studies containing data for the preference for delivery mode of 4,911 obstetricians. Both the crude and adjusted odds of a cesarean delivery were lower for those performed by female physicians (crude OR 0.75, 95% CI 0.68–0.84, τ2=0.029, adjusted OR 0.74, 95% CI 0.65–0.85, τ2=0.031). We also found that female physicians had a lower preference for cesarean delivery in both crude and adjusted analysis (crude OR 0.59, 95% CI 0.36–0.96, I2=77%, adjusted OR 0.58, 95% CI 0.40–0.84, I2=67%).

CONCLUSION:

Female physicians are less likely to perform cesarean delivery and less likely to prefer it. This was observed across different health systems and populations.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42020158442.
Laser refractive surgery in corneal dystrophies
Authors: Rocha-de-Lossada Carlos , Rachwani-Anil Rahul , Colmenero-Reina Elvira , Borroni Davide , Sánchez-González José-María
Published: November 2020

Twenty-eight case reports and case series published between 2000 and 2019 concerning laser refractive surgery in patients with corneal dystrophies, resulting in 173 eyes from 94 patients, were included in this systematic review. Best results were achieved in posterior corneal polymorphous and Cogan dystrophy. Unfavorable results were found in Avellino dystrophy and Fuchs endothelial corneal dystrophy (FECD). Photorefractive keratectomy was not indicated in Meesmann and Avellino dystrophy. Laser in situ keratomileusis was indicated in posterior polymorphous corneal dystrophy but not in FECD, Avellino, or Cogan dystrophy. Small-incision lenticule extraction and other dystrophies such as lattice, fleck, Lisch, or François did not achieve enough scientific evidence to report any recommendation.
Results of thin-cap small-incision lenticule extraction
Authors: Taneri Suphi , Arba-Mosquera Samuel , Rost Anika , Hansson Caroline , Dick H. Burkhard
Published: November 2020

Purpose:

To evaluate the influence of a thin cap in small-incision lenticule extraction (SMILE) for the correction of myopia or myopic astigmatism.

Setting:

Tertiary care private practice.

Methods:

A chart review of 102 eyes of 51 patients was performed. The effect of 120 µm vs 100 μm cap thickness on postoperative spherical equivalent refraction (SEQ), cylinder, corrected and uncorrected visual acuities, and ease of lenticule separation was assessed in a contralateral manner, whereas all other parameters were identical between eyes (including optical zone, minimum lenticule thickness, incision size, and energy and spot settings) using paired t test.

Results:

At 3 months postoperatively, SMILE with 120 μm cap thickness was undercorrected in SEQ relative to SMILE with 100 μm cap thickness in a cohort of 102 eyes of 51 consecutive patients. The difference of 0.06 ± 0.39 diopter (or 0.7% ± 5.7%) did not reach statistical significance. Postoperative cylinder was not statistically different in both groups. Visual acuity was similar in both groups. Ease of lenticule separation was identical in both groups. Suction time was shorter with a 100 μm cap (P < .005). Postoperative central residual stromal thickness was 20 ± 15 μm thicker with a 100 μm cap (P < .0001). Adverse events were comparable.

Conclusions

Postoperative refraction, visual acuity, ease of lenticule separation, and incidence of adverse events were not significantly affected by cap thickness. Surgeons might safely use 100 μm instead of 120 μm caps without nomogram adjustment. Alternatively, after suction loss during the lenticule cut, a second docking with a programmed cap thickness of 100 μm (and a larger optical zone) might be a rescue technique enabling surgeons to still perform the intended SMILE procedure.
Cataract surgery after myopic laser in situ keratomileusis: objective analysis to determine best formula and keratometry to use
Authors: Sandoval Helga P. , Serels Chad , Potvin Richard , Solomon Kerry D.
Published: November 2020

Purpose:

To objectively determine which formula/keratometry combination was best for calculating intraocular lens (IOL) sphere power in eyes with a history of myopic laser in situ keratomileusis (LASIK).

Setting:

One practice in the United States.

Design:

Retrospective, unmasked, nonrandomized chart review.

Methods:

Consecutive patients undergoing cataract surgery after previous myopic LASIK were included. Eyes had to have a postoperative refraction at least 3 weeks postoperatively. IOL power was calculated with the ASCRS online postrefractive IOL calculator using anterior keratometry and recalculated using total corneal power (TK). The accuracy of treatment was calculated and compared between different formulas and keratometry methods including intraoperative aberrometry (IA).

Results:

Data from 101 eyes, 44 of which had TK available, were analyzed. Using TK, the Wang-Koch-Maloney formula had the highest percentages of eyes with expected spherical equivalent refractive errors within 0.50 diopter (D) and 1.00 D of plano (57% and 87%, respectively). With anterior keratometry, the Barrett True-K formula had the highest percentages (64% and 92%, respectively) but was not significantly better than the Wang-Koch-Maloney formula, with expected errors within ±0.50 and ±1.00 D (P > .2, McNemar test). Expected sphere results based on IA were not significantly different than for Barrett True-K within ±0.50 D or within ±1.00 D (P > .2, McNemar test).

Conclusions:

Using TK in existing post-LASIK formulas did not seem beneficial. The formulas might have to be optimized for use with TK. The best expected results were obtained with the Barrett True-K and Haigis-L formulas using anterior keratometry. IA did not seem to materially improve results.
Visceral leishmaniasis in patients with lymphoma
Authors: Kalmi Galith , Vignon-Pennamen Marie-Dominique , Ram-Wolff Caroline , Battistella Maxime , Lafaurie Mathieu , Bouaziz Jean-David , Hamane Samia , Bernard Sophie , Bretagne Stéphane , Thiéblemont Catherine , Bagot Martine , de Masson Adèle
Published: November 2020

Introduction:

Non–HIV-related visceral leishmaniasis (VL) is becoming increasingly prevalent in nontropical countries because of the increasing number of patients with chronic diseases and the development of immune-modulating drugs.

Patient concerns:

Case 1 is a 60-year-old male patient of Senegalese origin presented with weight loss, lymphadenopathy, anemia, and elevated lactate dehydrogenases. Case 2 is a 46-year-old male patient of Algerian origin, with a negative HIV serology presented with cutaneous lesions.

Diagnosis:

Patient 1: The diagnosis of stage IV lymphocytic lymphoma (LL) was confirmed by an inguinal nodal biopsy in 2013. Patient 2: The diagnosis of T-cell lymphoma was made in 2003.

Interventions:

Patient 1 received 5 cycles of bendamustine and rituximab followed by a complete remission. Patient 2 was initially treated with >10 different treatments followed by 8 different chemotherapy regimens due to the disease progression.

Outcomes:

Patient 1: In 2017, after a follow-up of 4 years, the patient presented with fever, lymphadenopathy, splenomegaly, and pancytopenia in the setting of hemophagocytic syndrome. The initial diagnosis was a relapse of lymphoma and the patient was treated with ibrutinib. His status worsened, and Leishmania DNA was detected by polymerase chain reaction (PCR) on the blood and bone marrow aspirates. Ibrutinib was stopped. Amphotericin B treatment induced a complete clinical remission and clearance of Leishmania DNA from the blood.

Patient 2: In 2017, after a follow-up of 14 years, the patient presented with fever, lymphadenopathy, hepatosplenomegaly, pancytopenia with hemophagocytic syndrome, and an increase in the tumor skin lesions. A skin biopsy was taken from the face and the patient. A careful reexamination of the skin biopsy revealed the presence of Leishmania bodies. He was treated with 40 mg/kg liposomal amphotericin B leading to a regression of the clinical symptoms and negativation of the blood PCR.

Conclusions:

This case study shows that VL may be a diagnostic challenge in patients with lymphoma. Reactivation or primary infection should be considered in the differential diagnosis. The purpose of this study is to remind clinicians to think of VL in patients with systemic symptoms that could be misdiagnosed as a progression of the underlying lymphoma.
Primitive neuroectodermal tumor of urinary bladder
Authors: Gao Liang , Xie Wenjie , Li Kun , Huang Gaomin , Ji Yuanhai , Ou Yangkang , Chen Jie
Published: November 2020

Rationale:

Primitive neuroectodermal tumor (PNET) of the urinary bladder is a highly aggressive tumor with high local recurrence and distant metastasis rates in cases of incomplete excision. We report a case of a young female patient, in whom early laparoscopic radical cystectomy combined with standard lymph node dissection and a modified vincristine, doxorubicin hydrochloride, and cyclophosphamide (VAC) chemotherapy regimen was controversial. Because PNET of the urinary bladder is a rare malignancy, the standard treatment regimen has not yet been established. It is not clear whether surgery combined with postoperative chemotherapy for PNET patients may be superior to surgery alone on long term survival.

Patient concerns:

The patient was a 45-year-old Chinese woman who complained of lower urinary tract symptoms, including urgency, frequency, and difficulty in urination, for 2 months.

Diagnoses:

PNET.

Interventions:

The patient underwent laparoscopic radical cystectomy and standard lymph node dissection, combined with modified VAC chemotherapy regimens.

Outcomes:

After undergoing radical surgery in 2018, the patient completed 6 courses of adjuvant chemotherapy. Abdominal and thorax computed tomography scanning was performed 3, 6, 9, and 12 months after the surgery was completely free of tumor. The patient is still alive with no signs of recurrent disease 2 years after diagnosis.

Lessons:

Radical surgery and standard lymphadenectomy combined with adjuvant chemotherapy may be essential to improve the prognosis of PNET of the urinary bladder.
A Learning Health System for Pediatric Liver Transplant
Authors: Perito Emily R. , Squires James E. , Bray David , Bucuvalas John , Krise‐Confair Cassandra , Eisenberg Elizabeth , Gonzalez‐Peralta Regino P. , Gupta Nitika , Hsu Evelyn K. , Kosmach‐Park Beverly , Lobritto Steven , Logan Beth , Mohammad Saeed , Ng Vicky L. , Pillari Tony , Rasmussen Sara , Shemesh Eyal , Soltys Kyle , Szolna Jonathan , Superina Riccardo , Tunno John , Mazariegos George V.
Published: November 2020

Objective:

Learning health systems (LHS) integrate research, improvement, management, and patient care, such that every child receives “the right care at the right time…every time,” that is, evidence‐based, personalized medicine. Here, we report our efforts to establish a sustainable, productive, multicenter LHS focused on pediatric liver transplantation.

Methods:

The Starzl Network for Excellence in Pediatric Transplantation (SNEPT) is the first multicenter effort by pediatric liver transplant families and providers to develop shared priorities and a shared agenda for innovation in clinical care. This report outlines SNEPT's structure, accomplishments, and challenges as an LHS.

Results:

We prioritized 4 initial projects: immunosuppression, perioperative anticoagulation, quality of life, and transition of care. We shared center protocols/management to identify areas of practice variability between centers. We prioritized actionable items that address barriers to providing “the right care at the right time” to every pediatric liver transplant recipient: facilitating transparency of practice variation and the connection of practices to patient outcomes, harnessing existing datasets to reduce the burden of tracking outcomes, incorporating patient‐reported outcomes into outcome metrics, and accelerating the implementation of knowledge into clinical practice. This has allowed us to strengthen collaborative relationships, design quality improvement projects, and collect pilot data for each of our priority projects.

Conclusions:

The field of pediatric liver transplantation can be advanced through application of LHS principles. Going forward, SNEPT will continue to unite patient advocacy, big data, technology, and transplant thought leaders to deliver the best care, while developing new, scalable solutions to pediatric transplantation's most challenging problems.