bluuebunny/crossref_metadata_2025 huggingface dataset:
Mental Health and Quality of Life Among Adults With Single, Multiple, and No Religious Affiliations
Authors: Peres Mario Fernando Prieto , Swerts Diego , de Oliveira Arão Belitardo , Leão Frederico Camelo , Lucchetti Alessandra Lamas Granero , Vallada Homero , de Oliveira Maraldi Everton , Toniol Rodrigo , Lucchetti Giancarlo
Published: January 2020

Few studies have investigated the “multiple religious affiliations” phenomenon. This study aims to understand those with “multiple religious affiliations,” describing its prevalence and investigating if there are differences in mental health and quality of life between this group and those with a single religious affiliation and those with no religious affiliation. A total of 1169 adults were included, and 58% had a single religious affiliation, 27.7% had multiple religious affiliations, and 12.3% had no religious affiliation. Participants with a single religious affiliation presented better mental health and quality of life than those with multiple or no religious affiliations. Although most outcomes were similar between multiple and no religious affiliations, happiness and optimism were higher in the multiple religious group, and anxiety was lower in the no religious group. Health care professionals should be aware of the secondary religious affiliations of their patients to identify possible conflicts and to treat them comprehensively.
Predicting Patients' Readmission
Authors: Zanovello Sofia , Donisi Valeria , Tedeschi Federico , Ruggeri Mirella , Moretti Francesca , Rimondini Michela , Amaddeo Francesco
Published: January 2020

This study explores whether clinicians or a statistical model can better identify patients at risk of early readmission and investigates variables potentially associated with clinicians' risk judgment. We focus on a total of 142 patients discharged from acute psychiatric wards in the Verona Mental Health Department (Italy). Psychiatrists assessed patients' risk of readmission at 30 and 90 days postdischarge, predicted their postdischarge compliance, and assessed their Global Assessment of Functioning (GAF) score at admission and discharge. Clinicians' judgment outperformed the statistical model, with the difference reaching statistical significance for 30-day readmission. Clinicians' readmission risk judgment, both for 30 and 90 days, was found to be statistically associated with predicted compliance with community treatment and GAF score at discharge. Clinicians' superior performance might be explained by their risk judgment depending on nonmeasurable factors, such as experience and intuition. Patients with a poorer GAF score at discharge and poor assumed compliance were predicted to have a higher risk of readmission.
The Impact of Mindfulness Strategies for Nurses in a Residency Program
Authors: Bruette Brooke , Vandenhouten Christine L. , Willems Sherry , Nelson Ken
Published: January 2020

The purpose of this pilot study was to evaluate the impact of mindfulness education of new graduate nurse residents’ awareness and use of mindfulness strategies. This pre–post education design study was approved by the university institutional review board. Mindfulness has been shown to improve focus on patient care and reduce job stress and nurse turnover. Improved awareness and use of mindfulness strategies have the potential to improve patient outcomes and reduce the cost of nurse turnover.
Unifying Nursing Education Across the Care Continuum
Authors: Mangold Kara
Published: January 2020

Patients with complex healthcare needs, such as those undergoing organ transplantation, must receive consistent care and patient education across the care continuum for successful self-management. A coordinated effort to unify nursing education across acute care and ambulatory practices was successful; benefits included reduction in redundancy of effort on the part of nursing professional development specialists and assured compliance with regulatory requirements. The nursing professional development standards of practice were essential in guiding this program to success.
Creating a Sustainable Palliative Care Education Conference for Healthcare Professionals
Authors: Price Deborah M. , Wyse Diane M. , Conrad Christine M. , Harden Karen L. , Montagnini Marcos , Ghosh Bidisha
Published: January 2020

An interprofessional conference that addressed basic palliative care knowledge and skills was implemented annually at a large, academic healthcare institution. The conference significantly influenced participant’s self-perceived competencies in the delivery of quality palliative care. This conference led to a sustainable program of palliative care initiatives consisting of a yearly workshop for nurses focused on palliative care core competencies and a biennial interprofessional conference designed to facilitate networking and address significant topics in palliative care.
Prediction of Smoking Abstinence in Women Living With Human Immunodeficiency Virus Infection
Authors: Kim Sun S. , Cooley Mary E. , Lee Sang A , DeMarco Rosanna F.
Published: January 2020

Background

This study examined whether baseline negative emotional states (depression and anxiety) would predict craving for cigarettes and other nicotine withdrawal symptoms in early abstinence and whether those emotional states and withdrawal symptoms would predict failure in quitting smoking at 3 months postquit among U.S. women living with the human immunodeficiency virus (HIV).

Method

The study is a secondary analysis of data from two smoking cessation studies of women living with HIV. Craving for cigarettes and other withdrawal symptoms were assessed weekly with a total of 229 observations during the first 4 weeks following quit day. Descriptive statistics were used to examine baseline characteristics of the participants. A random growth curve model was used to estimate between-person differences in a within-person trend of changes in the withdrawal symptoms. A binary logistic regression analysis was performed to identify predictors of short-term smoking abstinence.

Results

Baseline anxiety was a predictor of postquit nicotine withdrawal symptoms but baseline depression was not. Neither baseline anxiety nor depression predicted postquit craving for cigarettes. Participants who received an HIV-tailored smoking cessation intervention showed a greater decline in craving symptom than those who received an attention-controlled intervention. HIV-tailored intervention and less craving predicted smoking abstinence at 3-month follow-up.

Discussion

Compared to an attention-controlled intervention, an HIV-tailored intervention effectively decreased craving for cigarette smoking after quitting—which effectively increased the rate of short-term smoking abstinence in women living with HIV.
Defining Best Practices for Patient Safety in Positioning and Transferring Patients With the Surgical Spine Table
Authors: Kraft Sarah J. , Lowndes Bethany R. , Hallbeck M. Susan
Published: January 2020

This quality improvement project's purpose was to define and provide best practices in surgical patient positioning and transfer processes with the surgical spine table to increase patient safety. Using the Define, Measure, Analyze, Improve, and Control quality improvement framework, a multidisciplinary team analyzed surveys, qualitative interviews, ergonomics, near-miss sentinel events and skin integrity data to standardize this process. Results reinforced the need to develop and standardize the process of patient positioning and transfer from cart to table. Findings resulted in practice changes, including a standardized best practice for transfer of patients, educational tools, and checklists for continued monitoring of patient safety issues. Metrics for intervention effectiveness include reduced patient skin integrity, increased staff satisfaction, and improved comfort level with use of spine table accessories and equipment. This practice improvement has a patient safety focus in the perioperative nursing practice.
Periarticular Ketorolac Improves Outcomes for Patients With Joint Replacements
Authors: Sasse Laura , Laessig-Stary Betsy , Abitz Tracey
Published: January 2020

BACKGROUND:

Effective analgesia after joint replacement allows for earlier mobilization, decreased length of stay, and reduced opioid use. The injection of the surgical area with ketorolac (Toradol) prior to closure has changed pain management in joint replacement surgery.

PURPOSE:

This retrospective research study examined the difference between patients who received periarticular injections of ketorolac versus those who did not. Postoperative outcomes were measured in the two groups.

METHODS:

Between January 2012 and December 2014, a random sample of 161 patient charts was reviewed to compare length of stay, distance ambulated in the first physical therapy (PT) session, and amount of opioids consumed.

RESULTS:

Ketorolac injected into the tissue prior to closure significantly impacted outcomes. Patients who received the injection had statistically significant shorter stays, ambulated further distances with their first PT session, and used fewer opioids on postoperative day 1.

CONCLUSION:

Periarticular ketorolac injections reduce pain and improve outcomes, which reduces healthcare costs.
Niraparib in Patients With Newly Diagnosed Advanced Ovarian Cancer
Authors: González-Martín Antonio , Pothuri Bhavana , Vergote Ignace , Christensen René DePont , Graybill Whitney , Mirza Mansoor R. , McCormick Colleen , Lorusso Domenica , Hoskins Paul , Freyer Gilles , Baumann Klaus , Jardon Kris , Redondo Andrés , Moore Richard G. , Vulsteke Christof , O'Cearbhaill Roisin E. , Lund Bente , Backes Floor , Barretina-Ginesta Pilar , Haggerty Ashley F. , Rubio-Pérez Maria J. , Shahin Mark S. , Mangili Giorgia , Bradley William H. , Bruchim Ilan , Sun Kaiming , Malinowska Izabela A. , Li Yong , Gupta Divya , Monk Bradley J.
Published: January 2020

(Abstracted from N Engl J Med 2019;381:2391–2402)

The standard treatment for newly diagnosed advanced epithelial ovarian cancer involves cytoreductive surgery and platinum-taxane combination chemotherapy. Unfortunately, recurrence occurs in up to 85% of patients after completing this chemotherapy regimen.
Effect of Behavioral and Pelvic Floor Muscle Therapy Combined With Surgery Versus Surgery Alone on Incontinence Symptoms Among Women With Mixed Urinary Incontinence: The ESTEEM Randomized Clinical Trial
Authors: Sung Vivian W. , Borello-France Diane , Newman Diane K. , Richter Holly E. , Lukacz Emily S. , Moalli Pamela , Weidner Alison C. , Smith Ariana L. , Dunivan Gena , Ridgeway Beri , Nguyen John N. , Mazloomdoost Donna , Carper Benjamin , Gantz Marie G.
Published: January 2020

(Abstracted from JAMA 2019;322:1066–1076)

It is estimated that urinary incontinence (UI) affects up to 58% of women and has a significant negative impact on their quality of life. Mixed UI includes both stress and urgency incontinence and is present in up to half of women with UI.
Abortion Rights in Peril—What Clinicians Need to Know
Authors: Nash Elizabeth
Published: January 2020

(Abstracted from N Engl J Med 2019;381(6):497–449)

Although attempts to ban abortion in the United States have been common since the 1973 Roe vs Wade and Doe vs Bolton decisions, 2019 has seen an unprecedented surge of abortion restrictions passed by states. The past 46 years have seen more than 1200 laws restricting abortion access put in place, despite continuous rulings by the Supreme Court affirming the constitutional right to abortion.
Endometriosis and Cumulative Live Birth Rate After Fresh and Frozen IVF Cycles With Single Embryo Transfer in Young Women: No Impact Beyond Reduced Ovarian Sensitivity—A Case Control Study
Authors: Feichtinger Michael , Nordenhök Emelie , Olofsson Jan I. , Hadziosmanovic Nermin , Rodriguez-Wallberg Kenny A.
Published: January 2020

(Abstracted from J Assist Reprod Genet 2019;36:1649–1656)

Although endometriosis affects approximately 10% of women of reproductive age and 40% of infertile women, the physiological mechanism of how this chronic inflammatory disease affects fertility remains unclear. There is little consensus in the literature that IVF/ICSI outcomes are impacted by endometriosis.
A Case of Personal Identification Via Postmortem Computed Tomography Confirmation of Aphakic Eyes
Authors: Oshima Toru , Yoshikawa Hiroshi , Yoshitomi Takeshi , Ohtani Maki , Mimasaka Sohtaro
Published: January 2020

Postmortem computed tomography (PMCT) is used commonly in forensic medicine. Postmortem computed tomography of the head provides information on the eyes and orbits and may reveal intraocular abnormalities. We present a case in which the identity of a deceased man was confirmed by the presence of aphakic eyes detected on PMCT. A decomposed body was found in a house and suspected to be a man in his 40s who lived alone. Autopsy identified pontine hemorrhage as the cause of death. Although signs of previous dental treatment were evident, the storage period of the householder's dental records had expired. He had no family members to provide DNA for a comparative DNA analysis. Postmortem computed tomography before autopsy revealed aphakia (ie, the absence of eye lenses) suggestive of previous ocular surgery. His medical records revealed that he had undergone ocular surgery for secondary glaucoma due to uveitis, which had resulted in artificial aphakia. Peripheral iridectomy scars fully matched the findings in his medical records, thus identifying the body. The unusual finding of artificial aphakia in a man in his 40s facilitated the personal identification in this case. In conclusion, PMCT provides additional information, and the correct interpretation of intraocular PMCT findings by forensic pathologists is crucial.
Stress
Authors: Oriot Denis , Trigolet Marine , Kessler David O. , Auerbach Marc A. , Ghazali Daniel Aiham
Published: January 2020

Background

Stress may impair the success of procedures in emergency medicine. The aims were to assess residents' stress during simulated and clinical lumbar punctures (LPs) and to explore the correlation of stress and performance.

Methods

A prospective study (2013–2016) was carried out in a pediatric emergency department. A mastery training and subsequently a just-in-time training were conducted immediately preceding each clinical LP. Stress was self-assessed by the Stress-O-Meter scale (0–10). Performance (checklist 0–6 points) and success rate (cerebrospinal fluid with <1000 red blood cells/mm3) were recorded by a trained supervisor. A survey explored self-confidence and potential causes of stress.

Results

Thirty-three residents performed 35 LPs. There was no stress during simulation procedure. Stress levels significantly increased for clinical procedure (P < 0.0001). Performance was similar in simulation and in clinic (respectively, 5.50 ± 0.93 vs 5.42 ± 0.83; P = 0.75). Success significantly decreased during clinical LP (P < 0.0001). The 2 most reported stress-related factors were fear of technical errors and personal fatigue.

Conclusions

Performance scores and success rates in simulation are insufficient to predict success in clinical situations. Stress level and stress-related factors (fear of technical errors and personal fatigue) might be different in simulated or real conditions and consequently impact success of a technical procedure even if a high-performance score is recorded.
Out-of-Hospital Seizures in Children
Authors: Salmi Heli , Oulasvirta Jelena , Rahiala Eero , Kuisma Markku , Lääperi Mitja , Harve Heini
Published: January 2020

Objectives

Seizures seem to represent a frequent cause for pediatric emergency medical (EM) and emergency room (ER) contacts, but few population-based data are available. Our aim was to study the incidence, prehospital and ER treatment, and outcomes of pediatric seizures necessitating out-of-hospital care.

Methods

We studied the out-of-hospital evaluation procedures, ER treatment, diagnostics and 2-year prognosis of all cases of pediatric (0–16 years) seizures encountered by the emergency medical services (EMS) in Helsinki, Finland, in 2012 (population 603,968, pediatric population 92,742); 251 patients were encountered by the EMS, of which 220 seen at the ER.

Results

The yearly incidence of pediatric seizures necessitating EMS activation was 2.8/1000 in the pediatric population. Febrile seizures were responsible for 97 (44.1%) of the cases transported to the ER. Only a minority of patients required advanced life support measures out-of-hospital or complex diagnostics in the ER. Still, of the 220 patients seen at ER, 68 (30.9%) were hospitalized, and 106 (48.2%) had follow-up contacts scheduled.

Conclusions

Pediatric seizures were a common cause for EM and ER contacts. Advanced life support measures were seldom needed, and the prognosis was good, but seizures still required considerable resources. They often resulted in urgent EM dispatch and transport, hospitalization, follow-up visits, new medication, and complementary studies. This emphasizes the role the EMS plays in recognizing and terminating pediatric seizures and in referring these children to appropriate care.
“Sim One, Do One, Teach One”
Authors: Holland Jaycelyn R. , Latuska Richard F. , MacKeil-White Kimberly , Ciener Daisy A. , Vukovic Adam A.
Published: January 2020

Objectives

The objective of this study was to determine the effectiveness of a simulation-based curriculum in improving confidence in trauma resuscitation skills and increasing attendance during trauma resuscitations for pediatric residents during their emergency medicine rotation.

Methods

A simulation-based orientation curriculum was implemented for the 2017–2018 academic year. Participants completed a qualitative survey before and after each session to assess their comfort level with skills required in a trauma resuscitation. Responses were compared using the Wilcoxon ranked sum test. Nursing documentation was reviewed for the 2016–2017 and 2017–2018 academic years to determine the frequency of resident attendance at trauma resuscitations. Pediatric resident attendance before and after intervention were compared via χ2 analysis.

Results

Survey responses showed a significant increase in confidence in all skills assessed, including primary and secondary survey performance, knowledge of pediatric resident role, knowledge of necessary equipment, ability to determine acuity of patient illness or injury, and ability to differentiate between modes of oxygen delivery (P < 0.01). There was no statistically significant change in the frequency of pediatric resident attendance at trauma bay resuscitations before and after curriculum implementation (21.2% vs 25.7%, P = 0.09).

Conclusions

Through the implementation of a simulation-based trauma orientation for pediatric residents, we were able to improve self-reported confidence in trauma resuscitation skills. This improvement did not result in an increased attendance at trauma resuscitations. Next steps include identifying additional barriers to pediatric resident attendance at trauma bay resuscitations.
Management of Toddler's Fractures
Authors: Jeganathan Kristine , Elangainesan Praniya , Kam April J.
Published: January 2020

Objectives

The aim of this study was to examine and compare the efficacy of external fixation strategies of toddler's fracture (TF) in acute care settings. Specifically, we aim to identify whether immobilization optimizes clinical outcomes for patients (based on immobilization duration, time to weight-bear/ambulate, and associated complications) compared with nonimmobilization, with a systematic review.

Study Design

After PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, 2 independent reviewers searched electronic databases OVID Medline, Embase, and CINAHL for studies evaluating the health outcomes of various treatment methods for TF (1937–2019). The studies were chosen based on specific inclusion criteria. The 2 reviewers were looking for primary research articles that assessed health outcomes (such as immobilization duration, time to weight-bear/ambulate, and associated complications) of various treatment strategies for TF Fractures in acute care settings.

Results

A total of 2385 articles were initially screened, reviewed, and then narrowed down to 6 studies for an in-depth analysis. Among these 6 studies, 5 were retrospective chart reviews and 1 was a cross-sectional online survey. A total of 565 patients from the retrospective chart reviews and 153 physicians from the cross-sectional online survey were further analyzed. The current evidence shows that there was no significant difference in clinical outcomes (ie, time to weight-bear and immobilization duration) between immobilization and nonimmobilization.

Conclusions

Further large-scale prospective studies examining the clinical outcomes of TF management techniques should be conducted to establish a consistent standardized guideline for TF treatment across acute care settings.
Taking the Pulse on Pediatric Simulation
Authors: Frey-Vogel Ariel , Rogers Amanda , Sparger Katherine , Mehta Renuka , Mirchandani-Shah Dipti , Mangold Karen , Mitchell Diana , Wood Amy
Published: January 2020

Objectives

There is abundant literature on simulation use in individual pediatric residency programs but limited overall data on simulation in US pediatric residency programs. This study sought to determine how US pediatric residency programs use simulation for teaching and assessment and the challenges programs face in their use of simulation.

Methods

The Association of Pediatric Program Director's Healthcare Simulation in Pediatrics Learning Community members developed a 15-multipart question survey on the use of simulation in US pediatric residency programs using best practices in survey design. The survey was distributed electronically to US pediatric residency program directors. Qualitative questions were analyzed by content analysis and quantitative questions using descriptive statistics.

Results

The survey response rate was 21%; respondents were disproportionately from large academic medical centers. Qualitative analysis found that respondents use simulation to teach pediatric residents in the areas of urgent/emergent situations, procedures, and communication, and common challenges to simulation implementation are time, physical resources, expertise, competing priorities, logistics, and buy-in. Quantitative analysis demonstrated that, although respondents are largely confident that their simulation programs improve resident preparedness and competence, few objectively evaluate their simulation programs.

Conclusions

Pediatric residency programs use simulation for similar purposes and face similar challenges. By collaborating, the resources of the national pediatric simulation community can be leveraged to collect evidence for best practices for simulation use in pediatric residency training.
Blinded or Nonblinded Randomized Controlled Trials in Rehabilitation Research
Authors: Malmivaara Antti , Armijo-Olivo Susan , Dennett Liz , Heinemann Allen W. , Negrini Stefano , Arokoski Jari
Published: January 2020

Objective

Some recent studies suggest that double blinding should not be considered a validity criterion in randomized controlled trials (RCTs) on real-life circumstances. This study aims to assess whether blinding vs. nonblinding have been analyzed conceptually in the rehabilitation literature. Propositions on the role of blinding in RCTs on rehabilitation are presented based on the conceptual analysis.

Design

Study questions, literature search strategy, and inclusion and exclusion criteria for the original studies were formulated. A health science librarian carried out the literature search. Eligibility was assessed and data extraction was performed by two independent researchers.

Results

The literature search identified a total of 1052 citations, of which 13 studies fulfilled the inclusion criteria. None of the included studies answered our research questions, and thus we were unable to extract any relevant data.

Conclusions

The ideas on blinding vs. nonblinding in RCTs have not been considered in the rehabilitation research literature. This conceptual systematic review proposes that a physical therapy modality is a single core element, and when the study question is on effectiveness of this single core element itself, double blinding in an RCT is indicated. In all other RCTs in rehabilitation, double blinding is not indicated and double blinding should not be considered a criterion for the assessment of risk of bias.
Clinically Lymph Node Positive Prostate Cancer: At the Intersection of Focal and Systemic Disease Control
Authors: Reichert Zachery R. , Dess Robert T.
Published: January 2020

Clinically node-positive prostate cancer is often found at the time of diagnosis by cross-sectional imaging and remains poorly understood. Advanced imaging modalities such as magnetic resonance imaging nanoparticles or positron emission tomography–based molecular imaging stand to rapidly change the field and hopefully will bring better diagnostic clarity. This will allow for prospective clinical trials using radiographic, clinical, or molecular parameters to establish who may benefit from both localized and systemic treatment intensification and who may avoid overtreatment. Recent advances in metastatic hormone-sensitive disease may offer clues, but direct studies for nodal disease patients remain.
Surrogate Endpoints in Localized Prostate Cancer
Authors: Hartman Holly E. , Jackson William C.
Published: January 2020

Randomized clinical trials assessing novel therapies in men with localized prostate cancer frequently require large patient numbers and more than a decade of follow-up to demonstrate improvements in overall survival. As the landscape of treatment options for prostate cancer is rapidly changing, clinical trials requiring long follow-up threaten to impede treatment improvements and run the risk of results being obsolete by the time that they are reported in publication. To address these issues, there has been tremendous interest in identifying an intermediate clinical endpoint that can be assessed earlier in the disease course to serve as a robust surrogate for overall survival in men with localized prostate cancer. Herein we review the relevant data for surrogate endpoints in localized prostate cancer, highlighting the work performed by the Intermediate Clinical Endpoints in Cancer of the Prostate Working Group identifying metastasis-free survival as a valid surrogate for men treated for localized prostate cancer.
Factors to Guide Treatment Selection for Hormone-Sensitive Metastatic Prostate Cancer
Authors: Tsao Phoebe A. , Caram Megan E. V.
Published: January 2020

For decades, the mainstay of treatment for metastatic hormone-sensitive prostate cancer has been androgen deprivation therapy. In recent years, 4 systemic therapies—docetaxel, abiraterone, enzalutamide, and apalutamide—have improved overall survival for men with metastatic hormone-sensitive prostate cancer when combined with androgen deprivation therapy, raising the question of which treatment to choose. The role for metastasis-directed therapy with surgery or radiation among these new treatments has also yet to be defined. Thus, several factors have come into play to guide treatment selection, including disease characteristics, age, fitness, and comorbidities of the patient, potential adverse effects of therapies, and health system considerations such as access to care and financial toxicity. Careful and shared decision making between patient and provider is critical. Future directions aimed at refining our treatment selection include researching the role of novel molecular imaging techniques, biomarkers predicting therapy response, sequencing and combining therapies, and understanding the long-term and late effects of these treatments.
Neoadjuvant Approaches Prior To Radical Prostatectomy
Authors: Ryan Stephen T. , Patel Devin N. , Parsons J. Kellogg , McKay Rana R.
Published: January 2020

Patients with high-risk localized prostate cancer benefit from multimodality therapy of curative intent. Androgen-deprivation therapy (ADT) combined with radiation improves survival in this population. However, prior clinical trials of neoadjuvant ADT and surgery failed to consistently demonstrate a survival advantage. The development of novel, more potent hormonal agents presents an opportunity to revisit the potential for neoadjuvant therapy to improve long-term outcomes for patients with localized prostate cancer. We review recent advances in neoadjuvant approaches for prostate cancer and emerging clinical trials data supporting the use of neoadjuvant therapy prior to radical prostatectomy.
Pathologically Node-Positive Prostate Cancer
Authors: Ginsburg Kevin B. , Cher Michael L. , Kutikov Alexander , Morgan Todd M.
Published: January 2020

The postoperative management of men with lymph node involved prostate cancer (pN+) remains a challenge as there is a general lack of randomized trial data and a range of management strategies. Retrospective studies suggest a variable clinic course for patients with pN+ prostate cancer. Some men progress rapidly to metastatic disease despite further therapies, whereas other men can have a period of prolonged quiescence without adjuvant androgen deprivation therapy (ADT) or radiation therapy (RT). For men who have undergone radical prostatectomy, randomized trial data indicate that the addition of ADT in pN+ disease extends metastasis-free, prostate cancer–specific, and overall survival. Additional retrospective studies suggest that adding RT is potentially beneficial in this setting, improving overall and cancer-specific survival especially in men with certain pathologic parameters. Conversely, men with lower disease burden in their lymph nodes have longer times to progression and may be candidates for observation and salvage therapy as opposed to adjuvant ADT/RT.
Treatment of Primary in Metastatic Prostate Cancer
Authors: Joseph Nuradh , Anjanappa Milan , Choudhury Ananya
Published: January 2020

Until recently, men with metastatic prostate cancer were commenced on androgen deprivation therapy at diagnosis, followed by sequential lines of treatment with the development of castration resistance. However, the results of recent clinical trials, which revealed that the addition of radiotherapy to the prostate to a dose of 55 to 60 Gy in 20 fractions over 4 weeks in patients with low-volume metastatic hormone-sensitive prostate cancer, in addition to androgen deprivation therapy and another systemic treatment option, either docetaxel, abiraterone, enzalutamide, or apalutamide, has led to a paradigm change in the management of this disease.
FDG PET/CT in Isolated Mediastinal Immunoglobulin G4–Related Disease
Authors: Kousik Vankadari , Kumar Rajender , Mittal Bhagwant Rai , Aggarwal Divya , Aggarwal Ashutosh Nath
Published: January 2020

Immunoglobulin G4–related disease is a fibroinflammatory condition that has the tendency to involve almost every organ of the body. We report the case of a young asymptomatic man with right suprahilar opacity on chest radiograph detected during routine annual health check-up. Mediastinoscopic sampling of the lesion was inconclusive. 18F-FDG PET/CT done to characterize the lesion revealed hypermetabolic mass with areas of necrosis in the right paratracheal location. Histopathologic examination from the FDG PET/CT-guided biopsy sample was suggestive of immunoglobulin G4–related disease.
18F-FDG PET/CT Evaluation of Crizotinib and Lorlatinib Therapy in Metastatic ROS-1–Positive Non–Small Cell Lung Cancer
Authors: Dejust Sébastien , Moubtakir Abdenasser , Prevost Alain , El Farsaoui Khadija , Morland David
Published: January 2020

ROS-1–positive non–small cell lung cancers (NSCLCs) are rare (approximately 1% of all NSCLCs) and require a first-line treatment by crizotinib. Crizotinib resistance is frequent within the first 12 months of treatment. Lorlatinib is a novel tyrosine kinase inhibitor of ROS-1 recently indicated for metastatic or locally advanced crizotinib-resistant NSCLC. We report the use of lorlatinib as second-line with a complete tumoral response after only 3 months of treatment. This case shows the major role of 18F-FDG PET/CT in treatment evaluation and monitoring targeted therapy in metastatic NSCLC.
Prognostic Value of 18F-FDG PET/CT—Metabolic Parameters at Baseline and Interim Assessment in Pediatric Anaplastic Large Cell Lymphoma
Authors: Mathew Boon , Vijayasekharan Kalasekhar , Shah Sneha , Purandare Nilendu C. , Agrawal Archi , Puranik Ameya , Prasad Maya , Narula Gaurav , Banavali Shripad , Rangarajan Venkatesh
Published: January 2020

Introduction

The event-free survival in pediatric anaplastic large cell lymphoma (ALCL) remains at 70% irrespective of the diverse chemotherapy regimens used. There is lack of valid prognostic factors identifying high-risk patients. We investigated the prognostic value of baseline metabolic parameters and interim response on 18F-FDG PET/CT in pediatric ALCL patients.

Methods

We retrospectively reviewed 40 pediatric ALCL patients with paired 18F-FDG PET/CT and treated uniformly on vinblastine-based institution protocol. The SUVmax, SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis of the lymphomatous lesion were measured. Continuous PET parameters were stratified by their median values. Deauville scoring system was used to assess response to chemotherapy in the interim scan. Prognostic factors for overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method, log-rank test, and Cox proportional hazards model.

Results

At median follow-up of 52 months, 13 patients died and 13 had recurrence. On univariate analysis, higher whole-body MTV (WBMTV) and partial response on interim scan were statistically associated with OS. High-risk features, WBMTV, and partial response were statistically associated with DFS. On multivariate analysis combining baseline characteristics and interim response, interim response (hazard ratio, 3.56; P = 0.034) was statistically significant for OS. Multivariate analysis for DFS using only baseline characteristics revealed WBMTV as statistically significant (hazard ratio, 4.08; P = 0.035), but none of the parameters was statistically significant when baseline characteristics and interim response were evaluated together.

Conclusions

Whole-body tumor burden assessment with MTV and interim response may help to identify high-risk patients who might get benefitted from intensive therapy.
Posterior Reversible Encephalopathy Syndrome After 90Y-Resin Microspheres Radioembolization
Authors: Unterrainer Marcus , Todica Andrei , Seidensticker Max , Beyer Leonie , Bartenstein Peter , Ricke Jens , Ilhan Harun
Published: January 2020

A 66-year-old man with colorectal carcinoma and liver-only metastases underwent radioembolization using 90Y-loaded, resin-based microspheres. One day after radioembolization, the patient experienced severe hypertension and multiple seizures. On MRI, symmetric edematous areas in the cerebellum and the parietal and occipital lobe were observed, a typical finding for posterior reversible encephalopathy syndrome (PRES). The PRES is associated with, for example, renal failure or blood pressure fluctuations leading to cerebral endothelial dysfunction. Antihypertensive and antiepileptic therapies led to normotensive blood pressure and neurological remission. Therefore, newly developed neurological symptoms accompanied by high blood pressure fluctuations after radioembolization should lead to PRES as differential diagnosis.
Presacral Anastomotic Sinus After Low Anterior Resection Mimicking Recurrent Rectal Cancer
Authors: Kim Chanwoo , Kim Deog Yoon , Hong Il Ki
Published: January 2020

Presacral anastomotic sinus is recognized as a complication of anastomotic leakage in patients with rectal cancer. Active inflammation in the anastomotic sinus can masquerade as pelvic recurrence of rectal cancer. We present a case of progressive inflammation in anastomotic sinus demonstrated by serial FDG PET/CT scans. Despite its benign nature, increased FDG uptake in this nonnegligible condition, which could lead to further detrimental complications including secondary cancer, may have clinical implications.
Incidental 18F-Fluciclovine Uptake in a Warthin Tumor of the Parotid Gland in a Patient Undergoing PET/CT Imaging for Biochemical Recurrent Prostate Cancer
Authors: Bitar Ryan , Martiniova Lucia , Bell Diana , Ravizzini Gregory
Published: January 2020

A 67-year-old asymptomatic man with biochemical recurrent prostate cancer underwent 18F-fluciclovine PET/CT for restaging to determine subsequent treatment strategy. PET/CT images were obtained from the proximal thighs to the vertex of the skull, after the intravenous administration of 362.6 MBq (9.8 mCi) of 18F-fluciclovine. PET/CT imaging demonstrated a focus of abnormally increased 18F-fluciclovine uptake corresponding to a small nodularity in the left parotid gland. Subsequent ultrasound-guided fine-needle aspiration biopsy of the lesion revealed histopathology compatible with a benign Warthin tumor.
“Hot Lung” Sign in Pulmonary Intravascular Large B-Cell Lymphoma on 18F-FDG PET/CT
Authors: Şahin Özlem , Kaya Buğra , Serdengeçti Mustafa , Çizmecioğlu Hilal Akay , Şen Ahmet Eren
Published: January 2020

Intravascular large B-cell lymphoma is a rare type of non-Hodgkin lymphoma characterized by intravascular proliferation of clonal lymphocytes within the lumen of small vessels, which is often fatal. Diffuse FDG uptake in the lung without clear/evident CT findings, “hot lung,” is quasi-pathognomonic for lung intravascular large B-cell lymphoma. In this report, we present the case of a 43-year-old man who was diagnosed as having intravascular lymphoma thanks to this rare finding.
Large Idiopathic Mesenteric Necrotizing Granuloma Mimicking Metastatic Disease on FDG PET/CT
Authors: Liu Yiyan
Published: January 2020

On restaging FDG PET/CT for an 81-year-old man with oral cavity cancer, a large FDG-avid mesenteric mass suspicious for either metastasis or second primary was incidentally noted. Surgical pathology showed necrotizing granulomatous inflammation without evidence of tumor. All stains were negative for microorganisms. An elastin stain was negative as well, which excluded an origin of damaged blood vessels or vasculitis. The patient had no prior abdominal surgery or known gastrointestinal disease. Granuloma always poses a dilemma in the interpretation of PET/CT, due to its high FDG avidity and mass-like appearance which mimics neoplastic disease.
Online Patient Resources for Breast Implant-Associated Anaplastic Large Cell Lymphoma
Authors: Cheah Michael A. , Sarmiento Samuel , Bernatowicz Elizabeth , Rosson Gedge D. , Cooney Carisa M.
Published: January 2020

Introduction

Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is an emerging issue facing the medical community. Government organizations such as the US Food and Drug Administration and specialty groups including the American Society of Plastic Surgeons have published online resources about BIA-ALCL for patients. Given the complexity of the diagnosis, it is important that patients can easily read these resources. In this study, we examined the readability levels of online BIA-ALCL patient resources using multiple verified reading scores.

Methods

“BIA-ALCL” and “breast implant–associated anaplastic large cell lymphoma” were entered into 3 Internet search engines. The top 20 results for each were filtered by resource type and intended audience (physician vs patient). Published scientific articles, online database physician resources, and Web sites requiring subscriptions or fees were excluded. We then examined the readability of each with multiple verified reading scores, including the Flesch-Kincaid, Gunning-Fog, Coleman-Liau, Simplified Measure of Gobbledygook, and Automated Readability Index indices. Obtained data were analyzed using descriptive statistics and t test for independent samples.

Results

Fifteen Web sites qualified for further analysis. For all texts, the average readability level was measured between 12 and 13 years of education on each readability index or approximately 18 to 19 years old. The Flesch-Kincaid Reading Ease average was 43.16 ±10.9 on a scale of 1 to 100, corresponding to a “difficult” designation. When compared by search criteria (spelled-out vs abbreviated), the results for the abbreviation “BIA-ALCL” had higher education requirements than those with the condition spelled out. However, these differences were not statistically significant. There was also great variation in word and sentence measurements. Twelve of the 15 Web sites contained more than 15% complex words, having more than 3 syllables, with breastcancer.org having the lowest (11%) and plasticsurgery.org the highest (20%).

Discussion

Since the initial announcement in 2014 by the National Cancer Comprehensive Network, the medical community has begun educating ourselves and our patients about BIA-ALCL. Unfortunately, this study suggests that online patient resources on BIA-ALCL may be too complex for most readers, exceeding that of the average US resident (eighth grade) and Medicare beneficiary (fifth grade). Although the goal of learning more about BIA-ALCL and counseling patients appropriately remains paramount, we should continue to improve patient education materials given their vital role in healthcare decision-making.
Temporal Muscle Flap as a Treatment of an Extensive Cleft Palate in an Adult Patient
Authors: Heitz Claiton , Garbin-Júnior Eleonor Álvaro , Conci Ricardo Augusto , Bin Luiza Roberta , Nadal Resident Letícia , Griza Geraldo Luiz , Érnica Natasha Magro
Published: January 2020

For the management of cleft palate, the surgical approach has been suggested at an early stage even in childhood, varying in the number of interventions. Once the interventions are not performed at appropriate times, such as sequences that may accompany specific psychological, functional, and aesthetic effects. Since it has been indicated, temporal muscle flap is a technique with satisfactory results for a resolution of extensive clef palate in adult patients. The purpose of this paper is reporting a case of temporal muscle flap in the soft and hard palate of an adult with a reconstruction of the donor area with a titanium mesh. A 37 year old male patient with cleft lip/palate, complained of difficulty in speech, chewing, swallowing, and breathing. Clinically, it was observed oroantral communication in the region of the hard and soft palate, with a previous cheiloplasty. A temporal rotation was planned to close the fissure for the treatment. The modified coronal approach was used. Temporal muscle traction and its interposition in the palate region were performed through the tunneling technique, and mass suturing was performed. After 3 years, he presented satisfactory results, with the improvement of the quality of life, as well as the area of exposure. In conclusion, since it has been indicated, temporal muscle flap is a technique with satisfactory results for a resolution of extensive cleft palate in adult patients.
Microvascular Replantation of Totally Avulsed Scalps: Failures and Successes
Authors: Jiang Liangfu , Jones Salazar , Wu Zhipeng , Xue Jixin , Jia Xiaofeng
Published: January 2020

Total scalp avulsion is a rare but devastating injury currently without proven reconstructive techniques. While microsurgical anastomosis procedures have advanced and allowed for the replantation of digits and limbs, special anatomical considerations and risk of fatal blood loss add to the difficulty of replanting totally avulsed scalps. The authors present their replantation experience of 4 totally avulsed scalps between 2008 and 2017. Despite meticulous reconstructive techniques with proven success in limb and digit replantation, the first 3 cases failed due to various factors (i.e., thrombosis, venous congestion, reavulsion), and with experience, the fourth case was successful. Since total scalp avulsions are rare injuries, case reports are scarce, with only few publications commenting on failures which hold crucial information for surgeons to avoid pitfalls and optimize techniques. In this article, we highlight our experience with both successful and failed replantation of totally avulsed scalps, and offer recommendations and insight for optimization of this rare procedure.
The Medial Subcoronoid Process Region as a Novel Source of Bone Grafts in Orthognathic Surgery and Genioplasty
Authors: Yao Chuan-Fong , Denadai Rafael , Pascasio Dax Carlo G. , Chen Yi-Chieh , Chen Yu-Ray
Published: January 2020

Background:

Since 2012, the authors have adopted the medial subcoronoid process bone interpositional grafting in OGS and genioplasty procedures. The purpose of this study was to present the technical details and clinical outcomes of this alternative bone interpositional grafting for LeFort I and chin osteotomies.

Methods:

Consecutive patients (n = 50) who underwent single-splint bimaxillary OGS with or without genioplasty and received medial subcoronoid bone interpositional grafting were included. Standardized facial and intraoral photographs at early and late postoperative periods (12.2 ± 3.3 and 44.8 ± 8.4 months postsurgery, respectively) were blindly rated to assess facial symmetry, chin, and occlusion status based on qualitative rating scales. Complication and reoperation rates were also reviewed.

Results:

The medial subcoronoid bone interpositional grafts were adopted to stabilize different LeFort I maxillary movement types or lengthening/advancing genioplasty (36 and 14 patients, respectively). Overall, the early facial symmetry, chin, and occlusion status were maintained at late evolutions. None of the patients had donor-site or bone graft-related complications (i.e., bad split, undesired mandible fracture, infection, fibrous union, nonunion, and/or permanent neurosensory deficit) or revisionary surgery during follow-up.

Conclusion:

The medial subcoronoid process bone grafting was a feasible alternative for bone interpositional defects of LeFort I and chin osteotomies with no significant morbidity and avoiding secondary donor sites.
A Large Dermoid Cyst Causing Plagiocephaly
Authors: Itinteang Tinte , Salomia Uriam , Metai Airam , Gates Robert
Published: January 2020

We report an adult case from Kiribati, with a large dermoid cyst, and resultant underlying plagiocephaly, that was managed well with surgical excision. We also discuss the pathogenesis of this condition and the optimum timing for surgical intervention to avoid the deformity.
Traumatic Cranio-Orbital Injury: Reconstruction Using Extraocular Muscles
Authors: Oh Christine , Lin Jason , Lettieri Salvatore
Published: January 2020

Cranio-orbital trauma is an uncommon yet devastating injury, especially one in the setting of a high-energy gunshot wound. Such injuries were historically reported in the setting of military conflict, and are associated with vision-threatening complications, often resulting in anophthalmos. The authors report a case of a self-inflicted gunshot wound to the eye, which requires orbital enucleation with exposed frontal lobe dura. To address the exposed dura, the extraocular muscles were utilized from the enucleation procedure to cover the defect in the acute setting prior to final staged reconstruction.