bluuebunny/crossref_metadata_2025 huggingface dataset:
Intereye Symmetry of 24-Hour Intraocular Pressure–related Patterns in Untreated Glaucoma Patients Using a Contact Lens Sensor
Authors: Mansouri Kaweh , Gillmann Kevin
Published: June 2020

Purpose:

Scarce data are available on the symmetry of 24-hour intraocular pressure (IOP) variations between fellow eyes of glaucoma patients, and such evidence could have profound consequences on the interpretation of monocular therapeutic trials. The objective is to evaluate the intereye correlation of continuously measured circadian IOP-related patterns in untreated glaucoma patients.

Methods:

In this single-center prospective study, a total of 29 untreated patients with open-angle glaucoma underwent bilateral ambulatory 24-hour monitoring of IOP-related patterns using a contact lens sensor (CLS; SENSIMED Triggerfish). IOP was measured before and after CLS monitoring using Goldmann applanation tonometry. Intereye agreement of 24-hour patterns was calculated using Spearman correlation (r) of raw data and after cosinor rhythmometry modeling.

Results:

Complete bilateral CLS data could be obtained in 20 patients (mean age: 55.5±15.7 y; 51.7% women). On average, intereye correlation was r=0.76±0.19 (range: 0.16 to 0.95) and r=0.77±0.15 (range: 0.49 to 0.91), after excluding 8 patients with lower quality recordings. Cosine rhythmometry modeling showed mean acrophases occurring at 4:21±2:20 am in left eyes and 3:39±1:50 am in right eyes (r=0.48; P=0.034). Mean acrophase amplitude was 110.9±51.9 for left eyes and 107.8±46.2 for right eyes (r=0.79; P<0.001). No serious adverse events related to CLS monitoring were recorded. Transient conjunctival hyperemia (13 patients) and blurred vision (11 patients) were the most frequent adverse events.

Conclusions:

In this group of untreated glaucoma patients, there was good intereye agreement for circadian IOP-related patterns using the CLS. These results show a higher degree of intereye symmetry, in terms of IOP peak timings and amplitudes, than previously reported with standard tonometry.
Clinical Utility of Triplicate En Face Image Averaging for Optical Coherence Tomography Angiography in Glaucoma and Glaucoma Suspects
Authors: Nelson Andrew J. , Chu Zhongdi , Burkemper Bruce , Chang Brenda R. , Xu Benjamin , Wang Ruikang K. , Richter Grace M.
Published: June 2020

Précis:

Averaging triplicate en face angiograms of the radial peripapillary capillary (RPC) plexus with optical coherence tomography angiography (OCTA) improves vessel visualization, reduces vessel density parameters, and increases the diagnostic accuracy for glaucoma of one such parameter.

Purpose:

The purpose of this study was to test the hypothesis that triplicate averaging of the RPC layer improves visualization and diagnostic accuracy of OCTA for glaucoma.

Materials and Methods:

This is a cross-sectional study involving 63 primary open-angle glaucoma patients and 70 age-matched glaucoma suspects. Triplicate 6×6 mm OCTA scans of the optic nerve head were acquired, and the RPC layer was extracted. RPC en face images were registered and averaged. Parameters of global entropy, global standard deviation, local texture correlation, local homogeneity, signal-to-noise ratio, and intercapillary distance were used to measure the change in visualization with averaging. Vessel area density (VAD), vessel skeleton density (VSD), and flux parameters were calculated in a 2.8 mm annulus excluding the optic disc. The diagnostic accuracy of these parameters for glaucoma was assessed by calculating the area under the receiver operating curve (AUC) values.

Results:

Three-frame averaging resulted in decreased global entropy and global standard deviation (Ps<0.001), and increased local texture correlation, local homogeneity, signal-to-noise ratio, and intercapillary distance (Ps<0.001). Averaged images also had reduced VAD, VSD, and flux (Ps<0.001). AUC was significantly increased for VSD after image averaging (P=0.018), while no significant change in AUC was observed for VAD (P=0.229) or flux (P=0.193).

Conclusions:

Triplicate averaging improves visualization of the RPC layer and the diagnostic accuracy of VSD for glaucoma. The impact of image averaging on OCTA diagnostic performance and other potential applications warrants further exploration.
Knowledge, Attitudes, and Practices Toward Coronavirus Disease 2019 Among People in a Tertiary Care Hospital in India
Authors: Doke Purwa , Rege Sujata , Palkar Sonali
Published: June 2020

Background

Novel coronavirus disease 2019 (COVID-19) has rapidly spread across the entire globe causing a lot of fear among the masses. India had more than 2,500 confirmed cases and more than 70 deaths at the time of submission of this article. This is probably the first study from India on the knowledge, attitudes, and practices toward COVID-19. Presently, there is only 1 similar study from China.

Methods

A cross-sectional observational study was performed in a tertiary care hospital in India to assess the knowledge, attitudes, and practices of the participants toward COVID-19 during the pandemic. The participants had to answer a questionnaire in the language well understood by them. It pertained to their basic knowledge about this disease, their attitudes, and correct practices. The participants were either doctors, staff, patients, or relatives visiting the hospital.

Results

Among the various age groups, the highest proportion (57.21%) of very good knowledge was in the 20 to 30 years age group. Among the respondents, poor knowledge was seen in the patients. Overall, 47.99% participants had an extremely optimistic attitude, whereas <50% doctors had extremely correct practices toward COVID-19. This is unacceptable during the ongoing pandemic and reveals scope for improvement.

Conclusions

The public health authorities at the regional and state level can use this information to increase awareness among the population, which may help to contain the pandemic. Educational campaigns targeting the correct population groups are essential to reduce the public anxiety toward this pandemic.
Management of malignant pleural effusions
Authors: Dipper Alexandra , Bhatnagar Rahul , Maskell Nick
Published: June 2020

Purpose of review

Malignant pleural effusion (MPE) is a common cause of breathlessness indicative of advanced disease. Treatment approaches focus on relief of breathlessness and optimizing quality of life. A number of recent, high-impact publications give further insight into the advantages of different treatment options. This article provides a summary of the most up-to-date evidence in this area.

Recent findings

Recent publications have demonstrated comparable pleurodesis outcomes of talc slurry to talc poudrage and explore strategies to combine the advantages of indwelling pleural catheters (IPCs) with a chemical pleurodesis. A daily IPC drainage regime improves the chances of pleurodesis success and early IPC removal in patients without significant trapped lung.

MPE is a diverse condition, with no one strategy representing the ‘best’ approach for all. Management decisions should be made in conjunction with the patient, taking their views and preferences into consideration.
Leucine-rich alpha-2 glycoprotein 1, high mobility group box 1, matrix metalloproteinase 3 and annexin A1 as biomarkers of ulcerative colitis endoscopic and histological activity
Authors: Kourkoulis Panagiotis , Michalopoulos George , Katifelis Hector , Giannopoulou Ioanna , Lazaris Andreas C. , Papaconstantinou Ioannis , Karamanolis George , Gazouli Maria
Published: June 2020

Objective

The LRG, HMGB1, MMP3 and ANXA1 proteins have been implicated in different inflammatory pathways in ulcerative colitis (UC), but their role as specific biomarkers of both endoscopic and histological activity has yet to be elucidated. In the present study, we aimed to evaluate the LRG1, HMGB1, MMP3 and ANXA1 as potential serum biomarkers for UC endoscopic and histological activity.

Methods

This cross-sectional study included UC patients under 5-ASA, and healthy controls (HC) undergoing colonoscopy. Blood and biopsy samples were obtained and endoscopic Mayo sub-score (Ms) was recorded for the UC patients. Intramucosal calprotectin as a marker of histologic activity was evaluated in all biopsy samples and serum LRG1, HMGB1, MMP3 and ANXA1 levels were measured in the blood samples.

Results

The HCs ANXA1 level was lower compared to that of the UC group [P = 0.00, area under the curve (AUC) = 0.881] and so was the HCs MMP3 level compared to that of patients (P = 0.00, AUC = 0.835). The HCs ANXA1 levels were also lower compared to these of the independent Ms groups, even to the Ms = 0 (P = 0.00, AUC = 0.913). UC endoscopic activity was associated with MMP3 levels (r = 0.54, P = 0.000) but not with ANXA1, LRG1 and HMGB1 levels

Conclusion

Serum ANXA1 is a potential diagnostic biomarker of UC and serum MMP3 is a potential biomarker of UC endoscopic and histological activity.
Risk factors for endoscopic severity of diverticular disease of the colon and its outcome: a real-life case-control study
Authors: Tursi Antonio , Violi Alessandra , Cambie’ Ginevra , Franceschi Marilisa , Baldassarre Gianluca , Rodriguez Kryssia Isabel , Miraglia Chiara , Brandimarte Giovanni , Elisei Walter , Picchio Marcello , Di Mario Francesco
Published: June 2020

Background

Diverticular disease is an increasing global problem.

Aims

To assess the factors associated with the severity of diverticular disease and its outcome, analyzing a real-life population.

Methods

A cohort of patients, submitted to colonoscopy from 1 January 2012 to 30 April 2018 was revised. The endoscopic severity of diverticular disease was scored according to the Diverticular Inflammation and Complications Assessment (DICA) classification.

Results:

A cohort of 11 086 patients was identified during the study period, 5635 with diverticulitis and 5451 without diverticulosis. Blood hypertension, diabetes and angiotensin receptor blocker users occurred more frequently in the study group, while the prevalence of colorectal cancer (CRC) was significantly lower. Age >70 years, BMI >30 and blood hypertension were factors independently related to the presence of diverticulosis, while diabetes and CRC were significantly associated with the absence of diverticulosis. Female sex, age, smoke, appendectomy, proton-pump inhibitors and acetyl-salicylic acid use were directly related to the severity of diverticular disease, while CRC and colonic polyp occurrence were inversely related to the severity of diverticular disease, significantly. Female sex, age >70 years and smoke were significantly related to the severity of diverticular disease. CRC and colonic polyps were significantly less in DICA 3 patients. DICA 3 patients were more often symptomatic, at higher risk of hospital admission, longer hospital stay and higher mean costs.

Conclusions

Several factors are associated with the severity of diverticular disease according to the DICA classification. The DICA classification is also predictive of the outcome of the disease in terms of hospital admission, stay and costs.
Endoscopic eradication therapy for Barrett's oesophagus: state of the art
Authors: Kolb Jennifer M. , Wani Sachin
Published: June 2020

Purpose of review

Barrett's oesophagus is the only identifiable precursor lesion to oesophageal adenocarcinoma. The stepwise progression of Barrett's oesophagus to dysplasia and invasive carcinoma provides the opportunity to intervene and reduce the morbidity and mortality associated with this lethal cancer. Several studies have demonstrated the efficacy and safety of endoscopic eradication therapy (EET) for the management of Barrett's oesophagus related neoplasia. The primary goal of EET is to achieve complete eradication of intestinal metaplasia (CE-IM) followed by enrolment of patients in surveillance protocols to detect recurrence of Barrett's oesophagus and Barrett's oesophagus related neoplasia.

Recent findings

EET depends on early and accurate detection and diagnosis of Barrett's oesophagus related neoplasia. All visible lesions should be resected followed by ablation of the remaining Barrett's epithelium. After treatment, patients should be enrolled in endoscopic surveillance programmes. For nondysplastic Barrett's oesophagus, surveillance alone is recommended. For low-grade dysplasia, both surveillance and ablation are reasonable options and should be decided on an individual basis according to patient risk factors and preferences. EET is preferred for high-grade dysplasia and intramucosal carcinoma. For T1b oesophageal adenocarcinoma, esophagectomy remains the standard of care, but endoscopic therapy can be considered in select cases.

EET is now standard of care and endorsed by societal guidelines for the treatment of Barrett's oesophagus related neoplasia. Future studies should focus on risk stratification models using a combination of clinical data and biomarkers to identify ideal candidates for EET, and to predict recurrence. Optimal therapy for T1b cancer and surveillance strategy after CE-IM are topics that require further study.
An expanded role for dipeptidyl peptidase 4 in cell regulation
Authors: Ropa James , Broxmeyer Hal E.
Published: June 2020

Purpose of review

Dipeptidyl peptidase 4 (DPP4) is a serine protease with diverse regulatory functions in healthy and diseased cells. Much remains unknown about the mechanisms and targets of DPP4. Here we discuss new studies exploring DPP4-mediated cellular regulation, provide an updated list of potential targets of DPP4, and discuss clinical implications of each.

Recent findings

Recent studies have sought enhanced efficacy of targeting DPP4's role in regulating hematopoietic stem and progenitor cells for improved clinical application. Further studies have identified DPP4 functions in different cellular compartments and have proposed ways to target this protein in malignancy. These findings, together with an expanded list of putative extracellular, cell surface, and intracellular DPP4 targets, provide insight into new DPP4-mediated cell regulation.

DPP4 posttranslationally modifies proteins and peptides with essential roles in hematopoietic cell regulation, stem cell transplantation, and malignancy. Targets include secreted signaling factors and may include membrane proteins and transcription factors critical for different hematopoietic functions. Knowing these targets and functions can provide insight into new regulatory roles for DPP4 that may be targeted to enhance transplantation, treat disease, and better understand different regulatory pathways of hematopoiesis.
Infectious complications of vascularized composite allograft transplantation
Authors: Steinbrink Julie M. , Wolfe Cameron R.
Published: June 2020

Purpose of review

Vascularized composite allograft (VCA) transplants constitute multiple tissues transplanted together as one functional unit. These procedures are increasing in frequency and complexity, yet data about graft survival, quality of life, and infection risk remain limited.

Recent findings

Informative guidance for this patient population is often inferred from the solid organ transplantation literature. Yet, it is important to understand that VCA transplantation additionally carries its own significant and distinctive risk factors for infection.

In this review, we give an overview of previously described infectious complications of VCA transplantation in the literature, discuss risk factors for future infection in these patients, and discuss how to manage such obstacles.
Comprehensive Targeted Sequencing Identifies Monogenic Disorders in Patients With Early‐onset Refractory Diarrhea
Authors: Uchida Takashi , Suzuki Tasuku , Kikuchi Atsuo , Kakuta Fumihiko , Ishige Takashi , Nakayama Yoshiko , Kanegane Hirokazu , Etani Yuri , Mizuochi Tatsuki , Fujiwara Shin‐ichi , Nambu Ryusuke , Suyama Kazuhide , Tanaka Masanori , Yoden Atsushi , Abukawa Daiki , Sasahara Yoji , Kure Shigeo
Published: June 2020

Objectives:

Causes of early‐onset refractory diarrhea include exudative diarrhea associated with very early‐onset inflammatory bowel diseases, osmotic or secretory diarrhea, and protein‐losing enteropathy. Monogenic disorders are included in these diseases, yet a comprehensive genetic analysis has not been fully established.

Methods:

We established targeted gene panels covering all responsible genes for early‐onset diarrhea. In total, 108 patients from 15 institutions were enrolled in this study. We collected clinical data from all patients. Seventy‐three patients with exudative diarrhea, 4 with osmotic or secretory diarrhea and 8 with protein‐losing enteropathy were subjected to genetic analysis.

Results:

A total of 15 out of the 108 enrolled patients (13.9%) were identified as monogenic. We identified 1 patient with RELA, 2 with TNFAIP3, 1 with CTLA4, 1 with SLCO2A1, 4 with XIAP, 3 with IL10RA, 1 with HPS1, 1 with FOXP3, and 1 with CYBB gene mutations. We also identified 1 patient with NFKB2 and 1 with TERT mutations from the gene panel for primary immunodeficiency syndromes. The patient with refractory diarrhea caused by heterozygous truncated RelA protein expression is the first case identified worldwide, and functional analysis revealed that the mutation affected nuclear factor kappa B signaling. Genotypes were significantly associated with the clinical and pathological findings in each patient.

Conclusions:

We identified variable monogenic diseases in the patients and found that genes responsible for primary immunodeficiency diseases were frequently involved in molecular pathogenesis. Comprehensive genetic analysis was useful for accurate molecular diagnosis, understanding of underlying pathogenesis, and selecting the optimal treatment for patients with early‐onset refractory diarrhea.

An infographic for this article is available at: http://links.lww.com/MPG/B853.
Medication-Assisted Treatment for Opioid Use Disorder in Pregnancy: Practical Applications and Clinical Impact
Authors: Zhao Lulu , Cheng Cece , Bouchard Lauren
Published: June 2020

Importance

Opioid use disorder is increasingly common in the United States and affects many pregnancies. Given the rise in pregnancies complicated by opioid use, providers should understand the diagnosis and management of opioid use disorder in pregnancy.

Objective

This article focuses on screening for opioid misuse, selecting appropriate treatment for patients, initiating medication-assisted treatment in the inpatient setting, and providing appropriate peripartum care.

Evidence Acquisition

A PubMed search was undertaken using the following search terms: “opioid use disorder”, “pregnancy,” “medication assisted treatment,” “buprenorphine,” “methadone,” “heroin,” “addiction,” “neonatal abstinence syndrome,” and “detoxification.” The search was limited to the English language publications, with most being published after 2000.

Results

All women should be screened for opioid use disorder during pregnancy. Opioid use has profound effects on the mother and infant. Medication-assisted treatment is the standard of care for pregnant women with opioid use disorder. Patients will require a multidisciplinary approach to management in the intrapartum and postpartum period.

Conclusions

Opioid use disorder is a common, chronic condition with significant implications during pregnancy. Recognition and appropriate treatment of this disorder can optimize maternal and fetal outcomes.

Relevance

Obstetricians are increasingly being challenged to manage pregnancies complicated by opioid use disorder and should be proficient in providing safe and effective care.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, the learner should be better able to describe the effects of opioid use disorder on the mother-infant dyad during the antepartum, intrapartum, and postpartum periods; assess why medication-assisted treatment remains the standard of care for pregnant women with opioid use disorder; and explain the risks and benefits of different types of medication-assisted treatment and illustrate specific medication-assisted treatment initiation protocols.
Electroconvulsive Therapy in Pregnancy: Safety, Best Practices, and Barriers to Care
Authors: Rose Sherrill , Dotters-Katz Sarah K. , Kuller Jeffrey A.
Published: June 2020

Importance

Approximately 10% to 16% of women meet diagnostic criteria for depression during pregnancy. Untreated maternal depression is associated with adverse pregnancy outcomes including premature birth, low birth weight, and fetal growth restriction.

Objective

The aim of this study is to review the current safety data on electroconvulsive therapy (ECT) in pregnancy and provide guidance to clinicians on the role of ECT in pregnancy and the special considerations for its use in our population.

Evidence Acquisition

We reviewed 4 meta-analyses on the use of ECT in pregnancy as well as the source material (case series, etc) for these meta-analyses. We reviewed the official position statements on ECT in pregnancy from obstetric and psychiatric governing bodies as well as clinical best practice information from practitioners of ECT in pregnancy.

Results

Electroconvulsive therapy may be underutilized due to stigma and lack of access for these women. Rates of ECT use in pregnancy are difficult to determine. There are physiologic differences in pregnancy that merit additional attention during ECT, including increased risk of aspiration, concern for aortocaval compression, and the possibility of fetal heart rate changes associated with prolonged seizure activity. Serious adverse outcomes associated with ECT use in pregnancy are rare.

Conclusions and Relevance

Electroconvulsive therapy is a highly effective and safe treatment modality for unipolar depression, bipolar disorder, schizophrenia, and other psychiatric illnesses. Electroconvulsive therapy treatment in pregnancy requires a multidisciplinary team approach with obstetrics, maternal-fetal medicine, psychiatry, and anesthesiology, but is overall felt to be safe and effective.

Target Audience

Obstetricians and gynecologist, family medicine physicians.

Learning Objectives

After completing this activity, the learner should be better able to assess the current evidence and best practices regarding ECT use in pregnant patients; describe risks, benefits, and contraindications to ECT use in pregnant patients; and explain the potential for practice gaps in the utilization of ECT in pregnancy.
Network Analysis of Organizations Providing HIV Services in Chicago: Toward an Integrated Response to the HIV Epidemic
Authors: Phillips Gregory , Lindeman Peter , Janulis Patrick , Johnson Amy K. , Beach Lauren B. , Stonehouse Patrick , Kern David , Boegner Joshua , Raman Anand , Greene George J.
Published: June 2020

Context:

The public health response to the HIV epidemic has increasingly centered on the uptake of and adherence to biomedical interventions (eg, pre-exposure prophylaxis [PrEP], treatment as prevention [TasP]). Traditionally, various community and health care organizations have worked to address different stages of PrEP or TasP care.

Objective:

To understand the importance of how HIV prevention organizations providing these services interact to provide the comprehensive care needed for successful HIV and PrEP continuum outcomes.

Design:

Utilizing an Organizational Network Survey, network ties were examined between formal and informal partnerships among community agencies.

Setting:

This study examined community agencies in the current HIV prevention system in Chicago.

Participants:

Seventy-two community agencies across the Chicago metropolitan area.

Main Outcome Measures:

Using network analysis, this study examined ties between community agencies and assessed perceptions of collaboration and competitiveness in the current HIV prevention system in Chicago.

Results:

Overall, respondents reported that the current environment of HIV prevention in Chicago was extremely (18.8%), moderately (37.5%), or somewhat collaborative (37.5%) and extremely (68.8%) or moderately competitive (25.0%). The majority of partnerships reported were informal, with less than a quarter being formalized. That said, those who reported formal partnerships reported being satisfied with those relationships. There was a significantly negative association between density and perceived collaboration—grantees experiencing a more collaborative also reported less dense networks.

Conclusion:

These findings indicate that, despite perceived competitiveness, agencies are willing to work together and create a cohesive HIV prevention and treatment system. However, more work should be done to foster an environment that can support the formation of partnerships, to improve a coordinated response to providing HIV care, and sustain mutually beneficial relationships.
Shifts in Community Benefits Spending Among Nonprofit Hospitals in Nebraska and 10 Proximate States, 2012 and 2015
Authors: Palm David , Pacino Valerie , Grimm Brandon
Published: June 2020

Context:

Federal and state policy makers have debated the evolving concept of community benefit and the extent to which nonprofit hospitals are providing benefits to the community in exchange for the tax benefits they receive.

Objective:

This study compares community benefits spending by nonprofit hospitals in Nebraska and other selected states in both 2012 and 2015. Expenditures are also examined by rural, regional, and urban hospitals within Nebraska.

Methods:

Community benefit expenditure data were taken from Community Benefit Insight and consolidated into the categories of direct patient care, community health improvement initiatives, and health professions education and research.

Results:

When community benefit expenditures were compared across 11 states, Nebraska had the highest percentage of expenditures for community health improvement initiatives in both 2012 and 2015. Although community benefit expenditures for the 44 nonprofit hospitals within Nebraska increased from 2012 to 2015, they remained flat as a share of total hospital expenditures. In 2015, 63% of community benefit expenditures were allocated to direct patient care, which represented a 7.3% decrease from 2012. This decline led to greater spending on community health improvement initiatives (3.1%) and health professions education and research (4.2%). Rural, regional, and urban hospitals spent more proportionately on community health improvement initiatives in 2015 than in 2012.

Conclusions:

The shift in community benefit expenditures from direct patient care to community health improvement initiatives and health professions education and research suggests that hospitals are investing in programs with broader community-wide benefits. Nebraska allocates a significantly larger share of its community benefits spending to community health improvement activities than other Great Plains and Midwestern states. Nebraska is in the process of implementing Medicaid expansion, which may shift future community benefits spending decisions.
Diabetes Prevention for Pacific People in the United States: A Mixed-Methods Feasibility Study to Adapt the Diabetes Prevention Program With Samoan/Tongan Church Communities
Authors: Parks Courtney A. , Panapasa Sela V. , Yaroch Amy L. , Fricke Hollyanne E. , Resnicow Kenneth
Published: June 2020

Objective:

To determine baseline characteristics of a group of Samoans/Tongans in Southern California at risk for type 2 diabetes mellitus and identify barriers, cultural factors, and readiness and capacity to implement a culturally tailored Diabetes Prevention Program (DPP) in a faith-based setting.

Design:

A mixed-methods pilot that included piloting modified DPP sessions, conducting a survey, and focus groups (N = 4).

Setting:

Samoan/Tongan faith-based organizations.

Participants:

Samoan/Tongan church members in Southern California who were interested in lifestyle behavior change.

Main Outcome Measures:

Surveys assessing sociodemographic, acculturation, health status, food insecurity, and psychosocial factors. Focus groups focusing on attitudes toward the curriculum, opportunities for tailoring, and specific barriers/facilitators for healthy weight, nutrition, and physical activity.

Results:

Participants (N = 47) were on average 42 years old, female (57%), and identified as Pacific Islander (35% Samoan, 30% American Samoan, and 35% Tongan). Ninety-eight percent of respondents were overweight/obese, and 45% of households were food insecure. Less than half of respondents were born in the United States, and 28% reported “poor” or “fair” English proficiency. Those with higher body mass indexes were more likely to score lower on internal locus of control and self-efficacy for healthy eating and were motivated to lose weight to feel in control of their health. Focus group results revealed that members of the Samoan/Tongan communities are “underserved” and experience a lack of culturally relevant programs to address obesity and chronic disease. Several barriers to healthier lifestyles were identified including adaptation of traditional recipes made in the United States (ie, to be less healthy), role of stress, cultural values (eg, preference for larger body size), and lack of awareness about healthy lifestyles. The church was identified as a resource that could be leveraged further to positively impact health outcomes.

Conclusions:

Results demonstrate possible ways to tailor the DPP for US-based Samoan/Tongan populations by harnessing cultural traditions and addressing existing barriers and psychosocial constructs.
Design and Implementation of a Musculoskeletal Ultrasound Curriculum for Physical Medicine and Rehabilitation Residents
Authors: Bitterman Jason , Lew Henry L. , Kirshblum Steven , Enam Nabela , Pierce Daniel , Ma Rex T.
Published: June 2020

Studies have shown that physical medicine and rehabilitation residents have poor surface anatomy palpation accuracy, suggesting that new methods of teaching musculoskeletal (MSK) examination need to be found. This study describes the design of a novel MSK ultrasound course that integrated ultrasonography skills with palpation skills. Ultrasound was used to teach, validate, and refine physical medicine and rehabilitation residents’ palpation of MSK structures. Surface anatomy palpation is intimately related to ultrasonography as clinicians should use palpation to guide their ultrasound examination rather than purely follow an algorithm. This study assessed whether the ultrasound course improved physical medicine and rehabilitation resident palpation accuracy at 12 upper limb structures. Palpation accuracy was tested at the beginning of their residency training and retested several weeks after completion of the ultrasound course’s upper limb component, to assess retention of skill. There was significant improvement (P < 0.05) in 9 of 12 sites from pretesting to posttesting. Mean postcourse palpation accuracy was within 1 cm for 8 of 12 structures. This study demonstrates that an integrated MSK ultrasound and palpation curriculum improves palpation accuracy at multiple MSK structures and this improvement is retained. Physical medicine and rehabilitation residencies should consider integrating palpation skills into their ultrasound curriculum to improve the caliber of their trainees.
Panic Disorder Correlates With the Risk for Sexual Dysfunction
Authors: LO YU-CHI , CHEN HSI-HAN , HUANG SHIAU-SHIAN
Published: June 2020

Background:

Reports have suggested that sexual dysfunction is an underestimated complication of panic disorder, but little research has focused on sexual dysfunction associated specifically with panic disorder. The purpose of this systematic review was to investigate whether patients with panic disorder who are not currently receiving treatment had a higher risk of sexual dysfunction than healthy people, as well as to clarify the appropriate treatment for this patient group.

Methods:

Articles that reported panic disorder complicated with sexual dysfunction were identified by a systematic literature search of electronic databases, including PubMed, the Cochrane databases, EMBASE, and PsycINFO.

Results:

Six articles were included in the review. Patients with panic disorder showed a high prevalence of sexual aversion (35.7% to 64%) and sexual infrequency (36% to 44%). One cohort study indicated that untreated patients with panic disorders had a higher risk of erectile dysfunction than controls. Another article that focused specifically on female patients reported that the patients with panic disorder exhibited decreased frequency of sexual behavior and decreased sexual desire compared with the controls. However, 2 studies found conflicting results after adjustment for confounding factors.

Conclusions:

Although the results were mixed, it appears that patients with panic disorder tended to be more susceptible to sexual dysfunction than the general population. Further trials with larger sample sizes and rigorous research designs are needed to establish the relationship between sexual dysfunction and panic disorder.
Obsessive-Compulsive Disorder in Older Adults: A Comprehensive Literature Review
Authors: JAZI ALI NAJAFIAN , ASGHAR-ALI ALI A.
Published: June 2020

We reviewed English-language articles concerning obsessive-compulsive disorder (OCD) in older adults. PubMed was searched using key words that included obsessive-compulsive disorder, geriatric, elderly, aging, and older. Of the 644 articles identified, we included 78 that were relevant to the topic. Articles that were excluded as irrelevant included studies that were not focused on OCD in older adults, animal studies, and older case reports if we identified similar more recent case reports. The literature contains very little information about the epidemiology, diagnosis, psychopathology, and treatment of OCD in older adults. Even though the diagnostic criteria for OCD are the same for older and younger adults, different manifestations and progression in older patients have been reported. While the domains and severity of symptoms of OCD do not change with age, pathologic doubt may worsen. The Yale-Brown Obsessive Compulsive Scale is used for diagnosing and evaluating illness severity, and the Obsessive-Compulsive Inventory-Revised is another valuable tool for use in older adults. Psychotherapy, specifically exposure and response prevention, is the first-line treatment for OCD because of minimal adverse effects and reported benefit. Although the US Food and Drug Administration has not approved any medications specifically for OCD in older adults, pharmacotherapy is a consideration if psychotherapy is not successful. Selective serotonin reuptake inhibitors have the fewest side effects, while the cardiovascular and anticholinergic side effects of tricyclic antidepressants are especially worrisome in older adults. OCD in older adults has received little attention, and further studies are needed.
The Impact of Personality Pathology on Treatment Outcome in Late-life Panic Disorder
Authors: GULPERS BERNICE , OUDE VOSHAAR RICHARD , KAMPMAN MIRJAM , VERHEY FRANS , VAN ALPHEN SEBASTIAAN , HENDRIKS GERT-JAN
Published: June 2020

Background:

Comorbid personality disorders are assumed to negatively interfere with the treatment outcome of affective disorders. Data on late-life panic disorder remain unknown. We examined the association of personality pathology and treatment outcome related to age and treatment modality.

Methods:

An observational study on the effectiveness of cognitive-behavioral therapy (CBT) for panic disorder with agoraphobia among patients 18 to 74 years of age and randomized controlled comparison of paroxetine and CBT in older patients (60 y of age or older) were performed. The diagnosis of panic disorder was confirmed by the Anxiety Disorder Interview Schedule-Revised (ADIS-IV) and personality features were assessed with the Personality Diagnostic Questionnaire. The impact of personality features on either agoraphobic cognitions (Agoraphobic Cognitions Questionnaire) or avoidance behavior (Mobility Inventory Avoidance Scale) was examined by multiple linear regression analyses adjusted for sex, level of education, duration of illness, comorbid psychopathology, and baseline severity. The interaction between personality and age was examined among those treated with CBT (n=90); the interaction between personality and treatment modality was examined among the older subgroup (n=34).

Results:

Cluster B personality pathology (evaluated on the basis of either Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R) or Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria depending on the date of assessment) was negatively associated with outcomes of CBT in both younger and older adults with panic disorder and agoraphobia. Older adults with a higher number of features of any personality pathology or cluster A pathology had worse treatment outcomes when treated with paroxetine compared with CBT.

Conclusions:

Cluster B pathology had a detrimental effect on CBT treatment outcome for panic disorder in both age groups. In late-life panic disorder with comorbid personality pathology, CBT may be preferred over treatment with paroxetine.
Improving Allergy Documentation: A Retrospective Electronic Health Record System–Wide Patient Safety Initiative
Authors: Li Lily , Foer Dinah , Hallisey Robert K. , Hanson Carol , McKee Ashley E. , Zuccotti Gianna , Mort Elizabeth A. , Sequist Thomas D. , Kaufman Nathan E. , Seguin Claire M. , Kachalia Allen , Blumenthal Kimberly G. , Wickner Paige G.
Published: June 2020

Objectives

Documentation of allergies in a coded, non–free-text format in the electronic health record (EHR) triggers clinical decision support to prevent adverse events. Health system-wide patient safety initiatives to improve EHR allergy documentation by specifically decreasing free-text allergy entries have not been reported. The goal of this initiative was to systematically reduce free-text allergen entries in the EHR allergy module.

Methods

We assessed free-text allergy entries in a commercial EHR used at a multihospital integrated health care system in the greater Boston area. Using both manual and automated methods, a multidisciplinary consensus group prioritized high-risk and frequently used free-text allergens for conversion to coded entries, added new allergen entries, and deleted duplicate allergen entries. Environmental allergies were moved to the patient problem list.

Results

We identified 242,330 free-text entries, which included a variety of environmental allergies (42%), food allergies (18%), contrast media allergies (13%), “no known allergy” (12%), drug allergies (2%), and “no contrast allergy” (2%). Most free-text entries were entered by medical assistants in ambulatory settings (34%) and registered nurses in perioperative settings (20%). We remediated a total of 52,206 free-text entries with automated methods and 79,578 free-text entries with manual methods.

Conclusions

Through this multidisciplinary intervention, we identified and remediated 131,784 free-text entries in our EHR to improve clinical decision support and patient safety. Additional strategies are required to completely eliminate free-text allergy entry, and establish systematic, consistent, and safe guidelines for documenting allergies.
Accuracy of Three-Dimensional Upper Airway Prediction in Orthognathic Patients Using Dolphin Three-Dimensional Software
Authors: Elshebiny Tarek , Bous Rany , Withana Thimanthi , Morcos Sherif , Valiathan Manish
Published: June 2020

Background:

Orthodontists and surgeons have been looking for more accurate methods to predict surgical outcomes in patients with skeletal discrepancies.

Methods:

The sample consisted of 20 patients from the surgical clinic of a graduate orthodontic program who had been treated with Le Fort I maxillary movement, bilateral sagittal split osteotomy, with or without genioplasty. All patients had to have preoperative (T0) and at least 6 months postoperative (T1) cone-beam computed tomographies that were imported to Dolphin 3-dimensional (3D) software. The 3D voxel-based superimposition on the cranial base was performed for T0 and T1 to accurately measure the skeletal surgical movements. A virtual orthognathic surgery was performed on T0 to mimic the actual skeletal osteotomies using the treatment simulation tool in Dolphin 3D. A prediction 3D soft-tissue image (Tp) was generated based on the Dolphin virtual skeletal planning. The upper airway was segmented and exported as stereolithography surface files in both T1 and Tp. The measurements of the 3D volume of the airway were calculated and compared among T1 and Tp by using surface superimposition technique. Mean and standard deviations of upper airway volume were compared and correlated using paired t-test.

Results:

There was no statistically significant difference between the upper airway volume of T1 and Tp.

Conclusion:

Dolphin 3D delivers accurate airway prediction which is an important step in 3D virtual planning.
Using Simulation to Measure and Improve Pediatric Primary Care Offices Emergency Readiness
Authors: Garrow Amanda L. , Zaveri Pavan , Yuknis Matthew , Abulebda Kamal , Auerbach Marc , Thomas Eileen M.
Published: June 2020

Introduction

Emergencies in the pediatric primary care office are high-risk, low-frequency events that offices may be ill-prepared to manage. We developed an intervention to improve pediatric primary care office emergency preparedness involving a baseline measurement, a customized report out with action plans for improvement (based on baseline measures), and a plan to repeat measurement at 6 months. This article reports on the baseline measurement.

Methods

This baseline measurement consisted of 2 components: preparedness checklists and in situ simulations. The preparedness checklists were completed in person to measure compliance with the American Academy of Pediatrics Policy Statement: preparation for emergencies in the offices of pediatricians and pediatric primary care providers, in the domains of equipment, supplies, medication, and guidelines. Two in situ simulations, a child in respiratory distress and a child with a seizure, were conducted with the offices' interprofessional teams; performance was scored using checklists.

Results

Baseline measurements were conducted in 12 pediatric offices from October to December 2018. Wide variability was noted for compliance with the American Academy of Pediatrics recommendations (range = 47%–87%) and performance during in situ simulations (range = 43%–100%).

Conclusions

Pediatric primary care office emergency preparedness was found to be variable. Simulation can be used to augment existing measures of emergency preparedness, such as checklists. By using simulation to measure office emergency preparedness, areas of knowledge deficit and latent safety threats were identified and are being addressed through ongoing collaboration.
Cost-Effective Filtrating Suction to Evacuate Surgical Smoke in Laparoscopic and Robotic Surgery During the COVID-19 Pandemic
Authors: Ouzzane Adil , Colin Pierre
Published: June 2020

The wide and fast spread of COVID-19 around the world has led to a dramatic increase in the need for protection products both for carers and for populations. Surgical team protection includes a systematic screening of patients, wearing protection devices by all the operating staff, and adequate management of aerosols. The risk of aerosol dispersal is particularly high during laparoscopic and robotic surgeries due to the interaction between circulating CO2 and surgical smoke that may contain small viral particles. To decrease the risk of virus transmission, many recommendations have been implemented including the use of integrated insufflation devices comprising smoke evacuation and filtration mode. Such devices are lacking in many centers around the world and to overcome this urgent unmet need, we designed a cost-effective filtrating suction as a more readily available alternative.
Comparative Analysis of Laparoscopic Inguinal Hernia Repair in Neonates and Infants
Authors: Walsh Caoimhe M. , Ng Jessica , Saxena Amulya K.
Published: June 2020

Background:

This study analyzed our cohort of infants (age below 12 mo) who underwent laparoscopic inguinal hernia repair (LIHR), comparing those 3 months and below (corrected premature) to above 3 months (term infants) corrected age at the time of surgery.

Materials and Methods:

Retrospective analysis of a single surgeon and associated trainees’ experience of LIHR in infants below 12 months over a 5-year period (2013-2018) was performed. The operative technique involved a 5-mm scope and 3-mm instruments for herniorrhaphy with 4/0 Prolene purse-string suture. Data collected included patient demographics, prematurity (<37 wk), corrected age and weight at surgery, preoperative hemoglobin level, comorbidities, anesthetic time, major perioperative complications, and inguinal hernia recurrence. A comparison was made between those operated at 3 months and below and above 3 months corrected age. Perioperative issues affecting infants 3 months and below were identified and analyzed. Statistical analysis includes T test and Fisher exact test (P<0.05 significance).

Results:

Eighty infants underwent LIHR (age below 12 mo), of which 67 (84%) were male with a median corrected age of 10.5 (range 2.5 to 44) weeks, the median weight of 5.5 kg (range 2.1 to 10.8). A total of 47 (59%) infants had a unilateral inguinal hernia repair and 33 (41%) had a bilateral repair. The median anesthetic time was significantly greater for infants 3 months and below at 93 (range 61 to 125) minutes, compared with 83 (range 47 to 146) minutes for the above 3 months age group (P=0.001) There were no perioperative complications or mortality. One patient had a recurrence of an inguinal hernia. Low hemoglobin levels, comorbidities, and extreme prematurity required more attention during preoperative assessment and postoperative management.

Conclusions:

Comparable cohorts demonstrated no significant difference in recurrences despite significant differences in weight and median anesthetic time. Preoperative hemoglobin is an important factor that needs to be addressed in infants 3 months and below for scheduling the procedure date (transfusion vs. iron supplementation).
Development of a novel patient focussed symptom severity index for use in assessing and treating inflammatory conditions of the lactating breast: a Delphi study
Authors: Cooper Melinda , Lowe Helen , McArdle Adelle
Published: June 2020

Aim:

To investigate the content and face validity of a patient-reported outcome measure used by Australian physiotherapists in the assessment of inflammatory conditions of the lactating breast.

Methods:

Sixty one experts representing ‘women who previously had inflammatory conditions of the lactating breast’ (48%), ‘clinicians’ (38%) and ‘academics’ (8%) interested in women's health and 7% unidentified participants were invited to complete a three round Delphi study.

Results:

Ninety five percent of participants agreed that overall, the patient-reported outcome measure was appropriate for use in assessing and treating inflammatory conditions of the lactating breast. The item ‘impact’ was added to ensure the appropriate assessment of functional aspects of daily life. The item terminology used in the patient-reported outcome measure was simplified to ‘pain’, ‘redness’, ‘hardness/tightness’, ‘temperature of affected area’, ‘sickness/wellness’ and ‘affected area. A clinician script was developed to ensure the patient-reported outcome measure has utility and consistency regardless of the experience of the women presenting with inflammatory conditions of the lactating breast or the clinician.

Conclusion:

The resultant Breast Inflammatory Symptom Severity Index (BISSI) is a patient-reported outcome measure for use in the diagnosis and monitoring of clinical changes of symptoms associated with inflammatory conditions of the lactating breast including engorgement, blocked ducts and mastitis. It utilizes person-centred language and assesses symptoms considered important to both patient and clinician. The development of the clinician script facilitates utility regardless of the experience of either the woman with the inflammatory condition or the treating clinician.