bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes of paediatric rheumatic disease
Authors: Minden Kirsten
Published: February 2018

Paediatric rheumatic illnesses are among the most common chronic diseases in children and adolescents. These illnesses have important impacts on patient’s body functions and structures, activities, and social participation. Knowledge about the effect and consequences of these diseases is necessary to formulate appropriate aims of treatments. The multidimensional outcomes of paediatric rheumatic diseases and their measurement are reviewed in this chapter.
Outcome measurement is complex in patients who have growing needs and changing expectations as they develop, especially in chronic conditions that have a variable and often unpredictable course, such as juvenile idiopathic arthritis, juvenile systemic lupus erythematosus, and juvenile dermatomyositis. Considerable work has been conducted recently in an effort to better define and value global outcomes for these patients. New and reliable outcome measures have been developed to capture all aspects of the patient’s life and integrate the patients’ perspective.
Existing outcome studies of paediatric rheumatic diseases have consistently shown, even though differing in their methodology, that patient outcomes have improved over the last decade. More patients with chronic inflammatory rheumatic conditions survive into adulthood, and patients’ long-term health, functional, and quality of life outcomes have improved. However, outcomes are still less than ideal. More than one-half of the patients with paediatric rheumatic diseases have ongoing active disease in early adulthood. Over one-third have evidence of disability and organ damage, with each underlying disease being associated with specific complications. Clearly, given the inherent potential for disability, morbidity, even mortality, young people with paediatric-onset rheumatic diseases require ongoing medical care into adulthood.
Enthesitis
Authors: Rudwaleit Martin
Published: February 2018

Enthesitis is one of the key manifestations of spondyloarthritis (SpA) including ankylosing spondylitis (AS) and psoriatic arthritis. Enthesitis can occur alone or in combination with peripheral arthritis, sacroiliitis, or spondylitis. The inflammatory process is typically located at the insertion of the enthesis or ligament to bone, often resulting in osteitis as well. Because of its anatomical and functional complexity the term ’enthesis organ’ has been coined. Biomechanical stress applied to the enthesis seems to play an important role for the occurrence of enthesitis in genetically predisposed individuals. Ultrasound imaging of peripheral entheses reveals enthesis abnormalities including entheseal calcification, bony erosion, or bony proliferation. Power Doppler signals demonstrating increased vascularization of inflamed entheses at the insertional site appear to be the most characteristic finding for enthesitis, yet study results are conflicting. Enthesitis-related osteitis and enthesitis at the spine is best visualized by MRI. Enthesitis may resolve spontaneously or may run a chronic course. Standard treatment includes local steroid injections, non-steroidal anti-inflammatory drugs (NSAIDs), and physical therapy. There is little evidence for the efficacy of disease-modifying antirheumatic drugs (DMARDs) in enthesitis. In contrast, anti-TNF agents have proven efficacy, and their use in treatment-resistant enthesitis is recommended in the Assessment of SpondyloArthritis international Society (ASAS)/European League Against Rheumatism (EULAR) recommendations for the management of AS and axial SpA and in the EULAR recommendations for psoriatic arthritis.
Ultrasound
Authors: Kane David , Platt Philip
Published: February 2018

Musculoskeletal ultrasound (MSUS) is rapidly becoming a standard part of many rheumatologists’ daily clinical practice. MSUS is safe, increasingly widely available, relatively low cost, non-invasive, and hence very acceptable to the patient. Current problems with availability of training, mentoring, and accreditation procedures need to be overcome for MSUS to reach its full potential for rheumatologists.
MSUS is capable of improving clinical diagnosis and the accuracy of intervention. MSUS is more sensitive than clinical examination in the detection of synovitis and effusion and is capable of rapid targeted assessment of widely spaced joints coupled with clinical correlation.
MSUS has advantages over other imaging modalities; the ability to display dynamic real-time movement makes it the imaging modality of choice for tendon problems. It is significantly more sensitive than plain radiology in the demonstration of early erosive changes, and although its sensitivity is less than that of MRI for the detection of erosions it is far more practical, timely, and available. The combination of sensitivity in detection of synovitis, tenosynovitis, and erosions makes it an ideal imaging modality in the context of an early arthritis clinic. Power Doppler has been shown to be an effective way of evaluating synovitis and hence is of value in early diagnosis and monitoring of inflammatory arthritides.
The accuracy of placement of local injection therapies is enhanced by MSUS, and it significantly increases the diagnostic success rate of aspiration of joints and bursas. The flexibility of ultrasound as a tool for rheumatologists is shown by its application in the assessment of vasculitides, peripheral nerve pathology, salivary glands, and skin lesions.
Cardiopulmonary investigations
Authors: Schreiber Benjamin E. , Keir Gregory J. , Coghlan J. Gerry
Published: February 2018

Cardiopulmonary investigations are growing in number and complexity, but are crucial in management of patients with multisystem disease. Patients with rheumatological conditions are frequently at increased risk of a wide range of cardiac and pulmonary complications. Cardiac complications include accelerated atherosclerosis, valvular dysfunction, and pericardial, myocardial and endocardial involvement. Pulmonary complications include airways disease, interstitial lung disease, pulmonary embolism, and pulmonary hypertension.
We aim to present some practical frameworks for selecting the appropriate initial tests in different clinical situations. This chapter is in three sections. In the first section, we review the recommended investigations for common clinical symptoms: shortness of breath, cough, chest pain, and syncope. In the second section, we review the importance of cardiopulmonary investigations in specific rheumatological conditions. In the third section we review the unique characteristics of the cardiopulmonary tests, stressing their particular strengths and weaknesses and associated complications.
Alternative therapies
Authors: Ernst Edzard
Published: February 2018

Alternative therapies are used by many patients suffering from rheumatic conditions. In this chapter, the efficacy and safety of various forms of alternative medicine will be discussed based on the evidence from clinical trials and systematic reviews. The following treatments will be considered: acupuncture, Ayurvedic medicine, chiropractic, dietary supplements, herbal remedies, homeopathy, massage, osteopathy, t’ai chi, and yoga.
Axial spondyloarthropathies
Authors: Sieper Joachim
Published: February 2018

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease predominantly of the sacroiliac joint (SIJ) and the spine. It starts normally in the second decade of life and has a slight male predominance. The prevalence is between 0.2% and 0.8% and is strongly dependent on the prevalence of HLA-B27 in a given population. AxSpA can be split in patients with radiographic axSpA (also termed ankylosing spondylitis (AS)) and in patients with non-radiographic axSpA (nr-axSpA). For the diagnosis of AS, the presence of radiographic sacroiliitis is mandatory. However, radiographs do not detect active inflammation but only structural bony damage. Most recently new classification criteria for axSpA have been developed by the Assessment of Spondylo-Arthritis International Society (ASAS) which cover AS but also the earlier form of nr-axSpA. MRI has become an important new tool for the detection of subchondral bone marrow inflammation in SIJ and spine and has become increasingly important for an early diagnosis. HLA-B27 plays a central role in the pathogenesis but its exact interaction with the immune system has not yet been clarified. Besides pain and stiffness in the axial skeleton patients suffer also from periods of peripheral arthritis, enthesitis, and uveitis. New bone formation as a reaction to inflammation and subsequent ankylosis of the spine determine long-term outcome in a subgroup of patients. Currently only non-steroidal anti-inflammatory drugs (NSAIDs) and tumour necrosis factor (TNF) blockers have been proven to be effective in the medical treatment of axial SpA, and international ASAS recommendations for the structured management of axial SpA have been published based on these two types of drugs. Conventional disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate are not effective.
Paediatric polymyositis and dermatomyositis
Authors: Pilkington Clarissa , McCann Liza
Published: February 2018

Juvenile polymyositis and dermatomyositis are inflammatory myopathies that affect muscle. Dermatomyositis also affects skin, and can have many extramuscular manifestations. Inflammatory myopathies are uncommon in childhood, with dermatomyositis occurring more than polymyositis. For this reason, published research has concentrated on juvenile dermatomyositis. The spectrum of disease severity ranges from mild cases that can recover completely without treatment, to multisystem inflammation that can be fatal. Treatments have improved over the decades, reducing mortality from 30% before the era of steroids, to less than 1% in the present day. Juvenile cases of dermatomyositis differ from those seen in adulthood, without tendency for associated malignancy, and a far greater incidence of calcinosis. Calcinosis can be deposited as small calcinotic lumps or as sheets of calcinosis. It is very difficult to treat and causes extensive morbidity, and depending on where the calcinosis is deposited, it can cause severe disability or even death.
Over the last decade, international collaborative work has concentrated on developing disease activity and assessment tools for both adult and juvenile forms of myositis. This will enable more subjective study of these rare diseases in multinational cohort studies, and enable clinical trials to investigate drug treatments. This work led to the first international double-blind placebo controlled trial of treatment in both adults and children with dermatomyositis (using rituximab as the drug). Further international collaboration has led to the development of core outcome variables, a definition of disease flare, and ongoing work on classification criteria.
Clinical assessment and monitoring of chest radiographs
Authors: Parkhomenko Alexander , Gurjeva Olga S , Yalynska Tetyana
Published: February 2018

This chapter reviews the main problems in obtaining portable X-rays in intensive cardiac care unit patients and describes specific features of radiographs taken in the supine anteroposterior position. It also includes a brief review of a systematic, multistep approach of evaluating the quality of radiographic images and describing the chest wall, pulmonary vasculature, the heart and its chambers, the great vessels, and the position of tubes, lines, and devices. This chapter covers the most common conditions for which chest radiographs are useful and provides intensive cardiac care unit physicians, cardiologists, cardiology fellows, and medical students with basic information on water retention, air collection, and lung-related problems. It also focuses on the monitoring of line and device placements (e.g. central venous catheters, tube malposition) and procedure-related abnormalities, which may be apparent on chest X-rays and are helpful for timely diagnoses.
Renal support therapy
Authors: Ronco Claudio , Ricci Zaccaria
Published: February 2018

Renal dysfunction is known to be frequently a component of multiple organ failure, a complex syndrome affecting the most severely ill critical patients. Bidirectional interaction between the kidneys and other organs has always been suspected; evidence suggests that severe kidney injury is an important protagonist in acute illness, even when managed by dialysis. In fact, if it seems that increasing the dose of renal replacement therapy does not reduce mortality, it could be inferred that acute kidney injury influences mortality through means that are not reversed by conventional renal support, either because the putative culprit toxins are not removed by renal replacement therapy or because renal replacement therapy is started too late to prevent these effects. It is known that the kidneys exert effects on other organs, such as the lung, liver, heart, and brain, in a process called ‘crosstalk’. This effect means that the kidney is not only a victim, but also a culprit regarding the malfunction of other organs. This chapter will detail some traditional aspects of different renal replacement therapy modalities and prescription schedules, but it will also describe the most recent evidence on the management and support of the kidney during failure of other organs.
Fibrinolytic, antithrombotic, and antiplatelet drugs in acute coronary syndromes
Authors: Sinnaeve Peter , Van de Werf Frans
Published: February 2018

Antithrombotic therapy is a major cornerstone in the treatment for acute coronary syndromes, as thrombus formation upon a plaque rupture or an erosion plays a pivotal role in non-ST-segment elevation as well as ST-segment elevation acute coronary syndromes. Both acute and long-term oral antiplatelet therapies, targeting specific platelet activation pathways, have demonstrated significant short- and long-term benefits. The use of anticoagulants is currently largely confined to the acute setting, except in patients with a clear indication for long-term treatment, including atrial fibrillation or the presence of intraventricular thrombi. Despite the benefit of primary percutaneous coronary intervention in ST-segment elevation myocardial infarction, fibrinolysis continues to play an important role throughout the world as well. In this chapter, the fibrinolytic, antiplatelet, and anticoagulant agents used in the management of acute coronary syndrome patients are discussed.
Infection, sepsis, and multiorgan dysfunction syndrome
Authors: Favory Raphaël , Vincent Jean-Louis
Published: February 2018

Sepsis is the main cause of multiple organ failure and remains a concern because of the associated high morbidity and mortality. In recent years, important advances have been made in the understanding of the pathophysiology of sepsis. Sepsis and septic shock are the end result of complex interactions between infecting organisms and various elements of the host response. A key feature of the common sequence of organ failure is dysfunction of the cardiovascular system, including microcirculatory elements. Outcome improvement in sepsis is based on recognizing the process early and instituting effective therapies. The time window for intervention is relatively short, and treatment must promptly control the source of infection, restore haemodynamic homoeostasis, and support failing organ systems.
Perioperative management of the high-risk surgical patient: cardiac surgery
Authors: Ranucci Marco , Castelvecchio Serenella , Ballotta Andrea
Published: February 2018

During the last decade, as a result of continually improving surgical strategy and the technology which supports it (e.g. anaesthesia), cardiac surgery is offered to patients with advanced age and those with increasingly complex co-existing conditions that were previously considered to be contraindications. In addition, an increasing number of patients have previously undergone angioplasty, thereby delaying their initial coronary artery bypass graft surgery to a more advanced age. In general, candidates for cardiac surgery may now be not only older than in the past, but also more likely to have health problems such as hypertension and diabetes. Risk stratification may help to identify ‘the’ high-risk patient: ‘pre-warned is pre-armed’. In high-risk cardiac surgery patients, the surgical treatment options and perioperative care must be tailored to each patient, in order to optimize the benefits and minimize the risk of detrimental effects. The preoperative anticoagulation practice is an important aspect, balancing the risk between ischaemic and bleeding complications. New antiplatelet agents and oral anticoagulants have been recently delivered, and their role in patients scheduled for heart surgery is an additional important issue.
Malignancy Index Using Intraoperative Flow Cytometry is a Valuable Prognostic Factor for Glioblastoma Treated With Radiotherapy and Concomitant Temozolomide
Authors: Saito Taiichi , Muragaki Yoshihiro , Shioyama Takahiro , Komori Takashi , Maruyama Takashi , Nitta Masayuki , Yasuda Takayuki , Hosono Junji , Okamoto Saori , Kawamata Takakazu
Published: February 2018

BACKGROUND

Intraoperative prediction of radiochemosensitivity is desirable for improving the clinical management of glioblastoma (GBM) patients. We have previously developed an original technique for intraoperative flow cytometry (iFC) and defined a malignancy index (MI).

OBJECTIVE

To determine whether MI correlates with prognosis in GBM patients who underwent the standard treatment protocol of radiotherapy and temozolomide administration.

METHODS

The current study included 102 patients with GBM that had been newly diagnosed from 2010 to 2015 who underwent our iFC analysis and received the standard treatment protocol. We evaluated MI values in each patient, then statistically analyzed the relationship between MI and prognosis using survival analysis that include other clinicopathological factors (age, sex, Karnofsky performance status [KPS], extent of resection, second-line bevacizumab, O6-methylguanine-DNA methyltransferase [MGMT] status, MIB-1 labeling index, and mutation of the isocitrate dehydrogenase 1 gene [IDH1]).

RESULTS

Log-rank test revealed that age, KPS, extent of resection, MGMT status, IDH1 mutation, and high MI (≥26.3%) significantly correlated with overall survival. Multivariate analysis with Cox regression modeling identified MI as the most significant prognostic factor (hazard ratio = 2.246; 95% confidence interval = 1.347-3.800; P = .0019). MI showed strong correlation with IDH1 mutation status in chi-square test (P = .0023). In addition, log-rank test revealed that MI affects overall survival more strongly in patients with IDH1 wildtype than those with IDH1 mutant.

CONCLUSION

MI from an iFC study may help predict the prognosis in patients with GBM who receive the standard treatment. Survival can be related to sensitivity to radio-chemotherapy.
How Does Learning and Education Help to Overcome the Disposition Effect?*
Authors: Vaarmets Tarvo , Liivamägi Kristjan , Talpsepp Tõnn
Published: February 2018

The paper assesses how intelligence, education, and learning affect the disposition effect using our exhaustive NASDAQ OMX Tallinn dataset. We employ survival analysis to show that higher intelligence and stronger learning abilities as measured by education level and the type of education lessen the disposition effect. More highly educated and intelligent investors also learn faster by trading. We find that mathematical abilities are beneficial for overcoming the disposition effect and propose that learning ability is one of the most important components of intelligence in affecting the disposition effect.
Loss-of-Function Mutations in the Dpp and Opp Permeases Render Erwinia amylovora Resistant to Kasugamycin and Blasticidin S
Authors: Ge Yixin , Lee Jae Hoon , Hu Baishi , Zhao Youfu
Published: February 2018

Extensive use of the antibiotic streptomycin to control fire blight disease of apples and pears, caused by the enterobacterial plant pathogen Erwinia amylovora, leads to the development of streptomycin-resistant strains in the United States and elsewhere. Kasugamycin (Ksg) has been permitted to be used as an alternative or replacement to control this serious bacterial disease. In this study, we investigated the role of two major peptide ATP-binding cassette transporter systems in E. amylovora, the dipeptide permease (Dpp) and oligopeptide permease (Opp), in conferring sensitivity to Ksg and blasticidin S (BcS). Minimum inhibitory concentration and spot dilution assays showed that the dpp deletion mutants exhibited slightly enhanced resistance to Ksg in rich medium, whereas the opp mutant exhibited slightly enhanced resistance to Ksg in minimal medium and BcS in rich medium. Deletion of both dpp and opp conferred a higher level of resistance to Ksg in both rich and minimal media, whereas deletion of opp alone was sufficient to confer high level of resistance to BcS in minimal medium. In addition, bioinformatic analysis combined with reverse transcription-quantitative polymerase chain reaction showed that the Rcs phosphorelay system negatively regulates opp expression and the rcsB mutant was more sensitive to both Ksg and BcS in minimal medium as compared with the wild type. An electrophoresis motility shift assay further confirmed the direct binding of the RcsA/RcsB proteins to the promoter region of the opp operon. However, neither the Dpp nor the Opp permeases contributed to disease progress on immature pears, hypersensitive response on tobacco leaves, or exopolysaccharide amylovoran production. These results suggested that Ksg and BcS employ the Dpp and Opp permeases to enter E. amylovora cells and the Dpp and Opp permeases act synergistically for illicit transport of antibiotics.
Coercion in the Evolution of Plant–Microbe Communication: A Perspective
Authors: Rowe S. L. , Norman J. S. , Friesen M. L.
Published: February 2018

Plants and microbes are dependent on chemical signals as a means of interkingdom communication. There are two predicted paths for the evolution of these signals. Ritualization is the oft-assumed pathway for the evolution of plant–microbe communication systems. In this process, chemical signals, which benefit both receiver and sender, evolve from chemical cues, which benefit only the receiver. However, plant–microbe signaling may evolve from coercive interactions as well, a process known as sensory manipulation. Here, we aim to highlight the prevalence of coercive interactions and discuss sensory manipulation in the context of plant–microbe interactions. We present two examples of stabilized coercion: microbial coercion of plants via the release of phytohormones and plant coercion of microbes via manipulation of quorum-sensing compounds. Furthermore, we provide an evolutionary framework for the emergence of signaling from coercive plant–microbe interactions through the process of sensory manipulation. We hope that researchers will recognize the relevance of coercive interactions in plant–microbe systems and consider sensory manipulation as a plausible evolutionary trajectory for the emergence of plant–microbe signaling.
Long-Distance Spread of Verticillium dahliae Through Rivers and Irrigation Systems
Authors: Baroudy Farah , Habib Wassim , Tanos Ghassan , Gerges Elvis , Saab Carine , Choueiri Elia , Nigro Franco
Published: February 2018

Verticillium dahliae Kleb. is a soilborne pathogen causing Verticillium wilt disease on several hosts. The pathogen survival structure (i.e., microsclerotia) can be efficiently spread by different dispersal methods. In the present study, the medium to long dispersal spread of the pathogen through rivers and irrigation canals was investigated. Samples of sediments (n = 29) were gathered from eight Lebanese rivers and three regional irrigation canals, in addition to samples of soil particles and plant residues (n = 14) from irrigation filters in commercial orchards. Specific conventional and real-time nested polymerase chain reaction assays detected the pathogen in six rivers—Al Kabir, Al Bared, Litani, Al Awali, Ostwan, and Litani South—and in all sampled canals—Ostwan, Al Bared, and Litani Canal 900. Starting DNA quantities ranged from 0.2 pg to 21.318 ng and an inoculum density, determined by a traditional plating method, varied between nondetectable and 0.2 microsclerotia/g. Viable V. dahliae microsclerotia were also found in residues collected from mesh-type irrigation filters of five commercial orchards. This study confirms that water is an important inoculum source of V. dahliae, being involved in the efficient spread of microsclerotia in Lebanese agricultural areas.
Professional Governance Scale
Authors: Weston Marla J. , Verran Joyce A. , Clavelle Joanne T. , Porter-O'Grady Tim
Published: February 2018

Instrument development and content validity testing resulted in a new instrument to measure the relatively new concept of professional governance. Professional governance is defined as the accountability, professional obligation, collateral relationships and decision making of a professional, foundational to autonomous practice and achievement of exemplary empirical outcomes. Fourteen experts with subject matter expertise either in measurement development or in creating professional practice environments assessed the validity of the proposed items and the instrument. The resulting Professional Governance Scale consisted of 75 items that adequately covered all attributes and their characteristics and had a Relevancy Mean Individual Content Validity Index of 95.
Assessing Postoperative Reduction After Acetabular Fracture Surgery: A Standardized Digital Computed Tomography–Based Method
Authors: Verbeek Diederik O. , van der List Jelle P. , Moloney Gele B. , Wellman David S. , Helfet David L.
Published: February 2018

Quality of reduction after acetabular fracture surgery is an important predictor of clinical outcome. Computed tomography (CT) is likely superior to plain pelvic radiography for assessment of postoperative reduction, but interobserver reliability may be limited in the absence of a widely adopted technique. We describe a standardized digital CT-based method for measuring residual (gap and step) displacement on CT after acetabular fracture surgery. In a selection of patients, we determined the interobserver reliability for measuring displacement and grading the quality of reduction on postoperative pelvic radiography and CT, with and without the use of this novel technique.
Early evolution of BRAFV600 status in the blood of melanoma patients correlates with clinical outcome and identifies patients refractory to therapy
Authors: Gonzalez-Cao Maria , Mayo de las Casas Clara , Jordana Ariza Nuria , Manzano Jose L. , Molina-Vila Miguel Á. , Soriano Virtudes , Puertolas Teresa , Balada Ariadna , Soria Ainara , Majem Margarita , Montagut Clara , Muñoz Eva , Rodriguez-Abreu Delvys , Perez Elisabeth , Garcia Almudena , Cortes Javier , Drozdowskyj Ana , Karachaliou Niki , Rosell Rafael
Published: February 2018

Serial analysis of BRAF mutations in circulating-free DNA (cfDNA) could be of prognostic value in melanoma patients. We collected blood samples from 63 advanced BRAFV600E/K melanoma patients and determined BRAFV600E/K status in cfDNA using a quantitative 5′-nuclease PCR-based assay. Levels of BRAF mutation in pre-cfDNAs were associated significantly with tumour burden, progression-free survival and overall survival. Changes in BRAF status in cfDNA after initiation of treatment (early-cfDNA) had a significant correlation with outcome. In patients with persistent BRAF mutations (n=12), progression-free survival and overall survival were 3.5 months [95% confidence interval (CI): 1.6–4.6] and 5.3 months (95% CI: 3.4–8.1) compared with 16.6 months (95% CI: 8.2–22.3) and 21.9 months (95% CI: 10.2–NR) in patients with BRAF negativization (n=16), and 15.1 months (95% CI: 2.3–NR) and NR (95% CI: 5.1–NR) in patients who maintained their initial negative status (n=12) (P<0.0001). The median duration of response in patients with radiological response, but persistence of BRAFV600 in early-cfDNA (n=5) was 4 months. Our study indicates that serial BRAF testing in the blood of advanced melanoma identifies patients refractory to therapy.
The Alliance for Innovation in Maternal Health Care: A Way Forward
Authors: MAHONEY JEANNE
Published: February 2018

The Alliance for Innovation in Maternal Health is a program supported by the Health Services Resource Administration to reduce maternal mortality and severe maternal morbidity in the United States. This program develops bundles of evidence based action steps for birth facilities to adapt. Progress is monitored at the facility, state and national levels to foster data-driven quality improvement efforts.
RISK FACTORS, TREATMENT STRATEGIES, AND OUTCOMES OF ENDOPHTHALMITIS ASSOCIATED WITH SEVERE FUNGAL KERATITIS
Authors: Wan Lei , Cheng Jun , Zhang Jing , Chen Nan , Gao Yan , Xie Li-Xin
Published: February 2018

Purpose:

To investigate risk factors, treatment strategies, and outcomes of endophthalmitis associated with severe fungal keratitis.

Methods:

Data from 392 patients diagnosed with fungal keratitis were retrospectively examined. Patients had severe disease that was refractory to topical or systemic antifungal therapy, and the infection involved the endothelium or perforated the cornea. The incidence and risk factors for endophthalmitis, and treatment outcomes were evaluated.

Results:

Thirty-seven of 392 patients (9.4%) had endophthalmitis. Multivariate logistic regression revealed the following risk factors for endophthalmitis: topical steroid use (odds ratio [OR] = 6.35, 95% confidence interval [CI]: 2.01–20.08), previous corneal laceration suturing (OR = 5.05, 95% CI: 1.11–22.93), large corneal ulcer size (≥10-mm diameter; OR = 4.43, 95% CI: 1.71–11.50), hypopyon (OR = 11.05, 95% CI: 2.12–57.55), and aphakia (OR = 15.45, 95% CI: 1.59–149.82). Thirty of the 37 eyes (81.1%) with endophthalmitis were saved by penetrating keratoplasty, vitrectomy, or intravitreal antifungal injection; 7 eyes (18.9%) were eviscerated.

Conclusion:

Most patients with endophthalmitis secondary to corneal fungal infection were successfully managed by penetrating keratoplasty, vitrectomy, or intravitreal antifungal therapy. Multiple risk factors for endophthalmitis were identified. Timely diagnosis and risk factor assessment were essential for ensuring early surgical intervention for fungal keratitis–related endophthalmitis.
Corneal Neurotization With a Great Auricular Nerve Graft: Effective Reinnervation Demonstrated by In Vivo Confocal Microscopy
Authors: Benkhatar Hakim , Levy Ora , Goemaere Isabelle , Borderie Vincent , Laroche Laurent , Bouheraoua Nacim
Published: February 2018

Purpose:

We describe the first case of minimally invasive corneal neurotization with the great auricular nerve (GAN) to treat unilateral neurotrophic keratopathy. We assessed corneal sensation and reinnervation by esthesiometry and confocal microscopy over 12 months of follow-up, and we provide a detailed description of the surgical technique.

Methods:

Corneal neurotization was successfully achieved with the ipsilateral GAN in a 58-year-old woman. Cochet–Bonnet esthesiometry and in vivo confocal microscopy were performed before and after corneal neurotization, to monitor the recovery of corneal sensation and corneal reinnervation by subbasal nerve fibers.

Results:

Neurotrophic keratopathy was a complication of the surgical treatment of meningioma. Before surgery, the patient had no corneal sensation or corneal innervation. Six months after surgery, confocal microscopy confirmed regrowth of a large number of nerve fibers in the subepithelial space of the cornea. Nine months after surgery, a central esthesiometry score of 10-mm was attained.

Conclusions:

Corneal neurotization leads to reinnervation of the cornea and recovery of ocular sensation in adults. The GAN is suitable for use in corneal neurotization because of its anatomical proximity and the low level of associated morbidity. Confocal microscopy demonstrated the occurrence of corneal reinnervation, which preceded the recovery of corneal sensation.
Descemet Membrane Endothelial Keratoplasty for Failed Deep Anterior Lamellar Keratoplasty: A Case Series
Authors: Einan-Lifshitz Adi , Sorkin Nir , Boutin Tanguy , Mednick Zale , Kreimei Mohammad , Chan Clara C. , Rootman David S.
Published: February 2018

Purpose:

To suggest a new surgical approach for posterior opacities or persistent Descemet membrane (DM) detachment in failed deep anterior lamellar keratoplasty (DALK) and to report the outcome of Descemet membrane endothelial keratoplasty (DMEK) in a series of patients with DALK failure.

Methods:

In this retrospective case series of patients who underwent DMEK for failed DALK at Toronto Western Hospital, 4 patients with failed DALK who underwent DMEK surgery were included. In all 4 cases, big bubble formation during initial DALK surgery had failed and the surgical technique was converted to manual dissection using the Melles technique. In 2 cases, the descemetorhexis in DMEK surgery was performed manually, and in 2 cases, the descemetorhexis was performed with the assistance of the femtosecond laser.

Results:

Four eyes of 4 patients aged 70 ± 4 years were included. Average follow-up time was 9 ± 5 months. Indications for DALK surgery were corneal dystrophy in 2 patients and corneal scars in the other 2. DALK failure was due to persistent DM detachment that created a double chamber in 2 patients and due to posterior lamellar haze in the other 2. After DMEK surgery, 2 patients had graft detachment and required rebubbling. In 1 patient, the DMEK scroll was attached after 1 rebubble attempt, and in the other patient, a second rebubble attempt was needed. The final visual acuities were 20/40, 20/50, 20/70, and 20/200 (because of dense cataract). All procedures were uneventful.

Conclusions:

DMEK surgery may be effective in managing DALK failure.
Same-Day Cancellation in Ambulatory Surgery
Authors: Smith Bradford B. , Smith Mark M. , Hyder Joseph A. , Mauermann William J. , Warner Mary E. , Licatino Lauren K. , Barbara David W.
Published: February 2018

Although ambulatory surgery offers patients convenience and reduced costs, same-day cancellation of ambulatory surgery negatively affects patient experiences and operational efficiency. We conducted a retrospective analysis to determine the frequency and reasons for same-day cancellations in an outpatient surgery center at a large academic tertiary referral center. Of 41 389 ambulatory surgical procedures performed, same-day cancellations occurred at a rate of 0.5% and were usually unforeseeable in nature. Focusing on foreseeable cancellations offers opportunities for enhanced patient satisfaction, improved quality of care, and systems-based practice improvements to mitigate cancellations related to areas such as scheduling or patient noncompliance.
Coordination Across Ambulatory Care
Authors: Chang Ji , Chokshi Dave , Ladapo Joseph
Published: February 2018

Urgent care centers have been identified as one means of shifting care from high-cost emergency departments while increasing after-hours access to care. However, the episodic nature of urgent care also has the potential to fragment care. In this study, we examine the adoption of 2 coordination activities—referrals and the electronic exchange of health information—at urgent care centers and other ambulatory providers across the United States. We find that setting is significantly associated with both health information exchange and referrals. Several organization-level variables and environment-level variables are also related to the propensity to coordinate care.
Establishing Teams
Authors: Chien Alyna T. , Kyle Michael Anne , Peters Antoinette S. , Nguyen Kevin H. , Tendulkar Shalini A. , Ryan Molly , Hacker Karen , Singer Sara J.
Published: February 2018

Little is known about how practices reorganize when transitioning from traditional practice organization to team-based care. We compared practice-level (1) configuration as well as practice- and team-level (2) size and (3) composition, before and after establishing teams. We employed a pre-/poststudy using personnel lists of 1571 to 1711 staff (eg, job licenses, titles, and team assignment) and practice manager surveys. All personnel (physician and nonphysician) worked within 18 Massachusetts academic primary care practices participating in a 2-year learning collaborative aimed at establishing team-based care. We found that establishing team-based care can involve changing practice configurations and composition without substantially changing practice size.
New-graduate Physical Therapists' Self-efficacy to Perform Patient Education Is Influenced by Entry-level Training Experiences
Authors: Forbes Roma , Mandrusiak Allison , Smith Michelle , Russell Trevor
Published: February 2018

Introduction.

Patient education is an integral component of physical therapy practice. Little is known about the factors that influence new-graduate physical therapists' preparedness to perform patient education. Self-efficacy is an important construct in understanding how graduates will engage in this professional role. The purpose of this study was to investigate new-graduate physical therapists' self-efficacy across patient education competencies and to explore the relationship between self-efficacy and entry-level training experiences.

Methods.

New-graduate physical therapists completed a survey with four components: 1) a self-efficacy scale derived from patient education competencies; 2) questions about their training experiences; 3) an open response question relating to their perception of their patient education ability; and 4) demographic questions. Self-efficacy data were compared between groups based on training experiences and demographic groups. Open response data were subject to qualitative framework analysis.

Results.

A total of 121 new-graduate physical therapists (84.6%) completed the survey. One third of new graduates reported having high self-efficacy in relation to all patient education competencies. Nearly all respondents perceived that performing patient education during clinical placements (96%) and receiving feedback (93%) had a significant influence on their confidence to perform patient education. Most respondents (89.3%) reported having previous experiences representing all sources of self-efficacy during their entry-level training. These respondents had significantly higher self-efficacy scores than those who were lacking one or more experiences (P = .045). Half of all respondents (52%) reported all training experiences as “significant” in contributing to their confidence and had significantly higher self-efficacy scores than those who did not perceive all experiences as “significant” (P < .001). Emerging themes relating to the most meaningful influences on ability to perform patient education were 1) direct clinical practice, 2) observation of others, 3) feedback, and 4) rehearsal.

Discussion and Conclusion.

These findings support the mediating effects of Bandura's main sources of self-efficacy on new graduates' self-efficacy regarding patient education. Considerations for physical therapy curricular aimed at enhancing development of self-efficacy related to patient education is outlined.
Staphylococcus and MRSA Prevalence in Physical Therapist Education Programs: Are Students at Risk?
Authors: Gibbs Karen A. , Rohde Rodney E. , Sanders Barbara , Acosta Martha , Wild Dana L.
Published: February 2018

Introduction.

Staphylococcus skin infections including methicillin-resistant Staphylococcus aureus (MRSA) are a major health concern in clinical and nonclinical settings where skin-to-skin and skin-to-surface contacts are frequent. This type of contact is inherent in entry-level physical therapy education laboratory classrooms, putting students at risk for exposure to harmful bacteria. With only one previous study examining the prevalence of Staphylococcus at a single program, the purpose of this study was to expand the study across multiple academic centers to further explore the presence of Staphylococcus and exposure risk in our laboratory classrooms.

Methods.

Four entry-level physical therapist education programs participated in the study. Swab samples were collected from plinths located in laboratory classrooms at each of the four academic sites and processed according to the previously documented protocol at each of the four academic sites.

Results.

Of the 333 total samples, 47 (14.1%) tested positive for S. aureus, 2 samples were positive for MRSA (0.06%). Although all four programs reported their laboratory classrooms were “multiuse,” the classrooms with the highest utilization had the highest prevalence of S. aureus.

Discussion and Conclusion.

Close quarters and frequent skin-to-skin and skin-to-surface contacts in physical therapist education increases student exposure risk to harmful bacteria. This risk increases in multiuse or high utilization laboratory classrooms. Education programs must develop and implement strong laboratory classroom disinfection protocols to protect students, faculty, and staff as well as the patients, family, and community members they may encounter. This simple environmental scan further highlights the need for additional multifacility screening regarding the prevalence of harmful bacteria in laboratory classrooms and close examination of cleaning protocols.
Performance in Simulation Is Associated With Clinical Practice Performance in Physical Therapist Students
Authors: Judd Belinda , Fethney Judith , Alison Jennifer , Waters Donna , Gordon Christopher
Published: February 2018

Introduction.

Simulation-based clinical education is often adopted before clinical practice to provide health professional students with practice in a safe environment. The simulated environment is often presumed to replicate clinical practice, but performance in these settings is likely to be different. Simulation may be able to determine student clinical competency before clinical practice. However, there is little research comparing health professional student performance in simulation followed by clinical practice. The aim of the study was to determine whether there was an association between the performance of physical therapist students in simulation and clinical practice and whether aspects of simulation performance could predict subsequent clinical performance.

Methods.

We measured clinical performance of 148 graduate entry-level master physical therapist students using the Assessment of Physiotherapy Practice (APP) tool (n = 296) at the end of 2 weeks of simulation and subsequent 3 weeks of clinical practice. Assessments were conducted by clinical educators. Data were analyzed using Pearson correlation and multiple regression with backward elimination for exploring predictors of clinical performance.

Results.

A significant association was found between student performance in simulation and clinical practice (r = .40, P < .001). Two domains of practice of the APP in simulation assessments, “analysis and planning” and “risk assessment,” were found to be predictive of student performance in subsequent clinical practice.

Discussion and Conclusion.

The association between physical therapist student performance in simulation and clinical practice adds support for simulation assessments being used to determine subsequent clinical practice performance. Educators may consider focusing on learner development in the domains of practice of “analysis and planning” and “risk assessment” in simulation as a way of assisting physical therapist student preparation for clinical practice and facilitating more effective implementation of simulation-based education practices.
Survey of Disability Competence Teaching and Assessment Strategies in Physical Therapist Education
Authors: Garrand Kiersten , Pechak Celia , Jimenez Liliana , Gell Nancy
Published: February 2018

Introduction.

Current research indicates that health care professionals' biased attitudes toward people with disabilities (PWDs) may contribute to increased health care disparities and poorer quality of care. Targeted disability competence education may improve this situation. The 4 specific purposes of this study were to identify (1) the disability competencies physical therapist education program faculty identified as relevant to physical therapist education; (2) the disability competencies physical therapist programs addressed; (3) the training strategies physical therapist educators used to promote disability competence; and (4) the assessment strategies used to evaluate disability competence.

Methods.

Faculty members of entry-level Doctor of Physical Therapy programs in the United States (US) with the most knowledge of each program's disability-related curricula. An online survey was developed based on a review of the literature, and then e-mailed to program directors. Respondents were faculty members of entry-level Doctor of Physical Therapy programs in the United States (US) with the most knowledge of each program's disability-related curricula. Survey responses were summarized through frequencies and means; open-ended responses were analyzed using content analysis.

Results.

Eighty-four surveys were completed in part or whole for a final response rate of 38.7%. Most respondents (78.6%) stated that they include “disability” in the framework of “cultural competence,” but only 9.5% of respondents reported that their programs used the term “disability competence.” The majority used the listed teaching methods except for planned community-based interactions with PWDs.

Discussion and Conclusion.

This study was the first to explore approaches to disability competence in US-based physical therapist education programs. However, further research is indicated to determine the most effective methods of promoting disability competence.
Cervical Adenocarcinoma: A Comparison of the Reproducibility of the World Health Organization 2003 and 2014 Classifications
Authors: Sar Aylin , Duan Qiuli , Khalil Moosa , DiFrancesco Lisa M. , Ewanowich Carol , Lytwyn Alice , Djordjevic Bojana , Itani Doha , Lee Sandra , Köbel Martin , Glaze Sarah , Park Elena , Duggan Máire A.
Published: February 2018

Objective

The aim of the study was to compare the reproducibility of malignant glandular tumors of the uterine cervix classified per World Health Organization (WHO) 2003 and 2014.

Materials and Methods

Two pathologists reviewed 228 cases composed of adenocarcinoma in situ and 22 adenocarcinoma histotypes and selected 405 representative hematoxylin and eosin slides, which were digitally scanned. Six other pathologists (3 gynecological and 3 anatomical) independently reviewed and classified the images per both WHO classifications. One year later, they classified a random sample of 25 cases. Inter- (inter-OR) and intra-observer (intra-OR) reproducibility of the 6 pathologists and separately for gynecological compared with anatomical pathologists was tested using κ statistics.

Results

Both classifications were collapsed into 6 categories as benign, adenocarcinoma in situ, and mucinous, endometrioid, rare, and adenosquamous-miscellaneous carcinomas. WHO 2014 had an additional category: endocervical adenocarcinoma, usual type. Inter-observer κ values were more reliable than the intra-OR results based on 95% CIs. The average inter-OR κ values with both classifications were moderate between the 6 pathologists and between the 3 anatomical pathologists. In contrast, they were substantial between the 3 gynecological pathologists. With both classifications, the average intra-OR κ values of the 6 pathologists and both pathologist groups trended toward substantial.

Conclusions

Reproducibility among 6 pathologists is unaffected by changes in the WHO 2014 classification and averages moderate between different and trends toward substantial between the same pathologist. Reproducibility between different pathologists can improve to substantial when they have expertise in gynecological pathology.