bluuebunny/crossref_metadata_2025 huggingface dataset:
Do Physicians Underestimate Pain in Terminal Cancer Patients? A Prospective Study in a Hospice Setting
Authors: Golčić Marin , Dobrila-Dintinjana Renata , Golčić Goran , Pavlović-Ružić Ira , Gović-Golčić Lidija
Published: July 2018

Objectives:

Unrelieved pain is present in a majority of terminal cancer patients. However, the treatment of pain in palliative and hospice care is affected by the lack of validated pain assessment. The goal of this study was to evaluate differences in pain evaluation between terminal cancer patients and physicians and evaluate the pain levels as a survival biomarker.

Materials and Methods:

Patients were evaluated every 7 days for a total of 4 assessments. Physicians evaluated patients’ pain on an numeric rating scale (NRS) scale after clinical examination, after which the patients completed NRS, Quality of Life Questionnaire Core 15 Pal (QLQ-C15-PAL), and Edmonton Symptom Assessment System (ESAS) questionnaires.

Results:

On average, physicians minimally underestimated the pain level in patients (3.47 vs. 3.94 on an NRS scale). Pain was overestimated in 28% and underestimated in 46% of the patients. However, half of all underestimation was clinically meaningful, compared with 28% of the overestimation. For patients with an NRS score of ≥7, pain underestimation was both clinically and statistically significant (5.56 vs. 8.17). Pain ratings exhibited a very small correlation to survival (up to r=−0.22), limiting their use as a survival biomarker.

Discussion:

Although physicians can accurately assess mild pain in terminal cancer patients in the hospice setting, the underestimation of pain is still clinically significant in almost a quarter of patients, and especially pronounced in patients with higher levels of pain and in female patients. Hence, validated pain assessment is a necessity in hospice care, with the choice of pain evaluation tool dependent on patient and physician preference.
Reducing the Incidence of Substance Use Disorders in Anesthesiology Residents
Authors: Fitzsimons Michael G. , Baker Keith , Malhotra Rajeev , Gottlieb Andrew , Lowenstein Edward , Zapol Warren M.
Published: July 2018

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

The incidence of substance use disorders in the United States among residents in anesthesiology is between 1% and 2%. A recent study reported that the incidence of substance use disorders in U.S. anesthesiology residents has been increasing. There are no reports of effective methods to prevent substance use disorder in residents. A comprehensive drug testing program including a random component may reduce the incidence of substance use disorders.

Methods

The authors initiated a comprehensive urine drug screening program of residents, fellows, faculty physicians, and certified nurse anesthetists. The authors performed 3,190 tests over 13 yr. The authors determined the incidence of substance use disorders among residents in our large anesthesiology residency program during the decade before (January 1, 1994, to December 31, 2003) and for the 13 yr after (January 1, 2004 to December 31, 2016) instituting a random urine drug testing program. A total of 628 residents trained in the program over these 23 yr; they contributed a total of 1,721 resident years for analysis. Fewer faculty and certified nurse anesthetists were studied, so we do not include them in our analysis.

Results

The incidence of substance use disorders among trainees in our department during the 10 yr before initiation of urine drug screening was four incidents in 719 resident years or 0.0056 incidents per resident-year. In the 13 yr after the introduction of urine drug screening, there have been zero incidents in 1,002 resident years in our residency program (P = 0.0305).

Conclusions

This single-center, comprehensive program including preplacement and random drug testing was associated with a reduction of the incidence of substance use disorders among our residents in anesthesiology. There were no instances of substance use disorders in our residents over the recent 13 yr. A large, multicenter trial of a more diverse sample of academic, government, and community institutions is needed to determine if such a program can predictably reduce the incidence of substance use disorders in a larger group of anesthesiology residents.
Supraspinal Mechanisms of Spinal Cord Stimulation for Modulation of Pain
Authors: Sivanesan Eellan , Maher Dermot P. , Raja Srinivasa N. , Linderoth Bengt , Guan Yun
Published: July 2018

The field of spinal cord stimulation is expanding rapidly, with new waveform paradigms asserting supraspinal sites of action. The scope of treatment applications is also broadening from chronic pain to include cerebral ischemia, dystonia, tremor, multiple sclerosis, Parkinson disease, neuropsychiatric disorders, memory, addiction, cognitive function, and other neurologic diseases. The role of neurostimulation as an alternative strategy to opioids for chronic pain treatment is under robust discussion in both scientific and public forums. An understanding of the supraspinal mechanisms underlying the beneficial effects of spinal cord stimulation will aid in the appropriate application and development of optimal stimulation strategies for modulating pain signaling pathways. In this review, the authors focus on clinical and preclinical studies that indicate the role of supraspinal mechanisms in spinal cord stimulation–induced pain inhibition, and explore directions for future investigations.
Impact of Adult Scoliosis on Roussouly Sagittal Shape Classification
Authors: Pizones Javier , Martin Montserrat Baldan , Perez-Grueso Francisco Javier Sánchez , Yilgor Caglar , Vila-Casademunt Alba , Serra-Burriel Miquel , Obeid Ibrahim , Alanay Ahmet , Acaroglu Emre R. , Pellisé Ferran
Published: July 2018

Study Design.

A retrospective analysis of data collected prospectively in an adult spine deformity multicenter database.

Objective.

The aim of this study was to determine the impact of adult scoliosis (AS) on the type of Roussouly sagittal shape in terms of classification applicability, scoliosis modification of a patient theoretical sagittal shape, and coronal-sagittal deformity associations.

Summary of Background Data.

Roussouly described a four-type sagittal shape classification in healthy individuals, which has been also applied to patients with degenerative spinal disease. However, it remains uncertain if its principles can be applied to AS patients.

Methods.

AS patients recorded in a prospective multicenter database of adult spinal deformity were included. Preoperative sagittal radiographs were analyzed using the KEOPS software to measure pelvic parameters, global sagittal alignment, and the various criteria used for the Roussouly classification. The different sagittal shape types were compared using the Chi-square and McNemars tests, and analysis of variance with Bonferroni correction.

Results.

The classification was applicable to all of the 190 analyzed AS patients. In addition to Roussouly criteria, two parameters helped differentiate the different shapes: T10-L2 angle (24° ± 19 type-1; 14° ± 15 type-2; 3° ± 15 type-3; 0.4° ± 14 type-4; P < 0.001), and lordosis distribution index (90% ± 17 type-1; 83% ± 16 type-2; 73% ± 21 type-3; 63% ± 16 type-4; P < 0.001). AS changed the theoretical shape in 34% of the patients (P < 0.001). Curve etiology and curve pattern were not associated with any particular type of sagittal shape (P > 0.05). Type-1 was associated with older patients (P = 0.02), degenerative curves (P = 0.02), and greater PI-LL mismatch (P = 0.012). Types 3 to 4 were associated with younger age and idiopathic etiology (P < 0.001).

Conclusion.

Roussouly four-type sagittal shape classification could be applied to AS patients. AS modified the theoretical type in one of every three patients. No particular association was found between the sagittal types and specific coronal deformities. Sagittal shape recognition in patients with AS will help restore the appropriate theoretical shape through surgery, which can eventually lead to better surgical outcomes

Level of Evidence: 2
In-Hospital Outcomes of Patients With Advanced Chronic Kidney Disease, Dialysis, and Kidney Transplant Undergoing Spinal Fusion
Authors: Yoshihara Hiroyuki , Yoneoka Daisuke
Published: July 2018

Study Design:

A retrospective analysis of population-based national hospital discharge data collected for the nationwide inpatient sample (NIS).

Objectives:

To examine the in-hospital outcomes of patients with advanced chronic kidney disease (CKD), dialysis, and kidney transplant undergoing spinal fusion on a national level.

Summary of Background Data:

Patients with advanced CKD have been living longer with the support and improvement of medical treatment, dialysis, and organ transplant. Some of those patients undergo spinal fusion surgery. However, there is limited information regarding the outcomes of patients with advanced CKD, dialysis, and kidney transplant, undergoing spinal fusion.

Methods:

Clinical data were derived from the US Nationwide Inpatient Sample (NIS) between 2000 and 2009. Patients who underwent spinal fusion were identified and divided into 4 groups: those with advanced CKD, dialysis, and kidney transplant, and those without advanced CKD. Data regarding, patient-system and health care system–related characteristics, comorbidities, in-hospital complications, and mortality were retrieved and analyzed. In-hospital outcomes were compared between the groups and analyzed with the use of multivariate logistic regression.

Results:

Among the all groups, overall in-hospital complications rate was the highest (42.0%) for patients with advanced CKD and in-hospital mortality rate was the highest (5.2%) for those with dialysis, undergoing spinal fusion. Patients with dialysis had 8.7 and 9.5 times higher risk of in-hospital mortality compared with those with kidney transplant and those without advanced CKD.

Conclusions:

Patients with advanced CKD, dialysis, and kidney transplant had significant higher rates and risks of in-hospital morbidity or mortality than those without advanced CKD, undergoing spinal fusion. Particularly, patients with dialysis undergoing spinal fusion need to be informed with high mortality risk.
Bracing Following Transforaminal Lumbar Interbody Fusion is not Necessary for Patients With Degenerative Lumbar Spine Disease
Authors: Yao Yu-Cheng , Lin Hsi-Hsien , Chang Ming-Chau
Published: July 2018

Study Design:

This is a prospective, randomized trial.

Objective:

This study aimed to evaluate the outcome of bracing following transforaminal lumbar interbody fusion (TLIF) in patients with degenerative lumbar spine diseases.

Summary of Background Data:

Bracing following spinal fusion for lumbar degenerative disease is common. However, the necessity of postoperative bracing is still controversial. A paucity of high-quality studies have assessed the efficacy of bracing.

Materials and Methods:

In total, 90 patients with degenerative lumbar disease receiving instrumented TLIF were randomly assigned to brace and no brace groups for postoperative care. Patients in the brace group were instructed to wear a rigid brace full-time for 12 weeks. Patients in the no brace group were instructed to wear a soft corset for 2 weeks, after which it was weaned off. In all patients, the Visual Analogue Scale and Oswestry Disability Index scores were evaluated preoperatively; postoperatively; and at 6 weeks, 3, 6, and 12 months of follow-up. The fusion rates, complications, and reoperation rates were recorded.

Results:

In total, 44 patients were assigned to the brace group (mean age, 69.2±10.7 y), and 46 were assigned to the no brace group (mean age, 68.8±11.9 y). All patients received at least 12 months of follow-up. There were no significant differences between the 2 groups with regard to patient demographic characteristics. The Visual Analogue Scale and Oswestry Disability Index scores at each follow-up were not significantly different between the 2 groups. The fusion rate and complications at the 12-month postoperative follow-up were not significantly different between the 2 groups.

Conclusions:

Our study showed that in patients with degenerative spinal disease who receive TLIF, wearing a rigid brace postoperatively is unnecessary. In addition, the fusion rate was not related to bracing, and there were no complications or reoperations whether a brace was worn.

Level of Evidence:

Level II—therapeutic.
Effect of Thiamine Administration on Lactate Clearance and Mortality in Patients With Septic Shock*
Authors: Woolum Jordan A. , Abner Erin L. , Kelly Andrew , Thompson Bastin Melissa L. , Morris Peter E. , Flannery Alexander H.
Published: July 2018

Objectives:

Mounting evidence has shown that critically ill patients are commonly thiamine deficient. We sought to test the hypothesis that critically ill patients with septic shock exposed to thiamine would demonstrate improved lactate clearance and more favorable clinical outcomes compared with those not receiving thiamine.

Design:

Retrospective, single-center, matched cohort study.

Setting:

Tertiary care academic medical center.

Patients:

Adult patients admitted with an International Classification of Diseases, 9th Edition, or International Classification of Diseases, 10th Edition, diagnosis code of septic shock to either the medicine or surgery ICU.

Interventions:

None.

Measurements and Main Results:

Patients who received IV thiamine supplementation within 24 hours of hospital admission were identified and compared with a matched cohort of patients not receiving thiamine. The primary objective was to determine if thiamine administration was associated with a reduced time to lactate clearance in septic shock. Secondary outcomes included 28-day mortality, acute kidney injury, and need for renal replacement therapy, and vasopressor and mechanical ventilation-free days. Two-thousand two-hundred seventy-two patients were screened, of whom 1,049 were eligible. The study consisted of 123 thiamine-treated patients matched with 246 patients who did not receive thiamine. Based on the Fine-Gray survival model, treatment with thiamine was associated with an improved likelihood of lactate clearance (subdistribution hazard ratio, 1.307; 95% CI, 1.002–1.704). Thiamine administration was also associated with a reduction in 28-day mortality (hazard ratio, 0.666; 95% CI, 0.490–0.905). There were no differences in any secondary outcomes.

Conclusions:

Thiamine administration within 24 hours of admission in patients presenting with septic shock was associated with improved lactate clearance and a reduction in 28-day mortality compared with matched controls.
Assessing Variability in Hospital-Level Mortality Among U.S. Medicare Beneficiaries With Hospitalizations for Severe Sepsis and Septic Shock*
Authors: Hatfield Kelly M. , Dantes Raymund B. , Baggs James , Sapiano Mathew R. P. , Fiore Anthony E. , Jernigan John A. , Epstein Lauren
Published: July 2018

Objectives:

To assess the variability in short-term sepsis mortality by hospital among Centers for Medicare and Medicaid Services beneficiaries in the United States during 2013–2014.

Design:

A retrospective cohort design.

Setting:

Hospitalizations from 3,068 acute care hospitals that participated in the Centers for Medicare and Medicaid Services inpatient prospective payment system in 2013 and 2014.

Patients:

Medicare fee-for-service beneficiaries greater than or equal to 65 years old who had an inpatient hospitalization coded with present at admission severe sepsis or septic shock.

Interventions:

None.

Measurements and Main Results:

Individual level mortality was assessed as death at or within 7 days of hospital discharge and aggregated to calculate hospital-level mortality rates. We used a logistic hierarchal linear model to calculate mortality risk-adjusted for patient characteristics. We quantified variability among hospitals using the median odds ratio and calculated risk-standardized mortality rates for each hospital. The overall crude mortality rate was 34.7%. We found significant variability in mortality by hospital (p < 0.001). The middle 50% of hospitals had similar risk-standardized mortality rates (32.7–36.9%), whereas the decile of hospitals with the highest risk-standardized mortality rates had a median mortality rate of 40.7%, compared with a median of 29.2% for hospitals in the decile with the lowest risk-standardized mortality rates. The median odds ratio (1.29) was lower than the adjusted odds ratios for several measures of patient comorbidities and severity of illness, including present at admission organ dysfunction, no identified source of infection, and age.

Conclusions:

In a large study of present at admission sepsis among Medicare beneficiaries, we showed that mortality was most strongly associated with underlying comorbidities and measures of illness on arrival. However, after adjusting for patient characteristics, mortality also modestly depended on where a patient with sepsis received care, suggesting that efforts to improve sepsis outcomes in lower performing hospitals could impact sepsis survival.
New insights into breast implant-associated anaplastic large cell lymphoma
Authors: Laurent Camille , Haioun Corinne , Brousset Pierre , Gaulard Philippe
Published: July 2018

Purpose of review

Breast implant-associated anaplastic large cell lymphoma (BI-ALCL) is a rare form of lymphoma arising adjacent to a breast implant. We aim to review the pathogenesis and clinico-biological features of BI-ALCL.

Recent findings

BI-ALCL is a new provisional entity in the 2017 updated WHO classification. Among several hypotheses, BI-ALCL development seems to be determined by the interaction of immune response related to implant products and additional genetic events.

BI-ALCL is an uncommon T-cell lymphoma which is increasingly diagnosed since its first description in 1997 with 500 estimated cases worldwide. Two BI-ALCL subtypes correlating with clinical presentation have been described. Although most BI-ALCL patients with tumor cell proliferation restricted to the periprosthetic effusion and capsule have excellent outcomes, other patients presenting with a tumor mass, may have a more aggressive disease. The pathogenesis of BI-ALCL remains elusive. It is postulated that local chronic inflammation elicitated by bacterial infection or implant products may promote the activation and proliferation of T cells. Additional genetic events resulting in the activation JAK/STAT pathway are also incriminated. Further investigations are needed to better characterize the pathogenesis of this disease in order to determine the potential risk to develop BI-ALCL after surgical implants.
Injectable Platelet-, Leukocyte-, and Fibrin-Rich Plasma (iL-PRF) in the Management of Androgenetic Alopecia
Authors: Schiavone Giovanni , Paradisi Andrea , Ricci Francesco , Abeni Damiano
Published: July 2018

BACKGROUND

The role of enriched autologous plasmas in androgenetic alopecia (AGA) management is emerging in recent literature.

OBJECTIVE

In this prospective study, the authors aimed to confirm that the induction of a minor local trauma immediately followed by injections of an enriched plasma made of a strongly concentrated platelet fraction, a robust white cell presence, concentrated fibrinogen, and other plasma proteins (injectable leukocyte platelet-rich fibrin [iL-PRF]) could be able to produce positive clinical results in patients with AGA.

MATERIALS AND METHODS

A 2-injection regimen was instituted, with a 3-month interval between the 2 interventions. A treatment group (TG) and a control group (CG) were instituted. Macrophotographs were taken at baseline and after 6 months, and rated by 5-people expert panel (blinded to this assignment) using the 15-point scale proposed by Jaeschke to evaluate the clinical change.

RESULTS

Overall, TG showed better scores compared with the CG in all 5 classes of global physician assessment at baseline, all age groups, and in both sexes, and such differences always reached statistical significance. A greater severity at baseline showed a larger improvement after treatment in the TG.

CONCLUSION

This study provides preliminary evidence that the biological composition of the iL-PRF is of crucial importance in ensuring a good degree of clinical efficacy in patients with AGA.
BILATERAL SIMULTANEOUS RHEGMATOGENOUS RETINAL DETACHMENT
Authors: Singh Niharika , Jain Mukesh , Jaisankar Durgasri , Sharma Tarun , Raman Rajiv ,   for the Sankara Nethralaya Vitreoretinal Study Group (SNVR-Study Group)
Published: July 2018

Purpose:

To elucidate the clinical characteristics and surgical outcome of consecutive patients with bilateral simultaneous retinal detachment who reported to a tertiary eye care institution over a period of 10 years.

Methods:

Retrospective interventional consecutive study of 168 eyes of 84 patients with bilateral simultaneous retinal detachment, observed by indirect ophthalmoscopy at the initial examination was performed. Demographic and clinical characteristics were collected before and after surgery. Patients with attached retina at final follow-up were considered to have anatomical success and those with two or more lines improvement in visual acuity were considered to have functional success.

Results:

Most cases (90% in the better eye and 82.1% in the worse eye) were managed by scleral buckling procedure. With scleral buckle, anatomical success was seen in 99% and functional success was seen in 87% of the cases. Pars plana vitrectomy was performed in remaining cases with anatomical success in 83% and functional success in 78% of cases. Eyes with partial retinal detachment, without macular involvement, and eyes in which additional surgeries were not performed had significantly better anatomical and functional results.

Conclusion:

Early sequential surgery gives good anatomical and functional outcomes. Surgical outcomes were better with scleral buckling than pars plana vitrectomy.
TYPICAL POLYPOIDAL CHOROIDAL VASCULOPATHY AND POLYPOIDAL CHOROIDAL NEOVASCULARIZATION
Authors: Jang Jun Won , Kim Jong Min , Kang Se Woong , Kim Sang Jin , Bae Kunho , Kim Kyung Tae
Published: July 2018

Purpose:

To compare typical polypoidal choroidal vasculopathy (T-PCV) and polypoidal choroidal neovascularization (P-CNV), which can be defined as two subtypes of PCV, and to elucidate the significance of the classification.

Methods:

Seventy-seven patients diagnosed with PCV and followed up for more than 12 months were reviewed. The PCV cases were divided into a T-PCV group (n = 36) and a P-CNV group (n = 41) according to the presence of features of pachychoroid or age-related macular degeneration. Angiographic and tomographic characteristics and changes in vision during the follow-up period were compared between the two groups.

Results:

Logarithm of the minimum angle of resolution visual acuity of T-PCV and P-CNV was 0.27 ± 0.31 and 0.62 ± 0.47 at baseline (P < 0.001) and 0.28 ± 0.41 and 0.54 ± 0.52 at the final visit (P = 0.006), respectively. A marginally higher rate of complete response to anti–vascular endothelial growth factor treatment was noted in the T-PCV group (47.2%) compared with the P-CNV group (26.8%) (P = 0.05). At the final visit, subfoveal fibrosis was noted in 11.1% of the T-PCV group and 39.0% of the P-CNV group (P = 0.009).

Conclusion:

The two subtypes of PCV, P-CNV and T-PCV, behave differently in terms of angiographic and tomographic manifestations and visual outcomes. Classifying PCVs would be helpful not only for pathogenic implications, but also for prognostic significance.
Differentiation Between Intralabyrinthine Schwannoma and Contrast-enhancing Labyrinthitis on MRI: Quantitative Analysis of Signal Intensity Characteristics
Authors: Bae Yun Jung , Song Jae-Jin , Choi Byung Se , Kang Young , Kim Jae Hyoung , Koo Ja-Won
Published: July 2018

Objective:

Distinguishing intralabyrinthine schwannoma (ILS) from labyrinthitis is crucial in deciding patient management between surgery and medication; however, the clinical and radiological differentiation between ILS and labyrinthitis is difficult, especially when labyrinthitis shows contrast-enhancement mimicking ILS on magnetic resonance imaging (MRI). This study aimed to evaluate the quantitative characteristics of signal intensity on 3T MRI for differentiating ILS from contrast-enhancing labyrinthitis (CEL).

Study Design:

Retrospective study.

Setting:

Tertiary referral center.

Patients:

Between July 2003 and June 2017, 9 subjects diagnosed with ILS (16 MRI cases) and 9 subjects diagnosed with CEL (9 MRI cases) were enrolled in the study.

Main Outcome Measures:

Normalized signal intensity on contrast-enhanced T1-weighted image (nCE-T1), normalized signal intensity on T2-weighted image (nT2), and normalized signal intensity on contrast-enhanced fluid-attenuated inversion recovery image (nFLAIR) were measured and compared between ILS and CEL. The diagnostic performance of these values was assessed using receiver operating characteristic (ROC) analysis.

Results:

In ILS, the nCE-T1 and the nT2 were significantly higher and lower, respectively, than in CEL (all, p < 0.05); and the nFLAIR did not significantly differ (p > 0.05). The maximal nCE-T1 achieved the highest area under the curve (AUC) in differentiating ILS and CEL, followed by the mean nCE-T1, the mean nT2, and the maximal nT2. Combination of the nCE-T1 and the nT2 showed higher AUC than the nCE-T1 alone, but without statistical significance (p = 0.340).

Conclusions:

Quantitative measurement of the signal intensity on MRI can be a viable imaging tool for differentiating ILS from CEL.
Facilitating cells: role in inducing transplantation tolerance
Authors: Chhabra Anita Yogendra , Ildstad Suzanne T.
Published: July 2018

Purpose of review

This review discusses the role and mechanisms by which facilitating cells promote stem cell engraftment and induce tolerance in HLA-disparate kidney transplant recipients.

Recent finding

Facilitating cells in both mice and human are heterogeneous, consisting of several subpopulations. They have been shown to enhance stem cell engraftment in allogeneic recipients. They also increase hematopoietic stem cells (HSC) clonogenicity, enhance migration and homing of stem cells via secretion of cytokines/chemokines/growth factors, prevent apoptosis of stem cells and induce regulatory cells. This review summarizes the findings that led to the development of chimerism-based induction of tolerance using FCRx (a mobilized blood product enriched in stem cells and facilitating cells) in allogenic kidney transplant patients.

A phase-2 clinical trial based on FCRx therapy has been successful in inducing tolerance to living donor kidney allografts, leading to withdrawal of immunosuppression in over 70% of patients transplanted. The ultimate goal of establishing tolerance in the absence of immunosuppresive drugs can be achieved using FCRx therapy.
Comparison of the Survival Outcomes of Pancreatic Cancer and Intraductal Papillary Mucinous Neoplasms
Authors: Yamada Suguru , Fujii Tsutomu , Hirakawa Akihiro , Takami Hideki , Suenaga Masaya , Hayashi Masamichi , Niwa Yukiko , Hattori Norifumi , Iwata Naoki , Kanda Mitsuro , Tanaka Chie , Kobayashi Daisuke , Nakayama Goro , Koike Masahiko , Fujiwara Michitaka , Kodera Yasuhiro
Published: July 2018

Objectives

The aims of the study were to compare survival outcomes between patients with pancreatic ductal adenocarcinoma (PDAC) and invasive intraductal papillary mucinous neoplasms (IPMN) and to determine candidates for adjuvant chemotherapy.

Methods

A total of 579 consecutive patients, including 375 PDAC and 204 IPMN patients, were reviewed. Stage-matched comparisons of survival data were conducted using the Cox proportional hazards model and propensity analysis. To evaluate prognostic factors, univariate and multivariate Cox regression analyses were performed.

Results

The overall survival for invasive IPMN was significantly longer than that for PDAC (hazard ratio, 2.34; P = 0.0001). When the analysis was limited to stage I patients, the 5-year overall survival rate of invasive IPMN patients was significantly better than that of PDAC patients (100% vs 74.1%, P = 0.0092); however, no difference was observed between stage II patients with invasive IPMN and PDAC (hazard ratio, 1.49; P = 0.09). The Cox proportional hazards model and propensity analysis demonstrated no difference in stage-matched survival. Multivariate analysis revealed that only T (≥3) was an independent prognostic factor for invasive IPMN.

Conclusions

Stage-matched analysis did not show a significant survival difference between invasive IPMN and PDAC patients, and T3 or higher was an independent prognostic factor for invasive IPMN.
In‐hospital Pediatric Endoscopic Retrograde Cholangiopancreatography Is Associated With Shorter Hospitalization for Children With Choledocholithiasis
Authors: Bonasso Patrick C. , Gurien Lori A. , Staszak Jessica , Gowen Marie E. , Troendle David M. , Odiase Eliane , Lazar Lauren , Ruan Wenly , Barth Bradley A. , Williams Regan F. , Dassinger Melvin S.
Published: July 2018

Objectives:

Children with choledocholithiasis are frequently managed at tertiary children's hospitals that do not have available endoscopic retrograde cholangiopancreatography (ERCP) proceduralists. We hypothesized that patients treated at hospitals without ERCP proceduralists would have a longer hospital length of stay (LOS) than those with ERCP proceduralists.

Methods:

Charts were reviewed for patients who underwent cholecystectomy and ERCP at 3 tertiary children's hospitals over 10 years. Trauma and complicated pancreatitis patients were excluded. Comparisons between patients requiring and not requiring transfer for ERCP were made using Wilcoxon rank‐sum tests for continuous variables and Fisher's exact tests for categorical variables.

Results:

One hundred and sixty‐four children underwent ERCP for suspected choledocholithiasis: 79 (48%) in the transfer group and 85 (52%) in the no transfer group.

Median LOS was longer for patients requiring transfer (7 vs 5 days, P < 0.0001). One‐third (34%) of the transfer patients had magnetic resonance cholangiopancreatography compared to only 7% that did not require transfer (P < 0.0001). Among the 123 patients who underwent ERCP before cholecystectomy, 53% required (66/123) transfer and 47% (57/123) did not. Transfer group patients had longer median hospital LOS (P < 0.0001), more days between admission and ERCP (P < 0.0001), and more days between ERCP and surgery (P = 0.0004).

Conclusions:

Overall median LOS was significantly shorter for patients who underwent ERCP at the admitting facility. Patients who underwent ERCP before cholecystectomy at hospitals without available ERCP proceduralists incurred longer LOS. There is a need for more pediatric proceduralists appropriately trained to perform ERCP in children.
Supernatural Explanations of Neurological and Psychiatric Disorders Among Health Care Professionals at an Academic Tertiary Care Hospital in Saudi Arabia
Authors: Tayeb Haythum , Khayat Alaa , Milyani Haneen , Alsawwaf Yousef , Alzaben Faten , Koenig Harold G
Published: July 2018

Saudi society is one of many where supernatural explanations for neurological and psychiatric disorders are prevalent among lay persons. The frequency of such beliefs among health care professionals in this country, however, is unknown. The frequency of supernatural explanations for neurological and psychiatric disorders was assessed in 126 health care professionals at an academic medical center in Jeddah. A high frequency of belief in supernatural factors as a cause for neurological and psychiatric illness, including the evil eye, divine testing and punishment, and sorcery, was found. Younger age and more junior level of training were associated with a higher likelihood of belief in supernatural causation. A surprisingly high prevalence of supernatural explanations was found among these health care professionals, 80% of whom were attending physicians or physicians in training. Future studies should focus on the potential impact of these beliefs on clinical practice.
Single Versus Multiple Suicide Attempts
Authors: Kochanski Kristen M. , Lee-Tauler Su Yeon , Brown Gregory K. , Beck Aaron T. , Perera Kanchana U. , Novak Laura , LaCroix Jessica M. , Lento Rene M. , Ghahramanlou-Holloway Marjan
Published: July 2018

Individuals with multiple suicide attempts have a greater risk for eventual suicide death. We investigated clinical differences in participants with single versus multiple suicide attempts. Individuals with multiple attempts were more likely to have severe depressive symptoms, drug use disorder, and a higher wish to die. Borderline personality disorder traits and drug use disorder were significant predictors of multiple attempts when adjusting for other psychiatric disorders. Participants with multiple attempts sustained higher suicidal ideation–worst and wish to die/wish to live–worst scores during the 3-month assessment period. Clinical differences between individuals with multiple versus single attempts point to the need of tailored suicide prevention efforts.
Care and Discharge Outcome of Acute Stroke in Lebanon
Authors: Lahoud Nathalie , Salameh Pascale , Hosseini Hassan , Saleh Nadine , Rizk Elias , Hallit Souheil , Abbas Marie Helene , Gebeily Souheil
Published: July 2018

The present study was conducted to assess stroke care and outcomes in two Lebanese hospitals. Patients admitted in 2012 and 2013 were retrospectively selected. Data were extracted from medical records for time to hospital arrival, stroke severity, management, and discharge outcomes. A Cox regression analysis was then conducted to predict time to in-hospital death. A total of 201 patients were included (mean age = 69.2 years), among whom 50% arrived within a delay of 3.75 hours. Half underwent brain imaging in the first hour, and nine patients received an acute intervention. Forty-four patients died at the hospital; 142 were discharged home, among whom 98 patients were dependent in their daily activities. Stroke severity on admission and time from onset to arrival were found to be significantly associated to the time to in-hospital death (adjusted hazard ratio [HRa] = 1.13 and HRa = 0.98 respectively; p < 0.05). The study sheds light on high case fatality and dependency rates at discharge among stroke patients in Lebanese hospitals.
The Emerging Imperative for a Consensus Approach Toward the Rating and Clinical Recommendation of Mental Health Apps
Authors: Torous John , Firth Joseph , Huckvale Kit , Larsen Mark E. , Cosco Theodore D. , Carney Rebekah , Chan Steven , Pratap Abhishek , Yellowlees Peter , Wykes Til , Keshavan Matcheri , Christensen Helen
Published: July 2018

With over 10,000 mental health– and psychiatry-related smartphone apps available today and expanding, there is a need for reliable and valid evaluation of these digital tools. However, the updating and nonstatic nature of smartphone apps, expanding privacy concerns, varying degrees of usability, and evolving interoperability standards, among other factors, present serious challenges for app evaluation. In this article, we provide a narrative review of various schemes toward app evaluations, including commercial app store metrics, government initiatives, patient-centric approaches, point-based scoring, academic platforms, and expert review systems. We demonstrate that these different approaches toward app evaluation each offer unique benefits but often do not agree to each other and produce varied conclusions as to which apps are useful or not. Although there are no simple solutions, we briefly introduce a new initiative that aims to unify the current controversies in app elevation called CHART (Collaborative Health App Rating Teams), which will be further discussed in a second article in this series.
Comparison of 22C3 PharmDx and SP263 Assays to Test PD-L1 Expression in NSCLC
Authors: Sughayer Maher A. , Alnaimy Farah , Alsughayer Anas M. , Qamhia Naim
Published: July 2018

Immunohistochemical assays for programmed cell death ligand 1 (PD-L1) expression in non–small cell lung cancer (NSCLC) are either required or recommended to guide therapy with immune checkpoint inhibitors. Four commercially available immunohistochemical assays are currently available as either complimentary or companion diagnostic assay for their counterpart therapy. Harmonization or exchangeability of one assay for the other is a highly sought for goal. The aim of this study was to compare one assay, 22C3, with another, SP263, and examine whether they can be exchanged one for the other. Seventy samples from 70 patients with NSCLC were tested for PD-L1 using the SP263 and then the 22C3 antibody clones according to the manufacturer’s instructions in case of the SP263 assay and according to a previously described and reported method for the 22C3 assay on the Ventana’s ultra immunstainer. Results were evaluable in 51 cases, which were interpreted independently by 2 different pathologists on 2 different occasions for each case. The cases were given a percentage score based on the tumor proportion score. The Pearson correlation coefficient was calculated. A high concordance rate was found between the 2 assays. The Pearson correlation coefficient was 0.95, which indicates an almost perfect correlation (95% confidence limits, 0.92-0.97 and P<0.0001). The findings indicate that SP263 assay can be used in place of the 22C3 assay for PD-L1 assay in NSCLC, and it can be used on the Ventana platform.
Next-generation Sequencing of an Ovarian Spindle Cell Tumor Identified an Ovarian Low-grade Endometrial Stromal Sarcoma: A Rare Entity
Authors: Choi Youn Jin , Ho Jungyoon , Yoo Jigeun , Liu Jingjing , Lee Ahwon , Park Jong Sup , Hur Soo Young
Published: July 2018

Ovarian spindle cell tumors comprise a heterogeneous group of ovarian neoplasms from benign to malignant. Since this morphologic finding describes a broad category of ovarian neoplasms, it is not easy to determine an accurate diagnosis. Low-grade endometrial stromal sarcoma (LG-ESS) is a rare gynecological malignancy that presents with spindle cell lesions. To identify ovarian LG-ESS, we performed whole-exome sequencing and transcriptome sequencing of a spindle cell tumor. The tumor harbored JAZF1-SUZ12, a well-known gene fusion commonly found in uterine LG-ESS. Moreover, 28 non-silent somatic mutations (13 frameshift, 12 missense, 2 nonsense and 1 splicing mutations) with five cancer-related genes (ACSL3, ATM, DST, HGF and PKHD1) were detected. Our results indicate that next-generation sequencing combined with conventional immunohistochemical analysis may be a better strategy than conventional analysis alone to identify ovarian LG-ESS with spindle cell lesions. Moreover, our data suggest that ovarian LG-ESS can harbor genetic characteristics similar to those of uterine LG-ESS.
High Completion Rate for 12 Weekly Doses of Isoniazid and Rifapentine as Treatment for Latent Mycobacterium tuberculosis Infection in the Federal Bureau of Prisons
Authors: Schmit Kristine M. , Lobato Mark N. , Lang Simona G. , Wheeler Sherri , Kendig Newton E. , Bur Sarah
Published: July 2018

Context:

Correctional facilities provide unique opportunities to diagnose and treat persons with latent tuberculosis infection (LTBI). Studies have shown that 12 weekly doses of isoniazid and rifapentine (INH-RPT) to treat LTBI resulted in high completion rates with good tolerability.

Objective:

To evaluate completion rates and clinical signs or reported symptoms associated with discontinuation of 12 weekly doses of INH-RPT for LTBI treatment.

Setting/Participants:

During July 2012 to February 2015, 7 Federal Bureau of Prisons facilities participated in an assessment of 12 weekly doses of INH-RPT for LTBI treatment among 463 inmates.

Main Outcome Measures:

Fisher exact test was used to assess the associations between patient sociodemographic characteristics and clinical signs or symptoms with discontinuation of treatment.

Results:

Of 463 inmates treated with INH-RPT, 424 (92%) completed treatment. Reasons for discontinuation of treatment for 39 (8%) inmates included the following: 17 (44%) signs/symptoms, 9 (23%) transfer or release, 8 (21%) treatment refusal, and 5 (13%) provider error. A total of 229 (49.5%) inmates reported experiencing at least 1 sign or symptom during treatment; most frequently reported were fatigue (16%), nausea (13%), and abdominal pain (7%). Among these 229 inmates, signs/symptoms significantly associated with discontinuation of treatment included abdominal pain (P < .001), appetite loss (P = .02), fever/chills (P = .01), nausea (P = .03), sore muscles (P = .002), and elevation of liver transaminases 5× upper limits of normal or greater (P = .03).

Conclusions:

The LTBI completion rates were high for the INH-RPT regimen, with few inmates discontinuing because of signs or symptoms related to treatment. This regimen also has practical advantages to aid in treatment completion in the correctional setting and can be considered a viable alternative to standard LTBI regimens.
Psychometric properties of the brief pain inventory modified for proxy report of pain interference in children with cerebral palsy with and without cognitive impairment
Authors: Barney Chantel C. , Stibb Stacy M. , Merbler Alyssa M. , Summers Rebekah L.S. , Deshpande Supreet , Krach Linda E. , Symons Frank J.
Published: July 2018

Introduction:

Cerebral palsy (CP) is the most common cause of physical disability in children and is often associated with secondary musculoskeletal pain. Cerebral palsy is a heterogeneous condition with wide variability in motor and cognitive capacities. Although pain scales exist, there remains a need for a validated chronic pain assessment tool with high clinical utility for use across such a heterogeneous patient population with and without cognitive impairment.

Objectives:

The purpose of this study was an initial assessment of several psychometric properties of the 12-item modified brief pain inventory (BPI) pain interference subscale as a proxy-report tool in a heterogeneous sample of children with CP with and without cognitive impairment.

Methods:

Participants (n = 167; 47% male; mean age = 9.1 years) had pain assessments completed through caregiver report in clinic before spasticity treatment (for a subgroup, the modified BPI was repeated after procedure). To measure concurrent validity, we obtained pain intensity ratings (Numeric Rating Scale of pain) and pain intensity, duration, and frequency scores (Dalhousie Pain Interview).

Results:

Modified BPI scores were internally consistent (Cronbach α = 0.96) and correlated significantly with Numeric Rating Scale intensity scores (rs = 0.67, P < 0.001), Dalhousie Pain Interview pain intensity (rs = 0.65, P < 0.001), pain frequency (rs = 0.56, P = 0.02), and pain duration scores (rs = 0.42, P = 0.006). Modified BPI scores also significantly decreased after spasticity treatment (pretest [scored 0–10; 3.27 ± 2.84], posttest [2.27 ± 2.68]; t (26) = 2.14, 95% confidence interval [0.04–1.95], P = 0.04).

Conclusion:

Overall, the modified BPI produced scores with strong internal consistency and that had concurrent validity as a proxy-report tool for children with CP.
Effectiveness of Cognitive Behavioral Therapy for Depression and Anxiety in Patients With Cardiovascular Disease: A Systematic Review and Meta-Analysis
Authors: Reavell James , Hopkinson Michael , Clarkesmith Danielle , Lane Deirdre A.
Published: July 2018

Objective

Depression and anxiety are highly prevalent in patients with cardiovascular disease (CVD) and influence their mental well-being and CVD prognosis. The primary objective was to assess the effectiveness of cognitive behavioral therapy (CBT) for depression and anxiety in patients with CVD. Secondary objectives were to assess the impact of CBT on cardiovascular mortality, cardiovascular events, patient satisfaction, and quality of life.

Methods

MEDLINE, PsycINFO, CINAHL, CENTRAL, and alternative sources were searched for randomized controlled trials and observational studies with a control. Studies were required to assess CBT in coronary heart disease, acute coronary syndrome, atrial fibrillation, or postmyocardial infarction patients, with anxiety and/or depression. Studies were independently screened by two reviewers and critically appraised using the Cochrane Risk of Bias tool. The random-effects model was used to pool standardized mean differences (SMD).

Results

Twelve randomized controlled trials were included. At follow-up, depression (SMD = −0.35, 95% confidence interval [CI] = −0.52 to −0.17, p < .001, I
2 = 59%) and anxiety (SMD = −0.34, 95% CI = −0.65 to −0.03, p = .03, I
2 = 71%) scores were significantly lower in CBT patients compared with controls. Change in mental health quality of life (SF-12) was also significantly greater for CBT patients, compared with controls (mean difference = 3.62, 95% CI = 0.22 to 7.02, p = .04, I
2 = 0%). No differences in patient satisfaction or cardiovascular events were evident between CBT and control groups. Among the study reports included in this meta-analysis, data specific to cardiovascular mortality were not reported.

Conclusions

Cognitive behavioral therapy seems to be an effective treatment for reducing depression and anxiety in patients with CVD and should be considered in standard clinical care.
Split-Skin-Graft Wrapped Conformer to Treat Severe Contracted Sockets
Authors: Hasan Sultan Al , Galindo-Ferreiro Alicia , Bigethi Carolina , Meneghim Roberta L.S.F. , Shaikh Osama Al , Schellini Silvana A.
Published: July 2018

This case series present the surgical management of cases with severe contracted sockets using a split-skin-graft wrapped conformer. Eight patients with severely contracted anophthalmic sockets underwent surgery. The surgical technique is described and a chart review was performed to collect patient data pre- and postoperatively. Preoperatively, all patients had grade 3 or 4 contracted sockets with shallow or obliterated fornices and patients were unable to retain an external prosthesis in place. Donor material was harvested from the supraclavicular area. The split-skin-graft was successfully performed in all cases without fornix-deepening sutures. All patients underwent a significant improvement of socket contracture enabling retention of the prosthesis and were satisfied with the outcomes. The split-skin-graft wrapped conformer is a rapid and less surgically challenging option to correct severe contracted anophthalmic sockets.