bluuebunny/crossref_metadata_2025 huggingface dataset:
Validity Evidence From Ratings of Pediatric Interns and Subinterns on a Subset of Pediatric Milestones
Authors: Turner Teri L. , Bhavaraju Vasudha L. , Luciw-Dubas Ulana A. , Hicks Patricia J. , Multerer Sara , Osta Amanda , McDonnell Jennifer , Poynter Sue , Schumacher Daniel J. , Tenney-Soeiro Rebecca , Waggoner-Fountain Linda , Schwartz Alan
Published: February 2017

Purpose

To investigate evidence for validity of faculty members’ pediatric milestone (PM) ratings of interns (first-year residents) and subinterns (fourth-year medical students) on nine subcompetencies related to readiness to serve as a pediatric intern in the inpatient setting.

Method

The Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network (APPD LEARN) and the National Board of Medical Examiners collaborated to investigate the utility of assessments of the PMs for trainees’ performance. Data from 32 subinterns and 179 interns at 17 programs were collected from July 2012 through April 2013. Observers used several tools to assess learners. At each site, a faculty member used these data to make judgments about the learner’s current developmental milestone in each subcompetency. Linear mixed models were fitted to milestone judgments to examine their relationship with learner’s rank and subcompetency.

Results

On a 5-point developmental scale, mean milestone levels for interns ranged from 3.20 (for the subcompetency Work effectively as a member of a team) to 3.72 (Humanism) and for subinterns from 2.89 (Organize and prioritize care) to 3.61 (Professionalization). Mean milestone ratings were significantly higher for the Professionalism competency (3.59–3.72) for all trainees compared with Patient Care (2.89–3.24) and Personal and Professional Development (3.33–3.51). Mean intern ratings were significantly higher than mean subintern ratings for all nine subcompetencies except Professionalization, Humanism, and Trustworthiness.

Conclusions

The PMs had a coherent internal structure and could distinguish between differing levels of trainees, which supports their validation for documenting developmental progression of pediatric trainees.
Perioperative Management of Adult Patients With External Ventricular and Lumbar Drains: Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care
Authors: Lele Abhijit V. , Hoefnagel Amie L. , Schloemerkemper Nina , Wyler David A. , Chaikittisilpa Nophanan , Vavilala Monica S. , Naik Bhiken I. , Williams James H. , Venkat Raghavan Lakshmikumar , Koerner Ines P.
Published: February 2017

External ventricular drains and lumbar drains are commonly used to divert cerebrospinal fluid and to measure cerebrospinal fluid pressure. Although commonly encountered in the perioperative setting and critical for the care of neurosurgical patients, there are no guidelines regarding their management in the perioperative period. To address this gap in the literature, The Society for Neuroscience in Anesthesiology & Critical Care tasked an expert group to generate evidence-based guidelines. The document generated targets clinicians involved in perioperative care of patients with indwelling external ventricular and lumbar drains.
Osteoid osteoma of the acetabulum: diagnosis and medical treatment
Authors: Laliotis Nikolaos A. , Bindoudi Antonia S. , Tsitouridis Ioannis A. , Petrakis Iordanis G. , Kirkos John M.
Published: February 2017

We describe the medical management of an acetabular osteoid osteoma in an 11-year-old girl. There was a 2-year delay until proper diagnosis of the patient’s pathology was made. Accurate localization of the nidus in the subchondral bone, involving the cartilage, is difficult on the basis of plain radiographs. All imaging methods, including computed tomography, MRI, and bone scintigraphy, were used to confirm the diagnosis. We proposed medical treatment to avoid possible severe complications from surgical intervention. At the patient’s latest follow-up visit, after 2 years of medical treatment with NSAIDs, there is complete healing of the osteoid osteoma and there is no sign of recurrence.
Values for bony acetabular roof angle and percentage femoral head cover in a selective ultrasound neonatal hip-screening programme: effect of age, sex and side
Authors: Wilkinson A. Graham , Wilkinson Sally , Elton Robert A.
Published: February 2017

Published maturation curves for bony acetabular roof or α angle (AA) and percentage femoral head cover (FHC) with age are sparse. We aimed to determine typical values for AA and FHC in 2236 infants referred to a selective ultrasound screening programme. There was increase in the values of first measurement of AA and FHC related to the logarithm of age. Males had greater values than females (P<0.001) and right hips had greater values than left (P<0.001) for both measurements. Significant side differences have not been reported previously. Treatment decisions should be made on the basis of sex, side and age-specific data.
Nationwide survey of pediatric acute osteomyelitis in the USA
Authors: Okubo Yusuke , Nochioka Kotaro , Testa Marcia
Published: February 2017

The epidemiology of pediatric acute osteomyelitis in the USA, such as annual hospitalization rates and disparities with respect to age, sex, race/ethnicity, and socioeconomic status, remains unknown. We obtained discharge records of hospitalized patients with acute osteomyelitis younger than 20 years of age from the Kids Inpatient Database for 2006, 2009, and 2012. We weighted the records to estimate the number of hospitalizations in the USA and calculated the annual rates of hospitalization because of acute osteomyelitis. We used a multivariable logistic regression analysis to assess the risk factors associated with the development of septic arthritis and bacteremia/septicemia. Overall annual hospitalization rates ranged from 1.34 to 1.66/100 000 children. Male-to-female ratios were 1.6−1.8. Black children, children aged 2, 7, and 12 years, and those living in very low median household income regions were more likely to have higher hospitalization rates. The lower limbs were the most frequent infection sites. Osteomyelitis at the pelvis/thigh, upper arm, hand, and forearm was significantly associated with the development of septic arthritis and bacteremia/septicemia. We determined the epidemiological patterns of pediatric acute osteomyelitis in the USA and identified the risk factors associated with the development of septic arthritis and bacteremia/septicemia. Level of Evidence: Level II.
Establishing a Classification System for High Fall-Risk Among Inpatients Using Support Vector Machines
Authors: Yokota Shinichiroh , Endo Miyoko , Ohe Kazuhiko
Published: February 2017

We constructed a model using a support vector machine to determine whether an inpatient will suffer a fall on a given day, depending on patient status on the previous day. Using fall report data from our own facility and intensity-of-nursing-care-needs data accumulated through hospital information systems, a dataset comprising approximately 1.2 million patient-days was created. Approximately 50% of the dataset was used as training and testing data. A multistep grid search was conducted using the semicomprehensive combination of three parameters. A discriminant model for the testing data was created for each parameter to identify which parameter had the highest score by calculating the sensitivity and specificity. The score of the model with the highest score had a sensitivity of 64.9% and a specificity of 69.6%. By adopting a method that relies on daily data recorded in the electronic medical record system and accurately predicts unknown data, we were able to overcome issues described in previous studies while simultaneously constructing a discriminant model for patients’ fall risk that does not burden nurses and patients with information gathering.
A multireferral centre retrospective cohort analysis on the experience in treatment of metastatic uveal melanoma and utilization of sequential liver-directed treatment and immunotherapy
Authors: Itchins Malinda , Ascierto Paolo A. , Menzies Alexander M. , Oatley Meredith , Lo Serigne , Douraghi-Zadeh Dariush , Harrington Timmothy , Maher Richard , Grimaldi Antonio M. , Guminski Alexander
Published: February 2017

Metastatic uveal melanoma is a rare malignancy with a poor prognosis. To date, systemic therapy has been ineffective; however, there are few data on the benefits of anti-CTLA4 or anti-PD-1 antibodies in sequence with liver-directed therapy. A retrospective cohort analysis was carried out on 37 consecutive patients managed in a tertiary referral centre examining the safety and efficacy of treatment; patterns of care; and impact on survival. The sequential treatment with transarterial chemotherapy (TAC), systemic immunotherapy (IT) and systemic chemotherapy was reviewed. In all, 18 patients in the series received sequential therapy. The median overall survival (OS) was 17 months (n=37), which compared favourably with previously reported series. Patients treated with TAC first or second line had an overall progression-free survival (PFS) of 9 months (n=29) and IT PFS 7 months (n=26). The overall response rate (ORR) for TAC first line was 26% and the disease control rate (DCR) was 65% (n=23). ORR for IT first line was 7%, DCR 77% (n=14). Second-line (cross-over) IT ORR was 16%, DCR 58% (n=12). For second-line (cross-over) TAC, ORR was 50% and DCR was 66% (n=6). Toxicity was manageable. There were no cases of autoimmune hepatitis. In this retrospective small series analysis in uveal melanoma, liver-directed therapy and IT in sequence have shown to be active and reasonably well tolerated. Further prospective clinical trials should clarify the role of these treatments and their potential survival benefit.
PET/CT surveillance detects asymptomatic recurrences in stage IIIB and IIIC melanoma patients: a prospective cohort study
Authors: Madu Max F. , Timmerman Pieter , Wouters Michel W.J.M. , van der Hiel Bernies , van der Hage Jos A. , van Akkooi Alexander C.J.
Published: February 2017

AJCC stage IIIB and IIIC melanoma patients are at risk for disease relapse or progression. The advent of effective systemic therapies has made curative treatment of progressive disease a possibility. As resection of oligometastatic disease can confer a survival benefit and as immunotherapy is possibly most effective in a low tumor load setting, there is a likely benefit to early detection of progression. The aim of this pilot study was to evaluate a PET/computed tomography (CT) surveillance schedule for resected stage IIIB and IIIC melanoma. From 1–2015, stage IIIB and IIIC melanoma patients at our institution underwent 6-monthly surveillance with PET/CT, together with 3-monthly S100B assessment. When symptoms or elevated S100B were detected, an additional PET/CT was performed. Descriptive statistics were used to evaluate outcomes for this surveillance schedule. Fifty-one patients were followed up, 27 patients developed a recurrence before surveillance imaging, five were detected by an elevated S100B, and one patient was not scanned according to protocol. Eighteen patients were included. Thirty-two scans were acquired. Eleven relapses were suspected on PET/CT. Ten scans were true positive, one case was false positive, and one case was false negative. All recurrences detected by PET/CT were asymptomatic at that time, with a normal range of S100B. The number of scans needed to find one asymptomatic relapse was 3.6. PET/CT surveillance imaging seems to be an effective strategy for detecting asymptomatic recurrence in stage IIIB and IIIC melanoma patients in the first year after complete surgical resection.
A Rare Case of CK20/CK7 Double Negative Merkel Cell Carcinoma
Authors: Le Mary D. , O'Steen Luke H. , Cassarino David S.
Published: February 2017

The authors present a case of Merkel cell carcinoma (MCC) with unique immunohistochemical staining characteristics. A 57-year-old woman presented with a firm 0.3 cm tan papule on her left nasal-labial fold that was reportedly increasing in size and bleeding. She had a history of multiple head and neck actinic keratoses, papillary thyroid carcinoma, and a family history of an uncle with melanoma. The clinical differential diagnosis was “non-melanoma skin cancer.” Histological examination showed a markedly atypical-appearing basaloid neoplasm, present mostly in the dermis, with focal pagetoid spread into the epidermis. The cells showed hyperchromatic-staining nuclei, crowding, nuclear molding, and scant cytoplasm with atypical mitoses. The findings were consistent with a malignant tumor, highly suspicious for MCC. A pancytokeratin stain was strongly positive and showed perinuclear dot-like positivity. CK20 and CK7 stains were both negative. Synaptophysin was strongly positive, chromogranin was focally positive, CD56 was weakly positive, and neurofilament was positive in a perinuclear dot-like pattern. TTF-1, PAX5, S100, and Melan-A were negative, arguing against metastatic small cell carcinoma of lung or thyroid, B-cell lymphoma, or melanoma, respectively. Although the CK20/CK7 double negativity is very unusual, the staining characteristics of this case are most consistent with a primary cutaneous MCC. Up to 10%–15% of MCCs can be CK20 negative, and those cases are typically CK7 positive. This case is unique, as a CK20/CK7 double negative case has not been previously reported; however, the diagnosis can still be rendered based on the clinical, histological, and other immunohistochemical findings.
Patch tests: not a useful tool in diagnosing adverse cutaneous drug reactions
Authors: Yadav Sushma
Published: February 2017

Cutaneous adverse drug reactions are common in India. We invited this review on the use of patch tests to diagnose these reactions. The findings show that patch tests are of limited value in diagnosing cutaneous adverse drug reactions.
Menopause and big data: Word Adjacency Graph modeling of menopause-related ChaCha data
Authors: Carpenter Janet S. , Groves Doyle , Chen Chen X. , Otte Julie L. , Miller Wendy R.
Published: February 2017

Objective:

To detect and visualize salient queries about menopause using Big Data from ChaCha.

Methods:

We used Word Adjacency Graph (WAG) modeling to detect clusters and visualize the range of menopause-related topics and their mutual proximity. The subset of relevant queries was fully modeled. We split each query into token words (ie, meaningful words and phrases) and removed stopwords (ie, not meaningful functional words). The remaining words were considered in sequence to build summary tables of words and two and three-word phrases. Phrases occurring at least 10 times were used to build a network graph model that was iteratively refined by observing and removing clusters of unrelated content.

Results:

We identified two menopause-related subsets of queries by searching for questions containing menopause and menopause-related terms (eg, climacteric, hot flashes, night sweats, hormone replacement). The first contained 263,363 queries from individuals aged 13 and older and the second contained 5,892 queries from women aged 40 to 62 years. In the first set, we identified 12 topic clusters: 6 relevant to menopause and 6 less relevant. In the second set, we identified 15 topic clusters: 11 relevant to menopause and 4 less relevant. Queries about hormones were pervasive within both WAG models. Many of the queries reflected low literacy levels and/or feelings of embarrassment.

Conclusions:

We modeled menopause-related queries posed by ChaCha users between 2009 and 2012. ChaCha data may be used on its own or in combination with other Big Data sources to identify patient-driven educational needs and create patient-centered interventions.
Intradermal Infiltration of Local Anesthetic—Rapid and Bloodless Deepithelialization of the Breast Pedicle
Authors: Bennett Katelyn G. , Gilman Robert H.
Published: February 2017

Breast reduction is one of the most commonly performed plastic surgery procedures, and pedicle deepithelialization remains a time-consuming step of the operation. This is especially true when using an inferior pedicle. We present a novel technique of intradermal infiltration of the breast pedicle with local anesthetic to facilitate efficient, bloodless deepithelialization. The senior author uses a 20-ml syringe to inject 0.25% lidocaine and 1:400,000 epinephrine just beneath the epidermis of the breast pedicle to create a series of wheals. Approximately 20 ml of local anesthetic is used per pedicle. After injection of local anesthetic, the breast pedicle is deepithelialized in less than 3 minutes. The plane is bloodless, allowing improved visualization secondary to the epinephrine-induced hemostasis. The senior author has had only one case of nipple necrosis in 20 years of experience. Intradermal infiltration of local anesthetic with epinephrine hydrodissects between the epidermis and dermis and provides hemostasis to facilitate rapid deepithelialization.
Board characteristics, governance objectives, and hospital performance: An empirical analysis of German hospitals
Authors: Thiel Andrea , Winter Vera , Büchner Vera Antonia
Published: February 2017

Background:

There is a growing need for hospital supervisory boards to support hospital management in different areas, including (financial) monitoring, resource provision, stakeholder relationships, and strategic decision-making. Little is currently known about how boards’ emphases on these various governance objectives contribute to performance.

Purpose:

Using a dominant logics perspective, this article aims to detect the governance logics that hospital boards emphasize, to determine whether there are distinct clusters of hospitals with the same sets of emphases, and to show how cluster membership relates to board characteristics and financial performance.

Methodology:

Using factor analysis, we identify latent classes of governance objectives and use hierarchical cluster analysis to detect distinct clusters with varying emphasis on the classes. We then use multinomial regression to explore the associations between cluster membership and board characteristics (size, gender diversity, and occupational diversity) and examine the associations between clusters and financial performance using OLS regression.

Results:

Classes of objectives reflecting three governance theories—agency theory, stewardship theory, and stakeholder theory—can be distinguished, and hospitals can be divided into four clusters based on their board’s relative emphasis on the classes. Cluster membership is significantly associated with board characteristics. There is also a significant association between cluster membership and hospital financial performance, with two of three groups performing significantly better than the reference group.

Conclusion:

High performance in hospitals can be the result of governance logics, which, compared to simple board characteristics, are associated with better financial outcomes.

Practice implications:

Hospitals can influence the emphasis placed on different governance objectives and enhance organizational success by creating boards that are small enough to be effective yet diverse enough to profit from a wide variety of expertise and experience.
Predicting HCAHPS scores from hospitals’ social media pages: A sentiment analysis
Authors: Huppertz John W. , Otto Peter
Published: February 2017

Background:

Social media is an important communication channel that can help hospitals and consumers obtain feedback about quality of care. However, despite the potential value of insight from consumers who post comments about hospital care on social media, there has been little empirical research on the relationship between patients’ anecdotal feedback and formal measures of patient experience.

Purpose:

The aim of the study was to test the association between informal feedback posted in the Reviews section of hospitals’ Facebook pages and scores on two global items from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, Overall Hospital Rating and Willingness to Recommend the Hospital.

Methodology/Approach:

We retrieved star ratings and anecdotal comments posted in Reviews sections of 131 hospitals’ Facebook pages. Using a machine learning algorithm, we analyzed 57,985 comments to measure consumers’ sentiment about the hospitals. We used regression analysis to determine whether consumers’ quantitative and qualitative postings would predict global measures from the HCAHPS survey.

Results:

Both number of stars and the number of positive comments posted on hospitals’ Facebook Reviews sections were associated with higher overall ratings and willingness to recommend the hospital. The findings suggest that patients’ informal comments help predict a hospital’s formal measures of patient experience.

Conclusion:

Consistent with crowd wisdom, ordinary consumers may have valid insights that can help others to assess patient experience at a hospital. Given that some people will judge hospital quality based on opinions voiced in social media, further research should continue to explore associations between anecdotal commentary and a variety of quality indicators.

Practice Implications:

Administrators can tap into the wealth of commentary on social media as the forum continues to expand its influence in health care. Comments on social media may also serve as an early snapshot of patient-reported experiences, alerting administrators to problems that may appear in subsequent HCAHPS survey results.
LONG-TERM OUTCOMES OF RITUXIMAB THERAPY IN PATIENTS WITH NONINFECTIOUS POSTERIOR UVEITIS REFRACTORY TO CONVENTIONAL IMMUNOSUPPRESSIVE THERAPY
Authors: Lasave Andres F. , You Caiyun , Ma Lina , Abusamra Khawla , Lamba Neerav , Valdes Navarro Manuel , Meese Halea , Foster C. Stephen
Published: February 2017

Purpose:

To assess long-term effectiveness of rituximab therapy for refractory noninfectious uveitis affecting the posterior segment.

Methods:

Retrospective case series. Patients diagnosed with recalcitrant noninfectious posterior uveitis who were treated with rituximab intravenous infusions between 2010 and 2015 were included. Patients underwent best-corrected visual acuity testing and fluorescein angiography evidence of disk or vascular staining at 6, 12, 18, and 24 months. Patients had at least 24 months of follow-up.

Results:

Eleven patients (21 eyes) with refractory posterior uveitis treated with intravenous rituximab were included. Nine (81.8%) patients were female. Mean follow-up was 29.3 ± 7.8 months. rituximab was administered as complementary therapy because of previous inefficacy of other therapies in 7 (63.7%) patients, and it was the only treatment in four (36.3%) patients who did not tolerate other drugs. Inflammation signs by fluorescein angiography were controlled in nine (81.8%) patients at the end of follow-up. Baseline best-corrected visual acuity was 20/80 (logarithm of the minimal angle of resolution 0.6 ± 0.4), and final best-corrected visual acuity was 20/40 (0.3 ± 0.5) (P = 0.005). No significant side effects were reported.

Conclusion:

Rituximab therapy was associated with stability and remission of recalcitrant noninfectious posterior uveitis in patients who did not tolerate or did not respond to other therapies.
Roles of Medication Responsibility, Executive and Adaptive Functioning in Adherence for Children and Adolescents With Perinatally Acquired HIV
Authors: Garvie Patricia A. , Brummel Sean S. , Allison Susannah M. , Malee Kathleen M. , Mellins Claude A. , Wilkins Megan L. , Harris Lynnette L. , Patton E. Doyle , Chernoff Miriam C. , Rutstein Richard M. , Paul Mary E. , Nichols Sharon L.
Published: February 2017

Background:

Medication adherence is a critical but challenging developmental task for children and adolescents with perinatally acquired HIV (PHIV). Understanding how medication responsibility, executive functions (EFs) and adaptive functioning (AF) influence adherence may help prepare adolescents for transition to adulthood.

Methods:

Participants included PHIV children and adolescents 7–16 years of age enrolled in the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol, who were prescribed antiretroviral medications. Measures included caregiver report and child self-report measures of adherence, medication responsibility and EF, caregiver report of child AF, examiner-administered tests of EF and processing speed and demographic and health characteristics.

Results:

Two hundred fifty-six participants with PHIV (mean age: 12 years old) were 51% female, 80% black and 79% non-Hispanic. Per 7-day recall, 72% were adherent (no missed doses). Children/adolescents self-reported that 22% had sole and 55% had shared medication responsibility. Adjusted logistic models revealed significantly higher odds of adherence with sole caregiver responsibility for medication [odds ratio (OR): 4.10, confidence interval (CI): 1.43–11.8, P = 0.009], child nadir CD4% <15% (OR: 2.26, CI: 1.15–4.43, P = 0.018), better self-reported behavioral regulation (OR: 0.65, CI: 0.44–0.96, P = 0.029) and slower processing speed (OR: 0.54, CI: 0.38–0.77, P < 0.001), adjusting for demographic variables (age, race and caregiver education).

Conclusions:

Among children and adolescents with PHIV, continued caregiver medication management, especially during adolescence, is essential. Although global EF and AF were not significantly associated with adherence, behavioral regulation was. Given that EF and AF develop throughout adolescence, their relationships to adherence should be evaluated longitudinally, especially as youth transition to adulthood and caregiver responsibility diminishes.
Case Series of Wounded Warriors Receiving Initial Fit PowerKnee™ Prosthesis
Authors: Pasquina Paul F. , Carvalho Antonio J. , Murphy Ian , Johnson Jessica L. , Swanson Thomas M. , Hendershot Brad D. , Corcoran Michael , Ritland Bradley , Miller Matthew E. , Isaacson Brad M.
Published: February 2017

Introduction

Combat-related lower-limb amputations challenge prosthetic device prescription and rehabilitation practices. Moreover, wounded warriors are relatively young and lived highly active lifestyles before injury, underscoring their eagerness to quickly regain independent mobility and higher levels of physical function.

Methods

Four US military service members with combat-related unilateral amputation were fit with the PowerKnee™ as their initial prosthesis.

Results

All patients achieved significant mobility milestones more rapidly than historical norms of similarly injured patients using other prosthetic knees. Level-ground gait analysis of each patient was comparable with historical normative data of patients using advanced microprocessor variable dampening knee (MPK) prostheses, although the PowerKnee users generated less power in their intact limb hip and knee, suggesting less strain on intact joints. Each patient was also subsequently fit with an MPK and offered a hydraulic knee prosthesis for higher-level activities. Two of the four patients ultimately chose an alternative prosthesis as their primary knee, citing weight, ability to run, and battery life as key determinants. All patients, however, perceived the PowerKnee prosthesis to be valuable during their rehabilitation. Conclusion: The PowerKnee may be a viable option for the initial prosthetic fitting of individuals with transfemoral amputation. Further research is necessary to better understand the advantages or disadvantages of powered prosthetic technology, including their biomechanical effects on intact limbs, especially for high-level activities, and their ability to enhance early rehabilitation and optimal patient selection and timing of fitting.
Genitourinary malformations: an under-recognized feature of ectrodactyly, ectodermal dysplasia and cleft lip/palate syndrome
Authors: Hyder Zerin , Beale Victoria , O’Connor Ruth , Clayton-Smith Jill
Published: February 2017

The ectodermal dysplasia and cleft lip/palate (EEC) syndrome describes the association of ectrodactyly, ectodermal dysplasia and orofacial clefting. As with many autosomal dominant disorders, there is variability in expression and not all of these three core features are present in every individual with the condition. Moreover, there may be additional associated features, which are under-recognized. One of these is the presence of genitourinary anomalies, some of which cause significant morbidity. This report details a further two patients with EEC syndrome and genitourinary involvement, including flaccid megacystis with detrusor muscle failure, bilateral hydronephrosis and megaureter, requiring significant renal and urological involvement during their childhood. We go on to review the literature on the diagnosis and management of genitourinary malformations in EEC syndrome.
Chronic hepatitis C and individuals with a history of injecting drugs in Spain: population assessment, challenges for successful treatment
Authors: Roncero Carlos , Littlewood Richard , Vega Pablo , Martinez-Raga Jose , Torrens Marta
Published: February 2017

In Spain, there is a need to improve chronic hepatitis C care among people who inject drugs (PWID). Injecting drug use is an important risk behaviour for hepatitis C virus (HCV) infection. Review of 28 sources of the relevant published literature mapped the size of the addiction-HCV population in Spain. Experts in opioid use disorder (OUD) treatment in Spain completed a consensus to define the population size, HCV prevalence and access or barriers to hepatitis C treatment for PWID populations. In Spain, over 300 000 individuals have a lifetime history of injecting drugs. Currently, 150 000 individuals in Spain have OUD; many have injected drugs. Each year, 80 000 individuals engage with treatment services for OUD. A proportion of this group continues to inject drugs. There is a high HCV prevalence in PWID – estimates of 60–80% in Spain. Uptake of hepatitis C therapy in PWID in Spain is limited; barriers include awareness of treatment pathways, advocacy for regular screening and effective joint care. There is an urgent need to address barriers to effective hepatitis C care for PWID in Spain. Practical and specific strategies including peer-led solutions, patient buddy systems and joint working models at the local level can make important short-term differences.
Surgical Endoscopy Versus Endoscopic Surgery for Obesity
Authors: Ungureanu Bogdan Silviu , Pătraşcu Ştefan , Şurlin Valeriu , Săftoiu Adrian
Published: February 2017

Background:

Obesity treatment options are of great interest worldwide with major developments in the past 20 years. From general surgery to natural orifice transluminal endoscopic surgery intervention nowadays, obesity surgical therapies have surely developed and are now offering a variety of possibilities.

Areas of Uncertainty:

Although surgery is the only proven approach for weight loss, a joint decision between the physician and patient is required before proceeding to such a procedure. With a lot of options available, the treatment should be individualized because the benefits of surgical intervention must be weighed against the surgical risks.

Data Sources:

Medline search to locate full-text articles and abstracts with obvious conclusions by using the keywords: obesity, surgical endoscopy, gastric bypass, bariatric surgery, and endoscopic surgery, alone and in various combinations. Additional relevant publications were also searched using the reference lists of the identified articles as a starting point.

Results:

Laparoscopic Roux-en-Y gastric bypass still is the most effective, less invasive, bariatric surgical intervention, although there are various complications encountered, such as postoperative hemorrhage (1.9%–4.4%), internal hernias, anastomotic strictures (2.9%–23%), marginal ulcerations (1%–16%), fistulas (1.5%–6%), weight gain, and nutritional deficiencies. However, the absence of parietal incisions, less pain, decreased risk of infection, and short hospital stay make room for endoscopic surgery as a possible valid option for obesity for both the doctors' and the patients' perspective.

Conclusions:

The current tendency is to promote surgical treatment of obesity to a status of less invasive scars therefore promoting minimally invasive surgical techniques.
Treatment diary for botulinum toxin spasticity treatment: a pilot study
Authors: Biering-Sørensen Bo , Iversen Helle K. , Frederiksen Inge M.S. , Vilhelmsen Jeanet R. , Biering-Sørensen Fin
Published: February 2017

The aim of this study is to develop a treatment diary for patients receiving spasticity treatment including botulinum toxin injection and physiotherapy and/or occupational therapy. The diary focuses on problems triggered by skeletal muscle overactivity; agreed goals for treatment and the patient’s self-evaluation of achievement on the Goal Attainment Scale; which skeletal muscles were injected; physiotherapists’ and occupational therapists’ evaluation of the patients’ achievement of objectives on the Goal Attainment Scale; and proposals for optimization of treatment and changing goals. The evaluation included a satisfaction questionnaire and the WHO-QoL BREF and WHO-5 well-being score. Overall, 10 patients were enrolled in the pilot study. The patients were generally satisfied with the diary, found that it involved them more in their treatment and made it easier to set personal goals, and found it worth the time spent using it. However, no clear advantage in relation to their quality of life (WHO-QoL BREF and WHO-5 well-being score) was reported.
Laryngeal sensitivity testing in youth with exercise-inducible laryngeal obstruction
Authors: Hočevar-Boltežar Irena , Krivec Uroš , Šereg-Bahar Maja
Published: February 2017

Exercise-inducible laryngeal obstruction (EILO) has been recognized as a not rare respiratory problem in youth practicing sports. The aim of the study was to test the mechanosensitivity of the larynx, and to identify the factors affecting it in a group of youth with proven EILO. Laryngeal sensory testing was performed in 54 adolescents and young adults with EILO. Laryngeal mucosal alterations were assessed according to the Reflux Finding Score (RFS). The data concerning diseases possibly affecting the upper airway, findings of previously performed flexible videolaryngoscopy during exercise, and RFS score were compared between the participants with laryngeal hyposensitivity and those with normal sensitivity. The participants with isolated vocal folds’ adduction during an EILO attack were compared with those who demonstrated supraglottis collapse. Testing revealed an increased threshold for mechanical stimuli in 81.5% of participants. Among participants with hyposensitivity, there were significantly more participants with dysphagia during EILO attacks than among the participants with normal laryngeal sensitivity. The hyposensitivity group had a significantly higher RFS score compared with the other group. Isolated vocal folds’ approximation was only observed in 11.9% of participants. These participants were younger and had asthma more frequently compared with the others. Only 16.9% of participants with EILO did not state symptoms related to gastroesophageal reflux. The decreased mechanosensitivity was detected in the majority of participants, suggesting that laryngopharyngeal reflux can be an important etiological factor. The problem of breathing difficulties during sport activities in youth can also be associated with the disproportionate growth of the respiratory tract.
Suicidal Ideation vs. Suicide Attempts: Clinical and Psychosocial Profile Differences Among Depressed Patients
Authors: Lewitzka Ute , Spirling Sina , Ritter Dirk , Smolka Michael , Goodday Sarah , Bauer Michael , Felber Werner , Bschor Tom
Published: February 2017

This study investigated whether personality traits, psychopathological characteristics, and sociodemographic factors in depressed patients differentiate patients with only suicidal thoughts from those who have attempted suicide. We investigated two groups of patients with an affective disorder: 198 patients with a suicide attempt within the last 3 months (sex ratio male to female, 1:1.3; mean age male to female, 44.8/44.7 years) and 30 patients without a suicide attempt but with suicidal thoughts (sex ratio male to female, 1:2; mean age male to female, 39.4/42.6 years) using a comprehensive measurement (Mini-International Neuropsychiatric Interview, Structured Clinical Interview for DSM-4 Axis II disorders, Hamilton Depression Scale, Beck Depression Inventory, State-Trait Anxiety Inventory, Hamilton Anxiety Scale, Brief Psychiatric Rating Scale, Clinical Global Impression Scale, Beck-Hopelessness Scale, Scale for Suicide Ideation, Impulsivity Rating Scale, Barratt Impulsivity Scale, Inventory for the Assessment of Aggression Factors, State-Trait Anger Expression Inventory, Ways of Coping Checklist). Several differences distinguished the two groups, namely, in personality traits such as anxiety or coping strategies and sociodemographics (e.g., education level). Personality traits, psychopathological characteristics, and sociodemographic factors are useful tools for assessing suicidal risk. Our findings encourage us to suggest that clinicians pay particular attention to sociodemographic variables such as separation/divorce and a lower education level when conducting risk assessments on suicidal patients.
Outer Retinal Tubulation: A Case Series
Authors: Rousso Leticia A. , Rodman Julie A. , Sutton Brad , Shechtman Diana L.
Published: February 2017

Purpose

The advent of spectral domain optical coherence tomography has led to superb imaging capabilities in addition to enhanced visualization of the retinal layers. Such advancements have led to the identification of a variety of new retinal conditions, including outer retinal tubulations (ORTs). ORTs are ovoid hyporeflective spaces located in the outer retina. The pathogenesis is unclear but seems to involve sublethal injury to the photoreceptors leading to a compensatory reorganization of the photoreceptor layer with the neighboring ellipsoid zone resulting in a hyperreflective border surrounding a central lumen. Most ORTs have been linked to wet age-related macular degeneration; however, these peculiar structures are now seen in a myriad of retinal disorders.

Case Reports

Our cases will highlight the wide variety of clinical presentations associated with outer retinal tubulations. The clinical presentations include two cases of wet age-related macular degeneration, a case of presumed ocular histoplasmosis syndrome, a case of central areolar choroidal dystrophy, and a case of pathological myopia.

Conclusions

By correctly differentiating outer retinal tubulations from other masqueraders, unnecessary referrals and interventions can be minimized. Understanding the various disease entities associated with outer retinal tubulation could give further insight into the mechanism and formation of these structures.
Impact of a Child Life and Music Therapy Procedural Support Intervention on Parental Perception of Their Child's Distress During Intravenous Placement
Authors: Ortiz Gabriela S. , O'Connor Todd , Carey Jessa , Vella Adam , Paul Audrey , Rode Diane , Weinberg Alan
Published: February 2017

Objectives

Child life specialists and music therapists have a unique and integral role in providing psychosocial care to pediatric patients and families. These professionals are trained to provide clinical interventions that support coping and adjustment and reduce the risk of psychological trauma related to hospital visits and health care encounters. The researchers devised a multimodal approach using a combined child life and music therapy intervention to address procedure-related distress in patients receiving intravenous (IV) placement in the pediatric emergency department. The aim of this study was to investigate the efficacy of this collaborative intervention by evaluating parental perception of their child's distress.

Methods

This study was a prospective analysis investigating the impact of a child life and music therapy intervention on children aged 4 to 11 years old receiving an IV placement in the pediatric emergency department. Efficacy was evaluated by comparing scores between a 4-question pretest and subsequent 4-question posttest that asked the child's parent to evaluate how they anticipated their child would respond to the procedure, and then to evaluate how they perceived their child to have responded after the procedure. Qualitative data were collected in the form of open-ended comments, which were accommodated at the end of the posttest. Data were analyzed by the Cochran-Mantel-Haenszel method for testing repeated ordinal responses and the PROC GENMOD procedure in the SAS system software.

Results

A total of 41 participants were enrolled in this study. Results of the statistical analysis revealed significant differences between all pre- and posttest scores (P < 0.05), and significant likelihood that the patient would improve relative to the 4 questions, as a result of the child life and music therapy intervention.

Conclusions

Improvement was demonstrated across all 4 questions, suggesting that the child life and music therapy intervention supported healthy, adaptive coping and helped to minimize distress experienced by patients during IV placement. These results underscore the importance and potential clinical impact of child life psychological preparation and psychotherapy-based music therapy interventions in reducing distress in pediatric patients during common medical procedures.
A Qualitative Analysis of General Emergency Medicine Providers' Perceptions on Pediatric Emergency Telemedicine
Authors: Kim Ji Won , Tiyyagura Gunjan , Langhan Melissa
Published: February 2017

Objective

Most children in the United States are evaluated in general emergency departments (ED), which are staffed by practitioners who care for both adults and children and may have limited pediatric resources. The application of telemedicine in pediatrics is growing and has been shown to be effective in outpatient as well as critical care settings. Telemedicine has the potential to address disparities in access to pediatric emergency care. The objective of this study was to explore experiences of general ED providers with telemedicine and their perception about a potential video telemedicine program with pediatric ED providers.

Methods

Using qualitative methods, a purposeful sample of general ED providers (attending physicians and physician assistants) in 3 Connecticut hospitals participated in audio-recorded semistructured interviews. In line with grounded theory, 3 researchers independently coded transcripts, collectively refined codes, and created themes. Data collection and analysis continued in an iterative manner, past the point of theoretical saturation.

Results

Eighteen general ED providers were interviewed. Three themes were identified: (a) familiarity with use in adult stroke patients but limited practical experience with telemedicine; (b) potential uses for pediatric telemedicine (guiding pediatric differential diagnosis and management, visual diagnosis, alleviating provider fears, low-frequency high-stakes events, determining disposition, assessing level of illness, and access to subspecialty consultation); and (c) limitations of telemedicine (infrequent need and implementation barriers).

Conclusions

General ED providers identified 7 specific potential uses of pediatric emergency video telemedicine. However, they also identified several limitations of telemedicine in caring for pediatric emergency patients. Further studies after implementation of telemedicine program and comparing provider perceptions with actual practice may be helpful. Furthermore, studies on telemedicine's effect on patient-related outcomes and studies on cost-effectiveness might be necessary before the widespread implementation of a telemedicine program.
Inappropriate Shocks and Power Delivery Using Adult Automatic External Defibrillator Pads in a Pediatric Patient
Authors: Tejman-Yarden Shai , Katz Uriel , Rubinstein Marina , Attias Yehuda , Yahia Reem , Mishali David , Glikson Michael
Published: February 2017

The use of automatic external defibrillators (AEDs) during pulseless resuscitations is considered safe and reliable, and was established as part of the guidelines in out-of-hospital events. Based on extensive studies, the use of the standard AED is now indicated in every age group with a preference of pediatric pad application for small children and babies. If unavailable, adult pads are recommended. We report a case of 2 inappropriate AED shocks that were delivered to a neonate during a pulseless resuscitation after application of adult pads. The 3.6-kg patient received 2 shocks, over 200 J each, for sinus bradycardia that was not detected by the device. Although treated inappropriately with high voltage, no cardiac or skin sequelae were detected, and the patient had normal cardiac and neurological development later on.
Traumatic Ventricular Septal Defect in a 1-Year-Old Boy After Accidental Chest Compression by an Adult
Authors: Wu Huang-Wei , Chien Jen-Hung , Weng Ken-Pen , Lin Chu-Chuan , Chen Bo-Hau , Huang Shih-Ming , Hung Yu-Chi
Published: February 2017

We report a 1-year-old boy with a delayed diagnosis of traumatic ventricular septal defect (VSD) related to chest compression. His cardiac function was stable after adequate medical treatment. Spontaneous closure of traumatic VSD occurred to this patient at the age of 4 years. This is a rare case of traumatic VSD associated with accidental chest compression, which is similar to rupture of the ventricular septum after blunt chest trauma. It should be kept in mind that traumatic VSD and concomitant thoracic injuries can develop during chest compression. The clinician should pay attention to the potential risk of traumatic VSD in patients experiencing chest compression. Echocardiography is a convenient and effective tool for serial follow-up examination and avoiding the delayed diagnosis. Troponin I level can be a useful screening test. Conservative management of traumatic VSD with hemodynamic stability is recommended because of possible spontaneous closure.
The Presentation of a Fussy Infant With Bruising
Authors: Wolpert Katherine , Szadkowski Matthew , Miescier Michael , Hewes Hilary A.
Published: February 2017

Vitamin K plays an integral role in the clotting cascade. Deficiency, specifically in vulnerable neonates with insufficient stores, can lead to spontaneous bleeding and devastating effects. In this case, we report a young infant with late-onset vitamin K deficiency bleeding who did not receive vitamin K prophylaxis after birth. Initially presenting with bruising and fussiness, the patient was later found to have intracerebral hemorrhage with midline shift and uncal herniation. The infant was not a surgical candidate and died shortly thereafter. Laboratory studies confirmed the diagnosis of late-onset vitamin K deficiency bleeding as the cause of hemorrhage and death.