bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimated Life-Time Savings in the Cost of Ongoing Care Following Specialist Rehabilitation for Severe Traumatic Brain Injury in the United Kingdom
Authors: Turner-Stokes Lynne , Dzingina Mendwas , Shavelle Robert , Bill Alan , Williams Heather , Sephton Keith
Published: March 2019

Objectives:

To evaluate cost-efficiency of rehabilitation following severe traumatic brain injury (TBI) and estimate the life-time savings in costs of care.

Setting/Participants:

TBI patients (n = 3578/6043) admitted to all 75 specialist rehabilitation services in England 2010–2018.

Design:

A multicenter cohort analysis of prospectively collated clinical data from the UK Rehabilitation Outcomes Collaborative national clinical database.

Main Measures:

Primary outcomes: (a) reduction in dependency (UK Functional Assessment Measure), (b) cost-efficiency, measured in time taken to offset rehabilitation costs by savings in costs of ongoing care estimated by the Northwick Park Dependency Scale/Care Needs Assessment (NPDS/NPCNA), and (c) estimated life-time savings.

Results:

The mean age was 49 years (74% males). Including patients who remained in persistent vegetative state on discharge, the mean episode cost of rehabilitation was £42 894 (95% CI: £41 512, £44 235), which was offset within 18.2 months by NPCNA-estimated savings in ongoing care costs. The mean period life expectancy adjusted for TBI severity was 21.6 years, giving mean net life-time savings in care costs of £679 776/patient (95% CI: £635 972, £722 786).

Conclusions:

Specialist rehabilitation proved highly cost-efficient for severely disabled patients with TBI, despite their reduced life-span, potentially generating over £4 billion savings in the cost of ongoing care for this 8-year national cohort.
Rehabilitation Practices in Patients With Moderate and Severe Traumatic Brain Injury
Authors: Kreitzer Natalie , Rath Kelly , Kurowski Brad G. , Bakas Tamilyn , Hart Kim , Lindsell Christopher J. , Adeoye Opeolu
Published: March 2019

Objective:

To characterize the indications, timing, barriers, and perceived value of rehabilitation currently provided for individuals with moderate or severe traumatic brain injury (TBI) admitted to the intensive care unit (ICU) based on the perspectives of providers who work in the ICU setting.

Participants:

Members (n = 66) of the Neurocritical Care Society and the American Congress of Rehabilitation Medicine.

Design:

An anonymous electronic survey of the timing of rehabilitation for patients with TBI in the ICU.

Main Measures:

Questions asked about type and timing of rehabilitation in the ICU, extent of family involvement, participation of physiatrists in patient care, and barriers to early rehabilitation.

Results:

Sixty-six respondents who reported caring for patients with TBI in the ICU completed the survey; 98% recommended rehabilitative care while patients were in the ICU. Common reasons to wait for the initiation of physical therapy and occupational therapy were normalization of intracranial pressure (86% and 89%) and hemodynamic stability (66% and 69%).

Conclusions:

The majority of providers caring for patients with TBI in the ICU support rehabilitation efforts, typically after a patient is extubated, intracranial pressure has normalized, and the patient is hemodynamically stable. Our findings describe current practice; future studies can be designed to determine optimal timing, intensity, and patient selection for early rehabilitation.
EVALUATION OF THE EFFECT OF TOPICAL INTERFERON α2b AS A COMPLEMENTARY TREATMENT OF MACULAR EDEMA OF PATIENTS WITH DIABETIC RETINOPATHY
Authors: Afarid Mehrdad , Meshksar Aidin , Salehi Alireza , Safarpour Mohammad Mostafa
Published: March 2019

Purpose:

The objective of this study is to evaluate the effect of the topical interferon α2b (IFNα2b) as an adjunctive therapy in the treatment of diabetic macular edema.

Method:

This was a randomized controlled clinical trial performed on patients with diabetic macular edema. Fifty eyes of 50 patients (one eye/patient) who were receiving treatment for diabetic macular edema were randomly assigned to get topical IFNα2b 1 MU/mL or artificial tear eye drop as an adjunctive therapy. The primary measure outcomes were best-corrected visual acuity and central macular thickness; the secondary goals were to assess the effect of topical IFNα2b on the intraocular pressure and its potential side effects.

Results:

Baseline demographic data of the two groups were similar. The improvement in visual acuity of patients on IFN was more than the patients on artificial tear by the end of the fourth week (6.85 and 1.45 Early Treatment Diabetic Retinopathy Study letters, respectively, P = 0.001) and the eighth week (6.75 and 1.05 Early Treatment Diabetic Retinopathy Study letters, respectively, P = 0.005). The central macular thickness was also decreased correspondingly by the end of fourth week (53.1 ± 153 µm for patients on IFN and 26.6 ± 119.1 µm for patients on artificial tear, P = 0.497) and eighth week (27.9 ± 67.7 for patients on IFN and 29.2 ± 98 µm for patients on artificial tear, P = 0.957), but it was not statistically significant. Intraocular pressure was decreased on the fourth week in IFN group for 1.7 mmHg ±3 and increased for 0.1 mmHg ±2.3 in the artificial tear group (P = 0.018). No significant side effect was detected with topical IFN drop.

Conclusion:

This study evaluated the short-term effects of topical IFNα2b 1 MU/mL. The drug was well tolerated and may have an effect on improvement of best-corrected visual acuity in patients with diabetic macular edema. It also had an intraocular pressure lowering effect on the studied eyes. However, further studies are needed to confirm this finding.
ASSESSING THE ACCURACY OF A LARGE OBSERVATIONAL REGISTRY OF NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Nguyen Vuong , Leung King Fai Calvin , Nguyen Chu Luan , Squirrell David , Essex Rohan , Arnold Jennifer , Young Stephanie , Barthelmes Daniel , Gillies Mark ,   the Fight Retinal Blindness! Study Group
Published: March 2019

Purpose:

To evaluate the accuracy of an observational database that tracks real-world treatment outcomes for neovascular age-related macular degeneration.

Methods:

We audited 245 randomly sampled eyes from 189 patients with 3,356 visits from 11 doctors in the Fight Retinal Blindness! database. Sex, birth year, previous treatments received, treatment, and visual acuity were validated against the clinical notes. Error rates, the proportion of missed visits (the number of visits present in the patient record but not entered into Fight Retinal Blindness!), the level of agreement using Cohen's kappa (κ) and intraclass correlation coefficients, and positive and negative predictive values were calculated. A visual acuity error was defined as an absolute difference of ≥5 letters.

Results:

The overall error rate was 3.5% (95% confidence interval: 3.1–3.9). The error rate for visual acuity was 5.1% (95% confidence interval: 4.2–5.9) and <5% for the remaining fields. The level of agreement for each field ranged from good to excellent (κ or intraclass correlation ≥ 0.75). The positive predictive value and negative predictive value for visits were 99% and 89%, respectively. The proportion of missed visits was 10.2%.

Conclusion:

Accuracy of the Fight Retinal Blindness! database was good (>95%). The rate of missed visits was high, possibly due to the high burden of retrospective data entry or patients switching practitioners during treatment.
ALTERATION OF OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN A PATIENT WITH OCULAR ISCHEMIC SYNDROME
Authors: Saito Kazuma , Akiyama Hideo , Mukai Ryo
Published: March 2019

Purpose:

To analyze optical coherence tomography angiography images in ocular ischemic syndrome (OIS) before and after carotid artery stenting.

Methods:

We report the case of an 80-year-old man with a history of hypertension and diabetes mellitus who developed OIS in the right eye due to right internal carotid artery stenosis 2 years earlier. After visual acuity declined in the left eye 2 years later, a neurosurgeon discovered left internal carotid artery stenosis, which led to the diagnosis of OIS in the left eye as well. After carotid artery stenting, improvements were observed in both visual acuity and blood flow as assessed by laser speckle flowgraphy. The area of the foveal avascular zone and density of the retinal vessel at the level of the superficial and deep retinal layers were analyzed using optical coherence tomography angiography before and after treatment.

Results:

Mean superficial foveal avascular zone area was 0.29 mm2 before treatment, decreasing by 29.97% to 0.20 mm2 after treatment. Mean deep foveal avascular zone area was 1.72 mm2 before treatment, decreasing by 20.35% to 1.37 mm2 after treatment. Superficial or deep vessel density increased by 33.4% and 34.3% after treatment, respectively.

Conclusion:

Optical coherence tomography angiography confirmed foveal avascular zone area reduction and increased vessel density in all retinal layers after carotid artery stenting for OIS. These findings suggest that optical coherence tomography angiography may be useful for evaluating blood flow and treatment efficacy in OIS.
Relationship Between Contact Lens and Pinguecula
Authors: Dundar Huseyin , Kocasarac Can
Published: March 2019

Purpose:

To investigate the effects of contact lens (CL) on the frequency of pinguecula, and the relationship between dry eye disease and pinguecula.

Methods:

Two hundred and 33 cases of soft CL wearers and 230 age-matched nonwearers were enrolled in the study. Schirmer I test (ST) scores and tear break-up time (TBUT) were determined in all participants. A questionnaire including ocular surface disease index (OSDI), age, sex, and duration of CL wear was implemented to the participants before the examination.

Results:

The prevalence of pinguecula was 27.8% (n: 65) in the CL group and 26.5% (n: 61) in the control group. There was no significant difference between the groups (P=0.841). The prevalence of pinguecula increased with age in both groups. There was no significant difference in the prevalence of pinguecula when users were divided into three groups according to the duration of CL wear (P=0.575). The TBUT scores were lower, and the OSDI scores were higher in the CL group. The TBUT scores were lower in patients with pinguecula in both groups. The OSDI scores were higher in the CL group. There was no significant difference regarding the OSDI scores between patients with pinguecula and healthy participants in the CL group; however, OSDI scores were significantly higher in patients with pinguecula in control group. There were no significant differences in the ST scores between the groups, and between patients with pinguecula and healthy participants.

Conclusion:

This is the second study that evaluates the effects of soft CL wearing on pinguecula prevalence. We found that CL wearing does not affect the prevalence of pinguecula. Considering the OSDI scores in patients with pinguecula in the CL group, CL may suppress the irritant symptoms of pinguecula.
Conjunctival Flaps: A Case Series and Review of the Literature
Authors: Oostra Tyler D. , Mauger Thomas F.
Published: March 2019

Purpose:

The purpose of this study was to examine the outcomes of conjunctival flaps performed at our institution.

Methods:

The medical records of all patients who underwent a total or partial conjunctival flap surgery over the course of a 6-year period from 2010 to 2015 were reviewed to identify the ocular diagnoses and perform a retrospective review of the preoperative and postoperative course.

Results:

Thirty-five patients received a conjunctival flap during the 6-year period, 20 partial flaps and 15 total flaps. Infectious keratitis or corneal ulceration accounted for 25 (71.4%) of the cases. The remaining flaps were performed for corneal perforation, graft rejection, bullous keratopathy, and secondary corneal edema. Seven patients had recession of their flap postoperatively, and 14 went on to have further surgical intervention. Conjunctival flap surgery successfully stabilized the patient's ocular surface in 97.1% of the cases.

Conclusion:

Conjunctival flap surgery is an important and useful surgical option in the treatment of ocular surface disease, especially recalcitrant infectious keratitis and corneal ulcers.
Assessment of Ocular Surface in Patients With Ankylosing Spondylitis
Authors: Oltulu Refik , Turk Huseyin Bugra , Oltulu Pembe , Turk Nazli , Satirtav Gunhal , Gunduz Mehmet Kemal
Published: March 2019

Purpose:

To evaluate the clinical findings and ocular surface changes in patients with ankylosing spondylitis (AS).

Methods:

This prospective study involved 45 patients with AS (group 1) and 28 healthy subjects (group 2). Patients in group 1 were in the inactive period. The study subjects underwent a complete ophthalmic examination. The right eyes of the subjects in each group were tested for the study including slit-lamp examination, Schirmer I test, tear break-up time (TBUT), conjunctival impression cytology (CIC), and ocular surface disease index (OSDI). Results between the two groups were compared.

Results:

The mean Schirmer I test result was found as 12.2±8 mm in group 1 and 20.3±9.9 mm in group 2 (P<0.001), whereas the mean TBUT value was found as 3.8±1.9 sec in group 1 and 10.1±4.8 sec in group 2 (P<0.001). The OSDI scores were significantly higher in group 1 (36.5±19.4) than in group 2 (9.1±12.9, P<0.001). The CIC scores were significantly higher in group 1 (2.12±0.7) than in group 2 (0.57±0.6, P<0.001). Notably, none of the patients in group 1 showed grade 0 differentiation, and none of the patients in group 2 showed grade 2 or 3 differentiation. The CIC scores were significantly higher in group 1 (2.12±0.7) than in group 2 (0.57±0.6, P<0.001).

Conclusion:

Ocular surface changes, including squamous metaplasia in the bulbar conjunctiva, can be observed in patients with AS.
An Antimicrobial Stewardship Intervention Improves Adherence to Standard of Care for Staphylococcus aureus Bloodstream Infection
Authors: Brock James B. , Cretella David A. , Parham Jason J.
Published: March 2019

Introduction:

Staphylococcus aureus bloodstream infections (SABSI) are a major cause of morbidity and mortality in the United States, and proper management is important to effect cure and prevent metastatic foci of infection. We aimed to utilize our antimicrobial stewardship program (ASP) to improve practices at a large academic hospital system.

Methods:

Our ASP implemented a SABSI educational campaign directed at the hospital medicine, cardiology, and infectious diseases divisions. A stewardship intervention was then begun for all patients with SABSI recommending infectious diseases consultation, transesophageal echocardiography (TEE), source control, and preliminary antibiotic changes. A retrospective review was performed for all SABSI cases 2 years before and after implementation of the SABSI intervention.

Results:

Two hundred forty-three cases before intervention and 259 after intervention were included. An increase in obtaining follow-up negative blood cultures (79.8% vs. 89.6%), infectious diseases consultation (52.7% vs. 86.5%), TEE (25.5% vs. 54.8%), beta-lactam switch for methicillin-susceptible S. aureus (55.2% vs. 74.4%), and source control (41.2% vs. 57.9%) was demonstrated. We demonstrated similar durations of bacteremia, length of stay, relapse, mortality, and rates of infective endocarditis.

Conclusions:

Adherence to standard of care for patients with SABSI can be dramatically improved through provider education, leveraging antimicrobial stewardship resources, and infectious diseases consultation.
Advances of pathological complete response after neoadjuvant therapy for pancreatic cancer
Authors: Yin Lingdi , Miao Yi , Yu Jun
Published: March 2019

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with a poor prognosis. Only 15% to 20% of patients present with a primarily resectable tumor at the time of diagnosis. There has been an increasing interest in the use of neoadjuvant chemotherapy alone or combination with radiotherapy in patients with resectable, borderline resectable, and locally advanced pancreatic cancer. Although the benefit of neoadjuvant therapy on resectable patients remains controversial, around one third of borderline resectable and locally advanced patients could be expected to have resectable tumors following neoadjuvant therapy, with comparable survival as those with primary resectable tumors. A pathological complete response (pCR) in PDAC is an indicator for significantly better survival although it's rather rare. In this review, we present recent progress of pCR and the controversies in pancreatic cancer after neoadjuvant therapy.
Prognostic factors for disease-free survival in patients with pancreatic ductal adenocarcinoma after surgery: a single center experience
Authors: Tian Xiaodong , Li Jisong , Gao Hongqiao , Zhuang Yan , Ma Yongsu , Chen Yiran , Xie Xuehai , Yang Yinmo
Published: March 2019

Objective:

To evaluate the risk factors for the disease-free survival (DFS) of pancreatic ductal adenocarcinoma (PDAC) patients after surgery, and to validate the clinical applicability and prognostic stratification of the 8th edition American Joint Committee on Cancer (AJCC) staging system.

Methods:

A cohort of 185 patients with PDAC who underwent surgical resection in the General Surgery Department of Peking University First Hospital from January 2010 to December 2017 was enrolled retrospectively. The clinicopathological characteristics and survival data were analyzed to find out risk factors correlated to DFS. The survival curves were calculated according to the 8th edition of AJCC staging system.

Results:

Among the 185 PDAC patients, 125 (67.6%) with pancreatic head carcinoma underwent pancreatoduodenectomy or total pancreatectomy, and 60 (32.4%) with tumors located in the pancreatic body and tail underwent distal pancreatectomy and splenectomy. R0 resection was achieved in 97 patients (52.4%), and the R1 and R2 resections rate was 44.9% and 2.7%, respectively. One hundred five patients (56.8%) received postoperative adjuvant chemotherapy. The median overall survival (OS) was 21 (95% confidence interval [CI] 17.7–24.3) months, and median DFS was 15 (95% CI 13.6–16.5) months. Univariate analysis showed that AJCC T and N staging, status of resection margin, grade of tumor differentiation, perineural invasion, intravascular cancer embolus, combined vascular resection, neutrophil-to-lymphocyte ratio (NLR) ≥ 2, carcinoembryonic antigen ≥5 ng/mL, carbohydrate antigen 19-9 (CA 19-9) ≥ 400 U/mL, and without postoperative adjuvant chemotherapy were correlated with shorter DFS. Furthermore, AJCC T3, N1 and N2 staging, R2 resection, low-grade or undifferentiated tumors, combined vascular resection, NLR ≥ 2, CA 19-9 ≥ 400 U/mL, and without postoperative adjuvant chemotherapy were independent risk factors for DFS. Both the DFS and OS curves were well separated by stage using the 8th staging classification.

Conclusions:

The 8th edition of AJCC T, primary tumor; N, regional lymph nodes; M, distant metastasis staging system could predict the prognosis of PDAC accurately. Patients with AJCC T3, N1 and N2 staging, R2 resection, low-grade or undifferentiated tumors, combined vascular resection, NLR ≥ 2, CA 19-9 ≥ 400 U/mL, and without postoperative adjuvant chemotherapy, have a significantly higher risk of tumor recurrence and shorter DFS after surgery. R0 resection and adjuvant chemotherapy could significantly prolong the DFS of PDAC patients.
The current surgical treatment of pancreatic cancer in China: a national wide cross-sectional study
Authors: Wu Wenming , Jin Gang , Wang Chunyou , Miao Yi , Wang Huaizhi , Lou Wenhui , Yu Xianjun , Sun Bei , Li Haimin , Qin Renyi , Wu Zheng , Wang Weilin , Xu Kesen , Wang Lei , Liang Tingbo , Hao Chunyi , Huang Heguang , Li Yixiong , Tan Guang , Zhao Yongfu , Hao Jihui , Wang Yifan , Peng Chenghong , Liu Xubao , Ou Jinrui , Yuan Chunhui , Wang Xuefeng , Yang Yinmo , Cai Shouwang , Guo Kejian , Jiang Jianxin , Yu Xiao , Wei Junmin , Li Fei , Wu Xinmin , Zhao Yupei
Published: March 2019

Objective:

The aim of this study is to investigate the current status of pancreatic cancer patients undoing surgical treatment in China and to find ways to improve the survival of these patients in the future.

Methods:

This study is a national, multicenter, cross-sectional study in China. Information regarding pancreatic cancer patients undergoing surgical treatment from 34 high-volume tertiary IIIA level hospitals was collected and analyzed from the March 1, 2016 to the February 28, 2017.

Results:

In total, 2200 pancreatic cancer patients were enrolled from 34 tertiary IIIA level hospitals in 16 provinces across China. The male-to-female ratio was 1.5. More than 80% of the patients were between 50 and 70 years old. The top 4 symptoms were epigastric discomfort, abdominal pain, jaundice, and weight loss. Carbohydrate antigen 19-9 and carcinoembryonic antigen were elevated in 70.9% and 27.1% of patients, respectively. A multidisciplinary team (MDT) discussion was carried out for 35.0% of patients before surgery. The proportion of minimally invasive pancreatic surgeries was approximately 20%. A total of 83.4% of the operations achieved R0 resection, and the incidence of grade 3/4 postoperative complications was 7.7%. Only 13.4% of the patients received postoperative adjuvant chemotherapy. The percentage of pathological stage I tumors was only 24.5%.

Conclusion:

The majority of pancreatic cancer patients undergoing surgical resection in China are in an advanced stage. The MDT consultations for pancreatic cancer have not been widely carried out. R0 resection has been achieved in most cases, with relatively low incidence of serious complications, but minimally invasive pancreatic surgery should be further promoted. The application of postoperative chemotherapy remains low. This national, multicentre, cross-sectional study comprehensively presents the current status of pancreatic cancer patients undergoing surgical treatment and shows the road to improve survival of these patients in the future.
Pancreatic cancer surgery with vascular resection: current concepts and perspectives
Authors: Rebelo Artur , Michalski Christoph W. , Ukkat Jörg , Kleeff Jörg
Published: March 2019

Pancreatic cancer is a devastating disease and resection at an early disease stage is the best chance of cure. Less than 20% of all patients present with a resectable tumor, while another 20% to 30% have locally advanced pancreatic cancer and the majority of the patient suffer from metastatic disease. Recently, it has been recognized that there is a 4th group of patients with so-called borderline resectable disease. Here, the tumor approaches or infiltrates the vascular axis (superior mesenteric vein/portal vein and/or superior mesenteric/hepatic artery/celiac trunk). While a large number of tumors with suspected venous infiltration can be resected with concomitant venous resection and reconstruction, arterial infiltration has been considered a contraindication to resection. Neoadjuvant treatment with combination chemotherapy protocols with or without radiotherapy has allowed for higher resection rates even in patients with arterial invasion. Here, we review the contemporary literature on extensive pancreatic cancer surgery with vascular resection and reconstruction.
Guidelines for Rehabilitation and Return to Play After Cervical Surgery in a General Athletic Population: A Delphi Analysis
Authors: Robben Elise , Kempeneers Kristof , De Groef An , Depreitere Bart , Peers Koen
Published: March 2019

Objective:

Decisions concerning the rehabilitation process and return to play (RTP) after cervical spine surgery in a general sporting population can be difficult and may be influenced by several factors. Moreover, no clear guidelines for this are currently available. The aim of this study was to create tentative guidelines for rehabilitation and RTP after cervical surgery in a general sporting population.

Design:

Five-step Delphi analysis.

Settings:

Primary, secondary, and tertiary medical practitioners.

Participants:

Panel of Belgian neurosurgeons, orthopedic surgeons, physiotherapists, and physical and rehabilitation medicine practitioners.

Assessment:

Round 1 (R1) was a brainstorm phase. A comprehensive list of answers from R1 was validated in round 2 (R2). In round 3 (R3), experts ranked these items in a chronological order. Contraindications and criteria to start each rehabilitation step were linked in round 4 (R4). In round 5 (R5), panelists ranked theses about contraindications and criteria on a 5-point Likert scale.

Main Outcome Measures:

Theses scoring ≥10% “oppose” or “strongly oppose” were rejected.

Results:

The response rate was 100% (n = 15) for R1, 93% (n = 14) for R2, 73% (n = 11) for R3, 53% (n = 8) for R4, and 67% (n = 10) for R5. In R5, 25 theses on absolute and relative contraindications and criteria were endorsed.

Conclusions:

This Delphi analysis resulted in contraindications and criteria for the rehabilitation process and RTP after cervical surgery in a general athletic population. Tentative guidelines and timetable are proposed. Key messages from these guidelines are (1) Rehabilitation should start before surgery with education; (2) Rehabilitation should be patient-tailored; and (3) An unstable arthrodesis is an absolute contraindication for RTP.
Does Concussion Affect Perception–Action Coupling Behavior? Action Boundary Perception as a Biomarker for Concussion
Authors: Eagle Shawn R. , Nindl Bradley C. , Johnson Caleb D. , Kontos Anthony P. , Connaboy Chris
Published: March 2019

Background:

After a concussion, athletes may be at increased risk of musculoskeletal injuries. Altered perception of action boundaries (ABP), or the limits of one's action capabilities, is one possible mechanism for this increase in injury risk after concussion.

Objective:

To evaluate differences in symptoms, neurocognitive, vestibular/oculomotor, and action boundary function between subjects with no concussion history (NoHx) and concussion history (ConcHX).

Design:

Cross-sectional study.

Setting:

Laboratory at the University of Pittsburgh.

Participants:

ConcHx (n = 22; age: 21.8 ± 3.0 years, height: 174.0 ± 8.3 cm, and mass: 77.8 ± 14.8 kg) and NoHx athletes (n = 24; age: 21.6 ± 2.0 years, height: 176.0 ± 10.0 cm, and mass: 72.0 ± 15.3 kg).

Intervention:

Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) and Post-Concussion Symptom Scale (PCSS), Vestibular–Ocular Motor Screening (VOMS) tool, and the Perception–Action Coupling Task (PACT). The PACT measures the accuracy of ABP.

Main Outcome Measures:

Neurocognitive domain scores, PCSS, VOMS subdomain symptom gain, ABP accuracy, and actualization.

Results:

ConcHx reported 2.7 ± 1.5 previous concussions occurring on average 263.8 ± 228.9 days prior. ConcHx was higher on several VOMS items including vertical/horizontal saccades (P = 0.001; P = 0.05), vertical/horizontal vestibular–ocular reflex (P < 0.001; P = 0.04), and visual motion sensitivity (P < 0.001). Average PACT movement time (P = 0.01) and reaction time (P = 0.01) were longer in ConcHx.

Conclusions:

These findings provide preliminary support for impaired vestibular/oculomotor function and ABP in ConcHx compared with NoHx. The current results may enhance our understanding of the mechanisms for increased musculoskeletal injury risk after concussion.
Increased access to nurse practitioner care in rural Nebraska after removal of required integrated practice agreement
Authors: Holmes LeAnn R. , Waltman Nancy
Published: March 2019

Nebraska is a largely rural state with many communities defined as medically underserved by primary care providers. In 2014, the state legislature voted to eliminate the requirement for an integrated practice agreement (IPA) between nurse practitioners (NPs) and physicians. This report describes changes in access to primary health care in rural and underserved areas of Nebraska after removal of the IPA barrier to practice. The report compares the number of primary care NPs working in medically underserved areas before and after the legislation that ended the required IPA. In addition, anecdotes will be provided of NP and patient experiences in rural, NP-owned practices in Nebraska after IPA requirements were eliminated.
Postpartum dyspnea in a breast cancer survivor
Authors: Stanley Angela Y. , Lin Andrew H. , Fajardo Johana
Published: March 2019

Breast cancer is the most common cancer among women and the second leading cause of cancer death in the world. As treatments advance and survival increases among breast cancer survivors, we will continue to see more obstetric patients exposed to anthracycline drugs. Anthracycline toxicity risk is dose dependent, and any exposure to anthracyclines places obstetric patients at risk to cardiotoxicity. In this case report, we explore the potential chemotherapy toxicities of anthracycline exposure.
Use of PHQ-9 and pharmacogenetic testing in clinical practice
Authors: Kierce Erica D. , Vanderhoef Dawn M. , Connors Laurie M.
Published: March 2019

Background:

This project evaluated the clinical use of pharmacogenetic testing in an outpatient psychiatric practice, integrated a standardized measure for assessing depressive symptoms, and captured data regarding treatment efficacy.

Local Problem:

According to the Centers for Disease Control and Prevention (2016), more than 10% of all outpatient office visits include a depression-related diagnosis. Patients who require more medication trials to experience remission of depressive symptoms are more likely to relapse in the follow-up period than those who do not (National Institute of Mental Health, 2001).

Methods and Interventions:

Baseline Patient Health Questionnaire-9 (PHQ-9) scores and medication regimens were recorded for 15 adults with major depressive disorder who completed pharmacogenetic testing. Repeat PHQ-9 scores and medication regimens were recorded at follow-up appointments within 6 weeks post-pharmacogenetic testing and compared with baseline data.

Results:

The PHQ-9 scores ranged from a 5-point reduction to a 2-point increase in depressive symptoms at follow-up appointment. The PHQ-9 scores were lower at follow-up screening for 14 participants. Six of the 15 participants were on a single medication, with significant drug–gene interactions. Medications with significant drug–gene interactions were eliminated from the regimen for three of the six patients. For the remaining three patients, providers deemed it to be reasonable to continue the medications with significant drug–gene interactions.

Conclusions:

Pharmacogenetic testing is a useful clinical tool for guiding medication selection but does not replace provider judgment. Drug–gene interaction testing results should be considered in addition to patient preference, medication cost, possible side effects, and immediate clinical needs.
Improving influenza immunization rates in the uninsured
Authors: Falcone Aimee L.
Published: March 2019

Background and Purpose:

Infection from influenza virus causes tens of thousands of deaths annually in the United States, costing millions to manage hospital complications. Barriers exist for patients to choose the influenza vaccine, which is proven to effectively reduce incidence of infection and complications from influenza virus. A significant percent of uninsured patients are at high risk of these complications because of chronic illness. This article examines the literature for evidence of effective interventions to increase influenza uptake rate in the uninsured adult population.

Methods:

Literature review of data sources including the Cumulative Index to Nursing and Allied Health Literature, PubMed, Scopus, and the Cochrane Database of Systematic Reviews.

Conclusions:

Effective interventions include free vaccines, mass communication efforts, implementing an influenza questionnaire, training health care workers, using a vaccine facilitator, implementing a standing orders policy and opt-out policy, scheduling year-round appointments, clinicians recommending the vaccine, clinician audit and feedback, tracking in an electronic medical record, and narrative communication techniques.

Implications for practice:

To reduce influenza-related costs, and improve health outcomes, it is imperative that nurse practitioners use evidence-based interventions in the practice setting to increase influenza uptake rates in the adult uninsured population.
Health care system changes supporting the development of the nurse practitioner role in Tanzania
Authors: Mboineki Joanes Faustine , Chen Changying
Published: March 2019

Background and purpose:

Accessibility to health care services remains a global challenge, and this has affected the quality of services delivered. This has affected the quality of health care services. Poor accessibility to health care services in Tanzania has hindered the achievements of health care system goals. The development of the nurse practitioner (NP) role has not yet received enough attention to resolve current existing and emerging problems facing the Tanzanian health care system. This study assessed the health care system changes that support the development of the NP role in Tanzania.

Methods:

A descriptive, cross-sectional study design was used to collect quantitative data. Purposive and convenience sampling techniques were used to collect data from 237 health care providers using a semi-structured questionnaire. Data were entered into SPSS version 20 and analyzed using descriptive statistics and Chi-square test for independence (Pearson Chi-square, χ2).

Conclusions:

Although the government of Tanzania has made some improvements in access to health care services, the rural health care facilities still suffer from an extreme shortage of skilled health care providers. This has forced the government to allow medical attendants to treat patients when they are not licensed to do so. The development of the NP role should be able to address the shortage of skilled health care providers in rural health care facilities.

Implications for practice:

The development of the NP role will improve the accessibility to health care services in rural primary health care facilities.
Nutrition knowledge, attitudes, and self-regulation as predictors of overweight and obesity
Authors: Balani Roula , Herrington Heidi , Bryant Emily , Lucas Colleen , Kim Son Chae
Published: March 2019

Background and purpose:

Nutrition knowledge, attitudes, and eating self-regulation are important determinants of overweight and obesity. Eating self-regulation is the link between eating intention and behavior. However, the extent to which these factors influence overweight and obesity has not been thoroughly studied. The study examined nutrition knowledge, attitudes, and eating self-regulation as predictors of overweight and obesity among adults in a community setting.

Methods:

A total of 313 adults participated in an online survey, which included the General Nutrition Knowledge Questionnaire–Revised, the Nutrition Attitudes Questionnaire, and the Self-Regulation of Eating Behavior Questionnaire. Descriptive statistics, Kendall's tau tests, and multivariate logistic regression procedures were performed.

Conclusions:

More than half of the participants were either overweight or obese (56.5%). The mean nutrition knowledge score was 74.1%, and only 28.1% correctly identified the body mass index for obesity. Positive predictors of overweight and obesity included poor eating self-regulation of giving up too easily on eating intentions (odds ratio [OR] = 3.81), male gender (OR = 2.0), and age (OR = 1.03), whereas nutrition attitudes were a negative predictor (OR = 0.74).

Implications for practice:

The odds of overweight or obesity were nearly four times greater for those who gave up too easily on their eating intentions. Nurse practitioners can play a critical role in establishing healthy dietary habits to maintain weight control by promoting good eating self-regulation, despite the current obesogenic environment. After assessing patient readiness and motivation, it is important to help patients make eating self-regulation as manageable as possible to promote long-term weight management.
Fibromyalgia treatment and management considerations for nurse practitioners
Authors: Stournaras Dana , Petrovic Kimberly
Published: March 2019

The purpose of this case study is to examine the role of the nurse practitioner in the management and treatment of a 35-year-old female patient diagnosed with several conditions, including fibromyalgia posttraumatic stress disorder, anxiety, and depression. Fibromyalgia is a chronic, nonprogressive rheumatic condition with cardinal symptoms of widespread pain and fatigue; it affects more than 5 million people in the United States. This case study examines the nurse practitioner's role in managing fibromyalgia. Benzodiazepines and opioids may be prescribed for treatment of symptoms but prove ineffective, thus contributing to dependency issues. Controversy exists over classification of fibromyalgia as a rheumatologic condition versus a mental health disorder. Fibromyalgia frequently is accompanied by anxiety and depression, making this illness difficult to diagnose and treat.
The hands that cradle: A pilot study of parent adverse childhood experience scores
Authors: Haltom John Patrick , Card Elizabeth , Wells Nancy , Lowen Deborah E.
Published: March 2019

The purpose of this study was to gather population-specific data within a pediatric hospital and contribute to understanding the intergenerational continuity of adverse childhood experiences (ACEs). This descriptive study aimed at measuring the ACE scores of parents or caretakers whose child was a suspected victim of abuse or neglect. The “Finding Your ACE Score questionnaire was used to determine participants' scores.” Fifteen participants enrolled in the study (N = 15), and 86.7% had exposure to ACEs. Statistical significance was found when comparing ACE scores with reported income levels (p = .051). This study supports previous findings of ACEs being present in a variety of populations, and it presents practice implications for advance practice registered nurses (APRNs) in various practice settings. Findings support that research regarding how to assess and treat ACEs throughout family members is both necessary and difficult. Additional data regarding the intergenerational continuity of ACEs might influence how APRNs deliver family-specific assessment, treatment, and prevention of ACEs throughout generations of family members.
Children's fears 2–13 months after sibling NICU/PICU/emergency department death
Authors: Roche Rosa M. , Brooten Dorothy , Youngblut JoAnne M.
Published: March 2019

Background and purpose:

Sibling loss can heighten children's fears. Approximately two million children in the United States experience the death of a sibling each year, leaving 25% of them in need of clinical intervention and more than 50% with significant behavioral problems. Fear, guilt, anxiety, and even distance from parents are some of the reactions that children feel after experiencing the loss of a sibling. The purpose of this study was to describe children's fears 2–13 months after their sibling's death. Fears were examined by children's age, gender, race/ethnicity, and time.

Methods:

Children completed two open-ended questions about fears and five fear items on the Spence Children's Anxiety Scale. The sample consisted of 132 children.

Results:

Children's top fears across age, gender, and race/ethnicity were daily situations (such as darkness, high places, and violent situations), bugs, animals, and medical examinations. Girls had more total fears than boys. These included fears of bugs and situations with parents and siblings. Boys and Hispanic children had more fears of daily situations. Black children had more fears of animals, whereas White children had more fears of bugs and medical examinations.

Implications for practice:

Children identify many fears after sibling death, including but not limited to fantasy creatures, common daily situations, bugs, animals, and medical examinations likely related to their sibling's death. Identifying children's fears early can help nurse practitioners assist families in better understanding and responding to children's behavior after sibling death.
A Single-Center Case Series Describing Tracheobronchial Bonastent Implantation
Authors: Avasarala Sameer K. , Sethi Sonali , Machuzak Michael , Almeida Francisco A. , Gildea Thomas R.
Published: March 2019

Background:

The Bonastent is one of the newest self-expanding metallic tracheobronchial prostheses being used in the central airways. Experience with this stent is limited; there is a gap in literature. We report herein a case series of Bonastent implantation across a variety of tracheobronchial pathologies.

Methods:

All adult patients who had a Bonastent implanted within the tracheobronchial tree between November 2017 through May 2018 were included in this case series. Data were derived from a combination of sources: electronic medical records and a Research Electronic Data Capture–based bronchoscopy registry. Demographic, procedural, and short-term outcome data were collected for each patient.

Results:

Thirteen Bonastents were implanted in 11 patients during the observational period. Seven patients were male (64%); the mean age was 62.2 years. The most common indication was nonmalignant airway obstruction in a transplanted lung (n=6, 56%). Over half of all stents (n=8) were implanted in the bronchus intermedius. Three patients (27%) had clinically significant obstruction from their Bonastent.

Conclusion:

The Bonastent is the newest self-expanding metallic endotracheobronchial stent on the market. Like any other stent, it has its advantages and drawbacks. Interestingly, we noted 3 instances of tissue ingrowth through the covered portion of the stent. Larger studies with a longer follow-up periods are needed to assess long-term efficacy and safety of this relatively novel stent.
A Repeated Biopsy by EBUS-TBNA Contributed to the Selection of an Appropriate Therapeutic Regimen for a Lung Cancer Patient
Authors: Naito Jun , Toyoda Takahide , Nakajima Takahiro , Fujiwara Taiki , Iwasawa Shunichiro , Suzuki Hidemi , Takiguchi Yuichi , Yoshino Ichiro
Published: March 2019

Since the development of third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors for lung cancer treatment, the need for a rebiopsy has increased. To select an appropriate therapeutic regimen, the genetic alterations in cancerous tissue should be determined. A rebiopsy plays an important role in the treatment of patients with diseases that are refractory to the previous generation of EGFR tyrosine kinase inhibitors. Cell-free DNA-based exploration is useful for determining the cause of treatment resistance in cases in which a rebiopsy is difficult; however, this method cannot detect histologic changes (a mechanism of resistance), which may lead to the selection of nonoptimum therapeutic agents. We herein report a case in which EGFR mutation-positive (exon 19 deletion) lung cancer was successfully treated with an appropriate chemotherapeutic regimen after disease progression. The regimen was selected based on the precise evaluation of a rebiopsy specimen, which determined the histologic type and detected a gene mutation.
Increased Cough Receptor Sensitivity to Capsaicin Predicts a Positive Bronchial Thermoplasty Response
Authors: Yamamura Kenta , Hara Johsuke , Ohkura Noriyuki , Abo Miki , Sone Takashi , Kimura Hideharu , Kasahara Kazuo
Published: March 2019

Background:

Bronchial thermoplasty (BT) is a novel bronchoscopic therapy for severe uncontrolled asthma unresponsive to standard pharmacological treatments, including inhaled corticosteroids and long-acting beta-2 agonists. Although several studies have shown that BT improves asthma control, the optimal predictors of BT response remain unknown.

Patients and Methods:

We reviewed 10 consecutive asthma patients treated with BT at Kanazawa University Hospital between January 2016 and March 2018 and attempted to identify factors that correlated with a positive BT response.

Results:

All patients had the most severe persistent asthma according to the 2017 Japanese guidelines for adult asthma and were uncontrolled despite adequate treatments including high-dose inhaled corticosteroids and long-acting beta-2 agonists. Six patients had significant improvement in asthma control evaluated with the Asthma Control Questionnaire-6. Eight patients showed a significant improvement in asthma-specific health-related quality of life evaluated with the Asthma Quality of Life Questionnaire. The number of severe asthma exacerbations decreased in 6 patients. The maintenance dose of oral corticosteroids decreased in 1 patient. There were no severe adverse events related to the procedure. Six patients showed a positive BT response, and all 4 patients with increased cough receptor sensitivity to capsaicin responded to BT. No other factors, including age, smoking status, body mass index, age of asthma onset, disease duration, blood eosinophil count, total serum immunoglobulin E, prebronchodilator forced expiratory volume in 1 second, reversibility to beta-2 agonist, or fractional exhaled nitric oxide, were associated with a positive BT response.

Conclusion:

Increased cough receptor sensitivity to capsaicin may predict a positive BT response.
Risk Factors Associated With Mortality in Patients With Otogenic Brain Abscess
Authors: Burton Brittany N. , Saliba Joe , Gabriel Rodney A. , Harris Jeffrey P.
Published: March 2019

Objective:

Otogenic brain abscess is a well-recognized clinical condition that describes brain abscess secondary to an ear infection or mastoiditis. Current evidence remains limited on risk factors associated with mortality as most data are from case series. We aimed to 1) report the mortality rate among patients who did and did not receive mastoidectomy 2) identify factors associated with inpatient mortality.

Study Design:

Retrospective cohort study.

Setting:

Multi-institutional.

Patients:

We identified a cohort of patients for years 2008 to 2014 who in their inpatient hospitalization carried the diagnoses of both brain abscess and infectious ear disease.

Interventions:

Inpatient neurotology and neurosurgical procedures.

Main Outcome Measures:

A multivariable logistics regression model was built to identify the factors associated with inpatient mortality.

Results:

The final analysis included 252 patients, of which 84 (33.3%) underwent mastoidectomy. The rate of inpatient morbidity and mortality were 17.5% and 4.0%, respectively. The rate of mortality in patients without mastoidectomy versus those with mastoidectomy was 4.2% versus 3.6%, respectively (p > 0.99). The odds of inpatient mortality were significantly increased for every 10-year increase in age (odds ratio [OR] 2.73, 95% confidence interval [CI]: 1.39–7.01, p = 0.011) and for Black compared to White patients (OR: 45.81, 95% CI: 4.56–890.92, p = 0.003).

Conclusion:

Older age and Black race were associated with increased odds of inpatient mortality and there were no significant differences in mortality between mastoidectomy cohorts. This research serves to generate further hypotheses for larger observational studies to investigate the association between sociodemographic factors and surgical variables with outcomes among this surgical population.