bluuebunny/crossref_metadata_2025 huggingface dataset:
IW And-type state in IM Eridani
Authors: Kato Taichi , Wakamatsu Yasuyuki , Kojiguchi Naoto , Kimura Mariko , Ohnishi Ryuhei , Isogai Keisuke , Niijima Keito , Yoshitake Tomohiro , Sugiura Yuki , Sumiya Sho , Ito Daiki , Nikai Kengo , Matsumoto Hanami , Matsumoto Katsura , Vanmunster Tonny , Hambsch Franz-Josef , Itoh Hiroshi , Babina Julia V , Antonyuk Oksana I , Baklanov Alex V , Pavlenko Elena P , Monard Berto , Dvorak Shawn
Published: November 2019

IW And stars are a recently recognized group of dwarf novae which are characterized by a repeated sequence of brightening from a standstill-like phase with damping oscillations followed by a deep dip. Kimura et al. (2019, PASJ, submitted) recently proposed a model based on thermal-viscous disk instability in a tilted disk to reproduce the IW And-type characteristics. IM Eri experienced the IW And-type phase in 2018 and we recorded three cycles of the (damping) oscillation phase terminated by brightening. We identified two periods during the IW And-type state: 4–5 d small-amplitude (often damping) oscillations and a 34–43 d long cycle. This behavior is typical for an IW And-type star. The object gradually brightened within the long cycle before the next brightening, which terminated the (damping) oscillation phase. This observation agrees with the increasing disk mass during the long cycle predicted by the Kimura et al. model of thermal-viscous disk instability in a tilted disk. We did not, however, succeed in detecting negative superhumps, which are considered to be the signature of a tilted disk.
When does prone sleeping improve cardiorespiratory status in preterm infants in the NICU?
Authors: Shepherd Kelsee L , Yiallourou Stephanie R , Odoi Alexsandria , Yeomans Emma , Willis Stacey , Horne Rosemary S C , Wong Flora Y
Published: November 2019

Study Objectives

Preterm infants undergoing intensive care are often placed prone to improve respiratory function. Current clinical guidelines recommend preterm infants are slept supine from 32 weeks’ postmenstrual age, regardless of gestational age at birth. However, respiratory function is also related to gestational and chronological ages and is affected by sleep state. We aimed to identify the optimal timing for adopting the supine sleeping position in preterm infants, using a longitudinal design assessing the effects of sleep position and state on cardiorespiratory stability.

Methods

Twenty-three extremely (24–28 weeks’ gestation) and 33 very preterm (29–34 weeks’ gestation) infants were studied weekly from birth until discharge, in both prone and supine positions, in quiet and active sleep determined by behavioral scoring. Bradycardia (heart rate ≤100 bpm), desaturation (oxygen saturation ≤80%), and apnea (pause in respiratory rate ≥10 s) episodes were analyzed.

Results

Prone positioning in extremely preterm infants reduced the frequency of bradycardias and desaturations and duration of desaturations. In very preterm infants, prone positioning only reduced the frequency of desaturations. The position-related effects were not related to postmenstrual age. Quiet sleep in both preterm groups was associated with fewer bradycardias and desaturations, and also reduced durations of bradycardia and desaturations in the very preterm group.

Conclusions

Cardiorespiratory stability is improved by the prone sleep position, predominantly in extremely preterm infants, and the improvements are not dependent on postmenstrual age. In very preterm infants, quiet sleep has a more marked effect than the prone position. This evidence should be considered in individualizing management of preterm infant positioning.
Can Mindfulness Help to Predict Veterans’ Mental Health Service Utilization?
Authors: Barr Nicholas , Kintzle Sara
Published: November 2019

Post–9/11 era military veterans are at high risk for posttraumatic stress disorder (PTSD) and depression, but less than half of veterans who screen positive for these disorders seek mental health treatment. Self-stigma of mental illness has emerged as a core barrier to mental health service use (MHSU) in this population. Mindfulness is associated with attention control, nonjudgment, and reduced self-stigma in civilians, but associations between PTSD and depression, mindfulness, self-stigma, and MHSU have never been investigated in military veterans. The present study used a logistic regression modeling strategy to investigate main and interaction effects for PTSD, depression, mindfulness, and self-stigma on MHSU. Study findings demonstrated a positive main effect for PTSD and negative main effects for mindfulness and self-stigma on MHSU, and a positive interaction effect for mindfulness and PTSD on MHSU. Findings suggest that more mindful individuals with PTSD symptoms are more likely to seek mental health services, whereas less mindful individuals with PTSD symptoms are less likely to seek treatment. More research into the potential for mindfulness to enhance MHSU outcomes for military veterans appears warranted.
Relationship between inorganic ion distribution, resting membrane potential, and the ΔG' of ATP hydrolysis: a new paradigm
Authors: Veech Richard L. , King M. Todd , Pawlosky Robert , Bradshaw Patrick C. , Curtis William
Published: November 2019

Cell membrane potential and inorganic ion distributions are currently viewed from a kinetic electric paradigm, which ignores thermodynamics. The resting membrane potential is viewed as a diffusion potential. The 9 major inorganic ions found in blood plasma (Ca2+, Na+, Mg2+, K+, H+, Cl–, HCO3–, H2PO4–, and HPO42–) are distributed unequally across the plasma membrane. This unequal distribution requires the energy of ATP hydrolysis through the action of the Na+‐K+ ATPase. The cell resting membrane potential in each of 3 different tissues with widely different resting membrane potentials has been shown to be equal to the Nernst equilibrium potential of the most permeant inorganic ion. The energy of the measured distribution of the 9 major inorganic ions between extra‐ and intracellular phases was essentially equal to the independently measured energy of ATP hydrolysis, showing that the distribution of these 9 major ions was in near‐equilibrium with the ΔG‘ of ATP. Therefore, thermodynamics does appear to play an essential role in the determination of the cell resting membrane potential and the inorganic ion distribution across the plasma membrane.—Veech, R. L., King, M. T., Pawlosky, R., Bradshaw, P. C., Curtis, W. Relationship between inorganic ion distribution, resting membrane potential, and the ΔG‘ of ATP hydrolysis: a new paradigm. FASEB J. 33, 13126–13130 (2019). www.fasebj.org
Health Professionals Should be Involved in Shaping Substance Use Disorder Policy
Authors: Rosenbloom David L. , Lewis David C.
Published: November 2019

Health professionals should become actively involved in creating evidence based SUD policies as individuals; as members of advisory commissions; as advocates within professional associations and through participation in political campaigns as candidates, donors or activists.
Racial and Ethnic Inequities in Postpartum Pain Evaluation and Management
Authors: Johnson Jasmine D. , Asiodu Ifeyinwa V. , McKenzie Christine P. , Tucker Christine , Tully Kristin P. , Bryant Katherine , Verbiest Sarah , Stuebe Alison M.
Published: November 2019

OBJECTIVE:

To evaluate whether the frequency of pain assessment and treatment differed by patient race and ethnicity for women after cesarean birth.

METHODS:

We performed a retrospective cohort study of all women who underwent cesarean birth resulting in a liveborn neonate at a single institution between July 1, 2014, and June 30, 2016. Pain scores documented and medications administered after delivery were grouped into 0–24 and 25–48 hours postpartum time periods. Number of pain scores recorded, whether any pain score was 7 of 10 or greater, and analgesic medication administered were calculated. Models were adjusted for propensity scores incorporating maternal age, body mass index, gestational age, nulliparity, primary compared with repeat cesarean delivery, classical hysterotomy, and admission to the neonatal intensive care unit.

RESULTS:

A total of 1,987 women were identified, and 1,701 met inclusion criteria. There were 30,984 pain scores documented. Severe pain (7/10 or greater) was more common among black (28%) and Hispanic (22%) women than among women who identified as white (20%) or Asian (15%). In the first 24 hours after cesarean birth, non-Hispanic white women had more documented pain assessments (adjusted mean 10.2) than, black, Asian, and Hispanic women (adjusted mean 8.4–9.5; P<.05). Results at 25–48 hours were similar, compared with non-Hispanic white women (adjusted mean 8.3). Black, Asian, and Hispanic women and women who were identified as other all received less narcotic medication at 0–24 hours postpartum (adjusted mean 5.1–7.5 oxycodone tablet equivalents; P<.001–.05), as well as at 25–28 hours postpartum.

CONCLUSION:

Racial and ethnic inequities in the experience, assessment and treatment of postpartum pain were identified. A limitation of our study is that we were unable to assess the role of patient beliefs about expression of pain, patient preferences with regards to pain medication, and beliefs and potential biases among health care providers.
Consent for Pelvic Examinations Under Anesthesia by Medical Students
Authors: Cundall Hannah L. , MacPhedran Sally E. , Arora Kavita Shah
Published: November 2019

We provide an overview of the issue of specific consent for pelvic examinations under anesthesia performed by medical students. Arguments that have historically been made against requiring consent for such examinations are reviewed and refuted. The implications of requiring consent for examinations under anesthesia are discussed as they relate to patient autonomy, medical student education, and society at large. Finally, we outline a solution and offer sample language that balances the interests of patients, learners, and society.
Effects of Selective Exclusion of Patients on Preterm Birth Test Performance
Authors: Boniface J. Jay , Burchard Julja , Saade George R.
Published: November 2019

The need to reduce the rate of preterm delivery and the recent emergence of technologies that measure hundreds of biological analytes (eg, genomics, transcriptomics, metabolomics, proteomics; collectively referred to as “omics approaches”) have led to proliferation of potential diagnostic biomarkers. On review of the literature, a concern must be raised regarding experimental design and data analysis reporting. Specifically, inaccurate performance has often been reported after selective exclusion of patients around the definition boundary of preterm birth. For example, authors may report the performance of a preterm delivery predictor by using patients who delivered early preterm compared with deliveries at 37 weeks of gestation or greater. A key principle that must be maintained during the development of any predictive test is to communicate performance for all patients for whom the test will be applicable clinically (ie, the intended-use population), which for prediction of preterm birth includes patients delivering throughout the spectrum of gestational ages, as this is what is to be predicted, and not known at the time of testing. Using biomarker data collected from the U.S.-based Proteomic Assessment of Preterm Risk clinical trial, we provide examples where the area under the receiver operating characteristic curve for the same test artifactually improves from 0.68 (for preterm delivery at less than 37 weeks of gestation) or 0.76 (for preterm delivery at less than 32 weeks of gestation) to 0.91 when patients who deliver late preterm are excluded. We review this phenomenon in this commentary and offer recommendations for clinicians and investigators going forward.

FUNDING SOURCE:

Sera Prognostics.
Expedited Scheduling of Interval Tubal Ligation
Authors: Mercier Rebecca J. , Perriera Lisa , Godcharles Cheryl , Shaber Allison
Published: November 2019

OBJECTIVE:

To assess whether expedited scheduling for permanent contraception increases the proportion of patients completing interval tubal ligation within 6 months of delivery.

METHODS:

We randomly assigned patients with unfulfilled immediate postpartum tubal ligation requests to standard scheduling after a postpartum office visit or an expedited process in which we scheduled the interval tubal ligation surgery before discharge from the hospital. The primary outcome was proportion of participants undergoing tubal contraceptive procedures within 6 months of delivery. Secondary outcomes included patient satisfaction with the scheduling process, repeat pregnancy rates, and surgical outcomes. We estimated that 122 patients (61 per group) would provide greater than 80% power to identify a 25% difference favoring expedited scheduling in the primary outcome (one-sided α of 0.05).

RESULTS:

Between September 2016 and June 2018, 239 patients requested tubal ligation at the time of delivery; 155 were not completed. Of these, 126 patients were eligible for the study. We stopped the study at the prespecified 50% enrollment point after 67 patients enrolled, with 34 and 33 assigned to the standard and expedited arms, respectively. Fifteen participants in the expedited group, and two in the standard group completed tubal ligation within 6 months (50% vs 9%; odds ratio 10.0, CI 2.0–50.2). Delivery-to-surgery interval was 49 days in the expedited group, compared with 121 days in the standard group (P=.05). Seventeen participants in the expedited group and three in the standard group reported being very satisfied with the scheduling process (57% vs 13%, P=.03). The only two interim pregnancies both occurred in the standard group (P=.09). There were no surgical complications in any of the 17 completed tubal procedures.

CONCLUSION:

Expedited scheduling significantly improves tubal contraceptive surgery completion and patient satisfaction. Laparoscopic or hysteroscopic tubal ligation or salpingectomy can be performed 4–6 weeks after delivery with minimal interval outpatient follow-up.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02875483.
Desired Sterilization Procedure at the Time of Cesarean Delivery According to Insurance Status
Authors: Morris Jane , Ascha Mustafa , Wilkinson Barbara , Verbus Emily , Montague Mary , Mercer Brian M. , Arora Kavita Shah
Published: November 2019

OBJECTIVE:

To evaluate whether women with Medicaid are less likely than their privately insured counterparts to receive a desired sterilization procedure at the time of cesarean delivery.

METHODS:

This is a secondary analysis of a single-center retrospective cohort examining 8,654 postpartum women from 2012 to 2014, of whom 2,205 (25.5%) underwent cesarean delivery. Insurance was analyzed as Medicaid compared with private insurance. The primary outcome was sterilization at the time of cesarean delivery. Reason for sterilization noncompletion and Medicaid sterilization consent form validity were recorded. Secondary outcomes included postpartum visit attendance, outpatient postpartum sterilization, and subsequent pregnancy within 365 days of delivery.

RESULTS:

Of the 481 women included in this analysis, 78 of 86 (90.7%) women with private insurance and 306 of 395 (77.4%) women with Medicaid desiring sterilization obtained sterilization at the time of cesarean delivery (relative risk 0.85, 95% CI 0.78–0.94). After multivariable logistic regression, gestational age at delivery (1.02 [1.00–1.03]), adequacy of prenatal care (1.30 [1.18–1.43]), and marital status (1.09 [1.01–1.19]) were associated with achievement of sterilization at the time of cesarean delivery. Sixty-four (66.0%) women who desired but did not receive sterilization at the time of cesarean delivery did not have valid, signed Medicaid sterilization forms, and 10 (10.3%) sterilizations were not able to be completed at the time of surgery owing to adhesions. Sterilization during cesarean delivery was not associated with less frequent postpartum visit attendance for either the Medicaid or privately insured population. Rates of outpatient postpartum sterilization were similar among those with Medicaid compared with private insurance. Among patients who did not receive sterilization at the time of delivery, 15 patients (each with Medicaid) had a subsequent pregnancy within the study period.

CONCLUSION:

Women with Medicaid insurance received sterilization at the time of cesarean delivery less frequently than privately insured counterparts, most commonly due to the absence of a valid Medicaid sterilization consent form as well as adhesive disease. The constraints surrounding the Medicaid form serve as a significant barrier to achieving desired sterilization.
Racial Disparities in Postpartum Pain Management
Authors: Badreldin Nevert , Grobman William A. , Yee Lynn M.
Published: November 2019

OBJECTIVE:

To evaluate racial and ethnic differences in women's postpartum pain scores, inpatient opioid administration, and discharge opioid prescriptions.

METHODS:

We conducted a retrospective cohort study of all deliveries at a single high-volume tertiary care center from December 1, 2015, through November 30, 2016. Women were included if they self-identified as non-Hispanic white, non-Hispanic black, or Hispanic; were at least 18 years of age; and did not have documented allergies to nonsteroidal antiinflammatory drugs or morphine. Medical records were queried for three outcomes: 1) patient-reported postpartum pain score (on a scale of 0–10) at discharge (dichotomized less than 5 or 5 or higher), 2) inpatient opioid dosing during postpartum hospitalization (reported as morphine milligram equivalents [MMEs] per postpartum day), and 3) receipt of an opioid prescription at discharge. The associations between each of these outcomes and maternal race–ethnicity were assessed using multivariable logistic regression models with random effects to account for clustering by discharge physician. A sensitivity analysis was conducted in which women of different race and ethnicity were matched using propensity scores.

RESULTS:

A total of 9,900 postpartum women were eligible for analysis. Compared with non-Hispanic white women, Hispanic and non-Hispanic black women had significantly greater odds of reporting a pain score of 5 or higher (adjusted odds ratio [aOR] 1.61, 95% 1.26–2.06 and aOR 2.18, 95% 1.63–2.91, respectively) but received significantly fewer inpatient MMEs/d (adjusted β −5.03, 95% CI −6.91 to −3.15, and adjusted β −3.54, 95% CI −5.88 to −1.20, respectively). Additionally, Hispanic and non-Hispanic black women were significantly less likely to receive an opioid prescription at discharge (aOR 0.80, 95% CI 0.67 to −0.96 and aOR 0.78, 95% CI 0.62–0.98) compared with non-Hispanic white women. Results of the propensity score analysis largely corroborated those of the primary analysis, with the exception that the difference in inpatient MMEs/d between non-Hispanic white and non-Hispanic black women did not reach statistical significance.

CONCLUSION:

Hispanic and non-Hispanic black women experience disparities in pain management in the postpartum setting that cannot be explained by less perceived pain.
Maternal Zika Virus Infection
Authors: Cooper Hannah J. , Iwamoto Martha , Lash Maura , Conners Erin E. , Paladini Marc , Slavinski Sally , Fine Anne D. , Kennedy Joseph , Heinke Dominique , Ciaranello Andrea , Seage George R. , Lee Ellen H.
Published: November 2019

OBJECTIVE:

To evaluate whether antenatal Zika virus infection is associated with risk of having a small-for-gestational-age (SGA) neonate, risk of preterm birth, and lower mean birth weight of term neonates.

METHODS:

For this retrospective observational study, we linked birth record data for women who delivered liveborn singleton neonates in New York City in 2016 to data for pregnant women with Zika virus infection reported to the New York City Health Department. We restricted the analysis to nonsmoking, nonwhite women and adjusted for maternal characteristics. Among women with antenatal Zika virus infection, we used modified Poisson regression to assess risks of having an SGA neonate and of delivering preterm, and linear regression to assess the association of infection with mean birth weight of term neonates.

RESULTS:

Of 116,034 deliveries of singleton neonates in New York City in 2016, 251 (0.2%) were to women with antenatal Zika virus infection. A higher percentage of women with Zika virus infection delivered an SGA neonate compared with those without (11.2% vs 5.8%; adjusted relative risk [RR] 1.8; 95% CI 1.3–2.6). There was no difference in preterm birth prevalence for women with and without Zika virus infection (adjusted RR 1.0; 95% CI 0.69–1.6). Mean birth weight of term neonates born to women with Zika virus infection was 47 g less (95% CI −105 to 11 g); this difference was not statistically significant in crude or adjusted analyses.

CONCLUSION:

For a cohort of New York City women, antenatal Zika virus infection was associated with an increased risk of having an SGA neonate, but not preterm birth or lower mean birth weight of term neonates. This supports a putative association between Zika virus infection during pregnancy and SGA.
Guidance for Evaluation and Management of Blunt Abdominal Trauma in Pregnancy
Authors: Greco Patricia S. , Day Lori J. , Pearlman Mark D.
Published: November 2019

Blunt abdominal trauma is the leading type of traumatic injury in pregnancy, with motor vehicle crashes, falls, and assault being the most common etiologies. Several adverse outcomes can occur in pregnancy, including placental abruption, preterm labor and preterm delivery, uterine rupture, and pelvic fracture. Understanding and integration of key anatomic and physiologic changes in pregnancy are key when evaluating a pregnant trauma patient. Pregnant women should be managed in a medical center with the ability to provide adequate care to both trauma patients—the pregnant woman and fetus. Multiple clinical providers are usually involved in the care of pregnant trauma patients, but obstetric providers should play a central role in the evaluation and management of a pregnant trauma patient given their unique training, knowledge, and clinical skills. An algorithm for management of trauma in pregnancy should be used at all sites caring for pregnant women. An alignment of policies within each system optimizes appropriate triage, integration of care, management, and monitoring of pregnant trauma patients and their fetuses. Ensuring effective protocols for prehospital and hospital treatment, as well as thorough training of involved health care providers, is essential in ensuring that optimal care is provided.
What Is New in Validation and Simulation Training?
Authors: Buek John
Published: November 2019

This month we focus on current research in validation and simulation training. Dr. Buek discusses four recent publications, which are concluded with a “bottom line” that is the take-home message. A complete reference for each can be found on Box 1 on this page along with direct links to the abstracts.
Real-world Outcomes Among Patients Treated With Gemcitabine-based Therapy Post-FOLFIRINOX Failure in Advanced Pancreatic Cancer
Authors: Tsang Erica S. , Spratlin Jennifer , Cheung Winson Y. , Kim Christina A. , Kong Shiying , Xu Yuan , Gill Sharlene
Published: November 2019

Objectives:

Limited evidence exists for chemotherapy selection in advanced pancreatic cancer (APC) after first-line FOLFIRINOX. Second-line gemcitabine/nab-paclitaxel (GEMNAB) is publicly funded in the Canadian provinces of Alberta (AB) and Manitoba (MB), but not in British Columbia (BC). We compared population-based outcomes by region to examine the utility of second-line GEMNAB versus gemcitabine (GEM) alone.

Methods:

We identified patients treated with first-line FOLFIRINOX between 2013 and 2015 across BC, AB, and MB. Baseline characteristics and treatment regimens were compared between AB/MB and BC. Survival outcomes were assessed by the Kaplan-Meier method and compared with log-rank test.

Results:

A total of 368 patients were treated with first-line FOLFIRINOX (143 AB/MB, 225 BC): median age 61 (interquartile range: 55 to 68) years, 42% comprising female individuals, and 67% with metastatic disease. Receipt of second-line therapy was 48% in AB/MB versus 44% in BC (P=0.35), and time from diagnosis to second-line therapy was 7.7 (AB/MB) versus 9.4 months (BC; P=0.1). Distribution of second-line GEM use: 73% GEMNAB, 23% GEM (AB/MB) versus 27% GEMNAB, 66% GEM (BC; P<0.001). Median overall survival (OS) from diagnosis was similar: 12.4 (AB/MB) versus 11.5 months (BC; P=0.91). On Cox regression analysis, region was not significant. Secondary survival analysis by second-line regimen demonstrated a median OS of 18.0 months with GEMNAB versus 14.3 months with GEM (P<0.01).

Conclusions:

In this population-based comparison of APC patients treated with first-line FOLFIRINOX, survival outcomes were comparable regardless of funded access to second-line GEMNAB. OS by regimen favored second-line GEMNAB, but patient selection may be largely responsible for this difference.
Historic transvaginal meshes and procedures: what did my patient have done?
Authors: Jacobs Kristin M. , Sammarco Anne G. , Madsen Annetta M.
Published: November 2019

Purpose of review

Transvaginal mesh kits were widely used to treat pelvic organ prolapse for over a 10-year period in the early 2000s. Due to safety concerns and FDA regulations, these mesh kits are no longer available for use. Thus, current Obstetricians and Gynecologists are likely to encounter these meshes, but may have no previous experience or exposure to the devices making it difficult to adequately monitor, counsel, and care for patients that underwent these types of procedures. This review highlights the most commonly used transvaginal mesh kit types, provides insight into signs and symptoms related to transvaginal mesh complications, and provides guidance for management of mesh complications.

Recent findings

Not all transvaginal mesh will give rise to a complication. If complications do occur, treatment options range from conservative observation to total mesh excision. Management must be customized to an individual patient's needs and goals.

Transvaginal mesh kits promised increased durability of surgical repair for pelvic organ prolapse. Safety concerns over time caused these kits to no longer be available for use. Practicing Obstetricians and Gynecologists should be aware of the history of transvaginal mesh and the signs and symptoms of mesh complications.
Menopausal hormone therapy for BRCA-mutation carriers: attitudes of Israeli healthcare providers before and after a brief educational intervention
Authors: Perri Tamar , Farhadian Yasmin , Friedman Eitan , Korach Jacob
Published: November 2019

Objective:

BRCA-mutation carriers are offered risk-reducing bilateral salpingo-oophorectomy (RRBSO) at age 35 to 40 years, leading to major life-quality and health-related issues associated with early menopause. Hormone therapy (HT) may significantly alleviate menopausal symptoms without increasing breast or ovarian cancer risk in BRCA carriers. We investigated attitudes of Israeli healthcare providers to HT post-RRBSO in BRCA carriers, before and after a brief educational intervention.

Methods:

In this pre-post survey of gynecologic departments in Israel, healthcare providers were given questionnaires (based on scores of 1-4) assessing attitudes to prescribing HT in different clinical scenarios, before and after an educational intervention on current knowledge about HT in BRCA-mutation carriers. Higher scores indicated higher tendency to prescribe HT. Mean and median scores were calculated for each scenario, and the association between scores and various healthcare providers’ characteristics were assessed. The change in attitude pre versus postintervention was evaluated, and the Cohen's d effect size was calculated.

Results:

Of the 200 healthcare providers who were offered participation, 162 responded. Of them, 25.3% were obstetricians, 13.6% gynecologists, 5.55% gynecologic-oncologists, 8% medical oncologists, 38.9% obstetrics-gynecology residents, and 8.6% were nurses. Median age was 44 (interquartile range 36-58); 42.6% were males. Higher score correlated weakly with older age, but did not correlate with gender or personal HT/menopause experience. Significantly higher mean and median preintervention scores were obtained by gynecologists (3.2±0.96; 4 [2.25-4]) and gynecologic-oncologists (3.6 ± 0.78; 4 [3.6-4.0]) than by medical oncologists (2.6 ± 1.06; 2.13 [1.88-3.81]), obstetricians (2.7 ± 1.09; 2.25 [1.88-4.0]), residents (2.48 ± 0.99; 2 [1.69-3.56]) or nurses (2.2 ± 0.92; 2 [1.5-2.69]). Overall scores were higher postintervention (P < 0.001, effect size d = 0.901). The change in scores postintervention was most prominent among younger participants and nurses.

Conclusions:

In Israel, it is acceptable to offer HT post-RRBSO to healthy BRCA-mutation carriers. Younger healthcare workers and nurses tend to be more hesitant, yet they are more likely to adopt a pro-HT attitude after an educational intervention. Such intervention is likely to improve overall care for BRCA-mutation carriers.
Real-world efficacy and safety of nebivolol in Korean patients with hypertension from the BENEFIT KOREA study
Authors: Shin Jinho , Choi Yu Jeong , Hong Geu-Ru , Jeon Dong Woon , Kim Dae-Hyeok , Koh Young Youp , Mancia Giuseppe , Manolis Athanasios J. , Yoon Hyuck-Jun , Park Sang Won
Published: November 2019

Objective:

The efficacy and safety of nebivolol in patients with hypertension is well established, but its effect in Asian patients with essential hypertension in the real world has not been studied.

Methods:

Adult South Korean patients with essential hypertension, with or without comorbidities, were enrolled to participate in this prospective, single-arm, open, observational study; 3011 patients received nebivolol either as monotherapy or add-on therapy. Changes in SBP, DBP and heart rate (HR) at 12 and 24 weeks were evaluated. Subgroup analysis for BP changes in newly diagnosed (de novo) patients and those receiving other antihypertensives at study entry were also conducted.

Results:

Nebivolol significantly decreased mean SBP and DBP at 12 and 24 weeks compared with baseline (P < 0.0001). A significant reduction in HR was also observed at 12 and 24 weeks (P < 0.0001). The reductions of SBP and DBP were notably greater when nebivolol was used as monotherapy inde novopatients (P < 0.0001) and as add-on therapy to existing antihypertensives (angiotensin II receptor blockers, angiotensin-converting enzyme inhibitors and calcium channel blockers;P < 0.0001). Majority of the reported adverse events were mild; the most common adverse events were dizziness (1.3%), headache (1.0%) and dyspnea (0.9%).

Conclusion:

Despite the limitations associated with observational studies, this real-world study in Asian patients with essential hypertension with and without comorbidities, demonstrated the efficacy and safety of once daily nebivolol, either as monotherapy or add-on therapy.

Clinical trial registration number:

NCT 03847350.

SDC Callout: Video Abstract, http://links.lww.com/HJH/B172
Avoid or engage? Outcomes of graded exposure in youth with chronic pain using a sequential replicated single-case randomized design
Authors: Simons Laura E. , Vlaeyen Johan W.S. , Declercq Lies , Smith Allison M. , Beebe Justin , Hogan Melinda , Li Eileen , Kronman Corey A. , Mahmud Farah , Corey Jenelle R. , Sieberg Christine B. , Ploski Christine
Published: November 2019

Pain-related fear is typically associated with avoidance behavior and pain-related disability in youth with chronic pain. Youth with elevated pain-related fear have attenuated treatment responses; thus, targeted treatment is highly warranted. Evidence supporting graded in vivo exposure treatment (GET) for adults with chronic pain is considerable, but just emerging for youth. The current investigation represents the first sequential replicated and randomized single-case experimental phase design with multiple measures evaluating GET for youth with chronic pain, entitled GET Living. A cohort of 27 youth (81% female) with mixed chronic pain completed GET Living. For each participant, a no-treatment randomized baseline period was compared with GET Living and 3- and 6-month follow-ups. Daily changes in primary outcomes fear and avoidance and secondary outcomes pain catastrophizing, pain intensity, and pain acceptance were assessed using electronic diaries and subjected to descriptive and model-based inference analyses. Based on individual effect size calculations, a third of participants significantly improved by the end of treatment on fear, avoidance, and pain acceptance. By follow-up, over 80% of participants had improved across all primary and secondary outcomes. Model-based inference analysis results to examine the series of replicated cases were generally consistent. Improvements during GET Living was superior to the no-treatment randomized baseline period for avoidance, pain acceptance, and pain intensity, whereas fear and pain catastrophizing did not improve. All 5 outcomes emerged as significantly improved at 3- and 6-month follow-ups. The results of this replicated single-case experimental phase design support the effectiveness of graded exposure for youth with chronic pain and elevated pain-related fear avoidance.
Offset analgesia: somatotopic endogenous pain modulation in migraine
Authors: Szikszay Tibor M. , Adamczyk Waclaw M. , Carvalho Gabriela F. , May Arne , Luedtke Kerstin
Published: November 2019

The complex mechanisms underlying migraine are not entirely understood. It has been suggested that descending endogenous pain modulation is an important contributing factor, although research is controversial. A frequently used method to quantify the inhibitory pain modulation system is offset analgesia (OA), defined as a disproportionally large decrease in pain perception in response to a small decrease of painful stimulation. The aim of this study is to evaluate the OA response in patients with migraine and healthy controls, measured at the forehead (trigeminal, V1) and forearm (extratrigeminal). Patients with episodic migraine during the headache-free interval (n = 26) and age- and sex-matched headache-free controls (n = 26) were included in this cross-sectional study. All participants underwent an individualized OA paradigm consisting of 3 stimulus offset trials and 3 constant temperature trials examined at both, a trigeminal and an extratrigeminal test site. Items from the quantitative sensory testing protocol were additionally included. In contrast to the extratrigeminal area, a reduced OA response was shown in the trigeminal area in patients with migraine compared with healthy controls (P < 0.01, mean difference: 13.7, 95% confidence interval: 3.8-23.6). Statistically significant differences between the trigeminal area and the extratrigeminal area were neither observed in healthy controls nor in patients with migraine (P > 0.05). Mechanical detection, mechanical pain threshold, warm detection, and heat pain threshold showed no significant differences between groups or test sites (P > 0.05). In summary, patients with episodic migraine in the headache-free interval exhibited somatotopically specific differences in endogenous pain modulation.
Evaluation of the Use of Open Versus Closed Short Peripheral Catheters on Catheter Dwell Time
Authors: Penoyer Daleen , Fowler Susan , Bennett Melody
Published: November 2019

Short peripheral catheters (SPCs) vary by design and materials. The investigators conducted a before-and-after study comparing catheter dwell time and complications with open and closed system SPCs. Many SPCs in the study were saline locks. Results showed that the closed system SPCs had a significantly longer dwell time than open system SPCs. Complications overall were few and not different between groups. Nurse survey ratings were more positive for reduced blood spillage and materials with the closed system SPC but favored the open system SPC for ease of use when handling the catheter and venipuncture. The most common reason for discontinuing the catheter was for patient discharge.
Effects of Blood Transfusion Sets on Red Blood Cell Hemolysis
Authors: Pardo Larissa Perez , Kusahara Denise Miyuki , Pires Maria Paula de Oliveira , Nani Luiz Augusto Silva , Avelar Ariane Ferreira Machado , Peterlini Maria Angélica Sorgini , Pedreira Mavilde Luz Gonçalves
Published: November 2019

This experimental randomized study compared the effects of macrodrop and microdrop blood transfusion sets on red blood cell (RBC) hemolysis. Twenty units of packed RBCs from different donors were infused through 48 infusion sets from 2 manufacturers at infusion rates of 10 and 100 mL/h. Pre- and postinfusion analysis was performed to determine total hemoglobin (g/dL), hematocrit (%), free hemoglobin (g/dL), potassium (mmol/L), haptoglobin (g/L), and degree of hemolysis (%). The results demonstrated that the level of free hemoglobin (P < .001) and degree of hemolysis (P < .001) increased postinfusion. A higher degree of hemolysis was noted when the RBCs were infused at a rate of 10 mL/h through a microdrop blood transfusion set.
Perspectives on Conducting Research in Indian Country
Authors: Jones Emily J. , Haozous Emily , Larsson Laura S. , Moss Margaret P.
Published: November 2019

Background

Certain research principles, framed within an indigenous context, are helpful guideposts to practice ethical, relevant, and sensitive inquiries. It is essential to further adapt research approaches based on the unique geographical, sociopolitical, and cultural attributes of partnering tribal communities. These adaptations are largely shaped by trial and error.

Objectives

The purpose of this article is to offer the prospective novice nurse researcher lessons that we learned when entering Indian country to conduct research for the first time. As indigenous and nonindigenous researchers, we are not seeking to set down a methodology but rather offer a list of processes, environments, timelines, and barriers that we never learned in didactic, seminar, clinical, practicum, or any other academic setting.

Methods

We organized a set of memories and thoughts through a series of semistructured iterative sessions specific to our first encounters as researchers in Indian country. We compiled our written responses and field notes from our dialogue, interpreted these data, and organized them into themes. We have reported what we felt would be the most surprising, frequent, or important information to note.

Results

We identified three overarching themes in our collective experience: orientation and negotiation, situating ourselves and our work, and navigating our way. Subthemes included perceiving ourselves as outsiders, negotiating distance and time realities, relying on the goodness of gatekeepers, shaping research questions per community priorities, honing our cross-cultural and intercultural communication skills, discovering the many layers of tribal approval processes, and developing sensibilities and intuition.

Discussion

Our previous experiences as novices leading research projects in Indian country have produced unique sensibilities that may serve to guide nurse researchers who seek to partner with tribal communities.
Psychotherapy and Advocacy: Four Freedoms as Fundamental Patient Rights
Authors: PLAKUN ERIC M.
Published: November 2019

This column differentiates the role of psychotherapist from the role of advocate for our patients. It introduces and provides an overview of areas worthy of advocacy efforts that are encapsulated as Four Freedoms that are inalienable rights of those struggling with the burden of mental disorders: freedom from stigma, freedom from dehumanizing treatment, freedom to pursue recovery, and freedom of access to effective, medically necessary treatment.
Increasing Access to Psychiatric Services in Schools: The Bridge Program
Authors: CHO EVELYN , HERMAN KEITH C. , SALAU MUSKINNI , YOUNG-WALKER LAINE
Published: November 2019

One in 5 youth experience a psychiatric disorder in any given year, but fewer than half of these youth receive mental health services. This lack of service utilization is often attributed to structural and perceptual barriers, and school-based mental health programs have been proposed as a means of addressing these barriers and increasing youths’ access to services. While universal prevention programs and targeted treatments may benefit most youth receiving services in schools, collaborations between schools and child psychiatry may benefit youth with the most severe symptoms and the greatest impairment. This article describes the Bridge Program, a school-based psychiatric program funded by a county-wide mental health tax initiative designed to provide psychiatric services in local schools without any out-of-pocket expenses for youth and families within 10 days of referral. Two case reports provide a description of the delivery of psychiatric services through the Bridge Program. Future research is needed to compare the feasibility and effectiveness of different approaches to increasing access to youth psychiatric care.
Lurasidone Malabsorption Following Bariatric Surgery: A Case Report
Authors: WARD HEATHER BURRELL , YUDKOFF BENJAMIN L. , FROMSON JOHN A.
Published: November 2019

A significant segment of the United States adult population is obese. Bariatric surgery is one approach to weight loss when nonsurgical efforts have failed. In individuals with a body mass index ≥50, gastric reduction with duodenal switch is more effective than gastric bypass. More than half of bariatric surgery candidates report a history of mental illness and more than one third were taking at least one psychotropic medication at the time of surgery. Thus, the impact of surgery on absorption of psychiatric medications should be considered. Lurasidone, a second-generation antipsychotic used to treat schizophrenia and bipolar disorder, is recommended to be taken with food of at least 350 calories. We describe the case of a patient with incomplete response to lurasidone therapy in the year following a duodenal switch procedure. This case raises concern about the effect that the duodenal switch procedure may have on lurasidone absorption.
Early Detection of Metastatic Prostate Cancer Relapse on 68Ga-PSMA-11 PET/CT in a Patient Still Exhibiting Biochemical Response
Authors: Plouznikoff Nicolas , Artigas Carlos , Sideris Spyridon , Gil Thierry , Flamen Patrick
Published: November 2019

Prostate cancer (PCa) treatment monitoring usually relies on prostate-specific antigen to detect disease progression or relapse. PET/CT with prostate-specific membrane antigen (PSMA) ligands has shown high accuracy in detecting metastatic PCa lesions and could help assess response to therapy. We describe herein the early relapse detection of a hormone-sensitive metastatic upfront PCa treated with docetaxel on 68Ga-PSMA-11 PET/CT before biochemical progression. PSMA PET/CT should be considered to monitor PCa response to chemotherapy to detect early relapse, regardless of prostate-specific antigen levels, increasing the chances of finding low-volume oligoprogressive disease.
Primary Leiomyosarcoma of the Bronchus
Authors: Li Chongjiao , Tian Yueli , Shen Ying , Wen Bing , He Yong
Published: November 2019

Primary leiomyosarcoma of the bronchus is an extremely rare malignant neoplasm. A 29-year-old man presented with persisting cough and sputum over 1 month. Unenhanced and contrast-enhanced chest CT showed a nodular lesion in the main bronchus of the left lower lobe and multiple enlarged lymph nodes in the mediastinum. Preoperative staging 18F-FDG PET/CT scan displayed a hypermetabolic lesion of the known nodule and mild FDG uptake of mediastinal lymph nodes. The histological examination confirmed bronchial leiomyosarcoma and reactive hyperplasia in lymph nodes.
Association Between Perfusate Oxygenation and Acute Lung Injury in Tetralogy of Fallot Surgery
Authors: Liu Hong , Zheng Si-qiang , Zeng Zhi-hua , Liu Zhi-gang , Liu Xiao-cheng , Shao Yong-feng
Published: November 2019

Purpose:

Little is known regarding precise estimates of the association between perfusate oxygenation (PpO2) and acute lung injury (ALI) following tetralogy of Fallot repair. The objective is to investigate PpO2 and the risk of ALI following tetralogy of Fallot repair in pediatric patients.

Methods:

We conducted a nested case-control study within a prospective Chinese TedaICH cohort including 134 ALI patients aged 1 month to 18 years undergoing complete repair of tetralogy of Fallot, and each was matched to two controls. We selected the highest PpO2 during aortic crossclamp as the exposure. Conditional logistic regression was used to quantify the association between PpO2 and overall ALI risk by covariates of interest. We identified and integrated the risk covariates to build ALI nomograms and internally validated the nomograms using bootstrapping.

Results:

After adjusting for covariates, continuously and categorically higher PpO2 values were associated with ALI risk (all P < 0.05), especially for those with a z-score of pulmonary annulus < −4.0 (P = 0.002), McGoon ratio < 1.5 (P = 0.029), and major aortopulmonary collateral arteries (P = 0.005), despite no statistical heterogeneity (all P interaction >0.05). Younger age, lower oxyhemoglobin saturation, untreated minor aortopulmonary collateral arteries, transannular patch, larger transpulmonary gradient, major transfusion, and longer cardiopulmonary bypass time were independent risk factors for ALI (all P < 0.05). Combining the PpO2 nomogram provided further risk discriminative information on ALI diagnosis compared with the covariate-based nomogram alone in the training cohort (AUC 0.865, 95% CI [0.828–0.903] vs. 0.869 [0.832–0.906], respectively) with no statistical significance (P = 0.445).

Conclusions:

The findings suggested an association between high PpO2 and ALI risk, and more importance should be attached to independent risk factors for ALI.
Laparoscopic Sleeve Gastrectomy Versus Laparoscopic Roux-en-Y Gastric Bypass
Authors: Lee Yung , Doumouras Aristithes G. , Yu James , Aditya Ishan , Gmora Scott , Anvari Mehran , Hong Dennis
Published: November 2019

Objective:

The aim of this study was to compare weight loss, obesity-related comorbidities, and biochemical outcomes of LSG versus LRYGB through a meta-analysis of randomized controlled trials (RCTs).

Summary of Background Data:

LSG and LRYGB are the 2 most commonly performed bariatric surgeries for the treatment of obesity. The comparative outcomes of the 2 surgeries is a topic of ongoing debate and medium-term outcomes remain uncertain.

Methods:

A search for RCTs comparing LRYGB versus LSG was conducted. Pooled outcomes between 2 procedures were compared using pairwise random-effects meta-analysis at 1, 3, and 5-year follow-up time points. Grading of recommendations, assessment, development, and evaluation was used to assess certainty of evidence.

Results:

Thirty-three studies involving 2475 patients were included. LRYGB resulted in greater loss of body mass index compared to LSG at 1 year [mean difference −1.25 kg/m2, 95% confidence interval (CI) −2.01 to −0.49, P = 0.001; moderate certainty of evidence] which persisted at 3 years, but there was insufficient evidence at 5 years. Resolution of dyslipidemia was higher for LRYGB than LSG at 1 year (risk ratio 0.58, 95% CI 0.46–0.73, P < 0.001; moderate certainty of evidence) and 5 years (risk ratio 0.68, 95%CI 0.46–0.99, P = 0.04; low certainty of evidence). There was no difference between LRYGB and LSG for remission of type 2 diabetes, hypertension, and hemoglobin A1c, fasting insulin, homeostatic model assessment of insulin resistance, high-density lipoprotein, and the rate of 30-day major and minor complications.

Conclusions:

There are insufficient data from RCTs to draw any conclusions regarding the long-term comparative effectiveness beyond 3 years between LRYGB and LSG.