bluuebunny/crossref_metadata_2025 huggingface dataset:
Spinal Cord Swelling After Surgery in Cervical Spondylotic Myelopathy
Authors: Ozawa Hiroshi , Aizawa Toshimi , Tateda Satoshi , Hashimoto Ko , Kanno Haruo , Ishizuka Masato
Published: May 2018

Study Design:

This is a prospective multicenter study.

Summary of Background Data:

Postoperative spinal cord swelling has been reported in patients with cervical spondylotic myelopathy. In the cases of the spinal cord swelling, the involvement in the intramedullary gadolinium­diethylenetriamine pentaacetic acid (Gd-DTPA) enhancement on magnetic resonance imaging (MRI) was referred.

Objective:

The prevalence and clinical relevance of postoperative spinal cord swelling and its relationship with intramedullary Gd-DTPA enhancement in patients with cervical spondylotic myelopathy were investigated.

Subjects and Methods:

A total of 683 consecutive patients with cervical spondylotic myelopathy who underwent laminoplasty were examined. T1, T2, and Gd-DTPA-enhanced MRI were performed before surgery. Patients with intramedullary Gd-DTPA enhancement were allocated to the enhancement group. Fifty consecutive cases who did not exhibit intramedullary Gd-DTPA enhancement were allocated to the nonenhancement group. Both groups underwent MRI examinations at 1 month and 1 year after surgery.

Results:

The prevalence of spinal cord swelling in the enhancement group (26%) was significantly higher than that in the nonenhancement group (4%) (P=0.0038). At 1 year after surgery, spinal cord swelling had resolved in all patients in the nonenhancement group, while it persisted in 3 of 13 patients (23%) in the enhancement group. On multiple regression analysis, intramedullary Gd-DTPA enhancement rather than the spinal cord swelling showed a significant influence in terms of recovery of the Japanese Orthopedic Association score.

Conclusions:

Surgical outcomes of patients with postoperative swelling should be evaluated separately according to the presence or absence of intramedullary Gd-DTPA enhancement on MRI. Spinal cord swelling associated with intramedullary Gd-DTPA enhancement was indicative of poor prognosis.
Critical Analysis of Evidence About the Impacts of Faculty Development in Systematic Reviews: A Systematic Rapid Evidence Assessment
Authors: Newman Mark , Reeves Scott , Fletcher Simon
Published: May 2018

Introduction:

Faculty Development (FD) encompasses a range of learning activities undertaken to prepare clinical teachers for their various roles as educators, leaders, and scholars. This article presents the findings of a systematic rapid evidence assessment that aimed to investigate the impact of FD on clinical teachers.

Methods:

We searched the published and gray literature for systematic reviews of FD to identify evidence to help inform judgments about which kinds of FD activities are effective for which groups of clinical teachers.

Results:

After screening the literature, we found seven systematic reviews met our inclusion criteria. Following a critical analysis of these reviews, we found that they contained a number of limitations in relation to their use of review methods and reporting of results.

Discussion:

On the basis of the analysis presented in this systematic rapid evidence assessment, we conclude that the included reviews do not provide high-quality evidence to effectively support decisions about choices of FD activities, even where the review authors made positive claims about impact. Suggestions are provided to improve the quality of systematic reviews in this area.
Integrating a Standardized Mobility Program and Safe Patient Handling
Authors: Dickinson Sharon , Taylor Sarah , Anton Paula
Published: May 2018

Early, routine mobilization of critically ill patients is safe and reduces hospital length of stay, shortens the duration of mechanical ventilation, and improves muscle strength and functional independence. At the University of Michigan, we have turned the tides by creating a structured process to get our patients moving while keeping them and our staff safe through the use of a standardized mobility protocol that incorporates the components of safe patient handling. Our protocol is simple and can easily be adapted for all patient populations by simply modifying some of the inclusion and exclusion criteria. The protocol incorporates safe patient handling and mobility preassessment guidelines, mobility standards, equipment guidelines, and documentation tools. The activities are grounded in the evidence and well thought out to prevent complications, promote mobilization, and prevent patient and staff injuries. This article will discuss a how a tertiary care facility incorporated a safe patient-handling initiative into an existing mobility program and operationalized it across a health care system to keep our patients and staff safe.
Changing the Perceptions of a Culture of Safety for the Patient and the Caregiver
Authors: Black Joyce M. , Salsbury Susan , Vollman Kathleen M.
Published: May 2018

Evidence indicates that chances for a successful patient mobility program, prevention of pressure injury and falls, and safe patient handling are enhanced when an organization possesses an appropriate culture for safety. Frequently, these improvement initiatives are managed within silos often creating a solution for one and a problem for the others. A model of prevention integrating early patient mobility, preventing pressure injuries and falls while ensuring caregiver safety, is introduced. The journey begins by understanding why early mobility and safe patient handling are critical to improving overall patient outcomes. Measuring current culture and understanding the gaps in practice as well as strategies for overcoming some of the major challenges for success in each of these areas will result in sustainable change.
Incorporating Safe Patient-Handling Techniques to Mobilize Our Most Complex Patients on Extra Corporeal Membrane Oxygenation
Authors: Rickelmann Constance , Knoblauch Diane J.
Published: May 2018

Historically, patients supported on extra corporeal membrane oxygenation were thought to be too unstable to engage in early mobility but are at increased risk for deconditioning from prolonged immobilization due to the nature of illness, numerous cannulas, equipment, and hemodynamic and respiratory instability along with heavy sedation/analgesia or paralysis. This article will discuss the specific considerations that should be employed to keep the patient and the staff safe while providing mobility to patients on extra corporeal membrane oxygenation.
A Multidisciplinary Approach to Equipment Use in Pediatric Patient Mobilization
Authors: Parchem Katie , Peck Amanda , Tales Katherine
Published: May 2018

Research has shown that patients who are mechanically ventilated or immobile for greater than 7 days are at increased risk for deconditioning and muscle atrophy. Immobility impacts length of stay as well as patients' ability to return to their prior level of function. As part of the safe patient-handling initiative created at Michigan Medicine, a special team of nurses and therapists was assembled to adapt an adult mobility framework for the pediatric population. The pediatric mobility model determines each patient's specific mobility “phase” based on detailed criteria. Clinical staff can then implement strategies aimed at preventing deconditioning and hospital-acquired weakness. At C.S. Mott Children's Hospital, a multidisciplinary team is available to support this pediatric mobility model. Specific equipment utilized during the different phases of mobility has been reviewed and discussed in this article.
Multifactorial Strategies for Sustaining Safe Patient Handling and Mobility
Authors: Totzkay Deborah L.
Published: May 2018

Reduction in nursing staff injuries has occurred with the use of an evidence-based approach to safe patient handling and mobility. Parts of the evidence-based practice initiative include having the appropriate equipment, such as mechanical patient-lifting devices, a no-lift policy, and the use of peer coaches. The combination of the implementation of a culture of safety can sustain evidence-based, safe patient-handling practices that reduce patient-handling injuries. Patient-handling programs should include adaptations for an aging nursing workforce. The use of safety checklists in health care can improve communication and compliance with safe patient-handling and mobility policy and program components.
Family Presence During Resuscitation
Authors: Powers Kelly A.
Published: May 2018

Background

Education on family presence during resuscitation (FPDR) has been shown to improve critical care nurses' support for FPDR; however, there have been limited studies in this area. Exploring nurses' perceived needs related to FPDR education is important to design educational interventions to promote FPDR in practice.

Objectives

The aim of this study was to explore the FPDR education needs of critical care nurses to provide recommendations for future educational interventions.

Methods

A cross-sectional survey design was used, and descriptive and qualitative data were collected online in 2016. A convenience sample of 395 critical care nurses was obtained. Participants completed online surveys, and descriptive statistics and thematic analysis were conducted.

Results

One-third of the participants had received FPDR education, and 83% desired to receive education on FPDR. Qualitative data revealed 4 themes: “nurses need education,” “team training is important,” “focus on implementation of FPDR,” and “a variety of preferences.”

Discussion

Critical care nurses' reported needs for FPDR education are currently not being met. It is important for nurse educators and researchers to design and test educational interventions to meet nurses' needs for guidance on implementing FPDR in clinical practice. In particular, online and simulation approaches should be investigated.
Adoption of an Electronic Template to Promote Evidence-Based Practice for Policies, Procedures, Guidelines, and Directives Documents
Authors: Corey Juliann , O'Donoghue Sharon C. , Kelly Veronica , Mackinson Lynn , Williams Donna , O'Reilly Kristin , DeSanto-Madeya Susan
Published: May 2018

Background

Policies, procedures, and guidelines standardize care, meet regulatory requirements, and can promote safety in clinical practice. The existing protocols, policies, guidelines, and directives (PPGDs) at a level 1 trauma academic medical center were underused by the intensive care unit clinicians and did not always clearly represent the supporting evidence.

Aims

The goals of this project were to update the Critical Care Practice Manual (CCPM) and to ensure that clinical practice was aligned with best evidence. The aim was to design a new PPGD template that used technology to enhance the presentation and functionality of these documents.

Methods

Nurse project consultants reviewed every PPGD and solicited feedback from critical care nurses who consistently identified 2 barriers to utilization of CCPM: difficulty finding PPGDs and the cumbersomeness of lengthy policies. This improvement project used the principles of the Plan-Do-Study-Act cycle to test changes in real time. When 95% of the PPGDs were in the new format, a 22-question survey was created to elicit feedback from the direct care nurses who used the PPGD in the new electronic format.

Results

On the basis of the survey results, nurses at the medical center accessed a PPGD at least once a month. The overall results indicated that the respondents agreed or strongly agreed that the PPGDs provided guidance (85%), reflected current practice (76%), were clear and concise (75%), and were evidence based (73%). Only 24% of those surveyed were still having difficulty finding PPGDs.

Discussion/Conclusion

To facilitate timely modification and early adoption of the new PPGD format, the Plan-Do-Study-Act cycle was effectively used. The CCPM adopted a new electronic format that met the aims of the project. When making a commitment to develop evidence-based practice policies and guidelines, it is important to revisit the process, consider ongoing support, and educate frontline staff as applicable. The new template restored and enhanced the standardization of PPGDs. Technology can enhance usability and improve functionality, but it can also prove to be frustrating when implementing changes that use it, especially if users are not comfortable with it.
Performance of Between-study Heterogeneity Measures in the Cochrane Library
Authors: Ma Xiaoyue , Lin Lifeng , Qu Zhiyong , Zhu Motao , Chu Haitao
Published: May 2018

The growth in comparative effectiveness research and evidence-based medicine has increased attention to systematic reviews and meta-analyses. Meta-analysis synthesizes and contrasts evidence from multiple independent studies to improve statistical efficiency and reduce bias. Assessing heterogeneity is critical for performing a meta-analysis and interpreting results. As a widely used heterogeneity measure, the I
2 statistic quantifies the proportion of total variation across studies that is caused by real differences in effect size. The presence of outlying studies can seriously exaggerate the I
2 statistic. Two alternative heterogeneity measures, the

JOURNAL/epide/04.03/00001648-201811000-00010/inline-graphic1/v/2023-09-08T093746Z/r/image-tiff

and

JOURNAL/epide/04.03/00001648-201811000-00010/inline-graphic2/v/2023-09-08T093746Z/r/image-tiff

have been recently proposed to reduce the impact of outlying studies. To evaluate these measures’ performance empirically, we applied them to 20,599 meta-analyses in the Cochrane Library. We found that the

JOURNAL/epide/04.03/00001648-201811000-00010/inline-graphic3/v/2023-09-08T093746Z/r/image-tiff

and

JOURNAL/epide/04.03/00001648-201811000-00010/inline-graphic4/v/2023-09-08T093746Z/r/image-tiff

have strong agreement with the I
2, while they are more robust than the I
2 when outlying studies appear.
Trends in Black and White Opioid Mortality in the United States, 1979–2015
Authors: Alexander Monica J. , Kiang Mathew V. , Barbieri Magali
Published: May 2018

Background:

Recent research on the US opioid epidemic has focused on the white or total population and has largely been limited to data after 1999. However, understanding racial differences in long-term trends by opioid type may contribute to improving interventions.

Methods:

Using multiple cause of death data, we calculated age-standardized opioid mortality rates, by race and opioid type, for the US resident population from 1979 to 2015. We analyzed trends in mortality rates using joinpoint regression.

Results:

From 1979 to 2015, the long-term trends in opioid-related mortality for Earlier data did not include ethnicity so this is incorrect. It is all black and all white residents in the US. blacks and whites went through three successive waves. In the first wave, from 1979 to the mid-1990s, the epidemic affected both populations and was driven by heroin. In the second wave, from the mid-1990s to 2010, the increase in opioid mortality was driven by natural/semi-synthetic opioids (e.g., codeine, morphine, hydrocodone, or oxycodone) among whites, while there was no increase in mortality for blacks. In the current wave, increases in opioid mortality for both populations have been driven by heroin and synthetic opioids (e.g., fentanyl and its analogues). Heroin rates are currently increasing at 31% (95% confidence interval [CI] = 27, 35) per year for whites and 34% (95% CI = 30, 40) for blacks. Concurrently, respective synthetic opioids are increasing at 79% (95% CI = 50, 112) and 107% (95% CI = −15, 404) annually.

Conclusion:

Since 1979, the nature of the opioid epidemic has shifted from heroin to prescription opioids for the white population to increasing of heroin/synthetic deaths for both black and white populations. See video abstract at, http://links.lww.com/EDE/B377.
Multiple mediators approach to study environmental chemicals as determinants of health disparities
Authors: Bellavia Andrea , Zota Ami R. , Valeri Linda , James-Todd Tamarra
Published: May 2018

A major goal of health disparities research is to identify and intervene upon modifiable risk factors that help explain the observed associations between social factors and adverse health outcomes. To this end, statistical methods incorporating mediation analysis have shown promise, as they quantify the contribution of an intermediate variable in an exposure–outcome association. A growing body of literature suggests that environmental chemicals can contribute to health disparities. However, evaluating environmental chemicals as an important component of health disparities introduces methodological complexities that may make standard mediation approaches inadequate. Specific to environmental health is the issue of evaluating both the source and biomarker of the environmental toxicant to calculate the proportion of the disparity that would remain had we intervened on the modifiable factors. Recent methodological developments on multiple mediators can improve efforts to integrate both source and biomarker of exposure into epidemiological studies of health disparities. We illustrate a conceptual framework and present how mediation techniques can be used to address environmental health disparities questions. With this, we provide a methodological tool that has the potential to advance this growing field, while simultaneously informing public health prevention and policy surrounding the impact of environmental factors on health disparities.
Feeding-produced subchronic high plasma levels of uric acid improve behavioral dysfunction in 6-hydroxydopamine-induced mouse model of Parkinson’s disease
Authors: Nakashima Akio , Yamauchi Atsushi , Matsumoto Junichi , Dohgu Shinya , Takata Fuyuko , Koga Mitsuhisa , Fukae Jiro , Tsuboi Yoshio , Kataoka Yasufumi
Published: May 2018

The development of Parkinson’s disease (PD) involves the degeneration of dopaminergic neurons caused by oxidative stress. Accumulating clinical evidence indicates that high blood levels of uric acid (UA), an intrinsic antioxidative substance, are associated with reduced risk of PD. However, this hypothesis has not been confirmed by in-vivo experiments. The present study investigated the effects of UA on behavioral abnormalities in the development of PD. We used unilateral 6-hydroxydopamine-lesioned mice, which were fed on a diet containing 1% UA and 2.5% potassium oxonate (an uricase inhibitor) to induce hyperuricemia. A significant elevation in UA levels was found in groups that were fed a UA diet. The 6-hydroxydopamine-lesioned mice showed impaired rotarod performance and increased apomorphine-induced contralateral rotations. These behavioral abnormalities were significantly reversed by feeding a UA diet for 1 week before and 5 weeks after surgery (subchronic hyperuricemia). These behavioral improvements occurred in parallel with recovery of tyrosine hydroxylase protein levels in the lesioned striatal side. The present study with a dietary hyperuricemia mice model confirms that UA exerts a neuroprotective effect on dopaminergic neuronal loss, improving motor dysfunction and ameliorating PD development.
Endometrioma, fertility, and assisted reproductive treatments: connecting the dots
Authors: Cecchino Gustavo N. , García-Velasco Juan A.
Published: May 2018

Purpose of review

Surgery has traditionally been the primary treatment option for endometriosis-related infertility of any phenotype. However, advances and refinements of assisted reproductive technologies (ART) permit a more conservative approach in many scenarios. This review summarizes the latest findings in the field of reproductive medicine, which have supported a paradigm shift towards more conservative management of ovarian endometrioma.

Recent findings

The presence of ovarian endometrioma per se is likely to impair ovarian reserve and alter ovarian functional anatomy. Conventional laparoscopic surgery is associated with significant risk of additional damage, and less invasive treatment approaches require further evaluation. With regard to infertile women with ovarian endometrioma who are scheduled for ART treatment, current data indicate that prior surgical intervention does not improve ART outcomes, and that controlled ovarian hyperstimulation (COH) does not affect quality of life or pain symptoms.

Reproductive medicine physicians frequently encounter patients with ovarian endometrioma. The current evidence does not support the postponement of infertility treatment in favour of surgery, except in cases with severe symptoms or to improve follicle accessibility. Although these patients may exhibit diminished ovarian response to COH, their endometrial receptivity, aneuploidy rates, and fertility outcomes are similar to healthy controls. Surgery for ovarian endometrioma provides no benefits in ART treatments.
Diagnostic Ability of Corneal Shape and Biomechanical Parameters for Detecting Frank Keratoconus
Authors: Sedaghat Mohammad-Reza , Momeni-Moghaddam Hamed , Ambrósio Renato , Heidari Hamid-Reza , Maddah Nasim , Danesh Zeynab , Sabzi Fatemeh
Published: May 2018

Purpose:

To assess the diagnostic capability of corneal shape and biomechanical parameters for distinguishing normal eyes from frank keratoconus (KCN).

Methods:

This is a retrospective analysis of eyes of 137 control subjects and 145 patients with KCN, with one of their eyes randomly selected as the study eye. Corneal biomechanical parameters were assessed using the Corvis ST (Oculus Optikgeräte GmbH) and Oculus Response Analyzer (Reichert Ophthalmic Instruments). Corneal tomography was performed using the Oculus Pentacam. The clinical diagnosis of KCN was based on slit-lamp findings (eg, Fleischer ring, Vogt striae) and abnormal topographic patterns on the sagittal (axial) front curvature map, disregarding tomographic and biomechanical findings. The discriminative ability for each parameter was tested using the Mann–Whitney U test. The accuracy of each parameter with statistically significant differences was determined using receiver operating characteristic curves, which were compared using the DeLong method.

Results:

Statistically significant differences were observed for all corneal shape and biomechanical parameters tested (P < 0.05) except peak distance at the highest concavity (P = 0.504). The area under the curve (AUC), sensitivity, and specificity for corneal hysteresis (CH) and corneal resistance factor (CRF) were 0.894, 80.7%, and 84.7% and 0.946, 85.5%, and 89.1%, respectively. The dynamic corneal response parameters from the Corvis ST, stiffness parameter at first applanation, integrated radius (IR), and deformation amplitude ratio at 2 mm (DA-2 mm) had AUC, sensitivity, and specificity of 0.965, 86.2%, and 94.9%; 0.961, 87.6%, and 93.4%; and 0.950, 80.7%, and 98.5%. The Corvis biomechanical index had an AUC of 0.998 (95% confidence interval, 0.983–1.000), with 96.6% sensitivity and 99.3% specificity. The Belin–Ambrósio enhanced ectasia deviation index (BAD-Dv3) and the tomographical/biomechanical index (TBI) had an AUC of 1.0 (95% confidence interval, 0.987–1.000), with sensitivity and specificity of 100%. The combined indices, Corvis biomechanical index, BAD-D, and TBI, had a statistically higher AUC than that of all corneal biomechanical parameters (DeLong, P < 0.001).

Conclusions:

The Scheimpflug-derived shape and biomechanical parameters are able to accurately distinguish normal corneas from frank (clinical) keratoconic corneas. However, the combined parameters were more effective. Further studies should test milder ectasia cases.
Bilateral Angle Closure Following the Infusion of a Monoclonal Antibody to Treat Relapsing Multiple Myeloma
Authors: Lee Andrew C. , Greaves Giovanni , Lee Ruby , Zdravkova Maria , Ahmad Samrah , McGovern Kerri , Ghiuzeli Cristina , Hymowitz Maggie
Published: May 2018

Purpose:

We describe a case of bilateral angle closure glaucoma following the infusion of daratumumab, a monoclonal antibody used to treat relapsing multiple myeloma.

Methods:

This is an interventional case report.

Results:

A 59-year-old woman presented with bilateral angle closure glaucoma one day following her first infusion of daratumumab. B-scan echography showed ciliochoroidal effusions in both eyes. Cycloplegia was implemented given the suspicion for drug-induced angle closure, which resulted in prompt deepening of the anterior chambers and normalization of intraocular pressures. The ciliochoroidal effusions resolved 16 days following the cessation of daratumumab.

Conclusions:

Daratumumab may be associated with drug-induced secondary angle closure glaucoma.
Diversity in the American Society of Ophthalmic Plastic and Reconstructive Surgery
Authors: Charlson Emily S. , Tsai Lester , Yonkers Marc A. , Tao Jeremiah P.
Published: May 2018

Purpose:

To assess the epidemiology of women and underrepresented minorities (URMs; Hispanic, African American, and Native American) in the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS).

Methods:

An observational retrospective study of living ASOPRS members was identified through the ASOPRS member directory, search engine-driven informatics, and direct communication. Members were profiled for gender, race, geographic location, and academic rank (or not). The percentage of women and URMs in the society over time was also assessed.

Results:

The authors identified 617 living ASOPRS members as of June 2017. Of these, 109 (17.7%) were female and 58 (9.4%) were URMs. Surgeons completed fellowships from 1961 (male) or 1973 (female) until 2015. Women members significantly increased from 7 (4.9% of the total) before 1986 to 24 (30.4%) between 2011 and 2015 (last 5 years). URMs significantly increased over time, with 0 female and 5 (3.4%) male minorities before 1985 to 5 (6.3%) females and 13 (16.5%) males within the last 5 years (p < 0.05). With only 1 female and 3 male members, African American representation was sparse. ASOPRS members were not found in 5 states and were most represented in California, New York, Florida, and Texas. Among ASOPRS members in full-time academic positions, women tended to have lower rank compared to men; however, after controlling for number of years post-fellowship, this finding was narrowly not statistically significant (p = 0.0624). There were no academic differences with URMs and nonminority groups.

Conclusions:

Women and URMs have increased steadily in ASOPRS, especially in recent years. Similar to the rest of ophthalmology and general medicine, there remain opportunities for ASOPRS to increase diversity.
Greater Proptosis Is Not Associated With Improved Compressive Optic Neuropathy in Thyroid Eye Disease
Authors: Nanda Tavish , Dunbar Kristen E. , Campbell Ashley A. , Bathras Ryan M. , Kazim Michael
Published: May 2018

Purpose:

Despite the paucity of supporting data, it has generally been held that proptosis in thyroid eye disease (TED) may provide relative protection from compressive optic neuropathy (CON) by producing spontaneous decompression. The objective of this study was to investigate this phenomenon in patients with bilateral TED-CON.

Methods:

We retrospectively reviewed the charts of 67 patients (134 orbits) with bilateral TED-CON at Columbia-Presbyterian Medical Center. Significant asymmetric proptosis (Hertel) was defined as ≥ 2 mm.
1
Significant asymmetric CON was defined first, as the presence of an relative afferent pupillary defect. Those without an relative afferent pupillary defect were evaluated according to the TED-CON formula y = -0.69 – 0.31 × (motility) – 0.2 × (mean deviation) – 0.02 × (color vision) as previously established for the diagnosis of TED-CON.
2
A difference in the formula result ≥ 1.0 between eyes was considered significant. Patients were then divided into 4 groups.

Results:

Forty-one of 67 patients demonstrated asymmetric CON (29 by relative afferent pupillary defect, 12 by formula). Twenty-one of 67 patients demonstrated asymmetric proptosis. Only 5 of 12 (41.6%) of the patients who had both asymmetric proptosis and asymmetric CON (group 1) showed greater proptosis in the eye with less CON. Twenty-nine patients (group 2) showed that asymmetric CON occurred despite symmetrical proptosis. Seventeen patients (group 3), showed the inverse, that asymmetric differences in proptosis occurred with symmetrical CON.

Conclusion:

Despite commonly held assumptions, our results suggest that greater proptosis is not associated with improved TED-CON. Combining groups 1 to 3—all of which demonstrated asymmetry of either proptosis, CON, or both—91.4% of patients did not show a relationship between greater proptosis and improved CON.
Establishing and Utilizing Strategic Partnerships for Vaccine-Preventable Diseases
Authors: Adrien Paul , Francois Jeannot , Parke Dana M. , Bebekoski Thomas , Boncy Paul Jacques , Corvil Salomon , Existe Alexandre , Jacques Roody , Joseph Gerard , Kaljee Linda M. , Kilgore Paul E. , Christophe Millien , Queuille Ludovic , Sévère Karine , Ternier Ralph , Zervos Marcus J.
Published: May 2018

On March 10 to 11, 2016, the Ministère de la Santé Publique et de la Population (Ministry of Health of Haiti) and the Global Health Initiative at Henry Ford Health System hosted their Second Annual Scientific Conference entitled, “Best Practices for Establishing and Utilizing Partnerships for Vaccine-Preventable Diseases in Haiti,” at the National Laboratory in Port-au-Prince, Haiti. The conference brought together Ministry of Health officials, researchers, clinicians, academics, public health professionals, and other stakeholders to discuss vaccine programs and policies in Haiti. This forum provides a learning and discussion space to fuel strategies and public health research responding to priority areas identified by the Ministry of Health, and consequently, this forum serves as counsel for the Ministry of Health in its decision making on strategies to prevent and control infectious diseases in Haiti. The following article summarizes the presentations and conclusions of the March 2016 conference and covers a variety of important issues relating to vaccines and vaccine-preventable diseases in Haiti, including Haiti's Expanded Program on Immunization, surveillance, logistical and funding challenges, and community approaches, as well as case studies detailing introduction of the pentavalent, rotavirus, oral cholera, and human papillomavirus vaccines in Haiti. Most importantly, this article highlights a model for effective partnerships for vaccines, a model that can transcend response to specific diseases and apply to all global health partnerships.
Internal Consistency and Factor Structure of the 3M Preschool Routines Functioning Scale
Authors: Morales Murillo Catalina Patricia , McWilliam R. A. , Grau Sevilla María Dolores , García Grau Pau
Published: May 2018

This article presents a pilot study of the 3M Preschool Routines Functioning Scale (3M) with Spanish children. Twenty teachers and 285 children, from 6 early childhood education centers in Valencia, Spain, participated. The teachers completed one 3M scale on each child in their classrooms. We studied the internal consistency of the scores of the scale items, the factor structure, and the sensitivity of the scale to identify differences on children's functioning level in relationship to their age. The 3M produced scores with strong internal consistency and an exploratory factor analysis resulted in 4 factors: Sophisticated Engagement, Personal–Social, Average Engagement, and Independence. The 3M total score had strong internal consistency, and the strong correlations among the factors and with the 3M total score suggested that the scale measured 1 dimension of child functioning, which we identified as participation.
The Outcomes of Professional Development on AAC Use in Preschool Classrooms
Authors: Hanline Mary Frances , Dennis Lindsay R. , Warren Amy W.
Published: May 2018

The purpose of this qualitative study was to describe early childhood special education service providers' perceptions of the use of alternative and augmentative communication (AAC) in their preschool classrooms as a result of participation in MELD (Multimodal Early Language Development) AAC professional development. MELD is a multicounty project that provides professional development to support service providers to meet the needs of preschool children with complex communication needs. Results indicate, in general, that the service providers felt the professional development met their individual needs to be successful in embedding the use of AAC in each of their preschool special education classrooms. The study extends past research about the components needed in effective early childhood professional development that results in teacher implementation of new instructional strategies to include the use of AAC strategies and adds new information about the context that may be needed. That context includes a positive and supportive relationship between coaches and service providers and a recognition of positive changes in the behavior of children by service providers. Implications for providing professional development and for future research are discussed.
Psychophysical and vasomotor evidence for interdependency of TRPA1 and TRPV1-evoked nociceptive responses in human skin: an experimental study
Authors: Nielsen Thomas Arendt , Eriksen Matilde Alida , Gazerani Parisa , Andersen Hjalte Holm
Published: May 2018

The TRPA1 and TRPV1 receptors are important pharmaceutical targets for antipruritic and analgesic therapy. Obtaining further knowledge on their roles and interrelationship in humans is therefore crucial. Preclinical results are contradictory concerning coexpression and functional interdependency of TRPV1 and TRPA1, but no human evidence exists. This human experimental study investigated whether functional responses from the subpopulation of TRPA1+nociceptors could be evoked after defunctionalization of TRPV1+nociceptors by cutaneous application of high-concentration capsaicin. Two quadratic areas on each forearm were randomized to pretreatment with an 8% topical capsaicin patch or vehicle for 24 hours. Subsequently, areas were provoked by transdermal 1% topical capsaicin (TRPV1 agonist) or 10% topical allyl isothiocyanate (“AITC,” a TRPA1 agonist), delivered by 12 mm Finn chambers. Evoked pain intensities were recorded during pretreatments and chemical provocations. Quantitative sensory tests were performed before and after provocations to assess changes of heat pain sensitivity. Imaging of vasomotor responses was used to assess neurogenic inflammation after the chemical provocations. In the capsaicin-pretreated areas, both the subsequent 1% capsaicin- and 10% AITC-provoked pain was inhibited by 92.9 ± 2.5% and 86.9 ± 5.0% (both:P< 0.001), respectively. The capsaicin-ablated skin areas showed significant heat hypoalgesia at baseline (P< 0.001) as well as heat antihyperalgesia, and inhibition of neurogenic inflammation evoked by both 1% capsaicin and 10% AITC provocations (both:P< 0.001). Ablation of cutaneous capsaicin-sensitive afferents caused consistent and equal inhibition of both TRPV1- and TRPA1-provoked responses assessed psychophysically and by imaging of vasomotor responses. This study suggests that TRPA1 nociceptive responses in human skin strongly depend on intact capsaicin-sensitive, TRPV1+fibers.
How Are Patients Accessing Primary Care Within the Patient-Centered Medical Home? Results From the Veterans Health Administration
Authors: Augustine Matthew R. , Nelson Karin M. , Fihn Stephan D. , Wong Edwin S.
Published: May 2018

The patient-centered medical home (PCMH) expands access by providing care same-day, by phone, and after hours; however, little is known about which patients seek these services. We examined the association of patient, clinical, and local economic characteristics with the self-reported use of 5 routine and nonroutine ways to access primary care within the Veterans Health Administration. We identified sets of characteristics, including gender- and age-specific, racial and ethnic, and socioeconomic differences of how veterans report seeking primary care. As the PCMH model develops, it will be important to further understand the differential demand for these services to optimize patient-centered access.
Portable Bladder Ultrasound Reduces Incidence of Urinary Tract Infection and Shortens Hospital Length of Stay in Patients With Acute Ischemic Stroke
Authors: Chen Shu-Chuan , Chen Pei-Ya , Chen Guei-Chiuan , Chuang Su-Yun , Tzeng I-Shiang , Lin Shinn-Kuang
Published: May 2018

Background:

Urinary tract infection (UTI) during acute ischemic stroke is associated with a longer hospital length of stay and unfavorable functional outcomes.

Objective:

We investigated the benefits of portable bladder ultrasound (PBU) scanning during acute ischemic stroke.

Methods:

We retrospectively reviewed patients with acute ischemic stroke from January 2011 to February 2017. Patients were divided into group 1 (PBU not available) and group 2 (PBU available), before or after the split date, April 9, 2014. Portable bladder ultrasound scanning was conducted by nurses to measure postvoid residual urine volume in patients with impaired consciousness and/or dependent ambulation.

Results:

In total, 1928 patients were enrolled, of whom 109 (5.7%) had UTI and 901 (46.7%) experienced unfavorable outcomes (modified Rankin scale score ≥ 3). Multivariate analysis revealed that factors that influenced UTI were age of 75 years or older, female gender, initial total National Institutes of Health Stroke Scale (NIHSS) score of 5 or higher, initial NIHSS conscious score of 1 or higher, initial NIHSS leg score of 2 or higher, and urinary catheterization. Factors influencing unfavorable outcomes were similar to those influencing UTI but further comprised UTI. C-statistic for UTI detection was 0.864 for model fitting, including significant factors in logistic regression. Compared with group 1, group 2 had a higher incidence of urinary catheterization (13.1% vs 8.2%), a lower incidence of UTI (4.0% vs 6.9%), and a shorter length of stay (11.9 vs 13.6 days).

Conclusions:

Portable bladder ultrasound scanning reduced the incidence of UTI and shortened length of stay. We suggest routine PBU procedures for patients with acute ischemic stroke who fulfill the AGN3 criteria for a high risk of UTI.
Benign Paroxysmal Positional Vertigo After Pediatric Sports-Related Concussion
Authors: Reimer Karen , Ellis Vanessa , Cordingley Dean M. , Russell Kelly , Ellis Michael J.
Published: May 2018

Objective:

Report the clinical findings and outcomes among pediatric patients diagnosed with benign paroxysmal positional vertigo (BPPV) after sports-related concussion (SRC).

Design:

Retrospective case series.

Setting:

Multidisciplinary pediatric concussion program.

Patients:

Patients younger than 19 years with a sport or recreation activity–related concussion referred for comprehensive vestibular physiotherapy assessment.

Main outcome measure:

Symptom resolution after targeted particle repositioning (PR).

Results:

During the study period, 115 pediatric SRC patients underwent vestibular physiotherapy assessment including 12 (10.4%) who were diagnosed with BPPV. Unilateral posterior semicircular canal (SCC) BPPV was diagnosed in 8/12 (75%) patients, and unilateral anterior SCC BPPV diagnosed in 4/12 (25%) patients. Benign paroxysmal positional vertigo was successfully treated in all patients with a mean of 1.58 targeted PR maneuvers (range = 1-4).

Conclusions:

Comprehensive management of pediatric SRC requires a multidisciplinary approach to address the heterogeneous pathophysiology of persistent postconcussion symptoms. Pediatric SRC patients with coexisting BPPV should be considered for targeted PR.
Measuring and monitoring lean body mass in critical illness
Authors: Looijaard Wilhelmus G.P.M. , Molinger Jeroen , Weijs Peter J.M.
Published: May 2018

Purpose of review

To help guide metabolic support in critical care, an understanding of patients’ nutritional status and risk is important. Several methods to monitor lean body mass are increasingly used in the ICU and knowledge about their advantages and limitations is essential.

Recent findings

Computed tomography scan analysis, musculoskeletal ultrasound, and bioelectrical impedance analysis are emerging as powerful clinical tools to monitor lean body mass during ICU stay. Accuracy, expertise, ease of use at the bedside, and costs are important factors which play a role in determining which method is most suitable. Exciting new research provides an insight into not only quantitative measurements, but also qualitative measurements of lean body mass, such as infiltration of adipose tissue and intramuscular glycogen storage.

Methods to monitor lean body mass in the ICU are under constant development, improving upon bedside usability and offering new modalities to measure. This provides clinicians with valuable markers with which to identify patients at high nutritional risk and to evaluate metabolic support during critical illness.
Evaluation of Important Analytical Parameters of the Peptest Immunoassay that Limit its Use in Diagnosing Gastroesophageal Reflux Disease
Authors: Dolina Jiří , Konečný Štefan , Ďurč Pavol , Lačná Júlia , Greguš Michal , Foret František , Skřičková Jana , Doubková Martina , Kindlová Dagmar , Pokojová Eva , Kubáň Petr
Published: May 2018

Goal:

To evaluate the analytical parameters of a lateral flow (LF) pepsin immunoassay (Peptest) and assess its suitability in the diagnostics of gastroesophageal reflux disease (GERD).

Background:

Peptest is a noninvasive assay to analyze pepsin in saliva, intended for use in GERD diagnostics. Although commercialized, fundamental studies on its performance are missing. The assay therefore requires basic analytical parameter evaluation to assess its suitability in clinical practice.

Study:

Assay reaction’s time dependence, reader device repeatability, and individual LF devices and longitudinal pepsin concentration reproducibility in individual subjects was evaluated. Salivary pepsin was analyzed in 32 GERD patients with extraesophageal reflux symptoms and 13 healthy individuals.

Results:

The assay’s signal increase is not completed at the recommend readout time and continues to increase for another 25 minutes. The relative standard deviation of measurement was good when using the same LF device, ranging from 2.3% to 12.9%, but the reproducibility of 10 different individual LF devices was poor. The random error when analyzing the same saliva sample on 10 LF devices was as high as 36 ng/mL and this value is thus suggested as the positivity cut-off. Pepsin concentration in individual subjects during a 10-day period varied significantly. The sensitivity of the Peptest was 36.8% in the group with acid reflux and 23.1% in the group with weakly acid reflux. The specificity was 61.5%.

Conclusions:

The Peptest assay’s sensitivity and specificity is low, the results are highly variable and it should not be used as a near-patient diagnostic method in primary care.
Clinical islet transplantation: is the future finally now?
Authors: Pepper Andrew R. , Bruni Antonio , Shapiro A.M. James
Published: May 2018

Purpose of review

Clinical pancreatic islet transplantation has evolved into a routine means to restore glycemic control in patients with type 1 diabetes mellitus (T1DM) suffering from life-threatening hypoglycemia and severe glucose liability. This chapter examines the current progress in islet transplantation while outlining the remaining limitations preventing this life-altering therapy's application to the broader T1DM population.

Recent findings

Islet transplantation has recently been demonstrated to provide superior glycemic control with reduced glucose lability and hypoglycemic events compared with standard insulin therapy. Transplant outcomes have steadily improved, in part, reflective of refinements, including more optimal islet donors and isolations, safer transplant techniques and more effective anti-inflammatory and immunomodulatory intervention. Furthermore, latest insulin independence rates 5-years posttransplant have reached parity with pancreas transplantation. Successful completion of a recent National Institutes of Health-sponsored Phase III multicenter clinical allogeneic islet transplantation trial confirmed the safety and efficacy of this therapeutic modality and will be used in the Biological Licensure Application by the United States Food and Drug Administration.

Implementation of novel immunosuppression, antiinflammatories, first-in-human stem cell and extrahepatic transplant site trials into clinical investigation has positioned β-cell replacement to become the mainstay treatment for all T1DM patients in the near future.
Application of the Eighth Edition of the American Joint Committee on Cancer Staging for Pancreatic Adenocarcinoma
Authors: Liu Chen , Cheng He , Jin Kaizhou , Guo Meng , Lu Yu , Wang Zhengshi , Yang Chao , Long Jiang , Ni Quanxing , Yu Xianjun , Luo Guopei
Published: May 2018

Objectives

Notable modifications have been made in the American Joint Committee on Cancer (AJCC) Staging eighth edition staging for pancreatic cancer for the consideration of the irreproducible and inapplicable of the AJCC seventh edition staging. However, the new staging classification has not been systemically verified.

Methods

A comparison was performed to evaluate the application of the AJCC seventh and eighth staging classifications using the Surveillance, Epidemiology, and End Results registry (18,450 patients) and an institutional series (2040 patients).

Results

For the eighth staging classification, patients with tumor diameter of greater than 4 cm (T3N0M0, IIA) had similar prognosis to patients with 1 to 3 positive nodes (T1–3N1M0, IIB). For patients who underwent tumor resection and without lymph node involvement, survival curves of T1 (≤2 cm), T2 (2–4 cm), and T3 (>4 cm) were well separated. Statistical difference in survival analyses was demonstrated in N0 (0 positive node), N1 (1–3 positive nodes), and N2 (≥4 positive nodes) patients underwent tumor resection. The AJCC eighth edition had better stage distribution than the AJCC seventh edition for pancreatic cancer.

Conclusions

The eighth edition of AJCC staging is more applicable and accurate than the seventh edition for pancreatic adenocarcinoma.