bluuebunny/crossref_metadata_2025 huggingface dataset:
Associations Between Physician Continuous Professional Development and Referral Patterns: A Systematic Review and Meta-Analysis
Authors: Cook David A. , Stephenson Christopher R. , Pankratz V. Shane , Wilkinson John M. , Maloney Stephen , Prokop Larry J. , Foo Jonathan
Published: January 2022

Purpose

Both overuse and underuse of clinician referrals can compromise high-value health care. The authors sought to systematically identify and synthesize published research examining associations between physician continuous professional development (CPD) and referral patterns.

Method

The authors searched MEDLINE, Embase, PsycInfo, and the Cochrane Database on April 23, 2020, for comparative studies evaluating CPD for practicing physicians and reporting physician referral outcomes. Two reviewers, working independently, screened all articles for inclusion. Two reviewers reviewed all included articles to extract information, including data on participants, educational interventions, study design, and outcomes (referral rate, intended direction of change, appropriateness of referral). Quantitative results were pooled using meta-analysis.

Results

Of 3,338 articles screened, 31 were included. These studies enrolled at least 14,458 physicians and reported 381,165 referral events. Among studies comparing CPD with no intervention, 17 studies with intent to increase referrals had a pooled risk ratio of 1.91 (95% confidence interval: 1.50, 2.44; P < .001), and 7 studies with intent to decrease referrals had a pooled risk ratio of 0.68 (95% confidence interval: 0.55, 0.83; P < .001). Five studies did not indicate the intended direction of change. Subgroup analyses revealed similarly favorable effects for specific instructional approaches (including lectures, small groups, Internet-based instruction, and audit/feedback) and for activities of varying duration. Four studies reported head-to-head comparisons of alternate CPD approaches, revealing no clear superiority for any approach. Seven studies adjudicated the appropriateness of referral, and 9 studies counted referrals that were actually completed (versus merely requested).

Conclusions

Although between-study differences are large, CPD is associated with statistically significant changes in patient referral rates in the intended direction of impact. There are few head-to-head comparisons of alternate CPD interventions using referrals as outcomes.
Validation of the height–width measurement in Perthes disease among interpreters of different experience levels
Authors: Sanitsakul Hafizz , Woratanarat Patarawan , Jaovisidha Suphaneewan , Woratanarat Thira
Published: January 2022

The epiphyseal height and metaphyseal width ratio estimated lateral pillar involvement with limited generalizability among various interpreters. The aim of the study was to evaluate the reliability and the validity of height–width ratio measurement in Perthes disease among interpreters of different experience levels. A cross-sectional study was conducted between 2019 and 2020. We included four groups of interpreters: orthopaedic residents, orthopaedic fellows, radiology residents and radiology fellows who were unaware of radiographic study materials. Each interpreter blindedly evaluated Perthes hip radiographs twice at 1-month intervals using the height–width ratio method. Patients’ and interpreters’ characteristics, height–width ratio and height–width ratio converted to lateral pillar classification (A, B and C) were collected. Intra- and interobserver reliability validated with the paediatric orthopaedist were estimated. Twenty-four interpreters assessed 18 Perthes radiographs. Intraobserver level of agreement (95% confidence interval) for height–width ratio was 0.022 (−0.017 to 0.062), −0.027 (−0.074 to 0.019), −0.010 (−0.095 to 0.074) and 0.019 (−0.109 to 0.146); and interobserver reliability compared with the paediatric orthopaedist was −0.007 (−0.091 to 0.077), 0.003 (−0.056 to 0.061), −0.021 (−0.077 to 0.035) and −0.002 (−0.090 to 0.086) for orthopaedic residents and fellows, radiology residents and fellows, respectively. Kappa statistics of height–width ratio converting to lateral pillar classification indicated intraobserver agreement of orthopaedic residents and fellows, radiology residents and fellows was 0.83, 0.75, 0.54 and 0.91; and interobserver agreement compared with the paediatric orthopaedist was 0.92, 0.83, 0.42 and 0.83, orderly. Height-width ratio and lateral pillar estimation by orthopaedic and radiology trainees have moderate to excellent reliability. Level of evidence: Level II – diagnostic study.
10-year prevalence of diagnostic and screening colonoscopy use in Germany: a claims data analysis
Authors: Hornschuch Michel , Schwarz Sarina , Haug Ulrike
Published: January 2022

Introduction

Studies providing detailed information on colonoscopy use are important for the interpretation of patterns and trends in colorectal cancer incidence and mortality, but there is a lack of such studies from Germany. To fill this gap, we aimed to describe the 10-year prevalence of colonoscopy use based on German health claims data.

Methods

Using the German Pharmacoepidemiological Research Database (short GePaRD; claims data from ~20% of the German population), we determined the 10-year prevalence of colonoscopy use for the year 2017. We determined this prevalence for any colonoscopy, screening (reimbursable from age 55) and diagnostic colonoscopy, stratified by sex, age, educational level and regional factors (e.g. federal state, physicians density in the district of residence).

Results

In men, the 10-year prevalence of colonoscopy use was as follows (not all age groups reported): 30–34 years: 8%, 40–44 years: 12%, 50–54 years: 21%, 55–59 years: 33% (screening: 10%), 60–64 years: 44% (screening: 23%), 70–74 years: 53% (screening: 23%), 80–84 years: 52% (screening: 15%). In women, the prevalences were similar, with differences mostly less than or equal to 3 percentage points. Also, in analyses stratified by educational level or regional factors, prevalences were mostly similar or varied by less than or equal to 4 percentage points.

Conclusion

In 2017, about 45–50% of men and women in Germany aged 60–84 years had any colonoscopy in the previous 10 years, and about 11–26% had a screening colonoscopy. Our findings suggest no relevant social or regional disparities in the utilization of colonoscopy in Germany.
Chronic fine particulate matter exposure, habitual exercise, and dyslipidemia: A longitudinal cohort study
Authors: Zeng Yi Qian , Chang Ly-yun , Guo Cui , Lin Changqing , Bo Yacong , Wong Martin C. S. , Tam Tony , Lau Alexis K. H. , Lao Xiang Qian
Published: January 2022

Background:

Physical activity may increase the intake of air pollutants due to a higher ventilation rate, which may exacerbate the adverse health effects. This study investigated the combined effects of habitual exercise and long-term exposure to fine particulate matter (PM2.5) on the incidence of dyslipidemia in a large longitudinal cohort in Taiwan.

Methods:

A total of 121,948 adults (≥18 years) who received at least two medical examinations from 2001 to 2016 were recruited, yielding 407,821 medical examination records. A satellite-based spatiotemporal model was used to estimate the 2-year average PM2.5 concentration (i.e., the year of and the year before the medical examination) at each participant’s address. Information on habitual exercise within 1 month before the medical examination was collected using a standard self-administered questionnaire. A Cox regression model with time-dependent covariates was used to investigate the combined effects.

Results:

Compared with inactivity, moderate and high levels of exercise were associated with a lower incidence of dyslipidemia, with hazard ratios (HRs) (95% confidence intervals [CIs]) of 0.91 (0.88, 0.94) and 0.73 (0.71, 0.75), respectively. Participants with a moderate (22.37–25.96 μg/m3) or high (>25.96 μg/m3) level of PM2.5 exposure had a higher incidence of dyslipidemia than those with a low level of PM2.5 exposure (≤22.37 μg/m3), with HRs (95% CIs) of 1.36 (1.32, 1.40), and 1.90 (1.81, 1.99), respectively. We observed a statistically significant, but minor, interaction effect of PM2.5 exposure and exercise on the development of dyslipidemia, with an overall hazard ratios (95% CI) of 1.08 (1.05, 1.10), indicating that an incremental increase in the level of exercise was associated with an 8% increase in the risk of dyslipidemia associated with every 10 μg/m3 increase in PM2.5 exposure. However, the negative association between habitual exercise and dyslipidemia remained, regardless of the level of PM2.5 exposure, suggesting that the benefits of increased habitual exercise outweighed the adverse effects of the increase in PM2.5 intake during exercise.

Conclusions:

Increased levels of exercise and reduced levels of PM2.5 exposures were associated with a lower incidence of dyslipidemia. Although an increase in habitual exercise slightly increased the risk of dyslipidemia associated with PM2.5 exposure, the benefits of the increased habitual exercise outweighed the risks. Our findings suggest that habitual exercise is an effective approach for dyslipidemia prevention, even for people residing in relatively polluted areas.
TRPA1 Channel Activation With Cinnamaldehyde Induces Cutaneous Vasodilation Through NOS, but Not COX and KCa Channel, Mechanisms in Humans
Authors: Kataoka Yufuko , Kenny Glen P. , Nishiyasu Takeshi , Amano Tatsuro , Mündel Toby , Zheng Huixin , Lei Tze-Huan , Watanabe Koichi , Fujii Naoto
Published: January 2022

Transient receptor potential ankyrin 1 (TRPA1) channel activation induces cutaneous vasodilation in humans in vivo. However, the mechanisms underlying this response remains equivocal. We hypothesized that nitric oxide synthase (NOS) and Ca2+ activated K+ (KCa) channels contribute to the TRPA1 channel–induced cutaneous vasodilation with no involvement of cyclooxygenase (COX). Cutaneous vascular conductance (CVC) in 9 healthy young adults was assessed at 4 dorsal forearm skin sites treated by intradermal microdialysis with (1) 1.985% dimethyl sulfoxide + 0.015% lactated Ringer solution with propylene glycol (vehicle control), (2) 10 mM l-NAME, a nonselective NOS inhibitor, (3) 10 mM ketorolac, a nonselective COX inhibitor, or (4) 50 mM tetraethylammonium, a nonselective KCa channel blocker. Cinnamaldehyde, a TRPA1 channel activator, was administered to each skin site in a dose-dependent manner (2.9%, 8.8%, 26%, and 80%, each lasting ≥30 minutes). Administration of ≥8.8% cinnamaldehyde increased CVC from baseline at the vehicle control site by as much as 27.4% (95% confidence interval of 5.3; P < 0.001). NOS inhibitor attenuated the cinnamaldehyde-induced increases in CVC at the 8.8%, 26%, and 80% concentrations relative to the vehicle control site (all P ≤ 0.05). In contrast, both the COX inhibitor and KCa channel blockers did not attenuate the cinnamaldehyde induced-increases in CVC relative to the vehicle control site for all concentrations (all P ≥ 0.130). We conclude that in human skin in vivo, NOS plays a role in modulating the regulation of cutaneous vasodilation in response to TRPA1 channel activation with no detectable contributions of COX and KCa channels.
Sex Differences in Low-Density Lipoprotein Cholesterol Reduction With PCSK9 Inhibitors in Real-world Patients: The LIPID-REAL Registry
Authors: Cordero Alberto , Fernández del Olmo M. Rosa , Cortez Quiroga Gustavo A. , Romero-Menor Cesar , Fácila Lorenzo , Seijas-Amigo José , Fornovi Aisa , Murillo Juan R. , Rodríguez-Mañero Moisés , Bello Mora María C. , Valle Alfonso , Miriam Sandin , Pamias Roman F. , Bañeras Jordi , García Pedro B. , Clemente Lorenzo Maria M. , Sánchez-Alvarez Sergio , López-Rodríguez Luis , González-Juanatey José R.
Published: January 2022

Background:

Previous evidence supports that monoclonal antibodies that inhibit the proprotein convertase subtilisin/kexin type 9 (PCSK9) reduce low-density lipoprotein cholesterol (LDLc) by 50%–65%, regardless of baseline treatments. We tested possible sex differences in a multicentre registry of real-world patients treated with PCSK9 inhibitors.

Methods:

This is a multicentre and retrospective study of 652 patients initiating treatment with any PCSK9 inhibitor in 18 different hospitals. Before-treatment and on-treatment LDLc and medical treatments, clinical indication, and clinical features were recorded.

Results:

Women represented 24.69% of the cohort. The use of statins was similar in both sexes, but women were receiving most frequently ezetimibe. Before-treatment median LDLc was 135 (interquartile range 115–166) mg, and it was higher in women. The median on-treatment LDLc was 57 (interquartile range 38–84) mg/dL, which represented a mean 54.5% reduction. On-treatment LDLc was higher in women, and the mean LDLc reduction was lower in women (47.4% vs. 56.9%; P = 0.0002) receiving evolocumab or alirocumab. The percentage of patients who achieved ≥50% LDLc reduction was higher in men (71.36% vs. 57.62%; P = 0.002). According to LDLc before-treatment quartiles, LDLc reduction was statistically lower in women in the 2 highest and a significant interaction of women and baseline LDLc >135 mg/dL was observed. Women were negatively associated with lower rates of LDLc treatment target achievement (odds ratio: 0.31). Differences were also observed in women with body mas index >25 kg/m2. Only 14 patients (2.14%) presented side effects.

Conclusions:

This multicentre and retrospective registry of real-world patients treated with PCSK9 inhibitors highlights significant gender differences in LDLc reduction.
Adrenal G Protein-Coupled Receptors and the Failing Heart: A Long-distance, Yet Intimate Affair
Authors: Borges Jordana I. , Ferraino Krysten E. , Cora Natalie , Nagliya Deepika , Suster Malka S. , Carbone Alexandra M. , Lymperopoulos Anastasios
Published: January 2022

Systolic heart failure (HF) is a chronic clinical syndrome characterized by the reduction in cardiac function and still remains the disease with the highest mortality worldwide. Despite considerable advances in pharmacological treatment, HF represents a severe clinical and social burden. Chronic human HF is characterized by several important neurohormonal perturbations, emanating from both the autonomic nervous system and the adrenal glands. Circulating catecholamines (norepinephrine and epinephrine) and aldosterone elevations are among the salient alterations that confer significant hormonal burden on the already compromised function of the failing heart. This is why sympatholytic treatments (such as β-blockers) and renin-angiotensin system inhibitors or mineralocorticoid receptor antagonists, which block the effects of angiotensin II (AngII) and aldosterone on the failing heart, are part of the mainstay HF pharmacotherapy presently. The adrenal gland plays an important role in the modulation of cardiac neurohormonal stress because it is the source of almost all aldosterone, of all epinephrine, and of a significant amount of norepinephrine reaching the failing myocardium from the blood circulation. Synthesis and release of these hormones in the adrenals is tightly regulated by adrenal G protein-coupled receptors (GPCRs), such as adrenergic receptors and AngII receptors. In this review, we discuss important aspects of adrenal GPCR signaling and regulation, as they pertain to modulation of cardiac function in the context of chronic HF, by focusing on the 2 best studied adrenal GPCR types in that context, adrenergic receptors and AngII receptors (AT1Rs). Particular emphasis is given to findings from the past decade and a half that highlight the emerging roles of the GPCR-kinases and the β-arrestins in the adrenals, 2 protein families that regulate the signaling and functioning of GPCRs in all tissues, including the myocardium and the adrenal gland.
Development and Evaluation of a Remote Patient Monitoring System in Autologous Breast Reconstruction
Authors: Hummelink Stefan L.M. , Paulus Vera A.A. , Wentink Eva C. , Ulrich Dietmar J.O.
Published: January 2022

Background:

Flap monitoring after a deep inferior epigastric perforator flap breast reconstruction is crucial to detect complications in time. A novel and innovative wireless device has been developed and tested in a feasibility study. This study describes our experience with remote patient monitoring via this device in postoperative monitoring of deep inferior epigastric perforator flaps.

Methods:

Following a deep inferior epigastric perforator breast reconstruction, the “Free Flap Patch” was adhered to the flap, continuously measuring temperature and tissue saturation. Data were stored locally on the patch and analyzed in a retrospective manner. Raw analog-digital-conversion values from the red- and infrared sensors, delta muscle saturation (dSmO2), and estimated tissue oxygenation (StO2) were assessed and compared with clinical records.

Results:

No adverse events related to the device were recorded. One patient suffered flap loss; a decrease in estimated tissue oxygenation was measured with the device in situ. No deviations in clinical variables were recorded in the uncompromised flaps.

Conclusions:

A wearable patient monitoring device was successfully utilized in clinical practice. In one patient, a flap failure was recorded where the PPG-derived StO2 parameter was indicatory for this event. The Free Flap Patch has the potential of automatically predicting blood supply issues in an early stage. More data are needed for clinical validation.
Epidemiology and 6- and 12-Month Outcomes of Intimate Partner Violence and Other Violence-Related Traumatic Brain Injury in Major Trauma: A Population-Based Trauma Registry Study
Authors: Gabbe Belinda J. , Braaf Sandra , Cameron Peter A. , Berecki-Gisolf Janneke
Published: January 2022

Objective:

To compare the epidemiology, in-hospital outcomes, and 6-month and 12-month patient-reported, outcomes of major trauma patients with intimate partner violence (IPV)–related traumatic brain injury (TBI) with other interpersonal violence (OV)–related TBI.

Setting:

Victoria, Australia.

Participants:

Adult (≥18 years) major trauma cases with TBI (concussion, skull fracture, or intracranial injury), injured through IPV or OV, between July 2010 and June 2020, and included on the population-based Victorian State Trauma Registry. There were 133 adult major trauma cases due to IPV and 1796 due to OV. The prevalence of TBI was 39% (n = 52) in the IPV group and 56% (n = 1010) in the OV group.

Design:

Registry-based cohort study.

Main Measures:

Trauma care indicators and 6- and 12-month patient-reported outcomes (self-reported disability, Glasgow Outcome Scale–Extended, EQ-5D-3L, and return to work).

Results:

The annual incidence (95% CI) of major trauma involving TBI was 0.11 (0.08-0.14) per 100 000 population for IPV and 2.11 (1.98-2.24) per 100 000 for OV. A higher proportion of IPV-related cases were women (73% vs 5%), had sustained a severe TBI (Glasgow Coma Scale score 3-8; 27% vs 15%), were admitted to intensive care (56% vs 37%), and died in hospital (14% vs 5%). The median (interquartile range) time to definitive care (4.7 hours vs 3.3 hours) and head computed tomographic scan (5.0 hours vs 3.1 hours) was longer in the IPV group. Follow-up rates at 6 and 12 months were 71% and 69%, respectively. The 6- and 12-month outcomes were generally poorer in the IPV-related group.

Conclusion:

The incidence of IPV-related major trauma with TBI was low. However, the prevalence of severe TBI, the time to key aspects of clinical care, in-hospital mortality, and longer-term work-related disability were higher. However, power to detect differences was low due to the small number of IPV-related cases compared with the OV group.
Longitudinal Analysis of Persistent Postconcussion Symptoms, Probable TBI, and Intimate Partner Violence Perpetration Among Veterans
Authors: Portnoy Galina A. , Relyea Mark R. , Presseau Candice , Orazietti Skye , Martino Steve , Brandt Cynthia A. , Haskell Sally G.
Published: January 2022

Objective:

To determine veterans' intimate partner violence (IPV) perpetration following report of traumatic brain injury (TBI) and persistent postconcussion symptoms (PPCSs).

Setting:

Five Department of Veterans Affairs (VA) medical centers.

Participants:

Veterans with nonmissing data on main measures, resulting in N = 1150 at baseline and N = 827 at follow-up.

Design:

Prospective cohort study with secondary data analysis of self-reported TBI, PPCSs, and IPV perpetration, controlling for common predictors of IPV, including binge drinking, marijuana use, pain intensity, and probable posttraumatic stress disorder.

Main Measures:

VA TBI Screening Tool to assess for probable TBI and PPCSs; Conflict Tactics Scale-Revised (CTS-2S) to assess for IPV perpetration.

Results:

Almost half (48%) of participants reported IPV perpetration at follow-up. Both probable TBI and higher PPCSs at baseline were associated with overall IPV perpetration and more frequent IPV perpetration at follow-up. Only PPCSs significantly predicted IPV perpetration after controlling for common predictors of IPV perpetration. Neither probably TBI nor PPCSs predicted frequency of IPV perpetration.

Conclusion:

When considered alongside common risk factors for IPV perpetration, PPCS was uniquely associated with the likelihood of IPV perpetration in this veteran sample. Given post-9/11 veterans' elevated risk for head injury, findings emphasize the distinctive value of PPCSs in understanding risk for IPV perpetration. We recommend increased assessment for PPCSs in clinical practice among veterans enrolled in VA care and highlight several important areas for future research and intervention development.
Cutaneous Myiasis in a Neglected Case of Pemphigus Vulgaris: A Case Report
Authors: Mohta Alpana
Published: January 2022

Introduction:

Myiasis is an infestation of the tissues and organs of living vertebrates and humans by fly larvae, usually those belonging to the Calliphoridae family. The larvae feed on the host’s necrotic or living tissue.

Here, we report a 58-year-old woman with a 1-year history of biopsy-proven pemphigus vulgaris presented with an acute flare-up.

Case presentation:

On mucocutaneous examination, the patient had multiple sinus tracts covered with purulent necrotic slough, and cylindrical maggots were crawling out of and around the areas of slough. The patient was diagnosed with wound myiasis caused by Cochliomyia hominivorax. Turpentine oil flushes and oral ivermectin were prescribed.

Discussion:

Cutaneous myiasis can be papular, pustular, furuncular, and nodular. It is more common in people who have poor hygiene and intimate contact with domestic animals, such as people living in rural areas and tropical/ subtropical countries. The chief aim of management is to remove the maggots as soon as possible, kill them to prevent maturation, promote wound healing, and prevent development of secondary complications.

Conclusion:

In the current case, the patient’s poor nursing and personal care and low socioeconomic condition predisposed her to secondary wound infection and maggot infestation. Such cases require prompt care to prevent secondary infection and septicemia.
Clinical Manifestations, Proposed Mechanisms, and Updated Management of Severe Atopic Dermatitis and Associated Pruritus
Authors: Kirchner Allison , Lake Eden
Published: January 2022

Atopic dermatitis (AD) is defined as a chronic inflammatory skin disease characterized by pruritus and xerosis. AD is the most common inflammatory skin disease, affecting about 200 million people worldwide. Although AD is diagnosed in all ages and races, there are distinct findings associated with the different age groups that can help guide the diagnosis. Recent, robust studies have identified hereditary and genetic risk factors, which have guided the treatment options for AD. This includes various topical agents, a new generation of systemic biologics (dupilumab, tralokinumab, and lebrikizumab), and Janus kinase inhibitors (abrocitinib and baricitinib). Here, we describe some of the common clinical manifestations, hypothesized mechanisms, and current therapeutic treatment options for patients with moderate-to-severe AD.
Pediatric Atopic Dermatitis
Authors: Johnson Jamie K. , Duncan Brandi , Ly Melinda , Buys Katie
Published: January 2022

Background

Atopic dermatitis is the most common pediatric skin disorder in the United States. Literature consensus designates patient education as crucial in atopic dermatitis management.

Local problem

Representing Alabama's only pediatric dermatology clinic, the clinic at Children's of Alabama receives a disproportionate number of referrals. The volume impedes on the clinician's ability to provide comprehensive patient education for new referrals.

Methods

All new atopic dermatitis referrals, newborn to 5 years old, are scheduled between August 2, 2019, and October 25, 2019, for the pediatric dermatology nurse practitioner's weekly clinic. To complete the visit, the nurse practitioner customizes an eczema action plan to be individually reviewed by the dermatology nurse with the patient.

Interventions

Before the visit, caregivers complete the Patient-Oriented Eczema Measure questionnaire to quantify eczema symptoms. They repeat this by phone 4–6 weeks later along with another Likert questionnaire measuring caregiver treatment confidence.

Results

Using SPSS Statistics 25 to analyze descriptive statistics, there was a statistically significant change in scores. Caregiver treatment confidence was uniformly high.

Conclusion

Improved atopic dermatitis symptoms and increased caregiver treatment confidence were observed after implementing nurse-led education with customized eczema action plans in new visits.
Effects of an Emotional Education Program on Prisoners: An Experimental Study
Authors: Martín-Cocinas Fernández Ma. Carmen , Gómez-Díaz Magdalena , Gómez-Sánchez Rosario , Conesa-Fuentes Ma. Carmen , Díaz-Agea José Luis , Leal-Costa César
Published: January 2022

Background

Emotional education has beneficial effects on physical and/or emotional health, resulting in a better quality of life. Thus, it is beneficial to provide prisoners with emotional education, because of the difficulties they often have, to attain these benefits.

Purpose

The aim of the study was to analyze the effects of a nursing intervention program in emotional education for incarcerated persons.

Methods

Experimental study with pretest–posttest repeated measures with a control group was conducted at a penitentiary center in the southeast of Spain. Forty-eight prisoners participated in the emotional education intervention program, and another 48 were part of the control group. The emotional intelligence questionnaire 24-item Trait Meta-Mood Scale, the resilience scale Connor–Davidson Resilience Scale, the Rosenberg Self-Esteem Scale, the Rathus Assertiveness Questionnaire, and the 36-item Short Form Health Survey were utilized.

Findings

The intragroup, preintervention and postintervention comparisons in the study group showed improvements in self-esteem (p = 0.00, r = 0.51), resilience (p = 0.00, r = 0.42), assertiveness (p = 0.00, r = 0.46), and emotional intelligence in its dimensions of repair (p = 0.00, r = 0.32) and clarity (p = 0.02, r = 0.22) as well as in most of the quality of life dimensions. Significant intergroup differences were also found in all of these variables, except for attention and emotional clarity dimensions.

Conclusion

The intervention improved the socioemotional health and quality of life of the prisoners, highlighting the importance of these interventions to be performed by the nursing personnel on a regular basis as a programmed activity within prisons.
Development of the Duquesne University School of Nursing Sexual Assault Nurse Examiner Training Model
Authors: Sekula L. Kathleen , Colbert Alison M. , Currie Meghan
Published: January 2022

Introduction

Lack of preceptors and hands-on training opportunities has long been an impediment to nurses pursuing sexual assault nurse examiner (SANE) practice and certification after completing a SANE didactic course. In addition, nurses in rural and underserved areas often lack the professional support and mentoring needed. To address this gap and increase the number of certified practicing SANEs, the Duquesne University School of Nursing (DUSON) received funding from the Department of Health Resources and Services Administration for a program designed to provide advanced nursing education to increase the number of nurses who are trained and certified as nurse examiners.

Approach

The DUSON developed a hands-on clinical preceptor course and other support programming to supplement the existing SANE didactic course training. The goal was to create a comprehensive model that took students from initial SANE training through to certification.

Lessons Learned

In the first two- and three-quarter years of the program, 36 nurses achieved certification, and another 116 completed a didactic course and initial hands-on skills training and are preparing for certification. Approximately 41.5% of participants are from rural and/or underserved areas. Challenges included the adaptations required by the COVID-19 pandemic and engagement of nurses once they returned to their home institution to complete additional hours.

Conclusions

The DUSON comprehensive model provides a solid pathway for nurses who want to become SANEs, and the structure of the program seems especially conducive for training nurses in rural and underserved areas.
Increasing Access to Forensic Nursing Services in Rural and Underserved Areas of Texas
Authors: Mitchell Stacey A. , Charles Laurie A. , Downing Nancy
Published: January 2022

Sexual assault is prevalent in the Unites States. Many areas of the country lack access to sexual assault nurse examiners (SANEs), especially in rural areas. The U.S. Health Resources and Services Administration Advanced Nursing Education-Sexual Assault Nurse Examiner educational grant provided an opportunity to improve equity and reduce disparity in rural and underserved communities by offering education and simulation experiences in the care of sexual assault patients. Through the Texas A&M Health Center of Excellence in Forensic Nursing, Texas A&M University College of Nursing developed an innovative program using simulated medical forensic examinations and mock testimony education. Rapid cycle quality improvement was utilized to adapt quickly to feedback and meet overarching goals. This article describes development and adaptation of the program using rapid cycle quality improvement processes and progress in recruitment, retention, and certification of nurses to provide sexual assault care in rural and underserved areas of Texas.
Combination polyene-anidulafungin therapy for isolated cerebral Rhizopus mucormycosis
Authors: LeWitt Tessa , Joshi Seema , Herc Erica
Published: January 2022

Rationale:

Mucormycosis is a rare fungal infection most commonly seen in immunocompromised patients or those with poorly controlled diabetes mellitus. Mucormycosis is exceedingly rare in immunocompetent hosts.

Patient concerns:

We present an unusual case of isolated cerebral mucormycosis in a young injection drug user.

Diagnosis:

The diagnosis of cerebral mucormycosis was made using stereotactic brain biopsy and tissue culture.

Interventions:

The patient was treated with a combination of amphotericin B and anidulafungin.

Outcomes:

Although the patient experienced residual neurologic deficits, she was able to resume many independent activities.

Lessons:

Although isolated cerebral mucormycosis is rare, it has an extremely poor prognosis. The most significant risk factor for isolated cerebral infection is injection drug use, which is likely secondary to the injection of drugs contaminated with Rhizopus spores. These patients typically present with brain abscesses in the basal ganglia. In critically ill patients and in those who fail polyene monotherapy, a combination of amphotericin B-anidulafungin therapy may provide survival benefits. Further study of synergy and combination therapy for isolated cerebral mucormycosis must be conducted before clinical conclusions can be drawn.
Pharmacological Management of Atrial Fibrillation: A Century of Expert Opinions in Cecil Textbook of Medicine
Authors: Manu Peter , Rogozea Liliana M. , Dan Gheorghe-Andrei
Published: January 2022

Background:

Advances in drug therapy for atrial fibrillation (AF) have had a significant impact on the quality of life of a substantial majority of affected persons, which has contributed to a remarkable decrease in the frequency and severity of thromboembolic complications, hospitalizations, and mortality.

Study Question:

What are the milestones of the changes in the expert approach to the pharmacological management of AF in the past century?

Study Design:

To determine the changes in the experts' approach to the management of AF, as presented in a widely used textbook in the United States.

Data Sources:

The chapters presenting the management of AF in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020.

Results:

AF was consistently described in Cecil Textbook of Medicine as the most common sustained arrhythmia in adults. The authors emphasized its thromboembolic complications and potential for hemodynamic deterioration. Rate control with digitalis and rhythm control with quinidine were the standard in 1927. The pharmacological advances have focused on atrioventricular nodal blocking for rate control, conversion to and maintenance of sinus rhythm, and preventive anticoagulation. The first new class of drugs for rate control was beta-adrenergic receptor blockers, starting with propranolol which was introduced in 1979, followed by the calcium channel blocker verapamil in 1988. Rhythm control with amiodarone, a potassium channel blocker, has been recommended since 2004, and the sodium channel blockers propafenone and flecainide became part of standard therapy in 2008. Anticoagulation with warfarin was recommended starting in 2000, followed by the introduction of direct thrombin inhibitor in 2012 and factor Xa inhibitors in 2016.

Conclusions:

The pharmacological management of AF was unchanged for more than 50 years (1927–1979), a period during which the devastating effects of thromboembolic complications were not addressed. The major therapeutic advance is represented by preventive anticoagulation with the newer, safer, and more user-friendly direct thrombin and factor Xa inhibitors.
Diagnosis and Follow‐up of Incidental Liver Lesions in Children
Authors: Karmazyn Boaz , Rao Girish S. , Johnstone Lindsey S. , Severance Tyler S. , Ferguson Michael J. , Marshalleck Francis E. , Molleston Jean P.
Published: January 2022

Incidental liver lesions are identified in children without underlying liver disease or increased risk of hepatic malignancy in childhood. Clinical and imaging evaluation of incidental liver lesions can be complex and may require a multidisciplinary approach. This review aims to summarize the diagnostic process and follow‐up of incidental liver lesions based on review of the literature, use of state‐of‐the‐art imaging, and our institutional experience. Age at presentation, gender, alpha fetoprotein levels, tumor size, and imaging characteristics should all be taken into consideration to optimize diagnosis process. Some lesions, such as simple liver cyst, infantile hemangioma, focal nodular hyperplasia (FNH), and focal fatty lesions, have specific imaging characteristics. Recently, contrast‐enhanced ultrasound (CEUS) was Food and Drug Administration (FDA)‐approved for the evaluation of pediatric liver lesions. CEUS is most specific in lesions smaller than 3 cm and is most useful in the diagnosis of infantile hemangioma, FNH, and focal fatty lesions. The use of hepatobiliary contrast in MRI increases specificity in the diagnosis of FNH. Recently, lesion characteristics in MRI were found to correlate with subtypes of hepatocellular adenomas and associated risk for hemorrhage and malignant transformation. Biopsy should be considered when there are no specific imaging characteristics of a benign lesion. Surveillance with imaging and alpha fetoprotein (AFP) should be performed to confirm the stability of lesions when the diagnosis cannot be determined, and whenever biopsy is not feasible.
Real‐life Performance of Multiplex Celiac Antibody Test in the Diagnosis of Pediatric Celiac Disease
Authors: Guz‐Mark Anat , Kori Michal , Topf‐Olivestone Chani , Weinberger Ronit , Morgenstern Sara , Ziv‐Sokolovskaya Nadya , Shamir Raanan
Published: January 2022

Objective:

Tissue‐transglutaminase antibodies (TGA) may be used to diagnose celiac disease (CD) without biopsy in selected cases. We aimed to investigate real‐life performance of a CD serology automated analyzer (Bioplex2200), and to explore the correlation between TGA levels and intestinal biopsies in children.

Methods:

A retrospective review was performed in 2 pediatric gastroenterological centers, between November 1, 2018 and April 1, 2020 and included patients with both TGA serology testing and duodenal biopsies. Retrieved data included patients’ demographics, medical background, TGA levels, and biopsy results.

Results:

Overall, 538 children were evaluated, 256 with positive TGA (68.4% girls, median age 6.4 years), and 282 with negative TGA (53.9% girls, median age 13.4 years). Among patients with positive TGA, intestinal biopsies confirmed CD in 219 (85.5%). Overall, positive serology with normal histology was found in 14.5% of the cohort, with 52%; 21.6%; 21.1%; and 4.2% in TGA ranges of 1 to 3 times upper limit of normal (ULN); 3 to 5 ULN; 5 to 10 ULN; and above 10 times ULN, respectively, P < 0.001. Area under the receiver‐operating characteristic curve (AUC) was 0.963 (95% CI 0.947–0.980). Among patients with positive TGA, 216 (84.4%) had positive anti‐endomysial antibodies. In this sub‐group, the overall diagnostic performance was inferior, with AUC of 0.737 (95% CI 0.834–0.839).

Conclusions:

The Multiplex TGA assay had a very high diagnostic accuracy in real‐life. Among patients with positive TGA, adding EMA did not improve the diagnostic performance of the test. False‐positive rates differed between different ranges of TGA and were low with TGA above 10 times ULN.
Nutrition-Focused Physical Examination Knowledge and Practice Changes in Clinical Dietitians and Dietetic Educators Who Completed a 12-Month Hybrid Training Program in Malaysia
Authors: Tomesko Jennifer , Brody Rebecca , Chen Seong-Ting , Chee Siew Swee Winnie , Sackey Joachim , Sullivan Jessie , Touger-Decker Riva
Published: January 2022

This pilot study explored nutrition-focused physical examination (NFPE) knowledge and practice changes in clinical dietitians and dietetics educators who completed a hybrid training program in Malaysia. Integration of NFPE into dietetics curricula was also assessed. Mean knowledge scores increased significantly from baseline to posttests immediately posttraining and at 6 and 12 months (P ≤ .001) posttraining. Dietitians were significantly more likely to report they perform versus not perform all NFPE tasks (P < .001). Educators included all NFPE tasks in their curricula 12 months posttraining. Participants demonstrated increased NFPE knowledge and curricular and clinical practices. The hybrid approach to teaching NFPE was feasible.
Promoting Weight Loss Success Following Bariatric Surgery Through Telehealth
Authors: Sylvestre Jane , Parker Anna , Zelig Rena , Radler Diane Rigassio
Published: January 2022

Bariatric surgery is effective in treating obesity. Postsurgical nutrition follow-up care is traditionally done in person, and limited research exists on the effectiveness of telehealth. This review aimed to determine whether telehealth compared with in-person-care is effective in achieving weight loss post–bariatric surgery. A comprehensive literature search yielded 3 relevant articles. Telehealth was found to be as effective as in-person care in achieving significant weight loss. Dietitians may consider telehealth a viable option for patient care when obstacles to in-person care exist. Future research should aim at identifying when to implement telehealth, ideal methods, and what population would benefit most.
Determinants of Total Body Weight Loss Among Palestinian Adults Post–Bariatric Surgery
Authors: Kittana Monia , Badrasawi Manal , Hamdan May , Abu Sharkh Kifaya , Shabaneh Nabeela
Published: January 2022

This study aimed to determine total weight loss percent (%TWL) and the contributing factors in 100 patients post-bariatric surgery. Self-reported anthropometric measurement, 13 dietary behaviors, lifestyle, sociodemographic, and bariatric surgery–related data were collected from the participants via telephone. The results revealed a %TWL mean of 29.00% ± 10.30%. %TWL was significantly associated with exercise, preoperative body mass index, locality type, and intake of dairy products (P < .05). Significant positive changes in dietary behaviors were reported postsurgically (P < .001). This study highlights the role of exercise and diet as part of overall post–bariatric surgical care.
Liver Transplantation in Recipients With Class III Obesity: Posttransplant Outcomes and Weight Gain
Authors: Soma Daiki , Park Yujin , Mihaylov Plamen , Ekser Burcin , Ghabril Marwan , Lacerda Marco , Chalasani Naga , Mangus Richard S. , Kubal Chandrashekhar A.
Published: January 2022

Background.

There has been a dramatic increase in obesity in the United States. Several studies have reported conflicting results for the impact of obesity on outcomes of liver transplantation (LT). This study aims to assess the impact of obesity on LT and changes in body mass index (BMI) after transplantation.

Methods.

All adult LTs performed at Indiana University between 2001 and 2018 were reviewed. BMIs of recipients were subdivided into 6 categories. Survival outcomes were compared across the subgroup. BMI was followed up in a cohort of patients from 2008 to 2018.

Results.

Among 2024 patients, 25% were in class I obesity, 9.3% were in class II obesity, and 1.1% were in class III obesity. There was no significant difference in patient and graft survival at 10-y follow-up with respect to BMI. Among 1004 patients in the subgroup, BMI of all groups except the underweight group declined in the first 3 mo postoperatively; however, the BMI of all groups except the class III obesity group returned to the pre-LT level by 2 y and reached a plateau by 5 y. In the class III obesity group, there was a significant increase in body weight at 5 y.

Conclusions.

Class III obesity was not associated with higher mortality in our cohort. Because our cohort is small, it may be underpowered to detect a smaller difference in outcome. From our observation, obesity should not be considered a contraindication for LT. Post-LT interventions are required to prevent significant weight gain for the class III obesity group.
Intraoperative Verapamil Fails to Reduce Delayed Graft Function in Donation After Circulatory Death Renal Allografts
Authors: Lovett Jessica T. , Stern Jeffrey , Weldon Elaina P. , Lonze Bonnie E. , Stewart Zoe A.
Published: January 2022

Background.

The shortage of transplantable organs has led to increased utilization of kidneys that may be particularly vulnerable to ischemia-reperfusion injury (IRI) and delayed graft function (DGF). Kidneys from donation after circulatory death (DCD) donors have additional IRI from donor procurement that results in increased risk of DGF. Verapamil may reduce IRI in kidney allografts when given at the time of organ reperfusion. This study sought to determine if intraoperative administration of verapamil (Ver) could reduce the risk of DGF in DCD kidney transplants.

Methods.

A single-center retrospective matched cohort study was performed of 93 Ver (–) kidney transplant recipients compared with 93 Ver (+) kidney transplant recipients, matched by donor age, Kidney Donor Profile Index, and DCD status. Covariates that could impact DGF risk were evaluated by univariate and multivariate logistic regression analyses.

Results.

The Ver (–) and Ver (+) matched cohorts did not have any significant differences in the demographic covariates. There was no difference in DGF rate between the Ver cohorts in either the overall study population or within the DCD subgroup. There was a trend toward reduced DGF in the Ver (+) cohort for cold ischemia time (CIT) ≤24 h, but this failed to achieve statistical significance. On multivariate analysis, only CIT was found to be independently associated with DGF.

Conclusions.

Intraoperative verapamil failed to reduce DGF risk in DCD kidney allografts. Limitations to this study include nonrandomization for the intraoperative administration of verapamil and the mean CIT >24 h in the study population. Only CIT was an independent prognosticator for DGF on multivariate analysis in a cohort matched for DCD status, consistent with prior studies.
Mammal virus diversity estimates are unstable due to accelerating discovery effort
Authors: Gibb Rory , Albery Gregory F. , Mollentze Nardus , Eskew Evan A. , Brierley Liam , Ryan Sadie J. , Seifert Stephanie N. , Carlson Colin J.
Published: January 2022

Host-virus association data underpin research into the distribution and eco-evolutionary correlates of viral diversity and zoonotic risk across host species. However, current knowledge of the wildlife virome is inherently constrained by historical discovery effort, and there are concerns that the reliability of ecological inference from host-virus data may be undermined by taxonomic and geographical sampling biases. Here, we evaluate whether current estimates of host-level viral diversity in wild mammals are stable enough to be considered biologically meaningful, by analysing a comprehensive dataset of discovery dates of 6571 unique mammal host-virus associations between 1930 and 2018. We show that virus discovery rates in mammal hosts are either constant or accelerating, with little evidence of declines towards viral richness asymptotes, even in highly sampled hosts. Consequently, inference of relative viral richness across host species has been unstable over time, particularly in bats, where intensified surveillance since the early 2000s caused a rapid rearrangement of species' ranked viral richness. Our results illustrate that comparative inference of host-level virus diversity across mammals is highly sensitive to even short-term changes in sampling effort. We advise caution to avoid overinterpreting patterns in current data, since it is feasible that an analysis conducted today could draw quite different conclusions than one conducted only a decade ago.
Active beating modes of two clamped filaments driven by molecular motors
Authors: Collesano Laura , Guido Isabella , Golestanian Ramin , Vilfan Andrej
Published: January 2022

Biological cilia pump the surrounding fluid by asymmetric beating that is driven by dynein motors between sliding microtubule doublets. The complexity of biological cilia raises the question about minimal systems that can re-create similar patterns of motion. One such system consists of a pair of microtubules that are clamped at the proximal end. They interact through dynein motors that cover one of the filaments and pull against the other one. Here, we study theoretically the static shapes and the active dynamics of such a system. Using the theory of elastica, we analyse the shapes of two filaments of different lengths with clamped ends. Starting from equal lengths, we observe a transition similar to Euler buckling leading to a planar shape. When further increasing the length ratio, the system assumes a non-planar shape with spontaneously broken chiral symmetry after a secondary bifurcation and then transitions to planar again. The predicted curves agree with experimentally observed shapes of microtubule pairs. The dynamical system can have a stable fixed point, with either bent or straight filaments, or limit cycle oscillations. The latter match many properties of ciliary motility, demonstrating that a two-filament system can serve as a minimal actively beating model.