bluuebunny/crossref_metadata_2025 huggingface dataset:
An Executive Summary of the Clinical Practice Guideline: Diagnosis of Upper-Quadrant Lymphedema Secondary to Cancer
Authors: Davies Claire , Levenhagen Kimberly , Ryans Kathryn , Perdomo Marisa , Gilchrist Laura
Published: July 2018

Secondary upper-quadrant lymphedema (SUQL) is a complication of cancer treatments that may impact a large number of cancer survivors. To identify lymphedema early, it is important to determine which diagnostic tools yield the best accuracy so that early intervention can minimize impairments and potentially reduce the cost of disease management while not misdiagnosing patients. The purpose of this executive summary is to briefly describe the major findings of the clinical practice guideline and provide current recommendations for evidence-based diagnostic methods and criteria for cancer-related SUQL.
Differential Diagnosis: Orthopedic Injury or Oncologic Process—A Case Report
Authors: Cobb Lorene , Galantino Mary Lou
Published: July 2018

Background and Purpose:

Patients referred for orthopedic management of musculoskeletal conditions warrant careful consideration when linear progress or decline is observed.

Case Description:

A 17-year-old male high school baseball player was referred by an orthopedic surgeon with a diagnosis of right medial epicondylitis. Physical therapy history, examination, and differential diagnosis led to “red flag” identification and a referral back to the orthopedic surgeon for diagnostic imaging. After negative findings, the patient returned for continued treatment of right medial epicondylitis. Upon a second physical therapy evaluation, symptoms progressed and functional capabilities decreased. This prompted the physical therapist to refer the patient and his family for additional medical examination.

Outcomes:

Review of previous diagnostic imaging led to the diagnosis of a primary osteoblastoma, surgical intervention, and physical therapy, with a quick return to independent functioning. Within 4 months, the aggressive tumor returned, which prompted referral to an orthopedic tumor specialist, and the patient underwent a second more extensive surgery and within a year, a third, most aggressive surgical procedure. He continues to receive medical and physical therapy follow-up visits and has not returned to competitive sports.

Discussion/Conclusion:

Physical therapists consistently demonstrate the ability to be extremely competent, efficient, and cost-effective in managing neuromusculoskeletal dysfunction. It is imperative to recognize signs, symptoms, and “red flags,” which indicate pathological conditions outside the scope of physical therapy practice, and ensure prompt and appropriate referrals.
Yoga for Persons With HIV-Related Distal Sensory Polyneuropathy: A Case Series
Authors: Kietrys David M. , Galantino Mary Lou , Cohen Evan T. , Parrott J. Scott , Gould-Fogerite Susan , O'Brien Kelly K.
Published: July 2018

Purpose:

Distal sensory polyneuropathy (DSP) is the most common neurologic complication of human immunodeficiency virus (HIV) disease. DSP-related symptoms have been associated with disability, reduced quality of life (QOL), and impaired function. Yoga has been shown to improve mental and physical status in people with chronic diseases. We assessed feasibility and measured the effect of a 4-week integrative yoga program in 3 persons with HIV-related DSP in the lower extremities.

Case Description:

Of 22 patients with DSP scheduled to attend an HIV pain clinic over 6 months, 3 enrolled in and completed the yoga program. Inclusion criteria were diagnosis of HIV disease and DSP in the feet, controlled HIV disease status, average foot pain of at least 4/10 on a numerical scale, sensory symptoms in the lower extremity, and an established regimen of pharmacologic pain management. The age range of participants was 56 to 64 years. Time since HIV disease diagnosis ranged from 15 to 30 years; time with DSP ranged from 7 to 15 years. A battery of QOL, function, disability, pain, and physical performance outcomes was measured at baseline, after the yoga intervention, and at 4-week follow-up.

Outcomes:

Overall attendance rate at the yoga classes was 88%. No adverse events occurred, and participants were highly satisfied with the program. Pain-related QOL and some gait parameters improved in all cases. It appeared that pain-related QOL improved without concurrent reduction in perceived pain severity or interference. Other outcomes, such a walking endurance, balance, and function, improved in some cases, but changes were inconsistent between individuals. No cases demonstrated improvement in vibration sensation or leg strength, nor reduction in self-reported disability.

Conclusions:

Although recruitment challenges led to concern regarding feasibility of this intervention, the program appeared to be safe and viewed favorably by the participants. There were inconsistent outcomes between individual participants; however, all experienced improved pain-related QOL and improvement in some gait characteristics. Yoga may be a viable nonpharmaceutical approach to the management of HIV-related DSP, but further research is needed to assess effectiveness, identify optimal format and dosage, and determine characteristics of potential responders.
Validation of the Lymphedema Life Impact Scale Version 2: A Condition-Specific Measurement Tool for Persons With Lymphedema
Authors: Weiss Jan , Daniel Todd
Published: July 2018

Background:

Evidence-based practice supports the use of validated outcome measures to assess the effect of lymphedema; however, condition-specific lymphedema assessment measures are needed. The Lymphedema Life Impact Scale (LLIS) has been validated as a comprehensive lymphedema-specific instrument to assess the effects of lymphedema in any extremity.

Objectives:

This multicenter, cross-sectional study investigated the reliability and validity of a revised version of the LLIS, known as LLIS version 2.

Methods:

Qualifying patients from lymphedema clinics across the United States completed self-report outcome measures; clinicians measured limb circumference. Test-retest reliability was assessed in a subgroup of 21 participants. Internal consistency and validity were assessed in 84 participants with upper- or lower-limb lymphedema.

Results:

Intraclass correlation coefficients for test-retest reliability ranged from 0.687 to 0.895. Cronbach α coefficients for internal consistency ranged between 0.847 and 0.953. Construct validity of the LLIS was upheld with symptoms but not with edema severity. The LLIS correlated from moderately to highly with most domains of the comparator LYMQOL (Lymphedema Quality of Life scale) used in this study. Minimal clinically important difference of the LLIS was 7.27; MDC95 was 12.74.

Limitations:

Despite adequate group sizes, the vast majority of participants were white females, so generalizations to male patients or to those of different races should be done cautiously.

Conclusions:

LLIS version 2 is a valid and reliable tool for the assessment of severity of impairment among patients with lymphedema.
The Brief Rehabilitation Assessment for Survivors of Head and Neck Cancer (BRASH): Content and Discriminant Validity
Authors: Komar Alyssa , Dunphy Colleen , McEwen Sara , Rios Jorge , Polatajko Helene , Ringash Jolie
Published: July 2018

Background:

Survivors of head and neck cancer (HNC) face challenges that may negatively impact health-related quality of life. Despite evidence suggesting that rehabilitation addresses many of their needs, survivors of HNC do not consistently receive rehabilitation services.

Purpose:

To evaluate the content and discriminant validity of the newly developed Brief Rehabilitation Assessment for Survivors of Head and Neck Cancer (BRASH), a patient-centered assessment tool.

Methods:

To assess content validity, 20 health care professionals completed the Content Validity Index (CVI). To assess discriminant validity, the BRASH goals and scores of 23 participants were compared with the items and scores of a standardized health-related quality-of-life measure. Data were analyzed using Spearman ρ correlation coefficients.

Results:

The BRASH received a CVI score of 0.81, indicating acceptable content validity. The BRASH's physical, cognitive/psychosocial, activity/role, open-ended question, and goal-setting domains received CVI scores of 0.81, 0.70, 0.84, 1.00, and 0.74, respectively, indicating acceptable content validity by domains. Regarding discriminant validity, of the 35 goals identified in the BRASH, 71% were addressed by the standardized measure. Correlations between the scores on the BRASH and the standardized measures were moderate to weak.

Limitations:

This study provides initial support for content and discriminant validity of the BRASH. Future research should examine additional aspects of validity and responsiveness.

Conclusions:

The BRASH demonstrates acceptable content validity, suggesting that it adds value to patient-centered rehabilitation consultation for survivors of HNC. In comparison with a standardized quality-of-life measure, it specifically focuses on rehabilitation needs of the individual patient.
Exploring the Effect of Exercise Physiology Intervention Among Adolescent and Young Adults Diagnosed With Cancer
Authors: Murnane Andrew , Thompson Kate , Mancuso Sam G. , Lewin Jeremy , Orme Lisa M.
Published: July 2018

Background:

Exercise in the adult oncology setting has proven to be an effective intervention in improving patients' physical condition and mental health and reducing treatment side effects; however, its role in the adolescent and young adult (AYA) population is less well understood. This study aimed to explore the effects of an exercise physiology (EP) intervention on the functional capacity of AYA diagnosed with malignancy.

Methods:

A prospective, single-institution cohort study was conducted of all AYA patients who were referred to the EP service and participated in baseline and postintervention assessment. Patients were provided with an individualized exercise program aimed at improving functional capacity as measured by the Six-Minute Walk Test, maximum push-ups, arm curls, and Sit-to-Stand Test, and a hand-held dynamometer was used to measure limb strength.

Results:

Fifty-one patients were included in the analysis, with predominant histological subgroups being sarcoma (37%) and lymphoma (26%). Thirty-seven percent of patients completed the program while on treatment and 63% were posttreatment. For those on treatment, there were significant improvement between baseline and postintervention strength assessments in sit-to-stand, push-ups, and arm curls, with robust effect sizes (Cohen's d
R) ranging from small (d
R = −0.02, U
3 = 49%) to large (d
R = 1.05, U
3 = 85%). For posttreatment AYA, there were differences between all baseline and postintervention functional and strength assessments, with effect sizes ranging from small (d
R = 0.30, U
3 = 61.8%) to large (d
R = 1.29, U
3 = 90.1%).

Conclusion:

An individualized exercise intervention had a positive effect on AYA cancer patients' physical performance both while undergoing treatment and posttreatment. Future randomized controlled trials are required to validate these findings.
Mindfulness and Cognitive Training in a CBT-resistant Patient With Gambling Disorder: A Combined Therapy to Enhance Self-control
Authors: von Hammerstein Cora , Miranda Ruben , Aubin Henri-Jean , Romo Lucia , Khazaal Yasser , Benyamina Amine , Luquiens Amandine
Published: July 2018

Despite the major health consequences of problem gambling, such as suicide, over-indebtedness, delinquency, or family problems, there is currently no approved drug available for the treatment of problem gambling. The efficacy of cognitive behavioral therapies (CBTs) has been demonstrated repeatedly. However, some people seem resistant to conventional CBT alone. We present the case of a 59-year-old woman with a gambling disorder, who relapsed, despite a CBT-based intervention, and who then received a combined therapy aiming to enhance self-control: a mindfulness-based therapy and cognitive training targeting inhibition.
Identification of gene expression levels in primary melanoma associated with clinically meaningful characteristics
Authors: Gorlov Ivan , Orlow Irene , Ringelberg Carol , Hernando Eva , Ernstoff Marc S. , Cheng Chao , Her Stephanie , Parker Joel S. , Thompson Cheryl L. , Gerstenblith Meg R. , Berwick Marianne , Amos Christopher
Published: July 2018

Factors influencing melanoma survival include sex, age, clinical stage, lymph node involvement, as well as Breslow thickness, presence of tumor-infiltrating lymphocytes based on histological analysis of primary melanoma, mitotic rate, and ulceration. Identification of genes whose expression in primary tumors is associated with these key tumor/patient characteristics can shed light on molecular mechanisms of melanoma survival. Here, we show results from a gene expression analysis of formalin-fixed paraffin-embedded primary melanomas with extensive clinical annotation. The Cancer Genome Atlas data on primary melanomas were used for validation of nominally significant associations. We identified five genes that were significantly associated with the presence of tumor-infiltrating lymphocytes in the joint analysis after adjustment for multiple testing:IL1R2,PPL,PLA2G3,RASAL1, andSGK2. We also identified two genes significantly associated with melanoma metastasis to the regional lymph nodes (PIK3CGandIL2RA), and two genes significantly associated with sex (KDM5CandKDM6A). We found thatLEF1was significantly associated with Breslow thickness andCCNA2andUBE2Twith mitosis.RAD50was the gene most significantly associated with survival, with a higher level of expression associated with worse survival.
Functional Outcomes of a Patient With Acute Paraplegia After Open Heart Surgery: A Case Report
Authors: Irons Sonya L. , Hoffman Julie E.
Published: July 2018

Introduction:

Paraplegia is a complication that may occur after open heart surgery. Minimal published research exists regarding functional outcomes for this patient population. The purpose of this case report is to describe the physical therapy management, including functional outcomes, as defined by the FIM instrument, before and after rehabilitation for a patient who developed paraplegia after open heart surgery.

Case Presentation:

A 69-year-old man with a past lumbar fusion presented with acute paraplegia immediately after a coronary artery bypass graft and aortic valve replacement surgery. Two months postoperatively, a neurologist determined the probable etiology to be a lumbar disc herniation. The medical charts were reviewed retrospectively. He spent 92 days in the hospital undergoing physical and occupational therapy in acute care and inpatient rehabilitation. He did not regain function in his lower extremities, and a power wheelchair became his primary mode of mobility. The patient was discharged home with his spouse as the primary caregiver.

Conclusion:

The patient demonstrated functional gains as evidenced by an increase of FIM total score, FIM efficacy, and FIM efficiency after multidisciplinary inpatient rehabilitation. This case report could assist health care professionals in the comprehensive rehabilitation management of this patient population regardless of etiology.
Physical Therapists' Clinical Reasoning and Decision-Making Processes When Mobilizing Patients Who Are Critically Ill: A Qualitative Study
Authors: Amundadottir Olof R. , Jonsdottir Helga , Sigurdsson Gisli H. , Dean Elizabeth
Published: July 2018

Purpose:

Although mobilization is a widely practiced intervention for patients who are critically ill, the clinical reasoning and decision-making processes used by physical therapists to maximize its effectiveness warrants elucidation. This study's purpose was to investigate factors guiding physical therapists' clinical reasoning and decision-making processes when initiating and progressing mobilization in patients who are critically ill.

Methods:

In a 2-phased qualitative research design, 12 physical therapists working in a tertiary care university hospital were observed before, during, and after a mobilization session with 1 patient, followed by a semistructured interview.

Results:

Six categories (patient; intensive care unit-context; physical therapist; transfer; FITT parameters [frequency, intensity, type, and time]; and expected outcome) and 4 encompassing factors (safety and well-being; continuous assessment and intervention intertwined; individualized and response-driven intervention; and barriers and solutions) emerged as important in guiding participants' clinical reasoning when mobilizing their patients.

Conclusions:

The categories and encompassing factors identified, influenced, and guided participants in their clinical reasoning and decision-making when they initiated mobilization and progressed its parameters. The approach was goal-oriented and tailored to each patient's needs based on moment-to-moment evaluation of responses. The categories and factors that emerged favored a response-driven rather than a protocol-driven approach to mobilizing patients who are critically ill.
Association Between Physical Activity and Cognitive Function Among a National Sample of Adults With Diabetes
Authors: Frith Emily , Loprinzi Paul D.
Published: July 2018

Purpose:

The cardiometabolic consequences associated with diabetes increase the risk of cognitive dysfunction. Physical activity is favorably associated with diabetes incidence and executive function, but surprisingly, there is limited research evaluating the effects of physical activity on cognitive function among adults with diabetes, which was the purpose of this study.

Methods:

Data from the 1999 to 2002 National Health and Nutrition Examination Survey (NHANES) were used. A national sample of older adults with diabetes was evaluated (N = 503; 60–85 yrs). The digit symbol substitution test (DSST) was used to assess executive function, with physical activity assessed through a valid questionnaire.

Results:

In an unadjusted weighted multivariable linear regression model, those meeting moderate-to-vigorous physical activity (MVPA) guidelines (vs not) had a DSST score 5.7 units higher (β = 5.7; 95% CI [1.46, 9.95];P= .01). After adjusting for age, sex, race-ethnicity, smoking status, energy intake, weight status, and hypertension, those meeting MVPA guidelines (vs not) had a DSST score 3.8 units higher (β = 3.8; 95% CI [0.25, 7.32];P= .03).

Discussion:

Physical activity is favorably associated with executive function among older adults with diabetes, but this association was attenuated after controlling for physical function and chronic illness.
Alternatives to excisional therapy: a clinical review of our current options to conservatively manage symptomatic leiomyomas
Authors: Ito Traci , Mattingly Patricia J. , Jan Ambareen G. , Biscette Shan M. , Kim Jin Hee J.
Published: July 2018

Purpose of review

This article provides a clinical review of the alternatives to traditional excisional surgical therapies for uterine leiomyomas, such as myomectomy or hysterectomy.

Recent findings

In this review, currently available hormonal medications will be briefly discussed. Then, nonhormonal medical therapy will be addressed with respect to mechanism of action, safety, and efficacy. Finally, the risk–benefit profile of nonexcisional procedures for management of leiomyomas will be addressed.

This provides an update on the information available for more conservative options for symptomatic leiomyoma management
Acupuncture, Its Place in Holistic Care
Authors: Wang Carol Chunfeng , Zhu Ruifang
Published: July 2018

Traditional Chinese medicine remains a valuable portal into an alternative way of perceiving health and illness. In view of holistic health care, this article supports nursing professionals embracing the concept and the skill of acupuncture as a great gift to empower them to expand on their already remarkable capacity in the nursing profession.
PHACOEMULSIFICATION CATARACT SURGERY WITH PROPHYLACTIC INTRAVITREAL BEVACIZUMAB FOR PATIENTS WITH COEXISTING DIABETIC RETINOPATHY
Authors: Feng Yifan , Zhu Senmiao , Skiadaresi Eirini , McAlinden Colm , Tu Ruixue , Gao Rongrong , Stephens Jeffrey W. , Wang Qinmei , Huang Jinhai
Published: July 2018

Purpose:

To evaluate the clinical effectiveness of intravitreal bevacizumab (IVB) injection combined with cataract surgery in the treatment of patients with cataract and coexisting diabetic retinopathy (DR).

Methods:

Pertinent comparative studies were identified through systemic searches of PubMed, EMBASE, and the Cochrane Controlled Trials Register up to March 1, 2016. Outcome measures included corrected distance vision acuity, central macular thickness, and progression of DR and maculopathy. A meta-analysis was performed using RevMan (Cochrane Collaboration, Oxford, United Kingdom).

Results:

Six studies describing a total of 283 eyes were identified. The meta-analysis results showed that corrected distance vision acuity measured at 1 month and 3 months after cataract surgery was significantly better in the IVB groups than in the control groups (P < 0.00001 and P = 0.01), whereas the corrected distance vision acuity at 6 months did not vary significantly between the 2 groups (P = 0.24). Similarly, the central macular thickness at 1, 3, and 6 months after surgery was significantly thinner in the IVB groups than in the control groups (P = 0.01, P = 0.0004, and P = 0.01, respectively). At 6 months, the progression of postoperative DR and maculopathy occurred more frequently in the control group than in the IVB group (P = 0.0001 and P < 0.0001, respectively).

Conclusion:

Our meta-analysis indicates that cataract surgery combined with IVB seems to be an effective treatment in patients with coexisting DR in the short term (up to 6 months). More randomized, prospective, and large-sample–sized trials are needed to evaluate the long-term effects of IVB at the time of cataract surgery in patients with DR.
Early Results of Penetrating Keratoplasty in Patients With Unilateral Chemical Injury After Simple Limbal Epithelial Transplantation
Authors: Gupta Nidhi , Farooqui Javed Hussain , Patel Nikunj , Mathur Umang
Published: July 2018

Purpose:

To evaluate clinical outcomes of sequential PKP in eyes with unilateral chemical injury, which have previously undergone autologous simple limbal epithelial transplantation (SLET) at a tertiary eye center in North India.

Methods:

This is a single-center, retrospective, noncomparative interventional case series reviewing patients with unilateral limbal stem cell deficiency treated by SLET and sequential PKP between 2012 and 2017. The primary outcome was defined as allograft survival, defined as a completely epithelialized, clear, avascular graft. The secondary outcome was improvement in best-corrected visual acuity by 2 lines or any complications.

Results:

Seven eyes of 7 patients, all aged below 40 years, who underwent SLET followed by PKP for unilateral ocular surface injury were included. Most of the patients were male (71.4%), and alkali injury (42.8%) was the most common cause of limbal stem cell deficiency. The mean duration between SLET and PK was 9.5 ± 11.9 months (2–36 mo), and the mean follow-up duration after PKP was 15.1 ± 5.4 months (6–21 mo). A successful outcome after SLET was achieved in all 7 patients and clear grafts in 6 patients, with a graft survival rate of 85% at 6 months. Visual success was noted in 4 patients. Poor vision in 3 patients was due to glaucoma, amblyopia, and graft failure.

Conclusions:

PKP was found to have a good outcome when the surface has been stabilized by SLET as an initial procedure in unilateral ocular chemical injury. The visual outcome was restricted mainly by other causes such as glaucoma and amblyopia.
Assessment of Infraorbital Hypesthesia Following Orbital Floor and Zygomaticomaxillary Complex Fractures Using a Novel Sensory Grading System
Authors: Homer Natalie , Glass Lora R. , Lee N. Grace , Lefebvre Daniel R. , Sutula Francis C. , Freitag Suzanne K. , Yoon Michael K.
Published: July 2018

Purpose:

Introduction of a novel sensory grading system to assess the incidence and long-term recovery of infraorbital hypesthesia following orbital floor and inferior orbital rim fractures.

Methods:

Patients who presented for evaluation of orbital floor and/or zygomaticomaxillary complex (ZMC) fractures between January 2015 and April 2016 were analyzed. Two-point subjective infraorbital sensory grading in 5 discrete anatomic areas was performed. Fractures were repaired based on traditional criteria; hypesthesia was not an indication for surgery. The sensory grading system was repeated a mean 21.7 months (range 18–28) after initial fracture.

Results:

Sixty-two patients (mean 41.8 years) participated in the initial symptom grading, and 42 patients (67.7%) completed the 2-year follow-up. Overall, 20 of 42 patients (47.6%) had some infraorbital hypesthesia. There were fewer with isolated orbital floor fractures versus ZMC fractures (31.8% vs. 68.4%; p = 0.019). Two years postinjury, 9.1% and 40.0% with isolated floor and ZMC fractures, respectively, had persistent sensory disturbance (p = 0.0188). Of patients with sensory disturbance on presentation, 71.4% with isolated floor fractures and 38.5% with ZMC fractures experienced complete sensory recovery (p = 0.1596). Patients with isolated floor fractures had improved recovery after surgery (100% vs. 33.3% recovery; p = 0.0410). Patients with ZMC fractures showed no difference in sensory prognosis between those repaired and observed.

Conclusions:

In this pilot study, isolated orbital floor fractures carried a good infraorbital sensory prognosis, further improved by surgical repair. Zygomaticomaxillary complex fractures portended a worse long-term sensory outcome, unaffected by management strategy. This study validates the novel sensory grading system in post-fracture analysis.
Interrelatedness of Distress Among Chinese-Speaking Patients and Family Caregivers
Authors: Lee Joyce W.K. , Gotay Carolyn , Sawatzky Richard , Kazanjian Arminée
Published: July 2018

Background

Cancer is a family disease, affecting the individual patient and the family. For Chinese patients and their families in Canada, adjusting to cancer may be particularly distressing when culture and language are not congruent with the mainstream model of care delivery.

Objective

In view of the limited research on the cancer experience of Chinese families, this study aims to examine the interrelatedness of patients and family caregivers' distress among a Chinese-speaking cancer population in Canada.

Methods

Semi-structured interviews were conducted with a purposive sample of 10 Chinese-speaking cancer patients and 6 family caregivers. Qualitative analysis of the interview data was conducted to construct cross-cutting themes regarding the experiences of distress after a cancer diagnosis.

Results

Four overarching themes emerged from the analysis: (1) misconception about cancer, (2) tensions in disclosure, (3) patient and family caregiver distress, and (4) concealing emotion in patient and family caregiver. Notably, the interrelatedness of patients and family caregivers' distress was highlighted, as patients and family caregivers both sought to regulate their own emotions to protect one another's mental well-being.

Conclusion

The study provides insights into the distress of living with cancer and the impact on family relationships. Understanding the patients and family members' cultural and social contexts also provides the foundation for patient- and family-centered care.

Implications for Practice

Healthcare professionals can provide culturally appropriate care by recognizing the needs, values, and beliefs of cancer patients and their families. Furthermore, the patient–family-caregiver dyad needs to be considered as the unit of care.
Nurses' Perception of the Impact of Electronic Documentation on the Nurse-Patient Relationship
Authors: Misto Kara , Padula Cynthia , Bryand Elizabeth , Nadeau Kate
Published: July 2018

Background:

While there are many benefits of electronic medical record documentation, the presence of a computer may adversely affect provider-patient interaction.

Purpose:

The purpose of this project was to examine staff nurses' perception of the impact of electronic documentation in the presence of the patient on the nurse-patient relationship.

Methods:

A survey was administered to 276 staff nurses, and open-ended interviews were conducted with 11 novice and 20 expert nurses.

Results:

Nurses identified benefits and challenges to electronic medical record documentation as well as strategies used to maintain therapeutic relationships and communication. Numerous nurses commented that documenting with their back to the patient had a negative impact on the nurse-patient relationship and communication.

Conclusions:

Both novice and expert nurses identified strategies that they used to ensure they were “maintaining the connection” to patients during electronic medical record documentation.
Symptom Assessment and Hospital Utilization in a Home-Based Palliative Care Program
Authors: Rotter Briana , Grant Marian
Published: July 2018

Palliative care delivery is shifting to the home, yet data are limited on symptom assessment tools and protocols for that setting. A quality improvement project was done in a home-based palliative care program to imbed the Edmonton Symptom Assessment System into the electronic health record. The purpose of the quality improvement project was to track symptom severity and collect utilization data. Baseline data were collected on 35 patients for symptom presence and severity as well as hospital utilization and readmission. The most common symptoms were tiredness, pain, and a lack of feeling of overall well-being. The most severe symptoms, those with a rating of 6 of 10 or higher, were pain, drowsiness, and anxiety. Seventy-seven percent of the symptoms within the Edmonton Symptom Assessment System showed an improvement over the 3-month QI project per the electronic health record data. Hospitalization rates also went from 4.2% to 2.6% and 30-day readmissions were reduced from 15% to 0%. The results suggest that the palliative care program was able to improve symptoms through the use of Edmonton Symptom Assessment System and that that may have affected hospital utilization.
The Role of Professional Competency in Influencing Job Satisfaction and Organizational Citizenship Behavior Among Palliative Care Nurses
Authors: Biagioli Valentina , Prandi Cesarina , Nyatanga Brian , Fida Roberta
Published: July 2018

It is crucial that palliative care nurses feel competent to practice their profession in accordance with ethical principles, to personalize care, to remain sensitive, to ensure respect, and to communicate effectively. The aim of this study was to verify that higher levels of perceived professional competency predict better individual and organizational outcomes, such as job satisfaction and organizational citizenship behavior. An online cross-sectional survey was conducted with 107 Italian palliative care nurses. Structural equation modeling technique was used for data analysis. The model fitted the data well. Professional competency was positively associated with both job satisfaction (β = 0.39) and organizational citizenship behavior (β = 0.53). The more confidence palliative care nurses have in their professional competency, the more they are satisfied with their job and engage in organizational citizenship behavior. Fostering professional competency in palliative nursing can help not only patients and their families but also the nurses themselves, the organization, and their coworkers.
Introducing Mindfulness Practices for Self-Care
Authors: Farina Sheila M. , Minerva Elizabeth , Glunt Jyl , Bernardo Lisa Marie
Published: July 2018

Nurses’ self-reported lack of self-care and work-related stress prompted professional educators to offer a 15-minute mindfulness experiential learning session during the facility’s annual professional development forums. Nurses were taught and practiced mindfulness (e.g., meditation, imagery), designed to empower them to be present in the moment with a sense of clarity and compassion. Outcomes measured were nurses’ self-reported practice benefit and interest in learning about and using mindfulness practices. Five hundred forty-five nurses attended the session. Most nurses (71%) reported benefit/great benefit from the session. Guided imagery and the mindful moment were the most frequently selected practices nurses would use and learn. Nursing professional development practitioners can incorporate mindfulness experiential learning opportunities into their existing education offerings.
Instrument Development and Testing for Selection of Nursing Preceptors
Authors: Cotter Elizabeth , Eckardt Patricia , Moylan Lois
Published: July 2018

The purpose of this pilot study was to develop and test a preceptor selection instrument for validity and reliability. Using a valid and reliable instrument to help identify and select an appropriate nurse preceptor supports the success of both the preceptor and the new nurse graduate. The 14-item Cotter Preceptor Selection Instrument was developed to assess attributes of potential preceptor candidates. Use of a robust and user-friendly instrument can provide nursing leadership with a consistent, measurable, and collaborative process for selecting preceptors.
Human Herpes Virus 6 (HHV-6)–associated Lymphadenitis
Authors: Balakrishna Jayalakshmi P. , Bhavsar Tapan , Nicolae Alina , Raffeld Mark , Jaffe Elaine S. , Pittaluga Stefania
Published: July 2018

Human herpes virus 6 (HHV-6) is a member of the β-herpesvirinae subfamily. Most people acquire HHV-6 primary infection early in life and reactivation may occur, most often in immunocompromised individuals, leading to various clinical manifestations. HHV-6 infected cells may be identified in lymph nodes in both reactive and neoplastic conditions. Cases were retrieved from the hematopathology consultation service archives at National Institutes of Health from 2003 to 2017 in which infection by HHV-6 had been documented by immunohistochemical stains to HHV-6 gp60/110 envelope glycoprotein. Five cases of reactive lymphadenitis and 3 cases of lymphoma; 2 angioimmunoblastic T-cell lymphoma and 1 classic Hodgkin lymphoma, positive for HHV-6 were identified. The reactive lymph nodes showed marked paracortical hyperplasia and admixed large atypical lymphoid cells exhibiting pleomorphic nuclei, vesicular chromatin, and prominent eosinophilic intranuclear inclusions. Vascular proliferation and necrosis were also present, raising suspicion of peripheral T-cell lymphoma. The 3 cases of lymphoma showed similar viral inclusions, in addition to the characteristic features diagnostic of the lymphoma. Staining for HHV-6 was positive with a membranous and Golgi pattern and was restricted to cells with evident inclusions on hematoxylin and eosin. HHV-6 infected cells were positive for CD3 and CD4. HHV-6 lymphadenitis can present with morphologic atypia creating a diagnostic pitfall for lymphoma. In such cases, careful attention to the characteristic viral inclusions can lead to immunohistochemical analysis highlighting the replicating virus. In cases of lymphoma, identification of the inclusions is key in detecting the associated infection as well as in avoiding misinterpretation of the lymphoma subtype.
A Cost Reimbursement Model for Hepatitis C Treatment Care Coordination
Authors: Behrends Czarina N. , Eggman Ashley A. , Gutkind Sarah , Bresnahan Marie P. , Fluegge Kyle , Laraque Fabienne , Litwin Alain H. , Meissner Paul , Shukla Shuchin J. , Perumalswami Ponni V. , Weiss Jeffrey , Wyatt Brooke E. , Schackman Bruce R.
Published: July 2018

Objective:

To estimate the cost of delivering a hepatitis C virus care coordination program at 2 New York City health care provider organizations and describe a potential payment model for these currently nonreimbursed services.

Design:

An economic evaluation of a hepatitis C care coordination program was conducted using micro-costing methods compared with macro-costing methods. A potential payment model was calculated for 3 phases: enrollment to treatment initiation, treatment initiation to treatment completion, and a bonus payment for laboratory evidence of successful treatment outcome (sustained viral response).

Setting:

Two New York City health care provider organizations.

Participants:

Care coordinators and peer educators delivering care coordination services were interviewed about time spent on service provision. De-identified individual-level data on study participant utilization of services were also used.

Intervention:

Project INSPIRE is an innovative hepatitis C care coordination program developed by the New York City Department of Health and Mental Hygiene.

Main Outcome Measures:

Average cost per participant per episode of care for 2 provider organizations and a proposed payment model.

Results:

The average cost per participant at 1 provider organization was $787 ($522 nonoverhead cost, $264 overhead) per episode of care (5.6 months) and $656 ($429 nonoverhead cost, $227 overhead, 5.7 months) at the other one. The first organization had a lower macro-costing estimate ($561 vs $787) whereas the other one had a higher macro-costing estimate ($775 vs $656). In the 3-phased payment model, phase 1 reimbursement would vary between the provider organizations from approximately $280 to $400, but reimbursement for both organizations would be approximately $220 for phase 2 and approximately $185 for phase 3.

Conclusions:

The cost of this 5.6-month care coordination intervention was less than $800 including overhead or less than $95 per month. A 3-phase payment model is proposed and requires further evaluation for implementation feasibility. Project INSPIRE's HCV care coordination program provides good value for a cost of less than $95 per participant per month. The payment model provides an incentive for successful cure of hepatitis C with a bonus payment; using the bonus payment to support HCV tele-mentoring expands HCV treatment capacity and empowers more primary care providers to treat their own patients with HCV.
Choosing Between Daily and Event-Driven Pre-exposure Prophylaxis: Results of a Belgian PrEP Demonstration Project
Authors: Reyniers Thijs , Nöstlinger Christiana , Laga Marie , De Baetselier Irith , Crucitti Tania , Wouters Kristien , Smekens Bart , Buyze Jozefien , Vuylsteke Bea
Published: July 2018

Background:

Daily pre-exposure prophylaxis and event-driven pre-exposure prophylaxis (PrEP) are efficacious in reducing HIV transmission among men who have sex with men (MSM). We analyzed baseline data from a PrEP demonstration project “Be-PrEP-ared” in Antwerp, Belgium, to understand preferences for daily PrEP or event-driven PrEP among MSM at high risk of HIV and factors influencing their initial choice.

Methods:

Cross-sectional data from an open-label prospective cohort study, using mixed methods. Participants who preregistered online were screened for eligibility and tested for sexually transmitted infections (STIs). Eligible participants chose between daily PrEP and event-driven PrEP and reported on behavioral data through an electronic questionnaire. In-depth interviews were conducted with a selected subsample. Bivariate associations were examined between preferred PrEP regimens and sociodemographic factors, sexual behavior, and STIs at screening.

Results:

In total, 200 participants were enrolled between October 2015 and December 2016. Self-reported levels of sexual risk-taking before enrollment were high. STI screening revealed that 39.5% had at least 1 bacterial STI. At baseline, 76.5% of participants preferred daily PrEP and 23.5% event-driven PrEP. Feeling able to anticipate HIV risk was the most frequent reason for preferring event-driven PrEP. Regimen choice was associated with sexual risk-taking behavior in the past 3 months. Almost all participants (95.7%) considered it likely that they would change their dosing regimen the following year.

Conclusion:

Event-driven PrEP was preferred by 23.5% of the participants, which better suits their preventive needs. Event-driven PrEP should be included in PrEP provision as a valuable alternative to daily PrEP for MSM at high risk of HIV.
Structural rearrangement of TFIIS- and TFIIE/TFIIF-like subunits in RNA polymerase I transcription complexes
Authors: Tafur Lucas , Sadian Yashar , Wetzel Rene , Weis Felix , Müller Christoph W.
Published: July 2018

RNA polymerase (Pol) I is a 14-subunit enzyme that solely transcribes pre-ribosomal RNA. Cryo-EM structures of Pol I initiation and elongation complexes have given first insights into the molecular mechanisms of Pol I transcription. Here, we present cryo-electron microscopy structures of yeast Pol I elongation complexes (ECs) bound to the nucleotide analog GMPCPP at 3.2 to 3.4 Å resolution that provide additional insight into the functional interplay between the TFIIE/TFIIF-like A49-A34.5 heterodimer and the TFIIS-like subunit A12.2 present in Pol I. Strikingly, most of the nucleotide-bound ECs lack the A49-A34.5 heterodimer and adopt a Pol II-like conformation, in which the A12.2 C-terminal domain is bound in a previously unobserved position at the A135 surface. Our work suggests a regulatory mechanism of Pol I transcription where the association of the A49-A34.5 heterodimer to Pol I is regulated by subunit A12.2, thereby explaining in vitro biochemical and kinetic data.
Genetic, inflammatory, and epithelial cell differentiation factors control expression of human calpain-14
Authors: Miller Daniel E. , Forney Carmy , Rochman Mark , Cranert Stacey , Habel Jeffery , Rymer Jeffrey , Lynch Arthur , Schroeder Connor , Lee Josh , Sauder Amber , Smith Quinton , Chawla Mehak , Trimarchi Michael P. , Lu Xiaoming , Fjellman Ellen , Brusilovsky Michael , Barski Artem , Waggoner Stephen , Weirauch Matthew T. , Rothenberg Marc E. , Kottyan Leah C.
Published: July 2018

Eosinophilic esophagitis (EoE) is a chronic, food-driven allergic disease resulting in eosinophilic esophageal inflammation. We recently found that EoE susceptibility is associated with genetic variants in the promoter ofCAPN14, a gene with reported esophagus-specific expression.CAPN14is dynamically up-regulated as a function of EoE disease activity and after exposure of epithelial cells to interleukin-13 (IL-13). Herein, we aimed to explore molecular modulation ofCAPN14expression. We identified three putative binding sites for the IL-13-activated transcription factor STAT6 in the promoter and first intron ofCAPN14. Luciferase reporter assays revealed that the two most distal STAT6 elements were required for the ~10-fold increase in promoter activity subsequent to stimulation with IL-13 or IL-4, and also for the genotype-dependent reduction in IL-13-induced promoter activity. One of the STAT6 elements in the promoter was necessary for IL-13-mediated induction ofCAPN14promoter activity while the other STAT6 promoter element was necessary for full induction. Chromatin immunoprecipitation in IL-13 stimulated esophageal epithelial cells was used to further support STAT6 binding to the promoter ofCAPN14at these STAT6 binding sites. The highestCAPN14and calpain-14 expression occurred with IL-13 or IL-4 stimulation of esophageal epithelial cells under culture conditions that allow the cells to differentiate into a stratified epithelium. This work corroborates a candidate molecular mechanism for EoE disease etiology in which the risk variant at 2p23 dampens mediatedCAPN14expression in differentiated esophageal epithelial cells following IL-13/STAT6 induction ofCAPN14promoter activity.
RocS drives chromosome segregation and nucleoid occlusion inStreptococcus pneumoniae
Authors: Mercy Chryslène , Lavergne Jean-Pierre , Slager Jelle , Ducret Adrien , Garcia Pierre Simon , Noirot-Gros Marie-Francoise , Dubarry Nelly , Nourikyan Julien , Veening Jan-Willem , Grangeasse Christophe
Published: July 2018

Segregation of replicated chromosomes in bacteria is poorly understood outside some prominent model strains and even less is known about how it is coordinated with other cellular processes. Here we report that RocS is crucial for chromosome segregation in the opportunistic human pathogenStreptococcus pneumoniae. RocS is membrane-bound and interacts both with DNA and the chromosome partitioning protein ParB to properly segregate the origin of replication region to new daughter cells. In addition, we show that RocS interacts with the tyrosine-autokinase CpsD required for polysaccharide capsule biogenesis, which is crucial forS. pneumoniae’s ability to prevent host immune detection. Altering the RocS-CpsD interaction drastically hinders chromosome partitioning and cell division. Altogether, this work reveals that RocS is the cornerstone of an atypical nucleoid occlusion system ensuring proper cell division in coordination with the biogenesis of a protective capsular layer.
Mutation Vulnerability Characterizes Human Cancer Genes
Authors: Li Yong Fuga , Xin Fuxiao
Published: July 2018

Recent studies by Tomasetti et al. revealed that the risk disparity among different types of cancer is mainly determined by inherent patterns in DNA replication errors rather than environmental factors. In this study we reveal that inherent patterns of DNA mutations plays a similar role in cancer at the molecular level. Cancer results from stochastic DNA mutations, yet non-random patterns of cancer mutations emerge when we look across hundreds of cancer genomes. Over 500 cancer genes have been identified to date as the hot spot genes of cancer mutations. It is generally believed that these gene are mutated more frequently because they reside in functionally important pathways and are hence selected during the somatic evolution process of tumor progression. This theory however does not explain why many genes in the same pathways of cancer genes are not mutated in cancer. In this study, we challenge this view by showing that the inherent patterns of spontaneous mutations of human genes not only distinguish cancer causing genes and non-cancer genes but also shapes the mutation profile of cancer genes at the sub-gene level.
Cross-task perceptual learning of object recognition in simulated retinal implant perception
Authors: Wang Lihui , Sharifian Fariba , Napp Jonathan , Nath Carola , Pollmann Stefan
Published: July 2018

The perception gained by retina implants (RI) is limited, which asks for a learning regime to improve patients’ visual perception. Here we simulated RI vision and investigated if object recognition in RI patients can be improved and maintained through training. Importantly, we asked if the trained object recognition can be generalized to a new task context, and to new viewpoints of the trained objects. For this purpose, we adopted two training tasks, a naming task where participants had to choose the correct label out of other distracting labels for the presented object, and a discrimination task where participants had to choose the correct object out of other distracting objects to match the presented label. Our results showed that, despite of the task order, recognition performance was improved in both tasks and lasted at least for a week. The improved object recognition, however, can be transferred only from the naming task to the discrimination task but not vice versa. Additionally, the trained object recognition can be transferred to new viewpoints of the trained objects only in the naming task but not in the discrimination task. Training with the naming task is therefore recommended for RI patients to achieve persistent and flexible visual perception.