bluuebunny/crossref_metadata_2025 huggingface dataset:
ENTEROCOCCUS ENDOPHTHALMITIS
Authors: Dave Vivek Pravin , Pathengay Avinash , Braimah Imoro Zeba , Panchal Bhavik , Sharma Savitri , Pappuru Rajeev Reddy , Mathai Annie , Tyagi Mudit , Narayanan Raja , Jalali Subhadra , Das Taraprasad
Published: February 2019

Purpose:

To report the clinical presentation and management outcome of patients with endophthalmitis caused by Enterococcus species and to report the susceptibility profile of the isolates.

Methods:

Twenty-nine cases with culture-proven Enterococcus endophthalmitis from January 2005 to May 2018 underwent vitrectomy/vitreous biopsy, intravitreal antibiotic with or without additional procedures. The undiluted vitreous was subjected to microbiologic evaluation. A favorable anatomical outcome was defined as preservation of the globe, absence of hypotony, attached retina, and absence of active inflammation at the last visit. Favorable visual outcome was final visual acuity ≥20/400.

Results:

There were 24 men (82.8%). Mean age at presentation was 32.89 ± 25.25 years (median 24 years). Inciting event was open globe injury in 18 (62%), endogenous in 5 (17.24%), postcataract surgery in 3 (10.34%), postscleral buckling in 2 (6.89%), and postkeratoplasty in 1 (3.44%). Enterococcus casseliflavus was the commonest species isolated (14/29, 48.27%) followed by E. faecalis (9/29, 31%). Susceptibility to vancomycin was seen in 27/29 isolates (93%). Visual acuity was ≤20/400 in all eyes at presentation and ≥20/400 in 10/29 cases (34.48%) at final visit. Anatomical success was seen in 18/29 eyes (62%). Corneal involvement was high at 24/29 eyes (82.75%).

Conclusion:

Enterococcus is not an uncommon organism in the setting of endophthalmitis after open globe injury. Resistance to vancomycin is rare. Multidrug resistance pattern is restricted to E. faecalis. Visual outcome is poor despite early and appropriate therapy due to inherent organism virulence.
SILICONE OIL TAMPONADE EFFECT ON MACULAR LAYER THICKNESS AND VISUAL ACUITY
Authors: Rabina Gilad , Azem Nur , Barequet Dana , Barak Adiel , Loewenstein Anat , Schwartz Shulamit
Published: February 2019

Purpose:

To evaluate the influence of silicone oil (SO) tamponade on retinal layers thickness and visual acuity in patients who underwent pars plana vitrectomy for rhegmatogenous retinal detachment.

Methods:

This is a retrospective case series of consecutive patients who underwent pars plana vitrectomy for rhegmatogenous retinal detachment with SO tamponade. Visual acuity and central macular thickness were measured with SO and at least a month after SO removal (SOR). Patients with insufficient or poor-quality images or macular pathologies such as macular edema or epiretinal membranes were excluded.

Results:

Forty-one patients with an average age of 56.1 ± 15.2 years were included, and 54% presented with fovea ON. Average tamponade duration was 151 ± 54 days. Central macular thickness of the operated eye increased from 249 ± 50 µm before to 279 ± 48 µm after SOR (P < 0.001), compared with 281 ± 21 µm of the fellow eye (P < 0.001). A mean change of 26 µm was found in the internal layers (P < 0.001). Visual acuity improved from 0.85 ± 0.97 logarithm of the minimal angle of resolution (logMAR; Snellen 20/140) with SO tamponade to 0.34 ± 0.28 logMAR (Snellen 20/43) after SOR (P < 0.001). For patients with fovea ON and without significant cataract, visual acuity was 0.19 ± 0.16 logMAR (Snellen 20/30) at presentation, 0.59 ± 0.41 logMAR (Snellen 20/80) with SO (P = 0.005), and 0.18 ± 0.15 logMAR (Snellen 20/30) after SOR (P = 0.003).

Conclusion:

Silicone oil tamponade causes a transient decrease in central macular thickness, mainly in the inner layers. After SOR, central macular thickness resembles to the fellow eyes. The mechanism for this effect is unclear, but apparently has no influence on final visual acuity.
EVALUATION OF TUMOR NECROSIS FACTOR INHIBITOR THERAPY IN SUSAC SYNDROME
Authors: Buelens Tom , Ossewaarde-van Norel Jeannette , de Boer Joke H. , Nubourgh Isabelle , Glibert Gérald , Kamgang Semeu Prochore , Fils Jean-François , Caspers Laure , Postelmans Laurence , Willermain François
Published: February 2019

Purpose:

To evaluate the effect of tumor necrosis factor (TNF) inhibitor therapy on ocular relapses in patients with Susac syndrome.

Methods:

Multicenter retrospective cohort study of patients diagnosed with Susac syndrome according to classical clinical criteria. We evaluated the disease activity before and after introduction of anti-TNF therapy and its value as a steroid-sparing agent.

Results:

Five patients were included. All were initially treated with a combination of corticosteroids and classical immunosuppressive drugs. Infliximab was started in three patients, and adalimumab was started in two patients. Patients had on average 5 ocular relapses during a mean follow-up time of 2.59 years before introducing a TNF inhibitor, corresponding with on average 1.93 relapses per year. After the introduction of an anti-TNF agent, this number was reduced by factor 5.51 to an average of 0.35 relapses per year for a mean follow-up of 2.86 years (P = 0.10). Before anti-TNF introduction ocular relapses occurred at a mean daily dose of 34 mg of prednisone, whereas with anti-TNF treatment, corticosteroid administration could be completely stopped in four patients with one patient still needing 5 mg daily (P = 0.10). Infliximab and adalimumab generally were well tolerated, and no serious adverse events were reported.

Conclusion:

Although not statistically significant, our results suggest that anti-TNF therapy can be a valuable option for the treatment of ocular Susac syndrome and may especially be considered in those patients unresponsive to more conventional immunosuppressive treatment.
Caregiver Contribution to Self-care in Patients With Heart Failure
Authors: Durante Angela , Paturzo Marco , Mottola Antonella , Alvaro Rosaria , Vaughan Dickson Victoria , Vellone Ercole
Published: February 2019

Background

Caregiver contribution to heart failure (HF) self-care maintenance and management is important in HF care. Literature remains unclear regarding which practices caregivers perform to contribute to self-care for patients with HF, especially in Southern Europe.

Objective: The objective of this study was to describe caregiver contributions to HF self-care maintenance (ie, treatment adherence and symptom monitoring) and management (ie, managing HF symptoms when they occur).

Methods

Forty HF caregivers were enrolled from 3 outpatient clinics in Italy for a qualitative descriptive study. Data were collected with a semistructured interview and analyzed using content analysis.

Results

Caregivers were 53.6 years old on average and mostly female (63.5%). Caregiver contributions to self-care maintenance included practices related to (1) monitoring medication adherence, (2) educating patients about HF symptom monitoring, (3) motivating patients to perform physical activity, and (4) reinforcing dietary restrictions. However, some of these practices were incorrect (eg, weighing the patient only once a week). Caregiver contributions to self-care management included practices related to (1) symptom recognition and (2) treatment implementation. Caregivers were able to recognize symptoms of HF exacerbation (eg, breathlessness) but lacked confidence regarding treatment implementation (eg, administering an extra diuretic).

Conclusions

Although caregivers described contributing to patients' HF self-care maintenance and management, some of their practices were incorrect. Because the caregiver contributions to HF self-care can improve patient outcomes, clinicians should routinely assess caregiver HF self-care practices and provide education and reinforcement regarding evidence-based practices.
Radial Endobronchial Ultrasound-guided Transbronchial Cryobiopsy
Authors: Abdelghani Ramsy , Thakore Sanket , Kaphle Upendra , Lasky Joseph A. , Kheir Fayez
Published: February 2019

Background:

Transbronchial lung cryobiopsy (TBLC) is a novel technique that has proved its diagnostic value in various diffuse parenchymal lung diseases (DPLD). However, there is substantial variability among interventional pulmonologists in procedural technique, diagnostic yield, and complication rate. Radial endobronchial ultrasound (R-EBUS) is useful for identification of ground-glass opacity lesions and can help identify target lung parenchyma. We aim to evaluate R-EBUS in TBLC histopathologic diagnosis for patients with DPLD.

Methods:

This was a prospective observational study of patients with clinical and radiologic features suggestive of DPLD who underwent TBLC. The R-EBUS probe was initially advanced to the desired lobe under fluoroscopic guidance until reaching 1 cm from the pleura. R-EBUS images were identified looking for either blizzard or mixed blizzard signs. TBLC samples were sent to pathology and microbiology laboratories for diagnostic analysis. Procedural complications were recorded.

Results:

In total, 40 patients (16 women/24 men) with a mean age of 63 years were included. The mean area of the samples was 36.2 mm2 (9 to 189 mm2) with mean number of samples per procedure of 3.45 (1 to 6). Definitive diagnosis was obtained in 37 patients (92.5%). The most frequent histopathologic patterns were: usual interstitial pneumonia (37.5%), nonspecific interstitial pneumonia (17.5%), and pulmonary infection (7.5%). There were 2 pneumothoraces (5%) and 5 cases of moderate bleeding (12.5%).

Conclusion:

The use of R-EBUS to locate and select target lung biopsy site before TBLC might increase diagnostic yield. Randomized studies comparing TBLC histopathologic diagnosis with and without R-EBUS are needed to ascertain its clinical value.
Factors Related to Overtreatment in the See-and-Treat Approach: A Retrospective Multicentric Observational Study
Authors: Ciavattini Andrea , Morini Stefano , Delli Carpini Giovanni , Del Fabro Anna , Serri Matteo , Verdecchia Valeria , Cigolot Federica , Cadel Manuela , Clemente Nicolò , Sopracordevole Francesco
Published: February 2019

Objective

The aim of the study was to evaluate the association between colposcopic features, age, menopausal status, and overtreatment in women subjected to “see-and-treat” approach, to identify subgroups of patients in which this approach could be more appropriate.

Materials and Methods

Retrospective multicentric cohort study conducted on women older than 25 years, with a high-grade squamous cytological report and a visible squamocolumnar junction, in which colposcopy and the excisional procedure were performed at the same time without a previous cervical biopsy (see and treat). Overtreatment was defined as histopathological finding of cervical intraepithelial lesion grade 1 or normal tissue.

Results

Among the 254 included patients, the overall overtreatment rate was 12.6%, whereas in women with a grade 2 colposcopy, it was 3.2% and, in women with grade 1 colposcopy, it was 22.0%. Among the considered factors (age, menopause, and grade 1 colposcopy), only a positive association with overtreatment and grade 1 colposcopy emerged (odds ratio = 8.70, 95% CI = 2.95–25.62, p < .001).

Conclusions

See and treat may be appropriate in women older than 25 years with a visible squamocolumnar junction and a high-grade squamous cervical cytology. Patients need to be informed about the higher risk of overtreatment in case of a grade 1 colposcopic impression, which however may still be considered acceptable. Patient's age and menopausal status should not influence the decision to propose a see-and-treat approach.
Is Hard Failure Still a Common Indication for Revision Surgery in Adult Cochlear Implant Recipients?
Authors: Stevens Shawn M. , Dougherty Hayden , Wenstrup Lisa , Hammer Theresa , Cole Tyler , Redmann Andrew , Pensak Myles L. , Samy Ravi N.
Published: February 2019

Outcome Objectives:

Study Design:

Retrospective chart review.

Setting:

Single tertiary care center, 2001 to 2016.

Patients:

Adult CI recipients were assessed. Inclusion required ≥1 revision surgeries, operative note(s), and postrevision follow-up of 6 months.

Interventions:

Therapeutic/rehabilitative.

Main Outcomes Measures:

Indications for revision (HF, SF, WC, and MM) were tabulated. The incidence of each was compared between cohorts implanted before/after 2011. Additional outcomes included implant usage, explantation rates, and postrevision speech scores.

Results:

Four hundred thirty-two patients received 512 CIs. Of these, 30 patients required 38 revisions. Median time to revision was 24.5 months. Frequency by indication was HF (n = 14), SF (n = 12), WC (n = 8), and MM (n = 4). The overall revision rate was 7.4%. There was a significant decline in overall revisions for patients implanted before/after 2011 (10.4 versus3.5%; p = 0.009). No patients implanted after 2011 experienced a HF (p = 0.002). Patients with WC/MM had significantly shorter time to revision compared with patients with HF/SF (p = 0.04). The overall median follow-up was 24 months. Twenty-three of 30 patients are still using their revised CI. Patients revised for HF and MM achieved the best outcomes.

Conclusion:

7.4% of adult CI recipients required revision surgery. Explantation/immediate reimplantation was an effective management strategy. While HF was the most common indication overall, no patients implanted after 2011 have suffered this complication. The overall revision rate has significantly declined since 2011.
Comparison of Skull Radiograph and Computed Tomography Measurements of Cochlear Implant Insertion Angles
Authors: Gallant Sara , Friedmann David R. , Hagiwara Mari , Roland J. Thomas , Svirsky Mario A. , Jethanamest Daniel
Published: February 2019

Background:

Measurement of the angular depth of insertion (aDOI) of cochlear implant electrode arrays has numerous clinical and research applications. Plain-film radiographs are easily obtained intraoperatively and have been described as a means to calculate aDOI. CT imaging with 3D reformatting can also be used for this measurement, but is less conveniently obtained and requires higher radiation doses, a particular concern in pediatrics. The extent to which plain-film and 3D CT image-based measurements are representative of the true position of the electrode within the cochlea is unknown.

Methods:

Cochlear implantation was performed on 10 cadaveric temporal bones. Five bones were implanted with perimodiolar electrodes (Contour Advance TM, Cochlear, Sydney, Australia) and five were implanted with lateral wall electrodes (Slim Straight, Cochlear). The insertion depths of the electrodes were varied. Each bone was imaged with a radiograph and CT. aDOI was measured for each bone in each imaging modality by a neurotologist and a neuroradiologist. To obtain a "gold standard" estimate of aDOI, the implanted temporal bones were embedded in an epoxy resin and methodically sectioned at 100 μm intervals; histologic images were captured at each interval. A 3D stack of the images was compounded, and a MATLAB script used to calculate aDOI of the most apical electrode. Measurements in the three modalities (radiograph, CT, and histology) were then compared.

Results:

The average aDOI across all bones was similar for all modalities: 423° for radiographs, 425° for CT scans, and 427° for histology, indicating that neither imaging modality resulted in large systematic errors. Using the histology-measured angles as a reference, the average error for CT-based measures (regardless of whether the error was in the positive or negative direction) was 12°, and that for radiograph-based measures was 15°. This small difference (12 vs 15° error) was not statistically significant.

Conclusion:

Based on this cadaveric temporal bone model, both radiographs and CTs can provide reasonably accurate aDOI measurements. In this small sample, and as expected, the CT-based estimates were more accurate than the radiograph-based measurements. However, the difference was small and not statistically significant. Thus, the use of plain radiographs to calculate aDOI seems judicious whenever it is desired to prevent unnecessary radiation exposure and expense.
Temporal Modulation Detection in Children and Adults With Cochlear Implants: Initial Results
Authors: Landsberger David Mark , Stupak Natalia , Green Janet , Tona Kaitlyn , Padilla Monica , Martinez Amy S. , Eisenberg Laurie S. , Waltzman Susan
Published: February 2019

Objectives:

The auditory experience of early deafened pediatric cochlear implant (CI) users is different from that of postlingually deafened adult CI users due to disparities in the developing auditory system. It is therefore expected that the auditory psychophysical capabilities between these two groups would differ. In this study, temporal resolving ability was investigated using a temporal modulation detection task to compare the performance outcomes between these two groups.

Design:

The minimum detectable modulation depth of amplitude modulated broadband noise at 100 Hz was measured for 11 early deafened children with a CI and 16 postlingually deafened adult CI users.

Results:

Amplitude modulation detection thresholds were significantly lower (i.e., better) for the pediatric CI users than for the adult CI users. Within each group, modulation detection thresholds were not significantly associated with chronologic age, age at implantation, or years of CI experience.

Conclusions:

Early implanted children whose auditory systems develop in response to electric stimulation demonstrate better temporal resolving abilities than postlingually deafened adult CI users. This finding provides evidence to suggest that early implanted children might benefit from sound coding strategies emphasizing temporal information.
Beyond Technology: The Interaction of Perceptual Accuracy and Experiential Factors in Pediatric Music Engagement
Authors: Gfeller Kate , Driscoll Virginia , Schwalje Adam
Published: February 2019

Background:

Music engagement (the active making of music, e.g., music lessons and ensembles) is a common part of educational and community experiences. Music making typically involves listening to and production of rapidly changing combinations of pitch, timbre, and rhythm, which can be challenging for cochlear implant (CI) recipients, given that pitch and timbre are poorly conveyed through the CI. Pediatric CI users have variable patterns of music engagement, but some have achieved, sustained participation despite the degraded CI signal. What factors contribute to their persistence in these demanding listening situations? Our study examined a cohort of pediatric CI recipients from our center to better understand those perceptual and experiential factors most influential in relation to music engagement.

Method:

Regressions and correlations were run for measures of pitch and speech perception, hearing history, familial involvement in music, personal importance of music, and extent of music engagement (years in music lessons; general involvement in music).

Results:

Pitch ranking accuracy was a significant predictor of sustained participation in music lessons (p = 0.0019), and sustained involvement in music (p = 0.0038), as well as performance on CNC words (p = −0.0060) and phonemes (p = −0.0174). Extent of familial involvement in music at the time of testing was significantly predictive of the user's musical engagement (p = 0.0007). Personal importance of music was not predicted by or significantly correlated with, any of the variables investigated.

Conclusion:

Better pitch perception was associated with sustained involvement in music lessons as well as better speech perception. However, familial involvement in music was of greater impact for sustained music engagement. Judicious choice of musical instrument also influenced persistence. The positive impact of familial involvement indicates that perceptual limitations associated with CI processing do not present insurmountable barriers to music engagement. Because music engagement provides normalizing social involvement and challenging auditory practice, the impact of parental involvement has implications for counseling parents of CI users.
Individual Hearing Preservation Cochlear Implantation Using the Concept of Partial Insertion
Authors: Lenarz Thomas , Timm Max Eike , Salcher Rolf , Büchner Andreas
Published: February 2019

Objective:

Aim of this study was to evaluate the method of partial insertion of flexible lateral wall electrodes in patients with residual hearing and potential electric–acoustic stimulation (EAS) users.

Patients and Intervention:

N = 6 patients with a high-frequency hearing loss were treated with a partial insertion using atraumatic lateral wall electrodes. In three cases, a electrode of 24 mm length was inserted with the aim to achieve a 16 mm insertion depth and in three cases a electrode of 28 mm length to achieve a 20 mm insertion depth.

Main Outcome Measure:

Differences between the pre- and postoperative unaided air-conducted pure tone thresholds in low frequencies (125 Hz–1.5 kHz) were analyzed. Freiburg monosyllables (FBM) at 65 dB and Hochmair–Desoyer sentence test in noise (10 dB SNR) were performed. The pre- and postoperative cochlea images were analyzed.

Results:

Residual hearing could be preserved in all patients (n = 6) and is stable up to 6 months follow-up. All patients could use EAS with an average speech understanding score of 65% in monosyllables (FBM) and 76% in sentences in noise. All patients benefit significantly compared to the preoperative best aided situation.

Conclusion:

First results of patients treated with partially inserted atraumatic lateral wall electrodes show good hearing preservation rates and very good speech perception results in EAS. Partial insertion appears to be a method for an individualized cochlea implantation. In case of postoperative hearing loss the electrode can be further inserted, so the patients can benefit from deeper insertion using electric stimulation only equivalent to larger electrodes.
Surgical Experience and Early Outcomes With a Slim Perimodiolar Electrode
Authors: Friedmann David R , Kamen Emily , Choudhury Baishakhi , Roland J. Thomas
Published: February 2019

Introduction:

In 2016 the Cochlear CI532 received FDA approval and has since been the primary full-length electrode from this manufacturer implanted at our center. Our experience to date including surgical technique and early patient outcomes are reviewed here.

Methods:

Since 2016, this array was used as our standard full length Cochlear array, including children with normal anatomy, with 237 total implantations. Surgical experience and clinical outcomes including low frequency hearing preservation and speech perception on CNC words were analyzed in those with at least 6 months follow-up implanted through June 2017 (n = 94).

Results:

Speech perception scores are improving over clinical follow-up in accord with other electrode arrays. Hearing preservation is possible with a number of patients utilizing acoustic low frequency hearing in conjunction with electric stimulation from their CI. Tip fold overs were infrequent (4.6%) and always identified on intraoperative x-ray. No patients left the operating room with a tip fold over.

Conclusions:

Speech perception outcomes with the CI532 slim periomodiolar array are similar to other full length arrays with the added potential for at least short term preservation of residual acoustic hearing. There is a learning curve to its use and intraoperative x-rays are valuable to ensure optimal placement.
The Natural History of Hearing Loss in Pendred Syndrome and Non-Syndromic Enlarged Vestibular Aqueduct
Authors: Mey Kristianna , Bille Michael , Rye Rasmussen Stig Hebbelstrup , Tranebjærg Lisbeth , Cayé-Thomasen Per
Published: February 2019

Introduction:

The aim was to investigate the progress of hearing loss over time in a cohort of pendred syndrome and non-syndromic enlarged vestibular aqueduct (PS/NSEVA) with one or two confirmed pathogenic variations in SLC26A4.

Study Design:

Retrospective cohort study.

Subjects and Methods:

At our tertiary referral center, a retrospective search of all patients with enlarged vestibular aqueduct, hearing loss and SLC26A4 mutations yielded 103 individuals by March 2017, 96 of whom had records of hearing levels; both an early audiometry and the latest between 3 and 668 months follow-up. Pure-tone average (PTA; average of thresholds at 0.5, 1, 2 and 4 kHz) was calculated for both ears at time 1 and time 2. Neonatal screening results were retrieved.

Results:

Eighty-seven (87) individuals had biallelic (M2) and 16 had monoallelic alterations (M1) in their SLC26A4. On average, the PTA progressed to 80 dB HL by the age of 6 years for the entire cohort, and 3.2 years for the biallelic (M2) affected individuals. 25% of the cohort was screened in the neonatal screening program; of these 42% had “passed” at least monaurally. Audiometric profiles related to age show faster deterioration in high frequencies than in low frequencies.

Conclusion:

In patients with PS/NSEVA and SLC26A4 mutations, the average hearing loss progresses to 80 dB HL by the age of 6 years. For biallelic (M2) affected individuals it was 3.2 years. Although hearing levels reached severe to profound during childhood, almost 1/2 had passed neonatal hearing screening, at least monaurally, emphasizing the need for close follow-up.
Revision Stapes Surgery: A Novel Technique of Overcoming Erosion of the Long Process of Incus Using Hydroxylapatite Cement and Shape Memory Piston
Authors: Rouhani Maral J. , Lavy Jeremy
Published: February 2019

Background:

Stapes surgery is performed to treat hearing loss in patients with otosclerosis. Erosion of the long process of incus can occur postoperatively and requires demanding revision surgery to further improve the hearing. The authors describe a novel method of performing revision stapes surgery where there is erosion of the long process of incus.

Methods:

A retrospective case series analysis of a database of revision stapes operations performed by one surgeon between July 2013 and December 2017 at a tertiary center was carried out. 26 cases were identified where there was significant erosion of long process of incus. The ossicular chain in these cases was reconstructed using a novel technique of using cement to fix the piston prosthesis to the incus remnant. The full technique is described herein. The pre- and postoperative audiometric data were analyzed.

Results:

Mean preoperative air bone gap (ABG) was 29.3 dB and mean postoperative ABG was 9.9 dB. Of the 22 patients with recorded postoperative masked bone conduction thresholds, 16 had ABG closure to < 10 dB (72.7%).

Conclusion:

We have shown highly favorable outcomes using this novel technique in addressing erosion of the long process of incus in revision cases for patients with otosclerosis.
The Father of the Electrical Stimulation of the Ear
Authors: Marchese-Ragona Rosario , Pendolino Alfonso Luca , Mudry Albert , Martini Alessandro
Published: February 2019

The Italian physicist Count Alessandro Volta, inventor of the electric battery, is considered the first scientist to have stimulated the ear with electricity, and the results of his experiments were presented in June 1800, at a meeting held by the Royal Society of London. Just recently, Mudry reported an electrical stimulation of the ear performed in 1748 by Benjamin Wilson (1721–1788), a British painter and scientist. After a thorough review of the literature available from the 18th century, we found that the first electrical stimulation of the ear was done in 1747, by a scientist in Bologna, Giuseppe Veratti.
Sequential versus Combination Treatment Using Steroids and Diuretics for Acute Low-Frequency Sensorineural Hearing Loss: A Noninferiority Trial
Authors: Yakunina Natalia , Lee Woo Hyun , Ryu Yoon-Jong , Nam Eui-Cheol
Published: February 2019

Objective:

Acute low-frequency hearing loss (ALHL) is typically treated with combination therapy, including steroids and diuretics. To avoid unnecessary use of steroids we proposed a method of sequential administration using these two drugs, and compared the efficacy of our protocol with that of existing combination treatments.

Methods:

A prospective, randomized, open-label, single-blind, noninferiority clinical trial was conducted to investigate whether the effectiveness of sequential treatment is noninferior to that of combination treatment for ALHL. Ninety-two patients with ALHL received either steroids and diuretics simultaneously for 2 weeks (combination group), or diuretics for 2 weeks followed by steroids for another 2 weeks if they did not respond to diuretic treatment (sequential group). The primary outcome measure was a change in mean hearing threshold at three frequencies (125, 250, and 500 Hz) at 4 weeks after treatment.

Results:

The mean hearing threshold of the low frequencies improved 20.0 and 17.2 dB in the combination and the sequential group, respectively. The 95% lower confidence interval was −8.0 dB and noninferiority was established at p < 0.05. At 4 weeks after treatment, the complete recovery rate was 80.5 and 82.9% in the combination and sequential groups, respectively.

Conclusion:

This is the first study on ALHL treatment following the establishment of Consolidated Standards of Reporting Trials (CONSORT). The sequential treatment is not inferior to combination treatment for ALHL, and therefore may be a better treatment guideline for ALHL considering that patients receive less steroid exposure and smaller restrictions in diuretic use compared with steroids.
Use of Direct Oral Anticoagulants in the Treatment of Left Ventricular Thrombus: Systematic Review of Current Literature
Authors: Kajy Marvin , Shokr Mohamed , Ramappa Preeti
Published: February 2019

Background:

Left ventricular thrombus (LVT) is an important complication in the setting of systolic dysfunction, particularly after acute myocardial infarction. Current guidelines recommend the vitamin-K antagonist, warfarin, for the treatment of LVT.

Area of Uncertainty and Study Question:

The direct oral anticoagulants (DOACs) are being increasingly used for the management of this entity, despite lack of randomized trials in support of it or knowledge about their efficacy. We aimed to assess the frequency of use and the efficacy of DOACs in the treatment of LVT.

Data Sources:

We searched published articles in Google Scholar, PubMed, MEDLINE, and Embase from the introduction of DOACs in any therapy until April 2018. Reports describing patients diagnosed with LVT and who were treated with a DOAC were examined. Patient characteristics, comorbidities, pharmacologic treatments, and outcomes were collected. The primary end points of this study were thrombus resolution and time to resolution. Other end points were bleeding and thromboembolic events.

Results:

Thirty articles describing 41 patients were analyzed. The most common risk factors for LVT formation were male gender, ischemic heart disease, and low ejection fraction. Most patients were treated with rivaroxaban (51.2%), followed by apixaban (26.8%) and dabigatran (22%). Patients were treated with DOAC alone (46.3%), DOAC and aspirin (12.2%), DOAC and clopidogrel (2.4%), and triple therapy (39%). Thrombus resolution success rate was 81%, 100%, and 88.9% for rivaroxaban, apixaban, and dabigatran, respectively. The median time of thrombus resolution was 40 days, 36 days, and 24 days for rivaroxaban, apixaban, and dabigatran, respectively. One nonfatal bleeding event and one stroke event were reported while on a DOAC.

Conclusions:

The use of DOACs is a reasonable alternative to vitamin-K antagonists in the management of LVT.
Design and Implementation of a Face-to-Face Peer Feedback Program for Ambulatory Nursing
Authors: Ryiz-Semmel Jennifer , France Monique , Bradshaw Robin , Khan Marjorie , Mulholland Barbara , Meucci Joanne , McGrath Jacqueline
Published: February 2019

BACKGROUND/PURPOSE

Ongoing dissatisfaction with anonymous peer feedback led to problem solving to equip nurses to provide and receive respectful and meaningful feedback during face-to-face peer review.

PROBLEM

Giving and receiving feedback about other's performance and collaboration are a vital aspect of teambuilding; yet, no programmatic training existed to prepare and equip nurses to feel confident and comfortable in providing or receiving face-to-face peer feedback. A search of the literature demonstrated a dearth of evidence related to developing these teambuilding relationships. The facilitator role appeared in some literature outside nursing but was poorly articulated and yet appeared important to the process.

METHODS

This was a quality improvement project that utilized online surveys with both multiple-choice and open-ended questions for data collection across 3 time points for 2 different cohorts over a 2-year implementation period. Strategies included education related to providing feedback with positive intent regardless of feedback type. A facilitator role was used to ensure effective communication and provide support to the peers during the process.

RESULTS

Nurse participants described increased comfort and knowledge related to providing/receiving face-to-face feedback. Training and use of a facilitator provided the necessary support; 75% of participants reported comfort with giving face-to-face feedback. However, the greater majority, 80% to 92%, of participants reported increased comfort with receiving face-to-face feedback.

CONCLUSIONS

Using active peer-to-peer support has become an accepted standard for face-to-face peer feedback as an aspect of the annual review process.
A Mechanical Intermittent Abdominal Pressure Ventilator
Authors: Bach John R. , Radbourne Mark , Potpally Nikhil , Chiou Michael
Published: February 2019

Pneumatically driven intermittent abdominal pressure ventilators were a popular means of daytime ventilatory support until the late 1960s paradigm shift to invasive (tracheostomy) mechanical ventilation. However, although many patients still use intermittent abdominal pressure ventilators, currently available turbine-driven portable home care ventilators are not powerful enough to always successfully operate them. We describe a new mechanically driven intermittent abdominal pressure ventilator operated by a 1-pound motor that provided a depth of abdominal compression of almost 2 in in 1.05 to 1.13 secs to normalize alveolar ventilation for a 72-yr-old postpolio survivor. It increased her autonomous 200- to 320-ml tidal volumes by greater than 300 ml to normalize her respiratory rate, relieve her dyspnea, and maintain normal oxyhemoglobin saturation levels throughout daytime hours for a 9-mo period of continuous ventilatory support.
Balance and Gait Alterations Observed More Than 2 Weeks After Concussion
Authors: Wood Tyler A. , Hsieh Katherine L. , An Ruopeng , Ballard Randy A. , Sosnoff Jacob J.
Published: February 2019

Objective

The aim of the study was to systematically review and quantitatively synthesize the existing evidence of balance and gait alterations lasting more than 2 wks after concussion in adults.

Design

A systematic review was conducted through PubMed, CINAHL, SPORTDiscus, and Web of Science. Investigations must include adult participants with at least one concussion, were measured for 14 days after injury, and reported balance or gait measures. Balance error scoring system scores, center of pressure sway area and displacement, and gait velocity were extracted for the meta-analysis.

Results

Twenty-two studies were included. Balance alterations were observed for 2 wks after concussion when participants were tested with eyes closed, for longer durations of time, and with nonlinear regulatory statistics. The meta-analysis of center of pressure sway area with no visual feedback indicated that concussed individuals had greater sway area (P< 0.001). Various gait alterations were also observed, which may indicate that concussed individuals adopt a conservative gait strategy. The meta-analysis revealed that concussed participants walked 0.12 m/sec (P< 0.001) and 0.06 m/sec (P= 0.023) slower in single and dual-task conditions, respectively.

Conclusions

Subtle balance and gait alterations were observed after 2 wks after a concussion. Understanding these alterations may allow clinicians to improve concussion diagnosis and prevent subsequent injury.
Interventions to Teach Medical Students About Disability
Authors: Ioerger Michael , Flanders Reed M. , French-Lawyer Jeremy R. , Turk Margaret A.
Published: February 2019

Historically, medical students have received little training about working with patients with disability, but there is now a greater recognition of the need to educate medical students in this domain. The aims of this review were to define the body of literature and to determine effective strategies for teaching medical students about disability. A systematic search protocol executed across six databases identified journal articles reporting interventions implemented to teach disability to medical students. Seventy-seven articles spanning 1960–2018 met inclusion criteria. Most articles reported objectives related to increasing knowledge and skills or changing attitudes. However, only half included evaluations for all of their stated objectives in those domains. In addition, few articles used longitudinal evaluations, resulting in most articles basing conclusions on immediate posttest evaluations. Overall, the reported interventions exhibit a high risk of potential bias, with only 10% of the articles receiving a global quality rating of “good.” Thus, although several articles have reported educational interventions to teach medical students about disability, the high risk of bias, incomplete reporting, and limitations of the evaluations prevent evidence-based determinations of effective strategies for teaching medical students about disability. The findings highlight ways to improve future studies in this domain.
How to Deal With Temporal Relationships Between Biopsychosocial Variables: A Practical Guide to Time Series Analysis
Authors: Stadnitski Tatjana , Wild Beate
Published: February 2019

Objective

Longitudinal data allow for conclusions about the temporal order of events and interactional dynamics between several processes. The aim of this article is to provide a concise and pragmatic description of time series analyses (TSAs) of patient samples with numerous (or daily) repeated biological, behavioral, or psychological measurements. In addition, the article demonstrates how to implement the described analyses with the software R.

Methods

To illustrate the concrete application of the time series method, we use two case series of patients with anorexia nervosa. Upon awakening, the patients collected salivary cortisol on a daily basis and answered several questions on a handheld computer (electronic diary) regarding psychosocial variables at the time of salivary collection.

Results

Basic concepts of time series analysis such as stationarity, auto- and cross-correlation, Granger causality, impulse response function, and variance decomposition are presented. In addition, we demonstrate vector autoregressive analyses with three variables. For Patient 1, we demonstrate how TSA is used to detect cortisol and anxiety decreases during inpatient treatment and also how TSA can be used to show that an increase in cortisol is followed by a next-day increase in anxiety. For Patient 2, TSA was used to show higher salivary cortisol upon awakening on the days the patient was weighed compared with other days. In addition, we show how interdependencies of depressive feelings, positive anticipations, and cortisol values can be quantified using TSA.

Conclusions

Time series designs enable modeling of temporal relationships and bidirectional associations between biopsychosocial variables within individuals. These individual patterns cannot be derived from traditional group-based statistical analyses. This article provides accessible research tools for conducting TSA relevant to psychosomatic and biobehavioral research.
Results of a Couples-Based Randomized Controlled Trial Aimed to Increase Testing for HIV
Authors: Darbes Lynae A. , McGrath Nuala M. , Hosegood Victoria , Johnson Mallory O. , Fritz Katherine , Ngubane Thulani , van Rooyen Heidi
Published: February 2019

Background:

Although couples HIV testing and counseling (CHTC) is effective for facilitating mutual disclosure and linkage to HIV care, uptake remains low. Using a randomized controlled design, we tested the efficacy of a behavioral couples-based intervention aimed to increase CHTC.

Setting:

The Vulindlela district of KwaZulu-Natal, South Africa.

Methods:

Couples were recruited from the community (eg, markets and community events). Couples were excluded if mutual HIV serostatus disclosure had occurred. Both partners had to report being each other's primary partner and relationship length was at least 6 months. Assessments occurred at baseline, and 3, 6, and 9 months after intervention. Eligible couples attended a group session (3–4 hours) after which randomization occurred. Intervention couples additionally received: one couples-based group session followed by 4 couples' counseling sessions (1–2 hours). Intervention topics included communication skills, intimate partner violence, and HIV prevention. Our primary outcomes were CHTC and sexual risk behavior.

Results:

Overall, 334 couples were enrolled. Intervention couples were significantly more likely to have participated in CHTC [42% vs. 12% (P ≤ 0.001)]. In addition, their time to participate in CHTC was significantly shorter (logrank P ≤ 0.0001) (N = 332 couples). By group, 59% of those who tested HIV-positive in intervention and 40% of those who tested in control were new HIV diagnoses (P = 0.18). There were no group differences in unprotected sex.

Conclusions:

Our intervention improved CHTC uptake—a vehicle for mutual serostatus disclosure and entrée into HIV treatment, both of which exert a significant public health impact on communities substantially burdened by HIV.
Female Genital Schistosomiasis and HIV: Research Urgently Needed to Improve Understanding of the Health Impacts of This Important Coinfection
Authors: O'Brien Daniel P. , Ford Nathan , Djirmay Amadou G. , Calmy Alexandra , Vitoria Marco , Jensen Tomas O. , Christinet Vanessa
Published: February 2019

Evidence suggests that there are important interactions between HIV and female genital schistosomiasis (FGS) that may have significant effects on individual and population health. However, the exact way they interact and the health impacts of the interactions are not well understood. In this article, we discuss what is known about the interactions between FGS and HIV, and the potential impact of the interactions. This includes the likelihood that FGS is an important health problem for HIV-positive women inSchistosoma-endemic areas potentially associated with an increased risk of mortality, cancer, and infertility. In addition, it may be significantly impacting the HIV epidemic in sub-Saharan Africa by making young women more susceptible to HIV. We call for immediate action and argue that research is urgently required to address these knowledge gaps and propose a research agenda to achieve this.
Big Data Research in Neuro-Ophthalmology: Promises and Pitfalls
Authors: Moss Heather E. , Joslin Charlotte E. , Rubin Daniel S. , Roth Steven
Published: February 2019

Background:

Big data clinical research involves application of large data sets to the study of disease. It is of interest to neuro-ophthalmologists but also may be a challenge because of the relative rarity of many of the diseases treated.

Evidence Acquisition:

Evidence for this review was gathered from the authors' experiences performing analysis of large data sets and review of the literature.

Results:

Big data sets are heterogeneous, and include prospective surveys, medical administrative and claims data and registries compiled from medical records. High-quality studies must pay careful attention to aspects of data set selection, including potential bias, and data management issues, such as missing data, variable definition, and statistical modeling to generate appropriate conclusions. There are many studies of neuro-ophthalmic diseases that use big data approaches.

Conclusions:

Big data clinical research studies complement other research methodologies to advance our understanding of human disease. A rigorous and careful approach to data set selection, data management, data analysis, and data interpretation characterizes high-quality studies.
Regulation of sexual differentiation is linked to invasion in malaria parasites
Authors: Josling Gabrielle A. , Venezia Jarrett , Orchard Lindsey , Russell Timothy J. , Painter Heather J. , Llinás Manuel
Published: February 2019

In the malaria parasite Plasmodium falciparum, the switch from asexual multiplication to sexual differentiation into gametocytes is essential for transmission to mosquitos. One of the key determinants of sexual commitment is the transcription factor PfAP2-G, which has been proposed to orchestrate this crucial cell fate decision by driving expression of gametocyte genes. We show conclusively that PfAP2-G is a transcriptional activator of gametocyte genes and identify the earliest known markers expressed during commitment. Remarkably, we also find that in sexually committed cells, PfAP2-G is associated with the promoters of genes important for red blood cell invasion and activates them through its interactions with a second transcription factor. We thus demonstrate an intriguing transcriptional link between the apparently opposing processes of red blood cell invasion and gametocytogenesis that is coordinated by the master regulator PfAP2-G. This finding has important implications for the development of new anti-malarial drugs that block the invasion of red blood cells by sexually committed cells, thereby preventing parasite transmission.
Using hospital network-based surveillance for antimicrobial resistance as a more robust alternative to self-reporting
Authors: Donker Tjibbe , Smieszek Timo , Henderson Katherine L. , Walker Timothy M. , Hope Russell , Johnson Alan P. , Woodford Neil , Crook Derrick W. , Peto Tim E.A. , Walker A. Sarah , Robotham Julie V.
Published: February 2019

Hospital performance is often measured using self-reported statistics, such as the incidence of hospital-transmitted micro-organisms or those exhibiting antimicrobial resistance (AMR), encouraging hospitals with high levels to improve their performance. However, hospitals that increase screening efforts will appear to have a higher incidence and perform poorly, undermining comparison between hospitals and disincentivising testing, thus hampering infection control. We propose a surveillance system in which hospitals test patients previously discharged from other hospitals and report observed cases. Using NHS Hospital Episode Statistics data, we analysed patient movements across England and assessed the number of hospitals required to participate in such a reporting scheme to deliver robust estimates of incidence. With over 1.2 million admissions to English hospitals previously discharged from other hospitals annually, even when only a fraction of hospitals (41/155) participate (each screening at least 1000 of these admissions), the proposed surveillance system can estimate incidence across all hospitals. By reporting on other hospitals, the reporting of incidence is separated from the task of improving own performance. Therefore the incentives for increasing performance can be aligned to increase (rather than decrease) screening efforts, thus delivering both more comparable figures on the AMR problems across hospitals and improving infection control efforts.