bluuebunny/crossref_metadata_2025 huggingface dataset:
Choose your weapon: the Royal Court softens a beneficiary exclusion
Authors: Dobbyn Robert
Published: July 2020

Jersey’s statutory Hastings-Bass and mistake regimes have offered relief to trustees, settlors and beneficiaries on many occasions. The archetypal scenario posits the establishment of a trust, or a distribution from a trust, which causes some unintended tax consequence. However, the recent judgment of In the matter of the representation of the Grundy Trust1 shows that the Royal Court can assist in many other situations—in this case, where a husband and wife were excluded as beneficiaries with greater vigour than was necessary. The judgment also offers insights to trustees facing requests to exclude beneficiaries, both as to whether or not they should agree to do so in the first place, and also as to exactly how any exclusion should be implemented.
Hierarchical Organization of Corticothalamic Projections to the Pulvinar
Authors: Abbas Farishta Reza , Boire Denis , Casanova Christian
Published: July 2020

Signals from lower cortical visual areas travel to higher-order areas for further processing through cortico-cortical projections, organized in a hierarchical manner. These signals can also be transferred between cortical areas via alternative cortical transthalamic routes involving higher-order thalamic nuclei like the pulvinar. It is unknown whether the organization of transthalamic pathways may reflect the cortical hierarchy. Two axon terminal types have been identified in corticothalamic (CT) pathways: the types I (modulators) and II (drivers) characterized by thin axons with small terminals and by thick axons and large terminals, respectively. In cats, projections from V1 to the pulvinar complex comprise mainly type II terminals, whereas those from extrastriate areas include a combination of both terminals suggesting that the nature of CT terminals varies with the hierarchical order of visual areas. To test this hypothesis, distribution of CT terminals from area 21a was charted and compared with 3 other visual areas located at different hierarchical levels. Results demonstrate that the proportion of modulatory CT inputs increases along the hierarchical level of cortical areas. This organization of transthalamic pathways reflecting cortical hierarchy provides new and fundamental insights for the establishment of more accurate models of cortical signal processing along transthalamic cortical pathways.
Neonatal Alloimmune Thrombocytopenia
Authors: Norton Tonya , Newberry Desi , Jnah Amy
Published: July 2020

Background:

Neonatal alloimmune thrombocytopenia (NAIT) is defined as an uncommon platelet disorder caused by maternal alloimmunization to human-specific antigens (HPAs) that are paternally inherited, resulting in low fetal/neonatal platelet levels and debilitating effects on the newborn. The incidence of NAIT is 1 in every 1000 live births within the United States; it is the most common cause of severe thrombocytopenia (<30 × 109/L) and intracranial hemorrhage in term newborns.

Purpose:

The purpose of this article is to discuss the pathophysiology, clinical manifestations, diagnosis, and treatment of NAIT and its implications upon the lifespan of the neonate.

Methods:

A literature review was conducted using PubMed, CINAHL, and Google Scholar (2014-2019). Search terms included NAIT, neonatal/fetal alloimmune thrombocytopenia, newborn platelets, and intracranial bleeding and NAIT.

Results:

NAIT can affect first pregnancies and often goes undiagnosed until delivery. Universal screening tools with a focus on HPA-1a typing via noninvasive testing have been successfully trialed and have yielded promising results indicating a 75% reduction in risks associated with NAIT; however, none have been incorporated into practice and prophylactic treatment remains unavailable.

Implications for Research:

Adopting a universal screening tool and prophylaxis for NAIT would allow for early diagnosis and treatment in utero.

Implications for Practice:

Many healthcare providers are not familiar with NAIT often focusing on other causes of thrombocytopenia as a potential diagnosis.
Screw Anterior Distal Femoral Hemiepiphysiodesis in Children With Cerebral Palsy and Knee Flexion Contractures: A Retrospective Case-control Study
Authors: Long Jason T. , Laron Dominique , Garcia Micah C. , McCarthy James J.
Published: July 2020

Background:

In children with cerebral palsy who demonstrate hamstring tightness, increasing attention is being paid to less invasive methods of correcting knee flexion contractures. Guided growth principles represent one such approach, and in tandem with a serial extension casting protocol, may provide a less invasive method of addressing these contractures. To date, no evidence is available on this combination of procedures. The purpose of this study was to investigate the effectiveness of a combined lengthening/guided growth procedure (hamstring lengthening, percutaneous anterior screw hemiepiphysiodesis, and serial extension casting) in addressing knee flexion contracture, and to compare this approach to hamstring lengthening and serial extension casting alone.

Methods:

Measures from preoperative and postoperative gait analyses were reviewed retrospectively for 10 patients with cerebral palsy who underwent anterior screw hemiepiphysiodesis and hamstring lengthening followed by serial extension casting [anterior epiphysiodesis (AE) group]. These findings were compared with measures from 19 patients with cerebral palsy who underwent hamstring lengthening followed by serial extension casting [no anterior epiphysiodesis (NAE) group]. Postoperative changes in clinical, functional, and kinematic parameters were assessed. Radiographic parameters were also assessed for the AE group.

Results:

In the AE group, improvements were measured in knee contracture, popliteal angle, peak stance phase knee extension, knee range of motion, and Gait Deviation Index. Similar results were observed in the NAE group. In the AE group, the lateral distal femoral angle increased into extension by 20.9 degrees at an average of 26-month follow-up. Both groups showed an increase in pelvic tilt postoperatively. There were no surgical complications associated with the screw anterior hemiepiphysiodesis. Four patients did have complaints of knee pain, but the pain was attributable to the implants in only one patient.

Discussion:

The AE group demonstrated statistically greater postoperative improvement in popliteal angle, knee flexion contracture, and peak knee extension during stance than the NAE group. Both procedures led to improvements in clinical and functional measures, indicating the validity of this approach as a means of correcting flexion contracture that is less invasive and allows immediate weight bearing.

Level of Evidence:

Level III—therapeutic study.
Responding to Health Care Professionals' Mental Health Needs During COVID-19 Through the Rapid Implementation of Project ECHO
Authors: Sockalingam Sanjeev , Clarkin Chantalle , Serhal Eva , Pereira Cheryl , Crawford Allison
Published: July 2020

Introduction:

The COVID-19 pandemic can cause significant mental health distress among health care professionals (HCPs). We describe the psychological needs of HCPs during COVID-19 and the implementation of Project Extension for Community Healthcare Outcomes (ECHO) Coping with COVID (ECHO-CWC) to help HCPs manage COVID-19 distress.

Methods:

We used an established rapid implementation approach to accelerate the development and delivery of ECHO-CWC to address the emerging needs of HCPs. Participants' needs were identified using a 10-question survey of participants' perceived risk of COVID-19 and a five-item self-efficacy measure. Implementation outcomes consisted of participant engagement and session satisfaction scores using a five-point Likert scale.

Results:

A total of 426 participants registered for ECHO-CWC. Needs assessment data (n = 129) showed that most participants reported feeling increased stress at work (84.5%), fear of infecting others (75.2%), and fear of falling ill (70.5%) from COVID-19, yet most participants accepted the risk associated with work during this time (59.7%). Participants were highly satisfied with the initial five sessions (mean = 4.26).

Discussion:

HCPs reported the greatest concern with fears of infection and infecting others during the acute phase of the pandemic. Using an iterative curriculum design approach and existing implementation frameworks, the ECHO tele-education model can be rapidly mobilized to address HCPs' mental health needs during the COVID-19 pandemic.
Comparative effects of neurally adjusted ventilatory assist and variable pressure support on lung and diaphragmatic function in a model of acute respiratory distress syndrome
Authors: Scharffenberg Martin , Moraes Lillian , Güldner Andreas , Huhle Robert , Braune Anja , Zeidler-Rentzsch Ines , Kasper Michael , Kunert-Keil Christiane , Koch Thea , Pelosi Paolo , Rocco Patricia R.M. , Gama de Abreu Marcelo , Kiss Thomas
Published: July 2020

BACKGROUND

Variable assisted mechanical ventilation has been shown to improve lung function and reduce lung injury. However, differences between extrinsic and intrinsic variability are unknown.

OBJECTIVE

To investigate the effects of neurally adjusted ventilatory assist (NAVA, intrinsic variability), variable pressure support ventilation (Noisy PSV, extrinsic variability) and conventional pressure-controlled ventilation (PCV) on lung and diaphragmatic function and damage in experimental acute respiratory distress syndrome (ARDS).

DESIGN

Randomised controlled animal study.

SETTING

University Hospital Research Facility.

SUBJECTS

A total of 24 juvenile female pigs.

INTERVENTIONS

ARDS was induced by repetitive lung lavage and injurious ventilation. Animals were randomly assigned to 24 h of either: 1) NAVA, 2) Noisy PSV or 3) PCV (n=8 per group). Mechanical ventilation settings followed the ARDS Network recommendations.

MEASUREMENTS

The primary outcome was histological lung damage. Secondary outcomes were respiratory variables and patterns, subject-ventilator asynchrony (SVA), pulmonary and diaphragmatic biomarkers, as well as diaphragmatic muscle atrophy and myosin isotypes.

RESULTS

Global alveolar damage did not differ between groups, but NAVA resulted in less interstitial oedema in dorsal lung regions than Noisy PSV. Gas exchange and SVA incidence did not differ between groups. Compared with Noisy PSV, NAVA generated higher coefficients of variation of tidal volume and respiratory rate. During NAVA, only 40.4% of breaths were triggered by the electrical diaphragm signal. The IL-8 concentration in lung tissue was lower after NAVA compared with PCV and Noisy PSV, whereas Noisy PSV yielded lower type III procollagen mRNA expression than NAVA and PCV. Diaphragmatic muscle fibre diameters were smaller after PCV compared with assisted modes, whereas expression of myosin isotypes did not differ between groups.

CONCLUSION

Noisy PSV and NAVA did not reduce global lung injury compared with PCV but affected different biomarkers and attenuated diaphragmatic atrophy. NAVA increased the respiratory variability; however, NAVA yielded a similar SVA incidence as Noisy PSV.

TRIAL REGISTRATION

This trial was registered and approved by the Landesdirektion Dresden, Germany (AZ 24-9168.11-1/2012-2).
Effect of Medication Adherence and Early Follow-Up on Unplanned Readmission Post-Myocardial Infarction: Quality Improvement in a Safety Net Hospital
Authors: Ashraf Hassan , Warren Elizabeth , Latner Joshua P. , Shah Khanjan B. , Bell Jessica , Lowe Sarah , Phillips Rose G. , Martinez Kimberly , Pommett Catherine , Lindsay Tammy , Adkins Jacqueline , Sheffield Lauren , Richter Julie , Keeley Ellen C.
Published: July 2020

Medication nonadherence is a strong predictor of adverse events and unplanned 30-day readmissions in post-myocardial infarction (MI) patients. Nonadherence with dual antiplatelet therapy (DAPT) is of particular concern in post-MI patients, given the high rate of percutaneous coronary intervention in this population. Review of post-MI quality measures revealed that compared to national benchmarks, our safety net hospital had lower DAPT adherence rates and higher unplanned 30-day readmission rates. The aim was to improve these important quality measures by creating a transition of care pathway primarily focused on medication accessibility and affordability of DAPT and early follow-up. A multidisciplinary task force created a transition of care pathway that included bedside medication delivery, patient assistance program enrollment for medications, and follow-up within 10 days of discharge in a dedicated post-MI clinic. Resources for the pathway (personnel and hospital) were already available and repurposed. We compared quality measures of DAPT adherence, proportion of patients evaluated early after hospital discharge, and unplanned 30-day readmissions before and after the initiative. Following initiation of the transition of care pathway, DAPT adherence increased from 56% pre-intervention to 92% post-intervention (P < 0.0001). The proportion of patients scheduled for early clinic follow-up after discharge increased and unplanned 30-day readmissions decreased following initiation of the pathway. A transition of care pathway for post-MI patients using readily available resources was associated with increased DAPT adherence and decreased 30-day unplanned readmissions.
Testosterone protects against the development of widespread muscle pain in mice
Authors: Lesnak Joseph B. , Inoue Shinsuke , Lima Lucas , Rasmussen Lynn , Sluka Kathleen A.
Published: July 2020

Chronic widespread pain conditions are more prevalent in women than men, suggesting a role for gonadal hormones in the observed differences. Previously, we showed that female mice, compared to male, develop widespread, more severe, and longer-duration hyperalgesia in a model of activity-induced muscle pain. We hypothesized testosterone protects males from developing the female pain phenotype. We tested whether orchiectomy of males before induction of an activity-induced pain model produced a female phenotype and whether testosterone administration produced a male phenotype in females. Orchiectomy produced longer-lasting, more widespread hyperalgesia, similar to females. Administration of testosterone to females or orchiectomized males produced unilateral, shorter-lasting hyperalgesia. Prior studies show that the serotonin transporter (SERT) is increased in the nucleus raphe magnus (NRM) in models of chronic pain, and that blockade of SERT in the NRM reduces hyperalgesia. We examined potential sex differences in the distribution of SERT across brain sites involved in nociceptive processing using immunohistochemistry. A sex difference in SERT was found in the NRM in the activity-induced pain model; females had greater SERT immunoreactivity than males. This suggests that testosterone protects against development of widespread, long-lasting muscle pain and that alterations in SERT may underlie the sex differences.
A genetic polymorphism that is associated with mitochondrial energy metabolism increases risk of fibromyalgia
Authors: van Tilburg Miranda A.L. , Parisien Marc , Boles Richard G. , Drury Gillian L. , Smith-Voudouris Julian , Verma Vivek , Khoury Samar , Chabot-Doré Anne-Julie , Nackley Andrea G. , Smith Shad B. , Whitehead William E. , Zolnoun Denniz A. , Slade Gary D. , Tchivileva Inna , Maixner William , Diatchenko Luda
Published: July 2020

Alterations in cellular energy metabolism have been implicated in chronic pain, suggesting a role for mitochondrial DNA. Previous studies reported associations of a limited number of mitochondrial DNA polymorphisms with specific pain conditions. In this study, we examined the full mitochondrial genomes of people with a variety of chronic pain conditions. A discovery cohort consisting of 609 participants either with or without a complex persistent pain conditions (CPPCs) was examined. Mitochondrial DNA was subjected to deep sequencing for identification of rare mutations, common variants, haplogroups, and heteroplasmy associated with 5 CPPCs: episodic migraine, irritable bowel syndrome, fibromyalgia, vulvar vestibulitis, or temporomandibular disorders. The strongest association found was the presence of the C allele at the single nucleotide polymorphism m.2352T>C (rs28358579) that significantly increased the risk for fibromyalgia (odds ratio [OR] = 4.6, P = 4.3 × 10−4). This relationship was even stronger in women (OR = 5.1, P = 2.8 × 10−4), and m.2352T>C was associated with all other CPPCs in a consistent risk-increasing fashion. This finding was replicated in another cohort (OR = 4.3, P = 2.6 × 10−2) of the Orofacial Pain: Prospective Evaluation and Risk Assessment study consisting of 1754 female participants. To gain insight into the cellular consequences of the associated genetic variability, we conducted an assay testing metabolic reprogramming in human cell lines with defined genotypes. The minor allele C was associated with decreased mitochondrial membrane potential under conditions where oxidative phosphorylation is required, indicating a role of oxidative phosphorylation in pathophysiology of chronic pain. Our results suggest that cellular energy metabolism, modulated by m.2352T>C, contributes to fibromyalgia and possibly other chronic pain conditions.
Diagnosis and Treatment Strategies of Outflow Graft Obstruction in the Fully Magnetically Levitated Continuous-Flow centrifugal Left Ventricular Assist Device: A Multicenter Case Series
Authors: Wert Leonhard , Kaufmann Friedrich , Solowjowa Natalia , Dreysse Stephan , Zimpfer Daniel , Falk Volkmar , Potapov Evgenij V. , Mulzer Johanna
Published: July 2020

Outflow graft obstruction in left ventricular assist devices (LVADs) is a rare complication whose clinical presentation may be subtle. We present six cases of outflow graft obstruction in patients on HeartMate 3 LVAD detected between 648 and 1,222 days on support. Detection principles are described and treatment strategies discussed. Three patients were successfully managed with stents, one underwent surgical revision, one patient died despite emergency treatment, and the last patient without symptoms was listed for heart transplantation.
Short-Term Ventricular Structural Changes Following Left Ventricular Assist Device Implantation
Authors: Sayer Gabriel , Medvedofsky Diego , Imamura Teruhiko , Kim Gene , Maffessanti Francesco , Fried Justin , Kruse Eric , Addetia Karima , Mor-Avi Victor , Jeevanandam Valluvan , Lang Roberto M. , Uriel Nir
Published: July 2020

Reverse remodeling of the left ventricle has been reported following left ventricular assist device (LVAD) implantation. However, left ventricular (LV) and right ventricular (RV) volumetric and shape changes have not been described. Consecutive candidates for LVAD were prospectively enrolled. Comprehensive 2- and 3-dimensional echocardiographic (2DE, 3DE) images were acquired before and 1 to 2 months following LVAD implantation. 3D endocardial surfaces were analyzed to derive shape indices, including LV sphericity and conicity and RV septal and free-wall curvatures. Sixty patients were enrolled with a mean age 56 ± 13 years, 77% male, and 83% destination therapy. 3DE showed that LV end-diastolic volume (EDV) improved from 461 ± 182 to 287 ± 144 ml (p < 0.001) and RV EDV showed no change (p = 0.08). RV longitudinal strain (LS) worsened from −9.1 ± 3.1 to −5.9 ± 2.6% (p < 0.01). LV sphericity and conicity improved (p < 0.001 for both), whereas the curvature of the interventricular septum and RV free wall did not change (p = 0.79 and 0.26, respectively). At 1 month following LVAD implantation, LV volumes decrease dramatically, and there is a favorable LV shape improvement, indicating reverse remodeling. RV shape did not change, whereas RV LS worsened, indicating an absence of RV reverse remodeling.
In vitro Hemocompatibility Evaluation of the HeartWare Ventricular Assist Device Under Systemic, Pediatric and Pulmonary Support Conditions
Authors: Chan Chris H. H. , Ki Katrina K. , Chu Ian Y. , Rolls Joshua , Morris Sasha , Lee Talvin J. , Bindorfer Stefan , Pauls Jo P. , Idachi Iki , Fraser John F.
Published: July 2020

The development of adult use right ventricular assist devices (RVADs) and pediatric left ventricular assist devices (pediatric LVADs) have significantly lagged behind compared to adult use left ventricular assist devices (LVADs). The HeartWare ventricular assist device (HVAD) intended to be used for adult’s systemic support, is increasingly used off-label for adult pulmonary and pediatric systemic support. Due to different hemodynamics and physiology, however, the HVAD’s hemocompatibility profiles can be drastically different when used in adult pulmonary circulation or in children, compared to its intended usage state, which could have a direct clinical and developmental relevance. Taking these considerations in mind, we sought to conduct in vitro hemocompatibility testing of HVAD in adult systemic, pediatric systemic and adult pulmonary support conditions. Two HVADs coupled to custom-built blood circulation loops were tested for 6 hours using bovine blood at 37°C under adult systemic, pediatric systemic, and adult pulmonary flow conditions (flow rate = 5.0, 2.5, and 4.5 L/min; differential pressure = 100, 69, and 20 mm Hg, respectively). Normalized index of hemolysis for adult systemic, pediatric systemic, and adult pulmonary conditions were 0.0083, 0.0039, and 0.0017 g/100 L, respectively. No significant difference was seen in platelet activation for these given conditions. High molecular weight von Willebrand factor multimer degradation was evident in all conditions (p < 0.05). In conclusion, alterations in the usage mode produce substantial differences in hemocompatibility of the HVAD. These findings would not only have clinical relevance but will also facilitate future adult use RVAD and pediatric LVAD development.
Risk Factors Analysis and Nomogram Development for Pancreatic Pseudocyst in Idiopathic Chronic Pancreatitis
Authors: Liu Yu , Wang Dan , Hao Lu , Wang Teng , Zhang Di , Yang Huai-Yu , Ma Jia-Yi , Li Juan , Zhang Ling-Ling , Lin Kun , Chen Cui , Guo Hong-Lei , Bi Ya-Wei , Xin Lei , Zeng Xiang-Peng , Chen Hui , Xie Ting , Liao Zhuan , Cong Zhi-Jie , Li Zhao-Shen , Hu Liang-Hao
Published: July 2020

Objective

The study concerns identifying risk factors and developing nomogram for pancreatic pseudocyst (PPC) in idiopathic chronic pancreatitis (ICP) to facilitate early diagnosis.

Methods

From January 2000 to December 2013, ICP patients admitted to our center were enrolled. Cumulative incidence of PPC was determined by Kaplan-Meier method. Patients were randomized into training group and validation group in a 2:1 ratio. Risk factors of PPC were determined through Cox proportional hazards regression model based on training cohort. The nomogram was constructed according to risk factors.

Results

Totally, 1633 ICP patients were included with a median follow-up duration of 9.8 years. Pancreatic pseudocyst was observed in 14.7% (240/1633) of patients after ICP onset. The cumulative incidences of PPC were 8.2%, 10.4%, and 12.9% at 3, 5, and 10 years after ICP onset, respectively. Male sex, smoking history, history of severe acute pancreatitis, and chronic pain at/before diagnosis of ICP and complex pathologic changes in main pancreatic duct were recognized as risk factors of PPC development. The nomogram constructed with these risk factors achieved good concordance indexes.

Conclusions

Risk for PPC could be estimated through the nomogram. High-risk patients were suggested to be followed up closely to help early diagnosis of PPC.
Different Hospital Readmissions and Outcomes of Acute Pancreatitis
Authors: Adejumo Adeyinka Charles , Pani Lydie
Published: July 2020

Objectives

Although acute pancreatitis (AP) is associated with recurrent hospitalizations, the impact of different hospital readmissions (DHR) versus same hospital readmissions (SHR) on outcomes is unknown. We study the burden of DHR among readmissions after survival from AP hospitalizations.

Methods

Among adult AP patients (Nationwide Readmissions Database), we calculated the prevalence, trends, and predictors of DHR, and its impact on mortality, hospital stay, and charges during 30- and 90-day readmissions.

Results

From 2010 to 2014, 15% and 26% of AP hospitalizations (422,950) were readmitted in 30 and 90 days, respectively. The DHR rates were similar (26.3%, 30 days; 26.4%, 90 days) and unchanged from 2010 to 2014 (P
trends > 0.10). The predictors of DHR were similar during both readmissions and included younger age category (18–45 years), hospital characteristics (nonteaching, small bed size, nonmicropolitan/metropolitan areas), substance abuse, comorbidities, and nonreception of cholecystectomy and pancreatectomy during index hospitalizations.

During readmissions (30 and 90 days), DHR was associated with adjusted odds ratio (95% confidence interval), higher mortality (1.40 [1.19–1.64] and 1.50 [1.32–1.71]), longer hospital stay (1.3 days [1.1–1.7 days] and 1.1 days [0.9–1.3 days]), and higher charges (US $16,779 [US $13,898–US $20,254] and US $14,299 [US $12,299–US $16,623]).

Conclusions

Targeted measures are needed toward patients at risk for DHR to curb the poor outcomes.
Complex Genetics in Pancreatitis
Authors: Ellison Mitchell A. , Spagnolo Daniel M. , Shelton Celeste , Orlova Ekatarina , LaRusch Jessica , Whitcomb David C. , Haupt Mark
Published: July 2020

Objectives

Chronic pancreatitis is the end stage of a pathologic inflammatory syndrome with multiple etiological factors, including genetic. We hypothesized that some pancreatitis etiology originates in pancreatic acinar or duct cells and requires both injury and compensatory mechanism failure.

Methods

One hundred pancreatitis patients were assessed using a DNA sequencing panel for pancreatitis. Cooccurrence of variants within and between genes was measured. Gene coexpression was confirmed via published single-cell RNA sequencing.

Results

One hundred and twenty-one variants were identified in 2 or more patients, 15 of which were enriched compared with reference populations. Single cell RNA-sequencing data verified coexpression of GGT1, CFTR, and PRSS1 in duct cells, PRSS1, CPA1, CEL, CTRC, and SPINK1 in acinar cells, and UBR1 in both. Multiple-risk variants with injury/stress effects (CEL, CFTR, CPA1, PRSS1) and impaired cell protection (CTRC, GGT1, SPINK1, UBR1) cooccur within duct cells, acinar cells, or both.

Conclusions

Pancreatitis is a complex disorder with genetic interactions across genes and cell types. These findings suggest a new, non-Mendelian genetic risk/etiology paradigm where a combination of nonpathogenic genetic risk variants in groups of susceptibility genes and injury/dysfunction response genes contribute to acquired pancreatic disease.
Cognitive behavior therapy-based intervention for a subacute stroke patient with severe fear of falling: a case report
Authors: Ohyagi Shunya , Tatemoto Tsuyoshi , Inoue Seigo , Sugita Sho , Honaga Kaoru , Otaka Yohei
Published: July 2020

We present the case of a 42-year-old man with subacute stroke who developed remarkable fear of falling and eventually recovered with an approach based on cognitive behavioral therapy (CBT). The CBT-based approach was implemented after the patient developed significant fear of falling with exacerbated obsessive-compulsive symptoms appeared immediately after a fall. The patient’s anxiety decreased over time, and his ability to perform these tasks and activities of daily living improved accordingly. After 6 weeks of intervention, his anxiety toward gait and stairs almost disappeared; additionally, he achieved modified independence for gait and supervision for stairs and was discharged home successfully. These findings in the present case suggest the effectiveness of an evaluation and interventional approach based on CBT for stroke patients with a severe fear of falling.
An Integrative Review on Factors Contributing to Fear of Cancer Recurrence Among Young Adult Breast Cancer Survivors
Authors: Gormley Maurade , Ghazal Lauren , Fu Mei R. , Van Cleave Janet H. , Knobf Tish , Hammer Marilyn
Published: July 2020

Background

Fear of cancer recurrence (FCR) is the most prevalent need among breast cancer survivors. Age is the most consistent predictor of higher FCR, with prevalence rates as high as 70% among young adults. Although the association between age and higher FCR is well established, a more comprehensive understanding of the factors contributing to higher FCR among young adult breast cancer survivors is needed.

Objective

The purpose of this integrative review was to explore the factors associated with higher FCR among young adult breast cancer survivors (≤ 45 years old).

Methods

A literature search was conducted using PubMed, CINAHL, PsycINFO, and EMBASE databases with specific Medical Subject Headings terms delimited to FCR, diagnosis, sex, and age range. The initial search yielded 378 studies, 13 of which met the eligibility criteria.

Results

Themes include motherhood status, health behaviors and decision making (eg, surveillance behaviors and surgical decision making), psychological morbidity, and social support. Cognitive behavioral factors include cognitive processing, metacognition, illness intrusiveness, and self-efficacy.

Conclusion

Fear of cancer recurrence among young adult breast cancer survivors is a unique construct requiring further exploration and tailored interventions to improve the health-related quality of life for this population.

Implications for Practice

Oncology nurses should screen all cancer survivors for FCR, with particular attention to the unique needs of young adults. Future research should address the role of age-appropriate support and increased levels of FCR during surveillance periods.
Keeping Patients Under the Damage Threshold for Pressure Injury
Authors: Tanner Laurel , Rappl Laurie , Oberg Craig , Call Evan
Published: July 2020

Background:

Pressure injuries (PI) are an ongoing problem in health care. Current interventions, both from clinicians and support surface technologies, do not sufficiently address PI prevention.

Problem:

Patient microclimate is a contributing risk factor for PI, one which can be more adequately addressed. However, the acceptable range for microclimate is unknown, in part because the body adapts to changing conditions.

Approach:

Two key concepts in allostasis are finite resources and responding to intrinsic and extrinsic demands. These concepts have not previously been applied to PI treatment or interventions. Addressing microclimate, when coupled with an increasing awareness of the cumulative effect of individual patient risk factors, can help resolve the risk of PI by lowering the cumulative inputs to keep patients under the threshold for tissue damage.

Conclusion:

This new approach, which places microclimate risk into the broader conceptual framework of allostasis, can produce more effective products and interventions to prevent PI.
Improving Sleep Disturbance in Hospitalized Dementia Patients
Authors: Haffner Susan Townsend , Bjorklund Pamela
Published: July 2020

Problem:

Sleep disturbance is common in hospitalized dementia patients. Consequences include adverse health outcomes and heavy social and economic costs. Education programs have improved dementia care and outcomes.

Aims:

A quality improvement project designed to improve sleep disturbance in hospitalized dementia patients was piloted on a medical-surgical unit of an urban, Midwestern hospital.

Methods:

Nurses and nursing assistants received education on evidence-based interventions to improve sleep disturbance in dementia patients. Pre-/posttests measured changes in staff knowledge. Sleep logs measured changes in hours of patient sleep.

Results:

Mean test scores increased for nurses from pre- to posttest. Sleep-wake tracking showed increased hours of sleep over time, but small sample sizes precluded pre- and posteducation statistical comparisons.

Conclusions:

Education programs can increase nurses' knowledge of evidence-based sleep disturbance care for dementia patients. Larger sample sizes are needed to determine whether such programs can significantly improve their sleep.
Interruptions Then and Now: Impact on Nurses’ Clinical Reasoning, Emotions, and Medication Safety
Authors: Wagner Elissa A. , Fuhrmann Sarah , Brant Amy , VanCamp Cathy , Dettore Joy , Guzman Yuri
Published: July 2020

Nurses transitioning to care and novice-level nurses experience difficulty managing interruptions in the acute care setting, which can result in loss of attention and potential errors. Understanding better the characteristics surrounding interruptions will better guide staff development educators in designing management strategies as well as improving clinical reasoning that supports a culture of safety among staff and professional partners.
Experience of an 8-Week Online Mindfulness Intervention for Nursing Students
Authors: Spadaro Kathleen C. , Hunker Diane F.
Published: July 2020

Background

Nurses returning to school often have stressors of work, family, and other obligations. Strategies are needed to mitigate the additional stress and promote academic success. Mindfulness is one proposed strategy.

Purpose

The purpose was to explore the experience of students participating in an 8-week mindfulness intervention.

Methods

A mixed-methods descriptive study used an emailed survey link with 13 open-ended questions at intervention completion. Interpretive description guided the qualitative analysis. Participant retention, reported practice frequency, and written feedback were analyzed for feasibility and acceptability.

Results

Twenty-six participants completed the survey. Time commitment, increased awareness, focus and concentration, and enhanced coping were identified themes. Findings supported the impact of mindfulness on student stress, anxiety and cognition, as well as acceptability and feasibility.

Conclusions

An online mindfulness program appeared effective, feasible, and acceptable. Qualitative findings informed the quantitative outcomes. Nursing faculty can impact student stress and academic success through mindfulness with their teaching.
Evaluating Scientific Writing Skill in DNP Program Students
Authors: DeCoux Hampton Michelle , Chafetz Linda
Published: July 2020

Background/Problem

Scientific writing skill development interventions in nursing are widely represented in the literature, but the specific skills required are poorly defined and measured.

Approach

This study used a cross-sectional, descriptive design to compare scientific writing skill assessment of doctor of nursing practice students' final project reports using 2 rubrics.

Outcomes

Of 13 skills, the strongest were: adherence to a standard structure, paraphrasing, and grammar, punctuation, and style. The weakest were: use of primary sources, concise, nonredundant presentation, and critical appraisal. Overall interrater agreement for the general essay writing rubric was 69.6%, and that for the scientific writing rubric was 82.3%.

Conclusions

Compared to the essay rubric, the scientific writing rubric was more useful for identifying skill strengths and weaknesses and improved interrater consistency.
Effects of Knowledge and Value on Quality of Supportive Peer Feedback
Authors: Tornwall Joni , Xie Kui , Yu Shirley L. , Stein David , Zurmehly Joyce , Nichols Robert
Published: July 2020

Background

Motivational barriers and lack of knowledge about peer review inhibit creation of supportive peer feedback between nursing students.

Purpose

The purpose of this study was to examine the effects of knowledge of peer-review practices and value for the process of creating supportive peer feedback on the quality of feedback nursing students create for their peers.

Method

Data from 155 graduate nursing students were analyzed in this quasi-experimental, repeated-measures design, using analysis of covariance and conditional process analysis.

Results

Students who had high levels of knowledge and a strong sense of value for providing feedback to peers produced higher-quality supportive peer feedback.

Conclusion

Even when a student has sufficient knowledge and skills to produce supportive peer feedback, their ability may not transfer to real peer-review contexts if they do not also have a strong sense of value for providing high-quality feedback to peers.
Vanilla
Authors: Singletary Keith W.
Published: July 2020

The vanilla bean, obtained fromVanilla planifoliaandVanilla tahitensis, members of the Orchidaceae family, is the source of vanilla extract, one of the most desired and widely used food flavorings worldwide. Besides uses of vanilla in foods, perfumes, and pharmaceuticals, it has complementary medicinal applications including alleviation of fever, spasms, and gastrointestinal irritations, to name a few. However, support from the scientific literature for human health benefits of vanilla and its chemical constituents vanillin and vanillic acid is limited and preliminary. This narrative review provides a summary of findings from human and animal studies addressing potential health benefits of the extract of this bean and select extract components.
Interhospital Transport of Children With Peripheral Venous Catheters by Private Vehicle: A Mixed Methods Assessment
Authors: Mangus Courtney W. , Canares Therese , Klein Bruce L. , Costabile Philomena , Monroe David , Noje Corina , Stevens Martha W.
Published: July 2020

Background

Many children seeking emergency care at community hospitals require transport to tertiary centers for definitive management. Interhospital transport via ambulance versus patient's own vehicle (POV) are 2 possible modes of transport; however, presence of a peripheral venous catheter (PIV) can determine transport by ambulance. Caregiver satisfaction, patient comfort, and PIV complications related to POV transport have not been described.

Objective

The aims of the study were to examine caregivers' satisfaction and perceptions of POV transport in children with/without PIVs and to assess PIV-related complications during transport.

Methods

We performed a mixed-methods, prospective cohort study of children who presented with low-acuity conditions to a community hospital and subsequently required transfer to a pediatric tertiary center. Caregivers of patients with/without PIVs were given the choice of transport by POV or ambulance. Surveys completed after transport used dichotomous, 5-point Likert scale, and open-ended responses to assess satisfaction, perceptions, and PIV-related complications. Responses were quantitatively and qualitatively analyzed accordingly. The receiving hospital assessed PIV integrity.

Results

Sixty-nine of 78 eligible patients were enrolled; of those, 67 (97%) elected transport by POV and 55 (82%) completed surveys. Most caregivers had positive responses related to satisfaction, comfort, and safety. Results did not differ significantly between those with/without PIVs. The majority (96%) would choose POV transport again. There were no reported PIV complications; all PIVs were functional upon arrival. Qualitative analysis identified themes of comfort, convenience, and efficiency.

Conclusions

In select scenarios, interfacility transport by POV is preferred by families and doing so with a saline-locked PIV does not result in complications.
Identifying Risk Factors for Elbow Injury in Children Presenting to the Emergency Department With Distal Forearm Fractures
Authors: Rubinstein Max , Hirway Priya , Zonfrillo Mark R.
Published: July 2020

Background

Pediatric distal forearm fractures are one of the most common injuries seen in the emergency department. Orthopedic teaching instructs providers to radiograph the joint above and the joint below the fracture site for concurrent injury. Despite this teaching, there is little evidence to suggest that elbow injuries are common in children with distal forearm fractures. Similarly, there are few data that help the clinician predict which children are at higher risk for co-injury.

Methods

We conducted a cross-sectional analysis of the 2011 National Emergency Department Sample data set. Children aged 2 to 17 years with an International Classification of Disease, Ninth Revision, code for a distal forearm fracture were included in the study. The primary outcome of interest was an “elbow” injury, defined as an International Classification of Disease, Ninth Revision, code for proximal radius, proximal ulna, or distal humeral fracture or dislocation. Multivariable logistic regression was performed using patient demographics, injury severity score, mechanism of injury, and underlying medical conditions.

Results

A total of 54,262 children with a distal forearm fracture were identified. Of these children, only 0.8% (n = 463) had an elbow injury. Supracondylar fractures of the humerus were the most common elbow injury seen (48.2% of elbow injuries seen). Children were more likely to have a co-injury if they were younger (9.8 years vs 8.3 years, P < 0.01), female (36% vs 44%, P < 0.01), injured via fall (68% vs 76%, P < 0.01), had a higher injury severity score (4.1 vs 4.5, P < 0.01), or were admitted for their injuries (1.5% vs 15.7%, P < 0.01). In the adjusted model, only age and disposition were predictors of co-injury. Isolated buckle fracture of the radius and metaphyseal fracture of the radius with dorsal angulation were protective against elbow injury (odds ratio = 0.39 and 0.60, respectively).

Conclusions

Children with distal forearm fractures very rarely have concurrent elbow injuries. These injuries are more likely in younger female children.
Variation in the Presentation of Intussusception by Age
Authors: Kimia Amir A. , Hadar Peter N. , Williams Scotty , Landschaft Assaf , Monuteaux Michael C. , Bachur Richard G.
Published: July 2020

Objective

To compare the clinical presentation of intussusception among children younger and older than 24 months of age.

Design/Methods

We performed a retrospective cross-sectional cohort study of children treated in the emergency department, aged 1 month to 6 years, who had an abdominal ultrasound to evaluate for intussusception over a 5-year period. After stratifying by an age cut-point of 24 months, univariate and multivariate analyses were performed.

Results

One thousand two hundred fifty-eight cases of suspected intussusception were studied; median age was 1.7 years (interquartile range, 0.8, 2.9 years), and 37% were female. Intussusception was identified in 176 children (14%); 153 (87%) were ileocolic, and 23 were ileoileal. Abdominal pain (odds ratio, 4.0; 95% confidence interval [CI], 1.5–10.5), emesis (OR, 3.5; 95% CI, 1.8–6.7), bilious emesis (OR, 2.9; 95% CI, 1.5–5.7), lethargy (OR, 2.3; 95% CI, 1.3–5.7), rectal bleeding (OR, 2.8; 95% CI, 1.4–5.7), and irritability (OR, 0.4; 95% CI, 0.2–0.8) were found to be predictors in those younger than 24 months. In children older than 24 months, male sex was the only predictor identified (OR, 2.0; 95% CI, 1.1–3.7). In cases where abdominal radiographs were obtained (n = 1212), any abnormality on abdominal radiograph was found to be predictive in both age groups (OR, 7.8; 95% CI, 3.8–25.7; and OR, 3.1; 95% CI, 1.8–5.2, respectively).

Conclusions

Intussusception presents differently in children younger than 24 months compared with older children. “Traditional” clinical predictors of intussusception should be interpreted with caution when assessing children older than 2 years.
Clinical Evaluation of Scar Quality Following the Use of Prophylactic Negative Pressure Wound Therapy in Obese Women Undergoing Cesarean Delivery
Authors: Hyldig Nana , Möller Sören , Joergensen Jan Stener , Bille Camilla
Published: July 2020

Objective

To evaluate the cosmetic result of using incisional negative-pressure wound therapy (iNPWT) compared with standard postsurgical dressings in obese women undergoing cesarean delivery (CD).

Methods

Postcesarean scars were objectively evaluated 6 and 12 months postsurgery by a plastic surgeon using the Manchester Scar Scale and the Stony Brook Scar Evaluation Scale. Subjective scar evaluation and health-related quality of life were assessed using the Patient Scar Assessment Scale and the EQ-5D-5L instrument, respectively. Main outcome measures were the cosmetic and functional outcome of treating a standardized surgical wound with iNPWT compared with standard dressings, changes in scar rating over time, and testing different scar scales for cosmetic evaluation.

Results

The study found no difference in long-term cosmetic outcomes between iNPWT and standard dressings. The study demonstrated a statistically significant positive change in scar rating from surgery to 12 months postsurgery. A strong association was found between the scar scales with a high correlation between the objective scar scales (R approximately 0.80) and a moderate correlation between the subjective scale and each objective scale (R approximately 0.50).

Conclusions

Prophylactic iNPWT has been found to reduce the risk of surgical site infection following CD. Conversely, this study was not able to detect a difference in the long-term cosmetic result after CD when compared with standard dressings.
Attachment-Oriented Endoscopic Treatment of Inverted Papilloma Involving the Frontal Sinus/Recess
Authors: Wang Yanjie , An Yunfang , Zhao Changqing , Dong Rui , Cheng Fengli
Published: July 2020

Purpose:

Sinonasal inverted papilloma (IP) is a benign but locally aggressive tumor for which an endoscopic or external surgical approach is the treatment of choice. Complete resection of IP involving the frontal sinus/recess forms one of the most challenging procedures in the field of sinonasal surgery. This study aims to present our experience in the management of extensive frontal sinus IP based on the attachment sites of the tumor.

Methods:

Thirteen patients with IP involving the frontal sinus/recess between 2010 and 2018 were presented. The data collected include demographic data, tumor attachment sites, tumor extension, tumor staging according to Meng's staging system, surgical approach, recurrence, and follow-up.

Results:

The patients were successfully treated by endoscopic surgery without any additional external approaches. The attachment sites of the IP were multifocal in some patients. No recurrence was identified after an average follow-up period of 52.88 months. No major intra- or postoperative complications were observed.

Conclusion:

The present study shows that attachment-oriented excision for IP involving the frontal sinus/recess is an acceptable approach. Surgeons should select the surgical approach based on the attachment sites of the tumor rather than the extension of the tumor. Even more importantly, the tumor attachment sites should include the sites of adhesion to the bone wall and the site of origin.