bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of a Prescription Drug Monitoring Program on Health Information Exchange Utilization, Prescribing Behaviors, and Care Coordination in an Emergency Department
Authors: Schoenbaum Anna E. , Seckman Charlotte
Published: October 2019

Timely access to patient data is critical in patient care. The utilization of health information exchange and prescription drug monitoring programs can make pertinent data readily accessible for emergency department providers to coordinate care. A quasi-experimental preintervention-postintervention design, with 62 providers and 53 554 emergency department visits linked to a health information exchange and prescription drug monitoring program, was used to evaluate rates for utilization, laboratory/imaging orders, narcotic prescribing and readmission. Health information exchange utilization increased significantly after the drug monitoring program was implemented (mean = 119.33 to mean = 231.33, t
2 = −15.79, P < .001). There was no significant effect postprescription drug monitoring program for laboratory/imaging orders or narcotics at discharge, although narcotic orders during emergency visits increased (F
1,23 = 7.953, P = .010), which may suggest the data confirmed the immediate need to control acute or chronic conditions. In addition, readmission rates decreased from 14.64% to 12.58%. Through streamlining processes, health information exchange and prescription drug monitoring program usage were increased, which can improve care. As organizations promote interoperability of health information, the nurse informaticist plays a significant role in managing access to systems that can assist all providers in coordinating care.
Developing Structured Omaha System Goals for Use in an Electronic Health Record
Authors: O'Neill Ann M. , Mossing Michael R. , Newcome Marci D. , Miller Kari B. , Monsen Karen A.
Published: October 2019

Use of standardized terminology has been essential for clear, concise, and accurate documentation of client assessments, care plans, and outcomes. The purpose of this study was to create standardized language goals for a case management system that used the Omaha System. A group of nursing informaticists analyzed, refined, and developed revised goals evaluated using medical vocabulary properties. A set of unique goals aligned with the Omaha System was developed with specifically designed characteristics and functionality that allowed individualization and evaluation of goal attainment. Goal statements and ratings were standardized and written to reflect goals a client could attain. The Omaha System goals served as a template for nurse case managers to use in telephonic support with clients and future development of new goals and allowed the organization the ability to generate quality metrics.
Rapid evolution of acute kidney injury after initial infusion of pembrolizumab in a melanoma patient concurrently treated with RAF/MEK inhibitors
Authors: Thummalapalli Rohit , Melms Johannes C. , Mier James , Izar Benjamin
Published: October 2019

The use of either immune checkpoint blockade or RAF/MEK inhibitors represents standard of care treatment options for metastatic melanoma. Each class of these drugs has distinct response kinetics, adverse effects, and unique clinical challenges. Combination of immune checkpoint blockade and RAF/MEK inhibitors may result in rapid and durable responses, however, the potential adverse effects of such combinations are poorly characterized. Here, we describe the case of a patient with BRAF-mutant melanoma who received an initial infusion of anti-PD-1 therapy while taking RAF/MEK inhibitors and experienced severe acute kidney injury, an otherwise infrequent side effect of any of these drugs alone. Treatment with corticosteroids rapidly reversed this process, indicating an underlying immune-mediated complication. A deeper understanding of potential adverse effects of combination therapies and their potential mechanisms should be carefully considered in the treatment landscape for melanoma and other cancers.
CA 19-9 Response
Authors: Diaz Celso L. , Cinar Pelin , Hwang Jimmy , Ko Andrew H. , Tempero Margaret A.
Published: October 2019

Objective:

The objective of this study was to determine the features of carbohydrate antigen (CA) 19-9 decline that correlates best with survival benefit in patients with metastatic pancreatic cancer.

Methods:

This is a retrospective study of 225 patients with metastatic pancreatic cancer receiving first-line therapy. Analysis was performed by the Kaplan-Meier method and Cox-proportional hazards ratios. CA 19-9 decline was grouped into quartiles within different CA 19-9 baseline groups. Time to nadir and CA 19-9 decline at month-2 (M2) of therapy were evaluated for patients with a baseline level ≥1000 U/mL.

Results:

No significant trend in survival was observed across baseline CA 19-9 levels. The greatest survival benefit was seen with a ≥75% decline to nadir. Among those with a ≥75% decline and baseline ≥1000 U/mL, 43 of 57 patients had a >50% decline at M2 of therapy and additional survival benefit was observed with a slower decline to nadir. Small sample sizes limited analysis of other baseline groups. CA 19-9 decline at M2 was not predictive.

Conclusions:

In patients with a CA 19-9 ≥1000 U/mL, serial CA 19-9 levels may be considered as a surrogate for serial imaging to evaluate treatment response, with a ≥75% decline indicating the greatest survival benefit. Survival was improved further in the setting of a slower decline to nadir with the highest benefit seen in patients with a nadir occurring at 4 months or longer.
General anaesthesia during caesarean sections: implications for the mother, foetus, anaesthetist and obstetrician
Authors: Ratnayake Gamunu , Patil Vinod
Published: October 2019

Purpose of review

A general anaesthetic is usually given for an emergency caesarean section (Category 1), where there is imminent threat to the mother or foetus. There are many risks in performing a general anaesthetic. The aim of this review is to highlight the effects and risks to the mother and foetus of each step of a general anaesthetic.

Recent findings

Anaesthetic techniques are changing, and the traditional mantra of using a general anaesthetic for an emergency caesarean sections is being challenged. There are also multiple potential risks of a general anaesthetic that are being better defined. This ranges from awareness during surgery, through to foetal and maternal risks of complications.

This review will outline the different stages of a general anaesthetic and highlight the risks. This summary will allow a better understanding of anaesthetic risks. This will allow obstetricians to have a more informed conversation with an anaesthetist as to form of anaesthetic required (general anaesthetic versus spinal or epidural top-up). The review will also allow obstetricians to give more informed consent to mothers and be aware of the postoperative risks.
Preventing term stillbirth: benefits and limitations of using fetal growth reference charts
Authors: Halimeh Rawad , Melchiorre Karen , Thilaganathan Basky
Published: October 2019

Purpose of review

This review examines the variation in clinical practice with regards to ultrasound estimation of fetal weight, as well as calculation of fetal weight centiles.

Recent findings

Placental dysfunction is associated with fetal smallness from intrauterine malnutrition as well as fetal disability and even stillbirth from hypoxemia. Although estimating fetal weight can be done accurately, the issue of which fetal weight centile chart should be used continues to be a contentious topic. The arguments against local fetal growth charts based on national borders and customization for variables known to be associated with disease are substantial. As for other human diseases such as hypertension and diabetes, there is a rationale for the use of an international fetal growth reference standard. Irrespective of the choice of fetal growth reference standard, a significant limitation of small for gestational age (SGA) detection programs to prevent stillbirth is that the majority of stillborn infants at term were not SGA at the time of demise.

Placental dysfunction can present with SGA from malnutrition and/or stillbirth from hypoxemia depending on the gestational age of onset. Emerging data show that at term, fetal Doppler arterial redistribution is associated more strongly with perinatal death than fetal size. Properly conducted trials of the role for maternal characteristics, fetal size, placental biomarkers, and Doppler assessing fetal well-being are required urgently.
To Robot or Not To Robot: The Use of Robotics in Benign Gynecologic Surgery
Authors: LIM COURTNEY S. , GRIFFITH KENDALL C. , TRAVIESO JENNIFER , AS-SANIE SAWSAN
Published: October 2019

The use of robotic-assisted laparoscopic surgery has continued to grow since the Food and Drug Administration approval for robotic-assisted gynecologic surgery in 2005. However, despite this growth in utilization, the data supporting its use in benign gynecologic surgery has not strongly supported its advantages over conventional laparoscopy. Controversy exists between supporters of robotic-assisted laparoscopic surgery and conventional laparoscopy. This article discusses the current literature regarding the use of robotic-assisted surgery in benign gynecologic surgery.
Trends in Estimated Thyroid, Salivary Gland, Brain, and Eye Lens Doses From Intraoral Dental Radiography Over Seven Decades (1940 TO 2009)
Authors: Fontana R.C. , Pasqual E. , Miller D.L. , Simon S.L. , Cardis E. , Thierry-Chef I.
Published: October 2019

The purpose of this study is to support retrospective dose estimation for epidemiological studies by providing estimates of historical absorbed organ doses to the brain, lens of the eye, salivary glands, and thyroid from intraoral dental radiographic examinations performed from 1940 to 2009. We simulated organ doses to an adult over 10 y time periods from 1940 to 2009, based on commonly used sets of x-ray machine settings collected from the literature. Simulations to estimate organ dose were performed using personal computer x-ray Monte Carlo software. Overall, organ doses were less than 1 mGy for a single intraoral radiograph for all decades. From 1940 to 2009, doses to the brain, eye lens, salivary glands, and thyroid decreased by 86, 96, 95, and 89%, respectively. Of these four organs, the salivary glands received the highest doses, with values decreasing from about 0.23 mGy in the 1940s to 0.025 mGy in the 2000s for a single intraoral radiograph. Based on simulations using collected historical data on x-ray technical parameters, improvements in technology and optimization of the technical settings used to perform intraoral dental radiography have resulted in a decrease in absorbed dose to the brain, eye lens, salivary glands, and thyroid over the period from 1940 to 2009.
Impact of Minimal Residual Disease Detection by Next-Generation Flow Cytometry in Multiple Myeloma Patients with Sustained Complete Remission after Frontline Therapy
Authors: Terpos Evangelos , Kostopoulos Ioannis V. , Kastritis Efstathios , Ntanasis-Stathopoulos Ioannis , Migkou Magdalini , Rousakis Pantelis , Argyriou Alexandra T. , Kanellias Nikolaos , Fotiou Despina , Eleutherakis-Papaiakovou Evangelos , Gavriatopoulou Maria , Ziogas Dimitrios C. , Papanota Aristea-Maria , Spyropoulou-Vlachou Marilyn , Trougakos Ioannis P. , Tsitsilonis Ourania E. , Paiva Bruno , Dimopoulos Meletios A.
Published: October 2019

Minimal residual disease (MRD) was monitored in 52 patients with sustained CR (≥2 years) after frontline therapy using next-generation flow (NGF) cytometry. 25% of patients initially MRD- reversed to MRD+. 56% of patients in sustained CR were MRD+; 45% at the level of 10−5; 17% at 10−6. All patients who relapsed during follow-up were MRD+ at the latest MRD assessment, including those with ultra-low tumor burden. MRD persistence was associated with specific phenotypic profiles: higher erythroblasts’ and tumor-associated monocytes/macrophages’ predominance in the bone marrow niche. NGF emerges as a suitable method for periodic, reproducible, highly-sensitive MRD-detection at the level of 10−6.
Psychometric Properties of the Keratoconus Outcomes Research Questionnaire: A Save Sight Keratoconus Registry Study
Authors: Kandel Himal , Pesudovs Konrad , Ferdi Alex , Mills Richard , Chen Jern Yee , Watson Adam , Poon Alexander , Downie Laura E. , Watson Stephanie L.
Published: October 2019

Purpose:

The aim of this study was to evaluate the psychometric properties of the Keratoconus Outcomes Research Questionnaire (KORQ) in patients enrolled in the Save Sight Keratoconus Registry.

Methods:

A cross-sectional study was conducted utilizing prospectively collected web-based registry data. The psychometric properties of the KORQ were assessed using both classical test theory and Rasch analysis. Andrich group rating scale variant of the Rasch analysis was conducted using Winsteps software, Version 3.92.1.

Results:

The KORQ was completed by 189 patients with keratoconus (men, 67.7%; white, 69.8%; median age 29 years; better eye median values: visual acuity, 75 LogMAR letters; Kmax, 51.3 D; K2, 46.5 D; thinnest pachymetry, 485 μm). Cronbach's α for the “Activity Limitation” and “Symptoms” scales were 0.95 and 0.91, respectively, with both scales free from floor or ceiling effects. On Rasch analysis, the category thresholds were ordered and well-spaced for both scales. The Activity Limitation scale had excellent psychometric properties including person separation index (3.6), unidimensionality (variance explained, 65.4%), fit statistics (<1.3 MnSq), and measurement range (3.6 logits). Similarly, the Symptoms scale had satisfactory psychometric properties including person separation index (2.5), unidimensionality (variance explained, 54.3%), fit statistics (<1.30 MnSq except for 1 item), and measurement range (2.0 logits). Both scales were well targeted to the population and free of differential item functioning.

Conclusions:

The KORQ is a psychometrically robust patient-reported outcome measure for evaluating quality of life parameters in keratoconus. It enables routine collection and monitoring of meaningful patient-reported outcome data in clinical settings, including registries.
Association Between Early Sjögren Markers and Symptoms and Signs of Dry Eye
Authors: Hubschman Sasha , Rojas Mario , Kalavar Meghana , Kloosterboer Amy , Sabater Alfonso L. , Galor Anat
Published: October 2019

Purpose:

Animal models suggest that early markers of Sjögren syndrome (EMS)—antibodies against salivary protein 1, parotid secretory protein, and carbonic anhydrase 6 (CA6)—are more accurate signals of early Sjögren when compared with classic markers (anti-Ro and anti-La). To further understand the relationship between EMS and dry eye (DE), we compared symptoms and signs of DE in subjects who tested positive versus negative for EMS.

Methods:

In this cross-sectional study, patients at the Miami Veterans Affairs Eye Clinic who were tested for EMS underwent a standard ocular surface examination. Indications for EMS testing included DE symptoms in combination with dry mouth symptoms, low tear production, corneal staining, or a Sjögren disease-associated autoimmune disease. Statistical tests performed were the χ2 test, Fisher exact test, independent sample t test, and Spearman correlation.

Results:

Seventy-three percent of 44 patients tested positive for 1 or more EMS. CA6 IgG was most frequently elevated, followed by CA6 IgM and parotid secretory protein IgG. EMS-positive versus EMS-negative subjects were more likely to escalate DE treatment past artificial tears to topical cyclosporine (n = 32, 100% vs. n = 9, 75%, P = 0.02). There were no demographic or comorbidity differences between EMS-positive and EMS-negative subjects, and marker levels did not correlate with more severe tear film measures.

Conclusions:

Most of the individuals with DE tested positive for 1 or more EMS antibodies, including men and Hispanics. Future studies will be needed to understand how to incorporate EMS data into the care of an individual with DE.
Astigmatism Orientation After Deep Anterior Lamellar Keratoplasty for Keratoconus and Its Correlation With Preoperative Peripheral Corneal Astigmatism
Authors: Elkadim Mohamed , Myerscough James , Bovone Cristina , Busin Massimo
Published: October 2019

Purpose:

To evaluate the orientation of keratometric astigmatism (KA) after deep anterior lamellar keratoplasty (DALK) for keratoconus and its correlation with preoperative peripheral KA.

Methods:

This is a retrospective, single-center observational study including keratoconic patients undergoing DALK between January 2016 and January 2017 with regular astigmatism postoperatively. The orientation of postoperative KA was classified as with-the-rule (WTR), against-the-rule, or oblique and was correlated with the corresponding preoperative peripheral KA, calculated by the sinusoidal fitting of points of the axial keratometric power map at 8 mm diameter.

Results:

Forty-one keratoconic eyes were included, with the most common orientation of KA post-DALK being WTR (65.9%), followed by against-the-rule (19.5%) and oblique (14.6%). A significant correlation was found between preoperative peripheral KA and post-DALK KA regarding axis (P < 0.001, r = 0.88) and power (P = 0.0128, r = 0.23).

Conclusions:

The axis of post-DALK astigmatism and to a lesser extent its respective power in keratoconic eyes can be predicted using the preoperative peripheral KA, with “WTR” being the most common astigmatic orientation.
Efficacy of Amniotic Membrane Transplantation for the Treatment of Corneal Ulcers
Authors: Schuerch Kaspar , Baeriswyl Andrea , Frueh Beatrice E. , Tappeiner Christoph
Published: October 2019

Purpose:

To evaluate the outcome of amniotic membrane transplantation (AMTX) as a treatment for corneal ulcers.

Methods:

Patients treated with AMTX for refractory corneal ulcers between 2012 and 2017 were evaluated in a retrospective analysis. Primary outcome measure was complete reepithelialization.

Results:

A total of 149 patients were included (mean age 68 ± 18 years). The mean duration between ulcer onset and AMTX was 42 ± 46 days. The longest time between ulcer diagnosis and AMTX was found in bacterial ulcers and the shortest time to AMTX in eyes with trauma/chemical burns (mean 65 ± 15 days and 14 ± 4 days, respectively). In 70% of the patients, a single AMTX procedure was sufficient to achieve epithelial closure (21% <1 month, 40% within 1 –3 months, and 9% within 3–6 months). Treatment failure was observed in 30% of all patients, and most of them underwent further interventions. Highest closure rates were found in bacterial ulcers, herpetic ulcers, and neurotrophic ulcers (80%, 85%, and 93%, respectively), whereas the lowest reepithelialization rates were found in ulcers after corneal surgery and ulcers associated with rheumatic disease (52% and 57%, respectively).

Conclusions:

AMTX is a valuable treatment option to achieve corneal epithelial wound healing in cases refractory to conventional treatment. Success rates differ depending on the etiology of ulcer.
Oxaliplatin-induced neuropathy occurs through impairment of haemoglobin proton buffering and is reversed by carbonic anhydrase inhibitors
Authors: Potenzieri Alberto , Riva Beatrice , Rigolio Roberta , Chiorazzi Alessia , Pozzi Eleonora , Ballarini Elisa , Cavaletti Guido , Genazzani Armando A.
Published: October 2019

Oxaliplatin is a cornerstone chemotherapeutic used in the treatment of colorectal cancer, the third leading cause of death in Western countries. Most side effects of this platinum-containing drug are adequately managed in the clinic, although acute and long-term neurotoxicity still severely compromises the quality of life of patients treated with oxaliplatin. We have previously demonstrated that therapeutically relevant concentrations/doses of oxaliplatin lead to a reduction in intracellular pH in mouse dorsal root ganglion (DRG) neurons in vitro and in vivo and that this alteration sensitizes TRPA1 and TRPV1 channels, which most likely mediate the allodynia associated with treatment. In this study, we show that oxaliplatin leads to a reduction of intracellular pH by forming adducts with neuronal haemoglobin, which acts in this setting as a proton buffer. Furthermore, we show that FDA-approved drugs that inhibit carbonic anhydrase (an enzyme that is linked to haemoglobin in intracellular pH homeostasis), ie, topiramate and acetazolamide, revert (1) oxaliplatin-induced cytosolic acidification and TRPA1 and TRPV1 modulation in DRG neurons in culture, (2) oxaliplatin-induced cytosolic acidification of DRG of treated animals, and (3) oxaliplatin-induced acute cold allodynia in mice while not affecting OHP-induced cytotoxicity on cancer cells. Our data would therefore suggest that reversal of oxaliplatin-induced cytosolic acidification is a viable strategy to minimize acute oxaliplatin-induced symptoms.
Gene amplification and tumor grading in parosteal osteosarcoma
Authors: Chen Paul Chih-Hsueh , Yen Chueh-Chuan , Hung Giun-Yi , Pan Chin-Chen , Chen Wei-Ming
Published: October 2019

Background:

Parosteal osteosarcoma (POS) is a unique low grade osteosarcoma. Two separate oncogenes,MDM2andCDK4, are specifically amplified in POS. Its clinical behavior is usually indolent. In some occasions, it may progress to high grade and become fatal. Malignant transformation with high grade differentiation is the most reliable indicator to predict its aggressiveness and metastatic potential. This study is to discover the relationship between gene amplification and grading.

Methods:

Retrospective analysis of MDM2/CDK4 expression/amplification using immunostaining, multiplex quantitative polymerase chain reaction (MQPCR) and fluorescencein situhybridization (FISH) were studied on 14 patients with recurrent POS.

Results:

Forty tumor specimens in formalin-fixed paraffin-embedded blocks from 14 patients of POS were included in this study. Twenty-seven tumors are low-grade, 13 are high-grade. All POS showed increased expression of both MDM2 and CDK4 proteins, but not those from conventional osteosarcoma. Except some tumors were non-informative (poor DNA quality), the rest of POS had a marked increase ofMDM2andCDK4genes copies by MQPCR, and confirmed byMDM2FISH. Moreover, the folds of amplification increase as tumors progress. And, the amplification folds in high-grade POS are consistently higher than those of conventional ones.

Conclusion:

FISH and MQPCR are both useful assays for estimating oncogene amplification status in bone tumors. Amplification levels ofMDM2andCDK4are related to tumor grading and progression. Molecular determination of gene amplification status can be a reliable alternative for predicting clinical behavior of POS at small biopsies.
Regulatory cytokines prescribe the outcome of the inflammation in the process of pseudoexfoliation production
Authors: SarenacVulovic Tatjana , Pavlovic Sladjana , Lutovac Mitar , Zdravkovic Vladimir , Sreckovic Suncica , Zdravkovic Nemanja
Published: October 2019

Background:

The purpose of this study is to reveal the participation of different regulatory cytokines within the process of pseudoexfoliation (PEX).

Methods:

Our study included 140 patients referred to cataract surgery with early and late stage of pseudoexfoliation syndrome (XFS) or pseudoexfoliation glaucoma (XFG). Humor and serum levels of cytokines: transforming growth factor beta (TGF-β), platelet-derived growth factor (PDGF), epidermal growth factor (EGF), insulin-like growth factor (IGF), IL-8 and interferon-inducible T cell alpha chemoattractant (ITAC) were measured in a sample using high sensitivity enzyme-linked immunoabsorbent assay (ELISA) kit.

Results:

Our results indicate that profibrotic action induced by increasing TGF-β and PDGF locally activates fibrous tissue production in the early XFS with a prolonged effect of PDGF (late XFS) and finally (XFG stage) it is dominantly controlled by EGF and IGF. ITAC overrides angiogenetic effects of IL-8 in XFG.

Conclusion:

Based on our findings, local chronic inflammation in the eye is accompanied by the secretion of different profibrotic cytokines (TGF-β, PDGF, EGF, IGF, IL-8) without angiogenesis due to effects of ITAC.
Recidivism After Endoscopic Treatment of Cholesteatoma
Authors: Killeen Daniel E. , Tolisano Anthony M. , Kou Yann Fuu , Kutz Joe Walter , Isaacson Brandon
Published: October 2019

Objective:

To investigate the recidivism rate of cholesteatoma treated via endoscopic ear surgery (EES), either via transcanal endoscopic ear surgery or endoscopic assisted tympanomastoidectomy compared with a microscopic postauricular approach.

Study Design:

Retrospective chart review.

Setting:

Academic otology practice.

Patients:

Adult patients (18 years and older) with at least 11 months of surgical follow-up who were treated for cholesteatoma via endoscopic techniques or microscopic postauricular approach.

Intervention:

Use of the endoscope for cholesteatoma dissection.

Main Outcome Measure:

Residual or recurrent cholesteatoma identified at second look surgery or postoperative diffusion-weighted magnetic resonance imaging.

Results:

Fifty-nine patients treated for cholesteatoma via endoscopic techniques and 35 patients treated via microscopic postauricular approach were analyzed. The endoscopic group required significantly fewer mastoid procedures (28% versus 80%, p-value 0.001). Postoperative changes in median ABG (5 dB versus 3.75 dB, p = 0.9519), median PTA (6.875 dB versus 1.25 dB, p = 0.3864), and median word recognition score (0% versus 0%, p = 0.3302) were not significantly different between the EES and microscopic surgery groups. Median operative times were not significantly different between the two groups (182 min endoscopic versus 174 min microscopic, p-value 0.66). The rate of residual disease (17% EES versus 17% microscopic, p = 0.959) or disease recurrence (18% endoscopic versus 20% microscopic, p = 0.816) were not significantly different between the two groups.

Conclusions:

EES is an effective option for cholesteatoma management with similar rates of recurrent or residual disease as compared with the more traditional microscopic postauricular approach in these samples.
Obesity Is Not Associated With Postoperative Complications After Vestibular Schwannoma Surgery in a Large Single Institution Series
Authors: Lipschitz Noga , Kohlberg Gavriel D. , Walters Zoe A. , Tawfik Kareem O. , Samy Ravi N. , Pensak Myles L. , Zuccarello Mario , Andaluz Norberto , Dinapoli Vincent A. , Breen Joseph T.
Published: October 2019

Objective:

Determine whether elevated body mass index (BMI) is associated with postoperative complications after vestibular schwannoma (VS) surgery.

Study Design:

Retrospective case series.

Setting:

Tertiary referral center.

Patients:

Two hundred six patients undergoing surgery for VS between 2010 and 2017, grouped into obese and nonobese patients.

Intervention:

Surgery for VS resection.

Main Outcome Measures:

Postoperative facial nerve outcomes, length of hospital stay, presence of postoperative cerebrospinal fluid leak, 30-day readmission, return to the operating room, wound complications, cardiovascular and thromboembolic complications.

Results:

After excluding 1 patient for missing BMI, our cohort included 205 patients. Seventy-nine patients (38.5%) were obese (mean BMI 36.2 kg/m2, range 30–55.1) and the remaining 126 (61.5%) were nonobese (mean BMI 25.0, range 18.8–29.8 kg/m2). Compared with nonobese patients, obesity was not associated with postoperative cerebrospinal fluid leak (OR 1.1, 95% CI 0.93–1.1), length of hospital stay (OR 0.98, 95% CI 0.65–1.47), 30-day readmission rates (1.04, 95% CI 0.95–1.14), return to operating room (OR 1.05, 95% CI 0.98–1.11), or other wound-related complications (OR 0.99, 95% CI 0.94–1.04).

Conclusion:

In this cohort, elevated BMI was not associated with an increased risk for postoperative complications after VS surgery. Our findings may mitigate concerns associated with surgical management of VS in obese patients.
Combined Endoscopic and Microscopic Surgery for Perilabyrinthine Lesions: Feasibility and Technique
Authors: Wei Xingmei , Gao Zhiqiang , Tian Xu , Zhao Yang , Feng Guodong
Published: October 2019

Objectives:

To determine the feasibility of endoscopic-assisted surgery for lesions involving the perilabyrinthine recesses, and develop and validate a technique for this kind of lesions that increases the possibility of preserving the labyrinth and cochlea.

Study Design:

Observational study.

Setting:

Referral center.

Cases:

Five patients who underwent endoscopy-assisted surgery for lateral skull base pathology involving the perilabyrinthine recesses between July 2010 and March 2016 were reviewed.

Interventions:

Clinical data of the five patients were collected.

Main Outcomes Measures:

Hearing level and recurrence.

Results:

Three of the five patients (three women, two men) had petrous bone cholesteatomas, one a facial neurofibroma, and one a petrous bone cholesterol granuloma. Complete excision with labyrinth and cochlea preservation was achieved using an endoscopic-assisted technique in all patients. Four had preoperative conductive hearing loss and one was totally deaf. In one patient, the postoperative air-bone gap was 30 dB lower than preoperatively levels, one stayed the same, and one was 30 dB because of closing of the external ear canal. After an average follow-up of 62.9 months, no patient had recurrence.

Conclusions:

Endoscope-assisted surgery is feasible for lesions involving the perilabyrinthine recesses and increases the likelihood to preserve the structure and function of labyrinth/cochlea, which may provide chances for artificial hearing devices implantation.
Horizontal Vestibulo-Ocular Reflex Gain Measures During Convergence Using a Monocular Video Technique
Authors: Figtree William V. C. , Schubert Michael C. , Migliaccio Americo A.
Published: October 2019

Hypothesis:

Vestibulo-ocular reflex (VOR) response measures during convergence, which are clinically important to measure peripheral vestibular organ function during rotational and translational rapid head movements, can be implemented using existing clinically available monocular video-oculography (VOG) systems.

Background:

We have developed and validated a monocular VOG technique that allows for accurate measurement of the convergence angle immediately before a rapid translational or rotational head movement.

Methods:

We recorded binocular eye movements while subjects performed active or passive horizontal head impulses while viewing near and far targets. We calculated the convergence angles and VOR gains using monocular and binocular methods and compared them with a geometric model.

Results:

The monocular VOG technique resulted in convergence angle and VOR gain (eye velocity/head velocity) calculations that differed by ∼10% compared with values calculated using the binocular data.

Conclusions:

The monocular VOG technique can be clinically implemented using any unmodified, commercially available, monocular VOG system, provided its camera can be positioned to track either eye. Many vestibular clinics already have access to such systems. This method makes possible reliable measurement of the near-viewing horizontal angular VOR during the head impulse test, the translational VOR during the head heave test in patients, and the clinical measurement of convergence insufficiency.
Auditory Characteristics in Patients With Mucopolysaccharidosis
Authors: Ahn Jungmin , Lee Jung Joo , Park Song-I. , Cho Sung-Yoon , Jin Dong-Kyu , Cho Yang-Sun , Chung Won-Ho , Hong Sung-Hwa , Moon Il Joon
Published: October 2019

Objective:

The purpose of the study was to evaluate audiologic findings according to mucopolysaccharidosis (MPS) subtypes and to estimate hearing changes as the disease progressed, as well as the therapeutic effect of enzyme replacement therapy on the hearing apparatus.

Methods:

A total of 124 patients who were diagnosed with MPS between September 1994 and December 2016 were retrospectively analyzed. Play audiometry or pure-tone audiometry was performed for hearing assessment, and auditory brainstem response was conducted in patients with poor compliance.

Results:

In total 124 patients were identified, ranging in age at diagnosis from 0 to 33 years. Fourteen of the patients had been diagnosed with type I, while 91 had type II, 2 had type III, 14 had type IV, and 3 had type VI. Mean bone conduction and air conduction for the better ear were 26.13±16.95 dB and 34.77 ± 20.00 dB in all patients, and 34.20±7.64 dB and 40.70±9.67 dB in patients with MPS II. The average auditory brainstem response threshold was 68.96 ±21.93 dB nHL. The most common type of hearing loss was pure sensorineural hearing loss in all subtypes, and the degree of hearing loss was variable mostly within the mild to severe range. The increase in the hearing threshold was also significantly correlated with the disease duration. However, the change in hearing level was not correlated with the duration of enzyme replacement therapy.

Conclusions:

Hearing impairment in MPS patients is common and is aggravated as the disease progresses. Thus, adequate intervention and hearing rehabilitation might play an important role in managing hearing disabilities in MPS patients.
Mortality and Cause of Death in Hearing Loss Participants: A Longitudinal Follow-up Study Using a National Sample Cohort
Authors: Kim So Young , Min Chanyang , Kim Hyung-Jong , Lee Chang Ho , Sim Songyong , Park Bumjung , Choi Hyo Geun
Published: October 2019

Objective:

The purpose of the present study was to estimate the risk of mortality in hearing loss subjects in accordance with the cause of death.

Study Design:

A longitudinal follow up study.

Setting:

Data from the Korean National Health Insurance Service-National Sample Cohort were collected from a period between 2002 and 2013.

Patients and Intervention:

The 4,606 severe and 1,007 profound hearing loss participants with 40 or more years old were 1:4 matched with control participants, respectively, for age, sex, income, and region of residence. The causes of death were grouped into 12 classifications.

Main Outcome Measures:

The ratio of mortality was compared between the hearing loss and control group using a χ2 test or Fisher's exact test. In a Cox-proportional hazard model, age, sex, income, region of residence, and past medical histories were considered confounders.

Results:

The severe and profound hearing loss groups showed 4.07 (95% CI = 3.71–4.46, p < 0.001) and 4.22 times (95% CI = 3.52–5.05, p < 0.001) higher mortality ratios in the adjusted models, respectively. Both the severe and profound hearing loss groups showed higher mortality by infection, neoplasm, trauma, and metabolic, mental, circulatory, respiratory, and digestive diseases than control groups (p < 0.05). Among various causes of death, death by trauma revealed the highest odds ratios in both the severe and profound hearing loss groups.

Conclusion:

Hearing loss was associated with a significant increase in mortality.
Whole-exome sequencing in a consanguineous Pakistani family identifies a mutational hotspot in the COL7A1 gene, causing recessive dystrophic epidermolysis bullosa
Authors: Rehman Atta Ur , Peter Virginie G. , Quinodoz Mathieu , Dawood Muhammad , Rivolta Carlo
Published: October 2019

Dystrophic epidermolysis bullosa is a major form of epidermolysis bullosa and may be inherited as an autosomal dominant or recessive trait, with associated mutations in the COL7A1 gene. Here, we describe a consanguineous Pakistani family with four affected individuals suffering from recessive dystrophic epidermolysis bullosa. Exome sequencing of the proband’s DNA revealed a homozygous missense variant (c.8038G>A:p.Gly2680Ser) in COL7A1 which cosegregated with disease in the family. The emergence of this particular glycine substitution in patients from diverse ethnic backgrounds such as China, United Kingdom, Poland, Iran, and Pakistan indicates that this variant most likely constitutes a recurrent mutational hotspot in the COL7A1 gene, rather than a germline mutation present at low levels in the general population.
Occupational voice is a work in progress: active risk management, habilitation and rehabilitation
Authors: Phyland Debra , Miles Anna
Published: October 2019

Purpose of review

The current article reviews recent literature examining occupational voice use and occupational voice disorders (January 2018–July 2019).

Recent findings

Our understanding of the prevalence of voice disorders and work-related vocal use, vocal load and vocal ergonomics (environmental and person influences) across different occupations is continuing to build. There is encouraging evidence for the value of intervention programs for occupational voice users, particularly of late with performers, teachers and telemarketers. Education and prevention programs are emerging for other ‘at risk’ occupations.

Occupational health and workforce legislation does not adequately acknowledge and guide educational, preventive and intervention approaches to occupational voice disorders. Voice disorders are prevalent in certain occupations and there is an urgent need for research to support occupational voice health and safety risk measurement, prevention and intervention. Large population-based studies are required with a focus on the health and economic burden of occupational voice disorders.
Obesity as a Potential Risk Factor for Vincristine-induced Peripheral Neuropathy
Authors: Sajdyk Tammy J. , Boyle Frances A. , Foran Kaitlin S. , Tong Yan , Pandya Pankita , Smith Ellen M.L. , Ho Richard H. , Wells Elizabeth , Renbarger Jamie L.
Published: October 2019

Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer. Vincristine is a core chemotherapeutic agent for patients with ALL; unfortunately, ∼78% will develop vincristine-induced peripheral neuropathy (VIPN). VIPN can result in vincristine dose reductions that decrease therapeutic efficacy: making it important to understand which children are at highest risk for VIPN. We hypothesized that pediatric ALL patients who were obese at diagnosis would develop worse VIPN than healthy weight children with ALL within the first year. Our results confirmed that obese pediatric patients have significantly (P=0.03) worse VIPN than patients of healthy weight.
Strategies to Promote the Success of Academically At-risk Accelerated Bachelor of Science in Nursing Students
Authors: Kramlich Debra , Holt Kristen , Law-Ham Dana
Published: October 2019

Background

Accelerated second-degree baccalaureate nursing (ABSN) programs are continuing to increase rapidly as a strategy to address a critical nursing shortage. The ABSN student profile differs from traditional entry-level nursing students, with some studies reporting higher attrition rates for ABSN students. Costs to students and nursing programs associated with program disruption can be high.

Purpose

The purpose was to identify academic risk factors and develop strategies to promote academic success for timely progression to graduation and licensure.

Methods

Two consecutive descriptive correlational studies were conducted on sequential ABSN cohorts in a nursing program in northern New England.

Results

Data revealed modifiable factors that put students at risk of program nonprogression or dismissal. Evidence-based, targeted, individualized academic support interventions were developed and implemented.

Conclusion

Strategies to promote academic success for ABSN students identified as at-risk have been shown to be effective.
The Essentials Competencies
Authors: Mitchell Ann M. , Mahmoud Khadejah F. , Finnell Deborah , Savage Christine L. , Weber Mary , Bacidore Vicki
Published: October 2019

Background

The use of substances including alcohol, tobacco, and other drugs increases the risk for injury, noncommunicable disease, and premature death and contributes to the global burden of disease.

Problem

The morbidity and mortality rates among patients with at-risk substance use point to the need for future nurses to have the requisite knowledge and competencies to provide care for this population.

Approach

This article provides guidance for nurse educators in designing curricula that include content related to substance use, including screening, brief intervention, and referral to treatment.

Outcomes

Expected outcomes for baccalaureate, master's, and doctor of nursing practice programs are informed by the corresponding American Association of Colleges of Nursing Essentials.

Conclusion

The overall goal of this guidance for nursing education is to advance the knowledge and competencies of the future nursing workforce to address the continuum of substance use and improve the health of the nation.
Pediatric Chronic Critical Illness: Gaps in Inpatient Intrateam Communication*
Authors: Hirschfeld Ryan S. , Barone Silvana , Johnson Emily , Boss Renee D.
Published: October 2019

Objectives:

The number of children with medical complexity and prolonged hospitalizations is rising. Strategies to adapt acute care approaches for this population are falling behind clinical demand. This study aimed to identify how inpatient team communication practices match the needs of teams caring for these patients and families, and to identify priority areas for improvement.

Design:

Cross-sectional mixed methods survey.

Setting:

Academic children’s hospital.

Subjects:

Interdisciplinary healthcare professionals: physicians, nurse practitioners, nurses, resident and fellow trainees, respiratory therapists, clinical pharmacists, occupational therapists, physical therapists, social workers, and child life specialists.

Interventions:

None.

Measurements and Main Results:

Four-hundred eight interdisciplinary healthcare professionals participated (33% response rate). Half (53%) worked in ICUs and 37% had greater than 10 years clinical experience. Three overarching themes emerged regarding communication during care of children with prolonged hospitalizations are as follows: 1) Dysfunctional team collaboration: the many involved healthcare providers for these children have inconsistent team meetings and few platforms for reaching clinical consensus; 2) Continuity gaps: time-limited clinician rotations and no designated longitudinal clinical leaders undermine relationships with families and key elements of shared decision-making; and 3) Inadequate communication skills and tools: healthcare professionals have inadequate training to address complex conversations and big picture concerns, and often default to daily management conversations. Nearly half (40%) perceived intra-team conflict to occur more commonly during care of these children compared with those with short hospitalizations, and many feel unskilled to address these conflicts. Healthcare providers working in ICUs were more likely than other healthcare providers to find care of children with chronic critical illness stressful “most of the time” (ICU 46%; 60/131 vs non-ICU 25%; 21/84; p = 0.02).

Conclusions:

Acute care inpatient communication practices require modification to meet the needs of healthcare professionals who provide longitudinal care to children with repeated and prolonged hospitalizations. Improvement strategies should prioritize building collaboration, continuity, and communication skills among healthcare professionals.
Reliability and Validity of the Korean Version of the Spinal Cord Independence Measure III
Authors: Cho Duk Youn , Shin Hyung-Ik , Kim Hye-Ri , Lee Bum-Suk , Kim Gyu Ree , Leigh Ja-Ho , Lee Keum-Ju , Han Zee-A
Published: October 2019

Objective

Given the lack of a Korean version of the Spinal Cord Independence Measure III (KSCIM-III) that accurately reflects the contextual and cultural aspect of the assessment tool, the aims of the study were to develop a new Korean version of the Spinal Cord Independence Measure III and to investigate its reliability and validity.

Design

Forty (N = 40) consecutive patients with spinal cord injury were included in this prospective study. Backward and forward translation of the Spinal Cord Independence Measure III was performed by fluent speakers in both languages. To measure the validity of Korean version of the Spinal Cord Independence Measure III, the scores were compared with the Modified Barthel Index. Each patient was examined by two occupational therapists. For test-retest reliability assessment, follow-up evaluation was repeated 1 mo after the initial assessment by the same evaluator.

Results

Reliability between the Korean version of the Spinal Cord Independence Measure III evaluators showed values of 0.710–1.000, and test-retest reliability showed high values ranging from 0.295 to 0.664. The validity of Korean version of the Spinal Cord Independence Measure III was confirmed by the close correlation with Modified Barthel Index (r = 0.953, P < 0.001).

Conclusions

The results of this study showed high interrater and substantial test-retest reliability. The Korean version of the Spinal Cord Independence Measure III is an appropriate tool to assess the activities of daily living in terms of independence for patients with spinal cord injury.
Factors Associated With Gains in Performance During Rehabilitation After Pediatric Brain Injury
Authors: Krasovsky Tal , Barak Sharon , Silberg Tamar , Yissar Tamar , Brezner Amichai , Landa Jana
Published: October 2019

Objective

Predicting recovery of functional performance within pediatric rehabilitation after brain injury is important for health professionals and families, but information regarding factors associated with change in functional skills (“what the child can do”) and functional independence (“what the child does”) is limited. The aim of the study was to examine change in functional skills and independence over time in children with moderate-severe brain injury during prolonged inpatient rehabilitation.

Design

This study used a retrospective cohort design. Longitudinal data from 139 children (age 1.6–20.6 yrs), hospitalized for 115.4 ± 72 days, were examined. Growth curve analysis was used to examine factors associated with change in the Pediatric Evaluation of Disability Inventory (functional skills and caregiver assistance, ie, functional independence) in mobility and self-care. Typical estimates for change per hospitalization day were obtained.

Results

Traumatic brain injury and older age at injury, but not sex, were associated with faster recovery. Length of stay was associated with rate of change in functional skills but not in functional independence, suggesting that improvement in functional independence during rehabilitation may be associated with other factors.

Conclusions

Identifying the factors associated with individual profiles of functional improvement can provide valuable information for clinicians and decision-makers to optimize performance after prolonged inpatient rehabilitation.