bluuebunny/crossref_metadata_2025 huggingface dataset:
Lights on MsFLASH: a review of contributions
Authors: Reed Susan D. , LaCroix Andrea Z. , Anderson Garnet L. , Ensrud Kristine E. , Caan Bette , Carpenter Janet S. , Cohen Lee , Diem Susan J. , Freeman Ellen W. , Joffe Hadine , Larson Joseph C. , McCurry Susan M. , Mitchell Caroline M. , Newton Katherine M. , Sternfeld Barbara , Guthrie Katherine A.
Published: January 2020

Objective:

The Menopause Strategies: Finding Lasting Answers for Symptoms and Health clinical trials network was funded by the National Institutes of Health to find new ways to alleviate the most common, bothersome menopausal symptoms by designing and conducting multiple concurrent clinical intervention studies, accommodating a wide scope of populations and intervention strategies.

Methods:

Trials were conducted in Boston, Indianapolis, Minneapolis, Oakland, Philadelphia, and Seattle, with the Data Coordinating Center in Seattle, and were designed with standardized eligibility criteria and endpoints. Primary outcomes focused on vasomotor symptoms, sleep quality and insomnia symptoms, and vaginal symptoms. Secondary outcomes included quality of life, sexual function, and mood.

Results:

We completed five randomized clinical trials and three ancillary studies, testing nine interventions in over 1,300 women and collecting nearly 16,000 bio-specimens. Escitalopram, venlafaxine hydrochloride extended release, and low-dose estradiol diminished hot flashes by approximately 50% as compared with a 30% decrease by placebo. No benefits on vasomotor symptoms were observed with yoga or exercise compared with usual activity, nor with omega-3 supplementation compared with placebo. Cognitive behavioral therapy for insomnia reduced self-reported insomnia symptoms and improved overall sleep quality compared with menopause education control. We did not find significant benefit from a vaginal estradiol tablet or a vaginal moisturizer compared with placebo tablet and gel in diminishing the severity of vaginal symptoms.

Conclusions:

The MsFLASH trials contributed substantially to our understanding of bothersome menopausal symptom treatment. It is important that clinicians counseling women about available treatment options consider all therapies—both nonhormonal and hormonal.
Intraoperative Laser Speckle Contrast Imaging in DIEP Breast Reconstruction: A Prospective Case Series Study
Authors: Zötterman Johan , Opsomer Dries , Farnebo Simon , Blondeel Phillip , Monstrey Stan , Tesselaar Erik
Published: January 2020

Introduction:

Laser speckle contrast imaging (LSCI) is a laser-based perfusion imaging technique that recently has been shown to predict ischemic necrosis in an experimental flap model and predicting healing time of scald burns. The aims were to investigate perfusion in relation to the selected perforator during deep inferior epigastric artery perforator (DIEP) flap surgery, and to evaluate LSCI in assisting of prediction of postoperative complications.

Methods:

Twenty-three patients who underwent DIEP-procedures for breast reconstruction at 2 centers were included. Perfusion was measured in 4 zones at baseline, after raising, after anastomosis, and after shaping the flap. The perfusion in relation to the selected perforator and the accuracy of LSCI in predicting complications were analyzed.

Results:

After raising the flap, zone I showed the highest perfusion (65 ± 10 perfusion units, PU), followed by zone II (58 ± 12 PU), zone III (53 ± 10 PU), and zone IV (45 ± 10 PU). The perfusion in zone I was higher than zone III (P = 0.002) and zone IV (P < 0.001). After anastomosis, zone IV had lower perfusion than zone I (P < 0.001), zone II (P = 0.01), and zone III (P = 0.02). Flaps with areas <30 PU after surgery had partial necrosis postoperatively (n = 4).

Conclusions:

Perfusion is highest in zone I. No perfusion difference was found between zones II and III. Perfusion <30 PU after surgery was correlated with partial necrosis. LSCI is a promising tool for measurement of flap perfusion and assessment of risk of postoperative ischemic complications.
Triple Use of Autologous Amnion Graft in the Treatment of Meningomyelocele and Split Cord Malformation
Authors: de Weerd Louis , Sjåvik Kristin , Pedersen Lars Kjelsberg , Weum Sven , Hennig Rune Otto
Published: January 2020

This article describes the triple use of autologous amnion graft as a new procedure in the treatment of myelomeningocele and in myelomeningocele with split cord malformation. The first amnion graft was used as a physical and mechanical barrier to protect the myelomeningocele (MMC) from desiccation and mechanical stress directly after birth. A second graft was used as a dura substitute to close the cerebrospinal fluid compartment. Autologous amnion seems to be the ideal dural graft for closure of an MMC and for an MMC with split cord malformation. A tension-free and watertight closure was obtained. With the epithelium side placed to the spinal cord and due to its beneficial effect on scar formation, the risk for tethering cord syndrome is reduced when using autologous amnion as a dural graft. The regenerative properties of autologous amnion may contribute to repair neural damage. Finally, a third amnion graft was placed beneath the perforator flap used to close the skin defect to provide a watertight barrier and to stimulate flap survival.
Management of Pediatric Distal Fingertip Injuries: A Systematic Literature Review
Authors: Venkatesh Ashwin , Khajuria Ankur , Greig Aina
Published: January 2020

Background:

Nail bed and fingertip injuries are the commonest hand injuries in children and can lead to profound functional and cosmetic impairments if not appropriately managed. Fingertip injuries can present with subungual hematomas, simple or stellate lacerations, crush, or avulsion injuries, often with associated fractures or tip amputations. The fundamentals of managing nail bed injuries concern restoring the form and function of a painless fingertip. However, there are controversies surrounding the optimal management of each of these injuries, which has led to nonuniformity of clinical practice.

Methods:

The PubMed database was searched from March 2001 to March 2019, using a combination of MeSH terms and keywords. Studies evaluating children (<18 years of age) and the fingertip (defined as distal to the distal interphalangeal joint) were included following screening by the authors.

Results and Conclusion:

The evidence base for the diverse clinical management strategies currently employed for fingertip injuries in the pediatric population is limited. Further studies yielding level I data in this field are warranted.
Needle Fasciotomy or Collagenase Injection in the Treatment of Dupuytren’s Contracture: A Retrospective Study
Authors: Abdelrahman Islam , Elmasry Moustafa , Steinvall Ingrid , Turesson Christina , Sjöberg Folke , Hansson Thomas
Published: January 2020

Background:

Dupuytren’s contracture is common among older people in Sweden. Previous studies comparing the treatment with an injection of collagenase with percutaneous needle fasciotomy found no differences.

Methods:

We retrospectively compared the degree of improvement in the deficit in extension of the joints in 2 groups of patients who had been treated with collagenase (71 fingers) or needle fasciotomy (109 fingers) before and 1 year after treatment. We compared the improvement of the extension deficit among the metacarpophalangeal (MCP) and proximal interphalangeal joints before and after the intervention; additionally, the level of improvement was classified into 3 levels (mild = 0° to 29°; moderate = 30° to 60°; considerable = 61° and more).

Results:

The degree of improvement of extension in the MCP joints was 11° greater in the collagenase group (P = 0.001). The number of patients who had an improvement of >60° (considerable) in extension was greater in the collagenase group (P = 0.02).

Conclusion:

Collagenase was more effective than needle fasciotomy in treating extension deficits of the MCP joints in Dupuytren’s contracture in this retrospective analysis. Further prospective studies are required to confirm the finding.
The “Needle-splint” Technique: A Method of Accurate Apposition and Eversion during Microvascular Anastomosis
Authors: Pafitanis Georgios , Pahal Gurjinderpal Singh , Myers Simon , Ramakrishnan Venkat
Published: January 2020

We present the “needle-splint” technique, a microsurgical suturing technique that enhances micro-suturing technique, while ensures finer apposition and vessels walls eversion during the placement of sutures in microvascular anastomosis. This report demonstrates the usefulness of this technique in simple interrupted, continuous-interrupted, or multi-loops microsurgical suturing. It further allows direct visualization of the intra-wall-edges space and intimal sutures surface and could be utilized as a safety stabilizer to errors as it allows optimal vessels alignment while the needle curvature is acting as a “pusher” to separate the posterior wall during knot tying.
Nutraceuticals and blood pressure control: a European Society of Hypertension position document
Authors: Borghi Claudio , Tsioufis Konstantinos , Agabiti-Rosei Enrico , Burnier Michel , Cicero Arrigo F.G. , Clement Denis , Coca Antonio , Desideri Giovambattista , Grassi Guido , Lovic Dragan , Lurbe Empar , Kahan Thomas , Kreutz Reinhold , Jelakovic Bojan , Polonia Jorge , Redon Josep , Van De Borne Philippe , Mancia Giuseppe
Published: January 2020

High-normal blood pressure (BP) is associated with an increased risk of cardiovascular disease, however the cost–benefit ratio of the use of antihypertensive treatment in these patients is not yet clear. Some dietary components and natural products seems to be able to significantly lower BP without significant side effects. The aim of this position document is to highlight which of these products have the most clinically significant antihypertensive action and wheter they could be suggested to patients with high-normal BP. Among foods, beetroot juice has the most covincing evidence of antihypertensive effect. Antioxidant-rich beverages (teas, coffee) could be considered. Among nutrients, magnesium, potassium and vitamin C supplements could improve BP. Among nonnutrient-nutraceuticals, soy isoflavones could be suggested in perimenopausal women, resveratrol in insulin-resistant patients, melatonin in study participants with night hypertension. In any case, the nutracutical approach has never to substitute the drug treatment, when needed.
Late-Life Depression: A Narrative Review on Risk Factors and Prevention
Authors: Vyas Chirag M. , Okereke Olivia I.
Published: January 2020

Learning objectives

After participating in this activity, learners should be better able to:

• Identify risk factors for late-life depression

• Evaluate strategies to prevent late-life depression

Late-life depression (LLD) is one of the major sources of morbidity and mortality in the world. Because LLD is related to increased public health burden, excess health care costs and utilization, reduced quality of life, and increased mortality, prevention is a priority. Older adults differ from younger adults with respect to key features, such as their chronicity and lifetime burden of depression and their constellation of comorbidities and risk factors. LLD likely arises from a complex interplay of risk factors, including medical, physiologic, psychosocial, behavioral, and environmental factors. Thus, a comprehensive understanding of LLD risk factors is necessary to inform prevention strategies. In this narrative literature review, we address both the risk architecture of LLD and several potential strategies for prevention. Our description of LLD risk factors and prevention approaches is informed by the framework developed by the National Academy of Medicine (formerly, Institute of Medicine), which includes indicated, selective, and universal approaches to prevention.
Limbal Stem Cell Deficiency After Glaucoma Surgery
Authors: Sun Yuzhao , Yung Madeline , Huang Linying , Tseng Chihong , Deng Sophie X.
Published: January 2020

Purpose:

To characterize the clinical presentation of limbal stem cell deficiency (LSCD) associated with glaucoma surgeries.

Methods:

This is a retrospective cross-sectional study of patients with LSCD and glaucoma who presented to the Stein Eye Institute at the University of California, Los Angeles, between 2009 and 2018. Patients who underwent trabeculectomy and/or aqueous shunt surgery were included. The severity of LSCD was staged using global consensus guidelines and a clinical scoring system, and basal epithelial cell density was measured by in vivo confocal microscopy. Anatomic locations of glaucoma and non-glaucoma surgeries, locations of LSCD, and severity of LSCD were compared.

Results:

Fifty-one eyes of 41 patients with LSCD associated with glaucoma surgery were included in this study. LSCD in these patients uniquely featured sectoral replacement of corneal epithelium by conjunctival epithelium, without corneal neovascularization or pannus. The sites of glaucoma surgery strongly correlated with the locations of LSCD (P = 0.002). There was a trend toward increased severity of LSCD in eyes with 2 or more glaucoma surgeries as compared to eyes with 1 glaucoma surgery, although the difference did not reach statistical significance (P = 0.3). Use of topical glaucoma medications correlated with LSCD severity, while the impact of antimetabolites did not reach statistical significance. The location of glaucoma drainage surgery is correlated with the location of LSCD.

Conclusions:

LSCD associated with glaucoma surgery has clinical features distinct from LSCD resulting from other etiologies. Further study is required to delineate the full impact of glaucoma surgery on limbal stem cell function and survival.
Mitochondrial Markers in Aging and Primary Open-Angle Glaucoma
Authors: Liu Hanhan , Mercieca Karl , Prokosch Verena
Published: January 2020

This review focuses on recent progress in understanding the role of mitochondrial markers in the context of mitochondrial dysfunction in glaucoma and discussing new therapeutic approaches to modulate mitochondrial function and potentially lead to improved outcomes in glaucoma.
Waste production from phacoemulsification surgery
Authors: Khor Hui Gim , Cho Irene , Lee Kenneth Rohan Chee Keong , Chieng Lee Ling
Published: January 2020

Purpose:

To determine the amount of waste produced from phacoemulsification surgeries and ways to curtail the problem.

Setting:

Miri Hospital, Sarawak, Malaysia.

Design:

Prospective study.

Methods:

Phacoemulsification surgery cases were included in this study; nonphacoemulsification surgeries were excluded. The waste was subdivided into 3 main categories, general waste, clinical waste, and sharps. The waste produced by ophthalmologists and trainees was accounted for separately. The mean weight of waste per case was obtained by dividing the total weight of waste produced with the total number of cases.

Results:

The total waste produced from a total of 203 cases of phacoemulsification surgeries was 167.965 kg, of which, 95.063 kg (56.6%) were clinical waste, 63.197 kg (37.6%) were general waste, and 9.705 kg (5.8%) were sharps; 32.193 kg (50.9%) out of the general waste pool were recyclable waste products. The mean waste production per case of phacoemulsification surgery for an ophthalmologist was 0.814 kg, 1.086 kg per case for a trainee. A case of phacoemulsification surgery would produce 0.282 kg of carbon dioxide equivalents in the setup based on the recyclable general waste.

Conclusions:

The average waste produced per case of phacoemulsification surgery in Miri Hospital was 0.827 kg. After excluding the recyclable material, the average waste produced per case was 0.669 kg. Following the 3 R's principles (reduce, reuse, and recycle) in the handling of waste production might reduce environmental impact.
Evaluation of total corneal power measurements with a new optical biometer
Authors: Shajari Mehdi , Sonntag Ruven , Ramsauer Michaela , Kreutzer Thomas , Vounotrypidis Efstathios , Kohnen Thomas , Priglinger Siegfried , Mayer Wolfgang J.
Published: January 2020

Purpose:

To evaluate the repeatability and validity of total corneal power measurements (total keratometry [TK]) obtained with a recently introduced optical biometer (IOLMaster 700, Carl Zeiss Meditec AG) to a Scheimpflug device (Pentacam, Oculus).

Setting:

Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.

Design:

Prospective randomized controlled trial.

Methods:

The inclusion criteria were a corneal astigmatism of 3.00 diopters (D) or less, no previous ocular surgery, no known corneal irregularities, and no known dry eyes. All eyes were measured 3 times using the optical biometer and the Scheimpflug device. The results were statistically compared using Bland–Altman, within-subject SD, and astigmatism vector analysis.

Results:

Ninety-three eyes of 93 subjects were included. Overall, the repeatability of all eyes measured was 0.42 for standard K, 0.40 for TK, 0.45 for total corneal refractive power (TCRP), 0.43 for true net power (TNP), and 0.39 for simulated K. Bland–Altman analysis showed no significant difference between the optical biometer's TK compared with standard K and the Scheimpflug device's simulated K, TNP, and TCRP, the P value exceeding .05 in each case. A difference of >0.50 diopters between astigmatism measurements between TK and TCRP was found in 10 cases compared with standard K and TNP with 0 and 2 cases.

Conclusions:

Repeatability of both devices was high, although measurements of meridian showed a great variability, suggesting that numerous measurements are needed to enhance accuracy. TCRP measurements between recently introduced TK and TCRP cannot be used interchangeably. Future studies are necessary to evaluate which measurement will result in a better outcome when respective measurements are used for toric intraocular lens calculations.
A systematic review and meta-analysis of pregabalin preclinical studies
Authors: Federico Carole A. , Mogil Jeffrey S. , Ramsay Tim , Fergusson Dean A. , Kimmelman Jonathan
Published: January 2020

Despite large efforts to test analgesics in animal models, only a handful of new pain drugs have shown efficacy in patients. Here, we report a systematic review and meta-analysis of preclinical studies of the commercially successful drug pregabalin. Our primary objective was to describe design characteristics and outcomes of studies testing the efficacy of pregabalin in behavioral models of pain. Secondarily, we examined the relationship between design characteristics and effect sizes. We queried MEDLINE, Embase, and BIOSIS to identify all animal studies testing the efficacy of pregabalin published before January 2018 and recorded experimental design elements addressing threats to validity and all necessary data for calculating effect sizes, expressed as the percentage of maximum possible effect. We identified 204 studies (531 experiments) assessing the efficacy of pregabalin in behavioral models of pain. The analgesic effect of pregabalin was consistently robust across every etiology/measure tested, even for pain conditions that have not responded to pregabalin in patients. Experiments did not generally report using design elements aimed at reducing threats to validity, and analgesic activity was typically tested in a small number of model systems. However, we were unable to show any clear relationships between preclinical design characteristics and effect sizes. Our findings suggest opportunities for improving the design and reporting of preclinical studies in pain. They also suggest that factors other than those explored in this study may be more important for explaining the discordance between outcomes in animal models of pain and those in clinical trials.
Pharmacological characterization of a rat Nav1.7 loss-of-function model with insensitivity to pain
Authors: Chen Lubin , Effraim Philip R. , Carrara Jennifer , Zhao Peng , Dib-Hajj Fadia B. , Dib-Hajj Sulayman D. , Waxman Stephen G.
Published: January 2020

Sodium channel Nav1.7, encoded by the SCN9A gene, is a well-validated target that plays a key role in controlling pain sensation. Loss-of-function mutations of Nav1.7 can cause a syndrome of profound congenital insensitivity to pain in humans. Better understanding of how the loss of Nav1.7 leads to loss of pain sensibility would help to decipher the fundamental mechanisms of nociception and inform strategies for development of novel analgesics. Using a recently described rat Nav1.7 loss-of-function model with deficient nociception but intact olfactory function, we investigated the involvement of endogenous opioid and cannabinoid systems in this rodent model of Nav1.7-related congenital insensitivity to pain. We found that both the opioid receptor antagonist naloxone and cannabinoid receptor blockers SR141716A (rimonabant) and SR144528 fail to restore acute pain sensitivity in Nav1.7 loss-of-function rats. We observed, however, that after rimonabant administration, Nav1.7 loss-of-function but not WT rats displayed abnormal behaviours, such as enhanced scratching, caudal self-biting, and altered facial expressions; the underlying mechanism is still unclear. Dorsal root ganglion neurons from Nav1.7 loss-of-function rats, although hypoexcitable compared with WT neurons, were still able to generate action potentials in response to noxious heat and capsaicin. Our data indicate that complete loss of dorsal root ganglion neuron excitability is not required for insensitivity to pain and suggest that endogenous opioid and cannabinoid systems are not required for insensitivity to pain in the absence of Nav1.7 channels in this rat Nav1.7 loss-of-function model.
Physiotherapists' perceptions of learning and implementing a biopsychosocial intervention to treat musculoskeletal pain conditions: a systematic review and metasynthesis of qualitative studies
Authors: Holopainen Riikka , Simpson Phoebe , Piirainen Arja , Karppinen Jaro , Schütze Rob , Smith Anne , O'Sullivan Peter , Kent Peter
Published: January 2020

Clinical practice guidelines recommend a biopsychosocial approach for the management of musculoskeletal pain conditions, but physiotherapists have reported feeling inadequately trained and lacking in confidence to deal with psychosocial issues. Although a growing number of studies are exploring physiotherapists' perceptions of biopsychosocial training, the results have not been synthesized. Therefore, the aim of this systematic review and metasynthesis of qualitative studies was to explore physiotherapists' perceptions of learning and implementing a biopsychosocial intervention to treat musculoskeletal pain conditions. A search of the electronic databases: MEDLINE, EMBASE, CINAHL, ERIC, PsycInfo, SportDiscus, and Sociological abstracts identified eligible studies. We included full-text qualitative and mixed-methodology studies published in English, which investigated physiotherapists' perceptions of learning and implementing biopsychosocial interventions. Twelve studies involving 113 participants met the inclusion criteria, and a thematic synthesis was conducted. The quality of the included studies was appraised using the Clinical Appraisal Screening Program. Four main themes emerged from the data: changed understanding and practice, professional benefits, clinical challenges, and learning requirements. The results of this study indicate that although the physiotherapists reported a shift towards more biopsychosocial and person-centered approaches, the training interventions did not sufficiently help them feel confident in delivering all the aspects. Planning future implementation interventions and training physiotherapists through a biopsychosocial approach should focus on adequate training and individualized mentoring related to psychosocial factors, and discussion of role boundaries, patient expectations, and organizational factors such as time constraints and referral pathways.
Does experimentally induced pain-related fear influence central and peripheral movement preparation in healthy people and patients with low back pain?
Authors: Schouppe Stijn , Clauwaert Amanda , Van Oosterwijck Jessica , Van Damme Stefaan , Palmans Tanneke , Wiersema Jan R. , Sanchis-Sanchéz Enrique , Danneels Lieven
Published: January 2020

Nonspecific chronic low back pain (CLBP) is a multifactorial disorder. Pain-related fear and altered movement preparation are considered to be key factors in the chronification process. Interactions between both have been hypothesized, but studies examining the influence of situational fear on movement preparation in low back pain (LBP) are wanting, as well as studies differentiating between recurrent LBP (RLBP) and CLBP. Therefore, this study examined whether experimentally induced pain-related fear influences movement preparation. In healthy controls (n = 32), RLBP (n = 31) and CLBP (n = 30) patients central and peripheral measures of movement preparation were assessed by concurrently measuring trunk muscle anticipatory postural adjustments (APA) with electromyography and contingent negative variation with EEG during performance of rapid arm movements. Two conditions were compared, one without (no fear) and one with (fear) possibility of painful stimulation to the back during rapid arm movements. Visual analogue scales were used to assess pain-related expectations/fear in both conditions. The experimentally induced fear of pain during movement performance led to an increase in contingent negative variation amplitude, which was similar in all 3 groups. Concerning APAs, no effects of fear were found, but group differences with generally delayed APAs in CLBP compared with controls and RLBP patients were evident. These results suggest that with fear, an attentional redirection towards more conscious central movement preparation strategies occurs. Furthermore, differences in movement preparation in patients with RLBP and CLBP exist, which could explain why patients with RLBP have more recovery capabilities than patients with CLBP.
Efficacy of a Mobile Behavioral Intervention for Workers With Insomnia
Authors: Omeogu Chinyere , Shofer Frances , Gehrman Philip , Green-McKenzie Judith
Published: January 2020

Objective:

Insomnia is often unrecognized in the workplace despite a 10% prevalence. Cognitive behavioral therapy for insomnia (CBTi) is efficacious but often not available. This study assessed the efficacy of the self-guided CBTi Coach mobile app.

Methods:

Using a pre/post design, the CBTi Coach was evaluated prospectively in hospital nurses with insomnia. The primary outcome measured was the Insomnia Severity Index (ISI) at 0, 3, and 6 weeks.

Results:

Thirteen of 17 (76%) female nurses who worked day shifts completed the study. Baseline ISI was 18.1 (range 15 to 22). After 3 and 6 weeks, ISI significantly decreased to 12 and 11, respectively. No difference in ISI score was noted between weeks 3 and 6.

Conclusion:

Use of CBTI Coach app demonstrated significant improvement in sleep quality in nurses with insomnia without coaching or healthcare provider visits.
Does Depression Mediate the Effect of Work Organization Conditions on Job Performance?
Authors: Parent-Lamarche Annick , Marchand Alain , Saade Sabine
Published: January 2020

Objective:

The present study proposes to shed light on the impact of workers’ depression on their work performance.

Methods:

We implemented a path analyses adjusted for design effects resulting from cluster sampling using MPlus software
1
on a sample of 1957 workers. These analyses allowed us to evaluate direct and indirect effects (mediation) while taking into account the nonindependence of observations due to cluster sampling (workers nested in their workplace).

Results:

Results indicate that three indirect associations were found to be significant. Psychological demands, work schedule, and job insecurity were indirectly associated with lower levels of professional efficacy/job performance because of their positive associations with depression.

Conclusions:

The results obtained suggest that interventions targeting specific work organization conditions could be warranted.
Exploring the Effectiveness of Mindfulness and Decentering Training in a Physician Assistant Curriculum
Authors: Hoover Eve B. , Butaney Bhupin , Stoehr James D.
Published: January 2020

Purpose

Several studies have documented the effects of physician assistant (PA) training on students' perceived stress and life satisfaction. Innovative curriculum design incorporating effective stress management resources may help address this concern.

Methods

Mindfulness and decentering training was incorporated into a first-quarter course for PA students. It included lecture, in-class demonstrations and practice, and out-of-class activities. Mindfulness (Experiences Questionnaire; Acceptance and Action Questionnaire) and general well-being (Satisfaction with Life Scale; Perceived Stress Scale) were assessed precourse, postcourse, and during follow-up.

Results

Students reported a significant increase in levels of mindfulness postcourse, which remained stable at a 4-month follow-up. These findings were consistent regardless of prior mindfulness practice. More importantly, changes in the levels of mindfulness significantly predicted changes in life satisfaction and perceived stress.

Conclusion

Stress management resources can be incorporated into PA courses through innovative curriculum design to help students cope with the demands of PA school.
Economic Evaluation of Percutaneous Titanium Implants for Bone Conduction Hearing: A Cost-benefit Analysis
Authors: Kruyt Ivo J. , Bours Marcel R. W. , Rovers Maroeska M. , Hol Myrthe K. S. , Rongen Jan
Published: January 2020

Introduction:

Developments in bone-anchored hearing implants have resulted in fewer complications, and, thus, lower complication-related costs. However, a weighing of the potential clinical benefits with higher implant purchase price is lacking.

Methods:

A mathematical Markov model was used to evaluate the total costs (complication costs, implant purchase price, and standard costs) of three widely used current generation implants with expected similar outcomes, compared to a previous generation implant in adult patients over a 10-year time horizon from a healthcare perspective. Parameter estimates were derived from published clinical literature. Missing parameter estimates were based on expert opinion. Implant costs were derived from manufacturer catalogues, while standard and complication costs related to the BAHI were derived from a Dutch University Hospital and Dutch guideline for cost-effectiveness research.

Results:

The average total costs of the treatment with a previous generation implant was €4.967 (SD ± €134) per patient over a 10-year time horizon, compared to €4.678 (SD ± €83) with a current generation implant. This implant type is potentially up to €506 more beneficial per patient over a 10-year horizon. By further improving implant survival, an additional €645 (SD ± €86) per patient could be saved over 10 years.

Conclusion:

Despite a higher initial purchase price, the current generation implants are potentially cost-beneficial compared with previous generation implants. More data on current generation implants is needed to be able to determine which of the newer implants is most cost-beneficial. Focussing future developments on improving implant survival is likely to have more impact on costs compared with developments on improving soft tissue tolerability.
Extracorporeal Membrane Oxygenation as Salvage Therapy in the Peripartum Period: A Case Series
Authors: Patel Sameer , Loveridge Robert , Willars Chris , Vercueil Andre , Best Thomas , Auzinger Georg
Published: January 2020

Despite considerable advances in maternity care, maternal death rates remain unacceptably high. Even with optimal care, unexpected complications can result in catastrophic consequences. Hemorrhage, cardiovascular and coronary conditions, and cardiomyopathy make up the three most common causes of pregnancy-associated deaths, followed by sepsis and thromboembolic disease. Although a number of deaths may be deemed to be potentially avoidable with appropriate education and infrastructure, others such as refractory hypoxia and peripartum cardiomyopathy are not. All possible interventions should be explored, including the use of more novel and aggressive life support technologies, such as extracorporeal membrane oxygenation. We report the successful use of extracorporeal membrane oxygenation in three cases of severe peripartum morbidity. The first case describes spontaneous coronary artery dissection supported with veno-arterial extracorporeal membrane oxygenation for refractory cardiogenic shock after out-of-hospital cardiac arrest. The second is a case of severe pregnancy-related liver disease bridged to emergency liver transplantation with veno-venous extracorporeal membrane oxygenation. Finally, we report the use of extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest in a postpartum patient. Peripartum extracorporeal membrane oxygenation is feasible in carefully selected patients, and should be considered early when conventional therapy is failing, or as a salvage rescue therapy when it has failed.
A comparison of coagulation test results from heparinized central venous catheter and venipuncture
Authors: Jeon Mijin , Han Arum , Kang Hyeran , Lee Kyoo-Hyung , Lee Je-Hwan , Lee Jung-Hee
Published: January 2020

Blood sampling via heparin-locked central venous catheter, including coagulation tests, is possible in accordance with the Clinical & Laboratory Standards Institute guidelines. However, differences exist between the test values of samples obtained from central venous catheter and those obtained from peripheral veins, even the guidelines are followed. To compare the coagulation time between blood samples from the heparin-locked central venous catheter and peripheral veins. In total, 72 hospitalized patients using heparin-locked Hickman catheters were enrolled. Blood samples for coagulation testing were simultaneously obtained via the peripheral veins and heparin-locked Hickman catheters. For sampling from the catheters, 0.9% sodium chloride flushing was performed and 10 or 23 ml of blood was discarded prior to collecting the coagulation test samples. Correlation, Bland–Altman plot, covariate, and regression analysis were performed for data analyses. Despite following the guidelines, the activated partial thromboplastin time test values differed. In the 10 ml of blood discard group, a correlation coefficient of 0.378 and a mean bias of 6.46 s were determined, while and in the 23 ml blood discard group, a correlation coefficient of 0.80 and a mean bias of 2.518 s were determined. Therefore, the volume of blood discarded from the heparin-locked Hickman catheters may affect the activated partial thromboplastin time test values.
The gastrointestinal system in the critically ill cirrhotic patient
Authors: Olson Jody C.
Published: January 2020

Purpose of review

ICU admissions due to complications of advanced liver disease continue to rise. Among indications for admission to the ICU in patients with cirrhosis, gastrointestinal issues such as bleeding are common. In patients in whom gastrointestinal issues are not the principal indication for ICU, gastrointestinal issues such as nutrition and ileus remain important concerns for generalized intensive care support. This review highlights current trends in management of gastrointestinal issues in patients with cirrhosis admitted to the ICU.

Recent findings

General management of upper gastrointestinal bleeding remains largely unchanged. Improvements in interventional techniques have increased the options for difficult to control bleeding, these include the development of expandable esophageal stents and expanded experience with advanced interventional radiology techniques for the management of bleeding gastric varices. Frailty as an important prognostic marker in advanced liver disease and liver transplantation is the subject of several new studies and serves to highlight the importance of nutrition in the management of the critically ill cirrhotic patient.

Gastrointestinal complications are frequent in the critically ill cirrhotic patient. Recognition and intervention in a timely manner may minimize morbidity and mortality and result in improved outcomes for this vulnerable population.
Nutrition intake in the post-ICU hospitalization period
Authors: Ridley Emma J. , Chapple Lee-anne S. , Chapman Marianne J.
Published: January 2020

Purpose of review

The care of critically ill patients has evolved over recent years, resulting in significant reductions in mortality in developed countries; sometimes with prolonged issues with recovery. Nutrition research has focused on the early, acute period of critical illness, until more recently, where the post-ICU hospitalization period in critical care survivors has become a focus for nutrition rehabilitation. In this period, nutrition rehabilitation may be a vital component of recovery.

Recent findings

Overall, oral nutrition is the most common mode of nutrition provision in the post-ICU period. Compared with oral intake alone, calorie and protein requirements can be better met with the addition of oral supplements and/or enteral nutrition to oral intake. However, calorie and protein intake remains below predicted targets in the post-ICU hospitalization period. Achieving nutrition targets are complex and multifactorial, but can primarily be grouped into three main areas: patient factors; clinician factors; and system factors.

A nutrition intervention in the post-ICU hospitalization period may provide an opportunity to improve survival and functional recovery. However, there are multiple barriers to the delivery of calculated nutrition requirements in this period, a limited understanding of how this can be improved and how this translates into clinical benefit.
Heat-sensitive moxibustion for anaphylactic rhinitis
Authors: Xiong Jun , Yang Jun , Yuan Ting , Wang Xue , Jiang Yunfeng , Zhou Xiaohong , Liao Kai , Xu Lingling
Published: January 2020

Background

Anaphylactic rhinitis (AR) is one of the most common allergic disorders globally. Heat-sensitive moxibustion (HSM) is an effective method for AR without the occurrence of drug damage. This study aims to systematically investigate the effectiveness and safety of HSM for patients with AR.

Methods

Seven relevant electronic databases from inception until January 2020 including PubMed, Embase, Cochrane Library, the China National Knowledge Infrastructure Database, Wanfang Database, Chinese Biomedical Literature Database, and Chinese Scientific Journal Database will be searched. All relevant randomized clinical trials published in English and Chinese about HSM for AR regardless of blinding or publication types can be included. The Cochrane Central Register of Controlled Trials and other potential articles in the reference list of included studies will also be searched. We recommend total nasal symptom score as primary outcomes. Secondary outcomes includes rhinoconjunctivitis quality of life questionnaire, IgE, visual analogue scale, laboratory examination, and side effects. Study selection, data extraction, and quality assessment will be performed independently by 2 reviewers. Assessment of risk of bias and data synthesis will be conducted by RevMan 5.3 software.

Ethics and dissemination

Ethical approval is not required for no personal data involved. The results of this SR will be disseminated through peer-reviewed publications according to the Preferred Reporting Items for Systematic reviews and Meta Analysis Protocols guidelines.

Results

The results will be published in a peer-reviewed journal.

Conclusion

The findings will provide further evidence for the management of AR.

PROSPERO registration number

CRD42019140723.
The postoperative hepatic artery resistance index after living donor liver transplantation can predict early allograft dysfunction
Authors: Lv Tao , Kong LingXiang , Yang Jiayin , Wu Hong , Wen Tianfu , Jiang Li , Yang Jian
Published: January 2020

To investigate whether postoperative hepatic hemodynamics have an impact on graft function.

Using a retrospective cohort with 262 adult living donor liver transplantation (LDLT) recipients, we discussed the relationship between postoperative hepatic hemodynamics and patient outcomes.

According to the definition of early allograft dysfunction (EAD), the patients were classified into the EAD group (43 patients) and the non-EAD group (219 patients). In terms of postoperative hemodynamic parameters, there was no significant differences between these 2 groups regarding hepatic artery flow (HAF), hepatic artery velocity (HAV), portal vein flow (PVF), and portal vein velocity (PVV), except for the hepatic artery resistance index (HARI) which was somewhat higher in the EAD group on postoperative day 3 (POD3) (0.70 vs 0.61, P < .05). According to these results, we used a ROC curve and found that a HARI of 0.68 was the cutoff point (with 73.8% sensitivity and 58.3% specificity) for predicting EAD after LDLT. In addition, multivariate analysis showed that fulminant hepatic failure, pretransplant hepatorenal syndrome, and HARI ≥ 0.68 on POD3 were independent risk factors for postoperative EAD.

Our results showed that postoperative hemodynamics might influence graft function by altering hepatic artery flow.
Exploring factors influencing whether residents participate in square dancing using social cognitive theory
Authors: Peng Feng , Yan Hongjia , Sharma Manoj , Liu Ying , Lu Ying , Zhu Shijie , Li Peiqian , Ren Nianyong , Li Ting , Zhao Yong
Published: January 2020

Physical inactivity is a worldwide public health problem, and it is a risk factor for several chronic diseases. Square dancing nightly may be an efficient way to promote physical activity among Chinese residents. This study aims to explore factors that affect resident participation in square dancing on the basis of social cognitive theory constructs (outcome expectations, outcome expectancies, self-efficacy, self-control, and environment) that may provide a scientific basis for designing interventions to promote physical activity in the future.

Forty squares near neighborhood communities in Chongqing were randomly selected. A sample of 1732 residents who came to these squares at 18:00–21:00 were interviewed using a social cognitive theory questionnaire jointly developed by researchers from Chongqing Medical University and Jackson State University.

Among 1732 respondents, 279 (16.1%) were male and 1457 (83.9%) were female. A total of 939 (54.2%) of the respondents were square dancers. The mean age of the dancers was 58.6 (SD = 9.1) years. Of the dancers, 825 (87.9%) danced at least 150 minutes every week, and 792 (84.2%) indicated that they had danced for more than 1 year. All the constructs of social cognitive theory were significantly different between residents whether they danced or not (P < .001 for all). Women (OR = 1.54, 95% CI: 1.03–2.31) were more likely to dance. Nonretired residents (OR = 0.53, 95% CI: 0.39–0.74) were less likely to dance. Residents with income of more than CNY 4000 per month were less likely to dance (OR = 0.44, 95% CI: 0.23–0.86). Residents with high self-efficacy (OR = 2.01, 95% CI: 1.81–2.22), and high self-control (OR = 1.26, 95% CI: 1.18–1.34) were more likely to dance.

This study provides salient implications for developing interventions to promote square dancing by using social cognitive theory. Gender, retirement, income, and self-efficacy would be the factors influencing whether residents participate in square dancing.
Multi-center, randomized, double-blind, placebo-controlled, exploratory study to evaluate the efficacy and safety of HAD-B1 for dose-finding in EGFR positive and locally advanced or metastatic NSCLC subjects who need Afatinib therapy
Authors: Park So-Jung , Kang Hwi-Joong , Jun Hyung-Joon , Shin Seong-Hoon , Yoo Hwa-Seung
Published: January 2020

Background:

In recent studies, afatinib, a second-generation inhibitor, showed superior outcomes, when compared to the first-generation of EGFR-tyrosine kinase inhibitors (TKIs), such as erlotinib and gefitinib, in patients with advanced non-small cell lung cancer (NSCLC) harboring mutations of epidermal growth factor receptor (EGFR). Patients who receive TKIs with a significant initial efficacy, inevitably experience an acquired resistance (AR) within 9 to 13 months. Traditional Korean medicine may have synergistic effects when combined with chemotherapy or radiotherapy. The purpose of this trial is to assess whether afatinib plus HAD-B1 improves disease control rates (DCRs) compared with afatinib alone and to evaluate the efficacy and safety of HAD-B1 for finding the proper dose.

Methods:

This is a randomized, double-blind, placebo-controlled, multi-center, therapeutic, exploratory clinical trial. This trial is designed to determine whether HAD-B1 combined with afatinib results in better DCRs with less toxicity than afatinib alone. A total of 66 NSCLC patients with EGFR mutations will be randomly assigned to treatment group 1 (afatinib 40 mg/day plus HAD-B1 972 mg), treatment group 2 (afatinib 40 mg/day plus HAD-B1 1944 mg) and a control group (afatinib 40 mg/day). Afatinib combined with HAD-B1 or with a placebo will be administered to the participants for 12 weeks. The primary endpoint is a comparison of the DCRs among groups. Secondary endpoints are comparisons of the complete response (CR) and the partial response (PR) to the treatment, the stability of the disease (SD), progression free survival (PFS), time to progression (TTP), and tumor marker (CEA, NSE) and WBC differential count (LMR, NLR) and natural killer cell activity and quality of life (QOL) among groups.

Discussion:

The results from this clinical trial will provide evidence of efficacy and safety of HAD-B1 in EGFR positive and locally advanced or metastatic NSCLC patients who need afatinib therapy.
The efficacy and safety of Xuebijing injection as an adjunctive treatment for acute pancreatitis
Authors: Tang Qilin , Tian Lixin , Gao Chao , Zhang Kai , Su Nan , Liu Baohong , Zhai Jingbo , Liu Si , Li Yan
Published: January 2020

Background:

Acute pancreatitis (AP) is one of the common diseases with increasing incidence in clinical surgery and other gastrointestinal-digestive departments. Despite the rapid development of modern medicine, the overall mortality rate of AP is still high. Xuebijing (XBJ) injection (a traditional Chinese patent medicine) is a potentially effective drug for AP. This study is designed to assess the efficacy and safety of XBJ injection for AP.

Methods:

We will extract data and assess methodological quality of included studies from 7 electronic databases from their inception to December 31, 2019. The primary outcomes include the mortality, surgical intervention, systemic inflammatory response syndrome (SIRS), local complications, systemic infections, gastrointestinal symptoms, and normal blood amylase recovery time. The statistical analysis will be performed using RevMan 5.3 software.

Results:

This study will provide high-quality evidence for the efficacy of XBJ injection as an adjuvant therapy for AP.

Conclusion:

The study will provide the key evidence for clinical doctors and the development of clinical guidelines.