bluuebunny/crossref_metadata_2025 huggingface dataset:
Anterior Corneal Folds Correlate With Low Intraocular Pressure and May Serve as a Marker for Ocular Hypotony
Authors: Abualhasan Hamza , Mimouni Michael , Safuri Shadi , Blumenthal Eytan Z.
Published: December 2018

Purpose:

Subtle folds can be seen in the anterior cornea in eyes with hypotony using fluorescein and blue light. We aim to assess their extent and grade with respect to the level of intraocular pressure (IOP).

Patients and Methods:

Patients who presented to the department of ophthalmology at Rambam Health Care Campus with IOP<10 mm Hg during the period between July 2016 and June 2017. Corneal folds were evaluated after instilling an anesthetic drop and fluorescein staining. Outcome measures included: IOP, presence of anterior corneal folds, and the percentage of corneal surface containing folds.

Results:

Overall, 100 eyes of 100 patients were included. The mean age±SD was 63.6±16.7 years (range, 19 to 96 y); 56% (n=56) were of male sex. Mean IOP was 5.3±2.7 mm Hg (range, 0 to 9 mm Hg). Subjects with and without anterior corneal folds were of similar age (P=0.25) and sex (P=0.69). Those with anterior corneal folds had a significantly lower IOP than the control group (4.0±2.4 vs. 7.4±1.7; P<0.001). Eyes with IOP of 0 to 2, 3 to 4, 5 to 6, 7 to 9 mm Hg demonstrated anterior corneal folds in 95%, 91%, 67%, and 18.4%, respectively. At an IOP≤5 mm Hg cut-off, the sensitivity and specificity of corneal folds as a predictor of hypotony was 89.8% and 70.6%, respectively. A significant inverse correlation between the relative area of the cornea covered by folds and the IOP was found (r=−0.7; P<0.001).

Conclusions:

Folds observed in the anterior corneal surface appear to be a robust sign of severe hypotony.
Comparison of Fellow Eyes of Acute Primary Angle Closure and Phacomorphic Angle Closure
Authors: Moghimi Sasan , Fathollahzadeh Navid , Chen Rebecca , Lin Shan C. , Weinreb Robert N.
Published: December 2018

Purpose:

To compare anterior segment parameters in fellow eyes of acute primary angle closure (APAC) and fellow eyes of phacomorphic angle closure (AC) and to identify parameters that could be used to differentiate fellow eyes of the 2 entities.

Methods:

This cross-sectional study included 55 unaffected fellow eyes of APAC, 48 unaffected fellow eyes of phacomorphic AC, and 52 eyes of control subjects. All patients underwent anterior segment optical coherence tomography imaging. Anterior chamber depth, anterior chamber area, anterior chamber width (ACW), iris thickness (IT), iris curvature, lens vault (LV), and angle parameters including angle-opening distance (AOD750) were measured in qualified images using customized software and compared among the groups using a linear mixed model.

Results:

Fellow eyes of APAC had the smallest axial length, AOD, anterior chamber depth, anterior chamber area, ACW, and the greatest LV, and IT (P≤0.002 for all), followed by fellow eyes of phacomorphic AC, after adjustment for age, sex, and pupil diameter. IT and curvature were comparable between fellow eyes of phacomorphic AC and controls. Angle parameters had the highest area of the receiver-operator characteristic curve for discrimination of fellow eyes of APAC eyes and phacomorphic AC (0.795, P=0.001 for AOD750). In a multivariable analysis, AOD750<0.161 µm [odds ratio (OR), 23.43; P=0.001], LV>768.6 µm (OR, 16.76; P=0.001), ACW<11.07 mm (OR, 8.93; P=0.023) and younger age (P=0.001) were the factors that discriminated fellow eyes of APAC from phacomorphic AC.

Conclusions:

Differences in ocular biometric parameters can be detected between fellow eyes of APAC and phacomorphic AC. Narrower angle, more anteriorly displaced lens, and thicker iris are the main parameters that distinguish fellow eyes of APAC and phacomorphic AC.
Association Between Sleep Parameters and Glaucoma in the United States Population: National Health and Nutrition Examination Survey
Authors: Qiu Mary , Ramulu Pradeep Y. , Boland Michael V.
Published: December 2018

Purpose:

The main purpose of this study was to investigate the relationship between glaucoma and sleep in United States adults.

Patients and Methods:

This cross-sectional study included 6784 glaucoma patients from the 2005 to 2008 National Health and Nutrition Examination Survey who were aged 40 years and above, and completed the sleep survey. Predictors included sleep duration, sleep latency, sleep disorders, sleep disturbances, sleep medication use, and daytime dysfunction due to sleepiness. Outcomes included disc defined glaucoma (either right or left disc demonstrating glaucomatous features) and visual field defects (VFDs) assessed by Frequency-Doubling Technology perimetry.

Results:

The odds of disc defined glaucoma were 3 times higher among subjects who slept for ≥10 hours per night [odds ratio (OR), 3.3; confidence interval (CI), 1.3-8.5; P=0.01] compared with 7 hours per night. The odds of disc defined glaucoma were 2 times higher among subjects who fell asleep in ≤9 minutes (OR, 2.0; CI, 1.2-3.1; P<0.01) and ≥30 minutes (OR, 2.3; CI, 1.4-3.7; P<0.01) compared with 10 to 29 minutes. The odds of VFD were 3 times higher among subjects who slept for ≤3 hours per night (OR, 3.0; CI, 1.1-8.1; P=0.03) and ≥10 hours per night (OR, 3.4; CI, 1.5-7.7; P<0.01), compared with 7 hours per night. The odds of VFD were 2 times higher among subjects who had difficulty remembering things (OR, 2.0; CI, 1.3-2.9; P<0.01) and 3 times higher among subjects who had difficulty working on a hobby (OR, 3.0; CI, 1.5-6.1; P<0.01) due to daytime sleepiness compared with those without difficulty.

Conclusions:

This study revealed associations between glaucoma and abnormal sleep duration, sleep latency, and daytime dysfunction; poor sleep parameters may be a risk factor for or a consequence of glaucoma.
Managing Delayed Suprachoroidal Hemorrhage After Insertion of XEN45 Glaucoma Device
Authors: Stringa Francesco , Ali Zaria , Christou Savvas , Karandikar Sumita , Shankar Vikas
Published: December 2018

A 78-year-old man with angle closure glaucoma and on treatment with oral anticoagulants, underwent phacoemulsification. An early acute suprachoroidal hemorrhage (SCH) occurred and the surgical wound was rapidly sutured without complete soft lens matter removal, nor insertion of intraocular lens. The SCH was managed conservatively and it resolved in 5 weeks; the intraocular pressure was 35 mm Hg despite maximal medical treatment. Secondary soft lens matter removal followed by intraocular lens implantation combined with XEN45 was then performed. After 7 days the patient developed a potentially “kissing” choroidal touch due to significant delayed SCH. This was treated with surgical drainage. Significant suprachoroidal bleeding can occur after minimally invasive glaucoma procedures. Patients on anticoagulant therapy may require careful monitoring while planning glaucoma surgery.
No Acute Effect of Smoking on Peripapillary and Macular Vessel Density in Healthy Middle-aged Smokers
Authors: Holló Gábor
Published: December 2018

Purpose:

To investigate the acute effect of smoking on peripapillary and superficial parafoveal vessel density (VD) in healthy smokers.

Materials and Methods:

One eye each of 7 healthy smokers (age 40 y and above) was imaged using the Angiovue/RTvue-XR optical coherence tomography after a period of at least 2 hours without smoking (baseline) and 5, 30, and 90 minutes after smoking a cigarette of the brand usually smoked by each participant. In each session, 3 high-quality peripapillary and macular VD scans were acquired. The corresponding measurement results were averaged for each session, respectively.

Results:

The participants’ age was 45.7±7.1 years; the length of smoking 19.9±10.3 years; and the number of cigarettes per day 15.1±4.0. The image quality scores were high for both peripapillary and macular VD images (medians: 9.0 and 8.7) and did not change during the study (P≥0.196). At baseline peripapillary capillary VD, all-vessels VD and parafoveal VD were 52.4%±2.0%, 58.8%±2.5%, and 49.8%±1.6%, respectively. None of these parameters changed during the study period after smoking (P≥0.276). The relative change from the mean baseline VD values at the 3 timepoints after smoking ranged between −0.45% and 0.42%, −0.37% and 0.47%, and −0.13% and 2.0%, respectively.

Conclusions:

Our results suggest that VD values in healthy middle-aged smokers are not influenced either by acute smoking a cigarette or by the time elapsed since the most recent cigarette. This indicates that in long-term investigations for glaucomatous VD progression no control for smoking is needed, at least in the healthy control groups.
Intraocular Pressure (IOP) Change and Frequency of IOP Spike After Cataract Surgery in Normal-tension Glaucoma: A Case-Control Study
Authors: Seol Bo Ram , Shin Joo Young , Choi Sangkyung , Kang Tae Gu , Jeoung Jin Wook , Park Ki Ho
Published: December 2018

Purpose:

To evaluate the early-postoperative intraocular pressure (IOP) changes and frequency of IOP spike after cataract surgery in normal-tension glaucoma (NTG) eyes and to compare them with those of nonglaucomatous eyes.

Materials and Methods:

This was a case-control study. We reviewed the medical records of patients who had undergone cataract surgery. One-to-one (1:1) case matching was performed, each matched set consisting of 1 NTG and 1 nonglaucomatous eye as the control eye. Comparisons between those 2 groups were performed. Specifically, IOP was measured preoperatively and 1 day, 1, 2, and 4 weeks postoperatively. The incidence of IOP spike was evaluated according to the criteria of IOP higher than 21, 25, 30 mm Hg, higher than 5, 10 mm Hg over baseline IOP, and 50% above preoperative IOP.

Results:

A total of 298 eyes (149 NTG eyes and 149 control eyes) were enrolled. Preoperative IOP did not show any significant difference between the 2 groups (P=0.687). IOP significantly decreased in both the NTG and control groups [P<0.001, repeated-measures analysis of variance (ANOVA)]. No significant differences in this regard were detected between the 2 groups (P=0.618, repeated-measures ANOVA). When IOP spike was evaluated according to the 6 criteria, the frequencies were <3% at any timepoint. There was no significant difference between the 2 groups.

Conclusions:

In both the NTG and control groups, IOP gradually decreased in the early-postoperative period after cataract surgery, and there was no significant difference between the 2 groups. The frequency of IOP spike was <5% in both the NTG group and the control group.
Choroidal Microvascular Dropout in Primary Open-angle Glaucoma Eyes With Disc Hemorrhage
Authors: Rao Harsha L. , Sreenivasaiah Shruthi , Dixit Shivani , Riyazuddin Mohammed , Dasari Srilakshmi , Venugopal Jayasree P. , Pradhan Zia S. , Puttaiah Narendra K. , Devi Sathi , Mansouri Kaweh , Webers Carroll A.B. , Weinreb Robert N.
Published: December 2018

Purpose:

The main purpose of this study was to compare the prevalence of choroidal microvascular dropout (CMvD) in primary open-angle glaucoma (POAG) eyes with and without disc hemorrhage (DH).

Methods:

In a cross-sectional study, 44 eyes of 44 control subjects, 32 eyes of 32 POAG patients with DH, and 41 eyes of 41 POAG patients without DH underwent visual fields (VFs), optical coherence tomography (OCT) and OCT angiography (OCTA). Presence of CMvD was evaluated on the choroidal OCTA slab. VF defect in the glaucoma eyes were classified into initial nasal defect, initial parafoveal scotoma, and combined nasal and parafoveal defect.

Results:

CMvD was detected in 17 POAG eyes with DH (53.1%) and 13 POAG eyes without DH (31.7%; P=0.06). On univariate analysis, CMvD in POAG eyes was associated with DH [odds ratio (OR): 2.44, P=0.06] and measures of glaucoma severity: VF mean deviation (OR: 0.85, P=0.02), retinal nerve fiber layer thickness (OR: 0.95, P=0.03), and peripapillary vessel density (OR: 0.94, P=0.09). On multivariate models that accounted for the measures of glaucoma severity, CMvD in POAG eyes was statistically significantly associated with DH (OR≥3, P<0.05). CMvD was more frequently seen in eyes with initial parafoveal scotoma than initial nasal defect both in POAG eyes with DH (P=0.06) and POAG eyes without DH (P<0.001).

Conclusions:

Prevalence of CMvD was significantly greater in POAG eyes with DH compared with POAG eyes without DH. CMvD in POAG eyes was also significantly associated with central VF defects and greater severity of glaucomatous damage.
Ocular Hemodynamics in Acute Nonarteritic Anterior Ischemic Optic Neuropathy Compared With Normal Tension Glaucoma
Authors: Kuerten David , Fuest Matthias , Bienert Marion , Walter Peter , Plange Niklas
Published: December 2018

Purpose:

The purpose of this study was to evaluate ocular hemodynamics in patients with a disease believed to be related to a chronic vascular damage [ie, normal tension glaucoma (NTG)] in comparison with an entity with an acute ischemic impact on the optic nerve [ie, acute nonarteritic anterior ischemic optic neuropathy (NAION)].

Materials and Methods:

Blood-flow velocities [peak systolic velocity (PSV), enddiastolic velocity (EDV)] of the ophthalmic artery (OA), central retinal artery (CRA), and nasal and temporal posterior ciliary arteries were measured using color Doppler imaging. Resistive index (RI) of all vessels was calculated (PSV-EDV/PSV). A total of 41 patients suffering from acute NAION (onset of symptoms <10 d) and 64 age-matched patients suffering from NTG were included in this prospective study.

Results:

No significant differences were recorded for either age or intraocular pressure inbetween the 2 groups. Systolic blood pressure was significantly higher in the NAION group, whereas no significant differences were recorded for the diastolic blood pressure. Only 3 color Doppler imaging parameters were found to differ significantly. The PSV (P<0.005) and EDV (P<0.02) in the CRA were significantly higher in NTG patients. Furthermore, the RI in the OA was significantly higher in the NAION patients (P<0.005).

Conclusions:

Decreased blood-flow velocities in the CRA and a higher RI in the OA can be recorded in NAION patients as compared with NTG. No differences with regard to the posterior ciliary arteries’ velocities were recorded. Ocular hemodynamics are suspected to play a critical role in NAION and NTG, whereas the blood-flow disturbances seem to be more severe in NAION than in NTG.
The paracetamol metabolite N-acetylp-benzoquinone imine reduces excitability in first- and second-order neurons of the pain pathway through actions on KV7 channels
Authors: Ray Sutirtha , Salzer Isabella , Kronschläger Mira T. , Boehm Stefan
Published: December 2018

Paracetamol (acetaminophen, APAP) is one of the most frequently used analgesic agents worldwide. It is generally preferred over nonsteroidal anti-inflammatory drugs because it does not cause typical adverse effects resulting from the inhibition of cyclooxygenases, such as gastric ulcers. Nevertheless, inhibitory impact on these enzymes is claimed to contribute to paracetamols mechanisms of action which, therefore, remained controversial. Recently, the APAP metabolites N-arachidonoylaminophenol (AM404) and N-acetyl-p-benzoquinone imine (NAPQI) have been detected in the central nervous system after systemic APAP administration and were reported to mediate paracetamol effects. In contrast to nonsteroidal anti-inflammatory drugs that rather support seizure activity, paracetamol provides anticonvulsant actions, and this dampening of neuronal activity may also form the basis for analgesic effects. Here, we reveal that the APAP metabolite NAPQI, but neither the parent compound nor the metabolite AM404, reduces membrane excitability in rat dorsal root ganglion (DRG) and spinal dorsal horn (SDH) neurons. The observed reduction of spike frequencies is accompanied by hyperpolarization in both sets of neurons. In parallel, NAPQI, but neither APAP nor AM404, increases currents through KV7 channels in DRG and SDH neurons, and the impact on neuronal excitability is absent if KV7 channels are blocked. Furthermore, NAPQI can revert the inhibitory action of the inflammatory mediator bradykinin on KV7 channels but does not affect synaptic transmission between DRG and SDH neurons. These results show that the paracetamol metabolite NAPQI dampens excitability of first- and second-order neurons of the pain pathway through an action on KV7 channels.
Semiquantification of Systemic Venous Admixture During Venovenous Extracorporeal Oxygenation Via Bicaval Double-Lumen Cannula in Critically Ill Patients
Authors: Yastrebov Konstantin , Kapalli Tejo , Manganas Con
Published: December 2018

Venovenous extracorporeal membrane oxygenation (VV-ECMO) is increasingly utilized in acute reversible cases of severe respiratory failure and as a bridge to lung transplantation. Venovenous extracorporeal membrane oxygenation using a bicaval double-lumen cannula (BCDLC) has several advantages over the traditional ECMO configuration; however, it also presents with several unique challenges. The assessment and quantification of venous admixture is difficult due to the specific position of BCDLC within the circulatory system. We describe the nature of the double-lumen bicaval venovenous ECMO cannula and relevant specific issues associated with monitoring complex details of oxygenation within different parts of circulation, including existing barriers for quantification of recirculation and venous admix. New conceptual approach to the quantification of venous admix is described. Right side echocardiographic contrast, when sequentially injected in separate superior vena cava (SVC) and inferior vena cava (IVC) venous basins, bypasses drainage ports of the catheter in double-lumen bicaval VV-ECMO configuration together with deoxygenated returning from the periphery venous blood. It was easily detectable entering right heart chambers by two- and three-dimensional echocardiography. Amount of bubbles from the agitated fluid contrast within right atrium indicates relative amount of venous admixture in relation to the returning from the oxygenator blood which is bubble free.
Dissemination and Implementation of Patient-centered Indicators of Pain Care Quality and Outcomes
Authors: Beck Susan L. , Dunton Nancy , Berry Patricia H. , Brant Jeannine M. , Guo Jia-Wen , Potter Catima , Spornitz Beth , Eaton Jacqueline , Wong Bob
Published: December 2018

Background:

Previous approaches to measuring and improving nursing-sensitive, patient-centered metrics of pain quality and outcomes in hospitalized patients have been limited.

Methods:

In this translational research study, we disseminated and implemented pain quality indicators in 1611 medical and/or surgical, step-down, rehabilitation, critical access, and obstetrical (postpartum) units from 326 US hospitals participating in the National Database of Nursing Quality Indicators. Eligible patients were English-speaking adults in pain. Trained nurses collected patients’ perceptions via structured interview including 9 pain quality indicators, demographic, and clinical variables; these patient experience data were merged with unit and hospital level data. Analyses included geographic mapping; summary statistics and 3-level mixed effects modeling.

Results:

Hospitals in 45 states and District of Columbia participated. Of 22,293 screened patients, 15,012 were eligible; 82% verbally consented and participated. Pain prevalence was 72%. Participants were 59.4% female; ages ranged from 19 to 90+ (median: 59 y); 27.3% were nonwhite and 6.5% were Hispanic. Pain intensity on average over the past 24 hours was 6.03 (SD=2.45) on a 0–10 scale. 28.5% of patients were in severe pain frequently or constantly. Race (nonwhite), younger age, being female and nonsurgical were associated (P<0.001) with greater pain. Care quality indicators ranking lowest related to discussion of analgesic side effects and use of nonpharmacologic approaches.

Conclusions:

Unrelieved pain remains a high-volume problem. Individual factors and unit type were significantly associated with pain outcomes. Hospitals can employ these quality indicators to direct continuous quality improvement targeting pain care quality.
Affordable Care Act–dependent Insurance Coverage and Access to Care Among Young Adult Women With a Recent Live Birth
Authors: Li Rui , Bauman Brenda , D’Angelo Denise V. , Harrison Leslie L. , Warner Lee , Barfield Wanda D. , Cox Shanna
Published: December 2018

Background:

The Affordable Care Act (ACA)-dependent coverage Provision (the Provision), implemented in 2010, extended family insurance coverage to adult children until age 26.

Objectives:

To examine the impact of the ACA Provision on insurance coverage and care among women with a recent live birth.

Research Design, Subjects, and Outcome Measures:

We conducted a difference-in-difference analysis to assess the effect of the Provision using data from the Pregnancy Risk Assessment Monitoring System among 22,599 women aged 19–25 (treatment group) and 22,361 women aged 27–31 years (control group). Outcomes include insurance coverage in the month before and during pregnancy, and at delivery, and receipt of timely prenatal care, a postpartum check-up, and postpartum contraceptive use.

Results:

Compared with the control group, the Provision was associated with a 4.7-percentage point decrease in being uninsured and a 5.9-percentage point increase in private insurance coverage in the month before pregnancy, and a 5.4-percentage point increase in private insurance coverage and a 5.9-percentage point decrease in Medicaid coverage during pregnancy, with similar changes in insurance coverage at delivery. Findings demonstrated a 3.6-percentage point increase in receipt of timely prenatal care, and no change in receipt of a postpartum check-up or postpartum contraceptive use.

Conclusions:

Among women with a recent live birth, the Provision was associated with a decreased likelihood of being uninsured and increased private insurance coverage in the month before pregnancy, a shift from Medicaid to private insurance coverage during pregnancy and at delivery, and an increased likelihood of receiving timely prenatal care.
Friendship in Adolescents and Young Adults With Experience of Cancer
Authors: Evered Jane A.
Published: December 2018

Background

Friendship is a complex social phenomenon important to human development, emotional health, and socialization. While making and maintaining peer friends are an emphasized task of adolescent and young adult development, the multidimensional experience of friendship is incompletely defined, particularly in the context of adolescents and young adults with cancer.

Objective

The aim of this study was to investigate the nature of friendship more deeply and completely by breaking down and then rebuilding meaning in this phenomenon.

Methods

The author searched 8 databases for relevant literature and conducted a dimensional analysis of the textual data from articles found in database searches and theoretical sampling. Dimensional analysis was an inductive process of determining all the components and attributes of the friendship concept. The author broke down and built up the meaningful units of friendship until a story of friendship in adolescents and young adults with experience of cancer emerged.

Results

Data from 80 empirical and theoretical articles published from 2013 to 2018 formed the literature base for this dimensional analysis.

Conclusions

An explanatory matrix built from the perspective of “Time Marking” reveals contexts, conditions, processes, and consequences that together provide an explanation of the nature of friendship in this population.

Implications for Practice

This concept analysis, combined with the limitations of this inquiry, impels future empirical and theoretical research and implies preliminary clinical implications. In particular, the understanding of friendship as conceptually distinct from social support and the experience of friendships in narrative time suggest a need to reconceptualize supportive care services for adolescents and young adults who experience cancer.
Psychometric Evaluation of a Korean Version of the Cancer Survivors' Self-efficacy Scale
Authors: Kim Soo Hyun , Lee Bo Gyeong , Lee Ji Yeon , Kim Sei Joong , Hur Min Hee , Lee Moon Hee , Han Mi Sook
Published: December 2018

Background

Self-efficacy has become the target outcome of many self-management interventions for cancer survivors. However, no measurement is available that can be used to measure cancer-specific self-efficacy in Korea.

Objective

The aim of this study was to cross-culturally evaluate the reliability and validity of a Korean version of the Cancer Survivors' Self-Efficacy Scale (CSSES-K).

Methods

We translated the original version of the CSSES (11 items) and created a Korean version. We then conducted a validation study with 204 cancer survivors who had completed their primary treatment. We conducted psychometric evaluation using item analysis, factorial construct validity (exploratory factor analysis and confirmative factor analysis), hypothesis testing construct validity, and internal consistency reliability (Cronbach's α).

Results

Exploratory factor analysis revealed 2 subscales for which model fitting was appropriate—“self-efficacy for managing health problems” (5 items) and “self-efficacy for seeking help and support” (5 items). Hypothesis testing construct validity was confirmed showing significant moderate correlations between the CSSES-K and general self-efficacy (r = 0.511, P < .001), anxiety (r = −0.596, P < .001), depression (r = −0.554, P < .001), and health-related quality of life (r = 0.586, P < .001). The internal consistency of the CSSES-K of total scale and subscales was high (Cronbach's α = .86–.92).

Conclusions

The results supported that the CSSES-K was valid and reliable in measuring self-efficacy among Korean cancer survivors after cancer treatment.

Implications for Practice

Our findings suggest that the CSSES-K can be effectively used for measuring self-efficacy in Korean cancer survivors.
Implementing Universal Design Instruction in Doctor of Nursing Practice Education
Authors: Anderson Kelley M. , Davis Diane , McLaughlin Maureen Kirkpatrick
Published: December 2018

Background

Faculty in Doctor of Nursing Practice (DNP) programs identify challenges of increased enrollment and variances in previous student educational preparation and professional experiences that require innovative approaches to curriculum transformation.

Purpose

This article informs nurse educators about the vibrant and inclusive approach of universal design for instruction (UDI), a framework to conceptualize and implement learning strategies in the DNP curriculum.

Approach

UDI is guided by 9 instructional principles that anticipate diverse learners and is intentionally inclusive of multiple ways of learning. Principles of UDI were synergized into several DNP didactic courses and the scholarly project process.

Conclusion

Integration of UDI into the DNP curriculum included precourse assessments, multiple modalities of content delivery, options to present acquired knowledge, and supporting the adult learner through the iterative work of the scholarly project.
Optimal Timing for Trichomonas vaginalis Test of Cure Using Nucleic Acid Amplification Testing
Authors: Craig-Kuhn Megan Clare , Granade Charleigh , Muzny Christina A. , Van Der Pol Barbara , Lillis Rebecca , Taylor Stephanie N. , Schmidt Norine , Martin David H. , Kissinger Patricia
Published: December 2018

Background

The optimal timing for nucleic acid amplification testing (NAAT) posttreatment for Trichomonas vaginalis has not been fully established. Testing too soon posttreatment may detect remnant nucleic acid that is not from viable organisms, falsely misclassifying person as infected. The purpose of this study was to examine how long T. vaginalis nucleic acid is detectable postmetronidazole (MTZ) treatment.

Methods

Women diagnosed with T. vaginalis treated with MTZ (2 g single-dose or 500 mg twice daily for 7 days multidose) self-collected a vaginal swab for NAAT at baseline and each week postcompletion of treatment through test of cure (TOC) at week 4, when a culture was also performed. Women who reported interim sexual exposure or who were culture positive at 4 weeks were excluded. Time to first negative NAAT was examined using Kaplan Meier analysis.

Results

All women receiving multidose metronidazole were NAAT-negative by 21 days and those receiving single dose by 28 days postcompletion of treatment. Though over half (60.7%) of the cohort reinitiated sex during follow-up¸ all reported using condoms during sex or that they and their partner were treated before sex. Six (6.7%) of 89 had a positive NAAT following their first negative NAAT.

Conclusions

The optimal timing for T. vaginalis retesting after completion of treatment is 3 weeks for those receiving multidose MTZ and 4 weeks for those receiving single-dose, though sexual reexposure and false negatives should be considered.
Goblet Cell Carcinoid/Carcinoma: An Update
Authors: Zhang Kuixing , Meyerson Cherise , Kassardjian Ari , Westbrook Lindsey M. , Zheng Wei , Wang Hanlin L.
Published: December 2018

Goblet cell carcinoid (GCC) or goblet cell carcinoma is a unique mixed endocrine-exocrine neoplasm that is almost exclusively seen in the appendix. The hallmark of GCC is the concentric infiltration of the appendiceal wall by small tight clusters, nests or cords of tumor cells that exhibit a goblet cell morphology with a small compressed nucleus and conspicuous intracytoplasmic mucin. The coexistence of high-grade adenocarcinoma with GCC has been increasingly recognized as a common finding, which has been called adenocarcinoma ex GCC or mixed GCC-adenocarcinoma. A number of studies have shown that it is the high-grade adenocarcinomatous component that dictates the prognosis. Several histologic classification/grading systems have been proposed, which correlate with overall patient survival. Treatment options are primarily based on tumor stage and the presence or absence of a high-grade adenocarcinomatous component.
Salivary Gland Fine Needle Aspiration and Introduction of the Milan Reporting System
Authors: Pusztaszeri Marc , Rossi Esther D. , Baloch Zubair W. , Faquin William C.
Published: December 2018

Fine needle aspiration (FNA) is a well-established procedure for the diagnosis and management of salivary gland lesions despite challenges imposed by their diversity, complexity, and cytomorphologic overlap. Until recently, the reporting of salivary gland FNA specimens was inconsistent among different institutions throughout the world, leading to diagnostic confusion among pathologists and clinicians. In 2015, an international group of pathologists initiated the development of an evidence-based tiered classification system for reporting salivary gland FNA specimens designated the “Milan System for Reporting Salivary Gland Cytopathology” (MSRSGC) that culminated with the publication of the MSRSGC Atlas in February 2018. The MSRSGC consists of 6 diagnostic categories, which incorporate the morphologic heterogeneity and overlap among various non-neoplastic, benign, and malignant lesions of the salivary glands. In addition, each diagnostic category is associated with a risk of malignancy and management recommendations. The main goal of the MSRSGC is to improve communication between cytopathologists and treating clinicians, while also facilitating cytologic‐histologic correlation, sharing of data from different laboratories for quality control, and research. Herein, we review the current status of salivary gland cytology and the role of MSRSGC in providing a framework for reporting salivary gland lesions.
A Novel Technique
Authors: Sir Ender , Eksert Sami , Ince M. Emin , Simsek Fatih , Ozkan Gokhan , Eskin M. Burak
Published: December 2018

Serratus anterior plane block has been used for pain management during the acute period of conditions affecting the thorax, such as postthoracotomy recovery, rib fracture, and breast surgery recovery. Here, we report the use of serratus anterior plane block in posttraumatic chronic pain treatment. We describe a case of posttraumatic chronic intercostal neuralgia, in which successful pain relief was achieved via repeated injections of local anesthetic and steroid combinations in the serratus anterior plane under ultrasonographic guidance. This novel technique is easy to administer, reliable, and warrants further investigation with regard to its use for rehabilitation of patients who are experiencing posttraumatic chronic neuropathies of the chest wall.
Transmembrane protein 100 is expressed in neurons and glia of dorsal root ganglia and is reduced after painful nerve injury
Authors: Yu Hongwei , Shin Seung Min , Wang Fei , Xu Hao , Xiang Hongfei , Cai Yongsong , Itson-Zoske Brandon , Hogan Quinn H.
Published: December 2018

Introduction:

Tmem100 modulates interactions between TRPA1 and TRPV1. The cell specificity of Tmem100 expression in dorsal root ganglia (DRGs) is not well defined, nor is the effect of peripheral nerve injury on Tmem100 expression.

Objective:

This study was designed to determine the cell specificity of Tmem100 expression in DRG and its subcellular localization, and to examine how Tmem100 expression may be altered in painful conditions.

Methods:

Dorsal root ganglion Tmem100 expression was determined by immunohistochemistry, immunoblot, and quantitative real-time PCR, and compared between various experimental rat pain models and controls.

Results:

Tmem100 is expressed in both neurons and perineuronal glial cells in the rat DRG. The plasma membrane and intracellular localization of Tmem100 are identified in 83% ± 6% of IB4-positive and 48% ± 6% of calcitonin gene-related peptide–positive neurons, as well as in medium- and large-sized neurons, with its immunopositivity colocalized to TRPV1 (94% ± 5%) and TRPA1 (96% ± 3%). Tmem100 is also detected in the perineuronal satellite glial cells and in some microglia. Tmem100 protein is significantly increased in the lumbar DRGs in the complete Freund adjuvant inflammatory pain. By contrast, peripheral nerve injury by spinal nerve ligation diminishes Tmem100 expression in the injured DRG, with immunoblot and immunohistochemistry experiments showing reduced Tmem100 protein levels in both neurons and satellite glial cells of DRGs proximal to injury, whereas Tmem100 is unchanged in adjacent DRGs. The spared nerve injury model also reduces Tmem100 protein in the injured DRGs.

Conclusion:

Our data demonstrate a pain pathology–dependent alteration of DRG Tmem100 protein expression, upregulated during CFA inflammatory pain but downregulated during neuropathic pain.
Treatment of Keloid Scars with Botulinum Toxin Type A versus Triamcinolone in an Athymic Nude Mouse Model
Authors: Fanous Amanda , Bezdjian Aren , Caglar Derin , Mlynarek Aleksander , Fanous Nabil , Lenhart Stephanie Fay , Daniel Sam J.
Published: December 2018

Background:

Keloid scarring is a serious condition that mostly affects patients of African or Asian descent. Often disfiguring, this condition can have devastating psychosocial consequences. To date, no treatment modality has been proven ideal. The authors’ objectives were (1) to determine the efficacy of botulin toxin type A injection for the treatment of keloid scars compared to steroid injection and to control saline injection (this was achieved through a basic science animal model using athymic nude mice and implanted human keloid tissue); and (2) to analyze the histopathologic changes that occur in an organized keloid scar following botulinum toxin type A injection as compared to steroid and saline injections.

Methods:

Keloid scars from four patients were excised and implanted subcutaneously into 28 mice. Three small keloid tissue samples were implanted in each of the 28 mice. One week after implantation, each implant received one of three injections: botulinum toxin type A (treatment drug), saline (control), or steroid injection (first-line gold standard). The keloid tissue was extracted 3 weeks after implantation. Weight analysis, immunohistochemistry, and standard hematoxylin and eosin pathologic analysis were performed on each extracted tissue sample.

Results:

Paired t test analysis of pretreatment and posttreatment tissue weights revealed a statistically significant difference between the treatment and control groups (p < 0.05). Analysis by a blinded pathologist confirmed fewer collagen bundles in the treatment group. Immunohistochemistry with Ki-67, a marker of cell proliferation, revealed significantly less staining in the treatment groups.

Conclusion:

Botulinum toxin type A could be an effective treatment for keloid scars.
Vascular and Nerve Relations of the Marginal Mandibular Nerve of the Face: Anatomy and Clinical Relevance
Authors: Touré Gaoussou , Tran de Fremicourt Minh–Kim , Randriamanantena Tahiry , Vlavonou Sandrine , Priano Virginia , Vacher Christian
Published: December 2018

Background:

The marginal mandibular nerve of the facial nerve is frequently injured during corrective and cosmetic surgery. Recent or emerging techniques such as the injection of filler materials, botulinum toxin, allotransplantation of composite tissues of the face, placement of chin implants, and submental cryolipolysis require in-depth knowledge of this nerve. The studies to date are not in agreement regarding the number of branches of the marginal mandibular nerve and its relationship with the vasculature and other nerves.

Methods:

This study involved 62 half-heads from cadavers.

Results:

In 22.6 percent of the cases, the marginal mandibular nerve of the facial nerve was a single branched entity and lateral to the pedicle, with respect to the facial artery and the facial vein. In 16 cases (29 percent), the marginal mandibular nerve had two branches. In 12.9 percent of the cases, the marginal mandibular nerve gave rise to three branches. In 17 cases (35.48 percent), the marginal mandibular nerve gave rise to between four and more than 10 branches, thereby forming a plexus at its end. Analysis of this collection of cases revealed that the marginal mandibular nerve was more consistently lateral to the facial vein than to the facial artery. The marginal mandibular nerve exhibited connections with other branches of the facial nerve and branches of the trigeminal nerve.

Conclusions:

The facial vein had a more consistent relationship with the marginal mandibular nerve than the facial artery. This study provides the anatomical bases of substitution, proprioception, and clinical variations in injuries of the marginal mandibular nerve and in their prognosis.
A Novel Noninvasive Patient-Specific Navigation Method for Orbital Reconstructive Surgery: A Phantom Study Using Patient Data
Authors: Lee Jeonghwan , Mekuria Kinde , Son Tae-geun , Jeong Woo Shik , Choi Jong Woo , Kim Youngjun
Published: December 2018

Background:

The correction of orbital deformities is an ongoing challenge in maxillofacial surgery. Computer-assisted navigation can improve surgical outcomes. However, conventional registration methods for navigation are not appropriate for orbital reconstructive surgery. This study proposes an accurate, noninvasive, patient-specific navigation method and demonstrates its feasibility.

Methods:

A noninvasive, patient-specific registration frame based on the external auditory canals and upper front teeth was designed using software developed in-house. A three-dimensional craniofacial model was segmented from patient computed tomographic data for the registration frame. A customized craniofacial phantom was also made using this three-dimensional model, with 20 embedded target points on the orbital model and 21 landmark points on the reference standard model. The proposed method was compared with two conventional registration methods: the dental splint–based method and the invasive marker frame–based method. Twenty trials were conducted for evaluation. Target registration error and surface registration error were computed to measure accuracy.

Results:

The proposed method showed a target registration error of 1.05 ± 0.52 mm, with greater accuracy than conventional methods (dental splint, 2.10 ± 0.63 mm; invasive marker frame, 1.22 ± 0.46 mm). The proposed method yielded the best results for surface registration error, with 0.38 mm of deviation (dental splint, 0.82 mm; invasive marker frame, 0.60 mm).

Conclusion:

The proposed noninvasive patient-specific registration method demonstrated superior results for both target registration error and surface registration error compared with other conventional registration methods for computer-assisted navigation in orbital reconstructive surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Nonsyndromic Unilateral Coronal Synostosis: A Comparison of Fronto-Orbital Advancement and Endoscopic Suturectomy
Authors: Isaac Kathryn V. , MacKinnon Sarah , Dagi Linda R. , Rogers Gary F. , Meara John G. , Proctor Mark R.
Published: December 2018

Background:

Comparative effectiveness research is needed to optimize treatment of unilateral coronal synostosis. This study compares perioperative morbidity, ophthalmic, and aesthetic outcomes of patients with nonsyndromic unilateral coronal synostosis treated by endoscopic suturectomy or fronto-orbital advancement.

Methods:

From 2004 to 2015, patients with unilateral coronal synostosis were reviewed and data recorded for operative details, reoperations, and aesthetic results using the Whitaker classification, severity of strabismus, and need for surgical correction. Categorical data were analyzed using the Fisher’s exact test and continuous data were analyzed using the Wilcoxon rank sum test.

Results:

Ninety-four patients were treated with endoscopic suturectomy (n = 60) or fronto-orbital advancement (n = 34). Median age at follow-up was 3.5 years (range, 1 to 9 years) for endoscopic suturectomy and 5.0 years (range, 2 to 11 years) for fronto-orbital advancement (p = 0.06). The endoscopic suturectomy group had a lower operative time (42 minutes versus 216 minutes), length of stay (1 day versus 4 days), blood loss (25 cc versus 260 cc), and transfusion rate (0 percent versus 88 percent). Two patients treated with fronto-orbital advancement required secondary intervention for intracranial pressure. Thirty-one percent (16 of 52) of the endoscopic suturectomy group and 65 percent (19 of 29) of the fronto-orbital advancement group developed clinically significant strabismus requiring surgical repair (p = 0.002). In the endoscopic suturectomy group, 88 percent (50 of 57) were Whitaker class I and 5 percent were class II. In the fronto-orbital advancement group, 41 percent (14 of 34) were class I and 44 percent class II. Need for bony revision (two of 57 versus three of 34) and need for secondary cranial procedure (two of 57 versus two of 34) were similar following endoscopic suturectomy and fronto-orbital advancement.

Conclusions:

For treatment of unilateral coronal synostosis, endoscopic suturectomy is associated with lower morbidity and comparable aesthetics. Patients treated with endoscopic suturectomy are half as likely to require strabismus surgery compared with those treated with fronto-orbital advancement.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
The Association Between Organizational Culture and the Ability to Benefit From “Just Culture” Training
Authors: David Donald Scott
Published: December 2018

Objective

This study aimed to determine whether there was an association between the organizational culture and the hospital's readiness to benefit from “Just Culture” training.

Methods

The “Just Culture” Assessment Tool and the Competing Values Framework surveys were administered before and 6 weeks after a structured “Just Culture” training session to 172 care providers and administrators on similar units at two community for-profit hospitals of compatible size and offering comparable services in suburban communities. Data were analyzed for significance using IBM SPSS software.

Results

At baseline, there was a significantly higher percentage of problematic responses (PPRs) for hospital 1 as compared with hospital 2. Administrators and managers reported significantly fewer PPRs than frontline staff. In addition, the archetypal organizational culture for hospital 1 was found to be more hierarchical, whereas the culture for hospital 2 was found to be more group oriented. Six weeks after the completion of “Just Culture” training, there was a 0.02% overall reduction in PPRs at hospital 1 as compared with a 62.01% overall reduction in PPRs at hospital 2. There was also a significant increase in the Group Culture Score, a significant decrease in both the Hierarchical Culture and Rational Culture scores for hospital 2 as compared with hospital 1.

Conclusions

There was a significantly greater reduction in PPR on the “Just Culture” Assessment Tool in the hospital with the more group-oriented organizational culture. Given the cost and effort required to conduct “Just Culture” training in an organization, it seems to be important to address the organizational culture before the implementation of this type of training.
Medication Adherence in Chinese Patients With Systemic Lupus Erythematosus
Authors: Du Xian , Chen Haoyang , Zhuang Yuan , Zhao Qian , Shen Biyu
Published: December 2018

Objective

Medication adherence plays an important role in improving symptoms and ameliorating the progression of systemic lupus erythematosus (SLE). The purpose of this study was to examine the medication adherence rate and explore the related factors for nonadherence in Chinese SLE patients.

Methods

A cross-sectional study from The Second Affiliated Hospital of Nantong University between January 2017 and February 2018 was conducted. Patients with SLE completed the Compliance Questionnaire on Rheumatology to evaluate adherence, the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) for disease activity, and the Hospital Anxiety and Depression Scale to assess anxiety and depression. χ2 Analyses, independent samples t tests, and logistic regression models were used to analyze data.

Results

This study included 144 SLE patients, and we found that 43.1% (n = 62) of the patients were nonadherence. Education, SLEDAI, anxiety, and depression were correlated with adherence in SLE patients. Moreover, logistic regression models identified education, SLEDAI, and depression as important associated factors of nonadherence.

Conclusions

This is the first time to evaluate demographic, clinical, and psychological related factors for medication adherence in Chinese SLE patients using SLEDAI and Hospital Anxiety and Depression Scale. Our study showed that 56.9% of SLE patients were not adherent, and education, SLEDAI, and depression were significantly related to medication adherence in SLE. These findings suggested that it was necessary to pay more attention to medication adherence of SLE patients, especially those with lower level of education, higher score of SLEDAI, and depression by effective intervention to improve SLE patients' adherence, so as to improve their quality of life.