bluuebunny/crossref_metadata_2025 huggingface dataset:
Challenges in Health Care Simulation: Are We Learning Anything New?
Authors: Henriksen Kerm , Rodrick David , Grace Erin N. , Brady P. Jeffrey
Published: August 2017

The growth of health care simulation in schools of medicine and nursing is noteworthy, as is the increasingly sophisticated simulation technology, support from funding agencies and foundations for research, well-attended annual conferences, and continued interest of accreditation and certification groups. Yet there are concerns preventing the full value of health care simulation to be realized when examined from a patient safety perspective. Basic questions are asked by funders of patient safety research when assessing past simulation projects undertaken to advance patient safety: Are the safety and quality of care to patients actually improved, and is something new being learned regarding the optimal use of simulation? Concerns focus on pursuing the right research questions to learn something new about the most effective use of simulation; doing more with simulation than simply providing an interesting, stand-alone educational experience; attending more seriously to how skill acquisition, maintenance, and progression get managed; and encouraging investigators, funders, and reviewers to expand their vision regarding what constitutes important inquiry and evidence in health care simulation. Patient safety remains a multifaceted challenge in the United States, requiring multifaceted approaches. Simulation training is considered a promising approach for improving the safety and quality of health services delivery. While it takes time for any new approach to gain momentum and learn from past efforts, it also will require addressing a systematic range of essential questions to improve existing knowledge on the optimal use of simulation, and to realize similar gains in safety that other high-risk industries have made.
The Poly-Pop. A Novel Technique for Removing the Polyethylene Liner in Revision THA
Authors: El Dafrawy Mostafa H. , Kuwabara Anne M. , Ponnusamy Karthik , Okafor Louis C. , Khanuja Harpal S.
Published: August 2017

The authors describe a novel technique for removing the polyethylene (PE) liner during revision total hip arthroplasty. The PE liner is popped out using a tapered, threaded Schanz pin. The pin is threaded through the plastic, and the PE is dislodged as the tip of the pin abuts the metal. This technique allows easy removal without the force generated by osteotomes and other means that are more traumatic.
Drivers of Continuing Education Learning Preferences for Veterans Affairs Women's Health Primary Care Providers
Authors: Zuchowski Jessica L. , Hamilton Alison B. , Washington Donna L. , Gomez Arthur G. , Veet Laure , Cordasco Kristina M.
Published: August 2017

Introduction:

Documented gaps in health professionals' training in women's health are a special concern for continuing education (CE). In the Veterans Affairs (VA) health care system, women veterans are a numerical minority, preferably assigned to designated women's health primary care providers (DWHPs). DWHPs need to maintain their knowledge and skills in women's health topics, in addition to general internal medicine topics. We explored drivers of VA DWHPs' learning preferences for women's health topics—ie, factors which influence greater and lesser learning interest.

Methods:

We conducted semistructured telephone interviews with DWHPs across six VA health care systems. Interviews were audio recorded, transcribed, and coded in ATLAS.ti. We synthesized results by grouping relevant coded sections of text to form emergent themes.

Results:

Among the 31 DWHPs interviewed, reported drivers of learning interests among women's health topics were (1) high frequency of clinical incidence of particular issues; (2) perceived appropriateness of particular issues for management in primary care settings; and (3) perceived appropriateness of particular issues for partial management in primary care. Lower interest in particular women's health topics was associated with (1) perceived existing competency or recent training in an issue and (2) perceived need for specialty care management of an issue.

Discussion:

Understanding drivers of DWHPs' CE learning priorities lays a foundation for developing CE programming that will be of interest to women's health primary care providers. Attention to drivers of learning interests may have applicability beyond women's health, suggesting a general approach for CE programming that prioritizes high-volume topics within the practice scope of target providers.
Bevacizumab as an effective treatment for radiation necrosis after radiotherapy for melanoma brain metastases
Authors: Glitza Isabella C. , Guha-Thakurta Nandita , D’Souza Neil M. , Amaria Rodabe N. , McGovern Susan L. , Rao Ganesh , Li Jing
Published: August 2017

Radiation necrosis (RN) is a potential late complication of radiotherapy for intracranial malignancy, which is often associated with significant neurological morbidity. Prolonged treatment with high-dose corticosteroids or surgical resection has been the standard care for RN, but protracted steroid use can lead to significant side effects and surgical resection is not always feasible. The antivascular endothelial growth factor monoclonal antibody bevacizumab induces clinical and radiographic improvements in RN, with overall good tolerance. However, evidence supporting its use for RN in melanoma brain metastases is minimal, likely secondary to concern for intracranial bleeding. Immunotherapy is now one of the most commonly used and effective therapies for metastatic melanoma. A higher risk of RN has been reported with immunotherapy, making alternative treatment for RN in this population a priority, especially as prolonged use of steroids may counteract the treatment efficacy of immunotherapy. We report on seven melanoma patients who developed RN after stereotactic radiosurgery with or without whole-brain radiation therapy who were treated with 2–6 doses of bevacizumab. All patients experienced improvements in symptoms and quality of life, with a concurrent improvement in imaging in six patients. Furthermore, bevacizumab was well tolerated and none of the seven patients experienced intracranial or extracranial bleeding. Our series suggests that in selected melanoma brain metastases patients, bevacizumab may be a safe and effective treatment for RN, especially for those who are undergoing immunotherapy, and should be further evaluated in a prospective setting.
RETINA EXPANSION TECHNIQUE FOR MACULAR HOLE APPOSITION REPORT 2
Authors: Wong Roger , Howard Catherine , Orobona Giancarlo Dell'aversana
Published: August 2017

Purpose:

To describe the safety and efficacy of a technique to close large thickness macular holes.

Methods:

A consecutive retrospective interventional case series of 16 patients with macular holes greater than 650 microns in “aperture” diameter were included. The technique involves vitrectomy, followed by internal limiting membrane peeling. The macula is detached using subretinal injection of saline. Fluid–air exchange is performed to promote detachment and stretch of the retina. After this, the standard fluid–air exchange is performed and perfluoropropane gas is injected. Face-down posturing is advised. Adverse effects, preoperative, and postoperative visual acuities were recorded. Optical coherence tomography scans were also taken.

Results:

The mean hole size was 739 microns (SD: 62 microns; mean base diameter: 1,311 microns). Eighty-three percent (14 of 16) of eyes had successful hole closure after the procedure. At 12-month follow-up, no worsening in visual acuity was reported, and improvement in visual acuity was noted in 14 of 16 eyes. No patients lost vision because of the procedure.

Conclusion:

It is possible to achieve anatomical closure of large macular holes using RETMA. No patients experienced visual loss. The level of visual improvement is likely limited because of the size and chronicity of these holes.
MANAGEMENT OF RETINOBLASTOMA WITH HIV SEROPOSITIVITY
Authors: Dhami Abhinav , Ramesh Anita , Khetan Vikas
Published: August 2017

Purpose:

To report a case of retinoblastoma with concomitant association with HIV seropositivity and its management.

Methods:

A retrospective case report of a 3-year-old male child presenting with right eye Group B and left eye Group E retinoblastoma with simultaneous positivity for HIV1 antibody. The parents were also tested positive for HIV and were referred for initiating antiretroviral therapy.

Results:

The child was managed with focal laser therapy for the right eye and six cycles of systemic chemotherapy, and the left eye was planned for enucleation with ball implant.

Conclusion:

This case poses an outlook into a dilemma as to whether or not systemic chemotherapy should be started along with antiretroviral therapy for treating retinoblastoma, as there are no cited case reports in the literature of retinoblastoma coexisting with HIV and its related management regime and future considerations to be taken for management.
Factors That Influence of Trabectome Surgery for Glaucoma Patients
Authors: Tojo Naoki , Abe Shinya , Hayashi Atsushi
Published: August 2017

Background:

The aim of this study was to investigate the factors that influence the outcome of trabectome surgery.

Methods:

This was a retrospective nonrandomized study. Seventy-eight glaucoma patients (86 eyes) who underwent trabectome surgeries and were followed up for more than 12 months were included. We classified the subtypes of glaucoma as: primary open-angle glaucoma (23 eyes), pseudo-exfoliation glaucoma (58 eyes), and secondary glaucoma (5 eyes). Forty-seven eyes underwent cataract and trabectome surgeries simultaneously, and 39 underwent only trabectome surgery. We evaluated the possible influencing factors including age, sex, glaucoma index, preoperative intraocular pressure (IOP), number of medications, visual field status, central corneal thickness, type of glaucoma and operation method (trabectome only or simultaneous cataract surgeries as well).

Results:

Trabectome surgeries significantly decreased the IOP from 23.0±6.7 to 12.5±3.0 mm Hg after 12 months (P<0.001). The success rate at 12 months was 73.3%. The results showed that a low preoperative IOP, thin central corneal thickness, prior non–selective laser trabeculoplasty history, and simultaneous cataract and trabectome surgeries were factors that contributed to the success rate.

Conclusions:

The success rate of trabectome surgery was higher for low-IOP glaucoma than high-IOP glaucoma. Trabectome could be a useful treatment for low-IOP glaucoma.
Feasibility and Relevance of Antipsychotic Safety Monitoring in Children With Tourette Syndrome
Authors: Pringsheim Tamara , Ho Josephine , Sarna Justyna R. , Hammer Tracy , Patten Scott
Published: August 2017

Purpose/Background

Antipsychotics are efficacious for tics and are increasingly prescribed to children with behavioral disorders. Antipsychotics have important adverse effects, and systematic monitoring of drug safety is infrequently performed. The objectives of this study were to determine the feasibility of antipsychotic safety monitoring in children with Tourette Syndrome using a defined protocol and to evaluate the risk of adverse effects with chronic use.

Methods/Procedures

A prospective longitudinal study of children prescribed antipsychotics was performed. Children were monitored for extrapyramidal, metabolic, and hormonal adverse effects using the Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotic Medications guidelines. This included the measurement of height, weight, waist circumference, the Extrapyramidal Symptom Rating Scale, and laboratory tests of lipids, glucose, insulin, and prolactin at prespecified time points.

Findings/Results

Fifty-seven children who started on risperidone or aripiprazole were monitored for a mean of 10 months 3 days. Significant increases in body mass index (BMI) and waist circumference percentiles occurred with time. There was a significant time by drug interaction, with children on aripiprazole having smaller changes in BMI initially, followed by a faster rate of increase than with risperidone. There was a significant difference between Extrapyramidal Symptom Rating Scale scores on versus before starting antipsychotics and significant increases in insulin and prolactin. Change from a healthy to overweight or obese BMI percentile occurred in 26%. Extrapyramidal symptoms occurred in 35%. Medication was discontinued because of metabolic effects in 19%, and extrapyramidal symptoms in 7%.

Implications/Conclusions

Monitoring of antipsychotic safety in children is feasible and recommended to inform treatment decisions.
An Open Trial of Iloperidone for Mixed Episodes in Bipolar Disorder
Authors: Singh Vivek , Arnold Jodi Gonzalez , Prihoda Thomas J. , Martinez Melissa , Bowden Charles L.
Published: August 2017

Background

Mixed mood states in bipolar disorder are difficult to treat and when present indicate worse illness trajectories. Several medications are US Food and Drug Administration approved to treat mixed episodes; however, the clinical trials have been short term and rarely reported depression response.

Methods

We conducted a 5-month open-label trial examining the tolerability and efficacy of iloperidone for bipolar disorder mixed episodes.

Results

Mania and depression scores significantly improved over the course of the study for study completers (ie, 60%–68% improvement for manic symptoms and 41%–49% for depression symptoms). Improvements were observed early in the trial and after adjusting for concomitant medication effects. The average daily dose in completers was 15 mg. Thirty-nine percent (12/31) of the eligible sample discontinued early because of adverse effects. The adverse events most commonly associated with withdrawal were increased heart rate/palpitations (n = 5 of 12) and urinary incontinence/intense urge to urinate (n = 3 of 12).

Conclusions

In a subset of patients, iloperidone provides relief for classic manic, depression, and irritability symptoms associated with mixed episodes in a long-term trial. Adverse effect profiles are likely to be a major factor contributing to individualized medication use.
Lived Experiences of Muscle Tightness Symptoms From Patients’ Perspectives
Authors: Bhimani Rozina , Carney-Anderson Lisa
Published: August 2017

The aims of this study were to understand symptoms of chronic muscle tightness from the patient’s perspective and explore symptom management strategies used by them. Muscle tightness, a common symptom, is a challenge to manage in clinical practice because it is commingled with other orthopedic conditions. Nurses may not be aware of the negative impact of tight muscles because this symptom is presumed to be self-limiting; however, if not treated appropriately, muscle tightness can become chronic. The focus of this study is the lived experience of patients with chronic muscle tightness. The researchers used a qualitative descriptive design in which patients provided insights into the experiences and self-management of chronic muscle tightness. Sixteen adult subjects experiencing physical impairments who were managed by physical therapists in a specialty clinic participated in the study. The subjects participated in 45- to 60-minute semistructured interviews to provide understanding of chronic muscle tightness. The interviews were recorded and transcribed for content analysis. Results indicate that patients identify day-to-day experiences of chronic muscle tightness as unresolving; these patients experience myriads of sensations and live with life restrictions that negatively affect their quality of life. Uses of complementary therapies are commonplace in managing this symptom. The symptom of chronic muscle tightness may linger, and patients use workarounds to manage their lives. Nurses must understand patients’ perspectives to assist them in achieving an acceptable quality of life.
An Interprofessional Approach to Amyotrophic Lateral Sclerosis Care
Authors: Jaffa Jerri L. , Dufault Marlene , Lavin Mary
Published: August 2017

Amyotrophic lateral sclerosis (ALS) is a progressive fatal neurodegenerative disease that is characterized by the death of motor neurons in the spinal cord, brain stem, and motor cortex that are responsible for voluntary movement. For unknown reasons, military veterans are approximately twice as likely as the public to be given a diagnosis of ALS. Currently, there is no cure for ALS. The only US Food and Drug Administration–approved disease-modifying medication is riluzole (Rilutek), which may slow ALS progression but only minimally increases survival time. Multidisciplinary care in ALS has been shown to improve survival time and improve quality of life. The purpose of this article is to describe the development of an innovative evidence-based interprofessional healthcare program in a Veterans Administration medical center to address the needs of this vulnerable veteran population.
Nurses Perceptions of a Novel Protocol Addressing Uniform Periods of Minimum Assessment Times
Authors: Steaphen Annamma , Olson DaiWai M. , Stutzman Sonja E.
Published: August 2017

Aims and Objectives: This quality improvement project aimed to understand the impact of a quiet time protocol on nurses and patients in the neurocritical care unit (NCCU) by comparing pretest and posttest outcomes, taking decibel readings, and abstracting chart information. Background: Sleep is essential for maintaining a healthy life. Patients in the NCCU often do not get adequate amounts of sleep. Quiet time studies have focused on implementing periods of reduced noise levels to improve patient sleep. However, the perceptions of the caregivers about the protocols have not been taken into consideration, leading to difficulty in implementing these protocols if it impedes with the routine work of the caregivers. Methods: This was a prospective quality improvement project, with a quiet time protocol in the novel setting of the NCCU with caregiver feedback on the protocol. The quiet protocol involved decreasing light, noise, and patient interactions between 11:30 pm and 2:30 am. There were 16 nurses who consented to the study and provided feedback via self-report questionnaires. Results: Implementation of this protocol did not suggest a decrease in nurse enjoyment with their job (P = .51). There were significant improvements in patient sleep quality and quantity (P < .0001). In addition, there was some evidence of decrease in the noise level and number of patient disruptions. Conclusions: The results of this single-site project suggest that, by implementing a quiet time protocol in the NCCU, patients obtained higher levels of sleep quality and quantity. The implementation of this protocol did not impact nurses’ job satisfaction, suggesting that the quiet time protocol is possible, improves patients care, and does not hinder nurses’ job satisfaction.
Carotid Body Tumor
Authors: Bakshi Satvinder S. , Kumar T Lokesh
Published: August 2017

A 17 year old girl presented with a progressively increasing swelling in her neck since 9 months. On examination a2*3 cm, firm, pulsatile swelling was felt in the left anterior triangle. The CT scan of the mass was suggestive of a carotid body tumor and urinary cathecholamines were negative. The mass was excised completely.
Current State of Test Development, Administration, and Analysis
Authors: Bristol Timothy J. , Nelson John W. , Sherrill Karin J. , Wangerin Virginia S.
Published: August 2017

Developing valid and reliable test items is a critical skill for nursing faculty. This research analyzed the test item writing practice of 674 nursing faculty. Relationships between faculty characteristics and their test item writing practices were analyzed. Findings reveal variability in practice and a gap in implementation of evidence-based standards when developing and evaluating teacher-made examinations.
The Spatial Association Between Federally Qualified Health Centers and County-Level Reported Sexually Transmitted Infections: A Spatial Regression Approach
Authors: Owusu-Edusei Kwame , Gift Thomas L. , Leichliter Jami S. , Romaguera Raul A.
Published: August 2017

Background

The number of categorical sexually transmitted disease (STD) clinics is declining in the United States. Federally qualified health centers (FQHCs) have the potential to supplement the needed sexually transmitted infection (STI) services. In this study, we describe the spatial distribution of FQHC sites and determine if reported county-level nonviral STI morbidity were associated with having FQHC(s) using spatial regression techniques.

Methods

We extracted map data from the Health Resources and Services Administration data warehouse on FQHCs (ie, geocoded health care service delivery [HCSD] sites) and extracted county-level data on the reported rates of chlamydia, gonorrhea and, primary and secondary (P&S) syphilis (2008–2012) from surveillance data. A 3-equation seemingly unrelated regression estimation procedure (with a spatial regression specification that controlled for county-level multiyear (2008–2012) demographic and socioeconomic factors) was used to determine the association between reported county-level STI morbidity and HCSD sites.

Results

Counties with HCSD sites had higher STI, poverty, unemployment, and violent crime rates than counties with no HCSD sites (P < 0.05). The number of HCSD sites was associated (P < 0.01) with increases in the temporally smoothed rates of chlamydia, gonorrhea, and P&S syphilis, but there was no significant association between the number of HCSD per 100,000 population and reported STI rates.

Conclusions

There is a positive association between STI morbidity and the number of HCSD sites; however, this association does not exist when adjusting by population size. Further work may determine the extent to which HCSD sites can meet unmet needs for safety net STI services.
Cutaneous Eruptions in Patients Receiving Immune Checkpoint Blockade
Authors: Kaunitz Genevieve J. , Loss Manisha , Rizvi Hira , Ravi Sowmya , Cuda Jonathan D. , Bleich Karen B. , Esandrio Jessica , Sander Inbal , Le Dung T. , Diaz Luis A. , Brahmer Julie R. , Drake Charles G. , Hollmann Travis J. , Lacouture Mario E. , Hellmann Matthew D. , Lipson Evan J. , Taube Janis M.
Published: August 2017

Cutaneous eruptions are among the most common immune-related adverse events (irAEs) associated with anti-programmed cell death protein 1/programmed cell death ligand 1 therapy, and are often clinically and histologically characterized as lichenoid. Nonlichenoid patterns may also occur and are likely to be encountered by surgical pathologists, given the increasing clinical use of these agents. The purpose of this study is to describe the histopathologic features of nonlichenoid cutaneous irAEs from patients receiving anti-programmed cell death protein 1/programmed cell death ligand 1 therapies for a variety of underlying advanced malignancies. Sixteen patients with 17 biopsied eruptions were included from 2 academic institutions with extensive experience administering and monitoring responses to immune checkpoint blockade as well as treating the potential side effects. Eruptions occurred a median of 10 days (range, 1 d to 11.4 mo) after treatment initiation. Nearly half of specimens demonstrated either a psoriasiform/spongiotic or an urticarial-type reaction pattern on histologic review. Patterns consistent with Grover disease, bullous pemphigoid, and granulomatous dermatitis were also observed. Nearly two-thirds of patients required systemic corticosteroids for treatment of the cutaneous irAE, and 19% of patients discontinued immunotherapy due to their skin eruptions. 75% of patients showed an objective antitumor response. The diverse array of nonlichenoid cutaneous irAE presented here should reflect and inform the scope of histologic patterns encountered by the practicing surgical pathologist. Such eruptions are seen in patients with a variety of underlying tumor types, many of whom ultimately demonstrate a favorable response to immune checkpoint blockade.
Idiopathic Myointimal Hyperplasia of Mesenteric Veins
Authors: Yantiss Rhonda K. , Cui Isabelle , Panarelli Nicole C. , Jessurun Jose
Published: August 2017

Idiopathic myointimal hyperplasia of mesenteric veins causes chronic ischemic mucosal injury with segmental strictures that mimic inflammatory bowel disease and nonocclusive ischemic colitis. It is characterized by myointimal proliferative changes that narrow the lumina of veins combined with ischemic injury and ulcers. Most cases reported to date have been diagnosed following surgical resection. The aim of this study was to determine whether mucosal changes of idiopathic myointimal hyperplasia of mesenteric veins are sufficiently sensitive and specific to allow its recognition in biopsy material. The study group consisted of 10 patients with idiopathic myointimal hyperplasia of mesenteric veins who underwent surgical resection of the affected colon, 7 of whom had available prior endoscopic biopsies. The control group included 10 patients each with radiation, nonocclusive ischemia, Crohn disease, diverticulitis, and mucosal amyloidosis, and 5 cases of small vessel (leukocytoclastic) vasculitis. Study patients were mostly older men with distal colorectal disease. All resection specimens showed mucosal ischemia with numerous thick-walled (arteriolized) capillaries and glassy subendothelial fibrin deposits; numerous hyalinized, eosinophilic thrombi were detected in 90% of colectomy specimens. Biopsies showed arteriolized capillaries (100%), subendothelial fibrin deposits (86%), fibrin thrombi (43%), and perivascular hyalinization (43%). Fibrin thrombi were observed in only one case each of ischemic colitis and small vessel vasculitis, and none of the other abovementioned features were seen in any of the controls. We conclude that arteriolized capillaries, subendothelial fibrin deposits, and perivascular hyalinization are frequent and specific features that can facilitate recognition of idiopathic myointimal hyperplasia of mesenteric veins in biopsy samples.
End-Tidal Co 2–Guided Chest Compression Delivery Improves Survival in a Neonatal Asphyxial Cardiac Arrest Model*
Authors: Hamrick Justin T. , Hamrick Jennifer L. , Bhalala Utpal , Armstrong Jillian S. , Lee Jeong-Hoo , Kulikowicz Ewa , Lee Jennifer K. , Kudchadkar Sapna R. , Koehler Raymond C. , Hunt Elizabeth A. , Shaffner Donald H.
Published: August 2017

Objectives:

To determine whether end-tidal Co
2–guided chest compression delivery improves survival over standard cardiopulmonary resuscitation after prolonged asphyxial arrest.

Design:

Preclinical randomized controlled study.

Setting:

University animal research laboratory.

Subjects:

1–2-week-old swine.

Interventions:

After undergoing a 20-minute asphyxial arrest, animals received either standard or end-tidal Co
2–guided cardiopulmonary resuscitation. In the standard group, chest compression delivery was optimized by video and verbal feedback to maintain the rate, depth, and release within published guidelines. In the end-tidal Co
2–guided group, chest compression rate and depth were adjusted to obtain a maximal end-tidal Co
2 level without other feedback. Cardiopulmonary resuscitation included 10 minutes of basic life support followed by advanced life support for 10 minutes or until return of spontaneous circulation.

Measurements and Main Results:

Mean end-tidal Co
2 at 10 minutes of cardiopulmonary resuscitation was 34 ± 8 torr in the end-tidal Co
2 group (n = 14) and 19 ± 9 torr in the standard group (n = 14; p = 0.0001). The return of spontaneous circulation rate was 7 of 14 (50%) in the end-tidal Co
2 group and 2 of 14 (14%) in the standard group (p = 0.04). The chest compression rate averaged 143 ± 10/min in the end-tidal Co
2 group and 102 ± 2/min in the standard group (p < 0.0001). Neither asphyxia-related hypercarbia nor epinephrine administration confounded the use of end-tidal Co
2–guided chest compression delivery. The response of the relaxation arterial pressure and cerebral perfusion pressure to the initial epinephrine administration was greater in the end-tidal Co
2 group than in the standard group (p = 0.01 and p = 0.03, respectively). The prevalence of resuscitation-related injuries was similar between groups.

Conclusions:

End-tidal Co
2–guided chest compression delivery is an effective resuscitation method that improves early survival after prolonged asphyxial arrest in this neonatal piglet model. Optimizing end-tidal Co
2 levels during cardiopulmonary resuscitation required that chest compression delivery rate exceed current guidelines. The use of physiologic feedback during cardiopulmonary resuscitation has the potential to provide optimized and individualized resuscitative efforts.
Comparison Between Corticosteroid and Lidocaine Injection in the Treatment of Tennis Elbow
Authors: Hsieh Lin-Fen , Kuo Ying-Chen , Lee Chia-Cheng , Liu Ya-Fang , Liu Yu-Chia , Huang Vincent
Published: August 2017

Objective

The aim of the study was to compare the effects of corticosteroid injection with lidocaine injection in treating tennis elbow.

Design

It is a prospective, double-blinded, randomized controlled trial. Patients with tennis elbow for more than 1 mo were recruited from a hospital-based rehabilitation outpatient clinic. A total of 70 patients were recruited, and 61 patients completed the study. Patients received an injection of either 10 mg (1 ml) of triamcinolone (corticosteroid group, n = 30) or 1 ml of 1% lidocaine (lidocaine group, n = 31). All of the outcome measures were evaluated before the intervention and at 2 wks and 2 mos after treatment.

Results

No significant group differences were observed between the corticosteroid and lidocaine groups regarding Patient-Rated Tennis Elbow Evaluation, Disability of the Arm, Shoulder, and Hand, visual analog scale for pain, and grip strength at baseline and at 2 wks and 2 mos after treatment (P > 0.05). However, within-group comparison showed significant improvement after injection with regard to Patient-Rated Tennis Elbow Evaluation, Disability of the Arm, Shoulder, and Hand, visual analog scale for pain, and grip strength in both groups (P > 0.05).

Conclusions

No differences in the short-term outcomes were found between lidocaine and corticosteroid injection in a small sample of people with tennis elbow with mean duration of 3.8 mos.
Do Psychosocial Factors Predict Muscle Strength, Pain, or Physical Performance in Patients With Knee Osteoarthritis?
Authors: Baert Isabel A. C. , Meeus Mira , Mahmoudian Armaghan , Luyten Frank P. , Nijs Jo , Verschueren Sabine M. P.
Published: August 2017

Objective

The aim of this study was to examine the relationship of psychosocial factors, namely, pain catastrophizing, kinesiophobia, and maladaptive coping strategies, with muscle strength, pain, and physical performance in patients with knee osteoarthritis (OA)–related symptoms.

Methods

A total of 109 women (64 with knee OA–related symptoms) with a mean age of 65.4 years (49–81 years) were recruited for this study. Psychosocial factors were quantified by the Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, and Pain Coping Inventory. Clinical features were assessed using isometric and isokinetic knee muscle strength measurements, visual analog scale, Western Ontario and McMaster Universities Osteoarthritis Index, and functional tests. Associations were examined using correlation and regression analysis.

Results

In knee OA patients, pain catastrophizing, kinesiophobia, and coping strategy explained a significant proportion of the variability in isometric knee extension and flexion strength (6.3%–9.2%), accounting for more overall variability than some demographic and medical status variables combined. Psychosocial factors were not significant independent predictors of isokinetic strength, knee pain, or physical performance.

Conclusions

In understanding clinical features related to knee OA, such as muscle weakness, pain catastrophizing, kinesiophobia, and coping strategy might offer something additional beyond what might be explained by traditional factors, underscoring the importance of a biopsychosocial approach in knee OA management. Further research on individual patient characteristics that mediate the effects of psychosocial factors is, however, required in order to create opportunities for more targeted, personalized treatment for knee OA.
Allopurinol Medication Adherence as a Mediator of Optimal Outcomes in Gout Management
Authors: Coburn Brian W. , Bendlin Kayli A. , Sayles Harlan , Meza Jane , Russell Cynthia L. , Mikuls Ted R.
Published: August 2017

Background

Patient and provider factors, including allopurinol medication adherence, affect gout treatment outcomes.

Objectives

The aim of this study was to examine associations of patient and provider factors with optimal gout management.

Methods

Linking longitudinal health and pharmacy dispensing records to questionnaire data, we assessed patient and provider factors among 612 patients with gout receiving allopurinol during a recent 1-year period. Associations of patient (medication adherence and patient activation) and provider factors (dose escalation, low-dose initiation, and anti-inflammatory prophylaxis) with serum urate (SU) goal achievement of less than 6.0 mg/dL were examined using multivariable logistic regression. Medication adherence was assessed as a mediator of these factors with goal achievement.

Results

A majority of patients (63%) were adherent, whereas a minority received dose escalation (31%). Medication adherence was associated with initiation of daily allopurinol doses of 100 mg/d or less (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.20–2.76). In adjusted models, adherence (OR, 2.35; 95% CI, 1.50–3.68) and dose escalation (OR, 2.48; 95% CI, 2.48–4.25) were strongly associated with SU goal attainment. Low starting allopurinol dose was positively associated with SU goal attainment (OR, 1.11; 95% CI, 1.02–1.20) indirectly through early adherence, but also had a negative direct association with SU goal attainment (OR, 0.21; 95% CI, 0.12–0.37).

Conclusions

Medication adherence and low starting dose combined with dose escalation represent promising targets for future gout quality improvement efforts. Low starting dose is associated with better SU goal attainment through increased medication adherence, but may be beneficial only in settings where appropriate dose escalation is implemented.
Omega-3 Fatty Acids in Rheumatic Diseases
Authors: Akbar Umair , Yang Melissa , Kurian Divya , Mohan Chandra
Published: August 2017

Many clinical trials of omega-3 fatty acids, supplied as fish oil supplements, have been carried out in rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), lupus nephritis, and osteoarthritis (OA) over the past 3 decades. This review attempts to summarize the highlights of these studies to evaluate the clinical efficacy for omega-3 fatty acids to be added alongside existing treatment regimens. A total of 20 clinical trials have been carried out in RA, of which 16 exhibited significant improvements in multiple disease clinical outcomes. Nine clinical trials have been completed in SLE and lupus nephritis, of which 6 exhibited significant improvements in 1 or more clinical outcomes. A total of 4 clinical trials have been conducted in OA, of which 3 exhibited significant improvements in at least 1 clinical parameter. Multiple mechanisms for the clinical effects of omega-3 fatty acids have been implicated, including the modulation of eicosanoid synthesis toward a more anti-inflammatory profile and suppressed production of proinflammatory cytokines. Overall, fish oil supplements appear to be a safe and effective agent that could be added to the current treatment regimens in RA. Longer-term trials with larger patient cohort sizes are warranted to establish any long-term benefits of fish oil supplements in SLE, lupus nephritis, and OA.
Increased Expiratory Computed Tomography Density Reveals Possible Abnormalities in Radiologically Preserved Lung Parenchyma in Idiopathic Pulmonary Fibrosis
Authors: Petroulia Valentina , Funke Manuela , Zumstein Pascal , Berezowska Sabina , Ebner Lukas , Geiser Thomas , Torbica Nenad , Heverhagen Johannes , Poellinger Alexander
Published: August 2017

Objectives

Idiopathic pulmonary fibrosis (IPF) is a progressive lethal chronic lung disease with unclear pathogenesis. Radiological hallmark is the pattern of usual interstitial pneumonia accentuated in peripheral and basal areas with otherwise preserved lung structure. One hypothesis is that alveolar collapse and consequent induration lead to fibrotic transformation of lung tissue. The aim of the study was to investigate normal-appearing tissue during expiration for signs of collapsibility and differences from other diseases or controls.

Materials and Methods

We retrospectively assessed a total of 43 patients (15 IPFs, 13 chronic obstructive pulmonary diseases, and 15 controls) with nonenhanced computed tomography (CT) in inspiration and expiration, performed for routine clinical workup. Densitometry of visually unaffected lung tissue was conducted in all lung lobes with a region of interest of 15-mm in diameter on soft tissue kernel reconstruction (slice thickness, 1 mm) during inspiration and expiration.

Results

One-factor analysis of variance analysis yielded significant difference in attenuation changes between inspiration and expiration of unaffected lung parenchyma among all subject groups in all lung lobes. For IPF patients, the highest differences in densities were observed in the lower lobes, which is the predominantly affected site of usual interstitial pneumonia. In the chronic obstructive pulmonary disease group, the density remained rather equal in the entire lung.

Conclusions

High CT attenuation changes between inspiration and expiration in IPF patients might suggest altered lung parenchyma in normal-appearing tissue on CT. Density changes during the respiratory cycle might be explained by alveolar collapse of radiologically unaffected lung tissue possibly preceding fibrosis. These results support the concept of alveolar collapse preceding lung fibrosis in IPF.
Acute Worsening of Tics on Varenicline
Authors: Mittal Shivam Om , Klassen Bryan T. , Hassan Anhar , Bower James H. , Coon Elizabeth A.
Published: August 2017

Objective

The aim of this study was to report worsening of Tourette syndrome (TS) in 2 patients treated with varenicline.

Background

Abnormal dopaminergic signaling is likely involved in the pathophysiology of TS. Varenicline is a partial α4β2 nicotinic acetylcholine agonist that enhances dopamine release. Therefore, the use of varenicline may influence tics in patients with TS.

Method

We analyzed and described 2 case studies on patients with significant worsening of tics after treatment with varenicline.

Results

Patient 1 had motor tics in childhood, which completely resolved by the age of 20 years. At the age of 25 years, he started varenicline and stopped smoking. Within 2 weeks, he developed motor followed by vocal tics that persisted despite stopping varenicline and restarting smoking. The tics were complex, medically refractory, and caused severe disability at work and school (Yale Global Tic Severity Scale score, 86). Patient 2 developed motor and vocal tics in adolescence that persisted into her 20s and caused significant disability in association with psychiatric comorbidities. At the age of 31 years, she started varenicline to quit smoking, which led to a marked increase in tic frequency and severity. Varenicline was discontinued after 3 weeks with improvement to baseline tic severity (Yale Global Tic Severity Scale score, 94). Ultimately, both patients successfully underwent deep brain stimulation to bilateral centromedian/parafascicular complex thalamic nuclei for medically refractory TS.

Conclusions

We report 2 patients with motor and/or vocal tics that had severe worsening of tics after varenicline use. This may be due to varenicline-induced increased striatal dopamine in conjunction with nicotine cessation, influencing dopamine receptor sensitivity in TS. Providers should be cautious in prescribing varenicline to patients with TS.
Prenatal environment affects embryonic response to song
Authors: Colombelli-Négrel Diane , Kleindorfer Sonia
Published: August 2017

Early environmental enrichment improves postnatal cognition in animals and humans. Here, we examined the effects of the prenatal acoustic environment (parental song rate) on prenatal attention in superb fairy-wren (
Malurus cyaneus
) embryos, the only songbird species with evidence of prenatal discrimination of maternal calls and
in ovo
call learning. Because both adults also sing throughout the incubation phase, we broadcast songs to embryos and measured their heart rate response in relation to parental song rate and tutor identity (familiarity, sex). Embryos from acoustically active families (high parental song rate) had the strongest response to songs. Embryos responded (i) strongest to male songs irrespective of familiarity with the singer, and (ii) strongest if their father had a high song rate during incubation. This is the first evidence for a prenatal physiological response to particular songs (potential tutors) in the egg, in relation to the prenatal acoustic environment, and before the sensitive period for song learning.
Charles Blagden in revolutionary America: two unpublished letters to John Lloyd
Authors: Frame Paul
Published: August 2017

Prior to becoming a secretary of the Royal Society in 1784 Charles Blagden (
bapt
. 1748–
d
. 1820) served as a surgeon in the British army during the Revolutionary War in America. In the two unpublished letters of 1778 discussed here, Blagden provides his Welsh friend John Lloyd (1749–1815) with a vivid description of the current state of affairs in America, from a British perspective, and with insights into continuing scientific endeavour in a time of war. The letters illustrate the attempt that two men made to keep alive an intellectual life and are testimony to the rapidity with which matters of scientific interest could be disseminated in the eighteenth century, even during a major international conflict.
Object recognition and localization from 3D point clouds by maximum-likelihood estimation
Authors: Dantanarayana Harshana G. , Huntley Jonathan M.
Published: August 2017

We present an algorithm based on maximum-likelihood analysis for the automated recognition of objects, and estimation of their pose, from 3D point clouds. Surfaces segmented from depth images are used as the features, unlike ‘interest point’-based algorithms which normally discard such data. Compared to the 6D Hough transform, it has negligible memory requirements, and is computationally efficient compared to iterative closest point algorithms. The same method is applicable to both the initial recognition/pose estimation problem as well as subsequent pose refinement through appropriate choice of the dispersion of the probability density functions. This single unified approach therefore avoids the usual requirement for different algorithms for these two tasks. In addition to the theoretical description, a simple 2 degrees of freedom (d.f.) example is given, followed by a full 6 d.f. analysis of 3D point cloud data from a cluttered scene acquired by a projected fringe-based scanner, which demonstrated an RMS alignment error as low as 0.3 mm.
Oriented, molecularly imprinted cavities with dual binding sites for highly sensitive and selective recognition of cortisol
Authors: Suda Narito , Sunayama Hirobumi , Kitayama Yukiya , Kamon Yuri , Takeuchi Toshifumi
Published: August 2017

Novel, molecularly imprinted polymers (MIPs) were developed for the highly sensitive and selective recognition of the stress marker cortisol. Oriented, homogeneous cavities with two binding sites for cortisol were fabricated by surface-initiated atom transfer radical polymerization, using a cortisol motif template molecule (TM1) which consists of a polymerizable moiety attached at the 3-carbonyl group of cortisol via an oxime linkage and an adamantane carboxylate moiety coupled with the 21-hydroxyl group. TM1 was orientationally immobilized on a β
-
cyclodextrin (β-CD)-grafted gold-coated sensor chip by inclusion of the adamantane moiety of TM1, followed by copolymerization of a hydrophilic comonomer, 2-methacryloyloxyethyl phosphorylcholine, with or without a cross-linker,
N,N′
-methylenebisacrylamide. Subsequent cleavage of the oxime linkage leaves the imprinted cavities that contain dual binding sites—namely, the aminooxy group and β-CD—capable of oxime formation and hydrophobic interaction, respectively. As an application, MIP-based picomolar level detection of cortisol was demonstrated by a competitive binding assay using a fluorescent competitor. Cross-linking of the MIP imparts rigidity to the binding cavities, and improves the selectivity and sensitivity significantly, reducing the limit of detection to 4.8 pM. In addition, detection of cortisol in saliva samples was demonstrated as a feasibility study.
Taxonomy assignment approach determines the efficiency of identification of OTUs in marine nematodes
Authors: Holovachov Oleksandr , Haenel Quiterie , Bourlat Sarah J. , Jondelius Ulf
Published: August 2017

Precision and reliability of barcode-based biodiversity assessment can be affected at several steps during acquisition and analysis of data. Identification of operational taxonomic units (OTUs) is one of the crucial steps in the process and can be accomplished using several different approaches, namely, alignment-based, probabilistic, tree-based and phylogeny-based. The number of identified sequences in the reference databases affects the precision of identification. This paper compares the identification of marine nematode OTUs using alignment-based, tree-based and phylogeny-based approaches. Because the nematode reference dataset is limited in its taxonomic scope, OTUs can only be assigned to higher taxonomic categories, families. The phylogeny-based approach using the evolutionary placement algorithm provided the largest number of positively assigned OTUs and was least affected by erroneous sequences and limitations of reference data, compared to alignment-based and tree-based approaches.
The
in situ
synthesis of PbS nanocrystals from lead(II)
n
-octylxanthate within a 1,3-diisopropenylbenzene–bisphenol A dimethacrylate sulfur copolymer
Authors: McNaughter P. D. , Bear J. C. , Mayes A. G. , Parkin I. P. , O'Brien P.
Published: August 2017

The synthesis of lead sulfide nanocrystals within a solution processable sulfur ‘inverse vulcanization’ polymer thin film matrix was achieved from the
in situ
thermal decomposition of lead(II)
n
-octylxanthate, [Pb(S
2
COOct)
2
]. The growth of nanocrystals within polymer thin films from single-source precursors offers a faster route to networks of nanocrystals within polymers when compared with
ex situ
routes. The ‘inverse vulcanization’ sulfur polymer described herein contains a hybrid linker system which demonstrates high solubility in organic solvents, allowing solution processing of the sulfur-based polymer, ideal for the formation of thin films. The process of nanocrystal synthesis within sulfur films was optimized by observing nanocrystal formation by X-ray photoelectron spectroscopy and X-ray diffraction. Examination of the film morphology by scanning electron microscopy showed that beyond a certain precursor concentration the nanocrystals formed were not only within the film but also on the surface suggesting a loading limit within the polymer. We envisage this material could be used as the basis of a new generation of materials where solution processed sulfur polymers act as an alternative to traditional polymers.