bluuebunny/crossref_metadata_2025 huggingface dataset:
Altered Mental Status in ICU Patients: Diagnostic Yield of Noncontrast Head CT for Abnormal and Communicable Findings
Authors: Chokshi Falgun H. , Sadigh Gelareh , Carpenter Walter , Kang Jian , Duszak Richard , Khosa Faisal
Published: August 2016

Objective:

To evaluate the diagnostic yield of noncontrast head CT for acute communicable findings in ICU patients specifically scanned for altered mental status.

Design:

Retrospective observational cohort study.

Setting:

University Hospital Neuroscience, Medical, and Surgical ICUs.

Patients:

ICU patients with new-onset altered mental status.

Intervention:

Noncontrast head CT.

Measurements and Main Results:

Reports on head CTs from two university hospitals performed for the sole indication of altered mental status in ICU patients between July 2011 and June 2013 were reviewed for 1) acute (new or worsening) hemorrhage, 2) mass effect/herniation, 3) infarction, and 4) hydrocephalus. Subgroup analyses of positive findings were performed by 1) ICU group type, 2) age, and 3) race. A total of 2,486 head CTs were performed in 1,357 patients whose age ranged from 14 to 116 years (median, 59; mean, 57.6 ± 16). Acute communicable findings in at least one of four categories were present in 22.8% (566/2,486) of examinations, with hydrocephalus being most common (11.5% [286/2,486]). The frequency of any acute communicable findings in neuroscience, medical, and surgical ICUs was 28.6% (471/1,648), 9.8% (43/440), and 13.1% (52/398), respectively. Neuroscience ICU head CTs had significantly higher rates of acute communicable findings in all categories, except for acute infarction, compared with the other two ICUs (p < 0.001). Acute hydrocephalus (13.6% vs 7.4%; p < 0.001) and mass effect (6.7% vs 4.3%; p = 0.01) were more common in patients less than 65 years. For other acute categories, no significant difference was noted by age. There was no significant difference in the likelihood of a positive examination by race.

Conclusions:

Almost one in four head CTs in a university ICU patient population performed for primary indication of altered mental status yields abnormal communicable findings. In this patient population, utilization management barriers to examination ordering should be minimized.
Is the Risk of Autism in Younger Siblings of Affected Children Moderated by Sex, Race/Ethnicity, or Gestational Age?
Authors: Xie Fagen , Peltier Morgan , Getahun Darios
Published: August 2016

Objective:

To evaluate the recurrence risk of autism spectrum disorders (ASD) in younger siblings of affected children and determine how it is modified by race/ethnicity and sex.

Method:

Medical records of children born in a large health maintenance organization (Kaiser Permanent Southern California) hospitals from January 1, 2001, through December 31, 2010, and who remained in our system until 2 to 11 years of age were used to assess the risk of recurrence of ASD in younger siblings. Children born at <28 or >42 weeks gestation, multiple births, or those who were not active members for ≥3 months were excluded. ASD diagnosis was ascertained from DSM-IV codes, and the magnitude of the association was estimated using adjusted relative risks (aRRs).

Results:

Among eligible younger siblings, 592 (1.11%) had the diagnosis of ASD. The ASD rates were 11.30% and 0.92% for younger siblings of older affected and unaffected siblings, respectively (aRR: 14.27; 95% confidence interval, 11.41–17.83). This association remained after adjusting for potential confounding factors. Race/ethnicity- and gestational age-specific analyses revealed a positive association of similar magnitude across groups. Risk remained higher in younger boys than girls regardless of the sex of affected older siblings.

Conclusion:

The findings of this study suggest that the risk of ASD in younger siblings is higher if the older sibling has ASD. The risk of ASD in younger siblings of older affected siblings was comparable across gestational age at birth and child's race/ethnicity groups. However, risk remains higher for boys. This study contributes to a better understanding of the influence of race/ethnicity, sex, and gestational age at birth in identifying children at higher risk of ASD.
Effectiveness of Liposomal Bupivacaine in Colorectal Surgery: A Pragmatic Nonsponsored Prospective Randomized Double Blinded Trial in a Community Hospital
Authors: Knudson Rachel A. , Dunlavy Paul W. , Franko Jan , Raman Shankar R. , Kraemer Soren R.
Published: August 2016

BACKGROUND:

Prior industry conducted studies have shown that long acting liposomal bupivacaine injection improves pain control postoperatively.

OBJECTIVE:

To evaluate whether liposomal bupivacaine reduced the use of postoperative opioid (http://links.lww.com/DCR/A253) pain medication as compared to standard bupivacaine following colorectal surgery.

DESIGN:

A double blinded, prospective, randomized controlled trial comparing liposomal bupivacaine versus standard bupivacaine in patients undergoing elective colon resection.

SETTINGS:

Community hospital with general surgery residency program with all cases performed by colorectal surgeons.

PATIENTS:

Fifty-seven patients were randomized and reported as intention-to-treat analysis with 6 protocol violations. Sensitivity analysis excluding these 6 patients demonstrated no change in study results or conclusion. Mean age was 67 ± 2 years and 56% were male. There were 36 patients who underwent minimally invasive surgery, and 21 patients had an open colon resection.

INTERVENTIONS:

Experimental arm received liposomal bupivacaine while control arm received standard bupivacaine.

MAIN OUTCOME MEASURES:

Primary outcome measure was intravenous hydromorphone equivalent used via PCA during first 48 hours after operation.

RESULTS:

There was no significant difference between the two groups in the amount of opioid used orally or intravenously in the postoperative period. The primary outcome measure was PCA hydromorphone consumption during first two postoperative days after operation (hydromorphone equivalent use in standard bupivacaine group 11.3 ± 8.9 mg versus 13.3 ± 11.9 mg in liposomal bupivacaine group, p = 0.58 Mann-Whitney test).

LIMITATIONS:

Small pragmatic trials typically remain underpowered for secondary analyses. A larger study could help to further delineate other outcomes that are impacted by postoperative pain.

CONCLUSIONS:

Liposomal bupivacaine did not change the amount of opioid used postoperatively. Based on our study, liposomal bupivacaine does not provide any added benefit over conventional bupivacaine after colon resection. (ClinicalTrials.gov: NCT02052557)
Prospective and Longitudinal Study of Urogenital Dysfunction After Proctectomy for Rectal Cancer
Authors: Adam Jean-Philippe , Denost Quentin , Capdepont Maylis , van Geluwe Bart , Rullier Eric
Published: August 2016

BACKGROUND:

Urogenital dysfunctions after rectal cancer treatment are well recognized, although incidence and evolution over time are less well known.

OBJECTIVE:

We aimed to assess the evolution of urogenital functions over time after the treatment for rectal cancer.

DESIGN:

This is a prospective, longitudinal cohort study.

SETTINGS:

This study was conducted at a quaternary referral center for colorectal surgery.

PATIENTS:

A total of 250 consecutive patients treated for rectal cancer were prospectively enrolled for urogenital assessment.

MAIN OUTCOME MEASURES:

End points were the International Prostatic Symptom Score, the International Index of Erectile Function, and the Female Sexual Index obtained by questionnaires before (baseline status) and after preoperative radiotherapy and 3, 6, and 12 months after surgery.

RESULTS:

Overall, 169 patients (68%) responded to the questionnaires. The urinary function decreased temporary after irradiation in men (International Prostatic Symptom Score: 7.8 vs 4.9; p < 0.001). Sexual activity decreased significantly in women after radiotherapy (p = 0.02), and in all patients after surgery (p < 0.001). At 12 months, sexual activity in women declined from 59% before treatment to 36% (p = 0.02). In men, sexual activity (82% vs 57%), erectile function (71% vs 24%), and ejaculatory function (78% vs 32%) decreased from baseline (p < 0.001). Stage T3T4 tumors (OR = 5.72 (95% CI, 1.24–26.36)) and low rectal tumors (OR = 17.86 (95% CI, 1.58–20.00)) were independent factors of worse sexual function.

LIMITATIONS:

This study was limited by the proportion of uncompleted questionnaires, especially in women, and by its monocentric feature.

CONCLUSIONS:

Most patients experienced sexual dysfunction at 12 months after surgery for rectal cancer, and predictive factors for this dysfunction were related to characteristics of the tumor.
Outcomes of Pelvic Exenteration with en Bloc Partial or Complete Pubic Bone Excision for Locally Advanced Primary or Recurrent Pelvic Cancer
Authors: Austin Kirk K. S. , Herd Andrew J. , Solomon Michael J. , Ly Ken , Lee Peter J.
Published: August 2016

INTRODUCTION:

Neoplasms infiltrating the pubic bone have until recently been considered a contraindication to surgery. Paucity of existing published data in regard to surgical techniques and outcomes exist.

OBJECTIVE:

This study aims to address outcomes of our recently published technique for en bloc composite pubic bone excision during pelvic exenteration.

DESIGN:

A prospective database was reviewed to identify patients who underwent a partial or complete pubic bone composite excision over a 12-year period.

SETTINGS:

This study was conducted at a tertiary level exenteration unit.

MAIN OUTCOME MEASURES:

Primary outcomes measured were resection margin and survival. Secondary outcomes included patient and operative demographics, type of cancer, extent of pubic bone excision, morbidity, and 30-day mortality.

RESULTS:

Twenty-nine of over 500 patients undergoing exenterations (mean age, 57.9; 20 males) underwent en bloc complete (11 patients) or partial (18 patients) composite pubic bone excision. Twenty-two patients (76%) underwent resection for recurrent as opposed to advanced primary malignant disease of which rectal adenocarcinoma was the most common followed by squamous-cell carcinoma. The median operating time was 10.5 (range, 6–15) hours, and median blood loss was 2971 (range, 300–8600) mL. Seventeen (59%) patients had a concurrent sacrectomy performed mainly S3 and below. A total cystectomy was performed in 26 patients (90%). Fifteen of 20 male patients (75%) had a perineal urethrectomy. A clear (R0) resection margin was achieved in 22 patients (76%) with a 5-year overall survival of 53% after a median follow-up of 3.2 years (r = 1.4–12.3 years). There was no 30-day mortality. Seventy percent of patients experienced morbidity with a pelvic collection the most common.

LIMITATIONS:

This study was limited because it was a retrospective review, it occurred at a single site, and it used a small heterogeneous sample.

CONCLUSION:

Within the realm of evolving exenteration surgery, en bloc composite pubic bone excision offers results comparable to central, lateral, and posterior compartment excisions, and, as such, is a reasonable strategy in the management of neoplasms infiltrating the pubic bone.
The therapeutic potential of the phytocannabinoid cannabidiol for Alzheimer’s disease
Authors: Karl Tim , Garner Brett , Cheng David
Published: August 2016

Alzheimer’s disease (AD) is the most common neurodegenerative disorder, characterized by progressive loss of cognition. Over 35 million individuals currently have AD worldwide. Unfortunately, current therapies are limited to very modest symptomatic relief. The brains of AD patients are characterized by the deposition of amyloid-β and hyperphosphorylated forms of tau protein. AD brains also show neurodegeneration and high levels of oxidative stress and inflammation. The phytocannabinoid cannabidiol (CBD) possesses neuroprotective, antioxidant and anti-inflammatory properties and reduces amyloid-β production and tau hyperphosphorylation in vitro. CBD has also been shown to be effective in vivo making the phytocannabinoid an interesting candidate for novel therapeutic interventions in AD, especially as it lacks psychoactive or cognition-impairing properties. CBD treatment would be in line with preventative, multimodal drug strategies targeting a combination of pathological symptoms, which might be ideal for AD therapy. Thus, this review will present a brief introduction to AD biology and current treatment options before outlining comprehensively CBD biology and pharmacology, followed by in-vitro and in-vivo evidence for the therapeutic potential of CBD. We will also discuss the role of the endocannabinioid system in AD before commenting on the potential future of CBD for AD therapy (including safety aspects).
Pharmacological investigations of a yohimbine–impulsivity interaction in rats
Authors: Mahoney Megan K. , Barnes John H. , Wiercigroch David , Olmstead Mary C.
Published: August 2016

Both impulsivity and stress are risk factors for substance abuse, but it is not clear how these two processes interact to alter susceptibility for the disorder. The aim of this project was to examine the pharmacology of a stress–impulsivity interaction in rats. To do so, we tested the effects of yohimbine on impulsive action and then assessed whether behavioural changes could be reduced by antagonists at different receptor subtypes. Male Long–Evans rats were injected with various doses of yohimbine (0–5.0 mg/kg) before testing in the response-inhibition task. In subsequent experiments, yohimbine (2.5 mg/kg) was injected following pretreatment with the following receptor antagonists: corticotropin-releasing factor receptor 1, antalarmin (0–20 mg/kg); glucocorticoid, mifepristone (0–30 mg/kg); noradrenergic (NA) α1, prazosin (0–2 mg/kg); NA α2, guanfacine (0–0.5 mg/kg); NA β2, propranolol (0.5–2.0 mg/kg); dopamine D1/5, SCH 39166 (0–0.0625 mg/kg); μ opioid, naloxone (0–2 mg/kg); or 5-HT2A, M100907 (0.005–0.05 mg/kg). In all experiments, impulsive action was measured as increased premature responding. Yohimbine dose dependently increased impulsive action, but the effect was not reversed by antagonist pretreatment. None of the drugs altered any other behavioural measure. We conclude that stress–impulsivity interactions are likely mediated by a synergy of multiple neurotransmitter systems.
Effectiveness and cost-effectiveness of pessary treatment compared with pelvic floor muscle training in older women with pelvic organ prolapse: 2-year follow-up of a randomized controlled trial in primary care
Authors: Panman Chantal M.C.R. , Wiegersma Marian , Kollen Boudewijn J. , Berger Marjolein Y. , Lisman-van Leeuwen Yvonne , Vermeulen Karin M. , Dekker Janny H.
Published: August 2016

Objective:

We investigated the effectiveness and cost-effectiveness of pessary treatment compared with pelvic floor muscle training (PFMT) in women with pelvic organ prolapse over a 2-year period.

Methods:

Randomized controlled trial with women (≥55 y) with symptomatic pelvic organ prolapse, identified by screening. Participants were recruited from 20 primary care practices (October 2009-December 2012). Primary outcome was the difference in change of pelvic floor symptoms (PFDI-20 score) between groups over 24 months. Secondary outcomes included prolapse, urinary, and anorectal symptoms; quality of life; costs; sexual functioning; prolapse stage; pelvic floor muscle function; and participants’ perceived symptom improvement.

Results:

There was a nonsignificant difference in the primary outcome between pessary treatment (n = 82) and PFMT (n = 80) with a mean difference of −3.7 points (95% CI, −12.8 to 5.3; P = 0.42) in favor of pessary treatment. A significantly greater improvement in the prolapse symptom score was, however, seen with pessary treatment (mean difference −3.2 points [95% CI, −6.3 to −0.0; P = 0.05]). Direct medical costs over the 2-year study were $309 and $437 per person for pessary treatment and PFMT, respectively.

Conclusions:

In older women with symptomatic prolapse, there was no significant difference between pessary treatment and PFMT in reducing pelvic floor symptoms, but specific prolapse-related symptoms did improve more with pessary treatment. Pessary treatment was preferable in the cost-effectiveness analysis. When counseling women for prolapse treatment it should, however, be taken into account that pessary fitting fails in a considerable portion of women and that pessary treatment was associated with more side effects compared with PFMT.
An Evaluation of FrancoForme
Authors: Prince Stephanie A. , Laflamme Marc , Harris Jennifer , Tulloch Heather E. , de Margerie Michele
Published: August 2016

Purpose:

Cardiovascular disease (CVD) is the leading cause of mortality globally. Telephone-delivered interventions targeting cardiovascular risk factors are gaining popularity. This study is an evaluation of FrancoForme, a cardiovascular risk factor reduction program for the primary and secondary prevention of CVD among French-speaking patients of Eastern Ontario.

Methods:

This study reports on changes in cardiovascular risk factors, weekly exercise levels, and psychosocial characteristics including anxiety, depression, and quality of life upon program completion (3 months) and at 1 year after the start of the program. Repeated-measures analysis of variance was used to compare changes in outcomes between primary prevention risk groups (low, moderate, and high risk for CVD) and the secondary prevention group (ie, cardiac rehabilitation) at baseline, 3 months and 12 months.

Results:

A total of 762 patients enrolled in FrancoForme between 2008 and 2015. At 3 months, all program completers (n = 507) experienced significant reductions for all cardiovascular risk factors except diastolic blood pressure. Minutes of self-reported exercise increased significantly by an average 90 minutes per week and all psychosocial variables improved. Significant group effects were observed across several risk factors. Among 12-month responders (n = 240), exercise, high-density lipoproteins, triglycerides, cholesterol, and all psychosocial variables were improved over baseline results.

Conclusions:

FrancoForme is unique in targeting both the primary and secondary prevention of CVD and removes several of the barriers to participating in a conventional CVD prevention program for French-speaking patients. FrancoForme is successful, receiving high satisfaction rates and resulting in significant improvements in cardiovascular risk factors, exercise, anxiety, and depression, as well as quality of life.
PURTSCHER RETINOPATHY AS A MANIFESTATION OF HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS
Authors: Sebrow Dov B. , Dhrami-Gavazi Elona , Horowitz Jason D. , Yannuzzi Lawrence A.
Published: August 2016

Purpose:

The authors describe a woman diagnosed with hemophagocytic lymphohistiocytosis and found to have retinal examination findings consistent with Purtscher retinopathy.

Methods:

A 52-year-old woman underwent multimodal imaging, including color fundus photography and spectral-domain optical coherence tomography, to confirm the diagnosis.

Results:

The ophthalmic examination and imaging confirmed the findings of Purtscher retinopathy with significant inner retinal thickening on spectral-domain optical coherence tomography. Throughout a hospital course complicated by multi-organ failure, she continued to have profoundly limited visual acuity, likely resulting from inner retinal ischemia affecting the posterior pole of both eyes.

Conclusion:

The authors describe a patient with hemophagocytic lymphohistiocytosis, a disease characterized by disruption of normal natural killer cell activity with subsequent uncontrolled cytokine release, who presented with Purtscher retinopathy confirmed with spectral-domain optical coherence tomography.
Structure-Functional Parameters in Differentiating Between Patients With Different Degrees of Glaucoma
Authors: Cennamo Gilda , Montorio Daniela , Romano Mario R. , Cardone Domenico M. , Minervino Carlo , Reibaldi Michele , Cennamo Giovanni
Published: August 2016

Purpose:

We evaluated spectral-domain optical coherence tomography (SD-OCT) parameters and visual field parameters in patients with different degrees of open-angle glaucoma (preperimetric, mild, moderate, and severe glaucoma) to determine which parameter best identifies each glaucomatous group.

Materials and Methods:

A total of 131 patients (66 preperimetric, 41 mild, 35 moderate, 40 severe glaucomatous eyes) and 40 normal eyes (control group) were included in this prospective study. The SD-OCT parameters [mean ganglion cell complex (GCC), superior GCC, inferior GCC, global loss volume, focal loss volume, mean circumpapillary retinal nerve fiber layer (RNFL), superior circumpapillary retinal nerve fiber layer [cpRNFL], and inferior cpRNFL] and visual field parameters (mean deviation and pattern SD) were evaluated. The area under the receiver operating characteristic curve (AUROC) was calculated for each parameter to determine which best identified glaucomatous changes.

Results:

Of the SD-OCT parameters, inferior (AUROC, 0.792) and mean GCC thickness (AUROC, 0.741) best discriminated between normal eyes and preperimetric glaucoma eyes.

Conclusions:

GCC measurements were more efficient than cpRNFL measurements in detecting preperimetric glaucomatous damage. This finding could be an aid to an early diagnosis.
Subepidermal Calcified Nodules of the Eyelid Differ in Children and Adults
Authors: AlWadani Saeed , Suarez Maria J. , Kass Jonathan J. , MacQuaid Emily , Edward Deepak P. , Alkatan Hind , Eberhart Charles
Published: August 2016

Purpose:

Subepidermal calcified nodule of the eyelid is considered as one of the types of calcinosis cutis. It generally occurs in children, and is not known to be associated with systemic disease. The authors report histopathological and clinical findings in 14 cases of subepidermal calcified nodule of the eyelid, including 3 older patients with unique microscopic features.

Methods:

Clinical records and pathological materials were critically reviewed in each case, including von kossa, CD3, CD20, and CD68 stains.

Results:

The 14 cases presented clinically as nodular eyelid lesions. All were treated with surgical excision. The authors found 2 distinct histopathological patterns which correlated with the patients’ age. In young patients, the authors observed multiple, small calcified bodies within the dermis surrounded by chronic inflammation and granulomatous foreign body reaction. On the other hand, in elderly patients, lesions were characterized by a single, large, well-demarcated amorphous calcified deposit surrounded by fibrous tissue, without chronic inflammation or foreign body reaction. One of these patients, a 70-year-old man, also suffered from gout. The presence of subepidermal calcified nodule was not documented as a preoperative diagnostic possibility in any of the cases.

Conclusions:

Subepidermal calcified nodule of the eyelid is a rare condition, but should be considered in any patient presenting with a painless white to yellowish colored nodule of the ocular adnexa, particularly during the teenage years. Clinicians and pathologists should be aware that this entity has a distinct appearance and could be associated with systemic conditions in elderly patients.
The cystine/glutamate antiporter system xc − drives breast tumor cell glutamate release and cancer-induced bone pain
Authors: Slosky Lauren M. , BassiriRad Neemah M. , Symons Ashley M. , Thompson Michelle , Doyle Timothy , Forte Brittany L. , Staatz William D. , Bui Lynn , Neumann William L. , Mantyh Patrick W. , Salvemini Daniela , Largent-Milnes Tally M. , Vanderah Todd W.
Published: August 2016

Bone is one of the leading sites of metastasis for frequently diagnosed malignancies, including those arising in the breast, prostate and lung. Although these cancers develop unnoticed and are painless in their primary sites, bone metastases result in debilitating pain. Deeper investigation of this pain may reveal etiology and lead to early cancer detection. Cancer-induced bone pain (CIBP) is inadequately managed with current standard-of-care analgesics and dramatically diminishes patient quality of life. While CIBP etiology is multifaceted, elevated levels of glutamate, an excitatory neurotransmitter, in the bone-tumor microenvironment may drive maladaptive nociceptive signaling. Here, we establish a relationship between the reactive nitrogen species peroxynitrite, tumor-derived glutamate, and CIBP. In vitro and in a syngeneic in vivo model of breast CIBP, murine mammary adenocarcinoma cells significantly elevated glutamate via the cystine/glutamate antiporter system xc
−. The well-known system xc
− inhibitor sulfasalazine significantly reduced levels of glutamate and attenuated CIBP-associated flinching and guarding behaviors. Peroxynitrite, a highly reactive species produced in tumors, significantly increased system xc
− functional expression and tumor cell glutamate release. Scavenging peroxynitrite with the iron and mangano-based porphyrins, FeTMPyP and SRI10, significantly diminished tumor cell system xc
− functional expression, reduced femur glutamate levels and mitigated CIBP. In sum, we demonstrate how breast cancer bone metastases upregulate a cystine/glutamate co-transporter to elevate extracellular glutamate. Pharmacological manipulation of peroxynitrite or system xc
− attenuates CIBP, supporting a role for tumor-derived glutamate in CIBP and validating the targeting of system xc
− as a novel therapeutic strategy for the management of metastatic bone pain.
Risk of Extrapyramidal Adverse Events With Aripiprazole
Authors: Etminan Mahyar , Procyshyn Ric M. , Samii Ali , Carleton Bruce C.
Published: August 2016

Aripiprazole is a unique atypical antipsychotic with partial agonist activity on the dopamine-2 (D2) receptor. This unique pharmacological profile of aripiprazole was thought to lead to a lower incidence of extrapyramidal symptoms (EPSs). However, recent case reports have alluded to an increase in the risk of EPS in aripiprazole users compared with nonusers of the drug. No epidemiologic studies to date have quantified this risk. We conducted a pharmacoepidemiologic study composed of a nested case-control study using a large health claims database (IMS Health) in the United States. In the nested case-control analysis, there were 5242 cases of EPS with 50,532 corresponding controls in the entire cohort. The odds ratio (OR) for EPS among those with any prescription of aripiprazole was 5.38 (95% confidence interval [CI], 3.03–9.57). The OR was lower among those taking 2 to 3 prescriptions (OR, 2.9; 95% CI, 1.07–7.85) but increased in those receiving greater than 4 prescriptions (OR, 8.64; 95% CI, 2.63–28.38). All risk periods were compared with those of subjects who had not used aripiprazole or other antipsychotics. For the secondary outcome of dyskinesia, the risk for aripiprazole was 8.50 (95% CI, 8.53–2.27–31.97) compared with that of nonusers. In conclusion, we found an increase in the risk of EPS and dyskinesias among users of aripiprazole.
Clustered Papulosquamous Lesions on the Posterior Neck
Authors: Bergman Daniel , Jacob Sharon E.
Published: August 2016

Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a case of clustered papulosquamous lesions on the posterior neck.
Primary Care Health Professionals’ Knowledge of Sun Safety
Authors: Cross Paige , Dy Connie , Garcia Stephanie , Huh Jin , Nelson Jenna , Schweitzer Arielle , Suchorzepka Natalia
Published: August 2016

It is well known that sun and ultraviolet exposure can increase the risk of skin cancers in individuals (New York State Department of Health, 2014). However, there is a lack of guidelines in primary care regarding routine skin examination for adolescents and insufficient evidence regarding sun safety education for all patients and their families in healthcare settings. Our study aimed to assess knowledge on sun safety and sun damage among healthcare professionals by surveying 50 family nurse practitioner students enrolled in the course of Diagnosis and Management II at Columbia University School of Nursing in the Year 2015. We hypothesized that the knowledge of sun safety will increase with our intervention of an educational pamphlet to participants. Our results reflect a lack of knowledge regarding sun safety among healthcare professionals. Despite the limitations in our study, it did show that pamphlet distribution on sun safety education does increase healthcare professionals’ knowledge. With increased awareness of sun safety in primary care health, health professionals will have the ability to influence individuals on positive habits that can prevent the development of skin cancer.
Now We Know: Assessing Sexual Assault Criminal Justice Case Processing in an Urban Community Using the Sexual Assault Nurse Practitioner Evaluation Toolkit
Authors: Valentine Julie L. , Shaw Jessica , Lark Alyssa , Campbell Rebecca
Published: August 2016

Campbell and colleagues developed an evaluation Toolkit for use by sexual assault nurse examiners (SANEs) to assess criminal case outcomes in adult sexual assault cases seen by SANE programs (Campbell, Townsend, Shaw, Karim, & Markowitz, 2014; Campbell, Bybee, et al., 2014). The Toolkit provides step-by-step directions and an easy-to-use statistical program. This study describes implementation of the Toolkit in Salt Lake County, the first site outside the pilot sites to utilize the program. The Toolkit revealed that, in Salt Lake County from 2003 to 2011, only 6% of adult sexual assault cases were successfully prosecuted. These findings prompted multiple community discussions, media attention, and a call to action to improve the investigation and prosecution of adult sexual assault cases. The primary purpose of this case report is to encourage other SANE teams and communities to use the Toolkit by sharing the successful experience of Salt Lake County in implementing the Toolkit.

Video Abstract available for additional insights from Dr. Valentine (see Supplemental Digital Content 1, http://links.lww.com/JFN/A19).
How does prior health status (age, comorbidities and frailty) determine critical illness and outcome?
Authors: Haas Barbara , Wunsch Hannah
Published: August 2016

Purpose of review

Critical illness has a significant impact on an individual's physical and mental health. However, it is less clear to what degree outcomes after critical illness are due to patients’ preexisting characteristics, rather than the critical illness itself. In this review, we summarize recent findings regarding the role of age, comorbidity and frailty on long-term outcomes after critical illness.

Recent findings

Age, comorbidity and frailty are all associated with an increased risk of critical illness. Although severity of illness drives the risk of acute mortality, recent data suggest that longer term outcomes are much more closely aligned with prior health status. There are growing data regarding the important role of noncardiovascular comorbidity, including psychiatric illness and obesity, in determining long-term outcomes. Finally, preadmission frailty is associated with poor long-term outcomes after critical illness; further data are needed to evaluate the attributable impact of critical illness on the health trajectories of frail individuals.

Age, comorbidity and frailty play a critical role in determining the long-term outcomes of patients requiring intensive care.
Complementary and Alternative Medicine Use in United States Adults With Liver Disease
Authors: Henson Jacqueline B. , Brown Cristal L. , Chow Shein-Chung , Muir Andrew J.
Published: August 2016

Goals:

To describe the complementary and alternative medicine (CAM) use in US adults with liver disease.

Background:

The prevalence and patterns of CAM use among US adults with liver disease have not been well characterized. The 2012 National Health Interview Survey is considered the most current and comprehensive source of information on CAM use in US adults.

Study:

Using the results of the 2012 National Health Interview Survey, the prevalence of CAM use, most common modalities used, reasons for CAM use, perceived benefits, perceived helpfulness and importance, and disclosure of CAM to health care providers were compared between adults with and without liver disease.

Results:

Of the 647 adults with liver disease, 41% reported using CAM in the prior year, compared with 33% of adults without liver disease. The most common modality was herbs and supplements (23%), and 3% of respondents reported consumption of a potentially hepatotoxic substance in the previous 30 days. Only a small proportion of CAM therapies were used specifically for liver disease, with milk thistle being the most common. Among respondents with liver disease, CAM was used more commonly for anxiety or depression, fatigue, and substance use. The majority believed that these therapies improved health. Nearly one-third of therapies were not reported to health care providers, mostly due to failure of the provider to ask.

Conclusions:

CAM use, particularly herbs and supplements, is prevalent among US adults with liver disease. Many do not disclose their CAM use to their providers, despite some using potentially hepatotoxic substances.
Prevalence of hepatic steatosis in apparently healthy medical students: a transient elastography study on the basis of a controlled attenuation parameter
Authors: Kaya Eda , Demir Dogac , Alahdab Yesim O. , Yilmaz Yusuf
Published: August 2016

Objective

Despite the increasing burden of nonalcoholic fatty liver disease (NAFLD) in modern societies, the optimal screening method to detect hepatic steatosis in the general population remains to be established. Controlled attenuation parameter (CAP) measured with transient elastography (TE) has recently emerged as a reliable imaging tool for the screening and diagnosis of NAFLD. Here, we sought to investigate the prevalence of TE-defined hepatic steatosis in a sample of apparently healthy medical students. We also assessed the relationships between CAP and traditional NAFLD risk factors.

Materials and methods

A total of 112 Turkish medical students (48 women and 64 men, mean age 20.5±1.1 years) underwent TE. On the basis of previous studies, a cut-off value of 238 dB/m for CAP was used for the diagnosis of hepatic steatosis.

Results

On the basis of the selected cut-off for CAP, we identified 26 students (23.2%) with TE-defined NAFLD. Univariate correlation analyses showed that CAP values were significantly associated with BMI (r=0.40, P<0.001), waist circumference (r=0.39, P<0.001), and hip circumference (r=0.34, P<0.001). In multivariable analysis, only BMI retained its independent association with CAP (β=0.36, t=3.4, P<0.001).

Conclusion

NAFLD is highly prevalent even in apparently healthy young individuals. CAP assessment with TE may be useful for an early, noninvasive identification of hepatic steatosis.
Inflammatory bowel disease: adherence to immunomodulators in a biological therapy era
Authors: Campos Sara , Portela Francisco , Sousa Paula , Sofia Carlos
Published: August 2016

Background

Combination therapy, with anti-tumor necrosis factor-α agents and immunomodulators, is the most effective option to induce and maintain remission in inflammatory bowel disease (IBD). Infliximab, with its administration features, determines particular conditions of adherence; the same is not possible with thiopurines. Nevertheless, research on adherence to these treatments is scarce. Nonadherence worsens the prognosis of IBD.

Aim

(a) Assess adherence to immunomodulators and (b) determine therapeutic nonadherence predictors.

Patients and methods

We included all IBD outpatients consecutively evaluated over a 6-month period in our center. Participants completed a study-specific questionnaire on IBD, IBD therapeutic adherence (Morisky Medication Adherence Scale-8-item), Therapeutics Complexity questionnaire, Beliefs about Medication questionnaire, and Hospital Anxiety and Depression Scale.

Results

A total of 112 patients under azathioprine were considered; 49.1% were also under anti-tumor necrosis factor-α. Self-assessed questionnaire showed that 70.5% were adherent to immunosuppression. Similar adherence was found with and without infliximab (68.4%-monotherapy vs. 72.7%-combination therapy; P=0.61). Nonintentional nonadherence was documented in 57.6%; 42.4% reported voluntary nonadherence. Nonadherence was higher in male patients [odds ratio (OR): 3.79; 95% confidence interval (CI): 1.2–11.95; P=0.023], younger patients (OR: 0.93; 95% CI: 0.87–0.98; P=0.01), nonsmokers (OR: 4.90; 95% CI: 1.22–19.73; P=0.025), and those who had depression (OR: 2.22; 95% CI: 1.36–3.62; P=0.001). Most of the IBD patients believed in the necessity of maintaining immunosuppression (86.7%), but 36.6% reported concerns about drugs.

Conclusion

Nonadherence to thiopurines plays a significant role in IBD. Nonetheless, it does not increase with association with biological agents. Involuntary nonadherence is higher. Male sex, younger age, nonsmoker, and presence of depression were independent predictors of nonadherence to immunomodulators. More than one-third of IBD patients had concerns about drugs. Optimizing the discussion on patients’ concerns to overcome perceptual barriers related to drugs may obviate the negative course of IBD related to nonadherence.
Symptoms and biomarkers associated with celiac disease: evaluation of a population-based screening program in adults
Authors: Kårhus Line L. , Thuesen Betina H. , Rumessen Jüri J. , Linneberg Allan
Published: August 2016

Objectives

To identify possible early predictors (symptoms and biomarkers) of celiac disease, compare symptoms before and after screening, and evaluate the diagnostic efficacy of serologic screening for celiac disease in an adult Danish population.

Methods

This cross-sectional population-based study was based on the 5-year follow-up of the Health2006 cohort, where 2297 individuals were screened for celiac disease; 56 were antibody positive and thus invited to clinical evaluation. Eight were diagnosed with biopsy-verified celiac disease. A follow-up questionnaire was sent to antibody-positive individuals 19 months after the clinical evaluation to obtain information on their symptoms and their experience with participation in the screening.

Results

Before screening, participants subsequently diagnosed with celiac disease did not differ from the rest of the population with respect to symptoms, but had significantly lower total cholesterol. Tissue transglutaminase IgA antibodies with a cut-off of 10 U/ml had a positive predictive value of 88%. The majority of participants were satisfied with their participation in the screening program. Individuals with celiac disease were generally satisfied with having been diagnosed and 71% felt better on a gluten-free diet.

Conclusion

There were no differences in the prevalence of symptoms between participants with and without screening-detected celiac disease, confirming that risk stratification in a general population by symptoms is difficult. The majority of participants diagnosed with celiac disease felt better on a gluten-free diet despite not reporting abdominal symptoms before diagnosis and participants in the clinical evaluation were generally satisfied with participation in the screening program.
Community nurse-led initiation of antiviral therapy for chronic hepatitis C in people who inject drugs does not increase uptake of or adherence to treatment
Authors: Lewis Heather , Kunkel Jan , Axten David , Dalton Jane , Gardner Hayley , Tippett Andrew , Wynne Stephanie , Wilkinson Mandie , Foster Graham R.
Published: August 2016

Background

Chronic hepatitis C is common in people who inject drugs (PWID) and this population serves as a reservoir for infection. Treatment levels are low among this group, ranging from 1 to 19%. We explored whether a nurse-initiated community treatment model increased uptake of and adherence to interferon-based therapies.

Methods

This was a cluster randomized trial of nurse-initiated versus physician-initiated antiviral therapy with pegylated interferon and ribavirin for hepatitis C virus in community clinics (trial registration: ISRCTN07774040).

Results

The proportion of participants initiating treatment during follow-up was 10% with nurse-initiated (6/62) and 9% with physician-initiated (6/76) therapy. Adherence was similar in both groups, with only one patient in each arm not adhering to therapy. There were no serious adverse events, but interferon-related side effects were common. Drug and alcohol use did not change during therapy.

Conclusion

Despite easy access to antiviral therapy, uptake of treatment was poor, with no significant difference between the groups. Nurse-led initiation of interferon-based antiviral therapy in PWID did not lead to increased uptake of, response to or adherence with treatment. Further service improvement is unlikely to increase the proportion of PWID undergoing antiviral therapy for hepatitis C virus and early adoption of interferon-free regimens may increase the proportion initiating and completing treatment.
Cytomegalovirus disease in inflammatory bowel disease: epidemiology and disease characteristics in a large single-centre experience
Authors: Bontà Jonas , Zeitz Jonas , Frei Pascal , Biedermann Luc , Sulz Michael C. , Vavricka Stephan R. , Scharl Sylvie , Fried Michael , Rogler Gerhard , Scharl Michael
Published: August 2016

Background

Patients with inflammatory bowel disease (IBD) show an increased risk of developing cytomegalovirus (CMV) disease because of immunosuppressive medication and malnutrition. Here, we aimed to investigate the prevalence and clinical characteristics of CMV disease in our cohort of IBD patients.

Patients and methods

We carried out a retrospective analysis of 1023 IBD patients treated at our IBD clinic at the University Hospital Zurich between 2007 and 2014. CMV disease was defined as a positive immunohistochemistry for CMV and 14 patients were identified.

Results

The prevalence of CMV disease in our IBD cohort was 1.37%. Twelve patients had ulcerative colitis and two had Crohn’s disease with colonic involvement. All patients who developed CMV disease received immunosuppressive medication or, as in one case, had HIV infection. The most used immunosuppressive medications were steroids and azathioprine. The most common therapeutic strategy was the consecutive use of ganciclovir and valganciclovir. Ten patients recovered and two were treatment refractory; among these, one required colectomy and two had a relapse.

Conclusion

CMV disease may influence the clinical course of IBD. There is probably an association between CMV disease and IBD-specific medication. Risk factors, epidemiology and therapeutic strategy need to be further investigated.
Examining Race and Ethnicity Information in Medicare Administrative Data
Authors: Filice Clara E. , Joynt Karen E.
Published: August 2016

Racial and ethnic disparities are observed in the health status and health outcomes of Medicare beneficiaries. Reducing these disparities is a national priority, and having high-quality data on individuals’ race and ethnicity is critical for researchers working to do so. However, using Medicare data to identify race and ethnicity is not straightforward. Currently, Medicare largely relies on Social Security Administration data for information about Medicare beneficiary race and ethnicity. Directly self-reported race and ethnicity information is collected for subsets of Medicare beneficiaries but is not explicitly collected for the purpose of populating race/ethnicity information in the Medicare administrative record. As a consequence of historical data collection practices, the quality of Medicare’s administrative data on race and ethnicity varies substantially by racial/ethnic group; the data are generally much more accurate for whites and blacks than for other racial/ethnic groups. Identification of Hispanic and Asian/Pacific Islander beneficiaries has improved through use of an imputation algorithm recently applied to the Medicare administrative database. To improve the accuracy of race/ethnicity data for Medicare beneficiaries, researchers have developed techniques such as geocoding and surname analysis that indirectly assign Medicare beneficiary race and ethnicity. However, these techniques are relatively new and data may not be widely available. Understanding the strengths and limitations of different approaches to identifying race and ethnicity will help researchers choose the best method for their particular purpose, and help policymakers interpret studies using these measures.
Role of noncoding RNA in vascular remodelling
Authors: Deng Lin , Bradshaw Angela C. , Baker Andrew H.
Published: August 2016

Purpose of review

Noncoding RNAs (ncRNAs), such as microRNAs (miRNAs) and long noncoding RNAs (lncRNAs) are becoming fundamentally important in the pathophysiology relating to injury-induced vascular remodelling. We highlight recent studies that demonstrate the involvement of ncRNAs in vein graft disease, in in-stent restenosis and in pulmonary arterial hypertension, with a particular focus on endothelial cell and vascular smooth muscle cell function. We also briefly discuss the emerging role of exosomal-derived ncRNAs and how this mechanism impacts on vascular function.

Recent findings

ncRNAs have been described as novel regulators in the pathophysiology of vascular injury, inflammation, and vessel wall remodelling. In particular, several studies have demonstrated that manipulation of miRNAs can reduce the burden of pathological vascular remodelling. Such studies have also shown that exosomal miRNA-mediated, cell-to-cell communication between endothelial cells and vascular smooth muscle cells is critical in the disease process. In addition to miRNAs, lncRNAs are emerging as regulators of vascular function in health and disease. Although lncRNAs are complex in both their sheer numbers and mechanisms of action, identifying their contribution to vascular disease is essential.

Given the important roles of ncRNAs in vascular injury and remodelling together will their capacity for cell-to-cell communication, manipulating ncRNA might provide novel therapeutic interventions.
Plaque angiogenesis and its relation to inflammation and atherosclerotic plaque destabilization
Authors: de Vries Margreet R. , Quax Paul H.A.
Published: August 2016

Purpose of review

The review discusses the recent literature on plaque angiogenesis and its relation to inflammation and plaque destabilization. Furthermore, it discusses how plaque angiogenesis can be used to monitor atherosclerosis and serve as a therapeutic target.

Recent findings

Histopathologic studies have shown a clear relationship between plaque angiogenesis, intraplaque hemorrhage (IPH), plaque vulnerability, and cardiovascular events. Hypoxia is a main driver of plaque angiogenesis and the mechanism behind angiogenesis is only partly known. IPH, as the result of immature neovessels, is associated with increased influx of inflammatory cells in the plaques. Experimental models displaying certain features of human atherosclerosis such as plaque angiogenesis or IPH are developed and can contribute to unraveling the mechanism behind plaque vulnerability. New imaging techniques are established, with which plaque angiogenesis and vulnerability can be detected. Furthermore, antiangiogenic therapies in atherosclerosis gain much attention.

Plaque angiogenesis, IPH, and inflammation contribute to plaque vulnerability. Histopathologic and imaging studies together with specific experimental studies have provided insights in plaque angiogenesis and plaque vulnerability. However, more extensive knowledge on the underlying mechanism is required for establishing new therapies for patients at risk.