bluuebunny/crossref_metadata_2025 huggingface dataset:
Self-Publishing
Authors: Waldrop Julee
Published: May 2018

Professional communication and the dissemination of expertise are expected of nurses prepared at the doctoral level. However, little emphasis is placed on opportunities for professional writing in most clinically focused doctoral programs for nurse practitioners. This innovative extracurricular writing project provided a professional writing experience for novice writers, helping them gain the confidence needed to achieve dissemination beyond the educational setting in the form of a self-published e-book. This project could be used for many other types of writing in nursing.
2017 Pathway Award® winner
Authors: Bates Melissa , McPherson Steven , McCurley Jane
Published: May 2018

UHCC employs Pathway to Excellence® standards and technology to facilitate safe, face-to-face hand-offs
The Extended Dwell Peripheral Intravenous Catheter Is an Alternative Method of NICU Intravenous Access
Authors: Chenoweth Kimberlee B. , Guo Jia-Wen , Chan Belinda
Published: May 2018

Background:

Establishing vascular access is a common neonatal intensive care unit procedure. The extended dwell peripheral intravenous (EPIV) catheter is a 6-cm and 8-cm silicone catheter for peripheral vein insertion, which is a newer vascular access device than peripherally inserted central catheters (PICCs) and peripheral intravenous (PIV) catheter. Extended dwell peripheral intravenous catheters have been widely used in adults but evidence in neonates is lacking.

Purpose:

To explore indwell time, success rate, catheter-associated complications, and cost among EPIV catheters, PICCs, and PIV catheters in neonates.

Methods:

We retrospectively compare patient demographics, indwell time, success rate, and catheter-associated complications, and analyze the rate of hyaluronidase-treated intravenous (IV) fluid extravasation on neonates who had an EPIV catheter, a PICC, or a PIV catheter in a level III neonatal intensive care unit. We also estimate the insertion cost of these 3 vascular access devices on the basis of our hospital charges.

Results:

Extended dwell peripheral intravenous catheters were inserted in 432 neonates with an indwell time of 4.0 ± 2.3 (mean ± SD) days. Peripherally inserted central catheters were inserted in 202 neonates with an average indwell time of 7.3 ± 4.4 (mean ± SD) days, which was longer than EPIV catheters (P < .001). Peripherally inserted central catheters had a higher success rate of 83.6% than 71.7% of EPIV catheters, meaning succeeded in lasting through the completion of therapy (P = .001). Peripherally inserted central catheters were associated with 4 cases of life-threatening complications; none was seen in the EPIV catheter group. The incidence of hyaluronidase-treated IV fluid extravasation was less in EPIV catheter recipients (1.2%) than in the PIV catheter recipients (3.9%) (P = .004); none was in the PICC group. Cost savings were noted with using an EPIV catheter.

Implications for Practice:

Extended dwell peripheral intravenous catheter is a feasible option for neonatal vascular access.

Implications for Research:

These data provide a baseline for future studies to explore the efficacy and effectiveness of EPIV catheter in the neonates.
Congenital Unilateral Atlanto-Occipital Rotatory Subluxation
Authors: Bapat Mihir R. , Gujral Amandeep , Patel Bharat K.
Published: May 2018

Study Design.

Case report.

Objective.

We report a rare case of congenital unilateral rotatory atlanto-occipital subluxation that presented with left C1 neuralgia.

Summary of Background Data.

Secondary occipital neuralgia is commonly attributed to pathologies of the atlanto-axial joint and C2/C3 nerve involvement. Our case depicts a model of slow creeping atlanto-occipital subluxation due to a rare left C1 superior articular facet dysplasia with C1 foraminal stenosis presenting as C1 neuralgia. We discuss the eitology and patho-anatomy of this rare undescribed presentation.

Methods.

A 42-year-old gentleman presented with deteriorating and intractable left occipital headache of 6 months duration. The neck disability index (NDI) was 64%. Cervical MR/computed tomography scan showed a unilateral C1 facet dysmorphism with a left sided C1 foramen bony compression. There was no central canal stenosis.

Results.

Posterior left C1 arch excision and decompression of C1 foramina with occipital-cervical fusion relieved C1 neuralgia.

Conclusion.

Our case depicts a model of slow creeping deformation due to left C1 superior articular facet dysplasia. An abnormal facet slope allowed the occipital condyle to migrate posteriorly and medially leading to crowding of the left C1 foramen. Although the etiology was congenital, the neck spasm was delayed till fourth decade. A secondary C1 foramen stenosis led to C1 occipital neuralgia that presented as an intractable headache.

Level of Evidence: 5
A Guide for Planning and Implementing Successful Mental Health Educational Programs
Authors: Blanco-Vieira Thiago , Ramos Fernando Augusto da Cunha , Lauridsen-Ribeiro Edith , Ribeiro Marcos Vinícius Vieira , Meireles Elisa Andrade , Nóbrega Brunno Araújo , Motta Palma Sonia Maria , Ratto Maria de Fátima , Caetano Sheila Cavalcante , Ribeiro Wagner Silva , Rosário Maria Conceição do
Published: May 2018

Introduction:

Considering the global burden of mental disorders, there is a worldwide need to improve the quality of mental health care. In order to address this issue, a change in how health care professionals are trained may be essential. However, the majority of the few reports published on this field's training programs do not discuss the characteristics associated with the success or failure of these strategies. The purpose of this review was to systematically examine the literature about mental health training programs designed for health care professionals in order to identify the relevant factors associated with their effective implementation.

Methods:

The MEDLINE/PubMed, SciELO, and Virtual Health Library databases were used to search for articles published before February 2017 and reviewed by two double-blind reviewers.

Results:

We found 77 original papers about mental health educational programs. Many of these studies were conducted in the USA (39%), addressed depression as the main subject (34%), and applied a quasi-experimental design (52%). Effective interventions were associated with the following characteristics: the use of learner-centered and interactive methodological approaches; a curriculum based on challenges in the trainees' daily routines; the involvement of experts in the program's development; the enrollment of experienced participants; interdisciplinary group work; flexible timing; the use of e-learning resources; and optimizing the implementation of knowledge into the participants' routine work practices.

Implications for Practice:

These results will be helpful for planning and improving the quality of future educational programs in mental health.
Making the Most of Continuing Medical Education: Evidence of Transformative Learning During a Course in Evidence-Based Medicine and Decision Making
Authors: Sokol Randi G. , Shaughnessy Allen F.
Published: May 2018

Introduction:

Continuing medical information courses have been criticized for not promoting behavior change among their participants. For behavior change to occur, participants often need to consciously reject previous ideas and transform their way of thinking. Transformational learning is a process that cultivates deep emotional responses and can lead to cognitive and behavioral change in learners, potentially facilitating rich learning experiences and expediting knowledge translation. We explored participants' experiences at a 2-day conference designed to support transformative learning as they encounter new concepts within Information Mastery, which challenge their previous frameworks around the topic of medical decision making. Using the lens of transformative learning theory, we asked: how does Information Mastery qualitatively promote perspective transformation and hence behavior change?

Methods:

We used a hermeneutic phenomenologic approach to capture the lived experience of 12 current and nine previous attendees of the “Information Mastery” course through individual interviews, focus groups, and observation. Data were thematically analyzed.

Results:

Both prevoius and current conference attendees described how the delivery of new concepts about medical decision making evoked strong emotional responses, facilitated personal transformation, and propelled expedited behavior change around epistemological, moral, and information management themes, resulting in a newfound sense of self-efficacy, confidence, and ownership in their ability to make medical decisions.

Discussion:

When the topic area holds the potential to foster a qualitative reframing of learners' guiding paradigms and worldviews, attention should be paid to supporting learners' personalized meaning-making process through transformative learning opportunities to promote translation into practice.
Moving the Bariatric Patient
Authors: Gillespie Twanda , Lane Sarah
Published: May 2018

The health care team must be able to mobilize bariatric patients efficiently and safely. It is challenging to find the proper equipment of sufficient variety to meet the need. Patients can feel self-conscious when staff are struggling to provide care, and staff can be injured when trying to mobilize patients without the proper equipment. This can result in feelings of humiliation for the patient and frustration for staff. Furthermore, staff often experience compassion fatigue when dealing with their frustration around this. This bariatric surgery unit experienced these issues with mobilization of larger patients and participated in the development of a Safe Patient Handling and Mobility program in an effort to gain understanding of the necessary equipment and how to implement such a program. The purpose of this article is to describe the successful implementation of a Safe Patient Handling and Mobility program to reduce staff injury and frustration and to improve the patient experience on a bariatric unit.
Pediatric Mobility
Authors: Owens Tonie , Tapley Christopher
Published: May 2018

Due to improvements in biomedical sciences and clinical expertise, childhood mortality has decreased. Pediatric patients experience similar complications from inactivity as adults, such as hospital-acquired conditions and delirium. Interdisciplinary collaboration is imperative to improve functional and developmental outcomes of children who suffers from either a chronic illnesses or an acute illness that results in a prolonged hospitalization. Pediatric nursing assessments should include gross motor function related to mobility. Activities to mobilize pediatric patients should be based on age and developmental assessment. The purpose of this article is to describe the modification of an adult mobility assessment for the pediatric population.
“Add It to the Parking Lot”
Authors: Havey Renee , Aebersold Cassandra , Terrasi Jason
Published: May 2018

Nelson and Baptiste noted that a standard approach to safe patient handling and mobility (SPHM) cannot be generalized to all patient care areas because the unique, high-risk tasks of each area require specific intervention. Matching the SPHM program to the setting, tasks, and roles is important in developing a program that will prevent harm. However, there is little evidence related to the use of SPHM programs in nontraditional care environments, such as emergency departments (EDs). A such, there is no standardized method for training ED nurses in safe patient handling. An SPHM challenge unique to the ED is extricating patients out of vehicles. There are several ways to extricate patients from vehicles, with some requiring more resources, people, and equipment than others. These resources vary depending on the patient's level of activity and acuity. The purpose of this article is to articulate the importance of SPHM programs in EDs and the unique challenges and workflows that complicate implementation in this chaotic environment through a review of manual and equipment-assisted methods of extricating patients from the vehicle.
Common Use of Stimulants and Alpha-2 Agonists to Treat Preschool Attention-Deficit Hyperactivity Disorder: A DBPNet Study
Authors: Blum Nathan J. , Shults Justine , Harstad Elizabeth , Wiley Susan , Augustyn Marilyn , Meinzen-Derr Jareen K. , Wolraich Mark L. , Barbaresi William J.
Published: May 2018

Objective:

To describe the use of stimulants and alpha-2 agonists (A2As) for the treatment of preschool-aged children with attention-deficit hyperactivity disorder (ADHD) at 2 Developmental-Behavioral Pediatrics Research Network sites.

Methods:

Demographic information, diagnoses, and medications prescribed by developmental-behavioral pediatricians (DBPs) were extracted from the electronic health record for all outpatient visits from January 1, 2010, to December 31, 2011. The subset of visits for children aged 2 to 5 years who had a diagnosis of ADHD was included in this analysis. Multivariable models were constructed to identify factors associated with prescribing stimulants and A2As.

Results:

Over the 2-year period, 984 children with a diagnosis of ADHD were seen at 1779 visits. Of the 984 children, 342 (34.8%) were prescribed a stimulant, and 243 (24.7%) were prescribed an A2A. Both medications were prescribed at the same visit at least once during the 2-year period for 97 children (9.9%). Alpha-2 agonists were prescribed more often at site 2 than site 1 (OR [odds ratio] = 1.62, p = 0.015). Stimulants were more likely to be prescribed for older preschool-aged children (OR = 1.66, p < 0.001), and A2As were more likely to be prescribed for younger children (OR = 0.82, p = 0.02). Both stimulants and A2As were more likely to be prescribed to children with ADHD and comorbid conditions.

Conclusion:

Alpha-2 agonists are commonly used by some DBPs for preschool ADHD. Variation in the use of A2As across sites may indicate a lack of consensus on when to use these medications and suggests a need for comparative effectiveness research to better define the relative benefits and side effects of A2As and stimulants for the treatment of preschool ADHD.
Melanoma Reporting Practices of United States Dermatologists
Authors: Svoboda Ryan M. , Glazer Alex M. , Farberg Aaron S. , Cowdrey Molly C.E. , Rigel Darrell S.
Published: May 2018

BACKGROUND

Accuracy of US cancer statistics depends on physicians' knowledge of and adherence to reporting mandates. Significant knowledge and practice gaps have been documented in regards to melanoma reporting requirements.

OBJECTIVE

To determine whether the gaps in dermatologists' knowledge and practice of melanoma reporting persist.

MATERIALS AND METHODS

The authors performed a survey of US dermatologists attending a national conference. The proportion aware of the melanoma reporting mandate and the proportion who routinely report newly diagnosed cases were calculated.

RESULTS

Ninety-one percent (158/174) of those sampled completed the survey. Forty-nine percent correctly identified melanoma as being a disease of mandated reporting. Only 34% reported newly diagnosed cases to their state registry. Dermatologists seeing low melanoma volumes were less likely to routinely report newly diagnosed cases to registries than those seeing high volumes (22.9% vs 45.4%, p = .004). Those in practice for ≤10 years were less likely to be aware of the mandate than those in practice longer (32.6% vs 57.0%, p = .006).

CONCLUSION

Most dermatologists remain unaware of melanoma reporting requirements. Resultant underestimates of the true incidence of melanoma could have resource allocation implications. Interventions aimed at improving knowledge of the mandate should focus on younger clinicians and those with lower melanoma case volumes.
Evaluating the Efficacy of Different Platelet-Rich Plasma Regimens for Management of Androgenetic Alopecia: A Single-Center, Blinded, Randomized Clinical Trial
Authors: Hausauer Amelia K. , Jones Derek H.
Published: May 2018

BACKGROUND

Studies suggest platelet-rich plasma (PRP) may mitigate androgenetic alopecia (AGA), but each varies in the frequency of and interval between treatments.

OBJECTIVE

To compare the efficacy, satisfaction, tolerability, and safety of 2 initial PRP injection protocols over 6 months.

METHODS

Prospective, randomized, single-blinded trial among 40 patients with moderate AGA. Participants received subdermal PRP injections according to 1 of 2 treatment protocols: 3 monthly sessions with booster 3 months later (Group 1) or 2 sessions every 3 months (Group 2). Folliscope hair count and shaft caliber, global photography, and patient satisfaction questionnaires were obtained at baseline, 3 months, and 6 months.

RESULTS

At 6 months, both groups demonstrated statistically significant increases in hair count (p < .001). These improvements occurred more rapidly and more profoundly for Group 1 (mean percent change: Group 1, 29.6 ± 13.6 vs Group 2, 7.2 ± 10.4; p < .001). Shaft caliber also increased significantly with no difference between groups. Treatments produced high satisfaction (82% “satisfied” or “highly satisfied”) and were safe and well tolerated (mean pain score 2.1).

CONCLUSION

Subdermal PRP injections are an efficacious and tolerable therapy among men and women with AGA. The benefits may be greater if first administered monthly. Clinicians should consider these findings when designing treatment plans.
Association between Oklahoma earthquakes and anxiety-related Google search episodes
Authors: Casey Joan A. , Goldman-Mellor Sidra , Catalano Ralph
Published: May 2018

Background:

Oklahoma has experienced a rise in seismicity since 2010, with many earthquakes induced by wastewater injection. While large single earthquakes have documented mental health repercussions, health implications of these new, frequent earthquakes remain unknown. We aimed to examine associations between Oklahoma earthquakes and statewide anxiety measured by Google queries.

Methods:

The U.S. Geologic Survey’s Advanced National Seismic System Comprehensive Catalog supplied earthquake dates and magnitudes. We used the Google Health application programming interface to compile the proportion of weekly Oklahoma-based health-related search episodes for anxiety. A quasi-experimental time-series analysis from January 2010 to May 2017 evaluated monthly counts of earthquakes ≥ magnitude 4 (a level felt by most people) in relation to anxiety, controlling for US-wide anxiety search episodes and Oklahoma-specific health-related queries.

Results:

Oklahoma experienced an average of two (SD = 2) earthquakes ≥ magnitude 4 per month during the study period. For each additional earthquake ≥ magnitude 4, the proportion of Google search episodes for anxiety increased by 1.3% (95% confidence interval = 0.1%, 2.4%); 60% of this increase persisted for the following month. In months with 2 or more ≥ magnitude 4 earthquakes, the proportion of Google search episodes focused on anxiety increased by 5.8% (95% confidence interval = 2.3%, 9.3%). In a sub-analysis, Google search episodes for anxiety peaked about 3 weeks after ≥ magnitude 4 quakes.

Conclusions:

These findings suggest that the recent increase in Oklahoma earthquakes has elicited a psychological response that may have implications for public health and regulatory policy.
SUVN-502, a novel, potent, pure, and orally active 5-HT6 receptor antagonist: pharmacological, behavioral, and neurochemical characterization
Authors: Nirogi Ramakrishna , Abraham Renny , Benade Vijay , Medapati Rajesh B. , Jayarajan Pradeep , Bhyrapuneni Gopinadh , Muddana NageswaraRao , Mekala Venkat R. , Subramanian Ramkumar , Shinde Anil , Kambhampati Ramasastry , Jasti Venkat
Published: May 2018

Research in Alzheimer’s disease is going through a big turnaround. New palliative therapies are being reconsidered for the effective management of disease because of setbacks in the development of disease-modifying therapies. Serotonin 6 (5-HT6) receptor has long been pursued as a potential target for the symptomatic treatment of Alzheimer’s disease. SUVN-502 is a novel 5-HT6 receptor antagonist (K

i
=2.04 nmol/l) with high receptor affinity and high degree of selectivity. SUVN-502 at doses ranging from 1 to 10 mg/kg, per os (p.o.) demonstrated procognitive effects in various behavioral animal models (object recognition task, water maze, and radial arm maze), and it acts on three phases of cognition, viz., acquisition, consolidation, and retention (object recognition task). SUVN-502 (3 and 10 mg/kg, p.o.) modulated glutamate levels when administered alone (microdialysis). At doses ranging from 1 to 10 mg/kg p.o., SUVN-502 potentiated the effects of donepezil (microdialysis). SUVN-502 [1 mg/kg, intravenous (i.v.)] also potentiated pharmacological effects of memantine (1 mg/kg, i.v.) and/or donepezil (0.3 mg/kg, i.v.) (θ modulation). The beneficial effects of SUVN-502 on learning and memory might be mediated through the modulation of cholinergic and/or glutamatergic neurotransmission in relevant brain regions. In summary, behavioral, neurochemical, and electrophysiological outcomes indicate that SUVN-502 may augment the beneficial effects of donepezil and memantine combination.
RECURRENT BRANCH RETINAL ARTERY OCCLUSION FROM SUSAC SYNDROME: CASE REPORT AND REVIEW OF LITERATURE
Authors: Ammar Michael J. , Kolomeyer Anton M. , Bhatt Nirali , Tamhankar Madhura A. , Mullen Michael T. , Brucker Alexander J.
Published: May 2018

Purpose:

We report a patient with branch retinal artery occlusion predominant Susac syndrome and review the literature on current diagnostic modalities and therapeutic approaches for this rare condition.

Methods:

Case report.

Results:

A 23-year-old white male presented with a 5-month history of a scotoma in his right eye vision, headaches, and intermittent paresthesias of the lower extremities. Ophthalmic examination was normal with the exception of a hypopigmented small retinal area inferonasal to the fovea in the right eye. Optical coherence tomography demonstrated inner retinal atrophy and optical coherence tomography angiography showed deep capillary layer vessel dropout in both eyes. Ultra-wide-field fluorescein angiography revealed bilateral arteriolar wall hyperfluorescence. Corpus callosal lesions were present on magnetic resonance imaging. Lumbar puncture demonstrated elevated protein. Audiogram was normal. A diagnosis of Susac syndrome was made. The patient initially received oral steroids followed by intravenous steroids and mycophenolate mofetil because of new branch retinal artery occlusions. Thirteen months after initial presentation, the vision was stable at 20/20 in both eyes.

Conclusion:

It is a diagnostic challenge when recurrent branch retinal artery occlusion secondary to Susac syndrome presents without the classic symptoms. Optical coherence tomography angiography and subtle magnetic resonance imaging findings aided in early recognition of the diagnosis in our patient. Ultra-wide-field fluorescein angiography was an important tool in disease monitoring. Aggressive management with intravenous corticosteroids and initiation of immunosuppression resulted in long-term preservation of vision and improvement in visual field.
Acanthamoeba Keratitis: Are Recent Cases More Severe?
Authors: Roozbahani Mehdi , Hammersmith Kristin M. , Rapuano Christopher J. , Nagra Parveen K. , Zhang Qiang (Ed) , Siu Sophia Y.
Published: May 2018

Purpose:

To identify a recent change in disease severity and visual outcomes of patients with Acanthamoeba keratitis (AK) at Wills Eye Hospital (WEH).

Methods:

A retrospective chart review was performed of all cases diagnosed with AK at WEH between January 1, 2009, and December 31, 2015. Failure of treatment was defined as having a final best-corrected visual acuity worse than 20/100 and/or requiring keratoplasty. The patients were grouped into 2 outcome categories: successfully treated and those who failed treatment; and prognostic factors associated with failure status were evaluated. Additionally, patients who presented from 2009 to 2012 (labeled “first interval”) were compared with those who presented more recently from 2013 to 2015 (labeled “second interval”) to determine whether the treatment outcomes and patients' characteristics from the 2 intervals were different.

Results:

Fifty-nine patients were diagnosed. The rate of treatment failure in the second interval was significantly higher than in the first interval (68% vs. 28%, P = 0.004). Compared with the patients in the first interval, those who presented in the second interval were significantly older, were treated with more corticosteroids before diagnosis, had more days from the symptom onset to initiation of AK treatment, and presented to WEH with poorer vision.

Conclusions:

In recent years, the general profile of patients with AK has changed at WEH. Currently, we are treating older patients with more severe keratitis who are presenting later and with worse vision compared with our previous patients. At the same time, treatment outcomes have been poorer.
Histopathologic Findings of Linear Scleroderma Displaying Focal Trichiasis Secondary to Tarsal Thinning
Authors: Reshef Edith R. , Wolkow Natalie , Jakobiec Frederick A. , Yoon Michael K.
Published: May 2018

Linear scleroderma en coup de sabre with ophthalmic findings has been previously described in the literature on numerous occasions. A 57-year-old woman presented with focal trichiasis secondary to tarsal thinning, adjacent to a linear brow and forehead deformity consistent with linear scleroderma en coup de sabre. Cases of linear scleroderma en coup de sabre involving the eyelids have been reported, most often with madarosis, ptosis, or skin atrophy; however, to the authors’ knowledge, this is the first reported case of linear scleroderma associated with trichiasis and involvement of the deeper eyelid tissues, particularly the tarsus.
Esophageal Squamous Cell Carcinoma Metastatic to the Orbit
Authors: Dempsey Katharine S. , Charles Norman C. , Belinsky Irina
Published: May 2018

A 74-year-old man presenting with proptosis and orbital inflammation was found on magnetic resonance imaging to have a unilateral intraconal mass. Biopsy revealed a high-grade malignant tumor that was interpreted as squamous cell carcinoma. Positron emission tomography-computed tomography imaging subsequently identified a primary lesion in the esophagus. Esophageal squamous cell carcinoma is a rare cause of orbital metastasis, with only 4 previously reported cases. The authors discuss an approach to orbital malignancies of obscure origin.
“I'm a Different Coach With Every Family”
Authors: Meadan Hedda , Douglas Sarah N. , Kammes Rebecca , Schraml-Block Kristen
Published: May 2018

Early intervention (EI) service providers working with young children with developmental disabilities and delays and their families often utilize coaching practices to engage caregivers in the EI process. Within the literature, the usefulness of coaching has been identified. However, little is known about how coaching practices look in naturalistic settings and service providers' perceptions of these practices. Through the use of an online survey, this study examined beliefs and reported practices of EI service providers. The findings indicated that EI providers considered coaching to be meaningful and offered several benefits to both caregivers and children. Some of the perceived advantages included engaging and empowering caregivers and increased opportunities for children to practice and master skills. Most coaching practices were ranked as highly important and were reportedly utilized frequently by service providers in the sample. However, some coaching practices, such as reflection and feedback, were not implemented as often as joint planning, observation, and action. In addition, the participants identified challenges and facilitators for using coaching as a style of interacting with caregivers. Discussion of EI provider perceptions, limitations, recommendations, implications, and future research directions are presented.
Cost-effectiveness of an Evidence-Based Childhood Asthma Intervention in Real-World Primary Care Settings
Authors: Dor Avi , Luo Qian , Gerstein Maya Tuchman , Malveaux Floyd , Mitchell Herman , Markus Anne Rossier
Published: May 2018

We present an incremental cost-effectiveness analysis of an evidence-based childhood asthma intervention (Community Healthcare for Asthma Management and Prevention of Symptoms [CHAMPS]) to usual management of childhood asthma in community health centers. Data used in the analysis include household surveys, Medicaid insurance claims, and community health center expenditure reports. We combined our incremental cost-effectiveness analysis with a difference-in-differences multivariate regression framework. We found that CHAMPS reduced symptom days by 29.75 days per child-year and was cost-effective (incremental cost-effectiveness ratio: $28.76 per symptom-free days). Most of the benefits were due to reductions in direct medical costs. Indirect benefits from increased household productivity were relatively small.
Retrospective Analysis of Hearing-Impaired Adult Patients Treated With an Active Transcutaneous Bone Conduction Implant
Authors: Rader Tobias , Stöver Timo , Lenarz Thomas , Maier Hannes , Zahnert Thomas , Beleites Thomas , Hagen Rudolf , Mlynski Robert , Baumgartner Wolf Dieter
Published: May 2018

Objective:

To determine the therapeutic success and safety of an active transcutaneous bone conduction implant (tBCI) in adult patients with conductive or mixed hearing loss.

Study Design:

Retrospective case review.

Setting:

Five university hospitals in Frankfurt, Hannover, Dresden, Würzburg, and Vienna.

Patients:

Data were analyzed from 61 patients (31 women, 30 men) with a mean age of 50 years (min. 26, max. 80). Forty patients had mixed, and 21 conductive hearing loss. Typical etiologies were history of otitis media (n = 20) and cholesteatoma (n = 17).

Interventions:

Implantation of the active tBCI.

Main Outcome Measures:

Data were analyzed for the following time points: up to 6 months postoperatively (“short-term”), 6 to 37 months postoperatively (“long-term”), and the last available measurement per patient (“most recent”). Pure-tone audiometry (air and bone conduction, AC and BC) and sound field thresholds with warble tones (WT), word recognition scores with Freiburger monosyllables (WRS), as well as speech reception thresholds (SRT) using the Oldenburg sentence test (OLSA) in quiet (SRT) and in noise (signal-to-noise ratio, SNR) were collected.

Results:

No significant changes in air- and bone-conduction thresholds were observed after implantation. A mean WRS improvement of 54% using the active tBCI was shown at the short-term assessment, i.e., a mean score of 79% compared with 25% in the unaided condition. Results remained stable, with a mean score of 75% at the long-term assessment. SRT in noise improved by 3.6 dB SNR in the implanted ear at the short-term assessment. Overall six adverse events and four serious adverse events were reported, resulting in a rate of 9.84 and 6.56%, respectively.

Conclusion:

The tBCI clearly improves speech intelligibility in patients with conductive or mixed hearing loss, showing stable results up to 1 year post-implantation.
Nutritional support in patients with extracorporeal life support and ventricular assist devices
Authors: Stoppe Christian , Nesterova Ekaterina , Elke Gunnar
Published: May 2018

Purpose of review

Extracorporeal life support (ECLS) including venovenous and venoarterial extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VAD) provide mechanical pulmonary and circulatory support, respectively, in patients with acute pulmonary or cardiovascular failure. This review discusses recently published data regarding specific topics of nutritional support in patients with ECLS and VAD.

Recent findings

ECLS may aggravate loss of endogenous and exogenous micronutrients and macronutrients. Observational studies have shown that enteral nutrition is feasible and most commonly used in patients with ECLS. Indirect calorimetry may be feasible for measuring energy expenditure during ECLS. Specific tools are available to assess malnutrition or nutrition risk in patients with VAD but require further validation in the perioperative setting. If parenteral nutrition is indicated, the use of intravenous lipid emulsions may be associated with membrane oxygenator dysfunction of the ECLS device or increased infectious risk in patients with VAD.

Despite the exponential use of ECLS and VAD over the last decade, the role of nutrition on clinical outcome in this patient population remains an important but yet underinvestigated field.
Management of Pancreatolithiasis
Authors: Inui Kazuo , Masamune Atsushi , Igarashi Yoshinori , Ohara Hirotaka , Tazuma Susumu , Sugiyama Masanori , Suzuki Yutaka , Miyoshi Hironao , Yamamoto Satoshi , Takeyama Yoshifumi , Nakano Eriko , Takuma Kensuke , Sakagami Junichi , Hayashi Kazuki , Kogure Atsuko , Ito Tetsuya , Mukai Tsuyoshi , Maetani Iruru , Nagahama Masatsugu , Serikawa Masahiro , Ueki Toshiharu , Furuya Ken , Isayama Hiroyuki , Moriyama Ichiro , Shigeno Masaya , Mizukami Kazuhiro , Nanashima Atsushi , Oana Shuhei , Ikehata Atsushi , Watanabe Noriko , Hirooka Yoshiki , Ogoshi Keiichiro , Sasaki Yoji , Iwata Yoshinori , Kudo Yasushi , Nakayama Ataru , Nakamura Masafumi
Published: May 2018

Objectives

The aim of this study was to assess prevailing treatment of pancreatolithiasis in Japan.

Methods

We surveyed clinical data from 1834 patients (1479 men and 355 women) at 125 hospitals.

Results

Extracorporeal shock-wave lithotripsy (ESWL) was performed alone in 103 patients (5.6%), ESWL plus an endoscopic procedure in 446 (24.3%), endoscopic treatment alone in 261 (14.2%), and surgery in 167 (9.1%). Other treatments were given to 358 (19.5%), whereas 499 (27.2%) received no treatment. Symptoms were relieved in 85.7% after ESWL, 80.8% after endoscopic treatment alone, and 92.8% after surgery. Early complication rates within 3 months after ESWL, endoscopic treatment alone, and surgery were 8%, 4.5%, and 27.1%, respectively. Late complications after ESWL, endoscopic procedures alone, and surgery were 1.7%, 2.5%, and 8.2%, respectively. Symptom relief but also early and late complications were greater after surgery than after ESWL and endoscopic treatment. Among 417 patients undergoing ESWL, 61 (14.6%) required surgery, as did 32 (16%) of 200 patients treated endoscopically. Surgery was required less frequently following initial operative treatment (11/164 patients [6.7%]). Nonsurgical initial treatments were chosen more frequently.

Conclusions

First-line treatment of pancreatolithiasis should be ESWL with or without endoscopy because of minimal invasiveness and fewer complications.
Downregulation of GEP100 Improved the Growth Inhibition Effect of Erlotinib Through Modulating Mesenchymal Epithelial Transition Process in Pancreatic Cancer
Authors: Xie Chuan-gao , Sun Shi-long , Wei Shu-mei , Xu Xiao-ming , Shao Li-ming , Chen Jia-min , Cai Jian-ting
Published: May 2018

Objective

The epidermal growth factor receptor is overexpressed in the majority of pancreatic cancer. Epidermal growth factor receptor tyrosine kinase inhibitor erlotinib was approved to treat patients combining with gemcitabine. However, the sensitivity is low. Here, we try to reveal the regulatory role of guanine nucleotide exchange protein 100 (GEP100) in erlotinib sensitivity.

Methods

We investigated the correlation between GEP100 expression and sensitivity to erlotinib in different pancreatic cancer cell lines, followed by examination of the effect of GEP100 on erlotinib sensitivity by establishing the stable knocked-down cell line. The expression level of epithelial mesenchymal transition–related protein was examined by Western blot, and the regulatory mechanism was investigated by short hairpin RNA. Xenograft experiment was also performed in nude mice.

Results

We identified a significant correlation between sensitivity to erlotinib and expression of GEP100. GEP100 downregulation increased its sensitivity to erlotinib. E-cadherin short hairpin RNA treatment inhibited this sensitivity. Immunohistochemical staining showed a mutual exclusive expression pattern of GEP100 and E-cadherin in human pancreatic cancer tissues. Xenograft showed that downregulation of GEP100 enhanced the growth inhibition of erlotinib in nude mice.

Conclusions

Our results suggested that GEP100 and E-cadherin have the predictive value for responsiveness to erlotinib in pancreatic cancer.
A Multicenter Open-Label Randomized Controlled Trial of Pancreatic Enzyme Replacement Therapy in Unresectable Pancreatic Cancer
Authors: Saito Tomotaka , Nakai Yousuke , Isayama Hiroyuki , Hirano Kenji , Ishigaki Kazunaga , Hakuta Ryunosuke , Takeda Tsuyoshi , Saito Kei , Umefune Gyotane , Akiyama Dai , Watanabe Takeo , Takagi Kaoru , Takahara Naminatsu , Hamada Tsuyoshi , Uchino Rie , Mizuno Suguru , Mouri Dai , Yagioka Hiroshi , Kogure Hirofumi , Togawa Osamu , Matsubara Saburo , Ito Yukiko , Yamamoto Natsuyo , Tada Minoru , Koike Kazuhiko
Published: May 2018

Objective

Exocrine pancreatic insufficiency may impair the nutritional status in pancreatic cancer (PC), but the role of pancreatic enzyme replacement therapy (PERT) is not fully evaluated. Therefore, we conducted this multicenter open-label randomized controlled trial to evaluate the role of PERT in PC patients.

Methods

Patients with unresectable PC receiving chemotherapy were randomly assigned to pancrelipase and nonpancrelipase groups. Patients in the pancrelipase group took oral pancrelipase of 48,000 lipase units per meal. N-benzoyl-tryrosyl para-aminobenzoic acid (NBT-PABA) test was performed at baseline. Our primary endpoint was change in body mass index (BMI) at 8 weeks. Secondary endpoints were change in other nutritional status at 8 weeks and overall survival.

Results

A total of 88 patients were enrolled between May 2014 and May 2016. The NBT-PABA test was lower than the normal range in 90%. There were no significant differences in change in BMI at 8 weeks: 0.975 and 0.980 in the pancrelipase and the nonpancrelipase groups, respectively (P = 0.780). The other nutritional markers were also comparable. The median overall survival was 19.0 and 12.0 months (P = 0.070).

Conclusions

In this randomized controlled trial, pancrelipase failed to improve the change in BMI at 8 weeks in PC patients receiving chemotherapy.
Vitamin D Intervention and Bone
Authors: Karlsland Åkeson Pia , Åkesson Kristina E. , Lind Torbjörn , Hernell Olle , Silfverdal Sven‐Arne , Öhlund Inger
Published: May 2018

Objectives:

The aim of the study was to evaluate vitamin D status and effects of vitamin D intervention on bone mineral density (BMD) and content (BMC) in children with fair and dark skin in Sweden during winter.

Methods:

In a 2‐center prospective double‐blinded randomized intervention study 5‐ to 7‐year‐old children (n = 206) with fair and dark skin in Sweden (55°N–63°N) received daily vitamin D supplements of 25 μg, 10 μg, or placebo (2 μg) during 3 winter months. We measured BMD and BMC for total body (TB), total body less head (TBLH), femoral neck (FN), and spine at baseline and 4 months later. Intake of vitamin D and calcium, serum 25‐hydroxy vitamin D (S‐25[OH]D), and related parameters were analyzed.

Results:

Despite lower S‐25(OH)D in dark than fair‐skinned children, BMD of TB (P = 0.012) and TBLH (P = 0.002) and BMC of TBLH (P = 0.04) were higher at baseline and follow‐up in those with dark skin. Delta (Δ) BMD and BMC of TB and TBLH did not differ between intervention and placebo groups, but FN‐BMC increased more among dark‐skinned children in the 25 μg (P = 0.038) and 10 μg (P = 0.027) groups compared to placebo. We found no associations between Δ S‐25(OH)D, P‐parathyroid hormone, P‐alkaline phosphatase, and Δ BMD and BMC, respectively.

Conclusions:

BMD and BMC remained higher in dark‐ than fair‐skinned children despite lower vitamin D status. Even though no difference in general was found in BMD or BMC after vitamin D intervention, the increase in FN‐BMC in dark‐skinned children may suggest an influence on bone in those with initially insufficient vitamin D status.
Early Life Incidence of Gastrointestinal and Respiratory Infections in Children With Gastroschisis
Authors: Bannister Jessica , Szatkowski Lisa , Sharkey Don , Tan Shin , Fiaschi Linda , Ban Lu
Published: May 2018

Objectives:

Survival in infants with gastroschisis is increasing although little is known about early childhood morbidity. In the context of a hypothesized link between the gastrointestinal (GI) tract and immune function, this study explores rates of GI and respiratory infections in children with gastroschisis.

Methods:

We conducted a population‐based retrospective cohort study using data from the Health Improvement Network, a large database of UK primary care medical records. We identified children born from 1990 to 2013, and extracted follow‐up data to their fifth birthday. We calculate incidence rates (IR) of GI and respiratory tract infections, overall and stratified by age, sex, socioeconomic status, and gestational age at birth, and compared these between children with and without gastroschisis by calculating adjusted incidence rate ratios (aIRR).

Results:

Children with gastroschisis had a 65% higher IR of GI infection compared to children without (aIRR 1.65, 95% confidence interval [CI] 1.37–1.99, P < 0.001). Children with gastroschisis had a 27% higher IR of all respiratory tract infections (aIRR 1.27, 95% CI 1.12–1.44, P < 0.001) and more than 2‐fold increase in lower respiratory tract infections compared to children without the condition (aIRR 2.15, 95% CI 1.69–2.74, P < 0.001).

Conclusions:

Children born with gastroschisis have a significantly higher incidence of GI and respiratory tract infections compared to children without gastroschisis. This association requires further investigations but could be related to the neonatal care they receive such as delayed enteral feeding or frequent antibiotic courses altering the gut microbiome and developing immune system.
Postmortem Analysis of 4 Mutation Hotspots of KCNQ1, KCNH2, and SCN5A Genes in Sudden Unexplained Death in Southwest of China
Authors: Jia Peng-Lin , Wang Yue-Bing , Fu Hua , Huang Wen-Li , Zhong Shu-Rong , Ma Lin , Li Yu-Hua , Dong Yi , Sun Zhong-Chun , Yang Lin , Qu Peng-Fei , Zhao Su , Qu Yong-Qiang , Xi Yan-Mei , Wang Shang-Wen , Tang Xue , Lei Pu-Ping
Published: May 2018

Long QT syndrome (LQTS) is known to be involved in some sudden unexplained death (SUD) cases. To make clear whether the pathogenic genes of LQTS are involved in SUD in Yunnan province, southwest of China, we examined 4 mutation hotspot segments of KCNQ1, KCNH2, and SCN5A genes in 83 SUD cases using polymerase chain reaction and direct DNA sequencing. Genomic DNA was extracted from paraffin-embedded tissues in 83 cases of sudden cardiac death. One novel homozygous missense variant was identified in exon 3 of KCNQ1, c. 575G>T (p.R192L) in one case. One novel heterozygous missense variant was identified in exon 7 of KCNH2, c.1789T>A (p.Y597N) in 1 case. One novel heterozygous missense variant was identified in exon 7 of KCNH2, c.1800C>A (p.S600R) in 9 cases. In addition, 18 individuals were found to have heterozygous missense variant in exon 7 of KCNH2, c.1801G>A (p.G601S). Our study suggests that some SUDs in Yunnan province may be related with the pathogenic genes of LQTS.
Acute Rheumatic Fever
Authors: Rhodes Kelsey L. , Rasa Malia M. , Yamamoto Loren G.
Published: May 2018

The Jones criteria of 2 major criteria or 1 major plus 2 minor criteria that have been classically used to establish the diagnosis have been significantly modified in 2015 by the American Heart Association. The criteria now include the utilization of echocardiography and Doppler color flow mapping as diagnostic tools for carditis, along with defining criteria in relation to overall population risk, delineating low- versus moderate-high risk populations. Monoarthritis and polyarthralgia are now major criteria for moderate- to high-risk groups.
Pediatric Lung Abscess
Authors: Kraft Clara , Lasure Benjamin , Sharon Melinda , Patel Paulina , Minardi Joseph
Published: May 2018

The diagnosis of lung abscess can be difficult to make and often requires imaging beyond plain chest x-ray. The decision to further image with computed tomography should be weighed against the risks of radiation exposure, especially in pediatric patients. In addition, the cost and potential impact on length of stay from obtaining computed tomography scans should be considered. In this report, we describe a case of lung abscess made immediately using point-of-care ultrasound in the emergency department. To our knowledge, there are no previous cases describing lung abscess diagnosed by point-of-care ultrasound. This case report aims to describe a case of pediatric lung abscess, review the ultrasound findings, and discuss relevant literature on the topic.
Assessment of pain quality reveals distinct differences between nociceptive innervation of low back fascia and muscle in humans
Authors: Schilder Andreas , Magerl Walter , Klein Thomas , Treede Rolf-Detlef
Published: May 2018

Introduction/Objectives:

Verbal descriptors are an important pain assessment parameter. The purpose of this study was to explore the ability to discriminate deep muscle pain and overlying fascia pain according to verbal descriptors and compare the pattern with skin stimulation (from previously published data).

Methods:

In 16 healthy human subjects, electrical stimulation was chosen to excite a broad spectrum of nociceptive primary afferents innervating the respective tissues. The 24-item Pain Perception Scale (Schmerzempfindungsskala [SES]) was used to determine the induced pain quality.

Results:

Overall, affective (P = 0.69) and sensory scores (P = 0.07) were not significantly different between muscle and fascia. Factor analysis of the sensory descriptors revealed a stable 3-factor solution distinguishing superficial thermal (“heat pain” identified by the items “burning,” “scalding,” and “hot”) from superficial mechanical (“sharp pain” identified by the items “cutting,” “tearing,” and “stinging”) and “deep pain” (identified by the items “beating,” “throbbing,” and “pounding”). The “deep pain” factor was more pronounced for muscle than fascia (P < 0.01), whereas the other 2 factors were more pronounced for fascia (both P < 0.01). The patterns of skin and fascia matched precisely in sensory factors and on single-item level.

Conclusion:

The differences in sensory descriptor patterns between muscle and fascia may potentially guide treatment towards muscle or fascia in low back pain physiotherapeutic regimes. The similarity of descriptor patterns between fascia and skin, both including the terms “burning” and “stinging,” opens the possibility that neuropathic back pain (when the dorsal ramus of the spinal nerve is affected) may be confused with low back pain of fascia origin.