bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic Resonance Texture Analysis in Identifying Complete Pathological Response to Neoadjuvant Treatment in Locally Advanced Rectal Cancer
Authors: Aker Medhat , Ganeshan Balaji , Afaq Asim , Wan Simon , Groves Ashley M. , Arulampalam Tan
Published: November 2018

BACKGROUND:

A certain proportion of patients with locally advanced rectal cancer experience complete response after undergoing neoadjuvant chemoradiotherapy. These patients might be suitable for a conservative “watch and wait” approach, avoiding high-morbidity surgery. Texture analysis is a new modality that can assess heterogeneity in medical images by statistically analyzing gray-level intensities on a pixel-by-pixel basis. This study hypothesizes that texture analysis of magnetic resonance images can identify patients with a complete response.

OBJECTIVE:

This study aims to determine whether texture analysis of magnetic resonance images as a quantitative imaging biomarker can accurately identify patients with complete response.

DESIGN:

This is a retrospective diagnostic accuracy study.

SETTINGS:

This study was conducted at Colchester General Hospital, January 2003 to 2014.

PATIENTS:

All patients diagnosed with locally advanced rectal cancer who underwent long-course chemoradiotherapy had a posttreatment magnetic resonance scan and underwent surgery are included.

INTERVENTION:

Texture analysis was extracted from T2-weighted magnetic resonance images of the rectal cancer.

MAIN OUTCOME MEASURES:

Textural features that are able to identify complete responders were identified by a Mann-Whitney U test. Their diagnostic accuracy in identifying complete responders was determined by the area under the receiver operator characteristics curve. Cutoff values were determined by the Youden index. Pathology was the standard of reference.

RESULTS:

One hundred fourteen patients with first posttreatment MRI scans (6.2 weeks after completion of neoadjuvant treatment) were included. Sixty-eight patients had a second posttreatment scan (10.4 weeks). With no filtration, mean (p = 0.033), SD (p = 0.048), entropy (p = 0.007), and skewness (p = 0.000) from first posttreatment scans, and SD (p = 0.042), entropy (p = 0.014), mean of positive pixels (p = 0.032), and skewness (p = 0.000) from second posttreatment scans were all able to identify complete response. Area under the curve ranged from 0.750 to 0.88.

LIMITATIONS:

Texture analysis of MRI is a new modality; therefore, further studies are necessary to standardize the methodology of extraction of texture features, timing of scans, and acquisition parameters.

CONCLUSIONS:

Texture analysis of MRI is a potentially significant imaging biomarker that can accurately identify patients who have experienced complete response and might be suitable for a nonsurgical approach. (Cinicaltrials.gov:NCT02439086). See Video Abstract at http://links.lww.com/DCR/A760.
The Effect of Surgical Training and Operative Approach on Outcomes in Acute Diverticulitis: Should Guidelines Be Revised?
Authors: Goldstone Robert N. , Cauley Christy E. , Chang David C. , Kunitake Hiroko , Ricciardi Rocco , Bordeianou Liliana
Published: November 2018

BACKGROUND:

Current guidelines accept partial colectomy and primary anastomosis with proximal diversion for select patients with perforated diverticulitis based on low-quality evidence.

OBJECTIVE:

This study aimed to compare the effect of operative approach and surgeon training on outcomes following urgent/emergent colectomy for diverticulitis.

DESIGN:

This is a statewide retrospective cohort study.

SETTING:

Data were obtained from the New York State all-payer sample from 2000 to 2014.

PATIENTS:

All patients who underwent an urgent/emergent sigmoid colectomy for diverticulitis with creation of an end colostomy or primary anastomosis with proximal diversion were included. We excluded all patients age <18 years, with IBD, colorectal cancer, ischemic colitis, or elective operations.

MAIN OUTCOME MEASURES:

The main outcomes measured were postoperative in-hospital mortality and complications,

RESULTS:

A total of 10,780 patients underwent urgent/emergent colectomy for diverticulitis: 10,600 (98.3%) received a Hartmann procedure and 180 (1.7%) received primary anastomosis with proximal diversion. Colorectal surgeons performed 6.0% of all operations. Utilization of primary anastomosis with proximal diversion was greater among colorectal surgeons but remained low overall (4.2% vs 1.5%; p < 0.001). Postoperative mortality was 2-fold greater when noncolorectal surgeons performed primary anastomosis vs Hartmann procedure (15% vs 7.4%; p < 0.001) and 1.4 times greater among noncolorectal surgeons than among colorectal surgeons (7.5% vs 5.3%; p = 0.04). On multivariable logistic regression (adjusting for patient demographics/characteristics, year, hospital academic status, and surgeon training) primary anastomosis with proximal diversion remained associated with increased mortality (OR, 2.7; 95% CI,1.7–4.4; p < 0.001), complications (OR, 1.8; 95% CI, 1.3–2.5; p < 0.001), and reoperation (OR, 3.4; 95% CI, 1.8–6.3; p < 0.001), whereas colorectal board certification was associated with decreased mortality (OR, 0.66; 95% CI, 0.46–0.95; p = 0.03).

LIMITATIONS:

Selection bias secondary to retrospective nature and absence of disease severity were limitations of this study.

CONCLUSIONS:

Despite current recommendations for primary anastomosis with proximal diversion for perforated diverticulitis, this operation in New York State was associated with increased postoperative morbidity and mortality when performed by general surgeons. Given that the majority of urgent/emergent colectomies for diverticulitis are not performed by colorectal surgeons, guidelines for operative management of perforated diverticulitis should be reevaluated. See Video Abstract at http://links.lww.com/DCR/A772.
Clinical Implications of Pretreatment: Lymphocyte-to-Monocyte Ratio in Patients With Rectal Cancer Receiving Preoperative Chemoradiotherapy
Authors: Yamamoto Akira , Toiyama Yuji , Okugawa Yoshinaga , Oki Satoshi , Ide Shozo , Saigusa Susumu , Araki Toshimitsu , Kusunoki Masato
Published: November 2018

BACKGROUND:

Despite advances in local control of rectal cancer, recurrence in distant organs is still one of the main causes of mortality. Prognostic biomarkers would be valuable for the treatment of patients who have rectal cancer.

OBJECTIVE:

The aim of our study was to investigate the prognostic impact of lymphocyte-to-monocyte ratio in patients with rectal cancer receiving preoperative chemoradiotherapy, and to clarify the clinical significance of lymphocyte-to-monocyte ratio.

DESIGN:

Prospectively maintained data of patients with rectal cancer were retrospectively evaluated to clarify the clinical relevance of the lymphocyte-to-monocyte ratio.

SETTING:

This study was conducted at a single expert center.

PATIENTS:

A total of 119 consecutive patients with rectal cancer through chemoradiotherapy followed by total mesorectal excision at our institute were enrolled in this study. Eight patients were excluded because of a lack of laboratory data, and finally 111 patients were assessed in this study.

MAIN OUTCOME MEASURES:

The primary outcome measured was the clinical relevance of the lymphocyte-to-monocyte ratio in patients with rectal cancer receiving chemoradiotherapy.

RESULTS:

Patients with a low pretreatment lymphocyte-to-monocyte ratio showed poor prognosis significantly both in overall survival and disease-free survival of those with rectal cancer receiving chemoradiotherapy. Multivariate analyses showed that low pretreatment lymphocyte-to-monocyte ratio level, presence of pathological lymph node metastasis (ypN(+)), and high pretreatment serum C-reactive protein level were independent prognostic factors of overall survival and disease-free survival. In addition, time-to-event analysis divided into 2 groups by ypN status showed that low pretreatment lymphocyte-to-monocyte ratio was correlated with poor overall survival and disease-free survival not only in group ypN(–) but also in group ypN(+).

LIMITATIONS:

The present study had several limitations, including that it was a retrospective observational and single institutional study with Japanese patients.

CONCLUSIONS:

The combination of lymphocyte-to-monocyte ratio and ypN status can be a predictive marker of poor prognosis and recurrence among patients with rectal cancer undergoing preoperative chemoradiotherapy. See Video Abstract at http://links.lww.com/DCR/A780.
Profile of Consecutive Fecal Calprotectin Levels in the Perioperative Period and Its Predictive Capacity for Early Endoscopic Recurrence in Crohn’s Disease
Authors: Liu Ruiqing , Guo Zhen , Cao Lei , Wang Zhiming , Gong Jianfeng , Li Yi , Zhu Weiming
Published: November 2018

BACKGROUND:

The perioperative behavior of fecal calprotectin and whether it predicts early postoperative endoscopic recurrence of Crohn’s disease are unknown.

OBJECTIVE:

We aimed to compare the perioperative profiles of fecal calprotectin between patients with Crohn’s disease and patients without Crohn’s disease undergoing intestinal resection and to identify the association between consecutive fecal calprotectin levels and endoscopic recurrence 3 months after surgery in patients with Crohn’s disease.

DESIGN:

This was a prospective observational study.

SETTINGS:

This study was conducted in a tertiary referral hospital.

PATIENTS:

One hundred fourteen consecutive patients (90 Crohn’s disease, 24 non-Crohn’s disease) who underwent resection were recruited.

MAIN OUTCOME MEASURES:

Univariate and multivariate analyses were performed to identify variations and risk factors. The predictive accuracy of the possible predictors was assessed by using receiver operating characteristic curves.

RESULTS:

The fecal calprotectin levels on preoperative day 14 and postoperative days 14, 21, 28, 60, and 90 were higher in the Crohn’s disease group than they were in non-Crohn’s disease group (p < 0.05). Twenty patients (22.2%) developed endoscopic recurrence 3 months after resection. The trend for fecal calprotectin change (Δfecal calprotectin) from preoperative day 14 to postoperative day 14 was opposite in the recurrence and nonrecurrence groups. Multivariate analysis showed that this change was a predictive factor of early endoscopic recurrence (p < 0.05). ΔFecal calprotectin was more accurate at predicting early endoscopic recurrence than was fecal calprotectin at single time points with a cutoff value of 240 μg/g.

LIMITATIONS:

This is a single-center trial with a limited cohort of patients.

CONCLUSIONS:

The perioperative fecal calprotectin levels were higher in patients with Crohn’s disease than they were in the control group. The change in fecal calprotectin levels from preoperative day 14 to postoperative day 14 could serve as a practical predictive index for early postoperative endoscopic recurrence. See Video Abstract at http://links.lww.com/DCR/A796.
Persistent Fistula After Anorectal Abscess Drainage: Local Experience of 11 Years
Authors: Sahnan Kapil , Askari Alan , Adegbola Samuel O. , Warusavitarne Janindra , Lung Phillip F.C. , Hart Ailsa , Faiz Omar , Phillips Robin K.S. , Tozer Phil
Published: November 2018

BACKGROUND:

The characteristics of patients who develop a fistula-in-ano after an anorectal abscess are unclear.

OBJECTIVE:

Our study explored this relationship and patient factors associated with fistula development.

DESIGN:

International Classification of Diseases, 10th Revision, and Classification of Interventions and Procedures, version 4, codes were used to identify all of the patients with a primary anorectal abscess. Multivariable analysis was used to identify factors predictive of fistula formation.

SETTINGS:

The study was conducted in a district general hospital.

PATIENTS:

Patients with anorectal abscess who were admitted to our institution (2004–2015) were included.

MAIN OUTCOMES MEASURES:

The rate of subsequent fistula formation was measured.

RESULTS:

A total of 1970 abscess patients were identified; 70.0% (n = 1379) were men, and 7.3% (n = 144) had Crohn’s disease. Fistulas occurred in 16.2% (n = 319) at a median of 7 months (interquartile range, 3–7 mo). Patients with Crohn’s disease were more than twice as likely to develop a fistula than patients without Crohn’s disease (32.6% vs 14.9%; OR = 2.5 (95% CI, 1.7–3.7); p < 0.001). Patients with Crohn’s disease with a fistula were more likely to be women (55.3% vs 34.6%; p = 0.007) and aged <30 years (51.1% vs 24.3%; p< 0.001) versus patients without Crohn’s disease with a fistula. At multivariable analysis of the entire cohort, male sex (OR = 0.7 (95% CI, 0.5–0.9); p = 0.005) and diabetes mellitus (OR = 0.5 (95% CI, 0.3–0.9); p = 0.027) were associated with a reduced likelihood of developing a fistula after abscess formation.

LIMITATIONS:

The study was limited by its single-center scope, retrospective analysis, and lack of a standardized definition for Crohn’s disease.

CONCLUSIONS:

Abscesses are more common in men, but progression to fistula is more likely in women. The rate of fistula progression in Crohn’s disease is twice that in patients without Crohn’s disease. Identification of patients at risk may help delineate those who will benefit from a more conservative surgical approach, enhanced follow-up, or investigation after abscess drainage. See Video Abstract at http://links.lww.com/DCR/A798.
Predictors of Oral Function and Facial Aesthetics Post Maxillofacial Reconstruction with Free Fibula Flap
Authors: Alotaibi Ahmed , Aljabab Abdulsalam , Althubaiti Ghazi
Published: November 2018

Background:

For maxillofacial reconstruction, free flaps have largely replaced pedicled flaps. In a Saudi Arabian sample, we (1) assessed patients’ postoperative oral function and facial aesthetics (OFFA), specifically pertaining to diet, speech intelligibility, oral opening, maxilla-mandibular occlusion, and facial aesthetics (all rated 0–2) following fibular free flap surgery; and (2) identified preoperative predictors of a novel 10-point OFFA rating scale combining these 5 parameters.

Methods:

We conducted a retrospective review of the medical records of all patients who underwent free fibula flap surgery for nontraumatic maxillofacial reconstruction from 2010 to 2017 and were followed postoperatively for at least 6 months or until death.

Results:

In 20 patients (10 female; mean age, 33.8; range, 7–56), the results were excellent, 19 of 20 patients ultimately resuming a normal diet, one a soft diet; good oral opening in 18; and normal speech, normal occlusion, and an aesthetically good result, each in 17 patients. Half the patients had a perfect (10/10) OFFA score at final assessment, whereas 2 scored 9/10, one 8/10, and two 6/10. On univariate analysis, patient age > 45, tumor of higher malignancy potential, comorbid illness, and adjuvant radiotherapy predicted a worse OFFA score, whereas a multivariate model combining comorbid illness (P = 0.002) and preoperative radiotherapy (P = 0.010) predicted a lower OFFA score, accounting for 57% of the variance (R2 = 0.57).

Conclusion:

In Saudi Arabia, fibular free flaps yielded overall very good to excellent results in 19 of 20 patients undergoing nontraumatic maxillofacial reconstruction.
Stripped Mesenteric Flap: A Novel Option for Preventing Anastomotic Leakage in Circumferential Pharyngeal Reconstruction
Authors: Fukunaga Yutaka , Higashino Takuya , Oshima Azusa , Hayashi Ryuichi
Published: November 2018

Reconstruction of a circumferential pharyngeal defect with a free jejunal flap is a well-established procedure. However, anastomotic leakage often occurs, which can lead to abscess formation, pharyngocutaneous fistula formation, and carotid rupture. Previous reports have described covering the anastomotic site with a mesenteric flap to prevent anastomotic leakage. However, the mesentery is covered by a serosal membrane, which interferes with adhesion and vascular communication. Therefore, we stripped off the serosal membrane to accelerate adhesion to the anastomotic site. We retrospectively studied patients who had a history of radiotherapy and who had received a stripped mesenteric flap in a circumferential pharyngeal reconstruction procedure. We collected the following data: operative time, blood loss, postoperative complications, interval to resumption of oral intake, and duration of hospital stay. We obtained data for 11 patients. The jejunal flap failed in one patient because of arterial thrombosis. One of the other 10 patients developed anastomotic leakage caused by congested mucous membrane necrosis. The patient was treated conservatively and showed no clinical symptoms of infection or inflammation. The 9 remaining patients had no anastomotic leakage. In the present series, although anastomotic leakage was observed in one of 10 patients who underwent circumferential pharyngeal reconstruction using a stripped mesenteric flap, the severity of the leakage was minimized.
Early Masseter to Facial Nerve Transfer May Improve Smile Excursion in Facial Paralysis
Authors: Zhang Shuhao , Hembd Austin , Ching Christina W. , Tolley Philip , Rozen Shai M.
Published: November 2018

Background:

Masseter-to-facial nerve transfer has been shown to be an effective and safe treatment option in patients with acute and subacute facial palsy. The present article aims to characterize whether there is a benefit in early nerve transfers while minimizing other confounding variables; we present a study that consist of only patients with complete facial nerve paralysis resulting from intratemporal facial nerve resections.

Methods:

Between 2012 and 2016, 7 masseter-to-facial nerve transfers were performed for complete facial nerve palsy after intratemporal proximal nerve resections. Pre- and postoperative photographic and video evaluations were performed using both the Sunnybrook facial grading scale and the MEEI FACE-gram software for more objective metric measurements. Statistical analysis was performed to determine which patient and surgical variables had significant effects on outcome.

Results:

Mean 14-month follow-up revealed that patients who underwent nerve transfer prior to 6 months’ denervation achieved postoperative oral commissural excursion of 11.1 mm versus 6.5 mm in patients who underwent nerve transfer after 6 months (P = 0.003). Performing masseter-to-facial nerve transfer to the main facial nerve trunk resulted in a significantly higher improvement in the modiolus-philtral ratio (31.6% versus 6.1%) than selective transfer in patients (P = 0.01) at the latest follow-up.

Conclusions:

Early masseter-to-facial nerve transfers, before 6 months of palsy duration, can potentially improve smile excursion and symmetry of open mouth smile. Additionally, truncal coaptations may provide improved tone over coapting to selective facial nerve branches. These findings necessitate larger studies regarding the importance of denervation time with fifth-to-seventh nerve transfers.
A Brief Review of Single-Item and Multi-Item Quality-of-Life Measures for Medicare Patients
Authors: Wasson John H.
Published: November 2018

Using responses to HowsYourHealth.org from 9068 patients aged 65 years or older, I illustrate measurement compromises for quality-of-life assessment and management.
Evaluating the Introduction of the Safewards Model to a Medium- to Long-Term Forensic Mental Health Ward
Authors: Maguire Tessa , Ryan Jo , Fullam Rachael , McKenna Brian
Published: November 2018

Care and treatment in forensic mental health wards can present with challenges when loss of hope and freedom, and aggression are present, which can then influence ward atmosphere and feelings of safety. Safewards is a model designed to address a range of conflict (e.g., aggression and self-harm) and containment (e.g., use of restrictive interventions) events and may provide a suitable approach to delivery of care in a forensic setting, while also addressing aggression, restrictive interventions, and ward atmosphere. The aim of this study was to evaluate the introduction of Safewards to a forensic mental health ward to determine suitability, and to explore if changes to conflict, containment, and ward atmosphere occurred. A mixed methods approach was used involving the collection of incident data related to conflict and containment, an assessment of the degree to which interventions were implemented, and an assessment of the social climate before and after implementation. Results suggested that there were fewer conflict events after Safewards was introduced; however, there did not appear to be any changes in the already low use of restrictive interventions. The Safewards interventions were implemented to a high degree of fidelity, and there was indication of an increase in a positive perception of ward atmosphere, supported by themes of positive change, enhanced safety, and respectful relationships. Safewards may assist in contributing to an improvement in the perception of ward atmosphere. To enhance implementation in a forensic mental health setting, there may be a need to consider additional elements to Safewards, pertinent to this setting.
Extreme Control and Instability: Insight Into Head Injury From Intimate Partner Violence
Authors: St. Ivany Amanda , Kools Susan , Sharps Phyllis , Bullock Linda
Published: November 2018

Aim:

The aim of this study was to understand the social context of the lives of women who experienced a head injury from intimate partner violence.

Background:

Sixty percent to 92% of survivors of intimate partner violence receive head trauma during the abuse. Little research exists regarding the episodes of abuse when women receive a head injury, or the reasons women might not seek medical care for the head injury or the abuse.

Method:

Twenty-one interviews from nine women who self-reported passing out from being hit in the head were analyzed using thematic analysis.

Findings:

Themes of extreme control and manipulation from abusers emerged, and women described living with instability from cycles of incarceration, drug and alcohol use, and fear of losing their children. Women did not receive medical care for head injury because the abusers often used forced sex immediately after the head injury to instill fear and authority.

Implications for Forensic Nursing:

Hitting women in the head is not only about physical abuse, but also about exerting dominance and creating an environment of extreme control. Forensic nurses are uniquely positioned to screen for head injuries during initial assessments and follow-up visits and connect women with appropriate resources.
Combatting the Opioid Crisis From Prison: Initiating Opioid Agonist Therapy
Authors: McIntyre Jessica L.
Published: November 2018

Presented is a case report of a young man dependent on fentanyl who did not receive opioid agonist therapy (OAT) during incarceration. Highlighted are the barriers to accessing OAT in custody, which exacerbates problems with drug-seeking behavior, diversion, and recidivism. Discussed are the implications for correctional healthcare, including the benefits of utilizing telehealth services to maximize accessibility to OAT in correctional institutions that will not only enhance the quality of patient care but also address the growing opioid epidemic across Canada.
Child Sexual Abuse Perpetrators: What Forensic Nurses Need to Know
Authors: Hornor Gail , Zeno Rosie
Published: November 2018

Child sexual abuse is a problem of epidemic proportions resulting in lifelong physical and mental health consequences for victims. Most child sexual abuse victims never disclose and do not receive needed treatment. Clearly, pediatric healthcare providers must understand the dynamics of child sexual abuse to better identify and protect potential victims. Forensic nurses are at the forefront of caring for victims of sexual abuse and are strong voices in the education of parents, community members, and other healthcare professionals regarding sexual abuse. Forensic nurses with a deeper understanding of child sexual abuse perpetrators will be better able to educate the public and advocate for children at risk for sexual abuse. In this article, specific types of child sexual abuse perpetration will be explored, and implications for forensic nursing will be discussed.
Return to Sport After Surgical Management of Proximal Hamstring Avulsions: A Systematic Review and Meta-analysis
Authors: Coughlin Ryan P. , Kay Jeffrey , Shanmugaraj Ajaykumar , Memon Muzammil , Naji Leen , Ayeni Olufemi R.
Published: November 2018

Objective:

To assess the rates and timing of return to sport for the surgical management of proximal hamstring avulsions (PHAs).

Methods:

Three databases, PubMed, MEDLINE, and EMBASE, were searched from database inception until October 7, 2017, by 2 reviewers independently and in duplicate. The inclusion criteria were studies reporting return to sport outcomes for surgical management of acute, chronic, complete, and partial PHA. The rate of return to sports was combined in a meta-analysis of proportions using a random-effects model.

Results:

Overall, 21 studies with a total of 846 patients met the inclusion criteria, with a mean age of 41.4 years (range, 14-71 years) and a mean follow-up of 37.8 months (range, 6-76 months). Two studies were of prospective comparative design (level II), 2 were retrospective comparative (level III), 8 were prospective case series (level IV), and 9 were retrospective case series (level IV). The overall mean time to return to sport was 5.8 months (range, 1-36 months). The pooled rate of return to any sport participation was 87% [95% confidence interval (CI), 77%-95%]. The pooled rate of return to preinjury level of sport was 77% (95% CI, 66%-86%).

Conclusions:

Pooled results suggest a high rate of return to sport after surgical management of PHA; however, this was associated with a lower preinjury level of sport. No major differences in return to sport were found between partial versus complete and acute versus chronic PHA.
Epidemiology of Concussions in High School Boys' Ice Hockey, 2008/09 to 2016/17 School Years
Authors: Kerr Zachary Y. , Pierpoint Lauren A. , Rosene John M.
Published: November 2018

Objective:

This study examined the epidemiology of concussions in high school boys' ice hockey during the 2008/09 to 2016/17 school years.

Design:

Prospective cohort study. Athletic trainers from an average 33 high schools annually reported boys' ice hockey concussion and athlete-exposure (AE) data for the High School Reporting Information Online system.

Setting:

Convenience sample of high school boys' ice hockey programs during the 2008/09 to 2016/17 school years.

Patients or Other Participants:

High school boys' ice hockey players (aged ∼14-18 years).

Independent Variables:

Concussion data on event type, injury mechanism, symptom resolution time, and time loss were obtained.

Main Outcome Measures:

Concussion rates with 95% confidence intervals (CIs) and distributions were calculated.

Results:

Overall, 348 concussions were reported in boys' ice hockey during the 2008/09 to 2016/17 academic years, leading to a concussion rate of 0.68/1000 AEs (95% CI, 0.61-0.75). Most occurred in competitions (85.6%), particularly after the first period (72.1% of all competition concussions). Among practice concussions, most occurred after the first hour of practice (60.0%). Most concussions were due to player contact (47.7%) and boards/glass contact (31.9%). Although 69.0% of concussed athletes had symptoms resolve in less than 7 days, only 14.1% returned to activity within a week.

Conclusions:

Most concussions occurred within the second and third periods. Preventive strategies that counter an increased risk of concussion due to a greater intensity of gameplay coupled with increased fatigue may be warranted. Moreover, athletes may further benefit from prevention efforts that focus on anticipating impacts during gameplay.
Language Outcomes Improved Through Early Hearing Detection and Earlier Cochlear Implantation
Authors: Yoshinaga-Itano Christine , Sedey Allison L. , Wiggin Mallene , Mason Craig A.
Published: November 2018

Hypothesis:

Early identification and intervention, earlier cochlear implantation, and mother's level of education will directly and/or indirectly impact the language outcomes of children with cochlear implants (CIs).

Background:

Identifying factors that contribute to the wide range of language outcomes in children who use CIs will assist healthcare and rehabilitation professionals in optimizing service delivery for this population. Universal newborn hearing screening provides an opportunity to examine the relationship between meeting the early hearing detection and intervention (EHDI) 1-3-6 guidelines and child language outcomes. These guidelines recommend screening by 1 month, confirmation of hearing loss by 3 months, and intervention by 6 months of age.

Methods:

Participants were 125 children with CIs ranging from 13 to 39 months of age. Language ability was measured using the Child Development Inventory and MacArthur-Bates Communicative Development Inventories.

Results:

Meeting EHDI 1-3-6, higher levels of maternal education and earlier cochlear implant activation had a direct, positive impact on language outcomes. Meeting the EHDI 1-3-6 guidelines also had an indirect positive effect on language outcomes via increasing the probability that the children's CIs would be activated earlier. Maternal education did not significantly predict age of cochlear implant activation nor whether a child met EHDI 1-3-6.

Conclusion:

Ensuring families meet the EHDI 1-3-6 guidelines is an early step that can lead to higher language outcomes and also earlier cochlear implantation.
Significance of 1 kHz Pure-tone Threshold in Acute Low-frequency Sensorineural Hearing Loss
Authors: Lee Chi Kyou , Lee Jong Bin , Park Kye Hoon , Lee Ho Yun , Choi Mi-Jin , Ban Wonwoo , Choi Seong Jun
Published: November 2018

Objectives:

To analyze risk factors for acute low-frequency hearing loss (ALFHL), and compare treatment outcomes in the presence or absence of such risk factors.

Study Design:

A case series featuring retrospective chart review.

Setting:

An academic university hospital.

Patients:

We included 170 ALFHL patients without vertigo. All of the patients received one of four treatments: low-dose steroid (LD-steroid), high-dose steroid (HD-steroid), LD-steroid and diuretics (LD-combination therapy), and ITDI (intratympanic dexamethasone injection) and diuretics (ITDI-combination therapy). To identify risk factors, we reviewed the clinical features of patients such as age, sex, chief complaint, accompanying symptoms, diabetes, hypertension, time from disease onset, the extent of hearing loss, treatment methods, and 1 kHz involvement.

Interventions:

ALFHL was diagnosed based on the average hearing loss >30 dB at 250 and 500 Hz.

Results:

The overall rates of hearing recovery were 70–80% in the four treatment groups. In terms of the prognosis of ALFHL patients, we found that a longer time from disease onset and 1 kHz involvement were independent risk factors for poor prognosis. In addition, we compared treatment outcomes of four treatment methods in the presence or absence of risk factors. In ALFHL patients with risk factors, we found statistically significant differences (p = 0.042) among treatment methods; effectiveness ranged in the order if ITDI-combination therapy, LD-combination therapy, HD-steroid, and LD-steroid.

Conclusions:

Risk factors for poor hearing recovery in ALFHL included longer symptom duration and 1 kHz involvement. In ALFHL with such risk factors, combination therapy was more effective than oral steroid therapy.
A Cohort Study of Hearing Outcomes Between Middle Fossa Craniotomy and Transmastoid Approach for Surgical Repair of Superior Semicircular Canal Dehiscence Syndrome
Authors: Zhang Lisa , Creighton Francis X. , Ward Bryan K. , Bowditch Stephen , Carey John P.
Published: November 2018

Objective:

To compare postoperative hearing outcomes between transmastoid and middle fossa craniotomy (MFC) approaches for surgical repair of superior semicircular canal dehiscence syndrome (SCDS) in a tertiary referral center.

Study Design:

Historical cohort study.

Setting:

Tertiary referral center.

Patients:

Twelve consecutive SCDS cases who underwent transmastoid plugging of the superior canal; “controls” were 18 audiogram-matched patients who underwent MFC plugging and resurfacing.

Main Outcome Measures:

Differences between preoperative, 7-day postoperative, and long-term (>6 wk) postoperative air and bone conduction, speech discrimination scores (SDS), and pure-tone averages (PTA) in TM cases versus MFC controls.

Methods:

MFC controls were selected by matching preoperative bone conduction (BC) pure-tone thresholds from the TM cases within 10-dBs NHL in ≥80% of recorded frequencies. Wilcoxon signed-rank tests were performed to compare primary outcomes between matches, with a Bonferroni corrected p value of 0.004 (n = 13 variables measured at each time period).

Results:

No statistically significant differences were found in long-term postoperative air conduction and BC thresholds at any frequency both during the immediate postoperative period as well as at long-term follow-up (p > 0.004). Similarly, there were no differences in long-term SDS or PTA (p > 0.004).

Conclusions:

In this pilot study, there were no long-term significant differences in hearing outcomes between the two repair techniques for SCDS. We recommend continuing with the established practice for recommending surgical repair based on individual patient characteristics and preferences in managing both vestibular and auditory function.
Neurocognitive Factors Contributing to Cochlear Implant Candidacy
Authors: Moberly Aaron C. , Castellanos Irina , Mattingly Jameson K.
Published: November 2018

Hypothesis:

Clinical adult cochlear implant (CI) candidacy evaluations rely heavily on measures of sentence recognition under the best-aided listening conditions. The hypothesis tested in this study was that nonauditory measures of neurocognitive processes would contribute to scores on preoperative sentence recognition for CI candidates, above and beyond hearing ability as assessed using pure-tone average (PTA). Support for this hypothesis would suggest that best-aided sentence recognition is not simply a measure of hearing ability; rather, neurocognitive functions contribute to performance and should be considered while counseling patients during CI candidacy evaluation about postoperative rehabilitative and outcome expectations.

Background:

Neurocognitive functions, such as working memory capacity, inhibition-concentration, information processing speed, and nonverbal reasoning contribute to aided speech recognition outcomes in adults with hearing loss. This study examined the roles of these neurocognitive factors on preoperative speech recognition performance in adults evaluated for CI candidacy.

Methods:

Thirty-one postlingually deafened adult CI candidates were enrolled. Participants were assessed using nonauditory measures of working memory capacity, inhibition-concentration, information processing speed, and nonverbal reasoning. Measures of sentence recognition in quiet and in multitalker babble (AzBio sentences) as well as sentences from the City University of New York in quiet were collected under best-aided conditions.

Results:

AzBio sentence recognition scores in babble were predicted significantly by scores of working memory capacity after accounting for PTA. Similarly, the City University of New York sentence recognition scores were predicted significantly by nonverbal reasoning after accounting for PTA.

Conclusions:

Findings support the idea that clinical measures of sentence recognition may be affected to varying degrees by neurocognitive functions, and these functions should be considered during evaluation for CI candidacy.
Neutropenia in glycogen storage disease Ib: outcomes for patients treated with granulocyte colony-stimulating factor
Authors: Dale David C. , Bolyard Audrey Anna , Marrero Tracy , Kelley Merideth L. , Makaryan Vahagn , Tran Emily , Leung Jamie , Boxer Laurence A. , Kishnani Priya S. , Austin Stephanie , Wanner Corbinian , Ferrecchia Iris A. , Khalaf Dina , Maze Dawn , Kurtzberg Joanne , Zeidler Cornelia , Welte Karl , Weinstein David A.
Published: November 2018

Purpose of review

Glycogen storage disease Ib (GSD Ib) is characterized by hepatomegaly, hypoglycemia, neutropenia, enterocolitis and recurrent bacterial infections. It is attributable to mutations inG6PT1, the gene for the glucose-6-phosphate transporter responsible for transport of glucose into the endoplasmic reticulum. Neutropenia in GSD Ib is now frequently treated with granulocyte colony-stimulating factor (G-CSF). We formed a cooperative group to review outcomes of the long-term treatment of GSD Ib patients treated with G-CSF.

Recent findings

The study enrolled 103 patients (48 men and 55 women), including 47 currently adult patients. All of these patients were treated with G-CSF, starting at a median age of 3.8 years (range 0.04–33.9 years) with a median dose of 3.0 mcg/kg/day (range 0.01–93.1 mcg/kg/day) for a median of 10.3 years (range 0.01–29.3 years). Neutrophils increased in response to G-CSF in all patients (median values before G-CSF 0.2 × 109/l, on G-CSF 1.20 x 109/l). Treatment increased spleen size (before G-CSF, 47%, on treatment on G-CSF 76%), and splenomegaly was the dose-limiting adverse effect of treatment (pain and early satiety). Clinical observations and records attest to reduce frequency of infectious events and the severity of inflammatory bowel symptoms, but fever and recurrent infections remain a significant problem. In the cohort of patients followed carefully through the Severe Chronic Neutropenia International Registry, four patients have developed myelodysplasia or acute myeloid leukemia and we are aware of four other cases, (altogether seven on G-CSF, one never treated with G-CSF). Liver transplantation in five patients did not correct neutropenia. Four patients had hematopoietic stem cell transplantation; two adults and two children were transplanted; one adult and one child survived.

GSD Ib is a complex disorder of glucose metabolism causing severe chronic neutropenia. G-CSF is effective to raise blood neutrophil counts and reduce fevers and infections in most patients. In conjunction with other therapies (salicylates, mesalamine sulfasalazine and prednisone), G-CSF ameliorates inflammatory bowel symptoms, but doses must be limited because it increases spleen size associated with abdominal pain.
Neurostimulation‐guided Anal Intrasphincteric Botulinum Toxin Injection in Children With Hirschsprung Disease
Authors: Louis‐Borrione Claude , Faure Alice , Garnier Sarah , Guys Jean‐Michel , Merrot Thierry , Héry Géraldine , Dariel Anne
Published: November 2018

Objectives:

In Hirschsprung disease (HD), despite successful surgical treatment, 50% of children experience long‐term functional gastrointestinal problems, particularly chronic functional obstructive symptoms. We report our experience regarding clinical effects of neurostimulation‐guided anal intrasphincteric botulinum toxin (BT) injections on postoperative obstructive symptoms attributed to a nonrelaxing anal sphincter complex in HD patients.

Methods:

In this monocenter cohort study, 15 HD patients with postoperative functional intestinal obstructive symptoms received neurostimulation‐guided anal intrasphincteric BT injections. Short‐, medium‐, and long‐term effects were evaluated. The Bristol stool form scale was used to assess stool consistency, and the Jorge‐Wexner (JW) score to assess fecal continence.

Results:

The median age at first injection was 4 years. In the short‐term, a significant improvement in stool consistency was noted in 12 of 14 patients (P = 0.0001) and JW score decreased for 14 of 15 patients (P = 0.001). In the medium‐term, JW score significantly decreased for all patients (P = 0.0001), with an improvement of 50% or more for 10 patients (66.7%). In the long term, 83.3% of patients had normal stool consistency and JW score was <3 for all. Recurrent enterocolitis decreased from 86.7% to 8.3%. A complete resolution of all symptoms without further medication was observed in 66.7% of patients in the long term.

Conclusions:

Intrasphincteric BT injection was a safe, effective, and durable option for the management of postoperative functional intestinal obstructive symptoms in HD. The use of neurostimulator guidance for specific delivery of BT to muscular fibers of nonrelaxing anal sphincter complex takes into consideration the variability of patient's anatomy secondary to curative surgery.
Association Between Obesity/Overweight and Functional Gastrointestinal Disorders in Children
Authors: Tambucci Renato , Quitadamo Paolo , Ambrosi Michela , De Angelis Paola , Angelino Giulia , Stagi Stefano , Verrotti Albero , Staiano Annamaria , Farello Giovanni
Published: November 2018

Objective:

Although emerging data indicate that obese/overweight children are more likely to develop functional gastrointestinal disorders (FGIDs) than normal‐weight peers, contrasting results have been reported. The present observational, case‐control study aimed at estimating the prevalence of FGIDs in obese/overweight children compared to normal‐weight peers.

Methods:

Consecutive obese and overweight children aged 4 to 18 years attending the obesity outpatient clinic were enrolled as study cases. Normal‐weight children were enrolled as comparison group. All the enrolled patients received a thorough health examination from both a pediatric endocrinologist and gastroenterologist. Moreover, they were asked to fill out the Rome III questionnaire for the diagnosis of FGIDs. Data were analyzed to compare the prevalence of FGIDs between cases and controls.

Results:

Throughout the study period we enrolled 103 cases and 115 controls. No significant age and sex differences were found between the 2 groups. FGIDs were significantly more prevalent in obese/overweight compared to normal‐weight children (47.57% vs 17.39%; P < 0.0001). Increased prevalence was observed for functional constipation (18.44% vs 7.82%; P = 0.025), functional dyspepsia (23.33% vs 6.95%; P = 0.001), and irritable bowel syndrome (10.67% vs 2.60%; P = 0.024), whereas no difference was observed for functional abdominal pain (1.94% vs 2.60%; P = 1.00).

Conclusions:

Our data suggest that there is a link between excess body fat and FGIDs in children. This finding may offer a model of patients in which the effects of food and nutritional substances, the gut microbial environment, and psychosocial factors are fitting well with the emerging biopsychosocial conceptual model for FGIDs.
Normal Complications and Abnormal Assumptions After Perinatal Death
Authors: Cacciatore Joanne , Thieleman Kara
Published: November 2018

There are several ways, clinically, to approach grief after perinatal death, including from a humanistic or a medicalized perspective. The death of a baby is complicated. The loss is an embodied one that incites deep psychological wounds and can be isolating for many parents. Parents process their grief experiences within a sometimes oppressive social context that either sees their expressions of loss as a normal response to an abnormal tragedy or as pathology. Several diagnostic categories have been proposed relative to the traumatic grief experiences of grieving parents that potentially affect them. We explore this nomenclature and, through the lens of a Social-Cognitive Processing Model, examine social support, attitudes, context, and oppressive interpersonal and social structures that affect parents. Clinical implications are discussed.
New Mothers' Experiences with Online Postpartum Forums
Authors: Teaford Dominique , McNiesh Susan , Goyal Deepika
Published: November 2018

Purpose:

To explore women's experiences with an online forum during the postpartum period.

Study Design and Methods:

All women involved in an online postpartum “birth club” on Babycenter.com during the first 6 months postpartum were invited to participate in the study. Participant characteristics and baseline mental well-being data were obtained along with their response to three open-ended questions about their experiences participating in an online mothers group. Descriptive statistics and qualitative content analysis were used to analyze data.

Results:

Women (N = 393) who responded to open-ended questions were 29.2 (SD = 5.3) years old, Caucasian (85%), married or in a committed relationship (81%), and lived in the United States (75%). Ninety percent (n = 354) completed the Edinburgh Postnatal Depression Screening Scale, of whom 18% (n = 65) scored ≥13, indicating risk of developing postpartum depression. Data analysis revealed five themes. The themes were integrated under the holistic concept of community and included 1) social support; 2) anonymity; 3) in-groups; 4) drama; and 5) entertainment/pastime.

Clinical Implications:

Findings suggest online forums can provide social support for new mothers. They can facilitate sharing of information, act as a source of entertainment, and provide a sense of community for participants who might otherwise feel isolated due to the demands of new motherhood. Nurses working with childbearing women should be aware of the positive and negative aspects of online forums so they can support new mothers who choose to participate.
Magnet® Nurses Improving Community Health
Authors: Graystone Rebecca
Published: November 2018

Keeping a community healthy requires more than hospital care. Magnet® nurses go beyond the bedside to promote a culture of health through volunteer work. To mark the season of giving, this month’s “Magnet Perspectives” column looks at the ways in which nurses from Magnet-recognized organizations care for their communities. What do they do? Why do they do it? How does the Magnet framework promote and support them? We explore the implications for larger issues, such as population health, and hear from the nurses themselves about why community involvement is important.
Technology Myth Busters for Nurse Leaders
Authors: Sensmeier Joyce , Ivory Catherine H.
Published: November 2018

Technology is frequently viewed as a barrier to workflow and efficiency rather than as a tool that can be used to improve the quality of our care, increase efficiency, or enhance patient outcomes. However, when technology is applied effectively, nurse leaders can leverage tools such as clinical decision support to avoid errors, inform decision making, and boost provider and patient satisfaction. These topics were discussed at the AONE annual meeting in a preconference session. In this article, AONE session leaders detail ways to ensure that information technology is a valuable tool—and not an obstacle—for effective nursing practice.
Cracks in the Foundation of the Care Environment Undermine Nurse Resilience
Authors: Virkstis Katherine , Herleth Anne , Langr Madeleine
Published: November 2018

To see a meaningful change in nurse burnout, leaders must address the factors in the care environment that undermine nurse resilience. In this article, the authors describe why leaders should focus on the care environment rather than individual resilience building.
Implementing a Peer Support Network to Promote Compassion Without Fatigue
Authors: Wahl Carol , Hultquist Teresa Barry , Struwe Leeza , Moore Judy
Published: November 2018

Objective

The aims of this study were to implement a Peer Support Network (PSN) pilot project including education/training, peer support, and resiliency training and to explore how interventions impact compassion satisfaction (CS) and compassion fatigue (CF) in a community hospital.

Background

CF has been reported to negatively affect nurse retention. The PSN provides a 3-tiered team approach to enhance CS and support nurses experiencing CF symptoms.

Methods

Twenty nurses participated in PSN training and completed preimplementation and 6-week postimplementation surveys: Professional Quality of Life, Compassion Practice Instrument, and self-care resource utilization.

Results

Statistically significant improvements in CS and nonstatistical improvements in CF were found.

Conclusion

Promoting a PSN may increase CS and potentially prevent work-related physical, emotional, social, and intellectual CF sequelae.