bluuebunny/crossref_metadata_2025 huggingface dataset:
VASCULAR PERFUSION DENSITY MAPPING USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY COMPARING NORMAL AND OPTIC DISK PIT EYES
Authors: Jiang Shangjun , Turco Bryen , Choudhry Netan
Published: November 2019

Purpose:

Optic disk pits (ODPs) are typically detected incidentally as small, gray, unilateral, oval-shaped excavation in the temporal optic disk on routine fundus examination. In this cross-sectional retrospective case series, we report optical coherence tomography angiography findings in patients with unilateral ODPs and describe changes in vessel perfusion associated with ODP.

Methods:

A total of eight eyes (four with ODP and four normal contralateral) were included in this study. Patients were excluded if any other optic disk abnormalities were present. Spectral-domain optical coherence tomography angiography (AngioVue; Optovue, Fremont, CA) imaging was conducted to map the vascularization of three layers in the optic nerve over a 4.5-mm × 4.5-mm region. The radial peripapillary capillaries, the nerve head capillaries, and the choriocapillaris were automatically segmented based on the OCT system software, and the capillary perfusion density (CPD) was quantified for each layer. Kruskal–Wallis one-way analysis of variance was used to compare CPD in normal and ODP eyes of four patients with monocular ODP.

Results:

Overall, CPD was lower in eyes with ODP compared with the contralateral normal eye in the radial peripapillary capillary (0.4521 ± 0.08 vs. 0.5505 ± 0.03, P = 0.08) and nerve head capillary layers (0.5461 ± 0.08 vs. 0.5989 ± 0.01, P = 0.08). Significantly lower CPD values were associated with ODP eyes in the radial peripapillary capillary layer within the disk (P = 0.04), inferior nasal (P = 0.04), and temporal (P = 0.02) regions and in the nerve head vessel layer within the disk region (P = 0.04). Significantly higher CPD values were associated with ODP eyes in the choriocapillaris layer within the nasal (P = 0.02), superior temporal (P = 0.02), and inferior temporal (P = 0.02) regions. Visual acuity was also decreased in ODP eyes at 0.4 ± 0.3 logarithm of the minimum angle of resolution units (20/50) compared with normal eyes at 0.1 ± 0.1 logarithm of the minimum angle of resolution units (20/25) (P = 0.12).

Conclusion:

This study demonstrated that the presence of an ODP is associated with decreased vascular density in some regions of the optic disk and reduced visual acuity.
CHOROIDAL LESIONS UNRESPONSIVE TO FLUOCINOLONE ACETONIDE INTRAVITREAL IMPLANT IN BIRDSHOT CHORIORETINOPATHY
Authors: Cheng Shuk Kei , Thompson Ian , Okeagu Chinwenwa , Nida Sen H.
Published: November 2019

Purpose:

To report the persistence of choroidal lesions despite fluocinolone acetonide intravitreal implants and their resolution with oral prednisone treatment.

Methods:

Retrospective chart review of a birdshot chorioretinopathy patient at a tertiary referral clinic.

Results:

Indocyanine angiography revealed resolution of choroidal lesions with oral prednisone and recurrence after discontinuation of oral prednisone.

Conclusion:

Choroidal lesions responded to oral prednisone despite bilateral active fluocinolone acetonide intravitreal implant in a birdshot chorioretinopathy patient.
INTERNAL DRAINAGE OF SUBRETINAL FLUID DURING CHANDELIER-ASSISTED SCLERAL BUCKLING
Authors: Ankamah Emmanuel , Siemerink Martin J. , Polkinghorne Philip J. , Nolan John M. , Ng Eugene
Published: November 2019

Purpose:

To describe the surgical technique of internal drainage of subretinal fluid as an adjunct to chandelier-assisted scleral buckling for the repair of rhegmatogenous retinal detachment.

Methods:

The technique of internal drainage with a sharp needle or cannula through a trocar is described and shown in a Supplemental Digital Content 1 (see Video, http://links.lww.com/ICB/A87).

Results:

Three patients (3 eyes) underwent scleral buckling for rhegmatogenous retinal detachment repair. Subretinal fluid was drained using the internal drainage approach in all cases. All three patients had successful reattachment of retina with improvement in visual function. No complications were reported related to vitreous loss, retinal incarceration, or redetachment following primary surgery.

Conclusion:

Internal drainage of subretinal fluid during chandelier-assisted scleral buckling is a useful technique that can be considered for repairing rhegmatogenous retinal detachment.
COMPLICATIONS OF SERIAL ANTERIOR CHAMBER PARACENTESIS FOR INCREASED INTRAOCULAR PRESSURE AFTER INTRAVITREAL INJECTIONS
Authors: Shah Amar P. , Sisk Robert A. , Foster Robert E.
Published: November 2019

Purpose:

To report complications after serial anterior chamber (AC) paracentesis for sustained elevation of intraocular pressure after intravitreal injection.

Methods:

A retrospective interventional case series of five patients who had received AC paracentesis after intravitreal injection.

Results:

Five patients presented with either decreased vision or increased pain after intravitreal injection with planned AC paracentesis. Of the five patients, three patients presented with profound hypotony due to persistent wound leak from the AC paracentesis site. Of these three, one resolved with pressure patch and cycloplegia. The other two patients required further intervention with either polyethylene glycol hydrogel or nylon suture for wound closure. The fourth patient presented with IOL optic prolapse into the AC that resolved with dilation. The fifth patient presented with vitreous prolapse through the AC paracentesis wound and was treated with YAG vitreolysis.

Conclusion:

A single AC paracentesis has been shown to demonstrate a favorable safety profile. Serial AC paracenteses may degrade the integrity of the peripheral cornea in patients with sustained elevation of intraocular pressure after repeated intravitreal injections.
Baseline Age and Mean Deviation Affect the Rate of Glaucomatous Vision Loss
Authors: Bommakanti Nikhil , De Moraes Carlos G. , Boland Michael V. , Myers Jonathan S. , Wellik Sarah R. , Elze Tobias , Pasquale Louis R. , Shen Lucy Q. , Ritch Robert , Liebmann Jeffrey M.
Published: November 2019

Purpose:

The purpose of this study was to assess the relationship between the rate of the glaucomatous visual field (VF) worsening and baseline age and baseline VF mean deviation (MD).

Design:

This study was a retrospective, multisite cohort.

Participants:

A total of 84,711 reliable Swedish Interactive Thresholding Algorithm 24-2 VF tests from 8167 eyes from 5644 patients with ≥6 VF tests, ≥5 years of follow-up, baseline age 18 years or above and baseline MD ≥−10 dB, and at least 2 abnormal VF tests were included from the Glaucoma Research Network Database.

Methods:

The global mean deviation rates (MDRs) and pointwise total deviation rates (TDRs) of VF progression (dB/y) were calculated for each eye using linear regression. The relationships between MDR and baseline age and MD were determined using linear mixed-effects models and logistic regression, with rapid progression defined as an MDR≤−1.0 dB/y. The relationships between TDR and baseline age and baseline MD were determined using linear mixed-effects models.

Main Outcome Measures:

Coefficients of the regression models.

Results:

In individual mixed-effects models both baseline age (β=−0.0079 dB/y2; P<0.001) and baseline MD (β=0.012/y; P<0.001) were associated with faster progression. All parameters were statistically significant in the full model with both parameters and their interaction (β=0.00065; P=0.0017) as covariates. With logistic regression, each year increase in baseline age increased the odds of belonging to the rapid-progressing group by a factor of 1.033, and each unit increase in baseline MD (less severe visual loss) decreased the odds by a factor of 0.8821. The mean pointwise TDR ranged from −0.21 to −0.55 dB/y, with the most rapid pointwise progression observed in the nasal and paracentral regions of the field.

Conclusions:

Older age and worse MD at baseline are associated with more rapid VF progression in this large dataset. The effect of age on MDR is influenced by baseline MD severity, supporting the importance of early detection and more aggressive therapy in older patients with worse VF damage. The pointwise rate of VF loss varies across the VF, providing a means for physicians to more effectively monitor progression.
Pacemaker Infections Caused by Rapidly Growing Mycobacteria
Authors: Jarrin Tejada Claudia D. , Brown Melanie K. , Vaughan Leroy B. , Wenzel Richard P.
Published: November 2019

There has been a steady rise in the use of cardiac pacemakers in the last 25 years and an associated increase in the number of device-related infections. Although Staphylococcus aureus and coagulase-negative staphylococci are the most common causes of these infections, rapidly growing mycobacteria have occasionally been implicated. We report 3 cases managed at our institution and review 21 cases found in the literature. Most patients underwent device removal and were managed with more than 1 antibiotic for at least 4 weeks. All but 2 patients achieved cure. It is important to recognize these organisms as potential etiologies of pacemaker infections and to request special culture media and stains. Furthermore, it is reasonable for antibiotic choice to be guided by susceptibility reports, and at least initially, more than 1 antibiotic is recommended.
Impact of Peptide Nucleic Acid Fluorescence in Situ Hybridization Testing for Coagulase-Negative Staphylococci in a Pediatric Setting
Authors: Drwiega Emily N. , Nichols Kristen R. , Kaschak Mallory , Walter Ashley , Winn Vera , Relich Ryan F. , Knoderer Chad A.
Published: November 2019

Background

Coagulase-negative staphylococci (CoNS) are common blood culture contaminants, whereas Staphylococcus aureus is a pathogen with isolation from blood requiring therapy. Peptide nucleic acid fluorescence in situ hybridization (PNA-FISH) permits distinction of CoNS and S. aureus and has been demonstrated to decrease hospital costs, vancomycin use, and length of stay when paired with antimicrobial stewardship intervention. The impact of this testing in a children's hospital in the absence of stewardship intervention is unknown. The objective of this study was to determine the impact of PNA-FISH in a setting without an antimicrobial stewardship protocol for response to rapid testing.

Methods

This retrospective cohort study included pediatric patients with at least 1 CoNS-positive blood culture between January 1, 2012, and August 1, 2016. Patients were categorized based on the use of Staphylococcus QuickFISH, a rapid PNA-FISH method of identification. The primary outcome was hours of vancomycin exposure. Secondary outcomes included time-to-therapy change, time to culture result, and hospital length of stay.

Results

Of the 211 identified patients who had at least 1 blood culture bottle positive for CONS, 179 (85%) received vancomycin. Median hours of vancomycin exposure decreased between groups (63 rapid diagnostic testing group vs 81 conventional testing group; P = 0.019).

Conclusions

Despite an observed decrease in vancomycin exposure with use of rapid PNA-FISH testing, the full benefits of rapid diagnostic testing are unrealized in the absence of an appropriate stewardship protocol. Further studies may allow determination of the full impact of rapid diagnostic testing in pediatric settings.
Highlights of Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria
Authors: Politis Paula A. , File Thomas M.
Published: November 2019

Asymptomatic bacteriuria is a common cause of unnecessary antimicrobial use. The Infectious Diseases Society of America has published an update of the clinical practice guideline for the management of asymptomatic bacteriuria. The guideline provides recommendations for avoidance of antimicrobial use for the great majority of patients with asymptomatic bacteriuria. Included in the recommendations is to refrain from screening with urinalysis and/or urine culture for older patients with cognitive impairment or fall and rather to look for alternative causes of altered mental status (eg, dehydration, metabolic causes, medication effects).
Rapid identification and clinical indices of fear-avoidance in youth with chronic pain
Authors: Heathcote Lauren C. , Bhandari Rashmi P. , Timmers Inge , Harrison Lauren E. , Simons Laura E.
Published: November 2019

Pain-related fear and avoidance are increasingly demonstrated to play an important role in adult and childhood chronic pain. The Fear of Pain Questionnaire for Children (FOPQC) is a 24-item measure of pain-related fear-avoidance in youth that has demonstrated good indices of reliability and validity, treatment responsiveness, and associations with brain circuitry alterations. This study describes the development and psychometric examination of the FOPQC-SF, a short form of the original measure. We selected 10 items for the short form that best represented the content and 2-factor (fear and avoidance) structure of the original measure from a cohort of 613 youth (Mage = 14.7 years) with chronic pain. Next, confirmatory factor analyses from a second sample of 526 youth (Mage = 14.7 years) with chronic pain who completed the FOPQC-SF supported the original 2-factor model but indicated that one item should be moved to the avoidance subscale. The FOPQC-SF demonstrates strong internal consistency and moderate-to-strong construct and criterion validity. The 3-month test–retest reliability estimates (N = 94) were strong, and there was preliminary evidence of responsivity to change. To aid integration into intervention trials and clinical practice, we provide clinical reference points and a criterion to assess reliable change. The short form could be used for rapid identification of pain-related fear and avoidance in youth during clinic evaluations, and is optimized for clinical registries.
Perceptions of Psychiatrists Toward the Use of Long-Acting Injectable Antipsychotics
Authors: Grover Sandeep , Sahoo Swapnajeet , Mehra Aseem
Published: November 2019

Purpose/Background

Despite proven benefits of long-acting injectables (LAIs), these are frequently underused by the psychiatrists. Accordingly, this study aimed to explore the perceptions of psychiatrists toward the use of LAI antipsychotics in their routine clinical practice.

Methods/Procedure

An online e-mail survey was conducted by using Survey Monkey platform.

Results

A total of 622 psychiatrists with a mean age of 41 years who were in psychiatric practice for approximately 14 years participated in the survey. Participants reported using LAI, mainly for patients with schizophrenia, with LAI prescribed to approximately one-tenth (9.30%) of their patients in acute phase of illness and in one-fifth (18.42%) of patients in stabilization/stable phase. Fluphenazine decanoate (32.7%) was the most commonly used LAI followed by flupenthixol decanoate (19.5%), haloperidol decanoate (17.8%), and olanzapine pamoate (11.1%). The most common reasons for starting LAI were history of medication (100%) and treatment (80.5%) nonadherence, followed by having frequent relapses/exacerbations of symptoms (54.8%). Overall, more than half of the participants felt the level of acceptance of LAI among patients offered to be quite reasonable (54.3%), and mostly, LAIs were used as combination therapy with oral antipsychotics (73.6%). Despite all these, approximately three-fifths (59%) of the participants reported that they underuse LAI to a certain extent, with most common reasons that deter them from using LAI being the cost (55.45%), lack of interest of patients in receiving LAI (42.9%), lack of regular availability (41.3%), and patients being scared of receiving injectables (41.2%).

Conclusions/Implications

The LAI antipsychotics despite having several benefits are still underused by a substantial proportion of practicing psychiatrists.
A Phase 3, 1-Year, Open-Label Trial of Valbenazine in Adults With Tardive Dyskinesia
Authors: Marder Stephen R. , Singer Carlos , Lindenmayer Jean-Pierre , Tanner Caroline M. , Comella Cynthia L. , Verghese Cherian , Jimenez Roland , Liang Grace S. , Burke Joshua , O'Brien Christopher F.
Published: November 2019

Purpose/Background

Valbenazine is approved to treat tardive dyskinesia (TD) in adults. KINECT 4 (NCT02405091) was conducted to explore the long-term effects of once-daily valbenazine in patients with TD.

Methods/Procedures

The study included a 48-week, open-label treatment period and 4-week washout. Dosing was initiated at 40 mg/d, with escalation to 80 mg/d at week 4 based on efficacy and tolerability. Standard safety methods were applied, including treatment-emergent adverse event (TEAE) reporting. Valbenazine effects on TD were assessed using the Abnormal Involuntary Movement Scale (AIMS), Clinical Global Impression of Change-TD, and Patient Global Impression of Change.

Findings/Results

After week 4, <15% of all participants had a serious TEAE (13.7%) or TEAE leading to discontinuation (11.8%). Participants experienced TD improvements during long-term treatment as indicated by mean change from baseline to week 48 in AIMS total score (sum of items 1–7, evaluated by site raters) with valbenazine 40 mg/d (−10.2 [n = 45]) or 80 mg/d (−11.0 [n = 107]). At week 48, most participants had ≥50% improvement from baseline in AIMS total score (40 mg/d, 90.0%; 80 mg/d, 89.2%), Clinical Global Impression of Change-TD rating of much or very much improved (40 mg/d, 90.0%; 80 mg/d, 95.9%), and Patient Global Impression of Change rating of much or very much improved (40 mg/d, 90.0%; 80 mg/d, 89.2%). No dose effects were apparent by week 36. Week 52 results indicated some loss of effect after washout.

Implications/Conclusions

Valbenazine was generally well tolerated, and no new safety concerns were detected. Substantial clinician- and patient-reported improvements were observed in adults with TD who received once-daily valbenazine for up to 48 weeks.
A Longitudinal Study of Serum Brain-Derived Neurotrophic Factor Levels in First-Episode Schizophrenia
Authors: Yee Jie Yin , Lee Tih-Shih , Lee Jimmy
Published: November 2019

Background

Biomarkers identified for psychosis might allow for early diagnosis, more accurate prognosis, and tailored individualized interventions. Brain-derived neurotrophic factor (BDNF) is suggested to be a likely candidate biomarker for the diagnosis and treatment evaluation in psychosis. The aims of present study were to examine the levels of serum BDNF in both patients with first-episode psychosis (FEP) and in healthy controls for a year, and to investigate the association between BDNF with symptom severity and remission status.

Methods

A sample of 31 healthy controls and 29 patients with FEP were included in this study. Diagnoses were ascertained on the Structured Clinical Interview for DSM-IV-TR. Symptom severity was assessed on the Positive and Negative Syndrome Scale. Serum levels of BDNF were measured using enzyme-linked immunosorbent assay method at recruitment and at 3-, 6-, and 12-month time points.

Results

Serum BDNF levels in both groups did not differ significantly over time. Baseline BDNF levels in patients with FEP did not correlate with symptom severity and neither baseline BDNF level nor its relative change at 3-month predicted remission status at 6- and 12-month follow-up visits. Of note, we observe similar fluctuations in serum BDNF levels in both patients and healthy controls over the 12-month period.

Conclusions

Findings from our study did not support a role for serum BDNF as a biomarker for patients with FEP. Because of the polygenic nature of psychosis, we recommend a comprehensive multimarker profile consisting of markers from representative components of mediated neuronal nutrition, neuroimmunology, and neurologic functional deficit to allow for better predictive power.
Effects of Pharmacogenetic Screening for CYP2D6 Among Elderly Starting Therapy With Nortriptyline or Venlafaxine
Authors: van der Schans Jurjen , Hak Eelko , Postma Maarten , Breuning Laura , Brouwers Jacobus R.B.J. , Ditters Kaspar , Jansen Paul A.F. , Kok Rob M. , Maring Jan G. , van Marum Rob , Mulder Hans , Nanninga Jaap , Oude Voshaar Richard C. , Risselada Arne J. , Vleugel Liesbeth , Stek Max , van Schaik Ron H.N. , Berm Elizabeth J.J. , Wilffert Bob
Published: November 2019

Purpose/Background

The duration of untreated depression is a predictor for poor future prognosis, making rapid dose finding essential. Genetic variation of the CYP2D6 isoenzyme can influence the optimal dosage needed for individual patients. The aim of this study was to determine the effectiveness of CYP2D6 pharmacogenetic screening to accelerate drug dosing in older patients with depression initiating nortriptyline or venlafaxine.

Methods/Procedures

In this randomized controlled trial, patients were randomly allocated to one of the study arms. In the intervention arm (DG-I), the specific genotype accompanied by a standardized dosing recommendation based on the patients' genotype and the prescribed drug was directly communicated to the physician of the participant. In both the deviating genotype control arm (DG-C) and the nonrandomized control arm, the physician of the participants was not informed about the genotype and the associated dosing advise. The primary outcome was the time needed to reach adequate drug levels: (1) blood levels within the therapeutic range and (2) no dose adjustments within the previous 3 weeks.

Findings/Results

No significant difference was observed in mean time to reach adequate dose or time to adequate dose between DG-I and DG-C. Compared with the nonrandomized control arm group, adequate drug levels were reached significantly faster in the DG-I group (log-rank test; P = 0.004), and there was a similar nonsignificant trend for the DG-C group (log-rank test; P = 0.087).

Implications/Conclusions

The results of this study do not support pharmacogenetic CYP2D6 screening to accelerate dose adjustment for nortriptyline and venlafaxine in older patients with depression.
Efficacy and Safety of Paliperidone Palmitate Treatment in Patients With Schizophrenia
Authors: Devrimci-Ozguven Halise , Atmaca Murad , Baran Zeynep , Cengisiz Cengiz , Çinar Cem , Erol Atila , Genç Yasin , Karadağ Hasan , Karakülah Kamuran , Karasu Umut , Kaya Mehmet Cemal , Kizil Emre , Özcan Halil , Tiryaki Ahmet , Üçok Alp , Varlik Cenk , Yazar Sila Menekşe , Yildiz Mesut
Published: November 2019

Purpose

The aim of the study was to assess efficacy and safety of paliperidone palmitate (PP) in schizophrenic patients using real-life data.

Methods

This national, multicenter, retrospective, and mirror-image study was performed reviewing the medical records of patients in 18 centers. Adult schizophrenic patients receiving PP treatment (n = 205) were enrolled. Patients' data covering the last 12 months before the initial PP injection and the period until the end of study with at least 12 months after the initial PP injection were evaluated. Patients' characteristics, scale scores, and adverse events were recorded.

Results

Nonadherence to prior medication was the most frequent reason for switching to PP treatment. Comparing with the period before PP treatment, the rate of patients visiting the hospital for relapse (79.5% vs 28.9%, P < 0.001) and the median number of hospitalizations (2 vs 0, P < 0.001) were lower during PP treatment. During PP treatment, the Positive and Negative Syndrome Scale score decreased by 20% or more (response to treatment) in 75.7% of the patients. The frequency of adverse events did not differ between the period before and during PP treatment. Improvement in functionality was higher in those with disease duration of 5 years or less.

Conclusions

Paliperidone palmitate is effective and safe in treatment of schizophrenic patients and in switching to PP treatment in patients with schizophrenia, which reduced the percentage of patients admitted to the hospital for relapse and the median number hospitalization, and has positive effects on functionality.
Pharmacokinetic-Pharmacodynamic Characterization of Relapse Risk for Paliperidone Palmitate 1-Month and 3-Month Formulations
Authors: Russu Alberto , Savitz Adam , Mathews Maju , Gopal Srihari , Feng Yu , Samtani Mahesh N.
Published: November 2019

Background

Pharmacokinetic-pharmacodynamic (PK/PD) models were developed to describe the relationship between the time course of paliperidone plasma concentrations and the risk of relapse of schizophrenia symptoms following administration of paliperidone palmitate 1-month (PP1M) and 3-month (PP3M) long-acting injectables, and to identify relevant covariates for relapse and dropout events.

Methods

Patient data from two global phase 3, relapse prevention studies comparing PP3M to placebo (study A) and PP3M to PP1M (study B) were analyzed. Dropout and relapse data were assessed using survival analysis as two separate single time-to-event models. Baseline covariates included age, sex, race/country, duration of illness, previous hospitalizations, prior use of long-acting injectables and use of multiple (≥2) antipsychotics at screening.

Results

The PK/PD analysis data set included 305 patients who were randomized to receive PP3M or placebo in the double-blind phase of study A and 1002 patients randomized to receive PP3M or PP1M in the double-blind phase of study B. Risk of relapse decreased with increasing paliperidone concentrations for both PP1M and PP3M, while it appeared to increase in patients with higher number of previous hospitalizations and/or with higher prerandomization (trough) paliperidone concentration (study A), and in patients on concomitant benzodiazepine medication and/or at Japan centers (study B). These findings are reflective of different illness severity in the population and of differences in medical practice for Japanese patients. In model-based simulations, PP3M and PP1M displayed similar relapse rates over time.

Conclusions

This PK/PD analysis confirmed that PP1M and PP3M provide comparable efficacy in terms of relapse prevention, and that PP3M is superior to placebo. The PK/PD models presented here may as well be applied to studies with similar designs as either study A or B.
Relationship of Direct-to-Consumer Advertising to Efficiency of Care, Quality of Care, and Health Outcomes
Authors: Filipova Anna A.
Published: November 2019

Background:

Direct-to-consumer advertising (DTCA) is effective in promoting pharmaceutical products to consumers and may pose a challenge to providers in the delivery of care. This study examined advanced practice nurse prescriber (APNP) general views of DTCA and tested the effects of DTCA discussion between the patient and APNP in an office visit on efficiency of care, quality of care, and health outcomes.

Methods:

A cross-sectional design was used to survey 1,163 APNPs in a single US Midwestern state. The final sample consisted of 316 participants (27.17%). Pearson's chi-squared and multinomial logistic regression analyses tested DTCA effects.

Results:

Direct-to-consumer advertising disadvantages were increased costs of drugs (80%) and misled patients (75%). Direct-to-consumer advertising benefits included a balanced presentation of risks and benefits (60%) and patients getting treatments (51%). Direct-to-consumer advertising discussion was viewed as worsening time efficiency of visit (53%). Worsened efficiency was associated with worsened nurse–patient relationship. Direct-to-consumer advertising discussion had no effect on quality of care (86%) and health outcomes (89%). Worsened quality was related to inappropriate clinical requests and challenged prescriptive authority among other factors. The nurse doing what the patient wanted was related to worsened health outcomes.

Conclusion:

The findings suggest training initiatives to maximize DTCA benefits in health care delivery.
Physician Practices in Against Medical Advice Discharges
Authors: Tummalapalli Sri Lekha , Chang Brian A. , Goodlev Eric R.
Published: November 2019

Background:

Patients discharged against medical advice (AMA) have disproportionately high health care costs and increased morbidity, mortality, and hospital readmissions. Although patient risk factors for discharge AMA are known, there are little data regarding physician discharge practices surrounding AMA discharges.

Methods:

We performed a cross-sectional analysis of patients discharged AMA from a large, urban, academic medical center. Our study predictors included patient demographics and admission characteristics: primary service team, time of discharge, documentation of anticipated AMA discharge, and length of stay. The primary outcomes were physician discharge practices including a scheduled follow-up appointment, documentation of informed consent, documentation of a risk/benefit discussion, and notification of the attending physician. Our coprimary outcome was the incidence of 30-day hospital readmission.

Results:

Among AMA discharges, 33% had follow-up appointments scheduled upon discharge. There was documentation of a risk/benefit discussion (69%), informed consent (63%), and notification of the attending physician (72%) in most discharges. Physician discharge practices were not associated with 30-day hospital readmission.

Conclusions:

Adherence to discharge best practices in AMA discharges was inconsistent and suboptimal, particularly for scheduling follow-up appointments, but was not associated with hospital readmission. Our results highlight the difficulty in facilitating safe transitions of care for patients discharged AMA.
Distributions and Reference Ranges for Automated Pupillometer Values in Neurocritical Care Patients
Authors: Lussier Bethany L. , Stutzman Sonja E. , Atem Folefac , Venkatachalam Aardhra M. , Perera Anjali C. , Barnes Arianna , Aiyagari Venkatesh , Olson DaiWai M.
Published: November 2019

BACKGROUND

Automated pupillometry is becoming widely accepted as an objective measure of pupillary function, especially in neurocritical care units. Normative reference values and thresholds to denote a significant change are necessary for integrating automated pupillometry into practice.

OBJECTIVE

Providing point estimates of normal ranges for pupillometry data will help clinicians intuit meaning from these data that will drive clinical interventions.

METHODS

This study used a planned descriptive analysis using data from a multicenter registry including automated pupillometry assessments in 2140 subjects from 3 US hospitals collected during a 3-year period.

RESULTS

We provide a comprehensive list of admission pupillometry data. Our data demonstrate significant differences in pupillary values for Neurological Pupil Index, latency, and constriction velocity when stratified by age, sex, or severity of illness defined by the Glasgow Coma Scale score.

CONCLUSION

This study provides a greater understanding of expected distributions for automated pupillometry values in a wide range of neurocritical care populations.
Impacts of Fatigue, Stress, and Perceived Health Status on Women With Rheumatic Diseases: A Comparison Study
Authors: HUNG Hsuan-Man , CHEN Ming-Fu , CHEN Chung-Hey
Published: November 2019

Background

Rheumatic conditions, which increase in prevalence as populations age, are a growing public health problem that disproportionately affects women. Understanding the influences of rheumatic diseases (RDs) on fatigue, stress, and perceived health status is deemed important to the improvement of physical and mental health for women with RDs.

Purpose

This study was designed to compare the fatigue, stress, and perceived physical and mental health status of women with RDs (RD group) with those of peers who did not have chronic illnesses (comparison group).

Methods

A cross-sectional, purposive sample and comparative design was used. Four hundred forty-three women with a mean age of 46.2 years participated in this study. Those with physician-diagnosed RDs (n = 212) were enrolled in the RD group, and those without chronic disease were enrolled in the comparison group (n = 231). Measures used included a demographic datasheet, Fatigue Severity Scale, Perceived Stress Scale, and Short Form-12 Items Health Survey. Analysis of covariance was used to examine the intergroup differences for major variables based on demographic covariates.

Results

The RD group reported significantly more fatigue and stress than the comparison group. Moreover, the RD group reported significantly poorer perceived physical health status, significantly poorer physical functioning and general health, and greater bodily pain compared with the comparison group. Conversely, the RD group reported significantly better perceived mental health status, significantly lower vitality, and better role emotional status than the comparison group.

Conclusions/Implications for Practice

The findings support the theory that RDs have a negative impact on perceived stress and fatigue in women. Physical function, bodily pain, and general health may be the most significantly affected domains of perceived physical health in women with RDs. Of note, with the exception of the vitality subscale, RDs did not adversely affect the perceived mental health of participants with RD in this study. Healthcare professionals should cooperate with clinical rheumatologists, psychologists, and physiotherapists to provide comprehensive care that includes long-term education to help patients with RD self-manage stress, restore vitality, relieve pain, and increase physical function.
Validation of the Supportive Care Needs Survey Screening Tool Chinese Version for Patients With Head and Neck Cancer in Taiwan
Authors: HU Chan-Chuan , YOU Kai-Lin , TSAI Li-Yun , FANG Yuan-Yuan , JHANG Sin-Yuan , LOU Pei-Jen , WANG Cheng-Ping , KO Jenq-Yuh , LEE Yun-Hsiang , LAI Yeur-Hur
Published: November 2019

Background

The increasing number of cancer survivors and the trend of shifting cancer treatments into outpatient clinics have increased rapidly the supportive care needs of patients with cancer. However, no brief assessment tool is available to screen for these needs.

Purpose

In this study, we aimed to (a) translate and develop a nine-item Chinese version of the Supportive Care Needs Survey Screening Tool (SCNS-ST9-C) and (b) examine the psychometric properties of this tool in a sample of patients with head and neck cancer (HNC) in Taiwan.

Methods

In this two-phase instrument validation study, the SCNS-ST9-C was translated and evaluated for content, face validity, and feasibility in Phase I and was examined for internal consistency reliability and construct validity (including factor structure and theoretically supported correlations) on a sample of patients with HNC in Phase II.

Results

In Phase I, the SCNS-ST9-C was translated and developed by three bilingual doctoral-prepared nurse researchers (Chinese and English). A standardized score system ranging from 0 to 100 was built, with higher scores indicating higher unmet supportive care needs. Good content and face validity were confirmed by five cancer care experts and 20 patients with HNC, respectively. In Phase II, 116 subjects were recruited. A clear four-factor structure, which incorporated one of the original five dimensions (sexuality care needs, with one item) into the dimension of psychological and emotional care needs, was identified using exploratory factor analysis. Good internal consistency reliability for the overall SCNS-ST9-C was supported by a Cronbach's α of .75 and its four subscales (domains). Good construct validity was also confirmed by the theoretically supported correlations. Better performance status and longer time since treatment completion correlated negatively with the SCNS-ST9-C (i.e., lower unmet care needs), whereas higher distress (anxiety, depression, and symptoms) correlated positively with the SCNS-ST9-C (i.e., greater unmet care needs). Female patients reported higher overall unmet care needs and psychological and emotional care needs and higher scores on the care and support needs subscale than male patients.

Conclusions

The SCNS-ST9-C is a brief, low-burden, and psychometrically valid instrument that may be applied in ethnically Chinese settings. This tool takes 1–2 minutes to complete. Further testing of the psychometrics of this instrument in different cancer populations is recommended.
Oral Dysfunction in Patients With Head and Neck Cancer: A Systematic Review
Authors: CHEN Shu-Ching
Published: November 2019

Background:

Head and neck cancers (HNCs) and their treatment may cause oral function impairment.

Purpose:

This study was designed to identify oral dysfunction in patients receiving treatment for HNCs using a systematic review.

Methods:

The PubMed, Embase, and CINAHL databases were searched for studies on oral function impairment in patients receiving treatment for HNCs published between January 2014 and May 2019. Only descriptive, correlational, and interventional quantitative studies that included patients receiving treatment for HNCs who presented with oral dysfunction, were published in English during the aforementioned time frame, and were accessible in full-text versions were selected.

Results:

Twenty-eight studies (13 cross-sectional, two longitudinal, 12 randomized controlled trial, and one retrospective chart review) fulfilled the inclusion criteria. Oral mucositis, dysphagia, xerostomia, trismus, and chewing and speech problems were the most common oral dysfunctions. Age, cancer stage, tumor location, treatment modalities, treatment status, treatment dose, and pretreatment oral function were factors associated with oral dysfunction. Although individual interventions were shown to improve oral dysfunction, the related evidence was inconclusive.

Conclusions/Implications for Practice:

Primary HNCs and their treatment significantly deteriorate oral function. A holistic and interdisciplinary approach may maximize oral function.
An Updated Overview of the Anatomy and Function of the Proximal Medial Patellar Restraints (Medial Patellofemoral Ligament and the Medial Quadriceps Tendon Femoral Ligament)
Authors: Chahla Jorge , Smigielski Robert , LaPrade Robert F. , Fulkerson John P.
Published: November 2019

The medial patellofemoral ligament (MPFL) has been widely accepted to function as “the primary static restraint to lateral patellar displacement.” However, current growing evidence suggests that there is a complex of medial patellofemoral/tibial ligaments, both proximal [MPFL, and medial quadriceps tendon femoral ligament (MQTFL)], and distal (medial patellotibial ligament and the medial patellomeniscal ligament) which restrain lateral patellar translation at different degrees of knee flexion. Specifically, the MQTFL has gained popularity over the last decade because of pure soft tissue attachments into the extensor mechanism that allow for avoidance of drilling tunnels into the patella during reconstruction. The purpose of this article was to report on the current knowledge (anatomy, biomechanics, diagnosis, indications for surgery, and techniques) on the proximal medial patellar restraints, namely the MPFL and the MQTFL, collectively referred to as the proximal medial patellar restraints.
When and How I Add Trochleoplasty in the Treatment of Recurrent Patella Instability
Authors: Fulkerson John P.
Published: November 2019

Long experience and recent evidence suggest that trochleoplasty is needed in very few patella stabilization surgeries. As trochleoplasty adds risk, this author recommends it only in patients with high degrees of dysplasia, prominent supratrochlear spurs, ligamentous laxity, and more dramatic J signs.
Concepts of the Distal Medial Patellar Restraints: Medial Patellotibial Ligament and Medial Patellomeniscal Ligament
Authors: Hinckel Betina B. , Lipinski Lukasz , Arendt Elizabeth A.
Published: November 2019

The important medial patellar ligamentous restraints to lateral dislocation are the proximal group (the medial quadriceps tendon femoral ligament and the medial patellofemoral ligament) and the distal group [medial patellotibial ligament (MPTL) and medial patellomeniscal ligament (MPML)]. The MPTL patellar insertion is at inferomedial border of patella and tibial insertion is in the anteromedial tibia. The MPML originates in the inferomedial patella, right proximal to the MPTL, inserting in the medial meniscus. On the basis of anatomy and biomechanical studies, the MPTL and MPML are more important in 2 moments during knee range of motion: terminal extension, when it directly counteracts quadriceps contraction. In a systematic review on MPTL reconstructions 19 articles were included detailing the clinical outcomes of 403 knees. All were case series. Overall, good and excellent outcomes were achieved in >75% of cohorts in most studies and redislocations were <10%, with or without the association of the medial patellofemoral ligament. The MPTL is a relevant additional tool to proximal restraint reconstruction in select patient profiles; however, more definitive clinical studies are necessary to better define surgical indications.
Why and Where to Move the Tibial Tubercle: Indications and Techniques for Tibial Tubercle Osteotomy
Authors: Middleton Kellie K. , Gruber Simone , Shubin Stein Beth E.
Published: November 2019

Patellofemoral disorders including pain and instability are common orthopedic problems, particularly in the adolescent population. Patellofemoral pain is usually anterior, poorly localized, and diffuse. Because of its multifactorial etiology, patellofemoral pain can be clinically challenging to diagnose and manage. With regards to instability, predisposing factors include trochlear dysplasia, patella alta, patellar tilt, and an elevated tibial tuberosity and trochlea groove distance. Initially, nonoperative management is recommended to treat patellofemoral maladies such as overload, maltracking, and acute first-time dislocations. However, tibial tubercle transfer (TTT) is commonly used to address cases of symptomatic malalignment and overload and recurrent patellar instability. The tubercle can be translated in multiplanar directions to correct patellar height, maltracking associated with instability, and to offload chondral defects. A thorough understanding of the anatomy and biomechanics of the patellofemoral joint is essential for optimizing results after TTT. Individualizing the direction and degree of tubercle transfer on the basis of patient parameters is critical to producing successful long-term results after surgery. This article will review the indications for performing a TTT and highlight the various techniques.
Completion of an Individualized Learning Plan for Otology-Related Milestone Subcompetencies Leads to Improved Otology Section Otolaryngology Training Exam Scores
Authors: Pennock Michael , Svrakic Maja , Bent John P.
Published: November 2019

Objective:

To examine the relationships among self-assessment of knowledge in otology via an individualized learning plan (ILP), otology milestone achievement rate, and otolaryngology training exam (OTE) otology scores.

Study Design:

Prospective study.

Setting:

One otolaryngology residency covering a tertiary care facility, trauma and hospital center, outpatient ambulatory surgery center, and outpatient clinics.

Participants:

Twenty otolaryngology residents, four from each class.

Methods:

Residents identified four milestones from otology-related sub-competencies to achieve in a 3-month rotation via an ILP. During the same rotation, the residents sat for the OTE, and their overall and otology scores were analyzed.

Main Outcome Measures:

Completion of an ILP before and at the end of the rotation, self-reported achievement of otology milestones, and OTE score components including total percent correct, scaled score, group stanine, national stanine, and residency group weighted scores.

Results:

Group stanine OTE otology scores were higher for those residents who completed pre- and post-rotation ILPs compared with those who did not, 4.0 (±0.348) versus 2.75 (±0.453), respectively (p = 0.04). Residents who self-reported achieving all four otology milestones had significantly higher otology group stanine scores than the residents who achieved less, 4.1 (±0.348) versus 2.9 ± 0.433, respectively (p = 0.045). Residents who performed well in their PGY program cohort on the otology OTE 1 year were less inclined to complete an ILP for otology in the subsequent year (Pearson correlation –0.528, p = 0.035).

Conclusion:

In the otology subspecialty, residents who completed ILPs scored better on OTE examinations independent of resident class. Consequently, programs may find ILPs useful in other otolaryngology subspecialties and across residencies.
Reducing Postoperative Call Volume Through Verbal Preoperative Education
Authors: Chern Alexander , Haynes David S. , Bennett Marc L.
Published: November 2019

Objective:

To improve patient satisfaction and understanding of what to expect after chronic ear surgery and reduce call volume to an otology clinic at an academic tertiary referral center.

Study Design:

Quality improvement initiative.

Setting:

A single-academic tertiary referral center.

Patients:

One hundred and ten patients who underwent chronic ear surgery in March to May 2018.

Intervention:

Preoperative counseling over the phone 1 week before surgery.

Main Outcome Measures:

Patient call volume to the clinic within a 2-week postoperative window, patient understanding, and satisfaction of perioperative course.

Results:

There was a significant increase in patient satisfaction (10.1% increase, 9.8 intervention vs. 8.9 no intervention, p = 0.0032) and in patient understanding of what to expect after surgery (6.7% increase, 9.5 intervention vs. 8.9 no intervention, p = 0.0275). There was a significant decrease in mean number of calls per patient to the clinic (57.6% decrease, 0.31 intervention vs. 0.72 no intervention, p = 0.0105) and in percentage of patients who made any number of calls to the clinic (20% intervention vs. 46%, no intervention, p = 0.00438).

Conclusions:

Verbal preoperative counseling over the phone was effective in significantly reducing unnecessary call volume to the clinic and in improving patient satisfaction and overall understanding of what to expect after surgery.
A Patient-Centered Hepatitis B Virus (HBV) Educational Intervention Improves HBV Care Among Underserved Safety-Net Populations
Authors: Wong Robert J. , Khalili Mandana
Published: November 2019

Goals:

To evaluate the impact of a prospective patient-centered hepatitis B virus (HBV) educational intervention on improving HBV care.

Background:

Improving patients’ HBV knowledge has the potential to improve adherence to HBV monitoring and management, particularly among underserved safety-net populations.

Methods:

Consecutive chronic HBV adults at a single-center safety-net liver clinic were recruited from July 2017 to July 2018 to evaluate the impact of an in-person, language concordant formal HBV educational intervention on improvements in HBV knowledge and HBV management: appropriate HBV clinic follow-up (≥1 visit/year), HBV laboratory monitoring (≥1 HBV viral load and alanine aminotransferase test/year), hepatocellular carcinoma surveillance (≥1 liver imaging test/year among eligible patients), and HBV treatment among treatment eligible patients. HBV knowledge and management were assessed before and after the intervention and compared with age-matched and sex-matched HBV controls who did not receive an education.

Results:

Among 102 patients with chronic HBV (54.9% men; mean age, 52.0±13.8), HBV education improved HBV knowledge scores by 25% (P<0.001), HBV clinic follow-up from 25.5% to 81.4% (P<0.001), HBV laboratory monitoring from 62.8% to 77.5% (P=0.02), and appropriate HBV treatment from 71.5% to 98.5% (P<0.001). Compared with 102 HBV controls, receiving HBV education was associated with higher rates of HBV clinic follow-up (81.4% vs. 39.2%; odds ratio, 7.02; 95% confidence interval, 3.64-13.56; P<0.001) and appropriate HBV laboratory monitoring (77.5% vs. 42.2%; odds ratio, 4.94, 95% confidence interval, 2.64-9.24; P<0.001).

Conclusion:

A formal, in-person, language concordant educational intervention leads to significant improvements in HBV knowledge, resulting in improved HBV monitoring and appropriate HBV treatment.