bluuebunny/crossref_metadata_2025 huggingface dataset:
Using Quick Response Codes in the Classroom
Authors: Zurmehly Joyce , Adams Kellie
Published: May 2017

With smart device technology emerging, educators are challenged with redesigning teaching strategies using technology to allow students to participate dynamically and provide immediate answers. To facilitate integration of technology and to actively engage students, quick response codes were included in a medical surgical lecture. Quick response codes are two-dimensional square patterns that enable the coding or storage of more than 7000 characters that can be accessed via a quick response code scanning application. The aim of this quasi-experimental study was to explore quick response code use in a lecture and measure students’ satisfaction (met expectations, increased interest, helped understand, and provided practice and prompt feedback) and engagement (liked most, liked least, wanted changed, and kept involved), assessed using an investigator-developed instrument. Although there was no statistically significant correlation of quick response use to examination scores, satisfaction scores were high, and there was a small yet positive association between how students perceived their learning with quick response codes and overall examination scores. Furthermore, on open-ended survey questions, students responded that they were satisfied with the use of quick response codes, appreciated the immediate feedback, and planned to use them in the clinical setting. Quick response codes offer a way to integrate technology into the classroom to provide students with instant positive feedback.
Significance of Frequencies, Compositions, and/or Antileukemic Activity of (DC-stimulated) Invariant NKT, NK and CIK Cells on the Outcome of Patients With AML, ALL and CLL
Authors: Boeck Corinna L. , Amberger Daniel C. , Doraneh-Gard Fatemeh , Sutanto Wishnu , Guenther Thomas , Schmohl Joerg , Schuster Friedhelm , Salih Helmut , Babor Florian , Borkhardt Arndt , Schmetzer Helga
Published: May 2017

Invariant natural killer T (iNKT)/natural killer (NK)/cytokine-induced killer (CIK) cells are important for immune surveillance. (I) Novel combinations of antibody 6B11 (targeting the Vα24-Jα18-invariant T-cell receptor) with CD4/CD8/CD1d/Vα24 for iNKT subset detection and “T/NK cell-like”-iNKT subsets were defined. Compared with healthy peripheral blood mononuclear cells (MNC) (significantly) lower proportions of iNKT cells (6B11+/6B11+CD3+/6B11+CD161+), NK cells (CD3−CD56+/CD3−CD161+), and CIK cells (CD3+CD56+/CD3+CD161+) were found in peripheral blood MNC from acute myeloid (AML)/acute myeloid, lymphoid (ALL)/chronic lymphoid leukemia (CLL) patients in acute disease stages. Subtyping of iNKT cells revealed (significantly) higher proportions of CD3+ T cells and CD161+ NK cells in AML/ALL/CLL expressing 6B11 compared with healthy MNC. Prognostic evaluations showed higher proportions of iNKT/NK/CIK cells in favorable AML subgroups (younger age, primary, no extramedullary disease, achievement/maintenance of complete remission) or adult ALL and CLL patients. (II) iNKT/NK/CIK cell frequencies increased after (vs. before) mixed lymphocyte cultures of T-cell–enriched immune reactive cells stimulated with MNC/whole blood with or without pretreatment with “cocktails” (dendritic cells generating methods/kits inducing blasts’ conversion to leukemia-derived dendritic cells from AML patients). Individual “cocktails” leading to “highest” iNKT cell frequencies could be defined. Antileukemic blast lytic activity correlated significantly with frequencies of iNKT/NK/CIK cells. In summary healthy MNC show significantly more iNKT/NK/CIK cells compared with AML/ALL/CLL MNC, a shift in the iNKT cell composition is seen in healthy versus leukemic samples and iNKT/NK/CIK cell-proportions in AML/ALL/CLL MNC samples correlate with prognosis. “Cocktail”-treated AML blasts lead to higher iNKT/NK/CIK cell frequencies and samples with antileukemic activity show significantly higher frequencies of iNKT/NK/CIK cells. Proportions of iNKT/NK/CIK cells should regularly be evaluated in AML/ALL/CLL diagnosis panels for quantitative/prognostic estimation of individual patients’ antileukemic potential and their role in dendritic cells/leukemia-derived dendritic cells triggered immune surveillance.
Introduction to the Anatomy and Physiology of Pulmonary Circulation
Authors: Sharara Rihab Saeed , Hattab Yousef , Patel Kaushal , DiSilvio Briana , Singh Anil C. , Malik Khalid
Published: May 2017

In the United States, venous thromboembolism is associated with high mortality and morbidity affecting as many as 900 000 people (1-2 per 1000) each year. Estimates suggest that 60 000 to 100 000 Americans die of deep venous thrombosis/pulmonary embolism and 10% to 30% die within 1 month of diagnosis, with sudden death being the first symptom in approximately 25% of population with pulmonary embolism. One-half of the patients with deep venous thrombosis will have postthrombotic syndrome, which includes swelling, pain, discoloration, and scaling in the affected limb. Approximately 33% of patients will have a recurrence within 10 years. It is important to understand the anatomy of the pulmonary circulation and the pathophysiology of the disease as it leads to understanding of the potential devastating clinical consequences.
Pathogenesis and Epidemiology of Venous Thromboembolic Disease
Authors: Patel Kaushal , Fasanya Adebayo , Yadam Suman , Joshi Aditya A. , Singh Anil C. , DuMont Tiffany
Published: May 2017

Venous thromboembolism is the formation of a blood clot in the vein. It mainly consists of 2 life-threatening conditions—deep venous thrombosis and pulmonary embolism. Deep venous thrombosis is a potentially dangerous condition with grave sequelae, the worst of which is pulmonary embolism. Venous thromboembolism can also lead to multiple other conditions with significant morbidity and mortality that include extension of thrombi, pulmonary hypertension, recurrence, and postthrombotic syndrome. An update on the epidemiology, etiology, and pathogenesis of venous thromboembolism will be reviewed in this article.
Clinical Presentation and Risk Factors of Venous Thromboembolic Disease
Authors: Alhassan Sulaiman , Pelinescu Anca , Gandhi Viral , Naddour Mouhib , Singh Anil C. , Bihler Eric
Published: May 2017

Venous thromboembolism (VTE) has a wide range of clinical presentations. Deep venous thrombosis may occur in upper or lower extremities or in visceral veins. Extremity deep venous thrombosis usually manifests with unilateral painful swelling in the limb, while visceral deep venous thrombosis manifestations vary on the basis of the involved organ. Pulmonary embolism classically manifests with sudden pleuritic chest pain and unexplained dyspnea. Superficial thrombophlebitis usually presents with acute inflammation around a palpable thrombosed superficial vein. Risk factors of VTE are either inherited or acquired. The inherited causes of VTE tend to be familial and more common in younger patients. The common acquired risk factors of VTE include previous history of venous thrombosis, immobilization, recent surgery or trauma, malignancy, and pregnancy. Identifying high-risk patients for VTE based on these risk factors is the cornerstone to provide the prophylactic treatment to prevent thrombotic events.
Consequences of Venous Thromboembolism, Including Chronic Thromboembolic Pulmonary Hypertension
Authors: Gandhi Viral , Hewston Matthew , Yadam Suman , Ma Kiet , Singh Anil C. , Cheema Tariq
Published: May 2017

Venous thromboembolism includes both deep vein thrombosis and pulmonary embolism. They pose a significant risk for morbidity and mortality. In an appropriate clinical setting, invasive interventions, including administration of thrombolytics, anticoagulation, and placement of vena cava filter, are warranted. Bleeding, postthrombotic syndrome, recurrence, and filter-associated complications are few of the complications of this disease. More recently, chronic thromboembolic pulmonary hypertension has gained clinical interest in patients with pulmonary embolism and has warranted close follow-up.
Deep Venous Thrombosis of the Upper and Lower Extremity
Authors: Hattab Yousef , Küng Sarah , Fasanya Adebayo , Ma Kiet , Singh Anil C. , DuMont Tiffany
Published: May 2017

Upper and lower extremity deep venous thrombosis (DVT) is defined as a blood clot within the deep veins of the affected extremities. These blood clots can either occur spontaneously or be associated with specific risk factors. Regardless of the cause, DVT is associated with significant morbidity and mortality and has the potential for lethal complications. The most notable complication is the potential for development of pulmonary embolism from a lower extremity DVT. As studies have reported, more than 90% of acute pulmonary emboli arise from the proximal veins. Venous thromboembolism is also associated with a significant economic burden on the health care system and the individual patient. In this article, we review DVT of the upper and lower extremity including risk factors, signs and symptoms, diagnosis, and management.
Controversies in Venous Thromboembolism
Authors: Yadam Suman , Popuri Anand , Hattab Yousef , Cheema Tariq
Published: May 2017

Numerous controversies exist in the diagnosis of venous thromboembolism despite all the guidelines that are currently available. Screening of malignancy in venous thromboembolism has been a debated issue, as it has not been shown to change mortality. Calf vein thrombosis is also a controversial topic, but evidence points to risk stratifying those patients. Overdiagnosis, most notably from the finding of subsegmental pulmonary embolism, ultimately requires evaluating the risk and benefit for each patient. In addition, treatment of upper extremity deep vein thrombosis is a challenging scenario that is quite common in clinical practice. Finally, postthrombotic syndrome may be reduced by graduated compression stockings, but their use has not been validated for preventive use at this time and is still being discussed.
Treatment of Actinic Keratoses: A Randomized Split-Site Approach Comparison of Sequential 5-Fluorouracil and 5-Aminolevulinic Acid Photodynamic Therapy to 5-Aminolevulinic Acid Photodynamic Monotherapy
Authors: Pei Susan , Kaminska Edidiong C.N. , Tsoukas Maria M.
Published: May 2017

BACKGROUND

Actinic keratoses (AKs) are skin lesions resulting from sun exposure and carry a risk of developing into squamous cell carcinoma. Current therapies for AK eradication include topical 5-fluorouracil (5-FU) and photodynamic therapy (PDT) with topical 5-aminolevulinic acid (ALA). However, sequential therapy with 5-FU-ALA-PDT may offer improved outcome compared to ALA-PDT alone.

OBJECTIVE

The purpose of this study is to compare the long-term efficacy of AK clearance by sequential therapy with 5-FU-ALA-PDT versus ALA-PDT alone.

MATERIALS AND METHODS

This is a single center, randomized split-site approach study on equivalent anatomical and clinical sites. Seventeen patients were enrolled with one half of the site randomized to receive sequential 5-FU-ALA-PDT and the other side with ALA-PDT monotherapy. Total AKs were counted at baseline, 6 and 12 months.

RESULTS

Median percentage reduction in AK number at 6 months for 5-FU-ALA-PDT versus ALA-PDT was 100% for 5-FU-ALA-PDT (N = 21) and 66.7% for ALA-PDT (N = 21), p = .001. Median percentage reduction in AK number at 12 months for 5-FU-ALA-PDT versus ALA-PDT was 100% for 5-FU-ALA-PDT (N = 22) and 82.6% for ALA-PDT (N = 22), p = .0002.

CONCLUSION

Sequential therapy with 5-FU-ALA-PDT is more effective at AK clearance at 6 and 12 months compared to ALA-PDT monotherapy.
A Two-Phase Pilot Study to Evaluate the Safety and Tolerability of an In Situ Polymerizing Collagen
Authors: Inglefield Christopher , Rone-McCrate Rebecca , Brooks Robert , Zhu Jiaxun , Grant Sheila , DeVore Dale P.
Published: May 2017

BACKGROUND

Demand for collagen-based fillers has declined primarily because of limited long-term clinical benefit and the introduction of hyaluronic acid compositions. In situ polymerizing collagen is a noncrosslinked solution of porcine collagen containing a collagenase shield that undergoes fibrillogenesis on injected into tissues forming a natural matrix.

OBJECTIVE

Conduct a prospective, single-center, dual-phase open-label study in 8 subjects to evaluate the safety, tolerability, and efficacy of the porcine collagen composition.

METHODS

In Phase I, potential hypersensitivity of the collagen composition was evaluated after skin testing in the back (men) or forearms of subjects (women). In Phase II, subjects showing no signs of hypersensitivity received collagen injections into the nasolabial area followed by evaluation at 1, 4, 8, and 12 weeks using the Global Aesthetic Improvement Scale.

RESULTS

None of the subjects had signs of hypersensitivity and all continued in Phase II. The treating physician(s) reported no post-treatment adverse events. Improvement of the nasolabial fold was observed by the physicians and confirmed by assessment of high-resolution photographs and Global Aesthetic Improvement Scale scores over the 12-week treatment were maintained.

CONCLUSION

In this pilot clinical study in situ polymerizing collagen was shown to be safe and effective throughout the 3-month study period.
Impact of Smoke Evacuation on Patient Experience During Mohs Surgery
Authors: Yonan Yousif , Ochoa Shari
Published: May 2017

BACKGROUND

There have been several investigations into possible health risks of surgical smoke exposure, and it has previously been associated with harboring pathogens and carcinogens. Patients in the authors' practice have expressed that the odor from the smoke created by electrosurgical equipment is unpleasant.

OBJECTIVE

The authors sought to determine if smoke evacuation decreases patient perception of smoke created by electrosurgery during Mohs surgery and if it subsequently improves patient satisfaction with their surgical experience by minimizing the associated odor.

MATERIALS AND METHODS

Thirty patients were enrolled in this comparative trial. Smoke evacuation was used during closure but not during Mohs stages. Patients were queried regarding their experience and preferences during and at the end of the procedure.

RESULTS

100% of patients reported the perception of a burning odor during removal of Mohs stages, compared with 40% reporting the perception of a burning odor during closure. During the Mohs stages, 66.6% of patients reported the odor as unpleasant compared with 16.6% of patients during closure. There were no statistically significant differences in patient perceptions when stratified by age, sex, or surgical site.

CONCLUSION

The authors believe that using a wall suction smoke evacuation system is simple and can result in a more pleasant experience for patients undergoing Mohs surgery.
Calcium Hydroxylapatite Dermal Filler for Treatment of Dorsal Hand Volume Loss: Results From a 12-Month, Multicenter, Randomized, Blinded Trial
Authors: Goldman Mitchel P. , Moradi Amir , Gold Michael H. , Friedmann Daniel P. , Alizadeh Kaveh , Adelglass Jeffrey M. , Katz Bruce E.
Published: May 2017

BACKGROUND

Calcium hydroxylapatite (CaHA) microspheres suspended in a carrier gel is an opaque dermal filler that has been used to provide immediate volume correction in the dorsal hands.

OBJECTIVE

To assess the safety and effectiveness of CaHA for the correction of volume loss in the hands up to 12 months.

MATERIALS AND METHODS

This multicenter, controlled, single-blind study (NCT01832090) included 114 subjects randomized 3:1 to CaHA treatment and untreated control groups. Effectiveness was assessed by blinded investigators using the validated Merz Hand Grading Scale (MHGS). Subject-reported improvement was assessed using the Global Aesthetic Improvement Scale. Effects of treatment on hand function were also assessed.

RESULTS

A total of 75% of subjects achieved ≥1-point improvement on the MHGS (p < .0001) at 3 months (primary end point); this response was generally maintained through 12 months. Proportions of subjects reporting improvement ranged from 98% (3 months) to 86% (12 months). There were no clinically significant differences between control and CaHA-treated subjects in any hand function measure. Adverse events were generally expected, minor, short-lived, injection-related, and similar to those observed in previous CaHA clinical studies.

CONCLUSION

Treatment with CaHA results in significant improvement in the appearance of the dorsal hand and is well tolerated.
The Prevalence of Posttraumatic Stress Disorder in Primary Care: A Systematic Review
Authors: Spottswood Margaret , Davydow Dimitry S. , Huang Hsiang
Published: May 2017

Learning objectives

After participating in this activity, learners should be better able to:

• Determine the prevalence of clinician-diagnosed posttraumatic stress disorder (PTSD) in primary care patients

• Identify the prevalence of questionnaire-ascertained PTSD symptoms in primary care patients

Objective

Determine the prevalence of clinician-diagnosed PTSD and questionnaire-ascertained PTSD symptoms in primary care patients.

Methods

A systematic review of the literature using the PRISMA method, searching MEDLINE, CINAHL, Cochrane Database, PsycINFO, EMBASE, Google Scholar, and relevant book chapter bibliographies. Studies that reported on the prevalence, including point or lifetime prevalence, of PTSD ascertained using diagnostic interviews or self-report questionnaires, or from administrative data, among patients seen in primary care were deemed eligible for inclusion. We abstracted data on the PTSD assessment tool, the mean questionnaire scores/cutoff scores, the time period of PTSD symptoms, and PTSD prevalence reported.

Results

Of 10,614 titles screened, 41 studies were eligible for inclusion. The included studies assessed PTSD in a total of 7,256,826 primary care patients. The median point prevalence of PTSD across studies was 12.5%. The median point prevalence in the civilian population was 11.1%; in the special-risk population, 12.5%; and in veterans, 24.5%. The point prevalence of diagnostic interview–ascertained PTSD ranged from 2% to 32.5%, and the point prevalence of questionnaire-based substantial PTSD symptoms ranged from 2.9% to 39.1%. Lifetime prevalence of diagnostic interview–ascertained PTSD ranged from 14.5% to 48.8%. The prevalence of PTSD in administrative data–based studies ranged from 3.5% to 29.2%.

Conclusions

PTSD is common in primary care settings. Additional research on effective and generalizable interventions for PTSD in primary care is needed.
Suture of Symptomatic YAG Laser Peripheral Iridotomies Following Phakic Intraocular Lens Implantation
Authors: Tognetto Daniele , De Giacinto Chiara , Cirigliano Gabriella
Published: May 2017

A 45-year-old woman complained of glare and photophobia after iris-fixated phakic intraocular lens (IFPIOL) implantation in her left eye. The patient underwent prophylactic laser peripheral iridotomies (LPIs) 2 days before surgery. The uncorrected visual acuity after surgery was 20/20 and the intraocular pressure was 14 mm Hg. The slit-lamp examination showed a well-centered IFPIOL and 2 LPIs at 10 and 2 o’clock partially covered by the upper lid. Twenty days after IFPIOL implantation, as symptoms persisted and were intolerable to the patient, we decide to suture iridotomies using a modified Siepser slip-knot technique. Postoperatively, visual acuity remains 20/20 and patient reported a complete disappearance of symptoms. No intraoperative and postoperative complications were noted. Experiencing glare and photophobia is a rare side effect due to LPI. Suture of iridotomies using a modified Siepser slip-knot technique can be considered a safe and effective procedure to solve this annoying complication.
HeartMate 3 in Lowest INTERMACS Profile Cohort: The Swiss Experience
Authors: Tozzi Piergiorgio , Banfi Carlo , Ahmadov Kameran , Hullin Roger , Meyer Philippe , Giraud Raphael , Liaudet Lucas , Gronchi Fabrizio , Huber Christophe , Kirsch Matthias
Published: May 2017

New generation devices for long-term mechanical circulatory support are centrifugal pumps having fully magnetically levitated rotors to reduce blood trauma. Recently, the novel HeartMate 3 was cleared for clinical application in Switzerland. In two Swiss University Hospitals part of the “Lausanne–Geneva Transplantation Network,” 10 consecutive patients in end-stage heart failure received the HeartMate 3 (Thoratec Corporation, Pleasanton, CA). Device implantation criteria were persistent low output syndrome despite optimal medical treatment. The primary end-point of the study was survival or transplantation to 90 days on the device. Five patients (50%) were in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) class 1 and 2 (two were under venoarterial extracorporeal membrane oxygenation [VA-ECMO]), and five were in class 3 and 4. The indication was bridge-to-transplant in seven patients, and destination therapy in three. Two patients (20%) received concomitant aortic valve surgery. Four patients (40%) required temporary right ventricle support (tRVAD) for a mean of 8 ± 1.5 days. Bleeding requiring surgical revision occurred in five (50%) patients, two during the tRVAD support. At the 90 day end-point, survival was 90%, one (10%) died due to respiratory failure. Three (30%) experienced critical illness polyneuropathy. Two had body temperature over 38.5°C for more than 7 days after implant, without infections. Two (20%) had late driveline infection. The pump allowed rapid improvement of patients’ clinical conditions even in severely compromised patients. Postoperative bleeding occurred in the setting of anticoagulation. No hemolysis or pump thrombosis occurred. Fever occurred frequently but was not associated with mortality. Hemodynamic support was consistent over time without significant adverse events.
Quantification of Postmembrane Gaseous Microembolization During Venoarterial Extracorporeal Membrane Oxygenation
Authors: Jiao York , Gipson Keith E. , Bonde Pramod , Mangi Abeel , Hagberg Robert , Rosinski David J. , Gross Jeffrey B. , Schonberger Robert B.
Published: May 2017

Prolonged use of venoarterial extracorporeal membrane oxygenation (VA ECMO) may be complicated by end-organ dysfunction. Although gaseous microemboli (GME) are thought to damage end organs during cardiopulmonary bypass, patient exposures to GME have not been well characterized during VA ECMO. We therefore performed an observational study of GME in adult VA ECMO patients, with correlation to clinical events during routine patient care. After institutional review board (IRB) approval, we used two Doppler probes to detect GME noninvasively in extracorporeal membrane oxygenation (ECMO) circuits on four patients for 15 hours total while also recording patient care events. We then conducted in vitro trials to compare Doppler signals with gold-standard measurements using an Emboli Detection and Classification EDAC quantifier (Luna Innnovations, Inc. Roanoke, VA) (Terumo Cardiovascular, Ann Arbor, MI) during simulated clinical interventions. Correlations between Doppler and EDAC data were used to estimate GME counts and volumes represented by clinical Doppler data. A total of 503 groups of Doppler peaks representing GME showers were observed, including 194 statistically larger showers during patient care activities containing 92% of total Doppler peaks. Intravenous injections accounted for an estimated 68% of GME and 88% of GME volume, whereas care involving movement accounted for an estimated 6% of GME and 3% of volume. Overall estimated embolic rates of 24,000 GME totaling 4 μl/hr rivals reported GME rates during cardiopulmonary bypass. Numerous GME are present in the postmembrane circuit during VA ECMO, raising concern for effects on microcirculation and organ dysfunction. Strategies to detect and minimize GME may be warranted to limit embolic exposures experienced by VA ECMO patients.
How Secure Is the Diagnosis of Ulcerative Colitis in Children, Even After Colectomy?
Authors: Jones Ian , Ramani Pramila , Spray Christine , Cusick Eleri
Published: May 2017

Objectives:

We reviewed all children who have undergone a colectomy for ulcerative colitis (UC) in our tertiary referral centre in a 12‐year period to assess the rate of reclassification as Crohn disease (CD). In contrast to CD, a colectomy is considered to be definitive treatment for patients with UC. Distinguishing between the 2 can be challenging when disease is manifest only within the colon—even histological examination of a colectomy specimen may be inconclusive. Historically, the recognised “rediagnosis” rate (post‐colectomy) was reported at approximately 3% to 7%. A recent study suggested that a higher rate of 13% should be expected in children. This has implications in terms of pre‐operative counselling and surgical decision making.

Methods:

A retrospective case‐note review of all patients who underwent a colectomy for UC between 2003 and 2014 in a single paediatric tertiary referral centre was performed.

Results:

Of the 570 children diagnosed with inflammatory bowel disease in this period, 190 were diagnosed as UC. Of these 190 cases, 29 underwent a colectomy. None of these was re‐classified following histological examination of the colectomy sample. Seven out of the 29 patients (24%) were subsequently diagnosed with CD (median follow‐up 7.6 years). This is significantly higher than previously reported rates (P = 0.003).

Conclusions:

Our data suggest that later manifestation of CD is more common than previously thought (24%). Therefore, a diagnosis of UC in children should be regarded as provisional and a potential later diagnosis of CD taken into account when considering colectomy and J‐pouch formation.
Risk of Eating Disorders in Patients With Celiac Disease
Authors: Babio Nancy , Alcázar Mireia , Castillejo Gemma , Recasens Miriam , Martínez‐Cerezo Francesc , Gutiérrez‐Pensado Vanessa , Vaqué Cristina , Vila‐Martí Anna , Torres‐Moreno Miriam , Sánchez Enric , Barrubés Laura , Salas‐Salvadó Jordi
Published: May 2017

Objectives:

Several cases of eating disorders (EDs) have been reported in patients with celiac disease (CD), suggesting that ED could be a comorbidity associated with CD. Few epidemiological studies have, however, assessed this potential association. We aimed to evaluate the risk of EDs in individuals diagnosed with CD in comparison to healthy controls.

Methods:

A total of 98 cases and 98 controls matched for sex, age, and body mass index between 10 and 23 years old were studied. A questionnaire was completed on medical history and sociodemographic as well as anthropometric characteristics. Various ED screening self‐reported tests were administered.

Results:

A total of 61.2% of the study population were girls with a mean age of 15.3 ± 3.7 years old. Patients with CD scored nonsignificantly higher on all the ED screening tests than control participants. No differences were observed between study groups in terms of the frequency of individuals who exceeded the clinical cutoff identifying those at risk of ED. Patients with CD above 13 years old were associated with a 2.15‐point increase in the Eating Attitude Test score compared with controls [β‐coefficient = 2.15 SE 1.04; P = 0.04] after adjusting for various confounders.

Conclusions:

Although being a patient with CD was associated with a significantly higher Eating Attitude Test score in individuals older than 13 years old, no clear differences were observed between individuals with CD and controls in terms of risk of ED when other screening tests were used. More studies with larger samples and prospective designs are warranted to confirm these findings.
Utilization of the Health Care System of Community Case Management Patients
Authors: Armold Sarah
Published: May 2017

Purpose of Study:

The Centers for Medicare & Medicaid Services (2015) has reduced payments to hospitals that have excessive readmissions. This mandate has made it imperative for hospitals to implement a plan to manage readmissions and transitions of care for patients they serve. The purpose of this study was to ascertain whether an advanced practice, nurse-led, community-based model is effective in reducing acute health care utilization.

Primary Practice Setting:

The community case management (CCM) program was created more than 20 years ago to assess and manage care of patients demanding frequent emergency department (ED) visits and frequent hospitalizations, by providing in-home visits and care coordination by an advanced practice nurse or masters-prepared nurse.

Methodology and Sample:

The charts of 307 patients who were referred to CCM were reviewed to assess their utilization of the health care system after referral. There were 2 groups of patients: those who accepted CCM services (N = 151) and those who refused CCM services (N = 156) upon referral.

Results:

It was found that if patients accepted CCM services, they had 55% fewer visits to the ED and 61% fewer hospital admissions than patients who refused CCM services. Utilization of urgent care was decreased by 47% in the patients who accepted CCM services, but this decline was not statistically significant.

Implication for Case Management Practice:

The results of this study indicate that CCM is effective in decreasing hospital admissions and ED visits for the patients using CCM services. Implementing a CCM program could be an effective method for decreasing utilization of the hospital and ED by adult patients with at least 1 chronic disease.
Partnerships in Transitions: Acute Care to Skilled Nursing Facility
Authors: Dizon Mae L. , Zaltsmann Ruth , Reinking Cheryl
Published: May 2017

Purpose/Objectives:

Older adults, in particular those discharged to skilled nursing facilities (SNFs), are at high risk for readmission. As part of a multifaceted approach to reduce readmissions, a community hospital initiated a 3-prong approach (Collaboration, Communication, and Competency) and partnered with regional SNFs.

Primary Practice Settings:

El Camino Hospital, an independent, locally owned, not-for-profit district, acute care hospital in Northern California, and 11 participating SNFs in the same region.

Findings/Conclusions:

Collaboration: The combined leadership team developed a case report form and instituted regular reviews of 7-day readmissions. Communication: Standardized form for transferring patients to SNFs, form for transfer from SNF to emergency department, and consent form to enable SNFs to administer antipsychotic medications were developed. Regular phone and video conferencing between clinicians at the hospital and receiving SNF were instituted. Competency: Educational series to recognize and intervene to prevent readmission, and mutual exchange of best practices among hospital and SNF staff, were instituted. Continued work among ECH and the participating SNFs has improved the flow of information in both directions; favorable results from the broader study to reduce readmissions hospital-wide provide support for these efforts.

Implications for Case Management Practice:

Initiating collaboration with the SNFs is imperative in the changing health care landscape. Because of the complexity of the problem, acute care facilities and SNFs need to create a partnership to ensure smooth patient transition. Communication between care settings is essential in achieving optimum patient outcomes.
Supporting the Support System
Authors: Harkey Jane , Young Jared , Carter Jolynne “Jo” , Demoratz Michael
Published: May 2017

Purpose/Objective:

The benefits of having a support system, such as social relationships with close friends and family, have been well documented for patients with serious health issues. As scientific evidence has shown, individuals who have the lowest level of involvement in social relationships face a greater mortality risk. Support systems, however, are not infallible. Relationship stress can have a negative impact on people—patient and caregiver alike—behaviorally, psychosocially, and physiologically. The purpose of this article is to encourage case managers who take a patient-centered approach to also consider the existence and extent of the support system, as well as any stresses or tensions that are observable within the support system. Although the case manager is ethically obliged to advocate for the individual receiving case management services, that advocacy can be extended to the support system for the good of all.

Primary Practice Settings:

This discussion applies to numerous case management practices and work settings including (but not limited to) hospital-based case management, home health, geriatrics, catastrophic case management, mental health, palliative care, and end of life/hospice.

Finding/Conclusions:

As part of the assessment phase of the case management process, case managers determine the extent of the patient's support system or social support network such as family and close friends. Although their advocacy is primarily for the patient receiving case management services, case managers also become aware of the needs of the support system members as they face their loved one's serious illness, severe injury, geriatric care demands, or end of life. Case managers can use their communication skills, especially motivational interviewing, with patients and their support systems to identify stresses and issues that can impact the pursuit of health goals. In addition, case managers ensure that individuals and their support systems are kept informed such as about the health condition, stage of disease, plan of care, treatment options, and care transition plan.

Implications for Case Management:

Professional case managers expand their role as advocates, serving primarily the patients (“clients”) who receive case management services and also members of the support system. By becoming more aware and sensitive to the needs of the support system, case managers help reduce stress on the support system, which can contribute to positive outcomes for patients (“clients”).
Learn to Focus in a World of Multitasking
Authors: Powell Suzanne K.
Published: May 2017

Case managers' days are hectic and unpredictable. This Editorial describes why multitasking may not be the best choice and identifies techniques and attitudes for smoothing out hectic days.
Pancreatic Cancer and Depression
Authors: Parker Gordon , Brotchie Heather
Published: May 2017

Depression is a common concomitant of pancreatic cancer, and, because it often occurs before the cancer is diagnosed, its occurrence is likely to be intrinsic to the condition rather than a reaction to such a diagnosis. Because pancreatic cancer is associated with a very high mortality, its early detection is a key task. We therefore review relevant literature to determine whether the depression is prototypically distinctive and whether its identification might lead to earlier diagnosis of pancreatic cancer. We report on the epidemiology and prognosis of pancreatic cancer and on the prevalence, description, and possible mechanisms involved for the occurrence of any associated depressive state, before reviewing the comparative utility of depression in relation to other risk factors in aiding diagnosis. Published studies fail to identify any distinct depressive prototypic phenotype to depression associated with pancreatic cancer. Although it is a relatively common concomitant of pancreatic cancer, the utility of depression as a marker of the condition is not suggested from a key study evaluating its contribution in relation to other symptoms and risk factors.
Patient, Provider, and System Factors Contributing to Patient Safety Events During Medical and Surgical Hospitalizations for Persons With Serious Mental Illness
Authors: McGinty Emma E. , Thompson David A. , Pronovost Peter J. , Dixon Lisa B. , Guallar Eliseo , Ford Daniel E. , Cahoon Elizabeth Khaykin , Boonyasai Romsai , Daumit Gail L.
Published: May 2017

This study aimed to explore patient-, provider-, and system-level factors that may contribute to elevated risk of patient safety events among persons with serious mental illness (SMI). We conducted a medical record review of medical/surgical admissions in Maryland hospitals from 1994 to 2004 for a community-based sample of adults with SMI (N = 790 hospitalizations). We estimated the prevalence of multiple patient, provider, and system factors that could influence patient safety among persons with SMI. We conducted a case crossover analysis to examine the relationship between these factors and adverse patient safety events. Patients' mental status, level of consciousness, disease severity, and providers' lack of patient monitoring, delay/failure to seek consultation, lack of trainee supervision, and delays in care were positively associated with adverse patient safety events (p < 0.05). Efforts to reduce SMI-related patient safety risks will need to be multifaceted and address both patient- and provider-level factors.
General Psychiatric Management for Suicidal Patients, With Remarks on Chronicity
Authors: Yager Joel , Feinstein Robert E.
Published: May 2017

Assessing, managing, and treating suicidal patients, particularly those with chronic suicidality, challenge clinical decision making and emotional self-management in trainees and seasoned practitioners. Educators and trainees have noted needs for additional teaching materials in these areas. This article assists in addressing these gaps. We reviewed diagnostic and phenomenological characteristics encountered in acutely and chronically suicidal patients, their comprehensive assessment, general approaches to management, risk mitigation and safety planning, and psychological and biological interventions. Integrating information from research and clinical experience–based literature, we offer concise guidance on comprehensive psychiatric management for the varieties of acutely and chronically suicidal patients encountered in practice. By actively engaging suicidal patients and their families, systematically attending to warning signs, conducting risk mitigation and safety planning, and using psychological and biological treatments as indicated, clinicians are likely to reduce suicidal ideation, plans, and attempts in patients and might reduce completed suicides.
Features of Resting-State Electroencephalogram Theta Coherence in Somatic Symptom Disorder Compared With Major Depressive Disorder: A Pilot Study
Authors: Ahn Jaeyoung , Han Doug Hyun , Hong Ji Sun , Min Kyoung Joon , Lee Young Sik , Hahm Bong-Jin , Kim Sun Mi
Published: May 2017

Objective

Somatic symptom disorder (SSD) often co-occurs with major depressive disorder (MDD). Both conditions share common psychobiological and biobehavioral characteristics, but little is known about differential patterns in brain function. In this study, we compared resting-state functional brain connectivity between SSD and MDD using quantitative electroencephalography.

Methods

Fifteen patients with SSD (SSD group), 15 patients with MDD (MDD group), and 15 healthy volunteers (healthy control [HC] group) participated in this study. Participants were assessed with quantitative electroencephalography using a 21-channel electroencephalogram system. Electroencephalogram coherence in the theta frequency range (3.5–7.5 Hz) was assessed between the following seven electrode pairs: Fp1 and Fp2, F7 and T3, F8 and T4, T5 and P3, P4 and T6, P3 and Pz, and Pz and P4. Differences in coherence between groups were analyzed using analysis of variance.

Results

Theta coherence between the F7 and T3 electrodes was lower in the SSD group than the MDD and HC groups (F(2,42) = 6.67, p = .0030). Theta coherence between the T5 and P3 electrodes was lower in the SSD and MDD groups than the HC group (F(2,42) = 5.65, p = .0067). Theta coherence between the Pz and P4 electrodes was lower in the SSD group than the MDD group (F(2,42) = 6.41, p = .0037).

Conclusions

Both SSD and MDD patients commonly showed decreased functional connectivity within the left temporoparietal junction, which has neurophysiological implications for cognitive-attentional processing and social interaction. Frontostriatal circuit dysfunction affects processes that control perception and emotion, as well as misperception of somatosensory data in the parietal somatosensory area, and is more likely to be a neuropathology of SSD than MDD.
Increased Reporting Accuracy of Alzheimer Disease Symptoms in Caribbean Hispanic Informants
Authors: Azar Martina , Zhu Carolyn , DeFeis Brittany , Gu Yian , Ornstein Katherine , Lawless Siobhan , Cosentino Stephanie
Published: May 2017

Introduction:

Informant report of symptoms is essential for diagnosing and characterizing Alzheimer disease (AD). Differences in the perception and experience of dementia across ethnicities may influence informant report. Understanding such differences is critical given that among those with AD, Hispanics are disproportionately affected.

Methods:

Cross-sectional analyses examined informant report of cognitive and functional symptoms in mild AD across white (n=107) and Caribbean Hispanic (n=71) informants. To explore its accuracy, informant report of symptoms was compared against objective measures of patient performance.

Results:

Adjusted analyses revealed Hispanics reported more symptoms than white informants. Informant report of symptoms was inversely correlated with patients’ global cognition in both ethnic groups. Only Hispanic report of symptoms was significantly associated with memory and language performance.

Discussion:

Informant report of symptoms was associated with patients’ global cognition, reflecting relatively accurate informant reports in both ethnic groups, and was stronger in Hispanics when examining memory and language. Such differences may reflect cultural caregiving practices and perceptions of dementia, having implications for diagnosis and treatment.
Ultrasound Imaging of Median Nerve Conduit in a Patient With Persistent Median Nerve Symptoms
Authors: Billakota Santoshi , Ruch David S. , Hobson-Webb Lisa D.
Published: May 2017

Peripheral nerve injury can be reconstructed using composite polymer nerve autografts, but the sonographic appearance of nerve wraps and conduits have not been well documented. This case report describes the sonographic findings in a 42-year-old woman with bilateral carpal tunnel syndrome status post nerve repair with a conduit. The cross-sectional area of the left median nerve was 24 mm2 at the carpal tunnel inlet and 5 mm2 at the forearm. The wrist to forearm ratio was 4.8. There was a hypoechoic space surrounding the nerve that was 1.8 to 1.9 mm thick and bordered by a thin, hyperechoic outer rim. On review of the operative record and consultation with her surgeon (DR), it was determined that this represented the 2-mm nerve wrap used in the last surgery. Inclusion of these structures with the median nerve measured a total area of 52 mm2 at its maximum. In describing this image, we hope to lay the foundation for describing the sonographic appearance of peripheral nerve repair.
Single Cell Transcriptomics and Flow Cytometry Reveal Disease-associated Fibroblast Subsets in Rheumatoid Arthritis
Authors: Mizoguchi Fumitaka , Slowikowski Kamil , Marshall Jennifer L , Wei Kevin , Rao Deepak A , Chang Sook Kyung , Nguyen Hung N , Noss Erika H , Turner Jason D , Earp Brandon E , Blazar Philip E , Wright John , Simmons Barry P , Donlin Laura T , Kalliolias George D , Goodman Susan M , Bykerk Vivian P , Ivashkiv Lionel B , Lederer James A , Hacohen Nir , Nigrovic Peter A , Filer Andrew , Buckley Christopher D , Raychaudhuri Soumya , Brenner Michael B
Published: May 2017

Fibroblasts mediate normal tissue matrix remodeling, but they can cause fibrosis or tissue destruction following chronic inflammation. In rheumatoid arthritis (RA), synovial fibroblasts expand, degrade cartilage, and drive joint inflammation. Little is known about fibroblast heterogeneity or if aberrations in fibroblast subsets relate to disease pathology. Here, we used an integrative strategy, including bulk transcriptomics on targeted subpopulations and unbiased single-cell transcriptomics, to analyze fibroblasts from synovial tissues. We identify 7 phenotypic fibroblast subsets with distinct surface protein phenotypes, and these collapsed into 3 subsets based on transcriptomics data. One subset expressing PDPN, THY1, but lacking CD34 was 3-fold expanded in RA relative to osteoarthritis (P=0.007); most of these cells expressed CDH11. The subsets were found to differ in expression of cytokines and matrix metalloproteinases, localization in synovial microanatomy, and in response to TNF. Our approach provides a template to identify pathogenic stromal cellular subsets in complex diseases.
The eIF2α kinase Heme Regulated Inhibitor (HRI) protects the host from infection by regulating intracellular pathogen trafficking
Authors: Bahnan Wael , Boucher Justin C. , Gayle Petoria , Shrestha Niraj , Rosen Mark , Aktas Bertal , Adkins Becky , Ager Arba , Khan Wasif N. , Schesser Kurt
Published: May 2017

Phosphorylation of eIF2α by its kinases is a stress response universally conserved among the eukaryota. Previously, we reported that the eIF2α kinases Heme Regulator Inhibitor (HRI) and Protein Kinase R (PKR) control distinct activities of diverse bacterial pathogens. Specifically forListeria monocytogenes, it was shown that in HRI-deficient cells there was a reduction in the translocation of the pathogen to the cytosolic compartment as well as reduced loading of pathogen-derived antigens on MHC-1 complexes. Here we show thatHri-/- mice, as well as wild-type mice treated with a HRI inhibitor, are more susceptible to listeriosis. In the first few hours ofL. monocytogenesinfection,Hri-/- mice supported greater pathogen proliferation in the liver compared to that observed inHri+/+ mice. This greater susceptibility ofHri-/- mice was not due to deficits in immune cell development as proportions and numbers of innate and adaptive cell compartments were largely normal and these mice could mount potent antibody responses to a model T cell-dependent antigen. Usingin vitrocellular infection assays, we show that the rate of pathogen efflux from infectedHri-/- macrophages and fibroblasts is significantly higher than that observed in infectedHri+/+ cells. In contrast to the stark differences betweenHri+/+ andHri-/- cells in the infection dynamics of virulentL. monocytogenes, HRI was entirely dispensable for killing non-virulent strains ofL. monocytogenes. These results suggest that in wild-type cells, HRI helps ensure the cellular confinement of virulentL. monocytogenesand loading of cytosolic-derived antigens on MHC-1 complexes that limit pathogen spreading and activating innate immune responses, respectively.
Control of microtubule dynamics using an optogenetic microtubule plus end–F-actin cross-linker
Authors: Adikes Rebecca C. , Hallett Ryan A. , Saway Brian F. , Kuhlman Brian , Slep Kevin C.
Published: May 2017

We developed a novel optogenetic tool, SxIP-iLID, to facilitate the reversible recruitment of factors to microtubule (MT) plus ends in an End Binding (EB) protein-dependent manner using blue light. We show that SxIP-iLID can track MT plus ends and recruit tgRFP-SspB upon blue light activation. We then used this system to investigate the effects of cross-linking MT plus ends and F-actin inDrosophilaS2 cells to gain insight into spectraplakin function and mechanism. We show that SxIP-iLID can be used to temporally recruit a F-actin binding domain to MT plus ends and cross-link the MT and F-actin networks. Light-mediated MT-F-actin cross-linking decreases MT growth velocities and generates a MT exclusion zone in the lamella. SxIP-iLID facilitates the general recruitment of specific factors to MT plus ends with temporal control enabling researchers to systematically regulate MT plus end dynamics and probe MT plus end function in many biological processes.

SxIP-iLID is a novel optogenetic tool designed to assess the spatiotemporal role of proteins on microtubule dynamics. We establish that optogenetic cross-linking of microtubule and actin networks decreases MT growth velocities and increases the cell area void of microtubules.