bluuebunny/crossref_metadata_2025 huggingface dataset:
Therapeutic Strategies and Prognostic Factors Based on 121 Spinal Neurenteric Cysts
Authors: Weng Jian-Cong , Zhang Zhi-Feng , Li Da , Wang Jun-Mei , Li Gui-Lin , Xu Yu-Lun , Yang Jun , Zhang Jun-Ting , Jia Wen-Qing
Published: April 2019

BACKGROUND

Limited data existed to guide the management of intraspinal neurenteric cysts (ISNECs).

OBJECTIVE

To evaluate the risk factors for progression-free survival (PFS), elucidate the radiological features of ISNECs, and propose a treatment protocol.

METHODS

From 2003 to 2015, 121 patients with pathologically confirmed ISNECs treated at our institute were included in this study. Pertinent risk factors were evaluated.

RESULTS

Gross total resection (GTR) was achieved in 55 (44.6%) patients; 106 (87.6%), 12 (9.9%), and 3 (2.5%) ISNECs were classified as Wilkins A, B, and C, respectively. After a median follow-up duration of 64.2 mo, recurrence occurred in 25 (22.7%) patients, with a median PFS time of 43.1 mo. The actuarial PFS rates at 5 and 10 yr were 73.2% and 66.2%, respectively. The actuarial overall survival rates at 5 and 10 yr were 100% and 97.6%, respectively. Non-GTR (hazard ratio [HR], 5.836; 95% confidence interval [CI], 1.698-20.058; P = .005), Wilkins B/C (HR, 3.129; 95% CI, 1.009-9.702; P = .048), and a history of surgical resection (HR, 3.690; 95% CI, 1.536-8.864; P = .004) were adverse factors.

CONCLUSION

GTR and Wilkins A were favorable factors for PFS. If tolerable, GTR alone was advocated as an optimal treatment. Because of the benign nature and favorable prognosis, non-GTR was an alternative if GTR failed. Close follow-up was needed because of the recurrent tendency of ISNEC. Future study with a large cohort is necessary to verify our findings.
Frailty in Patients With Trauma Who Are Critically Ill: A Prospective Observational Study to Determine Feasibility, Concordance, and Construct and Predictive Validity of 2 Frailty Measures
Authors: Tipping Claire J , Hodgson Carol L , Harrold Meg , Chan Terry , Holland Anne E
Published: April 2019

Background

As the older population increases, more older people are exposed to trauma. Frailty can be used to highlight patients at risk of a poorer outcome.

Objective

The objectives of this study were to compare 2 frailty measures with regard to concordance, floor and ceiling effects, and construct and predictive validity and to determine which is more valid and clinically applicable in a critically ill trauma population.

Design

This was a prospective observational study.

Methods

Patients were included if admitted to an intensive care unit (ICU) under a trauma medical unit and ≥ 50 years old. Frailty was determined using 2 frailty measures, the Frailty Phenotype (FP) and Clinical Frailty Scale (CFS).

Results

One hundred people were enrolled; their mean age was 69.2 years (SD = 10.4) and 81% had major trauma (as determined with the Injury Severity Score). Frailty was identified with the FP in 22 participants and with the CFS in 13 participants. The 2 frailty measures had an excellent correlation (Spearman rank correlation coefficient = 0.77; 95% confidence interval = 0.66–0.85). Both the FP and the CFS had large floor effects but no ceiling effects. The FP and CFS showed construct validity, with frailty being significantly associated with increasing age, requiring an aid to mobilize, and more falls and hospital admissions. Frailty on the FP was predictive of ICU and hospital mortality, whereas frailty on the CFS was predictive of hospital mortality.

Limitations

The limitations of this study include the use of a single site, small sample size, and collection of frailty measures retrospectively.

Conclusions

Measuring frailty in a trauma ICU population was feasible, with excellent correlation between the 2 frailty measures. Both showed aspects of construct and predictive validity; however, the FP identified frailty in more participants and was associated with more comorbidities and higher mortality at ICU discharge. Therefore, the FP might be more clinically relevant in this population.
Fixed Handheld Dynamometry Provides Reliable and Valid Values for Quadriceps Isometric Strength in People With Chronic Obstructive Pulmonary Disease: A Multicenter Study
Authors: Bui Kim-Ly , Mathur Sunita , Dechman Gail , Maltais François , Camp Pat , Saey Didier
Published: April 2019

Background

Quadriceps weakness is associated with poor clinical outcomes in chronic obstructive pulmonary disease (COPD). However, quadriceps isometric strength assessment has not been routinely adopted in clinical practice because of the lack of homogeneity in the devices and protocols and the lack of reliability studies.

Objective

The objectives of this study were to determine the test-retest reliability and the criterion validity of a commercially available handheld dynamometer for evaluating the quadriceps isometric maximal voluntary contraction (iMVCquad) using a standardized protocol and to investigate the relationship between iMVCquad and functional capacity in people with COPD.

Design

This was a prospective, observational, multicenter trial.

Methods

Participants with mild to severe COPD from 4 Canadian sites were tested on 2 separate days. Five iMVCquad measurements were obtained following a standardized procedure with a fixed handheld dynamometer (iMVCquad-HHD), and then 5 iMVCquad measurements were obtained with a computerized dynamometer (iMVCquad-CD; the gold standard). Functional capacity was assessed with the Short Physical Performance Battery. Intraclass correlation coefficients, standard errors of measurement, Bland-Altman plots, and Spearman correlation coefficients were used for analyses.

Results

Sixty-five participants (mean age = 69 years [SD = 8]; forced expiratory volume in 1 second = 48% of predicted value [SD = 21]) completed the study. The mean iMVCquad-HHD values on visits 1 and 2 were 102.7 (SD = 51.6) and 105.6 (SD = 58.8) N·m, respectively; the standard error of measurement was 11.4 N·m. The between-visits intraclass correlation coefficient for iMVCquad-HHD was 0.95 (95% confidence interval  = 0.92–0.97), with a mean bias of 2.0 (Bland-Altman plot). There was a strong correlation between iMVCquad-HHD and iMVCquad-CD (Spearman correlation coefficient = 0.86). There was no correlation between iMVCquad-HHD and Short Physical Performance Battery total score.

Limitations

Participants had stable COPD with few comorbidities and were more physically active than the general population of people with COPD; results might not be applicable to patients with acute exacerbations of the disease or more comorbidities. Assessment order between handheld and computerized dynamometers has not been randomized, but analyses did not highlight any systematic bias or learning effect.

Conclusions

Quadriceps strength assessment can be implemented in a reliable and valid way in people with COPD using a fixed handheld dynamometer and standardized procedure. This protocol should be established in clinical practice to facilitate the assessment of muscle strength in people with COPD.
The Methylcitrate Cycle is Required for Development and Virulence in the Rice Blast Fungus Pyricularia oryzae
Authors: Yan Yuxin , Wang Huan , Zhu Siyi , Wang Jing , Liu Xiaohong , Lin Fucheng , Lu Jianping
Published: April 2019

The methylcitrate cycle metabolizes propionyl-CoA, a toxic metabolite, into pyruvate. Pyricularia oryzae (syn. Magnaporthe oryzae) is a phytopathogenic fungus that causes a destructive blast disease in rice and wheat. We characterized the essential roles of the methylcitrate cycle in the development and virulence of P. oryzae using functional genomics. In P. oryzae, the transcript levels of MCS1 and MCL1, which encode a 2-methylcitrate synthase and a 2-methylisocitrate lyase, respectively, were upregulated during appressorium formation and when grown on propionyl-CoA-producing carbon sources. We found that deletion of MCS1 and MCL1 inhibited fungal growth on media containing both glucose and propionate, and media using propionate or propionyl-CoA-producing amino acids (valine, isoleucine, methionine, and threonine) as the sole carbon or nitrogen sources. The Δmcs1 mutant formed sparse aerial hyphae and did not produce conidia on complete medium (CM), while the Δmcl1 mutant showed decreased conidiation. The aerial mycelium of Δmcs1 displayed a lowered NAD+/NADH ratio, reduced nitric oxide content, and downregulated transcription of hydrophobin genes. Δmcl1 showed reduced appressorium turgor, severely delayed plant penetration, and weakened virulence. Addition of acetate recovered the growth of the wild type and Δmcs1 on medium containing both glucose and propionate and recovered the conidiation of both Δmcs1 and Δmcl1 on CM by reducing propionyl-CoA formation. Deletion of MCL1 together with ICL1, an isocitrate lyase gene in the glyoxylate cycle, greatly reduced the mutant’s virulence as compared with the single-gene deletion mutants (Δicl1 and Δmcl1). This experimental evidence provides important information about the role of the methylcitrate cycle in development and virulence of P. oryzae by detoxification of propionyl-CoA and 2-methylisocitrate.
Suspected hematologic malignancy complicates lupus cerebritis treatment
Authors: Walgren Morgan
Published: April 2019

Comorbidities make determining a patient's optimal treatment plan substantially more difficult. This article describes lupus cerebritis, a neuropsychiatric presentation of systemic lupus erythematosus, in a patient with a risk for hematologic malignancies. The patient's primary care team had to weigh the benefit versus potential harm of various therapies to find the best treatment.
Longitudinal survey of clinician behavior change in CKD management
Authors: Shaw-Gallagher Marlene , Boyle Rebecca , Zuber Kim
Published: April 2019

Objective:

To assess longitudinal improvement for a simple intervention to teach physician assistants (PAs) and NPs management of patients with diabetes and chronic kidney disease (CKD).

Methods:

The original cohort from the Kidneys in a Box quality improvement project was revisited at the 3-year mark and asked about patient statin use, A1C measurement, urine albumin-creatinine ratio (UACR), CKD staging, distribution of over-the-counter (OTC) medication caution lists, and documentation of smoking history.

Results:

A statistically significant increase in quality metrics was seen at 3 months postintervention for the original cohort. At the 3-year mark, these improvements were sustained. For UACR and smoking quality metrics, performance increased beyond the gains initially seen at 3 months.

Conclusions:

This study demonstrates that a single-intervention quality improvement program can affect sustained improvements in clinical care of patients with diabetes and CKD. The results provide evidence that one-time quality improvement interventions have the power to promote longitudinal practice changes associated with reduced rates of CKD progression and potentially reduced healthcare costs.
UV Light–inactivated HSV-1 Stimulates Natural Killer Cell–induced Killing of Prostate Cancer Cells
Authors: Samudio Ismael , Hofs Elyse , Cho Brandon , Li Michael , Bolduc Kayla , Bu Luke , Liu Guoyu , Lam Vivian , Rennie Paul , Jia William , Elisia Ingrid , Krystal Gerald
Published: April 2019

Herein we demonstrate that ultraviolet light–inactivated Herpes Simplex Virus-1 (UV-HSV-1) stimulates peripheral blood mononuclear cells (PBMCs) to lyse both androgen-sensitive and androgen-independent prostate cancer (PrCA) cell lines, but not the benign prostatic hyperplastic epithelial cell line, BPH-1, and is 1000–10,000-fold more potent at stimulating this killing than ultraviolet light-inactivated Vesicular Stomatitis Virus, adenovirus, reovirus or cytomegalovirus. Among PBMCs, natural killer (NK) cells appear to be a major cell type involved in this killing and UV-HSV-1 appears to directly and potently stimulate NK cell expression of CD69, degranulation, cytokine production, and migration to IL-8 in PC3 conditioned medium. We also found that UV-HSV-1 stimulates glycolysis in PBMCs and NK cells, and that 2-deoxyglucose and the protein kinase C inhibitor, Go6976, and the NFκB inhibitor, Bay 11-7082, all abrogate UV-HSV-1 activated killing of PC3 cells by PBMCs and NK cells. Using neutralizing anti-Toll-like receptor 2 (TLR2) we found that UV-HSV-1, like HSV-1, activates NK cells via TLR2. Taken together, these results are consistent with Toll-like receptor 2 ligands on UV-HSV-1 stimulating TLR2 on NK cells to activate protein kinase C, leading to enhanced glycolysis and NFκB activation, both of which play a critical role in this anti-PrCA innate immune response. Importantly, UV-HSV-1 synergizes with IL-15 to increase the cytolytic activity of PBMCs against PC3 cells and there was considerable donor-to-donor variation in killing ability. These results support the preclinical development of UV-HSV-1 as an adjuvant, in combination with IL-15, for cell infusions of healthy, preselected NK cells to treat PrCA.
Generation of a Transgenic BALB/c Mouse Line With Selective Expression of Human Mesothelin in Thyroid Gland: Application in Mesothelin-targeted Immunotherapy
Authors: Bera Tapan K. , Liu Wenlong , Leshem Yasmin , King Emily , Kozlov Serguei , Pastan Ira
Published: April 2019

Despite encouraging clinical results with immune checkpoint inhibitors and other types of immunotherapies, the rate of failure is still very high. The development of proper animal models which could be applied to the screening of effective preclinical antitumor drugs targeting human tumor antigens, such as mesothelin (MSLN), is a great need. MSLN is a 40 kDa cell-surface glycoprotein which is highly expressed in a variety of human cancers, and has great value as a target for antibody-based therapies. The present study reports the establishment of an immunocompetent transgenic mouse expressing human MSLN (hMSLN) only in thyroid gland by utilizing an expression vector containing a thyroid peroxidase (TPO) promoter. These mice do not reject genetically modified tumor cells expressing hMSLN on the cell membrane, and tolerate high doses of hMSLN-targeted immunotoxin. Employing this TPO-MSLN mouse model, we find that the combination treatment of LMB-100 and anti-CTLA-4 induces complete tumor regression in 91% of the mice burdened with 66C14-M tumor cells. The combination therapy provides a significant survival benefit compared with both LMB-100 and anti-CTLA-4 monotherapy. In addition, the cured mice reject tumor cells when rechallenged, indicating the development of long-term antitumor immunity. This novel TPO-MSLN mouse model can serve as an important animal tool to better predict tumor responses to any immunomodulatory therapies that target MSLN.
Response to the Rechallenge With Talimogene Laherparepvec (T-VEC) After Ipilimumab/Nivolumab Treatment in Patient With Cutaneous Malignant Melanoma Who Initially Had a Progression on T-VEC With Pembrolizumab
Authors: Afzal Muhammad Z. , Shirai Keisuke
Published: April 2019

Talimogene laherparepvec (T-VEC) is approved for unresected stage III–IV malignant melanoma. T-VEC has a direct cytotoxic effect and enhances the antitumor immunity of host cells. Immune checkpoints inhibitors also enhance the immunity of host cells by increasing the recruitment of antigen-presenting cells or activation and restoration of T-cell functions. Both type of therapies can potentiate the effect of the other therapy. We are reporting a case of T-VEC rechallenge who initially progressed on T-VEC with pembrolizumab but then responded to T-VEC rechallenge after intervening ipilimumab/nivolumab. An 83-year-old man developed a subungual lesion of the left thumb and found to have AJCC V. 7 stage IIIb melanoma. Few months later, he developed axillary lymphadenopathy and multiple subcutaneous nodules (AJCC V. 7 stage IIIc). The patient was started on intralesional rose Bengal and pembrolizumab. After 4 cycles of pembrolizumab with rose Bengal, a positron-emission tomography/computerized tomography scan showed the progression of disease. He was started on T-VEC intralesional injections with concurrent pembrolizumab, however, after 3 T-VEC injections and 2 more cycles of pembrolizumab, there was the progression of disease. Subsequently, ipilimumab/nivolumab was started and patient responded partially. Ipilimumab/nivolumab was held due to toxicity. Eight weeks from the last dose of ipilimumab/nivolumab, he experienced locoregional progression and was rechallenged with T-VEC monotherapy. The patient showed a significant response after second T-VEC injection and continued to show response 6 months since rechallenge. After, initial progression on T-VEC with pembrolizumab, intervening immune checkpoints inhibitors may favorably modify the antitumor immunity and potentiate antitumor effect of T-VEC rechallenge.
Atypical Lipomatous Tumors
Authors: Fourman Mitchell S. , van Eck Carola F. , Weiss Kurt R. , Goodman Mark A. , McGough Richard L.
Published: April 2019

Objectives:

Misnaming low-grade lipomatous tumors poses a clinical and medicolegal challenge, potentially subjecting patients to expensive and unnecessary surgeries. The terms atypical lipomatous tumor (ALT) and “well-differentiated” liposarcoma (WDL) have been used interchangeably in pathology reports, scholarly works and consensus recommendations, creating vagaries between low-virulence extremity tumors and retroperitoneal disease with metastatic potential.

Methods:

A systematic review was performed on all studies that reported on the local recurrence rate and metastasis of ALTs and WDLs in living human subjects. Local recurrence and metastases were compared using Fisher’s Exact Test.

Results:

In total, 20 studies evaluated ALTs (n=936), whereas 13 studied WDLs (n=626). Mean follow-up was 6.6±2.0 years (median, 7.0 y). No metastatic disease was observed among ALTs, whereas 15 patients with WDLs (2.7%, P<0.0001) had metastases. The local recurrence rate of ALTs was significantly lower than WDLs after both marginal (15.1%, 141/936 vs. 46.0%, 288/626, P<0.0001) and wide excisions (3.3%, 2/59 in ALT vs. 17.4%, 19/109, P=0.007).

Conclusions:

ALT should be reserved for extremity lesions meeting appropriate histopathologic criteria that represent nonmetastatic disease, reducing over-diagnosis, over-treatment, and patient risk.
CAR T Cell Toxicity: Current Management and Future Directions
Authors: Yáñez Lucrecia , Sánchez‐Escamilla Miriam , Perales Miguel‐Angel
Published: April 2019

By late 2018, 2 chimeric antigen receptor T (CAR T) cell products have been approved by US and European regulatory authorities. Tisagenlecleucel (Kymriah, Novartis) is indicated in the treatment of patients up to 25 years of age with B‐cell acute lymphoblastic leukemia (ALL) that is refractory or in second or later relapse, or adult patients with large B‐cell lymphoma relapsed or refractory (r/r) after 2 or more lines of systemic therapy, including diffuse large B‐cell lymphoma (DLBCL) not otherwise specified, high grade B‐cell lymphoma and DLBCL arising from follicular lymphoma. Axicabtagene ciloleucel (Yescarta, Kite) is indicated for the treatment of adult patients with large B‐cell lymphoma relapsed or refractory after 2 or more lines of systemic therapy, including DLBCL not otherwise specified, primary mediastinal large B‐cell lymphoma, high grade B‐cell lymphoma, and DLBCL arising from follicular lymphoma (ZUMA‐1 trial).

This review will offer a practical guide for the recognition and management of the most important toxicities related to the use of the current commercial CAR T cells, and also highlight strategies to diminish these side effects in the future.
Management of Ocular Allergy Itch With an Antihistamine-Releasing Contact Lens
Authors: Pall Brian , Gomes Paul , Yi Frank , Torkildsen Gail
Published: April 2019

Purpose:

A contact lens (CL)-based drug delivery system for therapeutic delivery of the antihistamine ketotifen was tested in 2 parallel, conjunctival allergen challenge-based trials.

Methods:

Both trials employed the same multicenter, randomized, placebo-controlled protocol. Test lenses were etafilcon A with 0.019 mg ketotifen; control lenses were etafilcon A with no added drug. Subjects were randomized into 3 treatment groups. Group 1 received test lens in one eye and control lens in the contralateral eye; the eye chosen to receive test lens was randomly selected in a 1:1 ratio. Group 2 received test lenses bilaterally, and group 3 received control lenses bilaterally. Allergen challenges were conducted on 2 separate visits: following lens insertion, the subjects were challenged at 15 minutes (to test onset) and 12 hours (to test duration). The primary endpoint was ocular itching measured using a 0 to 4 scale with half-unit steps. Secondary endpoints included ciliary, conjunctival, and episcleral hyperemia.

Results:

The mean itching scores were lower for eyes wearing the test lens as compared to those that received control lenses, indicating that the test lens effectively reduced allergic responses. Mean differences in itching were statistically and clinically significant (mean score difference ≥ 1) at both onset and duration for both trials.

Conclusions:

This large-scale assessment (n = 244) is the first demonstration of efficacy for CL delivery of a therapeutic for ocular allergy. Results are comparable to direct topical drug delivery and suggest that the lens/ketotifen combination can provide a means of simultaneous vision correction and treatment for CL wearers with ocular allergies.
Work-Related Predictors of Sleep Quality in Chinese Nurses: Testing a Path Analysis Model
Authors: LI Yuan , FANG Jinbo , ZHOU Chunfen
Published: April 2019

Background

Good sleep is essential to human health. Insufficient quality sleep may compromise the wellness of nurses and even jeopardize the safety of patients. Although the contributors of sleep quality in nurses have been previously studied, the direct and indirect effects of modifiable work-related predictors remain uncertain.

Purpose

The study was designed to explore the direct and indirect effects of modifiable work-related factors on sleep quality in Chinese nurses.

Methods

A multistage sampling method was employed in this cross-sectional study to recruit 923 participants. An evidence-based predicting model was postulated and then subsequently tested and optimized using path analysis.

Results

The final model fit the data well, with the involved predictors accounting for 34.1% of the variance in sleep quality of the participants. Shift work, job demands, exposure to hazards in work environments, chronic fatigue, and inter-shift recovery were identified as direct predictors, while whereas job satisfaction, job control, support at work, and acute fatigue were identified as indirect predictors.

Conclusions/Implications for Practice

Sleep quality in Chinese nurses is influenced directly and indirectly by various modifiable work-related factors. Interventions such as adjusting work shifts and reducing job burdens should be prioritized by administrative staff to ensure the sleep quality and clinical performance of Chinese nurses and to subsequently improve nursing care quality.
A Novel Deletion in the RPL5 Gene in a Lebanese Child With Diamond Blackfan Anemia Unresponsive to Steroid Treatment
Authors: Farah Roula A. , Kamel Lojine , Roy Noemi , Proven Melanie , Wray Katherine , Roberts Irene , Wlodarski Marcin W.
Published: April 2019

Diamond-Blackfan Anemia (DBA) is a rare inherited form of pure red cell aplasia that usually manifests in infancy or early childhood, and is characterized by normochromic macrocytic anemia and bone marrow erythroblastopenia. The majority of DBA cases are associated with mutations in ribosomal protein genes. Here, we describe a Lebanese girl with RPL5-mutated DBA unresponsive to steroid treatment who died from complications following late hematopoietic stem cell transplantation performed at the age of 15 years.
Typical or Atypical Hemolytic Uremic Syndrome and the Use of Eculizumab: 4 Illustrative Cases
Authors: de Ville de Goyet Maëlle , Detaille Thierry , Godefroid Nathalie
Published: April 2019

Typical hemolytic uremic syndrome (HUS) in children is caused mostly byEscherichia coli0157:H7 in our country. Atypical HUS (aHUS) causes includeStreptococcus pneumoniae, methyl malonic aciduria, deficiency of ADAMST 13, and genetic or acquired disorder of the complement. Treatment of HUS relies on supportive measures while treatment of aHUS includes plasmapheresis and specific treatments. Recently, eculizumab has been proposed for the treatment of aHUS and many clinicians now believe that eculizumab should be the first-line standard of care. The purpose of this article is to illustrate the difficulties in the diagnostic process of HUS and therefore the subsequent problem to promptly choose the appropriate treatment. To date, workup of HUS continues to take many days leaving the clinicians with a choice between several therapeutic options. With the emergence of eculizumab, it becomes crucial to find faster diagnostic tools and to adapt HUS treatment protocols. We reported here clinical cases where eculizumab use was probably not appropriate once the correct diagnosis of typical HUS was made and cases where it would have been useful because of the late diagnosis of aHUS.
Successful Treatment of Relapsed Isolated Extraocular Retinoblastoma in the Right Fibula With High-dose Chemotherapy and Autologous Stem Cell Transplantation
Authors: Uppuluri Ramya , Jayaraman Dhaarani , Sivasankaran Meena , Patel Shivani , Vellaichamy Swaminathan Venkateswaran , Raj Revathi
Published: April 2019

Literature on high-dose chemotherapy followed by autologous stem cell rescue in relapsed retinoblastoma is limited to <150 cases reported so far. We present our experience and the challenges faced in the management of a 7-year-old boy with relapsed isolated extraocular retinoblastoma in the right fibula who received salvage chemotherapy followed by high-dose chemotherapy and autologous stem cell rescue. Electrolyte disturbances, renal tubulopathy, and seizures were the most significant transplant-related morbidity. The child is now 3 years postautograft in remission. Monitoring for second malignant neoplasm and late side effects remain the main challenges in the years to come.
Predictors of Hospitals' Nonachievement of Baseline Nursing Standards for Pediatric Oncology
Authors: Sullivan Courtney E. , Morrissey Lisa , Day Sara W. , Chen Yanjun , Shirey Maria , Landier Wendy
Published: April 2019

Background

The International Society of Pediatric Oncology established baseline standards for pediatric oncology nursing; limited evidence is available to predict hospitals' capacity to meet these standards internationally.

Objectives

The aims of this study were to (1) determine the proportion of hospitals that met, partially met or did not meet baseline standards for pediatric oncology nursing and (2) identify predictors of hospitals' nonachievement of baseline standards for pediatric oncology nursing.

Methods/Analysis

A secondary analysis of International Society of Pediatric Oncology web-based survey data of baseline nursing standards was conducted. Predictor variables were derived from surveyed hospital characteristics and external data sources. Multivariable parsimonious logistic regression models identified predictors of hospitals' nonachievement of each standard.

Results

Nurses from 101 hospitals across 54 countries completed the survey; 12% to 66% of hospitals reported meeting each of 6 baseline standards. Predictors of nonachievement of standards included low current health expenditure as percentage of gross domestic product, World Health Organization Region of Africa, United Nations “developing or transition” country classification, countries with fewer than 3 nurses/midwives per 1000 population, and hospitals without bone marrow transplant and/or intensive care units.

Conclusions

Hospitals with characteristics predictive of inability to meet baseline standards will likely require greater capacity-building support and advocacy to improve the quality of nursing care.

Implications for Practice

Findings from this study highlight internal and external factors that challenge the delivery of high-quality pediatric oncology nursing care internationally.
Assessment of Primary Palliative Care Content Within Prelicensure Nursing Education
Authors: Lippe Megan
Published: April 2019

Primary palliative care education should be provided within prelicensure programs to maximize nurses’ preparation to care for patients with serious, life-limiting illness before entering professional practice settings. Curricula need to be assessed to identify current content integration across nursing programs. The specific aim of this feasibility study was to evaluate the effectiveness of a survey methodology to assess primary palliative care content integration within prelicensure nursing curricula in multiple programs. A secondary aim was to compare content integration across nursing programs. Faculty teaching in prelicensure courses at 3 accredited nursing programs were recruited to complete a 50-item curriculum assessment survey based on the End-of-Life Nursing Education Consortium Undergraduate Curriculum. Response rates were 73%, 26.7%, and 18.8%, respectively. All content areas were reported as being taught by at least 1 faculty member per institution. Lecture was the primary pedagogy to teach all End-of-Life Nursing Education Consortium Undergraduate content areas, followed by clinical conference/debriefing and simulation. Content was primarily taught in Critical Care, Maternity, Adult Health, Gerontology, and Fundamentals courses. The disparate response rates suggest that survey dissemination may prove ineffective for multisite curricula evaluation. Implications for nursing education and clinical practice will be discussed.
Integrating the Comfort Theory™ Into Pediatric Primary Palliative Care to Improve Access to Care
Authors: Lafond Deborah A. , Bowling Sabrina , Fortkiewicz Justine Mize , Reggio Cheryl , Hinds Pamela S.
Published: April 2019

Primary palliative care improves access to symptom control and quality-of-life care for children and families and can reduce moral distress in clinicians. This article describes the application of a nursing theory framework for an evidence-based practice/quality improvement project that embedded pediatric primary palliative care into a hospital-based setting using unit-specific projects. An evidence-based practice/quality improvement project, guided by the Comfort Theory™, provided primary palliative care education and mentorship to improve knowledge, skills, and attitudes of direct care clinicians. Training consisted of didactic and self-directed learning, mentoring, and completion of unit-based projects to establish meaning and impact best practices and policies. A total of 149 direct care clinicians, comprising 3 cohorts, enrolled in the program. Improvements in interdisciplinary collaboration in care were demonstrated through 21 unit-based projects, the development of triggers for specialty palliative care consults in several high-risk populations, and the development of institutional guidelines for end-of-life care. The Comfort Theory™ guided integration of palliative care for children with serious illness and their families. This project empowered direct care clinicians in caring for patients, providing support to clinical staff, and in developing best practices.
Resilience in Koreans With Cancer
Authors: Lee Shin-Young , Lee Haeok , Fawcett Jacqueline , Park Jeong-Hwan
Published: April 2019

Cancer is a major cause of mortality and morbidity in Korea. However, there has been no previous nursing literature review on the phenomenon of resilience among cancer patients in Korea. The purpose of this study was to identify information about theories, instruments, correlates, and outcomes of resilience in the cancer experiences of Korean adults. This was a scoping review that searched Ovid MEDLINE, CINAHL, Google Scholar, DBpia, and the Korean Studies Information Service System between 2000 and 2016 in order to identify English and Korean research reports. The review yielded 17 quantitative studies, including 2 resilience theories and 6 resilience-specific instruments. The factors self-efficacy, hope, social supports, self-esteem, anxiety, and depression were associated with resilience, regardless of the type of cancer. Quality of life and coping were commonly investigated outcome variables for resilience. This review suggests that a nursing theory reflecting Korean culture and qualitative research concerning the phenomenon of resilience should be conducted as research priorities as the foundation for developing culturally appropriate tools for resilience. This will lead to enhanced quality of life among Korean cancer patients, which is the core of palliative nursing care.
Advance Care Planning in Rural Montana
Authors: Christensen Kara L. , Winters Charlene A. , Colclough Yoshiko , Oley Erin , Luparell Susan
Published: April 2019

It is recommended that advance care planning take place across the lifespan. Rural populations have a heightened risk for poor quality and high cost of end-of-life care. A doctoral project was completed to assess rural nurses’ knowledge, attitudes, and experiences with advance directives using the Knowledge, Attitudinal, and Experimental Surveys on Advance Directives. Descriptive statistics were used for analysis. Participants were nurses who practice in rural settings (N = 22). The average age was 46.4 years; all were white (n = 22), and the majority were baccalaureate prepared (n = 12). Practice settings were primarily in home care and hospice. Knowledge scores on advance directives were low (57%). Nurses felt confident in counseling and initiating discussions with patients and families. Less than one-half of the nurses reported they feel part of the advance care planning team. The majority reported advance directive resources and mentorship of younger nurses would be beneficial and indicated the need for additional education, training, knowledge, time, and support to better assist with advance care planning. Project results and recommendations were presented to the participating health care organization. Recommendations included workplace education, support, mentorship, resources, and education on cultural sensitivity using the rural nursing theory.
Parents’ Wishes for What They Had or Had Not Done and Their Coping After Their Infant’s or Child’s Neonatal Intensive Care Unit/Pediatric Intensive Care Unit/Emergency Department Death
Authors: Caicedo Carmen , Brooten Dorothy , Youngblut JoAnne M. , Dankanich Julia
Published: April 2019

This qualitative study asked 70 mothers and 26 fathers 3 open-ended questions on what they wish they had and had not done and on coping 2, 4, 6, and 13 months after their infant’s/child’s neonatal intensive care unit/pediatric intensive care unit/emergency department death. Mothers wished they spent more time with the child, chosen different treatments, advocated for care changes, and allowed the child his or her wishes. Fathers wished they had spent more time with the child and gotten care earlier. Mothers wished they had not agreed to child’s surgery/treatment, taken her own actions (self-blame), and left the hospital before the death. Fathers wished they had not been so hard on the child, agreed with doctors/treatment, and taken own actions (self-blame). Religious activities, caring for herself, and talking about/with the deceased child were the most frequent mothers’ coping strategies; those of the fathers were caring for self and religious activities. Both mothers and fathers wished they had spent more time with their child and had not agreed to surgery/treatments. The most frequent coping was caring for themselves, likely to care for the family and retain employment. Nurses must be sensitive to parents’ need for time with their infant/child before and after death and to receive information on child’s treatments at levels and in languages they understand.
Kennedy Terminal Ulcers
Authors: Latimer Sharon , Shaw Joanie , Hunt Tracey , Mackrell Kristyn , Gillespie Brigid M.
Published: April 2019

Kennedy terminal ulcers, a subset of pressure injuries, are associated with the dying process. This scoping review aimed to identify and map the published literature on Kennedy terminal ulcers in terms of its definition, prevalence, assessment, treatment, management, health care costs, and quality of life for patients in all health care settings. Using the Arksey and O’Malley scoping review framework, we systematically searched the Cochrane Library, CINAHL, EMBASE, MEDLINE, and ProQuest databases and 5 guideline repositories between 1983 and 2018. The following search terms were used: Kennedy ulcers, Kennedy terminal ulcers, terminal ulcer, skin failure, and Skin Changes at Life’s End. Data were extracted using a purposely developed data collection tool. Initial searches yielded 2997 sources, with 32 included in this review. Most Kennedy terminal ulcer literature was published by nurses in the United States. Kennedy terminal ulcer prevalence data are limited, with no validated assessment tools available. Kennedy terminal ulcers may be misclassified as pressure injuries, potentially resulting in financial penalties to the institution. This scoping review revealed significant knowledge and clinical practice gaps in patient assessment, management, and treatment of Kennedy terminal ulcers. Timely patient education may help them to make informed care and quality end-of-life decisions. Further research is needed to inform clinical practice to improve patient care.
Validation Study of Tumor Invasive Thickness for Postoperative Prognosis in 110 Patients Who Underwent Pancreatoduodenectomy for Distal Cholangiocarcinoma at a Single Institution
Authors: Zhao Yang , Nakanishi Yoshitsugu , Ogino Mariko , Oba Mitsunobu , Okamura Keisuke , Tsuchikawa Takahiro , Nakamura Toru , Noji Takehiro , Asano Toshimichi , Tanaka Kimitaka , Hosoi Hayato , Nakayama Tomohide , Mitsuhashi Tomoko , Dai Chaoliu , Hirano Satoshi
Published: April 2019

The pT classification of the 8th American Joint Committee on Cancer (AJCC) for distal cholangiocarcinoma (DCC) is classified according to depth of invasion (DOI), which is the distance from the basal lamina to the most deeply advanced tumor cells. The Nagoya group proposed a new T classification for DCC based on invasive tumor thickness (ITT), which is the maximal vertical distance of the invasive cancer component (the ITT grade). In this study, we aimed to validate the ITT grade for the next pT classification of DCC in 110 patients. ITT could be measured in all patients, but DOI could only be measured in 62 (56%) patients. According to ITT grade, patients were classified into grades A to D, as follows: grade A, ITT <1 mm (n=9); grade B, ITT 1 mm or more but <5 mm (n=35); grade C, ITT 5 mm or more but <10 mm (n=40); and grade D, ITT 10 mm or greater (n=26). The median overall survival times in patients with ITT grades A, B, C, and D were 12.8, 5.7, 3.7, and 2.0 years, respectively. ITT grade could discriminate postoperative survivals between grades. On multivariate analysis, ITT grade, regional lymph node metastasis, and distant metastasis were selected as independent prognostic factors. In summary, our results showed that ITT grade was a suitable alternative to DOI for pT classification in the next edition of the AJCC for DCC.
Local Transmission of Zika Virus in Miami-Dade County: The Florida Department of Health Rises to the Challenge
Authors: Philip Celeste , Novick Carole G. , Novick Lloyd F.
Published: April 2019

As early as 2015, Florida and Centers for Disease Control and Prevention (CDC) public health officials recognized the potential danger of Zika for US residents and visitors. The Zika virus, a mosquito-borne flavivirus, is transmitted through the bite of the Aedes aegypti mosquito. A physician in Miami-Dade notified the Florida Department of Health (DOH) of the first non–travel-related Zika case in the United States. A 23-year old pregnant woman had presented on July 7, 2016, at 23 weeks of gestation, with a 3-day history of fever, widespread pruritic rash, and sore throat. Three more cases, involving men, were reported in Dade and Broward counties. These notifications set into motion additional activities from the DOH's Zika Playbook: increased mosquito surveillance; collaboration with the CDC on recommendations for mosquito abatement techniques; and increased awareness of the risks of Zika. In August, the department reported that active transmission of Zika virus was occurring in one small area in Miami-Dade County known as Wynwood. Mosquito trapping in the area with local transmission identified large numbers of the Zika vector, Aedes aegypti females and a large number of mosquito larval sites. Control efforts included larviciding, eliminating standing water, and backpack and truck spraying of insecticides. A communication strategy was developed that addressed risk mitigation, public concerns over application of noxious pesticides, loss of tourist revenue, and reproductive issues. It was reported on December 28, 2016, that there had been 256 locally acquired cases of infection of Zika, 1011 travel-related cases, and 208 pregnant women with laboratory evidence of Zika. At the end of 2018, 2 years after active Zika virus transmission was controlled in Florida, there have been 101 reported cases of Zika during 2018 but none have been linked to local transmission.
A Controlled Clinical Trial on the Effects of Exercise on Lower Urinary Tract Symptoms in Women With Multiple Sclerosis
Authors: Silva Ferreira Ana Paula , de Souza Pegorare Ana Beatriz Gomes , Miotto Junior Ari , Salgado Pedro Rippel , Medola Fausto Orsi , Christofoletti Gustavo
Published: April 2019

Objective

The aim of the study was to investigate the effects of two pelvic floor exercise programs on lower urinary tract symptoms and quality of life in participants with multiple sclerosis.

Design

This is a prospective, single-blind, clinical trial.

Settings

The study used a community rehabilitation program within a large metropolitan health service.

Participants

Thirty women in moderate stage of multiple sclerosis were referred for outpatient rehabilitation.

Interventions

In a period of 6 mos, participants underwent a pelvic floor exercise program, associated or not with vaginal electrotherapy.

Main Outcomes

The main outcomes are overactive bladder, perineal contraction, and quality of life.

Results

The findings showed benefits of both programs on overactive bladder and quality of life. Participants undergoing exercise plus electrotherapy presented greater improvement on contraction of the perineal musculature and quality of life.

Conclusions

Six months of exercise provided benefits on lower urinary tract symptoms and quality of life in women with multiple sclerosis. Electrical stimulation potentiated the improvement on perineal musculature and quality of life. This trial was registered prospectively with the Clinical Trials Register, ID: BR-287q65 (http://www.ensaiosclinicos.gov.br/rg/RBR-287q65/).
Perceptions of Pediatric Hospital Safety Culture in the United States: An Analysis of the 2016 Hospital Survey on Patient Safety Culture
Authors: Gampetro Pamela J. , Segvich John P. , Jordan Neil , Velsor-Friedrich Barbara , Burkhart Lisa
Published: April 2019

Introduction

Medical errors in the pediatric population can quickly cause harm. Research identified that hospitals with positive safety cultures work collaboratively to reduce errors. Strategies that identify gaps in hospital’s safety culture within the pediatric milieu have not been initiated. This study addressed this gap from an interprofessional perspective.

Methods

This cross-sectional descriptive study used data from the Agency for Healthcare Research and Quality’s 2016 Hospital Patient Safety Culture survey measuring 12 safety culture dimensions for registered nurses (RNs), physician assistants/nurse practitioners (PAs/NPs), physicians (MDs), and administrators/managers (n = 6682) in the United States that were employed in 287 (42%) pediatric hospitals or specialty units.

Results

Findings indicated that in the United States, the overall safety culture had low levels of agreement. Pairings between pediatric RNs, PAs/NPs, and MDs had similar levels of agreement for all dimensions but the perceptions of these three practitioners differed when compared with pediatric administrators/managers in nine of the 12 dimensions. The perceptions of pediatric RNs and MDs differed in six of the 12 dimensions, with MDs indicating higher levels of agreement. All four professional groups rated teamwork within hospital units with the highest level of agreement (mean, 4.14), with hospital handoffs and transitions rated the lowest (mean, 2.64). All four professional groups found punitive cultures (mean, 2.71) throughout the pediatric specialty.

Conclusions

Variations regarding pediatric professional’s perception of safety culture exist within U.S. hospitals. Effective and creative management will support cultures that prevents harm and improves the overall safety of children’s care with initiatives that are dedicated to excellence.
Peptide Receptor Radionuclide Therapy Combined With Chemotherapy in Patients With Neuroendocrine Tumors
Authors: Yordanova Anna , Ahrens Harriet , Feldmann Georg , Brossart Peter , Gaertner Florian C. , Fottner Christian , Weber Matthias M. , Ahmadzadehfar Hojjat , Schreckenberger Mathias , Miederer Matthias , Essler Markus
Published: April 2019

Purpose

Combinations of therapies may enhance therapeutic effects without significantly increasing the incidence of adverse events. However, there are few data regarding survival after concomitant chemotherapy and peptide receptor radionuclide therapy (PRRT) with [177Lu]Lu-octreotate in patients with neuroendocrine tumors (NETs). Thus, we explored the outcome of this combination of therapies.

Methods

Fifteen patients with somatostatin receptor–positive, rapidly progressive G2/G3 NETs during chemotherapy or PRRT alone from 2 German cancer centers were included in the retrospective analysis. The patients received a combination of PRRT and chemotherapy with temozolomide (n = 3) or temozolomide plus capecitabine (n = 12). To evaluate the effects of the combined treatment, we assessed the responses, survival, and adverse events.

Results

The cumulative administered activity of [177Lu]Lu-octreotate had a median of 21.3 GBq after 3 cycles of combination therapy. The patients exhibited a median progression-free survival of 7.1 months and a median overall survival of 25.3 months. The clinical benefit (objective response and stable disease) rates were as follows: 55% of patients according to CT, 38% in [18F]F-FDG PET/CT, and 44% in [68Ga]Ga-DOTATOC PET/CT. One patient with rapidly progressing liver metastases experienced grade 4 liver failure according to the Common Terminology Criteria for Adverse Events (version 5.0). Four other patients (27%) experienced significantly elevated (grade 3) liver parameters.

Conclusions

According to different imaging modalities, the combination of PRRT and temozolomide +/− capecitabine led to disease control in 38% to 55% of the progressive NETs after PRRT or chemotherapy alone failed. The overall survival in this extensively pretreated group of patients was nearly 25 months. The majority of patients did not experience any serious adverse events.
Reduced Scan Time in 123I-FP-CIT SPECT Imaging Using a Large-Field Cadmium-Zinc-Telluride Camera
Authors: Bani Sadr Alexandre , Testart Nathalie , Tylski Perrine , Scheiber Christian
Published: April 2019

We evaluated the reproducibility of 123I-ioflupane (123I-FP-CIT) SPECT with shorter scan times using a CZT camera. One hundred ninety-nine 123I-FP-CIT SPECT scans obtained with standard scan time (30 minutes) were truncated to provide 24-, 18-, and 15-minute study simulations. Striatal binding ratios were automatically calculated and remained stable for all series. At 15 minutes, only 10 of 398 striata (2.5%) showed statistically significant different striatal binding ratios compared with reference series. These series were reviewed by 2 operators, and a perfect agreement was found for each patient. Therefore, CZT camera allows a 2-fold scan time reduction in 123I-FP-CIT SPECT.