bluuebunny/crossref_metadata_2025 huggingface dataset:
Fish-Released Kairomones Affect Mosquito Oviposition and Larval Life History
Authors: Silberbush Alon
Published: August 2021

Several species of mosquitoes respond to the presence of kairomones released by larvivorous predators during oviposition habitat selection and larval development. These responses may differ among mosquito species and do not always correlate with larval survival. This study examined the responses of the mosquito Culiseta longiareolata Macquart (Diptera: Culicidae) to kairomones released by three species of fish, Gambusia affinis (Cyprinodontiformes: Poeciliidae), Aphanius mento (Cyprinodontiformes: Cyprinodontidae) and Garra rufa (Cypriniformes: Cyprinidae) during oviposition. In addition, the study examined the effects of kairomones released by Gm. affinis on larval development and survival. Results show that ovipositing female avoided cues from the two larvivorous fish species but not the algivorous Gr. rufa. In addition, developing larvae metamorphosed slower and showed increased mortality when exposed to fish-released kairomones. Culiseta longiareolata larvae are known as dominant competitors, and the straightforward responses of both larvae and adult female to fish-released kairomones may be explained by the lack of additional sources of larval stress other than the presence of predators.
Endoscope-Assisted Resection of Extra-Axial Premedullary Neurenteric Cyst via Far Lateral-Supracondylar Approach: 2-Dimensional Operative Video
Authors: Vakharia Kunal V , Naylor Ryan M , Van Gompel Jamie J
Published: August 2021

Neurenteric cysts are rare congenital lesions that may compress the ventral brainstem.
1-9
In this operative video, we illustrate the surgical treatment of an intradural extra-axial neurenteric cyst extending from the lower pons to the craniocervical junction. The patient, an asymptomatic 52-yr-old female, underwent surveillance imaging of the premedullary lesion for 14 yr without progression. However, after developing progressive strain-induced headaches, imaging revealed a significant enlargement of the lesion with brainstem compression and partial obstruction of the foramen magnum. Therefore, surgical resection was pursued. The patient consented to the procedure.

The patient underwent a lateral suboccipital craniotomy and C1 laminectomy through a far lateral approach. The lesion was immediately visualized upon opening the dura. After identifying the cranial nerves, we resected the tumor while taking care to preserve the neurovascular elements of the cerebellopontine angle and foramen magnum. During the resection, we unexpectedly encountered a firm nodule that was adherent to the right posterior inferior cerebellar artery. This was meticulously dissected and removed en bloc using intraoperative indocyanine green (ICG) angiography. The cavity was inspected with 0-degree and 30-degree endoscopes to ensure complete resection of the lesion.

Gross total resection was confirmed on postoperative magnetic resonance imaging. The patient was neurologically intact with no cranial nerve abnormalities and discharged home on postoperative day 3. This case demonstrates that the far lateral-supracondylar approach affords safe access to the ventral pontomedullary and craniocervical junctions and that intraoperative adjuncts, including ICG angiography and endoscopic visualization, can facilitate complete lesion resection with excellent clinical outcomes.
Intraoperative Simulation: Team Training for Resuscitation While Using Intraoperative Computed Tomography: 2-Dimensional Operative Video
Authors: Goldberg Jacob L , Bustillo Maria , Usenko Jaroslav K , Kuo Philip , Kirnaz Sertac , Carnevale Joseph A , Schwarz Justin T , McGrath Lynn , Sommer Fabian , Medary Branden , Härtl Roger
Published: August 2021

Spine surgeons increasingly use intraoperative computed tomography (iCT) to facilitate surgery. iCT has several advantages, including the ability to decrease radiation exposure, improve surgical accuracy, and decrease operative time.
1-3
However, the large footprint of the equipment can impede fast patient access in the event of an emergency resuscitation. This challenge is compounded when the patient is prone with rigid head fixation. To achieve fast, high-quality resuscitation, a large team must overcome numerous challenges. Cohesive team functioning under these circumstances requires planning, practice, and refinement.
4

 As a result of our simulation sessions, we have made several changes to the setup of our iCT cases. The following equipment is now routinely used: extralong tubing between the anesthesia circuit and patient, portable vital monitor, additional intravenous access is obtained, and extension tubing is used with all lines. We have created educational diagrams to streamline 2 challenging processes: optimal bed placement (for supination) and removal of equipment from the operating room (OR) to accommodate an influx of emergency personnel and equipment.

 Since the implementation of this protocol, 1 prone posterior cervical patient had intraoperative cardiac arrest. The protocol was followed. Return of spontaneous circulation was achieved within 5 min. The patient was discharged from the hospital with no neurological sequelae. During debriefing, stakeholders uniformly credited the simulated practice with this positive outcome.

 Emergency planning is a multifaceted process that continually evolves. With a steady flux of personnel and equipment, ongoing practice is essential to ensure readiness. Here, we share the key elements of our twice-yearly simulation.

 This simulation was performed on a training mannequin. This study did not involve human subjects. Any depictions of care rendered to nonidentifiable patients were standard (nonexperimental).
Altered cerebrocerebellar functional connectivity in patients with obstructive sleep apnea and its association with cognitive function
Authors: Park Hea Ree , Cha Jungho , Joo Eun Yeon , Kim Hosung
Published: August 2021

Study Objectives

Previous functional MRI studies have reported altered brain networks in patients with obstructive sleep apnea (OSA). However, the extent and pattern of abnormal connectivity were inconsistent across studies, and cerebrocerebellar connections have been rarely assessed. We investigated functional network changes in cerebral and cerebellar cortices of OSA patients.

Methods

Resting-state functional MRI, polysomnography, and neuropsychological (NP) test data were acquired from 74 OSA patients (age: 45.8 ± 10.7 years) and 33 healthy subjects (39.6 ± 9.3 years). Connectivity matrices were extracted by computing correlation coefficients from various regions of interest, and Fisher r-to-z transformations. In the functional connections that showed significant group differences, linear regression was conducted to examine the association between connectivity and clinical characteristics.

Results

Patients with OSA showed reduced functional connectivity (FC) in cerebrocerebellar connections linking different functional networks, and greater FC in cortical between-network connections in prefrontal regions involving the default mode network (DMN) and the control network. For OSA group, we found no correlation between FC and sleep parameters including lowest SaO2 and arousal index in the connections where significant associations were observed in healthy subjects. FC changes in DMN areas were related to reduced verbal fluency in OSA. Lower local efficiency and lower clustering coefficient of the salience network in the left cerebellum were also observed in OSA.

Conclusions

OSA affects mainly the cerebrocerebellar pathway. The disruption of function in these connections are related to sleep fragmentation and hypoxia during sleep. These abnormal network functions, especially DMN, are suggested to participate in cognitive decline of OSA.
Evening-types show highest increase of sleep and mental health problems during the COVID-19 pandemic—multinational study on 19 267 adults
Authors: Merikanto Ilona , Kortesoja Laura , Benedict Christian , Chung Frances , Cedernaes Jonathan , Espie Colin A , Morin Charles M , Dauvilliers Yves , Partinen Markku , De Gennaro Luigi , Wing Yun Kwok , Chan Ngan Yin , Inoue Yuichi , Matsui Kentaro , Holzinger Brigitte , Plazzi Giuseppe , Mota-Rolim Sérgio Arthuro , Leger Damien , Penzel Thomas , Bjorvatn Bjørn
Published: August 2021

Study Objectives

Individual circadian type is a ubiquitous trait defining sleep, with eveningness often associated with poorer sleep and mental health than morningness. However, it is unknown whether COVID-19 pandemic has differentially affected sleep and mental health depending on the circadian type. Here, the differences in sleep and mental health between circadian types are examined globally before and during the COVID-19 pandemic.

Methods

The sample collected between May and August 2020 across 12 countries/regions consisted of 19 267 adults with information on their circadian type. Statistical analyses were performed by using Complex Sample procedures, stratified by country and weighted by the number of inhabitants in the country/area of interest and by the relative number of responders in that country/area.

Results

Evening-types had poorer mental health, well-being, and quality of life or health than other circadian types during the pandemic. Sleep–wake schedules were delayed especially on working days, and evening-types reported an increase in sleep duration. Sleep problems increased in all circadian types, but especially among evening-types, moderated by financial suffering and confinement. Intermediate-types were less vulnerable to sleep changes, although morningness protected from most sleep problems. These findings were confirmed after adjusting for age, sex, duration of the confinement, or socio-economic status during the pandemic.

Conclusions

These findings indicate an alarming increase in sleep and mental health problems, especially among evening-types as compared to other circadian types during the pandemic.
Prevalence of Hypertension Among Pregnant Women When Using the 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines and Association With Maternal and Fetal Outcomes
Authors: Bello Natalie A. , Zhou Hui , Cheetham T. Craig , Miller Eliza , Getahun Darios , Fassett Michael J. , Reynolds Kristi
Published: August 2021

(Abstracted from JAMA Netw Open 2021;4:e213808)

Until 2017, the American College of Cardiology (ACC), American Heart Association (AHA), and American College of Obstetricians and Gynecologists (ACOG) had a common threshold for diagnosing hypertension: a blood pressure of 140/90 mm Hg or higher. That year, based on the outcomes of randomized trials on nonpregnant adults, the ACC-AHA lowered its recommended threshold to 130/80 mm Hg or higher.
Screening Embryos for Polygenic Conditions and Traits: Ethical Considerations for an Emerging Technology
Authors: Lázaro-Muñoz Gabriel , Pereira Stacey , Carmi Shai , Lencz Todd
Published: August 2021

(Abstracted from Genet Med 2021;23:432–434)

Polygenic embryo screening (PES) uses polygenic risk scores (PRSs) to estimate risk for complex disorders and traits as a part of preimplantation genetic testing (PGT). Preimplantation genetic testing has been used for many years in order to avoid transferring embryos that have aneuploidies or single gene Mendelian disorders.
The Reproducibility of Trophectoderm Biopsies in Euploid, Aneuploid, and Mosaic Embryos Using Independently Verified Next-Generation Sequencing (NGS): A Pilot Study
Authors: Sachdev Nidhee M. , McCulloh David H. , Kramer Yael , Keefe David , Grifo James A.
Published: August 2021

(Abstracted from J Assist Reprod Genet 2020;37:559–571)

Aneuploidy represents the major cause of implantation failure and miscarriage. Preimplantation genetic testing (PGT-A) was developed to select euploid embryos for transfer and improve pregnancy rate.
Skeletal muscle immunohistochemistry of acquired and hereditary myopathies
Authors: Danielsson Olof , Häggqvist Bo
Published: August 2021

Purpose of review

The continued development in the field of immunohistochemistry (IHC) has improved the ability to diagnose muscle diseases. Many hereditary diseases are diagnosed by the absence or abnormal localization of proteins. Detection of secondary pathological protein expression is also used in diagnostics, and to study disease processes. We relate and discuss recent reports, where IHC has been an important tool in the investigation of muscle diseases.

Recent findings

In idiopathic inflammatory myopathies, IHC has extended its role to diagnose subgroups. This is most evident concerning immune-mediated necrotizing myopathy and antisynthetase syndrome. The availability of new antibodies has increased the sensitivity of a muscle biopsy to diagnose several hereditary myopathies. The introduction of protein restoration therapies in muscular dystrophies also comes with the need to detect and measure protein levels. For the study of disease processes at the protein level, in both acquired and hereditary myopathies IHC, often combined with gene studies, PCR-based methods, western blotting and electron microscopy, continues to bring forth interesting results.

IHC is an integrated tool in muscle pathology, where recent studies contribute to improved diagnostic skills and increased insights into disease processes.
The Influence of Simulated Low Speed Vehicle Impacts and Posture on Passive Intervertebral Mechanics
Authors: Fewster Kayla M. , Barrett Jeff M. , Callaghan Jack P.
Published: August 2021

Study Design.

An in vitro biomechanics investigation exposing porcine functional spinal units (FSUs) to sudden impact loading although in a flexed, neutral, or extended posture.

Objective.

To investigate the combined effect of impact severity and postural deviation on intervertebral joint mechanics.

Summary of Background Data.

To date, no in vitro studies have been conducted to explore lumbar tissue injury potential and altered mechanical properties from exposure to impact forces. Typically, after a motor vehicle collision, the cause of a reported acute onset of low back pain is difficult to identify, with potential soft tissue strain injury sites including the intervertebral disc, facet joint and highly innervated facet joint capsule ligament.

Methods.

Seventy-two porcine functional spinal units (36 C34, 36 C56), consisting of 2 adjacent vertebrae, ligaments, and the intervening intervertebral disc were included in the study. Each specimen was randomized to 1 of 3 experimental posture conditions (neutral, flexed, or extended) and assigned to 1 of 3 impact severities representing motor vehicle accident accelerations (4 g, 8 g, and 11 g). Before impact (pre) and after impact (post) flexion-extension and anterior-posterior shear neutral zone testing was completed.

Results.

A significant two-way interaction was observed between pre-post and impact severity for flexion-extension neutral zone length and stiffness and anterior-posterior shear neutral zone length and stiffness. This was a result of increased

neutral zone range and decreased neutral zone stiffness pre-post for the highest impact severity (11 g), regardless of posture.

Conclusion.

Functional spinal units exposed to the highest severity impact (11 g) had significant neutral zone changes, with increases in joint laxity in flexion-extension and anterior-posterior shear and decreased stiffness, suggesting that soft tissue injury may have occurred. Despite observed main effects of impact severity, no influence of posture was observed.

Level of Evidence: N/A
Pediatric brain tumors as a developmental disease
Authors: Bruschi Marco , Grill Jacques , Guerrini-Rousseau Léa
Published: August 2021

Purpose of review

Brain tumors are the most frequent solid cancer in the pediatric population. Owing to the rarity of environmental clues about their origin, it is tempting to consider these neoplasms as developmental processes gone awry. Our review will explore the heuristic power of this hypothesis and the influence of these findings on the clinical management.

Recent finding

A more accurate description of cancer predisposition syndrome has shown their frequent association with developmental abnormalities. Several genes involved in pediatric brain tumor oncogenesis are involved in developmental processes. Modeling of several pediatric brain tumor in cerebral organoids, mimicking embryonal stage of brain development, indicates that early events during brain development create the conditions necessary for their oncogenesis.

The onset of multiple brain tumor types early in life suggests a functional relationship between brain development and oncogenesis. A growing body of evidence seems to support the hypothesis that some of the main developmental steps in the brain can be highjacked by the tumors during their initiation. Collaborations between neuroscientists and oncologists should provide room for improvement in the knowledge for these neoplasms.
Neutrophils in Fixed Drug Eruptions: Correction of a Mistaken Hypothesis
Authors: Li Aofei , Kazlouskaya Viktoryia
Published: August 2021

Classical histopathological findings of fixed drug eruption (FDE) include a lichenoid/interface dermatitis and perivascular infiltrate in the upper and deep dermis composed of lymphocytes and eosinophils accompanied by pigment incontinence. The presence of neutrophils is also an established finding but is less investigated. Sporadic cases of “neutrophilic FDE” have been reported and suggested as a separate entity, a rare variant, or an early stage of the condition. In this article, we report 16 cases of FDE with quantitative analysis showing that neutrophils are relatively common in FDE (68.8%) and that cases with abundant neutrophils had a significantly shorter onset-to-biopsy interval (3.7 vs. 16.9 days, P < 0.023). Our findings support that neutrophilic FDE more likely represents the early phase of FDE rather than a different entity. The presence of neutrophils expands the histopathological differential diagnosis of FDE to include neutrophilic dermatosis, signifying the value of clinical correlation.
A Rare Case of Epstein-Barr Virus–Positive T-Cell Lymphoma in the Skin of an Immunocompromised Patient
Authors: van Eijk Larissa E. , Koldijk Marjolein J. , van Kester Marloes S. , Diepstra Arjan , Diercks Gilles F. H.
Published: August 2021

Immunodeficiency-associated lymphoproliferative disorders are associated with latent infection by Epstein–Barr virus (EBV). Most cases of EBV-positive immunodeficiency-associated lymphoproliferative disorders arise from B cells, although some are of T-cell or natural killer origin. Cutaneous involvement is unusual and sporadically reported in the literature. We describe a rare case of an EBV-positive T-cell lymphoma presenting in the skin of a 32-year-old woman using adalimumab for neurosarcoidosis.
A Novel Application of Magnetic Resonance Imaging to Surgical Planning of Penile Inversion Vaginoplasty
Authors: Abu El Hawa Areeg A. , Orra Susan , Bekeny Jenna C. , Dekker Paige K. , Georges Nicholas P. , Del Corral Gabriel
Published: August 2021

Transfeminine patients undergoing vaginoplasty frequently require reoperation due to dissatisfaction with insufficient vaginal dimensions. The goal of this study was to evaluate the role of preoperative imaging with magnetic resonance imaging (MRI) in establishing appropriate patient expectations and surgical planning for vaginoplasty procedures. In this retrospective review, we identified all patients that received MRI before undergoing penile inversion vaginoplasty by a single surgeon from 2019 to 2020. Our findings suggest that MRI can provide valuable information that can be used to set realistic expectations with patients as well as for operative planning for vaginoplasty procedures. Unlike traditional planning, MRI eliminates subjectivity in its estimate of vaginal depth. Future studies should incorporate a larger patient population and objectively analyze the impact of preoperative imaging on patient satisfaction and other measures of operative outcomes.
Neuromodulating the SMAS for Natural Dynamic Results
Authors: Corduff Niamh
Published: August 2021

Physicians using neuromodulators need to develop an in-depth and holistic understanding of the facial musculature as a single, large, functional structure that does not work in isolation. In this Special Topic, I review the anatomy of the continuous fibromuscular layer of the face, discuss how certain age-related indications develop as a consequence of imbalances to this unified structure, and propose considerations for neuromodulator-based interventions of the upper, mid, and lower face. I provide evidence-supported recommendations on the most optimal applications of neuromodulators to help rebalance the musculoaponeurotic layer for more natural outcomes. Through outcomes of my patients, I show how the facial mimetic muscles can be modulated with careful placement of botulinum toxin, without causing unnatural facial expressions, to achieve an expressive, well-balanced face that reflects health, vitality and happiness.
Lymphatic Function in the Arms of Breast Cancer Patients—A Prospective Cohort Study
Authors: Alstrup Mathias , Johannessen Andreas L. , Mohanakumar Sheyanth , Offersen Birgitte V. , Hjortdal Vibeke E.
Published: August 2021

Background:

Lymphedema is a highly feared complication of breast cancer treatment, but the underlying complex mechanisms are still unknown. Thus, we investigated the lymphatic morphology and contractility in the lymphatic vessels of arms of high-risk breast cancer patients treated for node-positive early breast cancer.

Methods:

In this prospective cohort study 32 women treated for unilateral node-positive breast cancer were enrolled and studied 36 ± 23 days after loco-regional radiotherapy. Near-infrared fluorescence imaging was used to assess morphology and function of the superficial lymphatic vessels. Strain-gauge plethysmography was performed to evaluate the capillary filtration of fluid.

Both arms were investigated, with the non-treated arm acting as control. The patients were questioned about the presence of lymphedema yearly and finally 574 ± 118 days after ended radiotherapy.

Results:

Morphologically, 25% of the treated arms expressed lymphatic vessel abnormalities compared to the control arms (p = 0.0048). No difference in functional parameters (maximal pumping pressure, p = 0.20; contraction frequency, p = 0.63; contraction velocity, p = 0.55) was found between the treated and control arms. Patients who later developed lymphedema had a difference in velocity compared to those who did not develop lymphedema (p = 0.02). The capillary filtration rate was similar between the two arms (p = 0.18).

Conclusions:

Peripheral lymphatic vessels were morphologically changed in the ipsilateral arm in 25% of the patients and patients who later developed lymphedema showed an early increase in velocity. Other functional parameters and capillary filtration were unchanged in this early phase. These discrete changes might be early indicators of later development of lymphedema.
Critical Access Hospital Leaders Beat Challenges to Support Their Communities and Staffs
Authors: Schou Patricia M.
Published: August 2021

Critical access hospitals (CAHs) serve their rural communities as the main access points and communication centers for healthcare, typically with very limited financial, staffing, and support resources. Local residents rely on their CAHs as the only providers for many miles around. When the COVID-19 pandemic hit in early 2020, CAH leaders had to rethink operations and priorities, both internally with staffs and externally with community leaders and organizations. Few critical care beds were available when the need was greatest. Testing was problematic, and cultural barriers complicated care. Now, as virus variants strike where vaccination numbers are low, CAH leaders remain wary of financial hits to elective procedure income, limited resources, and added stress for their staffs. Working with community service organizations and larger regional healthcare centers is a crucial strategy for CAHs as they address care delivery issues and ensure that their caregivers can do their jobs now and in the future.
Behavioral Health in the Pandemic: Making the Shift from Mental Illness to Mental Well-Being
Authors: Merz Stephen M.
Published: August 2021

Fighting the global COVID-19 pandemic has shifted from immediate response efforts to recognition of the long-term effects on the mental health and well-being of the general population and healthcare workforce. Leaders need to understand the vital role of behavioral health services in a population-based, integrated healthcare framework and address the needs of the behavioral health workforce to successfully deploy services in their organizations and communities.

During the ongoing national response to COVID-19, three major trends have emerged: (1) a shift to telehealth and digital care, (2) greater awareness of the impact on the workforce of the shift to digital care, and (3) an open dialogue to counteract the stigma and discrimination related to mental illness and to emphasize mental well-being instead. When they address stigma and discrimination, healthcare leaders embrace a more holistic approach that welcomes behavioral health professionals as equal, vital members of the care team. They help their organizations advance the mental well-being of all.
Small Cell Neuroendocrine Carcinoma Presenting as Recurrent Dacryocystitis: Case Report of a Rare Entity
Authors: Amjad Muhammad M. , Jacobs Sarah M. , Callahan Michael A. , Gonzalez Manuel Lora , Tavakoli Mehdi
Published: August 2021

An 84-year-old man presented with a localized, firm, tender mass over the right lacrimal sac. He had a history of acute dacryocystitis in the same eye 6 months before presentation, which resolved with antibiotics followed by uneventful dacryocystorhinostomy. At repeat presentation, the patient underwent orbital imaging and excisional biopsy of the lesion. Histologic studies revealed a small cell neuroendocrine carcinoma. The patient was subsequently treated with chemotherapy and radiation. Although there are rare reports of small cell neuroendocrine carcinoma originating in the sino-orbital-lacrimal region, this is the first report of tumor presentation with acute dacryocystitis in a patient with prior dacryocystorhinostomy.
The impact of COVID-19 in pregnancy: Part II. Vaccination to pregnant women
Authors: Wang Peng-Hui , Lee Wen-Ling , Yang Szu-Ting , Tsui Kuan-Hao , Chang Cheng-Chang , Lee Fa-Kung
Published: August 2021

Effective strategies are urgently needed to decrease the risk of untoward outcomes of pregnant women with severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) infection. Pregnant women are a vulnerable population to infectious disease pandemics with dramatically increased infectious diseases-related serious complications, such as the need of hospitalizations, the need of admission to intensive care unit, and the final disease-related death compared with those nonpregnant counterparts or those pregnant women without infection. Several studies have shown that vaccinations in pregnancy are a safe and highly effective strategy, not only for pregnant women but also for fetus and/or newborn because of the passive transplacental transfer of antibodies to the offspring. Active and passive prevention of infectious diseases is approved as effective strategies for women who attempt to become pregnant or during pregnancy. Despite the large and proven scientific evidence, pregnant women still puzzle over whether they should get vaccinated. The question therefore arises: Why are pregnant women so reluctant to receive vaccination? The explanation is more likely in the way that the benefits of vaccination have been communicated “confusedly.” In fact, like virtually all clinical trials, all the COVID-19 vaccine trials have excluded pregnant and lactating women from participating, contributing to uncertainty of safety and efficacy in COVID-19 vaccines that have been well prepared and available for the general adult population worldwide. Moreover, messenger RNA vaccine is a relatively brand-new vaccine, and experience with this type of vaccine is still scarce. It is hard to overcome this innovation deadlock. The knowledge and awareness of pregnant women who are at risk, and full information on the knowledge of vaccines and related preventable diseases in pregnant women may avoid hesitancy and increase vaccine acceptance. The current review is a part two addressing the impact of COVID-19 on pregnant women. We focus on the up-to-date information about the application of vaccination on pregnant women, especially during this COVID-19 pandemic.
The Characteristics of Nurses Who Care for Dying Infants and Their Families
Authors: Eckenrode Jessica , Zimmerman Kathryn , Rice Mary Eve , Wilson Debra Rose
Published: August 2021

The purpose of this research was to explore the characteristics of nurses who care for dying infants and their families to better understand their strengths in this specialty and seek to give guidance to the nurse in this role.

Introduction

Caring for an infant and family at the end-of-life for the infant requires a unique set of nursing skills and characteristics. Nurses who have that skill set can shed light on the role and the individual strengths needed for success.

Methods

A phenomenological approach was used to examine the perceived traits and skills needed for these nurses. Eight participants were interviewed about their experience of working with these families. Interviews were audio-taped, transcribed verbatim, and analyzed using codes and categories. Four themes emerged.

Results

The four themes identified were flexibility, making memories, compassion, and nonjudgment.

Discussion

Understanding some of the characteristics required for this unique role can help nurses self-reflect and continue to care for these families and themselves during this sacred time. The findings have value for all pediatric nurses who care for children who may die.
Low myocardial mechano-energetic efficiency is an independent predictor of prognosis in advanced chronic liver disease
Authors: Cesari Maurizio , Frigo Anna Chiara , Piano Salvatore , Angeli Paolo
Published: August 2021

Objective

We aimed at investigating if a low myocardial mechano-energetic efficiency (MEE) with energy waste could be a feature of cirrhotic cardiomyopathy and predictive of poor prognosis.

Methods

We retrospectively interrogated a large data set of 115 cirrhotic patients followed up for 6 years and compared with 50 healthy controls. Echocardiographic and haemodynamic parameters were assessed at baseline according with current guidelines. MEE was estimated by echocardiographic stroke volume (z-derived)/(heart rate × 0.6).

Results

Cirrhotic patients presented low peripheral vascular resistance, a compensatory hyperdynamic syndrome with increased cardiac work, left atrial and left ventricular (LV) dimension and mass. Systolic parameters and MEE were similar between patients and controls. Patients with cirrhosis and refractory ascites showed significantly lower MEE compared with both patients with treatable ascites and patients without ascites (1.68 ± 0.47 vs. 1.98 ± 0.64 and 1.80 ± 0.37 ml/s; P < 0.05). Increased age and heart rate and reduced body weight, cardiac dimension and work significantly correlated with lower MEE, mostly when compared nonalcoholic with alcoholic cirrhosis (1.65 ± 0.42 vs. 1.95 ± 0.56 ml/s respectively; P = 0.002). Among the cardiovascular parameters left atrium enlargement and reduced MEE were independent predictors of death.

Conclusions

In advanced chronic liver disease left ventricular performance is blunted due to an energetically inefficient cardiac mechanical work which correlates with a poor prognosis. Therefore, the simple basal assessment of MEE can identify patients with a worst prognosis which requires a close follow-up.
Differences between sporadic hyperplastic gastric polyps and portal hypertensive gastric polyps: a review
Authors: Héroin Lucile , Saviano Antonio , Fenouil Tanguy , Sosa-Valencia Leonardo , Baumert Thomas F. , Habersetzer François , Mayer Pierre
Published: August 2021

Portal hypertension (PH) is one of the most severe complications of chronic liver diseases. It is defined as an increase in pressure in the portal venous system which results in a portosystemic gradient >5 mmHg. In the western world, cirrhosis is the most frequent cause of PH, mainly due to nonalcoholic fatty liver disease and alcoholic liver disease. Patients with PH have esophageal varices in 68–73% of cases, portal hypertensive gastropathy in 51–73% and hyperplastic polyps (HPs) in 0.9–2%. Recent studies have shown that HPs found in PH patients are different from classical HPs. They constitute a new entity called portal hypertensive polyps (PHPs). The main difference between sporadic HPs and PHP is the presence of larger and more numerous vascular capillaries in the lamina propria. The clinical course of PHPs is unknown. Their physiopathology seems different from HPs: the increased congestion caused by higher portal pressure in the stomach may induce capillaries proliferation and neoangiogenesis. PHPs may be responsible for symptoms, such as pyloric obstruction, iron deficiency and anemia. Their prevalence in portal hypertensive and cirrhotic patients is from 1% to 8%. PHPs can be single or numerous, in the antrum or the gastric corpus. Their size ranges from 2 to 3 cm. PHPs seem to disappear or shrink with the treatment of PH. They should be resected in case of symptom and if >10 mm, after Helicobacter pylori eradication if present. However, their recurrence is frequent (40–79%), thus surveillance endoscopy is mandatory, at the same time as esophageal varices.
Integrating Mental Health in Safety-net Primary Care
Authors: Leung Lucinda B. , Benitez Christopher T. , Dorsey Charmaine , Mahajan Anish P. , Hellemann Gerhard S. , Whelan Fiona , Park Nina J. , Braslow Joel T.
Published: August 2021

Background:

Beginning in 2010, Los Angeles County Departments of Health Services and Mental Health collaborated to increase access to effective mental health care. The Mental Health Integration Program (MHIP) embedded behavioral health specialists in primary care clinics to deliver brief, problem-focused treatments, and psychiatric consultation support for primary care-prescribed psychotropic medications.

Objective:

The aim was to compare primary care visits associated with psychiatric diagnoses before and after MHIP implementation.

Methods:

This retrospective cohort study (2009–2014) examined 62,945 patients from 8 safety-net clinics that implemented MHIP in a staggered manner in Los Angeles. Patients’ primary care visits (n=695,354) were either associated or not with a previously identified or “new” (defined as having no diagnosis within the prior year) psychiatric diagnosis. Multilevel regression models used MHIP implementation to predict odds of visits being associated with psychiatric diagnoses, controlling for time, clinic, and patient characteristics.

Results:

9.4% of visits were associated with psychiatric diagnoses (6.4% depression, 3.1% anxiety, <1% alcohol, and substance use disorders). Odds of visits being associated with psychiatric diagnoses were 9% higher [95% confidence interval (CI)=1.05–1.13; P<0.0001], and 10% higher for diagnoses that were new (CI=1.04–1.16; P=0.002), after MHIP implementation than before. This appeared to be fueled by increased visits for depression post-MHIP (odds ratio=1.11; CI=1.06–1.15; P<0.0001).

Conclusions:

MHIP implementation was associated with more psychiatric diagnoses coded in safety-net primary care visits. Scaling up this effort will require greater attention to the notable differences across patient populations and languages, as well as the markedly low coding of alcohol and substance use services in primary care.
The Impact of Language on Emergency Department Visits, Hospitalizations, and Length of Stay Among Home Care Recipients
Authors: Reaume Michael , Batista Ricardo , Rhodes Emily , Knight Braden , Imsirovic Haris , Seale Emily , Riad Karine , Prud’homme Denis , Tanuseputro Peter
Published: August 2021

Background:

Research considering the impact of language on health care utilization is limited. We conducted a population-based study to: (1) investigate the association between residents’ preferred language and hospital-based health care utilization; and (2) determine whether this association is modified by dementia, a condition which can exacerbate communication barriers.

Methods:

We used administrative databases to establish a retrospective cohort study of home care recipients (2015–2017) in Ontario, Canada, where the predominant language is English. Residents’ preferred language (obtained from in-person home care assessments) was coded as English (Anglophones), French (Francophones), or other (Allophones). Diagnoses of dementia were ascertained with a previously validated algorithm. We identified all emergency department (ED) visits and hospitalizations within 1 year.

Results:

Compared with Anglophones, Allophones had lower annual rates of ED visits (1.3 vs. 1.8; P<0.01) and hospitalizations (0.6 vs. 0.7; P<0.01), while Francophones had longer hospital stays (9.1 vs. 7.6 d per admission; P<0.01). After adjusting for potential confounders, Francophones and Allophones were less likely to visit the ED or be hospitalized than Anglophones. We found evidence of synergism between language and dementia; the average length of stay for Francophones with dementia was 25% (95% confidence interval: 1.10–1.39) longer when compared with Anglophones without dementia.

Conclusions:

Residents whose preferred language was not English were less frequent users of hospital-based health care services, a finding that is likely attributable to cultural factors. Francophones with dementia experienced the longest stays in hospital. This may be related to the geographic distribution of Francophones (predominantly in rural areas) or to suboptimal patient-provider communication.
Gastric intestinal metaplasia: when to treat? How to treat?
Authors: Abdelfattah Thaer , Shahab Omer , Shah Tilak U.
Published: August 2021

Purpose of review

Gastric intestinal metaplasia (GIM) is an attractive target for surveillance and treatment as it can progress to gastric adenocarcinoma (GAC). Yet, GIM remains a challenging area for clinicians as most patients do not progress to cancer, and there are conflicting data regarding the benefits of surveillance and therapy. This review aims to summarize recently published GIM surveillance guidelines, to discuss, which patients with GIM may benefit from treatment, and to review pivotal and recent literature on GIM therapy.

Recent findings

Guidelines published by American, British, and European gastroenterology societies do not recommend universal surveillance, but do suggest endoscopic surveillance in patients with risk factors for progression to GAC. Although light examination for at least 7 min and mapping biopsies may increase yield for dysplasia and GAC. In randomized trials, Helicobacter pylori eradication reduced risk of dysplasia and cancer. In GIM with visible dysplasia and early-stage GAC, endoscopic resection improves quality of life without reducing survival compared with surgery. Endoscopic ablation therapies have shown promise for invisible or extensive dysplasia.

Endoscopic resection is appropriate for visible dysplasia and early-stage GAC without high-risk features that persists despite H. pylori eradication therapy. Prospective studies are needed to assess the utility of endoscopic ablation in GIM.
Cardiopulmonary Resuscitation and Vital Function Failure Refresher Training Strengthen Healthcare Professionals’ Self-Assessed Abilities
Authors: Södersved Källestedt Marie-Louise , Hessulf Fredrik , Liljeström Simon , Remahl Lisa
Published: August 2021

Refresher training in cardiopulmonary resuscitation and recognition of patients with failure in vital functions are often completed on separate occasions. In this study, 63 healthcare professionals participated in a pilot course and self-assessed their abilities before and after the course. Combining training scenarios with different diagnoses of patient cases provided a real-life learning environment. The training strengthened the perceived ability of healthcare professionals to respond to an acute situation of a patient with failure of vital functions.
Improving Discharge Instructions Following a Concussion Diagnosis in the Pediatric Emergency Department: A Pre-post Intervention Study
Authors: Yengo-Kahn Aaron M. , Hibshman Natalie , Bezzerides Michael , Feldman Michael J. , Vukovic Adam A. , Mummareddy Nishit , Zhao Shilin , Penrod Cody H. , Bonfield Christopher M. , Vance E. Haley
Published: August 2021

Introduction:

Many children are discharged from the pediatric emergency department (PED) with incomplete or inappropriate instructions following a concussion. Our objective was to evaluate the effectiveness of a simple intervention in improving discharge instruction disbursement and completeness following PED diagnosis of concussion.

Methods:

A pre/post intervention study of 935 patients (375 preintervention and 560 postintervention) ages 5–19, diagnosed with a concussion and discharged from the PED between July 2016 and November 2019, was performed at a single United States pediatric tertiary-care center. Dedicated provider education sessions were held, and a consensus guideline–based set of discharge instructions were implemented in the electronic health record. Primary outcomes included the presence of return-to-play (RTP) instructions, return-to-learn (RTL) instructions, follow-up recommendations, and “complete” discharge (ie, all 3 components present). Statistical process control charts were generated and tested for special cause variation.

Results:

More patients received instructions for RTP (87% versus 59%) and RTL (60% versus 3%), and a complete discharge was more frequent (45% versus 2%), following the conclusion of the intervention. Only the improvement in RTP instructions was completely sustained into the following academic year, whereas RTL and complete discharge rates declined to 27% and 20%, respectively.

Conclusions:

A simple, low-cost intervention such as peer-to-peer education and consensus guideline–based discharge instruction templates can significantly improve discharge readiness after pediatric concussion. Further work is needed to maintain progress and continue improvements, at our large academic trauma center.
Improving Antibiotic Stewardship among Asymptomatic Newborns Using the Early-onset Sepsis Risk Calculator
Authors: Ellington Marty , Kasat Kavita , Williams Kim , Reichman Victoria , Stoffels Guillaume , Ming Leung Tung , Degoy Ana , Fisk Rebecca , Gonzalez-Ballesteros Luisa , Peralta-Reich Dinabel , Potash Aaron , Rao Kavya
Published: August 2021

Introduction:

Neonatologists have long struggled with identifying and treating early-onset sepsis (EOS) without overexposing newborns to unnecessary antibiotics.

Methods:

In January 2016, we instituted an EOS protocol based mainly on the 2012 AAP guidelines. We subsequently conducted 2 additional plan-do-study-act cycles to decrease antibiotic usage by integrating the EOS risk calculator into our algorithm. For the periods January 2016–June 2017 (period 1), June 2017–February 2018 (period 2), and February 2018–December 2018 (period 3), we tracked all asymptomatic newborns older than 36 weeks, including those admitted to the neonatal intensive care unit for evaluation of EOS. We monitored the monthly variation in asymptomatic newborns older than 36 weeks who received antibiotics using statistical process control. The number of asymptomatic infants treated with antibiotics during the 3 periods was analyzed. Pairwise comparisons were made using post hoc chi-square analysis.

Results:

The addition of the EOS calculator score to our guidelines reduced the number of asymptomatic infants older than 36 weeks treated with antibiotics by 73% (P < 0.0001). Adopting the EOS calculator score after clinical examination further reduced the number of infants treated by 89% (P < 0.0001). For period 1, the percentage of asymptomatic infants older than 36 weeks treated with antibiotics was 4.3%; for period 2, it was 1.16%, and for period 3, it was 0.12% (P < 0.0001).

Conclusions:

The addition of the EOS calculator score to our AAP-based guidelines reduced antibiotic use among asymptomatic infants older than 36 weeks by 73%. Further adoption of the EOS calculator score after the clinical examination enabled our team to defer antibiotics in almost all asymptomatic infants safely.
Case Volume-Dependent Changes in Operative Morbidity following Free Flap Breast Reconstruction: A 15-Year Single-Center Analysis
Authors: Ochoa Oscar , Pisano Steven , Ledoux Peter , Nastala Chet , Arishita Gary , Garza Ramon , Ketchum Norma , Song Xuemei , Michalek Joel , Chrysopoulo Minas
Published: August 2021

Background:

Operative morbidity is a common yet modifiable feature of complex surgical procedures. With increasing case volume, improvement in morbidity has been reported through designated procedural processes and greater repetition. Defined as a volume-outcome association, improvement in breast reconstruction morbidity with increasing free flap volume requires further characterization.

Methods:

A retrospective analysis was conducted among consecutive free flap patients using a two-microsurgeon model between January of 2002 and December of 2017. Patient demographics and operative characteristics were obtained from medical records. Complications including unplanned surgical intervention (take-back) and flap loss were obtained from prospectively kept databases. Individual surgeon operative volume was estimated by considering overall practice volume and correcting for the number of surgeons at any given time.

Results:

During the study period, 3949 patients met inclusion criteria. A total of 6607 breasts underwent reconstruction with 6675 free flaps. Mean patient age was 50 ± 9.4 years and mean body mass index was 28.8 ± 5.0 kg/m2. Bilateral reconstruction was performed on 2633 patients (66.5 percent), with 4626 breasts (70.5 percent) reconstructed in the immediate setting. Overall, breast and donor-site complications were reported in 507 breasts (7.7 percent) and 607 cases (15.4 percent), respectively. Take-back was required in 375 cases (9.5 percent), with complete flap loss occurring in 57 cases (0.9 percent). Based on annual flaps per surgeon, the incidence of complications decreased with increasing volume (slope = −0.12; p = 0.056).

Conclusion:

Through procedural efficiency and execution of defined clinical processes using a two-microsurgeon model, increases in microsurgical breast reconstruction case volume result in decreased morbidity.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.