bluuebunny/crossref_metadata_2025 huggingface dataset:
Recognizing Privilege and Bias: An Interactive Exercise to Expand Health Care Providers’ Personal Awareness
Authors: Holm Amanda L. , Rowe Gorosh Marla , Brady Megan , White-Perkins Denise
Published: July 2016

Problem

Despite increasing awareness of the social determinants of health, health care disparities among sociocultural groups persist. Health care providers’ unconscious bias resulting from unrecognized social privilege is one contributor to these disparities.

Approach

In 2009, Henry Ford Health System initiated the Healthcare Equity Campaign both to raise employees’ awareness of inequalities related to the social determinants of health and to increase their motivation to reduce them. After conducting awareness-raising activities to increase employees’ understanding of the social determinants of health, a curriculum team developed the interactive Privilege and Responsibility Curricular Exercise (PRCE) and incorporated it into a series of trainings. The team designed the exercise to enhance participants’ awareness of privilege in their lives and work, to improve their understanding of the impact of privilege on their own and others’ lived experiences as a step beyond cultural competence toward cultural humility, and to encourage them to leverage their advantages to reduce health care inequities.

Outcomes

About 300 participants of diverse professional and personal backgrounds from across the health system completed the training between the spring of 2009 and the spring of 2012, and many provided qualitative feedback about the exercise. Evaluations showed the exercise’s potential as a powerful learning experience that might enhance a variety of equity- or diversity-related trainings, and also showed that participants considered the PRCE a highlight of the training.

Next Steps

The PRCE is worthy of additional study and could prove valuable to other organizations.
Entrusting Observable Practice Activities and Milestones Over the 36 Months of an Internal Medicine Residency
Authors: Warm Eric J. , Held Justin D. , Hellmann Michael , Kelleher Matthew , Kinnear Benjamin , Lee Caroline , O’Toole Jennifer K. , Mathis Bradley , Mueller Caroline , Sall Dana , Tolentino Jonathan , Schauer Daniel P.
Published: July 2016

Purpose

Competency-based medical education and milestone reporting have led to increased interest in work-based assessments using entrustment over time as an assessment framework. Little is known about data collected from these assessments during residency. This study describes the results of entrustment of discrete work-based skills over 36 months in the University of Cincinnati internal medicine (IM) residency program.

Method

Attending physician and peer/allied health assessors provided entrustment ratings of resident performance on work-based observable practice activities (OPAs) mapped to Accreditation Council for Graduate Medicine Education/American Board of Internal Medicine reporting milestones for IM. These data were translated into milestones data and tracked longitudinally. The authors analyzed data from this new entrustment system’s first 36 months (July 2012–June 2015).

Results

During the 36-month period, assessors made 364,728 milestone assessments (mapped from OPAs) of 189 residents. Residents received an annualized average of 83 assessment encounters, producing means of 3,987 milestone assessments and 4,325 words of narrative assessment. Mean entrustment ratings (range 1–5) from all assessors for all milestones rose from 2.46 for first-month residents to 3.92 for 36th-month residents (r
2 = 0.9252, P < .001). Attending physicians’ entrustment ratings were lower than peer/allied health assessors’ ratings. Medical knowledge and patient care milestones were rated lower than professionalism and interpersonal and communication skills milestones.

Conclusions

Entrustment of milestones appears to rise progressively over time, with differences by assessor type, competency, milestone, and resident. Further research is needed to elucidate the validity of these data in promotion, remediation, and reporting decisions.
Preoperative Falls and Their Association with Functional Dependence and Quality of Life
Authors: Kronzer Vanessa L. , Tang Rose D. , Schelble Allison P. , Ben Abdallah Arbi , Wildes Troy S. , McKinnon Sherry L. , Sadiq Furqaan , Lin Nan , Helsten Daniel L. , Sharma Anshuman , Stark Susan L. , Avidan Michael S.
Published: July 2016

Background

No study has rigorously explored the characteristics of surgical patients with recent preoperative falls. Our objective was to describe the essential features of preoperative falls and determine whether they are associated with preoperative functional dependence and poor quality of life.

Methods

This was an observational study involving 15,060 surveys from adult patients undergoing elective surgery. The surveys were collected between January 2014 and August 2015, with a response rate of 92%.

Results

In the 6 months before surgery, 26% (99% CI, 25 to 27%) of patients fell at least once, and 12% (99% CI, 11 to 13%) fell at least twice. The proportion of patients who fell was highest among patients presenting for neurosurgery (41%; 99% CI, 36 to 45%). At least one fall-related injury occurred in 58% (99% CI, 56 to 60%) of those who fell. Falls were common in all age groups, but surprisingly, they did not increase monotonically with age. Middle-aged patients (45 to 64 yr) had the highest proportion of fallers (28%), recurrent fallers (13%), and severe fall-related injuries (27%) compared to younger (18 to 44 yr) and older (65+ yr) patients (P < 0.001 for each). A fall within 6 months was independently associated with preoperative functional dependence (odds ratio, 1.94; 99% CI, 1.68 to 2.24) and poor physical quality of life (odds ratio, 2.18; 99% CI, 1.88 to 2.52).

Conclusions

Preoperative falls might be common and are possibly often injurious in the presurgical population, across all ages. A history of falls could enhance the assessment of preoperative functional dependence and quality of life.
Perioperative Visual Loss in Spine Fusion Surgery
Authors: Rubin Daniel S. , Parakati Isaac , Lee Lorri A. , Moss Heather E. , Joslin Charlotte E. , Roth Steven
Published: July 2016

Background

Perioperative ischemic optic neuropathy (ION) causes visual loss in spinal fusion. Previous case–control studies are limited by study size and lack of a random sample. The purpose of this study was to study trends in ION incidence in spinal fusion and risk factors in a large nationwide administrative hospital database.

Methods

In the Nationwide Inpatient Sample for 1998 to 2012, procedure codes for posterior thoracic, lumbar, or sacral spine fusion and diagnostic codes for ION were identified. ION was studied over five 3-yr periods (1998 to 2000, 2001 to 2003, 2004 to 2006, 2007 to 2009, and 2010 to 2012). National estimates were obtained using trend weights in a statistical survey procedure. Univariate and Poisson logistic regression assessed trends and risk factors.

Results

The nationally estimated volume of thoracic, lumbar, and sacral spinal fusion from 1998 to 2012 was 2,511,073. ION was estimated to develop in 257 patients (1.02/10,000). The incidence rate ratio (IRR) for ION significantly decreased between 1998 and 2012 (IRR, 0.72 per 3 yr; 95% CI, 0.58 to 0.88; P = 0.002). There was no significant change in the incidence of retinal artery occlusion. Factors significantly associated with ION were age (IRR, 1.24 per 10 yr of age; 95% CI, 1.05 to 1.45; P = 0.009), transfusion (IRR, 2.72; 95% CI, 1.38 to 5.37; P = 0.004), and obesity (IRR, 2.49; 95% CI, 1.09 to 5.66; P = 0.030). Female sex was protective (IRR, 0.30; 95% CI, 0.16 to 0.56; P = 0.0002).

Conclusions

Perioperative ION in spinal fusion significantly decreased from 1998 to 2012 by about 2.7-fold. Aging, male sex, transfusion, and obesity significantly increased the risk.
Single-dose Antibiotic Prophylaxis in Regional Anesthesia
Authors: Bomberg Hagen , Krotten Denise , Kubulus Christine , Wagenpfeil Stefan , Kessler Paul , Steinfeldt Thorsten , Standl Thomas , Gottschalk André , Stork Jan , Meissner Winfried , Birnbaum Juergen , Koch Thea , Sessler Daniel I. , Volk Thomas , Raddatz Alexander
Published: July 2016

Background

Catheter-related infection is a serious complication of continuous regional anesthesia. The authors tested the hypothesis that single-dose antibiotic prophylaxis is associated with a lower incidence of catheter-related infections.

Methods

Our analysis was based on cases in the 25-center German Network for Regional Anesthesia database recorded between 2007 and 2014. Forty thousand three hundred sixty-two surgical patients who had continuous regional anesthesia were grouped into no antibiotic prophylaxis (n = 15,965) and single-dose antibiotic prophylaxis (n = 24,397). Catheter-related infections in each group were compared with chi-square test after 1:1 propensity-score matching. Odds ratios (ORs [95% CI]) were calculated with logistic regression and adjusted for imbalanced variables (standardized difference more than 0.1).

Results

Propensity matching successfully paired 11,307 patients with single-dose antibiotic prophylaxis (46% of 24,397 patients) and with 11,307 controls (71% of 15,965 patients). For peripheral catheters, the incidence without antibiotics (2.4%) was greater than with antibiotic prophylaxis (1.1%, P < 0.001; adjusted OR, 2.02; 95% CI, 1.49 to 2.75, P < 0.001). Infections of epidural catheters were also more common without antibiotics (5.2%) than with antibiotics (3.1%, P < 0.001; adjusted OR, 1.94; 95% CI, 1.55 to 2.43, P < 0.001).

Conclusions

Single-dose antibiotic prophylaxis was associated with fewer peripheral and epidural catheter infections.
Is Listening in Noise Worth It? The Neurobiology of Speech Recognition in Challenging Listening Conditions
Authors: Eckert Mark A. , Teubner-Rhodes Susan , Vaden Kenneth I.
Published: July 2016

This review examines findings from functional neuroimaging studies of speech recognition in noise to provide a neural systems level explanation for the effort and fatigue that can be experienced during speech recognition in challenging listening conditions. Neuroimaging studies of speech recognition consistently demonstrate that challenging listening conditions engage neural systems that are used to monitor and optimize performance across a wide range of tasks. These systems appear to improve speech recognition in younger and older adults, but sustained engagement of these systems also appears to produce an experience of effort and fatigue that may affect the value of communication. When considered in the broader context of the neuroimaging and decision making literature, the speech recognition findings from functional imaging studies indicate that the expected value, or expected level of speech recognition given the difficulty of listening conditions, should be considered when measuring effort and fatigue. The authors propose that the behavioral economics or neuroeconomics of listening can provide a conceptual and experimental framework for understanding effort and fatigue that may have clinical significance.
Cognitive Load and Listening Effort: Concepts and Age-Related Considerations
Authors: Lemke Ulrike , Besser Jana
Published: July 2016

Listening effort has been recognized as an important dimension of everyday listening, especially with regard to the comprehension of spoken language. At constant levels of comprehension performance, the level of effort exerted and perceived during listening can differ considerably across listeners and situations. In this article, listening effort is used as an umbrella term for two different types of effort that can arise during listening. One of these types is processing effort, which is used to denote the utilization of “extra” mental processing resources in listening conditions that are adverse for an individual. A conceptual description is introduced how processing effort could be defined in terms of situational influences, the listener’s auditory and cognitive resources, and the listener’s personal state. Also, the proposed relationship between processing effort and subjectively perceived listening effort is discussed. Notably, previous research has shown that the availability of mental resources, as well as the ability to use them efficiently, changes over the course of adult aging. These common age-related changes in cognitive abilities and their neurocognitive organization are discussed in the context of the presented concept, especially regarding situations in which listening effort may be increased for older people.
Autonomic Nervous System Reactivity During Speech Repetition Tasks: Heart Rate Variability and Skin Conductance
Authors: Mackersie Carol L. , Calderon-Moultrie Natalie
Published: July 2016

Cognitive and emotional challenges may elicit a physiological stress response that can include arousal of the sympathetic nervous system (fight or flight response) and withdrawal of the parasympathetic nervous system (responsible for recovery and rest). This article reviews studies that have used measures of electrodermal activity (skin conductance) and heart rate variability (HRV) to index sympathetic and parasympathetic activity during auditory tasks. In addition, the authors present results from a new study with normal-hearing listeners examining the effects of speaking rate on changes in skin conductance and high-frequency HRV (HF-HRV). Sentence repetition accuracy for normal and fast speaking rates was measured in noise using signal to noise ratios that were adjusted to approximate 80% accuracy (+3 dB fast rate; 0 dB normal rate) while monitoring skin conductance and HF-HRV activity. A significant increase in skin conductance level (reflecting sympathetic nervous system arousal) and a decrease in HF-HRV (reflecting parasympathetic nervous system withdrawal) were observed with an increase in speaking rate indicating sensitivity of both measures to increased task demand. Changes in psychophysiological reactivity with increased auditory task demand may reflect differences in listening effort, but other person-related factors such as motivation and stress may also play a role. Further research is needed to understand how psychophysiological activity during listening tasks is influenced by the acoustic characteristics of stimuli, task demands, and by the characteristics and emotional responses of the individual.
Pain management in knee arthroplasty: an overview
Authors: Azam MD Quamar , Sadat-Ali Mir , Badar Ahmad
Published: July 2016

Perioperative pain management after knee arthroplasty has undergone a conceptual revolution in the last decade. Along with other exciting innovations, including minimally invasive techniques, computer-assisted procedures and a significant stride in tribology, understanding pain modulation and drug action at a molecular level is recognized as the game changer in arthroplasty surgeries. While most patients usually recover and experience pain relief within 3 mo after TKA, about 20% (10–34%) of the patients are left with an unfavorable long-term pain outcome. Fifty-two percent of patients report moderate pain and 16% report severe pain at rest 30 days after TKA, while pain at movement affects as much as 78% of the patients. Inability to adequately control postoperative pain causes undue suffering, inability to participate in fast-track rehabilitation programs, sleep disturbance (44% patients first 3 nights), delayed discharge, and the development of persistent postsurgical pain. The goal of this review article is to give an overview of the fundamental concept of surgical pain, the molecular mechanism of action of different drugs, evolution of the concept of preventive analgesia, and state of the art for current pain management. When combined and standardized, these factors allow arthroplasty surgeons to offer outpatient arthroplasty procedures.
Predicting Postsurgical Satisfaction in Adolescents With Idiopathic Scoliosis: The Role of Presurgical Functioning and Expectations
Authors: Sieberg Christine B. , Manganella Juliana , Manalo Gem , Simons Laura E. , Hresko M. Timothy
Published: July 2016

Background:

There is a need to better assess patient satisfaction and surgical outcomes. The purpose of the current study is to identify how preoperative expectations can impact postsurgical satisfaction among youth with adolescent idiopathic scoliosis undergoing spinal fusion surgery.

Methods:

The present study includes patients with adolescent idiopathic scoliosis undergoing spinal fusion surgery enrolled in a prospective, multicentered registry examining postsurgical outcomes. The Scoliosis Research Society Questionnaire—Version 30, which assesses pain, self-image, mental health, and satisfaction with management, along with the Spinal Appearance Questionnaire, which measures surgical expectations was administered to 190 patients before surgery and 1 and 2 years postoperatively. Regression analyses with bootstrapping (with n=5000 bootstrap samples) were conducted with 99% bias-corrected confidence intervals to examine the extent to which preoperative expectations for spinal appearance mediated the relationship between presurgical mental health and pain and 2-year postsurgical satisfaction.

Results:

Results indicate that preoperative mental health, pain, and expectations are predictive of postsurgical satisfaction.

Conclusions:

With the shifting health care system, physicians may want to consider patient mental health, pain, and expectations before surgery to optimize satisfaction and ultimately improve clinical care and patient outcomes.

Level of Evidence:

Level I—prognostic study.
Comparison of Allograft and Bovine Xenograft in Calcaneal Lengthening Osteotomy for Flatfoot Deformity in Cerebral Palsy
Authors: Rhodes Jason , Mansour Alfred , Frickman Allison , Pritchard Breanna , Flynn Katherine , Pan Zhaoxing , Chang Frank , Miller Nancy
Published: July 2016

Background:

The Evan’s calcaneal lengthening osteotomy is a treatment method for spastic flatfoot deformity in patients with cerebral palsy that fail nonoperative measures. Autograft and allograft have been reported as potential graft choices. Bovine xenograft has been introduced as an alternative, but limited human data exists supporting its efficacy. This study compares the long-term results of allograft versus xenograft in isolated Evan’s procedure performed for correction of flexible spastic flatfoot deformity.

Methods:

This retrospective study accessed charts of 4- to 18-year-olds diagnosed with cerebral palsy who received an Evan’s procedure. Preoperative and postoperative radiographic measurements (lateral calcaneal pitch, lateral talocalcaneal, lateral talo-first metatarsal, anteroposterior talonavicular coverage, anteroposterior talo-first metatarsal), graft incorporation, recurrence, secondary procedures, and complications were recorded and analyzed between graft types.

Results:

Sixty-three feet (34 allograft and 29 xenograft) in 36 patients (mean age 9.3 y) were included. Gross Motor Function Classification System between groups was significant (P=0.001). Mean time for preoperative x-rays was 5.3 months before day of surgery (DOS) for allograft and 3.6 months for xenograft. Mean time of first and last postoperative x-ray for allograft was 3.6 and 39.5 months, respectively; for xenograft, 1.8 and 35.1 months, respectively. There was a significant difference in timing of preoperative x-ray to DOS and DOS to first postoperative x-ray (P=0.012, 0.006, respectively). Radiographically, xenograft retained postoperative improvement better than allograft, yet allograft had a higher grade 4 incorporation rate (P=0.036). The allograft group experienced significantly more cast pressure ulcers (P=0.006), but no other differences in complications between groups, and no infections were reported in either group.

Conclusions:

Allograft incorporated better than xenograft, likely with a greater potential to reach grade 5 incorporation, yet both groups retained postoperative improvement. Results indicate both grafts are appropriate; yet incorporation rate could affect correction maintenance, and should be considered during graft selection for Evan’s procedure.

Level of Evidence:

This study presents clinical results using a novel bone graft material. Level III—retrospective comparative study.
A Silver Medal Winner at the 13th World Wu Shu JOURNAL/spne/04.03/00007632-201702150-00019/inline-graphic1/v/2024-02-04T231018Z/r/image-tiff Championship 2015 17 Months After Selective Thoracic Fusion for Adolescent Idiopathic Scoliosis
Authors: Chan Chris Yin Wei , Aziz Izzuddin , Chai Fong Wei , Kwan Mun Keong
Published: July 2016

Study Design.

Case report.

Objective.

To report the successful rehabilitation and the training progress of an elite high performance martial art exponent after selective thoracic fusion for Adolescent Idiopathic Scoliosis (AIS).

Summary of Background Data.

Posterior spinal fusion for AIS will result in loss of spinal flexibility. The process of rehabilitation after posterior spinal fusion for AIS remains controversial and there are few reports of return to elite sports performance after posterior spinal fusion for AIS.

Methods.

We report a case of a 25-year-old lady who was a national Wu Shu exponent. She was a Taolu (Exhibition) exponent. She underwent Selective Thoracic Fusion (T4 to T12) using alternate level pedicle screw placement augmented with autogenous local bone graft in June 2014. She commenced her training at 3-month postsurgery and the intensity of her training was increased after 6 months postsurgery. We followed her up to 2 years postsurgery and showed no instrumentation failure or lost of correction.

Results.

After selective thoracic fusion, her training process consisted of mainly speed training, core strengthening, limb strengthening, and flexibility exercises. At 17 months of postoperation, she participated in 13th World Wu Shu Championship 2015 and won the silver medal.

Conclusion.

Return to elite high-performance martial arts sports was possible after selective thoracic fusion for AIS. The accelerated and intensive training regime did not lead to any instrumentation failure and complications.

Level of Evidence: 2
In Vivo Characteristics of Nondegenerated Adjacent Segment Intervertebral Foramina in Patients With Degenerative Disc Disease During Flexion-Extension
Authors: Cha Thomas D. , Moore Gregory , Liow Ming Han Lincoln , Zhong Weiye , Wu Minfei , Wang Shaobai , Kang James D. , Wood Kirkham B. , Li Guoan
Published: July 2016

Study Design.

In vivo patient biomechanical study.

Objective.

To investigate the dimensions of lumbar intervertebral foramen (LIVF) of patients with degenerative disc disease (DDD) during a flexion-extension motion of the body.

Summary of Background Data.

LIVF narrowing may result in nerve root compression. The area changes of degenerated and adjacent nondegenerated LIVFs in DDD patients under physiologic loading conditions are unknown.

Methods.

Nine symptomatic low back pain patients with radiological evidence of L4-S1 DDD were recruited. Each subject was magnetic resonance imaging scanned for construction of three-dimensional lumbar vertebral models, and fluoroscopically imaged when the body extended from 45 flexion to full extension for reconstruction of LIVF dimensions. The data of the adjacent segment L3/4 and diseased segments L4/5 and L5/S1 were compared with a normal control group at 45 flexion, upright, and full extension of the body.

Results.

The mean LIVF areas of DDD segments were significantly smaller than those of the normal subjects in all positions (P <0.05). In upright position, the LIVF areas of the DDD patients were 32.8% and 33.6% smaller than the normal subjects for L4/5 and L5/S1, respectively. For the adjacent L3/4, the LIVF area of the DDD patients was 32.3% smaller than that of the normal controls (P <0.05). The total change of L3/4 LIVF area in DDD patients from flexion to extension was significantly smaller than that of the normal subjects, but the changes in L4/5 and L5/S1 LIVF areas were similar between the two groups (P >0.05).

Conclusion.

Similar reductions of the LIVF dimensions were observed at the adjacent and the involved levels of the DDD patients, implying that biomechanical changes might have already occurred at the adjacent segment despite the lack of radiographic evidence of degeneration. Subsequent research should focus on the effects of surgical fusion on the biomechanical features of the adjacent segment.

Level of Evidence: N/A
Image-guided adaptive brachytherapy in locally advanced cervical cancer: recent advances and perspectives
Authors: Castelnau-Marchand Pauline , Chargari Cyrus , Haie-Meder Christine , Mazeron Renaud
Published: July 2016

Purpose of review

Image-guided adaptive brachytherapy (IGABT) is a high-precision radiation that allows defining accurately treatment targets and optimizing their coverage whereas sparing efficiently the surrounding organs at risk. Ten years ago, in a will of harmonizing the reporting of brachytherapy, the Groupe Européen de Curiethérapie – European Society for Radiation Oncology (GEC-ESTRO) published recommendations on target definitions and dosimetric parameters. During the last years, clinical and dosimetric studies supporting their relevance led the International Commission on Radiation Units and Measurements to propose a report on prescribing and reporting. This review aims to highlight the recent advances in IGABT and its future developments.

Recent findings

Clinical evidence demonstrating the superiority of IGABT over radiographs-based brachytherapy is accumulating. In parallel, dose–volume effects have been established between dose–volume parameters and tumor response or the occurrence of late radiation morbidity. Preliminary studies indicate that planning aims could be adapted to clinical situations and cofactors. The first publications from the large studies led by the GEC-ESTRO enforce these findings.

A trend emerges toward a personalization of treatment with the adaptation of planning aims to prognostic features and the development of individualized applicators. Image-guidance modalities are developed with a better use of MRI or conversely the use of more accessible modalities such as transrectal ultrasound.
Presence of histological regression as a prognostic factor in cutaneous melanoma patients
Authors: Tas Faruk , Erturk Kayhan
Published: July 2016

Regression is caused by a host immunological response primarily characterized by lymphocytic infiltration directed against melanoma cells. The prognostic significance of regression remains controversial in cutaneous melanoma patients. The aim of this study was to determine the clinical significance of the histological regression status in patients with cutaneous melanoma. A total of 664 patients with a pathologically confirmed cutaneous melanoma were enrolled into this study and were investigated retrospectively. The median age of the patients was 51 years, ranging in age from 16 to 104 years. The majority of them had lesions without regression (n=495; 74.5%) and others had lesions with regression (n=169; 25.5%). Melanoma patients with regression were more frequently males (60.1 vs 51.7%; P=0.038) and had axial localized lesions (67.5 vs 53.7%; P=0.002), superficial spreading histologic subtype (73.2 vs 49.1%; P=0.000), thin Breslow depth (<2 mm) (44.6 vs 33.5%; P=0.01), and the presence of tumor-infiltrating lymphocytes (74.4 vs 60.0%; P=0.001) than those without regression. However, regression was not significantly associated with age, Clark level, mitotic rate, ulceration, vertical growth phase, neurotropism, lymphovascular invasion, nor association with a pre-existing melanocytic nevus. Similarly, no significant correlations were found between regression and lymph node involvement, recurrence, nor metastasis of disease. Patients with, nodular pathology, advanced Clark invasion level (IV–V), thick Breslow depth (≥2 mm), high mitotic rate (>3/mm2), ulceration, vertical growth phase, neurotropism, lymphovascular invasion, lymph node involvement, metastasis, and recurrence of disease, and male patients had poor prognostic variables for both relapse-free survival and overall survival. However, the presence of regression was not associated with relapse-free survival (P=0.093) nor overall survival (P=0.113) similar to other factors such as age, tumor localization, tumor-infiltrating lymphocytes, and association with a pre-existing melanocytic nevus. Similar insignificant P values were also observed in multivariate analyses (P=0.115 and 0.816, respectively). In conclusion, the presence of histological regression plays no prognostic role in nodal involvement nor survival in patients with cutaneous melanoma.
Attention-Deficit/Hyperactivity Disorder–Related Impulsivity and Cyberbullying in Social Media
Authors: Reilly Marie , Fogler Jason , Selkie Ellen , Augustyn Marilyn
Published: July 2016

CASE:

Sarah is a 13-year-old eighth grader who was recently diagnosed for the first time with attention-deficit/hyperactivity disorder (ADHD)-inattentive type, and the family elected to treat her with behavioral interventions to help her organization and attention. She had struggled with distractibility and disorganization since the fourth grade. At home, Sarah's mother described her as “spacey” and unable to complete the morning routine without constant supervision. Over time, her mother observed that it seemed as if Sarah had given up on school.

As Sarah became an adolescent, her self-esteem suffered because of her academic struggles, and she placed increasing emphasis on her appearance, including focus on remaining thin and refusing to leave the house without makeup. It was in this context that Sarah recently posted photographs of herself in various stages of undress and/or drinking alcohol on Snapchat, a photograph-sharing application in which users can send “snaps”—photographs that disappear soon after opening. However, snap recipients can take a screenshot or photograph of the snap, thereby saving the image. For unknown reasons, Sarah's close female friend took screenshots of these provocative photographs and sent them to their classmates and Sarah's older brother.

Sarah's family contacted the police and has been working with her school to address this incident. This experience resulted in significant family stress and distrust of Sarah. For example, her mother took away her cell phone and laptop and has “grounded her” for a month from all out of school activities.

Sarah's family seeks guidance regarding teaching Sarah about using social media responsibly and preventing this from happening again. Sarah's mom comes to your urgent care session asking for help because she does not feel that Sarah has “learned her lesson.” What would you do next?
Histology and Long-term Stability of Diced Cartilage Graft for Revision Rhinoplasty in a Cleft Patient
Authors: Lin Susie I. , Hsiao Yen-Chang , Chang Chun-Shin , Chen Philip Kuo-Ting , Chen Jyh-Ping , Ueng Shir-Hwa
Published: July 2016

Diced cartilage graft wrapped in Surgicel or fascia has been widely reported in the literature. Pure diced cartilage graft without the use of a “sleeve,” on the contrary, is not as commonly reported. This could be due to concerns of graft dispersion, palpability, or visibility. In this case report, histologic findings of a pure diced cartilage graft placed 4½ years ago are reported. In addition, advantages and disadvantages of this technique are discussed in detail. Two pieces of the diced cartilage graft placed 4½ years prior were excised and sent for histologic analysis during a revision procedure. The microscopic examination reveals several small blocks of mature hyaline cartilage embedded in dense fibrous connective tissue with widely scattered small vascular channels. The cartilage is vital with scattered chondrocytes within their lacunae. Histology of the diced cartilage graft demonstrated viability and stability of the graft 4½ years after insertion. This case report also suggests that pure diced cartilage graft can provide reliable volume augmentation of nasal dorsum in cleft rhinoplasty.
A Predictable Approach for Osteotomy in Rhinoplasty: A New Concept of Open External Osteotomy
Authors: Hontanilla Bernardo , Cabello Alvaro , Olivas Jesus
Published: July 2016

Nasal osteotomies are a cornerstone step for closing an open roof deformity after dorsal hump surgery. Notwithstanding, the optimal method of nasal osteotomy remains controversial, as evidenced by the variety of approaches with no consensus between authors. Moreover, the election of the technique responds to surgeon’s preference. We proposed a new way to perform both medial and lateral osteotomies under direct vision. Direct vision of nasal osteotomies provides more predictable control and precision than blind procedures, making this procedure more reliable and easier for both novel and experienced surgeons. Other advantages include conservation of nasal muscle, angular vasculature, and periosteum, which allow less postoperative ecchymosis and edema and less risk of synechia and lacrimal sac injury.
Systematic Review of Quality of Patient Information on Liposuction in the Internet
Authors: Zuk Grzegorz , Palma Adrian Fernando , Eylert Gertraud , Raptis Dimitri Aristotle , Guggenheim Merlin , Shafighi Maziar
Published: July 2016

Background:

A large number of patients who are interested in esthetic surgery actively search the Internet, which represents nowadays the first source of information. However, the quality of information available in the Internet on liposuction is currently unknown. The aim of this study was to assess the quality of patient information on liposuction available in the Internet.

Methods:

The quantitative and qualitative assessment of Web sites was based on a modified Ensuring Quality Information for Patients tool (36 items). Five hundred Web sites were identified by the most popular web search engines.

Results:

Two hundred forty-five Web sites were assessed after duplicates and irrelevant sources were excluded. Only 72 (29%) Web sites addressed >16 items, and scores tended to be higher for professional societies, portals, patient groups, health departments, and academic centers than for Web sites developed by physicians, respectively. The Ensuring Quality Information for Patients score achieved by Web sites ranged between 8 and 29 of total 36 points, with a median value of 16 points (interquartile range, 14–18). The top 10 Web sites with the highest scores were identified.

Conclusions:

The quality of patient information on liposuction available in the Internet is poor, and existing Web sites show substantial shortcomings. There is an urgent need for improvement in offering superior quality information on liposuction for patients intending to undergo this procedure.
Immunologic Abnormalities, Treatments, and Recurrent Pregnancy Loss: What Is Real and What Is Not?
Authors: WANG NATHALIE F. , KOLTE ASTRID M. , LARSEN ELISABETH C. , NIELSEN HENRIETTE S. , CHRISTIANSEN OLE B.
Published: July 2016

Recurrent pregnancy loss, depending on the definition, affects 1% to 3% of women aiming to have a child. Little is known about the direct causes of recurrent pregnancy loss, and the condition is considered to have a multifactorial and complex pathogenesis. The aim of this review was to summarize the evaluation and the management of the condition with specific emphasis on immunologic biomarkers identified as risk factors as well as current immunologic treatment options. The review also highlights and discusses areas in need of further research.
Validating Evidence and Using Standard Outcomes for Recurrent Pregnancy Loss Tests and Treatments
Authors: SCOTT JAMES R.
Published: July 2016

Unproven diagnostic tests and treatments for recurrent pregnancy loss patients can no longer be justified. The use of accepted study guidelines for conducting randomized trials, observational studies, systematic reviews and meta-analyses, diagnostic tests, animal research, and the development of standardized consensus derived outcomes would greatly improve the quality of recurrent pregnancy loss studies and their reporting.
VISION LOSS IN A PATIENT WITH PRIMARY PULMONARY HYPERTENSION AND LONG-TERM USE OF SILDENAFIL
Authors: Sajjad Ahmar , Weng Christina Y.
Published: July 2016

Purpose:

To describe a case of bilateral, asymmetrical outer macular atrophy in a patient with pulmonary hypertension treated with long-term sildenafil (Revatio).

Methods:

Case report with fundus photography, spectral domain optical coherence tomography, fundus autofluorescence, and fluorescein angiography imaging.

Results:

A 32-year-old African American woman with a history of primary pulmonary hypertension and 5-year history of oral sildenafil (Revatio) use presented with decreasing central vision in her left eye. She reported a decline in central vision in the left eye that started 1 month after treatment initiation and progressed until discontinuation 5 years later. Visual acuity was 20/20 in the right eye and 20/100 in the left eye. Fundus photography revealed retinal pigment epithelial mottling and atrophy in the right eye and parafoveal retinal pigment epithelial mottling and atrophy in a ring-like configuration of the left eye. Optical coherence tomography demonstrated outer retinal irregularity in the right eye and disrupted outer retina involving the external limiting membrane, inner segment/outer segment junction, and the retinal pigment epithelium in the left eye; no choroidal thickening was observed. Fundus autofluorescence showed mild hypoautofluorescence in the foveal center with an irregular autofluorescence pattern in the parafovea of the left eye. Fluorescein angiography revealed capillary dropout with pinpoint hyperfluorescence and leakage in the far periphery bilaterally. A window defect was also observed in the foveal center of the left eye.

Conclusion:

Sildenafil and other PDE5 inhibitors have been associated with several ocular side effects. However, this is the first report in the literature of outer macular atrophy in a patient with pulmonary hypertension and long-term use of oral sildenafil. All patients with long-term use of sildenafil should be educated on the risk of potential visual adverse effects.
Modified Scleral Tunnel to Prevent Tube Exposure in Patients With Refractory Glaucoma
Authors: Ma Xiao-hua , Du Xiu-juan , Liu Bing , Bi Hong-sheng
Published: July 2016

Purpose:

To present and evaluate modified scleral tunnel in prevention of tube exposure following Ahmed valve implantation in refractory glaucoma.

Methods:

In the Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, a retrospective study was conducted in 36 eyes of 34 patients who were diagnosed with refractory glaucoma and underwent Ahmed glaucoma valve implantation. In the surgery, the modified scleral tunnel was done to prevent tube exposure.

Results:

At the end of follow-up (mean 21.68±9.25 mo), there was no conjunctival tube exposure in all 36 eyes. The mean intraocular pressure was 18.3±6.79 mmHg, and 8 eyes needed 1 to 3 types of drugs to decrease intraocular pressure.

Conclusions:

The modified scleral tunnel technique in Ahmed glaucoma valve implantation is able to prevent conjunctival tube exposure in the patients with refractory glaucoma.
Health-related quality of life and burden of disease in chronic pain measured with the 15D instrument
Authors: Vartiainen Pekka , Heiskanen Tarja , Sintonen Harri , Roine Risto P. , Kalso Eija
Published: July 2016

Health-related quality of life (HRQoL) measurement aims to capture the complete, subjective health state of the patients and to comprehensively evaluate treatment outcomes. The aim of this study was to assess, using the 15D HRQoL instrument, HRQoL in a sample of 1528 chronic pain patients, referred to the multidisciplinary pain clinic of the Helsinki University Hospital during 2004 to 2012. The 15D results of the chronic pain patients were compared with those of a matched general population. To analyse the properties of the 15D, the results were compared with the preadmission questionnaire of the pain clinic, containing questions about background factors, aspects of the pain, and its impact on life. The mean 15D score of the chronic pain patients was one of the lowest reported using 15D; 0.710 vs 0.922 in the general population. It equalled the score of advanced cancer patients in palliative care. The 15D scores were normally distributed, and 15D showed both statistically and clinically significant discriminative power in pain-related background factors. Visual analogue scale on pain intensity, visual analogue scale on pain-related distress, and the impact of pain on daily life correlated well with the 15D score. Pain intensity did not have independent predictive value on the score. The results indicate heavy perceived burden of illness in chronic pain patients. In light of the questions analysed, 15D appears sensitive and discriminative in chronic pain patients in tertiary care. Instead of pain intensity, the impaired HRQoL in chronic pain was mainly because of the psychosocial aspects of pain.
The “Everything About the Existence” Experiences of Turkish Women With Infertility: Solicited Diaries in Qualitative Research
Authors: Boz İlkay , Okumuş Hülya
Published: July 2016

Background:

Infertility as a gynecological illness causes many psychological problems. In Turkey, only a limited number of studies have used qualitative methods to explore the experiences of infertile women.

Purpose:

The aims of this study are to investigate the infertility experiences of women using Watson’s Theory of Human Caring as a guide and to sensitize healthcare professionals to the importance of the personal stories of these women.

Methods:

A phenomenological approach was used to guide our exploration of the stories of infertile women during their treatment for infertility. This study involved 18 infertile women in Turkey. Data were collected using solicited diaries and were evaluated using thematic analysis.

Results:

The findings identified the following themes: (a) losing control of everything, (b) facing up to the angst, (c) living with the unknown, (d) alienation from the fertile world, (e) existential faith and hope, and (f) nonhealing environment.

Conclusions/Implications for Practice:

This study identified “existentialist philosophy” as the most important aspect of the infertility experience. Participant experiences highlighted that they lived with a despair that was brought about by losses resulting from the infertility diagnosis and its treatment. Nurses should help infertile women reorganize the meaning of infertility to reach a healthy interpretation of infertility.
Spontaneous Regression of Endobronchial Carcinoid Tumor
Authors: Venkatram Sindhaghatta , Sinha Nupur , Hashmi Hafiz , Niazi Masooma , Diaz-Fuentes Gilda
Published: July 2016

Spontaneous regression (SR) of cancer refers to partial or complete disappearance of a malignant tumor in the absence of treatment or in the presence of therapy, which is considered inadequate to exert a significant influence on the growth of neoplastic disease. SR is a very rare phenomenon in primary lung cancers. Follow-up of these patients is generally either by imaging or bronchoscopy. We present a patient with SR of an endobronchial carcinoid, followed by serial bronchoscopies and biopsy over a 24-month period.
Transbronchial Saline Injection to Allow Visualization and Biopsy of Peripheral Lung Nodule on Linear Endobronchial Ultrasound
Authors: Berim Ilya G. , Naveed Albert , Sahak Freshta
Published: July 2016

Two peripheral lung nodules suspicious for lung cancer were noted in a patient. Surgical and CT-guided transthoracic needle biopsies were deemed to be high risk given advanced emphysema. The patient received nondiagnostic electromagnetic navigation bronchoscopy and endobronchial ultrasound (EBUS)-guided mediastinal needle biopsies. Repeat bronchoscopy was then performed. The lung nodules were difficult to visualize with both convex probe EBUS and electromagnetic navigation bronchoscopy guidance. Normal saline injection into vicinity of the peripheral lung nodule was then used in hopes of filling airspace with fluid and improving visualization of the lung nodule. After saline injection the nodule was visualized on convex probe EBUS, allowing for diagnostic needle aspirations.
Removal of Intrapleural Foreign Body by Medical Thoracoscopy
Authors: Narasimhan Ramesh L. , Sehgal Inderpaul S. , Dhooria Sahajal , Aggarwal Ashutosh N. , Behera Digambar , Agarwal Ritesh
Published: July 2016

Intrapleural foreign body is an uncommon condition, usually encountered in the setting of thoracic trauma, but can rarely complicate diagnostic procedures such as thoracentesis. The management involves urgent identification and removal of the foreign body. Although surgical extraction using thoracotomy or video-assisted thoracoscopic surgery under general anesthesia constitutes the primary management strategy, intrapleural foreign body can also be removed using medical thoracoscopy. Herein, we report the successful removal of 2 intrapleural foreign bodies using a rigid thoracoscope under local anesthesia and conscious sedation. We also performed a systematic review of the literature describing the use of medical thoracoscopy in the retrieval of an intrapleural foreign body.
Length of endoscopic workup in gastrointestinal bleeding
Authors: Woodward Zibing , Williams J. Lucas , Sonnenberg Amnon
Published: July 2016

Background

The number of procedures utilized in the general management of gastrointestinal bleeding (GIB) has not been investigated previously. We used the National Endoscopic Database of the Clinical Outcomes Research Initiative for an observational study to analyze the average length of workup in GIB.

Methods

The electronic database was queried for all patients aged 18 years and older who underwent an endoscopic evaluation for any bleeding indication between 2000 and 2014. Data were stratified by indication, type, and number of endoscopies per patient, and length of workup.

Results

A total of 603 807 endoscopic procedures among 451 470 individual patients were used in the workup of GIB, with 152 337 procedures among 113 030 patients (25%) being performed as a secondary procedure. The average length was 2.4±0.9 procedures per workup in procedural sequences involving multiple endoscopies. The length of workup was independent of the initial type of GIB. An esophago-gastro-duodenoscopy (EGD), followed by a colonoscopy or a colonoscopy, followed by an EGD were the most frequent combinations. In another substantial fraction of two consecutive procedures, the first and the second procedure were identical. This pattern applied not only to EGD and colonoscopy but also to flexible sigmoidoscopy, enteroscopy, and video capsule endoscopy.

Conclusion

The majority of patients with GIB require only one type of endoscopy to manage their bleeding. However, in a quarter of patients, on average, 2.4 procedures are needed. Previous trials assessing the outcomes of individual types of endoscopy may have exaggerated their overall success rates in diagnosing and treating GIB.