bluuebunny/crossref_metadata_2025 huggingface dataset:
The surgical treatment of spinal deformity in children with myelomeningocele: the role of personalized three-dimensional printed models
Authors: Karlin Lawrence , Weinstock Peter , Hedequist Daniel , Prabhu Sanjay P.
Published: November 2016

This study was carried out to evaluate the benefits of personalized three-dimensional printing as an aid to the performance of surgery for the correction of spinal deformity in children with myelomeningocele. We performed a retrospective review to include all such children for whom personalized three-dimensional spine models were used for surgical planning (group A) and compared them through subjective and objective criteria to a similar group that had no models (group B). The seven children in group A were younger and had more complex deformities than the 10 children in group B. The models provided a markedly improved appreciation of the complex anatomy and enabled the planning and performance of patient-specific spinal instrumentation that was secure and low profile. The efficiency of the surgery as measured by intraoperative fluoroscopy time and blood loss and the extent of the deformity correction was comparable or superior in group A.
Correlation between transverse plan kinematics and foot progression angle in children with spastic diplegia
Authors: Presedo Ana , Simon Anne-Laure , Mallet Cindy , Ilharreborde Brice , Mazda Keyvan , Pennecot Georges-François
Published: November 2016

In diplegic patients, the orientation of foot progression depends on multiple factors. We investigated the relationship between foot progression alignment, hip and pelvic rotations during gait, femoral anteversion, and tibial torsion. Kinematic and clinical parameters were evaluated for 114 children who walked independently and had not undergone previous surgery. Causes of intoeing presented combined in 72% of cases. Internal foot progression correlated with internal hip rotation and showed an inverse correlation with tibial torsion. Our results indicate that data from clinical examination and gait analysis should be evaluated carefully before making treatment recommendations, especially in terms of the correction of torsional problems, in patients with cerebral palsy.
Exploratory Study of Rural Physicians' Self-Directed Learning Experiences in a Digital Age
Authors: Curran Vernon , Fleet Lisa , Simmons Karla , Ravalia Mohamed , Snow Pamela
Published: November 2016

Introduction:

The nature and characteristics of self-directed learning (SDL) by physicians has been transformed with the growth in digital, social, and mobile technologies (DSMTs). Although these technologies present opportunities for greater “just-in-time” information seeking, there are issues for ensuring effective and efficient usage to compliment one's repertoire for continuous learning. The purpose of this study was to explore the SDL experiences of rural physicians and the potential of DSMTs for supporting their continuing professional development (CPD).

Methods:

Semistructured interviews were conducted with a purposive sample of rural physicians. Interview data were transcribed verbatim and analyzed using NVivo analytical software and thematic analysis.

Results:

Fourteen (N = 14) interviews were conducted and key thematic categories that emerged included key triggers, methods of undertaking SDL, barriers, and supports. Methods and resources for undertaking SDL have evolved considerably, and rural physicians report greater usage of mobile phones, tablets, and laptop computers for updating their knowledge and skills and in responding to patient questions/problems. Mobile technologies, and some social media, can serve as “triggers” in instigating SDL and a greater usage of DSMTs, particularly at “point of care,” may result in higher levels of SDL. Social media is met with some scrutiny and ambivalence, mainly because of the “credibility” of information and risks associated with digital professionalism.

Discussion:

DSMTs are growing in popularity as a key resource to support SDL for rural physicians. Mobile technologies are enabling greater “point-of-care” learning and more efficient information seeking. Effective use of DSMTs for SDL has implications for enhancing just-in-time learning and quality of care. Increasing use of DSMTs and their new effect on SDL raises the need for reflection on conceptualizations of the SDL process. The “digital age” has implications for our CPD credit systems and the roles of CPD providers in supporting SDL using DSMTs.
Flipping the Continuing Medical Education Classroom: Validating a Measure of Attendees' Perceptions
Authors: Stephenson Christopher R. , Wang Amy T. , Szostek Jason H. , Bonnes Sara L. , Ratelle John T. , Mahapatra Saswati , Mandrekar Jayawant N. , Beckman Thomas J. , Wittich Christopher M.
Published: November 2016

Introduction:

New teaching approaches for CME are needed. In flipped classrooms, coursework is completed beforehand and applied during class time. Studies of flipped classrooms and their potential benefits in CME have not been published. We sought to develop and validate an instrument measuring flipped classroom perceptions, identify whether participation changed perceptions, and determine which flipped classroom components were perceived as most effective.

Methods:

In this cross-sectional validation study, 167 participants in the Mayo Clinic's 2015 Internal Medicine Board Review course received surveys. Online modules were developed to deliver content before flipped classroom courses on acid-base disorders and electrolyte disorders. A flipped classroom perception instrument (FCPI) was developed and validated. The FCPI, with eight items structured on 5-point Likert scales, was given to participants before and after their flipped classroom experiences.

Results:

Of the 167 participants, 111 returned surveys. Flipped classroom perceptions improved, with mean (SD) FCPI scores increasing from 3.74 (0.75) to 3.94 (0.76) (P < .001). The percentage of participants who preferred flipped classrooms increased from 38% before the course to 53% after (P = .002). Positive changes in FCPI scores were unrelated to module completion. Most participants thought knowledge was enhanced by in-class sessions and online modules equally.

Discussion:

The FCPI, the first validated measure of participants' perceptions of a CME flipped classroom, has strong validity evidence. Participants' perceptions of and preference for the flipped classroom improved after experiencing the flipped CME classroom. These findings support the need to further explore flipped classroom models in CME.
A Novel Measure of “Good” Mentoring: Testing Its Reliability and Validity in Four Academic Health Centers
Authors: Pololi Linda H. , Evans Arthur T. , Civian Janet T. , Gibbs Brian K. , Gillum Linda H. , Brennan Robert T.
Published: November 2016

Introduction:

Despite the well-recognized benefits of mentoring in academic medicine, there is a lack of clarity regarding what constitutes effective mentoring. We developed a tool to assess mentoring activities experienced by faculty and evaluated evidence for its validity.

Methods:

The National Initiative on Gender, Culture, and Leadership in Medicine—“C-Change”—previously developed the C-Change Faculty Survey to assess the culture of academic medicine. After intensive review, we added six items representing six components of mentoring to the survey—receiving help with career and personal goals, learning skills, sponsorship, and resources. We tested the items in four academic health centers during 2013 to 2014. We estimated reliability of the new items and tested the correlation of the new items with a mentoring composite variable representing faculty mentoring experiences as positive, neutral, or inadequate and with other C-Change dimensions of culture.

Results:

Among the 1520 responding faculty (response rate 61–63%), there was a positive association between each of the six mentoring activities and satisfaction with both the amount and quality of mentoring received. There was no difference by sex. Cronbach α coefficients ranged from 0.89 to 0.95 across subgroups of faculty (by sex, race, and principal roles). The mentoring responses were associated most closely with dimensions of Institutional Support (r = 0.58, P < .001), Institutional Change Efforts for Faculty Support (r = 0.52, P < .001), Values Alignment (r = 0.58, P < .001), Self-efficacy (r = 0.43; P < .001), and Relationships/Inclusion/Trust (r = 0.41; P < .001).

Discussion:

Data demonstrated that the Mentoring scale is a valid instrument to assess mentoring. Survey results could facilitate mentoring program development and evaluation.
Integrating Quality Improvement and Continuing Professional Development at an Academic Medical Center: A Partnership Between Practice Plan, Hospital, and Medical School
Authors: Gold Barbara , England Dawn , Riley William , Jacobs-Halsey Ginny , Webb Corinne , Daniels Bobbi
Published: November 2016

Introduction:

While quality improvement (QI) initiatives can be a highly effective means for improving health care delivery in academic medical centers (AMCs), many health care professionals are not formally trained in basic QI methodology, engaging clinicians in QI activities can be challenging, and there is often a lack of integration and coordination among QI functions (eg, Departments of Quality and Safety, Continuing Professional Development). In our AMC, we undertook a collaborative approach to achieve better vertical and horizontal integration of our QI education efforts. This article provides a case example describing our organizational context, what was done, and with what effect and makes our example and lessons learned available to others.

Methods:

We developed a new educational QI program that was jointly planned and implemented by a group comprising major QI stakeholders. This project was intended to create horizontal organizational linkages between continuing professional development, clinicians, the hospital, and QI department and produce QI activities that aligned with the strategic objectives of senior management.

Results:

The group developed and implemented a curriculum based on Lean methodology and concepts from the Institute for Health Care Improvement Model for Improvement. Two cohorts (27 teams) completed the training and planned and implemented QI projects. All projects were aligned with organizational quality, safety, and patient experience goals. The majority of projects met their aim statements.

Discussion:

This case description provides an example of successful horizontal integration of an AMCs' QI functions to disseminate knowledge and implement meaningful QI aligned with strategic objectives (vertical integration).
Assessing Clinical Faculty Understanding of Statistical Terms Used to Measure Treatment Effects and Their Application to Teaching
Authors: Hazelton Lara , Allen Michael , MacLeod Tanya , LeBlanc Constance , Boudreau Michelle
Published: November 2016

Introduction:

Understanding of statistical terms used to measure treatment effect is important for evidence-informed medical teaching and practice. We explored knowledge of these terms among clinical faculty who instruct and mentor a continuum of medical learners to inform medical faculty learning needs.

Methods:

This was a mixed methods study that used a questionnaire to measure a health professional's understanding of measures of treatment effect and a focus group to explore perspectives on learning, applying, and teaching these terms. We analyzed questionnaire data using descriptive statistics and focus group data using thematic analysis.

Results:

We analyzed responses from clinical faculty who were physicians and completed all sections of the questionnaire (n = 137). Overall, approximately 55% were highly confident in their understanding of statistical terms; self-reported understanding was highest for number needed to treat (77%). Only 26% of respondents correctly responded to all comprehension questions; however, 80% correctly responded to at least one of these questions. There was a significant association among self-reported understanding and ability to correctly calculate terms. A focus group with clinical/medical faculty (n = 4) revealed themes of mentorship, support and resources, and beliefs about the value of statistical literacy.

Discussion:

We found that half of clinical faculty members are highly confident in their understanding of relative and absolute terms. Despite the limitations of self-assessment data, our study provides some evidence that self-assessment can be reliable. Recognizing that faculty development is not mandatory for clinical faculty in many centers, and the notion that faculty may benefit from mentorship in critical appraisal topics, it may be appropriate to first engage and support influential clinical faculty rather than using a broad strategy to achieve universal statistical literacy. Second, senior leadership in medical education should support continuous learning by providing paid, protected time for faculty to incorporate evidence in their teaching.
Improving the Reach of the National Diabetes Prevention Program Within a Health Disparities Population: A Bronx New York Pilot Project Crossing Health- and Community-Based Sectors
Authors: Morrow Robert , Ferretti Lisa , Norwood Chris , Reich Douglas , Chito-Childs Erica , McCallion Phillip , Tiburcio Jose , McGee Eleanor , Lopez Jose A.
Published: November 2016

Introduction:

Diabetes affects upward of 30% of South Bronx residents. The Centers for Disease Control and Prevention's National Diabetes Prevention Program (NDPP) reduces risk of progression to diabetes, yet implementation has been elusive within health disparities populations.

Methods:

This community-based, collaborative project piloted the NDPP in the South Bronx and evaluated implementation challenges and enablers. The New York State training group prepared community peer lifestyle coaches recruited by a community organization. A professional society trained academic detailers from local faculty. An interview process evaluated community needs and public health officials' beliefs. A portal managed by the New York State training group collected demographic and biometric data from the community participants and facilitated online registration. Data from interviews and observations were coded systematically using a thematic analysis framework.

Results:

We were successful at recruiting and training 14 lifestyle coaches and 7 academic detailers, as well as recruiting members of the health disparities population in the South Bronx into the program. Fifty-two individuals completed the first 6 months of the yearlong program, attending an average of 12.7 of 16 sessions. By week 16, weight loss averaged 7.4 lbs and many had doubled their minutes of physical activity. Local electronic referral and feedback systems were developed.

Discussion:

Health professionals, their teams, public health centers, and communities can work together to prevent diabetes by enhancing the reach of the NDPP to health disparities populations. Peer education using lifestyle coaches can provide a trustworthy process for crossing the boundaries between health teams and community support groups.
Coffee consumption and risk of nonmelanoma skin cancer: a dose–response meta-analysis
Authors: Vaseghi Golnaz , Haghjoo-Javanmard Shaghayegh , Naderi Jamal , Eshraghi Azadeh , Mahdavi Manijeh , Mansourian Marjan
Published: November 2016

Several epidemiological studies have evaluated the associations between coffee consumption and the risk of skin cancer; however, the results were not conclusive. This systematic review and meta-analysis of the cohort and case–control studies was carried out to determine the association between coffee intake and the risk of nonmelanoma skin cancer. Studies were identified by searching the PubMed and MEDLINE databases (to November 2015). Study-specific risk estimates were pooled under the random-effects model. We separately estimated the relative risk of the three conditions, for exposure to different doses of coffee consumption, kind of study design, and analysis restricted to the basal cell carcinoma type. The summary relative risks for nonmelanoma skin cancer were 0.96 [95% confidence interval (CI): 0.92–0.99] for one cup of coffee, 0.92 (95% CI: 0.88–0.97) for one to two cups of coffee, 0.89 (95% CI: 0.86–0.93) for two to three cups of coffee, and 0.81 (95% CI: 0.77–0.85) for more than three cups of coffee per day, respectively. This meta-analysis suggested that caffeinated coffee might have chemopreventive effects against basal cell carcinoma dose dependently. However, other prospective studies are warranted to confirm these effects.
Location and Grade of Prostate Cancer Diagnosed by Transperineal Template-guided Mapping Biopsy After Negative Transrectal Ultrasound-guided Biopsy
Authors: Bittner Nathan , Merrick Gregory , Taira Al , Bennett Abbey , Schattel Amy , Butler Wayne , Galbreath Robert , Adamovich Edward
Published: November 2016

Objectives:

To determine the location and grade of prostate cancer diagnosed by transperineal template-guided mapping (TTMB) after negative transrectal ultrasound-guided (TRUS) biopsy.

Materials and Methods:

This analysis consisted of 1118 consecutive patients who underwent TTMB from January 2005 to August 2015. Eight hundred thirty-five underwent TTMB after at least 1 negative TRUS biopsy and 283 underwent TTMB as the first biopsy procedure. The study population was divided into cohorts based on the number of prior TRUS biopsy sessions (0, 1, 2, and ≥3). No patient underwent multiparametric magnetic resonance imaging. Differences in location and cancer grade detected on TTMB were evaluated as a function of the number of prior TRUS biopsies.

Results:

Of the 1118 patients, 679 were diagnosed with prostate cancer. This included 208, 325, 104, and 42 patients who underwent 0, 1, 2, and ≥3 prior TRUS biopsies. The incidence of cancer detection on TTMB decreased as the number of prior TRUS biopsies increased (73.5% vs. 62.4% vs. 51.7% vs. 37.2%, P<0.001); however, it became increasingly likely that TTMB would detect anterior prostate only as the number of prior TRUS biopsies increased (P=0.007). Moreover, the incidence of high grade cancer (Gleason score ≥7) in the anterior gland increased with the number of previous TRUS biopsies.

Conclusions:

TTMB detected prostate cancer in over half of the patients with one or more negative TRUS biopsies. The majority of TTMB detected cancers were Gleason score ≥7. As the number of prior TRUS biopsies increased, there was a commensurate increase in the proportion of high-grade, anterior only disease.
Safety and Outcome Measures of First-in-Human Intraperitoneal α Radioimmunotherapy With 212Pb-TCMC-Trastuzumab
Authors: Meredith Ruby F. , Torgue Julien J. , Rozgaja Tania A. , Banaga Eileen P. , Bunch Patty W. , Alvarez Ronald D. , Straughn J. Michael , Dobelbower Michael C. , Lowy Andrew M.
Published: November 2016

Purpose:

One-year monitoring of patients receiving intraperitoneal (IP) 212Pb-TCMC-trastuzumab to provide long-term safety and outcome data. A secondary objective was to study 7 tumor markers for correlation with outcome.

Methods:

Eighteen patients with relapsed intra-abdominal human epidermal growth factor receptor-2 expressing peritoneal metastases were treated with a single IP infusion of 212Pb-TCMC-trastuzumab, delivered <4 h after 4 mg/kg IV trastuzumab. Seven tumor markers were studied for correlation with outcome.

Results:

Six dose levels (7.4, 9.6, 12.6, 16.3, 21.1, 27.4 MBq/m2) were well tolerated with early possibly agent-related adverse events being mild, transient, and not dose dependent. These included asymptomatic, abnormal laboratory values. No late renal, liver, cardiac, or other toxicity was noted up to 1 year. There were no clinical signs or symptoms of an immune response to 212Pb-TCMC-trastuzumab, and assays to detect an immune response to this conjugate were negative for all tested. Tumor marker studies in ovarian cancer patients showed a trend of decreasing Cancer antigen 72-4 (CA 72-4) aka tumor-associated glycoprotein 72 (TAG-72) and tumor growth with increasing administered radioactivity. Other tumor markers, including carbohydrate antigen (CA125), human epididymis protein 4 (HE-4), serum amyloid A (SAA), mesothelin, interleukin-6 (IL-6), and carcinoembryonic antigen (CEA) did not correlate with imaging outcome.

Conclusions:

IP 212Pb-TCMC-trastuzumab up to 27 MBq/m2 seems safe for patients with peritoneal carcinomatosis who have failed standard therapies. Serum TAG-72 levels better correlated to imaging changes in ovarian cancer patients than the more common tumor marker, CA125.
Academic Achievement in Adults with a History of Childhood Attention-Deficit/Hyperactivity Disorder: A Population-Based Prospective Study
Authors: Voigt Robert G. , Katusic Slavica K. , Colligan Robert C. , Killian Jill M. , Weaver Amy L. , Barbaresi William J.
Published: November 2016

Objective:

Previous research on the developmental course of attention-deficit/hyperactivity disorder (ADHD) is limited by biased clinic-referred samples and other methodological problems. Thus, questions about adult academic outcomes associated with childhood ADHD remain unanswered. Thus, the objective of this study was to describe academic outcomes in adulthood among incident cases of research-identified childhood ADHD versus non-ADHD referents from a population-based birth cohort.

Method:

Young adults with research-identified childhood ADHD (N = 232; mean age 27.0 yr; 72.0% men) and referents (N = 335; mean age 28.6 yr; 62.7% men) from a 1976 to 1982 birth cohort (N = 5699) were invited to participate in a followup study and were administered an academic achievement battery consisting of the basic reading component of the Woodcock-Johnson III Tests of Achievement (WJ-III) and the arithmetic subtest of the Wide Range Achievement Test—Third Edition (WRAT-3). Outcomes were compared between the 2 groups using linear regression models, adjusted for age, sex, and comorbid learning disability status.

Results:

Childhood ADHD cases scored from 3 to 5 grade equivalents lower on all academic tests compared with referents, with mean (SD) standard scores of 95.7 (8.4) versus 101.8 (8.1) in basic reading; 95.0 (9.3) versus 101.9 (8.5) in letterword identification; 98.2 (8.6) versus 103.2 (9.2) in passage comprehension; 95.7 (9.1) versus 100.9 (9.0) in word attack; and 87.8 (12.9) versus 98.0 (12.0) in arithmetic.

Conclusion:

This is the first prospective, population-based study of adult academic outcomes of childhood ADHD. Our data provide evidence that childhood onset ADHD is associated with long-term underachievement in reading and math that may negatively impact ultimate educational attainment and occupational functioning in adulthood.
Surveillance: A Nursing Intervention for Improving Patient Safety in Critical Care Environment
Authors: Pfrimmer Dale M. , Johnson Maren R. , Guthmiller Martha L. , Lehman Joanna L. , Ernste Vickie K. , Rhudy Lori M.
Published: November 2016

Background:

Nursing surveillance has been identified as a key intervention in early recognition and prevention of errors/adverse events. Nursing Intervention Classification (NIC) defines surveillance as “the purposeful and ongoing acquisition, interpretation, and synthesis of patient data for clinical decision making.” Because nurses are the main staffing constant in the critical care environment, the importance of surveillance as an intervention is fundamental.

Objective:

The aim of this study was to explore how surveillance is expressed by critical care nurses.

Methods:

A descriptive exploratory research design was used. Think-aloud was used for data collection. Twenty-one registered nurses from 3 critical care units participated in the study. Participants were asked to say out loud whatever they were thinking as they performed patient care at 3 time points: during handoff, initial patient assessment, and after 4 hours of care. Think-aloud (saying aloud what one is thinking) represents the information (cues) that is attended to in short-term memory, before it has been processed and stored. Data were analyzed using content analysis with key concepts and themes identified.

Results:

The expression of surveillance was through the main theme of finding meaning. Surveillance involved (a) knowing the patient, (b) shared understanding and decision making, and (c) thinking ahead. The outcomes of these activities were aimed at finding meaning in the cues that emerged as the overarching theme.

Discussion:

Surveillance was expressed through nurses’ gathering cues, reflecting on past knowledge, asking questions, verifying, and pulling it all together to find meaning. During handoff, surveillance involved collaborative cognitive work to find meaning in cues.
Role of orexin-2 and CB1 receptors within the periaqueductal gray matter in lateral hypothalamic-induced antinociception in rats
Authors: Esmaeili Mohammad-Hossein , Reisi Zahra , Ezzatpanah Somayeh , Haghparast Abbas
Published: November 2016

Orexin plays an important role in pain modulation. Orexin-1 and orexin-2 receptors (Ox1r and Ox2r) are found at high density in the ventrolateral periaqueductal gray matter (vlPAG). Our previous study showed that chemical stimulation of the lateral hypothalamus with carbachol induces antinociception in the tail-flick test, a model of acute pain, and Ox1r-mediated antinociception in the vlPAG is modulated by the activity of vlPAG CB1 receptors. In the current study, TCS OX2 29, an Ox2r antagonist (5, 15, 50, 150, and 500 nmol/l), was microinjected into the vlPAG 5 min before the administration of carbachol (125 nmol/l). TCS OX2 29 dose dependently reduced carbachol-induced antinociception. In a second set of experiments, animals were treated with carbachol 5 min after intra-vlPAG administration of 15 nmol/l TCS OX2 29 and 1 nmol/l AM251 (a selective CB1 receptor antagonist), or 150 nmol/l TCS OX2 29 and 10 nmol/l AM251. The findings showed that the antinociceptive effect of orexin is partially mediated by activation of vlPAG Ox2 receptors. Furthermore, the administration of ineffective doses of Ox2 and CB1 receptor antagonists reduced the lateral hypothalamus-induced antinociception. It seems that Ox2 and CB1 receptors act through different pathways and Ox2r-mediated antinociception is not dependent on CB1 receptor activity.
Levels of Care Burden and Self-efficacy for Informal Caregiver of Patients With Cancer
Authors: Yildiz Esra , Karakaş Sibel Asi , Güngörmüş Zeynep , Cengiz Mine
Published: November 2016

This descriptive study was conducted to determine the levels of self-efficacy and caregiver burden experienced by caregivers for patients with cancer. The study was conducted at the oncology clinic of a hospital in Erzurum city, Turkey. The study sample consisted of 101 caregivers of patients hospitalized with a diagnosis of cancer. The Self-Efficacy Scale Turkish version and the Zarit Caregiver Burden Scale, which is a sociodemographic questionnaire, were used for data collection. The level for the burden of care for caregivers to patients with cancer was moderate, and the level of self-efficacy was moderate. A statistically significant, positive relationship was found between the scores for the Care Burden Scale and the Completing Behavior Subscale (r = 0.213; P < .05). A statistically significant, negative relationship was observed between the mean scores of the Care Burden Scale with Self-Efficacy Scale's total score (r = −0.104; P < .05), Sustaining Behavior Subscale (r = −0.324; P < .01), and Initiating Behavior Subscale (r = −0.199; P ≤ .05). Therefore, initiatives focused on self-efficacy levels should be developed to increase the abilities of caregivers for patients with cancer.
AIR TAMPONADE COMBINED WITH NONSUPINE POSITIONING IN MACULAR HOLE SURGERY FOR PSEUDOPHAKIC EYES
Authors: Forsaa Vegard A. , Krohn Jørgen
Published: November 2016

Purpose:

To investigate the closure rate of primary full-thickness macular hole, following intraocular air tamponade combined with a nonsupine positioning regimen.

Methods:

A prospective study of patients with full-thickness macular hole, who underwent pars plana vitrectomy with internal limiting membrane peeling and intraocular air tamponade followed by 3 days of nonsupine positioning. Outcome measures were primary full-thickness macular hole closure and improvement in best-corrected visual acuity after 6 months.

Results:

A total of 34 eyes were included. In the group of full-thickness macular hole ≤400 μm, primary closure occurred in 95% (19/20), whereas only 57% (8/14) of those >400 μm closed (P = 0.01). The mean gain in best-corrected visual acuity was 3.5 ETDRS (Early Treatment Diabetic Retinopathy Study) lines (SD = 1.5) (P < 0.01). The air bubble meniscus height at the first postoperative day was estimated to a mean of 59% (range, 50–70%), at the second postoperative day it was 46% (range, 40–55%), and the third day it was 39% (range, 30–45%). Mean intraocular air bubble duration was 10 days (range, 8–13 days).

Conclusion:

The combination of air tamponade and nonsupine positioning regimen leads to high closure rates for small/medium macular holes (≤400 μm), but not for large macular holes (>400 μm).
Can pancreatic cancer behavior be predicted based on computed tomography measurements of fat and muscle mass?
Authors: Clark Whalen , Swaid Forat , Luberice Kenneth , Bowman Ty A. , Downs Darrell , Ross Sharona B. , Rosemurgy Alexander S.
Published: November 2016

Introduction:

Many studies purport that obesity, and specifically visceral fat, impact survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. However, these studies involve crude measures of obesity [eg, body mass index (BMI)] or visceral fat [eg, linear measurements on computed tomographic (CT) scans]. Some studies purport that weight loss and muscle wasting (ie, sarcopenia) presage poor survival in these patients. This study was undertaken to accurately measure and reexamine the impact of visceral fat, subcutaneous fat, and sarcopenia on pancreatic cancer.

Materials and methods:

CT scans of 100 patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma were reviewed using specialized software to precisely determine the cross-sectional area (CSA) of subcutaneous fat, visceral fat, and psoas muscles at the level of L5 vertebra. In addition, linear measurements of subcutaneous fat and visceral fat were undertaken. Measures of cancer progression included tumor (T) status, nodal (N) status, American Joint Committee on Cancer stage, and overall survival after resection. Regression analysis was utilized, with and without standardization of all measurements to body size. Median data are presented.

Results:

The median patient age was 67 years, with a BMI of 24 kg/m2. Cancer stage was IIB for 60% of patients. BMI, CSA of visceral fat, CSA for subcutaneous fat, CSA for psoas muscles, and linear measurements of visceral and subcutaneous fat were not significantly related to any measures of cancer progression or survival. Standardization to body size did not demonstrate any relationships with cancer progression or survival.

Conclusions:

Precise and reproducible measures of visceral fat, subcutaneous fat, and muscle mass, even when standardized to body size, do not predict cancer progression or survival in patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma. Pancreatic cancer biology and behavior is too complex to predict with a CT scanner. The main focus of pancreatic cancer research should continue to be at the molecular, genetic, and immunologic levels.
A Comparative Analysis of Goldmann Tonometry Correction
Authors: Asejczyk-Widlicka Magdalena , Srodka Wieslaw , Pierscionek Barbara K.
Published: November 2016

Purpose:

The measurement of intraocular pressure (IOP) by Goldmann applanation tonometry (GAT) is based on assumptions about corneal parameters. To correct for variations in corneal curvature and thickness, a number of equations have been proposed. This study evaluates the in vivo accuracy of these equations from individuals with primary open-angle glaucoma and compared them with measurements taken using the Pascal dynamic contour tonometer (DCT), which makes no assumptions about the corneal geometry or biomechanics.

Participants and Methods:

The study included 108 participants with primary open-angle glaucoma (47 male and 61 female) with an age range of 39 to 81 years. Participants were recruited from the Glaucoma Clinic at Wroclaw Medical University. A full ophthalmologic examination was conducted on all participants. Participants were divided into 3 groups depending on IOP as measured by GAT. Six formulae were applied and the results were compared with measurements taken with DCT.

Main Outcome Measures:

To determine as to which formula provides the closest value to IOP measured with DCT.

Results:

For IOP values ≤29 mm Hg, 2 of the formulae showed the smallest and comparable mean differences and SDs between corrected IOP values obtained with GAT and those measured with DCT. For IOP≥30 mm Hg, the formula derived from the model of corneal applanation that takes into account corneal buckling showed the closest agreement with measurements taken using DCT.

Conclusions:

Correction formulae provide widely varying results and their appropriateness can depend on the IOP values.
Prevalence and Visual Outcome of Glaucoma With Uveitis in a Thai Population
Authors: Pathanapitoon Kessara , Smitharuck Sarunya , Kunavisarut Paradee , Rothova Aniki
Published: November 2016

Objective:

The aim of this study was to report on the prevalence of uveitic secondary glaucoma (USG) and ocular hypertension in patients with uveitis in Thailand, and to identify factors associated with the development of USG and its visual outcome.

Design:

This is a retrospective cohort study.

Methods:

We included 174 consecutive uveitis patients (237 affected eyes) visiting the Ophthalmology Department of Chiang Mai University Hospital, Thailand, from January 2013 to March 2013.

Results:

The prevalence of USG was 29% (51/174) and that of ocular hypertension was 18% (32/174). The follow-up period ranged from 3 to 96 months (mean±SD=33±21 mo). Characteristics associated with the development of USG were as follows: age at onset of uveitis above 60 years and longer duration of uveitis (P=0.001). No association between location of uveitis and development of USG was observed. Clinical entities associated with the highest prevalence of USG consisted of Posner-Schlossman syndrome and herpetic uveitis. Within the anterior uveitis group, viral etiology was strongly associated with the development of USG, whereas human leukocyte antigen-B27 (HLA-B27)-associated anterior uveitis had lower prevalence of USG than did their HLA-B27-negative counterparts. The prevalence of patients with at least 1 blind eye was significantly higher in those who developed USG (21/51; 41%) than in uveitis patients without glaucoma (22/123; 18%, P=0.001). Characteristics associated with visual loss in USG included poor visual acuity at presentation (P<0.001), and undergoing glaucoma surgery (P<0.05).

Conclusions:

The prevalence of secondary glaucoma among Southeast Asian patients with uveitis was 29%. Blindness in at least 1 eye developed more commonly in patients with USG than in uveitis patients without USG.
“Salt in the Wound”
Authors: Bunce Arwen E. , Gold Rachel , Davis James V. , Mercer MaryBeth , Jaworski Victoria , Hollombe Celine , Nelson Christine
Published: November 2016

Electronic health record (EHR) data can be extracted for calculating performance feedback, but users' perceptions of such feedback impact its effectiveness. Through qualitative analyses, we identified perspectives on barriers and facilitators to the perceived legitimacy of EHR-based performance feedback, in 11 community health centers (CHCs). Providers said such measures rarely accounted for CHC patients' complex lives or for providers' decisions as informed by this complexity, which diminished the measures' perceived validity. Suggestions for improving the perceived validity of performance feedback in CHCs are presented. Our findings add to the literature on EHR-based performance feedback by exploring provider perceptions in CHCs.
Integration of Medical Scribes in the Primary Care Setting
Authors: Imdieke Brian H. , Martel Marc L.
Published: November 2016

There are little published data on the use of medical scribes in the primary care setting. We assessed the feasibility of incorporating medical scribes in our ambulatory clinic to support provider documentation in the electronic medical record. In our convenience sampling of patient, provider, and staff perceptions of scribes, we found that patients were comfortable having scribes in the clinic. Overall indicators of patient satisfaction were slightly decreased. Providers found scribe support to be valuable and overall clinician documentation time was reduced by more than 50% using scribes.
Leveraging Electronic Health Record Implementation to Facilitate Clinical and Operational Quality Improvement in an Ambulatory Surgical Clinic
Authors: Bobadilla Joseph L. , Roe Cathy S. , Estes Patricia , Lackey Jennifer , Steltenkamp Carol L.
Published: November 2016

The implementation of electronic health records is a challenging, complex process requiring significant resources. The temptation is to convert a paper process into electronic format. This strategy fosters a familiar product to the users but is fraught with pitfalls. We chose to utilize the opportunity of the implementation of an enterprise-wide ambulatory electronic health record to foster an overreaching clinical and operational improvement project in a multispecialty surgical ambulatory clinic practice. We interrogated every aspect of the practice: clinic design, scheduling, physical space, staffing, and clinical and operational workflows. We present here the results of a 3-year process improvement.
Method for Predicting Deformation Characteristics of Prosthetic Feet
Authors: Zhao Stacey R. , Haberman Andrea , Li Qingguo , Bryant J. Tim
Published: November 2016

Introduction

Although clinical studies have found that individuals with amputation prefer prosthetic feet that provide energy return, biomechanical studies investigating these findings have been mixed. The objective of this study was to develop a method that predicts the deformation of a prosthetic foot during a standardized loading profile representing gait. The specific aim was to provide insight into the timing aspects of mechanical properties influenced by features of the device.

Materials and Methods

Mechanical properties were measured from a series of force-deflection curves obtained at specific loads and shank angles extracted from a standard dataset used in ISO22675. Five commercially available prosthetic feet with differing design features and structural properties were analyzed to provide the predicted vertical deflection as a function of normalized stance time.

Results

The method successfully identified differences in features across different designs and across differing weight classes of a similar design. Furthermore, it was observed that in most specimens tested, the predicted peak displacement did not occur at the peak loading. In the heel, peak displacement led the peak force, whereas in the forefoot, peak displacement lagged the peak force. The observations of heel displacement lead and forefoot displacement lag reflect the nonlinear mechanical characteristics of these devices and the complex loading expected during gait.

Conclusion

The method extends those currently used by describing deformation throughout stance and predicting temporal aspects of prosthetic foot mechanical properties related to loading during prosthetic gait. Future studies should address how individual user loading characteristics affect these measurements.
Comparison of health-related quality of life and disability in ulcerative colitis patients following restorative proctocolectomy with ileal pouch-anal anastomosis versus anti-tumor necrosis factor therapy
Authors: van Gennep Sara , Sahami Saloomeh , Buskens Christianne J. , van den Brink Gijs R. , Ponsioen Cyriel Y. , D’Hoore André , de Buck van Overstraeten Anthony , van Assche Gert , Ferrante Marc , Vermeire Séverine , Bemelman Willem A. , D’Haens Geert R.A.M. , Löwenberg Mark
Published: November 2016

Background and aims

Health-related quality of life (HRQL) and disability were compared in ulcerative colitis (UC) patients who underwent restorative proctocolectomy versus patients who received treatment with anti-tumor necrosis factor (anti-TNF) agents.

Patients and methods

UC patients who underwent restorative proctocolectomy or started anti-TNF treatment between January 2010 and January 2015 were included at two tertiary referral centers. A matched cohort was created using propensity score matching for the covariates disease duration, Montreal classification, age, and sex. HRQL and disability were assessed using the Colorectal Functional Outcome (COREFO), Inflammatory Bowel Disease Disability Index (IBD-DI), EuroQol-5D-3L, and Short Form 36 (SF-36) questionnaires.

Results

In total, 297 patients were included, of whom 205 (69%) patients responded. Fifty-nine pouch patients were matched to 59 anti-TNF-treated patients. Pouch patients reported better general health scores (P=0.042) compared with the anti-TNF group (SF-36). No differences were found for the EuroQol-5D-3L and IBD-DI between the two groups. Pouch patients had significantly higher COREFO scores compared with anti-TNF-treated patients for ‘stool frequency’ (P<0.001), ‘antidiarrheal medication use’ (P<0.001), and ‘stool-related aspects’ (P=0.004), of which the latter was because of a higher perianal skin irritation frequency (P<0.001).

Conclusion

UC patients who underwent restorative proctocolectomy reported a higher bowel movement frequency and more perianal skin irritation compared with anti-TNF-treated patients, but this did not affect overall disease-specific disability outcomes. Patients in the surgery group reported better outcomes for generic health compared with those in the anti-TNF group.
Management of post-transplant lymphoproliferative disorders
Authors: Llaurador Gabriela , McLaughlin Lauren , Wistinghausen Birte
Published: November 2016

Purpose of review

Post-transplant lymphoproliferative disease (PTLD) is a major complication of hematopoietic stem cell and solid organ transplantation. The incidence of transplantation in childhood has been steadily rising, making PTLD the most common form of lymphoproliferation in childhood. The purpose of this review is to summarize the role of the Epstein–Barr virus (EBV) in the pathophysiology and discuss the management of PTLD.

Recent findings

More than 90% of pediatric PTLD is EBV-positive. In immunocompetent hosts, the virus is controlled by cytotoxic T-cells, the cells targeted by immunosuppression to avoid graft-versus-host disease and/or organ rejection in transplant patients. The majority of pediatric transplant candidates are EBV-negative prior to transplant increasing the risk of EBV-induced lymphoproliferation upon seroconversion after transplant. Treatment options include reduction of immunosuppression, anti-CD20 monoclonal antibodies, and/or chemotherapy. Advanced understanding of the importance of cellular immunity in controlling lymphoproliferation has led to the development of cellular therapies targeting virus-specific antigens.

PTLD is the most common form of lymphoproliferation in childhood due to the rising incidence of transplantation. EBV plays a pivotal role in the pathophysiology. Cellular therapies targeting viral antigens may replace chemotherapy in the treatment of PTLD in the near future.
Bartter's and Gitelman's syndrome
Authors: Seyberth Hannsjörg W. , Weber Stefanie , Kömhoff Martin
Published: November 2016

Purpose of review

The clinical presentations of Bartter's syndrome and Gitelman's syndrome will be reviewed including two most recently described hypokalemic salt-losing tubulopathies. By taking the quite heterogeneous presentations and the apparently different pathophysiologies as the basis, the applicability of the physiologic classification has been tested.

Recent findings

According to the physiologic approach, salt-losing tubulopathies can be divided into two major groups (with completely different tubular defects): first, disorders of the thick ascending limb of Henle's loop (loop disorders); second, disorders of the distal convolute tubule (DCT disorders). A combination of these two groups with complety different tubular defects will finally lead to a third group: the combined loop/DCT disorders. On the basis of pharmacologic tests (pharmacotyping), it appears that the Bartter's syndrome V belongs to the DCT group, whereas the most recently described transient antenatal Bartter's syndrome best fits in the group with the loop and DCT combination.

Besides secondary hyperaldosteronism, loop disorders present a whole spectrum of (secondary) pathophysiologic characteristics with significant diagnostic and therapeutic impact, such as polyhydramnios, hyperprostaglandinuria, nephrogenic diabetes insipidus, and nephrocalcinosis. Recent reports indicate that neonatal hyperparathyroidism has also to be added to the clinical presentation of isolated loop disorders.

As long as gene therapy is not available, the overall therapeutic management follows the clinical presentation, which leads to the underlying pathophysiology of renal salt wasting. Thus, when dealing with Bartter's syndrome and Gitelman's syndrome, the correct physiologic and pharmacologic characterization appears to be essential for a sound diagnostic and therapeutic patient management.
Lactobacillus reuteri DSM 17938 in the Treatment of Functional Abdominal Pain in Children
Authors: Jadrešin Oleg , Hojsak Iva , Mišak Zrinjka , Kekez Alemka Jaklin , Trbojević Tena , Ivković Lana , Kolaček Sanja
Published: November 2016

Objectives:

Beneficial therapeutic effect of probiotics has been reported in children with the irritable bowel syndrome (IBS) but not consistently in other functional abdominal pain‐related disorders. The aim of the present study was to investigate the effect of Lactobacillus reuteri DSM 17938 in the treatment of functional abdominal pain (FAP) and IBS in children.

Methods:

Children (age 4–18 years) referred to pediatric gastroenterologist at Children's Hospital Zagreb from May 2012 to December 2014, diagnosed as FAP or IBS, were randomized to receive L reuteri DSM 17938 108 CFU daily or placebo. The study was a prospective, randomized, double‐blind, placebo‐controlled parallel study. Symptoms were evaluated using Wong‐Baker FACES pain rating scale for pain and Bristol scale for stool shape and consistence.

Results:

Data were analyzed for 55 children (26 in the intervention group and 29 in the placebo group). Children in the intervention group had significantly more days without pain (median 89.5 vs 51 days, P = 0.029). Abdominal pain was less severe in children taking probiotics during the second month (P < 0.05) and fourth month (P < 0.01). The 2 groups did not differ in the duration of abdominal pain, stool type, or absence from school. Both groups experienced significant reduction in the severity of abdominal pain from first to fourth month, with the reduction more prominent in the intervention group (P < 0.001 vs P = 0.004).

Conclusions:

Administration of L reuteri DSM 17938 was associated with a possible reduction of the intensity of pain and significantly more days without pain in children with FAP and IBS.
Diet and Stress in Pediatric Eosinophilic Esophagitis
Authors: Case Christine , Furuta Glenn T. , Atkins Dan , Pan Zhaozing , Robinson Jane
Published: November 2016

Clinical experiences and recent studies suggest that eosinophilic esophagitis (EoE) has the potential to induce caregiver (CG) and child stress. The specific sources of CG EoE‐related stress remain uncertain. To address this, we performed a survey of CGs and youth attending a patient with EoE education symposium that measured potential stressful elements in their daily life. Our results indicated that CGs experienced most stress associated with purchasing, preparation, and completion of meals. We conclude that providers should consider this in choosing therapeutic approaches for children with EoE.