bluuebunny/crossref_metadata_2025 huggingface dataset:
Nationally Representative Health Care Expenditures of Community-Based Older Adults with Pain in the United States Prescribed Opioids vs Those Not Prescribed Opioids
Authors: Axon David R , Slack Marion , Barraza Leila , Lee Jeannie K , Warholak Terri
Published: March 2020

Objective

To compare health care expenditures between older US adults (≥50 years) with pain who were prescribed opioid medications and those who were not.

Design

Cross-sectional.

Setting

Community-based adults in the 2015 Medical Expenditure Panel Survey (MEPS).

Subjects

Nationally representative sample of US adults alive for the calendar year, aged 50 years or older, who reported having pain in the past four weeks.

Methods

Older US adults (≥50 years) with pain in the 2015 MEPS data were identified. The key independent variable was opioid prescription status (prescribed opioid vs not prescribed opioid). Hierarchical linear regression models assessed health care expenditures (inpatient, outpatient, office-based, emergency room, prescription medications, other, and total) in US dollars for opioid prescription status from a community-dwelling US population perspective, adjusting for covariates.

Results

The 2015 study cohort provided a national estimate of 50,898,592 noninstitutionalized US adults aged ≥50 years with pain in the past four weeks (prescribed opioid N = 16,757,516 [32.9%], not prescribed opioid N = 34,141,076 [67.1%]). After adjusting for covariates, individuals prescribed an opioid had 61% greater outpatient (β = 0.477, P < 0.0001), 69% greater office-based (β = 0.524, P < 0.0001), 14% greater emergency room (β = 0.131, P = 0.0045), 63% greater prescription medication (β = 0.486, P < 0.0001), 29% greater other (β = 0.251, P = 0.0002), and 105% greater total (β = 0.718, P < 0.0001) health care expenditures. There was no difference in opioid prescription status for inpatient expenditures (P > 0.05).

Conclusions

This study raises awareness of the economic impact associated with opioid use among US older adults with pain. Future research should investigate these variables in greater depth, over longer time periods, and in additional populations.
Exploring Physical Therapist Adherence to Clinical Guidelines When Treating Patients With Knee Osteoarthritis in Australia: A Mixed Methods Study
Authors: Tang Clarice Y , Pile Rebecca , Croft Anna , Watson Narelle J
Published: March 2020

Objective

The authors aimed to understand how physical therapists used practice guidelines to manage patients with knee osteoarthritis (OA) in Australia.

Methods

This study used a concurrent triangulation mixed-method approach to explore how physical therapists applied clinical guidelines when managing patients with knee OA in an outpatient setting via completion of a semi-structured interview. Interviews were thematically analyzed by 2 investigators using an inductive approach. Themes were then triangulated to the results of an audit that evaluated the level of adherence to respective areas in the clinical guidelines among physical therapists at the participating site.

Results

One main theme and 3 subthemes were identified from 18 participants: (1) physical therapists were most confident in applying guidelines to improving range of movement and strength; (2) lack of knowledge in prescription of aerobic exercise, weight, and pain management; (3) pain is a bigger barrier in areas where knowledge is lacking; and (4) lack of clarity around the scope of practice. Themes converged with the reported level of adherence to guidelines.

Conclusions

Physical therapists commonly include range of movement and muscle strength exercises when managing people with knee OA. However, they were less confident in prescribing aerobic exercise and recommending weight and pain management strategies.

Impact

Apart from the need to upskill physical therapists in the aforementioned areas of clinical practice, the role of a physical therapist in the management of people with knee OA requires further clarification.
Decentralized Mining in Centralized Pools
Authors: Cong Lin William , He Zhiguo , Li Jiasun
Published: March 2020

The rise of centralized mining pools for risk sharing does not necessarily undermine the decentralization required for blockchains: because of miners’ cross-pool diversification and pool managers’ endogenous fee setting, larger pools better internalize their externality on global hash rates, charge higher fees, attract disproportionately fewer miners, and grow more slowly. Instead, mining pools as a financial innovation escalate miners’ arms race and significantly increase the energy consumption of proof-of-work-based blockchains. Empirical evidence from Bitcoin mining supports our model’s predictions. The economic insights inform other consensus protocols and the industrial organization of mainstream sectors with similar characteristics but ambiguous prior findings.
Predictors of implementation in the Faith, Activity, and Nutrition dissemination and implementation study: application of the Consolidated Framework for Implementation Research (CFIR) in a statewide initiative
Authors: Wilcox Sara , Jake-Schoffman Danielle E , Saunders Ruth P , Kinnard Deborah , Kaczynski Andrew T , Hutto Brent , James Katherine L
Published: March 2020

Faith-based organizations, with broad reach and trust, are well-positioned to promote health. The purpose of the study was to examine 12-month implementation and its predictors in the statewide Faith, Activity, and Nutrition (FAN) dissemination and implementation (D&I) study. Churches (n = 93; 42% predominantly African American) in the [South Carolina] Conference of the United Methodist Church trained by Community Health Advisors participated in the study. Church FAN coordinators (n = 92) completed implementation surveys regarding opportunities, policies, messages, and pastor support for physical activity (PA) and healthy eating (HE) at baseline and 12 months. FAN coordinators and pastors (n = 93) completed CFIR-based measures at baseline, immediate post-training, and 12 months. Repeated measures ANOVAs tested change in PA and HE implementation composite scores; Cohen’s d indicated magnitude of change. Mixed model linear regression tested whether CFIR items predicted 12-month implementation, controlling for baseline implementation. PA (d = 1.42) and HE (d = 2.05) implementation increased significantly over time. PA and HE implementation were significantly greater in predominantly African American (versus White) congregations, and HE implementation was greater in churches with <500 members. FAN coordinators’ ratings of the inner setting (networks/communication, culture, tension for change, organizational rewards, readiness, and congregant needs) and implementation process (engaging opinion leaders and champions) domains were most predictive of implementation outcomes. Few pastor ratings related to implementation outcomes. This study identified constructs, guided by CFIR, that may be important for understanding PA and HE implementation in churches. Future studies will need to test them for replication. Greater changes in implementation outcomes among African American churches underscores the potential of promoting health equity through this setting.
Impacts of experimental defoliation on native and invasive saplings: are native species more resilient to canopy disturbance?
Authors: Hinman Elise D , Fridley Jason D
Published: March 2020

Many non-native, invasive woody species in mesic forests of North America are both shade tolerant and more productive than their native counterparts, but their ability to tolerate disturbances remains unclear. In particular, complete defoliation associated with herbivory and extreme weather events may have larger impacts on invaders if natives maintain greater resource reserves to support regrowth. On the other hand, invaders may be more resilient to partial defoliation by means of upregulation of photosynthesis or may be better able to take advantage of canopy gaps to support refoliation. Across a light gradient, we measured radial growth, new leaf production, non-structural carbohydrates (NSCs), chlorophyll content and survival in response to varying levels of defoliation in saplings of two native and two invasive species that commonly co-occur in deciduous forests of Eastern North America. Individuals were subjected to one of the four leaf removal treatments: no-defoliation controls, 50% defoliation over three growing seasons, 100% defoliation over one growing season and 100% defoliation over two growing seasons. Contrary to our hypothesis, native and invasive species generally did not differ in defoliation responses, although invasive species experienced more pronounced decreases in leaf chlorophyll following full defoliation and native species’ survival was more dependent on light availability. Radial growth progressively decreased with increasing defoliation intensity, and refoliation mass was largely a function of sapling size. Survival rates for half-defoliated saplings did not differ from controls (90% of saplings survived), but survival rates in fully defoliated individuals over one and two growing seasons were reduced to 45 and 15%, respectively. Surviving defoliated saplings generally maintained control NSC concentrations. Under high light, chlorophyll concentrations were higher in half-defoliated saplings compared with controls, which may suggest photosynthetic upregulation. Our results indicate that native and invasive species respond similarly to defoliation, despite the generally faster growth strategy of invaders.
Complications of Hematologic Malignancies in the Emergency Department: A Primer for the Radiologist
Authors: Rajdev Maharshi , Ramaiya Nikhil
Published: March 2020

Hematologic malignancies, including diseases such as Hodgkin and non-Hodgkin lymphoma, acute and chronic lymphocytic and myelogenous leukemia, and multiple myeloma, comprise a set of prevalent and clinically diverse diseases that can affect any organ system.1 Acute life-threatening oncologic emergencies can result secondary to the underlying disease or as a result of complications of therapy, and they are common in patients with hematologic malignancies. Oncologic emergencies can be categorized as metabolic, hematologic, and structural conditions.2 Although metabolic and hematologic emergencies are diagnosed most often on the basis of clinical and laboratory findings, imaging plays a significant role in determining the underlying cause for these entities. Imaging studies play a critical role in diagnosing structural pathologic conditions, which can result in bleeding, mechanical compression, or obstruction to the hollow organs. Radiologists should be aware of the acute clinical presentations of hematologic malignancies to make an accurate, timely diagnosis and provide appropriate patient care. This article reviews, in a systematic, organ-based approach, the acute metabolic and mechanical emergencies encountered in the emergency department in patients with hematologic malignancies.
Introducing the 2020 Pathway to Excellence® manual
Authors: Bates Melissa , Hargreaves Jennifer , McCright Maggie , Pabico Christine , Hume Leigh
Published: March 2020

Building positive practice environments around the globe
BRAF and MEK inhibitors rechallenge as effective treatment for patients with metastatic melanoma
Authors: Cybulska-Stopa Bożena , Rogala Paweł , Czarnecka Anna M. , Galus Łukasz , Dziura Robert , Rajczykowski Marcin , Kubiatowski Tomasz , Wiśniewska Magdalena , Gęga-Czarnota Adrianna , Teterycz Paweł , Ziobro Marek , Suwiński Rafał , Mackiewicz Jacek , Rutkowski Piotr
Published: March 2020

Despite considerable progress made in the treatment of patients with advanced melanoma, the majority of the patients treated with BRAF and mitogen-activated protein inhibitors (BRAFi and MEKi) experience a disease progression due to acquired resistance. Currently, ongoing studies explore the possibility to overcome or reverse this process. Our multicenter retrospective analysis included 51 patients with metastatic BRAF-mutated melanoma who had previously progressed on BRAFi/MEKi than had progressed on immunotherapy (anti-progression disease-1 or anti-cytotoxic T-lymphocyte-associated protein 4) and next were rechallenged with BRAFi/MEKi. Median age at BRAFi/MEKi rechallenge was 56 (range: 31–82 y/o). Median overall survival from the start of the first BRAFi/MEKi therapy and from rechallenge BRAFi/MEKi treatment was 29.7 and 9.3 months, respectively, whereas median progression-free survival was 10.5 and 5.9 months, respectively. Six-month, annual, and 2-year overall survival rates on both treatments were: 98% and 55%, 92% and 29%, and 69% and 2%, respectively. A response rate to treatment was higher in the group receiving BRAFi/MEKi for the first time as compared with the group receiving BRAFi/MEKi rechallenge and was overall response rate 72% and 27%; disease control rate 92% and 63%. Time interval between the end of the first BRAFi/MEKi treatment and the beginning of BRAFi/MEKi rechallenge did not influence median overall survival or progression-free survival. A lower toxicity rate was noted with BRAFi/MEKi rechallenge. BRAFi/MEKi rechallenge treatment remains clinically important and is associated with the lower toxicity. BRAFi/MEKi rechallenge efficacy is higher in patients who are in good performance status, with normal lactate dehydrogenase, and without brain metastases.
Do Temporal Trends in Cancer Incidence Reveal Organ System Connections for Cancer Etiology?
Authors: Yang Wan , Terry Mary Beth
Published: March 2020

Background:

Recent studies have reported substantial increases in cancer incidence in young adults under 40 years in the United States.

Methods:

We applied hierarchical cluster analysis to identify cancer anatomical clustering, for 48 anatomic sites, using incidence trends since 1973 for 25- to 39-year-olds.

Results:

Temporal trends mapped to three major clusters in men involving six organ systems (digestive, endocrine, urinary, blood, respiratory, and male genital) and one cluster in women involving five systems (digestive, endocrine, urinary, female genital, central nervous system). For both men and women, kidney, thyroid, and colorectal cancers consistently clustered for all ages 25–39 and for each 5-year age subgroup. Further, several cancers linked to the endocrine and digestive systems (three in men and six in women) had highly consistent temporal incidence trends.

Conclusions:

These findings suggest that there may be organ system connections for cancers of the endocrine and digestive systems; etiologic approaches focused on clusters of cancers rather than individual cancers may prove fruitful.
Culture-proven Bloodstream Infections at a Specialist Pediatric Hospital
Authors: Al Yazidi Laila S. , Outhred Alexander C , Britton Philip N. , Kesson Alison
Published: March 2020

Background:

Bloodstream infection (BSI) is one of the leading causes of morbidity and mortality in children. This study was done to assess the local epidemiology and outcome of BSIs managed at a large specialist pediatric hospital with a focus on community-onset BSI.

Methods:

We retrospectively reviewed laboratory-confirmed BSI in children (0–18 years) at The Children’s Hospital at Westmead over a 3-year period (2014–2016). Laboratory data and patient medical records were used to determine BSI rates, blood culture contamination rates, patient demographics, isolate profile, antimicrobial resistance and mortality rate in this cohort.

Results:

In total, 47,368 blood cultures were collected; 1027 (2.2%) grew probable contaminants and 991 (2.1%) grew clinically significant isolates. Clinically significant bacteremia accounted for 4.8 per 1000 admissions, with 391 children managed for 465 culture-proven BSI episodes. One hundred thirty-one (28.2%) episodes were community-onset community-associated, and 334 (71.8%) were either community-onset healthcare-associated (HCA) (187; 40.2 %) or hospital-onset (147; 31.6%). Of the significant isolates, 243 (52.3%) were Gram-positive bacteria, 198 (42.6%) were Gram-negative bacteria, 6 (1.3%) were polymicrobial infections and 18 (3.9%) were yeast. Staphylococcus aureus (115; 24.7%) and Escherichia coli (54; 11.6%) were the most common organisms identified. Osteoarticular infection (44; 33.6%) and urosepsis (23; 17.6%) were the most frequent sites of infection associated with non-HCA BSI. Mortality at 30 days was reported in 15 (3.3%) children, all whom had preexisting comorbidities.

Conclusions:

The majority of BSI episodes managed in our hospital were either community-onset HCA or hospital-onset infections. This highlights the considerable importance of infection control and central venous catheter device care initiatives. Among community-associated BSI, S. aureus in association with osteoarticular infection was predominant.
Clinical and Laboratory Characteristics of Herpes Zoster in Patients With HIV/AIDS and Those With Juvenile Systemic Lupus Erythematosus
Authors: Da Silva Adriana Maria Paixao De Sousa , De Moraes-Pinto Maria Isabel , Succi Regina Célia Menezes , Terreri Maria Teresa , Machado Daisy Maria
Published: March 2020

Background:

HIV infection and juvenile systemic lupus erythematosus (jSLE) are risk factors for the development of herpes zoster (HZ) and its complications. Both diseases share similar immunologic aspects, such as immunodeficiency and immune activation. Therefore, our objective was to evaluate and compare the frequency and characteristics of HZ episodes in pediatric patients with HIV infection and jSLE.

Methods:

A retrospective cohort study was carried out with the evaluation of 2 pediatric cohorts: HIV patients who were followed from January 1987 to December 2014 and patients with jSLE followed up from January 1990 to December 2014 in outpatient clinics.

Results:

Of the 190 HIV patients, 48 had HZ (25.3%), with 67 episodes; of the 92 patients with jSLE, 27 had HZ (29.3%), totaling 28 episodes. The median age at the first episode of HZ was higher in the jSLE than in the HIV group (8.9 vs. 12.5 years, respectively) (P = 0.020). HIV patients were more likely to have recurrent HZ (P = 0.025). In addition, there was a tendency for HIV patients to present with disseminated HZ more frequently (P = 0.060). Although the hospitalization rate was similar between groups, patients with jSLE received intravenous acyclovir more frequently (P = 0.014). When HIV non-immune reconstitution syndrome patients were compared with jSLE group, recurrence of HZ in HIV was the only significant difference between groups (P = 0.017).

Conclusions:

Patients with HIV had more recurrent HZ than patients with jSLE.
Population Pharmacokinetics of Cefoxitin Administered for Pediatric Cardiac Surgery Prophylaxis
Authors: Ricci Zaccaria , Benegni Simona , Cies Jeffrey J. , Marinari Eleonora , Haiberger Roberta , Garisto Cristiana , Rizza Alessandra , Giorni Chiara , Di Chiara Luca , Arpicco Silvia , Muntoni Elisabetta , Ferrari Fiorenza , Milla Paola
Published: March 2020

Background:

Available data about pharmacokinetics (PK) of antimicrobials administered as surgical prophylaxis to children undergoing cardiac surgery with cardiopulmonary bypass (CPB) showed that drug concentrations during CPB may be supra or subtherapeutic. The aim of this study was to determine the population PK and pharmacodynamic target attainment (PTA) of cefoxitin during pediatric CPB surgery.

Methods:

A prospective interventional study was conducted. Cefoxitin (40 mg/kg, up to max 1000 mg) was administered before skin incision. Blood samples were obtained in the operatory room throughout surgery. Population PK, PTA, and safety of cefoxitin were evaluated in neonates, infants, children <10 and >10 years old.

Results:

Forty patients were enrolled. Cefoxitin levels correlated with time from bolus administration (r = −0.6, P = 0.0001) and, after 240 minutes from bolus, drug values below the target (8 mg/L) were shown. Cefoxitin concentrations were best described by a one-compartment model with first order elimination. A significant relationship was identified between body weight, age, body mass index, and serum creatinine on drug clearance and age, body weight, and body mass index on cefoxitin volume of distribution. The PTA for free drug concentration being above the minimum inhibitory concentration of 8 mg/L for at least 240 minutes was >90% in all age groups except in patients >10 years of age (PTA = 62%).

Conclusions:

Cefoxitin PK appears to be significantly influenced by CPB with generally reduced drug clearance. The PTA was adequately achieved in the majority of patients except in patients >10 years old or longer surgeries.
Pediatric Community-Acquired Bone and Joint Staphylococcus Aureus Infections In Europe
Authors: Gijón Manuel , Bellusci Marcello , Petraitiene Birute , Noguera-Julian Antoni , Glikman Daniel , Saavedra-Lozano Jesús , Neth Olaf , Daskalaki Maria , Zilinskaite Virginija , Kaiser-Labusch Petra , Prieto Luis , Rojo Pablo
Published: March 2020

To analyze host and pathogen factors related to disease severity of community-acquired bone and joint infections in children, a cohort of pediatric patients was prospectively recruited from 13 centers in 7 European countries. A total of 85 children were included, 11 (13%) had a severe infection. Panton-Valentine leukocidin–positive isolates were 17%, and 6% of the isolates were methicillin-resistant Staphylococcus aureus. Multivariate analysis identified Panton-Valentine leukocidin presence (adjusted odds ratio, 12.6; P = 0.01) as the only factor independently associated with severe outcome, regardless of methicillin resistance.
The Treatment of Acute Rheumatic Fever
Authors: Wilson Nigel J. , Concannon Anthony , Malcolm John , Davidakova Sarka , Martin William John , Webb Rachel , Moreland Nicole J.
Published: March 2020

Hydroxychloroquine (HCQ) suppresses an interleukin-1β-granulocyte-macrophage colony-stimulating factor cytokine axis, reported to be dysregulated in peripheral blood mononuclear cells of acute rheumatic fever patients ex vivo. We describe HCQ treatment for 2 patients with rheumatic carditis and a protracted inflammatory course. HCQ was associated with control of inflammatory markers, control of pericarditis in first patient and stabilization of progressive carditis in the second patient.
Viral Etiology of Acute Lower Respiratory Tract Infections in Hospitalized Children in Nagasaki, a Regional City of Japan in 2013–2015
Authors: Hasuwa Tomoyuki , Kinoshita Fumiko , Harada Sadatomo , Nakashima Kazuhisa , Yoshihara Keisuke , Toku Yuichirou , Moriuchi Hiroyuki , Yoshida Lay Myint
Published: March 2020

Background:

Acute lower respiratory tract infections (ALRIs) are the most common disease for hospitalized children in Japan. The aim of this study was to identify viruses in children hospitalized for ALRIs and to demonstrate epidemiologic and clinical characteristics in Japan.

Methods:

During a 2-year period from February 2013 to January 2015, we collected nasopharyngeal swab specimens from almost all hospitalized children with ALRIs in Nagasaki, a regional city of Japan, and its environs. Viruses were detected by multiplex polymerase chain reaction from these samples.

Results:

We detected one or more viruses from 259 (69%) of 374 patients, 227 of whom were infected with a single virus, 30 with 2, and 2 with 3 viruses. Detected viruses in this study were rhinovirus (46.4%), respiratory syncytial virus (29.7%), human metapneumovirus (6.8%), parainfluenza virus (5.5%), enterovirus D68 (3.4%), influenza virus (2.7%), adenovirus (2.4%), bocavirus (2.0%) and Coxsackie virus (1.0%). We detected a seasonal shift in respiratory syncytial virus outbreaks from the 2013–2014 to the 2014–2015 seasons. There was no significant difference in clinical course and severity among those viruses. Patients with a history of asthma or underlying diseases were older and more frequently required oxygen therapy than previously healthy patients.

Conclusions:

Viral etiology in hospitalized children with ALRIs in Nagasaki, Japan, was similar to that in many other countries. Enterovirus D68, which was recently recognized as a causative agent of severe ALRIs, was also identified in this study area. Severity of ALRIs may depend on underlying disease rather than type of etiologic virus.
A Case of Reactivation of Herpes Simplex Virus Corneal Endotheliitis Following Periocular Botulinum Toxin A Injection
Authors: Das Nibedita , Das Joyeeta , Basak Samar
Published: March 2020

Botulinum toxin type-A is a standard treatment of a variety of neurological disorders. Here, the authors report a rare ocular adverse effect after periocular Botulinum Toxin-A injection for hemifacial spasm. Three weeks after the injection, facial spasm was relieved, but the patient had dimness of vision OS. Examination revealed corneal edema, anterior-chamber reaction, keratic precipitates, and elevated intraocular pressure in OS suggesting reactivation of herpes simplex viral endotheliitis with trabeculitis. The case was successfully treated with oral acyclovir (400 mg) and topical fluorometholone 0.1% for 6 weeks. Pre- and posttreatment anterior segment optical coherence tomography clearly demonstrated the evidence of keratic precipitates. To the best of the authors' knowledge, this is the first report of herpetic reactivation in the form of corneal endotheliitis with trabeculitis after Botulinum toxin-A injection. The aim of reporting this case is to alert the clinician about the possibility of such consequence of botulinum toxin injection.
Photochemical Collagen Cross-Linking Reverses Elastase-Induced Mechanical Degradation of Upper Eyelid Tarsus
Authors: Ugradar Shoaib , Karlin Justin , Le Alan , Park Joseph , Goldberg Robert A.
Published: March 2020

Introduction:

The floppy eyelid syndrome describes an eyelid disorder characterized by floppy tarsal plates that may be caused by a loss of elastin. The authors attempted to create floppy eyelids by digesting elastin from cadaveric tarsus and then treated them with cross-linking using ultraviolet A and riboflavin.

Methods:

Nine right and 9 left upper eyelids were excised from cadavers. Four vertical strips of central tarsus were removed from each eyelid. One strip of tarsus from each eyelid was treated with 10 units/ml of elastase for 2 hours. Another tarsal strip from each eyelid was immersed in normal saline for 2 hours (control). A third strip from the same eyelid was cross-linked using ultraviolet A at 6 mW/cm2 for 18 minutes. Finally, a fourth strip of tarsus was cross-linked in the same manner following treatment with elastase for 2 hours. A microtensile load cell was used to measure the Young modulus (stiffness) of each tissue.

Results:

Mean (standard deviation) Young modulus for controls (18.9 ± 3.6 MPa) was significantly higher than samples treated with elastase alone (6.6 ± 3.8 MPa, p <0.01). Samples that were treated with cross-linking after elastase had a mean (standard deviation) Young modulus of 26 ± 2.3 MPa, while those treated with cross-linking alone had a mean (standard deviation) Young modulus of 34 ± 0.15 MPa. The differences in stiffness between all groups were significant (p <0.01).

Discussion:

Treatment with elastase significantly reduces the stiffness of tarsal plates. This effect is reversed by cross-linking, raising the possibility of using this modality for the treatment of FES.
A matched case–control study of the clinical, economic, and patient-reported outcomes of cystoid macular edema complicating phacoemulsification surgery
Authors: Sanders Francis W.B. , Lowin Peta , Gupta Nitin , Roberts Harry W.
Published: March 2020

Purpose:

To assess the visual outcomes of pseudophakic cystoid macular edema (CME) as compared with age- and copathology-matched control subjects, the costs of treatment and follow-up, and the patient-reported outcomes using the new Cat-patient-reported outcome measures (PROM) 5 questionnaire.

Setting:

West Suffolk Hospital NHS Foundation Trust, United Kingdom.

Design:

Matched case–control study.

Methods:

Fifty-two eyes of 49 patients developed CME over an 18-month period. Age- and copathology-matched patients were identified from clinical records over the same time period in a 2:1 ratio (90 eyes). Postoperative clinical outcomes were recorded including treatments received, costs of treatments, and patient-reported outcome measures using the Cat-PROM5.

Results:

Patients with CME reported a significantly worse outcome from surgery than control subjects. Furthermore, patients with CME had significantly worse visual acuity postoperatively than control subjects (CME: logarithm of the minimum angle of resolution 0.40 ± 0.33, n = 37; control subjects: 0.30 ± 0.33; P < .05) despite there being no difference in preoperative visual acuity. In patients with epiretinal membrane (ERM), notably those with CME had worse patient-reported outcomes than control subjects with ERM, and only 18% received prophylactic corticosteroid injection at surgery compared with 63.6% of control subjects. CME resulted in an excess of 266 outpatient appointments, with 388 weeks of topical therapy, 18 orbital floor injections, 6 intravitreal steroid injections, 5 intravitreal antivascular endothelial growth factor injections, and 1 intravitreal dexamethasone implant with an excess expenditure of £216.81 per case.

Conclusions:

Patients developing CME after cataract surgery had reduced visual acuity at 4 to 6 weeks, patient-reported visual outcomes, and increased number of hospital appointments, treatments, and costs.
Effect of intracameral phenylephrine 1.0%–ketorolac 0.3% on postoperative cystoid macular edema, iritis, pain, and photophobia after cataract surgery
Authors: Visco Denise M. , Bedi Raman
Published: March 2020

Purpose:

To assess the effectiveness of intracameral phenylephrine–ketorolac during cataract surgery compared with postoperative topical steroids in reducing the incidence of postoperative clinical cystoid macular edema (CME) confirmed via optical coherence tomography (OCT), breakthrough iritis, pain, and photophobia.

Setting:

Ambulatory surgical center/clinical practice.

Design:

Retrospective 2-cohort study.

Methods:

This study of cataract surgery patients compared the incidence of postoperative CME, breakthrough iritis, pain, and photophobia between patients receiving either intracameral phenylephrine 1.0%–ketorolac 0.3% during surgery or topical loteprednol 0.5% 2 days preoperatively, tapered postoperatively. Patients with prior CME or at high risk for postoperative CME, combined cataract/glaucoma surgery, and medication protocols different from those studied here were excluded. All eyes received bromfenac 2 days preoperatively and 10 weeks postoperatively.

Results:

The study enrolled 2218 eyes (n = 1402). The phenylephrine/ketorolac treatment group included 1334 eyes (n = 830) and the topical loteprednol control group included 884 eyes (n = 572). The groups were comparable in age, race, gender, and perioperative characteristics. Clinical CME incidence was significantly lower in the phenylephrine–ketorolac group (0.52% vs 1.47%, P = .021). The phenylephrine–ketorolac group also had significantly lower breakthrough iritis (1.72% vs 4.86%, P < .001) and pain (1.27% vs 4.19%, P < .001) than the topical loteprednol group. The incidence of photophobia trended lower for the phenylephrine/ketorolac group relative to the topical loteprednol group (0.90% vs 1.13%, respectively, P = .590) but was not statistically significant.

Conclusions:

Intracameral phenylephrine/ketorolac and topical nonsteroidal antiinflammatory drugs (NSAIDs) without postoperative topical steroids significantly reduced postoperative clinical CME, breakthrough iritis, and pain after cataract surgery when compared with conventional perioperative topical steroids and NSAIDs.
Supporting the Health and Well-being of Caregivers
Authors: Bouchard Karen , Brownrigg Jane , Quinlan Bonnie , Bilodeau Jean , Higdon Gloria , Tulloch Heather
Published: March 2020

Background

Caregivers contribute substantially to patients' management of and recovery from cardiovascular disease (CVD). Yet, the distress that many caregivers experience in this role continues to be underresearched and their needs undersupported.

Purpose

Situated within a patient engagement framework and adapted from experience-based co-design guidelines, the process of developing a comprehensive caregiver support resource with joint contributions from caregivers and healthcare providers representing multiple disciplines is described. A discussion of the challenges encountered during the development of the caregiver support resource and recommendations for future sites embarking on co-design work are noted.

Conclusion

Developing feasible and relevant approaches, such as informational support instruments, to meet the needs of the growing population of CVD caregivers is essential.

Clinical Implications

Although co-design processes are often complex, take more time and resources to implement, and involve multiple levels of an organization and community than traditional practices, these efforts may help to improve healthcare quality to stem the burden of CVD.
Associations Between Bioaerosol Exposures and Lung Function Changes Among Dairy Workers in Colorado
Authors: Martenies Sheena E. , Schaeffer Joshua W. , Erlandson Grant , Bradford Mary , Poole Jill A. , Wilson Ander , Weller Zachary , Reynolds Stephen J. , Magzamen Sheryl
Published: March 2020

Objective:

Limited studies have examined effects of bioaerosols on the respiratory health of dairy workers; previous findings have been inconsistent across populations.

Methods:

Using a repeated measures design, exposures to dust, bioaerosols, and ozone were assessed and pre- and post-shift spirometry was performed for dairy workers (n = 36). Workers completed 1 to 8 visits. Linear mixed effect models estimated associations between air pollutant constituents and changes in spirometry.

Results:

There was an association between higher dust exposures and increased peak expiratory flow rate. However, for all other outcomes there was no association with the exposures considered.

Conclusions:

Relationships between bioaerosol exposures and respiratory health in dairy workers remain unclear. Future studies should increase sample sizes, include repeated measures designs, vary the timing of spirometry measurements, and include markers for Gram positive bacteria such as muramic acid or peptidoglycan.
Changes in Wide-band Tympanometry Absorbance Following Cochlear Implantation
Authors: Saoji Aniket A. , Shapiro Scott B. , Finley Charles C. , Koka Kanthaiah , Cassis Adam M.
Published: March 2020

Objective:

Determine if changes in middle ear absorbance measured with wide-band tympanometry (WBT) occur following hearing-preservation cochlear implantation (CI). Such measures may provide insight into the mechanisms of acoustic hearing loss postimplantation.

Study Design:

Clinical capsule report.

Setting:

Tertiary academic referral center.

Design:

WBT absorbance was measured bilaterally during pre- and postoperative clinical office visits in five unilaterally-implanted cochlear implant recipients. Pre- and postoperative WBT measures were compared within each subject in the implanted and contralateral, unimplanted ears.

Results:

In general, WBT absorbance measurements show a broad spectral pattern including two or three distinct peaks measured over a frequency range of 226 to 8000 Hz. Grand average and linear mixed model comparisons between the pre- and postoperative WBT patterns show significantly reduced (p < 0.05) low-frequency absorbance in the implanted ears in the frequency region over 0.6 to 1.1 kHz, but not in the unimplanted ears. The maximum effect occurred at 1 kHz with absorbance decreasing from ∼0.8 to ∼0.5 after implantation. The limited data are consistent with expected relationships between WBT absorbance and air- and bone-conduction thresholds, assuming an increased air-bone gap reflects conductive hearing loss.

Conclusion:

Cochlear implantation can result in reduction of low-frequency acoustic absorbance as measured by WBT. WBT may be a useful and sensitive tool for monitoring the mechanical status of the middle and inner ears following cochlear implantation.
Unusual Locations of Benign Paroxysmal Positional Vertigo: Rare Entity or Regular Occurrence?
Authors: Fath Léa , Vuong-Chaney Hella , Rohmer Dominique , Lamy Michael , Baumgartner Daniel , Simon François , Debry Christian , Charpiot Anne
Published: March 2020

Introduction:

According to the literature and our recent experience, even if patients present with symptoms strongly suggestive of benign paroxysmal positional vertigo (BPPV), the observed positional nystagmus does not always correspond to any previously described typical location. The aim of this multicentric study was to evaluate the frequency of both typical and less common forms of BPPV.

Material and Methods:

All consecutive patients presenting with BPPV in two hospitals between November 2016 and October 2017 were included. For each subject, answers to a standardized evaluation form and a recorded videonystagmoscopy were obtained by two otorhinolaryngologists. Appropriate diagnostic and therapeutic maneuvers were performed.

Results:

A total of 532 patients were studied and 491 cases of typical BPPV were found: 370 cases of canalolithiasis of the posterior semicircular canal (SCC), 3 cases of canalolithiasis of the anterior SCC, 107 cases of canalolithiasis of the lateral SCC, and 11 cases of cupulolithiasis of the lateral SCC. Fourty one patients reported symptoms suggestive of BPPV with positional nystagmus that could correspond to unusual locations of otoconia in the SCC: 18 cases of canalolithiasis in the anterior ampulla of the lateral SCC, 16 cases of posterior short arm canalolithiasis, four cases of pseudo-spontaneous nystagmus in canalolithiasis of the lateral SCC, and three cases of canalolithiasis of the posterior third of SCC.

Discussion:

Unusual BPPV accounted for almost 8% of BPPV treated in our clinics; it is paramount to know how to diagnose them, to carry out the appropriate therapeutic maneuvers and relieve these patients.
Congenital External Auditory Canal Cholesteatoma Resected by a Transcanal Endoscopic Approach
Authors: Ohki Masafumi , Kikuchi Shigeru
Published: March 2020

Objective:

To describe the first case of congenital external auditory canal cholesteatoma resected via a transcanal endoscopic approach and describe the possible pathologenesis of cholesteatoma.

Patient:

A 2-year-old female patient presented with a cholesteatoma that extended from the floor of the external auditory bony canal to the inferior quadrant of her right tympanic membrane.

Intervention:

Otological examinations and computed tomography were performed. The cholesteatoma was resected using a transcanal endoscopic approach.

Results:

Pathologic examination confirmed the diagnosis of external auditory canal cholesteatoma. The patient's postoperative hearing was observed to be normal. Cholesteatoma did not recur during the 2-year follow-up period. Computed tomography scan revealed an isodense mass, partly surrounded by bony tissue, on the floor of the external auditory canal, outside of the inferior quadrant of an intact tympanic membrane. A minor malformation of the bony tissue, covering the inferiolateral surface of the cholesteatoma, was observed. The proposed mechanisms of pathogenesis are: 1) the embryonic developmental deficits of the meatal plug, during its differentiation into squamous epithelium, cause the arrest of ectodermal tissues, 2) a remnant of the squamous epithelium becomes trapped in the niche of the foramen tympanicum.

Conclusion:

A rare case of congenital external auditory canal cholesteatoma, located on the inferior external auditory canal, was diagnosed and resected using a transcanal endoscopic approach. It was possibly caused by a minor anomaly of the first branchial cleft or by a remnant of the squamous epithelium trapped in the foramen tympanicum.
Hold the Salt: History of Salt Restriction as a First-line Therapy for Menière's Disease
Authors: Shim Timothy , Strum David Poran , Mudry Albert , Monfared Ashkan
Published: March 2020

Objectives:

To determine the historical origins of the usage of the salt restriction diet as an intervention for Menière's disease (MD).

Methods:

Articles on MD and salt restriction were identified using Pubmed and Google scholar. Original manuscripts from 19th and 20th century as well as selected otological textbooks in English, German, and French were also reviewed.

Results:

The oldest recommendation of salt restriction in the literature was by Dederding (1889–1955) in 1929. She and her mentor, Sydney Holger Mygind (1884–1970), believed MD was caused by dysfunctional water metabolism. In several published manuscripts, they proposed that a reduced salt and fluid diet was an effective treatment for MD. Their contemporaries supported their findings, most notably, Albert C. Furstenberg (1890–1969) who suggested salt restriction alone as treatment for MD. Furstenberg, in his initial study implementing salt restriction in 15 patients with MD and then in a larger study with 150 patients, was the first to produce results that supported salt restriction as therapy for MD. It was not until 1980, when LB Jongkees first published his criticism of this treatment, that salt restriction was questioned. Since then, numerous published articles have been critical of salt restriction therapy and skeptical of its initial adoption into clinical practice.

Conclusions:

Since Dederding's and Mygind's publications in 1929 and Furstenberg's trial in 1934, the salt restriction diet has remained a primary first-line treatment for MD. Since the 1950s, various publications have both supported and argued this treatment, and the evidence of its validity remains inconclusive.
The Cochlear Cleft: CT Correlation With Histopathology
Authors: Pucetaite Milda , Quesnel Alicia M. , Juliano Amy F. , Curtin Hugh D. , Reinshagen Katherine L.
Published: March 2020

Objective:

To show the histologic correlate of the cochlear cleft, a small low density focus just anterior to the oval window seen on computed tomography (CT) in three temporal bone specimens.

Patients:

Three temporal bone specimens donated to the National Temporal Bone Registry from patients aged 34 weeks gestation, 42 years, and 89 years with cochlear clefts seen on CT were studied.

Intervention:

Review and comparison of postmortem high-resolution CT and temporal bone histopathology

Main Outcome Measure:

Correlation of CT findings with temporal bone histopathology.

Results:

The cochlear cleft visible on CT as a pericochlear lucency anterior to the oval window corresponds to fatty marrow in areas of incomplete endochondral ossification of the otic capsule. The cochlear cleft is distinct from the fissula ante fenestram and can be present in adults.

Conclusion:

In these three cases, the cochlear cleft represents an area of fatty marrow from incomplete ossification of the otic capsule and can be present in adults. Care should be taken when interpreting temporal bone CT to avoid mistaking the cochlear cleft for true pathology (otosclerosis) of the temporal bone.
The effect of short foot exercise using visual feedback on the balance and accuracy of knee joint movement in subjects with flexible flatfoot
Authors: Kim Ju Sang , Lee Mi Young
Published: March 2020

Background:

Flexible flatfoot is a condition characterized by the deformations of the foot where the calcaneus is pronated by weight support. Flat feet can affect balance and the entire chain of motion, causing indirect problems in adjacent joints. We investigated the effects of short foot exercise (SFE) using visual feedback on the static balance and function of proximal joints in subjects with flexible flat feet.

Method and analysis:

This study involved 30 participants who were assigned to either of the 2 groups: the flexible flatfoot group (n = 15, 8 men and 7 women, aged 22.00 ± 2.07 years) and normal foot group (n = 15, 7 men and 8 women, aged 22.13 ± 1.55 years). All subjects performed the SFE with visual feedback. SFE programs were performed 20 minutes a day, 5 times a week, for a total of 5 weeks. The static balance and accuracy of knee joint motions were compared before and after training.

Results:

There was a significant difference in static balance pre- and post-exercise in the flatfoot group but not in the normal foot group. Moreover, in the flatfoot group, the accuracy of knee joint motions was significantly different between pre- and post-exercise in the closed chain but not in the open chain.

Conclusion:

This study examined the influence of SFE using visual feedback on the balance and accuracy of knee joint movements in subjects with flatfoot and demonstrated that this exercise, using visual feedback, improved the balance and accuracy of knee movement.
Carotid plaque magnetic resonance imaging and recurrent stroke risk
Authors: Deng Fengbin , Mu Changping , Yang Ling , Li Huaqinag , Xiang Xuemei , Li Kang , Yang Qingjun
Published: March 2020

Background:

MRI findings of carotid plaque components have been studied recently as a tool to predict recurrent ischemic events. We performed a systematic review and meta-analysis to summarize the association of MRI-determined intraplaque hemorrhage, lipid-rich necrotic core, and thinning/rupture of the fibrous cap with recurrent ischemic events.

Methods:

Electronic search was performed in PUBMED, EMBASE, Cochrane Controlled Register of Trials (CENTRAL) from inception to Oct 30, 2018. We included cohort studies with an average follow-up time of more than 1 month in which intraplaque hemorrhage, lipid-rich necrotic core, or thinning/rupture of the fibrous cap were associated with recurrent ipsilateral stroke or ischemic events. We performed heterogeneity assessment before carrying out meta-analysis. According to the heterogeneity, we selected fixed-effect model for meta-analysis of the included cohort studies.

Results:

Using a prespecified search strategy, of the 2128 articles, 6 studies with a total number of 621 participants met eligibility for systematic review and meta-analysis. The hazard ratios of intra-plaque hemorrhage, thinning/rupture of the fibrous cap and lipid rich necrotic core as recurrent Stroke/Transient ischemic attack (TIA) were 7.14(95% confidence interval, 4.32 to 11.82), 5.68(95% confidence interval, 2.40 to 13.47), and 2.73(95% confidence interval, 1.04 to 7.16), respectively. No significant heterogeneity was found in the 3 meta-analyses.

Conclusions:

The presence of intraplaque hemorrhage, lipid-rich necrotic core, and thinning/rupture of the fibrous cap on MRI of carotid plaque are strong predictors of recurrent stroke events. However, due to the lack of original studies, larger cohort studies are warranted.
Primary thymic mucosa-associated lymphoid tissue lymphoma complicated with renal amyloidosis
Authors: Chen Qin , Du Yongjing , Prince Singh , Zhang Ping , Li Guisen , Wang Li , Wang Wei
Published: March 2020

Introduction:

Primary mucosa-associated lymphoid tissue (MALT) lymphomas originating in thymus is rare. And, there have been few reports of patients with MALT coexisting with amyloidosis. As far as we know, this was the first case report on MALT lymphoma associated with renal amyloidosis.

Patient concerns:

A 57-year-old man presented with nephrotic syndrome. Further workup revealed IgM-Lambda type monoclonal gammopathy. Bone marrow biopsy showed 8% clonal plasma cells. Renal biopsy confirmed the diagnosis of Lambda light chain AL amyloidosis. positron emission tomography/computed tomography showed thymic lesions which upon biopsy were diagnosed as MALT lymphoma of the thymus.

Diagnosis:

Primary thymic MALT lymphoma complicated with renal amyloidosis.

Interventions:

The patient underwent surgical resection of the thymus mass and 2 courses of chemotherapy.

Outcomes:

Follow-up data showed that the patient survived 18 months after surgical excision and chemotherapy.

Conclusion:

The case highlights the importance of screening for malignancy in patients with renal amyloidosis.