bluuebunny/crossref_metadata_2025 huggingface dataset:
Temporary pacing
Authors: Gorenek Bulent
Published: February 2018

Temporary cardiac pacing by electrical stimulation of the heart is indicated as a short-term treatment of life-threatening bradyarrhythmias or tachyarrhythmias. It can be used temporarily until the arrhythmias resolve or as a bridge to permanent pacing. Symptomatic bradycardias needing temporary pacing may occur in acute myocardial infarction, during percutaneous coronary intervention, and in patients with sinus node dysfunction. Temporary pacing can also be useful for terminating or suppressing some types of supraventricular and ventricular arrhythmias. Single-chamber, dual-chamber, or biventricular pacing modes can be used. In haemodynamically compromised patients, dual-chamber pacing is preferred. Ideally, this procedure is performed under fluoroscopy, but electrode catheters can also be inserted without fluoroscopy, with ECG and/or pressure monitoring. Several methods of temporary pacing are available: transvenous, external, and transoesophageal pacing. Transvenous pacing is the most commonly used technique. Although this method is safe and easy, some complications related to venous access or caused by the inserted electrode catheters or by an electrical dysfunction of the pacing device may occur, either during or after the implantation.
Portable (short-term) mechanical circulatory support
Authors: Price Susanna , Vranckx Pascal
Published: February 2018

Mechanical circulatory support can be used to resuscitate patients, as a stabilizing measure for angiography and prompt revascularization, or to buy time until more definite measures can be taken. In addition, there is experimental evidence that ventricular unloading of the left ventricle can significantly reduce the infarct size. Different systems for mechanical circulatory support are available to the medical community. Treatment options for mechanical circulatory support must be tailored to each patient in order to maximize the potential benefits and minimize the risk of detrimental effects. Intra-aortic balloon pumping is still the most widely used mechanical circulatory support therapy. The relative ease and speed with which this device can be applied to patients with a rapidly deteriorating haemodynamic picture have led to its widespread use as a first-line intervention among critically unstable patients. Where intra-aortic balloon pumping is inadequate, an immediate triage to a more advanced percutaneous (short-term) mechanical circulatory support may be warranted. Despite their extensive use, the utility of mechanical circulatory support devices in acute heart failure syndromes and cardiogenic shock remains uncertain. This chapter concentrates on the application of mechanical circulatory support relevant to the interventional cardiologist and cardiac intensive care physician.
Atherosclerosis and thrombosis
Authors: Badimon Lina , Vilahur Gemma
Published: February 2018

Atherosclerosis is the main underlying cause of heart disease. The continuous exposure to cardiovascular risk factors induces endothelial activation/dysfunction which enhances the permeability of the endothelial layer and the expression of cytokines/chemokines and adhesion molecules. This results in the accumulation of lipids (low-density lipoprotein particles) in the intimal layer and the triggering of an inflammatory response. Accumulated low-density lipoprotein particles attached to the extracellular matrix suffer modifications and become pro-atherogenic, enhancing leucocyte recruitment and further transmigration across the endothelium into the intima. Infiltrated pro-atherogenic monocytes (mainly Mon2) differentiate into macrophages which acquire a specialized phenotypic polarization (protective/M1 or harmful/M2), depending on the stage of the atherosclerosis progression. Once differentiated, macrophages upregulate pattern recognition receptors capable of engulfing modified low-density lipoprotein, leading to foam cell formation. Foam cells release growth factors and cytokines that promote vascular smooth muscle cell migration into the intima, which then internalize low-density lipoproteins via low-density lipoprotein receptor-related protein-1 receptors becoming foam cells. As the plaque evolves, the number of vascular smooth muscle cells decline, whereas the presence of fragile/haemorrhagic neovessels and calcium deposits increases, promoting plaque destabilization. Disruption of this atherosclerotic lesion exposes thrombogenic surfaces rich in tissue factor that initiate platelet adhesion, activation, and aggregation, as well as thrombin generation. Platelets also participate in leucocyte and progenitor cell recruitment are likely to mediate atherosclerosis progression. Recent data attribute to microparticles a modulatory effect in the overall atherothrombotic process and evidence their potential use as systemic biomarkers of thrombus growth. This chapter reviews our current understanding of the pathophysiological mechanisms involved in atherogenesis, highlights platelet contribution to thrombosis and atherosclerosis progression, and provides new insights into how atherothrombosis may be prevented and modulated.
Percutaneous coronary interventions in acute coronary syndromes
Authors: Kočka Viktor , Kristensen Steen Dalby , Wijns William , Toušek Petr , Widimský Petr
Published: February 2018

Three different guidelines of the European Society of Cardiology cover the field of percutaneous coronary interventions. Their main recommendations are the following: All patients with an ST-segment elevation myocardial infarction should undergo immediate coronary angiography and percutaneous coronary intervention as soon as possible after the first medical contact. Thrombolysis can be used as an alternative reperfusion therapy if the time delay to primary percutaneous coronary intervention is more than 2 hours. Patients with very high-risk non-ST-segment elevation acute coronary syndromes (recurrent or ongoing chest pain, profound or dynamic electrocardiogram changes, major arrhythmias, or haemodynamic instability) should undergo urgent coronary angiography within less than 2 hours after the initial hospital admissionAll moderate- to high-risk (GRACE score >140 or at least one primary high-risk criterion) non-ST-segment elevation acute coronary syndromes patients should undergo coronary angiography before discharge; the ideal timing is within 24 hours after admission for high-risk groups, and within 72 hours for moderate-risk groups. Other patients with recurrent symptoms or at least one high-risk criterion should undergo coronary angiography within 72 hours of first presentation. Low-risk non-ST-segment elevation acute coronary syndromes may be treated conservatively, and the indication for an invasive evaluation can be done, based on the evidence of ischaemia during exercise stress testing. Stents should be used during all percutaneous coronary intervention procedures, whenever technically feasible. Second-generation drug-eluting stents do not increase stent thrombosis and can be safely used in the ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome settings. Triple pharmacotherapy, consisting of aspirin, thienopyridine antiplatelet agent, and anticoagulation with heparin or bivalirudin, should be used in all percutaneous coronary intervention procedures, with glycoprotein IIb/IIIa inhibitors added in patients with a high thrombus burden and low bleeding risk.
Acute heart failure: early pharmacological therapy
Authors: Dalzell Jonathan R , Jackson Colette E , Gardner Roy , McMurray John JV
Published: February 2018

Acute heart failure syndromes consist of a spectrum of clinical presentations due to an impairment of some aspect of the cardiac function. They represent a final common pathway for a vast array of pathologies and may be either a de novo presentation or, more commonly, a decompensation of pre-existing chronic heart failure. Despite being one of the most common medical presentations, there are no definitively proven prognosis-modifying treatments. The mainstay of current therapy is oxygen and intravenous diuretics. However, within this spectrum of presentations, there is a crucial dichotomy which governs the ultimate treatment approach, i.e. the presence, or absence, of cardiogenic shock. Patients without cardiogenic shock may receive vasodilators, whilst shocked patients should be considered for treatment with inotropic therapy or mechanical circulatory support, when appropriate and where available.
Pulmonary embolism
Authors: Torbicki Adam , Kurzyna Marcin , Konstantinides Stavros
Published: February 2018

Pulmonary embolism is usually a consequence of deep vein thrombosis, and together the two conditions are known as venous thromboembolism. Non-thromboembolic causes of pulmonary embolism are rare. Pulmonary thromboembolism is a potentially life-threatening disease, if left untreated. This is due to a natural tendency towards early recurrence of pulmonary emboli which may lead to fatal right ventricular failure. In more severe cases, secondary right ventricular failure may result from myocardial ischaemia and injury caused by systemic hypotension and adrenergic overstimulation. Clinical presentation of pulmonary embolism is non-specific and may include dyspnoea, chest pain, haemoptysis, syncope, hypotension, and shock. Patients with suggestive history, symptoms, and signs require an immediate triage which determines further management strategy. Computerized tomographic angiography has become the mainstay of diagnosis. However, depending on the clinical presentation, treatment decisions may also be made based on results from other tests. In particular, in high-risk patients with persistent hypotension or shock, bedside echocardiography may be the only available test to identify patients in need of primary thrombolysis, surgical embolectomy, or percutaneous intervention which will stabilize the systemic cardiac output. For most normotensive patients, anticoagulation is sufficient as initial treatment. However, in the presence of signs of right ventricular dysfunction and myocardial injury monitoring is recommended to allow prompt rescue reperfusion therapy in case of haemodynamic decompensation.
Is a Single Fecal Microbiota Transplant a Promising Treatment for Recurrent Clostridium difficile Infection?
Authors: Hota Susy S , Poutanen Susan M
Published: February 2018

Clostridium difficile infection, a common hospital-associated infection, is a gastrointestinal illness that becomes recurrent in about 25% of infected patients. Fecal microbiota transplantation (FMT) is increasingly supported by clinical trials as an effective treatment for recurrent Clostridium difficile infection, but a number of questions remain about how it can be optimally performed. In this Perspective, we discuss controversies in FMT methodologies and reporting within randomized controlled trials, all of which may influence clinical outcomes in treated patients. Finally, we focus on the question of whether single vs multiple FMTs are necessary to achieve favorable outcomes for the treatment of recurrent Clostridium difficile infection, postulating on why there may be an association between number of FMTs and clinical effectiveness.
Autonomous Trajectory Planning for External Ventricular Drain Placement
Authors: Beckett Joel S , Gaonkar Bilwaj , Babayan Diana , Mathew Justin , McArthur David , Salamon Noriko , Martin Neil , Yang Isaac , Macyszyn Luke
Published: February 2018

BACKGROUND

External ventricular drain (EVD) placement is the most frequently performed neurosurgical procedure for management of various conditions including hydrocephalus, traumatic brain injury, and stroke. State-of-the-art computational pattern recognition techniques could improve the safety and accuracy of EVD placement. Placement of the Kocher's point EVD is the most common neurosurgical procedure which is often performed in urgent conditions.

OBJECTIVE

To present the development of a novel computer algorithm identifying appropriate anatomy and autonomously plan EVD placement on clinical computed tomography (CT) scans.

METHODS

The algorithm was tested on 2 data sets containing 5-mm slice noncontrast CT scans. The first contained images of 300 patients without significant intracranial pathology (normal), the second of 43 patients with significant acute intracranial hemorrhage. Automated planning was performed by custom 2-tiered heuristic with run-time template selection in combination with refinement using nonlinear image registration.

RESULTS

Automated EVD planning was accurate in 297 of 300 normal and 41 of 43 patient cases. In the normal data set, mean distance between Kocher's point and the ipsilateral foramen of Monro was 63 ± 3.1 mm in women and 65 ± 6.5 mm in men (P = .0008). Trajectory angle with respect to the sagittal plane was 91 ± 6° in women and 90 ± 6° in men (obtuse posterior) (P = .15); to the coronal plane, 85 ± 6° and 86 ± 5° in women and men (P = .12), respectively (acute lateral).

CONCLUSION

A combination of linear and nonlinear image registration techniques accurately planned EVD trajectory in 99% of normal scans and 95% of scans with significant intracranial hemorrhage.
Impact of health challenges on pig growth performance, carcass characteristics, and net returns under commercial conditions
Authors: Cornelison A S , Karriker L A , Williams N H , Haberl B J , Stalder K J , Schulz L L , Patience J F
Published: February 2018

Understanding how disease affects commercial production is imperative for pig producers to quantify its full impact on pig performance, carcass quality, and net returns. The objective of this experiment was to assess the productivity and economic importance of naturally occurring health challenges (HC) under commercial conditions. Three 1,000 pig grow-finish facilities received 936 pigs each. The experimental period started approximately 34 d post placement at an average start BW of 13.1 ± 0.2 kg. Barns were characterized based on the relative HC, determined by diagnostic assessments as the main characterization tool, along with other health indicators. Barns were characterized as low challenge health (LCh), moderate challenge health (MCh), and high challenge health (HCh). All barns tested positive for porcine reproductive and respiratory syndrome virus infection prior to the start of the experiment. Additionally, the MCh and HCh barns experienced influenza type A virus of swine. Similar to commercial production conditions, the disease challenge was not imposed but rather occurred naturally. Reduced ADG, ADFI, and G:F were observed with an increased HC (P < 0.001). Similarly, mortality was increased when the HC increased (P < 0.001). Decreased ADG increased days to achieve harvest BW, by 10 and 15 d in the MCh and HCh treatments compared with LCh, respectively (P < 0.001). No differences were observed for percent lean, loin depth, or fat depth (P > 0.10). The economic impact of the HC was assessed by applying these growth performance data to two economic models encompassing the two main marketing methods used by U.S. pig producers: fixed-weight and fixed-time. Financial losses attributed to the variation in disease severity that occurred in the present study ranged from $8.49 and $26.10 U.S. dollars (USD)/pig marketed using a fixed-market weight model, or between $11.02 and $29.82 USD/pig using a fixed-time model, depending on feed costs and market hog prices. In conclusion, increasing severity of HC under commercial conditions reduced ADG by 8% and 14% and resulted in mortality as high as 19.9%. Losses of $8.49 to $29.82/pig marketed underscore the potential magnitude of the economic impact of mixed etiology concurrent diseases in pork production.
Improving veterans' access to gastroenterology clinical care
Authors: Hansen Thomas H.
Published: February 2018

At a VA hospital, wait times for gastroenterology care have been in the order of 60 to 90 days for new clinic consults. Through a quality improvement process, these times were reduced to less than 30 days. With a revised triage process, the number of consults needing to be scheduled into the clinic was reduced 34%. In addition to achieving rapid clinical access, the weekly half-day clinic became less congested and more efficient. We describe this process of achieving improved access.
Hormonal Contraceptives Increase Breast Cancer Risk
Authors: Rosenberg Karen
Published: February 2018

According to this study:

Current or recent users of hormonal contraceptives are at higher risk for breast cancer than women who have never used hormonal contraceptives.

The risk increases with the duration of use.
Meta-Analysis Shows Coffee Consumption is Generally Safe
Authors: Rosenberg Karen
Published: February 2018

According to this study:

Coffee drinking is more often associated with benefit than harm for a range of health outcomes.

The only consistent evidence of harm was regarding pregnancy outcomes and risk of bone fracture in women.
No Clinical Benefit From Surgery for Shoulder Pain
Authors: Rosenberg Karen
Published: February 2018

According to this study:

In patients with subacromial shoulder pain, arthroscopic decompression surgery and investigational arthroscopy were not found to be clinically beneficial compared with no treatment.
A Model to Predict Birth Stress in Adolescents Within 72 Hours of Childbirth
Authors: Anderson Cheryl A. , Connolly John P.
Published: February 2018

An organizing framework for understanding adolescent birth stress in immediate postpartum does not exist. Researchers evaluated adolescent birth stress within 72 hours postpartum via a modification of Slade's conceptual model of risk factors for posttraumatic stress (PTS). Birth stress was defined by negative birth appraisal and subjective distress. Precipitating factors pain management, partner presence, and delivery type, plus maintaining factor infant complications, predicted negative birth appraisal. Predisposing factors depression and prior trauma predicted subjective distress. Findings support utility of Slade's modified model of PTS risk factors for identification of adolescent early birth stress and generate nursing practice and research implications.
MACULAR MICROVASCULAR NETWORKS IN HEALTHY PEDIATRIC SUBJECTS
Authors: Borrelli Enrico , Lonngi Marcela , Balasubramanian Siva , Tepelus Tudor C. , Baghdasaryan Elmira , Iafe Nicholas A. , Pineles Stacy L. , Velez Federico G. , Sarraf David , Sadda SriniVas R. , Tsui Irena
Published: February 2018

Purpose:

To report optical coherence tomography angiography (OCTA) values in healthy pediatric eyes and to identify factors that may modify these values.

Methods:

In this prospective observational cross-sectional study, macular OCTA images were acquired from healthy pediatric patients. Main outcome measures were 1) foveal avascular zone (FAZ) area at the level of the superficial retinal capillary plexus (SCP); 2) SCP and deep retinal capillary plexus (DCP) perfusion density (based on the area of vessels); 3) SCP and DCP vessel density (based on a map with vessels of 1-pixel width); and 4) CC perfusion density. Multiple regression analysis was performed to assess the effect of age, sex, ethnicity, refraction, and foveal macular thickness (FMT) on OCTA parameters.

Results:

Seventy-seven eyes from 52 subjects (23 male and 29 female) were included in analysis. Mean age was 11.1 ± 3.3 years (range = 5.0–17.0 years). Twenty-nine (55.8%) subjects were white, 14 (27.0%) Hispanic, 8 (15.4%) Asian, and 1 (1.8%) African-American. Mean refraction was −0.1 ± 2.4 diopters (D) (range = −5.75 to +9.0 D). Mean FMT was 248.6 ± 18.6 μm. Larger FAZ area was significantly associated with older age (P = 0.014). Furthermore, larger FAZ area was associated with reduced FMT (P < 0.0001). Male sex was associated only with increased SCP perfusion density (P = 0.042). Increased CC perfusion density was associated with younger age (P = 0.022).

Conclusion:

We report data for pediatric OCTA parameters in healthy subjects. Several variables influence the density of macular microvascular networks, and these factors should be considered in the OCTA study of pediatric eye disorders.
Assessment of Glaucomatous Damage After Boston Keratoprosthesis Implantation Based on Digital Planimetric Quantification of Visual Fields and Optic Nerve Head Imaging
Authors: Ali Mohsin H. , Dikopf Mark S. , Finder Anthony G. , Aref Ahmad A. , Vajaranant Thasarat , de la Cruz Jose , Cortina Maria Soledad
Published: February 2018

Purpose:

To investigate glaucomatous damage in Boston keratoprosthesis type I (KPro) patients through structural analysis of the optic nerve head and digital planimetric quantification of Goldmann visual fields, a novel method of monitoring perimetric changes in KPro patients.

Methods:

Records of patients undergoing KPro implantation from 2007 to 2015 at a single institution were reviewed. Parameters related to glaucoma status and KPro outcomes were analyzed.

Results:

Twenty-two eyes from 21 patients met inclusion criteria, with mean follow-up of 49.4 months (range 15–90). Mean results for the following parameters before KPro implantation and at last follow-up were (pre-KPro; at last follow-up): best-corrected visual acuity (2.07; 0.70 logMAR), number of glaucoma medications (1.14; 1.05), intraocular pressure (IOP) (18.4; 18.4 mm Hg), vertical cup-to-disc ratio (C/D) (0.48; 0.50), and horizontal C/D (0.52; 0.52). IOP-lowering procedures were performed pre-KPro (5/22), concurrently with KPro (10/22), post-KPro (6/22), or never (6/22). An increase in C/D ≥0.1 and loss of V4e isopter area >30% occurred in 22.7% and 12.5%, respectively. Development of post-KPro glaucoma, progression of preexisting or post-KPro glaucoma, and no glaucoma development as evidenced by an objective assessment of structural and functional parameters were seen in 2/22 (9.1%), 7/22 (31.8%), and 6/22 (27.3%) eyes, respectively.

Conclusions:

Clinicians should strive to vigilantly monitor for glaucoma despite the inherent difficulties in tonometry, optic nerve visualization and imaging, and visual field testing in KPro patients. Meticulous glaucoma surveillance with structural and functional testing combined with earlier IOP-lowering surgical intervention may result in decreased rates of glaucomatous vision loss in KPro patients.
Refractive Outcomes After Phototherapeutic Refractive Keratectomy for Granular Corneal Dystrophy
Authors: Nakamura Tomoaki , Kataoka Takahiro , Kojima Takashi , Yoshida Yoko , Sugiyama Yasuo
Published: February 2018

Purpose:

This retrospective study aimed to evaluate the effectiveness of a novel procedure named phototherapeutic refractive keratectomy (PTRK), which is a sequential procedure composed of phototherapeutic keratectomy ablation for removal of opacities, followed by smoothing ablation for reducing the corneal surface irregularities and photorefractive keratectomy ablation for correcting refractive errors in eyes with primary granular corneal dystrophy.

Methods:

Twenty-three eyes of 17 patients with granular corneal dystrophy were treated with PTRK. Preoperative and postoperative visual acuity, corneal topography, and changes in spherical equivalent and cylindrical refraction were examined and analyzed.

Results:

The mean spherical equivalent power changed from −0.11 ± 1.36 diopters (D) to 0.19 ± 0.91 D postoperatively (P = 0.121). The change in the mean spherical equivalent was +0.30 ± 0.99 D. The mean preoperative uncorrected distance visual acuity (logMAR) of 0.40 ± 0.26 significantly improved to 0.075 ± 0.145 at 3 months after PTRK (P < 0.001). The mean preoperative corrected distance visual acuity (logMAR) of 0.18 ± 0.17 significantly improved to −0.02 ± 0.11 at 3 months after PTRK (P < 0.01). The surface regularity index was significantly decreased from 0.93 ± 0.46 preoperatively to 0.60 ± 0.30 postoperatively (P < 0.001).

Conclusions:

Our results showed that PTRK could improve corneal surface irregularities and remove opacities. Furthermore, both corrected visual acuity and uncorrected visual acuity improved by the addition of refractive correction. PTRK is a promising surgical procedure for improving postoperative quality of life with a high degree of patient satisfaction.
Accuracy of Xpert Mtb/Rif Ultra for the Diagnosis of Pulmonary Tuberculosis in Children
Authors: Nicol Mark P. , Workman Lesley , Prins Margaretha , Bateman Lindy , Ghebrekristos Yonas , Mbhele Silindile , Denkinger Claudia M. , Zar Heather J.
Published: February 2018

We determined the accuracy of the new Xpert MTB/RIF Ultra assay for diagnosis of pulmonary tuberculosis in children, using banked-induced sputum. Sensitivity and specificity were 75.3% and 96.9%, respectively, compared with a culture result from the same specimen. Of those children with microbiologically confirmed tuberculosis (positive Xpert, Ultra or culture), Xpert detected 63.2%, Ultra 73.7% and culture 82.9%.
Benchmarking Implications: Analysis of Medicare Accountable Care Organizations Spending Level and Quality of Care
Authors: Hong Young-Rock , Kates Frederick , Song Soon Ju , Lee Nayoung , Duncan R. Paul , Marlow Nicole M.
Published: February 2018

Early evidence has shown that Accountable Care Organizations (ACOs) have achieved some success in improving the quality of care and reducing Medicare costs. However, it has been argued that the ACO rewarding model may disproportionately affect relatively low-spending (LS; considered as efficient) organizations that have fewer options to cut unnecessary services compared with high-spending (HS; inefficient) organizations. We conducted a cross-sectional retrospective study to compare ACO financial and quality of care performance between HS-ACO and LS-ACO. After adjusting for ACO organizational factors and beneficiary characteristics, we found that HS-ACOs generated greater savings per beneficiary than LS-ACOs ($501 vs. −$108, p < .001); however, HS-ACOs had a lower quality of care performance (48.79 vs. 53.29, p = .002). Specifically, LS-ACOs had better quality performance than HS-ACOs in patient experience/satisfaction (p = .02), preventive care services (p = .004), and hospitalization management (p = .001), whereas HS-ACOs better performed in routine checkup/follow-up (p < .001) and risk population management (p = .048). Our findings indicated that Medicare ACO rewarding model seems to be advantageous for HS-ACOs regardless of the overall quality of care performance.
Perception of Patient Safety Culture in Pediatric Long-Term Care Settings
Authors: Hessels Amanda J. , Murray Meghan T. , Cohen Bevin , Larson Elaine L.
Published: February 2018

Introduction:

Patient safety culture (PSC) is an emerging construct in adult long-term care settings. No measures are validated to quantify PSC in pediatric long-term care (pLTC) settings despite the importance of safety for this vulnerable population. The study purposes are to (1) describe PSC in pLTC, (2) assess the relationship of PSC to facility recommendation and overall safety rating, and (3) test the stability and reliability of the PSC survey over time.

Methods:

A modified Nursing Home PSC (NHSPSC) survey was administered to employees at three pLTC facilities over 3 years; data were summarized and compared over time.

Results:

In all, 208 surveys were completed. Staff perceptions on “feedback and communication about incidents” and “overall perceptions of resident safety” were most positive and associated with responses of recommending the facility and high overall ratings for child safety (p < .05).

Conclusions:

The modified NHSPSC survey was reliable by Cronbach alpha and findings were consistent over time in these pLTC settings. This tool may be a useful adjunct to safety initiatives in pLTC. Knowledge derived from this survey can provide actionable information for consumers, pLTC employees, managers, and administrators.
Defining the Role of the Center Coordinator of Clinical Education: Identifying Responsibilities, Supports, and Challenges
Authors: Fitzpatrick Timmerberg Jean , Dungey Jill , Stolfi Angela M. , Dougherty Mary Ellen
Published: February 2018

Introduction.

Recent changes in physical therapy (PT) education along with changes in health care delivery have placed increased demands on sites providing clinical education. The center coordinator of clinical education (CCCE) has been identified as a critical component of ensuring the quality of clinical education experiences (CEEs). Little is known about how today's CCCEs are performing this position. The purpose of this study was to identify how CCCEs define their role and associated responsibilities in current practice, how they were prepared to be a CCCE, the structure of the clinical learning environment where they work, and available supports and challenges they encounter.

Methods.

A total of 1,109 CCCEs, identified from the Clinical Performance Instrument, responded to an online anonymous survey.

Results.

Respondents indicated that many of the CCCE's responsibilities as defined by the American Physical Therapy Association (APTA)
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are not being performed by all. Most CCCEs schedule students, meet with them while at their site, provide an orientation, monitor novice clinical instructor's (CI's), and assist in crisis intervention when a student is not meeting expectations. Most CCCEs report not having adequate time within their workday for those tasks. Fewer than half of the respondents were given support to attend professional development activities related to clinical education, had a job description provided, or had their role acknowledged on their facility's career ladder. Most CCCEs indicated that they had not been mentored but those who had, found it valuable. Fifty-two percent belong to the APTA, 5.5% were education section members, and 17% of respondents were members of a clinical education consortium. A vast majority of CCCEs requested support in providing crisis management when the student is not meeting expectations, as well as mentoring novice and experienced CI's. Respondents also noted that the best avenue to provide that support would be self-paced online modules.

Discussion and Conclusion.

There is considerable variability in the way individuals define and perform the role of CCCE. The structure of the clinical learning environment likely impacts the quality of the learning experiences offered, as well as the willingness of the staff to participate in clinical education. Many resources for the CCCE are provided through professional organizations. The results of this study indicate that many respondents are not members of such organizations and may not have access. Integral to the success of clinical education is the need for our profession, clinical facility administration, and clinical education consortia to value and support the vital role of the CCCE as a leader in providing CEEs that culminate in entry-level PT students.
Physical Therapist Students' Perceptions: Learning From a Community-Based, Client-Focused, Interprofessional Learning Experience
Authors: McGehee William F. , Dunleavy Kim , Blue Amy V. , Stetten Nichole E. , Black Erik W.
Published: February 2018

Introduction.

This study examined physical therapist students' perceptions of their learning from a year-long, community-based, client-focused, interprofessional education experience (IPE) involving nine disciplines.

Methods.

Sixty-nine Doctor of Physical Therapy students (n = 69) completed a reflection paper at the end of an IPE, consisting of small group visits of students from four of the nine different health care disciplines, with families in their homes, larger structured group discussions with faculty, and a wellness project. The students participated in four home visits, and six discussion sessions were completed over two semesters. Two teams of two researchers reviewed and coded the papers to identify key words and phrases to reflect meaning. All researchers then reached a consensus on themes and subthemes. Triangulation of analysis occurred throughout the analysis, and quotes that reflected the important themes were identified.

Results.

Themes included the following: 1) learning about differences in perspective, 2) importance of team communication, 3) value of seeing a patient in their own environment and realizing how this affects their health and health behaviors, 4) making a connection with a patient, and 5) realizing that the patient's goals can be different from the students' expectations.

Discussion and Conclusions.

This IPE was perceived as an effective and meaningful instructional strategy. The realistic situated learning methods resulted in students appreciating the need for individualized consideration of the patient as a whole person. The extended period of team-based requirements fostered a deeper understanding of communication across professions and with clients, along with insights into the perspectives of different health care professionals.
Perceived Value of Preadmission Physical Therapy Observation Hours and Their Ability to Predict Academic Performance
Authors: Wheeler Emma , Finucane Sheryl , Soper Shawne , Mayhew Thomas
Published: February 2018

Introduction.

Most physical therapist (PT) and physical therapist assistant (PTA) education programs require applicants to complete observation hours (ObHr) before admission. Observation hours are believed to enable the prospective PT and PTA student to gain knowledge about the profession and increase chances of success in academic programs; however, few studies have examined these relationships. The purposes of this study were to: 1) examine the relationship between the number of ObHr completed and indicators of success in a Doctor of Physical Therapy (DPT) program, 2) identify PT and PTA student opinions and perceived value of the required ObHr, including the number of hours needed to make an informed decision to pursue physical therapy as a career, and 3) identify clinical instructor (CI) opinions about the perceived value of ObHr and their impact on clinic productivity.

Methods.

Part 1 was a retrospective cohort study, examining data from 323 students who matriculated into a DPT program during a 6-year period (2009–2014). The relationship between admission variables (undergraduate grade point average [GPA], undergraduate math/science GPA, verbal Graduate Record Examination [GRE], quantitative GRE, age, and total ObHr) and outcome variables (National Physical Therapy Examination [NPTE] success, DPT probation status, and DPT GPA) were examined. Parts 2 and 3 focused on perceived value of ObHr gathered from surveys of PT and PTA students and CIs.

Results.

The number of ObHr was not a significant predictor of NPTE success, DPT probation status, or DPT GPA. Most PT (92%) and PTA (83%) students believed that ObHr positively impacted their decision to pursue physical therapy as a profession and that they needed 40–60 hours to make this decision. Most CIs (64%) do not believe that reducing ObHr opportunities would result in an increase in the number of full-time clinical experiences offered by their clinic. An overwhelming majority of the CIs (95%) believed that ObHr are meaningful for prospective students.

Discussion and Conclusion.

Observation hours were perceived as being valuable by both PT and PTA students and CIs. Observation hours may be useful to prospective PT students to help determine whether they pursue a career in physical therapy. However, there is no evidence that ObHr impact DPT academic performance. Physical therapist students may need fewer ObHr to confirm a career choice than what some programs currently require.
“The Future of Vulvar Disease: New and Ongoing Challenges”: Presidential Lecture - XXIV World Congress 2017, Mendoza, Argentina
Authors: Marchitelli Claudia
Published: February 2018

The 21st century brought along a number of discoveries and medical advances. With the advances, we can mention the following: target therapies for cancer, genomics and molecular biology, pharmacogenomics, minimally invasive and robotic surgery, immunosuppressive therapies in transplant patients, human papillomavirus in the era of vaccination, and aesthetic vulvovaginal procedures. All of them have greatly influenced medicine. As a scientific society, we have several challenges. In the past, you had to go to a library to get information. Now, we have readily available, accessible information. Thus, here comes the debate; we are facing a change in our educational paradigm, which needs to be approached from an integral and holistic perspective. New historical and cultural circumstances call for a deep reflection on the current social validity of scientific societies. They should be open to new ideas and allow dissent, work in teams, and speak a common language. They must be organized and, in constant communication with its members, support and organize research developing well-designed clinical trials and observational studies. We should work for our patients, recognizing the importance of the whole woman. We all have a great scientific and humanitarian challenge; to succeed, we must not lose sight of who we are working for. We work for them, our patients, and not for us. Our mission is to take care of our them!
Micronutrient Status and Nutritional Intake in 0‐ to 2‐Year‐old Children Consuming a Cows’ Milk Exclusion Diet
Authors: Kvammen Janne A. , Thomassen Rut A. , Eskerud Mari B. , Rugtveit Jarle , Henriksen Christine
Published: February 2018

Objectives:

To study micronutrient status and nutritional intake from complementary feeding in children on a cows’ milk exclusion (CME) diet.

Methods:

Fifty‐seven children with cows’ milk allergy, younger than 2 years, were included in a cross‐sectional study. Blood was analyzed for micronutrient status. Complementary feeding was defined as all solids and liquids except of breast milk, and assessed by 3‐day food diary. The results were analyzed according to 3 feeding patterns: mainly breast‐fed (mBF), partially breast‐fed, and no breast milk group (nBM).

Results:

The children had a median age of 9 months and micronutrient status was within normal range for total homocysteine (p‐tHcy), s‐B12, s‐folate, b‐Hb, s‐ferritin, s‐zinc, and s‐25(OH)D. There were no significant differences between feedings groups, except for B12‐biomarkers. The mBF had higher p‐tHcy (P < 0.000) and lower s‐B12 (P = 0.002) compared nBM. Vitamin B12 deficiency (p‐tHcy >6.5 μmol/L combined with s‐B12 <250 pmol/L) was found in 12% of participants, most frequently among the mBF (36%) and none in nBM group (P = 0.009). Vitamin B12 intake from complementary feeding was negatively correlated with p‐tHcy (r = −0.479, P = 0.001) and positively with s‐B12 (r = 0.410, P = 0.003). Iron deficiency anemia was found in 5%. Iron intake correlated positively with b‐Hb (r = 0.324, P = 0.02). Zinc deficiency was found in 7% and low 25(OH)D in 9%. Vitamin D intake was positively correlated with the use of supplements (r = 0.456, P = 0.001).

Conclusion:

The risk of B12 deficiency was high in mBF infants on CME diet, and complementary feeding was associated with better B12 status. Iron, zinc, and vitamin D deficiencies were present in all feeding groups. Complementary feeding should be introduced at 4 to 6 months of age. Vitamin D supplement is recommended to ensure adequate intake.
The Potential for Proactive Housing Inspections to Inform Public Health Interventions
Authors: Korfmacher Katrina Smith , Holt Kathleen D.
Published: February 2018

Municipal housing inspection data can inform planning, targeting, and evaluating interventions aimed at reducing housing hazards (lead paint, mold, pests, etc) that may affect residents' health. However, the potential of these data to inform public health initiatives is underexplored. We determined whether home health hazards identified by city inspectors during proactive inspections of single-family private rental housing are predicted by housing age, assessed value, or location in one of 26 geographic “inspector areas” in Rochester, New York. A comparison of linear mixed models, using housing inspector area as a random effect and assessment and construction year as fixed effects, shows that while a large proportion of variation (64%) in violations is due to housing stock, inspectors provide significant additional information about the presence of potential health hazards, particularly in the highest-risk housing stock. This suggests that inspector-generated housing hazard data may be valuable in designing public health interventions.
Brief Report: Efficacy and Safety of Switching to Coformulated Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Alafenamide (E/C/F/TAF) in Virologically Suppressed Women
Authors: Hodder Sally , Squires Kathleen , Kityo Cissy , Hagins Debbie , Avihingsanon Anchalee , Kido Anna , Jiang Shuping , Kulkarni Rima , Cheng Andrew , Cao Huyen
Published: February 2018

Background:

The integrase inhibitor regimen [elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (TDF)] demonstrated superior efficacy when compared with a protease inhibitor regimen [ritonavir-boosted atazanavir (ATV + RTV) and FTC/TDF] in 575 treatment-naive women at week 48. We investigated the efficacy, safety, and tolerability of switching to a TAF-based, single-tablet regimen containing elvitegravir, cobicistat, FTC, and tenofovir alafenamide (E/C/F/TAF) versus remaining on ATV + RTV plus FTC/TDF.

Methods:

After completing the initial randomized, blinded phase, virologically suppressed (HIV-1 RNA <50 copies/mL) women on ATV + RTV plus FTC/TDF were rerandomized (3:1) to receive open-label E/C/F/TAF versus remaining on their current regimen. The primary end point was proportion of participants with plasma HIV-1 RNA <50 copies per milliliter at week 48 (U.S. FDA snapshot algorithm), with a prespecified noninferiority margin of 12%. Safety [adverse events (AEs)] and tolerability were also assessed.

Results:

Of 575 women originally randomized and treated in the blinded phase, 159 were rerandomized to switch to E/C/F/TAF and 53 to remain on ATV + RTV plus FTC/TDF. At week 48, virologic suppression was maintained in 150 (94%) of women on E/C/F/TAF and 46 (87%) on ATV + RTV plus FTC/TDF [difference 7.5% (95% confidence interval −1.2% to 19.4%)], demonstrating noninferiority of E/C/F/TAF to ATV + RTV and FTC/TDF. Incidence of AEs was similar between groups; study drug–related AEs were more common with E/C/F/TAF (11% versus 4%).

Conclusions:

Switching to E/C/F/TAF was noninferior to continuing ATV + RTV plus FTC/TDF in maintaining virologic suppression and was well tolerated at 48 weeks.
Neprilysin in the Cerebrospinal Fluid and Serum of Patients Infected With HIV1-Subtypes C and B
Authors: de Almeida Sérgio M. , Tang Bin , Ribeiro Clea E. , Rotta Indianara , Vaida Florin , Piovesan Mauro , Batistela Fernandes Meire S. , Letendre Scott , Potter Michael , Ellis Ronald J. ,   the HIV Neurobehavioral Research Center (HNRC) Group
Published: February 2018

Objective:

Neprilysin (NEP) is the dominant Aβ peptide–degrading enzyme in the brain. HIV-1 subtype B transactivator of transcription protein is known to interfere with NEP function, but whether this is true of HIV-1C transactivator of transcription, which has a defective chemokine motif, is not known. This study aimed to analyze the impact of HIV subtype on NEP-mediated cleavage of Aβ by comparing cerebrospinal fluid (CSF) and serum levels of NEP between HIV+ (27 patients with HIV-1B and 26 with HIV-1C), healthy HIV− controls (n = 13), and patients with Alzheimer disease (n = 24).

Methods:

NEP and Aβ oligomers 38, 40, 42 levels were measured in CSF and serum by immunoassays. Ratios between NEP and Aβ-38, 40, 42, and total were calculated in CSF and serum. Comparisons between HIV(+) and HIV(−) were adjusted by linear regression for sex and age; HIV subtype comparisons were adjusted for nadir CD4 and plasma viral load suppression.

Results:

Levels of NEP and ratios in CSF were comparable for HIV-1C and B subtypes. The ratio of serum NEP/Aβ-40 was lower for HIV1-C than HIV1-B (P = 0.032). The CSF/serum index of NEP/Aβ-40, NEP/Aβ-42, and NEP/Aβ-total were lower for HIV1-B than HIV1-C (P = 0.008, 0.005, and 0.017, respectively), corroborating the findings for serum. CSF NEP was comparable for HIV+, HIV−, and AD.

Conclusion:

There was impact of HIV subtype on NEP. The ratio of NEP/Aβ-40 on serum was lower on HIV1-C than HIV1-B. These results are consistent with the results of CSF Aβ-42 levels decreased in HIV1-C compared with HIV1-B, suggesting higher amyloid β deposit on HIV1-C than HIV1-B.
Adenocarcinoma Prostate With Neuroendocrine Differentiation
Authors: Parida Girish Kumar , Tripathy Sarthak , Datta Gupta Shreya , Singhal Abhinav , Kumar Rakesh , Bal Chandrasekhar , Shamim Shamim Ahmed
Published: February 2018

68Ga-PSMA PET/CT is the upcoming imaging modality for staging, restaging and response assessment of prostate cancer. However, due to neuroendocrine differentiation in some of patients with prostate cancer, they express somatostatin receptors instead of prostate specific membrane antigen. This can be exploited and other modalities like 68Ga-DOTANOC PET/CT and 18F-FDG PET/CT should be used in such cases for guiding management. We hereby discuss a similar case of 67-year-old man of adenocarcinoma prostate with neuroendocrine differentiation, which shows the potential pitfall of 68Ga-PSMA PET/CT imaging and benefit of 68Ga-DOTANOC PET/CT and 18F-FDG PET/CT in such cases.
The Impact of the Affordable Care Act on Urogynecologic Surgery Cancelation Rates
Authors: Berger Alexander A. , Giugale Lauren E. , Shepherd Jonathan P.
Published: February 2018

Objectives

We examined the impact of the implementation of the Affordable Care Act (ACA) on female pelvic medicine and reconstructive surgery (FPMRS) surgical cancelation rates.

Methods

A retrospective cohort study was performed on patients scheduling FPMRS procedures 1 year before and after ACA implementation at a regional academic medical center. We compared cancelation rates as well as sociodemographic, surgical, and medical history data. Analysis included χ2 test, t test, and univariable and multivariable logistic regression.

Results

We included 746 subjects, 373 each before and after ACA implementation (January 2014). Subjects were 59.2 ± 14.0 years old, predominantly white (94.9%), employed (45.8%), and married (66.6%), with a body mass index of 28.8 ± 6.2. Subjects lived a median of 24 miles from the hospital. None of these were significant predictors of cancelations. Surgery cancelation rate was 17.1% and occurred 9 days before surgery.

On univariable analysis, cancelation rates did not differ relative to the ACA (15.5% before vs 18.6% after; mean difference, 3.16%; 95% confidence interval [CI], −2.29% to 8.69%; P = 0.254). Only 3 variables impacted cancelation rate on univariable analysis: women whose surgery was scheduled for later in the week, liver/renal disease, and minor vs major surgery.

On multivariable regression including variables with P < 0.20 as candidate variables, the same 3 variables remained significant. Cancelations increased with procedures scheduled later in the week (odds ratio [OR], 1.169 per day; 95% CI, 1.004–1.361) and liver or renal disease (OR, 2.342; 95% CI, 1.015–5.405). Major procedures had fewer cancelations (OR, 0.625; 95% CI, 0.414–0.943). The ACA implementation of still did not impact cancelations (OR, 1.230; 95% CI, 0.831–1.821).

Conclusions

The implementation of the ACA did not impact FPMRS cancelation rates. Significant predictors of surgical cancelation included later day of the week, comorbid renal or liver disease, and performance of a minor procedure.