bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient adherence with a smartphone app for patient-reported outcomes in rheumatoid arthritis
Authors: Colls Josh , Lee Yvonne C , Xu Chang , Corrigan Cassandra , Lu Fengxin , Marquez-Grap Georgia , Murray Meredith , Suh Dong H , Solomon Daniel H 
Published: April 2020

Abstract

Objectives
Electronic patient-reported outcomes (ePROs) transmitted digitally allow patients to communicate with their clinicians and track the activity of chronic diseases, such as RA. Several ePRO smartphone apps have been developed in rheumatology, yet few data have been reported regarding patient adherence. We developed a PRO app for RA and assessed adherence over 6 months.

Methods
We developed an app to deliver daily assessments to participants (RA App v.1.0). The app was tested as part of a randomized controlled trial examining potential clinical benefits. The current analyses focus on the adherence to the ePRO app for patients randomized to receive the app. We recruited RA patients from an academic rheumatology practice in the USA. Patients randomized to receive the app received daily notifications regarding ePROs. We examined adherence to the PRO questionnaires over the 6-month study and examined factors related to adherence.

Results
Seventy-eight patients received the app and have data included in these analyses: 63 (80.7%) were female, mean age was 55.2 years, 71% had attended college or beyond, and the mean Clinical Disease Activity Index at baseline was 9.7 (low disease activity). Median adherence to the daily questions was 79% (interquartile range 48–90%). Significant predictors of increased adherence were age ≥65 (P = 0.03) and low baseline Clinical Disease Activity Index (P = 0.02).

Conclusion
We developed and tested an ePRO app for RA over a 6-month study. Adherence to the app was strong. There was correlation between older age and better disease control and increased adherence.

Trial registration
ClinicalTrials.gov, https://clinicaltrials.gov/, NCT02822521.
Effect and Safety of Saccharomyces boulardii for Neonatal Necrotizing Enterocolitis in Pre-term Infants: A Systematic Review and Meta-Analysis
Authors: Gao Xia , Wang Yan , Shi Lingna , Feng Weidong , Yi Kang 
Published: April 2020

Abstract

Background and Objective
Necrotizing enterocolitis (NEC) is one of the most common and urgent neonatal emergencies in the neonatal intensive care unit. This disease leads to considerable morbidity and mortality; it also imposes a huge financial burden on patient family and society. Thus, Treatment and prevention of NEC are crucial. This meta-analysis aims to investigate the effect and safety of Saccharomyces boulardii for NEC in pre-term infants.

Methods
A comprehensive search was retrieved in six major databases. The search included randomized controlled trials (RCTs) reporting the incidence of NEC (stage ≥ II), sepsis, mortality, feeding intolerance, full feeding days, time to regain birth weight, days of hospitalization and adverse effects. The random model was used to calculate risk ratio (RR), the standard mean difference (SMD) and its 95% confidence interval (95% CI) between the S. boulardii group and control group. Statistical analyses were conducted using Cochrane systematic review software, Rev Man (version 5.3).

Results
In total, 10 RCTs involving 1264 participants met the inclusion criteria. There were significant reductions in the incidence of NEC [RR = 0.56, 95% CI (0.36–0.89)], feeding intolerance [RR = 0.52, 95% CI (0.39–0.68)], full feeding days [SMD = −1.25, 95% CI (−2.06 to −0.45)] and hospitalization days [SMD = −1.33, 95% CI (−2.64 to −0.02)] in the study group compared with the control group. However, there were no significant differences in sepsis [RR = 0.84, 95% CI (0.61–1.17)], death [RR = 1.12, 95% CI (0.46–2.70)] and the time to regain birth weight [SMD = −0.93, 95% CI (−1.88 to 0.03)] between the two groups. The adverse effect of S. boulardii was not reported. The overall methodological quality was evaluated as moderate by the Cochrane Bias Risk Assessment Tool.

Conclusion
According to this evidence we recommend S. boulardii to prevent NEC, reduce the feeding intolerance, shorten the full feeding days and hospitalization days. However, S. boulardii might be invalid on the incidence of sepsis, mortality and the time to regain birth weight.

Registration
This review has been registered to the PROSPERO (International prospective register of systematic reviews) on 5 December 2019 (ID: CRD42019147896).
Goals of Parents Whose Infant Is in the Neonatal Intensive Care Unit
Authors: Fucile Sandra , Samson Jessica , Rockley Jeremy , Dow Kimberly 
Published: April 2020

Background:
The aim of many neonatal intensive care units (NICU) today is to promote a family-centered practice that addresses parental concerns and needs. However, the specific goals of parents are often unaddressed by the healthcare team. The aim of this study was to understand the goals of parents whose infant was in the NICU to enhance collaboration and communication between parents and health professionals.

Methods:
A written questionnaire was disseminated to parents whose infant was in the NICU at the Kingston Health Sciences Centre. A thematic analysis of the goals was completed to identify key emergent themes and their implications.

Results:
A total of 23 questionnaires were disseminated to parents and 13 (57%) were returned. Returned questionnaires were most often completed by the mother (n = 9, 70%), and a total of 40 goals were recorded. Three key emergent themes were identified, which included feeding and weight gain, eliminating medical equipment, and successful hospital discharge.

Implications for Practice:
Understanding the goals of parents whose infant was in the NICU can enhance communication between parents and their healthcare team, thus aiding the implementation of a family-centered practice.

Implications for Research:
Future larger sample sizes studies across several NICUs would increase the generalizability of results and garner a larger volume of data to establish significant trends between specific infant and parent demographic data and the associated goals.
Early Mobilization in the ICU: A Collaborative, Integrated Approach
Authors: Linke Christopher A. , Chapman Leah B. , Berger Lindsey J. , Kelly Tara L. , Korpela Craig A. , Petty Michael G. 
Published: April 2020

Objectives:
To develop and implement a protocol to increase patient mobility in three adult ICUs using an interdisciplinary approach and existing resources.

Design:
The Iowa Model of Evidence-Based Practice was used for synthesis of literature and intervention planning. A retrospective pre- and post-intervention data collection design was used to compare outcomes of interest.

Setting:
Three adult ICUs (64 total beds) in an urban, academic hospital. Physician, nursing, respiratory therapy, physical therapy, and occupational therapy representatives participated in planning and development. All adult ICU patients were included.

Interventions:
Development and implementation of an inclusive early mobility protocol in three adult ICUs. Focus on interdisciplinary collaboration to restructure workflow, focusing on optimization and coordination of standard tasks. Multimodal education occurred in an interdisciplinary setting and on-site champions facilitated implementation.

Measurements and Main Results:
Time from admission to ambulation, overall frequency of ambulation, and frequency of ambulation by age group were assessed across three time periods: no awareness (Time 1), awareness without protocol (Time 2), and protocolization (Time 3). Decrease in hours from admission to ambulation were seen in the cardiovascular ICU (62.3 vs 56.1; p = 0.10) and surgical ICU (64.9 vs 58.6; p = 0.022). Significant increase demonstrated in the proportion of patients who ambulated while in the ICU (24.6% vs 33.0%; p < 0.001). All age groups had increase in frequency of ambulation. The largest gains in patients over 65 years old (T1 = 19.7%, T2 = 26.6%, T3 = 30.9%; p < 0.001). No change found in ICU length of stay, hospital length of stay, or ventilator days.

Conclusions:
This single-center evidenced-based practice project demonstrated increased mobility for ICU patients without addition of staff resources following implementation of an early mobility protocol using an interdisciplinary approach. Successful implementation led to creation of mobility protocol toolkit for use across all ICUs in the broader health system.
CONTRACTILE OPTIC DISK AND PERIPHERAL AVASCULAR RETINA IN A CASE OF MORNING GLORY DISK ANOMALY
Authors: Rajendran Anand , Kumar Jayant 
Published: April 2020

Purpose:
To report a rare case of morning glory disk anomaly with a contractile optic disk and a peripheral avascular retina along with detailed spectral domain optical coherence tomography characteristics of the contractions.

Methods:
Serial fundus photographs and optical coherence tomography images were taken to study the characteristics of optic disk contractions. Fundus fluorescein angiography was performed to delineate the peripheral avascular retina in the same eye.

Results:
A 9-year-old boy presented to us with morning glory disk anomaly in the left eye. He had contractile motions of the optic disk around two to three times in a minute, with each contraction lasting for 4 seconds to 5 seconds. Serial spectral domain optical coherence tomography images could depict an anterior contraction of the optic disk along with the surrounding peripapillary staphyloma with no evidence of any subretinal fluid. Fundus examination of the left eye also suggested the presence of an avascular retina temporally, which was confirmed on fundus fluorescein angiography.

Conclusion:
Our report provides detailed spectral domain optical coherence tomography images through the optic disk in morning glory disk anomaly during various phases of optic disk contractions. It also presents a second rare association of a peripheral avascular retina in the case.
Transcorneal Cryotherapy and Descemet Membrane Endothelial Keratoplasty to Treat Epithelial Downgrowth and Corneal Decompensation After Cataract Surgery
Authors: Diel Ryan J. , Morrow Nicole C. , Jiang Lai , Huffman James M. , Greiner Mark A. 
Published: April 2020

Purpose:
Epithelial downgrowth is a vision-threatening complication of intraocular surgery or penetrating ocular trauma, and although various therapeutic interventions have been performed to treat this disease, success has been limited. We present a case of corneal decompensation secondary to epithelial downgrowth after uncomplicated clear corneal cataract surgery in the left eye, treated successfully with sequential transcorneal cryotherapy to destroy epithelial cell nests followed by Descemet membrane endothelial keratoplasty (DMEK) to restore corneal clarity and vision.

Methods:
We applied a transcorneal cryotherapy probe using a double freeze-thaw technique at −80°C to the entire cornea, with care taken to spare the limbus except at the superior temporal quadrant overlying the clear corneal incision where treatment was applied intentionally. The same procedure was performed 2 weeks later to ensure complete ablation of epithelial nest cells. Uncomplicated DMEK surgery using standard technique was performed 1 week later to restore corneal clarity.

Results:
Visual acuity at presentation was 20/40. Endothelial cell densities were 2138 cells/mm2 (22% loss) and 1720 cells/mm2 (37% loss) at 3- and 12-months after DMEK, respectively. Two years after surgery, the best-corrected visual acuity remained 20/20 and the patient had no evidence of recurrence or limbal stem cell deficiency.

Conclusions:
The use of sequential cryotherapy as a targeted intervention to destroy invasive corneal epithelial cells followed by staged DMEK surgery to replace damaged corneal endothelium was, in this case, an effective treatment for endothelial decompensation secondary to epithelial downgrowth and may be a potential alternative for the management of this disease.
Topical Voriconazole as Supplemental Treatment for Acanthamoeba Keratitis
Authors: Musayeva Aytan , Riedl Jana C. , Schuster Alexander K. , Wasielica-Poslednik Joanna , Pfeiffer Norbert , Gericke Adrian 
Published: April 2020

Purpose:
Voriconazole was shown to inhibit ergosterol synthesis in various acanthamoeba species. The purpose of this study was to evaluate the clinical outcome of treatment with supplemental topical voriconazole in patients with acanthamoeba keratitis (AK).

Methods:
All patients who had been treated for AK with voriconazole 1% drops in conjunction with topical first-line antiacanthamoeba therapy composed of polyhexamethylene biguanide (PHMB) 0.02% and propamidine isethionate 0.1% (Brolene) between November 2014 and August 2017 at the Department of Ophthalmology, University Medical Center Mainz, were included. The main outcomes were treatment failure and recurrence rate. Secondary outcomes were visual acuity, need for keratoplasty, and presence of adverse reactions.

Results:
Twenty-eight eyes of 28 patients with AK, whose treatment had included topical voriconazole, were identified (12 men, 16 women, mean age: 41.7 ± 16.3 years), and 26 of them could be tracked for at least 3 months after cessation of therapy. Resolution of infection under therapy was seen in all eyes, and only one of 26 (3.85%) had a relapse after the therapy had been stopped. Best-corrected visual acuity improved during therapy. Keratoplasty because of central corneal scarring was scheduled in 5 of 26 patients (19.2%) after the pharmacological therapy had been stopped. Five of 26 patients (19.2%) reported on stinging or burning sensation after application of voriconazole 1% drops.

Conclusions:
Topical voriconazole 1% combined with first-line therapy composed of polyhexamethylene biguanide 0.02% and propamidine isethionate 0.1% appears to be an effective option with minor side effects for the treatment of AK.
Descemet Membrane Endothelial Keratoplasty: Development of Contrast Sensitivity and Color Vision in Patients With Fuchs Endothelial Corneal Dystrophy
Authors: Bayyoud Tarek , Wilhelm Helmut , Gelisken Faik , Martus Peter , Bartz-Schmidt Karl Ulrich , Thaler Sebastian 
Published: April 2020

Purpose:
To assess the developments in contrast sensitivity, color vision, and subjective perception after Descemet membrane endothelial keratoplasty (DMEK) in patients with Fuchs endothelial corneal dystrophy (FECD).

Methods:
Included in this study were pseudophakic, unilateral DMEK patients with bilateral FECD having a follow-up period of 6 months (n = 23). The mean age at surgery was 70 years (range: 52–81 years). Pseudophakic eyes without history of other ocular pathology or surgery served as a control (n = 10). Pelli–Robson contrast sensitivity and Panel-D15 color vision tests were used. Best-corrected visual acuity, modified visual functioning questionnaire-25, central corneal thickness, and endothelial cell density were assessed. We visualized the subjective impression of patients with bilateral FECD after unilateral DMEK in a subgroup using Photoshop CS6.

Results:
Contrast sensitivity improved significantly from 1.35 ± 0.26 to 1.64 ± 0.17 (P = 0.002; control eyes: 1.92 ± 0.09). No difference in the color vision error score was observed for preoperative and postoperative eyes (P = 0.063). The best-corrected visual acuity improved significantly after surgery (P = 0.001). The average values in the Logarithm of the Minimum Angle of Resolution were 0.59 ± 0.42 preoperatively and 0.1 ± 0.10 postoperatively (control eyes: 0.01 ± 0.03). Examinations revealed a decrease of the central corneal thickness and endothelial cell density after surgery (P = 0.001; P = 0.001, respectively). Scores in the general and the driving questionnaire were significantly higher after surgery (P = 0.001; P = 0.005, respectively).

Conclusions:
This study showed significant improvement in subjective patient satisfaction and contrast sensitivity. Spontaneous subjective color vision improvement might be explained by significantly improved contrast sensitivity. Contrast sensitivity might be considered as a parameter in preoperative decision-making and evaluation of surgical outcome.
Computational Model of Sclerotic Scatter
Authors: Johnston Fiona , Ho Arthur , Coroneo Minas 
Published: April 2020

Purpose:
A clinical examination technique to detect pathology within the anterior eye is known as “sclerotic scatter” (SS). Its propagation pathway has not been thoroughly investigated. Although conventionally theorized to occur by “total internal reflection” (TIR) within the cornea, existing data suggest that this may be an incomplete explanation.

Methods:
An anterior eye model representative of a human eye has been constructed using nonsequential ray tracing (OpticStudio 18.1). Three generations of the model were constructed to support the analyses of the pathway of light in SS. A design of experiment methodology involving the key parameters was used to determine the slit-lamp setup for optimum clinical visualization.

Results:
Most of the light directed into the temporal limbus in SS is lost (52%) into the sclera or reemitted back to the clinician. Only 0.006% of light that transits the central cornea undergoes TIR off the anterior cornea and more significantly 0.000125% off the posterior cornea. The optimal slit-lamp setup parameters to maximize the clinician's visualization are also summarized.

Conclusions:
The propagation of light within SS primarily does not occur by TIR off the posterior cornea but rather the direct transcameral propagation of light. SS also represents an inefficient usage of light, with approximately half of the light creating a potential glare source for clinicians. We have formulated a recommended set of parameters for the slit-lamp setup to maximize clinical visualization. We also describe the transcameral pathways involved in SS that create a corneal “backlighting” effect. Almost a century after Graves original description, the optics of this phenomenon are described here.
The Effect of Forced Cough to Minimize Pain and Discomfort at the Time of Colposcopy-Guided Cervical Biopsy
Authors: Kuhn Theresa , Ukazu Adanna , Strickland Pamela Ohman , Roche Natalie , Taveras Yanille , Kovalenko Olga , Pompeo Lisa , Einstein Mark 
Published: April 2020

Objective
The aim of the study was to determine whether forced cough during colposcopy-guided cervical biopsy affected pain and anxiety levels.

Materials and Methods
The study was conducted at the University Hospital (Newark, NJ) Ambulatory Care Center from December 2016 to June 2018 and evaluated 110 patients at the time of a colposcopy-guided cervical biopsy. Study patients were randomized to either cough or no cough group during the biopsy procedure. Pain level was assessed using a visual analog pain scale before, during, and immediately after a colposcopy-guided cervical biopsy. Study patients also completed a standardized anxiety survey before and after the procedure. T tests, Pearson χ2, or Cochran-Mantel-Haenszel were used to compare baseline characteristics between the cough and no cough groups. Multivariate linear regression analysis was used to identify potential confounders and then compare pain levels across both groups.

Results
There was no statistically significant difference in pain scores between the cough and no cough group when analyzed for each demographic variable even when confounders were accounted for. The anxiety scores for both study groups before and after the procedure were similar and not significantly reduced.

Conclusions
We observed a trend that cough reduced pain associated with the colposcopy-guided cervical biopsy but did not reach statistical significance. A similar outcome was observed in anxiety level, where anxiety was reduced in the cough group but was not statistically significant as compared with the no cough group. Further studies are necessary to assess various modalities in reducing pain and anxiety associated with colposcopy-guided cervical biopsy.
Risk Estimates Supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines
Authors: Egemen Didem , Cheung Li C. , Chen Xiaojian , Demarco Maria , Perkins Rebecca B. , Kinney Walter , Poitras Nancy , Befano Brian , Locke Alexander , Guido Richard S. , Wiser Amy L. , Gage Julia C. , Katki Hormuzd A. , Wentzensen Nicolas , Castle Philip E. , Schiffman Mark , Lorey Thomas S. 
Published: April 2020

Objective
The 2019 American Society for Colposcopy and Cervical Pathology Risk-Based Management Consensus Guidelines for the management of cervical cancer screening abnormalities recommend 1 of 6 clinical actions (treatment, optional treatment or colposcopy/biopsy, colposcopy/biopsy, 1-year surveillance, 3-year surveillance, 5-year return to regular screening) based on the risk of cervical intraepithelial neoplasia grade 3, adenocarcinoma in situ, or cancer (CIN 3+) for the many different combinations of current and recent past screening results. This article supports the main guidelines presentation
1
by presenting and explaining the risk estimates that supported the guidelines.

Methods
From 2003 to 2017 at Kaiser Permanente Northern California (KPNC), 1.5 million individuals aged 25 to 65 years were screened with human papillomavirus (HPV) and cytology cotesting scheduled every 3 years. We estimated immediate and 5-year risks of CIN 3+ for combinations of current test results paired with history of screening test and colposcopy/biopsy results.

Results
Risk tables are presented for different clinical scenarios. Examples of important results are highlighted; for example, the risk posed by most current abnormalities is greatly reduced if the prior screening round was HPV-negative. The immediate and 5-year risks of CIN 3+ used to decide clinical management are shown.

Conclusions
The new risk-based guidelines present recommendations for the management of abnormal screening test and histology results; the key risk estimates supporting guidelines are presented in this article. Comprehensive risk estimates are freely available online at https://CervixCa.nlm.nih.gov/RiskTables.