bluuebunny/crossref_metadata_2025_split huggingface dataset:
Graft Edge Reflection of a Tightly Scrolled Roll Using Endoillumination as a Simple Method for Determining Graft Orientation in Descemet Membrane Endothelial Keratoplasty
Authors: Kobayashi Akira , Yokogawa Hideaki , Mori Natsuko , Nishino Tsubasa , Sugiyama Kazuhisa 
Published: August 2020

Purpose:
To describe a simple finding that can be used to determine donor tissue orientation in Descemet membrane endothelial keratoplasty (DMEK). This involves the appearance of a highly reflective round curved line from an overlapping graft edge within the anterior chamber using light from an endoilluminator. We here name this Kobayashi sign (K-sign).

Methods:
Twelve consecutive eyes from 12 patients who underwent DMEK were evaluated for the presence of a K-sign. The presence of Berrospi sign (B-sign), a double-line reflection from the peripheral curls of the Descemet membrane (DM) roll that has been reported to be useful for correct graft orientation, was also evaluated.

Results:
Of 12 cases, 3 donors showed a loosely scrolled roll soon after DM donor insertion; all 3 of these showed a positive B-sign only when the endoilluminator was used. Nine donors showed a tightly scrolled DM roll without a B-sign; among these 9 donors, a K-sign was visible in 7 cases only when the endoilluminator was used. The remaining 2 cases with a tight scroll configuration showed no K-sign even with the use of endoillumination, indicating that the roll edge was located completely downward; rotation of the roll using a small jet of fluid from paracentesis revealed K-sign in these cases.

Conclusions:
This technique is useful for determining the correct orientation of a tightly scrolled DM roll, subsequently enabling rapid DMEK surgery. For loosely scrolled DM roll, endoillumination enhanced B-sing is proven useful.
Prevalence and predictors of burnout symptoms in multidisciplinary pain clinics: a mixed-methods study
Authors: Ashton-James Claire E. , McNeilage Amy G. , Avery Nicholas S. , Robson Luci H.E. , Costa Daniel 
Published: August 2020

Abstract
Frequent exposure to patient distress is associated with a higher prevalence of clinician distress and burnout. Patients with chronic pain often present with high levels of emotional distress. The current study examined the prevalence of burnout symptoms among a multidisciplinary sample of pain clinicians in Australia, the relationship between clinician confidence managing emotions and symptoms of burnout, and clinicians' perspectives on sources of stress and wellbeing at work. One hundred seventy-six clinicians from 58 multidisciplinary pain clinics across Australia completed a survey including the 22-item Maslach Burnout Inventory, a measure of clinician confidence managing patient emotions and their own emotions, and open-ended questions probing clinician perspectives on sources of stress and wellbeing at work. High levels of emotional exhaustion and depersonalisation were reported by 21.6% and 14.2% of respondents, respectively. These burnout symptoms were predicted by clinician confidence managing their own emotions. Low levels of personal accomplishment were reported by 18.8% of respondents and were predicted by clinician confidence managing patients' emotions. Consistent with these quantitative findings, qualitative data revealed that emotionally challenging patient encounters were common sources of stress. Working with a multidisciplinary team and supportive relationships with colleagues were commonly reported sources of clinician wellbeing. The results of this study are discussed in light of previous reports of burnout in pain medicine physicians. Implications for clinician training in pain management and the prevention of burnout in pain clinicians are discussed.
Novel bifunctional hybrid compounds designed to enhance the effects of opioids and antagonize the pronociceptive effects of nonopioid peptides as potent analgesics in a rat model of neuropathic pain
Authors: Piotrowska Anna , Starnowska-Sokół Joanna , Makuch Wioletta , Mika Joanna , Witkowska Ewa , Tymecka Dagmara , Ignaczak Angelika , Wilenska Beata , Misicka Aleksandra , Przewłocka Barbara 
Published: August 2020

Abstract
The purpose of our work was to determine the role of nonopioid peptides derived from opioid prohormones in sensory hypersensitivity characteristics of neuropathic pain and to propose a pharmacological approach to restore the balance of these endogenous opioid systems. Nonopioid peptides may have a pronociceptive effect and therefore contribute to less effective opioid analgesia in neuropathic pain. In our study, we used unilateral chronic constriction injury (CCI) of the sciatic nerve as a neuropathic pain model in rats. We demonstrated the pronociceptive effects of proopiomelanocortin- and proenkephalin-derived nonopioid peptides assessed by von Frey and cold plate tests, 7 to 14 days after injury. The concentration of proenkephalin-derived pronociceptive peptides was increased more robustly than that of Met-enkephalin in the ipsilateral lumbar spinal cord of CCI-exposed rats, as shown by mass spectrometry, and the pronociceptive effect of one of these peptides was blocked by an antagonist of the melanocortin 4 (MC4) receptor. The above results confirm our hypothesis regarding the possibility of creating an analgesic drug for neuropathic pain based on enhancing opioid activity and blocking the pronociceptive effect of nonopioid peptides. We designed and synthesized bifunctional hybrids composed of opioid (OP) receptor agonist and MC4 receptor antagonist (OP-linker-MC4). Moreover, we demonstrated that they have potent and long-lasting antinociceptive effects after a single administration and a delayed development of tolerance compared with morphine after repeated intrathecal administration to rats subjected to CCI. We conclude that the bifunctional hybrids OP-linker-MC4 we propose are important prototypes of drugs for use in neuropathic pain.
Safety of a Nurse-Driven Mobility Protocol in a Surgical Trauma Intensive Care Unit
Authors: Black Katelyn , Smith Stephanie , Frotan Mohammad , Vandertulip Kaeli , Miller Amy 
Published: August 2020

Background:
Traumatically injured patients are often admitted with complex multisystem injuries requiring a lengthy stay in the intensive care unit (ICU). Mobilizing patients in the ICU has been shown to reduce the adverse effects of immobility and can reduce the patient's length of stay in the hospital. However, little information is available about the safety of mobilizing traumatically injured patients.

Local Problem:
This quality improvement project was designed to determine whether a nurse-driven mobility protocol could lead to more frequent mobilization of traumatically injured patients. We also sought to determine patient outcomes, measured by the length of stay, adverse effects, and days on mechanical ventilation.

Methods:
A multidisciplinary group developed a nurse-driven early mobility protocol. Nurses were trained on mobilization practices for injured patients; they then mobilized eligible patients on their unit for the subsequent 6 months.

Results:
Nurses mobilized close to 80% of eligible patients in the surgical trauma ICU (STICU) during the implementation period, which was an 87.14% increase in patient mobilization from the preimplementation period. No mobility-associated adverse effects were observed for the patients who were mobilized in the STICU. No significant change in length of stay or ventilator-days occurred.

Conclusion:
Interdisciplinary planning led by physical therapists can ensure that a nurse-driven mobility protocol is a safe and effective method to mobilize patients earlier and more frequently. Future studies should consider a broader range of traumatically injured patients and the long-term effects of mobilization in the STICU.
Acute Care Physical and Occupational Therapy Early Intervention Pathway After Transcatheter Aortic Valve Replacement: A Retrospective Study
Authors: Myszenski Adele , Michon Barbara , Lupcke Danielle , Melican Cynthia , Pedawi Narmean , Ahmed Nazir , Fredal Wyman Janet 
Published: August 2020

Purpose:
Transcatheter aortic valve replacement (tAVR) has emerged as a less-invasive alternative to traditional surgical aortic valve replacement. The purpose of this study was to examine the effect of a novel clinical pathway with an emphasis on early physical therapy and occupational therapy on patients undergoing tAVR in the acute care setting.

Methods:
A retrospective study was conducted involving 189 patients who underwent tAVR. The control group (n = 74) included patients who underwent tAVR prior to the implementation of the pathway. The intervention group (n = 115) included patients who underwent tAVR following the implementation of the pathway. Inpatient length of stay and discharge disposition were measured.

Results:
No differences in demographics or clinical variables were found; for example, mean age was 79.5 ± 11.2 years, with 57% male in the control group versus 81.6 ± 8.4 years and 59% male in the intervention group. Length of stay was significantly lower in the intervention group (control 6.9 ± 5.4 days, intervention 4.8 ± 5.4 days, P = .009) and significantly shorter length of stay postprocedure (control 4.8 ± 2.9 days, intervention 3.5 ± 4.0, P = .015). The incidence of the patient's discharge disposition to home increased from 77% of patients in the control group to 86% of patients in the intervention group but was not statistically significant (P = .118).

Conclusions:
A clinical pathway specific to patients post-tAVR provided early mobility, targeted education, individualized functional goals, and discharge disposition recommendations. Patients in the intervention group experienced reduced hospital length of stay.
Physical Therapy Screening of Occult Cancer Presenting as Hip Pain in Acute Care Setting
Authors: Thompson Stephen R. , Krause David A. , Cloud-Biebl Beth A. 
Published: August 2020

Background and Purpose:
Physical therapists (PTs) in the acute care setting evaluate patients to determine discharge plans and perform mobility-based safety evaluations. When presented with a common problem different from the referral diagnosis, in this case, hip pain, the PT must use knowledge of palpation, range of motion, special tests, and outcome tools to evaluate the patient and identify possible sources of their pain. This case report aims to describe a patient's atypical presentation of hip pain that was ultimately diagnosed as metastatic bone disease. This report includes the description of differential diagnoses based on the patient examination, details of the subsequent events leading to her final diagnosis, and discussion of the importance of screening patients beyond their diagnosis in the acute care setting.

Case Description:
A 69-year-old woman was referred to physical therapy in the hospital following aortic surgery. During the initial evaluation, she described 10/10 hip pain that had gone undocumented thus far. Examination revealed pain with passive and active motion in all directions, increased pain with weight-bearing, and impaired mobility. Current evidence for the evaluation of hip pain was used to examine differential diagnoses aligned with the patient's symptoms. Based on the PT's evaluation, subsequent referrals and imaging were warranted and led to a diagnosis of metastatic adenocarcinoma.

Conclusion:
Hip pain caused by sinister pathologies is unusual. In this case, a PT identified “red flag” symptoms during the initial evaluation and collaborated with other providers for further investigation. The skilled evaluation and timely referral led to the discovery of previously undiagnosed metastatic adenocarcinoma.
Early Rehabilitation Following Saddle Pulmonary Embolism: Perspective From Physical Therapist as Patient
Authors: Brueilly Kevin E. , Hergott Colleen G. , Fox Ashley M. , Dowling Jeffrey S. 
Published: August 2020

Purpose:
Pulmonary embolism (PE) is a complication associated with the condition of deep vein thrombosis (DVT). Together, DVT and PE comprise the condition of venous thromboembolism (VTE). The presence of PE is a life-threatening acute complication, with the risk of death being 18-fold higher than that in patients with DVT alone. The long-term effects of VTE may influence a patient's ability to maintain appropriate levels of physical activity, resulting in impaired functional mobility, quality of life, and overall health and wellness. Physical therapists frequently work with patients who are at risk for or have a history of VTE across all practice settings and are often responsible for mobilizing patients after VTE. However, little guidance exists regarding optimal timing for initiation and intensity of treatment to combat the negative sequalae associated with PE.

Methods:
This case report describes the experience of a physical therapist who suffered an unprovoked submassive saddle PE.

Results:
The patient self-initiated and self-administered an exercise program with successful outcomes. The case provides a unique perspective of a physical therapist who used his clinical knowledge to make decisions, while experiencing the event through the lens of a patient.

Conclusion:
Evidence is provided to support the role of early physical therapy–directed progressive mobility to maximize long-term outcomes following PE.
123I-Ioflupane dopamine transporter imaging (DaTSCAN) appearances in relation to emotional responsiveness, impulsivity and olfaction in suspected Parkinsonian syndrome
Authors: La Torre Guglielmo , Herman Aleksandra Maria , Jessop Maryam , Abdula Nadia , Crawshaw Ania , Begley Patrick , Wroe Emma , Saha Romi Anirban , Duka Theodora , Dizdarevic Sabina 
Published: August 2020

Objective
The aim of our study was to ascertain relationships between DaTSCAN, olfactory loss, behavioural and subjective measurements of impulsivity and emotional responsiveness in patients with clinically suspected Parkinsonian syndrome (PS).

Methods
A prospective study of 20 drug-naive patients with parkinsonism, underwent the University of Pennsylvania Smell Identification Test, impulsivity measurements and mood-state-questionnaires before visual and semi-quantitative DaTQUANT analyses. There were two subgroups: nine patients with scans without evidence of dopaminergic deficit (SWEDD – controls) and 11 patients with PS.

Results
The PS group reported lower non-planning impulsivity than the SWEDD group (P = 0.039). A positive correlation was found between the non-planning impulsivity ratings and right anterior putamen/background (bck) ratio in PS group (r = 0.598, P = 0.068). Higher ratings of anger (r = 0.575, P = 0.016), fatigue (r = 0.746, P = 0.001), confusion (r = 0.561, P = 0.019) and depression were positively correlated with putamen/caudate ratios (R > L) on DaTSCAN. Higher self-reported arousal was associated with lower right putamen/caudate ratio (P = −0.581, P = 0.014). Only fatigue was positively correlated with putamen/bck (r = 0.564, P = 0.018). The degree of smell deficit correlated negatively with performance on reflection impulsivity tasks (r = −0.470, P = 0.049).

Conclusion
DaTSCAN appearances correlated with emotional dysfunction and self-reported impulsivity in patients with PS. Olfactory impairment was associated with increased reflection impulsivity and the age of patients. Higher DaTSCAN putamen/caudate ratios were associated with higher emotional responsiveness and higher non-planning impulsivity in PS patients. These preliminary findings may be relevant in clinical practice in differentiating PS from SWEDD and identifying susceptibility to impulse control disorder although larger studies are warranted.
Seronegative Villous Atrophy in Children
Authors: Mandile Roberta , Maglio Mariantonia , Pellino Nicoletta , Russo Marina , Miele Erasmo , Spagnuolo Maria Immacolata , Troncone Riccardo , Auricchio Renata 
Published: August 2020

ABSTRACTObjectives:Villous atrophy (VA) is not pathognomonic of celiac disease (CD). We aimed at reporting distribution, clinical, and immunohistochemical features of seronegative VA (SNVA) in a pediatric population.Methods:We retrospectively collected data from patients who underwent intestinal biopsies between 2010 and 2017 and showed VA without serum CD‐associated autoantibodies. Marsh‐Oberhuber grading was used. Density of intraepithelial lymphocytes (IELs) expressing CD3 or TCRγδ+ receptor and of lamina propria CD25+ cells was assessed by immunohistochemistry. Intestinal deposits of anti‐tissue tranglutaminase2 (anti‐TG2) were also investigated by double immunofluorescence.Results:Over a 7‐year period, 64 out of 1282 patients with VA had negative serum CD serology. Diagnoses were: inflammatory bowel diseases (IBD) (21/64), Gastro‐Esophageal Reflux Disease (GERD) (12/64), food allergy (8/64), infections (7/64, of which 3 HIV infections), immune deficiency (3/64), short bowel syndrome (3/64), congenital diarrhea (2/64), other/inconclusive diagnosis (8/64). Forty‐four, 15, and 5 showed Marsh 3a, 3b, and 3c lesion, respectively. The latter category included 2 patients with Crohn disease, 2 with immunodeficiencies, 1 with lymphohistiocytosis. In 41/46 (89%) patients, mononuclear CD25+ cells were above the cut‐off, indicating mucosal inflammation but only 18/46 (39%) had IELs and TCRγδ + IELs above limits of normality. In 10 of 46 (22%) patients, a positive immunofluorescence indicated the presence of anti‐TG2 mucosal antibodies.Conclusions:SNVA is not rare representing up to 5% of the cases of VA. Most patients have a Marsh 3a lesion. Immunohistochemical analysis may be helpful in excluding CD, whereas the finding of mucosal anti‐TG2, particularly with a weak staining, shows no absolute specificity for CD.
Method for Removing Thawed Human Milk From a Plastic Storage Bag Impacts Fat Retention
Authors: Friend Linda L. , Gutierrez dos Santos Bruna , El‐Khouri Kristina G. , Perrin Maryanne T. 
Published: August 2020

ABSTRACTObjectives:Determine how thaw stage and bag manipulation (folding and squeezing) influence the retention of fat and number of aerobic bacteria colony‐forming units when decanting human milk (HM) from plastic storage bags.Methods:Lactating women (n = 40) in the Greensboro, North Carolina area were recruited to provide fresh HM. Samples were equally divided and frozen in storage bags for 2 months. Two thaw stages (ice/liquid) and the use of bag manipulation (yes/no) were assessed. Fat was measured using ether extraction and bacteria were measured using plate enumeration. Paired t tests were used to compare the effects of thaw stage and bag manipulation on post‐thaw fat content. Repeated measures analysis of variance was used to compare the effect of bag manipulation on pre‐ and post‐thaw bacteria.Results:Fat retention was not significantly different when thawing to liquid versus ice (mean difference = 0.10 g/dL; n = 17 paired samples; P = 0.07). Decanting with bag manipulation retained more fat than decanting without manipulation, but only when HM was thawed to liquid (mean difference = 0.13 g/dL; n = 11 paired samples; P = 0.005), not when HM was thawed to ice (P = 0.47). Bag manipulation did not increase total aerobic bacteria for either thaw stage (P = 0.49).Conclusions:Fat retention is influenced by the method of removing previously frozen HM from plastic storage bags. Folding and squeezing the storage bag when decanting HM thawed to a liquid state increases fat recovery without increasing bacterial contamination.
Expedited surgery in geriatric hip fracture patients taking direct oral anticoagulants is not associated with increased short-term complications or mortality rates
Authors: Brown Alexander , Zmich Zachary , Roberts Aaron , Lipof Jason , Judd Kyle T. 
Published: August 2020

Abstract

Objectives:
The purpose of this study was to evaluate potential differences in time to surgery, bleeding risk, wound complications, length of stay, transfusion rate, and 30-day mortality between patients anticoagulated with direct oral anticoagulants (DOACs) and those not anticoagulated at the time of evaluation for an acute hip fracture.

Design:
Retrospective chart review Level III Study.

Setting:
One university-based hospital in Rochester, NY.

Patients/Intervention
: Patients 65 years and older undergoing operative treatment of a hip fracture over a 5-year period. Chart review identified patients on DOAC therapy at the time of injury as well as an age and sex-matched control group not on anticoagulation.

Main outcome measurements
: Demographics, procedure type, admission/postoperative laboratory work, perioperative metrics, transfusion metrics, discharge course, reoperation, readmission, wound complications, and 30-day mortality were obtained for comparison.

Results:
Thirty-six hip fractures anticoagulated on DOACs were compared to 108 controls. The DOAC group had delays to operative treatment (27.6 h, SD 16.3 h, 95% CL [22.0–33.1]) vs the control group (19.8 h, SD 10.5 h, 95% CL [17.7–21.8], P = .01). No differences were found in estimated blood loss, procedure time, or change in hemoglobin. Transfusion rates were not significantly different between groups (58.3% DOAC vs 47.2% control, P = .25). No difference in reoperation, readmission, wound complication, deep venous thrombosis rates, or 30-day mortality rates were found.

Conclusion:
Patients presenting on DOAC therapy at the time of hip fracture have a delay to surgery compared with age and sex-matched controls, but no increase in short term complications or mortality rates. Expedited surgery (within 48 h) appeared to be safe and effective treatment for hip fracture patients on DOAC therapies.
Impact of Infant Positioning on Cardiopulmonary Resuscitation Performance During Simulated Pediatric Cardiac Arrest: A Randomized Crossover Study
Authors: Mühlbacher Jakob , Pröbstl Cordula , Granegger Marcus , Schiefer Judith , Duma Andreas , Hüpfl Michael , Herkner Harald , Röhrich Michael , Schebesta Karl 
Published: August 2020

Objectives:
The primary objective was to determine the impact of infant positioning on cardiopulmonary resuscitation performance during simulated pediatric cardiac arrest.

Design:
A single-center, prospective, randomized, unblinded manikin study.

Setting:
Medical university-affiliated simulation facility.

Subjects:
Fifty-two first-line professional rescuers (n = 52).

Interventions:
Performance of cardiopulmonary resuscitation was determined using an infant manikin model in three different positions (on a table [T], on the provider’s forearm with the manikin’s head close to the provider’s elbow [P], and on the provider’s forearm with the manikin’s head close to the provider’s palm [D]). For the measurement of important cardiopulmonary resuscitation performance variables, a commercially available infant simulator was modified. In a randomized sequence, healthcare professionals performed single-rescuer cardiopulmonary resuscitation for 3 minutes in each position. Performances of chest compression (primary outcome), ventilation, and hands-off time were analyzed using a multilevel regression model.

Measurements and Main Results:
Mean (± sd) compression depth significantly differed between table and the other two manikin positions (31 ± 2 [T], 29 ± 3 [P], and 29 ± 3 mm [D]; overall p < 0.001; repeated measures design adjusted difference: T vs P, –2 mm [95% CI, –2 to –1 mm]; T vs D, –1 mm [95% CI, –2 to –1 mm]). Secondary outcome variables showed no significant differences.

Conclusions:
Compressions were significantly deeper in the table group compared to positions on the forearm during cardiopulmonary resuscitation, yet the differences were small and perhaps not clinically important.