bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gait characteristics during crossing over obstacle in patients with glaucoma using insole foot pressure
Authors: Lee Han-Suk , Lee Koon-Ja , Kim Jeong-Lae , Leem Hyun-Sung , Shin Hyun-Jin , Kwon Hyeok Gyu 
Published: August 2021

Abstract

Background:
Glaucoma, is the most common cause of irreversible visual deficits, presents as an injury to the optic nerve and it is mainly associated with elevated intraocular pressure. The main symptom of glaucoma is a reduction of the visual field, which is usually a source of complaint at the advanced stage of disease. Because of visual deficit, gait dysfunctions, including low gait speed and increased bumping into objects, postural sway, and falling are occurred. Many studies have used stopwatch or motion-sensing devices to report on gait function following glaucoma. However, there are few reports on gait dysfunction assessed by examining foot pressure. This study investigated gait ability following glaucoma according to different gait conditions by assessing foot pressure.

Methods:
Thirty older adults (15 in the sex- and age-matched normal group and 15 in the glaucoma group) were recruited for this study. All participants were walked under 2 different gait conditions in an F-scan system and the subject’ assessments were randomly assigned to rule out the order effect. Conditions included: gait over an obstacle in a straight 6 m path, gait in a straight path without an obstacle in the 6 m path. Gait variables included cadence, gait cycle, stance time, center of force (COF) deviation, and COF excursion. About 10 minutes were taken for gait evaluation.

Results:
When walking without an obstacle on a 6 m path, there were significant differences between the 2 groups in gait speed, cadence, gait cycle, and stance time (P < .05). There were significant differences when walking with an obstacle on a 6 m path (P < .05). Two-way analysis of variance showed significant effects associated with “glaucoma” not gait condition on all outcomes except for COF deviation and excursion. Also, there was no the interaction effect between “glaucoma” and “gait condition.”

Conclusion:
We demonstrated that glaucoma patients selected the gait strategy such as lower gait function in both gait conditions particularly, slower gait speed and cadence and longer gait cycle and stance time, as determined by examining foot pressure. We believe that our results could help to improve the quality of life of patients with glaucoma.
Resuming anticoagulation in patients with atrial fibrillation experiencing intracranial hemorrhage
Authors: Wu Victor Chien-Chia , Huang Yi-Chun , Chen Shao-Wei , Liu Chi-Hung , Chang Chun-Wei , Chen Ching-Chang , Chang Shang-Hung , Lin Ming-Shyan , Lee Tsong-Hai , Chen Mien-Cheng , Hsieh I-Chang , Chu Pao-Hsien , Lin Yu-Sheng 
Published: August 2021

Abstract
Globally, 32% to 70% patients with atrial fibrillation (AF) are prescribed oral anticoagulants (OACs) with warfarin for stroke prevention. However, patients with AF on OACs may experience intracranial hemorrhage (ICH), which presents a treatment dilemma. We therefore investigated whether resuming OACs in these patients is beneficial. Electronic medical records of patients with AF on OACs discharged with ICH between 2001 and 2013 were retrieved from the Taiwan National Health Insurance Research Database for analysis. We excluded patients who were <20 years old, who were not using OACs 6 months prior to ICH, or who had a CHA2DS2-VASc score of ≤1. We also excluded patients who died during admission for ICH, with follow-up for <6 weeks after discharge, or who started OAC >6 weeks after ICH diagnosis. The remaining patients were categorized into those who resumed OAC and those who discontinued OAC. Propensity score matching was performed between the 2 groups. Primary outcomes were mortality/ischemic stroke (IS)/systemic embolism (SE), IS/SE, and recurrent ICH at 6 months and 1 year. After the exclusion criteria were applied, 604 eligible patients (408 discontinued OAC and 196 resumed OAC within 6 weeks) were included in this study, and 186 patients in each group were 1:1 matched. Patients who resumed OAC had significantly lower mortality/IS/SE (hazard ratio [HR] = 0.39, 95% confidence interval [CI] = 0.20–0.76) and IS/SE (HR = 0.12, 95% CI = 0.03–0.53) at 6-month follow-up than patients who discontinued OAC. In addition, patients who resumed OAC had significantly lower mortality/IS/SE (HR = 0.56, 95% CI = 0.34–0.93) and IS/SE (HR = 0.26, 95% CI = 0.09–0.75) at 1-year follow-up. No difference in recurrent ICH was noted between the 2 groups. In conclusion, in patients with AF on OACs with ICH, resuming anticoagulant use was associated with significantly lower risks of composite outcomes of mortality/IS/SE and IS/SE than patients who discontinued OACs. No difference in recurrent ICH was observed between the 2 groups.
Emerging Treatment Strategies in Pancreatic Cancer
Authors: Trunk Andrew , Miotke Laura , Nevala-Plagemann Christopher , Verdaguer Helena , Macarulla Teresa , Garrido-Laguna Ignacio 
Published: August 2021

Abstract
Pancreatic ductal adenocarcinoma (PDAC) is one of the main causes of cancer death in well-developed countries. Therapeutic advances in PDAC to date have been modest. Recent progress to understand the molecular landscape of the disease has opened new treatment opportunities for a small subset of patients, frequently those with KRAS wild-type disease. Novel treatment strategies in PDAC include, among others, the use of nanotechnology and metabolic reprogramming. In addition, new strategies are being investigated, which are designed to overcome the resistance to checkpoint inhibitors, targeting DNA repair pathways including mismatch repair, increasing antigen presentation through the use of vaccines, targeting various signaling pathways, and reprogramming the tumor microenvironment. Here, we review the landscape of PDAC treatment strategies and some of these new agents.
Text or Not to Text? A Narrative Review of Texting as a Case Management Intervention
Authors: Sobers-Butler Keisia 
Published: August 2021

Purpose:
To review current literature on texting as a sustainable intervention of case management in the outpatient setting.

Findings:
Texting, as a case management intervention, provides the medically complex client with a pathway to achieve care plan goals. Texting increases adherence, communication, and self-management. It can increase client enrollment in disease management programs, while providing support, flexibility, convenience, cost savings, and increased participation.

Implications for Case Management Practice:
In current practice, such as management of the coronavirus (COVID-19), other pandemics, or natural/environmental disasters, texting is a solution-focused intervention that can deliver and retrieve real-time information to a medically complex population. It can link patients to resources and increase outreach, efficiency, quality, and coordination of care. Texting can promote adherence to appointments, increase medication compliance and disease management interventions, and provide motivational change messages. However, there are legal and regulatory concerns that carry potential consequences and implications that should be approached judiciously (Mellette, 2015). Texting is not one size fits all; it can cause HIPAA breeches, hinder communication with certain populations, confuse health messaging, and replace human communication, thereby reducing staffing in practice.
Pregnant and Parenting Women's Experiences with Substance Use Disorder
Authors: Wright Mary Ellen , Temples Heide S. , Shores Emily , Chafe Olivia , Lannamann Rebekkah , Lautenschlager Carla 
Published: August 2021

Abstract

Purpose:
The purpose of the study was to describe and analyze the experience of women with substance use disorder during pregnancy and parenting to inform health care services that promote recovery.

Study Design:
Interviews of pregnant or parenting women with substance use disorder were used in this qualitative descriptive study.

Methods:
Participants were recruited from two recovery centers serving pregnant or parenting women with substance use disorder. Participants called a study cellphone to speak with the researchers about their substance use and recovery. Four independent reviewers conducted thematic analysis and were facilitated by Atlas.ti qualitative analysis program.

Results:

N = 15 women called the study cellphone; 10 met inclusion criteria and were interviewed. Researchers coded 81 themes with the common occurrence of prior trauma, multiple substances used, stigma and judgment from others, and having children as a motivation to seeking recovery. Co-occurrence of themes of positive social support and the pursuit of recovery was identified.

Clinical Implications:
Positive social support co-occurring with recovery supports the need for strengthened social support structures. Health care professionals should intentionally address the culture of caring for pregnant and parenting women with substance use disorder through education, practice, advocacy, and research.
Identifying, Assessing, and Treating Korsakoff Syndrome Patients
Authors: Westermeyer Joseph John , Soukup Beverly , Mayer Jessica , Lee Kathryn 
Published: August 2021

Abstract
Objectives consist of updating published reports on the recognition, assessment, and care of patients with Wernicke-Korsakoff syndrome (WKS). Methods included defining relevant terms, describing core clinical phenomena, conducting meaningful reviews for latter-day WKS publications, and selecting instructive case examples. Findings covered epidemiology, precipitants, neuroimaging studies, alternate learning strategies in WKS, adjunctive treatments, and promising research. In conclusion, patients, their family members, clinicians, and public health experts should benefit from this updated knowledge. Countries with substantial alcohol consumption should consider emulating Holland in designating WKS research centers, founding regional clinical facilities, and funding multidisciplinary expert teams.
Clinical Nurse Specialist
Authors: Gabbard Erika R. , Klein Deborah , Vollman Kathleen , Chamblee Tracy B. , Soltis Lisa M. , Zellinger Mary 
Published: August 2021

OBJECTIVES
To describe the role of the clinical nurse specialist, an advanced practice registered nurse in the intensive care setting. The value and impact of the clinical nurse specialist role as a member of the ICU is presented along with a review of clinical nurse specialist education, licensure, and certification requirements as well as a description of the clinical nurse specialist role, scope of practice, and competencies. In addition, a selected review of clinical nurse specialist–led quality improvement and research that resulted in improved patient outcomes is provided.

DATA SOURCES
Review of published medical and nursing literature and expert opinion guidance from a collaborative effort between the Society of Critical Care Medicine, American Association of Critical Care Nurses, and National Association of Clinical Nurse Specialists.

STUDY SELECTION
Not applicable.

DATA EXTRACTION
Not applicable.

DATA SYNTHESIS
Not applicable.

CONCLUSIONS
The utilization of a clinical nurse specialist, an advanced practice role, in the ICU is a unique and valuable approach for organizations who strive to move evidence into sustainable practice and drive quality through an interprofessional approach. The valuable contributions made by the clinical nurse specialist efficiently and effectively meet the needs of patients, clinicians, and organizations while improving patient outcomes and optimizing cost avoidance strategies, which further lower economic demands on the healthcare system.
Environmental Life Cycle Assessment in Medical Practice: A User’s Guide
Authors: McGinnis Sean , Johnson-Privitera Camron , Nunziato Jaclyn D. , Wohlford Sara 
Published: August 2021

Importance
The environmental impacts of medical practice are becoming more important as the unsustainable activities of global societies continue to damage the environment and contribute to health problems. Life cycle assessment (LCA) is a methodology to quantify a wide range of environmental impacts, including global warming, over the full life cycle of products, processes, and systems, to allow for data-driven environmental decisions.

Objective
This article introduces the concepts, terminology, and methodology of LCA using examples from the medical industry. It provides guidance and best practices for the standard steps of an LCA study.

Evidence Acquisition
A review of the literature was done to provide examples of the use of LCA and carbon footprints in medicine. Hypothetical medical products were modeled using LCA software to illustrate the capabilities and limitations of this method.

Results
Life cycle assessment examples in medicine illustrate the ability of this method to compare environmental impacts for products that perform the same function. They also highlight the relative scale of damage across all life cycle phases for a variety of environmental impact categories. Resources have also been provided for various useful LCA tools.

Conclusions and Relevance
Life cycle assessment can provide medical practitioners with quantified environmental metrics in order to make decisions that minimize the environmental impacts of medical products, processes, and systems. Carbon footprints are LCA studies that focus only on the impact of climate change. Life cycle assessment is expected to grow as a tool for environmental decisions in medical practice.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After completion of this article, the reader should be better able to describe how environment impacts can occur throughout the different phases of the life cycle of a medical product or process; explain how product life cycle inputs/outputs are translated into quantified environmental impacts; identify the concept of a carbon footprint and differentiate it from an LCA; and summarize several of the main environmental impact categories considered in LCA studies.
Associations of Maternal Cardiovascular Health in Pregnancy With Offspring Cardiovascular Health in Early Adolescence
Authors: Perak Amanda M. , Lancki Nicola , Kuang Alan , Labarthe Darwin R. , Allen Norrina B. , Shah Svati H. , Lowe Lynn P. , Grobman William A. , Lawrence Jean M. , Lloyd-Jones Donald M. , Lowe William L. , Scholtens Denise M. 
Published: August 2021

(Abstracted from JAMA 2021;325:658–668)
The gestational period during pregnancy may be an opportune time to influence not only the health of the mother but also the long-term health of the offspring. Risk factors, such as obesity and diabetes, during pregnancy have been independently associated with higher risks of poor cardiovascular health (CVH).
High Prevalence of Macrolide and Fluoroquinolone Resistance–Mediating Mutations in Mycoplasma genitalium–Positive Urine Specimens From Saskatchewan
Authors: Parmar Nidhi R. , Mushanski Linda , Wanlin Tasker , Lepe Aurora , Lang Amanda , Minion Jessica , Dillon Jo-Anne R. 
Published: August 2021

Background

Mycoplasma genitalium is an emerging, sexually transmitted infection, which is more prevalent than Chlamydia trachomatis in some regions. An increase in antibiotic resistance, that is, azithromycin and moxifloxacin, recommended for treating M. genitalium infections has been noted. This is the first detailed report on the prevalence of M. genitalium and its antimicrobial resistance in Saskatchewan, Canada.

Methods
Aptima urine specimens (n = 1977), collected for the diagnosis of C. trachomatis/Neisseria gonorrhoeae, were tested for M. genitalium using the Aptima M. genitalium assay (MG-TMA). Antimicrobial resistance was ascertained using polymerase chain reaction and DNA sequencing of 23S rRNA (azithromycin) and parC (moxifloxacin) from Aptima M. genitalium assay–positive specimens; mutations predictive of resistance were noted.

Results
The prevalence of M. genitalium was 9.6% (189/1977). Predicted resistance to azithromycin (substitutions at positions 2058/2059 in 23S rRNA) was observed in 63.6% (70/110) of the specimens tested, whereas resistance to moxifloxacin (S83I in ParC) was observed in 10.6% (9/85) of the specimens. Mutations in both 23S rRNA and ParC were observed in 2.12% (4/189) of the specimens. Women aged 20 to 24 years had the highest prevalence (18.3%, P < 0.001), and in females, M. genitalium was significantly associated with C. trachomatis or N. gonorrhoeae/C. trachomatis (P < 0.001) coinfection. The prevalence of M. genitalium (9.6%) in the province of Saskatchewan was higher than that of the other 2 bacterial sexually transmitted infections (N. gonorrhoeae (3.09%) and C. trachomatis (6.85%).

Conclusions
The prevalence of M. genitalium (9.6%) and associated resistance to azithromycin (63.6%) in Saskatchewan high, suggesting that empiric azithromycin therapy may not be adequate for treating M. genitalium infections.
Comparison of Postoperative Occupational Therapy and Narcotic Use in Two Carpometacarpal Arthroplasty Approaches
Authors: Sarac Nikolas , Samade Richard , Jain Sonu A. 
Published: August 2021

Background:
The authors sought to determine whether differences exist in (1) the number of postoperative occupational therapy visits and (2) narcotic use in two carpometacarpal arthroplasty groups.

Methods:
A retrospective study comparing patients undergoing abductor pollicis longus (APL) suspensionplasty (154 patients) or flexor carpi radialis ligament reconstruction and tendon interposition (FCR LRTI) techniques (40 patients) between January 1, 2012, and August 1, 2018, was performed. Data included demographics, procedure performed, complications, number of postoperative occupational therapy visits, and postoperative morphine equivalent dosage used. Statistical testing used the chi-square test for proportions and the Wilcoxon-Mann-Whitney test for nonnormal data. The significance level was 0.05.

Results:
The APL suspensionplasty and FCR LRTI groups had similar ages (58.1 ± 7.8 years versus 58.1 ± 7.7 years), sex ratios (73 percent female versus 75 percent female), and preoperative narcotic user proportions (1 percent versus 3 percent). Complication rates following the procedures were similar (21 percent and 18 percent, respectively). The number of postoperative occupational therapy visits following APL suspensionplasty (median, 0; interquartile range, 0 to 4) and FCR LRTI (median, 0; interquartile range, 0 to 4) were not significantly different (p = 0.961). There was less use of narcotics following APL suspensionplasty (median, 375 morphine equivalent dosage; interquartile range, 241.9 to 525 morphine equivalent dosage) compared with FCR LRTI (median, 462.5 morphine equivalent dosage; interquartile range, 375 to 768.8 morphine equivalent dosage), and this difference was significant (p = 0.0007).

Conclusions:
The APL suspensionplasty technique had less narcotic use and similar complication rates and occupational therapy visits compared to FCR LRTI. Prospective studies comparing postoperative pain control and function with these two carpometacarpal arthroplasty techniques may be beneficial.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Targeted Muscle Reinnervation Improves Pain and Ambulation Outcomes in Highly Comorbid Amputees
Authors: Chang Brian L. , Mondshine Josh , Attinger Christopher E. , Kleiber Grant M. 
Published: August 2021

Background:
Approximately 200,000 people undergo a lower extremity amputation each year. Following amputation, patients suffer from chronic pain, inability to ambulate, and high mortality rates. Targeted muscle reinnervation is a nerve transfer procedure that redirects transected sensory and mixed nerves into motor nerves to treat neuroma and phantom limb pain. This study evaluates outcomes with prophylactic targeted muscle reinnervation at the time of below-knee amputation.

Methods:
This is a cohort study comparing 100 patients undergoing below-knee amputation with primary targeted muscle reinnervation and 100 patients undergoing below-knee amputation with standard traction neurectomy and muscle implantation. Outcome metrics included the presence of residual and phantom limb pain, pain severity, opioid use, ambulation ability, and mortality rates.

Results:
The targeted muscle reinnervation group was on average 60 years old with a body mass index of 29 kg/m2. Eighty-four percent had diabetes, 55 percent had peripheral vascular disease, and 43 percent had end-stage renal disease. Average follow-up was 9.6 months for the targeted muscle reinnervation group and 18.5 months for the nontargeted muscle reinnervation group. Seventy-one percent of targeted muscle reinnervation patients were pain free, compared with 36 percent (p < 0.01). Fourteen percent of targeted muscle reinnervation patients had residual limb pain, compared with 57 percent (p < 0.01). Nineteen percent of targeted muscle reinnervation patients had phantom limb pain, compared with 47 percent (p < 0.01). Six percent of targeted muscle reinnervation patients were on opioids, compared with 26 percent (p < 0.01); and 90.9 percent of targeted muscle reinnervation patients were ambulatory, compared with 70.5 percent (p < 0.01).

Conclusion:
Targeted muscle reinnervation reduces pain and improves ambulation in patients undergoing below-knee amputation, which may be critical in improving morbidity and mortality rates in this comorbid patient population.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Nerve Coaptation Improves the Sensory Recovery of the Breast in DIEP Flap Breast Reconstruction
Authors: Beugels Jop , Bijkerk Ennie , Lataster Arno , Heuts Esther M. , van der Hulst René R. W. J. , Tuinder Stefania M. H. 
Published: August 2021

Background:
Restoring the sensation of the reconstructed breast has increasingly become a goal of autologous breast reconstruction. The aim of this study was to analyze the sensory recovery of the breast and donor site of innervated compared to noninnervated deep inferior epigastric perforator (DIEP) flap breast reconstructions, to assess associated factors, and to compare the differences between preoperative and postoperative sensation.

Methods:
A prospective cohort study was conducted, including patients who underwent innervated or noninnervated DIEP flap breast reconstruction between August of 2016 and August of 2018. Nerve coaptation was performed to the anterior cutaneous branch of the third intercostal nerve. Preoperative and postoperative sensory testing of the breast and donor site was performed with Semmes-Weinstein monofilaments.

Results:
A total of 67 patients with 94 innervated DIEP flaps and 58 patients with 80 noninnervated DIEP flaps were included. Nerve coaptation was significantly associated with lower mean monofilament values for the breast (−0.48; p < 0.001), whereas no significant differences were found for the donor site (−0.16; p = 0.161) of innervated compared to noninnervated DIEP flaps. Factors positively or negatively associated with sensory recovery of the breast and donor site were identified. Preoperative versus postoperative comparison demonstrated significantly superior sensory recovery of the breast in innervated flaps (adjusted difference, −0.48; p = 0.017).

Conclusions:
This study demonstrated that nerve coaptation in DIEP flap breast reconstruction significantly improved the sensory recovery of the breast compared to noninnervated flaps. The sensory recovery of the donor site was not compromised in innervated reconstructions. The results support the role of nerve coaptation in autologous breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.