bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Treatment of Intercostal Brachial Nerve Pain after Mastectomy and Axillary Dissection
Authors: Kim Justine S. , Spiess Alexander M. 
Published: November 2021

Summary:
Postmastectomy chronic pain describes chronic pain in the anterior aspect of the thorax, axilla, and/or upper half of the arm present after surgical treatment of breast cancer and persistent for more than 3 months. The most common cause of this syndrome is damage to the intercostal brachial nerve. Current methods of treatment include medications, physical therapy, and peripheral nerve blocks. The literature lacks data regarding surgical interventions for intercostal brachial nerve pain in the postmastectomy and axillary dissection breast cancer patient. We discuss a case of a 47-year-old woman with left breast cancer status post-nipple-sparing mastectomy and sentinel lymph node biopsy complicated by refractory dysesthesias in the intercostal brachial nerve distribution. Axillary exploration demonstrated a surgical clip with an associated neuroma of a branch of the intercostal brachial nerve. Excision and repair resulted in immediate pain relief in the postoperative period. We propose a comprehensive treatment algorithm to address postmastectomy pain attributed to intercostal brachial nerve pathology.
CHORIORETINAL ATROPHY IN VITREORETINAL LYMPHOMA
Authors: Marchese Alessandro , Cicinelli Maria VITTORIA , Cavalleri Michele , Bandello Francesco , Modorati Giulio , Miserocchi Elisabetta 
Published: November 2021

Purpose:
To investigate the frequency, risk factors, and functional prognosis of chorioretinal atrophy (CRA) in vitreoretinal lymphoma (VRL).

Methods:
This was a retrospective cohort study of consecutive patients with vitreoretinal lymphoma. The demographic, clinical, and retinal features and the treatment modalities of each patient were collected. The charts and the multimodal imaging at each visit were reviewed. The risk factors associated with CRA were investigated with a mixed-model Cox regression.

Results:
Of the 79 eyes of 40 patients included, 41 eyes (52%) had CRA; 27 and 14 eyes had focal and diffuse CRA, respectively. The rate of vitreoretinal lymphoma lesions in the macula was similar between focal and diffuse CRA (96% vs. 93%). The eyes with CRA had worse best-corrected visual acuity (P = 0.006) than eyes with no CRA; diffuse atrophy had the worst best-corrected visual acuity (P < 0.001). The presence of retinal infiltrates (hazard ratio = 3.75, 95% confidence interval [CI] 1.46–9.59, P = 0.006) and vertical hyperreflective lesions (hazard ratio= 4.13 95% CI 1.14–14.93, P = 0.03) on optical coherence tomography and macular involvement (hazard ratio = 6.59, 95% CI 1.41–30.53, P = 0.02) were associated with a higher risk of CRA.

Conclusion:
Vitreoretinal lymphoma presenting with retinal infiltrates and macular involvement carried a higher risk of CRA. Risk factors for CRA should be identified for the potential of severe visual loss. Prompt diagnosis of vitreoretinal lymphoma may allow better control of the disease.
Total Anterior Staphyloma Secondary to Acanthamoeba Keratitis
Authors: Sachdev Amun , Sachdev Anshu , Mollan Susan P. , Snead David , Ahluwalia Harpreet S. 
Published: November 2021

Abstract:
There are very few published cases of total anterior staphyloma, all of which have been reported as secondary to fungal keratitis. This study reports the clinical and histopathological findings and subsequent management of a 27-year-old healthy female patient who developed total anterior staphyloma after poor compliance with treatment for clinically diagnosed acanthamoeba keratitis. She underwent a successful evisceration with good long-term results. This case highlights that total anterior staphyloma may also result from untreated keratitis which is not fungal in origin. In cases of fungal and acanthamoeba keratitis, patient compliance with both treatment and follow-up is paramount to avoid vision-threatening sequelae that present significant challenges in their management.
Nimodipine in Clinical Practice: A Pharmacological Update
Authors: Clough Brendon , Tenii Josephine , Wee Claribel , Gunter Elizabeth , Griffin Tara , Aiyagari Venkatesh 
Published: November 2021

ABSTRACT

INTRODUCTION: Enteral nimodipine provides a neuroprotective effect in patients who have experienced an aneurysmal subarachnoid hemorrhage (aSAH). Nimodipine remains the only US Food and Drug Administration–approved medication for aSAH. CONTENT: Nimodipine has been prescribed for patients with aSAH; however, little is known about factors to consider regarding dosing or patient-specific variables that may affect tolerability to nimodipine. Clinical impact of dose or dosing frequency changes has also been much debated based on risk of hypotension with currently approved dosing regimens. CONCLUSION: This review article addresses factors to consider for dosing and administration, pharmacokinetic and pharmacogenetic impact on nimodipine, and, finally, drug interaction considerations to assess as patients are initiated on enteral nimodipine for aSAH.
A Decade-long Comparison of Prestroke Health Behaviors Among Hypertensive Stroke Patients in Mainland China
Authors: Liu Qun-Hong , Tan Ju-Xiang , Hu Cai-Xia , Hu Dan-Lu , Wan Li-Hong 
Published: November 2021

ABSTRACT

BACKGROUND: Patients with hypertension are at a high risk for stroke, but a healthy lifestyle can greatly reduce the risk of stroke. However, there has been no research on the change in prestroke health behaviors in Chinese patients with hypertensive stroke over a decade. OBJECTIVES: The aims of this study were to determine whether prestroke health behaviors of patients with hypertensive stroke changed over a decade and to explore the predictors of prestroke health behaviors over a decade. METHODS: This study used data from 2 cross-sectional studies conducted in the neurology departments of 3 hospitals in Guangzhou, China. In total, 110 hypertensive stroke patients were recruited in stage I (2008-2009), and 119 hypertensive stroke patients were recruited in stage II (2018-2019). Patients' stroke knowledge was measured by the Stroke Knowledge Questionnaire. Patients' prestroke health behavior was measured by the Health Behavior Scale for Stroke Patients. RESULTS: The total score of prestroke health behaviors significantly increased over the decade (P < .001), but the scores of the subcategories of low-fat diet, low-sugar diet, and blood pressure checkups decreased over the decade (P < .05). Stroke knowledge was a significant predictor of prestroke health behaviors in stage I (P < .05). Besides stroke knowledge, sex and age were significant predictors of prestroke health behaviors in stage II (P < .05). CONCLUSIONS: Prestroke health behaviors of hypertensive stroke patients significantly improved over the decade. Moreover, prestroke health behaviors were significantly influenced by stroke-related knowledge over the decade. Healthcare providers should focus in particular on assisting patients who are male, young, and middle-aged, and lack stroke-related knowledge to improve their prestroke health behaviors, especially in terms of adherence to a low-fat/low-sugar diet and regular blood pressure checks.
Effect of respiratory muscle training on expiratory muscle strength and abdominal electrical activity in the acute phase of Stroke
Authors: Sartor Lorena Cristina Alvarez , Luvizutto Gustavo José , Souza Juli Thomaz , Miranda Luana Aparecida , Molle da Costa Evelin Roberta Silva Dalle , Ribeiro Priscila Watson , Modolo Gabriel Pinheiro , da Silva Taís Regina , Prudente Robson Aparecido , Antunes Letícia Cláudia de Oliveira , da Costa Rafael Dalle Molle , Ferreira Natália Cristina , Nunes Hélio Rubens de Carvalho , Bazan Silméia Garcia Zanati , Winckler Fernanda Cristina , Minicucci Marcos Ferreira , Bazan Rodrigo 
Published: November 2021

Abstract

Background:
Respiratory muscle function can be compromised during the acute phase and this study aims to assess the effectiveness, feasibility, and safety of short-term expiratory muscle training in acute stroke patients. Additionally, we will assess the effects of expiratory muscular training on the electromyographic activity of the abdominal muscle, vital capacity, stroke severity, hand grip strength, functional independence, autonomy, and quality of life.

Methods:
This single-center, randomized, single-blind, parallel-group study of 88 patients with stroke will include the following groups: 1) an intervention group that will undergo expiratory muscle training, physical therapy, and standard care (n = 44) and 2) a control group that will only undergo physical therapy and standard care (n = 44). The primary outcome is respiratory muscle strength assessed via inspiratory and expiratory pressures (cmH2O). The secondary outcomes are electromyography activity of the rectus abdominis muscle and abdominal external oblique muscle, vital capacity measured by a ventilometer, handgrip strength, stroke severity and disability [National Institutes of Health Stroke Scale, modified Rankin Scale, and Barthel index], and quality of life. We will assess all variables before and after the intervention. The delta will be compared between the groups (intervention vs. control) using Student t-test for normal distribution and Mann-Whitney test for skewed distribution. The data will be analyzed using SPSS and results with P-values <.05 will be considered statistically significant.

Discussion:
The ACANTHUS trial has clinical relevance and is necessary since previous studies have revealed that respiratory rehabilitation after stroke improves patients’ functional capacities.

Trial Registration:
Registro Brasileiro de Ensaios Clínicos (Rebec) - RBR-8w44f6
Commonly used biomarkers do not contribute to diagnosing irritable bowel syndrome
Authors: Kramer Sjoerd , Masclee Ad A.M. , Jebbink Ric J.A. , Tack Greetje J. 
Published: November 2021

Objective
The aim of this article was to examine the costs and effectiveness of standardized blood and fecal investigations in patients fulfilling the Rome criteria for irritable bowel syndrome (IBS).

Methods
We conducted a real-life cohort study in patients fulfilling the Rome III criteria for IBS without red flag signs or symptoms, in a center of excellence for IBS patients from 1 January 2015 till 1 January 2019. Standardized blood and fecal investigations [hemoglobin (Hb), thyroid-stimulating hormone (TSH), coeliac serology, and fecal calprotectin (FCP)] were performed during the first consultation. Patients were followed for at least 1 year. Primary outcome was the probability of another diagnosis than IBS with subsequent overall costs.

Results
A total of 218 patients were included. In approximately 200 patients blood and fecal investigations were performed and 47 patients underwent a colonoscopy. Two-hundred ten patients were diagnosed with IBS, 5 with inflammatory bowel disease (IBD), 1 with nonspecific acute ileitis, 1 with hyperthyroidism, and 1 with coeliac disease. The number needed to diagnose all included laboratory tests was 34, and for the individual test: TSH 197, coeliac serology 199, and FCP 50. The total costs were approximately €4900 to diagnose one patient with another diagnosis than IBS.

Conclusion
In our real-life cohort of adult patients under the age of 50 years fulfilling the Rome criteria for IBS without red flag symptoms, standardized blood, and fecal investigations have a very low diagnostic yield accompanied by high additional costs. Colonoscopy is not indicated in patients with Rome III positive IBS and normal FCP.
Prevalence of Barrett’s esophagus in a Southern European country: a multicenter study
Authors: Marques de Sá Inês , Leal Carina , Silva Joana , Falcão Daniela , Felix Catarina , Nascimento Catarina , Boal Carvalho Pedro , Vasconcelos Helena , Pedroto Isabel , Chagas Cristina , Cravo Marília , Cotter José , Sharma Prateek , Dinis-Ribeiro Mário 
Published: November 2021

Background
Identification of Barrett’s esophagus (BE) with the treatment of dysplasia is essential to prevent esophageal adenocarcinoma (EAC). Moreover, determination of BE prevalence is important to define subsequent management strategies. However, precise estimates on BE prevalence from several European countries are lacking. We aimed to determine BE prevalence in a Southern European country.

Methods
A cross-sectional, multicenter study from November 2019 to February 2020 was performed defining BE as a columnar extent in the distal esophagus greater than or equal to 1 cm with intestinal metaplasia.

Results
A total of 1550 individuals, 51% male with a mean age of 62 (SD = 15) years undergoing upper endoscopy were included. The overall BE prevalence was 1.29% (95% confidence interval: 0.73-1.85); significantly higher in men [2.05% (1.06-3.04)] vs. women [0.53% (0.01-1.04)]. Of the 20 BE patients, eight were newly diagnosed and 12 were under surveillance. The median extent was C3 (min 0; max 16) M4.5 (min 2; max 16). One patient each had EAC (0.06%) and high-grade dysplasia (0.06%) at the time of endoscopy. There was no difference in prevalence between geographical regions, centers, use of sedation or experience of endoscopists. Considering all reports, 93% used standardized terminology, 23% accurate photodocumentation and 69% photodocumented the esophagogastric junction (EGJ). Furthermore, 80% used Prague classification, 55% Seattle protocol, 60% distance to the squamocolumnar junction, 75% to the EGJ and 40% to the hiatal pinch. When considering only reports with EGJ photodocumentation or Prague classification, the prevalence was 1.78% (0.91-2.64) or 1.03% (0.53-1.53).

Conclusion
We report for the first time BE prevalence in Southern Europe and report a low overall prevalence in an unselected population. Future studies need to determine progression rates and how to improve quality metrics.
Perceptions of Nurses Who Are Second Victims in a Hospital Setting
Authors: Draus Catherine , Mianecki Therese B. , Musgrove Hannah , Bastien Danielle J. , Greggs Dana , Halash Christine , (Larry-Osman) Bellamy Cheryl , Lewis Amber , Mackenzie Wendy 
Published: November 2021

Background:
Second victims (SVs) are health care workers traumatized by unanticipated, adverse patient events. These experiences can have personal and professional effects on SVs. Research indicates that SVs experience inadequate support following adverse events.

Purpose:
To determine the prevalence of nurses who identified as SVs and their awareness and use of supportive resources.

Methods:
A convenience sample of nurses was surveyed, and SV responses were compared with those who did not identify as a SV. Responses were analyzed using nonparametric methods.

Results:
One hundred fifty-nine (44.3%) of 359 participants identified as SVs. There was a significant relationship between work tenure and SVs (P = .009). A relationship was found between SVs and awareness and use of support resources, with debriefing being the preferred method after an event.

Conclusions:
Adverse events trigger emotional trauma in SVs who require administrative awareness, support, and follow-up to minimize psychological trauma in the clinical nurse.
A Multidisciplinary Approach to Improving the Pediatric Discharge Process
Authors: Jubic Kayla , Dick Emily , Moelber Carrie 
Published: November 2021

Background:
A collaborative and multidisciplinary shared responsibility with providing discharge information to pediatric patients/families can support successful reassimilation to life posthospitalization.

Problem:
An analysis of the current discharge process at an urban pediatric hospital identified variations in discharge practices and instructions.

Approach:
A multidisciplinary taskforce used the Plan-Do-Study-Act methodology to standardize the discharge process including creating a discharge template, adopting a new education platform, enhancing the electronic health record, and implementing strategies to improve discharge.

Outcomes:
There was a reduction in 7-day readmission rate from preintervention 4.58 to postintervention for 4 consecutive quarters of 3.92, 4.20, 3.44, and 3.41, respectively. Percentile ranking and top box scores of the patient satisfaction measure of discharge preparation increased from 12th-62nd to 65th-95th percentile postimplementation and 81% to 88%, respectively.

Conclusions:
A local improvement initiative related to standardization of the discharge process resulted in a reduction in 7-day readmission rate and improved patient satisfaction scores.
Classification of Limb and Mobility Impairments in Persons With Stroke Using the STREAM
Authors: Winairuk Thitimard , Chaikeeree Nithinun , Sirisup Sirod , Saengsirisuwan Vitoon , Boonsinsukh Rumpa 
Published: November 2021

Background and Purpose:
Classification of functional impairment in persons with stroke can influence treatment planning but this information is missing in the Stroke Rehabilitation Assessment of Movement (STREAM) Scale. This study aimed to establish the classification of limb mobility impairments and item difficulty of the STREAM.

Methods:
Rasch analysis was conducted on the STREAM scores to examine the person and item reliability, the item difficulty, and level of impairments. A total of 240 participants were evaluated using the STREAM, the Fugl-Meyer Stroke Assessment (FM), and the Functional Ambulation Categories (FAC). The concurrent validity of the STREAM extremity (STREAM-E) category with the FM-motor category and the STREAM mobility (STREAM-M) category with the FAC category was analyzed using the Spearman rank-order correlation.

Results:
Person reliabilities of the STREAM-E and STREAM-M were 0.92 and 0.80, respectively. High-item reliability was observed in both STREAM-E (0.97) and STREAM-M (0.99). The STREAM items “flexes hip and knee in supine” and “rolls onto side” were the easiest items, whereas the “dorsiflexes affected ankle with knee extended” item was the most difficult item. The STREAM-E category demonstrated excellent concurrent validity with the FM-motor category (ρ = 0.83) in classifying individuals with stroke into 5 groups: mild, moderate, moderately severe, severe, and very severe limb impairment. The STREAM-M category showed a moderate correlation with the FAC category (ρ = 0.71) in categorizing persons with stroke into 3 groups: mild, moderate, and severe mobility impairment.

Discussion and Conclusions:
Findings can be used in the assessment and treatment planning of persons with stroke.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A373).
Pressure Injury Prevalence in Acute Care Hospitals With Unit-Specific Analysis
Authors: VanGilder Catherine A. , Cox Jill , Edsberg Laura E. , Koloms Kimberly 
Published: November 2021

PURPOSE:
The purpose of this study was to determine overall pressure injury (PI) prevalence and hospital-acquired pressure injury (HAPI) prevalence in US acute care hospitals. Additionally, analysis of patient characteristics associated with HAPIs will be presented.

DESIGN:
Observational, cross-sectional cohort study.

SUBJECTS AND SETTING:
An in-depth analysis of data was performed from the International Pressure Ulcer Prevalence™ (IPUP) Survey database for years 2018-2019 that included 296,014 patients. There were 914 participating US acute care facilities in 2018 and 887 in 2019. Overall PI prevalence and HAPI prevalence over time were also examined for 2006-2019 acute care data from 2703 unique facilities (1,179,108 patients).

METHODS:
Overall PI prevalence and HAPI prevalence were analyzed from the 2006-2019 IPUP survey database. Recent data for 2018-2019 PI prevalence are reported separately for medical-surgical, step-down, and critical care unit types. PI stages, anatomic locations, Braden score associated with HAPIs, and body mass index were analyzed.

RESULTS:
Overall PI prevalence and HAPI prevalence data declined between 2006 and 2019; however, the prevalence plateaued in the years 2015-2019. Data from 2018 to 2019 (N = 296,014) showed that 26,562 patients (8.97%) had at least one PI and 7631 (2.58%) had at least one HAPI. Patients cared for in medical-surgical inpatient care units had the lowest overall PI prevalence (7.78%) and HAPI prevalence (1.87%), while critical care patients had the highest overall PI prevalence (14.32%) and HAPI prevalence (5.85%). Critical care patients developed more severe PIs (stage 3,4, unstageable, and deep-tissue pressure injuries [DTPIs]), which were proportionally higher than those in the step-down or medical-surgical units. The sacrum/coccyx anatomic location had the highest overall PI prevalence and HAPI prevalence, except for DTPIs, which most common occurred on the heel.

CONCLUSIONS:
Overall and HAPI prevalence has plateaued 2015-2019. Prevalence of HAPIs, especially in critical care units, remain high. While medical advancements have improved survival rates among critically ill patients, survival may come with unintended consequences, including PI development.
Abdominal Soft Tissue Infection Caused by Mycobacterium wolinskyi After Cosmetic Surgery
Authors: Rauch-Pucher Mackenzie , McCartney Teresa , Cox-Reber Jessica , Markwell Ashley 
Published: November 2021

BACKGROUND:

Mycobacterium wolinskyi is a rare, fast-growing, painful bacterium causing soft tissue infections. Sparse case reports focus on long-term intravenous antibiotic therapy and surgical interventions. We searched the literature and found almost no discussion about treatment from a nursing and wound care perspective.

CASE:
Ms P, a 30-year-old Arabic female patient, underwent cosmetic surgery in Iraq including liposuction, abdominoplasty, and herniorrhaphy. One month postoperatively, she presented with an infection identified as M. wolinskyi resulting in multiple hospital admissions. Ms P received treatment with long-term antibiotic therapy and underwent multiple surgical debridements with extensive wound care management.

CONCLUSION:

Mycobacterium wolinskyi is an exceedingly rare bacterium not typically seen in the clinical setting and requires prolonged and aggressive treatment. It is painful and fast-growing, as evidenced by multiple abscess formations and tissue necrosis in this case. Daily assessments and wound management using a collaborative approach were important to promote optimal healing.
The role of KPNA2 mutations in breast cancer prognosis: A survey of publicly available databases
Authors: Alnoumas Layla , van Den Driest Lisa , Lannigan Alison , Johnson Caroline H , Rattray Nicholas JW , Rattray Zahra 
Published: November 2021

AbstractBreast cancer, comprising of several sub-phenotypes, is a leading cause of female cancer-related mortality in the UK and accounts for 15% of all cancer cases. Chemoresistant sub phenotypes of breast cancer remain a particular challenge. However, the rapidly-growing availability of clinical datasets, presents the scope to underpin a data driven precision medicine-based approach exploring new targets for diagnostic and therapeutic interventions. We report a survey of several publicly available databases probing the expression and prognostic role of Karyopherin-2 alpha (KPNA2) in breast cancer prognosis. Aberrant KPNA2 overexpression is directly correlated with aggressive tumour phenotypes and poor patient survival outcomes. We examined the existing information available on a range of commonly occurring mutations of KPNA2 and their correlation with patient survival.Our analysis of clinical gene expression datasets show that KPNA2 is frequently amplified in breast cancer, with differences in expression levels observed as a function of patient age and clinicopathologic parameters. We also found that aberrant KPNA2 overexpression is directly correlated with poor patient prognosis, warranting further investigation of KPNA2 as an actionable target for patient stratification or the design of novel chemotherapy agents.In the era of big data, the wealth of datasets available in the public domain can be used to underpin proof of concept studies evaluating the biomolecular pathways implicated in chemotherapy resistance in breast cancer.