bluuebunny/crossref_metadata_2025_split huggingface dataset:
Academy of Oncologic Physical Therapy EDGE Task Force on Cancer: A Systematic Review of Outcome Measures for Pain in Children
Authors: Miale Susan , Harrington Shana , Brown Kristin , Braswell Ashley , Cannoy Jill , Krisch Nancy , Rock Kelly E. 
Published: March 2019

Background:
Children with cancer can experience pain throughout their clinical course. Accurate assessment of pain can lead to more effective pain management.

Purpose:
To identify outcome measures used to assess pain in children and to appraise each tool based on psychometric properties, clinical utility, and application to pediatric oncology.

Methods:
The authors searched 3 electronic databases (MEDLINE, CINAHL, and SCOPUS), using specific search terms to identify measures used to evaluate pain in children with cancer. Of the 956 articles found, 270 were reviewed and 17 measures were identified for further assessment. Each outcome measure was reviewed by 2 independent reviewers, who then ranked each measure using the 4-point Cancer EDGE Task Force Outcome Measure Rating Scale. Discrepancies were discussed to reach consensus.

Results:
The Wong-Baker FACES Pain Rating Scale is highly recommended (4). The Oucher Pain Scale, Adolescent Pediatric Pain Tool, and Pieces of Hurt Assessment Tool/Poker Chip Tool are recommended (3). Six additional tools are deemed reasonable to use (2) and 7 tools are not recommended (1).

Conclusions:
Based on clinical utility, psychometric properties, and application to children with oncologic diseases, 4 outcome measures are recommended for the assessment of pain in children with a diagnosis of cancer.
Incorporating Physician Input Into a Maintenance of Certification Examination: A Content Validity Tool
Authors: Poniatowski Paul A. , Dugosh Jeremy W. , Baranowski Rebecca A. , Arnold Gerald , Lipner Rebecca S. , Dec George W. , Green Marianne M. 
Published: March 2019

Purpose
As part of the American Board of Internal Medicine’s (ABIM’s) continuing effort to update its Maintenance of Certification (MOC) program, a content validity tool was used to conduct structured reviews of MOC exam blueprints (i.e., test specification tables) by the physician community. Results from the Cardiovascular Disease MOC blueprint review are presented to illustrate the process ABIM conducted for several internal medicine disciplines.

Method
Ratings of topic frequency and importance were collected from cardiologists in 2016 using a three-point scale (low, medium, high). The web-based survey instrument presented 188 blueprint topic descriptions, each combined with five patient-related tasks (e.g., diagnosis, treatment). Descriptive statistics and chi-square analysis were employed.

Results
Responses from 441 review participants were analyzed. Frequency and importance ratings were aggregated as a composite statistic representing clinical relevance, and exam assembly criteria were modified to select questions, or items, addressing clinically relevant content only. Specifically, ≥ 88% of exam items now address high-importance topics, including ≤ 15% on topics that are also low frequency; and ≤ 12% of exam items now address medium-importance topics, including ≤ 3% on topics that are also low frequency. The updated blueprint has been published for test takers and provides enhanced information on content that would and would not be tested in subsequent examinations. It is linked to more detailed feedback that examinees receive on items answered incorrectly.

Conclusions
The blueprint review garnered valuable feedback from the physician community and provided new evidence for the content validity of the Cardiovascular Disease MOC exam.
Respiratory Variation of Internal Carotid Artery Blood Flow Peak Velocity Measured by Transfontanelle Ultrasound to Predict Fluid Responsiveness in Infants
Authors: Kim Eun-Hee , Lee Ji-Hyun , Song In-Kyung , Kim Hee-Soo , Jang Young-Eun , Kim Jin-Tae 
Published: March 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Cranial sonography is a widely used point-of-care modality in infants. The authors evaluated that the respiratory variation of the internal carotid artery blood flow peak velocity as measured using transfontanelle ultrasound can predict fluid responsiveness in infants.

Methods
This prospective observational study included 30 infants undergoing cardiac surgery. Following closure of the sternum, before and after the administration of 10ml · kg–1 crystalloid, the respiratory variation of the aorta blood flow peak velocity, pulse pressure variation, and central venous pressure were obtained. The respiratory variation of the internal carotid artery blood flow peak velocity was measured using transfontanelle ultrasound. Response to fluid administration was defined as an increase in stroke volume index, as measured with transesophageal echocardiography, greater than 15% of baseline.

Results
Seventeen subjects (57%) were responders to volume expansion. Before fluid loading, the respiratory variation of the internal carotid artery and the aorta blood flow peak velocity (means ± SD) of the responders were 12.6 ± 3.3% and 16.0 ± 3.8%, and those of the nonresponders were 8.2 ± 3.2% and 10.9 ± 3.5%, respectively. Receiver operating characteristic curve analysis showed that the respiratory variation of the internal carotid artery and the aorta blood flow peak velocity could predict fluid responsiveness; the area under the curve was 0.828 (P < 0.0001; 95% CI, 0.647 to 0.940) and 0.86 (P = 0.0001; 95% CI, 0.684 to 0.959), respectively. The cutoff values of the respiratory variation of the internal carotid artery and the aorta blood flow peak velocity were 7.8% (sensitivity, 94%; specificity, 69%) and 13% (sensitivity, 77%; specificity, 92%), respectively.

Conclusions
The respiratory variation of the internal carotid artery blood flow peak velocity as measured using transfontanelle ultrasound predicted an increase in stroke volume in response to fluid. Further research is required to establish any wider generalizability of the results.
Treatment of primary and secondary immune thrombocytopenia
Authors: Kado Ruba , McCune W. Joseph 
Published: March 2019

Purpose of review
Medical therapies for the treatment of immune thrombocytopenia (ITP) complicating SLE are increasingly being investigated as alternatives to splenectomy and IVIG. The purpose of this review is to highlight the therapies that are utilized in the treatment of primary ITP and ITP secondary to lupus.

Recent findings
Corticosteroids are still the standard initial treatment of ITP, with the addition of IVIG when a rapid response is needed. There are few studies dedicated to assessing the efficacy of disease-modifying antirheumatic (DMARD), biologic, and nonimmunosuppressive agents as treatment for lupus thrombocytopenia/lupus ITP. Rituximab and thrombopoeitin mimetics have been the most extensively studied therapies for primary ITP in recent years. Results of trials show adequate initial responses; however, the duration of therapy and sustainability of responses are variable. Splenectomy is less often utilized.

Summary
Although corticosteroids, intravenous immunoglobulin and splenectomy have proven to be effective measures to treat immune thrombocytopenia, newer studies have demonstrated positive outcomes of immunosuppressives and thrombopoeitin mimetics. In most cases, the reported duration of therapy was not prolonged. More studies are needed to fully assess the effect of medical therapy in lupus ITP and to determine how long to continue maintenance therapy.
Are CT Scans Overutilized in the Workup of Vertebral Compression Fractures?
Authors: McGowan Shane M. , Ramski David E. , Homcha Brittany , Sokunbi Gbolabo 
Published: March 2019

Study Design:
This was a retrospective chart review.

Objectives:
Computed tomography (CT) does not aid in determination of compression fracture chronicity and contributes to higher cost and radiation exposure. An examination of extraneous imaging will help to guide appropriate workup.

Summary of Background Data:
Cost for osteoporotic fracture treatment has been estimated at $17 billion annually; future costs are anticipated to increase by at least 50%.

Materials and Methods:
A chart review evaluated patients who received kyphoplasty or vertebroplasty as part of compression fracture treatment. The primary end point of the study was analysis of unnecessary imaging obtained during workup. The secondary outcome was excess radiation exposure incurred from unneeded imaging studies.

Results:
There were 104 instances (40.2% of n=259 workups) where patients underwent only magnetic resonance imaging (MRI) or bone scan after radiographs. There were 28 instances (10.8%) where patients underwent only radiographs with a comparison study. There were a total of 76 instances (29.3%) where patients underwent extraneous CT scans and 13 instances (5%) where patients underwent both MRI and bone scan, causing an average of 979.4 mGy cm additional radiation exposure.

Conclusions:
We recommend an algorithm that favors radiographs with comparison study or acquiring either MRI or bone scan to determine acuity. If these are available, CT scan becomes unnecessary and incurs increased costs and radiation exposure.
Thromboelastography Predicts Thromboembolism in Critically Ill Coagulopathic Patients*
Authors: Harahsheh Yusrah , Duff Oonagh C. , Ho Kwok M. 
Published: March 2019

Objectives:
Critically ill patients with deranged conventional coagulation tests are often perceived to have an increased bleeding risk. Whether anticoagulant prophylaxis for these patients should be withheld is contentious. This study assessed the ability of using in vitro clot strength, as measured by thromboelastography, to predict thromboembolism in patients with abnormal coagulation profiles.

Design:
Prospective cohort study.

Setting:
A tertiary ICU.

Patients:
Two-hundred and fifteen critically ill coagulopathic patients with thrombocytopenia and/or a derangement in at least one conventional coagulation test (international normalized ratio or activated partial thromboplastin time) within 48 hours of ICU admission.

Interventions:
None.

Measurements and Main Results:
Thromboelastography was performed for all study patients, and plasma thrombotic biomarkers were measured in a nested cohort (n = 40). Of the 215 patients included, 34 patients (16%) developed subsequent thromboembolism—predominantly among those with a normal (maximum amplitude, 54–72 mm) or increased (maximum amplitude, > 72 mm) in vitro clot strength on thromboelastography (91%; area under the receiver-operating characteristic curve, 0.74; 95% CI, 0.64–0.83). The ability of the maximum amplitude to predict thromboembolism was comparable to plasma P-selectin concentrations (thromboembolism, 78.3 ng/mL vs no thromboembolism, 59.5 ng/mL; p = 0.031; area under the receiver-operating characteristic curve, 0.73; 95% CI, 0.52–0.95). In addition, patients with an increased maximum amplitude were also less likely to receive blood product transfusions within 24 hours of testing compared with those with a subnormal maximum amplitude (12.8% vs 69.2%, respectively; area under the receiver-operating characteristic curve, 0.74; 95% CI, 0.67–0.80).

Conclusions:
In patients with abnormal coagulation profiles, an increased in vitro clot strength on thromboelastography was associated with an increased risk of thromboembolism, and a reduced risk of requiring transfusion compared with those with a normal or reduced in vitro clot strength.
Subcutaneous Panniculitis-Like T-Cell Lymphoma With Granulomas as the Predominant Feature
Authors: Lee Christine , Hsi Andy , Lazova Rossitza 
Published: March 2019

Abstract:
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare primary cutaneous lymphoma preferentially localized in the subcutaneous adipose tissue and composed of cytotoxic T cells with an α/β immunophenotype. The neoplastic T cells can be variably admixed with other inflammatory cells, including histiocytes, which can rarely form noncaseating granulomas. We present a case of SPTCL in which granulomas are the predominant feature, composing 75%–80% of the inflammatory infiltrate. The top differential diagnoses included infectious and autoimmune etiologies. However, special stains for microorganisms were negative, and immunohistochemical analysis of the atypical lymphocytes showed a CD3+, CD8+, TIA-1+, T-cell receptor (TCR) beta+, and CD4
−
infiltrate with a high Ki67 proliferation index of approximately 30%. TCR gene rearrangement studies by polymerase chain reaction with confirmation by high-throughput sequencing were necessary to exclude an autoimmune etiology, specifically lupus erythematosus panniculitis. To the best of our knowledge, only 1 other case of SPTCL with prominent granulomas has been reported in the literature. It is important for dermatopathologists to recognize this presentation of SPTCL. SPTCL with predominant granulomas should be included in the differential diagnosis of granulomatous panniculitis along with infectious and autoimmune panniculitides as well as other granulomatous lymphomas.
Parent and Provider Perspectives on the Diagnosis and Management of Autism in a Chinese Immigrant Population
Authors: Sakai Christina , Mulé Christina , LeClair Amy , Chang Frances , Sliwinski Samantha , Yau Yoyo , Freund Karen M. 
Published: March 2019

ABSTRACT:

Objective:
Minority families experience disparities in the diagnosis and management of autism spectrum disorder (hereafter “autism”). To date, the experiences of Chinese immigrant families in the United States have not been explored. Utilizing parent and provider perspectives, this research sought to identify barriers and facilitators to the diagnosis and management of autism among Chinese immigrant children.

Methods:
We conducted semistructured qualitative interviews with 16 parents of Chinese children diagnosed with autism and 16 providers who assist in the diagnosis and management of autism. Participant characteristics were analyzed utilizing descriptive statistics. Interviews were audiorecorded, transcribed, translated, and independently coded by 2 researchers until consensus was reached. Coded data were analyzed using a modified grounded therapy approach.

Results:
Parents and providers both identified cultural beliefs as an influence on the understanding and acceptance of autism as a diagnosis. There was a high degree of alignment in themes related to barriers to health care access and parent-provider communication. Recommendations to improve the system of care include (1) supporting communication, (2) cultural sensitivity, and (3) care coordination programming.

Conclusion:
Findings reinforce that diagnosis and treatment of autism should take into account culturally specific beliefs about child developmental norms and should address systems-, provider-, and family-level barriers.
Single Suture Müeller Muscle Conjunctival Resection (ssMMCR): A Modified Technique for Ptosis Repair
Authors: Ediriwickrema Lilangi S. , Geng June , Nair Archana A. , Prendes Mark , Gerber Austin L. , Yang Patrick T. , Liu Catherine Y. , Nunery William R. , Harold Lee H.B. , Kikkawa Don O. , Korn Bobby S. 
Published: March 2019

Purpose:
To evaluate the efficacy in degree of ptosis correction achieved by single suture Müeller muscle conjunctival resection (ssMMCR) when compared with that of traditional MMCR.

Methods:
A retrospective chart analysis of patients who underwent either ssMMCR or traditional MMCR at 2 institutions. Single suture MMCR was performed after using a ptosis clamp to imbricate conjunctiva and Müeller muscle. Margin-to-reflex distance 1 was measured pre- and postoperatively, and the change in margin-to-reflex distance 1 was analyzed for both groups. Patients were monitored in follow up for postoperative complications including lagophthalmos, corneal abrasions, and change in visual acuity. Statistical analysis was performed using the Microsoft Excel and Stata software programs.

Results:
Twenty-seven and 30 patients underwent single suture and traditional MMCR, respectively. The ssMMCR and MMCR groups were followed postoperatively for approximately 4.2 and 9.7 months, respectively and the average margin-to-reflex distance 1 increased by 2.93 mm and 2.81 mm, respectively. Notably, there was no statistically significant difference in the means identified by t test. Of the 94 eyelid surgeries evaluated, 1 ssMMCR and 3 MMCR eyelids required further surgical revision for persistent ptosis, and 1 ssMMCR developed a transient corneal epithelial abrasion. Surgical revisions were rare with both procedures, and patient satisfaction was high.

Conclusions:
Single suture MMCR is an efficient and effective method for ptosis repair. It results in comparable outcomes including elevation in margin-to-reflex distance 1, safety profile, and reoperation rates, when compared with traditional MMCR.
Improving Operational Efficiency, Effectiveness, and Value in Acute Care Physical Therapy Using the Therapy Value Quotient
Authors: Hull Brian L. , Thut M. Catherine 
Published: March 2019

Background and Purpose:
The shift in health care is toward value. However, operational efficiency measurement remains volume driven. Using behavioral economic heuristic theories and the Therapy Value Quotient (TVQ) as a basis for decision-making, the authors hypothesized that clinicians would demonstrate more effective and efficient clinical outcomes compared with the control group outcomes using traditional productivity decision-making heuristics.

Methods:
A quasiexperimental study design with quantitative analysis using the TVQ calculator was used. Also, an anonymous questionnaire on perceived decision-making empowerment and a semistructured focus group discussion with qualitative thematic analysis was used to understand better the heuristic strategies employed while trying to improve the TVQ Value Quotient.

Results:
Overall, the Value Quotient increased 14.7% resulting from a multitude of subcomponent improvements including increasing Activity Measure for Post-Acute Care (AM-PAC) Inpatient Mobility Short Form (IMSF) average change 28% from 2.84 to 3.64 points and decreasing Cost per Visit 8.9%. In addition, TVQ use improved clinician value focus, engagement, and perceived empowerment as evidenced by the 5 identified themes: (1) improved efficiency and staffing, (2) improved teamwork, (3) improved focus on value and not units, (4) improved patient-centeredness, and (5) professional empowerment.

Discussion:
Pursuing the simplicity of basic value-focused goals using the TVQ along with fast and frugal System 1 heuristics was more efficient and provided higher aggregated value compared with baseline management practice of units (Visits, Current Procedural Terminology codes, Relative Value Units) generated per hour. Furthermore, using the TVQ facilitated a paradigm shift from typical acquisition of units per hour worked to promoting an emphasis on delivering the highest overall value. The authors recommend acute care hospitals adopt the TVQ as a primary operational measurement to promote the highest value utilization of acute care physical therapy resources.
Effect of Digital Storytelling on Anxiety in Patients Who Are Candidates for Open-Heart Surgery
Authors: Moghimian Maryam , Akbari Mohammad , Moghaddasi Jafar , Niknajad Rayhaneh 
Published: March 2019

Background
Open-heart surgery in persons with cardiovascular disease is associated with high levels of anxiety.

Objective
The goal of this study was to determine the effect of digital storytelling on anxiety in patients who were candidates for open-heart surgery.

Methods
In this quasi-experimental study, 80 patients were randomly allocated into 2 groups. The intervention group received routine training and digital storytelling. In each group, anxiety was measured by the State-Trait Anxiety Inventory anxiety scale before surgery and 5 days after surgery. The collected data were analyzed using SPSS software V18.

Results
There was no significant difference in the anxiety of both groups during the 2 days before the surgery (P = .40). After the surgery, the mean of anxiety scores in the intervention group was lower than that of the control group (P < .001).

Conclusions
Digital storytelling is an effective method to reduce anxiety in patients who are candidates for open-heart surgery.
Lithium Augmentation Versus Citalopram Combination in Imipramine-Resistant Major Depression
Authors: Navarro Víctor , Boulahfa Ilham , Obach Amadeu , Jerez Dídac , Diaz-Ricart Maribel , Gastó Cristóbal , Guarch Joana 
Published: March 2019

Abstract

Purpose/Background
According to available international clinical guides, tricyclic antidepressants are our first- or second-line treatment of choice for severe unipolar major depression. However, the therapeutic option after an unsuccessful response to a tricyclic antidepressant drug in unipolar major depression is still unclear.

Methods/Procedures
This 10-week randomized open-label study assessed the effectiveness of add-on lithium (adjusted to plasma levels) compared with add-on citalopram (30 mg/d) in 104 severe unipolar major depressive patients after a 10-week unsuccessful imipramine (adjusted to plasma level). Efficacy analyses examined changes in the severity of depression symptoms from baseline visit to endpoint and the comparative remission rate between treatment subgroups.

Findings/Results
The randomized sample consisted of 104 imipramine-resistant severe unipolar major depressed patients. Both, the percentage of remitters (40.4% vs 21.1%, P = 0.034) and the mean reduction of the Hamilton Depression Rating Scale score (58.8% vs 42.5%, P = 0.005) were significantly greater in the add-on citalopram subgroup at endpoint visit.

Implications/Conclusions
Although we should be cautious about generalizing these results to patients with a less severe unipolar major episode, results from the present study suggest that add-on citalopram is a very effective treatment option in unipolar major depressive episodes after an unsuccessful imipramine regimen.