bluuebunny/crossref_metadata_2025_split huggingface dataset:
Toward Optimizing VEMP: Calculating VEMP Inhibition Depth With a Generic Template
Authors: Noij Kimberley S. , van Tilburg Mark J. , Herrmann Barbara S. , Marciniak Piotr , Rauch Steven D. , Guinan John J. 
Published: April 2018

Objectives:
Cervical vestibular evoked myogenic potentials (cVEMP) indirectly reveal the response of the saccule to acoustic stimuli through the inhibition of sternocleidomastoid muscle electromyographic response. VEMP inhibition depth (VEMPid) is a recently developed metric that estimates the percentage of saccular inhibition. VEMPid provides both normalization and better accuracy at low response levels than amplitude-normalized cVEMPs. Hopefully, VEMPid will aid in the clinical assessment of patients with vestibulopatholgy. To calculate VEMPid a template is needed. In the original method, a subject’s own cVEMP was used as the template, but this method can be problematic in patients who do not have robust cVEMP responses. We hypothesize that a “generic” template, created by assembling cVEMPs from healthy subjects, can be used to compute VEMPid, which would facilitate the use of VEMPid in subjects with pathological conditions.

Design:
A generic template was created by averaging cVEMP responses from 6 normal subjects. To compare VEMPid calculations using a generic versus a subject-specific template, cVEMPs were obtained in 40 healthy subjects using 500, 750, and 1000 Hz tonebursts at sound levels ranging from 98 to 123 dB peSPL. VEMPids were calculated both with the generic template and with the subject’s own template. The ability of both templates to determine whether a cVEMP was present or not was compared with receiver operating characteristic curves.

Results:
No significant differences were found between VEMPid calculations using a generic template versus using a subject-specific template for all frequencies and sound levels. Based on the receiver operating characteristic curves, the subject-specific and generic template did an equally good job at determining threshold. Within limits, the shape of the generic template did not affect these results.

Conclusions:
A generic template can be used instead of a subject-specific template to calculate VEMPid. Compared with cVEMP normalized by electromyographic amplitudes, VEMPid is advantageous because it averages zero when there is no sound stimulus and it allows the accumulating VEMPid value to be shown during data acquisition as a guide to deciding when enough data has been collected.
Effects of Combined Lower Thoracic Epidural/General Anesthesia on Pain Control in Patients Undergoing Elective Lumbar Spine Surgery
Authors: Thepsoparn Marvin , Sereeyotin Jariya , Pannangpetch Patt 
Published: April 2018

Study Design.
Randomized controlled trial.

Objective.
Our objective was to compare postoperative pain relief and operating field condition of single-shot, low-thoracic epidural anesthesia combined with general anesthesia versus general anesthesia alone.

Summary of Background Data.
Prior studies have suggested that continuous epidural analgesia provides better postoperative pain relief and less intraoperative blood loss, but with the risk of the epidural catheter contaminating the surgical field.

Methods.
A total of 22 patients scheduled for elective lumbar spine surgery were enrolled and randomly allocated into two groups. Group B (block) received a single-shot epidural block with 0.25% bupivacaine plus 4 mg of morphine with a total volume of 10 mL before receiving general anesthesia with desflurane, and cisatracurium. Group G (general) received general anesthesia alone with desflurane, cisatracurium, and any systemic analgesia deemed appropriate by the attending anesthesiologist. Postoperative pain score, opioid consumption, intraoperative blood loss, surgical field rating score, and other side effects were recorded at the postanesthesia care unit (PACU) and at 24 hours postoperatively.

Results.
Both groups were comparable for age, sex, body mass index, and American Society of Anaesthesiologists physical status. Fentanyl consumption was significantly lower (P < 0.05) for group B (block) at the PACU and 24 hours. Mean fentanyl consumption at PACU was 20 μg for group B and 85 μg for group G. At 24 hours mean fentanyl consumption was 80 μg for group B and 386 μg for group G. Pain measured with numerical rating scale, surgical field rating score, blood loss, and complications were similar in both groups.

Conclusion.
Single-shot low-thoracic epidural anesthesia combined with general anesthesia provides better pain control than general anesthesia alone.

Level of Evidence: 2
Feasibility and Safety of Intravascular Temperature Management for Severe Heat Stroke: A Prospective Multicenter Pilot Study
Authors: Yokobori Shoji , Koido Yuichi , Shishido Hajime , Hifumi Toru , Kawakita Kenya , Okazaki Tomoya , Shiraishi Shinichirou , Yamamura Eiji , Kanemura Takashi , Otaguro Takanobu , Matsumoto Gaku , Kuroda Yasuhiro , Miyake Yasufumi , Naoe Yasutaka , Unemoto Kyoko , Kato Hiroshi , Matsuda Kiyoshi , Matsumoto Hisashi , Yokota Hiroyuki 
Published: April 2018

Objectives:Heat stroke is a life-threatening condition with high mortality and morbidity. Although several cooling methods have been reported, the feasibility and safety of treating heat stroke using intravascular temperature management are unclear. This study evaluated the efficacies of conventional treatment with or without intravascular temperature management for severe heat stroke.Design:Prospective multicenter study.Setting:Critical care and emergency medical centers at 10 tertiary hospitals.Patients:Patients with severe heat stroke hospitalized during two summers.Interventions:Conventional cooling with or without intravascular temperature management.Measurements and Main Results:Cooling efficacy, Sequential Organ Failure Assessment score, occurrence rate of serious adverse events, and prognosis based on the modified Rankin Scale and Cerebral Performance Category. Patient outcomes were compared between five centers that were prospectively assigned to perform conventional cooling (control group: eight patients) and five centers that were assigned to perform conventional cooling plus intravascular temperature management (intravascular temperature management group: 13 patients), based on equipment availability. Despite their higher initial temperatures, all patients in the intravascular temperature management group reached the target temperature of 37°C within 24 hours, although only 50% of the patients in the control group reached 37°C (p< 0.01). The intravascular temperature management group also had a significant decrease in the Sequential Organ Failure Assessment score during the first 24 hours after admission (4.0 vs 1.5;p= 0.04). Furthermore, the intravascular temperature management group experienced fewer serious adverse events during their hospitalization, compared with the control group. The percentages of favorable outcomes at discharge and 30 days after admission were not statistically significant.Conclusions:The combination of intravascular temperature management and conventional cooling was safe and feasible for treating severe heat stroke. The results indicate that better temperature management may help prevent organ failure. A large randomized controlled trial is needed to validate our findings.
Development and Pilot Testing of a Measure of Potential Barriers and Facilitators to the Use of a Standardized Assessment Tool
Authors: Lam Wai Shun Priscilla , Bottari Carolina 
Published: April 2018

Introduction:
Standardized assessment tools (SATs) are essential to evidence-based assessment practices. Identifying what impedes clinicians' use of a SAT can help tailor strategies promoting its use in clinical practice. This article presents the development of the “Measure of potential barriers and facilitators to the Use of a Standardized assessment Tool (MUST)” questionnaire. Preliminary findings are also reported from pilot testing in which the MUST was used to investigate occupational therapists' (OTs) perceptions of potential barriers and facilitators to the use of the Activities of Daily Living Profile (ADL Profile), a SAT evaluating independence in everyday activities of cognitively impaired adults.

Methods:
The MUST was administered to 41 OTs attending continuing education workshops on the ADL Profile. Internal consistency was explored using Chronbach alpha. Descriptive statistics were used to analyze scores for each statement.

Results:
Internal consistency for subscales related to clinicians' characteristics (α = 0.7) and to the SAT's characteristics (α = 0.8) were adequate but lower for the subscale related to the clinical setting (α = 0.6). OTs' perceptions of potential barriers were associated with: OTs' perceived self-efficacy; ADL Profile's applicability to OTs' clienteles; ADL Profile's compatibility with values promoted in the work setting and with clients' preferences; limited peer support; time to implement the ADL Profile.

Discussion:
The MUST, a theory-informed questionnaire, may prove useful in identifying potential barriers needing to be addressed in continuing education training promoting the use of SATs by clinicians. The MUST is quick to administer and initial testing provides support for its internal consistency.
Three-Dimensional Modeling for Crohn’s Fistula-in-Ano: A Novel, Interactive Approach
Authors: Lam David , Yong Eric , D’Souza Basil , Woods Rodney 
Published: April 2018

BACKGROUND:
Pelvic MRI allows for clear delineation of anatomy in Crohn’s fistula-in-ano, although its interpretation is often difficult for nonradiologists.

OBJECTIVE:
The aim was to develop a 3-dimensional model where fistula tracts and their relationship to the sphincter complex can be accurately defined, which can then be rotated in multiple axes by the surgeon.

DESIGN:
A 3-dimensional model was created based on MRI images. An additional 3-dimensional T2-weighted sequence was added to the existing MRI protocol to obtain high-resolution images. Segmentation of the fistula tract and volume rendering of the segmented tract were performed to create the final model.

SETTINGS:
This was a single-center study conducted in Victoria, Australia.

PATIENTS:
All of the patients who had pelvic MRI for fistulating Crohn’s disease between March 2016 and March 2017 had the additional MRI sequence.

INTERVENTIONS:
Postprocessing of MRI images was performed by a single radiologist.

RESULTS:
Total acquisition time for MRI images was extended to 31 minutes compared with the standard 2-dimensional protocol lasting 25 minutes. Additional postprocessing time used to create the model was ≈15 minutes. Two clinical vignettes using this model are presented and compared with conventional 2-dimensional MRI images to highlight the use of the 3-dimensional modeling technique.

LIMITATIONS:
This technique involves a semiautomatic process of fistula tract segmentation that requires radiologist expertise and additional postprocessing time.

CONCLUSIONS:
This 3-dimensional modeling technique enables accurate identification of tracts in Crohn’s fistula-in-ano and improves spatial orientation for the surgeon. The model has the potential to be an invaluable preoperative tool to guide operative decision-making, as well as enabling the assessment of response to medical or surgical therapy.
Controlling for Frailty in Pharmacoepidemiologic Studies of Older Adults
Authors: Cuthbertson Carmen C. , Kucharska-Newton Anna , Faurot Keturah R. , Stürmer Til , Jonsson Funk Michele , Palta Priya , Windham B. Gwen , Thai Sydney , Lund Jennifer L. 
Published: April 2018

Background:
Frailty is a geriatric syndrome characterized by weakness and weight loss and is associated with adverse health outcomes. It is often an unmeasured confounder in pharmacoepidemiologic and comparative effectiveness studies using administrative claims data.

Methods:
Among the Atherosclerosis Risk in Communities (ARIC) Study Visit 5 participants (2011–2013; n = 3,146), we conducted a validation study to compare a Medicare claims-based algorithm of dependency in activities of daily living (or dependency) developed as a proxy for frailty with a reference standard measure of phenotypic frailty. We applied the algorithm to the ARIC participants’ claims data to generate a predicted probability of dependency. Using the claims-based algorithm, we estimated the C-statistic for predicting phenotypic frailty. We further categorized participants by their predicted probability of dependency (<5%, 5% to <20%, and ≥20%) and estimated associations with difficulties in physical abilities, falls, and mortality.

Results:
The claims-based algorithm showed good discrimination of phenotypic frailty (C-statistic = 0.71; 95% confidence interval [CI] = 0.67, 0.74). Participants classified with a high predicted probability of dependency (≥20%) had higher prevalence of falls and difficulty in physical ability, and a greater risk of 1-year all-cause mortality (hazard ratio = 5.7 [95% CI = 2.5, 13]) than participants classified with a low predicted probability (<5%). Sensitivity and specificity varied across predicted probability of dependency thresholds.

Conclusions:
The Medicare claims-based algorithm showed good discrimination of phenotypic frailty and high predictive ability with adverse health outcomes. This algorithm can be used in future Medicare claims analyses to reduce confounding by frailty and improve study validity.
Multiple Symmetric Lipomatosis: New Classification System Based on the Largest German Patient Cohort
Authors: Schiltz Daniel , Anker Alexandra , Ortner Christine , Tschernitz Sebastian , Koller Michael , Klein Silvan , Felthaus Oliver , Schreml Julia , Schreml Stephan , Prantl Lukas 
Published: April 2018

Background:
Multiple symmetric lipomatosis (MSL) is defined as a disorder of nonencapsulated adipose tissue growth. Its prevalence is indicated as 1:25,000 and affects, as stated in the literature, mainly Mediterranean males (male:female ratio of 15:1). Phenotypes are still classified as defined by Donhauser in 1991. We report clinical and phenotypic data of the largest patient cohort investigated in Germany so far.

Methods:
Forty-five patients diagnosed with MSL at the University Hospital Regensburg between 2007 and 2017 were photographed, clinically examined, and blood samples were taken. Based on the photographs (n = 33), 11 independent observers assessed patients using the Donhauser classification. Furthermore, the bodies of all patients were subdivided into 12 body areas, and the viewers had to indicate all MSL-affected areas per patient. Prevalence was calculated, comorbidities were assessed, and blood samples were analyzed.

Results:
According to the established Donhauser classification, less than 50% of the patients could be classified. Therefore, based on the constellations of MSL-affected body areas, a new classification that divides phenotypes of MSL into 5 types (Ia, Ib, Ic, II, and III) was set up and was able to cover 100% of our patients. The male to female ratio was found to be 1:2.5 (male:female). Prevalence of MSL in the catchment area was found to be 1:25,000. Hypercholesterinemia and hypothyroidism were frequent comorbidities, and blood analyses were normal besides a hypercholesterinemia.

Discussion:
The new proposed classification system describes 5 subtypes and allowed to classify all assessed patients. Male to female ratio (1:2.5) contradicted most previous publications.
Graft Detachment Pattern After Descemet Membrane Endothelial Keratoplasty Comparing Air Versus 20% SF6 Tamponade
Authors: Siebelmann Sebastian , Lopez Ramos Sebastian , Scholz Paula , Matthaei Mario , Schrittenlocher Silvia , Heindl Ludwig M. , Bachmann Björn , Cursiefen Claus 
Published: April 2018

Purpose:
The change from air to 20% sulfur hexafluoride (SF6) as anterior chamber tamponade for Descemet membrane endothelial keratoplasty (DMEK) significantly reduced the rebubbling rate. Nonetheless, underlying mechanisms are not completely understood. In this study, we investigate the morphology of graft detachments after DMEK depending on the tamponade and its influence on postoperative rebubbling.

Methods:
In this retrospective analysis of prospective data of 204 consecutive patients who underwent DMEK with 100% air, or 20% SF6, we compared the SF6 group with the air group regarding the number, lateral and axial diameter and localization of detachments, visual acuity (BSCVA), and incidence of rebubbling after 1 week (T1), after 1 (T2), 3 (T3), 6 (T4), and 12 (T5) months postoperatively.

Results:
The air group showed more detachments at all time points. Detachments in this group were of a larger axial diameter at T1, T4, and T5 and of a larger lateral diameter at T1, T3, T4, and T5 compared with the SF6 group. Patients receiving SF6 needed fewer rebubblings at T1 compared with patients receiving air (12.1% vs. 29.1%, P = 0.003), but not at T2 (15.1% vs. 19.1%, P = 0.56). There was no difference in postoperative BSCVA between the groups.

Conclusions:
Early graft attachment after DMEK, which is improved by the use of SF6 as anterior chamber tamponade, is important for the overall rebubbling rate and improves wound-healing mechanisms between the graft and recipient cornea. Faster resolving air tamponade is associated with extended detachments especially inferiorly and mid-peripherally, but has no negative effect on the long-term BSCVA.
Clinically Significant Drug Interactions Among Human Immunodeficiency Virus–Positive Patients on Antiretroviral Therapy in an Outpatient Setting
Authors: Monday Lea M. , Veltman Jennifer 
Published: April 2018

Abstract
Human immunodeficiency virus (HIV) treatment is complicated by antiretrovirals prone to clinically significant drug interactions (CSDIs). Objectives were to examine relationships of patient and medication characteristics and provider training level with CSDIs in an outpatient HIV clinic. A clinical pharmacist reviewed medication lists of randomly selected adult HIV-positive patients on antiretrovirals for accuracy and presence of a CSDI, defined as grade C, D, or X using Lexicomp software. Characteristics were compared between patients with and without CSDIs by χ2 tests for categorical variables and t tests for continuous variables. Associations between these parameters and CSDIs (presence vs absence) were evaluated by logistic regression. Associations between provider type (infectious disease physician [IDMD], infectious disease fellow [Fellow], and nurse practitioner [NP]) and number of CSDIs per patient, and provider response to being informed of a CSDI were analyzed by χ2 tests.
Of 107 records reviewed, 405 CSDIs were identified in 83 (76%) patient records. Clinically significant drug interaction presence was associated with older age, increased medications, protease inhibitor-based regimen, and medication list inaccuracies. Patients with and without CSDIs did not differ in sex, race, HIV viral load, or nonnucleoside reverse-transcriptase inhibitor regimen. Older age (odds ratio [95% confidence interval], 3.53 [1.21–11.64]) and a protease inhibitor-based regimen (odds ratio [95% confidence interval], 8.49 [2.18–46.07]) were associated with having a CSDI. Fellows were more likely to report being unaware of CSDIs than IDMDs and NPs and to request additional information versus IDMDs and NPs. These findings suggest that providers may benefit from involving a pharmacist to identify and educate about CSDIs.
A Qualitative Investigation of the Self-Perceived Health Behavior Changes in Seniors After Their Transitions Into a Retirement Home
Authors: Haney Danielle B. , Fletcher Paula C. , Robertson-Wilson Jennifer E. 
Published: April 2018

Purpose/Aims:
It is important for seniors to engage in positive health behaviors to reduce the incidence of health-related consequences associated with aging. The purpose of this research study was to examine self-perceived changes in physical activity, nutrition, and alcohol consumption behaviors of seniors living in a retirement home through consideration of previous behaviors and self-perceptions of behavior changes.

Design:
A qualitative research design was used for this study.

Methods:
Semistructured one-on-one interviews were conducted with 9 Canadian women living in a retirement home.

Results:
Two key themes, each with 3 subthemes, highlighted the various factors that influenced changes in health behaviors. The 2 themes consisted of (a) aging and adapting and (b) the transition: give a little to gain a lot.

Conclusions:
Participants’ insights revealed the importance of maintaining a positive attitude, the influence of the social environment on health behaviors, and the nutritional sacrifices of retirement living. Future research should investigate ways in which nurses can assist seniors in enhancing health behaviors throughout transitions into retirement homes.
Distinguishing the Clinical Nurse Specialist From Other Graduate Nursing Roles
Authors: Mohr Lynn D. , Coke Lola A. 
Published: April 2018

Purpose:
Today’s healthcare environment poses diverse and complex patient care challenges and requires a highly qualified and experienced nursing workforce. To mitigate these challenges are graduate nursing roles, each with a different set of competencies and expertise. With the availability of many different graduate nursing roles, both patients and healthcare professionals can be confused in understanding the benefit of each role. To gain the maximum benefit from each role, it is important that healthcare providers and administrators are able to distinguish the uniqueness of each role to best use the role and develop strategies for effective collaboration and interprofessional interaction. The purpose of this article was to define the role, educational preparation, role differences, and practice competencies for the clinical nurse specialist (CNS), nurse practitioner, clinical nurse leader, and nurse educator/staff development educator roles. A second purpose was to provide role clarity and demonstrate the unique value the CNS brings to the healthcare environment.

Description:
Using evidence and reviewing role competencies established by varying organizations, each role is presented with similarities and differences among the roles discussed. In addition, collaboration among the identified roles was reviewed, and recommendations were provided for the new and practicing CNSs.

Outcomes:
Although there are some similarities among the graduate nursing roles such as in educational, licensing, and certification requirements, each role must be understood to gain the full role scope and benefit and glean the anticipated outcomes.

Conclusions:
Healthcare providers must be aware of the differences in graduate nursing roles, especially in comparing the CNS with other roles to avoid confusion that may lead to roles being underused with a limited job scope. The CNS provides a unique set of services at all system outcome levels and is an essential part of the healthcare team especially in the acute care setting.