bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Relationship Between Fear-Avoidance and Objective Biomechanical Measures of Function in Patients With Adult Degenerative Scoliosis
Authors: Haddas Ram , Lieberman Isador H. , Block Andrew 
Published: August 2017

Study Design.
A prospective cohort study.

Objective.
The current study utilized quantitative gait analysis to examine the relationship of fear-avoidance beliefs to gait patterns in patients with adult degenerative scoliosis (ADS).

Summary of Background Data.
Among patients with chronic spine pain, fear-avoidance beliefs are predictive of behavioral deficiencies, poor work, and surgery outcomes. The impact of such beliefs on patients with major spinal deformity has yet to be investigated. Patients with ADS have previously been shown to have an altered gait pattern. Utilizing quantified gait analysis, this study aims to examine correlations between fear-avoidance and various aspects of gait in patients with ADS.

Methods.
Twenty-five ADS patients completed the Tampa Scale for Kinesiophobia (TSK) questionnaire and the Fear Avoidance Beliefs Questionnaire (FABQ). Each patient performed a series of overground gait trials at a self-selected comfortable speed. Pearson product correlation analysis was used to determine the relationship between the self-reported fear of movement measures and the objective gait analysis biomechanical data.

Results.
TSK score correlated strongly with gait speed, stride, step, double support times, and step length, and correlated moderately with cadence, and stride length. The FABQ physical portion strongly correlated with stride length and step length. The FABQ physical portion was moderately correlated with gait speed and single support time. The FABQ work portion was correlated with stride length and step length.

Conclusion.
This study demonstrates a strong correlation between biomechanical gait parameters, as measured with gait analysis, and fear-avoidance of movement, as measured with the TSK and FABQ. Further, it demonstrates that quantified gait analysis can be a useful tool to evaluate patients with spine deformity and to assess the outcomes of treatments in this group of patients. This study extends previous research on the role of fear-avoidance to include patients with spinal deformity.

Level of Evidence: 3
ECHO Pain Curriculum: Balancing Mandated Continuing Education With the Needs of Rural Health Care Practitioners
Authors: Shelley Brian M. , Katzman Joanna G. , Comerci George D. , Duhigg Daniel J. , Olivas Cynthia , Kalishman Summers , Monette Rebecca , Britt Melissa , Flatow-Trujillo Lainey , Arora Sanjeev 
Published: August 2017

Abstract:
Chronic pain is a common problem in the United States. Health care professions training at the undergraduate and graduate levels in managing chronic pain is insufficient. The Chronic Pain and Headache Management TeleECHO Clinic (ECHO Pain) is a telehealth approach at Project ECHO (Extension for Community Healthcare Outcomes), which supports clinicians interested in improving their knowledge and confidence in treating patients with chronic pain and safe opioid management. It is a vehicle for educating practicing clinicians (at the “spoke”) based on work-place learning with cases selected by participants from their patient panels combined with short lectures by experts (at the “hub”). ECHO Pain has designed an innovative, interprofessional longitudinal curriculum appropriate for individual and team-based clinicians which includes relevant basic and advanced pain topics. The specific design and delivery of the curriculum enhances its relevance and accessibility to busy clinicians in practice, yet also satisfies statutory requirements for CME in New Mexico. Specific features which balance hub-and-spoke needs are presented in this descriptive article, which is intended to serve as a guide to other clinician educators interested in developing or implementing similar telehealth curricula.
Hypoalbuminemia is a Predictive Factor for Fistula Formation in Recurrent Cervical Cancer
Authors: Palavalli Parsons Lavanya H. , Roane Brandon , Manders Dustin B. , Richardson Debra L. , Kehoe Siobhan M. , Carlson Matthew , Miller David S. , Lea Jayanthi S. 
Published: August 2017

Objective:
Antivascular endothelial growth factor monoclonal antibodies inhibit tumor angiogenesis, consequently impeding the recruitment of new vasculature to existing and new tumor lesions. We sought to evaluate toxicities in women with recurrent cervical cancer after receiving bevacizumab combination chemotherapy.

Methods:
A review was conducted of women with recurrent and metastatic cervical cancer who were treated with salvage chemotherapy with or without bevacizumab between 2005 and 2015. Clinicopathologic data and reasons for treatment discontinuation were recorded. Patients that were excluded had other histology than squamous or adenocarcinoma, received 1 cycle of salvage chemotherapy, single agent bevacizumab, currently on treatment, or noncompliant. Statistical analysis was performed using the Fishers Exact Test, logistic regression, and Kaplan-Meier Survival Analysis.

Results:
A total of 74 patients were included in analysis. Twenty-six patients were treated with bevacizumab (BEV) and chemotherapy and 48 patients with chemotherapy alone (chemotherapy). The progression free survival was significant with median 12 months versus 7 months for the BEV cohort (P<0.01) and the overall survival was a median 74 months versus 23 months for the BEV cohort (P=0.06). Cessation of treatment secondary to severe toxicities was seen in 46% (n=12) of BEV cohort versus 15% (n=7) of chemotherapy cohort (P<0.01). Twenty-seven percent (n=7) of patients in the BEV cohort stopped secondary because of fistula formations. Lower albumin levels and use of bevacizumab were identified as an independent predictor factors for fistula formation (P=0.004 and 0.024, respectively).

Conclusions:
Hypoalbuminemia and bevacizumab treatments are significant predictive factors of fistula formation in patients treated for recurrent cervical cancer.
Reflectance Confocal Microscopy Criteria of Pigmented Squamous Cell Carcinoma In Situ
Authors: Shahriari Neda , Grant-Kels Jane M. , Rabinovitz Harold S. , Oliviero Margaret , Scope Alon 
Published: August 2017

Abstract:
Pigmented squamous cell carcinoma in situ (pSCCis) is difficult to diagnose based on clinical and dermoscopic examination. Reflectance confocal microscopy (RCM) allows noninvasive differentiation between malignant and benign pigmented skin lesions. We determined the frequency of key RCM features of pSCCis and correlated the RCM criteria with the corresponding dermoscopic and histopathologic criteria. The study included 28 lesions with biopsy-proven diagnosis of pSCCis derived from 28 patients. Clinical, dermoscopic, and RCM images of these lesions were retrospectively analyzed by 3 independent observers. Assessment for the presence of RCM criteria revealed scale or parakeratosis (20/28; 71%); irregular honeycomb pattern in the spinous-granular layer (28/28; 100%); spindle-shaped cells with dendritic branches infiltrating the epidermis (12/28; 43%); edged papillae (24/28; 86%), and dilated looped blood vessels within the papillae (18/28; 64%). Fifty-three percent of the cases displayed at least 4 RCM criteria and 96% of cases displayed at least 3 RCM criteria. We propose that the diagnosis of pSCCis could be established based on 1 major criterion—irregular honeycomb pattern—and 2 of the following minor criteria—scale or parakeratosis, spindle-shaped cells with dendritic branches infiltrating the epidermis, edged papillae, and dilated looped blood vessels within the papillae.
Nicolau Syndrome (Embolia Cutis Medicamentosa): A Rare and Poorly Recognized Iatrogenic Cause of Cutaneous Thrombotic Vasculopathy
Authors: Tabor Dominic , Bertram Chandra G. , Williams Andrew J. K. , Mathers Marie E. , Biswas Asok 
Published: August 2017

Abstract:
Nicolau syndrome is a rare form of iatrogenic cutaneous necrosis which affects injection sites. Although classically associated with intramuscular injections, it may develop after subcutaneous or other routes of parenteral drug administration. Clinically, it manifests as necrotic ulcers that often develop in a background of erythematous and livedoid reticular patches. The histopathologic characteristics of Nicolau syndrome are poorly documented in the dermatopathology literature and features only rarely as one of the obscure causes of cutaneous thrombotic vasculopathy. We report a case of Nicolau syndrome developing secondary to subcutaneous injection of cyclizine to familiarize the clinicians and pathologists to this unusual condition. Given that it is potentially avoidable, pathologists should alert the clinicians to the possibility of Nicolau syndrome when a skin biopsy from an injection site shows signs of extensive thrombotic vasculopathy.
Computerized order entry, clinical decision support, and safer prescribing
Authors: Pontefract S.K. , Ferner R.E. 
Published: August 2017

Summary
Unintended harms from medicines caused by adverse drug reactions and medication errors are common. The medication process is very complex, and error can occur in the development, manufacture, distribution, prescribing, dispensing, administration, and monitoring of medicines. The prescriber, to avoid error, must first make careful decisions tailored to account for numerous factors that differ from patient to patient, then communicate orders that others must execute meticulously and whose consequences must be adequately monitored.
Breast cancer, endometrial cancer, and cardiovascular events in participants who used vaginal estrogen in the Women's Health Initiative Observational Study
Authors: Crandall Carolyn J. , Hovey Kathleen M. , Andrews Christopher A. , Chlebowski Rowan T. , Stefanick Marcia L. , Lane Dorothy S. , Shifren Jan , Chen Chu , Kaunitz Andrew M. , Cauley Jane A. , Manson JoAnn E. 
Published: August 2017

Abstract

Objective:
To determine the association between use of vaginal estrogen and risk of a global index event (GIE), defined as time to first occurrence of coronary heart disease (CHD), invasive breast cancer, stroke, pulmonary embolism, hip fracture, colorectal cancer, endometrial cancer, or death from any cause.

Methods:
For this prospective observational cohort study, we used data from participants of the Women's Health Initiative Observational Study, who were recruited at 40 US clinical centers, aged 50 to 79 years at baseline and did not use systemic estrogen therapy during follow-up (n = 45,663, median follow-up 7.2 years). We collected data regarding incident CHD, invasive breast cancer, stroke, pulmonary embolism, hip fracture, colorectal cancer, endometrial cancer, death, and self-reported use of vaginal estrogen (cream, tablet). We used Cox proportional-hazards regression models to adjust for covariates.

Results:
Among women with an intact uterus, the risks of stroke, invasive breast cancer, colorectal cancer, endometrial cancer, and pulmonary embolism/deep vein thrombosis were not significantly different between vaginal estrogen users and nonusers, whereas the risks of CHD, fracture, all-cause mortality, and GIE were lower in users than in nonusers (GIE adjusted hazard ratio 0.68, 95% confidence interval 0.55-0.86). Among hysterectomized women, the risks of each of the individual GIE components and of the overall GIE were not significantly different in users versus nonusers of vaginal estrogen (GIE adjusted hazard ratio 0.94, 95% confidence interval 0.70-1.26).

Conclusions:
The risks of cardiovascular disease and cancer were not elevated among postmenopausal women using vaginal estrogens, providing reassurance about the safety of treatment.
Associations among circulating colony-stimulating factor-1, estrogen, and bone mineral density in postmenopausal women: results from a randomized placebo-controlled trial
Authors: Haas Andrea V. , Cong Elaine , Simpson Christine A. , Sukumar Nitin , Deng Yanhong , Insogna Karl L. 
Published: August 2017

Abstract

Objective:
This study addresses the relationship between circulating levels of colony-stimulating factor 1 (CSF-1) and rates of postmenopausal bone loss. The purpose was to test the hypothesis that CSF-1 levels would correlate with the rate of bone loss in estrogen-deficient woman. We further hypothesized that estrogen replacement would eliminate this association.

Methods:
This was an ancillary study to the parent Kronos Early Estrogen Prevention Study (KEEPS)—a 4-year randomized placebo-controlled study that evaluated the effects of estrogen therapy on cardiovascular endpoints. Women between of the ages of 42 and 58, who had been amenorrheic for ≥6 months and ≤36 months, were enrolled in KEEPS. Participants were randomized to conjugated equine estrogen 0.45 mg daily, transdermal estradiol 50 micrograms weekly, or placebo.

Results:
There was no correlation between serum levels of CSF-1 and bone mineral density at the spine, hip, or femoral neck in estrogen-deficient women (correlation 0.0017, P = 0.99 for spine; correlation 0.0010, P = 0.0079 for hip, and correlation 0.0019, P = 0.99 for femoral neck). There was also no significant correlation in the treatment group (correlation 0.0015, P = 0.99; correlation −0.00024, P = 0.99; correlation 0.0011, P = 0.99 at spine, hip, and femoral neck respectively).

Conclusions:
This study did not demonstrate a meaningful relationship between circulating levels of CSF-1 and bone mineral density in either the placebo group or estrogen-treated group. Although CSF-1 is required for osteoclastic bone resorption, our data suggest that circulating levels of the cytokine may not reflect this process.
Resting-State Functional Connectivity in the Human Connectome Project: Current Status and Relevance to Understanding Psychopathology
Authors: Barch Deanna M. 
Published: August 2017

Abstract
A key tenet of modern psychiatry is that psychiatric disorders arise from abnormalities in brain circuits that support human behavior. Our ability to examine hypotheses around circuit-level abnormalities in psychiatric disorders has been made possible by advances in human neuroimaging technologies. These advances have provided the basis for recent efforts to develop a more complex understanding of the function of brain circuits in health and of their relationship to behavior—providing, in turn, a foundation for our understanding of how disruptions in such circuits contribute to the development of psychiatric disorders. This review focuses on the use of resting-state functional connectivity MRI to assess brain circuits, on the advances generated by the Human Connectome Project, and on how these advances potentially contribute to understanding neural circuit dysfunction in psychopathology. The review gives particular attention to the methods developed by the Human Connectome Project that may be especially relevant to studies of psychopathology; it outlines some of the key findings about what constitutes a brain region; and it highlights new information about the nature and stability of brain circuits. Some of the Human Connectome Project’s new findings particularly relevant to psychopathology—about neural circuits and their relationships to behavior—are also presented. The review ends by discussing the extension of Human Connectome Project methods across the lifespan and into manifest illness. Potential treatment implications are also considered.
UNILATERAL OPTIC NEURITIS AND CENTRAL RETINAL VASCULITIS DUE TO OCULAR SYPHILIS
Authors: Khan Murtaza S. , Kuruppu Dulanji K. , Popli Tanav A. , Moorthy Ramana S. , Mackay Devin D. 
Published: August 2017

Purpose:
Report a case of concurrent unilateral optic neuritis and central retinal artery occlusion as the presenting signs of syphilis.

Methods:
A case report of a 22-year-old man with progressive unilateral vision loss.

Results:
With no known previous history of syphilis, genital lesions, or other extraocular manifestations, the patient presented with pain with eye movements and decreased color vision. His vision dramatically worsened after a course of oral steroids. Examination was remarkable for severe right optic disk edema with a macular cherry-red spot and mild posterior uveitis. Magnetic resonance imaging of the orbits with contrast revealed enhancement and enlargement of the distal right optic nerve. Fluorescein angiography demonstrated delayed filling of the right central retinal artery, suggestive of impending central retinal artery occlusion. Syphilis serologies were positive from the serum, and cerebrospinal fluid Venereal Disease Research Laboratory test was reactive, consistent with neurosyphilis. Oral steroids were discontinued and vision improved with 2 weeks of intravenous penicillin.

Conclusion:
This unusual case highlights one of the possible initial presentations of syphilis: unilateral optic neuritis and central retinal artery vasculitis with mild posterior uveitis. The worsening of vision after administration of oral steroids also highlights a potential complication of oral steroid use in the absence of a known etiology of vision loss. A thorough history and examination may be helpful in identifying risk factors for infectious causes, including syphilis, and should prompt additional evaluation.
Reproducibility of Central Corneal Thickness Measurements in Healthy and Glaucomatous Eyes
Authors: Realini Tony , Gurka Matthew J. , Weinreb Robert N. 
Published: August 2017

Purpose:
The purpose of this study is to characterize intraday and interday variation in central corneal thickness (CCT) in healthy and glaucomatous subjects.

Methods:
In this prospective cohort study, 40 healthy subjects and 42 subjects with primary open-angle glaucoma underwent CCT measurements by ultrasonic pachymetry on 5 days over 1 year: first at baseline, then at 1 week and 1, 6, and 12 months after baseline. On 1visit, CCT was measured every 2 hours from 08:00 to 20:00. Intraday CCT variance was compared with interday CCT variance.

Results:
Mean CCT at all visits and time points ranged from 561 to 574 µm in healthy eyes and from 548 to 563 µm in glaucomatous eyes. The mean intraday CCT range (highest minus lowest readings) was 21±10 µm in healthy participants and 21±10 µm in glaucoma patients. The mean interday CCT range was 27±13 µm in healthy participants and 24±14 µm in glaucoma patients. Within-subject variance was significantly larger among the interday CCT measurements than the intraday CCT measurements in both healthy subjects and glaucoma patients (P<0.0001 for both) demonstrating that measurements taken on separate days are more different than measurements taken on the same day. Interday CCT differences of ≥30 µm were seen in 27.7% of normal subjects and 30% of glaucoma patients.

Conclusions:
CCT measurements exhibit intraday and interday variation, with the latter being significantly greater than the former. A single CCT assessment inadequately characterizes CCT and may impact risk assessment in patients with suspect and/or diagnosed glaucoma.
Practitioner Gender and Quality of Care in Ambulatory Cardiology Practices
Authors: Gupta Dipti , Tang Fengming , Masoudi Frederick A. , Jones Philip G. , Chan Paul S. , Daugherty Stacie L. 
Published: August 2017

Background:
Some studies suggest that female practitioners are more likely to provide guideline-concordant care than male practitioners; however, little is known about the role of practitioner gender in cardiology.

Objective:
The aim of the study was to measure the association between practitioner gender and adherence to the cardiovascular performance measures in the American College of Cardiology's ambulatory Practice Innovation and Clinical Excellence Registry.

Methods:
Patients with at least 1 outpatient visit with a unique practitioner were included. Among eligible patients, adherence to 7 guideline-supported performance measures for coronary artery disease, heart failure, and atrial fibrillation over 12 months after registry entry was compared by practitioner gender using hierarchical models adjusting for practitioner type (physicians vs advance practice practitioners) and number of visits.

Results:
The study cohort included 1493 individual practitioners who saw 769 139 patients; 80% of practitioners were men. Male practitioners were more often physicians compared with female practitioners (98.2% vs 43.7%, P < .01). Accounting for practitioner category and visit frequency, guideline adherence rates were similar by practitioner gender for all measures with the exception of marginally higher rates for coronary artery disease performance measures for male practitioners compared with female practitioners (antiplatelet: rate ratio [RR] = 1.06; 95% confidence interval [CI], 1.03–1.09; β-blockers: RR = 1.06; 95% CI, 1.01–1.10; and lipid-lowering drug: RR = 1.07; 95% CI, 1.04–1.10) and atrial fibrillation (oral anticoagulants: RR = 1.05; 95% CI, 1.01–1.09).

Conclusion:
Male practitioners marginally outperformed their female counterparts in ambulatory practices enrolled in a voluntary cardiovascular performance improvement registry program. Overall low adherence to some performance measures suggests room for improvement among all practitioners.
Evaluation of Concurrent Oral and Long-Acting Injectable Antipsychotic Prescribing at the Minneapolis Veterans Affairs Health Care System
Authors: Dimitropoulos Erica , Drogemuller Lisa , Wong Kara 
Published: August 2017

Abstract

Background
Antipsychotic polypharmacy is defined as the concomitant prescribing of more than 1 antipsychotic medication for an individual patient. Despite clinical guideline recommendations, long-acting injectable antipsychotics (LAIAs) are often used together with oral antipsychotics (OAPs) to treat a variety of psychiatric illnesses. Little research exists to address this form of antipsychotic polypharmacy, and its role in therapy is poorly understood. The purpose of this evaluation was to determine the prevalence of this prescribing pattern at our facility, identify provider rationale for polypharmacy, and analyze trends. To our knowledge, this study is the first to describe the prevalence of and rationale for concomitant LAIA and OAP prescribing in the veteran population.

Methods
All patients receiving an LAIA at the time of study initiation were included. Long-acting injectable antipsychotics/oral antipsychotics polypharmacy was defined as the use of both agents outside the manufacturer's recommendations for titration and overlap. Statistical analysis was performed to further evaluate prescribing patterns by agent, dose, and indication.

Results
Long-acting injectable antipsychotics/oral antipsychotics polypharmacy occurred in 28% (22/79) of subjects. Of these, 50% (11/22) were prescribed the same antipsychotic in both dosage forms, of which 73% (8/11) were risperidone. Patients on LAIA/OAP polypharmacy were half as likely to be on a maximum dose LAIA compared with those on monotherapy (13% vs. 26%).

Conclusions
Although LAIA/OAP polypharmacy occurred less frequently than reported in previous literature, this study highlights the need for further research to better understand this prescribing practice.