bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A Case Study
Authors: Halbert Roger Kelsey 
Published: August 2016

ABSTRACT
Anti-N-methyl-D-aspartate receptor encephalitis is an autoimmune syndrome that presents with personality changes, autonomic dysfunction, and neurologic deterioration. Most patients with this syndrome progress from psychosis to seizure to catatonia, often associated with abnormal movements, autonomic instability, and hypoventilation. First-line treatment constitutes resection of the associated neoplasm, corticosteroids, intravenous immunoglobulin, and plasma exchange. Second-line treatment includes rituximab and cyclophosphamide. A case of confirmed anti-N-methyl-D-aspartate receptor encephalitis is presented that illustrates the diagnostic and treatment challenges associated with this syndrome and underscores the nursing implications of medical management during immunosuppression. This case study recommends surface cooling and a pharmaceutical regimen for management of autonomic storming, which is a hallmark of this disorder.
Intraoperative nerve monitoring during thyroid surgery
Authors: Gardner Ivy H. , Doherty Gerard M. , McAneny David 
Published: August 2016

Purpose of review
Laryngeal nerve injury, resulting in speech and swallowing dysfunction, is a feared complication of thyroid operations. Routine visualization of the recurrent laryngeal nerve (RLN) has decreased the likelihood of nerve injury, and intraoperative nerve monitoring has been applied in the hope of further enhancing safety.

Recent findings
There is conflicting evidence about the value of nerve monitoring during thyroid operations, despite ample research. The data favor nerve monitoring in certain situations, such as neck re-explorations, contralateral RLN injury, extensive or challenging dissections, invasive tumors or large goiters, and nonrecurrent or branching recurrent laryngeal nerves. Continuous intraoperative nerve monitoring may reduce the chances of excessive traction, which is the most common mechanism of injury. Nerve monitoring may also identify and protect the external branches of the superior laryngeal nerve.

Summary
Surgeons should routinely identify recurrent laryngeal nerves during thyroid operations, and intraoperative nerve monitoring might be a useful adjunct to prevent injury. As a result of the relatively low probability of permanent recurrent laryngeal nerve injury, it is difficult to establish the absolute value of nerve monitoring. Further research may focus on continuous nerve monitoring and intraoperative monitoring of the external branches of the superior laryngeal nerves.
The gastrin receptor antagonist netazepide (YF476) in patients with type 1 gastric enterochromaffin-like cell neuroendocrine tumours: review of long-term treatment
Authors: Sagatun Liv , Mjønes Patricia , Jianu Constantin S. , Boyce Malcolm , Waldum Hege L. , Fossmark Reidar 
Published: August 2016

Objective
Netazepide (YF476) is a recently developed, orally active gastrin receptor antagonist that, in short trials in patients with type 1 gastric enterochromaffin-like cell neuroendocrine tumours, has been shown to induce a significant reduction in the number and size of tumours as well as serum chromogranin A (CgA). The aim of this review is to evaluate the long-term effect and safety of netazepide.

Patients and methods
Five patients previously treated with netazepide in an open-label trial were offered continuous treatment with netazepide 25 mg once daily. Upper endoscopy was performed every 6 months. The tumours were counted and measured, and tissue samples were obtained from the flat corpus mucosa. Enterochromaffin-like cell hyperplasia was classified according to Solcia and colleagues and volume density of CgA immunoreactive (IR) cells was calculated. Fasting serum CgA and fasting serum gastrin were measured every 3 months.

Results
All tumours regressed completely in three of five patients; time until total disappearance was 3, 9 and 12 months. In the other two patients, the number of tumours was reduced from 13 to 5 and from 14 to 3. Serum CgA showed a rapid and sustained decrease (P<0.001). The mean reduction in serum CgA was 4.1±0.5 nmol/l. Similarly, volume density of CgA IR cells in the flat corpus mucosa decreased (P<0.001), with the mean change being 2.0±0.4%. Serum gastrin and volume density of gastrin IR cells in the antral part of the stomach remained unchanged (P=0.2 and 0.7, respectively).

Conclusion
Long-term administration of netazepide is effective and safe.
Effect of Electroacupuncture in “Zusanli” and “Kunlun” Acupoints on TLR4 Signaling Pathway of Adjuvant Arthritis Rats
Authors: Dong Zhe-Qing , Zhu Ji , Lu De-zhao , Chen Qin , Xu Ying-ling 
Published: August 2016

Background:
Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease. Previous study suggested that toll-like receptor (TLR) signaling pathway contributes to the development and progression of RA. In recent years, acupuncture has become one of the most vital treatments of arthralgia. But little is known about the mechanisms of improving RA by acupuncture.

Study Question:
The study studied the effect of electroacupuncture in “Zusanli” and “Kunlun” acupoints on the expression of TLR4, myeloid differentiation factor 88 (MYD88), and NF-κB in adjuvant arthritis rats to clarify the molecular mechanism of acupuncture of RA.

Study Design:
A rat model of adjuvant arthritis was established with injection of 0.1 mL Freund complete adjuvant in the right hindlimb footpad. We next punctured the Zusanli and Kunlun acupoints with 0.25 × 40-mm acupuncture needles to 5-mm depth. Then, we performed electroacupuncture treatment for 28 days with frequency of 2 Hz and intensity of 2 mA, once a day and 30 minutes each time.

Measures and Outcomes:
Arthritis index and paw swelling were measured every week. FQ-PCR and western blot were used to detect the expression of TLR4, MYD88, and NF-κB.

Results:
Paw swelling of rats injected with Freund complete adjuvant was more serious than that of the normal rats, which illustrated the successful establishment of adjuvant arthritis rat model. After treatment for 14 days, the paw swelling and joint symptoms score decreased, paw tissue inflammation eased in the rats of treatment group compared with the model group during the same period. After treatment for 28 days, the expression of TLR4, MYD88, and NF-κB in the ankle bone tissues decreased at both mRNA and protein levels.

Conclusions:
Stimulation with electric needle in Zusanli and Kunlun acupoints can reduce the expression of TLR4, MYD88, and NF-κB, which play an important role in treatment of adjuvant arthritis.
Impact of a Value-based Formulary on Medication Utilization, Health Services Utilization, and Expenditures
Authors: Yeung Kai , Basu Anirban , Hansen Ryan N. , Watkins John B. , Sullivan Sean D. 
Published: August 2016

Background:
Value-based benefit design has been suggested as an effective approach to managing the high cost of pharmaceuticals in health insurance markets. Premera Blue Cross, a large regional health plan, implemented a value-based formulary (VBF) for pharmaceuticals in 2010 that explicitly used cost-effectiveness analysis (CEA) to inform medication copayments.

Objective of the Study:
The objective of the study was to determine the impact of the VBF.

Design:
Interrupted time series of employer-sponsored plans from 2006 to 2013.

Subjects:
Intervention group: 5235 beneficiaries exposed to the VBF. Control group: 11,171 beneficiaries in plans without any changes in pharmacy benefits.

Intervention:
The VBF-assigned medications with lower value (estimated by CEA) to higher copayment tiers and assigned medications with higher value to lower copayment tiers.

Measures:
Primary outcome was medication expenditures from member, health plan, and member plus health plan perspectives. Secondary outcomes were medication utilization, emergency department visits, hospitalizations, office visits, and nonmedication expenditures.

Results:
In the intervention group after VBF implementation, member medication expenditures increased by $2 per member per month (PMPM) [95% confidence interval (CI), $1–$3] or 9%, whereas health plan medication expenditures decreased by $10 PMPM (CI, $18–$2) or 16%, resulting in a net decrease of $8 PMPM (CI, $15–$2) or 10%, which translates to a net savings of $1.1 million. Utilization of medications moved into lower copayment tiers increased by 1.95 days’ supply (CI, 1.29–2.62) or 17%. Total medication utilization, health services utilization, and nonmedication expenditures did not change.

Conclusions:
Cost-sharing informed by CEA reduced overall medication expenditures without negatively impacting medication utilization, health services utilization, or nonmedication expenditures.
Perceived Stress, Multimorbidity, and Risk for Hospitalizations for Ambulatory Care–sensitive Conditions
Authors: Prior Anders , Vestergaard Mogens , Davydow Dimitry S. , Larsen Karen K. , Ribe Anette R. , Fenger-Grøn Morten 
Published: August 2016

Background:
Psychiatric disorders are associated with an increased risk for ambulatory care–sensitive condition (ACSC)-related hospitalizations, but it remains unknown whether this holds for individuals with nonsyndromic stress that is more prevalent in the general population.

Objectives:
To determine whether perceived stress is associated with ACSC-related hospitalizations and rehospitalizations, and posthospitalization 30-day mortality.

Research Design and Measures:
Population-based cohort study with 118,410 participants from the Danish National Health Survey 2010, which included data on Cohen’s Perceived Stress Scale, followed from 2010 to 2014, combined with individual-level national register data on hospitalizations and mortality. Multimorbidity was assessed using health register information on diagnoses and drug prescriptions within 39 condition categories.

Results:
Being in the highest perceived stress quintile was associated with a 2.13-times higher ACSC-related hospitalization risk (95% CI, 1.91, 2.38) versus being in the lowest stress quintile after adjusting for age, sex, follow-up time, and predisposing conditions. The associated risk attenuated to 1.48 (95% CI, 1.32, 1.67) after fully adjusting for multimorbidity and socioeconomic factors. Individuals with above reference stress levels experienced 1703 excess ACSC-related hospitalizations (18% of all). A dose-response relationship was observed between perceived stress and the ACSC-related hospitalization rate regardless of multimorbidity status. Being in the highest stress quintile was associated with a 1.26-times insignificantly increased adjusted risk (95% CI, 0.79, 2.00) for ACSC rehospitalizations and a 1.43-times increased adjusted risk (95% CI, 1.13, 1.81) of mortality within 30 days of admission.

Conclusions:
Elevated perceived stress levels are associated with increased risk for ACSC-related hospitalization and poor short-term prognosis.
Patterns of Hospitalization Risk for Women Surviving Into Very Old Age
Authors: Dolja-Gore Xenia , Harris Melissa L. , Kendig Hal , Byles Julie E. 
Published: August 2016

Background:
By 2050, adults aged 80 years and over will represent around 20% of the global population. Little is known about how adults surviving into very old age use hospital services over time.

Objective:
The objective of the study was to examine patterns of hospital usage over a 10-year period for women who were aged 84 to 89 in 2010 and examine factors associated with increased use.

Methods:
Survey data from 1936 women from the 1921 to 1926 cohort of the Australian Longitudinal Study on Women’s Health were matched with the state-based Admitted Patients Data Collection. Hospital use profiles were determined using repeated measures latent class analysis.

Results:
Four latent class trajectories were identified. One-quarter of the sample were at low risk of hospitalization, while 20.6% demonstrated increased risk of hospitalization and a further 38.1% had moderate hospitalization risk over time. Only 16.8% of the sample was classified as having high hospitalization risk. Correlates of hospital use for very old women differed according to hospital use class and were contingent on the timing of exposure (ie, short-term or long-term).

Conclusions:
Despite the perception that older adults place a significant burden on health care systems, the majority of women demonstrated relatively low hospital use over an extended period, even in the presence of chronic health conditions. High hospitalization risk was found to be concentrated among a small minority of these long-term survivors. The findings suggest the importance of service planning and treatment regimes that take account of the diverse trajectories of hospital use into and through advanced old age.
Race/Ethnicity and End-of-Life Care Among Veterans
Authors: Kutney-Lee Ann , Smith Dawn , Thorpe Joshua , del Rosario Cindy , Ibrahim Said , Ersek Mary 
Published: August 2016

Background:
Few studies have examined comprehensively racial/ethnic variations in quality of end-of-life care.

Objective:
Examine end-of-life care quality received by Veterans and their families, comparing racial/ethnic minorities to nonminorities.

Research Design:
This is a retrospective, cross-sectional analysis of chart review and survey data.

Subjects:
Nearly all deaths in 145 Veterans Affairs Medical Centers nationally (n=94,697) in addition to Bereaved Family Survey (BFS) data (n=51,859) from October 2009 to September 2014.

Measures:
Outcomes included 15 BFS items and 4 indicators of high-quality end-of-life care, including receipt of a palliative care consult, chaplain visit, bereavement contact, and death in hospice/palliative care unit. Veteran race/ethnicity was measured via chart review and defined as non-Hispanic white, non-Hispanic black, Hispanic, or other.

Results:
In adjusted models, no differences were observed by race/ethnicity in receipt of a palliative care consult or death in a hospice unit. Although black Veterans were less likely than white Veterans to receive a chaplain visit, Hispanic Veterans were more likely than white Veterans to receive a chaplain visit and to receive a bereavement contact. Less favorable outcomes for racial/ethnic minorities were noted on several BFS items. In comparison with family members of white Veterans, families of minority Veterans were less likely to report excellent overall care, and this difference was largest for black Veterans (48% vs. 62%).

Conclusions:
Bereaved family members of minority Veterans generally rate the quality of end-of-life care less favorably than those of white Veterans. Family perceptions are critical to the evaluation of equity and quality of end-of-life care.
Sex, Age, and Prevalence of Pediatric Irritable Bowel Syndrome and Constipation in Colombia
Authors: Lu Peter L. , Velasco‐Benítez Carlos A. , Saps Miguel 
Published: August 2016

ABSTRACTObjectives:Our objective was to evaluate the role of sex and age in the prevalence of irritable bowel syndrome (IBS) and functional constipation (FC) in Colombian children. We hypothesized that the prevalence of IBS and FC would be higher in female adolescents than in younger female children, with no corresponding difference in boys.Methods:We performed a cross‐sectional study of Colombian children. Subjects completed the Questionnaire on Pediatric Gastrointestinal Symptoms—Rome III. Subjects were divided into child and adolescent age groups using 2 different cutoffs. Cutoffs were established at 12 and 13 years (CH‐1 = 8–12 years, AD‐1 = 13–18 years, CH‐2 = 8–13 years, AD‐2 = 14–18 years).Results:A total of 3891 subjects (47.0% F, mean age 12.0 years) participated. One hundred eighty‐seven (4.8%) met criteria for IBS. There was no difference in sex composition between CH‐1/AD‐1 (56.0%, 43.5% F) and CH‐2/AD‐2 (53.4%, 46.8% F). Prevalence of IBS among girls was higher in CH‐1 than that in AD‐1 (6.4%, 3.7%, P < 0.05) and overall prevalence was higher in CH‐1 than in AD‐1 (5.4%, 4.0%, P < 0.05). Four hundred ninety‐four (12.7%) children met criteria for FC. There was no difference in sex composition between CH‐1/AD‐1 (47.6%, 48.7% F) and CH‐2/AD‐2 (47.7%, 49.0% F). Prevalence of FC among girls was higher in CH‐1/CH‐2 (14.6%, 14.1%) than in AD‐1/AD‐2 (10.4%, P < 0.01; 9.9%, P < 0.05). Prevalence of FC overall was higher in CH‐1/CH‐2 (14.5%, 14.0%) than in AD‐1/AD‐2 (10.0%, P < 0.0001; 9.3%, P < 0.0001).Conclusions:We did not find a significant female predominance among Colombian children with IBS or FC. Contrary to our hypothesis, IBS and FC prevalence was generally higher in younger children compared with adolescents regardless of sex.
Outcome Measures for Persons With Moderate to Severe Traumatic Brain Injury: Recommendations From the American Physical Therapy Association Academy of Neurologic Physical Therapy TBI EDGE Task Force
Authors: McCulloch Karen L. , de Joya Anna Lisa , Hays Kaitlin , Donnelly Erin , Johnson Tammie Keller , Nirider Coby D. , Roth Heidi , Saliga Sue , Ward Irene 
Published: August 2016

Background and Purpose:
The use of standardized outcome measures (OMs) is essential in assessing the effectiveness of physical therapy (PT) interventions. The purposes of this article are (1) to describe the process used by the TBI EDGE task force to assess the psychometrics and clinical utility of OMs used with individuals with moderate to severe traumatic brain injury (TBI); (2) to describe the consensus recommendations for OM use in clinical practice, research, and professional (entry-level) PT education; and (3) to make recommendations for future work.

Methods:
An 8-member task force used a modified Delphi process to develop recommendations on the selection of OMs for individuals with TBI. A 4-point rating scale was used to make recommendations based on practice setting and level of ambulation. Recommendations for appropriateness for research use and inclusion in entry-level education were also provided.

Results:
The TBI EDGE task force reviewed 88 OMs across the International Classification of Functioning, Disability, and Health (ICF) domains: 15 measured body functions/structure only, 21 measured activity only, 23 measured participation only, and 29 OMs covered more than 1 ICF domain.

Discussion and Conclusions:
Recommendations made by the TBI EDGE task force provide clinicians, researchers, and educators with guidance for the selection of OMs. The use of these recommendations may facilitate identification of appropriate OMs in the population with moderate to severe TBI. TBI EDGE task force recommendations can be used by clinicians, researchers, and educators when selecting OMs for their respective needs. Future efforts to update the recommendations are warranted in order to ensure that recommendations remain current and applicable.

Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A140).
A Tandem Cycling Program: Feasibility and Physical Performance Outcomes in People With Parkinson Disease
Authors: McGough Ellen L. , Robinson Cynthia A. , Nelson Mark D. , Houle Raymond , Fraser Gabriell , Handley Leslie , Jones Emilie R. , Amtmann Dagmar , Kelly Valerie E. 
Published: August 2016

Background and Purpose:
Individuals with Parkinson disease (PD) have motor and nonmotor impairments that interfere with exercise participation. The purpose of this study was to examine the feasibility and physical performance outcomes of a community-based indoor tandem cycling program that was designed to facilitate a higher cadence, consistency, and intensity of training.

Methods:
Forty-one participants with mild to moderate PD were enrolled. A high-cadence cycling protocol using mechanically augmented (or forced) exercise on a tandem bicycle was adapted for our program. Participants cycled 3 times per week for 10 weeks. Feasibility measures included program retention, attendance, and adverse events, as well as the ability to reach training goals for heart rate (HR) and cadence. Physical performance outcomes included the Berg Balance Scale (BBS), Short Physical Performance Battery (SPPB), Five-Times-Sit-to-Stand (FTSTS) Test, Timed Up and Go (TUG), and gait parameters during usual and fast-paced walking.

Results:
Program feasibility was demonstrated with a high attendance rate (96%) and retention rate (100%). There were no adverse events. The majority of participants reached their exercise training goals for target HR (87%) and cadence (95%). Statistically significant physical performance improvement (P < 0.05) was observed across domains of gait, balance, and mobility, suggesting a slowing or reversal of functional decline as a result of this cycling program.

Discussion and Conclusion:
Program feasibility and improved physical performance outcomes were demonstrated in individuals with mild to moderate PD participating in a community-based indoor tandem cycling program.

Video Abstract available for more insights from the authors (see supplemental digital content 1, http://links.lww.com/JNPT/A146).
Patching for Diplopia Contraindicated in Patients with Brain Injury?
Authors: Houston Kevin E. , Barrett A. M. 
Published: August 2016

ABSTRACT

Purpose
Patching for double vision is a common palliative treatment for head-trauma patients with acquired strabismus when prisms are not feasible.

Methods
We review literature on spatial neglect and discuss possible effects of monocular occlusion on spatial attention.

Results
Patching the left eye has been shown to worsen spatial judgments in some brain-injured patients with left neglect by inhibiting the right superior colliculus further impairing contralateral leftward orienting (the Sprague Effect).

Conclusions
Because more peripheral parts of the visual field increasingly project to the contralateral superior colliculus with the temporal crescent being entirely contralateral, avoiding patching of the temporal crescent was advised, and in most cases can be achieved by taping off the spectacle lens and avoiding an elastic eye patch.
Carotid Intima-Media Thickness Manual Measurements
Authors: Plasencia-Martínez Juana M. , García-Santos José María , Lozano-Herrero Jesús , Hernández-Vidal M. Julia 
Published: August 2016

Purpose
The aim of this study was to assess the intraoperator and interoperator agreement for manual measurements of intima-media thickness (IMT) performed under a strict carotid ultrasound technical protocol.

Methods
Two blinded experienced operators independently performed an ultrasound examination at the distal common carotid of 242 subjects in the same patient's position, diastolic phase, probe type, zooming, and depth. Thirty-six subjects were reevaluated in another time point. Three different-angle manual measurements (IMTindiv) were obtained. Interoperator agreements for each IMTindiv, and their mean (IMTmean) and maximum (IMTmax) values, were assessed with the intraclass correlation coefficient and Bland-Altman analysis. Intraoperator agreement was tested taking advantage of the second ultrasound round in 36 subjects.

Results
IMTmean agreements (intraoperator, 0.665–0.913; interoperator, 0.856–0.897) were higher than IMTmax (intraoperator, 0.435–0.793; interoperator, 0.631–0.718) and any IMTindiv (intraoperator, 0.355–0.676; interoperator, 0.590–0.717). Despite the small systematic error for IMTmean (intraoperator, ≤0.03; interoperator, ≤0.02 mm), at best of times, the sampling error size reached at least 0.28 and 0.25 mm for intraoperator and interoperator agreements, respectively, and was never less than 0.13 mm.

Conclusions
Although IMTmean agreement is excellent under a strict protocol, limits of agreement might be too wide to consider carotid ultrasound a robust cardiovascular risk biomarker.