bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retained Needle Following Transanal Hemorrhoidal Dearterialization
Authors: Celentano Valerio , Banerjee Anjan , Luvisetto Federico , Naqvi Syed , Khan Jim 
Published: October 2017

INTRODUCTION:
A needle was retained during transanal hemorrhoidal dearterialization. This rare complication has not been described before.

TECHNIQUE:
A spinal needle was inserted from the perianal skin to localize the retained foreign body that was located at 7 cm from the anal margin. A decision was made to proceed to intersphincteric dissection, and a 3-cm incision was made in the perianal skin from 2 to 4 o’clock. Deep pararectal dissection continued, and the needle was eventually found lying in the muscular layer, parallel to the plane of the dissection.

RESULTS:
The needle was retrieved intact, and repeat x-ray confirmed that no foreign body was retained. The patient made an uneventful recovery and was discharged home on postoperative day 1 with a 5-day course of oral antibiotics; she was examined in clinic 4 weeks following surgery and reported significant symptomatic improvement with no perianal pain or rectal bleeding. No anal fistula was found on the examination.

CONCLUSIONS:
X-ray guidance is a helpful adjunct to facilitate 3-dimensional localization. Intersphincteric dissection is a reliable alternative to the transanal approach, particularly when the needle cannot be seen arising from the mucosa or felt on palpation. Repeated attempts to palpate the needle should be avoided, because there is a potential risk of displacing it deeper or higher, making retrieval more difficult.
Keratoconus Progression in Patients With Allergy and Elevated Surface Matrix Metalloproteinase 9 Point-of-Care Test
Authors: Mazzotta Cosimo , Traversi Claudio , Mellace Pierfrancesco , Bagaglia Simone A. , Zuccarini Silvio , Mencucci Rita , Jacob Soosan 
Published: October 2017

Purpose:
To assess keratoconus (KC) progression in patients with allergies who also tested positive to surface matrix metalloproteinase 9 (MMP-9) point-of-care test.

Methods:
Prospective comparative study including 100 stage I–II keratoconic patients, mean age 16.7±4.6 years. All patients underwent an anamnestic questionnaire for concomitant allergic diseases and were screened with the MMP-9 point-of-care test. Patients were divided into two groups: patients KC with allergies (KC AL) and patients KC without allergies (KC NAL). Severity of allergy was established by papillary subtarsal response grade and KC progression assessed by Scheimpflug corneal tomography, corrected distance visual acuity (CDVA) measurement in a 12-month follow-up.

Results:
The KC AL group included 52 patients and the KC NAL group 48. In the KC AL group, 42/52 of patients (81%) were positive to MMP-9 point-of-care test versus two positive patients in the KC NAL group (4%). The KC AL group data showed a statistically significant decrease of average CDVA, from 0.155±0.11 to 0.301±0.2 logarithm of the minimum angle of resolution (P<0.005) at 12 months; Kmax value increased significantly, from 50.2 D±2.7 to 55.2 D±1.9 on average. The KC NAL group revealed a slight KC progression without statistically significant changes. Pearson correlation test showed a high correlation between Kmax worsening and severity of PSR in the KC AL group.

Conclusions:
The study demonstrated a statistically significant progression of KC in patients with concomitant allergies, positive to MMP-9 point-of-care test versus negative. A high correlation between severity of allergy and KC progression was documented.
Bezlotoxumab
Authors: Whitaker Andrea , Cosimi Reese A. , Reveles Kelly R. , Evoy Kirk E. 
Published: October 2017

Abstract
The purpose was to review the pharmacology, safety, and efficacy of bezlotoxumab (Zinplava; Merck Sharp & Dohme Corp, Whitehouse Station, NJ) as a novel therapy for prevention of recurrent Clostridium difficile infection (CDI). MEDLINE was searched (1946 to February 2017) using the terms bezlotoxumab, MK6072, MBL-CDB1, and MDX-1388. Additional studies were identified through searching FDA.gov, clinicaltrials.gov, and review of reference lists. Studies included were randomized control trials in English language on bezlotoxumab for recurrent CDI. Animal studies were excluded. Three randomized control trials were identified evaluating bezlotoxumab in adults receiving standard of care therapy for CDI. The primary outcome evaluated in all trials was CDI recurrence. A phase II trial found the combination of bezlotoxumab-actoxumab compared with placebo decreased CDI recurrence at 84 days (7% vs 25%, P < 0.001). Two similar, yet independent phase III trials evaluated recurrent CDI at 12 weeks. Results were consistent between the 2 trials and pooled analysis displayed a reduction in CDI recurrence in the bezlotoxumab group (absolute difference, −10.1%; 95% confidence interval, −14 to −6; P < 0.001) and the bezlotoxumab-actoxumab group (absolute difference, −11.5%; 95% confidence interval, −15.2 to −7.2; P < 0.001) compared with placebo. Initial and sustained clinical cure rates were similar between bezlotoxumab, bezlotoxumab-actoxumab, and placebo. Overall, the adverse effects associated with bezlotoxumab were similar to placebo, with diarrhea, nausea, pyrexia, and headache having a higher occurrence than placebo. In conclusion, bezlotoxumab is safe and effective at reducing CDI recurrence and the use of bezlotoxumab should be considered in patients who are at highest risk for CDI.
Evaluation of Antimicrobial Therapy Duration for Hospital-Acquired Pneumonia Treatment
Authors: Petite Sarah E. , Nguyen Khang 
Published: October 2017

Background
The Infectious Diseases Society of America recommends a 7-day duration of antimicrobial therapy for hospital-acquired pneumonia (HAP); however, this recommendation is based on low-quality evidence. This recommendation is supported by evidence from ventilator-associated pneumonia clinical trials. Use of guideline-recommended antimicrobial durations is variable in clinical practice owing to the lack of literature available.

Methods
This was a retrospective, cohort, single-center study. Adult patients admitted with a diagnosis of HAP and received at least 72 hours of antimicrobial therapy were included. The primary outcome was day 7 clinical stability in patients treated with standard (≤7 days) compared with extended (>7 days) duration antimicrobial therapy. Secondary outcomes included hospital and intensive care unit length of stay (LOS), 30-day mortality, and 30-day hospital readmission rates.

Results
Fifty-three patient encounters were identified. Thirty-two patients (60.4%) received standard duration (6 [4.5–7] days) antimicrobial therapy, and 21 patients (39.6%) received extended duration (14 [11–14] days) antimicrobial therapy (P < 0.001). There were no statistically significant differences between groups with respect to day 7 clinical stability (62.5% vs 47.6%; P = 0.29), hospital LOS (9 [7–16] days vs 12 [7.5–24] days; P = 0.29), intensive care unit LOS (5 [3.5–9.5] days vs 5 [3–20] days; P = 0.62), 30-day mortality (3.1% vs 9.5%; P = 0.56), or 30-day readmission rates (21.9% vs 38.1%; P = 0.2).

Conclusions
No differences were observed in clinical outcomes between antimicrobial treatment groups. Guideline-recommended durations of antimicrobial therapy should be used in patients with HAP.
Long-term Complications and Surgical Failures After Ossiculoplasty
Authors: Cox Matthew D. , Page Joshua Cody , Trinidade Aaron , Dornhoffer John L. 
Published: October 2017

Objective:
To study long-term complications after ossiculoplasty.

Study Design:
Case series with chart review.

Setting:
Tertiary care referral center otology practice.

Patients:
One hundred ninety-five patients (18–88 yr of age) undergoing ossiculoplasty with tympanoplasty or tympanomastoidectomy using cartilage tympanic membrane grafts, retrograde mastoidectomy with canal wall reconstruction, or mastoid obliteration techniques between July 1998 and July 2012. The studied patients all had at least 3 years of clinical follow-up.

Outcome Measures:
Incidence of long-term complications, including need for revision surgery, need for secondary ventilation tube placement, recurrence of conductive hearing loss (and related etiologies), recurrent cholesteatoma, and delayed graft failure (recurrent tympanic membrane perforation).

Results:
Long-term complications were observed in 10.3% (20/195) of patients. 8.2% (16/195) required revision surgery, 10.2% (17/195) required secondary ventilation tube placement, 3.6% (7/195) experienced recurrence of conductive hearing loss, 4.1% (8/195) had delayed failure of tympanic membrane graft, and 1.5% (3/195) had recurrence of cholesteatoma. Recurrence of conductive hearing loss was caused by the displacement of prosthesis in 3 of 7 patients and extensive scar tissue formation without prosthesis displacement in 4 of 7 patients. Seventy-two percent obtained a postoperative pure-tone average - air-bone gap  < 20 dB. Forty-eight percent (93/195) obtained a hearing result worse than expected based on the ossiculoplasty outcome parameter staging index.

Conclusion:
Long-term complications are a significant consideration in all the patients undergoing ossiculoplasty. Our data suggest that tobacco smoking, Eustachian tube dysfunction, and an unexpectedly poor hearing result on the first postoperative audiogram are all important risk factors for the development of significant complications.
Otology at the Academy of Gondishapur 200–600 CE
Authors: Ruben Robert J. 
Published: October 2017

Objective:
To investigate the way in which otology was practiced at the Academy of Gondishapur in ancient Persia from 200 to 600 CE.

Method:
The pertinent literature, using German and English translations of Latin, Greek, Arabic, and Sanskrit documents, was identified and reviewed through the indices of available books and through a PDF search for the following topics: auricle, deaf, deafness, dizziness, ear, hearing, medicine, otitis, pinna, punishment—ear, speech, surgery, vertigo, and voice.

Results:
The medical school at the Academy of Gondishapur followed the medical and surgical practices of Greece and Rome and, in the 6th century, incorporated those from India as detailed in the Shutra Samhita. This shutra, which originated during the first millennium BCE, detailed many interventions, among which one of the most unusual was the use of a pedicle cheek flap to restore the pinnae. The use of the pedicle flap for pinna restoration appears not have been reported in literature again until 1931, by Jacque Joseph.

Conclusion:
During the period of late antiquity, medical knowledge of both the east and west was preserved and taught in Persia. Among surgical interventions used during the first millennium BCE in India, knowledge of which passed, through the shutra, to the Sasanian Empire in the 6th century CE, was use of the pedicle cheek flap for pinna reconstruction. Even as late as the Renaissance, the pedicle flap was not known to surgeons in the West, and a pedicle flap, though not a cheek flap, was first incorporated into Western medical practice during the 1930s.
The crashing patient: hemodynamic collapse
Authors: Gidwani Hitesh , Gómez Hernando 
Published: October 2017

Purpose of review
Rapid restoration of tissue perfusion and oxygenation are the main goals in the resuscitation of a patient with circulatory collapse. This review will focus on providing an evidence based framework of the technological and conceptual advances in the evaluation and management of the patient with cardiovascular collapse.

Recent findings
The initial approach to the patient in cardiovascular collapse continues to be based on the Ventilate–Infuse–Pump rule. Point of care ultrasound is the preferred modality for the initial evaluation of undifferentiated shock, providing information to narrow the differential diagnosis, to assess fluid responsiveness and to evaluate the response to therapy. After the initial phase of resuscitative fluid administration, which focuses on re-establishing a mean arterial pressure to 65 mmHg, the use of dynamic parameters to assess preload responsiveness such as the passive leg raise test, stroke volume variation, pulse pressure variation and collapsibility of the inferior vena cava in mechanically ventilated patients is recommended.

Summary
The crashing patient remains a clinical challenge. Using an integrated approach with bedside ultrasound, dynamic parameters for the evaluation of fluid responsiveness and surrogates of evaluation of tissue perfusion have made the assessment of the patient in shock faster, safer and more physiologic.
Recollections of Emotional Abuse and Neglect in Childhood as Risk Factors for Depressive Disorders and the Need for Psychotherapy in Adult Life
Authors: Neumann Eva 
Published: October 2017

Abstract
Theoretical and empirical works have pointed out that depression comes along with adverse interpersonal experiences in childhood and adult life. The purpose of this study was to explore whether past and current experiences differ in their relevance for depression. A clinical group of 80 psychotherapy patients diagnosed with a depressive disorder was contrasted with a control group of 111 nondepressed patients from somatic facilities. Child abuse, neglect, and adult attachment dimensions were measured with self-report scales. Depression was correlated with emotional abuse, neglect, and attachment anxiety. However, solely emotional abuse and neglect significantly predicted the probability to be in the group of depressed patients, whereas attachment anxiety did not contribute to this prediction. The findings reveal that childhood variables, namely, recollections of emotional traumas, are more closely associated with depression than representations of adult attachment bonds and therefore need special attention in the psychotherapeutic treatment of depressive disorders.
Opportunities for the Advanced Practice Nurse to Enhance Hypertension Knowledge and Self-management Among African American Women
Authors: Jones Lenette M. , Rosemberg Marie-Anne S. , Wright Kathy D. 
Published: October 2017

Purpose:
Despite increased awareness and the advent of methods to manage the disease, hypertension is poorly controlled among African American women. This study explored hypertension knowledge and blood pressure in a sample of African American women.

Design:
A descriptive, cross-sectional design was used to collect survey data on hypertension knowledge.

Methods:
African American women attending a church conference were invited to complete a questionnaire, which included the Check Your High Blood Pressure Prevention IQ survey, and had their blood pressures measured.

Results:
Of the 151 women who participated, 62% were diagnosed with hypertension. Many of the women, even those not diagnosed with hypertension, had elevated blood pressures. Although the average scores showed that the women scored well on the survey, there were 4 items on the survey that a percentage of the women had difficulty with: questions about (1) stress as a cause of hypertension, (2) symptoms associated with high blood pressure, (3) whether hypertension could be cured, and (4) the amount of exercise needed to help reduce blood pressure.

Conclusion:
Despite efforts to increase awareness and control of hypertension, considerable misconceptions about the disease were found in this sample of African American women. To improve self-management of hypertension among this group, advanced practice nurses need to directly address these misconceptions.
Reliability and Validity of the Turkish Version of the Moral Competence Scale for Public Health Nurses
Authors: Yildiz Esra , Güdücü Tüfekci Fatma 
Published: October 2017

Background:
Moral competencies must be improved in nursing area practice. To evaluate the moral competence seems necessary for nurses.

Aim:
The aims of this study are to adapt and evaluate the psychometric properties of the moral competence questionnaire for public health nurses in Turkey.

Method:
The moral competence scale was translated into Turkish by a skilled translator, after which it was back-translated into English by another translator. We then administered the Turkish version of the moral competence scale to 138 public health nurses working in family and public health centers in Erzurum, a city in eastern Turkey. We analyzed the data using factor analysis and Cronbach’s α.

Results:
Three factors were extracted, which together explained a total of 67.50% of the variance. The Cronbach’s α values were .83, .91, .87, and .88 for factors 1, 2, and 3 and for the whole scale, respectively.

Conclusion:
The Turkish version of the moral competence scale for public health nurses is a valid and reliable assessment tool.
Process of Transition for Congenital Heart Patients
Authors: Habibi Hajar , Emmanuel Yaso , Chung Natali 
Published: October 2017

Purpose:
The aim of this article is to provide an overview of our nurse-led transition clinic provided to congenital heart disease patients moving from pediatric into adult care setting.

Description of the Service:
Nurse-led transition clinic was analyzed at various stages of young adult care from an early stage of 12 to 14 years to entering adult setting at 16 years or older.

Methods:
Overview of current transition service for young adults being transferred from pediatric into adult services highlights the integral role of clinical nurse specialist as a coordinator of care.

Results:
The result of the service overview indicates that nurse-led transition service enables patients to build on their knowledge. This is achieved by providing them time and the opportunities to develop an understanding of their condition and the attitudes required to engage with the adult care setting as indicated in the psychology questionnaire from transition day.

Conclusion:
A nurse-led transition clinic enhances long-term care of patients by supporting the young adults and their family/carer through the transition and transfer of the care to promote the young adult’s understanding of their condition and to prevent any lost to follow-up.
Impact of patient information leaflets on pain medication intake behavior: a pilot study
Authors: Schmitz Julia , Kamping Sandra , Wiegratz Janine , Müller Maike , Stork Jan , Colloca Luana , Flor Herta , Klinger Regine 
Published: October 2017

Abstract

Introduction:
Patient information leaflets on pain medication primarily list side effects while positive effects and action mechanisms remain underrepresented. Nocebo research has shown that negative instructions can lower analgesic effects.

Objectives:
Research on information leaflets and their influence on mood, memory of side effects, and intake behavior of healthy participants is needed.

Methods:
To determine the ratio of positive to negative phrases, 18 information leaflets of common, over-the-market analgesics were examined of which 1 was selected. In a randomized, controlled study design, 18 healthy participants read this leaflet while 18 control group participants read a matched, neutral leaflet of an electrical device. Collected data concerned the recall of positive and negative contents, mood, anxiety, and the willingness to buy and take the drug.

Results:
All examined leaflets listed significantly more side effects than positive effects (t17 = 5.82, P < 0.01). After reading the analgesic leaflet, participants showed a trend towards more negative mood (F
1,34 = 3.78, P = 0.06, ηp
2 = 0.1), a lower intention to buy [χ2 (1, n = 36) = 12.5, P < 0.01], a higher unwillingness to take the medication [χ2 (1, n = 36) = 7.2, P < 0.01], and even a greater recall for side effects than positive effects (t17 = 7.47, P < 0.01).

Conclusion:
Reading the patient information leaflets can increase fear and lower the intention to buy and the willingness to take a pain medication.
Association Between Cardiac Surgery and Mortality Among Patients With Infective Endocarditis Complicated by Sepsis and Septic Shock
Authors: Krajinovic Vladimir , Ivancic Stipe , Gezman Petar , Barsic Bruno 
Published: October 2017

ABSTRACT

Background:
Sepsis and septic shock are common presentations of infective endocarditis (IE), but little is known about clinical characteristics in this group of patients, use of surgical treatment, and their associations with outcome. We sought to determine the influence of cardiac surgery (CS) on the outcome of patients with IE in different stages of sepsis severity.

Methods:
Two hundred ninety four patients with definite IE native or prosthetic valve IE admitted between 2000 and 2011. Prospective evaluation using multivariable logistic regression to evaluate clinical characteristics and outcomes (in-hospital and 1-year mortality) in surgically and medically treated patients stratified by severity of sepsis and using new Sepsis-3 definitions.

Results:
The presence of sepsis or septic shock during IE showed a statistical relationship with increased in-hospital mortality (odds ratio [OR] 8.915, P < 0.001 and OR 35.969, P < 0.001, respectively) after adjusting for other risk factors of poor outcomes (neurological complications, congestive heart failure, and Staphylococcus aureus IE). Surgical treatment had a positive influence on in-hospital mortality in patients with sepsis or septic shock and IE (OR 5.157, P < 0.001) as well as on 1-year survival (hazard ratio 3.092, P < 0.001).

Conclusions:
The presence of sepsis or septic shock as defined in Sepsis-3 definitions is associated with unfavorable outcomes in patients with IE. Surgical treatment has a positive effect on outcomes (in-hospital mortality and 1-year survival) in patients with IE and sepsis or septic shock.
Is Inappropriate Response to Cosyntropin Stimulation Test an Indication of Corticosteroid Resistance in Septic Shock?
Authors: Hyvernat Hervé , Doyen Denis , Barel Rémy , Kaidomar Michel , Goubaux Bernard , Pradier Christian , Panaïa-Ferrari Patricia , Dellamonica Jean , Bernardin Gilles 
Published: October 2017

ABSTRACT
We recently published a comparison of two hydrocortisone dosage regimens in patients with septic shock. We compare the results conferred by the two regimens as a function of the response to cosyntropin stimulation test (CST). Patients with septic shock were treated by one of two hydrocortisone regimens: either a 50-mg intravenous bolus every 6 h during 7 days (200 mg group; n = 49), or a 100-mg initial bolus followed by a continuous infusion of 300 mg daily for 5 days (300 mg group; n = 50). Nonresponders was defined as a CST response of 9 μg/dL or less. Nonresponders had more severe septic shock, greater fluid resuscitation needs, and greater vasopressor dependence than responders. When analyzed only as a function of CST results, there was no difference in survival between responders and nonresponders. However, analyses crossing CST results and the treatment regimens showed that patients who were responders and in the 300 mg group had significantly less intensive care unit mortality compared with responders in the 200 mg group (respective mortality of 24% vs. 55% [relative risk 0.43, 95% confidence interval, 0.20 to 0.94, P = 0.018]). Multivariate analysis identified baseline blood cortisol as an independent prognostic factor for 28-day mortality in all groups (hazard ratio 1.002, 95% confidence interval, 1.001 to 1.002, P ≤ 0.0001). The results suggest that in patients who respond to CST, hydrocortisone can provide a dose-dependent benefit. In contrast, nonresponse may indicate corticosteroid resistance. This heterogeneity of response to hydrocortisone may explain the difficulties encountered when trying to demonstrate its benefit in septic shock.