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Recent Research Articles from JPS Health Network

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Updated: 2 hours 32 min ago

Orthopaedic Trauma-Induced Pyoderma Gangrenosum: A Case Report.

Sat, 07/11/2020 - 07:29
Related Articles

Orthopaedic Trauma-Induced Pyoderma Gangrenosum: A Case Report.

JBJS Case Connect. 2020 Apr-Jun;10(2):e0562

Authors: Hoelscher S, Hunter A, Barcak E, Wheeler M, Mapula S

Abstract
CASE: We present a case of a 60-year-old polytraumatized man who developed postoperative pyoderma gangrenosum (PG) after his initial stabilization procedures, mimicking a postoperative infection. This caused a delay in diagnosis, leading to progression of his wounds and a delay in initiation of the appropriate treatment. Once his PG was appropriately treated, his clinical status and wounds improved. He underwent successful wound coverage by plastic surgery and has been recovering from his injuries.
CONCLUSION: Prompt identification and initiation of treatment for postoperative PG is critical to avoid exacerbation of wounds and subsequent morbidity to the patient.

PMID: 32649133 [PubMed - as supplied by publisher]

Improving quality in a complex primary care system-An example of refugee care and literature review.

Wed, 07/01/2020 - 06:24
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Improving quality in a complex primary care system-An example of refugee care and literature review.

J Eval Clin Pract. 2020 Jun 29;:e13430

Authors: Young RA, Nelson MJ, Castellon RE, Martin CM

Abstract
RATIONALE, AIMS AND OBJECTIVES: Applying traditional industrial quality improvement (QI) methodologies to primary care is often inappropriate because primary care and its relationship to the healthcare macrosystem has many features of a complex adaptive system (CAS) that is particularly responsive to bottom-up rather than top-down management approaches. We report on a demonstration case study of improvements made in the Family Health Center (FHC) of the JPS Health Network in a refugee patient population that illustrate features of QI in a CAS framework as opposed to a traditional QI approach.
METHODS: We report on changes in health system utilization by new refugee patients of the FHC from 2016 to 2017. We review the literature and summarize relevant theoretical understandings of quality management in complex adaptive systems as it applies to this case example.
RESULTS: Applying CAS principles in the FHC, utilization of the Emergency Department and Urgent Care Center by newly arrived refugee patients before their first clinic visit was reduced by more than half (total visits decreased from 31%-14% of the refugee patients). Our review of the literature demonstrates that traditional algorithmic top-down QI processes are most often unsuccessful in improving even a few single-disease metrics, and increases clinician burnout and penalizes clinicians who care for vulnerable patients. Improvement in a CAS occurs when front-line clinicians identify care gaps and are given the flexibility to learn and self-organize to enable new care processes to emerge, which are created from bottom-up leadership that utilize existing interdependencies and interact with the top levels of the organization through intelligent top-down causation. We give examples of early adapters who are better applying the principles of CAS change to their QI efforts.
CONCLUSIONS: Meaningful improvement in primary care is more likely achieved when the impetus to implement change shifts from top-down to bottom-up.

PMID: 32596835 [PubMed - as supplied by publisher]

Increased Presence of Perineural Invasion in the Tongue and Floor of the Mouth: Could It Represent a More Aggressive Oral Squamous Cell Carcinoma, or Do Larger Aggressive Tumors Cause Perineural Invasion?

Fri, 06/26/2020 - 06:27
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Increased Presence of Perineural Invasion in the Tongue and Floor of the Mouth: Could It Represent a More Aggressive Oral Squamous Cell Carcinoma, or Do Larger Aggressive Tumors Cause Perineural Invasion?

J Oral Maxillofac Surg. 2019 Apr;77(4):852-858

Authors: Kim RY, Helman JI, Braun TM, Ward BB

Abstract
PURPOSE: Despite data showing worse outcomes and aggressive disease behavior, perineural invasion (PNI) has not been well characterized in terms of tumor location, histopathologic features, or cervical lymph node status. The specific aims of this study were to measure correlations between PNI, tumor location, and other known histopathologic characteristics used to define aggressive disease.
MATERIALS AND METHODS: This was a retrospective cohort study of adult patients with primary squamous cell carcinoma of the oral cavity who underwent neck dissection. We excluded patients whose neck was previously treated with surgery or radiation therapy. Demographic and histopathologic variables of interest were obtained from patient charts. The primary outcome of interest was PNI, and the predictors of interest included tumor location, histopathologic tumor characteristics, and cervical lymph node status. For continuous variables, mean differences were compared by t tests. For categorical variables, the differences in the distribution of the proportions were analyzed with the χ2 test. All variables were entered simultaneously into a multivariate logistic regression model to control for possible confounding. Statistical significance for the study was set at P < .05.
RESULTS: Three hundred sixty-eight patients met the study criteria. PNI showed statistically significant correlations with lymph node status, tumor depth, and specific primary tumor location. PNI was more likely to be seen in tumors located in the tongue or floor of the mouth. Tumors with PNI had a deeper depth of invasion: 15.9 ± 10.9 mm versus 10.2 ± 10.0 mm (P < .001). PNI tumors had a higher mean total number of positive nodes: 2.85 ± 5.23 versus 0.83 ± 1.80 (P < .001).
CONCLUSIONS: PNI is statistically correlated with tongue and floor-of-the-mouth subsites within the oral cavity, as well as larger tumors, deeper tumors, and disease that has progressed to the lymph nodes. Whether this correlation represents causation in either direction remains unknown.

PMID: 30142323 [PubMed - indexed for MEDLINE]

The effect of insurance status on overall survival among children and adolescents with cancer.

Wed, 06/24/2020 - 06:51
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The effect of insurance status on overall survival among children and adolescents with cancer.

Int J Epidemiol. 2020 Jun 23;:

Authors: Wang X, Ojha RP, Partap S, Johnson KJ

Abstract
BACKGROUND: Differences in access, delivery and utilisation of health care may impact childhood and adolescent cancer survival. We evaluated whether insurance coverage impacts survival among US children and adolescents with cancer diagnoses, overall and by age group, and explored potential mechanisms.
METHODS: Data from 58 421 children (aged ≤14 years) and adolescents (15-19 years), diagnosed with cancer from 2004 to 2010, were obtained from the National Cancer Database. We examined associations between insurance status at initial diagnosis or treatment and diagnosis stage; any treatment received; and mortality using logistic regression, Cox proportional hazards (PH) regression, restricted mean survival time (RMST) and mediation analyses.
RESULTS: Relative to privately insured individuals, the hazard of death (all-cause) was increased and survival months were decreased in those with Medicaid [hazard ratio (HR) = 1.27, 95% confidence interval (CI): 1.22 to 1.33; and -1.73 months, 95% CI: -2.07 to -1.38] and no insurance (HR = 1.32, 95% CI: 1.20 to 1.46; and -2.13 months, 95% CI: -2.91 to -1.34). The HR for Medicaid vs. private insurance was larger (pinteraction <0.001) in adolescents (HR = 1.52, 95% CI: 1.41 to 1.64) than children (HR = 1.16, 95% CI: 1.10 to 1.23). Despite statistical evidence violation of the PH assumption, RMST results supported all interpretations. Earlier diagnosis for staged cancers in the Medicaid and uninsured populations accounted for an estimated 13% and 19% of the survival deficit, respectively, vs. the privately insured population. Any treatment received did not account for insurance-associated survival differences in children and adolescents with cancer.
CONCLUSIONS: Children and adolescents without private insurance had a higher risk of death and shorter survival within 5 years following cancer diagnosis. Additional research is needed to understand underlying mechanisms.

PMID: 32572489 [PubMed - as supplied by publisher]

Erectile dysfunction: How to help patients and partners.

Sat, 06/20/2020 - 07:56
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Erectile dysfunction: How to help patients and partners.

J Fam Pract. 2020 Jun;69(5):251-254

Authors: Buck K, Stratton J, Hodgson J

Abstract
This guide and helpful list of key questions can provide a therapeutic framework for addressing the relationship side of ED.

PMID: 32555756 [PubMed - in process]

Associations of thoracic cage size and configuration with outcomes of adult in-hospital cardiac arrest: A retrospective cohort study.

Wed, 06/17/2020 - 05:29
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Associations of thoracic cage size and configuration with outcomes of adult in-hospital cardiac arrest: A retrospective cohort study.

J Formos Med Assoc. 2020 Jun 11;:

Authors: Pei-Chuan Huang E, Fu CM, Chang WT, Huang CH, Tsai MS, Chou E, Wolfshohl J, Wang CH, Wu YW, Chen WJ

Abstract
BACKGROUND: To analyse the association of thoracic cage size and configuration with outcomes following in-hospital cardiac arrest (IHCA).
METHODS: A single-centred retrospective study was conducted. Adult patients experiencing IHCA during 2006-2015 were screened. By analysing computed tomography images, we measured thoracic anterior-posterior and transverse diameters, circumference, and both anterior and posterior subcutaneous adipose tissue (SAT) depths at the level of the internipple line (INL). We also recorded the anatomical structure located immediately posterior to the sternum at the INL.
RESULTS: A total of 649 patients were included. The median thoracic circumference was 88.6 cm. The median anterior and posterior thoracic SAT depths were 0.9 and 1.5 cm, respectively. The ascending aorta was found to be the most common retrosternal structure (57.6%) at the INL. Multivariate logistic regression analyses indicated that anterior thoracic SAT depth of 0.8-1.6 cm (odds ratio [OR]: 2.98, 95% confidence interval [CI]: 1.40-6.35; p-value = 0.005) and thoracic circumference of 83.9-95.0 cm (OR: 2.48, 95% CI: 1.16-5.29; p-value = 0.02) were positively associated with a favourable neurological outcome while left ventricular outflow track or aortic root beneath sternum at the level of INL was inversely associated with a favourable neurological outcome (OR: 0.37, 95% CI: 0.15-0.91; p-value = 0.03).
CONCLUSION: Thoracic circumference and anatomic configuration might be associated with IHCA outcomes. This proof-of-concept study suggested that a one-size-fits-all resuscitation technique might not be suitable. Further investigation is needed to investigate the method of providing personalized resuscitation tailored to patient needs.

PMID: 32536380 [PubMed - as supplied by publisher]

Diversity and Inclusion: The Foundation for All Milestones.

Thu, 06/11/2020 - 07:31
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Diversity and Inclusion: The Foundation for All Milestones.

Fam Med. 2020 Jun;52(6):459-460

Authors: Elliott TC, Ko S

PMID: 32520384 [PubMed - as supplied by publisher]

Occurrence of Glioma in Pregnant Patients: An Institutional Case Series and Review of the Literature.

Thu, 06/04/2020 - 07:02
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Occurrence of Glioma in Pregnant Patients: An Institutional Case Series and Review of the Literature.

Anticancer Res. 2020 Jun;40(6):3453-3457

Authors: Singh P, Mantilla E, Sewell J, Hatanpaa KJ, Pan E

Abstract
BACKGROUND/AIM: Gliomas present a uniquely challenging clinical situation in the context of pregnancy, with no standard recommendations. This case series aimed to describe the treatment regimen and outcomes of five pregnant patients with gliomas.
PATIENTS AND METHODS: This is a retrospective study. A patient database from electronic medical records was evaluated to identify pregnant patients with gliomas treated at our institution between 2008-2018.
RESULTS: Five study patients who were pregnant with gliomas were identified. Of these, 4 were diagnosed during pregnancy, while 1 was diagnosed prior to her pregnancy. One patient had grade 2 astrocytoma, 1 had grade 3 anaplastic astrocytoma, and 3 had grade 4 glioblastomas (GBM). All patients received surgery, and one patient received radiation therapy without concurrent chemotherapy during her pregnancy. All delivered healthy babies. Three of the 5 patients remain alive, and 2 of the 5 were progression-free at the last follow-up.
CONCLUSION: Treatment plans must be specifically tailored to the individual patient based on the glioma grade, the mother's desire to continue the pregnancy, and the risks of delaying treatment until after pregnancy. Additional studies need to be performed to definitively establish uniform guidelines for the treatment of pregnant patients with glioma.

PMID: 32487644 [PubMed - in process]

Validation of the Ask Suicide-Screening Questions for Adult Medical Inpatients: A Brief Tool for All Ages.

Thu, 06/04/2020 - 07:02
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Validation of the Ask Suicide-Screening Questions for Adult Medical Inpatients: A Brief Tool for All Ages.

Psychosomatics. 2020 Apr 28;:

Authors: Horowitz LM, Snyder DJ, Boudreaux ED, He JP, Harrington CJ, Cai J, Claassen CA, Salhany JE, Dao T, Chaves JF, Jobes DA, Merikangas KR, Bridge JA, Pao M

Abstract
BACKGROUND: Few brief suicide risk screening instruments are validated for use in both adult and pediatric medical populations. Using the pediatric Ask Suicide-Screening Questions (ASQ) development study as a model, this study aimed to determine whether the ASQ is a valid suicide risk-screening instrument for use among adults medical patients, as well as to evaluate a set of other potential screening questions for use in adults.
METHODS: Adult patients hospitalized on inpatient medical/surgical units from 4 hospitals were recruited to participate in a cross-sectional instrument-validation study. The 4-item ASQ and other candidate items were compared against the 25-item, previously validated Adult Suicidal Ideation Questionnaire as the criterion standard.
RESULTS: A total of 727 adult medical inpatients completed the screening process. Compared with the Adult Suicidal Ideation Questionnaire, the ASQ performed best among the full set of candidate items, demonstrating strong psychometric properties, with a sensitivity of 100% (95% confidence interval = 90%-100%), a specificity of 89% (95% confidence interval = 86%-91%), and a negative predictive value of 100% (95% confidence interval = 99%-100%). A total of 4.8% (35/727) of the participants screened positive for suicide risk based on the standard criterion Adult Suicidal Ideation Questionnaire.
CONCLUSIONS: The ASQ is a valid and brief suicide risk-screening tool for use among adults. Screening medical/surgical inpatients for suicide risk can be performed effectively for both adult and pediatric patients using this brief, primary screener.

PMID: 32487323 [PubMed - as supplied by publisher]

An Epigenetics-Based, Lifestyle Medicine-Driven Approach to Stress Management for Primary Patient Care: Implications for Medical Education.

Tue, 06/02/2020 - 07:17
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An Epigenetics-Based, Lifestyle Medicine-Driven Approach to Stress Management for Primary Patient Care: Implications for Medical Education.

Am J Lifestyle Med. 2020 May-Jun;14(3):294-303

Authors: Lee J, Papa F, Jaini PA, Alpini S, Kenny T

Abstract
Over 75% of patients in the primary care setting present with stress-related complaints. Curiously, patients and health care providers all too often see stress as a relatively benign sequela of many common illnesses such as heart disease, cancer, lung disease, dementia, diabetes, and mental illness. Unfortunately, various day-to-day lifestyle choices and environmental factors, unrelated to the presence of any disease, can cause stress sufficient to contribute to the development of various diseases/disorders and suboptimal health. There is evidence suggesting that counseling in stress management-oriented therapeutic interventions (as offered by lifestyle medicine-oriented practitioners) may prevent or reduce the onset, severity, duration, and/or overall burden of stress-related illnesses. Such counseling often involves considerations such as the patient's nutrition, physical activity, interest in/capacity to meditate, drug abuse/cessation, and so on. Unfortunately, lifestyle medicine-oriented approaches to stress management are rarely offered in primary care-the patient care arena wherein such counseling would likely be best received by patients. Would health care outcomes improve if primary care providers offered counseling in both stress management and positive lifestyle choices? The purpose of this article is to provide both primary care practitioners and educators in health care training programs with an introductory overview of epigenetics. An emerging field of science offering insights into how factors such as stress and lifestyle choices interact with our genes in ways that can both positively and negatively impact the various micro (eg, cellular) through macro (eg, physiologic, pathophysiologic) processes that determine our tendencies toward illness or wellness. A deeper understanding of epigenetics, as provided herein, should enable primary care providers and medical educators to more confidently advocate for the primary benefits associated with counseling in both stress reduction and the pursuit of healthy lifestyle choices.

PMID: 32477032 [PubMed]

Resident Education in the Time of a Global Pandemic: Development of the Collaborative OMS Virtual Interinstitutional Didactic (COVID) Program.

Mon, 06/01/2020 - 05:38

Resident Education in the Time of a Global Pandemic: Development of the Collaborative OMS Virtual Interinstitutional Didactic (COVID) Program.

J Oral Maxillofac Surg. 2020 May 23;:

Authors: Moe J, Brookes C, Dyalram D, Kim R, Melville J, Quereshy F, Roser S, Salman S, Schlieve T, Steed M, Fisher E

PMID: 32473915 [PubMed - as supplied by publisher]

Outcomes and Survivorship of Biomet Microfixation Total Joint Replacement System: Results From an FDA Postmarket Study.

Sat, 05/23/2020 - 05:06
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Outcomes and Survivorship of Biomet Microfixation Total Joint Replacement System: Results From an FDA Postmarket Study.

J Oral Maxillofac Surg. 2020 Apr 23;:

Authors: Granquist EJ, Bouloux G, Dattilo D, Gonzalez O, Louis PJ, McCain J, Sinn D, Szymela V, Warner M, Quinn PD

Abstract
PURPOSE: In February 2011, the Food and Drug Administration issued a postmarket surveillance order to all manufacturers of temporomandibular joint (TMJ) implants in the United States. The objective of the present study was to measure implant subsequent surgical intervention (SSI) among patients who had undergone TMJ reconstruction with the Biomet TMJ replacement system (Zimmer Biomet, Warsaw, IN).
MATERIALS AND METHODS: A prospective observational study was conducted by sending a questionnaire to patients who had received a Biomet TMJ replacement system from 1995 to 2010 in the United States. The questionnaire was sent annually from 2012 to 2015. The primary endpoint was the SSIs. SSIs included both device removal and reoperations. Kaplan-Meier survival analysis was used to determine the survivorship, and Cox proportional hazard regression analysis was performed to evaluate the preoperative diagnosis and SSI.
RESULTS: The mean age at implantation was 46.6 ± 12.5 years, with a gender distribution of 86.1% female. Data from 499 joints in 319 subjects were collected as a part of the survey. The mean follow-up time was 8.6 ± 3.9 years (range, 2-20 years). The first SSI frequency was 11.2% (4.2% removal rate and 7.0% reoperation rate). The survivorship rate (Kaplan-Meier) was 96% at 3 years, 94% at 5 years, and 86% at 10 years. The mean interval to failure using a survival function to determine the time to SSI (Greenwood's formula) was 13.5 ± 0.193 years. The most common causes of SSI included adhesion removal (2.6%; 13 of 498), heterotopic bone/ankylosis (2.0%; 10 of 498), and infection (1.6%; 8 of 498).
CONCLUSIONS: The results from the present study are consistent with the reported survivorship rates for other orthopedic devices (5-year survival for total hip or knee arthroplasty, 95.9 and 97.2%, respectively). The etiology of SSIs in the Biomet TMJ replacement system was primarily secondary to biologic failure (ie, adhesions, heterotopic bone, and infection).

PMID: 32439381 [PubMed - as supplied by publisher]

Outcomes of tranexamic acid administration in military trauma patients with intracranial hemorrhage: a cohort study.

Sat, 05/16/2020 - 07:54

Outcomes of tranexamic acid administration in military trauma patients with intracranial hemorrhage: a cohort study.

BMC Emerg Med. 2020 May 14;20(1):39

Authors: Walker PF, Bozzay JD, Johnston LR, Elster EA, Rodriguez CJ, Bradley MJ

Abstract
BACKGROUND: Tranexamic acid (TXA) may be a useful adjunct for military patients with severe traumatic brain injury (TBI). These patients are often treated in austere settings without immediate access to neurosurgical intervention. The purpose of this study was to evaluate any association between TXA use and progression of intracranial hemorrhage (ICH), neurologic outcomes, and venous thromboembolism (VTE) in TBI.
METHODS: This was a retrospective cohort study of military casualties from October 2010 to December 2015 who were transferred to a military treatment facility (MTF) in the United States. Data collected included: demographics, types of injuries, initial and interval head computerized tomography (CT) scans, Glasgow Coma Scores (GCS), and six-month Glasgow Outcome Scores (GOS). Results were stratified based on TXA administration, progression of ICH, and VTE.
RESULTS: Of the 687 active duty service members reviewed, 71 patients had ICH (10.3%). Most casualties were injured in a blast (80.3%), with 36 patients (50.7%) sustaining a penetrating TBI. Mean ISS was 28.2 ± 12.3. Nine patients (12.7%) received a massive transfusion within 24 h of injury, and TXA was administered to 14 (19.7%) casualties. Patients that received TXA had lower initial reported GCS (9.2 ± 4.4 vs. 12.5 ± 3.4, p = 0.003), similar discharge GCS (13.3 ± 4.0 vs. 13.8 ± 3.2, p = 0.58), and a larger improvement between initial and discharge GCS (3.7 ± 3.9 vs. 1.3 ± 3.1, p = 0.02). However, there was no difference in mortality (7.1% vs. 7.0%, p = 1.00), progression of ICH (45.5% vs. 14.7%, p = 0.09), frequency of cranial decompression (50.0% vs. 42.1%, p = 0.76), or mean GOS (3.5 ± 0.9 vs. 3.8 ± 1.0, p = 0.13). Patients administered TXA had a higher rate of VTE (35.7% vs. 7.0%, p = 0.01). On multivariate analysis, however, TXA was not independently associated with VTE.
CONCLUSIONS: Patients that received TXA were associated with an improvement in GCS but not in progression of ICH or GOS. TXA was not independently associated with VTE, although this may be related to a paucity of patients receiving TXA. Decisions about TXA administration in military casualties with ICH should be considered in the context of the availability of neurosurgical intervention as well as severity of extracranial injuries and need for massive transfusion.

PMID: 32410581 [PubMed - in process]

Immediate Teeth in Fibulas: Planning and Digital Workflow With Point-of-Care 3D Printing.

Fri, 05/15/2020 - 06:13

Immediate Teeth in Fibulas: Planning and Digital Workflow With Point-of-Care 3D Printing.

J Oral Maxillofac Surg. 2020 Apr 14;:

Authors: Williams FC, Hammer DA, Wentland TR, Kim RY

Abstract
PURPOSE: Point-of-care 3-dimensional (3D) printing has become more common in recent years because many hospitals have created 3D printing laboratories. Traditional techniques to fabricate an immediate dental prosthesis for fibula and implant reconstructions have involve outsourcing to dental laboratories. This results in delays, making it suitable only for benign disease. In the present report, we have demonstrated a technique for in-house creation of a 3D printed dental prosthesis for placement of implants at free fibula maxillofacial reconstruction. Our digital method has reduced costs and shortened the interval to surgery compared with traditional laboratory techniques.
MATERIALS AND METHODS: Twelve patients underwent free fibula reconstruction of the mandible or maxilla with immediate implants and immediate teeth. A dental implant-retained restoration was created before surgery for immediate placement at fibula reconstruction. For the first 5 patients, the prosthesis was fabricated by a dental laboratory after virtual surgical planning. For the next 7 patients, the prosthesis was designed by the surgeon and 3D printed via the in-house laboratory. Four of these in-house cases were performed for malignant disease with skin paddles.
RESULTS: All 12 patients had received an immediate implant-retained fixed prosthesis at fibula reconstruction. The time required to generate the in-house 3D printed prostheses was significantly shorter than that required to create the dental laboratory-fabricated prostheses. The costs were also less with the 3D printed prostheses compared with the dental laboratory-fabricated prostheses.
CONCLUSIONS: The digital workflow we have presented eliminates the delay in creating a dental laboratory-fabricated provisional dental prosthesis for fibula and implant reconstruction. This allows for immediate dental restoration for patients with malignant disease previously considered unsuitable owing to the inherent delay required using an offsite dental laboratory. A decrease in cost to create in-house 3D printed prostheses was noted compared with the prostheses fabricated by a dental laboratory. Case selection is critical to predict the soft tissue needs for composite defects.

PMID: 32404269 [PubMed - as supplied by publisher]

A prospective study on prevalence and causes of insomnia among end-stage renal failure patients on hemodialysis in selected dialysis centers in Qassim, Saudi Arabia.

Wed, 05/13/2020 - 07:31
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A prospective study on prevalence and causes of insomnia among end-stage renal failure patients on hemodialysis in selected dialysis centers in Qassim, Saudi Arabia.

Saudi J Kidney Dis Transpl. 2020 Mar-Apr;31(2):454-459

Authors: Alkhuwaiter RS, Alsudais RA, Ismail AA

Abstract
Studies directed toward improving the life quality of hemodialysis (HD) patients revealed different etiologies for insomnia. We aimed to assess the prevalence of insomnia and determine associated etiologies in the AL Qassim region. This interview-based questionnaire study was conducted in HD centers for assessment of insomnia and its related causes using a validated screening questionnaire, developed by the JPS health network. Accordingly, patients were classified as insomnia, insomnia for further evaluation and management and no insomnia. Of 111 patients, there were 55 males and 56 females. The prevalence of primary insomnia was 28.82%, compared to 44% for secondary insomnia. Significant correlations linked insomnia with apnea, night itching, and not using phosphate binder usage. Primary and secondary insomnia is frequent among dialysis patients and require an application of diagnostic tools and severity scales. The assessment of causes and treatment of the complaints of apnea, usage of phosphate binders, and itching should be considered to decrease complications and improve quality of life.

PMID: 32394919 [PubMed - in process]

Temperature- and Pressure-Regulating Insoles for Prevention of Diabetic Foot Ulcers.

Mon, 05/11/2020 - 05:18

Temperature- and Pressure-Regulating Insoles for Prevention of Diabetic Foot Ulcers.

J Foot Ankle Surg. 2020 May 06;:

Authors: Yavuz M, Ersen A, Monga A, Lavery LA, Garrett AG, Salem Y, Hirschman GB, Myers R

Abstract
Diabetic foot ulcers (DFUs) pose a major threat to the United States healthcare system as well as patients and their families. High ulcer recurrence rates indicate that existing preventive measures are not effective. A new generation of multimodal preventive devices may reduce ulceration and amputation rates. Because previous research has revealed that tissue maintained at cooler temperatures is more resistant to breaking down, the evaluated technology may prevent foot ulceration. The purpose of this study was to test previously designed Temperature and Pressure Monitoring and Regulating Insoles (TAPMARI) in diabetic neuropathic and healthy subjects. A cooling unit, a mini-water pump, a battery pack, and a microcontroller (or simply thermostat) were placed inside a box attached to the subjects' calf, which provided cooling inside the shoe. The microcontroller was set at 28°C. Eight subjects provided informed consent, 3 of whom had diabetic neuropathy. Subjects used the instrumented shoe on the right foot and the matching control shoe on the left and walked on a treadmill for 5 minutes at self-selected speeds. Baseline and postwalking thermographs were obtained with a thermal camera. At the 2-hour midpoint, subjects again walked on the treadmill for 5 minutes at self-selected speeds. Second baseline and postwalking thermographs were captured. Plantar pressure distributions were also quantified. The TAPMARI successfully regulated foot temperatures at or below the target temperature. The mean baseline temperature of the right (regulated) and left (control) feet were 28.1 ± 1.9°C (mean ± standard deviation) for all subjects. The mean temperatures at the end of the study were 25.9 ± 2.5°C (right) and 31.7 ± 1.6°C (left) in all subjects. In the diabetic neuropathy group, the final mean temperatures were 27.5 ± 2.4°C (right) and 31.6 ± 0.8°C (left), which indicated that the temperature goal was met inside the instrumented shoe. By regulating temperatures, TAPMARI may reduce the metabolic demands in the foot and prevent cell autolysis by eliminating the imbalance between oxygen demand and supply. This study warrants further development and testing of TAPMARI as well as investigating the clinical effectiveness in preventing DFUs.

PMID: 32386918 [PubMed - as supplied by publisher]

Readmission Outcomes of Sliding Scale Insulin Compared to Basal-Bolus Insulin Prescribed at Discharge in an Insulin-Naive Patient Population.

Sat, 05/02/2020 - 05:53

Readmission Outcomes of Sliding Scale Insulin Compared to Basal-Bolus Insulin Prescribed at Discharge in an Insulin-Naive Patient Population.

J Pharm Pract. 2020 May 01;:897190020921028

Authors: Carter P, Eshelbrenner T, Kirk L, Fisk M, Rodrigues C

Abstract
BACKGROUND: Limited data are available that examine hospital readmission outcomes of sliding scale compared to basal-bolus insulin in indigent and insulin-naive patients.
OBJECTIVE: To evaluate hospital readmission outcomes in patients who are insulin naive with type 2 diabetes mellitus who are initiated on either sliding scale or basal-bolus insulin upon hospital discharge.
METHODS: A retrospective chart review was conducted of adult patients with a history of type 2 diabetes mellitus, who were insulin naive, had a hemoglobin A1c (HbA1c) 10% or greater, and were discharged with a prescription for sliding scale or basal-bolus insulin from January 2015 to July 2018. The primary objective measured all-cause 30-day hospital readmissions. The secondary objectives measured diabetes-related 30-day hospital readmissions and HbA1c change after 3 months of initial hospital admission. Data were analyzed using descriptive statistics, χ2 test, paired sample t test, and logistic regression.
RESULTS: Forty-one patients were prescribed sliding scale insulin and 105 patients were prescribed basal-bolus insulin. The majority were male (60%), spoke English (84%), were self-pay (39%), and had a mean age of 51 ± 10.2 years, initial HbA1c of 13% ± 1.9%, and LACE+ score of 51 ± 15.6 upon discharge. All-cause 30-day hospital readmissions occurred in 14.6% of sliding scale and 6.7% of basal-bolus insulin groups (odds ratio [OR]: 2.40, 95% confidence interval [CI]: 0.75-7.63). Hyperglycemia occurred in 7.3% of sliding scale and 0.9% of basal-bolus insulin groups. Mean HbA1c difference for basal-bolus and sliding scale insulin was 3.3 ± 3.1 and 2.9 ± 2.7, respectively (P = 0.459).
CONCLUSION: There was no significant difference in all-cause 30-day hospital readmissions comparing sliding scale to basal-bolus insulin.

PMID: 32356506 [PubMed - as supplied by publisher]

A Brief Review of Lung Ultrasonography in COVID-19: Is It Useful?

Sat, 05/02/2020 - 05:53
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A Brief Review of Lung Ultrasonography in COVID-19: Is It Useful?

Ann Emerg Med. 2020 Apr 08;:

Authors: Fiala MJ

PMID: 32354670 [PubMed - as supplied by publisher]

An Alternative Technique for Fixation of Tongue-Type Calcaneal Fractures: The "Hurricane Strap".

Sat, 05/02/2020 - 05:53
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An Alternative Technique for Fixation of Tongue-Type Calcaneal Fractures: The "Hurricane Strap".

J Foot Ankle Surg. 2020 May - Jun;59(3):560-567

Authors: Ernst J, Ryba D, Duncan K, Motley T

Abstract
Traditionally, tongue-type calcaneal fractures have been treated using screw fixation or tension band wiring. In this work, we aim to present a technique guide for an alternative approach to fixation of these fractures given the high potential for failure with traditional methods. Additionally, we present the results of 4 patients treated with this technique. A modified lateral extensile incision is made for application of a midfoot fusion plate that is pre-bent and fit to the calcaneus with 2 holes covering the superior surface of the calcaneus for bicortical interfragmentary purchase. Four screws are then placed orthogonally into the calcaneus through the plate. Typically, this allows for 2 screws to be placed in the superior fragment and 2 screws to be placed in the inferior fragment. All 4 patients went on to timely osseous union and were weightbearing in regular shoe gear at their last follow-up appointment. Average follow-up time was 16.5 (range 15 to 21) months. We believe that the "hurricane strap" provides a more mechanically sound construct than other methods. This construct may be especially useful in patients with osteoporotic bone where screws alone may not maintain adequate reduction or in neuropathic patients where noncompliance with weightbearing status may jeopardize maintenance of reduction.

PMID: 32354512 [PubMed - in process]

The effect of lifelong endurance exercise on cardiovascular structure and exercise function in women.

Thu, 04/30/2020 - 05:50

The effect of lifelong endurance exercise on cardiovascular structure and exercise function in women.

J Physiol. 2020 Apr 29;:

Authors: Carrick-Ranson G, Sloane NM, Howden EJ, Bhella PS, Sarma S, Shibata S, Fujimoto N, Hastings JL, Levine BD

Abstract
KEY POINTS: The beneficial effects of sustained or lifelong (>25 years) endurance exercise on cardiovascular structure and exercise function have been largely established in men. The current findings indicate that committed (≥ 4 weekly exercise sessions) lifelong exercise results in substantial benefits in exercise capacity (V̇O2 max), cardiovascular function at submaximal and maximal exercise, left ventricular mass and compliance, and blood volume compared to similarly aged or even younger (middle-age) untrained women. Endurance exercise training should be considered a key strategy to prevent cardiovascular disease with aging in women as well as men.
ABSTRACT: This study was a retrospective, cross-sectional analysis of exercise performance and left ventricular (LV) morphology in 70 women to examine whether women who have performed regular, lifelong endurance exercise acquire the same beneficial adaptations in cardiovascular structure and function and exercise performance that have been reported previously in men. Three groups of women were examined: 1) 35 older (>60 years) untrained women (older untrained, OU), 2) 13 older women who had consistently performed 4 or more endurance exercise sessions weekly for at least 25 years (older trained, OT), and 3) 22 middle-aged (range 35-59 years) untrained women (middle-age untrained, MU) as a reference control for the appropriate age-related changes. Oxygen uptake (V̇O2 ) and cardiovascular function [cardiac output (Q̇); stroke volume (SV)] (acetylene rebreathing) were examined at rest, steady-state submaximal exercise, and maximal exercise (maximal oxygen uptake, V̇O2 max). Blood volume (CO rebreathing) and LV mass (cardiac MRI), plus invasive measures of static and dynamic chamber compliance were also examined. V̇O2 max (p < 0.001) and maximal exercise Q̇ and SV were larger in older trained women compared to the two untrained groups (∼17% and ∼27% for Q̇ and SV respectively versus MU; ∼40% and ∼38% versus OU, all p < 0.001). Blood volume (ml.kg-1 ) and LV mass index (g.m2 ) were larger in OT versus OU (∼11% and ∼16% respectively, both p ≤ 0.015) Static LV chamber compliance was greater in OT compared to both untrained groups (median (25 - 75%): MU: 0.065(0.049 - 0.080); OU: 0.085(0.061 - 0.138); OT: 0.047(0.031 - 0.054), p ≤ 0.053). Collectively, these findings indicate that lifetime endurance exercise appears to be extremely effective at preserving or even enhancing cardiovascular structure and function with advanced age in women. This article is protected by copyright. All rights reserved.

PMID: 32347540 [PubMed - as supplied by publisher]

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