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Recent Research Articles from JPS Health Network

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A Comparison of Pavlik Harness Treatment Regimens for Dislocated But Reducible (Ortolani+) Hips in Infantile Developmental Dysplasia of the Hip.

Fri, 10/11/2019 - 05:19

A Comparison of Pavlik Harness Treatment Regimens for Dislocated But Reducible (Ortolani+) Hips in Infantile Developmental Dysplasia of the Hip.

J Pediatr Orthop. 2019 Nov/Dec;39(10):505-509

Authors: Hines AC, Neal DC, Beckwith T, Jo C, Kim HKW

Abstract
BACKGROUND: Variation exists in the Pavlik harness (PH) treatment regimen for infantile developmental dysplasia of the hip (DDH). The purpose of this study was to determine if the daily PH wear duration (23 vs. 24 h) and frequency of follow-up visits affect the clinical and radiographic outcomes of infants with dislocated but reducible (Ortolani+) hips.
METHODS: This study reviewed prospectively enrolled patients with DDH in a single center who presented at age <6 months with Ortolani+ hips and were treated with PH. Recommended daily PH wear duration (23 vs. 24 h) and the frequency of clinic visits in first 4 weeks after the initiation of PH treatment were analyzed. The clinical success (stable hip that did not require closed or open reduction or the use of an abduction orthosis) and radiographic success based on the acetabular index at 2-year follow-up were compared between different PH regimen groups.
RESULTS: Sixty-two patients (74 hips, 53 females) with Ortolani+ hips had a mean age of presentation of 23±28 days (range, 4 to 128 d) and mean follow-up of 33.2±18.4 months (range, 8 to 85 mo). Overall clinical success rate of PH for Ortolani+ hips was 93% (69/74 hips) and radiographic success rate at 2 years was 84% (48/57 hips). There was no difference in clinical or radiographic success rate between the 23- and 24-hour wear groups (P>0.99, 0.73) or between hips assessed almost weekly compared with once or twice during the first 4 weeks of PH treatment (P>0.99 for both).
CONCLUSIONS: The 23- versus 24-hour PH regimen and frequency of clinic visits in the first 4 weeks of PH treatment did not affect the clinical or radiographic success rate of Ortolani+ hips in infantile DDH. A strict weekly clinic visit and 24-hour PH regimen may not be necessary to obtain stable reduced hips in infants presenting <6 months of age with Ortolani+ hips.
LEVEL OF EVIDENCE: Level III-therapeutic.

PMID: 31599859 [PubMed - in process]

Comparative Analysis of LASIK Flap Diameter and its Centration Using Two Different Femtosecond Lasers.

Fri, 10/11/2019 - 05:19
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Comparative Analysis of LASIK Flap Diameter and its Centration Using Two Different Femtosecond Lasers.

Med Hypothesis Discov Innov Ophthalmol. 2019;8(3):241-249

Authors: Moshirfar M, Brown TW, Heiland MB, Rosen DB, Ronquillo YC, Hoopes PC

Abstract
The aim of this study was to compare the diameter, accuracy, variability, and centration with respect to the limbus of corneal flaps created by two femtosecond lasers, the VisuMax, and Wavelight FS200, for laser in situ keratomileusis (LASIK) and how these flaps affect visual outcomes. This is a retrospective chart review of flap morphology created during LASIK Surgery. Overall, 168 eyes underwent flap creation using the WaveLight FS200 laser, and on 189 eyes, the VisuMax laser was used. Of these total number, flap morphology was analyzed in a random sample of 158 eyes; 80 with the Visumax laser and 78 with the WaveLight FS200 laser. Intraoperative photos of the flaps taken by the Wavelight Allegretto EX500 were analyzed. Flap diameters and centration were measured using Adobe Acrobat Pro. All patients had visual acuity measurements including uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent refraction (SE) and refractive astigmatism recorded three months postoperatively. Greater than 90% of patients in both groups achieved a UDVA of 20/20 postoperatively. The mean difference between targeted and achieved flap diameter was 0.50 +/- 0.15 mm in the VisuMax group and 0.35 +/- 0.15 millimeters (mm) in the FS200 group (P<0.01). The flap diameters of the VisuMax group were more precise with a variance of 0.024 mm compared to a variance of 0.038 mm in the FS200 group (P<0.05). VisuMax flaps were more nasally displaced (log(NA/TA) = -0.21 +/- 0.10 mm) compared to the FS200 flaps (log(NA/TA) = 0.03 +/- 0.10 mm), (P< 0.01). We concluded that both the VisuMax and FS200 created flaps larger than the preoperative targeted diameter. VisuMax created corneal flaps that had a greater degree of deviation from the targeted diameter when compared to flaps from the FS200. However, there was less variance in the VisuMax flap diameter. In addition, VisuMax flaps were more nasally displaced. There were no statistically significant differences in visual outcomes when comparing the two femtosecond lasers.

PMID: 31598523 [PubMed]

Hospice care, cancer-directed therapy, and Medicare expenditures among older patients dying with malignant brain tumors.

Wed, 10/09/2019 - 12:59
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Hospice care, cancer-directed therapy, and Medicare expenditures among older patients dying with malignant brain tumors.

Neuro Oncol. 2018 06 18;20(7):986-993

Authors: Dover LL, Dulaney CR, Williams CP, Fiveash JB, Jackson BE, Warren PP, Kvale EA, Boggs DH, Rocque GB

Abstract
Background: End-of-life care for older adults with malignant brain tumors is poorly understood. The purpose of this study is to quantify end-of-life utilization of hospice care, cancer-directed therapy, and associated Medicare expenditures among older adults with malignant brain tumors.
Methods: This retrospective cohort study included deceased Medicare beneficiaries age ≥65 with primary malignant brain tumor (PMBT) or secondary MBT (SMBT) receiving care within a southeastern cancer community network including academic and community hospitals from 2012-2015. Utilization of hospice and cancer-directed therapy and total Medicare expenditures in the last 30 days of life were calculated using generalized linear and mixed effect models, respectively.
Results: Late (1-3 days prior to death) or no hospice care was received by 24% of PMBT (n = 383) and 32% of SMBT (n = 940) patients. SMBT patients received late hospice care more frequently than PMBT patients (10% vs 5%, P = 0.002). Cancer-directed therapy was administered to 18% of patients with PMBT versus 25% with SMBT (P = 0.003). Nonwhite race, male sex, and receipt of any hospital-based care in the final 30 days of life were associated with increased risk of late or no hospice care. The average decrease in Medicare expenditures associated with hospice utilization for patients with PMBT was $-12,138 (95% CI: $-18,065 to $-6210) and with SMBT was $-1,508 (95% CI: $-3,613 to $598).
Conclusions: Receiving late or no hospice care was common among older patients with malignant brain tumors and was significantly associated with increased total Medicare expenditures for patients with PMBT.

PMID: 29156054 [PubMed - indexed for MEDLINE]

Antihypertensive Drug Therapy for Mild to Moderate Hypertension During Pregnancy.

Wed, 10/02/2019 - 08:32

Antihypertensive Drug Therapy for Mild to Moderate Hypertension During Pregnancy.

Am Fam Physician. 2019 Oct 01;100(7):403-405

Authors: LeFevre N, Krumm E

PMID: 31573163 [PubMed - in process]

Sex differences in prescription opioid use patterns assessed through a community engagement program in Florida.

Tue, 10/01/2019 - 06:49

Sex differences in prescription opioid use patterns assessed through a community engagement program in Florida.

Drug Alcohol Depend. 2019 Sep 20;204:107568

Authors: Serdarevic M, Striley CW, Gurka KK, Leeman RF, Cottler LB

Abstract
BACKGROUND: Morbidity and mortality attributed to prescription opioids are a crisis in the US and spreading globally. Sex differences related to these conditions have not been adequately assessed.
METHODS: Through our community engagement program, data on demographics, health status, and substance use, including prescription opioids (e.g., Vicodin®, Oxycodone), were collected from community members in Florida (primarily North Central Florida) during a health needs assessment. Participants over 18 years of age were classified by opioid use: past 30-day, lifetime but not past 30-day, or no lifetime prescription opioid use. Descriptive statistics and chi-square tests were calculated, and multinomial logistic regression was used to calculate adjusted odds ratios (aOR; CI). Analyses were conducted for men and women separately to examine sex specific effects.
RESULTS: Among 9221 community members assessed, the mean age was 45 years, 60% were female, and 58% were black. Respondents who endorsed past 30-day use and lifetime use were more likely to be female. Prescription sedative use was the strongest risk factor for past 30-day (aOR = 3.96; 95% CI, 3.35-4.68) and lifetime (aOR = 2.67; 95% CI, 2.34-3.04) prescription opioid use, regardless of sex. Other factors including marijuana use and history of cancer were significantly associated with prescription opioid use; they varied by sex.
CONCLUSIONS: The risk factors identified in this community sample provide additional information not accounted for by national studies. Future examinations of the consequences of concomitant opioid and sedative use, especially among women, are needed.

PMID: 31568932 [PubMed - as supplied by publisher]

Managing Delirium and Agitation in the Older Emergency Department Patient: The ADEPT Tool.

Mon, 09/30/2019 - 05:33

Managing Delirium and Agitation in the Older Emergency Department Patient: The ADEPT Tool.

Ann Emerg Med. 2019 Sep 26;:

Authors: Shenvi C, Kennedy M, Austin CA, Wilson MP, Gerardi M, Schneider S

Abstract
Agitation and delirium are common reasons for older adults to seek care in the emergency department (ED). Providing care for this population in the ED setting can be challenging for emergency physicians. There are several knowledge translation gaps in how to best screen older adults for these conditions and how to manage them. A working group of subject-matter experts convened to develop an easy-to-use, point-of-care tool to assist emergency physicians in the care of these patients. The tool is designed to serve as a resource to address the knowledge translation and implementation gaps that exist in the field. The purpose of this article is present and explain the Assess, Diagnose, Evaluate, Prevent, and Treat tool. Participants were identified with expertise in emergency medicine, geriatric emergency medicine, geriatrics, and psychiatry. Background literature reviews were performed before the in-person meeting in key areas: delirium, dementia, and agitation in older adults. Participants worked electronically before and after an in-person meeting to finalize development of the tool in 2017. Subsequent work was performed electronically in the following months and additional expert review sought. EDs are an important point of care for older adults. Behavioral changes in older adults can be a manifestation of underlying medical problems, mental health concerns, medication adverse effects, substance abuse, or dementia. Five core principles were identified by the group that can help ensure adequate and thorough care for older adults with agitation or delirium: assess, diagnose, evaluate, prevent, and treat. This article provides background for and explains the importance of these principles related to the care of older adults with agitation. It is important for emergency physicians to recognize the spectrum of underlying causes of behavioral changes and have the tools to screen older adults for those causes, and methods to treat the underlying causes and ameliorate their symptoms.

PMID: 31563402 [PubMed - as supplied by publisher]

Injustice Appraisal but not Pain Catastrophizing Mediates the Relationship Between Perceived Ethnic Discrimination and Depression and Disability in Low Back Pain.

Sun, 09/29/2019 - 07:37
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Injustice Appraisal but not Pain Catastrophizing Mediates the Relationship Between Perceived Ethnic Discrimination and Depression and Disability in Low Back Pain.

J Pain. 2019 Sep 25;:

Authors: Ziadni MS, Sturgeon JA, Bissell D, Guck A, Martin KJ, Scott W, Trost Z

Abstract
Despite growing evidence of significant racial disparities in the experience and treatment of chronic pain, the mechanisms by which these disparities manifest have remained relatively understudied. The current study examined the relationship between past experiences of racial discrimination and pain-related outcomes (self-rated disability and depressive symptomatology), and tested the potential mediating roles of pain catastrophizing and perceived injustice related to pain. Analyses consisted of cross-sectional path modeling in a multiracial sample of 137 individuals with chronic low back pain (Hispanics N=43; Blacks N=43; Whites N=51). Results indicated a positive relationship between prior discriminatory experiences and severity of disability and depressive symptoms. In mediation analyses, pain-related appraisals of injustice, but not pain catastrophizing, were found to mediate these relationships. Notably, the association between discrimination history and perceived injustice was significantly stronger in Black and Hispanic participants and was not statistically significant in White participants. The findings suggest that race-based discriminatory experiences may contribute to racial disparities in pain outcomes and highlight the specificity of pain-related, injustice-related appraisals as a mechanism by which these experiences may impair physical and psychosocial function. Future research is needed to investigate temporal and causal mechanisms suggested by the model through longitudinal and clinical intervention studies. PERSPECTIVE: More frequent prior experiences of racial discrimination are associated with greater depressive symptomatology and pain-related disability in individuals with chronic low back pain. These associations are explained by the degree of injustice perception related to pain, but not pain catastrophizing, and were stronger among Black and Hispanic participants.

PMID: 31562992 [PubMed - as supplied by publisher]

Comparing Unsheltered and Sheltered Homeless: Demographics, Health Services Use and Predictors of Health Services Use.

Thu, 09/26/2019 - 07:29
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Comparing Unsheltered and Sheltered Homeless: Demographics, Health Services Use and Predictors of Health Services Use.

Community Ment Health J. 2019 Sep 24;:

Authors: Petrovich JC, Hunt JJ, North CS, Pollio DE, Roark Murphy E

Abstract
Secondary data obtained through the 2015 point-in-time homelessness count and an administrative health care utilization database was used to identify differences in demographic characteristics, health service use, and predictors of health service use among people experiencing unsheltered and sheltered homelessness. Compared to sheltered participants, unsheltered participants had higher proportions of males and Caucasians, were younger, were more likely to use any type of health service and ED services, and used significantly more of any health service and ED and outpatient services. Results also confirm that health services utilization is a complex phenomenon predicted by a variety of predisposing, enabling, and need-related factors, including mental health problems. Together, these findings demonstrate important differences between people living unsheltered and those residing in shelters and they inform local health policy and program initiatives tailored towards these homeless populations.

PMID: 31552539 [PubMed - as supplied by publisher]

Comparative effectiveness of 8- and 12-week ledipasvir/sofosbuvir regimens for HCV infection.

Thu, 09/26/2019 - 07:29
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Comparative effectiveness of 8- and 12-week ledipasvir/sofosbuvir regimens for HCV infection.

Antivir Ther. 2018;23(7):585-592

Authors: Ojha RP, MacDonald BR, Chu TC, Fasanmi EO, Moore JD, Stewart RA

Abstract
BACKGROUND: Real-world studies have aimed to compare the effects of 8- and 12-week ledipasvir/sofosbuvir regimens on sustained virological response (SVR) among HCV infection genotype-1 (HCV-1) treatment-naive patients. Nevertheless, real-world comparative effectiveness studies pose unique challenges, such as confounding by indication, that were not adequately addressed in prior studies. We thus aimed to address limitations in prior studies and compare overall- and subgroup-specific effectiveness of 8- and 12-week ledipasvir/sofosbuvir regimens among HCV-1 treatment-naive patients.
METHODS: Patients eligible for our study were aged ≥18 years and initiated 8- or 12-week ledipasvir/sofosbuvir regimens for treatment-naive HCV-1 at an urban public hospital network. We excluded patients with HIV or cirrhosis. We used marginal structural models to estimate overall and subgroup-specific risk ratios (RRs) and 95% confidence limits (CL) comparing the effect of 8- and 12-week ledipasvir/sofosbuvir regimens on 12-week SVR.
RESULTS: Our study population comprised 191 patients. Among both regimens, the majority were aged >50 years, non-Hispanic White and uninsured. The overall risk of SVR was comparable between the 8- and 12-week regimens (RR=1.01, 95% CL: 0.92, 1.11). The risk of SVR did not vary by race/ethnicity (non-Hispanic Black: RR=1.01, 95% CL: 0.84, 1.21; non-Hispanic White: RR=1.01, 95% CL: 0.89, 1.04).
CONCLUSIONS: Our real-world results suggest that 8- and 12-week ledipasvir/sofosbuvir have comparable effects on SVR among HCV-1 patients without cirrhosis or HIV. In addition, the comparable effectiveness of 8- and 12-week regimens among non-Hispanic Black individuals adds to the growing body of evidence that supports the removal of race-based treatment guidelines.

PMID: 29969099 [PubMed - indexed for MEDLINE]

Practitioner Application: How Does Electronic Health Information Exchange Affect Hospital Performance Efficiency? The Effects of Breadth and Depth of Information Sharing.

Thu, 09/26/2019 - 07:29
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Practitioner Application: How Does Electronic Health Information Exchange Affect Hospital Performance Efficiency? The Effects of Breadth and Depth of Information Sharing.

J Healthc Manag. 2018 May-Jun;63(3):228-229

Authors: Goodstein RS

PMID: 29734284 [PubMed - indexed for MEDLINE]

Lifestyle factors and health-related quality of life in adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort Study.

Tue, 09/24/2019 - 07:08
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Lifestyle factors and health-related quality of life in adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort Study.

Cancer. 2018 10 01;124(19):3918-3923

Authors: Zhang FF, Hudson MM, Huang IC, Bhakta N, Ness KK, Brinkman TM, Klosky J, Lu L, Chen F, Ojha RP, Lanctot JQ, Robison LL, Krull KR

Abstract
BACKGROUND: Survivors of childhood cancer report poor health-related quality of life (HRQOL). Modifiable lifestyle factors such as nutrition and physical activity represent opportunities for interventions to improve HRQOL.
METHODS: The authors examined the association between modifiable lifestyle factors and HRQOL among 2480 adult survivors of childhood cancer in the St. Jude Lifetime Cohort Study. Dietary intake, physical activity, cigarette smoking, and alcohol consumption were assessed through questionnaires. Weight and height were measured in the clinic. HRQOL was evaluated using the Medical Outcome Study 36-Item Short Form Survey. The physical component summary (PCS), mental component summary (MCS), and 8 domain scores of HRQOL were calculated. Multivariable linear regression models were used to estimate regression coefficients (β) associated with HRQOL differences.
RESULTS: Being physically active (PCS β = 3.10; and MCS β = 1.48) was associated with higher HRQOL whereas current cigarette smoking (PCS β = -2.30; and MCS β = -6.49) and obesity (body mass index ≥30 kg/m2 ) (PCS β = -3.29; and MCS β = -1.61) were associated with lower HRQOL in both the physical and mental domains. Better diet (Healthy Eating Index-2015) was associated with higher physical HRQOL (PCS β = 1.79). Moderate alcohol consumption was associated with higher physical (PCS β = 1.14) but lower mental (MCS β = -1.13) HRQOL (all P <.05). Adherence to multiple healthy lifestyle factors demonstrated a linear trend with high scores in both physical and mental HRQOL (highest vs lowest adherence: PCS β = 7.60; and MCS β = 5.76 [P for trend, <.0001]).
CONCLUSIONS: The association between healthy lifestyle factors and HRQOL is cumulative, underscoring the importance of promoting multiple healthy lifestyles to enhance HRQOL in long-term survivors of childhood cancer.

PMID: 30204245 [PubMed - indexed for MEDLINE]

Nasal Sebaceous Carcinoma: A Case Report and Review of the Literature.

Thu, 09/19/2019 - 07:37
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Nasal Sebaceous Carcinoma: A Case Report and Review of the Literature.

J Oral Maxillofac Surg. 2019 Aug 21;:

Authors: Kholaki O, Chang D, Kim RY

Abstract
Sebaceous carcinoma arising from the nasal vestibule is exceedingly rare, with 3 cases previously reported. We have described the case of a 69-year-old man with an indolent exophytic growth on the medial aspect of his right nasal vestibule. Incisional biopsy demonstrated sebaceous carcinoma. The clinical and pathologic features, in addition to the surgical course and the postoperative outcome, are discussed. We also report our findings from a review of the reported data, focusing on the diagnosis and treatment of this rare skin malignancy.

PMID: 31526773 [PubMed - as supplied by publisher]

Response to lubiprostone in chronic constipation is associated with increased mucus and mucin output: a randomized clinical trial.

Sat, 09/14/2019 - 06:18
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Response to lubiprostone in chronic constipation is associated with increased mucus and mucin output: a randomized clinical trial.

J Gastrointestin Liver Dis. 2019 Sep 01;28(3):263-264

Authors: Tarasiuk A, Milad M, Ahmed ST, Majewski M, Wallner G, Fichna J, Bashashati M, Sarosiek J

Abstract
.

PMID: 31517334 [PubMed - in process]

Comparison of Pavlik Harness treatment regimens for reduced but dislocatable (Barlow positive) hips in infantile DDH.

Sat, 09/14/2019 - 06:18
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Comparison of Pavlik Harness treatment regimens for reduced but dislocatable (Barlow positive) hips in infantile DDH.

J Orthop. 2019 Sep-Oct;16(5):440-444

Authors: Neal D, Beckwith T, Hines A, Lee WC, Kilinc BE, Jo C, Kim H

Abstract
Objective: Although the Pavlik Harness (PH) is the most utilized treatment for developmental dysplasia of the hip (DDH), the ideal treatment protocol (frequency of clinic visits in the first month and daily wear duration) for Barlow ​+ ​hips (reduced but dislocatable) has yet to be defined.
Methods: This study compared DDH patients with Barlow hips who were treated with 23 vs 24 h per day PH wear and weekly vs every other week visits. Clinical success was defined as a stable hip that did not require closed or open reduction, or the use of an abduction orthosis prior to achieving clinical stability. Radiographic success was based on the acetabular index at 2-year follow up.
Results: Sixty-five patients (75 hips/58 females) with Barlow hips had a mean age of presentation of 15 ± 12 days (range 4-70) and mean follow-up of 33 ± 17 months (range 6-90). There was no difference in clinical or radiographic success rate between 23 h vs 24 h wear groups (p > 0.99 both) or the Frequently vs Infrequent visit groups (p = 0.49 both). Overall clinical success rate was 97% (73/75 hips) and radiographic success rate at 2 years was 97% (58/60 hips).
Conclusion: A strict, weekly clinic visit and 24-h PH regimen may not be necessary to obtain good clinical and radiographic outcomes in infants presenting <6 months of age with Barlow positive hips.
Level of evidence: Therapeutic, Level III.

PMID: 31516214 [PubMed]

American College of Surgeons' Guidelines for the Perioperative Management of Antithrombotic Medication.

Fri, 09/13/2019 - 05:05
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American College of Surgeons' Guidelines for the Perioperative Management of Antithrombotic Medication.

J Am Coll Surg. 2018 11;227(5):521-536.e1

Authors: Hornor MA, Duane TM, Ehlers AP, Jensen EH, Brown PS, Pohl D, da Costa PM, Ko CY, Laronga C

PMID: 30145286 [PubMed - indexed for MEDLINE]

Associations Between Race, Perceived Psychological Stress, and the Gut Microbiota in a Sample of Generally Healthy Black and White Women: A Pilot Study on the Role of Race and Perceived Psychological Stress.

Tue, 09/10/2019 - 07:27
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Associations Between Race, Perceived Psychological Stress, and the Gut Microbiota in a Sample of Generally Healthy Black and White Women: A Pilot Study on the Role of Race and Perceived Psychological Stress.

Psychosom Med. 2018 09;80(7):640-648

Authors: Carson TL, Wang F, Cui X, Jackson BE, Van Der Pol WJ, Lefkowitz EJ, Morrow C, Baskin ML

Abstract
OBJECTIVE: Racial health disparities persist among black and white women for colorectal cancer. Understanding racial differences in the gut microbiota and related covariates (e.g., stress) may yield new insight into unexplained colorectal cancer disparities.
METHODS: Healthy non-Hispanic black or white women (age ≥19 years) provided survey data, anthropometrics, and stool samples. Fecal DNA was collected and isolated from a wipe. Polymerase chain reaction was used to amplify the V4 region of the 16SrRNA gene and 250 bases were sequenced using the MiSeq platform. Microbiome data were analyzed using QIIME. Operational taxonomic unit data were log transformed and normalized. Analyses were conducted using linear models in R Package "limma."
RESULTS: Fecal samples were analyzed for 80 women (M (SD) age = 39.9 (14.0) years, 47 black, 33 white). Blacks had greater average body mass index (33.3 versus 27.5 kg/m, p < .01) and waist circumference (98.3 versus 86.6 cm, p = .003) than whites. Whites reported more stressful life events (p = .026) and greater distress (p = .052) than blacks. Final models accounted for these differences. There were no significant differences in dietary variables. Unadjusted comparisons revealed no racial differences in alpha diversity. Racial differences were observed in beta diversity and abundance of top 10 operational taxonomic units. Blacks had higher abundances than whites of Faecalibacterium (p = .034) and Bacteroides (p = .038). Stress was associated with abundances of Bifidobacterium. The association between race and Bacteroides (logFC = 1.72, 0 = 0.020) persisted in fully adjusted models.
CONCLUSIONS: Racial differences in the gut microbiota were observed including higher Bacteroides among blacks. Efforts to cultivate an "ideal" gut microbiota may help reduce colorectal cancer risk.

PMID: 29901485 [PubMed - indexed for MEDLINE]

Participation and retention can be high in randomized controlled trials targeting underserved populations: a systematic review and meta-analysis.

Tue, 09/10/2019 - 07:27
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Participation and retention can be high in randomized controlled trials targeting underserved populations: a systematic review and meta-analysis.

J Clin Epidemiol. 2018 06;98:154-157

Authors: Ojha RP, Jackson BE, Lu Y, Burton M, Blair SE, MacDonald BR, Chu TC, Teigen KJ, Acosta M

PMID: 29183689 [PubMed - indexed for MEDLINE]

Fixed-dose gabapentin augmentation in the treatment of alcohol withdrawal syndrome: a retrospective, open-label study.

Sat, 09/07/2019 - 05:03

Fixed-dose gabapentin augmentation in the treatment of alcohol withdrawal syndrome: a retrospective, open-label study.

Am J Drug Alcohol Abuse. 2019 Sep 06;:1-9

Authors: Andaluz A, DeMoss D, Claassen C, Blair S, Hsu J, Bakre S, Khan M, Atem F, Rush AJ

Abstract
Background: Lorazepam use in the treatment of alcohol withdrawal syndrome (AWS) is not without risk. Objective: This study compares AWS outcomes using a standard, symptom-triggered lorazepam dosing protocol (control group) and symptom-triggered lorazepam dosing augmented with a gabapentin loading dose and taper (GABA group). Methods: Consecutive, non-randomized adults (n = 982; 64.0% male) undergoing treatment for AWS were included in this retrospective, open-label study. Symptom-triggered lorazepam dosing was informed by scores on the Clinical Institute Withdrawal Assessment-Alcohol, revised (CIWA-Ar). Gabapentin augmentation utilized an initial loading dose (900 mg) and a three-day taper. Outcomes included average symptom severity per treatment hour and average lorazepam dose per treatment hour. Average time in the protocol by group, stratified by highest CIWA-Ar score, was examined as a secondary outcome. A priori group differences were controlled statistically. Results: GABA patients were older and exhibited somewhat more severe withdrawal symptoms than controls. After controlling for confounders, gabapentin augmentation did not significantly lower average lorazepam dosing per treatment hour or withdrawal symptom severity per treatment hour. Compared to controls, overall withdrawal symptoms diminished somewhat more rapidly for GABA patients experiencing low or moderate-level withdrawal symptoms; however, severe withdrawal symptoms remitted more slowly in the GABA group. Results should be interpreted in light of the uncontrolled nature of group assignment and other confounders. Conclusions: Compared to symptom-triggered lorazepam dosing alone, gabapentin augmentation did not produce better outcomes during treatment of acute AWS. These results do not support the use of scheduled gabapentin as an augmentation to benzodiazepines during inpatient treatment of AWS.

PMID: 31490712 [PubMed - as supplied by publisher]

Addition of Advanced Practice Registered Nurses to the Trauma Team: An Integrative Systematic Review of Literature.

Thu, 09/05/2019 - 09:01
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Addition of Advanced Practice Registered Nurses to the Trauma Team: An Integrative Systematic Review of Literature.

J Trauma Nurs. 2019 May/Jun;26(3):141-146

Authors: Crawford CC

Abstract
The total cost of inpatient care from a traumatic mechanism of injury in the United States between 2001 and 2011 was $240.7 billion. Medical resident work hour reductions mandated in 2011 left a shortage of available in-hospital providers to care for trauma patients. This created gaps in continuity of care, which can lead to costly increased lengths of stay (LOS) and increased medical errors. Adding advanced practice nurses (APNs) specializing in acute or trauma care to the trauma team may help fill this shortage in trauma care providers. The purpose of this integrative systematic review of the literature was to determine whether adding APNs to the admitting trauma team would decrease LOS. A systematic review of primary research in CINAHL and PubMed databases was performed using the following terms: nurse practitioner, advanced practice nurse, trauma team, and length of stay. Included studies examined the effects of adding APNs to trauma teams, were written in English, and were published in 2007-2017. Six studies were included in the final sample, and all were completed at Level I trauma centers in the United States except one from Canada. Combined sample size was 25,083 admitted trauma patients. All 6 studies reported a decrease in LOS ranging from 0.8 to 2.54 days when APNs were added to the trauma team. More research is needed to identify the best utilization of an APN on a trauma team. It is recommended that all trauma centers add APNs to the trauma team to not only decrease admitted trauma patients' LOS but also provide continuity of care, decreasing costs, and minimizing errors.

PMID: 31483771 [PubMed - in process]

Civilian Prehospital Tourniquet Use Is Associated with Improved Survival in Patients with Peripheral Vascular Injury.

Thu, 09/05/2019 - 09:01
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Civilian Prehospital Tourniquet Use Is Associated with Improved Survival in Patients with Peripheral Vascular Injury.

J Am Coll Surg. 2018 05;226(5):769-776.e1

Authors: Teixeira PGR, Brown CVR, Emigh B, Long M, Foreman M, Eastridge B, Gale S, Truitt MS, Dissanaike S, Duane T, Holcomb J, Eastman A, Regner J, Texas Tourniquet Study Group

Abstract
BACKGROUND: Tourniquet use has been proven to reduce mortality on the battlefield. Although empirically transitioned to the civilian environment, data substantiating survival benefit attributable to civilian tourniquet use is lacking. We hypothesized that civilian prehospital tourniquet use is associated with reduced mortality in patients with peripheral vascular injuries.
STUDY DESIGN: We conducted a multicenter retrospective review of all patients sustaining peripheral vascular injuries admitted to 11 Level I trauma centers (January 2011 through December 2016). The study population was divided into 2 groups based on prehospital tourniquet use. Baseline characteristics were compared and factors associated with mortality identified. Logistic regression, adjusting for demographic, physiologic and injury-related parameters, was used to evaluate the association between prehospital tourniquet use and mortality. Delayed amputation was the secondary end point.
RESULTS: During 6 years, 1,026 patients with peripheral vascular injuries were admitted. Prehospital tourniquets were used in 181 (17.6%) patients. Tourniquet time averaged 77.3 ± 63.3 minutes (interquartile range 39.0 to 92.3 minutes). Traumatic amputations occurred in 98 patients (35.7% had a tourniquet). Mortality was 5.2% in the non-tourniquet group compared with 3.9% in the tourniquet group (odds ratio 1.36; 95% CI 0.60 to 1.65; p = 0.452). After multivariable analysis, the use of tourniquets was found to be independently associated with survival (adjusted odds ratio 5.86; 95% CI 1.41 to 24.47; adjusted p = 0.015). Delayed amputation rates were not significantly different between the 2 groups (1.1% vs 1.1%; adjusted odds ratio 1.82; 95% CI 0.36 to 9.99; adjusted p = 0.473).
CONCLUSIONS: Although still underused, civilian prehospital tourniquet application was independently associated with a 6-fold mortality reduction in patients with peripheral vascular injuries. More aggressive prehospital application of extremity tourniquets in civilian trauma patients with extremity hemorrhage and traumatic amputation is warranted.

PMID: 29605726 [PubMed - indexed for MEDLINE]

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