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Catherine F Eubanks, J Christopher Muran, Jeremy D Safran
A rupture is a deterioration in the therapeutic alliance, manifested by a disagreement between the patient and therapist on treatment goals, a lack of collaboration on therapeutic tasks, or a strain in their emotional bond. We present the most frequently used measures of alliance ruptures and clinical examples to illustrate their repair. To examine the relation of rupture repairs to outcome, and the impact of rupture resolution training on outcome, we conducted two meta-analyses. In the first meta-analysis, we examined 11 studies (1,314 patients) that examined the relation between rupture repair episodes and patient treatment outcomes...
December 2018: Psychotherapy
A W Yen, A Amato, S Cadoni, S Friedland, Y H Hsieh, J W Leung, M Liggi, J Sul, F W Leung
BACKGROUND: Underwater polypectomy (UWP) of large (≥ 20 mm) colorectal lesions is well described, but reports of UWP for lesions ≤ 20 mm in size, which account for > 95% of polyps encountered in routine clinical practice, are limited. We assessed the feasibility of UWP in routine practice across various sites for colorectal lesions ≤ 20 mm in size. METHODS: A multicenter retrospective study was performed on pooled data from nine colonoscopists at 3 U...
October 17, 2018: Surgical Endoscopy
P F Stillhard, H Frima, C Sommer
The majority of pilon or tibial plafond fractures are complex articular fractures and the treatment strategy, including the choice of the ideal surgical approach, is essential for a good functional outcome. In this paper, we discuss the considerations for dealing with such fractures as well as the pro and cons of the different approaches. The standard protocol consists of a two-staged procedure following the slogan span-scan-plan. After applying an ankle-spanning external fixator (span), the diagnostic work-up is completed by a CT scan with axial views, two-dimensional and three-dimensional reconstruction (scan) to fully understand the fracture pattern...
October 17, 2018: Operative Orthopädie und Traumatologie
Allison N Martin, Jean Claude Byiringiro, Robin T Petroze, Menelas Nkeshimana, Fidele Byiringiro, James F Calland
BACKGROUND: There is conflicting evidence regarding the impact of human immunodeficiency virus serostatus on trauma outcomes in low-resource settings. This study sought to evaluate the impact of human immunodeficiency virus serostatus on mortality outcomes for Rwandan patients presenting after trauma. METHODS: This retrospective review of the University of Rwanda trauma registry captured all adult trauma patients with known human immunodeficiency virus status presenting between March 2011 and July 2015...
October 13, 2018: Surgery
Linyuan Wang, Peter F Rambau, Linda E Kelemen, Michael S Anglesio, Samuel Leung, Aline Talhouk, Martin Köbel
AIMS: Ovarian endometrioid carcinoma (EC) generally has a good prognosis. Adjuvant chemotherapy can be spared in low stage disease, but prognostic biomarkers are needed to refine the treatment threshold. Wnt/β-catenin signaling is commonly altered in EC. We examined immunohistochemical expression of nuclear β-catenin and CDX2, both are mediators of the Wnt pathway, as prognostic biomarkers for EC. METHODS AND RESULTS: We evaluated two ovarian EC cohorts, discovery set (N=183) and validation set (N=174), with ovarian cancer-specific survival (OCSS) as the primary end-point...
October 16, 2018: Histopathology
L F Rose, E J Wolf, T Brindle, A Cernich, W K Dean, C L Dearth, M Grimm, A Kusiak, R Nitkin, K Potter, B J Randolph, F Wang, D Yamaguchi
Regenerative rehabilitation is the synergistic integration of principles and approaches from the regenerative medicine and rehabilitation fields, with the goal of optimizing form and function as well as patient independence. Regenerative medicine approaches for repairing or replacing damaged tissue or whole organs vary from utilizing cells (e.g., stem cells), to biologics (e.g., growth factors), to approaches using biomaterials and scaffolds, to any combination of these. While regenerative medicine offers tremendous clinical promise, regenerative rehabilitation offers the opportunity to positively influence regenerative medicine by inclusion of principles from rehabilitation sciences...
2018: NPJ Regenerative Medicine
Konstantin Frey, Markus Rehm, Daniel Chappell, Jana Eisenlohr, Alexander Crispin, Thomas Saller, Philipp Groene, Ben Ockert, Klaus F Hofmann-Kiefer
BACKGROUND: Hemodynamic instability frequently occurs in beach chair positioning for surgery, putting patients at risk for cerebral adverse events. This study examined whether preoperative volume loading with crystalloids alone or with a crystalloid-colloid combination can prevent hemodynamic changes that may be causative for unfavorable neurologic outcomes. METHODS: The study randomly assigned 43 adult patients undergoing shoulder surgery to 3 study groups. Each group received an infusion of 500 mL of Ringer's acetate between induction of anesthesia and being placed in the beach chair position...
October 12, 2018: Journal of Shoulder and Elbow Surgery
Manisha Gandhi, Rajshi Gandhi, Lauren M Mack, Roman Shypailo, Anne L Adolph, Maurice R Puyau, William W Wong, Russell L Deter, Haleh Sangi-Haghpeykar, Wesley Lee, Nancy F Butte
Background: Although the impact of gestational weight gain (GWG) on birth weight in twin pregnancies has been demonstrated, the specific components of GWG have not been delineated for twin gestations. Fetal body composition has been shown to be modifiable in singleton gestations based on nutritional intervention strategies and may prove to have similar modifications in twin gestations. Objective: We aimed to determine the relation of maternal body composition changes to birth weight, birth length, and neonatal fat mass (FM) in dichorionic-diamniotic twin pregnancies...
October 1, 2018: American Journal of Clinical Nutrition
Suzanne A Maher, Richard Kyle, Bernard F Morrey, Michael J Yaszemski
Despite the wealth of innovation in the orthopaedic sciences, few technologies translate to clinical use. By way of a 2-day symposium titled "AAOS/ORS Translating Orthopaedic Technologies into Clinical Practice: Pathways from Novel Idea to Improvements in Standard of Care Research Symposium," key components of successful commercialization strategies were identified as a passionate entrepreneur working on a concept aimed at improving patient outcomes and decreasing the cost and burden of disease; a de-risking strategy that has due recognition of the regulatory approval process and associated costs while maximizing the use of institutional, state, and federal resources; and a well thought-out and prepared legal plan and high quality, protected intellectual property...
October 12, 2018: Journal of the American Academy of Orthopaedic Surgeons
Lauren F Lichty, L Kris Gowen
Adolescents and young adults face the highest incidence of sexual assault, yet only limited research focuses on the experience of adolescent survivors, adolescent rape myth acceptance, or the ways youth respond to rape. Survivors tend to disclose to at least one person, typically peers, and the response, whether positive or negative, can impact well-being and help-seeking behaviors. Focus groups across Oregon, a leader in state-level comprehensive sexuality education policy, solicited high school-student reactions to an alcohol-involved rape scenario...
October 15, 2018: Journal of Interpersonal Violence
Bas Vaarwerk, Reineke A Schoot, Heleen Maurice-Stam, Olga Slater, Benjamin Hartley, Peerooz Saeed, Eva Gajdosova, Michiel W van den Brekel, Alfons J M Balm, Marinka L F Hol, Stefanie van Jaarsveld, Leontien C M Kremer, Cecile M Ronckers, Henry C Mandeville, Bradley R Pieters, Mark N Gaze, Raquel Davila Fajardo, Simon D Strackee, David Dunaway, Ludi E Smeele, Julia C Chisholm, Huib N Caron, Martha A Grootenhuis, Johannes H M Merks
BACKGROUND: Head and neck rhabdomyosarcoma (HNRMS) survivors are at risk to develop adverse events (AEs). The impact of these AEs on psychosocial well-being is unclear. We aimed to assess psychosocial well-being of HNRMS survivors and examine whether psychosocial outcomes were associated with burden of therapy. PROCEDURE: Sixty-five HNRMS survivors (median follow-up: 11.5 years), treated in the Netherlands and the United Kingdom between 1990 and 2010 and alive ≥2 years after treatment visited the outpatient multidisciplinary follow-up clinic once, in which AEs were scored based on a predefined list according to the Common Terminology Criteria for Adverse Events...
October 14, 2018: Pediatric Blood & Cancer
John F Cursio, Robin J Mermelstein, Donald Hedeker
Latent trait shared-parameter mixed models for ecological momentary assessment (EMA) data containing missing values are developed in which data are collected in an intermittent manner. In such studies, data are often missing due to unanswered prompts. Using item response theory models, a latent trait is used to represent the missing prompts and modeled jointly with a mixed model for bivariate longitudinal outcomes. Both one- and two-parameter latent trait shared-parameter mixed models are presented. These new models offer a unique way to analyze missing EMA data with many response patterns...
October 14, 2018: Statistics in Medicine
D Hu, W F Zhu, W C Shen, Y Xia, X F Wu, H J Zhang, W Liu, Z L Cui, X W Zheng, G Chen
Objective: To investigate the expression of Apelin and Snail proteins in breast cancer and their relationship with the clinicopathological features and prognosis. Methods: The expression of Apelin and Snail proteins was detected by immunohistochemistry in 89 cases of breast cancer and 50 cases of mammary adenosis collected from January to June in 2008 at Fujian Cancer Hospital; the expression was correlated with the clinicopathological features and outcome of the patients. Results: Apelin and Snail were expressed in 42 cases(47...
October 8, 2018: Zhonghua Bing Li Xue za Zhi Chinese Journal of Pathology
Pahriya Ashrap, Deborah J Watkins, Antonia M Calafat, Xiaoyun Ye, Zaira Rosario, Phil Brown, Carmen M Vélez-Vega, Akram Alshawabkeh, José F Cordero, John D Meeker
BACKGROUND: Understanding important sources and pathways of exposure to common chemicals known or suspected to impact human health is critical to eliminate or reduce the exposure. This is particularly important in areas such as Puerto Rico, where residents have higher exposures to numerous chemicals, as well as higher rates of many adverse health outcomes, compared to the mainland US. OBJECTIVE: The aim of this study was to assess distributions, time trends, and predictors of urinary triclocarban, phenol, and paraben biomarkers measured at multiple times during pregnancy among women living in Northern Puerto Rico...
October 10, 2018: Environment International
Brent A Lanting, Harley A Williams, Nicholas F Matlovich, Pieter-Jan Vandekerckhove, Matthew G Teeter, Edward M Vasarhelyi, James L Howard, Lyndsay E Somerville
BACKGROUND: Following a total knee arthroplasty (TKA), restoration of the mechanical axis of the lower limb to a neutral position of 0° ± 3° is generally considered the standard of care. Little is known, however, regarding the impact of realignment defined according to the patient's physiologic anatomy on clinical outcome scores. METHODS: The study included 67 knees with a mean age of 65.9 ± 8.3 years with unilateral osteoarthritis (OA) who underwent a primary unilateral TKA for medial end-stage OA...
October 9, 2018: Knee
Abigail Quintos, Mario Naranjo, Colleen Kelly, Stuart F Quan, Sunil Sharma
PURPOSE: The HoSMed Database recently demonstrated a high prevalence of obstructive sleep apnea (OSA) in hospitalized obese patients. Based on a long-term follow-up, this study showed an improved survival among patients who were adherent with the therapy. In this post-hoc analysis we explore the characteristics, associations, and mortality outcome of OSA in the African American (AA) population. METHODS: These subset analyses included obese AA patients screened in the hospital as high-risk for OSA...
October 9, 2018: Journal of the National Medical Association
Amanda C Kentner, John F Cryan, Susanne Brummelte
Despite the increasing attention to early life adversity and its long-term consequences on health, behavior, and the etiology of neurodevelopmental disorders, our understanding of the adaptations and interventions that promote resiliency and rescue against such insults are underexplored. Specifically, investigations of the perinatal period often focus on negative events/outcomes. In contrast, positive experiences (i.e. enrichment/parental care//healthy nutrition) favorably influence development of the nervous and endocrine systems...
October 11, 2018: Developmental Psychobiology
Patrick J G Gunn, Joanne R Marks, Evgenia Konstantakopoulou, David F Edgar, John G Lawrenson, Stephen A Roberts, Anne F Spencer, Cecilia H Fenerty, Robert A Harper
BACKGROUND: Glaucoma referral filtering schemes have operated in the UK for many years. However, there is a paucity of data on the false-negative (FN) rate. This study evaluated the clinical effectiveness of the Manchester Glaucoma Enhanced Referral Scheme (GERS), estimating both the false-positive (FP) and FN rates. METHOD: Outcome data were collected for patients newly referred through GERS and assessed in 'usual-care' clinics to determine the FP rate (referred patients subsequently discharged at their first visit)...
October 11, 2018: British Journal of Ophthalmology
Judith Trotman, Sally F Barrington, David Belada, Michel Meignan, Robert MacEwan, Carolyn Owen, Václav Ptáčník, András Rosta, Günter R Fingerle-Rowson, Jiawen Zhu, Tina Nielsen, Deniz Sahin, Wolfgang Hiddemann, Robert E Marcus, Andrew Davies
BACKGROUND: Initial results from the ongoing GALLIUM trial have shown that patients with follicular lymphoma have a longer progression-free survival after first-line immunochemotherapy with obinutuzumab than with rituximab. The aim of this secondary analysis was to evaluate the prognostic value of PET-CT responses after first-line immunochemotherapy in the GALLIUM study. METHODS: GALLIUM is an open-label, parallel-group randomised, phase 3 trial, which recruited previously untreated patients with CD20-positive follicular lymphoma (grades 1-3a; disease stage III/IV, or stage II with largest tumour diameter ≥7 cm) who were aged 18 years or older and met the criteria for needing treatment...
October 8, 2018: Lancet Oncology
Bettina F Cuneo, Sven-Erik Sonesson, Stephanie Levasseur, Anita J Moon-Grady, Anita Krishnan, Mary T Donofrio, Marie-Josee Raboisson, Lisa K Hornberger, Peter Van Eerden, Elena Sinkovskaya, Alfred Abuhamad, Bhawna Arya, Anita Szwast, Helena Gardiner, Katherine Jacobs, Grace Freire, Lisa Howley, Aimee Lam, Alexander M Kaizer, D Woodrow Benson, Edgar Jaeggi
BACKGROUND: Fetal atrioventricular block (AVB) occurs in 2% to 4% of anti-Ro antibody-positive pregnancies and can develop in <24 h. Only rarely has standard fetal heart rate surveillance detected AVB in time for effective treatment. OBJECTIVES: Outcome of anti-Ro pregnancies was surveilled with twice-daily home fetal heart rate and rhythm monitoring (FHRM) and surveillance echocardiography. METHODS: Anti-Ro pregnant women were recruited from 16 international centers in a prospective observational study...
October 16, 2018: Journal of the American College of Cardiology
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