Pyriform Costal Cartilage Graft Improves Cleft-Side Alar Asymmetry in Secondary Cleft Rhinoplasty.

Objective: The asymmetry of a retrusive cleft-side ala positioned posterior, lateral, and inferior relative to the noncleft ala is exacerbated by ipsilateral deficiency of the pyriform aperture. We describe use of pyriform costal cartilage grafts for enhanced structural foundation and alar symmetry in secondary cleft rhinoplasty.

Design: Retrospective case series.

Venous thromboembolism following initiation of atypical antipsychotics in two geriatric patients.

Background: Although not formally highlighted as a risk factor in current practice guidelines, several observational studies have reported a possible association between antipsychotic use and development of venous thromboembolism (VTE). However, it is unclear to what extent the risk is elevated.

Case Report: Described are 2 cases of VTE following recent initiation of second-generation antipsychotics in elderly patients.

Lithium rechallenge after renal transplant.

Mrs B is a 65-year-old, married, white woman with long-standing history of bipolar disorder type I who achieved mood stability with chronic lithium treatment. She developed end-stage renal disease, which was suspected to be the result of chronic lithium exposure in the context of medical comorbidity, and subsequently required renal transplantation. Following transplantation and discontinuation of lithium, Mrs B was unable to achieve mood stability with multiple medication trials and required more than 40 medical and psychiatric hospitalizations with eventual transition to skilled nursing care.

Patient characteristics in variable left ventricular recovery from Takotsubo syndrome.

Background: Takotsubo syndrome (TTS) is a heart failure syndrome which is usually reversible. Factors associated with degree of recovery of left ventricular systolic function in TTS are poorly understood.

Materials And Methods: We conducted a retrospective analysis of 90 TTS patients treated at our institution from 2006 to 2014.

Searching for Evidence of an Anti-Inflammatory Diet in Children: A Systematic Review of Randomized Controlled Trials for Pediatric Obesity Interventions With a Focus on Leptin, Ghrelin, and Adiponectin.

Problem: To address the complex phenomenon of pediatric obesity, one must understand the physiological mechanisms regulating energy intake and inflammation. The peptide hormones leptin, ghrelin, and adiponectin are involved in both, but their functions are dysregulated in obesity. The purpose of this systematic review is (1) to characterize studies of nutrition interventions for weight management in children who measure these peptides as outcomes, (2) to assess risk of bias in the studies, and (3) to determine the relationships between these peptides and body mass index (BMI).

Treating depression with botulinum toxin: a pooled analysis of randomized controlled trials.

Introduction: Botulinum toxin A (BTA) injection into the glabellar region is currently being studied as a treatment for major depressive disorder (MDD). Here we explore efficacy data of this novel approach in a pooled analysis.

Methods: A literature search revealed 3 RCTs on this topic.

A Cross-Sectional Relationship Between Social Capital, Self-Compassion, and Perceived HIV Symptoms.

Context: Individual resources of social capital and self-compassion are associated with health behaviors and perceived symptoms, suggesting that both are positive resources that can be modified to improve a person's symptom experience.

Objectives: The aim was to examine the relationship between self-compassion and social capital and its impact on current HIV symptom experience in adult people living with HIV (PLWH). We further explored the impact of age on this relationship.

Treatment of Catatonia With Ultrabrief Right Unilateral Electroconvulsive Therapy: A Case Series.

Catatonia is a syndrome heterogeneous with regard to presentation and etiology. Electroconvulsive therapy (ECT) remains the first-line treatment for catatonia. Literature review reveals only a few published case reports on the use of right unilateral (RUL) ECT in catatonia, 1 case report on ultrabrief RUL ECT, and an absence of evidence on the relative effectiveness and tolerability of RUL versus bilateral ECT in treating catatonia.

Agitation predicts response of depression to botulinum toxin treatment in a randomized controlled trial.

In a randomized, controlled trial (n = 30), we showed that botulinum toxin injection to the glabellar region produces a marked improvement in the symptoms of major depression. We hypothesized that the mood-lifting effect was mediated by facial feedback mechanisms. Here we assessed if agitation, which may be associated with increased dynamic psychomotor activity of the facial musculature, can predict response to the treatment.

A case of possible HIV prophylaxis-induced anxiety and obsessive-compulsive disorder.

There is considerable literature on the neuropsychiatric effects of antiretrovirals. This is the first case, to our knowledge, of new-onset obsessive-compulsive symptoms correlated with emtricitabine/tenofovir, a commonly prescribed HIV prophylaxis combination. We describe the case of a woman, who developed upsetting obsessive thoughts following initiation of this pharmacotherapy and include discussion of relevant literature.

Efficacy of right unilateral ultrabrief pulse width ECT: a preliminary report.

Background And Objectives: Ultrabrief (right unilateral) electroconvulsive therapy (UB-RU ECT) is a newer form of ECT, which uses a shorter pulse width than the standard ECT (0.3 vs 1.0 millisecond, respectively).

Anterior-posterior dissociative slide facilitates the second stage of 3-stage forehead flap nasal reconstruction.

Pedicle-lining skin grafts contract between the first and second stage in a 3-stage forehead flap nasal reconstruction. The second stage involves an inherent reduction in vascularity due to the soft tissue thinning performed. The Anterior-Posterior Dissociative Slide restores first-stage pedicle length at the second stage.

Designing a needs assessment survey for clinical nurse educators.

Clinical nurse educators frequently have a wide range of job responsibilities. In the changing healthcare environment, the identification of education needs must be specific, measurable, and applicable to their assigned responsibilities. A literature search into academic and industry professional development helped the authors develop a needs assessment survey for clinical nurse educators.

Clinical controversies in thrombolytic therapy for the management of acute pulmonary embolism.

Acute pulmonary embolism is a common complication in hospitalized patients, spanning multiple patient populations and crossing various therapeutic disciplines. Due to the heterogeneous clinical manifestations, the selection of management strategies for patients with acute pulmonary embolism is a challenge for clinicians, and a nuanced understanding of the relevant literature is required. Previous studies that evaluated thrombolytic therapy in patients with acute pulmonary embolism are limited and controversial.

Hospitalizations Due to Respiratory Syncytial Virus Outside of the Typical Season.

Respiratory Syncytial Virus (RSV) is the most common cause of bronchiolitis and viral lower respiratory tract infections in children. It is associated with annual winter epidemics across the United States, typically October through April. Our objective is to describe the clinical characteristics of children hospitalized outside the typical RSV season and to compare them with those admitted during the season.

Improvement of venous leg ulcers with androgen replacement therapy in a patient with undiagnosed klinefelter syndrome.

Klinefelter syndrome (KS) is the most common genetic form of male hypogonadism. The majority (80-90%) of patients have 47, XXY karyotype while mosaicism is seen in only 10-20% of patients. Leg ulcers may be a presenting symptom of KS with a prevalence of 6-13%.

On-boarding and enculturation of new chief nursing officers.

Given that chief nursing officers (CNOs) play a critical role in hospital organizations and require a diverse set of executive leadership and professional competencies, what competencies are most critical? What kind of support is needed for a leader who is new to this executive role? What is needed to successfully on-board an experienced leader who is new to the organization? How can a CNO demonstrate the unique value he/she brings to the executive "C" suite? The author presents findings from on-boarding 6 new CNOs by using an in-depth 360-degree process to assess competency, an on-boarding development road map, and a CNO scorecard.