157 results on '"Elizabeth Roth"'
Search Results
2. Rat Hindlimb Amputation Model to Assess Nerve Transfers for Pain Relief
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Jose Zepeda, Gabriella Mraz, Elizabeth Roth, and Gwendolyn Hoben, MD, PhD
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Surgery ,RD1-811 - Published
- 2023
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3. P697: Gauging medical student comfort in the delivery of difficult news in the context of genetics
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Elizabeth Roth, Gianna Arrizurieta, Juan Hervas, Jessica Vissicchio, Tracey Weiler, and Andrew Sobering
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Genetics ,QH426-470 ,Medicine - Published
- 2023
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4. Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interface Support Similar Quantities of Sensory Neurons But Vary in Motor Neuron Regeneration in a Rat Model
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Claire Saltzman, Nathan Staidl, MD, Elizabeth Roth, Dorothee Weihrauch, and Gwendolyn M. Hoben, MD, PhD
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Surgery ,RD1-811 - Published
- 2022
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5. Repetitive Mild Traumatic Brain Injury in Rats Impairs Cognition, Enhances Prefrontal Cortex Neuronal Activity, and Reduces Pre-synaptic Mitochondrial Function
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Yin Feng, Keguo Li, Elizabeth Roth, Dongman Chao, Christina M. Mecca, Quinn H. Hogan, Christopher Pawela, Wai-Meng Kwok, Amadou K. S. Camara, and Bin Pan
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mild traumatic brain injury ,rat model ,cognitive impairment ,neuronal activity ,mitochondrial function ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
A major hurdle preventing effective interventions for patients with mild traumatic brain injury (mTBI) is the lack of known mechanisms for the long-term cognitive impairment that follows mTBI. The closed head impact model of repeated engineered rotational acceleration (rCHIMERA), a non-surgical animal model of repeated mTBI (rmTBI), mimics key features of rmTBI in humans. Using the rCHIMERA in rats, this study was designed to characterize rmTBI-induced behavioral disruption, underlying electrophysiological changes in the medial prefrontal cortex (mPFC), and associated mitochondrial dysfunction. Rats received 6 closed-head impacts over 2 days at 2 Joules of energy. Behavioral testing included automated analysis of behavior in open field and home-cage environments, rotarod test for motor skills, novel object recognition, and fear conditioning. Following rmTBI, rats spent less time grooming and less time in the center of the open field arena. Rats in their home cage had reduced inactivity time 1 week after mTBI and increased exploration time 1 month after injury. Impaired associative fear learning and memory in fear conditioning test, and reduced short-term memory in novel object recognition test were found 4 weeks after rmTBI. Single-unit in vivo recordings showed increased neuronal activity in the mPFC after rmTBI, partially attributable to neuronal disinhibition from reduced inhibitory synaptic transmission, possibly secondary to impaired mitochondrial function. These findings help validate this rat rmTBI model as replicating clinical features, and point to impaired mitochondrial functions after injury as causing imbalanced synaptic transmission and consequent impaired long-term cognitive dysfunction.
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- 2021
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6. Associations between provider communication and personal recovery outcomes
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Eunice C. Wong, Rebecca L. Collins, Joshua Breslau, M. Audrey Burnam, Matthew S. Cefalu, and Elizabeth Roth
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Provider communication ,Provider respect ,Personal recovery ,Life satisfaction ,Stigma ,Empowerment ,Psychiatry ,RC435-571 - Abstract
Abstract Background This study examined whether two types of provider communication considered important to quality of care (i.e., shows respect and explains understandably) are associated with mental health outcomes related to personal recovery (i.e., connectedness, hope, internalized stigma, life satisfaction, and empowerment). This study also tested whether these associations varied by the type of provider seen (i.e., mental health professional versus general medical doctor). Methods This sample included participants from the 2014 California Well-Being Survey, a representative survey of California residents with probable mental illness, who had recently obtained mental health services (N = 429). Multiple regression was used to test associations between provider communication and personal recovery outcomes and whether these associations were modified by provider type. Results Providers showing respect was associated with better outcomes across all five of the personal recovery domains, connectedness (β = 1.12; p
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- 2019
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7. Design and implementation of a decision aid for juvenile idiopathic arthritis medication choices
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William B. Brinkman, Ellen A. Lipstein, Janalee Taylor, Pamela J. Schoettker, Katherine Naylor, Karla Jones, Sheetal S. Vora, Catherine C. Mims, Elizabeth Roth-Wojcicki, Beth Gottlieb, Nancy Griffin, Carole Lannon, and Esi Morgan
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Juvenile idiopathic arthritis ,Patient education ,Shared decision-making ,Decision aids ,Pediatrics ,RJ1-570 ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Abstract Background Randomized trials have demonstrated the efficacy of patient decision aids to facilitate shared decision making in clinical situations with multiple medically reasonable options for treatment. However, little is known about how best to implement these tools into routine clinical practice. In addition, reliable implementation of decision aids has been elusive and spread within pediatrics has been slow. We sought to develop and reliably implement a decision aid for treatment of children with juvenile idiopathic arthritis. Methods To design our decision aid, we partnered with patient, parent, and clinician stakeholders from the Pediatric Rheumatology Care and Outcomes Improvement Network. Six sites volunteered to use quality improvement methods to implement the decision aid. Four of these sites collected parent surveys following visits to assess outcomes. Parents reported on clinician use of the decision aid and the amount of shared decision making and uncertainty they experienced. We used chi-square tests to compare eligible visits with and without use of the decision aid on the experience of shared decision making and uncertainty. Results After 18 rounds of testing and revision, stakeholders approved the decision aid design for regular use. Qualitative feedback from end-users was positive. During the implementation project, the decision aid was used in 35% of visits where starting or switching medication was discussed. Clinicians used the decision aid as intended in 68% of these visits. The vast majority of parents reported high levels of shared decision making following visits with (64/76 = 84%) and without (80/95 = 84%) use of the decision aid (p = 1). Similarly, the vast majority of parents reported no uncertainty following visits with (74/76 = 97%) and without (91/95 = 96%) use of the decision aid (p = 0.58). Conclusions Although user acceptability of the decision aid was high, reliable implementation in routine clinical care proved challenging. Our parsimonious approach to outcome assessment failed to detect a difference between visits with and without use of our aid. Innovative approaches are needed to facilitate use of decision aids and the assessment of outcomes.
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- 2017
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8. Use Of And Willingness To Use Video Telehealth Through The COVID-19 Pandemic
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Shira H. Fischer, Zachary Predmore, Elizabeth Roth, Lori Uscher-Pines, Matthew Baird, and Joshua Breslau
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Health Policy - Published
- 2022
9. Fractions strategy differences in those born extremely preterm
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Sarah Carr, W. Michael Babinchak, Ana Istrate, Blaine Martyn-Dow, George Wang, Weicong Chen, Jeremy Fondran, Jing Zhang, Michael Wien, Seo Yeon Yoon, Anne Birnbaum, Elizabeth Roth, Carol Gross, Nori Minich, Lee Thompson, Won Hwa Kim, Yaakov Stern, Chiara Nosarti, H. Gerry Taylor, and Curtis Tatsuoka
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IntroductionTo investigate the effects of different strategies and cognitive load we explored brain hemodynamic responses associated with the use of different strategies to solve subtraction of fractions. We focused on those born extremely preterm (EPT; MethodsFunctional MRI was acquired while the participants mentally solved fraction equations using either a strategy based on improper or mixed fractions. Different fraction item types were given, which affected respective required cognitive loads per strategy. Diffusion and T1-weighted structural images were also acquired.ResultsThe EPT and FT groups differed in terms of task-related hemodynamic responses. Functional group differences were greatest when strategies were applied to item types that result in high cognitive load. Other findings showed reduced white and grey matter volume and reduced white matter connectivity in widespread areas in the EPT group compared to the FT group.ConclusionThe understanding of function and structure presented here may help inform pedagogical practices by allowing for tailoring of mathematical education through identifying suitable strategy adoption that depends on item type, to circumvent weaknesses in cognitive skills.
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- 2022
10. A longitudinal study of predictors of serious psychological distress during COVID-19 pandemic
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Katherine Grace Carman, Matthew D. Baird, Rebecca L. Collins, Elizabeth Roth, and Joshua Breslau
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Social stress ,education.field_of_study ,Longitudinal study ,serious psychological distress ,business.industry ,Population ,Psychological intervention ,longitudinal study ,COVID-19 ,Logistic regression ,Mental health ,Psychiatry and Mental health ,mental disorders ,Life course approach ,Medicine ,Original Article ,education ,business ,Socioeconomic status ,Applied Psychology ,Demography - Abstract
BackgroundThe prevalence of serious psychological distress (SPD) was elevated during the COVID-19 pandemic in the USA, but the relationships of SPD during the pandemic with pre-pandemic SPD, pre-pandemic socioeconomic status, and pandemic-related social stressors remain unexamined.MethodsA probability-based sample (N = 1751) of the US population age 20 and over was followed prospectively from February 2019 (T1), with subsequent interviews in May 2020 (T2) and August 2020 (T3). Multinomial logistic regression was used to assess prospective relationships between T1 SPD with experiences of disruption of employment, health care, and childcare at T2. Binary logistic regression was then used to assess relationships of T1 SPD, and socioeconomic status and T2 pandemic-related stressors with T3 SPD.ResultsAt T1, SPD was associated with age, race/ethnicity, and household income. SPD at T1 predicted disruption of employment (OR 4.5, 95% CI 1.4–3.8) and health care (OR 3.2, 95% CI 1.4–7.1) at T2. SPD at T1 (OR 10.2, 95% CI 4.5–23.3), low household income at T1 (OR 2.6, 95% CI 1.1–6.4), disruption of employment at T2 (OR 3.2, 95% CI 1.4–7.6), and disruption of healthcare at T2 (OR 3.3, 95% CI 1.5–7.2) were all significantly associated with elevated risk for SPD at T3.ConclusionsElevated risk for SPD during the COVID-19 pandemic is related to multiple psychological and social pathways that are likely to interact over the life course. Policies and interventions that target individuals with pre-existing mental health conditions as well as those experiencing persistent unemployment should be high priorities in the mental health response to the pandemic.
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- 2021
11. Cognitive Outcomes in Children with Mild Traumatic Brain Injury: An Examination Using the National Institutes of Health Toolbox Cognition Battery
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H. Gerry Taylor, Elizabeth Roth, Ann Bacevice, Leah Chadwick, Daniel M. Cohen, Leslie K. Mihalov, Barbara A. Bangert, Nicholas Zumberge, Erin D. Bigler, Keith Owen Yeates, and Nori Minich
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Male ,Battery (electricity) ,030506 rehabilitation ,Adolescent ,Traumatic brain injury ,Neuropsychological Tests ,Bone and Bones ,Executive Function ,03 medical and health sciences ,Cognition ,0302 clinical medicine ,Reaction Time ,medicine ,Humans ,Attention ,Child ,Brain Concussion ,Memory Disorders ,Original Articles ,medicine.disease ,United States ,Toolbox ,Cognitive test ,Inhibition, Psychological ,National Institutes of Health (U.S.) ,Socioeconomic Factors ,Female ,Neurology (clinical) ,Cognitive Assessment System ,Cognition Disorders ,0305 other medical science ,Psychology ,Psychomotor Performance ,030217 neurology & neurosurgery ,Clinical psychology - Abstract
This study is the first to examine cognitive outcomes after pediatric mild TBI using the National Institutes of Health Toolbox Cognition Battery (NIHTB-CB), a computerized cognitive test battery. The NIHTB-CB includes two complex measures of attention and executive function that allow differentiation of accuracy and response speed. We compared performance on the NIHTB-CB among children 8–16 years of age with mild TBI (n = 143) versus children with orthopedic injuries (OIs; n = 74) recruited in emergency departments and followed for 6 months post-injury. Mixed-model analyses showed that the mild TBI group showed significantly lower Fluid Cognition composite scores than the OI group at 10 days (group intercept, p = 0.018); the magnitude of group differences declined modestly over time (group × time interaction, p = 0.055). Effect sizes were d = 0.34 at 10 days post-injury, d = 0.27 at 3 months, and d = 0.10 at 6 months. No significant effects of group or time were found for the Crystallized Cognition composite. Analyses of Fluid Cognition subtests indicated that children with mild TBI displayed deficits for as long as 3 months on measures of attention and executive function (e.g., cognitive flexibility, inhibitory control), but not on measures of explicit memory, working memory, or processing speed. The poorer performance of the mild TBI group on measures of attention and executive function was attributable largely to slowed reaction time, not decreased accuracy. The findings suggest that children with mild TBI demonstrate persistent deficits in fluid cognition that are most apparent on tasks that combine demands for both speed and executive function.
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- 2021
12. Prenatal Diagnosis of Bladder Exstrophy and OEIS over 20 Years
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Ted Lee, Dana Weiss, Elizabeth Roth, Eric Bortnick, Susan Jarosz, Sahar Eftekharzadeh, Travis Groth, Aseem Shukla, John V. Kryger, Richard S. Lee, Douglas A. Canning, Michael E. Mitchell, and Joseph G. Borer
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Urology - Abstract
To examine the prenatal diagnosis rates of bladder exstrophy (BE) and Omphalocele-Exstrophy-Imperforate anus-Spinal Defect Syndrome (OEIS) in a large cohort of patients over a 20-year period. We hypothesized that prenatal diagnosis rates improved over time due to evolving techniques in fetal imaging.A multi-institutional database was queried to identify BE or OEIS patients who underwent primary closure between 2000 and 2020. We retrospectively determined prenatally or postnatal diagnosis. Those with unknown prenatal history were excluded. Multivariable logistic regression was used to investigate temporal pattern in rate of prenatal diagnosis while adjusting for sex and treating institution.Among 197 BE and 52 OEIS patients, 155 BE and 45 OEIS patients had known prenatal history. Overall prenatal diagnosis rates of BE and OEIS were 47.1% (73/155) and 82.2% (37/45), respectively. Prenatal diagnosis rate was significantly lower in BE versus OEIS (p0.0001). The prenatal diagnosis rate for BE significantly increased over time (OR 1.10; [95%CI: 1.03-1.17]; p=0.003). Between 2000 and 2005, the prenatal diagnosis rate of BE was 30.3% (10/33). Between 2015 and 2020, prenatal diagnosis rate of BE was 61.1% (33/54). Prenatal diagnosis rate for OEIS did not change over time. Rates of prenatal diagnosis did not differ by sex or treating institution.Rates of prenatal diagnosis of BE and OEIS are higher than previously reported. Prenatal diagnosis rate of BE doubled in the last 5 years compared to the first 5 years of the study period. Nonetheless, a significant proportion of both BE and OEIS patients remain undiagnosed prior to delivery.
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- 2022
13. Perceived Need for Mental Health Treatment and the Mental Health Response to the COVID-19 Pandemic in the United States
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Melissa L. Finucane, Joshua Breslau, Carol S. North, Rebecca L. Collins, and Elizabeth Roth
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Adult ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Population ,MEDLINE ,Psychological Distress ,Logistic regression ,Article ,Young Adult ,Pandemic ,Humans ,Medicine ,education ,Psychiatry ,Pandemics ,education.field_of_study ,SARS-CoV-2 ,business.industry ,COVID-19 ,Mental health ,United States ,Outreach ,Psychiatry and Mental health ,Distress ,Mental Health ,business - Abstract
Objective: Population-based information on the extent of perceived need for mental health treatment and clinically significant psychological distress can help inform strategies for responding to the mental health impact of the COVID-19 pandemic.Methods: A representative sample of U.S. adults, age 20 and over (N = 1,957), completed surveys in May and June 2020. Potential target populations were distinguished based on perceived need for mental health treatment and psychological distress, assessed by the Kessler-6, among those without perceived need. Populations were characterized with respect to demographic characteristics and prior mental health treatment history using logistic regression models.Results: The prevalence of perceived need for mental health treatment was 21%. Perceived need was strongly associated with pre-pandemic treatment history; compared to those with no treatment history, perceived need was dramatically higher among those in treatment when the pandemic began (OR = 53.8 95% CI 28.2-102.8) and those with pre-pandemic treatment history (OR = 9.3, 95% CI 5.1-16.8). Among the 79% who did not perceive need, moderate or greater distress was reported by 19% and was associated with younger age and Hispanic ethnicity (OR = 2.1, 95% CI 1.2-3.6).Conclusions: In the U.S., where mental health treatment is relatively common, mental health treatment response during the pandemic, and perhaps other crises, should target people with a history of mental health treatment. Outreach to people less likely to seek care on their own despite clinically significant distress should target Hispanic populations.
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- 2021
14. Improving physician wellness through electronic health record education
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Elizabeth Roth and Elizabette Johnson
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medicine.medical_specialty ,business.industry ,Trainer ,Internship and Residency ,Physicians, Family ,Pilot Projects ,Intention to use ,Resident physician ,Burnout ,Psychiatry and Mental health ,Electronic health record ,health services administration ,Family medicine ,Intervention (counseling) ,Statistical significance ,medicine ,Electronic Health Records ,Humans ,Job satisfaction ,business ,Burnout, Professional - Abstract
Objective Our goal is to improve the wellness of our Family Medicine residents now and in the future by educating them on more efficient use of our electronic health record (EHR). Resident physician burnout is a significant problem and is correlated with time spent using an EHR after work hours. Family physicians have the highest rate of burnout of all specialties, and the EHR is a significant contributor to this burnout. Studies have shown that increased EHR education can improve job satisfaction. Method Over 5 months, we provided weekly brief (15 minute) educational sessions covering 6 topics twice and a one-hour individualized meeting of each resident physician with an EHR trainer. We evaluated our intervention with wellness surveys and objective measures of EHR efficiency both pre and post intervention. We further evaluated efficiency by comparing pre and post-intervention values of the following: average keystrokes, mouseclicks, accelerator use, minutes per encounter and percent closed encounters at month’s end. Results Resident questionnaires showed lessons increased knowledge and intention to use EHR accelerators, but this was not statistically significant. Analysis of objective data showed most efficiency metrics worsened, though most not to a degree that was statistically significant. Residents reported subjective increases in efficiency, and paired data from wellness surveys showed an overall decrease in burnout post-intervention vs. baseline. Conclusions Much of the data in this pilot study does not reach statistical significance, but is highly suggestive that increased EHR training can improve at least perceived efficiency and thereby resident wellness.
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- 2021
15. Nationally Representative Sample Shows an Increase in Domestic Conflict Early in the COVID-19 Pandemic
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Melissa L. Finucane, Alicia Revitsky Locker, Elizabeth Roth, Katherine Grace Carman, and Joshua Breslau
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021110 strategic, defence & security studies ,Brief Report ,pandemic ,media_common.quotation_subject ,Social distance ,0211 other engineering and technologies ,Public Health, Environmental and Occupational Health ,COVID-19 ,Poison control ,Human factors and ergonomics ,02 engineering and technology ,Suicide prevention ,Occupational safety and health ,03 medical and health sciences ,0302 clinical medicine ,domestic conflict ,Injury prevention ,Pandemic ,030212 general & internal medicine ,Worry ,Psychology ,financial worry ,Demography ,media_common - Abstract
Objective:The coronavirus disease (COVID-19) pandemic and associated social distancing increased stressors related to risk for domestic conflict, but increases in domestic conflict early in the pandemic have yet to be studied in community samples.Methods:Increase in domestic conflict (verbal or physical fights) since the beginning of the pandemic was assessed in 1196 partnered and cohabitating respondents, drawn from a nationally representative sample, in May 2020. Chi-square tests and logistic regression analyses were used to estimate associations of demographic characteristics and financial worry with domestic conflict.Results:An increase in domestic conflict was reported by 10.6% (95% CI: 7.7-13.4) of the sample. Domestic conflict increase was significantly associated with younger age, lower education, and financial worry.Conclusion:Increases in domestic conflict were seen in certain vulnerable groups and in those who report financial worry. Policies ensuring financial stability, particularly early in the disaster conditions, could reduce domestic conflict during continued COVID-19 conditions or other disasters.
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- 2021
16. Associations between depression subtype and functional impairment and treatment utilization in a national sample of adolescents
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Elizabeth Roth, Rachel M. Burns, Joshua Breslau, Stephen E. Gilman, and Megan S. Schuler
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Adolescent ,Logistic regression ,Article ,Suicidal Ideation ,03 medical and health sciences ,0302 clinical medicine ,Prevalence ,Humans ,Medicine ,Child ,Major depressive episode ,Suicidal ideation ,Depression (differential diagnoses) ,Depressive Disorder, Major ,Depression ,business.industry ,Cognition ,Latent class model ,030227 psychiatry ,Psychiatry and Mental health ,Clinical Psychology ,Cross-Sectional Studies ,Treatment utilization ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Clinical psychology ,Adolescent health - Abstract
Background Prior studies have characterized distinct major depressive episode (MDE) subtypes among adults, yet limited evidence exists regarding variation in MDE during adolescence. Methods Using 2008-2016 National Survey of Drug Use and Health data, latent class analysis (LCA) was used to characterize depression subtypes (based on symptom presentation) among 9,896 youth ages 12-17 with recent first-onset MDE. Logistic regression was used to estimate associations of MDE subtype with functional outcomes and treatment utilization, adjusting for demographic characteristics and depression severity (i.e., number of MDE diagnostic criteria and recurrence status) Results A 5-class LCA model provided optimal fit. Three distinct categories of MDE symptoms generally clustered together, which we termed “somatic,” “cognitive,” and “self-worth;” classes were differentiated by distinct combinations of symptoms across these 3 categories. Subtypes were characterized as: Highly Symptomatic (39% of youth); Somatic & Cognitive (24%), Somatic (22%), Diffuse Symptoms (8%), and Somatic & Self-Worth (6%). The majority of youth reported at least moderate impairment across multiple domains; subtype was a significant predictor of functional impairment. Only 34% of youth received any past-year depression-related treatment; treatment utilization was significantly higher for MDE subtypes with the highest prevalences of suicidal ideation. Limitations Due to cross-sectional data, we cannot establish causal directionality. Conclusions Subtype was significantly predictive of functional impairment and treatment utilization, above and beyond number of MDE diagnostic criteria or recurrence status. Understanding distinct profiles of adolescent depression, as well as potential differential associations with impairment, can inform prevention, diagnosis, and treatment of depression among youth.
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- 2021
17. Racial-Ethnic Differences in Mental Health Stigma and Changes Over the Course of a Statewide Campaign
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Elizabeth Roth, Joshua Breslau, Eunice C. Wong, M. Audrey Burnam, Matthew Cefalu, Ryan K. McBain, and Rebecca L. Collins
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Adult ,Race ethnicity ,Mental health stigma ,Adolescent ,Racial Groups ,Stigma (botany) ,Hispanic or Latino ,Mental illness ,medicine.disease ,Article ,Psychiatry and Mental health ,Mental Health ,Ethnicity ,medicine ,Humans ,Racial/ethnic difference ,Psychology ,Minority Groups ,Prejudice (legal term) ,Clinical psychology - Abstract
OBJECTIVE: This study examined whether shifts in mental health-related stigma differed across racial and ethnic groups over the course of a California statewide anti-stigma campaign and whether racial and ethnic disparities were present at the beginning of the campaign and one year later. METHODS: Participants had taken part in the 2013 and 2014 California Statewide Survey (CASS), a longitudinal random-digit dialing telephone survey of California adults ages 18 years and older (N=1,285). Surveys were administered in English, Spanish, Mandarin, Cantonese, Vietnamese, Khmer, and Hmong. RESULTS: Compared to whites, Latino-Spanish and Asian non-English interview respondents who preferred to take the survey in their native language exhibited higher levels of mental health-related stigma on a number of domains at the 2013 CASS. Specifically, Latino-Spanish and Asian non-English interview respondents were more likely to report social distance, prejudice, and perceptions of dangerousness toward people with mental illness than white respondents. These racial and ethnic disparities persisted one year later at the 2014 CASS. Latino-Spanish respondents did experience significant decreases in social distance over the course of the campaign but not to a degree that eliminated disparities at the 2014 CASS. Disconcertingly, Latino-Spanish respondents experienced significant increases in perceptions of dangerousness between the 2013 and 2014 CASS. CONCLUSIONS: Future research is needed to better understand which components of anti-stigma campaigns are effective across racial and ethnic minority groups and whether more targeted efforts are needed, especially in light of the persistent and growing racial and ethnic disparities in mental health care.
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- 2021
18. V08-05 THE ANATOMIC BLADDER NECK TAILORING IN CPRE: THE PATH TO NORMAL ANATOMY
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Dana Weiss, Elizabeth Roth, Travis Groth, John Kryger, Richard Lee, Aseem Shukla, Joseph G., Michael Mitchell, and Douglas Canning
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Urology - Published
- 2022
19. MP11-12 PRENATAL DIAGNOSIS OF BLADDER AND CLOACAL EXSTROPHY OVER 20 YEARS
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Ted Lee, Dana Weiss, Elizabeth Roth, Sahar Eftekharzadeh, Saafia Masoom, Susan Jarosz, John Kryger, Aseem Shukla, Travis Groth, Michael Mitchell, Richard Lee, Douglas Canning, and Joseph Borer
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Urology - Published
- 2022
20. Key anatomic findings on fetal ultrasound and MRI in the prenatal diagnosis of bladder and cloacal exstrophy
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Aseem R. Shukla, Edward R. Oliver, Joseph G. Borer, John V. Kryger, Teresa Victoria, Elizabeth Roth, Dana A. Weiss, Travis W. Groth, Michael E. Mitchell, and Douglas A. Canning
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Urology ,030232 urology & nephrology ,Prenatal diagnosis ,Umbilical cord ,Ultrasonography, Prenatal ,Anus, Imperforate ,Abdominal wall ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Prenatal Diagnosis ,030225 pediatrics ,medicine ,Humans ,Child ,Retrospective Studies ,Omphalocele ,business.industry ,Abdominal wall defect ,Bladder Exstrophy ,Infant ,Anatomy ,medicine.disease ,Cloacal exstrophy ,Magnetic Resonance Imaging ,Bladder exstrophy ,medicine.anatomical_structure ,Pediatrics, Perinatology and Child Health ,Abdomen ,Female ,business ,Hernia, Umbilical - Abstract
Summary Introduction Prenatal determination of bladder exstrophy (BE) or cloacal exstrophy (CE), known also as the omphalocele-exstrophy-imperforate anus-spinal anomaly complex (OEIS), is challenging. Distinguishing between BE and CE is important because children with CE have many more challenges initially and during their lifetime. An accurate diagnosis is critical when counselling expectant parents. We hypothesized that there are key imaging features that can distinguish BE from CE, and that there are areas of diagnostic concordance and discordance between fetal ultrasound (fUS) and fetal MRI (fMRI) among these entities. Materials and methods We queried a single institutional IRB-approved registry of children with BE and CE to identify those with accessible fetal imaging from 2000 to 2018, and formal interpretations were collected. Two pediatric radiologists performed independent retrospective blinded review of the images. Criteria evaluated included: genitalia, kidneys, bowel appearance, presence of anal dimple, location of insertion of umbilical cord into the abdomen relative to the abdominal wall defect, umbilical vessels, bladder protuberance, presence of omphalocele, and spine/neural cord abnormalities. We evaluated concordance between radiologic interpretations and postnatal diagnosis, as well as between specific findings in the two diagnostic modalities. Results Twenty-one infants born between 2000 and 2018 with BE or CE had fetal imaging for review: 15 had both fUS and fMRI, 2 had fUS alone, and 4 fMRI alone. There was 100% concordance between fUS and fMRI in evaluating kidneys, presence of anal dimple, location of abdominal insertion of umbilical cord relative to the defect, number of umbilical vessels, and spine abnormalities/level of neural cord termination. The following discrepancies were observed: 1) genitalia and bowel appearance, and bladder protuberance in 1/15 (6.7%); 2) presence of an omphalocele in 2/15 (13.3%). Of the initial radiologic interpretations, 4/17 (23.5%) of fUS and 2/19 (10.5%) of fMRI erroneously were interpreted as on the OEIS spectrum when the post-natal diagnosis was BE. Errors in diagnosis were due to a protuberant bladder plate extending beyond the plane of the abdominal wall with bowel loops posteriorly mimicking an omphalocele. In all of these BE cases, the abdominal wall defect was located inferior to the umbilical cord insertion on the abdominal wall. Conclusion An everting bladder plate with bowel loops posterior to the plate in classic BE may be misdiagnosed as CE. Identification of the location of umbilical cord insertion relative to the abdominal wall defect, with fetal US or MRI, results in the correct differentiation between BE and CE. Download : Download high-res image (350KB) Download : Download full-size image Summary Figure . T2 sagittal images of fetal MRI (a&b) and fetal US (c&d) in a patient with BE demonstrating: a&c) insertion of umbilical cord (long arrows) superior to a defect (short arrows), b&d) protuberant bladder plate with bowel posterior to it (short arrows), (in d, abdomen and thorax highlighted by white circle, protuberance outlined in yellow, and umbilical cord highlighted in red) and e) post-natal appearance of male with BE and large protruding bladder.
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- 2020
21. Initial Experience of Pediatric Urology Consortium in Taking Care of Children with Bladder Exstrophy: the Search for the Holy Grail
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Michael E. Mitchell, Douglas A. Canning, Elizabeth Roth, Dana A. Weiss, John V. Kryger, Travis W. Groth, Joseph G. Borer, and Aseem R. Shukla
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medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,business.industry ,General surgery ,030232 urology & nephrology ,Outcome measures ,Epispadias ,Physiologic process ,Surgical correction ,medicine.disease ,Biochemistry ,Pediatric urology ,Holy Grail ,Bladder exstrophy ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,medicine ,business ,Molecular Biology - Abstract
The bladder exstrophy-epispadias complex is a very rare and complex spectrum of congenital anomalies. The holy grail of treatment for BEEC is volitional voiding with preservation of the upper tracts and patient satisfaction. The development of a collaboration can increase the exposure and experience for a panel of surgeons to better improve the care of babies with this anomaly, both in the surgical correction and in the pre- and post-operative care. The reported outcomes after exstrophy repair vary widely due to different approaches to closure as well as the variable outcome measures used to report experiences. While it is yet too soon to report on final continence outcomes, over the last 6 years, a collaboration between three institutions has increased by three-fold the experience for every individual under the guidance of an experienced coach. The treatment of patients with bladder exstrophy and epispadias is a complex anatomic and physiologic process that requires careful attention to a precise surgery while also focusing on the long-term growth of the bladder and keeping the upper tracts safe. This collaboration, which is predicated on a dedicated team with a focused target, has increased experience and exposure to exstrophy for all institutions.
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- 2020
22. Mental Health Services and Personal Recovery in California: A Population-Based Analysis
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Eunice C. Wong, Ryan K. McBain, Elizabeth Roth, Joshua Breslau, M. Audrey Burnam, Mathew S. Cefalu, and Rebecca L. Collins
- Subjects
Adult ,Male ,Mental Health Services ,medicine.medical_specialty ,Adolescent ,Social Stigma ,Stigma (botany) ,Population based ,Psychological Distress ,Article ,California ,Hope ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,medicine ,Humans ,030212 general & internal medicine ,Psychiatry ,Mental Disorders ,Life satisfaction ,Middle Aged ,Mental health treatment ,Mental health ,030227 psychiatry ,Psychiatry and Mental health ,Cross-Sectional Studies ,Mental Health Recovery ,Multivariate Analysis ,Linear Models ,Quality of Life ,Empowerment ,Female ,Psychology - Abstract
OBJECTIVE. Compared to clinical recovery measures, personal recovery measures have mostly been examined among treatment-seeking individuals enrolled in high-quality care. The authors examined whether utilization of any mental health services is associated with personal recovery in a population-based sample of adults (N=1,954) with clinically significant psychological distress. METHODS. K-6 was used to measure respondents’ level of psychological distress, alongside five dimensions of personal recovery: hope, life satisfaction, empowerment, connectedness and internalized stigma. The authors conducted multivariable linear regression analyses to examine relationships among personal recovery and treatment (none, ≤12-months prior, >12-months prior), self-reported treatment completion, provider type, and adequacy of care. RESULTS. Those who received care >12 months prior reported lower levels of hope (95%CI: −0.36, −0.06, p
- Published
- 2020
23. MP44-03 COMPARISON OF AESTHETIC PREFERENCES FOLLOWING 3 NEOUMBILICOPLASTY TECHNIQUES
- Author
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Elizabeth Roth, Dana A. Weiss, Joseph G. Borer, John V. Kryger, Susan L. Jarosz, Aseem R. Shukla, Travis W. Groth, Michael E. Mitchell, Douglas A. Canning, Jen Frazier, and Ted Lee
- Subjects
business.industry ,Aesthetics ,Urology ,Medicine ,business - Published
- 2021
24. The Transition to Telehealth during the First Months of the COVID-19 Pandemic: Evidence from a National Sample of Patients
- Author
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Lori Uscher-Pines, Joshua Breslau, Shira H. Fischer, and Elizabeth Roth
- Subjects
2019-20 coronavirus outbreak ,Telemedicine ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,MEDLINE ,Sample (statistics) ,Personal Satisfaction ,Telehealth ,Pandemic ,Internal Medicine ,Humans ,Medicine ,Pandemics ,Infection Control ,SARS-CoV-2 ,business.industry ,Remote Consultation ,COVID-19 ,Professional-Patient Relations ,Organizational Innovation ,United States ,Family medicine ,Patient Safety ,business ,Concise Research Report - Published
- 2021
25. Safety, efficacy, and tolerability of memantine for cognitive and adaptive outcome measures in adolescents and young adults with Down syndrome: a randomised, double-blind, placebo-controlled phase 2 trial
- Author
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Alberto C S Costa, Ana C Brandão, Richard Boada, Veridiana L Barrionuevo, Hudson G Taylor, Elizabeth Roth, Melissa R Stasko, Mark W Johnson, Fernanda F Assir, Maria P Roberto, Patrícia Salmona, Guilherme Abreu-Silveira, Ilya Bederman, Erin Prendergast, Anke Hüls, Sarina Abrishamcar, Zan Mustacchi, Thomas Scheidemantel, Nancy J Roizen, and Stephen Ruedrich
- Subjects
Male ,Young Adult ,Cognition ,Treatment Outcome ,Adolescent ,Double-Blind Method ,Memantine ,Humans ,Female ,Neurology (clinical) ,Down Syndrome - Abstract
Down syndrome is a chromosomal disorder with considerable neurodevelopmental impact and neurodegenerative morbidity. In a pilot trial in young adults with Down syndrome, memantine (a drug approved for Alzheimer's disease) showed a significant effect on a secondary measure of episodic memory. We aimed to test whether memantine would improve episodic memory in adolescents and young adults with Down syndrome.We did a randomised, double-blind, placebo-controlled phase 2 trial with a parallel design, stratified by age and sex. Participants (aged 15-32 years) with either trisomy 21 or complete unbalanced translocation of chromosome 21 and in general good health were recruited from the community at one site in Brazil and another in the USA. Participants were randomly assigned (1:1) to receive either memantine (20 mg/day orally) or placebo for 16 weeks. Computer-generated randomisation tables for both sites (allocating a placebo or drug label to each member of a unique pair of participants) were centrally produced by an independent statistician and were shared only with investigational pharmacists at participating sites until unblinding of the study. Participants and investigators were masked to treatment assignments. Neuropsychological assessments were done at baseline (T1) and week 16 (T2). The primary outcome measure was change from baseline to week 16 in the California Verbal Learning Test-second edition short-form (CVLT-II-sf) total free recall score, assessed in the per-protocol population (ie, participants who completed 16 weeks of treatment and had neuropsychological assessments at T1 and T2). Linear mixed effect models were fit to data from the per-protocol population. Safety and tolerability were monitored and analysed in all participants who started treatment. Steady-state concentrations in plasma of memantine were measured at the end of the trial. This study is registered at ClinicalTrials.gov, number NCT02304302.From May 13, 2015, to July 22, 2020, 185 participants with Down syndrome were assessed for eligibility and 160 (86%) were randomly assigned either memantine (n=81) or placebo (n=79). All participants received their allocated treatment. Linear mixed effect models were fit to data from 149 (81%) participants, 73 in the memantine group and 76 in the placebo group, after 11 people (eight in the memantine group and three in the placebo group) discontinued due to COVID-19 restrictions, illness of their caregiver, adverse events, or low compliance. The primary outcome measure did not differ between groups (CVLT-II-sf total free recall score, change from baseline 0·34 points [95% CI -0·98 to 1·67], p=0·61). Memantine was well tolerated, with infrequent mild-to-moderate adverse events, the most common being viral upper respiratory infection (nine [11%] participants in the memantine group and 12 [15%] in the placebo group) and transient dizziness (eight [10%] in the memantine group and six [8%] in the placebo group). No serious adverse events were observed. Amounts of memantine in plasma were substantially lower than those considered therapeutic for Alzheimer's disease.Memantine was well tolerated, but cognition-enhancing effects were not recorded with a 20 mg/day dose in adolescents and young adults with Down syndrome. Exploratory analyses point to a need for future work.Alana Foundation.For the Portuguese translation of the abstract see Supplementary Materials section.
- Published
- 2021
26. Social Marketing of Mental Health Treatment: California’s Mental Illness Stigma Reduction Campaign
- Author
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Eunice C. Wong, M. Audrey Burnam, Matthew Cefalu, Joshua Breslau, Rebecca L. Collins, and Elizabeth Roth
- Subjects
Adult ,Male ,Mental Health Services ,medicine.medical_specialty ,Social stigma ,Cross-sectional study ,Social Stigma ,MEDLINE ,Health Promotion ,AJPH Research ,03 medical and health sciences ,Surveys and Questionnaires ,medicine ,Humans ,Psychiatry ,Association (psychology) ,Aged ,Aged, 80 and over ,030505 public health ,Mental Disorders ,Public Health, Environmental and Occupational Health ,Middle Aged ,Stigma reduction ,Mental illness ,medicine.disease ,Mental health ,Social marketing ,Cross-Sectional Studies ,Social Marketing ,Female ,0305 other medical science ,Psychology ,Social Media - Abstract
Objectives. To understand the processes involved in effective social marketing of mental health treatment. Methods. California adults experiencing symptoms of probable mental illness were surveyed in 2014 and 2016 during a major stigma reduction campaign (n = 1954). Cross-sectional associations of campaign exposure with stigma, treatment overall, and 2 stages of treatment seeking (perceiving a need for treatment and use conditional on perceiving a need) were examined in covariate-adjusted multivariable regression models. Results. Campaign exposure predicted treatment use overall (odds ratio [OR] = 1.82; 95% confidence interval [CI] = 1.17, 2.83). Exposure was associated with perceived need for services (OR = 1.64; 95% CI = 1.09, 2.47) but was not significantly associated with treatment use in models conditioned on perceiving a need (OR = 1.52; 95% CI = 0.78, 2.96). Exposure was associated with less stigma, but adjustment for stigma did not affect associations between exposure and either perceived need or treatment use. Conclusions. The California campaign appears to have increased service use by leading more individuals to interpret symptoms of distress as indicating a need for treatment. Social marketing has potential for addressing underuse of mental health services and may benefit from an increased focus on perceived need.
- Published
- 2019
27. Quality Improvement Project to Improve the Timeliness of Care for Children With Testicular Torsion in the Emergency Department
- Author
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Sri S. Chinta, Matthew P. Gray, Matthew Kopetsky, Shannon H. Baumer-Mouradian, Amy L. Drendel, Elizabeth Roth, Catherine C. Ferguson, Mark Nimmer, Kevin Boyd, and David C. Brousseau
- Subjects
Building and Construction - Published
- 2022
28. High resolution structural and functional MRI of the hippocampus in young adults with Down syndrome
- Author
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Alberto C.S. Costa, Stephen Ruedrich, Melissa R. Stasko, Elizabeth Roth, Se-Hong Oh, James B. Leverenz, H. Gerry Taylor, Z. Irene Wang, and Katherine A. Koenig
- Subjects
medicine.medical_specialty ,Down syndrome ,hippocampus ,Hippocampal formation ,Grey matter ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,0302 clinical medicine ,Internal medicine ,Intellectual disability ,medicine ,Hippocampus (mythology) ,Biological Psychiatry ,030304 developmental biology ,0303 health sciences ,AcademicSubjects/SCI01870 ,business.industry ,Dentate gyrus ,functional connectivity ,Neuropsychology ,spatial memory ,medicine.disease ,Psychiatry and Mental health ,medicine.anatomical_structure ,Neurology ,Cardiology ,Original Article ,AcademicSubjects/MED00310 ,business ,Trisomy ,030217 neurology & neurosurgery ,MRI - Abstract
Down syndrome is the phenotypic consequence of trisomy 21, with clinical presentation including both neurodevelopmental and neurodegenerative components. Although the intellectual disability typically displayed by individuals with Down syndrome is generally global, it also involves disproportionate deficits in hippocampally-mediated cognitive processes. Hippocampal dysfunction may also relate to Alzheimer’s disease-type pathology, which can appear in as early as the first decade of life and becomes universal by age 40. Using 7-tesla MRI of the brain, we present an assessment of the structure and function of the hippocampus in 34 individuals with Down syndrome (mean age 24.5 years ± 6.5) and 27 age- and sex-matched typically developing healthy controls. In addition to increased whole-brain mean cortical thickness and lateral ventricle volumes (P, Graphical Abstract Graphical Abstract, Individuals with Down syndrome show distinct deficits in cognitive processes that are mediated by the hippocampus. Using high-resolution MRI, Koenig et al. find volume reductions of select hippocampal subfields and widespread changes in synchronicity of the hippocampus in individuals with Down syndrome.
- Published
- 2021
29. Sir Thopas and Sir Thomas Norny: Romance Parody in Chaucer and Dunbar
- Author
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Eddy, Elizabeth Roth
- Published
- 1971
30. The Richard Grady Monsplasty: A vertical Z-plasty technique
- Author
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John V. Kryger, Erin Steffe, Travis W. Groth, Michael E. Mitchell, Aseem R. Shukla, Joseph G. Borer, Elizabeth Roth, Dana A. Weiss, and Douglas A. Canning
- Subjects
Male ,Urology ,medicine.medical_treatment ,urologic and male genital diseases ,Introitus ,Clitoris ,Z-plasty technique ,Vulva ,Abdominal wall ,Urethra ,medicine ,Humans ,business.industry ,Bladder Exstrophy ,Anatomy ,medicine.disease ,Clitoral hood ,Bladder exstrophy ,medicine.anatomical_structure ,Z-plasty ,Labia minora ,Pediatrics, Perinatology and Child Health ,Vagina ,Female ,business - Abstract
Summary Classic bladder exstrophy in the female results in an exstrophic bladder and urethra, an anterior introitus with a bifid clitoris and short labia minora. During closure, the lower abdominal wall is closed and the bifid clitori are brought into close apposition, but are often not completely closed to prevent injury to the clitoral bodies, thus leaving a persistent gap between the clitoral bodies that grows over time. We demonstrate a vertical z plasty closure to provide a 2 layer closure of the mons that decreases tension and improves cosmetic appearance by recreating a clitoral hood that provides a more normal appearance of the external genitalia for girls with bladder exstrophy.
- Published
- 2021
31. Hippocampal subfield volume differences are independent of age in teenagers and young adults with Down syndrome
- Author
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Anne Birnbaum, Katherine A. Koenig, Melissa R. Stasko, Emma Lissemore, Se-Hong Oh, Nancy J. Roizen, Stephen Ruedrich, H. G. Taylor, James B. Leverenz, Thomas Scheidemantel, Elizabeth Roth, and Alberto C.S. Costa
- Subjects
Down syndrome ,Epidemiology ,business.industry ,Health Policy ,Anatomy ,Hippocampal formation ,medicine.disease ,Temporal lobe ,Psychiatry and Mental health ,Cellular and Molecular Neuroscience ,Developmental Neuroscience ,Neuroimaging ,medicine ,Neurology (clinical) ,Geriatrics and Gerontology ,Young adult ,business ,Volume (compression) - Published
- 2020
32. Contact With Persons With Mental Illness and Willingness to Live Next Door to Them: Two Waves of a California Survey of Adults
- Author
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Eunice C. Wong, Elizabeth Roth, Joshua Breslau, Rebecca L. Collins, M. Audrey Burnam, Amy L. Shearer, Mathew S. Cefalu, and Ryan K. McBain
- Subjects
Adult ,medicine.medical_specialty ,Mental Disorders ,Social Stigma ,Stigma (botany) ,Interpersonal communication ,Mental illness ,medicine.disease ,California ,Psychiatry and Mental health ,Surveys and Questionnaires ,Dangerous Behavior ,medicine ,Housing ,Humans ,Psychiatry ,Psychology ,Association (psychology) - Abstract
This study sought to extend findings from previous studies of the association between having had interpersonal contact with individuals with mental illness and the desire to avoid contact with them (i.e., social distance).The authors used a longitudinal design with a representative sample of 1,057 California adults who completed a survey in 2013 (wave 1) and 2014 (wave 2). Bivariable and multivariable logistic regression analyses were used to test whether demographic characteristics and changes in past-year contact with individuals with mental illness affected perceptions of the dangerousness of individuals with mental illness and willingness to move next door to someone with mental illness.An increase in contact with someone with mental illness between the two waves was associated with a decrease in unwillingness to move nearby a person with mental illness, even after the analysis accounted for contact and unwillingness at wave 1 (odds ratio [OR]=0.51, 95% confidence interval [CI]=0.31-0.84). Wave 1 beliefs that persons with mental illness are dangerous were associated with unwillingness to move nearby (OR=3.81, 95% CI=2.29-6.35) but changes in beliefs about dangerousness were not (OR=0.71, 95% CI=0.42-1.19).Increased naturally occurring contact with individuals with mental illness appears to decrease unwillingness to move near a person with mental illness for as long as 1 year after the contact. Housing and services that aim to integrate individuals with mental illness into the community should consider strategies that include contact with individuals with mental illness to counter community opposition.
- Published
- 2020
33. Bilateral ureteral reimplantation at complete primary repair of exstrophy: Post-operative outcomes
- Author
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Susan L. Jarosz, Elizabeth Roth, Joseph G. Borer, Ted Lee, Travis W. Groth, John Weaver, Michael E. Mitchell, Dana A. Weiss, Douglas A. Canning, John V. Kryger, and Aseem R. Shukla
- Subjects
medicine.medical_specialty ,Univariate analysis ,Randomization ,business.industry ,Urology ,Medical record ,Reflux ,urologic and male genital diseases ,medicine.disease ,Vesicoureteral reflux ,Surgery ,Bladder exstrophy ,Pediatrics, Perinatology and Child Health ,Cohort ,Recurrent pyelonephritis ,medicine ,business - Abstract
Extended Summary Background and Study Objective The value of bilateral ureteral reimplant (BUR) at the time of complete primary repair of bladder exstrophy (CPRE) has been suggested, however, outcomes are poorly characterized in current medical literature. We hypothesize that BUR at time of CPRE will decrease the rate of recurrent pyelonephritis, post-operative vesicoureteral reflux (VUR), and the need for subsequent ureteral surgery. Study Design We analyzed 64 consecutive patients with a diagnosis of classic bladder exstrophy (BE) who underwent CPRE at three institutions from 2013 to 2019. 15 patients underwent cephalotrigonal BUR-CPRE and 49 patients underwent CPRE alone. Our primary outcome was >1 episode of pyelonephritis as documented in the medical record. Secondary outcomes were persistent vesicoureteral reflux (VUR), with a sub-analysis of number of refluxing renal units and presence of dilating VUR, and the need for subsequent ureteral surgery. Descriptive statistics in addition to standard, two tailed univariate statistics, were used to compare the groups where appropriate. Results BUR-CPRE was associated with a significant decrease in the rates of post-operative VUR, number of refluxing renal units, and need for subsequent ureteral surgery (p=0.002, p=0.001, and p=0.048 respectively). There was a reduction in the rates of recurrent pyelonephritis and dilating reflux in patients undergoing BUR-CPRE, though it did not reach significance. Female gender was significantly associated with recurrent pyelonephritis regardless of BUR-CPRE status (p=0.005). There were no reports of distal ureteral obstruction or other complications following BUR-CPRE. The mean post-operative follow up for the BUR-CPRE group was 46.33 (10.26) months vs. 53.76 (26.05) months for CPRE, (p=0.11). Discussion Recurrent pyelonephritis following bladder closure in patients with BE is a well-documented surgical complication, with centers performing CPRE reporting rates of post-operative pyelonephritis from 22 to 50%. Our series demonstrates similar efficacy of BUR-CPRE compared to other contemporary series and provides additional detail about need for subsequent ureteral surgeries and increased long term follow-up of these complex patients. Limitations of the study include male predominance of the cohort and lack of randomization of BUR-CPRE. Conclusions BUR-CPRE decreases postoperative VUR and the need for additional ureteral surgery in select BE patients; it should be considered when technically feasible. While results continue to suggest a trend toward decreased recurrent pyelonephritis and dilating reflux, further longitudinal follow-up in our cohort will be needed.
- Published
- 2022
34. Opioid prescribing is excessive and variable after pediatric ambulatory urologic surgery
- Author
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Muzi Lin, Samir K. Gadepalli, Ted Lee, Jennifer F. Waljee, Elizabeth Roth, Lauren E. Corona, Angela Thao, Courtney S. Streur, and Calista M. Harbaugh
- Subjects
Male ,medicine.medical_specialty ,Narcotic ,medicine.medical_treatment ,Urology ,030232 urology & nephrology ,Drug Prescriptions ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,medicine ,Humans ,Orchiopexy ,Hernia ,Medical prescription ,Practice Patterns, Physicians' ,Child ,Retrospective Studies ,Pain, Postoperative ,business.industry ,Infant, Newborn ,Infant ,Ambulatory Surgical Procedure ,medicine.disease ,Pediatric urology ,Analgesics, Opioid ,Opioid ,Ambulatory Surgical Procedures ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Ambulatory ,Emergency medicine ,Female ,business ,medicine.drug - Abstract
Acute pain after surgery is one of the most frequent indications for opioid prescribing in children. Opioids are often not stored or disposed of safely after their use, placing children and others in the home at risk for accidental ingestion or intentional misuse. We currently lack evidence-based guidelines for post-operative pain management after common ambulatory pediatric urologic procedures. Thus, each surgeon must decide if and how much opioid to prescribe based on his/her own assumptions of perceived post-operative pain.As part of an effort to establish opioid prescribing guidelines across two academic centers, the objectives of this study were to evaluate current variability in pediatric urologists' opioid prescribing factors and identify patients at greatest risk of being prescribed high doses of opioids after common ambulatory pediatric urologic procedures.We retrospectively evaluated post-operative opioid prescribing patterns after common ambulatory pediatric urology procedures (circumcision, orchiopexy, and hernia/hydrocele) at two major children's hospitals. Specifically, we evaluated if and how much opioid was prescribed for all children (18 years or younger) between 2016 and 2017. Bivariate analysis was performed using Kruskal-Wallis Test and Wilcoxon Rank Sum. Multivariable logistic regression was performed to determine patient, surgeon, and procedural factors that predicted the prescription of a high dose of opioids (greater than the median number of doses prescribed for that procedure).Over the two-year period, 811 circumcisions and 883 inguinal surgeries (inguinal orchiopexy and hernia/hydrocele) were performed. 94% of patients undergoing circumcision and 97% of those undergoing inguinal surgery were prescribed opioid analgesia. The median number of doses prescribed for circumcision was 20; for inguinal surgeries, 23.75% of patients received 15 opioid doses or more. Patients ages 0-2 years, who represented the largest age group (41% of all patients), received significantly more opioid doses than all other age groups, followed by those10 years (p 0.01). There was significant variation in opioid prescribing patterns by provider (p 0.01) (Figure 1) On multivariable logistic regression, younger age, pill form, and earlier year were all associated with a greater number of opioid doses prescribed for all surgeries.Across two institutions without a formal post-operative opioid prescribing policy for ambulatory pediatric urologic procedures, we observed considerable variability in provider prescribing patterns, with nearly all patients receiving an opioid, and those 0-2 years receiving the highest number of doses. This highlights the need for evidence-based guidelines for post-operative pain management after ambulatory pediatric urologic surgeries.
- Published
- 2020
35. Long-Term Neurodevelopmental and Functional Outcomes of Normally Developing Children Requiring PICU Care for Bronchiolitis
- Author
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Deanne Wilson-Costello, Elizabeth Pace, Elizabeth Roth, Katherine Slain, and Steven L. Shein
- Subjects
Mechanical ventilation ,Pediatric intensive care unit ,Pediatrics ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Critical Care and Intensive Care Medicine ,medicine.disease_cause ,medicine.disease ,Bayley Scales of Infant Development ,Post-intensive care syndrome ,03 medical and health sciences ,0302 clinical medicine ,Bronchiolitis ,030225 pediatrics ,Pediatrics, Perinatology and Child Health ,Medicine ,Computerized adaptive testing ,Toddler ,business ,Nasal cannula ,030217 neurology & neurosurgery - Abstract
Bronchiolitis is a common pediatric intensive care unit (PICU) illness and often affects generally healthy children, making it a promising disease in which to study long-term neurodevelopmental outcomes. We previously found that approximately 15% of critical bronchiolitis patients have evidence of post-PICU morbidity using coarse definitions available in administrative data sets. In this study, we measured neurodevelopmental outcomes using four more precise tools. Children who had previously been admitted to our PICU with bronchiolitis were included; those with evidence of developmental delay at PICU admission were excluded. Approximately 1 to 2 years after PICU discharge, the parent of each subject completed two questionnaires (Ages and Stages Questionnaire and Pediatric Evaluation of Disability Inventory Computer Adaptive Test). Each subject also underwent two in-person assessments administered by a certified examiner (Bayley Scales of Infant and Toddler Development, 3rd edition, and the Amiel-Tison neurological assessment). For each domain of each test, a score of > 1 standard deviation below the norm for the subject's age defined “moderate” disability and a score ≥ 2 standard deviations below the norm defined “severe” disability. Eighteen subjects (median ages of 3.7 months at PICU admission and 2.3 years at testing) were enrolled, 17 of whom were supported by high-flow nasal cannula and/or mechanical ventilation. Fifteen children (83%) scored abnormally on ≥ 1test. Eight children (44%) had disabilities in ≥ 3 domains and/or ≥ 1 severe disability identified. Our findings that motor, language, and cognitive disabilities are commonly observed months to years after critical bronchiolitis require larger studies to confirm this finding, assess causality, and identify modifiable risk factors.
- Published
- 2020
36. State medical marijuana laws, cannabis use and cannabis use disorder among adults with elevated psychological distress
- Author
-
Matthew Cefalu, Eunice C. Wong, Amy L. Shearer, Ryan K. McBain, Elizabeth Roth, M. Audrey Burnam, Joshua Breslau, and Rebecca L. Collins
- Subjects
Drug ,Adult ,Male ,Marijuana Abuse ,Adolescent ,Substance-Related Disorders ,media_common.quotation_subject ,Marijuana Smoking ,Medical Marijuana ,Toxicology ,Logistic regression ,Psychological Distress ,Article ,Odds ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Prevalence ,Medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,media_common ,Cannabis ,Pharmacology ,biology ,business.industry ,Psychological distress ,Cannabis use ,Middle Aged ,biology.organism_classification ,Mental health ,United States ,Psychiatry and Mental health ,Distress ,Law ,Hallucinogens ,Female ,business ,030217 neurology & neurosurgery - Abstract
Background Cannabis use and cannabis use disorder are more prevalent in U.S. states with medical marijuana laws (MMLs), as well as among individuals with elevated psychological distress. We investigated whether adults with moderate and serious psychological distress experienced greater levels of cannabis use and/or disorder in states with MMLs compared to states without MMLs. Methods National Survey of Drug Use and Health data (2013–2017) were used to compare past-month cannabis use, daily cannabis use, and cannabis use disorder prevalence among adults with moderate and serious psychological distress in states with versus without MMLs. We executed pooled multivariable logistic regression analyses to test main effects of distress, MMLs and their interaction, after adjustment. Results Compared to states without MMLs, states with MMLs had higher adjusted prevalence of past-month use (11.1 % vs. 6.8 %), daily use (4.0 % vs. 2.2 %), and disorder (1.7 % vs. 1.2 %). Adults with moderate and serious psychological distress had greater adjusted odds of any use (AORs of 1.72 and 2.22, respectively) and of disorder (AORs of 2.17 and 2.94, respectively), compared to those with no/mild distress. We did not find evidence of an interaction between MMLs and distress category for any outcome. Conclusions Associations between elevated distress and cannabis use patterns are no greater in states with MML. However, cannabis use is more prevalent in MML states. Thus, higher base rates of cannabis use and disorder among adults with elevated distress are proportionally magnified in these states.
- Published
- 2020
37. A longitudinal study of psychological distress in the United States before and during the COVID-19 pandemic
- Author
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Melissa L. Finucane, Matthew D. Baird, Rebecca L. Collins, Joshua Breslau, Alicia Revitsky Locker, and Elizabeth Roth
- Subjects
Adult ,Male ,Longitudinal study ,medicine.medical_specialty ,Time Factors ,Epidemiology ,media_common.quotation_subject ,Logistic regression ,Psychological Distress ,01 natural sciences ,Recession ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Surveys and Questionnaires ,Pandemic ,Medicine ,Humans ,030212 general & internal medicine ,Longitudinal Studies ,0101 mathematics ,Young adult ,Pandemics ,media_common ,Aged ,Aged, 80 and over ,business.industry ,SARS-CoV-2 ,Mental Disorders ,010102 general mathematics ,Public Health, Environmental and Occupational Health ,COVID-19 ,Middle Aged ,Mental health ,United States ,Distress ,Female ,business ,Stress, Psychological ,Demography - Abstract
The COVID-19 pandemic has caused financial stress and disrupted daily life more quickly than any prior economic downturn and on a scale beyond any prior natural disaster. This study aimed to assess the impact of the pandemic on psychological distress and identify vulnerable groups using longitudinal data to account for pre-pandemic mental health status. Clinically significant psychological distress was assessed with the Kessler-6 in a national probability sample of adults in the United States at two time points, February 2019 (T1) and May 2020 (T2). To identify increases in distress, psychological distress during the worst month of the past year at T1 was compared with psychological distress over the past 30-days at T2. Survey adjusted logistic regression was used to estimate associations of demographic characteristics at T1 (gender, age, race, and income) and census region at T2 with within-person increases in psychological distress. The past-month prevalence of serious psychological distress at T2 was as high as the past-year prevalence at T1 (10.9% vs. 10.2%). Psychological distress was strongly associated across assessments (X2(4) = 174.6, p
- Published
- 2020
38. A randomised test of the effect of medical v. lay idiom on assessment of perceived mental health condition in the USA
- Author
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M.A. Burnam, Ryan K. McBain, Eunice C. Wong, Elizabeth Roth, Rebecca L. Collins, Matthew Cefalu, and Joshua Breslau
- Subjects
Adult ,Male ,Mental Health Services ,medicine.medical_specialty ,Epidemiology ,Population ,Ethnic group ,Affect (psychology) ,Odds ,Mental health service ,Young Adult ,idiom of distress ,medicine ,Humans ,education ,methodological experiment ,Aged ,education.field_of_study ,Mental Disorders ,Public Health, Environmental and Occupational Health ,Middle Aged ,Mental health ,United States ,Test (assessment) ,Psychiatry and Mental health ,Mental Health ,Outcome and Process Assessment, Health Care ,Original Article ,Female ,Perception ,Psychology ,Clinical psychology - Abstract
Aims To test the impact of using different idioms in epidemiological interviews on the prevalence and correlates of poor mental health and mental health service use. Methods We conducted a randomised methodological experiment in a nationally representative sample of the US adult population, comparing a lay idiom, which asked about ‘problems with your emotions or nerves’ with a more medical idiom, which asked about ‘problems with your mental health’. Differences across study arms in the associations of endorsement of problems with the Kessler-6 (a validated assessment of psychological distress), demographic characteristics, self-rated health and mental health service use were examined. Results Respondents were about half as likely to endorse a problem when asked with the more medical idiom (18.1%) than when asked with the lay idiom (35.1%). The medical idiom had a significantly larger area under the ROC curve when compared against a validated measure of psychological distress than the lay idiom (0.91 v. 0.87, p = 0.012). The proportion of the population who endorsed a problem but did not receive treatment in the past year was less than half as large for the medical idiom (7.90%) than for the lay idiom (20.94%). Endorsement of problems differed in its associations with age, sex, race/ethnicity and self-rated health depending on the question idiom. For instance, the odds of endorsing problems were threefold higher in the youngest than the oldest age group when the medical idiom was used (OR = 3.07; 95% CI 1.47–6.41) but did not differ across age groups when the lay idiom was used (OR = 0.76; 95% CI 0.43–1.36). Conclusion Choice of idiom in epidemiological questionnaires can affect the apparent correlates of poor mental health and service use. Cultural change within populations over time may require changes in instrument wording to maintain consistency in epidemiological measurement of psychiatric conditions.
- Published
- 2020
39. Women’s Afternoon: What the Congressional Record Can—and Cannot—Tell us about the Meaning of 'Sex' Under Title VII
- Author
-
Elizabeth Roth
- Subjects
civil rights legislation ,Title VII ,Law ,Political science ,Legislative history ,Sexual orientation ,sex ,Legislation ,Narrative ,Meaning (existential) ,Construct (philosophy) ,Congressional Record ,Supreme court - Abstract
Author(s): Roth, Elizabeth | Abstract: Editors’ NoteThis essay reviews the Congressional debate surrounding the addition of the term “sex” to Title VII of the Civil Rights Act of 1964. We included this essay because it serves as a reminder that the narratives we construct regarding legal and legislative history are often at risk of oversimplification. As the Justices of the Supreme Court deliberate and consider recent oral arguments regarding whether the term “sex” extends legal protections to persons on the basis of sexual orientation or gender identity, the Congressional Record from February 8, 1964 suggests one lesson: There are limits to relying on historical dialogues that exclude or mock marginalized voices. That is, if many of the proclaimed supporters of an amendment advancing women’s equality supported it solely to undermine the passage of civil rights legislation, how instructive can it be to speculate about what they intended by the term “sex”? While this essay does not answer this question, it suggests that the sincere supporters of the amendment—and even those opposed to it on the grounds it would impede passage of the legislation—were fundamentally concerned with advancing equality for any and all groups who had faced discrimination.
- Published
- 2020
40. 2 Improving the timeliness of care for children with testicular torsion in the pediatric emergency department
- Author
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Matthew Gray, Elizabeth Roth, David C. Brousseau, Amy L. Drendel, Matthew Kopetsky, Kevin P. Boyd, Sri S. Chinta, Catherine C. Ferguson, and Shannon H. Baumer-Mouradian
- Subjects
medicine.medical_specialty ,Quality management ,business.industry ,Psychological intervention ,Testicular pain ,Guideline ,Emergency department ,medicine.disease ,Documentation ,Emergency medicine ,Health care ,medicine ,Testicular torsion ,medicine.symptom ,business - Abstract
Background Early diagnosis and timely surgery are critical to treat children with testicular torsion. Only 33% of patients met the hospital goal of ‘critical diagnosis to operating room time of 60 minutes or less [CDOR60]’ prior to starting the QI project. Objectives The objective of the quality improvement project was to increase the utilization of TWIST score, a validated clinical scoring system from 0% to 80% over 12 months period for children evaluated for testicular torsion, as a means of increasing the number of patients with CDOR60. Methods Deploying the Institute for Healthcare Improvement Model for Improvement, we formulated an aim statement and identified key drivers. Of our interventions, successful implementation of the TWIST score in the emergency department (ED), with a guideline to support earlier notification of urology for high risk patients with testicular pain, was determined to be the highest impact intervention. We educated providers and gave biweekly feedback about guideline adherence, created order panels and documentation tabs in our electronic medical record to encourage documentation. Results Between September 2018 and April 2019, TWIST score documentation improved to >80% and was sustained at that rate for 4 months. After implementation of the guideline, the critical diagnosis to OR time of 60 minutes or less was achieved in 12 out of 16 patients diagnosed with testicular torsion in the ED [75%] compared to our baseline of 33%. Conclusions A quality improvement project to improve the timeliness of care for children with testicular torsion resulted in delivery of expedited surgical care for these patients.
- Published
- 2019
41. Antibiotic Prophylaxis with Trimethoprim-Sulfamethoxazole versus No Treatment after Mid-to-Distal Hypospadias Repair: A Prospective, Randomized Study
- Author
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Charles T. Durkee, Ruth M. Swedler, Travis W. Groth, John V. Kryger, Elizabeth Roth, and Melissa Lingongo
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medicine.medical_specialty ,Article Subject ,Urology ,Urinary system ,030232 urology & nephrology ,Bacteriuria ,lcsh:RC870-923 ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,medicine ,Antibiotic prophylaxis ,business.industry ,Sulfamethoxazole ,Obstetrics and Gynecology ,lcsh:Diseases of the genitourinary system. Urology ,medicine.disease ,Trimethoprim ,Pyuria ,Surgery ,Hypospadias ,030220 oncology & carcinogenesis ,medicine.symptom ,business ,medicine.drug - Abstract
Purpose. To evaluate the impact of prophylactic antibiotics after distal hypospadias repair on postoperative bacteriuria, symptomatic urinary tract infection, and postoperative complications in a prospective, randomized trial. Materials and Methods. Consecutive patients aged 6 months to 2 years were enrolled at our institution between June 2013 and May 2017. Consenting patients were randomized to antibiotic prophylaxis with trimethoprim-sulfamethoxazole versus no antibiotic. Patients had catheterized urine samples obtained at surgery and 6–10 days postoperatively. The primary outcome was bacteriuria and pyuria at postoperative urine collection. Secondary outcomes included symptomatic urinary tract infection and postoperative complications. Results. 70 patients consented to the study, of which 35 were randomized to receive antibiotics compared to 32 who did not. Demographics, severity of hypospadias, and type of repair were similar between the groups. Patients in the treatment group had significantly less pyuria (18%) and bacteriuria (11%) present at stent removal compared to the nontreatment group (55% and 63%; p=0.01 and p<0.001, resp.). No patient had a symptomatic urinary tract infection. There were 11 postoperative complications. Conclusions. Routine antibiotic prophylaxis appears to significantly decrease bacteriuria and pyuria in the immediate postoperative period; however, no difference was observed in symptomatic urinary tract infection or postoperative complications. Clinical Trial Registration Number NCT02593903.
- Published
- 2018
42. Assessment of Patient Preferences for Telehealth in Post–COVID-19 Pandemic Health Care
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Lori Uscher-Pines, Elizabeth Roth, Joshua Breslau, Zachary Predmore, and Shira H. Fischer
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Adult ,Male ,medicine.medical_specialty ,MEDLINE ,Sample (statistics) ,Telehealth ,Surveys and Questionnaires ,Pandemic ,Health care ,medicine ,Humans ,Pandemics ,health care economics and organizations ,Original Investigation ,SARS-CoV-2 ,business.industry ,Research ,Health Policy ,Public health ,COVID-19 ,Patient Preference ,General Medicine ,Middle Aged ,Patient preference ,Telemedicine ,United States ,Preference ,Online Only ,Family medicine ,Videoconferencing ,Female ,business ,Delivery of Health Care - Abstract
This survey study assesses the factors associated with continued use of telehealth services, including experience with, cost of, and benefits or barriers to video-based clinician visits among adult patients., Key Points Question What role do US adults envision for telehealth in their future medical care? Findings In this survey study of 2080 adults, most respondents were willing to use video visits in the future but, when presented with the choice between an in-person or a video visit for nonemergency care, most preferred in-person care. Willingness to pay for preferred visit modality was higher for those who preferred in-person care, and those who preferred video visits were more sensitive to out-of-pocket cost. Meaning The findings of this study suggest that awareness of patient preferences will help define telehealth’s role in US health care after the COVID-19 pandemic., Importance Telehealth use greatly increased in 2020 during the first year of the COVID-19 pandemic. Patient preferences for telehealth or in-person care are an important factor in defining the role of telehealth in the postpandemic world. Objective To ascertain patient preferences for video visits after the ongoing COVID-19 public health emergency and to identify patient perceptions of the value of video visits and the role of out-of-pocket cost in changing patient preference for each visit modality. Design, Setting, and Participants This survey study was conducted using a nationally representative sample of adult members of the RAND American Life Panel. The data were obtained from the American Life Panel Omnibus Survey, which was fielded between March 8 and 19, 2021. Main Outcomes and Measures Preferences for video visits vs in-person care were analyzed in the survey. The first question was about participants’ baseline preference for an in-person or a video visit for a nonemergency health issue. The second question entailed choosing between the preferred visit modality with a cost of $30 and another modality with a cost of $10. Questions also involved demographic characteristics, experience with video visits, willingness to use video visits, and preferences for the amount of telehealth use after the COVID-19 pandemic. Results A total of 2080 of 3391 sampled panel members completed the survey (participation rate, 61.3%). Participants in the weighted sample had a mean (SE) age of 51.1 (0.67) years and were primarily women (1079 [51.9%]). Most participants (66.5%) preferred at least some video visits in the future, but when faced with a choice between an in-person or a video visit for a health care encounter that could be conducted either way, more than half of respondents (53.0%) preferred an in-person visit. Among those who initially preferred an in-person visit when out-of-pocket costs were not a factor, 49.8% still preferred in-person care and 23.5% switched to a video visit when confronted with higher relative costs for in-person care. In contrast, among those who initially preferred a video visit, only 18.9% still preferred a video visit and 61.7% switched to in-person visit when confronted with higher relative costs for video visits. Conclusions and Relevance This survey study found that participants were generally willing to use video visits but preferred in-person care, and those who preferred video visits were more sensitive to paying out-of-pocket cost. These results suggest that understanding patient preferences will help identify telehealth’s role in future health care delivery.
- Published
- 2021
43. Efficacy of targeted muscle reinnervation is directly affected by timing of intervention in a neuropathic pain model
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Gwendolyn M. Hoben, Elizabeth Roth, Quinn H. Hogan, and Cheryl L. Stucky
- Subjects
medicine.medical_specialty ,SNi ,business.industry ,Hand surgery ,Limb amputation ,Neuroma ,medicine.disease ,Plastic surgery ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Neurology ,Anesthesia ,Intervention (counseling) ,Neuropathic pain ,Medicine ,Neurology (clinical) ,business ,Reinnervation - Abstract
Purpose Targeted muscle reinnervation (TMR) coapts amputated nerves to small motor nerves to power a prosthetic limb. Additionally, clinical studies have shown TMR performed within 3 months of major limb amputation prevents or reduces phantom and residual limb pain. However, TMR delayed over 3 months is much less effective. We have previously shown that TMR performed 3 weeks following SNI returned pain behaviors to baseline. This study examined the effect of TMR performed at the time of TMR versus a delay of 12 weeks following SNI to determine whether this model reflects clinical findings. SNI was performed in male rats and interventions were applied at the time of SNI, 3 weeks, and 12 weeks following SNI. Pain behaviors were assessed with von Frey threshold, pin testing, dynamic brush testing and acetone testing prior to intervention and at 1, 3, 6, and 12 weeks following intervention. Simple neuroma excision (NE) was used as a control intervention. TMR performed immediately at the time of SNI prevented the development of a pain phenotype. Animals tested 3 and 12 weeks following SNI showed a robust pain phenotype: increased hyperalgesic responses, reduced Von Frey thresholds, and increased cold sensitivity. TMR at 3 weeks following SNI successfully reversed the pain behaviors to baseline. In contrast, if TMR or NE was delayed 12 weeks after SNI, the pain behaviors persisted. The neuropathic pain phenotype generated by SNI can be treated with TMR performed immediately and 3 weeks following development of a pain phenotype. In contrast, delayed TMR provides no relief of pain behaviors. This model closely corresponds to clinical experience in patients with limb amputation and will facilitate further understanding of the mechanisms behind TMR and how the intervention may be modified to help chronic amputation-related pain. Medical College of Wisconsin Neurosciences Research Center Plastic Surgery Foundation- American Association for Hand Surgery Pilot Grant 628811.
- Published
- 2021
44. V09-09 THE RICHARD GRADY MONSPLASTY
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Michael E. Mitchell, Douglas A. Canning, Joseph G. Borer, Aseem R. Shukla, Erin Steffe, John V. Kryger, Groth Travis, Elizabeth Roth, and Dana A. Weiss
- Subjects
business.industry ,Urology ,Closure (topology) ,Bifid clitoris ,Anatomy ,urologic and male genital diseases ,medicine.disease ,female genital diseases and pregnancy complications ,Introitus ,Z-plasty technique ,Bladder exstrophy ,medicine.anatomical_structure ,Urethra ,Labia minora ,Medicine ,business - Abstract
INTRODUCTION AND OBJECTIVE:Classic bladder exstrophy in the female results in an exstrophic bladder and urethra, an anterior introitus with a bifid clitoris, and short labia minora. During closure,...
- Published
- 2020
45. What intravaginal treatments during or after an episode of acute bacterial vaginosis decrease this risk of recurrence?
- Author
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Puja Samudra, Elizabeth Roth, Cathy Bryant, and Heidi Harris
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Fundamentals and skills ,Bacterial vaginosis ,medicine.disease ,business - Published
- 2020
46. Stories of Exploration in a Student-Centered Learning Environment
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Nicole Elizabeth Roth
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Class (computer programming) ,Visual Arts and Performing Arts ,Learning environment ,media_common.quotation_subject ,Student centered ,Creativity ,Experiential learning ,Visual arts education ,Education ,White paper ,Mathematics education ,Psychology ,Discovery learning ,media_common - Abstract
Sometimes in art class it's like the same thing, you're using crayons or markers to color on regular white paper. I liked this project because it was different. You could paint on the cardboard, or...
- Published
- 2016
47. Behavior Profiles at 2 Years for Children Born Extremely Preterm with Bronchopulmonary Dysplasia
- Author
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Jane E. Brumbaugh, Edward F. Bell, Scott F. Grey, Sara B. DeMauro, Betty R. Vohr, Heidi M. Harmon, Carla M. Bann, Matthew A. Rysavy, J. Wells Logan, Tarah T. Colaizy, Myriam A. Peralta-Carcelen, Elisabeth C. McGowan, Andrea F. Duncan, Barbara J. Stoll, Abhik Das, Susan R. Hintz, Michael S. Caplan, Richard A. Polin, Abbot R. Laptook, Martin Keszler, Angelita M. Hensman, Elisa Vieira, Emilee Little, Robert T. Burke, Bonnie E. Stephens, Barbara Alksninis, Carmena Bishop, Mary L. Keszler, Teresa M. Leach, Victoria E. Watson, Andrea M. Knoll, Michele C. Walsh, Avroy A. Fanaroff, Nancy S. Newman, Deanne E. Wilson-Costello, Allison Payne, Monika Bhola, Gulgun Yalcinkaya, Bonnie S. Siner, Harriet G. Friedman, Elizabeth Roth, William E. Truog, Eugenia K. Pallotto, Howard W. Kilbride, Cheri Gauldin, Anne Holmes, Kathy Johnson, Allison Knutson, Kurt Schibler, Brenda B. Poindexter, Stephanie Merhar, Kimberly Yolton, Teresa L. Gratton, Cathy Grisby, Kristin Kirker, Sandra Wuertz, David P. Carlton, Ira Adams-Chapman, Ellen C. Hale, Yvonne C. Loggins, Diane I. Bottcher, Colleen Mackie, Sheena L. Carter, Maureen Mulligan LaRossa, Lynn C. Wineski, Gloria V. Smikle, Angela Leon-Hernandez, Salathiel Kendrick-Allwood, C. Michael Cotten, Ronald N. Goldberg, Ricki F. Goldstein, William F. Malcolm, Patricia L. Ashley, Joanne Finkle, Kimberley A. Fisher, Sandra Grimes, Kathryn E. Gustafson, Matthew M. Laughon, Carl L. Bose, Janice Bernhardt, Gennie Bose, Diane Warner, Janice Wereszczak, Stephen D. Kicklighter, Ginger Rhodes-Ryan, Rosemary D. Higgins, Stephanie Wilson Archer, Gregory M. Sokol, Lu Ann Papile, Abbey C. Hines, Dianne E. Herron, Susan Gunn, Lucy Smiley, Kathleen A. Kennedy, Jon E. Tyson, Julie Arldt-McAlister, Katrina Burson, Allison G. Dempsey, Patricia W. Evans, Carmen Garcia, Margarita Jiminez, Janice John, Patrick M. Jones, M. Layne Lillie, Karen Martin, Sara C. Martin, Georgia E. McDavid, Shawna Rodgers, Saba Khan Siddiki, Daniel Sperry, Patti L. Pierce Tate, Sharon L. Wright, Pablo J. Sánchez, Leif D. Nelin, Sudarshan R. Jadcherla, Patricia Luzader, Christine A. Fortney, Gail E. Besner, Nehal A. Parikh, Dennis Wallace, Marie G. Gantz, Jamie E. Newman, Jeanette O'Donnell Auman, Margaret Crawford, Jenna Gabrio, David Leblond, Carolyn M. Petrie Huitema, Kristin M. Zaterka-Baxter, Krisa P. Van Meurs, Valerie Y. Chock, David K. Stevenson, Marian M. Adams, M. Bethany Ball, Barbara Bentley, Maria Elena DeAnda, Anne M. Debattista, Beth Earhart, Lynne C. Huffman, Magdy Ismael, Casey E. Krueger, Andrew W. Palmquist, Melinda S. Proud, Elizabeth N. Reichert, Meera N. Sankar, Nicholas H. St. John, Heather L. Taylor, Hali E. Weiss, Ivan D. Frantz, John M. Fiascone, Brenda L. MacKinnon, Ellen Nylen, Anne Furey, Cecelia E. Sibley, Ana K. Brussa, Waldemar A. Carlo, Namasivayam Ambalavanan, Kirstin J. Bailey, Fred J. Biasini, Monica V. Collins, Shirley S. Cosby, Vivien A. Phillips, Richard V. Rector, Sally Whitley, Uday Devaskar, Meena Garg, Isabell B. Purdy, Teresa Chanlaw, Rachel Geller, Neil N. Finer, Yvonne E. Vaucher, David Kaegi, Maynard R. Rasmussen, Kathy Arnell, Clarence Demetrio, Martha G. Fuller, Wade Rich, Radmila West, Michelle L. Baack, Dan L. Ellsbury, Laurie A. Hogden, Jonathan M. Klein, John M. Dagle, Karen J. Johnson, Tracy L. Tud, Chelsey Elenkiwich, Megan M. Henning, Megan Broadbent, Mendi L. Schmelzel, Jacky R. Walker, Claire A. Goeke, Kristi L. Watterberg, Robin K. Ohls, Conra Backstrom Lacy, Sandra Brown, Janell Fuller, Carol Hartenberger, Jean R. Lowe, Sandra Sundquist Beauman, Mary Ruffner Hanson, Tara Dupont, Elizabeth Kuan, Barbara Schmidt, Haresh Kirpalani, Aasma S. Chaudhary, Soraya Abbasi, Toni Mancini, Dara M. Cucinotta, Judy C. Bernbaum, Marsha Gerdes, Hallam Hurt, Carl T. D'Angio, Ronnie Guillet, Gary J. Myers, Satyan Lakshminrusimha, Anne Marie Reynolds, Michelle E. Hartley-McAndrew, Holly I.M. Wadkins, Michael G. Sacilowski, Linda J. Reubens, Rosemary L. Jensen, Joan Merzbach, William Zorn, Osman Farooq, Deanna Maffett, Ashley Williams, Julianne Hunn, Stephanie Guilford, Kelley Yost, Mary Rowan, Diane M. Prinzing, Karen Wynn, Cait Fallone, Ann Marie Scorsone, Myra H. Wyckoff, Luc P. Brion, Roy J. Heyne, Diana M. Vasil, Sally S. Adams, Lijun Chen, Maria M. De Leon, Frances Eubanks, Alicia Guzman, Elizabeth T. Heyne, Linda A. Madden, Nancy A. Miller, Lizette E. Lee, Lara Pavageau, Pollieanna Sepulveda, Cathy Twell Boatman, Roger G. Faix, Bradley A. Yoder, Mariana Baserga, Karen A. Osborne, Shawna Baker, Karie Bird, Jill Burnett, Susan Christensen, Brandy Davis, Jennifer O. Elmont, Jennifer J. Jensen, Manndi C. Loertscher, Trisha Marchant, Earl Maxson, Stephen D. Minton, D. Melody Parry, Carrie A. Rau, Susan T. Schaefer, Mark J. Sheffield, Cynthia Spencer, Mike Steffen, Kimberlee Weaver-Lewis, Sarah Winter, Kathryn D. Woodbury, Karen Zanetti, Seetha Shankaran, Sanjay Chawla, Beena G. Sood, Athina Pappas, Girija Natarajan, Monika Bajaj, Rebecca Bara, Mary E. Johnson, Laura Goldston, Stephanie A. Wiggins, Mary K. Christensen, Martha Carlson, John Barks, Diane F. White, Richard A. Ehrenkranz, Harris Jacobs, Christine G. Butler, Patricia Cervone, Sheila Greisman, Monica Konstantino, JoAnn Poulsen, Janet Taft, and Elaine Romano
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,CBCL ,behavioral disciplines and activities ,Language Development ,Severity of Illness Index ,03 medical and health sciences ,0302 clinical medicine ,Cognition ,030225 pediatrics ,mental disorders ,Medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Child Behavior Checklist ,Motor skill ,Bronchopulmonary Dysplasia ,Problem Behavior ,business.industry ,Confounding ,Postmenstrual Age ,Infant, Newborn ,medicine.disease ,Bronchopulmonary dysplasia ,Motor Skills ,Child, Preschool ,Infant, Extremely Premature ,Pediatrics, Perinatology and Child Health ,Infant Behavior ,Gestation ,Female ,business - Abstract
To characterize behavior of 2-year-old children based on the severity of bronchopulmonary dysplasia (BPD).We studied children born at 22-26 weeks of gestation and assessed at 22-26 months of corrected age with the Child Behavior Checklist (CBCL). BPD was classified by the level of respiratory support at 36 weeks of postmenstrual age. CBCL syndrome scales were the primary outcomes. The relationship between BPD grade and behavior was evaluated, adjusting for perinatal confounders. Mediation analysis was performed to evaluate whether cognitive, language, or motor skills mediated the effect of BPD grade on behavior.Of 2310 children, 1208 (52%) had no BPD, 806 (35%) had grade 1 BPD, 177 (8%) had grade 2 BPD, and 119 (5%) had grade 3 BPD. Withdrawn behavior (P .001) and pervasive developmental problems (P .001) increased with worsening BPD grade. Sleep problems (P = .008) and aggressive behavior (P = .023) decreased with worsening BPD grade. Children with grade 3 BPD scored 2 points worse for withdrawn behavior and pervasive developmental problems and 2 points better for externalizing problems, sleep problems, and aggressive behavior than children without BPD. Cognitive, language, and motor skills mediated the effect of BPD grade on the attention problems, emotionally reactive, somatic complaints, and withdrawn CBCL syndrome scales (P values .05).BPD grade was associated with increased risk of withdrawn behavior and pervasive developmental problems but with decreased risk of sleep problems and aggressive behavior. The relationship between BPD and behavior is complex. Cognitive, language, and motor skills mediate the effects of BPD grade on some problem behaviors.
- Published
- 2019
48. V07-05 COMPLETE PRIMARY REPAIR OF BLADDER EXSTROPHY IN THE GIRL: RISK FACTORS FOR URINARY RETENTION LESSONS LEARNED AND CURRENT TECHNIQUE
- Author
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Aseem R. Shukla, Joseph G. Borer, Michael E. Mitchell, Bryan S. Sack, Douglas A. Canning, John V. Kryger, Travis W. Groth, Elizabeth Roth, and Dana A. Weiss
- Subjects
medicine.medical_specialty ,business.industry ,Urinary retention ,Urology ,media_common.quotation_subject ,medicine.disease ,Surgery ,Bladder exstrophy ,Primary repair ,medicine ,Girl ,medicine.symptom ,business ,media_common - Published
- 2019
49. Timing of inguinal hernia following complete primary repair of bladder exstrophy
- Author
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Ted Lee, Aseem R. Shukla, Tanya Logvinenko, Jennifer R. Frazier, John V. Kryger, Alyssia Venna, Evalynn Vasquez, Melissa Lingongo, Travis W. Groth, Elizabeth Roth, Dana A. Weiss, Joseph G. Borer, Michael E. Mitchell, and Douglas A. Canning
- Subjects
Male ,medicine.medical_specialty ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Hernia, Inguinal ,Osteotomy ,Article ,03 medical and health sciences ,Primary repair ,0302 clinical medicine ,030225 pediatrics ,Humans ,Medicine ,Hernia ,Child ,Pelvis ,Retrospective Studies ,Proportional hazards model ,business.industry ,Incidence (epidemiology) ,Bladder Exstrophy ,medicine.disease ,Surgery ,Bladder exstrophy ,stomatognathic diseases ,Inguinal hernia ,surgical procedures, operative ,Treatment Outcome ,medicine.anatomical_structure ,Pediatrics, Perinatology and Child Health ,Urologic Surgical Procedures ,Female ,business - Abstract
Summary Introduction/background: Bladder exstrophy patients have a high prevalence of inguinal hernia that often become clinically evident following bladder closure. Understanding when the bladder exstrophy patient is under greatest risk of developing an inguinal hernia following bladder closure is important, since incarceration resulting in strangulation of intra-abdominal contents can lead to significant morbidity if not addressed in a timely fashion. Although the incidence and risk factors of inguinal hernia have been reported, the timing of occurrence is not well understood. Objective: The primary objective of this study was to assess the timing of inguinal hernia following complete primary repair of bladder exstrophy (CPRE). In addition, we aimed to evaluate possible risk factors associated with inguinal hernia, including sex, age at bladder closure and iliac osteotomy status. Study Design: A multi-institutional retrospective review identified patients with bladder exstrophy repaired by CPRE under 6 months of age while excluding those who underwent inguinal hernia repair before or during bladder closure. Timing of inguinal hernia following bladder closure was evaluated using Kaplan–Meier methods. Cox proportional hazards model was used to investigate association of sex, age at bladder closure, and osteotomy on the risk of developing of inguinal hernia while clustering for institution. Results: 91 subjects were included in our analysis with median follow-up time of 6.5 years. 34 of 53 males (64.2%) and 2 of 38 females (5.3%) underwent inguinal hernia repair. The median time to inguinal hernia was 4.7 months following closure. The greatest hazard of inguinal hernia was within the first six months following closure. In multivariate analysis, male sex was strongly associated with inguinal hernia (HR = 19.00, p = 0.0038). Osteotomy and delay in closure were not significantly associated with inguinal hernia. 7 of 36 patients (19.4%) who underwent inguinal hernia repair presented with recurrence on the ipsilateral side. Discussion: Our results suggest that the greatest risk of inguinal hernia is within the first six months following bladder closure. The decreased risk of inguinal hernia after one year of follow-up may reflect anatomic stability that is reached following major reconstruction of the pelvis. While male bladder exstrophy patients are significantly more susceptible to inguinal hernias following CPRE, osteotomy and delayed bladder closure do not appear to be protective factors for inguinal hernia development following initial bladder closure. Conclusions: There is a heightened risk of inguinal hernia in the first six months following closure. The rate of recurrence following inguinal hernia repair is significantly elevated compared to the general pediatric population. Download : Download high-res image (250KB) Download : Download full-size image Summary Figure . Kaplan–Meier curves for overall probability of inguinal hernia repair for males and females
- Published
- 2021
50. Evaluation of outcomes following complete primary repair of bladder exstrophy at three individual sites prior to the establishment of a multi-institutional collaborative model
- Author
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Jennifer R. Frazier, John V. Kryger, Travis W. Groth, Michael E. Mitchell, Elizabeth Roth, Dana A. Weiss, Douglas A. Canning, Bryan S. Sack, Joseph G. Borer, and Aseem R. Shukla
- Subjects
medicine.medical_specialty ,Urology ,030232 urology & nephrology ,Urination ,Bladder capacity ,Intermediate group ,03 medical and health sciences ,Primary repair ,0302 clinical medicine ,030225 pediatrics ,Humans ,Medicine ,Child ,Retrospective Studies ,business.industry ,Bladder Exstrophy ,Clean Intermittent Catheterization ,medicine.disease ,Surgery ,Bladder exstrophy ,Neck of urinary bladder ,Treatment Outcome ,Urethra ,medicine.anatomical_structure ,Pediatrics, Perinatology and Child Health ,Urologic Surgical Procedures ,Surgical history ,business - Abstract
Summary Purpose The Multi-Institutional Bladder Exstrophy Consortium (MIBEC) was established in 2013 to refine technical aspects of the complete primary repair of bladder exstrophy (CPRE), to decrease complications, and to improve outcomes. In order to place outcomes from the consortium into context of historic outcomes, we evaluated continence and dry intervals in children who were repaired prior to the beginning of the consortium at these institutions. We hypothesized that continence (voiding with dryness) is rarely achieved after primary CPRE and surgery following CPRE improves dryness but may hinder voiding per urethra. Materials and methods We reviewed prospectively maintained IRB approved databases of children who underwent CPRE for classic bladder exstrophy (BE) between 5/1993 and 1/2013 at 3 institutions. Exclusion criteria included: lack of continence documentation, and lack of follow up subsequent to January 2014. We recorded age at closure, method of bladder emptying, bladder capacity and surgical history. We used a 3 part dryness scale for both patients who void volitionally and those on CIC. Children were considered dry if they could hold urine for over 3 h. An intermediate group was defined as having a dry interval of 2–3 h, with minimal dampness in between voids. If dry intervals were Results A total of 54 of 73 (38 M) children met inclusion criteria. 35 of 54 (64.8%) children void per urethra, while 18 (33.3%) perform clean intermittent catheterization (CIC) and 1 underwent a vesicostomy due to incomplete emptying and UTI's. 25/35 (71.4%) of those voiding per urethra underwent CPRE only, while the remaining 10 underwent secondary continence procedures. In total, 26 of 54 (48.1%) are dry, that is either continent or not wet for > 3 h, while only 11/54 (20.4%) are truly continent, i.e., voiding per urethra. Only 9/54 (16.7%) are continent after a single surgery (CPRE). 14/54 children who are dry (25.9%) underwent a bladder neck procedure with or without augmentation and empty with CIC. Discussion and conclusion Granular detail about the specifics of emptying, surgical history, and dry intervals is crucial to understand the true outcomes from the repair of BE. Children with BE undergoing CPRE prior to the institution of MIBEC experienced variable results, with only 17% achieving continence while spontaneously voiding per urethra without additional reconstruction. We are now engaged in MIBEC to identify factors that contribute to continence and to attempt to render such findings reproducible. Summary Table 1 . Wet (20) 2-3 h (8) Dry (26) N = 54 Type of voiding Void 17 7 11 35 CIC 1 1 13 15 Void + CIC to empty 1 0 2 3 Vesicostomy 1 0 0 1 Procedures CPRE only 12 4 11 ∗ 27 CPRE + BNI 5 ∗∗ 3 1 ∗ 9 CPRE + BNR 2 0 2 4 CPRE + APV 0 0 1 1 CPRE + BNR + APV 1 ∗ 0 3 4 CPRE + BNR + Augment ± APV 0 1 6 7 CPRE + BNC + Augment + APV 0 0 2 2 CIC: Clean Intermittent Catheterization. BNI: Bladder neck injection. BNR: Bladder neck reconstruction. BNC: Bladder neck closure. APV: Appendicovesicostomy. ∗ 1 voids and CIC to empty completely. ∗∗ 1 went on to vesicostomy.
- Published
- 2020
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