Research Spotlight

King, K., R. Sudan, S. Bardaro, I. Soriano, A. T. Petrick, S. C. Daly, E. Lo Menzo, D. Davis, A. Leyva-Alvizo, M. Gonzalez-Urquijo, D. Eisenberg and M. El Chaar (2021). “Assessment and management of gastroesophageal reflux disease following bariatric surgery.” Surg Obes Relat Dis 17(11): 1919-1925.

Full text of this article.

Gastroesophageal reflux disease (GERD) is a common disease in patients with obesity. The incidence of de novo GERD and the effect of bariatric surgery on patients with pre-existing GERD remain controversial. Management of GERD following bariatric surgery is complicated and can range from medical therapy to non-invasive endoscopic options to invasive surgical options. To address these issues, we performed a systematic review of the literature on the incidence of GERD and the various modalities of managing GERD in patients following bariatric surgery. Given the increased number of laparoscopic sleeve gastrectomy (LSG) procedures being performed and the high incidence of GERD following LSG, bariatric surgeons should be familiar with the options available to manage GERD following LSG as well as other bariatric procedures.

Cengiz, A., L. H. Yoder and V. Danesh (2021). “A Concept Analysis of Role Ambiguity Experienced by Hospital Nurses Providing Bedside Nursing Care.” Nurs Health Sci Oct 24. [Epub ahead of print].

Full text of this article.

The concept of role ambiguity, despite its wide application in nursing research, lacks a clear definition and conceptualization, resulting in inconsistencies about how it is defined, operationalized, and applied in research. The purpose of this paper was to analyze and define the concept of role ambiguity among hospital nurses providing nursing care using the concept analysis method developed by Walker and Avant. The three defining attributes of role ambiguity were lack of information (information deficiency), lack of clarity, and unpredictability. Antecedents included lack of clear role definitions, lack of education/training, communication problems, supervisory behaviors and support, organizational culture, practice environment conditions, experience, group cohesiveness, and preferred work setting. The consequences of role ambiguity included increased stress, lack of organizational commitment, job dissatisfaction, burnout, and increased intent to leave. This concept analysis provides a clear conceptual definition to better understand role ambiguity among hospital nurses along with implications for nurse leaders, educators, clinicians, and researchers to support nurses and guide future research. This paper further emphasizes the importance of nurse-manager relationships in reducing experience of role ambiguity among nurses in hospitals.

Pinkhasov, A., G. Xiong, J. A. Bourgeois, T. W. Heinrich, H. Huang, S. Coriolan, A. Annamalai, J. P. Mangal, S. Frankel, M. Lang, Y. P. Raj, M. Dandois, K. Barth, A. L. Stewart, J. Rado, J. Pesek, A. Sanders, E. V. Spearman-McCarthy, J. Gagliardi and J. G. Fiedorowicz (2021). “Management of SIADH-related hyponatremia due to psychotropic medications – An expert consensus from the Association of Medicine and Psychiatry.” J Psychosom Res Oct 28;151:110654. [Epub ahead of print]. 110654.

Full text of this article.

OBJECTIVE: Hyponatremia is the most common electrolyte imbalance encountered in clinical practice and is associated with negative healthcare outcomes and cost. SIADH is thought to account for one third of all hyponatremia cases and is typically an insidious process. Psychotropic medications are commonly implicated in the etiology of drug induced SIADH. There is limited guidance for clinicians on management of psychotropic-induced SIADH. METHODS: After an extensive review of the existing literature, clinical-educators from the Association of Medicine and Psychiatry developed expert consensus recommendations for management of psychotropic-induced SIADH. A risk score was proposed based on risk factors for SIADH to guide clinical decision-making. RESULTS: SSRIs, SNRIs, antipsychotics, carbamazepine, and oxcarbazepine have moderate to high level of evidence demonstrating their association with SIADH. Evaluation for an avoidance of medications that cause hyponatremia is particularly important. Substitution with medication that is less likely to cause SIADH should be considered when appropriate. We propose an algorithmic approach to monitoring hyponatremia with SIADH and corresponding treatment depending on symptom severity. CONCLUSIONS: The proposed algorithm can help clinicians in determining whether psychotropic medication should be stopped, reduced or substituted where SIADH is suspected with recommendations for sodium (Na+) monitoring. These recommendations preserve a role for clinical judgment in the management of hyponatremia with consideration of the risks and benefits, which may be particularly relevant for complex patients that present with medical and psychiatric comorbidities. Further studies are needed to determine whether baseline and serial Na+ monitoring reduces morbidity and mortality.

Sewell, E. K., S. E. G. Hamrick, R. M. Patel, M. Bennett, V. N. Tolia and K. A. Ahmad (2021). “Association between anti-seizure medication and outcomes in infants.” J Perinatol.

Full text of this article.

OBJECTIVE: To compare treatment failure between: (1) infants treated with phenobarbital versus levetiracetam for first-line treatment and (2) infants treated with phenytoin versus levetiracetam for second-line treatment following phenobarbital. STUDY DESIGN: This retrospective cohort study included infants with seizures receiving phenobarbital or levetiracetam as the initial anti-seizure medication. Treatment failure was defined as the need for additional anti-seizure medication within 24-72 h and compared using mixed-effect logistic regression after adjustment for confounding factors, including center. RESULTS: In this cohort of 6842 infants, the incidence of treatment failure was 31% vs. 38% in infants receiving first-line phenobarbital versus levetiracetam (adjusted OR: 0.70; 95% CI 0.58-0.84). There was no significant difference in second-line treatment failure (adjusted OR: 1.31; 95% CI 0.92-1.86). CONCLUSIONS: First-line treatment of neonatal seizures with phenobarbital is associated with a lower rate of treatment failure than levetiracetam. There was no significant difference in second-line treatment failure.

Nyancho, D., F. D. Atem, A. M. Venkatachalam, A. Barnes, M. Hill, J. I. Traylor, S. E. Stutzman, N. Bedros, V. Aiyagari and S. G. Aoun (2021). “Anisocoria Correlates With Injury Severity and Outcomes After Blunt Traumatic Brain Injury.” J Neurosci Nurs 53(6): 251-255.

Full text of this article.

BACKGROUND: Automated infrared pupillometry (AIP) has been shown to be helpful in the setting of aneurysmal subarachnoid hemorrhage and stroke as an indicator of imminent irreversible brain injury. We postulated that the early detection of pupillary dysfunction after light stimulation using AIP may be useful in patients with traumatic brain injury (TBI). METHODS: We performed a retrospective review of the Establishing Normative Data for Pupillometer Assessment in Neuroscience Intensive Care database, a prospectively populated multicenter registry of patients who had AIP measurements taken during their intensive care unit admission. The primary eligibility criterion was a diagnosis of blunt TBI. Ordinal logistic modeling was used to explore the association between anisocoria and daily Glasgow Coma Scale scores and discharge modified Rankin Scale scores from the intensive care unit and from the hospital. RESULTS: Among 118 subjects in the who met inclusion, there were 6187 pupillometer readings. Of these, anisocoria in ambient light was present in 12.8%, and that after light stimulation was present in 9.8%. Anisocoria after light stimulation was associated with worse injury severity (odds ratio [OR], 0.26 [95% confidence interval (CI), 0.14-0.46]), lower discharge Glasgow Coma Scale scores (OR, 0.28 [95% CI, 0.17-0.45]), and lower discharge modified Rankin Scale scores (OR, 0.28 [95% CI, 0.17-0.47]). Anisocoria in ambient light showed a similar but weaker association. CONCLUSION: Anisocoria correlates with injury severity and with patient outcomes after blunt TBI. Anisocoria after light stimulation seems to be a stronger predictor than does anisocoria in ambient light. These findings represent continued efforts to understand pupillary changes in the setting of TBI.