bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing Aggression Management Programs for Nurses
Authors: Rosenberg Karen
Published: January 2018

According to this study:

Aggression management education improved both acute care nurses’ knowledge and the skills nurses needed to handle workplace violence.

The specific needs of the patient population and the historical trends of workplace violence on each unit should be considered when planning an aggression management program.
Cataract Surgery is Associated with Lower Mortality in Older Women
Authors: Rosenberg Karen
Published: January 2018

According to this study:

Older women who undergo cataract surgery have a lower risk of total and cause-specific mortality than those who have cataracts but don't have the procedure.

This result doesn't prove a causal relationship between cataract surgery and reduced mortality, however; factors such as higher socioeconomic status and a healthier lifestyle could also explain this association.
Percutaneous Coronary Intervention in Stable Angina
Authors: Rosenberg Karen
Published: January 2018

According to this study:

The first blinded, placebo-controlled trial of percutaneous coronary intervention in patients with stable angina showed no significant difference in exercise time or angina symptom relief compared with patients who had a placebo intervention.

However, the authors note that percutaneous coronary intervention shouldn't be ruled out for the management of stable angina.
The Hands
Authors: Cosby Vanessa
Published: January 2018

A neonatal ICU nurse makes a lasting impression on a new mother.
What Is the Evidence for Use of a Supplemental Feeding Tube Device as an Alternative Supplemental Feeding Method for Breastfed Infants?
Authors: Penny Frances , Judge Michelle , Brownell Elizabeth , McGrath Jacqueline M.
Published: January 2018

Background:

According to the Healthy People 2020 goals, the sustainability of breastfeeding duration rates within the United States has not been achieved. To increase these rates, it is important that women with breastfeeding difficulties receive the support needed to continue breastfeeding. When supplementation occurs, it is essential that the breastfeeding relationship be preserved. Various methods of supplementation are often recommended including use of the supplemental feeding tube device (SFTD).

Purpose:

The question guiding this brief is “What evidence exists to support the use of an SFTD as a method of supplementation for breastfed infants?”

Search Strategy:

The PubMed and CINAHL databases were queried for original research published in English from 1990 through July 2016. Search terms included “supplemental feeding tube,” “breastfeeding,” “term infants,” “premature infants,” “Supplemental Nursing System,” “Lact-aid,” and “supply line.”

Findings:

Very limited research exists on the use of SFTDs as a method of supplementation for breastfed infants; however, existing research suggests that an SFTD may be useful as a supplementation method for breastfed infants. High-quality research is needed to evaluate the efficacy of using an SFTD for supporting exclusive and all breastfeeding rates.

Implications for Practice:

Nurses and providers need to be educated and trained in the use of SFTDs as well as all supplemental feeding methods. Information on efficacy and SFTD use should also be included in policies related to breastfeeding and human milk use.

Implications for Research:

Further research should determine best methods of supplementation for breastfed infants and should examine differences in breastfeeding rates when using the SFTD for supplementation.
Nursing Assessment of Intra-abdominal Hypertension and Abdominal Compartment Syndrome in the Neonate
Authors: Reitsma Jenifer , Schumacher Bette
Published: January 2018

Background:

Abdominal compartment syndrome in the surgical neonate is a low-frequency, high-risk occurrence that if overlooked is often accompanied with long-term sequelae and sometimes death. The importance of early detection of signs and symptoms through expert nursing assessment cannot be overstated.

Purpose:

To review the components of nursing assessment as it applies to detection of abdominal compartment syndrome in the surgical neonate and its relationship to the pathophysiology.

Methods/Search Strategy:

Detailed search of the nursing and medical literature.

Implications for Practice:

The purpose of this article is to describe the onset of abdominal compartment syndrome in the neonate. Early detection of this low-frequency, high-risk occurrence hinges on expert nursing assessment. Complications of abdominal compartment syndrome in the neonate involve bowel perforation, short bowel syndrome, and sometimes death. Components of this expert nursing assessment and its relationship to the pathophysiology of compartment syndrome are presented.
Predicting Survival in Patients Treated With Extracorporeal Membrane Oxygenation After Myocardial Infarction
Authors: Pabst Dirk , Foy Andrew J. , Peterson Brandon , Soleimani Behzad , Brehm Christoph E.
Published: January 2018

Objectives:

Acute myocardial infarction is the most common cause of cardiogenic shock. Although the number of patients with acute myocardial infarction complicated by cardiogenic shock who were treated with venoarterial extracorporeal membrane oxygenation increased during the last decade, detailed data on survival are lacking. We sought to analyze covariates that were independently associated with survival in this patient population and to externally validate the newly developed prEdictioN of Cardiogenic shock OUtcome foR Acute myocardial infarction patients salvaGed by venoarterial Extracorporeal membrane oxygenation (ENCOURAGE) score.

Design:

Retrospective clinical study.

Setting:

A single academic teaching hospital.

Patients:

Adult patients with acute myocardial infarction complicated by cardiogenic shock who were supported by venoarterial extracorporeal membrane oxygenation from June 2008 to September 2016.

Interventions:

Fourteen individual variables were assessed for their association with the primary endpoint. These variables were prespecified by the study team as being the most likely to affect survival. A receiver operating characteristic analysis was also performed to test the ability of the ENCOURAGE score to predict survival in this patient cohort.

Measurements and Main Results:

The primary endpoint of the study was in-hospital survival. A total of 61 patients were included in the analysis. Thirty-seven (60.7%) could be weaned from venoarterial extracorporeal membrane oxygenation and 36 (59.0%) survived. Survival was significantly higher in patients less than 65 years old (odds ratio, 14.6 [CI, 2.5–84.0]; p = 0.003), whose body mass index was less than 32 kg/m2 (odds ratio, 5.5 [CI, 1.2–25.4]; p = 0.029) and international normalized ratio was less than 2 (odds ratio, 7.3 [CI, 1.3–40.1]; p = 0.022). In patients where the first lactate drawn was less than 3 mmol/L, the survival was not significantly higher (odds ratio, 4.4 [CI, 0.6–32.6]; p = 0.147). The C-statistic for predicting survival using a modified version of the ENCOURAGE score, which replaced prothrombin activity less than 50% with an international normalized ratio greater than 2, was 0.74 (95% CI, 0.61–0.87).

Conclusions:

In this single-center study, several important covariates were associated with improved survival in patients with acute myocardial infarction complicated by cardiogenic shock who were supported by venoarterial extracorporeal membrane oxygenation and the ENCOURAGE score was found to be externally valid for predicting survival to hospital discharge.
Acute Kidney Injury and Subsequent Frailty Status in Survivors of Critical Illness: A Secondary Analysis
Authors: Abdel-Kader Khaled , Girard Timothy D. , Brummel Nathan E. , Saunders Christina T. , Blume Jeffrey D. , Clark Amanda J. , Vincz Andrew J. , Ely E. Wesley , Jackson James C. , Bell Susan P. , Archer Kristin R. , Ikizler T. Alp , Pandharipande Pratik P. , Siew Edward D.
Published: January 2018

Objectives:

Acute kidney injury frequently complicates critical illness and is associated with high morbidity and mortality. Frailty is common in critical illness survivors, but little is known about the impact of acute kidney injury. We examined the association of acute kidney injury and frailty within a year of hospital discharge in survivors of critical illness.

Design:

Secondary analysis of a prospective cohort study.

Setting:

Medical/surgical ICU of a U.S. tertiary care medical center.

Patients:

Three hundred seventeen participants with respiratory failure and/or shock.

Interventions:

None.

Measurements and Main Results:

Acute kidney injury was determined using Kidney Disease Improving Global Outcomes stages. Clinical frailty status was determined using the Clinical Frailty Scale at 3 and 12 months following discharge. Covariates included mean ICU Sequential Organ Failure Assessment score and Acute Physiology and Chronic Health Evaluation II score as well as baseline comorbidity (i.e., Charlson Comorbidity Index), kidney function, and Clinical Frailty Scale score. Of 317 patients, 243 (77%) had acute kidney injury and one in four patients with acute kidney injury was frail at baseline. In adjusted models, acute kidney injury stages 1, 2, and 3 were associated with higher frailty scores at 3 months (odds ratio, 1.92; 95% CI, 1.14–3.24; odds ratio, 2.40; 95% CI, 1.31–4.42; and odds ratio, 4.41; 95% CI, 2.20–8.82, respectively). At 12 months, a similar association of acute kidney injury stages 1, 2, and 3 and higher Clinical Frailty Scale score was noted (odds ratio, 1.87; 95% CI, 1.11–3.14; odds ratio, 1.81; 95% CI, 0.94–3.48; and odds ratio, 2.76; 95% CI, 1.34–5.66, respectively). In supplemental and sensitivity analyses, analogous patterns of association were observed.

Conclusions:

Acute kidney injury in survivors of critical illness predicted worse frailty status 3 and 12 months postdischarge. These findings have important implications on clinical decision making among acute kidney injury survivors and underscore the need to understand the drivers of frailty to improve patient-centered outcomes.
Suture Technique to Prevent Air Leakage during Negative-Pressure Wound Therapy in Fournier Gangrene
Authors: Chang Feng-Shu , Chou Chieh , Hu Chuan-Yu , Huang Shu-Hung
Published: January 2018

Background:

The use of negative-pressure wound therapy (NPWT) for Fournier gangrene management is well documented; however, it is difficult to fixate GranuFoam dressings and maintain an airtight seal over the perineum area. We developed a simple method to facilitate GranuFoam fixation and improve airtight sealing.

Methods:

The Fournier’s gangrene severity index (FGSI) score less than 9 was collected in from January 2015 to October 2016. All 13 patients underwent fasciotomy, and NPWT was applied directly on fasciotomy wounds after the debridement of infected tissue. Partial wound closure was performed, and a portion of GranuFoam was inserted to facilitate fixation. The seal check was converted to a 0–10 scale score that was recorded every 4 hours during NPWT. Patient profiles including medical history, FGSI, method of wound closure, and length of stay were collected in this study.

Results:

The median age of the patients was 62 (38–76) years. The mean FGSI score was 4.3 ± 3.1. The average duration of NPWT was 17.5 ± 11.5 days, and the average seal check score was 0.8 ± 0.5. No seal check alarms were noted during the study. Successful wound closure was achieved in all patients without using additional reconstruction methods such as skin grafting or muscle flap coverage.

Conclusions:

The present results suggest that partial wound-edge closure and in situ GranuFoam fixation improve the NPWT leaks in Fournier gangrene wounds. Furthermore, this method is simple to learn and can be useful in applying NPWT to anatomically difficult areas.
TOXIC EFFECTS OF HYDROXYCHLOROQUINE ON THE CHOROID
Authors: Ahn Seong Joon , Ryu So Jung , Lim Han Woong , Lee Byung Ro
Published: January 2018

Purpose:

To investigate the choroidal changes that occur in hydroxychloroquine (HCQ) retinopathy using multimodal imaging including fluorescein angiography, indocyanine green angiography, and optical coherence tomography (OCT) angiography and to correlate these changes with retinal findings obtained using OCT and fundus autofluorescence.

Methods:

In 20 patients (n = 40 eyes) with systemic lupus erythematosus or rheumatoid arthritis diagnosed to have HCQ retinopathy, imaging modalities including swept-source OCT, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, and OCT angiography were used to evaluate retinal and choroidal changes associated with retinopathy. The assessments included specific findings such as presence of hyperfluorescent or hypofluorescent lesions on angiography and signal void zones on OCT angiography, their frequencies, and the correlations among the retinal and choroidal findings. These findings were also correlated with the severity of retinopathy. Retinopathy progression was defined using fundus autofluorescence and OCT and correlated with the retinal/choroidal findings.

Results:

Fluorescein angiography demonstrated a hyperfluorescent area, which reflects a defective retinal pigment epithelium, with multiple tiny dark spots within the area. Indocyanine green angiography showed a hypofluorescent area with dark spots, which was matched to the hypoautofluorescent area on fundus autofluorescence. Although there were no specific morphologic abnormalities in the choroid layers using en face choroidal imaging, OCT angiography demonstrated signal void areas on the choriocapillaris in the areas of the retinal pigment epithelium defect. Even after cessation of HCQ, there was progression of retinopathy in eyes with choroidal involvement, particularly on the area of choroidal findings.

Conclusion:

Multimodal imaging demonstrates choriocapillaris degeneration in eyes with HCQ retinopathy, particularly those with severe retinopathy. The choroidal change was associated with outer retinal toxicity of HCQ.
Corneal Neurotization for Neurotrophic Keratopathy: Clinical Outcomes and In Vivo Confocal Microscopic and Histopathological Findings
Authors: Ting Darren S. J. , Figueiredo Gustavo S. , Henein Christin , Barnes Eric , Ahmed Omar , Mudhar Hardeep S. , Figueiredo Francisco C.
Published: January 2018

Purpose:

To describe the long-term outcomes and in vivo confocal microscopic (IVCM) and histopathological findings after corneal neurotization surgery.

Methods:

We included 2 patients who underwent corneal neurotization surgery for severe unilateral neurotrophic keratopathy secondary to cerebellopontine angle meningioma. Corneal sensation was measured using the Cochet–Bonnet esthesiometer (CBE) (0–60 mm). IVCM was performed using the Heidelberg HRT3 Rostock Corneal Module. Histopathological examination was performed on the excised corneoscleral disc of patient 2.

Results:

In patient 1, corneal sensation improved from 0 mm preoperatively to 60 mm in all 4 quadrants by 2 years postoperatively and was maintained at 5 years postoperatively with identifiable subbasal and stromal corneal nerves on IVCM. In patient 2, corneal sensation improved from 0 mm preoperatively to 10 mm in 3 quadrants (9 months postoperatively) but returned to 0 mm in all quadrants by 2 years postoperatively. IVCM failed to identify any subbasal and stromal corneal nerves. At 5 years postoperatively, evisceration was performed to ameliorate uncontrolled and persistent ocular pain and poor cosmesis. Histopathological examination of the excised corneoscleral disc confirmed the presence of normal-sized, central corneal stromal nerve fascicles but without direct continuity with the transplanted perilimbal nerve bundles.

Conclusions:

Our study elucidates the mechanism of corneal neurotization surgery at a cellular level. Although only 1 patient achieved long-term improvement in corneal sensation postoperatively, the findings on IVCM and histopathological examination suggest that partial regeneration/maintenance of corneal nerves after corneal neurotization surgery is likely attributed to the paracrine neurotrophic support, instead of direct sprouting, from the perilimbal transplanted nerve fascicles.
Safety, Tolerability and Pharmacokinetics of MEDI8897, an Extended Half-life Single-dose Respiratory Syncytial Virus Prefusion F-targeting Monoclonal Antibody Administered as a Single Dose to Healthy Preterm Infants
Authors: Domachowske Joseph B. , Khan Anis A. , Esser Mark T. , Jensen Kathryn , Takas Therese , Villafana Tonya , Dubovsky Filip , Griffin M. Pamela
Published: January 2018

Background:

MEDI8897 is a recombinant human monoclonal antibody being developed for prophylaxis of serious respiratory syncytial virus (RSV) disease in all infants.

Methods:

In this phase 1b/2a dose-escalation study, healthy preterm infants with a gestational age of 32–35 weeks were randomized to receive a single intramuscular injection of MEDI8897 (10, 25 or 50 mg) or placebo. Safety, pharmacokinetics, RSV-neutralizing antibody and antidrug antibody (ADA) assessments were performed during the 360-day follow-up period. Infants who experienced medically attended lower respiratory tract infections (LRTIs) were tested for RSV.

Results:

MEDI8897 serum half-life ranged from 62.5–72.9 days. On day 151, 87% of infants in the 50 mg group had serum concentrations above the 90% effective concentration target level of 6.8 µg/mL, and 90% showed a ≥4-fold rise from baseline in serum RSV-neutralizing antibody levels. Adverse events (AEs) were reported in 17 of 18 (94.4%) placebo and 66 of 71 (93.0%) MEDI8897 recipients. Three MEDI8897 recipients experienced 5 serious AEs (3 LRTIs, 2 febrile seizures). ADA was detected at any time postbaseline in 28.2% of MEDI8897 recipients and at day 361 only in 26.5% of subjects. ADA response was not associated with AEs. Five (7%) MEDI8897 recipients experienced medically attended LRTIs through day 150; 1 tested positive for RSV (10 mg group).

Conclusions:

MEDI8897 had a favorable safety profile in healthy preterm infants. The extended half-life of MEDI8897 and demonstrated RSV-neutralizing activity support protection from RSV for the duration of a typical 5-month season after a single 50 mg intramuscular (IM) dose.
The Individualized Facelift Technique in Improving Facial Asymmetry for Asian Patients
Authors: Zhang Pan , Sui Bing , Ren Lihong , Yang Jenny , Ma Xu , Li Qingchun , Yang Daping
Published: January 2018

Purpose:

Among multiple influential factors affecting facial symmetry, the role of soft tissue is often overlooked. Skin and skeletal differences between Asian and Caucasian people also require the adaptation of current techniques for Asian patients. This article aimed to explore the ability of individual facelift techniques to improve facial symmetry and reset youthful eye in Asian people, while a new method, called the grid method, was tried to evaluate the improvement in facial symmetry.

Methods:

The authors conducted a review of 58 consecutive facelifts, which were all performed by a single surgeon between April 2009 and December 2016 following institutional review board approval. Among them, 21 patients underwent lower eyelid blepharoplasty. The original frontal photograph of each patient was evaluated by the grid method. Five independent plastic surgeons reviewed the facial asymmetry of the images before and after the operations using a visual analog scale to analyze the facial asymmetry of the patients.

Results:

In the preoperative group evaluated by the grid, the mean facial asymmetry score was 4.11, while in the postoperative group, the mean score was 1.07, which was significantly lower than the mean score before the operation (p < 0.001). The change in mean scores illustrated that the technique was effective in improving facial symmetry in Asian people. A total of 8 patients experienced hematomas and recovered well without obvious sequelae.

Conclusions:

The individual facelift technique was effective for improving facial symmetry and reshaping youthful eye in Asian people.
Bony Regrowth After Deep Lateral Orbital Decompression
Authors: Ramesh Sathyadeepak , Eichhorn Knut , Leibowitz Steven , Goldberg Robert
Published: January 2018

Purpose:

To report on 2 cases of late bony regrowth with clinically apparent proptosis after deep lateral orbital decompression for thyroid orbitopathy.

Methods:

A retrospective review of 2 cases identified by the authors as having late bony regrowth. The authors review the clinical, historical, radiologic, and anatomical findings and discuss the significance thereof.

Results:

Bony regrowth with bowing toward the middle cranial fossa is observed at postoperative month 8 in the first case. Cortical bone and marrow was observed to regrow at 2 years postoperatively in the second case. Both patients underwent successful repeat deep lateral orbital decompression with resolution of proptosis and clinical symptoms.

Conclusions:

Late bony regrowth should be considered as a possible cause of recurrent proptosis after orbital decompression in thyroid eye disease.
State of Evidence-Based Practice in Physician Assistant Education
Authors: White Dawn M. , Stephens Phillip
Published: January 2018

Purpose

Evidence-based practice (EBP) involves using the best evidence available to guide patient care. The use of EBP improves patient outcomes and the quality of care delivered. Studies have investigated how EBP is taught in other health professions but not in physician assistant (PA) programs. The purpose of this study was to explore how PA programs teach this subject matter.

Methods

After permission was obtained, a survey was adapted from a similar study completed in medical schools. Requests were emailed to 186 accredited PA programs with available contact information. These data were analyzed using descriptive statistics. The text responses were reviewed and summarized to describe how EBP was taught in the programs surveyed.

Results

Eighty-four responses were received from the 186 PA programs contacted with the survey request, giving a 45.2% return. Approximately 95% of respondents reported having formal EBP training in their curriculum. Respondents reported formal EBP training through a variety of educational activities, with time spent on these activities ranging from 4 hours to 550 hours. Barriers to implementation of an EBP curriculum were reported by 27% of respondents, with the most common barrier being lack of time.

Conclusions

Most PA programs that responded have formal EBP training in the curriculum. There is little standardization regarding the methods used and time spent in these activities. The Accreditation Review Commission on Education for the Physician Assistant may be able to assist in overcoming the reported barriers and improving standardization by implementing a specific EBP accreditation standard.
Institutional Betrayal and Gaslighting
Authors: Ahern Kathy
Published: January 2018

Despite whistle-blower protection legislation and healthcare codes of conduct, retaliation against nurses who report misconduct is common, as are outcomes of sadness, anxiety, and a pervasive loss of sense of worth in the whistle-blower. Literature in the field of institutional betrayal and intimate partner violence describes processes of abuse strikingly similar to those experienced by whistle-blowers. The literature supports the argument that although whistle-blowers suffer reprisals, they are traumatized by the emotional manipulation many employers routinely use to discredit and punish employees who report misconduct. “Whistle-blower gaslighting” creates a situation where the whistle-blower doubts her perceptions, competence, and mental state. These outcomes are accomplished when the institution enables reprisals, explains them away, and then pronounces that the whistle-blower is irrationally overreacting to normal everyday interactions. Over time, these strategies trap the whistle-blower in a maze of enforced helplessness. Ways to avoid being a victim of whistle-blower gaslighting, and possible sources of support for victims of whistle-blower gaslighting are provided.
Partnering With a Medical Malpractice Insurer to Improve Patient Safety and Decrease Risk
Authors: Keohane Carol A. , Dwyer Kathy , Boulanger Jason , Zigmont Katherine , Babayan Astrid , Cushing Elizabeth , Walsh Brian
Published: January 2018

Implementing evolving science into clinical practice remains challenging. Assimilating new scientific evidence into clinical protocols and best practice recommendations, in a timely manner, can be difficult. In this article, we examine the value of partnering with a captive medical malpractice insurance company and its Patient Safety Organization to use data and convening opportunities to build upon the principles of implementation science and foster efficient and widespread adoption of the most current evidence-based interventions. Analyses of medical malpractice and root-cause analysis data set the context for this partnership and acted as a catalyst for creating best practice guidelines for adopting therapeutic hypothermia in the treatment of neonatal encephalopathy. What follows is a powerful example of successfully leveraging the collective wisdom of healthcare providers across specialties and institutional lines to move patient safety forward while managing risk.
Gait Kinematics and Energy Expenditure of Users Walking with Semiflexion Knee-Ankle-Foot Orthosis: A Pilot Study
Authors: Bapat Ganesh M. , Ojha Rajdeep , Chalageri Prashanth , Sujatha S.
Published: January 2018

Introduction

The knee joint of a conventional knee-ankle-foot orthosis (KAFO) is locked during walking. This study aims to evaluate the effects of stance phase knee flexion on the kinematics, spatiotemporal parameters, and energy consumption of KAFO users.

Materials and Methods

A retrofitting drop lock that allows 12° of stance flexion in a single-axis knee joint was developed (called the semiflexion knee joint). Four subjects with quadriceps weakness volunteered to participate in the study. Gait analysis was conducted for the locked knee and the semiflexion knee orthosis using a calibrated eight-camera three-dimensional motion capture system. Preceding each trial, participants were given 5 days of gait training with the corresponding KAFO. Subjective feedback about the performance of the new KAFO was collected.

Results

Walking with the semiflexion KAFO did not significantly improve the speed (p = 0.161), cadence (p = 0.232), and stride length (p = 0.95) compared with walking with a locked KAFO. Although not significant (p = 0.132), trends of Physiological Cost Index (PCI) seemed to reduce in all subjects while walking with the semiflexion knee.

Conclusions

Using the KAFO with stance flexion did not significantly improve any of the locked knee gait parameters. However, there was a trend of reduction in the PCI score while walking with the semiflexion KAFO, and it also improved the ease of doing some activities of daily living.
Nature and role of surgical margins in transoral laser microsurgery for early and intermediate glottic cancer
Authors: Fiz Ivana , Koelmel Jan Constantin , Sittel Christian
Published: January 2018

Purpose of review

Summarize recent findings regarding the impact of margin status on oncologic outcomes and organ preservation, as well as evaluate possible management policies of close and positive margins after transoral laser microsurgery (TLM) for Tis-T2 glottic carcinomas.

Recent findings

Impact of margin status on survival rates remains controversial, whereas some authors found close and positive margins to be independent risk factors for recurrence and poorer survival rates, others did not find any significant variations compared with negative ones. A common trend can be observed in performing a watchful waiting policy or second look TLM in patients with close-superficial and positive single-superficial margins. Further treatment seems preferable in case of deep and positive multiple superficial margins.

Positive margins are present in up to 50% of patients treated by TLM, even though a high rate of false positivity, reaching 80%, has been described. Close and positive single superficial margins seem to be linked to higher recurrence rates compared with negative margins, even though watchful wait and see policy, especially when performed by adjunctive visual aids like Narrow Band Imaging, maintains good final oncological and organ preservation outcomes. Further treatments are required in case of deep margin positivity.
Stroop Test Validation to Screen for Minimal Hepatic Encephalopathy in Pediatric Extrahepatic Portal Venous Obstruction
Authors: Suresh Meera Vyshni , Jagadisan Barath , Kandasamy Preeti , Senthilkumar Gandhipuram Periyasamy
Published: January 2018

Objectives:

Minimal hepatic encephalopathy (MHE) has been reported in children with extrahepatic portal vein obstruction (EHPVO). MHE assessment is restricted to research situations as neuropsychiatric tests are time‐intensive. Computerized Stroop Test (CST) has been used in cirrhotic adults for MHE screening. The study aims to assess MHE frequency in young Indian children with EHPVO and validate CST for MHE screening in pediatric EHPVO.

Methods:

Thirty‐seven children with EHPVO between 7 and 12 years of age and 37 age‐ and sex‐matched controls were enrolled. Fasting plasma ammonia was measured. MHE was diagnosed by Revised Amsterdamse Kinder Intelligentie Test. The performance of a Tamil language version of CST in MHE screening was assessed.

Results:

MHE was diagnosed in 18.9% (7/37) of EHPVO (EHPVO‐MHE). Plasma ammonia levels were higher in EHPVO‐MHE compared to EHPVO without MHE (EHPVO‐No‐MHE) but abnormal plasma ammonia levels are unsuitable for MHE screening. CST was administered in 35 EHPVO and 37 controls. EHPVO‐MHE, compared to EHPVO‐No‐MHE, had longer “on time,” “off time,” “(on+off) time,” and “(on‐off) time.” For MHE diagnosis, specificity and sensitivity of “(on+off) time” were 100% and 89.6% for a cutoff of >180.4 seconds (area under receiver operating characteristic = 0.97).

Conclusions:

In the absence of other risk factors for neurological insult or patent surgical shunts, MHE frequency in young Indian children with EHPVO, determined by Revised Amsterdamse Kinder Intelligentie Test, was lesser than in earlier studies. CST is suitable for MHE screening in clinical practice to select patients for neuropsychiatric evaluation.
Psychological Factors and Outcomes in the Surgical Treatment of Pediatric Patients With Median Arcuate Ligament Syndrome
Authors: Stiles‐Shields Colleen , Skelly Christopher L. , Mak Grace Zee , Speaker Christopher , Boyd Hope , O'Brien Setareh , Drossos Tina
Published: January 2018

Objective:

Median arcuate ligament syndrome (MALS) is a frequently overlooked cause of chronic abdominal pain (CAP), and results in many symptoms that mimic other gastrointestinal conditions that result in CAP. A small, but growing body of literature indicates that surgery improves quality of life (QOL) in patients with MALS. The purpose of the current study was to examine the psychological characteristics of pediatric patients with MALS to determine their prevalence and impact on surgical outcomes.

Methods:

Thirty‐two pediatric patients completed psychological assessments before surgery, and 6 months postsurgical intervention. Descriptive analyses and t tests were conducted to characterize the sample and compare psychosocial and QOL items. To explore possible associations between coping and ultimate changes in QOL, exploratory multiple regressions were conducted.

Results:

Comorbid psychological conditions were common, occurring in about half the sample before and after surgery. Current pain significantly improved, as well as patient and parent‐reported QOL constructs (Ps < 0.05). Parent‐reported observations of patients using catastrophizing or helpless strategies to cope with pain before surgery was significantly associated with changes in patient and parent‐reported QOL following surgery (Ps = 0.04).

Conclusions:

Comorbid psychological conditions are common in pediatric patients with MALS, and are maintained following surgery. While surgery improved pain and QOL, the need for presurgical psychological interventions for MALS is implicated.
Prevalence of Posttraumatic Stress Disorder in Patients With Multiple Sclerosis
Authors: Carletto Sara , Borghi Martina , Scavelli Francesco , Francone Diana , Perucchini Maria Luisa , Cavallo Marco , Pagnini Francesco , Bertolotto Antonio , Oliva Francesco , Ostacoli Luca
Published: January 2018

Chronic and life-threatening illnesses, such as multiple sclerosis (MS), have been identified as significant stressors potentially triggering posttraumatic stress disorder (PTSD). The study aims to investigate the prevalence of PTSD according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) criteria in a large sample of patients with MS. A total of 988 patients with MS were screened with the Impact of Event Scale–Revised, and then assessed with the PTSD module of the Structured Clinical Interview for DSM-IV and with the Clinician-Administered PTSD Scale to confirm PTSD diagnosis. Posttraumatic symptoms were reported by 25.5% of the sample. A confirmed diagnosis of PTSD was found in 5.7% of patients, but prevalence could reach 8.5%, including also dropout patients. Further studies are needed to evaluate if adjustment disorder could better encompass the frequently encountered subthreshold posttraumatic stress symptoms and how clinicians can deal with these symptoms with appropriate interventions.
Extended-Release Naltrexone Improves Viral Suppression Among Incarcerated Persons Living With HIV With Opioid Use Disorders Transitioning to the Community: Results of a Double-Blind, Placebo-Controlled Randomized Trial
Authors: Springer Sandra A. , Di Paola Angela , Azar Marwan M. , Barbour Russell , Biondi Breanne E. , Desabrais Maureen , Lincoln Thomas , Skiest Daniel J. , Altice Frederick L.
Published: January 2018

Objective:

To determine whether extended-release naltrexone (XR-NTX) would improve or maintain viral suppression (VS) among prisoners or jail detainees with HIV and opioid use disorder (OUD) transitioning to the community.

Design:

A 4-site, prospective randomized double-blind, placebo-controlled trial was conducted among prison and jail inmates with HIV and OUD transitioning to the community from September 2010 through March 2016.

Methods:

Eligible participants (N = 93) were randomized 2:1 to receive 6 monthly injections of XR-NTX (n = 66) or placebo (n = 27) starting at release and observed for 6 months. The primary outcome was the proportion that maintained or improved VS (<50 copies/mL) from baseline to 6 months.

Results:

Participants allocated to XR-NTX significantly improved to VS (<50 copies/mL) from baseline (37.9%) to 6 months (60.6%) (P = 0.002), whereas the placebo group did not (55.6% at baseline to 40.7% at 6 months P = 0.294). There was, however, no statistical significant difference in VS levels at 6 months between XR-NTX (60.6%) vs. placebo (40.7%) (P = 0.087). After controlling for other factors, only allocation to XR-NTX (adjusted odds ratio = 2.90; 95% confidence interval = 1.04 to 8.14, P = 0.043) was associated with the primary outcome. Trajectories in VS from baseline to 6 months differed significantly (P = 0.017) between treatment groups, and the differences in the discordant values were significantly different as well (P = 0.041): the XR-NTX group was more likely than the placebo group to improve VS (30.3% vs. 18.5%), maintain VS (30.3% vs. 27.3), and less likely to lose VS (7.6% vs. 33.3%) by 6 months.

Conclusions:

XR-NTX improves or maintains VS after release to the community for incarcerated people living with HIV with OUD.
Outpatient management of community-acquired pneumonia
Authors: Froes Filipe , Pereira João Gonçalves , Póvoa Pedro
Published: January 2018

Purpose of review

The first guidelines on community-acquired pneumonia (CAP) were published in 1993, but since then many of the challenges regarding the outpatient management of CAP persist. These include the difficulty in establishing the initial clinical diagnosis, its risk stratification, which will dictate the place of treatment, the empirical choice of antibiotics, the relative scarcity of novel antibiotics and the importance of knowing local microbiological susceptibility patterns.

Recent findings

New molecular biology methods have changed the etiologic perspective of CAP, especially the contribution of virus. Lung ultrasound and biomarkers might aid diagnosis and severity stratification in the outpatient setting. Antibiotic resistance is a growing problem that reinforces the importance of novel antibiotics. And finally, prevention and the use of anti–pneumococcal vaccine are instrumental in reducing the burden of disease.

Most of CAP cases are managed in the community; however, most research comes from hospitalized severe patients. New and awaited advances might contribute to aid diagnosis, cause and assessment of patients with CAP in the community. This knowledge might prove decisive in the execution of stewardship programmes that maintain current antibiotics, safeguard future ones and reinforce prevention.
Predictors of Impaired Mental Health and Support Seeking in Adults With Inflammatory Bowel Disease
Authors: Knowles Simon , Andrews Jane M. , Porter Anna
Published: January 2018

This study explored the possible factors associated with psychological distress in adults with inflammatory bowel disease (IBD) and also engagement in mental health services (MHS) in those reporting distress in a large Australian cohort. Participants with IBD completed an online survey assessing perceived IBD activity (Manitoba Index; MI), mental health status (K10), demographic details, and engagement with MHS for IBD-associated issues. Of 336 participants, 76.5% perceived themselves as having active disease over the past 6 months, and on K10 scores, 51.8% had a mental health issue. Of participants with a mental health issue, only 21.3% were currently receiving mental health support. A stepwise logistic regression analysis correctly classified 78.7% of the status of receiving mental health support, with lower income (<$60,000 per annum) the only significant predictor. Paradoxically, the degree of psychological distress did not correlate with seeking mental health support. The data show that in individuals with ongoing symptoms attributed to active IBD, mental health issues are highly prevalent, with older age and higher income being additional drivers of mental health issues. The greater challenge, however, seems not to be identifying mental health issues, but in getting those in need to engage in MHS.
Illness Cognitions and Health-Related Quality of Life of Patients With Inflammatory Bowel Disease
Authors: Gurková Elena , Soósová Mária Sováriová
Published: January 2018

Patients' cognitions about their disease and treatment are important mediators between health and quality of life of patients with chronic diseases and also explain the occurrence of individual differences in individuals' adjustment to chronic disease. The aim of this study was to examine the relationship between illness cognitions and health-related quality of life among adult patients with inflammatory bowel disease. Self-report data on illness cognition and health-related quality of life were collected from 118 people with Crohn disease or ulcerative colitis. Illness cognition of greater helplessness significantly predicted health-related quality of life in patients with inflammatory bowel disease. A relative contribution of acceptance and perceived benefits was not confirmed as a predictor of health-related quality of life. The other variables (type of disease, duration of disease, age, and episode of relapses) did not have statistical significance, except for gender. Results demonstrate that experiencing helplessness in relation to the disease, its treatment, and consequences can be generalized to patients in all areas of daily life, leading to deterioration in their overall psychological and physical functioning. These results can provide useful indicators of potential patient's adherence in treatment and self-management of inflammatory bowel disease.
Cost-Utility Analysis of Virtual and Mannequin-Based Simulation
Authors: Haerling Katie A.
Published: January 2018

Introduction

The purposes of this study were to (1) compare learning outcomes between students who participated in mannequin-based simulation activities and students who participated in virtual simulation activities and (2) describe a cost-utility analysis comparing the two types of simulation activities in terms of costs and multiple measures of effectiveness.

Methods

Nursing student participants were randomly assigned to one of two experimental groups to complete either a mannequin-based or virtual simulation activity. The simulation scenario was the same for both groups and involved the care of a hospitalized patient experiencing a chronic obstructive pulmonary disease exacerbation. Participants completed presimulation and postsimulation assessments reflecting qualitative and quantitative measures of learning. A random sample of participants from each group completed a postsimulation performance assessment during which they interacted one on one with a standardized patient.

Results

Eighty-four nursing students were enrolled in the study and completed the simulation activities. There were no significant differences in quantitative measures of learning or performance between participants in the mannequin-based and virtual simulation groups. Participants’ qualitative responses to postintervention written reflections and questions yielded additional data for describing learning from the two interventions. In the cost-utility analysis, the virtual simulation activity had a more favorable cost-utility ratio of US $1.08 versus the mannequin-based simulation activity’s US $3.62.

Conclusions

Healthcare educators striving to make evidence-based decisions about how to best employ simulation pedagogy may consider these findings about the cost utility of various simulation modalities. However, additional research is needed.
Validity of Simulation-Based Assessment for Accreditation Council for Graduate Medical Education Milestone Achievement
Authors: Isaak Robert S. , Chen Fei , Martinelli Susan M. , Arora Harendra , Zvara David A. , Hobbs Gene , Stiegler Marjorie P.
Published: January 2018

Introduction

The Accreditation Council for Graduate Medical Education requires biannual evaluation of anesthesiology residents on 25 subcompetency milestones. Some milestone domains are particularly challenging to repeatedly and reliably observe during clinical care. Simulation-Based Milestones Assessment (SBMA) may help overcome these challenges. However, few studies have examined the external validation of simulation assessment scores (ie, the relationships between simulation-based assessment scores and other standard measures of ability) for milestones. This study analyzed whether SBMA scores (1) discriminate by postgraduate year, (2) improve over time, and (3) correlate with traditional measures of performance.

Methods

This is a retrospective analysis of 55 residents' SBMA data from 30 scenarios for two academic years. Each scenario was evaluated for time-in-training discrimination. Scenarios were then analyzed for SBMA scoring trends over time, and SBMA scores were compared with residents' clinical evaluations.

Results

Twenty-four SBMA scenarios discriminated by postgraduate year. Repeated measure analysis of variance showed statistically significant between-session score improvements (F (3, 54) = 17.79, P < 0.001). Pearson correlation coefficients demonstrated moderate to strong correlation between SBMA and clinical evaluations: January 2015 r = 0.67, P < 0.01 (n = 27); May 2015 r = 0.43, P = 0.09 (n = 17); November 2015 r = 0.70, P < 0.01 (n = 24); and April 2016 r = 70, P < 0.01 (n = 27).

Conclusions

The associations between SBMA scores and experience level, time-in-training, and clinical performance evaluations provide evidence that SBMA may be used as metrics of residents' Accreditation Council for Graduate Medical Education milestone competencies.
Factors Associated With Pediatric Hospital-Acquired Pressure Injuries
Authors: Razmus Ivy
Published: January 2018

PURPOSE:

The purpose of this study was to identify associations among pediatric patient characteristics (age and gender), hospital characteristics, inpatient unit characteristics (unit type, pressure injury prevention practices, and nurse staffing measures), and hospital-acquired pressure injuries (HAPIs) in a group of pediatric patients and in those determined to be at risk for pressure injury.

DESIGN:

A descriptive, correlational analysis of data from a large dataset.

SUBJECTS AND SETTING:

The sample comprised 39,984 children aged 1 day to 18 years of age from 678 pediatric units in 271 participating hospitals across the United States.

METHODS:

Data related to pressure injuries and prevention among pediatric patients from the National Database of Nursing Quality Indicators (NDNQI) were analyzed. All data were collected during the year 2012. Descriptive statistics were used to summarize the study sample. Hierarchical logistic regression analysis was used to analyze patient age and gender, unit type, pressure injury risk, prevention and staffing measures, and hospital characteristics associated with HAPI.

RESULTS:

The likelihood of a HAPI was more than 9 times higher among patients who were determined to be at risk for pressure injuries (odds ratio [OR]: 9.42, 95% confidence interval [CI]: 7.28-12.17, P < .001) compared to patients deemed not at risk. Hospital-acquired pressure injury was more likely to occur on pediatric critical care units (OR: 2.59, 95% CI: 1.28-5.26, P = .009) and rehabilitation units (OR: 4.05, 95% CI: 1.21-13.55, P = .02). Patients from hospitals that only provided care for children (OR: 2.6, 95% CI: 1.42-4.78, P = .002) were also more likely to be associated with HAPI compared to hospitals that provided care for adults and children. Among the 11,203 pediatric patients deemed at risk for pressure injuries, 95.8% received one or more prevention interventions. There were no prevention interventions associated with a lower occurrence of HAPI.

CONCLUSIONS:

Study findings support pressure injury risk assessment among pediatric patients and elucidates important information regarding pediatric unit and hospital characteristics associated with HAPI.