bluuebunny/crossref_metadata_2025 huggingface dataset:
Locking Cap Designs Improve Fatigue Properties of Polyaxial Screws in Upper Extremity Applications
Authors: Namdari Surena , Mehta Samir , Tierney Ann , Hast Michael W.
Published: January 2017

Objectives:

This study sought to examine fatigue characteristics of 2 polyaxial locking screw designs: locking cap (LC) and cross-threaded (CT). The goal was to compare LC and CT implants at 0, 10, and 15 degrees of angulation to determine the effect of locking mechanism on screw–plate interface failure. The hypothesis was that LC implants would have superior fatigue properties in comparison to CT designs and that increased angulation of the screw would have a negative impact on the fatigue life of CT implants, but would not have any effect on LC implants.

Methods:

A total of 72 screws were tested in 4 upper extremity implants. Implants were subjected to cyclic shear loads and subsequent ramp to failure. Performance characteristics were statistically compared using nonparametric statistical methods.

Results:

Fatigue testing demonstrated that LC designs were consistently able to sustain a significantly higher number of cyclic loads than CT designs. There were no significant differences in the number of cycles sustained by LC designs because of changes in screw angle, but CT implants exhibited decreases in screw stability with increasing angulation.

Conclusions:

Likely because of the spherical screw head geometry, LC fatigue characteristics are not influenced by the orientation of the screw relative to the plate. Application of an LC in the operating room requires additional time, but provides significantly more robust fixation of the screw, especially at oblique angles to the plate and provides a more predictable and consistent biomechanical result.
Application of CASIA SS-1000 Optical Coherence Tomography Tear Meniscus Imaging in Testing the Efficacy of New Strip Meniscometry in Dry Eye Diagnosis
Authors: Shinzawa Megumi , Dogru Murat , Miyasaka Keiichi , Shimazaki Jun , Sekiryu Tetsuju
Published: January 2017

Purpose:

To investigate the applicability of CASIA SS-1000 anterior-segment optical coherence tomography (AS-OCT) imaging parameters in testing the efficacy of the new strip meniscometry (SM) namely “Strip Meniscometry Tube” (SMTube) in the diagnosis of dry eyes.

Methods:

Forty-three eyes of 22 patients (4 men and 18 women) with definite dry eye disease (DED) and 49 eyes of 28 normal controls (6 men and 22 women) were studied. All subjects underwent symptom questionnaires, SMTube, the Schirmer-1 test, tear film break-up time measurement, vital staining examinations, as well as tear meniscus height (TMH) and TM area (TMA) measurements using an AS-OCT system. We evaluated the cutoff values for the diagnosis of DED, looked into the correlations between TMH, TMA, and SMTube scores and checked the sensitivity and specificity of these parameters in the diagnosis of DED.

Results:

The mean values of TMH, TMA, and SMTube scores in the patient group were 0.138±0.102 mm, 0.013±0.015 mm2 and 1.4±2.3 mm, whereas those for the control group were 0.27±0.10 mm, 0.033±0.025 mm2 and 5.8±2.8 mm, respectively. The differences between both groups were significant (P<0.001). The cutoff values of TMH, TMA, and SMTube for DED were 0.197 mm, 0.020 mm2 and 3.8 mm, respectively. SMTube had significant correlations with TMH (r=0.82, P<0.001) and TMA (r=0.86, P<0.001).

Conclusions:

The SMTube was useful in DED diagnosis, the validity of which could be effectively evaluated by the CASIA SS-1000 AS-OCT TM parameters.
Endoscopic Cyclophotocoagulation for the Treatment of Glaucoma in Boston Keratoprosthesis Type II Patient
Authors: Poon Linda Yi-Chieh , Chodosh James , Vavvas Demetrios G. , Dohlman Claes H. , Chen Teresa C.
Published: January 2017

We describe the surgical technique of endoscopic cyclophotocoagulation in a Boston keratoprosthesis type II patient. This patient with ocular cicatricial pemphigoid had pars plana endoscopic cyclophotocoagula through wounds created in the eyelids.
Prophylactic Antibiotics for Enucleation and Evisceration: A Retrospective Study and Systematic Literature Review
Authors: Pariseau Brett , Fox Barry , Dutton Jonathan J.
Published: January 2017

Purpose:

To report surgical site infection (SSI) rates of eviscerations and enucleations with implants performed without perioperative intravenous (IV) antibiotics or postoperative oral antibiotics, and to give SSI prevention recommendations.

Methods:

A single-center retrospective chart review was performed after obtaining institutional review board approval. Charts were found by Current Procedural Terminology codes. Demographics, surgical indication, procedure, implant, antibiotic use, and postoperative course were recorded. SSIs occurring within 30 days after surgery were reviewed and postoperative infection rates were determined.

Results:

Four hundred eighty-one cases from January 1999 to December 2015 were analyzed. There were 102 eviscerations with implants, 314 enucleations with implants, 23 enucleations without implants, 23 implant exchanges, 15 implants placed secondarily after enucleation, and 4 implant removals. Seventy cases (14.6%) were given perioperative IV antibiotics, and in this group one periorbital infection occurred unrelated to orbital surgery (1.4%). Of the 411 cases (85.4%) not given perioperative IV antibiotics, 1 of 87 eviscerations with implants developed an SSI (1.1%), 2 of 273 enucleations with implants developed SSIs (0.7%), and none of the 13 enucleations without implants developed SSIs.

Conclusions:

To our knowledge, this is the first published case series reporting SSI rates of enucleations and eviscerations with implants performed without perioperative IV antibiotics or postoperative oral antibiotics. With infection rates comparing favorably to other case series where antibiotics were given, the routine use of perioperative IV antibiotics and postoperative oral antibiotics for enucleations and eviscerations may not be indicated.
The Current Status of Nursing Professionalism Among Nursing Faculty in Japan
Authors: Tanaka Michiko , Taketomi Kikuko , Yonemitsu Yoshikazu , Kawamoto Rieko
Published: January 2017

Background:

The faculty of nursing schools plays an important role in the successful execution of nursing education. Therefore, faculty behavior strongly affects the professional development of nurses. However, few studies have examined professional nursing behaviors from the perspective of nursing faculty.

Purpose:

Members of nursing faculty in Japan were surveyed regarding their perspectives on behaviors related to professionalism.

Methods:

The model, Miller’s Wheel of Professionalism in Nursing, was used as the theoretical framework. The Behavioral Inventory for Professionalism in Nursing (BIPN) was completed by 74 full-time nursing faculty who were currently working at 10 institutes of nursing education in Japan.

Results:

The mean BIPN score for the participants was 11.56 (SD = 6.08) of a possible total of 27. The highest and lowest BIPN category scores were for “research development, use, and evaluation” and “community service,” respectively. Professionalism was found to relate significantly to higher educational preparation (F = 32.17, p < .0001). The Tukey–Kramer multiple comparison test found a significant association between having a graduate degree and higher scores for professionalism (p < .0001). The Spearman correlation coefficient was significant and positive for the relationship between professionalism and both educational preparation (r = .85, p < .0001) and number of years as a nursing educator (r = .31, p = .0077).

Conclusions:

The results support the idea that a higher level of educational preparation and more years of experience as a member of a nursing faculty are associated with higher levels of nursing professionalism. The professional behavior scores suggest that “community service” is an issue that requires further improvement among Japanese nursing faculty. Awareness of extrinsic factors such as education is important to maximize nursing professionalism. The findings of this study may help nursing faculty continue their self-development.
Translation and Psychometric Testing of the Chinese Version of the Multidimensional Assessment of Interoceptive Awareness
Authors: Lin Feng-Lien , Hsu Chin-Che , Mehling Wolf , Yeh Mei-Ling
Published: January 2017

Background:

Mind–body interventions are used to alleviate physical and psychological symptoms. The multidimensional assessment of interoceptive awareness (MAIA), which is used to self-report the effects of mind–body interventions, is not currently available in Chinese.

Purpose:

This study aimed to translate the MAIA from English into Chinese (MAIA-C) and to examine the psychometric properties of the MAIA-C.

Methods:

This was a methodological study. The MAIA was translated forward and backward systematically, and content validity was assessed by a panel of experts. A convenience sample of adult participants with mind–body practice was recruited from social clubs in Taiwan. The MAIA-C was administered to study participants. Internal consistency and test–retest reliability were tested using Cronbach’s alpha and intraclass correlation coefficient. Construct validity was assessed in two ways: using confirmatory factor analysis and using the differences between the known groups to divide the sample into two groups of highly experienced and less experienced participants.

Results:

The complete data for the 294 participants were analyzed. The eight-factor structure of the MAIA-C was confirmed. Cronbach’s α was .91 overall and .46–.88 for the individual scales of the instrument. Intraclass correlation coefficient and composite reliability for the scales ranged from .60 to .85 and .55 to .87, respectively. The result of confirmatory factor analysis revealed a fair fit of the model to the data with a root mean square error of approximation of .076 and a comparative fit index of .95. Significant differences were found for the seven scales between the two groups.

Conclusions/Implications for Practice:

The MAIA-C showed acceptable reliability and validity in psychometric testing. Therefore, this scale may be used in studies that assess interoceptive awareness in Chinese-speaking populations who are undergoing mind–body interventions.
Assessment of Cochlea Endolymphatic Hydrops Using 3-D FLAIR and 3-D Real IR Sequence in Guinea Pigs via 3T MRI After Intratympanic Gadolinium: A Histopathological Comparison
Authors: Wang Feng , Lyu Huiying , Zhao Menglong , Sha Yan , Zhang Fang , Cheng Yushu , Huang Wenhu , Tang Wenlin , Xie Youzhou , Lu Ping
Published: January 2017

Objective:

We assessed whether the three-dimensional fluid-attenuated inversion-recovery (3-D FLAIR) and three-dimensional inversion-recovery with real reconstruction (3-D real IR) sequences can be used to detect cochlea endolymphatic hydrops (EHs) in guinea pigs using 3 Tesla magnetic resonance imaging (3T MRI). The results of 3-D real IR imaging were compared with histopathological outcomes.

Materials and Methods:

Fourteen healthy men and women albino guinea pigs were used in this study. Their right ears received procedures that promoted EHs, and their left ears were used as untreated controls. High-resolution 3T MRI, combined with the intratympanic injection of gadolinium (Gd) in both ears, was performed 8 to 12 weeks after surgery. Both sides of the cochlea midmodiolar sections were observed under a light microscope and saved as the histopathological images. The signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) between the T2-weighted 3-D FLAIR and T2-weighted 3-D real IR sequences were compared. The appearance of EHs in the basal, second, third, and apical turns of the cochlea was further evaluated using 3-D FLAIR, 3-D real IR, and the histopathological images. Moreover, the maximum scala media area ratios (SMRs) on the histopathological sections were compared with the grading of the EHs on the 3-D real IR sequence with regard to each turn of the cochlea.

Results:

Significant differences were found between the 3-D FLAIR and 3-D-real IR sequences with regard to the SNRs and CNRs (p < 0.05): the 3-D FLAIR sequence exhibited higher SNRs (SNRROI: 347.95 ± 105.01; SNRB: 103.28 ± 17.61) compared with the 3-D real IR sequence (SNRROI: 86.71 ± 30.11; SNRB: 11.11 ± 3.45), whereas the 3-D real IR sequence showed higher CNRs (2.78 ± 0.58) compared with the 3-D FLAIR sequence (2.18 ± 0.55). Various degrees of EHs were observed in each turn of the cochlea in the experimental ears on the basis of the histopathological images. Thirteen, 10, 4, and 0 EHs were observed in the basal, second, third, and apical turns of the cochlear using 3-D FLAIR images, respectively, whereas 14, 14, 14, and 13 EHs were found using 3-D real IR images, respectively. Significant differences were found between the two sequences when evaluating the second, third, and apical turns of the cochlear but not with regard to the basal turn (p < 0.05). The SMRs were proportional to the extent of the EHs on 3-D real IR imaging in each turn of the cochlea.

Conclusions:

3-D real IR images are clearer than 3-D FLAIR images, and they can display cochlea EHs more precisely using 3T MRI in guinea pigs. The extent of the EHs on 3-D real IR imaging was more consistent with the histopathological observations in each turn of the cochlea.
The Irish Helicobacter pylori Working Group consensus for the diagnosis and treatment of H. pylori infection in adult patients in Ireland
Authors: Smith Sinead , Boyle Breida , Brennan Denise , Buckley Martin , Crotty Paul , Doyle Maeve , Farrell Richard , Hussey Mary , Kevans David , Malfertheiner Peter , Megraud Francis , Nugent Sean , O’Connor Anthony , O’Morain Colm , Weston Shiobhan , McNamara Deirdre
Published: January 2017

Background

Irish eradication rates forHelicobacter pyloriare decreasing and there is an increase in the prevalence of antibiotic-resistant bacteria. These trends call into question current management strategies.

Objective

To establish an IrishHelicobacter pyloriWorking Group (IHPWG) to assess, revise and tailor current available recommendations.

Methods

Experts in the areas of gastroenterology and microbiology were invited to join the IHPWG. Questions of relevance to diagnosis, first-line and rescue therapy were developed using the PICO system. A literature search was performed. The ‘Grading of Recommendations Assessment, Development and Evaluation’ approach was then used to rate the quality of available evidence and grade the resulting recommendations.

Results

Key resultant IHPWG statements (S), the strength of recommendation and quality of evidence include S8: standard triple therapy for 7 days’ duration can no longer be recommended (strong and moderate). S9: 14 days of clarithromycin-based triple therapy with a high-dose proton pump inhibitor (PPI) is recommended as first-line therapy. Bismuth quadruple therapy for 14 days is an alternative if available (strong and moderate). S12: second-line therapy depends on the first-line treatment and should not be the same treatment. The options are (a) 14 days of levofloxacin-based therapy with high-dose PPI, (b) 14 days of clarithromycin-based triple therapy with high-dose PPI or (c) bismuth quadruple therapy for 14 days (strong and moderate). S13: culture and antimicrobial susceptibility testing should be performed following two treatment failures (weak and low/very low).

Conclusion

These recommendations are intended to provide the most relevant current best-practice guidelines for the management ofH. pyloriinfection in adults in Ireland.
Stage of fibrosis and portal pressure correlation in nonalcoholic steatohepatitis
Authors: Sourianarayanane Achuthan , Talluri Jyothsna , Humar Abinav , McCullough Arthur J.
Published: January 2017

Background

Hepatic venous pressure gradient (HVPG) measurement correlates with staging of liver fibrosis. Patients with nonalcoholic steatohepatitis (NASH) have a different pattern of fibrosis compared with hepatitis C virus (HCV) with possible alterations in pressures.

Aim

The aim of this study was to compare portal pressures with the stage of fibrosis in NASH in comparison with other liver diseases.

Patients and methods

Records of all patients who had undergone transjugular liver biopsy with pressure measurements between January 2001 and June 2013 were reviewed. Wedge hepatic venous pressure (WHVP) and HVPG were compared with stages of fibrosis in liver diseases of different etiologies.

Results

Among 142 patients included in this study, the liver disease etiology was as follows: HCV (26.6%) and NASH (24.6%), with the remaining (38.7%) grouped under other categories. The mean age of the patients was 51.2±11.5 years, with more men with HCV (73.1%) compared with NASH (51.4%) in terms of etiology (P=0.046). There were strong correlations between the stage of fibrosis with both the HVPG (r=0.64; P<0.0001) and the WHVP (r=0.63; P<0.0001) in NASH patients. Compared with HCV patients, NASH patients had a lower HVPG (3.4±2.4 vs. 7.5±11 mmHg/stage; P=0.01) with a coefficient estimate of −0.24 (P=0.017) and WHVP (9.6±5.5 vs. 14.6±15.2 mmHg/stage; P=0.03) for the stage of fibrosis.

Conclusion

HVPG and WHVP measurements were strongly correlated with stages of fibrosis in NASH. Patients with NASH had lower HVPG and WHVP for each stage of fibrosis compared with HCV patients. This raises the concern of underestimation of pressures by HVPG in NASH etiology for the stage of disease or increased fibrosis despite lower pressures in them.
‘Single-checked’ Patient Group Directions during initial nurse assessment within paediatric emergency departments of the UK and Ireland
Authors: Bird Chris K. , Sinclair Anthony G. , Hartshorn Stuart
Published: January 2017

Objective

Double checking medications at initial assessment within paediatric emergency departments (EDs) has the potential to delay patient flow, and doubt has been cast on the efficacy of double checking in all but high-risk medications. We aimed to benchmark current practice for the use of Patient Group Direction (PGD) medications at initial assessment in EDs within the Paediatric Emergency Research UK and Ireland (PERUKI) network, with a focus on the use of ‘single-checker’ PGDs.

Methods

Online survey was distributed to the research representative at each PERUKI site. The survey was open for 5 weeks (from March 2015 to April 2015) and was completed by any appropriate clinician within the site.

Results

The response rate was 84% (36/43 EDs). From these, 22 out of 36 (61%) EDs were using single-checker PGDs. The commonest single-checked medications in use were paracetamol and ibuprofen for pain. Among PERUKI sites, 21.9% of EDs reported drug errors related to standard (double-checked) PGDs, whereas 13.6% of those with single-checked PGDs reported drug errors (Fisher’s exact test with significance level of 0.05, P=0.501). The commonest errors reported were duplicated dose, incorrect weight, incorrect volume drawn up, contraindication missed.

Conclusion

Single-checker PGDs are currently in use in nearly two-thirds of PERUKI sites. No evidence of increased medication errors was reported with this practice; however, more detailed studies are required to support this finding and to inform best practice.
The Effect of Authentic Leadership, Person-Job Fit, and Civility Norms on New Graduate Nurses’ Experiences of Coworker Incivility and Burnout
Authors: Laschinger Heather K. Spence , Read Emily A.
Published: January 2017

OBJECTIVE:

This study examined the influence of authentic leadership, person-job fit with 6 areas of worklife, and civility norms on coworker incivility and burnout among new graduate nurses.

BACKGROUND:

New graduate nurses report experiencing high levels of workplace incivility from coworkers, which has been found to negatively impact their job and career satisfaction and increase their intention to leave. The role of civility norms in preventing burnout and subsequent exposure to incivility from coworkers has yet to be examined among new graduate nurses.

METHODS:

A cross-sectional mail survey of 993 new graduate nurses across Canada was conducted.

RESULTS:

The results supported the hypothesized relationships between study variables.

CONCLUSIONS:

Civility norms play a key role in preventing early career burnout and coworker incivility experienced by new graduate nurses. Leaders can influence civility norms by engaging in authentic leadership behaviors and optimizing person-job fit.
Nurse Engagement in Shared Governance and Patient and Nurse Outcomes
Authors: Kutney-Lee Ann , Germack Hayley , Hatfield Linda , Kelly Sharon , Maguire Patricia , Dierkes Andrew , Del Guidice Mary , Aiken Linda H.
Published: January 2017

OBJECTIVE:

The objectives of this study were to examine differences in nurse engagement in shared governance across hospitals and to determine the relationship between nurse engagement and patient and nurse outcomes.

BACKGROUND:

There is little empirical evidence examining the relationship between shared governance and patient outcomes.

METHODS:

A secondary analysis of linked cross-sectional data was conducted using nurse, hospital, and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data.

RESULTS:

Engagement varied widely across hospitals. In hospitals with greater levels of engagement, nurses were significantly less likely to report unfavorable job outcomes and poor ratings of quality and safety. Higher levels of nurse engagement were associated with higher HCAHPS scores.

CONCLUSIONS:

A professional practice environment that incorporates shared governance may serve as a valuable intervention for organizations to promote optimal patient and nurse outcomes.
The Role of the Nurse Executive in Rural Hospital Closure
Authors: Warden Deborah Hughes , Probst Janice C.
Published: January 2017

Between 2010 and June 2016, 75 rural hospitals closed, and more than 250 more are at risk of closure. Nurse executives need to be prepared for this eventuality. There is a need for formal direction on how to close a highly regulated healthcare facility.
Do Leadership Style, Unit Climate, and Safety Climate Contribute to Safe Medication Practices?
Authors: Farag Amany , Tullai-McGuinness Susan , Anthony Mary K. , Burant Christopher
Published: January 2017

OBJECTIVES:

This study aims at: examining if leadership style and unit climate predict safety climate; and testing the direct, indirect, and total effect of leadership style, unit climate, and safety climate on nurses’ safe medication practices.

BACKGROUND:

The Institute of Medicine and nursing scholars propose that safety climate is a prerequisite to safety practices. However, there is limited empirical evidence about factors contributing to the development of safety climate and about the association with nurses’ safe medication practices.

METHOD:

This cross-sectional study used survey data from 246 RNs working in a Magnet® hospital.

RESULTS:

Leadership style and unit climate predicted 20% to 50% of variance on all safety climate dimensions. Model testing revealed the indirect impact of leadership style and unit climate on nurses’ safe medication practices.

CONCLUSION:

Our hypothesized model explained small amount of the variance on nurses’ safe medication practices. This finding suggests that nurses’ safe medication practices are influenced by multiple contextual and personal factors that should be further examined.
Wired to the Workplace
Authors: Gardner Candace , Hailey Amy , Nguyen Christi , Prichard Charlsea , Newcomb Patricia
Published: January 2017

OBJECTIVE:

The aim of this study is to describe the beliefs and behaviors of nurse leaders regarding electronic connectedness with their workplace and workplace support.

BACKGROUND:

Electronic communication enables leaders’ continuous availability to the workplace. This may blur home-work boundaries and contribute to burnout.

METHODS:

This mixed-methods study surveyed nurses in 6 acute care hospitals in north Texas. A qualitative phase employed focus groups composed of nurses from participating hospitals to validate and enrich data collected in the quantitative phase.

RESULTS:

Data showed that leader support directly influenced work-related electronic communication by influencing expectations regarding connectedness. Furthermore, leaders who frequently thought of leaving employment reported significantly lower levels of supervisor support and stronger beliefs that work interfered with home life than other respondents did. Focus group data supported survey findings.

CONCLUSIONS:

Electronic availability of nurse leaders did not directly affect satisfaction, but supervisor support and perception that work interferes with home life strongly and directly affected satisfaction.
Accountable Care Organization Implementation Experiences and Rural Participation
Authors: Bagwell Matt Thomas , Bushy Angeline , Ortiz Judith
Published: January 2017

BACKGROUND:

Little is known about how accountable care organizations (ACOs) participate with rural health providers. This pilot study examines ACO participation with rural health clinics (RHCs).

METHODS:

Telephone interviews with 8 ACO administrators were conducted to determine the early implementation experiences of these organizations, and their participation with rural health providers, such as RHCs, using qualitative content analysis, ACO characteristics, and emerging themes from the ACO executive responses was identified.

RESULTS:

Three predominant themes emerged: 1) ACOs are growing in size and number and have various organizational structures; 2) there is an expanding emphasis on preventive primary care and chronic disease management for patients; and 3) there is a need for improved information technology integration with clinical services and financial systems.

CONCLUSION:

Of 8 participants, 7 reported that their ACO was planning to expand into rural areas and partner with rural providers.
The Effect of Reported Sleep, Perceived Fatigue, and Sleepiness on Cognitive Performance in a Sample of Emergency Nurses
Authors: Wolf Lisa A. , Perhats Cydne , Delao Altair , Martinovich Zoran
Published: January 2017

OBJECTIVE:

The aim of this study is to explore the relationship between reported sleep, perceived fatigue and sleepiness, and cognitive performance.

BACKGROUND:

Although evidence suggests that fatigue and sleepiness affect the provision of care in inpatient units, there is a lack of research on the sleep patterns of emergency nurses and the effects of disturbed sleep and fatigue on their cognitive abilities and susceptibility to medical errors.

METHODS:

A quantitative correlational design was used in this study; in each of 7 different statistical models, zero-order relationships between predictors and the dependent variable were examined with appropriate inferential tests.

RESULTS:

Participants reported high levels of sleepiness and chronic fatigue that impeded full functioning both at work and at home.

CONCLUSIONS:

Although high levels of self-reported fatigue did not show any effects on cognitive function, other factors in the environment may contribute to delayed, missed, or inappropriate care. Further research is indicated.
Clinician Perceptions of Teamwork in the Emergency Department
Authors: Weaver Amy L. , Hernandez Susan , Olson Daiwai M.
Published: January 2017

OBJECTIVE:

This study was intended to determine whether positioning emergency department (ED) physicians, physician assistants, and nurse practitioners at the same workstations as registered nurses (RNs) improved communication and teamwork.

BACKGROUND:

Historically in this organization, providers and staff had separate physical locations (workstations). Construction of a new ED provided the opportunity to redesign the physical layout and to study whether a new design improved the perception of communication and teamwork among medical providers.

METHODS:

A prospective, self-administered presurvey-postsurvey using the TeamSTEPPS Teamwork Perceptions Questionnaire (TPQ) was completed at 2 medical centers with the same staff premove and postmove but different ED designs. The presurvey was conducted while the staff were at the older facility with a more linear floor design and separated nurse and physician stations. The postsurvey was conducted 3 months after employees and physicians were relocated to a new hospital with a pod design and communal workstations in the ED.

RESULTS:

Forty-six staff members completed both the presurvey and the postsurvey. There was a statistically significant improvement in the total TPQ scores (P = .0009) and 4 of the 5 components of the TPQ: team structure (P = .0283), situation monitoring (P = .0006), mutual support (P < .0001), and communication (P < .0001). There was no change in the leadership component (P = .4519).

CONCLUSIONS:

Adopting a more communal physical layout was associated with improved overall TPQ scores and most of the TPQ components. The lack of change in the leadership component was explained by the lack of change in leadership structure. The physical placement of medical providers and RNs in an ED is important and can increase the perception of communication and teamwork and thereby improve patient outcomes.
Improving the Use of Evidence-Based Practice and Research Utilization Through the Identification of Barriers to Implementation in a Critical Access Hospital
Authors: Stavor Dawn Carol , Zedreck-Gonzalez Judith , Hoffmann Rosemary L.
Published: January 2017

OBJECTIVE:

This study explored the relationship between perceived barriers to research use and the implementation of evidence-based practice (EBP) among rural hospital nurses.

BACKGROUND:

The Institute of Medicine recommends that 90% of clinical decisions be evidence based by 2020.

METHODS:

This descriptive, quality improvement study used a convenience sampling of registered nurses (RNs). Participants completed multiple questionnaires.

RESULTS:

Overall the attitude toward EBP was positive. Nurses recognize the importance to their practice but identified a lack of educational preparation regarding the process of research utilization.

CONCLUSION:

Providing education on research process and supportive monitoring during implementation may increase compliance with EBP initiatives.
Transmission Behaviors and Prevalence of Chlamydia and Gonorrhea Among Adult Film Performers
Authors: Javanbakht Marjan , Dillavou M. Claire , Rigg Robert W. , Kerndt Peter R. , Gorbach Pamina M.
Published: January 2017

Background

Adult film work involves multiple sex partners, unprotected intercourse and frequent oral/rectal contact. Data on sexual networks and sexual behaviors of adult film performers (AFP) are limited.

Methods

From August 2012 to May 2013, AFPs in Los Angeles, CA, seeking care at 2 clinics that provide sexually transmitted infections (STIs) testing to performers were offered urogenital, pharyngeal, and rectal chlamydia/gonorrhea testing. Participants were 18 years or older and performed in at least 1 adult film scene within the past year. A Web-based survey was used to collect sexual behavior information.

Results

A total of 360 AFPs were enrolled; 75% (n = 271) were women, and the median age was 25 years (interquartile range, 22–31 years). Most reported a main partner (73%), 23% reported non-film transactional partners, and only 6% reported always using condoms on-set. Overall, 24% (n = 86) tested positive for chlamydia or gonorrhea; 15% for chlamydia (n = 54) and 11% for gonorrhea (n = 41). Prevalence of chlamydia/gonorrhea varied by time as a performer (median, year 2 vs year 3; P = 0.06), and days of adult film-work in the past 30 days (median, 6 days vs 4 days; P = 0.02). In multivariable analyses, age (adjusted odds ratio, 0.90; 95% confidence interval, 0.85–0.96) and type of scene (adjusted odds ratio for double vaginal = 2.89; 95% confidence interval, 1.29–6.48) were associated with chlamydia/gonorrhea positivity.

Conclusions

Adult film performers had a high prevalence of STIs and reported low levels of condom use in the context of most sexual partnerships. Targeted intervention strategies—both in and outside the workplace—are needed to limit the spread of STIs.
Expression of Glucose-Regulated Protein 78 and miR-199a in Rat Brain After Fatal Ligature Strangulation
Authors: Feng Xueying , Zhang Dongchuan , Gong Qingjin , Zhang Zhiyong , Quan Li
Published: January 2017

The roles of endoplasmic reticulum (ER) stress and microRNA in the brain tissue after fatal mechanical asphyxia have not been clearly elucidated. We examined the expression of glucose-regulated protein 78 (GRP78), the key regulator of unfolded protein response, and miR-199a in the brain tissues of rats subjected to fatal ligature strangulation to understand the roles of ER stress and microRNA in ligature strangulation. The expressions of GRP78 and miR-199a in rat cortex, hippocampi, and midbrain were measured by immunohistochemistry and Western blot analysis in a rat model of ligature strangulation. Furthermore, the levels of miR-199a-3p and miR-199a-5p were detected by real-time fluorescent quantitative polymerase chain reaction. Glucose-regulated protein 78 was highly expressed in the cortex and midbrain in the ligature strangulation group (P < 0.01) when compared with the control group. The expression of GRP78 in the hippocampi showed no significant difference between the 2 groups. miR-199a-3p in the cortex and midbrain was significantly down-regulated in the ligature strangulation group (P < 0.01). However, miR-199a-5p in each brain region showed no significant difference between the 2 groups. In conclusion, ER stress was involved in the physiological and pathological processes of ligature strangulation. Furthermore, upstream miR-199a may play an important regulatory role in mechanical asphyxia.
Prognostic Impact of MUM1/IRF4 Expression in Burkitt Lymphoma (BL)
Authors: Satou Akira , Asano Naoko , Kato Seiichi , Elsayed Ahmed A. , Nakamura Naoya , Miyoshi Hiroaki , Ohshima Koichi , Nakamura Shigeo
Published: January 2017

MUM1/IRF4 expression is detected in 18% to 41% of Burkitt lymphoma (BL). However, only a few studies of MUM1-positive (MUM1+) BL have been reported, and its characteristics still remain controversial. To highlight the features of MUM1+ BL, we compared the clinicopathologic characteristics of 37 cases of MUM1+ and 51 cases of MUM1-negative (MUM1−) BL in Japan. Compared with MUM1− BL, patients with MUM1+ BL showed significantly younger onset (P=0.0062) and a higher ratio of females (P=0.013). We have also revealed the difference in the involved sites. The MUM1+ group showed lower incidences of involvement of stomach (P=0.012) and tonsil (P=0.069). There was a more tendency in MUM1+ group to involve colon (P=0.072), breast (P=0.073), and kidney (P=0.073). Regarding the prognosis, a trend toward a lower overall survival for MUM1+ group was noted (P=0.089). Notably, comparing MUM1+ and MUM1− BL cases of adults (age16 y old and above), the former showed significantly worse prognosis (P=0.041). Among the BL patients treated with the intensive chemotherapy, a standard therapy for BL, MUM1+ cases showed worse prognosis (P=0.056). In conclusion, MUM1+ BL showed worse prognosis, particularly in adult cases, compared with MUM1− BL. In addition, the difference of the onset age, sex ratio, and involved sites between the 2 groups was noted. Our results demonstrate that MUM1 expression might predict worse prognosis of BL, and MUM1+ BL should be distinguished from MUM1− BL.
Does the Use of a Vein Visualization Device for Peripheral Venous Catheter Placement Increase Success Rate in Pediatric Patients?
Authors: Demir Duygu , Inal Sevil
Published: January 2017

Background

Peripheral intravenous catheterization is one of the most frequently encountered medical procedures for hospitalized children and is one that can often be painful. Pediatric nurses should therefore use techniques that increase the success rate or shorten the duration of peripheral intravenous catheterization.

Objectives

This study was performed with the objective of determining the effect of using a vein visualization device on the success of the procedure. Success was determined based on the number of attempts per patient, the duration of the procedure, and the first stick success rate.

Methods

This was a randomized, controlled experimental study on 129 children aged 3 to 18 years.

Results

The duration of peripheral intravenous catheterization was shorter in the study group (S) than in the control (C) patients (37.24 ± 20.07 vs 172.65 ± 153.21 seconds; P = 0.001), with fewer attempts (S, 1.08 ± 0.28; C, 2.23 ± 1.57; P < 0.01). The first stick success rate was higher in the control group (S, 91.7%; C, 47.4%; P = 0.001).

Conclusions

Peripheral intravenous catheterization using vein visualization device support reduces the number of attempts per patient and the operation duration but increases the rate of first stick success. We may therefore state that vein visualization device support improves the success of peripheral intravenous catheterization.
Swimming Pool Electrical Injuries
Authors: Tashiro Jun , Burnweit Cathy A.
Published: January 2017

Objective

Electrical injuries in swimming pools are an important pediatric public health concern. We sought to (1) improve our understanding of the clinical presentation and outcomes following and (2) describe the epidemiology of swimming pool electrical injuries in the United States.

Methods

We reviewed 4 cases of pediatric (<18 y old) electrical injury from a single, urban level 1 pediatric trauma center. We also queried the National Electronic Injury Surveillance System (NEISS) for emergency department visits due to electrical injury associated with swimming pools, occurring between 1991 and 2013.

Results

Overall, 566 cases were reported, with a mean (SD) age of 9.2 (4.1) years. Patients were mostly treated and released from the emergency department (91.8%), whereas 8.2% were hospitalized. When stated, injuries occurred most frequently at home (57.0%), followed by public (23.9%) and sports facilities (19.1%). Electrical outlets or receptacles (39.8%) were most commonly implicated, followed by electrical system doors (18.2%), electric wiring systems (17.0%), thermostats (16.3%), hair dryers (4.6%), and radios (4.1%). Pediatric cases represented 48.4% of swimming pool–related electrical injuries reported to NEISS.

Conclusions

Electrical injuries occurring in and around swimming pools remain an important source of morbidity and mortality. Although NEISS monitors sentinel events, current efforts at preventing such cases are less than adequate. All electrical outlets near swimming pools should be properly wired with ground fault circuit interrupter devices. Possible approaches to increasing safe electrical device installation are through strengthening public awareness and education of the potential for injury, as well as changes to current inspection regulations.
Instruments to Identify Commercially Sexually Exploited Children
Authors: Armstrong Stephanie
Published: January 2017

Objective

This review examines the screening instruments that are in existence today to identify commercially sexually exploited children. The instruments are compared and evaluated for their feasibility of use in an emergency department setting.

Methods

Four electronic databases were searched to identify screening instruments that assessed solely for commercial sexual exploitation. Search terms included “commercially sexually exploited children,” “CSEC,” “domestic minor sex trafficking,” “DMST,” “juvenile sex trafficking,” and “JST.” Those terms were then searched in combination with each of the following: “tools,” “instruments,” “screening,” “policies,” “procedures,” “data collection,” “evidence,” and “validity.”

Results

Six screening instruments were found to meet the inclusion criteria. Variation among instruments included number of questions, ease of administration, information sources, scoring methods, and training information provided. Two instruments were determined to be highly feasible for use in the emergency department setting, those being the Asian Health Services and Banteay Srei's CSEC Screening Protocol and Greenbaum et al's CSEC/child sex trafficking 6-item screening tool.

Conclusions

A current dearth of screening instruments was confirmed. It is recommended that additional screening instruments be created to include developmentally appropriate instruments for preadolescent children. Numerous positive features were identified within the instruments in this review and are suggested for use in future screening instruments, including succinctness, a simple format, easy administration, training materials, sample questions, multiple information sources, designation of questions requiring mandatory reporting, a straightforward scoring system, and an algorithm format.
World Health Organization Framework: Multimodal Hand Hygiene Strategy in Piedmont (Italy) Health Care Facilities
Authors: Bert Fabrizio , Giacomelli Sebastian , Ceresetti Daniela , Zotti Carla Maria
Published: January 2017

Objectives

In 2009, the World Health Organization (WHO) introduced the “Hand Hygiene Self-Assessment Framework” (HHSAF) to evaluate the level of the application of the Multimodal Hand Hygiene Improvement Strategy (MHHIS), which defines preventive interventions, standards, and tools conceived to improve hand hygiene in healthcare facilities. The aim of our study was to evaluate the implementation of the MHHIS in Piedmont healthcare units in 2014 using the HHSAF document.

Methods

Our surveillance was performed through collection and analysis of the data from 50 Piedmont healthcare facilities recorded through the HHSAF in 2014. The HHSAF describes the hand hygiene level evaluating the following 5 parameters: system changes, education/staff training, evaluation and feedback, reminders in the workplace, and promotion of an institutional safety climate.

Results

We reported that 70.4% of the healthcare facilities involved in the study achieved the intermediate hand hygiene level, 19% the advanced level, and 11% the basic level. No facility exhibited an inadequate level of WHO multimodal implementation. Only 55% of the healthcare units provided information about hand hygiene to patients, and only 15% actively involved patients and their families.

Conclusions

The implementation of the MHHIS has achieved important results all over the world in terms of hand hygiene. Piedmont has reached an overall good level, particularly in terms of the supply and availability of hand washing products and staff education. Our results revealed, however, some critical issues related to direct and indirect monitoring of hand hygiene, providing reminders and the active involvement of patients, family members, and caregivers.
Feasibility and Technique for Transvaginal Natural Orifice Transluminal Endoscopic Surgery Liver Resection: A Porcine Model
Authors: Katagiri Toshio , Otsuka Yuichiro , Horgan Santiago , Sandler Bryan J. , Jacobsen Garth R. , Coker Alisa M. , Tsuchiya Masaru , Maeda Tetsuya , Kaneko Hironori
Published: January 2017

Introduction:

Natural orifice transluminal endoscopic surgery (NOTES) is a challenging minimally invasive procedure. Although laparoscopic techniques for liver resection are gaining acceptance worldwide, few studies have investigated NOTES liver resection. We used a porcine model to assess the feasibility and safety of transvaginal NOTES liver resection (TV NOTES LR).

Materials and Methods:

Nine female pigs underwent TV NOTES LR. A nonsurvival acute porcine model with general anesthesia was used in all cases. Using hybrid NOTES technique, we placed only 1 umbilical 12-mm umbilical trocar in the abdominal wall, which was used to create pneumoperitoneum. A laparoscope was then advanced to obtain intra-abdominal visualization. A 15-mm vaginal trocar was inserted under direct laparoscopic vision, and a flexible endoscope was introduced through the vaginal trocar. A long, flexible grasper and endocavity retractor were used to stably retract the liver. The liver edge was partially transected using energy devices inserted through the umbilical trocar. To transect the left lateral lobe, a flexible linear stapler was inserted alongside the vaginal trocar. A specimen extraction bag was deployed and extracted transvaginally. Blood loss, bile leakage, operative time, and specimen size were evaluated. Necropsy studies were performed after the procedures.

Results:

Eighteen transvaginal NOTES partial liver resections and 4 transvaginal NOTES left lateral lobectomies were successfully performed on 9 pigs. Mean operative time was 165.8 minutes, and mean estimated blood loss was 76.6 mL. All TV NOTES LRs were performed without complications or deaths. Necropsy showed no bile leakage from remnant liver.

Conclusions:

Our porcine model suggests that TV NOTES LR is technically feasible and safe and has the potential for clinical use as a minimally invasive alternative to conventional laparoscopic liver resection.
Robotic Versus Laparoscopic Gastric Resection for Primary Gastrointestinal Stromal Tumors >5 cm: A Size-Matched and Location-Matched Comparison
Authors: de’Angelis Nicola , Genova Pietro , Amiot Aurelien , Charpy Cecile , Disabato Mara , Belgaumkar Ajay P. , Chahrour Ali , Legou Francois , Azoulay Daniel , Brunetti Francesco
Published: January 2017

This study compared robotic (RR) and laparoscopic resection (LR) for primary gastrointestinal stromal tumors (GISTs) of the stomach >5 cm. Twelve consecutive patients who underwent RR from 2012 to 2015 were matched for tumor size and location with 24 patients who underwent LR from 2000 to 2012. The median tumor size was 7.1 cm (range, 5.5 to 11.5). GISTs were resected by wedge resection (91.7%) or distal gastrectomy. The median RR operative time was longer than that of LR (162.5 vs. 130 min, respectively; P=0.004). Only 1 LR patient required conversion. The time to flatus and hospital stay were similar between groups. Overall, 3 patients developed minor postoperative complications that were medically treated. Mortality was nil. All resections were R0. No difference was observed in the incidence of recurrence. RR was significantly more expensive (+21.6%) than LR. RR appears to be safe and feasible for GISTs>5 cm, but is associated with longer operative times and greater costs.