bluuebunny/crossref_metadata_2025 huggingface dataset:
Kidney transplantation in patients with multiple myeloma: narrative analysis and review of the last two decades
Authors: Chitty David W , Hartley-Brown Monique A , Abate Mersema , Thakur Richa , Wanchoo Rimda , Jhaveri Kenar D , Nair Vinay
Published: December 2020

There have been significant advances in the treatment of multiple myeloma in the last two decades. Approximately 25% of patients with newly diagnosed myeloma have some degree of kidney impairment. During the course of illness, nearly 50% of myeloma patients will develop kidney disease. Moreover, ∼10% of myeloma patients have advanced kidney disease requiring dialysis at presentation. Hemodialysis is associated with a significantly reduced overall survival (OS). In the setting of prolonged long-term OS due to the use of newer immunotherapeutic agents in the treatment of myeloma, patients with myeloma and advanced kidney disease may benefit from more aggressive management with kidney transplantation (KTx). Unfortunately, most data regarding outcomes of KTx in patients with myeloma come from single-center case series. With the advent of novel treatment choices, it remains unclear if outcomes of kidney transplant recipients with myeloma have improved in recent years. In this descriptive systematic review, we coalesced published patient data over the last 20 years to help inform clinicians and patients on expected hematologic and KTx outcomes in this complex population. We further discuss the future of KTx in patients with paraproteinemia.
Testing Augmented Reality for Eliciting Cue-Provoked Urges to Smoke: Toward Moving Cue-Exposure Into the Real World
Authors: Brandon Karen O , Vinci Christine , Kleinjan Marloes , Hernandez Laura M , Sawyer Leslie E , Sutton Steven K , Brandon Thomas H
Published: December 2020

Background

Cue exposure for extinguishing conditioned urges to smoking cues has been promising in the laboratory, but difficult to implement in natural environments. The recent availability of augmented reality (AR) via smartphone provides an opportunity to overcome this limitation. Testing the ability of AR to elicit cue-provoked urges to smoke (ie, cue reactivity [CR]) is the first step to systemically testing the efficacy of AR for cue exposure therapy.

Objectives

To test CR to smoking-related AR cues compared to neutral AR cues, and compared to in vivo cues.

Methods

A 2 × 2 within-subject design comparing cue content (smoking vs. neutral) and presentation modality (AR vs. in vivo) on urge response. Seventeen smokers viewed six smoking-related and six neutral cues via AR smartphone app and also six smoking and six neutral in vivo cues. Participants rated their urge to smoke and reality/co-existence of the cue.

Results

Average urge to smoke was higher following smoking-related AR images (Median = 7.50) than neutral images (Median = 3.33) (Z = −3.44; p = .001; d = 1.37). Similarly, average urge ratings for in vivo smoking-related cues (Median = 8.12) were higher than for neutral cues (Median = 2.12) (Z = −3.44; p = .001; d = 1.64). Also, greater CR was observed for in vivo cues than for AR cues (Z = −2.67, p = .008; d = .36). AR cues were generally perceived as being realistic and well-integrated.

Conclusions

CR was demonstrated with very large effect sizes in response to AR smoking cues, although slightly smaller than with in vivo smoking cues. This satisfies the first criterion for the potential use of AR for exposure therapy.

Implications

This study introduces AR as a novel modality for presenting smoking-related stimuli to provoke cue reactivity, and ultimately to conduct extinction-based therapy. AR cues presented via a smartphone have the advantage over other modes of cue presentation (pictures, virtual reality, in vivo, etc.) of being easily transportable, affordable, and realistic, and they can be inserted in a smokers’ natural environment rather than being limited to laboratory and clinic settings. These AR features may overcome the generalizability barriers of other methods, thus increasing clinical utility for cue exposure therapies.
The Equilibrium Impact of Agricultural Risk on Intermediate Inputs and Aggregate Productivity
Authors: Donovan Kevin
Published: December 2020

I consider the aggregate impact of low intermediate input intensity in the agricultural sector of developing countries. In a dynamic general equilibrium model with idiosyncratic shocks, incomplete markets, and subsistence requirements, farmers in developing countries use fewer intermediate inputs because it limits their exposure to uninsurable shocks. The calibrated model implies that Indian agricultural productivity would increase by 16% if markets were complete, driven by quantitatively important increases in both the average real intermediate share and measured TFP through lower misallocation. I then extend the results to consider the importance of risk in other contexts. First, the introduction of insurance decreases cross-country differences in agricultural labour productivity by 14%. Second, scaling the introduction of improved seeds to decrease downside risk reduces inequality by reallocating resources from rich to poor farmers via equilibrium effects. This reallocation substantially increases aggregate productivity relative to what would be expected from extrapolating the partial equilibrium impact.
Genomics Reveals Widespread Ecological Speciation in Flightless Insects
Authors: McCulloch Graham A , Foster Brodie J , Dutoit Ludovic , Harrop Thomas W R , Guhlin Joseph , Dearden Peter K , Waters Jonathan M
Published: December 2020

Recent genomic analyses have highlighted parallel divergence in response to ecological gradients, but the extent to which altitude can underpin such repeated speciation remains unclear. Wing reduction and flight loss have apparently evolved repeatedly in montane insect assemblages and have been suggested as important drivers of hexapod diversification. We test this hypothesis using genomic analyses of a widespread wing-polymorphic stonefly species complex in New Zealand. We identified over 50,000 polymorphic genetic markers generated across almost 200 Zelandoperla fenestrata stonefly specimens using a newly generated plecopteran reference genome, to reveal widespread parallel speciation between sympatric full-winged and wing-reduced ecotypes. Rather than the existence of a single, widespread, flightless taxon (Zelandoperla pennulata), evolutionary genomic data reveal that wing-reduced upland lineages have speciated repeatedly and independently from full-winged Z. fenestrata. This repeated evolution of reproductive isolation between local ecotype pairs that lack mitochondrial DNA differentiation suggests that ecological speciation has evolved recently. A cluster of outlier single-nucleotide polymorphisms detected in independently wing-reduced lineages, tightly linked in an approximately 85 kb genomic region that includes the developmental “supergene” doublesex, suggests that this “island of divergence” may play a key role in rapid ecological speciation. [Ecological speciation; genome assembly; genomic island of differentiation; genotyping-by-sequencing; incipient species; plecoptera; wing reduction.]
The resolutions of the board of trust protectors in the context of the Mexican private express trust
Authors: Ibarra Garza Rafael , Garza Gómez Marcelo José
Published: December 2020

Significant legal uncertainty exists around the validity of resolutions of the board of trust protectors of private express trusts in Mexican law due to its lacunary regulation. By comparing with Mexican corporate law, specifically with the Mexican sociedad anónima (corporation), the conditions for the validity of the board of trust protectors’ resolutions are resolved. The comparison is made with the regulations that apply to the board of directors’ resolutions and their duty or loyalty and care.
Quasi-trustees, unauthorised purposes and ethical investment: What is the significance of the R (Palestine Solidarity Campaign Ltd & Anor) v Secretary of State for Communities and Local Government [2020] UKSC 16 case for the trustees’ fiduciary duty of investment and “ethical” investment opportunities?
Authors: Brown Lloyd
Published: December 2020

This case analysis concerns the decision of the UK Supreme Court in R (Palestine Solidarity Campaign Ltd & Anor) v Secretary of State for Communities and Local Government, which determines whether guidance issued by the Secretary of State was ultra vires. The guidance confined the administration of a local government pension scheme in respect to “ethical” investments deemed contrary to central government policy. The outcome of the decision is significant for its acknowledgment of the overriding importance of the trustees’ fiduciary duty of investment, together with being contemporaneous with the current trend for “ESG” considerations in the economic markets.
When Western History Tried to Reinvent Itself: Revisionism, Controversy, and the Reception of the New Western History
Authors: Massip Nathalie
Published: December 2020

This article reviews the reception of the New Western History, whose emergence coincided with the history and culture wars of the late twentieth century. I analyze debates and arguments created by revisionists’ writings, both within the walls of academia and beyond. The discussions which the movement triggered within the historical profession led to exceptional press coverage that attested to the central place the West occupies in the American imagination. Similarly, the uproar generated by the 1991 Smithsonian’s West as America exhibition further demonstrated Americans’ singular attachment to the story of the West as the creation myth of the nation. Just as the culture wars of the period hinged on a definition of an American identity, the reappraisal of the western past was perceived, by some, as questioning what it meant to be a westerner and, ultimately, an American.
Co-occurring Substance Use Disorders Identified Among Delivery Hospitalizations in the United States
Authors: Jarlenski Marian , Krans Elizabeth E.
Published: December 2020

Objectives:

Substance use in pregnancy is increasing in the United States (US), although little is know about co-occurring substance use disorders in pregnancy. Our objective was to determine the prevalence and patterns of co-occurring substance use disorders identified at delivery hospitalizations among US women.

Methods:

Using data from the National Inpatient Sample, a nationally representative sample of hospitalizations in the US, we identified females ages 15 to 44 years with a delivery hospitalization from 2007 to 2016 (weighted N = 38 million). We identified diagnoses for use of any of the following substance use disorders: alcohol, amphetamines, cannabis, cocaine, opioids, sedatives, or tobacco. Using multivariable regression, we calculated the weighted adjusted prevalence of additional substances used within each specific substance use disorder category.

Results:

Seven percent of women were diagnosed with any substance use disorder at delivery hospitalization (6.5% tobacco, 1% cannabis, 0.5% opioids, and <1% amphetamines, alcohol, cocaine, and sedatives). Among those with any substance use disorder diagnosis, the adjusted prevalence of any co-occurring use disorder was greatest for those who used alcohol (69%), cocaine (69%), amphetamines (63%), and opioids (62%). Among pregnant women who were diagnosed with cocaine, amphetamines, alcohol or opioid use disorder, tobacco (>45% in all groups), and cannabis (>10% in all groups) were the most common additional substances used. Tobacco and cannabis use disorders were commonly diagnosed together.

Conclusions:

Co-occurring substance use disorders are common among women with any substance use disorder in pregnancy. Findings support the need for public health efforts to monitor and address multiple, concurrent use of substances in pregnancy.
Revisiting the Role of Health Care Proxies in Reproductive Choice
Authors: Narayana Sirisha , Gaw Stephanie L. , Aldrich J. Matthew , Guterman Elan L.
Published: December 2020

In an effort to protect patients' reproductive rights, many states prohibit health care proxies from serving as surrogate decision makers for pregnancy termination in patients who lack capacity. We explore the case of a 24-year-old developmentally delayed woman with intractable seizures and complex psychosocial needs who was found to be pregnant. Her older sister was her health care proxy and declared that an abortion would be in her best interest, medically and socially; the patient herself lacked capacity to make this decision. Legally, her sister's judgment alone was insufficient to move forward with the procedure. Here we describe our multidisciplinary medical, ethical, and legal review of this case and how, despite agreeing with the patient's sister, legal barriers hindered our ability to obtain an abortion for this patient. Her situation illustrates the unintended consequences of our current approach to surrogate decision making in pregnancy termination. It highlights the need to reconsider the role of health care proxies in reproductive-choice decisions and emphasizes the value of a holistic evaluation of patients' social circumstances.
Effect of Topical Steroid on Swallowing Following ACDF
Authors: Kim Han Jo , Alluri Ram , Stein Dan , Lebl Darren , Huang Russel , Lafage Renaud , Bennett Tianna , Lafage Virginie , Albert Todd
Published: December 2020

Study Design.

Randomized, double-blinded, controlled trial.

Objective.

To investigate the effectiveness of local intraoperative corticosteroids at decreasing the severity of swallowing difficulty following multilevel anterior cervical discectomy and fusion (ACDF).

Summary of Background Data.

Dysphagia is a common complication after ACDF, and while for most patients the symptoms are mild and transient, some patients can suffer from severe dysphagia resulting in significant postoperative morbidity. Previous studies investigating the local application of corticosteroids are limited.

Methods.

This was a prospective, randomized, double-blinded, controlled trial of patients undergoing 2, 3, or 4 level ACDF for radiculopathy and/or myelopathy. Patients undergoing multilevel ACDF were randomized to receive local corticosteroid in the retropharyngeal space or placebo (no steroid). Dysphagia was assessed using validated outcomes including the Eating Assessment Tool-10 (Eat-10) and Swallowing Quality of Life (SWAL-QOL) Questionnaire both preoperatively and at 1 day (POD1), 2 days (POD2), and 1-month postoperatively.

Results.

One-hundred nine patients had a complete dataset available for analysis. Eat-10 scores were significantly lower in the Steroid group on POD2 (8 vs. 16, P = 0.03) and 1-month postoperatively (2 vs. 5, P = 0.03). A comparison of the individual SWAL-QOL subscale scores demonstrated that patients in the Steroid group had better scores than the Control group in various subscales at all postoperative time points. Significant differences were noted (always in favor of the Steroid group) in 40% of subscales on POD1, 60% of subscales on POD2, and 50% of subscales at 1-month postoperatively. The Control group never had a better SWAL-QOL subscale score at any time point postoperatively.

Conclusion.

Local administration of corticosteroid after multilevel ACDF can decrease postoperative severity and symptomatology of dysphagia during the immediate postoperative period to 1-month postoperatively. The long-term effects of local steroid administration on fusion and other complications will need to be established in future studies.

Level of Evidence: 1
A Novel Magnetic Resonance Imaging-based Lumbar Muscle Grade to Predict Health-related Quality of Life Scores Among Patients Requiring Surgery
Authors: Virk Sohrab , Wright-Chisem Joshua , Sandhu Milan , Vaishnav Avani , Albert Todd J. , Gang Catherine Himo , Qureshi Sheeraz
Published: December 2020

Study Design.

Retrospective cross-sectional cohort.

Objective.

The aim of this sudy was to determine whether muscle health measurements are associated with health-related quality of life scores (HRQOLs) for patients with lumbar spine pathology.

Summary of Background Data.

Poor muscle health has been implicated as a source of pain/dysfunction for patients with lumbar spine pathology. Our aim was to quantify the relationship using muscle health measurements and HRQOLs.

Methods.

Three hundred and eight patients were included (mean age 57.7 ± standard deviation 18.2 years’ old). We randomly selected patients into a derivation cohort (200) and validation cohort (108) to create our muscle health grade. We measured muscle health by the lumbar indentation value (LIV), goutallier classification (GC), and ratio of paralumbar muscle cross-sectional area over body mass index (PL-CSA/BMI). A muscle health grade was derived based on whether a measurement showed a statistically significant impact on visual analog scale back and leg pain (VAS-leg and VAS-leg), Oswestry Disability Index (ODI), short-form 12 physical health score (SF-12 PHS), short-form 12 mental health score (SF-12 MHS) and Patient-reported Outcomes Measurement Information System (PROMIS). A variety of statistical tools were used to determine whether there was a relationship between a measurement and HRQOLs.

Results.

In the derivation cohort, a muscle health grade was created based on the GC and PL-CSA/BMI ratio. For patients with a GC ≤2, one point was given. For patients with a PL-CSA/BMI ≥130, one point was given. Patients with 2 points were graded as “A” and 0 or 1 point were graded “B.” Within the validation cohort of patients, there was a statistically significant higher PROMIS (mean 34.5 ± standard deviation 12.6 vs. 27.6 ± 14.0, P = 0.002), ODI (38.8 ± 18.3 vs. 45.8 ± 18.1, P = 0.05) and SF-12 PHS (34.7 ± 11.3 vs. 29.1 ± 6.3, P = 0.002) for patients with a good muscle health grade of “A.”

Conclusion.

This study offers an objective measurement of muscle health that correlates with HRQOLs for patients with lumbar spine pathology.

Level of Evidence: 3
A Novel Approach to Tying Personal Protective Isolator Aprons in Fighting Coronavirus Pandemic: The One-handed Single Throw Tie Strap Knot
Authors: Al Hussainy Haydar Atheer
Published: December 2020

The humble disposable plastic apron has been essential in the worldwide fight against the coronavirus pandemic. Tying the apron can take time, be a cumbersome process especially when wearing disposable gloves, rushing to attend ill patients or when healthcare provider shoulders are too stiff to reach behind backs for a lengthy amount of time. A novel technique is described by using a one-handed single throw tie strap knot technique to secure the disposable plastic apron. The new technique is a simple, easy, effective, and secure method of tying disposable plastic aprons.
Facilitators and Barriers to Glaucoma Screening Identified by Key Stakeholders in Underserved Communities: A Community-engaged Research Approach
Authors: Ballouz Dena , Cho Juno , Woodward Maria A. , Elam Angela R. , Musch David C. , Zhang Jason , Moroi Sayoko E. , Johnson Leroy , Cederna Jean , Newman-Casey Paula A.
Published: December 2020

Précis:

Community-engaged research (CER) enables researchers to identify community-specific barriers and facilitators to program implementation. Broadly applicable barriers to glaucoma care, such as Cost, Transportation, and Trust, and community-specific barriers, such as Language and Convenience/Access, were identified.

Purpose:

The aim was to identify the facilitators and barriers to implementing glaucoma screening programs in 2 community clinics.

Methods:

A concurrent mixed-methods process analysis using CER. Key stakeholders—including patients, providers, and staff members—from 2 community clinics were interviewed using a semistructured interview guide. Interviews had 2 parts: (1) asking patients about community-based facilitators and barriers to implementing glaucoma screening and care and (2) eliciting feedback about a personalized coaching program. The transcripts were coded using Grounded Theory. Number of participants and number of representative citations were counted per theme. The qualitative analysis was coded using Dedoose 8.3.17 (Los Angeles, CA).

Results:

Thematic saturation was reached after coding 12 interviews. 30 participants were interviewed, 13 from Hamilton Clinic (Flint, MI; 8 patients, 5 providers and staff members) and 17 from Hope Clinic (Ypsilanti, MI; 6 patients, 11 providers and staff members). The most commonly cited themes were: Priorities (98 citations, 30 participants), Knowledge (73, 26) Transportation (63, 26), Cost (60, 23), and Convenience/Access (63, 22). Broadly applicable barriers to glaucoma care, such as Cost, Transportation, and Trust were identified alongside community-specific barriers such as Language and Convenience/Access. Participants rated their likelihood to follow up with an ophthalmologist after participating in the personalized coaching program at a mean of 8.83 (on a scale of 1 to 10 with 10 being the most confident).

Conclusions:

CER enables researchers to identify community-specific barriers and facilitators, allowing more effective program implementation.
The Sustainable Development Goals and the Community of Portuguese Speaking Countries (CPLP) in the post-COVID-19 era
Authors: Lapão Manuel J. Clarote
Published: December 2020

The universalization and full realization of the objectives and goals of the United Nations 2030 Agenda for Sustainable Development can be called into question by the significant drop in international funding available to support developing countries. This situation may be worsened by the effects caused by the COVID-19 pandemic and the consequent increase in nonregular cooperation programs, based on humanitarian and emergency actions. The promotion of horizontalization strategies for the Sustainable Development Goals (SDGs), considering interventions with a transversal nature, in a 360° view, which encourages the promotion of strategic alliances, multisectoral and multidimensional partnerships as well as shared financing mechanisms, appears as a credible hypothesis to assure the commitment with sustainable development. The article addresses some perceptions of multilateral organizations, namely within the scope of the United Nations System and Bretton Woods institutions, and how the strategic development cooperation instruments created by Community of Portuguese Speaking Countries may contribute to boosting post-COVID-19 cooperation scenarios aligned with the accomplishment of the SDGs in this community.
Personal Protective Equipment (PPE) in COVID 19 Pandemic
Authors: Battista Rosa Alessia , Ferraro Milena , Piccioni Lucia Oriella , Malzanni Giulia Elvira , Bussi Mario
Published: December 2020

Objectives:

To assess prevalence of Personal Protective Equipment (PPE)-related symptoms and adverse reactions during Coronavirus Disease 2019 pandemics.

Methods:

We conducted an observational study among people exposed to various degree of infectious risk. Data were collected with a self-administered online questionnaire.

Results:

The entire cohort complained about a wide range of adverse reactions: respiratory symptoms affected 80.3% of respondents, 68.5% referred pressure-related skin lesions, fewer manifested a dermatosis of different grade or ocular symptoms. Most of the affected individuals belonged to healthcare staff and manifestations were predicted by wearing time (more than 6 h/d). Moreover, symptoms were higher in the healthcare staff wearing N95/FFP2 respirator mask.

Conclusions:

Given the crucial role of PPE to contain the pandemic infection, more attention has to be paid to exposed categories, establishing preventive measure of side effects to ensure total safety.
Prevalence and Predictors of Moral Injury Symptoms in Health Care Professionals
Authors: Mantri Sneha , Lawson Jennifer Mah , Wang ZhiZhong , Koenig Harold G.
Published: December 2020

This study examined the prevalence and predictors of moral injury (MI) symptoms in 181 health care professionals (HPs; 71% physicians) recruited from Duke University Health Systems in Durham, NC. Participants completed an online questionnaire between November 13, 2019, and March 12, 2020. Sociodemographic, clinical, religious, depression/anxiety, and clinician burnout were examined as predictors of MI symptoms, assessed by the Moral Injury Symptoms Scale–Health Professional, in bivariate and stepwise multivariate analyses. The prevalence of MI symptoms causing at least moderate functional impairment was 23.9%. Younger age, shorter time in practice, committing medical errors, greater depressive or anxiety symptoms, greater clinician burnout, no religious affiliation, and lower religiosity correlated with MI symptoms in bivariate analyses. Independent predictors in multivariate analyses were the commission of medical errors in the past month, lower religiosity, and, especially, severity of clinician burnout. Functionally limiting MI symptoms are present in a significant proportion of HPs and are associated with medical errors and clinician burnout.
Origin and Outcomes of Acute Care Nurse Practitioner Practice
Authors: Kapu April
Published: December 2020

Acute care nurse practitioners (NPs) are educated, clinically trained, and board certified to care for acutely and critically ill patients, largely in hospital settings. Acute care NPs can positively impact patient care outcomes and are often added to acute care teams to drive optimal, reliable, efficient, and safe care, often referred to as “high value” care.
Strategies for Success in Regulatory Readiness
Authors: DiSciullo Brigid , Calfin Donna , Hickerson Kirsten A. , Kubis Sherri E. , Patton Ashley M. , Simpson Carol J. , Figueroa-Altmann Ana
Published: December 2020

This article describes the formation of a Regulatory Advisory Council to address regulatory preparedness. The council used quality improvement methods to address data and findings from previous mock surveys and created 2 categories of work, an environment of care and clinical standards group, with checklists and work streams to improve organizational success with regulatory readiness.
Four Years Later
Authors: Schenk Elizabeth , Marks Nicole , Hoffman Kelli , Goss Lola
Published: December 2020

OBJECTIVE

To examine changes in registered nurse (RN) perceptions of electronic documentation over a 4-year period.

BACKGROUND

The investigators previously reported differences in RN perceptions prior to and 1 year after adoption of a comprehensive electronic health record (EHR).

METHODS

Investigators repeated the study 4 years after adoption, using the Nurses' Perceptions of Electronic Documentation tool and interviews with a subset of RNs.

RESULTS

Nurses scored higher on ease of use domain and lower on concern about the EHR domain and showed no difference on the impacts of the EHR domain. Interviews revealed that 4 years later, some aspects of documentation were easier; the tool was comprehensive, but not without risk, and nurses remained ambivalent about the EHR.

CONCLUSIONS

Use of EHR technology impacts nursing work. It is important to understand how nurses' perceptions change over time. This study gives nursing leaders insight into adoption and acceptance of an EHR.
Inconsistency in Faculty and Student Perceptions of DNP and PhD Leader Scholarly Activity
Authors: Jenkins Peggy , Meek Paula , Amura Claudia , Robertson Glenda
Published: December 2020

OBJECTIVE

We aimed to quantify faculty and student perceptions of scholarly activities for doctor of nursing practice (DNP) and PhD leaders.

BACKGROUND

The American Association of Colleges of Nursing describes DNP as a practice-focused degree and PhD as a research-focused degree. In 2016, the Council on Graduate Education for Administration in Nursing (now Association for Leadership Science in Nursing) published in the Journal of Nursing Administration sample practice objectives for DNP and research objectives for PhD leaders.

METHODS

Using the published objectives, we surveyed faculty and students to quantify congruence with the publication and consistency within groups. The data informed intraprofessional education constructed using action research.

RESULTS

There was low congruence between faculty and student responses with the article. PhD faculty had the least, and PhD students, the greatest, consistency in survey responses.

CONCLUSIONS

Confusion exists within our faculty and students around differentiating PhD and DNP scholarly activities. Data supported need to clarify scholarly role boundaries through intraprofessional education.
The Evolution of Ambulatory Care Nursing
Authors: Martinez Kathleen , Graystone Rebecca
Published: December 2020

In this month's Magnet Perspectives column, guest author Kathleen Martinez, MSN, RN, CPN, joins Rebecca Graystone, MS, MBA, RN, NE-BC, for an in-depth look at the explosive growth of ambulatory care nursing over the past decade. The authors take a deep dive into multiple factors contributing to this rapid evolution, the role of the Magnet Recognition Program® in accelerating and supporting ambulatory care and the nurses who provide it, and the prospects for continued growth in the decade ahead.
Effects of Platelet-Rich Fibrin/Collagen Membrane on Sciatic Nerve Regeneration
Authors: Vares Peyman , Dehghan Mohammad Mehdi , Bastami Farshid , Biazar Esmaeil , Shamloo Nafiseh , Heidari Keshel Saeed , Khojasteh Arash
Published: December 2020

Alternative treatment approaches to improve the regeneration ability of damaged peripheral nerves are currently under investigation. The aim of the current study was to evaluate the effects of leucocyte/platelet-rich fibrin (L-PRF) with or without a collagen membrane as a supporter on crushed sciatic nerve healing in a rat model. Recovery of motor function and electrophysiologic measurements were evaluated at 4 weeks postoperatively. The whole number of myelinated axons, peripheral nerve axon density, average nerve fiber diameter (μm), and G-ratio were analyzed and compered among the groups. Functional, electrophysiological, and histological evaluations showed no significant difference among the groups with the exception of the L-PRF with collagen membrane groups that showed relatively positive effects on the functional and histological nerve recovery. In addition, the collagen membrane with L-PRF can be effect in nerve regeneration.
Analysis of National Outcomes for Simple Versus Complex Nasal Dermoid Cyst Excision
Authors: Kalmar Christopher L. , Patel Vijay A. , Taylor Jesse A.
Published: December 2020

Nasal dermoid cysts represent a spectrum of complexity from dermal sacs to multiloculated sinus tracts with intracranial extension with treatments ranging from outpatient excision to transcranial procedures involving dissection of the dermoid from the dura mater. In this study, the authors examined national outcomes across the spectrum utilizing the NSQIP database. Interestingly, complication rates were uniformly low at 1.2% even though those requiring transcranial excision required significantly longer surgical procedures (P = 0.001), and were significantly more likely to be admitted as inpatients (P < 0.001). Risk factors for longer surgery included patients with comorbidities (P = 0.006), patients requiring rhinoplasty (P = 0.001), and patients requiring a craniotomy (P = 0.023). While uncommon (0.3%), infectious complications remain primary drivers of postoperative morbidity. The NSQIP database does not allow for calculation of recurrence risk, likely a driver of poorer long-term outcomes, and efforts to quantify recurrence risk will be the subject of future research.
Titanium Fan Plate Reconstruction for Lateral Orbital Traumatic Defects
Authors: O’Connor Kate E. , Pinzas Lauren A. , Sivam Sunthosh K.
Published: December 2020

Fractures of the orbit often require operative repair with materials ranging from autologous tissue to titanium implants. Reconstructive techniques of the lateral orbital rim and wall offer a unique challenge due to the structural and aesthetic demands with regard to its natural contour. The authors present a case in which a patient sustained a ballistic injury involving the lateral orbital rim and wall requiring reconstruction. The authors employed the use of a single titanium orbital mesh fan plate (DePuy Synthes, Warsaw IN) in an injury-specific and cost-effective technique to rapidly restore the contour and structure of the lateral orbit rivaling the result of a 3D printed custom plate.
Endoscopic Versus Open Total Vault Reconstruction of Sagittal Craniosynostosis
Authors: Al-Shaqsi Sultan Z. , Lam Nicole Wing , Forrest Christopher R. , Phillips John H.
Published: December 2020

Sagittal craniosynostosis is the most common form of congenital cranial deformity. Surgical interventions are performed either open or endoscopic. Advancements in minimally invasive surgery have enabled the development of the endoscopic suturectomy technique. This is contrasted to the traditional open cranial vault reconstruction. There is a paucity of data comparing the head shape changes from both techniques. This study aims to compare the morphological outcome of endoscopic suturectomy versus total cranial vault reconstruction.

Methods:

This is a retrospective comparative study involving 55 cases of sagittal craniosynostosis, 37 of which has open total cranial vault reconstruction and 18 had endoscopic suturectomy procedure. Preoperative and postoperative 3D photographs of both groups were analyzed and compared. The change in correction between preoperative and postoperative state was measured against a crowd-driven standard for acceptable head shape.

Results:

Total cranial vault had higher percentage change between pre and postoperative cranial index than endoscopic suturectomy (14.7% versus 7.7%, P = 0.003). However, both techniques were able to achieve the minimum standard of 70% correction (TCV 107.5%, ES 100.4%, P = 0.02).

Conclusion:

Total cranial vault and endoscopic suturectomy are effective in correcting scaphocephaly among children with sagittal craniosynostosis. Additionally, both techniques are able to achieve a percentage correction that exceeds the 70% benchmark established by the lay public.
Superolateral Dislocation of Bilateral Mandibular Condyles With a Mandibular Body and Condyle Fracture
Authors: Han Song Hyun , Kim Soon Heum , Jo Dong In
Published: December 2020

An 82-year-old man fell from a motorcycle and was admitted with superolateral dislocation of the bilateral mandibular condyles. The displaced condyles on the right and left were hooked in the posterior root of the zygomatic arch and in the temporal fossa beyond the zygomatic arch, respectively. There was a sagittal split fracture on the medial side of the right mandibular condyle and a right mandibular body fracture. Under general anesthesia, manual reduction of the dislocation was successfully performed the day after the injury. Bilateral superolateral dislocations hooked to the temporal fossa or zygomatic arch are very rare, as they may require multiple strong impacts to occur. Open reduction and closed reduction are possible treatment modalities, and the period from trauma to treatment is relevant for the choice of treatment.
Burn Injury Impairs Neutrophil Chemotaxis Through Increased Ceramide
Authors: Beckmann Nadine , Schumacher Fabian , Kleuser Burkhard , Gulbins Erich , Nomellini Vanessa , Caldwell Charles C.
Published: December 2020

Infection is a common and often deadly complication after burn injury. A major underlying factor is burn-induced immune dysfunction, particularly with respect to neutrophils as the primary responders to infection. Temporally after murine scald injury, we demonstrate impaired bone marrow neutrophil chemotaxis toward CXCL1 ex vivo. Additionally, we observed a reduced recruitment of neutrophils to the peritoneal after elicitation 7 days after injury. We demonstrate that neutrophil ceramide levels increase after burn injury, and this is associated with decreased expression of CXCR2 and blunted chemotaxis. A major signaling event upon CXCR2 activation is Akt phosphorylation and this was reduced when ceramide was elevated. In contrast, PTEN levels were elevated and PTEN-inhibition elevated phospho-Akt levels and mitigated the burn-induced neutrophil chemotaxis defect. Altogether, this study identifies a newly described pathway of ceramide-mediated suppression of neutrophil chemotaxis after burn injury and introduces potential targets to mitigate this defect and reduce infection-related morbidity and mortality after burn.
Development and Considerations for Virtual Reality Simulations for Resuscitation Training and Stress Inoculation
Authors: Chang Todd P. , Hollinger Trevor , Dolby Thomas , Sherman Joshua M.
Published: December 2020

Introduction

Resuscitation simulations immerse learners into the complexity of emergency patient management. Head-Mounted Display Virtual Reality (VR) has been used for stress inoculation therapy for phobias and posttraumatic stress disorder. However, VR for stress inoculation in resuscitation leadership training has not been studied. We sought to develop VR simulation for stress inoculation, as exposure therapy training, for resuscitations.

Methods

We explain the conceptual design, development, production, and initial evaluation process for 2 VR simulations in infant status epilepticus and pediatric anaphylactic shock. We further describe deliberate game mechanic choices to maximize psychological fidelity. In–virtual reality performance data for time-to-critical actions and stress physiology markers (heart rate, salivary cortisol) were collected from expert pediatric emergency physicians and novice pediatric residents. Data were analyzed to examine differences between the 2 groups for both outcome types to determine the extent of stress response or performance deficit the VR induced.

Results

Multiple difficulties and distractions were designed for the 2 scenarios; we evaluated the highest difficulty and environmental distraction versions. Between 19 expert physicians and 15 novice physicians, no performance differences were found in typical airway, breathing, and circulation actions. Residents preferred more lorazepam first-line antiepileptics than attendings (P = 0.003) and performed a cricothyrotomy later than attendings (P = 0.02). Residents, however, manifested higher salivary cortisol levels than attendings (+0.07 μg/dL, 95% confidence interval = 0.03–0.12, P = 0.001).

Conclusions

A VR resuscitation simulation manifested expected stress physiology changes in physicians. Further evaluation is needed to determine the effect of VR simulation as longitudinal stress inoculation for healthcare providers.
Use of Simulation to Measure the Effects of Just-in-Time Information to Prevent Nursing Medication Errors
Authors: Berg Thomas A. , Hebert Susan H. , Chyka Deb , Nidiffer Stephanie , Springer Cary
Published: December 2020

Introduction

Medication administration error (MAE) is the improper dispensing of medication. It is a significant contributor to the occurrence of medical errors. A novel systems thinking approach using a pediatric simulation and student nurses were used to evaluate the benefit of applying just-in-time information (JITI) to reduce medication errors. Just-in-time information applies highly focused information delivered when needed.

Methods

A smart device app was developed to provide JITI medication administration information. The effect JITI had on MAE occurrence was assessed via a controlled study. The study population included 38 teams having 2 to 3 senior nursing students on each team. The teams were separated into a control and 2 intervention groups to complete a medication administration simulation.

Results

The intervention groups (100%, N = 10) that made significant use of the JITI app demonstrated improved performance for medication administration over the control group. Familiarity with the app was pivotal to how frequently it was used and to the success of the groups in administering medications. Although those with access to the app having limited training successfully executed the simulation 27.3% (n = 11) of the time, those with extended training had a success rate of 77.8% (n = 9).

Conclusions

Providing JITI significantly reduced the occurrence of MAEs for these student nurses. Familiarity with the app, including extended training opportunities, contributed significantly to student success.
Gender Minorities in Simulation: A Mixed Methods Study of Medical School Standardized Patient Programs in the United States and Canada
Authors: Bohnert Carrie A. , Combs Ryan M. , Noonan Emily J. , Weathers Aaron E. , Weingartner Laura A.
Published: December 2020

Purpose

A provider's ability to translate knowledge about transgender health to affirming patient care is key to addressing disparities. However, standardized patient (SP) programs have little published guidance for gender-affirming care or addressing disparities experienced by transgender and nonbinary patients.

Method

Between 2018 and 2019, we invited all 208 accredited US and Canadian medical schools to participate in a study to determine how gender minorities are represented in SP encounters. Responding programs (n = 59, response rate = 28%) that represented patients with diverse gender identities were invited to complete semistructured interviews about SP case content, impact, and barriers to this work. Discussions were analyzed using a modified grounded theory method.

Results

Fifty nine of 208 eligible programs (response rate = 28.3%) completed our survey and 24 completed interviews. More than half of programs used gender minority SPs (n = 35, 59.3%). More than half of the programs also reported portraying gender minority cases (n = 31, 52.5%). Interviewees described how effective SP simulation required purposeful case development, engaging subject matter experts with lived experience, and ensuring psychological safety of gender minority SPs. Barriers included recruitment, fear of disrespecting gender minority communities, and transphobia. Engaging gender minorities throughout case development, training, and implementation of SP encounters was perceived to reduce bias and stereotyping, but respondents unanimously desired guidance on best practices on SP methodology regarding gender identity.

Conclusions

Many programs have established or are developing SP activities that portray gender minority patients. Effective SP simulation hinges on authenticity, but the decisions around case development and casting vary. Specifically, programs lack consensus about who should portray gender minority patients. This research suggests that input from gender minority communities both to inform best practices at the macro level and in an ongoing advisory capacity at the program level will be essential to teach gender-affirming care.
Implementation of Simulation Training During the COVID-19 Pandemic
Authors: Pan Di , Rajwani Kapil
Published: December 2020

Summary Statement

Simulation played a critical role in our institution's response to the COVID-19 pandemic in New York City. With the rapid influx of critically ill patients, resource limitations, and presented safety concerns, simulation became a vital tool that provided solutions to the many challenges we faced. In this article, we describe how simulation training was deployed at our institution throughout the course of the pandemic, which included the period of our medical surge. Simulation helped refine protocols, facilitate practice changes, uncover safety gaps, and train redeployed healthcare workers in unfamiliar roles. We also discuss the obstacles we encountered with implementing simulations during the pandemic, the measures we took to adapt to our limitations, and the simulation strategies and end products that were derived from these adaptations.
Therapeutic Perspectives and Mechanistic Insights of Phage Therapy in Allotransplantation
Authors: Dery Kenneth J. , Górski Andrzej , Międzybrodzki Ryszard , Farmer Douglas G. , Kupiec-Weglinski Jerzy W.
Published: December 2020

Bacterio(phages) are bacteria-infecting viruses that employ host translation machinery to replicate, and upon cell lysis, release new particles into the environment. As a result, phages are prey-specific, thus making targeted phage therapy (PT) possible. Indeed, pre- and posttransplant bacterial infections pose a substantial risk to allograft recipients in their clinical course. Moreover, with the increasing threat of antibiotic resistance, the interest in PT as a potential solution to the crisis of multidrug-resistant bacterial pathogens has rapidly grown. Although little is known about the specific characteristics of the phage-directed immune responses, recent studies indicate phages exert anti-inflammatory and immunomodulatory functions, which could be beneficial in allotransplantation (allo-Tx). PT targeting multidrug-resistant Klebsiella pneumoniae, Mycobacterium abscessus, and Pseudomonas aeruginosa have been successfully applied in renal, lung, and liver allo-Tx patients. In parallel, the gastrointestinal microbiota appears to influence allo-Tx immunity by modulating the endoplasmic reticulum stress and autophagy signaling pathways through hepatic EP4/CHOP/LC3B platforms. This review highlights the current relevant immunobiology, clinical developments, and management of PT, and lays the foundation for future potential standard care use of PT in allo-Tx to mitigate early allograft dysfunction and improve outcomes. In conclusion, with novel immunobiology and metabolomics insights, harnessing the potential of PT to modulate microbiota composition/diversity may offer safe and effective refined therapeutic means to reduce risks of infections and immunosuppression in allo-Tx recipients.
Veno-occlusive Disease in HSCT Patients: Consensus-based Recommendations for Risk Assessment, Diagnosis, and Management by the GITMO Group
Authors: Bonifazi Francesca , Sica Simona , Angeletti Alessia , Marktel Sarah , Prete Arcangelo , Iori Anna Paola , Olivari Diletta , Rossetti Giulia , Bertaina Alice , Botti Stefano , Busca Alessandro , Carella Angelo Michele , Cerretti Raffaella , Gargiulo Gianpaolo , Grassi Anna , Gualandi Francesca , Irrera Giuseppe , Milone Giuseppe , Risitano Antonio Maria , Santarone Stella , Vassallo Elena , Zecca Marco , Ciceri Fabio , Pomponio Giovanni
Published: December 2020

Variation in clinical practice affects veno-occlusive disease management, mainly in patients who undergo allogeneic hematopoietic stem cell transplantation. Disputes about diagnostic criteria, treatment, and prophylaxis, due to the lack of high-quality data, are at the base of this variability. With the aim of limiting inconsistency in clinical care, thus improving both patient outcomes and data collection reliability, the Italian Society of Stem cell transplant (Gruppo Italiano Trapianto Midollo Osseo e Terapia Cellulare) launched a collaborative effort to formulate recommendations based on integration of available evidence and expert’s consensus. A systematic method, according to US National Institute of Health guidelines and Italian National System for Guidelines, was used. Twenty-nine recommendations were approved with a strong (20) or weak (9) level of agreement, while 26 were rejected. In particular, the panel pointed out the need to achieve an early diagnosis, encouraging the adoption of European Society for Blood and Marrow Transplantation criteria and the prompt use of ultrasonography. Moreover, our experts strongly recommended in favor of prophylactic use of ursodeoxycholic acid. As soon as a veno-occlusive disease diagnosis is established, treatment with defibrotide should be started for at least 21 days. A number of areas of uncertainty, particularly concerning risk stratification and use of diagnostic tools such as elastography has been identified and discussed.