bluuebunny/crossref_metadata_2025 huggingface dataset:
Corneal Transplantation in New Zealand 2000 to 2009
Authors: Crawford Alexandra Z. , Krishnan Thiyagaraj , Ormonde Susan E. , Patel Dipika V. , McGhee Charles N.
Published: December 2017

Purpose:

To quantify all minor/major adverse events in a large cohort of consecutive corneal transplants, particularly in respect to penetrating keratoplasty (PKP).

Methods:

All corneal transplants in the Auckland region over a 10-year period (2000–2009) were identified through the New Zealand National Eye Bank. Relevant clinical records were assessed for this period and 2 years after. All intraoperative or postoperative adverse events/complications, visual acuity, and graft outcomes were recorded.

Results:

Detailed data were available for 941 (94.5%) of 996 procedures in the study period, including 834 PKPs, 73 deep anterior lamellar keratoplasties, 28 Descemet stripping endothelial keratoplasties, and 6 tectonic keratoplasties. Intraoperative adverse events occurred in 117 (12.4%) procedures, most commonly positive vitreous pressure (6.3%). Postoperative adverse events included elevated intraocular pressure (21.3%, >30 mm Hg), graft rejection (29.8%), suture-related complications (30.1%), dry eye (15.9%), epithelial defect (9.8%), wound compromise (3.4%), microbial keratitis (3.2%), and endophthalmitis (0.6%). At 2 years, 58.7% of eyes achieved best-corrected visual acuity of ≥6/12 (20/40) and 69.6% achieved ≥6/18 (20/60). Graft survival at 2 years was 87.9%, 92.3%, and 100% for PKP, deep anterior lamellar keratoplasty, and Descemet stripping endothelial keratoplasty, respectively.

Conclusions:

In this study of 941 consecutive, principally penetrating, corneal transplants, adverse events were found to be more common than typically reported. In an era in which PKP is increasingly substituted by lamellar surgery, this provides useful insight into operative and postoperative adverse events in penetrating surgery.
Characterization of Corneal Endothelial Injury During Penetrating Keratoplasty
Authors: Vo Thomas A. , Oakey Zack , Garg Sumit
Published: December 2017

Purpose:

To characterize corneal endothelial injury during penetrating keratoplasty in a controlled wet laboratory environment using human tissue. To identify potential areas or steps within surgery in which insult to the corneal endothelium may be most affected by trauma during routine penetrating keratoplasty.

Methods:

Human donor corneas (n = 12) with intact endothelium underwent experimental penetrating keratoplasty. Endothelial injury was evaluated after each suture quartile using trypan staining, a validated modality for assessing endothelial injury. Insult was quantified using high-resolution photography and computer software.

Results:

Statistical significance was found in the change in staining between quartiles as determined by repeated-measures analysis of variance (F
3,11 = 5.83, P < 0.0044). A post hoc Tukey test indicated that the change in staining during the first quartile (3.38% ± 0.5%) was significantly lower than the remaining quartiles at P < 0.021. The change in staining did not differ significantly between the second (8.36% ± 1.2%), third (7.88% ± 1.2%), and fourth (7.73% ± 0.9%) quartiles at P > 0.97.

Conclusions:

Evidence from this investigation suggests that injury to the endothelium occurs most during the second quartile. This may be a promising area in which clinicians could target their efforts to avoid injury to this vital tissue layer for best surgical outcomes and graft longevity.
Comparison of Sulfur Hexafluoride (SF6) and Air Tamponade in Noniridectomized Descemet Membrane Endothelial Keratoplasty
Authors: Einan-Lifshitz Adi , Sorkin Nir , Boutin Tanguy , Showail Mahmood , Borovik Armand , Jamshidi Farzad , Chan Clara C. , Rootman David S.
Published: December 2017

Purpose:

To compare the efficacy and safety of 20% sulfur hexafluoride gas (SF6) and air tamponade in patients who underwent noniridectomized Descemet membrane endothelial keratoplasty (DMEK).

Methods:

A retrospective chart review of patients who underwent DMEK with either air or SF6 tamponade: 41 eyes received air tamponade (group 1) and 41 received SF6 tamponade (group 2). Best spectacle-corrected visual acuity, endothelial cell density, and complications including graft detachment and elevated intraocular pressure were compared.

Results:

The mean follow-up time was 8 ± 4 months in group 1 and 3 ± 2 months in group 2. Mean best spectacle-corrected visual acuity improved from 1.12 ± 0.88 to 0.64 ± 0.78 logarithm of the minimum angle of resolution (logMAR) in group 1 (P = 0.009) and from 1.00 ± 0.78 to 0.62 ± 0.53 logMAR in group 2 (P = 0.006). The graft detachment rate was 39% (16 eyes) in group 1 and 42% (17 eyes) in group 2 (P = 0.822). The rate of graft detachment larger than one third of the graft area was 17% in group 1 and 20% in group 2 (P = 0.775). Rebubbling was performed in 26.8% and 20% of eyes in group 1 and 2, respectively (P = 0.43). Average endothelial cell loss was 32% in group 1 and 33% in group 2 (P = 0.83). In the immediate postoperative period, elevated intraocular pressure was observed in 2 eyes (5%) in group 1 and in 4 eyes (10%) in group 2 (P = 0.4). There was 1 primary graft failure in each group.

Conclusions:

Use of air with it being readily available and short acting is a good method of Descemet membrane tamponade in noniridectomized DMEK.
Clinical Features, Antibiotic Susceptibility Profile, and Outcomes of Infectious Keratitis Caused by Stenotrophomonas maltophilia
Authors: Palioura Sotiria , Gibbons Allister , Miller Darlene , O'Brien Terrence P. , Alfonso Eduardo C. , Spierer Oriel
Published: December 2017

Purpose:

Stenotrophomonas maltophilia, an uncommon cause of infectious keratitis, is difficult to treat because of its resistance to multiple antibiotics. The purpose of this study is to describe the clinical features, antibiotic susceptibility profile, and outcomes of S. maltophilia keratitis.

Methods:

A retrospective review of records from 1987 to 2016 identified 26 eyes of 26 patients who were treated at the Bascom Palmer Eye Institute for an S. maltophilia corneal ulcer. Clinical data were analyzed as to predisposing factors, clinical presentation, antibiotic susceptibility, treatment selection, and clinical outcomes.

Results:

Median age at presentation was 65 years (range, 16–98). Twelve patients were using topical corticosteroids, 8 patients had a history of penetrating keratoplasty, and 9 were contact lens wearers. All patients received topical antibiotics, 2 required therapeutic penetrating keratoplasty, and 1 was enucleated. At presentation, 57.7% (15/26) of the patients had visual acuity of 20/400 or worse. At the final visit, only 30.4% (7/23) of the patients had visual acuity worse than 20/400, whereas 65.2% (15/23) of the patients had 20/100 or better. Almost all isolates (25/26, 96.2%) were susceptible to fluoroquinolones and 77.3% (17/22) of them to polymyxin B/trimethoprim. Only 33.3% (5/15) of the tested isolates were susceptible to aminoglycosides and 58.3% (7/12) to cephalosporins.

Conclusions:

Infectious keratitis due to S. maltophilia presents a treatment challenge because of its resistance to aminoglycosides and cephalosporins, which are typically used for empiric broad-spectrum gram-negative coverage as fortified solutions. Fluoroquinolones and polymyxin B/trimethoprim should be considered instead in cases of S. maltophilia infection.
Meibography of Eyes With Sequelae of Trachoma
Authors: AlDarrab Abdulrahman , Al-Faky Yasser H. , Mousa Ahmed , Alsuhaibani Adel H.
Published: December 2017

Purpose:

To study the effect of trachoma on meibomian glands using infrared meibography and to correlate the results with tear film parameters.

Methods:

This is a prospective cohort study in which 86 eyes of healthy volunteers and 90 eyes with trachoma were included. Clinical assessment was performed including the following: slit-lamp examination looking for signs of sequelae of trachoma, tear breakup time (TBUT), superficial punctate keratopathy (SPK), Schirmer II test (with anesthesia), and meibum score. Noncontact meibography was performed on both upper and lower eyelids separately using the meibograde system, which involved distortion of the meibomian gland, shortening, and dropout.

Results:

Lid margin abnormalities (telangiectasia, lid margin swelling, and hyperemia) were all significantly higher in the trachoma group. The mean SPK (1.36), meibum score (1.76), meibography dropout, distortion, shortening, and total meibography (8.19 for upper eyelids and 3.81 for lower eyelids) were all significantly higher in the trachoma group (P < 0.001) compared with the normal group were SPK (0.88), meibum score (0.16), and total meibography (1.24 for upper eyelids and 0.92 for lower eyelids). Mean TBUT (4.2 s) was significantly shorter in the trachoma group than in the normal group (10.3 s) (P < 0.001). There was no significant difference between both groups in the Schirmer II test.

Conclusions:

Meibography of patients with sequelae of trachoma was in agreement with the histopathologic studies. Upper eyelids were much more affected than the lower eyelids. TBUT, SPK, and meibum score were correlated with the status of meibomian glands and meibography, which were significantly different in the trachoma group.
Evidence for Rise in Meningococcal Serogroup C Bactericidal Antibody Titers in the Absence of Booster Vaccination in Previously Vaccinated Children
Authors: Badahdah Al-Mamoon , Khatami Ameneh , Tashani Mohamed , Rashid Harunor , Booy Robert
Published: December 2017

Background:

The introduction of meningococcal serogroup C (MenC) conjugate vaccines in the United Kingdom and Australia led to an impressive decline in the incidence of invasive disease. This study examined bactericidal antibody titers over time in the UK and Australian children who received a MenC conjugate vaccine in early childhood to test the hypothesis that ongoing boosting of immunity in the absence of further doses of vaccine in some children may contribute to ongoing protection from disease.

Methods:

Serum bactericidal assay using rabbit complement (rSBA) titers at each follow-up visit were compared with all preceding visits to identify any ≥4-fold rise in titers. The proportion of children with a ≥4-fold rise in rSBA titers in paired sera at any visit-to-visit comparison was calculated.

Results:

Of 392 children with at least one set of paired sera in the Australian cohort, 72 (18.4%) had a ≥4-fold increase in rSBA titers at least one year after vaccination, including six children (1.5%) who showed evidence of boosting twice. Of 234 children with at least one set of paired sera in the UK cohort, 39 (16.7%) had a ≥4-fold rise in rSBA titers at least one year after vaccination including 2 children (0.9%) with evidence of boosting twice.

Conclusions:

A substantial minority of children immunized with MenC conjugate vaccine in early childhood had a rise in bactericidal antibody titers in the years after immunization in the absence of booster vaccination. This occurs most commonly at around 6–7 years of age corresponding to school entry and greater social mixing and might indicate exposure to MenC carriage.
Acute Pharyngitis Associated With Streptococcus dysgalactiae Subspecies equisimilis in Children
Authors: Kakuya Fujio , Kinebuchi Takahiro , Okubo Hitoshi , Matsuo Kumihiro , Kuroda Mami , Fujiyasu Hiroaki
Published: December 2017

Background and Objectives:

The importance of Streptococcus dysgalactiae subsp. equisimilis (SDSE) in causing sporadic pharyngitis in children remains controversial. The aims of this study were (1) to report the incidence and (2) to compare the epidemiologic and clinical features of patients with SDSE to those with Streptococcus pyogenes (SP).

Methods:

A prospective study was conducted on acute pharyngitis associated with SDSE in children over a 2-year period. SDSE was identified using a phenotypic method, M protein gene (emm) analysis and matrix-assisted laser desorption ionization–time of flight mass spectrometry. Patients with positive SDSE or SP cultures received cephalosporins for 5 days and were followed up. The emm genotyping and specific virulence genes analyses were performed.

Results:

From 3416 throat cultures, 67 isolates (2.0%) were identified as SDSE and 515 (15.1%) were identified as SP. The mean age of patients with SDSE (8.3 years) was older than those with SP (6.6 years; P < 0.01). There was minimal seasonal variation in the isolation rates of SDSE. The febrile patients’ rates, gender distribution, cervical lymph node adenopathy rates, hospitalization rates, eradication and failure rates and the nonsuppurative sequelae between patients with SDSE and SP were similar. All SDSE isolates possessed important virulence genes. The emm genotyping of SDSE showed high strain diversity.

Conclusions:

The incidence of acute pharyngitis associated with accurately identified SDSE was 2/15 of that with SP. Epidemiologic and clinical features of acute pharyngitis associated with SDSE are indistinguishable from those with SP, with the exception of age and seasonal variation.
Morbidity and Mortality of a Cohort of Peruvian HIV-infected Children 2003–2012
Authors: Baker Amira N. , Bayer Angela M. , Viani Rolando M. , Kolevic Lenka , Sim Myung-Shin , Deville Jaime G.
Published: December 2017

Background:

Data on pediatric HIV in Peru are limited. The National Institute of Child Health (Instituto Nacional de Salud del Niño: INSN) cares for the most HIV-infected children under the age of 18 years in the country. We describe the outcomes of children seen at INSN’s HIV clinic over the 10 years when antiretroviral therapy and prevention of mother-to-child transmission (PMTCT) interventions became available in 2004.

Methods:

We conducted a retrospective review of INSN HIV clinic patients between 2003 and 2012. Deidentified data were collected and analyzed.

Results:

A total of 280 children were included: 50.0% (140/280) were male; 80.0% (224/280) lived in metropolitan Lima. Perinatal transmission was the mode of HIV infection in 91.4% (256/280) of children. Only 17% (32/191) of mothers were known to be HIV-infected at delivery; of these mothers, 41% (13/32) were receiving antiretroviral therapy at delivery, 72% (23/32) delivered by Cesarean section and 47% (15/32) of their infants received antiretroviral prophylaxis. Median age at HIV diagnosis for all children was 35.7 months (interquartile range 14.5–76.8 months), and 67% (143/213) had advanced disease (clinical stage C). After HIV diagnosis, the most frequent hospitalization discharge diagnoses were bacterial pneumonia, chronic malnutrition, diarrhea, anemia and tuberculosis. Twenty-four patients (8.6%) died at a median age of 77.4 months.

Conclusions:

Most cases of pediatric HIV were acquired via perinatal transmission; few mothers were diagnosed before delivery; and among mothers with known HIV status, PMTCT was suboptimal even after national PMTCT policy was implemented. Most children were diagnosed with advanced disease. These findings underscore the need for improving early pediatric HIV diagnosis and treatment, as well as PMTCT strategies.
Immediate and Long-term Hearing Outcomes With the Middle Cranial Fossa Approach for Vestibular Schwannoma Resection
Authors: Ahmed Sameer , Arts H. Alexander , El-Kashlan Hussam , Basura Gregory J. , Thompson B. Gregory , Telian Steven A.
Published: December 2017

Objective:

To analyze the immediate postoperative and long-term hearing outcome data in patients who have undergone hearing preservation attempts with the middle cranial fossa (MCF) approach for the resection of sporadic vestibular schwannoma.

Study Design:

Retrospective review of a surgical patient cohort.

Setting:

Tertiary academic referral center.

Patients:

Adult patients with unilateral sporadic vestibular schwannoma.

Intervention:

Surgical treatment with a MCF approach.

Main Outcome Measure:

Comparison of pre- and postoperative audiometric data in accordance with the 1995 and 2012 American Academy of Otolaryngology/Head and Neck Surgery guidelines on reporting hearing outcomes and with a word recognition score only scale. Long-term hearing outcome data were analyzed in the following postoperative groups: 3 to 5, 6 to 8, 9 to 11, and 12+ years after surgery.

Results:

From 1999 to 2016, 174 patients underwent the MCF approach and 155 of them met inclusion criteria for analysis of hearing outcome data. Class A or B hearing was preserved in 70% of the entire cohort after recovery. Seventy-one patients with measurable hearing met criteria for long-term data analysis. The rate of American Academy of Otolaryngology/Head and Neck Surgery class A or B hearing preservation was 82% at 3 to 5 years and declined thereafter. The rate of word recognition score class I or II hearing preservation was 98% at 3 to 5 years and declined less rapidly thereafter. Patients with preoperative Class A hearing had significantly higher rates of successful hearing preservation at all postoperative intervals.

Conclusion:

Delayed hearing loss occurs in a progressively increasing fashion but speech understanding remains durable for a majority of patients whose hearing is initially preserved with the MCF approach.
Effect of Prophylactic Medication on Associated Dizziness and Motion Sickness in Migraine
Authors: Lee Seung-Han , Jeong Seong-Hae , Kim Ji-Soo , Kim Hyo-Jung , Choi Kwang-Dong , Choi Jae-Hwan , Oh Sun-Young , Park Ji-Yun , Kim Dong Uk , Kim Byung-Kun
Published: December 2017

Objective:

To determine the efficacy of prophylactic medications for migraine in reducing associated dizziness and motion sickness.

Study Design:

Multicenter prospective observational study.

Setting:

Nationwide 9 Dizziness Clinics in South Korea.

Patients:

One hundred thirty-eight patients who required a preventive medication for migraine accompanied by dizziness and motion sickness.

Intervention:

At least one of the prophylactic medications was prescribed among the beta-blockers, calcium channel blockers, tricyclic antidepressants, and antiepileptic drugs.

Main Outcome Measure:

For 3 months from the index visit, the patients had monthly assessments of the headache (frequency and duration), dizziness handicap inventory, University of California Los Angeles dizziness questionnaire, vertigo symptom scale, and motion sickness score.

Results:

The prophylactic medications significantly improved the headache profiles, all three parameters of dizziness (dizziness handicap inventory, University of California Los Angeles dizziness questionnaire, and vertigo symptom scale), and severity of motion sickness (p < 0.001).

Conclusion:

The prophylactic medication for migraine also improves associated dizziness and motion sickness as well as the headaches.
Electrophysiological Evaluation of the Facial Muscles in Congenital Unilateral Lower Lip Palsy
Authors: Baba Shintaro , Kondo Kenji , Yamasoba Tatsuya
Published: December 2017

Objectives:

Congenital unilateral lower lip palsy (CULLP) is a congenital facial asymmetry in which one corner of the mouth does not dip downward symmetrically (Kobayashi, 1979). We analyzed the electrophysiological findings in cases of CULLP to understand the facial nerve mechanisms underlying this pathological condition.

Methods:

The electrophysiological findings in 20 patients with CULLP including an electroneuronography (ENoG) of the orbicularis oris muscle, nerve excitability test (NET) results, and the blink reflex (BR) were analyzed.

Results:

Of 21 patients with CULLP, 20 underwent ENoG, 12 underwent a NET, and 14 underwent a BR examination. Nine of 19 patients with CULLP showed higher ENoG amplitude in the affected side than in the unaffected side. In four patients, the ENoG amplitude in the affected side was similar to that in the unaffected side whereas six patients had higher ENoG amplitude in the unaffected side. All patients showed a normal BR response and only one patient had a left–right difference in the NET response in the marginal mandibular branch. NET also demonstrated that the muscular twitch appeared on the lower lip of the affected side.

Conclusion:

These results suggested that in CULLP, each of the facial nerve branches including the marginal mandibular branch appeared to function within normal parameters. The marginal mandibular branch of the facial nerve, which usually innervates the depressor anguli oris and depressor labii inferioris muscles, may innervate adjacent muscles as well, such as the orbicularis oris muscle, during prenatal development.
Limitations of teaching endoscopy
Authors: Sonnenberg Amnon
Published: December 2017

Background and aim

Endoscopic procedures of the gastrointestinal tract represent a category of diagnostic tests that considerably rely on skills and dexterity of a human tester. The present analysis aimed to delineate factors that affect the success of teaching endoscopy and potentially limit the acquisition of new skills and knowledge.

Methods

The performance of the endoscopist is described in terms of sensitivity and specificity. The outcomes of sequential testing and acquisition of new knowledge are calculated using matrix algebra. Teaching is modeled as an iterative process with an incremental improvement in a fellow’s performance matrix.

Results

As a diagnostician, an endoscopist cannot measure beyond his/her own level of competence. The cognition and endoscopic skills of both the fellow and the attending physician determine how fast the fellow’s endoscopic performance improves over time. The better the fellow’s and the attending’s abilities are to recognize and amend residual deficiencies, the faster the fellow’s endoscopic performance improves. Severe or even complete diagnostic incompetence by either party can draw out the training process or even result in a complete standstill, respectively.

Conclusion

The description of endoscopic performance in terms of test characteristics provides valuable insights into the influence of endoscopic performance characteristics on the outcome of endoscopy and on the constraints of teaching endoscopic skills.
Study of Insulin Resistance in Patients With β Thalassemia Major and Validity of Triglyceride Glucose (TYG) Index
Authors: Ansari Arif M. , Bhat Kamalakshi G. , Dsa Smitha S. , Mahalingam Soundarya , Joseph Nitin
Published: December 2017

Complications like impaired glucose tolerance and diabetes mellitus due to iron overload need early identification in thalassemia. We studied the proportion of insulin resistance in thalassemia major patients on chronic transfusion, identified insulin resistance using homeostasis model assessment of insulin resistance (HOMA-IR) and triglyceride glucose (TYG) index, compared them and validated TYG index. In total, 73 thalassemia patients on regular transfusion for 3 years with serum ferritin >1500 ng/mL were studied. Serum ferritin, fasting blood glucose, triglycerides, and insulin levels were measured, HOMA-IR, and TYG index calculated and analyzed. Mean fasting glucose, triglyceride, and serum insulin values were 104 mg/dL, 164.18 mg/dL, and 19.6 m IU/mL, respectively. Mean serum ferritin was 5156 ng/mL. Insulin resistance was prevalent in one third of thalassemia patients and showed increase with age and serum ferritin. Insulin resistance by HOMA-IR was 32% as against 16% by TYG index with a cut-off value of 4.3. Using receiver operating charecteristic curve analysis, it was found that, by lowering the value of TYG index to 4.0215, sensitivity improved to 78.3% (from 39.13%) with specificity of 70%. Hence, we recommend a newer lower cut-off value of 4.0215 for TYG index for better sensitivity and specificity in identifying insulin resistance.
Usefulness of the Braden Scale in Intensive Care Units
Authors: Han Yina , Choi Jung Eun , Jin Yin Ji , Jin Tai Xian , Lee Sun-Mi
Published: December 2017

Nurses working in intensive care units have expressed concern that some categories of the Braden scale such as activity and nutrition are not suitable for intensive care unit patients. Upon examining the validity of the Braden scale using the electronic health data, we found relatively low predictability of the tool. Risk factors from the sensory perception and activity categories were not associated with risk of pressure ulcers.
Family Caregivers' Experiences of Within-Hospital Handoffs for Older Adults in Acute Care
Authors: Bristol Alycia A. , Crist Janice D. , Phillips Linda R. , Shea Kimberly D. , Lacasse Cheryl
Published: December 2017

Family caregivers' experiences during within-hospital handoffs between acute care units are not well understood. Qualitative description methodology was employed to describe family caregivers' experiences during their loved ones' handoffs. Semistructured interviews were conducted with 10 caregivers of hospitalized older adults. Three themes emerged: Lack of care coordination, Muddling through handoffs alone, and Wariness toward the care delivery system. Findings can help clinicians shape their interactions with caregivers to maximize their involvement in post–hospital care.
Six Nursing Care Problems in Hospitals
Authors: Eglseer Doris , Hödl Manuela , Lohrmann Christa
Published: December 2017

Background:

Investigations on the quality of nursing care relating to various care problems are rare.

Purpose:

This study assessed the (1) fulfillment of structural indicators, (2) application of nursing interventions as process indicators, and (3) prevalence rate as outcome indicators with regard to various care problems.

Methods:

A cross-sectional multicenter study was conducted in 30 Austrian hospitals with 2878 patients.

Results:

The highest number of structural quality indicators was fulfilled for pressure ulcers, falls, restraints, and pain. In malnutrition and urinary incontinence, a lack of structural indicators was observed. Most interventions were offered to patients with pressure ulcers or those who had experienced a fall. The lowest frequency of nursing interventions was seen in malnourished and incontinent persons.

Conclusion:

There is a need for the national adaptation of guidelines for malnutrition and urinary incontinence. This may increase the frequency of evidence-based nursing interventions.
Shifting the Paradigm
Authors: Potter Teddie
Published: December 2017

In this month's CGEAN column, leaders discuss the current complexities of healthcare requiring nurses to practice competently in interprofessional partnerships. Nurse administrators and executives play a key role in leading culture change so the benefits of full partnership are realized.
Nursing Staff Perceptions of Fall Risk
Authors: Gibson Terri Lea , Lloyd Susan L.
Published: December 2017

Nurses and unlicensed assistive personnel on 2 medical-surgical units were asked about their perceptions regarding patient falls. Their responses reflect learned helplessness and a lack of nurse empowerment that are relevant findings as nurse executives work to decrease patient falls.
Systems Addressing Frail Elder Care
Authors: Ansryan Lianna Zaven , Aronow Harriet Udin , Borenstein Jeff Edward , Mena Viola , Haus Flora , Palmer Katherine , Chan Ellen , Swanson Jane W. , Mass Sharon , Rosen Bradley , Braunstein Glenn David , Burnes Bolton Linda
Published: December 2017

OBJECTIVE

The aim of this article is to describe the Systems Addressing Frail Elder (SAFE) Care model, features of the interprofessional team and reengineered workflow, and details of the intervention.

BACKGROUND

Older inpatients are vulnerable to adverse events related to frailty. SAFE Care, an interprofessional team-based program, was developed and evaluated in a cluster randomized controlled trial (C-RCT). Results found reduced length of stay and complications. The purpose of this article is to support and encourage the replication of this innovation or to help facilitate implementation of a similar process of organizational change.

METHODS

This was a review of model features and intervention data abstracted from electronic health records.

RESULTS

Salient features of team composition, training, and workflow are presented. The C-RCT intention-to-treat sample included 792 patients, of whom 307 received the SAFE Care huddle intervention. The most frequent problem was mobility (85.7%), and most frequent recommendation was fall precautions protocol (83.1%).

CONCLUSIONS

The SAFE Care model may provide a standardized framework to approach, assess, and address the risks of hospitalized older adults.
Targeted Interventions to Advance a Culture of Inquiry at a Large, Multicampus Hospital Among Nurses
Authors: Carter Eileen J. , Rivera Reynaldo R. , Gallagher Kelly A. , Cato Kenrick D.
Published: December 2017

OBJECTIVES

The aim of this study is to assist nurse leaders in developing innovative structures to foster a culture of inquiry among professional nurses.

BACKGROUND

Critical to nurse’s engagement in evidence-based practice (EBP) is a culture of inquiry, in which nurses critically evaluate patient care activities and actively review existing evidence to address identified clinical issues. A bundle of structural interventions was implemented across a large, multisite hospital to advance a culture of inquiry. We measured the impact of these interventions on nurses' library use and on nurses' knowledge, attitudes, and practices towards EBP.

METHODS

Structural interventions included: 1) EBP and Research Committee meetings, in which nurses were educated on how to formulate a clinical question and critically appraise a research article; 2) Academic Partners Program, in which nurse academicians provided scholarly mentorship and guidance during monthly committee meetings; 3) hiring of clinical nurse scientists who provided 1-on-1 education and mentorship to clinical nurses in EBP and research; and 4) a Nurse Residency Program partnership, in which newly graduated nurses were required to complete an EBP project. We examined the impact of these structural interventions on nurses' use of library resources and nurses' knowledge, attitudes, and practices toward EBP.

RESULTS

The implementation of structural interventions to support nurses' engagement in EBP was associated with a significant increase in the number of nurse-generated library consultative requests over time. Results showed high levels of nurse knowledge, attitudes, and practices in EBP.

CONCLUSIONS

Nurse leaders may advance a culture of inquiry by providing the infrastructure to support EBP activities and by empowering nurses to question and seek answer to identified practice questions. Infrastructures should include access to scientific articles and partnerships with schools of nursing. Additional research is needed to validate nurse library use as a measure of nurse engagement in EBP.
The Appraisal of Nursing Practice
Authors: Becker Heather , Meraviglia Marty , Seo Jin (EunJin) , Ndlovu Chipo , Kimmel Lois , Rowin Toni
Published: December 2017

OBJECTIVE

We describe the development of the Appraisal of Nursing Practice (ANP) and present initial psychometric data.

BACKGROUND

Although measures of new nurses' confidence in clinical practice exist, psychometrically sound observational tools that assess a broad range of nursing competencies are needed.

METHODS

Based on the Quality and Safety Education for Nurses competencies, the 37-item ANP covers person-centered care, teamwork and collaboration, evidence-based practice/quality improvement, safety, informatics, professionalism, and overall satisfaction (with the new nurse's functioning). Cognitive interviewing was used to refine the items. Assessment of interrater reliability and a field test in a new nurse residency program were conducted.

RESULTS

Interrater reliability and internal consistency reliability were generally acceptable. Scores increased significantly for nurses as they moved through a nurse residency program.

CONCLUSIONS

The ANP can help nursing administrators identify areas where nurse residents are building needed competencies versus areas that need more work to achieve desired competency outcomes.
Disseminating Knowledge Through Publication
Authors: Graystone Rebecca
Published: December 2017

Clinical nurses and nurse leaders are inspiring and fostering amazing outcomes. In this column, the new Magnet Recognition Program® director discusses the expectation for dissemination of outcomes from Magnet®-designated organizations building on work presented at the 2017 National Magnet Conference™.
Reducing Childhood Admissions to the PICU for Poisoning (ReCAP2) by Predicting Unnecessary PICU Admissions After Acute Intoxication
Authors: Patel Meral M. , Travers Curtis D. , Stockwell Jana A. , Numur Ezaldeen A. , Geller Robert J. , Kamat Pradip P. , Grunwell Jocelyn R.
Published: December 2017

Objective:

To derive and validate clinical prediction models to identify children at low risk of clinically significant intoxications for whom intensive care admission is unnecessary.

Design:

Retrospective review of data in the National Poison Data Systems from 2011 to 2014 and Georgia Poison Center cases from July to December 2016.

Setting:

United States PICUs and poison centers participating in the American Association of Poison Control Centers from 2011 to 2016.

Patients:

Children 18 years and younger admitted to a United States PICU following an acute intoxication.

Interventions:

None.

Measurements and Main Results:

The primary study outcome was the occurrence of clinically significant intoxications defined a priori as organ system–based clinical effects that require intensive care monitoring and interventions. We analyzed 70,364 cases. Derivation (n = 42,240; 60%) and validation cohorts (n = 28,124; 40%) were randomly selected from the eligible population and had similar distributions of clinical effects and PICU interventions. PICU interventions were performed in 1,835 children (14.1%) younger than 6 years, in 374 children (15.4%) 6–12 years, and in 4,446 children (16.5%) 13 years and older. We developed highly predictive models with an area under the receiver operating characteristic curve of 0.834 (< 6 yr), 0.771 (6–12 yr), and 0.786 (≥13 yr), respectively. For predicted probabilities of less than or equal to 0.10 in the validation cohorts, the negative predictive values were 95.4% (< 6 yr), 94.9% (6–12 yr), and 95.1% (≥ 13 yr). An additional 700 patients from the Georgia Poison Center were used to validate the model and would have reduced PICU admission by 31.4% (n = 110).

Conclusions:

These validated models identified children at very low risk of clinically significant intoxications for whom pediatric intensive care admission can be avoided. Application of this model using Georgia Poison Center data could have resulted in a 30% reduction in PICU admissions following intoxication.
An Assessment of Information Exchange Practices, Challenges, and Opportunities to Support US Disease Surveillance in 3 States
Authors: Garcia Macarena C. , Garrett Nedra Y. , Singletary Vivian , Brown Sheereen , Hennessy-Burt Tamara , Haney Gillian , Link Kimberly , Tripp Jennifer , Mac Kenzie William R. , Yoon Paula
Published: December 2017

Background:

State and local public health agencies collect and use surveillance data to identify outbreaks, track cases, investigate causes, and implement measures to protect the public's health through various surveillance systems and data exchange practices.

Purpose:

The purpose of this assessment was to better understand current practices at state and local public health agencies for collecting, managing, processing, reporting, and exchanging notifiable disease surveillance information.

Methods:

Over an 18-month period (January 2014-June 2015), we evaluated the process of data exchange between surveillance systems, reporting burdens, and challenges within 3 states (California, Idaho, and Massachusetts) that were using 3 different reporting systems.

Results:

All 3 states use a combination of paper-based and electronic information systems for managing and exchanging data on reportable conditions within the state. The flow of data from local jurisdictions to the state health departments varies considerably. When state and local information systems are not interoperable, manual duplicative data entry and other work-arounds are often required. The results of the assessment show the complexity of disease reporting at the state and local levels and the multiple systems, processes, and resources engaged in preparing, processing, and transmitting data that limit interoperability and decrease efficiency.

Conclusions:

Through this structured assessment, the Centers for Disease Control and Prevention (CDC) has a better understanding of the complexities for surveillance of using commercial off-the-shelf data systems (California and Massachusetts), and CDC-developed National Electronic Disease Surveillance System Base System. More efficient data exchange and use of data will help facilitate interoperability between National Notifiable Diseases Surveillance Systems.
Assessment of the Sustainability Capacity of a Coordinated Approach to Chronic Disease Prevention
Authors: Moreland-Russell Sarah , Combs Todd , Polk LaShaun , Dexter Sarah
Published: December 2017

Objective:

This article outlines some factors that influenced the sustainability capacity of a coordinated approach to chronic disease prevention in state and territory health departments.

Design:

This study involved a cross-sectional design and mixed-methods approach. Quantitative data were collected using the Program Sustainability Assessment Tool (PSAT), a 40-item multiple-choice instrument that assesses 8 domains of sustainability capacity (environmental support, funding stability, partnerships, organizational capacity, program evaluation, program adaptation, communications, and strategic planning). Qualitative data were collected via phone interviews.

Participants:

The PSAT was administered to staff and stakeholders from public health departments in 50 US states, District of Columbia, and Puerto Rico, who were involved in the implementation of coordinated chronic disease programs. Phone interviews were conducted with program coordinators in each state.

Main Outcome Measure(s):

Sustainability score patterns and state-level categorical results, as well as strengths and opportunities for improvement across the 8 program sustainability domains, were explored.

Results:

On average, programs reported the strongest sustainability capacity in the domains of program adaptation, environmental support, and organizational capacity, while funding stability, strategic planning, and communications yielded lowest scores, indicating weakest capacity. Scores varied the most by state in environmental support and strategic planning.

Conclusion:

The PSAT results highlight the process through which states approached the sustainability of coordinated chronic disease initiatives. This process included an initial focus on program evaluation and partnerships with transfer of priority to long-term strategic planning, communications, and funding stability to further establish coordinated chronic disease efforts. Qualitative interviews provided further context to PSAT results, indicating that leadership, communications, partnerships, funding stability, and policy change were perceived as keys to success of the transition. Integrating these findings into future efforts may help those in transition establish greater sustainability capacity. The PSAT results and interviews provide insight into the capacity for sustainability for programs transitioning from traditional siloed programs to coordinated chronic disease programs.
Development and Validation of Surveillance-Based Algorithms to Estimate Hepatitis C Treatment and Cure in New York City
Authors: Moore Miranda S. , Bocour Angelica , Jordan Lizeyka , McGibbon Emily , Varma Jay K. , Winters Ann , Laraque Fabienne
Published: December 2017

Context:

Treatment options for chronic hepatitis C virus (HCV) have improved in recent years. The burden of HCV in New York City (NYC) is high. Measuring treatment and cure among NYC residents with HCV infection will allow the NYC Department of Health and Mental Hygiene (DOHMH) to appropriately plan interventions, allocate resources, and identify disparities to combat the hepatitis C epidemic in NYC.

Objective:

To validate algorithms designed to estimate treatment and cure of HCV using RNA test results reported through routine surveillance.

Design:

Investigation by NYC DOHMH to determine the true treatment and cure status of HCV-infected individuals using chart review and HCV test data. Treatment and cure status as determined by investigation are compared with the status determined by the algorithms.

Setting:

New York City health care facilities.

Participants:

A total of 250 individuals with HCV reported to the New York City Department of Health and Mental Hygiene (NYC DOHMH) prior to March 2016 randomly selected from 15 health care facilities.

Main Outcome Measures:

The sensitivity and specificity of the algorithms.

Results:

Of 235 individuals successfully investigated, 161 (69%) initiated treatment and 96 (41%) achieved cure since the beginning of 2014. The treatment algorithm had a sensitivity of 93.2% (95% confidence interval [CI], 89.2%-97.1%) and a specificity of 83.8% (95% CI, 75.3%-92.2%). The cure algorithm had a sensitivity of 93.8% (95% CI, 88.9%-98.6%) and a specificity of 89.4% (95% CI, 83.5%-95.4%). Applying the algorithms to 68 088 individuals with HCV reported to DOHMH between July 1, 2014, and December 31, 2016, 28 392 (41.7%) received treatment and 16 921 (24.9%) were cured.

Conclusions:

The algorithms developed by DOHMH are able to accurately identify HCV treatment and cure using only routinely reported surveillance data. Such algorithms can be used to measure treatment and cure jurisdiction-wide and will be vital for monitoring and addressing HCV. NYC DOHMH will apply these algorithms to surveillance data to monitor treatment and cure rates at city-wide and programmatic levels, and use the algorithms to measure progress towards defined treatment and cure targets for the city.
Contemporary protease inhibitors and cardiovascular risk
Authors: Lundgren Jens , Mocroft Amanda , Ryom Lene
Published: December 2017

Purpose of review

To review the evidence linking use of HIV protease inhibitors with excess risk of cardiovascular disease (CVD) in HIV+ populations.

Recent findings

For the two contemporary most frequently used protease inhibitors, darunavir and atazanavir [both pharmacologically boosted with ritonavir (/r)], darunavir/r has been shown to be associated with increased CVD risk. The effect is cumulative with longer exposure increasing risk and an effect size comparable to what has been observed for previously developed protease inhibitors. Biological mechanisms may be overlapping and include perturbed lipid metabolism and accumulation of cholesterol derivatives within macrophages. Conversely, atazanavir/r has not been shown to be associated with CVD, possibly because of its ability to increase cardioprotective bilirubin levels.

Evidence linking protease inhibitors to CVD is based on observational studies only, whereas plausible biological explanations are well established and derived from randomized trials and controlled experiments. Given the possible association with clinical disease, a conservative approach to apply the data in daily practise is proposed which is focused on individualization of care based on underlying risk of CVD.
A Novel Method to Calculate the Volume of Alveolar Cleft Defect Before Surgery
Authors: Chen Guo C. , Sun Min , Yin Ning B. , Li Hai D.
Published: December 2017

Background:

This study aimed to evaluate a novel subtractive method for the precise calculation of alveolar cleft defect volume before surgery using the three-dimensional imaging software Mimics.

Methods:

Ten patients (3 female, 7 male, age range 8–12 years) with unilateral alveolar cleft were enrolled in the study. Preoperative helical computed tomography scans were performed for all patients. A new subtractive method was introduced to precisely calculate the alveolar cleft defect volume before surgery with the aid of Mimics. The DICOM data of every patient were processed using the subtractive method. Statistical analyses were performed using Pearson's correlation test and t test.

Results:

The mean volume of the alveolar cleft defect was 1811.97 ± 817.90 mm3. The mean time spent to calculate an alveolar cleft defect volume was 60.60 ± 11.67 minutes. The Pearson correlation test (r = 0.38, P = 0.279) indicated a poor correlation between alveolar cleft defect volume and calculation time.

Conclusions:

Preoperative knowledge of defect volume is crucial in alveolar cleft repair. Accurate estimation of graft volume in alveolar cleft patients can be performed using this new subtractive method. Compared with previous methods, this new subtractive method is time-saving and suitable for both unilateral and bilateral clefts. Surgeons can use this method to design a surgical plan for each patient before surgery within a short time, and with less cost.
The experience of head and neck cancer survivorship (including laryngectomy): an integrated biopsychosocial model
Authors: Jacobson Marlene C.
Published: December 2017

Purpose of review

The head and neck cancer (HNC) survivorship experience is unique among cancer populations. This review seeks to explore the HNC survivor experience associated with altered upper aerodigestive tract (UADT) function using principles of survivorship.

Recent findings

HNC survivors experience complex physical, functional, and psychosocial challenges related to UADT dysfunction. Interventions need to address all of these dimensions being mindful of the survivor experience. Studies reveal related unmet needs of both HNC survivors and their family members. An expose of the HNC survivorship experience is timely since 2016/2017 contains the release of landmark position papers and guidelines in the field. These address the unique challenges faced by the HNC population, their management, and the triad psychosocial, functional, and physical survivor burden. Such developments will drive future care.

The head and neck survivorship experience is characterized by complex changes with broad impact when examined in an experiential framework. HNC survivor care demands clinical excellence from multiple disciplines that are positioned to enact recent HNC guidelines and adopt survivorship principles. Future research in this population that explores experiential aspects of altered UADT function would be valuable in informing clinical practice. A biopsychosocial framework is presented for conceptualizing the HNC survivorship experience.
Effects of mutations in phage restriction sites during escape from restriction–modification
Authors: Pleška Maroš , Guet Călin C.
Published: December 2017

Restriction–modification systems are widespread genetic elements that protect bacteria from bacteriophage infections by recognizing and cleaving heterologous DNA at short, well-defined sequences called restriction sites. Bioinformatic evidence shows that restriction sites are significantly underrepresented in bacteriophage genomes, presumably because bacteriophages with fewer restriction sites are more likely to escape cleavage by restriction–modification systems. However, how mutations in restriction sites affect the likelihood of bacteriophage escape is unknown. Using the bacteriophage λ and the restriction–modification system EcoRI, we show that while mutation effects at different restriction sites are unequal, they are independent. As a result, the probability of bacteriophage escape increases with each mutated restriction site. Our results experimentally support the role of restriction site avoidance as a response to selection imposed by restriction–modification systems and offer an insight into the events underlying the process of bacteriophage escape.