bluuebunny/crossref_metadata_2025 huggingface dataset:
Duodenal Disaccharidase Activities During and After Weaning off Parenteral Nutrition in Pediatric Intestinal Failure
Authors: Sanaksenaho Galina , Mutanen Annika , Koivusalo Antti I. , Merras‐Salmio Laura , Pakarinen Mikko P.
Published: August 2016

Objectives:

Data on factors affecting absorptive function in children with intestinal failure (IF) are sparse. We evaluated duodenal disaccharidase activities and inflammation in relation to parenteral nutrition (PN) and intestinal resection in pediatric onset IF.

Methods:

Disaccharidase (maltase, sucrase, and lactase) activities and histologic inflammation were evaluated from duodenal biopsies in 58 patients during PN (n = 23) or full enteral nutrition (n = 40) and in 43 matched controls. The first and the last postresection biopsies were analyzed separately after 4.3 (1.2–9.7) years and 6.5 (2.3–12.4) years, respectively.

Results:

During PN, maltase and sucrase activities were 1.6‐fold lower and mucosal inflammation more frequent (22% vs 3%) when compared to matched controls (P < 0.05 for both). In patients on full enteral nutrition, activities of maltase and sucrase were significantly higher than that in patients receiving PN and comparable to those of matched controls. Postresection time correlated positively (r = 0.448 and r = 0.369) and percentage length of the remaining small intestine inversely (r = –0.337 and r = –0.407) with maltase and sucrase activity in patients on full enteral nutrition (P < 0.05 for all), whereas proportional length of remaining colon correlated positively with maltase and lactase activity (r = 0.424–0.544, P < 0.05) in patients receiving PN.

Conclusions:

In children with IF, PN dependency associated with decreased duodenal maltase and sucrase activities and mucosal inflammation, which may disturb intestinal absorptive function. Localization and extent of intestinal resection and post‐resection time correlated with duodenal disaccharidase activities.
Prevalence, Clinical Profile, and Outcome of Ascitic Fluid Infection in Children With Liver Disease
Authors: Srivastava Anshu , Malik Rohan , Bolia Rishi , Yachha Surender K. , Poddar Ujjal
Published: August 2016

Objectives:

Pediatric literature on spontaneous bacterial peritonitis (SBP) is limited. We evaluated the prevalence, subtypes, clinical profile, and effect on outcome of ascitic fluid infection (AFI) in children with liver disease.

Methods:

Children with liver disease‐related ascites and subjected to paracentesis were classified as no‐AFI and AFI (SBP, culture‐negative neutrocytic ascites [CNNA], and monomicrobial non‐neutrocytic bacterascites). Clinical and laboratory parameters, in‐hospital mortality, and outcome in follow‐up were noted.

Results:

Two hundred sixty‐two children (163 boys; age 84 [1–240] months, chronic liver disease [CLD, n = 173], non‐CLD [n = 89]) were enrolled. A total of 28.6% (n = 75) had SBP/CNNA, more common in CLD than non‐CLD (55/173 [31.7%] vs 20/89 [22.4%]; P = 0.1). A total of 50.6% SBP/CNNA cases were symptomatic for AFI. Gram‐negative bacilli were isolated from 70% SBP cases. Twenty‐five percent (18/72) CLD children with AFI had a poor hospital outcome, with INR, Child‐Pugh score and gastrointestinal bleeding predicting outcome on multivariate analysis. Patients with CLD with SBP had higher in‐hospital mortality (10/20 vs 5/35; P = 0.01) than those with CNNA, but similar Child‐Pugh score (12[7–15] vs 11[7–14]; P = 0.1), recurrence of AFI (3/9 vs 6/24; P = 0.6) and mortality in follow‐up (22.2% vs 25%; P = 0.1). Patients with CLD with SBP/CNNA had higher mortality over 1 year follow‐up than no‐AFI (24.2% [8/33] vs 12.2% [7/57]; P = 0.1) but the difference was not significant.

Conclusions:

A total of 28.6% children with liver disease‐related ascites have SBP/CNNA; 50% are symptomatic. Patients with CLD with SBP/CNNA have a mortality of 24% over 1year follow‐up. CLD with SBP is similar to CNNA except for higher in‐hospital mortality.
Specialized Imaging and Procedures in Pediatric Pancreatology
Authors: Lin Tom K. , Troendle David M. , Wallihan Daniel B. , Barth Bradley , Fox Victor L. , Fishman Douglas S. , Morinville Veronique D.
Published: August 2016

Objectives:

An increasing number of children are being diagnosed with pancreatitis and other pancreatic abnormalities. Dissemination of the information regarding existing imaging techniques and endoscopic modalities to diagnose and manage pancreatic disorders in children is sorely needed.

Methods:

We conducted a review of the medical literature on the use of the following imaging and procedural modalities in pediatric pancreatology: transabdominal ultrasonography (TUS), computed tomography (CT), magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP). Recommendations for current use and future research were identified.

Results:

TUS offers noninvasive images of the pancreas but has limitations to details of parenchyma and ductal structures. CT offers improved detail of pancreatic parenchyma, solid masses, and traumatic injuries, but requires relatively high levels of ionizing radiation and does not adequately assess ductal anatomy. MRI/MRCP offers detailed intrinsic tissue assessment and pancreatic ductal characterization, but requires longer image acquisition time and is relatively poor at imaging calcifications. EUS provides excellent evaluation of pancreatic parenchyma and ductal anatomy, but can be subjective and operator dependent and requires sedation or anesthesia. EUS offers the capacity to obtain tissue samples and drain fluid collections and ERCP offers the ability to improve drainage by performing sphincterotomy or placing pancreatic stents across duct injuries and strictures.

Conclusions:

Various imaging modalities may be used in pediatric pancreatology, but TUS and MRI/MRCP are favored. Interventional therapeutic maneuvers primarily involve use of ERCP and EUS. Future research is necessary to optimize equipment, expertise, and appropriate indications.
Fulminant Liver Failure in a Child With β-Thalassemia on Deferasirox: A Case Report
Authors: Ramaswami Archie , Rosen Danya J. , Chu Jaime , Wistinghausen Birte , Arnon Ronen
Published: August 2016

Deferesirox (DFX), an oral chelating agent, is used to treat chronic iron overload in several hematological diseases such as β-thalassemia, sickle cell disease, and myelodysplastic anemia. DFX is generally well tolerated with the exception of gastrointestinal disturbances and rash, although cases of renal toxicity, as well as acute and chronic liver failure, have been reported in adults and children. Here we describe a 3-year-old girl with β-thalassemia undergoing treatment with DFX who presented with acute liver failure and Fanconi’s syndrome. It is important for pediatric gastroenterologists, hepatologists, and hematologists to be aware that the commonly used drug DFX can lead to acute liver failure in children, and liver function should be monitored closely in all patients taking DFX.
The use of commercial video games in rehabilitation: a systematic review
Authors: Bonnechère Bruno , Jansen Bart , Omelina Lubos , Van Sint Jan Serge
Published: August 2016

The aim of this paper was to investigate the effect of commercial video games (VGs) in physical rehabilitation of motor functions. Several databases were screened (Medline, SAGE Journals Online, and ScienceDirect) using combinations of the following free-text terms: commercial games, video games, exergames, serious gaming, rehabilitation games, PlayStation, Nintendo, Wii, Wii Fit, Xbox, and Kinect. The search was limited to peer-reviewed English journals. The beginning of the search time frame was not restricted and the end of the search time frame was 31 December 2015. Only randomized controlled trial, cohort, and observational studies evaluating the effect of VGs on physical rehabilitation were included in the review. A total of 4728 abstracts were screened, 275 were fully reviewed, and 126 papers were eventually included. The following information was extracted from the selected studies: device type, number and type of patients, intervention, and main outcomes. The integration of VGs into physical rehabilitation has been tested for various pathological conditions, including stroke, cerebral palsy, Parkinson’s disease, balance training, weight loss, and aging. There was large variability in the protocols used (e.g. number of sessions, intervention duration, outcome measures, and sample size). The results of this review show that in most cases, the introduction of VG training in physical rehabilitation offered similar results as conventional therapy. Therefore, VGs could be added as an adjunct treatment in rehabilitation for various pathologies to stimulate patient motivation. VGs could also be used at home to maintain rehabilitation benefits.
Patient Safety and Workplace Bullying
Authors: Houck Noreen M. , Colbert Alison M.
Published: August 2016

Workplace bullying is strongly associated with negative nursing outcomes, such as work dissatisfaction, turnover, and intent to leave; however, results of studies examining associations with specific patient safety outcomes are limited or nonspecific. This integrative review explores and synthesizes the published articles that address the impact of workplace nurse bullying on patient safety.
Reduction of Medication Errors
Authors: Schmidt Kaye , Taylor Amy , Pearson Anthony
Published: August 2016

Medication errors are a source of serious patient harm. A unique approach, Socio-Technical Probabilistic Risk Assessment, was used to analyze historical errors in this setting. The goal was to identify a minimal number of steps that would establish increased reliability and decrease errors if these steps were used every time. Three steps were identified that should be taken with every intravenous medication or fluid administration. Preliminary analysis revealed a 22% reduction in errors when using these 3 steps.
Exploring Safety Culture in Jordanian Hospitals
Authors: Suliman Mohammad , Aljezawi Maen , AlBashtawy Mohammed , Fitzpatrick Joyce , Aloush Sami , Al-Awamreh Khitam
Published: August 2016

Medical error is a serious issue in hospitals in Jordan. This study explored Jordanian nurses' perceptions of the culture of safety in their hospitals. The Hospital Survey of Patient Safety Culture translated into Arabic was administered to a convenience sample of 391 nurses from 7 hospitals in Jordan. The positive responses to the 12 dimensions of safety culture ranged from 20.0% to 74.6%. These are lower than the benchmarks of the Agency for Healthcare Research and Quality. Jordanian nurses perceive their hospitals as places that need more effort to improve the safety culture.
Improving the Patient's Experience With a Multimodal Quiet-at-Night Initiative
Authors: Wilson Claire , Whiteman Kimberly , Stephens Kimberly , Swanson-Biearman Brenda , LaBarba Judy
Published: August 2016

This project describes a multifaceted noise reduction program on 2 hospital units designed to ensure a quiet hospital environment, with the goal of improving the patient experience. The noise committee in an urban city hospital developed a plan to control noise including scripted leadership rounding, staff education, a nighttime sleep promotion cart, and visual aids to remind staff to be quiet. Postintervention improvement in patient satisfaction scores was noted.
Levels of Serum Brain-Derived Neurotrophic Factor in Schizophrenia
Authors: Lee Jimmy , Nurjono Milawaty , Lee Tih-Shih
Published: August 2016

Recent meta-analyses of serum brain-derived neurotrophic factor (BDNF) have reported lower levels in patients with schizophrenia. However, most studies did not consider the potential confounding effects of time of collection, age, sex, smoking, and obesity. Here, we sought to examine differences in serum BDNF between medicated patients with schizophrenia compared with control subjects, taking into consideration the potential confounders of serum BDNF. Serum was obtained from a sample of fasted blood collected from all participants, and BDNF was assayed on a commercially available kit. After adjusting for potential confounders, there was no statistically significant difference between cases and control subjects (p = 0.261). In the model, body mass index emerged as the most significant predictor of serum BDNF (β = 0.22, p = 0.009). The present study did not support a role for serum BDNF as a biomarker in schizophrenia. This could be due to the nonspecific nature of serum BDNF and its association with both mental and physical conditions.
The Psychology of Schizophrenia
Authors: Dewan Mantosh J.
Published: August 2016

The focus on recent advances in the neurobiology of schizophrenia has pushed aside the psychological understanding of the person with schizophrenia for several decades. However, a useful functional psychology of schizophrenia (in distinction to a psychological approach to symptoms) remains clinically important for several reasons: it is a core part of the bio-psycho-social formulation; it helps us understand and connect with persons with schizophrenia; and it provides a framework by which to organize our treatment efforts (both psychotherapeutic and particularly biological), which can improve adherence and outcomes. A coherent psychological model (the deficit model) based on object relations theory best explains all the biological, psychological, clinical, and sociocultural factors relevant to the understanding and treatment of persons with schizophrenia. A better understanding of a coherent psychology of persons with schizophrenia and provision of psychotherapies improves both the biological and psychotherapeutic treatment of persons with schizophrenia.
“One Flare at a Time”
Authors: Skrastins Olivia , Fletcher Paula C.
Published: August 2016

Purpose:

The purpose of this investigation is to study the lived experiences of female postsecondary students diagnosed with inflammatory bowel disease and/or irritable bowel syndrome.

Methods:

Nine women between the ages of 18 and 26 years were recruited to participate in this study. Participants completed an informed consent form and background questionnaire before completing a semi-structured one-on-one interview. This interview explored the lived experiences of these individuals in relation to condition management.

Results:

Three salient themes that emerged from the data included (1) it can add to my life; (2) why me: my condition runs my life; and (3) I'm doing the best I can with what I have. The salient theme of I'm doing the best I can with what I have, the theme addressed in this article, was subdivided into adaptive and maladaptive coping behaviors. Reasons for the use of these behaviors included to avoid triggers or flare-ups/harmful effects, to achieve instant relief/pleasure, to respond to environmental pressures, and to become accustomed to dealing with the everyday hassles of their conditions.

Conclusion:

Community health nurses may become part of the solution to help women with inflammatory bowel disease and irritable bowel syndrome find more adaptive coping behaviors. Other implications are discussed.
Integrating Retired Registered Nurses Into a New Graduate Orientation Program
Authors: Baldwin Kathleen M. , Black Denice L. , Normand Lorrie K. , Bonds Patricia , Townley Melissa
Published: August 2016

Purpose:

The project goal of was to decrease new graduate nurse (NGN) attrition during the first year of employment by improving communication skills and providing additional mentoring for NGNs employed in a community hospital located in a rural area.

Description of Project:

All NGNs participate in the Versant Residency Program. Even with this standardized residency program, exit interviews of NGNs who resigned during their first year of employment revealed 2 major issues: communication problems with patients and staff and perceived lack of support/mentoring from unit staff. A clinical nurse specialist–led nursing team developed an innovative program integrating retired nurses, Volunteer Nurse Ambassadors (VNAs), into the Versant Residency Program to address both of those issues.

Outcome:

All NGNs mentored by a retired nurse remain employed in the hospital (100% retention). Before the VNA program, the retention rate was 37.5%. Both the NGNs and VNAs saw value in their mentor-mentee relationship. There have been no critical incidences or failure to rescue events involving NGNs mentored by a VNA.

Conclusion:

Use of VNAs to support NGNs as they adjust to the staff nurse role can prevent attrition during their first year of nursing practice by providing additional support to the NGN.
Clinical Nurse Specialist Roles in Conducting Research
Authors: Albert Nancy M. , Rice Karen L. , Waldo Mary J. , Bena James F. , Mayo Ann M. , Morrison Shannon L. , Westlake Cheryl , Ellstrom Kathleen , Powers Jan , Foster Jan
Published: August 2016

Purpose:

The aim of this study is to describe clinical nurse specialists' characteristics, interest, confidence, motivators, and barriers in conducting research.

Design:

This study was a descriptive, multicohort design.

Methods:

Clinical nurse specialists were recruited electronically through national and local organizations to complete anonymous surveys 3 times, over 3 years. Comparative analyses included χ
2 and Kruskal-Wallis tests.

Results:

Of 2052 responders (initial, n = 629; 18 months, n = 465; and 3 years, n = 958), mean (SD) participant age was 50.3 (9.3) years. Overall, 41.7% of participants were involved as principal or coinvestigators in research. Interest in conducting nursing research (on a 0–100 scale) was 61.1 (38.4) and was lowest among the 18-month time point participant group (score, 39.1 [32.2]) and highest at the 3-year time point (68.3, [30.7]; P < .001). Confidence in conducting research, discussion of statistics, and perceptions of motivators and barriers to conducting research did not differ across time period groups. Access to literature and mentors and research knowledge were the most prevalent barriers to conducting research.

Conclusions:

Less than 42% of clinical nurse specialists conducted research and the rate did not change between different time groups. Access and knowledge barriers to conducting research were prominent. Workplace leaders need to consider resources and support of academic educational opportunities to increase research conduct by clinical nurse specialists.
Five-Year PROSE Treatment for Aniridic Keratopathy
Authors: Kojima Takashi , Hasegawa Asato , Nakamura Tomoaki , Isogai Naoki , Kataoka Takahiro , Ichikawa Kazuo
Published: August 2016

Purpose

Aniridic keratopathy is vision-threatening condition in patients with aniridia. The keratopathy occurs due to limbal stem cell deficiency. When conventional treatments fail, surgical treatments such as corneal limbal transplantation or cultivated oral mucosal epithelium transplantation are the alternatives. Here, we report our experience with the management and monitoring of the progress of a case with aniridic keratopathy treated with a scleral lens.

Case Report

We describe the case of a 30-year-old woman with aniridic keratopathy in both eyes. She visited our outpatient clinic for treatment of visual disturbances in her left eye, which showed a 360° invasion of the conjunctiva. Despite conventional treatment with artificial tears and autologous serum eye drops, the left eye started to suffer from recurrent corneal erosions at 19 months after the initial visit. At 50 months after the initial visit, it presented with persistent epithelial defects and decrease in vision because of the invasion of the vascularized conjunctiva with subepithelial fibrosis. Upon concluding that conventional treatment was ineffective, we tried using a scleral lens (Prosthetic Replacement of the Ocular Surface Ecosystem; PROSE). After the scleral lens treatment, the epithelial defect quickly healed, and visual acuity improved. Six years after the initial visit, the patient’s right eye also started to show epithelial irregularities, which were also treated with a scleral lens. The visual acuity in the right eye too recovered, and corneal transparency was maintained until 3 years after the scleral lens treatment.

Conclusions

The current case showed that long-term scleral lens treatment is a promising option to maintain a healthy ocular surface and visual function in eyes with aniridia caused by limbal stem cell deficiency. Early treatment with a scleral lens may be beneficial in preventing stromal scar formation in the cornea affected by aniridic keratopathy.
Prognostic Significance of High Ki-67 Index and Histogenetic Subclassification in Primary Central Nervous System Lymphoma
Authors: Cho Uiju , Oh Woo Jin , Hong Yong-Kil , Lee Youn Soo
Published: August 2016

In diffuse large B-cell lymphoma (DLBCL), the germinal center B-cell (GCB) subtype is associated with a better prognosis compared with the nongerminal center B-cell-like (non-GCB) subtype. However, validity of this immunohistochemical subgrouping in primary DLBCL of the central nervous system is unclear. A total 45 cases of primary central nervous system lymphoma (PCNS)/DLBCL were selected, and immunohistochemistries for CD10, Bcl-6, MUM1, and Ki-67 were performed. Each of the cases was subclassified as either GCB or non-GCB based on its immunoprofile. Among clinical and immunologic markers, patients under 70 years of age and who had methotrexate chemotherapy showed a significantly better overall survival (OS). High Ki-67 (ie, a Ki-67 index ≥90%) was an independent prognostic factor for a poor OS in the whole cohort and in the patients with non-GCB subtype tumors (P=0.017, HR=4.267, 95% CI, 1.3-14.0;P=0.031, HR=3.752, 95% CI, 1.3-12.5). Tumors were dominantly non-GCB subtype (41/45, 91.1%); only 4 (8.9%) were GCB subtype. The 2-year OS rates for these groups were 73% and 100%. There was, however, no statistically significant difference between these groups for OS and progression-free survival. The subclassification of PCNS/DLBCL into GCB and non-GCB subtypes did not seem to have a prognostic value. In non-GCB subtype PCNSL patients, high Ki-67 index was an adverse independent prognostic marker that could be used to stratify patients for more suitable management.
Function of the Left and Right Ventricles and the Interactions Between Them
Authors: Penny Daniel J. , Redington Andrew N.
Published: August 2016

Objectives:

There has been a recent increase in our understanding of mechanisms whereby the two sides of the heart interact and modulate each other that may be particularly relevant to patients in the ICU. For this review, our objectives are to examine the function of the left ventricle, consider some of the ways in which the function of the right ventricle differs from that of the left, and examine the effects of the left ventricle on the function of the right and vice versa.

Data Source:

MEDLINE and PubMed.

Conclusions:

There are fundamental differences between the function of the left and right ventricles, which relate to a significant extent to differences in their respective arterial loads. Although traditionally it has been usual to consider the function of the left and right ventricle in isolation, it is now recognized that this approach is flawed and as a result there is an increasing appreciation of the continual cross talk between the two sides of the heart in both the normal and diseased states. A more rational approach to the use of standard therapies frequently used in the cardiac ICU will come from a better understanding of these important fundamental concepts, and novel therapeutic concepts are already emerging from new data regarding biventricular interactions.
Echocardiography and Focused Cardiac Ultrasound
Authors: Klugman Darren , Berger John T.
Published: August 2016

Objectives:

The following review will describe the use of focused cardiac ultrasound performed by noncardiologists and its role as an acute hemodynamic monitoring tool in pediatric cardiac critical care.

Data Source:

MEDLINE and PubMed.

Conclusion:

The use of focused cardiac ultrasound has grown tremendously over recent years, and is increasingly being performed and interpreted by intensivists, anesthesiologists, and emergency medicine physicians. These imaging techniques are useful in establishing etiologies of cardiac dysfunction and should compliment the physical examination and standard hemodynamic monitoring.
Left Ventricular Outflow Tract Obstruction: Coarctation of the Aorta, Interrupted Aortic Arch, and Borderline Left Ventricle
Authors: Kaza Aditya K. , Thiagarajan Ravi R.
Published: August 2016

Objectives:

The objectives of this review are to discuss the perioperative management of coarctation of the aorta, interrupted aortic arch, and the borderline left ventricle.

Methods:

MEDLINE and PubMed.

Conclusions:

Successful management of systemic obstructive lesions involves a thorough evaluation of the anatomy and pathophysiology to determine the most effective management strategy.
Nursing Considerations in Pediatric Cardiac Critical Care
Authors: Jones Melissa B. , Tucker Dawn
Published: August 2016

Objective:

The objectives of this review are to describe the education and critical thinking skills that characterize pediatric critical care nursing and how these skills impact patient care and outcomes in pediatric cardiac critical care.

Data Source:

MEDLINE and PubMed.

Conclusions:

Pediatric cardiac critical care nurses manage complex and vulnerable patients requiring various levels of support. Effective care of these patients requires knowledge about the complex anatomy and physiology associated with congenital and acquired heart disease, as well as the effects of mechanical ventilation, mechanical circulatory support, and vasoactive medications. Strong physical examination skills, accurate interpretation of hemodynamic and laboratory data, active participation in bedside rounds, excellent communication skills, meticulous care of invasive monitoring catheters and tubes, and compassionate support of families are among the skills that distinguish a cardiac critical care nurse.
A Simple and Robust Bedside Model for Mortality Risk in Pediatric Patients With Acute Respiratory Distress Syndrome*
Authors: Spicer Aaron C. , Calfee Carolyn S. , Zinter Matthew S. , Khemani Robinder G. , Lo Victoria P. , Alkhouli Mustafa F. , Orwoll Benjamin E. , Graciano Ana L. , Boriosi Juan P. , Howard James P. , Flori Heidi R. , Matthay Michael A. , Sapru Anil
Published: August 2016

Objectives:

Despite declining mortality, acute respiratory distress syndrome is still involved in up to one third of pediatric intensive care deaths. The recently convened Pediatric Acute Lung Injury Consensus Conference has outlined research priorities for the field, which include the need for accurate bedside risk stratification of patients. We aimed to develop a simple yet robust model of mortality risk among pediatric patients with acute respiratory distress syndrome to facilitate the targeted application of high-risk investigational therapies and stratification for enrollment in clinical trials.

Design:

Prospective, multicenter cohort.

Setting:

Five academic PICUs.

Patients:

Three hundred eight children greater than 1 month and less than or equal to 18 years old, admitted to the ICU, with bilateral infiltrates on chest radiograph and Pao
2/Fio
2 ratio less than 300 in the clinical absence of left atrial hypertension.

Interventions:

None.

Measurements and Main Results:

Twenty clinical variables were recorded in the following six categories: demographics, medical history, oxygenation, ventilation, radiographic imaging, and multiple organ dysfunction. Data were measured 0–24 and 48–72 hours after acute respiratory distress syndrome onset (day 1 and 3) and examined for associations with hospital mortality. Among 308 enrolled patients, mortality was 17%. Children with a history of cancer and/or hematopoietic stem cell transplant had higher mortality (47% vs 11%; p < 0.001). Oxygenation index, the Pao
2/Fio
2 ratio, extrapulmonary organ dysfunction, Pediatric Risk of Mortality-3, and positive cumulative fluid balance were each associated with mortality. Using two statistical approaches, we found that a parsimonious model of mortality risk using only oxygenation index and cancer/hematopoietic stem cell transplant history performed as well as other more complex models that required additional variables.

Conclusions:

In the PICU, oxygenation index and cancer/hematopoietic stem cell transplant history can be used on acute respiratory distress syndrome day 1 or day 3 to predict hospital mortality without the need for more complex models. These findings may simplify risk assessment for clinical trials, counseling families, and high-risk interventions such as extracorporeal life support.
Ketosis After Cardiopulmonary Bypass in Children Is Associated With an Inadequate Balance Between Oxygen Transport and Consumption*
Authors: Klee Philippe , Arni Delphine , Saudan Sonja , Schwitzgebel Valérie M. , Sharma Ruchika , Karam Oliver , Rimensberger Peter C.
Published: August 2016

Objectives:

Hyperglycemia after cardiac surgery and cardiopulmonary bypass in children has been associated with worse outcome; however, causality has never been proven. Furthermore, the benefit of tight glycemic control is inconsistent. The purpose of this study was to describe the metabolic constellation of children before, during, and after cardiopulmonary bypass, in order to identify a subset of patients that might benefit from insulin treatment.

Design:

Prospective observational study, in which insulin treatment was initiated when postoperative blood glucose levels were more than 12 mmol/L (216 mg/dL).

Setting:

Tertiary PICU.

Patients:

Ninety-six patients 6 months to 16 years old undergoing cardiac surgery with cardiopulmonary bypass.

Interventions:

None.

Measurements and Main Results:

Metabolic tests were performed before anesthesia, at the end of cardiopulmonary bypass, at PICU admission, and 4 and 12 hours after PICU admission, as well as 4 hours after initiation of insulin treatment. Ketosis was present in 17.9% patients at the end of cardiopulmonary bypass and in 31.2% at PICU admission. Young age was an independent risk factor for this condition. Ketosis at PICU admission was an independent risk factor for an increased difference between arterial and venous oxygen saturation. Four hours after admission (p = 0.05). Insulin corrected ketosis within 4 hours.

Conclusions:

In this study, we found a high prevalence of ketosis at PICU admission, especially in young children. This was independently associated with an imbalance between oxygen transport and consumption and was corrected by insulin. These results set the basis for future randomized controlled trials, to test whether this subgroup of patients might benefit from increased glucose intake and insulin during surgery to avoid ketosis, as improving oxygen transport and consumption might improve patient outcome.
Treatment of Pediatric Septic Shock With the Surviving Sepsis Campaign Guidelines and PICU Patient Outcomes*
Authors: Workman Jennifer K. , Ames Stefanie G. , Reeder Ron W. , Korgenski E. Kent , Masotti Susan M. , Bratton Susan L. , Larsen Gitte Y.
Published: August 2016

Objectives:

The Surviving Sepsis Campaign recommends rapid recognition and treatment of severe sepsis and septic shock. Few reports have evaluated the impact of these recommendations in pediatrics. We sought to determine if outcomes in patients who received initial care compliant with the Surviving Sepsis Campaign time goals differed from those treated more slowly.

Design:

Single center retrospective cohort study.

Setting:

Emergency department and PICU at an academic children’s hospital.

Patients:

Three hundred twenty-one patients treated for septic shock in the emergency department and admitted directly to the PICU.

Interventions:

None.

Measurements and Main Results:

The exposure was receipt of emergency department care compliant with the Surviving Sepsis Campaign recommendations (delivery of IV fluids, IV antibiotics, and vasoactive infusions within 1 hr of shock recognition). The primary outcome was development of new or progressive multiple organ dysfunction syndrome. Secondary outcomes included mortality, need for mechanical ventilation or vasoactive medications, and hospital and PICU length of stay. Of the 321 children studied, 117 received Surviving Sepsis Campaign compliant care in the emergency department and 204 did not. New or progressive multiple organ dysfunction syndrome developed in nine of the patients (7.7%) who received Surviving Sepsis Campaign compliant care and 25 (12.3%) who did not (p = 0.26). There were 17 deaths; overall mortality rate was 5%. There were no significant differences between groups in any of the secondary outcomes. Although only 36% of patients met the Surviving Sepsis Campaign guideline recommendation of bundled care within 1 hour of shock recognition, 75% of patients received the recommended interventions in less than 3 hours.

Conclusions:

Treatment for pediatric septic shock in compliance with the Surviving Sepsis Campaign recommendations was not associated with better outcomes compared with children whose initial therapies in the emergency department were administered more slowly. However, all patients were treated rapidly and we report low morbidity and mortality. This underscores the importance of rapid recognition and treatment of septic shock.
Disaster Preparedness Among Michigan's Licensed Child Care Programs
Authors: Chang Megan T. , Bradin Stuart , Hashikawa Andrew N.
Published: August 2016

Objective

This study aimed to assess if Michigan child care directors have created disaster management plans, and if local resources were used to develop and implement plans.

Methods

From December 2013 to March 2014, the Early Childhood Investment Corporation conducted a survey of licensed child care programs in Michigan. An online survey regarding disaster preparedness and training resources was distributed to the directors of a convenience sample of registered child care centers among the Early Childhood Investment Corporation's statewide network of 11 resource centers.

Results

A total of 210 child care programs responded. Most (91%) of respondents had a disaster plan, but 40% did not include accommodations for special needs children, 51% did not have a family/child identification or reunification plan, and 67% did not have car safety devices and a predetermined route for evacuation. Fewer than 9% made disaster plans available online. Few collaborated with local fire (22%), police (27%), or pediatric or emergency medicine organizations (11%). Online modules were the most desirable training format.

Conclusions

In a state without mandated child care guidelines for disaster preparedness, a substantial proportion of child care programs were missing critical components of disaster planning. Future interventions must focus on increasing partnerships with local organizations and developing guidelines and training to include plans for special needs children, family/child identification and reunification, and evacuation/relocation.
Accidental Burn by Intentional Laxative Use
Authors: MacDuff Sabrina , Sun Joanne , Bell Derek E. , Lentz Christoper W. , Kahn Steven A.
Published: August 2016

Objective

The purpose of this study was to present a case report and review the relevant literature on laxative-induced dermatitis being mistaken for scald injury and child abuse.

Case

A 33-month-old girl presented with partial thickness burn to the buttocks and perineum, which were suspected to be caused by child abuse. On further investigation, the parents had been administering large doses of laxatives to the child for chronic constipation.

Discussion

Child abuse by burning has characteristic physical examination findings, which differ from the pattern of laxative-induced dermatitis that has been reported in the literature. Diapers appear to be a risk factor for laxative-induced dermatitis. Surprisingly, the dose of laxative does not correlate with the severity of the burn injury. All physicians must be aware of the possibility of laxative-induced dermatitis mimicking scald burn injury to the buttocks. Parents should be educated about the risk of administering over-the-counter laxatives to children.
Lumbar Artery Perforator Flap: An Anatomical Study Using Multidetector Computed Tomographic Scan and Surgical Pearls for Breast Reconstruction
Authors: Hamdi Moustapha , Craggs Barbara , Brussaard Carola , Seidenstueker Katrin , Hendrickx Benoit , Zeltzer Assaf
Published: August 2016

Background:

Breast reconstruction with the lumbar artery perforator flap is indicated in patients with unfavorable abdominal donor site. In addition to their clinical experience with lumbar artery perforator free flap breast reconstruction, the authors present an anatomical study of the origin and course of the perforators.

Methods:

Images of multidetector computerized tomography scans were used to visualize the location of the dominant lumbar artery perforator in 20 patients. The medical files of the authors’ patients who underwent lumbar artery perforator flap breast reconstruction were also analyzed.

Results:

Multidetector computed tomographic imaging in 20 female patients with a mean age of 47 years revealed an equal number of dominant perforators (10 left and 10 right); 60 percent were third lumbar artery perforators, 30 percent were fourth, and the remaining were second. The dominant perforators were mainly located 42.6 mm from the y axis at their origin at the transverse process, and 69.5 mm when emerging in the subcutaneous tissue. Six patients had nine successful lumbar artery perforator flaps for breast reconstruction. Average operative time was 270 minutes. Due to shortness of pedicle and mismatching between diameter of lumbar artery and internal mammary artery, vascular bypass (harvested from the deep inferior epigastric vessels) was required in 50 percent of the cases. The major complication at the donor site was seroma (80 percent).

Conclusions:

The lumbar artery perforator has a constant anatomical location. The free lumbar artery perforator flap provides an ample amount of tissue for breast reconstruction; however, its major disadvantages are the small artery diameter, shortness of the pedicle, and high seroma rate at the donor site.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Effects of the Ultra–High-Frequency Electrical Field Radiofrequency Device on Mouse Skin: A Histologic and Molecular Study
Authors: Kim Miri , Kim Kyung-Eun , Jeong Seo-won , Hwang Se Won , Jo Hyunmu , Lee Jahyung , Cho Daeho , Park Hyun Jeong
Published: August 2016

Background:

Radiofrequency technology is one of the most recently developed methods for noninvasive skin tightening and facial contouring, and works by generating thermal energy in the deep dermis. Although clinical improvements have been reported using radiofrequency devices, there are few histologic and molecular studies about the mechanisms of dermal collagen remodeling. The authors investigated the histologic effects of an ultra–high-frequency electrical field (40.68 MHz) radiofrequency device (Polargen) on collagen remodeling in hairless mouse skin and evaluated its relative molecular mechanism.

Methods:

The radiofrequency was applied to the dorsal skin of hairless mice three times per week for 2 weeks. At 21 days after initial treatment, treated skin and nontreated control skin samples were excised for semiquantitative analysis of histologic features, including collagen. The authors also checked the mRNA expression levels of collagen type 1, transforming growth factor (TGF)-β, matrix metalloproteinase-1, vascular endothelial growth factor, tumor necrosis factor-α, and interleukin-1.

Results:

Histologic examination revealed epidermal hyperplasia, increased collagen staining, and fat atrophy in treated skin area compared with the nontreated skin area. In addition, mRNA expression of collagen type І, TGF-β, and vascular endothelial growth factor in radiofrequency-treated areas was significantly increased compared with that in untreated control areas (p < 0.05, p < 0.05, and p < 0.01, respectively).

Conclusions:

These results suggest that the device may facilitate replacement of subcutaneous fat tissue with new collagen in association with the increased mRNA levels in TGF-β and vascular endothelial growth factor. Therefore, this device may effectively reduce adipose tissue and achieve facial contouring in addition to skin tightening.
One versus Two Venous Anastomoses in Anterolateral Thigh Flap Reconstruction after Oral Cancer Ablation
Authors: Lee Yao-Chou , Chen Wei-Chen , Chen Szu-Han , Hung Kuo-Shu , Hsiao Jenn-Ren , Lee Jing-Wei , Shieh Shyh-Jou
Published: August 2016

Background:

Whether one-vein or two-vein drainage yields better outcomes in anterolateral thigh flap reconstruction after oral cancer ablation is still being debated. Thus, the authors investigated this question.

Methods:

In this retrospective cohort study, the authors reviewed the charts of 321 patients with oral cancer who, between August of 2010 and July of 2014, had undergone ablative surgery and then immediate reconstruction with the anterolateral thigh flap. Patients who underwent simultaneous reconstruction with additional free flaps were excluded. The patients were subgrouped into newly diagnosed (n = 221) and previously treated (n = 100) groups and then subgrouped into one-vein and two-vein groups.

Results:

Overall, operative time was significantly longer (366.8 ± 112.7 minutes versus 336.3 ± 99.7 minutes; p = 0.009) and hospitalization was significantly shorter (22.0 ± 13.3 days versus 24.5 ± 13.8 days; p = 0.027) in the two-vein group. In the newly diagnosed two-vein group, operative time was also significantly longer (355.5 ± 91.7 minutes versus 319.9 ± 95.9 minutes; p = 0.008), anterolateral thigh flap take-backs for vascular compromise (3.2 percent versus 10.9 percent; p = 0.041) and venous congestion (1.1 percent versus 7.8 percent; p = 0.027) were fewer, and flap survival was greater (100 percent versus 95.3 percent; p = 0.041). Differences between the one-vein and two-vein previously treated subgroups were not significant.

Conclusion:

In newly diagnosed patients undergoing anterolateral thigh flap reconstruction after oral cancer ablation, better outcomes are achieved with two venous anastomoses rather than one.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Ethical Issues in Pediatric Face Transplantation: Should We Perform Face Transplantation in Children?
Authors: Marchac Alexandre , Kuschner Tomasine , Paris John , Picard Arnaud , Vazquez Marie Paule , Lantieri Laurent
Published: August 2016

Background:

In 2005, face transplantation ceased to be fiction and became a scientific reality. Today, 10 teams from six different countries have performed 32 face transplantations. Immunosuppressive treatments are similar to other solid organ transplants, and patients have experienced a significant functional improvement. The authors are logically considering expanding face transplantation to children; however, children are not simply small adults.

Methods:

The authors searched for pediatric patients in need of restoration of fundamental functions of the face, such as orbicularis oris or oculi muscle closure by, first, selecting cases from a pediatric plastic surgery reference center and, second, analyzing the feasibility of face transplantation in those patients. The authors then identified the specific problems that they would encounter during a pediatric face transplant. The authors identified three potential candidates for pediatric face transplantation.

Results:

Children’s youth imposes additional ethical and psychological considerations, such as the balance of risk to benefit when it is quality of life, not life itself, that is at stake; the process of informed consent; the selection process; and the protection of privacy against media exposure. The question becomes not whether children should be included as candidates for face transplantation but whether any ethical barriers should preclude children as candidates for a full face transplant.

Conclusion:

After careful consideration of the physical, psychological, and ethical aspects of such a procedure, the authors found no such barrier that would either disqualify such vulnerable subjects as profoundly disfigured children or conflict with their best interests.
A Longitudinal Relationship Between Depressive Symptoms and Development of Metabolic Syndrome: The Coronary Artery Risk Development in Young Adults Study
Authors: Womack Veronica Y. , De Chavez Peter John , Albrecht Sandra S. , Durant Nefertiti , Loucks Eric B. , Puterman Eli , Redmond Nicole , Siddique Juned , Williams David R. , Carnethon Mercedes R.
Published: August 2016

Objective

Despite variability in the burden of elevated depressive symptoms by sex and race and differences in the incidence of metabolic syndrome, few prior studies describe the longitudinal association of depressive symptoms with metabolic syndrome in a diverse cohort. We tested whether baseline and time-varying depressive symptoms were associated with metabolic syndrome incidence in black and white men and women from the Coronary Artery Risk Development in Young Adults study.

Methods

Participants reported depressive symptoms using the Center for Epidemiologic Studies Depression Scale at four examinations between 1995 and 2010. At those same examinations, metabolic syndrome was determined. Cox proportional hazards models were used to examine the associations of depressive symptoms on the development of metabolic syndrome in 3208 participants without metabolic syndrome at baseline.

Results

For 15 years, the incidence rate of metabolic syndrome (per 10,000 person-years) varied by race and sex, with the highest rate in black women (279.2), followed by white men (241.9), black men (204.4), and white women (125.3). Depressive symptoms (per standard deviation higher) were associated with incident metabolic syndrome in white men (hazard ratio = 1.25, 95% confidence interval = 1.08–1.45) and white women (hazard ratio = 1.17, 95% confidence interval = 1.00–1.37) after adjustment for demographic characteristics and health behaviors. There was no significant association between depression and metabolic syndrome among black men or black women.

Conclusions

Higher depressive symptoms contribute modestly to the onset of metabolic syndrome among white adults.