bluuebunny/crossref_metadata_2025 huggingface dataset:
Implementing Electronic Patient-Reported Outcome Measures in Outpatient Cosmetic Surgery Clinics: An Exploratory Qualitative Study
Authors: Kaur Manraj , Pusic Andrea , Gibbons Chris , Klassen Anne F
Published: October 2018

Background

Patient-reported outcome measure (PROM) data are increasingly being collected over the internet or on a smart device by means of electronic versions (e-PROMs). Limited evidence exists about factors influencing e-PROM implementation in outpatient clinics.

Objectives

The authors sought to identify barriers to collection of PRO data from different locations (home or cosmetic surgery office) by means of different modes (paper vs e-PROM) from the perspective of patients, plastic surgeons, and clinic administrative staff; and to explore patient preferences for the design of e-PROM platforms.

Methods

Semistructured interviews were conducted with 11 patients, 3 cosmetic surgeons, and administrative staff. Patients were shown 1 of the 3 PROMs (ie, the BODY-Q Satisfaction with Body scale, BREAST-Q Augmentation Module Satisfaction with Breast scale, or FACE-Q Satisfaction with Facial Appearance scale). The formats included paper and electronic (REDCap and TickiT) on a tablet and laptop computer. The interviews were audio-recorded and transcribed verbatim. Qualitative descriptive analysis was conducted.

Results

Patients and providers preferred electronic over paper format. The flexibility of the hardware, data entry point (remote location vs point-of-care), and the privacy of the data were the most recurring themes from the patient’s perspective. The objective of collecting PROM data, role in peer-benchmarking, and return on investment were key to surgeons and administrative staff.

Conclusions

The e-PROMs were well accepted in the community setting by the patients and plastic surgeons alike. The design and interface features of e-PROMs were explored in this study, which may be useful for future, mixed method studies evaluating the implementation of e-PROMs.
Strong order 1/2 convergence of full truncation Euler approximations to the Cox–Ingersoll–Ross process
Authors: Cozma Andrei , Reisinger Christoph
Published: October 2018

We study convergence properties of the full truncation Euler scheme for the Cox–Ingersoll–Ross (CIR) process in the regime where the boundary point zero is inaccessible. Under some conditions on the model parameters (precisely, when the so-called Feller ratio is greater than three) we establish the strong order 1/2 convergence in $L^{p}$ of the scheme to the exact solution. For the global error criterion studied in this paper this is consistent with the optimal rate of strong convergence for approximations to the CIR process based on sequential evaluations of the driving Brownian motion.
A game theoretical semantics for a logic of formal inconsistency
Authors: Başkent Can , Henrique Carrasqueira Pedro
Published: October 2018

This paper introduces a game theoretical semantics for a particular logic of formal inconsistency called mbC.
Non-deterministic algebraization of logics by swap structures1
Authors: Coniglio Marcelo E , Figallo-Orellano Aldo , Golzio Ana Claudia
Published: October 2018

Multialgebras (or hyperalgebras or non-deterministic algebras) have been much studied in mathematics and in computer science. In 2016 Carnielli and Coniglio introduced a class of multialgebras called swap structures, as a semantic framework for dealing with several Logics of Formal Inconsistency (or LFIs) that cannot be semantically characterized by a single finite matrix. In particular, these LFIs are not algebraizable by the standard tools of abstract algebraic logic. In this paper, the first steps towards a theory of non-deterministic algebraization of logics by swap structures are given. Specifically, a formal study of swap structures for LFIs is developed, by adapting concepts of universal algebra to multialgebras in a suitable way. A decomposition theorem similar to Birkhoff’s representation theorem is obtained for each class of swap structures. Moreover, when applied to the 3-valued algebraizable logics J3 and Ciore, their classes of algebraic models are retrieved, and the swap structures semantics become twist structures semantics (as independently introduced by M. Fidel and D. Vakarelov). This fact, together with the existence of a functor from the category of Boolean algebras to the category of swap structures for each LFI (which is closely connected with Kalman’s functor), suggests that swap structures can be seen as non-deterministic twist structures. This opens new avenues for dealing with non-algebraizable logics by the more general methodology of multialgebraic semantics.
How Lives Change
Authors: Himanshu  , Lanjouw Peter , Stern Nicholas
Published: October 2018

Development economics is about understanding how and why lives and livelihoods change. This book is about economic development in the village of Palanpur, in Moradabad district, Uttar Pradesh, in north India. It draws on seven decades of detailed data collection by a team of dedicated development economists to describe the evolution of Palanpur’s economy, its society, and its politics. The emerging story of integration of the village economy with the outside world is placed against the backdrop of a rapidly transforming India and, in turn, helps to understand the transformation. The role of, and scope for, public policy in shaping the lives of individuals is examined. The book describes how changes in Palanpur’s economy since the late 1950s were initially driven by the advance of agriculture through land reforms, the expansion of irrigation, and the introduction of ‘green revolution’ technologies. Then, since the mid-1980s, newly emerging off-farm opportunities in nearby towns and outside agriculture became the key drivers of growth and change. These key forces of change have profoundly influenced poverty, income mobility, and inequality in Palanpur. Village institutions such as those governing access to land are shown to have evolved in subtle but clear ways over time, while individual entrepreneurship and initiative is found to play a critical role in driving and responding to the forces of change. And yet, against a backdrop of real economic growth and structural transformation, the book documents how human development outcomes have shown only weak progress and remain stubbornly resistant to change.
Short-term Efficiency and Tolerance of Ketoprofen and Methylprednisolone in Acute Sciatica: A Randomized Trial
Authors: Gastaldi Romain , Durand Marjorie , Roustit Matthieu , Zulian Myriam , Monteiro Irène , Juvin Robert , Gaudin Philippe , Baillet Athan
Published: October 2018

Objective

Although anti-inflammatory drugs are commonly used in acute discogenic sciatica, data regarding their efficacy are scarce and controversial. We compared the efficacy and safety of intravenous ketoprofen and methylprednisolone with placebo in sciatica.

Design

Multicenter, double-blinded randomized controlled trial.

Subjects

Patients with confirmed discogenic acute sciatica, without neurologic deficit, were randomized into three arms.

Methods

Besides standard-of-care analgesic therapy, they received intravenous injections of methylprednisolone (60 mg/d) or ketoprofen (200 mg/d) or placebo for five days. The primary outcome was leg pain over five days. Secondary outcomes were clinical responses at days 3 and 5, lumbar pain, Straight Leg Raise Test and lumbar flexion index, analgesic consumption, realization of lumbar spine injections, and surgery during the study period.

Results

Fifty-four patients were randomized, and 50 completed the study. In patients admitted to the hospital for pain control with acute lumbar radicular pain due to intervertebral disc herniation and receiving an oral analgesic protocol including paracetamol, nefopam, tramadol, and morphine, there was no additional analgesic effect seen between groups. There was no significant difference in leg pain between the three groups over the study period. In the methylprednisolone group, however, we observed a higher rate of clinically relevant responses at day 3. No difference was observed on other secondary efficacy outcomes and safety.

Conclusion

No significant difference in leg pain was observed between groups. However, there was a higher proportion of patients relieved with intravenous methylprednisolone at day 3, compared with ketoprofen or placebo.
Firming Up Inequality*
Authors: Song Jae , Price David J , Guvenen Fatih , Bloom Nicholas , von Wachter Till
Published: October 2018

We use a massive, matched employer-employee database for the United States to analyze the contribution of firms to the rise in earnings inequality from 1978 to 2013. We find that one-third of the rise in the variance of (log) earnings occurred within firms, whereas two-thirds of the rise occurred due to a rise in the dispersion of average earnings between firms. However, this rising between-firm variance is not accounted for by the firms themselves but by a widening gap between firms in the composition of their workers. This compositional change can be split into two roughly equal parts: high-wage workers became increasingly likely to work in high-wage firms (i.e., sorting increased), and high-wage workers became increasingly likely to work with each other (i.e., segregation rose). In contrast, we do not find a rise in the variance of firm-specific pay once we control for the worker composition in firms. Finally, we find that two-thirds of the rise in the within-firm variance of earnings occurred within mega (10,000+ employee) firms, which saw a particularly large increase in the variance of earnings compared with smaller firms.
ORGAN DOSE ESTIMATION ACCOUNTING FOR UNCERTAINTY FOR PEDIATRIC AND YOUNG ADULT CT SCANS IN THE UNITED KINGDOM
Authors: Lee Choonsik , Journy Neige , Moroz Brian E , Little Mark , Harbron Richard , McHugh Kieran , Pearce Mark , Berrington de Gonzalez Amy
Published: October 2018

Since our previous publication of organ dose for the pediatric CT cohort in the UK, there have been questions about the magnitude of uncertainty in our dose estimates. We therefore quantified shared and unshared uncertainties in empirical CT parameters extracted from 1073 CT films (1978–2008) from 36 hospitals in the study and propagated these uncertainties into organ doses using Monte Carlo random sampling and NCICT organ dose calculator. The average of 500 median brain and marrow doses for the full cohort was 35 (95% confidence interval: 30–40) mGy and 6 (5–7) mGy, respectively. We estimated that shared uncertainty contributed ~99% of coefficient of variation of median brain doses in brain scans compared to unshared uncertainty (1% contribution). We found that the previous brain doses were slightly underestimated for <1990 and overestimated for >1990 compared to the results in the current study due to the revised CTDI models based on CT films.
Nontoxic Three-Part Combination Local Wound Therapy to Eradicate Carbapenem-Resistant Klebsiella pneumoniae
Authors: Kim Nicholas , Murphy Mary , Choudry Umar
Published: October 2018

This case report describes eradication of carbapenem-resistant Klebsiella pneumoniae from an ischial pressure injury in a patient who underwent a 3-week course of nontoxic three-part combination local wound therapy. With this therapy, providers prevented systemic spread of this multidrug-resistant pathogen and avoided the nephrotoxicity associated with conventional triple antibiotic therapy.
Using Simulation to Improve Student and Faculty Knowledge of Telehealth and Rural Characteristics
Authors: Mennenga Heidi A. , Johansen Laurie , Foerster Becka , Tschetter Lois
Published: October 2018

The purpose of this study was to evaluate the knowledge of senior baccalaureate nursing students and faculty members regarding telehealth and rural nursing concepts before and after participation in a newly developed simulation, which incorporated telehealth use in a rural home environment. Statistically significant increases in knowledge were found in both faculty and students following participation in the simulation. The results of this research indicate the need to increase student and faculty knowledge about telehealth and rural nursing concepts.
Evaluating the Effectiveness of Two Teaching Strategies to Improve Nursing Students’ Knowledge, Skills, and Attitudes About Quality Improvement and Patient Safety
Authors: Maxwell Karen L. , Wright Vivian H.
Published: October 2018

The purpose of this study was to evaluate two teaching strategies with regard to quality and safety education for nurses content on quality improvement and safety. Two groups (total of 64 students) participated in online learning or online learning in conjunction with a flipped classroom. A pretest/posttest control group design was used. The use of online modules in conjunction with the flipped classroom had a greater effect on increasing nursing students’ knowledge of quality improvement than the use of online modules only. There was no statistically significant difference between the groups for safety.
Exploring the Performance Outcomes of Senior-Level Nursing
Authors: Beroz Sabrina T.
Published: October 2018

The new graduate nurse must be prepared for the complexities of the workplace. Research has shown the role that experience plays in providing quality nursing care. This pilot study explored the performance outcomes of final semester nursing students in a multiple-patient simulation. Twelve students were evaluated by an independent rater who viewed videotapes to measure the behaviors using the Seattle University Simulation Evaluation Tool. The data found that the students were unable to consistently prioritize, delegate, and communicate the plan of care while in an environment with competing demands. The findings support the use of multiple-patient simulation.
The Dark Side of Dissemination: Traditional and Open Access Versus Predatory Journals
Authors: Masten Yondell B. , Ashcraft Alyce S.
Published: October 2018

AIM

The purpose of the article is to alert faculty about predatory online journals, review characteristics of three broad categories of journals, and provide suggestions for faculty evaluation of journals before submission of scholarship for publication.

BACKGROUND

The availability of online journals in recent years has rapidly increased the number of journals available for publication of faculty scholarship. However, not all online journals meet the same standards as traditional journals.

METHOD

The article is not a report for a research study.

RESULTS

Currently, there are three broad categories of journals for faculty scholarship publication: traditional, open access scholarly, and predatory open access journals.

CONCLUSION

Faculty authors need to carefully evaluate the journal characteristics and publisher business practices before submitting a manuscript for publication to prevent inadvertent submission to a predatory open access journal.
Eye-Tracking Technology
Authors: Henneman Elizabeth A. , Gawlinski Anna
Published: October 2018

This article discusses the use of eye-tracking technology as an innovative teaching-learning approach that can be used to evaluate and improve safety behaviors during simulation sessions of high-risk and/or complex clinical activities. The use of eye-tracking technology to evaluate visual scanning patterns can provide important information about nurses’ safety behaviors.
Simulation in an Undergraduate Nursing Pharmacology Course: A Pilot Study
Authors: Tinnon Elizabeth , Newton Rebecca
Published: October 2018

This study examined the effectiveness of simulation as a method of teaching pharmacological concepts to nursing students; perceptions of satisfaction with simulation as a teaching strategy were also evaluated. Second-semester juniors participated in three simulations and completed the National League for Nursing Student Satisfaction and Self-Confidence in Learning Questionnaire and the Student Evaluation of Educational Quality Survey; a control group received traditional lectures. A unit exam on anticoagulant therapy content was administered to measure effectiveness. Findings support that simulation is as effective as traditional lecture for an undergraduate pharmacology course.
Using Simulation to Enhance Education in an Obstetrical Nursing Course
Authors: Gray Brooke , Cavner Jackie
Published: October 2018

This pilot study describes the effects of a simulation experience on students’ confidence level and performance in the clinical lab setting. Seven groups of students in an obstetrical rotation participated in a postpartum hemorrhage scenario. Roles were blindly chosen, and interventions were performed and evaluated. The confidence level of the students was assessed prior to and following the simulation. Overall confidence levels increased. The best performances included placing a Foley catheter and inserting an intravenous catheter; the worst performances were documentation and safety.
Assessment of Nursing Students’ Communication Skills
Authors: Abdrbo Amany
Published: October 2018

Communication is vital in all areas of nursing: prevention, treatment, therapy, rehabilitation, education, and health promotion. This descriptive, longitudinal study aimed to assess nursing students’ attitudes toward learning communication skills, perceived importance of nursing communication, and caring efficacy. A self-administered questionnaire was used with a convenience sample to collect data from nursing students and nurse interns. No significant differences over time were found for students’ attitudes toward learning communication skills or perceived importance of communication; interns reported higher scores for caring efficacy. Nursing students need to be strong communicators in clinical practice to deal with patients’ needs, anxieties, and concerns.
Evaluation of Lesbian, Gay, Bisexual, and Transgender Knowledge in Basic Obstetrical Nursing Education
Authors: Echezona-Johnson Chinazo
Published: October 2018

AIM

The purpose of the study was to examine how the lesbian, gay, bisexual, and transgender community (LGBT) population is represented and portrayed in mainstream obstetrical nursing courses, curricula, textbook, and syllabi.

BACKGROUND

Researchers have indicated that LGBT patients are often dissatisfied with their health care experiences because of the limited training received by nursing professionals.

METHOD

This study employed a qualitative, intrinsic case study research method. Qualitative data were collected via document reviews and unstructured interviews with open-ended questions. The data were analyzed by theme analysis and constant comparison.

RESULTS

Data analysis indicated that nurse faculty are not knowledgeable about LGBT obstetrical health issues and how to incorporate LGBT issues into the curriculum.

CONCLUSION

There is a critical need for faculty development on how to infuse information on LGBT content in obstetrics curricula.
Using Simulation and Case Studies Combined to Improve Student Knowledge: A Retrospective Study
Authors: Sarasnick Janice A. , Pyo Katrina A. , Draper Jason
Published: October 2018

AIM

The aim of the study was to examine effects of high-fidelity simulation and computerized case studies in an advanced medical-surgical course.

BACKGROUND

The challenges of coordinating clinical education and desire to utilize innovative methods of teaching were the impetus for course design.

METHOD

A retrospective review compared HESITM specialty exam scores for groups of the newer and former course design. In the newly configured course, students alternated weekly between simulation and computer-assisted case studies and traditional clinical experiences.

RESULTS

Quantitative methods were utilized to analyze data; HESI specialty exam scores were determined to be statistically significantly higher for the groups of the newer design model.

CONCLUSION

Incorporating case studies and high-fidelity simulation on a biweekly basis may be the reason for improved performance.
Interventions for Test Anxiety in Undergraduate Nursing Students: An Integrative Review
Authors: Brodersen Lisa D.
Published: October 2018

AIM

An integrative review was conducted to identify and evaluate interventions for test anxiety (TA) in undergraduate nursing students.

BACKGROUND

Test performance has a major impact on the academic success of nursing students. Therefore, testing is a source of stress and anxiety, which may impair academic performance.

METHOD

A systematic search was conducted to locate peer-reviewed literature about interventions for TA in undergraduate nursing students.

RESULTS

Review of 33 publications dated 1973 to 2014 identified 19 interventions for TA in undergraduate nursing students. Findings included experimental evidence supporting aromatherapy, music therapy, and various cognitive or behavioral interventions. Nonexperimental evidence supporting collaborative testing, crib sheets, and humorous exam items was also found.

CONCLUSION

Many interventions for mitigating TA in nursing students have been evaluated since the 1970s. Current research is needed to corroborate and strengthen the evidentiary support for existing interventions and to evaluate new interventions.
Promoting Simulation Globally: Networking with Nursing Colleagues Across Five Continents
Authors: Alfes Celeste M. , Madigan Elizabeth A.
Published: October 2018

Simulation education is gaining momentum internationally and may provide the opportunity to enhance clinical education while disseminating evidence-based practice standards for clinical simulation and learning. There is a need to develop a cohesive leadership group that fosters support, networking, and sharing of simulation resources globally. The Frances Payne Bolton School of Nursing at Case Western Reserve University has had the unique opportunity to establish academic exchange programs with schools of nursing across five continents. Although the joint and mutual simulation activities have been extensive, each international collaboration has also provided insight into the innovations developed by global partners.
Using YouTube in Teaching Pharmacology to Nursing Students
Authors: Zamora Zelne , Sarpy Nancy , Kittipha Panicha
Published: October 2018

Nursing pharmacology can pose a challenge to nursing students as they learn about different disease processes and interventions. Having students engage in their own learning process aids in the retention of information and gives positive reinforcement for exams. Using YouTube as a part of student group presentations helps students engage in the learning process and learn difficult pharmacological concepts in an alternative classroom setting.
Identifying and Describing Nurse Faculty Workload Issues: A Looming Faculty Shortage
Authors: Bittner Nancy Phoenix , Bechtel Cynthia Francis
Published: October 2018

AIM

The purpose of this project was to address factors contributing to the nurse faculty shortage.

BACKGROUND

There is a demonstrated need to sustain and stabilize faculty currently in the workforce to avoid exacerbating the current and future faculty shortage in nursing. Recommendations of previous studies focus on strategies for recruitment, retention, and ongoing faculty development.

METHOD

A survey was employed to identify and describe the workload of nurse faculty and identify the impact of retirement and other retention issues.

RESULTS

Findings showed an aging and nondiverse nursing faculty with increased and variable workload. There was no standard means of calculating workload. With identification of increased workload, faculty are considering retirement at a higher than projected rate.

CONCLUSION

Four primary areas to address the nursing faculty shortage include focus on diversity balance, development of collaborative positions (joint appointments), and clear identification of nursing faculty workload.
The Impact of Web-Based Video Lectures on Learning in Nursing Education: An Integrative Review
Authors: Wolf Andrew B.
Published: October 2018

AIM

The purpose of this review was to explore what is known about the efficacy of web-based video lectures (WBVLs).

BACKGROUND

Nurse educators have embraced innovations such as online, flipped, and blended learning. Such innovations are enhanced by WBVLs, but there has been limited research on effective design.

METHOD

A systematic search was conducted to identify studies of the efficacy of WBVL in nursing education between 2005 and 2017. An established framework was used to analyze the quality of studies.

RESULTS

Findings from 11 studies revealed that students were satisfied with WBVL as supplement to or replacement for in-person lectures. Studies were hampered by lack of theory, methodological concerns, and an absence of experimental trials.

CONCLUSION

Findings suggest that the efficacy of WBVL may be equivalent to or better than in-person lectures. Future studies should be guided by pedagogical theory and focus on comparing design practices for WBVL.
Sleep Problem Detection and Documentation in Children With Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder by Developmental-Behavioral Pediatricians: A DBPNet Study
Authors: Won Dana C. , Feldman Heidi M. , Huffman Lynne C.
Published: October 2018

Objective:

To determine the percentage of children with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and combined ASD + ADHD who had sleep problems documented by developmental-behavioral pediatricians at diagnostic and follow-up visits at 12 US academic medical centers comprising the Developmental-Behavioral Pediatrics Research Network (DBPNet) and to identify the predictors of sleep problem documentation.

Methods:

Developmental-behavioral pediatricians completed encounter forms that covered sociodemographic, medical, clinician, and visit factors. There was 1 dependent variable, sleep problem documentation, for which 4 definitions were developed (Model 1 = Sleep Disorder coded; Model 2 = Sleep Disorder or polysomnogram coded; Model 3 = Sleep Disorder, polysomnogram, or sleep medication coded; and Model 4 = Sleep Disorder, polysomnogram, sleep medication, or clonidine coded).

Results:

Sleep problem documentation was 14.1% for Model 1, 15.2% for Model 2, 17.3% for Model 3, and 19.7% for Model 4. All values were lower (p < 0.001) than the reported prevalence of sleep problems in these conditions. For Model 4, predictors of sleep problem documentation were age group, ethnicity, medical insurance type, and DBPNet site.

Conclusion:

Developmental-behavioral pediatricians in DBPNet under-reported sleep problems in children with ASD and ADHD. Variation among sites was substantial. Care plans for children with ASD and ADHD should specify which treating clinician(s) monitors sleep issues.
Effects of Early Parent Training on Mother-Infant Feeding Interactions
Authors: Globus Inbal , Latzer Yael , Pshetatzki Oded , Shani Levi Carmit , Shaoul Ron , Elad Iris , Rozen Geila S.
Published: October 2018

Objective:

This study examined whether professional behavioral and nutritional training for first-time mothers can improve feeding interaction at age 12 months.

Methods:

Participants were 128 mother-infant dyads: 86 in the intervention group and 42 in the control group. The mean mothers' age was 30 years (±2.6). The intervention group received Mother-Infant Feeding Interaction (MI-FI) training: 4 weekly workshops for mothers when infants were aged 4 to 6 months old, followed by internet-based support by a dietitian and social worker until infants reached age 12 months. The control group received municipal well-baby clinic's standard mother-infant support. We assessed the mothers' tolerance to ambiguity and feeding-related reports. Blinded coders evaluated videotaped home mealtime interactions (age 12 months) using the Chatoor Feeding Scale (CFS).

Results:

Significant intergroup differences emerged in mealtime interactions for 4 of the 5 CFS dimensions: dyadic conflict (MI-FI = 4.69 vs control = 8.38), talk and distraction (3.75 vs 4.90), struggle for control (2.30 vs 4.88), and maternal noncontingency (1.61 vs 2.75). Findings indicated significantly more positive mother-infant mealtime interactions and maternal responses to infant cues in the MI-FI group than in the control group.

Conclusion:

Very early maternal training may support the development of more positive mother-infant feeding interactions. This may contribute to preserved internal hunger and satiety cues and improved eating habits.
Imaging of Placenta Accreta Spectrum
Authors: BERKLEY ELIZA M. , ABUHAMAD ALFRED
Published: October 2018

Placenta accreta spectrum (PAS) refers to an abnormally invasive implantation of the placenta into the uterine myometrium. The resultant risk is that of severe maternal hemorrhage and significant maternal morbidity and even mortality. The 2 strongest risk factors for the development of PAS are a history of a prior cesarean section and a placenta previa in the current pregnancy. Clinically, most patients are asymptomatic but some will present with vaginal bleeding and abdominal cramping. The goal of this article is to discuss the common clinical presentation and risk factors for placenta accreta spectrum, and to review in detail the ultrasound features/markers of PAS in each trimester.
Recurrent Clostridium difficile infection is associated with treatment failure and prolonged illness in cancer patients
Authors: Abu-Sbeih Hamzah , Choi Kati , Tran Cynthia N. , Wang Xuemei , Lum Phillip , Shuttlesworth Gladis , Stroehlein John R. , Okhuysen Pablo C. , Wang Yinghong
Published: October 2018

Background

Cancer patients are susceptible to recurrent Clostridium difficile infection (CDI) that is increasing globally, necessitating new approaches to prevent fatal consequences. We examined the clinical characteristics of cancer patients with recurrent CDI (RCDI).

Patients and methods

A retrospective review of cancer patients with C. difficile-positive test between January 2015 and May 2017 was carried out. CDI was defined as diarrhea and toxigenic C. difficile detection in the stool by nucleic acid amplification test and enzyme immunoassay. Patients having two CDI episodes were categorized as single recurrent CDI (SRCDI), and those having three or more CDI episodes were categorized as multiple recurrent CDI (MRCDI). Treatment failure was defined as the requirement of antimicrobial alteration or repetition.

Results

We included 170 patients having 270 CDI episodes; 85 patients had non-RCDI, and 85 had RCDI; 14 of them had MRCDI. Previous hospitalization and immunosuppressant use were more frequent in MRCDI group than in SRCDI group (P=0.009 and 0.002, respectively). Physicians treated more SRCDI episodes than MRCDI episodes with metronidazole alone (P=0.017), whereas, more MRCDI episodes needed combination antimicrobials (P=0.072). The mean duration of CDI treatment was longer in the MRCDI group than in the SRCDI group (P=0.030). MRCDI was associated with treatment failure more than SRCDI (P=0.021). The risk for a recurrent episode of CDI was increased in patients who had the following features of the first CDI episode: previous use of antibiotic, NSAID, immunosuppressant, chemotherapy, comorbidities, CDI treatment failure, and severe CDI (P<0.05).

Conclusion

Risk factors for RCDI in cancer patients are similar to those without cancer, with the exception of chemotherapy that is only given to cancer patients. Long CDI treatment and CDI treatment failure are associated with MRCDI.
Evidence for the Quadruple Aim
Authors: Rathert Cheryl , Williams Eric S. , Linhart Hillary
Published: October 2018

Background:

Experts express concern that attaining of the Triple Aim of reducing health care costs, improving patient experiences and ultimately population health, may be compromised by high levels of burnout among physicians. Some have called for a fourth aim of improving the work environment for care providers.

Objectives:

Burnout has been linked to poor outcomes in many occupational settings. This study’s aim was to investigate linkages between physician burnout and patient outcomes through a systematic review of the literature.

Research Design:

Systematic search of 3 databases using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. In total, 1201 articles were reviewed, and 28 were included in the final analysis. Studies needed to be empirical, measure physician burnout as a predictor, and include patient outcome measures.

Measures:

The majority of studies were cross-sectional and measured patient outcomes via physician perception self-reports (n=14). Five studies reported clinical measures (quality, errors), and 9 included patient ratings of their care.

Results:

Studies using self-reports of suboptimal quality and errors found that physicians higher in burnout consistently reported worse quality, yet studies linking burnout to independent clinical outcomes found no relationships. Similarly, burnout was related to lower patient ratings of care, but when specific behaviors were rated there was no relationship.

Conclusions:

Although the interest in burnout’s effects is strong, the lack of rigorous empirical studies examining patient outcomes is problematic. Future research should develop and test causal models to better understand which domains of patient care are influenced by physician burnout.
Assessing the Impact of Body Mass Index Information on the Performance of Risk Adjustment Models in Predicting Health Care Costs and Utilization
Authors: Kharrazi Hadi , Chang Hsien-Yen , Heins Sara E. , Weiner Jonathan P. , Gudzune Kimberly A.
Published: October 2018

Background:

Using electronic health records (EHRs) for population risk stratification has gained attention in recent years. Compared with insurance claims, EHRs offer novel data types (eg, vital signs) that can potentially improve population-based predictive models of cost and utilization.

Objective:

To evaluate whether EHR-extracted body mass index (BMI) improves the performance of diagnosis-based models to predict concurrent and prospective health care costs and utilization.

Methods:

We used claims and EHR data over a 2-year period from a cohort of continuously insured patients (aged 20–64 y) within an integrated health system. We examined the addition of BMI to 3 diagnosis-based models of increasing comprehensiveness (ie, demographics, Charlson, and Dx-PM model of the Adjusted Clinical Group system) to predict concurrent and prospective costs and utilization, and compared the performance of models with and without BMI.

Results:

The study population included 59,849 patients, 57% female, with BMI class I, II, and III comprising 19%, 9%, and 6% of the population. Among demographic models, R
2 improvement from adding BMI ranged from 61% (ie, R
2 increased from 0.56 to 0.90) for prospective pharmacy cost to 29% (1.24–1.60) for concurrent medical cost. Adding BMI to demographic models improved the prediction of all binary service-linked outcomes (ie, hospitalization, emergency department admission, and being in top 5% total costs) with area under the curve increasing from 2% (0.602–0.617) to 7% (0.516–0.554). Adding BMI to Charlson models only improved total and medical cost predictions prospectively (13% and 15%; 4.23–4.79 and 3.30–3.79), and also improved predicting all prospective outcomes with area under the curve increasing from 3% (0.649–0.668) to 4% (0.639–0.665; and, 0.556–0.576). No improvements in prediction were seen in the most comprehensive model (ie, Dx-PM).

Discussion:

EHR-extracted BMI levels can be used to enhance predictive models of utilization especially if comprehensive diagnostic data are missing.
Interventions to Improve Maternal-Infant Relationships in Mothers With Postpartum Mood Disorders
Authors: Lindensmith Rebekah
Published: October 2018

Introduction:

During the postpartum period, women may have changes in their mental health and experience postpartum mood disorders. Postpartum depression (PPD) is an especially prevalent postpartum mood disorder, affecting 10% to 15% of new mothers. Although PPD has detrimental effects on women's health, it can also affect maternal–infant attachment, bonding, and interaction, which influence the maternal–infant relationship and can lead to poor outcomes for infants later in life. The purpose of this review is to identify effective strategies for improving the maternal–infant relationship for mothers with postpartum mood disorders.

Methods:

A literature search was conducted via three databases: PubMed, Cochrane Library, and Medline using key search terms. A total of 1,347 articles were scanned to determine their relevance; 19 articles were selected for review. Inclusion criteria included articles in English that focused in the postpartum period and measured outcomes related to the maternal–infant relationship.

Results:

Infant massage appears to benefit the maternal–infant relationship, whereas psychotherapy and education had mixed results. Pharmacological interventions were not found to improve maternal–infant relationships. Family involvement was shown to improve infant attachment, but not the maternal–infant relationship.

Clinical Implications:

Nurses should be aware of the importance of including interventions targeted at improving the maternal–infant relationship for women with postpartum mood disorders, especially PPD. However, data are limited, thus more research is needed to develop evidence-based strategies that can be implemented to support women experiencing postpartum mood disorders and their infants.
Paget’s “Seed and Soil” Theory of Cancer Metastasis: An Idea Whose Time has Come
Authors: Akhtar Mohammed , Haider Abdulrazzaq , Rashid Sameera , Al-Nabet Ajayeb Dakhilalla M.H.
Published: October 2018

The concept that the pattern of metastatic spread of cancer is not random and that cancer cells exhibit preferences when metastasizing to organs, dates back to 1889 when Steven Paget published his “seed and soil” hypothesis. He proposed that the spread of tumor cells is governed by interaction and cooperation between the cancer cells (seed) and the host organ (soil). Extensive studies during the last several decades have provided a better understanding of the process of metastatic spread of cancer and several stages such as intravasation, extravasation, tumor latency, and development of micrometastasis and macrometastasis have been defined. Furthermore, recent studies have shown that the target organs may be prepared for metastatic deposits by the development of premetastatic niches. This specialized microenvironment is involved in promoting tumor cell homing, colonization, and subsequent growth at the target organ. The premetastatic niche consists of accumulation of aberrant immune cells and extracellular matrix proteins in target organs. The primary tumor plays a key role in the development of premetastatic niches by producing tumor-derived soluble factors which mobilize bone marrow-derived hematopoietic cells to the premetastatic niche. Exosomes-derived from the primary tumor also contribute to cancer-favorable microenvironment in the premetastatic niches. These changes prime the initially healthy organ microenvironment and render it amenable for subsequent metastatic cell colonization.
A 7-Day-Old Male Infant With Carbon Monoxide Poisoning Treated With Hyperbaric Oxygen
Authors: Turan Caner , Yurtseven Ali , Baki Beyter Mehmet , Saz Eylem Ulas
Published: October 2018

Objective

Children are presented with an unknown intoxication at emergency department (ED) after carbon monoxide (CO) poisoning. Although CO poisoning is well defined in the adult literature, little information exists regarding CO poisoning in childhood, especially in infants. The only diagnostic test for CO poisoning is elevation of the carboxyhemoglobin level in the blood.

Case

We report the second youngest neonate in literature who was severely poisoned by CO and treated with hyperbaric oxygen at the ED. He present to the ED with fussiness and feeding difficulty. Upon arrival, he was lethargic, hypotonic, and crying weak. He had a high carboxyhemoglobin measurement, and the levels of cardiac markers elevated. He was treated with hyperbaric oxygen and discharged a good clinical condition.

Conclusions

If there is a baby with unexplained neurologic symptoms and signs, CO poisoning should be considered in the differential diagnosis. Early diagnosis and treatment prevent complications and sequelaes.
Seizures, Meds, and Vtach
Authors: Fitzgerald David P. , Das Srikant , Malone Matthew P. , Holland B. Shane , Schexnayder Stephen M.
Published: October 2018

Sudden cardiac arrest of cardiac etiology is rare in children and adolescents and most often occurs with exertion. Conversely, syncope is a common pediatric emergency department complaint but rarely is associated with a serious underlying cardiac disorder. This report describes a case of the channelopathy Brugada syndrome (BrS) as a cause of sudden cardiac arrest in a febrile preadolescent child taking medications known to affect cardiac conduction. The patient received cardiopulmonary resuscitation and was successfully defibrillated. Initial electrocardiogram (ECG) demonstrated findings consistent with BrS. Confirmatory electrophysiologic testing was performed, and an implantable cardiac defibrillator was placed. Pediatric emergency specialists must recognize both the importance of ECG in the workup of syncope and be familiar with the specific ECG findings suggestive of BrS. Ventricular arrhythmias that occur at rest should raise the suspicion of this genetic cardiac channelopathy, regardless of age.
A Prospective, Randomized Phase II Study of Adjuvant Gemcitabine Versus S-1 After Major Hepatectomy for Biliary Tract Cancer (KHBO 1208)
Authors: Kobayashi Shogo , Nagano Hiroaki , Tomokuni Akira , Gotoh Kunihito , Sakai Daisuke , Hatano Etsuro , Seo Satoru , Terajima Hiroaki , Uchida Yoichiro , Ajiki Tetsuo , Satake Hironaga , Kamei Keiko , Tohyama Taiji , Hirose Tetsuro , Ikai Iwao , Morita Satoshi , Ioka Tatsuya
Published: October 2018

Objective:

To evaluate each arm independently and compare adjuvant gemcitabine (GEM) and S-1 chemotherapy after major hepatectomy (hemihepatectomy or trisectionectomy) for biliary tract cancer (BTC).

Background:

Standardized adjuvant therapy is not performed after major hepatectomy for BTC, and we determined the recommended dose in the former study (KHBO1003).

Methods:

We performed a multicenter, randomized phase II study. The primary measure was 1-year recurrence-free survival (RFS); the secondary measures were other RFS, overall survival (OS), and others. The following 6-month adjuvant chemotherapy was administered within 12 weeks of R0/1: GEM (1000 mg/m2) every 2 weeks; or S-1 (80 mg/m2/d) for 28 days every 6 weeks. Thirty-five patients were assigned to each arm (alpha error, 10%; beta error, 20%).

Results:

No patients were excluded for the per-protocol analysis. There were no statistically significant differences in the patient characteristics of the 2 arms. The 1-year RFS and 1-year OS rates of the GEM arm were 51.4% and 80.0%, respectively, whereas those of the S-1 group were 62.9% and 97.1%. The comparison of the 2 arms revealed that 2-year RFS rate, 1 and 2-year OS rates, and OS curve of the S-1 arm were superior to GEM. With regard to OS, the hazard ratio of the S-1 group was 0.477 (90% confidence interval 0.245–0.927).

Conclusion:

The comparison of the survival of the 2 groups revealed that adjuvant S-1 therapy may be superior to adjuvant GEM therapy after major hepatectomy for BTC.
Genetic Analysis of Small Well-differentiated Pancreatic Neuroendocrine Tumors Identifies Subgroups With Differing Risks of Liver Metastases
Authors: Pea Antonio , Yu Jun , Marchionni Luigi , Noe Michael , Luchini Claudio , Pulvirenti Alessandra , de Wilde Roeland F. , Brosens Lodewijk A. , Rezaee Neda , Javed Ammar , Chianchiano Peter , Gobbo Stefano , Regi Paolo , Salvia Roberto , Bassi Claudio , He Jin , Weiss Matthew J. , Cameron John L. , Offerhaus G. Johan A. , Hruban Ralph H. , Lawlor Rita T. , Scarpa Aldo , Heaphy Christopher M. , Wood Laura D. , Wolfgang Christopher L.
Published: October 2018

Objective:

The aim of this study was to investigate the key molecular alterations in small primary pancreatic neuroendocrine tumors (PanNETs) associated with the development of liver metastases.

Background:

Well-differentiated PanNETs with small size are typically indolent; however, a limited subset metastasize to the liver.

Methods:

A total of 87 small primary PanNETs (<3 cm), including 32 metastatic cases and 55 nonmetastatic cases after a 5-year follow-up, were immunolabeled for DAXX/ATRX and analyzed for alternative lengthening of telomeres (ALT) by Fluorescence In Situ Hybridization. A subset of these cases, 24 that metastasized and 24 that did not metastasize, were assessed by targeted next-generation sequencing and whole-genome copy number variation.

Results:

In the entire cohort, high Ki-67 (OR 1.369; 95% CI 1.121–1.673; P = 0.002), N-stage (OR 4.568; 95% CI 1.458–14.312; P = 0.009), and ALT-positivity (OR 3.486; 95% CI 1.093–11.115; P = 0.035) were independently associated with liver metastases. In the subset assessed by next-generation sequencing and copy number variation analysis, 3 molecular subtypes with differing risks of liver metastases were identified. Group 1 (n = 15; 73% metastasized) was characterized by recurrent chromosomal gains, CN-LOH, DAXX mutations, and ALT-positivity. Group 2 (n = 19; 42% metastasized, including 5 G1 tumors) was characterized by limited copy number alterations and mutations. Group 3 (n = 14; 35% metastasized) were defined by chromosome 11 loss.

Conclusions:

We identified genomic patterns of small PanNETs associated with a different risk for liver metastases. Molecular alterations, such as DAXX mutations, chromosomal gains, and ALT, are associated with an increased risk of metastasis in small PanNETs. Therefore, targeted sequencing and/or ALT analysis may help in the clinical decisions for these small PanNETs.
Reappraising the Concept of Conditional Survival After Pancreatectomy for Ductal Adenocarcinoma
Authors: Malleo Giuseppe , Maggino Laura , Ferrone Cristina R. , Marchegiani Giovanni , Warshaw Andrew L. , Lillemoe Keith D. , Bassi Claudio , Castillo Carlos Fernàndez-del , Salvia Roberto
Published: October 2018

Objective:

To reappraise the concept of conditional survival (CS) following pancreatectomy for pancreatic ductal adenocarcinoma (PDAC), accounting for the patient's present disease status relative to recurrence.

Background:

CS, defined as the probability of surviving an additional time frame based on accrued lifespan, offers dynamic survival projections as compared with baseline overall survival.

Methods:

Patients undergoing pancreatectomy for PDAC at 2 institutions from 2000 to 2013 were retrospectively analyzed. The 12-month CS was estimated separately for patients who were disease-free or with recurrence at the given time points. Next, the conditional probability of reaching 60-months of survival was examined in each conditioning set across strata of prognostic covariates, including American Joint Committee on Cancer stage, tumor grade, R-status, and adjuvant treatment.

Results:

The study population consisted of 1005 patients. In disease-free patients, the 12-month CS increased as a function of time already survived, showing an opposite trend compared with overall survival. In patients who recurred, the 12-month CS was lower than the disease-free counterpart, especially within 24 months postoperatively. When stratifying by the levels of prognostic covariates, the 60-months CS estimates for disease-free patients tended to level off progressively, indicating that factors independently associated with survival at the time of pancreatectomy lost power over time. This concept did not apply to the conditioning set of patients with recurrence, where CS estimates across variables strata diverged with accrued lifespan.

Conclusion:

This paper provides new information on how prognosis following pancreatectomy for PDAC evolves over time, adjusting for the time the patient already survived, and for the patient's present disease status relative to recurrence.