bluuebunny/crossref_metadata_2025 huggingface dataset:
Acupuncture as an add-on therapy to sublingual allergen-specific immunotherapy for patients with allergic rhinitis
Authors: Li Jiang-hua , Yang Lin-hong , Chen Ying , Fan Zong-xian
Published: January 2019

This study retrospectively analyzed the effectiveness of acupuncture as add-on therapy (AAOT) to sublingual allergen-specific immunotherapy (SASIT) for patients with allergic rhinitis (AR). A total of 120 eligible cases of adult patients with AR were included in this retrospective study. Of these, 60 patients received AAOT plus SASIT and were assigned to a treatment group, while the other 60 subjects underwent SASIT only, and were assigned to a control group. Primary outcome was AR symptoms. The secondary outcome was quality of life, as evaluated by the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). In addition, adverse events were also recorded during the study period. All outcomes were assessed before and after 8 weeks treatment. After 8 weeks treatment, patients in the treatment group had much better effectiveness in symptoms relief (P <.05), and quality of life improvement (activity domain, P = .04; practical domain, P = .03), compared with patients in the control group. In addition, although patients in the treatment group reported more mild pain at local area after the treatment than that in the control group (P <.01), no patients stopped the treatment. The results of this study showed that AAOT plus SASIT achieved more benefits in patients with AR than SASIT alone.
Visual acuity of young men in China
Authors: Wan Yi , Jiang Xun , Zhang Jie-Qiong , Zhang Jin-Peng , Chen Ning-Xu , Cao Yang , Xu Yong-Yong , Shang Lei
Published: January 2019

The prevalence of low vision has increased in China especially among youth population, which is an important public health issue. The trend on the prevalence of subnormal visual acuity and updated information is essential to quantify health effects and to prompt decision makers to prioritize action and assess the effectiveness of measures. Therefore, the study aimed to analyze the prevalence and geographical distribution of visual acuity level among young men in China based on 3 national cross-sectional surveys from 1974 to 2012.

The data on visual acuity of young men were collected from 3 national surveys among military recruit youth conducted in 1974, 2001, and 2012 by using a stratified cluster sampling method in China. The prevalence of visual acuity among military recruit youth during this period was analyzed by region, year, age, and economic level.

A total of 139,929, 72,894, and 58,106 young men were included, covering all 31 provinces of mainland of China, from the 3 national surveys respectively. The prevalence of subnormal visual acuity had geographic diversity and increased significantly from 1974 to 2012 (P < .05). The visual acuity level was negatively correlated with the age (17–23 years) in 2012 (P < .05). Furthermore, the prevalence of subnormal visual acuity was positively correlated with the gross domestic product in 31 provinces of China (P ≤ .001).

The prevalence of subnormal visual acuity increased with economic development among young men from 1974 to 2012, with distinct variation among geographic areas in China. Furthermore, subnormal visual acuity was increasingly prevalent with age and warrant public health attention.
Ulnar osteotomy and the ilizarov mini-fixator for pediatric chronic monteggia fracture-dislocations
Authors: Take Masaki , Tomori Yuji , Sawaizumi Takuya , Majima Tokifumi , Nanno Mitsuhiko , Takai Shinro
Published: January 2019

Treatment of chronic Monteggia fracture-dislocations remains controversial in skeletally immature patients. The present study aimed to review the clinical outcomes of surgical treatment with an Ilizarov mini-fixator for chronic Monteggia fracture-dislocations in children. From April 2003 to March 2014, 5 pediatric patients (4 males, 1 female) with chronic Monteggia fracture-dislocation were treated with an Ilizarov mini-fixator at our institution. The median age at the time of surgery was 9 years (range 5–14 years), median duration from injury to surgery was 31 months (range 2–125 months), and median duration of follow-up was 12 months (range 11 months–10 years). All patients underwent opening wedge osteotomy of the proximal ulna followed by the application of an Ilizarov mini-fixator. Although closed reduction was attempted after ulnar osteotomy and application of the Ilizarov mini-fixator, open reduction of the radial head was required in all patients. In 4 patients, dense scar tissue in the radiocapitellar joint was excised to enable reduction of the radial head; the remaining patient had traumatic radioulnar synostosis, and underwent separation of the synostosis followed by anconeus interposition arthroplasty. No patient received bone grafting at the ulnar osteotomy site, repair or reconstruction of the annular ligament, or temporary fixation of the radial head with transarticular wire. The median period of external fixation was 10 weeks (range 8–13 weeks). Although there were no severe complications such as deep infection and neurovascular disturbance, asymptomatic radial head subluxation occurred in 2 patients. The patient with traumatic synostosis had residual posterior subluxation with limitation of forearm rotation, and another patient with radial head enlargement had residual anterior subluxation. The median postoperative ranges of motion in pronation, supination, extension, and flexion were 90°, 90°, 0°, and 140°, respectively. The median Kim's elbow performance score was 65 (range 50–75) preoperatively, which improved to 94 (range 80–100) at final follow-up. The outcome was rated as excellent in 4 cases, and good in 1. In pediatric chronic Monteggia fracture-dislocations, ulnar osteotomy followed by the application of an Ilizarov mini-fixator is a viable option that is less invasive than plate fixation.
Comparison of the long-term efficacy of tenofovir and entecavir in nucleos(t)ide analogue-naïve HBeAg-positive patients with chronic hepatitis B
Authors: Cai Dachuan , Pan Chen , Yu Weihua , Dang Shuangsuo , Li Jia , Wu Shanming , Jiang Nan , Wang Maorong , Zhang Zhaohua , Lin Feng , Xin Shaojie , Yang Yongfeng , Shen Baoshen , Ren Hong
Published: January 2019

Objective:

We conducted this study to compare the efficacy and safety of entecavir and tenofovir in the treatment of treatment-naïve HBV e antigen (HBeAg)-positive patients with chronic hepatitis B (CHB) for 144 weeks.

Methods:

A total of 320 treatment-naïve HBeAg-positive CHB patients who received randomly a single regimen of either entecavir capsule (ETV) (n = 160) or tenofovir disoproxil fumarate capsule (TDF) (n = 160) for 144 weeks were consecutively enrolled from 14 tertiary hospitals or university hospitals in China between January 2012 and December 2014.

Results:

Two groups showed no difference in baseline characteristics. After 144 weeks of treatment, HBV DNA levels were similarly suppressed in both groups (ETV vs TDF; -6.6485 vs −6.692 log10IU/mL, P = .807). At the same time, both groups showed no difference in terms of the serologic and biochemical response. Of all patients, 2 dropped out due to adverse events and 5 experienced serious adverse reactions.

Conclusion:

Both capsules (ETV or TDF) were equally effective in nucleos(t)ide-naive CHB patients with a comparable side-effect profile even in a long-term of 144 weeks.
Respiratory electrophysiologic studies in chronic obstructive pulmonary disease
Authors: Wang Yu , Liu Na , Zhang Zhecheng
Published: January 2019

Respiratory failure is common during acute exacerbation of chronic obstructive pulmonary disease (AE-COPD). Phrenic nerve conduction (PNC), transcranial magnetic stimulation (TMS), and cervical magnetic stimulation (CMS) are of great value in identifying the feature and site of AE-COPD.

PNC, TMS, and CMS were performed in 20 AE-COPD patients with respiratory failure, and re-examined after weaning. Latencies and amplitudes of the diaphragmatic compound muscle action potential (dCMAP), motor evoked potential of the diaphragm (dMEP) evoked by TMS and CMS, and central motor conduction time (CMCT) were measured. Blood gas analysis and serum electrolyte levels were also evaluated. The results were compared with those from 20 healthy subjects.

AE-COPD patients showed prolonged CMCT and latencies of dCMAP and dMEP, decreased amplitudes of dCMAP and dMEP evoked by CMS, while CMCT and the latency of dMEP evoked by TMS were shortened after weaning. Significant correlation was identified between arterial blood gas analysis, serum electrolyte levels, disease duration, the duration of mechanical ventilation and the electrophysiological findings in AE-COPD patients prior to weaning.

The central and peripheral respiratory pathway is involved in AE-COPD. Central respiratory pathway function is improved after weaning in AE-COPD patients with respiratory failure.
The analgesic efficacy of oblique subcostal transversus abdominis plane block after laparoscopic hysterectomy
Authors: Korkmaz Toker Melike , Altiparmak Basak , Uysal Ali İhsan , Demirbilek Semra Gumus
Published: January 2019

Background:

We aimed to assess whether an ultrasound (US)-guided oblique subcostal transversus abdominis plane (OSTAP) block would improve the postoperative pain scores and decrease the tramadol consumption after a laparoscopic hysterectomy.

Methods:

Sixty-six female patients with American Society of Anesthesiologists I, II, or III, aged 18 to 65 years who were scheduled for laparoscopic hysterectomy for benign gynecologic pathologies were recruited in this randomized, controlled, observer-blinded trial. Sixty patients completed the study. Patients were randomized into 2 groups. In the OSTAP group, the patients received a bilateral OSTAP block with 40 mL of 0.375% bupivacaine and in the Sham group received an US-guided bilateral OSTAP with 40 mL of 0.9% saline. All patients received tramadol patient-controlled analgesia for the first 24th hour. Patients in the Sham group received an US-guided bilateral OSTAP with 40 mL of 0.9% saline. The primary outcome was the 24th hour tramadol consumption. The secondary outcomes included visual analog scale (VAS) scores during movement, the tramadol consumption at the 1st, 4th, and 12th postoperative hours, and nausea scores at the 24th hour postoperatively.

Results:

At all time points, tramadol consumption of the OSTAP group remained significantly lower when compared with Sham group. The OSTAP group showed a statistically significant reduction at the postoperative 24th hour tramadol consumption (mean difference 22 mg, 95% confidence interval −38.4 to −5.6 mL; P = .009). Compared with the Sham group, OSTAP block reduced the VAS scores at all time points during movement. Nausea scores at the 24th postoperative hour were significantly lower in the OSTAP group compared with the Sham group

Conclusion:

We concluded that bilateral US-guided OSTAP blocks reduced 24th hour tramadol requirements and VAS scores after laparoscopic hysterectomy. The OSTAP block is a promising technique for producing effective and prolonged postoperative analgesia in patients undergoing laparoscopic hysterectomy surgeries.
A novel variation of SERPINC1 caused deep venous thrombosis in a Chinese family
Authors: Peng Yu , Wang Tun , Zheng Yu , Lian Aojie , Zhang Di , Xiong Zhimin , Hu Zhengmao , Xia Kun , Shu Chang
Published: January 2019

Rationale:

Deep vein thrombosis (DVT) is the formation of a blood clot formed in the deep veins of the lower limbs. Known genetic factors of DVT include deficiencies of antithrombin (AT), protein C, protein S, factor V Leiden mutation, and prothrombin G20210A mutation. Here, a 5-generation Chinese family with inherited DVT was recruited for genetic analysis.

Patient concerns:

The patient came to see a doctor because of leg swelling. A color Doppler ultrasound examination showed extensive thrombosis within the deep veins of her left leg. Computed tomography angiography showed a pulmonary embolism in her right lower pulmonary artery.

Diagnoses:

Type II AT deficiency lead to inherited DVT.

Interventions:

Whole-exome sequencing and cosegregation analysis were carried for the DVT family.

Outcomes:

An unreported heterozygous missense variation, c.281T>C, was identified within the SERPINC1 gene. This missense variation of SERPINC1 leads to type II AT deficiency.

Lessons:

This result further enriched the variation spectrum of the SERPINC1 gene.
A giant mesenteric fibromatosis involving the muscular layer of the colon wall
Authors: Ji Haibin , Zhu Wentao , Zhao Baolei , Shi Jian , Wei Qiang , Sun Baofang , Chen Qiangpu
Published: January 2019

Rationale:

Mesenteric fibromatosis (MF) is a rare tumor whose biological behavior is intermediate between benign fibrous neoplasms and fibrosarcomas, and the characteristic of these tumors are local aggressive lesions which is prone to local recurrence but non-metastasizing. The common symptom is abdominal distention or painless mass. We report a case of giant MF in abdominal cavity with abdominal distention as the main symptom.

Patient concerns:

A 26-year-old male presented with 2-month history of abdominal distention, lack of appetite, and symptoms grew progressively more debilitating with time.

Diagnoses:

This patient underwent a contrast-enhanced computed tomography scan which showed a giant (37 × 25 × 13 cm), inhomogeneous enhancing, well-defined, and soft tissue density mass in abdominal cavity, possibly arising in mesocolon, which suggested a high possibility of MF. The postoperative pathology showed that the tumor cells to be positive for β-catenin, vimentin, negative for CD34, CD117, DOG-1, S-100, Desmin, which confirmed the diagnosis of MF.

Interventions:

Exploratory laparotomy was performed, which revealed a large mass involving the transverse colon wall, the root of mesocolon, and encasing the middle colic vessels and the 1st branch of jejunal arteries. The complete surgical resection was performed and the mass weighted 10 kilograms (kg).

Outcomes:

The patient recovered uneventfully and was discharged 9 days after surgery. Three-month, 6-month, 12-month and 18-month on follow-up after surgery, showed no evidence of recurrence.

Lessons:

The MF is a very rare tumor, especially a giant tumor (10 kg) involving the muscular layer of colon wall. In addition, treatment of giant MF still remains a challenge. We consider that surgical resection with negative margins is the goal but not at the expense of damaging the function of vital organs. Specific measures should be considered based on the individual patient in order to relieve symptoms and improve quality of life.
The association between prelaminar tissue thickness and peripapillary choroidal thickness in untreated normal-tension glaucoma patients
Authors: Park Ji-Hye , Yoo Chungkwon , Jung Jae Hoon , Girard Michael J.A. , Mari Jean-Martial , Kim Yong Yeon
Published: January 2019

To evaluate the association between prelaminar tissue thickness (PLT) and peripapillary choroidal thickness (PCT) in untreated normal-tension glaucoma (NTG) patients.

A cross-sectional study was conducted in 65 untreated NTG patients. All of the subjects were imaged with swept-source optical coherence tomography (SS-OCT, DRI OCT; Topcon, Tokyo, Japan) to obtain the horizontal scan crossing the optic nerve head center. The PLT was calculated by subtracting the anterior prelaminar depth (APLD) from the anterior lamina cribrosa depth (ALCD). The retinal nerve fiber layer thickness and PCT were measured automatically using the in-built automated software of the OCT device. Spearman correlation analysis was conducted to investigate the ocular factors that were associated with PLT.

The average PLT, APLD, ALCD, and PCT values were 134.05 ± 55.54, 314.59 ± 113.59, 448.64 ± 125.69, and 121.23 ± 59.56 μm, respectively. PLT was correlated with the axial length, visual field index (VFI), ALCD, and PCT. When the subjects were divided into 2 groups according to their PLT values (median value, 125.114 μm), the thin PLT group showed worse mean deviation, VFI values, and thinner PCT when compared to the thick PLT group.

The PLT was significantly associated with the PCT, and the thinner PLT showed the greater glaucomatous damage in untreated NTG. The thickness of the prelaminar tissue may be related with the choroidal blood flow in untreated NTG patients.
Long-term Efficacy of Single-agent Vemurafenib for Pleomorphic Xanthoastrocytoma
Authors: Finch Elizabeth A. , Elton Scott W. , Huang Benjamin Y. , Trembath Dimitri G. , Blatt Julie
Published: January 2019

Pleomorphic xanthoastrocytoma is a malignant brain tumor that has a good prognosis with complete resection but does not respond well to chemotherapy if there is residual tumor. BRAF
V600E mutations are common in pleomorphic xanthoastrocytomas and provide an additional means for treatment when excision is not possible. Monotherapy with the BRAF V600E inhibitor vemurafenib has only been reported in a small number of cases and mostly in adults. We present the case of a 16-year-old male who responded to vemurafenib monotherapy initially and had an additional response to vemurafenib following progression after a brief time off the medication.
Effectiveness and Safety of 4-factor Prothrombin Complex Concentrate (4PCC) in Neonates With Intractable Bleeding or Severe Coagulation Disturbances: A Retrospective Study of 37 Cases
Authors: Mitsiakos Georgios , Karametou Margarita , Gkampeta Anastasia , Karali Crysa , Papathanasiou Aimilia Eirini , Papacharalambous Efthimia , Babacheva Evgenyia , Papadakis Emmanouil , Yupsani Anastasia , Chatziioannidis Ilias , Soubasi Vassiliki
Published: January 2019

Background:

To date, clinical experience with prothrombin complex concentrate (PCC) in the neonatal population has been limited.

Aim:

The objective of this study was to describe our experience regarding the effectiveness and safety of PCC administration in newborns with severe bleeding or coagulopathy resistant to conventional therapy.

Methodology:

We retrospectively analyzed data from 37 neonates with intractable bleeding or severe coagulation disturbances. All patients received intravenous bolus administration of 20 or 30 u/kg of PCC per dose, as a rescue procedure.

Results:

Hemostasis was achieved in the majority of neonates and we observed statistically significant improvement in prothrombin time, international normalized ratio, and activated partial thromboplastin time (P<0.001, P=0.044, P<0.001, respectively). Thirteen neonates survived, whereas 24 did not survive. In those who survived, PCC had been administered earlier (<24 h) in the disease process compared with those who died (P=0.043). Neither acute adverse events nor thromboembolic complications were observed in all neonates.

Conclusions:

In our study, PCC seemed to be a safe and effective intervention for hemostasis and early intervention was more effective as a rescue therapy, without any adverse event. Further prospective controlled trials are required to determine optimal dose and timing of PCC administration in neonates.
Hemophagocytic Lymphohistiocytosis Associated With 2 Cases of Pediatric Lymphocyte-depleted Classic Hodgkin Lymphoma
Authors: Cader Fathima Z. , Colmenero Isabel , Mussai Francis
Published: January 2019

Hemophagocytic lymphohistiocytosis (HLH) is a rare and often fatal syndrome of abnormal T-cell activation and cytokine production, which can be familial or secondary in nature. Although HLH can occur concomitantly with lymphomas, the development of HLH alongside Hodgkin lymphoma in children is unusual. Here we report the diagnostic evaluation and clinical course of 2 pediatric cases of HLH secondary to lymphocyte-depleted classic Hodgkin lymphoma. These cases highlight the need to be vigilant for this rare presentation and the difficulties in managing these patients.
Civilian Nurses' Experiences Caring for Military Veterans
Authors: Elliott Brenda
Published: January 2019

Over nine million people living in the United States are military Veterans over the age of 65. Many utilize civilian care providers, creating a need for civilian providers to have an understanding of the unique healthcare issues of this population. This article describes the qualitative results of a mixed-methods study of nine home care nurses' experiences caring for Veterans. Three themes emerged from the data: Challenges Coordinating Care, Building a Rapport Takes More Time, and Recognizing Impact of Military Service on Patient's Worldview. As demonstrated in this study, home care nurses care for Veterans every day. Although similarities exist, nurses readily described differences in caring for Veterans compared with non-Veterans that can impact patient outcomes. It is imperative for the nursing workforce to not only assess for military/Veteran status but to also have some knowledge of military culture and Veteran-specific healthcare issues.
Nurse Comfort With Palliative and End-of-Life Communication
Authors: Isaacson Mary J. , Minton Mary E. , DaRosa Patricia , Harming Shana
Published: January 2019

Communication is a key component of palliative and end-of-life care. Little is known about comfort with palliative and end-of-life communication among nurses working in rural and urban settings. We assessed this comparison using the 28-item (including 2 ranked items) Comfort with Communication in Palliative and End-of-Life Care instrument. Descriptive analyses of the sample (N = 252) identified statistically significant results differences for age and experience; rural nurses were older and more experienced. Urban nurses reported less comfort than did rural nurses based on composite score analysis (P = .03) and reported less comfort than did rural nurses in talking with patients and families about “end-of-life decisions” (P < .05). Overall, years of experience were significant for more comfort with end-of-life communication. Our instrument could be used within academic settings to establish baseline awareness of comfort with palliative and end-of-life communication and in institutional settings to provide a continuing education bridge from prelicensure through licensure. Moreover, experienced nurses are integral in mentoring new graduates in initiating and sustaining difficult conversations.
Spiritual Uncertainty Among Hospice Providers
Authors: Stephenson Pam Shockey , Sheehan Denice , Hansen Dana , Mayo M. Murray
Published: January 2019

How providers of end-of-life care perceive spirituality both within themselves and for others can directly impact their ability to provide spiritual care to patients and families. Uncertainty about spirituality can contribute to the awkwardness of spiritual care. Spiritual uncertainty includes the questions, worries, and doubts people have about the meaning, beliefs, connections, self-transcendence, and value that comprise spirituality. This article reports qualitative findings from a mixed-methods study that sought to understand spiritual uncertainty among hospice providers. Data were collected from 28 hospice team members (nurses, physicians, social workers, and expressive therapist) using focus groups, reflective journals, and one-on-one interviews. An overarching theme emerged that described the tensions perceived by providers caring for hospice patients. Those tensions were further categorized as being interpersonal, intrapersonal, and transpersonal in nature. The identification of tension as a source of strain for providers delivering spiritual care is necessary to the development of future interventions that can assist providers and patients navigating end-of-life spirituality.
Young Adult Knowledge and Readiness to Engage in Advance Care Planning Behaviors
Authors: Schnur Kaylee , Radhakrishnan Kavita
Published: January 2019

Although advance care planning (ACP) has increased in importance and discussion, little is known about young adults' engagement in ACP. The purpose of this study was to identify associations among college-age students' characteristics, knowledge of ACP, and readiness to engage in ACP-related behaviors. One hundred forty-seven students at the University of Texas at Austin (aged 18–26 years) participated in an online survey regarding ACP knowledge, perceptions, and behavior engagement. Although 98% of the students had no advance directive, 85% rated themselves as “pro” ACP. Regarding ACP behaviors, at least 83% of participants had never considered completing a living will or health care proxy, but 33% and 45% of participants had talked with loved ones about being kept alive on machines or about quality of life, respectively. Greater knowledge of ACP correlated weakly with a favorable view of ACP (P = .002). Young adults should be made aware of their ability to dictate the care they want to receive in situations in which they are incapacitated, as well as advocate for their family members to engage in ACP. Discovering characteristics associated with readiness to engage in ACP can enable hospice and palliative care nurses to tailor discussions with young adults regarding ACP.
Evaluation of Quality Improvement Initiatives to Improve and Sustain Advance Care Planning Completion and Documentation
Authors: Fink Regina M. , Somes Elizabeth , Brackett Hareklia , Shanbhag Prajakta , Anderson Ashley N. , Lum Hillary D.
Published: January 2019

Despite the established benefit of advance care planning (ACP), achieving and sustaining high rates of ACP completion continue to be a challenge in many health care settings. A palliative care champions committee has targeted improving the ACP process through quality improvement initiatives at an academic medical center. To understand the impact of multiyear efforts to improve ACP, surveys of registered nurses, care coordinators, and medical assistants from inpatient and outpatient settings were conducted in 2013 and 2017 to explore comfort level with ACP, barriers preventing completion of ACP in daily practice, and suggestions for overcoming these barriers. The findings suggest strategies to further integrate ACP through interdisciplinary teams, including outpatient staff education, inpatient and outpatient quality improvement initiatives, and dedicated staff for ACP.
Palliative Care Education in Undergraduate Nursing Curriculum in Italy
Authors: Mastroianni Chiara , Ramon Codina Mireia , D’Angelo Daniela , Petitti Tommasangelo , Latina Roberto , Casale Giuseppe , Turrziani Adriana , Piredda Michela , de Marinis Maria Grazia
Published: January 2019

Worldwide, more than 19 million people require palliative care because of an advanced stage of disease. Undergraduate nursing education should include palliative care as the European consensus suggests. In 2004, the European Society of Palliative Care issued a guide for the development of palliative nurse education in Europe. This study aims to describe the extension and characteristics of palliative care education within all of the nursing degree curricula in Italy, as well as to what extent their topics match the European Society of Palliative Care guide. A descriptive study was conducted through the universities web pages. For each degree, the curricula of the academic years from 2010 to 2014 were analyzed. Sixty percent of the curricula had formal education in palliative care, heterogeneously distributed in different courses and provided few compulsory and mandatory teaching hours. Data on clinical training suggested that education was essentially theoretical, with poor theory and practice integration. The increasing need for palliative care in different settings corresponds to increasing attention to nursing education in palliative care from the undergraduate level. The inclusion of palliative care teaching in universities at all levels of education and research development represent the future challenges for this discipline.
Applying the Pit Crew Resuscitation Model to the Inpatient Care Setting
Authors: Colquitt James D. , Walker Angela B. , Haney Nancy S.
Published: January 2019

The Pit Crew Resuscitation model for team performance was designed to facilitate emergency team performance. This article documents observations during model implementation to the in-hospital setting. Low-fidelity simulations were evaluated on medical-surgical nursing units. Six significant findings were obtained: finder confusion, first responder chaos, leaderless teams, equipment disorder, limited space, and disjointed integration. Recommendations were developed and tested. Research is needed to develop training methods for in-hospital application.
Simulation for Clinical Preparedness in Pediatric Emergencies
Authors: Mariani Bette , Zazyczny Kelly Ann , Decina Patricia , Waraksa Lisa , Snyder Patricia , Gallagher Elizabeth , Hand Carol
Published: January 2019

Positive outcomes for pediatric in-hospital cardiopulmonary arrest remain low with little change in mortality rates. Infrequently used clinical knowledge and skills decline quickly, contributing to poor quality of resuscitation. The aim of this pilot study exploring the outcomes of repeated pediatric mock code simulations with structured debriefing demonstrated statistically significant differences in participants’ knowledge of pediatric emergencies, with no significant decline in resuscitation skills. This provides an evidence-based approach for professional development educators working with nurses on pediatric emergencies.
The Impact of Hospital-Based In Situ Simulation on Nurses’ Recognition and Intervention of Patient Deterioration
Authors: Lee Corinne , Mowry Jolé L. , Maycock Susan E. , Colaianne-Wolfer Marie E. , Knight Suzanne W. , Wyse Diane M.
Published: January 2019

Preparing nurses to recognize the signs and symptoms of a deteriorating patient and to provide appropriate initial interventions is essential. Hospital-based in situ simulation education is an effective evidence-based method that supports adult learning in a safe environment. The purpose of this article is to discuss the development, implementation, and evaluation of an in situ simulation program and the positive impact on nurses’ confidence level in the recognition and initiation of interventions for a deteriorating patient.
Beyond Clinical Skills
Authors: Woolforde Launette
Published: January 2019

Environmental scanning allows nursing professional development practitioners to determine what factors are influencing practice and what programs and activities are needed. Incivility, bullying, diversity, inclusion, and self-care are all surfacing as key factors impacting the healthy work environment. Nursing professional development practitioners can provide programming to address this.
One Hospital's Experience With Implementing On-Demand Annual Competencies for Nurses
Authors: Ostrander Kathy , Garrison Elisabeth , Caruso April
Published: January 2019

Competence in nursing practice can be determined by self-assessment, peer review, knowledge tests, and performance observations. In the hospital setting, this determination is traditionally completed during an annual competency day. By implementing on-demand competencies in one organization, the assessment of nurse competence is completed in real-time, resulting in increased nurse satisfaction and positive financial impact for the organization.
Improving End-of-Life Communications Using Technology-Assisted Continuing Education With Interprofessional Teams
Authors: Gullatte Mary Magee , Allen C. Suzanne , Botheroyd Elizabeth , Hess Robert G. , Higgins Melinda , Meneghetti Julia , Mullings Sandra , Mensik Jennifer , Okonye Joy A. , Salmon Nadine
Published: January 2019

Registered nurses and social workers may have little experience engaging in end-of-life discussions. Technology-assisted continuing education (TACE) improves interprofessionals’ capability and comfort with these difficult discussions. This study measured the impact of TACE on improving the capability and comfort of caregivers with end-of-life communication. Comfort and capability scores increased postintervention. This was the first dual site two-discipline pilot study to explore this TACE methodology.
Improving Provider Use of the Teach-Back Method
Authors: Holman Carita K. , Weed L. Diane , Kelley Sabrina P.
Published: January 2019

The purpose of this pilot study was to improve patient health literacy by teaching acute care nurses the teach-back method. The study involved administration of an evaluation tool to assess knowledge, attitudes, and use of teach-back prior to and 30 days after an education session. Nursing professional development practitioners can use the findings from this study to develop an education program to improve patient health literacy.
Carotid Dissection and Cerebral Infarction From Posterior Oropharyngeal Trauma
Authors: Rose Emily A. C. , Sherwin Thomas
Published: January 2019

Posterior oropharyngeal trauma commonly occurs in children and frequently presents to the emergency department (ED). Rarely, serious infectious and neurologic sequelae result. Emergency providers are tasked with the challenge of diagnosing the minority with life-threatening complications while maintaining thoughtful stewardship regarding radiation exposure. A previously healthy 2-year-old girl sustained trauma to her posterior oropharynx with a toothbrush that resulted in a left carotid dissection. This dissection was diagnosed in the ED via computed tomography angiogram, Otolaryngology and neurosurgery were consulted in the ED, and anticoagulation therapy was initiated with aspirin. The child did initially well and was without neurologic deficit and no brain ischemia on magnetic resonance imaging. She was discharged home on aspirin therapy. Four days after initial injury, the child returned to the ED after a seizure. Computed tomography scan of the head demonstrated infarction at the junction of the left parietal and temporal areas. Although neurologic complications are rare, posterior oropharyngeal trauma in children is not. There are many diagnostic and therapeutic challenges in its management. This case is, to the authors' awareness, the first case report in the English literature of a known and treated carotid dissection in a child after posterior oropharyngeal trauma that resulted in stroke despite diagnosis and initiation of treatment. The diagnostic and therapeutic challenges of posterior oropharyngeal trauma in children are discussed in this article.
Facial Reconstruction After Mohs Surgery: A Critical Review of Defects Involving the Cheek, Forehead, and Perioral Region
Authors: Johnson Anna R. , Egeler Sabine A. , Wu Winona W. , Bucknor Alexandra , Ibrahim Ahmed M.S. , Lin Samuel J.
Published: January 2019

Facial defects following Mohs surgery can cause significant functional, cosmetic, and psychologic sequelae. Various techniques for nasal reconstruction after Mohs surgery have been analyzed in the medical literature, yet there has been less attention given to procedures for other crucial facial aesthetic regions. A literature search using PubMed, EMBASE, and ISI Web of Science for studies assessing reconstructive techniques of the forehead, cheek, and perioral regions after Mohs surgery was performed. No limitations on date or language were imposed. Studies meeting inclusion criteria consisted of an entirely post-Mohs population, specified technique for aesthetic unit reconstruction, and detailed complications. The initial search yielded 2177 citations. Application of the author's inclusion and exclusion criteria resulted in 21 relevant studies. Linear closure was highlighted as the predominant technique when possible in all 3 aesthetic zones. Local flaps remained the workhorse option for cheek and forehead defects. Cheek and perioral reconstruction were associated with higher complication rates. Eighty-one percent of studies did not include patient-reported outcomes or standardized outcome measurement assessments. Mohs surgery has become a valuable approach for treatment of skin malignancies of the face. This review has identified significant study heterogeneity in methodology, design, and outcome assessment. Currently, there is no evidence-based literature to support an algorithm to guide surgeon choice of treatment in these 3 central areas. Recommendations are provided to improve the quality of future studies to better inform appropriate surgical technique for each facial unit analyzed.
Interictal Slow and High-Frequency Oscillations: Is it an Epileptic Slow or Red Slow?
Authors: Inoue Takeshi , Inouchi Morito , Matsuhashi Masao , Matsumoto Riki , Hitomi Takefumi , Daifu-Kobayashi Masako , Kobayashi Katsuya , Nakatani Mitsuyoshi , Kanazawa Kyoko , Shimotake Akihiro , Kikuchi Takayuki , Yoshida Kazumichi , Kunieda Takeharu , Miyamoto Susumu , Takahashi Ryosuke , Ikeda Akio
Published: January 2019

Purpose:

We reported the presence of interictal slow and high-frequency oscillations (HFOs) (IIS + HFO) and its temporal change so as to elucidate its clinical usefulness as a surrogate marker of epileptogenic zone in a patient with intractable focal epilepsy.

Methods:

We focused on one of the core electrodes of epileptogenicity, and investigated IIS + HFO in the pre- and post-segment of 30 minutes to all the 6 seizures. We adopted interictal slow in duration of 0.33 to 10 seconds, amplitude ≥50 μV and co-occurring with HFOs, and then divided into 5 groups depending on the amplitude of slow wave.

Results:

Before and after all the 6 seizures, the number of IIS + HFO was 2,890 at one electrode in the core epileptogenic zone. The number of IIS + HFO significantly decreased for 30 minutes after seizures. Furthermore, the number of IIS + HFO with the amplitude of 200 to 399 μV significantly decreased after seizures.

Conclusions:

IIS + HFO with the amplitude of 200 to 399 μV was influenced by and decreased after seizures. It may reflect the core part of epileptogenic area as similarly as ictal direct current shifts and ictal HFOs do. IIS + HFO could be called as the term “red slow,” which may be useful to delineate at least a part of the epileptogenic zone.
Pressure Injury Documentation Practices in the Department of Veteran Affairs
Authors: Chavez Margeaux A. , Duffy Allyson , Rugs Deborah , Cowan Linda , Davis Avaretta , Morgan Storm , Powell-Cope Gail
Published: January 2019

Evidence suggests that inaccurate and incomplete pressure injury (PI) documentation threatens the validity of treatment and undermines policy and quality improvement. This quality improvement project sought to identify barriers and facilitators when conducting and documenting the daily comprehensive skin assessment in 31 Department of Veterans Affairs (VA) facilities. Evaluators in this 1-year, cross-sectional quality improvement project, using a qualitative approach, interviewed nurses of medical-surgical and critical care units. Participants (N = 62) from 12 high reassessment units (HRUs) and 13 low reassessment units (LRUs) were interviewed using telephone focus groups. Staff from HRUs reported 9 activities that ensured consistency in clinical practices, in validating data, and in correcting inaccuracies. The LRU staff tended to report performing only 2 of the 9 activities. The main barriers to accurate documentation were lack of knowledge, poor templates, and staffing issues such as understaffing and turnover, and main facilitators were an internal data validation process and a documentation template to local practices. Findings from this project led to increased VA leadership engagement, development of 3 innovative, award-winning VA mobile PI prevention and management applications, updated policies and directives on PI prevention, and upgrading of the national VA HAPI workgroup to an advisory committee and improved collaboration between the PI advisory committee and nursing informatics.
Efficacy of Maggot Therapy on Staphylococcus aureus and Pseudomonas aeruginosa in Diabetic Foot Ulcers
Authors: Malekian Azam , Esmaeeli Djavid Gholamreza , Akbarzadeh Kamran , Soltandallal Mehdi , Rassi Yavar , Rafinejad Javad , Rahimi Foroushani Abbas , Farhoud Amir Reza , Bakhtiary Ronak , Totonchi Mehrangiz
Published: January 2019

PURPOSE:

This study was conducted to evaluate the antimicrobial effects of medicinal maggots of Lucilia sericata on Staphylococcus aureus and Pseudomonas aeruginosa on diabetic foot ulcers (DFUs).

DESIGN:

Randomized controlled trial.

SUBJECTS AND SETTING:

The sample comprised 50 adult patients from the clinic of the Academic Center for Education, Culture and Research of Tehran University of Medical Sciences, Iran. All participants who had at least 1 DFU present for at least 12 weeks, an arterial brachial index value of more than 0.6, and a hemoglobin A1c value of less than 8% were included in this study.

METHODS:

Subjects were randomly selected for the maggot-treated (treatment) or conventional treatment (control) group. Conventional treatments such as antibiotic therapy, debridement, and offloading were done for both groups, but maggot therapy (MT) was added to the protocol of the treatment group. Bacterial burden was monitored and compared for both groups using cultures collected using swab technique. Wound secretions were measured and compared in both groups.

RESULTS:

The number of infected cases with S aureus in the treatment group was significantly reduced after 48 hours in comparison with the control group (P = .047). The number of infected cases with P aeruginosa was significantly reduced after 96 hours (P = .002). We also found that wound secretions in the treatment group were significantly higher than in the control group (P < .00).

CONCLUSIONS:

Our findings indicate that MT is a safe and efficacious treatment of DFUs.
Alternating Pressure Overlay for Prevention of Intraoperative Pressure Injury
Authors: Joseph Jain , McLaughlin Dylan , Darian Vigen , Hayes Lillian , Siddiqui Aamir
Published: January 2019

PURPOSE:

The purpose of this study was to evaluate the effect of a low-profile alternating pressure (AP) overlay system on hospital-acquired pressure injuries (HAPIs).

DESIGN:

Prospective case series with historical controls.

SUBJECTS AND SETTING:

The study setting was the operating room and critical care unit of an urban quaternary care hospital in the Midwestern United States. One hundred neurosurgery patients undergoing surgery for 2 hours or longer in supine position were included in the study (AP group). The outcomes for the AP group were compared to a historical control group of 292 patients.

METHODS:

A group of 100 patients were prospectively placed on the AP overlay during surgery. Participants were enrolled preoperatively and tracked by the research team during their hospital stay. Demographic data, details of the operation, and pressure injury risk factors were recorded. Following surgery, AP group patients were evaluated daily and continued on standard protocol for pressure injury prevention. The primary study outcome was HAPI rate during the perioperative period (up to 5 days postsurgery) for the AP group (plus standard of care) compared to the standard of care alone (historical control). Control group data were extracted from electronic health records for the prior 2 years. A written questionnaire was given to the care team that used the AP technology; items queried the degree of acceptance of the overlay by surgeons and the operating room and intensive care unit (ICU) staff.

RESULTS:

None of the patients in the AP group developed perioperative pressure injuries. Review of historical control group revealed a 6% perioperative pressure injury incidence (18 pressure injuries in a group of 292 patients). Responses on the written questionnaire indicated that the AP technology was well accepted by surgeons and the operating room and ICU staff. There were no adverse events.

CONCLUSIONS:

Study findings suggest that AP overlay system can safely and reliably be used during neurological surgeries. Findings further suggest that using the AP product may improve outcomes with respect to perioperative HAPIs, including patients deemed at high risk for pressure injury development. Further studies are underway to evaluate the use of this AP overlay system beyond the operating room for more comprehensive care.
Long-Term Effects of a Self-management Program for Older Women With Urinary Incontinence in Rural Korea
Authors: So Aeyoung , De Gagne Jennie C. , Park Sunah
Published: January 2019

PURPOSE:

The purpose of the study was to examine the long-term effects of a urinary incontinence (UI) self-management program for older women on the severity, knowledge, and attitudes regarding UI.

DESIGN:

This was a quasi-experimental design (nonrandomized trial) with intervention and comparison groups.

SUBJECTS AND SETTING:

Participants were recruited from a primary health care facility in rural Korea. Forty-four older women with UI were assigned to either the intervention or the control group. Of 44 participants, 26 (17 experimental and 9 control) completed the study: 7 participants did not meet inclusion criteria (eligibility criteria partially relied on scores of a validated instrument measuring UI severity administered after initial consent to study participation), and 6 dropped out of the intervention group because of admission to hospital, hearing problems, difficulty traveling to meetings, and disinterest in the program. Five subjects in the comparison group were lost to follow-up.

METHODS:

The intervention group (n = 17) underwent a 5-session UI self-management educational program held once weekly. Its contents included a lecture, instruction on pelvic muscle exercises, and assignments related to action plans (exercises and a daily bladder diary). The study's main outcome measures were the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score, along with knowledge and attitudes toward UI measured by the UI knowledge scale (UIKS) and UI attitude scale (UIAS). Data were collected at baseline, immediately following the intervention, and at the 1-year follow-up. Repeated-measures analysis of variance was used to analyze changes in ICIQ-SF, UIKS, and UIAS scores over time.

RESULTS:

A significant improvement in UI severity was found in the intervention group, who showed a gradually decreasing ICIQ-SF score from at pretest to 5 weeks and 12 months, while it increased over the 12-month period in the control group (main effect of group, F = 17.31, P < .001; main effect of time, F = 8.45, P = .001; interaction effect, F = 22.54, P < .001). There was no significant improvement in UIKS scores over time. Scores on the UIAS changed significantly over time in the experimental group (χ2 = 6.76, P = .034), but the mean score at 1-year follow-up (mean ± standard deviation: 2.61 ± 0.56) was lower than the mean score at baseline (2.64 ± 0.19).

CONCLUSIONS:

Study findings suggest that the UI self-management educational program is effective for improving UI and related lower urinary tract symptoms and feasible to conduct as a long-term intervention program for older women living in communities. However, strategies for a systematic follow-up management are needed for long-term retention of improved UI knowledge and attitudes toward incontinence.