bluuebunny/crossref_metadata_2025 huggingface dataset:
Record keeping and social media
Authors: Flynn Maria , Mercer Dave
Published: June 2018

A hallmark of good nursing practice is how it is recorded and communicated to colleagues and other members of the healthcare team. Local policy and procedures will dictate how this important duty is undertaken in specific settings, but key principles ensure that professional standards, ethical guidelines, and legal requirements are achieved. Systems of recording nursing decisions and actions have changed greatly over the years but, whatever the form, the individual nurse is responsible and accountable for this written communication. Accurate and efficient record keeping has benefit for the recipient of care, and for the nurse if their practice is ever called into question. Few, if any, aspects of contemporary social life have been untouched by the information technology (IT) revolution of recent decades. From ‘gaming’ and ‘dating’ to ‘politics’ and ‘protest’, many people now spend much of their time in a virtual reality, negotiating the super-highways of cyber-space. Attention is given to social media and professional practice where the advantages of mass communication for the nursing profession have to be considered alongside the costs of increasingly blurred boundaries between public and private space.
Conflict resolution
Authors: Flynn Maria , Mercer Dave
Published: June 2018

Given the nature of nursing work and the stresses of any clinical environment, it is inevitable that conflict situations will emerge in day-to-day practice. Sometimes these can escalate into episodes of verbal or physical abuse, or prompt overt acts of aggressive or violent behaviours. These negatively charged interactions can occur between the service user and the nurse, within the multidisciplinary team, or as some form of dispute in employer/employee relations. The impact of conflict in the arena of care delivery can only ever be detrimental. Knowing how to use effective communication skills in any of these situations, to defuse anger or cope with volatile outbursts, is a valuable resource for adult nurses. This chapter explores individual interventions and organizational responsibilities where the primary aims are to maintain the dignity and safety of the patient and to support members of staff involved in the management of challenging incidents.
Risk assessment
Authors: Flynn Maria , Mercer Dave
Published: June 2018

General adult nurses work with people in hospitals, hospices, community care services, and people’s homes. Irrespective of the place of work, there will be many routine procedures which are an important part of reducing risk to people and organizing subsequent nursing work. It is recognized that all organizations will have different risk assessment tools and recording procedures, but there are generic principles of safety which underpin all these tools. An important aspect of nursing decision-making and practice is understanding and managing risk, and factoring risk management into the planning and delivery of nursing care. This chapter considers the broad principles of risk assessments which are widely used across healthcare environments.
Physiological measurements
Authors: Flynn Maria , Mercer Dave
Published: June 2018

An important part of nursing decision-making, in both hospital and community settings, is interpreting the results of physiological measurements. These may be used to assist in making a diagnosis, monitoring the effects of treatments, or assessing changes to a person’s health condition. Physiological values are always interpreted within the context of what is known about the person and their health state, and can guide nursing practices and interventions. This chapter describes widely used physiological measurements, together with reference range values which may be useful to the general nurse.
Cardiovascular conditions
Authors: Flynn Maria , Mercer Dave
Published: June 2018

Cardiovascular disease is a growing, and significant, health condition. It is often associated with other long-term health disorders and affects a large proportion of the adult population. Whilst much of cardiac care is carried out by advanced and specialist nurses, general adult nurses are likely to encounter people with cardiovascular conditions across acute, community, and end-of-life care settings. This chapter outlines key facts about cardiovascular disease which are likely to be useful to the general nurse. These include an overview of cardiac conditions and their treatments, and a summary of associated clinical investigations. The chapter also includes a short section on key facts related to cardiovascular surgery. Important nursing considerations when working with people with cardiovascular conditions are outlined, and an overview of frequently prescribed medicines is presented in a summary table.
Diabetes
Authors: Flynn Maria , Mercer Dave
Published: June 2018

Diabetes is recognized as a significant, and increasing, long-term health condition. General adult nurses may encounter people with diabetes in a variety of circumstances and settings, but many people manage their own condition in the community, supported by specialist nurses. This chapter outlines key facts relating to diabetes, likely to be of relevance to the general nurse. These include the different types of diabetes, their symptoms and treatments, and diabetic emergencies. A summary of clinical investigations in diabetes is also presented, along with a summary table of medications frequently used to treat the condition. Key nursing considerations for working with people newly diagnosed or living with diabetes are outlined.
Musculoskeletal conditions
Authors: Flynn Maria , Mercer Dave
Published: June 2018

The skeleton, skeletal muscles, joints, tendons, and ligaments function to protect the body’s internal organs and facilitate movement and mobility. Disorders of the musculoskeletal system will often be the result of trauma or long-term degenerative conditions, which can affect people of any age, although older people are at increased risk. Many people with musculoskeletal conditions will be treated by specialist orthopaedic and rheumatology services, but general adult nurses will come into contact with many people who are suffering from a range of musculoskeletal disorders. Whether these are muscle sprains, people living with long-term arthritic conditions, or those who have suffered a potentially life-threatening traumatic injury, all will have some degree of compromised movement. It is important that general adult nurses can work with people to help restore function and reduce risk from the many complications which can arise from immobility or disability. This chapter outlines key facts about musculoskeletal conditions which are likely to be useful to the general nurse, alongside clinical investigations, and key nursing considerations. A summary table of frequently prescribed medicines is also presented.
Radiology
Authors: Cascarini Luke , Schilling Clare , Gurney Ben , Brennan Peter
Published: June 2018

This chapter discusses radiology in oral and maxillofacial surgery, including Guidelines for dental radiology, Dental radiography, Panoramic radiography, Ultrasonography, Computed Tomography (CT), Cone beam CT, Magnetic Resonance Imaging (MRI), Nuclear medicine imaging and Sialography
Essential skills
Authors: Cascarini Luke , Schilling Clare , Gurney Ben , Brennan Peter
Published: June 2018

This chapter discusses essential skills in oral and maxillofacial surgery, including Local anaesthesia, Intra-oral suturing, Managing the bleeding socket, Managing the dry socket, Suturing facial lacerations, Packing the nose and midface for bleeding, Re-implanting and splinting teeth, Temporomandibular joint relocation, Bridle wiring and intermaxillary fixation, Incision and drainage of intra-and-extra-oral abscesses, Biopsy of intra- and extra-oral lesions, Taking dental impressions, and Cricothyroidotomy
The Type III Effector AvrBsT Enhances Xanthomonas perforans Fitness in Field-Grown Tomato
Authors: Abrahamian Peter , Timilsina Sujan , Minsavage Gerald V. , KC Sushmita , Goss Erica M. , Jones Jeffrey B. , Vallad Gary E.
Published: June 2018

Type III secretion system effectors contribute to pathogenicity through various mechanisms. Recent surveys showed an increasing prevalence of the type III secretion effector avrBsT among Xanthomonas perforans strains. We hypothesized that the acquisition of avrBsT has a fitness advantage for the pathogen. The contribution of avrBsT to fitness on tomato was evaluated based on disease severity, in planta growth, competition, and recovery rates of wild-type (WT) and avrBsT mutant strains in greenhouse and field plants. GEV872 and GEV1001, representative strains of two phylogenomic groups of X. perforans, were selected for generating avrBsT mutants. Disease severity was higher for WT strains compared with the avrBsT mutant strains. X. perforans WT and avrBsT mutant strains did not differ following leaf infiltration of greenhouse plants in direct competition and in planta growth assays. The effect of avrBsT on pathogen fitness was noticeable under field conditions. Differences in strain recovery were significant, with WT being recovered two to eight times more than avrBsT mutant strains in the case of both strains GEV872 and GEV1001. WT strains were capable of spreading longer distances across field plots compared with avrBsT mutant strains. Findings suggest that the functional AvrBsT affects the fitness of X. perforans under field conditions, making it an ideal candidate for bacterial spot resistance breeding efforts in tomato.
De novo lipogenesis represents a therapeutic target in mutant Kras non‐small cell lung cancer
Authors: Singh Anju , Ruiz Christian , Bhalla Kavita , Haley John A. , Li Qing Kay , Acquaah‐Mensah George , Montal Emily , Sudini Kuladeep R. , Skoulidis Ferdinandos , Wistuba Ignacio I. , Papadimitrakopoulou Vassiliki , Heymach John V. , Boros Laszlo G. , Gabrielson Edward , Carretero Julian , Wong Kwok‐Kin , Haley John D. , Biswal Shyam , Girnun Geoffrey D.
Published: June 2018

Oncogenic Kras mutations are one of the most common alterations in non‐small cell lung cancer and are associated with poor response to treatment and reduced survival. Driver oncogenes, such as Kras are now appreciated for their ability to promote tumor growth via up‐regulation of anabolic pathways. Therefore, we wanted to identify metabolic vulnerabilities in Kras‐mutant lung cancer. Using the KrasLSL‐G12D lung cancer model, we show that mutant Kras drives a lipogenic gene‐expression program. Stable‐isotope analysis reveals that mutant Kras promotes de novo fatty acid synthesis in vitro and in vivo. The importance of fatty acid synthesis in Kras‐induced tumorigenesis was evident by decreased tumor formation in KrasLSL‐G12D mice after treatment with a fatty acid synthesis inhibitor. Importantly, with gain and loss of function models of mutant Kras, we demonstrate that mutant Kras potentiates the growth inhibitory effects of several fatty acid synthesis inhibitors. These studies highlight the potential to target mutant Kras tumors by taking advantage of the lipogenic phenotype induced by mutant Kras.—Singh, A., Ruiz, C., Bhalla, K., Haley, J. A., Li, Q. K., Acquaah‐Mensah, G., Montal, E., Sudini, K. R., Skoulidis, F., Wistuba, I. I., Papadimitrakopoulou, V., Heymach, J. V., Boros, L. G., Gabrielson, E., Carretero, J., Wong, K.‐K., Haley, J.D., Biswal, S., Girnun, G.D. De novo lipogenesis represents a therapeutic target in mutant Kras non‐small cell lung cancer. FASEB J. 32, 7018–7027 (2018). www.fasebj.org
The chemerin knockout rat reveals chemerin dependence in female, but not male, experimental hypertension
Authors: Watts Stephanie W. , Darios Emma S. , Mullick Adam E. , Garver Hannah , Saunders Thomas L. , Hughes Elizabeth D. , Filipiak Wanda E. , Zeidler Michael G. , McMullen Nichole , Sinal Christopher J. , Kumar Ramya K. , Ferland David J. , Fink Gregory D.
Published: June 2018

Measures of the adipokine chemerin are elevated in multiple cardiovascular diseases, including hypertension, but little mechanistic work has been done to implicate chemerin as being causative in such diseases. The chemerin knockout (KO) rat was created to test the hypothesis that removal of chemerin would reduce pressure in the normal and hypertensive state. Western analyses confirmed loss of chemerin in the plasma and tissues of the KO vs. wild‐type (WT) rats. Chemerin concentration in plasma and tissues was lower in WT females than in WT males, as determined by Western analysis. Conscious male and female KO rats had modest differences in baseline measures vs. the WT that included systolic, diastolic, mean arterial and pulse pressures, and heart rate, all measured telemetrically. The mineralocorticoid deoxycorticosterone acetate (DOCA) and salt water, combined with uninephrectomy as a hypertensive stimulus, elevated mean and systolic blood pressures of the male KO higher than the male WT. By contrast, all pressures in the female KO were lower than their WT throughout DOCA‐salt treatment. These results revealed an unexpected sex difference in chemerin expression and the ability of chemerin to modify blood pressure in response to a hypertensive challenge.—Watts, S. W., Darios, E. S., Mullick, A. E., Garver, H., Saunders, T. L., Hughes, E. D., Filipiak, W. E., Zeidler, M. G., McMullen, N., Sinal, C. J., Kumar, R. K., Ferland, D. J., Fink, G. D. The chemerin knockout rat reveals chemerin dependence in female, but not male, experimental hypertension. FASEB J. 32, 6596–6614 (2018). www.fasebj.org
Oxidant sensor cation channel TRPM2 regulates neutrophil extracellular trap formation and protects against pneumoseptic bacterial infection
Authors: Tripathi Jitendra Kumar , Sharma Atul , Sukumaran Pramod , Sun Yuyang , Mishra Bibhuti Bhusan , Singh Brij Bhan , Sharma Jyotika
Published: June 2018

Neutrophil extracellular trap (NET) formation constitutes an important extracellular antimicrobial function of neutrophils that plays a protective role in bacterial pneumonia. Formation of reactive oxygen species (ROS) such as highly diffusible hydrogen peroxide (H2O2) is a hallmark of oxidative stress during inflammatory lung conditions including pneumonia. However, the impact of exogenous ROS on NET formation and the signaling pathway involved in the process is not completely understood. Here we demonstrate that the ROS‐sensing, non‐selective, calcium‐permeable channel transient receptor potential melastatin 2 (TRPM2) is required for NET formation in response to exogenous H2O2. This TRPM2‐dependent H2O2‐mediated NET formation involved components of autophagy and activation of AMPK and p38 MAPK, but not PI3K and AKT. Primary neutrophils from Trpm2–/– mice fail to activate this pathway with a block in NET release and a concomitant decrease in their antimicrobial capacity. Consequently, Trpm2–/– mice were highly susceptible to pneumonic infection with Klebsiella pneumoniae owing to an impaired NET formation and high bacterial burden despite increased neutrophil infiltration in their lungs. These results identify a key role of TRPM2 in regulating NET formation by exogenous ROS via AMPK/p38 activation and autophagy machinery, as well as a protective antimicrobial role of TRPM2 in pneumonic bacterial infection.—Tripathi, J. K., Sharma, A., Sukumaran, P., Sun, Y., Mishra, B. B., Singh, B. B., Sharma, J. Oxidant sensor cation channel TRPM2 regulates neutrophil extracellular trap formation and protects against pneumoseptic bacterial infection. FASEB J. 32, 6848–6859 (2018). www.fasebj.org
Processed Electroencephalogram Monitoring and Postoperative Delirium
Authors: MacKenzie Kristen K. , Britt-Spells Angelitta M. , Sands Laura P. , Leung Jacqueline M.
Published: June 2018

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Postoperative delirium complicates approximately 15 to 20% of major operations in patients at least 65 yr old and is associated with adverse outcomes and increased resource utilization. Furthermore, patients with postoperative delirium might also be at risk of developing long-term postoperative cognitive dysfunction. One potentially modifiable variable is use of intraoperative processed electroencephalogram to guide anesthesia. This systematic review and meta-analysis examines the relationship between processed electroencephalogram monitoring and postoperative delirium and cognitive dysfunction.

Methods

A systematic search for randomized controlled trials was conducted using Ovid MEDLINE, PubMed, EMBASE, Cochrane Library, and Google search using the keywords processed electroencephalogram, Bispectral Index, postoperative delirium, postoperative cognitive dysfunction. Screening and data extraction were conducted by two independent reviewers, and risk of bias was assessed. Postoperative delirium combined-effect estimates calculated with a fixed-effects model were expressed as odds ratios with 95% CIs.

Results

Thirteen of 369 search results met inclusion criteria. Postoperative cognitive dysfunction data were excluded in meta-analysis because of heterogeneity of outcome measurements; results were discussed descriptively. Five studies were included in the quantitative postoperative delirium analysis, with data pooled from 2,654 patients. The risk of bias was low in three studies and unclear for the other two. The use of processed electroencephalogram-guided anesthesia was associated with a 38% reduction in odds for developing postoperative delirium (odds ratio = 0.62; P < 0.001; 95% CI, 0.51 to 0.76).

Conclusions

Processed electroencephalogram-guided anesthesia was associated with a decrease in postoperative delirium. The mechanism explaining this association, however, is yet to be determined. The data are insufficient to assess the relationship between processed electroencephalogram monitoring and postoperative cognitive dysfunction.
Behavioral Measures of Listening Effort in School-Age Children: Examining the Effects of Signal-to-Noise Ratio, Hearing Loss, and Amplification
Authors: McGarrigle Ronan , Gustafson Samantha J. , Hornsby Benjamin W. Y. , Bess Fred H.
Published: June 2018

Objectives:

Increased listening effort in school-age children with hearing loss (CHL) could compromise learning and academic achievement. Identifying a sensitive behavioral measure of listening effort for this group could have both clinical and research value. This study examined the effects of signal-to-noise ratio (SNR), hearing loss, and personal amplification on 2 commonly used behavioral measures of listening effort: dual-task visual response times (visual RTs) and verbal response times (verbal RTs).

Design:

A total of 82 children (aged 6–13 years) took part in this study; 37 children with normal hearing (CNH) and 45 CHL. All children performed a dual-task paradigm from which both measures of listening effort (dual-task visual RT and verbal RT) were derived. The primary task was word recognition in multi-talker babble in three individually selected SNR conditions: Easy, Moderate, and Hard. The secondary task was a visual monitoring task. Listening effort during the dual-task was quantified as the change in secondary task RT from baseline (single-task visual RT) to the dual-task condition. Listening effort based on verbal RT was quantified as the time elapsed from the onset of the auditory stimulus to the onset of the verbal response when performing the primary (word recognition) task in isolation. CHL completed the task aided and/or unaided to examine the effect of amplification on listening effort.

Results:

Verbal RTs were generally slower in the more challenging SNR conditions. However, there was no effect of SNR on dual-task visual RT. Overall, verbal RTs were significantly slower in CHL versus CNH. No group difference in dual-task visual RTs was found between CNH and CHL. No effect of amplification was found on either dual-task visual RTs or verbal RTs.

Conclusions:

This study compared dual-task visual RT and verbal RT measures of listening effort in the child population. Overall, verbal RTs appear more sensitive than dual-task visual RTs to the negative effects of SNR and hearing loss. The current findings extend the literature on listening effort in the pediatric population by demonstrating that, even for speech that is accurately recognized, school-age CHL show a greater processing speed decrement than their normal-hearing counterparts, a decrement that could have a negative impact on learning and academic achievement in the classroom.
A Modified Posterior C1/C2 Fusion Technique for the Management of Traumatic Odontoid Type II Fractures by Using Intraoperative Spinal Navigation: Midterm Results
Authors: Ishak Basem , Schneider Till , Gimmy Valerie , Unterberg Andreas W. , Kiening Karl L.
Published: June 2018

Objectives:

To assess midterm safety and efficacy of a modified Goel–Harms technique for the treatment of odontoid instabilities.

Design:

Longitudinal prospective cohort study.

Setting:

Urban Level 1 Trauma Center in Southwest Germany.

Patients/Participants:

Orthopaedic and neurosurgical trauma patients older than 18 years admitted for ≤24 hours.

Main Outcome Measurements:

The outcome was evaluated with respect to neurological outcome, radiological outcome and surgical complications. For the functional assessment, the EQ-5D questionnaire was used. Furthermore, the Neck Disability Index and visual analog scale for neck pain were determined. A median follow-up of 39 months (range: 6–97 months) was given.

Results:

Of the total sample (n = 56), 26 patients with an acute traumatic odontoid fracture type II underwent posterior atlantoaxial instrumentation using spinal navigation. Neck pain evaluated with visual analog scale and Neck Disability Index showed a significant decrease at final follow-up compared to preoperative values (P < 0.05). According to the EQ-5D, the valuation of quality of life after C1/C2 fusion showed an excellent outcome with complete recovery in most cases (0.7–1).

Conclusions:

Our results demonstrate satisfactory and maintained midterm clinical and radiological results after a median follow-up of 39 months. With the use of intraoperative spinal navigation, we demonstrate a modified C1/C2 posterior fusion technique, rendering accuracy, feasibility, and overall safety.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Hypertensive Disorders of Pregnancy and Genital Anomalies in Boys: A Danish Nationwide Cohort Study
Authors: Arendt Linn Håkonsen , Henriksen Tine Brink , Lindhard Morten Søndergaard , Parner Erik T , Olsen Jørn , Ramlau-Hansen Cecilia Høst
Published: June 2018

Background:

Although congenital abnormalities in the male reproductive tract are common, their causes remain poorly understood. We studied associations between hypertensive disorders of pregnancy (pregestational hypertension, gestational hypertension, and preeclampsia) and the genital anomalies, cryptorchidism (undescended testes), and hypospadias (ventrally displaced urethral meatus).

Methods:

We established a population of 1,073,026 Danish boys born alive between 1 January 1978 and 31 December 2012. By means of Cox regression analyses, we estimated hazard ratios with 95% confidence intervals for cryptorchidism and hypospadias according to type and severity of hypertensive disorder. Further, we used restricted cubic spline analyses to investigate the association between gestational age at onset of severe and moderate preeclampsia and the two genital anomalies.

Results:

We found associations between pregestational hypertension and cryptorchidism (HR: 1.3; 95% CI = 1.1, 1.6) and hypospadias (HR: 1.7; 95% CI = 1.3, 2.3), whereas gestational hypertension was only associated with cryptorchidism (HR: 1.2; 95% CI = 1.1, 1.4). Boys of mothers with preeclampsia had the highest occurrence of cryptorchidism and hypospadias, increasing with preeclampsia severity. Women with HELLP syndrome faced the highest risk of having a child with both cryptorchidism (HR: 2.1; 95% CI = 1.4, 3.2) and hypospadias (HR: 3.9; 95% CI = 2.5, 6.1). Further, the occurrence increased with early onset of preeclampsia diagnosis.

Conclusions:

These findings support the hypotheses that preeclampsia and genital anomalies share common etiologic factors and that placental dysfunction and androgen deficiency in early pregnancy are important in the etiology of male genital anomalies.
Cincinnati Protocol for Preoperative Screening and Donor Selection for Ocular Surface Stem Cell Transplantation
Authors: Cheung Albert Y. , Sarnicola Enrica , Kurji Khaliq H. , Govil Amit , Mogilishetty Gautham , Eslani Medi , Wright Elizabeth , Brailey Paul , Holland Edward J.
Published: June 2018

Purpose:

To describe our process for preoperative screening and donor selection for ocular surface stem cell transplantation (OSST).

Methods:

A 7-year retrospective chart review was performed on limbal stem cell deficiency patients. The inclusion criterion was all patients who underwent an OSST procedure. The exclusion criterion was eyes with unilateral disease in which an autograft was performed. Data for human leukocyte antigen (HLA) typing, virtual crossmatching, donor-specific antibody, and panel reactive antibody level were obtained.

Results:

Of the included 142 eyes (104 patients), 19 patients had no recorded living donor availability data, and HLA typing was not performed on 16 patients. A total of 94 donors (mean 1.4 donors/patient, range 1–6) were tested for 67 recipients. For 2 patients with graft-versus-host disease, no further HLA typing was needed, as the donors were known HLA-identical donors. For 47 patients, only 1 donor was tested, whereas multiple donors underwent HLA typing for 20 patients. There were 73 ABO (blood group)-compatible matches for the 61 tested recipients, and only 1 recipient did not have any ABO-compatible donor. For the virtual crossmatch, there were 5 patients who did not have a compatible donor (positive virtual crossmatch). The best available donor match was a sibling for 41 recipients (65%), a parent for 19 recipients (30%), and an offspring for 3 recipients (5%).

Conclusions:

Our protocol for OSST preoperative screening and donor selection minimizes the antigenic burden for transplanted tissue by selecting the best available donor match.
Predictive Value of Corneal Donor Demographics on Endothelial Cell Density
Authors: McGlumphy Elyse J. , Margo Jordan A. , Haidara Moulaye , Brown Clayton H. , Hoover Caroline K. , Munir Wuqaas M.
Published: June 2018

Purpose:

Corneal endothelial cell density (ECD) is an important measure for determining suitability for transplantation. Although age has been correlated with ECD, the impact of sex and ethnicity is unclear.

Methods:

Corneal donor information from SightLife Eye Bank was collected between 2012 and 2016. Tests of association were adjusted for covariates using linear regression including age, race, and sex. “Unsuitable for transplantation” was a label assigned to specimens with extensive cell dropout, ECD <2000 cells/mm2, and poor cell morphology. Repeated-measures analysis was used to account for the within-individual correlation between left and right eyes.

Results:

A total of 39,679 donor corneas were analyzed, with a mean ECD 2743.5 cells/mm2 and mean age of 58. Simple linear regression demonstrated an association between ECD and age (P < 0.001). Multiple regression showed no association between sex and ECD. Compared with whites, African American, and Asian ethnicities were predictors of increased ECD (mean +45.7 cells/mm2 (P < 0.001) and +90.3 cells/mm2 (P < 0.001), respectively); Hispanic ethnicity was a predictor of decreased ECD [mean −36.9 cells/mm2 (P = 0.002)]. A total of 233 (0.59%) corneas were unsuitable for transplantation, which was associated with age (P < 0.001) but not sex or ethnicity.

Conclusions:

Analysis of a large sample of donor corneas continues to show age but not sex as a predictor of decreased ECD. African American and Asian ethnicities tend to have slightly higher ECD than that of white donors, whereas Hispanic donors have slightly lower ECD; however, ethnicity was not a predictor of suitability for transplantation. Clinical significance of these findings is yet to be determined.
Thoracoscopic Resection of Congenital Cystic Adenomatoid Malformation in a Patient with Fused Lung Fissure Using Hookwire
Authors: Lau Chin-Tung , Wong Kenneth K. Y.
Published: June 2018

Thoracoscopic resection is being used more commonly for the treatment of congenital cystic adenomatoid malformation in neonates and infants. However, in the rare case of congenital cystic adenomatoid malformation with congenital absence of lung fissure, thoracoscopic lobectomy cannot be performed safely. Moreover, if the lung lesion is deep-seated and cannot be visualized on the pleural surface, wedge resection may result in residual lesion. Here, we reported our approach of thoracoscopic resection under hookwire guidance to tackle this problem.
Transesophageal Echocardiography–Guided Epicardial Left Ventricular Lead Placement by Video-Assisted Thoracoscopic Surgery in Nonresponders to Biventricular Pacing and Previous Chest Surgery
Authors: Schroeder Carsten , Chung Jane M. , Mackall Judith A. , Cakulev Ivan T. , Patel Aaron , Patel Sunny J. , Hoit Brian D. , Sahadevan Jayakumar
Published: June 2018

Objective

The aim of the study was to study the feasibility, safety, and efficacy of transesophageal echocardiography–guided intraoperative left ventricular lead placement via a video-assisted thoracoscopic surgery approach in patients with failed conventional biventricular pacing.

Methods

Twelve patients who could not have the left ventricular lead placed conventionally underwent epicardial left ventricular lead placement by video-assisted thoracoscopic surgery. Eight patients had previous chest surgery (66%). Operative positioning was a modified far lateral supine exposure with 30-degree bed tilt, allowing for groin and sternal access. To determine the optimal left ventricular location for lead placement, the left ventricular surface was divided arbitrarily into nine segments. These segments were transpericardially paced using a handheld malleable pacing probe identifying the optimal site verified by transesophageal echocardiography. The pacing leads were screwed into position via a limited pericardiotomy.

Results

The video-assisted thoracoscopic surgery approach was successful in all patients. Biventricular pacing was achieved in all patients and all reported symptomatic benefit with reduction in New York Heart Association class from III to I–II ( P = 0.016). Baseline ejection fraction was 23 ± 3%; within 1-year follow-up, the ejection fraction increased to 32 ± 10% ( P = 0.05). The mean follow-up was 566 days. The median length of hospital stay was 7 days with chest tube removal between postoperative days 2 and 5.

Conclusions

In patients who are nonresponders to conventional biventricular pacing, intraoperative left ventricular lead placement using anatomical and functional characteristics via a video-assisted thoracoscopic surgery approach is effective in improving heart failure symptoms. This optimized left ventricular lead placement is feasible and safe. Previous chest surgery is no longer an exclusion criterion for a video-assisted thoracoscopic surgery approach.
Reducing Inappropriate Antibiotics for Urinary Tract Infections in Long-Term Care
Authors: Cooper Denise , McFarland Marilyn , Petrilli Francesca , Shells Cherrell
Published: June 2018

Background:

Nursing home providers face challenges in urinary tract infection assessment and treatment, often prescribing unnecessary antibiotics for asymptomatic bacteriuria, a practice that can result in adverse drug reactions, drug resistance, and an increase in antibiotic-associated diarrhea.

Purpose:

The purpose of this project was to replicate the Cooper Urinary Tract Infection Program in another facility and measure its effectiveness.

Methods:

Using a pre-post design, this project was implemented at a 120-bed, long-term care and rehabilitation facility located in the Midwest United States.

Interventions:

This project used the multifaceted Cooper Urinary Tract Infection Program that includes the Cooper tool algorithm, didactic education for providers, and change champions.

Results:

The results were significant improvements in nurse knowledge and reduced rates of urinary tract infections, inappropriate antibiotic treatments, and urinalyses.

Conclusions:

These results add to the evidence for implementing the Cooper Urinary Tract Infection Program in long-term care facilities for effective reduction of inappropriate antibiotic usage for urinary tract infection.
A Capstone Simulation for Leadership Development
Authors: Strickland Haley P. , Welch Teresa D.
Published: June 2018

Background

New graduate nurses are expected to function autonomously and be practice-ready upon graduation. However, transitioning from the role of student to one of leadership in the professional nurse's role is a complex experience.

Problem

Concerns for safety and liability in an increasingly complex health care environment may limit the availability of relevant clinical experiences for nursing students to develop leadership skills.

Approach

The Mock Hospital, a comprehensive capstone simulation, was designed to immerse senior nursing students into the leadership role of the professional nurse.

Outcome

Positive feedback obtained from students through reflection and discussion supports the implementation of a capstone simulation.

Conclusions

Supporting new graduate nurses' transition into practice, while preparing the next generation of nurses to successfully meet the challenges of a complex health care environment, will require innovative and transformative educational experiences.
RBC Exposure in Pediatric Extracorporeal Membrane Oxygenation: Epidemiology and Factors Associated With Large Blood Transfusion Volume*
Authors: O’Halloran Conor P. , Alexander Peta M. A. , Andren Kristofer G. , Mecklosky Jessica , Salvin Joshua W. , Larsen Stephanie , Zalieckas Jill , Fynn-Thompson Francis , Thiagarajan Ravi R.
Published: June 2018

Objectives:

To quantify and identify factors associated with large RBC exposure in children supported with extracorporeal membrane oxygenation.

Design:

Retrospective cohort study.

Setting:

Single tertiary care children’s hospital.

Patients:

One-hundred twenty-two children supported with extracorporeal membrane oxygenation for greater than 12 hours during January 1, 2015, to December 31, 2016.

Interventions:

None.

Measurements and Main Results:

Clinical, laboratory, and survival data were obtained from medical records. Only data from patients’ first extracorporeal membrane oxygenation run were used. The primary outcome was RBC volume exposure during extracorporeal membrane oxygenation (mL/kg/d). Patients with RBC exposure volume greater than 75th percentile were categorized as “high RBC use” patients. A “bleeding day” was identified if mediastinum or cannula sites were explored and/or Factor VIIa administration, gastrointestinal, pulmonary, or intracranial hemorrhages occurred. Median age was 0.3 years (interquartile range, 0–3 yr). Congenital heart disease (n= 56; 46%) was the most common diagnosis. Median RBC volume transfused during extracorporeal membrane oxygenation was 39 mL/kg/d (interquartile range, 21–66 mL/kg/d). High RBC use patients were more likely be supported by venoarterial extracorporeal membrane oxygenation (100 vs 76%;p= 0.006), have congenital heart disease (68 vs 39%;p= 0.02), and experience bleeding (33 vs 11% d;p< 0.001). High RBC use patients showed a trend toward higher in-hospital mortality (58 vs 37%;p= 0.07). In the multivariable analysis, younger age (–9% per year; 95% CI, –10% to –7%;p< 0.001), more blood draws per day (+8%; 95% CI, 6–11%;p< 0.001), and higher proportion of bleeding days (+22% per 10% increase; 95% CI, 16–29%;p< 0.001) were associated with larger RBC exposure (modelR2= 0.66).

Conclusions:

Bleeding during extracorporeal membrane oxygenation, frequent laboratory draws, and younger age were associated with increased RBC exposure during extracorporeal membrane oxygenation. Higher transfusion volume was associated with increased mortality.
Ability to Assent in Pediatric Critical Care Research: A Prospective Environmental Scan of Two Canadian PICUs
Authors: O’Hearn Katharine J. , Martin Dori-Ann , Dagenais Maryse , Menon Kusum
Published: June 2018

Objectives:

To determine the number of patients considered not appropriate to approach for assent within the first 24 hours of PICU admission.

Design:

Exploratory prospective 1-month environmental scan.

Setting:

Two tertiary Canadian PICUs.

Patients:

Ninety patients age newborn to 17 years old admitted to the PICU during September 2016 (Site 1) or May 2017 (Site 2).

Interventions:

None.

Measurements and Main Results:

At PICU admission, 81% of patients were deemed not appropriate to approach for assent most commonly due to age, influence of psychotropic medications, and/or mechanical ventilation. At PICU discharge, 74% of patients were considered not appropriate to approach, most commonly due to age and/or developmental delay. There was moderate to good agreement between the research team and care team assessments of appropriateness for assent. Only 8% of patients considered not approachable at admission become appropriate to approach for assent by PICU discharge.

Conclusions:

Very few patients were considered approachable for assent during the first 24 hours of PICU admission. Those who were considered appropriate to approach were less ill, spent less time in PICU, and were unlikely to be considered for enrollment in pediatric critical care research.
Ibuprofen for Pain Control in Children
Authors: Poddighe Dimitri , Brambilla Ilaria , Licari Amelia , Marseglia Gian Luigi
Published: June 2018

Background

Acute pain is one of the major complaints reported in pediatric emergency departments and general wards. Recently, both the US Food and Drug Administration and European Medicine Agency emitted some warnings regarding the use of opioids, including codeine, in children.

Objective

The aims of this study were summarizing the main pharmacological aspects of ibuprofen, discussing the current evidence about the use of ibuprofen in different and specific clinical settings, and providing a comparison with acetaminophen and/or codeine, according to available studies.

Study Design and Methods

Studies evaluating ibuprofen for the management of acute pain in children were extracted from the PubMed and MEDLINE database within the period ranging from 1985 through 2017. After discussing safety of ibuprofen and its concomitant use with acetaminophen, the specific indications for the clinical practice were considered.

Results

Ibuprofen resulted to be more effective than acetaminophen, and comparable to the combination acetaminophen-codeine, for the control of acute pain related to musculoskeletal pain. Moreover, similar results have been reported also in the management of toothache and inflammatory diseases of the oral cavity and pharynx. Ibuprofen resulted to be useful as a first approach to episodic headache. Finally, the role of ibuprofen in the management of postoperative pain and, particularly, after tonsillectomy and/or adenoidectomy has been reconsidered recently.

Conclusions

Ibuprofen resulted to be the most studied nonsteroidal anti-inflammatory drug in the management of acute pain in children; in general, it showed a good safety profile and provided evidence of effectiveness, despite some differences according to the specific clinical context.
Depressive Symptoms Are Associated With Low Treatment Adherence in African American Individuals With Systemic Lupus Erythematosus
Authors: Heiman Erica , Lim S. Sam , Bao Gaobin , Drenkard Cristina
Published: June 2018

Objective

African American (AA) people with systemic lupus erythematosus (SLE) are at high morbidity and mortality risk, and they often require multiple medications. Low medication adherence is a highly prevalent, multidimensional problem associated with poor outcomes in people with SLE. Depression, a predictor of low adherence in people with chronic conditions, has been described in over 35% of AAs with SLE. We hypothesized that depressive symptoms would be increasingly associated with low adherence in this population.

Methods

Research subjects predominantly belong to the Georgians Organized Against Lupus cohort, a population-based cohort of predominantly AA individuals with SLE in the Atlanta metropolitan area. Medication adherence and severity of depressive symptoms were measured using validated self-reported tools: the 8-item Morisky Medication Adherence Scale and the 9-item Patient Health Questionnaire, respectively. We used univariate and multivariate logistic regression to examine the odds ratios of low medication adherence across individuals with increasing severity of depressive symptoms.

Results

Among 632 AA SLE participants, 336 (54%) reported low medication adherence and 217 (34.6%) reported “moderate” or “severe” depressive symptoms. In univariate logistic regression, significant risk factors for low adherence were depressive symptoms, low self-efficacy, poor satisfaction with care, female sex, younger age, hurried patient-physician communication, poorer shared decision-making, less compassionate physician communication style, poor/fair health, and higher disease activity score. In multivariate regression, younger age, female sex, and more severe depressive symptoms were associated with low medication adherence.

Conclusions

This is the first study to examine factors associated with low medication adherence among a population-based cohort of AA individuals with SLE. Depression was a strong correlate of low medication adherence. Mental health interventions aiming to address and treat depression may increase medication adherence.
Systemic Sclerosis at an Intensive Care Unit
Authors: Naranjo-Escobar Juan , Hormaza Andrés A. , Posso-Osorio Iván , Pino-Escobar Jessica , Betancur Juan F. , Tobón Gabriel J.
Published: June 2018

Introduction

Systemic sclerosis (SSc) is a multisystemic autoimmune disease. Few studies have focused on the outcomes of SSC patients who require intensive care unit (ICU) admission, largely due to the absence of protocols for the optimal management of this disease during an ICU stay.

Objectives

This study aimed to describe the outcomes of a series of SSc patients admitted to the ICU at a single center in Cali, Colombia.

Methods

Case series of SSc patients admitted to the ICU were reviewed. The main outcome was ICU mortality. Statistical analysis was performed with measures of central tendency and proportions.

Results

All the patients (n = 14) were female and either middle-aged or elderly; 9 (64%) were diagnosed with diffuse cutaneous sclerosis, and the remaining 5 patients with limited cutaneous sclerosis. Some were readmitted; therefore, the total number of ICU admissions was 21. The principal causes of ICU admissions were non–SSc-related causes (n = 15 [71.4%]). The respiratory system was the most involved on ICU admissions. The ICU mortality rate was 43% (n = 6).

Conclusions

The severity of the disease at ICU admission and comorbidity are independently associated with ICU-related mortality. Furthermore, the optimal management of SSc patients includes accurate detection of SSc-associated organ involvement. More studies involving this category of patients are needed to establish the best effective protocols.
Hand-assisted Laparoscopy: Expensive but Considerable Step Between Laparoscopic and Open Colectomy
Authors: Gulcu Baris , Isik Ozgen , Ozturk Ersin , Yilmazlar Tuncay
Published: June 2018

Purpose:

Hand-assisted laparoscopic colectomy (HALC) and laparoscopic-assisted colectomy (LAC) have been shown to have comparable short-term outcomes while there are limited data regarding costs. The aim of our study was to compare the short-term outcomes and costs of HALC and LAC.

Materials and Methods:

In total, 46 patients who underwent HALC or LAC for benign or malignant disease between January 2011 and December 2014 at our institution were included in the study. Patients were randomized into HALC or LAC group. Patients’ demographics and characteristics, operative details, short-term outcomes, and costs were evaluated.

Results:

There were 25 patients in LAC group and 21 patients in HALC group. Patient’s demographics and characteristics and short-term outcomes were comparable between the LAC and HALC groups. Conversion rate was significantly lower in the HALC group (4.7% vs. 28%, P=0.03) while surgical costs ($1706.83±203.70 vs. $1304.93±305.67, P=0.038) and total costs ($2427.18±254.27 vs. $2044.03±215.22, P=0.021) were significantly higher in HALC group.

Conclusions:

HALC is associated with increased surgical and total hospital costs, and decreased rate of conversion. Although it is more expensive, HALC may be helpful by providing a step between LAC and open surgery before considering conversion.
The Risk of Failure With HLA Mismatch and Recipient Age in First Pediatric (<18 years) Kidney Transplants
Authors: Williams Robert C. , West Lori J. , Opelz Gerhard
Published: June 2018

Background

Even in the modern era of kidney transplantation with improved surgical techniques, immunosuppression, and clinical care, HLA matching has been shown to be important in allograft survival in adults who receive an organ from either a deceased or living donor. We now explore the impact of genetic matching in pediatric first-kidney transplants.

Methods

Using the United Network for Organ Sharing data, we identified 18 602 first pediatric (<18 years) kidney transplants between October 1, 1987, and December 31, 2016. Recipients were classified by number of HLA mismatches and donor origin. Cox proportional hazard analyses, adjusting for recipient and donor transplant covariates, were performed to study the impact of HLA on kidney allograft survival.

Results

For the fully adjusted Cox model there was a 30% increase in the hazard of allograft failure for 1 HLA mismatch, when compared with 0 mismatched recipients, and a 92% increase in risk for 6 mismatches. Although pediatric allografts from living donors survive as long or longer than those from deceased persons, they have a higher hazard of failure as a function of HLA mismatch. Kidney allografts from deceased donors HLA mismatched 0 to 3 were found to survive as long as organs from living donors HLA mismatched 4 to 6. In the full Cox model, there was a strong, linear effect on the hazard of allograft failure with quartile of age such that the youngest patients at age of transplant had the longest surviving grafts.

Conclusions

HLA plays an important role in the survival of first pediatric kidney transplants. The better the match, and the earlier the transplant is performed in the child’s life, the lower is the risk that the organ will fail.