bluuebunny/crossref_metadata_2025 huggingface dataset:
The Utilization of Vital Signs During Physical Therapy Evaluation and Intervention After Elective Total Joint Replacement: A Mixed-Methods Pilot Study
Authors: Crick James P. , Smith Nancy
Published: March 2020

Background:

Previous literature in physical therapy has suggested that vital signs (VS) are not used as often as is recommended in clinical practice. However, this finding has not been established in the immediate postorthopedic surgery population, and physical therapy practitioners' views toward VS assessment in this population have not been previously examined. Therefore, the purpose of the current study was to (1) determine how often VS are measured via chart review, (2) describe attitudes, inclinations, and factors that may influence VS measurement by physical therapist practitioners, and (3) provide an explanation for the use or nonuse of VS in an immediate postorthopedic surgical population.

Methods:

This was a mixed-methods study with 2 phases. Phase 1 (quantitative) involved a retrospective chart review of 50 patients treated after total joint arthroplasty. Phase 2 (qualitative) involved interviewing 2 physical therapists and 1 physical therapist assistant who had treated patients in phase 1 to provide an explanation for phase 1 data. Quantitative analysis was performed on phase 1 data, and qualitative analyses were performed on phase 2 data. These data were subsequently corroborated.

Results:

Vital signs were documented on only 29 occasions over 134 therapy sessions. No correlation was found between comorbidities and VS assessment. Five major themes were induced from the qualitative data.

Discussion:

The results of this study suggest that physical therapy practitioners may practice in a manner that is inconsistent with their beliefs with respect to the assessment of VS for patients following total joint arthroplasty. Multiple explanatory mechanisms for VS utilization are suggested by physical therapy clinicians.
An exploratory descriptive study of compassion fatigue and compassion satisfaction: Examining potential risk and protective factors in advanced nurse practitioners
Authors: Glover-Stief Maggie , Jannen Sophie , Cohn Tanya
Published: March 2020

Background:

Larger patient caseloads and increased workplace responsibility for nurse practitioners (NPs) may exacerbate factors leading to compassion fatigue (CF).

Purpose:

The purpose of this study is to analyze the rate of burnout in practicing NPs by looking at contributing factors that play a role in CF and compassion satisfaction (CS).

Methods:

A NP social media platform was used to distribute a survey to a convenience sample of 208 NPs. Data included the Professional Quality of Life Scale V (ProQOL V) tool, demographic data, and protective factor questions. The data were dissected for CF and protective factors of CS.

Results:

The relationship of mindfulness practices and levels of CS was statistically significant. The relationship between support from family, coworkers, and administration and levels of CS was also found statistically significant. A large association was found between the correlation of burnout and support from coworkers.

Implications for practice:

Findings showed an average to high level of CS with a low-to-average burnout rate among the NPs surveyed. There was a direct impact between the amount of support participants received from individual support systems and their level of CS. These findings could be beneficial for new NP graduates in establishing a sense of community while reducing the risk for burnout.
Treatment Options for Thrombocytopenia in Patients With Chronic Liver Disease Undergoing a Scheduled Procedure
Authors: Saab Sammy , Bernstein David , Hassanein Tarek , Kugelmas Marcelo , Kwo Paul
Published: March 2020

Thrombocytopenia is a consequence of portal hypertension and is the most common hematological manifestation of chronic liver disease (CLD) (ie, cirrhosis). Data indicates the rates of CLD are increasing and, as a result, so will the incidence of this complication. Although bleeding risks are only relevant when elective procedures are performed, this is a frequent concern as these procedures are commonly part of the spectrum of care for patients with cirrhosis. As such, thrombocytopenia remains a pertinent issue. Fortunately, we now have effective and accurate treatment modalities to raise platelet counts before scheduled procedures, known as thrombopoietin receptor agonists. Two drugs in this therapeutic class (avatrombopag and lusutrombopag) are now approved for the treatment of thrombocytopenia in adults with CLD undergoing a procedure and have revolutionized how this is managed. Although there is progress in the field, peer-reviewed literature and expert guidance are lacking. Recognizing these unmet needs, a group of expert hepatologists comprised this review, which summarizes the most current and relevant peer-reviewed literature on thrombocytopenia in CLD and provides clinical expertise on this timely topic.
The effect of icariin for infertile women with thin endometrium
Authors: Du Juan , Lu Hua , Yu Xujun , Dong Liang , Mi Ling , Wang Jinpeng , Zheng Xia , Feng Kai
Published: March 2020

Background:

Thin endometrium, defined as <7 mm of the endometrial thickness around ovulation period, had been identified as a negative factor on pregnancy rate of infertile women. It was considered to be the toughest part in treatment of infertility, because there was a lack of significant effect, although many drugs had been already used. Icariin was one of the major bioactive pharmaceutical constituent extracted from the Chinese herb “Ying Yang Huo,” in the genus of Epimedium, and some randomized controlled trials reported its application for thin endometrium. There is no systematic review focusing on the effective of icariin in treating infertile women with thin endometrium, so our review aims to explore it.

Methods:

The bibliographic database and electronic library will be systematically searched online, such as MEDLINE, EMBASE, Web of Science, Clinicaltrails.org., China National Knowledge Infrastructure Database (CNKI), Wan fang Database, China Biology Medicine Database (CBM), VIP Science Technology Periodical Database, and Cochrane Library. And the reference listed for potential literatures of included studies will be scanned additionally. Related randomized controlled trials (RCTs) will be collected and selected before January 4, 2020. Trials will be screened by independent reviewers, and the literature will be search in English or Chinese, with the search terms as “Icariin,” “Epimedium,” “infertile women,” “female infertility,” “endometrium,” “pregnancy rate.” The software for Systematic review and Meta-analysis is RevMan 5.3. The protocol and the systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement.

Result and conclusion:

The efficacy of icariin to treat thin endometrium will be evaluated, and the conclusion will be published to help clinicians determine treatment strategy for infertile women with thin endometirum by providing medical evidence.

Registration information:

PROSPERO CRD42019148977.
Drug-eluting beads transarterial chemoembolization by CalliSpheres is effective and well tolerated in treating intrahepatic cholangiocarcinoma patients
Authors: Luo Jun , Zheng Jiaping , Shi Changsheng , Fang Jian , Peng Zhiyi , Huang Jing , Sun Junhui , Zhou Guanhui , Li Tiefeng , Zhu Dedong , Xu Huanhai , Hou Qinming , Ying Shihong , Sun Zhichao , Du Haijun , Xie Xiaoxi , Cao Guohong , Ji Wenbin , Han Jun , Gu Wenjiang , Guo Xiaohua , Shao Guoliang , Yu Zhihai , Zhou Jian , Yu Wenqiang , Zhang Xin , Li Ling , Hu Hongjie , Hu Tingyang , Wu Xia , Chen Yutang , Ji Jiansong , Hu Wenhao
Published: March 2020

This study aimed to investigate the efficacy and safety of drug-eluting beads (DEB) transarterial chemoembolization (TACE) treatment in Chinese intrahepatic cholangiocarcinoma (ICC) patients.

37 ICC patients underwent DEB-TACE treatment in CTILC study (registered on clinicaltrials.gov with registry No. NCT03317483) were included in this present study. Treatment response was assessed according to modified Response Evaluation Criteria in Solid Tumors (mRECIST). Overall survival (OS) was calculated from the time of DEB-TACE operation until the date of death from any causes. Liver function change and adverse events (AEs) were recorded during and after DEB-TACE operation.

3 (8.1%) patients achieved complete response (CR) and 22 (59.5%) patients achieved partial response (PR), with objective response rate (ORR) of 67.6%. After DEB-TACE treatment, mean OS was 376 days (95%CI: 341–412 days). Multivariate logistic regression analysis revealed that Bilobar disease (P = .040, OR: 0.105, 95% CI: 0.012–0.898) and portal vein invasion (P = .038, OR: 0.104, 95% CI: 0.012–0.881) could independently predict less possibility of ORR. Patients with ALB abnormal, TP abnormal, ALT abnormal and AST abnormal were increased at 1-week post DEB-TACE treatment (P = .034, P = .001, P < .001, P = .006, respectively), while returned to the levels at baseline after 1 to 3 months (all P > .050). Besides, most of the AEs were mild including pain, fever, vomiting, and nausea in this study.

DEB-TACE was effective and well tolerated in treating ICC patients, and bilobar disease as well as portal vein invasion were independently correlated with less probability of ORR achievement.
Development and validation of a driving simulator for evaluating the residual effects of drugs on driving performance – sensitivity analysis using zopiclone as a positive control
Authors: Iwata Mari , Iwamoto Kunihiro , Kambe Daiji , Tachibana Naoki , Ando Masahiko , Ozaki Norio
Published: March 2020

Introduction:

Drugs acting on the central nervous system (CNS), especially hypnotics, can impair driving. The US Food and Drug Administration started requiring pharmaceutical companies to evaluate the residual influence of CNS agents on driving performance to review their recommended doses. Although it is important for physicians to discuss automobile driving while on medication with patients to promote traffic safety, the package inserts of most CNS agents in Japan uniformly prohibit patients from driving. Although more evidence-based information regarding the effects of drugs on driving performance is needed, the current evaluation methods for driving performance abroad cannot be applied directly to Japanese drivers because of differences in traffic environments, laws, and constitutions. Therefore, we plan to establish a new driving simulator (DS) that would enable the next-day residual effects of drugs on driving performance to be examined.

Methods:

In this double-blind, randomized, placebo-controlled, crossover trial, we plan to recruit 26 healthy Japanese males aged 21 to 64 years through advertisements. During the test periods, which will take place twice every other week, the participants will undergo a DS evaluation in the hospital for 2 days/1 night after the first and last doses of the study drug following 8 days of administration. The participants in the study drug group will take zopiclone 7.5 mg at bedtime on the first and eighth days in the hospital, and placebo on the other days. The DS evaluation consists of road tracking, car following, and harsh braking tests. The primary outcome is the standard deviation of lateral position (SDLP), which is a gold standard evaluation item, in the 60-min road-tracking test. The exploratory outcomes are other evaluation items in the DS tests, in the Karolinska Sleepiness Scale sleep questionnaire, and the Profile of Mood States Second Edition rating scale. The estimated difference in the SDLP between the zopiclone and placebo groups will then be calculated.

Trial registration:

This study was registered at ClinicalTrials.gov NCT 04108351, on September 30, 2019. Ethics approval was obtained from the Ethics Committee at Hakata Clinic and the Nagoya University Medical School Hospital Bioethics Review Committee.
The association between the socioeconomic status and body pain
Authors: Yu Tong , Wei Zhen , Xu Tan , Gamber Michelle , Han Jingnan , Jiang Yan , Li Jian , Yang Daihe , Sun Wenjie
Published: March 2020

Pain is a significant burden among different communities, but little is known regarding the epidemiology of pain, particularly with respect to socioeconomic status (SES).

The aim of the study was to estimate the prevalence of body pain and to identify risk factors of pain in middle-aged and older Chinese.

The data were extracted from the 2008 Chinese Suboptimal Health Study that consisted of 18,316 Chinese subjects aged 18 to 65 years. Information on SES including occupation and education levels and body pain were collected. A Likert scale was used to evaluate reported body pain. We used the multiple logistic regression model to examine the association between SES and body pain.

Overall, 65.34% reported body pain (male: 60.93%; female: 69.73%). After adjustments based on sex, age, education, area of residence, marital status, smoking, drinking and health status, the results showed that students (odds ratio [OR] = 1.51; 95% confidence interval [CI]: 1.32–1.74) and professionals (OR = 1.22; 95% CI: 1.08–1.37) had significant high risk for body pain, compared with civil servants and farmers (OR = 0.64; 95% CI: 0.55–0.75) who significantly lower risk of body pain. The study demonstrates there is a significant negative association between education and reported body pain.

The results indicated an association between SES and body pain within the Chinese community. Body pain varied among different Chinese occupation-related population and people with higher education level are less like to have body pain.
Treatment of herpes labialis by photodynamic therapy
Authors: La Selva Andreia , Negreiros Renata Matalon , Bezerra Daniela Teixeira , Rosa Ellen Perin , Pavesi Vanessa Christina Santos , Navarro Ricardo Scarparo , Bello-Silva Marina Stella , Ramalho Karen Müller , Aranha Ana Cecília Corrêa , Braz-Silva Paulo Henrique , Fernandes Kristianne Porta Santos , Bussadori Sandra Kalil , Horliana Anna Carolina Ratto Tempestini
Published: March 2020

Background:

Lesions of herpes labialis are caused by the herpes simplex virus type 1 and cause pain and aesthetic compromise. It is characterized by the formation of small vesicles that coalesce and rupture forming extremely painful ulcers, that evolve to crusts, dry desquamations until their complete remission. Currently the treatment of these lesions is done with acyclovir. Although it diminishes the symptomatology, it causes viral resistance and does not prevent the recurrence of the lesions. It is known that antimicrobial photodynamic therapy (aPDT) has numerous advantages, among them: the reduction of the time of remission, and does not cause resistance. This protocol will determine the effectiveness of PDT in lesions of herpes labialis.

Materials and methods:

A total of 30 patients with herpes labialis in the prodromal stage of vesicles, ulcers, and crusts will be selected to participate in the study and randomized into 2 groups: G1 control and G2 experimental. After signing Research Ethics Committee and TA, patients in group G1 will undergo the standard gold treatment for herpes labialis with acyclovir and simulated PDT treatment. Patients in the experimental G2 group will be treated simulating the gold standard treatment of herpes labialis (placebo) and PDT. In all patients, saliva samples will be collected for analysis of cytokines, and will be performed exfoliative cytology in the lesions. The pain will be assessed through a pain scale and a questionnaire of quality of life related to oral health (OHIP-14) will be given to them. Patients will continue to be followed up after 7 days, 1 month, 3 months, and 6 months; if there is a recurrence of the lesion, they will contact the researchers.

Clinical registration: clinicaltrials.gov - NCT 04037475. Registered on July 2019.
A tablet computer-based cognitive training program for young children with cognitive impairment
Authors: Ko Eun Jae , Sung In Young , Yuk Jin Sook , Jang Dae-Hyun , Yun Gijeong
Published: March 2020

Background:

Evidences suggest that cognitive training facilitates cognitive function, and most studies have targeted adults and children older than 4 years of age. This study investigated the applicability and efficacy of a tablet computer-based cognitive training program for young children with cognitive impairment of cognitive age between 18 and 36 months.

Methods:

Thirty-eight children were randomly assigned to the intervention (n = 20, administered a tablet computer-based cognitive training program, for 30 minutes per session and twice a week over a period of 12 weeks) and control (n = 18, received the traditional rehabilitation program) groups. Mental scale of Bayley Scales of Infant Development II (BSID II), Pediatric Evaluation of Disability Inventory (PEDI), interest/persistence domain of the Laboratory Temperament Assessment Battery (LAP-TAB), Early Childhood Behavior Questionnaire (ECBQ), and Goal Attainment Scale (GAS) were evaluated before and after 12 weeks of therapeutic intervention.

Results:

The tablet computer-based cognitive training program was applicable to all children in the intervention group without any problems including irritable behavior or obsession about a tablet computer. After 12 weeks, Mental scale of BSID II, PEDI (social function), LAB-TAB (observation), LAB-TAB (manipulation), and GAS showed statistically significant improvements in the intervention group, compared with the values in the control group (P < .05). After adjusting for the pre-treatment measurements and cognitive age, the tablet computer-based cognitive training program had significant effect on the post-treatment measurements of Mental scale of BSID II, PEDI (social function), LAB-TAB (observation), LAB-TAB (manipulation), and GAS (P 
< .05). There was no association between the change in the scores and the severity of cognitive delay in the most of the measurements, however, the self-care domain of PEDI showed a negative association with the severity of the cognitive delay (r = −0.462, P 
= .04).

Conclusions:

Application of a tablet computer-based cognitive training program was feasible and showed improvements in cognitive function in young children with cognitive impairment of cognitive age between 18 and 36 months, regardless of the severity of the cognitive delay. But severe cognitive delay can be related with less improvement in the self-care domain of PEDI.

Trial registration number:
https://cris.nih.go.kr (KCT0002889)
Comparison of MRI and MRA for the diagnosis of rotator cuff tears
Authors: Liu Fanxiao , Cheng Xiangyun , Dong Jinlei , Zhou Dongsheng , Han Shumei , Yang Yongliang
Published: March 2020

Background:

Numerous quantitatively based studies measuring the accuracy of MRI and MRA for the diagnosis of rotator cuff tears remain inconclusive. In order to compare the accuracy of MRI with MRA in detection of rotator cuff tears a meta-analysis was performed systematically.

Methods:

PubMed/Medline and Embase were utilized to retrieve articles comparing the diagnostic performance of MRI and MRA for use in detecting rotator cuff tears. After screening and diluting out the articles that met inclusion criteria to be used for statistical analysis the pooled evaluation indexes including sensitivity and specificity as well as hierarchical summary receiver operating characteristic (HSROC) curves with 95% confidence interval (CI) were calculated.

Results:

Screening determined that 12 studies involving a total of 1030 patients and 1032 shoulders were deemed viable for inclusion in the meta-analysis. The results of the analysis showed that MRA has a higher sensitivity and specificity than MRI for the detection of any tear; similar results were observed in the detection of full-thickness tears. However, for the detection of partial-thickness tear, MRI has similar performance with MRA.

Conclusion:

MRI is recommended to be a first-choice imaging modality for the detection of rotator cuff tears. Although MRA have a higher sensitivity and specificity, it cannot replace MRI after the comprehensive consideration of accuracy and practicality.
The effect of pay for performance on risk incidence of hip fracture in type 2 diabetic patients: a nationwide population-based cohort study
Authors: Lee Yung-Heng , Kung Pei-Tseng , Kuo Wei-Yin , Kao Su-Ling , Tsai Wen-Chen
Published: March 2020

Objectives:

Diabetes mellitus (DM) increases the risk of hip fracture. The literature rarely discusses the importance of pay-for-performance (P4P) programs for the incidence of hip fractures in patients with type 2 DM (T2DM). This study aimed to examine the impact of the P4P program on hip fracture risk in patients with T2DM.

Methods:

This retrospective cohort study focused on data from T2DM patients aged 45 and older between 2001 and 2012. We continued to track these data until 2013. The data were collected from the National Health Insurance Research Database in Taiwan. To minimize selection bias, T2DM patients were divided into P4P enrollees and non-enrollees. Propensity score matching by greedy matching technique (1:1 ratio) was used to include 252,266 participants. A Cox proportional hazard model was performed to examine the impact of the P4P program on hip fracture risk. We used the bootstrap method to perform sensitivity analysis by random sampling with replacement.

Results:

Our results showed that the risk of hip fracture in P4P enrollees was 0.92 times that of non-enrollees. (hazards ratio [HR] = 0.92; 95% confidence interval [CI]: 0.85–0.99). P4P enrollees who received regular treatment had lower risk in the first 4 years (HR = 0.90; 95%CI: 0.84–0.96) but no statistically significant difference after 4-year enrollment (HR = 0.99; 95%CI: 0.93–1.06). There was no statistically significant difference in the effect of hip fractures between P4P non-enrollees and P4P enrollees with irregular treatment (HR = 0.94, 95%CI: 0.87–1.03). Through sensitivity analysis, the results also showed P4P enrollees had a lower risk of hip fracture compared to P4P non-enrollees (mean HR = 0.919; 95% CI: 0.912–0.926). Stratified analysis showed that patients without DM complications (DCSI = 0) who enrolled in P4P had lower risks of hip fractures than the non-enrollees (HR = 0.90; 95% CI: 0.82–0.98).

Conclusion:

T2DM patients enrolled in P4P program can reduce the risks of hip fracture incidence. Early inclusion of patients without DM complications in the P4P program can effectively reduce hip fractures.
Linking Hospital Consumer Assessment of Healthcare Providers and Systems to Swanson Caring Theory
Authors: Ray Joel , Stargardt Deb
Published: March 2020

Given the implications of value-based reimbursement, nurse leaders must thoughtfully assimilate an extraordinary amount of quality, safety, and patient experience data to effectively drive behavioral change. This article proposes Swanson Caring Theory (SCT) as context for Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) improvement strategies. The diagnostic model described herein is not intended to encompass the full scope of nursing care, but rather to help nurse leaders interpret HCAHPS results in terms of the SCT attributes of compassion, competence, and patient well-being.
Predictive Hiring to Maintain Excellence in Patient Care
Authors: Potts Jessica , Brouder Pamela , Helm Sarah , Leach Kathy
Published: March 2020

OBJECTIVE

The purpose of this research study was to design and pilot a predictive hiring model to improve the hospital's operational vacancy rate and reduce premium pay expenses.

BACKGROUND

According to Purcell, the average nursing turnover rate is at 18.2%, and the new-graduate nurse turnover rate is higher at 35%. With turnover rates high for nurses, the importance of recruiting, hiring, and training the new nurse needs to be completed as soon as possible. Often, a nurse manager cannot interview and hire into a position until it is vacated. Premium pay including overtime is typically used to cover the time from the position being vacated until the next nurse is trained.

METHODS

This was a pretest/posttest design with a predictive hiring model intervention. The intervention was a 3-pronged approach that consisted of a strategy for recruiting graduate nurses, hiring to operation vacancy rates, and utilizing a predictive hiring method. Operational vacancy is a calculation to determine if a department has the right amount of hired labor available to work scheduled shifts without having to routinely rely on agency nurses and/or premium pay. These are people ready to work.

RESULTS

The hospital significantly decreased premium pay and eliminated the use of agency nurses by implementing a predictive hiring model tailored to the department's operational vacancy.

CONCLUSIONS

A predictive model is a useful vehicle in assisting nurse managers to plan and replace positions more quickly. The model needs continued testing to support application beyond the testing site.
Nonclinical Transition-to-Practice Courses
Authors: Hampton Kimberly B. , Smeltzer Suzanne C. , Ross Jennifer Gunberg
Published: March 2020

Background

Both clinical and nonclinical transition-to-practice courses have been offered to facilitate the transition from student to novice nurse.

Problem

Nonclinical transition-to-practice courses are less widely discussed in the literature; thus, their content and effectiveness have not been examined.

Approach

Academic institutions with baccalaureate nursing programs were surveyed to determine if they offered a nonclinical transition-to-practice course and to identify the associated content.

Outcome

Of 19 responding institutions, 15 reported having a nonclinical transition-to-practice course. Eighty-seven percent of the courses address ethical dilemmas, and 80% include delegation, interview preparation, stress management, and work/life balance.

Conclusion

Although schools of nursing are urged to address students' transition to practice, there is considerable variation in the nonclinical topics addressed. Research is needed to provide guidance to maximize the impact of these nonclinical transition-to-practice courses on new nurses' transition experience.
Short- and Long-Term Outcome in Critically Ill Children After Acute Interhospital Transport to a PICU in Sweden*
Authors: Hannegård Hamrin Tova , Radell Peter J. , Fläring Urban , Berner Jonas , Eksborg Staffan
Published: March 2020

Objectives:

Data on long-term survival in children after interhospital transport to a PICU are scarce. The main objective was to investigate short- and long-term outcome after acute interhospital transport to a PICU for different age and risk stratification groups. Secondary aims were to investigate whether neonatal patients would have higher mortality and be more resource demanding than older patients.

Design:

Single-center, retrospective cohort study.

Setting:

Specialist pediatric transport team and a tertiary PICU in Sweden.

Patients:

Critically ill children 0–18 years old, acutely transported by a specialist pediatric transport team to a PICU in Sweden (January 1, 2008, to December 31, 2016).

Interventions:

None.

Measurements and Main Results:

A total of 401 acute transport events were included. Overall mortality was 15.7% with a median follow-up time of 3.4 years (range, 0–10.2 yr). Median predicted death rate was 4.9%. There was no mortality during transport. Cumulative mortality almost doubled within the first 6 months after PICU discharge, from 6.5% to 12.0%. Of late deaths, 66.7% occurred in the risk stratification group predicted death rate 0–10%, and 95% suffered from severe comorbidity. There were no deaths after PICU discharge in the neonatal group. Cumulative mortality in multiple transported patients was 36.4%.

Conclusions:

This is the first report on long-term survival after acute pediatric interhospital transport. For the entire cohort, there was significant mortality after PICU discharge, especially in multiple transported patients. In contrast, survival in the subgroup of neonatal patients was high after PICU discharge.
Assessing Frequency of Respiratory Complications in Children Undergoing Adenotonsillectomy
Authors: Baker Alyson K. , Carroll Christopher L. , Grindle Christopher R. , Sala Kathleen A. , Cowl Allison S.
Published: March 2020

Objectives:

To determine the frequency of respiratory complications in children admitted to the ICU after adenotonsillectomy and to identify factors associated with the risk of respiratory complications in this cohort.

Design:

Retrospective observational study.

Setting:

PICU.

Patient Population:

All children admitted to the ICU following adenotonsillectomy from September 30, 2009, to March 30, 2014.

Measurements and Main Results:

Of the 165 children included in the study, 150 (91%) received no respiratory support other than oxygen in the first 2 hours postoperatively. Of the 15 who required support following 2 hours, 14 required nasopharyngeal airways, one required invasive mechanical ventilation, and seven required supplemental oxygen for more than 2 hours. None of the children who received respiratory support for less than 2 hours required subsequent ICU level care. When comparing those who received support for more than 2 hours to those who did not, there were no differences in clinical characteristics except that those who received support were more likely to have chronic neurologic disease including autism, seizures, or cerebral palsy (odds ratio, 3.7; 95% CI, 1.1–11.9; p = 0.04). Intraoperative events were not predictive of need for respiratory support. Most of the children (n = 117/165 or 71%) had sleep studies preoperatively. Abnormal sleep studies (apnea-hypopnea index > 20 [n = 68] or oxygen saturation nadir < 80% [n = 48]) were not associated with need for postoperative respiratory support.

Conclusions:

Most children admitted to the ICU following adenotonsillectomy in this population required no support after 2 hours. Preoperative factors such as obesity and abnormal sleep studies were not predictive of need for postoperative respiratory support. Need for respiratory support at 2 hours may be a useful criterion for need for ICU level care in this population.
Lung-Protective Mechanical Ventilation Strategies in Pediatric Acute Respiratory Distress Syndrome
Authors: Wong Judith Ju Ming , Lee Siew Wah , Tan Herng Lee , Ma Yi-Jyun , Sultana Rehana , Mok Yee Hui , Lee Jan Hau
Published: March 2020

Objectives:

Reduced morbidity and mortality associated with lung-protective mechanical ventilation is not proven in pediatric acute respiratory distress syndrome. This study aims to determine if a lung-protective mechanical ventilation protocol in pediatric acute respiratory distress syndrome is associated with improved clinical outcomes.

Design:

This pilot study over April 2016 to September 2019 adopts a before-and-after comparison design of a lung-protective mechanical ventilation protocol. All admissions to the PICU were screened daily for fulfillment of the Pediatric Acute Lung Injury Consensus Conference criteria and included.

Setting:

Multidisciplinary PICU.

Patients:

Patients with pediatric acute respiratory distress syndrome.

Interventions:

Lung-protective mechanical ventilation protocol with elements on peak pressures, tidal volumes, end-expiratory pressure to Fio
2 combinations, permissive hypercapnia, and permissive hypoxemia.

Measurements and Main Results:

Ventilator and blood gas data were collected for the first 7 days of pediatric acute respiratory distress syndrome and compared between the protocol (n = 63) and nonprotocol groups (n = 69). After implementation of the protocol, median tidal volume (6.4 mL/kg [5.4–7.8 mL/kg] vs 6.0 mL/kg [4.8–7.3 mL/kg]; p = 0.005), Pao
2 (78.1 mm Hg [67.0–94.6 mm Hg] vs 74.5 mm Hg [59.2–91.1 mm Hg]; p = 0.001), and oxygen saturation (97% [95–99%] vs 96% [94–98%]; p = 0.007) were lower, and end-expiratory pressure (8 cm H2O [7–9 cm H2O] vs 8 cm H2O [8–10 cm H2O]; p = 0.002] and Paco
2 (44.9 mm Hg [38.8–53.1 mm Hg] vs 46.4 mm Hg [39.4–56.7 mm Hg]; p = 0.033) were higher, in keeping with lung protective measures. There was no difference in mortality (10/63 [15.9%] vs 18/69 [26.1%]; p = 0.152), ventilator-free days (16.0 [2.0–23.0] vs 19.0 [0.0–23.0]; p = 0.697), and PICU-free days (13.0 [0.0–21.0] vs 16.0 [0.0–22.0]; p = 0.233) between the protocol and nonprotocol groups. After adjusting for severity of illness, organ dysfunction and oxygenation index, the lung-protective mechanical ventilation protocol was associated with decreased mortality (adjusted hazard ratio, 0.37; 95% CI, 0.16–0.88).

Conclusions:

In pediatric acute respiratory distress syndrome, a lung-protective mechanical ventilation protocol improved adherence to lung-protective mechanical ventilation strategies and potentially mortality.
Fracture-Associated Bruising and Soft Tissue Swelling in Young Children With Skull Fractures
Authors: Metz James B. , Otjen Jeffrey P. , Perez Francisco A. , Done Stephen L. , Brown Emily C. B. , Wiester Rebecca T. , Jenny Carole , Ganti Sheila , Feldman Kenneth W.
Published: March 2020

Objectives

The aim of this study was to determine how reliable scalp bruising and soft tissue swelling/cephalohematomas (STS) are for underlying young child skull fractures.

Methods

This was a retrospective clinical and imaging review from 2011 to 2012 of children younger than 4 years with skull fractures from 2 tertiary care hospitals. Imaging was reread by 3 pediatric radiologists. Descriptive statistics were utilized. The retrospective review had institutional review board approval.

Results

We identified 218 subjects for review: 210 unintentional and 8 abusive. One hundred forty-three had available 3-dimensional computed tomography reconstructions: 136 unintentional and 7 abused. Two-thirds were younger than 1 year. Twelve subjects had visible scalp bruising, but 73% had clinically and 93% radiologically apparent fracture-associated STS. There was no difference in clinical STS with simple (79%) versus complex (68%) fractures. Nor was there difference in subjects with fractures from minor (77%) versus major (70%) trauma. Unintentionally injured infants did not differ from abused for detectable STS (74% vs 50%). Parietal and frontal bones most frequently sustained fractures and most consistently had associated STS.

Conclusions

Clinically apparent STS is present in approximately three-fourths of children with skull fractures. It may not be important to consistently identify skull fractures in unintentionally injured children. Point-of-care ultrasound may be adequate. For abuse concerns, it is important to identify skull fractures as evidence of cranial impacts and intracranial hemorrhages. The most sensitive, widely available imaging technique, cranial computed tomography scan with 3-dimensional skull reconstruction, should be utilized. Scalp bruising is present in a minority of young children with skull fractures. Its absence does not exclude cranial impact injury.
Case Studies of Challenges in Emergency Care for Children With Autism Spectrum Disorder
Authors: Gray James M. , Roback Mark G.
Published: March 2020

Autism spectrum disorder (ASD) affects more than 1% of children in the United States, with the rate of new diagnoses climbing significantly in the last 15 years. Emergent conditions and subsequent visits to the emergency department (ED) can be particularly challenging for children with ASD, most of whom also have comorbidities in addition to their deficits in social communication and interaction. In the emergency setting, these conditions can cause a range of behaviors that result in challenges for health care providers and may result in suboptimal experiences for children with ASD and their families. We present the ED course of 3 children with ASD to illustrate these challenges, emphasize successful strategies, and highlight opportunities for improvement.
Practical Classification of Upper Lateral Cartilage in Middle Vault Asymmetry
Authors: Hafezi Farhad , Naghipour Rouhollah , Naghibzadeh Bijan , Ashtiani Abbas Kazemi , Forghani Siamak Farokh
Published: March 2020

Background:

Middle vault asymmetry is a common reason for retained postoperative deviations. Although minor deformities can be camouflaged with cartilage, soft-tissue materials, or injectable fillers, comprehensive observation of upper lateral cartilage and subsequent topographic classification in major anatomical anomalies will help surgeons better plan their procedures to obtain better symmetry.

Methods:

Photographs of 71 randomly selected primary open rhinoplasty patients were analyzed for anatomical presentation of their upper lateral cartilage. Photographs were taken before and after separation of upper lateral cartilage from the septum. Upper lateral cartilage was classified from class I to class V according to the width of the transverse subunits and curvature of the vertical subunits.

Results:

The authors observed 142 upper lateral cartilages of 71 rhinoplasty patients. Upper lateral cartilage was classified as follows: class I, 53 cases; class II, three cases; class III, 40 cases; class IV, 36 cases; and class V, 10 cases.

Conclusions:

Upper lateral cartilage asymmetry is a common occurrence in rhinoplasty, and the upper lateral cartilage itself may be the source of nasal deviation. The middle vault requires special attention, and establishment of a classification system could enable surgeons to devise an effective plan for correction and prevention of retained postoperative nasal deviation.
The Effect of Surgical Video on Resident Performance of Carpal Tunnel Release: A Cadaveric Simulation-Based, Prospective, Randomized, Blinded Pilot Study
Authors: Yee Andrew , Padovano William M. , Rowe Amanda G. , Hill Elspeth J. R. , Fox Ida K. , Moore Amy M. , Coert J. Henk , Mackinnon Susan E.
Published: March 2020

Background:

Surgical videos are increasingly common, although their role in residency curricula remains unclear. The aim of this study was to evaluate the impact of an educational surgical video on resident performance of an open carpal tunnel release through an Objective Structured Assessment of Technical Skills and serial questionnaires.

Methods:

Twenty-two residents representing six postgraduate years were randomized to receive text-based materials with or without a surgical video before performing a carpal tunnel release on human cadavers. Procedures were video recorded, anonymized, and independently evaluated by three hand surgeons using the Objective Structured Assessment of Technical Skills global rating scale, a procedure-specific technical rating scale, a record of operative errors, and pass/fail designation. Residents completed questionnaires before and after the procedure to track confidence in their technical skills.

Results:

Residents in their first and second postgraduate years (n = 10) who watched the surgical video committed fewer operative errors (median, 4 versus 1.3; p = 0.043) and were more confident in their abilities following the procedure (median, 75 versus 32; p = 0.043) than those receiving text resources alone. There were no significant differences in Objective Structured Assessment of Technical Skills performance or questionnaire responses among more senior residents (n = 12). The technical rating scale was internally consistent (Cronbach α = 0.95; 95 percent CI, 0.91 to 0.98), reliable (intraclass correlation coefficient, 0.73; 95 percent CI, 0.40 to 0.88), and correlated with surgical experience (Spearman ρ = 0.57; p = 0.006).

Conclusion:

Watching an educational surgical video to prepare for a cadaveric procedure significantly reduced operative errors and improved confidence among junior trainees performing a carpal tunnel release.
Dual-Plane versus Prepectoral Breast Reconstruction in High–Body Mass Index Patients
Authors: Gabriel Allen , Sigalove Steven , Storm-Dickerson Toni L. , Sigalove Noemi M. , Pope Nicole , Rice Jami , Maxwell G. Patrick
Published: March 2020

Background:

Breast reconstruction in patients with a high body mass index (BMI) (≥30 kg/m2) is technically challenging and is associated with increased postoperative complications. The optimal reconstructive approach for these patients remains to be determined. This study compared outcomes of prepectoral and dual-plane reconstruction in high-BMI patients to determine whether there was an association between postoperative complications and the plane of reconstruction.

Methods:

High-BMI patients who underwent immediate dual-plane or prepectoral expander/implant reconstruction were included in this retrospective study. Patients were stratified by reconstructive approach (dual-plane or prepectoral), and postoperative complications were compared between the groups. Multivariate logistic regression analysis was performed to determine whether the plane of reconstruction was an independent predictor of any complication after adjusting for potential confounding differences in patient variables between the groups.

Results:

Of 133 patients, 65 (128 breasts) underwent dual-plane and 68 (129 breasts) underwent prepectoral reconstruction. Rates of seroma (13.3 percent versus 3.1 percent), surgical-site infection (9.4 percent versus 2.3 percent), capsular contracture (7.0 percent versus 0.8 percent), and any complication (25.8 percent versus 14.7 percent) were significantly higher in patients who had dual-plane versus prepectoral reconstruction (p < 0.05). Multivariate logistic regression identified dual-plane, diabetes, neoadjuvant radiotherapy, and adjuvant chemotherapy as significant, independent predictors of any complication (p < 0.05). Dual-plane reconstruction increased the odds of any complication by 3-fold compared with the prepectoral plane.

Conclusion:

Compared with the dual-plane approach, the prepectoral approach appears to be associated with a lower risk of postoperative complications following immediate expander/implant breast reconstruction and may be a better reconstructive option in high-BMI patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Who, What, Where: Demographics, Severity of Presentation, and Location of Treatment Drive Delivery of Diabetic Limb Reconstructive Services within the National Inpatient Sample
Authors: Fan Kenneth L. , DeLia Derek , Black Cara K. , Zolper Elizabeth , Singh Tanvee , Wirth Peter , Luvisa Kyle , Song David H. , Attinger Christopher E. , Evans Karen K.
Published: March 2020

Background:

Technical advances have been made in reconstructive diabetic limb salvage modalities. It is unknown whether these techniques are widely used. This study seeks to determine the role of patient- and hospital-level characteristics that affect use.

Methods:

Admissions for diabetic lower extremity complications were identified in the 2012 to 2014 National Inpatient Sample using International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes. The study cohort consisted of admitted patients receiving amputations, limb salvage without flap techniques, or advanced limb salvage with flap techniques. Multinomial regression analysis accounting for the complex survey design of the National Inpatient Sample was used to determine the independent contributions of factors expressed as marginal effects.

Results:

The authors’ study cohort represented 155,025 admissions nationally. White non-Hispanic patients had the highest proportion of reconstruction without and with flaps, whereas black patients had the lowest. Multinomial regression models revealed that controlling for nongas gangrene and critical limb ischemia, both of which have a much greater incidence in minorities, the effect of race against receipt of reconstructive modalities was attenuated. Access to urban teaching hospitals was the strongest protective factor against amputation (9 percent reduction; p < 0.01) and predictor of receiving limb salvage without flaps (5 percent increase; p < 0.01) and with flaps (3 percent increase; p < 0.01).

Conclusions:

This study identified multiple patient- and hospital-level factors associated with decreased access to the gamut of reconstructive limb salvage techniques. Disparity reduction will likely require a multifaceted strategy that addresses the severity of disease presentation seen in minorities and delivery system capabilities affecting access and use of reconstructive limb salvage procedures.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Do We Publish What We Present? A Critical Analysis of Abstracts Presented at Three Plastic Surgery Meetings
Authors: Asaad Malke , Rajesh Aashish , Tarabishi Ahmad S. , Sakkal Najeeb , Banuelos Joseph , Vyas Krishna S. , Tran Nho V.
Published: March 2020

Background:

Presentation of research at scientific conferences provides an opportunity for researchers to disseminate their work and gain peer feedback. However, much of the presented work is never published in peer-reviewed journals. The authors analyzed the conversion rate of abstracts presented at three national plastic surgery meetings.

Methods:

Abstracts presented at the American Association of Plastic Surgeons (AAPS), the American Society of Plastic Surgeons (ASPS), and the Plastic Surgery Research Council (PSRC) annual meetings in 2014 and 2015 were identified to analyze the rates of successful conversion into full-text publications. Meeting administrators were contacted to obtain the respective acceptance rates of submitted abstracts.

Results:

A total of 1174 abstracts were analyzed. The overall conversion rate was 65 percent. The AAPS meeting had the highest conversion rate (73 percent), followed by the PSRC (66 percent) and the ASPS (61 percent). Conversely, the AAPS meeting had a lower acceptance rate (28 percent) compared with the ASPS (42 percent) and PSRC (49 percent) meetings. The conversion rate was significantly higher for abstracts from native English-speaking countries, whereas no significant differences were noted between oral and poster presentations. Plastic and Reconstructive Surgery had the highest percentage of published manuscripts (34 percent). Abstracts presented at the PSRC meeting had the highest mean impact factor for the journal of publication. First authors changed in 31 percent and last authors changed in 18 percent of publications. The overall median time to publication from the date of presentation was 13 months.

Conclusions:

Almost two-thirds of abstracts presented at AAPS, ASPS, and PSRC meetings successfully converted into full-text publications. Plastic surgery departments/divisions should follow unpublished work in their institutions to benefit both patients and the scientific community.
Calcified Adrenal Lesions: Pattern Recognition Approach on Computed Tomography With Pathologic Correlation
Authors: Consul Nikita , Venkatesan Aradhana M. , Blair Katherine J. , Morshid Ali , Menias Christine O. , Shaaban Akram M. , Elmohr Mohab M. , Gaballah Ayman H. , Elsayes Khaled M.
Published: March 2020

Incidental adrenal lesions are found in 2% to 10% of the population. The presence and pattern of calcifications, in conjunction with other clinical and imaging features, such as soft tissue attenuation, enhancement, and laterality, can aid in narrowing a differential diagnosis, thereby preventing unnecessary biopsies and avoiding delays in management. Calcified adrenal lesions can be categorized under the clinical and laboratory headings of normal adrenal function, hyperfunctioning adrenal tissue, and adrenal insufficiency. In this review, we provide an algorithmic approach to assessing calcified adrenal nodules with correlative radiologic findings.