bluuebunny/crossref_metadata_2025 huggingface dataset:
Winning strategies for full access to care
Authors: Quinn Winifred V.
Published: March 2019

The Center to Champion Nursing in America and the Future of Nursing: Campaign for Action envision everyone in America can live a healthier life, supported by nurses as essential partners in providing care and promoting health equity and well-being. This column describes the history of partnerships created in support of these efforts and strategies learned through grassroots efforts. The discussion offers an example of how one person's experiences and education led her to positions in support of actions designed to promote healthier life by all and practical strategies everyone can use in support of the goal of promoting care, health equity, and well-being for all Americans.
Sex differences in the prevalence of Helicobacter pylori infection: an individual participant data pooled analysis (StoP Project)
Authors: Ferro Ana , Morais Samantha , Pelucchi Claudio , Dierssen-Sotos Trinidad , Martín Vicente , López-Carrillo Lizbeth , Malekzadeh Reza , Tsugane Shoichiro , Hamada Gerson S. , Hidaka Akihisa , Hernández-Ramírez Raul U. , López-Cervantes Malaquias , Zaridze David , Maximovitch Dmitry , Pourfarzi Farhad , Zhang Zuo-Feng , Yu Guo-Pei , Pakseresht Mohammadreza , Ye Weimin , Plymoth Amelie , Leja Marcis , Gasenko Evita , Derakhshan Mohammad H. , Negri Eva , La Vecchia Carlo , Peleteiro Bárbara , Lunet Nuno
Published: March 2019

Background

Helicobacter pylori (H. pylori) infection is more frequent among men, though the magnitude of the association might be inaccurate due to potential misclassification of lifetime infection and publication bias. Moreover, infection is common, and most studies are cross-sectional. Thus, prevalence ratios (PRs) may be easier to interpret than odds ratios (ORs).

Aim

The aim of this study was to quantify the association between sex and H. pylori infection using controls from 14 studies from the Stomach Cancer Pooling (StoP) Project.

Participants and methods

H. pylori infection was defined based on IgG serum antibody titers or multiplex serology. Participants were also classified as infected if gastric atrophy was present, based on histological examination or serum pepsinogen (PG) levels (PG I≤70 and PG I/II ratio≤3). Summary ORs and PRs, adjusted for age, social class and smoking, and corresponding 95% confidence intervals (CIs), were estimated through random-effects meta-analysis.

Results

Men had significantly higher OR (OR: 1.33, 95% CI: 1.04–1.70) and PR (PR: 1.05, 95% CI: 1.00–1.10) of infection, with stronger associations among hospital-based or older controls. Results were similar when considering the presence of gastric atrophy to define infection status, particularly among participants older than 65 years.

Conclusion

This collaborative pooled-analysis supports an independent effect of sex on the prevalence of H. pylori infection, while minimizing misclassification of lifetime infection status and publication bias.
Update in Electrical Storm Therapy
Authors: Cozma Dragos , Tint Diana , Szegedi Nandor , Sallo Zoltan , Geller Laszlo
Published: March 2019

Background:

Electrical storm (ES) is a major life-threatening event, which announces a possible negative outcome and poor prognosis and poses challenging questions concerning etiology and management.

Data Sources:

A literature search was conducted through MEDLINE and EMBASE (past 30 years until the end of September 2018) using the following search terms: ES, ventricular fibrillation, ventricular tachycardia, ablation, and implantable defibrillator. Clinicaltrials.gov was also consulted for studies that are ongoing or completed. Additional articles were identified through bibliographical citations.

Area of Uncertainty:

There is no homogeneous attitude, and therapeutic strategies vary widely.

Therapeutic Advances:

The aim of this review is to define the concept of ES, to review the incidence and prognostic implications, and to describe the most common strategies of therapeutic advances and trends. The management strategy should be decided after an accurate risk stratification is done in initial evaluation according to hemodynamic tolerability and presence of triggers and comorbidities. General care should be provided in an intensive cardiovascular care unit. The cornerstone of acute medical therapy used in ES is mainly represented by amiodarone and beta-blockers. Deep sedation and mechanical ventilation should provide comfort for treatment administration. First-choice drugs are benzodiazepines and short-acting analgesics. General care may also include thoracic epidural anesthesia to modulate neuroaxial efferents to the heart and to decrease sympathetic hyperactivity. We include a special focus on ablation as a reliable tool to target the mechanism of arrhythmia, finally building an up-to-date standardization.

Conclusions:

ES management needs a complex assessment and interpretation of a critical situation in a life-threatening condition. Optimal implantable cardioverter-defibrillator-reprogramming, antiarrhythmic drug therapy and sedation are in first-line approach. Catheter ablation is the elective therapy and plays a central key role in the treatment of ES if possible in combination with hemodynamic support.
Therapeutic Advances in the Management of Acute Decompensated Heart Failure
Authors: Antohi Elena-Laura , Ambrosy Andrew P. , Collins Sean P. , Ahmed Ali , Iliescu Vlad Anton , Cotter Gad , Pang Peter S. , Butler Javed , Chioncel Ovidiu
Published: March 2019

Background:

Acute decompensated heart failure (ADHF) is the most common presenting phenotype of acute heart failure (AHF). The main goal of this article was to review the contemporary management strategies in these patients and to describe how future clinical trials may address unmet clinical needs.

Areas of Uncertainty:

The current pathophysiologic understanding of AHF is incomplete. The guideline recommendations for the management of ADHF are based only on algorithms provided by expert consensus guided by blood pressure and/or clinical signs of congestion or hypoperfusion. The lack of adequately conducted trials to address the unmet need for evidence therapy in AHF has not yet been surpassed, and at this time, there is no evidence-based strategy for targeted decongestive therapy to improve outcomes. The precise time point for initiation of guideline-directed medical therapies (GDMTs), as respect to moment of decompensation, is also unknown.

Data Sources:

The available data informing current management of patients with ADHF are based on randomized controlled trials, observational studies, and administrative databases.

Therapeutic Advances:

A major step-forward in the management of ADHF patients is recognizing congestion, either clinical or hemodynamic, as a major trigger for heart failure (HF) hospitalization and most important target for therapy. However, a strategy based exclusively on congestion is not sufficient, and at present, comprehensive assessment during hospitalization of cardiac and noncardiovascular substrate with identification of potential therapeutic targets represents “the corner-stone” of ADHF management. In the last years, substantial data have emerged to support the continuation of GDMTs during hospitalization for HF decompensation. Recently, several clinical trials raised hypothesis of “moving to the left” concept that argues for very early implementation of GDMTs as potential strategy to improve outcomes.

Conclusions:

The management of ADHF is still based on expert consensus documents. Further research is required to identify novel therapeutic targets, to establish the precise time point to initiate GDMTs, and to identify patients at risk of recurrent hospitalization.
Therapeutic Advances in the Management of Cardiogenic Shock
Authors: Chioncel Ovidiu , Collins Sean P. , Ambrosy Andrew P. , Pang Peter S. , Radu Razvan I. , Antohi Elena-Laura , Masip Josep , Butler Javed , Iliescu Vlad Anton
Published: March 2019

Background:

Cardiogenic shock (CS) is a life-threatening state of tissue hypoperfusion, associated with a very high risk of mortality, despite intensive monitoring and modern treatment modalities. The present review aimed at describing the therapeutic advances in the management of CS.

Areas of Uncertainty:

Many uncertainties about CS management remain in clinical practice, and these relate to the intensity of invasive monitoring, the type and timing of vasoactive therapies, the risk–benefit ratio of mechanical circulatory support (MCS) therapy, and optimal ventilation mode. Furthermore, most of the data are obtained from CS in the setting of acute myocardial infarction (AMI), although for non–AMI-CS patients, there are very few evidences for etiological or MCS therapies.

Data Sources:

The prospective multicentric acute heart failure registries that specifically presented characteristics of patients with CS, distinct to other phenotypes, were included in the present review. Relevant clinical trials investigating therapeutic strategies in post–AMI-CS patients were added as source information. Several trials investigating vasoactive medications and meta-analysis providing information about benefits and risks of MCS devices were reviewed in this study.

Therapeutic Advances:

Early revascularization remains the most important intervention for CS in settings of AMI, and in patients with multivessel disease, recent trial data recommend revascularization on a “culprit-lesion-only” strategy. Although diverse types of MCS devices improve hemodynamics and organ perfusion in patients with CS, results from almost all randomized trials incorporating clinical end points were inconclusive. However, development of new algorithms for utilization of MCS devices and progresses in technology showed benefit in selected patients. A major advance in the management of CS is development of concept of regional CS centers based on the level of facilities and expertise. The modern systems of care with CS centers used as hubs integrated with emergency medical systems and other referee hospitals have the potential to improve patient outcomes.

Conclusions:

Additional research is needed to establish new triage algorithms and to clarify intensity and timing of pharmacological and mechanical therapies.
Cardiac Arrest in Special Circumstances—Recent Advances in Resuscitation
Authors: Cimpoesu Diana , Corlade-Andrei Mihaela , Popa Tudor Ovidiu , Grigorasi Gabriela , Bouros Catalin , Rotaru Luciana , Nedelea Paul Lucian
Published: March 2019

Background:

Cardiopulmonary resuscitation (CPR) in special circumstances includes the emergency intervention for special causes, special environments, and special patients. Special causes cover the potential reversible causes of cardiac arrest that must be identified or excluded during any resuscitation act. The special environments section includes recommendations for the treatment of cardiac arrest occurring in specific locations: cardiac surgery, catheterization laboratory, dialysis unit, dental surgery, commercial airplanes or air ambulances, playing field, difficult environment (eg, drowning, high altitude, avalanche, and electrical injuries) or mass casualty incident. CPR for special patients gives guidance for the patients with severe comorbidities (asthma, heart failure with ventricular assist devices, neurological disease, and obesity) and pregnant women or older people.

Areas of Uncertainty:

There are no generally worldwide accepted resuscitation guidelines for special circumstance, and there are still few studies investigating the safety and outcome of cardiac arrest in special circumstances. Applying standard advanced life support (ALS) guidelines in this situation is not enough to obtain better results from CPR, for example, cardiac arrest caused by electrolyte abnormalities require also the treatment of that electrolyte disturbance, not only standard CPR, or in the case of severe hypothermia, when standard ALS approach is not recommended until a temperature threshold is reached after warming measures. Data sources for this article are scientific articles describing retrospective studies conducted in CPR performed in special circumstances, experts' consensus, and related published opinion of experts in CPR.

Therapeutic Advances:

The newest advance in therapeutics applied to resuscitation field for these particular situations is the use of extracorporeal life support/extracorporeal membrane oxygenation devices during CPR.

Conclusions:

In special circumstances, ALS guidelines require modification and special attention for causes, environment, and patient particularities, with specific therapeutic intervention concomitant with standard ALS.
Financial compensation for organ donors
Authors: Harbell Jack W. , Mathur Amit K.
Published: March 2019

Purpose of review

With an increasing demand for donor organs, strategies to increase the number of available donor organs have become more focused. Compensating donors for donation is one strategy proposed to increase the availability of organs for transplant. This has been implemented in several systems internationally, but debate continues in the United States with respect to appropriate strategies. The National Organ Transplant Act (NOTA) currently prohibits the transfer of any human organ ‘for valuable consideration’ for transplantation, but allows for the removal of financial disincentives.

Recent findings

Several proposals currently exist for compensating patients for living donation. Recent data have focused on studying and creating mechanisms for reimbursement of costs incurred as part of the donation process, which is related to the removal of disincentives to living donation. Others have advocated for the provision of actual incentives to patients for the act of donating, in an attempt to further expand living donation. The current debate focuses on what measures can reasonably be taken to increase donation, and whether additional incentives will encourage more donation or reduce the motivation for altruistic donation.

Currently, the transplant community broadly supports the removal of disincentives for living donors, including reimbursement of expenses for travel, housing and lost wages incurred during evaluation, surgery and after care. Others have advocated for financial incentives to further increase the number of donor organs available for transplant. Although the removal of disincentives is currently allowed under the existing legal structure of NOTA, providing financial incentives for living donation would require further evaluation of the economics, law, ethics and public readiness for a significant policy shift.
Current status of lipid emulsions in the prevention of intestinal failure-associated liver disease
Authors: Lim Joel , Oschman Alexandra , Curiel Kayla
Published: March 2019

Purpose of review

The current review provides a summary of available lipid products and discusses current literature and the limitations to the use of various lipid products for treatment and prevention of intestinal failure-associated liver disease (IFALD) in pediatric patients dependent on parenteral nutrition.

Recent findings

Improvements in markers of cholestasis and liver function have been seen with minimizing soybean lipid, fish oil lipid, and mixed fish oil-containing lipid emulsions. Soybean-based lipid products are thought to be the biggest contributor to development of IFALD. Mixed fish oil-containing lipid emulsions are most promising for minimizing and improving IFALD.

Several types of lipid-based products are available for parenteral nutrition. Newer products like the mixed fish oil-containing-based lipid emulsions, that closely mimic the lipid composition provided by enteral feeding, may impact prevention and treatment of IFALD. Limitations exist in the current literature regarding mixed fish oil-containing-based emulsions, as many of the studies were designed to show efficacy with regard to growth, not prevention or treatment of IFALD. Based on available literature, it is reasonable to make some recommendations with regard to product selection for lipid provision.
Liver transplantation for colorectal liver metastasis
Authors: Simoneau Eve , D’Angelica Michael , Halazun Karim J.
Published: March 2019

Purpose of review

The aim of this review is to discuss existing data on liver transplantation for colorectal liver metastasis, emerging controversies, and future directions.

Recent findings

Contemporary experience with transplanting patients with liver metastasis from colon cancer is mainly derived from European centers, with a large proportion being from a single institution (SECA study), made possible in part by a relatively high donor pool. The initial results prove to be encouraging by demonstrating an overall survival advantage over unresectable patients with liver-limited disease managed with chemotherapy only. Recurrence patterns, however, suggest a need for better patient selection and treatment sequencing optimization. In North America, the main barriers in establishing similar protocols result from national liver graft shortage, which represents an issue of competing resources when indications have yet to be well defined. Evolving strategies in transplantation, such as the utilization of marginal liver grafts and living donor liver transplantation might constitute potential solutions.

Evidence suggests a potential survival benefit of liver transplantation for a subset of patients with unresectable liver-limited CRLM. Further prospective trials are needed to clarify the role and feasibility of this treatment strategy in oncotransplantation.
An Integrative Review of Nurse-to-Nurse Incivility, Hostility, and Workplace Violence
Authors: Crawford Cecelia L. , Chu Frances , Judson Lorie H. , Cuenca Emma , Jadalla Ahlam A. , Tze-Polo Lisa , Kawar Lina Najib , Runnels Cindy , Garvida Roque
Published: March 2019

Bullying, lateral violence, and incivility are real phenomena in the nursing workplace and remain widespread across all care settings. The American Nurses Association recommends zero tolerance for any form of violence from any source and adopting evidence-based strategies to mitigate incivility and bullying. This integrative review examined the evidence regarding nurse-to-nurse incivility, bullying, and workplace violence for 4 nurse populations—student, new graduate, experienced, and academic faculty. Ganong and Cooper's review methodology structured the evidence synthesis. Twenty-one articles pertained to the clinical inquiry. The evidence consistently described the incidents, instigators, and targets of incivility/bullying, which contributes to 84 negative academic, organizational, work unit, and personal outcomes. A safe and just organizational culture demands a comprehensive systems-level approach to create civil environments. The evidence-based structures, processes, and recommendations serve as a Global Positioning System for practice and academic leaders to use in creating a healthy work environment where nurses are encouraged and empowered. The critical choices by nurse leaders will determine not only the future of 21st century professional nursing practice but how the public views the nursing profession for many years to come.
Engaging Clinical Nurses in Research
Authors: Landon Leslie , Crane Stacey , Nance Stacy , Stegenga Kristin , Cherven Brooke , Perez Prado Luz N. , Butrum Karen Dawn , Beacham Barbara , Haase Joan
Published: March 2019

Despite the recognized need for clinical nurses to engage in the conduct of research, little is known about their research experiences. This article describes the experiences of nurses who delivered the communication intervention in a behavioral oncology clinical trial for parents of adolescents and young adults (AYAs) with cancer. A qualitative thematic analysis was conducted of nurse interveners' (NIs') reflections on their experiences delivering the communication intervention. Ten data-generating questions were developed to guide NIs' reflections. Twelve NIs responded via verbal discussions. Six of these also provided written responses. Overall, nurses' experiences as interveners were powerful and positive, and included time and space to be fully present with patients and families. Nurse interveners identified barriers to their involvement in research related to time constraints, administrative support, physical space to privately conduct the intervention, and difficulties maintaining expertise with the intervention. The importance of ongoing collaboration between nurses, unit staff, leaders, and study teams was corroborated. An unexpected finding was the importance of reflective clinical research.
Authentic Nurse Leadership Conceptual Framework
Authors: Giordano-Mulligan Marie , Eckardt Sarah
Published: March 2019

Today's nurse leaders are challenged to successfully implement and sustain healthy work environments and promote staff engagement. Authentic leaders possess inner core values that are consistent with the nursing profession. Authentic nurse leaders are able to create a healthy work environment that leads to engaged nurses. The first aim of this study was to develop the authentic nurse leadership conceptual framework and instrument. The second was to identify nurses' perception of authentic nurse leader attributes, grounded in the nursing discipline, that support a healthy work environment and promote nurse engagement. A crossover design was employed to compare the Authentic Nurse Leadership Questionnaire (ANLQ) with the Authentic Leadership Questionnaire, which has been used for leaders from multiple disciplines. The study sample consisted of 309 registered nurses, whose work includes at least 50% direct patient care. Results of the study indicate that the ANLQ is valid and reliable; ANLQ concepts were statistically supported by both exploratory and confirmatory factor analyses. The ANLQ better identified nursing values, as indicated by a stronger relationship with nurse work-life and nurse engagement.
Increasing Competence in Pressure Injury Prevention Using Competency-Based Education in Adult Intensive Care Unit
Authors: Aquino Carla , Owen Amanda , Predicce Ashley , Poe Stephanie , Kozachik Sharon
Published: March 2019

Background:

There is a significant focus on pressure injury prevention to promote better patient outcomes and control health care cost.

Local Problem:

In 2016, the institution's pressure injury quarterly prevalence survey showed that two-thirds of the patients surveyed who developed unit-acquired pressure injury stage 2 and greater were in the adult intensive care units.

Methods:

The quality improvement project used a pre- and postintervention design.

Interventions:

The adult medical intensive care unit (MICU) executed a competency-based education project to increase staff implementation of pressure injury prevention.

Results:

Following initiation of competency-based education, staff documentation of pressure injury prevention implementation increased, and unit-acquired pressure injury stage 2 and greater rates were reduced.

Conclusions:

The use of a competency-based education program may be effective in increasing pressure injury prevention in the intensive care unit.
Measuring Quality of Care
Authors: Stolt Minna , Katajisto Jouko , Kottorp Anders , Leino-Kilpi Helena
Published: March 2019

Background:

Patient-centeredness is emphasized in both health policies and practice, calling for reliable instruments for the evaluation of the quality of nursing care.

Purpose:

The purpose was to analyze the psychometric properties of the Good Nursing Care Scale (GNCS) in a sample of surgical patients and nurses.

Methods:

An explorative cross-sectional study design was used. Data were collected with the 40-item GNCS from surgical patients (n = 476) and nurses (n = 167) in Finland. The data were analyzed with Rasch analysis.

Results:

The GNCS provided evidence of unidimensionality with acceptable goodness-of-fit to the Rasch model in both samples. Person-separation validity was acceptable. Person misfit was reasonable. The Rasch-equivalent Cronbach α was 0.81 (patient data) and 0.88 (nurse data).

Conclusions:

The findings support that the GNCS is a psychometrically sound instrument that can be used in measuring the quality of nursing care, from the perspective of both patients and nurses.
Driving Innovation in Health Care
Authors: Noles Kristen , Barber Rebekah , James David , Wingo Nancy
Published: March 2019

Background:

The clinical nurse leader (CNL) role was developed as a strategy for redesigning care delivery to address quality and safety gaps in health care. However, innovation competencies have never been assessed in this group.

Purpose:

The purpose of this study was to determine whether CNLs have different perceptions of innovation and their own competence to lead it, compared with other nurse leaders.

Methods:

A web-enabled concurrent mixed-method survey design was used to compare self-reported innovation competencies between nurses in a leadership role and certified CNLs at a large academic medical center.

Results:

A statistically significant difference between groups was found for only 1 competency, with non-CNLs rating themselves as more competent in the use of unconventional approaches than CNLs. Qualitative data showed wide variation in recognition of innovation and how it is defined.

Conclusions:

Replication of this study is needed with an increased sample size of CNLs to determine whether curriculum change is needed.
Systemwide Practice Change Program to Combat Hospital-Acquired Pressure Injuries
Authors: Barakat-Johnson Michelle , Lai Michelle , Wand Timothy , Coyer Fiona , White Kathryn
Published: March 2019

Background:

Considerable evidence exists on how to prevent hospital-acquired pressure injuries (HAPIs). However, processes employed to implement evidence play a significant role in influencing outcomes.

Problem:

One Australian health district experienced a substantial increase in HAPIs over a 5-year period (by almost 60%) that required a systemwide practice change.

Approach:

This article reports on the people, processes, and learnings from using the Promoting Action on Research Implementation in Health Services (PARiHS) framework taking into account the evidence, context, and facilitation to address HAPIs.

Outcomes:

Applying this approach resulted in a significant decrease in pressure injuries and positive practice change, leading to improved patient outcomes in a shorter time frame than previous strategies.

Conclusion:

Processes guided by the PARiHS enhanced the effectiveness of translating evidence into practice and positively assisted clinicians to promote optimal patient care. This approach is transferrable to other health care settings.
Improving Nurses' Behavioral Health Knowledge and Skills With Mental Health First Aid
Authors: Baker Margaret W. , Dower Catherine , Winter Peggi Banahan , Rutherford Marcella M. , Betts Virginia Trotter
Published: March 2019

Given the current professional behavioral health workforce shortage, nursing professional development practitioners require educational resources to fully support registered nurses across settings in responding to patients with behavioral health symptoms. Mental Health First Aid is an 8-hour training to help nonprofessional bystanders assess a mental health crisis, provide initial help, and connect to supports and self-help resources in the local community. Mental Health First Aid was acceptable and useful to 60 RNs and can be supplemented with additional content.
Gaps in Chlamydia Treatment Within California Family Planning Clinics: Are Patients Filling Prescriptions?
Authors: Kovaleski Laura , Feldman Claire , Baker Scott , Howard Holly , Barandas Aileen , Chow Joan , Bauer Heidi
Published: March 2019

Background

Compared with receiving medication dispensed in a health center, patients receiving prescriptions must take additional steps for treatment. Few clinics have protocols for ensuring prescriptions are filled. This study evaluated prescription fill rates for chlamydia treatment based on claims data in California Title X clinics and examined fill rates by patient demographics and clinic type.

Methods

We collected treatment information during Title X site audits for a convenience sample of patients with a positive chlamydia test between January 2008 and March 2013. We categorized patients as receiving treatment on-site versus via prescription and matched prescriptions to pharmacy billing claims within 90 days of test date. We examined treatment rates by patient age, gender, and race/ethnicity, and by clinic type, and assessed the median time to treatment.

Results

Among 790 patients diagnosed with chlamydia across 79 clinics, 65% (n = 513) were treated on-site and 33% (n = 260) via prescription; 17 (2%) did not have treatment information. Sixty-seven percent of prescriptions had confirmed receipt of treatment. Prescription fill rates were lower for patients age 18 years and younger (47% vs. 71%, P < 0.01) and for patients attending federally qualified health centers compared with stand-alone family planning clinics (63% vs. 88%, P < 0.01). Median time to treatment was similar for patients treated on-site (5 days) or via prescription (4 days).

Conclusions

Delays in chlamydia treatment increase risk of complications and ongoing transmission. Providing medications on-site can improve treatment rates, especially among younger patients. These insights can inform clinic treatment protocols and efforts to improve quality of chlamydia care.
Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition: Update of the Brain Trauma Foundation Guidelines, Executive Summary
Authors: Kochanek Patrick M. , Tasker Robert C. , Carney Nancy , Totten Annette M. , Adelson P. David , Selden Nathan R. , Davis-O’Reilly Cynthia , Hart Erica L. , Bell Michael J. , Bratton Susan L. , Grant Gerald A. , Kissoon Niranjan , Reuter-Rice Karin E. , Vavilala Monica S. , Wainwright Mark S.
Published: March 2019

Objectives:

The purpose of this work is to identify and synthesize research produced since the second edition of these Guidelines was published and incorporate new results into revised evidence-based recommendations for the treatment of severe traumatic brain injury in pediatric patients.

Methods and Main Results:

This document provides an overview of our process, lists the new research added, and includes the revised recommendations. Recommendations are only provided when there is supporting evidence. This update includes 22 recommendations, nine are new or revised from previous editions. New recommendations on neuroimaging, hyperosmolar therapy, analgesics and sedatives, seizure prophylaxis, temperature control/hypothermia, and nutrition are provided. None are level I, three are level II, and 19 are level III. The Clinical Investigators responsible for these Guidelines also created a companion algorithm that supplements the recommendations with expert consensus where evidence is not available and organizes possible interventions into first and second tier utilization. The purpose of publishing the algorithm as a separate document is to provide guidance for clinicians while maintaining a clear distinction between what is evidence based and what is consensus based. This approach allows, and is intended to encourage, continued creativity in treatment and research where evidence is lacking. Additionally, it allows for the use of the evidence-based recommendations as the foundation for other pathways, protocols, or algorithms specific to different organizations or environments. The complete guideline document and supplemental appendices are available electronically from this journal. These documents contain summaries and evaluations of all the studies considered, including those from prior editions, and more detailed information on our methodology.

Conclusions:

New level II and level III evidence-based recommendations and an algorithm provide additional guidance for the development of local protocols to treat pediatric patients with severe traumatic brain injury. Our intention is to identify and institute a sustainable process to update these Guidelines as new evidence becomes available.
Role of Antioxidants in Minor Salivary Glands Cancer in the Elderly
Authors: Oteri Giacomo , Lentini Maria , Cicciù Marco , Peditto Matteo , Rey Eva Otero , Carrión Andrés Blanco , Marciano Antonia
Published: March 2019

Background:

Minor salivary gland tumors (MSGTs) are infrequent, representing 10% to 15% of all salivary neoplasms. Despite this low frequency, a significant increase in the incidence of these tumors has been reported in the lasts 30 years. While tumors of the salivary glands can appear at any age, different authors consider the peak of incidence to be associated with old age (60+). The etiopathogenesis of MSGTs remains unclear. In this context, the aim of this study was to explore the hypothesis that age-related changes in salivary antioxidant capacity are involved in the pathogenesis of minor salivary glands tumors to identify possible preventive measures.

Furthermore the study aimed to describe the clinico-pathological features of a multi-institutional case series of MSGTs which results are consistent with data in the literature.

Methods:

An electronic search of the English language literature was performed using PubMed and Google scholar (). Databases were screened for papers using a number of search strings constructed using relevant terms (minor salivary glands tumors, elderly, diet, antioxidant, saliva, salivary glands).

Results:

According to the world literature, the peak of incidence of MSGTs is between the fifth and seventh decades of life. To date, the only confirmed risk factor for salivary gland tumors is the exposure to ionizing radiation. The significantly reduced salivary antioxidant capacity in old people may explain the higher prevalence of these tumors in the elderly population.

Conclusions:

Further investigation is required to determine the real etiopathogenesis of MSGTs and why these tumors result more frequent in elderly patients.
Cartilage and Fascia Graft In Type 1 Tympanoplasty: Comparison of Anatomical and Audological Results
Authors: Mouna Bellakhdhar , Khalifa Mouna , Ghammem Monia , Limam Manel , Meherzi Abir , Kermani Wassim , Abdelkefi Mohamed
Published: March 2019

Tympanoplasty is a surgical procedure aiming to reconstruct the tympanic membrane and hearing. The aim of this study was to compare anatomic and audiological results of cartilage graft with temporal fascia graft in type 1 tympanoplasty patients. We conducted a descriptive, retrospective study of medical records of patients who underwent tympanoplasty between January 2010 and December 2015 at the Department of Otolaryngology Head and Neck Surgery of Farhat Hached University Hospital. In total, we obtained 46 patients. Twenty-three patients who underwent type 1 cartilage tympanoplasty using cartilage graft were compared with 23 patients in whom temporal muscle fascia was used. In follow-up, residual perforation occurred in 1 of 23 patients (4.3%) undergoing cartilage tympanoplasty and in 2 of 23 patients undergoing fascia tympanoplasty (8.7%), which was found to be statistically non significant (P > 0.05). In both cartilage and fascia groups, when they were compared in terms of gain, no significant difference was found between groups (P = 0.271), air bone gap gain was found to be 12.9 ±9.9 decibels in cartilage group, whereas it was 10 ± 6.6 decibels in fascia group. Operation success is defined by successful anatomical and functional outcome. Among all patients, 35 (76%) were reported to have operation success. It was established that type of operation had no significant influence on success (P = 0.73). Currently, there is an increasing interest in using cartilage grafts in primary tympanoplasty. Especially, in patients with severe middle ear pathology, cartilage graft should be used routinely without risk on influencing audiological results.
Correlation Between Maxillary Canine Impaction and Facial Biotype
Authors: Crincoli Vito , Tettamanti Lucia , Lucchina Alberta Greco , Dedola Alberto , Cazzolla Angela Pia , Lacaita Maria Grazia , Mastrangelo Filiberto
Published: March 2019

Aim:

The etiology of teeth impaction is still not fully understood, despite that cofactors have been considered important to develop such a clinical picture. The aim of the authors’ paper was to investigate about facial biotype, about the values of inclination of the upper cuspid axis to the perpendicular to Frankfort-horizontal plane and about the distance “d” of the canine cuspid to occlusal plane: each factor was statistically compared. The authors also performed a comparative analysis on the radicular length of the left and right lateral incisors of subjects with impacted maxillary canine.

Methods:

The authors recruited with “cluster sampling” randomization more than 30 patients, then refined to 25 after the application of exclusion criteria. Specific values were carried out by x-rays: the authors calculated both the α and β angles, the intermaxillary angle, the distance “d” and the inclination of upper cuspid axis to the perpendicular-to-Frankfort-horizontal plane. Spearman rank correlation coefficient or Spearman rho (ρ) was used as statistical methods.

Results:

The authors’ results assessed that the inclination of the upper cuspid axis to the perpendicular-to-Frankfort-horizontal plane showed a statistically significant inverse correlation with the intermaxillary angle.

Conclusion:

The authors’ data clearly indicate that hyperdivergence is a key-factor that will certainly support the eruption path of canine cuspid: in this light, the treatment of tooth impaction in hyperdivergent subjects can be considered as predictive for a good prognosis.
A New Method To Reposition the Displaced Articular Disc For a Patient With Comminuted Condylar Fracture
Authors: Yan Guangqi , Zhou Qing , Yang Mingliang
Published: March 2019

Background:

Repositioning the displaced articular disc is the key procedure that prevents ankylosis of the temporomandibular mandibular joint (TMJ) in the treatment of patients with comminuted condylar fractures. The conventional procedure performed clinically is to use two anchors and sutures to reposition the displaced articular disc. Therefore, this paper introduces a new and economical method to reposition the articular disc without metallic implantation materials.

Clinical presentation:

A 60-year-old male patient who had fainted suddenly 3 days before came to our hospital to complain of pain of the bilateral TMJ areas and limited mouth opening. Clinical examination revealed severe restriction of mouth opening and the disappearance of bilateral condylar movements. Preoperational 3-dimensional computed tomography (3-DCT) indicated bilateral intracapsular comminuted fractures of the mandibular condyles. The patient was operated in a bilateral preauricular approach for repositioning of the bilateral articular discs and removal of the fracture fragments. Instead of repositioning the displaced disc with anchors, we designed a method to use sutures to stabilize the TMJ disc and to assess the disc's position using a magnetic resonance imaging (MRI) scan when following up. There were no severe complications during the operation. Results of an MRI scan 1 month after operation showed that post-operation articular discs kept their normal position, the mouth opening and the lateral and protrusive movements of the mandible recovered when followed up for 3 months.

Conclusion:

The method of using sutures to reposition and stabilize the articular disc for a patient with comminuted fractures is effective. There is great significance not only for patients with comminuted condylar fractures but for treatment of TMJ dysfunction especially for patients with high psychological pressure who persist in requiring the removal of metallic anchors although there are no clinical symptoms.
Incidence and Severity of Maxillofacial Injuries During the Syrian Civil War in Syrian Soldiers and Civilians
Authors: Ucak Murat
Published: March 2019

Purpose:

The aim of this study was to assess the maxillofacial injuries (MFIs) and our surgical approaches in the Syrian Civil War that emerged during the spring of 2011, among Syria's government and Syrians.

Patients and Methods:

The present study is a prospective clinical study of injured patients at Turkey's Border Hospitals during the Syrian Civil Conflict. Patients’ data cover to all emergency and plastic surgery hospitals throughout Turkey. We assessed the patients’ data according to location of trauma, duration of hospitalization, the severity and etiology of MFIs with the Injury Severity Score.

Results:

MFIs were found in 112 of the 956 wounded. The injuries occurred in 69 civilians (61.6%) and 43 soldiers (38.3%). The mean age ranged from 8 to 66 (mean: 29,1 ± 12). Eighty-two percent or higher rates of the injuries needed >4 days’ hospitalization. We observed the mortality at a rate of 13.3% for the MFIs. Majority of the MFIs were accompanied by >3 concomitant injuries (n = 59; 52.6%). Most of the facial injuries were located at Mandibula (n = 75; 66.9%), Maxilla (n = 69; 61.6%) and orbitofrontal (n = 52; 46.4%) regions.

Conclusions:

Severity and incidence of MFIs were extremely high compared with previously published studies of other wars, especially affecting the civilians in the Syrian Civil War. The high rates of LeFort III fractures exhibit its devastating damages on civilians.
The Impact of Parecoxib on Pain Management for Laparoscopic Cholecystectomy: A Meta-analysis of Randomized Controlled Trials
Authors: Luo Zhifang , Wang Huarong , Huang Dinggui
Published: March 2019

Introduction:

The efficacy of parecoxib on pain management for laparoscopic cholecystectomy remains controversial. We conducted a systematic review and meta-analysis to explore the impact of parecoxib on pain management after laparoscopic cholecystectomy.

Materials and Methods:

We searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library database results through September 2018 for randomized controlled trials to assess the effect of IV parecoxib versus placebo or noting on pain management after laparoscopic cholecystectomy. This meta-analysis was performed using the random-effect model.

Results:

Seven randomized controlled trials were included in the meta-analysis. Overall, compared with control group for laparoscopic cholecystectomy, intravenous parecoxib showed no notable impact on pain scores within 2 hours [mean difference (MD), −0.22; 95% confidence interval (CI), −0.82 to 0.38; P=0.48] and 4 hours (MD, −0.33; 95% CI, −1.04 to 0.38; P=0.36), but showed results of significant decrease in pain scores at 6 hours (MD, −0.82; 95% CI, −1.45 to −0.20; P=0.01), 12 hours (MD, −0.69; 95% CI, −1.23 to −0.15; P=0.01), 24 hours (MD, −0.49; 95% CI, −0.89 to −0.10; P=0.01), and postoperative analgesics need (risk ratio, 0.45; 95% CI, 0.30-0.65; P<0.0001). In addition, no increase in nausea and vomiting is observed after parecoxib use compared with control intervention (risk ratio, 0.89; 95% CI, 0.44-0.76; P=0.76).

Conclusions:

Parecoxib can substantially promote postoperative pain relief in patients with laparoscopic cholecystectomy.
Intracorporeal Versus Extracorporeal Anastomosis for Laparoscopic Resection of the Splenic Flexure Colon Cancer: A Multicenter Propensity Score Analysis
Authors: Grieco Michele , Cassini Diletta , Spoletini Domenico , Soligo Enrica , Grattarola Emanuela , Baldazzi Gianandrea , Testa Silvio , Carlini Massimo
Published: March 2019

Purpose:

The aim of this study is to compare the short and long-term outcomes of intracorporeal anastomosis (IA) versus extracorporeal anastomosis (EA) during laparoscopic resection of splenic flexure for cancer, in 3 high-volume Italian centers.

Materials and Methods:

A retrospective analysis was conducted on a multicenter database of a consecutive series of patients who underwent an elective laparoscopic resection of the splenic flexure for colon cancer in 3 high-volume centers between January 2008 and August 2017. Propensity score matching analysis was performed to overcome patients’ selection bias between the 2 surgical techniques. Data on patients’ demographics, operative details, short-term and long-term outcomes were prospectively recorded.

Results:

In total, 102 patients were selected. After propensity score match, 72 patients were compared: 36 for the IA group, 36 for the EA group. The IA group showed a significantly shorter median time to first flatus, time to first stool, time to oral feeding, and time to discharge, as well as significantly lower incidence of postoperative severe surgical complications, especially in terms of wound infections, and of incisional hernia (IH).

Risk factors for IH on logistic regression were longer operative time, EA, longer incision, postoperative blood transfusions, and longer specimen.

Conclusions:

The IA in laparoscopic resection of the splenic flexure is feasible and safe in terms of short-term and long-term outcomes. Major advantages are shorter time to first flatus and first stool, complete oral feeding and time to discharge, with minor incidence of severe surgical complications, such as wound infection, and lower incidence of IH.
Pusillimonas thiosulfatoxidans sp. nov., a thiosulfate oxidizer isolated from activated sludge
Authors: Koh Hyeon-Woo , Song Myeong-Sub , Do Kyoung-Tag , Kim Hongik , Park Soo-Je
Published: March 2019

A Gram-stain-negative, motile bacterium, designated strain YE3T, was isolated from activated sludge obtained from a municipal wastewater treatment plant in Daejeon Metropolitan City, Republic of Korea. The cells were oxidase- and catalase-positive, and grew under aerobic conditions at 10–40 °C (optimum, 30 °C), with 1.0–8.0 % (w/v) NaCl (1.0 %) and at pH 5.5–9.0 (pH 7.0). Phylogenetic analysis based on the 16S rRNA gene sequence indicated that strain YE3T was most closely related to

Pusillimonas

harenae

KACC 14927T (98.2 % sequence similarity) and

Pusillimonas

ginsengisoli

KCTC 22046T (98.0 %). DNA–DNA relatedness values for strain YE3T and

P. harenae

KACC 14927T,

P. ginsengisoli

KCTC 22046T and

P. soli

KCTC 22455T were 28.7±2.27 %, 21.3±1.16 %, and 14.0±0.67 %, respectively. The genomic G+C content of the type strain YE3T was 59.3 mol%, as determined by whole-genome sequencing. The dominant fatty acids were C16 : 0 (39.2 %) and C17 : 0cyclo (37.5 %). The major polar lipids of strain YE3T were diphosphatidylglycerol, phosphatidylglycerol and phosphatidylethanolamine. Two aminophospholipids and four unidentified lipids were also detected. Furthermore, strain YE3T was able to oxidize thiosulfate under heterotrophic conditions. Based on the phenotypic, genotypic, chemotaxonomic and phylogenetic analyses, strain YE3T represents a novel species of the genus

Pusillimonas

, for which the name Pusillimonas thiosulfatoxidans sp. nov. is proposed. The type strain is YE3T (=KCTC 62737T=NBRC 113113T).