bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antimicrobial Stewardship Metrics that Matter
Authors: Wagner Jamie L. , Carreno Joseph J. , Kenney Rachel M. , Kilgore Paul E. , Davis Susan L. 
Published: January 2020

Background
Guidelines for antimicrobial stewardship programs (ASPs) highlight the need for measuring quality metrics as surrogate markers for outcome. The objective of this study was to determine the relationship between ASP quality metrics and patient outcomes at an institution with an established ASP.

Methods
Retrospective cohort study including 442 patients receiving intravenous antibiotics for 72 hours or more in 1 of 3 designated inpatient units were assessed for compliance with ASP metrics and associated outcomes. Clinical success was defined as discharged alive, without adverse drug reaction and not readmitted within 30 days of discharge.

Results
The mean (SD) age was 62 (17) years with 205 males (46%) enrolled. A total of 422 patients (96%) had documented indication for therapy, 365 (83%) had appropriate cultures obtained at baseline, 354 (80%) had appropriate empiric therapy at baseline, and 166 (83%) of 199 had appropriate deescalation performed. All metrics were met in 58% of patients. Sixty-two percent of patients achieved clinical success; while, 14% died, 13% had an adverse drug reaction, and 21% were readmitted within 30 days. Completion of all ASP metrics was not associated with clinical success (odds ratio, 0.862; P = 0.46). Documentation of indication for therapy was a significant indicator for clinical success (97.8% vs 91.7%; P = 0.003); this remained associated after adjusting for infection type and severity.

Conclusions
Documented indication showed strong association with clinical success, providing support for use of the Centers for Disease Control's Core Elements as a metric for quality of care.
Evolution of visual acuity, flap thickness, and optical density after laser in situ keratomileusis performed with a femtosecond laser
Authors: Parafita-Fernandez Alberto , Garcia-Gonzalez Montserrat , Gros-Otero Juan , Alvarez-Rementería Capelo Laureano , Blázquez Sánchez Vanesa , Teus Miguel 
Published: January 2020

Purpose:
To describe the postoperative evolution of visual acuity, flap morphology, and stromal optical density femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK).

Setting:
Clínica Rementería, Madrid, Spain.

Design:
Prospective case series.

Methods:
The study comprised 44 consecutive eyes that had FS-LASIK performed with the WaveLight FS200 and the Allegretto excimer laser to correct myopia. Visual outcomes, flap thickness, and stromal optical density were assessed 1 day, 1 week, 1 month, and 3 months postoperatively.

Results:
A statistically significant improvement in the mean uncorrected distance visual acuity at 1 day (0.94 ± 0.2) and 1 week (0.93 ± 0.2) to 1 month (1.04 ± 0.2) and 3 months (1.11 ± 0.1) postoperatively (P < .05). At 3 months postoperatively, the femtosecond laser had good outcomes in efficacy (0.98 ± 0.1), safety (0.98 ± 0.1), and predictability (100% of eyes were within ± 0.5 D of emmetropia). The femtosecond-created flaps were slightly thicker than intended, the mean SD intraflap was 7.1 μm, the range between the thickest and thinnest points in each flap was 25.4 μm, and the mean flap thickness homogeneity was 7.6 μm at 3 months postoperatively. A progressive decrease in the optical density of the flap stroma and the residual stromal bed was detected during follow-up.

Conclusions:
The femtosecond laser study appears to be a safe, effective, and predictable platform to obtain LASIK flaps. The flaps were planar and homogeneous but slightly thicker than intended. The optical density of the flap stroma was slightly higher at early follow-up and decreased over time.
Incision size changes after cataract surgery with intraocular lens implantation: comparison of 2 preloaded IOL implantation injectors
Authors: Haldipurkar Suhas S. , Shetty Vijay , Haldipurkar Tanvi , Dhamankar Rita , Sehdev Nancy , Khatib Zain , Nagvekar Pranoti , Mhatre Paresh , Setia Maninder Singh 
Published: January 2020

Purpose:
To compare incision size enlargement at different times of cataract surgery and visual outcomes after surgery in 2 different intraocular lens (IOL) delivery systems (Vivinex iSert and UltraSert Preloaded IOL Delivery System).

Setting:
Tertiary care eye institution.

Design:
Prospective nonrandomized comparison study.

Methods:
All eyes had uneventful temporal clear corneal phacoemulsification cataract surgery. The surgery was done by standard direct horizontal chop with a bimanual irrigation aspiration of the cortex. The primary incision size was measured after clear corneal incision, after the completion of phacoemulsification, and after IOL implantation.

Results:
The study comprised 276 eyes of 220 patients. The mean initial corneal incision was similar in both groups (2.2 mm). There was no significant difference in the mean incision size after phacoemulsification between the 2 groups (2.250 mm ± 0.068 mm [SD] vs 2.251 ± 0.066 mm [SD], P > .99). There was no significant difference in the mean (SD) incision size after IOL insertion between the 2 groups (2.367 ± 0.066 mm vs 2.369 ± 0.062 mm [SD], P = .815. The corrected distance visual acuity was 6/6 at 1 month in 80% of the participants in the UltraSert group and 86% in the Vivinex group. After adjusting for age, sex, grade of cataract, and IOL power, no significant difference was found in the magnitude of surgically induced astigmatism (SIA) in the Vivinex group compared with the UltraSert group (0.06, 95% CI, −0.11 to 0.24; P = .47).

Conclusions:
No significant difference was found in the change in the incision size, visual acuity, and SIA between UltraSert and Vivinex IOL delivery systems. This suggests that both IOL delivery systems are comparable in terms of post-IOL delivery incision enlargement for incisions of 2.2 mm.
Safety of intracameral moxifloxacin in the pediatric population: an equivalence study
Authors: Khalili Sina , Imtirat Ahed , Williams Sara , Ali Asim , Tehrani Nasrin , Mireskandari Kamiar 
Published: January 2020

Purpose:
To investigate whether the safety of intracameral moxifloxacin (IC-Mox) was equivalent to subconjunctival antibiotics (SC-Abs) in pediatric lens surgery.

Setting:
The Hospital for Sick Children, Toronto, Canada.

Design:
Retrospective consecutive cohort study.

Methods:
This equivalence study compared 95% CI in the difference between the preoperative and postoperative safety variables of best corrected visual acuity (BCVA), intraocular pressure (IOP), central corneal thickness (CCT), endothelial cell density (ECD), corneal edema, and anterior chamber (AC) inflammation in IC-Mox with SC-Abs. The zone of clinical equivalence for BCVA was set at ±0.2 logarithm of the minimum angle of resolution, IOP at ±3 mm Hg, CCT at ±30 μm, and ECD at ±400 cells/mm2.

Results:
The charts of 358 patients undergoing lens-related surgeries were reviewed. Of 317 eyes (215 patients) included, 170 eyes received IC-Mox and 147 eyes had SC-Abs. The mean age was 4.9 and 5.1 years with a mean follow-up of 19 and 34.4 months (P < .001) in IC-Mox and SC-Ab groups, respectively. The 95% CIs for the change from preoperative to postoperative safety parameters between IC-Mox and SC-Abs were all in the zones of clinical equivalence (BCVA, P = 0.75; highest IOP in the first 6 weeks postoperatively, P = 0.27; IOP at the last visit, P = 0.74; CCT, P = 0.89; and ECD, P = 0.76). During the first 6 weeks postoperatively, there was no difference in corneal edema (P = .69) and AC flare (P = .4) between IC-Mox and SC-Ab groups, whereas AC cellular activity was significantly higher in the SC-Ab group (P = .028).

Conclusions:
IC-Mox prophylaxis in pediatric patients showed equivalent postoperative safety outcomes when compared with SC-Abs. The use of IC-Mox (250 μg) for endophthalmitis prophylaxis appears to be safe in the pediatric population.
Factors predicting successful customized excimer laser treatment in irregular corneas
Authors: Hanna Rana , Mimouni Michael , Plaza Ana Belen , Alió Jorge L. 
Published: January 2020

Purpose:
To identify factors associated with a successful wavefront-guided customized treatment (WG-CT) with an excimer laser in highly aberrated corneas.

Setting:
VISSUM Alicante Spain.

Design:
Retrospective consecutive noncomparative case series.

Methods:
Treatment was performed with the WG-CT Amaris excimer laser using the ORK-CAM software for the calculation of the ablation profile. Eyes of patients with significantly aberrated corneas, including postrefractive and keratoplasty procedures or high irregular astigmatism with significant higher-order aberrations (HOAs) that had WG-CT were included. Refractive outcomes, HOAs, and visual outcomes were recorded. Statistical analysis was performed to identify factors associated with technical (based on HOAs) or refractive outcome success.

Results:
The study included 55 treatments of 51 eyes (35 patients). The postoperative uncorrected distance visual acuity was 0.2 logarithm of the minimum angle of resolution or better in 72% of the eyes, and the postoperative residual manifest refraction spherical equivalent was ±0.50 diopter in 56% of the eyes, whereas 11% of the eyes lost 1 line or more in corrected distance visual acuity. Successful reduction in the total root mean square (RMS) of HOAs occurred in 36 eyes (65%), and these eyes had a significantly higher preoperative RMS of HOAs (1.45 ± 0.93 μ vs 0.91 ± 0.34 μ, P = .003) and preoperative coma-like aberrations (1.09 ± 0.83 μ vs 0.55 ± 0.28 μ, P = .001). In multivariate analysis, posthyperopic treatment eyes were less likely to achieve refractive outcome success (odds ratio = 0.09, P = .02).

Conclusions:
WG-CT in highly aberrated corneas had a limited refractive predictability. Eyes with preoperative coma-like aberrations are more likely to benefit from a reduction in HOAs. Posthyperopic treatment is associated with a higher rate of refractive surprises.
Safety and efficacy of a small-aperture capsular bag–fixated intraocular lens in eyes with severe corneal irregularities
Authors: Shajari Mehdi , Mackert Marc J. , Langer Julian , Kreutzer Thomas , Wolf Armin , Kohnen Thomas , Priglinger Siegfried , Mayer Wolfgang J. 
Published: January 2020

Purpose:
To implant a small-aperture intraocular lens (IOL) (IC-8) in eyes with severe corneal irregularities to reduce higher-order aberrations and provide better central visual acuity.

Setting:
University Hospital, LMU Munich, Germany.

Design:
Prospective nonrandomized interventional case series.

Methods:
Eyes with severe corneal irregularities due to keratoconus, previous penetrating keratoplasty, status postradial keratotomy, or scarring after ocular trauma were enrolled. Exclusion criteria were progressive keratoconus, pseudoexfoliation, glaucoma, maculopathy, reduced endothelial cells (<1800 cells/mm2), and central corneal opacity. Conventional phacoemulsification with implantation of the small-aperture IOL was performed. The primary efficacy endpoint was corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA). Secondary endpoints were life quality assessment using the Visual Function Questionnaire-25 and determination of the refractive defocus curve.

Results:
Seventeen eyes of 17 patients were enrolled. In all 17 patients, CDVA improved from 0.37 ± 0.09 to 0.19 ± 0.06 logarithm of the minimum angle of resolution (logMAR) 3 months postoperatively (P < .0001). Similarly, postoperative UDVA, UIVA, and UNVA improved significantly in 100%, 88%, and 88%, respectively. The defocus curve showed best results at 0.17 logMAR with a defocus of −0.5 diopter. In addition, overall life quality analyses reported less difficulty with activities under reduced optical phenomena conditions.

Conclusions:
The small-aperture IOL was a useful option in eyes with severe corneal irregularities, had a high safety index and a high satisfaction rate, and can lead to better visual quality in these cases. Further studies are needed to improve power calculation of this IOL.
Structural integrity of intraocular lenses with eyelets in a model of transscleral fixation with the Gore-Tex suture
Authors: Pollmann André S. , Lewis Darrell R. , Gupta R. Rishi 
Published: January 2020

Purpose:
To compare fracture characteristics of intraocular lenses (IOLs) used in transscleral fixation with the Gore-Tex suture.

Setting:
Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada.

Design:
Experimental study.

Methods:
A model was designed to compare the eyelet fracture characteristics of enVista MX60 IOL (model available before June 2018), the enVista MX60E IOL (current model), the Akreos AO60 IOL, and the CZ70BD IOL. Tension was applied through the Gore-Tex suture and measured with a digital force gauge. Two suture configurations (radial and nonradial) were tested using the MX60E IOL.

Results:
A total of 25 trials were conducted. The mean eyelet fracture force was 1.666 newtons (N) for the MX60 IOL (range, 1.000–2.000), 1.000 N for the MX60E IOL (range, 1.000–1.000), 2.330 N for the AO60 IOL (range, 2.000–3.000), and 0.998 N for the CZ70BD IOL (range, 0.990–1.000). When compared with the MX60E IOL, a greater eyelet strength was observed with the MX60 (P = .024) and AO60 (P = .004) IOLs. Radial and nonradial suture configurations did not affect the MX60E eyelet fracture force.

Conclusions:
The enVista MX60E eyelet may be less resistant to Gore-Tex suture tear out compared with the MX60 and AO60 IOLs. Altering suture configuration did not affect enVista eyelet resistance to fracture. During off-label use in transscleral fixation, extra caution should be taken when handling IOLs and applying tension on sutures.
The Association Between Patient Outcomes and the Initial Emergency Severity Index Triage Score in Patients With Suspected Acute Coronary Syndrome
Authors: Frisch Stephanie O. , Faramand Ziad , Leverknight Brandi , Martin-Gill Christian , Sereika Susan M. , Sejdić Ervin , Hravnak Marilyn , Callaway Clifton W. , Al-Zaiti Salah 
Published: January 2020

BackgroundThe Emergency Severity Index (ESI) is a widely used tool to triage patients in emergency departments. The ESI tool is used to assess all complaints and has significant limitation for accurately triaging patients with suspected acute coronary syndrome (ACS).ObjectiveWe evaluated the accuracy of ESI in predicting serious outcomes in suspected ACS and aimed to assess the incremental reclassification performance if ESI is supplemented with a clinically validated tool used to risk-stratify suspected ACS.MethodsWe used existing data from an observational cohort study of patients with chest pain. We extracted ESI scores documented by triage nurses during routine medical care. Two independent reviewers adjudicated the primary outcome, incidence of 30-day major adverse cardiac events. We compared ESI with the well-established modified HEAR/T (patient History, Electrocardiogram, Age, Risk factors, but without Troponin) score.ResultsOur sample included 750 patients (age, 59 ± 17 years; 43% female; 40% black). A total of 145 patients (19%) experienced major adverse cardiac event. The area under the receiver operating characteristic curve for ESI score for predicting major adverse cardiac event was 0.656, compared with 0.796 for the modified HEAR/T score. Using the modified HEAR/T score, 181 of the 391 false positives (46%) and 16 of the 19 false negatives (84%) assigned by ESI could be reclassified correctly.ConclusionThe ESI score is poorly associated with serious outcomes in patients with suspected ACS. Supplementing the ESI tool with input from other validated clinical tools can greatly improve the accuracy of triage in patients with suspected ACS.
A Survey of Stress and Burnout in Forensic Mental Health Nursing
Authors: Newman Claire , Jackson Jane , Macleod Shona , Eason Michelle 
Published: January 2020

ABSTRACT

Background
Although it is known that forensic mental health nurses (FMHNs) work in a stressful environment, their experience of stress and burnout remains largely unexplored.

Aim
The study aimed to measure levels of burnout and workplace stressors experienced by FMHNs.

Methods
A survey of 205 FMHNs was undertaken. Respondents completed the Maslach Burnout Inventory and the Nursing Stress Scale.

Findings
Fifty-seven FMHNs completed the survey, representing a response rate of 27.8%. Only five respondents (8.8%) experienced high levels of burnout across all three Maslach Burnout Inventory subscales. The most reported workplace stressors were related to “workload,” “conflict with other nurses,” and “conflict with physicians.” A correlation between total Nursing Stress Scale score and both “emotional exhaustion” and “cynicism” were found (r = 0.45, p < 0.001, and r = 0.34, p < 0.011, respectively), indicating that FMHNs who reported higher workplace stress are at an increased risk of burnout.

Conclusion
Most FMHNs in the current study experienced moderate levels of burnout, although they continued to feel self-assured in their practice and found their work rewarding. Consistent with other nursing populations, the FMHNs in this study reported feeling stressed by their workload and as the result of conflict with other nurses and physicians.

Implications for Clinical Forensic Nursing Practice
Reduced well-being, associated with stress and burnout, may lead to increased absences from work and the delivery of poor-quality forensic mental health consumer care. The implementation of staff well-being strategies is recommended to address stress and burnout in FMHNs.
Experiences of Family Violence Committed by Relatives With Severe Mental Illness: A Grounded Theory
Authors: Paradis-Gagné Etienne , Holmes Dave , Perron Amélie 
Published: January 2020

ABSTRACT
In forensic psychiatry, family violence perpetrated by a loved one suffering from severe mental illness is a significant problem thought to affect nearly half of families. To examine this poorly documented issue, a qualitative study using a grounded theory research strategy was conducted with family members who have experienced violence committed by a relative with severe mental illness. Semistructured interviews were conducted with 14 participants who had experienced this type of violence. The works of poststructuralist thinkers Jacques Donzelot and Michel Foucault inform the theoretical framework. Qualitative analysis of the data led to the emergence of five major themes: medicolegal apparatus, experience of violence, family's responsibility toward the violent relative, exclusion and stigmatization, and suffering and resilience. The main results of this qualitative study indicate that families are governed through specific mechanisms, including instrumentalization of the family's role and transfer of the violent person's care to the family. Obstacles preventing families from being included in their relative's care were also raised. This research contributes to nursing by shedding light on clinical interventions and health policy in family care. It also offers insight into the provision of appropriate quality care in particularly complicated family situations.
Respiratory Diseases in Post-9/11 Military Personnel Following Southwest Asia Deployment
Authors: Krefft Silpa D. , Wolff Jenna , Zell-Baran Lauren , Strand Matthew , Gottschall Eva Brigitte , Meehan Richard , Rose Cecile Stephanie 
Published: January 2020

Objective:
Persistent respiratory symptoms following post-9/11 military deployment to Iraq and Afghanistan are well-recognized, but the spectrum of respiratory diseases remains poorly characterized. This study describes deployment-related respiratory diseases and the diagnostic utility of resting and exercise pulmonary function testing.

Methods:
Between 2009 and 2017, 127 consecutive military workers (“deployers”) with new-onset respiratory symptoms underwent clinical evaluation. Deployment-related respiratory diseases were classified as proximal and/or distal. Using descriptive statistics and logistic regression, we analyzed lung function parameters associated with deployment-related distal lung disease (DDLD).

Results:
Common deployment-related respiratory diseases included asthma (31.5%), intermittent laryngeal obstruction (14.2%), rhinosinusitis (15%), and DDLD (68.5%). Decreased diffusion capacity (odds ratio [OR] = 4.6, 95% confidence interval [CI]: 1.4 to 15.1, P = 0.01) was significantly associated with DDLD.

Conclusions:
A comprehensive diagnostic approach may identify a spectrum of proximal and distal respiratory diseases that can occur in symptomatic post-9/11 deployers, requiring a personalized approach to care.
Alterations of chromosome 3p in 24 cases of gastrinomas and their correlations with clinicopathological and prognostic features
Authors: Chen Yuan-Jia , Ojeaburu Jeremiah V. , Vortmeyer Alexander , Yu Shuang , Jensen Robert T. 
Published: January 2020

Abstract

Purpose:
The pathogenesis of gastrinomas is largely unknown, and there is a lack of reliable genetic determinants that are useful to distinguish malignant and benign forms of this tumor or predict the prognosis of patients with this disease. Loss of heterozygosity (LOH) on chromosome 3p is reported to occur in pancreatic neuroendocrine tumors (PNETs) as well as in non-PNETs and its presence is reported to correlate with tumor prognosis in non-endocrine tumors. However, little data are available from prospective studies on gastrinomas.

Experimental design:
We assessed occurrence of 3p LOH in 24 gastrinomas and correlated its presence with tumor biological behavior and other clinicopathological features of gastrinomas.

Results:
Either 3p LOH or microsatellite instability involving 3p occurred in 11 of 24 tumors (46%). Seven (29%) gastrinomas had 3p LOH. Of the 7 gastrinomas with 3p LOH, 5 (71%) had 3p12 LOH with the marker D3S2406, which was the shortest region of highest overlap (SRO). Chromosome 3p LOH was not associated with aggressive biological behavior of gastrinomas or with poor prognosis of patients with gastrinoma. Similarly, 3p12 LOH (SRO) was not correlated with aggressive growth of tumors and/or liver metastases.

Conclusion:
Gastrinomas have a relative high frequency of 3p12 LOH suggesting this area may harbor putative tumor suppressor gene(s), which may play a role in the tumorigenesis, but not aggressiveness, of a subset of these tumors.