bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serum-Associated Antibiotic Tolerance in Pediatric Clinical Isolates of Pseudomonas aeruginosa
Authors: Morrison John M , Chojnacki Michaelle , Fadrowski Jeffrey J , Bauza Colleen , Dunman Paul M , Dudas Robert A , Goldenberg Neil A , Berman David M 
Published: December 2019

Abstract

Background
When grown in human serum, laboratory isolates of Pseudomonas aeruginosa exhibit tolerance to antibiotics at inhibitory concentrations. This phenomenon, known as serum-associated antibiotic tolerance (SAT), could lead to clinical treatment failure of pseudomonal infections. Our purpose in this study was to determine the prevalence and clinical impact of SAT in Pseudomonas isolates in hospitalized children.

Methods
The SAT phenotype was assessed in patients aged &lt;18 years admitted with respiratory or blood cultures positive for P. aeruginosa. The SAT phenotype was a priori defined as a ≥2-log increase in colony-forming units when grown in human serum compared with Luria-Bertani medium in the presence of minocycline or tobramycin.

Results
SAT was detected in 29 (64%) patients. Fourteen patients each (34%) had cystic fibrosis (CF) and tracheostomies. Patient demographics and comorbidities did not differ by SAT status. Among CF patients, SAT was associated with longer duration of intravenous antibiotics (10 days vs 5 days; P &lt; .01).

Conclusions
This study establishes that SAT exists in P. aeruginosa from human serum and may be a novel factor that contributes to differences in clinical outcomes. Future research should investigate the mechanisms that contribute to SAT in order to identify novel targets for adjunctive antimicrobial therapies.
Relationship Between Shoulder Impingement Syndrome and Thoracic Posture
Authors: Hunter Donald J , Rivett Darren A , McKeirnan Sharmain , Smith Lyn , Snodgrass Suzanne J 
Published: December 2019

Abstract

Background
Shoulder impingement syndrome (SIS) is the most common form of shoulder pain and a persistent musculoskeletal problem. Conservative and invasive treatments, aimed at the shoulder joint, have had limited success. Research suggests shoulder function is related to thoracic posture, but it is unknown whether thoracic posture is associated with SIS.

Objective
The objective of this study was to investigate whether there is a relationship between SIS and thoracic posture.

Design
This was a case control study.

Methods
Thoracic posture of 39 participants with SIS and 39 age-, gender-, and dominant arm-matched controls was measured using the modified Cobb angle from a standing lateral radiograph. Thoracic range of motion (ROM) was also measured using an inclinometer. Between-group differences were compared using t tests. The relationship between thoracic posture and thoracic ROM was determined with linear regression.

Results
Twenty women and 19 men with SIS (mean age = 57.1 years, SD = 11.1) and 39 age-matched, gender-matched, and dominant arm-matched controls (mean age = 55.7years, SD = 10.6) participated. Individuals with SIS had greater thoracic kyphosis (mean difference = 6.2o, 95% CI 2.0–10.4) and less active thoracic extension (7.8o, 95% CI = 2.2–13.4). Greater thoracic kyphosis was associated with less extension ROM (ie, more flexion when attempting full extension: β = 0.71, 95% CI = 0.45–0.97).

Limitations
These cross-sectional data can only demonstrate association and not causation. Both radiographic measurements and inclinometer measurements were not blinded.

Conclusion
Individuals with SIS had a greater thoracic kyphosis and less extension ROM than age- and gender-matched healthy controls. These results suggest that clinicians could consider addressing the thoracic spine in patients with SIS.
Trustee residual obligation: no basis for it
Authors: Davern Ray 
Published: December 2019

Abstract
This article discusses the recent decision of the Hong Kong Court of Final Appeal in Zhang Hong Li and others v DBS Bank (Hong Kong) Limited and others that has rejected the idea of a ‘residual’ or ‘high-level supervisory’ obligation upon trustees and accordingly endorsed the effectiveness of a well-drawn anti-Bartlett clause that sought to exclude any obligation upon the trustee to intervene in the management of an underlying company other than in the case of actual knowledge of dishonesty.
Correction and Control of Hyperammonemia in Acute Liver Failure: The Impact of Continuous Renal Replacement Timing, Intensity, and Duration
Authors: Warrillow Stephen , Fisher Caleb , Bellomo Rinaldo 
Published: December 2019

Objectives:
Hyperammonemia is a key contributing factor for cerebral edema in acute liver failure. Continuous renal replacement therapy may help reduce ammonia levels. However, the optimal timing, mode, intensity, and duration of continuous renal replacement therapy in this setting are unknown. We aimed to study continuous renal replacement therapy use in acute liver failure patients and to assess its impact on hyperammonemia.

Design:
Retrospective observational study.

Setting:
ICU within a specialized liver transplant hospital.

Patients:
Fifty-four patients with acute liver failure.

Interventions:
Data were obtained from medical records and analyzed for patient characteristics, continuous renal replacement therapy use, ammonia dynamics, and outcomes.

Main Results:
Forty-five patients (83%) had high grade encephalopathy. Median time to continuous renal replacement therapy commencement was 4 hours (interquartile range, 2–4.5) with 35 (78%) treated with continuous venovenous hemodiafiltration and 10 (22%) with continuous venovenous hemofiltration. Median hourly effluent flow rate was 43 mL/kg (interquartile range, 37–62). The median ammonia concentration decreased every day during treatment from 151 µmol/L (interquartile range, 110–204) to 107 µmol/L (interquartile range, 84–133) on day 2, 75 µmol/L (interquartile range, 63–95) on day 3, and 52 µmol/L (interquartile range, 42–70) (p < 0.0001) on day 5. The number of patients with an ammonia level greater than 150 µmol/L decreased on the same days from 26, to nine, then two, and finally none. Reductions in ammonia levels correlated best with the cumulative duration of therapy hours (p = 0.03), rather than hourly treatment intensity.

Conclusions:
Continuous renal replacement therapy is associated with reduced ammonia concentrations in acute liver failure patients. This effect is related to greater cumulative dose. These findings suggest that continuous renal replacement therapy initiated early and continued or longer may represent a useful approach to hyperammonemia control in acute liver failure patients.
Plasma lipid concentrations and survival in geriatric population
Authors: Wang Mu-Cyun , Hu Hsiao-Yun , Lin I-Feng , Chuang Jhih-Tung 
Published: December 2019

Abstract
Plasma lipids in mid-life are important predictors for cardiovascular events and deaths. However, the association between plasma lipid concentrations and mortality in late life is controversial. Recent studies showed that older people with extremely low total cholesterol (TC) have poor survival outcome, but this conclusion was drawn mostly from Western cohorts. Our study investigated association between plasma lipid concentrations and mortality in Taiwanese elderly population.
A retrospective cohort study was conducted among the 69,824 elderly people who participated in the Taipei City Geriatric Health Examination between 2006 and 2010, with a mean follow-up of 3.6 years. The measurements of TC, high density lipoprotein (HDL) and triglycerides were obtained from the records of the participants. Low density lipoprotein (LDL) was calculated using Friedewald formula in 69,088 participants. All lipid components were categorized into quartiles. Males and females were analyzed separately using multivariate Cox proportional hazards models.
The elderly with the lowest quartile of TC (<175 mg/dL), HDL cholesterol (<43 mg/dL) and LDL cholesterol (<100.4 mg/dL) were at higher risk of all-cause mortality. Older females with the lowest quartile of TC and LDL cholesterol had higher cardiovascular mortality. Older females with the lowest quartile of HDL had higher mortality from cardiovascular and cerebrovascular diseases.
We concluded that TC, mostly attributed to LDL cholesterol, was inversely related to all-cause mortality. HDL remained to be protective against both cardiovascular and stroke mortality in older females. The target levels of plasma lipids in people older than 65 years should be different from that in younger adults.
Chronic mesh infection complicated by an enterocutaneous fistula successfully treated by infected mesh removal and negative pressure wound therapy
Authors: Liu Hongquan , Liu Xiaochun , Zheng Guofu , Ye Bo , Chen Weiqing , Xie Hailiang , Liu Yunqiang , Guo Yi 
Published: December 2019

Abstract

Rationale:
Tension-free repair of inguinal hernia with prosthetic materials in adults has become a routine surgical procedure. However, serious complications may arise such as mesh displacement, infection, and even enterocutaneous fistula (EF). The management of chronic mesh infection (CMI) complicated by an EF is very challenging. A simple treatment of infected mesh removal and negative pressure wound therapy (NPWT) may cure the patients with EF with CMI.

Patient concerns:
A 75-year-old male patient underwent tension-free treatment for a bilateral inguinal hernia at a county hospital 10 years ago. Three months before admission, the right groin gradually formed a skin sinus with outflow of fetid thin pus, and it could not heal.

Diagnoses:
The patient was diagnosed preoperatively with mesh plug adhesion to the intestine, which resulted in low-flow EF combined with CMI.

Interventions:
The patient received a simple treatment mode consisting of an incision made from the original incision, but the new incision did not penetrate the abdominal cavity; treatment included resection of the fistula, removal of the mesh, repair of the intestine and local tissue, and continuous irrigation of vacuum sealing drainage (VSD) devices for NPWT.

Outcomes:
The infected mesh was completely removed. Five VSD devices were utilized to treat the EF and wound. The time from intervention to wound healing was 35 days, and follow-up for 6 months revealed no infection and no hernia recurrence in the right groin.

Lessons:
The NPWT is effective in treating CMI concomitant with EF and does not increase the risk of hernia recurrence.
Co-infection with Strongyloides stercoralis hyperinfection syndrome and Klebsiella in a nephrotic syndrome patient
Authors: Wang Wei-Li , Zhang Qi-Wu , Tang Sha , Chen Feng , Zhang Jing-Bo 
Published: December 2019

Abstract

Rationale:
Patients with chronic Strongyloides stercoralis infection are usually asymptomatic; therefore, their condition is easily overlooked. In immunosuppressed patients, mortality is high because of disseminated infection and hyperinfection. This report describes a fatal S stercoralis hyperinfection in a patient with nephrotic syndrome after treatment with steroids.

Patient concerns:
A 70-year-old male presented with a history of progressive edema, skin infection, persistent fever, cough, intermittent abdominal pain, and progressive respiratory failure after steroid treatment.

Diagnosis:
Nephrotic syndrome; cellulitis; S stercoralis hyperinfection; Klebsiella pneumonia.

Interventions:
During the first hospital admission, the patient was administered full-dose glucocorticoid and antibiotic therapy after suffering from cellulitis. During the second admission, he was diagnosed and treated for normal digestive discomfort and a bacterial infection. The patient had progressive respiratory failure and was placed on a ventilator. He was immediately treated with albendazole when S stercoralis was found in samples of his sputum and feces.

Outcomes:
The patient died despite treatment with albendazole and antibiotic therapy.

Lessons:
It is essential to consider the possibility of S stercoralis infection in immunosuppressed patients with nephrotic syndrome. Given the lack of classic manifestations and high mortality rate of advanced disease, continuous monitoring, early diagnosis, and proper treatment are imperative.
Comparison of prevalence and associated risk factors of cognitive function status among elderly between nursing homes and common communities of China
Authors: Yang Li , Jin Xiaoqing , Yan Jing , Jin Yu , Xu Shanhu , Xu Ying , Liu Caixia , Yu Wei , Zheng Pinpin 
Published: December 2019

Abstract
Dementia among elderly is a serious problem worldwide. This study was conducted to estimate the prevalence and associated risk factors of dementia and mild cognitive impairment (MCI) in nursing homes (NHs) and common communities (CCs) among elderly in China.
A cross-sectional survey was conducted in 4 communities across 12 cities in Southern China from May to November of 2014. Qualified psychiatrists and trained nurses carried out relevant diagnosis, assessments, interviews, and information collection. Screening test of mini-mental state examination was conducted among participants firstly, then confirmed diagnosis was carried out among the ones with positive results. Student t test, χ test, univariate, and multivariate logistic regression analysis were conducted to analyze data.
A total of 2015 participants aged 65 or older were included in the final analysis; 908 came from NHs while 1107 came from CCs. The crude prevalence rates of dementia and MCI were 22.0% and 15.8%, respectively among all the participants. Dementia prevalence was 42.4% among those living in NHs, which was significantly higher than that of 5.3% in CCs (P < .0001). There were more moderate and severe dementia in NHs compared with CCs (P < .0001). It showed that older age, illiterate compared with high level of education (adjusted odds ratio, AOR = 3.32, 95% CI: 1.53–7.21), heavy drinking (AOR = 1.51 (1.00–2.24), having a medical history of diabetes (AOR = 1.41, 95% CI: 1.02–2.33), and stroke (AOR = 1.21, 95% CI: 1.01–1.23) were associated with dementia in NHs, and middle socioeconomic status might be a protective factor for dementia (AOR = 0.33, 95% CI: 0.21–0.51).
The problem of senile dementia in NHs is much more serious than our estimation, and there are not enough trained nursing staffs in NHs. More population-based strategies in NHs, including conducting cognitive screening accompanied with routine physical examination among elderly population, carrying out related primary prevention policies and public health services, and paying attention to some modifiable associated risk factors such as heavy smoking and drinking are needed.
Co-existence of well-differentiated fetal adenocarcinoma of the lung with tuberculosis in a young female
Authors: Guo Fengzhu , Wang Jiantao , Hu Haoyue , Xie Xiaoxiao , Liu Kuncheng , Luo Feng 
Published: December 2019

Abstract

Rationale:
Fetal adenocarcinoma of the lung (FLAC) with fetal lung-like morphology is a rare entity of pulmonary adenocarcinoma. Well-differentiated fetal adenocarcinoma (WDFA) belongs to its the low-grade form, which possesses a relatively favorable prognosis. Tuberculosis (TB) is an aggressive infectious disease that has been ranked as one of the top 10 causes of death worldwide. There may be a connection between the 2 and attention should be paid to the differential diagnosis.

Patient concerns:
A 28-year-old non-smoking female was admitted with signs of hemoptysis, and she had been coughing up phlegm for 5 years. The patient was previously diagnosed with TB in another hospital, and underwent an anti-TB regimen.

Diagnosis:
The co-existence of WDFA and TB was confirmed via histopathological evaluation of postoperative samples.

Interventions:
The patient was subjected to a right lower lobectomy together with a wedge resection of the right upper lobe using video-assisted thoracoscopic surgery, with systemic lymphadenectomy.

Outcomes:
The patient tolerated the surgical procedure well and underwent an uneventful postoperative course.

Lessons:
To our knowledge, no previous reports exist of cases with WDFA accompanied by TB. The present case indicated that a prior diagnosis of TB might predispose to lung cancer regardless of smoking history. It is also essential to distinguish WDFA from TB because of the similarity in clinical features and sites of pathological changes. Patients with WDFA usually have a better prognosis and surgery is the preferred treatment.
Threats to Patient Safety in the Inpatient Maternity Setting
Authors: O'Neill Loraine , Miller Lisa A. , Rohan Annie J. 
Published: December 2019

Abstract
As part of our special topics issue on inpatient maternity care, experts were asked to offer their thoughts about the main issues putting mothers and babies at risk in the maternity inpatient setting and what quality and safety practices may be beneficial in keeping them safe from harm. Each of the experts has a unique perspective. Loraine O'Neill was one of the original perinatal patient safety nurses who were established as part of an effort by a professional liability company to promote patient safety in birthing hospitals that they covered in several states (Will, Hennicke, Jacobs, O'Neill, & Raab, 2006). She now is the perinatal patient safety officer in a large academic medical center in New York City. Lisa Miller is a well-known expert on fetal assessment during labor, certified nurse midwife, attorney, educator, patient safety expert, and editor of a popular fetal monitoring textbook (Miller, Miller, & Cypher, 2020). She has taught fetal monitoring to nurses, midwives, and physicians in multidisciplinary groups all over the United States and consulted on numerous patient safety initiatives. Annie Rohan is a dual-certified neonatal and pediatric nurse practitioner with a 30-plus year clinical practice career with infants, children, and families facing critical and chronic illness. She is currently a healthcare researcher, and oversees advanced practice and doctoral nursing programs at SUNY Downstate Health Sciences University.
A Systematic Process for Evaluating Teaching Methods in Nursing Education
Authors: Thrower Eileen J. B. , Fay Rebecca , Cole Linda , Stone-Gale Vicky , Mitchell Angela , Tenney Erin , Smith Sarah , Swint Charlotte 
Published: December 2019

Background
An evidence-based process for the evaluation of teaching methods in nursing education, including classroom assignments, is not well described in the literature.

Problem
Nurse educators are familiar with evidence-based teaching but may be less knowledgeable about evidence-based methodologies to evaluate the effectiveness of teaching methods. Global measures of students' success, such as passing a licensing or certification examination, are often used as benchmarks for nursing education programs.

Approach
The authors suggest an evidence-based, 8-step evaluation process for evaluating the effectiveness of teaching methods. This process is demonstrated using simulation learning experiences in 2 courses in an advanced practice nursing education program.

Outcomes
The 8-step evaluation process was found to be effective for evaluating teaching methods within a graduate-level nursing education program.

Conclusions
The proposed evaluation process is applicable for evaluating teaching methods at all levels of nursing education. This systematic evaluation of teaching methods may ensure that students are engaged in learning activities leading to the attainment of assignment and course objectives.
Electrocardiographic Changes in Children With Acute Opioid Poisoning
Authors: Riasi Hamidreza , Rabiee Navid , Chahkandi Tayebeh , Arzanin Forough , Kafian Atary Siavash , Salehi Forod 
Published: December 2019

Objectives
Opioid poisoning in children is a common pediatric emergency in Iran. The emergence and spread of new synthetic opioids have come up with new consequences in case of toxicity. In this study, we aimed to evaluate electrocardiographic changes in children with acute opiate poisoning.

Methods
This cross-sectional study was performed on all children with opioid poisoning admitted to the emergency ward of Vali-e-Asr Hospital, Birjand, Iran, from December 2015 to February 2017. Data (demographics, manifestations, clinical course, and outcome) were collected using a predesigned checklist. An electrocardiogram (ECG) was obtained and evaluated for arrhythmias, corrected QT interval (QTc), and other ECG indices. Data were analyzed using SPSS version 21. A value of P less than 0.05 was considered statistically significant.

Results
A total of 85 children were enrolled in this study. Most of them were male (51.8%). The mean age of the patients was 3.46 ± 3.36 years. Among these children, 38.8% were poisoned with synthetic opioids (methadone). Mean QTc length was 399 ± 24 milliseconds in nonsynthetic opioid poisoning and 407 ± 66 milliseconds in methadone poisoning, and it was prolonged (>450 milliseconds) in 3.5% of cases. Other ECG changes were limited to 1 U wave formation (1.2%) that was detected in a patient with methadone poisoning.

Conclusions
Electrocardiogram changes due to acute opioid toxicity in children are not common, although in the case of methadone poisoning, long QT interval and associated arrhythmias should be anticipated. Moreover, because of life-threatening effects of opioids such as respiratory insufficiency and decreased consciousness, it is necessary to be prepared for these conditions.
Assessing the Utility of Urine Testing in Febrile Infants 2 to 12 Months of Age With Bronchiolitis
Authors: Elkhunovich Marsha A. , Wang Vincent J. , Pham Phung , Arpilleda Joyce C. , Clingenpeel Joel M. , Mansour Karim , Riech Teresa , Yen Ken , Liu Deborah R. 
Published: December 2019

Background
The utility of testing for urinary tract infection (UTI) in febrile infants with bronchiolitis is indeterminate.

Objective
The objective of this study was to investigate if the incidence of UTIs in febrile infants 2 to 12 months of age with bronchiolitis is higher than the presumed incidence of asymptomatic bacteriuria and determine risk factors associated with UTIs in this population.

Methods
This prospective multicenter cross-sectional study was conducted in the emergency departments of 6 children's hospitals between November 2011 and June 2015. We obtained a convenience sample of febrile infants with bronchiolitis 2 to 12 months of age who were tested for UTI. Patient characteristics analyzed included age, maximum temperature, duration of fever, ethnicity, sex, and circumcision status.

Results
A total of 442 patients (including 86 from a previously published pilot study) were enrolled. Mean age was 5.5 months, 65.2% were Latino, 50.9% were male, and 27.6% of male infants were circumcised. Urinary tract infections were found in 33 patients (7.69%, binomial; 95% confidence interval [CI], 5.19%–10.33%). Urinary tract infections were not related to age, height of temperature, duration of fever, or ethnicity. Uncircumcised males were significantly more likely to have UTIs than circumcised males (7.64% vs 0%, P = 0.03). Odds ratios (ORs) were lower for circumcised males but not uncircumcised males when compared with females (OR, 0.12; CI, 0.0–0.71; P = 0.01 vs OR, 0.77; CI, 0.33–1.74; P = 0.64).

Conclusions
Febrile infants 2 to 12 months of age with bronchiolitis have a clinically significant incidence of UTI, suggesting that UTI evaluation should be considered in these patients.