bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quadruple Versus Double Flexible Intramedullary Nails to Treat Pediatric Distal-third Tibial Shaft Fractures: A Biomechanical Comparison
Authors: Zubair Adnan , Samuelson Eric M. , Morris Randal P. , Foreman Mark , Gagnon-Bartsch Johann A. , Rosenfeld Scott B. 
Published: June 2020

Background:
The vast majority of pediatric distal-third tibial shaft fractures can be treated with closed reduction and casting. If conservative measures fail, then these fractures are usually treated with 2 antegrade flexible intramedullary nails. A postoperative cast is usually applied because of the tenuous fixation of the 2 nails. Recent studies have described the use of 4 nails to increase the stability of the fixation, a technique that may preclude the need for postoperative casting. The purpose of this biomechanical study is to quantify the relative increase in stiffness and load to failure when using 4 versus 2 nails to surgically stabilize these fractures.

Methods:
Short, oblique osteotomies were created in the distal third of small fourth-generation tibial sawbones and stabilized with 2 (double) or 4 (quadruple) flexible intramedullary nails. After pilot testing, 5 models per fixation method were tested cyclically in axial compression, torsion, and 4-point bending in valgus and recurvatum. At the end of the study, each model was loaded to failure in valgus. Stiffness values were calculated, and yield points were recorded. The data were compared using Student’s t tests. Results are presented as mean±SD. The level of significance was set at P≤0.05.

Results:
Stiffness in valgus 4-point bending was 624±231 and 336±162 N/mm in the quadruple-nail and double-nail groups, respectively (P=0.04). There were no statistically significant differences in any other mode of testing.

Conclusions:
The quadruple-nail construct was almost 2 times as stiff as the double-nail construct in resisting valgus deformation. This provides biomechanical support for a previously published study describing the clinical success of this fixation construct.
Electronic Consultation Systems: Impact on Pediatric Orthopaedic Care
Authors: Chang Youjin , Carsen Sasha , Keely Erin , Liddy Clare , Kontio Ken , Smit Kevin 
Published: June 2020

Background:
The demand for pediatric orthopaedic surgery consultation has grown rapidly, leading to longer wait times for elective consultation in some regions. Some specialties are addressing this increased demand through electronic consultation services. We wanted to examine the impact of pediatric orthopaedic e-consultations in Canada’s Eastern Ontario region.

Methods:
We developed a cross-sectional study of all the cases directed to a pediatric orthopaedic surgery specialist using the Champlain Building Access to Specialists through eConsultation (BASE) eConsult service over a 2-year period and examined their impact on in-person referrals, time of e-consultation and primary care satisfaction as well as types of clinical questions that were asked.

Results:
Electronic consultations avoided in-person appointments in 68% of the submitted cases. The median response by specialists received by the primary care providers (PCPs) was <20 hours. A total of 69% of consultations involve >1 type of clinical questions, most commonly about basic trauma/fracture care and management recommendations. Ninety-seven percent of the PCPs found the overall value for the care of the patients to be good or excellent.

Conclusions:
This cross-sectional study demonstrates the effective and timely use of eConsult in pediatric orthopaedic surgery. It also shows a significant reduction in the number of in-person consultations required and demonstrates a high satisfaction rate by PCPs using the service.

Clinical Relevance:
In addition to the efficacy and time-sensitive care provided to the patients, the study shows that, professionally, 89% of PCPs found this service to be excellent or good. The broader implications of electronic consultation on overall quality of care, population health, and patient satisfaction requires further investigation.
Consequences and Solutions for the Impact of Communication Impairment on Noninvasive Ventilation Therapy for Acute Respiratory Failure: A Focused Review
Authors: Wong An-Kwok Ian , Cheung Patricia C. , Happ Mary Beth , Gay Peter C. , Collop Nancy A. 
Published: June 2020

Objectives:
With over 2 million cases of acute respiratory failure in the United States per year, noninvasive ventilation has become a leading treatment modality, often supplanting invasive mechanical ventilation as the initial treatment of choice. Most acute respiratory failure patients use a full face (oronasal) mask with noninvasive ventilation, which is known to impair communication, but its popularity and benefit has led many providers to accept the communication impairment. Medical staff periodically remove masks to communicate with patients, but patients are often limited to short utterances and risk lung derecruitment upon removal of positive pressure. These problems can lead to noninvasive ventilation failure, which is often linked to worse outcomes than first initiating invasive mechanical ventilation and can lead to increased hospitalization costs.

Data Sources:
We searched MEDLINE and Google Scholar for “speech,” “communication,” “impairment,” “failure,” “complications,” “NIPPV,” “NIV,” and “noninvasive ventilation.”

Study Selection:
We included articles with patients in acute respiratory failure. We excluded articles for patients using noninvasive ventilation therapy for obstructive sleep apnea.

Data Synthesis:
Communication impairment has been associated with increasing noninvasive ventilation anxiety (odds ratio, 1.25). Of patients using noninvasive ventilation, 48% require early discontinuation, 22% refuse noninvasive ventilation, and 9% are ultimately intubated. Improvements to communication have been shown to reduce fear and anxiety in invasive mechanical ventilation patients. Analogous communication problems exist with effective solutions in other fields, such as fighter pilot masks, that can be easily implemented to enhance noninvasive ventilation patient care, increase adherence to noninvasive ventilation treatment, and improve patient outcomes.

Conclusions:
Communication impairment is an underappreciated cause of noninvasive ventilation complications and failure and requires further characterization. Analogous solutions—such as throat microphones and mask-based microphones—that can be easily implemented show potential as cost-effective methods to reduce noninvasive ventilation failure.
Design for Implementation of a System-Level ICU Pandemic Surge Staffing Plan
Authors: Harris Gavin H. , Baldisseri Marie R. , Reynolds Benjamin R. , Orsino Antoinette S. , Sackrowitz Rachel , Bishop Jonathan M. 
Published: June 2020

Background:
The current coronavirus disease 2019 pandemic is causing significant strain on ICUs worldwide. Initial and subsequent regional surges are expected to persist for months and potentially beyond. As a result of this, as well as the fact that ICU provider staffing throughout the United States currently operate at or near capacity, the risk for severe and augmented disruption in delivery of care is very real. Thus, there is a pressing need for proactive planning for ICU staffing augmentation, which can be implemented in response to a local surge in ICU volumes.

Methods:
We provide a description of the design, dissemination, and implementation of an ICU surge provider staffing algorithm, focusing on physicians, advanced practice providers, and certified registered nurse anesthetists at a system-wide level.

Results:
The protocol was designed and implemented by the University of Pittsburgh Medical Center’s Integrated ICU Service Center and was rolled out to the entire health system, a 40-hospital system spanning Pennsylvania, New York, and Maryland. Surge staffing models were developed using this framework to assure that local needs were balanced with system resource supply, with rapid enhancement and expansion of tele-ICU capabilities.

Conclusions:
The ICU pandemic surge staffing algorithm, using a tiered-provider strategy, was able to be used by hospitals ranging from rural community to tertiary/quaternary academic medical centers and adapted to meet specific needs rapidly. The concepts and general steps described herein may serve as a framework for hospital and other hospital systems to maintain staffing preparedness in the face of any form of acute patient volume surge.
Attentional Bias Assessed With Event-Related Potentials in Long-term Hypnotic Users
Authors: Yang Chien-Ming , Lin Yu-Siou , Tu Alice Yuting , Huang Ya-Chuan , Sung Jia-Ying 
Published: June 2020

Abstract

Purpose/Background
Attentional bias toward drug-related cues is considered to be an indication of neurocognitive processes associated with drug dependence. While this phenomenon has been shown in other addictive substances, whether hypnotic medication would lead to similar processes remains an issue to be investigated. The present study examined attentional bias toward drug-related cues in long-term hypnotic users and the effect of negative affect on this process.

Methods/Procedures
Thirteen long-term hypnotic users participated in this study. They spent 2 nights in the sleep laboratory: a mood-induction night and a neutral night. Attentional bias was measured through the recording of event-related potentials using a cue-reactivity paradigm; subjective craving for hypnotics was assessed using a single-item rating scale, and negative affect was measured using the Positive and Negative Affect Schedule.

Findings/Results
The results showed that the amplitudes of P300 and slow positive wave for hypnotic-related and sleep-related photographs were significantly higher than those for neutral photographs in both conditions. Negative mood induction did not significantly increase attentional bias.

Implications/Conclusions
The findings provide preliminary evidence that long-term hypnotic users do have attentional bias for hypnotic-related photos, suggesting the possibility of neurocognitive processes associated with drug dependence. However, the results did not show higher attentional bias under negative mood, suggesting that the use of hypnotics is not reinforced by the desire to eliminate negative affect. Because of the limited sample size and lack of a control group, the results should be considered as preliminary findings that call for future studies to further investigate this issue.
Longitudinal Immune Phenotype Assessment and Serological Outcome in Foreign‐born Children With Chronic Hepatitis B
Authors: Nicastro Emanuele , Mangili Benedetta , Giacomet Vania , Benincaso Anna Rita , Di Giorgio Angelo , Sansotta Naire , Callegaro Annapaola , D’Antiga Lorenzo 
Published: June 2020

ABSTRACTObjectives:The aim of the study was to assess changes in clinical phenotype, and identify determinants of outcome in children with chronic hepatitis B virus (HBV) infection born in HBV‐endemic countries followed in 2 Italian tertiary care centers after immigration or adoption.Methods:A prospective observational study on hepatitis B e‐antibodies–negative chronic hepatitis B children started on 2002. Patients with liver fibrosis, or those needing antiviral treatment were excluded. Immune active patients were defined those with raised transaminases (alanine aminotransferase > 40 IU/L), immune tolerants those having normal alanine aminotransferase, both exhibiting substantial viral replication (HBV DNA >2000 IU/mL).Results:Sixty‐nine patients (44 boys, median age 4.7 years) had a median follow‐up of 53 months. At entry, 18 (26%) children were immune tolerant, 47 (68%) immune active, and 4 had indeterminant immune status. At last follow‐up, 14 (78%) of the immune‐tolerant patients remained so, whereas only 23 (49%) of the immune active children maintained their initial immune phenotype. Seroconversion to hepatitis B e antibodies (SCHBe) occurred in only 2 (11%) immune tolerants, whereas 13 (28%) immune active patients achieved SCHBe.Ethnicity was the only feature independently correlated to SCHBe: Asian origin reduced by 4.1 times the probability of SCHBe (Asian vs other; odds ratio = 0.24 [95% confidence interval = 0.07–0.76]; P = 0.016) compared to other ethnicities, whereas viral genotype did not influence the outcome.Conclusions:Ethnicity and immune status phenotype against HBV, rather than HBV genotype, are the main determinants of SCHBe in foreign‐born children with chronic HBV infection.
Effect of Tactile Experience During Preterm Infant Feeding on Clinical Outcomes
Authors: Pickler Rita H. , Meinzen-Derr Jareen , Moore Margo , Sealschott Stephanie , Tepe Karin 
Published: June 2020

Background
Although the survival rate of very preterm infants has improved, rates of subsequent neurobehavioral disabilities remain high. One factor implicated in poor neurobehavioral and developmental outcomes is hospitalization and inconsistent caregiving patterns in the neonatal intensive care unit. Although much underlying brain damage occurs in utero or shortly after birth, neuroprotective strategies may stop progression of damage, particularly when these strategies are used during the most sensitive periods of neural plasticity 2–3 months before term age.

Objective
The purpose of this analysis was to test the effect of a patterned feeding experience involving a tactile component (touch and/or holding) provided during feedings on preterm infants’ clinical outcomes, measured by oral feeding progress, as an early indicator of neurodevelopment.

Methods
We used an experimental, longitudinal, two-group random assignment design. Preterm infants (n = 120) were enrolled within the first week of life and randomized to an experimental group receiving a patterned feeding experience or to a control group receiving usual feeding care.

Results
Analysis of data from 91 infants showed that infants receiving touch at more than 25% of early gavage feedings achieved full oral feeding more quickly; as touch exposure increased, time from first oral to full oral feeding decreased. There was no association between holding during early gavage feedings or touch during transition feedings and time to full oral feeding.

Discussion
Neurological expectation during critical periods of development is important for infants. However, a preterm infant’s environment is not predictable: Caregivers change regularly, medical procedures dictate touch and holding, and care provision based on infant cues is limited. Current knowledge supports caregiving that occurs with a naturally occurring sensation (i.e., hunger), is provided in a manner that is congruent with the expectation of the neurological system, and occurs with enough regularity to enhance neuronal and synaptic development. In this study, we modeled an experience infants would “expect” if they were not in the neonatal intensive care unit and demonstrated a shorter time from first oral feeding to full oral feeding, an important clinical outcome with neurodevelopmental implications. We recommend further research to determine the effect of patterned caregiving experiences on other areas of neurodevelopment, particularly those that may occur later in life.
Do Health Care Providers Pay Attention to Sharing Hospital Patient Safety Incidents Through Social Media in Saudi Arabia?
Authors: Alanzi Turki , Alfuraikh Alhanouf 
Published: June 2020

Purpose
The aim of this study was to find out if health care providers in Saudi Arabia used social media to share the safety incidents that occurred in hospitals.

Participants and Methods
To carry out this study, we conducted a survey using a valid and reliable questionnaire that was distributed through WhatsApp groups by means of a link to a sample of 450 health care providers in Saudi Arabia. The response rate was 33.55%, and 151 respondents answered the questionnaire. The survey was carried out in January 2019. The data were analyzed using basic descriptive statistics.

Results
More than half of the respondents (54%) were female, and 68% of them were younger than 40 years. Also, 42% of the participants had a bachelor’s degree, and 57% were working in the health care quality field. The participants used the following social media: WhatsApp (21%), Twitter (17%), YouTube (15%), Snapchat (13%), LinkedIn (12%), and Instagram (12%). They used these networks for education and professional development (24%), networking (23%), self-promotion (16%), employment (15%), sharing incidents that affect patient safety (11%), and health promotion (11%). Besides, 60% of the participants reported safety incidents that occurred in hospitals, and 72% of them did not agree to share these incidences through social media. In addition, 82% of participants thought that social networks were beneficial to obtain knowledge about quality of patient care.

Conclusions
The findings of this research showed that most health care providers in Saudi Arabia considered that safety incidents that occur in hospitals should not be shared through social media because they affect the policies and privacy of hospitals, patients, and personnel. However, most of the respondents believed that social media could contribute to improving the quality of patient attention and thought that WhatsApp and Twitter could be the most useful social media for these purposes.
High-Alert Medication Stratification Tool—Revised Phase II: A Multisite Study Examining the Validity, Interrater Reliability, and Ease of Use of the High-Alert Medication Stratification Tool—Revised
Authors: Shenk McKenzie R. , Washburn Natalie C. , Stephens Sarah S. , Burger Gregory P. , Curtis James M. , Henney Jessalynn K. , McCarthy Jamie L. , Degenkolb Kerri E. , Fritschle Andrew C. , Macik Monica R. , Dossett Heather A. , Walroth Todd A. 
Published: June 2020

Objectives
The primary objective of this multisite study, High-Alert Medication Stratification Tool—Revised (HAMST-R) phase II, was to assess the content validity of HAMST-R. Secondary outcomes included interrater reliability and ease of use.

Methods
HAMST-R was designed as an objective tool to evaluate high-alert medications (HAMs) at a single site during HAMST-R Phase I. Medication safety experts from 7 health systems across the United States volunteered to participate in this phase II study. Participants completed a demographic survey, oversaw evaluation of 47 HAMs and 35 non-HAMs using HAMST-R, and submitted scores for each medication evaluated. In addition, participants rated each question of HAMST-R on its relevance to assess a medication’s safety risk, measured as scale-content validity index. Positive and negative predictive values were evaluated in a post hoc analysis. Interrater reliability was evaluated using the Kendall coefficient of concordance (K), and ease of use was assessed using a mixed-methods approach.

Results
Scale-content validity index was 0.80, indicating that the tool was valid. Positive predictive value was 90.5% (95% confidence interval, 87.2%–93.0%), and negative predictive value was 98.2% (95% confidence interval, 95.4%–99.3%). A score of 4 or more differentiated between HAMs and non-HAMs, confirming phase I findings. K was 0.56, indicating moderate agreement. Participants confirmed that the tool was easy to use and plan to incorporate the tool into HAM policies and procedures, formulary review, and safety strategy implementation.

Conclusions
HAMST-R is a valid, objective, and easy to use method that institutions may implement to evaluate a medication’s potential safety risk.
Neutrophil-to-Lymphocyte Ratio and Outcomes in Louisiana COVID-19 Patients
Authors: Tatum Danielle , Taghavi Sharven , Houghton August , Stover Jacob , Toraih Eman , Duchesne Juan 
Published: June 2020

ABSTRACT

Background:
Due to the rapidly escalating number of cases and the low baseline of overall health in Louisiana, we sought to determine the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in hospitalized COVID patients in two major metropolitan areas with the highest prevalence of cases and exceedingly high rates of obesity and other comorbid conditions. We hypothesized that elevated NLR would be a prognostic indicator of mortality.

Methods:
This was a review of a prospective registry of adult (18+ years) hospitalized Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) patients from two large urban safety net hospitals in Louisiana. Blood cell counts at days 2 and 5 were used to obtain NLR. Receiver operating characteristic curve analysis assessed predictive capacity of NLR on mortality. Kaplan–Meier survival analysis and Cox regression models examined the effect of NLR on survival.

Results:
The study population of 125 patients was majority African American (88.6%) and female (54.8%) with a mean age and body mass index of 58.7 years and 34.2. Most (96.0%) had comorbidities of which hypertension (72.0%), obesity (66.7%), and diabetes (40.0%) were the most common. Mortality was 18.4%. NLR > 4.94 on day 1 predicted intubation (P = 0.02). NLR above established cutoff values on hospital days 2 and 5 each significantly predicted mortality (P < 0.001 and P = 0.002, respectively).

Conclusions:
NLR is a prognostic factor for endotracheal intubation upon hospital admission and independent predictor for risk of mortality in SARS-CoV-2 patients on subsequent hospital days. Clinical research efforts should examine effects of strategies such as arginase inhibition alone and/or inhaled nitric oxide to ameliorate the effects of elevated NLR.
The Clinical Application of a Self-developed Gasless Laparoendoscopic Operation Field Formation Device on Patients Undergoing Cholecystectomy
Authors: Hu Hai , Zhao Gang , Zhang Kai , Cai Hao , Jiang Zhaoyan , Huang Anhua , Cai Jingli , Xu Anan , Li Haidong , He Chuanqi 
Published: June 2020

Background:
We have designed a new gasless laparoscopic operation field formation (LOFF) device for cholecystectomy which was successfully tested on animal model. The goal of this study is to investigate the feasibility, safety and effectiveness of this LOFF device on patients undergoing cholecystectomy.

Methods:
Patients with cholecystolithiasis or gallbladder polyps who underwent single port cholecystectomy from June 2015 to May 2016 were retrospectively reviewed. Either the LOFF-assisted laparoendoscopic single-port surgery (LESS) (LOFF-LESS) or the traditional LESS was performed. Operation time, intraoperative bleeding, postoperative hospital stay, surgical complications, incision pain score, shoulder and back pain and cosmetic satisfaction were compared.

Results:
A total of 186 patients were included in this study, with 79 in the LOFF-LESS group and 107 in the LESS group. There was no significant difference between LOFF-LESS group and LESS group in operation field establishment time, cholecystectomy time, intraoperative bleeding, postoperative hospital stay, incision pain and cosmetic satisfaction. A lower intraoperative arterial carbon dioxide pressure was documented in the LOFF-LESS group (P<0.01). The incidence of postoperative shoulder and back pain was significantly lower in LOFF-LESS group (P<0.01).

Conclusion:
LOFF-LESS has comparable benefits of traditional LESS; it deceases incidence of pneumoperitoneum related complications as well.