bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hospital Experiences of Young Adults With Congenital Heart Disease: Divergence in Expectations and Dissonance in Care
Authors: Kools Susan , Tong Elizabeth M. , Hughes Rene , Jayne Rae , Scheibly Kimberly , Laughlin Judith , Gilliss Catherine L. 
Published: November 2019

• Background Despite increasing survival for adults with congenital heart disease, little is known about hospitalization for young adult patients with this disease and for their families. Because of the complexity of the disease and its management during the life span, young adults are often hospitalized on both pediatric and adult units during a stay in the hospital.
• Objectives To explore the experience of hospitalization of young adults with congenital heart disease, the experience of their families, and the views of the nurses who cared for these patients and to generate substantive theory on interactions between patients, patients’ families, and nurses.
• Methods Semistructured interviews and naturalistic observations were conducted with young adults with congenital heart disease (mean age, 28.6 years), their family members, and nurses who cared for the patients during hospitalization (N = 34). Dimensional analysis was used to analyze interviews and field notes from observations.
• Results A grounded theory was derived, explaining how the hospital context and relationships between patients, patients’ families, and nurses affect patients’ hospital experiences. Expectations differed among the groups, leading to dissonance in care, as exemplified by role confusion and power struggles over control of care. This dissonance resulted in interpersonal conflict, distrust, anxiety, and dissatisfaction with the care and caring experiences.
• Conclusions Changes in hospital units, a better understanding of the healthcare needs of young adults with congenital heart disease, and acknowledgment of the expertise of patients and patients’ families are needed to improve nursing care for these patients and their families.
Practices and Predictors of Analgesic Interventions for Adults Undergoing Painful Procedures
Authors: Puntillo Kathleen A. , Wild Lorie Rietman , Morris Ann Bonham , Stanik-Hutt Julie , Thompson Carol Lynn , White Cheri 
Published: November 2019

• Background Research is limited on analgesic practices associated with the commonly performed procedures of turning, inserting central venous catheters, removing wound drains, changing dressings on nonburn wounds, suctioning the trachea, and removing femoral sheaths.• Objective To determine types of analgesics administered for procedures, the prevalence and amounts of drugs given, and factors predictive of analgesic administration.• Methods Pain was assessed before and immediately after procedures. Analgesic, sedative, and anesthetic agents administered within 1 hour before and/or during each procedure were noted.• Results A total of 5957 adult patients at 164 national and 5 international sites participated. Pain intensity increased at the time of procedure for all procedures. More than 63% of patients received no analgesics. Less than 20% received opiates; mean total dose of opiate was 6.44 mg (SD, 8.96 mg). Only 10% of patients received combination therapy. Factors associated with the likelihood of receiving opiates were pain intensity before a procedure, femoral sheath removal, being white, and the duration of a procedure. Patients less likely to receive opiates had a medical diagnosis or were having tracheal suctioning. Only 14.5% of the variance in the amount of opiate administered was explained by factors entered into multiple regression models. Type of procedure was the only significant predictor of amount of opiate administered.• Conclusions Most patients were not intentionally medicated even though pain intensity increased during their procedure. When used, analgesic amounts were low, and combination therapy was infrequent. Clinical trials are needed to evaluate optimal pain management for patients undergoing procedures.
Cardiac Outcomes After Myocardial Infarction in Elderly Patients With Diabetes Mellitus
Authors: Chyun Deborah , Vaccarino Viola , Murillo Jaime , Young Lawrence H. , Krumholz Harlan M. 
Published: November 2019

• Objective To examine the association between (1) comorbid conditions related to diabetes mellitus, clinical findings on arrival at the hospital, and characteristics of the myocardial infarction and (2) risk of heart failure, recurrent myocardial infarction, and mortality in the year after myocardial infarction in elderly 30-day survivors of myocardial infarction who had non–insulin- or insulin-treated diabetes.• Methods Medical records for June 1, 1992, through February 28, 1993, of Medicare beneficiaries (n = 1698), 65 years or older, hospitalized for acute myocardial infarction in Connecticut were reviewed by trained abstractors.• Results One year after myocardial infarction, elderly patients with non–insulin- and insulin-treated diabetes mellitus had significantly greater risk for readmission for heart failure and recurrent myocardial infarction than did patients without diabetes mellitus, and risk was greater in patients treated with insulin than in patients not treated with insulin. Diabetes mellitus, comorbid conditions related to diabetes mellitus, clinical findings on arrival, and characteristics of the myocardial infarction, specifically measures of ventricular function, were important predictors of these outcomes. Mortality was greater in patients not treated with insulin than in patients treated with insulin; the increased risk was mostly due to comorbid conditions related to diabetes mellitus and poorer ventricular function.• Conclusions Risk of heart failure, recurrent myocardial infarction, and mortality is elevated in elderly patients who have non–insulin- or insulin-treated diabetes mellitus. Comorbid conditions related to diabetes mellitus and ventricular function at the time of the index myocardial infarction are important contributors to poorer outcomes in patients with diabetes mellitus.
Hyperglycemia After Cardiac Surgery
Authors: Stoodley Lynda , Wung Shu-Fen 
Published: November 2019

Background
The Surgical Care Improvement Project #4 (SCIP#4) performance measure is used to evaluate achievement of target blood glucose control after cardiac surgery.

Objectives
The purpose of this study was to identify patient characteristics and outcomes in patients undergoing cardiac surgery who met the SCIP#4 performance measure versus those who did not.

Methods
A retrospective case-control design was used.

Results
Preoperative hemoglobin A1C (HbA1C) level and history of diabetes were 2 major risk factors for failing to meet the SCIP#4 measure. A trend toward a longer length of stay was observed, mortality was 3 times more prevalent, and renal failure was 4 times more frequent in patients who did not meet the SCIP#4 quality measure.

Conclusions
Not meeting the SCIP#4 measure is associated with adverse outcomes. History of diabetes and preoperative HbAIC level should be considered when evaluating strategies for managing postsurgical hyperglycemia.
Placement of an Esophageal Temperature Probe by Nurses
Authors: Makic Mary Beth Flynn , Lovett Karen , Azam M. Fareedul 
Published: November 2019

Background
Current guidelines support therapeutic hypothermia after cardiac arrest. An esophageal temperature probe (ETP) provides a core temperature assessment; however, accurate placement is necessary.

Objectives
To demonstrate accurate placement of an ETP and evaluate the effectiveness of high-fidelity simulation with anatomic imaging.

Methods
Registered nurses (RNs) were educated using 3-dimensional, high-fidelity simulation with VH Dissector technology (Touch of Life Technologies, Aurora, Colorado) to demonstrate ETP placement. The RNs provided survey responses on the effectiveness of simulation before and after using the simulator.

Results
Thirty-two RNs participated and did not demonstrate difficulties with the skill; however, 53.1% required more than 1 attempt for accurate placement in the distal esophagus. Survey results found that participants had increased confidence and high satisfaction with simulation and 3-dimensional imaging (P &lt; .001).

Conclusions
Literature is lacking to guide ETP placement. In this study, RNs overestimated the depth for ETP insertion. Accurate temperature readings are highly dependent on accurate anatomical location placement. Providing skill competency training that incorporated anatomical imaging technology enhanced RNs’ awareness for effective skill acquisition.
Pediatric Brain Death: Updated Guidelines
Authors: Mullen Jodi E. 
Published: November 2019

Logan, a 5-year-old boy, was riding his bike with his 7-year-old brother when he was struck from behind by a car traveling at approximately 40 mph. The driver indicated that she did not see the riders until she hit Logan, who was not wearing a helmet at the time of the accident. Logan was thrown from his bike and was found at the side of the road, unresponsive and posturing. Although he was uninjured, Logan’s brother witnessed the incident.Emergency medical services arrived and placed Logan on a backboard with a c-collar. Because he was not protecting his airway, he was intubated and then given sodium chloride fluids and brought to the pediatric emergency department. Upon arrival, his Glasgow Coma Scale score was 5, and his right pupil was 6 mm and not reactive.Logan’s initial head computed tomographic scan showed diffuse brain edema, with early downward transtentorial brain herniation. The pediatric neurosurgeon determined that no operative management was appropriate for Logan. Besides a small laceration on his forehead, Logan had no other injuries. At this time, he was taking a few spontaneous respirations and had occasional posturing of his extremities.
Finding the Right Fit
Authors: Lampe Julie S. , Geddie Patricia I. , Aguirre Lillian , Sole Mary Lou 
Published: November 2019

Purpose and Background. The purpose of this article is to describe how clinical nurse specialists (CNSs) in one organization developed a structured interviewing process for CNS candidates. The process has evolved in relation to implementation of national CNS competencies, growth of the role in the organization, and changes to reporting structure.
Outcomes. The CNS interview process includes panel interviews with various organizational leaders, CNSs, and team members. A behavioral-based tool relevant to the CNS role is used. Involving CNS peers in the interview ensures the successful hiring and retaining of suitable candidates. Clinical nurse specialists who were interviewed using the current peer interview procedure have reported satisfaction with the experience.
Implications. Peer interviews for CNSs provide a forum for meaningful dialogue about the CNS role, competencies, and fit with the organization. This process can be used for other advanced practice disciplines.
ALCUNI PASSI DEL POEMA DI GILGAMESH IN DUE TAVOLETTE ITTITE INEDITE
Authors: Mora Clelia , Giorgieri Mauro 
Published: November 2019

In this paper we present two fragments of a cuneiform tablet that contain some passages of the Gilgamesh saga in the Hittite language. They give us the opportunity to delve into some aspects concerning the rediscovery, the interpretation and the fortune of this poem widely widespread throughout the Ancient Near East. The first part of the paper deals with these general issues, while the second one focuses on the philological examination of the new fragments and the interesting contribution they offer from the content viewpoint.
Aprendizaje-Servicio en escenarios digitales de aprendizaje: propuesta innovadora en la educación superior
Authors: Ruiz-Corbella Marta , García-Gutiérrez Juan 
Published: November 2019

El reconocimiento y el rediseño de los aprendizajes en diferentes escenarios de aprendizaje son los principales desafíos a los que se enfrenta actualmente la educación superior. Una de las líneas de trabajo es el impulso de metodologías innovadoras, como el aprendizaje-servicio (ApS), capaces de crear experiencias prácticas reales que cierren la brecha entre el aprendizaje que se genera en el aula y su aplicación en el mundo real. Metodologías que no pueden quedar al margen de las innovaciones tecnológicas, que no se entienden sin la información que proporcionan y sin la comunicación que es capaz de facilitar. Por primera vez, la transformación afecta a lo más genuino de todo ser humano: su estructura comunicativa y cognitiva desarrollado a través de un lenguaje multimodal, hipertextual y no lineal, lo que exige la transformación de la educación, a la vez que su apertura a los escenarios digitales. En este proceso, este artículo revisa los supuestos de esta apuesta por la innovación en la cual la tecnología posibilita esas nuevas formas de aprendizaje. En este marco, el ApS virtual integra las tecnologías en su diseño y desarrollo posterior, apoyándose en los recursos digitales que nos facilita este medio. Es decir, aprendizaje y servicio se desarrollan en y con la red, generando una modalidad inmersiva y real en el ciberespacio. Es necesario analizar lo que suponen estos nuevos escenarios educativos, en los que se incluyen estas metodologías que, al contacto con las tecnologías digitales, multiplican y amplifican sus posibilidades y efectos pedagógicos.
Avaliação de diferentes métodos para estimar qualidade do colostro e transferência de imunidade passiva (TIP) em bezerras Holandesas
Authors: Oliveira Sylvia Marquart Fontes Novo de , Silva Bruno Toledo , Leite Stephanie Blima Paulino , Mori Clara Satsuki , Gomes Viviani 
Published: November 2019

O objetivo deste estudo foi a comparação das metodo-logias mais comuns empregadas em diferentes fazendas para a avaliação da qualidade do colostro e identificação de falha na transferência de imunidade passiva (FTIP) em bezerras Holandesas. Sessenta e oito bezerras Holandesas recém-nascidas foram distribuídas em dois grupos: G1 - provenientes de propriedade com manejo de colostro adequado; G2 - oriundas de propriedade com falhas no manejo do colostro. Foram colhidas amostras de colostro fornecido para cada bezerra de cada grupo (250 ml) para a avaliação de IgG, sólidos totais, PT e albumina. Amostras sanguíneas foram obtidas às 48 horas de vida para a determinação de PT e de globulina e para a estimativa indireta de IgG por meio dos testes de turvação pelo sulfato de zinco, precipitação pelo sulfito de sódio e coagulação do glutaraldeído. Os teores de IgG observados no colostro pelo colostrômetro (G1: 98,63 ±1 5,58 mg/ml; G2: 85,66 ± 29,81 mg/ml; p = 0,09), índice Brix (G1: 27,61 ± 2,96%; G2: 22,40 ± 4,58%; p = 0,00), PT (G1: 10,42 ± 2,29g/dL; G2: 9,04 ±2 ,29g/dL; p = 0,06) e albumina (G1: 1,25 ± 0,37g/dL; G2: 0,91 ± 0,38g/dL; p = 0,00) foram superiores no G1 quando comparados ao G2. A determinação de PT no soro das bezerras foi realizada por um analisador bioquímico automático, revelando taxas de FTIP (< 5,2 g/dL) somente no G2 (46,67%). Os resultados dos testes qualitativos (turvação pelo sulfato de zinco, precipitação pelo sulfito de sódio e coagulação do glutaraldeído) foram diferentes dos resultados de PT (p = 0,00) e não se mostraram eficientes para a detecção da FTIP. Esta pesquisa demonstrou que além do uso do colostrômetro para a avaliação da qualidade do colostro, a utilização do refratrômetro Brix e níveis de PT do colostro devem ser consideradas. A identificação de FTIP no rebanho pode ser realizada seguramente por meio dos níveis séricos de PT e globulina.
Kan det finnes kime til livsmot i forskningssamtaler med etterlatte pårørende, der sorg danner bakteppe?
Authors: Lind Ranveig 
Published: November 2019

Can research conversations with the relatives of deceased ICU patients provide the germ of courage for life against a backdrop of grief?
This essay deals with conducting research interviews with the relatives of deceased ICU patients, where grief is a fundamental element. Based on the underlying profound seriousness of these conversations, the term “interview” is discarded in order to emphasize their relational aspect. Care and consideration to maintain dignity is shaped by these research conversations. The relationship between researcher and participant is not of a private nature. Yet a dialogue that persistently aims at the research goal is not possible either. The text touches on the various considerations necessary to include when planning and conducting studies aimed at this group of relatives. The risk of role change from researcher to therapist is described. But the ethical care aspect of this interpersonal encounter is of greater importance than the “therapeutic” aspect. Against the backdrop of a life phenomenon such as grief, care is used to protect the other and promote courage for life. The material is drawn from reflections on research interviews for a PhD project that was completed in 2013.
Total Phenolics, Flavonoids Contents, Antioxidant Activity and DNA Protective Effect of Lenten Rose (Helleborus orientalis)
Authors: Öztürk Meral , Bulduk İbrahim , Korcan Safiye Elif , Liman Recep , Çoban Funda Karabağ , Kargıoğlu Mustafa , Konuk Muhsin 
Published: November 2019

The aims of the present study were to evaluate the antioxidant activity and DNA Protective effect of Helleborus orientalis (HO) leaf extract against oxidative damage, and to determine the total phenolic and flavonoid contents of the plant species studied.
Methods: The total phenol content (TPC) of H. orientalis (Ranunculaceae) extract was determined using the Folin-Ciocalteu technique. The aluminum chloride colorimetric assay in the determination of The total flavonoid content (TFC) and was used, Analysis of Phenolic Acids was identified by High-Performance Liquid Chromatography (HPLC). Antioxidant activity was analyzed by the 2,2-Diphenyl-1-picrylhydrazyl (DPPH) Assay. Protective effect of H. orientalis leaf extract against to H2O2 was evaluated by using TAS, TOS methods and Comet assay.
Key Findings: H. orientalis ethanol extracts contain high amounts of antioxidants. The HO leaf methanol extract (LME) decreased the DNA damage at all tested concentrations in a dose-dependent manner (r=0.86 p<0.01) against to H2O2.
Conclusions: The total phenol content in the extracts of different parts of the plant varied from 4.00 mg GAE/1 gr to 19.42 mg GAE/1 gr. The flowers had the highest phenol content (19.42 mg GAE/1 gr sample) and followed by the leaves (17.20 mg GAE/1 gr sample). The total flavonoid content in the extracts from different parts of the plant varied from 2.57 mg QE/1 gr to 11.88 mg QE/1 gr. The flowers had the highest flavonoid content (11.88 mg QE/1 gr sample) and followed by the leaves (10.21 mg QE/1 gr sample).
Antioxidant activity of fractions was explained as a percentage of DPPH radicals’ scavenging and IC50 values (μg/ml). Leaf and flowers of HO are richer in antioxidant than its root and stem. As the concentration of leaf extracts used increased, the DNA protective effect increased and it was statistically significant at overdoses of 2500 μg/mL. Total antioxidant status (TAS) levels were significantly (p <0.05) decreased in the H2O2 group (3.4±0.21) but H. orientalis was significantly (p<0.05) increased TAS levels in this group. When the concentration of leaf extracts used increased, the protective effect has also increased and statistically significant at overdoses of 2500 μg / mL (6.3±0.67). Total oxidant status (TOS) levels were significantly (p <0.05) increased in the H2O2 group (25.3±0.74) and H. orientalis was significantly (p<0.05) decreased TOS levels in groups.
The Relationship between Chronic Lower Urinary Tract Symptoms and Psychological Disorders in Women Referring to Baqyiatallah Hospital Clinic in Tehran City
Authors: Heidari Fatemeh , Abbaszadeh Shahin , Rezadoust Bentolhoda , Ghadian Alireza , Ebrahimi Mehrdad 
Published: November 2019

Introduction: Lower urinary tract symptoms (LUTS) refer to a group of medical symptoms with the prevalence of 62.5% in men and 66.6% in women. LUTS (Lower Urinary Tract Symptoms) was associated with increased risk of having clinically relevant depressive symptoms or depression and vice versa. We assumed that patients with chronic lower urinary tract symptoms who referred to urology clinic and have negative urologic evaluations, may suffer from psychological symptoms such as anxiety, depression or obsession.
Methods and Materials: This was a cross-sectional, single group survey of women living in Tehran province. Patients who were suffering from lower urinary tract symptoms for over than 6 months, were included in the study. We evaluate the presence of LUTS by asking the patients about their problems of urinary tract in two major categories: Filling or irritative symptoms - e.g. frequency, urgency, dysuria, nocturia, stress incontinence, urge incontinence. Chi square and independent T tests were used to evaluate the correlation between study variables. All statistical analysis was performed using SPSS software version 16.
Results: There was a positive correlation between irritative symptoms and depression symptoms (p‹0.001) and a negative correlation between obstructive symptoms and depression (p‹0.001). There was no association between LUTS and symptoms of OCD (Obsessive- Compulsive disorder). The mean age of participants with positive BDI (Beck depression inventory) was higher than those with negative BDI. (p= 0.007).
Discussion: The results of this study emphasized the important association of LUTS and depression. In conclusion, depressive disorder can increase the risk of developing LUTS or accelerate this process. So when a patient with either urinary or depression symptoms referred to a psychiatry center, he should be screened for the other disease. This requires an adequate interaction between urology and psychiatry departments to achieve.
Near Infrared Fluorescence Imaging to Assess Breast Flap Perfusion and Prevention of Ischemia: Case Report
Authors: Cheong Ju Yong , Goltsman David , Warrier Sanjay 
Published: November 2019

Introduction:
Breast skin flap ischemia and necrosis is a serious consequence of breast reconstruction with reported incidence of 10% to 15%. Current clinical method of assessing breast skin flap perfusion includes combination of skin color, temperature, dermal edge bleeding, and capillary refill. Given the high incidence of ischemia and the presence of certain cohort of patient with greater risk, there is a need for an objective method of assessing the skin flap perfusion. Near infrared fluorescence imaging using indocyanine green is a new technique of assessing skin flap perfusion. We present a first reported case where breast skin flap ischemia was objectively identified intraoperatively by NIRF imaging, and this ischemia was reversed through active intra- and postoperative measures, which was objectively again identified by NIRF imaging.

Case presentation:
A 36-year-old female patient underwent bilateral nipple sparing mastectomies with immediate reconstruction using tissue expanders. Clinical assessment of the breast skin flap was equivocal. NIRF imaging using SPY imaging system (Novadaq Technologies Inc, Toronto, ON, Canada) showed poor perfusion in the periareolar region. As a result, it was decided to completely deflate the expander, actively warm the skin flap and encourage cutaneous perfusion through use of topical glycerin trinitrate patch. A repeat NIRF imaging 48 hours showed 10-fold increase in perfusion in the skin flap.

Conclusion:
NIRF imaging is a useful tool in assessing breast skin perfusion and to predict potential ischemia, which can aid in surgeon's management of patient.