bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparing Nonopioids Versus Opioids for Acute Pain in the Emergency Department: A Literature Review
Authors: Sin Billy , Sikorska Gabriela , YauLin Joi , Bonitto Rianne A. , Motov Sergey M. 
Published: November 2019

Background:
Pain is the most common reason for patient visits in the emergency department (ED). Opioids have been long considered the standard of care for acute pain in the ED. Because of the opioid crisis, investigation and implementation of novel practices to manage pain is needed. The use of various nonopioids has been suggested as a plausible alternative to opioids, with emerging literature to support its use for acute pain in the ED.

Study Question:
To evaluate the safety, efficacy, opioid-sparing effects of nonopioids in patients who present with acute pain in the ED.

Data Sources:
We systematically searched PubMed and EMBASE (July 1970 to January 2019).

Study Design:
Randomized controlled trials that evaluated nonopioids versus opioids in the ED were eligible. The clinical outcomes measured were change in pain scores compared with baseline, the incidence of adverse events, and use of rescue analgesia.

Results:
Twenty-five randomized controlled trials that evaluated the use of nonopioids in 2323 patients [acetaminophen (APAP) (n = 651), diclofenac (n = 547), ketamine (n = 272), ketorolac (n = 225), lidocaine (n = 219), ibuprofen (n = 162), ibuprofen & APAP (n = 162), hydroxyzine & dihydroergotamine (n = 85)] met inclusion criteria. Four trials found significant greater reductions in pain scores, favoring nonopioids. In all trials, the duration of pain relief provided by nonopioids was not sustained over an extended period. Eighteen trials reported no significant differences in reduction of pain scores. Two trials reported improved pain reduction with opioids and one trial reported noninferiority.

Conclusions:
Evidence from primary literature suggests that nonopioids could be a feasible alternative to opioids for management of acute pain in the ED as it is effective, safe, and decreases the need for rescue analgesia.
Orthopaedic care of the child with arthrogryposis: a 2020 overview
Authors: van Bosse Harold J.P. 
Published: November 2019

Purpose of review
The orthopaedic treatment of children with arthrogryposis multiplex congenita has evolved steadily over the past two decades. Interrelated factors have spurred this on, including better appreciation of the functional potential of persons with arthrogryposis, development of newer procedures specific for the arthrogrypotic deformities, and outcomes studies that provide understanding of the overall capabilities of adults with arthrogryposis and follow-up to determine which treatments were beneficial and which were not. This article briefly sketches out of some of these advances and indicates areas that need further development.

Recent findings
Outcome studies show that the majority of adults with arthrogryposis are ambulatory but less than half are fully independent. Adults frequently experience ongoing pain, particularly foot and back pain, limiting ambulation and standing. Advancements in the upper extremity treatment include improving elbow function, wrist repositioning, and improving thumb positioning. In the lower extremities, correction of hip and knee contractures leads to improved ambulatory potential, and treating clubfeet with serial casting decreases poor outcomes.

Summary
Clinical evaluation, both physical examination and assessment of the patient's needs, are important in directing treatment in arthrogryposis. Further outcomes studies are needed to continue to refine procedures and define the appropriate candidates.
The Effects of a Tripod Approach for Cancer Patients on Illness Stress, Health-Promoting Lifestyle, Hope, and Resilience
Authors: Sung Kyung Mi , Yu Mi , Kang Young Sil , Gu Mee Ock , Jung Myun Sook , Eun Young , Jeon Mi Yang 
Published: November 2019

Background
Health-related exercise and education program for cancer patients are necessary to provide physical and emotional support to enable efficient and appropriate self-management at home.

Objective
This study aimed to investigate the effects of a tripod approach including physical exercise, education, and emotional support program on illness stress, health promotion lifestyle, hope, and resilience in cancer patients.

Interventions/Methods
This was a quasi-experimental repeated-measures study using a pre-post design with a nonhomogeneous control group. A total of 72 cancer patients (experimental group = 37, control group = 35) who were currently receiving treatment and staying at home were enrolled.

Results
The experimental group showed significantly lower illness stress scores (F = 17.35, P < .001) and increase in health promotion lifestyle scores (F = 4.05, P = .048) compared with the control group, especially social relationships (t = 1.85, P = .073) and stress management (t = 2.30, P = .027). However, there were no effects on hope and resilience. Also, illness stress showed significant changes after 6 weeks (t = −3.35, P = .001) and after 10 weeks (t = −5.04, P < .001). Overall health promotion lifestyle showed changes after 10 weeks (t = 2.25, P = .030), with meaning of life (t = 2.57, P = .014), stress management (t = 2.30, P = .027), and medical behaviors (t = 2.46, P = .019) especially showing significant changes.

Conclusions
The results showed that the tripod approach had positive effects on illness stress and health promotion lifestyle of cancer patients staying at home. Further study to improve positive emotions such as hope and resilience is needed.

Implications for Practice
Based on our findings, combining nursing intervention with physical exercise, education, and emotional support could be incorporated into cancer patients in community and early survivorship care plans in clinical practice.
Reflections of Healthcare Experiences of African Americans With Sickle Cell Disease or Cancer: A Qualitative Study
Authors: Dyal Brenda W. , Abudawood Khulud , Schoppee Tasha M. , Jean Stacy , Smith Valandrea M. , Greenlee Amelia , Staton Lindsey M. , Duckworth Laurie , Mandernach Molly W. , Black Vandy , Heldermon Coy D. , Yao Yingwei , Wilkie Diana J. , Ezenwa Miriam O. 
Published: November 2019

Background
The experiences of African American adult patients before, during, and after acute care utilization are not well characterized for individuals with sickle cell disease (SCD) or cancer.

Objective
To describe the experiences of African Americans with SCD or cancer before, during, and after hospitalization for pain control.

Methods
We conducted a qualitative study among African American participants with SCD (n = 15; 11 male; mean age, 32.7 ± 10.9 years; mean pain intensity, 7.8 ± 2.6) or cancer (n = 15; 7 male; mean age, 53.7 ± 15.2 years; mean pain intensity, 4.9 ± 3.7). Participants completed demographic questions and pain intensity using PAINReportIt and responded to a 7-item open-ended interview, which was recorded and transcribed verbatim. We used content analysis to identify themes in the participants’ responses.

Results
Themes identified included reason for admission, hospital experiences, and discharge expectations. Pain was the primary reason for admission for participants with SCD (n = 15) and for most participants with cancer (n = 10). Participants of both groups indicated that they experienced delayed treatment and a lack of communication. Participants with SCD also reported accusations of drug-seeking behavior, perceived mistreatment, and feeling of not being heard or believed. Participants from both groups verbalized concerns about well-being after discharge and hopeful expectations.

Conclusions
Race-concordant participants with SCD but not with cancer communicated perceived bias from healthcare providers.

Implications for Practice
Practice change interventions are needed to improve patient-provider interactions, reduce implicit bias, and increase mutual trust, as well as facilitate more effective pain control, especially for those who with SCD.
Health-Related Quality of Life and Its Associated Factors in Prostate Cancer Patients Who Receive Androgen Deprivation Therapy
Authors: Chien Ching-Hui , Chuang Cheng-Keng , Liu Kuan-Lin , Wu Chun-Te , Pang See-Tong , Chang Ying-Hsu 
Published: November 2019

Background
Presently, few studies have examined the impact of positive thinking on the HRQoL of prostate cancer patients who receive androgen deprivation therapy (ADT).

Objectives
We explored the factors that affect health-related quality of life (HRQoL), particularly positive thinking, of prostate cancer patients who receive ADT.

Methods
A cross-sectional design was used. A total of 132 prostate cancer patients, drawn from outpatient clinics of 2 medical centers, who were receiving ADT were included. Structured questionnaires, including a basic information sheet, the Positive Thinking Scale, Social Support Scale, and Functional Assessment of Cancer Therapy–Prostate (FACT-P), were used for data collection. Statistical analysis was performed by using independent-sample t tests, one-way analysis of variance, Pearson correlation, and multiple regression.

Results
Prostate cancer patients who were receiving ADT were more likely to engage in positive thinking, which was correlated with better social/family well-being, emotional well-being, functional well-being, prostate cancer concern, and a higher score on the FACT-P. Improved self-reported health status was correlated better with all subdimensions of HRQoL and better scores on the FACT-P. Greater social support was correlated with high social/family well-being.

Conclusions
Positive thinking, self-reported health status, and social support are important associated factors of HRQoL in prostate cancer patients who receive ADT.

Implications for Practice
Oncology nurses can improve HRQoL by improving positive thinking, self-reported health status, and social support of prostate cancer patients who receive ADT.
The Heart Failure Journey Board to Discharge
Authors: Kranz Clare , Spencer Delois , Polancich Shea , Curry Carolyn , Miltner Rebecca S. 
Published: November 2019

Background:
Patients with heart failure (HF) require lifestyle changes to improve functional status and health outcomes.

Local Problem:
Heart failure was the most common readmitting diagnosis, with costs per patient of $5332, length of stay (LOS) of 5.9 days, and readmission rate of more than 30%.

Implementation:
The purpose was to adapt and implement a journey board discharge tool for adults with HF.

Methods:
A journey board was created, piloted, and trialed on 1 nursing unit. Large journey boards were attached to communication boards in patient rooms for nurses to mark off topics, listed in the form of a tile (n = 19), as complete following education sessions.

Results:
Nurses reported the tool helped them know what educational topics were covered by previous shifts. Following implementation, the average LOS was 5.3 days, patient cost per patient was $4848, and readmission rate was 28%.

Conclusions:
Utilizing journey board discharge education tools with patients can improve communication and evidence-based self-care instruction.
Reducing Blood Culture Contamination in the Emergency Department
Authors: McLeod Casey G. 
Published: November 2019

Background:
Blood culture contamination results in delayed or unnecessary treatments, increased morbidity risk, extended lengths of hospital stay, and increased health care costs. Collecting 2 sets of blood cultures from separate sites helps differentiate bloodstream infections (BSIs) from contamination.

Local Problem:
Blood culture contamination rates trailed the national threshold of less than 3% in one southeastern US emergency department (ED). Same-site and single-set collection issues were also identified.

Methods:
This pre-/postintervention quality improvement study included 1137 patients (preintervention: n = 560; postintervention: n = 577) of all ages with blood culture orders in a 13-bed tertiary care ED.

Interventions:
A staff educational program, blood culture collection checklist with protocol, and monthly collective and individual feedback were implemented.

Results:
Blood culture contamination rates decreased from 3.39% to 2.6%. Same-site collection rates decreased from 15.13% to 4.14%.

Conclusions:
The interventions effectively reduced blood culture contamination rates and same-site blood culture collections in the ED, enhancing the quality of care for patients with BSIs.
Standardizing Nurse Leader Safety Rounds to Promote Highly Reliable Care
Authors: Meyer Priya , Hill Cindy , Baker Deborah 
Published: November 2019

Background:
Despite decades of intensive resource allocation to eliminate preventable harm and increase high reliability in the hospital, the prevalence of serious harm remains consistent.

Local Problem:
A hospital reduced targeted preventable harms using audit and feedback (A&F) but failed to globally reduce harm or increase proactive awareness. Nurse leaders lacked a defined process for identifying errors, mitigating risk, and teaching systems thinking to influence resiliency among teams.

Methods:
Nurse leaders underwent A&F of daily safety rounds. Adherence data on frequency, high-quality, and high-reliability organizational (HRO) leader practice standards and precursor incident reporting rates were trended.

Results:
Rounding practice adherence increased for the following defined standards: frequency (63%-79%); high quality (50%-90%); and HRO leadership (0%-67%). Precursor incident reporting rates increased 25%.

Conclusions:
A&F reinforced quality and accountability for daily safety rounds. HRO theory–guided feedback offered an innovative way to translate HRO influence into nurse leader practice.
Alert Types and Frequencies During Bar Code–Assisted Medication Administration
Authors: Sloss Elizabeth A. , Jones Terry L. 
Published: November 2019

Background:
Existing literature explores the effectiveness of bar code–assisted medication administration (BCMA) on the reduction of medication administration error as well as on nurse workarounds during BCMA. However, there is no review that comprehensively explores types and frequencies of alerts generated by nurses during BCMA.

Purpose:
The purpose was to describe alert generation type and frequency during BCMA.

Methods:
A systematic review of the literature using PRISMA guidelines was conducted using CINAHL, PubMed, EMBASE, and Ovid Medline databases.

Results:
After screening for inclusion and exclusion criteria, a total of 8 articles were identified and included in the review. Alert types included patient mismatch, wrong medication, and wrong dose, though other alert types were also reported. The frequency of alert generation varied across studies, from 0.18% to 42%, and not all alerts were clinically meaningful.

Conclusions:
This systematic review synthesized literature related to alert type and frequency during BCMA. However, further studies are needed to better describe alert generation patterns as well as factors that influence alert generation.
Decreasing Time from Decision to Intubation in Premedicated Neonates: A Quality Improvement Initiative
Authors: Glenn Tara J. , Grathwol Melissa M. , McClary Jacquelyn D. , Wainwright Rebecca J. , Gorman Sara M. , Rodriguez Ashley M. , Bhola Monika 
Published: November 2019

Introduction:
Endotracheal intubation carries the risk of discomfort, decompensation, oral trauma, and endotracheal tube malposition. Treatment with premedications reduces complications, increases overall intubation safety, improves pain control, and improves first-pass success. However, time is frequently a barrier to administration. We aimed to decrease the decision-to-intubation time interval from a baseline of 40 minutes to less than 35 minutes over 6 months.

Methods:
We used the Model for Improvement with multiple plan–do–study–act cycles to reduce the time from decision to successful intubation in nonemergent neonatal intubations. Key drivers were timely administration of medications, availability of skilled personnel and equipment, and efficient use of time.

Results:
During this project, time from the decision to successful intubation decreased from a historical mean of 40 minutes to a new baseline of 27 minutes. This change represents a 33% decrease, with 80% of intubations occurring within 35 minutes. During this time, success rates remained stable, and medication errors and side effects did not increase.

Conclusions:
Standard processes to prepare and administer premedications decreased the time from decision to intubation without significant adverse effects, allowing the benefit of premedication administration in a safe and timely manner in nonemergent neonatal intubations.
Sciatic Nerve Variants in Patients Diagnosed With Sciatica: Is There a Correlation?
Authors: Khan Hayat , Ling Stephen , Ali Sayed , Jonnalagadda Padmaja , Ramsey Frederick , Weiner Mark , Awan Omer 
Published: November 2019

Purpose
Compression of the sciatic nerve in its path along the piriformis muscle can produce sciatica-like symptoms. There are 6 predominant types of sciatic nerve variations with type 1 being the most common (84.2%), followed by type 2 (13.9%). However, there is scarce literature on the prevalence of sciatic nerve variation in those diagnosed with sciatica.

Materials and Methods
The charts of 95 patients clinically diagnosed with sciatica who had a magnetic resonance imaging of the pelvis/hip were retrospectively studied. All patients had T1-weighted axial, coronal, and sagittal images. Magnetic resonance imagings were interpreted separately by 2 board-certified fellowship-trained musculoskeletal radiologists to identify the sciatic nerve variant.

Results
Seven cases were excluded because of inadequate imaging. Of the remaining 88 patients, 5 had bilateral sciatica resulting in a sample size of 93 limbs. Fifty-two (55.9%) had type 1 sciatic nerve anatomy, 39 (41.9%) had type 2, and 2 (2.2%) had type 3. The proportions of type 1 and 2 variations were significantly different from the normal distribution (P < 0.001), whereas type 3, 4, 5, and 6 variants were not (P = 1.00).

Conclusions
There is strong statistical significance regarding the relationship between sciatic nerve variation and the clinical diagnosis of sciatica. Preoperative magnetic resonance imaging can be considered in sciatica patients to prevent iatrogenic injury in pelvic surgery.
Elbow Injuries Detected on Magnetic Resonance Imaging in Athletes Participating in the Rio de Janeiro 2016 Summer Olympic Games
Authors: Alizai Hamza , Engebretsen Lars , Jarraya Mohamed , Roemer Frank W. , Guermazi Ali 
Published: November 2019

Background
Athletes are prone to both acute and chronic overuse injuries of the elbow joint. The purpose of this study was to describe the frequency, anatomic distribution, and severity of magnetic resonance imaging (MRI)–detected elbow joint injuries among athletes who competed in the Rio de Janeiro 2016 Summer Olympics.

Methods
All sports injuries reported by the National Olympic Committee medical teams and the Organizing Committee medical staff during the 2016 Summer Olympics were analyzed. Magnetic resonance imaging was performed at the International Olympic Committee's polyclinic within the Olympic Village, using 3- and 1.5-T scanners. The MRIs were read centrally and retrospectively by musculoskeletal radiologists with expertise in sports injuries. The distribution of elbow joint injuries by anatomic location and sports discipline and the severity of injuries were recorded.

Results
A total of 1101 injuries were reported in the 11,274 athletes from 207 teams at the Games. Central review of MRI revealed elbow joint injuries in 15 athletes (60% male; median age, 22 years; range, 18–39 years). Ligamentous injuries were most common, with injuries of the ulnar collateral ligament being the most prevalent (n = 12; 80%), followed by the common flexor tendon (n = 8; 53%). Osseous injuries were far less common (n = 3; 20%), with no acute fractures seen. Weightlifting (n = 4; 27%) and judo (n = 4; 27%) athletes were most commonly affected.

Conclusion
Magnetic resonance imaging–detected elbow injuries during the 2016 Summer Olympics affected mainly the ulnar collateral ligament and the common flexor tendon, with the highest occurrence in weight lifting and judo.
Combined Qualitative and Quantitative Assessment of Low-Attenuation Renal Lesions Improves Identification of Renal Malignancy on Noncontrast Computed Tomography
Authors: Picard Melissa , Shah Neil , Flemming Brian , Kovacs Mark , Freeman Kyle , Burchett Phillip F. , Giovagnoli Dante A. , Hardie Andrew D. 
Published: November 2019

Objective
The objective of this study was to assess renal lesions measuring less than 20 Hounsfield units (HU) on noncontrast computed tomography (NCT).

Methods
Twenty-one (18.1%) of 116 consecutive pathologically proven renal cell carcinomas measured less than 20 HU on NCT and were compared with 40 confirmed benign cysts also measuring less than 20 HU. All lesions were assessed qualitatively (heterogeneous or homogenous) by 3 blinded readers and quantitatively with commercially available textural analysis software. Finally, a combined assessment was performed.

Results
Qualitative assessment performed well (sensitivity, 76%–90%; specificity, 70%–88%). Quantitative assessment revealed mean positive pixels as having the highest performance (area under the curve, 0.912; sensitivity, 90%; specificity, 80% at a cutoff value of 21). The combined assessment, using the mean positive pixel cutoff, improved the sensitivity (reader 1, 100%; reader 2, 95%; and reader 3, 95%).

Conclusion
Qualitative and quantitative assessments have relatively good performance, but the combination can nearly eliminate renal cell carcinomas being missed on NCT.
Surveillance Magnetic Resonance Imaging in Detecting the Second Breast Cancer in Women With a Personal History of Breast Cancer
Authors: Liu Haiquan , Hua Yanqing , Peng Weijun , Zhang Xun 
Published: November 2019

Objective
The objective of this study was to evaluate the diagnostic performance of magnetic resonance imaging (MRI) in detecting the secondary breast cancer among women with a personal history of the lesion.

Materials and Methods
We retrospectively reviewed breast MRI examinations performed between 2007 and 2011. A total of 798 women with a history of breast cancer were included in the study. Cancer detection rate, positive predictive value (PPV), recall rate, sensitivity, and specificity were assed. Cancer detection rate was stratified by interval after surgery of the primary breast cancer. Also, we derived 1 comparison group from the women for comparing the performance of x-ray mammography, ultrasound, and MRI in detecting the second breast cancer.

Results
Of the 798 patients, 47 of the 49 secondary breast carcinomas were detected by MRI. The sensitivity and specificity of MRI in detecting the secondary lesions were 95.9% and 96.3%, respectively. The recall rate was 9.5%, and the PPV was 61.8%. Cancer detection rate of MRI examinations performed at more than 36 months after initial surgery was significantly higher than that at 36 months or less after initial surgery (13.7% vs 3.6, P < 0.001). In comparison group, the sensitivity and specificity of MRI, mammography, and ultrasound were 96.7% and 96.1%, 48.4% and 93.9%, and 77.4% and 96.1%, respectively.

Conclusions
Surveillance MRI for women with a personal history of breast cancer has high sensitivity in finding the secondary malignancies with a reasonable recall rate and PPV.
Ovarian Cancer Genetics and Implications for Imaging and Therapy
Authors: Elsherif Sherif B. , Faria Silvana C. , Lall Chandana , Iyer Revathy , Bhosale Priya R. 
Published: November 2019

Abstract
Ovarian cancer is the second most common gynecologic malignancy in the United States. Ovarian cancer has a dismal prognosis when diagnosed at an advanced stage. Therapy for these cancers is determined not only by stage but also by their heterogeneous pathologic features, genetic mutations, and biology. In this review, we will discuss types of epithelial ovarian cancer, and their associated genetic mutations and the implications for imaging and treatment.