bluuebunny/crossref_metadata_2025_split huggingface dataset:
A tablet computer-based cognitive training program for young children with cognitive impairment
Authors: Ko Eun Jae , Sung In Young , Yuk Jin Sook , Jang Dae-Hyun , Yun Gijeong 
Published: March 2020

Abstract

Background:
Evidences suggest that cognitive training facilitates cognitive function, and most studies have targeted adults and children older than 4 years of age. This study investigated the applicability and efficacy of a tablet computer-based cognitive training program for young children with cognitive impairment of cognitive age between 18 and 36 months.

Methods:
Thirty-eight children were randomly assigned to the intervention (n = 20, administered a tablet computer-based cognitive training program, for 30 minutes per session and twice a week over a period of 12 weeks) and control (n = 18, received the traditional rehabilitation program) groups. Mental scale of Bayley Scales of Infant Development II (BSID II), Pediatric Evaluation of Disability Inventory (PEDI), interest/persistence domain of the Laboratory Temperament Assessment Battery (LAP-TAB), Early Childhood Behavior Questionnaire (ECBQ), and Goal Attainment Scale (GAS) were evaluated before and after 12 weeks of therapeutic intervention.

Results:
The tablet computer-based cognitive training program was applicable to all children in the intervention group without any problems including irritable behavior or obsession about a tablet computer. After 12 weeks, Mental scale of BSID II, PEDI (social function), LAB-TAB (observation), LAB-TAB (manipulation), and GAS showed statistically significant improvements in the intervention group, compared with the values in the control group (P < .05). After adjusting for the pre-treatment measurements and cognitive age, the tablet computer-based cognitive training program had significant effect on the post-treatment measurements of Mental scale of BSID II, PEDI (social function), LAB-TAB (observation), LAB-TAB (manipulation), and GAS (P
< .05). There was no association between the change in the scores and the severity of cognitive delay in the most of the measurements, however, the self-care domain of PEDI showed a negative association with the severity of the cognitive delay (r = −0.462, P
= .04).

Conclusions:
Application of a tablet computer-based cognitive training program was feasible and showed improvements in cognitive function in young children with cognitive impairment of cognitive age between 18 and 36 months, regardless of the severity of the cognitive delay. But severe cognitive delay can be related with less improvement in the self-care domain of PEDI.

Trial registration number:
https://cris.nih.go.kr (KCT0002889)
Comparison of MRI and MRA for the diagnosis of rotator cuff tears
Authors: Liu Fanxiao , Cheng Xiangyun , Dong Jinlei , Zhou Dongsheng , Han Shumei , Yang Yongliang 
Published: March 2020

Abstract

Background:
Numerous quantitatively based studies measuring the accuracy of MRI and MRA for the diagnosis of rotator cuff tears remain inconclusive. In order to compare the accuracy of MRI with MRA in detection of rotator cuff tears a meta-analysis was performed systematically.

Methods:
PubMed/Medline and Embase were utilized to retrieve articles comparing the diagnostic performance of MRI and MRA for use in detecting rotator cuff tears. After screening and diluting out the articles that met inclusion criteria to be used for statistical analysis the pooled evaluation indexes including sensitivity and specificity as well as hierarchical summary receiver operating characteristic (HSROC) curves with 95% confidence interval (CI) were calculated.

Results:
Screening determined that 12 studies involving a total of 1030 patients and 1032 shoulders were deemed viable for inclusion in the meta-analysis. The results of the analysis showed that MRA has a higher sensitivity and specificity than MRI for the detection of any tear; similar results were observed in the detection of full-thickness tears. However, for the detection of partial-thickness tear, MRI has similar performance with MRA.

Conclusion:
MRI is recommended to be a first-choice imaging modality for the detection of rotator cuff tears. Although MRA have a higher sensitivity and specificity, it cannot replace MRI after the comprehensive consideration of accuracy and practicality.
The effect of pay for performance on risk incidence of hip fracture in type 2 diabetic patients: a nationwide population-based cohort study
Authors: Lee Yung-Heng , Kung Pei-Tseng , Kuo Wei-Yin , Kao Su-Ling , Tsai Wen-Chen 
Published: March 2020

Abstract

Objectives:
Diabetes mellitus (DM) increases the risk of hip fracture. The literature rarely discusses the importance of pay-for-performance (P4P) programs for the incidence of hip fractures in patients with type 2 DM (T2DM). This study aimed to examine the impact of the P4P program on hip fracture risk in patients with T2DM.

Methods:
This retrospective cohort study focused on data from T2DM patients aged 45 and older between 2001 and 2012. We continued to track these data until 2013. The data were collected from the National Health Insurance Research Database in Taiwan. To minimize selection bias, T2DM patients were divided into P4P enrollees and non-enrollees. Propensity score matching by greedy matching technique (1:1 ratio) was used to include 252,266 participants. A Cox proportional hazard model was performed to examine the impact of the P4P program on hip fracture risk. We used the bootstrap method to perform sensitivity analysis by random sampling with replacement.

Results:
Our results showed that the risk of hip fracture in P4P enrollees was 0.92 times that of non-enrollees. (hazards ratio [HR] = 0.92; 95% confidence interval [CI]: 0.85–0.99). P4P enrollees who received regular treatment had lower risk in the first 4 years (HR = 0.90; 95%CI: 0.84–0.96) but no statistically significant difference after 4-year enrollment (HR = 0.99; 95%CI: 0.93–1.06). There was no statistically significant difference in the effect of hip fractures between P4P non-enrollees and P4P enrollees with irregular treatment (HR = 0.94, 95%CI: 0.87–1.03). Through sensitivity analysis, the results also showed P4P enrollees had a lower risk of hip fracture compared to P4P non-enrollees (mean HR = 0.919; 95% CI: 0.912–0.926). Stratified analysis showed that patients without DM complications (DCSI = 0) who enrolled in P4P had lower risks of hip fractures than the non-enrollees (HR = 0.90; 95% CI: 0.82–0.98).

Conclusion:
T2DM patients enrolled in P4P program can reduce the risks of hip fracture incidence. Early inclusion of patients without DM complications in the P4P program can effectively reduce hip fractures.
Predictive Hiring to Maintain Excellence in Patient Care
Authors: Potts Jessica , Brouder Pamela , Helm Sarah , Leach Kathy 
Published: March 2020

OBJECTIVE
The purpose of this research study was to design and pilot a predictive hiring model to improve the hospital's operational vacancy rate and reduce premium pay expenses.

BACKGROUND
According to Purcell, the average nursing turnover rate is at 18.2%, and the new-graduate nurse turnover rate is higher at 35%. With turnover rates high for nurses, the importance of recruiting, hiring, and training the new nurse needs to be completed as soon as possible. Often, a nurse manager cannot interview and hire into a position until it is vacated. Premium pay including overtime is typically used to cover the time from the position being vacated until the next nurse is trained.

METHODS
This was a pretest/posttest design with a predictive hiring model intervention. The intervention was a 3-pronged approach that consisted of a strategy for recruiting graduate nurses, hiring to operation vacancy rates, and utilizing a predictive hiring method. Operational vacancy is a calculation to determine if a department has the right amount of hired labor available to work scheduled shifts without having to routinely rely on agency nurses and/or premium pay. These are people ready to work.

RESULTS
The hospital significantly decreased premium pay and eliminated the use of agency nurses by implementing a predictive hiring model tailored to the department's operational vacancy.

CONCLUSIONS
A predictive model is a useful vehicle in assisting nurse managers to plan and replace positions more quickly. The model needs continued testing to support application beyond the testing site.
Nonclinical Transition-to-Practice Courses
Authors: Hampton Kimberly B. , Smeltzer Suzanne C. , Ross Jennifer Gunberg 
Published: March 2020

Background
Both clinical and nonclinical transition-to-practice courses have been offered to facilitate the transition from student to novice nurse.

Problem
Nonclinical transition-to-practice courses are less widely discussed in the literature; thus, their content and effectiveness have not been examined.

Approach
Academic institutions with baccalaureate nursing programs were surveyed to determine if they offered a nonclinical transition-to-practice course and to identify the associated content.

Outcome
Of 19 responding institutions, 15 reported having a nonclinical transition-to-practice course. Eighty-seven percent of the courses address ethical dilemmas, and 80% include delegation, interview preparation, stress management, and work/life balance.

Conclusion
Although schools of nursing are urged to address students' transition to practice, there is considerable variation in the nonclinical topics addressed. Research is needed to provide guidance to maximize the impact of these nonclinical transition-to-practice courses on new nurses' transition experience.
Short- and Long-Term Outcome in Critically Ill Children After Acute Interhospital Transport to a PICU in Sweden*
Authors: Hannegård Hamrin Tova , Radell Peter J. , Fläring Urban , Berner Jonas , Eksborg Staffan 
Published: March 2020

Objectives:
Data on long-term survival in children after interhospital transport to a PICU are scarce. The main objective was to investigate short- and long-term outcome after acute interhospital transport to a PICU for different age and risk stratification groups. Secondary aims were to investigate whether neonatal patients would have higher mortality and be more resource demanding than older patients.

Design:
Single-center, retrospective cohort study.

Setting:
Specialist pediatric transport team and a tertiary PICU in Sweden.

Patients:
Critically ill children 0–18 years old, acutely transported by a specialist pediatric transport team to a PICU in Sweden (January 1, 2008, to December 31, 2016).

Interventions:
None.

Measurements and Main Results:
A total of 401 acute transport events were included. Overall mortality was 15.7% with a median follow-up time of 3.4 years (range, 0–10.2 yr). Median predicted death rate was 4.9%. There was no mortality during transport. Cumulative mortality almost doubled within the first 6 months after PICU discharge, from 6.5% to 12.0%. Of late deaths, 66.7% occurred in the risk stratification group predicted death rate 0–10%, and 95% suffered from severe comorbidity. There were no deaths after PICU discharge in the neonatal group. Cumulative mortality in multiple transported patients was 36.4%.

Conclusions:
This is the first report on long-term survival after acute pediatric interhospital transport. For the entire cohort, there was significant mortality after PICU discharge, especially in multiple transported patients. In contrast, survival in the subgroup of neonatal patients was high after PICU discharge.
Assessing Frequency of Respiratory Complications in Children Undergoing Adenotonsillectomy
Authors: Baker Alyson K. , Carroll Christopher L. , Grindle Christopher R. , Sala Kathleen A. , Cowl Allison S. 
Published: March 2020

Objectives:
To determine the frequency of respiratory complications in children admitted to the ICU after adenotonsillectomy and to identify factors associated with the risk of respiratory complications in this cohort.

Design:
Retrospective observational study.

Setting:
PICU.

Patient Population:
All children admitted to the ICU following adenotonsillectomy from September 30, 2009, to March 30, 2014.

Measurements and Main Results:
Of the 165 children included in the study, 150 (91%) received no respiratory support other than oxygen in the first 2 hours postoperatively. Of the 15 who required support following 2 hours, 14 required nasopharyngeal airways, one required invasive mechanical ventilation, and seven required supplemental oxygen for more than 2 hours. None of the children who received respiratory support for less than 2 hours required subsequent ICU level care. When comparing those who received support for more than 2 hours to those who did not, there were no differences in clinical characteristics except that those who received support were more likely to have chronic neurologic disease including autism, seizures, or cerebral palsy (odds ratio, 3.7; 95% CI, 1.1–11.9; p = 0.04). Intraoperative events were not predictive of need for respiratory support. Most of the children (n = 117/165 or 71%) had sleep studies preoperatively. Abnormal sleep studies (apnea-hypopnea index > 20 [n = 68] or oxygen saturation nadir < 80% [n = 48]) were not associated with need for postoperative respiratory support.

Conclusions:
Most children admitted to the ICU following adenotonsillectomy in this population required no support after 2 hours. Preoperative factors such as obesity and abnormal sleep studies were not predictive of need for postoperative respiratory support. Need for respiratory support at 2 hours may be a useful criterion for need for ICU level care in this population.
Lung-Protective Mechanical Ventilation Strategies in Pediatric Acute Respiratory Distress Syndrome
Authors: Wong Judith Ju Ming , Lee Siew Wah , Tan Herng Lee , Ma Yi-Jyun , Sultana Rehana , Mok Yee Hui , Lee Jan Hau 
Published: March 2020

Objectives:
Reduced morbidity and mortality associated with lung-protective mechanical ventilation is not proven in pediatric acute respiratory distress syndrome. This study aims to determine if a lung-protective mechanical ventilation protocol in pediatric acute respiratory distress syndrome is associated with improved clinical outcomes.

Design:
This pilot study over April 2016 to September 2019 adopts a before-and-after comparison design of a lung-protective mechanical ventilation protocol. All admissions to the PICU were screened daily for fulfillment of the Pediatric Acute Lung Injury Consensus Conference criteria and included.

Setting:
Multidisciplinary PICU.

Patients:
Patients with pediatric acute respiratory distress syndrome.

Interventions:
Lung-protective mechanical ventilation protocol with elements on peak pressures, tidal volumes, end-expiratory pressure to Fio
2 combinations, permissive hypercapnia, and permissive hypoxemia.

Measurements and Main Results:
Ventilator and blood gas data were collected for the first 7 days of pediatric acute respiratory distress syndrome and compared between the protocol (n = 63) and nonprotocol groups (n = 69). After implementation of the protocol, median tidal volume (6.4 mL/kg [5.4–7.8 mL/kg] vs 6.0 mL/kg [4.8–7.3 mL/kg]; p = 0.005), Pao
2 (78.1 mm Hg [67.0–94.6 mm Hg] vs 74.5 mm Hg [59.2–91.1 mm Hg]; p = 0.001), and oxygen saturation (97% [95–99%] vs 96% [94–98%]; p = 0.007) were lower, and end-expiratory pressure (8 cm H2O [7–9 cm H2O] vs 8 cm H2O [8–10 cm H2O]; p = 0.002] and Paco
2 (44.9 mm Hg [38.8–53.1 mm Hg] vs 46.4 mm Hg [39.4–56.7 mm Hg]; p = 0.033) were higher, in keeping with lung protective measures. There was no difference in mortality (10/63 [15.9%] vs 18/69 [26.1%]; p = 0.152), ventilator-free days (16.0 [2.0–23.0] vs 19.0 [0.0–23.0]; p = 0.697), and PICU-free days (13.0 [0.0–21.0] vs 16.0 [0.0–22.0]; p = 0.233) between the protocol and nonprotocol groups. After adjusting for severity of illness, organ dysfunction and oxygenation index, the lung-protective mechanical ventilation protocol was associated with decreased mortality (adjusted hazard ratio, 0.37; 95% CI, 0.16–0.88).

Conclusions:
In pediatric acute respiratory distress syndrome, a lung-protective mechanical ventilation protocol improved adherence to lung-protective mechanical ventilation strategies and potentially mortality.
Fracture-Associated Bruising and Soft Tissue Swelling in Young Children With Skull Fractures
Authors: Metz James B. , Otjen Jeffrey P. , Perez Francisco A. , Done Stephen L. , Brown Emily C. B. , Wiester Rebecca T. , Jenny Carole , Ganti Sheila , Feldman Kenneth W. 
Published: March 2020

Objectives
The aim of this study was to determine how reliable scalp bruising and soft tissue swelling/cephalohematomas (STS) are for underlying young child skull fractures.

Methods
This was a retrospective clinical and imaging review from 2011 to 2012 of children younger than 4 years with skull fractures from 2 tertiary care hospitals. Imaging was reread by 3 pediatric radiologists. Descriptive statistics were utilized. The retrospective review had institutional review board approval.

Results
We identified 218 subjects for review: 210 unintentional and 8 abusive. One hundred forty-three had available 3-dimensional computed tomography reconstructions: 136 unintentional and 7 abused. Two-thirds were younger than 1 year. Twelve subjects had visible scalp bruising, but 73% had clinically and 93% radiologically apparent fracture-associated STS. There was no difference in clinical STS with simple (79%) versus complex (68%) fractures. Nor was there difference in subjects with fractures from minor (77%) versus major (70%) trauma. Unintentionally injured infants did not differ from abused for detectable STS (74% vs 50%). Parietal and frontal bones most frequently sustained fractures and most consistently had associated STS.

Conclusions
Clinically apparent STS is present in approximately three-fourths of children with skull fractures. It may not be important to consistently identify skull fractures in unintentionally injured children. Point-of-care ultrasound may be adequate. For abuse concerns, it is important to identify skull fractures as evidence of cranial impacts and intracranial hemorrhages. The most sensitive, widely available imaging technique, cranial computed tomography scan with 3-dimensional skull reconstruction, should be utilized. Scalp bruising is present in a minority of young children with skull fractures. Its absence does not exclude cranial impact injury.
Case Studies of Challenges in Emergency Care for Children With Autism Spectrum Disorder
Authors: Gray James M. , Roback Mark G. 
Published: March 2020

Abstract
Autism spectrum disorder (ASD) affects more than 1% of children in the United States, with the rate of new diagnoses climbing significantly in the last 15 years. Emergent conditions and subsequent visits to the emergency department (ED) can be particularly challenging for children with ASD, most of whom also have comorbidities in addition to their deficits in social communication and interaction. In the emergency setting, these conditions can cause a range of behaviors that result in challenges for health care providers and may result in suboptimal experiences for children with ASD and their families. We present the ED course of 3 children with ASD to illustrate these challenges, emphasize successful strategies, and highlight opportunities for improvement.
Practical Classification of Upper Lateral Cartilage in Middle Vault Asymmetry
Authors: Hafezi Farhad , Naghipour Rouhollah , Naghibzadeh Bijan , Ashtiani Abbas Kazemi , Forghani Siamak Farokh 
Published: March 2020

Background:
Middle vault asymmetry is a common reason for retained postoperative deviations. Although minor deformities can be camouflaged with cartilage, soft-tissue materials, or injectable fillers, comprehensive observation of upper lateral cartilage and subsequent topographic classification in major anatomical anomalies will help surgeons better plan their procedures to obtain better symmetry.

Methods:
Photographs of 71 randomly selected primary open rhinoplasty patients were analyzed for anatomical presentation of their upper lateral cartilage. Photographs were taken before and after separation of upper lateral cartilage from the septum. Upper lateral cartilage was classified from class I to class V according to the width of the transverse subunits and curvature of the vertical subunits.

Results:
The authors observed 142 upper lateral cartilages of 71 rhinoplasty patients. Upper lateral cartilage was classified as follows: class I, 53 cases; class II, three cases; class III, 40 cases; class IV, 36 cases; and class V, 10 cases.

Conclusions:
Upper lateral cartilage asymmetry is a common occurrence in rhinoplasty, and the upper lateral cartilage itself may be the source of nasal deviation. The middle vault requires special attention, and establishment of a classification system could enable surgeons to devise an effective plan for correction and prevention of retained postoperative nasal deviation.
The Effect of Surgical Video on Resident Performance of Carpal Tunnel Release: A Cadaveric Simulation-Based, Prospective, Randomized, Blinded Pilot Study
Authors: Yee Andrew , Padovano William M. , Rowe Amanda G. , Hill Elspeth J. R. , Fox Ida K. , Moore Amy M. , Coert J. Henk , Mackinnon Susan E. 
Published: March 2020

Background:
Surgical videos are increasingly common, although their role in residency curricula remains unclear. The aim of this study was to evaluate the impact of an educational surgical video on resident performance of an open carpal tunnel release through an Objective Structured Assessment of Technical Skills and serial questionnaires.

Methods:
Twenty-two residents representing six postgraduate years were randomized to receive text-based materials with or without a surgical video before performing a carpal tunnel release on human cadavers. Procedures were video recorded, anonymized, and independently evaluated by three hand surgeons using the Objective Structured Assessment of Technical Skills global rating scale, a procedure-specific technical rating scale, a record of operative errors, and pass/fail designation. Residents completed questionnaires before and after the procedure to track confidence in their technical skills.

Results:
Residents in their first and second postgraduate years (n = 10) who watched the surgical video committed fewer operative errors (median, 4 versus 1.3; p = 0.043) and were more confident in their abilities following the procedure (median, 75 versus 32; p = 0.043) than those receiving text resources alone. There were no significant differences in Objective Structured Assessment of Technical Skills performance or questionnaire responses among more senior residents (n = 12). The technical rating scale was internally consistent (Cronbach α = 0.95; 95 percent CI, 0.91 to 0.98), reliable (intraclass correlation coefficient, 0.73; 95 percent CI, 0.40 to 0.88), and correlated with surgical experience (Spearman ρ = 0.57; p = 0.006).

Conclusion:
Watching an educational surgical video to prepare for a cadaveric procedure significantly reduced operative errors and improved confidence among junior trainees performing a carpal tunnel release.