bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence and risk factors for progression from prehypertension to hypertension: a 12-year Korean Cohort Study
Authors: Yu Eun Sun , Hong Kwan , Chun Byung Chul 
Published: May 2020

Objectives:
This study evaluated the incidence and risk factors for progression from prehypertension to hypertension among middle-aged and elderly Korean adults.

Methods:
A total of 115 456 participants with prehypertension in 2003–2004 were selected from the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) Program. All participants were followed until 2015. Potential risk factors for progression to hypertension were evaluated using the chi-squared test or t-test. A Cox proportional hazards model was used to predict the risk of progression to hypertension according to sex. The incidence of hypertension in the prehypertension group was evaluated by calculating the incidence density during the entire follow-up period.

Results:
During the follow-up period, 48 919 participants experienced progression to hypertension, which corresponded to incidence densities of 45.82/1000 person-years among men and 53.57/1000 person-years among women. Among both men and women, progression to hypertension was predicted by an elevated BMI, family history of hypertension, history of diabetes mellitus, and older age. Among men, progression to hypertension was associated with frequent drinking and high alanine aminotransferase levels. Among women, progression to hypertension was associated with high hemoglobin levels and low household income.

Conclusion:
This study identified various risk factors for progression from prehypertension to hypertension among middle-aged and elderly Korean adults. This information may help researchers develop comprehensive and effective strategies for managing prehypertension.
Ocular Findings in Pontine Tegmental Cap Dysplasia
Authors: Mehner Lauren C. , Jung Jennifer L. , Maloney John A. , McCourt Emily A. 
Published: May 2020

Purpose:
To describe the ocular complications experienced by patients with pontine tegmental cap dysplasia (PTCD) and the management strategies used to care for these children.

Methods:
Subjects with PTCD were recruited through social media advertisement and completed a survey gathering information on potential ocular problems related to the patient's PTCD disease and any current or previous treatments.

Results:
Twenty-two patients or guardians completed the survey. Neurotrophic cornea was the most common ocular diagnosis (82%), followed by facial palsy (59%), dry eye syndrome (59%), and blepharitis (55%). Other diagnoses included cortical visual impairment (27%), strabismus (27%), amblyopia (18%), and nystagmus (18%). Common treatment modalities included lubricating eye drops (59%) or ointment (50%), contact lenses (14%), punctal plugs (27%), glasses (45%), and patching (18%). The most common surgical interventions were temporary or permanent tarsorrhaphy (64%) and amniotic membrane grafts (23%). In total, 68% of families reported self-injury to eyes and 91% reported the child to be primarily a visual learner.

Conclusions:
PTCD is a newly described, very rare disorder with a variety of vision-threatening ocular manifestations. It is essential that the ophthalmologist be aware of the potential for neurotrophic cornea because timely treatment could prevent corneal scarring, perforation, and blindness.
Temporal redistribution of cap and residual stromal thickness after SMILE
Authors: Olsen Markus V. , Lyngstadaas Anne V. , Zhou Wen , Stojanovic Aleksandar , Utheim Tor P. , Wang Xiaorui , Badian Reza A. , Chen Xiangjun 
Published: May 2020

Purpose:
To investigate corneal sublayer alterations during the postoperative period after small-incision lenticule extraction (SMILE).

Setting:
Synslaser clinic, Oslo, Norway.

Study design:
Retrospective.

Methods:
Patients who underwent SMILE for treating myopia were included. The thicknesses of the corneal epithelium, cap, stromal part of the cap (StromaCap), residual stromal bed (StromaRes), and total stroma (StromaTot) were measured using spectral-domain optical coherence tomography at 1 day, 1 week, 1 month, 3 months, and 6 months postoperatively. Postoperative changes in the corneal sublayer thicknesses were analyzed and correlated with changes in spherical equivalence and anterior and posterior keratometry (K).

Results:
The study was based on analyses of the right eyes of 51 patients. From 1 day to 6 months postoperatively, the corneal epithelium, cap, StromaCap, StromaRes, and StromaTot thicknesses increased from 54.4 ± 4.0 µm to 57.3 ± 5.2 µm; 137.1 ± 5.5 µm to 140.3 ± 5.1 µm; 82.7 ± 5.9 µm to 82.8 ± 6.3 µm; 375.0 ± 40.8 µm to 381.4 ± 30.6 µm; and 457.6 ± 41.1 µm to 462.1 ± 36.7 µm, respectively. Between 1 month and 6 months postoperatively, the increase in anterior K correlated significantly with the thickening of the cap (r = 0.37, P = .03) and the stromal component of the cap (r = 0.36, P = .04) within the central cornea.

Conclusions:
The post-SMILE remodeling behavior between the anterior (StromaCap) and posterior (StromaRes) stroma were dissimilar. There was a significant correlation between changes in anterior K and the central cap and the stromal component of the cap. This might be because of biomechanical changes, tissue remodeling, and wound healing or a combination of some or all of the aforementioned processes.
Regional variations in cardiovascular risk factors and access to care among US veterans with cardiovascular disease
Authors: Srivastava Pallavi , Butler Javed , Shroyer A. Laurie , Templeton Rebecca , Parikh Puja B. 
Published: May 2020

Background
It remains unclear whether cardiovascular risk factors and access to healthcare for veterans with cardiovascular disease (CVD) vary among US regions. This study sought to determine the extent of regional variations in cardiovascular risk factors and access to medical care in a cohort of veterans with CVD in the USA.

Methods
The 2016 Centers for Disease Control Behavioral Risk Factor Surveillance Survey was utilized to identify a cohort of veteran patients with CVD. Participants were classified based on four US regions: (1) Northeast, (2) Midwest, (3) South, and (4) West. We compared demographic data, medical history, and access to care for veterans of each US region. The outcomes of interest included financial barriers to medical care and annual medical checkup.

Results
Among the 13 835 veterans, 18.3% were from the Northeast, while 23.5, 37.1, and 21.1% were from the Midwest, South, and West, respectively. Veterans of each region differed significantly with respect to demographic characteristics, prior medical history, and access to care. Rates of financial barriers to medical care were similar across the four regions (7.3 vs. 7.1 vs. 8.0 vs. 6.9%, P = 0.203). Veterans from the West had the lowest rates of medical checkup within the past year (91.7 vs. 89.5 vs. 91.4 vs. 86.6%). On multivariate analysis, the Midwest [odds ratio (OR) 0.69; 95% CI, 0.53–0.89] and West (OR 0.53; 95% CI 0.41–0.68) regions were independently associated with lower rates of medical checkup within the past year compared to the Northeast.

Conclusions
In this observational study involving US veterans with CVD, cardiovascular risk factors and frequency of annual medical checkup differed amongst each US region. Further large-scale studies examining the prevalence of impaired access to care and quality of care in US veterans with CVD are warranted.
Fatigue in inflammatory bowel disease: a problematic ailment
Authors: Qazi Taha 
Published: May 2020

Purpose of review
Fatigue, a protean complaint encompassing both physical, mental exhaustion but also demotivation, has shown to effect quality of life in patients with inflammatory bowel disease (IBD). Here we present a review of the literature as it relates to IBD-associated fatigue. Moreover, we present the common causes attributed to fatigue and present an algorithmic approach to the assessment of fatigue. Finally, we report data regarding potential management strategies for IBD-associated fatigue.

Recent findings
Unfortunately, owing to its multidimensional nature and multifactorial causes, patients with IBD may continue to report fatigue despite optimization of disease management, replenishment of nutritional deficiencies, or management of coexistent disorders. Management likely requires a multidisciplinary approach.

Summary
The majority of patients with IBD report fatigue symptoms both in setting of active disease but also during the course of remission. Fatigue is a multidimensional complaints, and management likely requires a multidisciplinary approach. Herein, we present a framework for the management and assessment of fatigue in IBD.
Integration of telemedicine into clinical practice for inflammatory bowel disease
Authors: George Lauren A. , Dominic Maria Rose , Cross Raymond K. 
Published: May 2020

Purpose of review
In the context of the rising incidence and complexity of inflammatory bowel disease (IBD), telehealth offers new ways to support remote and efficient delivery of healthcare services. The aim of this review is to assess the current status of telehealth services in the management of IBD and challenges to adopting telehealth in clinical practice.

Recent findings
Different modalities of telehealth such as virtual clinics and remote patient monitoring have been studied in many IBD centers. They are found to be associated with high patient acceptance, decreased healthcare costs, improved quality of life, treatment adherence, and disease knowledge among patients. The major challenges encountered in the integration of telemedicine into clinical practice include risks to patient privacy and confidentiality, requirement for informed consent, lack of uniform reimbursement policies, operational difficulties, provider acceptance, and licensing.

Summary
Telehealth is an effective, efficient, and low-cost intervention that can address increasingly complex care of patients with IBD. However, for telemedicine to be adopted widely, new policies and reforms need to reduce the burden of physician licensing in multiple states, allow for receipt of all telehealth services in the patient's home or office, and require reimbursement for services on par with an office visit.
Protection of hematopoietic stem cells from stress-induced exhaustion and aging
Authors: Singh Shweta , Jakubison Brad , Keller Jonathan R. 
Published: May 2020

Purpose of review
Hematopoietic stem cells (HSCs) are defined by their ability to self-renew and differentiate to replenish all blood lineages throughout adult life. Under homeostasis, the majority of HSCs are quiescent, and few stem cells are cycling to sustain hematopoiesis. However, HSCs can be induced to proliferate and differentiate in response to stress signals produced during infection, inflammation, chemotherapy, radiation, bone marrow transplantation, and aging. Recent evidence suggests that acute and chronic stress impact the number and function of HSCs including their ability to repopulate and produce mature cells. This review will focus on how chronic stress affects HSC biology and methods to mitigate HSC loss during chronic hematopoietic stress.

Recent findings
Quiescent HSCs exit dormancy, divide, and differentiate to maintain steady-state hematopoiesis. Under conditions of acute stress including infection or blood loss some HSCs are pushed into division by cytokines and proinflammatory stimuli to differentiate and provide needed myeloid and erythroid cells to protect and reconstitute the host; after which, hematopoiesis returns to steady-state with minimal loss of HSC function. However, under conditions of chronic stress including serial bone marrow transplantation (BMT), chronic inflammation, and genotoxic stress (chemotherapy) and aging, HSCs are continuously induced to proliferate and undergo accelerated exhaustion. Recent evidence demonstrates that ablation of inhibitor of DNA binding 1 (Id1) gene can protect HSCs from exhaustion during chronic proliferative stress by promoting HSC quiescence.

Summary
Increasing our understanding of the molecular processes that protect HSCs from chronic proliferative stress could lead to therapeutic opportunities to prevent accelerated HSC exhaustion during physiological stress, genotoxic stress, BMT, and aging.
A Nationwide Italian Cross-sectional Study on Nursing Students' Perceived Workplace Safety During Clinical Practice
Authors: Gonella Silvia , Brugnolli Anna , Bosco Alice , Mansutti Irene , Canzan Federica , Randon Giulia , Saiani Luisa , Terzoni Stefano , Zannini Lucia , Destrebecq Anne , Dimonte Valerio , Grassetti Luca , Palese Alvisa 
Published: May 2020

Background
Nursing students' perception of a safe clinical working environment may impact the development of professional skills and progression in the profession.

Purpose
The aims of this study were to describe to what extent nursing students perceive the working environments as safe during their most recent clinical rotation and to explore factors associated with their perception of a safe workplace environment.

Methods
A nationwide Italian cross-sectional study involving 9607 students in 27 universities across 95 three-year nursing programs was performed in 2015-2016, and secondary analyses were run in 2019.

Results
The workplace environment was perceived by students as only a little (n = 2598 [27.0%]), to some extent (n = 4048 [42.1%]), and always (n = 2555 [26.0%]) safe; 406 (4.2%) students reported to have never felt that the workplace as safe. At the multivariate level, factors promoting students' perception of a safe clinical environment were a setting offering higher (a) learning opportunities, (b) safety and nursing care quality, (c) quality of tutorial strategies, and (d) self-directed learning opportunities.

Conclusions
Nursing faculty should assess the quality of clinical settings before deciding on environments for students' learning experience.
Using Simulation Evaluation for Prelicensure Nursing Program Review
Authors: Thomas Christine M. , Yocom Danielle , Kaulback Michelle , Meehan Carolyn D. 
Published: May 2020

Background
Faculty in a prelicensure baccalaureate nursing program were interested in establishing a process for use of simulation for the evaluation of program outcomes.

Problem
Several infrastructure barriers existed for the implementation of simulation for a fair, valid, and reliable student evaluation.

Approach
Faculty chose to evaluate student performance in simulation to examine student achievement of program outcomes.

Conclusions
The project informed curricular decisions moving forward, helped faculty to standardize scenarios, and outlined a process of establishing validity and reliability that could be implemented in the future for student evaluation.
The Effects of Interdisciplinary Bedside Rounds on Patient Centeredness, Quality of Care, and Team Collaboration: A Systematic Review
Authors: Heip Tine , Van Hecke Ann , Malfait Simon , Van Biesen Wim , Eeckloo Kristof 
Published: May 2020

Background
Research indicates that having multiple healthcare professions and disciplines simultaneously at the patient’s bedside improves interprofessional communication and collaboration, coordination of care, and patient-centered shared decision-making. So far, no review has been conducted, which included qualitative studies, explores the feasibility of the method, and looks at differences in definitions.

Objectives
The aim of the study was to explore available evidence on the effects of interdisciplinary bedside rounds (IBRs) on patient centeredness, quality of care and team collaboration; the feasibility of IBRs; and the differences in definitions.

Data Sources
PubMed, Web of Science, and Cochrane databases were systematically searched. The reference lists of included articles and gray literature were also screened. Articles in English, Dutch, and French were included. There were no exclusion criteria for publication age or study design.

Study Appraisal and Synthesis Methods
The included (N = 33) articles were critically reviewed and assessed with the Downs and Black checklist. The selection and summarizing of the articles were performed in a 3-step procedure, in which each step was performed by 2 researchers separately with researcher triangulation afterward.

Conclusions and Implications of Key Findings
Interdisciplinary bedside round has potentially a positive influence on patient centeredness, quality of care, and team collaboration, but because of a substantial variability in definitions, design, outcomes, reporting, and a low quality of evidence, definitive results stay uncertain. Perceived barriers to use IBR are time constraints, lack of shared goals, varied responsibilities of different providers, hierarchy, and coordination challenges. Future research should primarily focus on conceptualizing IBRs, in specific the involvement of patients, before more empiric, multicentered, and longitudinal research is conducted.
Wide Variation in Unplanned Extubation Rates Related to Differences in Operational Definitions
Authors: Ndakor Sussan Mbi , Pezzano Chad J. , Spilman Lynn , Geis Gina , Munshi Upender , Dunton Cheryl , Pinheiro Joaquim M. B. 
Published: May 2020

Objectives
Unplanned extubation (UE) rate is a patient safety metric for which there are varied and inconsistently interpreted definitions. We aimed to test the sensitivity of UE rates to the application of different operational definitions.

Methods
We analyzed neonatal intensive care unit (NICU) quality improvement data on UE events defined inclusively as “any extubation that was not performed electively, or not previously intended for that time.” Unplanned extubations were classified as involving an endotracheal tube (ETT) that was either objectively “dislodged” or “removed” without proof of prior dislodgement. We used descriptive statistics to explore how UE rates vary when applying alternate UE definitions.

Results
For 33 months, 241 UEs were documented, 70% involving dislodged tubes and 30% ETTs removed by staff. Among dislodged ETTs, only 9% were found completely externalized, whereas 77% were at an adequate depth but in the esophagus. Thirteen percent of events occurred outside the NICU and 13% were initially unreported. The overall UE rate was 4.9/100 ventilator days. If the least inclusive definition was used (i.e., counting only “self-extubations” by patients, requiring reintubation, and occurring within the NICU), 83% of UEs would have been excluded.

Conclusions
Most UEs in our NICU population involved staff either removing ETTs from the trachea or partly removing them after internal dislodgement. In settings where ETTs removed by staff are not counted, UE rates may be substantially lower and associated risks underestimated. An inclusive, patient-centric operational definition along with a standardized classification would allow benchmarking, while enabling targeted approaches to minimize locally predominant causes of UEs.
Medication Order Errors at Hospital Admission Among Children With Medical Complexity
Authors: Blaine Kevin , Wright John , Pinkham Amy , O’Neill Margaret , Wilkerson Sarah , Rogers Jayne , McBride Sarah , Crofton Charis , Grodsky Sarah , Hall David , Mauskar Sangeeta , Akula Vinita , Khan Alisa , Mercer Alexandra , Berry Jay G. 
Published: May 2020

Objectives
We sought to characterize the nature and prevalence of medication order errors (MOEs) occurring at hospital admission for children with medical complexity (CMC), as well as identify the demographic and clinical risk factors for CMC experiencing MOEs.

Methods
Prospective cohort study of 1233 hospitalizations for CMC from November 1, 2015, to October 31, 2016, at 2 children’s hospitals. Medication order errors at admission were identified prospectively by nurse practitioners and a pharmacist through direct patient care. The primary outcome was presence of at least one MOE at hospital admission. Statistical methods used included χ2 test, Fisher exact tests, and generalized linear mixed models.

Results
Overall, 6.1% (n = 75) of hospitalizations had ≥1 MOE occurring at admission, representing 112 total identified MOEs. The most common MOEs were incorrect dose (41.1%) and omitted medication (34.8%). Baclofen and clobazam were the medications most commonly associated with MOEs. In bivariable analyses, MOEs at admission varied significantly by age, assistance with medical technology, and numbers of complex chronic conditions and medications (P < 0.05). In multivariable analysis, patients receiving baclofen had the highest adjusted odds of MOEs at admission (odds ratio, 2.2 [95% confidence interval, 1.2–3.8]).

Conclusions
Results from this study suggest that MOEs are common for CMC at hospital admission. Children receiving baclofen are at significant risk of experiencing MOEs, even when orders for baclofen are correct. Several limitations of this study suggest possible undercounting of MOEs during the study period. Further investigation of medication reconciliation processes for CMC receiving multiple chronic, home medications is needed to develop effective strategies for reducing MOEs in this vulnerable population.
Risk Factors Associated With the Progression From Acute to Chronic Neuropathic Pain After Burn-Related Injuries
Authors: Klifto Kevin M. , Dellon Arnold Lee , Hultman Charles Scott 
Published: May 2020

Background
Pain, unrelated to the initial thermal trauma itself, can result after burn injury and prolong the recovery/rehabilitation phase of the patient's care. This pain, after discharge from the burn unit, may be acute and self-limiting or chronic and contribute to long-term patient morbidity. The purposes of this study were to compare burn patients who had, after discharge from the burn unit, only acute pain with burn patients who developed chronic, neuropathic pain (CNP) and to determine risks factors for progression from acute to chronic pain in the setting of a burn center.

Methods
A single-center, retrospective chart review of patients admitted to the adult burn center was performed from January 1, 2014, to January 1, 2019. Patients included were older than 15 years, sustained a burn injury, and admitted to the burn unit. Chronic pain was defined as pain lasting greater than 6 months after discharge from the burn unit. Pain descriptors included shooting, stabbing, sharp, burning, tingling, numbness, throbbing, pruritus, intermittent, and/or continuous dysesthetic sensations after the burn. Patients were excluded if they had preexisting neuropathic pain due to an underlying medical illness or previous surgery.

Results
During a 5-year period, of the 1880 admissions to the burn unit, 143 burn patients developed post–initial-onset pain as a direct result of their burn. Of the 143 patients with acute pain, pain resolved in 30 patients, whereas pain progressed to CNP in 113 patients (79%). Patient follow-up was a median (interquartile range [IQR]) of 26.5 (10–45) months. Patients whose pain progressed to CNP had significantly greater percent total body surface area burns (median [IQR], 6 [3–25] vs 3 [1–10]; P = 0.032), had more full-thickness burns (66/113 [58%] vs 8/30 [27%] patients, P = 0.004), had surgery (85/113 [75%] vs 16/30 [53%] patients, P = 0.042), had more surgical procedures (median [IQR], 2 [1–6] vs 1 [0–3], P = 0.002), and developed more complications (32/113 [28%] vs 2/30 [7%] patients, P = 0.014) compared with those with acute neuropathic pain, respectively.

Conclusions
Burn patients who progressed from having acute to CNP had significantly greater percent total body surface area burns, had more full-thickness burns, had surgery, had more surgical procedures, and developed more complications compared with burn patients with only acute pain.