bluuebunny/crossref_metadata_2025_split huggingface dataset:
Challenges and Lessons Learned Tailoring a Behavioral Intervention for Stroke Survivor–Care Partner Dyads
Authors: Tierney Meghan K. , Tracy Mary Fran , Everson-Rose Susan A. , Hadidi Niloufar Niakosari 
Published: July 2020

ABSTRACT

INTRODUCTION: Research is increasingly exploring interventions for patient–care-partner dyads, but little has been reported regarding challenges of implementing dyad-focused interventions. This article reports the lessons learned in a pilot feasibility study of problem-solving therapy versus stroke education in stroke survivor–care partner dyads. CHALLENGES AND LESSONS LEARNED: Challenges arose in numerous aspects of intervention delivery. These ranged from personalizing the intervention to meet individual needs and balancing participation between dyad members to maintaining focus, managing conflict, and addressing ethical concerns, all of which required attention from the nurse researcher. These anticipated and unanticipated challenges were addressed using a variety of solutions, including engagement, active listening, redirection, and structured adaptation. IMPLICATIONS FOR PRACTICE: The knowledge gained and lessons learned in this study may be applied to other patient–care-partner dyads and other behavioral therapies. Nurses may also identify opportunities to increase inclusion of care partners in other interventions. Awareness of these challenges may lead to greater success in working with dyads. CONCLUSIONS: Dyad-focused behavioral interventions hold promise for use with stroke survivors and their care partners. They also present unique implementation challenges compared with survivor-only interventions.
Outcomes of a Structured, Stepwise Approach to Endoscopic Necrosectomy
Authors: Bang Ji Young , Wilcox Charles Mel , Hawes Robert , Varadarajulu Shyam 
Published: July 2020

Background and Aim:
Despite the increasing number of procedures being performed, there is no consensus on the optimal approach to performing direct endoscopic necrosectomy (DEN), which is a labor-intensive, nonstandardized intervention. We prospectively validated the usefulness of a predefined, structured, stepwise approach to DEN with the objective of improving procedural efficiency and resource use.

Materials and Methods:
A prospective study of patients with necrotizing pancreatitis who after endoscopic transluminal drainage did not have clinical improvement and required DEN. The study was undertaken in 2 phases. Phase I was a retrospective analysis of interventions performed using an unstructured, conventional approach. Median of 3 necrosectomy sessions (range, 2 to 3) were required to achieve 80% treatment success in 20 patients. On the basis of these observations, a structured approach that included 3 steps (debridement, necrosis extraction, and irrigation) was developed and validated prospectively in phase II in 39 patients. The main outcome was to compare procedural efficiency defined as a number of necrosectomy sessions to achieve treatment success.

Results:
Although there was no significant difference in treatment success (phase I=80.0 vs. phase II=94.9%, P=0.17), the procedure was more efficient in phase II [median session, 2 (interquartile range=1 to 3) vs. 3 (interquartile range=2 to 3); P=0.003]. Multiple logistic regression analysis revealed that a structured, stepwise approach was associated with fewer necrosectomy sessions to achieve treatment success (odds ratio=4.7; 95% confidence interval=1.5-15.0; P=0.008) when adjusted for patient demographics, lab parameters, and disease characteristics.

Conclusions:
By decreasing the number of necrosectomy sessions, a structured, stepwise approach to endoscopic necrosectomy seems to improve procedural efficiency.
Long-term Outcomes of Per-oral Endoscopic Myotomy in Spastic Esophageal Motility Disorders
Authors: Nabi Zaheer , Chavan Radhika , Ramchandani Mohan , Basha Jahangeer , Jagtap Nitin , Karyampudi Arun , Darisetty Santosh , Tandan Manu , Goud Rajesh , Rao Guduru Venkat , Reddy Duvvur Nageshwar 
Published: July 2020

Background and Aims:
Spastic esophageal motility disorders (SEMD) are a rare group of motility disorders including type III achalasia, distal esophageal spasm (DES), and Jackhammer esophagus (JHE). Limited data suggest that per-oral endoscopic myotomy (POEM) may be effective in these disorders. In this study, we aimed to evaluate the long-term outcomes of POEM in SEMD.

Methods:
The data of patients with SEMD who underwent POEM (January 2013 to December 2019) were analyzed, retrospectively. The following outcomes were recorded: POEM procedure details, technical and clinical success, adverse events, and gastroesophageal reflux disease (GERD). Clinical success was classified as immediate (<1 y), short-term (1 to 3 y), medium term (3 to 5 y), and long-term (>5 y).

Results:
A total of 1115 POEM procedures were performed during the study period for achalasia and nonachalasia spastic motility disorders. POEM was performed for SEMD in 74 (6.6%) patients including type III in 53, DES in 11, and JHE in 10 patients. Technical success was achieved in all the patients. The median follow-up for the entire group was 47.5 months (range: 2 to 77 mo). Clinical success at short-term (1 to 3 y) and long-term follow-up (>5 y) was attained in 85.2% and 82.6% patients, respectively. There was no significant difference in the clinical success between type III achalasia and JHE/DES. Mild and moderate adverse events were recorded in 21 (28.4%) cases. GERD was detected in 23 (56.1%) patients with 24-hour pH study. Erosive esophagitis and symptomatic GERD were found in 36 (48.6%) and 16 (21.6%) patients, respectively.

Conclusions:
POEM is a safe, effective, and durable treatment modality for spastic motility disorders of the esophagus. However, GERD is found in about half of the patients mandating close monitoring after POEM.
When to use probiotics in luminal gastrointestinal disorders?
Authors: Elangovan Abbinaya , Fischer Monika 
Published: July 2020

Purpose of review
With the growing popularity and commercialization of probiotics, it is important to understand the implications of existing randomized controlled trials and their applicability in the clinical setting to treat luminal gastrointestinal diseases.

Recent findings
Probiotics may be useful in the prevention of antibiotic-associated diarrhea, prevention of Clostridioides difficile infection and eradication of Helicobacter pylori. Some evidence supports the use of probiotics in the treatment of ulcerative colitis, prevention and treatment of pouchitis and irritable bowel syndrome. Caution has to be exercised in immunocompromised and critically ill individuals. New society guidelines do not encourage probiotic use in gastrointestinal disorders with the exception of premature infants to prevent necrotizing enterocolitis.

Summary
Despite burgeoning body of literature and wide acceptance by the public, a thorough understanding of efficacy and safety of probiotics is lacking. Uniform dosage, standardized clinical end points, personalization based on host microbial profile and longer duration of follow-up on the research front may help in the future in appropriate positioning of probiotics in health and disease.
Assessment of energy expenditure: are calories measured differently for different diets?
Authors: Sanchez-Delgado Guillermo , Ravussin Eric 
Published: July 2020

Purpose of reviewThe prevalence and burden of obesity has reached alarming levels. The assessment of human energy expenditure enables the identification of obesity-prone and obesity-resistant individuals and helps to explain the short and long-term success of weight loss treatments. In this review, we describe the state-of-the-art methods used in the assessment of human energy expenditure and the impact of dietary intake on the interpretation of the data.Recent findingsThe reference techniques to assess energy expenditure in humans have not significantly changed during the last century. Today, indirect calorimetry, either using a metabolic chamber or a metabolic cart, is the favored method to assess human energy expenditure and is the only method enabling the assessment of macronutrient oxidation. The doubly labeled water method however provides accurate assessment of human energy expenditure under free living conditions.SummaryAlthough energy expenditure and macronutrient oxidation can be assessed by simple calculations from oxygen consumption and carbon dioxide production, these calculations can provide erroneous results or require corrections and/or more complex interpretation when several biochemical pathways are simultaneously engaged. Such physiological mechanisms are often elicited by dietary interventions including, among other, gluconeogenesis, lipogenesis, ketogenesis, alcohol oxidation and under or overfeeding.
Evolving spectrum of treatment for CTEPH
Authors: Khangoora Vikramjit S. , Shlobin Oksana A. 
Published: July 2020

Purpose of review
The present review provides an update on treatment of chronic thromboembolic pulmonary hypertension (CTEPH), a rare form of pulmonary hypertension characterized by precapillary pulmonary hemodynamic parameters with chronic thrombotic occlusion of the pulmonary vasculature.

Recent findings
Pulmonary thromboendarectomy (PTE) remains the recommended treatment for patients with surgically accessible disease. Recent data suggest that patients preoperatively bridged with medical therapy may have improved outcomes but further research is needed. Riociguat improves hemodynamics, right ventricular function, quality of life, and functional capacity and is the drug of choice for patients with inoperable/persistent disease. Recently published data suggest that endothelin receptor blockers and treprostinil may also have a role in medical management of this patient population. A growing body of evidence indicates that in experienced centers balloon pulmonary angioplasty (BPA) may be a well tolerated and effective adjunct to pharmacological treatment for patients with inoperable disease affecting subsegmental vasculature.

Summary
Untreated CTEPH carries significant morbidity and mortality. Recent publications provide a wealth of data on safety and efficacy of BPA for inoperable subsegmental disease, but its precise fit in the treatment algorithm, both pharmacological and procedural, requires further investigation. PTE remains the procedure of choice for surgically accessible disease.
Insights into pathogenesis and clinical implications in myositis-associated interstitial lung diseases
Authors: Yanagihara Toyoshi , Inoue Yoshikazu 
Published: July 2020

Purpose of review
Interstitial lung diseases (ILDs) have been reported to be associated with myositis (including polymyositis and dermatomyositis). These myositis-associated ILDs carry significant morbidity and mortality. This review summarizes recent findings on myositis-associated ILD with a focus on pathogenesis and emerging treatment.

Recent findings
Recent advances in genetics have revealed 22 myositis-associated genome-wide loci, which were significantly enriched in regulatory regions in immune cells. An analysis of such disease-associated loci elucidated potential drug targets (e.g., TYK2 targeted by tofacitinib). In another study, an intronic variant in WDFY4 in association with clinically amyopathic dermatomyositis (CADM) had an effect for higher expression of a truncated WDFY4 isoform. Truncated WDFY4 markedly enhanced the MDA5-mediated NF-κB activation and cell apoptosis, indicating the dysregulated WDFY4-MDA5 pathway as a novel pathogenesis of CADM. As a novel strategy, tofacitinib treatment showed a promising improvement in survival and clinical features of CADM-associated ILD.

Summary
The genetic differences in the myositis-susceptible loci may explain the heterogeneous phenotypes and treatment responses in myositis-associated ILD. The understanding of pathogenesis with the genetic background as well as autoantibodies will enable the practice of personalized treatment in the management of the disease.
Looking into the future of sarcoidosis: what is next for treatment?
Authors: Miedema Jelle R. , Bonella Francesco , Grunewald Johan , Spagnolo Paolo 
Published: July 2020

Purpose of review
Sarcoidosis is a complex granulomatous disease of unknown cause. Corticosteroids and immune suppressants are often given long term in chronic disease, which may result in substantial toxicity. Validated strategies for selecting patients at risk for disease progression, who might benefit from early and targeted treatment, are lacking. Consequently, the unmet need for new treatment options in sarcoidosis is high. In this review, we critically discuss potential therapeutic targets and ongoing clinical trials in sarcoidosis.

Recent findings
Despite the heterogeneous clinical manifestations and the lack of a reliable animal model, our knowledge and understanding of the pathogenesis of sarcoidosis has improved in recent years, which has resulted in the identification of several potential therapeutic strategies. They include the inhibition of cytokines involved in maturation of macrophages, activation of dendritic cells, and maturation and activation of pathogenic T-lymphocytes. The inflammasome and the autophagy are additional areas for future research. Antifibrotic therapy might also be a reasonable choice in selected patients, although the best treatment strategy in progressive fibrotic sarcoidosis remains undetermined.

Summary
In this article, we review novel approaches to sarcoidosis treatment and potential therapeutic targets.
Agreement between emergency physicians and radiologists for the diagnosis of deep venous thrombosis with compression ultrasound: a prospective study
Authors: Elsenga Hylmar E. , Collée Annelieke , Rosendaal Arthur V. 
Published: July 2020

Introduction
The time factor in diagnosis and management of a deep vein thrombosis of the lower extremities (LE DVT) is of increasing importance in the era of crowding of emergency departments (ED). Current techniques used to detect LE DVT include a two-point regional compression ultrasound (rCUS), yet assessments are usually performed only during office hours. Outside office hours ultrasonography is postponed and low molecular weight heparin (LMWH) prescribed.

Objectives
Primary outcome of the study was to assess the level of agreement in rCUS for LE DVT when performed by Dutch emergency physicians compared to rCUS by a radiologist. Secondary outcome was time to diagnosis.

Method
We performed a single-blind cohort study. All consecutive patients aged 18 years and older attending the ED with clinical suspicion of LE DVT were considered eligible for study enrolment. rCUS was ordered at the radiology department; subsequently, the bedside rCUS examination was also performed in the ED by the emergency physicians or ED residents.

Results
A total of 138 patients were included, of whom 28 patients were diagnosed with DVT by a radiologist. Emergency physicians and radiologists showed comparable agreement [absolute agreement 94% (P < 0.001), Cohen’s Kappa 0.87]. Emergency physicians decreased overall time to diagnosis by 01:04 h, ED residents showed comparable results. During out-of-office hours, time benefit was 16:39 h on weekdays and 18:40 h during weekends.

Conclusion
Emergency physicians show comparable agreement in diagnosing LE DVT using rCUS when compared to radiologists. Average time benefit is over an hour, thereby reducing unnecessary waiting and improving time to disposition. ED residents demonstrated similar results in both agreement and time-saving.
Implications of Tobacco Smoking and Alcohol Consumption on Ectopic Fat Deposition in Individuals After Pancreatitis
Authors: Stuart Charlotte E. , Ko Juyeon , Modesto Andre E. , Alarcon Ramos Gisselle C. , Bharmal Sakina H. , Cho Jaelim , Singh Ruma G. , Petrov Maxim S. 
Published: July 2020

Objectives
Tobacco smoking and alcohol consumption are established risk factors for pancreatitis. This study investigated the associations between tobacco smoking/alcohol consumption in people after an attack of pancreatitis and intrapancreatic fat deposition (IPFD), intrahepatic fat deposition (IHFD), and skeletal muscle (SMFD) fat deposition.

Methods
In this cross-sectional study, magnetic resonance imaging was used to quantify IPFD, IHFD, and SMFD by 2 independent raters. A validated questionnaire was used to determine tobacco smoking and alcohol consumption.

Results
A total of 119 individuals after an attack of pancreatitis were included. Average tobacco smoking contributed most to variance in IPFD (R
2 = 6.5%) and least to variance in SMFD (R
2 = 0.4%). Average alcohol consumption contributed most to variance in variance in IPFD (R
2 = 2.8%) and least to IHFD (R
2 = 1.1%). Packs/day contributed more than years of smoking to variance in IPFD (R
2 = 4.9 and 0.2%, correspondingly), whereas years of drinking contributed more than average daily alcohol consumption (R
2 = 3.9 and 3.2%, correspondingly).

Conclusions
Tobacco smoking and alcohol consumption contributed more to variance in IPFD than IHFD and SMFD. Smoking contributed more than drinking to variance in IPFD. The daily amount of tobacco smoked appeared to be more important than years of smoking for IPFD.
Hemoglobin S/Hemoglobin Quebec-Chori Presenting as Sickle Cell Disease: A Case Report
Authors: Goode Erin , Boruchov Donna , Oliveira Jennifer L. , Lau Ching C. 
Published: July 2020

Background:
Sickle cell disease is a homozygous hemoglobinopathy with vaso-occlusive complications secondary to abnormal sickling of red blood cells under stressful conditions such as hypoxia. Children with sickle cell trait have a heterozygous genetic state, typically without symptoms.

Observation:
An 8-year-old boy diagnosed with sickle cell trait was found to have multiple complications consistent with sickle cell disease, including pain crises, osteomyelitis, and priapism. Over a 6-year period, he underwent routine laboratory evaluations without a definitive diagnosis. The diagnosis of a compound heterozygous state of hemoglobin S/hemoglobin Quebec-Chori was eventually made on the basis of mass spectrometry and confirmed with hemoglobin subunit beta gene sequencing.

Conclusion:
Expanding diagnostic evaluation in patients with abnormal clinical presentations is vital to making the correct diagnosis and hence earlier institution of appropriate management of rare hemoglobinopathies.
Implementation of an Automated Sepsis Screening Tool in a Community Hospital Setting
Authors: Cooper Penny B. , Hughes Bobbi J. , Verghese George M. , Just J. Scott , Markham Amy J. 
Published: July 2020

Background:
Early identification of sepsis remains the greatest barrier to compliance with recommended evidence-based bundles.

Purpose:
The purpose was to improve the early identification and treatment of sepsis by developing an automated screening tool.

Methods:
Six variables associated with sepsis were identified. Logistic regression was used to weigh the variables, and a predictive model was developed to help identify patients at risk. A retrospective review of 10 792 records of hospitalizations was conducted including 339 cases of sepsis to retrieve data for the model.

Results:
The final model resulted an area under the curve of 0.857 (95% CI, 0.850-0.863), suggesting that the screening tool may assist in the early identification of patients developing sepsis.

Conclusion:
By using artificial intelligence capabilities, we were able to screen 100% of our inpatient population and deliver results directly to the caregiver without any manual intervention by nursing staff.
Bridging the Gap
Authors: Englund Heather , Basler Jennifer 
Published: July 2020

Background
The purpose of this study was to investigate the relationship between an acid-base imbalance educational gaming activity and subsequent performance on a course examination on the subject.

Method
A nonexperimental descriptive design was employed using retrospective data obtained from both College of Nursing internal records and the learning management system used by the nursing program. A total of 435 students in the intervention group and 409 in the control group were included in the study.

Results
Differences in mean (SD) scores between the 2 groups for the acid-base content questions on the course examination were statistically significant (intervention group, 16.64 [1.92]; control group, 16.03 [1.62]; t
842 = 2.34, P = .019).

Conclusion
The results suggest that using educational gaming may improve retention and application of nursing knowledge.
Omental Infarction
Authors: Di Nardo Giovanni , Di Serafino Marco , Gaglione Giovanni , Mercogliano Carmela , Masoni Luigi , Villa Maria Pia , Parisi Pasquale , Ziparo Chiara , Vassallo Francesca , Evangelisti Melania , Vallone Gianfranco , Esposito Francesco 
Published: July 2020

Objective
To evaluate the prevalence of omental infarction (OI) in children with suspected appendicitis, the role of ultrasonography (US) in its diagnosis and management and the efficacy of conservative management.

Methods
Consecutive children with suspected acute appendicitis were prospectively enrolled. Ultrasonography was performed at baseline, during follow-up, before the discharge, and at 15-day intervals until US findings of OI disappeared. All children with a diagnosis of OI were treated conservatively.

Results
One hundred ninety-nine children (91 male; age range, 3–15 years) were evaluated. Eighty-four patients had acute appendicitis. Omental infarctions were found in 14 children (8 male; mean age, 9.8 ± 2.6 years), with an incidence of 7%. Ultrasonography depicted an echogenic mass consistent with OI in all children. Ultrasonography detected in 8 patients a normal-looking appendix, whereas in other 6 patients, it identified neither appendix nor indirect signs of acute appendicitis. A normal appendix has been detected by US during follow-up in 2 of these 6 patients. During follow-up, US finding of OI disappeared in all cases and no signs of acute appendicitis or other disease occurred. All 14 OIs were treated conservatively, with no reported complications.

Conclusions
Omental infarction is an underestimated cause of abdominal pain in children accounting for 7% of patients with suspected appendicitis. Ultrasonography is a useful method for the diagnoses and to guide clinical management of OI. Conservative therapy is a safe option for the management of OI.