bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using Simulation in Training Pediatric Residents on Neonatal Abstinence Syndrome Scoring
Authors: Agana Marisha , Vos Duncan , Williams Mark , Baumgartner Hans , Soares Neelkamal 
Published: April 2020

Background:
Neonatal abstinence syndrome (NAS) is characterized by significant physiological and behavioral signs involving multiple-organ systems in neonates following a prenatal exposure to opioids and other nonopioid drugs. Neonatal abstinence syndrome can result in serious morbidity, and even death, if unrecognized and untreated. The purpose of this study was to develop a simulation model of a standard video training of the Finnegan Neonatal Abstinence Scoring System (FNAS) and investigate the perceptions of comfort and competency of pediatric residents undergoing video or simulation training.

Methods:
Thirty-one pediatric and medicine-pediatric residents participated in this single-blinded randomized intervention study. The experimental group completed demonstrated simulation while the control group received the traditional video instruction. Both groups completed FNAS scoring on a case of a neonate with NAS. The FNAS scores of residents were compared with the scores of 2 expert raters. Pre- and posttraining and preference surveys were obtained from all participants.

Results:
Both experimental and control groups scored the FNAS scenario similarly and were also similar to the expert raters. Both groups also reported comparable levels of comfort and competency after the training, though first-year residents reported greater improvement than upper-level residents. The FNAS scores from expert raters were identical for the simulation and video scenarios.

Implications for Practice:
Although this study showed that a simulation training module can be used as a standardized teaching method to administer the FNAS, it can be cost-prohibitive and daunting to produce. Nursing professionals need to be aware of medical education training around FNAS due to the interdisciplinary nature of care for neonates with NAS. Institutions should consider implementing a diversity of practices and models with an interdisciplinary approach to training assessment of the neonate with NAS.

Implications for Research:
A more hands-on, less cost-prohibitive simulation training needs to be developed to teach FNAS administration with a broader range of professionals including interdisciplinary teams of nursing and medical professionals.
Meta-analysis and Trial Sequential Analysis of Randomized Controlled Trials Comparing High and Low Ligation of the Inferior Mesenteric Artery in Rectal Cancer Surgery
Authors: Hajibandeh Shahab , Hajibandeh Shahin , Maw Andrew 
Published: April 2020

BACKGROUND:
Despite ongoing debates, there is still no consensus regarding where to divide the inferior mesenteric artery for oncological reasons in rectal cancer: at its origin from the aorta (high ligation) or distal to the origin of the left colic artery (low ligation).

OBJECTIVES:
The purpose of this study was to compare the outcomes of high and low ligation of the inferior mesenteric artery in rectal cancer surgery.

DATA SOURCES:
MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry, ClinicalTrials.gov, and ISRCTN Register were searched.

STUDY SELECTION:
andomized controlled trials investigating outcomes of curative anterior resection in patients with cancer of the rectum were included.

INTERVENTIONS:
High ligation of the inferior mesenteric artery was compared with low ligation technique.

MAIN OUTCOME MEASURES:
We measured the total number of lymph nodes harvested, anastomotic leak, postoperative complications, postoperative mortality, operative time, intraoperative blood loss, conversion to open surgery, overall survival, and disease-free survival.

RESULTS:
Analysis of 1102 patients from 8 trials suggested no difference between high and low ligation of the inferior mesenteric artery in terms of total number of lymph nodes harvested (mean difference = –0.87; p = 0.26), anastomotic leak (OR = 1.39; p = 0.15), postoperative complications (OR = 1.39; p = 0.78), postoperative mortality (risk difference = –0.00; p = 0.48), operative time (mean difference = –1.99; p = 0.79), intraoperative blood loss (mean difference = –2.28; p = 0.77), conversion to open surgery (risk difference = 0.01; p = 0.48), 5-year overall survival (OR = 0.76; p = 0.32), 5-year disease-free survival (OR = 0.88; p = 0.58), overall survival at maximum follow up (OR = 0.80; p = 0.43), and disease-free survival at maximum follow-up (OR = 0.83; p = 0.35).

LIMITATIONS:
Limited data were available on functional and long-term survival outcomes.

CONCLUSIONS:
There is no difference between high and low ligation of the inferior mesenteric artery in terms of oncological outcomes or postoperative morbidity and mortality. The available evidence is subject to potential confounding by the use of neoadjuvant therapy, adjuvant therapy, disease stage, location of tumor, and use of protective stoma. Functional outcomes including postoperative bowel, urinary and sexual function, and long-term survival outcomes should be the outcome of study in future trials. PROSPERO registration number: CRD42019148626
Continuous Monitoring of Coronary Care Mortality Using the Global Registry for Acute Coronary Events (GRACE) Score
Authors: Ciambrone Graciana , Higa Claudio C. , Gambarte Jimena , Novo Fedor , Nogues Ignacio , Borracci Raul A. 
Published: April 2020

Background:
The aim was to assess the utility of cumulative sum techniques for continuous monitoring of coronary care outcomes, applied to patients with acute coronary syndrome stratified by the Global Registry for Acute Coronary Events (GRACE) risk score.

Methods:
A prospective longitudinal study to assess GRACE score for real-time monitoring of coronary care mortality in a community hospital was conducted between January 2012 and December 2017. An expected-to-observed probability of death chart for individual risk and a variable life-adjusted display were used to monitor the results.

Results:
A total of 1,255 patients undergoing acute coronary syndrome were included in the analysis. GRACE-based variable life-adjusted plots monitoring in-hospital mortality showed that observed death rates remained in general within the expected 95% confidence limit over time, and these behaviors were similar for ST-segment elevation and non-ST-segment elevation myocardial infarction. In-hospital all-cause mortality was 2.6% for the overall population, and 56% of these cases corresponded to unexpected deaths; conversely, unexpected survival occurred in 5.2% of survivors.

Conclusions:
Continuous monitoring of coronary care mortality based on cumulative sum charts and the GRACE score demonstrated the occurrence of series of favorable and unfavorable outcomes on a real-time basis. Additionally, plotting the expected-to-observed probability of death for individual cases was useful to individualize unexpected deaths in low-risk patients. Although overall coronary care performance was adequate according to the GRACE score, we found that there is still some room for improvement, since over half of the deaths occurring in low-risk patients were potentially preventable.
Characterization of Applied Forces and Torques During Rigid Bronchoscopy Intubation
Authors: Barrette Louis-Xavier , Turkseven Melih , De Suvranu , Majid Adnan , Parikh Mihir , Chee Alex 
Published: April 2020

Background:
Rigid bronchoscopy intubation poses a significant risk of complication to patients from mechanical trauma. Despite the importance of precision in forces exerted by surgeons during intubation, no prior study has analyzed the overall forces and torques involved in rigid bronchoscopy intubation, and whether existing training modalities accurately replicate them.

Methods:
A bronchoscope was equipped with a 6-axis load sensor to measure forces and torques applied during rigid bronchoscopy intubation. The device was applied to measure intubation forces in low-fidelity manikins and patients by interventional pulmonologists.

Results:
Axial and lateral forces were measured during rigid bronchoscope intubation from the mouth to the mid-trachea. The mean axial/lateral forces recorded during manikin trials were 6.93/18.06 N, whereas those recorded during patient trials were 4.57/9.43 N. Average axial and lateral force application was therefore 51.6% and 92.6% higher in manikin, respectively. Applied axial torque averaged across all human trials was 130.5 N-mm compared with 78.3 N-mm for manikin trials, 40% lower in manikin than in human. Lateral torque application during manikin intubation showed greater variation in between trials and a greater range of SDs within trials.

Conclusion:
This was the first application of a rigid bronchoscope measurement device designed to measure forces applied at the handle. Force and torque discrepancies between manikin training and patient applications were found, indicating a possible mismatch between the haptic feedback received by physicians during rigid training and application. This inconsistency could be resolved via novel haptic training modalities and help increase atraumatic intubations.
Evaluating Yield of 19 Versus 21 G EBUS-TBNA Needles
Authors: Elmufdi Firas S. , Peterson Marissa K. , Niccum David , Asche Stephen , Ham Kealy 
Published: April 2020

Background:
Controversy remains regarding the effect of needle size on the diagnostic yield of endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration. We conducted a prospective study comparing the diagnostic yield of 19 and 21 G EBUS needles and hypothesized that the 19 G have a greater EBUS-guided transbronchial needle aspiration diagnostic yield as compared with the 21 G needle.

Methods:
A total of 60 patients undergoing EBUS-guided transbronchial needle aspiration were enrolled with informed consent. Both 19 and 21 G needles were used at each lymph node station in alternating fashion, we randomized which needle, to begin with. Two rapid on-site cytology evaluation stations were present and assigned to one of the 2 needles. They reported sample adequacy and prepared a separate cell block per lymph node sampled for their assigned needle.

Results:
A total of 141 lymph nodes were analyzed. Diagnosis included 69 benign lymph nodes, 47 malignant lymph nodes, 22 noncaseating granulomas, and 3 infected lymph nodes. Five hundred seventy-three passes (average: 4.1 passes/lymph node) were done with 19 G and 581 passes with 21 G needles (average: 4.1 passes/lymph node). Diagnostic yield was similar between 19 and 21 G needles overall (89.4% vs. 88.7%, P=0.71). The 19 G needles showed higher smear cellularity (32.6% vs. 13.0%, P=0.05), and rapid on-site cytology evaluation adequacy (84.8% vs. 63.0%, P=0.004) in lymph nodes with cancer diagnosis. In 7 of the 141 lymph nodes, samples from only one of the needles provided the final diagnosis.

Conclusion:
There is no difference in the overall diagnostic yield between 19 and 21 G needles. Further studies are needed to confirm the trend of the superiority of 19 G in cancerous lymph nodes.
Incorporating Stakeholder Feedback in Guidelines Development for the Management of Abnormal Cervical Cancer Screening Tests
Authors: Perkins Rebecca B. , Fuzzell Lindsay N. , Lake Paige , McIntyre McKenzie , Nayar Ritu , Saraiya Mona , Loukissas Jennifer , Felder Tamika , Guido Richard S. , Vadaparampil Susan T. 
Published: April 2020

Objective
The 2019 ASCCP Risk-Based Management Consensus Guidelines present a paradigm shift from results- to risk-based management. Patient and provider factors can affect guideline adoption. We sought feedback from stakeholders to inform guideline development.

Materials and Methods
To solicit provider feedback, we surveyed attendees at the 2019 ASCCP annual meeting regarding readiness to adopt proposed changes and used a web-based public comment period to gauge agreement/disagreement with preliminary guidelines. We elicited patient feedback via a brief survey on preferences around proposed recommendations for treatment without biopsy. Surveys and public comment included both closed-ended and free-text items. Quantitative results were analyzed using descriptive statistics; qualitative results were analyzed using content analysis. Results were incorporated into guideline development in real time.

Results
Surveys indicated that 98% of providers currently evaluate their patients' past results to determine management; 88% felt formally incorporating history into management would represent an improvement in care. Most providers supported expedited treatment without biopsy: 22% currently perform expedited treatment and 60% were willing to do so. Among patients, 41% preferred expedited treatment, 32% preferred biopsy before treatment, and the remainder were undecided. Responses from the public comment period included agreement/disagreement with preliminary guidelines, reasons for disagreement, and suggestions for improvement.

Conclusions
Stakeholder feedback was incorporated into the development of the 2019 ASCCP Risk-Based Management Consensus Guidelines. Proposed recommendations with less than two-thirds agreement in the public comment period were considered for revision. Findings underscore the importance of stakeholder feedback in developing guidelines that meet the needs of patients and providers.
Hiccups triggered by bladder filling after bilateral pontine hemorrhage
Authors: Chon Jinmann , Yoo Seung Don , Lee Seung Ah 
Published: April 2020

Abstract

Introduction:
A hiccup is myoclonus of a sudden involuntary contraction of the diaphragm. Hiccups have various causes, and brain stem stroke is one of the causes of central hiccups. Certain types of hiccups are caused by diseases that can be fatal. Therefore, it is beneficial for physicians to be familiar with the various cases of unusual hiccups. We report a case of hiccups triggered by urinary bladder filling in a brain stem stroke patient. To the best of our knowledge, previous reports have not described a similar case.

Patient concerns:
We describe the case of a 54-year-old patient who had acute bilateral pontine hemorrhage. The patient had intermittent hiccups in the early stages of the stroke onset. The hiccups ceased by the administration of medication or stimulation of the pharyngeal or tracheal wall. Two months after the onset, the Foley catheter was removed to check if the patient could void the bladder voluntarily. Hiccups occurred whenever the bladder was filled with some amount of urine.

Diagnosis:
Pontine hemorrhage, neurogenic bladder, and quadriplegia.

Interventions:
When the hiccups occurred, the amount of urine in the bladder was checked using a transabdominal bladder ultrasonography scanner. After clean intermittent catheterization for bladder emptying, the hiccups subsided.

Outcomes:
The hiccups occurred 5 or 6 times a day, as often as the bladder was filling. He was unable to void the urine voluntarily for 5 days after the removal of the Foley catheter. Percutaneous suprapubic cystostomy was performed finally to remove the stimulation of bladder filling and the hiccups disappeared.

Conclusion:
Bladder filling is suspected to increase the sympathetic tone and cause a hiccup reflex. Bladder filling could be a factor triggering hiccups in pontine hemorrhage.
ABO blood type, smoking status, other risk factors and prognosis of pancreatic ductal adenocarcinoma
Authors: Li Shuang-Shuang , Zhou Cong-Ya , Liao Rong , Xiong Lai , Weng Ning-Na , Zhao Ya-Qin , Mason Clifford , Gou Hong-Feng , Yi Cheng , Zhu Qing 
Published: April 2020

Abstract
The aim of this observational study was to test whether ABO blood type was a prognostic factor for pancreatic ductal adenocarcinoma (PDAC) patients and whether other risk factors could influence pancreatic cancer patients’ survival. This study included 610 patients who were diagnosed as pancreatic cancer and had undergone radical surgery. Patients’ characteristics included age, gender, tumor stage, tumor grade, adenosquamous carcinoma (ASC) status, preoperative serum carbohydrate antigen 19-9 (CA19-9) levels, preoperative serum carcinoembryonic antigen (CEA) levels, ABO blood type, smoking status, and drinking status were analyzed in this study. Cox proportional hazards regression model and Kaplan–Meier method were used to evaluate the role of prognostic factors. For pancreatic cancer patients undergoing radical surgery, the overall survival was worse for ASC patients than PDAC patients (Log-rank = 11.315, P < .001). Compared with ASC patients (Log-rank < 0.001, P = .996), PDAC patients can benefit from chemotherapy (Log-rank = 17.665, P < .001). For PDAC patients, O blood type had better overall survival than non-O blood type (Log-rank = 4.153, P = .042). Moreover, the group with higher serum levels of CA19-9 had poor prognosis compared to another group with low serum CA19-9 (Log-rank = 4.122, P = .042). Higher CEA levels indicated poor prognosis (Log-rank = 13.618, P < .001). In conclusion, ASC status was associated with overall survival of pancreatic cancer patients and cannot benefit from postoperative chemotherapy. Non-O blood type was a prognostic factor for PDAC patients.
Ultrasonographic measurement of femoral cartilage thickness in type II diabetic patients
Authors: Bedewi Mohamed A. , Elsifey Ayman A. , Naguib Moheyeldeen F. , Saleh Ayman K. , Al-Ghamdi Sameer , Alhariqi Bader A. , Aldossary Nasser M. , Gould Elaine S. 
Published: April 2020

Abstract
The aim of this study is to compare the distal femoral cartilage thickness of patients with type II diabetes mellitus with those of healthy subjects using ultrasonography. The study comprised 34 patients and 36 healthy subjects. Demographic characteristics of all the participants were recorded. The thickness of the femoral articular cartilage was measured using a 5-18MHzlinearprobe.Measurements were performed bilaterally from three points (intercondylar area, medial condyle, and lateral condyle). No significant difference could be found between patients and healthy subjects. Two demographic characteristics correlated positively with diabetic patients.
Obstructive jaundice in a patient with polycystic liver disease complicated with polycystic kidney and polycystic lung
Authors: Zhang Liling , Gan Linwang , Liu Qi , Li Ying , Lin Jiaru , Ou Santao 
Published: April 2020

Abstract

Rationale:
Polycystic liver disease (PLD) is an autosomal-dominant disorder that is commonly associated with autosomal-dominant polycystic kidney disease (PKD) but rarely complicated with polycystic lung. Here, we report the first case of severe obstructive jaundice caused by multiple liver cysts in a patient with PLD complicated by PKD and polycystic lung.

Patient concerns:
A 72-year-old man with a history of PLD complicated with polycystic kidney presented with progressive jaundice, hematuria, poor appetite, nausea, and weight loss since 3 months.

Diagnosis:
PLD complicated with PKD and polycystic lung was identified using computed tomography, and obstructive jaundice was identified using magnetic resonance imaging and magnetic resonance cholangiopancreatography.

Interventions:
The patient could not undergo surgery, and was therefore treated with combined bilirubin adsorption and continuous veno-venous hemofiltration.

Outcomes:
The patient's symptoms and laboratory findings improved after bilirubin adsorption and continuous veno-venous hemofiltration. Unfortunately, the patient was unable to continue the treatment due to financial reasons, and died of shock most likely due to cyst rupture.

Lessons:
Imaging examination of the lungs is necessary for patients with PLD. Although infrequent, jaundice can occur in these patients and cause severe hyperbilirubinemia. When surgery is contraindicated, blood purification may serve as an alternative treatment for patients with PLD-related obstructive jaundice.
The effectiveness of a novel surgical approach for the treatment of congenital muscular torticollis
Authors: Shan Jianlin , Jiang Heng , Zhang Yang , Zhang Zhicheng , Ren Dajiang , Zhu Bing 
Published: April 2020

Abstract
The outcomes of surgical treatment for congenital muscular torticollis (CMT) are poor in many cases, primarily from surgeon's fear of damage to important blood vessels in the carotid sheath. The current research aimed to establish a novel, safer and more effective surgical approach for the treatment of CMT based on the anatomic relationship between the fascial sheath of the sternocleidomastoid muscle and the carotid sheath.
A total of 12 formalin-fixed cadaveric specimens (including 9 males and 3 females with average age of 48.1 years at the time of death) were used to observe the anatomical integrity and the compactness of the sternocleidomastoid fascial sheath and its relationship with the carotid sheath. From January 2013 to December 2015, 22 patients with CMT were treated surgically, including 12 males and 10 females with an average age of 13 years (range: 6–28 years). All patients underwent surgical treatment using the novel approach designed by the author, that is, separation of the fascial sheath of the sternocleidomastoid and the carotid sheath was performed.
The fascial sheath of the sternocleidomastoid muscle is easily isolated from the carotid sheath in all specimens. All procedures were successfully completed. The space between the fascial sheath of the sternocleidomastoid muscle and the carotid sheath can be accessed in all patients. Carotid sheath contracture was identified in 1 patient and divided successfully. The average follow-up period was 19 months (range: 5 to 43 months). No postoperative lateral band was noted in the neck in any of the patients. Satisfaction regarding cosmetic and functional outcomes was considered excellent in 13 patients, good in 7 patients, and fair in 2 patients.
The fascial sheath of the sternocleidomastoid muscle is easily isolated from the carotid sheath. This anatomical feature is the basis of division of the sternocleidomastoid muscle and can improve the safety and effectiveness of surgical treatment for CMT in patients older than 6 years old.
Effects of body weight support and gait velocity via antigravity treadmill on cardiovascular responses early after total knee arthroplasty
Authors: Kim Bo Ryun , Kim Sang Rim , Nam Kwang Woo , Lee So Young , Park Yong Geun , Suh Min Ji , Jeon Young Tae 
Published: April 2020

Abstract
To investigate the effects of body weight support (BWS) and gait velocity on cardiovascular responses during walking on an antigravity treadmill early after unilateral and bilateral total knee arthroplasty (TKA).
This study was a cross-sectional study design. Fifty patients (7 males and 43 females; average age, 72.0 ± 5.1 years) at 4 weeks after unilateral (n = 25) and bilateral (n = 25) primary TKA were enrolled in the study. Subjects walked on an antigravity treadmill at speeds of 2.5 km/hour and 3.5 km/hour with 3 levels (50%, 25%, and 0%) of BWS. Cardiovascular responses were monitored by measuring oxygen consumption (VO2), heart rate (HR), systolic and diastolic blood pressure (SBP/DBP), the respiratory exchange ratio (RER), and rate pressure product (RPP). Borg rating of perceived exertion (RPE) and a visual analog scale (VAS) of knee pain were recorded immediately after each trial.
There were no significant differences in cardiovascular responses between the unilateral and bilateral TKA groups. In the repeated measures Analysis of Variance, VO2 levels, HR, RPP, RPE, RER, and VAS were significantly increased in proportion to 3 levels (50%, 25%, and 0%) of BWS for unilateral and bilateral TKA groups, respectively. Meanwhile, SBP and DBP were unaffected by differences in BWS. At 3.5 km/hour, VO2, RPE, and RER values were statistically greater than those at 2.5 km/hour under the same BWS conditions.
We found that the reduction in the metabolic demand of activity, coupled with positive pressure on the lower extremities, reduced VO2 and HR values as BWS increased.
Cardiovascular responses vary according to BWS and gait velocity during antigravity treadmill walking. BWS rather than gait velocity had the greatest effect on cardiovascular responses and knee pain.