bluuebunny/crossref_metadata_2025_split huggingface dataset:
Moderate Certainty Evidence Suggests the Use of High-Flow Nasal Cannula Does Not Decrease Hypoxia When Compared With Conventional Oxygen Therapy in the Peri-Intubation Period: Results of a Systematic Review and Meta-Analysis
Authors: Chaudhuri Dipayan , Granton David , Wang Dominic Xiang , Einav Sharon , Helviz Yigal , Mauri Tommaso , Ricard Jean-Damien , Mancebo Jordi , Frat Jean-Pierre , Jog Sameer , Hernandez Gonzalo , Maggiore Salvatore M. , Hodgson Carol , Jaber Samir , Brochard Laurent , Burns Karen E. A. , Rochwerg Bram 
Published: January 2020

Objective:
The role of high-flow nasal cannula during and before intubation is unclear despite a number of randomized clinical trials. Our objective was to conduct a systematic review and meta-analysis examining the benefits of high-flow nasal cannula in the peri-intubation period.

Data Sources:
We performed a comprehensive search of relevant databases (MEDLINE, EMBASE, and Web of Science).

Study Selection:
We included randomized clinical trials that compared high-flow nasal cannula to other noninvasive oxygen delivery systems in the peri-intubation period.

Data Extraction:
Our primary outcome was severe desaturation (defined as peripheral oxygen saturation reading < 80% during intubation). Secondary outcomes included peri-intubation complications, apneic time, Pao
2 before and after intubation, Paco
2 after intubation, ICU length of stay, and short-term mortality.

Data Synthesis:
We included 10 randomized clinical trials (n = 1,017 patients). High-flow nasal cannula had no effect on the occurrence rate of peri-intubation hypoxemia (relative risk, 0.98; 95% CI, 0.68–1.42; 0.3% absolute risk reduction, moderate certainty), serious complications (relative risk, 0.87; 95% CI, 0.71–1.06), apneic time (mean difference, 10.3 s higher with high-flow nasal cannula; 95% CI, 11.0 s lower to 31.7 s higher), Pao
2 measured after preoxygenation (mean difference, 3.6 mm Hg higher; 95% CI, 3.5 mm Hg lower to 10.7 mm Hg higher), or Pao
2 measured after intubation (mean difference, 27.0 mm Hg higher; 95% CI, 13.2 mm Hg lower to 67.2 mm Hg higher), when compared with conventional oxygen therapy. There was also no effect on postintubation Paco
2, ICU length of stay, or 28-day mortality.

Conclusions:
We found moderate-to-low certainty evidence that the use of high-flow nasal cannula likely has no effect on severe desaturation, serious complications, apneic time, oxygenation, ICU length of stay, or overall survival when used in the peri-intubation period when compared with conventional oxygen therapy.
Direct Oral Anticoagulants and Coronary Artery Disease: The Debacle of the Aspirin Era?
Authors: García-Ropero Álvaro , Vargas-Delgado Ariana P. , Santos-Gallego Carlos G. , Badimon Juan J. 
Published: January 2020

Abstract:
Long-standing aspirin is the cornerstone to prevent recurrence of thrombotic events in patients with ischemic heart disease. However, clopidogrel, a more potent antiplatelet agent, is preferred over aspirin in targeted populations, including those with a high risk of gastrointestinal bleeding. In addition, clopidogrel offers superior oral tolerance, and it may reduce the rates of intracranial hemorrhages compared with aspirin. However, an extensive inhibition of the coagulation cascade seems to be reasonable to minimize thrombotic events in such patients. After several failed exploratory investigations in the past with vitamin K antagonists, the newest direct oral anticoagulants may represent an alternative. To counterbalance bleeding complications, a low dose of these agents should be considered. Few publications have already showed promising results with the combination of clopidogrel and low-dose direct oral anticoagulants. Further investigations should be addressed to elucidate whether this is the downfall of the aspirin era for secondary prevention of atherosclerotic cardiovascular events.
Physical Activity in Adults With Wearable Cardioverter Defibrillators in the Post–Myocardial Infarction Period
Authors: Tripp Connor , Burch Ashley E. , Erath Julia W. , Hain Andreas , Sears Samuel F. 
Published: January 2020

Purpose:
Wearable cardioverter defibrillators (WCDs) provide lifesaving defibrillation and are equipped with accelerometers, capable of providing information on patient wear time and physical activity (PA). The purpose of this study was to report on patient PA while wearing a WCD.

Methods:
This study derived data from the WCD vendor in patients prescribed WCD post–myocardial infarction (MI) with left ventricular ejection fraction ≤35% in 2016. Using the device accelerometer, the relationship between wear time and PA was examined in a sample of consistent wearers of the WCD. Demographic variables, including sex and age, were examined for impact on wear time and PA. Changes in PA over time were also examined.

Results:
A total of 1952 patients (71% male) with a median age of 63 yr were included. Descriptive analyses indicated that overall median wear time was 23.8 hr/d; PA was 5568 steps/d. Significant differences in PA over time were identified, with median steps increasing by 67% from the first week of wear to the last week of wear. Patient age and wear time significantly predicted PA; patient age also significantly predicted patient wear time. There were significant differences in median hours of wear time, as well as median steps, based on sex.

Conclusions:
PA in adults early after hospital discharge is modest and improves over the course of the 90-d WCD prescription in regular wearers. Improved health status may account for this change. The WCD accelerometer may have value in future clinical care and research by providing a window into daily patient PA levels via remote monitoring.
5-Fluorouracil Management of Oculofacial Scars: A Systematic Literature Review
Authors: Bui Anh D. , Grob Seanna R. , Tao Jeremiah P. 
Published: January 2020

Purpose:
To review the literature for the safety and efficacy of intralesional 5-fluorouracil (5-FU) in the management of oculofacial scars.

Methods:
A literature search was performed in July 2019 in the PubMed database to identify reports of the use of 5-FU injections for modulating oculofacial cutaneous scars. The search yielded 152 articles, of which 15 met criteria outlined for assessment. Data were abstracted from these 15 relevant articles.

Results:
While there were no high-level prospective randomized controlled trials, 8 were lower-quality randomized controlled trial, 3 were retrospective cohort studies, and 4 were case series. Most studies pooled results of facial and nonfacial cutaneous applications. Three studies focused solely on oculofacial applications, and these were all lower-level evidence studies. The study outcomes included scar dimension reduction, erythema, patient satisfaction score, observer assessment of scar improvement, and recurrence rates. 5-Fluorouracil was administered as monotherapy or as part of multimodality treatment with other agents (usually corticosteroids) or with CO2 laser, radiotherapy, or pulsed dye laser. 5-Fluorouracil was usually given as an intralesional injection, but in some studies, it was applied topically after micropuncture of the skin. The number and timing of treatments varied between studies. Overall, the level of safety of 5-FU was high. Pain with injection was the most common reported side effect. Other common adverse side effects included pruritus, telangiectasias, changes in pigmentation, and purpura, and 2 studies noted more serious events, such as ulceration, superficial necrosis, and local infection. There were no severe side effects such as anaphylaxis, immune suppression, secondary malignancy, systemic infection, blindness, or death. In all studies, 5-FU was associated with prophylaxis of oculofacial scars or improvement of keloids or hypertrophic scars in terms of reducing size, erythema, and pruritus. 5-Fluorouracil application was associated with favorable patient satisfaction and observer assessment scores especially compared with corticosteroid injections alone.

Conclusions:
High-quality randomized controlled trials are currently lacking, and the existing literature is predominately not specific to use of 5-FU on the face. These studies, however, suggest that intralesional 5-FU is safe and probably more effective than other options in the management of cutaneous scars in the oculofacial region. The delivery methods, timing, dosing, and concomitant therapies were highly variable. Further high-quality controlled studies specific to oculofacial scars may be indicated to assess the efficacy of 5-FU and to establish the best protocols for administering this medication.
Removal of Orbital Metallic Foreign Bodies With Image-Guided Surgical Navigation
Authors: Zhao Yiping , Li Yinwei , Li Zhengkang , Deng Yuan 
Published: January 2020

Purpose:
To describe the use of an image-guided 3-dimensional surgical navigation system for the removal of metallic foreign bodies from the human intraorbital region.

Patients and methods:
Between January 2016 and June 2019, 30 patients with metallic foreign bodies in the orbital area underwent image-guided 3-dimensional surgical navigational removal at the authors’ center, and their data were retrospectively analyzed. Patients’ age, gender, complaints, cause of initial injury, location, interval between injury, and surgery were recorded. Preoperative CT scans of the orbits were obtained and used for preoperative planning. The 3-dimensional navigation system was used for intraoperative navigation.

Results:
In all 30 patients, the foreign bodies were removed by minimally invasive access without any severe complications. The intraoperative average depth of foreign bodies was 19.98 ± 11.47 mm which was consistent with the depth measured in preoperative planning. The mean length, width, and height of foreign bodies determined in preoperative planning were confirmed by postoperative measurements. There was no significant difference between preoperative and postoperative mean logarithm of Mininal Angle Resolution (logMAR) best-corrected visual acuity. According to the postoperative CT scan, all 30 patients’ metallic foreign bodies were successfully removed by surgeries using the surgical navigation system. Most patients who presented with diplopia, eye movement pain, and paresthesia were improved after surgery.

Conclusion:
This study demonstrated that computer-assisted image-guided 3-dimensional surgical navigation had the advantages of accurate real-time localization of foreign bodies, minimizing collateral damage, determining the appropriate surgical path, and increasing the successful rate of foreign body retrieval.
Factors Influencing Time to Cochlear Implantation
Authors: Dornhoffer James R. , Holcomb Meredith A. , Meyer Ted A. , Dubno Judy R. , McRackan Theodore R. 
Published: January 2020

Objective:
To determine demographic and audiologic factors associated with time to treatment with cochlear implantation.

Methods:
Retrospective review of a prospectively maintained adult cochlear implant database. A total of 492 patients were implanted from 2012 to 2017. Time to implantation, preimplantation audiologic outcomes, and demographic data were collected. Multivariate analysis was undertaken to establish demographic/audiologic factors that predict time to cochlear implantation.

Results:
Using multivariate analysis, nonwhite race (hazard ratio 0.157, p = 0.038) and increased age (hazard ratio 0.970, p = 0.038) were associated with increased time to cochlear implantation. Nonwhite patients had significantly higher pure-tone averages and lower speech recognition scores (consonant–nucleus–consonant words and AzBio sentences in quiet) and were less likely to use hearing aids as compared with white patients (all p < 0.001). Sex (p = 0.188), health insurance type (p = 0.255), preoperative hearing aid use (p = 0.174), and audiologic outcomes were not significant predictors of time to implantation.

Conclusion:
Nonwhite patients have poorer preoperative hearing and speech recognition and lower hearing aid use and are at risk for delay in referral and treatment for severe to profound sensorineural hearing loss. Other demographic factors, notably health insurance status, did not significantly predict time to cochlear implantation. Given the observed hearing healthcare disparities, special outreach programs may be needed to ensure timely cochlear implantation and effective hearing screening and rehabilitation.
Monitoring Cochlear Nerve Integrity During Vestibular Schwannoma Microsurgery in Real-Time Using Cochlear Implant Evoked Auditory Brainstem Response and Streaming Neural Response Imaging
Authors: Patel Neil S. , Saoji Aniket A. , Olund Amy P. , Carlson Matthew L. 
Published: January 2020

Objective:
Intraoperative far-field auditory brainstem response (ABR) and direct cochlear nerve action potential monitoring using neural response imaging (NRI) are techniques for monitoring the cochlear nerve during vestibular schwannoma (VS) surgery. A new paradigm has developed where the cochlear nerve is anatomically preserved during tumor removal to facilitate cochlear implantation in select circumstances. This report describes the use of an unmodified commercial cochlear implant (CI) to elicit electrically-evoked direct cochlear nerve and far-field ABR monitoring to evaluate the status of the cochlear nerve during tumor resection in real time.

Patients:
Adult female with unilateral, sporadic VS.

Intervention(s):
Cochlear implantation followed by translabyrinthine resection of VS in single operation.

Main Outcome Measures:
During tumor resection intra-cochlear electrodes were used to deliver electrical stimulation and measure NRI or the cochlear nerve action potential. Electrically-evoked ABR (eABR) was measured using surface electrodes and wave V was monitored (far-field ABR) during surgery.

Results:
A 61-year-old female was evaluated for a unilateral, enlarging intracanalicular VS with asymmetric SNHL. The patient opted for microsurgery and due to her bilateral hearing loss was a candidate for CI. Cochlear implantation with an unmodified, commercially available lateral wall electrode was performed. The remainder of the approach and tumor resection was performed under continuous eABR and NRI monitoring. Gross total resection was achieved with intact eABR and NRI at the conclusion of the case. Changes in ABR and NRI consistently recovered after modifying dissection strategy. The patient reported auditory percepts with her cochlear implant postoperatively.

Conclusions:
This report demonstrates the feasibility of using real-time NRI and eABR with a CI to facilitate preservation of the cochlear nerve during VS microsurgery. Using this method to mitigate cochlear nerve trauma during microsurgery may preserve the option of CI for hearing rehabilitation.
Endoscope-assisted Partial Cochlectomy for Intracochlear Schwannoma With Simultaneous Cochlear Implantation: A Case Report
Authors: Ma Andrew K. , Patel Nirmal 
Published: January 2020

Introduction:
Intralabyrinthine schwannomas are a small subset of vestibular schwannomas which originate within the labyrinthine structures. Management typically consists of watch-and-wait strategies given that surgical intervention will sacrifice hearing. Endoscopic resection of primary intracochlear schwannoma with simultaneous cochlear implantation for a patient with progressive hearing loss and debilitating tinnitus is described.

Patient:
A 56-year-old male presenting with asymmetric left sensorineural hearing loss (SNHL) was diagnosed with intracochlear schwannoma on MRI.

Intervention:
Surgery was indicated due to tumor growth on serial imaging, worsening SNHL, and severe tinnitus. Partial cochlectomy was performed via transcanal endoscopic approach. Cochlear implantation via mastoidectomy and posterior tympanotomy was simultaneously performed with a CI512 Contour Advanced implant (Cochlear, Sydney, Australia).

Main Outcome Measures:
Post partial cochlectomy speech performance.

Results:
Preoperative audiometry showed left profound SNHL with 20% speech recognition score despite maximal amplification. Speech perception testing 5 months postoperatively demonstrated good unilateral discrimination when testing the implanted ear alone (BKB sentences 66%, CUNY sentences 79%), open-set comprehension, and excellent binaural performance.

Conclusion:
The endoscope offers an additional viable approach to the otic capsule for the removal of intracochlear schwannoma and good audiologic outcomes can be achieved with simultaneous cochlear implantation even after partial cochlectomy.
An Exploratory Examination of Client Perspectives on a Positive Memory Technique for PTSD
Authors: Caldas Stephanie V. , Jin Ling , Dolan Megan , Dranger Paula , Contractor Ateka A. 
Published: January 2020

Abstract
Posttraumatic stress disorder (PTSD) treatments primarily address traumatic memories, despite PTSD's association with both traumatic and positive memory difficulties. Addressing this gap, we explored the perspectives of trauma-exposed individuals with mental health treatment experience on therapeutically addressing positive memories. A treatment-seeking sample from a community mental health center (n
1 = 60) and a community sample from Amazon's Mechanical Turk (n
2 = 123) were queried on the acceptability, feasibility, and delivery/components of a pilot positive memory technique. Results indicated interest or willingness in therapeutically discussing positive memories; most endorsed benefits were improved mood, positive thoughts, and self-esteem. Few barriers were identified (e.g., lack of evidence) compared with feasibility factors (ease/usefulness, improved satisfaction/tolerability, and engagement in PTSD treatment). Preferred treatment components included identifying/discussing positive memories, eliciting associated positive affect, and writing about the positive memory as homework. Results provide formative support for the development and integration of a positive memory technique into PTSD treatments.
A Multidisciplinary Initiative to Increase Inpatient Discharges Before Noon
Authors: Kane Marlena , Weinacker Ann , Arthofer Rudolph , Seay-Morrison Timothy , Elfman Wesley , Ramirez Mark , Ahuja Neera , Pickham David , Hereford James , Welton Mark 
Published: January 2020

OBJECTIVE:
The aim of this study is to evaluate the effect of 2 hospital-wide interventions on achieving a discharge-before-noon rate of 40%.

BACKGROUND:
A multidisciplinary team led by administrative and physician leadership developed a plan to diminish capacity constraints by minimizing late afternoon hospital discharges using 2 patient flow management techniques.

METHODS:
The study was a preintervention/postintervention retrospective analysis observing all inpatients discharged across 19 inpatient units in a 484-bed, academic teaching hospital measuring calendar month discharge-before-noon percentage, patient satisfaction, and readmission rates. Patient satisfaction and readmission rates were used as baseline metrics.

RESULTS:
The discharge-before-noon percentage increased from 14% in the 11-month preintervention period to an average of 24% over the 11-month postintervention period, whereas patient satisfaction scores and readmission rates remained stable.

CONCLUSIONS:
Implementation of the 2 interventions successfully increased the percentage of discharges before noon yet did not achieve the goal of 40%. Patient satisfaction and readmission rates were not negatively impacted by the program.
A Community Hospital’s Evaluation of Alarm Management Safety Factors
Authors: Kurnat-Thoma Emma , Shah Kayuri 
Published: January 2020

BACKGROUND:
The Joint Commission’s 2014 National Patient Safety Goals required hospitals to evaluate alarm safety in 2014–2015 and implement alarm safety policies.

OBJECTIVE:
The aim of this study was to assess common alarm management safety factors in our 187-bed community hospital.

METHODS:
Two weeks’ worth of IV pump report data was evaluated to characterize 33 IV pump alarm types. Hospital and IV pump noise was measured, and an alarm management nurse survey was conducted.

RESULTS:
There were 8731 total IV pump alarms/alerts (24-hour mean, 623.6) across 6 units. The 2-minute idle alarm accounted for 32.4% of all total IV alarms/alerts, suggestive of high levels of nurse multitasking and nurse work interruptions. IV pump volumes contributed to overall hospital noise. Survey data identified patient units and alarm safety practices needing additional support.

CONCLUSIONS:
Characterization of IV pump alarms/alerts is an emerging area of scientific inquiry. Findings indicate the need for organizations to evaluate alarm burden and alarm management safety practices to reduce alarm fatigue risks.
Advancing Patient-Centered Communication Content for Prelicensure Nursing Students Using StudentSPEACS
Authors: Tate Judith Ann , Newtz Christa , Ali Awais , Happ Mary Beth 
Published: January 2020

Background
Many patients live with communication disorders that present significant challenges during interactions with health care providers across settings. Yet, nurses receive little to no training in how to communicate with communication impaired patients.

Purpose
The purpose of this study was to determine the feasibility and acceptability of delivering the Study of Patient-Nurse Effectiveness With Assistive Communication Strategies (StudentSPEACS) program to prelicensure nursing students and to describe student clinical applications of this content in the year following the communication training.

Methods
We used mixed methods to describe student perceptions of StudentSPEACS content and application of content in clinical encounters.

Results
Junior nursing students (n = 86, 53.75%) responded to the survey. Students rated content as very valuable and rated their overall ability to communicate with patients after the training program as average. Students provided 48 clinical case application exemplars.

Conclusions
The StudentSPEACS program can help prelicensure nursing students acquire and practice communication skills with patients who have communication impairments.
Restrictions on Nursing Students' Electronic Health Information Access
Authors: Hansbrough Wendy , Dunker Kimberly Silver , Ross Jennifer Gunberg , Ostendorf Marilyn 
Published: January 2020

Background
Restrictions on students' use of electronic health information have been anecdotally reported as a threat to clinical learning, development of informatics competency, and adherence to personal health information privacy laws. However, evidence on which informatics education and policy strategies can be designed is lacking.

Purpose
This study describes the scope of nursing students' access to and use of electronic health information systems as reported by clinical instructors.

Methods
Clinical faculty (n = 193) in prelicensure programs from 25 states completed the online survey.

Results
Students are often restricted in retrieving patient health information, charting assessment data and delivered care, and using medication administration systems. Students alternatively use faculty or staff nurses' system security access.

Conclusions
Results suggest the need for critical review of nursing curriculum related to informatics competency and clinical site health records access policies.