bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patients' perspectives of pain in dialysis: systematic review and thematic synthesis of qualitative studies
Authors: Zhang Kelly , Hannan Elyssa , Scholes-Robertson Nicole , Baumgart Amanda , Guha Chandana , Kerklaan Jasmijn , Hanson Camilla S. , Craig Jonathan C. , Davison Sara N. , Hecking Manfred , Tong Allison 
Published: May 2020

Abstract
Pain is a severe and common symptom in patients receiving dialysis but remains inadequately managed in clinical practice. Understanding patient experiences of pain can inform strategies to address this patient-important symptom. We aimed to describe patients' perspectives on causes, experiences, and impacts of dialysis-associated pain. MEDLINE, Embase, PsycINFO, and CINAHL were searched to August 2019 for all qualitative studies that described the perspectives of pain in adults aged 18 years or older receiving dialysis. Findings from the primary studies were analyzed using thematic synthesis. We included 60 studies across 14 countries involving 1343 participants (1215 receiving hemodialysis and 128 receiving peritoneal dialysis), and identified 6 themes: gripped by an all-consuming agony (draining cognitive capacity, exacerbating other symptoms); suffering in silence (surrendering to the inevitable, ignored or dismissed, hiding symptoms to protect others); provoking fear of treatment (resistance to cannulation, avoiding dialysis, anxious from witnessing other patients in pain); preventing life participation (preventing fulfilment of valued roles, depleting the will to live); coping aided by connection with others (shared understanding among patients, comforted and supported by others); and developing awareness, assertiveness, and self-reliance (procedural vigilance, finding strategies to minimize pain, bodily understanding and knowing thresholds, positive thinking). Struggling with pain in dialysis involved a progression of agony, fear, avoidance, and despair. However, support from others and self-management strategies were used to cope with pain. Strategies to empower patients to report and minimize pain and its consequences in dialysis are needed.
Eruptive Cutaneous Collagenoma: Report of Two Cases
Authors: Wu Jian , Cai Mei-Hong , Chen Ling-Ling , Wu Lei , Chen Xiao-Jian , Zhu Hong-Yan , Shi Feng 
Published: May 2020

Abstract

Introduction:
Eruptive cutaneous collagenoma is non familial connective tissue nevi of unknown etiology presented with an abrupt onset. To date, the literatures on eruptive cutaneous collagenoma are extremely rare in china. Here, we report two women with eruptive cutaneous collagenoma.

Case present:
Two women presented with multiple asymptomatic, skin-colored papules and nodules on the trunk and extremities with no systemic involvement. Histopathology revealed dense, coarse collagen fibers by hematoxylin-esoin stain and decreased, fragmented elastic fibers by Elastic stain compared with the normal skin. Basing on these findings, the diagnosis of eruptive cutaneous collagenoma was made. No specific treatment was given.

Discussion:
Eruptive cutaneous collagenoma is a very rare dermatosis that is often misdiagnosed as other connective tissue nevi. The pathogenesis is unclear, and also no efficient treatment is available. It is usually diagnosed based on clinical and histopathological findings.

Conclusion:
The present cases are relatively rare type of eruptive cutaneous collagenoma that provide more experience for clinician, and may be helpful for them to make correct diagnosis for suspicious cases.
Recognizing asthma in patients with chronic obstructive pulmonary disease
Authors: Shedd Glenn Clinton , Thompson Alexandra , Calvert Robert Owen 
Published: May 2020

ABSTRACT
Newer guidelines for the use of inhaled corticosteroids in chronic obstructive pulmonary disease (COPD) state that they should be reserved for those patients who are likely to derive the greatest benefits from this medication class. This makes the latest Global Initiative for Chronic Obstructive Lung disease (GOLD) guidelines of great importance. This article examines the utility of a previous diagnosis of asthma, the presence of eosinophilia, elevated immunoglobulin E, and positive bronchodilator response in identifying the people with COPD who also have asthma, and it presents two case studies of patients with COPD to illustrate the use of the GOLD guidelines in clinical practice.
Improving efficiency within a trauma nurse practitioner team
Authors: Atkinson Shelley , Crutcher Terri D. , King Joan E. 
Published: May 2020

ABSTRACT

Background:
Clinicians, including nurse practitioners (NPs), face a number of challenges in delivering high-quality care including frequent interruptions that can potentially compromise patient safety and job satisfaction.

Local Problem:
Trauma NPs voiced frustration with their efforts to provide efficient, high-quality care with frequent interruptions, most commonly pager alerts. The purpose of this quality improvement (QI) initiative was to increase trauma NPs' perceptions of patient safety and improve NPs' job satisfaction by reducing workflow interruptions.

Methods:
The Model for Improvement guided this initiative.

Interventions:
The aims of this initiative were to reduce the percentage of nonurgent workflow interruptions via pager alerts by 20% and to increase the utilization of a standardized trauma NP patient rounding process from 0% to 50%.

Results:
Use of the standardized rounding process improved from 0% to 87%. Interruptions via pager alerts decreased by 36.2%. All nine (100%) trauma NP survey responses revealed an improvement in NP perception of patient safety and job satisfaction.

Conclusion:
The QI initiative found that increasing communication during rounds by using a standardized rounding process involving the bedside registered nurse can minimize interruptions and improve the efficiency of a trauma NP team. The key to the success of the QI initiative was the implementation of a standardized rounding process.
The role of uric acid in inflammasome-mediated kidney injury
Authors: Braga Tarcio Teodoro , Foresto-Neto Orestes , Camara Niels Olsen Saraiva 
Published: May 2020

Purpose of review
Uric acid is produced after purine nucleotide degradation, upon xanthine oxidase catalytic action. In the evolutionary process, humans lost uricase, an enzyme that converts uric acid into allantoin, resulting in increased serum uric acid levels that may vary according to dietary ingestion, pathological conditions, and other factors. Despite the controversy over the inflammatory role of uric acid in its soluble form, crystals of uric acid are able to activate the NLRP3 inflammasome in different tissues. Uric acid, therefore, triggers hyperuricemic-related disease such as gout, metabolic syndrome, and kidney injuries. The present review provides an overview on the role of uric acid in the inflammasome-mediated kidney damage.

Recent findings
Hyperuricemia is present in 20–35% of patients with chronic kidney disease. However, whether this increased circulating uric acid is a risk factor or just a biomarker of renal and cardiovascular injuries has become a topic of intense discussion. Despite these conflicting views, several studies support the idea that hyperuricemia is indeed a cause of progression of kidney disease, with a putative role for soluble uric acid in activating renal NLRP3 inflammasome, in reprograming renal and immune cell metabolism and, therefore, in promoting kidney inflammation/injury.

Summary
Therapies aiming to decrease uric acid levels prevent renal NLRP3 inflammasome activation and exert renoprotective effects in experimental kidney diseases. However, further clinical studies are needed to investigate whether reduced circulating uric acid can also inhibit the inflammasome and be beneficial in human conditions.
Interobserver and intraobserver agreement on prostate-specific membrane antigen PET/CT images according to the miTNM and PSMA-RADS criteria
Authors: Demirci Emre , Akyel Reşit , Caner Biray , Alan-Selçuk Nalan , Güven-Meşe Şermin , Ocak Meltem , Kabasakal Levent 
Published: May 2020

Aim
In this study, we aimed to measure interobserver and intraobserver agreement in Ga-68–prostate-specific membrane antigen (PSMA) PET/computed tomography (CT) image interpretation. In addition, the limitations of these criteria and levels of personal confidence reported by the readers when reporting the findings were determined. The effects of interpersonal differences on clinical decisions were also investigated.

Methods
PSMA PET images from 133 cases were reported independently by four different readers at different times according to the molecular imaging TNM (miTNM) and PSMA-reporting and data system (RADS) templates.

Results
There was substantial interobserver agreement for overall positivity, miT, miN and miM staging (Fleiss’ κ = 0.65, 0.625, 0.731, and 0.779). Substantial agreement levels were observed in reporting of seminal vesicle invasion, the number of lymph node stations with metastasis, total number of intraprostatic areas containing tumors, and lymph node metastasis staging (Fleiss’ κ = 0.622 and 0.779). The highest variation was seen in the reporting of intraprostatic distribution: In International Society of Urological Pathology (ISUP) grade group 1, moderate agreement was observed, and it was seen that the agreement level for the T staging increased with an increasing ISUP group in the staging group (Fleiss’ κ = 0.531 vs. 0.655). There was near-perfect interobserver agreement in the reporting of five-point PSMA-RADS scoring [intraclass correlation coefficient (ICC) κ = 0.904; 95% CI, 0.865–0.934]. Disagreement according to miTNM staging had a major effect on clinical management in only 9% (n = 12) of the patients.

Conclusion
PSMA PET has a lower interobserver variability and higher reproducibility than other imaging methods used for imaging of prostate cancer do, including CT, MRI, and bone scintigraphy. The miTNM template provides a reporting format that is highly reproducible and has a high level of agreement among readers, but the prostatic template needs development. In contrast, the PSMA-RADS system leads to slightly increased interobserver reporting differences and reduces personal confidence, but at the same time, it still exhibits almost-perfect agreement in terms of scoring.
The treatment approach to inflammatory bowel disease in 2020
Authors: Vachon Ashley , Scott Frank I. 
Published: May 2020

Purpose of review
Multiple new medications with novel mechanisms of action are now available to treat inflammatory bowel disease (IBD). Identifying the appropriate patients in whom to use these therapies is critical in maximizing benefit and reducing unnecessary risks. Once the appropriate therapy is selected, using a treat-to-target algorithm including symptomatic, biochemical, and endoscopic monitoring can improve clinical outcomes. If symptoms recur, these same principles, coupled with therapeutic drug monitoring, should be considered to confirm inflammation and determine next therapeutic steps.

Recent findings
Multiple network meta-analyses can assist clinicians in determining the ideal biologic or small molecule therapy for patients with moderate-to-severe IBD. Once selected, several clinical trials have demonstrated that follow-up in 3 to 4 months, coupled with fecal calprotectin or C-reactive protein monitoring, can improve clinical remission and mucosal healing rates. Structural assessment should be performed via colonoscopy, enterography, or capsule endoscopy, dependent on disease location, at 9--12 months to confirm healing.

Summary
Appropriate disease stratification, coupled with biologic or small molecule medication selection and treat-to-target follow-up, can greatly assist clinicians who are managing patients with IBD in achieving the greatest potential benefits of medical therapy.
Understanding the Impacts of Caregiver Stress
Authors: Broxson Janna , Feliciano Leilani 
Published: May 2020

Purpose/Objectives:
Identifying risk factors associated with caregiver stress and suggesting methods for systematic caregiver screening for caregiver strain, depression, and anxiety.

Primary Practice Setting:
Emergency department, primary care, and other health care settings.

Findings/Conclusions:
Caregiver stress can lead to multiple negative outcomes including declines in physical health, increased mental health concerns, and overall decreased quality of life. Caregiver stress also leads to increased financial costs to the person, family, and health care systems, making it a public health issue. Recognizing caregiver stress is the initial step to identifying those in need of support and to providing quality care. Fortunately, caregiver stress can be prevented or reduced using a culturally competent multidimensional approach to addressing social determinants of health and unmet physical, psychological, and social/emotional needs of caregivers.

Implications for Case Management:
Case management plays a critical role in assessing, educating, advocating, creating care plans, and advocating for both the caregiver and the care recipient.
Essential Case Management Practices Amidst the Novel Coronavirus Disease 2019 (COVID-19) Crisis: Part 2
Authors: Tahan Hussein M. 
Published: May 2020

Objectives:
This is the second of a 2-part article that discusses essential case management practices and strategies amidst the novel coronavirus disease 2019 (COVID-19). The series showcases the potential professional case managers have in support of managing during a crisis such as a global pandemic. Part II continues to describe reenvisioned roles and responsibilities of case managers and their leaders to meet the needs of patients/support systems during the crisis. It focuses on the increased need for end-of-life care, impact on workers' compensation case management practice, and the self-care needs of the professional case manager.

Primary Practice Settings:
Applicable to the various case management practice settings across the continuum of health and human services, with special focus on acute care.

Findings/Conclusions
The COVID-19 global pandemic has resulted in a crisis case managers and other health care professionals never faced something like it before. At the same time, it has provided opportunities for innovation and creativity including use of digital and telecommunication technology in new ways to ensure the continued delivery of health and human services to those who need them regardless of location. It has also resulted in the development of necessary and impactful partnerships within and across different health care organizations and diverse professional disciplines. Most importantly, this pandemic has required special attention to the increased need of patients for timely palliative and end-of-life care. In addition, it has prompted a focus on the safety, health, and well-being of case managers and other health care professionals, resulting in expanded workers' compensation case management practice coupled with the need for self-care and resilience.

Implications for Case Management Practice:
Professional case managers are integral members of interprofessional health care teams. Their roles and responsibilities are even more necessary during the uncertainty of a global pandemic such as COVID-19. So far, the experience of this crisis has resulted in a deliberate need to ensure the safety of both, those who are the recipients of health care services and those who are responsible for the provision of care. Self-care and resilience of health care professionals and case managers, especially due to the complex dynamics of the COVID-19 pandemic, have advanced a desirable and necessary view of remote/virtual practice and as a strategy for enhancing the person's health and well-being. This pandemic has forced the development of impactful partnerships and collaborations among the diverse contexts of health care organizations and support service providers. These contexts of care delivery have also emphasized the necessary legal and ethical practice of case managers and the other involved parties. Experts agree that the innovative care delivery methods practiced during the pandemic will undoubtedly remain as desirable beyond the current crisis period.
Mirrored Ribs: A Sign for Pneumothorax in Neonates*
Authors: Küng Erik , Aichhorn Lukas , Berger Angelika , Werther Tobias 
Published: May 2020

Objectives:
To evaluate if “mirrored ribs”—a mirroring of chest structures—is a sign for pneumothorax in lung ultrasound in neonates.

Design:
Retrospective study.

Setting:
Medical University Vienna/General Hospital, Vienna, Austria.

Patients:
All neonates admitted with clinical signs of pneumothorax between July 2018 and February 2019.

Interventions:
Chest radiograph and lung ultrasound in succession.

Measurements and Main Results:
Anterior-posterior chest radiograph and lung ultrasound were compared. “Mirrored ribs” were defined as mirroring of at least one rib and intercostal muscles in B-mode in the absence of B-lines. Twenty-nine cases in 26 patients were considered. Pneumothorax was diagnosed in 55% of cases using reported signs for pneumothorax in lung ultrasound and in 31% using chest radiograph. Lung ultrasound identified all pneumothoraces visible in chest radiograph. “Mirrored ribs” were visible in all patients with signs for pneumothorax and in none without signs for pneumothorax in lung ultrasound, representing a specificity and sensitivity of 100% compared with reported signs for pneumothorax in lung ultrasound.

Conclusions:
The occurrence of “mirrored ribs” in lung ultrasound in combination with absence of lung sliding, absence of B-lines and lung point might facilitate the rapid recognition of pneumothorax in neonates.
Outcomes After In-Hospital Pediatric Recurrent Cardiac Arrests*
Authors: Brown Stephanie R. , Brogan Thomas V. , McMullan D. Michael , Roberts Joan S. 
Published: May 2020

Objectives:
The objective of this study is to determine outcomes of recurrent cardiac arrest events in the general pediatric inpatient population.

Design:
Retrospective cohort study of inpatients in a single institution.

Setting:
A tertiary care free-standing children’s hospital.

Patients:
All patients less than 18 years old at Seattle Children’s Hospital with recurrent cardiac arrest events occurring from January 1, 2010, to March 1, 2018, were included.

Interventions:
None.

Measurements and Main Results:
Overall survival to hospital discharge was 50% and all survivors had a good neurologic outcome, defined as Pediatric Cerebral Performance Category of 3 or less, or unchanged from baseline. Survival among patients who received extracorporeal life support was 43% and among those who received extracorporeal cardiopulmonary resuscitation, 33%. Initial arrest factors associated with survival included initial rhythm of ventricular tachycardia or ventricular fibrillation, shorter duration of cardiopulmonary resuscitation, and absence of multiple organ dysfunction. Additionally, nonsurvivors had more severe metabolic acidosis in the prearrest and postarrest period.

Conclusions:
Survival after pediatric in-hospital recurrent cardiac arrest is higher than previously reported. There is also evidence that initial rhythm other than ventricular tachycardia/ventricular fibrillation and longer duration of cardiopulmonary resuscitation as well as multiple organ dysfunction and more severe lactic acidosis in the peri-arrest period are associated with poor outcomes.
Successful Increase of Outpatient Clinic Continuity in a Fellowship Quality Improvement Project
Authors: Srinivasan Ranjini , Sambatakos Peter , Lane Mariellen , Krishnan Usha , Weller Rachel , Flyer Jonathan N. , Robinson Keith , Glickstein Julie 
Published: May 2020

Background:
Patient-to-physician continuity is the result of coordinated and consistent care. Optimizing continuity can be a challenge in medical training without impacting work hours. We sought to use quality improvement science during graduate medical training to increase outpatient continuity.

Objective:
The primary goal was to improve outpatient continuity in our pediatric cardiology fellowship, without increasing trainee clinic hours, from a baseline of 38% to ≥70% within 18 months.

Methods:
Our fellowship conducted a quality improvement project across 3 years to improve continuity-of-care in our outpatient clinic using the Institute for Healthcare Improvement model for improvement. We conducted Plan-Do-Study-Act cycles and completed a key driver diagram using a multidisciplinary team. We defined continuity as a patient being evaluated by their primary fellow or a different fellow that was provided a handoff. The outcome measure was the continuity rate over 2-week periods.

Results:
Continuity improved from 38% to ≥80%. The improvement resulted from a series of interventions, including creating a handoff system among fellows, identifying follow-up patients in advance, and communicating this information to the clinic team. Although we anticipated a decrease when new fellows were incorporated, continuity continued to be ≥70%. This system retained continuity above 90% one year after completion of the project.

Conclusions:
Our fellowship created a system change to improve primary patient-to-fellow continuity care rates. We achieved sustainable continuity by working with a multidisciplinary team without altering staffing, infrastructure, or fellow work hours. This project engaged trainees to address the practical application of quality improvement methodology to solve a common clinical problem.
A Comparative Study Evaluating Speech Outcomes in Classic versus Occult Submucous Cleft Palate Using a Primary Furlow Palatoplasty Technique
Authors: Denadai Rafael , Chou Pang-Yun , Bergonzani Michela , Sato Nobuhiro , Yun Claudia , Lo Lun-Jou 
Published: May 2020

Background:
No consensus exists on the selection of procedures for the treatment of submucous cleft palate, with scarce reports on long-term outcomes from single-surgeon experience. This study assessed the outcomes of using extended indication criteria of Furlow palatoplasty as the first-line procedure for the management of submucous cleft palate–associated velopharyngeal insufficiency.

Methods:
Consecutive nonsyndromic patients with submucous cleft palate (n = 216) treated by a single surgeon between 1998 and 2018 were reviewed. Furlow palatoplasty was performed in all patients diagnosed with submucous cleft palate–associated velopharyngeal insufficiency, regardless of the age cutoff, number of Calnan triad features, or velopharyngeal gap size and pattern. Postoperative velopharyngeal function outcome (adequate, marginal, or inadequate) and the need for secondary surgery were investigated. Age at surgery, sex, submucous cleft palate type (classic and occult), and presence of complication were evaluated for potential associations with this outcome.

Results:
Forty-seven patients aged 8.3 ± 4.6 years with occult submucous cleft palate were significantly (p < 0.001) older than those with the classic type (n = 169; 5.6 ± 3.1 years). Most (p < 0.001) of the included patients [n = 181 (83.8 percent)] achieved adequate postoperative velopharyngeal function outcome. Three patients (1.4 percent) presented surgery-related complications, including bleeding and partial wound disruption. Secondary speech surgery was recommended in 24 patients (11.1 percent). In the bivariate and multivariate analyses, none of the tested variables was found to be associated (all p > 0.05) with the postoperative velopharyngeal function outcome.

Conclusion:
The extended indication criteria of Furlow palatoplasty provided adequate velopharyngeal insufficiency management with a low complication rate and satisfactory speech outcome.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.