bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hospitalized Infections in People With Osteoarthritis: A National US Study
Authors: Singh Jasvinder A. , Cleveland John D. 
Published: August 2020

Objective.To study the incidence, time trends, and outcomes of serious infections in people with osteoarthritis (OA).Methods.We used 1998–2016 US National Inpatient Sample (NIS) data. Using recommended weights, we examined the epidemiology of 5 types of serious infections requiring hospitalization in people with OA (opportunistic infections [OIs], skin and soft tissue infections [SSTIs], urinary tract infections [UTIs], pneumonia, and sepsis/bacteremia). We performed multivariable-adjusted logistic regression analyses to analyze factors associated with healthcare utilization (hospital charges, length of hospital stay, discharge to nonhome setting), and in-hospital mortality.Results.Of all serious infection hospitalizations, 46,708,154 were without OA and 3,258,416 had OA. People with OA were 16.4 years older, more likely to be female (52% vs 65%), White (59% vs 70%), have a Deyo-Charlson Comorbidity Index (DCCI) ≥ 2 (42% vs 51%), receive Medicare (54% vs 80%), and less likely to receive care at an urban teaching hospital (45% vs 39%). Serious infection rates per 100,000 NIS hospitalizations increased from the study period of 1998–2000 to 2015–2016: OI (from 4.5 to 7.2); SSTI (from 48.4 to 145.9); UTI (from 8.4 to 104.6); pneumonia (from 164.0 to 224.3); and sepsis (from 39.4 to 436.3). In multivariable-adjusted analyses, older age, higher DCCI, sepsis, northeast region, urban hospital, and medium or large hospital bed size were significantly associated with higher healthcare utilization outcomes and in-hospital mortality; Medicaid insurance, non-White race, and female sex were significantly associated with higher healthcare utilization.Conclusion.Serious infection rates have increased in people with OA. Association of demographic, clinic, and hospital variables with serious infection outcomes identifies potential targets for future interventions.
Maintaining Hepatitis B Protection in Immunocompromised Pediatric Rheumatology and Inflammatory Bowel Disease Patients
Authors: Aljaberi Najla , Ghulam Enas , Smitherman Emily A. , Favier Leslie , Dykes Dana M.H. , Danziger-Isakov Lara A. , Brady Rebecca C. , Huggins Jennifer 
Published: August 2020

ObjectiveHepatitis B virus (HBV) infection remains a significant public health challenge, particularly for immunocompromised patients. Our aim was to evaluate the serologic immunity in immunocompromised rheumatology and inflammatory bowel disease (IBD) patients, assess factors for serologic nonimmunity, and evaluate their response to 1 HBV booster dose.MethodsImmunocompromised rheumatology and IBD patients with completed HBV screening were identified. A chart review was performed to collect demographics, clinical information, baseline HBV serology results, and serologic response to booster vaccination. Serologic nonimmunity was defined as a negative/indeterminate hepatitis B surface antibody (anti-HBs) level.ResultsAmong 580 patients, 71% were nonimmune. The highest portion of nonimmune patients were 11–18 years old (P = 0.004). There was no significant difference between immune and nonimmune patients with regards to diagnosis (P = 0.34), age at diagnosis (P = 0.64), duration of treatment (P = 0.07), or type of medications (P = 0.08). Sixty-two percent of those who received a booster vaccine were rescreened, and most (68%) seroconverted. In those 18 years or older, only half seroconverted.ConclusionResults of this study support the benefit of HBV screening in immunosuppressed patients. Beginning at age 11 years, most patients lacked serologic immunity to HBV. Seroconversion for most patients 11–18 years occurred after 1 booster vaccine. Thus, for immunocompromised patients without recent HBV serologic data, obtaining the HBV serology beginning at age 11 years might be considered. Those 18 years and older were least likely to seroconvert after 1 booster, indicating that they may benefit from receiving the 3-dose HBV vaccine series.
Use of Disease-modifying Antirheumatic Drugs, Biologics, and Corticosteroids in Older Patients With Rheumatoid Arthritis Over 20 Years
Authors: Hanly John G. , Lethbridge Lynn 
Published: August 2020

Objective.To examine changes in prescribing patterns, especially the use of corticosteroids (CS), in patients with rheumatoid arthritis (RA) over 2 decades.Methods.This was a secondary analysis of health administrative data using a previously validated dataset and case definition for RA. Cases were matched 1:4 by age and sex to controls within a population of approximately 1 million inhabitants with access to universal health care. Longitudinal data for incident and prevalent RA cases were studied between 1997 and 2017.Results.There were 8240 RA cases (all ≥ 65 yrs) with a mean (SD) age 72.2 (7.5) years and 70.6% were female. Over 20 years, annual utilization of coxibs in prevalent RA cases fell with a concomitant increase in disease-modifying antirheumatic drugs (DMARDs) and biologics. Over the same period, CS use was largely unchanged. Approximately one-third of patients had at least 1 annual prescription for CS, most frequently prednisone. The mean annual dose showed a modest reduction and the duration of utilization in each year shortened. Rheumatologists prescribed CS less frequently and in lower doses than other physician groups. For incident RA cases, there was a significant fall in annual prescribed dose of prednisone by rheumatologists over time.Conclusion.In older adults with RA, the utilization of DMARDs and biologics has increased over the past 20 years. However, the use of CS has persisted. Renewed efforts are required to minimize their use in the long-term pharmacological management of RA.
L’enrôlement différencié des usagers dans les living labs en santé et autonomie en France
Authors: Berthou Valentin , Gaglio Gérald 
Published: August 2020

Les Living Labs (LL) sont des organisations qui se proposent de promouvoir des nouveautés, souvent de nature technologique, par de la co-construction avec des usagers. Pour ce faire, elles dupliquent des lieux du quotidien et/ou utilisent des plateformes techniques. Dans cet article, nous nous focalisons sur deux LL en santé et autonomie (LLSA). Après avoir retracé par quel cheminement l’usager est devenu une figure centrale, nous indiquons la façon dont les acteurs concernés projettent l’utilité desdits usagers dans la conception d’artefacts et pour l’institutionnalisation des LLSA. Via une comparaison, nous montrons ensuite que ces usagers sont à « trouver ». Il s’agit de définir leur identité, de les faire venir dans les LL puis de les mobiliser concrètement dans des projets. Cela donne à voir des processus d’enrôlement des usagers différenciés, soit très artisanaux et fluctuants, soit plus stabilisés et répétés.
Assessment and Management of Delirium in Critically Ill Veterans
Authors: Kresevic Denise M. , Miller Donna , Fuseck Carole W. , Wade Mia , Whitney Laura , Conley Mary , Rimac Joanne , Jacono Frank , O’Leary-Wilson Heather L. , Burant Christopher J. 
Published: August 2020

BackgroundDelirium is a complex syndrome prevalent in the intensive care unit. It has been associated with significant morbidity including distress, longer hospital stays, prolonged cognitive impairment, and increased mortality.ObjectiveTo describe a nurse-led interdisciplinary quality improvement initiative to increase nurses’ knowledge of delirium, documentation of delirium assessment, and patient mobility.MethodsSixty-seven nurses in medical and surgical intensive care units were required to attend an interactive education program on delirium assessment and management. Scores on tests taken before and after the education program were used to evaluate knowledge. Medical records and bedside rounds were used to validate Confusion Assessment Method for the Intensive Care Unit documentation and interventions. Descriptive statistics were used to describe changes over time. A delirium resource team composed of nurses, physicians, and therapists provided didactic education paired with simulation training and bedside coaching. Mobility screening tests and computer templates guided assessments and interventions.ResultsDocumentation of the Confusion Assessment Method improved from less than 50% to consistently 99%. Mobilization in the surgical intensive care unit increased from 90% to 98% after intervention. Days of delirium significantly decreased from 51% before intervention to 31% after intervention (χ12=7.01, P = .008).ConclusionsThe success of this quality improvement project to enhance recognition of delirium and increase mobility (critical components of the pain assessment, breathing, sedation choice, delirium, early mobility, and family education bundle) was contingent on nursing leaders hip, interdisciplinary team collaboration, and interactive education.
Early Mobility for Critically Ill Patients: Building Staff Commitment Through Appreciative Inquiry
Authors: Fernald Michelle M. , Smyrnios Nicholas A. , Vitello Joan 
Published: August 2020

Background
Immobility contributes to many adverse effects in critically ill patients. Early progressive mobility can mitigate these negative sequelae but is not widely implemented. Appreciative inquiry is a quality improvement method/change philosophy that builds on what works well in an organization.

Objectives
To explore whether appreciative inquiry would reinvigorate an early progressive mobility initiative in a medical intensive care unit and improve and sustain staff commitment to providing regular mobility therapy at the bedside. Secondary goals were to add to the literature about appreciative inquiry in health care and to determine whether it can be adapted to critical care.

Methods
Staff participated in appreciative inquiry workshops, which were conducted by a trained facilitator and structured with the appreciative inquiry 4-D cycle. Staff members’ attitudes toward and knowledge of early progressive mobility were evaluated before and after the workshops. Performance of early progressive mobility activities was recorded before and 3 and 10 months after the workshops.

Results
Sixty-seven participants completed the program. They rated the workshops as successfully helping them to understand the importance of early progressive mobility (98%), explain their responsibility to improve patient outcomes (98%), and engender a greater commitment to patients and the organization (96%). Regarding mobility treatments, at 3 months orders had improved from 62% to 88%; documentation, from 52% to 89%; and observation, from 39% to 87%. These improvements were maintained at 10 months.

Conclusion
Participation in the workshops improved the staff’s attitude toward and performance of mobility treatments. Appreciative inquiry may provide an adjunct to problem-based quality improvement techniques.
Holding and Mobility of Pediatric Patients With Transthoracic Intracardiac Catheters
Authors: Lisanti Amy Jo , Helman Stephanie , Sorbello Andrea , Fitzgerald Jamie , D’Amato Annemarie , Zhang Xuemei , Gaynor J. William 
Published: August 2020

Background
Nursing care of pediatric patients after cardiac surgery consists of close hemodynamic monitoring, often through transthoracic intracardiac catheters, requiring patients to remain on bed rest and limiting holding and mobility.

Objectives
The primary aim of this quality improvement project was to determine the feasibility of safely mobilizing pediatric patients with transthoracic intracardiac catheters out of bed. Once feasibility was established, the secondary aim was to increase the number of days such patients were out of bed.

Methods and Interventions
New standards and procedures were implemented in July 2015 for pediatric patients with transthoracic intracardiac catheters. After initiation of the new policies, complications were tracked prospectively. Nursing documentation of activity and positioning for all patients with transthoracic intracardiac catheters was extracted from electronic health records for 2 fiscal years before and 3 fiscal years after the new policies were implemented. The Cochran-Armitage test for trend was used to determine whether patterns of out-of-bed documentation changed over time.

Results
A total of 1358 patients (approximately 250 to 300 patients each fiscal year) had activity and positioning documented while transthoracic intracardiac catheters were in place. The Cochran-Armitage test for trend revealed that out-of-bed documentation significantly increased after the new policies and procedures were initiated (P &lt; .001). No major complications were noted resulting from patient mobility with transthoracic intracardiac catheters.

Conclusion
Pediatric patients with transthoracic intracardiac catheters can be safely held and mobilized out of bed.
Implementation of an Interdisciplinary AACN Early Mobility Protocol
Authors: Schallom Marilyn , Tymkew Heidi , Vyers Kara , Prentice Donna , Sona Carrie , Norris Traci , Arroyo Cassandra 
Published: August 2020

BackgroundIncreasing mobility in the intensive care unit is an important part of the ABCDEF bundle. Objective To examine the impact of an interdisciplinary mobility protocol in 7 specialty intensive care units that previously implemented other bundle components.MethodsA staggered quality improvement project using the American Association of Critical-Care Nurses mobility protocol was conducted. In phase 1, data were collected on patients with intensive care unit stays of 24 hours or more for 2 months before and 2 months after protocol implementation. In phase 2, data were collected on a random sample of 20% of patients with an intensive care unit stay of 3 days or more for 2 months before and 12 months after protocol implementation.ResultsThe study population consisted of 1266 patients before and 1420 patients after implementation in phase 1 and 258 patients before and 1681 patients after implementation in phase 2. In phase 1, the mean (SD) mobility level increased in all intensive care units, from 1.45 (1.03) before to 1.64 (1.03) after implementation (P &lt; .001). Mean (SD) ICU Mobility Scale scores increased on initial evaluation from 4.4 (2.8) to 5.0 (2.8) (P = .01) and at intensive care unit discharge from 6.4 (2.5) to 6.8 (2.3) (P = .04). Complications occurred in 0.2% of patients mobilized. In phase 2, 84% of patients had out-of-bed activity after implementation. The time to achieve mobility levels 2 to 4 decreased (P = .05). Intensive care unit length of stay decreased significantly in both phases.ConclusionsImplementing the American Association of Critical-Care early mobility protocol in intensive care units with ABCDEF components in place can increase mobility levels, decrease length of stay, and decrease delirium with minimal complications.
Utilization of endobronchial electrocautery for removal of an impacted airway foreign body
Authors: Nongpiur Vijay Noel , Mittal Saurabh , Madan Karan , Mohan Anant , Hadda Vijay 
Published: August 2020

Dear Editor,
Aspiration of a foreign body into the tracheobronchial tree can occur at any age, though it occurs more commonly in children. In small children, the foreign body commonly gets lodged in the central airways (trachea and mainstem bronchi); hence, the presentation is usually sudden onset of cough and dyspnea or even lifethreatening respiratory failure in an otherwise healthy child. A witnessed aspiration or a history of aspiration can usually be elicited.
Cerebral dysautonomy as a clinical repercussion in children with traumatic brain injury
Authors: Da Silva Jassiara Soares , Pereira Carlos Umberto , Rabelo Nicollas Nunes 
Published: August 2020

Introduction: Dysautonomia or Paroxysmal Sympathetic Hyperactivity (PSH) affects more than 50% of patients suffering from severe traumatic brain injury (TBI), which is a major cause of morbidity and mortality in children under 12 years. The goal is to demonstrate that PSH is established as a consequence in children with severe brain trauma.
Methodology: Forty articles were found in databases such as LILACS, Elsevier and Scielo that address the theme, excluding those that addressed the TBI in adults and including those that addressed the theme in the pediatric context and published about the PSH, published until the year of 2019.
Results: Severe TBI is established as a common cause of hospitalization of children and PSH as a common consequence. Diagnosis and management of this complication require the help of tools such as "PSH-Assessment Measure (PSH-AM)", which has criteria that facilitate the exclusion of other possible causes and guide the treatment. Non-pharmacological therapeutic measures include control of room temperature and low sensory and pharmacological stimuli to deal with symptoms, such as drugs such as opioids, gabaergic agonists, benzodiazepines and adrenergic antagonists.
Conclusion: Severe TBI, a common pediatric emergency, can be considered a predictor of PSH. Even though there is no consensus on the diagnosis, PSH-AM proves to be a reliable alternative to professionals dealing with conditions that may or may not correspond with post trauma dysautonomia. This makes it possible to determine not only the child's clinical condition but also the best therapy to apply.
Assessment of Animal Bites in Selected Veterinary Establishments in Plateau State: A Three Year Review
Authors: Akosu TJ , Afolaranmi TO , Fayenuwo JO , Kumbak FD , Okorie CG , Adamu U , Iduh DE , Ntung S , Zoakah AI 
Published: August 2020

Background: Animal bites are common and sometimes result in the transmission of preventable diseases with high morbidity and fatality. This study sought to determine the pattern of animal bites reported in selected veterinary establishments in Plateau State and the vaccination status of the animals involved. Methods: This was a 3 year retrospective study of vertebrate animal bites of humans reported to 2 public veterinary centres in Jos. Data were extracted from the records of the centres and analysed using SPSS version 21.0. Results: There were 898 bites reported during the period, about one third (33.3%) of which were in children 1-10 years old. Over half of the victims (52.6%) were males and most (72.2%) resided in urban areas. Almost all the bites (97.9%) were from dogs, with local dogs accounting for 67.7% of dog bites. The lower limbs were the commonest site of bites and 80% of bites were unprovoked. Though 80.2% of animals responsible for the bites had identifiable owners, 56.7% had no record of rabies vaccination. Among the animals with vaccination records, 78.9% had either never been vaccinated or their vaccinations had expired. Only 21.1% were fully vaccinated. Median time from bite to presentation at the veterinary centres was 1 day (IQR 0.5-2.0 days) Conclusion: Bite injuries from unvaccinated dogs remain a major public health problem in Plateau State. Urgent efforts should be made to enlighten dog owners and reduce the incidence of bites
Arbitragem na Administração Pública e o seu potencial para revigorar a relação do Estado com a sociedade - Arbitration in Public Administration and its potential to reinvigorate the state's relationship with society
Authors: Gomes Andréia 
Published: August 2020

<p>Procura o presente estudo analisar a utilização da arbitragem, como forma de solução válida de conflitos entre a Administração Pública e o administrado. Para tanto, concentra-se a pesquisa no valor legítimo da via arbitral como instrumento facilitador ao acesso a justiça que, por via de consequência, coopera para o exercício da cidadania, valendo-se, ainda, de um estudo de caso a respeito das Parcerias Público-Privadas, Lei n° 11.079/2004.</p><p> </p><p>Search this study to analyze the use of arbitration as a means of valid solution of conflicts between the Public Administration and administered. For this, the research focuses on the value of arbitration as a legitimate instrument to facilitate access to justice, by consequence, cooperate for the exercise of citizenship, making use also of a case study about the Partners Public-Private Law No. 11.079/2004.</p>
Os Conselhos de Consumidores de Energia Elétrica como instrumento de participação social - The Electricity Consumers’ Councils as an instrument of social participation
Authors: Alves Alex Cavalcante , Santos Joseanne Carla De Aguiar 
Published: August 2020

<p>A Constituição de 1988, além de marco da redemocratização brasileira, institucionalizou a participação da sociedade nas ações do Estado, o que também foi sendo aperfeiçoado com a legislação posterior a 1988, paralelamente à profissionalização da Administração Pública e ao desenvolvimento do campo de públicas. Este trabalho aborda especificamente os Conselhos de Consumidores de Energia Elétrica, instituições participativas que representam os interesses coletivos dos consumidores de energia. No setor elétrico, os Conselhos exercem a função de examinar questões ligadas ao fornecimento de energia elétrica ao consumidor final. Tal papel pode ser desempenhado por meio da participação em audiências públicas realizadas pela ANEEL, de forma a auxiliar na formulação de atos normativos, permitindo ao Regulador analisar os impactos de suas propostas sob a ótica do consumidor antes da tomada de decisão. O trabalho pretende demonstrar a evolução nessa participação ao longo dos últimos anos, evidenciando a consolidação desse instrumento da democracia participativa.</p><p> </p><p>The 1988 Constitution, as well as the framework of the Brazilian redemocratization, institutionalized the participation of society in the actions of the State, which was also perfected with legislation after 1988, in parallel with the professionalization of the Public Administration and the development of the public policies field. This paper specifically addresses the Consumers Councils of Electric Energy, participatory institutions that represent the collective interests of energy consumers. In the electricity sector, the Councils perform the function of examining issues related to the electric power supply to the final consumer. This role can be played through participation in public hearings held by ANEEL, in order to assist in the formulation of normative acts, allowing the Regulator to analyze the impacts of its proposals from the perspective of the consumer before the decision making. This paper also intends to demonstrate the evolution of this participation over the last years, evidencing the consolidation of this instrument of participatory democracy.</p>