bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality of Reduction of Displaced Intra-articular Calcaneal Fractures Using a Sinus Tarsi Versus Extensile Lateral Approach
Authors: Busel Gennadiy , Mir Hassan R. , Merimee Stephanie , Patel Raahil , Atassi Omar , De La Fuente Guadalupe , Donohue David , Maxson Ben , Infante Anthony , Shah Anjan , Watson David , Downes Katheryne , Sanders Roy W. 
Published: September 2020

Objective:
To evaluate the difference in the quality of fracture reduction between the sinus tarsi approach (STA) and extensile lateral approach (ELA) using postoperative Computed Tomography (CT) scans in displaced intra-articular calcaneal fractures (DIACFs).

Design:
Retrospective.

Setting:
Level 1 and level 2 academic centers.

Patients:
Consecutive patients undergoing operative fixation of DIACFs with postoperative CT scans and standard radiographs.

Methods:
Patients were identified based on Current Procedural Terminology code and chart review. All operative calcaneal fractures treated between 2012 and 2018 by fellowship-trained orthopaedic trauma surgeons were evaluated. Those with both postoperative CT scans and radiographs were included. Exclusion criteria included extra-articular fractures, malunions, percutaneous fixation, ORIF and primary fusion, and those patients without a postoperative CT scan. The Sanders classification was used. Cases were divided into 2 groups based on ELA versus STA. Bohler angle and Gissane angle were evaluated on plain radiographs. CT reduction quality grading included articular step off/gap within the posterior facet, and varus angulation of the tuberosity: CT reduction grading included: excellent (E): no gap, no step, and no angulation; good (G): <1 mm step, <5 mm gap, and/or <5° of angulation, fair (F): 1–3 mm step, 5–10 mm gap, and/or 5–15° angulation; and poor (P): >3 mm step, >10 mm gap, and/or >15° angulation.

Results:
Seventy-seven patients with 83 fractures were included. Average age was 42 years (range, 18–74 years), with 57 men. Four fractures were open. There were 37 Sanders II and 46 Sanders III fractures; 36 fractures were fixed using the STA, whereas 47 used the ELA. Average days to surgery were 5 for STA and 14 for ELA (P < 0.001). A normal Bohler angle was achieved more often with the ELA (91.5%) than with STA (77.8%) (P < 0.001). There was no difference by approach for Gissane angle (P = 0.5). ELA had better overall reduction quality (P = 0.02). For Sanders II, there was no difference in reduction quality with STA versus ELA (P = 0.51). For Sanders III, ELA trended toward better reduction quality (P = 0.06).

Conclusions:
The ELA had a better overall reduction of Bohler angle on plain radiographs and of the posterior facet and tuberosity on postoperative CT scans. For Sanders type II DIACFs, there was no difference between STA and ELA. Importantly, for Sanders III DIACFs, ELA trended toward better reduction quality. In addition to fracture reduction, surgeon learning curve, early wound complications, and long-term outcomes must be considered in future studies comparing the ELA and STA.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
A Pilot Study of End-Tidal Carbon Dioxide in Prediction of Inhospital Cardiac Arrests
Authors: Mucksavage Jeffrey J. , He Kevin J. , Chang James , Panlilio-Villanueva Maria , Wang Tianxiu , Fraidenburg Dustin , Benken Scott T. 
Published: September 2020

Objectives:
A validated means to predict inhospital cardiac arrest is lacking. The purpose of this study was to evaluate the changes in end-tidal carbon dioxide, as it correlates with the progression to inhospital cardiac arrest in ICU patients.

Design, Setting, and Patients:
Single-center, retrospective cohort study of mechanically ventilated ICU patients (age > 18 yr old) having inhospital cardiac arrest with advanced cardiac life support and continuous end-tidal carbon dioxide monitoring at a single academic center from 2014 to 2017. Demographics, clinical variables, and outcomes were collected. End-tidal carbon dioxide was collected from 5 to 2,880 minutes before inhospital cardiac arrest. Data were analyzed using descriptive statistics, and model estimates were generated using a repeated-measures categorical model with restricted maximum likelihood estimation and fully specified (autoregressive) covariance to assess the effect of time on changes in end-tidal carbon dioxide.

Measurements and Main Results:
A total of 788 patients were identified and 104 met inclusion criteria, where 62% were male with an average age of 58.5 years. Seventy-four percent required vasopressors and 72% experienced pulseless electrical activity. Mean end-tidal carbon dioxide 5 minutes prior to inhospital cardiac arrest was significantly lower than all evaluated time points except 180 minutes (p < 0.05). One patient survived to hospital discharge. In multivariate logistic regression modeling for return of spontaneous circulation, a greater change in the prearrest end-tidal carbon dioxide maximum to prearrest end-tidal carbon dioxide minimum was associated with a decreased likelihood of return of spontaneous circulation (odds ratio 0.903; 95% CI, 0.832–0.979; p = 0.014). Additionally, a change from prearrest end-tidal carbon dioxide maximum to prearrest end-tidal carbon dioxide minimum greater than 17 mm Hg was associated with a decreased likelihood of return of spontaneous circulation and odds ratio 0.150; 95% CI, 0.036–0.66; p = 0.012).

Conclusions:
Mean end-tidal carbon dioxide is significantly lower immediately before inhospital cardiac arrest. The statistical and clinical significance of end-tidal carbon dioxide may highlight its utility for predicting inhospital cardiac arrest in ICU patients. Comparison analysis and modeling explorations in a larger cohort are needed.
Rescue of Nimodipine-Induced Refractory Vasoplegia With Hydroxocobalamin in Subarachnoid Hemorrhage: A Case Report
Authors: Clifford Katherine M. , Madhok Jai , Murray Nick M. , Mohindra Vibha 
Published: September 2020

Background:
We report a case of refractory vasoplegia after nimodipine administration that was unresponsive to triple vasopressor therapy and was rescued by IV hydroxocobalamin.

Case Summary:
An 84-year-old male presented comatose from a subarachnoid hemorrhage and developed severe hypotension unresponsive to three vasopressors following a single dose of enteral nimodipine. Multisystem point-of-care ultrasonography ruled out alternate etiologies of shock, indicating that this was likely a vasoplegic state caused by nimodipine. We administered 5 grams of IV hydroxocobalamin over 15 minutes due to the possibility of impaired nitric oxide metabolism as the driver of vasoplegia. This led to immediate improvement in hemodynamics and rapid discontinuation of vasopressors. The patient experienced chromaturia but no other adverse effects due to hydroxocobalamin.

Conclusions:
Nimodipine administration is a standard practice for patients with aneurysmal subarachnoid hemorrhage to reduce unfavorable outcomes from cerebral vasospasm. Although mild hypotension is a common side effect of nimodipine, in rare cases, it may become profound, leading to refractory vasoplegia. There is no evidence-base for reversal agents for nimodipine-induced vasoplegia, and this case is the first to demonstrate successful use of hydroxocobalamin as a potential rescue therapy. We also propose an algorithm for treatment of vasoplegia with consideration of medications that act on nitric oxide–mediated vasodilation and their side-effect profiles.
Persevering With Prone Ventilation in Coronavirus Disease 2019 Pneumonia
Authors: Byrne Matthew , Kler Prabhjoyt , Bandla Nageswar , Scott Timothy 
Published: September 2020

Background:
As well as placing unprecedented demands on resources and staff involved in the care of these patients, there has been significant uncertainty regarding the optimal management of patients with coronavirus disease 2019 pneumonia. Randomized controlled trials have shown clear benefits of both neuromuscular blockade and prone positioning in treating moderate to severe acute respiratory distress syndrome, as defined by the Berlin Criteria.

Case Summary:
We present a case of a 53-year-old patient with a severe coronavirus disease 2019 pneumonia who has made a remarkable recovery following a turbulent period on intensive care. During his stay, he was prone positioned on 16 consecutive occasions and is an exemplar of the many patients we treated who benefited considerably from this intervention.

Conclusion:
We believe that sustained administration of prone position ventilation was instrumental in saving his life. While there is associated morbidity, we encourage clinicians to continue with this strategy beyond their normal practice.
Exploring the Relational Intervention of Storytelling: A Qualitative Study of the Patient Stories Project in a Single ICU
Authors: Gurney Lara , MacPhee Maura , Howard A. Fuchsia , Rodney Patricia 
Published: September 2020

Objectives:
Our study objective was to explore nurses’ experiences of how the Patient Stories Project, an intervention consisting of garnering and sharing ICU survivor stories with the ICU team, influenced their perceptions of the value of their work and their nurse-patient relationships.

Design:
This was a qualitative descriptive case study that used thematic analysis.

Setting:
This study was conducted in a single, 34-bed adult ICU in a Canadian tertiary care teaching hospital, serving a mixed medical and surgical patient population and employing over 200 nurses.

Subjects:
Semistructured focus groups with 12 ICU nurses were conducted between June 2019 and July 2019.

Intervention:
The Patient Stories Project is a systematic process for collecting and sharing former patients’ stories. On a regular basis, former ICU patients return to the ICU to say, “thank you,” share their experiences, and tell their stories to staff.

Measurements and Main Results:
Storytelling through the Patient Stories Project gives meaning to nurses’ work and provides avenues for nurses to think about their work more positively. Key themes were as follows: 1) perspective taking, 2) emphasizing the value in caring, 3) providing positive closure, 4) engendering team belonging, and 5) building a sense of hope.

Conclusions:
This study addresses the Critical Care Societies Collaboratives “call to action” to create a healthy work environment. Nurse focus group participants articulated how an initiative such as the Patient Stories Project may augment the relational aspects of work that are important to nurses, as well as their patients and families. Our study results have implications for the importance of using storytelling as a relational strategy to protect against depersonalization and cynicism, elements of burnout.
Male Mammary Paget Disease: A Tale of 2 Contrasting Cases
Authors: Roy Madhuchhanda , Teshome Mediget , Damodaran Senthilkumar , Sahin Aysegul A. , Khazai Laila , Arribas Elsa , Candelaria Rosalind P. , Scoggins Marion E. , Lane Deanna L. , Giordano Sharon H. , Albarracin Constance T. , Prieto Victor G. , Nagarajan Priyadharsini 
Published: September 2020

Abstract:
Mammary Paget disease (MPD) comprises 1.45% all male breast cancers, compared with only 0.68% of all female breast cancers. Patients usually present in the fifth and sixth decades of life with ulceration, eczematous changes, discharge, bleeding, itching, and induration of the nipple and areola. Typically, there is a delay in definitive diagnosis and treatment from the onset of symptoms because most patients are initially treated for a rash. At the time of diagnosis, about half of the patients may have palpable breast mass, positive lymph nodes, or both. In this article, we present 2 cases of male MPD representing the extremes of clinical, radiologic, and histopathologic spectrum of the disease. One patient presented with a rash of the nipple of several months duration without an underlying lesion, whereas the other presented with sensitivity and pain of the nipple for 1 year and an underlying mass. Biopsies were diagnostic of MPD in both cases, and definitive surgery revealed an underlying ductal carcinoma in situ in the first case and an invasive ductal carcinoma in the second, highlighting the importance of early biopsy to initiate appropriate management.
Can Breathing Exercise or Pranayama Affect the Intraocular Pressure in the Short-term?
Authors: Paidimarri Suharsha , Bhardwaj Rishi , Pathak-Ray Vanita 
Published: September 2020

Purpose:
To demonstrate any transient short-term effect of a particular type of breathing exercise (alternate nostril breathing of Nadi Shuddhi type of pranayama exercise) on the intraocular pressure (IOP) in glaucomatous as well as healthy eyes.

Methods:
A prospective, nonrandomized, observational, cross-sectional study was conducted in a tertiary eyecare hospital setup recruiting 3 groups of subjects—glaucoma group and a normal group that underwent the breathing exercise as well as a normal group that did not. IOP was recorded at baseline, then at 4 minutes after 10 cycles of the breathing exercise and also after 10 minutes of rest—corresponding to IOPb, IOPc, and IOPr of all the study groups. Only those subjects were recruited who were above 18 and under 80 years and were naive to breathing exercise.

Results:
A total of 56 normal eyes (28 subjects, Normalb) and 33 glaucomatous eyes (19 subjects) were recruited for the breathing exercise and were compared with the IOP as obtained for 26 eyes of 26 subjects that did not undergo the breathing exercise (Normalnb). IOPb did not differ between both normal groups (13.7±1.4 mm Hg in Normalb vs. 13.9±1.6 mm Hg in Normalnb, P=0.183) but was significantly different between groups (16.7±3.1 mm Hg in the glaucoma group and 13.7±1.4 in Normalb, P<0.001 and Normalnb 13.9±1.6 mm Hg, P<0.001) but analysis of variance was not significant within groups comparing IOPb, IOPc, and IOPr of all the study groups.

Conclusion:
There is no short-term transient effect of alternate nostril breathing exercise on IOP; a longitudinal study is recommended.
Psychometric Examination of the Dutch Objective Burden Inventory in Heart Failure Caregivers
Authors: Grant Joan S. , Graven Lucinda J. , Prapanjaroensin Aoyjai , Azuero Andres , Luttik Marie Louise 
Published: September 2020

Background
Psychometric properties of the 38-item version of the Dutch Objective Burden Inventory (DOBI) have been evaluated primarily in older female caregivers, with no published studies that vary by a different gender and age distribution.

Objective
The aim of this study was to test the construct validity and reliability of the DOBI in caregivers of individuals with heart failure from the United States and other countries.

Methods
This secondary analysis from a cross-sectional study used an online survey. Factorial validity was tested with confirmatory factor analysis, item performance was examined with ordinal item response analysis, and convergent validity was tested correlating DOBI subscale scores with Bakas Caregiving Outcomes Scale scores. Internal consistency reliability was assessed with Cronbach α.

Results
Item response analysis removed 14 items. Confirmatory factor analysis retained the original 4-factor solution. Original and reduced instruments demonstrated good internal consistency. Validity was supported by meaningful associations with the Bakas Caregiving Outcomes Scale.

Conclusions
Both the original 38-item DOBI and the reduced 24-item DOBI had support for their construct validity and internal consistency. The 24-item DOBI may be a useful alternative to the 38-item version, because it maintains psychometric properties of the original instrument while decreasing data collection burden. However, more research is needed to assess whether the shorter version is useful in assessing objective caregiving burden.
Knowledge, attitudes, and practices related to human papillomavirus vaccination among college students in a state university: Implications for nurse practitioners
Authors: D'Errico Maria Poggio , Tung Wei-Chen , Lu Minggen , D'Errico Rhone 
Published: September 2020

ABSTRACT

Background:
Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and disproportionately affects adolescents and young adults. Although a safe and efficacious vaccine is available, many college students are unimmunized against HPV. Most students presenting to college health centers are within the age range for catch-up immunization, giving nurse practitioners (NPs) in this setting an opportunity to increase vaccination rates. More information is needed about college students' HPV knowledge, attitudes, and vaccination uptake so that NPs can make effective vaccine recommendations to this population.

Purpose:
To examine (a) Knowledge and attitudes about HPV and its vaccine; (b) HPV immunization practices; and (c) factors associated with HPV knowledge, attitudes, and vaccination among college students in a US university.

Methods:
This cross-sectional quantitative study collected data from participants in a state university student health center. Data collected included knowledge, attitudes, and practices about HPV and its vaccine from 627 students.

Results:
Participants had a moderately low HPV knowledge but positive attitudes toward HPV and its vaccine. Participants with a higher level of HPV knowledge were US born, health-related majors, married or divorced, and had positive attitudes. Higher HPV knowledge, vaccine uptake, and a family history of cervical cancer were associated with positive attitudes. Predictors for vaccine uptake include being a health-related major and positive vaccine attitudes.

Implications for practice:
The results of this study help NPs, registered nurses, and other health care providers make effective HPV vaccine recommendations to college students. Students with positive HPV attitudes can serve as peer educators to increase HPV vaccination awareness in this population.
Development of an advanced practice preceptor evaluation tool
Authors: Klein Colleen J. , Chan Garrett K. , Pierce Lisa , Van Keuren-Parent Korinne , Cooling Melinda 
Published: September 2020

ABSTRACT

Background:
Preceptors are essential in advanced practice registered nurse (APRN) and physician assistant (PA) fellowships; however, no tools exist for fellows to evaluate their preceptor.

Purpose:
The study's purpose was to examine the use of a modified preceptor evaluation tool (PET) in a new population APRNs and PAs who participated in a formalized postgraduate fellowship program.

Methodological orientation:
A qualitative study involving cognitive interviewing methods was used to evaluate original and modified items of the PET as a means to determine face validity. Over a period of 19 months, five different focus groups were conducted. Study participants completed an independent analysis of the tool prior to engaging in a focus group discussion. Further testing of new items was performed using the last two focus group cohorts and achieved data saturation.

Sample:
The sample included 23 fellows who had completed an acute, ambulatory, or primary care yearlong fellowship. More than half of the fellows ranged in age from <30 to 40 years.

Conclusions:
All original 19 items were retained, with the majority (79%) requiring slight modifications. Using feedback from fellows, 10 items were added to the final version, including two open-ended questions. The new items added a focus on preceptors' ability to foster domains of professional growth in the fellows' provider role.

Implications for practice:
This newly developed tool with face validity provides a new mechanism for preceptor evaluation by APRN and PA fellows. Additional research is needed with larger groups of fellows as a means to establish the tool's psychometric properties.
The Cervical Dysplasia Worksheet: A Longitudinal Map of Cervical Dysplasia Cytology and Histology Tests and Procedures
Authors: Johnson Camille A. , Madrigal Jessica M. , Metoyer Kelly , Zhukovsky Sara D. , Patel Ashlesha 
Published: September 2020

Objective
Our objectives were to describe the Cervical Dysplasia Worksheet (CDW), provide evidence of its feasibility to view patient cervical dysplasia results over time, and evaluate patient attitudes toward the tool in the setting of abnormal result follow-up.

Materials and Methods
The CDW augments the ASCCP guidelines for managing abnormal cervical cancer screenings by visually depicting cervical cytological and histological history along a color gradient showing severity. We evaluated tool feasibility by graphing a retrospectively reviewed convenience sample of patient data. A cross-sectional evaluation of the tool was then performed to assess patient attitudes in the setting of either dysplasia or colposcopy clinic. Patients had their data graphed on the CDW and explained to them before their clinical encounter. They then gave general comments about the tool and filled out a short evaluation survey.

Results
The large majority of retrospective patient data (N = 167) fit well within the CDW with roughly 20% requiring space for additional comments. Among the 30 patients who participated in our evaluation, almost all agreed (n = 29, 96.7%) that the tool helped them understand their history and results and that they would use the tool in the future.

Conclusions
The CDW is a novel tool to display a patient's cervical dysplasia history to visualize treatment and future care while enhancing patient-provider communication. Patient evaluation of the tool was largely positive, and suggestions will be taken into consideration for future modification. Further evaluation of the CDW among healthcare providers is needed to analyze its efficacy in the clinical setting.
Sound Quality Ratings of Amplified Speech and Music Using a Direct Drive Hearing Aid: Effects of Bandwidth
Authors: Vaisberg Jonathan , Folkeard Paula , Levy Suzanne , Dundas Drew , Agrawal Sumit , Scollie Susan 
Published: September 2020

Objective:
To determine sound quality for extended bandwidth amplification using a direct drive hearing device.

Study Design:
Prospective double-blind within-subjects repeated measures study.

Setting:
University hearing research laboratories.

Patients:
Fifteen experienced hearing aid users with symmetric mild-sloping-to-severe sensorineural hearing loss.

Intervention(s):
Sound quality ratings of speech and music passages were obtained using the Multiple Stimulus with Hidden References and Anchors (MUSHRA) protocol after wearing a direct drive hearing aid for at least 4 weeks. Passages were processed to filter out low-frequency (below 123 and 313 Hz) and high-frequency (above 4455, 5583, 6987, and 10,869 Hz) energy.

Main Outcome Measure(s):
Comparison of sound quality ratings for speech and music between low and high-pass filter frequencies measured from 0 to 100, where 0 represents “bad” and 100 represents “excellent.”

Results:
Wider bandwidth stimuli received higher sound quality ratings compared with narrower bandwidth stimuli. Conditions with more low-frequency energy (full-band and 123 Hz cut-off) were rated as having higher sound quality. More low-frequency energy in the 123 Hz condition was rated as having higher sound versus the 313 Hz condition (mean difference: 11.2%, p = 0.001). Full-band conditions with more low- and high-frequency energy were higher than the other high-frequency cutoff conditions (mean difference range: 12.9–15%, p < 0.001).

Conclusions:
The direct drive system provides higher sound quality of both speech and music compared to narrowband conditions. Sound quality improvements were mainly attributable to low-frequency sound, but stimuli with specific high-frequency content were rated with higher sound quality when additional high-frequency energy was present.