bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predicting and Surviving Prolonged Critical Illness After Congenital Heart Surgery
Authors: DeWitt Aaron G. , Rossano Joseph W. , Bailly David K. , Bhat Priya N. , Chanani Nikhil K. , Kirkland Brandon W. , Moga Michael-Alice , Owens Gabe E. , Retzloff Lauren B. , Zhang Wenying , Banerjee Mousumi , Costarino Andrew T. , Bird Geoffrey L. , Gaies Michael 
Published: April 2020

Objectives:
Prolonged critical illness after congenital heart surgery disproportionately harms patients and the healthcare system, yet much remains unknown. We aimed to define prolonged critical illness, delineate between nonmodifiable and potentially preventable predictors of prolonged critical illness and prolonged critical illness mortality, and understand the interhospital variation in prolonged critical illness.

Design:
Observational analysis.

Setting:
Pediatric Cardiac Critical Care Consortium clinical registry.

Patients:
All patients, stratified into neonates (≤28 d) and nonneonates (29 d to 18 yr), admitted to the pediatric cardiac ICU after congenital heart surgery at Pediatric Cardiac Critical Care Consortium hospitals.

Interventions:
None.

Measurements and Main Results:
There were 2,419 neonates and 10,687 nonneonates from 22 hospitals. The prolonged critical illness cutoff (90th percentile length of stay) was greater than or equal to 35 and greater than or equal to 10 days for neonates and nonneonates, respectively. Cardiac ICU prolonged critical illness mortality was 24% in neonates and 8% in nonneonates (vs 5% and 0.4%, respectively, in nonprolonged critical illness patients). Multivariable logistic regression identified 10 neonatal and 19 nonneonatal prolonged critical illness predictors within strata and eight predictors of mortality. Only mechanical ventilation days and acute renal failure requiring renal replacement therapy predicted prolonged critical illness and prolonged critical illness mortality in both strata. Approximately 40% of the prolonged critical illness predictors were nonmodifiable (preoperative/patient and operative factors), whereas only one of eight prolonged critical illness mortality predictors was nonmodifiable. The remainders were potentially preventable (postoperative critical care delivery variables and complications). Case-mix–adjusted prolonged critical illness rates were compared across hospitals; six hospitals each had lower- and higher-than-expected prolonged critical illness frequency.

Conclusions:
Although many prolonged critical illness predictors are nonmodifiable, we identified several predictors to target for improvement. Furthermore, we observed that complications and prolonged critical care therapy drive prolonged critical illness mortality. Wide variation of prolonged critical illness frequency suggests that identifying practices at hospitals with lower-than-expected prolonged critical illness could lead to broader quality improvement initiatives.
Attention-Deficit/Hyperactivity Disorder and Outcome After Concussion: A Systematic Review
Authors: Cook Nathan E. , Iaccarino Mary Alexis , Karr Justin E. , Iverson Grant L. 
Published: April 2020

ABSTRACT:Objective:To synthesize the literature and conduct a gap analysis on the association between attention-deficit/hyperactivity disorder (ADHD) and clinical outcome from sport-related concussion.Method:The electronic search for this systematic review (PROSPERO ID: CRD42019128281) was conducted in February 2019 using terms related to concussion, sports/athletics, and predictors/modifiers of outcome to search the PubMed, PsycINFO, MEDLINE, CINAHL, Cochrane Library, EMBASE, SPORTDiscus, Scopus, and Web of Science databases. Eligible studies evaluated the association between ADHD and outcome from sport-related concussion. Of 4014 studies screened, 359 full-text articles were reviewed, with 14 studies ultimately included, involving 3623 participants (n = 359 [9.9%] with ADHD).Results:Study samples were primarily from specialty medical clinics (57.1%) and high school or college athletic groups (28.6%). Only 2 studies reported a statistically significant association between ADHD and worse clinical outcome. Of these, 1 included 13 participants with ADHD and the other included only 8 participants with ADHD. Only 1 previous study in this review was designed specifically to examine ADHD and prolonged concussion recovery, and that study did not report a statistically significant association.Conclusion:There is not a clear association between ADHD and worse clinical outcome from concussion. However, eligible studies had limitations in research design, and nearly all studies were underpowered and evaluated the association between ADHD and concussion outcome as a secondary focus rather than the primary research question, precluding definitive conclusions. The association between ADHD and clinical outcomes remains unclear, and future research specifically examining ADHD and concussion recovery is needed.
Assessment of Wellbeing and Anxiety-related Disorders in Those Seeking Rhinoplasty: A Crowdsourcing-based Study
Authors: Shauly Orr , Calvert Jay , Stevens Grant , Rohrich Rod , Villanueva Nate , Gould Daniel J. 
Published: April 2020

Background:
Recently, it has been proposed that psychosocial concerns may motivate the demand for aesthetic rhinoplasty. Although successful operations often improve the quality of life and self-esteem symptoms in patients with sound mental health, they may actually result in unsatisfactory outcomes in those patients with significant depression, anxiety, or other severe psychological disorders. The purpose of this study was to assess the incidence of psychological disorders in patients seeking rhinoplasty.

Methods:
A prospective cross-sectional study of 298 random volunteers was conducted, with each participant completing a survey instrument that was administered through an internet crowd-sourcing service (Amazon Mechanical Turk). Participants were asked to complete a 10-item standardized SHNOS scale, and a 26-question PRIME-MD questionnaire in order to assess functional and aesthetic need for rhinoplasty, and the incidence of psychological disorders respectively

Results:
38.95% of female participants reported a willingness to undergo aesthetic rhinoplasty, with a significantly lower number of men reporting the same (27.78%, P = 0.042). Adults between the ages of 18-24 (52.92%) were more willing to undergo aesthetic rhinoplasty, as compared to any other age group (P < 0.01). It was found that 57.84% of patients interested in surgery reported a psychological disorder as determined by the PRIME-MD questionnaire.

Conclusions:
Those suffering from major depressive disorder, generalized anxiety disorder, or body dysmorphic disorder may seek aesthetic rhinoplasty as a solution. It is important that surgeons assess patient mental health prior to treatment in order to avoid unsuccessful outcomes secondary to psychosocial illness.
Crane Principle Revisited
Authors: Kadry Hamed M. , Taha Ahmed A. 
Published: April 2020

Background:
Scalp and forehead defects represent one of the most complex defects for reconstruction. The nature of these sites being hair bearing, together with the complicated nature of the injuries, for example, electrical burns and motor vehicle accidents, and of course the aesthetic concern being in the face, all add to the complexity of reconstruction.

Methods:
This is a case series representing the experience of the authors in using the “crane principle” in the reconstruction of various defects in the forehead and the scalp presented to emergency department, Cairo University Hospital, for the period between January 2018 and January 2019.

Results:
Twenty patients, 15 men and 5 women, presented with various soft tissue defects of the forehead and the scalp. The injuries of eighteen patients were due to motor vehicle accidents, and 2 patients had postelectrical burns. Age range was from 20 to 65 years, with a mean follow-up of 8 months. The number of total complications was 5. Three patients had wound dehiscence, and 2 patients had ulceration in the grafts placed at the flap donor site.

Conclusion:
Crane principle represents an adequate reconstruction tool for forehead and scalp defects especially when the access to free flap and more complex reconstruction techniques is not available.
Bifurcation of Patient Reviews: An Analysis of Trends in Online Ratings
Authors: Devgan Lara L. , Klein Elizabeth J. , Fox Stephen , Ozturk Tugce 
Published: April 2020

Background:
Online reviews have become increasingly important drivers of healthcare decisions. Data published by the Pew Research Center from 2016 suggest that 84% of adult Americans use online rating sites to search for information about health issues. The authors sought to analyze physician reviews collected from a large online consumer rating site to better understand characteristics that are associated with positive and negative review behavior.

Methods:
Published patient reviews from RealSelf were sampled over a 12-year period (June 2006 to August 2018). SQL, Python, and Python SciPy were used for statistical analysis on 156,965 reviews of 10,376 unique physicians. Python VADER was used to quantify consumer sentiment with review text as input.

Results:
Surgical procedures tended to be higher rated than nonsurgical treatments. The highest-rated procedures were breast augmentation, rejuvenation of the female genitalia, and facelift. The lowest-rated surgical procedures were buttock augmentation, rhinoplasty, and eyelid surgery. The mean physician rating was 4.6, with 87% of reviews being 5-star and 5% being 1-star. Sentiment analysis revealed positive consumer sentiment in 5-star reviews and negative sentiment in 1-star reviews.

Conclusions:
These findings suggest that online reviews of doctors are polarized by extreme ratings. Within the surgical category, significant differences in ratings exist between treatments. Perceived problems with postprocedural care are most associated with negative reviews, whereas satisfaction with a physician’s answers to patient questions is most associated with positive reviews. Polarization of physician reviews may suggest selection bias in reviewer participation.
Coronavirus Disease 2019 State Guidelines on Elective Surgery: Considerations for Plastic and Reconstructive Surgeons
Authors: Sarac Benjamin A. , Schoenbrunner Anna R. , Wilson Stelios C. , Chiu Ernest S. , Janis Jeffrey E. 
Published: April 2020

Background:
Vague recommendations regarding elective surgery have been proposed by national organizations in an attempt to conserve personal protective equipment and to protect healthcare workers during the coronavirus disease 2019 pandemic. In response, some states have attempted to provide more clear guidance.

Methods:
An internet search was performed to identify and analyze what guidance each state published through government websites through April 10, 2020.

Results:
Thirty-five states and the District of Columbia published guidance in the form of either a recommendation or a mandate. Procedures relating to cosmetics and malignancy were found to be mentioned in 4 and 12 states, respectively, but ultimately lacked case-specific information.

Conclusions:
Current government and state recommendations do not provide clear guidance on how plastic and reconstructive surgeons should approach elective surgeries. Ultimately, it is the responsibility of all plastic and reconstructive surgeons to operate under appropriate law while individualizing their practices to best suit the needs of their patients while being mindful of resource limitations and exposure risks.
Aberrant lncRNA Profiles Are Associated With Chronic Benzene Poisoning and Acute Myelocytic Leukemia
Authors: Tian Wei , Wang Tong-shuai , Fang Yan , Wu Han-tian , Zheng Guo-qiao , Guo Kong-rong , Huang Ming , Sun Dao-yuan , Xia Zhao-lin 
Published: April 2020

Objective:
This study investigates the mechanisms of benzene hematotoxicity.

Methods:
We used microarray to detect expression profiles of long non-coding RNAs (lncRNAs) and mRNAs in peripheral lymphocytes from chronic benzene poisoning, acute myelocytic leukemia, and healthy controls. The lncRNAs and mRNAs were validated using real-time quantitative PCR (RT-qPCR). Cytokinesis-block micronucleus assay was used to analyze chromosomal aberration.

Results:
We found 173 upregulated and 258 downregulated lncRNAs, and 695 upregulated and 804 downregulated mRNAs. The lncRNA CUST_40243 and mRNA PDGFC and CDKN1A associated with chronic benzene poisoning. Relevant inflammatory response, hematopoietic cell lineage, and cell cycle may be important pathways for the sifted lncRNAs and mRNAs. Furthermore, micronuclei frequency was significantly higher in off-post chronic benzene poisoning patients.

Conclusions:
Chromosomal aberration induced by benzene exposure is irreversible. The lncRNA CUST_40243 and mRNA PDGFC and CDKN1A are related to chronic benzene poisoning.
Moving Toward Equitable Health Care for Lesbian, Gay, Bisexual, Transgender, and Queer Patients: Education and Training in Physical Therapy Education
Authors: Glick Jared Calvo , Leamy Claire , Hewlett Molsberry Anne , Kerfeld Cheryl Irene 
Published: April 2020

Introduction.
Disparities in health and health care experienced by sexual and gender minorities in the United States (US) are well documented, and physical therapists (PTs) play a role in perpetuating them. This study aimed to determine to what degree lesbian, gay, bisexual, transgender, and queer (LGBTQ) health education and training is integrated into physical therapy education curricula. Studies in medicine and nursing have led to increased curricular attention to LGBTQ health topics; yet, similar physical therapy education research has not been published.

Methods.
A link to an anonymous Google Forms survey was emailed to Program Directors (PDs) of US physical therapist education programs accredited by the Commission on Accreditation in Physical Therapy Education for the academic years of 2015–2017. The survey gathered information on the current and optimal number of curricular hours spent on equitable care for LGBTQ patients and perceived barriers to inclusion of LGBTQ curriculum.

Results.
Seventy-two of 229 (31%) programs responded to the survey. Half of the respondents reported inclusion of LGBTQ-related topics in the curriculum. The average number of current hours was 1.43 per year. The average number of optimal hours was 2.82 per year. Eighty-nine percent reported that one or more curricular hours per year should be included. Barriers to LGBTQ health education and training include perceived lack of time and adequate faculty training.

Discussion.
Most PDs believe that more hours should be dedicated to LGBTQ health topics. Open-ended question responses reflect various perspectives held by PDs regarding the importance of including LGBTQ health topics and barriers to inclusion. The development of core competencies may facilitate the inclusion of LGBTQ-specific health education in Doctor of Physical Therapy program curricula.

Conclusion.
Resources to educate faculty and students on LGBTQ health topics are readily available. These topics may be effectively woven into existing curricula, making it an attainable goal to increase the competency of entry-level PTs to assist in meeting the American Physical Therapy Association's mandate to provide nondiscriminatory care.
Clinical efficacy and safety of ketotifen in treating irritable bowel syndrome with diarrhea
Authors: Wang Jing , Wang Yucheng , Zhou Haibin , Gu Weigang , Wang Xia , Yang Jianfeng 
Published: April 2020

Objective:
The aim of the study was to investigate the clinical efficacy and safety of ketotifen for the treatment of irritable bowel syndrome with diarrhea (IBS-D).

Methods:
A total of 108 enrolled IBS-D patients were randomly divided into a ketotifen group (n = 55) and a control (placebo) group (n = 53). The patients in the ketotifen group received ketotifen tablets (1 mg, oral) two times daily; patients in the control group received oral placebo for 8 weeks. Before and after 8 weeks of treatment, gastrointestinal symptoms, anorectal sensory function and the number and activity status of mast cells were assessed for both groups.

Results:
(1) The overall effective rate of gastrointestinal symptom improvement in the ketotifen group was significantly higher than that in the control group (76.4 vs. 37.7%, P < 0.001). (2) First sensation, defecation urgency and discomfort/pain threshold in the ketotifen group improved significantly after treatment (P < 0.05); no significant changes were observed in the control group (P > 0.05). (3) In the ketotifen group, the number of mast cells in the terminal ileum decreased, and the percentages of degranulated mast cells in the sigmoid colon, ascending colon and terminal ileum decreased significantly after treatment compared with before treatment; these differences were statistically significant (P < 0.01). In the control group, the number of mast cells and the percentages of degranulated mast cells in various sites did not change significantly before and after treatment (P > 0.05). (4) Six patients (10.9%) in the ketotifen group experienced drowsiness and fatigue, but the symptoms disappeared after 1 week of treatment.

Conclusion:
Ketotifen significantly alleviated gastrointestinal symptoms and improved visceral hypersensitivity in patients with IBS-D. The therapeutic effect of ketotifen is related to a reduced number and decreased activity of mast cells in the intestinal mucosa, especially in the terminal ileum.
The Effect of an Evidence-Based Practice Education and Mentoring Program on Increasing Knowledge, Practice, and Attitudes Toward Evidence-Based Practice in a Rural Critical Access Hospital
Authors: Mudderman Jamie , Nelson-Brantley Heather V. , Wilson-Sands Cathy L. , Brahn Pam , Graves Kristal L. 
Published: April 2020

OBJECTIVE
The aim of this study was to determine the effect of an evidence-based practice (EBP) education and mentoring program on the knowledge, practice, and attitudes toward EBP among staff nurses and clinicians in a rural critical access hospital.

BACKGROUND
While rural nurses value EBP, they often have more limited resources to engage in EBP activities compared with urban-based nurses.

METHODS
Direct care nurses and clinicians participated in a 5-month EBP education and mentoring program following the Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Health Care. The Evidence-Based Practice Questionnaire was used to assess pretest-posttest knowledge, practice, and attitudes toward EBP.

RESULTS
Knowledge and practice of EBP increased significantly (P = .008 and P = .015, respectively) after the EBP education and mentoring intervention. Attitudes toward EBP also increased, although the increase was not statistically significant (P = .106).

CONCLUSIONS
Education and mentoring of healthcare clinicians in rural settings are crucial to the translation of evidence-based research into practice to improve patient outcomes.
The Underuse of STI Prevention Counseling in Primary Care
Authors: Diamond Victoria , Harman Jeffrey , Gerend Mary A. 
Published: April 2020

Abstract
Although sexually transmitted infection (STI) rates are increasing in the United States, prevention efforts remain limited. This study examined how often STI prevention counseling is given during primary care office visits using nationally representative data. Sexually transmitted infection prevention counseling occurred in 0.6% of visits and differences by patient race and physician specialty were observed.
Evaluation of Preparedness and Recovery Needs of Private Well Users After the Great Louisiana Flood of 2016
Authors: Gilliland Aubrey E. , Pieper Kelsey J. , Straif-Bourgeois Susanne , Rhoads William J. , Dai Dongjuan , Edwards Marc , Brisolara Kari , Olexia Darcie , Katner Adrienne 
Published: April 2020

Context:
The August 2016 Louisiana flood marked the second 500-year flood in the state in 1 year.

Objective:
The aim of this study was to identify private well user needs in the aftermath of the flood and to develop disaster planning and recovery recommendations for flood-prone well-reliant communities.

Design:
A descriptive cross-sectional study was conducted to collect information from a convenience sample of flood-impacted well users via surveys and water sampling kits, which were distributed to well users 9 to 11 weeks after floodwaters receded (n = 106).

Setting:
Surveys and kits were distributed at roadside flood response and recovery stations set up by local churches in French Settlement, Livingston Parish, Louisiana, an area at the epicenter of the flood-impacted area.

Participants:
Subjects were included if they self-reported having a flood-impacted well.

Main Outcome Measures:
Surveys collected information to characterize knowledge gaps, risk perceptions, flood impacts, resource accessibility, and well maintenance barriers. Well water tests evaluated total coliform and Escherichia coli.

Results:
Among those in low-risk flood zones (n = 22), 27% were in areas designated as having flooded. Among flood-impacted wells that were shock chlorinated after the flood (n = 16), 31.3% tested positive for total coliform and 12.5% for E coli. Only 26% of respondents received well-related information after the disaster.

Conclusions:
Results highlight critical needs for disaster planning and well user education in flood-prone areas, changes to flood risk maps, and concerns with the efficacy of disinfection strategies. Information and resources needs for flood-impacted well users are presented and recommendations on how to improve flood preparedness and recovery are made.
Validation of Appropriate Use Criteria for Coronary Computed Tomographic Angiography for Chest Pain Evaluation in a Tertiary Care Emergency Room
Authors: Teressa Getu , Manjur Jahan , Ciuffo Marissa , Noack Pamela , Radulescu Vlad A. , Kanagaraj Gautham , Ahuja Ankur , Malaney Roshini , Poon Michael 
Published: April 2020

Purpose:
Appropriate use criteria (AUC) defines the appropriateness of imaging procedures for specific clinical scenarios to promote evidence-based utilization and improve cost-effective care. The goal of this study was to assess the diagnostic yield and downstream health care resource utilization according to the AUC categorization for coronary computed tomography angiography (CCTA) in emergency department (ED) patients presenting with chest pain.

Materials and Methods:
A total of 789 consecutive patients in the ED with chest pain and no known coronary artery disease (CAD) who underwent CCTA were classified as appropriate, uncertain, or inappropriate use according to the 2010 AUC. We abstracted index and 30-day data from the electronic medical record to determine diagnostic yield (rate of obstructive CAD and revascularization) and health care resource utilization (downstream stress test and 30-d hospital return rate).

Results:
Rates of appropriate, uncertain, and inappropriate utilization were 48.4%, 48.8%, and 2.8%. Among appropriate, uncertain, and inappropriate classifications, rates of obstructive CAD were 9%, 8%, and 32% (P=0.002); rates of revascularization were 3%, 1%, and 36% (P<0.001); downstream stress test utilization rates were 5% versus 5% versus 14% (P=0.17), and 30-day hospital return rates were 6% versus 6% versus 5% (P>0.99), respectively.

Conclusions:
Appropriate and uncertain uses were associated with low diagnostic yield compared with inappropriate use; however, our findings do not demonstrate differences between appropriate use categories with respect to downstream health care resource utilization. Further studies are needed to define the role of AUC for CCTA in the ED setting.