bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prone Position in Acute Respiratory Distress Syndrome Patients
Authors: Lucchini Alberto , Bambi Stefano , Mattiussi Elisa , Elli Stefano , Villa Laura , Bondi Herman , Rona Roberto , Fumagalli Roberto , Foti Giuseppe 
Published: November 2019

Background
Early application of prolonged prone positioning has been shown to improve patient survival in moderate to severe adult respiratory distress syndrome (ARDS) patients. Prone position is a key component of lung protective mechanical ventilation in association with low tidal volume and neuromuscular blocking agents in patients with severe ARDS. Pressure sores are the major prone position complication. The rate of complication is lowering with the increase in center expertise.

Aims
The aim of this study was to examine the onset of pressure sores and other complications caused by the use of prone position in patients having ARDS.

Design
This is a single-center, retrospective, observational study.

Results
One hundred seventy patients were enrolled, with a median age of 49 years (interquartile range [IQR], 38-63). Of all participants, 58% (n = 98) survived the intensive care unit recovery. The total prone position maneuvers were 526, with a median of 2 prone position sessions for each patient (IQR, 1-3). The median length of the prone position session was 9 hours (IQR, 7-12). Twenty-three patients developed pressure sores after prone position (14%). The anatomical positions of pressure sores were as follows: face/chin, 5% (n = 8); face/cheekbones, 6% (n = 11); thorax, 2% (n = 3); trochanter, 1% (n = 1); and other sites, 5% (n = 8). Complications were observed in 1% (n = 6) of all pronation maneuvers (vomit, 2%; respiratory device removal, 0.4%). No removal of intravascular catheter was observed.

Conclusions
The onset rate of complications given by the use of prone position in ARDS patients is similar to data reported by previous literature. The implementation of a dedicated protocol in specialized centers and the involvement of 5 trained and skilled professionals while moving the patient in the prone position are recommended to prevent the occurrence of similar adverse events.
Central aortic blood pressure estimation in children and adolescents: results of the KidCoreBP study
Authors: Mynard Jonathan P. , Goldsmith Greta , Springall Gabriella , Eastaugh Lucas , Lane Geoffrey K. , Zannino Diana , Smolich Joseph J. , Avolio Alberto , Cheung Michael M.H. 
Published: November 2019

Background:
Central aortic SBP (cSBP) may have superior prognostic value compared with peripheral SBP (pSBP), but noninvasive cSBP measurement techniques have not been formally validated in children and adolescents.

Method:
This study assessed the accuracy of two automated devices and the radial tonometry/transfer function method (RT-TF) for estimating central pressures and pulse pressure amplification (PPA) in this population, with adherence to validation guidelines for central pressure devices. In 69 children/adolescents aged 3–18 years undergoing clinically indicated aortic catheterization, high fidelity ascending aortic cSBP was measured with a micromanometer-tipped wire and compared with values from SphygmoCor XCEL, Mobil-O-Graph (systolic/diastolic calibration, MoG-C1, or mean/diastolic calibration, MoG-C2) and RT-TF. Reference intra-arterial pSBP was derived from the tonometry pulse calibrated to central mean/diastolic pressures.

Results:
XCEL, MoG-C1 and MoG-C2 overestimated cSBP by 7.9 ± 6.8 mmHg (mean ± SD), 5.7 ± 10.3 mmHg, and 19.1 ± 14.9 mmHg, exceeding the validation cut-off (5 ± 8 mmHg). Brachial pSBP was also overestimated by XCEL (10.9 ± 8.4 mmHg) and Mobil-O-Graph (11.5 ± 12.3 mmHg). By contrast, central and brachial diastolic pressures were underestimated by the automated devices, albeit mostly within acceptable limits; pulse pressures were, therefore, substantially overestimated. Central-brachial PPA (4.5 ± 4.4 mmHg) was overestimated by XCEL (8.7 ± 3.2 mmHg) and MoG-C1 (11.1 ± 6.4 mmHg), but underestimated by MoG-C2 (−3.0 ± 6.6 mmHg). Given accurate pulse calibration, RT-TF achieved acceptable accuracy for cSBP (−0.2 ± 4.6 mmHg) and central-radial PPA (1.9 ± 5.1 mmHg).

Conclusion:
In conclusion, XCEL and Mobil-O-Graph overestimated pSBP and cSBP in children and adolescents. cSBP can be obtained via the same transfer function used in adults, but accurate pressure pulse calibration is critical.
Video Abstracts: http://links.lww.com/HJH/B222
A Survey of Physical Therapist Education: Relationships Among Pediatric Curriculum Delivery, Faculty, and Clinical Education
Authors: Anderson Deborah K. , Kenyon Lisa K. , Frost Jody S. 
Published: November 2019

Introduction.
This study is a secondary analysis of a 2014 survey study exploring pediatric clinical education in professional physical therapist (PT) education and describes PT education programs within the United States with respect to (1) how the pediatric curricular content is delivered; (2) the characteristics of the individual primarily responsible for delivering the pediatric content; (3) the relationship between characteristics of the individual primarily responsible for delivering the pediatric content and a program's report of sufficient numbers and variety of pediatric clinical education sites; and (4) the relationship between the type of pediatric curricular design used by a program and the program's report of sufficient numbers and variety of pediatric clinical education sites.

Methods.
A single Director of Clinical Education/Academic Coordinator of Clinical Education from 159 accredited professional PT programs completed the survey. Survey questions in this secondary analysis of the 2014 survey study pertain to the delivery of the pediatric content, characteristics of faculty, and pediatric clinical education experiences. Cross tabulations were used to examine possible relationships.

Results.
Ninety-nine (62.3%) responding programs reported delivery of the pediatric content through a single stand-alone course. One hundred and twelve (70.4%) responding programs reported that the pediatric content was delivered by a core faculty member with pediatric clinical experience. No significant relationships were found between a report of sufficient numbers and variety of pediatric clinical education sites and either characteristics of individuals delivering the pediatric curricular content or the type of pediatric curricular design used by a program.

Discussion and Conclusion.
Delivery methods for the pediatric curricular content are variable. Characteristics of the individual delivering this pediatric content are mixed.
Evidence-based strategies to increase vaccination uptake: a review
Authors: Cataldi Jessica R. , Kerns Mattie E. , O’Leary Sean T. 
Published: November 2019

Purpose of review
To summarize evidence-based strategies for improving pediatric immunization rates including physician behaviors, clinic and public health processes, community-based and parent-focused interventions, and legal and policy approaches

Recent findings
Studies continue to show the effectiveness of audit and feedback, provider reminders, standing orders, and reminder/recall to increase immunization rates. Provider communication strategies may improve immunization rates including use of a presumptive approach and motivational interviewing. Centralized reminder/recall (using a state Immunization Information System) is more effective and cost-effective compared to a practice-based approach. Recent work shows the success of text messages for reminder/recall for vaccination. Web-based interventions, including informational vaccine websites with interactive social media components, have shown effectiveness at increasing uptake of pediatric and maternal immunizations. Vaccination requirements for school attendance continue to be effective policy interventions for increasing pediatric and adolescent vaccination rates. Allowance for and ease of obtaining exemptions to vaccine requirements are associated with increased exemption rates.

Summary
Strategies to increase vaccination rates include interventions that directly impact physician behavior, clinic and public health processes, patient behaviors, and policy. Combining multiple strategies to work across different settings and addressing different barriers may offer the best approach to optimize immunization coverage.
Digital sextortion: Internet predators and pediatric interventions
Authors: Hong Suyeon , Lu Nancy , Wu Doreen , Jimenez David E. , Milanaik Ruth L. 
Published: November 2019

Purpose of review
Sextortion is defined as the act of coercing people into sending explicit images of themselves and subsequently blackmailing victims with the public release of said images. Prosecutions of sextortion cases involving minors have increased almost two-fold in the past 5 years. The purpose of this review is to explore the literature regarding the behavior of both victims and perpetrators, the effects on victims, and the support resources available for clinicians, victims, and parents.

Recent findings
Sextortion begins as an unassuming request for personal pictures and quickly escalates. Minors targeted by predators fear both punishment by guardians and the social consequences that follow the release of their explicit pictures. This cycle of victimization endangers minors and may lead to mental health problems, such as anxiety and depression. Recently, sextortion cases have risen to the forefront of national attention through the mainstream media with celebrities revealed as both perpetrators and victims. This higher visibility of sextortion highlights the importance of reviewing recent research regarding minors and their online behavior and the tactics of perpetrators.

Summary
Sextortion, an extreme form of cyber abuse, endangers minors and may lead to anxiety and depression. Pediatricians should be familiar with the concept of sextortion and discuss its dangers and available resources with parents and minors.
Tarsal coalition
Authors: Soni Jamil F. , Valenza Weverley , Matsunaga Carolina 
Published: November 2019

Purpose of review
Tarsal coalitions may cause painful pes planovalgus and recurrent sprains, and can lead to arthrosis if improperly managed. In this review, we discuss the current topics related to talocalcaneal and calcaneonavicular coalitions.

Recent findings
Tarsal coalitions are initially managed with conservative therapy, and when this approach fails, surgery is performed. Treatment of calcaneonavicular coalitions involves resection of the coalition and interposition of the extensor digitorum brevis muscle or fat, and in cases of marked valgus deformity, correction of the deformity. In talocalcaneal coalitions, recommendations include coalition resection for those affecting less than 50% of the area of the posterior facet and with a less than 16° valgus, coalition resection and valgus correction for those affecting less than 50% of the area and valgus greater than 16°, and isolated valgus correction for those affecting more than 50% of the area and with a more than or less than 16° valgus. Arthrodesis is reserved as a salvage procedure.

Summary
Talocalcaneal and calcaneonavicular coalitions can cause painful pes planovalgus. Their diagnoses are confirmed by plain radiograph, computed tomography, and, in cases of fibrous or cartilaginous coalitions, MRI. Initial treatment is conservative, and when symptoms persist, resection of the coalition is recommended along with tissue graft interposition with or without associated valgus correction. Arthrodesis is indicated as a salvage procedure whenever treatment fails or with advanced arthrosis.
Human leukocyte antigen molecular mismatch to risk stratify kidney transplant recipients
Authors: Wiebe Chris , Nickerson Peter W. 
Published: November 2019

Purpose of review
Stalled drug development and the lack of improvement in long-term graft survival reflect the unmet need for prognostic and predictive biomarkers in transplantation. Although conventional human leukocyte antigen (HLA) mismatch is too imprecise to fulfill this need, HLA molecular mismatch increases the precision in alloimmune risk assessment by quantifying the difference between donors and recipients at the molecular level.

Recent findings
Within each conventional HLA mismatch, recipients exhibit a wide range of HLA molecular mismatches with their donors. Quantifying HLA molecular mismatch improves the precision of alloimmune risk assessment for de novo donor-specific antibody development (dnDSA). Alloimmune risk categories developed analyzing dnDSA development were also found to correlate with T-cell-mediated rejection, antibody-mediated rejection, and all cause graft loss in adjusted and unadjusted models.

Summary
All alloimmunity is driven by differences between donors and recipients at the molecular level. HLA molecular mismatch may represent a fast, reproducible, cost-effective, way to improve alloimmune risk assessment at the time of transplantation to move the field towards precision medicine.
Pediatric Nasopharyngeal Carcinoma: A Rare Tumor in a Developing Country—What Do We Learn?
Authors: Zekri Wael , Wahed Mohamed A. , Attia Eman , Khalil Ehab 
Published: November 2019

Background/Aim:
Nasopharyngeal carcinoma (NPC) is rare in children, accounting for 1% of pediatric malignancies. The 5-fluorouracil Cisplatin regimen could be considered as a standard of care induction chemotherapy followed by concomitant chemoradiotherapy. This study aimed at detecting the survival outcome in correlation with different prognostic factors together with the toxicity of different treatment modalities.

Patients and Methods:
This was a retrospective study carried out from 2007 to 2016 that included all NPC patients below 18 years treated at the National Cancer Institute, Egypt.

Results:
A total of 21 patients were included with a median follow-up period of 33.9 months. The median age was 14.8 years (range: 9 to 18). All patients were treated by neoadjuvant chemotherapy with cisplatin and 5- fluorouracil, followed by concurrent radiotherapy (median dose: 61.2 Gy) and cisplatin as a radiosensitizer. After induction chemotherapy, the response rate was 53%. After completion of treatment, 67% had a complete response; partial response was seen in 14%; and progressive disease was seen in 19%. By the end of the study, 7 (33.3%) patients had progression/relapse; 4 of them died from disease. The 3-year overall survival and event-free survival were 85.7% and 66.7%, respectively.

Conclusions:
Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy was an effective strategy in the treatment of pediatric NPC with good overall survival and event-free survival. High systemic failure (33.3%) remains another challenge to solve. More efforts should be made to improve survival by developing more efficient systemic treatment modalities, especially for progressive/relapsed disease. Multicenter studies on a larger number of patients are needed to identify different prognostic factors and standardize treatment strategies.
Developing a Virtual Nursing Team to Support Predictive Analytics and Gaps in Patient Care
Authors: Lisk Laure E. , Buckley Jacqueline D. , Wilson Kristine , Martinez Vanessa A. , Cadiz Vilma R. , Poropat Lorelle , Scruth Elizabeth Ann 
Published: November 2019

Purpose/Aims
Development and implementation of a predictive analytic scoring system in a system of 21 hospitals required 24-hour surveillance to ensure alerts were responded and acted upon. Identification of gaps in patient care created an opportunity to innovate and develop a team to integrate both workflows.

Description of Project/Program
A Virtual Nurse team of master's degree–prepared nurses with backgrounds in intensive care and management led by a clinical nurse specialist work remotely from their homes. Each nurse is assigned to either of 2 workflows: Advance Alert Monitor—predictive analytic scores or e-Hospital involving capturing of care gaps. The Virtual Nurse team covers 24 hours a day/7 days a week.

Outcomes
The program has resulted in 169 lives saved and an observed-to-expected mortality of 0.8. Improvements in standard workflows across the system have enabled Rapid Response Teams to be implemented in each hospital.

Conclusions
The success of the Virtual Nurse team has resulted in developments to spread the program into other Kaiser Permanente regions. The Virtual Nurse team has grown to 40 nurses and will expand as the program spreads.
Implementation of a Neonatal Audit Tool to Drive Quality Initiatives
Authors: Grayson Stephanie , McKenna Kristin , Carroll Jean M. , Koran Jeanette , Chuo John 
Published: November 2019

Introduction:
Audit tools optimize the delivery of healthcare to patients. A network of 11 neonatal intensive care units (NICUs) affiliated with a large urban pediatric care institution implemented an audit tool for use on daily patient rounds. The article reports findings collected from 2011 to 2016.

Methods:
Primary drivers for implementation were (1) engagement from local providers; (2) identification of local improvement needs and improvement progress; (3) ability to customize audit questions based on local needs; (4) encouragement of information sharing between NICUs; and (5) improving measurable outcomes in neonatal care delivery. The Level IV NICU managed and refined a centralized process for managing site-specific tools, data analysis, and reporting. Each NICU customized the number and wording of action questions based on their needs. Answer choices were limited to “yes” or “no,” which corresponded to favorable or unfavorable actions toward the patient. Users also answered, “Was action taken as a result of an unfavorable response?”

Results:
Plan-Do-Study-Action cycles were completed to refine the tool and its implementation process. Adherence was variable among and within each network site. Across the network, 11.4% of actions tracked by the audit indicated improvement over time.

Conclusion:
Generalized use of the Audit Tool resulted in limited optimization of care actions addressed in the NICUs. Success depended on multi-disciplinary, multi-professional teamwork, respect for local autonomy, and leadership support. Increasing the use of the Audit Tool likely depends on the team’s ability to evolve the tool’s intrinsic value from a reminder to a monitoring system.
The Effect of Smartphone-Based Application Learning on the Nursing Students’ Performance in Preventing Medication Errors in the Pediatric Units
Authors: Pourteimour Sima , Hemmati MalsakPak Masumeh , Jasemi Madineh , Eghtedar Samereh , Parizad Naser 
Published: November 2019

Introduction:
Medication errors (MEs) are potentially harmful patient safety events in all age groups. MEs are particularly hazardous in the pediatric population, especially with patients who require special attention due to the high incidence and severity of disease. This study aimed to determine the effect of a smartphone messenger application on nursing students’ learning regarding the prevention of MEs in pediatric patients.

Methods:
We performed this quasi-experimental study with 80 nursing students who were randomly divided into intervention and control groups. We collected the data using a researcher-made checklist. We conducted learning through Telegram, a smartphone messenger application (app), for 3 weeks. We analyzed data using SPSS version 16.0 by utilizing descriptive and inferential statistics, and P < 0.05 was considered to be significant.

Results:
The mean age of the students was 23.5 ± 2.9 years. The majority of mistakes related to MEs in the control groups included the lack of proper control of the following: high risk medication administration, medication incompatibility interactions, medication administration card, medication dose calculations, adverse drug event recognition, pharmaceutical name recognition during drug selection, aseptic and sterile technique adherence, microbore IV tubing flush practices, IV drip rate adjustment, and medication administration schedules. The mean scores of students’ performance were significantly different in the knowledge of preventing MEs between the 2 groups. (P = 0.022).

Conclusions:
Smartphone learning with the Telegram messenger app improves nursing student knowledge regarding the prevention of MEs in pediatric patients. We recommend that this form of learning be used in nursing schools to prevent errors related to medication ordering, dosing, and administration.
Noncontact Phased-Array Ultrasound Facilitates Acute Wound Healing in Mice
Authors: Wakabayashi Nao , Sakai Atsushi , Takada Hiroya , Hoshi Takayuki , Sano Hitomi , Ichinose Shizuko , Suzuki Hidenori , Ogawa Rei 
Published: November 2019

Background:
The authors developed a noncontact low-frequency ultrasound device that delivers high-intensity mechanical force based on phased-array technology. It may aid wound healing because it is likely to be associated with lower risks of infection and heat-induced pain compared with conventional ultrasound methods. The authors hypothesized that the microdeformation it induces accelerates wound epithelialization. Its effects on key wound-healing processes (angiogenesis, collagen accumulation, and angiogenesis-related gene transcription) were also examined.

Methods:
Immediately after wounding, bilateral acute wounds in C57BL/6J mice were noncontact low-frequency ultrasound– and sham-stimulated for 1 hour/day for 3 consecutive days (10 Hz/90.6 Pa). Wound closure (epithelialization) was recorded every 2 days as the percentage change in wound area relative to baseline. Wound tissue was procured on days 2, 5, 7, and 14 (five to six per time point) and subjected to histopathology with hematoxylin and eosin and Masson trichrome staining, CD31 immunohistochemistry, and quantitative polymerase-chain reaction analysis.

Results:
Compared to sham-treated wounds, ultrasound/phased-array–treated wounds exhibited significantly accelerated epithelialization (65 ± 27 percent versus 30 ± 33 percent closure), angiogenesis (4.6 ± 1.7 percent versus 2.2 ± 1.0 percent CD31+ area), and collagen deposition (44 ± 14 percent versus 28 ± 13 percent collagen density) on days 5, 2, and 5, respectively (all p < 0.05). The expression of Notch ligand delta-like 1 protein (Dll1) and Notch1, which participate in angiogenesis, was transiently enhanced by treatment on days 2 and 5, respectively.

Conclusions:
The authors’ noncontact low-frequency ultrasound phased-array device improved the wound-healing rate. It was associated with increased early neovascularization that was followed by high levels of collagen-matrix production and epithelialization. The device may expand the mechanotherapeutic proangiogenesis field, thereby helping stimulate a revolution in infected wound care.