bluuebunny/crossref_metadata_2025_split huggingface dataset:
Standardizing the Frequency of Neurologic Assessment After Acute Stroke
Authors: Wells-Pittman Jennifer , Gullicksrud Angela 
Published: February 2020

ABSTRACT
The National Institutes of Health Stroke Scale (NIHSS) is considered the standard for assessing neurologic status after an acute stroke. Currently, there is no guideline for when this assessment should be completed, nor is there consensus on how frequently or for how long.
We initiated a quality improvement project that sought first to determine when and how often nurses at a variety of institutions in our multisite health care system completed the NIHSS assessment and then to identify the minimum frequency at which nurses should complete the assessment. After reviewing the literature and current practices and observing internal and external benchmarks, we set a new standard for all institutions in the system to follow.
The new assessment frequency was based on patient condition and level of care, although that frequency would change if a patient showed new or worsening neurologic changes. The new standard was successfully implemented at all the primary and comprehensive certified stroke centers in our network. Ongoing monitoring confirmed that the frequency of NIHSS assessment met the needs of our patients and ensured staff adherence to the new practice.
Promoting Readiness for Residency: Embedding Simulation-Based Mastery Learning for Breaking Bad News Into the Medicine Subinternship
Authors: Vermylen Julia H. , Wayne Diane B. , Cohen Elaine R. , McGaghie William C. , Wood Gordon J. 
Published: February 2020

Purpose
It is challenging to add rigorous, competency-based communication skills training to existing clerkship structures. The authors embedded a simulation-based mastery learning (SBML) curriculum into a medicine subinternship to demonstrate feasibility and determine the impact on the foundational skill of breaking bad news (BBN).

Method
All fourth-year students enrolled in a medicine subinternship at Northwestern University Feinberg School of Medicine from September 2017 through August 2018 were expected to complete a BBN SBML curriculum. First, students completed a pretest with a standardized patient using a previously developed BBN assessment tool. Learners then participated in a 4-hour BBN skills workshop with didactic instruction, focused feedback, and deliberate practice with simulated patients. Students were required to meet or exceed a predetermined minimum passing standard (MPS) at posttest. The authors compared pretest and posttest scores to evaluate the effect of the intervention. Participant demographic characteristics and course evaluations were also collected.

Results
Eighty-five students were eligible for the study, and 79 (93%) completed all components. Although 55/79 (70%) reported having personally delivered serious news to actual patients, baseline performance was poor. Students’ overall checklist performance significantly improved from a mean of 65.0% (SD = 16.2%) items correct to 94.2% (SD = 5.9%; P < .001) correct. There was also statistically significant improvement in scaled items assessing quality of communication, and all students achieved the MPS at mastery posttest. All students stated they would recommend the workshop to colleagues.

Conclusions
It is feasible to embed SBML into a required clerkship. In the context of this study, rigorous SBML resulted in uniformly high levels of skill acquisition, documented competency, and was positively received by learners.
Pediatric Medial Epicondyle Fracture Management: A Systematic Review
Authors: Pezzutti Dante , Lin James S. , Singh Satbir , Rowan Mallory , Balch Samora Julie 
Published: February 2020

Background:
There remains controversy surrounding the treatment of pediatric medial epicondyle fractures. This systematic review examines the existing literature with the aim to elucidate optimal management strategies.

Methods:
A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was executed. All data collection was completed by August 01, 2018. Functional outcomes, diagnostic imaging, athlete management, union rates, ulnar nerve symptoms, surgical methods, surgical positioning, and posttreatment protocols were categorized and recorded. Frequency-weighted mean values were calculated with associated SDs.

Results:
Thirty-seven studies with 1022 patients met the inclusion criteria. Functional outcomes for patients were mostly good following operative and nonoperative management. The most common complication was a slight loss of elbow extension (7.6±5.9 degrees) and flexion (13.3±5.8 degrees). Operative treatment was associated with higher union rates than nonoperative management (700/725, 96% vs. 69/250, 28%; P<0.001). Standard diagnostic imaging techniques to measure displacement were unreliable with a newly proposed axial view having high inter-rater and intrarater reliability. The most common surgical method used was open reduction and internal fixation with Kirschner wires. Whereas surgical management of patients with associated ulnar nerve symptoms led to symptom resolution, nonoperative management occasionally led to the development of these symptoms. Elbow range of motion was initiated at ~2.8±1.4 (range, 0 to 8 wk) weeks after surgery and 3.4±1.2 (range, 3 to 5 wk) weeks without surgery (P<0.001).

Conclusions:
Although there is still no consensus on treatment of pediatric medial epicondyle fractures, both operative and nonoperative approaches result in good outcomes.

Level of Evidence:
Level IV—therapeutic
Spinal Growth in Patients With Juvenile Idiopathic Scoliosis Treated With Boston Brace
Authors: Heemskerk Johan L. , Wijdicks Sebastiaan P.J. , Altena Mark C. , Castelein René M. , Kruyt Moyo C. , Kempen Diederik H.R. 
Published: February 2020

Study Design.
Retrospective comparative cohort.

Objective.
The aim of this study was to determine whether spinal growth is restricted by brace treatment in patients with juvenile idiopathic scoliosis (JIS).

Summary of Background Data.
Spinal fusion can negatively affect spinal growth if performed before the growth spurt. Brace treatment is often given in this young population to control the spinal deformity while allowing spinal growth. It is unknown whether the applied pressure of brace treatment on spine results in growth restriction. The aim of the study is to evaluate spinal growth in braced JIS patients.

Methods.
A total of 49 JIS patients treated with Boston brace were retrospectively selected from a scoliosis database. T1-T12/T1-S1 perpendicular and freehand (height following the curvature of the spine) height were measured on radiographs of patients that had reached skeletal maturity and were matched with 49 controls without scoliosis. Spinal growth was calculated from brace initiation until cessation and was compared with normal spinal growth values as reported by Dimeglio.

Results.
The mean age of diagnosis was 7.4 years. The age of the braced scoliosis patients at skeletal maturity was 17.5 years. The average T1-T12 and T1-S1 freehand height measured by following the curvature of the scoliosis was 29.3 cm (±2.4) and 47.2cm (±4.0), respectively, and was not significant different from the control group. Brace treatment was initiated at a mean age of 11.2 and the mean age of cessation was 14.8. Spinal growth (freehand) during brace treatment was 1.10 cm/year for the thoracic spine and 1.78 cm/year for the full spine and was not significant different from normal values.

Conclusion.
No significant influence of bracing on spinal growth could be detected in this cohort of JIS patients. The spinal height measurements at skeletal maturity were similar to matched controls. In addition, spinal growth did not significantly differ from Dimeglio normal growth data, indicating that the effect of bracing on spinal growth is absent or minimal.

Level of Evidence: 3
Early Tracheostomy in Severe Traumatic Brain Injury Patients: A Meta-Analysis and Comparison With Late Tracheostomy
Authors: de Franca Sabrina Araujo , Tavares Wagner M. , Salinet Angela S. M. , Paiva Wellingson S. , Teixeira Manoel J. 
Published: February 2020

Objectives:
To elucidate the impact of early tracheostomy on hospitalization outcomes in patients with traumatic brain injury.

Data Sources:
Lilacs, PubMed, and Cochrane databases were searched. The close-out date was August 8, 2018.

Study Selection:
Studies written in English, French, Spanish, or Portuguese with traumatic brain injury as the base trauma, clearly formulated question, patient’s admission assessment, minimum follow-up during hospital stay, and minimum of two in-hospital outcomes were selected. Retrospective studies, prospective analyses, and case series were included. Studies without full reports or abstract, commentaries, editorials, and reviews were excluded.

Data Extraction:
The study design, year, patient’s demographics, mean time between admission and tracheostomy, neurologic assessment at admission, confirmed ventilator-assisted pneumonia, median ICU stay, median hospital stay, mortality rates, and ICU and hospital costs were extracted.

Data Synthesis:
A total of 4,219 studies were retrieved and screened. Eight studies were selected for the systematic review; of these, seven were eligible for the meta-analysis. Comparative analyses were performed between the early tracheostomy and late tracheostomy groups. Mean time for early tracheostomy and late tracheostomy procedures was 5.59 days (sd, 0.34 d) and 11.8 days (sd, 0.81 d), respectively. Meta-analysis revealed that early tracheostomy was associated with shorter mechanical ventilation duration (–4.15 [95% CI, –6.30 to –1.99]) as well as ICU (–5.87 d [95% CI, –8.74 to –3.00 d]) and hospital (–6.68 d [95% CI, –8.03 to –5.32 d]) stay durations when compared with late tracheostomy. Early tracheostomy presented less risk difference for ventilator-associated pneumonia (risk difference, 0.78; 95% CI, 0.70–0.88). No statistical difference in mortality was found between the groups.

Conclusions:
The findings from this meta-analysis suggest that early tracheostomy in severe traumatic brain injury patients contributes to a lower exposure to secondary insults and nosocomial adverse events, increasing the opportunity of patient’s early rehabilitation and discharge.
Vertical Midface Lifting: An Improved Technique for Asians
Authors: Zou Chong , Liu Yuanbo , Wang Xiangyue , Wang Tailing , Wang Jiaqi 
Published: February 2020

BACKGROUND
Treatment of the aging midface is increasingly deemed a key part of facial and periorbital rejuvenation. Compared with Westerners, Asians tend to have a relatively prominent zygoma and mandibular angle, thicker dermis, and greater propensity for scar formation.

OBJECTIVE
This study was performed to review our surgical method of vertical midface lifting in Asian patients and evaluate the clinical outcomes.

METHODS AND MATERIALS
This retrospective observational study involved 116 Asian women who complained of an aged midface. All patients underwent midface rejuvenation surgery with one lower eyelid incision and 2 small frontal–temporal incisions. Clinical results were assessed objectively using photographs and subjectively by a patient satisfaction survey.

RESULTS
All patients recovered well without major complications. High patient satisfaction (94%) was attained. The improvement scores as evaluated by the panel demonstrated a higher level of improvement for the malar eminence (8.3 ± 0.6), nasojugal groove (8.0 ± 0.8), and nasolabial fold (7.9 ± 0.7) than for the lower face (6.2 ± 1.0).

CONCLUSION
Our vertical midface lift technique is safe and effective for older Asian patients with a midface aging appearance.

LEVEL OF EVIDENCE
Therapeutic IV.
Impacts of interactions between ADH1B and ALDH2 genotypes on alcohol flushing, alcohol reeking on the day after drinking, and age distribution in Japanese alcohol-dependent men
Authors: Yokoyama Akira , Yokoyama Tetsuji , Matsui Toshifumi , Mizukami Takeshi , Kimura Mitsuru , Matsushita Sachio , Higuchi Susumu , Maruyama Katsuya 
Published: February 2020

Objective:This study sought to evaluate the impacts of interactions between thealcohol dehydrogenase-1B(rs1229984) genotype and thealdehyde dehydrogenase-2(rs671) genotype on alcohol flushing, alcohol reeking on the day after drinking, and the age distribution in alcohol-dependent patients.Methods:The study subjects were 4107 Japanese alcohol-dependent men who underwentalcohol dehydrogenase-1Bandaldehyde dehydrogenase-2genotyping: 4051 patients were asked about their current or former tendency to experience facial flushing after drinking a glass of beer, and 969 patients were asked about whether they had ever been told that they reeked of alcohol more than 12 hours after they had stopped drinking.Results:Current, former, and never flushing were reported in 3.5, 14.9, and 81.5%, respectively, of the subject, and alcohol reeking after more than 12 hours in 36.1% of the subjects. The fast-metabolizingADH1B*2(+) genotype (*1/*2or*2/*2) and the inactiveALDH2*2(+) genotype (*1/*2or*2/*2) affected the multivariate odds ratios for current or former flushing [odds ratio, 95% confidence interval = 2.27 (1.79–2.86) and 23.0 (18.6–28.5), respectively, vs. *2(−) genotype] and for alcohol reeking [0.39 (0.29–0.52) and 1.56 (1.09–2.25), respectively, vs. *2(−) genotype]. An age-dependent decrease in theADH1B*2(−) andALDH2*2(−) combination from 32.3% in the 30–39-year age group to 12.5% in the 70–79-year age group and an age-dependent increase in theADH1B*2(+) andALDH2*2(−) combination from 52.5% in the 30–39-year age group to 70.5% in the 70–79-year age group were observed (P< 0.0001 for trend). The frequencies of theADH1B*2(−) andALDH2*2(+) combination (4.7–6.2%) and theADH1B*2(+) andALDH2*2(+) combination (8.9–12.0%) did not change markedly with increasing age.Conclusion:Interactions between thealcohol dehydrogenase-1Bandaldehyde dehydrogenase-2genotypes modified alcohol flushing, alcohol reeking on the day after drinking, and the age distribution. These findings support the protective roles of theADH1B*2(+) andALDH2*2(+) genotypes against the development of alcohol dependence.
Defining a New Leadership Model to Stay Relevant in Healthcare
Authors: Kaplan Gary S. 
Published: February 2020

Summary
Because the healthcare landscape is in a state of extreme disruption, the ability to adapt is essential for organizations and their leadership teams. Players outside the sector, changing workforce and patient demographics, new technologies, cost pressures, and other influences are challenging hospital and health systems’ abilities to perform as expected.
Amid this ambiguity, a lack of urgency is preventing organizations from adjusting to a business environment in flux. Never has it been more important for leaders to show courage, learn, and guide their organizations to the front lines of innovation. In today’s world, being a learning organization—one in which leaders and team members lean together into change, rather than back away—is crucial to remaining relevant. To quote philosopher Eric Hoffer, “In times of change, learners inherit the earth while the learned find themselves beautifully equipped to deal with a world that no longer exists.”
At Virginia Mason, a health system based in Seattle, Washington, our management methodology—the Virginia Mason Production System—allows the organization to be a nimble responder to change. It also empowers individuals across the enterprise, regardless of job or title, to assume hands-on roles in accomplishing our collective vision to transform healthcare. This “we culture” shines a bright light on improvement opportunities and provides the framework needed for collaborative, interdisciplinary efforts to develop solutions.
The Susceptibility to Other Infectious Diseases Following Measles During a Three Year Observation Period in Switzerland
Authors: Behrens Lynn , Cherry James D. , Heininger Ulrich ,   for the Swiss Measles Immune Amnesia Study Group
Published: February 2020

Background:
Measles virus infection leads to significant immunosuppression. In developing countries, this translates to an increased nonspecific mortality, whereas its effects in developed countries are less clear.

Methods:
We performed a cohort study to investigate whether children hospitalized with measles (cases) between 2000 and 2015 in Switzerland would have a higher frequency of hospital admissions due to other infectious diseases thereafter than children who did not have measles (controls). Cases were identified by ICD-10 discharge diagnoses for measles and/or keyword search and matched to 2 controls by time of hospitalization, age and sex. All hospitalizations ≤3 years after original admission, infectious or noninfectious in origin, were identified in cases and controls.

Results:
One hundred thirteen cases (56% males), mean age 9.0 years (range 2 weeks–17.8 years), and 196 controls were identified. Twelve rehospitalizations due to an infectious disease occurred in 11 cases and 6 in 6 controls (episode rates 0.106 versus 0.031 per person; ratio 3.47; 95% CI: 1.20–11.3; P = 0.012) in 3 years of follow-up. Of these, 9 and 3 occurred in cases and controls, respectively, during year 1 [ratio 5.20 (95% CI: 1.30–29.88; P = 0.012)]. Infectious diseases following measles affected various organ systems, were neither particularly severe nor fatal and revealed no specific pattern.

Conclusions:
The increased risk for nonspecific infectious disease hospitalizations supports the concept of immunologic amnesia after measles. Universal immunization against measles provides additional benefit beyond protection against measles itself.
The Clinical and Parasitologic Follow-up of Trypanosoma cruzi–infected Children in a Nonendemic Country
Authors: Simón Marina , Iborra M. Asunción , Carrilero Bartolomé , Romay-Barja María , Vázquez Cristina , Gil-Gallardo Luis J. , Segovia Manuel 
Published: February 2020

Background:
Chagas disease has become a global health problem, with the pediatric population being especially vulnerable. Our aim was to describe the clinical-epidemiologic aspects of disease in this population, as well as tolerance and adherence to treatment and the subsequent evolution of the disease.

Methods:
A prospective study involving 949 children 0–14 years of age screened from 2007 to 2018. Diagnosis was performed by polymerase chain reaction and/or microhematocrit in <1-year-old children or serology in those ≥1 year of age. After diagnosis, children were examined for the clinical manifestation of Chagas disease and were treated with benznidazole. Treatment response was monitored by polymerase chain reaction and serology.

Results:
Forty children were infected (4.2% of the population screened). Twelve children were diagnosed during the acute phase (≤1-year-old), 3 of whom were symptomatic, and 28 (4- to 14-year-olds) were in the chronic phase: 18 in the indeterminate phase and 10 presented cardiac and/or digestive involvement. Regarding treatment, 10 (25.6%) children had side effects (6 mild, 2 moderate and 2 severe reactions), leading to treatment interruption in 3 of them. No side effects were detected in ≤1-year-old children (P < 0.05). Cure was confirmed in 29.4% of the children during follow-up, and the age of the children at treatment (≤1 year) was clearly associated with the effectiveness of treatment (P < 0.05).

Conclusions:
Effectiveness and safety of treatment were optimum in ≤1-year-old children. Increased side effects, cardiac and/or digestive disorder incidence and lower treatment effectiveness were detected in older children, highlighting the need for early screening.
Targeted Multidrug Resistant Organism Antimicrobial Prophylaxis and Postoperative Infections in Pediatric Cardiothoracic Surgical Patients
Authors: Cies Jeffrey J. , Palladino Christina , Mahmood Hera , Moore Wayne S. , Chopra Arun 
Published: February 2020

Background:
To determine if receiving targeted antimicrobial (AM) prophylaxis has an effect on the rate of postoperative infections in patient’s colonized with a multidrug resistant organism (MDRO) undergoing cardiothoracic surgery (CTS).

Methods:
Single-center, retrospective medical record review of pediatric patients from birth to 18 years of age undergoing CTS from January 2013 to September 2018. Demographic data collected included age, specific MDRO, site of MDRO colonization, type of surgery, perioperative AM agent and type of infection. Patients were stratified into 2 groups, MDRO+ and MDRO–. Demographic and clinical characteristics were compared between groups with a Student’s t test for continuous variables and a χ2, Fisher exact test or Mann–Whitney U test for noncontinuous variables. A 2-sided significance level of α = 0.05 was used to determine statistical significance. All analyses were performed using IBM SPSS Version 24 (SPSS Inc., Chicago, IL).

Results:
Fifty patients (26 males/24 females) were included in the MDRO (+) group and 295 patients (168 males/127 females) in the MDRO (–) group. The median age was 0.48 years (interquartile range 0.24–1 year) and 0.9 years (interquartile range 0.19–8 years) in the MDRO (+) and MDRO (–) groups, P = 0.003. 2 of 50 (4%) MDRO (+) patients and 15 of 295 (5.1 %) MDRO (–) patients developed an infection, P = 1. 10 of 50 (20%) MDRO (+) patients received targeted AM toward the MDRO and none developed an infection. Of the 2 MDRO (+) patients with infection, 1 was infected with the MDRO. For MDRO (+) patients, there was no difference in the rate of infection whether targeted AM therapy was received, P = 1.

Conclusions:
There was no difference in the rate of postoperative infection between MDRO (+) and MDRO (–) patients. Additionally, these preliminary pediatric data suggest targeting AM agents to a specific MDRO does not impact the rate of postoperative infection in children undergoing CTS. Larger studies are warranted to confirm these findings.
Development of two different pharmacogenomics detection methods for second-generation antipsychotic drugs quetiapine and aripiprazole
Authors: Zhang Lichen , Zhang Xingyu , Zhang Xiaoqing , You Guoling , Fu Qihua 
Published: February 2020

Objective:
Second-generation antipsychotics are widely used in mental illness, but the treatment effects and side effects are affected by single nucleotide polymorphisms (SNPs) of related genes. Quetiapine and aripiprazole are two frequently used secondgeneration antipsychotic drugs. The aim of this study was to develop two different SNP detection methods for four SNP alleles associated with the pharmacokinetics of quetiapine and aripiprazole, based on high-resolution melting (HRM) and multicolor melting curve assay (MMCA) respectively.

Methods:
Whole genome DNA samples were obtained from 240 healthy people (107 females and 133 males) without genetic diseases. HRM methods were established using four kinds of specific primers and a saturated fluorescent dye. Each SNP allele with their own primers was detected in a single reaction. In the MMCA method, a multiplex polymerase chain reaction with 4 different-colored fluorescent probes was established to detect four SNP alleles in a single reaction. All experimental protocols were approved by the Ethics Committee of the Shanghai Children’s Medical Center, China (SCMC-201015) on November 22, 2010.

Results:
Two detection methods for the pharmacogenomics of quetiapine and aripiprazole, based on HRM and MMCA respectively, were established in this study. The single-target HRM method can be completed in 96 minutes, whereas the quadruplex MMCA method takes 133 minutes. It was found that the results of HRM and MMCA for the four SNP alleles had 100% coincidence with Sanger sequencing in the 240 samples.

Conclusion:
This study developed two methods for the detection of four pharmacogenomic SNP alleles that correlated with quetiapine and aripiprazole. Both methods are rapid, cost-saving, highly accurate and potentially facilitate rational use of second-generation antipsychotics for clinical medication.