bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Throughput for Patients Admitted From the Emergency Department
Authors: Wolak Eric , Jones Cheryl , Leeman Jennifer , Madigan Catherine 
Published: January 2020

Background:
Inefficient emergency department to inpatient handoff processes can contribute to delayed care.

Local Problem:
The average emergency department length of stay for admitted patients and admission wait times at this institution were well above national averages, and a standard handoff process was lacking.

Methods:
Lean methodology was used to evaluate flow and identify opportunities for improvement.

Interventions:
Two tools were developed to standardize handoff.

Results:
Emergency department length of stay and admission wait times were not significantly improved following intervention implementation. However, patient transfer time decreased significantly (P < .01, F = 29.02) from 30.5 minutes (SD = 18.2) to 21.7 minutes (SD = 7.4). The length of time to give/receive report also decreased significantly (P = .04, F = 2.2) from 3.8 (SD = 1.6) minutes to 2.8 (SD = 1.2) minutes.

Conclusions:
Although length of stay and admission wait times did not decline significantly, implementation of standard work and tools can potentially improve patient flow.
Outcomes of a Nurse-Led Difficult Urinary Catheter Team in an Academic Medical Center
Authors: Price David , McKeon Leslie 
Published: January 2020

Background:
Catheter insertion for complex patients by inexperienced nurses can lead to avoidable iatrogenic urethral injury and catheter-associated urinary tract infection (CAUTI).

Purpose:
The study aim was to evaluate a comprehensive nurse-led difficult urinary catheterization (DUC) Program to reduce patient CAUTIs.

Methods:
A retrospective cohort study design was used to evaluate the DUC Program's effectiveness during 2013 to 2017. Measures included RN DUC consultations, protocol adherence, patient CAUTIs, and urology consults.

Results:
The RN DUC team consulted 435 patients with a 92% insertion success rate. The DUC protocol adherence was 66.1%. Patient CAUTIs decreased from baseline (169) to year 4 (24) (odds ratio: 0.1889, 95% confidence interval = 0.1231-0.2898, P < .001). Urology consults decreased from baseline (40) to year 3 (21), however, increased in year 4 (80) when a urology residency program was started.

Conclusion:
This comprehensive program was effective in improving catheter insertion technique, eliminating urology consults, and reducing CAUTIs when combined with organizational prevention measures.
Comparison of a Nurse-Nurse Handoff Mnemonic With Real-World Handoffs
Authors: O'Rourke Jennifer , Lopez Karen Dunn , Riesenberg Lee Ann , Abraham Joanna 
Published: January 2020

Background:
Communication failures, including clinical handoff or clinical handover errors, contribute to 80% of all serious preventable adverse events each year. The N-PAS, N = Nurse, P = Patient Summary, A = Action Plan, and S = Synthesis, is a flexible standardized clinical handoff tool for nurses.

Purpose:
The purpose of this study was to determine the proportion of N-PAS core components present in real-world patient handoffs.

Methods:
A mixed-methods design was used to analyze secondary data. Patient handoffs (n = 138) were transcribed into statements and then independently coded by 2 research assistants.

Results:
Of all handoff statements, 63.2% were coded as Patient Summary and 13.6% were coded as Action Plan, whereas Synthesis was not coded in any handoffs. Three new Patient Summary elements and 1 new Action Plan element were identified.

Conclusion:
Patient Summary and Action Plan are critical data reported during clinical handoff. A handoff synthesis is a critical step to include in handoff training.
Predischarge Provider Visits as a Method of Improving Transitional Care Clinic Visit Rates
Authors: James Tess C. , Corbett Cynthia F. , Jones Katherine , Moore-Gibbs Ashley 
Published: January 2020

Background:
Transitional care interventions have been associated with reduced 30-day patient readmission, better quality of health care, and lower emergency department visits and health care costs.

Local Problem:
Transition Services at a major quaternary care center was underutilized by patients who were referred to the program.

Methods:
A pre-/postimplementation evaluation design was used to evaluate a quality improvement intervention.

Intervention:
A face-to-face meeting between eligible patients and a Transition Services provider prior to patients being discharged from the hospital was evaluated as a process improvement intervention. The primary outcome was initial appointment attendance at the Transition Services clinic following hospital discharge.

Results:
There was no statistically significant difference (P = .59) in patients' initial appointment attendance at Transition Services between the preintervention (48.1%) and intervention phases (54.8%).

Conclusion:
Provider engagement during hospitalization did not increase initial appointment attendance at Transition Services. Other strategies to improve Transition Services attendance rates are needed.
Implementation of Fall Preventions Over the Past 15 Years
Authors: Taylor Beth , Tymkew Heidi , Vyers Kara , Taylor Madeline , Roney Wilhelmina , Costantinou Eileen 
Published: January 2020

Background:
Hospital fall rates have changed minimally with preventive measures; however, the effect on injury rate is unclear.

Purpose:
The purpose was to determine whether fall-related injuries have changed over time.

Methods:
A retrospective comparison was done of 1134 adult inpatient falls in 2017 to 1235 falls in 2001-2002 for injury and fall circumstances. Separate comparisons were made of patient characteristics by service line for 2017.

Results:
Severe fall injuries declined from 6% to 2.4%. Elimination issues remained the most common circumstance (38.9% and 42%). In 2017, malnutrition (31.6%), low function (61.4%), fall history (26.3%), and use of high-risk medications (83.2%) were common in patients who fell. Predictors of falls with injury by patient population were as follows: surgery—male gender (P = .01), low function (P = .006), elimination issues (P = .04); oncology—low function (P = .04); and neurology—low function (P = .02).

Conclusions:
Severe fall-related injuries have decreased in the past 15 years. The most common circumstance for falls remains elimination issues.
The Magnitude and Duration of the Effect of Intra-articular Corticosteroid Injections on Pain Severity in Knee Osteoarthritis
Authors: Saltychev Mikhail , Mattie Ryan , McCormick Zachary , Laimi Katri 
Published: January 2020

Objectives
The aims of the study were to clarify the evidence on the magnitude and duration of treatment effect of intra-articular corticosteroid injections for knee osteoarthritis compared with placebo, to evaluate a treatment effect by steroid type, and to describe the reported adverse effects.

Design
Cochrane Controlled Trials Register, Medline, Embase, CINAHL, Scopus, and Web of Science databases were searched. The risk of systematic bias was assessed according to the Cochrane Collaboration’s domain-based evaluation framework.

Results
The final sample included eight randomized controlled studies with follow-ups from 1 to 26 wks. The risk of systematic bias was considered low in five and high in three studies. The pooled standardized mean difference was −0.58 (95% confidence interval = −0.88 to −0.27) and number needed to treat 5.1 (95% confidence interval = 10.0 to 3.7). The heterogeneity was considerable. The pooled effect size approached the level of statistical insignificance at 4 mos. The pooled risk ratio of adverse effects was insignificant 0.95 (95% confidence interval = 0.34 to 2.55).

Conclusions
The intra-articular corticosteroid had a mild to moderate effect on pain severity up to 3 mos after the injection—much longer than it had previously been reported. The effect may vary substantially in different patient groups and appropriate patient selection is important. The risk of adverse effects was low.
Predictors of Exceeding Target Inpatient Rehabilitation Length of Stay After Hip Fracture
Authors: Daly Natalie , Fortin Christian , Jaglal Susan , MacDonald Shannon L. 
Published: January 2020

AbstractObjectiveThe aim of the study was to identify factors associated with exceeding a target inpatient rehabilitation length of stay of 28 days or less for individuals with hip fracture.DesignRetrospective cohort study of hip fracture patients admitted to an urban Canadian inpatient rehabilitation facility between January 1, 2013, and January 1, 2018. Patient characteristics previously shown to be associated with individual outcomes and/or length of stay after hip fracture were extracted from the institution’s data warehouse. Regression models were used to examine factors associated with exceeding target length of stay as well as overall length of stay.ResultsFour hundred ninety-three subjects were included in the analysis. Three hundred forty-five (70%) met and 148 (30%) exceeded their target length of stay. Patients who exceeded their target were more likely to be elderly (odds ratio, 1.05; 95% confidence interval, 1.02–1.08), to live alone prefracture (odds ratio, 1.72; 95% confidence interval, 1.02–2.91), to have dementia (odds ratio, 2.79; 95% confidence interval, 1.12–6.97), and higher admission pain scores (severe pain odds ratio, 2.51; 95% confidence interval, 1.06–5.93). Higher admission motor Functional Independence Measure scores (odds ratio, 0.95; 95% confidence interval, 0.92–0.98) were protective.ConclusionsAdvancing age, having dementia, living alone prefracture, and reporting moderate or severe pain at the time of admission not only increased the odds of an individual exceeding their target length of stay but also was associated with an overall increase in length of stay. Conversely, having a higher admission motor Functional Independence Measure score was protective.
Burden and Patterns of Multimorbidity
Authors: Jacob Mini E. , Ni Pengsheng , Driver Jane , Leritz Elizabeth , Leveille Suzanne G. , Jette Alan M. , Bean Jonathan F. 
Published: January 2020

Objective
The aim of this study was to assess the impact of the burden and patterns of multimorbidity on disability domains.

Design
In a cross-sectional study of 425 older adults from the Boston Rehabilitative Impairment Study of the Elderly, participants self-reported 13 chronic conditions and underwent assessment of body function (leg strength, velocity, and power, trunk extensor endurance, leg range of motion, foot sensation), activities (400-m walk test, Short Physical Performance Battery, Late Life Function and Disability Instrument function scores) and participation (Late Life Function and Disability Instrument participation scores). The association between multimorbidity patterns (identified by latent class analysis) and disablement measures, as well as multimorbidity burden (captured by a multimorbidity score) and disablement measures, was tested.

Results
Latent class analysis identified three classes—low multimorbidity, high multimorbidity, and predominantly musculoskeletal conditions. Class membership (multimorbidity pattern) was not associated with disablement measures, but multimorbidity score was associated with poor performance in all domains. A 1-point higher multimorbidity score was associated with lower scores in body functions (by 0.06 SD unit), activities (0.07–0.10 SD units), as well as participation (0.07–0.09 units).

Conclusion
Multimorbidity counts may be an excellent tool for risk stratification and identification of persons in need of rehabilitation.

To Claim CME Credits
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives
Upon completion of this article, the reader should be able to (1) describe and distinguish the effect of multimorbidity burden and multimorbidity patterns on three disability domains in older adults; (2) identify and discuss possible reasons why high multimorbidity burden may result in a restriction among social participation in older adults; and (3) detect disability risk among older patients during clinical assessment by using a simple count of common chronic conditions.

Level
Advanced

Accreditation
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Effectiveness of Ultrasound-Guided Platelet-Rich Plasma Injections in Relieving Sacroiliac Joint Dysfunction
Authors: Wallace Patrick , Bezjian Wallace Laurie , Tamura Sarah , Prochnio Kirk , Morgan Kyle , Hemler Douglas 
Published: January 2020

Objective
The aim of the study was to investigate the efficacy of ultrasound-guided platelet-rich plasma in reducing sacroiliac joint disability and pain.

Design
Prospective nonrandomized interventional study analyzing 50 patients with low back pain secondary to sacroiliac joint dysfunction. Platelet-rich plasma was injected into the sacroiliac joint under ultrasound guidance. Oswestry Disability Index and Numeric Rating Scale were measured at baseline, 2 wks, 4 wks, 3 mos, and 6 mos after injection.

Results
The mean reduction in Oswestry Disability Index and Numeric Rating Scale scores were significantly reduced at 6 mos after injection compared with baseline values (mean = −9.79%, 95% CI = −6.06 to −13.52) and (mean = −1.94, 95% CI = −1.14 to −2.78), respectively. All timeframes showed significant mean reduction compared with baseline, but overall improvement tapers off after 4 wks with no statistically significant reduction from 4 wks to 3 mos or 3 to 6 mos.

Conclusions
Ultrasound-guided platelet-rich plasma injections in the sacroiliac joint are effective at reducing disability and pain with most improvement seen within 4 wks after injection and with sustained reduction at 6 mos.
Depot medroxyprogesterone acetate administration increases cervical CCR5+CD4+ T cells and induces immunosuppressive milieu at the cervicovaginal mucosa
Authors: Tasker Carley , Pizutelli Vanessa , Lo Yungtai , Ramratnam Bharat , Roche Natalie E. , Chang Theresa L. 
Published: January 2020

Objectives:
Depot medroxyprogesterone acetate (Depo-Provera) is the most commonly used injectable hormone contraceptive in Sub-Saharan Africa where HIV incidence is high. We determined the impact of Depo-Provera on cervical immune cells and mediators in healthy women.

Methods:
In this longitudinal study, vaginal, endocervical, and rectal swabs were collected at baseline (visit 1), 1 month (visit 2), and 3 months (visit 3) after Depo-Provera injection. Cervical cells were collected by cytobrush and immune markers on cervical CD4+ T cells were analyzed by multicolor flow cytometry at three different visits. The levels of immune mediators in cytobrush supernatants as well as vaginal, cervical, and rectal secretions from swabs were analyzed by multiplex assays and ELISA.

Results:
Compared with baseline levels, we found a significant increase in the frequency of cervical CCR5+CD4+ T cells and a significant decrease in the frequency of cervical central memory CD4+ T cells. Depo-Provera treatment had little effect on expression of immune mediators in rectal mucosa but significantly suppressed numerous immune mediators at cervicovaginal mucosa. Levels of MCP-1, G-CSF, IL-6, IL-10, GM-CSF, and IP-10 were significantly decreased in both vaginal and cervical secretions after Depo-Provera injection. In cervical samples collected by cytobrush, we found reduced levels of 22 of 25 immune mediators after Depo-Provera injection. Changes in immune mediators differed between vaginal and cervical mucosa, demonstrating compartment-specific responses.

Conclusion:
Depo-Provera altered immune profiles of cervical CD4+ T cells and suppressed host immune response at cervicovaginal mucosa, suggesting its likely effect on transmission of sexually transmitted infections including HIV.
Plasma and antibody glycomic biomarkers of time to HIV rebound and viral setpoint
Authors: Giron Leila B. , Papasavvas Emmanouil , Azzoni Livio , Yin Xiangfan , Anzurez Alitzel , Damra Mohammad , Mounzer Karam , Kostman Jay R. , Sanne Ian , Firnhaber Cynthia S. , Tateno Hiroaki , Liu Qin , Montaner Luis J. , Abdel-Mohsen Mohamed 
Published: January 2020

Objective:
HIV cure research urgently needs to identify pre-analytic treatment interruption (ATI) biomarkers of time-to-viral-rebound and viral setpoint to mitigate the risk of ATI and accelerate development of a cure. We previously reported that galactosylated IgG glycans, G2, negatively correlate with cell-associated HIV DNA and RNA during antiretroviral therapy (ART). We hypothesized that this and other plasma glycomic traits can predict time-to-viral-rebound and viral setpoint upon ART cessation.

Design:
We profiled the circulating glycomes (plasma and bulk IgG) of two geographically distinct cohorts: Philadelphia Cohort – 24 HIV-infected, ART-suppressed individuals who had participated in an open-ended ATI study without concurrent immunomodulatory agents. Johannesburg Cohort – 23 HIV-infected, ART-suppressed individuals who had participated in a 2-week ATI.

Methods:
Capillary electrophoresis and lectin microarray were used for glycomic analyses. Cox proportional-hazards model and log-rank test were used for statistical analyses.

Results:
Higher pre-ATI levels of the IgG glycan, G2, were significantly associated with a longer time-to-viral-rebound (hazard ratio = 0.12, P = 0.05). In addition to G2, we identified several predictive glycomic traits in plasma, for example, levels of FA2BG1, a non-sialylated, core-fucosylated glycan, associated with a longer time-to-viral-rebound (hazard ratio = 0.023, P = 0.05), whereas FA2G2S1, a sialylated glycan, associated with a shorter time-to-viral-rebound (hazard ratio = 24.1, P = 0.028). Additionally, pre-ATI plasma glycomic signatures associated with a lower viral setpoint, for example, T-antigen (Galβ1-3GalNAc) (r = 0.75, P = 0.0007), or a higher viral setpoint, for example, polylactosamine (r = −0.58, P = 0.01). These results were initially validated in the Johannesburg Cohort.

Conclusion:
We describe first-in-class, non-invasive, plasma and IgG glycomic biomarkers that inform time-to-viral-rebound and viral setpoint in two geographically distinct cohorts.
Tetramethylpyrazine/Ligustrazine Can Improve the Survival Rate of Adipose-Derived Stem Cell Transplantation
Authors: Zhou Jinghe , Zhang Jufang , Wu Lihong , Zhu Fei , Xu Huifang 
Published: January 2020

Background
We aimed to study the effect of tetramethylpyrazine/ligustrazine (TMP) on the survival rate of adipose-derived stem cell (ADSC) transplantation.

Methods
Human ADSCs were cultured and subcultured. Detection of cell growth was performed using CCK8 kit. A total of 12 BALB/c nude mice including 4 groups (group 1: ADSC–hyaluronic acid [HA] + phosphate-buffered saline [PBS]; group 2: ADSC-HA + TMP injection; group 3: ADSC-HA + TMP soaking; group 4: ADSC-HA + TMP injection + TMP soaking) were used for the animal experiments. Furthermore, hematoxylin-eosin staining and oil red O staining were conducted for the frozen section from the animal tissues. Besides, RNA was extracted from the samples, and reverse transcriptase–polymerase chain reaction experiment was performed. At last, samples were detected using transmission electron microscope.

Results
Tetramethylpyrazine/ligustrazine resulted in significant increase for cell proliferation on the seventh day. It was easier to promote the growth of adipose cell after injection and soaking of TMP. Hematoxylin-eosin staining and oil red O stain showed that injection and soaking of TMP could significantly increase the size of fat. The relative expression of peroxisome proliferator–activated receptor γ, CCAAT/enhancer-binding protein α, and Alu in group 4 was significantly higher than that in other groups.

Conclusions
Tetramethylpyrazine/ligustrazine can improve the survival rate of ADSC transplantation. The possible mechanisms of it may be that TMP induces the expression of transcription factor associated with fat formation including peroxisome proliferator–activated receptor γ, CCAAT/enhancer-binding protein α, and Alu and then promotes the growth of adipose cell.
Composite Tissue Preservation
Authors: Dickey Ryan M. , Hembd Austin S. , Fruge Seth , Haddock Nicholas T. , Papas Klearchos K. , Suszynski Thomas M. 
Published: January 2020

Abstract
Composite tissue (CT) preservation is important to outcomes after replant or transplant. Since the first limb replant, the mainstay of preservation has been static cold storage with the amputated part being placed in moistened gauze over ice. Historically, the gold-standard in solid organ preservation has been static cold storage with specialized solution, but this has recently evolved in the last few decades to develop technologies such as machine perfusion and even persufflation. This review explores the impact of cooling and oxygenation on CT, summarizes the work done in the area of CT preservation, discusses lessons learned from our experience in solid organ preservation, and proposes future directions.
Utility of a Team-Based Multimodal Opioid Reduction Protocol for the Pediatric Plastic Surgery Population
Authors: Crowley Jiwon Sarah , Hsieh Sun , Gabriel Rodney A. , McLean Paige , Gosman Amanda , Lance Samuel 
Published: January 2020

Abstract
Opioid use can cause significant adverse side effects with increased propensity toward both short- and long-term complications in the pediatric population. We present a multifaceted opioid reduction protocol based on physician and care team member education. The strategy was designed to alter prescribing practices, improve preoperative and postoperative patient education, increase the use of nonnarcotic pain control modalities, and improve coordination of opiate reduction strategies for all team members participating in patient care. We present the utility of this strategy in limiting postoperative narcotic use in the pediatric plastic surgery population.
A prospective study with historical controls was conducted to evaluate pediatric patients undergoing elective pediatric plastic surgery procedures at 3-month intervals in 2016, 2017, and 2018. In the final year, the dedicated opiate reduction protocol was implemented before the data collection period, and results were compared with the prior 2 collection periods. The primary outcomes were total days and doses of outpatient narcotics prescribed after surgery.
The median days (quartiles) of opioids prescribed in 2016, 2017, and 2018 cohorts were 1.5 (1.1, 2.5) days, 1.5 (1.4, 2.5) days, and 0.8 (0, 1.6) days, respectively. The median doses (quartiles) of opioids prescribed in 2016, 2017, and 2018 cohorts were 6.3 (6, 10), 6.0 (5.7, 15.0), and 4.2 (0, 6.2) doses, respectively. There were statistically significantly less days and doses of opioids prescribed in the 2018 cohort when compared with the 2016 (P < 0.0001) and 2017 (P < 0.0001) cohorts.
A multimodal opioid reduction protocol was successfully implemented for the pediatric plastic surgery population. Patients were able to shorten the duration of narcotic prescription upon discharge with the use of a multidisciplinary team approach.