bluuebunny/crossref_metadata_2025_split huggingface dataset:
Being a Research Mentor
Authors: Clark Rebecca Culver , Jennings Cathy D. , Carter Kimberly F. 
Published: December 2019

OBJECTIVES
This qualitative study was designed to describe the experiences of mentors for a nursing research fellowship at a southeastern US academic medical center.

BACKGROUND
Mentoring is an important aspect of nursing and is a key strategy to develop nurse leaders and faculty. Research mentors have been identified as essential for novice researchers to be able to complete clinical studies. However, there has been limited research on the experience of nursing research mentors, despite the emphasis on the critical nature of this role.

METHODS
Eight mentors for 23 studies over 8 years of a nursing research fellowship participated in a study outlining their experiences as research mentors.

RESULTS
Common themes emerged from mentors' identification of key components in the research mentoring process and elements necessary for effective support of frontline nurse researchers.

CONCLUSIONS
Recommendations for developing effective, confident research mentors are drawn from the analyses.
Data Entry Automation Improves Cost, Quality, Performance, and Job Satisfaction in a Hospital Nursing Unit
Authors: Bauer Jeffrey C. , John Eileen , Wood Christopher L. , Plass Debra , Richardson Dale 
Published: December 2019

OBJECTIVE
An Automated Data Entry Process Technology tool was developed to free nurses from data entry tasks, thus creating time for patient care and other activities associated with improvements in performance and job satisfaction.

BACKGROUND
Manually transferring data from patient measurement devices to electronic health records (EHRs) is an intensive, error-prone task that diverts nurses from patient care while adversely affecting job performance and employee satisfaction.

METHODS
Performance improvement analytics were used to compare matched sets of manual and automated EHR data entries for 1933 consecutive vital signs records created by 49 RNs and certified nursing assistants in a 23-bed medical-surgical unit at a large tertiary hospital. Performance and quality effects were evaluated via nurses' responses to a postintervention survey.

RESULTS
Data errors decreased from approximately 20% to 0; data transfer times were reduced by 5 minutes to 2 hours per measurement event; nurses had more time for direct patient care; and job satisfaction improved.

CONCLUSION
Data entry automation eliminates data errors, substantially reduces delays in getting data into EHRs, and improves job satisfaction by giving nurses more time for direct patient care. Findings are associated with improvements in quality, work performance, and job satisfaction, key goals of nursing leaders.
The Impact of Interprofessional Shared Governance and a Caring Professional Practice Model on Staff's Self-report of Caring, Workplace Engagement, and Workplace Empowerment Over Time
Authors: Olender Lynda , Capitulo Kathleen , Nelson John 
Published: December 2019

OBJECTIVE
To describe the impact of the implementation of interprofessional shared governance and a caring professional practice model (Relationship-Based Care [RBC]) on the staff's self-report of caring, work engagement, and workplace empowerment over a 4-year time frame.

BACKGROUND
Shared or interprofessional governance has moved mainstream within healthcare settings, particularly within agencies seeking to sustain high reliability in the offering of quality patient care services and/or interest in meeting Magnet® standards or embarking upon the Pathway to Excellence®. Nurse leaders report that organizations having implemented shared governance thrive, citing professional governance as key to workplace engagement and empowerment, particularly related to quality care initiatives. Transition to interprofessional shared governance structures typically takes 2 to 3 years. It is unknown whether related outcome variables are sustainable over time.

METHODS
Utilizing Watson's theory of human caring and appreciative inquiry as underlying frameworks, a longitudinal, quantitative study design was employed. Interprofessional focus groups and introductory sessions were offered to inform and engage all personnel within the medical center. Motivated units were identified, professional shared governance council members elected, and unit-specific education provided. Quality improvement initiatives were facilitated within unit councils, and formal leadership programs to enhance project guidance and to support staff empowerment skills for the managers of the units that were up-and-running were provided. Preimplementation and postimplementation measurements of staff's caring, workplace engagement and work empowerment were assessed, compared, and trended across units over time.

RESULTS
Only work empowerment scores among staff working within RBC units were sustainable and increased progressively and significantly over time. Work engagement levels initially rose and then stabilized over time. Caring levels remained stable despite the implementation of a caring professional practice model. Statistically significant correlations were noted between work engagement and empowerment, followed by the relationship between work engagement and caring, followed by the relationship between empowerment and caring.

CONCLUSIONS
The sustainability of work empowerment is likely related to the periodic provision of education for leaders regarding leading within an empowered work environment. A stronger focus on staff caring, particularly within quality improvement initiatives, with leadership guidance, will be paramount moving forward.
Virtual Simulation to Increase Self-efficacy Through Deliberate Practice
Authors: Mabry Jennifer , Lee Emily , Roberts Toni , Garrett Rebecca 
Published: December 2019

Background
To reduce performance anxiety and increase engagement in medical-surgical simulations, virtual simulation (VS) was introduced prior to complex high-fidelity simulation to increase students' self-efficacy.

Problem
A presimulation preparation needed to be expanded for high-fidelity simulation involving emergent clinical situations.

Approach
Combined frameworks of Ericsson's theory of deliberate practice and Bandura's self-efficacy theory were applied. Students completed VS scenarios until a specific score of mastery was obtained, and then the same scenario was repeated in the high-fidelity simulation laboratory. A modified self-efficacy scale survey was administered presimulation and postsimulation. Data were collected on 3 cohorts of students (n = 151) over an academic year.

Outcomes
VS followed by high-fidelity simulation significantly increased student perception of self-efficacy in all 3 cohorts (P = .001, P = .037, P = .005).

Conclusion
Preparation for high-fidelity simulation using VS increases self-efficacy and allows students to engage in the simulation experience, thus achieving higher levels of mastery through deliberate practice.
Emergency Department Implementation of the Brain Trauma Foundation's Pediatric Severe Brain Injury Guideline Recommendations
Authors: Lumba-Brown Angela , Totten Annette , Kochanek Patrick M. 
Published: December 2019

Abstract
The “Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition: Update of the Brain Trauma Foundation Guidelines” published in Pediatric Critical Care Medicine in 2019 provides new and updated recommendations applicable to the emergency department management of children with severe traumatic brain injury. Practice-changing takeaways include specific recommendations for administration of 3% hypertonic saline, administration of seizure prophylaxis, and avoiding hyperventilation.
Fast Brain Magnetic Resonance Imaging With Half-Fourier Acquisition With Single-Shot Turbo Spin Echo Sequence in Detection of Intracranial Hemorrhage and Skull Fracture in General Pediatric Patients
Authors: Kabakus Ismail Mikdat , Spampinato Maria Vittoria , Knipfing Michael , Cervantes Gustavo , Patel Avni , Eskandari Ramin , Yazdani Milad 
Published: December 2019

Objective
The objective of this study was to determine the accuracy of fast brain magnetic resonance imaging (MRI) in the detection of intra- and extra-axial intracranial hemorrhage compared with standard-of-care computed tomography (CT) or MRI in pediatric patients. Unlike previous studies, we did not focus exclusively on patients with head trauma. We evaluated the fast brain MRI findings in a general pediatric population referred for indications other than evaluation of ventricular size.

Methods
We retrospectively reviewed 48 pediatric patients with indications other than hydrocephalus and shunt follow-up, who underwent a standard head CT or standard MRI within 15 days of the fast brain MRI. All fast brain MRI scans included half-Fourier acquisition with single-shot turbo spin echo (HASTE) sequences in the axial, coronal, and sagittal plane. Two neuroradiologists blinded to patient information and study indications reviewed the fast brain MRI studies independently and then concurrently.

Results
A total of 48 patients met the inclusion and exclusion criteria. The median and mean time interval between the standard and fast imaging were 2 and 3.9 days, respectively. The sensitivity and specificity of fast brain MRI to detect intraparenchymal hemorrhage were 100% and 97%, respectively. The sensitivity and specificity of fast brain MRI in the detection of extra-axial hemorrhage (subdural and/or epidural) were 86% and 96%, respectively. The sensitivity and specificity of fast brain MRI were, respectively, 10% and 100% for subarachnoid hemorrhage, 50% and 100% for intraventricular hemorrhage, and 47% and 97% for skull fracture, respectively.

Conclusions
Our results show that fast brain MRI with HASTE sequence is as sensitive as CT and standard MRI in the detection of intra-axial hemorrhage and has moderate sensitivity in the detection of extra-axial hemorrhage. Our preliminary results show that T2-weighted HASTE imaging may be suitable for the follow-up of intraparenchymal and extra-axial (subdural and/or epidural) hemorrhages.
Can We Expect Any Effect of Rituximab on Fatigue in Primary Sjögren Syndrome?
Authors: Hermans An-Marie , Vulsteke Jean-Baptiste , Lenaerts Jan , De Langhe Ellen 
Published: December 2019

Introduction
Fatigue is a major determinant of impaired quality of life in primary Sjögren syndrome (pSS) patients. Effective therapeutic strategies are lacking.

Objectives
To review the potential benefit of rituximab, a chimeric anti-CD20 antibody, in the treatment of fatigue in pSS.

Methods
A systematic review on the effect of rituximab on fatigue-related outcome measures was conducted, retrieving evidence from CENTRAL (Cochrane Central Register of Controlled Trials), MEDLINE (via PubMed), EMBASE, and Scopus.

Results
No benefit of rituximab over placebo on any fatigue-related outcome measure could be demonstrated in the included trials. Significant effects were only observed when compared with baseline, but not when compared with placebo.

Conclusions
The use of rituximab for the treatment of pSS-related fatigue cannot be supported by the currently available evidence.
Coaching as a Mechanism to Challenge Surgical Professional Identities
Authors: Byrnes Mary E. , Engler Tedi A. , Greenberg Caprice C. , Fry Brian T. , Dombrowski Janet , Dimick Justin B. 
Published: December 2019

Background:
The “surgical personality” is a mostly negative academic and cultural image of the surgeon as egotistical, paternalistic, and inflexible. Because of this image, surgeons have been viewed as resistant to change and some behaviors, vulnerability, for example, are viewed as “suspect” because they seemingly threaten professional competency. We report on exit interviews of surgeons who participated in a coaching program and demonstrate how their narratives challenge the surgical “personality” and forge an evolving and more open professional surgical identity.

Methods:
We interviewed n = 34 bariatric surgeons at the end of a 2-year surgical coaching program. Transcribed interviews were analyzed in NVivo, computer-assisted qualitative data analysis software. Coding of transcripts was approached through iterative steps. We utilized an exploratory method; each member of our team independently examined 3 transcripts to evaluate emergent themes early in the investigation. The team met to discuss our independent themes and develop the codebook collectively. We created a descriptive framework for our first round of coding based on emerging themes and employed an interpretive framework to arrive at our themes.

Results:
Three major themes emerged from our data. Participants in this study discussed the ways that participation in the coaching program initially conflicted with their identity as a competent professional. Surgeons were acutely aware of how participation might have destabilized their surgical identity because they might be viewed as vulnerable. Despite these concerns about image, surgeons found impetus for improvement because of poor outcome scores or because they desired early career affirmation. Finally, surgeons report that the safe spaces of intentional coaching contributed to their ideas about how surgeons, and ultimately surgery, can change.

Conclusions:
Participation in a coaching program challenged how surgeons thought of themselves in relationship to social and peer expectations. Our results indicate that surgeons do feel peer and social pressures related to identity but are much more complex and nuanced than has been previously discussed. The safe space of intentional coaching allowed participants to practice vulnerability without the pressures of sometimes caustic professional norms. Participants in this study viewed coaching as the way to improve the culture of surgery.
Regionalization of emergency general surgery operations: A simulation study
Authors: Becher Robert D. , Sukumar Nitin , DeWane Michael P. , Gill Thomas M. , Maung Adrian A. , Schuster Kevin M. , Stolar Marilyn J. , Davis Kimberly A. 
Published: December 2019

BACKGROUND
It has been theorized that a tiered, regionalized system of care for emergency general surgery (EGS) patients—akin to regional trauma systems—would translate into significant survival benefits. Yet data to support this supposition are lacking. The aim of this study was to determine the potential number of lives that could be saved by regionalizing EGS care to higher-volume, lower-mortality EGS institutions.

METHODS
Adult patients who underwent one of 10 common EGS operations were identified in the California Inpatient Database (2010–2011). An algorithm was constructed that “closed” lower-volume, higher-mortality hospitals and referred those patients to higher-volume, lower-mortality institutions (“closure” based on hospital EGS volume-threshold that optimized to 95% probability of survival). Primary outcome was the number of lives saved. Fifty thousand regionalization simulations were completed (5,000 for each operation) employing a bootstrap resampling method to proportionally redistribute patients. Estimates of expected deaths at the higher-volume hospitals were recalculated for every bootstrapped sample.

RESULTS
Of the 165,123 patients who underwent EGS operations over the 2-year period, 17,655 (10.7%) were regionalized to a higher-volume hospital. On average, 128 (48.8%) of lower-volume hospitals were “closed,” ranging from 68 (22.0%) hospital closures for appendectomy to 205 (73.2%) for small bowel resection. The simulations demonstrated that EGS regionalization would prevent 9.7% of risk-adjusted EGS deaths, significantly saving lives for every EGS operation: from 30.8 (6.5%) deaths prevented for appendectomy to 122.8 (7.9%) for colectomy. Regionalization prevented 4.6 deaths per 100 EGS patient-transfers, ranging from 1.3 for appendectomy to 8.0 for umbilical hernia repair.

CONCLUSION
This simulation study provides important new insight into the concept of EGS regionalization, suggesting that 1 in 10 risk-adjusted deaths could be prevented by a structured system of EGS care. Future work should expand upon these findings using more complex discrete-event simulation models.

LEVEL OF EVIDENCE
Therapeutic/Care Management, level IV.
An analysis of outcomes and predictors of intensive care unit bouncebacks in a mature trauma system
Authors: Bradburn Eric H. , Jammula Shreya , Horst Michael A. , Morgan Madison , Vernon Tawnya M. , Gross Brian W. , Miller Jo Ann , Cook Alan D. , Kim Patrick K. , Von Nieda Danielle , Rogers Frederick B. 
Published: December 2019

BACKGROUND
With the recent birth of the Pennsylvania TQIP Collaborative, statewide data identified unplanned admissions to the intensive care unit (ICU) as an overarching issue plaguing the state trauma community. To better understand the impact of this unique population, we sought to determine the effect of unplanned ICU admission/readmission on mortality to identify potential predictors of this population. We hypothesized that ICU bounceback (ICUBB) patients would experience increased mortality compared with non-ICUBB controls and would likely be associated with specific patterns of complications.

METHODS
The Pennsylvania Trauma Outcome Study database was retrospectively queried from 2012 to 2015 for all ICU admissions. Unadjusted mortality rates were compared between ICUBB and non-ICUBB counterparts. Multilevel mixed-effects logistic regression models assessed the adjusted impact of ICUBB on mortality and the adjusted predictive impact of 8 complications on ICUBB.

RESULTS
A total of 58,013 ICU admissions were identified from 2012 to 2015. From these, 53,715 survived their ICU index admission. The ICUBB rate was determined to be 3.82% (2,054/53,715). Compared with the non-ICUBB population, ICUBB patients had a significantly higher mortality rate (12% vs. 8%; p < 0.001). In adjusted analysis, ICUBB was associated with a 70% increased odds ratio for mortality (adjusted odds ratio, 1.70; 95% confidence interval, 1.44–2.00; p < 0.001). Adjusted analysis of predictive variables revealed unplanned intubation, sepsis, and pulmonary embolism as the strongest predictors of ICUBB.

CONCLUSION
Intensive care unit bouncebacks are associated with worse outcomes and are disproportionately burdened by respiratory complications. These findings emphasize the importance of the TQIP Collaborative in identifying statewide issues in need of performance improvement within mature trauma systems.

LEVEL OF EVIDENCE
Epidemiological study, level III.
Hospital resources do not predict accuracy of secondary trauma triage: A population-based analysis
Authors: Tillmann Bourke W. , Nathens Avery B. , Guttman Matthew P. , Pequeno Priscila , Scales Damon C. , Pechlivanoglou Petros , Haas Barbara 
Published: December 2019

BACKGROUNDThe identification of patients who require transfer from non–trauma centers to trauma centers (secondary triage) is complicated by high rates of undertriage and overtriage. The objective of this study was to evaluate variations in secondary triage accuracy across non–trauma centers and identify factors associated with highly accurate secondary triage.METHODSWe performed a population-based study of injured patients who presented to non–trauma centers in a large regional trauma system. Patients were categorized as undertriaged, overtriaged, or appropriately triaged based on transfer status and presence of a severe injury (Injury Severity Score >15, death within 24 hours, or critical injury as defined by the American College of Surgeons). Mixed-effect models, adjusted for case mix and hospital resource, were used to compare triage accuracy across hospitals and identify factors associated with high-performing centers.RESULTSAmong 118,973 patients identified at 182 non–trauma centers, 37,528 (31.5%) had severe injuries. The majority (76.9%) of severely injured patients were not transferred to a trauma center (undertriaged), while 9.6% of nonseverely injured patients were transferred to a trauma center (overtriaged). Mixed-effect models demonstrated that at the average hospital severely injured patients were 3.76 times more likely to be transferred than nonseverely injured patients (diagnostic odds ratio, 3.76; 95% confidence interval, 3.20–4.31). Despite significant variation in triage accuracy across hospitals, adjusted analyses suggested that local resources bore no relationship to triage accuracy.CONCLUSIONTriage accuracy varies significantly across non–trauma centers, after adjusting for hospital resources. These findings suggest that other potentially modifiable factors play a key role in transfer decisions.LEVEL OF EVIDENCETherapeutic/care management, level IV.
Abdominal aortic and junctional tourniquet versus zone III resuscitative endovascular balloon occlusion of the aorta in a swine junctional hemorrhage model
Authors: Schechtman David W. , Kauvar David S. , De Guzman Rodolfo , Polykratis I. Amy , Prince M. Dale , Kheirabadi Bijan S. , Dubick Michael A. 
Published: December 2019

BACKGROUND
Junctional hemorrhage is a leading contributor to battlefield mortality. The Abdominal Aortic and Junctional Tourniquet (AAJT) and infrarenal (zone III) resuscitative endovascular balloon occlusion of the aorta (REBOA) are emerging strategies for controlling junctional hemorrhage, with AAJT currently available in select forward deployed settings and increasing interest in applying REBOA in the military prehospital environment. This study compared the hemostatic, hemodynamic, and metabolic effects of these devices used for junctional hemorrhage control.

METHODS
Shock was induced in anesthetized, mechanically ventilated swine with a controlled hemorrhage (20 mL/kg) and closed femur fracture followed by uncontrolled hemorrhage from a partial femoral artery transection (40% total hemorrhage volume). Residual femoral hemorrhage was recorded during 60-minute AAJT (n = 10) or zone III REBOA (n = 10) deployment, and the arterial injury was repaired subsequently. Animals were resuscitated with 15 mL/kg autologous whole blood and observed for 6 hours.

RESULTS
One animal in each group died during observation. Both devices achieved hemostasis with mean residual femoral blood loss in the AAJT and REBOA groups of 0.38 ± 0.59 mL/kg and 0.10 ± 0.07 mL/kg (p = 0.16), respectively, during the 60-minute intervention. The AAJT and REBOA augmented proximal blood pressure equally with AAJT allowing higher distal pressure than REBOA during intervention (p < 0.01). Following device deflation, AAJT animals had transiently lower mean arterial blood pressure than REBOA pigs (39 ± 6 vs. 54 ± 11 mm Hg p = 0.01). Both interventions resulted in similar degrees of lactic acidemia which resolved during observation. Similar cardiac and renal effects were observed between AAJT and REBOA.

CONCLUSION
The AAJT and REBOA produced similar hemostatic, resuscitative, and metabolic effects in this model of severe shock with junctional hemorrhage. Both interventions may have utility in future military medical operations.