bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric Preparedness of European Emergency Departments
Authors: Mintegi Santiago , Maconochie Ian K. , Waisman Yehezkel , Titomanlio Luigi , Benito Javier , Laribi Said , Moll Henriette ,   on behalf of the Research in European Pediatric Emergency Medicine (REPEM) network
Published: May 2020

Introduction
Children and adolescents often lack optimal emergency care. The objective of the study was to assess the level of preparedness of European emergency departments (EDs) for pediatric patients.

Methods
This was an international multicenter Internet-based survey of EDs with attending children and adolescents younger than 18 years in 101 EDs from 21 countries. Questionnaires were based on the recommendations in the consensus document published by the International Federation for Emergency Medicine, which defines quality of care standards for children aged 0 to 18 years in the ED. A multivariate binary logistic regression was performed to identify independent factors that are related to the expected standards of care provided by the EDs.

Results
Most (95.0%) of the EDs fulfilled more than 50% of the International Federation for Emergency Medicine essential standards of care, and 24 (23.7%) EDs fulfilled more than 80%. Best results were obtained in the standards that related to equipment, departmental policies, procedures, and protocols, and being able to stabilize an ill or injured child. Worst results were associated with inadequate staffing levels, quality, and safety; adolescents, mental health, and substance misuse delivery issues; and major incidents. Being included in a multicenter international research network was the unique independent factor associated with a good level of preparedness of the EDs for pediatric cases.

Conclusions
Overall, surveyed European EDs fit well the essential standards of pediatric emergency care. Certain improvement actions are required to guarantee that essential standards of care for pediatric emergency care are always fulfilled in European EDs.
Pediatric Cervical Spine Clearance and Immobilization Practice Among Prehospital Emergency Medical Providers
Authors: Khetarpal Shailesh , Smith Jaron , Weiss Brian , Bhattarai Bikash , Sinha Madhumita 
Published: May 2020

Objectives
Pediatric cervical spine injuries are rare but potentially life threatening. Although published guidelines for assessment of such injuries exist, there is less uniformity in its implementation in out-of-hospital settings. Our purpose was to assess the knowledge and practice patterns for pediatric cervical spine immobilization among prehospital emergency medical services (EMS) providers in Arizona.

Methods
A cross-sectional web-based survey was conducted (October–December 2018), using an electronic mailing list of certified EMS providers (ground and air) in Arizona. A 20-question structured web-based survey was developed and deployed.

Results
One hundred eight EMS stations were contacted with the survey. Sixty-eight providers responded; majority were emergency medical paramedics (73.1%). Most of the stations surveyed did not have a pediatric trauma center (66.2%). When treating children younger than 3 years, half of the respondents stated they did not know of a specific cervical spine clearance criterion; 59.3% felt that cervical spine immobilization was required “sometimes,” and 40.0% were unaware of the state's EMS pediatric cervical spine clearance algorithm; 93.9% of EMS providers felt that an age-based algorithm for cervical spine clearance in children would be useful.

Conclusions
In this statewide survey involving prehospital EMS providers, we found that pediatric cervical spine clearance and immobilization practices, even within a specific geographic location, remain inconsistent.
Shoulder Release and Tendon Transfer following Neonatal Brachial Plexus Palsy: Gains, Losses, and Midline Function
Authors: Adidharma Widya , Lewis Sarah P. , Liu Yusha , Osorio Marisa B. , Steinman Suzanne E. , Tse Raymond W. 
Published: May 2020

Background:
Shoulder release and tendon transfer is frequently performed to address persistent weakness from neonatal brachial plexus palsy. Although postoperative improvements in motion are well described, associated deficits are poorly documented, and functional assessments are lacking. Loss of ability to reach midline can occur with surgery and may result in impairment. The purpose of this study was to comprehensively assess the gains, losses, functional changes, and patient-reported outcome associated with the authors’ surgical approach.

Methods:
Consecutive patients undergoing surgery with 2-year follow-up were included (n = 30). Prospectively recorded assessments by therapists were reviewed. Changes were assessed by t test and Wilcoxon rank sum (p < 0.05).

Results:
Active external rotation and abduction improved and internal rotation diminished. Aggregate modified Mallet score increased with improvements in all subscales, except that hand to spine was unchanged and hand to belly decreased. Functional assessment using the Brachial Plexus Outcome Measure revealed an increase of aggregate score, with no decline in any subscales. Improvements were in hand to back of head, forward overhead reach, holds plate with palm up, opening large container, and strings bead. Aggregate patient self-report of appearance and function increased (from 18 to 23). Loss of ability to reach midline occurred in three patients (10 percent) who had extended Erb or total palsy and preoperative limitations of internal rotation.

Conclusions:
Secondary reconstruction rebalances shoulder motion by increasing external rotation and abduction and reducing internal rotation. In this study, a conservative surgical approach results in overall improvement in task-based abilities and self-reported outcomes and preservation of internal rotation within a functional range.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Direct maternal deaths attributable to HIV in the era of antiretroviral therapy: evidence from three population-based HIV cohorts with verbal autopsy
Authors: Calvert Clara , Marston Milly , Slaymaker Emma , Crampin Amelia C. , Price Alison J. , Klein Nigel , Herbst Kobus , Michael Denna , Urassa Mark , Clark Samuel J. , Ronsmans Carine , Reniers Georges 
Published: May 2020

Objective:
To assess whether HIV is associated with an increased risk of mortality from direct maternal complications.

Design:
Population-based cohort study using data from three demographic surveillance sites in Eastern and Southern Africa.

Methods:
We use verbal autopsy data, with cause of death assigned using the InSilicoVA algorithm, to describe the association between HIV and direct maternal deaths amongst women aged 20–49 years. We report direct maternal mortality rates by HIV status, and crude and adjusted rate ratios comparing HIV-infected and uninfected women, by study site and by ART availability. We pool the study-specific rate ratios using random-effects meta-analysis.

Results:
There was strong evidence that HIV increased the rate of direct maternal mortality across all the study sites in the period ART was widely available, with the rate ratios varying from 4.5 in Karonga, Malawi [95% confidence interval (CI) 1.6–12.6] to 5.2 in Kisesa, Tanzania (95% CI 1.7–16.1) and 5.9 in uMkhanyakude, South Africa (95% CI 2.3–15.2) after adjusting for sociodemographic confounders. Combining these adjusted results across the study sites, we estimated that HIV-infected women have 5.2 times the rate of direct maternal mortality compared with HIV-uninfected women (95% CI 2.9–9.5).

Conclusion:
HIV-infected women face higher rates of mortality from direct maternal causes, which suggests that we need to improve access to quality maternity care for these women. These findings also have implications for the surveillance of HIV/AIDS-related mortality, as not all excess mortality attributable to HIV will be explicitly attributed to HIV/AIDS on the basis of a verbal autopsy interview.
Secondary Intention Healing After Mohs Surgical Excision as an Alternative to Surgical Repair
Authors: Liu Katherine Y. , Silvestri Brittni , Marquez Jocellie , Huston Tara L. 
Published: May 2020

Background
A multitude of reconstructive options exist for patients after Mohs surgery of cutaneous neoplasms of the head and neck. Secondary intention healing is often overlooked and underused but has numerous advantages, including superior esthetic outcomes compared with surgical reconstruction for wounds that exhibit particular characteristics. The ability to predict cosmetic results based on wound characteristics can greatly help in the decision between surgical repair and secondary intention healing. Although other studies have discussed results after secondary intention healing on various areas of the head and neck, here, we specifically focus on cases of the nasal area.

Methods
We conducted a chart review of 37 patients with nasal reconstructions using secondary intention healing by a single surgeon over a 2-year period. Wound outcomes were graded as poor, acceptable, good, or excellent based on definitions found in the literature.

Results
We found that overall, the best cosmetic outcomes were associated with concave areas of the nose, such as the nasal ala and sidewall, and that superficial wounds healed better than deep wounds. Furthermore, we found that convex areas of the nose, such as the nasal tip, did not heal as well by secondary intention. However, if the wound was small and superficial enough, the wound still healed with a good to excellent cosmetic outcome.

Conclusions
Healing by secondary intention is a reasonable consideration for suitable wounds. The need for surgical scar revision is addressed, if necessary, after the wound has healed. The benefits of secondary intention healing include:
Future studies will address a larger cohort size of patients with more varied skin types and ages, as these are characteristics that can influence cosmetic outcome. Furthermore, healed wounds continue to improve in appearance over time, and it would be worthwhile to monitor patients' cosmetic outcomes over a longer follow-up period.
Availability of COVID-19 Information From National Plastic Surgery Society Web Sites
Authors: Al-Benna Sammy , Gohritz Andreas 
Published: May 2020

Background
National plastic surgery society web sites are an important source of information for patients, family members, and healthcare professionals. There are currently no standardized recommendations for the information provided on web sites. The aim of this study was to assess the information available on each national plastic surgery society web site on the current pandemic of COVID-19.

Methods
A Google search was performed of United Nations member sovereign states to determine whether they had a national plastic surgery society web site and to assess its contents. The presence of COVID-19 information was recorded. Access to contact information, Facebook page, Twitter, and Instagram handles were noted.

Results
Thirty-five percent of sovereign states had plastic surgery society web sites. Twenty-two percent of national society web sites had a specific COVID-19 section. Fourteen (93%) of these 15 web sites had COVID-19–specific guidelines available for health care professionals.

Conclusions
COVID-19 information provided by national plastic surgery society web sites is sparse. Two-thirds of national plastic surgery societies do not have a web presence. The availability of COVID-19 clinical guidelines and patient information sheets on national plastic surgery society web sites is limited. This study suggests that improvement and increase in COVID-19 information provided by many national plastic surgery society web sites are needed.
Clinical Outcomes of Robotic Surgery Compared to Conventional Surgical Approaches (Laparoscopic or Open)
Authors: Muaddi Hala , Hafid Melanie El , Choi Woo Jin , Lillie Erin , de Mestral Charles , Nathens Avery , Stukel Therese A. , Karanicolas Paul J. 
Published: May 2020

Objective:
Describe clinical outcomes (eg, postoperative complications, survival) after robotic surgery compared to open or laparoscopic surgery.

Background:
Robotic surgery utilization has increased over the years across a wide range of surgical procedures. However, evidence supporting improved clinical outcomes after robotic surgery is limited.

Methods:
We systematically searched MEDLINE, EMBASE, and the Cochrane Central Register of systematic reviews from inception to January 2019 for systematic reviews describing postoperative outcomes after robotic surgery. We qualitatively described patient outcomes of commonly performed robotic procedures: radical prostatectomy, hysterectomy, lobectomy, thymectomy, rectal resection, partial nephrectomy, distal gastrectomy, Roux-en-Y gastric bypass, hepatectomy, distal pancreatectomy, and cholecystectomy.

Results:
One hundred fifty-four systematic reviews included 336 studies and 18 randomized controlled trials reporting on patient outcomes after robotic compared to laparoscopic or open procedures. Data from the randomized controlled trials demonstrate that robotic-assisted radical prostatectomy offered fewer biochemical recurrence and improvement in quality of recovery and pain scores only up to 6 weeks postoperatively compared to open radical prostatectomy. When compared to laparoscopic prostatectomy, robotic surgery offered improved urinary and sexual functions. Robotic surgery for endometrial cancer had fewer conversion to open compared to laparoscopic. Otherwise, robotic surgery outcomes were similar to conventional surgical approaches for other procedures except for radical hysterectomy where minimally invasive approaches may result in patient harm compared to open approach.

Conclusion:
Robotic surgery has been widely incorporated into practise despite limited supporting evidence. More rigorous research focused on patient-important benefits is needed before further expansion of robotic surgery.
Complement 5 Inhibition Ameliorates Hepatic Ischemia/reperfusion Injury in Mice, Dominantly via the C5a-mediated Cascade
Authors: Kusakabe Jiro , Hata Koichiro , Tamaki Ichiro , Tajima Tetsuya , Miyauchi Hidetaka , Wang Yi , Nigmet Yermek , Okamura Yusuke , Kubota Toyonari , Tanaka Hirokazu , Tsuruyama Tatsuaki , Uemoto Shinji 
Published: May 2020

Background.
Hepatic ischemia/reperfusion injury (IRI) is a serious complication in liver surgeries, including transplantation. Complement activation seems to be closely involved in hepatic IRI; however, no complement-targeted intervention has been clinically applied. We investigated the therapeutic potential of Complement 5 (C5)-targeted regulation in hepatic IRI.

Methods.
C5-knockout (B10D2/oSn) and their corresponding wild-type mice (WT, B10D2/nSn) were exposed to 90-minute partial (70%) hepatic ischemia/reperfusion with either anti-mouse-C5 monoclonal antibody (BB5.1) or corresponding control immunoglobulin administration 30 minutes before ischemia. C5a receptor 1 antagonist was also given to WT to identify which cascade, C5a or C5b-9, is dominant.

Results.
C5-knockout and anti-C5-Ab administration to WT both significantly reduced serum transaminase release and histopathological damages from 2 hours after reperfusion. This improvement was characterized by significantly reduced CD41+ platelet aggregation, maintained F4/80+ cells, and decreased high-mobility group box 1 release. After 6 hours of reperfusion, the infiltration of CD11+ and Ly6-G+ cells, cytokine/chemokine expression, single-stranded DNA+ cells, and cleaved caspase-3 expression were all significantly alleviated by anti-C5-Ab. C5a receptor 1 antagonist was as effective as anti-C5-Ab for reducing transaminases.

Conclusions.
Anti-C5 antibody significantly ameliorated hepatic IRI, predominantly via the C5a-mediated cascade, not only by inhibiting platelet aggregation during the early phase but also by attenuating the activation of infiltrating macrophages/neutrophils and hepatocyte apoptosis in the late phase of reperfusion. Given its efficacy, clinical availability, and controllability, C5-targeted intervention may provide a novel therapeutic strategy against hepatic IRI.
Carbamazepine-, Oxcarbazepine-, Eslicarbazepine-Associated Movement Disorder: A Literature Review
Authors: Rissardo Jamir Pitton , Caprara Ana Letícia Fornari 
Published: May 2020

BackgroundCarbamazepine (CBZ), oxcarbazepine (OXC), and eslicarbazepine (ESL) acetate belong to the dibenzazepine family. In this context, the aim of this literature review is to evaluate the clinical epidemiological profile, pathological mechanisms, and management of CBZ-, OXC-, and ESL-associated movement disorders (MDs).Review SummaryRelevant reports in 6 databases were identified and assessed by 2 reviewers without language restriction. Reports where the individuals only developed tremor or ataxia after CBZ/OXC/ESL use were not included. A total of 73 reports containing 191 individuals who developed MD associated with CBZ/OXC/ESL were identified. Were found, respectively, the following: 33 patients with myoclonus, 23 with dystonia, 14 with tics, 13 with dyskinesia, 8 with parkinsonism, and 5 with akathisia. In the group not clearly defined, there were 44 with myoclonus, 29 with dyskinesia, 20 with dystonia, 1 with incoordination, and 1 with akathisia. The mean age was 28.53 years. The most frequent sex was male in 52.77% (38/72), and the drug indication was epilepsy in 74.19% (69/93). The mean (SD) CBZ dose when the MD occurred was 692.68 (363.58) mg. The mean time until MD onset was 33.59 days, and the mean recovery period was 8.7 days. The most common form of MD management was drug withdrawal.ConclusionsThe number of cases associated with CBZ is higher than those with OXC + ESL. We believe that the study of CBZ contributes not only to the improvement of this drug but also to the knowledge about the drug-induced MD of OXC and ESL. In the literature, the description of the MD onset and recovery has been poorly reported.
Wound Healing in the Long-Term Acute Care Setting Using an Air Fluidized Therapy/Continuous Low-Pressure Therapeutic Bed
Authors: Arnold Malgorzata , Yanez Cecilia , Yanez Blanca 
Published: May 2020

BACKGROUND:
We evaluated a new bed that updates the functionality of the current air fluidized therapy (AFT)/continuous low-pressure (CLP) pressure redistributing beds. This bed was evaluated in conjunction with standard wound care interventions in a long-term acute care hospital (LTACH). The AFT feature is designed to provide pressure distribution via a fluid-like medium that forces air though millions of tiny silicone beads that float the patient's body to achieve maximum immersion and envelopment. The CLP feature of the bed provides pressure distribution for the upper body. Standard wound care was provided that included debridement, topical treatments, and biophysical therapies such as negative pressure wound therapy, as indicated.

CASES:
Our multiple case series comprised 10 medically compromised patients with 25 wounds. Their mean age was 63 years, 50% were male, and the mean cumulative Braden Scale score was 12.4 out of 23, indicating a high risk for pressure injury (PI). Seven of 10 patients were incontinent of urine, 6 had fecal incontinence, and 2 had ostomies. Types of wounds treated included 2 large tissue defects from surgical excisions for the treatment of gangrene and 23 PIs. On admission, wounds had an average surface area of 139.1 cm2. The mean percentage of reduction in wound surface area was 59.3% over an average of 31.3 days of therapy. No new wounds formed during their course of care despite being at elevated risk.

CONCLUSIONS:
Findings from this multiple case series suggest that the AFT/CLP bed facilitates healing of advanced wounds in medically complex patients when included as part of a wound care program. Despite mild to high risk, no new PIs developed, and severe PIs and large tissue defects significantly improved or completely resolved. One hundred percent of surveyed staff members recommend use of the AFT/CLP bed.
Testing lags and emerging COVID-19 outbreaks in federal penitentiaries: A view from Canada
Authors: Blair Alexandra , Parnia Abtin , Siddiqi Arjumand 
Published: May 2020

ABSTRACTObjectivesTo provide the first known comprehensive analysis of COVID-19 outcomes in a federal penitentiary system. We examined the following COVID-19 outcomes within federal penitentiaries in Canada and contrasted them with estimates for the overall population in the penitentiaries’ respective provincial jurisdictions: testing, prevalence, the proportion recovered, and fatality.MethodsData for prisons were obtained from the Correctional Service of Canada and, for the general population, from the Esri COVID-19 Canadian Outbreak Tracking Hub. Data were retrieved between March 30 and April 21, 2020, and are accurate to this date. Penitentiary-, province- and sex-specific frequency statistics for each outcome were calculated.ResultsData on 50 of 51 penitentiaries (98%) were available. Of these, 72% of penitentiaries reported fewer tests per 1000 population than the Canadian general population average (16 tests/1000 population), and 24% of penitentiaries reported zero tests. Penitentiaries with high levels of testing were those that already had elevated COVID-19 prevalence. Five penitentiaries reported an outbreak (at least one case). Hardest hit penitentiaries were those in Quebec, Ontario, and British Columbia, with some prisons reporting COVID-19 prevalence of 30% to 40%. Of these, two were women’s prisons. Female prisoners were over-represented among cases (31% of cases overall, despite representing 5% of the total prison population).ConclusionIncreased sentinel or universal testing may be appropriate given the confined nature of prison populations. This, along with rigorous infection prevention control practices and the potential release of prisoners, will be needed to curb current outbreaks and those likely to come.GRAPHICAL SUMMARYBetween 20% and 57% fewer tests per 1000 population have been conducted in federal prisons in Saskatchewan, New Brunswick, Nova Scotia and Alberta than in the general population of those provinces.Though Alberta, Manitoba, Saskatchewan, New Brunswick and Nova Scotia are reporting lower counts of COVID-19 cases, these are also the regions reporting the lowest levels of testing.Case incidence has been highest in federal prisons in Quebec, Ontario, and British Columbia, where a total of five prisons are experiencing outbreaks (1 or more cases). These regions are those reporting the highest levels of testing – higher than the testing levels in the general population.