bluuebunny/crossref_metadata_2025_split huggingface dataset:
C5 palsy after C5/6/7 posterior foraminal decompression
Authors: Oshina Masahito , Segawa Tomohide , Oshima Yasushi , Tanaka Sakae , Inanami Hirohiko 
Published: January 2020

Abstract

Rationale:
Although C5 palsy is a common complication of cervical spine surgery, its cause has not been confirmed. There are various hypotheses for its mechanism, including spinal cord impairment and nerve involvement. Therefore, prophylactic foraminotomy is one of the methods recommended for preventing C5 palsy. However, we describe a patient who experienced C5 palsy after microendoscopic foraminotomy between the left C5/6 and C6/7 levels.

Patient concerns:
A 43-year-old man presented with a 14-month history of progressive numbness in the left upper limb. We performed microendoscopic left foraminal decompressions at the C5/6/7 levels to treat the left C6 and C7 radiculopathy. On the postoperative day 1, we observed weak motor strength of the left deltoid, left biceps, and left forearm pronator, while the motor strength of the other muscles was normal.

Diagnoses:
C5 palsy following C5/6/7 left foraminotomy.

Intervention:
Follow-up rehabilitation with muscle strength training and range of motion training.

Outcome:
The patient recovered his motor strength completely within 3 months postoperatively.

Lessons:
In this case, the C5 palsy could not be adequately explained by the theory of nerve root impingement or disruption in blood circulation following spinal cord decompression. We hypothesized that the patient had drill heat-induced C5 palsy. Regarding the C5 palsy without C5 nerve root decompression, we hypothesize that the C5 palsy in C5/6/7 foraminotomy could be related to variations in the formation of the brachial plexus. Prophylactic foraminotomy for cervical posterior surgery should be performed with care, limiting its use in patients who are at a risk of developing C5 palsy because the prophylactic procedure can cause C5 palsy. We must also consider that even without decompression at the C4/5 level, there is a possibility of C5 palsy occurring.
Comparison of the immediate analgesic effect of perpendicular needling and transverse needling at SP6 in patients with primary dysmenorrhea
Authors: Afshari Fard Mohammad Reza , Mohammadi Ali , Ma Liang-Xiao , Mu Jie-dan , Yu Wen-Yan , Song Yue , Wang Jun-Xiang , Gan Ying-Ying , Tian Yuan , Qian Xu , Sun Tian-Yi , Iravani Somayeh 
Published: January 2020

AbstractBackground:Acupuncture has been widely used to treat primary dysmenorrhea (PD) with satisfactory outcomes. Sanyinjiao (SP6) is the most commonly used acupoint for PD. Different needling techniques may influence the effect of SP6, and its underlying mechanism needs to be explored. This randomized controlled parallel trial is designed to evaluate the immediate analgesic effect and hemodynamic responses in uterine arterial blood flow of perpendicular needling and transverse needling at SP6 in patients with PD of cold-dampness stagnation pattern using color doppler ultrasonography.Methods:Forty-eight patients who meet inclusion criteria will be randomized in a ratio of 1:1 to either perpendicular needling or transverse needling groups. Every participant will receive 1 session of acupuncture treatment for 10 minutes at bilateral SP6. In the perpendicular needling group, needles will be inserted vertically 1 to 1.2 cun and will be manipulated to achieve needling sensation. In transverse needling group, the needles will be inserted transversely 1 to 1.2 cun toward the abdomen without any manipulation to avoid needling sensation. Color doppler ultrasonography will be performed before, during, and after needling. The primary outcome measure is visual analog scale for pain. The secondary outcome measures include the uterine artery blood flow changes by measuring pulsatility index, resistance index values, and ratio of systolic peak and diastolic peak, the Hamilton anxiety scale, blood pressure, and heart rate. Adverse events in both groups also will be recorded.Discussion:This trial will be the first study protocol designed to explore the influence of needling techniques on the analgesia effect of solo acupoint and its hemodynamic responses for PD. It will promote more widespread awareness of the benefits of using suitable needling techniques in acupuncture clinical setting and provide a further explanation of the underlying hemodynamic mechanism.Trial registration:This study protocol was registered at the Chinese clinical trial registry (ChiCTR1900026051).
The impact of physicians’ knowledge on outpatient antibiotic use
Authors: Wushouer Haishaerjiang , Wang Zhuangfei , Tian Ye , Zhou Yue , Zhu Dawei , Vuillermin Daniel , Shi Luwen , Guan Xiaodong 
Published: January 2020

Abstract
We designed this study to explore how factors, especially knowledge, influence the use and prescriptions of antibiotics among physicians in China's county hospitals.
A questionnaire was designed to evaluate the knowledge levels of physicians. The rates of antibiotic prescriptions were collected through on-the-spot investigations. The percentage of encounters with antibiotics prescribed and the percentage of encounters with antibiotics combination prescribed were used to measure antibiotics use. Univariate analysis and the generalized linear model were applied to analyze the knowledge levels among physicians as well as their antibiotic prescriptions.
A total of 334 physicians in 60 county hospitals filled out the questionnaires, and 385,529 prescriptions were collected. The mean score of the questionnaire was a pass (62.8). The physicians in the eastern region of China demonstrated higher levels of knowledge than other regions (P = .08). Physicians with a higher score prescribed less antibiotics (P < .01) and less antibiotics combination (P = .07).
The knowledge gap of Chinese physicians is evident and those with a higher degree of knowledge always prescribe fewer antibiotics. Targeted training and courses to educate physicians about the risks of over-prescription of antibiotics should be conducted to improve the practice of antibiotic prescriptions.
Impact of CCL4 gene polymorphisms upon the progression of lung cancer in a Han Chinese cohort
Authors: Hu Weiwei , Chien Szu-Yu , Ying Pengqing , Liu Po-I , Su Chen-Ming , Tang Chih-Hsin 
Published: January 2020

Abstract
Lung cancer is the most common malignancy in China and has a low survival rate amongst Han Chinese. The high mortality is largely attributed to late-stage diagnosis, when treatment is largely ineffective. Identification of genetic variants could potentially assist with earlier diagnosis and thus more effective treatment. Chemokine (C–C motif) ligand 4 (CCL4) plays a critical role as a chemoattractant in tumor development, metastasis and angiogenesis. In this study, we explored three CCL4 single nucleotide polymorphisms (SNPs) (rs1634507, rs1719153, and rs10491121) in 538 patients with lung cancer and 370 healthy, cancer-free controls. Carriers of the GT + TT heterozygote of rs1634507 had a lower risk of lung cancer than wild-type (GG) carriers, while the presence of the AG + GG heterozygote at rs10491121 was associated with a higher risk of lung cancer compared with having the AA genotype. The G/A/G and T/A/A CCL4 haplotypes significantly reduced and increased the risks for lung cancer, respectively. Our study is the first to document correlations between CCL4 polymorphisms and lung cancer development and progression in people of Han Chinese ethnicity.
Correlating Self-directed Learning Abilities to Lifelong Learning Orientation in Baccalaureate Nursing Students
Authors: Kaulback Michelle K. 
Published: January 2020

Background
Lifelong learning is an important part of professionalism as nurses need to maintain competency and current knowledge for practice.

Purpose
The purpose of this study was to examine the relationship between baccalaureate nursing students' self-directed learning (SDL) abilities and lifelong learning orientation.

Methods
A quantitative, correlational research design was used. Students (n = 124) completed the Self-Directed Learning Inventory (SDLI) and the Jefferson Scale of Lifelong Learning–Health Professions Students (JeffSLL-HPS).

Results
There was a significant, positive correlation between the SDLI total scores and the JeffSLL-HPS total scores (r = 0.64, P < .0001). There also were positive correlations between the JeffSLL-HPS total scores and 4 SDL domains: interpersonal communication (r = 0.39, P < .0001), planning and implementing (r = 0.52, P < .0001), self-monitoring (r = 0.48, P < .0001), and learning motivation (r = 0. 63, P < .0001).

Conclusion
Nursing faculty should implement teaching and learning strategies that foster SDL abilities to increase lifelong learning orientation in nursing students.
Nursing Care for Hospitalized Older Adults With and Without Cognitive Impairment
Authors: Macieira Tamara G. R. , Yao Yingwei , Smith Madison B. , Bian Jiang , Wilkie Diana J. , Keenan Gail M. 
Published: January 2020

Background
The presence of cognitive impairment (CI) among hospitalized older adults (aged 85 years and older) could interfere with the identification and treatment of other important symptoms experienced by these patients. Little is known, however, about the nursing care provided to this group. Contrasting the nursing care provided to patients with and without CI may reveal important insights about symptom treatment in the CI population.

Objective
The aim of this study was to examine the relationship of CI to nursing care provided and length of stay for hospitalized older adults using standardized nursing data retrieved from electronic health records.

Methods
We conducted a comparative secondary data analysis. A data set of standardized nursing plan of care data retrieved from electronic health record data of nine units at four hospitals was analyzed. The plan of care data for this study were previously transformed into one of eight categories (family, well-being, mental comfort, physical comfort, mental, safety, functional, and physiological care). Fisher exact tests were used to compare the differences in the nursing care for hospitalized older adults with and without CI. Mixed-effects models were used to examine associations of patient’s cognitive status and nursing care, and cognitive status and length of stay.

Results
We identified 4,354 unique patients; 746 (17%) had CI. We observed that older adults with CI were less likely to receive physical comfort care than those without CI for seven of nine units. Older adults’ cognitive status was associated with the delivery of mental comfort care. In addition, a worsening in cognitive status was associated with an increase in length of stay for older adults with CI.

Discussion
Older adults with CI appeared to be undertreated for symptoms of pain when compared to those without CI across units. There is a need for further research to improve symptom recognition and management for this population. The presence of CI was associated with variation in nursing care provided and length of stay. Future studies that include the analysis of nursing data merged with elements stored in the electronic health record representing the contributions of other health professions are expected to provide additional insights into this gap.
A National Survey Across Primary Care Pediatricians Regarding Immunization Views and Practices in Children With Rheumatic Diseases
Authors: Papailiou Stayroula , Markade Aikaterini , Eleftheriou Irene , Tsolia Maria N. , Garoufi Anastasia , Maritsi Despoina N. 
Published: January 2020

Objective
The aims of this study were to describe the knowledge, attitude, and current practice of general pediatricians working in primary care regarding vaccination in children with rheumatic diseases (RDs) and to identify barriers and facilitators that could be used to promote uptake.

Methods
Cross-sectional survey conducted with an anonymous questionnaire of 34 items distributed to pediatricians via an online platform. Four hundred questionnaires were sent, and 256 were returned and analyzed using STATA 13. Data collection included demographics, questions on knowledge, perceptions, and opinions, as well as advice given to families.

Results
The majority of doctors felt that vaccination in children with RDs is essential. Responders were using a variety of guidelines to reach a clinical decision. Fifty percent were hesitant to adhere to the national vaccination scheme without expert input. Reasons were as follows: not convinced from current literature that the vaccine is safe (32%), afraid to cause disease flare (43%), and unable to deal with parental concerns/refusal (54%). Twelve percent of responders felt that the RD may have been triggered by a vaccine. The majority (82%) of doctors were pro annual influenza vaccination. Seventy percent of doctors were keener to administer booster doses rather than primary ones.

Conclusions
Variation in opinion and clinical practice exists. Overall, although general pediatricians are informed regarding efficacy and adverse effects of immunizations in patients with RDs, there are steps to be made from principle to practice. Vaccinating these children is of vital importance, and primary care pediatricians should be updated regarding existing guidelines referring to this field.
“Medial Hemi-Mastopexy”
Authors: Agrawal Amit , Garreffa Emanuele 
Published: January 2020

Introduction
Therapeutic mammaplasty is a well-established advanced oncoplastic technique for larger tumors in large breasts. However, the larger the breasts are, the greater is the lower outer parenchymal displacement due to weight resulting in relative emptiness in the medial/cleavage part. Therefore, the default practice of excising the medial wing parenchymal component of Wise pattern (WP) incision may either maintain or worsen such anatomy.

Methods
We present a technical innovation to improve the standard WP technique: instead of excision, the medial wing of the WP incision is deepithelized, and parenchyma is preserved to retain or augment bulk.

Results
Between July 2015 and December 2018, a total of 16 patients (26 breasts) underwent a medial hemi-mastopexy. This technique seems to be safe, with minimal complications even after radiotherapy.

Conclusions
Although its use is limited in lower inner quadrant tumors, “medial hemi-mastopexy” can be safely applied to cancers located in all the other quadrants and potentially in the cosmetic setting as well. This case series is limited by the small numbers and short follow-up; however, the data show promising results.
Patient-reported Outcomes at 6 to 12 Months Among Survivors of Firearm Injury in the United States
Authors: Herrera-Escobar Juan Pablo , de Jager Elzerie , McCarty Justin Conrad , Lipsitz Stuart , Haider Adil H. , Salim Ali , Nehra Deepika 
Published: January 2020

Objective:
Assess outcomes in survivors of firearm injuries after 6 to 12 months and compared them with a similarly injured trauma population.

Background:
For every individual in the United States who died of a firearm injury in 2017, three survived, living with the burden of their injury. Current firearm research largely focuses on mortality and short-term health outcomes, while neglecting the long-term consequences.

Methods:
We contacted adult patients with a moderate-to-severe injury from a firearm or motor vehicle crash (MVC) treated at 3 level I trauma centers in Boston between 2015 and 2018. Patients were contacted 6 to 12 months postinjury to measure: presence of daily pain; screening for post-traumatic stress disorder (PTSD); new functional limitations; return to work; and physical and mental health-related quality of life. We matched each firearm injury patient to MVC patients using Coarsened Exact Matching. Adjusted Generalized Linear Models were used to compare matched patients.

Results:
Of 177 eligible firearm injury survivors, 100 were successfully contacted and 63 completed the study. Among them, 67.7% reported daily pain, 53.2% screened positive for PTSD, 38.7% reported a new functional limitation in an activity of daily living, and 59.1% have not returned to work. Compared with population norms, overall physical and mental health-related quality of life was significantly reduced among firearm injury survivors. Compared with matched MVC survivors (n = 255), firearm injury survivors were significantly more likely to have daily pain [adjusted odds ratio (OR) 2.30, 95% confidence interval (CI) 1.08–4.87], to screen positive for PTSD (adjusted OR 3.06, 95% CI 1.42–6.58), and had significantly worse physical and mental health-related quality of life.

Conclusions:
This study highlights the need for targeted long-term follow-up care, physical rehabilitation, mental health screening, and interventions for survivors of firearm violence.
Validating clinical threshold values for a dashboard view of the compensatory reserve measurement for hemorrhage detection
Authors: Convertino Victor A. , Wampler Mallory R. , Johnson Michael , Alarhayem Abdul , Le Tuan D. , Nicholson Susannah , Myers John G. , Chung Kevin K. , Struck Katie R. , Cuenca Camaren , Eastridge Brian J. 
Published: January 2020

BACKGROUND
Compensatory reserve measurement (CRM) is a novel noninvasive monitoring technology designed to assess physiologic reserve using feature interrogation of arterial pulse waveforms. This study was conducted to validate clinically relevant CRM values with a simplified color-coded dashboard view.

METHODS
We performed a prospective observational study of 300 injured patients admitted to a level I trauma center. Compensatory reserve measurement was recorded upon emergency department admission. Data collected to complement the analysis included patient demographics, vital signs, lifesaving interventions, Injury Severity Score (ISS), and outcomes. Threshold values of CRM were analyzed for predictive capability of hemorrhage.

RESULTS
A total of 285 patients met the inclusion criteria. Mean age of the population was 47 years, and 67% were male. Hemorrhage was present in 32 (11%), and lifesaving intervention was performed in 40 (14%) patients. Transfusion of packed red blood cells was administered in 33 (11.6%) patients, and 21 (7.4%) were taken to the operating room for surgical or endovascular control of hemorrhage. Statistical analyses were performed to identify optimal threshold values for three zones of CRM to predict hemorrhage. Optimal levels for red, yellow, and green areas of the dashboard view were stratified as follows: red if CRM was less than 30%, yellow if CRM was 30% to 59%, and green if CRM was 60% or greater. Odds of hemorrhage increased by 12-fold (odds ratio, 12.2; 95% confidence interval, 3.8–38.9) with CRM less than 30% (red) and 6.5-fold (odds ratio, 6.5; 95% confidence interval, 2.7–15.9) with CRM of equal to 30% to 59% (yellow) when compared with patients with CRM of 60% or greater. The area under the receiver operating characteristic curve for three-zone CRM was similar to that of continuous CRM (0.77 vs. 0.79) but further increased the ability to predict hemorrhage after adjusting for ISS (area under the receiver operating characteristic curve, 0.87).

CONCLUSION
A three-zone CRM could be a potentially useful predictor of hemorrhage in trauma patients with added capabilities of continuous monitoring and a real-time ISS assessment. These data substantiate easily interpretable threshold dashboard values for triage with potential to improve injury outcomes.

LEVEL OF EVIDENCE
Diagnostic, level II.
Diagnosis in children with exercise-induced respiratory symptoms: a multi-centre study
Authors: Pedersen Eva SL , Ardura-Garcia Cristina , de Jong Carmen CM , Jochmann Anja , Moeller Alexander , Mueller-Suter Dominik , Regamey Nicolas , Singer Florian , Goutaki Myrofora , Kuehni Claudia E 
Published: January 2020

AbstractObjectiveExercise-induced respiratory symptoms (EIS) are common in childhood and reflect different diseases that can be difficult to diagnose. In children referred to respiratory outpatient clinics for EIS, we compared the diagnosis proposed by the referring primary care physician with the final diagnosis from the outpatient clinic and described diagnostic tests performed and treatment prescribed after the diagnostic evaluation.DesignObservational study nested in the Swiss Paediatric Airway Cohort (SPAC), which includes respiratory outpatients aged 0-16 years.PatientsWe included children with EIS as main reason for referral. Information about diagnostic investigations, final diagnosis, and treatment prescribed came from outpatient records.Results214 were referred for EIS (mean age 12 years, 99 (46%) female). The final diagnosis was asthma in 115 (54%), extrathoracic dysfunctional breathing (DB) in 35 (16%), thoracic DB in 22 (10%), asthma plus DB in 23 (11%), insufficient fitness in 10 (5%), chronic cough in 6 (3%), and other diagnoses in 3 (1%). Final diagnosis differed from referral diagnosis in 115 (54%). Spirometry, body plethysmography and measurements of exhaled nitric oxide were performed in almost all; exercise-challenge tests in a third. 91% of the children with a final diagnosis of asthma were prescribed inhaled medication and 50% of children with DB were referred to physiotherapy.ConclusionsDiagnosis given at the outpatient clinic often differed from the diagnosis suspected by the referring physician. Diagnostic evaluation, management and follow-up were inconsistent between clinics and diagnostic groups, highlighting the need for diagnostic guidelines in children seen for EIS.Mandatory statements for Archives of Disease in ChildhoodWhat is already known on this topic (2-3 statements of max 25 words)Exercise-induced symptoms are common in childhood but not easy to diagnose because different diagnoses share similar clinical presentationsOnly few studies focused on children with exercise-induced symptoms and all have included selected groups of patients with difficult-to-diagnose problemsWhat this study adds (2-3 statements of max 25 words)Exercise-induced respiratory symptoms was the main reason for referral in one fifth of the children referred to paediatric respiratory outpatient clinics.Dysfunctional breathing is an under-recognised diagnosis; it was frequently diagnosed in the outpatient clinic (in 37%) but rarely suspected by the referring physician (6%)Diagnostic evaluation, management, and follow-up were inconsistent between clinics highlighting the need for diagnostic guidelines in children seen for EIS.