bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Argument for the Safety of Immediate Device Reconstruction following Mastectomy during the COVID-19 Crisis
Authors: Huang Hao , Fu Rose H. , Vartanian Emma , Du Jerry Y. , Otterburn David M. 
Published: May 2021

Background:
Although oncologic surgery is deemed urgent during the COVID-19 pandemic, clinical guidelines in reconstructive surgery have been unclear. Utilizing propensity-matched pre-pandemic data and our institutional experience during the crisis, we aimed to assess the safety of immediate device reconstruction following mastectomy to aid in decision-making during the pandemic.

Methods:
Women undergoing mastectomy only and mastectomy with immediate breast reconstruction (IBR) with tissue expander or permanent implant from the 2007–2013 ACS-NSQIP datasets were included. Multivariate analysis of independent variables was used to form propensity-matched cohorts. Incidence of 30-day major postoperative bleeding and hospital length of stay were compared.

Results:
In total, 13,580 mastectomy only patients and 11,636 IBR patients were identified. Factors that were found to be associated with IBR included age (P = 0.022), BMI (P < 0.001), race (P = 0.010), diabetes (P = 0.007), chronic steroid use (P = 0.003), pulmonary disease (P = 0.004), cardiovascular disease (P < 0.001), disseminated cancer (P = 0.001), chemotherapy before surgery (P = 0.016), low hematocrit (P < 0.001), and total operative time (P < 0.001). After propensity matching, immediate device reconstruction following mastectomy was not found to be associated with greater risk of postoperative bleeding (1.4% versus 1.0%, P = 0.334) or increased length of stay (1.5 ± 2.9 versus 1.5 ± 3.5 days, P = 0.576).

Conclusions:
Immediate device reconstruction does not elevate morbidity in terms of postoperative bleeding or does not increase the length of hospital exposure. Tissue expander or implant reconstruction can be safely performed immediately following mastectomy during the COVID-19 pandemic. Further, our institutional experience during the pandemic indicates that select patients can continue to safely undergo ambulatory mastectomy with device placement.
Myocardial infarction with nonobstructive coronary artery disease (MINOCA): a review of pathophysiology and management
Authors: Cheema Asim N. , Yanagawa Bobby , Verma Subodh , Bagai Akshay , Liu Shuangbo 
Published: May 2021

Purpose of review
Myocardial infarction with nonobstructive coronary artery disease (MINOCA) (≥ 50% stenosis) accounts for 5–8% of acute coronary syndrome (ACS) presentations. The demographic characteristics, risk factors, and management of patients with MINOCA differ from those with atherosclerotic ACS. The objective of this review is to provide a contemporary understanding of the epidemiology, pathophysiology, clinical presentation, and management of MINOCA.

Recent findings
MINOCA is increasingly being recognized as an important and distinct cause of myocardial infarction among patients presenting with ACS. The predominant pathophysiologic mechanisms of MINOCA include both coronary (epicardial vasospasm, coronary microvascular disorder, spontaneous coronary artery dissection, coronary thrombus/embolism) and noncoronary (Takotsubo cardiomyopathy, myocarditis) pathologies. Coronary imaging with intravascular ultrasound and optical coherent tomography, coronary physiology testing, and cardiac magnetic resonance imaging offers important investigative modalities to facilitate diagnosis for appropriate management of MINOCA patients.

Summary
MINOCA is an important cause of ACS observed in certain patients with unique challenges for diagnosis and management. A high index of suspicion and a comprehensive diagnostic evaluation are critical for early recognition and successful management.
Effect of age and cycloplegia on the morphology of the human crystalline lens: swept-source OCT study
Authors: Li Zhangliang , Qu Wenyong , Huang Jinhai , Meng Ziqi , Li Xiuyuan , Zou Rui , Zhao Yune 
Published: May 2021

Purpose:
To evaluate the effect of age and cycloplegia on the morphology of the crystalline lens using a swept-source optical coherence tomography (SS-OCT) system.

Setting:
Hospital.

Design:
Prospective cross-sectional study.

Methods:
The parameters including anterior chamber depth (ACD), the radii of curvature of the anterior and posterior surface of the crystalline lens (ALR and PLR), lens thickness (LT), lens equatorial diameter (LED), and lens vault (LV) were quantified by the SS-OCT before and after cycloplegia. The paired t test was used to compare the parameters before and after cycloplegia. A multivariate linear regression model was built to analyze the association between the parameters/cycloplegia-induced changes and age, while adjusting for the effect of axial length, refractive status, and sex.

Results:
76 individuals (age range, 18 to 86 years) were recruited. The ALR and ACD were negatively correlated with age (P ≤ .002), and the LT, LV, and LED were positively correlated with age (P ≤ .004). In participants younger than 60 years, the ALR and ACD significantly increased, whereas the LV and LT significantly decreased after cycloplegia (all P < .001). With aging, cycloplegia-induced differences of ALR (P = .001) and ACD (P = .014) significantly decreased, and of LT (P < .001), LT (P < .001), and LV (P = .001) significantly increased.

Conclusions:
The crystalline lens morphology measured by the SS-OCT revealed steepening anterior surface and increasing equatorial diameter with age. Cycloplegia caused a significant change of anterior surface morphology in participants younger than 60 years, and this effect diminished with age.
Family nursing conversations with patients with chronic non-cancer pain and their selected family members
Authors: Roenne Pernille Friis , Esbensen Bente Appel , Broedsgaard Anne , Andersen Lasse Oestergaard , Hansen Carrinna Aviaja 
Published: May 2021

Abstract

Introduction:
Chronic non-cancer pain (CNCP) is a disabling condition with comprehensive physical, psychosocial and socio-economic consequences. The biopsychosocial approach is the gold standard in treatment planning. Still, pain rarely resolves, rendering CNCP a condition of life – which requires patient acceptance. From a social perspective, family involvement may increase patients’ ability to manage CNCP. However, the area is underexposed and needs research to describe the impact of specific involvement approaches on the manageability of CNCP. This trial aims to investigate whether an intervention with family nursing conversations (FNC) in the context of established CNCP treatment, compared to usual treatment, will improve both patients’ and family members’ self-efficacy.

Methods:
The trial has a prospective non-blinded quasi-experimental design with two comparable groups: A control group and an intervention group, including 25 family dyads in both groups, each consisting of the patient and between one and three selected family members. In the intervention group, every family dyad will be offered three-four FNC based on the family systems nursing framework. Each conversation lasts 1.5 hours with three weeks interval. The trial setting is a multidisciplinary pain centre in the Capital Region of Denmark. The intervention will be conducted by the employed nurses who will be trained in FNC over a three-day course, followed by practice with test families. Data in the control group will be collected before training onset. The primary outcome is self-efficacy. Secondary outcomes are family function, health-related quality of life, anxiety and depression. Data will be collected at baseline, week nine and, for the intervention group, also at week 26.

Discussion:
CNCP is a devastating condition that lacks effective treatment services. With this trial, an initial step is taken to fill the research gap by illuminating the family's role in the day-to-day management of CNCP, creating knowledge within the social part of the biopsychosocial treatment approach. With effective intervention, FNC may be implemented as a standard treatment in the future.

Trial registration:
ClinicalTrials.gov: Family Nursing for Patients With Chronic Nonmalignant Pain, NCT03981302, initial released June 4, 2019. Protocol version, March 2021. The collection of data for the intervention group is in progress.
Abdominal-based free flaps in head and neck reconstruction
Authors: Bloom Joshua A. , Homsy Christopher 
Published: May 2021

Purpose of review
The head and neck reconstructive surgeon is intimately familiar with the anterolateral thigh, radial forearm, and parascapular flaps. This review serves to describe the major abdominal-based free tissue transfers in head and neck reconstruction that can be used as alternatives to these traditional workhorse flaps.

Recent findings
Abdominal-based free flaps, while not traditionally used in head and neck reconstruction, are great alternatives or second-line flaps. For example, the deep circumflex iliac artery flap is an excellent alternative to the fibular free flap due to its bone height and greater overall quality of life.

Summary
This review article serves to review the major abdominal-based free tissue transfers in head and neck reconstruction in order to expand the toolbox of the head and neck surgeon.
Acute and Severe Acute Pancreatitis and the Effect of Cannabis in States Before and After Legalization Compared With States Without Legalized Cannabis
Authors: Lara Luis F. , Nemer Laura , Hinton Alice , Balasubramanian Gokulakrishnan , Conwell Darwin L. , Krishna Somashekar 
Published: May 2021

Objectives
Cannabis legalization has increased its use. The incidence of acute pancreatitis (AP) and severe acute pancreatitis (SAP) has also increased. In this study, data on pancreatitis were obtained from 2 states before and after cannabis legalization and compared with 2 states without legalized cannabis.

Methods
Data were extracted from State Inpatient Databases from the states of Colorado and Washington before recreational cannabis legalization (2011) and after legalization (2015). Arizona and Florida were used as the nonlegalized cannabis states. Multivariable logistic regression models were fit for AP and SAP to determine a trend difference between legalized and nonlegalized cannabis states.

Results
Cannabis use, AP, and SAP increased in all states. The increase in AP and SAP was not significantly different between the states that legalized cannabis use and those that did not. Legalized cannabis states had lower charges for AP and SAP and shorter length of hospitalizations.

Conclusions
The trend of AP and SAP increased during the study period, but this was not correlated to cannabis use. Cannabis users had lower hospitalization costs and hospital stay. The effects of other confounders such as cannabis dose and delivery methods, alcohol, tobacco, and others need to be studied further as use increases.
Maternal Obesity Is Associated With Higher Cord Blood Adipokines in Offspring Most Notably in Females
Authors: Jaramillo‐Ospina Ángela , Castaño‐Moreno Erika , Muñoz‐Muñoz Estefanía , Krause Bernardo J. , Uauy Ricardo , Casanello Paola , Castro‐Rodriguez José A. 
Published: May 2021

ABSTRACTBackground:Deleterious long‐term effects in the offspring from women with pregravid obesity have been described; however, the evidence supporting early metabolic and inflammatory markers in the offspring at birth and gender differences are conflicting.Objective:The present study aimed to compare cord blood adipokines and cytokines concentrations and anthropometric characteristics of the offspring of women with maternal obesity (MO) and normal‐weight mothers (NWM). Also, maternal and neonatal variables on the association of maternal body mass index (BMI) with cord blood adipokines were evaluated.Methods:A cross‐sectional analysis of a subsample of mother–child dyads participating in a cohort study (n = 221) was assessed. Anthropometrics, cord blood adipokines (leptin and adiponectin) and cytokines (interleukin [IL]‐1β, IL‐4, IL‐10, IL‐12 p40, IL‐12p70, IL‐13, and tumor necrosis factor α) concentrations in the offspring of normal‐weight women (BMI >18.5 and <24.9 kg/m2) and women with pregravid obesity (BMI > 30 kg/m2) without comorbidities was performed.Results:Offspring from mothers with obesity had higher birth weight, a higher proportion of large for gestational age, higher ponderal index, and heavier placentae than offspring from normal‐weight mothers (P < 0.05). Within the offspring from women with obesity, males had significantly higher weight, length, the proportion of large‐for‐gestational‐age newborns, higher weight for length ratio. Males had more efficient placentas than females (P < 0.05). Higher adiponectin and leptin in both sexes and higher leptin in female offspring of mothers with obesity after adjusting for birth size (P < 0.05) were found. Higher IL‐12p40 in the offspring of women with MO with no other differences in other cytokines among groups were evidenced.Conclusions:Maternal obesity associates with a higher concentration of adiponectin and leptin in their offspring at birth. There is a relevant effect on anthropometrics in male offspring and on leptin in female newborn. Further studies need to evaluate the extension of these effects in postnatal life.Trail identification number:NCT02903134
A Resident-driven Initiative to Increase Bedside Teaching on Interdisciplinary Rounds
Authors: Becker Andrew , Frosch Olivia , Argraves Melissa , Carroll Bryn , Kamsheh Alicia , Krass Polina , Mehta Sanjiv , Salazar Elizabeth , Taylor April , Hart Jessica 
Published: May 2021

Introduction:
Inpatient rounding serves numerous roles. The American Academy of Pediatrics recommends a family-centered bedside model. Residents identified physical examination teaching during and satisfaction with rounds as areas for improvement. A resident group developed a project utilizing quality improvement (QI) methodology to address these concerns. We aimed to increase the frequency of bedside physical examination teaching most or every day on a single inpatient unit by 20% over 1 year, with secondary goals to increase the percentage of interns spending one hour or more at bedside per day by 10% and intern satisfaction by 15%, without impacting rounding duration.

Methods:
We developed an organizational structure to complete a long-term resident-led project. Interventions included daily bedside examination teaching on rounds, afternoon examinations, goal communication, topic recording, and a teaching “tip sheet.” Using an institutional QI framework, we utilized iterative plan-do-study-act cycles to implement interventions and surveys to assess outcomes, with rounding efficiency as a balancing measure.

Results:
The survey response rate was 57%. Bedside teaching frequency increased from a mean of 10% to 61%, perceived time at the bedside increased from 37% to 59%, and rounding satisfaction improved from a rating of 6.7/10 to 7.4/10. Efficiency was not impacted.

Conclusions:
We improved inpatient rounds bedside physical examination teaching and satisfaction without sacrificing efficiency. This project demonstrates the feasibility and success of a resident-driven education initiative to successfully motivate fellow residents and colleagues across disciplines to enact change. The organizational structure may serve as a model for resident-led QI projects across institutions.
Translational Simulation Improves Compliance with the NEAR4KIDS Airway Safety Bundle in a Single-center PICU
Authors: Colman Nora , Newman Jordan W. , Nishisaki Akira , Register Melinda , Gillespie Scott E. , Hebbar Kiran B. 
Published: May 2021

Introduction:
The National Emergency Airway Registry for Children (NEAR4KIDS) Airway Safety Quality Improvement (QI) Bundle is a QI tool to improve the safety of tracheal intubations. The ability to achieve targeted compliance with bundle adherence is a challenge for centers due to competing QI initiatives, lack of interdisciplinary involvement, and time barriers. We applied translational simulations to identify safety and performance gaps contributing to poor compliance and remediate barriers by delivering simulation-based interventions.

Methods:
This was a single-center retrospective review following translational simulations to improve compliance with the NEAR4KIDS bundle
. The simulation was implemented between March 2018 and December 2018. Bundle adherence was assessed 12 months before simulation and 9 months following simulation. Primary outcomes were compliance with the bundle and utilization of apneic oxygenation. The secondary outcome was the occurrence of adverse tracheal intubation-associated events.

Results:
Preintervention bundle compliance was 66%, and the application of apneic oxygenation was 27.9%. Following the simulation intervention, bundle compliance increased to 93.7% (P < 0.001) and adherence to apneic oxygenation increased to 77.9% (P < 0.001). There was no difference in the occurrence of tracheal intubation-associated events.

Conclusions:
Translational simulation was a safety tool that improved NEAR4KIDS bundle compliance and elucidated factors contributing to successful implementation. Through simulation, we optimized bundle customization through process improvement, fostered a culture of safety, and effectively engaged multidisciplinary teams in this quality initiative to improve adherence to best practices surrounding tracheal intubations.
Improving Administration of Prehospital Corticosteroids for Pediatric Asthma
Authors: Riney Lauren C. , Schwartz Hamilton , Murtagh Kurowski Eileen , Collett Lindsey , Florin Todd A. 
Published: May 2021

Introduction:
Early administration of systemic corticosteroids for asthma exacerbations in children is associated with improved outcomes. Implementation of a new emergency medical services (EMS) protocol guiding the administration of systemic corticosteroids for pediatric patients with asthma exacerbations went into effect in January 2016 in Southwest Ohio. Our SMART aim was to increase the proportion of children receiving systemic prehospital corticosteroids for asthma exacerbations from 0% to 70% over 2 years.

Methods:
Key drivers were derived and tested using multiple plan-do-study-act cycles. Interventions included community EMS outreach and education, improved clarity in the prehospital protocol language, distribution of pocket-sized educational cards, and ongoing individualized EMS agency feedback on protocol adherence. Eligible patients included children age 3–16 years, who were transported by EMS to the pediatric emergency department with diagnoses consistent with asthma exacerbation. Manual chart review assessed eligibility to receive prehospital corticosteroids. Statistical process control charts tracked adherence to corticosteroid recommendations.

Results:
A total of 256 encounters met the criteria for receiving prehospital corticosteroids for pediatric asthma exacerbations between January 1, 2016, and April 30, 2019. Special cause variation was demonstrated following education at high-volume EMS stations, and the centerline shifted to 34%. This shift has been sustained for 28 months.

Conclusion:
Improvement methodology increased prehospital corticosteroid administration for pediatric asthma exacerbations, although we failed to achieve our aim of increasing use to 70%. Many barriers exist in pediatric prehospital protocol implementation, many of which can be improved with quality improvement tools.
Expanding Hospital Capacity during the COVID-19 Pandemic: The Family Voice Matters
Authors: Connor Jean A. , Hurtig Michelle , Ormsby Jennifer A. , Hickey Patricia A. 
Published: May 2021

Introduction:
During the initial COVID-19 response, this children’s hospital reduced its inpatient capacity by 52 beds with double rooms’ conversion to single patient occupancy, causing significant capacity constraints. To solve this challenge, the family perspective was engaged to safely redouble patient rooms and expand capacity as clinical activity increased during the COVID-19 response.

Methods:
The team conducted qualitative descriptive interviews with parents of children undergoing congenital heart surgery admitted to the inpatient cardiac unit in a 404-bed free-standing children’s hospital. A 2-week pilot study utilizing patient-specific inclusion criteria, newly developed patient room guidelines, universal masking, physical distancing, and inpatient room enhancements with parent COVID-19 testing was conducted.

Results:
Interviews were conducted [pre (n = 7) and post (n = 6)] regarding patient room redoubling. Participants perceived utilization of double rooms as safe with increased protection, including universal masking, physical distancing, room enhancements, and increased bathroom cleaning. However, some families verbalized anxiety regarding visitation restriction to one parent at a time at the bedside. Additional concerns were voiced around the timing of communication about the need to be placed in a double room. In response, visitation increased to 2 parents at bedside and communication of utilization of double rooms was included in preoperative preparations postpilot. Inclusion criteria were expanded to patients of all ages and included full use of shared in-room bathrooms by parents and patients.

Conclusions:
Parents perceived patient room redoubling as safe and family centered. Findings from the pilot study were used to scale broad utilization and increase access to care across the institution.
Development and Implementation of Pediatric ICU-based Mobility Guidelines: A Quality Improvement Initiative
Authors: Ames Stefanie G. , Alessi Lauren J. , Chrisman Maddie , Stanger Meg , Corboy Devin , Sinha Amit , Fink Ericka L. 
Published: May 2021

Introduction:
Critical illness results in physical impairments which may be mitigated by intensive care unit (ICU)-based early mobility. This initiative aimed to develop and implement ICU-based mobility guidelines for critically ill children.

Methods:
A multidisciplinary team developed and implemented ICU-based mobility guidelines. Guideline implementation success was determined by comparing utilization of physical (PT) and occupational therapies (OT) and changes in functional status scale scores in preimplementation and postimplementation cohorts. The team also assessed barriers and adverse events.

Results:
Thirty-four patients were identified preimplementation and 55 patients postimplementation. PT/OT consultation by 72 hours occurred in 44 (81.5%) of patients postimplementation compared to 6 (17%) preimplementation (P < 0.001). Implementation did not result in more ICU-based therapy sessions or shorter time to active therapies. High deferral rates for PT/OT sessions [PT: n = 72 (46.2%) preimplementation versus 112 (39.4%) postimplementation; OT: n = 71 (46.1%) preimplementation versus 134 (41.5%) postimplementation] occurred. No difference in new morbidity between cohorts was identified. Barriers to treatment included the patient’s sedation status, severity of illness, and patient availability.

Conclusions:
Implementation of ICU-based mobility guidelines resulted in a 4-fold increase in PT/OT consultation. They did not result in increased treatment sessions due to frequent deferrals. Future guidelines should focus on interventions to address identified barriers to treatment in a critically ill pediatric population.