bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergency General Surgery Regionalization: Retrospective Cohort Study of Emergency General Surgery Patients at a Tertiary Care Center
Authors: Ayuso Sullivan A. , Elhage Sharbel A. , Cunningham Kyle W. , Britton Christmas A. , Sing Ronald F. , Thomas Bradley W. , May Addison K. , Reinke Caroline E. , Ross Samuel W. 
Published: August 2021

Background Emergency general surgery (EGS) patients presenting at tertiary care hospitals may bypass local hospitals with adequate resources. However, many tertiary care hospitals frequently operate at capacity. We hypothesized that understanding patient geographic origin could identify opportunities for enhanced system triage and optimization and be an important first step for EGS regionalization and care coordination that could potentially lead to improved utilization of resources. Methods We analyzed patient zip code and categorized EGS patients who were cared for at our tertiary care hospital as potentially divertible if the southern region hospital was geographically closer to their home, regional hospital admission (RHA) patients, or local admission (LA) patients if the tertiary care facility was closer. Baseline characteristics and outcomes were compared for RHA and LA patients. Results Of 14 714 EGS patients presenting to the tertiary care hospital, 30.2% were categorized as RHA patients. Overall, 1526 (10.4%) patients required an operation including 527 (34.5%) patients who were potentially divertible. Appendectomy and cholecystectomy comprised 66% of the operations for potentially divertible patients. Length of stay was not significantly different ( P = .06) for RHA patients, but they did have lower measured short-term and long-term mortality when compared to their LA counterparts ( P < .05). Conclusions EGS diagnoses and patient geocode analysis can identify opportunities to optimize regional operating room and bed utilization. Understanding where EGS patients are cared for and factors that influenced care facility will be critical for next steps in developing EGS regionalization within our system.
Historical Changes in Introductory Psychology Lectures, Readings, and Assessments: Lessons Learned
Authors: Brase Gary L. , Du Meixuan (Rebecca) 
Published: August 2021

Introduction Psychology instructors face decisions about adopting new approaches to lectures, readings, and assessment in their courses. Statement of the Problem These choices about course structure can be both intimidating and confusing in terms of the costs and benefits for different options. Literature Review As framed by anecdotal and empirical evidence from personal experience in teaching introductory psychology, this article reviews research on impactful pedagogy. The goal is to provide useful encouragement and cautionary notes on these different options. Teaching Implications Based on 18 classes, taught over a dozen years, the authors provide concrete tips for how to navigate decision points and implement these teaching changes, as supported by student performance and course evaluation data. Conclusion Though unable to make causal conclusions from this limited data, it is worthwhile to discuss the tradeoffs of choices surrounding lectures, readings, and assessments in introductory psychology.
Kurzweil Reading Machine: Evaluation of Model One
Authors: Scadden Lawrence A. 
Published: August 2021

In summary, the evaluation of the KRM has demonstrated that this approach and this specific machine can permit immediate access to printed material by most blind individuals. The greatest limitation at this stage of development is related to the confidence level that many users have placed in the ability of the machine to read various kinds of reading material. This factor has limited the use of the machine as an aid to employment of blind people. It is believed that many of the problems identified in the evaluation process can be overcome with further research and development of the KRM. The evaluation of the KRM by blind and sighted individuals throughout the country has led to the unanimous conclusion that further investigations with improved models of the KRM are warranted. The software in the existing models should be improved to eliminate some of the problems identified above. Hardware changes should be made to eliminate other identified problems. The concern regarding the lack of use of the KRM by employed blind individuals residing close to existing machines probably cannot be alleviated until reading machines of this kind can be located within the actual employment situation. Blind individuals are not willing, nor should they be, to travel to where machines are located in order to read work related materials. Other alternatives, including sighted readers, can be utilized within a work setting. This conclusion suggests the necessity of reaching the point at which speech-output reading machines can be affordable by individuals. Postscript: Since the completion of this evaluation project and the submission of the final report to the supporting governmental agency and to the manufacturer, KCP announced plans for Model Three of the KRM, a desk-top unit. The design includes most of the recommendations suggested in this report such as a hand-scanning option, a small tactile display to assist in format recognition, automatic contrast control with manual override capability, and a spell-next-letter feature. In addition, KCP announced several innovative features. The new model will permit the improved speech synthesizer to speak at rates up to 250 words per minute. Model Three will also have the capability of attaching to a braille embosser to provide direct print to braille conversion. The unit can also be attached to a computer to provide immediate full vocabulary output for computers. A new program is being developed to be used with all KRM's to permit the reading machines to be used as high-powered, programmable, scientific calculators. The new models and programs are scheduled for distribution in early fall 1978. Comprehensive evaluation of these advances is planned.
Novel biomarker for predicting sepsis mortality: vitamin D receptor
Authors: Erdoğan Murat , Fındıklı Hüseyin Avni 
Published: August 2021

Objective There are currently no studies on the role of vitamin D receptor (VDR) levels as a cause of or risk factor for sepsis. We aimed to establish the association between VDR levels and 28-day mortality in critically ill patients with sepsis. Methods This prospective cross-sectional observational study included 148 patients diagnosed with sepsis who were treated in the intensive care unit. We measured VDR levels, laboratory characteristics, and health scores and related them to survival. Results The 148 patients included 96 survivors and 52 non-survivors, with VDR levels of 1.92 and 1.36 ng/mL, respectively. Baseline VDR was a significant predictor of 28-day mortality, with an area under the curve of 0.778. A low VDR level was significantly associated with lower overall survival in patients with sepsis according to Kaplan–Meier curve analysis. VDR levels were also negatively correlated with lactate, C-reactive protein, acute physiological and clinical health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores, and disease severity. Conclusions VDR levels were associated with high 28-day mortality and negatively correlated with lactate, C-reactive protein, APACHE II and SOFA scores, and disease severity in patients with sepsis. VDR levels can predict poor outcomes in patients with sepsis.
Association Between Meniscal Allograft Tears and Early Surgical Meniscal Allograft Failure
Authors: Winkler Philipp W. , Wagala Nyaluma N. , Hughes Jonathan D. , Irrgang James J. , Fu Freddie H. , Musahl Volker 
Published: August 2021

Background: Meniscal allograft transplantation (MAT) has become a viable treatment option for patients with symptomatic meniscal deficiency. Some patients experience early surgical meniscal allograft failure attributed to causes that have not yet been sufficiently clarified. Purpose: To evaluate the prevalence, types, and distribution of arthroscopically confirmed meniscal allograft tears and the associated effect on surgical meniscal allograft survival. Study Design: Cohort study; Level of evidence, 3. Methods: Patients undergoing MAT with a minimum 2-year follow-up were retrospectively reviewed. Descriptive and surgical data were collected. Type and location of arthroscopically confirmed meniscal allograft tears were recorded and compared between medial and lateral allografts and suture-only and bone block fixation. A survival analysis was conducted to evaluate the effect of meniscal allograft tears on surgical meniscal allograft survival. Results: This study included 142 patients (54% male; mean ± SD age, 29.6 ± 10.4 years) with a mean follow-up of 10.3 ± 7.5 years. The prevalence of meniscal allograft tears was 32%, observed at a median of 1.2 years (interquartile range, 2.8 years) after MAT. The posterior horns were most frequently affected, followed by the posterior roots, midbodies, anterior horns, and anterior roots. The most frequently observed tear types were root tears (43%), followed by longitudinal, horizontal, radial, complex, bucket-handle, and meniscocapsular separation tears. A statistically significant association was found between meniscal allograft tear types and fixation techniques ( P = .027), with root tears predominant after suture-only as compared with bone block fixation (57% vs 22%). Patients with meniscal allograft root tears were a mean of 5.4 years (95% CI, 1.6-9.2 years; P = .007) younger than were patients without root tears. The 1-year surgical meniscal allograft survival rate was significantly lower for torn versus intact meniscal allografts (75% vs 99%; P < .001). Conclusion: Meniscal allograft root tears were predominant, associated with younger patient age, and more often observed when using the suture-only fixation technique versus the bone block fixation technique. Torn meniscal allografts were associated with early surgical graft failure when compared with intact meniscal allografts, resulting in a significantly lower 1-year survival rate.
Prevalence and Burden of Self-Reported Health Problems in Junior Male Elite Ice Hockey Players: A 44-Week Prospective Cohort Study
Authors: Nordstrøm Anine , Bahr Roald , Clarsen Ben , Talsnes Ove 
Published: August 2021

Background: Little is known about the burden of overuse injuries and illnesses in junior elite ice hockey. Purpose: To describe the prevalence and burden of all health problems in junior male elite ice hockey players in Norway during 1 school year. Study Design: Descriptive epidemiological study. Methods: A total of 206 junior male ice hockey players (mean age, 17 years; range, 15-20 years) attending specialized sports academy high schools in Norway reported all health problems, acute injuries, overuse injuries, and illnesses, weekly during the 2018-2019 school year (44 weeks). The players self-reported injuries and illnesses using the Oslo Sports Trauma Research Center Questionnaire on Health Problems. Results: Of the players included, 25% (95% CI, 23%-27%) reported at least 1 health problem at any given time, while 16% (95% CI, 14%-17%) experienced health problems with a substantial negative effect on training and performance. Of the total burden of health problems, acute injuries accounted for 44%, overuse injuries 31%, and illnesses 25%. For acute injuries, the greatest burden was caused by injuries to the ankle, knee, and hand, whereas for overuse injuries the most burdensome location was the hip/groin and knee. Conclusion: This study documented that while acute injuries did represent the greatest problem among junior elite ice hockey players, overuse injuries, especially to the knee and hip/groin, also had a substantial effect.
Mortality Trends of Oncology and Hematopoietic Stem Cell Transplant Patients Supported on Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis
Authors: Pravin R. R. , Huang Benjamin Xiongzheng , Sultana Rehena , Tan Chuen Wen , Goh Ken Junyang , Chan Mei-Yoke , Ng Heng Joo , Phua Ghee Chee , Lee Jan Hau , Wong Judith Ju-Ming 
Published: August 2021

Background: There is an increasing frequency of oncology and hematopoietic stem cell transplant (HSCT) patients seen in the intensive care unit and requiring extracorporeal membrane oxygenation (ECMO), however, prognosis of this population over time is unclear. Methods: MEDLINE, EMBASE, Cochrane and Web of Science were searched from earliest publication until April 10, 2020 for studies to determine the mortality trend over time in oncology and HSCT patients requiring ECMO. Primary outcome was hospital mortality. Random-effects meta-analysis model was used to obtain pooled estimates of mortality and 95% confidence intervals. A priori subgroup metanalysis compared adult versus pediatric, oncology versus HSCT, hematological malignancy versus solid tumor, allogeneic versus autologous HSCT, and veno-arterial versus veno-venous ECMO populations. Multivariable meta-regression was also performed for hospital mortality to account for year of study and HSCT population. Results: 17 eligible observational studies (n = 1109 patients) were included. Overall pooled hospital mortality was 72% (95% CI: 65, 78). In the subgroup analysis, only HSCT was associated with a higher hospital mortality compared to oncology subgroup [84% (95% CI: 70, 93) vs. 66% (95% CI: 56, 74); P = 0.021]. Meta-regression showed that HSCT was associated with increased mortality [adjusted odds ratio (aOR) 3.84 (95% CI 1.77, 8.31)], however, mortality improved with time [aOR 0.92 (95% CI: 0.85, 0.99) with each advancing year]. Conclusion: This study reports a high overall hospital mortality in oncology and HSCT patients on ECMO which improved over time. The presence of HSCT portends almost a 4-fold increased risk of mortality and this finding may need to be taken into consideration during patient selection for ECMO.
Missed nursing care and its relationship with perceived ethical leadership
Authors: Arslan Gülşah Gürol , Özden Dilek , Göktuna Gizem , Ertuğrul Büşra 
Published: August 2021

Background: Determination of the factors affecting missed nursing care and the impact of ethical leadership is important in improving the quality of care. Aim: This study aims to determine the missed nursing care and its relationship with perceived ethical leadership. Research design: A cross-sectional study. Participants and research context: The sample consisted of 233 nurses, of whom 92.7% were staff nurses and 7.3% were charge nurses, who work in three different hospitals in Turkey. The study data were collected using a personal and professional characteristics data form, the Missed Nursing Care Survey, and the Ethical Leadership Scale. Ethical considerations: The study was approved by the non-interventional ethics committee of Dokuz Eylül University Ethics Committee for Noninvasive Clinical Studies. All participants’ written and verbal consents were obtained. Findings: The most missed nursing care practices were ambulation, attending interdisciplinary care conferences, and discharge planning. According to the logistic regression analysis, sex, the number of patients that the nurse is in charge of giving care, the number of patients discharged in the last shift, and satisfaction with the team were determined as factors affecting missed care. No significant relationship was found between ethical leadership and missed nursing care (p > 0.05), and a weak but significant relationship was found between the clarification of duties/roles subscale and missed nursing care (r = −0.136, p < 0.05). Discussion: Ethical leaders should collaborate with policy-makers at an institutional level to particularly achieve teamwork that is effective in the provision of care, to control missed basic nursing care, and to organize working hours and at the country level to determine roles and to increase the workforce. Conclusion: The results of this study contribute to the international literature on the most common type of missed nursing care, its reasons, and the relationship between the missed care and ethical leadership in a different cultural context.
Core Outcome Set for Reporting Outcomes of Interventions for Velopharyngeal Dysfunction: Final Results of the COS-VPD Initiative
Authors: de Blacam Catherine , Baylis Adriane L. , Kirschner Richard E. , Smith Susan , Sell Debbie , Sie Kathleen C.Y. , Harris Helen E. , Orr David J.A. 
Published: August 2021

Objective To date, the recording of outcomes of interventions for velopharyngeal dysfunction (VPD) has not been standardized. This makes a comparison of results between studies challenging. The aim of this study was to develop a core outcome set (COS) for reporting outcomes in studies examining the management of VPD. Design A two-round Delphi consensus process was used to develop the COS. Patients, Participants The expert Delphi panel comprised patients and caregivers of patients with VPD, surgeons and speech and language therapists specializing in cleft palate, and researchers with expertise in VPD. Interventions A long list of outcomes was derived from the published literature. In each round of a Delphi survey, participants were asked to score outcomes using the Grading of Recommendations, Assessment, Development, and Evaluations scale of 1 to 9, with 1 to 3 labeled “not important,” 4 to 6 labeled “important but not critical,” and 7 to 9 labeled “critical.” Main outcome measure Consensus criteria were specified a priori. Outcomes with a rating of 75% or more of the panel rating 7 to 9 and 25% or fewer rating 1 to 3 were included in the COS. Results A total of 31 core outcomes were identified from the Delphi process. This list was condensed to combine topic areas to produce a final COS of 10 outcomes, including both processes of care and patient-reported outcomes that should be considered for reporting in future studies of VPD. Conclusions Implementation of the COS-VPD will facilitate consistency of outcomes data collection and comparison of results across studies.
The Current State of Cleft Care in Sub-Saharan Africa: A Narrative Review
Authors: Wester James R. , Weissman Joshua P. , Reddy Narainsai K. , Chwa Emily S. , Gosain Arun K. 
Published: August 2021

Objective To identify practices and limitations of cleft care in sub-Saharan Africa (SSA). Design A retrospective narrative nonsystematic literature review was performed. Setting Literature exploring the management practices of cleft lip and/or palate across regions in SSA was included. Participants Full text case reports, retrospective studies, prospective studies, clinical trials, and review articles written and published in English between 1966 and February 1, 2021, were included in this analysis utilizing PubMed, MEDLINE, EMBASE, and Google scholar databases. Main Outcome Measures Qualitative themes identified in analysis were clinical practice patterns, current infrastructure and limitations of cleft repair, training and interdisciplinary teams, economic analyses, and international partnerships. Results Significant barriers to care identified in SSA include lack of hospital resources, craniofacial training, access to multidisciplinary specialists, and public awareness. These problems make the entire care journey difficult for patients. Increasing public education has the power to diminish late presentations to hospitals. Providing adequate hospital resources and craniofacial training through international and organizational partnerships can ensure that more patients will receive care. Increasing the availability and number of multidisciplinary specialists is crucial to follow up care which aims at improving functional outcomes. Conclusion This narrative review highlights current practices and limitations in cleft care, emphasizing the importance of effective and timely repair of clefts in SSA. Targeted efforts aimed at establishing sustainable infrastructure for cleft care in SSA can have significant individual and community health and economic benefits.
Study on prediction of arterio-venous fistula maturation by flow mediated dilatation and AVF blood flow
Authors: Singh Mansi , Mahapatra Himansu Sekhar , Pursnani Lalit , Muthukumar B , Neeraj Anant Inamdar , Kumar Adarsh , Kaur Navjot , Singh Anamika , Krishnan Chandra 
Published: August 2021

Background: The physiology and pathology of AVF maturation depends on the vessels characteristics and its ability to remodel. Outcome of AVF using flow mediated dilatation (FMD), AVF blood flow and diameter has been studied. Methodology: Present observational study included single stage AVF (both Radiocephalic and Brachiocephalic) in consecutive CKD five patients ( n = 158) prospectively over 1 year. Demographic and Doppler ultrasound parameters of upper limb (for vessel diameter and FMD) at baseline were recorded. Blood flow, diameter and depth of AVF were studied at 2, 6 and 12 weeks and their association with clinical maturation (usage of fistula with two needles for 75% of dialysis sessions during 15 day period) was studied ( n = 129, after excluding lost to followup and expired patients; accordingly cohort was divided in matured ( M) or non-matured (NM) groups. Clinical and radiological parameters between both groups were compared; receiver operator curve (ROC) and correlation of Doppler parameters were analysed. Results: Of 129 AVF, 67.4% were matured and 32.5% non-matured. Mean age was 40 years with male predominance75% in both the groups. The mean arterial diameter for distal (NM = 1.96 ± 0.58 and M = 2.02 ± 0.41) and proximal AVF (NM = 3.37 ± 0.82 and M = 3.36 ± 0.75) was not statistically different in both the groups. The matured fistula group had a mean FMD of 11.67 ± 4.09 as against FMD value of 9.365 ± 3.55 in the failed fistula group ( p value 0.01). For maturation prediction, sensitivity and specificity of blood flow at 2 weeks were 86.2% and 59.5% and at 6 weeks 96.6% and 64.3%, respectively. In multivariate analysis predictors for AVF maturation were FMD (adjusted odds ratio (AOR) = 1.15) and blood flow (AOR = 1.67). Conclusion: Second and Sixth week AVF blood flow was found to be predicting AVF maturation. Higher baseline FMD correlated with the AVF maturation, but not with vessel diameter.
Needle-free connectors to prevent central venous catheter occlusion at a tertiary cardiac center: A prospective before and after intervention study
Authors: Sansalone Andrea , Vicari Raffaello , Orlando Fabio , Dell’Avo Alessandro , Giuffrida Silvia , Deelen Paula , Bernasconi Stefano , Villa Michele 
Published: August 2021

Objectives: To evaluate the effectiveness of needle-free connectors to maintain Central Venous Catheter—CVC patency. Background: Loss of patency is a common complication associated with CVC. For patients, this can be stressful and painful, and can result in a delay in infusion therapy. Pressure-activated anti-reflux needle-free connectors are one of the most modern devices; however, no studies have compared this connector with the open-system three-way stopcock in terms of the incidence of CVC occlusion. Methods: This study is a prospective before and after intervention study. From March to August 2018, an observation phase was conducted with the three-way stopcock as the standard central venous catheter hub and closure system (phase 1). After implementation of needle-free connectors (phase 2), post-intervention observations were made from September 2019 to January 2020 (phase 3). Results: Of 199 CVCs analyzed, 41.2% (40/97) occluded in at least one lumen in the first phase, and 13.7% (14/102) occluded after introducing the technological device, absolute risk reduction 27.5% (95% confidence interval 15.6%–39.4%). The lumens supported by needle-free connectors showed a higher probability of maintaining patency compared with three-way stopcocks. No differences were observed in the rate of infection. Conclusions: Pressure-activated anti-reflux needle-free connectors are effective and safe devices suitable for the management of vascular access in cardiac patient care. Staff training, even on apparently simple devices, is essential to avoid the risk of infection.