bluuebunny/crossref_metadata_2025_split huggingface dataset:
Planned Induction Versus Spontaneous Delivery Among Women Using Prophylactic Anticoagulation Therapy: A Retrospective Study
Authors: Rottenstreich A. , Zacks N. , Kleinstern G. , Levin G. , Sompolinsky Y. , Mankuta D. , Ezra Y. , Rottenstreich M. , Yagel S. , Kalishc Y 
Published: May 2021

(BJOG. 2020;127:1241–1248)
Venous thromboembolism (VTE) in pregnant women is commonly prevented using low-molecular weight heparin (LMWH), which does not cross the placenta. Women treated with LMWH often stop treatment for 24 hours prior to planned induction of labor or cesarean delivery to ensure safe neuraxial analgesia. It is unclear, however, how planned induction affects maternal outcomes compared with spontaneous delivery. This study aimed to fill a gap in the literature by comparing planned induction of labor and spontaneous onset of labor in pregnant patients using prophylactic LMWH therapy.
Hand Placement During Chest Compressions in Parturients: A Pilot Study to Identify the Location of the Left Ventricle Using Transthoracic Echocardiography
Authors: Delgado C. , Dawson K. , Schwaegler B. , Zachariah R. , Einav S. , Bollag L. 
Published: May 2021

(Int J Obstet Anesthesia. 2020;43:31–35)
Current guidelines for cardiopulmonary resuscitation (CPR) in pregnant women recommend hand placement on the lower half of the sternum, as this is an easily identifiable landmark. However, the heart is rotated during pregnancy and one study found the left ventricle (LV) was located under the sternum in only about half of cases. This study used transthoracic echocardiography (TTE) to investigate the displacement of the LV by the gravid uterus and left uterine displacement.
The Influence of Obesity on Coagulation in Healthy Term Pregnancy as Assessed by Rotational Thromboelastometry
Authors: Lee J. , Eley V.A. , Wyssusek K.H. , Kimble R.M.N. , Way M. , Cohen J. , van Zundert A.A. 
Published: May 2021

(Aust N Z J Obstet Gynaecol. 2020;60:714–719)
Rotational thromboelastometry (ROTEM), a point-of-care coagulation test, has demonstrated hypercoagulability in both the pregnant and obese populations. This enhanced clotting tendency in pregnant patients can prove crucial in preventing postpartum hemorrhage. This study aimed to assess the combined effect of pregnancy and obesity on coagulation in healthy women using ROTEM.
Maternal and Perinatal Outcomes for Women With Body Mass Index ≥50 kg/m2 in a Non-tertiary Hospital Setting
Authors: Pratt A. , Howat P. , Hui L. 
Published: May 2021

(Aust N Z J Obstet Gynaecol. 2020;60:361–368)
It is well known that maternal obesity increases the risk of several obstetric complications and interventions. However, data is limited regarding maternal prevalence and obstetric outcomes for obese Australian women, particularly for those with BMI ≥50 kg/m2. This study aimed to assess the prevalence of women with BMI ≥50 kg/m2 in a non-tertiary setting and to analyze outcomes for pregnant women based on BMI, with an emphasis on women with BMI ≥50 kg/m2.
Higher or Lower Hemoglobin Transfusion Thresholds for Preterm Infants
Authors: Kirpalani H. , Bell E.F. , Hintz S.F. , Tan S. , Schmidt B. , Chaudhary A.S. , Johnson K.J. , Crawford M.M. , Newman J.E. , Vohr B.R. , Carlo W.A. , D’Angio C.T. , Kennedy K.A. , Ohls R.K. , Poindexter B.B. , Schibler K. , Whyte R.K. , Widness J.A. , Zupancic J.A.F. , Wyckoff M.H. , Truog W.E. , Walsh M.C. , Chock V.Y. , Laptook A.R. , Sokol G.M. , Yoder B.A. , Patel R.M. , Cotten C.M. , Carmen C.F. , Devaskar U. , Chawla S. , Seabrook R. , Higgins R.D. , Das A. 
Published: May 2021

(N Engl J Med. 2020;383:2639–2651)
Extremely-low birthweight infants are commonly treated with packed red-cell transfusions to treat low hemoglobin, but transfusion protocols vary. Randomized control trial (RCT) evidence is limited, and more evidence is needed to evaluate low and high hemoglobin thresholds in terms of complications. This study, informed by a previous study of more than 450 neonates, compared transfusions at low and high hemoglobin thresholds in terms of incidence of death or neurodevelopmental impairment in infants at 22 to 26 months of age.
Safety Guideline: Neurological Monitoring Associated With Obstetric Neuraxial Block 2020 A Joint Guideline by the Association of Anaesthetists and the Obstetric Anaesthetists’ Association
Authors: Yentis S.M. , Lucas D.N. , Brigante L. , Collis R. , Cowley P. , Denning S. , Fawcett W.J. , Gibson A. 
Published: May 2021

(Anaesthesia. 2020;75:913–919)
Early detection of neurological complications following a neuraxial procedure is essential to minimizing harm. Previous guidelines for management of neuraxial anesthesia lack guidance on neurological monitoring or are not specific to obstetric patients. The recommendations in this paper were produced by representatives from the Association of Anesthetists and Obstetric Anesthetists’ Association with the goal to guide monitoring and management of neurologic recovery in obstetric patients following neuraxial block.
Incidence and Risk Factors for Maternal Hypoxaemia During Induction of General Anesthesia for Non-elective Caesarean Section: A Prospective Multicentre Study
Authors: Bonnet M.P. , Mercier F.J. , Vicaut E. , Galand A. , Keita H. , Baillard C 
Published: May 2021

(British J Anaesthesia. 2020;125:e81–e87)
General anesthesia, which can increase the risk of respiratory complications, is used in about 5% of deliveries and is mainly used in emergency cesarean sections. One study found that hypoxemia affected 2% of cesarean patients undergoing general anesthesia, but no risk factors were identified. This study aimed to determine the incidence and risk factors of hypoxemia in patients undergoing general anesthesia for non-elective cesarean delivery.
Enhanced Recovery After Caesarean Delivery Versus Standard Care Studies: A Systematic Review of Interventions and Outcomes
Authors: Sultan P. , Sharawi N. , Blake L. , Carvalho B. 
Published: May 2021

(Int J Obstet Anesthesia. 2020;43:72–86)
Obstetric units worldwide are incorporating enhanced recovery after cesarean (ERAC) programs. These are multimodal care pathways aimed at improving outcomes, reducing complications and decreasing length of hospital stay. However, the ERAC interventions used, and the outcomes used to assess success of ERAC protocols vary widely. Given this, there is the need to assess the level of evidence supporting the use of ERAC. This review aimed to identify ERAC implementation studies that compared patients cared for with ERAC principles to a control group, identify specific interventions and outcome measures, and compare interventions with published guidelines, The study also reports on the impact of ERAC and the level of available evidence supporting the use of ERAC.
Inhalational Induction of General Anaesthesia for Elective Caesarean: Ethical Acceptability in Treatment-resistant Needle Phobia?
Authors: Parrott N. , Prabhu P. , Yeow C. 
Published: May 2021

(Int J Obstet Anesthesia. 2020;43:27–29)
This case study describes the cesarean delivery of a woman with a severe needle phobia, which led her to decline regional anesthesia, IV access, or other processes involving needles while awake. The patient previously underwent general anesthesia for an emergency cesarean delivery and requested inhalational induction of anesthesia for her elective repeat cesarean.
A Call for a Patient Preference Predictor
Authors: Wendler David 
Published: May 2021

OBJECTIVES:
When patients lose the capacity to make their own decisions, current practice relies on their family and loved ones to try to identify the treatment course the patient would have chosen for themselves. The fact that this approach has remained essentially unchanged for over 40 years raises the question of whether it successfully provides care that is consistent with patients’ treatment preferences.

DATA SOURCES:
Published studies on the outcomes and impact of surrogate decision-making.

STUDY SELECTION:
All identified articles.

DATA EXTRACTION:
Review by the author.

DATA SYNTHESIS:
Surrogates frequently are not able to identify the treatment preferences of decisionally incapacitated patients and can experience significant distress as a result of making decisions for them.

CONCLUSIONS:
Revisions to existing practice are needed to increase the extent to which surrogates are able to identify the treatment preferences of decisionally incapacitated patients. One possibility is to assess whether predicting patients’ treatment preferences based on the preferences of similar patients might increase the extent to which patients are treated consistent with their preferences and thereby reduce the burden on their surrogates.
Navigating the Doctor of Nursing Practice project within an academic practice partnership
Authors: Hartjes Tonja M. , Starr Kathryn , Kittelson Sheri , Duckworth Laurie 
Published: May 2021

ABSTRACT
The Doctor of Nursing Practice (DNP) curriculum was initially developed in 2004. The DNP degree is a practice doctorate, which educates nurses to the highest level of clinical nursing practice. DNP students must complete a scholarly project in accordance with the American Association of Colleges of Nursing (AACN) guidelines. The project is an opportunity for the student to integrate skills into practice and demonstrate principles of advanced nursing practice. The AACN provides recommendations for the DNP project, but much confusion regarding the context and implementation of the project still exists. At one academic health sciences center, DNP project students often complete their projects within academic practice partnerships. Such partnerships are encouraged by the AACN. Several DNP quality improvement (QI) projects were submitted a hospital's interdisciplinary quality week event. Upon review, some of the abstracts were found to contain aspects of research. This finding prompted the review of all DNP project processes to standardize methods for faculty, students, the University, and the academic practice partner.
An exploration of perceived neonatal nurse practitioner authority in a restricted practice setting
Authors: Bailey Teresa , Staebler Suzanne , Pont Molly , Christiansen Brittany , Champion Jane Dimmit 
Published: May 2021

ABSTRACT

Background:
Perceptions of autonomy in practice affect Neonatal Nurse Practitioner (NNP) job satisfaction, retention, and motivation to pursue NNP roles. However, Novice to Expert theory describes the processes for transitioning to nurse practitioner roles are not in relationship with NNP practice autonomy.

Purpose:
Relationships between Advanced Practice Registered Nurse (APRN) practice authority, state restrictions, APRN volume, and health care access exist. However, do APRN perceptions of autonomy relate to motivation to pursue practice authority? This study provides an exploration of perceptions of NNP practice autonomy in this context.

Methodology:
Semistructured interviews conducted with NNPs and neonatologists practicing in a restricted setting explored perceptions of practice expertise and autonomy, based on Patricia Benner's Novice to Expert theoretical framework. Laddered methodology organized survey questions, and the Framework Method was used for analysis of results.

Results:
The majority of eligible NNPs (n = 12, 67%) and neonatologists (n = 8, 67%) agreed to study participation. Identified themes were grouped into larger concepts, including “NNP practice authority,” “NNP expertise,” and “NNP autonomy.” For example, “NNP expertise” included the theme “determining NNP expertise” and associated factors included “procedural skills,” “years and acuity of practice level,” and “confidence in management plan and emergent situations.”

Conclusions:
Both neonatologists and NNPs perceived neonatologists as a practice authority with support for NNP autonomy. Factors indicating NNP expertise correlated with domains in Benner Novice to Expert theory.

Implications:
These findings support previous work concerning the evolution of expertise and transition to practice. More inquiry to understand perspectives of APRNs in restricted practice settings is indicated.
Comparing nurse practitioners/physician assistants and physicians in diagnosing pediatric abdominal pain for ESI level 3 patients seen in the emergency department
Authors: Hoyt Karen Sue , Agan Donna L. , Jordan Kathleen Sanders , Ramirez Elda , Nichols Stephen , Topp Robert 
Published: May 2021

Background:
Accuracy of emergency department (ED) diagnosis affects care management including tests, discharges, and readmissions.

Purpose:
This retrospective study compared nurse practitioners/physician assistants (NPs/PAs) with physicians (MDs/DOs) on accuracy of diagnosing Emergency Severity Index (ESI) level 3 pediatric abdominal pain (AP) in the ED. Abdominal pain unrelated to trauma is a common ED pediatric visit.

Methodology:
Data acquired from four hospital sites of a multistate emergency group examined patients younger than 18 years who were initially admitted for AP ESI level 3.

Results:
The accuracy of AP ESI level 3 diagnoses was 94.9%, 90.9%, and 96.5% by physicians, NPs/PAs, and a collaboration of NP/PA/physician, respectively (χ2 = 13.187, p < .001). Accuracy of AP ESI level 3 diagnoses was greater with general admissions, intensive care unit admissions, transfers, or left against medical advice (100%) than with those who were discharged (χ2 = 11.058, p = .001). Abdominal pain complaints were segmented into five areas (i.e., AP, back pain, chest pain, epigastric pain, and pelvic pain). Irrespective of provider, those with a final diagnosis of AP or epigastric pain were correctly triaged and those with a final diagnosis of chest or back pain were incorrectly triaged as AP ESI level 3.

Conclusions:
When comparing providers in this subset (n = 43), there was no significant difference in the accuracy of assigning AP ESI level 3 (χ2 = 0.467, p = .495).

Implications:
Only cases with a final diagnosis of pelvic/genitourinary pain saw disparity in the accuracy (27 correct, 16 incorrect, χ2 = 1,681.80, p < .001).
Extending the radius of family-centered care in the pediatric cardiac intensive care unit through virtual rounding
Authors: Tallent Sarah , Turi Jennifer L. , Thompson Julie , Allareddy Veerajalandhar , Hueckel Rémi 
Published: May 2021

ABSTRACT

Background:
The arrival of COVID-19 brought urgent limitation of visitation in hospitals across the country. Family-centered care and its delivery rapidly changed and left the family behind—unable to actively participate in their loved one's care.

Local problem:
A southeastern academic medical center pediatric cardiac intensive care unit (PCICU) needed to augment family-centered medical rounds when parents could not be at the bedside. No alternative to physical presence for daily medical rounds existed in the PCICU.

Methods:
A virtual rounding (VR) program was implemented allowing parents of patients admitted to PCICU to join medical rounds remotely through teleconferencing. Preintervention and postintervention rounding times, staff perceptions of the program, and parental satisfaction scores using the Pediatric Family Satisfaction in the Intensive Care Unit (pFS-ICU) tool were measured.

Interventions:
This quality improvement project implemented a VR program offered to all families of patients in the PCICU.

Results:
VR did not increase rounding times after implementation (p = .673). Staff satisfaction surveys revealed that staff felt the VR program did not prolong rounding times (p ≤ 0.001), workload impact perceptions improved after intervention (p = <0.001), and staff felt VR should be offered to families in PCICU (p ≤ 0.001). Only nine pFS-ICU surveys were completed giving the family a limited voice in the evaluation of this project.

Conclusions:
This project demonstrates that VR can be successfully implemented for family engagement without increased burden on staff.
Comparative Anatomical Study of Fronto-Orbito-Zygomatic and Fronto-Temporal Approach to the Central Skull Base
Authors: Spina Alfio , Gagliardi Filippo , Bailo Michele , Boari Nicola , Calvanese Francesco , Mortini Pietro 
Published: May 2021

Abstract
Despite the advances in microsurgery and neuroanatomy, surgery of the central skull base still represents a challenge. Fronto-temporal approach has represented the mainstay of surgical approaches to this region. With advances in skull base surgery, orbital and zygomatic extensions were added to fronto-temporal approach to improve exposure minimizing brain retraction.
The authors compared fronto-temporal and fronto-orbitozygomatic approaches to the central skull base by using the previously described operability score, to three different anatomical targets: the ipsilateral anterior clinoid process, the contralateral anterior clinoid process, and the ipsilateral posterior clinoid process.
Based on the measurements taken, fronto-orbitozygomatic approache showed higher values at all 3 targets. The reported values were critically discussed.
The operability score has been reported as an effective method to compare surgical approaches. The present study demonstrated the maximal possibility of exposure of the two approaches. Based on the strong variability of this anatomical region, especially because of the different pathologies, the authors suggest considering the operability score as a further tool to better define the best surgical approach to this anatomical region.
Assessment of Tissue Perfusion Using the Peripheral Perfusion Index and Lactate Clearance in Shock in Pediatric Patients
Authors: Bazaraa Hafez , Roby Shereen , Salah ElShimaa , Algebaly HebatAllah 
Published: May 2021

ABSTRACT

Background:
Pediatric shock has a high mortality rate because many of the early clinical signs are subtle and have poor sensitivity and specificity. Pediatric shock was categorized either: compensated with normal blood pressure, poor skin perfusion (CRT >2 s, mottled, cool peripheries, peripheral cyanosis), weak peripheral pulse, age specific tachycardia, tachypnoea, and oliguria or decompensated with hypotension (SBP < 70 + (2× age in years) mm Hg and decreased mental status. The perfusion index is a non-invasive method for assessing peripheral perfusion and may be a useful marker for identifying shock early in pediatric patients.

Objective:
This prospective cohort study (November 2019 to August 2020) evaluated whether the perfusion index, lactate, and/or lactate clearance could predict mortality among pediatric shock patients.

Methods:
Fifty children (68% male) with shock underwent assessments at presentation to the emergency room to evaluate their heart rate, blood pressure, capillary refill time, central venous pressure, perfusion index, cardiac index, systemic vascular resistance, central venous oxygen saturation, and lactate clearance.

Results:
The perfusion index range was 0.03 to 2.2 and ≤0.18 as the cut-off for mortality prediction providing 74% sensitivity and 78% specificity. The serum lactate concentration range was 0 to 16 mmol/L and >5.7 mmol/L as the cut-off for mortality prediction provided 70% sensitivity and 96% specificity at presentation to the emergency room. The lactate clearance range was 3% to 75% and >10% as the cut-off for survival prediction after resuscitation and at 6 h later.

Conclusion:
Perfusion index (PI), lactate, and lactate clearance provided comparable sensitivity and specificity for predicting outcomes among pediatric patients with shock Therefore, we suggest that the PI is an inexpensive, rapid, and non-invasive tool that can be used to predict illness severity and mortality in busy pediatric intensive care units and emergency departments. This tool may guide better patient triage and an earlier diagnosis of shock in this setting.
Spectrum of neurological manifestations and systematic evaluation of cerebrospinal fluid for SARS-CoV2 in patients admitted to hospital during the COVID-19 epidemic in South Africa
Authors: Davis Angharad G , Bremer Marise , Schäfer Georgia , Dixon Luke , Abrahams Fatima , Goliath Rene T , Maxebengula Mpumi , Proust Alize , Chavda Anesh , Black John , Wilkinson Robert J ,   And the HIATUS Study Consortium
Published: May 2021

AbstractNeurological manifestations of COVID-19 are increasingly described in the literature. There is uncertainty whether these occur due to direct neuroinvasion of the virus, para-infectious immunopathology, as result of systemic complications of disease such as hypercoagulability or due to a combination of these mechanisms. Here we describe clinical and radiological manifestations in a sequential cohort of patients presenting to a district hospital in South Africa with neurological symptoms with and without confirmed COVID-19 during the first peak of the epidemic. In these patients, where symptoms suggestive of meningitis and encephalitis were most common, thorough assessment of presence in CSF via PCR for SARS-CoV2 did not explain neurological presentations, notwithstanding very high rates of COVID-19 admissions. Although an understanding of potential neurotropic mechanisms remains an important area of research, these results provide rationale for greater focus towards the understanding of para-immune pathogenic processes and the contribution of systemic coagulopathy and their interaction with pre-existing risk factors in order to better manage neurological disease in the context of COVID-19. These results also inform the clinician that consideration of an alternative diagnosis and treatment for neurological presentations in this context is crucial, even in the patient with a confirmed diagnosis COVID-19.
Getting the Nod: Characterizing pediatric head motion in movie- and resting-state fMRI
Authors: Frew Simon , Samara Ahmad , Shearer Hallee , Eilbott Jeffrey , Vanderwal Tamara 
Published: May 2021

AbstractHead motion continues to be a major problem in fMRI research, particularly in developmental studies where an inverse relationship exists between head motion and age. Despite multifaceted and costly efforts to mitigate motion and motion-related signal artifact, few studies have characterized in-scanner head motion itself.This study leverages a large public dataset (N=1388, age 5-21y, The Healthy Brain Network Biobank) to characterize pediatric head motion in space, frequency, and time. We focus on practical aspects of head motion that could impact future study design, including comparing motion across groups (low, medium, and high movers), across conditions (movie-watching and rest), and between males and females.Analyses showed that in all conditions, high movers exhibited a different pattern of motion than low and medium movers that was dominated by x-rotation, and z- and y-translation. High motion spikes (>0.3mm) from all participants also showed this pitch-z-y pattern. Problematic head motion is thus composed of a single type of biomechanical motion, which we infer to be a nodding movement, providing a focused target for motion reduction strategies. A second type of motion was evident via spectral analysis of raw displacement data. This was observed in low and medium movers and was consistent with respiration rates. We consider this to be a baseline of motion best targeted in data preprocessing. Further, we found that males moved more than, but not differently from, females.Significant cross-condition differences in head motion were found. Movies had lower mean motion, and especially in high movers, movie-watching reduced within-run linear increases in head motion (i.e., temporal drift). Finally, we used intersubject correlations of framewise displacement (FD-ISCs) to assess for stimulus-correlated motion trends. Subject motion was more correlated in movie than rest and stimulus-correlated stillness occurred more often than stimulus-correlated motion. Possible reasons and future implications of these findings are discussed.