bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trauma Dictations in the Emergency Department: A Quality Improvement/Patient Safety Project
Authors: Toth Eric W. , Richardson Kristopher , Berry Courtney , Butki Nikolai 
Published: February 2021

CONTEXT Trauma patients frequently represent a unique and challenging patient population in emergency medicine care settings. The policy of the McLaren Oakland Emergency Department (ED) is to have the treatment of all Level 1 and Level 2 trauma activations dictated by the ED resident. This policy is intended to facilitate both patient safety through clear communication between multiple medical services and quality improvement through reporting trauma specific quality metrics to third party agencies. Despite this requirement, trauma dictations in this setting were often found to not be completed. The purpose of this quality improvement/patient safety project was to implement a trauma dictation template to increase the rate of completed ED trauma dictations to above 75% of all Level 1 and Level 2 trauma activations. METHODS A trauma dictation template was created to aid ED residents while completing trauma dictations. It was thought by the authors that the implementation of a standardized dictation template would help residents specify the necessary components needed to improve both patient safety and quality reporting. The development of the template was a collaborative effort between the emergency medicine residents and faculty, the trauma coordinator and trauma surgeons. The project was evaluated using two separate measures. A “process measure” was first used to determine if the addition of the trauma template made dictating less burdensome for ED residents, and an “outcomes measure” helped the authors examine whether template implementation actually led to an increased rate in completed trauma dictation. RESULTS Data were collected during a three-month period prior to template implementation and three months after implementation. From November, 2015 through April, 2016, a total of 132 Trauma Activations were reviewed. The rate of completed dictations on Level 1 trauma activations increased from 45.16% to 53.33%. However, the rate of dictations on Level 2 trauma activations decreased from 50% to 30.4%, suggesting that Level 1 trauma patient care may have derived greater improvements from the new dictation template. CONCLUSIONS The results of the ED residents’ evaluative survey responses were generally positive, indicating that the trauma template was perceived by most residents as a useful tool to complete dictations. Even though the outcome goal was not achieved, the project successfully achieved the goal of creating and implementing a usable trauma dictation template. Following the Plan-Do-Study-Act model for quality improvement/patient safety projects, the next project will examine additional barriers preventing users from utilizing this initial well-received tool.
Delayed Intracranial Hemorrhage in Patients Taking Warfarin with Head Trauma
Authors: Macedo Mark , Grima Jonathon , Yangouyian Michael , Kim Brian S. 
Published: February 2021

CONTEXT Patients presenting to the Emergency Department after a minor head injury have been shown to have a higher incidence of delayed spontaneous intracranial bleed, even with an initial negative CT. Some institutions have initiated a protocol of 24-hour observation followed by repeat head CT scan the next day. At the authors’ institution, a 24-hour observation protocol was adopted in January 2012. The authors sought to evaluate the utility of this protocol given the apparently limited amount of data to support such a practice. METHODS A 12-month prospective observational study conducted at a community hospital evaluating a 24-month observation protocol for patients presenting after a minor head injury. During this study period, a sample of minor head injury patients were identified and followed through their hospital course. CT scan results were also compiled, and patient charts were reviewed at 30 days for any return visits or post-injury complications. RESULTS A total of 51 patients were enrolled during the study period. Of those patients receiving a repeat head CT, none showed any evidence of a new or worsening intracranial bleed, with all patients discharged safely from the hospital. At 30 days, patients’ charts were reviewed to examine whether any patients had returned to the hospital for any reason. No sample patients returned to the hospital within the 30-day review period. CONCLUSION Similar to the results of the retrospective chart review, no sample patients with minor head injuries showed any evidence of a subsequent delayed intracranial bleed during the 12-month study period. Our study results suggest that 24-hour observation protocols with costly repeat CT head scans may not be useful in the management of most head trauma patients. Patients may be better served to be discharged home with education including signs of symptoms of a worsening bleed (i.e., confusion, worsening headaches and not feeling right) that actually warrant a return to the hospital.
Utilizing PDSA Cycle in Implementing a Chest Pain Accelerated Diagnostic Protocol
Authors: Breckner Gretchen , Walker Jennifer , Hanley Karen , Butki Nikolai 
Published: February 2021

CONTEXT The authors in the Emergency Department (ED) at McLaren Oakland utilized the Plan-Do-Study-Act (PDSA) model to implement, evaluate and incrementally modify a Chest Pain Accelerated Diagnostic Protocol (CPADP) using the History, EKG, Age, Risk Factors, Troponin (HEART) Score at their institution. The objective of this study was to evaluate the ability of patients who presented to the ED with chest pain and fell into the low risk category based on their HEART Score to receive adequate outpatient follow-up for their chest pain. METHODS Modifying protocols implemented at other institutions, in 2016 the authors developed CP-ADP utilizing the HEART Score to risk-stratify patients presenting to the ED with chest pain as low, moderate or high risk for major adverse cardiac events (MACE). Patients identified as low risk were offered the options of hospital observation or being discharged home with outpatient follow-up within seven days. Patients who were risk-stratified into the medium or high risk for MACE were admitted into the in-patient setting for cardiac evaluation. Once implemented, the protocol was evaluated to measure patient follow-up within thirty days. RESULTS During a five-month period, 50 patients presenting to the ED with chest pain were risk-stratified as low risk for adverse cardiac events and opted for discharge from the ED to follow-up in the outpatient setting. A total of 18 patients were lost to follow up, and two patients subsequently returned to the ED for further evaluation of their chest pain and were admitted to the inpatient setting. These two patients were not included in the analysis. Thirty patients were successfully contacted by telephone 30 days postdischarge. Of those 30 patients contacted, none experienced any MACE events. However, only 14 (47%) low risk patients followed up with a primary care provider or cardiologist and only four (13%) received provocative cardiac testing (i.e., stress testing). CONCLUSIONS Only 47% of patients discharged from the ED received outpatient follow-up and only 13% received cardiac testing. As a result of the study, the multi-disciplinary Chest Pain Committee has progressed to the Act ‘A’ step of the PDSA cycle to modify the authors’ protocol to ensure more clinically appropriate outpatient follow-up for patients discharged under the CP-ADP.
Use of Disposable Punch Biopsy Device to Add Foley Catheter Fenestration to Improve Drainage of Post Radical Prostatectomy Anastomotic Leak
Authors: Allen Aubrey , Wynberg Jason , Walton Eric 
Published: February 2021

CONTEXT Radical prostatectomy (RP) is a major oncologic urological surgery that can have high morbidity if complications arise. Bladder-urethral urine anastomotic leaks (AL) are one of the most common complications and can greatly increase morbidity. To date, there are few resources to manage AL. One management technique is using a Foley catheter with an additional auxiliary drainage port, also known as a fenestrated catheter. This type of auxiliary drainage port allows a low-pressure drainage source that is located near the anastomosis to increase urine drainage from catheter rather than from the AL site. The optimal size and location of this additional drainage port is currently unknown. This experiment evaluated the optimal auxiliary drainage port size and an inexpensive technique to easily construct such a catheter. METHODS Utilizing different size punch biopsies, auxiliary drainage ports were placed in different size Foley catheters and drainage rates and the structural integrity of the catheter was assessed. RESULTS A 3.0 mm punch biopsy located 1.0 cm proximal to the Foley balloon in an 18 French (Fr) catheter was determined to be the optimal size. A 2.0 mm punch biopsy provided significantly less drainage. The 4.0 mm punch biopsy compromised the structural integrity of the catheter. CONCLUSIONS Based on these experimental results, we recommend using a 3.0 mm punch biopsy in an 18 Fr catheter 1.0 cm. proximal to the balloon for an auxiliary drain site in Foley catheter when the anastomosis is not watertight or the surgeon has reason to believe the patient is at higher risk for an AL Factors such as history of pelvic radiation, abnormal anatomy, large prostate, post-surgical hematoma formation, obesity, previous prostatic surgery, difficult anastomosis, blood loss and postoperative urinary tract infection may make use of this type of device more attractive.
Tranexamic Acid in the Treatment of Hip Fractures: A Clinical Review
Authors: Krebs Nathan M. , VanWagner Michael J. , Marchewka Tiffany , Faraj Usama , Vitale Christopher R. 
Published: February 2021

INTRODUCTION Although regularly used as a method to reduce blood loss in elective orthopedic procedures (e.g., total hip and knee arthroplasty), there currently is little evidence concerning the optimal dosage, timing and route for the use of tranexamic acid to reduce postoperative blood loss in hip fracture repair. SUMMARY OF THE EVIDENCE The current literature suggests that tranexamic acid may be used to reduce postoperative blood loss in addition to reducing the risk of requiring blood transfusions following the surgical repair of hip fractures. Furthermore, it may have the potential to improve patient outcomes and decrease the overall costs of caring for this patient population. CONCLUSIONS Further studies are needed to truly gauge the effect of tranexamic acid on long-term patient outcomes and hospital costs.
Sub-Dissociative Ketamine Use in the Emergency Department for Treatment of Suspected Acute Nephrolithiasis: The SKANS Study
Authors: Grill Justin , Bryant Caleb , Dunikoski Leonard , Carrasco Zach , Wisniewski Samuel J. , Price Kristen 
Published: February 2021

CONTEXT Currently, there is no standard therapy for treatment of acute renal colic. With the increased scrutiny and controversy now surrounding opioids, the authors identified a need to investigate an alternative medication for pain control. As such, they sought to determine the efficacy of sub-dissociative (i.e., low) doses (0.3 mg/kg) of ketamine in providing Emergency Department (ED) patients acute pain management for renal colic secondary to nephrolithiasis. METHODS After institutional review board (IRB) approval, the authors conducted a non-blinded, prospective clinical study. A convenience sample of n = 34 patients from the ED of a Western Michigan-based health system with suspected renal colic received one intravenous dose of ketorolac, 30 mg if over 50 kg body weight or 15 mg if under 50 kg In patients weighing greater than 50 kg, up to two doses of sub-dissociative ketamine were then given to further control pain. Pain was assessed at times 0, 30, 60, 90 and 120 minutes. RESULTS There was a statistically significant pain reduction with administration of sub-dissociative ketamine, with 24 (69.2%) patients reporting an average reduction in pain score > 30% (t = 3.16, p = 0.004). Initial average pain scores for patients receiving sub-dissociative ketamine averaged 7.76 (SD = 2.55) on the 11-point verbal Pain Numeric Rating Scale. After a first dose of ketamine, patients’ average pain score was 3.56 (SD = 0.74) at 30 minutes. After two hours, patients’ average score was 2.56 (SD = 0.65), indicating that pain control was still effective over time with no statistically significant change in pain scores. Additionally, there was no statistically significant difference in pain reduction observed between genders (t = -0.192, p = 0.850). CONCLUSIONS Based on these results, sub-dissociative ketamine may be considered a reasonable and effective supplemental non-opiate treatment option for suspected renal colic in otherwise healthy 18-70-year-old patients and could provide an effective alternative to traditional therapies. Further studies utilizing this methodology with larger, more generalizable samples are needed to further validate these findings.
Relationship between BI-RADS and the Results of the Wire-Guided Percutaneous Localization for Non-Palpable Breast Lesions
Authors: Dughayli Mohamad , DeFatta Jason , Dashtaei Ayda , Peace Amber , Baidoun Fadi , Olson Gregory 
Published: February 2021

INTRODUCTION The aim of this study is to evaluate the relationship between Breast Imaging Reporting and Data System and surgical biopsies that may increase effectiveness of wire-guided percutaneous localizations for non-palpable breast lesions. METHODS A retrospective review of a sample of 149 patients who underwent wire-guided localization with wide local excision for non-palpable breast lesions at the authors’ institution between January 2013 and April 2016. After IRB approval, sample patients’ records were reviewed and data were collected concerning their radiological, histological and surgical characteristics. RESULTS One (0.67%) complication occurred related to wire migration. There were nine (6.04%) recorded cases of seroma and three (2.01%) cases of hematoma. Breast Imaging Reporting and Data System (BI-RADS) Category 4 was found to have a positive predictive value of 28.4% for breast cancer. Under Category 4 subcategorization 4A, 4B, and 4C, the number of positive lesions were two (6.89%), three (10.34%) and five (17.24%), respectively. Forty (78.43%) of the 51 patients with cancer had negative (i.e., non-cancerous) margins compared to 11 (21.57%) cases that had positive margins after the first procedure. CONCLUSION The BI-RADS Category 4 encompasses the majority of lesions, with approximately 70% of such biopsies lesions later found to be benign. A subcategorization of BI-RADS 4 needs further clarification in distinguishing benign vs malignant imaging characteristics. Future retrospective studies designed to identify benign vs. malignant lesions, confirmed by validating prospective studies, will better clarify a new subcategorization of BI-RADS Category 4, thus allowing surgeons and radiologists to make the best surgical recommendations for their patients.
Do Not Let it Be the Last: End-of-Life Care Decisions in the Primary Care Clinic
Authors: Dang My-Trang T. , Ahmed Zohair , Betcher Jason M. , Kadakia Saloni , Wisniewski Samuel J. , Sealey John W. 
Published: February 2021

CONTEXT For many patients, end-of-life care (EOLC) wishes are unknown and are generally only brought up during healthcare crises. During such healthcare episodes, loved ones are often distraught, and as such, can find it difficult to focus on details surrounding the event. The best place for these discussions may be in non-acute settings including primary care clinics. The purpose of this study was to examine how well a sample of patients (N = 177) in three Michigan-based primary care teaching clinics thought they and their loved ones were prepared in terms of having their EOLC wishes known. METHODS Prospective data were collected from three Internal Medicine teaching clinics in the Metro-Detroit area through an anonymous written survey addressing EOLC issues in a 16-item cross-sectional study. Respondents were adult patients at one of three participating primary care clinics. Perceived preparedness for EOLC was measured by: 1) possibly having had a prior EOLC discussion with a healthcare provider 2) having created an Advance Directive, such as a Durable Power of Attorney (DPOA) or Living Will with medical decision preferences, 3) reported preferences for quality versus quantity of life, and 4) preferences for CPR and other specific life-sustaining interventions. RESULTS In this sample, 77 (43.5%) of 177 respondents had discussed their EOLC wishes with a provider. Regarding Advance Directives, 63/177 (35.6%) had established a DPOA, and 59/177 (22%) had made a Living Will. The majority of respondents preferred quality over quantity of life. The most difficult EOLC questions included the decision for CPR, tracheostomy, and PEG tube placement. CONCLUSIONS Based on these results, EOLC discussions probably occur infrequently in the primary care or other healthcare settings. Most survey responses indicated that sample patients were unprepared concerning the details of future EOLC decisions. Engagement of such discussions should be a part of routine visits in the primary care clinic and should be re-visited when there is a change in a patient’s health. Further larger-scale studies using validated surveys are required in this vitally important area of practice. Key Words: advance care planning, end-of-life care conversations, primary care
The transformation of the forest steppe in the lower Danube Plain of southeastern Europe: 6000 years of vegetation and land use dynamics
Authors: Feurdean Angelica , Grindean Roxana , Florescu Gabriela , Tanţău Ioan , Niedermeyer Eva M. , Diaconu Andrei-Cosmin , Hutchinson Simon M. , Nielsen Anne Brigitte , Sava Tiberiu , Panait Andrei , Braun Mihaly , Hickler Thomas 
Published: February 2021

Abstract. Forest steppes are dynamic ecosystems, highly susceptible to changes in
climate, disturbances and land use. Here we examine the Holocene history of
the European forest steppe ecotone in the lower Danube Plain to better
understand its sensitivity to climate fluctuations, fire and human impact,
and the timing of its transition into a cultural forest steppe. We used
multi-proxy analyses (pollen, n-alkanes, coprophilous fungi, charcoal and
geochemistry) of a 6000-year sequence from Lake Oltina (southeastern Romania) combined
with a REVEALS (Regional Estimates of Vegetation Abundance from Large Sites) model of quantitative vegetation cover. We found a greater tree cover, composed of xerothermic (Carpinus orientalis and Quercus) and temperate (Carpinus betulus, Tilia, Ulmus and Fraxinus) tree taxa,
between 6000 and 2500 cal yr BP. Maximum tree cover (∼ 50 %), dominated by C. orientalis occurred between 4200 and 2500 cal yr BP at a time of
wetter climatic conditions and moderate fire activity. Compared to other
European forest steppe areas, the dominance of C. orientalis represents the most distinct
feature of the woodland's composition at this time. Tree loss was underway
by 2500 yr BP (Iron Age), with the REVEALS model indicating a fall to
∼ 20 % tree cover from the Late Holocene forest maximum,
linked to clearance for agriculture, while climate conditions remained wet.
Biomass burning increased markedly at 2500 cal yr BP, suggesting that fire
was regularly used as a management tool until 1000 cal yr BP when woody
vegetation became scarce. A sparse tree cover, with only weak signs of
forest recovery, then became a permanent characteristic of the lower Danube
Plain, highlighting more or less continuous anthropogenic pressure. The
timing of anthropogenic ecosystem transformation here (2500 cal yr BP) falls between that in central-eastern (between 3700 and 3000 cal yr BP) and
eastern (after 2000 cal yr BP) Europe. Our study is the first quantitative
land cover estimate at the forest steppe ecotone in southeastern Europe
spanning 6000 years. It provides critical empirical evidence that, at a
broad spatial scale, the present-day forest steppe and woodlands reflect the
potential natural vegetation in this region under current climate
conditions. However, the extent of tree cover and its composition have
been neither stable in time nor shaped solely by the climate. Consequently,
vegetation change must be seen as dynamic and reflecting wider changes in
environmental conditions including natural disturbances and human impact.
Name of the Year Report 2020
Authors: Sutton Laurel 
Published: February 2021

The fourteenth annual Name of the Year vote was held online by the American Name Society on January 24, 2021. The discussion was moderated by ANS President Laurel Sutton and former Name of the Year Coordinator, Dr. Cleveland Evans. The event was attended virtually by 23 scholars from around the globe. This report provides a summary of the deliberations and onomastic selections.
A MÍDIA COMO INSTRUMENTO PARA A CONSTRUÇÃO DE CONSENSOS (THE MEDIA AS INSTRUMENT FOR THE CONSTRUCTION OF CONSENSUS) - Doi: http://dx.doi.org/10.5212/OlharProfr.v.11i2.253273
Authors: Holleben Índia Mara Aparecida Dalavia de Souza , Sapelli Marlene Lucia Siebert 
Published: February 2021

A educação acontece em diferentes espaços. A mídia também é um desses espaços. Por isso, neste artigo, propusemo-nos a analisar algumas questões, que consideramos relevantes e que, em geral, ocultam a hegemonia de uma classe sobre a outra. No processo educativo que acontece por meio da mídia, há uma contribuição para fortalecer tal hegemonia. Isso comprova a não neutralidade da educação. A mídia tem se mostrado como partido ideológico da elite, e o poder que exerce neste espaço social pode ser definido como poder simbólico, atrelado intimamente ao poder econômico, político e, em alguns casos, até coercitivo. Para discutirmos a mídia como instrumento educativo, em favor da manutenção do status quo, optamos em fazê-lo apresentando como duas temáticas que são por ela tratadas: Gênero e o Movimento dos Trabalhadores Rurais Sem Terra. Palavras-chave: Mídia. Educação. Consenso. Hegemonia. Gênero. Movimento dos Trabalhadores Rurais Sem Terra. Education is settled in different places and the media is also one of these places. Therefore, in this article we propose to analyze some relevant questions that can usually hide the hegemony of a class on the other. In the educative process intermediated by the media, we can notice a contribution to empower this hegemony. This put in evidence the education no neutrality position. The media can be understood as an ideological political organization of the upper class and its power can be defined as a symbolic one, linked to the economic and politician forces and even acting, in some cases, as a coercion element. To discuss the media as an educative instrument, in favor of the of the status quo maintenance, we present two thematic that have been followed: Gender and Movimento dos Trabalhadores Rurais Sem Terra (The Movement of the Agricultural Workers With No Land). Keywords: Media. Education. Consensus. Hegemony. Gender. Movimento dos Trabalhadores Rurais Sem Terra.
Ação pedagógica de promoção a crianças e adolescentes institucionalizados: uma face da educação não-escolar
Authors: Cavagnari Luzia Borsato 
Published: February 2021

O artigo apresenta um aspecto da atuação de professores e acadêmicos do curso de Pedagogia e outras Licenciaturas no projeto de extensão: Ação Pedagógica de Promoção à Crianças e Adolescentes participantes de Instituições Sociais e Assistenciais de Ponta Grossa. Parte do contexto social e histórico das entidades assistenciais do município e do significado das ações sociais, situando o direito à cidadania como base da formação tanto das crianças / adolescentes institucionalizadas quanto dos educadores que atuam nas instituições. No texto, as ações de formação dos profissionais são enfatizadas.