bluuebunny/crossref_metadata_2025_split huggingface dataset:
Standardized adult-gerontology acute care nurse practitioner point-of-care ultrasound training: A new perspective in the age of a pandemic
Authors: Chen Leon L. 
Published: January 2021

ABSTRACT
Our health care landscape is rapidly changing. With the aging population and seemingly increasing outbreak of communicable diseases, it is expected that there will be a continued demand for inpatient/critical care providers. The current COVID-19 pandemic provides a glimpse of a health care system in severe provider shortage. Adult-gerontology acute nurse practitioners (AGACNPs) can play a vital part in relieving that shortage. But with the increased role, there is an increased responsibility and need for expansion of AGACNP skill set. This includes the training and utilization of point-of-care ultrasound (POCUS). The case reports and data available from countries that have already combated COVID-19 outbreak show POCUS can play a key part in managing critically ill patients on isolation precautions. This article provides my perspective on POCUS training and competency achievement for AGACNPs.
Multifocal Skull Base Defects With Associated Spontaneous Cerebrospinal Fluid Leaks
Authors: Schwartz Nofrat , Brown Kevin D. , Sasaki-Adams Deanna , Morgan Selleck A. , Zanation Adam M. , Thorp Brain D. , O’Connell Brandan P. 
Published: January 2021

Objective:
Spontaneous cerebrospinal fluid (CSF) leaks are thought to arise due to elevated intracranial pressure which is distributed across the skull base, potentially predisposing the development of multifocal CSF leaks. The aims of this study are to evaluate the characteristics of this population at presentation and surgical outcomes.

Study Design:
Retrospective case series.

Setting:
Tertiary referral center.

Patients:
Patients 18 years or older with spontaneous CSF leak diagnosis were eligible for study inclusion. Multifocal spontaneous CSF leak was defined as leaks originating from more than one skull base defect at anatomically distinct subsites.

Intervention:
None.

Main Outcome Measure:
Clinical presentation and surgical outcome.

Results:
Two hundred ninety-three patients with diagnosis of spontaneous CSF leak were identified. Of these, 11 (3.8%) were characterized as having multifocal spontaneous CSF leaks. Mean body mass index was significantly higher in multifocal CSF leak patients (31.5 ± 8.5 vs 46.2 ± 9.9, p < 0.0001). There was also higher prevalence of women (100% vs 63.8%, p = 0.012) and African-Americans (63.6% vs 23.4%, p = 0.003). The overall success rate of CSF leak repair was 95%. Fifty percent of patients developed headaches or blurry vision after surgical repair, and two patients required ventriculoperitoneal shunting.

Conclusions:
Multifocal spontaneous CSF leaks are rare and occurred in 3.8% of patients with spontaneous CSF. These patients were morbidly obese and more likely to be female and African American. Surgical repair conferred excellent outcomes. However, these patients have high risk of developing symptoms suggestive of elevated intracranial pressure postoperatively and should be counseled accordingly.
Uses and pitfalls of measurement of end-tidal carbon dioxide during cardiac arrest
Authors: Nicholson Tonia C. , Paiva Edison F. 
Published: January 2021

Purpose of review
To discuss recent studies relevant to the utility of measuring end-tidal carbon dioxide (ETCO2) during cardiopulmonary resuscitation (CPR) and its correlation with outcome in adults experiencing cardiac arrest.

Recent findings
Over the past couple of years, at least five studies have included measurement of ETCO2 in their methods. Two of these studies were prospective and two retrospective. All considered ETCO2 measurements after out-of-hospital cardiac arrest, either in the prehospital setting, or after arrival in the emergency department. All assessed for an association between ETCO2 measurement and return of spontaneous circulation (ROSC). However, the timing of measurement, whether a one-off value or a trend and the cut-off values used to determine whether or not there was an association were different in all cases.

Summary
Higher values of ETCO2 during resuscitation from cardiac arrest are generally associated with a greater likelihood of ROSC. However, timing of measurements and cut-off values used show significant variability across different studies, making it hard to draw any conclusions about the utility of any particular reading for prognostication. Future studies might aim to develop an accepted standard for the timing and cut-off value of ETCO2 used, to enable comparison of the parameter across different studies.
The microbiome and the immune system in critical illness
Authors: Miniet Ashley A. , Grunwell Jocelyn R. , Coopersmith Craig M. 
Published: January 2021

Purpose of review
Although the gut microbiome plays a crucial role in the maintenance of health, it is hypothesized to drive morbidity and mortality in critically ill patients. This review describes the relationship between the gut microbiome and the immune system in critical illness.

Recent findings
The gut microbiome is converted to a pathobiome in the ICU, characterized by decreased microbial diversity and pathogen predominance. These changes are induced by a pathologic microenvironment and are further exacerbated by common medical treatments initiated in the ICU. The conversion of the microbiome to a pathobiome has direct consequences on the regulation of inflammation and immunity by loss of beneficial host responses and initiation of maladaptive changes that can further propagate critical illness.

Summary
The gut microbiome is dramatically altered in the ICU. In light of constant crosstalk between the microbiome and the host immune system, the pathobiome may play a key mechanistic role in driving a maladaptive response in critically ill patients. The pathobiome represents a potential therapeutic target in the management of critical illness whereby restoration of a healthier microbiome may directly alter the host inflammatory response, which could lead to improved patient outcomes.
Impact of statin use on the risk and prognosis of hepatocellular carcinoma: a meta-analysis
Authors: Wang Jianfeng , Li Xiaogang 
Published: January 2021

Background
Previous studies have demonstrated that statin use might be associated with a reduced risk of hepatocellular carcinoma (HCC). However, the value of statin on the prognosis still needs to be evaluated. Based on the above considerations, we conducted a meta-analysis regarding the value of statin on the prevention and prognosis of HCC.

Methods
Articles regarding the impact of statin use on the risk, prognosis of HCC and published before October 2020 were searched in the five databases. We computed odds ratio (OR)/relative risk (RR) or hazard ratio (HR) and 95% confidence intervals (CIs) regarding the association between statin use and the risk or prognosis of HCC by using STATA 12.0 software.

Results
Twenty-six studies (including 1772 463 participants) detected the association between statin use and risk of HCC. Additionally, seven studies (including 8925 statin users and 76 487 no-statin users) explored the association between statin use and mortality of HCC. The meta-analysis showed that statin use was associated with lower risk and all-cause mortality of HCC with random effects models (risk: OR/RR = 0.57, 95% CI 0.49–0.65, I2 = 86.0%, P < 0.0001; all-cause mortality: HR = 0.80, 95% CI 0.68–0.94, I2 = 77.6%, P < 0.0001). However, statin use was not associated with cancer-specific mortality of HCC with a random effects model (HR = 0.80, 95% CI 0.62–1.03, I2 = 73.9%, P = 0.002).

Conclusion
In conclusion, our results have demonstrated the salutary effect of statin on the prevention and prognosis of HCC.
Improving Payment for Collaborative Mental Health Care in Primary Care
Authors: Wolk Courtney Benjamin , Alter Carol L. , Kishton Rachel , Rado Jeffrey , Atlas Jacob A. , Press Matthew J. , Jordan Neil , Grant Michael , Livesey Cecilia , Rosenthal Lisa J. , Smith Justin D. 
Published: January 2021

Background:
There is strong evidence supporting implementation of the Collaborative Care Model within primary care. Fee-for-service payment codes, published by Current Procedural Terminology in 2018, have made collaborative care separately reimbursable for the first time. These codes (ie, 99492–99494) reimburse for time spent per month by any member of the care team engaged in Collaborative Care, including behavioral care managers, primary care providers, and consulting psychiatrists. Time-based billing for these codes presents challenges for providers delivering Collaborative Care services.

Objectives:
Based on experience from multiple health care organizations, we reflect on these challenges and provide suggestions for implementation and future refinement of the codes.

Conclusions:
Further refinements to the codes are encouraged, including moving from a calendar month to a 30-day reimbursement cycle. In addition, we recommend payers adopt the new code proposed by the Centers for Medicare and Medicaid Services to account for smaller increments of time.
Long-term Follow-up for Missed Cases of Eosinophilic Esophagitis in Children With Previous Foreign Body in the Esophagus
Authors: Thulin Helena , Nilsson Caroline , Svensson Jan F. , Olén Ola , Altman Maria 
Published: January 2021

ABSTRACT

Objectives:
A foreign body impacted in the esophagus could be a sign of eosinophilic esophagitis (EoE). Our aim was to investigate if children previously diagnosed with a foreign body in the esophagus had a missed diagnosis of EoE.

Methods:
In this population-based longitudinal study, all children (0–18 years) diagnosed with a foreign body in the esophagus in Stockholm, Sweden 2006 to 2016, were identified. In addition to a review of medical files, each family was contacted (n = 325) and asked standardized questions. Children with symptoms indicating EoE were offered esophagogastroduodenoscopy (EGD).

Results:
We found 325 pediatric cases of foreign body. Two hundred and seven (64%) underwent an endoscopy at the event, 3 of these had biopsies taken, whereby 2 were diagnosed with EoE. Six additional patients were diagnosed with EoE between the initial event and the study follow-up. Children with persisting symptoms suggestive of EoE at the follow-up (n = 21), were offered EGD whereof 7 accepted. Four new cases of EoE were found. Hence, 12 (3.7%) of the children with a previous foreign body, either spontaneously released or endoscopically removed, were diagnosed with EoE. In the structured interview, dysphagia, food impactions and drinking excessively with meals, as well as food allergies, were significantly more common in EoE patients.

Conclusions:
Children with a foreign body in the esophagus are at risk of having EoE. Biopsies should be taken during foreign body removal and questions about swallowing problems and allergic diseases should be carefully explored also in children who do not need EGD because of spontaneous release.
Antiretroviral Therapy Use and HIV Transmission Among Discordant Couples in Nonresearch Settings in Kigali, Rwanda
Authors: Nyombayire Julien , Ingabire Rosine , Mukamuyango Jeannine , Karita Etienne , Mazzei Amelia , Wall Kristin M. , Parker Rachel , Tichacek Amanda , Allen Susan , Hunter Eric , Price Matt A. 
Published: January 2021

Background
Antiretroviral therapy (ART) efficacy for HIV prevention among discordant couples has been demonstrated in clinical trials. Effectiveness outside of research settings is less well understood.

Methods
HIV-discordant couples were enrolled in couples' testing and follow-up at 20 government clinics in Kigali from 2010 to 2014. We performed viral linkage analysis on seroconverting couples to determine infection sources (intracouple vs. extracouple). Antiretroviral therapy use in index partners was collected at baseline and during follow-up by self-report with verification of government medical records.

Results
A total of 3777 HIV-discordant couples were identified and followed up at government health clinics. Fifty-four incident HIV infections were identified, of which 36 were confirmed linked to the index partner, 4 were unlinked, and 14 were unknown. Among the 50 linked or unknown transmission pairs, 38% occurred among couples in which the index partner was on ART (HIV incidence rate of 0.63/100 person-years), whereas 62% occurred among couples in which the index partner was not on ART (HIV incidence rate of 5.51/100 person-years; adjusted rate ratio, 6.9). HIV acquisition was higher in women than in men with non-ART using index partners (P < 0.001).

Conclusions
Couples in a government clinic couples’ HIV testing and follow-up program in Rwanda had an 89% reduction in HIV incidence when index partners were using ART, slightly lower than efficacy estimates from randomized trials. Antiretroviral therapy for prevention should be prioritized for key populations including discordant couples identified via couples’ voluntary counseling and testing, with increased efforts to improve uptake, adherence, and viral load monitoring.
Emergency Department–Based Human Immunodeficiency Virus Preexposure Prophylaxis Referral Program—Using Emergency Departments as a Portal for Preexposure Prophylaxis Services
Authors: Zhao Zezhou , Jones Joyce , Arrington-Sanders Renata , Gladfelter Gaby , McDonald Steven , Reed Christopher , Myer Deanna , Schlenker Noah , Fulton Glenn , Jones Tiana , Saheed Mustapha , Rothman Richard , Hsieh Yu-Hsiang 
Published: January 2021

Abstract
A pilot program was implemented to assess the feasibility of emergency department (ED) preexposure prophylaxis (PrEP) referral. Of 119 eligible patients approached and assessed, 39 (33%) expressed interest and were referred to peer navigators. Of these, 16 (41%) scheduled for appointments; four (10%) initiated PrEP, which demonstrated ED-based PrEP referral was feasible.
Screening and Treatment of Sexually Transmitted Infections Among Medicaid Populations—A 2-State Analysis
Authors: Merrell Melinda A. , Betley Charles , Crouch Elizabeth , Hung Peiyin , Stockwell Ian , Middleton Alice , Pearson William S. 
Published: January 2021

Background
Chlamydia, gonorrhea, and syphilis are common, treatable sexually transmitted infections (STIs) that are highly prevalent in the general US population. Costs associated with diagnosing and treating these conditions for individual states' Medicaid participants are unknown. The purpose of this study was to estimate the cost of screening and treatment for 3 common STIs for state Medicaid program budgets in Maryland and South Carolina.

Methods
A retrospective, cross-sectional study was conducted using Medicaid administrative claims data over a 2-year period. Claims were included based on the presence of one of the 3 study conditions in either diagnosis or procedure codes. Descriptive analyses were used to characterize the participant population and expenditures for services provided.

Results
Total Medicaid expenditures for STI care in state fiscal years 2016 and 2017 averaged $43.5 million and $22.3 million for each year in Maryland and South Carolina, respectively. Maryland had a greater proportion of costs associated with outpatient hospital and laboratory settings. Costs for care provided in the emergency department were highest in South Carolina.

Conclusions
Diagnosis and treatment of commonly reported STIs may have a considerable financial impact on individual state Medicaid programs. Public health activities directed at STI prevention are important tools for reducing these costs to states.
New Mexico’s COVID-19 Experience
Authors: Jackson Nicole R. , Zeigler Karen , Torrez Mary , Makino Yohsuke , Adolphi Natalie L. , Lathrop Sarah , Decker Lauren , Dvorscak Lauren , Proe Lori , Paul Ian D. , Zumwalt Ross , Jarrell Heather 
Published: January 2021

Abstract
The 2019 novel coronavirus disease (COVID-19) has spread worldwide, infiltrating, infecting, and devastating communities in all locations of varying demographics. An overwhelming majority of published literature on the pathologic findings associated with COVID-19 is either from living clinical cohorts or from autopsy findings of those who died in a medical care setting, which can confound pure disease pathology. A relatively low initial infection rate paired with a high biosafety level enabled the New Mexico Office of the Medical Investigator to conduct full autopsy examinations on suspected COVID-19–related deaths. Full autopsy examination on the first 20 severe acute respiratory syndrome coronavirus 2–positive decedents revealed that some extent of diffuse alveolar damage in every death due to COVID-19 played some role. The average decedent was middle-aged, male, American Indian, and overweight with comorbidities that included diabetes, ethanolism, and atherosclerotic and/or hypertensive cardiovascular disease. Macroscopic thrombotic events were seen in 35% of cases consisting of pulmonary thromboemboli and coronary artery thrombi. In 2 cases, severe bacterial coinfections were seen in the lungs. Those determined to die with but not of severe acute respiratory syndrome coronavirus 2 infection had unremarkable lung findings.
Early Mobilization Rehabilitation Program for Children With Cerebral Palsy Undergoing Single-Event Multilevel Surgery
Authors: Howard Melissa , Bickley Christina , Linton Judi , Northcutt Leah , Lux Melanie , Scott Allison , Stephenson Lindsay , Barnes Douglas 
Published: January 2021

Purpose:
This study investigates functional and technical outcomes to support an early mobilization approach to rehabilitation after single-event multilevel surgery (SEMLS) for children with cerebral palsy (CP), and disseminates innovative guidelines emphasizing early walking.

Methods:
Twenty-three participants with spastic diplegic CP ages 7 through 17 years, Gross Motor Function Classification System levels I to III, who underwent an early mobilization program after SEMLS were reviewed. Outcomes were examined from motion analysis data and clinical documentation.

Results:
All participants were able to return to school walking at discharge. At 1-year postoperatively, participants had returned to their prior walking level or better. Change in Gait Deviation Index and Pediatric Outcomes Data Collection Instrument indicated improvements in functional mobility and gait consistent with or greater than the literature.

Conclusion:
This intensive early mobilization program restores participation in daily activities, walking, and school within the first month postoperatively.
Assimilation of the Pediatric Essential Core Competencies by Professional Physical Therapist Education Programs
Authors: Weaver Priscilla A. , Catalino Tricia , Townsend Elise L. , Martin Kathy , Dole Robin L. 
Published: January 2021

Purpose:
This study examined the degree to which pediatric essential core competencies (ECCs) are meeting their intended purpose to provide guidance to pediatric educators in professional physical therapy (PT) education programs and to determine facilitators, barriers, and recommendations to implementation of ECCs in curricula.

Methods:
Pediatric PT educators from professional PT education programs were recruited to participate in a survey. Descriptive statistics were used to analyze close-ended questions for frequency of responses and content analysis to generate themes.

Results:
Of the 162 completed surveys, most participants were aware of the ECCs (96%) and used them to inform pediatric curriculum (88%). A mean proportion (86%-95%) of participants perceived their program curricula addressed the ECCs very or moderately well. Multiple themes of facilitators/barriers/recommendations to ECC implementation were determined.

Conclusions:
Most pediatric educators are aware of and using the ECCs to guide pediatric education to prepare graduates for pediatric patients/clients.
I Want to Play: Children With Cerebral Palsy Talk About Their Experiences on Barriers and Facilitators to Participation in Leisure Activities
Authors: Longo Egmar , Regalado Isabelly Cristina Rodrigues , Galvão Elida Rayane Viana Pinheiro , Ferreira Haryelle Nárima Confessor , Badia Marta , Baz Begonã Orgaz 
Published: January 2021

Purpose:
To explore how children with cerebral palsy (CP) experience participation in leisure activities and to describe the environmental barriers and facilitators.

Methods:
Sixteen children with cerebral palsy aged 7 to 17 years participated in 3 focus groups. Data were analyzed thematically by 3 researchers on the basis of the International Classification of Functioning, Disability and Health.

Results:
A total of 38 International Classification of Functioning, Disability and Health categories were identified (4 linked to Body functions; 2 linked to Body structures; 8 linked to Activities & Participation, and 24 to Environmental factors: 10 facilitators and 14 barriers). The most mentioned categories were Voluntary movement control functions, Functions related to gait pattern, Structure of upper arm, Recreation and leisure, Nuclear family and finally, and Individual attitudes of acquaintances.

Conclusions:
The main barriers identified by children with cerebral palsy highlight aspects of the physical, social, and attitudinal environment that could be modified to enhance participation in leisure activities.
A Reverse Orbicularis-Tarsus Fixation Technique in Double-Eyelid Blepharoplasty: A Novel Fixation Technique Different From Park's Technique
Authors: Liu Hai-Peng , Shen Zheng-Zhou , Zhang Duo 
Published: January 2021

Background:
Although Park's “orbicularis-levator fixation technique” has been widely used as a mature double-eyelid surgery in China recently. Shortcomings related to this method cannot be ignored. Thus, a reverse orbicularis-tarsus fixation technique in double-eyelid blepharoplasty has now been devised. The method is to create a physiological double-eyelid fold based on the formation mechanism of double-eyelid creases.

Methods:
A retrospective study of 112 Chinese patients who underwent double-eyelid surgery between October 2017 and September 2019 was undertaken through a review of medical records. All these patients underwent a reverse tarsus and orbicularis oculi muscle fixation technique, with postoperative follow-up ranging from 6 months to 2 years. Postoperative outcomes were reviewed, evaluated, and analyzed.

Results:
Altogether, 112 patients who underwent the double-eyelid surgery were reviewed. Among them, the results were judged as excellent in 104 cases (92.9%), good in 4 cases (3.6%), fair in 3 cases (2.7%), and poor in 1 case (0.8%). Clinical effectiveness was satisfactory in most of the patients (104/112, 92.9%). Only 5 patients (4.5%) expressed subjective dissatisfaction with postoperative outcomes; of these, 3 patients complained of eyelids asymmetry (2.7%). Two patients complained of eyelids scar formation (1.7%); Whereas surgical revision was required in only 1 patient (0.8%).

Conclusions:
The reverse orbicularis-tarsus fixation technique for upper eyelid blepharoplasty is safe and effective, with better biomechanics and a satisfying aesthetic outcome. Therefore, this provides an alternative option in Chinese double-eyelid surgery.

Level of Evidence: Level IV, case studies.