bluuebunny/crossref_metadata_2025_split huggingface dataset:
Infections in Children With Cancer
Authors: Karavanaki Kyriaki , Kossiva Lydia , Sklavou Rigina , Kakleas Kostas , Tsentidis Charalambos , Gourgiotis Dimitris , Marmarinos Antonis , Sdogou Triantafyllia , Tsolia Maria , Polychronopoulou Sophia 
Published: February 2021

Background
Infections in patients with cancer are a major cause of morbidity and mortality. In most cases, the presence of neutropenia renders them prone to infections to either common or opportunistic pathogens. A wide spectrum of bacterial, viral, or fungal agents is encountered in these patients.

Aim
The aim of this study was to evaluate infection types and pathogens in pediatric patients with cancer with and without neutropenia.

Methods
A total of 37 pediatric patients with cancer (median age ± 25% quartile, 6.0 ± 2.0% years) with 70 febrile episodes were evaluated at fever’s onset and 48 hours later with complete blood count, C-reactive protein, cultures of biological fluids, polymerase chain reaction, and antibody titers.

Results
Of 70 infections, 30 (42.85%) were bacterial, 13 (18.57%) were viral, 3 (4.28%) were fungal, 16 (22.85%) were fever of unknown origin, 18 (25.71%) were opportunistic, and 12 (17.14%) were mixed infections. Neutropenia was detected in 42 (60.0%) of 70 febrile episodes, mainly in patients with hematological malignancies [odds ratio, 2.81 (0.96–8.22); P = 0.059]. Neutropenic patients had higher prevalence of mucocutaneous infections (47.6% vs 7.14%; P = 0.004). Herpes simplex virus 1 infections occurred only in the neutropenic group (14.3%).

Conclusions
Patients with cancer exhibited a high prevalence of bacterial (42.85%), opportunistic (25.7%), and mixed infections (17.14%). Patients with hematological malignancies and neutropenia presented higher frequency of mucocutaneous and herpes simplex virus 1 infections than the nonneutropenic ones.
Osteomyelitis in an Unusual Location With an Atypical Presentation
Authors: Gerber Nicole , Fawcett Kelsey , Bittman Mark , Beiner Joshua 
Published: February 2021

Abstract
Bacterial osteomyelitis of the scapula is rare in pediatric patients. When it occurs, it usually affects young infants and patients often exhibit fever and functional limitation of the extremity. We present a case of a 12-year-old boy with subacute bacterial scapular osteomyelitis and a normal physical examination. The patient was briefly treated with intravenous antibiotics and then transitioned to oral antibiotics to complete a 4-week course for methicillin-sensitive Staphylococcus aureus osteomyelitis.
Improving CPR Quality by Using a Real-Time Feedback Defibrillator During Pediatric Simulation Training
Authors: Frazier Maria , Dewan Maya , Keller-Smith Rachel , Shoemaker Jamie , Stewart Claire , Tegtmeyer Ken 
Published: February 2021

Objective
The aim of this study was to assess the effectiveness of a defibrillator with real-time feedback during code team training to improve adherence to the American Heart Association (AHA) resuscitation guidelines.

Methods
This is a retrospective cohort study designed to compare pediatric resident adherence to the AHA cardiopulmonary resuscitation guidelines before and after use of real-time feedback defibrillator during code team training simulation. After institution of a real-time feedback defibrillator, first-year resident's adherence to the AHA guidelines for chest compression rate (CCR), fraction, and depth during code team training from January 2017 to December 2018 was analyzed. It was then compared with results of a previously published study from our institution that analyzed the CCR and fraction from January 2015 to January 2016, before the implementation of a defibrillator with real-time feedback.

Results
We compared 19 eligible session preintervention and 36 postintervention sessions. Chest compression rate and chest compression fraction (CCF) were assessed preintervention and postintervention. The depth of compression was only available postintervention. There was improvement in the proportion of code team training sessions with mean compression rate (74% preintervention vs 100% postintervention, P = 0.003) and mean CCF (79% vs 97%, P = 0.04) in adherence with the AHA guideline.

Conclusions
The use of real-time feedback defibrillators improved the adherence to the AHA cardiopulmonary resuscitation guidelines for CCF and CCR during pediatric resident simulation.
Reducing Alarm Burden in a Level IV Neonatal Intensive Care Unit
Authors: McCauley Kortany E. , Schroeder Alissa A. , DeBoth Tawney K. , Wiebe Alexander M. , Bosley Christopher L. , Ballweg Diane D. , Fang Jennifer L. 
Published: February 2021

Introduction:
Excessive alarm burden contributes to alarm fatigue, causing staff to ignore or delay response to clinically significant alarms. The objective of this quality improvement project was to reduce yellow self-resolving SpO2 alarms from a mean of 14 alarms/patient-hour (APH) to 7 APH (a 50% reduction) within a 6-month period, without significantly decreasing the amount of time spent in target SpO2 range (90%–95%).

Methods:
A multidisciplinary team used Define-Measure-Analyze-Improve-Control methodology to identify etiologies of alarm frequency and design improvement interventions to reduce alarm burden in a single-site Level IV NICU. Data-driven changes in alarm limit settings, alarm delay, and trial of a new pulse oximeter probe were used. Alarm data from the bedside monitor were analyzed following each improvement cycle. As a balancing measure, histograms monitored time spent in target SpO2 range.

Results:
SpO2 alarm data were collected for 4,320 patient-hours (180 patient-days) on 40 neonatal intensive care unit patients meeting inclusion criteria. Corresponding histograms were obtained for each patient day. Following 5 Plan-Do-Study-Act cycles, the mean number of yellow self-resolving SpO2 alarms decreased from 14 to 5 APH, a 64% decrease. There was no difference in time spent in target SpO2 range (50% versus 50%, P = 0.93). After achieving the project aim, 2 control phase measurements demonstrated sustained improvement (mean APH = 6).

Conclusions:
Yellow self-resolving SpO2 alarm frequency was reduced by 64% through the implementation of data-driven changes in alarm limit settings, alarm delays, and trial of a more sensitive oximeter probe without introducing harm to patients.
Stewardship Intervention to Optimize Central Venous Catheter Utilization in Critically Ill Children
Authors: Blumenthal Jennifer A. , Ormsby Jennifer A. , Mirchandani Dimple , Petti Chonel A. , Carpenter Jane , Geller Maggie , Harding Stephanie N. , O’Brien Mary , Sandora Thomas J. , Kleinman Monica E. , Priebe Gregory P. , Mehta Nilesh M. 
Published: February 2021

Introduction:
We aimed to describe utilization and indication(s) for long-term central venous catheters (CVCs) in a pediatric intensive care unit (PICU) and identify potential strategies to decrease CVC utilization.

Methods:
We conducted a single-center prospective quality improvement initiative at a 30-bed PICU in a large, freestanding, academic children’s hospital. We created an electronic report to identify patients with an indwelling CVC for 7 days and older (defined as long term). We discussed the ongoing need for each long-term CVC with PICU clinicians at weekly interdisciplinary structured “CVC stewardship rounds.” We then made recommendations around expedited removal of CVCs. We conducted multiple Plan-Do-Study-Act cycles to categorize CVC indications, identify modifiable factors, and educate PICU clinicians. We hypothesized that CVC stewardship rounds would decrease long-term CVC utilization in our PICU.

Results:
From October 2016 to September 2017, 607 long-term CVCs were eligible for the stewardship intervention. Compared to the preintervention period, we recorded a significant increase in peripherally inserted central catheters and a decrease in nontunneled CVCs (P < 0.001). Most patients had single- or double-lumen CVCs in both the preintervention and intervention periods (86% and 91%, respectively). The utilization of overall long-term CVC devices, and those with modifiable indications, decreased during the intervention period.

Conclusions:
A single-center QI intervention focused on PICU CVC stewardship was associated with a decrease in CVC utilization.
Patient Safety Education in Entry to Practice Pharmacy Programs: A Systematic Review
Authors: El-Awaisi Alla , Koummich Sarra , Koraysh Somaya , El Hajj Maguy Saffouh 
Published: February 2021

Objectives
The aim of this systematic review was to synthesize, summarize, and evaluate the quality of extant quantitative and qualitative literature related to patient safety in pharmacy education. This systematic review included literature that targeted the content, delivery, and outcomes of patient safety in addition to literature that explored the perspectives of pharmacy students and faculty on how patient safety is integrated within their curricula.

Methods
A systematic review was conducted. Four electronic databases were searched for articles published between 2000 and 2019: PubMed, MEDLINE, EMBASE, and ScienceDirect. Selection was based on prespecified criteria and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Two independent reviewers selected articles, extracted data, and assessed articles’ qualities using the Crowe Critical Appraisal Tool. Discrepancies were resolved by consensus or by consulting a third reviewer. Descriptive synthesis of data was performed.

Results
Twenty-five eligible articles were included. The majority of studies originated from United States (n = 15). Educational content involved principles of patient safety, and identification, disclosure, and management of medication errors. There was a lack of standardization on how patient safety is incorporated into the pharmacy curricula. Eleven articles (64%) were interprofessional in nature, delivered as a patient safety course (n = 6), through simulation (n = 3), as seminars (n = 1), or as part of student experiential learning (n = 1). Of the 7 articles discussing delivery of patient safety through courses or modules, 4 (57%) were offered as elective courses. Students’ perceptions and attitudes significantly improved after all patient safety interventions, reflecting the importance of addressing patient safety in education to ensure optimum future practice.

Conclusions
This systematic review demonstrated how patient safety education was incorporated into pharmacy programs in terms of the content and methods of delivery. It was promising to see patient safety content being delivered interprofessionally and in experiential education. Students and faculty regarded implementing patient safety in education as an essential act to meet future work demands. Longitudinal studies to assess the long-term impact of incorporating patient safety on student behaviors upon graduation and health outcomes are needed.
Impact of Efavirenz Mid-dose Plasma Concentration on Long-Term Weight Change Among Virologically Suppressed People Living With HIV
Authors: Huang Sung-Hsi , Huang Wei-Chieh , Lin Shu-Wen , Chuang Yu-Chung , Sun Hsin-Yun , Chang Sui-Yuan , Kuo Po-Hsien , Wu Pei-Ying , Liu Wen-Chun , Chiang Chieh , Hung Chien-Ching , Chang Shan-Chwen 
Published: February 2021

Background:
Pharmacogenetic studies have shown that slow and intermediate metabolizers of efavirenz (EFV) gained less weight compared with extensive metabolizers. It is hypothesized that increased EFV exposure suppresses weight gain. We investigated the effect of EFV mid-dose plasma concentration (C12) on long-term weight change among virologically suppressed people living with HIV (PLWH).

Methods:
Participants in a prospective EFV pharmacokinetic study were included if they had been taking EFV-containing combination antiretroviral therapy for more than 240 weeks and had 3 or more weight measurements. The weight changes and time to ≥5% of weight gain over 192 weeks were compared between PLWH with higher and those with lower EFV C12 (using mean population C12 as the cutoff). EFV C12 and CYP2B6 516G>T polymorphism were examined in generalized estimating equations and in a Cox proportional hazards model for associations with weight gain, after adjustments for age, sex, companion antiretroviral agent, CD4 lymphocyte count, and plasma HIV RNA.

Results:
One hundred eighteen PLWH were included. PLWH with higher EFV C12 had less mean weight gain compared with those with lower C12 after 192 weeks (−0.09 vs +1.58 kg, P = 0.033). PLWH with higher C12 were less likely to gain ≥5% weight in Kaplan–Meier analysis (P = 0.0003). In both generalized estimating equations and Cox proportional hazards models, a higher EFV C12 was associated with less weight gain, while CYP2B6 516G>T was not, after adjustments made for confounding factors.

Conclusions:
Our findings support that increased EFV exposure was associated with less weight gain.
Maternal HIV Infection and Spontaneous Versus Provider-Initiated Preterm Birth in an Urban Zambian Cohort
Authors: Price Joan T. , Vwalika Bellington , Edwards Jessie K. , Cole Stephen R. , Kasaro Margaret P. , Rittenhouse Katelyn J. , Kumwenda Andrew , Lubeya Mwansa K. , Stringer Jeffrey S. A. 
Published: February 2021

Objective:
We investigated the effect of maternal HIV and its treatment on spontaneous and provider-initiated preterm birth (PTB) in an urban African cohort.

Methods:
The Zambian Preterm Birth Prevention Study enrolled pregnant women at their first antenatal visit in Lusaka. Participants underwent ultrasound, laboratory testing, and clinical phenotyping of delivery outcomes. Key exposures were maternal HIV serostatus and timing of antiretroviral therapy initiation. We defined the primary outcome, PTB, as delivery between 16 and 37 weeks' gestational age, and differentiated spontaneous from provider-initiated parturition.

Results:
Of 1450 pregnant women enrolled, 350 (24%) had HIV. About 1216 (84%) were retained at delivery, 3 of whom delivered <16 weeks. Of 181 (15%) preterm deliveries, 120 (66%) were spontaneous, 56 (31%) were provider-initiated, and 5 (3%) were unclassified. In standardized analyses using inverse probability weighting, maternal HIV increased the risk of spontaneous PTB [RR 1.68; 95% confidence interval (CI): 1.12 to 2.52], but this effect was mitigated on overall PTB [risk ratio (RR) 1.31; 95% CI: 0.92 to 1.86] owing to a protective effect against provider-initiated PTB. HIV reduced the risk of preeclampsia (RR 0.32; 95% CI: 0.11 to 0.91), which strongly predicted provider-initiated PTB (RR 17.92; 95% CI: 8.13 to 39.53). The timing of antiretroviral therapy start did not affect the relationship between HIV and PTB.

Conclusion:
The risk of HIV on spontaneous PTB seems to be opposed by a protective effect of HIV on provider-initiated PTB. These findings support an inflammatory mechanism underlying HIV-related PTB and suggest that published estimates of PTB risk overall underestimate the risk of spontaneous PTB.
Progression of Cabozantinib-Related Osteonecrosis Mimicking Metastases on Bone Scan
Authors: Xu Guofan , Lu Yang 
Published: February 2021

Abstract
Patient was a 73-year-old woman with metastatic renal cell carcinoma. Bone scan showed multifocal bone metastases. The patient received cabozantinib treatment for more than 1 year. On the follow-up bone scan, the previously biopsy-proven left pelvic bone lesion has improved, whereas the right maxillary lesion showed increased extent and intensity of abnormal radiotracer uptake. Given the different change pattern of these lesions, the right maxillary lesion was further evaluated. Biopsy results confirmed devitalized bone with bacterial colonies overgrowth and without tumor cell, suggestive of medication-related osteonecrosis.
Panniculectomy Performed in Conjunction With Gynecologic Surgery in Obese and Morbidly Obese Patients
Authors: Nag Shayoni , Patel Tirth , Gaughan John P. , Bonawitz Steven C. 
Published: February 2021

Introduction
Panniculectomy is a common procedure in plastic surgery, often performed after massive weight loss and in morbidly obese patients. It is also performed in combination with various gynecologic procedures based on the rational that it will reduce complication rates and benefit the patient (Am J Obstet Gynecol, 2000. 182, 1502–1505; J Gynecol Technol, 1997;3:9–16; J Am Coll Surg, 1995). These and other studies fail to provide proof of these claims for a number of reasons, including study design, lack of a control group and the inclusion of nonmorbidly obese patients (J Am Coll Surg, 1995; Gynecol Oncol, 1998, 70, 80–86; Int J Gynecol Cancer, 2015;25(8):1503–1512). Recent medical practice has focused increasingly on minimizing patient morbidity and trends in reimbursement are moving toward penalizing practices, which increase complications. The aim of this study was to evaluate the premise that the addition of panniculectomy to gynecologic surgery in the obese and morbidly obese patient population results in a statistically significant improvement in measureable outcomes.

Methods/Results
The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was reviewed to assess the association of complications with panniculectomy combined with gynecologic surgery in the morbidly obese patient population. The query identified 296 patients with a body mass index greater than 30 who had panniculectomy concomitant with gynecologic surgery. The results demonstrated a statistically significant relationship (P < 0.05) of these concomitant procedures with superficial infection, wound infection, pulmonary embolism, systemic sepsis, return to operating room, length of operation and length of stay. A systematic review of the literature was then performed which identified only 5 studies that included comparative cohorts of those with gynecologic surgery, with and without panniculectomy. There was no significant benefit across the studies in measured paramters.

Conclusions
This NSQIP study and systematic review of the existing literature does not support the premise that there is a statistically significant benefit associated with performing panniculectomy in conjunction with gynecologic surgery in the morbidly obese patient population. The NSQIP data demonstrate significant elevation of negative outcomes in morbidly obese patients undergoing combined procedures. In the light of the risks to patients and current direction of medical practice the addition of elective panniculectomy to gynecologic surgery should be reevaluated in the a patient population with a body mass index greater than 30.
Successful Treatment of a Nail Gun Injury in Right Parietal Region and Superior Sagittal Sinus
Authors: Wang An Shuo , Zeng Ming Hui , Wang Fei 
Published: February 2021

Background Introduction:Nail injuries are important causes of penetrating craniocerebral injuries. Theirs incidence is very low, but the injuries can be fatal. Since the nail gun was gradually popularized in 1959, the incidence of nail injuries has been increasing. Here we report a case of nail gun injury to superior sagittal sinus and review the literature of the past 60 years to find out what are the possible factors of nail gun injury and what are their respective ratios?Clinical Report:An 18-year-old male patient was accidentally injured in the head by the worker's nail gun, accompanied by scalp pain, no physical sensation disorder, and consciousness disorder. A computed tomography scan of his skull showed the penetrating site at the right frontal area, near the superior sagittal sinus. Seven days later, the patient underwent a successful surgery without neurological sequelae.Discussion:Nail injuries are rare, but can be potentially fatal. We found that nail guns were the main cause of nail injuries, and other causes include occupational injury, violence, lack of supervision of young children (potential for domestic violence, and child abuse), mental illness, and suicide attempts. While paying attention to the anatomical location of trauma, clinicians should also think more about the possibility of injury so as to provide better help to patients in time.
Single Layer and Double Layer Duraplasty for the Management of Persistent Cerebrospinal Fluid Rhinorrhea Following Frontal Sinus Trauma: A Retrospective Study
Authors: Sahoo Nanda Kishore , Thakral Ankur , Carvalho AS. , Gulati Prachi 
Published: February 2021

Abstract
Persistent cerebrospinal fluid (CSF) rhinorrhea is an infrequent complication of frontal sinus trauma. It often require craniotomy for dural repair and obliteration of sinus with well vascularized pericranial flap. The multilayer vascularized techniques have gained popularity over the years owing to low rate of postoperative CSF leaks. The study retrospectively analyzed 25 frontal sinus trauma patients (20 males, 5 females) of mean age 32 ± 10.23 years with persistent CSF rhinorrhea from January 2011 to December 2018. All patients underwent frontal craniotomy and duraplasty was done with pericranial flap alone in 14 patients (Group I) and in combination with fascia lata graft in 11 patients (Group II). The clinical outcomes of single and double layer dural reconstruction techniques in management of CSF leak were analyzed. The size of defects ranged between 3 to 28 mm. Significant association was present between defect size and reconstruction technique with large defects underwent double layer repair. Two patients developed CSF leak following repair with pericranial flap alone. The rate of successful closure of CSF fistula was 100% with double layer reconstruction technique. However, statistically no significant association was noted between postoperative CSF leak and reconstruction technique. There was no evidence of meningitis, subdural hematoma, intracranial abscess, and mucocele formation in all patients during follow-up of 50.7 ± 23.6 months. To conclude, pericranial flap is a reliable reconstruction material for management of post traumatic frontal sinus CSF leaks. Dual flap technique that combine the use of fascia lata provides comprehensive solution of CSF fistula repair.
The Harvest of a Lateral Segment of Costal Cartilage for Treating Nasal Deformities
Authors: Jiang Jiang , Fan Xu-Hui , Yue Lei , Jia Zhi-Yu , Yang Wei , Zhao Yun-Zhuan , Liu Ji-Lun , Liu Yao-Qiang , Zhang Ying-Huai 
Published: February 2021

Background:
Although costal cartilage has many uses and is a reliable source of cartilage for rhinoplasty procedures, donor-site complications may arise with conventional harvesting techniques. The present report reports a novel technique of harvesting costal cartilage using a specially designed scalpel and studies the use of the harvested cartilage in the reconstruction of secondary nasal deformities in patients with cleft lips.

Methods:
Ten patients (7 females and 3 males) with nasal deformities secondary to cleft lip underwent rhinoplasty using this new technique at the Department of Oral and Maxillofacial Surgery, Second Hospital of Hebei Medical University, China, between May 2011 and December 2013. Clinical outcomes were evaluated with a follow-up period of 6 to 30 months.

Results:
The new technique successfully corrected primary nasal deformities, including flat nasal tip, short columella, flaring alae, and asymmetrical nostrils. Surgeons and patients assessed the outcome to be either good or satisfactory. Patients experienced transient discomfort at the wound site but there were no major complications (such as wound infection, dehiscence, exposure, graft extrusion, and pulmonary involvement).

Conclusions:
The novel technique can harvest a lateral segment of costal cartilage for use in the reconstruction of nasal deformities secondary to cleft lip in a one-stage procedure, with minimal donor-site morbidity.