bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomized Clinical Trial of a Self-care and Communication Intervention for Parents of Adolescent/Young Adults Undergoing High-Risk Cancer Treatment
Authors: Haase Joan E. , Stegenga Kristin , Robb Sheri L. , Hooke Mary C. , Burns Debra S. , Monahan Patrick O. , Stump Timothy E. , Henley Amanda K. , Haut Paul R. , Cherven Brooke , Roll Lona , Langevin Anne-Marie , Pickler Rita H. , Albritton Karen , Hawkins DeAnna , Osterkamp Erin , Mitby Pauline , Smith Jackie , Diaz Virginia R. , Garcia-Frausto Erica , Moore Margo 
Published: November 2021

Background
Parents of adolescents and young adults (AYAs) with cancer offer primary support to their children and often experience their own high levels of distress, affecting parent-AYA communication and quality of life.

Objective
To reduce parent distress and improve communication during high-risk cancer treatment, we examined efficacy of a self-care and communication intervention for parents and indirect benefit for AYAs receiving a therapeutic music video (TMV) intervention.

Methods
In this study, we conducted a multisite, randomized controlled trial with AYAs and parents enrolled as dyads (n = 110). Parents were randomized to intervention or low-dose control; all AYAs received TMV. Data collection occurred at baseline, 2 weeks post intervention (T2), and 90 days post intervention (T3).

Results
There were no significant between-group differences on primary outcomes for parents or AYAs. We did find significant differences favoring the parent intervention group on parenting confidence at T2 and marginally better outcomes for family adaptability/cohesion at T3. Both groups exhibited significant within-group improvement for parent distress (state anxiety, T3; perceived stress, T2 and T3; mood, T3), state anxiety (T2) intervention only, and family strengths control group only. Qualitative data demonstrate the parent intervention raised self-awareness and parent confidence in the short term.

Conclusion
Parents found their intervention helpful. Absence of significant results may be due to short intervention duration, need for tailored content, underpowered sample, and potential indirect parent benefit from AYA participation in TMV. The parent intervention did not provide an indirect benefit for AYAs.

Implications for Nursing
Parents identified their own need for communication and support from nurses. Nurses can optimize AYA care by attending to parent needs through supportive listening and encouraging self-care.
A Clinical Nurse Specialist–Driven Project to Improve Emergency Department Triage Accuracy
Authors: Campbell Denise , Fetters Lisa , Getzinger Jac , Perko Alayna , Slater Scott 
Published: November 2021

Purpose/Aims
The purpose of this quality improvement project was to examine the use of video-simulated scenarios and mobile technology to improve accuracy of emergency department (ED) nurses' triage using the Emergency Severity Index (ESI).

Design
A quality improvement project with a pre/post educational intervention design consisting of a convenience sample (n = 33) of ED registered nurses (RNs) at a large tertiary hospital in the Midwest was used.

Methods
A retrospective chart review (n = 495) was completed to obtain ESI accuracy for each triage RN. For 12 consecutive weeks, the ED RNs received different video simulations via mobile technology to determine the ESI level. After receiving their scores, the project team provided the RNs the correct ESI score with rationale via mobile technology. Post intervention, a retrospective chart review was conducted to evaluate RNs' ESI accuracy.

Results
Results of this ED triage educational intervention to improve the accuracy of ED nurses' ESI scores were not significant; however, this novel approach may be considered in addition to other teaching strategies to improve outcomes.

Conclusions
Triage nurses' ESI scoring accuracy can be inconsistent. Therefore, to ensure patients are receiving prompt and appropriate care for their acuity level, it is important to continuously provide education on ESI scoring.
A Clinical Nurse Specialist–Led Initiative to Reduce Catheter-Associated Urinary Tract Infection Rates Using a Best Practice Guideline
Authors: Pajerski Dawn M. , Harlan Melissa D. , Ren Dianxu , Tuite Patricia K. 
Published: November 2021

Purpose
The purpose of this clinical nurse specialist–led initiative was to reduce catheter-associated urinary tract infection rates to less than 1 infection per 1000 catheter days, to reduce catheter device utilization, and to improve staff adherence to documentation requirements on a traumatic brain injury rehabilitation unit.

Description of the Project
Catheter-associated urinary tract infections are costly hospital-acquired infections increasing length of stay and morbidity for patients. Following an education intervention, a best practice initiative was implemented. Staff performance based on electronic health record documentation, infection rates, and device utilization were compared before and after a bundle of interventions including education, staff competency, simulation, and audits.

Outcomes
Catheter-associated urinary tract infection rates were reduced from 16.67 to 0 per 1000 catheter days and device utilization ratio from 0.122 to 0.056 per patient day. The unit maintained zero infections upon project completion. Following initiative implementation, documentation improved related to urinary catheter necessity, daily care interventions, patient education, and urine output.

Conclusion
This initiative resulted in reductions in device utilization and catheter infection rates, which were maintained following project completion. Adherence to documentation audit criteria also improved.
Accuracy of Machine Learning Models to Predict In-hospital Cardiac Arrest
Authors: Moffat Laura M. , Xu Dongjuan 
Published: November 2021

Purpose/Aims
Despite advances in healthcare, the incidence of in-hospital cardiac arrest (IHCA) has continued to rise for the past decade. Identifying those patients at risk has proven challenging. Our objective was to conduct a systematic review of the literature to compare the IHCA predictive performance of machine learning (ML) models with the Modified Early Warning Score (MEWS).

Design
The systematic review was conducted following the Preferred Reporting Items of Systematic Review and Meta-Analysis guidelines and registered on PROSPERO CRD42020182357.

Method
Data extraction was completed using the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies checklist. The risk of bias and applicability were evaluated using the Prediction model Risk of Bias Assessment Tool.

Results
Nine articles were included in this review that developed or validated IHCA prediction models and compared them with the MEWS. The studies by Jang et al and Kim et al showed that their ML models outperformed MEWS to predict IHCA with good to excellent predictive performance.

Conclusions
The ML models presented in this systematic review demonstrate a novel approach to predicting IHCA. All included studies suggest that ML models had similar or better predictive performance compared with MEWS. However, there is substantial variability in performance measures and concerns for risk of bias.
The Use of Vastus Lateralis Muscle Flap for Functional Lip Reconstruction
Authors: Lelala Bruce , Pienaar Conrad , Hudson Donald A. 
Published: November 2021

Background:
Total or near-total lip defects poses a serious challenge to a reconstructive surgeon with static procedures not providing desired functional and aesthetic outcomes. The dynamic lip reconstructive methods using functional muscles have become a current issue in recent years showing admirable results. This study present 3 cases of successful total and near-total lip reconstruction are presented using vastus lateralis muscle.

Methods:
This is a retrospective analysis of a consecutive series of 3 patients (2 men and 1 woman) aged 44 to 56 years (mean) who had resection of extensive squamous cell carcinoma 2 had both upper and lower lip involved and 1 had lower lip involvement only. After resection patients had near total full thickness lower lip defect and 40% upper lip defect. The innervated vastus lateralis muscle free flap was transferred to the lip and end-to-end vascular anastomosis on the facial artery and end-to-side to internal jaguar vein was performed. The marginal mandibular branch of the facial nerve was used for nerve coaptation. The inner and outer surfaces of the flaps were grafted with a thick-split-thickness skin graft. Drooling rating scale and patient and observer scar assessment scale as well as electromyography were performed to evaluate oral competency and aesthetic outcome.

Results:
All patients underwent single stage near-total lower lip and 2 had part of upper lip reconstruction successfully and survived the surgical operation. One patient lost the skin graft and was managed consecutively and muscle granulated and healed. Two patients underwent radiation therapy and 1 died before starting radiation due to other unnatural causes. The 2 patients achieved perfect oral sphincter competence without drooling and at 9months postoperative demonstrated successful reinnervation of the vastus lateralis muscle.

Conclusions:
This study demonstrates that lip reconstruction using an innervated vastus lateralis muscle free flap is a reliable method, providing a functional lip
The Detrimental Impact of the COVID-19 Pandemic on Major Trauma Outcomes in the Netherlands
Authors: Driessen Mitchell L. S. , Sturms Leontien M. , Bloemers Frank W. , Duis Henk Jan ten , Edwards Michael J. R. , den Hartog Dennis , Kuipers E. J. , Leenhouts Peter A. , Poeze Martijn , Schipper Inger B. , Spanjersberg Richard W. , Wendt Klaus W. , de Wit Ralph J. , van Zutphen Stefan W. A. M. , de Jongh Mariska A. C. , Leenen Luke P. H. 
Published: November 2021

Objective:
To evaluate the impact of the COVID-19 pandemic on the outcome of major trauma patients in the Netherlands.

Summary Background Data:
Major trauma patients highly rely on immediate access to specialized services, including ICUs, shortages caused by the impact of the COVID-19 pandemic may influence their outcome.

Methods:
A multi-center observational cohort study, based on the Dutch National Trauma Registry was performed. Characteristics, resource usage, and outcome of major trauma patients (injury severity score ≥16) treated at all trauma-receiving hospitals during the first COVID-19 peak (March 23 through May 10) were compared with those treated from the same period in 2018 and 2019 (reference period).

Results:
During the peak period, 520 major trauma patients were admitted, versus 570 on average in the pre-COVID-19 years. Significantly fewer patients were admitted to ICU facilities during the peak than during the reference period (49.6% vs 55.8%; P=0.016). Patients with less severe traumatic brain injuries in particular were less often admitted to the ICU during the peak (40.5% vs 52.5%; P=0.005). Moreover, this subgroup showed an increased mortality compared to the reference period (13.5% vs 7.7%; P=0.044). These results were confirmed using multivariable logistic regression analyses. In addition, a significant increase in observed versus predicted mortality was recorded for patients who had a priori predicted mortality of 50% to 75% (P=0.012).

Conclusions:
The COVID-19 peak had an adverse effect on trauma care as major trauma patients were less often admitted to ICU and specifically those with minor through moderate brain injury had higher mortality rates.
Surgeon Postoperative Opioid Prescribing Intensity and Risk of Persistent Opioid Use Among Opioid-naive Adult Patients
Authors: Wunsch Hannah , Hill Andrea D. , Bethell Jennifer , Fu Longdi , Bateman Brian T. , Ladha Karim S. , Wijeysundera Duminda N. , Neuman Mark D. 
Published: November 2021

Objective:
The aim of this study was to determine the relationship between surgeon opioid prescribing intensity and subsequent persistent opioid use among patients undergoing surgery.

Summary Background Data:
The extent to which different postoperative prescribing practices lead to persistent opioid use among surgical patients is poorly understood.

Methods:
Retrospective population-based cohort study assessing opioid-naive adults who underwent 1 of 4 common surgeries. For each surgical procedure, the surgeons' opioid prescribing intensity was categorized into quartiles based on the median daily dose of morphine equivalents of opioids dispensed within 7 days of the surgical visit for all the surgeons' patients. The primary outcome was persistent opioid use in the year after surgery, defined as 180 days or more of opioids supplied within the year after the index date excluding prescriptions filled within 30 days of the index date. Secondary outcomes included a refill for an opioid within 30 days and emergency department visits and hospitalizations within 1 year.

Results:
Among 112,744 surgical patients, patients with surgeons in the highest intensity quartile (Q4) were more likely to fill an opioid prescription within 7 days after surgery compared with those in the lowest quartile (Q1) (83.3% Q4 vs 65.4% Q1). In the primary analysis, the incidence of persistent opioid use in the year after surgery was rare in both highest and lowest quartiles (0.3% Q4 vs 0.3% Q1), adjusted odds ratio (AOR) of 1.18, 95% CI 0.83–1.66). However, multiple analyses using stricter definitions of persistent use that included the requirement of a prescription filled within 7 days of discharge after surgery showed a significant association with surgeon quartile (up to an AOR 1.36, 95% CI 1.25, 1.47). Patients in Q4 were more likely to refill a prescription within 30 days (4.8% Q4 vs 4.0% Q1, AOR 1.14, 95% CI 1.04–1.24).

Conclusions:
Surgeons' overall prescribing practices may contribute to persistent opioid use and represent a target for quality improvement. However, the association was highly sensitive to the definition of persistent use used.
Comprehensive genomic, immunological and clinical analysis of COVID-19 vaccine breakthrough infections: a prospective, comparative cohort study
Authors: Tian Di , Song Yang , Zhang Man , Pan Yang , Ge Ziruo , Zhang Yao , Ren Xingxiang , Wen Jing , Xu Yanli , Guo Hong , Yang Peng , Chen Zhihai , Xu Wenbo 
Published: November 2021

AbstractObjectivesAs the COVID-19 pandemic is still ongoing and SARS-CoV-2 variants are circulating worldwide, an increasing number of breakthrough infections have been detected despite the good efficacy of COVID-19 vaccines.MethodsA prospective, comparative cohort study was conducted in Beijing Ditan Hospital to evaluate the clinical, immunological and genomic characteristics of COVID-19 breakthrough infections. Data on 88 COVID-19 breakthrough cases (vaccinated group) and 41 unvaccinated cases (unvaccinated group) from June 1 to August 20, 2021 were extracted from a cloud database. Among these 129 COVID-19 cases, we successfully sequenced 33 whole genomes, including 16 from the vaccinated group and 17 from the unvaccinated group.ResultsAsymptomatic and mild cases predominated in both groups, but 2 patients developed severe disease in the unvaccinated group. Between the two groups, the median time of viral shedding in the vaccinated group were significantly lower than those in the unvaccinated group (p = 0.003). A comparison of dynamic IgG titres of cases in the two groups indicated that IgG titres in the vaccinated group showed a significantly increasing trend (P =0.028). The CD4+T lymphocyte count was lower in the unvaccinated group, and there was a significant difference between the two groups (p=0.018). In the vaccinated group, the number of moderate cases who received Sinopharm BBIBP (42 cases) was significantly higher than those who received Sinovac Coronavac (p=0.020). Whole-genome sequencing revealed 23 cases of delta variants, including 15 patients from the vaccinated group. However, no significant difference was observed in either the RT-qPCR results or viral shedding time.ConclusionsCOVID-19 vaccine breakthrough infections were mainly asymptomatic and mild, the IgG titres were significantly higher and increased rapidly, and the viral shedding was short. Delta variants may be more likely to cause breakthrough infections, and vaccination may not reduce the viral loads and shedding time.
Protocol for Development of a Reporting Guideline for Causal and Counterfactual Prediction Models
Authors: Xu Jie , Guo Yi , Wang Fei , Xu Hua , Lucero Robert , Bian Jiang , Prosperi Mattia 
Published: November 2021

ABSTRACTIntroductionWhile there are protocols for reporting on observational studies (e.g., STROBE, RECORD), estimation of causal effects from both observational data and randomized experiments (e.g., AGREMA, CONSORT), and on prediction modelling (e.g., TRIPOD), none is purposely made for assessing the ability and reliability of models to predict counterfactuals for individuals upon one or more possible interventions, on the basis of given (or inferred) causal structures. This paper describes methods and processes that will be used to develop a reporting guideline for causal and counterfactual prediction models (tentative acronym: PRECOG).Materials and MethodsPRECOG will be developed following published guidance from the EQUATOR network, and will comprise five stages. Stage 1 will be bi-weekly meetings of a working group with external advisors (active until stage 5). Stage 2 will comprise a scoping/systematic review of literature on counterfactual prediction modelling for biomedical sciences (registered in PROSPERO). In stage 3, we will perform a computer-based, real-time Delphi survey to consolidate the PRECOG checklist, involving experts in causal inference, statistics, machine learning, prediction modelling and protocols/standards. Stage 4 will involve the write-up of the PRECOG guideline (including its checklist) based on the results from the prior stages. In stage 5, we will work on the publication of the guideline and of the scoping/systematic review as peer-reviewed, open-access papers, and on their dissemination through conferences, websites, and social media.ConclusionsPRECOG can help researchers and policymakers to carry out and critically appraise causal and counterfactual prediction model studies. PRECOG will also be useful for designing interventions, and we anticipate further expansion of the guideline for specific areas, e.g., pharmaceutical interventions.
Spatiotemporal mapping of major trauma in Victoria, Australia
Authors: Beck Ben , Zammit-Mangion Andrew , Fry Richard , Smith Karen , Gabbe Belinda 
Published: November 2021

ABSTRACTBackgroundSpatiotemporal modelling techniques allow one to predict injury across time and space. However, such methods have been underutilised in injury studies. This study demonstrates the use of statistical spatiotemporal modelling in identifying areas of significantly high injury risk, and areas witnessing significantly increasing risk over time.MethodsWe performed a retrospective review of hospitalised major trauma patients from the Victorian State Trauma Registry, Australia, between 2007 and 2019. Geographical locations of injury events were mapped to the 79 local government areas (LGAs) in the state. We employed Bayesian spatiotemporal models to quantify spatial and temporal patterns, and analysed the results across a range of geographical remoteness and socioeconomic levels.ResultsThere were 31,317 major trauma patients included. For major trauma overall, we observed substantial spatial variation in injury incidence and a significant 2.1% increase in injury incidence per year. Area-specific risk of injury by motor vehicle collision was higher in regional areas relative to metropolitan areas, while risk of injury by low fall was higher in metropolitan areas. Significant temporal increases were observed in injury by low fall, and the greatest increases were observed in the most disadvantaged LGAs.ConclusionsThese findings can be used to inform injury prevention initiatives, which could be designed to target areas with relatively high injury risk and with significantly increasing injury risk over time. Our finding that the greatest year-on-year increases in injury incidence were observed in the most disadvantaged areas highlights the need for a greater emphasis on reducing inequities in injury.
Conserved recombination patterns across coronavirus subgenera
Authors: de Klerk Arné , Swanepoel Phillip , Lourens Rentia , Zondo Mpumelelo , Abodunran Isaac , Lytras Spyros , MacLean Oscar A , Robertson David , Kosakovsky Pond Sergei L , Zehr Jordan D , Kumar Venkatesh , Stanhope Michael J. , Harkins Gordon , Murrell Ben , Martin Darren P 
Published: November 2021

AbstractRecombination contributes to the genetic diversity found in coronaviruses and is known to be a prominent mechanism whereby they evolve. It is apparent, both from controlled experiments and in genome sequences sampled from nature, that patterns of recombination in coronaviruses are non-random and that this is likely attributable to a combination of sequence features that favour the occurrence of recombination breakpoints at specific genomic sites, and selection disfavouring the survival of recombinants within which favourable intra-genome interactions have been disrupted. Here we leverage available whole-genome sequence data for six coronavirus subgenera to identify specific patterns of recombination that are conserved between multiple subgenera and then identify the likely factors that underlie these conserved patterns. Specifically, we confirm the non-randomness of recombination breakpoints across all six tested coronavirus subgenera, locate conserved recombination hot- and cold-spots, and determine that the locations of transcriptional regulatory sequences are likely major determinants of conserved recombination breakpoint hot-spot locations. We find that while the locations of recombination breakpoints are not uniformly associated with degrees of nucleotide sequence conservation, they display significant tendencies in multiple coronavirus subgenera to occur in low guanine-cytosine content genome regions, in non-coding regions, at the edges of genes, and at sites within the Spike gene that are predicted to be minimally disruptive of Spike protein folding. While it is apparent that sequence features such as transcriptional regulatory sequences are likely major determinants of where the template-switching events that yield recombination breakpoints most commonly occur, it is evident that selection against misfolded recombinant proteins also strongly impacts observable recombination breakpoint distributions in coronavirus genomes sampled from nature.