bluuebunny/crossref_metadata_2025_split huggingface dataset:
Giant R waves on electrocardiogram in children with asphyxia after cardiopulmonary resuscitation
Authors: Guo QiFeng , Chen YueE. , Xu XiangLin 
Published: October 2021

Abstract

Introduction:
Giant R waves on electrocardiogram (ECG) in pediatric patients is extremely rare. The present case report explores the giant R wave ECG characteristics and clinical features of children with asphyxia after cardiopulmonary resuscitation.

Patient concerns:
Two children presented with suffocation due to drowning and foreign body inhalation. Cardiopulmonary resuscitation was performed, and the children were admitted to the hospital.

Diagnosis:
On the day of admission, the two children were in a deep coma, with decreased blood pressure, elevated myocardial enzymes and glucose, and metabolic acidosis. However, ECG examination showed no obvious abnormalities. On the day after admission, the children experienced frequent convulsions. The ECG showed the features of giant R waves from three consecutive ECG readings.

Interventions:
Treatment measures during hospitalization included tracheal intubation assisted ventilation, ice cap to protect the brain to reduce basal brain metabolism, anti-infection, dehydration, lower intracranial pressure, correction of acidosis, adjustment of glucose levels, sedation, analgesia, normal saline to supplement blood volume and protect liver function.

Outcomes:
The giant R waves on ECG persisted until the children passed away three days after admission.

Conclusion:
Giant R waves on ECG in children with asphyxia after cardiopulmonary resuscitation may be related to the large release of catecholamines, which results in myocardial injury. Giant R waves on ECG indicates a serious illness and poor prognosis of the patient. In addition, giant R waves on ECG may be misdiagnosed as other arrhythmias and needs to be carefully differentiated.
Laparoscopic omental flap for rectovaginal fistula after low anterior resection
Authors: Kidate Kaoru , Kobayashi Hironori , Miyamoto Katsunari , Sakashita Yoshihiro , Yokoyama Yujirou , Hashimoto Yasushi , Toyota Kazuhiro , Hara Tetsuhiro , Doi Hirofumi , Kuhara Yuta 
Published: October 2021

Abstract

Introduction:
Nearly 1.8% to 9.9% of patients suffer from a rectovaginal fistula after a low anterior resection. The treatment and management of rectovaginal fistulas is challenging for surgeons. Here, we report a case of rectovaginal fistula after low anterior resection that was successfully treated with laparoscopic omental flap surgery.

Patient Concerns:
An 89-year-old woman underwent laparoscopic low anterior resection for stage IIA rectal adenocarcinoma. The patient noticed fecal discharge from her vagina 6 days postoperatively.

Diagnosis:
Enema examination results using a contrast agent showed a 1 cm rectovaginal fistula located 1 cm proximal to the anastomotic stapler line.

Interventions:
We performed laparoscopic rectovaginal fistula repair using an omental flap and laparoscopic transverse colostomy 12 days postoperatively. The omentum was placed between the vaginal and rectal walls and secured with sutures.

Outcomes:
Oral food intake was resumed 2 days postoperatively, and there were no signs of recurrence of the rectovaginal fistula. The patient underwent a procedure to close the colostomy 36 days after the second surgery.

Conclusion:
Laparoscopic surgery is helpful in achieving good access during surgery, especially in narrow areas, such as the pelvis. It is essential to use a flap in good condition to treat a rectovaginal fistula. Omentum is an ideal flap with good blood flow that exerts no tension on the tissue. Hence, laparoscopic omental flap is a feasible treatment option for rectovaginal fistulas.
Aggression and criminality in androgen abusers
Authors: Chegeni Razieh , Pallesen Ståle , Sagoe Dominic 
Published: October 2021

Purpose of review
To systematically review and meta-synthesize current (2019–2021) literature on aggression and criminality in androgen abusers. Results from 13 empirical human studies are discussed.

Recent findings
Some androgen abusers engage in aggressive and criminal behavior. Here, results show positive effects and associations between the administration of androgens and aggression, and descriptions of various patterns and kinds of aggression and criminality in androgen abusers. Still, this positive relationship seems to be mediated by various factors, such as cognition, neurobiology, personality, polypharmacy, and study methods.

Summary
The current literature on aggression and criminality in androgen abusers shows methodical diversity and underlines the need to synthesize the current evidence in order to draw overall conclusions as well as identify relevant and important knowledge gaps. On the basis of a systematic literature search, we identified 13 studies and categorized them by methodology. Of the 13 studies, 4 were meta-analyses and systematic reviews, 1 was a randomized controlled trial, 4 were cross-sectional studies, and 4 constituted case reports. Evidence on the relationship between androgen abuse and involvement in aggressive behavior seems to be mediated by cognition, neurobiology, personality, and polypharmacy as well as methodical factors, such as study design, aggression severity, type of measurement, and temporal proximity. Implications for practice and future research are presented.
Perceived versus Patient-Reported Significance of Surgeon Gender in Breast Reconstruction
Authors: Hsu Jessica J. , Kubiak Carrie A. , Billig Jessica I. , Qi Ji , Hamill Jennifer B. , Kim Hyungjin M. , Wilkins Edwin G. , Kung Theodore A. 
Published: October 2021

Background:
Previous investigators demonstrated that female patients often prefer female providers. However, these studies have not determined whether there are gender preferences for breast reconstruction surgeons or whether the effects of surgeon gender impacts patient-reported outcomes.

Methods:
Adult women were crowdsourced using Amazon Mechanical Turk to characterize societal preferences for the gender of breast and plastic surgeons in a hypothetical scenario. The authors also used data from the Mastectomy Reconstruction Outcomes Consortium to determine the association between surgeon gender and patient satisfaction after breast reconstruction. The BREAST-Q questionnaire was used to assess patient-reported outcomes at 3 months and 2 years following reconstruction. Regression analyses were performed to investigate the effects of surgeon gender on patient-reported outcomes.

Results:
In total, 1413 surveys were collected. Forty-two percent preferred female plastic surgeons, 5 percent preferred male surgeons, and 53 percent reported no preference. The Mastectomy Reconstruction Outcomes Consortium analysis included 2236 patients of 55 male and nine female plastic surgeons. In this cohort, 1921 patients (82.2 percent) had male surgeons, whereas 415 patients (17.8 percent) had female surgeons. Regression analysis at 2 years revealed no differences in satisfaction with surgeon, outcome, or psychosocial well-being. Only satisfaction with information differed, as patients of female surgeons reported greater satisfaction in this category, with an adjusted mean difference of 2.82 (p = 0.018).

Conclusions:
Although nonpatient women hypothetically prefer female providers, surgeon gender makes little difference in actual patient satisfaction with breast reconstruction. More investigation is needed to determine whether the difference in information delivery is clinically significant and whether it reflects variations in practices between male and female surgeons.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
A Matched Comparison of the Benefits of Breast Reduction on Health-Related Quality of Life
Authors: Elfanagely Omar , Othman Sammy , Rios-Diaz Arturo J. , Cunning Jessica R. , Whitely Cutler , Butler Paris , Fischer John P. 
Published: October 2021

Background:
Breast reduction surgery has consistently fallen within the top 10 surgical procedures performed by plastic surgeons. This is because of its capability to relieve the physical and psychological impact of macromastia. Although numerous women pursue consultation, many never undergo the procedure. The authors aim to quantify the impact of breast reduction surgery on quality of life by comparing patients who underwent breast reduction surgery with those who did not.

Methods:
Patients seeking breast reduction surgery between 2016 and 2019 were identified. As standard-of-care, patients are surveyed during the consultation visit and postoperative visits using the BREAST-Q. The preoperative survey was readministered a second time for those who did not undergo breast reduction surgery. Propensity score matching, based on patient demographics, comorbidities, and breast examination, was used to balance baseline characteristics.

Results:
A total of 100 propensity-matched patients were identified (operative, n = 78; nonoperative, n = 22). Mean participant age was 39.5 ± 25 years and mean body mass index was 31.1 ± 7.4 kg/m2. Quality of life significantly improved in each domain for those in the operative group (p < 0.05). Those who did not undergo breast reduction surgery realized no improvement in quality of life and had a downward trend in quality of life across two of the four domains.

Conclusions:
Breast reduction surgery offers a significant improvement in quality of life for macromastia. This matched study demonstrates that patients who are able to undergo breast reduction surgery have a statistically significant improvement in all aspects of quality of life, whereas nonsurgical patients experience no benefit with time, with a trend toward deterioration in specific domains.
Ear Reconstruction with the Combination of Expanded Skin Flap and Medpor Framework: 20 Years of Experience in a Single Center
Authors: Wang Yongzhen , Zhang Jinming , Liang Weiqiang , Xiao Xiaolian , Zhang Jiaqi , Zhang Jian , Su Zheng , Liu Meng , Chen Yuhong , Ji Chenyang 
Published: October 2021

Background:
In ear reconstruction, the difficulty lies in reestablishing the ear’s bionic form with adequate skin coverage and an appropriate framework. Skin expansion and a porous polyethylene (i.e., Medpor) framework are often used for ear reconstruction. However, a long-term review of the combined application of the expanded skin and Medpor framework has not been reported. This article reviews ear reconstruction combining these two factors over the past 20 years in the authors’ center to summarize the surgical technique and analyze the postoperative results and complications.

Methods:
A retrospective review was performed that included all patients who underwent ear reconstruction with expanded skin and Medpor framework in the authors’ center between 1998 and 2018.

Results:
A total of 68 patients with microtia who were admitted to the authors’ center for surgical ear reconstruction were included, and 70 ears were reconstructed. Fifty-seven of the patients (83.82 percent) felt satisfied with their reconstructed ear, five patients (7.35 percent) were not satisfied with the reconstructed ear, and six patients (8.82 percent) had the frameworks removed. Fifteen patients (22.06 percent) developed complications, including framework exposure (13.24 percent), infection (4.41 percent), scar hypertrophy (4.41 percent), and hematoma (2.94 percent).

Conclusions:
Framework exposure limits the combined application of expanded skin flap and Medpor framework when reconstructing the ear without additional fascial interposition. Using a temporoparietal fascia or postauricular fascia flap during the operation is effective to decrease the exposure rate; however, this complication cannot be completely avoided. Using postauricular fascia and skin graft may lead to scar hypertrophy; thus, these techniques should be used with caution.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Risk Factors for Complications after J Medial Thighplasty following Massive Weight Loss: A Multivariate Analysis of 94 Consecutive Patients
Authors: Bertheuil Nicolas , Duisit Jérôme , Bekara Farid , Watier Eric , Gandolfi Silvia , Bergeat Damien 
Published: October 2021

Background:
Bariatric surgery has increased the number of patients requiring medial thighplasty after massive weight loss. However, despite the various complications, the procedure improves quality of life. The authors report postoperative complications of vertical J-shaped medial thigh lift in a series of patients and identify preoperative risk factors.

Methods:
For almost 5 years, the details of all J medial thighplasties performed by a single surgeon were recorded; detailed medical records were also available. Complications can be major (e.g., need for early surgical revision or readmission) or minor (delayed wound healing).

Results:
During the study period, 94 patients were treated and only minor complications were recorded (42.5 percent). On multivariate analysis, older age (OR, 1.05; 95 percent CI, 1.01 to 1.10) and a body mass index greater than or equal to 30 kg/m2 (OR, 2.82; 95 percent CI, 1.10 to 7.22) were independent risk factors for postoperative complications.

Conclusions:
As with other postbariatric operations, medial thighplasty is associated with significant morbidity, but the risk thereof can be easily established and managed. Specific algorithms for determining the risk of postoperative complications based on age and body mass index are needed to guide preoperative discussions with patients and perform patient selection.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Immunosuppressive adherence after kidney transplantation in adult patients treated at an outpatient clinic: a better practice implementation project
Authors: Campos Caroline S. , Ferreira Gustavo F. , Bastos Kamille V. , da Costa Carbogim Fábio , de Brito Poveda Vanessa , de Araújo Püschel Vilanice A. , dos Santos Kelli B. 
Published: October 2021

ABSTRACT

Objective:
To evaluate the compliance of the practice with the evidence-based criteria in relation to interventions developed to improve the immunosuppressive adherence of adults in postkidney transplantation.

Method:
A best practice implementation project, based on the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice audit tool for promoting change in health practice, was conducted. A baseline and a follow-up audit were conducted in a kidney transplant clinic, including a sample of kidney transplant patients with a maximum of 30 days postoperatively, and health professionals working in the post-transplant period.

Results:
The basic audit revealed that the parameters related to the professionals’ knowledge did not reach adequate compliance; the involvement of patients in strategies to overcome barriers that interfere with nonadherence; guidelines for specific therapeutic regimens for patients and the prescription of immunosuppressants according to the patient's routine. To solve the identified weaknesses, training strategies were implemented with the professionals, follow-up by telephone contact with the patients and the elaboration and distribution of an educational booklet with guidance on the use of immunosuppressants, leading to an increase from 50 to 87.5% of conformity in the evaluated service.

Conclusion:
The evidence implementation project provided improvements in clinical practice behaviors. It demonstrated that there are strategies that facilitate the implementation of evidence regarding the promotion of interventions to improve immunosuppressive adherence. Additional audits are still needed to improve and assess the quality of interventions promoted by professionals regarding drug adherence in the post-transplant period, as well as to verify the behavior of patients, ensuring that the project will be maintained and supported.
Sharps injuries prevention among healthcare providers in surgical, medical and pediatric wards of a public hospital in Jimma Zone: a best practice implementation project
Authors: Asefa Yisalemush , Admassu Bitiya , Wondimnew Tesaka , Morankar Sudhakar 
Published: October 2021

ABSTRACT

Background:
Sharps injuries are a serious public health problem that healthcare providers face and constitute a major risk for the transmission of blood-borne infections. Prevention of sharps injuries in hospitals requires that healthcare providers comply with universal precautions.

Objectives:
The aim of this study was to assess and improve the compliance of healthcare providers with protocols based on best available evidence for prevention of sharps injuries in medical, surgical and pediatric wards of the hospital.

Methods:
A three-phase clinical audit was carried out using the online JBI Practical Application of Clinical Evidence System and Getting Research into Practice Program. Six audit criteria based on available evidence were used. Phase 1 of the project was the baseline audit, phase 2 the implementation of the best practice, and phase 3 the follow-up audit. Data were collected through observation, interview and resource inventory.

Results:
The postintervention compliance report showed maximum improvement in compliance in criterion 1 (sharps containers are not filled above the mark that indicates the bin is full) and criterion 2 (sharps containers are positioned out of the reach of children at a height that enables safe disposal by staff). Between the baseline and postintervention audits, the compliance rate for these criteria improved by more than half (criterion 1) and by nine-fold (criterion 2) (from 38 to 100% and 0 to 93%, respectively). During baseline, two nurses reported experiencing sharps injuries, noting that they think it is not important to report the injury if the patient is negative for HIV, and when they do not know where to report it, regardless. At the postintervention audit no injuries were reported.

Conclusion:
The best practice recommendations using a clinical audit process was an effective intervention for improving knowledge and compliance of healthcare workers with protocols for the prevention of sharps injuries in low-resource settings.
Prevention of deep venous thrombosis in stroke: a best practice implementation project
Authors: Luo Yansi , Zhou Chunlan , Deng Qiulin , Xu Weihao , Zhang Xiaomei 
Published: October 2021

ABSTRACT

Objectives:
The current evidence implementation project aims to promote evidence-based practice in the care of patients with stroke, specifically around the prevention of deep venous thrombosis (DVT), in the neurology department of a tertiary hospital in Guangzhou, China.

Introduction:
The prevalence of DVT within 14 days after stroke is 10–75%. Approximately 20% of patients with DVT develop pulmonary embolism, the third most common cause of death in patients with stroke and the most common cause of autopsy-verified death between the second and fourth week after stroke. Several risk factors are associated with the development of DVT, many of which can be alleviated by evidence-based strategies that can prevent or reduce the risk of DVT.

Methods:
The current evidence implementation project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System program and involved 30 patients in each audit criterion. Interventions included staff education, involvement of rehabilitation staff, and building a patient education bundle. A postimplementation reaudit was undertaken including the same number of patient samples.

Results:
The baseline audit results showed that the compliances for two audit criteria (patient mobilization and patient education) were under 20%, whereas those for the other criteria were at least 60%. After implementing the strategies, there were significant improvements especially in the two weak-compliance criteria. In addition, the overall compliance for most criteria increased.

Conclusion:
The project standardized the DVT prevention process in the Neurology Department of Nanfang Hospital. The overall compliance with DVT prevention for patients with stroke in the department improved.
Overcoming barriers to maintain hemodialysis adequacy amongst hemodialysis patients in hospital: a best practice implementation project
Authors: Tseng Peng-Lin , Lin Ni-Ni , Hsu Li-Ping , Tasi Yu-Mei , Chen Bao-Chen , Mu Pei-Fan 
Published: October 2021

ABSTRACT

Objective:
The aim of this evidence implementation project was to identify the barriers and omissions affecting adequacy of hemodialysis and to develop implementable strategies to maintain hemodialysis adequacy among hemodialysis patients with end-stage renal disease.

Introduction:
Assessing adequacy of hemodialysis and improving quality of life are important issues for patients with end-stage renal disease. However, they are often inadequately addressed, and evidence-based practices are not always followed.

Methods:
A clinical audit was undertaken using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice approaches. Seven audit criteria that represent best practice recommendations for maintaining hemodialysis adequacy among hemodialysis patients were used. A baseline audit was performed, which was followed by the implementation of multiple improvement strategies over 20 weeks and the outcomes finalized using a follow-up audit to determine the change to be implemented in practice.

Results:
The baseline audit results showed that most audit criteria were less than 77% in practice. The compliance rates for nurses who had received education regarding hemodialysis, checking the prescription order for each patient at each session, and using the prescribed dialyzer for every session were determined to have reached 100% at the follow-up audit. The compliance rates for completion prehemodialysis checks, using a sterile technique when inserting an arteriovenous catheter, matching a blood flow rate with the prescription, and maintaining a blood flow rate throughout the treatment session were found to be 73–95% at the follow-up audit. The most significant finding was the proportion of hemodialysis patients with inadequate urea reduction ratio was reduced from 4.6 to 3.2% after implementation of the best practice approaches.

Conclusion:
The implementation of institution-specific evidence-based resources brought about immediate improvements in hemodialysis adequacy management and practice. A variety of strategies contributed to the success of this implementation project, such as scenario simulation education, Objective Structured Clinical Examination, the interrelation response system Kahoot, the use of hemodialysis International Organization for Standardization job descriptions, regular weekly audits, and collaboration with physicians when caring for patients during clinical practice.