bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Education and Data Feedback on Guideline-Concordant Prescribing for Urinary Tract Infections in the Outpatient Setting
Authors: Funaro Jason R , Moehring Rebekah W , Liu Beiyu , Lee Hui-Jie , Yang Siyun , Sarubbi Christina B , Anderson Deverick J , Wrenn Rebekah H 
Published: April 2021

Abstract

Background
Urinary tract infections (UTIs) are the most common outpatient indication for antibiotics and an important target for antimicrobial stewardship (AS) activities. With The Joint Commission standards now requiring outpatient AS, data supporting effective strategies are needed.

Methods
We conducted a 2-phase, prospective, quasi-experimental study to estimate the effect of an outpatient AS intervention on guideline-concordant antibiotic prescribing in a primary care (PC) clinic and an urgent care (UC) clinic between August 2017 and July 2019. Phase 1 of the intervention included the development of clinic-specific antibiograms and UTI diagnosis and treatment guidelines, presented during educational sessions with clinic providers. Phase 2, consisting of routine clinic- and provider-specific feedback, began ~12 months after the initial education. The primary outcome was percentage of encounters with first- or second-line antibiotics prescribed according to clinic-specific guidelines and was assessed using an interrupted time series approach.

Results
Data were collected on 4724 distinct patients seen during 6318 UTI encounters. The percentage of guideline-concordant prescribing increased by 22% (95% CI, 12% to 32%) after Phase 1 education, but decreased by 0.5% every 2 weeks afterwards (95% CI, –0.9% to 0%). Following routine data feedback in Phase 2, guideline concordance stabilized, and significant further decline was not seen (–0.6%; 95% CI, –1.6% to 0.4%). This shift in prescribing patterns resulted in a 52% decrease in fluoroquinolone use.

Conclusions
Clinicians increased guideline-concordant prescribing, reduced UTI diagnoses, and limited use of high-collateral damage agents following this outpatient AS intervention. Routine data feedback was effective to maintain the response to the initial education.
An unusual case of chronic abdominal pain: an association between Celiac disease and Crohn’s disease
Authors: Doya Leen Jamel , Naamah Maria , Karkamaz Noura , Hajo Narmin , Bijow Fareeda Wasfy , Ibrahim Ali , Issa Rana 
Published: April 2021

ABSTRACT
Inflammatory bowel diseases (IBD) and Celiac disease (CeD) are immune-mediated gastrointestinal diseases with incompletely understood etiology. Both diseases show a multifactorial origin with a complex interplay between genetic, environmental factors, and some components of the commensal microbiota. The coexistence of celiac disease with Crohn’s disease is rarely reported in the literature. Here, we report a case of a 13-year-old Syrian male who presented with a history of abdominal pain, anorexia and pallor. CeD and Crohn’s disease was documented on gastrointestinal endoscopy and histological study. The patient was treated with a gluten-free, low fiber, high caloric diet, and a course of oral corticosteroids with an improvement in growth rate and abdominal pain.
Leydig cell hypoplasia type 1 diagnosed in early childhood with inactivating mutation in LHCGR gene
Authors: Çömlek Fatma Özgüç , Yıldız Raif , Seyrek Fatma , Tütüncüler Filiz 
Published: April 2021

ABSTRACT
Leydig cell aplasia/hypoplasia is an autosomal recessive condition. In its complete form, these patients are 46XY but are cryptorchid and phenotypically female. Most cases reported in literature presented with in adolescence with pubertal delay. We reported a case with a predefined mutation in the LHCGR gene, presenting with swelling in the inguinal region and therefore diagnosed in early childhood. We wanted to emphasize the necessity of keeping Leydig cell hypoplasia in mind in the differential diagnosis of sexual development disorders in early childhood.
Effects of Antenatal Magnesium Sulfate on the Gut Function of Preterm (&lt;32 weeks) Very Low Birth Weight Neonates: Experience from a Tertiary Institute in South India
Authors: Chandran Shanu , Tergestina Mintoo , Ross Benjamin , Joshi Avadhesh , Rebekah Grace , Kumar Manish 
Published: April 2021

AbstractObjectiveAntenatal magnesium sulfate (MgSO4) is found to have various adverse effects in newborn, but the effect on preterm gut is still unclear. This study aimed to evaluate the effects of antenatal MgSO4 on preterm gut function by assessing the clinical outcomes and mesenteric blood flow.MethodsThis was a prospective cohort study on all preterm very low birth weight (VLBW) neonates born at a tertiary care center in South India from November 2016 to August 2017. Neonates with antenatal magnesium (Mg) exposure were compared with those with no exposure for various neonatal outcome variables like time to reach full feeds, feed intolerance, necrotizing enterocolitis (NEC) and other preterm complications, serial serum Mg levels and superior mesenteric artery (SMA) Doppler velocity measurements at two time points (24–48 h and 4–5 days after birth).ResultsOut of 84 neonates, 56 neonates were exposed to antenatal Mg with a median cumulative maternal dose of 28 g and the rest 28 neonates had no exposure. The mean time to reach full feeds was the same in both groups (10.5 days). Feed intolerance episodes were similar in the first week of life between the exposed and unexposed groups (48.2% vs. 46.4%; p = 0.88). Univariate analysis revealed no difference between groups concerning rates of NEC (p = 0.17) or mortality (p = 0.39). There was no significant difference in SMA Doppler parameters and hypermagnesemia between the two groups.ConclusionOur study found no significant impact on postnatal feed tolerance and mesenteric blood flow among preterm VLBW neonates with antenatal MgSO4 exposure.
Legacy Patient-reported Outcome Measures Can Be Reliably Translated to PROMIS Domains for Use in Adolescent Spinal Deformity
Authors: Yau Annie , Heath Madison R. , Nguyen Joseph T. , Fabricant Peter D. 
Published: April 2021

Study Design.
Retrospective cohort study.

Objective.
The aim of this study was to determine whether Patient-reported Outcomes Measurement Information System (PROMIS) Pediatric Domain scores can be accurately and reliably predicted from legacy patient-reported outcome measures (PROMs) for use in adolescent idiopathic scoliosis.

Summary of Background Data.
Previous efforts have been made to develop translational models between PROMIS domains and legacy PROMs in adult spinal deformity, but translational models for pediatric and adolescent patients with spinal deformity have not yet been developed.

Methods.
Scores were retrospectively collected on pediatric patients 8–17 years old who were diagnosed with spinal asymmetry or scoliosis for the following PROMs: Scoliosis Research Society-22r (SRS-22r), Trunk Appearance Perception Scale (TAPS), Hospital for Special Surgery Functional Activity Brief Scale (HSS Pedi-FABS), and PROMIS Pediatric Domains: Pain Interference, Mobility, Physical Stress Experiences, Psychological Stress Experiences, and Physical Activity. Pearson correlations were calculated between legacy and PROMIS scores. In the derivation cohort, PROMIS domains were modeled from SRS-22r or HSS Pedi-FABS using linear regression. These equations were used to predict PROMIS scores in the test cohort to determine the reliability of the translation model.

Results.
A total of 1171 patients (68% female) with a mean age of 13.4 ± 2.3 years were included in the final analyses. PROMIS Pain Interference was dependent on SRS-22r domains Pain, Function, Mental Health, and Management Satisfaction, PROMIS Mobility was dependent on SRS-22r Pain, Function, Mental Health, and Self-Image, PROMIS Physical Stress Experiences and Psychological Stress Experiences were dependent on SRS-22r Pain, Mental Health, and Management Satisfaction, and PROMIS Physical Activity was dependent on HSS Pedi-FABS. (P < 0.05 for all). In the test cohort, all developed models for PROMIS domains demonstrated strong correlations between estimated and actual scores (r = 0.63–0.75).

Conclusion.
All of the evaluated PROMIS domains (Pain Interference, Mobility, Physical Stress Experiences, Psychological Stress Experiences, Physical Activity) were reliably translated directly from these legacy scores for pediatric and adolescent patients with spinal deformity.

Level of Evidence: 3
Minimally Invasive Surgery for Neuromuscular Scoliosis: Results and Complications at a Minimal Follow-up of 5 Years
Authors: Gaume Mathilde , Vergari Claudio , Khouri Nejib , Skalli Wafa , Glorion Christophe , Miladi Lotfi 
Published: April 2021

Study Design.
A prospective study.

Objective.
The aim of this study was to report the results of an alternative technique to growing rods (GR) for neuromuscular scoliosis using a minimally invasive fusionless surgery with a minimum of 5 years’ follow-up.

Summary of Background Data.
Conservative treatment is not effective in progressive neuromuscular scoliosis. Early surgery using GR is increasingly advocated to control the deformity while preserving spinal and thoracic growth before arthrodesis. These techniques still provide a high rate of complications.

Methods.
The technique relies on a bilateral double rod sliding instrumentation anchored proximally by four hooks claws and distally to the pelvis by iliosacral screws through a minimally invasive approach. The clinical and radiological outcomes of 100 consecutive patients with neuromuscular scoliosis who underwent this fusionless surgery with a minimum follow-up of 5 years were reviewed.

Results.
6.5 ± 0.7 years after initial surgery, six patients were lost of follow-up and 11 died of unrelated raison. Of the 83 remaining patients at latest follow-up, mean Cobb angle was stable to 35.0° which correspond to 61% correction of the initial deformation. Mean pelvic obliquity was 29.6° (0.3°–80.0°) preoperatively and 7.2 (0.2°–23.5°) at latest follow-up. Correction of the hyper kyphosis remained stable. Skeletal maturity
was reached in 42 of 83 patients (50.6%). None of these patients has required spinal fusion. The global complication rate was 31.3%.

Conclusion.
The outcomes of this minimally invasive fusionless technique at 5 years follow-up showed a stable correction of spinal deformities and pelvic obliquity over time, with a reduced rate of complication. The arthrodesis was not required for all patients at skeletal maturity. This technique could be a good alternative to arthrodesis for neuromuscular scoliosis.

Level of Evidence: 3
Adolescents Treated for Attention-Deficit/Hyperactivity Disorder in Pediatric Primary Care: Characterizing Risk for Stimulant Diversion
Authors: Molina Brooke S. G. , Joseph Heather M. , Kipp Heidi L. , Lindstrom Rachel A. , Pedersen Sarah L. , Kolko David J. , Bauer Daniel J. , Subramaniam Geetha A. 
Published: April 2021

ABSTRACT:

Objective:
To describe the clinical and psychosocial characteristics, and their hypothesized interrelations, as it pertains to risk for stimulant diversion (sharing, selling, or trading) for adolescents in pediatric primary care treatment for attention-deficit/hyperactivity disorder.

Methods:
Baseline data for 341 adolescents in a cluster-randomized controlled trial of stimulant diversion prevention in pediatric primary care (NCT_03080259) were used to (1) characterize diversion and newly measured risk factors, (2) examine their associations with age and sex, and (3) test whether associations among risk factors were consistent with model-implied predictions. Data were collected through multi-informant electronic surveys from adolescents and parents.

Results:
Diversion was rare (1%) in this sample (Mage = 15, SD = 1.5, 74% male participants). Older age was associated with being approached to divert (r = 0.25, p < 0.001) and higher risk on variables pertinent to stimulant treatment, such as treatment disclosure (r = 0.12, p < 0.05), tolerance for stimulant misuse and diversion (r = 0.17, p < 0.05), and peer norms favorable to stimulant misuse and diversion (r values = 0.15–0.34, p < 0.001). Sex differences were minimal. Variables from our conceptual model and specific to stimulants (e.g., perceived likelihood of negative consequences from diversion and schoolmate stimulant misuse/diversion) were related in multivariable regressions to hypothesized immediate precursors of diversion (e.g., diversion intentions).

Conclusion:
Although diversion was rare for these primary care–treated adolescents, risk levels appear to be higher for older adolescents. Prevention may be most effective by capitalizing on current psychosocial strengths and discussing stimulant-specific attitudes, behaviors, and social norms before vulnerability to diversion increases in the final years of high school and into college.
Longitudinal Associations Between Parenting Practices and Youth Sleep Problems
Authors: Acosta Juliana , Parent Justin , DiMarzio Karissa , McMakin Dana L. , McKee Laura G. , Dale Chelsea F. 
Published: April 2021

ABSTRACT:

Objective:
Sleep problems among youth are highly prevalent and associated with adjustment difficulties. When considering influences on youth's sleep, bidirectional links between youth's sleep health and family functioning have been suggested. Parenting practices are among the many familial factors that could be transactionally related to poor sleep in youth; however, research is lacking on potential longitudinal associations between parenting practices and sleep problems in youth. In addition, sensitive periods for this link are mostly unknown. The current study examined longitudinal relations between constellations of parenting practices and youth sleep health to identify profiles of parenting practices that are predictive of sleep problems in youth across different developmental stages.

Method:
Participants were 292 parents (M = 36.51, SD = 7.3) of children between the ages of 3 and 14 years (M = 8.4, SD = 3.6). A person-centered approach was used to create profiles across traditionally labeled positive and negative parenting practices, as well as supportive and unsupportive parental emotion socialization strategies. Parenting profiles were then examined as longitudinal predictors of youth sleep problems.

Results:
Findings revealed 3 distinct parenting profiles, which were differentially associated with sleep problems in youth, with the first profile predicting the lowest levels of sleep problems and the third profile predicting the highest levels of sleep problems, particularly among peripubertal youth.

Conclusion:
This study extends previous findings by elucidating distinct constellations of parenting practices that are differentially predictive of youth sleep problems and highlighting parenting among the various family processes that can longitudinally contribute to youth's sleep health.
Severe Inflammation, Acute Kidney Injury, and Drug–Drug Interaction: Triple Penalty for Prolonged Elimination of Apixaban in Patients With Coronavirus Disease 2019: A Grand Round
Authors: Launay Manon , Demartin Anne-Laure , Ragey Sophie Perinel , Mismetti Patrick , Botelho-Nevers Elisabeth , Delavenne Xavier 
Published: April 2021

Abstract:
In this article, we present a case of apixaban elimination prolonged by 450% in a patient with coronavirus disease 2019 because of multiple conditions, including drug–drug interaction, severe inflammation, and acute kidney injury. Therapeutic drug monitoring was used to explain unusual routine coagulation assays. This grand round highlights the importance of dialog between the clinician and a therapeutic drug monitoring consultant for optimal patient care.
Disruptive behavior in a high-power distance culture and a three-dimensional framework for curbing it
Authors: Lim Sandy , Goh E-Yang , Tay Eugene , Tong Yew Kwan , Chung Deborah , Devi Kamala , Tan Chay Hoon , Indran Inthrani Raja 
Published: April 2021

Background
Disruptive behavior can harm high-quality care and is prevalent in many Western public health systems despite increasing spotlight on it. Comparatively less knowledge about it is available in Asia, a region commonly associated with high-power distance, which may limit its effectiveness in addressing disruptive behavior.

Purpose
The aim of this study was to develop a comprehensive framework for tackling disruptive behavior among health care professionals in a public health system.

Methodology
A nationwide cross-sectional study relying on the Nurse–Physician Relationship Survey was conducted in Singapore. Four hundred eighty-six public health care professionals responded.

Results
Two hundred ninety-eight doctors (95.5%) and 163 nurses (93.7%) had witnessed a form of disruptive behavior. Doctors observed disruptive behavior committed by other doctors and nurses much more frequently than did nurses. Doctors made stronger associations between disruptive behavior and negative employee outcomes and between disruptive behavior and negative patient outcomes. Qualitative analyses of participants’ open-ended answers produced a multipronged three-dimensional approach for tackling disruptive behavior: (a) deterrent measures, (b) development of knowledge and skills, and (c) demonstration of organizational commitment through proper norms, empathizing with staff, and structural reforms.

Practice Implications
Disruptive behavior is a multifaceted problem requiring a multipronged approach. Our three-dimensional framework is a comprehensive approach for giving health care professionals the capability, opportunity, and motivation to address disruptive behavior effectively.
Eflornithine
Authors: Chen Ana Carolina , Luke Janiene D. 
Published: April 2021

ABSTRACT
Drugs are substances that exert effects in the body in order to alter an existing physiological or biochemical process. There are several methods of administering drugs, including the use of creams, ointments, liquids, skin patches, capsules, and injections. This column aims to highlight some of the drugs commonly utilized in dermatology. More precisely, this column hopes to better inform readers about the mechanism of action, administration, dosage, adverse effects, and possible alternatives for each particular drug discussed. This article highlights the use of eflornithine as a topical treatment for hirsutism.
A Quality Improvement Collaborative for Adolescents Living With HIV to Improve Immediate Antiretroviral Therapy Initiation at 25 Health Facilities in Lusaka, Zambia
Authors: Dougherty Gillian , Boccanera Rodrigo , Boyd Mary Adetinuke , Gantt Tracey , Chilungu Kasonka Siphiwe , Kasonde Prisca , Kaetano Nila , Madevu-Matson Caitlin , Milimo Phales , Mwamba Mukuka , Panya Milembe , Senyana Brenda , Tsiouris Fatima , Walker Lauren , Zyongwe Nancy , Zulu Alice , Rabkin Miriam 
Published: April 2021

Abstract
HIV testing with rapid antiretroviral therapy (ART) initiation are life-saving interventions for adolescents living with HIV. However, in Zambia, HIV diagnosis and immediate ART initiation among adolescents living with HIV is lagging. In collaboration with the Zambian Ministry of Health, the U.S. Health Resources and Services Administration, the U.S. Centers for Disease Control and Prevention in Zambia, and ICAP at Columbia University designed and implemented a quality improvement collaborative (QIC) to improve adolescent immediate ART initiation at 25 health facilities in Lusaka. Over the 12-month implementation period, quality improvement teams tested and identified targeted intervention, that significantly improved ART initiation within 14 days of receiving positive test results, from 24% at baseline to more than 93% for the final 6 months of implementation. The quality improvement collaborative approach empowered health care workers to innovate addressing the root causes of suboptimal performance and produced a package of successful interventions that will be shared throughout Zambia.
Factors Associated With the Presenteeism of Single-Person Household Employees in Korea
Authors: Min Deulle , Lee Su Jeong 
Published: April 2021

Objective:The number of single-person households is rapidly increasing worldwide. Many workers from these households have to work even when they are sick, leading to presenteeism. The study aimed to identify factors affecting presenteeism in workers from single-person households.Methods:This study is a retrospective survey, a secondary data analysis using data from the 5th Korean Working Conditions Survey of 2017.Results:Of 2156 workers, 366 (17%) showed presenteeism and 1790 (83%) did not. Multiple logistic regression analysis showed that being a woman, subjective health status being moderate or good, presence of disease, longer commuting hours, and longer working hours per week are related to presenteeism.Conclusions:To reduce the presenteeism of workers from single-person households, specific programs and organizational policies can be developed.
Establishment and assessment of a nomogram model for predicting the risk of fulminant myocarditis
Authors: Xu Guifen , Chen Feizhen , Zhao Wenxiang , Zheng Yong , Zhuang Wei , Yu Fuling 
Published: April 2021

Abstract
We aimed to identify potential clinical predictors associated with the risk of fulminant myocarditis, and further to establish and assess a nomogram model based on significant attributes for clinical practicability.
This is a retrospective, cross-sectional study, involving 28 patients with fulminant myocarditis and 35 age-, and sex-matched patients with non-fulminant myocarditis. Effect-size estimates are expressed as odds ratio (OR) and 95% confidence interval (CI).
Fifteen factors were primarily identified to be associated with the significant risk of fulminant myocarditis after adjusting for confounders. Due to strong correlation, 6 factors were retained, including mean arterial pressure (OR, 95% CI, P: .82, .72–.94, .005), creatinine (2.15, 1.13–4.10, 0.020), blood urea nitrogen (1.45, 1.04–2.02, 0.028), aspartate aminotransferase (2.62, 1.16–5.91, 0.021), troponin I (1.43, 1.07–1.90, 0.015), and ventricular wall motion abnormality (25.81, 2.52–264.69, 0.006). The contribution of the 6 significant factors to predicting fulminant myocarditis risk was significant from multi-angle analyses, and regressing these factors in a nomogram model exhibited good predictive accuracy, as reflected by both C-index (>90%, P < .001).
We have identified 6 clinical factors in significant association with fulminant myocarditis, and their prediction capability was more obvious in a nomogram model. Further investigations with larger sample sizes and longer follow-up intervals are warranted.
Wild type transthyretin cardiac amyloidosis in a young individual
Authors: Ghosh Shreya , Khanra Dibbendhu , Krishna Vinay , Thakur Ashwani Kumar 
Published: April 2021

Abstract

Rationale:
Senile systemic amyloidosis, a disease of elderly is caused by amyloid deposition of wild-type transthyretin. The symptoms often overlap with other heart diseases. Hence it is either misdiagnosed or considered as a normal aging process in majority of cases.

Patient concerns:
We present a young patient of wild-type transthyretin amyloidosis, contradicting its only senile presence. The 34-year-old man presented with dyspnoea on exertion. He was suffering from hypertension for consecutive 3 years.

Diagnosis:
Echocardiography demonstrated left ventricular hypertrophy with reduced global longitudinal strain and apical sparing. Congo red staining and immuno-histochemical staining of the abdominal fat biopsy confirmed transthyretin amyloid deposition. Genetic analysis revealed absence of any mutant variant/s of transthyretin gene, confirming wild-type transthyretin amyloidosis.

Intervention:
A combination of amlodipine 5 mg, telmisartan 40 mg, and chlorthalidone 12.5 mg once daily was given to control the blood pressure of the patient.

Outcome:
Blood pressure was controlled but he continued to have exertional dyspnoea. The patient expired in December 2019.

Lessons:
A systematic diagnosis for wild type transthyretin amyloid cardiomyopathy (ATTR-CM) shall be considered in young cardiac patients suffering from cardiac distress with unknown etiology.