bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving breastfeeding duration through creation of a breastfeeding-friendly pediatric practice
Authors: Imboden Annie , Lawson Robin 
Published: February 2021

ABSTRACT

Background:
Breastfeeding is the gold standard for infant feeding. In the United States, 83.2% of women initiate breastfeeding on their infant's birth. When the infant reaches 6 months of age, however, only 57.6% of mothers are still breastfeeding, and a mere 24.9% are breastfeeding exclusively.

Local problem:
Breastfeeding rates in rural areas are below the national averages. The greatest disparities exist in minorities and individuals with lower educational and socioeconomic status.

Methods:
A preintervention/postintervention design was used for this quality improvement project. The Model for Improvement's Plan, Do, Study, Act cycle guided the project processes. Breastfeeding rates were obtained at each well-child visit from newborn through 4 months of age. On completion, mean preimplementation and postimplementation breastfeeding rates were compared to determine effectiveness.

Interventions:
A breastfeeding support initiative was implemented at a multisite rural Illinois pediatric practice. An evidence-based breastfeeding policy was developed, staff education sessions were conducted, private lactation rooms were created, and breastfeeding photographs/posters were displayed throughout the offices. Lactation support services were publicized via signs and social media postings.

Results:
Overall breastfeeding rates were higher at each time point after implementation. Statistically significant increases occurred at the newborn and 1-month visits, with a modest improvement at 2 and 4 months.

Conclusions:
This project demonstrated an improvement in breastfeeding duration rates. It is anticipated that this practice-wide standard of care change will promote breastfeeding throughout the first 12 months of life.
Implementation of the standardized, evidence-based three-stage suicide risk screening: Experience of a large Veterans Affairs medical center
Authors: Nwangwu Helen , de Peralta Shelly S. , Birman Sharon , Hicks Rodney W. 
Published: February 2021

ABSTRACT
Suicide is a global public health concern and may be preventable with early identification. The suicide rate among US veterans is increasing. In response to the increase, Veterans Health Administration recommended a new standardized three-step, evidence-based suicide risk screening process across all Veterans Health Administration sites. The purpose of this project was to implement the new three-step suicide screening method and evaluate the rate of provider adherence. The implementation occurred in seven clinical sites in the Veterans Affairs Greater Los Angeles Health care System. Following initial implementation, two Plan-Do-Study-Act (PDSA) evaluated provider adherence to the screening processes. Staff members at each site received suicide prevention education. Staff members had the option of using an embedded template in the course of normal patient care workflow. Plan-Do-Study-Act 1 measured the early results. Staff members achieved a performance adherence rate of 18%, indicating that staff were less likely to proactively screen for risk of suicide. In PDSA-2, the mandatory use of screening replaced the optional use. Staff members achieved a 95% adherence rate after 3 months. Changing the workflow within the electronic health record from optional to mandatory utilization brought forth improvements in suicide prevention screening.
The impact of nurse practitioner and physician assistant workforce supply on Medicaid-related emergency department visits and hospitalizations
Authors: Norful Allison A. , de Jacq Krystyna , Liu Jianfang , Ye Siqin , Khadka Simran , Poghosyan Lusine 
Published: February 2021

ABSTRACT

Background:
New York State (NYS) has approximately 4.7 million Medicaid beneficiaries with 75% having at least one or more chronic conditions. An estimated 10% of Medicaid beneficiaries seek emergency department (ED) services for nonurgent matters. It is unclear if an increased supply of nurse practitioners (NPs) and physician assistants (PAs) impact utilization of ED and subsequent hospitalizations for chronic conditions.

Purpose:
To investigate the relationship between NYS workforce supply (physicians, NPs, and PAs) and 1) ED use and 2) in-patient hospitalizations for chronically ill Medicaid beneficiaries.

Methods:
A cross-sectional study design was employed by calculating total workforce supply per NYS county and the proportion of physicians, NPs, and PAs per total number of Medicaid beneficiaries. We extracted the frequencies of all NYS Medicaid beneficiary chronic condition–related ED visits and in-patient admissions. Medicaid beneficiaries were considered to have a chronic condition if there was a claim indicating that the beneficiary received a service or treatment for this specific condition. We calculated the proportion of ED visits/beneficiary for each chronic disease category and the proportion of category-specific in-patient hospitalizations per the number of beneficiaries with that diagnosis.

Results:
As the NP/beneficiary proportion increased, ED visits for dual and nondual eligible beneficiaries decreased (p = .007; β = −2.218; 95% confidence interval [CI]: −3.79 to −0.644 and p = .04; β = −2.698; 95% CI: −5.268 to −0.127, respectively).

Implications for practice:
Counties with a higher proportion of NPs and PAs had significantly lower numbers of ED visits and hospitalizations for Medicaid beneficiaries.
Predictors of serious adverse drug events from opioids: Results from the Food and Drug Administration Adverse Events Reporting System
Authors: McDonald Deborah Dillon , Srisopa Pornpan 
Published: February 2021

ABSTRACT

Background:
Opioids pose significant increased risk for serious adverse drug events (ADEs).

Purpose:
The purpose was to identify significant predictors and their associated magnitude of risk for serious life-threatening opioid ADEs.

Methods:
A post hoc design was used to examine predictors of opioid analgesics ADEs with Food and Drug Administration Adverse Events Reporting System (FAERS) data. The sample consisted of all eligible cases from the second quarter of the 2019 FAERS where an opioid analgesic was identified as the primary suspect for an ADE. Logistic regression was used to predict serious life-threatening ADEs. Final predictors included age, gender, misuse/substance use disorder, number of concurrent opioids; use of benzodiazepines, other sedatives, and antidepressants; and use of morphine, fentanyl, and oxycodone.

Results:
Life-threatening ADEs, excluding suicide and suicide attempts, comprised 19.9% of the cases. Protective factors that reduced risk included female gender, use of antidepressants, and use of morphine. Harmful factors that increased risk of a serious ADE included misuse/substance use disorder, use of benzodiazepines, and use of other sedatives. Persons taking an opioid with both a benzodiazepine and another sedative increased risk of a serious ADE by 18.78 times.

Implications for practice:
Results provide risk data helpful to share with people who use prescribed opioids for self-management of pain. Combination of opioids and clinically indicated antidepressants that do not both promote serotonin uptake inhibition may reduce risk for serious opioid ADEs. Practitioners should continue to avoid prescribing benzodiazepines and other sedatives when opioids are used.
Knowledge and clinical dialogues about complementary health approaches among nurse practitioners specialized in geriatrics
Authors: Geisler Carol , Cheung Corjena , Johnson Steinhagen Stasia , Brueggemann Alvina 
Published: February 2021

ABSTRACT

Background:
In the United States, people over the age of 65 years will account for 20% of the population by 2030, and these elders are more likely to have chronic comorbid complex health problems. Sixty-three percent use complementary health approaches (CHAs) but less than half disclose their use to their health care providers. Nurse practitioners (NPs) are the fastest growing population of primary care health providers.

Purpose:
This study identifies to what degree NPs with specialized training in geriatrics understand CHAs, use them themselves, encourage their patients to access them, and engage in CHA clinical dialogue.

Methods:
Cross-sectional online survey collecting quantitative and narrative data; US NPs with specialized training in geriatrics (n = 170, mean age 52 years, SD: 9.0, range: 29–73).

Results:
Although NPs are knowledgeable about some CHA and believe they are beneficial for older adults to use, they want more education to help understand the effects of a variety of CHA, be more aware of possible treatment interactions, and to integrate CHA into the current health care system. Patient factors (impaired cognitive function, acute health problems, and not open to CHA), provider factors (inadequate CHA knowledge, limited referral paths and resources), and system factors (limited accessibility and availability of CHA in in-patient setting, CHA not covered by insurance, and limited clinical time) disrupt NPs from assessing and discussing CHA with their patients.

Implications for practice:
There is a need to develop and implement NP practice guidelines for CHA clinical management for older adults and provide educational opportunities to incorporate CHA into clinical practice.
Defining the urology nurse practitioner role in the United States: A Delphi study
Authors: Quallich Susanne , Lajiness Michelle J. 
Published: February 2021

ABSTRACT

Background:
Nurse practitioners (NPs) achieve expertise in urology environments due to on-the-job training and independent study, coupled with mentoring. This creates a wide variety of preparation and role descriptions, and despite the availability of sought NP certification in urology, there is not a current definition for a “urology NP.”

Purpose:
This project sough to develop a contemporary definition of the urology NP role, based on expert opinion.

Methods:
Study design was the Delphi method, which evaluates consensus and opinion when there is incomplete knowledge or lack of evidence. Participants were a nonrandom panel of experts on the urology NP role with at least 2 years as a full-time urology NP. This exempted study collected data via an online platform that ensured anonymity, and was completed in two rounds.

Results:
The following definition is proposed after the study results: “The Urology NP provides acute and chronic care to individuals experiencing urological health care needs across the lifespan, engages in office-based urology procedures in accordance with the state Board of Nursing, maintains membership in professional organizations and acts as preceptor to all health care disciplines.” Certification in the specialty role was deemed important.

Implications for practice:
Results demonstrated the very patient-care centered nature of this specialty NP role, as professional roles of the NP were given less weight. The project offers a definition of the urology NP role that can be offered to educators and other stakeholders.
The fiscal impact of repeat imaging in a pediatric orthopedic clinic
Authors: Thompson Cynthia T. , Bartolomei Olivia , Vuillermin Carley 
Published: February 2021

ABSTRACT

Background:
Many patients present to an initial pediatric orthopedic clinic visit without bringing previously obtained x-rays (XRs), leading to repeat imaging, unnecessary radiation exposure, and increased health care costs. Importing images to the picture archiving and communication system and the use of cloud-based medical image-sharing software systems result in the reduction of reimaging rates and health care costs.

Local problem:
Unnecessary duplicative XR imaging was recognized in our pediatric orthopedic clinic as an area for quality improvement. Our purpose was to determine the magnitude of the problem and the feasibility of decreasing total visit charges through electronic retrieval of previous XRs.

Method:
Data collection occurred from May 22, 2019, through June 22, 2019, in the orthopedic trauma clinics at the main campus of a quaternary care pediatric hospital in the northeast United States and its three satellite locations.

Intervention:
The number of patients who did not bring XRs to their initial orthopedic visit and the type of XR ordered were recorded by clinicians. A retrospective chart audit was also completed for comparison.

Results:
Of 699 new patient visits, 77 (11%) did not bring previous XRs. This resulted in total reimaging charges of $33,326, representing 30%–50% of total visit charges. Retrospective chart audit identified 60% more new patients than the clinicians.

Conclusions:
Electronic retrieval of XRs in pediatric orthopedic clinics can decrease duplicative charges, radiation exposure, and health care waste. It can also contribute to successful care of patients via virtual visits in times of restricted access such as a pandemic.
A practical approach to obesity prevention: Healthy home habits
Authors: Fruh Sharon , Williams Susan , Hayes Katey , Hauff Caitlyn , Hudson Geoffrey M. , Sittig Scott , Graves Rebecca J. , Hall Heather , Barinas Jennifer 
Published: February 2021

ABSTRACT
Families have the potential to foster a healthy home environment aimed at reducing the risk of overweight and obesity. Establishing habits associated with reduced risk of obesity and overweight early in childhood can have lasting effects into adulthood. Nurse practitioners can encourage families to participate in healthy habits by addressing areas of growth for obesity prevention within the home. A review of the most recent literature, approximately over the past decade, was used to provide a consolidated source of reference for healthy home habits for the nurse practitioner. The search included terms such as “obesity,” “overweight,” “healthy habits,” “physical activity,” “obesogenic behaviors,” “family meals,” “screen time,” “depression,” “sugary beverages,” and “portion sizes.” The information was synthesized into three content areas: nutrition and consumption, patterns of activity, and stress within the home. Establishing healthy habits early in life can protect against the development of overweight and obesity. Nurse practitioners can serve a vital role in the prevention of pediatric, adolescent, and adult obesity. Equipped with the unique role of assisting those from a diverse patient base, nurse practitioners can inform patients how to improve healthy habits to decrease the likelihood of obesity or overweight. Encouraging behavior change related to the healthy habits associated with the prevention of overweight and obesity can have a long-term impact on the health of an entire family.
Inflammation at the Tissue-Electrode Interface in a Case of Rapid Deterioration in Hearing Performance Leading to Explant After Cochlear Implantation
Authors: Hough Kate , Sanderson Alan , Grasmeder Mary , Mitchell Tim , Verschuur Carl A. , Newman Tracey A. 
Published: February 2021

Objective:
The reasons for soft failure after cochlear implantation require investigation. This study proposes a method to study and characterize the tissue response to the array in a case of soft failure in a person undergoing reimplantation.

Case:
The woman in her 50s, with an underlying autoimmune condition, received a cochlear implant using hearing preservation technique after developing profound hearing loss more than 2 kHz with a moderate loss of less than 500 Hz over a 10-year period. The case was identified as a soft failure due to deteriorating performance, discomfort, and migration over the 10 months after implantation. Impedance telemetry, speech perception measures, and audiometric thresholds are described. At explantation there was evidence of fibrosis.

Intervention(s):
To use histology and immunohistochemistry to determine the cellular response of the tissue associated with the electrode array at time of explantation.

Main Outcome Measure(s):
Identification of the cell types, regional variations, and inflammatory marker expression in the fibrotic tissue associated with the array.

Results:
Neutrophils and eosinophils were identified, along with a variable pattern of collagen deposition. CD68 and CD163-positive macrophages and T cells were variably distributed through the tissue and interleukin-1 beta and vascular endothelial growth factor receptor-2 expression was identified.

Conclusions:
The expression profile is evidence of active inflammation in the tissue despite the time since implantation. This study is the first to characterize the tissue response to the array in a person undergoing reimplantation, and who can be followed to determine the individual response to arrays. It establishes that the investigation of explanted devices after soft-failure is feasible.
Ultrasound-Controlled Manual Magnet Repositioning in Magnet Dislocation of Cochlear Implants
Authors: Rupp Robin , Hornung Joachim , Balk Matthias , Traxdorf Maximilian , Sievert Matti , Hoppe Ulrich , Iro Heinrich , Gostian Antoniu-Oreste 
Published: February 2021

Objective:
To investigate whether ultrasound is a helpful and reliable diagnostic tool to survey the status of the magnet previous and after manual repositioning in patients with partially dislocated cochlear implant (CI) magnets and to assess the success rate of a manual repositioning maneuver.

Design:
A prospective cohort study.

Setting:
A tertiary referral medical center.

Patients:
Patients with a cochlear implant who presented with magnet dislocation after magnetic resonance imaging (MRI) between June 1, 2019 and July 15, 2020.

Interventions:
Manual repositioning of the partially dislocated CI magnet surveyed by pre- and post-interventional ultrasound.

Main Outcome Measures:
Rate of successfully diagnosed and manually repositioned magnets; complication rate and recurrence rate after initial manual repositioning maneuver.

Results:
Nine patients presented with a partial magnet dislocation diagnosed by pre-interventional ultrasound following MRI (n = 9 magnets; three ♀; eight right-sided implants; 65.4 ± 21.7 yr). All magnets were repositioned manually. The magnets were successfully repositioned at the first attempt in six out of eight patients. Two patients required a second and one patient a third attempt of manual repositioning. Post-interventional ultrasound confirmed the entirely restored magnet position in all cases. During the mean follow-up period of 7.3 months (±5.4 mo) no patient experienced any complication or recurrent dislocation of the respective magnet.

Conclusion:
Manual magnet repositioning is a feasible and reliable method with a high success rate for partially dislocated CI magnets. The pre-interventional diagnosis as well as the post-interventional confirmation of the magnet status can be effectively determined by ultrasound. Thus, manual magnet repositioning and ultrasound investigation can be advocated as first-line therapeutic and diagnostic instruments when dealing with partial magnet dislocation.
Tobacco Use and Skin Reactivity in Patients With Percutaneous Auditory Osseointegrated Implants
Authors: Gardiner Lauren , Lavallee Martin , Sima Adam , Coelho Daniel H. 
Published: February 2021

Objectives:
To determine if there is an association between tobacco use and the development of postoperative skin reactions in patients undergoing percutaneous osseointegrated auditory implant (pOAI) surgery.

Study Design:
Single surgeon retrospective cohort study.

Setting:
Academic medical center.

Subjects and Methods:
Retrospective chart review was performed on all patients who underwent pOAI. Smoking status (current and former users versus never-users) was recorded as were numerous demographic and surgical variables. The primary outcome measure was skin reactivity as measured by Holgers score. Secondary outcomes studied included total number of problem visits, minor interventions, and major interventions.

Results:
126 patients, 73 with no tobacco history (NT) and 53 with a positive smoking tobacco history (T) underwent pOAI surgery in this study. The T group was found to have higher rates of first postoperative visit soft tissue reactions compared with the NT group (24.5% versus 6.8%, p 1/4 0.011, odds ratio [OR] 4.42, 95% confidence interval [CI]: 1.5, 13.3), but not at long-term follow-up. When former smokers were eliminated from analysis, differences were also found at long- term follow-up (40.9% versus 19.2%, p 1/4 0.037, OR 2.92, 95% CI [1.0 – 8.1]). There were no differences in total number of problem visits or total number of minor or major interventions.

Conclusions:
Patients with a history of tobacco use have a significantly higher rates of skin reactivity compared with patients without, though smoking cessation may partially mitigate long-term risks. Surgeons should be aware of the risks of early skin reactivity and should counsel patients accordingly.
Feasibility of Cochlea High-frequency Ultrasound and Microcomputed Tomography Registration for Cochlear Computer-assisted Surgery: A Testbed
Authors: Akkari Mohamed , Subsol Gérard , Zemiti Nabil , Lavenir Lucas , Farah Charlotte , François Florence , Mondain Michel , Captier Guillaume , Poignet Philippe , Venail Frédéric 
Published: February 2021

Introduction:
There remains no standard imaging method that allows computer-assisted surgery of the cochlea in real time. However, recent evidence suggests that high-frequency ultrasound (HFUS) could permit real-time visualization of cochlear architecture. Registration with an imaging modality that suffers neither attenuation nor conical deformation could reveal useful anatomical landmarks to surgeons. Our study aimed to address the feasibility of an automated three-dimensional (3D) HFUS/microCT registration, and to evaluate the identification of cochlear structures using 2D/3D HFUS and microCT.

Methods:
MicroCT, and 2D/3D 40 MHz US in B-mode were performed on ex vivo guinea pig cochlea. An automatic rigid registration algorithm was applied to segmented 3D images. This automatic registration was then compared to a reference method using manual annotated landmarks placed by two senior otologists. Inter- and intrarater reliabilities were evaluated using intraclass correlation coefficient (ICC) and the mean registration error was calculated.

Results:
3D HFUS/microCT automatic registration was successful. Excellent levels of concordance were achieved with regards intra-rater reliability for both raters with micro-CT and US images (ICC ranging from 0.98 to 1, p < 0.001) and with regards inter-rater reliability (ICC ranging from 0.99 to 1, p < 0.001). The mean HFUS/microCT automated RE for both observers was 0.17 ± 0.03 mm [0.10–0.25]. Identification of the basilar membrane, modiolus, scala tympani, and scala vestibuli was possible with 2D/3D HFUS and micro-CT.

Conclusions:
HFUS/microCT image registration is feasible. 2D/3D HFUS and microCT allow the visualization of cochlear structures. Many potential clinical applications are conceivable.