bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and Efficacy of Single-Dose Ketorolac for Postoperative Pain Management After Primary Palatoplasty: A Prospective Cohort Study With Historical Controls
Authors: Stein Jason R. , Mantilla-Rivas Esperanza , Aivaz Marudeen , Rana Md Sohel , Mamidi Ishwarya Shradha , Ichiuji Brynne A. , Manrique Monica , Rogers Gary F. , Finkel Julia C. , Oh Albert K. 
Published: May 2021

Objective: To analyze safety and efficacy of single-dose ketorolac after primary palatoplasty (PP). Design: Consecutive cohort of patients undergoing PP, comparing to historical controls. Setting: A large academic children’s hospital. Patients, Participants: A consecutive cohort of 111 patients undergoing PP (study n = 47) compared to historical controls (n = 64). Interventions: All patients received intraoperative acetaminophen, dexmedetomidine, and opioids while the study group received an additional single dose of ketorolac (0.5 mg/kg) at the conclusion of PP. Main Outcome Measures: Safety of ketorolac was measured by significant bleeding complications and need for supplementary oxygen. Efficacy was assessed through bleeding, Face Legs Activity Cry Consolability (FLACC) scale, and opioid dose. Results: Length of stay was similar for both groups (control group 38.5 hours [95% CI: 3.6-43.3] versus study group 37.6 hours [95% CI: 31.3-44.0], P = .84). There were no significant differences in all postoperative FLACC scales. The mean dose of opioid rescue medication measured as morphine milligram equivalents did not differ between groups ( P = .56). Significant postoperative hemorrhage was not observed. Conclusions: This is the first prospective study to evaluate the safety and efficacy of single-dose ketorolac after PP. Although lack of standardization between study and historical control groups may have precluded observation of an analgesic benefit, analysis demonstrated a single dose of ketorolac after PP is safe. Further investigations with more patients and different postoperative regimens may clarify the role of ketorolac in improving pain after PP.
Economic impact of implementation of an automated drug supplying and management system in a Central Chemotherapy Preparation Unit in a Moroccan hospital
Authors: Baraka Soumaya El , Ouedraogo Jean-Marie , Sessouma Abou , Arbai Soumaya , Belahcen Mohammed-Jaouad , Rahali Younes 
Published: May 2021

Objective Automated Drug Supplying and management System (ADS) are effective devices that secure drug’s circuit and reduce hospital’s expenses. The purposes of this study are to estimate the earnings made from ADS through a cost-benefit medical economic study, to highlight its impact on Central Chemotherapy Preparation Unit’s (CCPU) global organization, its ergonomy and staff’s satisfaction. Method Measurement of cytotoxic drug’s consumption, expiration losses, pharmacy staff’s working time, drugs stock-out before and after the implementation of ADS on the one hand, and assess its ergonomy and acceptability by users on the other hand. Results After the implementation of ADS, cytotoxic drug’s consumption decreased by 9 (%), expiration losses by 98.3 (%), and we could see a gain in working time among CCPU’S technicians of 1.32 (h/day) and pharmacist of 0.67 (h/day), in contrast to the stock manager who increased his working time by 0.95 (h/day). Stock-out have decreased by 41.1 (%). The cost-benefit analysis has shown a net benefit of 67,437 between the two six-month phases, which corresponds to an economy of 134,874 (USD) over one year. The ADS was generally appreciated by the CCPU and pharmaceutical staff and 93(%) don’t want to return to the old system. Conclusion ADS implementation within CCPU led to financial savings in the hospital, an optimization of expenses and better pharmaceutical management.
Paediatric post-discharge pain and parent perceptions of support from an Australian nurse practitioner led acute pain service
Authors: Forster Elizabeth M. , Kotzur Catherine , Richards Julianne , Gilmour John 
Published: May 2021

Poorly managed post-operative pain remains an issue for paediatric patients. Post-discharge telephone follow-up is used by an Australian Nurse Practitioner Acute Pain Service (NpAPS) to provide access to effective pain management post-discharge from hospital. This cross-sectional survey design study aimed to determine the pain levels of children following discharge and parent views on participation in their child’s pain management and perceptions of support from the NpAPS. Parents completed the Parents’ Postoperative Pain Measure–Short Form (PPPM-SF) and factors affecting parents’ participation in children’s pain management questionnaire (FPMQ). Results indicated that pain score was high, especially on the day of discharge and 24 hours post-discharge. Parents, despite feeling supported by the NpAPS, experienced uncertainty, emotional responses and expressed concerns about communication and coordination of care. The clinically significant pain levels of the majority of children on the day of discharge and day post-discharge from hospital are a concern. Worry and uncertainty among parents, particularly on the day and first night of discharge, suggest this transition period where responsibility of clinical management of pain is handed over to parents may require greater focus for parental support.
Percutaneous endovascular abdominal aortic aneurysm repair with monitored anesthesia care decreases operative time but not pulmonary complications
Authors: Kronenfeld Joshua P , Ryon Emily L , Lall Alex , Kang Naixin , Kenel-Pierre Stefan , DeAmorim Hilene , Rey Jorge , Karwowski John , Bornak Arash 
Published: May 2021

Objectives To report our experience and compare the results of percutaneous endovascular aortic aneurysm repair (PEVAR) performed under monitored anesthesia care (MAC) to PEVAR under general anesthesia (GA). Methods A retrospective review of patients who underwent non-emergency endovascular abdominal aortic aneurysm repair (EVAR) was completed. Patients were excluded if they had a complex repair, including fenestrated, branched, or parallel endografting. Demographics, operative data, 30-day mortality/morbidity and postoperative outcomes were analyzed. Results A total of 159 patients were identified with a median age of 69. 115 patients had PEVAR, 45 (39.1%) PEVAR MAC and 70 (60.9%) PEVAR GA. PEVAR MAC compared to PEVAR GA had decreased operative time (106 vs. 134 min, P < 0.001), time in the operating room (163 vs. 245 min, P = 0.016), and estimated blood loss (EBL) (115 vs. 176 mL P = 0.012). There was no statistically significant difference in the hospital length of stay (LOS) (1.9 vs. 2.7 days, P = 0.133), and post-operative complications including pulmonary (2.2 vs. 2.9%, P = 0.835). Forty-four patients had EVAR with a femoral cutdown (FC), including 14 PEVAR conversions. PEVAR conversion was associated with higher EBL (543 vs. 323 mL, P = 0.03), operative time (230 vs. 178 min, P = 0.01), and operating room time (307 vs. 275 min, P = 0.01) compared to planned EVAR with FC. Conclusions PEVAR under MAC is associated with shorter time in the operating room compared to PEVAR under GA. PEVAR under MAC does however not decrease overall morbidities, including postoperative pulmonary complications.
Identification of Heat Shock Protein 90 as a Recurrence Related Marker in Juvenile Nasopharyngeal Angiofibroma
Authors: Wang Jingjing , Hu Li , Liu Zhuofu , Wang Huan , Zhang Huankang , Song Xiaole , Sun XiCai , Wang DeHui 
Published: May 2021

Background Juvenile nasopharyngeal angiofibroma (JNA) is a highly recurrent tumor after curative surgery. Objective The purpose of this study was to evaluate heat shock protein 90 (HSP90) expression in JNA and its association with tumor recurrence. Methods Immunohistochemistry was performed to assess HSP90 expression using tissue microarrays containing 70 JNA patients and 10 control subjects. The associations of HSP90 expression with clinicopathological features and tumor recurrence were analyzed. Results Immunohistochemistry revealed high HSP90 expression in JNA compared with normal middle turbinate samples. High expression of HSP90, which correlated with MVD ( P = .001), ER-α ( P = .001), VEGF ( P < .001) and JNA recurrence ( P = .009), was an independent prognostic factor of time to recurrence ( P = .017). The combination of HSP90 and ER-α had a better power to predict disease recurrence than other clinicopathological features ( P = .008). Conclusions HSP90 may be an independent prognostic marker in JNA patients administered surgical treatment. Combination of HSP90 and ER-α expression may be the best predictor of tumor recurrence among all clinicopathological factors.
How Cooperative Learning Is Conceptualized and Implemented in Chinese Physical Education: A Systematic Review of Literature
Authors: Dyson Ben , Shen Yanhua , Xiong Wen , Dang Linxiu 
Published: May 2021

Purpose: The purpose of this literature review was to investigate how cooperative learning (CL) has been conceptualized and implemented in Chinese physical education (PE). CL is one of the most influential and widespread areas of theory, research, and practice in western education. With the promotion of Chinese government policies, CL has become a popular field of research and was widely used as a pedagogical practice in Chinese. Design/Approach/Methods: Shulruf’s five methodological steps were utilized as the process of screening and selecting relevant studies. Inductive analysis and constant comparison were conducted for analyzing the chosen literature. Findings: The analytic induction revealed four key themes: (a) historical development, (b) policy influence, (c) conceptualization of CL, and (d) implementation of CL. We found that the conceptualization of CL in Chinese PE was ambiguous, and the implementation of CL was predominantly documented by quantitative research methods. In addition, few studies were conducted at the elementary school level. Originality/Value: This is a comprehensive literature review on CL in Chinese PE. Findings and recommendations in this article will be beneficial for policymakers, scholars, and PE teachers to better understand and promote CL in China.
Surveillance Cultures and Infection in 230 Pacemaker and Defibrillator Generator Changes in Pediatric and Adult Congenital Patients
Authors: Webster Gregory , Balmert Lauren C. , Patel Ami B. , Kociolek Larry K. , Gevitz Melanie , Olson Rachael , Chaouki Ahmed S. , El-Tayeb Osama , Monge Michael C. , Backer Carl 
Published: May 2021

Background: Postoperative infections can occur during surgical replacement of pulse generators for pacemakers and implantable cardioverter-defibrillators. The incidence of infection is poorly documented in children and patients with adult congenital heart disease. The utility of surveillance cultures obtained from device pocket swabs is unknown in this group. Methods: We reviewed surgical replacements of cardiovascular implantable pulse generators from 2010 to 2017. Two cohorts were defined. In a surveillance cohort (123 patients), aerobic and anaerobic culture swabs of the device pocket were obtained at the time of generator change. In a nonsurveillance cohort (107 patients), generator change occurred without obtaining cultures. Results: During 230 generator changes (mean patient age 19 years; 77% with structural congenital heart disease), two clinical infections occurred at the surgical site (0.9% incidence). Neither infection occurred in the surveillance cohort. Cultures were positive in 12 (9.8%) of 123 patients in the surveillance cohort, but 11 of 12 were likely contaminants and none were subsequently associated with clinical disease. There was no association between clinical infection or positive surveillance cultures and the location of pulse generator, the presence of other concurrent surgeries, or a history of prior pocket infection. Conclusions: Clinical infection was rare after pulse generator change in children and young adults. No cases required reintervention on the pocket. Surveillance cultures did not improve clinical care. These data extend current recommendations that surveillance cultures are not required during generator change to the pediatric and young adult population.
Pediatric Cardiac Surgical Patterns of Practice and Outcomes in Japan and Europe
Authors: Hörer Jürgen , Hirata Yasutaka , Tachimori Hisateru , Ono Masamichi , Vida Vladimiro , Herbst Claudia , Kansy Andrzej , Jacobs Jeffrey P. , Tobota Zdzislaw , Sakamoto Kisaburo , Ebels Tjark , Maruszewski Bohdan 
Published: May 2021

Objectives: The Japan Cardiovascular Surgery Database–Congenital section (JCVSD-Congenital) and the European Congenital Heart Surgeons Association (ECHSA) Congenital Heart Surgery Database (CHSD) share the same nomenclature. We aimed at comparing congenital cardiac surgical patterns of practice and outcomes in Japan and Europe using the JCVSD-Congenital and ECHSA-CHSD. Methods and Results: We examined Japanese (120 units, 63,365 operations) and European (96 units, 90,098 operations) data in JCVSD-Congenital and ECHSA-CHSD from 2011 to 2017. Patients’ age and weight, periprocedural times, mortality at hospital discharge, and postoperative length of stay were calculated for ten benchmark operations. There was a significantly higher proportion of ventricular septal defect closures and Glenn operations and a significantly lower proportion of coarctation repairs, tetralogy of Fallot repairs, atrioventricular septal defect repairs, arterial switch operations, truncus repairs, Norwood operations, and Fontan operations in JCVSD-Congenital compared to ECHSA-CHSD. Postoperative length of stay was significantly longer following all benchmark operations in JCVSD-Congenital compared to ECHSA-CHSD. Mean STAT mortality score (Society of Thoracic Surgeons European Association for Cardio-Thoracic Surgery mortality score) was significantly higher in JCVSD-Congenital (0.78) compared to ECHSA-CHSD (0.71). Mortality at hospital discharge was significantly lower in JCVSD-Congenital (4.2%) compared to ECHSA-CHSD (6.0%, P < .001). Conclusions: The distribution of the benchmark procedures and age at the time of surgery differ between Japan and Europe. Postoperative length of stay is longer, and the mean complexity is higher in Japan compared to European data. These comparisons of patterns of practice and outcomes demonstrate opportunities for continuing bidirectional transcontinental collaboration and quality improvement.
Transaxillary Approach for Surgical Repair of Simple Congenital Cardiac Lesions: Pitfalls, and Complications
Authors: Bayya Praveen Reddy , Kottayil Brijesh Parayaru , Srimurugan Balaji , Balachandran Rakhi , Jayashankar Jessin Puliparambil , Baquero Luis , Kumar Raman Krishna 
Published: May 2021

Background: In the treatment of simple congenital cardiac lesions, percutaneous and cosmetic surgical approaches have steadily gained prominence. Surgically, right vertical axillary approach is sparsely used despite superior cosmesis and less pain and blood product usage. Knowledge of potential pitfalls could lead to its more widespread acceptance. Methods: We retrospectively analyzed perioperative outcomes of 104 consecutive patients who underwent surgery by this technique between mid-2016 and December 2019, including ostium secundum (67), sinus venosus (34), coronary sinus (1), and ostium primum (1) atrial septal defects and hemianomalous pulmonary venous connection (1). Perioperative variables, surgical times, complications, and follow-up data were analyzed. Results: Patient weight ranged from 6.8 to 41 kg. Incision length ranged from 4 to 6 cm. There was no mortality. All cannulation was central. Difficulty in cannulation (inferior vena cava) was seen in two patients. Morbidity included pneumothorax in 2 (1.9%) patients and subcutaneous emphysema necessitating prolonged intercostal drain retention in 20 (19.2%) patients. Surgical time increased linearly (r = 0.567; P < .001) with increasing patient weight but cardiopulmonary bypass (CPB) time remained unaffected. No chest deformities or paresthesia were noted on follow-up. Scar size decreased in some patients. Conclusions: Right vertical axillary approach can be safely employed to treat simple congenital cardiac lesions with adequate awareness of potential pitfalls. Increasing patient weight increases the surgical time but does not affect CPB times. Incidence of pneumothorax and subcutaneous emphysema is similar to other thoracotomy approaches. It is cosmetically superior.
Outcomes Following Surgery to Address Shone Syndrome in Children
Authors: Dalton Tyler J. , Johnson William K. , Kuhn Evelyn M. , Goot Benjamin H. , Woods Ronald K. , Mitchell Michael E. , Hraska Viktor 
Published: May 2021

Background: Shone syndrome is characterized by coincident mitral valve stenosis and left ventricular outflow tract obstruction. Although first described in 1963, little research has expounded surgical outcomes. We sought to evaluate our experience with this cohort, emphasizing outcomes including mortality, morbidity, and cardiac function. Methods: A retrospective chart review of 46 patients who underwent operation for Shone syndrome between 1990 and May 2018 was conducted. Index operations included 32 repairs of the left ventricular outflow tract, four mitral valve repair/replacements, nine combined repairs, and one non-Shone’s repair. Median age at index procedure was 22 days (2 days-10 years). Mean follow-up was 9.1 years (2 months-21 years), and 70 additional operations (51 reoperations) were required. Three patients were lost to follow-up. Results: Overall survival was 95.7% with two late deaths. Freedom from death or transplant was 93.5%. Thirteen (28.3%) patients remained free from reoperation. Thirty-three patients required 51 reoperations of the left ventricle outflow tract (n = 12), mitral valve (n = 16), combined repairs (n = 21), and transplant (n = 1). At most recent follow-up, patients exhibited mitral stenosis (n = 21), aortic stenosis (n = 7), and diminished LV function (n = 2). Conclusion: Surgical correction of Shone’s offers excellent survival benefit, but reoperation burden is high, with >70% of patients requiring reintervention in the follow-up period. A total of 65% of patients developed recurrent obstruction of left ventricular inflow or outflow, however, ventricular function is preserved in the majority of patients. All but one patient had no functional deficits, classified as New York Heart Association I with > 60% requiring no medication.
What Factors Should Be Considered to Improve Outcome of Mechanical Mitral Valve Replacement in Children?
Authors: Elsisy Mohamed F. , Dearani Joseph A. , Ashikhmina Elena , Krishnan Prasad , Anderson Jason H. , Taggart Nathaniel W. , Van Dorn Charlotte S. , Stephens Elizabeth H. 
Published: May 2021

Objective: To identify risk factors for pediatric mechanical mitral valve replacement (mMVR) to improve management in this challenging population. Methods: From 1993 to 2019, 93 children underwent 119 mMVR operations (median age, 8.8 years [interquartile range [IQR]: 2.1-13.3], 54.6% females) at our institution. Twenty-six (21.8%) patients underwent mMVR at ≤2 years and 93 (78.2%) patients underwent mMVR at >2 years. Median follow-up duration was 7.6 years [IQR: 3.2-12.4]. Results: Early mortality was 9.7%, but decreased with time and was 0% in the most recent era (13.9% from 1993 to 2000, 7.3% from 2001 to 2010, 0% from 2011 to 2019, P = .04). It was higher in patients ≤2 years compared to patients >2 years (26.9% vs 2.2%, P < .01). On multivariable analysis for mitral valve reoperation, valve size <23 mm was significant with a hazard ratio of 5.38 (4.87-19.47, P = .01);. Perioperative stroke occurred in 1% and permanent pacemaker was necessary in 12%. Freedom from mitral valve reoperation was higher in patients >2 years and those with a prosthesis ≥23 mm. Median time to reoperation was 7 years (IQR: 4.5-9.1) in patients >2 years and 3.5 years (IQR: 0.6-7.1) in patients ≤2 years ( P = .0511), but was similar between prosthesis sizes ( P = .6). During follow-up period (median 7.6 years [IQR: 3.2-12.4], stroke occurred in 10%, prosthetic valve thrombosis requiring reoperation in 4%, endocarditis in 3%, and bleeding in 1%. Conclusion: Early and late outcomes of mMVR in children are improved when performed at age >2 years and with prosthesis size ≥23 mm. These factors should be considered in the timing of mMVR.
First Harvest of Pediatric and Congenital Heart Surgery Multicenter Database in Turkey: Novel Application of Real-Time Online Reporting
Authors: Erek Ersin , Yalçınbaş Yusuf Kenan , Sarıosmanoğlu Nejat , Özkan Murat , Yıldız Okan , Şenkaya Işık , Özdemir Fatih , Biçer Mehmet , Sarıtaş A. Bülent , Atay Yüksel , Seçici Serkan , Kutsal Ali , Haydin Sertac , Bilen Cagatay , Onan Ismihan Selen , Tuncer Osman Nuri , Citoglu Gorkem , Doğan Abdullah , Turkoz Riza , Temur Bahar , Koc Murat , Sarıoğlu C. Tayyar 
Published: May 2021

Objectives: A new congenital heart surgery database (CKCV) with real-time online reporting function was recently developed in Turkey. All standard international parameters were used, but Aristotle Comprehensive Complexity score was modified. In this study, the first analysis of the CKCV Database is reported. Methods: The CKCV Database included 2307 procedures from 12 centers between January 2018 and March 2020. All parameters, including 10 real-time online reports, which represent the number of centers, number and mortality rates of all procedures, number of extracorporeal membrane oxygenation (ECMO) and results, details of postoperative complications, age-group statistics, analysis for priority status, mean intensive care and hospital stay durations of the procedures, results of Aristotle Basic, Modified Aristotle Comprehensive (MACC) and Society of Thoracic Surgeons-European Association (STAT) Score Categories, comparison of centers were analyzed. Results: Most common 10 procedures were ventricular septal defect (VSD) repair (n = 273), tetralogy of Fallot (TOF) repair (n = 243), atrial septal defect (ASD) repair (n = 181), complete AVSD repair (n = 95), cavopulmonary anastomosis (n = 81), systemic to pulmonary shunt (n = 79), modified Fontan (n = 71), subaortic resection, (n = 66) PA banding (n = 66), and arterial switch operation (n = 66). Cardiopulmonary bypass was used in 84.6% of the procedures. Overall mortality rate was 6.0%. A total of 618 major and 570 minor complications were observed in 333 and 412 patients, respectively. According to six MACC categories, number of the patients and mortality rates were I (293; 0.3%); II (713; 1.4%); III (601; 3.3%); IV (607; 12%); V (84; 35.7%); and VI (9; 55.6%), respectively. Analysis of five STAT Categories showed 0.7, 3.8, 5.4, 14.9, and 54.7% mortality rates. Conclusions: CKCV Database has a great potential for nationwide quality improvement studies. Users could instantly analyze and compare their results to national and international aggregate data using a real-time online reporting function. This is the first multicenter congenital database study in Turkey.