bluuebunny/crossref_metadata_2025_split huggingface dataset:
Social and Educational Outcomes in Patients With Biliary Atresia
Authors: Alexander Emma C. , Greaves William , Vaidya Hrisheekesh J. , Burford Charlotte , Jain Vandana , Samyn Marianne 
Published: September 2021

ABSTRACTObjectives:To systematically review the social outcomes of patients with biliary atresia (BA), including educational, employment and family outcomes.Methods:We conducted a systematic review of Medline, EMBASE, Global Health, Maternity and Infant Care Database, supplemented by reference searching. National Heart, Lung and Blood Institute scoring was conducted for quality assessment. The PROSPERO registration ID was CRD42020178846.Results:Fifty‐one studies were included (41 cohort, 10 cross‐sectional), including 4631 participants across 16 countries. Cohorts were BA post‐liver transplant (LT) (18 studies), native liver survivors (NLS) (16 studies), mixed (13 studies) and four other cohorts. Outcomes covered; education (n = 35), employment (n = 16), family outcomes (n = 22), and social functioning (n = 22). BA patients had lower school functioning scores than controls, with no difference between NLS versus post‐LT. Between 2% and 48% of children required additional educational support. Between 60% and 100% of adult patients with BA were employed. Pregnancies were described in 17 studies, with small samples, and some noted complications. Social functioning scores were similar to healthy controls in 8 of 11 comparisons.Conclusions:Despite BA being the primary indication for liver transplantation in childhood, social outcomes for children and adolescents are predominantly reported in non‐controlled, single‐centre survey‐based studies. School functioning is lower compared to peer groups, with no evidence of a difference for those having a liver transplant. We recommend routine psychosocial assessment of these patients during follow‐up, alongside multi‐centre collaborations, to maximise the quality of evidence for future patients.
Effect of Added Free Water to Enteral Tube Feeds in Children Receiving Commercial Blends
Authors: Hirsch Suzanna , Solari Toni , Rosen Rachel 
Published: September 2021

ABSTRACTObjectives:To determine the impact of free water administration on clinical outcomes in medically complex patients, based on the hypothesis that patients receiving more thin liquids have worse outcomes related to increased risk of gastroesophageal reflux.Methods:This was a retrospective chart review of children initiated on commercial blenderized tube feedings from 2010 to 2019. The percentage of gastrostomy intake that was a thin liquid was determined, with thin liquids including free water or thin formula based on the International Dysphagia Diet Standardization Initiative (IDDSI) framework. Patients were categorized into those receiving low volumes of thin liquids (“percent thin” ⩽20%) and those receiving higher volumes (“percent thin” >20%). Emergency room visits, hospital admissions, and chest X‐rays during the year after starting the blend were compared.Results:Forty‐five patients age 12 months to 18.7 years (median 3.7 years) were included. Twenty patients (44%) were receiving a blend with an IDDSI‐categorized thin consistency and 25 patients (56%) were receiving a thicker blend. In addition to the blend, patients received a median of 320 mL per day of water (range 0–1000 mL). Patients receiving <20% thin liquids were less likely to undergo chest X‐rays during follow‐up than patients receiving larger amounts of thin liquids (10% in the minimal thin group versus 48% in the greater thin group, P = 0.03). In a multivariable logistic regression, this relationship remained significant after controlling for underlying pulmonary disease, aspiration, method of feed administration (bolus or continuous feeds), fundoplication status, and oral intake status.Conclusions:Our study demonstrates that patients on blenderized tube feeds receive widely variable amounts of added thin liquids, like water. The addition of water to tube feeds, while typically given for hydration, can modify feed viscosity and clinical outcomes, such as chest X‐ray performance.
Efficacy and Safety of Iron Chelation Therapy After Allogeneic Hematopoietic Stem Cell Transplantation in Pediatric Thalassemia Patients: A Retrospective Observational Study
Authors: Kupesiz Funda T. , Sivrice Cigdem , Akinel Aysenur , Kintrup Gulen T. , Guler Elif , Kupesiz Alphan 
Published: September 2021

Background:
Studies on the increased body iron load in patients with thalassemia major have thoroughly demonstrated the problems caused by iron overload. In patients who undergo hematopoietic stem cell transplantation (HSCT) as curative therapy, iron overload continues long after transplantation. There are few pediatric studies on chelation therapy in the posttransplant period. In this study, we present the outcomes of our patients who received posttransplant oral chelation therapy.

Patients and Methods:
This retrospective observational study evaluated the outcomes of pediatric patients with thalassemia major who used oral chelation therapy after allogeneic HSCT at the Akdeniz University Pediatric Bone Marrow Unit between January 2008 and October 2019.

Results:
Deferasirox therapy was initiated in 58 pediatric patients who underwent HSCT for thalassemia. Pretreatment mean serum ferritin was 2166±1038 ng/mL. Treatment was initiated at a mean of 12±6.7 months after transplantation and continued for a mean of 15.7±11.5 months. At treatment discontinuation, the mean serum ferritin was 693±405 ng/mL and the mean reduction was −1472.75±1121.09 ng/mL (P<0.001 vs. posttreatment). Serum ferritin was below 500 ng/mL in 52% of the patients at treatment discontinuation. Manageable side effects such as nausea, vomiting, liver enzyme elevation, and proteinuria were observed in 17% of the patients, while one patient developed ototoxicity.

Conclusions:
Deferasirox therapy effectively reduces iron overload in the posttransplant period. Studies evaluating the effects of early treatment on the graft may help to establish guidelines for posttransplant chelation therapy. Clear guidelines are needed regarding when to initiate and discontinue treatment.
Barriers to Care and Outcomes of Pediatric Acute Lymphoblastic Leukemia Treatment in the Gaza Strip
Authors: Mills David , Abushanab Salah , Elhaloul Awad , El Nuweiry Heiam , Shbair Mahmoud , Qaddoumi Ibrahim , Salman Zeena 
Published: September 2021

Background:
Childhood acute lymphoblastic leukemia (ALL) is the most common pediatric cancer worldwide. Although children in high-income countries enjoy survival rates of ~90%, children in countries with limited resources suffer from survival rates of <35%. No published data on pediatric cancer incidence, management, or outcomes in the Gaza Strip are available.

Methods:
A retrospective cohort study was undertaken for pediatric (below 12 y of age) ALL diagnoses admitted to the only pediatric cancer ward in the Gaza Strip between 2010 and 2015. Outcomes included event-free survival (EFS) and overall survival (OS) calculated by Kaplan-Meier estimates. Events were defined as induction failure, relapse, and death.

Results:
The 3-year EFS estimate was 80% (95% confidence interval [CI], 66%-89%). The EFS at 1 and 3 years for high-risk ALL was 55% (95% CI, 27%-76%) and 23% (95% CI, 4%-51%), respectively. The 3-year OS was 93% (95% CI, 82%-97%). The 3-year OS for high-risk ALL was 69% (95% CI, 30%-90%). All 84 (100%) patients required referral to an outside hospital for definitive ALL diagnoses and induction therapy. Forty-four (52%) patients required at least one additional referral.

Conclusions:
The overall outcomes demonstrated relatively high survival rates at 3 years which may be artificially elevated due to exclusion of adolescents, limited follow up, and deceased patient charts unavailable. Structural determinants of health in Gaza lead to limited diagnostic and treatment capabilities, limited access to advanced medical training, and reliance on out-of-territory transfers for care. These barriers impact the access to comprehensive pediatric care within the Gaza Strip.
Stability of Symptom Clusters in Patients With Gynecologic Cancer Receiving Chemotherapy
Authors: Pozzar Rachel A. , Hammer Marilyn J. , Cooper Bruce A. , Kober Kord M. , Chen Lee-May , Paul Steven M. , Conley Yvette P. , Cartwright Frances , Wright Fay , Levine Jon D. , Miaskowski Christine 
Published: September 2021

Background
Patients with gynecologic cancer undergoing chemotherapy experience multiple co-occurring symptoms. Understanding how symptom clusters change over time is essential to the development of interventions that target multiple co-occurring symptoms.

Objective
The aim of this study was to assess the relative stability of symptom clusters across a chemotherapy cycle in patients with gynecologic cancer.

Methods
This is a longitudinal, descriptive study. Eligible patients (n = 232) were English-speaking adults (≥18 years old) with gynecologic cancer. Data were collected in the week before patients' second or third cycle of chemotherapy (T1) and at 1 (T2) and 2 (T3) weeks after chemotherapy. Three dimensions of the symptom experience (occurrence, severity, and distress) were assessed using a modified version of the Memorial Symptom Assessment Scale. Symptom clusters for each dimension and time point were identified through exploratory factor analysis.

Results
A 5-factor solution was selected for each exploratory factor analysis. Hormonal, respiratory, and weight change clusters were identified across all dimensions and time points. A psychological symptom cluster was identified at T1 for occurrence and severity and at T2 and T3 for all 3 dimensions. A gastrointestinal symptom cluster was identified at T1 for occurrence and at T2 and T3 for all 3 dimensions. The hormonal, respiratory, psychological, and weight change symptom clusters exhibited common symptoms across dimensions and time points.

Conclusions
Hormonal, respiratory, weight change, and psychological symptom clusters are relatively stable across a cycle of chemotherapy in patients with gynecologic cancer.

Implications for Practice
Clinicians need to assess patients for multiple co-occurring symptoms and initiate multimodal interventions.
Factors Correlated With Fear of Cancer Recurrence in Cancer Survivors
Authors: Zhang Xu , Sun Di , Qin Nan , Liu Meishuo , Jiang Nan , Li Xiaohan 
Published: September 2021

Background
Fear of cancer recurrence (FCR) is one of the most common and aversive psychological phenomena among cancer survivors. Understanding the independent and potentially modifiable risk factors that contribute toward FCR seen in cancer survivors would inform future interventional trials aimed at reducing this risk.

Objective
The aim of this study was to provide an evidence synthesis of factors correlated with FCR to inform the development of preventive interventions.

Methods
A literature search was performed of the PsycINFO, EMBASE, and MEDLINE (PubMed) databases. Reports published from inception to 2020 focusing on the correlates of FCR with physical, psychological, and social factors were identified. Authors assessed the studies’ risk of bias in accordance with the Standard Quality Assessment Criteria for Quantitative Studies (QualSyst criteria) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. After extracting data and assessing the quality of the included studies, meta-analysis was conducted using RevMan 5.3 software.

Results
Thirty-four articles were included in this study with a total sample of more than 13 000 cancer patients. Fear of cancer recurrence was positively correlated with anxiety, depression, avoidance, chemotherapy, distress, intrusive thoughts, fatigue, rumination, and neuroticism. It was negatively correlated with optimism, age, social support, quality of life, time since diagnosis, well-being, and self-efficacy.

Conclusions
We identified 16 factors that are correlated with FCR, 9 positively correlated with FCR and 7 negatively correlated with FCR.

Implications for Practice
The findings of this study provide direction for the development of precise interventions for FCR in cancer survivors and lay the foundation for the further construction of an FCR-related nursing theoretical framework.
If We Make It, Will They Take It? Attitudes Toward the Acceptability of Chlamydia Point-of-Care Testing Among Adolescents and Young Adults
Authors: Pastolero Peter Coronel , Suss Amy , Cambridge Rhonda , Hammerschlag Margaret R. 
Published: September 2021

Background
Adolescent women, 15 to 19 years of age, have the highest rate of Chlamydia trachomatis infection in the United States. The objective of this study was to ascertain knowledge and experience of C. trachomatis and acceptance of C. trachomatis point-of-care testing (POCT) if made available over-the-counter (OTC). Currently, there are no tests for C. trachomatis available OTC for purchase.

Methods
Patients attending adolescent clinics at University Hospital of Brooklyn and Kings County Hospital received an anonymous 12-item questionnaire. Both clinics serve predominantly African and Caribbean American urban populations. Questions included demographics, sexual orientation, chlamydia knowledge, testing history, prior infection, partner notification, and acceptance of OTC POCT for C. trachomatis.

Results
Surveys from 151 patients (116 women, 35 men) aged 12 to 21 years (mean age, 17.6 years) were analyzed. Only 34 of the 151 (22.5%) respondents understood C. trachomatis transmission; 31 (20.5%) knew its complications. Sixty-seven (44.4%) would purchase an OTC test but 101 (66.8%) would pay no more than $20. All 151 patients reported that they would follow-up with doctor if positive; 143 (94.7%) would notify partners, although 5 of the 31 (16.1%) women with prior infection did not notify partners.

Conclusions
Nearly half (44%) of adolescents in our population would be interested in using a potential OTC test for C. trachomatis. Cost was a major disincentive. Knowledge of infection remains cursory. However, those with a history of C. trachomatis infection and familiar with its complications were more interested in purchasing a home test. Although 100% of the respondents reported that they would follow-up with their physician if they tested positive, past behavior suggests that partner notification might be suboptimal.
Association Between Hyperoxemia and Increased Cell-Free Plasma Hemoglobin During Cardiopulmonary Bypass in Infants and Children*
Authors: Gretchen Catherine , Bayir Hϋlya , Kochanek Patrick M. , Ruppert Kristine , Viegas Melita , Palmer David , Kim-Campbell Nahmah 
Published: September 2021

OBJECTIVES:
To determine potential risk factors for severe hemolysis during pediatric cardiopulmonary bypass and examine whether supraphysiologic levels of oxygen and cardiopulmonary bypass duration are associated with hemolysis.

DESIGN:
Prospective observational study.

SETTING:
Cardiac ICU in a university-affiliated children’s hospital.

PATIENTS:
Greater than 1 month to less than 18 years old patients undergoing cardiopulmonary bypass for cardiac surgery.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Plasma samples from 100 patients to assess cell-free plasma hemoglobin levels were obtained at start cardiopulmonary bypass, at the end of cardiopulmonary bypass, and 2 and 24 hours after reperfusion. Arterial blood gas samples were obtained before and every 30 minutes during cardiopulmonary bypass. Patient demographics and laboratory data were collected from the electronic medical record. Plasma hemoglobin levels peaked at the end of cardiopulmonary bypass and haptoglobin levels continued to fall throughout all time points. There were 44 patients with severe hemolysis (change in cell-free plasma hemoglobin > 50 mg/dL). Younger age (odds ratio/sd 0.45 [95% CI, 0.25–0.81]) and higher mean Pao
2 × cardiopulmonary bypass duration (31.11 [1.46–664.64]) were identified as risk factors for severe hemolysis in multivariable analysis. Severe hemolysis was associated with longer hospital and ICU lengths of stay as well as acute kidney injury.

CONCLUSIONS:
We observed younger age and the exposure to both oxygen and duration of cardiopulmonary bypass as risk factors for hemolysis. Oxygen delivery through the cardiopulmonary bypass circuit is an easily modifiable risk factor. Its role in the production of reactive oxygen species that could alter the erythrocyte membrane deserves further examination in larger prospective studies.
Antimicrobial Stewardship in Bronchiolitis: A Retrospective Cohort Study of Three PICUs in Canada
Authors: Aljassim Nada A. , Noël Kim C. , Maratta Christina , Tam Ingrid , Almadani Ahmed , Papenburg Jesse , Quach Caroline , Thampi Nisha , McNally James D. , Dendukuri Nandini , Lefebvre Marie-Astrid , Zavalkoff Samara , O’Donnell Shauna , Jouvet Philippe , Fontela Patricia S. 
Published: September 2021

OBJECTIVES:
To determine the association between the implementation of an antimicrobial stewardship program at a local PICU and to determine the association between the presence of an antimicrobial stewardship programs and antimicrobial use across three Canadian PICUs, among critically ill children with bronchiolitis.

DESIGN:
A multicenter retrospective cohort study.

SETTING:
Three Canadian PICUs over two winter seasons.

INTERVENTIONS:
An antimicrobial stewardship program was implemented at PICU 1 at the end of season 1.

PATIENTS:
Patients less than or equal to 2 years old admitted with bronchiolitis.

MEASUREMENTS AND MAIN RESULTS:
We used regression models with an interaction term between site (PICU 1 and PICU 2) and season (1 and 2) as the primary analysis to determine the association between implementation of an antimicrobial stewardship program at PICU 1 and 1) the proportion of antimicrobials discontinued 72 hours after hospital admission (logistic regression), 2) antimicrobial treatment duration (negative binomial regression), and 3) antimicrobial prescriptions within 48 hours of hospital admission (logistic regression). As a secondary analysis, we determined the association between having an antimicrobial stewardship program present and the aforementioned outcomes across the three PICUs. A total of 372 patients were included. During seasons 1 and 2, median age was 2.2 months (interquartile range, 1.2–6.2 mo) and 2.1 months (interquartile range, 1.3–6.8 mo), respectively. Among patients with viral bronchiolitis, implementation of an antimicrobial stewardship program at PICU 1 was associated with increased odds of discontinuing antimicrobials (odds ratio, 25.63; 95% CI, 2.86–326.29), but not with antimicrobial duration (odds ratio, 0.56; 95% CI, 0.31–1.02) or antimicrobial prescriptions (odds ratio, 0.33; 95% CI, 0.10–1.04). The presence of an antimicrobial stewardship program was similarly associated with antimicrobial discontinuation among patients with viral bronchiolitis (odds ratio, 20.79; 95% CI, 2.46–244.92), but not with antimicrobial duration (odds ratio, 0.57; 95% CI, 0.32–1.03) or antimicrobial prescriptions (odds ratio, 0.37; 95% CI, 0.12–1.11).

CONCLUSIONS:
Antimicrobial stewardship programs were associated with increased likelihood of discontinuing antimicrobial treatments in the PICU patients with viral bronchiolitis. However, larger studies are needed to further determine the role of an antimicrobial stewardship programs in reducing unnecessary antimicrobial use in this patient population.
Influencing kinetic energy using ankle-foot orthoses to help improve walking after stroke: a pilot study
Authors: Kimura Nodoka , Ohata Koji , Kawasaki Shihomi , Nogi Shiori , Tsuruda Akihiro , Yamada Shigehito 
Published: September 2021

Background:
An ankle-foot orthosis with an oil damper (AFO-OD) may improve kinetics and kinematics for efficient walking after stroke. Yet it is unknown whether hemiplegic walking behaves like “inverted-pendulum” gait and how it is modulated by using AFO-ODs for efficiency.

Objectives:
This study examined whether the use of AFO-ODs improves the kinetics of total vertical ground reaction force (vGRF) and kinematics of vertical pelvic displacement (vPD) in different walking phases, and gait speed following stroke. Also, the relationship between those gait parameters was examined to assess efficient walking.

Study design:
Observational study within subject.

Methods:
Eight participants with hemiplegia walked at self-selected speed without and with AFO-ODs over the walkway and gait speed was measured. Force plates were used to measure total vGRF during the double-limb support phase with the paretic leading limb and with the paretic trailing limb (DSPT). The vPD in the paretic and nonparetic stance phases was measured by a three-dimensional motion analysis system.

Results:
Without AFO-ODs, reduced total vGRF during DSPT was related to greater vPD in the subsequent nonparetic stance. Using AFO-ODs significantly increased gait speed and total vGRF during double-limb support phase with the paretic leading limb and during DSPT, which were significantly correlated. Vertical pelvic displacement in the nonparetic stance was higher than the paretic stance in both conditions.

Conclusions:
Decreased total vGRF during DSPT was compensated by excessive vPD in the nonparetic stance phase without AFO-ODs, indicating inefficient walking. However, the use of AFO-ODs improved the kinetic energy of total vGRF during the double-limb support phase, contributing to efficient walking.

Clinical relevance statement:
The AFO-ODs can be used to improve kinetic energy and to modulate functions in the weight transition during the double-limb support phase, with faster walking speed. Thus, AFO-ODs can be considered to be therapeutic AFOs to acquire efficient walking performance in poststroke rehabilitation.
Effects of Ankle-Foot Orthoses on acceleration and energy cost of walking in children and adolescents with cerebral palsy
Authors: Goihl Tobias , Ihlen Espen Alexander F. , Bardal Ellen Marie , Roeleveld Karin , Ustad Astrid , Brændvik Siri Merete 
Published: September 2021

Background:
Impaired postural control is a key feature of cerebral palsy that affects daily living. Measures of trunk movement and acceleration have been used to assess dynamic postural control previously. In many children with cerebral palsy, ankle-foot orthoses are used to provide a stable base of support, but their effect on postural control is not yet understood.

Objectives:
The objectives of the current study were to investigate the effects of ankle-foot orthoses on postural control and energy cost of walking in children with cerebral palsy.

Study design:
Clinical study with controls.

Methods:
Trunk accelerometry (amplitude and structure) and energy cost of walking (J/kg/m) were recorded from five-minute walking trials with and without ankle-foot orthoses for children with cerebral palsy and without orthoses for the reference group.

Results:
Nineteen children with unilateral spastic cerebral palsy and fourteen typically developed children participated. The use of ankle-foot orthoses increased structure complexity of trunk acceleration in mediolateral and anterior–posterior directions. The use of ankle-foot orthoses changed mediolateral-structure toward values found in typically developed children. This change was not associated with a change in energy cost during walking.

Conclusions:
The use of ankle-foot orthoses does affect trunk acceleration that may indicate a beneficial effect on postural control. Using measures of trunk acceleration may contribute to clinical understanding on how the use of orthoses affect postural control.