bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of the Opioid Epidemic and Associated Prescribing Restrictions on People Who Live With Chronic Noncancer Pain in Canada
Authors: Kaboré Jean-Luc , Pagé M. Gabrielle , Martel Marc O. , Dassieu Lise , Hudspith Maria , Moor Gregg , Sutton Kathryn , Roy Jean-Sébastien , Williamson Owen D. , Choinière Manon 
Published: May 2021

Objectives:
Little is known about the consequences of the opioid epidemic on people living with chronic noncancer pain (CNCP). This study examined this issue in people who lived in the most impacted province by opioid overdoses in Canada (British Columbia [BC]) or one of the least impacted (Quebec [QC]), and examined the factors associated with opioid use.

Materials and Methods:
This cross-sectional study was carried out in adults living in BC (N=304) and QC (N=1071) who reported CNCP (≥3 months) and completed an online questionnaire that was tailored to their opioid status.

Results:
Almost twice as many participants in BC as in QC were proposed to cease their opioid medication in the past year (P<0.001). The proportion who reported having hoarded opioids in fear of not being able to get more in the future was also significantly higher in BC (P<0.001) compared with QC. In addition, they were significantly more likely to have had their opioid dose decreased than those in QC (P=0.001). No significant association was found between opioid discontinuation and province of residence. Two-thirds of the BC participants felt that the media coverage of the opioid crisis was very to extremely detrimental to CNCP patients in general, this percentage being significantly higher than in QC (P<0.001).

Discussion:
The opioid epidemic and associated prescribing restrictions have had harmful effects on Canadians with CNCP. The clinical community, the general public, and the media need to be aware of these negative consequences to decrease patients’ stigmatization and minimize inadequate treatment of CNCP.
Relationship Between Moral Distress and Intent to Leave a Position Among Neonatal Intensive Care Nurses
Authors: Hally Suzanne M. , Settle Margaret , Nelson Brett D. 
Published: May 2021

Background:
The phenomenon of moral distress is prevalent in the literature, but little is known about the experiences of nurses working in the neonatal intensive care unit (NICU). In addition, a paucity of literature exists exploring the relationship between moral distress and intent to leave a position in NICU nurses.

Purpose:
To explore the phenomenon of moral distress in NICU nurses using the Measure of Moral Distress for Health Care Professionals (MMD-HP) survey.

Methods:
A cross-sectional, descriptive, correlational study was conducted nationally via an electronic survey distributed to NICU nurses who are members of National Association of Neonatal Nurses (NANN). Participants were asked to electronically complete the MMD-HP survey between March 27 and April 8, 2020.

Findings:
A total of 75 NICU nurses completed the survey, and 65 surveys were included for data analysis. Five situations from the survey had a composite MMD-HP score of more than 400. Results indicated that 41.5% of the NICU nurses surveyed considered leaving a clinical position due to moral distress, and 23.1% of the nurses surveyed left a position due to moral distress.

Implications
for Practice: NICU nurses experiencing high MMD-HP scores are more likely to leave a position. Further research is needed to develop strategies useful in mitigating moral distress in and prevent attrition of NICU nurses.

Implications for Research:
Many NICU nurses experiencing high levels of moral distress have left positions or are considering leaving a clinical position. Longitudinal interventional studies are vital to understand, prevent, and address the root causes of moral distress experienced by NICU nurses.
Effectiveness of e-Learning on Neonatal Nurses' Pain Knowledge and Pain Measurement Skills
Authors: Ozawa Mio , Yokoo Kyoko , Sumiya Takahiro , Kawano Reo 
Published: May 2021

Background:
Reported benefits of virtual programs include user satisfaction and feasibility to train nurses to utilize pain scales. However, the effectiveness of the virtual neonatal pain management program on nurses' knowledge and scoring skill acquisition has not been examined.

Purpose:
This study developed a comprehensive virtual program on neonatal pain management and examined its effectiveness on nurses' knowledge and skill acquisition of selected pain scales.

Methods:
Evidence-based content was designed as a virtual program and pre-and posttests to examine skill and knowledge acquisition were developed and validated. Analysis of covariance was used to assess the differences from pre- to posttest based on the intensity of participants' involvement while examining the overall effectiveness of the program.

Results:
A total of 115 nurses representing 7 hospitals completed the virtual neonatal pain management program, and 52 nurses completed the posttest. The Student paired t test showed an increase in posttest scores from pretest scores among participants. Participants' final degrees and years of experience were not related to posttest scores. The analysis of covariance showed that the high study group had a significantly higher amount of change in total scores and pain measurement skill scores than the low study group on the posttest.

Implications for Practice:
The virtually delivered neonatal pain management program can be useful for nurses' attainment of knowledge and skills for managing neonatal pain, including an appropriate use of selected scoring tools.

Implications for Research:
It is necessary to examine how organizational unit attendance rate for e-learning and posttest results are related to patient outcomes.

Video Abstract available at:

https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=46
A Systematic Review of the Effects of Skin-to-Skin Contact on Biomarkers of Stress in Preterm Infants and Parents
Authors: Forde Dorothy , Fang Min Lin , Miaskowski Christine 
Published: May 2021

Background:
Premature infants and their parents experience significant stress related to separation and lifesaving procedures. While evidence suggests that skin-to-skin contact (SSC) is a stress-reducing intervention for both neonates and parents, the mechanisms that underlie its efficacy are not well understood.

Objective:
Purpose of this systematic review is to summarize the current state of knowledge on changes in biomarkers (ie, oxytocin [OT], cortisol, hypoxanthine, xanthine, uric acid, and allantoin), associated with SSC in premature infants and parents, that may reflect physiologic responses to stress.

Methods:
A comprehensive literature search was conducted from 1990 to 2020. Studies were selected using prespecified inclusion and exclusion criteria.

Results:
Of the 175 studies identified, only 19 are included in this review. Ten studies evaluated only infants, 2 evaluated only parents, and 7 evaluated for changes in biomarkers in both infants and parents. Cortisol was the most common biomarker evaluated. While changes in infants' cortisol levels were highly variable, in 55% of the parent studies, parent cortisol levels decreased following SSC. In both parents and infants, OT levels decreased following SSC. Only 1 study found that allantoin levels were significantly lower in infants who received SSC.

Implications for Practice and Research:
While evidence suggests the numerous benefits of SSC, additional research is needed to identify the optimal biomarker to determine the mechanisms that underlie these effects. The use of novel biomarkers (eg, gene expression changes microbiome) may provide new insights into the mechanisms that underlie the efficacy of SSC.

Video Abstract available at:
https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=48
Barriers to Kangaroo Care in the NICU
Authors: Saltzmann April M. , Sigurdson Krista , Scala Melissa 
Published: May 2021

Background:
Despite its benefits, parents in the neonatal intensive care unit (NICU) face significant barriers to kangaroo care (KC). Clinician-reported barriers to KC include staff education, environment, and equipment among others; however, parent-perceived barriers are underexplored.

Purpose:
To examine parental understanding of KC, parental perception of experiences with KC, and parental views on the key factors that help or hinder KC.

Methods:
This is an observational, mixed-methods study that used an author-developed survey to assess parental feelings, perceived importance, and barriers to KC. Likert scale responses were analyzed using descriptive statistics. Free-text responses were analyzed using thematic analysis. A comparison of results was made between parents receiving and not receiving infant mental health services.

Results:
Fifty (N = 50) parents completed surveys. Eighty percent of parents stated they wanted more information on KC. Common barriers to KC were reported by parents, such as issues with space/environment. The most frequently reported barrier when asked openly was fear of hurting their infant. Ninety-six percent of parents believed that KC helped their emotional well-being. Parents receiving mental health services reported more fear but results did not reach significance.

Implications for Practice and Research:
The frequency with which factors are reported as important to parents may allow a prioritization of barriers to KC, which may help focus quality improvement initiatives. The results of this study underscore the vital role nurses play in supporting KC. Additional attention needs to be given to the mental health of NICU parents and its impact on care practices.
Abdominal wall endometriosis: an update in diagnosis, perioperative considerations and management
Authors: Allen Sarah E. , Rindos Noah B. , Mansuria Suketu 
Published: May 2021

Purpose of review
Abdominal wall endometriosis (AWE) is rare with limited evidence guiding diagnosis and treatment. The purpose of this review is to provide an update of the diagnosis, perioperative considerations, and treatment of AWE.

Recent findings
Recent studies further characterize presenting symptoms and locations of AWE. Prior abdominal surgery remains the greatest risk factor for the development of AWE. Newer evidence suggests that increasing BMI may also be a risk factor. Ultrasound is first-line imaging for diagnosis. Magnetic resonance image is preferred for surgical planning for deep or extensive lesions. Laparotomy with wide local excision is considered standard treatment for AWE with great success. Novel techniques in minimally invasive surgery have been described as effective for the treatment of AWE. A multidisciplinary surgical approach is often warranted for successful excision and reapproximation of skin and/or fascial defects. Noninvasive therapies including ultrasonic ablation or cryotherapy are also emerging as promising treatment strategies in select patients.

Summary
Recent studies provide further evidence to guide diagnosis through physical exam and imaging as well as pretreatment planning. Treatment options for AWE are rapidly expanding with novel approaches in minimally invasive and noninvasive therapies now available.
The effect of heart rate and pulse pressure on mean arterial pressure: the combined formula for calculation of mean arterial pressure
Authors: Kaypakli Onur , Özgeyik Mehmet 
Published: May 2021

Background
We demonstrate a new formula to predict mean arterial pressure (MAP) using corrections of the key factors associated with the inaccuracy of the standard formula: heart rate (HR) and pulse pressure (PP).

Methods
A total of 99 patients (50 men, 49 women; mean age 52.5 ± 10.3 years), who underwent elective coronary angiography, were enrolled in our study. The arterial pressure was measured in the aortic root. MAP was measured digitally by the area-under-the-pressure-time curve method. We evaluated the accuracy of four different formulas: the standard formula, the formula of Razminia et al., the formula of Meaney et al. and the combined formula.

Results
PP coefficient deviation of the standard formula was negatively correlated with PP (R = −0,561, P < 0.001), and positively correlated with HR (R = 0,298, P = 0.003). Both R and R
2 values of the combined formula were higher than previous formulas. Accuracy parameters of the combined formula [root mean square error (RMSE): 1.801 mmHg, mean square residuals (MSR): 3.244 mmHg2, Akaike information criterion (AIC): 401.4] were superior to the standard formula (RMSE: 1.902 mmHg, MSR: 3.620 mmHg2, AIC: 412.3), the formula of Razminia et al. (RMSE: 2.022 mmHg, MSR: 4.089 mmHg2, AIC: 424.3) and the formula of Meaney et al. (RMSE: 2.137 mmHg, MSR: 4.568 mmHg2, AIC: 435.3). In the multivariate linear regression analysis, the combined formula was the only method that independently predicts the measured MAP (beta = 0,990, P < 0.001).

Conclusion
The combined formula is superior to previous formulas for accurately predicting MAP.
Rates of Disenrollment From Medicare Advantage Plans Are Higher for Racial/Ethnic Minority Beneficiaries
Authors: Martino Steven C. , Mathews Megan , Damberg Cheryl L. , Mallett Joshua S. , Orr Nate , Ng Judy H. , Agniel Denis , Tamayo Loida , Elliott Marc N. 
Published: May 2021

Background:
Each year, about 10% of Medicare Advantage (MA) enrollees voluntarily switch to another MA contract, while another 2% voluntarily switch from MA to fee-for-service Medicare. Voluntary disenrollment from MA plans is related to beneficiaries’ negative experiences with their plan, disrupts the continuity of care, and conflicts with goals to reduce Medicare costs. Little is known about racial/ethnic disparities in voluntary disenrollment from MA plans.

Objective:
The objective of this study was to investigate differences in rates of voluntary disenrollment from MA plans by race/ethnicity.

Subjects:
A total of 116,770,319 beneficiaries enrolled in 736 MA plans in 2015.

Methods:
Differences in rates of disenrollment across racial/ethnic groups [Asian or Pacific Islander (API), Black, Hispanic, and White] were summarized using 4 types of logistic regression models: adjusted and unadjusted models estimating overall differences and adjusted and unadjusted models estimating within-plan differences. Unadjusted overall models included only racial/ethnic group probabilities as predictors. Adjusted overall models added age, sex, dual eligibility, disability, and state of residence as control variables. Between-plan differences were estimated by subtracting within-plan differences from overall differences.

Results:
Adjusted rates of disenrollment were significantly (P<0.001) higher for Hispanic (+1.2 percentage points), Black (+1.2 percentage points), and API beneficiaries (+2.4 percentage points) than for Whites. Within states, all 3 racial/ethnic minority groups tended to be concentrated in higher disenrollment plans. Within plans, API beneficiaries voluntarily disenrolled considerably more often than otherwise similar White beneficiaries.

Conclusion:
These findings suggest the need to address cost, information, and other factors that may create barriers to racial/ethnic minority beneficiaries’ enrollment in plans with lower overall disenrollment rates.
Aligning Health Care and Social Services to Reduce Hospitalizations and Emergency Department Visits
Authors: Akiya Kelley , Fisher Elisa , Wells Annie , Li Yan , Peck Christine , Pagán José A. 
Published: May 2021

Background:
Integration of social services in health care delivery is increasingly recognized as a potential strategy for improving health and reducing the use of acute care services. Collaborative models that provide older adults with case management, linkages to social services, and assistance with health care navigation have emerged as promising strategies.

Objective:
The objective of this study was to evaluate the Community Care Connections (CCC) program, a cross-sector collaboration designed to align social and health care services for older adults.

Research Design:
We compared hospitalizations and emergency department (ED) visits 90 days after enrollment with a propensity score–matched group of non-CCC patients. Subgroup analyses were also conducted for adults with hypertension, diabetes, and high cholesterol.

Subjects:
A total of 1004 patients enrolled in CCC between June 1, 2016, and November 15, 2018, and 1004 matched patients from the same metropolitan area.

Measures:
Mean hospitalizations and ED visits per patient 90 days after CCC enrollment.

Results:
Mean hospitalizations were lower among CCC patients 90 days after enrollment than among non-CCC adults [difference=−0.039, 95% confidence interval (CI): −0.077 to −0.001, P=0.044]. They were also lower among CCC patients with hypertension (difference=−0.057, 95% CI: −0.103 to −0.010, P=0.017). However, 90 days after enrollment mean ED visits were higher among CCC patients relative to non-CCC adults (difference=0.238, 95% CI: 0.195–0.281, P<0.001).

Conclusions:
Connecting older adults to social services while being served by the health care system may lead to decreases in hospitalizations. Cross-sector partnerships that address social and economic needs may reduce the use of costly health care services.
Trends in Pediatric Patient-Ventilator Asynchrony During Invasive Mechanical Ventilation
Authors: Blokpoel Robert G. T. , Burgerhof Johannes G. M. , Markhorst Dick G. , Kneyber Martin C. J. 
Published: May 2021

OBJECTIVES:
To explore the level and time course of patient-ventilator asynchrony in mechanically ventilated children and the effects on duration of mechanical ventilation, PICU stay, and Comfort Behavior Score as indicator for patient comfort.

DESIGN:
Secondary analysis of physiology data from mechanically ventilated children.

SETTING:
Mixed medical-surgical tertiary PICU in a university hospital.

PATIENTS:
Mechanically ventilated children 0–18 years old were eligible for inclusion. Excluded were patients who were unable to initiate and maintain spontaneous breathing from any cause.

MEASUREMENTS AND MAIN RESULTS:
Twenty-nine patients were studied with a total duration of 109 days. Twenty-two study days (20%) were excluded because patients were on neuromuscular blockade or high-frequency oscillatory ventilation, yielding 87 days (80%) for analysis. Patient-ventilator asynchrony was detected through analysis of daily recorded ventilator airway pressure, flow, and volume versus time scalars. Approximately one of every three breaths was asynchronous. The percentage of asynchronous breaths significantly increased over time, with the highest prevalence on the day of extubation. There was no correlation with the Comfort Behavior score. The percentage of asynchronous breaths during the first 24 hours was inversely correlated with the duration of mechanical ventilation. Patients with severe patient-ventilator asynchrony (asynchrony index > 10% or > 75th percentile of the calculated asynchrony index) did not have a prolonged duration of ventilation.

CONCLUSIONS:
The level of patient-ventilator asynchrony increased over time was not related to patient discomfort and inversely related to the duration of mechanical ventilation.
Coping Mechanisms Mitigate Psychological Stress in Patients With Rheumatologic Diseases During the COVID-19 Pandemic
Authors: Wang Xin A. , Duculan Roland , Mancuso Carol A. 
Published: May 2021

Background
Coping with stress is part of self-managing systemic rheumatic diseases. Our objective was to assess stress and coping during the coronavirus disease 2019 (COVID-19) pandemic.

Methods
During the pandemic in New York City, patients taking disease-modifying antirheumatic drugs answered open-ended questions about the pandemic's effects on daily life and their rheumatic condition. Themes of stress and coping were discerned from volunteered responses. Patients also completed the standard Generalized Anxiety Disorder (GAD-7) scale/PROMIS Anxiety surveys. Anxiety scores were independent variables in multivariable analyses with stress and coping themes as combined dependent variables.

Results
Of the 112 patients interviewed (86% women; mean age, 50 years), 72 volunteered COVID-19–related stress on their rheumatic condition, home, work, and finances. Patients volunteering stress were younger, had disease longer, were taking more than 1 medication, had worse GAD-7 scores and a positive anxiety screen, and had worse PROMIS scores that were significantly worse than population norms (all comparisons, p ≤ 0.01; all variables remained associated in multivariable analyses). Fourty-one patients volunteered coping mechanisms including support from others, engaging in activities, and resilience already establish in dealing with rheumatic diseases. Of these, 18 volunteered both coping and stress and 23 volunteered coping and no stress. Patients in the latter (coping-only) group were more likely to be older, taking only 1 medication, and had better GAD-7 and PROMIS scores (all comparisons, p ≤ 0.02). In multivariable analysis, older age (p = 0.02) and lower GAD-7 (p = 0.03) or PROMIS scores (p = 0.03) remained associated.

Conclusions
Patients reported stress and coping due to the COVID-19 pandemic. Analyses with standard anxiety measures demonstrated lower anxiety in patients who volunteered coping mechanisms.
Frontoethmoidal Encephalomeningocele Correction by Medial Orbital Composite-Unit Translocation Technique: 13 Years of Siriraj Hospital Experience
Authors: Chaisrisawadisuk Sarut , Boonvisut Sriprasit 
Published: May 2021

Abstract
Frontoethmoidal encephalomeningocele (FEEM) is a congenital anomaly involving herniation of the glial tissues and the meninges. Our unit implemented single-stage repair in 1996, and this was followed by the introduction of the medial orbital composite-unit translocation (MOCUT) technique for encephalocele repair in 2001. This report describes the long-term outcomes of patients who underwent the MOCUT technique. Data were collected on 32 patients operated on between 2005 and 2018. A full analysis was subsequently made of the data from 4 selected patients who had been monitored for at least 5 years, and their age-related anterior interorbital distances were compared. Two of the patients, who had simple forms of FEEM, demonstrated improvements in their intercanthal and anterior interorbital distances, whereas telecanthus was experienced by the 2 other cases, both of whom had complex FEEM types. We recommend using the MOCUT technique for simple types of FEEM (especially Type IA) and patients whose medial canthal ligaments are still anatomically attached to the medial orbits.
One-Year Craniofacial Surgery Fellowship at Chang Gung Memorial Hospital
Authors: Bhandari Kishor 
Published: May 2021

Abstract
Residency trainings in oral and maxillofacial surgery, plastic surgery, or otolaryngology do not sufficiently cover all aspects of craniofacial surgery to enable fresh graduates to independently practice as craniofacial surgeons. Fellowship trainings are almost mandatory to gain added skills and knowledge in the subspecialty. There are limited number of fellowship centers around the globe that accept international fellows, provide an excellent hands-on experience, arrange free accommodation and pay stipend to the selected candidates. The author presents his critical review of 1-year craniofacial surgery fellowship at Chang Gung Memorial Hospital, Taiwan, sponsored by Noordhoff Craniofacial Foundation (NCF), during which he rotated in pediatric craniofacial surgery unit for five and half months, orthognathic surgery unit for 4 months and craniofacial trauma and reconstruction unit for two and half months. The surgical log is presented along with critical review of individual postings, pearls of the overall fellowship along with suggestions for interested candidates to join the fellowship.