bluuebunny/crossref_metadata_2025_split huggingface dataset:
Classifying Adverse Events Following Lower Limb Orthopaedic Surgery in Children With Cerebral Palsy: Reliability of the Modified Clavien-Dindo System
Authors: Zhou Leena , Willoughby Kate , Strobel Natalie , Thomason Pam , Gallagher Charles , Harambasic Mela , Khot Abhay , Graham H. Kerr 
Published: July 2018

Background:
The modified Clavien-Dindo (MCD) system is a reliable tool for classifying adverse events (AEs) in hip preservation surgery and has since been utilized in studies involving lower limb surgery for ambulant and nonambulant children with cerebral palsy (CP). However, the profile of AEs recorded in children with CP compared with typically developing children is different, and the reliability of the MCD in CP is unknown. This study aimed to evaluate the interrater and intrarater reliability of the MCD system for classifying AEs following lower limb surgery in children with CP.

Methods:
Eighteen raters were invited to participate, including clinicians from surgical, nursing, and physical therapy professions, and individuals with CP. Following a MCD familiarization session, participants rated 40 clinical scenarios on 2 occasions, 2 weeks apart. Fleiss’ κ statistics were used to calculate interrater and intrarater reliability.

Results:
The overall Fleiss’ κ value for interrater reliability in the first rating was 0.70 (95% confidence interval, 0.61-0.80), and increased to 0.75 (95% confidence interval, 0.66-0.84) in the second rating. The average Fleiss’ κ value for intrarater reliability was 0.78 (range, 0.48 to 1.00). Grading of more severe AEs (MCD III to V) achieved near perfect agreement (κ, 0.87 to 1.00). There was a lower level of agreement for minor AEs (MCD I-II) (κ, 0.53 to 0.55). A κ score of 0 to 0.2 was deemed as poor, 0.21 to 0.4 as fair, 0.41 to 0.6 as good, 0.61 to 0.8 as very good, and 0.81 to 1.0 as almost perfect agreement.

Conclusions:
The MCD System demonstrates a very good interrater and intrarater reliability following lower limb surgery in children with CP. The MCD can be used by clinicians from different health care professions with a high level of reliability. The MCD may improve standardization of AE recording with a view to accurate audits and improved clarity in outcome studies for CP.

Level of Evidence:
Level II—diagnostic.
Gatekeeper Suicide Training's Effectiveness Among Malaysian Hospital Health Professionals: A Control Group Study With a Three-Month Follow-Up
Authors: Siau Ching Sin , Wee Lei-Hum , Ibrahim Norhayati , Visvalingam Uma , Yeap Lena Lay Ling , Wahab Suzaily 
Published: July 2018

Introduction:
There is a lack of suicide-related training in the nonpsychiatric health professional's basic education. We suggest that a continuing education through a brief gatekeeper suicide training program could be a suitable platform to improve suicide-related knowledge, self-efficacy, and attitudes. This study aimed at examining the effectiveness of the Question, Persuade, Refer gatekeeper program on improving the knowledge, self-efficacy in suicide prevention, and understanding of/willingness to help suicidal patients of Malaysian hospital health professionals.

Methods:
The Question, Persuade, Refer program materials were translated and adapted for implementation in the hospital setting for nonpsychiatric health professionals. There were 159 (mean age = 35.75 years; SD = 12.26) participants in this study. Most participants were female (84.9%), staff/community nurses (52.2%), who worked in the general medical department (30.2%) and had no experience managing suicidal patients (64.2%). Intervention participants (n = 53) completed a survey questionnaire at pretraining, immediately after training, and after three months. Control participants (n = 106) were not exposed to the training program and completed the same questionnaire at baseline and three months later.

Results:
Significant improvement occurred among intervention participants in terms of perceived knowledge, self-efficacy, and understanding of/willingness to help suicidal patients immediately after training and when compared with the control participants 3 months later. Improvements in declarative knowledge were not maintained at the 3-month follow-up.

Discussion:
This study confirmed the short-term effectiveness of the gatekeeper training program. Gatekeeper suicide training is recommended for implementation for nonpsychiatric health professionals nationwide.
EXUDATIVE RETINAL DETACHMENT DOCUMENTED BY HANDHELD SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY AFTER RETINAL LASER PHOTOCOAGULATION FOR RETINOPATHY OF PREMATURITY
Authors: Cabrera Michelle T. , Brewer Erika M. , Grant Laura , Tarczy-Hornoch Kristina 
Published: July 2018

Background:
Few cases of exudative retinal detachments have been reported in the literature after laser treatment for retinopathy of prematurity, and none of the cases include optical coherence tomography images.

Methods:
Case report.

Results:
A 469-g birth weight, 25-week gestational age baby girl at 35-week postmenstrual age received a retinal laser (1,724 spots in the right eye and 1,287 spots in the left eye) for bilateral Stage 3 Zone II plus disease retinopathy of prematurity. The patient developed a large macular exudative retinal detachment seen in the right eye at the first follow-up, 5 days after the laser. Serial handheld optical coherence tomography demonstrated resolution of retinal detachment and intraretinal fluid over the course of 4 weeks with only topical tobramycin/dexamethasone ophthalmic ointment 3 to 4 times daily for 2 weeks. The patient was left with a residual subretinal scar and outer retinal loss on optical coherence tomography, with a later appearance of a dragged macula on funduscopic examination noted at 52-week postmenstrual age. It is unclear whether systemic steroid therapy, intravitreal bevacizumab, or surgery would hasten resolution of exudative retinal detachment after the retinopathy of prematurity laser and avoid photoreceptor damage seen on optical coherence tomography in this case.

Conclusion:
This case suggests that post–retinopathy of prematurity laser exudative retinal detachments can resolve without aggressive intervention, but may cause permanent retinal sequelae.
Decreased Serum Levels of Complement C3 Reflect Complement System Dysregulation in Patients With Primary Open-angle Glaucoma: Results From a Pilot Study
Authors: Li Shengjie , Li Danhui , Shao Mingxi , Cao Wenjun , Sun Xinghuai 
Published: July 2018

Purpose:
To evaluate the serum complement component (C)3 concentration in patients with primary open-angle glaucoma (POAG) and to investigate the association between C3 levels and POAG severity.

Materials and Methods:
This study enrolled 190 consecutive POAG patients and 204 normal control subjects. A detailed eye and systematic examination, including intraocular pressure, gonioscopy, fundus photography, A-scan ultrasound, visual field testing, electrocardiograms, x-rays, liver function, renal function, infectious disease, etc., and measurement of serum C3 concentration by immunoturbidimetry, was performed. The subgroups were classified according to age (17 to 29, 30 to 49, 50 to 69, 70+ y), sex, and visual field: mild (MD≤6 dB), moderate (6 dB<MD≤12 dB), and severe (MD>12 dB) glaucoma.

Results:
The serum C3 level of the POAG (95.63±17.71 mg/dL) was ∼20.93% lower than that of the control group (115.65±22.19 mg/dL) (P<0.001). A similar result was observed when serum levels of C3 were compared between the POAG and control groups with respect to age and sex. The mean serum C3 level was lowest in the severe POAG group (85.18±19.62 mg/dL), followed by the moderate POAG group (96.62±12.63 mg/dL) and the mild POAG group (110.44±14.89 mg/dL) (P<0.001). Multiple logistic regression analyses revealed a significant correlation between the C3 levels and the vertical cup-disc ratio (B=−0.373, P=0.026), C3 levels and MD (B=−0.546, P=0.001). Logistic regression analyses revealed that serum C3 levels were associated (odds ratio=0.939, 95% CI=0.901-0.979, P=0.003) with severity of POAG.

Conclusions:
The POAG patients had decreased C3 levels, which were further negatively associated with POAG severity, suggesting the involvement of C3 in the pathomechanisms of POAG.
Characteristics of State Policies Impact Health Care Delivery
Authors: Horný Michal , Shwartz Michael , Duszak Richard , Christiansen Cindy L. , Cohen Alan B. , Burgess James F. 
Published: July 2018

Background:
Increased breast tissue density may mask cancer and thus decrease the diagnostic sensitivity of mammography. A patient group advocacy led to the implementation of laws to increase the awareness of breast tissue density and to improve access to supplemental imaging in many states. Given limited evidence about best practices, variation exists in several characteristics of adopted policies.

Objective:
To identify which characteristics of state-level policies with regard to dense breast tissue were associated with increased use of downstream breast ultrasound.

Research Design:
This was a retrospective series of monthly cross-sections of screening mammography procedures before and after implementation of laws.

Subjects:
A sample of 13,481,554 screening mammography procedures extracted from the MarketScan Research database performed between 2007 and 2014 on privately insured women aged 40–64 years that resided in a state that had implemented relevant legislation during that period.

Measures:
The outcome was an indicator of whether breast ultrasound imaging followed a screening mammography procedure within 30 days. The main independent variables were policy characteristics indicators.

Results:
Notification of patients about issues surrounding increased breast density was associated with increased follow-up by ultrasound by 1.02 percentage points (P=0.016). Some policy characteristics such as the explicit suggestion of supplemental imaging or mandated coverage of supplemental imaging by health insurance augmented that effect. Other policy characteristics moderated the effect.

Conclusions:
The heterogeneous effect of state legislation with regard to dense breast tissue on screening mammography follow-up by ultrasound may be explained by specific and unique characteristics of the approaches taken by a variety of states.
Performance in the Medicare Shared Savings Program by Accountable Care Organizations Disproportionately Serving Dual and Disabled Populations
Authors: Sen Aditi P. , Chen Lena M. , Wong Samson Lok , Epstein Arnold M. , Joynt Maddox Karen E. 
Published: July 2018

Background:
The growth of accountable care organizations (ACOs) and other alternative payment models has prompted concern about whether these models will disadvantage providers who serve vulnerable populations, particularly those living in poverty or with a disability.

Objective:
To examine performance by ACOs in the top quintile of their proportion of beneficiaries dually enrolled in Medicare and Medicaid (high-dual) and the top quintile of disabled beneficiaries (high-disabled).

Research Design:
This is a retrospective cohort study.

Subjects:
The 333 ACOs in the Medicare Shared Savings Program in 2014, followed through 2016.

Measures:
Quality scores, savings per beneficiary, whether or not the ACO shared savings, and amount of shared savings.

Results:
High-dual and high-disabled ACOs had slightly lower quality and similar or higher baseline spending than other ACOs, but achieved greater savings per beneficiary than other ACOs ($212 vs. $51 for high-dual ACOs, P=0.04; $241 vs. $44 for high-disabled ACOs, P=0.012). Further, these ACOs were equally or more likely to earn shared savings; just over 30% of high-dual ACOs earned shared savings compared with 25% of non–high-dual ACOs (P=0.35) and 38% of high-disabled ACOs earned shared savings compared with 23% of non–high-disabled ACOs (P=0.013). In longitudinal analyses, we found a decrease in the differences in quality between high-social risk and other ACOs over time. Savings remained higher for high-dual and high-disabled ACOs relative to other ACOs over 2014–2016 though the gap narrowed over time.

Conclusions:
High-dual and high-disabled ACOs had similar or higher spending than other ACOs at baseline, but achieved greater savings and were equally or more likely to earn shared savings, suggesting that alternative payment models can have positive financial outcomes for providers who serve vulnerable populations.
Subverting bradykinin-evoked inflammation by co-opting the contact system: lessons from survival strategies of Trypanosoma cruzi
Authors: Scharfstein Julio 
Published: July 2018

Purpose of reviewDuring Chagas disease,Trypanosoma cruzialternates between intracellular and extracellular developmental forms. After presenting an overview about the roles of the contact system in immunity, I will review experimental studies showing that activation of the kallikrein-kinin system (KKS) translates into mutual benefits to the host/parasite relationship.Recent findingsT. cruzitrypomastigotes initiate inflammation by activating tissue-resident innate sentinel cells via the TLR2/CXCR2 pathway. Following neutrophil-evoked microvascular leakage, the parasite's major cysteine protease (cruzipain) cleaves plasma-borne kininogens and complement C5. Tightly regulated by angiotensin-converting enzyme (ACE), kinins and C5a in turn further propagate inflammation via iterative cycles of mast cell degranulation, contact system activation, bradykinin release and activation of endothelial bradykinin B2 receptors (B2R). Recently, studies in the intracardiac model of infection revealed a dichotomic role for bradykinin and endothelin-1: generated upon contact activation (mast cell/KKS pathway), these pro-oedematogenic peptides reciprocally stimulate trypomastigote invasion of heart cells that naturally overexpress B2R and endothelin receptors (ETaR/ETbR).SummaryStudies focusing on the immunopathogenesis of Chagas disease revealed that the contact system plays a dual role in host/parasite balance:T. cruzico-opts bradykinin-induced plasma leakage as a strategy to increment heart parasitism and increase immune resistance by upregulating type-1 effector T-cell production in secondary lymphoid tissues.
Advances in computer-aided design for bony free-flap reconstruction
Authors: Sahovaler Axel , Fung Kevin 
Published: July 2018

Purpose of review
The current article reviews the most recent publications of computer-assisted reconstruction using bony free flaps, emphasizing on comparative reports using these novel techniques.

Recent findings
Computer-aided reconstruction has shown some benefits in comparison with traditional techniques and some of the perceived limitations are currently being addressed in the latest reports. Still, there is a lack of appropriate comparative studies and unblinded measurements to establish solid conclusions.

Summary
Despite the application of new technologies showed encouraging results, it is premature to state that the traditional technique should be replaced by the modern approaches.
Assessment of vestibular function in elderly patients
Authors: Krager Rachael 
Published: July 2018

Purpose of review
Individuals over the age of 60 are at an increased risk of falls, even if they do not have an isolated dysfunction of the vestibular system. The aim of this article is to review the various vestibular testing currently available and its usefulness in determining the presence of vestibular dysfunction in the elderly population. The primary vestibular tests to be reviewed include: balance function testing, vestibular evoked myogenic potentials (VEMPs), and video head impulse testing (vHIT).

Recent findings
Balance function testing is important as it evaluates the integration of vestibular information along with sensory and visual information, which may also be impaired. VEMP testing provides a small diagnostic yield as most elderly patients have absent or reduced responses. vHIT gain is reduced in this population, but will still be within the normal range for individuals with normal balance function.

Summary
The combination of various vestibular tests provides complimentary information instead of redundant information on the patient's balance function. Each test evaluates various aspects of the vestibular system which are all needed to determine stable balance in the elderly population.
Nursing Students’ Perceptions of Skills Learning
Authors: Aldridge Michael D. , Hummel Faye 
Published: July 2018

Background
Deliberate practice (DP) and cognitive load theory have renewed educators’ interest in effective psychomotor skills teaching.

Purpose
The purpose of this research was to explore how prelicensure nursing students learned psychomotor skills.

Methods
Nine senior nursing students participated in this phenomenological study to capture how they experienced learning nursing skills. Colaizzi’s method was used to analyze in-depth interviews of open-ended questions.

Results
Six themes emerged: (a) the umbrella of emotion, (b) practice, (c) learning through technology, (d) fidelity affects learning, (e) teaching matters, and (f) importance of peers. Students found creative ways to learn nursing skills. Research findings contributed to a greater understanding of student experiences in gaining competency in nursing skills.

Conclusions
Participants used aspects of DP, cognitive load theory, and technology to learn skills. These findings provide current information to nurse educators about skills learning and recommendations for effective skills teaching.
Transforming Health Care Through Meaningful Doctor of Nursing Practice Community Partnerships
Authors: Hooshmand Mary , Foronda Cynthia , Snowden Kenya , de Tantillo Lila , Williams Jessica Roberts 
Published: July 2018

Background
A critical component of doctor of nursing practice (DNP) education is practice immersion. DNP programs require 1000 hours of clinical practice experience to obtain the DNP degree.

Problem
Faculty struggle with providing meaningful clinical experiences congruent with the role of the DNP.

Approach
This article describes a unique practice immersion course joining DNP students with community health care partners to provide meaningful experiences with the potential to transform health care. DNP students are assigned system-level projects designed to create organizational change.

Outcomes
Over the course of 4 years, the practice immersion opportunities more than doubled from 30 to 66 live projects. Integrating collaborative practice immersion into the curriculum builds students’ leadership skills and strengthens long-standing bonds among academia, practice, and the community.

Conclusions
The creation of structured, meaningful collaborations between DNP students and community partners is an approach that has the potential to facilitate transformative, sustainable change in health care.
Medical Errors in Iowa: Prevalence and Patients' Perspectives
Authors: Lind David P. , Andresen David R. , Williams Andrew 
Published: July 2018

Objectives
The following primary objectives of this study were to: (1) establish baselines of prevalence and causes of medical errors experienced by Iowans in medical settings, (2) determine whether Iowa patients were informed of the errors by the responsible healthcare providers, (3) understand reasons why Iowans who experienced medical errors did or did not report the errors, and (4) discover how Iowans view mandatory reporting of medical errors.

Methods
A total of 1010 Iowa adults took part in a telephone survey in summer 2017. Interviews were completed via random landlines and random digit dialing of cell phone numbers.

Results
Nearly one fifth of surveyed Iowa adults (18.8%) reported being involved in a medical error in their own care or in the care of someone close to them, and yet only four in 10 (39.1%) were notified of the error by the responsible provider. Most Iowans strongly agree that Iowa hospitals (79.5%), physicians (74.1%), and nursing homes (82.2%) should be required to report all medical errors to the patient and to a state agency.

Conclusions
A significant proportion of Iowans will experience a medical error. They also desire full transparency from healthcare providers with respect to medical errors, including notifying the patient when an error occurs and mandating that providers report errors to a state-based agency. Iowa regulators should carefully assess and initiate stringent regulatory guidelines for mandatory reporting of medical errors.
“It Matters What I Think, Not What You Say”: Scientific Evidence for a Medical Error Disclosure Competence (MEDC) Model
Authors: Hannawa Annegret F. , Frankel Richard M. 
Published: July 2018

Objective
This study sought to validate the ability of a “Medical Error Disclosure Competence” (MEDC) model to predict the effects of physicians’ communication skills on error disclosure outcomes in a simulated context.

Method
A random sample of 721 respondents was assigned to 16 experimental disclosure conditions that tested the MEDC model’s constructs across 2 severity conditions (i.e., minor error and sentinel event).

Results
Severity did not affect survey respondents’ perceptions of the physician’s disclosure style. Respondents who viewed the nonverbally skilled disclosure perceived the disclosure as more adequate compared to respondents in the “low nonverbal skill” disclosure condition. Interpersonal adaptability did not affect respondents’ adequacy ratings. Consistent with the MEDC model, those who viewed the physician’s error disclosure as inadequate indicated that they would be more prone to engage in relational distancing behaviors, while those who rated the disclosure as adequate were more likely to reinvest into their relationship with their physician. These respondents also had higher resilience scores. In the context of a sentinel event, perceived adequacy significantly predicted endorsing legal redress or remedies (e.g., lawsuit). Verbal apology (e.g., “I’m sorry,” “I apologize”) did not predict any significant variance in the model beyond the physician’s nonverbal skill.

Conclusion
In a simulated disclosure setting, physicians’ communicative skills—particularly effective nonverbal communication during a disclosure—trigger outcomes that affect the patient, the physician, and the provider-patient relationship. Findings from this study suggest that MEDC guidelines may be helpful in reducing financial and reputational risks to individual providers and institutions, particularly in the context of a sentinel event.