bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased Use of Noninvasive Ventilation Associated With Decreased Use of Invasive Devices in Children With Bronchiolitis
Authors: Soshnick Sara H. , Carroll Christopher L. , Cowl Allison S. 
Published: August 2019

Objective:
To assess how a change in practice to more frequent use of high-flow nasal cannula for the treatment of bronchiolitis would affect the use of invasive devices in children.

Design:
Retrospective cohort study of children under 2 years old admitted to the ICU with respiratory failure secondary to bronchiolitis. Outcomes and invasive device use were compared between two time periods, before and after the practice change.

Setting:
Eighteen bed tertiary care PICU.

Patients:
A total of 325 children: 146 from 2010 to 2012 and 179 from 2015 to 2016.

Interventions:
None.

Measurements and Main Results:
There were no significant differences between the two time periods regarding gender, race/ethnicity, medical history, and viral profile, although children were younger in the earlier cohort (median age of 1.9 mo [interquartile range, 1.2–3.5] vs 3.3 mo [1.7–8.6]; p < 0.001). There was an increased use of noninvasive ventilation in the second time period (94% from 69%; p < 0.001), as well as a decreased frequency of intubation (13% from 42%; p < 0.001) and reduced central venous catheter placement (7% from 37%; p < 0.001). There was no significant difference in mortality between the two groups. A logistic regression analysis was conducted, which found that time period, intubation, and hospital length of stay were all independently associated with central venous catheter placement.

Conclusions:
A practice change toward managing patients with bronchiolitis in respiratory failure with less invasive means was associated with a reduction in the use of other invasive devices. In our cohort, minimizing the use of invasive ventilation and devices was not associated with an increase in mortality and could potentially have additional benefits.
Detecting Delirium Using a Physiologic Monitor
Authors: Mulkey Malissa A. , Everhart Daniel Erik , Kim Sunghan , Olson DaiWai M. , Hardin Sonya R. 
Published: August 2019

For the past 2500 years, delirium has been described based on the presence of behavioral symptoms. Each year, as many as 1 in 5 acute care and 80% of critically ill patients develop delirium. The United States spends approximately $164 million annually to combat the associated consequences of delirium. There are no laboratory tools available to assist with diagnosis and ongoing monitoring of delirium; therefore, current national guidelines for psychiatry, geriatrics, and critical care strongly recommend routine bedside screening. Despite the significance, health care teams fail to accurately identify approximately 80% of delirium episodes.
The utility of conventional electroencephalogram (EEG) in the diagnosis and monitoring of delirium has been well established. Neurochemical and the associated neuroelectrical changes occur in response to overwhelming stress before behavioral symptoms; therefore, using EEG will improve early delirium identification. Adding EEG analysis to the current routine clinical assessment significantly increases the accuracy of detection. Using newer EEG technology with a limited number of leads that is capable of processing EEG may provide a viable option by reducing the cost and need for expert interpretation. Because EEG monitoring with automatic processing has become technically feasible, it could increase delirium recognition. Electroencephalogram monitoring may also provide identification before symptom onset when nursing interventions would be more effective, likely reducing the long-term ramifications. Having an objective method that nurses can easily use to detect delirium could change the standard of care and provide earlier identification.
Implementing a Weaning Protocol for Cardiac Surgery Patients Using Simulation
Authors: Tierney Catherine C. , Oermann Marilyn H. , Molloy Margory A. , Brien Lori , Neisler Cherith 
Published: August 2019

Background
Mechanical ventilation is the standard of care after cardiac surgery, but it imposes physiologic and psychological stress on patients. The Society of Thoracic Surgery recommends 6 hours as the goal for extubation, but 60% of our patients were not meeting this metric.

Objectives
The objectives of this project were to decrease cardiac surgery patients' ventilation hours and intensive care unit length of stay using a ventilator weaning protocol.

Methods
An evidence-based ventilator weaning protocol was developed, and nurses were prepared for its implementation using a simulation education program.

Results
Ventilator hours were reduced from 7.74 to 6.27 (t = 2.5, P = .012). The percentage of patients extubated in 6 hours increased from 40% to 63.5% (χ2 = 7.757, P = .005). There was no statistically significant decrease in cardiovascular intensive care unit length of stay (17.15 to 15.99, t = 0.619, P = .537). Nurses' scores on a knowledge test increased significantly from pre (6.11) to post (7.79) (t = −5.04, P < .001). Their perception of confidence increased in weaning from pre (median, 4; IQR, 4,4) to post (median, 4; interquartile range [IQR], 4,5), z = −2.71, P = .007, and also in using the protocol from pre (median, 4; IQR, 3,4) to post (median, 4; IQR, 4,5) (z = −3.17, P = .002).

Discussion
Using a nurse-led ventilator weaning protocol resulted in decreased ventilator hours for patients and increased knowledge and confidence for nurses.
Cerebrospinal fluid biomarkers of inflammation in trigeminal neuralgia patients operated with microvascular decompression
Authors: Ericson Hans , Abu Hamdeh Sami , Freyhult Eva , Stiger Fredrik , Bäckryd Emmanuel , Svenningsson Anders , Gordh Torsten , Kultima Kim 
Published: August 2019

AbstractCompression of the trigeminal root entry zone by a blood vessel can cause trigeminal neuralgia (TN). However, a neurovascular conflict does not explain all cases of TN, and TN can exist without a neurovascular contact. A common observation during microvascular decompression surgery to treat TN is arachnoiditis in the region of the trigeminal nerve. Thus, aberrant inflammatory mechanisms may be involved in the pathophysiology of TN but information about the role of inflammation in TN is scarce. We used Proximity Extension Assay technology to analyse the levels of 92 protein biomarkers related to inflammation in lumbar cerebrospinal fluid from patients with TN (n = 27) before and after microvascular decompression compared to individuals without TN. We aimed to analyse the pattern of inflammation-related proteins in order to improve our understanding of the pathophysiology of TN. The main finding was that immunological protein levels in the cerebrospinal fluid from patients with TN decreased after surgery towards levels observed in healthy controls. Two proteins seemed to be of specific interest for TN: TRAIL and TNF-β. Thus, inflammatory activity might be one important mechanism in TN.
Housing Instability, Depression, and HIV Viral Load Among Young Black Gay, Bisexual, and Other Men Who Have Sex With Men in Atlanta, Georgia
Authors: Solomon Hiwote , Linton Sabriya L. , del Rio Carlos , Hussen Sophia A. 
Published: August 2019

Abstract
Housing instability is common among sexual minority youth. Research suggests that psychological distress, such as depression, may mediate the association between housing instability and poor HIV-related outcomes, but this hypothesis remains underexplored. Housing instability was assessed using two variables (residential moves in 6 months, and self-reported homelessness at any time since age 15 years). We examined cross-sectional relationships between the housing instability variables and detectable HIV-1 viral load (VL) in a sample of young Black gay, bisexual, and other men who have sex with men (YB-GBMSM) living with HIV (N = 81) in Atlanta, GA, in 2015–2016. Additionally, we explored whether depressive symptoms mediated this relationship. Our exploratory study suggests that psychological distress may partially mediate the association between housing instability and detectable VL. In addition to structural interventions that ensure housing stability, increasing use of mental health services by unstably housed YB-GBMSM may improve VL suppression in this high-risk population.
International perspectives on the pediatric nurse practitioner role
Authors: Würtz Gitte M. F. , Jensen Claus Sixtus , Egerod Ingrid 
Published: August 2019

Introduction:
Advanced pediatric nurse practitioners (APNPs) working in acute settings are represented in pediatric hospitals, clinics, and wards around the world. They work independently and autonomously. The aim of this study was to compare the role of APNPs in four different countries to gain knowledge on the qualifications and experience of the practitioners and their impact on pediatric patients and families.

Method:
A qualitative design with semistructured keyinformant interviews with four nurses from Sweden, Norway, England, and the United States was conducted. Analyses were performed using thematic analysis.

Results:
Three themes were identified: 1) Qualification and Competencies, illustrated parallels within the four educations and daily practice. 2) Responsibility and Autonomy, highlighted differences. The informants experienced a mutual understanding of the concepts of advanced practice. Interprofessional collaboration with aphysician was crucial to ensure best practice. 3) Holistic Nurse Perspective highlighted the importance of APNPs having competencies to make holistic and family-centered decisions at a higher level.

Conclusion:
From the perspective of four APNPs, advanced pediatric nursing practice is beneficial to the patient, family, and professionals. The formal education varies in the countries studied, but the basic tenets of practice are the same. Family-centered practice and holism are basic to the APNP role.
Improving patient access through office hysteroscopy clinic redesign
Authors: Wygant Jenna N. , Laughlin-Tommaso Shannon K. , Green Isabel C. , Price Kelly R. , Burnett Tatnai L. , Hopkins Matthew R. , Famuyide Amimbola O. , Breitkopf Daniel M. 
Published: August 2019

Abstract

Background and objective:
Patients with abnormal uterine bleeding (AUB) often require hysteroscopy as part of the diagnostic workup. The purpose of this study was to improve efficiency by shortening the time to patient appointment for office hysteroscopy.

Interventions:
Preintervention, nurse practitioners (NPs) and gynecologists saw patients with abnormal uterine bleeding (AUB) separately. This created inefficiency for the patients, frequently requiring second visits for hysteroscopy. A new hysteroscopy clinic was designed to increase practice efficiency. A collaborative team model was created including consecutive visits with NPs and gynecologists. Each patient with AUB was first evaluated by an NP, followed immediately by a shorter visit with a gynecologist for office hysteroscopy as indicated. NPs managed other diagnostic evaluation and bleeding treatment if hysteroscopy was not warranted. Collaborative clinic staffing consisted of two NPs seeing patients with AUB paired with one gynecologist for procedural support.

Measurements and results:
Electronic records of 393 patients scheduled for AUB visits from January to June 2015 were evaluated for preintervention data. Postintervention, 647 patient records were reviewed from January to June of 2016. During the preintervention period, 30% of patients had a hysteroscopy appointment scheduled within 0–13 days from the initial visit for AUB. Postintervention, the wait time for appointments decreased, with 63% of patients scheduled within 0–13 days. Clinic redesign also resulted in an increase of 57.5% in appointment slots. No-show rates and appointment fill rates were not adversely affected.

Conclusions:
A collaborative team-based care model using NPs and gynecologists improved efficiency and access to office hysteroscopy services.
Optimizing therapy of bloodstream infection due to extended-spectrum β-lactamase-producing Enterobacteriaceae
Authors: Gudiol Carlota , Cuervo Guillermo , Carratalà Jordi 
Published: August 2019

Purpose of review
Infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) are increasing worldwide. Carbapenems are usually regarded as the antibiotics of choice for the treatment of serious ESBL infections. However, because of the alarming emergence or carbapenem resistance, interest in effective alternatives has emerged. The present review summarizes the findings published on the antibiotics currently available for treatment of patients with an ESBL-E bloodstream infection (BSI).

Recent findings
Meropenem and imipenem are the drugs recommended for treatment of ESBL BSIs in critically ill patients, and in infections with high bacterial loads or elevated β-lactam minimum inhibitory concentrations. Ertapenem should be reserved for patients with less severe presentations, and should be used at high doses. In milder presentations or BSIs from low-risk sources, other carbapenem-sparing alternatives could be considered: cephamycins, fluoroquinolones, and particularly a β-lactam/β-lactam inhibitor combination (particularly piperacillin/tazobactam). Optimized dosing of piperacillin/tazobactam is recommended (high doses and extended infusion). There are few data on the use of the promising newly available drugs (e.g. ceftolozane/tazobactam, ceftazidime/avibactam, cefiderocol, and plazomicin), and it seems reasonable to reserve them as last-resort drugs.

Summary
Carbapenems should be used in patients with serious infections; alternatives could be used individually, particularly for definitive treatment of patients with milder presentations.
Implementation of an Emergency Department Screening and Care Management Referral Process for Patients With Sickle Cell Disease
Authors: Rushton Sharron , Murray Debbie , Talley Charles , Boyd Sandra , Eason Kern , Earls Marian , Tanabe Paula 
Published: August 2019

Purpose of Study:
The purpose of the project was to describe the implementation and evaluation of a care management referral program from emergency departments (EDs) to care management services for patients with sickle cell disease (SCD).

Primary Practice Setting:
Patients were referred to Community Care of North Carolina (CCNC), which is a private–public collaboration providing care management services and served as a referral hub for the program. Patients received follow-up from either CCNC or the North Carolina Sickle Cell Syndrome Program.

Methodology and Sample:
A multidisciplinary, multiorganizational group streamlined the referral process for patients with SCD who have ongoing care needs by linking patients from the ED to care management services. The article presents a review of program implementation and evaluation over a 3½-year period. The target population were patients who had a diagnosis of SCD and presented to the ED for treatment. Emergency department staff used a modified version of the Emergency Department Sickle Cell Needs Assessment of Needs and Strengths tool to screen for social behavioral health needs in areas such as emotional, financial, pain management, and resources. All forms were faxed to a central number at CCNC for follow-up care management services. Community Care of North Carolina then linked the patient with the appropriate agency and staff for follow-up.

Results:
More than 900 referrals were received in 3½ years. Pain was the most common reason for referral. An increase in care management intensity was observed over time. All levels of care management intensity saw an increase in the number of patients.

Implications for Case Management:
Care management occurred across organizations after careful planning among stakeholders. The interagency cooperation permitted the development of a streamlined process. In particular, the creation of a single point for referral was an important component to allow for population-level monitoring and ease of making referrals. Patients with ongoing care needs were identified and there was an increase in the intensity of outpatient care management services delivered.
Clinical Findings and Electrodiagnostic Testing in Ulnar Neuropathy at the Elbow and Differences According to Site and Type of Nerve Damage
Authors: Vinciguerra Claudia , Curti Stefania , Aretini Alessandro , Sicurelli Francesco , Greco Giuseppe , Mattioli Stefano , Mondelli Mauro 
Published: August 2019

Objective
The aim of the study was to evaluate the clinical and electrodiagnostic testing in ulnar neuropathy at the elbow and differences according to site (humeroulnar arcade vs. retroepicondylar groove) and injury physiopathology (axonal vs. demyelinating), through prospective multicenter case-control study.

Design
Cases and controls were matched by age and sex. Ulnar neuropathy at the elbow diagnosis was made on symptoms. Statistical analysis was performed using Mann-Whitney, χ2, and analysis of variance tests.

Results
One hundred forty-four cases and 144 controls were enrolled. Sensory loss in the fifth finger had the highest sensitivity (70.8%) compared with clinical findings. Motor conduction velocity across elbow reached the highest sensitivity (84.7%) in localizing ulnar neuropathy at the elbow recording from at least one of the two hand muscles (first dorsal interosseous and abductor digiti minimi). Abnormal sensory action potential amplitude from the fifth finger occurred more frequently in axonal than in demyelinating forms. Differences between retroepicondylar groove and humeroulnar arcade regarded conduction block and job type.

Conclusions
Clinical findings have less usefulness than electrodiagnostic testing in ulnar neuropathy at the elbow diagnosis. Motor conduction velocity across elbow recorded from both abductor digiti minimi and first dorsal interosseous increases diagnostic accuracy. Axonal forms have greater clinical and electrodiagnostic testing severity than demyelinating forms, which are more frequent in retroepicondylar groove. Manual workers prevailed in humeroulnar arcade. These findings may be helpful in prognostic and therapeutic approaches.
Severe malaria: update on pathophysiology and treatment
Authors: Brejt Josef A. , Golightly Linnie M. 
Published: August 2019

Purpose of review
Malaria threatens the lives of over 200 million individuals with the disease each year. Plasmodium falciparum is the predominant cause of severe malaria which may be lethal and result in neurocognitive sequelae despite appropriate treatment. We review recent advances regarding the pathophysiology of severe malaria and treatment recommendations for severe disease in the United States.

Recent findings
Infected red blood cell (iRBC) sequestration in microvascular beds is a critical factor in the development of severe malaria syndromes. Interactions between iRBC variant adhesive peptides and the endothelial protein C receptor (EPCR) result in perturbations of coagulation and cytopreservation pathways. Alterations in the protein C/EPCR axis are implicated in cerebral malaria, respiratory distress, and anemia. Brain MRIs reveal the posterior reversible encephalopathy syndrome in cerebral malaria patients. Transcriptomic analysis reveals commonalities in disease pathogenesis in children and adults despite differences in clinical presentation. US guidelines for severe malaria treatment currently recommend intravenous artesunate including in pregnant women and children.

Summary
Despite advances in our understanding of malarial pathogenesis much remains unknown. Antimalarial agents eradicate parasites but no treatments are available to prevent or ameliorate severe malaria or prevent disease sequelae. Further study is needed to develop effective adjunctive therapies.
Work-Related Musculoskeletal Discomfort and Injury in Craniofacial and Maxillofacial Surgeons
Authors: Howarth Ashley L. , Hallbeck M. Susan , Lemaine Valerie , Singh Davinder J. , Noland Shelley S. 
Published: August 2019

Introduction:
Long, complex surgical procedures with non-ergonomic postures, headlights, loupe magnification, and microscope use may put craniofacial and maxillofacial surgeons at an increased risk of work-related musculoskeletal discomfort (WRMD). Identifying the prevalence and impact of WRMD may guide preventive strategies to prolong well-being, job satisfaction, and career duration.

Methods:
A 31-question survey was designed to evaluate WRMD. The survey was sent to American Society of Craniofacial Surgeons and American Society of Maxillofacial Surgeons members. The survey was created and distributed electronically through a private survey research center (Qualtrics Survey Software).

Results:
There were 95 respondents (23.75% response rate): 75% male, 56% aged 31 to 50 years old, and 73% in academic practice. On a scale of 0 to 10 (0 no pain, 10 worst pain), WRMD for surgery without loupes/microscope had a median of 3, with loupes 4, and with microscope 5. Pain was most common in the neck. Pain within 4 hours of surgery was present in 55% and 38% feared pain would influence future surgical performance. Surgeon discomfort affects posture (72%), stamina (32%), sleep (28%), surgical speed (24%), relationships (18%), and concentration (17%). Medical treatment for discomfort was sought by 22%. Time off work for treatment occurred in 9%.

Conclusion:
The WRMD can affect many aspects of a craniofacial or maxillofacial surgeon's life and has the potential to shorten or end a career. Occupational health and surgical ergonomics should be emphasized during surgical training and in surgical practice.
Predictors of Speech Outcome in Posterior Pharyngeal Fat Graft Surgery for Velopharyngeal Insufficiency Management
Authors: Denadai Rafael , Sabbag Anelise , Vieira Pedro Ribeiro , Raposo-Amaral Cesar Augusto , Buzzo Celso Luiz , Raposo-Amaral Cassio Eduardo 
Published: August 2019

Background:
The identification of variables potentially correlated with speech outcome, following posterior pharyngeal fat grafting for treatment of velopharyngeal insufficiency (VPI), can provide useful information to guide decision-making and preoperative counseling. This study assessed the predictors of speech outcome after posterior pharyngeal fat grafting for VPI management.

Methods:
One hundred and sixty-seven consecutive patients with repaired cleft palate and VPI who underwent posterior pharyngeal fat grafting were retrospectively enrolled. Perceptual speech and nasendoscopic parameters were randomly rated by 3 blinded evaluators. Speech outcome was stratified based on previously published criteria. Bivariate and multivariate analyses were performed to identify independent predictors of 15-month postoperative speech outcomes.

Results:
Large velopharyngeal gap, higher number of previous palatal surgical procedures, and referral pattern (ie, patients who underwent primary palatoplasty elsewhere) were independently negative (for all, P < 0.05) predictors of speech outcome, whereas small velopharyngeal gap size was positively (P < 0.05) correlated with this outcome. Age, sex, race, Veau hierarchy, syndromic diagnosis, Angle classification of malocclusion, type of primary palatoplasty, body mass index, obstructive sleep apnea-related scores, surgical period, donor site, grafted volume, recipient site-related complications, and preoperative status (velopharyngeal closure pattern, hypernasality, audible nasal emissions, and intraoral pressure) were not associated (for all, P > 0.05) with speech outcomes.

Conclusion:
Posterior pharyngeal fat grafting improves speech function in patients with VPI, whereas gap size, number of previous palatal surgeries, and referral pattern affect the speech outcome.