bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rare primary malignant mixed Müllerian tumor of the mediastinum
Authors: Wang Chunming , Liu Riqiang , Huang Feifei , Wei Haiming , Yu Lei 
Published: October 2018

Abstract

Rationale:
Malignant mixed Müllerian tumor (MMMT) of extragenital organs is rare, especially in male. To our knowledge, this is the first reported case of primary MMMT at the mediastinum in male.

Patient concerns:
A 54-year-old male was admitted to the hospital due to repeated stimulating dry cough for 2 years. His systemic examination was unremarkable. Laboratory workup revealed that all blood indicators were within normal limits. But subsequent computerized tomography (CT) scans of chest showed an abnormal soft tissue density in the area of its left, measuring approximately 4 cm in anterior-posterior dimension and 7 cm in maximum transverse dimension.

Diagnoses and Interventions:
The pathogenesis of these tumors remains controversial. The diagnosis is combined with biopsy and immunohistochemical staining. So, the patient underwent radical surgical resection and pathologic examination of the excised specimen was consistent with the diagnosis of MMMT. After surgery, he was treated by sequential chemoradiotherapy.

Outcomes:
The patient died from tumor recurrence 16 months later.

Lessons:
MMMT is a rare, highly aggressive tumor associated with interesting embryological origin, a definite diagnosis of which is only confirmed on pathological assessment. Due to its high degree of malignancy and high rate of recurrence, complete macroscopic excision of the tumor is recommended as soon as possible.
Choriocarcinoma with brain metastasis after term pregnancy
Authors: Song Liang , Li Qingli , Yin Rutie , Wang Danqing 
Published: October 2018

AbstractRationale:Although the incidence of postpartum choriocarcinoma is extremely low, careful postpartum placental examination, histopathological examination in patients with abnormalities, and blood β-human chorionic gonadotropin (HCG) monitoring in high-risk pregnant women are necessary for early diagnosis of postpartum choriocarcinoma and improvement in prognosis.Patient concerns:A 32-year-old woman presented with the chief complaint of postpartum irregular vaginal bleeding for 45 days and coughing and hemoptysis for 7 days.Diagnosis:Clinical findings when combined with her medical history and various physical examinations confirmed the diagnosis as postpartum choriocarcinoma with brain metastases (stage IV postpartum choriocarcinoma and a risk score of 16).Interventions:The patient was administered three courses of multidrug chemotherapy (5-fluorouracil + actinomycin D) with intrathecal methotrexate injection. The 5-fluorouracil + actinomycin D maintenance chemotherapy regimen was continued for 4 cycles; whole brain radiotherapy was also administered.Outcomes:After the completion of chemotherapy and radiotherapy, the patient underwent regular follow-up examinations; no recurrence was noted for 17 months.Lessons:Timely diagnosis of postpartum choriocarcinoma can significantly improve its prognosis. A stratified treatment should be administered according to the International Federation of Gynecology and Obstetrics staging and World Health Organization prognostic scoring systems. Blood β-HCG is a sensitive marker for evaluating therapeutic efficacy and follow-up after remission.
Nursing students’ relationships among meaning in life, well-being, and positive beliefs
Authors: Tsai Fu-Ju , Chen Cheng-Yu , Yeh Gwo-Liang , Hu Yih-Jin , Tseng Chie-Chien , Chen Si-Chi 
Published: October 2018

Abstract
Nursing educators have a core responsibility to develop nursing students’ health promotion. The purpose of this study was to explore nursing students regarding their relationships among meaning in life, well-being, and positive beliefs. A cross-sectional survey design was adopted in this study. Purposive sampling was used. A total of 219 nursing students participated in the study. Quantitative analysis was utilized for the data analyses. The study found that nursing students had the following mean scores on the meaning in life, 4.33 (86.60%) standard deviation (SD) 0.79; well-being, 4.23 (84.60%) SD 0.78; and positive beliefs, 4.32 (86.40%) SD 0.75. The nursing students’ characteristics, meaning in life, and well-being explained 79% of the variance in positive beliefs (adjusted R

2
= 0.79, F = 114.57, P < .001). Nursing educators can promote meaning in life and well-being to nursing students as an effective way to increase their positive beliefs.
Validating the 6-minute walk test as an indicator of recovery in patients undergoing cardiac surgery
Authors: Chen Yueh-Chi , Chen Kun-Chung , Lu Li-Hua , Wu Yi-Liang , Lai Te-Jen , Wang Chun-Hou 
Published: October 2018

Abstract
The 6-minute walk test (6MWT) has been applied to assess postsurgical recovery in cardiac populations. This study mainly investigated whether the 6MWT could serve as an indicator for physical functioning in patients undergoing cardiac surgery.
Participants completed the 6MWT and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) at baseline, discharge, and 3 months postoperatively, in order to analyze the construct validity and responsiveness of the 6MWT. The participants in this study were 125 patients (92 males and 33 females) with an average age of 65.1 ± 11.1 years. The mean 6MWT was 308.9 ± 77.3 m in the preoperative phase, decreased to 277.3 ± 85.7 m at discharge, and returned to 378.1 ± 95.2 m at 3-month follow-up. The results showed that the 6-minute walk distances at baseline and at 3-month follow-up were moderately to highly correlated with the physical functioning subscale of the SF-36 (r

s
= .44 and .54, respectively) and had weak correlation with the nonphysical functioning subscales. The recovery level of physical functioning is meaningfully associated with the 6MWT change from baseline to discharge and from baseline to 3-month follow-up. Patients with higher New York Heart Association (NYHA) Functional Classification levels had lower 6MWT. Additionally, the 6MWT was sensitive to change during the perioperative period (effect sizes from −0.51 to 1.72).
The supporting evidence includes the construct validity and responsiveness of the 6MWT. This study supports the feasibility of the 6MWT as an evaluation tool of physical functioning for assessment of postcardiac surgical recovery.
Sevoflurane is an effective adjuvant to propofol-based total intravenous anesthesia for attenuating cough reflex in nonintubated video-assisted thoracoscopic surgery
Authors: Lai Hou-Chuan , Huang Tsai-Wang , Tseng Wei-Cheng , Lin Wei-Lin , Chang Hung , Wu Zhi-Fu 
Published: October 2018

Abstract

Background:
Nonintubated video-assisted thoracic surgery (VATS) has been widely developed during the recent years. Cough reflex is an inevitably encountered problem while approaching lung lesions, and it may induce major bleeding. Sevoflurane anesthesia may attenuate cough reflex by inhibiting the pulmonary irritant receptors. However, the incidence of postoperative nausea and vomiting (PONV) in inhalational anesthesia is higher than in the propofol-based total intravenous anesthesia (TIVA). We investigated the effect of sevoflurane combination with propofol-based TIVA on cough reflex and PONV in nonintubated VATS.

Methods:
Ninety patients undergoing nonintubated VATS with laryngeal mask airway (LMA) and spontaneous breathing were randomly assigned for TIVA or propofol/sevoflurane anesthesia. In the TIVA group (n = 45), anesthesia was induced and maintained with propofol and fentanyl; in the propofol/sevoflurane (P/S) group (n = 45), 1% sevoflurane anesthesia was added to propofol and fentanyl anesthesia. The primary outcome measurements were cough reflex. In addition, the incidence of PONV and extubation time were investigated.

Results:
Patients with cough reflex were significantly fewer in the P/S group than in the TIVA group (10/45 vs 34/45; P < .001). The cough severity (35/5/5/0 vs 11/17/17/0; P < .001) and limb movement (40/5/0/0 vs 28/17/0/0; P < .001) were lower in the P/S group than in the TIVA group. Besides, incremental fentanyl bolus for cough reflex was 5 (0 [0–1]) in the P/S group and 17 (0 [0–3]) in the TIVA group (P < .05). And there was no conversion to general anesthesia, postoperative hemorrhage, aspiration pneumonia, or PONV in the 2 groups. Besides, there was no significant difference in extubation time (TIVA: 5.04 ± 2.88 vs P/S: 4.44 ± 2.98 minutes; P = .33).

Conclusion:
Sevoflurane attenuated cough reflex under propofol-based TIVA and did not increase the incidence of PONV and extubation time in nonintubated VATS.
Updates in Pediatric Pancreatology
Authors: Grover Amit S. , Freeman Alvin J. , Abu‐El‐Haija Maisam , Eisses John F. , Gardner Timothy B. , Liu Quin Y. , Lowe Mark E. , Nathan Jaimie D. , Palermo Tonya M. , Singh Vikesh K. , Trout Andrew T. , Uc Aliye , Husain Sohail Z. , Morinville Veronique D. 
Published: October 2018

ABSTRACTThe Pancreas Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition aims to promote awareness of pediatric pancreatic diseases, support clinical and basic science research in the field, educate pediatric gastroenterologists, and advocate on behalf of pediatric patients with pancreatic disorders. At the 2017 Annual North American Society for Pediatric Gastroenterology, Hepatology and Nutrition meeting, the Pancreas Committee held a full day symposium on pediatric pancreatic diseases, entitled, “Frontiers in Pediatric Pancreatology.” The symposium served as a timely and novel academic meeting that brought together individuals with a vested interest in the care of children with pancreatic disorders. The objective of this day‐long course was to update practicing gastroenterologists on the latest advances in research, management algorithms, endoscopic therapies, radiographic resources, surgical approaches, and novel drug therapies targeted to pediatric pancreatitis. Presentations were divided into 4 modules: diagnosis, risk factors, and natural history of pancreatitis; pancreatic imaging and exocrine function; management of pancreatitis; and new frontiers in pediatric pancreatitis research. The course fostered a unique ecosystem for interdisciplinary collaboration, in addition to promoting discussion and stimulating new research hypotheses regarding pediatric pancreatic disorders. Oral presentations by experts in various fields of pancreatology led to thought‐provoking discussion; in addition, a meet‐the‐professor luncheon stimulated critical evaluation of current research in pediatric pancreatic diseases, highlighting knowledge gaps and future research endeavors. The current report summarizes the major learning points from this novel symposium focusing on the growing demographic of pediatric pancreatic diseases.
Validation of the Smoking Cessation Counseling Scale Chinese Version in Taiwan
Authors: Tsai Hsiu-Wen , Chen Shu-Ching , Wu Hsein-Lin , Hong Ming-Ying , Lee Yun-Hsiang , Lai Yeur-Hur 
Published: October 2018

Background
Providing tobacco control (TC) and smoking cessation (SC) counseling is an important part of healthcare. An assessment tool to understand healthcare providers' experiences in providing SC counseling may enhance TC.

Objective
The aims of this study were to (1) translate and develop the Smoking Cessation Counseling Scale–Chinese version (SCCS-C) and (2) evaluate its psychometric properties in Taiwan.

Methods
This is a 2-phase instrument testing study. In the first phase, the SCCS-C was developed and translated. In the second phase, 2 groups of participants were recruited. First, 292 SC educator trainees completed the psychometric assessment measures (internal consistency reliability and construct validity). The 2-week test-retest reliability was assessed in certified TC instructors.

Results
The results showed that (1) the SCCS-C has satisfactory content validity and internal consistency reliability with a Cronbach's α of .96; (2) the overall 2-week test-retest reliability was 0.70; (3) instead of the 4-factor structure of the original scale, a 3-factor structure of the SCCS-C was identified by exploratory factor analysis to explain 65.37%; (4) construct validity was supported by significant negative correlations between SCCS-C and barriers regarding TC and positive correlations with counseling, responsibility, and self-efficacy; and (5) discriminant validity was supported by significant differences between SC educator trainees and the certified TC instructors, as well as between those living with or without smokers.

Conclusions
The SCCS-C has satisfactory reliability, test-retest reliability, and construct validity.

Implications for Practice
The SCCS-C is a valid, reliable instrument for assessing healthcare counseling activities for SC in Taiwan.
Improving Handoffs Between Operating Room and Pediatric Intensive Care Teams: Before and After Study
Authors: Malenka Emma C. , Nett Sholeen T. , Fussell Melissa , Braga Matthew S. 
Published: October 2018

Introduction:
Patient transfer between teams and units is known to be a high-risk event for miscommunication and therefore error. We instituted a quality improvement initiative to formalize patient handoffs from the operating room (OR) to the Pediatric Intensive Care Unit (PICU). We hypothesized that measures of information transfer would improve.

Methods:
In this before and after study, a multidisciplinary team developed a standardized handoff protocol (including a checklist) instituted in the Dartmouth PICU over the summer of 2016. We directly observed pediatric admissions from OR to PICU and collected data on information transfer and patient outcome metrics both before and after the institution of the handoff protocol at the time of transfer (intervention).

Results:
We directly observed 52 handoffs (29 preintervention, 23 postintervention). The mean patient age was 9.3 years (SD, 6.5), with 55% male. Preintervention the average information transfer was 56% (upper control limit, 76%; lower control limit, 36%), whereas postintervention it was 81% (upper control limit, 97%, lower control limit, 65%). The improvement in information transfer postintervention was statistically significant (P < 0.001). There was no statistically significant change in maximum pain score in the first 6 hours after admission (preintervention, 4.5, SD 3.9; postintervention, 2.9, SD 1.3, P = 0.15). There was no difference in the time required for handoff pre- versus postintervention (8.7 minutes, SD 5.5 versus 10.1 minutes, SD 4.6, P = 0.34).

Conclusion:
Standardization of OR to PICU patient transfers using a predetermined checklist at the time of handoff can improve the completeness of information transfer without increasing the length of the handoff.
Using Quality Improvement to Change Testing Practices for Community-acquired Pneumonia
Authors: Rogers Amanda J. , Lye Patricia S. , Ciener Daisy A. , Ren Bixiang , Kuhn Evelyn M. , Morrison Andrea K. 
Published: October 2018

Background:
National guidelines for pediatric community-acquired pneumonia (CAP) contain recommendations regarding diagnostic testing including chest radiographs (CXRs), complete blood counts (CBCs), and blood cultures. Local data indicated that our institution was not delivering care at standards outlined by these guidelines. This project aimed to decrease CXRs for children with CAP discharged from the emergency department (ED) by 10% and decrease CBCs and blood cultures for patients hospitalized with uncomplicated CAP by 20% within 1 year.

Methods:
This single-site quality improvement initiative targeted otherwise healthy children 3 months to 18 years who presented to the ED with uncomplicated CAP at a free-standing academic children’s hospital. A quality improvement team performed a series of interventions including guideline implementation, data sharing, and annual education. Process measures included CXR, CBC, and blood culture rates. Balancing measures included the number of patients diagnosed with CAP, the frequency of antibiotic use, length of stay, and ED and hospital return rates. The team used statistical process control charts to plot measures.

Results:
There was special cause improvement with a desirable downward shift in testing that correlated with the project’s interventions. The percentage of CXRs for discharged patients decreased from 79% to 57%. CBCs and blood cultures for hospitalized patients decreased from 30% to 19% and 24% to 14%, respectively. Balancing measures remained unchanged.

Conclusions:
We used elements of quality improvement methodology to reduce testing for uncomplicated CAP without impacting the number of patients diagnosed with CAP, the frequency of antibiotic use, length of stay, and reutilization rates.
Automated E-mail Reminders Linked to Electronic Health Records to Improve Medication Reconciliation on Admission
Authors: Johnson Kristen , Burkett Gregory S. , Nelson Daniel , Chen Allen R. , Matlin Carol , Garger Cathy , McMahan Steven , Hughes Helen , Miller Marlene , Kim Julia M. 
Published: October 2018

Introduction:
Medication reconciliation can reduce medication discrepancies, errors, and patient harm. After a large academic hospital introduced a medication reconciliation software program, there was low compliance with electronic health record documentation of home medication reconciliation. This quality improvement project aimed to improve medication reconciliation on admission in 4 pediatric inpatient units by 50% over 3 months.

Methods:
We used Lean Sigma methodology to observe medication reconciliation processes; interview residents, nurses, pharmacists, and families; and perform swim lane process mapping and Ishikawa Cause and Effect analysis. The improvement plan included education and automated e-mails sent to admitting residents who had not completed medication reconciliation within 24 hours of admission. The daily percentage of patients without medication reconciliation within 24 hours of admission, indicated by the presence of old prescriptions in Sunrise Prescription Writer (RxWriter) (Allscripts Healthcare Solutions, Chicago, Ill.) from prior admissions, was assessed from March 2015-June 2016. We constructed statistical process control charts and identified special causes.

Results:
Key barriers included lack of knowledge about RxWriter and lack of accountability for completing medication reconciliation. The percentage of patients without medication reconciliation decreased from 32% at baseline to 22% with education (P < 0.001), to 15% with the use of automated e-mail reminders (P < 0.001). We sustained improvement over the following year. Statistical process control testing indicated shifts aligning with each stage of the study.

Conclusion:
Provider-tailored, automated e-mail reminders linked to electronic health record with educational training significantly improved resident compliance with use of an electronic tool for documentation of home medication reconciliation on hospital admission.
Adherence to Daily Weights and Total Fluid Orders in the Pediatric Intensive Care Unit
Authors: Ahearn Marshall A. , Soranno Danielle E. , Stidham Timothy , Lusk Jennifer , Gist Katja M. 
Published: October 2018

Background:
Fluid is central to the resuscitation of critically ill children. However, many pay limited attention to continued fluid accumulation. Fluid overload (FO) is associated with significant morbidity and mortality. The Volume Status Awareness Program (VSAP) is a multi-phase quality improvement initiative aimed at reducing iatrogenic FO. For baseline data, the authors examined a retrospective cohort of patients admitted to the pediatric intensive care unit.

Methods:
Cohort included diuretic-naive patients admitted to the pediatric intensive care unit at a tertiary care children’s hospital in 2014. Furosemide-exposure was used to indicate provider-perceived FO. Variables included daily weight and total fluid (TF) orders, and their timing, frequency, and adherence. Implementation of VSAP phase 1 (bundle of interventions to promote consistent use of patient weights) occurred in June 2017.

Results:
Forty-nine patients met criteria. Five (10%) had daily weight orders, and 41 (84%) had TF orders—although 7 of these orders followed furosemide administration. Adherence to TF orders was good with 32 (78%) patients exceeding TF limits by < 10%. Thirty (63%) had > 5% FO by day 1, and 22 (51%) had > 10% cumulative FO by day 3. Following phase 1 of the VSAP, the frequency of daily weight orders increased from 6% to 88%.

Conclusions:
In our institution, use of fluid monitoring tools is both inconsistent and infrequent. Early data from the VSAP project suggests simple interventions can modify ordering and monitoring practice, but future improvement cycles are necessary to determine if these changes are successful in reducing iatrogenic FO
Dissemination of a Novel Framework to Improve Blood Culture Use in Pediatric Critical Care
Authors: Woods-Hill Charlotte Z. , Lee Laura , Xie Anping , King Anne F. , Voskertchian Annie , Klaus Sybil A. , Smith Michelle M. , Miller Marlene R. , Colantuoni Elizabeth A. , Fackler James C. , Milstone Aaron M. 
Published: October 2018

Introduction:
Single center work demonstrated a safe reduction in unnecessary blood culture use in critically ill children. Our objective was to develop and implement a customizable quality improvement framework to reduce unnecessary blood culture testing in critically ill children across diverse clinical settings and various institutions.

Methods:
Three pediatric intensive care units (14 bed medical/cardiac; 28 bed medical; 22 bed cardiac) in 2 institutions adapted and implemented a 5-part Blood Culture Improvement Framework, supported by a coordinating multidisciplinary team. Blood culture rates were compared for 24 months preimplementation to 24 months postimplementation.

Results:
Blood culture rates decreased from 13.3, 13.5, and 11.5 cultures per 100 patient-days preimplementation to 6.4, 9.1, and 8.3 cultures per 100 patient-days postimplementation for Unit A, B, and C, respectively; a decrease of 32% (95% confidence interval, 25–43%; P < 0.001) for the 3 units combined. Postimplementation, the proportion of total blood cultures drawn from central venous catheters decreased by 51% for the 3 units combined (95% confidence interval, 29–66%; P < 0.001). Notable difference between units included the identity and involvement of the project champion, adaptions of the clinical tools, and staff monitoring and communication of project progress. Qualitative data also revealed a core set of barriers and facilitators to behavior change around pediatric intensive care unit blood culture practices.

Conclusions:
Three pediatric intensive units adapted a novel 5-part improvement framework and successfully reduced blood culture use in critically ill children, demonstrating that different providers and practice environments can adapt diagnostic stewardship programs.