bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unique Issues of DNP Students
Authors: Volkert Delene , Johnston Heidi 
Published: August 2018

Abstract

AIM
The purpose of this study was to explore, analyze, and describe nursing doctoral students' perceptions of factors that impacted them during their doctoral program.

BACKGROUND
There are two major pathways for nurses to earn a doctoral degree, the most recent of which is the doctor of nursing practice (DNP) degree. Enrollment in and graduates from nursing DNP programs have increased dramatically over the last decade.

METHOD
Answers to an open-ended question in a national descriptive survey study of nursing doctoral students across the United States were analyzed. Colaizzi’s procedural methods were used as a guideline.

RESULTS
The content analysis identified issues unique to DNP students, which related to lack of clarity for the DNP degree and student concerns within academic settings.

CONCLUSION
Recommendations include having DNP faculty on DNP project committees and for standardization of guidelines for the DNP project to ensure rigor and consistency.
Therapeutic approaches for suicidal adolescents
Authors: Rajamohan Santhiny , Sharkey Patricia L. , Heavey Elizabeth 
Published: August 2018

Abstract:
Suicide is one of the most preventable causes of death among children and adolescents. Because nurses are often the first to interact with someone who is suicidal, all healthcare settings should have protocols for suicide screening and prevention. This article addresses the issue of suicide among adolescents and focuses on risk assessment, therapeutic interventions, and recommendations for successful outcomes.
The clinico-serological spectrum of overlap myositis
Authors: Fredi Micaela , Cavazzana Ilaria , Franceschini Franco 
Published: August 2018

Purpose of review
To provide the most recent evidence on the overlap myositis.

Recent findings
Several new evidences on the overlap myositides have recently emerged. Regarding the classical myositis associated antibodies, several contributions focused on a better definition of the clinical associations and the disease course associated with these autoantibodies. Moreover, in the last years, new autoantibodies in idiopathic inflammatory myositis or other connective tissue diseases have been identified [namely anti-RuvBL1/2, poly-U-binding factor 60 kDa protein (PUF-60) and cytosolic 5′-nucleotidase 1A (NT5C1A)], and an increasing number of publications allow now to consider them as new myositis-associated antibodies with probably their own peculiar clinical profile.

Summary
Overlap myositis is probably the largest subgroup within the idiopathic inflammatory myositis, with a prevalence that can reach 50% of all adult patients. The serological spectrum of overlap myositis has recently been enriched by the discovery of new autoantibodies. The spread of multiparametric methods has facilitated the identification of the autoantibody marker of overlap myositis and the better definition of the clinical profiles associated with them.
What’s New in Pediatric Orthopaedic Quality, Safety, and Value? A Systematic Review With Results of the 2016 POSNA Quality, Safety, and Value Initiative (QSVI) Challenge
Authors: Miller Daniel J. , Cahill Patrick J. , Janicki Joseph A. , Stephenson Lindsay P. , Choi Paul D. 
Published: August 2018

Background:
Enhancing the safety, quality, and value of care provided is a point of emphasis for modern health care systems. We performed a review of recent literature to highlight those efforts relevant to pediatric musculoskeletal care.

Methods:
We searched the PubMed database for all papers related to quality improvement, patient safety, and/or value in pediatric orthopaedics published from October 1, 2012 to October 31, 2017, yielding 193 papers.

Results:
A total of 36 papers were selected for review based upon new findings. Papers were selected based on significant contributions in the following categories: casting safety, antibiotic stewardship/infection prevention, perioperative care pathways, blood conservation, venous thromboembolic disease prevention, and imaging safety/appropriateness.

Conclusions:
There have been numerous advances in safety, quality, and value in pediatric orthopaedic care. Quality improvement efforts emphasizing provider education and safety monitoring can lead to a decrease in cast-related complications. Perioperative care pathways and bundles are associated with a decrease risk of surgical site infection and decreased length of stay in pediatric spinal deformity surgery. Increased scrutiny has been placed on the value of routine follow-up radiographs in pediatric fracture and spinal deformity care.

Level of Evidence:
Level 4—literature review.
Improvement in Back and Leg Pain and Disability Following Adult Spinal Deformity Surgery
Authors: Verma Ravi , Lafage Renaud , Scheer Justin , Smith Justin , Passias Peter , Hostin Richard , Ames Christopher , Mundis Gregory , Burton Douglas , Kim Han Jo , Bess Shay , Klineberg Eric , Schwab Frank , Lafage Virginie 
Published: August 2018

Study Design.
A retrospective review of a prospective, multicenter adult spinal deformity (ASD) database.

Objective.
Our objective was to quantify the change in disability reported for patients with radiculopathy as compared with patients with back pain only following ASD realignment surgery.

Summary of Background Data.
Studies utilizing patient-reported outcomes (PROs) have shown that ASD patients suffer from significant pain and disability. Although surgical correction has been effective at improving back and leg pain, no studies have investigated the impact of radiculopathy on pain and disability in ASD patients.

Methods.
Inclusion criteria were age ≥ 18 years and presence of spinal deformity as defined by coronal Cobb angle ≥ 20°, sagittal vertical axis (SVA) ≥ 5 cm, pelvic tilt (PT) angle ≥ 25°, or thoracic kyphosis (TK) angle ≥ 60°. Demographics and PRO were collected. Patients with radiculopathy were propensity matched with patients with back pain. Preoperative, postoperative, and 2-year follow-up radiographic parameters and PRO were analyzed.

Results.
Three hundred twenty-four patients met inclusion criteria, and following propensity matching, 90 patients were placed into the radiculopathy and back pain groups. These groups showed no difference in demographic or radiographic parameters. The groups were similar in PRO, with a difference in leg pain as per design. At baseline, leg pain patients had higher disability [Oswestry Disability Index (ODI) and Scoliosis Research Society (SRS)]. Surgical strategies between the two groups showed no differences. Postoperative radiographic parameters showed no difference. Despite a significantly greater decrease in numerical rating scale (NRS) Leg for the leg pain group, postoperatively, these patients remained more disabled than the nonleg group in terms of NRS (back and leg), ODI, and most of the SRS domains.

Conclusion.
ASD patients with radiculopathy exhibit increased pain and disability when compared with patients without leg pain. This increased pain and disability persists after surgical correction in these patients.

Level of Evidence: 3
The Effects of Bed Bathing on Vital Signs and Oxygen Saturation in Children Who Are Connected to Mechanical Ventilation
Authors: Kzl Hamiyet , Şendir Merdiye 
Published: August 2018

Aim
This study is a quasi-experimental research that was conducted to evaluate the effects of bathing on vital signs and oxygen saturation in intubated children who are connected to mechanical ventilation.

Methods
The study sample consisted of children who are treated in the pediatric intensive care unit, University of Istanbul Cerrahpasa Faculty of Medicine Hospital. A total of 60 children who met the criteria of the sample group were included in the study. The children were given bed bathing with plain warm water of 32°C to 38°C on 3 different days. The vital signs and oxygen saturation values of the children were measured before bathing, just after bathing, and 30 minutes after bathing them.

Results
Most of the children (65%) were on mechanical ventilation because of respiratory system diseases; 91.7% of them were connected to mechanical ventilation with endotracheal tube. The first bed bathing of children was given mean of 1.54 ± 3.57 days after their hospitalization, and bathing durations were mean of 18.3 minutes. The vital signs (pulse, blood pressure, body temperature) were compared before and after bed bathing, and it was observed that the values before bathing, just after bathing, and 30 minutes after bathing had advanced level of difference (P < .001). The lowest values of all signs except body temperature were obtained 30 minutes after bed bathing. When oxygen saturation measurement values before bathing (94.5%) and after bathing were compared, it was found that the highest values (97.3%) were obtained 30 minutes after bed bathing.

Conclusion
The bed bathing positively affected the vital signs and oxygen saturation values in intubated children connected to the mechanical ventilation. Yet, there is still a need for more research to test the effects of bed bathing on respiratory and circulatory function.
Patient Presentations in Outpatient Settings
Authors: Zogg Cheryl K. , Haring R. Sterling , Xu Likang , Canner Joseph K. , Ottesen Taylor D. , Salim Ali , Haider Adil H. , Schneider Eric B. 
Published: August 2018

Background:
While deaths, hospitalizations, and emergency department visits for head trauma are well understood, little is known about presentations in outpatient settings. Our objective was to examine the epidemiology and extent of healthcare-seeking adult (18–64 years) head trauma patients presenting in outpatient settings compared with patients receiving nonhospitalized emergency department care.

Methods:
We used 2004–2013 MarketScan Medicaid/commercial claims to identify head trauma patients managed in outpatient settings (primary care provider, urgent care) and the emergency department. We examined differences in demographic and injury-specific factors, Centers for Disease Control and Prevention–defined head trauma diagnoses, and extent of and reasons for postindex visit ambulatory care use within 30/90/180 days by index visit location, as well as annual and monthly variations in head trauma trends. We used outpatient incidence rates to estimate the US nationwide outpatient burden.

Results:
A total of 1.19 million index outpatient visits were included (emergency department: 348,659). Nationwide, they represented a weighted annual burden of 1.16 million index outpatient cases. These encompassed 46% of all known healthcare-seeking head trauma in 2013 (outpatient/emergency department/inpatient/fatalities) and increased in magnitude (+31%) from 2004 to 2013. One fourth (27%) of office/clinic visits led to diagnosis with concussion on index presentation (urgent care: 32%). Distributions of demographic factors varied with index visit location while injury-specific factors were largely comparable. Subsequent visits reflected high demand for follow-up treatment, increased concussive diagnoses, and sequelae-associated care.

Conclusions:
Adult outpatient presentations of head trauma remain poorly understood. The results of this study demonstrate the extensive magnitude of their occurrence and close association with need for follow-up care.
Shared and Study-specific Dietary Patterns and Head and Neck Cancer Risk in an International Consortium
Authors: De Vito R. , Lee Yuan Chin Amy , Parpinel M. , Serraino D. , Olshan Andrew Fergus , Zevallos Jose Pedro , Levi F. , Zhang Zhuo Feng , Morgenstern H. , Garavello W. , Kelsey K. , McClean M. , Schantz S. , Yu Guo Pei , Boffetta P. , Chuang Shu Chun , Hashibe M. , La Vecchia C. , Parmigiani G. , Edefonti V. 
Published: August 2018

Background:
A few papers have considered reproducibility of a posteriori dietary patterns across populations, as well as pattern associations with head and neck cancer risk when multiple populations are available.

Methods:
We used individual-level pooled data from seven case–control studies (3844 cases; 6824 controls) participating in the International Head and Neck Cancer Epidemiology consortium. We simultaneously derived shared and study-specific a posteriori patterns with a novel approach called multi-study factor analysis applied to 23 nutrients. We derived odds ratios (ORs) and 95% confidence intervals (CIs) for cancers of the oral cavity and pharynx combined, and larynx, from logistic regression models.

Results:
We identified three shared patterns that were reproducible across studies (75% variance explained): the Antioxidant vitamins and fiber (OR = 0.57, 95% CI = 0.41, 0.78, highest versus lowest score quintile) and the Fats (OR = 0.80, 95% CI = 0.67, 0.95) patterns were inversely associated with oral and pharyngeal cancer risk. The Animal products and cereals (OR = 1.5, 95% CI = 1.1, 2.1) and the Fats (OR = 1.8, 95% CI = 1.4, 2.3) patterns were positively associated with laryngeal cancer risk, whereas a linear inverse trend in laryngeal cancer risk was evident for the Antioxidant vitamins and fiber pattern. We also identified four additional study-specific patterns, one for each of the four US studies examined. We named them all as Dairy products and breakfast cereals, and two were associated with oral and pharyngeal cancer risk.

Conclusion:
Multi-study factor analysis provides insight into pattern reproducibility and supports previous evidence on cross-country reproducibility of dietary patterns and on their association with head and neck cancer risk. See video abstract at, http://links.lww.com/EDE/B430.
ATYPICAL CONGENITAL HYPERTROPHY OF THE RETINAL PIGMENT EPITHELIUM COMPLICATED BY PRESUMED RETINAL PIGMENT EPITHELIAL ADENOMA AND EXUDATIVE MACULOPATHY
Authors: Mehta Nitish , Gal-Or Orly , Barbazetto Irene , Modi Yasha , Shields Carol L. , Freund K. Bailey 
Published: August 2018

Purpose:
To report a retinal pigment epithelium (RPE) tumor with exudative maculopathy, originating from an atypical RPE lesion presumed to represent congenital hypertrophy of the RPE or RPE hyperplasia.

Methods:
Multimodal imaging including fundus autofluorescence, optical coherence tomography, fluorescein angiography, and optical coherence tomography angiography.

Results:
A 76-year-old West African man noted visual acuity reduction to count fingers in the right eye and 20/400 in the left eye. Features of chronic glaucoma were noted. In addition, there was a fairly well-circumscribed darkly pigmented RPE lesion in the paramacular region in the right eye, measuring 4 mm in diameter and flat and consistent with atypical congenital hypertrophy of the RPE or RPE hyperplasia. On the posterior margin of this mass was an RPE tumor, presumed to represent RPE adenoma, producing exudative maculopathy and cystoid macular edema. Multimodal imaging was used to distinguish the RPE tumor from macular neovascularization. A similar atypical congenital hypertrophy of the RPE without retinopathy measuring 3.5mm in diameter was noted in the temporal macular region in the left eye. After six monthly doses of intravitreal bevacizumab (1.25 mg/0.05 mL) in the right eye, the maculopathy resolved and the RPE mass showed partial involution with visual acuity return to baseline 20/200.

Conclusion:
Congenital hypertrophy of the RPE and RPE hyperplasia can produce RPE adenoma with related exudative maculopathy. In this case, the maculopathy responded to bevacizumab.
SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY FINDINGS IN A CASE OF WHIPLASH MACULOPATHY WITH INCOMPLETE RESOLUTION
Authors: Cappello Ezio , Della Guardia Chiara , Cecchin Elisa , Morselli Simonetta 
Published: August 2018

Purpose:
To report spectral domain optical coherence tomography (OCT) findings of a patient who experienced bilateral visual loss after a motorcycle accident.

Methods:
A 51-year-old man presented to the emergency department complaining of bilateral visual loss after a motorcycle falling down. A complete ophthalmologic examination and OCT testing were made on the same day of the accident. Follow-up was made at 2 days, 2 weeks, 5 months, and 12 months adding central visual field assessment using Humphrey automated perimetry.

Results:
At presentation, best-corrected visual acuity was 20/200 in both eyes, anterior segment was normal, and fundus examination showed a bilateral macular edema confirmed by OCT. After 2 days, visual acuity recovered to 20/25. Optical coherence tomography findings showed foveal detachment, hyperreflective clump below external limiting membrane, and hyperreflectivity of Henle layer nasally to the fovea. After 15 days, visual acuity was 20/20, but vision was altered by a paracentral scotoma and some irregularities of OCT findings persisted. At 1 year of follow-up, best-corrected visual acuity was 20/20, and paracentral scotoma was very tiny in the right eye, whereas larger and deeper in the left eye. Optical coherence tomography was normal in the right eye, whereas some fragmentations of interdigitation zone were still evident in the left eye.

Conclusion:
We report a case of bilateral whiplash maculopathy from vitreoretinal traction subsequent to road traffic accident. After 1 year of follow-up, visual acuity was restored but paracentral scotoma persisted. Optical coherence tomography appearance of the left eye was still abnormal.
Visual and Refractive Outcomes After Sub-Bowman Keratomileusis and Transepithelial Photorefractive Keratectomy for Myopia
Authors: Zhang Riping , Sun Lixia , Li Jinyu , Law Antony , Jhanji Vishal , Zhang Mingzhi 
Published: August 2018

Purpose:
To compare the visual and refractive outcomes of transepithelial photorefractive keratectomy (Trans-PRK) and sub-Bowman femtosecond-assisted laser in situ keratomileusis (SBK).

Setting:
University hospital.

Design:
Retrospective, comparative study.

Methods:
Two hundred forty patients with myopia and myopic astigmatism underwent SBK (n=157) or Trans-PRK (n=83). The main outcome measures included manifest spherical equivalent refraction (MRSE), logarithm of the minimum angle of resolution uncorrected visual acuity (UCVA), and best-corrected visual acuity (BCVA), which were evaluated at 1 and 3 months postoperatively.

Results:
The preoperative mean MRSE was −4.00±1.2 diopters (D) and −4.05±1.36 D (P=0.76) in Trans-PRK and SBK groups, respectively. There was a significant improvement in UCVA after Trans-PRK (1.29–0.00 at 1 month and −0.05 at 3 months; P<0.001 for both) and SBK (1.25 to −0.04 at 1 month and −0.05 at 3 months; P<0.001 for both). Both UCVA and BCVA were better after SBK compared with Trans-PRK at 1 month (−0.07 vs. −0.03; P<0.001) but not at 3 months (−0.08 vs. −0.07; P=0.223). The patients in Trans-PRK group were significantly more hyperopic compared with those in the SBK group at 1 month (0.11 vs. 0.04; P=0.034) and 3 months (0.11 vs. 0.04; P=0.011) postoperatively. Subgroup analysis showed that patients with myopia >3 diopters were more hyperopic at 1 month postoperatively as compared to patients with myopia of ≤3 diopters.

Conclusions:
Both Trans-PRK and SBK are effective procedures to correct mild to moderate myopia and myopic astigmatism. Patients undergoing SBK experience quick visual recovery. Both procedures had no difference in visual outcomes 3 months postoperatively.
Infrared Video Meibography of Lower Lid Meibomian Glands Shows Easily Distorted Glands: Implications for Longitudinal Assessment of Atrophy or Growth Using Lower Lid Meibography
Authors: Maskin Steven L. , Testa Whitney R. 
Published: August 2018

Purpose:
To evaluate measurement reliability of the meibomian gland (MG) tissue area during infrared video meibography (IR-VM) of the lower lid.

Methods:
This is a retrospective analysis, using ImageJ, of IR-VM of 17 lids of 11 consecutive patients (age 56.6 ± 15.9 years; 9 females and 2 males) focusing on the presence of a statistically significant variation of the MG tissue area and the MG tissue area relative to the total measurement field (TMF) secondary to inadvertent lid distortion and/or an altered vertical gaze direction during a single-image acquisition video sequence.

Results:
For lids with distortions, 10 of 10 lids with distortion showed a statistically significant difference (P < 0.0001–0.0136) in the mean individual gland area (MIGA, % change: 16.2%–114.1%) and/or the ratio of MIGA to TMF (% change: 19.8%–108.5%) during its video sequence. For the altered vertical gaze direction, 7 of 9 lids individually showed a statistically significantly increased MIGA/TMF with the globe in primary gaze compared with upgaze (P = 0.001–0.0156), whereas collectively as a group, all 9 lids showed a significant increase in MIGA/TMF (P < 0.0001, % change: 1.1%–38.9%). Two lids from the same patient were evaluated for both types of distortion.

Conclusions:
IR-VM of lower lids revealed statistically significant unreliability of measuring the MG tissue area from inadvertent lid distortion or an altered vertical globe gaze direction during meibography. These data suggest that, lacking context seen when using the video, still-shot nonvideo infrared meibography images of the lower lid, and related data, may be specious and should be used with caution in drawing conclusions of the change in the MG area over time, to avoid misguided clinical decision making.
Incidence and Risk Factors of Dry Eye in a Spanish Adult Population: 11-Year Follow-Up From the Salnés Eye Study
Authors: Millán Alejandro , Viso Eloy , Gude Francisco , Parafita-Fernández Alberto , Moraña Noelia , Rodríguez-Ares María Teresa 
Published: August 2018

Purpose:
To estimate the incidence of dry eye (DE) and to evaluate risk factors in an adult cohort in Spain.

Methods:
The Salnés Eye Study (SES) was a cross-sectional population-based study of 654 subjects conducted from 2005 to 2006. After 11 years, 264 individuals (65.8% response rate) participated in SES 2. The incidence cohort consisted of 209 subjects not diagnosed with DE in SES 1 [mean age (SD) 67.6 years (±10.1), range: 51–92, women 69.4%]. DE was defined as the simultaneous presence of symptoms and at least 1 sign. A Schirmer test score ≤5 mm, tear film breakup time ≤10 seconds, rose bengal staining ≥3, and fluorescein staining ≥1 were considered indicative of signs. Poisson regression models were performed to evaluate risk factors.

Results:
The 11-year incidence of DE was 25.4% (95% confidence interval, 19.5–31.3) and that of symptoms was 31.6% (confidence interval, 25.4–37.8). DE incidence was significantly associated with age (P < 0.05). After adjusting for age, secondary or university studies were protective factors for DE; taking anxiolytics or antidepressants and angiotensin-converting enzyme inhibitors increased the risk of symptoms; a history of hypertension, chronic obstructive pulmonary disease, or autoimmune diseases increased the risk of signs.

Conclusions:
The annual incidence of DE, symptoms, and signs, was found to be 2.3 per 100 person-years. The incidence of symptoms was higher than that reported in similar studies. This study suggests that some factors may increase the risk of symptoms, whereas other factors may increase the risk of signs.