bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Apert Hand Syndrome: Strategies for Achieving a Five-Digit Hand
Authors: Raposo-Amaral Cassio Eduardo , Denadai Rafael , Furlan Pedro , Raposo-Amaral Cesar Augusto 
Published: July 2018

Background:
Apert hand reconstruction requires complex surgical planning. The purpose of this study was to describe the authors’ 8-year surgical experience with Apert syndrome hand reconstruction, and provide specific surgical strategies for achieving a five-digit hand in Upton type I and II hands.

Methods:
A retrospective analysis of consecutive Apert syndrome patients who underwent web-space releases between 2007 and 2015 was performed. Demographic, surgical, and outcome data were verified through medical records, clinical photographs, radiographic images, and patient interviews.

Results:
A total of 41 Apert syndrome patients [23 boys (56.1 percent) and 18 girls (43.9 percent)] have been treated at our hospital since 2007. A five-digit hand was achieved in all patients (100 percent) with Upton type I and II hands, and in eight patients (72.7 percent) with Upton type III hands. A four-digit hand was obtained in three of 11 patients (27.3 percent) with Upton type III hands. Four of 20 patients (25 percent) with Upton type I hands, three of 10 patients (30 percent) with Upton type II hands, and six of 11 patients (54.5 percent) with Upton type III hands required subsequent revision for aesthetic reasons.

Conclusions:
Upton type III hands have demonstrated higher revision rates than type I and II hands, regardless of whether a four- or five-digit hand is obtained. Treatment strategies for Apert syndrome hands based on hand type are offered to guide four–web-space release in all patients with Upton type I and II hands.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
How to Identify Organizational High-Alert Medications
Authors: Schepel Lotta , Lehtonen Lasse , Airaksinen Marja , Lapatto-Reiniluoto Outi 
Published: July 2018

Objectives
High-alert medications may cause significant patient harm when used in error. Hospital-specific safety data should be used to customize high-alert medication lists to fit the local context. The aim of this study was to identify organizational high-alert medications by evaluating university hospital’s data on adverse drug reaction (ADR) and medication error (ME).

Methods
The Anatomical Therapeutic Chemical (ATC) codes and top active substances in ADR (n = 401) and ME (n = 11,668) reports of Helsinki University Hospital from 2015–2016 were analyzed and compared with hospitals’ drug consumption and the Institute for Safe Medication Practices’ (ISMP) list of high-alert medications.

Results
The top ATC groups and active substances in ADR and ME reports were not similar. The most numerous ATC groups were L, antineoplastic and immunomodulating agents (30%) in ADRs and N, nervous system (26%) in MEs. According to ADR and ME reports, several high-alert medications from Institute for Safe Medication Practices’ lists, such as antineoplastic agents, antithrombotics, opioids, and insulins, should be considered high-alert medications also in Helsinki University Hospital. Although no ADR reports of amphotericin B existed, it had the highest number of MEs causing severe/moderate harm or unexpected reactions relative to its consumption.

Conclusions
To identify organizational high-alert medications, both drug safety information and medication safety information should be used. Adverse drug reaction and ME data are needed to recognize high-alert medications, but these should also be combined with a literature search and local expert opinions.
Understanding the Types and Effects of Clinical Interruptions and Distractions Recorded in a Multihospital Patient Safety Reporting System
Authors: Kellogg Kathryn M. , Puthumana Joseph S. , Fong Allan , Adams Katharine T. , Ratwani Raj M. 
Published: July 2018

Objectives
Interruptions and distractions have been shown to be a frequent occurrence across health care and have been linked to negative outcomes that create potential patient safety risks. Although observational studies have catalogued interruption frequency and source, the impact of an interruption is difficult to observe. We analyzed patient safety event (PSE) reports related to interruptions to identify clinical processes reported to be frequently interrupted and the reported outcomes of those interruptions.

Methods
We retrospectively analyzed PSE reports entered by frontline staff between January 2013 and January 2016. Of 79,428 total PSEs entered, 220 reports were identified using keyword matching and subsequent manual review as being directly related to a clinical interruption. Categories were developed to identify the cause of the interruption, task being interrupted, and the result of the interruption. Percentages were calculated.

Results
Nurses were most often reported to be interrupted in the PSEs (50%). General distractions (43.2%) or high workload (18.6%) were most commonly noted to interrupt the individual’s work. The interrupted activity was most often a medication task (50.9%), frequently in the administration phase (24.1%), or the ordering phase (16.8%). The most common medication error was wrong dose administration (14.4% of total medication-related errors). Laboratory processes were reported to be disturbed by interruptions in 22.7% of reports, and this frequently resulted in mislabeling of specimens (75% of laboratory-related errors).

Conclusions
This retrospective review of PSE reports involving interruptions of clinical activities reveals that interruptions affect a variety of aspects of patient care and can help to guide future work on interruption management.
Setting Global Research Priorities in Pediatric and Adolescent HIV Using the Child Health and Nutrition Research Initiative (CHNRI) Methodology
Authors: Irvine Cadi , Armstrong Alice , Nagata Jason M. , Rollins Nigel , Schaaf Diddie , Doherty Meg , Penazzato Martina , Vicari Marissa 
Published: July 2018

Background:
WHO and the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) of the International AIDS Society (IAS) led a collaborative process to set global prioritized research agendas, aiming to focusing future research, funding, and stakeholder's efforts. This study describes the methodology used to establish the research agendas.

Methods:
The Child Health and Nutrition Research Initiative methodology was adapted in parallel exercises on pediatric and adolescent HIV. After definition of scope by an expert working group, priority questions were collected from stakeholders through an online survey. Submitted questions were coded, analyzed, and collated. The same respondents were asked to score the collated lists through a second online survey. The top 10 ranked questions per thematic area (testing, treatment, and service delivery) were reviewed and priority themes developed with consideration of existing policy, systematic reviews, and planned, ongoing, and recently published research.

Results:
A total of 375 respondents submitted 1735 priority research questions. The majority of respondents were from Africa; 55% self-identified as researchers. The final collated lists included 51 and 61 research questions for pediatric and adolescent HIV, respectively. The response rate for the second survey was 48%. The final research agendas include 5 priority research themes per area, discussed in 2 separate publications.

Conclusions:
To date, this is the largest example of the Child Health and Nutrition Research Initiative method in pediatric and adolescent HIV in terms of stakeholders reached, and the first to incorporate top thematic areas based on current evidence. Its impact on improving outcomes for these populations will require strong political and financial commitment.
Propelling the Pediatric HIV Therapeutic Agenda With Science, Innovation, and Collaboration
Authors: Abrams Elaine J. , Ananworanich Jintanat , Archary Moherndran , Ngongondo McNeil , Brouwers Pim 
Published: July 2018

Background:
A number of well-described obstacles to the pediatric therapeutic agenda have resulted in substantial delays in the introduction of new medications, formulations, strategies, and approaches to treat infants, children, and adolescents living with HIV.

Setting:
Global landscape.

Methods:
The authors will provide a summary of current and emerging initiatives to accelerate the pediatric therapeutic agenda including illustrative case studies of innovations and scientific discovery in diagnosis and treatment of very young children with HIV infection.

Results:
The challenges posed by rapid physiologic and developmental changes that characterize the trajectory of childhood as well as the complex regulatory and fiscal milieu of HIV therapeutics have hampered pediatric HIV therapeutic research. Recent efforts to accelerate this agenda include prioritizing agents and formulations, defining dosing by weight bands, applying innovative study designs, synergizing work across research networks to achieve common goals, and the establishment of a global prioritized research agenda. A case study of initiatives to diagnose and effectively treat newborns and infants will illustrate the critical role of basic science research and novel approaches to study design and implementation that are informing global efforts to end AIDS.

Conclusions:
A pediatric therapeutic agenda informed by basic science and achieved through innovation and global cooperation is essential to achieve an AIDS-free generation.
Optimizing Clinical Trial Design to Maximize Evidence Generation in Pediatric HIV
Authors: Ford Deborah , Turner Rebecca , Turkova Anna , Penazzato Martina , Musiime Victor , Bwakura-Dangarembizi Mutsa , Violari Avy , Chabala Chishala , Puthanakit Thanyawee , Sudjaritruk Tavitiya , Cressey Tim R. , Lallemant Marc , Gibb Diana M. 
Published: July 2018

Abstract:
For HIV-infected children, formulation development, pharmacokinetic (PK) data, and evaluation of early toxicity are critical for licensing new antiretroviral drugs; direct evidence of efficacy in children may not be needed if acceptable safety and PK parameters are demonstrated in children. However, it is important to address questions where adult trial data cannot be extrapolated to children. In this fast-moving area, interventions need to be tailored to resource-limited settings where most HIV-infected children live and take account of decreasing numbers of younger HIV-infected children after successful prevention of mother-to-child HIV transmission. Innovative randomized controlled trial (RCT) designs enable several questions relevant to children's treatment and care to be answered within the same study. We reflect on key considerations, and, with examples, discuss the relative merits of different RCT designs for addressing multiple scientific questions including parallel multi-arm RCTs, factorial RCTs, and cross-over RCTs. We discuss inclusion of several populations (eg, untreated and pretreated children; children and adults) in “basket” trials; incorporation of secondary randomizations after enrollment and use of nested substudies (particularly PK and formulation acceptability) within large RCTs. We review the literature on trial designs across other disease areas in pediatrics and rare diseases and discuss their relevance for addressing questions relevant to HIV-infected children; we provide an example of a Bayesian trial design in prevention of mother-to-child HIV transmission and consider this approach for future pediatric trials. Finally, we discuss the relevance of these approaches to other areas, in particular, childhood tuberculosis and hepatitis.
18F-FDG PET/CT in a Patient With Pregnancy and Lactation-Associated Osteoporosis
Authors: Chen Jinchuan , Wang Qian , Qiu Liheng 
Published: July 2018

Abstract
A 33-year-old woman in the 6th month postpartum and breast-feeding period suffered from acute thoracolumbar pain for 1 month. She presented with slightly decreased serum calcium level. Other laboratory assessments were unremarkable. Considering the worsening symptom and her strong demand to exclude potential malignancy, 18F-FDG PET/CT was performed. Multiple FDG-avid foci in the thoracic and lumbar vertebra were detected on FDG PET, corresponding to vertebral compression fractures on CT, and diffuse FDG uptake was seen within bilateral breast, and dual-X ray absorptiometry showed markedly decreased bone mineral density, all of which supported the diagnosis of pregnancy and lactation-associated osteoporosis.
To Use or Not to Use 131I in Thyroid Cancer
Authors: Metter Darlene , Phillips William T. , Walker Ronald C. , Blumhardt Ralph 
Published: July 2018

Purpose
The purpose of the following commentary is to discuss recent controversies in the use of radioactive iodine for differentiated thyroid cancer (DTC).

Methods
R. M. Tuttle (Thyroid 2010; 20:257–263), at Memorial Sloan Kettering Cancer Center, has enumerated the well-accepted goals of radioactive iodine therapy (RAIT) in DTC: (1) ablate residual thyroid to facilitate future surveillance, (2) “adjuvant therapy” for residual radioactive iodine–avid disease, and (3) a post-RAIT scan may reveal unknown local and/or distant metastases. Using these goals as a guide, the authors have critically reviewed a recent movement to decrease the use of RAIT in DTC that is being advocated by some investigators.

Results
As a result, a recent article has highlighted this new treatment philosophy. A 2017 publication in the Journal of Clinical Oncology (Molenaar et al, 2017 0:JCO.2017.75.0232) recommends that RAIT not be used in low- or intermediate-risk DTC. In this article, the authors claim that the RAIT risks in DTC, particularly leukemia, outweigh its potential benefits. This change, if adopted, in our opinion will have profound deleterious consequences on patient outcomes. We also have identified a major problem with the article of Molenaar et al. The authors use the American Thyroid Association's criteria for staging thyroid cancer. In our opinion, this method of staging is severely flawed. We also quantitatively compare the article's alleged risk of RAIT-induced leukemia with the benefits of RAIT for DTC.

Conclusions
In summary, this matter must be debated before eliminating RAIT in low- or intermediate-risk DTC. If RAIT is eliminated for these patients, many such patients will no longer benefit from the RAIT goals listed by R. M. Tuttle, including the critical advantage of potentially improved overall and event-free survival.
Pineal Anaplastic Ependymoma With Multifocal Intradural Extramedullary Metastases on MRI and 18FDG-PET
Authors: Ben Bouallègue Fayçal , Vauchot Fabien , Menjot de Champfleur Nicolas , Mariano-Goulart Denis 
Published: July 2018

Abstract
A 49-year-old woman presented to the emergency room with subacute paraparesis associated with bilateral cervicobrachial neuralgia. Brain and spine MRI revealed a heterogeneous hypervascular pineal tumor and a multifocal thoracolumbar intradural-extramedullary infiltrate with signs of medullary compression. C7-T2 laminectomy was performed on the same day for medullary decompression, allowing for partial lesion excision. Histological examination was in favor of a poorly differentiated anaplastic ependymoma. Two weeks later, FDG-PET showed markedly increased uptake in the pineal mass and significant hypermetabolism of the spinal metastases.
FET PET in Primary Central Nervous System Vasculitis
Authors: Burghaus Lothar , Kabbasch Christoph , Deckert Martina , Ruge Maximilian I. , Fink Gereon R. , Langen Karl-Josef , Galldiks Norbert 
Published: July 2018

Abstract
Primary central nervous system vasculitis is confined to the brain and spinal cord. While serological markers of inflammation are usually normal, conventional angiography may confirm the diagnosis. The diagnostic method of choice is central nervous system biopsy. A 57-year-old man suffered from a first generalized epileptic seizure. MRI revealed a contrast-enhancing lesion, and O-(2-[18F]fluoroethyl)-l-tyrosine amino acid PET displayed increased metabolic activity, both findings highly suggestive of a malignant glioma. Surprisingly, histology obtained following stereotactic biopsy revealed small-vessel vasculitis.
Successful Intrathecal Baclofen Therapy for Intractable Paroxysmal Sympathetic Hyperactivity in Patient with Pontine Hemorrhage: A case report
Authors: Kim Hyeon Su , Kim Na Young , Kim Yong Wook 
Published: July 2018

Abstract
Paroxysmal sympathetic hyperactivity (PSH) is characterized by increased activity of the sympathetic nervous system. Although several treatments have been proposed for PSH, their efficacies are uncertain. We report a case of a patient with intractable PSH after pontine hemorrhage who was treated with intrathecal baclofen (ITB). A 61-year-old man was diagnosed with pontine hemorrhage expanding to the bilateral midbrain. Beginning 2 weeks after onset, he developed paroxysmal hyperthermia, tachycardia, tachypnea, hypertension, and generalized dystonic movements. Several medications were administered to the patient, including fentanyl patch, dantrolene, gabapentin, and β blockers. Nevertheless, PSH episodes continued to occur more than twice per day. Seven months after onset, we performed a trial of ITB injection, which led to reduced severity and frequency of PSH. Therefore, the ITB therapy was implanted. Continuous ITB was initiated at a rate of 100 μg/d, which was gradually increased up to 200 μg/d. Oral medications were tapered off. No PSH episode occurred for 4 weeks. Our findings suggest that ITB therapy may be used to manage intractable PSH. Intrathecal baclofen may inhibit postsynaptic activity and suppress sympathetic activity via the stimulation of γ-aminobutyric acid B receptors the brain.
Development and Validation of an Instrument Measuring Self-Care in Persons With a Fecal Ostomy
Authors: Collado-Boira Eladio J. , Machancoses Francisco H. , Temprado Maria Dolores 
Published: July 2018

PURPOSE:
The purpose of this study was to describe development of the Specific Self-Care for Ostomized Patients Questionnaire (CAESPO) instrument and evaluate its construct validity, internal reliability, and test-retest reliability (temporal stability).

DESIGN:
Prospective evaluation of psychometric properties of the instrument.

SUBJECTS AND SETTING:
The study sample comprised 125 persons (n = 89, 71.2% men) with a temporary (n = 42, 33.6%) and permanent (n = 83, 66.4%) colostomy (n = 102, 81.6%) and ileostomy (n = 23, 18.4%). Their mean age was 66.72 years; all had undergone ostomy surgery at least 3 months prior to study participation. Participants were drawn from 4 acute care facilities in the province of Castellon, Spain.

INSTRUMENT:
The CAESPO Questionnaire is completed by a nurse or health care provider. It comprises 3 sections: the first queries sociodemographic data, the second queries pertinent clinical data, and the third contains 58 scored items with 4 ordinal responses. Possible cumulative scores ranged from 58 to 232 points; scores are reported based on a derived percentage score that varies from 0 to 100, where a score of 0 indicates lower self-care and 100 indicates a high level of self-care.

METHODS:
Data were collected at baseline and retesting was completed 6 months later. Internal consistency of the CAESPO was evaluated using the Cronbach α coefficient; temporal stability (test-retest reliability) was evaluated using the test-retest procedure; confirmatory factor analysis based on conceptually hypothesized factor structure was performed to evaluate construct validity.

RESULTS:
Initial assessment of the construct validity of the CAESPO using confirmatory factory analysis revealed a poor fit, resulting in removal of multiple items from each of the subscales owing to low-factor loading values. The final model comprised 58 scored items; it was found to have a good fit based on standard indices (χ2= 43.132, P < .001; root mean square error of approximation = 0.155 [0.107-0.204]; Bentler-Bonett normed fit index = 0.957; comparative fit index = 0.967; incremental fit index = 0.968), indicating adequate construct validity. The internal consistency of the CAESPO total score was acceptable at α = 0.889. Test-retest reliability (temporal stability) was deemed excellent (α = 0.987).

CONCLUSIONS:
Psychometric tests indicate that the CAESPO is a valid and reliable instrument for measuring self-care in persons living with a fecal ostomy.
Using Alternative Light Source Technology to Enhance Visual Inspection of the Skin
Authors: Owens Lisa , Warfield Tonnie , MacDonald Ryan , Krenzischek Erudina 
Published: July 2018

BACKGROUND:
The identification of deep tissue pressure injury (DTPI) in the early stages of evolution presents a challenge, as skin compromise is only visually apparent when evidence of damage reaches its outer layers.

CASE DESCRIPTION:
We describe use of an alternative light source (ALS) to enhance visual skin assessment in 3 cases. Case 1 was a 47-year-old African American man with a hyperpigmented inner buttocks and a mixture of partial- and shallow full-thickness skin loss from incontinence-associated dermatitis and friction. Case 2 was a 62-year-old African American woman with a gluteal cleft DTPI. Case 3 was a 57-year-old African American woman with a stage 3 pressure injury of the right buttock.

CONCLUSION:
The ALS enabled visualization of skin nuances not visible to the unaided eye. Based on this experience, we conclude that use of an ALS provided additional visual details when compared to traditional visual inspection. We found that as the ALS interplays with skin layers, penetrating and absorbing at differing depths, compromised skin appeared darker and more distinct when compared to adjacent, intact skin. Additional research is needed to determine whether the ALS enables earlier pressure injury detection, timelier and more effective intervention, decreased morbidity, and cost savings.