bluuebunny/crossref_metadata_2025_split huggingface dataset:
Processed Electroencephalogram Monitoring and Postoperative Delirium
Authors: MacKenzie Kristen K. , Britt-Spells Angelitta M. , Sands Laura P. , Leung Jacqueline M. 
Published: June 2018

Abstract

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Postoperative delirium complicates approximately 15 to 20% of major operations in patients at least 65 yr old and is associated with adverse outcomes and increased resource utilization. Furthermore, patients with postoperative delirium might also be at risk of developing long-term postoperative cognitive dysfunction. One potentially modifiable variable is use of intraoperative processed electroencephalogram to guide anesthesia. This systematic review and meta-analysis examines the relationship between processed electroencephalogram monitoring and postoperative delirium and cognitive dysfunction.

Methods
A systematic search for randomized controlled trials was conducted using Ovid MEDLINE, PubMed, EMBASE, Cochrane Library, and Google search using the keywords processed electroencephalogram, Bispectral Index, postoperative delirium, postoperative cognitive dysfunction. Screening and data extraction were conducted by two independent reviewers, and risk of bias was assessed. Postoperative delirium combined-effect estimates calculated with a fixed-effects model were expressed as odds ratios with 95% CIs.

Results
Thirteen of 369 search results met inclusion criteria. Postoperative cognitive dysfunction data were excluded in meta-analysis because of heterogeneity of outcome measurements; results were discussed descriptively. Five studies were included in the quantitative postoperative delirium analysis, with data pooled from 2,654 patients. The risk of bias was low in three studies and unclear for the other two. The use of processed electroencephalogram-guided anesthesia was associated with a 38% reduction in odds for developing postoperative delirium (odds ratio = 0.62; P < 0.001; 95% CI, 0.51 to 0.76).

Conclusions
Processed electroencephalogram-guided anesthesia was associated with a decrease in postoperative delirium. The mechanism explaining this association, however, is yet to be determined. The data are insufficient to assess the relationship between processed electroencephalogram monitoring and postoperative cognitive dysfunction.
Behavioral Measures of Listening Effort in School-Age Children: Examining the Effects of Signal-to-Noise Ratio, Hearing Loss, and Amplification
Authors: McGarrigle Ronan , Gustafson Samantha J. , Hornsby Benjamin W. Y. , Bess Fred H. 
Published: June 2018

Objectives:
Increased listening effort in school-age children with hearing loss (CHL) could compromise learning and academic achievement. Identifying a sensitive behavioral measure of listening effort for this group could have both clinical and research value. This study examined the effects of signal-to-noise ratio (SNR), hearing loss, and personal amplification on 2 commonly used behavioral measures of listening effort: dual-task visual response times (visual RTs) and verbal response times (verbal RTs).

Design:
A total of 82 children (aged 6–13 years) took part in this study; 37 children with normal hearing (CNH) and 45 CHL. All children performed a dual-task paradigm from which both measures of listening effort (dual-task visual RT and verbal RT) were derived. The primary task was word recognition in multi-talker babble in three individually selected SNR conditions: Easy, Moderate, and Hard. The secondary task was a visual monitoring task. Listening effort during the dual-task was quantified as the change in secondary task RT from baseline (single-task visual RT) to the dual-task condition. Listening effort based on verbal RT was quantified as the time elapsed from the onset of the auditory stimulus to the onset of the verbal response when performing the primary (word recognition) task in isolation. CHL completed the task aided and/or unaided to examine the effect of amplification on listening effort.

Results:
Verbal RTs were generally slower in the more challenging SNR conditions. However, there was no effect of SNR on dual-task visual RT. Overall, verbal RTs were significantly slower in CHL versus CNH. No group difference in dual-task visual RTs was found between CNH and CHL. No effect of amplification was found on either dual-task visual RTs or verbal RTs.

Conclusions:
This study compared dual-task visual RT and verbal RT measures of listening effort in the child population. Overall, verbal RTs appear more sensitive than dual-task visual RTs to the negative effects of SNR and hearing loss. The current findings extend the literature on listening effort in the pediatric population by demonstrating that, even for speech that is accurately recognized, school-age CHL show a greater processing speed decrement than their normal-hearing counterparts, a decrement that could have a negative impact on learning and academic achievement in the classroom.
A Modified Posterior C1/C2 Fusion Technique for the Management of Traumatic Odontoid Type II Fractures by Using Intraoperative Spinal Navigation: Midterm Results
Authors: Ishak Basem , Schneider Till , Gimmy Valerie , Unterberg Andreas W. , Kiening Karl L. 
Published: June 2018

Objectives:
To assess midterm safety and efficacy of a modified Goel–Harms technique for the treatment of odontoid instabilities.

Design:
Longitudinal prospective cohort study.

Setting:
Urban Level 1 Trauma Center in Southwest Germany.

Patients/Participants:
Orthopaedic and neurosurgical trauma patients older than 18 years admitted for ≤24 hours.

Main Outcome Measurements:
The outcome was evaluated with respect to neurological outcome, radiological outcome and surgical complications. For the functional assessment, the EQ-5D questionnaire was used. Furthermore, the Neck Disability Index and visual analog scale for neck pain were determined. A median follow-up of 39 months (range: 6–97 months) was given.

Results:
Of the total sample (n = 56), 26 patients with an acute traumatic odontoid fracture type II underwent posterior atlantoaxial instrumentation using spinal navigation. Neck pain evaluated with visual analog scale and Neck Disability Index showed a significant decrease at final follow-up compared to preoperative values (P < 0.05). According to the EQ-5D, the valuation of quality of life after C1/C2 fusion showed an excellent outcome with complete recovery in most cases (0.7–1).

Conclusions:
Our results demonstrate satisfactory and maintained midterm clinical and radiological results after a median follow-up of 39 months. With the use of intraoperative spinal navigation, we demonstrate a modified C1/C2 posterior fusion technique, rendering accuracy, feasibility, and overall safety.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Hypertensive Disorders of Pregnancy and Genital Anomalies in Boys: A Danish Nationwide Cohort Study
Authors: Arendt Linn Håkonsen , Henriksen Tine Brink , Lindhard Morten Søndergaard , Parner Erik T , Olsen Jørn , Ramlau-Hansen Cecilia Høst 
Published: June 2018

Background:
Although congenital abnormalities in the male reproductive tract are common, their causes remain poorly understood. We studied associations between hypertensive disorders of pregnancy (pregestational hypertension, gestational hypertension, and preeclampsia) and the genital anomalies, cryptorchidism (undescended testes), and hypospadias (ventrally displaced urethral meatus).

Methods:
We established a population of 1,073,026 Danish boys born alive between 1 January 1978 and 31 December 2012. By means of Cox regression analyses, we estimated hazard ratios with 95% confidence intervals for cryptorchidism and hypospadias according to type and severity of hypertensive disorder. Further, we used restricted cubic spline analyses to investigate the association between gestational age at onset of severe and moderate preeclampsia and the two genital anomalies.

Results:
We found associations between pregestational hypertension and cryptorchidism (HR: 1.3; 95% CI = 1.1, 1.6) and hypospadias (HR: 1.7; 95% CI = 1.3, 2.3), whereas gestational hypertension was only associated with cryptorchidism (HR: 1.2; 95% CI = 1.1, 1.4). Boys of mothers with preeclampsia had the highest occurrence of cryptorchidism and hypospadias, increasing with preeclampsia severity. Women with HELLP syndrome faced the highest risk of having a child with both cryptorchidism (HR: 2.1; 95% CI = 1.4, 3.2) and hypospadias (HR: 3.9; 95% CI = 2.5, 6.1). Further, the occurrence increased with early onset of preeclampsia diagnosis.

Conclusions:
These findings support the hypotheses that preeclampsia and genital anomalies share common etiologic factors and that placental dysfunction and androgen deficiency in early pregnancy are important in the etiology of male genital anomalies.
Cincinnati Protocol for Preoperative Screening and Donor Selection for Ocular Surface Stem Cell Transplantation
Authors: Cheung Albert Y. , Sarnicola Enrica , Kurji Khaliq H. , Govil Amit , Mogilishetty Gautham , Eslani Medi , Wright Elizabeth , Brailey Paul , Holland Edward J. 
Published: June 2018

Purpose:
To describe our process for preoperative screening and donor selection for ocular surface stem cell transplantation (OSST).

Methods:
A 7-year retrospective chart review was performed on limbal stem cell deficiency patients. The inclusion criterion was all patients who underwent an OSST procedure. The exclusion criterion was eyes with unilateral disease in which an autograft was performed. Data for human leukocyte antigen (HLA) typing, virtual crossmatching, donor-specific antibody, and panel reactive antibody level were obtained.

Results:
Of the included 142 eyes (104 patients), 19 patients had no recorded living donor availability data, and HLA typing was not performed on 16 patients. A total of 94 donors (mean 1.4 donors/patient, range 1–6) were tested for 67 recipients. For 2 patients with graft-versus-host disease, no further HLA typing was needed, as the donors were known HLA-identical donors. For 47 patients, only 1 donor was tested, whereas multiple donors underwent HLA typing for 20 patients. There were 73 ABO (blood group)-compatible matches for the 61 tested recipients, and only 1 recipient did not have any ABO-compatible donor. For the virtual crossmatch, there were 5 patients who did not have a compatible donor (positive virtual crossmatch). The best available donor match was a sibling for 41 recipients (65%), a parent for 19 recipients (30%), and an offspring for 3 recipients (5%).

Conclusions:
Our protocol for OSST preoperative screening and donor selection minimizes the antigenic burden for transplanted tissue by selecting the best available donor match.
Predictive Value of Corneal Donor Demographics on Endothelial Cell Density
Authors: McGlumphy Elyse J. , Margo Jordan A. , Haidara Moulaye , Brown Clayton H. , Hoover Caroline K. , Munir Wuqaas M. 
Published: June 2018

Purpose:
Corneal endothelial cell density (ECD) is an important measure for determining suitability for transplantation. Although age has been correlated with ECD, the impact of sex and ethnicity is unclear.

Methods:
Corneal donor information from SightLife Eye Bank was collected between 2012 and 2016. Tests of association were adjusted for covariates using linear regression including age, race, and sex. “Unsuitable for transplantation” was a label assigned to specimens with extensive cell dropout, ECD <2000 cells/mm2, and poor cell morphology. Repeated-measures analysis was used to account for the within-individual correlation between left and right eyes.

Results:
A total of 39,679 donor corneas were analyzed, with a mean ECD 2743.5 cells/mm2 and mean age of 58. Simple linear regression demonstrated an association between ECD and age (P < 0.001). Multiple regression showed no association between sex and ECD. Compared with whites, African American, and Asian ethnicities were predictors of increased ECD (mean +45.7 cells/mm2 (P < 0.001) and +90.3 cells/mm2 (P < 0.001), respectively); Hispanic ethnicity was a predictor of decreased ECD [mean −36.9 cells/mm2 (P = 0.002)]. A total of 233 (0.59%) corneas were unsuitable for transplantation, which was associated with age (P < 0.001) but not sex or ethnicity.

Conclusions:
Analysis of a large sample of donor corneas continues to show age but not sex as a predictor of decreased ECD. African American and Asian ethnicities tend to have slightly higher ECD than that of white donors, whereas Hispanic donors have slightly lower ECD; however, ethnicity was not a predictor of suitability for transplantation. Clinical significance of these findings is yet to be determined.
Transesophageal Echocardiography–Guided Epicardial Left Ventricular Lead Placement by Video-Assisted Thoracoscopic Surgery in Nonresponders to Biventricular Pacing and Previous Chest Surgery
Authors: Schroeder Carsten , Chung Jane M. , Mackall Judith A. , Cakulev Ivan T. , Patel Aaron , Patel Sunny J. , Hoit Brian D. , Sahadevan Jayakumar 
Published: June 2018

Objective The aim of the study was to study the feasibility, safety, and efficacy of transesophageal echocardiography–guided intraoperative left ventricular lead placement via a video-assisted thoracoscopic surgery approach in patients with failed conventional biventricular pacing. Methods Twelve patients who could not have the left ventricular lead placed conventionally underwent epicardial left ventricular lead placement by video-assisted thoracoscopic surgery. Eight patients had previous chest surgery (66%). Operative positioning was a modified far lateral supine exposure with 30-degree bed tilt, allowing for groin and sternal access. To determine the optimal left ventricular location for lead placement, the left ventricular surface was divided arbitrarily into nine segments. These segments were transpericardially paced using a handheld malleable pacing probe identifying the optimal site verified by transesophageal echocardiography. The pacing leads were screwed into position via a limited pericardiotomy. Results The video-assisted thoracoscopic surgery approach was successful in all patients. Biventricular pacing was achieved in all patients and all reported symptomatic benefit with reduction in New York Heart Association class from III to I–II ( P = 0.016). Baseline ejection fraction was 23 ± 3%; within 1-year follow-up, the ejection fraction increased to 32 ± 10% ( P = 0.05). The mean follow-up was 566 days. The median length of hospital stay was 7 days with chest tube removal between postoperative days 2 and 5. Conclusions In patients who are nonresponders to conventional biventricular pacing, intraoperative left ventricular lead placement using anatomical and functional characteristics via a video-assisted thoracoscopic surgery approach is effective in improving heart failure symptoms. This optimized left ventricular lead placement is feasible and safe. Previous chest surgery is no longer an exclusion criterion for a video-assisted thoracoscopic surgery approach.
Reducing Inappropriate Antibiotics for Urinary Tract Infections in Long-Term Care
Authors: Cooper Denise , McFarland Marilyn , Petrilli Francesca , Shells Cherrell 
Published: June 2018

Background:
Nursing home providers face challenges in urinary tract infection assessment and treatment, often prescribing unnecessary antibiotics for asymptomatic bacteriuria, a practice that can result in adverse drug reactions, drug resistance, and an increase in antibiotic-associated diarrhea.

Purpose:
The purpose of this project was to replicate the Cooper Urinary Tract Infection Program in another facility and measure its effectiveness.

Methods:
Using a pre-post design, this project was implemented at a 120-bed, long-term care and rehabilitation facility located in the Midwest United States.

Interventions:
This project used the multifaceted Cooper Urinary Tract Infection Program that includes the Cooper tool algorithm, didactic education for providers, and change champions.

Results:
The results were significant improvements in nurse knowledge and reduced rates of urinary tract infections, inappropriate antibiotic treatments, and urinalyses.

Conclusions:
These results add to the evidence for implementing the Cooper Urinary Tract Infection Program in long-term care facilities for effective reduction of inappropriate antibiotic usage for urinary tract infection.
A Capstone Simulation for Leadership Development
Authors: Strickland Haley P. , Welch Teresa D. 
Published: June 2018

Background
New graduate nurses are expected to function autonomously and be practice-ready upon graduation. However, transitioning from the role of student to one of leadership in the professional nurse's role is a complex experience.

Problem
Concerns for safety and liability in an increasingly complex health care environment may limit the availability of relevant clinical experiences for nursing students to develop leadership skills.

Approach
The Mock Hospital, a comprehensive capstone simulation, was designed to immerse senior nursing students into the leadership role of the professional nurse.

Outcome
Positive feedback obtained from students through reflection and discussion supports the implementation of a capstone simulation.

Conclusions
Supporting new graduate nurses' transition into practice, while preparing the next generation of nurses to successfully meet the challenges of a complex health care environment, will require innovative and transformative educational experiences.
RBC Exposure in Pediatric Extracorporeal Membrane Oxygenation: Epidemiology and Factors Associated With Large Blood Transfusion Volume*
Authors: O’Halloran Conor P. , Alexander Peta M. A. , Andren Kristofer G. , Mecklosky Jessica , Salvin Joshua W. , Larsen Stephanie , Zalieckas Jill , Fynn-Thompson Francis , Thiagarajan Ravi R. 
Published: June 2018

Objectives:To quantify and identify factors associated with large RBC exposure in children supported with extracorporeal membrane oxygenation.Design:Retrospective cohort study.Setting:Single tertiary care children’s hospital.Patients:One-hundred twenty-two children supported with extracorporeal membrane oxygenation for greater than 12 hours during January 1, 2015, to December 31, 2016.Interventions:None.Measurements and Main Results:Clinical, laboratory, and survival data were obtained from medical records. Only data from patients’ first extracorporeal membrane oxygenation run were used. The primary outcome was RBC volume exposure during extracorporeal membrane oxygenation (mL/kg/d). Patients with RBC exposure volume greater than 75th percentile were categorized as “high RBC use” patients. A “bleeding day” was identified if mediastinum or cannula sites were explored and/or Factor VIIa administration, gastrointestinal, pulmonary, or intracranial hemorrhages occurred. Median age was 0.3 years (interquartile range, 0–3 yr). Congenital heart disease (n= 56; 46%) was the most common diagnosis. Median RBC volume transfused during extracorporeal membrane oxygenation was 39 mL/kg/d (interquartile range, 21–66 mL/kg/d). High RBC use patients were more likely be supported by venoarterial extracorporeal membrane oxygenation (100 vs 76%;p= 0.006), have congenital heart disease (68 vs 39%;p= 0.02), and experience bleeding (33 vs 11% d;p< 0.001). High RBC use patients showed a trend toward higher in-hospital mortality (58 vs 37%;p= 0.07). In the multivariable analysis, younger age (–9% per year; 95% CI, –10% to –7%;p< 0.001), more blood draws per day (+8%; 95% CI, 6–11%;p< 0.001), and higher proportion of bleeding days (+22% per 10% increase; 95% CI, 16–29%;p< 0.001) were associated with larger RBC exposure (modelR2= 0.66).Conclusions:Bleeding during extracorporeal membrane oxygenation, frequent laboratory draws, and younger age were associated with increased RBC exposure during extracorporeal membrane oxygenation. Higher transfusion volume was associated with increased mortality.
Ability to Assent in Pediatric Critical Care Research: A Prospective Environmental Scan of Two Canadian PICUs
Authors: O’Hearn Katharine J. , Martin Dori-Ann , Dagenais Maryse , Menon Kusum 
Published: June 2018

Objectives:
To determine the number of patients considered not appropriate to approach for assent within the first 24 hours of PICU admission.

Design:
Exploratory prospective 1-month environmental scan.

Setting:
Two tertiary Canadian PICUs.

Patients:
Ninety patients age newborn to 17 years old admitted to the PICU during September 2016 (Site 1) or May 2017 (Site 2).

Interventions:
None.

Measurements and Main Results:
At PICU admission, 81% of patients were deemed not appropriate to approach for assent most commonly due to age, influence of psychotropic medications, and/or mechanical ventilation. At PICU discharge, 74% of patients were considered not appropriate to approach, most commonly due to age and/or developmental delay. There was moderate to good agreement between the research team and care team assessments of appropriateness for assent. Only 8% of patients considered not approachable at admission become appropriate to approach for assent by PICU discharge.

Conclusions:
Very few patients were considered approachable for assent during the first 24 hours of PICU admission. Those who were considered appropriate to approach were less ill, spent less time in PICU, and were unlikely to be considered for enrollment in pediatric critical care research.
Ibuprofen for Pain Control in Children
Authors: Poddighe Dimitri , Brambilla Ilaria , Licari Amelia , Marseglia Gian Luigi 
Published: June 2018

BackgroundAcute pain is one of the major complaints reported in pediatric emergency departments and general wards. Recently, both the US Food and Drug Administration and European Medicine Agency emitted some warnings regarding the use of opioids, including codeine, in children.ObjectiveThe aims of this study were summarizing the main pharmacological aspects of ibuprofen, discussing the current evidence about the use of ibuprofen in different and specific clinical settings, and providing a comparison with acetaminophen and/or codeine, according to available studies.Study Design and MethodsStudies evaluating ibuprofen for the management of acute pain in children were extracted from the PubMed and MEDLINE database within the period ranging from 1985 through 2017. After discussing safety of ibuprofen and its concomitant use with acetaminophen, the specific indications for the clinical practice were considered.ResultsIbuprofen resulted to be more effective than acetaminophen, and comparable to the combination acetaminophen-codeine, for the control of acute pain related to musculoskeletal pain. Moreover, similar results have been reported also in the management of toothache and inflammatory diseases of the oral cavity and pharynx. Ibuprofen resulted to be useful as a first approach to episodic headache. Finally, the role of ibuprofen in the management of postoperative pain and, particularly, after tonsillectomy and/or adenoidectomy has been reconsidered recently.ConclusionsIbuprofen resulted to be the most studied nonsteroidal anti-inflammatory drug in the management of acute pain in children; in general, it showed a good safety profile and provided evidence of effectiveness, despite some differences according to the specific clinical context.