bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Administration of Postintubation Sedation in the Pediatric Emergency Department
Authors: Berg Kathleen , Gregg Victoria , Cosgrove Peter , Wilkinson Matthew 
Published: February 2019

Background
The administration of postintubation sedation (PIS) is an essential component of postintubation care. Recent studies in the adult emergency medicine literature have highlighted both delays in time to administration of PIS and subtherapeutic dosing of sedative agents in the emergency department. We aimed to investigate the administration of PIS in the pediatric population as this has not been adequately reviewed to date.

Objectives
The aim of this study was to determine the percentage of pediatric emergency department patients who received PIS within an adequate time frame. We also investigated the relationship between this primary outcome and the rapid sequence intubation (RSI) agents used, the reason for intubation, and individual patient characteristics.

Methods
This was a retrospective cohort analysis of all pediatric patients who underwent RSI at a tertiary care pediatric emergency department from July 2007 to January 2016. The primary outcome of “sedation in an adequate time frame” was defined as a time to post-RSI sedative administration that was shorter than the duration of action of the RSI sedative agent used. Logistic regression was performed to identify predictors of adequate sedation.

Results
A total of 240 patients were included in the analysis. Of these, 28% (95% confidence interval, 22.7%–34.1%) met the primary outcome of sedation within an adequate time frame; 72.8% (95% confidence interval, 66.8%–78.1%) of patients received some form of PIS during their emergency department stay. Patients receiving long-acting paralytic agents were much less likely to receive PIS with an odds ratio (OR) of 0.16 for meeting the primary outcome (P < 0.001, adjusted OR [AOR] = 0.13, P < 0.001). Children with higher systolic blood pressure were more likely to receive appropriate PIS with an OR of 1.02 for every mm Hg increase in systolic blood pressure (P = 0.006, AOR = 1.02, P = 0.021). Finally, patients who were ultimately admitted to the pediatric intensive care unit (vs the operating room, transfer, or neonatal intensive care unit) were less likely to receive PIS as evidenced by an OR of 0.37 (P = 0.009, AOR = 0.27, P = 0.004).

Conclusions
Most pediatric patients do not receive PIS within an adequate time frame. Patients who receive long-acting paralytic agents are much less likely to be adequately sedated after RSI compared with those receiving succinylcholine.
Differences in Clinical Findings Based on the Duration of Symptoms and Age of Children With Ileocolic Intussusception
Authors: Aoki Yoshihiro , Iguchi Akihiro , Kitazawa Katsuhiko , Kobayashi Hironobu , Senda Masayoshi , Honda Akihito 
Published: February 2019

Objectives
The objective of this study was to determine whether the rates of abdominal pain or irritability, vomiting, and hematochezia differ depending on the duration of symptoms and age of the children with ileocolic intussusception.

Methods
We retrospectively investigated the charts of ileocolic intussusception children between January 2008 and December 2017 at a rural general hospital in Japan. Children were separated into 2 groups: the early visiting group, including children examined within 6 hours after onset, and the late visiting group, including children examined more than 6 hours after onset. We further separated them into 2 groups based on age: the infant group (age, <18 months) and the child group (age, ≥18 months). We compared clinical features, such as abdominal pain or irritability, vomiting, and hematochezia, between each group.

Results
Among 105 children with ileocolic intussusception, 51 were in the early visiting group and 49 were in the infant group. Hematochezia less frequently occurred in the early visiting group than in the late visiting group (29% vs 50%, P = 0.046). Furthermore, abdominal pain or irritability occurred less frequently in the infant group than in the child group (79.6% vs 98.2%, P = 0.003). Conversely, vomiting and hematochezia were more frequent in the infant group than in the child group (83.7% vs 51.8%, P < 0.001; 55.1% vs 26.8%, P = 0.005).

Conclusions
Clinical features of pediatric ileocolic intussusception may depend on symptom duration and age.
Japanese cross-cultural validation study of the Pain Stage of Change Questionnaire
Authors: Adachi Tomonori , Sunohara Momoka , Enomoto Kiyoka , Sasaki Keitaro , Sakaue Gaku , Fujita Yoshitsugu , Mizuno Yasuyuki , Okamoto Yoshiaki , Miki Kenji , Yukioka Masao , Nitta Kazuhito , Iwashita Narihito , Kitagawa Hirotoshi , Shibata Masahiko , Sasaki Jun , Jensen Mark P. , Fukui Sei 
Published: February 2019

Abstract

Introduction:
Although evidence supports efficacy of treatments that enhance self-management of chronic pain, the efficacy of these treatments has been hypothesized to be influenced by patient readiness for self-management. The Pain Stage of Change Questionnaire (PSOCQ) is a reliable and valid measure of patient readiness to self-manage pain. However, there is not yet a Japanese version of the PSOCQ (PSOCQ-J), which limits our ability to evaluate the role of readiness for pain self-management in function and treatment response in Japanese patients with chronic pain.

Objective:
Here, we sought to develop the PSOCQ-J and evaluate its psychometric properties.

Methods:
We recruited 201 patients with chronic pain. The study participants were asked to complete the PSOCQ-J and other measures assessing pain severity, pain interference, catastrophizing, self-efficacy, and pain coping strategies.

Results:
The results supported a 4-factor structure of the PSOCQ-J. We also found good to excellent internal consistencies and good test–retest reliabilities for the 4 scales. The Precontemplation scale had weak to moderate positive correlations with measures of pain-related dysfunction and maladaptive coping. The Action and Maintenance scales had weak to moderate positive correlations with measures of self-efficacy and adaptive coping. The Contemplation scale had weak positive correlations with measures of pain interference and both adaptive and maladaptive coping.

Conclusions:
The PSOCQ-J demonstrated adequate psychometric properties in a sample of Japanese patients with chronic pain. This measure can be used to evaluate the role that readiness to self-manage pain may play in adjustment to chronic pain in Japanese pain populations.
Coronary Artery Spasm, Coronary Reactivity, and Their Psychological Context
Authors: Mehta Puja K. , Thobani Aneesha , Vaccarino Viola 
Published: February 2019

ABSTRACT
Symptomatic individuals suspected of having myocardial ischemia often have no obstructive atherosclerotic narrowing of epicardial coronary arteries. Abnormal coronary vascular reactivity and, in particular, coronary artery vasospasm (CAS) may be an explanation in a subset of these patients. Psychological factors play an important role in ischemic heart disease, but their role in CAS is not clear; autonomic dysfunction and increased inflammation are two prevailing pathophysiological mechanisms implicated in abnormal coronary reactivity resulting from mental health conditions. Interrelationships between psychological factors, abnormal coronary reactivity, and sex/gender differences are poorly defined in the etiology of CAS. In this issue of Psychosomatic Medicine (2019;81:237–245), Hung et al. report a frequency of less than 0.1% of new-onset CAS in the Taiwanese population, with higher occurrence in women and younger individuals. Patients with CAS had a higher prevalence of previous anxiety and depression compared with those with coronary artery disease and controls, with no sex differences. In this editorial comment, we discuss the potential reasons for underreporting of CAS and the challenges regarding the use of administrative health records for psychosomatic research. In this editorial, a model is presented to explain the association between emotional stressors and mental health factors with CAS, including the role of sympathetic nervous system activation, inflammation, oxidative stress, endothelial dysfunction, and smooth muscle cell dysregulation.
Patient Safety Incidents Describing Patient Falls in Critical Care in North West England Between 2009 and 2017
Authors: Thomas Antony N. , Balmforth Joanna E. 
Published: February 2019

Aim
The aim of the study was to review reported falls in critical care units to see whether the causes and results were different from those described in a general hospital population.

Methods
We reviewed and classified patient safety incidents describing falls from critical care units in the North West of England between 2009 and 2017. The classification reviewed patient and staff factors contributing to the fall, the environment of the fall, and the reported consequences. We then calculated and compared rates of falls in different units.

Results
There were 914 falls reported, representing only 2.0% of all reported incidents. The median (interquartile range) unit rate was 1.0 falls per 1000 (0.5–1.2) days, and falls were unrelated to the number of single rooms and were no more common in specialist units. There were 304 (33%) falls in patients transferring (207 to standing, 8 from standing), and there were 259 (28%) falls from bed. Patient factors included attempting tasks without assistance (323 incidents [35%]) and organic confusion (188 incidents [21%]). Staff factors included being away from the patient (375 incidents [41%]). Harm was described in 201 incidents (22%), including removal of medical devices (40 incidents), injury to staff (10 incidents) subdural hematoma, and possible spinal injury (1 incident each).

Conclusions
There is a low rate of falls and associated harm in critical care units. The variation between units suggests that this rate could be further reduced by the prevention and management of delirium and by educating patients and staff to take care when moving patients to the standing position.
Pursuing Patient Safety at the Intersection of Design, Systems Engineering, and Health Care Delivery Research: An Ongoing Assessment
Authors: Henriksen Kerm , Rodrick David , Grace Erin N. , Shofer Marjorie , Jeffrey Brady P. 
Published: February 2019

Objectives
Despite endorsements for greater use of systems approaches and reports from national consensus bodies calling for closer engineering/health care partnerships to improve care delivery, there has been a scarcity of effort of actually engaging the design and engineering disciplines in patient safety projects. The article describes a grant initiative undertaken by the Agency for of Healthcare Research and Quality that brings these disciplines together to test new ideas that could make health care safer.

Methods
Collectively known as patient safety learning laboratories, grantee teams engage in phase-based activities that parallel a systems engineering process—problem analysis, design, development, implementation, and evaluation—to gain an in-depth understanding of related patient safety problems, generate fresh ideas and rapid prototypes, develop the prototypes, ensure that developed components are implemented as an integrated working system, and evaluate the system in a simulated or clinical setting.

Findings
Obstacles are described that can derail the best of intentions in deploying the systems engineering methodology. Based on feedback received from project teams, lessons learned are emerging that find considerable variation among project teams in deploying the methodology and a longer than anticipated amount of time in bringing team members from different disciplines together where they learn to communicate and function as a team.

Conclusions
Three narratives are generated in terms of what success might look like. Much is yet to be learned about the limitations and successes of the ongoing learning laboratory initiative, which should be relevant to the broader scale interest in learning health systems.
Validation of the Casa Colina Fall Risk Assessment Scale in Predicting Falls in Inpatient Rehabilitation Facilities
Authors: Kaplan Stephanie E. , Cournan Michele , Gates Jason , Thorne Melanie , Jones Annette , Ponce Tom , Rosario Emily R. 
Published: February 2019

Abstract

Objective
The aim of this study was to assess the validity, efficacy, and generalizability of a fall risk assessment tool created specifically for inpatient rehabilitation facilities (IRFs).

Design
The Casa Colina Falls Risk Assessment Scale (CCFRAS) was assessed both retrospectively and prospectively on consecutive patients at three IRFs to determine the sensitivity and specificity of this tool in predicting fall risk.

Setting
The setting was in three IRFs.

Participants
Individuals admitted to three IRFs participated in the study.

Main Outcomes Measures
Each IRF quantified the number of falls detected for the patient population under evaluation and determined the site-specific sensitivity and specificity of the CCFRAS.

Results
The sensitivity and specificity of the CCFRAS ranged from 75% to 80% and from 47% to 70%, respectively, for the different IRFs. Using a logistic regression analysis, we identified the optimal CCFRAS cutoff score for identifying high-risk patients at each individual facility, thus improving the specificity to 70%–79%.

Conclusion
Multisite evaluation of this assessment tool indicates that the CCFRAS is effective and broadly generalizable for predicting patients at high risk for falling.
Recombinant Human Bone Morphogenic Protein-2 Combined With Autogenous Bone Graft for Reconstruction of Alveolar Cleft
Authors: Jahanbin Arezoo , Zarch Hossein Hosseini , Irani Sahar , Eslami Neda , Kermani Hamed 
Published: February 2019

Abstract
Recombinant human bone morphogenic proteins (rhBMPs) have been introduced for reconstruction of alveolar defects. The volume of the bone formed at the cleft region may be related to rhBMP-2 dose. Greater side effects have been reported with increased doses of rhBMP-2. The aim of the present study was to assess the bone at the cleft area using low dose of rhBMP-2 combined with autogenous bone graft for reconstruction of the alveolar cleft. Patients with unilateral cleft lip and palate between the 11 to 14 years old were enrolled. After palatal expansion, autogenous graft was placed at the side of cleft in the control group (n = 6). In the BMP group, the rhBMP-2 was injected into the autogenous bone graft at the defect site (n = 5). Cone beam computed tomography (CBCT) images were taken of all patients immediately and 3 months after graft surgery to compare the density, thickness, and height of the bone graft between the 2 groups. Intermolar and interpremolar widths were also measured. The authors found less diminish of density and height of the bone graft 3 months postsurgery in patients with autogenous bone graft combined with rhBMP-2. However, significant difference in the relapse tendency of transverse dimension of the arch or thickness of the bone graft was not observed between the 2 groups. Thus, low dose rhBMP-2 combined with autogenous bone graft can be promising to reach predictable results after alveolar reconstruction in cleft lip and palate patients.
Transient Retinal Artery Occlusion After Uncomplicated Rhinoplasty
Authors: Guler Alis Meryem , Acikalin Banu , Alis Abdulkadir , Ucal Yusuf Orhan 
Published: February 2019

Purpose:
Loss of vision is an extremely rare and unexpected complication following a routine uncomplicated nasal surgery. In majority of patients, visual loss has attributed to retinal emboli which occur with retrograde flow of the intra-arterially injected agents into the nasal cavity or direct trauma to the optic nerve. In this report, the authors present a patient with unilateral decreased vision due to branch retinal artery occlusion soon after a routine nasal surgery.

Methods:
Clinical report.

Result:
A 32-year-old female patient admitted to the author’ clinic with the complaints of decreased visual acuity in the left eye. She stated that she had undergone rhinoplasty operation 1 week ago and vision loss started immediately after the surgery.
In the ophthalmological examination, the best corrected visual acuity with Snellen chart was 1.0 in the right eye and 0.3 in the left eye. In the fundoscopic examination of left eye there was a pale area in the inferior part of the macula. Fundus fluorescein angiography showed no evidence of nonperfusion in the right and left eyes and vascular structure was normal. On the optic coherence tomography, hyperreflectivity and increased thickness were observed in the inner retinal layers of the left eye. In the visual field test, there was a loss of the visual field which corresponds to the pale area on the left eye. Hyperbaric oxygen therapy was recommended. The ophthalmologic examination carried out 2 months later revealed a best corrected visual acuity of the left eye 0.9. In the fundoscopy pale area was regressed in the left eye. Fundus fluorescein angiography showed a good perfusion. There was a little progression in the visual field test.

Conclusion:
Direct mechanical trauma and vasoplastic/embolic vascular events are thought to be possible mechanisms. The authors think in this case, there was a retrograde flow of agents used during the surgery through ophthalmic artery to retinal arteries and vasospasm by epinephrin worsened the situation. Although rare retinal artery occlusion may develop after rhinoplasty, vision loss as a result of a surgery, if done for aesthetic purposes is not acceptable.
Assessing the Impact of Suboptimal Donor Characteristics on Mortality After Liver Transplantation: A Time-dependent Analysis Comparing HCC With Non-HCC Patients
Authors: Wallace David , Walker Kate , Charman Susan , Suddle Abid , Gimson Alex , Rowe Ian , Callaghan Chris , Cowling Tom , Heaton Nigel , van der Meulen Jan 
Published: February 2019

Background.
Patients who receive a liver transplant for hepatocellular carcinoma (HCC) often receive poorer-quality livers. Tumor recurrence also has a negative effect on posttransplant outcomes. We compared mortality of HCC and non-HCC recipients in different posttransplant time periods (epochs) to separate the impact of these different risk factors on short-term and longer-term posttransplant survival.

Methods.
We identified a population-based cohort of first-time liver transplant recipients (aged ≥16 years) between 2008 and 2016 in the United Kingdom. We used Cox regression to estimate hazard ratios (HRs) comparing posttransplant mortality between HCC and non-HCC patients in 3 posttransplant epochs: 0 to 90 days, 90 days to 2 years, and 2 to 5 years, with adjustment first for recipient and later also for donor characteristics.

Results.
One thousand two hundred seventy HCC and 3657 non-HCC transplant recipients were included. Five-year posttransplant survival was 74.5% (95% confidence interval [CI] 71.2%–77.5%) in HCC patients and 84.6% (83.0%–86.1%) in non-HCC patients. With adjustment for recipient characteristics only, mortality of HCC patients was lower but not statistically significantly different in the first 90 days (HR, 0.76; 95% CI, 0.53–1.09; P = 0.11), but significantly higher thereafter (90 days to 2 years: HR, 1.99; 95% CI, 1.48–2.66; P < 0.001; 2 to 5 years HR, 1.77; 95% CI, 1.30–2.42; P < 0.001). Further adjustment for donor characteristics had little impact on these results.

Conclusions.
HCC recipients have poorer 5-year posttransplant survival than non-HCC recipients, most likely because of tumor recurrence. The more frequent use of poorer-quality donor organs for HCC does not explain this difference.
Brain Death in Asia: Do Public Views Still Influence Organ Donation in the 21st Century?
Authors: Liu Christopher W. , Yeo Charlene , Lu Zhao Boyu , Lai Clin K.Y. , Thankavelautham Suhitharan , Ho Vui Kian , Liu Jean C.J. 
Published: February 2019

Background.
Historically, brain death legislation was adopted in Asia at a much later stage than it was in the West, with heated public debates surrounding these laws. In this study, we investigated whether the poor acceptance of brain death continues to the present day, focusing on the following: (1) what the Asian public understands brain death to be; (2) how views toward brain death are compared with those of cardiac death; and (3) the extent to which brain death perception contributes to the low rate of deceased organ donation that has been observed amongst Asians.

Methods.
Using a door-to-door sampling strategy, we recruited 622 residents in Singapore between September 2016 and July 2017.

Results.
Our results suggest that resistance toward brain death persists, with the majority of respondents equating this as a bleak outcome but not as death. Correspondingly, they considered cardiac death a better indicator of death and were more fearful of being alive during organ donation. In turn, these views predicted a decreased willingness to donate either their own or their family members’ organs.

Conclusions.
Taken together, our results suggest that views of brain death continue to hamper organ donation, and are seemingly resistant to both time and legislation.
Outcomes in Older Kidney Transplant Recipients After Prior Nonkidney Transplants
Authors: Haugen Christine E. , Luo Xun , Holscher Courtenay M. , Bowring Mary G. , DiBrito Sandra R. , Garonzik-Wang Jacqueline , McAdams-DeMarco Mara , Segev Dorry L. 
Published: February 2019

Background.
Recipients of nonkidney solid organ transplants (nkSOT) are living longer, and 11%–18% will develop end stage renal disease (ESRD). While our general inclination is to treat nkSOT recipients who develop ESRD with a kidney transplant (KT), an increasing number are developing ESRD at an older age where KT may not be the most appropriate treatment. It is possible that the risk of older age and prior nkSOT might synergize to make KT too risky, but this has never been explored.

Methods.
To examine death-censored graft loss and mortality for KT recipients with and without prior nkSOT, we used Scientific Registry of Transplant Recipients data to identify 42 089 older (age ≥65) KT recipients between 1995 and 2016. Additionally, to better understand treatment options for these patients and survival benefit of KT, we identified 5023 older (age ≥65) with prior nkSOT recipients listed for subsequent KT, of whom 863 received transplants.

Results.
Compared with 41 159 older KT recipients without prior nkSOT, death-censored graft loss was similar (adjusted hazard ratio [aHR]: 1.13, 95% CI: 0.93-1.37, P = 0.2), but mortality (aHR: 1.40, 95% CI: 1.28-1.54, P < 0.001) was greater for older KT recipients with prior nkSOT. Nonetheless, in a survival benefit model (survival with versus without the transplant), among older prior nkSOT recipients, KT decreased the risk of mortality by more than half (aHR: 0.47, 95% CI: 0.42-0.54, P < 0.001).

Conclusions.
Older prior nkSOT recipients who subsequently develop ESRD derive survival benefit from KT, but graft longevity is limited by overall survival in this population. These findings can help guide patient counseling for this challenging population.