bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Automated Software Application Reduces Controlled Substance Discrepancies in Perioperative Areas
Authors: Shah Nirav , Sinha Anik , Thompson Aleda , Tremper Kevin , Meka Arjun , Kheterpal Sachin 
Published: September 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Perioperative controlled substance diversion and tracking have received increased regulatory focus throughout the United States. The authors’ institution developed and implemented an automated web-based software application for perioperative controlled substance management. The authors hypothesized that implementation of such a system reduces errors as measured by missing controlled substance medications, missing controlled substance kits (a package of multiple controlled substance medications), and missing witness signatures during kit return.

Methods
From December 1, 2014 to March 31, 2017, the authors obtained missing controlled substance medication, controlled substance kit, and witness return signature data during the preimplementation, implementation, and study period of the controlled substance management application at a single university hospital. This before and after study was based on a QI project at the authors’ institution. The authors included all cases requiring anesthesia services. The primary outcome of this study was the rate of missing controlled substance medications. Secondary outcomes included rates for kits not returned to pharmacy and missing kit return witness signatures.

Results
There were 54,302 cases during the preimplementation period, 57,670 cases during the implementation period, and 65,911 cases during the study period. The number of missing controlled substance medication (difference 0.7 per 1,000 cases; 95% CI, 0.38–1.02; P < 0.001) and kit return errors (difference 0.45 per 1,000 cases; 95% CI, 0.24–0.66, P < 0.001) declined after implementation of the application. There was no difference in the number of missing witness return signatures (difference 0.09 per 1,000 cases; 95% CI, −0.08 to 0.26, P = 0.350). A user survey with 206 of 485 (42%) response rate demonstrated that providers believed the new application managed controlled substances better than the previous system.

Conclusions
A software application that tracks perioperative controlled substance kits with deep integration into the electronic health record and pharmacy systems is associated with a decrease in management errors.
Deficit Accumulation and Phenotype Assessments of Frailty Both Poorly Predict Duration of Hospitalization and Serious Complications after Noncardiac Surgery
Authors: Sonny Abraham , Kurz Andrea , Skolaris Linda A. , Boehm Laura , Reynolds Angela , Cummings Kenneth C. , Makarova Natalya , Yang Dongsheng , Sessler Daniel I. 
Published: September 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Frailty is associated with adverse postoperative outcomes, but it remains unclear which measure of frailty is best. This study compared two approaches: the Modified Frailty Index, which is a deficit accumulation model (number of accumulated deficits), and the Hopkins Frailty Score, which is a phenotype model (consisting of shrinking, weakness, exhaustion, slowness, and low physical activity). The primary aim was to compare the ability of each frailty score to predict prolonged hospitalization. Secondarily, the ability of each score to predict 30-day readmission and/or postoperative complications was compared.

Methods
This study prospectively enrolled adults presenting for preanesthesia evaluation before elective noncardiac surgery. The Hopkins Frailty Score and Modified Frailty Index were both determined. The ability of each frailty score to predict the primary outcome (prolonged hospitalization) was compared using a ratio of root-mean-square prediction errors from linear regression models. The ability of each score to predict the secondary outcome (readmission and complications) was compared using ratio of root-mean-square prediction errors from logistic regression models.

Results
The study included 1,042 patients. The frailty rates were 23% (Modified Frailty Index of 4 or higher) and 18% (Hopkins Frailty Score of 3 or higher). In total, 12.9% patients were readmitted or had postoperative complications. The error of the Modified Frailty Index and Hopkins Frailty Score in predicting the primary outcome was 2.5 (95% CI, 2.2, 2.9) and 2.6 (95% CI, 2.2, 3.0) days, respectively, and their ratio was 1.0 (95% CI, 1.0, 1.0), indicating similarly poor prediction. Similarly, the error of respective frailty scores in predicting the probability of secondary outcome was high, specifically 0.3 (95% CI, 0.3, 0.4) and 0.3 (95% CI, 0.3, 0.4), and their ratio was 1.00 (95% CI, 1.0, 1.0).

Conclusions
The Modified Frailty Index and Hopkins Frailty Score were similarly poor predictors of perioperative risk. Further studies, with different frailty screening tools, are needed to identify the best method to measure perioperative frailty.
Artificial Intelligence in Anesthesiology
Authors: Hashimoto Daniel A. , Witkowski Elan , Gao Lei , Meireles Ozanan , Rosman Guy 
Published: September 2019

Abstract
Artificial intelligence has been advancing in fields including anesthesiology. This scoping review of the intersection of artificial intelligence and anesthesia research identified and summarized six themes of applications of artificial intelligence in anesthesiology: (1) depth of anesthesia monitoring, (2) control of anesthesia, (3) event and risk prediction, (4) ultrasound guidance, (5) pain management, and (6) operating room logistics. Based on papers identified in the review, several topics within artificial intelligence were described and summarized: (1) machine learning (including supervised, unsupervised, and reinforcement learning), (2) techniques in artificial intelligence (e.g., classical machine learning, neural networks and deep learning, Bayesian methods), and (3) major applied fields in artificial intelligence.
The implications of artificial intelligence for the practicing anesthesiologist are discussed as are its limitations and the role of clinicians in further developing artificial intelligence for use in clinical care. Artificial intelligence has the potential to impact the practice of anesthesiology in aspects ranging from perioperative support to critical care delivery to outpatient pain management.
NICU Nurses' Stress and Work Environment in an Open Ward Compared to a Combined Pod and Single-Family Room Design
Authors: Feeley Nancy , Robins Stephanie , Charbonneau Lyne , Genest Christine , Lavigne Geneviève , Lavoie-Tremblay Mélanie 
Published: September 2019

Background:
The architectural design of a neonatal intensive care unit may affect the quality of the work environment for nurses, yet few studies have been conducted using reliable and valid measures. Recent studies have suggested some drawbacks of single-family rooms (SFRs) for both infants and parents. Research is needed to explore nurses' work environment in units combining pods and SFRs.

Purpose:
To compare neonatal intensive care unit nurses' work stress, satisfaction, obstacles, support, team effectiveness, ability to provide family-centered care, and satisfaction with noise, light, and sightlines in an open ward with a new unit of pods and SFRs.

Methods:
A pre-post occupancy study was conducted in a level 3 unit before and after transitioning to a new unit of 6-bed pods and SFRs.

Results:
There were no significant differences in nurse stress, satisfaction, support from colleagues, perceptions of team effectiveness, and ability to provide family-centered care between the open ward and the pod/SFR unit. Organizational obstacles, such as difficulties obtaining information from colleagues, were significantly lower in the pod/SFR. In contrast, environmental and technology obstacles were greater in the new pod/SFR unit.

Implications for Practice:
Some specific aspects of the pod/SFR unit are optimal for neonatal intensive care unit nurses, while other aspects of the open ward are perceived more favorably.

Implications for Research:
Studies are needed to examine the isolation the nurses may experience in SFR units, as well as strategies to reduce isolation.
Considerations for Preterm Human Milk Feedings When Caring for Mothers Who Are Overweight or Obese
Authors: Robinson Daniel T. , Josefson Jami , Van Horn Linda 
Published: September 2019

Background:
Mother's milk is the recommended source of nutrition for all newborns. Preterm infants may be further compromised by maternal factors that impede successful lactation and alter milk composition.

Purpose:
To review and summarize the state of the science regarding implications of maternal overweight and obesity on successful lactation and associated alterations in preterm mother's milk composition.

Methods/Search Strategy:
PubMed, EMBASE, and Web of Science searches were performed using relevant key words to identify references addressing maternal overweight or obesity, prematurity, human milk, and lactation.

Findings/Results:
In the United States, more than half of women enter pregnancy with an overweight or obese body mass index. These women have increased risk of adverse pregnancy outcomes and obstetric complications that can undermine successful initiation and continuation of lactation, including preterm birth. Maternal overweight and obesity are also associated with alterations in mother's milk composition.

Implications for Practice:
Mother-preterm infant dyads affected by maternal overweight and obesity are at risk for barriers to initiation and continuation of lactation. Support for early initiation of milk expression is needed. Continued support, especially during the first weeks of lactation, can facilitate sustained milk production.

Implications for Research:
Considerable knowledge gaps remain in this area of human milk science. Future research is needed to facilitate more comprehensive understanding of differences in milk composition associated with maternal overweight and obesity and their impact on clinical outcomes in the preterm infant.
To Consent, or Not to Consent, That Is the Question
Authors: McGlothen-Bell Kelly , Cleveland Lisa , Pados Britt Frisk 
Published: September 2019

Background:
Evidence supports the superiority of mother's own milk (MOM) in reducing the comorbidities common to prematurity and very low birth weight. In situations where an insufficient amount of MOM is available or maternal contraindications prevent its use, pasteurized donor human milk (DHM) is a viable substitution. When DHM is deemed best, a common practice in many neonatal intensive care units (NICUs) is for parents to provide their consent. However, no universal mandate for informed consent exists. Often, healthcare providers present and obtain the consent for DHM use prior to delivery or shortly after birth and this consent may be “bundled” along with other standardized NICU treatment consents. This approach is likely less than ideal since it provides insufficient time for decision making and often precedes the mother's ability to initiate the expression of her own milk.

Purpose:
To review the history of DHM use and the ethics surrounding the consenting process including the ethical principles involved in infant feeding decision making. We argue for the standardization and consistent use of informed consent for DHM in the NICU and offer clinical practice implications.

Findings/Results/Implications for Practice and Research:
Providers face several challenges in the consenting process for the use of DHM in the NICU setting. These include limited time to support parents and educate them appropriately during the decision-making process. Standardized and consistent use of informed consent is essential to address the ethical concerns surrounding the use of DHM in the NICU setting.
Barriers to Providing Mother's Own Milk to Extremely Preterm Infants in the NICU
Authors: Fernández Medina Isabel María , Fernández-Sola Cayetano , López-Rodríguez María Mar , Hernández-Padilla José Manuel , Jiménez Lasserrotte María del Mar , Granero-Molina José 
Published: September 2019

Background:
Mothers' own milk (MOM) has more than nutritional benefits for extremely preterm infants (<28 weeks). However, mothers encounter barriers that make it difficult to provide their own milk to their extremely preterm infants.

Purpose:
The aim of this study was to describe and understand the experiences of mothers of extremely preterm infants regarding barriers to providing their own milk during infant hospital stay in the neonatal intensive care unit (NICU).

Methods:
This study followed a qualitative, interpretative design using Gadamer's hermeneutic approach and included 15 in-depth semistructured interviews. The data were analyzed using a modified form of the steps described by Fleming.

Results:
Fifteen mothers of extremely preterm infants participated in the study. The following themes were extracted from the data analysis: (1) “unexpected and unusual lactation,” including the subthemes “the extremely preterm birth and the decision to provide MOM,” “the battle to produce milk,” and “my job was to make milk”; and (2) “providing MOM to a tiny infant in an unknown technological environment,” with the subthemes “the limitations of providing MOM in the NICU” and “the difficulties of having an extremely preterm infant.”

Implications for Practice:
To provide MOM to an extremely preterm infant, there is a need for informational and practical counseling by neonatal nurses educated in breastfeeding according to mothers' requirements and emotional needs.

Implications for Research:
Future research may analyze the parents' and neonatal nurses' experience about facilitators to improve MOM provision and the influence of women's sociodemographic characteristics in providing MOM to the extremely preterm infants.
Human Milk and Breastfeeding Outcomes in Infants With Myelomeningocele
Authors: Spatz Diane L. , Froh Elizabeth B. 
Published: September 2019

Background:
In 2015, the study setting instituted an enteral feeding pathway, “PO Ad Lib Feeding to Support Breastfeeding.” Many infants admitted to the study setting's newborn/infant intensive care unit with a primary diagnosis of myelomeningocele fall within the setting's enteral feeding pathway's inclusion criteria.

Purpose:
The primary objective of this study is to describe the enteral feeding exposure and trends, by type and method, among infants with myelomeningocele.

Methods:
Retrospective descriptive cohort design. Participants were infants with a primary diagnosis of myelomeningocele between 2013 and 2016. The electronic health record was used to collect descriptive data (demographics and daily enteral feeding exposure). Data were analyzed using descriptive statistics.

Findings/Results:
More than 80% (n = 148, 81.3%) of the participants' mothers had a personalized prenatal nutrition consultation and the majority of those mothers (n = 102/118, 86.4%) had a goal to breastfeed for more than 6 months. The majority (n = 144/182, 79.1%) of the study cohort was exposed to mothers' own human milk as their first feed. It is also notable that 80.8% (n = 147) fed at least once directly at the breast; however, infants were also fed by bottle or by feeding tube.

Implications for Practice:
It demonstrates that with appropriate evidence-based breastfeeding interventions, mothers having infants with myelomeningocele can expect to feed their infants human milk as well as direct breastfeed.

Implications for Research:
Future research should focus on human milk/breastfeeding outcomes of infants with myelomeningocele post–hospital discharge. Long-term breastfeeding may have an important role in the development of infants with myelomeningocele.
The 100 Top-Cited Articles on Spinal Deformity
Authors: Zhang Yanbin , Wumaier Muhetaer , He Da , Xiao Bin , Zhang Jianguo 
Published: September 2019

Study Design.
A bibliometric analysis.

Objective.
To identify and analyze the 100 top-cited articles on spinal deformity.

Summary of Background Data.
The nature of spinal deformity leads to the complexity of its treatment. There is a scarcity of guidelines for the treatment of spinal deformity despite of the growing literature. So it is crucial to discern researches with higher impact and quality.

Methods.
A keyword search using the Thomson Reuters Web of Science was conducted to select articles relevant to spinal deformity. The 100 top-cited articles were identified based on titles and abstracts, and then analyzed.

Results.
The citation count for the final 100 articles ranged from 154 to 775, with an average of 243.0 citations. Most studies were published in the journal Spine (49/100). The most productive publication time was from 2000 to 2009. The natural history of scoliosis was the most frequent topic (10 articles), followed by pedicle screw instrumentation (8), outcome of nonoperative treatment for adolescent idiopathic scoliosis (AIS) (8), health-related quality of life (7), relationship between sagittal parameters and clinical symptoms (7), and complications of surgical treatment (7). Despite AIS was the most common deformity, the top two most frequently cited articles were all about adult spinal deformity, both describing the correlation between sagittal parameters and symptoms.

Conclusion.
The current study attempted to develop a resource with detailed information on 100 top-cited articles on spinal deformity. It demonstrated the essential advances in spinal deformity. Although the most common spinal deformity is AIS, the adult spinal deformity is of greater impact. These insights into priorities and trends of the researches could help future academic pursuits.

Level of Evidence: 5
High, As Well As Low, Preoperative Platelet Counts Correlate With Adverse Outcomes After Elective Posterior Lumbar Surgery
Authors: Malpani Rohil , Gala Raj J. , Adrados Murillo , Galivanche Anoop R. , Clark Michael G. , Mercier Michael R. , Pathak Neil , Mets Elbert J. , Grauer Jonathan N. 
Published: September 2019

Study Design.
Retrospective cohort study of prospectively collected data.

Objective.
Assess correlation between preoperative platelet counts and postoperative adverse events after elective posterior lumbar surgery procedures.

Summary of Background Data.
Preoperative low platelet counts have been correlated with adverse outcomes after posterior lumbar surgery. Nonetheless, the effect of varying platelet counts has not been studied in detail for a large patient population, especially on the high end of the platelet spectrum.

Methods.
Patients who underwent elective posterior lumbar surgery were identified in the 2011 to 2016 National Surgical Quality Improvement Program database. Preoperative platelet counts were considered relative to 30-day perioperative adverse outcomes. Patients were classified into platelet categories based on determining upper and lower bounds on when the adverse outcomes crossed a relative risk of 1.5. Univariate and multivariate analyses compared 30-day postoperative complications, readmissions, operative time, and hospital length of stay between those with low, normal, and high platelet counts.

Results.
In total, 137,709 posterior lumbar surgery patients were identified. Using the relative risk threshold of 1.5 for the occurrence of any adverse event, patients were divided into abnormally low (≤140,000/mL) and abnormally high (≥447,000/mL) platelet cohorts. The abnormally low and high platelet groups were associated with higher rates of any, major, minor adverse events, transfusion, and longer hospital length of stay. Furthermore, the abnormally low platelet counts were associated with a higher risk of readmissions.

Conclusion.
The data-based cut-offs for abnormally high and low platelet counts closely mirrored those found in literature. Based on these definitions, abnormally high and low preoperative platelet counts were associated with adverse outcomes after elective posterior lumbar surgery. These findings facilitate risk stratification and suggest targeted consideration for patients with high, as well as low, preoperative platelet counts.

Level of Evidence: 3
Decompression With or Without Fusion for Lumbar Stenosis
Authors: Ziino Chason , Mertz Kevin , Hu Serena , Kamal Robin 
Published: September 2019

Study Design.
Retrospective database review.

Objective.
Compare 1-year episode of care costs between single-level decompression and decompression plus fusion for lumbar stenosis.

Summary of Background Data.
Lumbar stenosis is the most common indication for surgery in patients over 65. Medicare direct hospital costs for lumbar surgery reached $1.65 billion in 2007. Despite stenosis being a common indication for surgery, there is debate as to the preferred surgical treatment. Cost-minimization analysis is a framework that identifies potential cost savings between treatment options that have similar outcomes. We performed a cost-minimization analysis of decompression versus decompression with fusion for lumbar stenosis from the payer perspective.

Methods.
An administrative claims database of privately insured patients (Humana) identified patients who underwent decompression (n = 5349) or decompression with fusion (n = 8540) for lumbar stenosis with and without spondylolisthesis and compared overall costs. All patients were identified and costs identified for a 1-year period. Complication rates and costs were described using summary statistics.

Results.
Mean treatment costs at 1 year after surgery were higher for patients who underwent decompression and fusion compared to patients who underwent decompression alone ($20,892 for fusion vs. $6329 for decompression; P < 0.001). Facility costs (P < 0.001), surgeon costs (P < 0.001), and physical therapy costs (P < 0.001) were higher in the fusion group. Cost differences related to infection or durotomy reached significance (P < 0.04). No difference in cost was identified for supplies.

Conclusion.
Decompression had significantly lower costs for the treatment of lumbar stenosis, including treatment for postoperative complications. If cost minimization is the primary goal, decompression is favored for surgical treatment of lumbar stenosis. Other factors including shared decision-making directed toward patient's values, patient-reported outcomes, and preferences should also be recognized as drivers of healthcare decisions.

Level of Evidence: 3