bluuebunny/crossref_metadata_2025_split huggingface dataset:
Driving Innovation in Health Care
Authors: Noles Kristen , Barber Rebekah , James David , Wingo Nancy 
Published: March 2019

Background:
The clinical nurse leader (CNL) role was developed as a strategy for redesigning care delivery to address quality and safety gaps in health care. However, innovation competencies have never been assessed in this group.

Purpose:
The purpose of this study was to determine whether CNLs have different perceptions of innovation and their own competence to lead it, compared with other nurse leaders.

Methods:
A web-enabled concurrent mixed-method survey design was used to compare self-reported innovation competencies between nurses in a leadership role and certified CNLs at a large academic medical center.

Results:
A statistically significant difference between groups was found for only 1 competency, with non-CNLs rating themselves as more competent in the use of unconventional approaches than CNLs. Qualitative data showed wide variation in recognition of innovation and how it is defined.

Conclusions:
Replication of this study is needed with an increased sample size of CNLs to determine whether curriculum change is needed.
Systemwide Practice Change Program to Combat Hospital-Acquired Pressure Injuries
Authors: Barakat-Johnson Michelle , Lai Michelle , Wand Timothy , Coyer Fiona , White Kathryn 
Published: March 2019

Background:
Considerable evidence exists on how to prevent hospital-acquired pressure injuries (HAPIs). However, processes employed to implement evidence play a significant role in influencing outcomes.

Problem:
One Australian health district experienced a substantial increase in HAPIs over a 5-year period (by almost 60%) that required a systemwide practice change.

Approach:
This article reports on the people, processes, and learnings from using the Promoting Action on Research Implementation in Health Services (PARiHS) framework taking into account the evidence, context, and facilitation to address HAPIs.

Outcomes:
Applying this approach resulted in a significant decrease in pressure injuries and positive practice change, leading to improved patient outcomes in a shorter time frame than previous strategies.

Conclusion:
Processes guided by the PARiHS enhanced the effectiveness of translating evidence into practice and positively assisted clinicians to promote optimal patient care. This approach is transferrable to other health care settings.
Gaps in Chlamydia Treatment Within California Family Planning Clinics: Are Patients Filling Prescriptions?
Authors: Kovaleski Laura , Feldman Claire , Baker Scott , Howard Holly , Barandas Aileen , Chow Joan , Bauer Heidi 
Published: March 2019

Background
Compared with receiving medication dispensed in a health center, patients receiving prescriptions must take additional steps for treatment. Few clinics have protocols for ensuring prescriptions are filled. This study evaluated prescription fill rates for chlamydia treatment based on claims data in California Title X clinics and examined fill rates by patient demographics and clinic type.

Methods
We collected treatment information during Title X site audits for a convenience sample of patients with a positive chlamydia test between January 2008 and March 2013. We categorized patients as receiving treatment on-site versus via prescription and matched prescriptions to pharmacy billing claims within 90 days of test date. We examined treatment rates by patient age, gender, and race/ethnicity, and by clinic type, and assessed the median time to treatment.

Results
Among 790 patients diagnosed with chlamydia across 79 clinics, 65% (n = 513) were treated on-site and 33% (n = 260) via prescription; 17 (2%) did not have treatment information. Sixty-seven percent of prescriptions had confirmed receipt of treatment. Prescription fill rates were lower for patients age 18 years and younger (47% vs. 71%, P < 0.01) and for patients attending federally qualified health centers compared with stand-alone family planning clinics (63% vs. 88%, P < 0.01). Median time to treatment was similar for patients treated on-site (5 days) or via prescription (4 days).

Conclusions
Delays in chlamydia treatment increase risk of complications and ongoing transmission. Providing medications on-site can improve treatment rates, especially among younger patients. These insights can inform clinic treatment protocols and efforts to improve quality of chlamydia care.
Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition: Update of the Brain Trauma Foundation Guidelines, Executive Summary
Authors: Kochanek Patrick M. , Tasker Robert C. , Carney Nancy , Totten Annette M. , Adelson P. David , Selden Nathan R. , Davis-O’Reilly Cynthia , Hart Erica L. , Bell Michael J. , Bratton Susan L. , Grant Gerald A. , Kissoon Niranjan , Reuter-Rice Karin E. , Vavilala Monica S. , Wainwright Mark S. 
Published: March 2019

Objectives:
The purpose of this work is to identify and synthesize research produced since the second edition of these Guidelines was published and incorporate new results into revised evidence-based recommendations for the treatment of severe traumatic brain injury in pediatric patients.

Methods and Main Results:
This document provides an overview of our process, lists the new research added, and includes the revised recommendations. Recommendations are only provided when there is supporting evidence. This update includes 22 recommendations, nine are new or revised from previous editions. New recommendations on neuroimaging, hyperosmolar therapy, analgesics and sedatives, seizure prophylaxis, temperature control/hypothermia, and nutrition are provided. None are level I, three are level II, and 19 are level III. The Clinical Investigators responsible for these Guidelines also created a companion algorithm that supplements the recommendations with expert consensus where evidence is not available and organizes possible interventions into first and second tier utilization. The purpose of publishing the algorithm as a separate document is to provide guidance for clinicians while maintaining a clear distinction between what is evidence based and what is consensus based. This approach allows, and is intended to encourage, continued creativity in treatment and research where evidence is lacking. Additionally, it allows for the use of the evidence-based recommendations as the foundation for other pathways, protocols, or algorithms specific to different organizations or environments. The complete guideline document and supplemental appendices are available electronically from this journal. These documents contain summaries and evaluations of all the studies considered, including those from prior editions, and more detailed information on our methodology.

Conclusions:
New level II and level III evidence-based recommendations and an algorithm provide additional guidance for the development of local protocols to treat pediatric patients with severe traumatic brain injury. Our intention is to identify and institute a sustainable process to update these Guidelines as new evidence becomes available.
Role of Antioxidants in Minor Salivary Glands Cancer in the Elderly
Authors: Oteri Giacomo , Lentini Maria , Cicciù Marco , Peditto Matteo , Rey Eva Otero , Carrión Andrés Blanco , Marciano Antonia 
Published: March 2019

Background:
Minor salivary gland tumors (MSGTs) are infrequent, representing 10% to 15% of all salivary neoplasms. Despite this low frequency, a significant increase in the incidence of these tumors has been reported in the lasts 30 years. While tumors of the salivary glands can appear at any age, different authors consider the peak of incidence to be associated with old age (60+). The etiopathogenesis of MSGTs remains unclear. In this context, the aim of this study was to explore the hypothesis that age-related changes in salivary antioxidant capacity are involved in the pathogenesis of minor salivary glands tumors to identify possible preventive measures.
Furthermore the study aimed to describe the clinico-pathological features of a multi-institutional case series of MSGTs which results are consistent with data in the literature.

Methods:
An electronic search of the English language literature was performed using PubMed and Google scholar (<scholar.google.com>). Databases were screened for papers using a number of search strings constructed using relevant terms (minor salivary glands tumors, elderly, diet, antioxidant, saliva, salivary glands).

Results:
According to the world literature, the peak of incidence of MSGTs is between the fifth and seventh decades of life. To date, the only confirmed risk factor for salivary gland tumors is the exposure to ionizing radiation. The significantly reduced salivary antioxidant capacity in old people may explain the higher prevalence of these tumors in the elderly population.

Conclusions:
Further investigation is required to determine the real etiopathogenesis of MSGTs and why these tumors result more frequent in elderly patients.
Cartilage and Fascia Graft In Type 1 Tympanoplasty: Comparison of Anatomical and Audological Results
Authors: Mouna Bellakhdhar , Khalifa Mouna , Ghammem Monia , Limam Manel , Meherzi Abir , Kermani Wassim , Abdelkefi Mohamed 
Published: March 2019

Abstract
Tympanoplasty is a surgical procedure aiming to reconstruct the tympanic membrane and hearing. The aim of this study was to compare anatomic and audiological results of cartilage graft with temporal fascia graft in type 1 tympanoplasty patients. We conducted a descriptive, retrospective study of medical records of patients who underwent tympanoplasty between January 2010 and December 2015 at the Department of Otolaryngology Head and Neck Surgery of Farhat Hached University Hospital. In total, we obtained 46 patients. Twenty-three patients who underwent type 1 cartilage tympanoplasty using cartilage graft were compared with 23 patients in whom temporal muscle fascia was used. In follow-up, residual perforation occurred in 1 of 23 patients (4.3%) undergoing cartilage tympanoplasty and in 2 of 23 patients undergoing fascia tympanoplasty (8.7%), which was found to be statistically non significant (P > 0.05). In both cartilage and fascia groups, when they were compared in terms of gain, no significant difference was found between groups (P = 0.271), air bone gap gain was found to be 12.9 ±9.9 decibels in cartilage group, whereas it was 10 ± 6.6 decibels in fascia group. Operation success is defined by successful anatomical and functional outcome. Among all patients, 35 (76%) were reported to have operation success. It was established that type of operation had no significant influence on success (P = 0.73). Currently, there is an increasing interest in using cartilage grafts in primary tympanoplasty. Especially, in patients with severe middle ear pathology, cartilage graft should be used routinely without risk on influencing audiological results.
Correlation Between Maxillary Canine Impaction and Facial Biotype
Authors: Crincoli Vito , Tettamanti Lucia , Lucchina Alberta Greco , Dedola Alberto , Cazzolla Angela Pia , Lacaita Maria Grazia , Mastrangelo Filiberto 
Published: March 2019

Aim:
The etiology of teeth impaction is still not fully understood, despite that cofactors have been considered important to develop such a clinical picture. The aim of the authors’ paper was to investigate about facial biotype, about the values of inclination of the upper cuspid axis to the perpendicular to Frankfort-horizontal plane and about the distance “d” of the canine cuspid to occlusal plane: each factor was statistically compared. The authors also performed a comparative analysis on the radicular length of the left and right lateral incisors of subjects with impacted maxillary canine.

Methods:
The authors recruited with “cluster sampling” randomization more than 30 patients, then refined to 25 after the application of exclusion criteria. Specific values were carried out by x-rays: the authors calculated both the α and β angles, the intermaxillary angle, the distance “d” and the inclination of upper cuspid axis to the perpendicular-to-Frankfort-horizontal plane. Spearman rank correlation coefficient or Spearman rho (ρ) was used as statistical methods.

Results:
The authors’ results assessed that the inclination of the upper cuspid axis to the perpendicular-to-Frankfort-horizontal plane showed a statistically significant inverse correlation with the intermaxillary angle.

Conclusion:
The authors’ data clearly indicate that hyperdivergence is a key-factor that will certainly support the eruption path of canine cuspid: in this light, the treatment of tooth impaction in hyperdivergent subjects can be considered as predictive for a good prognosis.
A New Method To Reposition the Displaced Articular Disc For a Patient With Comminuted Condylar Fracture
Authors: Yan Guangqi , Zhou Qing , Yang Mingliang 
Published: March 2019

Background:
Repositioning the displaced articular disc is the key procedure that prevents ankylosis of the temporomandibular mandibular joint (TMJ) in the treatment of patients with comminuted condylar fractures. The conventional procedure performed clinically is to use two anchors and sutures to reposition the displaced articular disc. Therefore, this paper introduces a new and economical method to reposition the articular disc without metallic implantation materials.

Clinical presentation:
A 60-year-old male patient who had fainted suddenly 3 days before came to our hospital to complain of pain of the bilateral TMJ areas and limited mouth opening. Clinical examination revealed severe restriction of mouth opening and the disappearance of bilateral condylar movements. Preoperational 3-dimensional computed tomography (3-DCT) indicated bilateral intracapsular comminuted fractures of the mandibular condyles. The patient was operated in a bilateral preauricular approach for repositioning of the bilateral articular discs and removal of the fracture fragments. Instead of repositioning the displaced disc with anchors, we designed a method to use sutures to stabilize the TMJ disc and to assess the disc's position using a magnetic resonance imaging (MRI) scan when following up. There were no severe complications during the operation. Results of an MRI scan 1 month after operation showed that post-operation articular discs kept their normal position, the mouth opening and the lateral and protrusive movements of the mandible recovered when followed up for 3 months.

Conclusion:
The method of using sutures to reposition and stabilize the articular disc for a patient with comminuted fractures is effective. There is great significance not only for patients with comminuted condylar fractures but for treatment of TMJ dysfunction especially for patients with high psychological pressure who persist in requiring the removal of metallic anchors although there are no clinical symptoms.
Incidence and Severity of Maxillofacial Injuries During the Syrian Civil War in Syrian Soldiers and Civilians
Authors: Ucak Murat 
Published: March 2019

Purpose:
The aim of this study was to assess the maxillofacial injuries (MFIs) and our surgical approaches in the Syrian Civil War that emerged during the spring of 2011, among Syria's government and Syrians.

Patients and Methods:
The present study is a prospective clinical study of injured patients at Turkey's Border Hospitals during the Syrian Civil Conflict. Patients’ data cover to all emergency and plastic surgery hospitals throughout Turkey. We assessed the patients’ data according to location of trauma, duration of hospitalization, the severity and etiology of MFIs with the Injury Severity Score.

Results:
MFIs were found in 112 of the 956 wounded. The injuries occurred in 69 civilians (61.6%) and 43 soldiers (38.3%). The mean age ranged from 8 to 66 (mean: 29,1 ± 12). Eighty-two percent or higher rates of the injuries needed >4 days’ hospitalization. We observed the mortality at a rate of 13.3% for the MFIs. Majority of the MFIs were accompanied by >3 concomitant injuries (n = 59; 52.6%). Most of the facial injuries were located at Mandibula (n = 75; 66.9%), Maxilla (n = 69; 61.6%) and orbitofrontal (n = 52; 46.4%) regions.

Conclusions:
Severity and incidence of MFIs were extremely high compared with previously published studies of other wars, especially affecting the civilians in the Syrian Civil War. The high rates of LeFort III fractures exhibit its devastating damages on civilians.
The Impact of Parecoxib on Pain Management for Laparoscopic Cholecystectomy: A Meta-analysis of Randomized Controlled Trials
Authors: Luo Zhifang , Wang Huarong , Huang Dinggui 
Published: March 2019

Introduction:
The efficacy of parecoxib on pain management for laparoscopic cholecystectomy remains controversial. We conducted a systematic review and meta-analysis to explore the impact of parecoxib on pain management after laparoscopic cholecystectomy.

Materials and Methods:
We searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library database results through September 2018 for randomized controlled trials to assess the effect of IV parecoxib versus placebo or noting on pain management after laparoscopic cholecystectomy. This meta-analysis was performed using the random-effect model.

Results:
Seven randomized controlled trials were included in the meta-analysis. Overall, compared with control group for laparoscopic cholecystectomy, intravenous parecoxib showed no notable impact on pain scores within 2 hours [mean difference (MD), −0.22; 95% confidence interval (CI), −0.82 to 0.38; P=0.48] and 4 hours (MD, −0.33; 95% CI, −1.04 to 0.38; P=0.36), but showed results of significant decrease in pain scores at 6 hours (MD, −0.82; 95% CI, −1.45 to −0.20; P=0.01), 12 hours (MD, −0.69; 95% CI, −1.23 to −0.15; P=0.01), 24 hours (MD, −0.49; 95% CI, −0.89 to −0.10; P=0.01), and postoperative analgesics need (risk ratio, 0.45; 95% CI, 0.30-0.65; P<0.0001). In addition, no increase in nausea and vomiting is observed after parecoxib use compared with control intervention (risk ratio, 0.89; 95% CI, 0.44-0.76; P=0.76).

Conclusions:
Parecoxib can substantially promote postoperative pain relief in patients with laparoscopic cholecystectomy.
Intracorporeal Versus Extracorporeal Anastomosis for Laparoscopic Resection of the Splenic Flexure Colon Cancer: A Multicenter Propensity Score Analysis
Authors: Grieco Michele , Cassini Diletta , Spoletini Domenico , Soligo Enrica , Grattarola Emanuela , Baldazzi Gianandrea , Testa Silvio , Carlini Massimo 
Published: March 2019

Purpose:
The aim of this study is to compare the short and long-term outcomes of intracorporeal anastomosis (IA) versus extracorporeal anastomosis (EA) during laparoscopic resection of splenic flexure for cancer, in 3 high-volume Italian centers.

Materials and Methods:
A retrospective analysis was conducted on a multicenter database of a consecutive series of patients who underwent an elective laparoscopic resection of the splenic flexure for colon cancer in 3 high-volume centers between January 2008 and August 2017. Propensity score matching analysis was performed to overcome patients’ selection bias between the 2 surgical techniques. Data on patients’ demographics, operative details, short-term and long-term outcomes were prospectively recorded.

Results:
In total, 102 patients were selected. After propensity score match, 72 patients were compared: 36 for the IA group, 36 for the EA group. The IA group showed a significantly shorter median time to first flatus, time to first stool, time to oral feeding, and time to discharge, as well as significantly lower incidence of postoperative severe surgical complications, especially in terms of wound infections, and of incisional hernia (IH).
Risk factors for IH on logistic regression were longer operative time, EA, longer incision, postoperative blood transfusions, and longer specimen.

Conclusions:
The IA in laparoscopic resection of the splenic flexure is feasible and safe in terms of short-term and long-term outcomes. Major advantages are shorter time to first flatus and first stool, complete oral feeding and time to discharge, with minor incidence of severe surgical complications, such as wound infection, and lower incidence of IH.
From root to tips: sporulation evolution and specialization inBacillus subtilisand the intestinal pathogenClostridioides difficile
Authors: Ramos-Silva Paula , Serrano Mónica , Henriques Adriano O. 
Published: March 2019

AbstractBacteria of the Firmicutes phylum are able to enter a developmental pathway that culminates with the formation of a highly resistant, dormant spore. Spores allow environmental persistence, dissemination and for pathogens, are infection vehicles. In both the modelBacillus subtilis, an aerobic species, and in the intestinal pathogenClostridioides difficile, an obligate anaerobe, sporulation mobilizes hundreds of genes. Their expression is coordinated between the forespore and the mother cell, the two cells that participate in the process, and is kept in close register with the course of morphogenesis. The evolutionary mechanisms by which sporulation emerged and evolved in these two species, and more broadly across Firmicutes, remain largely unknown. Here, we trace the origin and evolution of sporulation. Using the genes involved in the process inB. subtilisandC. difficile, and estimating their gain-loss dynamics in a comprehensive bacterial macro-evolutionary framework we show that sporulation evolution was driven by two major gene gain events, the first at the base of the Firmicutes and the second at the base of theB. subtilisgroup and within the Peptostreptococcaceae family, which includesC. difficile. We also show that early and late sporulation regulons have been co-evolving and that sporulation genes entail greater innovation inB. subtiliswith many Bacilli-lineage restricted genes. In contrast,C. difficilemore often recruits new sporulation genes by horizontal gene transfer, which reflects both its highly mobile genome, the complexity of the gut microbiota and an adjustment of sporulation to this particular ecosystem.
An Oculometrics-based Biofeedback System to Impede Fatigue Development during Computer Work: a Proof-of-Concept Study
Authors: Marandi Ramtin Zargari , Madeleine Pascal , Omland Øyvind , Vuillerme Nicolas , Samani Afshin 
Published: March 2019

AbstractA biofeedback system may objectively identify fatigue and provide an individualized timing plan for micro-breaks. We developed and implemented a biofeedback system based on oculometrics using continuous recordings of eye movements and pupil dilations to moderate fatigue development in its early stages. Twenty healthy young participants (10 males and females) performed a cyclic computer task for 31-35 min over two sessions: 1) self-triggered micro-breaks (manual sessions), and 2) biofeedback-triggered micro-breaks (automatic sessions). The sessions were held with one-week inter-session interval and in a counterbalanced order across participants. Each session involved 180 cycles of the computer task and after each 20 cycles (a segment), the task paused for 5-s to acquire perceived fatigue using Karolinska Sleepiness Scale (KSS). Following the pause, a 25-s micro-break involving seated exercises was carried out whether it was triggered by the biofeedback system if the fatigue state (KSS≥5) was detected in automatic sessions or by the participants in manual sessions. National Aeronautics and Space Administration Task Load Index (NASA-TLX) was administered after sessions. The functioning core of the biofeedback system was based on a Decision Tree Ensemble model for fatigue classification, which was developed using an oculometrics dataset previously collected during the same computer task. The biofeedback system identified fatigue states with a mean accuracy of approx. 70% and remained robust against circadian rhythms. Perceived workload obtained from NASA-TLX was significantly lower in the automatic sessions compared with the manual sessions, p=0.01 Cohen’s d=0.89. The results give support to the robustness and effectiveness of integrating oculometrics-based biofeedback in time planning of micro-breaks to impede fatigue development during computer work.