bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Systematic Review and Meta-Analysis Examining the Impact of Sleep Disturbance on Postoperative Delirium
Authors: Fadayomi Ayòtúndé B. , Ibala Reine , Bilotta Federico , Westover Michael B. , Akeju Oluwaseun 
Published: October 2018

Objectives:
Basic science and clinical studies suggest that sleep disturbance may be a modifiable risk factor for postoperative delirium. We aimed to assess the association between preoperative sleep disturbance and postoperative delirium.

Data Sources:
We searched PubMed, Embase, CINAHL, Web of Science, and Cochrane from inception until May 31, 2017.

Study Selection:
We performed a systematic search of the literature for all studies that reported on sleep disruption and postoperative delirium excluding cross-sectional studies, case reports, and studies not reported in English language.

Data Extraction:
Two authors independently performed study selection and data extraction. We calculated pooled effects estimates with a random-effects model constructed in Stata and evaluated the risk of bias by formal testing (Stata Corp V.14, College Station, TX),

Data Synthesis:
We included 12 studies, from 1,238 citations that met our inclusion criteria. The pooled odds ratio for the association between sleep disturbance and postoperative delirium was 5.24 (95% CI, 3.61–7.60; p < 0.001 and I
2 = 0.0%; p = 0.76). The pooled risk ratio for the association between sleep disturbance and postoperative delirium in prospective studies (n = 6) was 2.90 (95% CI, 2.28–3.69; p < 0.001 and I
2 = 0.0%; p = 0.89). The odds ratio associated with obstructive sleep apnea and unspecified types of sleep disorder were 4.75 (95% CI, 2.65–8.54; p < 0.001 and I
2 = 0.0%; p = 0.85) and 5.60 (95% CI, 3.46–9.07; p < 0.001 and I
2 = 0.0%; p = 0.41), respectively. We performed Begg’s and Egger’s tests for publication bias and confirmed a null result for publication bias (p = 0.371 and 0.103, respectively).

Conclusions:
Preexisting sleep disturbances are likely associated with postoperative delirium. Whether system-level initiatives targeting patients with preoperative sleep disturbance may help reduce the prevalence, morbidity, and healthcare costs associated with postoperative delirium remains to be determined.
CHANGES IN DIABETIC RETINOPATHY SEVERITY WHEN TREATING DIABETIC MACULAR EDEMA WITH RANIBIZUMAB
Authors: Bressler Susan B. , Odia Isoken , Glassman Adam R. , Danis Ronald P. , Grover Sandeep , Hampton G. Robert , Jampol Lee M. , Maguire Maureen G. , Melia Michele 
Published: October 2018

Purpose:
To explore 5-year changes from baseline in diabetic retinopathy severity among eyes treated with ranibizumab for diabetic macular edema.

Methods:
Diabetic retinopathy severity was assessed from study visits and annual fundus photographs among participants in Protocol I (DRCR.net). The proportion of eyes that improved at annual examinations and the cumulative probability of worsening through 5 years were estimated.

Results:
Among 235 participants with nonproliferative diabetic retinopathy at baseline, there were 29%, 28%, and 32% of eyes with retinopathy improvement at 1, 3, and 5 years, respectively. Among 111 participants with proliferative diabetic retinopathy, corresponding improvement percentages were 38%, 35%, and 23%. The 5-year cumulative probability of worsening was 18% (95% CI: 14%–25%) among nonproliferative diabetic retinopathy eyes and 31% (95% CI: 23%–42%) among proliferative diabetic retinopathy eyes (P = 0.01). In Years 1, 3, and 5, the mean (SD) number of ranibizumab injections was 8.1 (2.5), 2.2 (2.6), and 1.8 (2.6) for nonproliferative diabetic retinopathy eyes, and 9.0 (2.8), 2.3 (2.9), and 1.7 (2.6) for proliferative diabetic retinopathy eyes, respectively. Proportions with improvement or rates of worsening did not change with time.

Conclusion:
Individuals receiving ranibizumab therapy for diabetic macular edema may have favorable changes in DR severity throughout a 5-year period concomitant with sequential reduction in anti–vascular endothelial growth factor therapy.
Early Declines in Vaccine Type Pneumococcal Carriage in Children Less Than 5 Years Old After Introduction of 10-valent Pneumococcal Conjugate Vaccine in Mozambique
Authors: Sigaúque Betuel , Moiane Benild , Massora Sergio , Pimenta Fabiana , Verani Jennifer R. , Mucavele Helio , Chaúque Alberto , Quintó Llorenç , dos Santos Rita T. , Carvalho Maria da Gloria , Whitney Cynthia G. , Lessa Fernanda C. 
Published: October 2018

Background:
Pneumococcal carriage is a precursor of invasive pneumococcal disease. Mozambique introduced 10-valent pneumococcal conjugate vaccine (PCV10) in April 2013, using a 3-dose schedule without a booster. We evaluated PCV10 impact on pneumococcal carriage and colonization density by HIV status.

Methods:
We conducted 2 cross-sectional surveys (pre and post PCV10 introduction) among children 6 weeks to 59 months old. Participants included HIV-infected children presenting for routine care at outpatient clinics and a random sample of HIV-uninfected children from the community. We collected demographic data, vaccination history and nasopharyngeal swabs. Swabs were cultured and isolates serotyped by Quellung. We selected serotypes 11A, 19A and 19F for bacterial density analyses. We compared vaccine-type (VT) carriage prevalence from the pre-PCV10 with the post-PCV10 period by HIV status.

Findings:
Prevalence of VT carriage declined from 35.9% (110/306) pre already defined in the background. It should be pre-PCV (PCV) to 20.7% (36/174 fully vaccinated) post PCV (P < 0.001) in HIV-uninfected and from 34.8% (144/414) to 19.7% (27/137 fully vaccinated) (P = 0.002) in HIV-infected children. Colonization prevalence for the 3 serotypes (3, 6A, 19A) included in the 13-valent PCV but not in PCV10 increased from 12.4% (38/306) to 20.7% (36/174 fully vaccinated) (P = 0.009) among HIV- uninfected children, mainly driven by 19A; no significant increase was observed in HIV-infected children. VT carriage among unvaccinated children decreased by 30% (P = 0.005) in HIV-infected children, with no significant declines observed in HIV-uninfected children.

Conclusion:
Declines in VT carriage were observed in both HIV-uninfected and HIV-infected children after PCV10 introduction with an early signal of herd effect especially in HIV-infected children. Ongoing monitoring of increases in 19A carriage and disease is necessary.
Community Origins and Regional Differences Highlight Risk of Plasmid-mediated Fluoroquinolone Resistant Enterobacteriaceae Infections in Children
Authors: Logan Latania K. , Medernach Rachel L. , Rispens Jared R. , Marshall Steven H. , Hujer Andrea M. , Domitrovic T. Nicholas , Rudin Susan D. , Zheng Xiaotian , Qureshi Nadia K. , Konda Sreenivas , Hayden Mary K. , Weinstein Robert A. , Bonomo Robert A. 
Published: October 2018

Background:
Fluoroquinolones are uncommonly prescribed in children, yet pediatric multidrug resistant (MDR) enterobacteriaceae (Ent) infections often reveal fluoroquinolone resistance (FQR). We sought to define the molecular epidemiology of FQR and MDR-Ent in children.

Methods:
A case–control analysis of children with MDR-Ent infections at 3 Chicago hospitals was performed. Cases were children with third-generation cephalosporin-resistant and/or carbapenem-resistant Ent infections. Polymerase chain reaction and DNA analysis assessed bla and plasmid-mediated FQR (PMFQR) genes. Controls were children with third-generation cephalosporin, fluoroquinolone, and carbapenem-susceptible Ent infections matched by age, source and hospital. We assessed clinical-epidemiologic predictors of PMFQR Ent infection.

Results:
Of 169 third-generation cephalosporin-resistant and/or carbapenem-resistant Ent isolates from children (median age, 4.8 years), 85 were FQR; 56 (66%) contained PMFQR genes. The predominant organism was Escherichia coli, and most common bla gene bla
CTX-M-1 group. In FQR isolates, PMFQR gene mutations included aac6’1bcr, oqxA/B, qepA and qnrA/B/D/S in 83%, 15%, 13% and 11% of isolates, respectively. FQR E. coli was often associated with phylogroup B2, ST43/ST131. On multivariable analysis, PMFQR Ent infections occurred mostly in outpatients (odds ratio, 33.1) of non–black-white-Hispanic race (odds ratio, 6.5). Residents of Southwest Chicago were >5 times more likely to have PMFQR Ent infections than those in the reference region, while residence in Central Chicago was associated with a 97% decreased risk. Other demographic, comorbidity, invasive-device, antibiotic use or healthcare differences were not found.

Conclusions:
The strong association of infection with MDR organisms showing FQR with patient residence rather than with traditional risk factors suggests that the community environment is a major contributor to spread of these pathogens in children.
Disease- and Treatment-related Morbidity in Adolescents With Perinatal HIV Infection in Asia
Authors: Bartlett Adam W. , Mohamed Thahira Jamal , Sudjaritruk Tavitiya , Kurniati Nia , Nallusamy Revathy , Hansudewechakul Rawiwan , Ly Penh Sun , Truong Khanh Huu , Lumbiganon Pagakrong , Puthanakit Thanyawee , Chokephaibulkit Kulkanya , Nguyen Lam Van , Do Viet Chau , Kumarasamy Nagalingeswaran , Nik Yusoff Nik Khairulddin , Fong Moy Siew , Wati Dewi Kumara , Sohn Annette H. , Kariminia Azar 
Published: October 2018

Background:
Perinatally HIV-infected adolescents (PHIVA) are exposed to a chronic systemic infection and long-term antiretroviral therapy (ART), leaving them susceptible to morbidities associated with inflammation, immunodeficiency and drug toxicity.

Methods:
Data collected 2001 to 2016 from PHIVA 10–19 years of age within a regional Asian cohort were analyzed using competing risk time-to-event and Poisson regression analyses to describe the nature and incidence of morbidity events and hospitalizations and identify factors associated with disease-related, treatment-related and overall morbidity. Morbidity was defined according to World Health Organization clinical staging criteria and U.S. National Institutes of Health Division of AIDS criteria.

Results:
A total 3,448 PHIVA contributed 17,778 person-years. Median age at HIV diagnosis was 5.5 years, and ART initiation was 6.9 years. There were 2,562 morbidity events and 307 hospitalizations. Cumulative incidence for any morbidity was 51.7%, and hospitalization was 10.0%. Early adolescence was dominated by disease-related infectious morbidity, with a trend toward noninfectious and treatment-related morbidity in later adolescence. Higher overall morbidity rates were associated with a CD4 count <350 cells/µL, HIV viral load ≥10,000 copies/mL and experiencing prior morbidity at age <10 years. Lower overall morbidity rates were found for those 15–19 years of age compared with 10–14 years and those who initiated ART at age 5–9 years compared with <5 or ≥10 years.

Conclusions:
Half of our PHIVA cohort experienced a morbidity event, with a trend from disease-related infectious events to treatment-related and noninfectious events as PHIVA age. ART initiation to prevent immune system damage, optimize virologic control and minimize childhood morbidity are key to limiting adolescent morbidity.
Nocardia brasiliensis Preseptal Cellulitis in an Immunocompetent Patient
Authors: Kareff Samuel , Gottlieb Lindsey , Maturana Colleen , Caplivski Daniel 
Published: October 2018

Abstract
The Nocardia subspecies are opportunistic pathogens ubiquitous in the environment that most often cause infection in immunocompromised hosts. Here we describe a case of community-acquired preseptal cellulitis in a previously healthy man who we believe acquired the infection from contact with soil while gardening.
Mycobacterium avium Complex Cutaneous Infections in Non-HIV Patients
Authors: Rizvi Humaira , Saravolatz Louis Donald 
Published: October 2018

Abstract
We report a rare case of Mycobacterium avium complex cutaneous infection in a non-HIV patient with a report of 13 other cases of M. avium complex cutaneous infection in non-HIV patients found in the literature since 1992.
Predictors of 30-day Postdischarge Readmission to a Multistate National Sample of State Psychiatric Hospitals
Authors: Ortiz Glorimar 
Published: October 2018

ABSTRACT

Background:
Early discharge from psychiatric inpatient care may pose challenges for the patient's recovery and may incite a rapid return to the hospital. This study identified demographic, clinical, and the continuing of care characteristics associated with rapid readmission into a sample of psychiatric inpatient hospitals.

Methods:
Cross-sectional analysis of 60,254 discharges from state psychiatric hospitals. Logistic regression explored the relationship between predictors of rapid readmission.

Results:
Eight percent of discharges were readmitted to the same hospital within 30 days after discharge. Factors significantly related with rapid readmission included white (odds ratio, 1.23; 95% confidence interval, 1.13–1.34), non-Hispanic (1.48, 1.26–1.73), not married (1.53, 1.32–1.76), voluntarily admitted (1.18, 1.05–1.33), with length of stay (LOS) ≤ 7 days (3.52, 3.04–4.08), or LOS 8–31 days (3.20, 2.79–3.66), or LOS 32–92 days (1.91, 1.65–2.22), with a schizophrenia or other psychotic disorders (1.69, 1.46–1.96) or personality disorder (1.76, 1.50–2.06), referred to a setting different from the outpatient (1.27, 1.16–1.40), or with a living arrangement different from private residence (1.54, 1.40–1.68).

Conclusions:
Disparities in rapid readmission rates exist among state psychiatric hospitals. A national overview of the individuals with mental illness at risk of being prematurely discharged may suggests insights into quality initiatives aimed at reducing rapid readmissions into psychiatric inpatient care.
Self-teaching to improve patient confidence in resuscitation skills: A quality improvement project
Authors: Winchester David E. , Kittles Irene 
Published: October 2018

ABSTRACT

Background and purpose:
Sudden cardiac death occurs predominantly at home where cardiopulmonary resuscitation (CPR) is often not provided. We tested the hypothesis that a self-teaching kit distributed to patients would effectively increase self-confidence in CPR.

Methods:
Patients seen by an advanced registered nurse practitioner in a general cardiology clinic were offered a self-teaching kit to learn CPR. Four-point scale survey questions were assessed at distribution and via phone call at 30 days.

Conclusions:
Kits were distributed to 21 patients; of whom, 17 (81%) patients used the kit. Patients reported greater self-confidence of performing CPR (2.6 before versus 3.2 after, p < .05) and greater comfort if someone needed CPR (2.4 before versus 3.1 after, p < .05).

Implications for practice:
Self-teaching CPR kits were used by the substantial majority of patients and were effective at increasing both self-confidence and willingness to perform CPR. Similar nurse-run programs could increase awareness and impact of CPR in communities.
An educational intervention to enhance nurse practitioner role transition in the first year of practice
Authors: Thompson Angela 
Published: October 2018

ABSTRACT

Background and Purpose:
Role transition is a natural process that occurs when the registered nurse pursues additional education to become a nurse practitioner (NP). Role transition generates feelings of anxiety and insecurity, leading to a longer and more tumultuous adjustment. This study investigated whether an evidence-based role transition webinar would support NP role transition during this critical period.

Methods:
This study was a nonrandomized, pretest–posttest, and single-group study using a convenience sample to address the research question: “Does completion of a role transition webinar enhance the perception of new NPs of their ability to perform well in their role?”

Conclusions:
The educational webinar was shown to have a positive influence on some aspects of the participant's reported perceptions of NP role transition. Having practical and assessable educational interventions to optimize NP role transition and determining factors that contribute to the success of these interventions would be prudent.

Implications for Practice:
This is the first quantitative study to investigate the positive association between an online educational intervention and NP role transition. A timelier and less tumultuous transition would allow NPs to perform more effectively in their new role.
Quality of Life Within the First 6 Months of Vestibular Schwannoma Diagnosis With Implications for Patient Counseling
Authors: Carlson Matthew L. , Tombers Nicole M. , Kerezoudis Panagiotis , Celda Maria Peris , Lohse Christine M. , Link Michael J. 
Published: October 2018

Objective:
To evaluate quality-of-life (QOL) in patients with sporadic vestibular schwannoma (VS) with particular focus on those recently diagnosed.

Study Design:
Cross-sectional survey, Penn Acoustic Neuroma Quality of Life (PANQOL) instrument.

Setting:
Acoustic Neuroma Association and a single tertiary referral center.

Patients:
Patients with sporadic VS.

Main Outcome Measures:
Domain-specific and total PANQOL scores comparing treatment modalities after adjusting for baseline covariates of interest.

Results:
Among all 1,288 respondents there were 229 (18%) who were recently diagnosed and had not yet selected a treatment modality, 303 (24%) who were observed, 185 (14%) who underwent radiosurgery alone, 507 (39%) who underwent microsurgery alone, and 64 (5%) who underwent radiosurgery and microsurgery. After adjusting for covariates of interest, total PANQOL scores were highest for the observation cohort (65; 95% CI 62–68), lowest for patients treated with multimodality therapy (56; 51–61) and those recently diagnosed (58; 55–62), and intermediate for those who received microsurgery alone (60; 58–62) and radiosurgery alone (61; 57–64) (global comparison, p = 0.001). When comparing groups that received single-modality therapy, there were no statistically significant differences in total PANQOL scores at short (0–5 yr), intermediate (6–10 yr), or long-term (≥11 yr) follow-up after adjusting for baseline covariates (all, p > 0.05).

Conclusion:
A new diagnosis of VS frequently imparts significant anxiety on the patient and leads to a temporary reduction in QOL. Notably, anxiety domain QOL scores among patients with newly diagnosed VS are poorer than patients who have observed their tumor for 6 months or longer. When feasible, an initial period of observation may afford patients valuable time to reconcile with the new diagnosis, to learn more about treatment options, and to discover whether there is tumor growth. In turn, this valuable information can be used to inform sound decision-making regarding tumor management.
Nystagmus Findings and Hearing Recovery in Idiopathic Sudden Sensorineural Hearing Loss Without Dizziness
Authors: Choi Hye Rang , Choi Seongjun , Shin Jung Eun , Kim Chang-Hee 
Published: October 2018

Objectives:
To investigate the incidence of nystagmus in patients with sudden sensorineural hearing loss (SSNHL) without dizziness, and to evaluate the correlation of the presence of nystagmus with hearing recovery in those patients.

Study Design:
Retrospective study.

Setting:
Tertiary referral academic medical center.

Patients:
Thirty-eight patients with SSNHL who did not complained of dizziness were enrolled.

Main Outcome Measure:
The presence of nystagmus was evaluated by recording eye movements, and if present, nystagmus was classified as direction-fixed or positional nystagmus. Vestibular function tests were performed, including caloric test.

Results:
Of 33 idiopathic SSNHL patients without dizziness, nystagmus was observed in 22 patients (67%), of which 14 patients exhibited direction-fixed nystagmus, and 8 patients exhibited direction-changing nystagmus. Among the 14 patients with direction-fixed nystagmus, 9 displayed the paretic type, and 5 displayed the irritative type. Direction-changing nystagmus (n = 8) was defined as that in which the direction of nystagmus was changed in a supine head-roll test, and the geotropic type and apogeotropic type were observed in two and six patients, respectively. The mean initial pure tone threshold was 58.2 ± 28.1 dB and 57.3 ± 20.0 dB in SSNHL patients with and without nystagmus, respectively, which was not significantly different (p = 0.925). When hearing improvement was compared according to the presence of nystagmus, 39% (8 of 21) of patients with nystagmus were found to belong in the good prognosis group, and 72% (8 of 11) of patients without nystagmus were found to belong in the good prognosis group, which showed marginal statistical significance (p = 0.063).

Conclusion:
Nystagmus was observed in two-thirds of idiopathic SSNHL patients without dizziness, and the pattern of nystagmus was either direction fixed or direction changing. Because hearing recovery was worse in patients with nystagmus than those without it, the diagnosis of nystagmus, even in SSNHL patients without dizziness, may be important in evaluating the hearing prognosis.
Expressions of KAI1 and E-cadherin in nonsmall cell lung cancer and their correlation with vasculogenic mimicry
Authors: Ci Hongfei , Xu Zhouyi , Xu Jing , Wang Yichao , Wu Shiwu 
Published: October 2018

Abstract

Background:
Metastasis and recurrence are the most common reasons for treatment failure of nonsmall cell lung cancer (NSCLC). Vasculogenic mimicry (VM, new blood supply formation in malignant tumors), E-Cadherin (a calcium-dependent transmembrane glycoprotein that mediates intercellular adhesion), KAI1 (a suppressor gene of tumor metastasis) are all valuable factors for metastasis and prognosis in diverse common human cancers. However, the correlation of VM, E-Cadherin, and KAI1 in NSCLC is still unclear. In this study, we analyzed the correlations among these factors as well as their respective correlations with clinicopathological parameters and survival in NSCLC.

Methods:
The level of VM, E-Cadherin, and KAI1 in 163 tissue samples of NSCLC was examined by immunhistochemistry. Clinical data were also collected.

Results:
Levels of VM was significantly higher, and levels of KAI1 and E-Cadherin significantly lower in NSCLC tissues than in normal lung tissues. Levels of VM were positively associated with lymph node metastasis (LNM), size, grade, and tumor node metastasis (TNM) stages, and negatively associated with patients’ overall survival (OS). Levels of KAI1 and E-Cadherin were negatively correlated with LNM, size, grade, and TNM stage, and positively associated with patients’ OS. In multivariate analysis, high levels of VM, E-Cadherin, and KAI1, as well as TNM stages were independently correlated with lower OS in patients with NSCLC.

Conclusion:
VM and the expression of E-Cadherin and KAI1 may represent promising metastatic and prognostic biomarkers, as well as potential therapeutic targets for NSCLC.
The clinical efficacy of using autologous platelet-rich plasma in total hip arthroplasty
Authors: Wang Xi , Ma Jianbin , Wang Zhiyuan , Xiao Lin 
Published: October 2018

Abstract
This study evaluated whether intra-articular platelet-rich plasma (PRP) might prevent postoperative bleeding in total hip arthroplasty (THA).
In this study, 260 hips that underwent THA were evaluated randomly by paramedical staffs, 130 of which involved the intraoperative use of PRP, and 130 of which served as control group. Postoperative blood loss (drain bag volume), estimated blood loss, and change in hemoglobin (Hb) at day 1, 2, 4, and 7 were analyzed, respectively.
PRP-treated group had a significant decrease in mean postoperative blood loss (92.6 ± 168.2 mL) compared to control group (682.3 ± 185.5 mL, P < .01). The mean postoperative estimated blood loss (526.1 ± 236.1 mL) in the PRP-treated group was significantly less than that in the control group (629.2.2 ± 142.3 mL, P < .01). There was a statistically significant difference in Hb value (mg/dL) at day 1, 2, 4, and 7 (−1.35 vs −1.98, −1.59 vs −2.52, −1.96 vs −2.82, and −1.76 vs −2.47, P < .05).
We found a significant reduction in postoperative blood loss (drain bag volume), estimated blood loss, and change in Hb after the use of autologous platelet gel in patients of THA, and PRP appears to be effective in reducing postoperative bleeding in THA.