bluuebunny/crossref_metadata_2025_split huggingface dataset:
Getting Addiction Into the Nursing Education “Water Supply”: A U.K. Case Study
Authors: Clancy Carmel , Oyefeso Adenekan 
Published: September 2019

Abstract
Evidence remains fundamentally unchanged over the last 30 years that nurses are not sufficiently prepared during their undergraduate education to work with alcohol and other drug (AOD) use. Employing a mixed-methods longitudinal panel design, our study objectives were to (a) explore perceptions among entry level nursing students regarding AOD work and (b) explore whether current alcohol and drug education efforts impact on the perception of AOD by nursing students over time. Two hundred forty-two students were recruited (94% response rate). Most (86%) of the study participants identified AOD training as relevant/extremely relevant to their future practice. After exposure to AOD sessions in the nursing curriculum, there was no significant change to participants' score on either alcohol or drug role security between T1 and T2/T3. However, there was a statistically significant improvement in alcohol therapeutic commitment between T1 and T2/T3 (F(2, 136) = 5.87, p < .01), but not between T2 and T3; conversely, drug therapeutic commitment was significantly higher at T2 but signficantly lower at T3 (F(2, 149) = 254.19, p < .0001). There was no significant difference in alcohol or drug role security between the three nurse training pathways. However, alcohol and drug therapeutic commitment scores at T1 were significantly higher in students taking the mental health field/track (F(2, 160) = 9.45, p < .001, and F(2, 236) = 15.23, p < .0001). Although the positive message is that students recognize the importance of the topic to their future practice, concerns remain regarding the impact and efforts of readiness for practice. Over a 3-year training period, no significant gains were made in increasing students' knowledge and skills, and their training experiences in clinical practice appear to have a negative effect on “therapeutic commitment” influenced by exposure/contact to patients with drug use disorders specifically and less than positive mentoring experiences with qualified nursing staff. How to address these issues is explored including the need to perhaps shift the focus of attention from “negative attitudes” held by students to exploring the barriers and obstacles in upskilling nursing faculty and clinical mentors so that they feel able and willing to teach and be a role model of good practice in this area.
Methamphetamine Use
Authors: Fogger Susanne A. 
Published: September 2019

Abstract

Background
The ongoing drug crisis in the United States continues to be headlined with numbers of deaths related to opioid overdose. Less known to the public and health care providers is the rise in methamphetamine use, often in conjunction with opioids or adulterated with fentanyl. An old practice with a new twist is the use of methamphetamine in conjunction with an opioid such as heroin.

Purpose
Although there are no Food and Drug Administration-approved medications to treat individuals with stimulant use disorders, a review of available studies suggests a few promising medications that may be helpful for patients in early recovery from methamphetamine.

Outcome
Some individuals are more likely to respond to medications such as long-acting naltrexone, bupropion, and mirtazapine, who have light-to-moderate use of methamphetamine. Naloxone kits should be considered for all patients who are actively using stimulants because of a high potential of adulterated methamphetamine.
The International Nurses Society on Addictions
Authors: Clancy Carmel , Fornili Katherine 
Published: September 2019

Abstract
The International Nurses Society on Addictions (IntNSA) believes that nurses are key to improving the well-being of individuals affected by substance use, including their families and friends and the society within which they live. It is essential that nurses are able to effectively influence change at local, organizational, systems, national, regional, and international levels.
Historically, IntNSA has drawn its membership from within the United States, reflective of its origins as a national organization. In recognition of the potential for a wider international impact, members voted to formally expand its membership and status to international in 2000. In 2014, members elected its first international member to the Board, and the Board established an International Development Task Force.
In 2015, the IntNSA Board outlined its plan for increasing opportunities for nurses around the world to collaborate to change and shape responses to addictions at all levels. In 2019, IntNSA's Board reviewed its progress, updated its plan, and developed consensus for further actions to be undertaken.
This Policy Watch column provides a transparent overview of IntNSA's plans for global development and an update on its current progress. Its aim is to keep current and potential IntNSA members, our agency partners and interdisciplinary colleagues, and nurses in all specialties, including addictions nurses, informed about this important work. These strategies will ensure that IntNSA will achieve its stated vision “to be a global leader in addictions nursing” and accomplish its mission “to advance excellence in addictions nursing practice through advocacy, collaboration, education, research and policy development” (www.intnsa.org).
Patient-controlled Sedation During Flexible Bronchoscopy
Authors: Grossmann Benjamin , Nilsson Andreas , Sjöberg Folke , Nilsson Lena 
Published: September 2019

Background:
Patient-controlled sedation (PCS) is a documented method for endoscopic procedures considered to facilitate early recovery. Limited data have been reported, however, on its use during flexible bronchoscopy (FB).

Methods:
This study hypothesized that PCS with propofol during FB would facilitate early recovery, with similar bronchoscopist and patient satisfaction compared with nurse-controlled sedation (NCS) with midazolam. A total of 150 patients were randomized 1:1:1 into a control group (premedication with morphine-scopolamine and NCS with midazolam), PCS-MS group (premedication with morphine-scopolamine and PCS with propofol), and PCS-G group (premedication with glycopyrronium and PCS with propofol).

Results:
The procedures included transbronchial biopsy, transbronchial needle aspiration, cryotherapy/biopsy, and/or multistation endobronchial ultrasound. FB duration values in median (range) were 40 (10 to 80), 39 (12 to 68), and 44 (10 to 82) minutes for the groups NCS, PCS-MS, and PCS-G, respectively. An overall 81% of the patients in the combined PCS groups were ready for discharge (modified Post Anaesthetic Discharge Scoring System, score 10) 2 hours after bronchoscopy compared with 40% in the control group (P<0.0001). Between PCS groups, 96% of the PCS-G group patients were ready for discharge compared with 65% in the PCS-MS group (P=0.0002) at 2 hours. Bronchoscopists’ and patients’ satisfaction scores were high in all groups. Postdischarge quality scores showed no differences among the groups.

Conclusion:
PCS with propofol during FB is feasible, as it shortened recovery time without compromising procedure conditions for bronchoscopists or patients. A rapid postsedation stabilization of vital signs facilitates surveillance before the patient leaves the hospital.
Predictors of Intraprocedural Respiratory Bronchoscopy Complications
Authors: May Anna M. , Kazakov Jordan , Strohl Kingman P. 
Published: September 2019

Purpose:
Sleep apnea can increase adverse outcomes during ambulatory surgery but not during gastrointestinal endoscopy. We hypothesize that STOP-BANG is associated with intraprocedural bronchoscopy respiratory complications.

Methods:
Consecutive patients undergoing bronchoscopy under moderate sedation were prospectively administered the STOP-BANG questionnaire. Participants were assessed for intraprocedural complications including hypoxemia (oxygen saturation≤85%), bradypnea (respiratory rate<8), premature procedure cessation as well as the use of nonrebreather mask, bag-mask ventilation, jaw lift/chin tilt, nasal/oral airway, and naloxone administration. Associations were assessed via logistic regression. Least absolute shrinkage and selection operator was used for multivariable model variable selection.

Results:
The 223 participants—mean age 61.1±15.5 years, body mass index 25.4kg/m2 (interquartile range: 22.4 to 30.7), 50.7% female, and 45.3% inpatient—had a high rate of respiratory complications (37.7%). There were no associations between STOP-BANG score and respiratory complications [odds ratio (OR)=1.07, 95% confidence interval (CI): 0.92-1.25]. Asthma was protective in univariable models (OR=0.26, 95% CI: 0.04-0.98), whereas endobronchial ultrasound (OR=2.34, 95% CI: 1.35-4.10) and the number of procedure types (OR=1.24, 95% CI: 1.01-1.51) was associated with increased complications. The following factors were associated with respiratory complications in both multivariable and univariate analyses: increasing age (OR=1.28/decade, 95% CI: 1.03-1.61), baseline oxygen use per each liters per minute (OR=1.57, 95% CI: 1.21-2.09), and bronchoscopy duration (OR=1.20/10 min, 95% CI: 1.08-1.33).

Conclusion:
Bronchoscopy respiratory complications are common. STOP-BANG was not associated with increased immediate bronchoscopy complication risk. Increasing age, oxygen use, and bronchoscopy duration were associated with respiratory complications; increased vigilance in these circumstances may prevent complications.
Safety of Early Repeated Thrombolysis
Authors: Caruso Paola , Furlanis Giovanni , Ridolfi Mariana , Ajcevic Milos , Naccarato Marcello , Manganotti Paolo 
Published: September 2019

Introduction:
Intravenous thrombolysis within 4.5 hours from symptom onset improves functional outcome in acute ischemic stroke patients. Repeated intravenous tissue plasminogen activator (IVtPA) is contraindicated in patients presenting with early recurrent stroke (ERS) within 3 months from the initial stroke because of a greater risk of intracranial hemorrhage.

Case Presentation:
A 59-year-old man presented with ERS, National Institute of Health Stroke Scale of 16, 10 days after a previous stroke. Brain computed tomography (CT) showed a previous hypodensity with 4 cm3 volume. Angio-CT highlighted the left middle cerebral artery and left internal carotid occlusion. Perfusion CT showed small deep core and large penumbra. The patient underwent IVtPA. After 24 hours, the National Institute of Health Stroke Scale was 7, and CT scan showed an acute ischemic lesion in the left basal ganglia area and frontal lobe without hemorrhagic transformation.

Conclusion:
This case report suggests that further randomized studies may evaluate whether repeated IVtPA may be safe and effective in ERS occurring shortly after a previous stroke when patients experience a period of complete neurological regression, minor disability, and a small infarct volume. Should the hypothesis be confirmed, small volume core and wide volume penumbra at perfusion CT may support the decision of adopting IVtPA repetition.
Intravenous Thrombolysis For Acute Ischemic Stroke in Fabry Disease
Authors: Kargiotis Odysseas , Psychogios Klearchos , Safouris Apostolos , Kalyvas Pericles , Magoufis Georgios , Stamboulis Eleftherios , Tsivgoulis Georgios 
Published: September 2019

Introduction:
Fabry is a rare X-linked recessive genetic disease caused by α-galactosidase A deficiency. Cerebrovascular events occur in ∼13% of patients, whereas stroke may be the presenting clinical manifestation. There are very limited case reports of tissue plasminogen activator administration for acute ischemic stroke in patients with Fabry disease.

Case report:
A 46-year-old man presented with right-sided hemiparesis with a National Institutes of Health Stroke Scale score of 3. Brain computed tomography showed a hyperdense lesion resembling carvenous angioma. The patient received intravenous thrombolysis 265 minutes after symptom onset, with clinical improvement (discharge National Institutes of Health Stroke Scale score of 1). Brain magnetic resonance imaging disclosed acute thalamic infarction, cavernous angioma, and multiple cerebral microbleeds. The presence of skin angiokeratomas and cardiac hypertrophy prompted further positive investigation for Fabry disease (nondetectable α-galactosidase activity, excessively elevated lyso-Gb3, and pathogenic deletion in the GLA gene).

Conclusion:
The present case supports the scarce data underscoring the safety of intravenous thrombolysis for acute ischemic stroke in Fabry disease patients even when cerebral microbleeds are present.
Cause or Consequence
Authors: Türay Sevim , Kabakuş Nimet , Hanci Fatma , Tunçlar Aslihan , Hizal Mustafa 
Published: September 2019

Aim:
The aims of our study were to refer to the complex relationship between idiopathic intracranial hypertension (IIHT) and cerebral sinovenous thrombosis (CSVT), and to determine the differences and commonalities between the patients with and without CSVT in their etiology, along with documenting the uncertainties in concluding on the diagnosis and treatment of these patients.

Material and Methods:
IIHT was diagnosed according to Dandy criteria, while CSVT was screened for by way of a cranial magnetic resonance imaging for all patients and cranial magnetic resonance venography only if the magnetic resonance imaging was nebulous or there was a family history.

Results:
We retrospectively evaluated a total of 26 patients (9 of whom had CSVT) diagnosed with IIHT between 2014 and 2018. A total of 9 patients with concurrent CSVT were described as suffering from vascular IIHT, while the remaining 17 were described as suffering from other IIHT. Demographic characteristics were similar in both groups (mean age: 12 vs. 11; male/female ratio: 2/7 vs. 5/12 in vascular IIHT and other IIHT, respectively). Clinical findings, cerebrospinal fluid-opening pressure values, and pathologies of etiology were also similar (vitamin D deficiency: 66% vs. 52%; vitamin B12 deficiency: 11% vs. none; iron deficiency: 22% vs. 11%; obesity: 22% vs. 23%). A mixture of acetazolamide, topiramate, anticoagulant therapy, and acetylsalicylic acid were given according to the diagnoses.

Conclusion:
CSVT is a common clinical entity among the causes of IIHT, and it should be taken into consideration in this patient group. However, there is a need for a common guideline for laboratory and imaging methods to understand the etiopathogenesis of childhood IIHT and determine the patients at risk.
Impact of Positive Feedback on Antimicrobial Stewardship in a Pediatric Intensive Care Unit: A Quality Improvement Project
Authors: Jones Alison S. , Isaac Rhian E. , Price Katie L. , Plunkett Adrian C. 
Published: September 2019

Introduction:
We hypothesized that antimicrobial stewardship (AMS) could be enhanced through positive feedback for the behaviors of healthcare professionals. This project aimed to reduce antimicrobial consumption in a Pediatric Intensive Care Unit (PICU) by >5%, with secondary aims to reduce broad-spectrum antimicrobial consumption, and processes related to AMS. Learning from Excellence is a positive feedback initiative conceptualized at our institution.

Methods:
This project took place over 12 months (April 2017–March 2018) in a 31-bedded PICU. We identified and measured processes about AMS daily. Healthcare professionals, achieving success in these processes, received positive feedback via Learning from Excellence, during a 6 months intervention period. Selected reports were followed with appreciative inquiry interviews to reinforce positive feedback. We calculated antimicrobial consumption data from existing databases (antimicrobial doses dispensed divided by PICU bed-days). Health Care-Associated Infection (HCAI) rates were included as a balancing measure.

Results:
Antimicrobial consumption was 6.5% lower during the intervention period compared with the matching period from the previous year. We reduced broad-spectrum antimicrobial (meropenem) consumption by 17.6%. Improvements in processes were mixed: a daily review of antimicrobials and documentation of antimicrobial prescription and administration significantly improved. Other processes failed to improve. HCAI rates did not change.

Conclusions:
Positive feedback can be used as a QI intervention to improve processes around AMS. This intervention may contribute to a reduction in antimicrobial consumption. Not all processes are impacted equally, and there may be a “dose-response” effect. Further evaluation would benefit from a trial study design in other settings.
Reducing Healthcare Costs in the Management of Pediatric Metacarpal Neck Fractures
Authors: Beals Corey , Lin James , Holstine Jessica B. , Samora Julie Balch 
Published: September 2019

Background:
We hypothesize that a quality improvement initiative utilizing a Velcro ulnar gutter brace over traditional casting will impart significant savings without compromising clinical outcomes in the management of small metacarpal neck fractures.

Methods:
Baseline data on number and treatment regimens of small metacarpal neck fractures were collected starting in October 2015. Velcro ulnar gutter braces were purchased for all orthopedic clinics in December 2016. Patients with <70 degrees of angulation and no rotational deformity of the small finger were eligible to have brace treatment without reduction of the fracture. Data were collected each month on several patients managed by Velcro ulnar gutter brace.

Results:
Three hundred twelve pediatric patients met nonoperative guidelines. Before the intervention, patients were casted and followed radiographically for a minimum of 2 orthopedic clinic visits—which total $916.25 in charges. From October 2015 to November 2016, we treated <1% (1/147) of patients with metacarpal neck fractures without casting. Following the implementation of interventions from December 2016 to January 2019, the percentage of patients treated without cast immobilization increased to 54.5% (90/165), with a process mean shift to >65%. These patients did not have a scheduled follow-up or further radiographic evaluation. In the first 26 months of implementation, this decreased healthcare expenditures by $261,846.

Conclusions:
A quality improvement initiative emphasizing Velcro ulnar gutter brace treatment for pediatric metacarpal neck fractures resulted in a shift away from cast immobilization in >65% of patients, reducing risks and expenses of cast immobilization.
The Complexity of Conducting a Multicenter Clinical Trial: Taking It to the Next Level Stipulated by the Federal Agencies
Authors: Chung Kevin C. , Malay Sunitha , Shauver Melissa J. 
Published: September 2019

Summary:
Randomized controlled trials are becoming increasingly difficult to organize and conduct efficiently. This, in turn, hinders the ability to derive the highest level of evidence. Often, investigators forget or remain unaware of essential practices that will help them fulfill their study goals. This article emphasizes the common issues that a study team experiences during the planning and conducting of randomized controlled trials. The authors sought to share remedies to overcome these issues with the experience garnered in conducting several multicenter clinical trials and observational studies. In addition, the authors list resources from sponsors such as the National Institutes of Health and the U.S. Food and Drug Administration that study teams can apply to undertake studies effectively.
Sonographic Evaluation of Genitourinary Inflammatory Pseudotumors and Its Mimics
Authors: Forrest Allison , Numbere Numbereye , Jean-Gilles Jerome , Dogra Vikram 
Published: September 2019

Abstract
Inflammatory pseudotumor is a relatively rare, nonneoplastic lesion composed of inflammatory cells and myofibroblastic spindle cells that can be identified on sonographic evaluation of the genitourinary system. These lesions are thought to be an inflammatory response to insults such as surgery, trauma, infection, or malignancy. Such lesions need to be distinguished from true neoplasms and other benign lesions, including inflammatory responses and infectious processes. Identification of inflammatory pseudotumors and its mimics is important for radiologists to guide patient treatment and follow-up. This pictorial essay presents sonographic features of inflammatory pseudotumors of the genitourinary tract and its mimics with cross-sectional imaging and histopathology, where available.
Development and Validation of Novel Three-Dimensional Craniofacial Landmarks on Cone-Beam Computed Tomography Scans
Authors: Liberton Denise K. , Verma Payal , Contratto Anthony , Lee Janice S. 
Published: September 2019

Abstract
As cone-beam computed tomography (CBCT) scans become increasingly common, it is vital to have reliable 3-dimensional (3D) landmarks for quantitative analysis of craniofacial skeletal morphology. While some studies have developed and used 3D landmarks, these landmark sets are generally small and derived primarily from previous 2-dimensional (2D) cephalometric landmarks. These derived landmarks lack information in parts of the skull such as the cranial base, which is an important feature for cranial growth and development. The authors see a real need for development and validation of 3D landmarks, particularly bilateral landmarks, across the skull for improved cephalometric analysis. The primary objective of this study is to develop and validate a set of 61 3D anatomical landmarks on the face, cranial base, mandible, and teeth for use in clinical and research studies involving CBCT imaging. Each landmark was placed 3 times by 3 separate trained observers on a set of 10 anonymized CBCT patient scans. Intra-rater and inter-rater estimates of consistency and agreement were calculated using the intraclass correlation coefficient. Measurement error was calculated per landmark and per X, Y, and Z landmark coordinate. The authors had high ICC estimates within rates, indicating high consistency, and high ICC estimates among raters, indicate good agreement across raters. Overall measurement error for each landmark and each X, Y, and Z coordinate was low. Our results confirm the accuracy of novel 3D landmarks including several on the cranial base that will serve researchers and clinicians for use in future studies involving 3D CBCT imaging and craniofacial development.
A Comparison of Surgical Outcomes of Two Combination Surgeries for Involutional Entropion: Fixing 3 vs 2 Pathologic Components
Authors: Yang Sungwon , Kim Seungheon , Baek Sehyun 
Published: September 2019

Abstract
The purpose of this study was to compare the surgical outcomes of two combinational surgeries for involutional entropion: Inferior retractor tightening (IRT) + lateral tarsal strip (LTS) + skin muscle excision (SME) vs LTS + SME. The authors reviewed the records of 2 groups which were made up of 80 (85 eyelids) and 58 (63 eyelids) involutional entropion patients with 71.4 and 71.8 years on average respectively. The 2 groups were categorized into Group A and Group B by different surgical techniques. The former underwent IRT + LTS + SME surgery between April 2004 and February 2014, while the latter received LTS + SME surgery between March 2014 and February 2018. The authors evaluated the surgical outcomes of 2 combinational surgeries. In Group A, 84 out of 85 (98.8%) lids were successfully corrected and 1 (1.2%) lower eyelid suffered from recurrence during the follow-up period of 26.5 ± 4.6 months. Two canthal deformity cases occurred in this group. In Group B, 62 out of 63 (98.2%) lids were successfully treated and there was 1 (1.8%) case of recurrence during the follow-up period of 21.0 ± 10.0 months. No cases of complications were noted. IRT + LTS + SME procedure took 26.4 ± 2.4 minutes and LTS + SME procedure took 20.6 ± 3.9 minutes (P < 0.001). The LTS + SME technique exhibited a comparable success rate with the IRT + LTS + SME operation. LTS + SME appeared to be significantly faster and safer compared to the IRT + LTS + SME procedure.