bluuebunny/crossref_metadata_2025_split huggingface dataset:
Genetics of vascular malformation and therapeutic implications
Authors: Zúñiga-Castillo Miguel , Teng Christopher L. , Teng Joyce M.C. 
Published: July 2019

Purpose of review
Vascular malformations (VaMs) are a consequence of disrupted morphogenesis that may involve arterial, capillary, venous, or lymphatic endothelium alone or in a combination. VaMs can have serious health impacts, leading to life-threatening conditions sometimes. Genetic mutations affecting proliferation, migration, adhesion, differentiation, and survival of endothelial cells, as well as integrity of extracellular matrix are believed to be the pathogenesis of these disorders. Here, we present an updated review of genetic mutations and potential therapeutic targets for VaMs.

Recent findings
Increased number of genetic mutations have been discovered in vascular anomalies via targeted deep sequencing. When a genetic defect is identified, it often presents in only a small percentage of cells within the malformation. In addition, mutations within the same gene may result in different clinical phenotypes. Management of VaMs can be challenging depending on the severity and functional impairment associated. There are no standard treatment algorithms available to date for VaMs, therefore the disorder has significant unmet clinical needs. Currently, the focus of therapeutic development is to target constitutively activated intracellular signaling pathways resulted from genetic mutations.

Summary
Knowledge about the genetic mutations and altered signaling pathways related to VaMs have improved our understanding about the pathogenesis of vascular anomalies and provided insights to the development of new targeted therapies.
Roles of Reexamination of Core Beliefs and Rumination in Posttraumatic Growth Among Parents of Children With Cancer
Authors: Irie Wataru , Shiwaku Hitoshi , Taku Kanako , Suzuki Yuko , Inoue Yukiko 
Published: July 2019

Background
Studies have indicated that the impact of a traumatic experience can be negative and can provide the opportunity to experience psychological growth, known as posttraumatic growth (PTG).

Objective
To evaluate the role of cognitive processing in PTG among parents of childhood cancer survivors (CCSs) based on the PTG theoretical model. We compared the model between parents of SCC and parents of children with chronic disease (CCDs) to determine how the role of cognitive processing in PTG is different depending on the children’s illness.

Methods
Final sample consisted of 78 parents of CCSs and 44 parents of CCDs. The survey included standardized measurements assessing reexamination of core beliefs, intrusive and deliberate rumination, posttraumatic stress symptoms, and PTG. The hypothetical relationships among the variables were tested by covariance structure analysis.

Results
Posttraumatic growth among parents of CCSs had significantly strong association with reexamination of core beliefs, but not with deliberate rumination. Reexamination of core beliefs was significantly more likely to foster PTG among parents of CCSs, whereas deliberate rumination was significantly more likely to be associated with PTG among parents of CCDs.

Conclusions
For parents of CCSs, reexamination of core beliefs had a greater impact on PTG than deliberate rumination. Our results suggest that support should focus on the process of reexamining core beliefs in facilitating PTG among parents of CCSs.

Implications for Practice
Nurses should provide parents of CCSs with reassurance regarding their experiences of the reexamination of core beliefs, which will likely lead to PTG.
A Concept Analysis of Parental Uncertainty in Illness of an Infant
Authors: Malin Kathryn Jeanne , Johnson Teresa S. 
Published: July 2019

Abstract

Background:
The concept of uncertainty in illness has been well described and applied to many different areas of nursing and other disciplines. Specifically, parental uncertainty in illness of an infant is a meaningful concept that has specific attributes and implications. A current concept analysis that considers the changing healthcare setting, historical conceptual inconsistencies, and a lack of information concerning parents of infants is needed.

Purpose:
To identify essential antecedents, attributes, and consequences of parental uncertainty in illness using Rodgers' Evolutionary Concept Analysis method.

Methods:
A literature search was conducted using PubMed, CINAHL, and PsycInfo. The following keywords were used in combination using the Boolean terms “AND” and “OR”: parental uncertainty; infants; parental uncertainty in illness; preterm infants; parent; uncertainty. Inclusion criteria: articles published between 2000 and 2017 and published in English. The search included 38 articles published from 2000 to 2017 with a specific focus on parental uncertainty in illness.

Findings:
Parental uncertainty in illness of an infant is a paradoxical, cognitive, and emotional experience in which there is an inability to create meaning and may cause disruption in parental role development.

Implications for Practice:
Nursing care of parents with ill infants and children must include sensitivity to parents' experiences of uncertainty in illness. Nurses are uniquely positioned to normalize parental uncertainty and facilitate healthy coping.
Care and Treatment Recommendations for Pregnant Women with Opioid Use Disorder
Authors: Reising Virginia A. , Bergren Martha Dewey , Bennett Amanda 
Published: July 2019

Abstract

Background:
Recent data suggest a significant increase in use of opioids among pregnant women. In the United States, reported rates of neonatal abstinence syndrome increased from 1.5 per 1,000 to 6.0 per 1,000 live births from 2000 to 2013. Use of opioids, both pharmacologic and nonpharmacologic, during pregnancy exposes women and babies to increased risks of adverse health outcomes. Professional organizations recommend addressing the complex needs of women who use opioids during pregnancy.

Objective:
The purpose is to review the role of nurses in the prenatal setting caring for pregnant women with opioid use disorder.

Methods:
We conducted a literature search using the CINAHL, PubMed, and PsycInfo electronic databases through January 2018 to identify best practices for referring women to treatment from the prenatal care office. Search terms included “substance use disorder,” “pregnancy,” “prenatal care,” “referral,” and “referral pathway.”

Results:
From our search, 68 abstracts were identified as relevant for review. Eight articles were selected for the analysis based on our focus. The findings assisted in development of our recommendations for nurses.

Clinical Implications:
During prenatal care, nurses can screen for opioid use disorder, develop positive relationships, and refer to treatment. This care should be based on values-neutral strategies to promote healthy outcomes for pregnant women and their babies.
Current Epidemiology of Vocal Cord Dysfunction After Congenital Heart Surgery in Young Infants
Authors: Gorantla Siddharth C. , Chan Titus , Shen Irving , Wilkes Jacob , Bratton Susan L. 
Published: July 2019

Objectives:
Surgery of the aortic arch poses risk of recurrent laryngeal nerve injury due to the anatomic proximity and can manifest as vocal cord dysfunction after surgery. We assessed risk factors for vocal cord dysfunction and calculated surgical procedure associated rates in young infants after congenital heart surgery.

Design:
Cross section analysis.

Setting:
Forty-four children’s hospitals reporting administrative data to Pediatric Health Information System.

Participants:
Cardiac surgical patients less than or equal to 90 days old and discharged between January 2004 and June 2014.

Interventions:
None.

Measurements and Main Results:
Overall, 2,319 of 46,567 subjects (5%) had vocal cord dysfunction, increasing from 4% to 7% over the study period. Of those with vocal cord dysfunction, 75% had unilateral partial paralysis. Vocal cord dysfunction was significantly more common in newborn infants (74%), those with aortic arch procedures (77%) and with greater surgical complexity. Rates of vocal cord dysfunction ranged from 0.7% to 22.4% across surgical procedure groups. Vocal cord dysfunction was significantly associated with greater use of: prolonged mechanical ventilation (53% vs 40%), diaphragmatic plication (3% vs 1%), feeding tube use (32% vs 8%), surgical airways (4% vs 2%), and prolonged length of stay (44 vs 21 d). Vocal cord dysfunction testing increased significantly over the study (6–14 %), and vocal cord dysfunction diagnosis increased almost two-fold (odds ratio, 1.9; 95% CI, 1.7–2.1) comparing the last to first study quarters with the increase in vocal cord dysfunction diagnosis occurring predominately in surgeries to the aortic arch supported by cardiopulmonary bypass. However, aortic procedures without cardiopulmonary bypass and nonaortic arch procedures were common surgeries accounting for 27% and 23% of vocal cord dysfunction cases despite low overall vocal cord dysfunction rates (3.7% and 2.6%).

Conclusions:
Vocal cord dysfunction complicated all cardiac surgical procedures among infants including those without aortic arch involvement. Increased efforts to determine appropriate indications for prevention, screening and treatment of vocal cord dysfunction among young infants after congenital heart surgery are needed.
Anemia at Discharge From the PICU: A Bicenter Descriptive Study
Authors: Demaret Pierre , Valla Frédéric V. , Behal Hélène , Mimouni Yanis , Baudelet Jean-Benoît , Karam Oliver , Recher Morgan , Duhamel Alain , Tucci Marisa , Javouhey Etienne , Leteurtre Stéphane 
Published: July 2019

Objective:
To determine the prevalence and risk markers of anemia at PICU discharge.

Design:
Bicenter retrospective cohort study.

Setting:
Two multidisciplinary French PICUs.

Patients:
All children admitted during a 5-year period, staying in the PICU for at least 2 days, and for whom a hemoglobin was available at PICU discharge.

Interventions:
None.

Measurements and Main Results:
Patient, admission, and PICU stay characteristics were retrospectively collected in the electronic medical records of each participating PICU. Anemia was defined according to the World Health Organization criteria. Among the 3,170 patients included for analysis, 1,868 (58.9%) were anemic at discharge from PICU. The proportion of anemic children differed between age categories, whereas the median hemoglobin level did not exhibit significant variations according to age. After multivariate adjustment, anemia at PICU admission was the strongest predictor of anemia at PICU discharge, and the strength of this association varied according to age (interaction). Children anemic at PICU admission had a reduced risk of anemia at PICU discharge if transfused with RBCs during the PICU stay, if less than 6 months old, or if creatinine level at PICU admission was low. Children not anemic at PICU admission had an increased risk of anemia at PICU discharge if they were thrombocytopenic at PICU admission, if they had higher C-reactive protein levels, and if they received plasma transfusion, inotropic/vasopressor support, or mechanical ventilation during the PICU stay.

Conclusions:
Anemia is frequent after pediatric critical illness. Anemia status at PICU admission defines different subgroups of critically ill children with specific prevalence and risk markers of anemia at PICU discharge. Further studies are required to confirm our results, to better define anemia during pediatric critical illness, and to highlight the causes of post-PICU stay anemia, its course, and its association with post-PICU outcomes.
Outcomes of Day 1 Multiple Organ Dysfunction Syndrome in the PICU*
Authors: Typpo Katri , Watson R. Scott , Bennett Tellen D. , Farris Reid W. D. , Spaeder Michael C. , Petersen Nancy J. 
Published: July 2019

Objectives:
We sought to describe current outcomes of Multiple Organ Dysfunction Syndrome present on day 1 of PICU admission.

Design:
Retrospective observational cohort study.

Setting:
Virtual Pediatric Systems, LLC, database admissions, January 2014 and December 2015.

Patients:
We analyzed 194,017 consecutive PICU admissions, (age 1 mo to 18 yr) from the 2014–2015 Virtual Pediatric Systems database.

Interventions:
We identified day 1 Multiple Organ Dysfunction Syndrome by International Pediatric Sepsis Consensus Conference criteria with day 1 laboratory and vital sign values. Functional status was evaluated by Pediatric Overall Performance Category and Pediatric Cerebral Performance Category scores from PICU admission and discharge.

Measurements and Main Results:
Overall, PICU mortality was 2.1%. We identified day 1 Multiple Organ Dysfunction Syndrome in 14.4% of admissions. Patients with Multiple Organ Dysfunction Syndrome had higher mortality than those without Multiple Organ Dysfunction Syndrome (10.3% vs 0.7%; p < 0.0001), and a higher percentage of survivors had greater than or equal to 2 category worsening in Pediatric Cerebral Performance Category score (3.6% vs 0.5%; p < 0.0001) or Pediatric Overall Performance Category score (6.0% vs 1.8%; p < 0.0001). The odds of death with day 1 Multiple Organ Dysfunction Syndrome was 14.3 (95% CI, 13–15.7), while the odds of death or discharge with Pediatric Overall Performance Category/Pediatric Cerebral Performance Category score greater than or equal to 3 (poor functional outcome) was 6.7 (95% CI, 6–7.4). In a subset of 148,188 patients from hospitals where limitation of support decisions were recorded, 5.8% patients with Multiple Organ Dysfunction Syndrome had limitation of support decisions in place, compared with 0.8% of patients without Multiple Organ Dysfunction Syndrome (p < 0.0001). Of day 1 Multiple Organ Dysfunction Syndrome patients who died, 43.1% had limitation of support decisions in place, and 41.6% had withdrawal of life-sustaining therapies (p < 0.0001).

Conclusions:
Multiple Organ Dysfunction Syndrome present on day 1 of admission continues to be a major source of morbidity and mortality in the PICU, but risk of poor neurologic outcome may be improved. Further research is needed to understand decisions regarding limitation of support and withdrawal of life-sustaining therapy decisions in patients admitted with day 1 Multiple Organ Dysfunction Syndrome.
Antipyretic Efficacy of Acetaminophen and Ibuprofen in Critically Ill Pediatric Patients
Authors: Moffett Brady S. , Gutierrez Kristina , Davis Kasey , Sigdel Binayak , Strobel Nathaniel 
Published: July 2019

Objectives:
To determine the antipyretic efficacy of acetaminophen (IV, enteral, rectal) and ibuprofen (enteral) in critically ill febrile pediatric patients.

Design:
Retrospective cohort study.

Setting:
Quaternary care pediatric hospital ICUs.

Patients:
Pediatric patients less than 19 years old who were febrile (≥ 38.0°C), received a dose of IV acetaminophen, enteral acetaminophen, rectal acetaminophen, or enteral ibuprofen and had at least one temperature measurement in the following 6 hours.

Interventions:
None.

Measurements and Main Results:
A total of 3,341 patients (55.8% male, median age 2.5 yr [interquartile range, 0.63–9.2 yr]) met study criteria. Baseline temperature was median 38.6°C (interquartile range, 38.3–38.9°C) measured via axillary (76.9%) route. Patients became afebrile (87.5%) at median 1.4 hours (interquartile range, 0.77–2.3 hr) after the first dose of medication, a –2.9 ± 1.6% change in temperature. Antipyretic medications included as follows: enteral acetaminophen (n = 1,664), IV acetaminophen (n = 682), rectal acetaminophen (n = 637), and enteral ibuprofen (n = 358). Enteral ibuprofen had a significantly greater odds of defervescence on multivariable logistic regression analysis (p = 0.04) with a decrease of –1.97 ± 0.89°C while IV acetaminophen was significant for a decreased time to defervescence at median 1.5 hours (interquartile range 0.8–2.3 hr) after a dose (p = 0.03). Patient age, presence of obesity, and baseline temperature were significant for decreased antipyretic efficacy (p < 0.05).

Conclusions:
Enteral ibuprofen was the most efficacious antipyretic and IV acetaminophen had the shortest time to defervescence.
Current Approach to the Evaluation and Management of Septic Arthritis
Authors: Gottlieb Michael , Holladay Dallas , Rice Melissa 
Published: July 2019

Abstract
Septic arthritis is an emergent condition caused by bacterial infection of a joint space. The most common etiology is hematogenous spread from bacteremia, but it can also occur from direct inoculation from bites, injection injuries, cellulitis, abscesses, or local trauma. Septic arthritis occurs most frequently in the lower extremities, with the hips and knees serving as the most common locations. The most sensitive findings include pain with motion of the joint, limited range of motion, tenderness of the joint, new joint swelling, and new effusion. Laboratory testing and imaging can support the diagnosis, but the criterion standard is diagnostic arthrocentesis. Treatment involves intravenous antibiotics and joint decompression.
Infections After Large Joint or Bursa Injection
Authors: Cushman Daniel M. , Christiansen Jacob , Clements Nathan D. , Cunningham Shellie , Teramoto Masaru , McCormick Zachary L. 
Published: July 2019

Objective
Despite the ubiquity of intra-articular and bursal injections for the treatment of joint pain and bursitis, relatively little literature is available on the prevalence of infection after these procedures. The aim of this study was to identify the number of infections recalled by sports medicine physicians who perform injections of large joints and bursae at least once per month.

Design
A survey of physician members of the American Medical Society for Sports Medicine identified the reported number of recalled infections for each large joint/bursal location.

Results
Of a total of 554 physicians, only 31 infections were recalled by 27 physicians. Only 4.87% of all physicians were aware of an infection after an injection during their career. On average, one infection was recalled of 170 physician-years in practice. No differences in infection rates were observed when comparing primary specialties (P = 0.281).

Conclusions
This study, the largest to date, demonstrates that sports medicine physicians rarely encounter infections after large joint and bursa injections. Though rare, because of their catastrophic nature, risk mitigation strategies should be maintained.
Early Quantitative Partial Weight-Bearing Exercise After Periarticular Fractures of the Tibia Using a Lower-Body Positive-Pressure Treadmill
Authors: Kim Ju Chan , Leigh Ja Ho , Jang Jun Young , Kim Jin-Kak , Cho Jae-Woo , Oh Jong-Keon , Nam Hyung Seok , Chung Sun Gun , Chang Yoon Hee , Lee Seung Hak 
Published: July 2019

Abstract
The partial weight-bearing protocol after lower limb fracture is an important issue in postoperative rehabilitation. Because it is difficult to quantify the actual weight load and provide a constant weight, the protocol is unestablished. By training with a lower-body positive-pressure treadmill and using an in-shoe pressure-measuring device, partial weight-bearing exercise can be performed with quantified loads. This case series illustrates the applicability of an early quantitative partial weight-bearing rehabilitation program using lower-body positive-pressure treadmill with an in-shoe pressure-measuring device after periarticular tibial fractures, which provides a quantitatively predetermined constant load.
Resident Education of Ultrasound-Guided Procedures
Authors: Charnoff Jesse , Naqvi Usker , Weaver Martin , Price Chanë 
Published: July 2019

Abstract
The aim of this study was to evaluate an agar model that could be used to train physicians to perform ultrasound-guided procedures. Eleven (N = 11) physical medicine and rehabilitation residents volunteered to be subjects. All subjects completed a questionnaire about their experience and comfort with ultrasound-guided procedures. In phase 1, subjects were instructed to identify specific structures and perform specific procedures on the agar models; these tasks were timed. All subjects were then given a short lecture on fundamentals of ultrasound-guided procedures and percutaneous needle tenotomy. In phase 2, subjects then performed the same tasks again on the agar model and completed the questionnaire again. Analysis was performed using paired t tests. The number of structures successfully identified significantly increased from phase 1 (mean = 1.45) to phase 2 (mean = 2.54) (P = 0.003). Time to complete the needle access task in phase 2 (mean = 258 secs) significantly decreased compared with phase 1 (mean = 394 secs) (P = 0.04). Subjectively, our participants reported that they felt more comfortable performing ultrasound-guided procedures (P = 0.005) and felt more familiar with percutaneous needle tenotomy (P = 0.00004) after using the model. In conclusion, residents demonstrated improvement in ultrasound-guided procedural skills and reported increased comfort performing these procedures after training on the agar model.
Elevated Preoperative Hemoglobin A1c Associated with Increased Wound Complications in Diabetic Patients Undergoing Primary, Open Carpal Tunnel Release
Authors: Cunningham Daniel J. , Baumgartner Rita E. , Federer Andrew E. , Richard Marc J. , Mithani Suhail K. 
Published: July 2019

Background:
An increased rate of complications has been demonstrated with increasing hemoglobin A1c value for a variety of orthopedic procedures, including arthroplasty and spine surgery. The authors investigated the effects of elevated hemoglobin A1c value on postoperative complications at the time of carpal tunnel release.

Methods:
This retrospective, cohort study evaluated all diabetic patients with a preoperative hemoglobin A1c value within 90 days of primary, open carpal tunnel release at a single academic institution within the past 10 years. Binary hemoglobin A1c thresholds were tested for association with outcomes of superficial or deep infection, delayed wound healing, and persistent symptoms using chi-square analysis. Multivariable models with adjustment for baseline and operative factors were then constructed. Odds ratios and 95 percent confidence intervals were displayed.

Results:
Hemoglobin A1c value greater than or equal to 7.8 percent was most strongly associated with an increased risk of all-cause wound healing complications (p = 0.049) at an odds ratio of 4.2 (95 percent CI, 1.0 to 17.7) in adjusted analyses. Six patients (4 percent) experienced delayed wound healing and five patients (4 percent) developed a superficial infection. Six patients (4 percent) reported persistent carpal tunnel syndrome symptoms.

Conclusions:
Diabetic patients undergoing open, primary carpal tunnel release with a hemoglobin A1c value of 7.8 percent or higher had a higher rate of postoperative wound complications compared to diabetic patients with improved preoperative glucose control. Diabetics with poor glycemic control should be counseled that their risk of postoperative complication is higher. Further work is needed to determine whether delaying surgery to optimize glucose control could result in a reduction of wound healing complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.