bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating and managing chronic idiopathic urticaria in adults
Authors: Webster Lindsay , Rider Nicholas L. , Archambault Mark E. 
Published: June 2018

ABSTRACT
Chronic idiopathic urticaria (CIU), also known as chronic spontaneous urticaria, is characterized by the presence of hives on most days of the week, for 6 weeks or longer, and without an identifiable or consistent cause. Evaluation is clinical and based on the presence of episodic urticarial lesions. Although patients are subject to overtesting during the diagnosis of CIU, guidelines suggest starting with three basic laboratory tests. Treatment is a stepwise approach, involving second-generation antihistamines, histamine2 antagonists, leukotriene receptor antagonists, first-generation antihistamines, and potent antihistamines. Refractory CIU requires adding alternative agents such as omalizumab, anti-inflammatory agents, and immunosuppressants.
Val & Holly: Teaching Empathy Through an Evolving Case Study
Authors: Leiningen Cheryl , Kelly Laura 
Published: June 2018

Abstract
With the demand for learning required technical skills continuing to increase, nurse educators must not lose sight of the importance of assisting undergraduate nursing students to develop skills essential for creating a trusting therapeutic relationship. Teaching empathy through a semester-long family care project presented as an unfolding case study can help students understand what it is like for a patient and family to struggle with the multiple issues associated with having a chronic disease.
Getting Students to Value Leadership Early in the Nursing Curriculum: Innovation Makes It Possible
Authors: Knight Candace C. , Hamilton Sharon H. 
Published: June 2018

Abstract
Introducing leadership content early in a nursing program and weaving related concepts throughout the curriculum allow students opportunities to try on leadership roles and styles and become more skilled in applying leadership concepts. This article describes the implementation and revision of a personal leadership course taught early in an undergraduate nursing curriculum using service-learning, simulation, and team-based learning. The innovative delivery of the course improved student satisfaction and relevance of leadership concepts to second-semester nursing students. The course is foundational and taken in addition to the traditional management and systems leadership course.
Self-Regulated E-Learning Modules for Prenursing Success
Authors: Briscoe Gina S. , Brown Lynn G. 
Published: June 2018

Abstract
To be successful in their courses, nursing students must possess and routinely practice a wide range of self-regulated learning skills. Self-monitoring and regulation of cognition, metacognition, and behaviors influence learning for nursing practice. As reading and studying for comprehension, effective note taking, and taking tests successfully are challenging for many students, faculty at a rural community college created five self-regulated e-learning modules to equip prenursing students with evidence-based techniques to facilitate learning. This article describes the framework of self-regulated learning, the learning modules, student feedback, and implications for nurse educators.
Development and Validation of Simulation-Based Procedural Checklists for Evaluation of Neonatal Nurse Practitioner Performance
Authors: Jarding Laura , Hogden Laurie A. , Messier Stephen E. , Kozmenko Valeriy , Simanton Edward , Bjornson Kerri , Ortman Brockmueller Charisse 
Published: June 2018

Background:
Neonatal nurse practitioner (NNP) procedural competence is essential. Procedural simulation provides opportunity to practice high-risk, low-frequency procedures and helps improve skill retention. A formal procedural simulation experience was created in an attempt to provide sufficient experience for NNPs. While preparing for the simulation experience, the group recognized the lack of validated competency metrics for most neonatal intensive care unit (NICU) procedures.

Purpose:
The purpose of this study was to create and validate procedural checklists measuring competence of NNPs participating in simulated performance of 9 high-risk NICU procedures.

Methods:
IRB approval was obtained and NNPs agreed to data collection. A self and peer assessment tool was developed and distributed to NNPs, nurses, and neonatologists to gather a baseline perception of procedural competency. Procedural checklists were then developed to measure/assess individual skills against a standard. Benchmark videos were created to demonstrate the standard approach to procedural performance. Each procedural skill performed by the NNP participant was scored by 3 individual evaluators: once in real time and twice by video recording analysis.

Findings/Results:
A Cronbach α was used to measure the reliability and validity of the procedural checklists. Comparison was made between live grading and video-based grading scores using analysis of variance. Difference between grading modalities was less than 3% and nonsignificant for 8 of 9 procedures. No significant difference was found between individual graders for any of the skills being evaluated and suggested high interrater reliability of the checklists.

Implications for Practice:
Objective, standardized procedural checklists are valid tools to evaluate NNP procedural skills in simulation. Procedural simulation experiences help strengthen skills, improve performance, and possibly improve patient outcomes.
Comparing N-PASS and NIPS
Authors: Desai Amita , Aucott Susan , Frank Karen , Silbert-Flagg JoAnne 
Published: June 2018

Background:
Proper assessment of pain is essential to allow for safe and compassionate care of infants in the neonatal intensive care unit (NICU). The Neonatal Infant Pain Scale (NIPS) used in an urban level IV NICU addresses acute pain but may not adequately measure chronic neonatal pain.

Purpose:
The purpose of this quality improvement study was to improve acute and chronic pain measurements for neonates in an NICU through implementation of the Neonatal Pain, Agitation, and Sedation Scale (N-PASS).

Methods/Search Strategy:
An evidence search for a comprehensive tool to assess neonatal pain in the setting of a 45-bed level IV NICU was completed. The N-PASS was found to be inclusive of measuring acute and chronic neonatal pain. Participants for a quality improvement study, including NICU nurses and providers, were educated on the N-PASS. Nurses documented in the N-PASS and the NIPS during routine pain assessments for NICU infants for comparison. Participants completed a survey assessing knowledge of the N-PASS.

Findings/Results:
When compared, the N-PASS generated 98% of pain scores greater than the NIPS. Surveys demonstrated an increase in staff knowledge for the N-PASS.

Implications for Practice:
Implementation of a multidimensional pain tool that measures acute and chronic pain is essential for proper pain assessment. Providers can manage neonatal pain when accurate documentation is available.

Implications for Research:
Further research evaluating guided management of acute and chronic pain scores on the N-PASS would aid hospital policies on therapies for neonatal pain.
Evolution of Delivery Room Management for Meconium-Stained Infants
Authors: Chabra Shilpi 
Published: June 2018

Background:
The approach to intrapartum and postnatal management of an infant born through meconium-stained amniotic fluid (MSAF) in the delivery room (DR) has changed several times over the last few decades, leading to confusion and anxiety among health care providers (nurses, nurse practitioners, respiratory therapists, midwives, and physicians). This article provides state-of-the-art insight into the evidence or lack thereof for the changes in guidelines.

Purpose:
To discuss the evidence for evolution of DR management of vigorous and nonvigorous infants born through any type of MSAF.

Methods:
Review of guidelines from the Neonatal Resuscitation Program of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, the International Liaison Committee on Resuscitation, Consensus on Science and Treatment Recommendations, and textbooks of neonatal resuscitation and research using MEDLINE via PubMed.

Findings:
In pregnancies complicated by MSAF, intrapartum suctioning of the oro- and nasopharynx and postnatal intubation with tracheal suctioning of infants have been traditionally used to clear the airway and decrease meconium aspiration syndrome. The recommendations for these perinatal practices have changed several times due to some evidence that the procedures are not beneficial and may even be harmful.

Implications for Practice:
Intrapartum suctioning and postnatal tracheal suctioning of infants (vigorous or nonvigorous) born through MSAF are not recommended. This is a “high-risk” delivery requiring 2 team members to be present at birth—one with full resuscitation skills including tracheal intubation.

Implications for Research:
Need to evaluate effects of discontinuing the practice of tracheal suctioning in nonvigorous infants on the incidence of meconium aspiration syndrome and neonatal mortality.
Introduction of Continuous Video EEG Monitoring into 2 Different NICU Models by Training Neonatal Nurses
Authors: Goswami Ipsita , Bello-Espinosa Luis , Buchhalter Jeffrey , Amin Harish , Howlett Alexandra , Esser Michael , Thomas Sumesh , Metcalfe Cathy , Lind Jan , Oliver Norma , Kozlik Silvia , Mohammad Khorshid 
Published: June 2018

Background:
Continuous video electroencephalographic (EEG) (cvEEG) monitoring is emerging as the standard of care for diagnosis and management of neonatal seizures. However, cvEEG is labor-intensive and the need to initiate and interpret studies on a 24-hour basis is a major limitation.

Purpose:
This study aims at establishing consistency in monitoring of newborns admitted to 2 different neonatal intensive care units (NICUs) managed by the same neurocritical care team.

Methods:
Neonatal nurses were trained to apply scalp electrodes, troubleshoot technical issues, and identify amplitude-integrated EEG abnormalities. Guidelines, checklists, and visual training modules were developed. A central network system allowed remote access to the cvEEGs by the epileptologist for timely interpretation and feedback. A cohort of 100 infants with moderate to severe hypoxic-ischemic encephalopathy before and after the training program was compared.

Results:
During the study period, 192 cvEEGs were obtained. The time to initiate brain monitoring decreased by 31.5 hours posttraining; this, in turn, led to an increase in electrographic seizure detection (20% before vs 34% after), decrease in seizure clinical misdiagnosis (65% before and 36% after), and reduction in antiseizure medication burden.

Implications for Practice:
Training experienced NICU nurses to set up, start, and monitor cvEEGs can decrease the time to initiate cvEEGs, which may lead to better seizure diagnosis and management.

Implications for Research:
Further understanding of practice bundles for best supporting infants at risk and being treated for seizures needs to be evaluated for integration into practice.

Video Abstract Available at
https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.
Comparison of Neonatal Nursing Practices for Determining Feeding Tube Insertion Length and Verifying Gastric Placement With Current Best Evidence
Authors: Parker Leslie A. , Withers Jessica H. , Talaga Elizabeth 
Published: June 2018

Background:
Oral-nasogastric feeding tubes (FTs) are often malpositioned, placing infants at risk for complications. Confusion exists regarding the accuracy of methods to determine FT insertion length and verify gastric FT placement, and it is unknown whether evidence-based methods are used by neonatal nurses.

Purpose:
To compare individual and unit-based neonatal nursing practices regarding methods used to determine FT insertion length and verify gastric FT placement.

Methods:
Neonatal nurses were surveyed about individual and unit-based practices regarding methods used to determine FT insertion length and verify gastric FT placement in infants in the neonatal intensive care unit.

Results:
Sixty neonatal nurses completed the survey, with 63% utilizing the nose-ear-midway to the umbilicus method, which was included in 50% of protocols and is associated with up to a 90% accuracy rate. Although it has an unacceptably high inaccuracy rate, the nose-to-ear-to-xiphoid method was used by 32% of nurses and recommended in 30% of protocols. To verify gastric FT placement, 98% of nurses used auscultation of a whoosh sound and 83% used aspiration of gastric contents. Neither verification method is supported by evidence or recommended for use.

Implications for Practice:
A lack of consistency exists between nursing practice and evidence-based methods.

Implications for Research:
Research is needed to determine more accurate and reliable ways to determine FT insertion depth and verify gastric FT placement in neonates.
Interpregnancy Interval and Singleton Live Birth Outcomes From In Vitro Fertilization
Authors: Quinn Molly M. , Rosen Mitchell P. , Huddleston Heather G. , Cedars Marcelle I. , Fujimoto Victor Y. 
Published: June 2018

OBJECTIVE:
To describe the relationship between a short interpregnancy interval and adverse pregnancy outcomes in the population undergoing assisted reproductive technology.

METHODS:
This is a retrospective analysis using data from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System. The cohort includes patients with a history of live birth from assisted reproductive technology who returned for a fresh, autologous in vitro fertilization (IVF) cycle from 2004 to 2013. Interpregnancy interval was defined as the interval from live birth to cycle start. Logistic regression models of preterm delivery (less than 37 weeks of gestation) and low birth weight (less than 2,500 g) on interpregnancy interval were fit with adjustment for age, body mass index, and history of preterm delivery. Predicted probabilities were generated from the logistic model.

RESULTS:
Of 51,997 fresh IVF cycles after an index live birth, 17,536 resulted in a repeat live birth with 11,271 singleton live births from autologous IVF. An interpregnancy interval of less than 18 months occurred in 40.9% of cycles. Compared with a reference interpregnancy interval of 12 to less than 18 months, the adjusted odds ratio for singleton preterm delivery was 1.66 (95% CI 1.05–2.65) for an interpregnancy interval less than 6 months and 1.34 (95% CI 1.06–1.69) for 6 to less than 12 months. An interpregnancy interval 6 to less than 12 months was associated with a 3.0% increase in preterm delivery (13.6±1.1% vs 10.6±0.7%, P=.030) and a 2.7% increase in low birth weight (8.0±0.9% vs 5.3±0.5%, P=.025) compared with an interpregnancy interval of 12 to less than 18 months.

CONCLUSION:
In this nationally representative population, an interval from delivery to treatment start of less than 12 months is associated with increased rates of preterm delivery and low birth weight in singleton live births from assisted reproductive technology. The data support delaying the start of IVF treatment 12 months from a live birth, but do not suggest a benefit from a longer interval as has been recommended for naturally conceiving couples.
A 17β-Estradiol–Progesterone Oral Capsule for Vasomotor Symptoms in Postmenopausal Women
Authors: Lobo Rogerio A. , Archer David F. , Kagan Risa , Kaunitz Andrew M. , Constantine Ginger D. , Pickar James H. , Graham Shelli , Bernick Brian , Mirkin Sebastian 
Published: June 2018

OBJECTIVE:
To evaluate efficacy, endometrial safety, and overall safety of a single-capsule 17β-estradiol–progesterone (TX-001HR) for treating menopausal moderate-to-severe vasomotor symptoms.

METHODS:
REPLENISH was a phase 3, 12-month, randomized, double-blind, placebo-controlled, multicenter trial. Women (aged 40–65 years) with vasomotor symptoms and a uterus were randomized to daily estradiol (mg)–progesterone (mg) (1/100, 0.5/100, 0.5/50, or 0.25/50), and women in the vasomotor symptoms substudy (women with moderate-to-severe hot flushes [seven or greater per day or 50 or greater per week]) to those estradiol–progesterone doses or placebo. The primary safety endpoint was endometrial hyperplasia incidence at 12 months in all women (the total population), and the primary efficacy endpoints were frequency and severity changes (from daily diaries) in moderate-to-severe vasomotor symptoms with estradiol–progesterone compared with placebo at weeks 4 and 12 in the vasomotor symptoms substudy. A sample size of 250 women in each active treatment arm with two or less endometrial hyperplasia cases would result in 1% or less annual incidence (upper bound 2.5% or less, one-sided 95% CI).

RESULTS:
One thousand eight hundred forty-five women were enrolled and randomized from August 2013 to October 2015; 1,835 received medication (safety population); 1,255 were eligible for the endometrial safety population; 726 comprised the vasomotor symptoms substudy; their mean age and body mass index were 55 years and 27, respectively; one third were African American. No endometrial hyperplasia was found. Frequency and severity of vasomotor symptoms significantly decreased from baseline with 1 mg estradiol and 100 mg progesterone and 0.5 mg estradiol and 100 mg progesterone compared with placebo at week 4 (frequency: by 40.6 and 35.1 points [1 mg and 100 mg and 0.5 mg and 100 mg, respectively] vs 26.4 points [placebo]; severity: by 0.48 and 0.51 vs 0.34 points) and week 12 (by 55.1 and 53.7 vs 40.2; severity: by 1.12 and 0.90 vs 0.56); 0.5 mg estradiol and 50 mg progesterone improved (P<.05) frequency and severity at week 12, and 0.25 mg estradiol and 50 mg progesterone frequency but not severity at weeks 4 and 12.

CONCLUSION:
No endometrial hyperplasia was observed while single-capsule estradiol–progesterone provided clinically meaningfully improvements in moderate-to-severe vasomotor symptoms. This estradiol–progesterone formulation may represent a new option, using naturally occurring hormones, for the estimated millions of women using nonregulatory-approved, compounded hormone therapy.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT01942668.
Feasibility of Complete Salpingectomy Compared With Standard Postpartum Tubal Ligation at Cesarean Delivery
Authors: Subramaniam Akila , Blanchard Christina T. , Erickson Britt K. , Szychowski Jeff , Leath Charles A. , Biggio Joseph R. , Huh Warner K. 
Published: June 2018

OBJECTIVE:
To evaluate the feasibility of salpingectomy compared with standard bilateral tubal ligation at the time of cesarean delivery in women with undesired fertility.

METHODS:
We included women at 35 weeks of gestation or greater desiring permanent sterilization at the time of cesarean delivery. Patients were randomized after skin incision to bilateral salpingectomy or bilateral tubal ligation by a computer-generated scheme. If salpingectomy could not be completed on one or both sides, bilateral tubal ligation was attempted. Primary feasibility outcomes were total operative time and bilateral completion of the randomized procedure. Secondary outcomes included clinically estimated blood loss and surgical complications up to 6 weeks postpartum. We estimated that 80 patients (40 per group) would provide greater than 80% power to identify a 10-minute difference in the primary outcome (time) with a SD of 15 minutes and a two-sided α of 0.05. Analysis was by intent to treat.

RESULTS:
Of 221 women screened from June 2015 to April 2017, 115 (52%) consented to the study; 80 were randomized—40 to salpingectomy and 40 to bilateral tubal ligation. Groups were similar at baseline. A total of 27 bilateral salpingectomies were successfully completed compared with 38 bilateral tubal ligations (68% compared with 95%, P=.002). Total operative time was on average 15 minutes longer for salpingectomies (75.4±29.1 compared with 60.0±23.3 minutes, P=.004). No adverse outcomes directly related to the sterilization procedure were noted in either group. Although estimated blood loss of only the sterilization procedure (surgeon estimate) was greater for the salpingectomy group (median 10 [interquartile range 5–25] compared with 5 [interquartile range 5–10] cc, P<.001), total estimated blood loss and safety outcomes were similar for both groups.

CONCLUSION:
Adding 15 minutes to total operative times, salpingectomy can be successfully completed in approximately two thirds of women desiring permanent contraception with cesarean delivery.

CLINICAL TRIAL REGISTRATION:

Clinicaltrials.gov, NCT02374827.
Clinical Variables Associated With Adverse Maternal Outcomes in Puerperal Group A Streptococci Infection
Authors: Kaiser Jennifer E. , Bakian Amanda V. , Silver Robert M. , Clark Erin A. S. 
Published: June 2018

OBJECTIVE:
To identify clinical variables associated with increased risk of composite adverse outcome in a cohort of women with puerperal group A streptococci infection.

METHODS:
Our prospective case registry enrolled patients between 1991 and 2017. Chart abstraction was conducted for admission demographic and clinical data in patients with culture-proven puerperal group A streptococci infection. We created a composite variable of signs of capillary leakage including pulmonary edema, pleural effusion, ascites, and abdominal distention. The composite adverse outcome included death, hysterectomy, intensive care unit admission, mechanical ventilation, and blood transfusion. Clinical characteristics were compared between those with a composite adverse outcome and those without. We fit unadjusted log-linear models with robust error variance to measure the relative risk of a composite adverse outcome associated with clinical and demographic variables among patients with group A streptococci.

RESULTS:
Thirty-five of 71 (49%) patients had an adverse outcome. Women who had adverse outcomes had higher admission heart rates (126±19 vs 112±22 beats per minute, P=.008) and respiratory rates (26±10 vs 20±5 breaths per minute, P=.01), lower systolic blood pressure (98±24 vs 114±19 mm Hg, P=.004), and were more likely to have signs of capillary leakage (77% vs 20%, P<.001) and symptoms of capillary leakage (dyspnea, cough, shoulder pain, abdominal bloating, and chest pain) (40% vs 17%, P=.03) compared with those without adverse outcomes. Log-linear models indicated that these clinical variables were individually associated with increased risk of a composite adverse outcome. The relative risk of an adverse outcome was 3.5 times higher among women with signs of capillary leakage (relative risk 3.67, 95% CI 1.94–6.94, P<.001).

CONCLUSION:
Vital sign parameters consistent with severe infection correlate with adverse outcomes in women with puerperal group A streptococci infection. Signs of capillary leakage are most strongly associated with a composite adverse outcome. These clinical characteristics, particularly signs of capillary leakage, are potentially useful to guide clinical care.