bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic readiness tests: Preparing nurse practitioner students for national certification examinations
Authors: Coppa Denise , Barcelos Winchester Suzy 
Published: March 2019

ABSTRACT

Background and purpose:
Nurse practitioner (NP) faculties are challenged to offer programs that balance didactic knowledge with the clinical experiences required to prepare graduates for the complexities of health care. Students have the stress of extrapolating the information they obtain during these programs and applying it to postgraduation certification examinations. Innovative educational tools are necessary to ease the uncertainty that NP students experience to graduate and pass certification examinations. Tools include academic–clinical partnerships (ACPs) to enhance clinical opportunities and resources to integrate diagnostic readiness tests (DRTs) into curricula.

Methods:
This was a quasi-experimental one group, pretest/posttest design using a convenience sample of NP students randomly assigned to clinical in ACP or non-ACP clinical placements. They completed the DRTs twice during their final program semesters.

Conclusions:
The overall DRT group scores for the NP students significantly improved over time. The Wilcoxon signed ranks test showed that the posttest scores were significantly higher than the pretest scores. The Mann–Whitney U test revealed no differences between the ACP and non-ACP students. Students performed the best on assessment, diagnosis, management, and pharmacology domains. This demonstrates support for the integration of DRTs into NP programs.

Implications for practice:
Integrating DRTs into NP programs can facilitate transition to the NP role.
MedManage: The development of a tool to assist medication reconciliation in a rural primary care clinic
Authors: Jarrett Traci , Cochran Jill , Baus Adam , Delmar Kayla 
Published: March 2019

ABSTRACT

Background:
Medication reconciliation is a critical step in the health care process to prevent hospital readmission, adverse drug events, and fall prevention. The purpose of the study was to pilot test a medication reconciliation process, MedManage, informed by the Medications at Transitions and Clinical Handoffs (MATCH) toolkit with nursing staff in a rural primary care clinic.

Methods:
The research team conducted 38 chart audits of high-risk patients, and preintervention and postintervention were conducted to assess changes in medications reported by patients. The intervention included a chart audit tool and medication reconciliation tool created by the interdisciplinary team, MedManage, were pilot tested in the clinic.

Conclusions:
The Use of MedManage resulted in improvements in patient reporting of over-the-counter (82% of patients reported previously unrecorded OTCs), PRN medications (3% unreported), and herbal supplements/vitamins (28% reported previously unrecorded vitamins).

Implications for Practice:
MedManage may be an effective tool to assist clinical nursing staff to attain a more complete and accurate medication list from patients and should be assessed more broadly across rural primary care clinics.
Assessment of Cochlear Implant Revision Surgeries in a Cohort of 802 Patients
Authors: Karamert Recep , Düzlü Mehmet , Tutar Hakan , Eravcı Fakih Cihat , Türkcan Alper Kutalmış , Zorlu Mehmet Ekrem , Uğur Mehmet Birol , Cebeci Süleyman , Bezgin Selin Üstün , Cevizci Raşit , Bayazıt Yıldırım Ahmet 
Published: March 2019

Objective:
To assess the etiology, demographics, rates and outcomes of revision surgeries, and device survival rates after cochlear implantation.

Study Design:
Retrospective case review.

Setting:
Tertiary Otology & Neurotology center.

Patients:
Cochlear implantees who received revision surgeries after implantation

Interventions:
Any surgical intervention, performed due to device failure or the major complications of cochlear implantation.

Main Outcome Measure:
Medical records of the patients who received cochlear implants (CIs) between July 2002 and March 2018 were reviewed retrospectively regarding postoperative complications. Demographic data, device survival rates, and causes of revisions were recorded.

Results:
Totally, 924 implantations were performed in 802 patients. Eighty one (8.7%) of them underwent 102 revision surgeries. The most common causes of revision surgeries were device failures and flap related problems which were seen in 28 and 18 patients, respectively.
Overall CI survival rate was 91.9% in a 10 years period, which remained almost stable after 10 years. Although age was not found to be related with device failure (p = 0.693), device loss rates were significantly higher in adult implantees than children (p = 0.006).

Conclusion:
Device failure seems the most common cause of revision. The revision surgeries are usually safe and help to resolve the problem although flap problems are the most difficult to treat and may necessitate multiple revision surgeries. The device failure rate may reach to a plateau after 6 years. Overall CI survival rate exceeds 90% in 10 years period, and then remains stable.
Does Transfer to Intensive Care Units Reduce Mortality? A Comparison of an Instrumental Variables Design to Risk Adjustment
Authors: Keele Luke , Harris Steve , Grieve Richard 
Published: March 2019

Background:
Instrumental variable (IV) analysis can estimate treatment effects in the presence of residual or unmeasured confounding. In settings wherein measures of baseline risk severity are unavailable, IV designs are, therefore, particularly appealing, but, where established measures of risk severity are available, it is unclear whether IV methods are preferable.

Objective:
We compared regression with an IV design to estimate the effect of intensive care unit (ICU) transfer on mortality in a study with well-established measures of risk severity.

Research Design:
We use ICU bed availability at the time of assessment for ICU transfer as an instrument. Bed availability increases the chance of ICU admission, contains little information about patient characteristics, and it is unlikely that bed availability has any direct effect on in-hospital mortality.

Subjects:
We used a cohort study of deteriorating ward patients assessed for critical care unit admission, in 49 UK National Health Service hospitals between November 1, 2010, and December 31, 2011.

Measures:
Detailed demographic, physiological, and comorbidity data were collected for all patients.

Results:
The risk adjustment methods reported that, after controlling for all measured covariates including measures of risk severity, ICU transfer was associated with higher 28-day mortality, with a risk difference of 7.2% (95% confidence interval=5.3%–9.1%). The IV estimate of ICU transfer was −5.4% (95% confidence interval=−47.1% to 36.3%) and applies to the subsample of patients whose transfer was “encouraged” by bed availability.

Conclusions:
IV estimates indicate that ICU care is beneficial but are imprecisely estimated. Risk-adjusted estimates are more precise but, even with a rich set of covariates, report that ICU care is harmful.
Bone marrow aspirate concentrate with cancellous allograft versus iliac crest bone graft in the treatment of long bone nonunions
Authors: Lin Kenneth , VandenBerg James , Putnam Sara M. , Parks Christopher D. , Spraggs-Hughes Amanda , McAndrew Christopher M. , Ricci William M. , Gardner Michael J. 
Published: March 2019

Abstract

Objectives:
The purpose of this study was to compare bone marrow aspirate concentrate (BMAC) with cancellous allograft to iliac crest bone graft (ICBG) in the treatment of long bone nonunions.

Design:
Retrospective cohort study.

Setting:
A single level I trauma center.

Patients:
26 patients with long bone diaphyseal or metaphyseal nonunions with defects >2 mm and treated with open repair and BMAC, compared to 25 patients with long bone diaphyseal or metaphyseal nonunions with defects >2 mm and treated with open repair and ICBG.

Intervention:
Open repair of long bone nonunion using either autologous ICBG or BMAC with cancellous allograft.

Main outcome measure:
Nonunion healing, radiographically measured by the modified Radiographic Union Score for Tibia (mRUST) score. Secondary outcomes included risk factors associated with failed repair.

Results:
The union rates for the BMAC and ICBG cohorts were 75% and 78%, respectively (P = .8). Infection was the only risk factor of statistical significance for failure.

Conclusion:
In this study, we found no significant difference in union rate for long bone nonunions treated with ICBG or BMAC with allograft. BMAC and allograft led to 75% successful healing in this series. Given the heterogeneity of the control group and loss to follow-up, further prospective investigation should be conducted to more rigorously compare BMAC to ICBG for nonunion treatment.

Level of evidence:
III, retrospective cohort.
Acute total hip arthroplasty versus open reduction internal fixation for posterior wall acetabular fractures in middle-aged patients
Authors: MacCormick Lauren M. , Lin Carol A. , Westberg Jerald R. , Schmidt Andrew H. , Templeman David C. 
Published: March 2019

Abstract

Introduction:
Open reduction internal fixation (ORIF) is the standard of care for displaced acetabular fractures, but the inability to achieve anatomic reduction, involvement of the posterior wall, articular impaction, and femoral head cartilaginous injury are known to lead to poorer outcomes. Acute total hip arthroplasty (THA) is a reasonable treatment option for older patients with an acetabular fracture and risk factors for a poor outcome, but it is only described in case series. The purpose of this study is to compare outcomes of ORIF and acute THA in middle-aged patients with an acetabular fracture from a single center.

Methods:
Retrospective case-controlled study of patients aged 45 to 65 years old with acetabular fractures involving the posterior wall treated with acute THA or ORIF at a level 1 trauma center between 1996 and 2011. Patients were matched by fracture pattern and age at a 2 (ORIF):1 (acute THA) ratio. Functional outcome, complications, and reoperation rates of acute THA and ORIF were compared.

Results:
Sixteen acute THA patients (average age 56.4 years) and 32 ORIF patients (average age 54.3 years) were evaluated at an average follow-up of 6.2 years (range 1–15.2). The average Oxford Hip Score in the acute THA group was 44 compared to 40 in the ORIF group (P = .075). Complication rates were similar between both the groups. Twelve hips (37%) in the ORIF group had undergone THA or been referred for THA, and 2 revisions (13%) had occurred in the acute THA group. A Kaplan–Meier survival analysis showed that those undergoing acute THA had significantly better survival of their index procedure (P = .031).

Conclusions:
Both ORIF and acute THA for high-energy acetabular fractures involving the posterior wall in middle-aged patients can provide excellent results, with acute THA patients achieving improved survival of the index procedure and improved functional scores.
Prevalence and patterns of traumatic bone loss following open long bone fractures at Mulago Hospital
Authors: Kironde Edward , Sekimpi Patrick , Kajja Isaac , Mubiri Paul 
Published: March 2019

Abstract

Introduction:
Significant traumatic bone loss in developed countries occurs in a high proportion of open fractures ranging from 11.4% to 40%. However, literature from developing countries such as Uganda scarcely documents the prevalence and patterns of traumatic bone loss. Direct trauma and iatrogenic factors have been associated with traumatic bone loss as possible etiologies.

Objective:
The study was aimed at establishing the prevalence and patterns of traumatic bone loss following open long bone fractures, and identifying factors associated with traumatic bone loss among patients presenting to Mulago Hospital within 24 hours of sustaining the injury up to completion of the initial fracture debridement, reduction, and fixation.

Methodology:
It was a prospective cohort study conducted at Mulago Hospital. A total of 136 open long bone fractures were registered and physically examined for traumatic bone loss. Patients who consented were recruited consecutively to participate in the study. Data on the patients’ sociodemographics and fracture patterns were collected using pretested questionnaires and analyzed using Stata version 12.

Results:
From 123 patients, a total of 136 open long bone fractures were registered. The prevalence of traumatic bone loss following open long bone fractures was 26.5%. Of the 36 open long bone fractures with traumatic bone loss, the more common pattern (61.1%) was significant traumatic bone loss (≥ 2.5 cm long). Commercial motorcycle riders (22.0%) and traders (20.3%) were the most common occupations associated with open long bone fractures. Gunshot injuries were the leading cause of traumatic bone loss in open long bone fractures.

Conclusion:
Our setting has a high prevalence of traumatic bone loss among open long bone fractures with the majority occurring in Gustilo type IIIB injuries of the tibia. The likelihood of traumatic bone loss is higher in open fractures caused by gunshots.
3D printed titanium cages combined with the Masquelet technique for the reconstruction of segmental femoral defects
Authors: Tetsworth Kevin , Woloszyk Anna , Glatt Vaida 
Published: March 2019

Abstract

Introduction:
Traumatic femoral segmental bone loss is a complex clinical problem, one that often requires extreme solutions. This study examines a new treatment strategy for segmental bone loss using patient-specific 3D printed titanium cages in conjunction with the Masquelet technique.

Methods:
The study was composed of a clinical observational case series, and a basic science investigation to evaluate the biological activity of the induced membranes using histology, immunohistochemistry (IHC), and gene expression analysis. Eligible patients were: adult; post-traumatic; with segmental femoral defects; minimum follow-up 1 year; managed under a 2-stage protocol, with an interim antibiotic poly (methyl methacrylate) (PMMA) spacer. Definitive reconstruction was completed with exchange to a 3D printed custom titanium cage filled with bone graft, and stabilized with either an intramedullary (IM) nail or a lateral locked plate.

Results:
Patient-specific 3D printed titanium cages were used in 5 consecutive patients to reconstruct post-traumatic segmental femoral defects. The mean interval between stages was 100.2 days (83–119 days), the mean defect length was 14.0 cm (10.3–18.4 cm), and the mean bone defect volume measured 192.4 cc (114–292 cc). The mean length of follow-up was 21.8 months (12–33 months). There were no deep infections, fractures, nerve injuries, loss of alignment, or nonunions identified during the period of follow-up. All of the patients achieved union clinically and radiographically. Histology and IHC demonstrated a greater number of vessels, cell nuclei, and extensive staining for cluster of differentiation 68 (CD68), platelet and endothelial cell adhesion molecule 1 (PECAM-1), and vascular endothelial growth factor (VEGF) in the induced membranes compared to local fascia controls. Gene expression analysis revealed significant differential regulation of essential genes involved in inflammatory, angiogenic, and osteogenic pathways [interleukin 6 (IL-6), nuclear factor kappa B1 (NF-κB1), receptor activator of nuclear factor kappa-β ligand (RANKL), vascular endothelial growth factor A (VEGFA), angiogenin (ANG), transforming growth factor, beta 1 (TGF-β1), bone morphogenetic protein-2 (BMP-2), growth differentiation factor 5 (GDF-5), growth differentiation factor 10 (GDF-10), and runt-related transcription factor 2 (RUNX-2)] in the induced membranes.

Conclusions:
This study demonstrates that the use of a patient-specific 3D printed custom titanium cage, inserted into an induced membrane in a 2-stage protocol, can achieve very acceptable clinical outcomes in selected cases of post-traumatic femoral segmental defects. Patient-specific 3D printed titanium cages, used in conjunction with the Masquelet technique, are a promising new treatment option for managing complex trauma patients with femoral bone loss.

Level of Evidence:
Level IV (observational case series).
Prescription Drug Shortages
Authors: Donnelly Katie A. , Zocchi Mark S. , Katy Tamara A. , Fox Erin R. , Pines Jesse M. , van den Anker John N. , Mazer-Amirshahi Maryann E. 
Published: March 2019

Objectives
Drug shortages have been increasing over the past 2 decades. There are limited data on drug shortages and their effect on pediatric emergency and critical care. Our objective was to describe pediatric emergency and critical care drug shortages.

Methods
Drug shortage data from January 2001 to December 2015 were obtained from the University of Utah Drug Information Services. Shortages were reviewed, identifying agents used in pediatric emergency and critical care. Shortage data were analyzed for the type of drug, formulation, shortage reason, duration, marketing status (generic vs brand name), or if it was a pediatric-friendly formulation, used for a high-acuity condition, or a single-source product. The availability of a substitute was also described.

Results
Of 1883 products on shortage, 779 were used in pediatric emergency or critical care. The annual number of shortages decreased from 2001 to 2004, but then increased, reaching a high in 2011. The median duration for resolved shortages was 7.6 months (interquartile range, 3.0–17.6 months). The most common category affected was infectious disease drugs. High-acuity agents were involved in 27% of shortages and in 11% of pediatric-friendly formulations. An alternative agent was available for 95% of drugs, yet 43% of alternatives were also affected at some time during the study period. The most common reported reason for a shortage was manufacturing problems.

Conclusions
From 2001 to 2015, drug shortages affected a substantial number of agents used in pediatric emergency and critical care. This has had implications to the medications available for use and may impact patient outcomes. Providers must be aware of current shortages and implement mitigation strategies to optimize patient care.
Caloric Intake Relative to Total Daily Energy Expenditure Using a Spinal Cord Injury–Specific Correction Factor
Authors: Farkas Gary J. , Gorgey Ashraf S. , Dolbow David R. , Berg Arthur S. , Gater David R. 
Published: March 2019

Objective
The aims of the study were to evaluate the influence of level of spinal cord injury (SCI) on caloric intake relative to total daily energy expenditure (TDEE) and body composition, and to develop a SCI–specific correction factor for the TDEE estimation.

Design
Individuals with paraplegia (PARA, n = 28) and tetraplegia (TETRA, n = 13) were analyzed. Daily caloric intake, basal metabolic rate, and TDEE were obtained using dietary recall, indirect calorimetry, and prediction equations, respectively. Caloric intake and TDEE were adjusted to bodyweight. Body composition was assessed using dual-energy x-ray absorptiometry.

Results
Total caloric (PARA 1516.4 ± 548.4, TETRA 1619.1 ± 564.3 kcal/d), fat (PARA 58.6 ± 27.4, TETRA 65.8 ± 29.7 g), and protein (PARA 62.7 ± 23.2, TETRA 71.5 ± 30.9 g) intake were significantly higher in TETRA versus PARA (P < 0.05) when adjusted for bodyweight. Adjusted and unadjusted TDEE (unadjusted: PARA 1851.0 ± 405.3, TETRA 1530.4 ± 640.4 kcal/d) and basal metabolic rate (unadjusted: PARA 1516.6 ± 398.0, TETRA 1223.6 ± 390.2 kcal/d) were significantly higher in PARA versus TETRA (P < 0.05). Bone mineral content (PARA 3.17 ± 0.6, TETRA 2.71 ± 0.5 g), lean body mass (PARA 50.0 ± 8.6, TETRA 40.96 ± 8.8 kg), and regional percent body fat (PARA 36.45 ± 8.0, TETRA 41.82 ± 9.1) were different between groups (P < 0.05). The SCI–specific correction factor was 1.15.

Conclusions
A dichotomy exists in caloric intake, TDEE, and body composition among TETRA and PARA. The SCI–specific correction factor of 1.15 is a promising tool to estimate TDEE in SCI.

To Claim CME Credits
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives
Upon completion of this article, the reader should be able to: (1) Understand the influence of spinal cord level of injury on energy expenditure and body composition; (2) Appreciate that equations used to estimate total daily energy expenditure overestimate energy expenditure in individuals with spinal cord injury; and (3) Understand the importance of normalizing caloric intake to bodyweight after spinal cord injury.

Level
Advanced.

Accreditation
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The Association of Academic Physiatrists designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Assessing the Accuracy of Ultrasound-Guided Needle Placement in Sacroiliac Joint Injections
Authors: De Luigi Arthur Jason , Saini Vikramjeet , Mathur Rajat , Saini Amanpreet , Yokel Nathan 
Published: March 2019

Objective
The aim of the study was to assess the accuracy of ultrasound-guided needle placement for sacroiliac joint injections.

Design
Institutional review board approval was gained for a prospective cohort study of 50 patients (N = 50). Study patients who were referred for sacroiliac joint injections for sacroiliac joint mediate pain and met inclusion/exclusion criteria were enrolled in the study. Each patient underwent needle placement with ultrasound guidance in the procedure suite. After the needle was placed with the ultrasound guidance, fluoroscopy was used to confirm correct placement via contrast injection confirming a sacroiliac joint arthrogram. The arthrogram was confirmed via the performing physician and radiologist.

Results
The placement of the needle with ultrasound guidance into the sacroiliac joint was confirmed successful in 96% (48/50) patients by fluoroscopic arthrogram. The two patients with unsuccessful arthrograms after initial placement of the needle with ultrasound were morbidly obese. There was intravascular uptake during the arthrogram of one patient who had a successful arthrogram.

Conclusions
Ultrasound-guided injection of the sacroiliac joint is successful and accurate upon confirmation of fluoroscopic arthrogram and should be used as an imaging modality for needle guidance.
Minimal Clinically Important Difference of Shoulder Outcome Measures and Diagnoses
Authors: Dabija Dominique I. , Jain Nitin B. 
Published: March 2019

Objective
Patient-reported outcome scales determine response to treatment. The minimal clinically important difference of these scales is a measure of responsiveness: the smallest change in a score associated with a clinically important change to the patient. This study sought to summarize the literature on minimal clinically important difference for the most commonly reported shoulder outcome scales.

Design
A literature search of PubMed and EMBASE databases identified 193 citations, 27 of which met the inclusion/exclusion criteria.

Results
For rotator cuff tears, a minimal clinically important difference range of 9–26.9 was reported for American Shoulder and Elbow Surgeons, 8 or 10 for Constant, and 282.6–588.7 for the Western Ontario Rotator Cuff Index. For patients who underwent arthroplasty, a minimal clinically important difference range of 6.3–20.9 was reported for American Shoulder and Elbow Surgeons, 5.7–9.4 for Constant, and 14.1–20.6 for the Shoulder Pain and Disability Index. For proximal humeral fractures, a minimal clinically important difference range of 5.4–11.6 was reported for Constant and 8.1–13.0 for Disability of the Arm, Shoulder, and Hand.

Conclusions
A wide range of minimal clinically important difference values was reported for each patient population and instrument. In the future, a uniform outcome instrument and minimal clinically important difference will be useful to measure clinically meaningful change across practices and the spectrum of shoulder diagnoses.