bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Value of Dorsal Medulla Oblongata Involvement Detected With Conventional Magnetic Resonance Imaging for Prediction of Outcome in Children With Enterovirus 71-Related Brainstem Encephalitis
Authors: Liu Kun , Zhou Yongjin , Cui Shihan , Song Jiawen , Ye Peipei , Xiang Wei , Huang Xiaoyan , Chen Yiping , Yan Zhihan , Ye Xinjian 
Published: April 2018

Background:
Brainstem encephalitis is the most common neurologic complication after enterovirus 71 infection. The involvement of brainstem, especially the dorsal medulla oblongata, can cause severe sequelae or death in children with enterovirus 71 infection. We aimed to determine the prevalence of dorsal medulla oblongata involvement in children with enterovirus 71-related brainstem encephalitis (EBE) by using conventional magnetic resonance imaging (MRI) and to evaluate the value of dorsal medulla oblongata involvement in outcome prediction.

Methods:
Forty-six children with EBE were enrolled in the study. All subjects underwent a 1.5 Tesla MRI examination of the brain. The disease distribution and clinical data were collected. Dichotomized outcomes (good vs. poor) at longer than 6 months were available for 28 patients. Logistic regression was used to determine whether the MRI-confirmed dorsal medulla oblongata involvement resulted in improved clinical outcome prediction when compared with other location involvement.

Results:
Of the 46 patients, 35 had MRI evidence of dorsal medulla oblongata involvement, 32 had pons involvement, 10 had midbrain involvement and 7 had dentate nuclei involvement. Patients with dorsal medulla oblongata involvement or multiple area involvement were significantly more often in the poor outcome group than in the good outcome group. Logistic regression analysis showed that dorsal medulla oblongata involvement was the most significant single variable in outcome prediction (predictive accuracy, 90.5%), followed by multiple area involvement, age and initial Glasgow Coma Scale score.

Conclusions:
Dorsal medulla oblongata involvement on conventional MRI correlated significantly with poor outcomes in EBE children, improved outcome prediction when compared with other clinical and disease location variables, and was most predictive when combined with multiple area involvement, Glasgow Coma Scale score and age.
Perinatal Risk Factors Associated With Gastroenteritis Hospitalizations in Aboriginal and Non-Aboriginal Children in Western Australia (2000–2012): A Record Linkage Cohort Study
Authors: Fathima Parveen , Snelling Thomas Laurence , de Klerk Nicholas , Lehmann Deborah , Blyth Christopher Charles , Waddington Claire Shelley , Moore Hannah Catherine 
Published: April 2018

Background:
Gastroenteritis is a leading cause of childhood morbidity worldwide. We aimed to assess the maternal and infant characteristics and population attributable fractions associated with childhood gastroenteritis-related hospitalizations.

Methods:
We conducted a whole-of-population retrospective birth cohort study of 367,476 children live-born in Western Australia 2000–2012. We identified hospital admissions up to <15 years of age pertaining to these children, with a principal diagnosis code for infectious gastroenteritis. Cox regression was used to obtain the adjusted hazard ratios with 95% confidence intervals and the population attributable fractions associated with each risk factor in Aboriginal and non-Aboriginal children for their first gastroenteritis-related hospital admission.

Results:
There were a total of 15,888 gastroenteritis-related hospital admissions (25.7% occurring among non-Aboriginal children). The overall gastroenteritis hospitalization rate for children <15 years of age was 4.6/1000 child-years for non-Aboriginal children and 21.5/1000 child-years for Aboriginal children. Male gender, <20 years of maternal age, preterm birth, low birth weight, residence in remote regions of Western Australia and birth in the pre-rotavirus vaccine era were significant independent risk factors for gastroenteritis hospitalization in both Aboriginal and non-Aboriginal children. Additionally, birth by caesarean section and low socioeconomic status were identified as being associated with gastroenteritis hospitalization in non-Aboriginal children. Population attributable fractions suggest that 39% of all gastroenteritis hospitalizations in non-Aboriginal children (38% in Aboriginal children) could be averted if all children receive the rotavirus vaccine.

Conclusions:
Given the beneficial effect of infant rotavirus vaccination in preventing all-cause gastroenteritis hospitalization, efforts should be taken to optimize rotavirus vaccine coverage in those at highest risk.
Piperacillin-Tazobactam–Induced Neutropenia and Fever
Authors: Al Soub Hussam , Al Madhoun Eyad , Al Maslamani Muna , Al-Khal Abdullatif , Al Soub Deema 
Published: April 2018

Background
This study aims to describe our experience with 11 cases of piperacillin-tazobactam–related neutropenia and fever that were observed over a 6-year period and detail some of their clinical findings, risk factors, management, and outcome.

Method
Review of the records of all cases of piperacillin-tazobactam–related neutropenia and fever reported to the adverse drug reaction reporting system of the Department of Pharmacy at Hamad General Hospital in the period between 2010 and 2015 was performed.

Results
During the study period, 11 cases of piperacillin-tazobactam–related neutropenia and fever were identified. Nine were males, and 2 were females, with a mean age of 36 years. All patients had neutropenia, and 10 had fever at the same time. The mean duration of piperacillin-tazobactam use before the development of neutropenia and fever was 17.3 days. Concomitant anemia and thrombocytopenia were observed in 82% and 55%, respectively. Recovery was fast with resolution of fever and neutropenia in 1.5 days and 2.9 days, respectively. All patients survived.

Conclusion
Piperacillin-tazobactam is a commonly used antibiotic in Qatar. Neutropenia and fever related to piperacillin-tazobactam does occur, however, very rarely. The most important risk factor for its occurrence is prolonged use of more than 17 days. Discontinuation of the drug results in rapid resolution with no sequelae. We report these cases to alert physicians to this uncommon adverse effect of piperacillin-tazobactam and to encourage reporting.
Altered prefrontal correlates of monetary anticipation and outcome in chronic pain
Authors: Martucci Katherine T. , Borg Nicholas , MacNiven Kelly H. , Knutson Brian , Mackey Sean C. 
Published: April 2018

Abstract
Chronic pain may alter both affect- and value-related behaviors, which represents a potentially treatable aspect of chronic pain experience. Current understanding of how chronic pain influences the function of brain reward systems, however, is limited. Using a monetary incentive delay task and functional magnetic resonance imaging (fMRI), we measured neural correlates of reward anticipation and outcomes in female participants with the chronic pain condition of fibromyalgia (N = 17) and age-matched, pain-free, female controls (N = 15). We hypothesized that patients would demonstrate lower positive arousal, as well as altered reward anticipation and outcome activity within corticostriatal circuits implicated in reward processing. Patients demonstrated lower arousal ratings as compared with controls, but no group differences were observed for valence, positive arousal, or negative arousal ratings. Group fMRI analyses were conducted to determine predetermined region of interest, nucleus accumbens (NAcc) and medial prefrontal cortex (mPFC), responses to potential gains, potential losses, reward outcomes, and punishment outcomes. Compared with controls, patients demonstrated similar, although slightly reduced, NAcc activity during gain anticipation. Conversely, patients demonstrated dramatically reduced mPFC activity during gain anticipation—possibly related to lower estimated reward probabilities. Further, patients demonstrated normal mPFC activity to reward outcomes, but dramatically heightened mPFC activity to no-loss (nonpunishment) outcomes. In parallel to NAcc and mPFC responses, patients demonstrated slightly reduced activity during reward anticipation in other brain regions, which included the ventral tegmental area, anterior cingulate cortex, and anterior insular cortex. Together, these results implicate altered corticostriatal processing of monetary rewards in chronic pain.
Sources of opioid medication for misuse in older adults: results from a nationally representative survey
Authors: Schepis Ty S. , McCabe Sean Esteban , Teter Christian J. 
Published: April 2018

Abstract
Despite increasing rates of prescription opioid (PO) misuse in adults 50 years of age and older, little research has investigated such misuse in this population. This work aimed to examine sources of misused opioid medication in adults 50 years and older, with comparisons to younger groups. Data were from the 2009 to 2014 National Survey on Drug Use and Health surveys. Prevalence rates of PO sources, misuse, and PO use disorder (POUD) symptoms were estimated. Design-based logistic regression investigated age-based differences in these factors and the association of sources with POUD symptoms and other concurrent substance use. Nearly half (47.7%) of adults 65 years and older used physician sources for past 30-day PO misuse, with the second highest rates in those 50 to 64 years old (39.2%). Conversely, use of theft (5.3%), purchases (8.5%), or friends/family (for free; 23.2%) to obtain opioids were least common in adults 65 years and older, with prevalence rates of these sources in those 50 years and older closer to those of younger groups. Across those 50 years and older, use of purchases, physician, or multiple sources were associated with elevated POUD symptom prevalence. Older adults, particularly those 65 years and older, use a different pattern of PO sources than adolescents or younger adults, and those using physician sources have elevated POUD symptoms. Physicians are a key avenue for older adults to obtain opioids for misuse, highlighting the potential role of clinicians in limiting such misuse.
Pharmacokinetics of Sustained-Release Oral Dexamphetamine Sulfate in Cocaine and Heroin-Dependent Patients
Authors: Herbrink Maikel , Nuijten Masha , Nuijen Bastiaan , Huitema Alwin D.R. , Beijnen Jos H. , Hendriks Vincent M. , Blanken Peter , Janmohamed Amin , van den Brink Wim 
Published: April 2018

AbstractIntroductionResearch has shown that sustained-release (SR) dexamphetamine is a promising agonist treatment for cocaine dependence. However, little is known about the pharmacokinetics (PKs) of SR oral dexamphetamine. This study examined the PKs of a new SR dexamphetamine formulation in cocaine plus heroin-dependent patients currently in heroin-assisted treatment.MethodsThe study was designed as an open-label PK study in 2 cohorts: n = 5 with once daily 60 mg and n = 7 with once daily 30 mg SR oral dexamphetamine. Five days of blood plasma dexamphetamine concentrations measured with liquid chromatography–mass spectrometry with PK parameter estimates using noncompartmental analysis.ResultsTwelve cocaine-dependent plus heroin-dependent patients in heroin-assisted treatment were included. The initial cohort 1 dose of 60 mg once daily was adjusted to 30 mg after mild to moderate adverse events. After oral administration,tmaxvalues (coefficient of variation %) were 6.0 (17.0%) and 6.3 (16.3%) hours andt1/2were 11 (24.6%) and 12 (25.4%) hours for 60 mg and 30 mg SR dexamphetamine, respectively. At steady state,CSSmaxvalues were reached at 100 (27.5%) ng/mL and 58.4 (14.4%) ng/mL, whereasCSSminvalues were 39.5 (38.9%) ng/mL and 21.8 (19.8%) ng/mL for 60 mg and 30 mg, respectively.ConclusionsThe investigated SR formulation of dexamphetamine showed favorable slow-release characteristics in cocaine and heroin-dependent patients. A dose-proportional steady-state concentration was achieved within 3 days. These findings support the suitability of the SR formulation in the treatment of cocaine dependence.
Decreasing the Time to Administration of First Dose of Antibiotics in Children With Severe Sepsis
Authors: Mittal Yash , Sankar Jhuma , Dhochak Nitin , Gupta Samriti , Lodha Rakesh , Kabra Sushil Kumar 
Published: April 2018

ABSTRACT

Objectives:
To measure difference in median time to antibiotic administration in severe sepsis before and after making process changes and clinical outcomes such as duration of hospitalization and mortality.

Methods:
The study was carried out in the emergency department in children <17 years of age with severe sepsis/septic shock. In phase 1, data were collected and reasons for delayed antibiotic administration were identified. Following this, process changes like creating a triage tool, re-enforcing the severe sepsis protocol and increasing the number of nurses were made to correct the delay. In phase 2, we measured outcomes to compare the effect of the process changes.

Results:
A total of 28 and 13 children each were included during phase 1 and phase 2 of the study respectively. The median interquartile range time to administration of antibiotics from the time of admission decreased significantly from 50 minutes (18, 65) to 20 minutes (15, 20) (p = .02). Duration of hospital stay was longer in phase 1 as compared to phase 2 (12 days vs. 6 days). However, the difference was not statistically significant (p = .1).

Conclusions:
Use of a triage tool, severe sepsis protocol, and increasing the number of nurses resulted in earlier recognition and administration of first dose of antibiotics in children with severe sepsis.
How Useful Is the Flexion–Adduction–Internal Rotation Test for Diagnosing Femoroacetabular Impingement: A Systematic Review
Authors: Shanmugaraj Ajaykumar , Shell Jaymee R. , Horner Nolan S. , Duong Andrew , Simunovic Nicole , Uchida Soshi , Ayeni Olufemi R. 
Published: April 2018

Objective:
Clinicians use the flexion, adduction, and internal rotation (FADIR) test in the diagnosis of femoroacetabular impingement (FAI). However, the diagnostic utility of this test remains unclear. The purpose of this review was to determine the utility of the FADIR test in diagnosing FAI.

Data Sources:
MEDLINE, EMBASE, and PubMed were searched using relevant key terms and study screening was performed in duplicate. Patient demographics, diagnostic imaging, and summary measures (eg sensitivity, specificity, etc.) of the FADIR test in patients with FAI were recorded.

Main Results:
Eight studies of levels III (87.5%) and IV (12.5%) evidence were included. Four hundred fifty-two patients (622 hips) with a mean age of 27.0 ± 9.0 were examined. Alpha (75.1%) and/or center-edge (26.8%) angles were used to diagnose hips with FAI. X-ray (78.9%), magnetic resonance imaging (MRI) (16.2%), and computed tomography (CT) (4.8%) were used to confirm the diagnosis of FAI. The sensitivity when confirmed by x-ray, MRI, or CT was 0.08 to 1, 0.33 to 1 and 0.90, respectively. The specificity when confirmed by x-ray and MRI was 0.11 and 1, respectively.

Conclusions:
Although the overall utility of the FADIR test in diagnosing FAI remains unclear given its moderate sensitivity and specificity, it may be a useful screening tool for FAI because of its low risk. Clinicians should consider the variability in sensitivity and specificity values reported and the low quality of literature available. Future studies should use large sample sizes and consistent radiographic measurements to better understand the usefulness of this physical examination maneuver in diagnosing FAI.

Level of Evidence:
Level IV, Systematic Review of Level III and IV studies.
Management of anaphylaxis in Spain: pediatric emergency care providers’ knowledge
Authors: Olabarri Mikel , Gonzalez-Peris Sebastiá , Vázquez Paula , González-Posada Aranzazu , Sanz Nuria , Vinuesa Ana , Diez Nuria , Benito Javier , Mintegi Santiago 
Published: April 2018

Background
Acute care providers must diagnose and treat patients with anaphylaxis. The objective was to analyze Spanish pediatric emergency departments’ (ED) providers’ knowledge of the international recommendations for the management of anaphylaxis.

Methods
A web-based survey including providers (both attending and residents) from seven Spanish pediatric EDs was conducted. To analyze the knowledge of the identification of anaphylaxis, we used the diagnostic criteria given by the National Institute of Allergy and Infectious Disease and Food Allergy and the Food Allergy and Anaphylaxis Network (2005). To analyze the management, we used the practical recommendations on the management of anaphylaxis published by the Joint Task Force on Practice Parameters (2014).

Results
A total of 425 physicians received the link and 337 (79.2%) completed the survey (138 attending, 76.6%; 199 residents, 81.2%, P<0.05). More than 90% of the providers correctly identified the anaphylaxis, except for not diagnosing it when reduced blood pressure is detected after exposure to a known allergen (69.7%) and misdiagnosis of anaphylaxis in patients with progressive urticaria with significant angioedema (65.9%). Nearly 100% identified epinephrine as the first-line treatment. Main failures of treatment were related to the position of the patient, the effect of medications in preventing a biphasic reaction, the recommended time to observe patients, and those related to the follow-up. No significant differences were found between attendings and residents.

Conclusion
Even though the Spanish pediatric ED providers’ knowledge of the management of anaphylaxis is good, certain improvement areas are identified in both the identification and the management of these patients.
The Role of the Clinical Nurse Specialist From the Perspective of Parents of Children Born With Cleft Lip and/or Palate in the United Kingdom
Authors: Searle Aidan , Neville Patricia , Ryan Sara , Waylen Andrea 
Published: April 2018

Purpose/Aim:
This qualitative study explores parents’ perspectives of the clinical nurse specialist (CNS) after diagnosis of cleft lip and/or palate and while preparing for/after lip or palate closure and other events on the cleft treatment pathway in the United Kingdom.

Design:
Parents with children on the “cleft treatment pathway” were recruited from multiple regions across the United Kingdom. In-depth interviews were conducted with 24 parents of children born with cleft lip and/or palate.

Methods:
Thematic analysis identified 4 key themes: relationship with CNS, information provision, preoperative care and multidisciplinary team (MDT), and postoperative support.

Results:
Clinical nurse specialists are a highly valued point of contact and act as a trusted mediator between parents and other professionals in the MDT. Clinical nurse specialists are important gatekeepers in providing support and information and developing trust after diagnosis and birth and throughout the cleft treatment pathway.

Conclusion:
The present findings affirm the emotional, social, and informational support that the CNS can offer parents whose children are on a cleft treatment pathway. The CNS is a vital member of the cleft service MDT.
Congenital Syphilis Prevention: Strategies, Evidence, and Future Directions
Authors: Plotzker Rosalyn E. , Murphy Ryan D. , Stoltey Juliet E. 
Published: April 2018

BackgroundCongenital syphilis (CS)—the preventable transmission ofTreponema pallidumfrom infected mother to fetus—remains a significant problem worldwide.MethodsFrom July through November 2017, 239 articles relevant to CS prevention were identified via keyword searches in PubMed and Google Scholar, ancestry searches, and expert recommendation. Articles were then assessed for (1) measurement of a specified CS or adverse pregnancy outcomes (APOs) and (2) geographic setting in high/upper middle income countries according to United Nations criteria. In total, 119 articles met inclusion criteria. These were then vetted for 1 of 3 arms of CS prevention, after which additional ancestral searches were conducted within each arm to arrive at the final collection of articles per CS prevention strategy—maternal prenatal treatment (n = 33), prenatal screening (n = 24), and public health interventions that support screening and treatment (n = 15).ResultsOf the 7 studies that evaluated treatment with benzathine penicillin G (BPG) use within the context of a modern health care system, all showed BPG to be highly effective in CS prevention; 3 additional studies demonstrated BPG effectiveness in preventing APOs. Ten studies revealed early disease detection through prenatal screening significantly reduces CS and APOs when paired with BPG. There was limited literature evaluating public health interventions, such as partner notification, surveillance, and prenatal screening laws.ConclusionsCongenital syphilis is a preventable disease, effectively avoided with appropriate prenatal screening and BPG therapy. Increasing syphilis rates among all adults, accompanied by gaps in the provision of prenatal care to women at high risk of infection, are major contributors to CS persistence.
Recent Changes in Prevention Funding to Areas With High Racial and Ethnic Disparities in Sexually Transmitted Disease Rates
Authors: Williams Austin M. , Chesson Harrell W. 
Published: April 2018

Abstract
We examined changes in federal sexually transmitted disease funding allocations to areas with high racial/ethnic disparities in sexually transmitted diseases after the implementation of a funding formula in 2014. The funding formula increased prevention funding allocations to areas with high relative racial/ethnic disparities. Results were mixed for areas with high absolute disparities.
Furosemide Response Predicts Acute Kidney Injury After Cardiac Surgery in Infants and Neonates
Authors: Borasino Santiago , Wall Kevin M. , Crawford Jack H. , Hock Kristal M. , Cleveland David C. , Rahman Fazlur , Martin Kimberly D. , Alten Jeffrey A. 
Published: April 2018

Objective:
Cardiac surgery–induced acute kidney injury occurs frequently in neonates and infants and is associated with postoperative morbidity/mortality; early identification of cardiac surgery–induced acute kidney injury may be crucial to mitigate postoperative morbidity. We sought to determine if hourly or 6-hour cumulative urine output after furosemide in the first 24 hours after cardiopulmonary bypass could predict development of cardiac surgery–induced acute kidney injury and other deleterious outcomes.

Design:
Retrospective chart review.

Setting:
Pediatric cardiac ICU.

Patients:
All infants younger than 90 days old admitted to the cardiac ICU from October 2012 to December 2015 who received at least one dose of furosemide in the first 24 hours after cardiopulmonary bypass surgery.

Interventions:
None.

Measurements and Main Results:
Ninety-nine patients met inclusion and exclusion criteria. In total, 45.5% developed cardiac surgery–induced acute kidney injury. Median time between cardiopulmonary bypass and furosemide was 7.7 hours (interquartile range, 4.4–9.5). Six-hour cumulative urine output was 33% lower (p = 0.031) in patients with cardiac surgery–induced acute kidney injury. Area under the curve for prediction of cardiac surgery–induced acute kidney injury was 0.69 (p = 0.002). Other models demonstrated urine output response to furosemide had significant area under the curves for prediction of peak fluid over load greater than 15% (0.68; p = 0.047), prolonged peritoneal dialysis (area under the curve, 0.79; p = 0.007), prolonged mechanical ventilation (area under the curve, 0.79; p < 0.001), prolonged hospitalization (area under the curve, 0.62; p = 0.069) and mortality (area under the curve, 0.72; p = 0.05).

Conclusions:
Urine output response to furosemide within 24 hours of cardiopulmonary bypass predicts cardiac surgery–induced acute kidney injury development and other important morbidity in children younger than 90 days old; prospective validation is warranted.