bluuebunny/crossref_metadata_2025_split huggingface dataset:
U.K. Intensivists’ Preferences for Patient Admission to ICU: Evidence From a Choice Experiment
Authors: Bassford Christopher R. , Krucien Nicolas , Ryan Mandy , Griffiths Frances E. , Svantesson Mia , Fritz Zoe , Perkins Gavin D. , Quinton Sarah , Slowther Anne-Marie 
Published: August 2019

Objectives:
Deciding whether to admit a patient to the ICU requires considering several clinical and nonclinical factors. Studies have investigated factors associated with the decision but have not explored the relative importance of different factors, nor the interaction between factors on decision-making. We examined how ICU consultants prioritize specific factors when deciding whether to admit a patient to ICU.

Design:
Informed by a literature review and data from observation and interviews with ICU clinicians, we designed a choice experiment. Senior intensive care doctors (consultants) were presented with pairs of patient profiles and asked to prioritize one of the patients in each task for admission to ICU. A multinomial logit and a latent class logit model was used for the data analyses.

Setting:
Online survey across U.K. intensive care.

Subjects:
Intensive care consultants working in NHS hospitals.

Measurements and Main Results:
Of the factors investigated, patient’s age had the largest impact at admission followed by the views of their family, and severity of their main comorbidity. Physiologic measures indicating severity of illness had less impact than the gestalt assessment by the ICU registrar. We identified four distinct decision-making patterns, defined by the relative importance given to different factors.

Conclusions:
ICU consultants vary in the importance they give to different factors in deciding who to prioritize for ICU admission. Transparency regarding which factors have been considered in the decision-making process could reduce variability and potential inequity for patients.
Randomized Clinical Trial of an ICU Recovery Pilot Program for Survivors of Critical Illness*
Authors: Bloom Sarah L. , Stollings Joanna L. , Kirkpatrick Olivia , Wang Li , Byrne Daniel W. , Sevin Carla M. , Semler Matthew W. 
Published: August 2019

Objectives:
To examine the effect of an interdisciplinary ICU recovery program on process measures and clinical outcomes.

Design:
A prospective, single-center, randomized pilot trial.

Setting:
Academic, tertiary-care medical center.

Patients:
Adult patients admitted to the medical ICU for at least 48 hours with a predicted risk of 30-day same-hospital readmission of at least 15%.

Interventions:
Patients randomized to the ICU recovery program group were offered a structured 10-intervention program, including an inpatient visit by a nurse practitioner, an informational pamphlet, a 24 hours a day, 7 days a week phone number for the recovery team, and an outpatient ICU recovery clinic visit with a critical care physician, nurse practitioner, pharmacist, psychologist, and case manager. For patients randomized to the usual care group, all aspects of care were determined by treating clinicians.

Measurements and Main Results:
Among the primary analysis of enrolled patients who survived to hospital discharge, patients randomized to the ICU recovery program (n = 111) and usual care (n = 121) were similar at baseline. Patients in the ICU recovery program group received a median of two interventions compared with one intervention in the usual care group (p < 0.001). A total of 16 patients (14.4%) in the ICU recovery program group and 26 patients (21.5%) in the usual care group were readmitted to the study hospital within 30 days of discharge (p = 0.16). For these patients, the median time to readmission was 21.5 days (interquartile range, 11.5–26.2 d) in the ICU recovery program group and 7 days (interquartile range, 4–21.2 d) in the usual care group (p = 0.03). Four patients (3.6%) in the ICU recovery program and 14 patients (11.6%) in the usual care group were readmitted within 7 days of hospital discharge (p = 0.02). The composite outcome of death or readmission within 30 days of hospital discharge occurred in 20 patients (18%) in the ICU recovery program group and 36 patients (29.8%) in usual care group (p = 0.04).

Conclusions:
This randomized pilot trial found that a multidisciplinary ICU recovery program could deliver more interventions for post ICU recovery than usual care. The finding of longer time-to-readmission with an ICU recovery program should be examined in future trials.
Persistent Mitochondrial Dysfunction Linked to Prolonged Organ Dysfunction in Pediatric Sepsis
Authors: Weiss Scott L. , Zhang Donglan , Bush Jenny , Graham Kathryn , Starr Jonathan , Tuluc Florin , Henrickson Sarah , Kilbaugh Todd , Deutschman Clifford S. , Murdock Deborah , McGowan Francis X. , Becker Lance , Wallace Douglas C. 
Published: August 2019

Objectives:
Limited data exist about the timing and significance of mitochondrial alterations in children with sepsis. We therefore sought to determine if alterations in mitochondrial respiration and content within circulating peripheral blood mononuclear cells were associated with organ dysfunction in pediatric sepsis.

Design:
Prospective observational study

Setting:
Single academic PICU.

Patients:
One-hundred sixty-seven children with sepsis/septic shock and 19 PICU controls without sepsis, infection, or organ dysfunction.

Interventions:
None.

Measurements and Main Results:
Mitochondrial respiration and content were measured in peripheral blood mononuclear cells on days 1–2, 3–5, and 8–14 after sepsis recognition or once for controls. Severity and duration of organ dysfunction were determined using the Pediatric Logistic Organ Dysfunction score and organ failure-free days through day 28. Day 1–2 maximal uncoupled respiration (9.7 ± 7.7 vs 13.7 ± 4.1 pmol O2/s/106 cells; p = 0.02) and spare respiratory capacity (an index of bioenergetic reserve: 6.2 ± 4.3 vs 9.6 ± 3.1; p = 0.005) were lower in sepsis than controls. Mitochondrial content, measured by mitochondrial DNA/nuclear DNA, was higher in sepsis on day 1–2 than controls (p = 0.04) and increased in sepsis patients who had improving spare respiratory capacity over time (p = 0.005). Mitochondrial respiration and content were not associated with day 1–2 Pediatric Logistic Organ Dysfunction score, but low spare respiratory capacity was associated with higher Pediatric Logistic Organ Dysfunction score on day 3–5. Persistently low spare respiratory capacity was predictive of residual organ dysfunction on day 14 (area under the receiver operating characteristic, 0.72; 95% CI, 0.61–0.84) and trended toward fewer organ failure-free days although day 28 (β coefficient, –0.64; 95% CI, –1.35 to 0.06; p = 0.08).

Conclusions:
Mitochondrial respiration was acutely decreased in peripheral blood mononuclear cells in pediatric sepsis despite an increase in mitochondrial content. Over time, a rise in mitochondrial DNA tracked with improved respiration. Although initial mitochondrial alterations in peripheral blood mononuclear cells were unrelated to organ dysfunction, persistently low respiration was associated with slower recovery from organ dysfunction.
Clonazepam: Indications, Side Effects, and Potential for Nonmedical Use
Authors: Dokkedal-Silva Vinícius , Berro Laís Fernanda , Galduróz José Carlos Fernandes , Tufik Sergio , Andersen Monica Levy 
Published: August 2019

Learning objectives
After participating in this activity, learners should be better able to:
• Assess the misuse potential of clonazepam
• Characterize the nonmedical use of clonazepam
• Identify the health problems associated with long-term use of clonazepam

Abstract
Clonazepam, a benzodiazepine, is commonly used in treating various conditions, including anxiety disorders and epileptic seizures. Due to its low price and easy availability, however, it has become a commonly misused medication, both in medical and recreational contexts. In this review, we aim to highlight the behavioral and pharmacological aspects of clonazepam and its history following its approval for human use. We examine the circumstances commonly associated with the nonmedical use of clonazepam and raise points of particular concern. Clonazepam, alone or in combination with other psychoactive substances, can lead to unwanted effects on health, such as motor and cognitive impairment, sleep disorders, and aggravation of mood and anxiety disorders. Prolonged use of clonazepam may lead to physical dependence and tolerance. There is therefore a need to find safer therapeutic alternatives for treating seizures and anxiety disorders. Greater awareness of its frequent nonmedical use is also needed to achieve safer overall use of this medication.
Preparedness for Clinical Practice and the Development of Professional Competencies
Authors: Carter Kimberly , Stoehr James D. 
Published: August 2019

Purpose
To assess students' level of perceived preparedness for clinical competencies and simultaneously identify the effective curricular methods to develop these competencies.

Methods
Prior to graduation students reported their level of preparedness for clinical practice using a modified Preparation for Hospital Practice Questionnaire and rated the most effective teaching methods to improve the development of clinical and professional competencies.

Results
Students gave a high rating to group dynamics and teamwork, along with continuous professional development. They felt least prepared in pharmacotherapeutics and the handling of medical emergencies. Rated most effective were didactic lecturing instruction for the acquisition of medical knowledge, standardized patient encounters and simulations for the promotion of interpersonal skills, case groups for the integration of knowledge and critical thinking, and interprofessional events for the maintenance of professional accountability.

Conclusion
This survey approach may lead to an efficient and focused method for improving clinical and professional competencies and serve as an additional self-assessment tool to support curriculum development and reform.
Student-Led Mobile Health Clinic: Patients Served and Learning Experience
Authors: Duford Amie , Matvienko Oksana 
Published: August 2019

Purpose
Community medicine curriculum prepares physician assistant (PA) students to provide services to vulnerable and underserved populations. This article describes a service-learning model that uses a mobile health clinic (MHC) experience as part of the community medicine rotation. It provides an overview of the clinic's operation, patient documentation and characteristics, and student learning experiences.

Methods
Students collected demographic information on patients who visited the MHC during January through December 2017. The students summarized patient demographics and reflected on their experiences in a report.

Results
Two main outcomes are discussed: characteristics of the MHC patients and student observations about their experiences. In 2017, 113 students rotated through the MHC and recorded 813 patient encounters. The largest proportions of patients reported living on the street or in a shelter (71%) and were older than 56 years (40%), males (74%), Caucasian (43%), single (65%), nonveterans (77%), and high school graduates (41%). The top 5 reasons for visits were preventive care, cognitive/functional impairment, cardiometabolic disorders, skin issues, and respiratory illness. The MHC experience and process of recording and analyzing demographic data contributed to students' data management and analytical skills. The students identified problems of recordkeeping and their implications for patient care, gained a greater understanding of medical needs and complexities of treating the homeless, and provided suggestions for improving quality and efficiency of care.

Conclusions
The MHC service-learning model provides diverse, meaningful experiences for students. Our findings benefit PA programs aiming to expand and strengthen their community medicine curriculum.
Impact of Variations in PACKRAT Administration: A Retrospective Review
Authors: Rizzolo Denise , Cavanagh Kim , Ziegler Olivia , Janal Malvin 
Published: August 2019

Abstract
The Physician Assistant Clinical Knowledge Rating and Assessment Tool (PACKRAT) was developed to be an objective, comprehensive self-assessment tool for students. When the PACKRAT exam was initially developed, its goal was to help students determine what level of knowledge they currently possessed and what they had to learn prior to graduation. The purpose of this study was to review PACKRAT test-taker scores over the past 5 years and analyze the variations in test administration. Deidentified PACKRAT scores, exam length in minutes, and proctored or unproctored status, along with time extensions were analyzed from 2013 to 2018. Descriptive statistics and frequency counts were used to summarize the data. An independent samples t-test was used to determine if there was a difference in test-taker scores between proctored and unproctored exams. The 83,271 student test-taker exam data were analyzed, and time ranged from 180 to 360 minutes with a mean of 226.5 minutes. When comparing test-taker scores between proctored and unproctored exams, the mean scores were 145.02 and 144.77, respectively, with no significant difference. The Physician Assistant Clinical Knowledge Rating and Assessment Tool can be confidently used and compared to national scores whether a program administers the exam proctored or without a proctor. The average time taken for exam completion is close to the recommended 225 minutes that is suggested by Physician Assistant Education Association PACKRAT exam developers.
Evaluation of a nurse practitioner–led transitional care program
Authors: Sherlock Patrick J. , Rounds Linda R. 
Published: August 2019

ABSTRACT

Background:
Transitional care management (TCM) is a growing field in the delivery of post hospital discharge care. Current data suggest that implemented nurse practitioner (NP)-led transitional care models can be useful in reducing 30-day readmission rates. However, there is lack of data regarding the costs involved to implement and sustain a transitional care model.

Local problem:
The Transitional Care Encounter Program (TCEP) implemented by an NP at a private practice affiliated with a 250-bed acute care facility required program evaluation. This article addresses the TCEP's cost and sustainability, reimbursement, and nonmonetary value added to the practice.

Methods:
The Centers for Disease Control and Prevention (1999) “Framework for Program Evaluation in Public Health” was used for formal program evaluation. The TCEP's billing and revenue data compared with the TCEP's cost determined the financial impact. Qualitative data were also collected.

Interventions:
Patients discharged from the hospital to home had a TCEP visit within 7 days of discharge. The patient's hospital records were extensively reviewed. Medication reconciliation, education about current medications, diagnosis, and treatment plan were incorporated.

Results:
Total reimbursement was $53,330.32. Providers expressed they could allocate more time to primary care patients and averaged 2–3 more patients by having a dedicated transitional care provider. Providers expressed patients were “empowered” after the TCEP visit.

Conclusions:
The TCEP was a source of revenue and improved provider satisfaction. Exploration of the TCM's impact on 30-day readmission rates and patient satisfaction are recommended to further support the model.
How Does Comprehensive Care Impact Life of Pediatric Patients With Hemophilia? Results From a Center in a Developing Country
Authors: Villarreal-Martínez Laura , Meléndez-Aguirre Atenas , Cantú-Moreno Marcela , Garay-Mendoza Domingo , Garza José A. , Ibarra-Ramírez Marisol , Quiroga-Treviño Marbely , Pope-Salazar Sulia E. , Velasco-Ruiz Ileana 
Published: August 2019

Background:
Quality of life (QoL) has been included as a marker of treatment effectiveness in pediatric patients with chronic diseases. We believe that frequent multidisciplinary interventions and patient education could lead to an improvement in QoL.

Aims:
Determine the QoL and economic impact of monthly interventions in multidisciplinary treatment.

Materials and Methods:
The Haemo-QoL questionnaire was applied to patients who attended the hemophilia center of the University Hospital “Dr. José Eleuterio González,” Monterrey, Mexico, at the time of enrollment and 1 year later.

Results:
Male patients between 4 and 16 years diagnosed with hemophilia were included. The score results presented are based on Haemo-QoL versions that classify patients by their age group: group 1 (4 to 7 y) and group 2 (8 to 12 y). Statistical significant improvement was observed in the overall score (sociodemographic, psychosocial, etc.) after 1 year of follow-up in both groups (P<0.05).

Conclusions:
Impact on the QoL of patients receiving this approach was favorable. Improvement was observed regardless of severity and in those who were already in prophylaxis, suggesting that this type of approach could be causing the improvement. Results support the application of multidisciplinary treatment as the gold standard, and it should be considered in all centers including those with limited resources.
Sedentary behaviour facilitates conditioned pain modulation in middle-aged and older adults with persistent musculoskeletal pain: a cross-sectional investigation
Authors: Mani Ramakrishnan , Adhia Divya Bharatkumar , Leong Sook Ling , Vanneste Sven , De Ridder Dirk 
Published: August 2019

Abstract

Introduction:
Higher physical activity (PA) and lower sedentary behaviour (SB) levels have demonstrated beneficial effects on temporal summation (TS) and conditioned pain modulation (CPM) in healthy adults. This cross-sectional study investigated the relationships between PA and SB and TS/CPM responses in individuals with chronic musculoskeletal pain.

Methods:
Sixty-seven middle-aged and older adults with chronic musculoskeletal pain were recruited from the community. Questionnaires measuring demographics, pain, and psychological measures were completed. Physical activity/SB levels were measured using the International Physical Activity Questionnaire—short form and Sedentary Behaviour Questionnaire, respectively. Semmes monofilament was used to assess mechanical TS (MTS) at the most symptomatic (MTS-S) and a reference region (MTS-R); change in the pain scores (baseline-10th application) was used for analysis. Conditioned pain modulation procedure involved suprathreshold pressure pain threshold (PPT-pain4) administered before and after (CPM30sec, CPM60sec, and CPM90sec) conditioning stimulus (2 minutes; ∼12°C cold bath immersion). For analysis, PPT-pain4 (%) change scores were used.

Results:
PPT-pain4 (%) change scores at CPM30sec and CPM60sec demonstrated significant weak positive correlations with SB levels and weak negative correlations with PA measures. After adjusting for confounding variables, a significant positive association was found between SB (h/d) and PPT-pain4 (%) change scores at CPM30sec and CPM60sec. No significant associations between MTS and PA/SB measures.

Conclusion:
Sedentariness is associated with higher pain inhibitory capacity in people with chronic musculoskeletal pain. The observed relationship may be characteristic of a protective (sedentary) behaviour to enhance pain modulatory mechanism. Prospective longitudinal studies using objective PA/SB measures are required to validate the observed relationship in a larger sample size.
Consolidation Time and Relapse: A Systematic Review of Outcomes in Internal versus External Midface Distraction for Syndromic Craniosynostosis
Authors: Bertrand Anthony A. , Lipman Kelsey J. , Bradley James P. , Reidhead Jacob , Lee Justine C. 
Published: August 2019

Background:
The choice between internal and external distraction osteogenesis for midface advancement in patients with syndromic craniosynostosis is based primarily on surgeon preference and expertise. However, differences in outcomes between the two techniques have been sparingly compared. In this work, the authors performed a systematic review to compare outcomes between internal versus external midface distraction.

Methods:
A systematic review was performed of studies published between 1998 and 2018 (61 studies included; n = 689 patients). Operative characteristics, early reoperations, complications, and relapse rates were extracted. Bias evaluation was performed using the Newcastle-Ottawa instrument. Statistical analyses were performed with independent samples t tests and linear regression analyses (p < 0.05 considered significant).

Results:
The authors found that external distraction was associated with more Le Fort III osteotomies and hardware adjustments (p = 0.023), whereas internal distraction was associated with more monobloc osteotomies and longer consolidation times (p = 0.008). No significant differences in the distance of midface advancement, reoperations, complications, or relapse rates were noted between internal versus external distraction, although external distraction trended toward a slightly higher relapse rate. Regardless of distraction protocol, consolidation time was found to be a strong negative predictor for relapse (beta = −0.792; p = 0.02).

Conclusions:
No significant differences were demonstrated in advancement distance, reoperative rates, complication rates, or relapse rates for internal versus external distraction for midface advancement. Regardless of distraction type, consolidation time was strongly inversely associated with relapse rates. The trend toward higher relapse in external distraction is potentially explained by the significantly lower consolidation times.
Angiotensin II Type I Receptor Blockade Is Associated with Decreased Cutaneous Scar Formation in a Rat Model
Authors: Murphy Amanda , LeVatte Terry , Boudreau Colton , Midgen Craig , Gratzer Paul , Marshall Jean , Bezuhly Michael 
Published: August 2019

Background:
Angiotensin II engagement of angiotensin II type 1 receptor (AT1R) is implicated in fibrogenesis, with AT1R blockers used clinically to attenuate cardiac and renal fibrosis. The authors tested the hypothesis that the AT1R blocker losartan could reduce postsurgical cutaneous scarring in rats.

Methods:
Human dermal fibroblasts were treated with losartan and assessed for viability, contractile activity, migration, and profibrotic gene transcription by means of calcein, collagen gel, scratch, and quantitative reverse transcriptase polymerase chain reaction assays, respectively. Monocyte migration and adhesion to losartan-treated and control fibroblasts were examined. Losartan effects in vivo were assessed using a mechanical distraction hypertrophic scar model. Three days after incisions were made and closed on their backs, rats were assigned randomly to receive drinking water with or without losartan (1 mg/kg per day; n = 6 per group). Distraction devices were applied and activated up to day 14. On day 28, scars underwent cross-sectional area and elevation index analyses, and α-SMA+ (alpha-smooth muscle actin) and CD68+ (monocyte/macrophage marker) immunostaining.

Results:
Losartan-treated human dermal fibroblasts displayed decreased contractile activity, migration, and gene expression of transforming growth factor-β1, collagen I, and monocyte chemoattractant protein-1 relative to controls (p < 0.05). Monocyte migration and adhesion to losartan-treated fibroblasts were reduced (p < 0.01). Compared to controls, scars from losartan-treated rats demonstrated decreased cross-sectional area (19.4 ± 3.1 mm2 versus 45.0 ± 5.2 mm2; p = 0.002), elevation index (1.5 ± 0.1 versus 2.6 ± 0.3; p = 0.003), and α-SMA+ and CD68+ immunostaining (p < 0.001).

Conclusions:
Losartan decreases myofibroblast activity and reduces monocyte trafficking to cutaneous scar. These findings support losartan as a potential novel therapy for the prevention of hypertrophic scars.