bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased Cough Receptor Sensitivity to Capsaicin Predicts a Positive Bronchial Thermoplasty Response
Authors: Yamamura Kenta , Hara Johsuke , Ohkura Noriyuki , Abo Miki , Sone Takashi , Kimura Hideharu , Kasahara Kazuo 
Published: March 2019

Background:
Bronchial thermoplasty (BT) is a novel bronchoscopic therapy for severe uncontrolled asthma unresponsive to standard pharmacological treatments, including inhaled corticosteroids and long-acting beta-2 agonists. Although several studies have shown that BT improves asthma control, the optimal predictors of BT response remain unknown.

Patients and Methods:
We reviewed 10 consecutive asthma patients treated with BT at Kanazawa University Hospital between January 2016 and March 2018 and attempted to identify factors that correlated with a positive BT response.

Results:
All patients had the most severe persistent asthma according to the 2017 Japanese guidelines for adult asthma and were uncontrolled despite adequate treatments including high-dose inhaled corticosteroids and long-acting beta-2 agonists. Six patients had significant improvement in asthma control evaluated with the Asthma Control Questionnaire-6. Eight patients showed a significant improvement in asthma-specific health-related quality of life evaluated with the Asthma Quality of Life Questionnaire. The number of severe asthma exacerbations decreased in 6 patients. The maintenance dose of oral corticosteroids decreased in 1 patient. There were no severe adverse events related to the procedure. Six patients showed a positive BT response, and all 4 patients with increased cough receptor sensitivity to capsaicin responded to BT. No other factors, including age, smoking status, body mass index, age of asthma onset, disease duration, blood eosinophil count, total serum immunoglobulin E, prebronchodilator forced expiratory volume in 1 second, reversibility to beta-2 agonist, or fractional exhaled nitric oxide, were associated with a positive BT response.

Conclusion:
Increased cough receptor sensitivity to capsaicin may predict a positive BT response.
Risk Factors Associated With Mortality in Patients With Otogenic Brain Abscess
Authors: Burton Brittany N. , Saliba Joe , Gabriel Rodney A. , Harris Jeffrey P. 
Published: March 2019

Objective:
Otogenic brain abscess is a well-recognized clinical condition that describes brain abscess secondary to an ear infection or mastoiditis. Current evidence remains limited on risk factors associated with mortality as most data are from case series. We aimed to 1) report the mortality rate among patients who did and did not receive mastoidectomy 2) identify factors associated with inpatient mortality.

Study Design:
Retrospective cohort study.

Setting:
Multi-institutional.

Patients:
We identified a cohort of patients for years 2008 to 2014 who in their inpatient hospitalization carried the diagnoses of both brain abscess and infectious ear disease.

Interventions:
Inpatient neurotology and neurosurgical procedures.

Main Outcome Measures:
A multivariable logistics regression model was built to identify the factors associated with inpatient mortality.

Results:
The final analysis included 252 patients, of which 84 (33.3%) underwent mastoidectomy. The rate of inpatient morbidity and mortality were 17.5% and 4.0%, respectively. The rate of mortality in patients without mastoidectomy versus those with mastoidectomy was 4.2% versus 3.6%, respectively (p > 0.99). The odds of inpatient mortality were significantly increased for every 10-year increase in age (odds ratio [OR] 2.73, 95% confidence interval [CI]: 1.39–7.01, p = 0.011) and for Black compared to White patients (OR: 45.81, 95% CI: 4.56–890.92, p = 0.003).

Conclusion:
Older age and Black race were associated with increased odds of inpatient mortality and there were no significant differences in mortality between mastoidectomy cohorts. This research serves to generate further hypotheses for larger observational studies to investigate the association between sociodemographic factors and surgical variables with outcomes among this surgical population.
For Whom the Bell's Toll: Recurrent Facial Nerve Paralysis, A Retrospective Study and Systematic Review of the Literature
Authors: Chweya Cynthia M. , Anzalone C. Lane , Driscoll Colin L. W. , Lane John I. , Carlson Matthew L. 
Published: March 2019

Purpose:
To examine the etiology, clinical course, and management of recurrent peripheral facial nerve paralysis.

Methods:
Retrospective review at a single tertiary academic center and systematic review of the literature. Clinical presentation, laboratory and imaging findings, treatment and outcome for all cases of recurrent ipsilateral, recurrent contralateral, and bilateral simultaneous cases of facial paralysis are reviewed.

Results:
Between 2000 and 2017, 53 patients [41.5% men, 29 median age of onset (range 2.5 wk–75 yr)] were evaluated for recurrent facial nerve paralysis at the authors’ institution. Twenty-two (41.5%) cases presented with ipsilateral recurrences only, while the remaining 31 patients (58.5%) had at least 1 episode of contralateral recurrent paralysis. No cases of bilateral simultaneous facial nerve paralysis were observed. The median number of paretic events for all patients was 3 (range 2–20). The median nadir House–Brackmann score was 4, with a median recovery to House–Brackmann grade 1.5 over a mean recovery time of 61.8 days (range 1–420 d). Diagnostic evaluation confirmed Melkersson–Rosenthal syndrome in four (7.5%) cases, neurosarcoidosis in two (3.7%), traumatic neuroma in one (1.9%), Ramsay Hunt syndrome in one (1.9%), granulomatosis with polyangiitis in one (1.9%), and neoplastic causes in three (5.7%) cases [facial nerve schwannoma (n = 2; 3.7%), metastatic squamous cell carcinoma to the deep lobe of the parotid gland (n = 1; 1.9%)]; ultimately, 77.4% (41) of cases were deemed idiopathic. Facial nerve decompression via a middle cranial fossa approach was performed in three (5.7%) cases without subsequent episodes of paralysis.

Conclusion:
Recurrent facial nerve paralysis is uncommon and few studies have evaluated this unique population. Recurrent ipsilateral and contralateral episodes are most commonly attributed to idiopathic facial nerve paralysis (i.e., Bell's palsy); however, a subset harbor neoplastic causes or local manifestations of underlying systemic disease. A comprehensive diagnostic evaluation is warranted in patients presenting with recurrent facial nerve paralysis and therapeutic considerations including facial nerve decompression can be considered in select cases.
Association of Speech Processor Technology and Speech Recognition Outcomes in Adult Cochlear Implant Users
Authors: Dixon Peter R. , Shipp David , Smilsky Kari , Lin Vincent Y. , Le Trung , Chen Joseph M. 
Published: March 2019

Objective:
Determine association of advancements in speech processor technology with improvements in speech recognition outcomes.

Study Design:
Retrospective cohort.

Setting:
Tertiary referral center.

Patients:
Adult unilateral cochlear implant (CI) recipients.

Intervention:
Increasing novelty of speech processor defined by year of market availability.

Main Outcome Measures:
Consonant-Nucleus-Consonant (CNC) and Hearing in Noise Test (HINT) in quiet.

Results:
From 1991 to 2016, 1,111 CNC scores and 1,121 HINT scores were collected from 351 patients who had complete data. Mean post-implantation CNC score was 53.8% and increased with more recent era of implantation (p < 0.001, analysis of variance [ANOVA]). Median HINT score was 87.0% and did not significantly vary with implantation era (p = 0.06, ANOVA). Multivariable generalized linear models were fitted to estimate the effect of speech processor novelty on CNC and HINT scores, each accounting for clustering of scores within patients and characteristics known to influence speech recognition outcomes. Each 5-year increment in speech processor novelty was independently associated with an increase in CNC score by 2.85% (95% confidence limits [CL] 0.26, 5.44%) and was not associated with change in HINT scores (p = 0.30).

Conclusion:
Newer speech processors are associated with improved CNC scores independent of the year of device implantation and expanding candidacy criteria. The lack of association with HINT scores can be attributed to a ceiling effect, suggesting that HINT in quiet may not be an informative test of speech recognition in the modern CI recipient. The implications of these findings with respect to appropriate interval of speech processor upgrades are discussed.
Clinical Features of Ears With Otosclerosis and Endolymphatic Hydrops
Authors: Wang Fei , Yoshida Tadao , Sugimoto Satofumi , Shimono Mariko , Teranishi Masaaki , Naganawa Shinji , Sone Michihiko 
Published: March 2019

Objective:
Endolymphatic hydrops (EH) has been reported in ears with otosclerosis. The objective of this study was to investigate the clinical features of ears with otosclerosis and EH on magnetic resonance imaging (MRI) and identify predictors for the presence of EH.

Study Design:
Retrospective study.

Setting:
University hospital.

Materials and Methods:
Forty-six ears from 37 patients with otosclerosis were included in the present study.

Interventions:
The subjects were divided into three groups, those with no, mild, or significant EH, based on 3-T MRI with intravenous injection of gadolinium. Hearing levels and the extent of otosclerotic lesions graded based on the computed tomography (CT) findings were compared among the groups. Moreover, to examine the vascular activity of the disease, intraoperative measurements of blood flow were also evaluated.

Main Outcome Measures:
Imaging, hearing levels, and blood flow values.

Results:
The overall rate of EH was 58.7% (27 of 46 ears); cochlear EH (52.2%) was more frequent than vestibular EH (26.1%). Average thresholds in ears with significant EH were significantly higher at several frequencies, both on air and bone conduction, than those with no or mild EH. Significant EH was more frequently observed in ears with advanced stages on CT than in those without advanced stages. The values of blood flow in the area anterior to the oval window were higher in some ears with EH than in ears without EH.

Conclusion:
EH was frequently present in ears with otosclerosis, especially those with severe hearing loss or advanced disease on CT.
Optical Coherence Tomography Doppler Vibrometry Measurement of Stapes Vibration in Patients With Stapes Fixation and Normal Controls
Authors: MacDougall Dan , Morrison Loran , Morrison Christine , Morris David P. , Bance Manohar , Adamson Robert B. A. 
Published: March 2019

Hypothesis:
Ears with otosclerotic stapes fixation will exhibit lower-than-normal levels of ossicular mobility as measured by Optical Coherence Tomography Doppler Vibrometry (OCT-DV).

Background:
OCT-DV measures the vibration of middle ear structures in response to sound non-invasively through the intact tympanic membrane. This allows, in particular, direct measurement of the vibration at the lenticular process of the incus which is expected to be lower in patients with otosclerotic stapes fixation.

Methods:
OCT-DV was performed on ears presumptively diagnosed with otosclerosis (n = 13) and a group of normal control ears (n = 42). Displacement was measured at the umbo and the lenticular process of the incus in response to 500 and 1000 Hz stimulus tones at 100 dBSPL.

Main Outcome Measure:
The ability to discriminate between groups was assessed using receiver operator characteristic analysis, with the main outcome measures being the area-under-curve (AUC) and the sensitivity and specificity.

Results:
For the best condition tested (500 Hz at the incus), the AUC was 0.998 and discriminated the otosclerotic from normal ears with a sensitivity/specificity of 1.00/0.98. One anomalous patient with surgically confirmed stapes fixation exhibited hypermobility at the umbo, possibly due to a partial ossicular discontinuity. Despite the high umbo mobility, this patient's stapes fixation was correctly discriminated based on the measured incus vibration levels.

Conclusions:
OCT-DV is a promising tool for preoperatively assessing ossicular mobility non-invasively in the clinic. Our results suggest OCT-DV may also be useful in discriminating other ossicular pathologies that result in conductive hearing loss.
Metabolic Monitoring of Child and Adolescent Patients on Atypical Antipsychotics by Psychiatrists and Primary Care Providers
Authors: Wakefield Sarah , Aligeti Manish , Rachamallu Vivekananda , Baronia Regina , Aynampudi Ram , Parmar Ankit , Peterson Phyllis , Masodkar Kanak 
Published: March 2019

Background:
Antipsychotic drug use in children has doubled from 2001 to 2007 with concomitant increase in obesity. Second-generation antipsychotic (SGA) medication use is associated with weight gain, metabolic derangements, and blood sugar and lipid abnormalities in children. The American Psychiatric Association and the American Diabetes Association have recommended metabolic monitoring guidelines for patients using SGA.

Study Question:
The study objective was to investigate and compare metabolic monitoring for SGA medications in psychiatry (PSY), and pediatrics and family medicine [primary care providers (PCP)] outpatient clinics of a university medical center.

Study Design:
This is a retrospective study of 149 charts of patients newly prescribed with SGA, ages 5–18 years, from their initial visit in the outpatient clinics.

Measures and Outcomes:
Compliance with recommended metabolic monitoring was evaluated for initial and subsequent clinic visits. Parameters included body mass index, waist circumference, blood pressure, fasting plasma glucose, and fasting lipid profile.

Results:
Of the 149 charts, 110 patients were in PSY and 39 in PCP. The parameter most regularly monitored was body mass index (baseline: PSY 88.3%, PCP 97.4%; 12 weeks: PSY 86.4%, PCP 85.0%; and 24 weeks: PSY 91.8%, PCP 100%). Fasting plasma glucose (baseline: PSY 18.9%, PCP 25.6% and 12 weeks: PSY 8.6%, PCP 10.0%) and fasting lipid profile (baseline: PSY 12.7%, PCP 25.6% and 12 weeks: PSY 7.0%, PCP 10.0%) had low completions rates. No difference was seen in metabolic monitoring by sex or ethnic group.

Conclusions:
Metabolic monitoring rate of child and adolescent patients on SGAs was low overall. No statistically significant differences were seen between psychiatry and PCP except a significantly higher rate of fasting plasma glucose level monitoring at baseline among PCP. Limitations to the study include the small sample size obtained for the period investigated and insufficient documentation in some electronic charts. Extending the period studied may increase the statistical significance of the data.
Off-Label Use of Clozapine in Children and Adolescents—A Literature Review
Authors: Rachamallu Vivekananda , Elberson Benjamin W. , Vutam Emily , Aligeti Manish 
Published: March 2019

Background:
Clozapine is a second-generation antipsychotic typically used for refractory schizophrenia or otherwise psychotic pathology. There are no FDA or manufacturer guidelines for use of clozapine in pediatric population. We investigated the current state of research concerning the use of clozapine in pediatric patients.

Areas of Uncertainty:
We describe consistent calls for more research into the long-term and short-term effects of clozapine use in a young patient population. Despite the strongly supported efficacy, questions concerning clear indications for use and risk–benefit analysis persist. We acknowledge that a more comprehensive meta-analysis would greatly benefit the field. However, this is the first article of its kind for clozapine in recent history, and therefore, serves as a focus and reference point for future, more in-depth analyses.

Data Sources:
We conducted a search of PubMed, ClinicalKey, PsycINFO, and MEDLINE databases. Keywords used included, in varying combinations: clozapine, off-label, indications, children and adolescent, pediatric, behavioral, suicidality, psychosis, early and very-early onset schizophrenia, side-effect profile, and long-term use. Further criteria and selection are described in Methods below.

Results:
We describe the documented efficacy of clozapine for the management of refractory psychotic and nonpsychotic symptoms in the pediatric population. The authors highlight the risk of unmanaged early-onset schizophrenia, aggressive or suicidal behavior, and severe nonpsychotic pathology. Unfortunately, these studies are generally small. There is little consistency in when clozapine is prescribed, how long it is administered, and how long patients are followed. Despite the lack of FDA and manufacturer guidelines, clozapine continues to be used for the benefit of young patients.

Conclusions:
Indications for prescription of clozapine should be revisited, given the data presented in this manuscript of a low risk–benefit ratio for properly chosen patients. Larger studies should be conducted to provide more statistical power and determine clear guidelines for use, risk of side effects, and long-term adverse events that may arise.
Impact of Psychological Empowerment on Workplace Bullying and Intent to Leave
Authors: Hampton Debra , Rayens Mary Kay 
Published: March 2019

OBJECTIVE
The objective of this study was to understand the association of psychological empowerment (PE) with workplace bullying and intent to leave among nurse leaders.

BACKGROUND
Nurse leaders who experience bullying cope in varied ways. Some leaders have higher levels of empowerment and resilience, whereas others are more negatively impacted by bullying.

METHODS
This study used a descriptive, cross-sectional survey design. Instruments used in the study included 2 PE tools: a bullying instrument and an intent-to-leave tool. The analysis tested for bivariate correlations and used analysis of variance to discern differences among nurse leaders.

RESULTS
PE was negatively correlated with both bullying and intent to leave. Chief nursing officers and directors had significantly higher PE than did nurse managers, but there was no significant difference in intent to leave among the leader groups.

CONCLUSIONS
PE may help protect against the impact of bullying. Continued development of leaders to strengthen their PE is needed.
Efficacy of a Breastfeeding Pain Self-Management Intervention: A Pilot Randomized Controlled Trial
Authors: Lucas Ruth , Zhang Yiming , Walsh Stephen J. , Evans Heather , Young Erin , Starkweather Angela 
Published: March 2019

Background
Over 90% of women experience pain during breastfeeding initiation and lack strategies to self-manage breast and nipple pain. Guided by the Individual and Family Self-Management Theory, a breastfeeding self-management (BSM) intervention targeted women's knowledge, beliefs, and social facilitation to manage their breast and nipple pain and achieve their breastfeeding goals.

Objectives
The purpose of this longitudinal pilot randomized control trial (RCT) was to test the preliminary efficacy of the BSM intervention on general and specific pain related to breastfeeding.

Methods
Sixty women intending to breastfeed were approached within 48 hours of delivery to participate in this pilot RCT (30 randomized to the BSM intervention and 30 randomized to the control group). All participants provided baseline data before discharge and pain and breastfeeding measures at 1, 2, and 6 weeks. Participants in the BSM intervention group received educational modules addressing breast and nipple pain and biweekly, text-based nurse coaching and completed a daily breastfeeding journal.

Results
Women in the BSM intervention group reported significantly less breast and nipple pain at 1 and 2 weeks using a visual analog scale (p < .014 and p < .006) and at 2 weeks using the Brief Pain Inventory intensity scale (p < .029), but no difference in breastfeeding duration.

Discussion
The BSM intervention pilot demonstrates a positive effect on breastfeeding specific and overall generalized pain. Future investigation is needed to identify at-risk women of ongoing breastfeeding pain and develop precision interventions to sustain this beneficial health behavior for mothers and infants.
Guideline Adherence in Diagnostic Testing and Treatment of Community-Acquired Pneumonia in Children
Authors: McLaren Son H. , Mistry Rakesh D. , Neuman Mark I. , Florin Todd A. , Dayan Peter S. 
Published: March 2019

Objectives
The objective of this study was to determine emergency department (ED) physician adherence with the 2011 Pediatric Infectious Diseases Society (PIDS) and Infectious Diseases Society of America (IDSA) guidelines for outpatient management of children with mild-to-moderate community-acquired pneumonia (CAP).

Methods
A cross-sectional survey of physicians on the American Academy of Pediatrics Section on Emergency Medicine Survey listserv was conducted. We evaluated ED physicians' reported adherence with the PIDS/IDSA guidelines through presentation of 4 clinical vignettes representing mild-to-moderate CAP of presumed viral (preschool-aged child), bacterial (preschool and school-aged child), and atypical bacterial (school-aged child) etiology.

Results
Of 120 respondents with analyzable data (31.4% response rate), use of chest radiograph (CXR) was nonadherent to the guidelines in greater than 50% of respondents for each of the 4 vignettes. Pediatric emergency medicine fellowship training was independently associated with increased CXR use in all vignettes, except for school-aged children with bacterial CAP. Guideline-recommended amoxicillin was selected to treat bacterial CAP by 91.7% of the respondents for preschool-aged children and by 75.8% for school-aged children. Macrolide monotherapy for atypical CAP was appropriately selected by 88.2% and was associated with obtaining a CXR (adjusted odds ratio, 3.9 [95% confidence interval, 1.4–11.1]). Guideline-adherent antibiotic use for all vignettes was independently associated with congruence between respondent's presumed diagnosis and the vignette's intended etiologic diagnosis.

Conclusions
Reported ED CXR use in the management of outpatient CAP was often nonadherent to the PIDS/IDSA guidelines. Most respondents were adherent to the guidelines in their use of antibiotics. Strategies to increase diagnostic test accuracy are needed to improve adherence and reduce variation in care.
Epinephrine at 25°C Core Body Temperature and During Rewarming
Authors: Mann Christian , Baer Walter , Riedel Thomas 
Published: March 2019

Abstract
Epinephrine plays a controversial role in accidental hypothermia (<30°C). We report its use in the advanced life support of a 13-month-old white girl with pulseless electrical activity and 25°C core body temperature after 32 minutes of submersion in a fast-running Swiss mountain stream at 8°C. Two doses of epinephrine (10 μg/kg) were given in the field, followed by 12 doses (10 μg/kg) and an infusion of 0.1 μg/kg per minute during rewarming. Spontaneous circulation returned at 29.5°C after 2.5 hours of cardiopulmonary resuscitation. Neurologic long-term outcome was excellent. We conclude that in the presence of nonshockable rhythm the benefits of epinephrine may outweigh the risks of side effects when used in pediatric advanced life support for accidental hypothermia.
Massive Iatrogenic Pediatric Ketamine Overdose With Serial Levels and Minimal Morbidity
Authors: Bowman Connor F. , Pruitt Brandon , Marx Jared , Thornton Stephen L. 
Published: March 2019

Abstract
Ketamine is a dissociative anesthetic commonly used for procedural sedation owing to its perceived favorable safety profile. Despite its frequent use, overdoses of ketamine are rarely reported, and no cases with serum levels of ketamine or its metabolite have previously been reported. We report a case of an iatrogenic pediatric ketamine 20 mg/kg intramuscular overdose with serial ketamine and norketamine levels that resulted in minimal toxicity.