bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Anti‐drug Antibodies to Biologic Medications in Children With Inflammatory Bowel Disease
Authors: Cohen Reuven Zev , Schoen Bess T. , Kugathasan Subra , Sauer Cary G. 
Published: July 2019

ABSTRACTBackground:Treatment of pediatric inflammatory bowel disease (IBD) with monoclonal anti‐ tumor necrosis factor‐alpha (TNFα) can result in immunogenicity and formation of anti‐drug antibodies (ADAs). ADAs are associated with loss of clinical response and worsening disease progression. Data examining treatment interventions to overcome ADA in pediatric patients with IBD are lacking.Results:Medical records were reviewed from 234 children and adolescents with IBD treated with infliximab or adalimumab who underwent therapeutic drug monitoring (626 tests). All patients who had detectable antibodies were further analyzed. A total 58 patients (24.8%) developed ADA while being treated with infliximab or adalimumab. The incidence of antibody development was 12.9 per 100 person‐years of anti‐TNF treatment. Twenty‐eight patients underwent dose optimization and 54% had undetectable ADA on follow‐up monitoring. The mean duration of antibody suppression was 16.8 ± 10.9 months in those who were successfully suppressed with optimization. Patients who switched to a second anti‐TNF medication were not more likely to develop antibodies to the second agent.Conclusions:With limited therapies for IBD and the chronicity of the disease, we advocate salvage of the current anti‐TNF through dose optimization in pediatric patients with antibody level <10 U/mL.
Incidence of Paediatric Stricturing Duodenal Crohn Disease
Authors: Burgess Christopher J. , Gillett Peter , Mitchell David , Hammond Philip , Henderson Paul , Wilson David C. 
Published: July 2019

ABSTRACTObjectives:Stricturing duodenal Crohn disease (CD) is a rare but serious presentation of CD causing significant morbidity. We aim to provide the first robust incidence data and case studies on this severe presentation in children.Methods:A regional cohort of prospectively acquired incident cases of paediatric CD diagnosed <16 years of age in South‐East Scotland was captured over a 19‐year period (1999–2018). A retrospective review was conducted on the medical records of all patients together with a review of the available literature and consensus guidelines. Incidence rates for all CD and for duodenal stricturing CD were calculated.Results:A total of 247 new cases of paediatric CD were diagnosed within the study period. Median age at diagnosis was 12.5 years with 62% male predominance. Overall paediatric CD incidence rate was 5.70/100,000/year with a specific duodenal B2 phenotype disease incidence rate of 0.05/100,000/year; representing 0.8% of incident cases at diagnosis. Two incident cases of stricturing duodenal CD presented with systemic symptoms of weight loss, abdominal pain, anorexia, and lethargy, together with persistent vomiting suggestive of obstruction. Both cases partially responded to intensive medical therapy but eventually required laparoscopic gastroduodenostomy. A detailed literature search confirmed there are no paediatric incidence data, guidelines, or case reports relating to duodenal stricture as either a presentation or complication of CD.Conclusions:Duodenal structuring disease is a rare but serious presentation of CD causing significant morbidity and not currently covered in the paediatric literature or consensus guidelines. Best practice medical and surgical management remain uncertain and require further research.
Management of Biliary Atresia in France 1986 to 2015
Authors: Fanna Martina , Masson Guillaume , Capito Carmen , Girard Muriel , Guerin Florent , Hermeziu Bogdan , Lachaux Alain , Roquelaure Bertrand , Gottrand Frédéric , Broue Pierre , Dabadie Alain , Lamireau Thierry , Jacquemin Emmanuel , Chardot Christophe 
Published: July 2019

ABSTRACTObjectives:This study analyses the prognosis of biliary atresia (BA) in France since 1986, when both Kasai operation (KOp) and liver transplantation (LT) became widely available.Methods:The charts of all patients diagnosed with BA born between 1986 and 2015 and living in France were reviewed.Results:A total of 1428 patients were included; 1340 (94%) underwent KOp. Total clearance of jaundice (total bilirubin ≤20 μmol/L) was documented in 516 patients (39%). Age at KOp (median 59 days, range 6–199) was stable over time. Survival with native liver after KOp was 41%, 35%, 26%, and 22% at 5, 10, 20, and 30 years, stable in the 4 cohorts. 25‐year survival with native liver was 38%, 27%, 22%, and 19% in patients operated in the first, second, third month of life or later, respectively (P = 0.0001). Center caseloads had a significant impact on results in the 1986 to 1996 cohort only. 16%, 7%, 7%, and 8% of patients died without LT in the 4 cohorts (P = 0.0001). A total of 753 patients (55%) underwent LT. Patient survival after LT was 79% at 28 years. Five‐year patient survival after LT was 76%, 91%, 88%, and 92% in cohorts 1 to 4, respectively (P < 0.0001). Actual BA patient survival (from diagnosis) was 81%. Five‐year BA patient survival was 72%, 88%, 87%, and 87% in cohorts 1986 to 1996, 1997 to 2002, 2003 to 2009, and 2010 to 2015, respectively (P < 0.0001).Conclusions:In France, 87% of patients with BA survive nowadays and 22% reach the age of 30 years without transplantation. Improvement of BA prognosis is mainly due to reduced mortality before LT and better outcomes after LT.
The Role of Distress and Pain Catastrophizing on the Health‐related Quality of Life of Children With Inflammatory Bowel Disease
Authors: De Carlo Chiara , Bramuzzo Matteo , Canaletti Claudia , Udina Chiara , Cozzi Giorgio , Pavanello Paolo M. , Rampado Stefania , Martelossi Stefano , Giudici Fabiola , Di Leo Grazia , Barbi Egidio 
Published: July 2019

ABSTRACTObjectives:Inflammatory bowel disease (IBD) can be particularly challenging during the pediatric age with a relevant impact on patient's health‐related quality of life (HRQoL). Disease activity accounts for only a small part of the variability in HRQoL, and psychological factors can play a significant role. We aimed to evaluate the impact of patient's distress and pain catastrophizing on children and adolescents with IBD.Methods:We prospectively recruited children aged 8 to 18 with IBD and recorded demographic and disease characteristics. Patients answered questionnaires on HRQoL (IMPACT III), distress (distress thermometer [DT]), and pain catastrophizing (Pain Catastrophizing Scale‐Children [PCS‐C]). Univariate and multivariate regression models analysis were used to evaluate correlations between patients’ characteristics, disease activity, distress, pain catastrophizing, and HRQoL.Results:Seventy‐one patients were enrolled (median age 13.6, 49.3% Crohn disease, 50.7% ulcerative colitis). Median HRQoL, DT, and PCS‐C scores were 78.6 (interquartile range 68.0–87.1), 3.0 (1.0–5.0), and 12.0 (4.0–23.0), respectively. Patient's distress and pain catastrophizing levels significantly correlated with HRQoL. Pain catastrophizing had the strongest impact on HRQoL (Spearman correlation coefficient, ρ = 0.73), followed by distress (ρ = 0.67), and ulcerative colitis severity (ρ = 0.67). The DT and the PCS‐C scores were significantly associated (ρ = 0.46).Conclusions:Distress and pain catastrophizing have a significative impact on HRQoL in young patients with IBD. Physicians should recognize the role of these psychological factors and consider cognitive‐behavioral therapy to optimize the patient's health.
Vitamin D Supplementation and T Cell Regulation in Preterm Infants
Authors: Aly Hany , Mohsen Lamiaa , Bhattacharjee Indrani , Malash Amr , Atyia Amr , Elanwary Sherif , El Hawary Rabab 
Published: July 2019

ABSTRACTThe objective of this study was to evaluate the effect of 2 different doses of vitamin D on the expression of T regulatory cells (Treg) in premature infants. A double‐blind randomized controlled trial was conducted on preterm infants born with gestational age between 280/7 and 336/7 weeks. Subjects were randomly assigned to receive 400 or 800 IU/day of vitamin D3 when they achieved 100 mL/kg of enteral feeds. Percentage increase in Treg cell counts were measured by flow cytometry at enrollment, and after 1 and 4 weeks of oral vitamin D supplementation at the allotted doses in both groups. Short‐term morbidity and mortality outcomes were also assessed. A total of 40 infants were enrolled, 20 in each group. The change in Treg count (%) was significantly less in the low‐dose vitamin D3 supplementation group after 1 week (1.9 ± 5.5 vs 60 ± 5.6, P = 0.0005) and after 4 weeks (1.8 ± 5.7 vs 73.7 ± 5.6, P = 0.0028). The 2 groups did not differ in anthropometric measurements, duration of oxygen and respiratory support, and mortality. Length of hospital stay was longer in the low‐dose group (24.9 ± 5.14 vs 22 ± 3.49, P = 0.04). Oral vitamin D supplementation has a dose and time dependent effect on percentage of Treg in infants born prematurely. The 800 IU dose of vitamin D3 did not have apparent short‐term side effects. Larger studies are needed to explore the effect of vitamin D3 dosing on length of hospital stay.
Biliary Atresia as a Disease Starting In Utero
Authors: Mysore Krupa R. , Shneider Benjamin L. , Harpavat Sanjiv 
Published: July 2019

ABSTRACTBiliary atresia (BA) is the most common reason for pediatric liver transplant. BA's varied presentation, natural history, and treatment with the Kasai portoenterostomy have been well described; however, when BA starts relative to birth has not been clearly defined. In this review, we discuss laboratory, imaging, and clinical data which suggest that most if not all forms of BA may start before birth. This early onset has implications in terms of delivering treatments earlier and identifying possible factors underlying BA's etiology.
Celiac Dietary Adherence Test simplifies Determining Adherence to a Gluten‐free Diet in Swedish Adolescents
Authors: Johansson Katarina , Norström Fredrik , Nordyke Katrina , Myleus Anna 
Published: July 2019

ABSTRACTObjectives:The aims of the study were to ascertain whether the Celiac Dietary Adherence Test (CDAT) could contribute in determining adherence to a gluten‐free diet in patients with celiac disease and to evaluate the diet adherence and well being of a study population 5 years after a celiac disease screening known as “Exploring the Iceberg of Celiacs in Sweden.”Methods:Through the screening, 90 adolescents (born 1997) were diagnosed with biopsy‐proven celiac disease at 12 years of age. Of them, 70 (78%) came to a 5‐year follow‐up where anti–tissue transglutaminase antibodies 2 was tested and a questionnaire was filled in, including CDAT, which consists of 7 questions related to adherence. Nonparametrical tests were used to determine associations between adherence measures.Results:Among the adolescents, 86% were adherent to a gluten‐free diet 5 years after screening, 38% reported their general well being as excellent, 50% very well, and 12% well. Statistically significant associations were seen between anti–tissue transglutaminase antibodies 2 and the CDAT score (P = 0.033), and the self‐reported adherence question and the CDAT score (P < 0.001).Conclusions:The screening‐detected adolescents reported a high level of well being and adherence to a gluten‐free diet 5 years after screening. We conclude that the CDAT can be used in clinical practice as an estimation of adherence to a gluten‐free diet. It would be most suitable to use in conjunction with currently used adherence measures, but can also be used as a stand‐alone method when others are not accessible.
Evaluation of Bone Mineral Density in Children With Hemophilia: An Observational Case-Control Study
Authors: Ashritha A. , Delhi Kumar C.G. , Sahoo Jayaprakash , Nalini P. 
Published: July 2019

Objectives:
The objectives of this study were to study bone mineral content (BMC), bone mineral density (BMD), vitamin D level, and bone turnover markers in children with hemophilia and compare it with their normal counterparts.

Design:
This was an observational case-control study.

Setting:
This study was conducted in our tertiary care institute during the period spanning from September 2016 to June 2018.

Materials and Methods:
A total of 38 children with hemophilia 2 to 18 years of age and 38 age-matched and sex-matched healthy controls were included. Children with symptomatic hypocalcemia and those receiving drugs affecting BMC and BMD were excluded. Dual-energy x-ray absorptiometry was performed to estimate BMC and BMD. 25-Hydroxyvitamin D [25(OH)D], intact parathormone, osteocalcin, calcium, phosphate and alkaline phosphatase, and spot urine pyrilinks-D/creatinine ratio were estimated in them.

Results:
BMC and BMD in cases was lower than that in controls (P<0.05). Prevalence of low BMC was seen in 22 (58%) and low BMD in 8 (21%) of cases. All controls had normal BMC and BMD for age. The prevalence of low vitamin D level (<20 ng/mL) was seen in 36 (95%) among cases and in 25 (65%) among controls (P<0.001). Serum phosphorus was lower, and serum alkaline phosphatase was higher in cases than in controls (P<0.05).

Conclusion:
BMC, BMD, and vitamin D in hemophiliacs were lower than in the general population.
ADN-to-BSN Articulation, Academic Progression, and Transition
Authors: Jeffreys Marianne R. 
Published: July 2019

Background
Although improvements have been made in articulation agreements, credit transfers, and concurrent enrollments, meeting the 80% BSN by 2020 goal falls short.

Problem
Nursing students at key transitional points (such as first- and last-semester students) are faced with numerous academic and career path challenges and opportunities simultaneously, often leaving them overwhelmed and in need of additional support and resources.

Approach
Guided by Jeffreys' Nursing Universal Retention and Success model, a proactive, holistic approach for facilitating articulation, academic progression, and transition is presented.

Outcomes
Implementation with fourth/last-semester associate degree nursing students and newly admitted RN-BSN students yielded positive student feedback and survey data.

Conclusions
Nurse educators can make a positive difference in students' transitional experiences, career path planning, and educational mobility via a coordinated, connected, proactive, holistic approach guided by an evidence-based theoretical framework.
An Integrative Review Examining Student-to-Student Incivility and Effective Strategies to Address Incivility in Nursing Education
Authors: Rose Kristine , Jenkins Sheryl , Mallory Caroline , Astroth Kim , Woith Wendy , Jarvill Melissa 
Published: July 2019

Background
Incivility is a low-intensity, discourteous behavior intended to disrupt or harm positive interaction. If allowed, student-to-student incivility can undermine the educational environment.

Purpose
The purpose of the integrative review was to examine factors influencing incivility among nursing students and teaching strategies used to reduce incivility in nursing education.

Methods
Qualitative and quantitative studies were reviewed. The Johns Hopkins Research Evidence Appraisal tool was used to narrow down the selection of articles. Content analysis was used to evaluate the qualitative research.

Results
Five major points of interest were identified: workload and high expectations contributed to incivility, degrees of incivility, effects of incivility, coping mechanisms among individuals, and effective teaching strategies addressing incivility.

Conclusion
Continued research on innovative teaching strategies that raise awareness of civility while reducing incivility is warranted.
A Bayesian Approach to Gateway Course Identification With Implications for the Prenursing Curriculum
Authors: Stankus Jo-Ann , Hamner Mark , Stankey Michael , Mancuso Peggy 
Published: July 2019

Background
Analysis of student performance in gateway courses has been an important predictor of successful admission into upper-division nursing.

Purpose
The aim was to explore the utility of a Bayesian statistical framework for determining threshold grades in prenursing courses that serve as gateways for successful admission into upper-division nursing programs.

Methods
Records of 3500 prenursing students who entered the prenursing program of a midsized public university during the past decade were analyzed. The Bayesian framework was used to incorporate conditional probabilistic concepts of sensitivity and specificity to calculate gateway impact of various grade level cutoffs on successful upper-division nursing admission.

Results
Identification, sequencing, and combination of grades attained in these gateway courses revealed different pathways to successful admission into upper-division nursing based on first-semester grade point average and ethnicity.

Conclusions
Identification of primary/secondary gateway courses enhances successful matriculation and provides valuable information for advisors and curriculum planners for prenursing majors.
Assessing the Impact of Telehealth Objective Structured Clinical Examinations in Graduate Nursing Education
Authors: Phillips Tiffany A. , Munn Allison C. , George Tracy P. 
Published: July 2019

Background
The National Organization of Nurse Practitioner Faculties supports the incorporation of telehealth in nurse practitioner (NP) education.

Purpose
The purpose of this article is to describe the implementation of a no-cost telehealth simulation and its impact on students in their first NP clinical course.

Methods
Twenty-eight NP students participated in the telehealth objective structured clinical examination (OSCE). Students completed an online survey about the impact of telehealth OSCE simulation both before and after the simulation.

Results
The students' general understanding of the field of telehealth was significantly greater after the telehealth OSCE experience. Directed content analysis revealed 3 themes: usefulness of telehealth, benefit in role preparation, and technology.

Conclusion
The use of telehealth simulation can be an effective strategy to assess clinical competency, provide individualized feedback, and ensure students are using evidence-based practice.
Doctoral Degree Preferences for Nurse Educators
Authors: King Tara Spalla , Melnyk Bernadette Mazurek , O'Brien Tara , Bowles Wendy , Schubert Carolyn , Fletcher Linnea , Anderson Cindy M. 
Published: July 2019

Background
Current doctoral degree options may not meet needs of nurses desiring educator roles in academic or health care settings.

Purpose
The purpose of the study was to assess preferences for existing terminal degree options for nurse educators and determine the need for a new doctoral degree in nursing education.

Method
Nurses in practice, academia, and leadership nationwide (n = 826) answered a 19-item needs assessment survey regarding adequacy of and interest in terminal degree options.

Results
More than 60% reported current doctoral degrees available to nurse educators lack content in curriculum development and teaching-learning best practices in nursing. Most data supported a new terminal degree.

Conclusion
A primary factor in nurses choosing not to enroll in a terminal degree program may be limited availability of education aligned with career goals. The doctor of nursing education, a practice degree parallel to the DNP, could prepare nurses for academic and practice educator roles.
Marijuana Use in Pregnancy: A Review
Authors: Thompson Rebecca , DeJong Katherine , Lo Jamie 
Published: July 2019

ImportanceMarijuana is the most commonly used dependent substance in pregnancy. The main active chemical of marijuana (delta-9-tetrahydrocannabinol [THC]) readily crosses the placenta, and cannabinoid receptors have been identified in fetal brain and placenta. As a result, prenatal marijuana use could potentially have detrimental impact on fetal development.ObjectiveThis review aims to summarize the existing literature and current recommendations for marijuana use while pregnant or lactating.Evidence AcquisitionA PubMed literature search using the following terms was performed to gather relevant data: “cannabis,” “cannabinoids,” “marijuana,” “fetal outcomes,” “perinatal outcomes,” “pregnancy,” “lactation.”ResultsAvailable studies on marijuana exposure in pregnancy were reviewed and support some degree of developmental disruption, including an increased risk of fetal growth restriction and adverse neurodevelopmental consequences. However, much of the existing prenatal marijuana research was performed in the 1980s, when quantities of THC were lower and the frequency of use was less. Additionally, most human studies are also limited and conflicting as most studies have been observational or retrospective, relying primarily on patient self-report and confounded by polysubstance abuse and small sample sizes, precluding determination of a causal effect specific for marijuana. Given the paucity of evidence, it is currently recommended to avoid using marijuana while pregnant or when breastfeeding.Conclusion and RelevanceThere is a critical need for research on effects in pregnancy using present-day THC doses. Once the adverse perinatal effects of marijuana exposure are identified and well characterized, patient education and antenatal surveillance can be developed to predict and mitigate its impact on maternal and fetal health.Target AudienceObstetricians and gynecologists, family physicians.Learning ObjectivesAfter participating in this activity, the provider should be better able to counsel patients regarding prenatal marijuana use; assess patients during pregnancy for marijuana use; and explain recommendations regarding marijuana use while breastfeeding.