bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring Inpatient Medication Patterns
Authors: Loresto Figaro L. , Welton John , Grim Stephanie , Valdez Carolyn , Eron Kathryn 
Published: May 2019

PURPOSE
Exploratory study to examine inpatient medication administration patterns.

METHODS
Data from multiple sources were utilized for this study. The outcome was time difference between medication schedule and administration. A 3-level hierarchical linear regression approach, both unadjusted and adjusted, was considered for this study where medication administration events are nested within patients nested within nurses or units. Intraclass correlation coefficients (ICCs) were calculated and compared.

RESULTS
On average, medications were delayed by 12 (SD, 48.8) minutes. From the full model, patient ICCs decreased when “unit” replaced “nurse” as the 3rd level (0.541 vs 0.444). Patients who spoke Spanish had a significant 2.3- to 4.2-minute delay in medication administration. Certified nurses significantly give medications earlier compared with noncertified nurses by 1.6 minutes.

DISCUSSION
Optimal medication administration is a multifactorial concern with nurses playing a role. Nursing leaders should also consider patient demographics and unit conditions, such as culture, for medication administration optimization.
Chromogenic and Silver in Situ Hybridization for Identification of HER 2 Overexpression in Breast Cancer Patients: A Systematic Review and Meta-Analysis
Authors: Grazziotin Luiza R. , Dada Bukky R. , de la Rosa Jaimes Carolina , Cheung Winson Y. , Marshall Deborah A. 
Published: May 2019

Introduction:
This systematic review has the purpose to characterize the accuracy of chromogenic in situ hybridization (CISH) and silver in situ hybridization (SISH), in comparison to fluorescence in situ hybridization (FISH) in the identification of human epidermal growth factor receptor-2 (HER2) overexpression and to inform decisions about test selection.

Materials and Methods:
We searched MEDLINE and EMBASE databases using these eligibility criteria: studies evaluating invasive breast cancer samples which examined agreement between CISH or SISH, and FISH, and reported sensitivity, specificity, or concordance. We performed a bivariate meta-analysis of sensitivity and specificity using a generalized linear mixed model. We used likelihood ratio tests from meta-regression to compare accuracy between HER2 tests.

Results:
The search identified 4475 articles, of which 32 were included. The summary estimates for sensitivity and specificity were 0.91 [95% confidence interval (CI), 0.85-0.95], and 0.97 (95% CI, 0.93-0.99) for SISH; 0.97 (95% CI, 0.83-1.00) and 0.99 (95% CI, 0.96-1.00) for single-probe CISH; and, 0.98 (95% CI, 0.92-0.99) and 0.98 (95% CI, 0.91-0.99) for dual-probe CISH. Significantly higher sensitivity was reported for dual-CISH than SISH (χ2: 5.36; P=0.02) when compared with the reference test FISH.

Conclusions:
The agreement between new bright field tests (SISH and CISH) and FISH is high (≥92%). Indirect comparison of HER2 tests indicated that overall CISH performance exceeds that of SISH. The pooled estimates from this meta-analysis summarize the current published literature and, in addition to other factors such as costs differentials, can help inform future HER2 test selection decisions.
Autoimmune Pancreatitis Type 2
Authors: Gupta Rajib , Neyaz Azfar , Chougule Abhijit , Akita Masayuki , Zen Yoh , Forcione David , Castillo Carlos Fernandez-Del , Ferrone Cristina R. , Deshpande Vikram 
Published: May 2019

Background:
Autoimmune pancreatitis (AIP) encompasses a heterogenous disease group that includes IgG4-related type 1 AIP and non–IgG4-related type 2 AIP. Clinically and on imaging, type 2 AIP mimics type 1 AIP, other forms of chronic pancreatitis and pancreatic ductal adenocarcinoma (PDAC); therefore, discriminatory markers may aid proper diagnosis. Herein, we examine the expression of PD-L1 and indoleamine 2,3-dioxygenase (IDO1) as a diagnostic tool to distinguish type 2 AIP from other forms of pancreatitis and PDAC.

Design:
We evaluated 35 pancreatectomy specimens diagnosed with type 2 AIP and potential mimics of this disease including type 1 AIP (n=14), chronic pancreatitis-not otherwise specified (n=10), groove pancreatitis (n=14), and PDAC (n=278). We scored inflammatory infiltrates, fibrosis and atrophy and performed immunohistochemical staining for PD-L1 and IDO1. We validated our findings on a series of endoscopic ultrasound–guided biopsies from patients with suspected type 2 AIP and inflammatory and neoplastic mimics of this disease (n=37).

Results:
The mean age of patients with type 2 AIP was 50 years with a F:M ratio of 1.2:1. Patients with type 2 AIP showed pancreatic ductal staining for PD-L1 and IDO1 in 69% (24/35) and 60% (15/25) of cases, respectively. PD-L1 reactivity was noted in 3% of patients with other forms of chronic pancreatitis and 3% of PDACs; notably, peritumoral ducts and acini were negative. Eight of 9 endoscopic ultrasound–guided biopsies with pancreatic ductal epithelium from patients with type 2 AIP were positive for PD-L1, while the inflammatory and neoplastic mimics were negative. Collectively, the sensitivity and specificity of PD-L1 as a marker of type 2 AIP was 70% and 99%, respectively.

Conclusions:
Ductal PD-L1 reactivity has the potential to distinguish type 2 AIP from other forms of pancreatitis and PDAC.
Performance of Emergency Medical Service Providers in Pediatric and Adult Simulation of Unstable Supraventricular Tachycardia
Authors: Khalil Paul A. , Berkovich Jennifer , Maniaci Vincenzo , Lozano Juan Manuel , Lowe David A. 
Published: May 2019

Objective
The aim of the study was to compare emergency medical service resuscitation of pediatric and adult high-fidelity manikins in unstable supraventricular tachycardia. The primary objective was time to cardioversion. The secondary objective was to assess if the cardioversion was synchronized at the correct dosage for the manikin's weight.

Methods
Emergency medical service providers were voluntarily enrolled as part of an emergency medical service training program. Participants were randomized to either a pediatric or adult resuscitation as their study scenario. They then completed the second resuscitation as part of the training program. Participants completed presurvey and postsurvey. Resuscitations were videotaped and analyzed by a blinded reviewer. The study was powered to detect a 60-second difference in performance between pediatric and adult scenarios with a β of 0.8 and 2-tailed α of 0.05 using an independent-samples t test.

Results
A total of 37 participants were enrolled. Participants in the pediatric arm had a longer mean time to cardioversion, but the difference was not statistically significant. The mean delay to cardioversion in the pediatric scenario was 34 seconds (197 vs 163 seconds; difference 95% confidence interval [CI], −5 to 73 seconds; P = 0.09). There was no significant difference in the percentage of participants who administered a correct dose (32% vs 50%; difference 95% CI, −50% to 13%; P = 0.75) or regarding synchronization of cardioversion (74% vs 83%; difference 95% CI, −36% to 17%; P = 0.42).

Conclusions
Emergency medical service providers did not have a significant difference in time to cardioversion between pediatric and adult unstable supraventricular tachycardia simulations.
Emergency Department Visits for Pediatric Firearm Injuries by Trauma Center Type
Authors: Cutler Gretchen J. , Zagel Alicia L. , Spaulding Alicen B. , Linabery Amy M. , Kharbanda Anupam B. 
Published: May 2019

Objectives
This study aimed to characterize pediatric visits to emergency departments (EDs) for firearm injuries and examine differences by trauma center type.

Methods
Analyses included all patients younger than 19 years from the National Trauma Data Bank, years 2009 to 2014. Trauma centers were categorized as adult, mixed adult and pediatric, or pediatric based on certification level. Baseline characteristics were compared between subgroups using χ2 tests. Multivariable logistic regression was used to examine risk of death.

Results
Of 466,403 pediatric ED visits, 21,416 (4.6%) resulted from a firearm injury. Most firearm injuries were treated at an adult (64.9%) or mixed trauma center (29.1%) and involved patients that were male (87.1%), in the 15- to 18-year age group (83.2%), and black or African American (61.3%). Most visits were for injuries resulting from assault (78.1%), followed by unintentional (12.6%) and self-inflicted (4.7%) injuries, undetermined intent (3.7%), and legal intervention (0.8%). Patients visiting EDs for firearm injuries had more than 7 times the odds of dying compared with patients with other injuries (odds ratio, 7.30; 95% confidence interval, 6.82–7.72), and firearm injuries were responsible for more than a quarter (26.1%) of the total pediatric deaths in the National Trauma Data Bank (n = 2866). Assault-related injuries resulted in the most deaths (n = 2010; 70.1%), but the case fatality rate was highest for self-inflicted (n = 453; 44.6%).

Conclusion
We identified more than 20,000 firearm-related ED visits by pediatric patients from 2009 to 2014, averaging nearly 10 visits per day. Findings from this study can inform strategic planning in hospitals focused on preventing firearm injuries in children and adolescents.
Feedback at the Point of Care to Decrease Medication Alert Rates in an Electronic Health Record
Authors: van Camp P. J. , Kirkendall Eric S. , Hagedorn Philip A. , Minich Thomas , Kouril Michal , Spooner S. Andrew , Gecili Emrah , Dexheimer Judith W. 
Published: May 2019

Objective
Frequently overridden alerts in the electronic health record can highlight alerts that may need revision. This method is a way of fine-tuning clinical decision support. We evaluated the feasibility of a complementary, yet different method that directly involved pediatric emergency department (PED) providers in identifying additional medication alerts that were potentially incorrect or intrusive. We then evaluated the effect subsequent resulting modifications had on alert salience.

Methods
We performed a prospective, interventional study over 34 months (March 6, 2014, to December 31, 2016) in the PED. We implemented a passive alert feedback mechanism by enhancing the native electronic health record functionality on alert reviews. End-users flagged potentially incorrect/bothersome alerts for review by the study's team. The alerts were updated when clinically appropriate and trends of the impact were evaluated.

Results
More than 200 alerts were reported from both inside and outside the PED, suggesting an intuitive approach. On average, we processed 4 reviews per week from the PED, with attending physicians as major contributors. The general trend of the impact of these changes seems favorable.

Discussion
The implementation of the review mechanism for user-selected alerts was intuitive and sustainable and seems to be able to detect alerts that are bothersome to the end-users. The method should be run in parallel with the traditional data-driven approach to support capturing of inaccurate alerts.

Conclusions
User-centered, context-specific alert feedback can be used for selecting suboptimal, interruptive medication alerts.
Mild Traumatic Brain Injury
Authors: Waldmeier-Wilhelm Sandra , Studer Martina , Weisstanner Christian , Heinks Theda , Grunt Sebastian , Steinlin Maja 
Published: May 2019

Abstract
Pediatric mild traumatic brain injury is a frequent cause for emergency consultations. Very often, management decisions focus only on acute neurological problems, without considering possible long-term impairment. Our case describes a 14-year-old girl who developed a pronounced and prolonged postconcussive syndrome and subsequent posttraumatic stress symptoms after (mild) traumatic brain injury. Early discharge without adequate instructions about the appropriate time to return to school and daily life activities promoted these striking problems. Only the delayed interventions including reduction of school workload and initiation of physiotherapy led to an improvement of symptoms.

Conclusions
Traumatologists, pediatricians, and general practitioners should call families' and teachers' attention to the risk of potential postconcussive syndrome and advise them on appropriate coping strategies. Thorough clinical examination should rule out potentially treatable physical impairments. Prescription of physical and cognitive rest at an early stage is mandatory and should be part of concussion management already at emergency department. Pediatricians or general practitioners should follow up patients and support their gradually working back into full activity.
Medical Errors and Malpractice Lawsuits
Authors: Rappaport David I. , Selbst Steven M. 
Published: May 2019

Abstract
Every pediatric emergency medicine provider will be involved in medical errors during their career and many will face the prospect of at least one malpractice lawsuit. These events can cause significant stress, including detrimental effects on providers' mental and physical health. This stress may also impact the provider's ability to care for future patients. In this installment of our series, “A Call to Restore Your Calling: Self-care of the Emergency Physician in the Face of Life-Changing Stress,” we examine how medical errors and malpractice lawsuits may affect providers and how individuals and organizations can address these events.
Hyperbaric Oxygen Improves Functional Recovery of the Injured Spinal Cord by Inhibiting Inflammation and Glial Scar Formation
Authors: Zhou Yue , Dong Qirong , Pan Zhenzhen , Song Yue , Su Peng , Niu Yanping , Sun Yongming , Liu Dong 
Published: May 2019

Background
Inflammation and glial scar formation determine the recovery process after spinal cord injury. Hyperbaric oxygen is used as a rehabilitation therapy for various clinical diseases, including spinal cord injury. However, the relationship between hyperbaric oxygen therapy and inflammation or glial scar is not fully understood.

Objective
The aim of this study was to investigate the therapeutic effect and molecular mechanism of hyperbaric oxygen on spinal cord injury.

Methods
A total of 54 developing female Sprague-Dawley rats were randomly divided into sham group, spinal cord injury group, and hyperbaric oxygen group, with 18 rats in each group. The model of spinal cord injury was established using Allen’s method. Hyperbaric oxygen therapy was administered once a day until the rats were killed.

Results
The results demonstrated inflammation and glial scar formation are involved in secondary spinal cord injury. After hyperbaric oxygen treatment, there was a notable improvement of the locomotor function in rats. Hyperbaric oxygen reduced the inflammatory reaction and glial scar formation by inhibiting inflammation-related factors iNOS and COX-2 and glial scar–related components GFAP and NG2. This process may be achieved by inhibiting AKT and NF-kB pathways.

Conclusions
Hyperbaric oxygen effectively promotes the recovery of spinal cord injury by inhibiting inflammation and glial scar formation.
The Feasibility and Effects of Acupuncture on Muscle Soreness and Sense of Well-being in an Adolescent Football Population
Authors: Luetmer Marianne T. , Do Alexander , Canzanello Nick C. , Bauer Brent A. , Laskowski Edward R. 
Published: May 2019

Objective
The aims of the study were to assess the feasibility of performing acupuncture on multiple adolescent athletes in a warm weather, high-intensity training environment and to measure perceived effects of acupuncture on delayed-onset muscle soreness and sense of well-being.

Design
This is a prospective feasibility study (registered clinical trial NCT03478800). Forty-two healthy male participants, aged 13–18 yrs, were involved in at least 1 of 5 treatment days for a total of 147 individual treatment sessions. Fifteen-minute treatments of traditional needle acupuncture were administered at the football field. Time, cost, adverse effects, and participant/provider ratio were observed. Effect on delayed-onset muscle soreness and sense of well-being were measured via pretreatment and posttreatment visual analog scale (0–10) rating analyses.

Results
The results are as follows: time required by research staff on treatment days, 75 mins; total cost, US $700; temperature range, 21°C–28°C; and largest participant to acupuncturist ratio, 7–10:1. No major adverse effects occurred; 55% reported minimal adverse effects, such as mild focal numbness or tingling. Overall pretreatment to posttreatment effect on delayed-onset muscle soreness (average over 5 days) demonstrated significantly improved posttreatment scores (pre 4.6 ± 2.0; post 2.9 ± 2.2, P < 0.001). There was no significant effect on sense of well-being (P = 0.12).

Conclusions
Effectively providing acupuncture to multiple adolescent football players in their training environment is feasible with appropriate staff and resources. Despite mild adverse effects, treatment was well tolerated. This study provides guidance on acupuncture delivery to other athletes in their training environments.
Energy Cost of Slow and Normal Gait Speeds in Low and Normally Functioning Adults
Authors: Rowley Taylor W. , Cho Chi , Swartz Ann M. , Staudenmayer John , Hyngstrom Allison , Keenan Kevin G. , Welch Whitney A. , Strath Scott J. 
Published: May 2019

Objective
Slow walking speed paired with increased energy cost is a strong predictor for mortality and disability in older adults but has yet to be examined in a heterogeneous sample (ie, age, sex, disease status). The aim of this study was to examine energy cost of slow and normal walking speeds among low- and normal-functioning adults.

Design
Adults aged 20–90 yrs were recruited for this study. Participants completed a 10-m functional walk test at a self-selected normal walking speed and were categorized as low functioning or normal functioning based on expected age- and sex-adjusted average gait speed. Participants completed two successive 3-min walking stages, at slower than normal and normal walking speeds, respectively. Gas exchange was measured and energy cost per meter (milliliter per kilogram per meter) was calculated for both walking speeds.

Results
Energy cost per meter was higher (P < 0.0001) in the low-functioning group (n = 76; female = 59.21%; mean ± SD age = 61.13 ± 14.68 yrs) during the slower than normal and normal (P < 0.0001) walking speed bouts compared with the normal-functioning group (n = 42; female = 54.76%; mean ± SD age = 51.55 ± 19.51 yrs).

Conclusions
Low-functioning adults rely on greater energy cost per meter of walking at slower and normal speeds. This has implications for total daily energy expenditure in low-functioning, adult populations.
Early Detection of Diabetic Polyneuropathy Using Paired Stimulation Studies of the Sensory Nerves
Authors: Lee Ahry , Kwon Hee-Kyu 
Published: May 2019

Objective
This study seeks to use the relative refractory period, a sensitive parameter for detecting early change in peripheral polyneuropathies, as a tool for early detection of diabetic polyneuropathy.

Design
The relative refractory period of the median and sural sensory nerves was measured in 57 diabetic patients (male 31, female 26) and 23 healthy controls (male 16, female 7). The shortest interstimulus interval, where the latency of the response to the second stimulus recovers to normal, was defined as the relative refractory period.

Results
The relative refractory period of the median and sural nerves were significantly longer in diabetic patients (3.6 msec, P < 0.001, and 3.8 msec, P < 0.001, respectively) than in the control group (3.0 msec in both nerves). Relative refractory period values of both nerves were also significantly prolonged compared with the control group, even in diabetic patients without diabetic polyneuropathy based on conventional conduction studies (3.3 msec, P = 0.002, for median nerve; 3.5 msec, P < 0.001, for sural nerve) or without any clinical symptoms and signs (3.3 msec, P = 0.007, for median nerve; 3.5 msec, P = 0.001, for sural nerve).

Conclusions
The relative refractory period was prolonged in diabetic patients even before other electrophysiologic abnormalities or clinical findings appeared. These results suggest that the relative refractory period can be a possible early indicator of diabetic polyneuropathy.
Needle EMG, a Jigsaw to Disclose Lipid Storage Myopathy Due to Multiple Acyl-CoA Dehydrogenase Deficiency
Authors: Santananukarn Manasawan , Amornvit Jakkrit , Pasutharnchat Nath , Jongpiputvanich Sungkom 
Published: May 2019

Abstract
Multiple acyl-CoA dehydrogenase deficiency is a rare autosomal recessive inborn error of metabolism. The late-onset multiple acyl-CoA dehydrogenase deficiency is frequently caused by mutations in ETFDH gene. Because of its clinical heterogeneity, diagnosis and treatment of late-onset multiple acyl-CoA dehydrogenase deficiency are often delayed. The authors described a previously healthy 40-yr-old Thai woman presenting with subacute severe weakness of bulbar-limb muscles and elevated serum creatine kinase. The authors emphasized the importance of needle EMG and prompt muscle histopathological evaluation, which rapidly led to the diagnosis and riboflavin therapy, resulting in a dramatic and rapid improvement before genetic study disclosed mutation in ETFDH gene.
Inhibiting Autophagy in Renal Cell Cancer and the Associated Tumor Endothelium
Authors: Russell Kira L. , Gorgulho Carolina Mendonça , Allen Abigail , Vakaki Marianna , Wang Yue , Facciabene Andrea , Lee Daniel , Roy Partha , Buchser William J. , Appleman Leonard J. , Maranchie Jodi , Storkus Walter J. , Lotze Michael T. 
Published: May 2019

Abstract
The clear cell subtype of kidney cancer encompasses most renal cell carcinoma cases and is associated with the loss of von Hippel-Lindau gene function or expression. Subsequent loss or mutation of the other allele influences cellular stress responses involving nutrient and hypoxia sensing. Autophagy is an important regulatory process promoting the disposal of unnecessary or degraded cellular components, tightly linked to almost all cellular processes. Organelles and proteins that become damaged or that are no longer needed in the cell are sequestered and digested in autophagosomes upon fusing with lysosomes, or alternatively, released via vesicular exocytosis. Tumor development tends to disrupt the regulation of the balance between this process and apoptosis, permitting prolonged cell survival and increased replication. Completed trials of autophagic inhibitors using hydroxychloroquine in combination with other anticancer agents including rapalogues and high-dose interleukin 2 have now been reported. The complex nature of autophagy and the unique biology of clear cell renal cell carcinoma warrant further understanding to better develop the next generation of relevant anticancer agents.
Adoptive Cell Therapy for Acute Myeloid Leukemia and T-Cell Acute Lymphoblastic Leukemia
Authors: Lulla Premal D. , Mamonkin Maksim , Brenner Malcolm K. 
Published: May 2019

Abstract
Refractory and relapsed acute myeloid leukemia (AML) and T-lineage leukemia have poor prognosis and limited therapeutic options. Adoptive cellular immunotherapies are emerging as an effective treatment for patients with chemotherapy refractory hematological malignancies. Indeed, the use of unselected donor lymphocyte infusions has demonstrated successes in treating patients with AML and T-lineage leukemia post–allogeneic transplantation. The development of ex vivo manipulation techniques such as genetic modification or selection and expansion of individual cellular components has permitted the clinical translation of a wide range of promising cellular therapies for AML and T-cell acute lymphoblastic leukemia. Here, we will review clinical studies to date using adoptive cell therapy approaches and outline the major challenges limiting the development of safe and effective cell therapies for both types of acute leukemia.