bluuebunny/crossref_metadata_2025_split huggingface dataset:
PB2453 DISTRIBUTION OF BLOOD DONOR IN DIFFERENT AGE GROUP IN KATHMANDU NEPAL
Authors: Nepal B. 
Published: June 2019

Background:Voluntary non‐remunerated blood donor consists of 78% blood donor's population in Nepal. Therefore demographic about the distribution of blood donors according to the age group is important to achieve 100% Voluntary non‐remunerated blood donors in Nepal.Aims:To explore the demographic distribution of the blood donor in different age group in the Kathmandu Nepal.Methods:This is retrospective study conducted at Nepal Red Cross Society Central Blood Transfusion Service. Data from January 2013 to January 2017 were collected from donor management software. The data includes socio demographic data. Data has been process with SPSS version ‐17Results:During 4 years study period, total of 276,290 Blood donation happened from both mobile blood collection and in‐house blood collection.Out of 276,290 Collection, 48351 (17.5%) are from 18‐24 age group; 106924 (38.7%) are from 25‐31 age group 53324 (19.3%) are from 32‐38 age group; 34536 (12.5%) are from group 39‐45 age group; 23761 (8.6%) are from age group 46‐52 and 9394 (3.4%) from age group above 53 respectively.Summary/Conclusion:The distribution of ABO blood group varies regionally and from one population to another. In Kathmandu, Nepal 18‐38 years age group is the most common age group encountered donating blood. The data generated in the present study and several other studies of different geographical region of India will be useful to health planners and future health challenges in the region
Graduate-Entry Education for Nonnurses: Preparation, Pathways, and Progress
Authors: Jackson Molly , Marchi Nadine 
Published: June 2019

Abstract

AIM
The aim of the study was to review education and role preparation in US direct-entry graduate nursing programs.

BACKGROUND
In the last 15 years, there has been an increase in nursing programs targeting college graduates with nonnurse degrees. Educational pathways, role preparation, and doctoral study options vary.

METHOD
A literature search was conducted. A secondary search of direct-entry graduate nursing programs was performed using electronic databases, including academic nursing sources and university websites.

RESULTS
Forty-three journal articles were located. The secondary search identified 42 direct-entry graduate nursing programs. The majority of programs emphasize role preparation for clinical nurse leadership and advanced practice registered nursing (APRN) certification; 62 percent require doctoral preparation for entry to APRN practice.

CONCLUSION
The growth of direct-entry graduate nursing programs will require educators to prepare and evaluate student outcomes to ensure competent entry to practice.
Heterogeneous Trajectories of Delayed Communicative Development From 12 to 36 Months: Predictors and Consequences
Authors: Hentges Rochelle F. , Madigan Sheri , Plamondon Andre , Racine Nicole , Collisson Beverly , Tough Suzanne , Graham Susan 
Published: June 2019

ABSTRACT:Objective:The objective of the study was to identify distinct trajectories of delayed communicative development from 12 to 36 months and examine differences in risk factors and developmental outcomes for each trajectory.Methods:Participants were 2192 children drawn from a prospective longitudinal pregnancy cohort in a large Canadian city. Maternal pregnancy medical records were used to determine perinatal risk factors. The Ages and Stages Questionnaire Communication subscale was administered at 12, 24, and 36 months. At 36 months, mothers reported on the child's health, cognitive, and behavioral development.Results:Using growth mixture modeling, we identified 4 trajectories of communicative development. Most children (81.1%) were characterized by high and stable scores from 12 to 36 months. The remaining children fell into a low-increasing class (13.0%), a moderate-stable class (4.5%), and a low-decreasing class (1.4%). At 36 months, the low-increasing class had caught up to the high-stable group. However, by 36 months, the low-decreasing class fell under the recommended “referral” cutoff, and the moderate-stable class fell under the “monitoring” cutoff criteria. Children with continued communication problems at 36 months were more likely to have a congenital anomaly and lower family income than late-talking children who had caught up.Conclusion:Repeated assessments of a brief screening tool were able to differentiate patterns of communicative development over time, each with unique risk factors and developmental outcomes. Results highlight the potential for risk factors and repeated screenings to help identify children most at risk for persistent communication delays and in need of early support services.
Prevalence of Gram-Negative Bacteria in Ventilator-Associated Pneumonia in Neonatal Intensive Care Units
Authors: Erfani Yousef , Rasti Arezoo , Janani Leila , Tanha Kiarash , Noghabi Samaneh Lotfi , Azami Seyedeh Roya , Kamali Mahboobeh 
Published: June 2019

Abstract
This systematic review was conducted to determine the prevalence of gram-negative bacteria in ventilator-associated pneumonia (VAP) as a potentially lethal and serious infection among mechanically ventilated neonates in neonatal intensive care units (NICUs). We searched PubMed, SCOPUS, EMBASE, and the ISI Web of Science databases as well as Google Scholar search engine up to November 20, 2017, with no restriction on language. We included studies reporting prevalence of gram-negative bacterial infection of neonatal VAP in NICUs. Risk of bias assessment using the tool developed by Hoy et al (J Clin Epidemiol. 2012; 65:934–939), and data extraction were conducted by 2 independent reviewers. A random-effects meta-analysis was used for combining the data. Of 11,072 screened references, 9 relevant studies were included in this meta-analysis. The overall pooled prevalence rate of gram-negative bacterial infections of neonates who were on mechanical ventilation for more than 48 hours was 72.0% (95% confidence interval, 0.60–0.83). Among the isolated gram-negative bacteria, Klebsiella species had the highest detection rate, with 41.0% overall pooled prevalence. When the results were merged, the VAP rate was found to be 3/1000 ventilator-days. Male sex, prolonged hospitalization stay, and cesarean delivery were statistically significant risk factors for VAP incidence in NICUs. Prevalence of gram-negative bacteria in VAP in NICUs is high, and it is mainly caused by Klebsiella species and could be affected by several factors. Further studies should be conducted on the drug resistance pattern of these bacteria. In addition, effective mechanisms for infection control should be considered to prevent these bacterial infections in VAP in NICUs.
Personality and Psychopathology in Patients With Mixed Sensory-Motor Functional Neurological Disorder (Conversion Disorder)
Authors: Søgaard Ulf , Mathiesen Birgit B. , Simonsen Erik 
Published: June 2019

Abstract
The purpose of this pilot study was to explore differences in the level of personality functioning, symptom severity, and personality pathology in patients with mixed sensory-motor functional neurological disorder (conversion disorder). Individuals with psychogenic nonepileptic seizures were not included. We recruited 15 patients, mean age of 33.5 years (SD, 11.4 years), 13 females and 2 males, from an outpatient clinic for psychotherapeutic treatment. We assessed the patients using the Structured Clinical Interview for DSM-4 Axis II Personality Disorders, the SCL-90-R, the Karolinska Psychodynamic Profile, and the Defense Style Questionnaire. We were able to distinguish two levels of difficulty in relation to personality functioning as distinct subgroups: 1) “neurotic” with less severe or moderate personality psychopathology and 2) “borderline” with severe personality psychopathology. Furthermore, we concluded that all patients showed severe deficits in personality functioning. The study points out the clinical relevance of identifying personality functioning as part of an assessment in the preparation of a treatment strategy.
Plasma Neutrophil Gelatinase-Associated Lipocalin Is Associated With Acute Kidney Injury and Clinical Outcomes in Neonates Undergoing Cardiopulmonary Bypass
Authors: Schroeder Luke W. , Buckley Jason R. , Stroud Robert E. , Martin Renee H. , Nadeau Elizabeth K. , Barrs Ryan , Graham Eric M. 
Published: June 2019

Objectives:
Acute kidney injury is a frequent complication following neonatal cardiac surgery and is associated with significant morbidity and mortality. The objectives of this study were to determine if plasma neutrophil gelatinase-associated lipocalin levels were associated with acute kidney injury and clinical outcomes in neonates with congenital heart disease undergoing cardiopulmonary bypass.

Design:
Retrospective single-center observational study.

Setting:
A pediatric cardiac ICU within a tertiary-care academic hospital.

Patients:
Patients age less than 30 days undergoing cardiac surgery requiring cardiopulmonary bypass.

Interventions:
None.

Measurements and Main Results:
Plasma neutrophil gelatinase-associated lipocalin peaked at 12 hours postcardiopulmonary bypass and more than doubled compared with preoperative levels. Higher preoperative and 24-hour postoperative neutrophil gelatinase-associated lipocalin levels were associated with acute kidney injury (r = 0.30, r = 0.49), longer duration of mechanical ventilation (r = 0.40, r = 0.51), ICU (r = 0.32, r = 0.33) and hospital lengths of stay (r = 0.28, r = 0.32), and total hospital charges (r = 0.35, r = 0.30; all p values < 0.05).

Conclusions:
Both preoperative and 24-hour postoperative plasma neutrophil gelatinase-associated lipocalin levels are associated with acute kidney injury and worse clinical outcomes in neonates undergoing cardiac surgery. Plasma neutrophil gelatinase-associated lipocalin levels may have a role in risk stratification for predicting postoperative renal dysfunction as well as providing a potential clinical trajectory in the postoperative period.
Evaluating the Practice of Repositioning Endotracheal Tubes in Neonates and Children Based on Radiographic Location*
Authors: Im Daniel D. , Ross Patrick A. , Hotz Justin , Newth Christopher J. L. 
Published: June 2019

Objectives:
Chest radiographs are commonly performed in the ICU setting to confirm the position of the endotracheal tube. The purpose of this study was to evaluate the practice and accuracy of repositioning endotracheal tubes in the pediatric population based on chest radiograph.

Design:
Retrospective review of patient’s medical record and chest radiograph.

Setting:
Single-institution, academic children’s hospital.

Patients:
PICU and cardiothoracic ICU patients who had repositioning of their endotracheal tube from September 1, 2016, to September 1, 2017.

Measurements and Main Results:
Chest radiograph before and after endotracheal tube repositioning were examined measuring the distance from the endotracheal tube tip to carina. A total of 183 endotracheal tube repositionings were assessed. Twenty-nine percent of endotracheal tube repositionings resulted in a persistently malpositioned endotracheal tube, requiring another intervention. For intended endotracheal tube repositioning of ± 2.0 cm, the actual change measured compared to intended adjustment was a median of 0.7 cm (interquartile range, 0.35–1.1 cm). For intended ± 1.5 cm, the median difference was 0.4 cm (interquartile range, 0.16–0.90 cm). For intended ± 1.0 cm, the median difference was 0.5 cm (interquartile range, 0.20–0.90 cm). For intended ± 0.5 cm, the median difference was 0.3 cm (interquartile range, 0.2–0.88 cm). When the head was malpositioned the difference from intended endotracheal tube repositioning to actual was median 0.70 cm (interquartile range, 0.40–1.1 cm), this was significantly higher than when the head was in a good position

Conclusions:
When repositioning endotracheal tubes based on chest radiograph, there is a significant difference between intended and actual adjustment with great variability. Avoiding very small repositionings (± 0.5 cm) and standardizing head position prior to daily chest radiograph may reduce these errors.
A Specialized Pediatric Emergency Medicine Track Decreases Computed Tomography in Head Injured Patients
Authors: Conrad Heather B. , Hollenbach Kathryn A. , Ratnayake Kristin , Gehlbach Daniel L. , Carstairs Keri L. 
Published: June 2019

Background
There is an increased emphasis on reducing exposure to ionizing radiation in pediatric patients. Guidelines from the Pediatric Emergency Care Applied Research Network help practitioners identify patients at low risk for clinically important traumatic brain injury after head injury.

Objectives
We seek to determine whether the institution of a pediatric track staffed by pediatric emergency medicine physicians (PEMs) within a community emergency department (ED) impacts the overall utilization of head computed tomography (CT) on children younger than 15 years with head injury.

Methods
We used a retrospective cohort analysis of patients under the age of 15 years presenting to a community ED in the year before and the year of institution of a pediatric emergency track. Relative risk estimates were used to determine the risk of CT use associated with nonpediatric-trained emergency providers.

Results
The community ED saw 11,094 patients and 14,639 patients younger than 15 years in fiscal years 2014–2015 and 2015–2016, respectively. In the year before PEMs, there were 312 children younger than 15 years seen for head injury; 47.09% received head CTs. After PEM coverage, there were 396 children younger than 15 years seen for head injury; 17.17% received head CTs. Pediatric patients with head injury were 2.2 times more likely to receive CTs before the institution of the pediatric track (95% confidence interval, 1.8–2.6).

Conclusion
The implementation of a pediatric emergency track demonstrated a significant decrease in CT utilization for head injury. Continued development of pediatric tracks in community EDs can lead to reduction of CTs.
The Relation Between Loss of Consciousness, Severity of Traumatic Brain Injury, and Injury of Ascending Reticular Activating System in Patients With Traumatic Brain Injury
Authors: Jang Sung Ho , Kim Oh Lyong , Kim Seong Ho , Kim Jong Bum 
Published: June 2019

Objective
Loss of consciousness is an indicator of the severity of traumatic brain injury and the ascending reticular activating system has been considered as a main structure for consciousness. However, no study on the relation between loss of consciousness and ascending reticular activating system injury in traumatic brain injury has been reported. We investigated the relation between loss of consciousness, severity of traumatic brain injury, and ascending reticular activating system injury using diffusion tensor tractography.

Design
One hundred twenty patients were recruited. Three components of ascending reticular activating system, fractional anisotropy, and tract volume were measured.

Results
In lower dorsal and ventral ascending reticular activating system, fractional anisotropy and tract volume value in mild group were higher than those of moderate and severe groups, and there was no difference between moderate and severe groups. In upper ascending reticular activating system, fractional anisotropy value in mild group was higher than in moderate group, and it was higher than in moderate group than in severe group. Tract volume value in mild group was higher than in severe group. Loss of consciousness showed moderate negative correlations with tract volume value of lower dorsal ascending reticular activating system (r = −0.348), fractional anisotropy value of lower ventral ascending reticular activating system (r = −0.343), and fractional anisotropy value of upper ascending reticular activating system (r = −0.416).

Conclusions
Injury severity was different among the three traumatic brain injury groups in upper ascending reticular activating system but did not differ between moderate and severe groups in lower dorsal and ventral ascending reticular activating system.
Fat Grafting and the Palpable Breast Mass in Implant-Based Breast Reconstruction: Incidence and Implications
Authors: Knackstedt Rebecca W. , Gatherwright James , Ataya Dana , Duraes Eliana F. R. , Schwarz Graham S. 
Published: June 2019

Background:
Fat grafting is a powerful and increasingly used technique in breast reconstruction. However, fat necrosis can lead to palpable postoperative changes that can induce anxiety and lead to unplanned diagnostic studies. The authors’ aim in this study was to evaluate the incidence, type, and timing of these unanticipated studies; the specialty of the ordering provider; and the factors that trigger the ordering process.

Methods:
A retrospective chart review was conducted for patients from 2006 to 2015 who underwent fat grafting as part of implant-based breast cancer reconstruction and had at least 1-year follow-up after fat grafting.

Results:
From 2006 to 2015, 166 patients underwent fat grafting as part of implant-based breast reconstruction. Forty-four women (26.5 percent) underwent at least one imaging procedure. Thirteen women (7.8 percent) underwent 17 biopsies. For a palpable mass, the initial imaging test most commonly ordered was ultrasound, followed by mammography/ultrasound. The percentage of patients with a diagnosis of fat necrosis on mammography, ultrasound, and biopsy was 4.2, 12.7, and 5.4 percent, respectively. Seven patients (4.2 percent) had distant metastases. Tissue diagnosis of local recurrence was never identified. Mean follow-up was 2.4 years.

Conclusions:
Fat-grafting sequelae may lead to early unplanned invasive and noninvasive procedures initiated by a variety of providers. In this study, fat grafting had no impact on local recurrence rate. As use of fat grafting grows, communication among breast cancer care providers and enhanced patient and caregiver education will be increasingly important in optimizing the multidisciplinary evaluation and monitoring of palpable breast lesions.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
A Quantitative Analysis of Animation Deformity in Prosthetic Breast Reconstruction
Authors: Kim John Y. S. , Qiu Cecil S. , Chiu Wen-Kuan , Feld Lauren N. , Mioton Lauren M. , Kearney Aaron , Fracol Megan 
Published: June 2019

Background:
Animation deformity is characterized by implant deformity with pectoralis contraction after subpectoral implant-based breast reconstruction. Extant methods to measure and analyze animation deformity are hampered by the paucity of objective, quantitative data. The authors endeavored to supplement subjective measures with an in-depth quantitative analysis.

Methods:
Patients undergoing subpectoral implant-based breast reconstruction were followed prospectively with video analysis of animation deformity. Nipple displacement and surface area of contour deformity in resting and contracted states were quantified using imaging software. Degree of animation was compared to breast size, body mass index, division of pectoralis muscle, complications, and radiation therapy.

Results:
One hundred forty-five reconstructed breasts (88 patients) were analyzed. Mean nipple displacement was 2.12 ± 1.04 cm, mean vector of nipple displacement was 62.5 ± 20.6 degrees, and mean area of skin contour irregularity was 16.4 ± 15.41 percent. Intraoperative pectoralis division, smooth/round implants, and bilateral reconstructions were associated with greater deformity. A three-tiered grading system based on thresholds of 2-cm net nipple displacement and 25 percent skin contour irregularity placed 41.4 percent of breasts in grade 1, 35.9 percent in grade 2, and 22.8 percent in grade 3. Interrater variability testing demonstrated 89.5 percent overall agreement (kappa = 0.84).

Conclusions:
This study presents the first quantitative analysis of animation deformity in prosthetic breast reconstruction. Geometric analysis of nipple displacement vector and increasing animation with pectoralis division both implicate the inferior pectoralis myotome as a primary driver of animation deformity. A concomitant grading schema was developed to provide a standardized framework for discussing animation from patient to patient and from study to study.
Benchmarking the Outcomes of Single-Stage Augmentation Mastopexy against Primary Breast Augmentation: A Single Surgeon’s Experience of 905 Consecutive Cases
Authors: Montemurro Paolo , Cheema Mubashir , Hedén Per , Behr Björn , Wallner Christoph 
Published: June 2019

Background:
Augmentation mastopexy may be a one- or two-stage procedure. Because of the opposing force vectors in augmentation and in mastopexy, some surgeons advocate a two-stage procedure. The literature appears divided on which operation has a more favorable complication profile. The purpose of this review was to benchmark the outcomes of single-stage augmentation mastopexy against those of a commonly performed aesthetic breast operation (primary breast augmentation).

Methods:
The authors reviewed electronic patient records of all consecutive female patients who underwent single-stage augmentation mastopexy and primary breast augmentation performed by the first author at our clinic between April of 2009 and May of 2017 with at least a 6-month follow-up. Data from single-stage augmentation mastopexy were benchmarked against the outcomes of primary breast augmentations performed by the same surgeon, for the same period, and at the same clinic.

Results:
One hundred four single-stage augmentation mastopexies and 801 primary breast augmentations were performed during this period, with mean follow-up of 15.4 months and 14.0 months, respectively. Augmentation mastopexy patients were significantly more likely to be older, have a higher body mass index, have more children, and were significantly less likely to use oral contraceptives. There was no statistically significant difference in overall complication rate between the two groups.

Conclusions:
The authors’ experience suggests that single-stage augmentation mastopexy has outcomes comparable to those of primary breast augmentation. Smokers were more likely to undergo reoperation because of postoperative complication (seroma), but the rate of implant exchange was not different.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Can Early ‘Shallow’ Needle-knife Papillotomy be the First Choice in ERCP?
Authors: Kalayci Mustafa U. , Altintas Tansu 
Published: June 2019

Purpose:
Needle-knife sphincterotomy, known as ‘precut’ is recommended as the second option in the case of difficult cannulation due to its potential higher complication (bleeding and perforation) rates. The aim of this study was to present our experience on early shallow needle-knife papillotomy (eSNKP) as the first-line choice independently of standard technique with or without difficult cannulation.

Materials and Methods:
A total of 70 patients underwent therapeutic endoscopic retrograde cholangiopancreatography. A standard eSNKP and guidewire cannulation technique was routinely preferred as a first-line intervention. Deep biliary cannulation rate and timing were recorded, as well as intraoperative and postoperative complication rates.

Results:
Successful deep biliary cannulation was performed in 66 (94.3%) patients during the first procedure. In 4 patients (5.7%), the procedure was terminated due to failed cannulation and repeated successfully after 72 hours. Minor complications were observed in 3 (4.3%) patients. No mortality was seen.

Conclusion:
eSNKP is a safe, time-saving, and effective technique as the first-line of endoscopic retrograde cholangiopancreatography for common bile duct cannulation.