bluuebunny/crossref_metadata_2025_split huggingface dataset:
A nurse practitioner–led medication reconciliation process to reduce hospital readmissions from a skilled nursing facility
Authors: Anderson Rachel , Ferguson Rita 
Published: August 2019

ABSTRACT

Background and purpose:
Skilled nursing facilities (SNFs) are penalized for hospital readmissions within 30 days. Medication errors often precipitate hospital returns. The Centers for Medicare and Medicaid Services mandates that health care providers must determine whether medications pose significant risks and implement corrective actions. Federal restrictions exist regarding nurse practitioners (NPs) in long-term care; however, NPs are efficient in the health care of patients requiring a SNF, including completing thorough medication reconciliation and correcting deficiencies.

Local Problem:
A needs assessment of a 90-bed SNF revealed inadequate medical coverage and no formalized program to reduce hospital readmissions, including a mandated medication reconciliation process. The problem contributed to an average 30-day readmission rate of 24.15%.

Methods:
The investigators sought to determine whether an NP-led medication reconciliation on admission would reduce hospital readmissions from a SNF. A pre- and postimplementation design was used to compare 30-day hospital readmission rates over a 30-day project period.

Interventions:
An evidence-based workflow process for systematic medication reconciliation was designed. A full-time NP used the workflow process to complete stabilization visits with medication reconciliation on each facility admission.

Results:
Results revealed a hospital readmission rate of 19.2% preimplementation and 13.5% postimplementation, reflecting a 29.7% decrease in the rate of hospital readmissions within a 30-day period.

Conclusion:
A chi-square analysis conveyed no statistical significance; yet, the positive benefits of NP intervention included reduced hospitalizations, increased revenue, improved quality measures and survey results, and preparation for the Centers for Medicare and Medicaid Services mandates.

Implications for practice:
Nurse practitioners have the necessary education and skills to provide quality care as well as achieving CMS mandates and improving quality measures in SNF settings.
Debate as a learning tool in an online environment
Authors: DeClerk Leonie , LaBorde Pam , Smith-Olinde Laura 
Published: August 2019

ABSTRACT
Debate offers an opportunity to increase student interaction and develop critical thinking and presentation skills. The investigators used an online debate during a first-semester Doctor of Nursing Practice (DNP) course. The purpose of this evaluation was to 1) evaluate the feasibility of conducting a live-streamed debate and 2) assess students' perceived gained skills. Student pairs were assigned to speak for or against a statement applicable to professional practice of a DNP-prepared nurse approximately 4 weeks before the scheduled debates. During the debate, each pair presented opening arguments, formulated and presented a rebuttal, and provided closing statements. The faculty debriefed immediately after each debate, and all 15 students completed an online instrument evaluating perceived critical thinking and presentation skills after the debate. Completing the live-stream online debate was feasible. Students had statistically significant increases in skills of applying literature to support a position, defending a position, and predicting and countering opposing arguments, self-assurance in delivering a professional presentation, and establishing and persuading the listener with credibility. Skills not demonstrating statistical improvement included selecting, analyzing, and evaluating literature and composing a clear and well-organized oral presentation. Live-stream online debate was a feasible and effective learning tool for DNP students exploring professional issues. Debate should be evaluated with other content such as health policy, ethics, and clinical management.
Pharmacological treatments for patients with irritable bowel syndrome
Authors: Qin Di , Yue Ling , Xue Bin , Chen Min , Tang Tai-Chun , Zheng Hui 
Published: August 2019

Abstract

Introduction:
Several pharmacological treatments are beneficial for patients with irritable bowel syndrome (IBS), and there are numbers of systematic reviews evaluating the effectiveness of these treatments. However, the overall quality of the evidence has not been quantitatively assessed. The aim of this study is to evaluate the possible biases in the published systematic reviews and determine the treatments with reliable evidence.

Methods and analysis:
We will perform an umbrella review to identify eligible systematic reviews. A comprehensive literature search will be conducted in MEDLINE, EMBASE, and the Cochrane library for systematic reviews. We will describe the general information such as participants, interventions, outcome measurements, and conclusion. Additionally, the heterogeneity and inconsistency between trials will be assessed by the I
2 statistical test and Cochrane Q test. We will assess risk of bias, and summarize the strength evidence.

Conclusion:
The umbrella reviews will assess the reliability of the evidence so that doctors and patients can make better medical choices.

PROSPERO registration number:
CRD42018109597
Longitudinal virological outcomes and factors associated with virological failure in behaviorally HIV-infected young adults on combination antiretroviral treatment in the Netherlands, 2000 to 2015
Authors: Weijsenfeld Annouschka M. , Blokhuis Charlotte , Stuiver Martijn M. , Wit Ferdinand W.N.M. , Pajkrt Dasja 
Published: August 2019

Abstract
Achieving and maintaining viral suppression in young adults (18–24 years) living with HIV is challenging. Overall HIV viral suppression rates are lower in young as compared to older adults. Longitudinal data provide valuable insight on dynamics of viral suppression and variables of potential influence on HIV virological failure (VF), but is scarce in young adults living with HIV on combination antiretroviral therapy (cART). We evaluated longitudinal virological outcomes of behaviorally young adults (18–24 years) living with HIV in the Netherlands over a period of 15 years.
We analyzed data from the Dutch national HIV database of 816 young adults living with HIV on cART in the Netherlands from 2000 to 2015. VF was defined as 2 consecutive detectable plasma HIV-1 viral load (VL) measurements > 200 copies/ml. Generalized linear mixed model analyses were used to assess HIV VF over time and identify risk factors associated with VF.
VF during the study follow-up occurred at least once in 26% of cases. The probability of experiencing VF decreased over the study period per calendar year (OR 0.78, 95% confidence interval [CI];0.72; 0.85). Factors significantly associated with VF were being infected through heterosexual contact (OR 5.20, CI 1.39;19.38) and originating from Latin America or the Caribbean (OR 6.59, CI 2.08;20.92). Smaller, yet significant risk factors for VF were being infected through a blood transfusion or a needle accident (OR9.93, CI 1.34;73.84, and having started with cART with a nadir CD4 count >500 cells/μl (OR 11.36, CI 2.03;63.48).
In our large cohort of young adults, the risk of VF has diminished over 15 years. Specific subgroups were identified to be at risk for suboptimal treatment.
Acute myeloid leukemia with adult atopic dermatitis as first manifestation
Authors: Ma Wei-Wei , Kasyanju Carrero Lorna Martin , Yin Xu-Feng , Liu Hou-Fang , Zhou Bing-Rong 
Published: August 2019

Abstract

Rationale:
Atopic dermatitis (AD) is a chronic recurrent dermatitis with profound itching, which could be the first manifestation of acute myeloid leukemia (AML).

Patient concerns:
A 53-year-old Chinese man suffered a 6-month history of systemic symmetrical dermatitis, accompanied with profound itching. The patient was diagnosed as “eczema” in several hospitals, and the effects of antihistamine and topical steroid creams were poor. Nocturnal sleep was seriously affected by aggravating pruritus. Laboratorial examination was compatible with AML-M4.

Diagnoses:
AML-M4 with AD as first manifestation.

Interventions:
IA regimen (ayninen and cytarabine) were used in induction chemotherapy. However, the patient did not achieve complete remission, and although his rash had improved, he still experienced severely general body itching. On the seventh day of chemotherapy, the patient entered the period of granulocyte deficiency with infection.

Outcomes:
The patient died due to septic shock after chemotherapy.

Lessons:
The case strengthens the awareness of AML with AD as first manifestation and raises oncological vigilance in patients with AD refractory.
Effectiveness evaluation of computer-aided diagnosis system for the diagnosis of thyroid nodules on ultrasound
Authors: Zhao Wan-Jun , Fu Lin-Ru , Huang Zhi-Mian , Zhu Jing-Qiang , Ma Bu-Yun 
Published: August 2019

AbstractBackground:More and more automated efficient ultrasound image analysis techniques, such as ultrasound-based computer-aided diagnosis system (CAD), were developed to obtain accurate, reproducible, and more objective diagnosis results for thyroid nodules. So far, whether the diagnostic performance of existing CAD systems can reach the diagnostic level of experienced radiologists is still controversial. The aim of the meta-analysis was to evaluate the accuracy of CAD for thyroid nodules’ diagnosis by reviewing current literatures and summarizing the research status.Methods:A detailed literature search on PubMed, Embase, and Cochrane Libraries for articles published until December 2018 was carried out. The diagnostic performances of CAD systems vs radiologist were evaluated by meta-analysis. We determined the sensitivity and the specificity across studies, calculated positive and negative likelihood ratios and constructed summary receiver-operating characteristic (SROC) curves. Meta-analysis of studies was performed using a mixed-effect, hierarchical logistic regression model.Results:Five studies with 536 patients and 723 thyroid nodules were included in this meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (DOR) for CAD system were 0.87 (95% confidence interval [CI], 0.73–0.94), 0.79 (95% CI 0.63–0.89), 4.1 (95% CI 2.5–6.9), 0.17 (95% CI 0.09–0.32), and 25 (95% CI 15–42), respectively. The SROC curve indicated that the area under the curve was 0.90 (95% CI 0.87–0.92). The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and DOR for experienced radiologists were 0.82 (95% CI 0.69–0.91), 0.83 (95% CI 0.76–0.89), 4.9 (95% CI 3.4–7.0), 0.22 (95% CI 0.12–0.38), and 23 (95% CI 11–46), respectively. The SROC curve indicated that the area under the curve was 0.96 (95% CI 0.94–0.97).Conclusion:The sensitivity of the CAD system in the diagnosis of thyroid nodules was similar to that of experienced radiologists. However, the CAD system had lower specificity and DOR than experienced radiologists. The CAD system may play the potential role as a decision-making assistant alongside radiologists in the thyroid nodules’ diagnosis. Future technical improvements would be helpful to increase the accuracy as well as diagnostic efficiency.
Randomized controlled evaluation of the effect of music therapy with cognitive-behavioral therapy on social anxiety symptoms: Retracted
Authors: Egenti Nkechi T. , Ede Moses O. , Nwokenna Edith N. , Oforka Theresa , Nwokeoma Bonaventure N. , Mezieobi Daniel I. , Onah Sabastian O. , Ede Kelechi R. , Amoke Chijioke , Offordile Edmund E. , Ezeh Ngozi E. , Eze Celestine O. , Eluu Patrick E. , Amadi Kingley C. , Ugwuanyi Benedict E. , Uzoagba Ngozi C. , Ugwonna Grace O. , Nweke Maduka L. , Victor-Aigbodion Vera 
Published: August 2019

AbstractObjective:This study examined the effects of music therapy with cognitive behavioral therapy on social anxiety in a sample of schooling adolescents in south-east Nigeria.Methods:We adopted a randomized controlled trial design involving a treatment group and a waiting-list control group. A total of 155 schooling adolescents served as the study sample. The sample size was ascertained usingGPowersoftware. A 12-week MTCBP manual for social anxiety was employed to deliver the intervention. Data analyses were completed using repeated measures analysis of variance.Results:We found that social anxiety significantly decreased in the treatment group over time, whereas the waitlist control group showed no significant changes in social anxiety. Therefore, music therapy with cognitive-behavioral therapy was significantly beneficial in decreasing social anxiety symptoms of the treatment group. The follow-up assessment performed after 3 months revealed a significant reduction in social anxiety for the treatment group.Conclusion:The study, therefore, suggests that the use of music therapy with cognitive-behavioral therapy is significant in reducing social anxiety among schooling adolescents.
Safety and effectiveness of endoscopic mucosal resection or endoscopic submucosal dissection for gastric neoplasia within 2 days’ hospital stay
Authors: Choi Joon Young , Park Young Soo , Na Gyeongjae , Park Sung Jae , Yoon Hyuk , Shin Cheol Min , Kim Nayoung , Lee Dong Ho 
Published: August 2019

Abstract
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been well-established methods of treating upper gastrointestinal neoplasia. The aim of this study was to identify the safety and effectiveness of endoscopic treatment for gastric neoplasia within a 2-day hospital stay.
Between 2004 and 2015, a total of 914 patients with gastric neoplasia were treated with EMR or ESD within 2 days of hospitalization. The neoplasia sites, en bloc resection rates, pathology, local residual neoplasia rates, and major complications were evaluated retrospectively.
The mean age was 63.4 years old, and 636 (69.6%) patients were male. Adenoma was the most common final diagnosis (60.9%), followed by adenocarcinoma (28.9%). The first follow-up endoscopy was performed 4.9 ± 1.1 months after the procedure, and an average of 4.4 endoscopic examinations were performed for 7.16 years (range, 2.1 to 10.2 years). Additional surgery was performed in 11 (1.2%) cases based on post-procedure pathology results. On follow-up endoscopy, a mean of 5.9 months after the procedure, there were 18 residual neoplasia cases (EMR = 13, ESD = 5). Only 4 (0.4%) patients returned to the emergency unit with delayed bleeding, but all 4 cases were successfully controlled with endoscopic treatment. There were no other complications such as delayed perforation or aspiration pneumonia during the 2 days in hospital.
EMR and ESD within only 2 days in hospital showed safe and effective outcomes in terms of managing early gastric neoplasia with low complication and local residual rates.
Tachycardia-induced cardiomyopathy in a patient with left-sided accessory pathway and left bundle branch block
Authors: Minciuna Ioan Alexandru , Puiu Mihai , Cismaru Gabriel , Gusetu Gabriel , Comsa Horatiu , Caloian Bogdan , Zdrenghea Dumitru , Pop Dana , Radu Rosu 
Published: August 2019

Abstract

Rationale:
Tachycardia-induced cardiomyopathy (TIC) is defined as systolic and/or diastolic dysfunction of the left ventricle resulting from prolonged elevated heart rates, completely reversible upon control of the arrhythmia. Atrioventricular reentrant tachycardia (AVRT) is one of the most frequent causes of TIC. In its incessant form, it is unlikely to be controlled by pharmacological treatment, catheter ablation being the principal therapeutic option. The coexistence of left bundle branch block (LBBB) in patients with AVRT may cause difficulties in the early diagnosis and management of tachycardia because of the wide complex morphology, making it harder to localize the accessory pathway (AP).

Patient concerns:
A 60-year-old woman, presented incessant episodes of palpitations and shortness of breath due to a LBBB tachycardia leading to hemodynamic instability.

Diagnosis:
The patient had a wide QRS tachycardia, with LBBB morphology and a heart rate of 160/minute. Echocardiography showed global hypokinesia with 25% left ventricular ejection fraction (LVEF). Considering the patient's clinical picture, TIC was suspected.

Interventions:
The electrophysiological study revealed a left lateral accessory pathway. Catheter ablation was successfully performed at the level of the lateral mitral ring.

Outcomes:
One week after the ablation the patient had no signs of heart failure and the LVEF normalized to 55%. During 6-months follow-up the patient presented no more episodes of tachycardia or heart failure and the LVEF remained normal.

Lessons:
AVRT is rarely associated with intrinsic LBBB, being a potential cause of TIC. In these patients, it is unlikely to control the arrhythmia pharmacologically, catheter ablation being the best therapeutic option. The variation of QRS complex duration between LBBB pattern in SR and AVRT could be useful for early diagnosis of an ipsilateral AP on surface ECG.
Lack of expression of ALK and CD30 in breast carcinoma by immunohistochemistry irrespective of tumor characteristics
Authors: Nassif Samer , El-Zaatari Ziad M. , Attieh Michel , Hijazi Maya , Fakhreddin Najla , Aridi Tarek , Boulos Fouad 
Published: August 2019

Abstract
CD30 is a member of the tumor necrosis factor family of cell surface receptors normally expressed in lymphocytes, as well as some lymphomas, but has been described in other malignancies. Anaplastic lymphoma kinase (ALK) is a tyrosine kinase receptor that belongs to the insulin receptor superfamily, and is normally expressed in neural cells, but has been detected in several malignancies. There is conflicting data in the literature that describes the expression of these receptors in breast cancer, and the aim of this study is to test the expression of CD30 and ALK in a cohort of Middle Eastern patients with breast carcinoma.
Cases of invasive breast cancer from the archives of AUBMC were reviewed over a period of 9 years, and the blocks that were used for immunohistochemical staining for ER, PR, Her-2/neu were selected. Immunohistochemical staining for CD30 (JCM182) and ALK (5A4 and D5F3) was performed.
Two hundred eighty-four cases were identified (2 cases were male), with a mean age of 55 ± 12. CD30 and ALK expression was not seen in any of the cases.
Our cohort showed complete negativity to both CD30 and ALK, adding to the conflicting data available in the literature, and more studies are needed to reliably identify a trend of expression of CD30 and ALK in breast carcinoma, especially in the Middle East.
Atypical presentation of giant cell arteritis in a patient with vertebrobasilar stroke
Authors: Elhfnawy Ahmed Mohamed , Bieber Michael , Schliesser Mira , Kraft Peter 
Published: August 2019

Abstract

Rationale:
Giant cell arteritis (GCA) is known to present with typical manifestations like temporal headache and visual abnormalities. However, several cases with atypical manifestations were reported. Stroke occurs in 3% to 7% of patients with GCA.

Patient concerns:
A 67-year-old male patient with known hypertension presented with somnolence, disorientation and mild bilateral limb ataxia. The magnetic resonance imaging showed multiple acute infarctions in the territory of the vertebrobasilar system with occlusion of the left vertebral artery.

Diagnosis:
Ten months later, during a routine neurovascular follow-up, recanalization of the left vertebral artery was observed and a hypoechoic concentric “halo” sign around both vertebral arteries, mainly on the left side was evident. On further examination of the superficial temporal artery, a hypoechoic concentric “halo” sign was also found, which—along with increased inflammatory markers—raised suspicion about GCA. Classical GCA features like headache, temporal tenderness or amaurosis fugax were not present. Repeated in-depth diagnostic work-up including 48 hours Holter-ECG did not reveal another stroke etiology.

Interventions:
Intravenous Methylprednisolone 250 mg/d was immediately started and after 6 days the dose was tapered to 80 mg/d. The patient was discharged on a tapering scheme with the recommendation to start azathioprine. Additionally, we placed the patient on acetylsalicylic acid 100 mg/d and clopidogrel 75 mg/d. However, the patient was not compliant to treatment; he stopped prednisolone early and did not start azathioprine.

Outcomes:
The inflammatory markers were markedly reduced at the beginning of the treatment. After stopping the immunosuppressive medications, the inflammatory markers were once again increased. Three months later, the patient developed bilateral middle cerebral artery and right occipital lobe infarctions.

Lessons:
In patients with cryptogenic vertebrobasilar strokes, GCA may be considered in the differential diagnosis, especially if the inflammatory markers are increased.
Penile prosthesis implant for primary erectile dysfunction in patient with Klippel-Trenaunay syndrome complicated by consumptive coagulopathy
Authors: Bettocchi Carlo , Spilotros Marco , Lucarelli Giuseppe , Utano Emanuele , Sebastiani Francesco , Bittner Lukas , Ditonno Pasquale , Battaglia Michele 
Published: August 2019

Abstract

Rationale:
Klippel-Trenaunay syndrome (KTS) is a congenital disorder characterized by cutaneous port wine capillary malformations, varicose veins with hemihypertrophy of soft tissue and bone.
Pelvic and retroperitoneal vascular malformations have been described up to the 30% of patients with KTS while hemangiomas of the urinary tract have been reported in 6%

Patient concerns:
A 30-year-old man with KTS was referred to our center for primary erectile dysfunction (ED) associated with varicosities of unusual distribution and asymmetry of the lower limbs. Furthermore, he suffered from hypertension and autosomal dominant polycystic kidney disease.
During penile prosthesis implantation, a significant intraoperative bleeding (1 liter) due to large scrotal venous malformations and profuse bleeding from both corpora was recorded. One month later, the day after the first prosthesis training session, the patient returned with swelling in the penoscrotal region. A large inguino-scrotal hematoma was drained. There was a complete bilateral dehiscence of corpora cavernosa with a spread venous bleeding in the scrotum.

Diagnoses:
CT scan showed hypertrophy of the right hypogastric artery with severe vascular malformations: the right pudendal artery was massively dilated with early visualization of venous drainage without evidence of arteriovenous fistulae; regular bulbocavernous capillary blush; right upper gluteus artery hypertrophic and dilated. Multiple twisting and aneurysms of the right internal pudenda artery were bleeding from multiple points. Cystoscopy showed a fistula between the proximal urethra and the penoscrotal dartos. Coagulation tests revealed the presence of factor XIII deficiency

Interventions:
The patient underwent several procedures including percutaneous scleroembolization of the internal pudendal arteries, removal of the penile implant, recombinant factor XIII (FXIII) administration, and cord blood platelet gel application.

Outcomes:
The patient was discharged after almost 3 months in hospital, hemodynamically stable.

Lessons:
Experience regarding management of ED in KTS patient is limited and in case of concomitant factor XIII deficiency, the clinical scenario can be life-threatening. A multidisciplinary approach including a urologist, an interventional radiologist and a hematologist in our experience represented the key approach in case of severe bleeding following surgery for ED.