bluuebunny/crossref_metadata_2025_split huggingface dataset:
An einem Strang ziehen
Authors: Sprenger Walburga , Wittchen Susanne 
Published: December 2018

ZusammenfassungDamit ein Grade- und Skill-Mix gelingen kann, müssen Strukturen und Prozesse im Krankenhaus verändert werden. Es muss klar
sein, wer was mit welcher Ausbildung und Kompetenz übernimmt. Und es müssen alle Berufsgruppen mitziehen, um die Ziele gemeinsam
zu verfolgen.
Er war stets bemüht …
Authors: Balzert Daniel 
Published: December 2018

Zusammenfassung
Um die Zeugnissprache ranken unzählige Mythen. Viele Arbeitnehmer vermuten einen Geheimcode und interpretieren jedes Wort. Das führt dazu, dass
Arbeitsgerichte sich immer häufiger mit Zeugniswortlauten beschäftigen müssen. Hier einige Fakten.
Quo vadis Pflegekraft?
Authors: Sprenger Walburga , Wittchen Susanne 
Published: December 2018

ZusammenfassungDie Diskussion um die Aufgabenteilung im Krankenhaus ist nicht neu – aber dringlicher denn je. Ein Problem: Jede Berufsgruppe
möchte zwar Aufgaben abgeben, aber dennoch Stellenanteile behalten. Hier Möglichkeiten zur Verschiebung von
Tätigkeiten.
Schlummernde Talente nutzen
Authors: Ebner Markus 
Published: December 2018

ZusammenfassungPositive Leadership setzt darauf, Talente der Mitarbeiter zu entdecken und zu
fördern. Werkzeuge helfen dabei, die Personalentwicklung messbar zu
machen. Mehr dazu erläutert Organisationspsychologe Dr. Markus Ebner.
Zukunft gestalten
Authors: Spenner Katharina , Frommherz Gertrud 
Published: December 2018

ZusammenfassungDen Horizont erweitern, andere Perspektiven einnehmen und jede Menge Rüstzeug für eine aktive Mitarbeit bei der Gestaltung einer spannenden
Unternehmenszukunft – das lernen die Teilnehmer des Projektes „Wir Zukunft“ an den Kliniken des Landkreises Lörrach.
Pain sensitivity in fish.
Authors: Schroeder P. 
Published: December 2018

Abstract
The question of whether fish have the capacity to experience a state akin to pain was first empirically addressed by Jan Verheijen's seminal study on carps in 1983. Subsequently, comprehensive evidence has been presented not only on the anatomical prerequisites for a pain system in several fish species, but also for a behavioural component. Opinions against fish perceiving pain focus on the difference in neuroanatomy between higher mammals and lower vertebrates that do not possess a neocortex. Finally, the successful (behaviour sparing) use of analgesics can be interpreted as further evidence that fish are able to perceive pain and can be adversely affected by a painful event.
Epidemiology and Resource Utilization of Simple Febrile Seizure-associated Hospitalizations in the United States, 2003-2012
Authors: Huang Yolanda Y. , Li Guohua , Sun Lena S. 
Published: December 2018

Background:
Simple febrile seizure (SFS) affects 2% to 4% of children under 6 years of age. The purpose of this study is to examine the epidemiologic patterns and resource utilization of SFS-associated hospitalizations in children aged younger than 6 years of age in the United States.

Materials and Methods:
This study is a serial, retrospective analysis of the Healthcare Cost and Utilization Project Kids’ Inpatient Databases for the years 2003, 2006, 2009, and 2012. SFS-associated hospitalizations were identified based on International Classification of Diseases, Ninth Revision, Clinical Modification, diagnosis code 780.31. We calculated the proportion of hospitalizations in pediatric patients under 6 years of age due to SFS and all other nonbirth causes, the rate of SFS-associated hospitalizations per 100,000 population, the mean length of stay and inflation-adjusted hospital costs of SFS-associated hospitalizations, as well as patient demographics and hospital characteristics.

Results:
From 2003 to 2012, the weighted proportion of hospitalizations due to SFS declined from 0.83% to 0.41% (P<0.01) and the annual rate of SFS-associated hospitalizations per 100,000 population decreased from 48.0 to 18.7 (P<0.01). However, use of computed tomography, electroencephalogram, and lumbar puncture in SFS-associated hospitalizations decreased significantly (all P<0.001), but the utilization rate of magnetic resonance imaging remained stable (P=0.53). The mean length of stay for SFS-associated hospitalizations decreased from 2.03 days in 2003 to 1.74 days in 2012, and the mean hospital costs (exclusive of professional payment) decreased from $3830 in 2003 to $3223 in 2012 (both P<0.001).

Conclusions:
SFS-associated hospitalizations and resource utilization in children under 6 years of age have decreased markedly in the United States, probably due to improved clinical adherence to the practice parameters set forth by the American Academy of Pediatrics for managing patients with SFS.
Medical Referral Patterns and Etiologies for Children With Mild-to-Severe Hearing Loss
Authors: Judge Paul D. , Jorgensen Erik , Lopez-Vazquez Monica , Roush Patricia , Page Thomas A. , Moeller Mary Pat , Tomblin J. Bruce , Holte Lenore , Buchman Craig 
Published: December 2018

Objectives:
To (1) identify the etiologies and risk factors of the patient cohort and determine the degree to which they reflected the incidence for children with hearing loss and (2) quantify practice management patterns in three catchment areas of the United States with available centers of excellence in pediatric hearing loss.

Design:
Medical information for 307 children with bilateral, mild-to-severe hearing loss was examined retrospectively. Children were participants in the Outcomes of Children with Hearing Loss (OCHL) study, a 5-year longitudinal study that recruited subjects at three different sites. Children aged 6 months to 7 years at time of OCHL enrollment were participants in this study. Children with cochlear implants, children with severe or profound hearing loss, and children with significant cognitive or motor delays were excluded from the OCHL study and, by extension, from this analysis. Medical information was gathered using medical records and participant intake forms, the latter reflecting a caregiver’s report. A comparison group included 134 children with normal hearing. A Chi-square test on two-way tables was used to assess for differences in referral patterns by site for the children who are hard of hearing (CHH). Linear regression was performed on gestational age and birth weight as continuous variables. Risk factors were assessed using t tests. The alpha value was set at p < 0.05.

Results:
Neonatal intensive care unit stay, mechanical ventilation, oxygen requirement, aminoglycoside exposure, and family history were correlated with hearing loss. For this study cohort, congenital cytomegalovirus, strep positivity, bacterial meningitis, extracorporeal membrane oxygenation, and loop diuretic exposure were not associated with hearing loss. Less than 50% of children underwent imaging, although 34.2% of those scanned had abnormalities identified. No single imaging modality was preferred. Differences in referral rates were apparent for neurology, radiology, genetics, and ophthalmology.

Conclusions:
The OCHL cohort reflects known etiologies of CHH. Despite available guidelines, centers of excellence, and high-yield rates for imaging, the medical workup for children with hearing loss remains inconsistently implemented and widely variable. There remains limited awareness as to what constitutes appropriate medical assessment for CHH.
Extradiscal Epiduroscopic Percutaneous Endoscopic Discectomy for Upper Lumbar Disc Herniation A Technical Note
Authors: Shin Myung-Hoon , Bae Jung-Sik , Cho Hyung-Lea , Jang Il-Tae 
Published: December 2018

Study Design:
This study was a technical case report.

Objectives:
To introduce a new transforaminal percutaneous endoscopic lumbar discectomy (PELD) technique for the treatment of upper lumbar disc herniation using an extradiscal epiduroscopic approach.

Summary of Background Data:
Although upper lumbar disc herniation accounts for only 1%–2% of all cases of lumbar disc herniation, the treatment is difficult and shows relatively poor outcomes compared with lower lumbar disc herniation. The anatomic characteristics of the upper lumbar spine are somewhat different from those of the lower lumbar spine. Thus, conventional transforaminal PELD may fail to remove the herniated disc.

Methods:
In the setting of extradiscal epiduroscopic PELD for upper lumbar disc herniation, the approach angle on the axial plane is ~30 degrees, which is less than that of the conventional transforaminal endoscopic discectomy and the working cannula is directly targeted to the herniated disc. Four patients who presented with back and/or leg pain due to disc herniation at L1–L2 or L2–L3 disc space were treated with extradiscal epiduroscopic PELD.

Results:
The patients experienced relief from symptoms and were discharged the next day.

Conclusions:
Extradiscal epiduroscopic PELD is a promising treatment strategy for upper lumbar disc herniation, which may otherwise lead to a poor outcome.
Norway's Kirkens Bymisjon Leads the Way in Care of the Vulnerable
Authors: Cone Pamela H. 
Published: December 2018

ABSTRACT:
Caring for vulnerable persons is a global humanitarian and nursing concern. The Norwegian Kirkens Bymisjon system cares for vulnerable people groups in 40 cities, serving as a model for other countries. In 2009, church–city–mission collaborations in Bergen, Trondheim, and Tromsø were visited; follow-up data were collected in 2014. At each site, a combination of the diaconal organization, the city or municipality, and donors from the private sector identify and establish a governing board, analyze vulnerable groups most in need of service, and build programs to meet needs.
Preoperative Modeling for Mirror Hand: Simplifying a Difficult Problem Using 3-Dimensional Printing and Simulation
Authors: Podolsky Dale J. , Borschel Gregory H. 
Published: December 2018

Summary:
Mirror hand is an extremely rare congenital anomaly. We modeled and simulated the reconstruction of mirror hand in a 2-year-old boy utilizing a preoperative 3-dimensional model to aid surgical planning. A soft-tissue hand model was created using preoperative imaging, 3-dimensional printing, and silicone casting, and the model was used to perform trial surgery. Given the complexity of the deformity, the model greatly facilitated the final operative plan for reconstruction.
Acute Appendicitis After Umbilical Cord Blood Transplant
Authors: Curtis Caitlin 
Published: December 2018

Abstract
Acute appendicitis is a common pediatric surgical problem. Management of acute appendicitis in immunocompromised children is a clinical challenge. This case study discusses the management of acute appendicitis with a laparoscopic appendectomy in a 13-year-old male 21 days after unrelated umbilical cord blood transplant with urgent laparoscopic appendectomy without complication.
Getting Everyone in the Same Room: The Combined Therapist Approach to Teaching Independence in Clean Intermittent Catheterization
Authors: Singh Ranjit Kaur Jarneal , Sng Jamie , Yeong Melissa May Yan , Nadeson Vannaja , Ong Caroline Choo Phaik 
Published: December 2018

Introduction
Most pediatric patients with neurogenic bladder require clean intermittent catheterization (CIC), several times daily, for maintenance of continence and health. CIC is performed by the caregiver until the child is developmentally ready to learn self-CIC. Children with associated mobility, dexterity, and cognitive deficits tend to take much longer to learn self-CIC. We piloted a combined pediatric urotherapy and occupational therapy clinic to address this problem.

Methods
Five children (6–14 years old) and their parents attended combined therapist sessions for 6 months. Explanation of self-CIC was done using show-and-tell method followed by doll play and/or supervised practice. Patients' mastery difficulties were identified by demonstration and collaborative discussion. Specific tasks and activities were recommended for home practice after task assessment and analysis. Reasons for slow progress in learning self-CIC were documented.

Results
All five children had motor and cognitive difficulties. Previously, caregivers regularly overassisted, which prevented patient practice and exposure. Task assessment, analysis, and recommendation had been suboptimal because patients' different combinations of disabilities caused unique difficulties with self-CIC that were unrecognized when attending individual therapist sessions. After the combined clinic, patients increased participation in the preparatory phase of self-CIC, functional mobility and dressing tasks.

Discussion
Despite longer session duration and scheduling constraints, the combined therapist approach was more efficient and effective for this category of patients, with fewer return sessions needed to achieve the desired outcome. We recommend early identification and referral of appropriate patients for a combined therapy clinic.
Prevalence, Evolution, and Extent of Impaired Cerebral Autoregulation in Children Hospitalized With Complex Mild Traumatic Brain Injury*
Authors: Lele Abhijit V. , Watanitanon Arraya , Lakireddy Viharika , Clark-Bell Crystalyn , Moore Anne , Zimmerman Jerry J. , Chesnut Randall M. , Armstead William , Vavilala Monica S. 
Published: December 2018

Objectives:
To examine cerebral autoregulation in children with complex mild traumatic brain injury.

Design:
Prospective observational convenience sample.

Setting:
PICU at a level I trauma center.

Patients:
Children with complex mild traumatic brain injury (trauma, admission Glasgow Coma Scale score 13–15 with either abnormal head CT, or history of loss of consciousness).

Interventions:
Cerebral autoregulation was tested using transcranial Doppler ultrasound between admission day 1 and 8.

Measurements and Main Results:
The primary outcome was prevalence of impaired cerebral autoregulation (autoregulation index < 0.4),determined using transcranial Doppler ultrasonography and tilt testing. Secondary outcomes examined factors associated with and evolution and extent of impairment. Cerebral autoregulation testing occurred in 31 children 10 years (sd, 5.2 yr), mostly male (59%) with isolated traumatic brain injury (91%), median admission Glasgow Coma Scale 15, Injury Severity Scores 14.2 (sd, 7.7), traumatic brain injury due to fall (50%), preadmission loss of consciousness (48%), and abnormal head CT scan (97%). Thirty-one children underwent 56 autoregulation tests. Impaired cerebral autoregulation occurred in 15 children (48.4%) who underwent 19 tests; 68% and 32% of tests demonstrated unilateral and bilateral impairment, respectively. Compared with children on median day 6 of admission after traumatic brain injury, impaired autoregulation was most common in the first 5 days after traumatic brain injury (day 1: relative risk, 3.7; 95% CI, 1.9–7.3 vs day 2: relative risk, 2.7; 95% CI, 1.1–6.5 vs day 5: relative risk, 1.33; 95% CI, 0.7–2.3). Children with impaired autoregulation were older (12.3 yr [sd, 1.3 yr] vs 8.7 yr [sd, 1.1 yr]; p = 0.04) and tended to have subdural hematoma (64% vs 44%), epidural hematoma (29% vs 17%), and subarachnoid hemorrhage (36% vs 28%). Eight children (53%) were discharged home with ongoing impaired cerebral autoregulation.

Conclusions:
Impaired cerebral autoregulation is common in children with complex mild traumatic brain injury, despite reassuring admission Glasgow Coma Scale 13–15. Children with complex mild traumatic brain injury have abnormal cerebrovascular hemodynamics, mostly during the first 5 days. Impairment commonly extends to the contralateral hemisphere and discharge of children with ongoing impaired cerebral autoregulation is common.
Is the Medial Sural Artery Perforator Flap a New Workhorse Flap? A Systematic Review and Meta-Analysis
Authors: Daar David A. , Abdou Salma A. , Cohen Joshua M. , Wilson Stelios C. , Levine Jamie P. 
Published: December 2018

Background:
The medial sural artery perforator flap offers thin, pliable tissue with a relatively long pedicle and low donor-site morbidity. This study explores the characteristics and uses of the medial sural artery perforator flap along with postoperative outcomes and complications.

Methods:
A systematic literature review was performed using PubMed, Embase, and Cochrane Central Register of Controlled Trials to identify all cases of medial sural artery perforator flap reconstruction. Descriptive and meta-analyses were performed on pooled outcomes. Multivariate logistic regression identified factors associated with increased complication rates.

Results:
Thirty-five studies encompassing 526 medial sural artery perforator flaps were included for analysis. The most common reasons for surgery were oncologic (47.6 percent) and traumatic injuries (31.8 percent). The oral cavity was the most common recipient location (45.5 percent). Average flap dimensions were 6.0 ± 2.3 cm × 9.8 ± 3.6 cm, with an average pedicle length of 10.1 ± 6.6 cm. Meta-analysis revealed an overall complication rate of 14.3 percent (Q value = 22.16; p = 0.877; I
2= −39.9). Use of chimeric medial sural artery perforator flaps was associated with significantly higher rates of complications (OR, 3.92; p = 0.039; 95 percent CI, 1.10 to 13.89). The majority of flap donor sites were closed primarily (68 percent) versus 32 percent that were covered with split-thickness skin grafts. A flap width greater than 5.75 cm had an odds ratio of 5.3 (95 percent CI, 1.3 to 21.8; p = 0.014) of having a donor-site complication if closed primarily.

Conclusions:
The medial sural artery perforator flap offers thin, pliable tissue with a relatively long pedicle and has minimal donor-site morbidity when the donor site is managed appropriately. As such, it should be considered a workhorse flap for both head and neck and extremity reconstruction.
The Occipital Artery–Based Fascial Flap for Ear Reconstruction
Authors: Reinisch John F. , van Hövell tot Westerflier Claire Vera Aimée , Tahiri Youssef , Yao Caroline A. 
Published: December 2018

Background:
The temporoparietal fascia flap is frequently used in ear reconstruction. When the temporoparietal fascia flap is unavailable, options for primary or secondary salvage reconstruction are limited. In these patients, an inferiorly based occipital artery fascia transpositional flap is a good alternative for soft-tissue coverage over a framework. This article describes the use of the occipital artery fascia flap for ear reconstruction in conjunction with a porous polyethylene framework.

Methods:
The authors included all patients who underwent occipital artery fascia flap surgery with a porous polyethylene framework for ear reconstruction performed by the first author from 1992 to 2017.

Results:
A total of 83 patients received an occipital artery fascia flap: 24 for primary microtia reconstruction and 59 for revision or salvage of unsatisfactory results. All had contraindications for temporoparietal fascia flap use: prior use, flap injury from previous surgery, trauma, inappropriate flap location, or inadequate flap perfusion. Twelve patients (14 percent) developed occipital artery fascia flap complications (infection or necrosis) and underwent further revision to achieve satisfactory results.

Conclusions:
Given the paucity of reported techniques for large-scale auricular salvage/revision, the authors offer a versatile option that remains available when other conventional flaps are unavailable. The occipital artery fascia flap may be used with either alloplastic or autologous frameworks.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Forward genetic screen forCaenorhabditis elegansmutants with a shortened locomotor healthspan
Authors: Kawamura Kazuto , Maruyama Ichiro N. 
Published: December 2018

AbstractTwo people with the same lifespan do not necessarily have the same healthspan. One person may retain locomotor and cognitive functions until the end of life, while another person may lose them during adulthood. Unbiased searches for genes that are required to maintain locomotor capacities during adulthood may uncover key regulators of locomotor healthspan. Here, we take advantage of the relatively short lifespan of the nematodeCaenorhabditis elegansand develop a novel screening procedure to collect mutants with locomotor deficits that become apparent in adulthood. After ethyl methanesulfonate mutagenesis, we isolated fiveC. elegansmutant strains that progressively lose adult locomotor activity. In one of the mutant strains, a nonsense mutation in Elongator Complex Protein Component 2 (elpc-2)causes a progressive decline in locomotor function. Mutants and mutations identified in the present screen may provide insights into mechanisms of age-related locomotor impairment and the maintenance of locomotor healthspan.
Hepatocyte-specific deletion of Pparα promotes NASH in the context of obesity
Authors: Régnier Marion , Polizzi Arnaud , Smati Sarra , Lukowicz Céline , Fougerat Anne , Lippi Yannick , Fouché Edwin , Lasserre Frédéric , Naylies Claire , Bétoulières Colette , Barquissau Valentin , Mouisel Etienne , Bertrand-Michel Justine , Batut Aurélie , Saati Talal Al , Canlet Cécile , Tremblay-Franco Marie , Ellero-Simatos Sandrine , Langin Dominique , Postic Catherine , Wahli Walter , Loiseau Nicolas , Guillou Hervé , Montagner Alexandra 
Published: December 2018

AbstractObjectivesPeroxisome proliferator activated receptor α (PPARα) acts as a fatty acid sensor to orchestrate the transcription of genes coding for rate-limiting enzymes required for lipid oxidation in hepatocytes. Mice only lacking Pparα in hepatocytes spontaneously develop steatosis without obesity in aging. Altough steatosis is a benign condition it can develop into non alcoholic steatohepatitis (NASH), which may progress to irreversible damage, such as fibrosis and hepatocarcinoma. While NASH appears as a major public health concern worldwide, it remains an unmet medical need. Several drugs are being tested in clinical trials, including pharmacological agonists for the different PPAR isotypes. In current study, we investigated the role of hepatocyte PPARα in a preclinical model of steatosis.Methods/ResultsWe have investigated the role of hepatocyte PPARα in a preclinical model of steatosis using High Fat Diet (HFD) feeding as a model of obesity in C57BL/6J male Wild-Type mice (WT), in whole-body (Pparα-/-) mice and in mice lacking Pparα in hepatocyte (Pparαhep-/-). We provide evidence that Pparα deletion in hepatocytes promotes NASH in mice fed an HFD. This enhanced NASH susceptibility occurs without development of glucose intolerance. Moreover, our data reveal that non-hepatocytic PPARα activity predominantly contributes to the metabolic response to HFD.ConclusionTaken together, our data support hepatocyte PPARα as being essential to the prevention of steatosis progression to NASH and that extra-hepatocyte PPARα activity contributes to whole-body lipid homeostasis.HighlightsPparα deletion in hepatocytes promotes steatosis and inflammation in HFD-induced obesityHepatocyte-specific deletion of Pparα dissociates NAFLD from glucose intolerance in HFD-induced obesity obesityExtrahepatic PPARα activity contributes to the metabolic response to HFD-induced obesity