bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing Pressure Injury Knowledge Using the Pieper-Zulkowski Pressure Ulcer Knowledge Test
Authors: Delmore Barbara , Ayello Elizabeth A. , Smart Hiske , Sibbald R. Gary 
Published: August 2018

ABSTRACT

OBJECTIVE:
To determine the pressure injury knowledge of health professionals before and after providing an interactive, educational intervention.

DESIGN AND SETTING:
The research design was a quasi-experimental study using a nonrandomized pretest/posttest methodology in Manila, Philippines.

PATIENTS AND INTERVENTION:
The population for this study was healthcare professionals who participated in a 2-day Basic WoundPedia course. There were 57 participants on day 1 and 55 participants on day 2. The Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT, version 2), a standardized, validated instrument with 72 items, was used to measure 3 domains: prevention (28 items), staging (20 items), and wounds (24 items). The test was used to determine the baseline pressure injury knowledge of the students on day 1 before the course began and on day 2 after related content was completed. The intent of this approach was to document that knowledge deficits were met, especially for future courses.

MAIN RESULTS:
There was a statistically significant increase in pressure injury knowledge scores after healthcare professionals received an interactive, educational intervention.

CONCLUSIONS:
Measuring knowledge before and after educational intervention should be considered to determine whether knowledge deficits are corrected. This methodology reinforced the adult learning theory and to help participants realize their own knowledge deficits. The PZ-PUKT may prove a valuable nonthreatening instrument for adult learners to self-identify, self-learn, and self-correct knowledge according to the best new evidence as it becomes available. These findings documented that this interactive, educational intervention did improve the percentage of correct pressure injury knowledge concepts for this group in all 3 subscales. This study also added support for the newly revised PZ-PUKT.
The Safety of Negative-Pressure Wound Therapy on Surgical Wounds: An Updated Meta-analysis of 17 Randomized Controlled Trials
Authors: Ge Dongmei 
Published: August 2018

ABSTRACT

OBJECTIVE:
To assess whether negative-pressure wound therapy (NPWT) reduced complications such as wound infection, dehiscence, seroma/hematoma, skin necrosis/blistering, and bleeding compared with non-NPWT treatments.

METHODS:
This meta-analysis involved randomized clinical trials of NPWT compared with non-NPWT on surgical wound healing. The main outcome was surgical site infections; secondary outcomes were dehiscence, seroma/hematoma, skin necrosis/blistering, bleeding, and reoperation.

MAIN RESULTS:
Seventeen randomized controlled trials met the inclusion criteria, reporting on 928 NPWT and 930 non-NPWT patients. Compared with non-NPWT, NPWT was not associated with a significant reduction in wound infection (relative risk, 0.96; 95% confidence interval, 0.74–1.24). The reduction in wound dehiscence, seroma/hematoma, skin necrosis/blistering, and bleeding in the NPWT group was significant compared with that in the non-NPWT groups. Significant heterogeneity was observed in seroma/hematoma and skin necrosis/blistering between the NPWT and non-NPWT groups. No publication bias was observed.

CONCLUSIONS:
Compared with non-NPWT, NPWT significantly reduced the rates of dehiscence, seroma/hematoma, skin necrosis\blistering, and bleeding, but not surgical site infections.
Machine Learning Models for the Hearing Impairment Prediction in Workers Exposed to Complex Industrial Noise: A Pilot Study
Authors: Zhao Yanxia , Li Jingsong , Zhang Meibian , Lu Yao , Xie Hongwei , Tian Yu , Qiu Wei 
Published: August 2018

Objectives:
To demonstrate the feasibility of developing machine learning models for the prediction of hearing impairment in humans exposed to complex non-Gaussian industrial noise.

Design:
Audiometric and noise exposure data were collected on a population of screened workers (N = 1,113) from 17 factories located in Zhejiang province, China. All the subjects were exposed to complex noise. Each subject was given an otologic examination to determine their pure-tone hearing threshold levels and had their personal full-shift noise recorded. For each subject, the hearing loss was evaluated according to the hearing impairment definition of the National Institute for Occupational Safety and Health. Age, exposure duration, equivalent A-weighted SPL (LAeq), and median kurtosis were used as the input for four machine learning algorithms, that is, support vector machine, neural network multilayer perceptron, random forest, and adaptive boosting. Both classification and regression models were developed to predict noise-induced hearing loss applying these four machine learning algorithms. Two indexes, area under the curve and prediction accuracy, were used to assess the performances of the classification models for predicting hearing impairment of workers. Root mean square error was used to quantify the prediction performance of the regression models.

Results:
A prediction accuracy between 78.6 and 80.1% indicated that the four classification models could be useful tools to assess noise-induced hearing impairment of workers exposed to various complex occupational noises. A comprehensive evaluation using both the area under the curve and prediction accuracy showed that the support vector machine model achieved the best score and thus should be selected as the tool with the highest potential for predicting hearing impairment from the occupational noise exposures in this study. The root mean square error performance indicated that the four regression models could be used to predict noise-induced hearing loss quantitatively and the multilayer perceptron regression model had the best performance.

Conclusions:
This pilot study demonstrated that machine learning algorithms are potential tools for the evaluation and prediction of noise-induced hearing impairment in workers exposed to diverse complex industrial noises.
Lung transplantation in scleroderma: recent advances and lessons
Authors: Jablonski Renea , Dematte Jane , Bhorade Sangeeta 
Published: August 2018

Purpose of review
The purpose of this review is to highlight recent data regarding feasibility and outcomes following lung transplantation for patients with systemic sclerosis related pulmonary disease as well as to emphasize areas of uncertainly in need of further study. We include a description of our centre's approach to lung transplant evaluation and posttransplant management in this complex patient population.

Recent findings
Historical data have demonstrated that patients with scleroderma have an increased risk of complications following lung transplantation owing to the multisystem nature of disease, particularly concurrent gastrointestinal, cardiac and renal involvement. Emerging data support the safety of lung transplant in appropriately selected patients with scleroderma-related interstitial lung disease and pulmonary arterial hypertension.

Summary
Accumulating evidence validates that a diagnosis of scleroderma is not a priori a contraindication to lung transplant. In the carefully selected patient, both short-term and long-term outcomes following lung transplantation are comparable to counterparts with fibrotic lung disease or pulmonary arterial hypertension. However, further prospective study to detail how these patients should be evaluated and managed posttransplant is definitely needed. Cardiac disease is an emerging cause of morbidity and mortality in the scleroderma population and deserves particular attention during the pre and posttransplant period.
Impact of Cardiac Resynchronization Therapy on Daily Physical Activity in Heart Failure Patients
Authors: Gad Sandra AbdelGawad , Martin Sylvia , Kimber Shane , Williams Randy , Gulamhusein Sajad , Lockwood Evan , Haennel Robert G. 
Published: August 2018

Purpose:
Cardiac resynchronization therapy (CRT) has emerged as a beneficial therapy for heart failure (HF) patients. It has been shown to enhance cardiac pump function and increase exercise capacity in patients with HF who display wide QRS complex on their electrocardiogram. To date, few studies have assessed daily physical activity (PA) in CRT patients. The objective of this pilot study was to assess the impact of CRT on the physical function and daily PA of HF patients who met the standard indications for CRT implantation.

Methods:
The daily PA of 18 CRT patients was measured using a SenseWear Armband for ∼3 d. Daily PA measurements included steps/d and time spent sedentary (≤1.5 metabolic equivalent tasks), in light PA (1.6-2.9 metabolic equivalent tasks), and in moderate-vigorous PA (≥3 metabolic equivalent tasks). To assess exercise capacity, a 6-min walk test was performed pre- and post-CRT.

Results:
There was no significant change in the 6-min walk test distance from pre- to post-CRT (383 ± 99 m at baseline vs 402 ± 104 m post-CRT). There was a decrease in total steps/d from 3405 ± 2334 pre-CRT to 2553 ± 1692 post-CRT (P = .017). Furthermore, no significant changes were observed pre- to post-CRT with regard to the additional PA assessments.

Conclusions:
Our patients exhibited a sedentary lifestyle pre- and post-CRT. These findings underscore the need for a cardiac rehabilitation program that encourages post-CRT patients to decrease sedentary time.
PERSISTENT PLACOID MACULOPATHY IN A PATIENT WITH HIGH MYOPIA
Authors: Kolomeyer Anton M. , Brucker Alexander J. 
Published: August 2018

Purpose:
To describe a case of persistent placoid maculopathy in a patient with high myopia.

Methods:
Interventional case report.

Results:
A 59-year-old white man with high myopia presented with blurriness in the left eye. Vision was 20/20 bilaterally. Optical coherence tomography showed subretinal thickening and fluid without definitive leakage on fluorescein angiography after which anti–vascular endothelial growth factor (anti-VEGF) therapy was initiated. The patient was diagnosed with persistent placoid maculopathy based on multimodal imaging and clinical response. His disease course was characterized by multiple bilateral recurrences despite active treatment. At final visit (23 months after presentation), the vision was 20/20 in the right eye and 20/25 in the left eye, and the disease remained quiescent on immunomodulating therapy.

Conclusion:
Prompt initiation of anti-VEGF injections and immunosuppression resulted in disease control and preservation of vision in both eyes for almost 2 years.
The Role of Ocular Response Analyzer in Differentiation of Forme Fruste Keratoconus From Corneal Astigmatism
Authors: Kirgiz Ahmet , Karaman Erdur Sevil , Atalay Kursat , Gurez Ceren 
Published: August 2018

Purpose:
To determine the diagnostic accuracy of corneal biomechanical factors in differentiating patients with forme fruste keratoconus (FFKC) from astigmatic and normal cases.

Methods:
A total of 50 eyes with FFKC, 50 with astigmatism and 50 normal eyes, were included in this study. All patients had a detailed ophthalmologic examination including slit-lamp evaluation, Goldmann tonometry, indirect fundoscopy, topography by Scheimpflug imaging biomicroscopic anterior and posterior segment examination, and corneal biomechanical and intraocular pressure evaluation with ocular response analyzer (ORA).

Results:
All topographic findings were statistically significant among the three groups (P>0.05). Although there was no statistically significant difference in the corneal-compensated intraocular pressure (IOPcc) among the three groups, the Goldmann-correlated intraocular pressure (IOPg), corneal hysteresis (CH), and corneal resistance factor (CRF) were statistically significantly lower in the FFKC group, compared with the other groups (P<0.001). There were no statistically significant difference in the IOPg, CH, and CRF between astigmatism and control groups (P=0.99, 0.79, and 0.86, respectively). The area under the receiver operating characteristic (AUROC) curve was greater than 0.85 for IOPg (0.80), CH (0.85), and CRF (0.90) for discriminating between FFKC and controls; whereas the AUROC was greater than 0.85 for IOPg (0.80), CH (0.79), and CRF (0.85) for discriminating between FFKC and astigmatism groups.

Conclusion:
Based on our study results, in differentiation of patients with FFKC from normal control cases or astigmatic patients, corneal biomechanical parameters play a role particularly in patients with suspicious results. We suggest using ORA in combination with corneal topography for better and more accurate diagnosis of FFKC.
Multicenter Assessment of Grafts in Coronaries
Authors: Balkhy Husam H. , Patel Nirav C. , Ramshandani Mahesh , Kitahara Hiroto , Subramanian Valavunar A. , Augelli Nicholas V. , Tobler Gareth , Cai Tung H. ,   for the MAGIC Study Investigators
Published: August 2018

Objective The commercially available C-Port distal anastomotic device (Food and Drug Administration cleared in 2007) is an automated miniature vascular stapler that performs the coronary anastomosis. This prospective multicenter registry sought to evaluate midterm patency using this device compared with hand-sewn grafts. Methods Patients receiving at least one C-Port anastomosis during coronary artery bypass grafting surgery were enrolled at eight sites. Of the 117 patients enrolled, 78 patients (67%) with 104 C-Port vein grafts completed the study to patency assessment via computed tomography angiography. Clinical follow-up and index graft patency (Gated 64-slice computed tomography scan) were performed at least 12 months postoperatively. The primary efficacy endpoint was patency compared with the peer-reviewed results from the PRoject of Ex-vivo Vein graft ENgineering via Transfection IV (PREVENT IV) trial. Results The patient population was consistent with the PREVENT IV placebo cohort. The mortality at 12 months was 0.85% (1/117). The major cardiac morbidity rate was 3.4% (4/117). The C-Port vein graft occlusion rate was 16.3% (17/104) compared with 26.6% (597/2242) in the PREVENT IV trial ( P = 0.011). Within this study, C-Port graft occlusion rates were not significantly different from the hand-sewn grafts ( P = 0.821). Conclusions The C-Port device is safe and effective in creating the distal anastomosis with equivalent patency rates to hand-sewn grafts at 12 months. When compared with hand-sewn anastomoses from a recent large prospective trial, the C-Port device demonstrated a statistically significant reduction in midterm graft occlusion. Further studies are required to evaluate its effect in less invasive coronary surgery.
Outcomes of Impella 5.0 in Cardiogenic Shock
Authors: Batsides George , Massaro Joe , Cheung Anson , Soltesz Edward , Ramzy Danny , Anderson Mark B. 
Published: August 2018

Objective The aim of the study was to comprehensively summarize the survival outcomes and complications of Impella 5.0 (Abiomed Inc, Danvers, MA USA) use in patients with cardiogenic shock (CS). Methods We performed a literature review for relevant studies by searching in Medline, Medline In-Process, EMBASE, and the CENTRAL bibliographic databases on April 30, 2017. Nonoverlapping studies with 10 patients or more supported for cardiogenic shock with Impella 5.0 or Impella left direct were included. Data on patient characteristics, indication of support, and outcomes were extracted. A random effect was used to pool the various outcomes. Results This meta-analysis included six studies totaling 163 patients (mean ± SD age = 56.3 ± 12.0, male 81%). Indications for support included 88 (54.0%) for acute on chronic decompensated heart failure, 35 (21.5%) for postcardiotomy cardiogenic shock, 27 (16.6%) for acute myocardial infarction complicated by cardiogenic shock, and, 13 (8.0%) for cardiogenic shock due to other reasons. Survival to next therapy was 73.5% in patients supported for acute on chronic decompensated heart failure. The survival to device explant among patients supported for postcardiotomy cardiogenic shock or acute myocardial infarction complicated by cardiogenic shock was 90.2%, and of those, myocardial recovery was achieved in 73.8%. The overall estimated survival to discharge, 30, 180, and 365 days was 73.5%, 72.6%, 62.7%, and 58.4%, respectively. Patients supported for postcardiotomy cardiogenic shock had the highest heart recovery among survivors to explant (92.1%) and highest survival at 30 (89.5%) and 365 days (69.5%). Conclusions Impella 5.0/LD is associated with favorable survival outcomes and higher rate of myocardial recovery in patients with cardiogenic shock.
Minimally Invasive versus Full-Sternotomy Septal Myectomy for Hypertrophic Cardiomyopathy
Authors: Musharbash Farah N. , Schill Matthew R. , Hansalia Vivek H. , Schuessler Richard B. , Leidenfrost Jeremy E. , Melby Spencer J. , Damiano Ralph J. 
Published: August 2018

Objective Septal myectomy remains the criterion standard for the treatment of patients with hypertrophic obstructive cardiomyopathy refractory to medical therapy. There have been few reports of minimally invasive approaches. This study compared a minimally invasive septal myectomy performed at our institution with the traditional full-sternotomy approach. Methods Patients receiving a stand-alone septal myectomy were retrospectively reviewed from November 1999 to December 2016 (N = 120). Patients were stratified by surgical approach: traditional full sternotomy (n = 34) and ministernotomy (n = 86). Preoperative and perioperative variables were compared as well as follow-up symptomatic and echocardiographic outcomes. Results Both groups had a significant decrease in New York Heart Association class heart failure symptoms ( P < 0.001). At a mean ± SD follow-up time of 2.0 ± 3.4 years, postoperative New York Heart Association class distribution was similar between ministernotomy and full sternotomy ( P = 0.684). Follow-up resting left ventricular outflow tract gradient was also similar between ministernotomy and full sternotomy (11 mm Hg ± 15 vs 9 mm Hg ± 13, P = 0.381). Perioperatively, ministernotomy was not significantly different from full sternotomy in median cardiopulmonary bypass time (81 minutes vs 78 minutes, P = 0.101) but had a slightly longer median cross-clamp time (39 minutes vs 35 minutes, P = 0.017). Major complications were similar in the two groups. There was one 30-day mortality in the full-sternotomy group, but no in-hospital deaths. Conclusions Septal myectomy performed using a minimally invasive approach has similar outcomes to the criterion standard operation done through a full sternotomy. It represents a feasible option for patients with hypertrophic obstructive cardiomyopathy unresponsive to medications.
Geometric Ring Annuloplasty for Aortic Valve Repair during Aortic Aneurysm Surgery
Authors: Rankin J. Scott , Mazzitelli Domenico , Fischlein Theodor , Choi Yeong-Hoon , Pirk Jan , Pfeiffer Steffen , Wei Lawrence M. , Badhwar Vinay 
Published: August 2018

Objective An aortic annuloplasty ring could be useful for aortic valve repair. This trial evaluated intermediate-term outcomes of internal geometric ring annuloplasty for repair of trileaflet and bicuspid aortic insufficiency associated with ascending aortic and/or aortic root aneurysms. Methods Under regulatory supervision, 47 patients with aortic insufficiency and ascending aortic (n = 22) and/or aortic root (n = 25) aneurysms were managed with aortic valve repair and aneurysm resection. Valve repair was performed using trileaflet (n = 40) or bicuspid (n = 7) internal geometric rings, together with leaflet reconstruction. Ascending aortic and/or remodeling root replacements were accomplished with Dacron grafts 5 to 7 mm larger than the rings. An Echo Core Lab provided independent echocardiographic assessments, and changes over time were evaluated by Friedman tests. Results Mean ± SD age was 60 ± 14 years, 57% (27/47) were male, 15% (7/47) had bicuspid valves, 87% (41/47) had moderate-to-severe aortic insufficiency, and 13% (6/47) had mild aortic insufficiency. All patients had annular dilatation, with a mean ± SD of 26.5 ± 2.6 mm before repair, and mean ± SD ring sizes were 21.7 ± 1.7 mm. Follow-up was 42 months (mean = 27 months). No operative mortality or valve-related complications occurred. Two patients died beyond 1 year from nonvalve-related causes. One patient required valve replacement for repair failure. Survival free of complications or valve replacement was 94% at 2 years. Significant reduction in aortic insufficiency and New York Heart Association class were observed ( P < 0.0001), and valve gradients remained low. No heart block or direct ring complications occurred. Conclusions In preliminary regulatory studies, aortic ring annuloplasty seemed safe and effective during aortic aneurysm surgery. This approach could help standardize aortic valve repair.
Direct Femoral Cannulation in Minimal Invasive Pediatric Cardiac Surgery
Authors: Wadhawa Vivek A. , Patel Kartik G. , Doshi Chirag P. , Shah Jigar K. , Ramani Jaydip A. , Garg Pankaj D. , Adalti Sudhir H. , Rana Yashpal R. , Pandya Himani M. , Gupta Vijay 
Published: August 2018

Objective One of the major challenges faced in minimally invasive pediatric cardiac surgery is cannulation strategy for cardiopulmonary bypass. Central aortic cannulation through the same incision has been the usual strategy, but it has the disadvantage of cluttering of the operative field. We hereby present the results of femoral cannulation in minimally invasive pediatric cardiac surgery in terms of adequacy and safety. Methods From January 2013 to June 2016, 200 children (122 males) with mean ± SD age of 9.2 ± 4.51 years (median = 6 years, range = 3–18 years) and weight of 19.22 ± 8.49 kg (median = 15 kg, range = 8–45 kg) were operated for congenital cardiac defects through anterolateral thoracotomy. The most common diagnosis was atrial septal defect (144 patients). In all the patients, femoral artery and femoral vein were cannulated along with direct superior vena cava cannulation for institution of cardiopulmonary bypass. Results There were no deaths or any major complications related to femoral cannulation. Femoral artery cannulation provided adequate arterial inflow, whereas femoral vein with direct superior vena cava cannulation provided adequate venous return in all the patients. No patient required vacuum-assisted venous drainage. No patient required conversion to sternotomy or developed vascular, neurological complications. At discharge and at 1-year follow-up, both femoral artery and vein were patent without a significant stenosis on color Doppler ultrasonography in all the patients. At mean ± SD follow-up period of 30.63 ± 10.09 months, all the patients were doing well without any wound-related, neurological, or vascular complications. Conclusions Femoral arterial and venous cannulation is a feasible, reliable, and efficient method for institution of cardiopulmonary bypass in minimally invasive pediatric cardiac surgery.
A 5-Year Evaluation of Faculty Use of Practical Within-Course Writing Development Strategies in a DNP Program
Authors: Hampton Michelle DeCoux 
Published: August 2018

Background
Nursing students are underprepared for the rigors of graduate writing. The lack of sufficient writing opportunities and skill development in prelicensure nursing education creates barriers that threaten course and program progression.

Approach
This study used a prospective, repeated-measures design to evaluate 5 years of faculty-implemented writing development strategies in a DNP program.

Outcomes
Faculty adopted 12 strategies in 10 courses. The strategies addressed skill building in content, construction, format, plagiarism, and citation use. The most frequently used strategies were rubrics, plagiarism detection software, multistep assignments, and examples of well-written papers, all strategies that increased in use over the 5-year study.

Conclusions
Graduate faculty interact with students and assess writing development outcomes firsthand. Changes in faculty practices over time can indicate the strategies they consider most valuable for writing development.