bluuebunny/crossref_metadata_2025_split huggingface dataset:
Learning curve-cumulative summation analysis of visual estimation of left ventricular function in novice practitioners
Authors: Lee Yoonje , Shin Hyungoo , Kim Changsun , Lee Inhye , Choi Hyuk Joong 
Published: April 2019

Abstract
The aim of the present study was to determine the value of cumulative summation (CUSUM) analysis in assessing the proficiency of novice practitioners in estimating the left ventricular ejection fraction (EF).
Seven novice practitioners with no echocardiography experience were recruited in this observational study. Each practitioner assessed EF from echocardiographic video files of 100 cases, one by one, and received feedback and teaching. We obtained a CUSUM score through comparison of the gold standard values of EF and the EF values determined by the practitioners. Then, the practitioners underwent the same test 4 weeks later, except without feedback and teaching, using echocardiographic video files from 100 other cases.
The mean number of visual estimation cases required to pass the learning curve (LC)-CUSUM test was 56.3 ± 9.1 (95% CI 47.8–64.7). The LC-CUSUM average of the 7 novice practitioners showed improvement in visual estimation skill, with an average acceptable level achieved after a mean experience of 55 cases. In the test performed after 4 weeks, 5 of the 7 novice practitioners showed significantly good overall agreement. All novice practitioners had a kappa coefficient greater than .8, and significant and almost perfect agreement was observed. All the participants exhibited a percentage of correct answers greater than 81%.
We found that the novice practitioners could acquire an acceptable level of skill for estimating EF with short-term, self-learning-focused echocardiographic training.
Periprocedural Management of Patients Undergoing Liver Resection or Embolotherapy for Neuroendocrine Tumor Metastases
Authors: Kwon Daniel H. , Paciorek Alan , Mulvey Claire K. , Chan Hilary , Fidelman Nicholas , Meng Lingzhong , Nakakura Eric K. , Zhang Li , Bergsland Emily K. , Van Loon Katherine 
Published: April 2019

Objectives
The objective of this study was to describe the periprocedural management of patients with well-differentiated neuroendocrine tumors with hepatic metastases who underwent liver-directed procedures.

Methods
We performed a retrospective review of patients with metastatic neuroendocrine tumors who underwent liver resection, ablation, or embolotherapy at a single center from 2012 to 2016. The primary outcome was occurrence of documented carcinoid crisis (CC) or hemodynamic instability (HDI), defined as 10 minutes or more of systolic blood pressure less than 80 or greater than 180 mm Hg, or pulse greater than 120 beats per minute.

Results
We identified 75 patients who underwent liver resection/ablation (n = 38) or embolotherapy (n = 37). Twenty-four patients (32%) experienced CC or HDI (CC/HDI); CC occurred in 3 patients. No clinicopathologic or procedural factors, including procedure type, octreotide or long-acting somatostatin analog use, and history of carcinoid syndrome, were associated with CC/HDI. Grades 2 to 4 complications were reported in 42% of patients who experienced CC/HDI versus in 16% of patients who did not experience CC/HDI (P < 0.05).

Conclusions
A significant portion of patients developed CC/HDI, and these patients were more likely to develop severe postprocedural complications. Periprocedural octreotide use was not associated with lower CC/HDI occurrence, but continued use is advised given its safety profile until additional studies definitively demonstrate lack of benefit.
Risk and Predictors of Postoperative Morbidity and Mortality After Pancreaticoduodenectomy for Pancreatic Neuroendocrine Neoplasms
Authors: Partelli Stefano , Tamburrino Domenico , Cherif Rim , Muffatti Francesca , Moggia Elisabetta , Gaujoux Sébastien , Sauvanet Alain , Falconi Massimo , Fusai Giuseppe 
Published: April 2019

Objectives
Pancreaticoduodenectomy (PD) is associated with a high risk of postoperative complications and mortality. The aim of this study was to compare postoperative morbidity after PD in patients undergoing resections for pancreatic neuroendocrine neoplasms (PanNENs) with patients undergoing the same resection for pancreatic ductal adenocarcinoma (PDAC).

Methods
Data of 566 patients from 3 European tertiary referral centers between 1998 and 2014 were considered.

Results
Overall, 566 patients (179 with PanNENs, 387 with PDAC) who underwent PD were analyzed. Patients with PanNENs were significantly younger (56 vs 64 years, P < 0.0001). The consistency of the pancreas was soft in 147 patients (82%) with PanNENs and in 162 patients (42%) with PDAC (P < 0.0001). Patients in the PanNENs group had a significantly higher rate of pancreatic fistula (P < 0.0001), bile leak (P = 0.004), abdominal collection (P = 0.017), and development of sepsis (P = 0.042). No differences in terms of overall postoperative complications, median length of stay, and in-hospital mortality were found. On multivariate analysis sex (male), PanNENs indication, blood transfusion, and a soft pancreatic texture were independent predictors of pancreatic fistula after PD.

Conclusions
Pancreaticoduodenectomy for PanNENs is associated with higher rate of surgical-specific postoperative complications than those for PDAC.
Long-Term Services and Supports
Authors: Treiger Teresa M. 
Published: April 2019

Purpose/Objectives:
The Centers for Medicare & Medicaid Services (CMS) announced that beginning in 2019, Medicare Advantage (MA) health plans may begin offering additional benefits for nonmedical home services. In 2019, this change impacts the Long-Term Services and Supports (LTSS) landscape dramatically. This 2-part article describes LTSS, its traditional demographic and health care footprint, the regulatory and accreditation landscape, quality measurement and outcomes, and the critical importance of maintaining care continuity for individuals receiving LTSS. The objectives are to:
define LTSS,identify client demographics,identify delivery models,discuss regulation and accreditation environments,discuss quality improvement and outcomes initiatives,identify promising practices and best practices, andidentify useful resources.

Primary Practice Setting(s):
Applicable to all health care sectors where case management is practiced.

Findings/Conclusions:
Historically, once Medicare recognizes a product or service, managed health plans and commercial insurance carriers follow suit. Professional case managers must become fluent in the language of LTSS, the implications of these CMS changes, and the impact on case management practice across the care continuum.

Implications for Professional Case Management Practice:
Professional case managers should understand LTSS, especially as it pertains to care transitions and continuity of health care services to our most vulnerable clients.
Integration of the National Comprehensive Cancer Network (NCCN) Distress Screening Tool as a Guidepost for Telephonic Oncology Case Management
Authors: Swanson Alysia Jean , Castel Liana DesHarnais , McKenna Patricia A. , Shen Yuming Albert , Sagar Bhuvana 
Published: April 2019

Purpose of Study:
Cigna's oncology case management programs identified the opportunity for case managers to integrate distress screening as recommended by the National Comprehensive Cancer Network (NCCN) in oncology populations. Our purpose in conducting this study was to quantify oncology case management program improvements as a result of using the NCCN Distress Screening Tool to guide telephonic case management. The program improvements we measured comprised more efficient identification of biopsychosocial problems and appropriate resource referrals.

Primary Practice Setting:
Case managers in a large commercial health plan piloted integration of distress screening into telephonic case management among U.S. oncology customers experiencing a new diagnosis or care transition from September 2016 to April 2017.

Methodology and Sample:
A retrospective, matched case–control study was conducted among Cigna customers eligible for oncology case management. The pilot group of 317 received distress screening early in the oncology case management assessment. Outcomes included distress severity ranging from 0 to 10 (where 0 = no distress, 1–3 = mild, 4–7 = moderate, and 8–10 = severe), identification and number of biopsychosocial health problems, and percentage of direct resource referrals by case managers to supportive services.

Results:
More than half (54%) of the screened customers reported mild or greater distress, and there was a strong correlation between degree of distress and average numbers of biopsychosocial health problems or direct resource referrals. Screened customers were 16% more likely to be referred to internal and external resources than customers not screened with the tool (66% vs. 50%, χ2
p < .001).

Implications for Case Management Practice:
This study advances evidence-based oncology case management practice during care transitions by providing quantitative evidence for the utility of integrating the NCCN Distress Screening Tool into telephonic oncology case management. Using the tool (thermometer and problem list) to guide telephonic oncology case management and care coordination facilitated more tailored referrals to individuals with cancer enrolled in a large commercial health plan. On the basis of our findings, we integrated distress screening to address unmet biopsychosocial needs in patients with cancer.
Leveraging Interprofessional Team-Based Care Toward Case Management Excellence
Authors: Fink-Samnick Ellen 
Published: April 2019

Health care teams continue to be a constructive way to approach, assess, coordinate, plan, and facilitate the care of clients and populations. Independent of practice setting, some type of team is in place, engaging different professionals and specialists. There has been considerable evolution of these teams over the years, with a heritage of terms to frame each one, including “multidisciplinary,” “interdisciplinary,” and “transdisciplinary.” However, these long-standing framings have been replaced by a timelier model that shifts both focus and aim of the team effort. Interprofessional team-based care (IPTBC) sets the tone for how students entering the industry are educated and empowers the workforce to a more intentional means to the care end. This is the first in a 2-part series focusing on the evolution and implementation of IPTBC across the industry. Part 1 focuses on the history and fundamental concepts of interprofessional models. Evidence and outcomes to promote the value proposition for IPTBC implementation are also provided.

Purpose/Objectives:

This article:
Reviews the evolution of health care teams;Defines IPTBC;Discusses the challenges to implementation of IPTBC; andIdentifies the implications for professional case management.

Primary Practice Setting(s):
Applicable to all health and behavioral health settings where case management is practiced.

Findings/Conclusions:
Interprofessional team-based care models demonstrate a successful means to achieve client-driven, quality, and cost-effective care across disease states and practice settings.

Implications for Case Management Practice:
With case management so closely linked to the fiscal imperatives of organizations, engagement in IPTBC is a necessity for every practice setting. Poor team collaboration contributes to unsuccessful outcomes for clients, increased costs, and concerning quality and risk management issues for the organization. The latest generation of value-based care initiatives and complex population health needs (e.g., social determinants of health, co-occurring physical and behavioral health) translates to greater pressures on case managers to maximize financial risk and attain their share of financial incentives (e.g., bonuses, shared savings) by avoiding readmissions, preventable complications, and duplicate services.
Making the Transition
Authors: Short Kathleen , Freedman Kara , Matays Jennie , Rosamilia Melody , Wade Kara 
Published: April 2019

Purpose:
This article describes the impact of a hands-on critical care skills day led by clinical nurse specialist (CNS) to enhance junior nurses’ clinical skills. Program objectives included providing specialized skills training to meet the needs of high-acuity patient population and reviewing nurse-sensitive indicator–associated care bundles with the goal of increasing compliance.

Description of the Project:
An 8-hour program of lecture and hands-on skills was developed. Curriculum included nursing-sensitive indicators, sepsis management, complex tubes and drains, airway management, and emergency response. Clinical nurse specialists mentored senior nurses to colead program planning and execution. The program has been offered 9 times. Qualitative and quantitative data were collected on attendees.

Outcome:
Quantitative data analysis showed that 89% of the assessed components were affected by the program. Medium effect was noted in defibrillator skills, retrieving items from code care, care of suicidal patient, and sepsis screening. Qualitative data based on attendee survey are also presented and analyzed. Decreases in indwelling catheter utilization on select units are discussed.

Conclusion:
The CNS has the responsibility to ensure nursing practice is reflective of hospital policy and current evidence. This program demonstrates the impact of CNSs in staff education, mentorship, and competency assessment.
Pain Management Pillars for the Clinical Nurse Specialist
Authors: Klaess Cynthia C. , Urton Michael , Whitehead Phyllis , Rosier Patricia Kelly , Burnie Jeannie , Michel Marti 
Published: April 2019

Purpose:
This article describes the work of the National Association of Clinical Nurse Specialists (NACNS) Opioid/Pain Management Task Force and provides guidance for the clinical nurse specialist (CNS) in evidence-based pain management interventions and organizational program development.

Description:
In September 2016, the NACNS commissioned a group of pain management experts to identify the resources that CNSs need to address appropriate opioid use and pain management in various practice settings. Challenges faced by CNSs related to opioids and pain management were identified through NACNS Conference forums and a pain management survey of NACNS members.

Outcome:
On the basis of member input, the task force highlighted key components, or pain pillars, necessary for optimal pain management. Use of these pillars can guide the CNS and healthcare organizations to develop comprehensive pain management practices that provide the foundation for safe, effective, and individualized patient care.

Conclusions:
As an expert in clinical, professional, and systems leadership, the CNS is ideally suited to convene interprofessional groups focused on pain management including development of organizational philosophies, policies, and evidence-based care.
Risk of Severe Intraventricular Hemorrhage in the First Week of Life in Preterm Infants Transported Before 72 Hours of Age*
Authors: Shipley Lara , Gyorkos Timea , Dorling Jon , Tata Laila J. , Szatkowski Lisa , Sharkey Don 
Published: April 2019

Objectives:
Evaluate the risk of severe intraventricular hemorrhage, in the first week of life, in preterm infants undergoing early interhospital transport.

Design:
Retrospective cohort study.

Setting:
Tertiary neonatal centers of the Trent Perinatal Network in the United Kingdom.

Patients:
Preterm infants less than 32 weeks gestation, who were either born within and remained at the tertiary neonatal center (inborn), or were transferred (transported) between centers in the first 72 hours of life.

Interventions:
None.

Measurements and Main Results:
Multivariable logistic regression models adjusting for key confounders were used to calculate odds ratios for intraventricular hemorrhage with 95% CIs for comparison of inborn and transported infants. Cranial ultrasound findings on day 7 of life. Secondary analyses were performed for antenatal steroid course and gestational age subgroups. A total of 1,047 preterm infants were included in the main analysis. Transported infants (n = 391) had a significantly higher risk of severe (grade III/IV) intraventricular hemorrhage compared with inborns (n = 656) (9.7% vs 5.8%; adjusted odds ratio, 1.69; 95% CI, 1.04–2.76), especially for infants born at less than 28 weeks gestation (adjusted odds ratio, 1.83; 95% CI, 1.03–3.21). Transported infants were less likely to receive a full antenatal steroid course (47.8% vs 64.3%; p < 0.001). A full antenatal steroid course significantly decreased the risk of severe intraventricular hemorrhage irrespective of transport status (odds ratio, 0.33; 95% CI, 0.2–0.55). However, transported infants less than 28 weeks gestation remained significantly more likely to develop a severe intraventricular hemorrhage despite a full antenatal steroid course (adjusted odds ratio, 2.84; 95% CI, 1.08–7.47).

Conclusions:
Preterm infants transported in the first 72 hours of life have an increased risk of early-life severe intraventricular hemorrhage even when maternal antenatal steroids are given. The additional burden of postnatal transport could be an important component in the pathway to severe intraventricular hemorrhage. As timely in-utero transfer is not always possible, we need to focus research on improving the transport pathway to reduce this additional risk.
Effect of sustained experimental muscle pain on joint position sense
Authors: Summers Simon J. , Schabrun Siobhan M. , Hirata Rogerio P. , Graven-Nielsen Thomas , Cavaleri Rocco , Chipchase Lucy S. 
Published: April 2019

Abstract

Introduction:
Joint position sense (JPS) is impaired in clinical musculoskeletal pain conditions, but when this impairment develops in the transition from initial to prolonged pain is not known.

Objectives:
This study assessed whether progressively developing sustained experimentally induced muscle pain impacts JPS in healthy individuals.

Methods:
Twenty-eight healthy individuals received injection of nerve growth factor (NGF) into the right extensor carpi radialis brevis muscle on days 0 and 2 to induce sustained pain and hyperalgesia. Wrist JPS was assessed 2 days before day 0 (day −2), before the injection on days 0 and 2, and on days 4 and 14. Joint position sense was quantified as the ability to return the wrist to a neutral position following movements in the direction of radial and ulnar deviation. A 3-dimensional motion analysis system was used to calculate absolute, relative, and joint-angle repositioning errors. Numerical rating scale scores of pain intensity, body chart pain drawings, and pressure pain thresholds (PPTs) were recorded on each day.

Results:
Compared with baseline, pressure pain thresholds decreased while pain intensity and area increased at day 2 (P < 0.001) and day 4 (P < 0.001) before returning to baseline on day 14 (P > 0.13). Relative to day 0, there was no change in wrist JPS at day 2, 4, and 14 following movements in either target direction (P > 0.05).

Conclusion:
Despite the presence of sustained muscle pain and hyperalgesia for 4 days at the elbow, no statistical change in wrist joint position error was observed. These findings suggest that pain and hyperalgesia lasting as long as 4 days does not impair JPS.
Ultrasound as a Useful Tool in the Diagnosis of Rheumatoid Arthritis in Patients With Undifferentiated Arthritis
Authors: Gutierrez Marwin , Bertolazzi Chiara , Castillo Edwin , Reyes-Long Samuel , Clavijo-Cornejo Denise , Santos-Moreno Pedro 
Published: April 2019

Background
Nowadays, rheumatologists face challenges in finding an effective method to classify and treat patients with undifferentiated arthritis (UA). There is a need for new tools that could ensure accurate characterization of inflammatory processes in these patients.

Objective
The aim of this study was to investigate if a characterization of UA patients using ultrasound (US) may help to fulfill the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) rheumatoid arthritis (RA) classification criteria in a real-life cohort.

Methods
We conducted a cross-sectional study in 2 rheumatology care clinics. Patients not fulfilling the 2010 ACR/EULAR RA criteria were included. On the examination day, all patients underwent a physical examination, radiography, and US. The 7-joint US score was adopted to scan all patients. The US was performed according to EULAR criteria and interpreted by Outcome Measures in Rheumatology definitions. Gray-scale and power Doppler synovitis and tenosynovitis were scored. Bone erosions were also evaluated during the US examination.

Results
A total of 204 patients were included. The diagnosis was modified from UA to RA in 86 patients (42.1%). Also, the final score of the 2010 ACR/EULAR RA classification criteria changed from a mean of 4.6 to 6.5 after the US examination. In addition to synovitis, a wide range of tenosynovitis and bone erosions were detected by US. Synovitis was more frequently detected in second metacarpophalangeal joint followed by second metatarsophalangeal joint (MTPj) and fifth MTPj. The tendons of the wrist and second and third fingers were the most affected. In relation to bone erosions, second metacarpophalangeal joint and fifth MTPj were the joints with more proportion of anatomical damage.

Conclusions
The US demonstrated to be useful to help accurately classify as RA patients previously diagnosed with UA.
Application of Dextroscope in a Rare Type of Angiomatous Meningioma Characterized With Coral-Like Vessels
Authors: Ma Shun-Chang , Yang Jun , Jia Wang 
Published: April 2019

Abstract
A 43-year-old female diagnosed with meningioma was admitted to our department. Preoperative imaging revealed a spherical lesion located in the sphenoid ridge with obvious enhancement and inhomogeneous density into 3 layers on magnetic resonance (MR) images, coral-like vessel images inside the tumor was obtained after the raw computed tomography angiography data were imported into the Dextroscope virtual-reality system. Due to her progressive headache and visual deterioration, surgery was performed after comprehensive study in the Dextroscope system, details about the correlation among skull base, lesion, branches of internal carotid artery, and vessels inside the tumor were well demonstrated in this system. It is diagnosed as a rare type of angiomatous meningioma, based on the abnormal manifestation on images, which even make it important to make further evaluation before making any surgical plan. Surgical resection has been the optimal treatment for most meningiomas and is meticulously performed accordingly. The patient is doing fine with no evidence of tumor recurrence on recent MR scans.