bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Detection of Bacteria and Matrix Proteins on Clinically Benign and Pathologic Implants
Authors: Walker Jennifer N. , Pinkner Chloe L. , Pinkner Jerome S. , Hultgren Scott J. , Myckatyn Terence M. 
Published: February 2019

Background:
Bacterial contamination of breast implants causes infection, can lead to capsular contracture, and is implicated in breast implant-associated anaplastic large cell lymphoma. Bacteria, however, also colonize clinically benign breast implants and little is known about the biologic signals that trigger the switch from a benign to pathologic state.

Methods:
Explanted smooth as well as Biocell and Siltex textured breast implants associated with clinically normal and pathologic conditions were analyzed in this observational study. Immunofluorescence and bacterial culture techniques were performed. To avoid sampling bias, implant surfaces >25 sq cm were analyzed.

Results:
Bacteria were detected on 9 of 22 clinically normal explanted devices or periprosthetic capsules, including 40% of Biocell tissue expanders and 75% of Biocell textured implants. Staphylococcus epidermidis was identified in 67% of the bacteria-positive capsular contractures. Fibrinogen was present on 17 of 18, and collagen on 13 of 18 analyzed breast implants. S. epidermidis co-localized with collagen, while group B streptococci and Klebsiella pneumoniae co-localized with fibrinogen.

Conclusions:
Bacteria are often detectable on clinically benign breast implants when a multimodal approach is applied to a substantial proportion of the device surface to avoid sampling bias. The impact of bacteria on breast implant pathology should be studied in the presence of an adequate negative control group to account for clinically benign bacteria. Disruption of the interaction of bacteria with matrix proteins coating the surface of breast implants may represent a nonantibiotic strategy for the prevention of breast implant bacterial contamination.
Development of a Plastic Surgery Supply Cart: Patient Outcomes and Quality of Care
Authors: Fahrenkopf Matthew P. , Eichhorn Mitchell G. 
Published: February 2019

Background:
Plastic surgeons experience unique quality issues related to the specialty nature of patient procedures. Lack of accessibility to specialty supplies is a rate-limiting variable that impacts treatment efficiency and hospital resources. This study had the following goals: (1) to develop a mobile plastic surgery cart and (2) to assess the impact of a plastic surgery cart on time to treatment of consults.

Methods:
Two plastic carts were developed using preexisting hospital supplies. Cart composition was designed and approved by hospital staff. A prospective study was conducted to assess overall time to treatment of patient consults throughout the hospital comparing a plastics cart versus a traditional hunt and gather methodology. One surgeon recorded time to treatment with and without the plastics cart for each consult during on-call duty hours over a 6-month period.

Results:
A total of 40 patients were treated for either head or neck (60%) or hand-related (40%) cases. The average time (minutes) to treatment across all procedures with the plastics cart was 3.7 ± 1.9 versus 46.3 ± 60.0 without the plastics cart. The maximum time to treatment was 9.5 minutes with the plastics cart and 3 hours without the plastics cart. Usage of the plastics cart resulted in a significant reduction in total time to treatment of 42.5 ± 60.3 minutes (P < 0.0001).

Conclusions:
A specialty supplies cart has quality improvement implications for patients, physicians, and hospitals. Increased accessibility of specialty supplies may significantly reduce the time to treatment for plastic surgery patient consults throughout a hospital.
Protocols for Reporting Speech Outcomes following Palatoplasty or Velopharyngeal Surgery: A Literature Review
Authors: Kummer Ann W. , Hosseinabad Hedieh Hashemi , Redle Erin , Clark Stacey 
Published: February 2019

Background:
To determine best practices, surgeons who perform cleft palate surgery or surgery for velopharyngeal insufficiency need to be able to compare their outcomes in normalizing the velopharyngeal valve.

Methods:
We conducted a comprehensive review of articles that reported speech/resonance outcomes following palatoplasty or surgery for velopharyngeal insufficiency. We analyzed protocols that were used and how the results were reported. We found 170 articles, published between 1990 and 2014, that met our inclusion criteria.

Results:
Most studies (66%) had a sample size of <50 subjects, were retrospective (67%), were not blinded (83%), and did not report the use of reliability (68%). Most studies included 1 evaluator (27%) or 2 evaluators (30%). Only 80% of the articles specified that at least one speech pathologist was an evaluator. Most articles (56%) did not specify the speech samples used, and 65% used an informal test or did not specify the type of test used. Most studies used a perceptual rating scale for articulation (75%) and resonance (83%). Only 39% of the studies included an evaluation of velopharyngeal function. Finally, objective measures were used in only 28% of the studies (9% used aerodynamic measures and 19% used nasometry).

Conclusions:
Because these articles showed significant variability in how speech/resonance is evaluated and how the outcomes are reported, it is virtually impossible to compare results to determine best surgical procedures. Suggestions are given to standardize outcome measures to improve comparability of data.
Effect of Age on Procedural Success, Complications, and Clinical Outcome From a Large Angioplasty Registry
Authors: Mousavi Mehdi , Poorhosseini Hamidreza , Nematipour Ebrahim , Kassaian Seyed Ebrahim , Salarifar Mojtaba , Alidoosti Mohammad , Hajizeinali Alimohammad , Nozari Younes , Amirzadegan Alireza , Hosseini Seyed Kianoosh , Fathollahi Mahamood Sheikh , Movahed Mohammad Reza 
Published: February 2019

Background:
Increasing age appears to be a risk factor for adverse outcome in patients undergoing percutaneous coronary intervention (PCI). The goal of this study was to compare procedural success, complications, and 12 months major adverse cardiac events (MACE) based on age using a large angioplasty registry.

Methods:
This registry included 10,412 patients with at least 12-month follow-up from April 1993 to April 2011. Patients were divided into 3 age groups: group 1 age < 60 (n = 6195), group 2 age 60–75 (n = 3724) and group 3 elderly age ≥ 75 (n = 493).

Results:
Procedural success rate was not significantly different across the 3 age groups. (96.9% in group 1, 97.1% in group 2, and 96.1% in elderly group, P = 0.759). Procedural complications occurred in 179 (2.9%) of group 1, 98 (2.6%) of group 2 and 15 (3.0%) of elderly group (P = 0.678). In-hospital complications increased with increasing age (311 [5.0%] in group 1, 235 [6.3%] in group 2, and 46 [9.3%] in elderly group; P < 0.001). Twelve-month MACE also increased with increasing age (235 [4.1%] in group 1, 169 [4.9%] in group 2 and 26 [5.7%] in elderly group; P = 0.021). Multivariate analysis showed that age was not a predictor for unsuccessful PCI, procedural complications, or 12-month MACE. However, increasing age was independent predictors of in-hospital complications and death.

Conclusion:
Despite increased in-hospital complications with increasing age, procedural success, and complications were not higher in elderly. Our data suggest that PCI should not be denied in elderly if indicated with procedural safety similar to other age groups.
Adherence to NSTEMI Guidelines in the Emergency Department
Authors: Gilutz Harel , Shindel Sevatlana , Shoham-Vardi Ilana 
Published: February 2019

Background:
Adherence to guidelines for the initial treatment of ST-Segment Elevation Myocardial Infarction has been thoroughly studied, whereas the study of emergency department (ED) adherence to guidelines for Non–ST-Segment Elevation Myocardial Infarction-Acute Coronary Syndrome (NSTEMI-ACS) has been much scarcer. The recommended guidelines for the initial prompt workup and treatment of NSTEMI-ACS remains a challenge.

Aim:
We studied adherence to guidelines for NSTEMI in the ED.

Methods:
A single-center, retrospective study of consecutive patients with NSTEMI admitted to a tertiary hospital and discharged alive between March 2013 and March 2014. ED records were manually reviewed for adherence to prespecified parameters. Cases with sudden death, shock, or type-II NSTEMI were excluded. Canadian Triage and Acuity Scale score system was used for triage in the ED.

Results:
Adherence rates were 33.3%/24.6% of 240 patients for ECG/troponin obtained within 10/60 minutes receptively and 31.3% for anticoagulation within 15 minutes from diagnosis of ACS. Females were less likely to undergo electrocardiography (P = 0.009) or troponin-level tests within the specified timeframe (P = 0.043). Many cardiovascular risk markers were missed. Global Registry of Acute Coronary Events score was not used to risk stratify patients.

Conclusions:
Prompt identification and early medical treatment of NSTEMI in the ED is lacking. Better computerized medical history assembly, attention to typical and atypical clinical presentation, and the employment of an appropriate cardiologic risk stratification method may unblind the treating teams at the point of care and improve adherence to NSTEMI guidelines.
Diagnostic and Prognostic Role of the Modified Diamond-Forrester Model in Combination With Coronary Calcium Score in Acute Chest Pain Patients
Authors: Lavenburg Philip , Cantor Gregg , Agunloye Olufunmilayo , Bhagat Aditi , Taub Erin , Teressa Getu 
Published: February 2019

Background:
The aim of this study was to evaluate whether pretest probability (PTP) assessment using the Diamond-Forrester Model (DFM) combined with coronary calcium scoring (CCS) can safely rule out obstructive coronary artery disease (CAD) and 30-day major adverse cardiovascular events (MACE) in acute chest pain patients.

Methods:
We retrospectively evaluated consecutive patients, age ≥18 years, with no known CAD, negative initial electrocardiogram, and troponin level. All patients had coronary computed tomographic angiography (CCTA) with CCS, and our final cohort consisted of 1988 patients. Obstructive CAD was defined as luminal narrowing of ≥50% in 1 or more vessels by CCTA. Patients were classified according to PTP as low (<10%), intermediate (10%–90%), or high (>90%).

Results:
The DFM classified 293 (14.7%), 1445 (72.7%), and 250 (12.6%) of patients as low, intermediate, and high risk, respectively, with corresponding 30-day MACE rates of 0.0%, 2.35%, and 14.8%. For patients with intermediate PTP and CCS ≤10, the negative predictive value was 99.2% (95% confidence interval: 98.7–99.8) for 30-day MACE while it was 92.62% (95% confidence interval: 87.9–97.3) for patients with high PTP. Among patients with a high PTP and CCS of zero, the prevalence of 30-day MACE and obstructive CAD remained high (7.07% and 10.1%, respectively).

Conclusions:
In acute chest pain patients without evidence of ischemia on initial electrocardiogram and cardiac troponin, low PTP by DFM or the combination of intermediate PTP and CCS ≤10 had excellent negative predictive values to rule out 30-day MACE. CCS is not sufficient to exclude obstructive CAD and 30-day MACE in patients with high PTP.
Dengue Vaccine Booster in Healthy Adolescents and Adults in Latin America
Authors: Coronel Diana , García-Rivera Enid J. , Rivera Maribel , Arredondo-García José Luis , Dietze Reynaldo , Perroud Ana Paula , Cortés Margarita , Bonaparte Matthew , Zhao Jessie , Tila Mihaela , Jackson Nick , Zambrano Betzana , Noriega Fernando 
Published: February 2019

Background:
The tetravalent dengue vaccine (CYD-TDV, Dengvaxia, Sanofi Pasteur) demonstrated efficacy in 2 previous phase III trials conducted in endemic countries. Neutralizing antibodies (NAbs) elicited by 3 doses of this vaccine have been associated with efficacy. Long-term follow-up data has shown that NAb immune responses tend to wane over time, after the third dose. This study compared the immune response elicited by a booster (4th) dose of CYD-TDV with the immune responses from the same participants obtained post-dose 3 of the primary series administered 4–5 years earlier.

Methods:
This multicenter, observer-blind, randomized, placebo-controlled, phase II noninferiority trial was conducted in healthy adolescents and adults in dengue endemic countries of Latin America (Colombia, Honduras, Brazil, Mexico and Puerto Rico). All participants had been immunized with 3 doses of CYD-TDV in phase II studies conducted 4–5 years earlier. NAb levels against each dengue virus serotype 28 days postbooster or placebo injection were reported.

Results:
A total of 187 participants received CYD-TDV and 64 received placebo. Prospectively defined noninferiority criteria for dengue NAbs after the booster dose compared with postdose 3 were met for all 4 serotypes. Prospectively defined superiority criteria were met for 3 of the 4 serotypes.

Conclusions:
Antidengue NAb levels can be boosted to levels at least as high as, or higher than those observed after completion of the primary 3-dose series, with an additional dose of CYD-TDV 4–5 years after the standard 3-dose vaccination schedule.
Highly Sensitive Molecular Assay for Group A Streptococci Over-identifies Carriers and May Impact Outpatient Antimicrobial Stewardship
Authors: Tanz Robert R. , Ranniger Elizabeth J. , Rippe Jason L. , Dietz Renée L. , Oktem Caroline L. , Lowmiller Christine L. , Shulman Stanford T. 
Published: February 2019

Background:
Timely, accurate diagnosis of group A streptococci (GAS) pharyngitis prevents acute rheumatic fever and limits antibiotic overuse. The illumigene group A Streptococcus assay (Meridian Bioscience, Cincinnati, OH) is a molecular test for GAS pharyngitis with high sensitivity and specificity. We sought to determine whether the illumigene test is more likely than throat culture to be positive in patients without pharyngeal symptoms and explore the limits of detection of the test.

Methods:
Patients 3–17 years of age were eligible if they had no history of pharyngitis or use of antibiotics within the previous 2 weeks; there were no upper respiratory infection symptoms, sore throat or fever and no signs of infection. Culture and illumigene were performed on duplicate throat swabs. Excess lysate from a subset of illumigene tests was evaluated by real-time polymerase chain reaction. Institutional Review Board approval was obtained.

Results:
We enrolled 385 patients from February 2016 to October 2017; mean age was 10 yr; 51% were male. Most visits were for health supervision (69%). Significantly more illumigene tests (78/385, 20.3%) than throat cultures (48/385, 12.5%) were positive (χ2; P =0.0035). Illumigene was “indeterminate” for 3 patients, leaving 382 pairs of swabs for analysis. Results were discordant for 32 of 382 pairs (8.4%); 31 of 32 (97%) were illumigene-positive/culture-negative (McNemar test; P < 0.000001). Real-time polymerase chain reaction was negative in 4 of 13 (31%) tested illumigene-positive lysates; the paired culture had been negative in all four. The limit of detection for the illumigene test was 55 colony forming units/mL.

Conclusions:
The illumigene test is significantly more likely than throat culture to yield positive results in patients without GAS pharyngitis. Failure to appropriately select patients for testing may negatively impact antimicrobial stewardship efforts without benefit to patients.
The Feasibility Study of a Revised Standard Care Procedure on the Capacity of Nasogastric Tube Placement Verification Among Critical Care Nurses
Authors: Yang Feng-Huang , Lin Feng-Yu , Hwu Yueh-Juen 
Published: February 2019

ABSTRACT

Background
Evidence-based studies propose that the aspirate pH test may be easily and reliably conducted to verify the proper placement of nasogastric tubes (NGTs). Nurses rarely implement this procedure because of the lack of related knowledge.

Purpose
The purpose of this study was to explore the feasibility of implementing a revised standard care procedure to enhance nurses' ability to verify placement of the NGT.

Methods
his study used a quasi-experimental, longitudinal research design. Nurses from two intensive care units were randomly assigned to the experimental group (n = 35) and the control group (n = 31). A revised standard-of-care procedure to confirm the proper placement of an NGT was incorporated into a slideshow presentation, a printed leaflet, and an audit checklist. The experimental group received continuous education and individual teaching on the revised standard-of-care procedure, whereas the control group did not receive additional education and continued to provide conventional care. The study gathered data using scales designed to address knowledge of and attitudes toward verification of NGT placement and the checklist for auditing the NGT care procedure. Scales were implemented before and after the practice program was conducted, in Months 1, 2, and 3, to evaluate the feasibility of the developed improvement measures.

Results
This study found significant improvements in the experimental group in terms of knowledge regarding NGT placement verification and the NGT care auditing procedure. The positive improvement of the intervention on the NGT care auditing procedure remained for at least 3 months after the end of the intervention.

Conclusions
The findings suggest that using an aspirate pH test is a feasible approach to verify NGT placement in critical care units, a crucial aspect of care necessary to promote patient safety and quality of care.
The Functionality of the Bio-Mechanical Prosthetic Finger When Compared With Results on Standardized and Functional Assessments: A Single-Case Study
Authors: Denham Susan P. , Hawkins Taylor , Johnson Kelsey , Rhoads Jenna , Sims Sara 
Published: February 2019

ABSTRACT

Introduction
The purpose of this study was to examine the functionality of the bio-mechanical prosthetic finger (BPF). The researchers administered various assessments to examine how the BPF performed in comparison with the affected hand without the BPF, as well as the unaffected hand.

Materials and Methods
A single subject participant with amputations at the proximal phalanx of the third and fourth digits was recruited for this study. The subject was assessed without a prosthetic device and while wearing a BPF on each digit. The researchers also assessed the uninvolved hand for comparison. The following standardized assessments were administered: Minnesota Manual Dexterity Test, Jamar Hand Function Test, and Box and Blocks Test. Two qualitative questionnaires and The Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire were also administered to examine the participant's abilities and satisfaction with and without the prosthetic device.

Results
The results were analyzed to assess the difference in performance with and without the prosthetic device as compared with the unaffected side. The results indicated that the participant performed at a higher level on all assessments while using the BPF. In addition, the participant reported a higher level of comfort and satisfaction while using the prosthesis.

Conclusions
The results of the study showed that the BPF is a viable option for digit amputations to restore function in daily tasks.
American Medical Society for Sports Medicine Position Statement on Concussion in Sport
Authors: Harmon Kimberly G. , Clugston James R. , Dec Katherine , Hainline Brian , Herring Stanley A. , Kane Shawn , Kontos Anthony P. , Leddy John J. , McCrea Michael A. , Poddar Sourav K. , Putukian Margot , Wilson Julie C. , Roberts William O. 
Published: February 2019

Abstract:Sport-related concussion (SRC) is a common injury in recreational and organized sport. Over the past 30 years, there has been significant progress in our scientific understanding of SRC, which in turn has driven the development of clinical guidelines for diagnosis, assessment, and management of SRC. In addition to a growing need for knowledgeable health care professionals to provide evidence-based care for athletes with SRC, media attention and legislation have created awareness and, in some cases, fear about many issues and unknowns surrounding SRC. The American Medical Society for Sports Medicine formed a writing group to review the existing literature on SRC, update its previous position statement,1and address current evidence and knowledge gaps regarding SRC. The absence of definitive outcomes-based data is challenging and requires relying on the best available evidence integrated with clinical experience and patient values. This statement reviews the definition, pathophysiology, and epidemiology of SRC, the diagnosis and management of both acute and persistent concussion symptoms, the short- and long-term risks of SRC and repetitive head impact exposure, SRC prevention strategies, and potential future directions for SRC research. The American Medical Society for Sports Medicine is committed to best clinical practices, evidence-based research, and educational initiatives that positively impact the health and safety of athletes.
Young Age Predicts Acute Pancreatitis Severity in Children
Authors: Galai Tut , Cohen Shlomi , Yerushalmy‐Feler Anat , Weintraub Yael , Moran‐Lev Hadar , Amir Achiya Z. 
Published: February 2019

ABSTRACTObjectives:The course and evolution of pediatric acute pancreatitis (AP) is poorly understood. Prognostication models in children perform poorly and lack consensus. We aimed to identify predictors of AP severity, and the risk for AP recurrence.Methods:We retrospectively studied all patients hospitalized with AP at a single tertiary center, between January 1995 and June 2016. Patient demographics and admission laboratory data were assessed for severity and recurrence prediction.Results:A total of 68 patients accounting for a total of 117 (15 moderate‐severe) AP episodes were reviewed. Patients with moderate‐severe disease were significantly younger (median [interquartile range (IQR)] of 8.3 [4.0–14.4] vs 13.8 [8.1–16.0] years, P = 0.02). Young age at presentation was associated with odds ratio of 3.8 (confidence interval [CI] 1.2–12.1) for children younger than 12 years and 5.8 (CI 1.6–21.4) for children younger than 6 years for developing moderate‐severe disease.Further subanalysis of the 59 patients with first‐time AP episodes, demonstrated younger age (median [IQR] of 5.3 [2.9–10.4] vs 12.0 [6.3–15.8] years, P = 0.03) and elevated white blood cell count (median [IQR] of 22.8 [11.8–31.3] vs 11.0 [8.1–14.6] 109/L, P < 0.01) of patients with moderate‐severe disease, conferring a risk for moderate‐severe disease with odds ratio of 7.5 (CI 1.5–38.2) for children younger than 6 years and 5.3 (CI 1.1–25.4) for patients with white blood cell count >15 × 109/L, respectively. Fourteen (23.7%) of 59 patients with first‐time episodes had recurrent AP. Analysis of the data at the primary episode failed to identify predictors to indicate future recurrence.Conclusions:In our cohort, only young age (<12 years) predicted AP severity. No parameters were identified to predict future development of AP recurrence.