bluuebunny/crossref_metadata_2025_split huggingface dataset:
Estimating the Weight of Children During Simulated Emergency Situations Using the Broselow Tape
Authors: Larose Guylaine , Levy Arielle , Bailey Benoit , Cummins-McManus Barbara , Lebel Denis , Gravel Jocelyn 
Published: September 2018

Objective
The objective of this study was to evaluate whether residents can accurately estimate children's weight using the Broselow tape.

Method
We conducted a preplanned secondary analysis from an experimental trial. Participants were residents in pediatrics, family medicine, and emergency medicine rotating in the ED. Residents were randomly assigned to 2 sets of paired scenarios during 2 sessions. They were asked to estimate the weight of a manikin using the Broselow tape at the beginning of each scenario. The first scenario from the initial session and the last scenario from the second session were used for the current study. The primary analysis was the proportion of participants who accurately estimated manikin weight within a 10% margin of error.

Results
Forty residents were recruited. Thirty-two (80%) reported knowledge of the Broselow tape and 13 (32.5%) reported previous use. Weight estimation was accurate in 60% (24/40; 95% confidence interval [CI], 45%–74%) during the first scenarios. Error in weight estimation differed by greater than 25% in 28% (11/40). Error in estimation was not associated with previous knowledge (odds ratio, 6.2; 95% CI, 0.68–56) or previous use (odds ratio, 0.9; 95% CI, 0.23–3.5) of the Broselow tape. In the last scenario, 88% accurately estimated manikin weight (35/40; 95% CI, 73%–95%).

Conclusions
Although most residents reported knowledge of the Broselow tape, 40% made erroneous weight estimations by at least 10% with the first use in this simulation study. With repeated use, they improved significantly over time. Teaching appropriate use of the Broselow tape should be part of residency-training curricula and pediatric advanced life support course.
Characteristics of Children Cared for by a Physician-Staffed Helicopter Emergency Medical Service
Authors: Enomoto Yuki , Tsuchiya Asuka , Tsutsumi Yusuke , Kikuchi Hitoshi , Ishigami Koji , Osone Junpei , Togo Masahito , Yasuda Susumu , Inoue Yoshiaki 
Published: September 2018

Objectives
The effectiveness of Japanese helicopter emergency medical services (HEMS) and interventions at the scene is not clear as regard children. For effective use of HEMS at the clinical scene, we need to clarify the characteristics of pediatric patients cared for by HEMS. Therefore, the objective of this study was to describe the characteristics of pediatric scene flights and to describe the procedures performed on the patients.

Methods
This was a retrospective cohort study based on the database for children aged younger than 18 years who were cared for by physician-staffed HEMS of Ibaraki prefecture, in Japan. We reviewed the database for air medical transports conducted at our institution from July 2010 to December 2016.

Results
During the 6.5-year period, the Ibaraki HEMS attended to 288 children. The median age of the children was 11 (interquartile range, 5–14) years. Of the total, 196 (68.1%) of the children had trauma-related injuries. The head was the most common site of significant injuries (12.4%). The most common cause of nontrauma incidents was seizure (9.0%). In 65.9% of the patients, the injury or illness was of mild or moderate severity at the scene. An intervention was applied at the scene in 76.0% of the cases: 75.1%, intravenous route; 6.9%, intubation; and 13.4%, drug administration. Of those patients, 29.1% were discharged from the emergency department. In-hospital mortality accounted for 1.5% (n = 2) of the cases.

Conclusions
Although the condition at the scene of most of the pediatric patients transported by the physician-staffed HEMS was not severe, an intervention was frequently applied from the scene. Improving the dispatch criteria and monitoring compliance are needed for appropriate use of HEMS.
How Much Cardiopulmonary Resuscitation Does a Pediatric Emergency Provider Perform in 1 Year? A Video-Based Analysis
Authors: Donoghue Aaron , Abbadessa Mary Kate , Hsieh Ting-Chang , Frankenberger Warren , Myers Sage 
Published: September 2018

Objectives
We aimed to quantify time performing chest compressions (CCs) per year of individual providers in a pediatric ED and to project a rate of opportunity for CC based on median clinical hours per provider category.

Methods
This was an observational study of video-recorded resuscitations in a pediatric ED over 1 year. Events where CCs were performed for more than 2 minutes were included. Identification of providers and duration of CCs per provider were determined by video review. Time of CCs was totaled per provider over the study period. Data were expressed as median and interquartile range (IQR). Rate of opportunity for providing CC to a child was calculated by dividing the median clinical hours per year per provider type by the number of CC events per year.

Results
Twenty-three CC events totaling 340 minutes of CCs were analyzed. Chest compressions were performed by 6 (13%) of 45 attending physicians, 3 (25%) of 12 fellows, 32 (22%) of 143 nurses, and 19 (59%) of 32 technicians. The median amount of time performing CC was 182 seconds (IQR, 91–396 seconds); by provider category, median amount of time was as follows: attending physicians, 83 seconds (IQR, 64–103 seconds); fellows, 45 seconds (IQR, 6–83 seconds); nurses, 128 seconds (IQR, 93–271 seconds); and technicians, 534 seconds (IQR, 217–793 seconds). The projected hours needed for an opportunity to perform CCs was 730 hours (91 shifts) for attending physicians, 243 hours (30 shifts) for fellows, and 1460 hours (121 shifts) for nurses and technicians.

Conclusions
Performing CCs on children in the ED is a rare event, with a median of 3 minutes per provider per year. Future studies should determine training methods to optimize readiness for these rare occurrences.
Safety in Hand Surgery: Eliminating Wrong-Site Surgery
Authors: Brown Ronald D. , Hammert Warren C. 
Published: September 2018

Learning Objectives:
After studying this article, the participant should be able to: 1. Understand the definition of wrong-site surgery and what it may encompass. 2. State the causes of wrong-site hand surgery. 3. Give examples of initiatives used to prevent wrong-site surgery. 4. Describe a process to minimize the risk of performing wrong-site surgery.

Summary:
Wrong-site surgery remains a problem in our ever-evolving culture of surgical safety, and hand surgeons are at particularly high risk. Broadly speaking, wrong-site surgery is a procedure performed at an incorrect anatomical site. In hand surgery, this includes errors in laterality, wrong digit(s), wrong procedure(s), or even a failure to complete all indicated procedures. This article examines the scope of this safety issue, the current challenges to preventing wrong-site surgery, and the authors’ proposed solutions to eliminating wrong-site surgery and establishing a culture of safety in hand surgery.
PET/CT Imaging for Solitary Primary Bone Lymphoma of Thoracic Vertebra
Authors: Shen Guohua , Su Minggang , Liu Bin , Kuang Anren 
Published: September 2018

Abstract
Primary bone lymphoma without classic nodal lesions or advanced disease may be mistaken for other osseous diseases, especially when involving a single bone site. In this patient, a series of imaging modalities including MRI, bone scan, and 18F-FDG PET/CT revealed only 1 solitary osseous lytic lesion with abnormal uptake in the third thoracic vertebra, suggesting a primary skeletal malignancy. The subsequent histopathologic examination confirmed the diagnosis of diffuse large B-cell lymphoma. After chemotherapy, he achieved an excellent clinical and metabolic response.
Uptake of Prostate-Specific Membrane Antigen–Targeted 18F-DCFPyL in Cerebral Radionecrosis
Authors: Salas Fragomeni Roberto A. , Pienta Kenneth J. , Pomper Martin G. , Gorin Michael A. , Rowe Steven P. 
Published: September 2018

Abstract
Recent PET imaging of glioblastoma multiforme and other high-grade gliomas using prostate-specific membrane antigen (PSMA)–targeted small-molecule radiotracers suggests a role for these agents in diagnostic imaging of recurrent/residual tumor and that PSMA-targeted endoradiotherapies may provide a new approach to therapy for patients with these difficult-to-treat tumors. We present a case of cerebral radionecrosis demonstrating PSMA-targeted radiotracer uptake. Our findings may represent a potential pitfall and limitation to the diagnostic application of PSMA-targeted agents for high-grade gliomas.
Pedicled Flaps Versus Free Flaps for Back Reconstruction
Authors: Komagoe Sho , Watanabe Toshiyuki , Komatsu Seiji , Kimata Yoshihiro 
Published: September 2018

Background
Back reconstructions using a flap are relatively rare, and clinical reports on such reconstructions are few. We analyzed whether a pedicled flap or free flap was best for treating back defects and established a simplified algorithm for flap selection.

Methods
We retrospectively analyzed the cases of 22 patients who underwent flap reconstructions for the back between July 2000 and August 2016. We extracted data on the operative time, defect size, patients' height and body weight, and reoperation, and each defect size was calculated as a percentage in relation to the body surface area (BSA). We compared these values between both flap types using univariate analysis. In addition, reconstructions using pedicled flaps were classified as single pedicled flap and combination pedicled flap reconstructions. The reasons for reoperation were also reviewed.

Result
Seventeen patients underwent reconstructions using pedicled flaps, and 5 patients underwent reconstructions using free flaps. The operative time and the percentage of defect size in relation to the BSA were significantly lower when using pedicled flaps than when using free flaps (P = 0.002, P = 0.046, respectively). There was no significant difference in terms of the rate of reoperation (P = 0.16) between the 2 types of reconstructions. The operative time was also significantly shorter when using combination pedicled flaps than when using free flaps. However, there was no significant difference in terms of the percentage of defect size in relation to the BSA between combination pedicled flaps and free flaps. Reoperation was necessary because of flap necrosis in pedicled flaps and skin graft necrosis in free flaps.

Conclusions
Our results demonstrated that pedicled flaps should be the first choice for back reconstruction, independent of the defect size, reoperation rate, and reason for reoperation. This is because the operation time required is significantly lower, which benefits patients and surgeons. Free flaps can be used when pedicled flaps cannot be used efficiently.
Skin-Reducing Mastectomy and Direct-to-Implant Breast Reconstruction With Submuscular-Dermal-Mesh Pocket
Authors: Bonomi Stefano , Sala Laura , Gennaro Massimiliano , Ricci Cristian , Cortinovis Umberto 
Published: September 2018

Background
Despite skin-sparing mastectomy techniques have significantly improved reconstructive options and aesthetic outcomes, patients with large and ptotic breasts remain a challenging group to treat satisfactorily. The Wise-pattern skin-reducing mastectomy (SRM) has been designed for this kind of patients but is not without morbidity. To improve safety, the authors reviewed their experience with a modified SRM and immediate 1-stage implant-based breast reconstruction, using a synthetic absorbable mesh combined with a dermal flap.

Methods
A retrospective review was undertaken to identify women with medium to large ptotic breast and medium minimally ptotic breast who had undergone SRM and direct-to-implant breast reconstruction using definitive anatomical gel implant, de-epithelialized dermal flap, and absorbable synthetic mesh, between October 2014 and December 2016. Patient demographics were queried, and complication rates, aesthetic outcomes, and patients satisfaction were assessed.

Results
Sixty-two procedures of SRM were performed in 56 patients. Forty-five women received contralateral symmetrization. Twenty-one overall complications occurred in 16 patients. Statistical correlation between risk factors and complications onset was assessed. Body mass index resulted the most substantial risk factor (P = 0.0028) for developing complications, whereas preoperative chemotherapy (P = 0.0050) and comorbidities (P = 0.0117) played a decent role. Smoking attitude (P = 0.1122), age (P = 0.9990), and implant weight (P = 0.1583) did not result as significant risk factors. The reconstructive outcomes were good to excellent in 92.8%, with patient satisfaction ranking very to highly satisfied in 84%.

Conclusions
The authors' series suggests that SRM with direct-to-implant breast reconstruction can be easily performed when an appropriate SRM pattern is designed, providing complete implant coverage with submuscular-dermal-mesh pocket.
US FDA Breast Implant Postapproval Studies
Authors: Coroneos Christopher J. , Selber Jesse C. , Offodile Anaeze C. , Butler Charles E. , Clemens Mark W. 
Published: September 2018

Objective:
To analyze the long-term safety and efficacy outcomes of patients with breast implants.

Summary Background Data:
Research is ongoing regarding the safety of silicone breast implants. Despite the number of patients with breast implants followed by United States Food and Drug Administration large postapproval studies (LPAS), this database has not been thoroughly analyzed or reported.

Methods:
This is a multicentered, cohort study. LPAS prospectively monitor long-term implant-related outcomes and systemic harms for silicone/saline implants from 2 manufacturers (Allergan and Mentor) placed for primary/revision augmentation/reconstruction. Systemic harms, self-harm, and reproductive outcomes are compared with normative data. Implant-related complications are analyzed by implant composition and operative indication in the short and long terms.

Results:
LPAS data includes 99,993 patients, 56% of implants were silicone for primary augmentation. Long-term magnetic resonance imaging surveillance is under 5%. Compared with normative data, silicone implants are associated with higher rates of Sjogren syndrome (Standardized incidence ratio [SIR]8.14), scleroderma (SIR 7.00), rheumatoid arthritis (SIR5.96), stillbirth (SIR4.50), and melanoma (SIR3.71). One case of BI-ALCL is reported. There is no association with suicide. In the short term, rupture is higher for saline (2.5% vs. 0.5%, P < 0.001), and capsular contracture higher for silicone (5.0% vs. 2.8%, P < 0.001). At 7 years, reoperation rate is 11.7% for primary augmentation, and 25% for primary/revision reconstruction. Capsular contracture (III/IV) occurs in 7.2% of primary augmentations, 12.7% primary reconstructions, and is the most common reason for reoperation among augmentations.

Conclusions:
This is the largest study of breast implant outcomes. Silicone implants are associated with an increased risk of certain rare harms; associations need to be further analyzed with patient-level data to provide conclusive evidence. Long-term safety and implant-related outcomes should inform patient and surgeon decision-making when selecting implants.
Patient-Initiated Telephone Calls in the Postoperative Period After Female Pelvic Reconstructive Surgery
Authors: Ramaseshan Aparna S. , LaSala Christine , O’Sullivan David M. , Steinberg Adam C. 
Published: September 2018

Objective
The aim of this study was to evaluate reasons and factors associated with patient calls in the postoperative period after female pelvic medicine and reconstructive surgery.

Methods
A retrospective review using electronic medical records was performed on consecutive patients who underwent surgery within our academic female pelvic medicine and reconstructive surgery practice during a 6-month period. Calls after postoperative discharge until first scheduled postoperative visit were included. Reasons and number of calls were tabulated. Clinical and surgical factors were extracted. Continuous data were evaluated with a Student t test or analysis of variance; categorical data were evaluated with a χ2 test. P < 0.05 was considered significant.

Results
During the designated period, 302 patients underwent surgery, and 173 (57.3%) patients made 345 calls (mean ± SD, 2.0 ± 1.5 calls). Reasons were categorized under 6 distinct domains: bowel, pain, activity, medication regimen, urinary, and bleeding. The most frequent concern within each domain was constipation (11.6%), abdominal pain (6.4%), physical activity (8.7%), pain regimen (14.5%), urinary catheter related (13.3%), and vaginal bleeding (12.1%), respectively. A greater number of phone calls were recorded among patients discharged home with catheters (P = 0.015), and patients who underwent posterior colporrhaphy (P = 0.005) and retropubic urethropexy (P = 0.014). Patients discharged with home nursing (11, 6.4%) demonstrated a significantly higher number of phone calls (3.8 ± 2.5, P < 0.001). Evaluations were required for 37% of callers. Twelve patients were seen in the emergency department, of whom 3 (1.7%) were readmitted to the hospital.

Conclusions
Postoperative patient-initiated telephone calls after pelvic reconstructive surgery are common. Bowel-, urinary-, and medication-based phone calls account for the highest frequency and volume.
Evaluation of Urine Choline Levels in Women With and Without Overactive Bladder Syndrome
Authors: Sheyn David , Hijaz Adonis K. , Hazlett Fred E. , Dawodu Konyinsola , El-Nashar Sherif , Mangel Jeffrey M. , Petrikovets Andrey , Mahajan Sangeeta T. 
Published: September 2018

Objective
The objective of this study was to determine whether levels of choline (Ch) differ in women with and without overactive bladder (OAB) symptoms.

Methods
New patients were evaluated using the overactive bladder symptom score; Medical, Epidemiologic, and Social Aspects of Aging (MESA) urgency incontinence questionnaire; and Impact Questionnaire 7 and provided a urine sample. Patients were stratified into asymptomatic controls, scoring 0 on overactive bladder symptom score and the MESA questionnaire, and patients with OAB and urgency incontinence (OAB-wet). Patients with conditions predisposing to OAB or had a history of OAB treatment were excluded. Choline detection was accomplished using a commercially available kit. Wilcoxon rank sum test and Fisher exact test were used to express differences between groups. Spearman ρ correlation was used to determine the relationship between Ch and questionnaire scores. Logistic regression was used to identify significant variables associated with OAB.

Results
Sixty-three women were included in the final analysis. Patients with OAB-wet were older (P = 0.001), more likely to be obese (P = 0.04), had greater apical descent (P = 0.02), were more likely to be postmenopausal (P = 0.01), and were more likely to have stress incontinence (P = 0.005). Choline was 34.8% lower in OAB compared with the controls (P = 0.014). Lower Ch levels were associated with higher MESA (Spearman ρ = −0.311, P = 0.03). After logistic regression, lower Ch (adjusted odds ratio [aOR], 0.97; 95% confidence interval [CI], 0.96–0.98), age (aOR, 1.12; 95% CI, 1.08–1.18), and body mass index (aOR, 1.09; 95% CI, 1.01–1.18) were significantly associated with OAB-wet.

Conclusions
Choline levels are significantly decreased in women complaining of OAB with urgency incontinence, and lower levels are associated with higher MESA scores.
Health-related quality of life in children after burn injuries: A systematic review
Authors: Spronk Inge , Legemate Catherine M. , Polinder Suzanne , van Baar Margriet E. 
Published: September 2018

BACKGROUND
Through improved survival of burns, more children have to deal with consequences of burns. Health-related quality of life (HRQL) measurement is important to qualify the perceived burden of burns in children. No systematic study of this outcome in children exists. Therefore, our objective was to review study designs, instruments, methodological quality, outcomes, and predictors of HRQL in children after burns.

METHODS
A systematic literature search was conducted in CINAHL, Embase, Google Scholar, Medline, The Cochrane library, and Web of science (PROSPERO ID, CRD42016048065). Studies examining HRQL in pediatric burn patients were included. The risk of bias was assessed using the Quality in Prognostic Studies (QUIPS) tool.

RESULTS
Twenty-seven studies using 12 HRQL instruments were included. The Burns Outcome Questionnaire aged 0 to 4 and 5 to 18 years were most often applied. All longitudinal studies showed improvement of HRQL over time. However, problems were reported on the longer term on the domains “(parental) concern” and “appearance.” Parental proxy scores were in general comparable to children's self-ratings. Severity of burns, facial burns, hand burns, comorbidity, and short time since burn predicted an impaired HRQL. The risk of bias of the studies was, in general, moderate.

CONCLUSION
Health-related quality of life in children after burns increases over time. Domains and patient groups that require special attention are identified. However, due to lack of comparability of studies, the available information could not be used optimally. To further improve our understanding of HRQL, consensus on design, data-analysis, and data presentation are needed.

LEVEL OF EVIDENCE
Systematic review, level III.
Neurophysiological Evidence of Motor Network Reorganization in Myotonic Dystrophy Type 1: A Pilot Magnetoencephalographic Study
Authors: Formaggio Emanuela , Del Felice Alessandra , Turco Cristina , Cudia Paola , Baba Alfonc , Bevilacqua Francesca , Masiero Stefano , Piccione Francesco 
Published: September 2018

Purpose:
Myotonic dystrophy type 1 is the most common muscular dystrophy in adults. Although brain involvement is well recognized, the relationship between cortical motor control and voluntary movement has not been sufficiently explored. This study aims at assessing magnetoencephalographic (MEG) rhythms at oscillatory and connectivity levels to map central motor control.

Methods:
Magnetoencephalographic data were acquired from healthy subjects and five myotonic dystrophy type 1 subjects during resting state and foot movement. Resting state EEG band power, event-related desynchronization/synchronization, functional connectivity, and network features (node strength and betweenness centrality) were estimated. A statistical comparison of these indexes between the two groups was run; a linear correlation between event-related desynchronization and motor performance was obtained.

Results:
Myotonic dystrophy type 1 subjects showed higher theta power over central motor regions and lower beta power over frontal areas, with a decrease of beta node strength over the dominant hemisphere and an increase of betweenness centrality over the vertex. Foot movement in the most impaired myotonic dystrophy type 1 subjects was inefficient in evoking event-related desynchronization. In less severely impaired participants, dominant foot movement was related to a bilateral sensorimotor event-related desynchronization.

Conclusions:
Results provide proof of a central dysfunction of movement. Identification of neurophysiological motor patterns in myotonic dystrophy type 1 could provide a guide for tailored therapy.