bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and Implementation of a Model for Research, Evidence-Based Practice, Quality Improvement, and Innovation
Authors: Hagle Mary , Dwyer Darcy , Gettrust Lynn , Lusk Dana , Peterson Kristen , Tennies Sherry 
Published: July 2019

Background:
Our medical center nursing council evaluated its current evidence-based practice (EBP) model and decided to consider alternatives.

Problem:
No models were inclusive of major nursing activities, such as EBP and quality improvement (QI) projects and research studies.

Approach:
A model was developed, meeting the criteria of accessibility, ease of use, and reflective of professional practice activities: EBP and QI projects, research studies, and innovation. In the new model, I3 Model for Advancing Quality Patient Centered Care, professional practice is represented by 3 “I's”: Inquiry, Improvement, and Innovation.

Outcomes:
The model provides an algorithm with steps and decision points for nurses to follow based on a question from a clinical issue or problem. The model was approved by nursing-shared governance and is used for guiding relevant projects.

Conclusion:
The I3 Model guides the nurse in inquiry or improvement while supporting a culture of innovation in professional practice.
Meaning of Courtesy and Respect
Authors: Mayfield Elizabeth , Highfield Martha E. F. , Mendelson Sherri 
Published: July 2019

Background:
Treating patients with courtesy and respect has quality, ethical, and fiscal ramifications.

Purpose:
This qualitative study revealed meanings of nurse courtesy and respect as imbedded in nurse and patient stories.

Methods:
Audio-recorded interviews were collected from 15 registered nurses and 17 patients on a medical-surgical unit in a 377-bed, nonprofit, Magnet-recognized facility.

Results:
Six themes related to courtesy and respect emerged during descriptive content analysis by 2 researchers: (1) being attentive (with subthemes taking time, physical care, and proactive engagement); (2) giving empathetic support; (3) honoring culture and beliefs; (4) recognizing the family; (5) recognizing patient space; and (6) recognizing personhood (with subthemes of showing ordinary politeness and recognizing the individual and honoring choices).

Conclusions:
Informants' stories contributed toward a better understanding of what it means to treat patients with courtesy and respect; and they created context for interpreting HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) numerical results. Further research is warranted.
Implementing Clinical Practice Guidelines for Replacing Peripheral Intravenous Catheters
Authors: Oh Jong Hee , Shelly Mark , Nersinger Sharon , Cai Xueya , Olsan Tobie 
Published: July 2019

Background:
A community hospital policy of routinely replacing peripheral intravenous catheters (PIVCs) needed updating to the clinical practice guideline (CPG) of clinically indicated replacement.

Methods:
Guided by Lean principles, a clinical nurse leader (CNL) led a quality improvement small test of change on a 38-bed medical unit. The impact of the CPG was evaluated using quality, safety, and workflow measures.

Results:
Nurses managed 469 inpatients, receiving 1033 PIVCs. Routine PIVC replacement declined from 34% to 3% (P < .001). PIVC dwell time ranged from 4 to 20 days and did not increase phlebitis (P = .41) or catheter-related bloodstream infections. Nurses attributed the improvements in workflow (P = .01) and the quality of patient care (94%) to the updated PIVC guideline.

Conclusions:
Clinically-indicated PIVC replacement reduced unnecessary catheter insertions, maintained patient safety, improved efficiency, and is being implemented hospital-wide. This project highlights and advances the CNL role in transforming healthcare.
Improving Sepsis Bundle Implementation Times
Authors: Threatt David L. 
Published: July 2019

Background:
Early recognition of sepsis in the emergency room (ER) has been shown to improve treatment intervention times and decrease mortality.

Local Problem:
Failure to recognize early signs and symptoms of sepsis in the ER has led to poor sepsis bundle completion times.

Methods:
A comparison of preintervention and postintervention data was performed to determine whether sepsis bundle implementation times, mortality, and length of stay (LOS) improved.

Interventions:
An ER Nurse Sepsis Identification Tool, leadership buy-in from key stakeholders, and systemic inflammatory response syndrome (SIRS) education were implemented.

Results:
Postintervention, average bundle compliance time decreased 458 minutes (P < .001), average antibiotic administration time decreased 101 minutes (P < .001), overall sepsis mortality decreased 5.9% (P = .074), and there was no change to LOS.

Conclusions:
The implementation of an ER early sepsis identification tool, leadership buy-in, and SIRS education can lead to improved bundle implementation times in the ER.
FDG-PET/CT Demonstrates Splenic Angiosarcoma Bone Marrow Metastasis
Authors: Takahashi Hiroaki , Hara Tadashi , Suzuki Hideo , Hashimoto Ryosuke , Minami Manabu 
Published: July 2019

Abstract
Some patients with splenic angiosarcoma initially manifest thrombocytopenia owing to hypersplenism or tumor-related bone marrow fibrosis. The diagnosis of bone marrow metastasis in patients with splenic angiosarcoma is challenging, as the presentation mimics idiopathic thrombocytopenic purpura or primary myelofibrosis. Our case showed diffuse FDG uptake in the vertebral bodies, sacroiliac bone, humerus, femur, and clavicles. It was pathologically diagnosed as bone marrow metastasis of splenic angiosarcoma. We believe that the heterogeneous FDG accumulation in the bone marrow, although nonspecific, can be useful for the diagnosis of the bone marrow metastasis in patients with splenic angiosarcoma.
Diffuse Infiltration of Multiple Myeloma With Initial Manifestation of Cavernous Sinus Syndrome Unveiled by 18F-FDG PET/CT
Authors: Li Chunyan , Shao Fuqiang , Yang Yuhui , Lan Xiaoli 
Published: July 2019

Abstract
Intracranial infiltration is a rare complication of multiple myeloma (MM), which is usually seen in advanced stage. Here, we report a 47-year-old woman with only cavernous sinus syndrome as first manifestation. Brain MR revealed cavernous sinus masses, leptomeningeal nodules, and osseous erosion, which were considered metastases. 18F-FDG PET/CT, which was further performed to identify potential primary lesions, showed increased uptake not only in cavernous sinus and leptomeninges but also in diffuse bone lesions, hepatic nodules, lymph nodes, subcutaneous nodules, and bilateral ovarian masses. Multiple myeloma with intracranial involvement was confirmed by biopsy and cerebrospinal fluid examination.
Detection of Uterine Leiomyosarcoma Peritoneal Lesions by SPECT/CT and ROLL Technique
Authors: Manca Gianpiero , Garau Ludovico Maria , Romanini Antonella , Rubello Domenico , Nuzzo Amedeo , Barbarello Linda , Fantechi Lorenzo , Colletti Patrick M. , Boggi Ugo , Volterrani Duccio 
Published: July 2019

Abstract
We reported the preoperative radio-guided localization of 4 peritoneal metastatic nodules in the case of a 45-year-old woman with uterine leiomyosarcoma. Three lines of chemotherapy were tried, but cardiotoxicity occurred. Within the context of so-called GOSTT (guided intraoperative scintigraphic tumor targeting), preoperative radio-guided localization of peritoneal metastases enabled their subsequent radio-guided excisional biopsy. SPECT/CT allowed for anatomical localization of the hot lesions and generated a 3-dimensional volume-rendering roadmap, facilitating a surgical approach.
Prognostic Value of Pretreatment Radiomic Features of 18F-FDG PET in Patients With Hodgkin Lymphoma
Authors: Lue Kun-Han , Wu Yi-Feng , Liu Shu-Hsin , Hsieh Tsung-Cheng , Chuang Keh-Shih , Lin Hsin-Hon , Chen Yu-Hung 
Published: July 2019

Purpose
This study investigated whether a radiomic analysis of pretreatment 18F-FDG PET can predict prognosis in patients with Hodgkin lymphoma (HL).

Methods
Forty-two patients who were diagnosed as having HL and underwent pretreatment 18F-FDG PET scans were retrospectively enrolled. For each patient, we extracted 450 radiomic features from PET images. The prognostic significance of the clinical and radiomic features was assessed in relation to progression-free survival (PFS) and overall survival (OS). Receiver operating characteristic curve, Cox proportional hazards regression, and Kaplan-Meier analyses were performed to examine the potential independent predictors and to evaluate the predictive value.

Results
Intensity nonuniformity extracted from a gray-level run-length matrix and the Ann Arbor stage were independently associated with PFS (hazard ratio [HR] = 22.8, P < 0.001; HR = 7.6, P = 0.024) and OS (HR = 14.5, P = 0.012; HR = 8.5, P = 0.048), respectively. In addition, SUV kurtosis was an independent prognosticator for PFS (HR = 6.6, P = 0.026). We devised a prognostic scoring system based on these 3 risk predictors. The proposed scoring system further improved the risk stratification of the current staging classification (P < 0.001).

Conclusions
The radiomic feature intensity nonuniformity is an independent prognostic predictor of PFS and OS in patients with HL. We devised a prognostic scoring system, which may be more beneficial for patient risk stratification in guiding therapy compared with the current Ann Arbor staging system.
18F-FDOPA PET Compared With 123I-Metaiodobenzylguanidine Scintigraphy and 18F-FDG PET in Secreting Sporadic Pheochromocytoma
Authors: Lugat Alexandre , Drui Delphine , Mirallié Eric , Kraeber-Bodéré Françoise , Ansquer Catherine 
Published: July 2019

Abstract
We report the case of a 23-year-old man presenting a right hypersecreting pheochromocytoma, falsely negative on 18F-FDG PET/CT and on 123I-metaiodobenzylguanidine (123I-MIBG) scintigraphy but strongly positive on 18F-FDOPA PET/CT. Functional imaging has a key role in diagnosis and prognosis of pheochromocytomas, but choosing the most relevant modality remains difficult. Despite its high specificity, 123I-MIBG has a limited sensitivity. 18F-FDG can be used, but it is an unspecific tracer, and 18F-FDG uptake in brown adipose tissue can hinder the analysis. However, 18F-FDOPA shows very high sensitivity and specificity in pheochromocytomas with fewer drug interferences than 123I-MIBG.
Pediatric Cervicofacial Actinomycosis: Lessons From a Craniofacial Unit
Authors: Glass Graeme E. , Staruch Robert M.T. , Bradshaw Karen , Charles Adrian K. , Stotland Mitchell A. 
Published: July 2019

Abstract
Actinomycosis is a rare disease that remains difficult to diagnose and manage. Prompted by 2 recent cases the authors sought evidence-based conclusions about best practice. A systematic review was conducted using standard PRISMA methodology. The study was registered prospectively (PROSPERO: CRD42018115064). Thirty-three children from 23 series are described. The mean age was 8 years (range 3–17). Fifty-five percent were female. Twenty cases involved bone (usually mandible); 13 cases involved cervicofacial soft tissue. Poor dental hygiene and oral trauma were implicated. The median diagnostic delay was 12 weeks (range 1–156 weeks). The median duration of definitive antibiotic therapy was 17 weeks (range 1–130 weeks). Although diagnostic delay did not correlate with number of surgeries, bony involvement was associated with more procedures (P
= 0.008, unpaired t test). All (6) cases with residual infection had bony involvement (P
= 0.06, Fisher exact test). Neither diagnostic delay nor number of surgeries significantly influenced infection-free outcome which, instead, relies on aggressive surgical debridement and prolonged antibiotic therapy. Mandibular involvement exhibits a higher surgical burden and chronicity in around a third of cases. As dental caries are implicated in mandibular disease, preventative strategies must focus on improving pediatric oral hygiene.
Factors Affecting Prognosis in Patients With Spontaneous Supratentorial Intracerebral Hemorrhage Under Medical and Surgical Treatment
Authors: Akpinar Elif , Gürbüz Mehmet Sabri , Berkman Mehmet Zafer 
Published: July 2019

Abstract
Spontaneous intracerebral hemorrhage (ICH) is a vascular brain disease that causes very high rates of death and disability. Whether surgical or medical treatment is more appropriate is controversial.
The purpose of the study was to examine the morbidity and mortality rates of surgical and medical therapy and their differences in order to determine which patients should be operated.
In our study, the authors selected randomly and evaluated retrospectively 49 patients who were operated in Haydarpaşa Numune Research and Education Hospital Neurosurgery Clinic and 51 patients who received medical therapy at Neurology Clinic for spontaneous supratentorial ICH between January 2007 and December 2011.
The authors documented a detailed history of each patient featuring their neurological examination, Glasgow Coma Scale (GCS), Modified Rankin Disability Scale (MRDS), imaging, age, gender, and history of stroke, hypertension, diabetes mellitus, smoking and alcohol use, aspirin, or coumadin usage.
As a result, the mortality rate found in our study was similar to previous studies (49%). Mortality of patients who underwent surgery (63%) found a higher rate of disability. This is because hematoma of the patients who were operated on larger volumes and diameters, GCS lower than and the higher MRDS scores, higher rates of herniation is connected. The authors concluded that very early operation does not create a difference in treatment between mortality rates. The authors observed that the most important factors for the prognosis of ICH patients whether operated or not are the GCS of patients at the time of arrival to the hospital and the nature of the hematoma.
Evaluation of Vestibular Bone Thickness in Class I Malocclusion Treatment With Corticotomy-Assisted Rapid Orthodontics
Authors: Gonen Zeynep Burcin , Alkan Alper , Ekizer Abdullah , Kutuk Nukhet , Tasdemir Zekeriya 
Published: July 2019

Background:
Corticotomy-assisted rapid orthodontics is a widely used method for speeding up conventional orthodontics. This study (i) evaluates the effects of corticotomy alone, corticotomy combined with bone graft, and corticotomy with platelet-rich fibrin (PRF) on vestibular alveolar bone thickness in patients with class I malocclusion; (ii) compares the treatment time with a conventional orthodontic therapy group, and (iii) investigates the periodontal health of patients who have undergone corticotomy-assisted rapid orthodontics.

Methods:
The patients were divided into 3 groups: Group 1 (n = 10) underwent corticotomy alone; Group 2 (n = 10) underwent corticotomy combined with bone graft, and Group 3 (n = 10) underwent corticotomy combined with PRF. In the following stage, vestibular alveolar bone thicknesses were evaluated using 3-dimensional cone-beam computed tomography images.

Results:
The findings showed that Group 2 achieved a more significant augmentation of the vestibular alveolar bone than Groups 1 and 3 (P = 0.001, P = 0.003), while corticotomy-assisted rapid orthodontics decreased treatment times. Sufficient alveolar bone thickness and preservation of the periodontal health were achieved when the corticotomy procedure was either combined with a bone graft or with PRF in the Class-I malocclusion patients.

Conclusion:
Bone grafts provided better bone thickness at the buccal surface of the anterior teeth of the mandible and maxilla, whereas the thickness of the keratinized gingiva was better with PRF.
Comparison Effects of Platelet-Rich Fibrin on Macrofat and Shuffling Fat Grafting
Authors: Zhai Zhen , Yu Panxi , Huang Minlu , Jin Xiaolei , Yang Xiaonan , Qi Zuoliang 
Published: July 2019

Abstract
Fat acquisition, processing, and grafting techniques are considered to be the main factors affecting the volume retention rate of fat grafting. Shuffling fat (SF) is obtained by refining macrofat (MF), both of which have been applied in autologous fat grafting. However, few studies have focused on comparison effects of platelet-rich fibrin (PRF) on MF and SF grafting. Grafts were prepared by mixing MF and SF with PRF or normal saline at a ratio of 5:1, and grafted into symmetric recipient sites of a mouse's buttock. Grafts were harvested and analyzed at 4, 8, and 12 weeks. Groups containing PRF showed high volume retention rates and microcosmic evaluation scores at each time point compared with the control groups. Although without improved volume retention rate, group of SF containing PRF showed superior microcosmic evaluations compared with group of MF containing PRF. The results demonstrated that both the efficacy of MF and SF grafting can be enhanced by PRF, with even better quality of grafts for the SF grafting.
LncRNA-Ang362 Promotes Pulmonary Arterial Hypertension by Regulating miR-221 and miR-222
Authors: Wang Han , Qin Ruiling , Cheng Yanqin 
Published: July 2019

ABSTRACT

Background:
Pulmonary arterial hypertension (PAH) is a life-threatening cardiopulmonary disorder. LncRNA-Ang362 (lnc-Ang362) regulates miR-221 and miR-222 in vascular smooth muscle cell proliferation, which can lead to PAH. The present study was designed to investigate the function and underlying mechanisms of lnc-Ang362 in PAH.

Methods:
The expression of lnc-Ang362, miR-221, and miR-222 in 15 PAH patients and 10 healthy controls was measured by qRT-PCR. Lnc-Ang362 overexpression vector and siRNA were transfected into human pulmonary arterial smooth muscle cells (HPASMCs), and cell proliferation, migration, and apoptosis rate were assessed. The protein expression of p-p65 and p-IκBα was measured by western blot. MiR-221 or miR-222 inhibitor was cotransfected with lnc-Ang362 overexpression vector into HPASMCs.

Results:
Data from the present study showed significantly increased lnc-Ang362, miR-221, and miR-222 expression in the lung tissues of patients with PAH and in hypoxic HPASMCs. Although overexpression of lnc-Ang362 promoted proliferation and migration of HPASMCs, inhibition of lnc-Ang362 had the opposite effect. In addition, apoptosis of HPASMCs significantly decreased after lnc-Ang362 overexpression and increased after lnc-Ang362 inhibition. Meanwhile, lnc-Ang362 upregulated miR-221 and miR-222 expression and activated the NFκB signaling pathway in HPASMCs. Moreover, miR-221 and the miR-222 inhibitor both attenuated the proliferation and migration effects of lnc-Ang362 and elevated apoptosis in these cells.

Conclusion:
Lnc-Ang362 played an important role in regulating the biological function of HPASMCs by promoting miR-221 and miR-222. Lnc-Ang362 thus may be a novel therapeutic lncRNA candidate for treating PAH.
Myofascial pain syndrome and trigger points: evaluation and treatment in patients with musculoskeletal pain
Authors: Barbero Marco , Schneebeli Alessandro , Koetsier Eva , Maino Paolo 
Published: July 2019

Purpose of review
Myofascial pain syndrome is a chronic pain condition characterized by the presence of myofascial trigger point, a hyperirritable painful spot involving a limited number of muscle fibers. The literature suggest that myofascial trigger points should be considered peripheral pain generators and this critical review will summarize recent findings concerning the clinical evaluation and the treatment of myofascial trigger points.

Recent findings
The clinical features of myofascial trigger points and their contribution to the patient pain and disability have been detailed in several recent studies, which support the clinical relevance of the condition. Recent studies reported that manual palpation to identify MTrPs has good reliability, although some limitations are intrinsic to the diagnostic criteria. During the last decade, a plethora of treatments have been proposed and positive effects on pain and function demonstrated.

Summary
The myofascial trigger point phenomenon has good face validity and is clinically relevant. Clinicians are encouraged to consider the contribution of myofascial trigger points to the patient's pain and disability through a careful medical history and a specific manual examination. Patients with myofascial trigger points will benefit from a multimodal treatment plan including dry needling and manual therapy techniques. Internal and external validity of research within the field must be improved.
Neuropathies and paraproteins
Authors: Lunn Michael P. 
Published: July 2019

Purpose of review
There is an increasingly recognized association between haematological and neurological disease. This is especially true in the peripheral nervous system in which, to an extent, proof of a link is easier to achieve. The most sensitive low level paraprotein detection methods should always be employed in which a paraprotein is suspected. Peripheral nerves can be damaged not only by the immunological targeting of the myelin by the paraprotein, but by deposition (light chain amyloid and cryoglobulins) or direct infiltration (neurolymphomatosis). This has resulted in other defined paraprotein-related disease pathogeneses.

Recent findings
Our opportunities for treating these patients are greater not only through better recognition of disease but also treatments introduced from haematological research. Beyond rituximab, combination therapies, proteasome inhibition and novel biological treatments are being described in haematological practice with early efficacy in neurology. Important developments here should be exploited in neurology to improve outcomes.

Summary
This review of the current literature focuses not only on the long-term outcome studies in anti-myelin-associated glycoprotein neuropathy, but developments in the diagnosis and treatment of monoclonal gammopathy of undetermined significance and Waldenström's Macroglobulinaemia.
New insights on the disease contribution of neuroinflammation in amyotrophic lateral sclerosis
Authors: Chiot Aude , Lobsiger Christian S. , Boillée Séverine 
Published: July 2019

Purpose of review
Amyotrophic lateral sclerosis (ALS) is a degenerative motor neuron disease with a strong neuroinflammatory component. This review summarizes how the connection between neurodegeneration and the immune system is strengthened by new discoveries from ALS genetics and the analysis of subpopulations of immune cells in ALS.

Recent findings
Recent genes identified in ALS encode for proteins with direct immune roles, which when mutated lead to deregulation of immune functions, potentially influencing the disease. Although neuroinflammation in the central nervous system (CNS) of ALS patients has been well documented, new evidence suggests also direct malfunctions of immune cells in the CNS and at the periphery. Although CD4+ T-regulatory lymphocytes are protective in ALS, their number and function are altered over the disease course. CD8+ T cells are detrimental for motor neurons in the CNS but show some protective roles at the periphery. Similarly, the presence of mast cells in muscles of ALS models and patients and impairments of monocyte functions reveal potential new players in ALS disease progression.

Summary
Although motor neuron degeneration is considered the prime event in ALS, dysfunctions in immune processes can impact the disease, highlighting that targeting specific immune components is a strategy for developing biomarkers and ultimately new drugs.