bluuebunny/crossref_metadata_2025_split huggingface dataset:
Proactive Psychiatry Intervention Using a Nurse-Led Behavioral Response Model for Hospitalized Patients With Behavioral Disturbances
Authors: Afriyie-Boateng Mavis , Loftus Carla , Wiesenfeld Lesley , Hunter Meghan , Lawson Andrea 
Published: June 2019

ABSTRACT

Background:
The health care sector has one of the highest rates of workplace violence, putting staff at risk and impeding care. To deliver quality health care, staff need targeted resources. This article describes a program to improve staff safety and reduce barriers to care for patients with behavioral disturbances.

Program Description:
A nurse-led behavioral response team was created to identify high-risk patients and offer prompt targeted interventions. The Behavioral Optimization and Outcomes Support Team (BOOST) was implemented in November 2012, in conjunction with a proactive model of care, enabling psychiatric intervention. Advanced practice nurses in psychiatry respond to requests from staff on medical/surgical units to assist with management of behavioral disturbances.

Methods:
Consultation and intervention data were reviewed, and staff satisfaction surveys were completed to evaluate the program.

Results:
The program has contributed to staff feeling more supported and safer at work. There has also been a reduction in staff's experience of perceived burden in the care of patients with behavioral disturbances although they are caring for more of these patients.

Conclusions:
Although violence risk in health care continues to be a significant issue, programs to intervene early can be effective in supporting staff to minimize these risks.
Interfacility patient transfers in Lebanon—A culture-changing initiative to improve patient safety and outcomes
Authors: El Sayed Mazen , El Sibai Rayan , Bachir Rana , Khalil Diana , Dishjekenian Maggy , Haydar Lili , Aguehian Rosanne , Mouawad Ramzi 
Published: June 2019

Abstract
Organizing interfacility transfers is an essential component of regionalized care to improve patient outcomes. This study examines transfer characteristics after establishing a transfer center in a tertiary care center in Beirut Lebanon, and identifies predictors of success in patient transfers.
This retrospective observational chart review examined all transfer center requests to and from the tertiary care center over a 4-year period (2013–2017). Descriptive analysis was done, followed by a bivariate analysis comparing transfers based on final decision (accepted yes/no) and by a multivariate logistic regression to identify predictors of successful transfers.
A total of 4100 transfer requests were analyzed. Incoming transfer requests were more common than outgoing requests (56.5% vs 43.4%) and were mainly for adult patients (71.0% incoming and 78.7% outgoing). Reasons of transfers were mostly medical (99.4%) for incoming transfers and financial (73.1%) and medical (17.9%) for outgoing transfers. Requested level of care was most commonly intensive care unit for incoming transfers (61.6%) and regular floor for outgoing transfers (48.6%). Outgoing transfers were more successful than incoming transfers (59.9% vs 39.6%). Predictors of success in patient transfers within the healthcare system were identified: These included specific types of financial coverage, diagnoses, levels of care, and medical services for incoming transfers in addition to age groups and receiving hospital location for outgoing transfers.
Transfer centers can be implemented successfully in any healthcare system to improve patient care and safety. Identifying facilitators and barriers to successful transfers can help healthcare administrators and policymakers address gaps in the system and improve access to care.
Effects of probucol on contrast-induced acute kidney injury in patients undergoing percutaneous coronary intervention
Authors: Wang Yong , Shi Yun , Xu Xuesheng , Ge Wenkun , Yang Shuo , Lu Chengzhi 
Published: June 2019

Abstract

Objective:
This study was performed to explore the effects of probucol on contrast-induced acute kidney injury (CIAKI) in patients with coronary heart disease undergoing percutaneous coronary intervention (PCI).

Methods:
In total, 220 patients undergoing PCI were randomly assigned to either the control group (hydration from 12 hours before to 12 hours after contrast administration; n = 110) or the probucol group (hydration plus probucol 500 mg twice daily 1 day before and 3 days after the operation; n = 110). The primary endpoint was the occurrence of serum creatinine (Scr)-based CIAKI, defined as an absolute increase in Scr by 0.5 mg/dl (44.2 μmol/L) or a relative 25% increase from baseline within 48 to 72 hours after exposure to contrast medium. The secondary outcomes were composite variations in Scr, blood urea nitrogen (BUN), creatinine clearance rate (Ccr) within 48 to 72 hours, and major adverse events during hospitalization or the 7-day follow-up period after PCI.

Results:
The overall incidence of Scr-based CIAKI was 7.3% (16/220): 5.5% (6/110) in the control group and 9.1% (10/110) in the probucol group (χ2 = 1.078, P = .298). There were no significant differences in the occurrence rate of major adverse events during hospitalization or the 7-day follow-up period after PCI between the groups. Multivariate logistic regression analysis showed that probucol was not an independent protective factor for CIAKI (odds ratio, 1.825; 95% confidence interval, 0.639–5.212; P = .261). However, hydration was an independent protective factor (odds ratio, 0.997; 95% confidence interval, 0.995–0.999; P = .004).

Conclusion:
Probucol cannot effectively reduce the incidence of CIAKI through its anti-inflammatory and antioxidative stress effects.
Blood and cerebrospinal fluid characteristics in neonates with a suspected central nervous system infection
Authors: de Blauw Dirkje , Bruning AHL , Vijn LJ , Wildenbeest JG , Wolthers KC , Biezeveld MH , van Wermeskerken Anne-Marie , Nauta Femke , Pajkrt Dasja 
Published: June 2019

Abstract
Clinical signs and symptoms of central nervous system (CNS) infections in neonates are often nonspecific. Therefore, cerebrospinal fluid (CSF) analysis is performed to diagnose CNS infections. Data on combined microbiological results and their correlation with biochemical characteristics in CSF and blood in infants younger than 90 days are limited. This study provides an overview of microbiological test results, CSF- and hematological characteristics among infants with a clinically suspected CNS infection.
This retrospective study included infants younger than 90 days, with a clinically suspected CNS infection who underwent a diagnostic lumbar puncture between January 2012 and January 2014. Data on the presence of microbiological pathogens in CSF, CSF inflammation markers (white blood cell [WBC] counts, protein levels and glucose CSF/serum ratio) and blood inflammatory responses (WBC count, C-reactive protein [CRP], neutrophil percentage) were collected by reviewing patient files.
We included data from 576 infants (median age 12.5 days, interquartile range, 6–27 days) of whom 383 (66.5%) were born prematurely. In total, 16 bacterial pathogens (3.0%) and 21 viruses (5.5%) were detected in CSF. Escherichia coli was detected in 5 cases (1.0%), Enterovirus was detected in 12 cases (3.1%). Leucocytosis in CSF was associated with identification of a pathogen in CSF. Increased CRP was associated with the identification of a bacterial pathogen in CSF.
Bacterial or viral pathogens were only identified in a small proportion of infants with a clinically suspected CNS infection. Leucocytosis in CSF was associated with CNS infection in infants. An increased CRP was indicative of bacterial meningitis.
Spectral CT in patients with acute thoracoabdominal bleeding—a safe technique to improve diagnostic confidence and reduce dose?
Authors: Kahn Johannes , Fehrenbach Uli , Böning Georg , Feldhaus Felix , Maurer Martin , Renz Diane , Streitparth Florian 
Published: June 2019

Abstract
Computed tomography (CT) protocols for the detection of bleeding sources often include unenhanced CT series to distinguish contrast agent extravasation from calcification. This study evaluates whether virtual non-contrast images (VNC) can safely replace real non-contrast images (RNC) in the search for acute thoracoabdominal bleeding and whether monoenergetic imaging can improve the detection of the bleeding source.
The 32 patients with active bleeding in spectral CT angiography (SCT) were retrospectively analyzed. RNC and SCT series were acquired including VNC and monoenergetic images at 40, 70, and 140 keV. CT numbers were measured in regions of interest (ROIs) in different organs and in the bleeding jet for quantitative image analysis (contrast-to-noise ratios [CNR] and signal-to-noise ratio [SNR]). Additionally, 2 radiologists rated detectability of the bleeding source in the different CT series. Wilcoxon rank test for related samples was used.
VNC series suppressed iodine sufficiently but not completely (CT number of aorta: RNC: 33.3±12.3, VNC: 44.8 ± 9.5, P = .01; bleeding jet: RNC: 43.1 ± 16.9, VNC: 56.3 ± 16.7, P = .02). VNC showed significantly higher signal-to-noise ratios than RNC for all regions investigated. Contrast-to-noise ratios in the bleeding jet were significantly higher in 40 keV images than in standard 140 keV images. The 40 keV images were also assigned the best subjective ratings for bleeding source detection.
VNC can safely replace RNC in a CT protocol used to search for bleeding sources, thereby reducing radiation exposure by 30%. Low-keV series may enhance diagnostic confidence in the detection of bleeding sources.
Reliability and validity of the mandarin version of the tinnitus primary function questionnaire
Authors: Lu Tao , Liu Jie-Hai , Li Gang , Xiang Ting , Ma Ying , Zhong Juan , Chen Jia-Mei , He Yu-Rui , Huang He-Mei , Zhang Zong-Yun , Liu Pan , Zheng Yun 
Published: June 2019

Abstract
Tinnitus is a prevalent condition among different populations. As the nature of tinnitus is subjective, self-reported measures have been validated and utilized to assess psychometric properties of tinnitus patients. Without exception, Chinese clinicians have administered these measures to patients in mainland China after cross-cultural adaptation. However, shortcomings of these Mandarin measures limited the widespread use of them. Measures which can be fully adapted to the context of Chinese tinnitus patients are still needed. The objective of this study was to evaluate the reliability and validity of the Mandarin Tinnitus Primary Function Questionnaire (TPFQ-M) in a Chinese population.
In this observational questionnaire study, we recruited 350 subjects with primary tinnitus from hearing clinics of West China Hospital and administered the TPFQ-M, Mandarin Tinnitus Handicap Inventory (THI-M), and a systematic hearing test battery.
The subjects finished the TPFQ-M within 3 minutes. Exploratory and confirmatory factor analyses demonstrated that a 4-factor model was close to fit. The Cronbach alpha of TPFQ-M was 0.925, and test-retest reliability was reasonable with a 7-day test interval (ICC = 0.857, P < .001; 95% CI: 0.764–0.915). Test-retest reliabilities of subdomains were not parallel to each other, with 0.612 for Emotion, 0.766 for Sleep, 0.860 for Concentration, and 0.897 for Hearing. The convergent validity of TPFQ-M compared to the THI-M was moderate (r = 0.705, P < .001; 95% CI: 0.647–0.754).
The TPFQ-M, which shows high internal consistency and good factor structure, is simple and relatively easy to administer in busy clinics. Additional in-depth research involving multiple centers in mainland China is warranted.
Application of deep learning (3-dimensional convolutional neural network) for the prediction of pathological invasiveness in lung adenocarcinoma
Authors: Yanagawa Masahiro , Niioka Hirohiko , Hata Akinori , Kikuchi Noriko , Honda Osamu , Kurakami Hiroyuki , Morii Eiichi , Noguchi Masayuki , Watanabe Yoshiyuki , Miyake Jun , Tomiyama Noriyuki 
Published: June 2019

Abstract
To compare results for radiological prediction of pathological invasiveness in lung adenocarcinoma between radiologists and a deep learning (DL) system.
Ninety patients (50 men, 40 women; mean age, 66 years; range, 40–88 years) who underwent pre-operative chest computed tomography (CT) with 0.625-mm slice thickness were included in this retrospective study. Twenty-four cases of adenocarcinoma in situ (AIS), 20 cases of minimally invasive adenocarcinoma (MIA), and 46 cases of invasive adenocarcinoma (IVA) were pathologically diagnosed. Three radiologists of different levels of experience diagnosed each nodule by using previously documented CT findings to predict pathological invasiveness. DL was structured using a 3-dimensional (3D) convolutional neural network (3D-CNN) constructed with 2 successive pairs of convolution and max-pooling layers, and 2 fully connected layers. The output layer comprises 3 nodes to recognize the 3 conditions of adenocarcinoma (AIS, MIA, and IVA) or 2 nodes for 2 conditions (AIS and MIA/IVA). Results from DL and the 3 radiologists were statistically compared.
No significant differences in pathological diagnostic accuracy rates were seen between DL and the 3 radiologists (P >.11). Receiver operating characteristic analysis demonstrated that area under the curve for DL (0.712) was almost the same as that for the radiologist with extensive experience (0.714; P = .98). Compared with the consensus results from radiologists, DL offered significantly inferior sensitivity (P = .0005), but significantly superior specificity (P = .02).
Despite the small training data set, diagnostic performance of DL was almost the same as the radiologist with extensive experience. In particular, DL provided higher specificity than radiologists.
The impact of level of the American College of Surgeons Committee on Trauma verification and state designation status on trauma center outcomes
Authors: Elkbuli Adel , Dowd Brianna , Flores Rudy , Boneva Dessy , McKenney Mark 
Published: June 2019

Abstract
The American College of Surgeons (ACS) Committee on Trauma (COT) verification and State designation of trauma centers (TCs) into Level 1 or 2 establishes a distinction based on resources, trauma volume, and educational commitment. The ACS COT and individual states each verify TCs to differentiate performance levels. We aim to determine the relationship between ACS and State Level 1 versus 2, and injury-adjusted, all-cause mortality in a national sampling.
TCs were identified by review of the National Sample Program (NSP) from the National Trauma Data Bank (NTDB)—the largest validated trauma database in the nation—of the year 2013. TCs were categorized by ACS or State Level 1 or 2 status, all others were excluded. Adjusted mortality was determined using observed/expected mortality (O/E) ratios, derived by trauma and injury severity score (TRISS) methodology. Chi-squared and t test analyses were used for categorical variables, with a statistical significance defined as P-value <.05.
Of the 94 TCs in the NSP, 67 had ACS and 80 had State designations. There were 38 ACS Level 1 TCs and 29 ACS Level 2. For State designations, there were 45 as State Level 1 and 35 State Level 2. ACS Level 1 TCs had a similar O/E compared with ACS Level 2 verified centers (0.73 vs 0.75, chi-square, P = .36). Level 1 TCs designated by their state, had a similar O/E compared with State Level 2 centers (0.70 vs 0.74, chi-square, P = .08).
Both ACS and State Level 1 and 2 trauma centers performed similarly on injury adjusted, all-cause mortality.
Comparison of curettage and bone grafting combined with elastic intramedullary nailing vs curettage and bone grafting in the treatment of long bone cysts in children
Authors: Zhang Ke , Wang ZhongLiang , Zhang Zheng 
Published: June 2019

Abstract
To compare the efficacy of curettage and bone grafting combined with elastic intramedullary nailing (EIN) vs curettage and bone grafting in the treatment of long bone cysts in children and to clarify the necessity of using EIN in the treatment of bone cysts.
Sixty-two patients were involved in this study from Jan. 2009 to Sept. 2017 (43 males, 19 females; 27 humeri, 35 femurs); the patients were assigned to an EIN group, comprising 30 patients who underwent curettage and bone grafting combined with EIN, or to a non–elastic intramedullary nailing (NEIN) group, comprising 32 patients who underwent curettage and bone grafting alone. The prognosis of the 2 groups was assessed with reference to the standard of Capanna.
No statistically significant differences in sex, age, location, activity, pathological fracture, cyst volume, operative time and intraoperative blood loss were found between the 2 groups (P > .05). The effective rate was 90.0% in the EIN group and 68.8% in the NEIN group, and the difference was statistically significant (P < .05).
Compared to simple curettage and bone grafting, curettage and bone grafting combined with EIN treatment can significantly improve the prognosis of children with bone cysts. It is recommended that EIN be added to bone cyst curettage and bone grafting.
Primary hepatic melanoma
Authors: Ao Weiqun , Wang Jian , Mao Guoqun , Yang Guangzhao , Han Xiaoyu , Jia Yuzhu , Cheng Yougen 
Published: June 2019

Abstract

Rationale:
Malignant melanoma predominantly develops in middle-aged and older adults, most commonly occurring on the skin and rarely on internal organs. Malignant melanoma originating in the liver is extremely rare. Imaging findings of primary hepatic melanoma (PHM) are scarce in relevant literature.

Patient concerns:
The patient was a 69-year-old woman from Zhejiang, China, who was admitted to the hospital because of upper abdominal pain that persisted for >10 days.

Diagnoses:
Computed tomography (CT) findings indicated the presence of a circular low-density shadow of approximately 7.5 × 8.0 cm in the hepatic hilar region. Magnetic resonance imaging (MRI) indicated a heterogeneous solid cystic mass in the hepatic hilar region. The mass exhibited heterogeneous low-signal intensity on a T1-weighted image (T1WI) and slightly higher signal intensity on a T2-weighted image (T2WI). The tumor appeared as multiple irregular strips with high-signal intensity on T1WI and low-signal intensity on T2WI. The diffusion-weighted image revealed increased signal intensity. The tumor continued to be enhanced after enhancement. Clinical data suggested that the tumor was a malignant liver tumor.

Interventions:
The patient underwent a CT guide puncture hepatic biopsy. The tumor was located in the hepatic hilar region adjacent to the large blood vessels and invaded the portal vein. Because a resection was highly risky, conservative treatment was conducted.

Outcomes:
Postoperative pathology and clinical examination confirmed that the tumor was malignant PHM. The patient has been followed up for 6 months. The patient underwent CT reexamination 2 months after conservative treatment, the results of which revealed that the tumor progressed. Multiple lesions were identified; moreover, the tumor size had increased and the tumor had invaded the portal vein and intrahepatic bile duct. The patient was reexamined by CT in another hospital 6 months after conservative treatment. The results revealed peritoneal, omental metastases and multi bone metastases.

Lessons:
To our best knowledge, this is the first reported case of a PHM with complete imaging data, including preoperative CT and MRI examinations and a follow-up CT examination. From compiling the CT and MRI findings of this patient and those of relevant studies, this study can serve as a reference for the preoperative diagnosis and differential diagnosis of PHM.
Auto-Allo Graft Parallel Juxtaposition for Improved Neuroregeneration in Peripheral Nerve Reconstruction Based on Acellular Nerve Allografts
Authors: Boriani Filippo , Savarino Lucia , Fazio Nicola , Pedrini Francesca Alice , Fini Milena , Nicoli Aldini Nicolò , Martini Lucia , Zini Nicoletta , Bernardini Marco , Bolognesi Federico , Marchetti Claudio , Baldini Nicola 
Published: June 2019

Introduction
Nerve repair poses a significant surgical challenge, and much research on this topic for improvement in reconstruction of segmental defects is ongoing. The aims of the study were to reconfirm the accuracy and safety of a previously described nerve decellularization method on a larger experimental population of rabbits, as well as on human nerves, and to establish in vivo the efficacy of a new-concept mixed graft, comprising autologous and acellular nerve allograft components within the same graft.

Methods
Acellular nerve allografts were implanted into tibial nerve defects of 5 rabbits (group A), autografts were implanted, representing the criterion standard, in other 5 animals (group B), and the innovative technique was used in the remaining 5 (group C). Twelve weeks postoperatively, nerve conduction evaluations were performed; animals were euthanatized, and grafts were harvested and morphologically, histomorphometrically, and immunohistochemically analyzed. Eventually, a preliminary in vitro validation of the decellularization method was performed on human nerves from a cadaver.

Results
No clinical adverse effect was revealed during all the experimental times. No tissue reaction was observed, and in all groups, regenerated fascicles and bundles were shown by histology. However, both histology and histomorphometry demonstrated a better regenerative efficiency in group C. The morphological evaluation of the human nerve treated with the novel method showed complete decellularization.

Conclusion
The microsurgical combined model demonstrated a better neuroregeneration than did pure autografts and acellular nerve allografts. The decellularization method seemed effective also on human nerves. Deeper investigations are necessary to further validate and transfer this new encouraging protocol to the clinical arena.
Two-Dimensional Ablation of Apocrine Glands With the Use of Hydrosurgical Treatment of Axillary Osmidrosis
Authors: Wu Michael , Wu Wen-Horng 
Published: June 2019

Abstract
Axillary osmidrosis is a distressing social problem. Topical antiperspirants are only transient solutions. Permanent solutions always need invasive operation. In this study, we evaluated the effectiveness and complications of a minor surgical procedure. From January 2010 to December 2017, 480 patients (376 females and 104 males) whose ages ranged from 8 to 72 years, with an average age of 28 years, were treated for axillary osmidrosis with hydrosurgery (Versajet unit surgical instruments) under local anesthesia on an outpatient basis. Patients were followed for 4 to 80 months with an average of 24 months. The total satisfaction rate was 99.6% (478/480). The patient complication rate was 2.7% (13/480) and the wound complication rate was 1.8% (17/960). There was 2 patient (3 axillae) got recurrent malodor cured with second operation. There were no contracture scars, arm abduction limitation, or any nerve injury in our series. The minor procedure can be an efficient and predictable treatment choice for axillary osmidrosis.