bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence factors and a predictive scoring model for measuring the biochemical response of primary biliary cholangitis to ursodeoxycholic acid treatment
Authors: Chen Jialiang , Xue Dongying , Gao Fangyuan , Tao Le , Li Yuxin , Zhang Qun , Wang Rui , Sun Le , Yang Xue , Liu Yao , Zhu Bingbing , Niu Shuaishuai , Wang Xianbo 
Published: June 2018

AimsThe biochemical response after ursodeoxycholic acid (UDCA) treatment contributes toward predicting the prognosis for primary biliary cholangitis (PBC) patients. This study aimed to establish a score model that can be used for predicting the biochemical response.Patients and methodsA total of 218 patients in the derivation group and 66 patients in the verification group were enrolled. Response endpoints were based on the Barcelona criteria combined with the Paris I criteria. We determined independent factors of the biochemical response by univariate and multivariate analyses. Then, we established a predictive score model on the basis of regression coefficients after adjusted multivariate analyses.ResultsThe median follow-up duration in the derivation and the verification group was 12.9 and 12.2 months, respectively. Multivariate logistic regression analysis after adjusting for sex and age indicated that First-UDCA treatment [odds ratio (OR)=2.543, 95% confidence interval (CI): 1.234–5.240,P=0.011], baseline alanine aminotransferase level (OR=1.265, 95% CI: 1.089–1.471,P=0.002), and baseline total bilirubin level (OR=0.571, 95% CI: 0.420–0.776,P<0.001) were independent factors that influenced the biochemical response in PBC patients after 1 year of UDCA treatment. Therefore, the resulting biochemical response prediction score model represented the sum of the points corresponding to these three variables. The area under the receiver operating characteristic curve of the score model in the derivation group and the verification group was 0.763 (95% CI: 0.701–0.817,P<0.001) and 0.798 (95% CI: 0.681–0.887,P<0.001), respectively.ConclusionWe developed and verified an easy-to-use scoring model for the first time, which showed excellent predictive value for the biochemical response in PBC patients.
Sirolimus for Recurrent Giant Cell Myocarditis After Heart Transplantation: A Unique Therapeutic Strategy
Authors: Patel Apurva D. , Lowes Brian , Chamsi-Pasha Mohammed A. , Radio Stanley J. , Hyden Marshall , Zolty Ronald 
Published: June 2018

Clinical Features:
Giant cell myocarditis (GCM) is a rare and a rapidly progressive disorder with fatal outcomes such that patients often require heart transplantation. We present a case of recurrent GCM in a transplanted patient with a history of Crohn disease requiring a novel therapeutic approach.

Therapeutic Challenge:
After the orthotopic heart transplantation, GCM recurred on aggressive immunosuppression over the months, which included corticosteroids, basiliximab, tacrolimus, antithymocyte globulin, and rituximab. Although combination immunosuppressive therapy containing cyclosporine and 2–4 additional drugs including corticosteroids, azathioprine, mycophenolate mofetil, muromonab, gammaglobulin, or methotrexate have shown to prolong the transplant-free survival by keeping the disease under control, its role in preventing and treating recurrence posttransplantation is unclear.

Solution:
We added sirolimus, a macrolide antibiotic, with properties of T- and B-lymphocyte proliferation inhibition on the above immunosuppressive treatment postrecurrence of GCM. After sirolimus initiation and continuation, the patient has remained disease free.
Collaborative Rural Nurse Peer Review
Authors: Drobny Stephanie D. , Snell Amy , Morris Lisa , Harshbarger Cathy , Village Pat , Fischer Shelly A. 
Published: June 2018

Background:
Peer review is an essential element of professional nursing practice.

Local Problem:
Implementing nursing practice peer review is a challenge in any organization; some characteristics of small and rural hospitals can make the task especially daunting.

Methods:
A team of nursing leaders and staff nurses from rural and critical access hospitals within 1 health care system was formed to make recommendations about implementing nursing practice peer review in the small rural facilities. Barriers included limited numbers of nurse reviewers by nursing specialty and inherent bias of reviewers due to personal knowledge of cases and nurses involved.

Interventions:
A collaborative rural nursing practice peer review council was created, with staff nurse and leader representation from 6 geographically distinct facilities.

Results:
The rural collaborative council has developed processes for case referral, reviewer assignment, investigation, and scoring founded on Just Culture principles. Satisfaction among staff nurses, reviewers, and Chief Nursing Officers has been high.

Conclusions:
Barriers to implementation of nursing practice peer review in rural hospitals can be mitigated through a collaborative approach, resulting in efficient and effective processes for small, rural, and geographically distinct hospitals.
Decreasing Wait Times and Increasing Patient Satisfaction
Authors: Godley Mary , Jenkins Jeanne B. 
Published: June 2018

Background:
Patient satisfaction scores in the vascular interventional radiology department were low, especially related to wait times in registration and for tests/treatments, with low scores for intentions to recommend.

Purpose:
The purpose of our quality improvement project was to decrease wait times and improve patient satisfaction using Lean Six Sigma's define, measure, analyze, improve, and control (DMAIC) framework with a pre-/postintervention design.

Results:
There was a statistically significant decrease in wait times (P < .0019) and an increase in patient satisfaction scores in 3 areas: registration wait times (from 17 to 99 percentiles), test/treatment (from 19 to 60 percentiles), and likelihood to recommend (from 6 to 97 percentiles).

Conclusions:
Lean Six Sigma was an effective framework for use in decreasing wait times and improving patient satisfaction.
Perspectives on Patient and Family Engagement With Reduction in Harm
Authors: Schenk Elizabeth C. , Bryant Ruth A. , Van Son Catherine R. , Odom-Maryon Tamara 
Published: June 2018

Background:Despite continued efforts to improve safety in hospitals, hospital-acquired harm persists. Strategies have been identified to establish patient-centered care and improve patient engagement with care. However, the relationship of patient and family engagement to reduction of harm is not well understood, with limited findings available in current literature.Purpose:This qualitative study explored the perceptions and attitudes of patients and family members and several clinical disciplines toward patient engagement in reducing preventable harm in hospitalized patients.Methods:We conducted 8 focus groups at 2 nonprofit hospitals with several constituencies: patients/families, registered nurses, physician hospitalists, and pharmacists/physical therapists.Results:Thematic analysis of transcripts revealed multiple themes from different perspectives, including: family presence increases safety, the hospital environment is intimidating, and communication is essential, but I am not being heard.Conclusions:The rich data suggest a significant opportunity for reducing risk and harm by more actively engaging patients and families in the effort. Increasing patient acuity and complexity of care furthers the need for partnering with patients and families more intentionally for increased safety.
Association of Nurse Engagement and Nurse Staffing on Patient Safety
Authors: Brooks Carthon J. Margo , Hatfield Linda , Plover Colin , Dierkes Andrew , Davis Lawrence , Hedgeland Taylor , Sanders Anne Marie , Visco Frank , Holland Sara , Ballinghoff Jim , Del Guidice Mary , Aiken Linda H. 
Published: June 2018

Background:
Nurse engagement is a modifiable element of the work environment and has shown promise as a potential safety intervention.

Purpose:
Our study examined the relationship between the level of engagement, staffing, and assessments of patient safety among nurses working in hospital settings.

Methods:
A secondary analysis of linked cross-sectional data was conducted using survey data of 26 960 nurses across 599 hospitals in 4 states. Logistic regression models were used to examine the association between nurse engagement, staffing, and nurse assessments of patient safety.

Results:
Thirty-two percent of nurses gave their hospital a poor or failing patient safety grade. In 25% of hospitals, nurses fell in the least or only somewhat engaged categories. A 1-unit increase in engagement lowered the odds of an unfavorable safety grade by 29% (P < .001). Hospitals where nurses reported higher levels of engagement were 19% (P < .001) less likely to report that mistakes were held against them. Nurses in poorly staffed hospitals were 6% more likely to report that important information about patients “fell through the cracks” when transferring patients across units (P < .001).

Conclusions:
Interventions to improve nurse engagement and adequate staffing serve as strategies to improve patient safety.
False Alarms and Overmonitoring
Authors: Simpson Kathleen Rice , Lyndon Audrey 
Published: June 2018

Background:
Nurses can be exposed to hundreds of alarms during their shift, contributing to alarm fatigue.

Purpose:
The purposes were to explore similarities and differences in perceptions of clinical alarms by labor nurses caring for generally healthy women compared with perceptions of adult intensive care unit (ICU) and neonatal ICU nurses caring for critically ill patients and to seek nurses' suggestions for potential improvements.

Methods:
Nurses were asked via focus groups about the utility of clinical alarms from medical devices.

Results:
There was consensus that false alarms and too many devices generating alarms contributed to alarm fatigue, and most alarms lacked clinical relevance. Nurses identified certain types of alarms that they responded to immediately, but the vast majority of the alarms did not contribute to their clinical assessment or planned nursing care.

Conclusions:
Monitoring only those patients who need it and only those physiologic values that are warranted, based on patient condition, may decrease alarm burden.
Impacting the Patient's Experience in a Children's Hospital Using a Communication Bundle Strategy
Authors: Bumpers Bernadette , Dearmon Valorie , Dycus Paula 
Published: June 2018

Background:
The aim of this quality improvement project was to determine whether a communication bundle would impact parents' ratings of nurse-child communication in relation to (a) how often the nurse listened carefully to the child and (b) how often the nurse explained things in a way easy for the child to understand.

Local Problem:
The Child Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores on the unit lagged behind the hospital's 75th percentile external benchmark established by the National Research Corporation.

Methods:
A convenience sample of the unit's staff participated in the project.

Interventions:
The outcome measure was a comparison of Child HCAHPS scores and percentile ranks for the questions pre- and postimplementation of the communication bundle.

Results:
Following implementation of the communication bundle, the unit's patient satisfaction scores for both questions exceeded the 75th-percentile benchmark.

Conclusions:
This project enhanced nurse communication at the bedside and the parent's perception of nurse-child communication.
Comparison of the Microstructures and Properties of Different Microcannulas for Hyaluronic Acid Injection
Authors: Wu Kelun , Xie Li , Wang Muyao , Jiang Yichen , Tang Yingfeng , Wang Hang 
Published: June 2018

Background:
Microcannulas are used for hyaluronic acid and other filler injections and reduce the side effects and complications. There are several microcannulas and the differences between microcannulas have not been carefully investigated. The purpose of this study was to compare the microstructures and properties of different microcannulas by several trials and provide guidance for clinical application.

Methods:
Nine types of microcannulas from different manufacturers were chosen. Scanning electron microscopy was used to obtain high-definition images of microstructures, chemical composition analyzers were used to test the chemical composition of the tips, and a universal testing machine was used to measure mechanical properties. The injection speed test recorded the time spent for the weight to push hyaluronic acid out of microcannulas. The vessel piercing force test was conducted to simulate the process of puncturing the vessels in vitro.

Results:
The scanning electron microscopic images showed the tip shapes and inner surfaces that may relate to the characteristics. The chemical composition of most microcannulas met the American Society for Testing and Materials standards basically. The mechanical properties were obviously different. The results of the injection speed test were discrepant more than seven times. The vessel piercing test showed which microcannula was the most difficult and easiest to puncture the aorta.

Conclusions:
The results indicated that there are significant differences between different microcannulas. The differences are instructive to physicians for selecting suitable microcannulas to improve the injection effect and reduce discomfort and complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
The Differential Use of Bilobed and Trilobed Transposition Flaps in Cutaneous Nasal Reconstructive Surgery
Authors: Knackstedt Thomas , Lee Kachiu , Jellinek Nathaniel J. 
Published: June 2018

Background:
Bilobed and trilobed transposition flaps are versatile random pattern transposition flaps that reliably restore nasal symmetry, topography, light reflex, and contour and are frequently used in cutaneous nasal reconstructive surgery. The authors wish to compare the characteristics of bilobed and trilobed flaps in cutaneous reconstructive surgery and to identify scenarios for their differential use.

Methods:
A retrospective chart review over 7 years of consecutive patients who underwent reconstruction with a bilobed or trilobed flap after Mohs micrographic surgery was performed. Statistical analysis of patient and surgery characteristics, anatomical distribution, postprocedural events, and need for revisions after both flap types was conducted.

Results:
One hundred eleven patients with bilobed flaps and 74 patients with trilobed flaps were identified. Bilobed flaps are significantly more frequently used on the inferior nasal dorsum and on the sidewall, whereas trilobed flaps are significantly more frequently used on the nasal tip and infratip. No significant difference in postprocedural events (e.g., complications, erythema, trapdoor) was noted between the two flap types.

Conclusions:
Bilobed and trilobed transposition flaps are versatile means of repair for nasal reconstruction. Trilobed flaps may be used to repair defects in a more distal nasal location than bilobed flaps. Regardless of flap type, complications are rare.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Oncologic Resection and Reconstruction of the Chest Wall: A 19-Year Experience in a Single Center
Authors: Salo Juho T. K. , Tukiainen Erkki J. 
Published: June 2018

Background:
The aim of this study was to analyze chest wall reconstruction following oncologic resection performed by a single surgeon over a 19-year period.

Methods:
A retrospective review was performed for 135 patients who underwent oncologic chest wall resection from 1997 to 2015.

Results:
Average patient age was 57.8 years. Indications for resection were advanced breast cancer (n = 44), soft-tissue sarcoma (n = 38), bone sarcoma or chondrosarcoma (n = 28), desmoid tumor (n = 11), metastasis from other cancers (n = 7), and other primary tumors (n = 7). There were 72 full-thickness and 63 partial-thickness resections (34 soft-tissue resections only and 29 skeletal bone resections only). Resection margins were wide (n = 29), marginal (n = 82), and intralesional (n = 24). Reconstruction was warranted in 118 cases: chest wall stabilization and flap coverage in 57, chest wall stabilization only in 36, and soft-tissue flap coverage only in 25 cases. In total, 82 flaps were performed (17 free flaps and 65 pedicled/local flaps). There were no perioperative mortalities or flap losses. Complications occurred in 29 operations (Clavien-Dindo classifications grade II, n = 12; grade IIIa, n = 4; grade IIIb, n = 10; and grade IVa, n = 3) and 19 reoperations were necessary. Median follow-up was 49 months. Survival was calculated by the Kaplan-Meier method. One-, 2-, and 5-year survival rates were 84, 82, and 70 percent, respectively.

Conclusion:
With careful patient selection, appropriate perioperative and postoperative care, and accurate surgical technique, even extensive chest wall resections and reconstructions are safe.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
A Simple Dynamic Strategy to Deliver Stem Cells to Decellularized Nerve Allografts
Authors: Rbia Nadia , Bulstra Liselotte F. , Bishop Allen T. , van Wijnen Andre J. , Shin Alexander Y. 
Published: June 2018

Background:
The addition of adipose-derived mesenchymal stromal cells to decellularized nerve allografts may improve outcomes of nerve reconstruction. Prior techniques used for cell seeding are traumatic to both the mesenchymal stromal cells and nerve graft. An adequate, reliable, and validated cell seeding technique is an essential step for evaluating the translational utility of mesenchymal stromal cell–enhanced decellularized nerve grafts. The purpose of this study was to develop a simple seeding strategy with an optimal seeding duration.

Methods:
A dynamic bioreactor was used to seed rat and human mesenchymal stromal cells separately onto rat and human decellularized nerve allografts. Cell viability was evaluated by MTS assays and cellular topology after seeding was determined by scanning electron microscopy. Cell density and distribution were determined by Live/Dead assays and Hoechst staining at four different time points (6, 12, 24, and 72 hours). The validity and reliability of the seeding method were calculated.

Results:
Cells remained viable at all time points, and mesenchymal stromal cells exhibited exponential growth in the first 12 hours of seeding. Seeding efficiency increased significantly from 79.5 percent at 6 hours to 89.2 percent after 12 hours of seeding (p = 0.004). Both intrarater reliability (r = 0.97) and interrater reliability (r = 0.92) of the technique were high.

Conclusions:
This study describes and validates a new method of effectively seeding decellularized nerve allografts with mesenchymal stromal cells. This method is reproducible, distributes cells homogenously over the graft, and does not traumatize the intraneural architecture of the allograft. Use of this validated seeding technique will permit critical comparison of graft outcomes.
Anatomical Understanding of Target Subcutaneous Tissue Layer for Thinning Procedures in Thoracodorsal Artery Perforator, Superficial Circumflex Iliac Artery Perforator, and Anterolateral Thigh Perforator Flaps
Authors: Kim So Young , Lee Young Jae , Mun Goo-Hyun 
Published: June 2018

Background:
Thinned perforator flaps, reported techniques, and degree of thinning differ by study. This study investigated the anatomy of subcutaneous tissue according to the varying fattiness and identified which component and how much of the subcutaneous tissue layer needed to be excluded to meet target flap thickness using computed tomography.

Methods:
Three stratified fattiness groups consisting of 30 donors were formed for thoracodorsal artery perforator, superficial circumflex iliac artery perforator, and anterolateral thigh flaps. Thickness of the superficial fat and the deep fat layers was measured at specific points in donor sites of the three flaps and the proportion of superficial and deep fat layers to exclude to reach the target flap thickness (4, 6, and 8 mm) was calculated.

Result:
The median proportion for the superficial fat layer varies depending on donor fattiness. The estimated percentage reduction of thickness after thin flap elevation along superficial fascia was approximately one-third of the whole layer. A variable proportion of each fat layer needs to be excluded to obtain required thinness and in very thick groups, part of the superficial fat layer must be removed to reach any of the target thicknesses for the three flaps.

Conclusions:
The present study demonstrated the frequent need for superficial fat layer manipulation when obtaining a thin perforator flap. To cope with various combinations of donor-site fattiness and different required thicknesses effectively, an appropriate thinning method should have increased adaptability, including the ability to control superficial fat layer thickness.
Acceleration of Magnetic Resonance Cholangiopancreatography Using Compressed Sensing at 1.5 and 3 T
Authors: Taron Jana , Weiss Jakob , Notohamiprodjo Mike , Kuestner Thomas , Bamberg Fabian , Weiland Elisabeth , Kuehn Bernd , Martirosian Petros 
Published: June 2018

ObjectivesMagnetic resonance cholangiopancreatography (MRCP) is an established technique in routine magnetic resonance examination. By applying the compressed sensing (CS) acceleration technique to conventional MRCP sequences, scan time can be markedly reduced. With promising results at 3 T, there is a necessity to evaluate the performance at 1.5 T due to wide scanner availabilities. Aim of this study is to test the feasibility of accelerated 3-dimensional (3D) MRCP with extended sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) using CS in navigator triggering and in a single breath-hold in a clinical setting at 1.5 T and 3 T and compare it with a conventional navigator-triggered 3D SPACE-MRCP.Materials and MethodsPhantom measurements were performed to adapt sequence parameters. Conventional 3D SPACE-MRCP in navigator triggering (STD_MRCP) as well as CS-accelerated 3D SPACE-MRCP acquired in navigator triggering and in a single breath-hold (CS_MRCP and CS_BH_MRCP) was performed in 66 patients undergoing clinically induced MRI of the pancreatobiliary system at 1.5 T and 3 T. Image quality evaluation was performed by 2 independent radiologists. Dedicated statistics were performed (P< 0.05 considered significant).ResultsIn patient imaging, CS_MRCP was superior to STD_MRCP and CS_BH_MRCP in aspects of overall image quality at 1.5 T (P= 0.01;P< 0.001) and 3 T (P= 0.002;P= 0.013). Overall image quality in CS_BH_MRCP was inferior compared with STD_MRCP and CS_MRCP at 1.5 T. At 3 T, overall image quality in CS_BH_MRCP was superior to STD_MRCP (P= 0.001). Scan time was reduced by 25% to 46% covering 5% of k-space (CS_MRCP at 1.5 and 3 T) and 97% covering 3.6% of k-space (CS_BH_MRCP at 1.5 and 3 T).ConclusionsCompressed sensing-accelerated MRCP is feasible in clinical routine at 1.5 and 3 T offering major reduction of acquisition time. When applying a single breath-hold CS imaging, field strengths of 3 T are recommended.
Prostate-Specific Membrane Antigen Expression in Distal Radius Fracture
Authors: Hoberück Sebastian , Michler Enrico , Kaiser Daniel , Röhnert Anne , Zöphel Klaus , Kotzerke Jörg 
Published: June 2018

Abstract
A 79-year old man with prostate cancer under active surveillance for 5 years was referred for a PSMA-PET/MRI for re-evaluation because of a rising prostate-specific antigen value. PET/MRI revealed a ribbonlike tracer accumulation in a healing fracture of the distal radius. This case illustrates that PSMA expression may occur in healing bone fractures in the distal radius. It can be assumed that benign causes of tracer accumulations in the upper extremities are missed in PET/CT due to elevated position of the arms during image acquisition.