bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving the Efficiency and Effectiveness of Parent Education in the Neonatal Intensive Care Unit
Authors: Gehl Melissa B. , Alter Caroline C. , Rider Nikki , Gunther Lori G. , Russell Rebecca B. 
Published: July 2019

Background:
March of Dimes partners with hospitals across the country to implement NICU Family Support (NFS) Core Curriculum, a program providing education to parents in neonatal intensive care units (NICUs) across the country.

Purpose:
This NFS project's goal was to increase the efficiency and effectiveness of NICU parent education by establishing consistency, improving quality, and identifying best practices.

Methods/Search Strategy:
A 5 topic curriculum was developed and implemented across NFS program sites. The project studied 4 main outcomes of interest related to efficiency and effectiveness: increase in parenting confidence, parent learning, knowledge change, and satisfaction. Data were collected from speakers and attendees immediately following educational sessions. Analytical approaches included descriptive statistics such as frequency, percentage, and response rate, and inferential approaches such as t test, χ2, and analysis of variance.

Findings/Results:
Findings suggest that the NFS Core Curriculum improved both program efficiency and effectiveness. Sessions fully implemented according to recommended strategies had better outcomes than sessions not fully implemented according to recommended strategies (P < .0001). Across the 3648 attendees at 41 sites, 77% of parents reported learning “a lot” at the session they attended and 85% of attendees reported increased confidence. Attendees also reported positive knowledge change and high satisfaction.

Implications for Practice:
Parent education best practices identified through this initiative can be utilized for future NFS Core Curriculum topics and potentially generalized to all NICU parent education and family education in other hospital intensive care units.

Implications for Research:
Content and best practices identified through this project will require regular review to ensure medical accuracy and appropriateness of best practices as the physical design of NICUs evolves.
The Importance of the Biopsy Technique in the Diagnosis of Histoid Leprosy
Authors: Rodrigues Daxbacher Egon L. , Cabrera Pereira João P. , Ramos de Oliveira Suellen , Duarte Tortelly Violeta , Carneiro Sueli , Jeunon Thiago 
Published: July 2019

Abstract:Histoid leprosy (HL) was originally described by Wade in 1963 and is regarded as a rare variant of lepromatous leprosy (LL). These characteristic clinical lesions are firm, deeply adhered nodules with features reminiscent of dermatofibromas or keloids in a background of apparently healthy skin. The main histopathological findings described are the presence of spindle cell histiocytes immersed in a richly collagenized background, usually forming a nodular pattern of infiltration with sharply delimitation and positive staining for acid-fast bacilli. The classical form of HL lesions should be devoid of foam histiocytes and globi. However, we and other authors noticed that in most of the cases, despite characteristic clinical features, histopathology depicts a mixture of LL and HL patterns. Therefore, we present a case with clinical features similar to HL in which an excisional scalpel biopsy of a nodule demonstrated features of classical LL in the center of the lesion and features of HL in the periphery, highlighting that a proper biopsy technique could enhance the ability of the dermatopathologist to histopathologically diagnose cases of HL. In cases in which HL is clinically suspected, we advocate replacing the usual 4-mm incisional punch biopsy by a broader elliptical scalpel biopsy, encompassing the totality of the lesion whenever possible to achieve a reliable representation of the pathologic process.
Monitoring Perinatal Exposure to Cannabis and Synthetic Cannabinoids
Authors: Carlier Jeremy , Huestis Marilyn A. , Zaami Simona , Pichini Simona , Busardò Francesco P. 
Published: July 2019

Purpose:
Drug use during pregnancy is a critical global challenge, capable of severe impacts on neonatal development. However, the consumption of cannabis and synthetic cannabinoids is on the rise in pregnant women. Obstetric complications with increased risks of miscarriage, fetal growth restriction, and brain development impairment have been associated with perinatal cannabis exposure, but data on synthetic cannabinoid use during pregnancy are limited.

Methods:
We reviewed studies that investigated the risks associated with cannabis and synthetic cannabinoid use and those that reported the concentrations of cannabinoids and synthetic cannabinoids in maternal (breast milk) and neonatal (placenta, umbilical cord, meconium, and hair) matrices during human pregnancy. A MEDLINE and EMBASE literature search to identify all relevant articles published in English from January 1998 to April 2019 was performed.

Results:
Cannabis use during pregnancy is associated with increased risks of adverse obstetrical outcomes, although neurobehavioral effects are still unclear. Analyses of cannabinoids in meconium are well documented, but further research on other unconventional matrices is needed. Adverse effects due to perinatal synthetic cannabinoid exposure are still unknown, and analytical data are scarce.

Conclusions:
Awareness of the hazards of drug use during pregnancy should be improved to encourage health care providers to urge pregnant women to abstain from cannabis and, if cannabis-dependent, seek treatment. Moreover, substances used throughout pregnancy should be monitored as a deterrent to cannabis use, and potential cannabis-dependent women should be identified, so as to limit cannabis-fetal exposure during gestation, and provided appropriate treatment.
Fractional CO2 laser versus promestriene and lubricant in genitourinary syndrome of menopause: a randomized clinical trial
Authors: Politano Carlos A. , Costa-Paiva Lucia , Aguiar Luiza B. , Machado Helymar C. , Baccaro Luiz F. 
Published: July 2019

Abstract

Objective:
The aim of this study was to compare the effects of fractional CO2 laser therapy, promestriene, and vaginal lubricants on genitourinary syndrome treatment and sexual function in postmenopausal women.

Methods:
We performed a randomized clinical trial including 72 postmenopausal women over the age of 50 years. The women were randomized into three intervention groups to receive one of the following treatments: three sessions of intravaginal fractional CO2 laser therapy; 10 mg of intravaginal promestriene cream 3 times a week; and vaginal lubricant application alone. Vaginal maturation, Vaginal Health Index (VHI) score, and Female Sexual Function Index (FSFI) were evaluated at baseline and after 14 weeks of therapy.

Results:
We observed an improvement in the vaginal elasticity, volume, moisture, and pH in the CO2 laser and promestriene groups. The VHI score at 14 weeks was higher in the CO2 laser group (mean score 18.68) than in the promestriene (15.11) and lubricant (10.44) groups (P < 0.001). Regarding vaginal maturation, basal cells were reduced and superficial cells were increased after treatment. This improvement was more significant in the CO2 laser group (P <0.001). The FSFI score only showed improvement in the desire and lubrication domains in the CO2 laser group. There were no differences in total FSFI score among the three treatment groups. There were no adverse effects associated with any of the treatments.

Conclusions:
The use of fractional CO2 laser therapy to treat genitourinary syndrome resulted in better short-term effects than those of promestriene or lubricant with respect to improving the vaginal health in postmenopausal women.
A Methodology For Studying Organizational Performance
Authors: Lasater Karen B. , Jarrín Olga F. , Aiken Linda H. , McHugh Matthew D. , Sloane Douglas M. , Smith Herbert L. 
Published: July 2019

Background:Rigorous measurement of organizational performance requires large, unbiased samples to allow inferences to the population. Studies of organizations, including hospitals, often rely on voluntary surveys subject to nonresponse bias. For example, hospital administrators with concerns about performance are more likely to opt-out of surveys about organizational quality and safety, which is problematic for generating inferences.Objective:The objective of this study was to describe a novel approach to obtaining a representative sample of organizations using individuals nested within organizations, and demonstrate how resurveying nonrespondents can allay concerns about bias from low response rates at the individual-level.Methods:We review and analyze common ways of surveying hospitals. We describe the approach and results of a double-sampling technique of surveying nurses as informants about hospital quality and performance. Finally, we provide recommendations for sampling and survey methods to increase response rates and evaluate whether and to what extent bias exists.Results:The survey of nurses yielded data on over 95% of hospitals in the sampling frame. Although the nurse response rate was 26%, comparisons of nurses’ responses in the main survey and those of resurveyed nonrespondents, which yielded nearly a 90% response rate, revealed no statistically significant differences at the nurse-level, suggesting no evidence of nonresponse bias.Conclusions:Surveying organizations via random sampling of front-line providers can avoid the self-selection issues caused by directly sampling organizations. Response rates are commonly misinterpreted as a measure of representativeness; however, findings from the double-sampling approach show how low response rates merely increase thepotential fornonresponse bias but do not confirm it.
The Surveillance Patterns of Incidentally Detected Pancreatic Cysts Vary Widely and Infrequently Adhere to Guidelines
Authors: Schenck Robert J. , Miller Frank H. , Keswani Rajesh N. 
Published: July 2019

Objectives
We aimed to determine incidental pancreatic cyst (“cyst”) surveillance patterns, predictors of receiving surveillance, and guideline adherence.

Methods
We performed a retrospective cohort study of all patients receiving longitudinal care at a single tertiary care center with a newly diagnosed incidental pancreatic cyst over a 2-year period (2010–2011). All follow-up care was abstracted over a 5-year period.

Results
Of 3241 eligible imaging studies reviewed, 100 patients with newly diagnosed incidental cysts eligible for surveillance were identified. A majority (53%) received no follow-up. We identified 4 predictors of cyst surveillance: radiology report conclusion mentioning the cyst (odds ratio [OR], 14.9; 95% confidence interval [CI], 1.9–119) and recommending follow-up (OR, 5.5; 95% CI, 2.1–13.9), pancreas main duct dilation (OR, 10.7; 95% CI, 1.3–89), and absence of multiple cysts (OR, 2.5; 95% CI, 1.1–10.0). Of the 47 patients who received surveillance, 66% met minimum surveillance imaging intervals of at least one guideline. Conversely, 21% of patients met the criteria for overutilization in at least one guideline.

Conclusions
Although guidelines recommend that surgically fit patients with incidental cysts undergo surveillance, most patients receive no follow-up. When follow-up occurs, surveillance patterns vary widely and infrequently conform to guidelines. Interventions to reduce care variation require study.
Significance of Lymph Node Metastasis in Resectable Well-differentiated Pancreatic Neuroendocrine Tumor
Authors: Harimoto Norifumi , Hoshino Kouki , Muranushi Ryo , Hagiwara Kei , Yamanaka Takahiro , Ishii Norihiro , Tsukagoshi Mariko , Igarashi Takamichi , Tanaka Hiroshi , Watanabe Akira , Kubo Norio , Araki Kenichirou , Hosouchi Yasuo , Suzuki Hideki , Arakawa Kazuhisa , Hirai Keitarou , Fukazawa Takaharu , Ikota Hayato , Shirabe Ken 
Published: July 2019

ObjectivesUnderstanding the effect of lymph node metastasis (LNM) on prognosis in pancreatic neuroendocrine neoplasm is helpful for surgery and follow-up. In this study, we investigated the significance of LNM in well-differentiated pancreatic neuroendocrine tumors (PanNETs) according to the World Health Organization 2017 classification.MethodsWe retrospectively collected data for 95 consecutive patients with PanNET who underwent pancreatic resection with curative intent between January 2008 and December 2017 at 6 institutions. The clinicopathological factors were compared in patients with and without LNM, and prognostic factors were analyzed.ResultsLymph node metastasis was significantly associated with malignant potential of PanNET, such as larger tumor size, higher Ki-67 index, higher tumor grade, and higher incidence of lymphatic, vessel, and neural invasion. Lymph node metastasis was also associated with disease-free but not overall survival. Multivariate analysis identified NET grade 2 (G2) and G3 as independent risk factors for recurrence after curative resection.ConclusionsWorld Health Organization 2017 classification was the most independent prognostic factor in patients with resectable well-differentiated PanNETs. Patients with G2 and higher-grade tumors require lymph node dissection to improve prognosis.
Endogenous Gastrin Collaborates With Mutant KRAS in Pancreatic Carcinogenesis
Authors: Nadella Sandeep , Burks Julian , Huber Matthew , Wang Juan , Cao Hong , Kallakury Bhaskar , Tucker Robin D. , Boca Simina M. , Jermusyck Ashley , Collins Irene , Vietsch Eveline E. , Pierobon Mariaelena , Hodge K. Alex , Cui Waxing , Amundadottir Laufey T. , Petricoin Emanuel , Shivapurkar Narayan , Smith Jill P. 
Published: July 2019

ObjectiveTheKRASgene is the most frequently mutated gene in pancreatic cancer, and no successful anti-Ras therapy has been developed. Gastrin has been shown to stimulate pancreatic cancer in an autocrine fashion. We hypothesized that reactivation of the peptide gastrin collaborates with KRAS during pancreatic carcinogenesis.MethodsLSL-KrasG12D/+;P48-Cre(KC) mutant KRAS transgenic mice were crossed with gastrin-KO (GKO) mice to develop GKO/KC mice. Pancreata were examined for 8 months for stage of pancreatic intraepithelial neoplasia lesions, inflammation, fibrosis, gastrin peptide, and microRNA expression. Pancreatic intraepithelial neoplasias from mice were collected by laser capture microdissection and subjected to reverse-phase protein microarray, for gastrin and protein kinases associated with signal transduction. Gastrin mRNA was measured by RNAseq in human pancreatic cancer tissues and compared to that in normal pancreas.ResultsIn the absence of gastrin, PanIN progression, inflammation, and fibrosis were significantly decreased and signal transduction was reversed to the canonical pathway with decreased KRAS. Gastrin re-expression in the PanINs was mediated by miR-27a. Gastrin mRNA expression was significantly increased in human pancreatic cancer samples compared to normal human pancreas controls.ConclusionsThis study supports the mitogenic role of gastrin in activation of KRAS during pancreatic carcinogenesis.
High Rate of Repeat Sexually Transmitted Diseases Among Men Who Have Sex With Men in South Africa: A Prospective Cohort Study
Authors: van Liere Geneviève A.F.S. , Kock Marleen M. , Radebe Oscar , Struthers Helen E. , Morre Servaas , McIntyre James A. , Peters Remco P.H. 
Published: July 2019

Abstract
We observed a high rate of incident sexually transmitted diseases within 55 days (median) of follow-up (78% retention) among symptomatic men who have sex with men (n = 78) in South Africa (188 per 100 person-years; 95% confidence interval, 1.2–2.7); 16 newly acquired and 10 with persistent positivity. This highlights the need to strengthen prevention efforts, whereas introduction of diagnostics is urgently warranted.
Comparison of Wavefront-guided and Best Conventional Scleral Lenses after Habituation in Eyes with Corneal Ectasia
Authors: Hastings Gareth D. , Applegate Raymond A. , Nguyen Lan Chi , Kauffman Matthew J. , Hemmati Roxana T. , Marsack Jason D. 
Published: July 2019

SIGNIFICANCE
Visual performance with wavefront-guided (WFG) contact lenses has only been reported immediately after manufacture without time for habituation, and comparison has only been made with clinically unrefined predicate conventional lenses. We present comparisons of habitual corrections, best conventional scleral lenses, and WFG scleral lenses after habituation to all corrections.

PURPOSE
The purpose of this study was to compare, in a crossover design, optical and visual performance of eyes with corneal ectasias wearing dispensed best conventional scleral lens corrections and dispensed individualized WFG scleral lens corrections.

METHODS
Ten subjects (20 eyes) participated in a randomized crossover study where best conventional scleral lenses and WFG scleral lenses (customized through the fifth radial order) were worn for 8 weeks each. These corrections, as well as each subject's habitual correction and normative data for normal eyes, were compared using (1) residual higher-order aberrations (HORMS), (2) visual acuity (VA), (3) letter contrast sensitivity (CS), and (4) visual image quality (logarithm of the visual Strehl ratio, or logVSX). Correlations were performed between Pentacam biometric measures and gains provided by WFG lenses.

RESULTS
Mean HORMS was reduced by 48% from habitual to conventional and 43% from conventional to WFG. Mean logMAR VA improved from habitual (+0.12) to conventional (−0.03) and further with WFG (−0.09); six eyes gained greater than one line with WFG over conventional. Area under the CS curve improved by 26% from habitual to conventional and 14% from conventional to WFG. The percentage of the eyes achieving normal levels were as follows: HORMS, 40% for conventional and 85% for WFG; VA, 50% for conventional and 85% for WFG; and CS, 60% for conventional and 90% for WFG. logVSX improved by 16% from habitual to conventional and 25% further with WFG. Reduction in aberrations with WFG lenses best correlated with posterior cornea radius of curvature.

CONCLUSIONS
Visual performance was superior to that reported with nonhabituated WFG lens wear. With WFG lenses, HORMS and logVSX significantly improved, allowing more eyes to reach normal levels of optical and visual performance compared with conventional lenses.
Innovation in Central Venous Access Device Security: A Pilot Randomized Controlled Trial in Pediatric Critical Care
Authors: Ullman Amanda J. , Long Debbie , Williams Tara , Pearson Kylie , Mihala Gabor , Mattke Adrian C. , Macfarlane Fiona , Rickard Claire M. 
Published: July 2019

Objectives:
Central venous access devices enable many treatments during critical illness; however, 25% of pediatric central venous access devices fail before completion of treatment due to infection, thrombosis, dislodgement, and occlusion. This is frequently attributed to inadequate securement and dressing of the device; however, high-quality research evaluating pediatric central venous access device securement innovation to prevent central venous access device failure is scarce. This study aimed to establish the feasibility of a definitive randomized control trial examining the effectiveness of current and new technologies to secure central venous access devices in pediatrics.

Design:
Single-center, parallel group, superiority, pilot randomized control trial.

Setting:
Anesthetic and intensive care departments of a tertiary pediatric hospital

Subjects:
One-hundred eighty pediatric patients with nontunneled central venous access device

Interventions:
Participants were randomized to receive central venous access device securement via standard care (bordered polyurethane dressing, with prolene sutures, chlorhexidine gluconate disc), tissue adhesive (Histoacryl, B Braun, Melsungen, Germany) in addition to standard care; or integrated dressing securement (SorbaView SHIELD [Centurion Medical Products, Franklin, MA], with prolene sutures and chlorhexidine gluconate disc). Outcomes: Primary: Feasibility (including effect size estimates, acceptability); central venous access device failure; central venous access device complications; secondary: individual central venous access device complications, skin damage, dressing performance, and product cost.

Measurements and Main Results:
Feasibility criteria were achieved as recruitment occurred with acceptable eligibility, recruitment, missing data, and attrition rates, as well as good protocol adherence. Family members and staff-reported comparable levels of acceptability between study arms; however, tissue adhesive was reported as the most difficult to apply. Overall, 6% of central venous access devices failed, including 6% (3/54; incident rate, 13.2 per 1,000 catheter days) standard care, 2% (1/56; incident rate, 3.65 per 1,000 catheter days) integrated, and 8% (5/59; 25.0 per 1,000 catheter days) tissue adhesive.

Conclusions:
It is feasible to conduct an efficacy randomized control trial of the studied interventions. Further research is required to definitively identify clinical, cost-effective methods to prevent central venous access device failure by examining new dressing and securement technologies and techniques.
Anti–N-Methyl-d-Aspartate Receptor Encephalitis
Authors: Zhao Bailey , Nelson David G. 
Published: July 2019

Abstract
Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is an underdiagnosed disease that has been described thus far only in case series. Patients, the majority of which are females, develop neuropsychiatric symptoms that can often be misdiagnosed as purely psychiatric illness. Although teratomas are nearly pathognomonic for anti-NMDAR encephalitis, these are less common in children and males. This case illustrates some common features of anti-NMDAR encephalitis and some of the challenges in diagnosis.
Deep Learning Algorithm to Predict Need for Critical Care in Pediatric Emergency Departments
Authors: Kwon Joon-myoung , Jeon Ki-Hyun , Lee Myoungwoo , Kim Kyung-Hee , Park Jinsik , Oh Byung-Hee 
Published: July 2019

Background and Objectives
Emergency department (ED) overcrowding is a national crisis in which pediatric patients are often prioritized at lower levels. Because the prediction of prognosis for pediatric patients is important but difficult, we developed and validated a deep learning algorithm to predict the need for critical care in pediatric EDs.

Methods
We conducted a retrospective observation cohort study using data from the Korean National Emergency Department Information System, which collected data in real time from 151 EDs. The study subjects were pediatric patients who visited EDs from 2014 to 2016. The data were divided by date into derivation and test data. The primary end point was critical care, and the secondary endpoint was hospitalization. We used age, sex, chief complaint, symptom onset to arrival time, arrival mode, trauma, and vital signs as predicted variables.

Results
The study subjects consisted of 2,937,078 pediatric patients of which 18,253 were critical care and 375,078 were hospitalizations. For critical care, the area under the receiver operating characteristics curve of the deep learning algorithm was 0.908 (95% confidence interval, 0.903–0.910). This result significantly outperformed that of the pediatric early warning score (0.812 [0.803–0.819]), conventional triage and acuity system (0.782 [0.773–0.790]), random forest (0.881 [0.874–0.890]), and logistic regression (0.851 [0.844–0.858]). For hospitalization, the deep-learning algorithm (0.782 [0.780–0.783]) significantly outperformed the other methods.

Conclusions
The deep learning algorithm predicted the critical care and hospitalization of pediatric ED patients more accurately than the conventional early warning score, triage tool, and machine learning methods.