bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effective workload management in child welfare: Understanding the relationship between caseload and workload
Authors: Kim Jangmin , Yi Eun‐Hye , Pierce Barbara , Hall James 
Published: March 2019

AbstractA common assumption in public social service organizations is that workload may be positively associated with caseload. However, few empirical studies have examined what specific characteristics of caseload affect caseworkers' workloads in the child welfare system. This study attempts to address this gap by identifying specific individual and regional factors that influence both subjective and objective dimensions of workloads. Survey data were collected from 1,244 caseworkers at one public child welfare agency in a Midwestern state in the United States. The data indicated that both perceptions of unmanageable workloads and self‐reported overtime work were significantly higher when caseworkers had a greater number of cases than the state caseload standard for the investigations units and worked with at least two different types of cases simultaneously (e.g., working with both investigation and ongoing service cases). Additionally, sufficient staffing numbers to meet caseload demands at the regional level significantly decreased the odds ratio of having to do overtime work. The major findings suggest that the objective and subjective dimensions of workload vary by individual‐ and regional‐level variables. Practice implications are discussed for effective and efficient workload management in the public child welfare system.
Bloodstream infection caused by enteric organisms during the first 6 months after intestinal transplant
Authors: Simkins Jacques , Morillas‐Rodriguez Jose A. , Morris Michele I. , Abbo Lilian M. , Camargo Jose F. , Selvaggi Gennaro , Beduschi Thiago , Tekin Akin , Vianna Rodrigo 
Published: March 2019

AbstractBackgroundData on bloodstream infection (BSI) due to enteric organisms are scarce.MethodsThis retrospective study (1/2009‐5/2017) was aimed to evaluate the incidence of BSI episodes due to enteric organisms during the first 6 months after intestinal transplant (ITx). Differences between the first (2009‐2012) and second period (2013‐2017) were evaluated as they differed from each other in the perioperative fungal prophylaxis and immunosuppressive regimen.ResultsFifty‐five adult patients were analyzed. Twenty‐eight (51%) patients developed a total of 51 episodes of BSI. Mean time from transplant to BSI was 85.5 ± 58.8 days. The most common organisms were Klebsiella pneumoniae (33%), Enterococcus spp (31%), and Candida spp (18%). Twenty‐three (45%) were multidrug resistant. The most common sources were gut translocation (35%), central line infection (20%), and intra‐abdominal abscess (14%). Biopsy‐proven rejection was associated with 16 (31%) of the BSI episodes. Patients during the first period were more likely to develop BSI (79% vs 41%, P = 0.03). There were more episodes of rejection associated with BSI in the first period (45% vs 14%, P = 0.03). The rate of reoperation into the abdominal cavity within 2 weeks after ITx was higher and the transplant hospital stay was longer among those who developed BSI (P = 0.04 for both).ConclusionsHalf of our patients developed BSI (typically during the first 3 months). Gut translocation was the most common source of BSI. Patients with rejection and/or enteritis should be monitored closely for BSI.
Chronological storage age and metabolic age of stored red blood cells: are they the same?
Authors: D'Alessandro Angelo , Zimring James C. , Busch Michael 
Published: March 2019

KEY IDEAS
Red blood cell (RBC) storage in the blood bank is characterized by the progressive loss of metabolic regulation, a phenomenon that targets energy and antioxidant metabolism;
While the progression of the storage lesion is inevitable, the rate at which this phenomenon occurs varies from donor to donor;
Red blood cells from some donors at the end of storage are metabolically superior to RBCs from other donors at the beginning of storage, suggesting that the age of blood alone may not be a sufficiently accurate predictor of stored blood quality; and
Animal studies and large‐scale omics screening in blood donors have helped identify mechanistic contributors to the metabolic heterogeneity of stored blood units.
Acute coronary syndromes presentations and care outcomes in white, South Asian and Chinese patients: a cohort study
Authors: King-Shier Kathryn , Quan Hude , Kapral M K , Tsuyuki Ross , An Libin , Banerjee Suvro , Southern Danielle A , Khan Nadia 
Published: March 2019

ObjectivesSuccessful treatment of acute coronary syndrome (ACS) relies on its rapid recognition. It is unclear whether the accepted presentation of chest pain applies to different ethnic groups. We thus examined potential ethnic variations in ACS symptoms and clinical care outcomes in white, South Asian and Chinese patients.DesignCross-sectional survey.SettingParticipants were hospitalised at 1 of 12 Canadian centres across four provinces.Participants1334 patients with ACS (630 white; 488 South Asian; 216 Chinese).Main outcome measuresACS presentation symptoms (classic/typical midsternal pain/discomfort with or without radiation to the left neck, shoulder or arm) were assessed by self-report. Clinical care outcomes (time to emergency room [ER] presentation, cardiac catheterisation; receipt of cardiac catheterisation, percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) were obtained by health record audit.ResultsThe mean age of the sample was 62 years and 30% had ST-elevation myocardial infarction (STEMI). The most common presenting symptom was midsternal pain/discomfort of any intensity regardless of ethnic status. Yet, a substantial proportion of patients reported atypical symptoms (33% white, 19% South Asian, 20% Chinese; p<0.006). After adjustment for age, sex, education, current smoking, extent of coronary artery disease, presence of diabetes or chronic kidney disease and STEMI vs non-STEMI/unstable angina, South Asians were more likely to present with at least moderate intensity midsternal pain/discomfort (adjusted OR [AOR] 1.44; 95% CI 1.05 to 1.98), whereas Chinese were less likely to present with radiating symptoms (AOR 0.53; 95% CI 0.38 to 0.74) compared with whites. South Asians with atypical pain (relative to those with midsternal pain/discomfort) took significantly longer to present to the ER (p=0.037), and were less likely to receive PCI (p=0.008) or CABG (p=0.041).ConclusionsAtypical presentations were associated with greater delays in arrival to the emergency department and reduced invasive cardiovascular care in South Asians.
Relationship between nursing home quality indicators and potentially preventable hospitalisation
Authors: Xu Dongjuan , Kane Robert , Arling Greg 
Published: March 2019

BackgroundHospitalisations are very common among nursing home residents and many of these are deemed inappropriate or preventable. Little is known about whether clinical care quality is related to hospitalisation, especially potentially preventable hospitalisations (PPHs). Among the few studies that have been conducted, the findings have been inconsistent. The objective of this study was to examine the relationship between quality indicators and overall and PPHs among Medicaid beneficiaries aged 65 years and older receiving care at nursing homes in Minnesota.Methods23 risk-adjusted quality indicators were used to assess nursing home quality of care. Quality indicators and other facility-level variables from the Minnesota Nursing Home Report Card were merged with resident-level variables from the Minimum Data Set. These merged data were linked with Medicaid claims to obtain hospitalisation rates during the 2011–2012 period. The sample consisted of a cohort of 20 518 Medicaid beneficiaries aged 65 years and older who resided in 345 Minnesota nursing homes. The analyses controlled for resident and facility characteristics using the generalised linear mixed model.ResultsThe results showed that about 44 % of hospitalisations were PPHs. Available quality indicators were not strongly or consistently associated with the risk of hospitalisation (neither overall nor PPH). Among these 23 quality indicators, five quality indicators (antipsychotics without a diagnosis of psychosis, unexplained weight loss, pressures sores, bladder continence and activities of daily living [ADL] dependence) were related significantly to hospitalisation and only four quality indicators (antipsychotics without a diagnosis of psychosis, unexplained weight loss, ADL dependence and urinary tract infections) were related to PPH.ConclusionAlthough general quality indicators can be informative about overall nursing home performance, only selected quality indicators appear to tap dimensions of clinical quality directly related to hospitalisations.
Continuous Spinal Analgesia: Comparison Between Patient-Controlled and Bolus Administration of Plain Bupivacaine for Postoperative Pain Relief
Authors: Rundshagen I. , Standl T. , Kochs E. , Müller M. , Schulte am Esch J. 
Published: March 2019

Background and ObjectivesAdequate postoperative pain relief has been achieved in orthopedic patients by subarachnoid bolus administration of plain bupivacaine. This prospective randomized study compares bolus injections of bupivacaine with a patient controlled infusion via subarachnoid 28-gauge microcatheters for postoperative analgesia after elective hip replacement.MethodsForty-two patients (mean age, 69 ± 11 years) were randomly allocated to one of two groups. Group 1 patients received a constant subarachnoid infusion of 0.6 mg/h of bupivacaine by a patientcontrolled device and were allowed to self-administer 0.6 mg every 30 minutes Group 2 patients received a nurse-administered bolus of 3.75 mg of plain bupivacaine on request. Pain was assessed by patients and nurses by a visual analog scale (VAS) every hour. The degree of motor block and the level of analgesia were documented every 4 hours. Hemodynamic and respiratory parameters were recorded hourly. Differences between groups were tested by analysis of variance for repeated measurement.ResultsTechnical problems occurred in six patients were more frequent in group 1 but none in group 2. Patient-controlled analgesia resulted in lower pain scores than bolus application during 18 postoperative hours (VAS score 19 ± 19 mm in group 1 and 39 ± 30 mm in group 2; P < .01). Lower total doses of bupivacaine were required in group 1 (17.6 ± 4 mg) than in group 2 (22.3 ± 7 mg: P < .05). The groups did not differ with respect to the degree of motor block (Bromage score 3.5 ± 0.5), the sensory level (L1-2 ± 1), or hemodynamic or respiratory parameters.ConclusionIn spite of a higher incidence of technical problems, patient-controlled analgesia with a continuous background infusion via microspinal catheters provides more effective postoperative analgesia, without hemodynamic or respiratory side effects, than bolus administration.
Anesthetic Management of a Parturient With an Incompletely Resected Cerebral Arteriovenous Malformation
Authors: Viscomi Christopher M. , Wilson James , Bernstein Ira 
Published: March 2019

Background and ObjectivesThe anesthetic, neurosurgical, and obstetric literature regarding management of parturients with intracranial arteriovenous malformations is relatively sparse. A case report is given of a parturient, with a recent subtotal resection of a cerebral arteriovenous malformation, who presented for delivery of a viable male fetus.MethodsThe patient was scheduled for an elective labor induction, with early epidural analgesia advocated as a strategy to minimize the cardiovascular changes of labor and prevent involuntary Valsalva maneuvers. An elective instrumental delivery was planned when the fetal head had descended appropriately.ResultsEpidural analgesia was initiated when the patient reached 3 cm cervical dilation and provided excellent labor analgesia. After a passive fetal descent during the second stage of labor, Luikart-Simpson forceps were used to facilitate this stage. The newborn Apgar score was 9 at both 1 and 5 minutes after delivery. Both the patient and the infant have done well.ConclusionsThe available obstetric and neurosurgical literature does not offer firm recommendations for the optimal route of fetal delivery or the timing of neurosurgical resection of an arteriovenous malformation in the parturient. Anesthetic management is predicated on the principles of minimizing the cardiovascular changes of labor and preventing involuntary Valsalva maneuvers during the second stage of labor. Both of these goals are readily accomplished with epidural anesthesia.
Effects of Diluent Volume of a Single Dose of Epidural Bupivacaine in Parturients During the First Stage of Labor
Authors: Christiaens Frank , Verborgh Christian , Dierick Ann , Camu Frédéric 
Published: March 2019

Background and Objectives0.1% bupivacaine for obstetric epidural analgesia is given by infusion, using a loading dose of a higher concentration alone or in combination with opioid analgesics. A single dose of 0.1% without any additive for relief of first-stage labor pain has not yet been documented.MethodsFifty-eight primiparae in active labor and with less than 5 cm cervical dilatation received 20 mg epidural bupivacaine diluted in 4 mL [group 1: 0.5% (I)], 10 mL [group 2: 0.2% (II)], or 20 mL [group 3: 0.1% (III)]. Pain relief, dermatomal spread, and motor block were assessed.ResultsVisual analog pain scale (VAS) was significantly lower in group 2 (0.88 ± 1.34) and group 3 (0.25 ± 0.61) than in group 1 (4.37 ± 2.57). Onset and time to maximum analgesia was significantly shorter in group 2 than in group 3. Mean duration of analgesia was 120 ± 21 minutes in group 3, 100 ± 26 in group 2, and 43 ± 21 in group 1. The mean numbers and upper limits of dermatomes blocked did not differ between groups 2 and 3, but were higher than in group 1. Motor blocks in groups 2 and 3 were more extensive than in group 1 with no difference between groups 2 and 3. Ten mL 0.2% or 20 mL 0.1% epidural bupivacaine results in a similar degree of pain relief, superior to that following 4 mL 0.5%, while duration was longest after 20 mL 0.1%.ConclusionsAnalgesia lasts significantly longer following 20 mL 0.1% bupivacaine than following 10 mL 0.2% bupivacaine when given for first-stage labor pain. Four milliliters 0.5% bupivacaine results in inadequate pain relief.
Spinal Anesthesia With Tetracaine in 0.75% Glucose: Influence of the Vertebral Interspace Used for Injection
Authors: Sakura Shinichi , Sumi Mariko , Morimoto Noriko , Yamamori Yuji , Saito Yoji 
Published: March 2019

Background and ObjectivesThe anesthetic behavior and hemodynamic consequences of spinal anesthesia with marginally hyperbaric tetracaine containing a low concentration of glucose injected at two different interspaces were examined and compared with those of conventionally hyperbaric solution.MethodsOne-hundred twenty ASA Physical Status I or II patients scheduled for elective surgery to the lower limb were sequentially assigned to one of three equal groups to receive spinal anesthesia: Group 1 received 0.5% tetracaine in 0.75% glucose with 0.125% phenylephrine at the L2-L3 interspace; group 2 0.5% tetracaine in 0.75% glucose with 0.125% phenylephrine at the L3-L4 interspace; group 3 0.5% tetracaine in 7.5% glucose with 0.125% phenylephrine at the L3-L4 interspace. Neural block was assessed in a double-blinded manner by cold, pinprick, and touch sensation, and a modified Bromage scale after the injection of the study drug.ResultsInjection at the L2-L3 interspace produced significantly higher spread of analgesia [median T7 (10th, 90th percentiles T10, T4)] than injection at L3-L4 interspace [T10 (L1, T5)] when using the solution in 0.75% glucose. There were no significant differences in peak dermatomal levels between groups 1 and 3, but the number of patients who required ephedrine for the treatment of hypotension was larger in group 3.ConclusionsA marginally hyperbaric tetracaine solution injected at the L2-L3 interspace with the patient in the lateral position produced greater extent of cephalad spread than that at the L3-L4 interspace. When compared to a conventionally hyperbaric tetracaine solution injected at the L3-L4 interspace, the marginally hyperbaric solution injected at the L2-L3 interspace caused less hemodynamic variability despite similar levels of maximum sensory block.
Alkalinizing Water-Soluble Local Anesthetic Solutions by Addition of Cyclodextrin
Authors: Miyoshi Michio , Imoto Toshiaki , Hiji Yasutake 
Published: March 2019

Background and objectivesThe use of sodium bicarbonate for alkalinization of local anesthetics to improve their efficacy has some disadvantages including decreased stability of the solutions. The present study was performed to evaluate usefulness of cyclodextrins (CDs) in improving the solubility and stability of local anesthetic solutions at near physiologic pH without precipitation.MethodsSolubility of local anesthetics with or without CDs in physiologic saline was investigated by monitoring cloudiness or precipitate formation visually and by recording absorbance at 620 nm. Interaction of anesthetic and CD was also studied spectrophotometrically using spectral change of the drugs associated with the inclusion complex formation.ResultsCyclodextrins improved the solubility and stability of the four local anesthetics studied (dibucaine, tetracaine, bupivacaine, and lidocaine). In the neutral pH region, the effects of the CDs were more significant with dibucaine and tetracaine, which are more hydrophobic than the other two. A type of effective CD was different for each anesthetic depending partly on the tendency to form inclusion complex with local anesthetic. The local anesthetic solutions solubilized by CDs were found to remain clear for more than 72 hours without any visible precipitation or turbidity at neutral pHs.ConclusionsThe improved solubility of local anesthetics by adding CD may be caused by inclusion complex formation of CD with local anesthetics. This new preparation for the alkalinized water-soluble anesthetic solutions may be useful for practical application in the clinical setting, although this awaits further study.
Addition of Bupivacaine to Sufentanil in Patient-Controlled Epidural Analgesia After Lower Limb Surgery in Young Adults
Authors: Vercauteren Marcel P. , Van Den Bergh Lieve , Kartawiadi Sri L. , Van Boxem Koen , Hoffmann Vincent L.H. 
Published: March 2019

Background and ObjectivesThe usefulness of adding bupivacaine to an opioid administered by the epidural route is controversial. This study examines both the quality of pain relief and side effects, in particular urinary retention, during patient-controlled epidural analgesia (PCEA) with sufentanil alone or in combination with two different concentrations of bupivacaine.MethodsIn a double-blind randomized study, 60 healthy young adults undergoing open knee or ankle surgery with combined spinal-epidural anesthesia received postoperative analgesia via PCEA with sufentanil alone or with 0.06% or 0.12% bupivacaine. In addition to pain scores at rest and during mobilization, bladder function was evaluated. Strict criteria were respected in scoring the occurrence of problems suggestive of urinary retention. The 24-hour analgesic consumption and the incidence of other side effects were also recorded.ResultsPatients receiving bupivacaine had better pain relief than those receiving only the opioid, but this difference was more pronounced when measuring dynamic pain scores. The consumption of sufentanil was significantly higher in the group receiving the opioid alone than in the group receiving 0.06% bupivacaine. The bupivacaine dose requirements were twice as high with the 0.12% concentration. Bladder problems occurred significantly more frequently in patients treated with the highest bupivacaine concentration. Motor impairment was not a major problem.ConclusionsA 0.06% bupivacaine-sufentanil combination offered the best results in terms of analgesic quality and lower side effects, mainly micturition problems, which may be explained by the higher consumption of local anesthetic at the higher bupivacaine concentration. Analgesic quality could not be improved by increasing the bupivacaine concentration.
Sympathetic Hyperactivity, Respiratory Failure, Pruritus, and Anesthesia After Unintentional Epidural Injection of Potassium Chloride: Case Report
Authors: do Nascimento Paulo , Módolo Norma Sueli Pinheiro , do Amaral Meletti José Fernando , Braz José Reinaldo Cerqueira 
Published: March 2019

Background and ObjectivesA combination of epidural and general anesthesia has been widely used to attenuate the surgical stress response and to provide postoperative analgesia. This case report illustrates the use of this anesthetic technique. Analgesia was induced with local anesthetic in the immediate postoperative period using unintentional 19.1% potassium chloride (KCI) as diluent.MethodsAn ASA I male patient was scheduled for surgical correction of idiopathic megaesophagus under continuous epidural anesthesia combined with general anesthesia. In the postoperative period, while preparing 10 mL 0.125% bupivacaine to be administered through the epidural catheter for pain control, 5 mL 19.1% KCI was unintentionally used as diluent, resulting in a 9.55% potassium solution concentration.ResultsThe patient developed warmness of the lower limbs, tachycardia, hypertension, intense pruritus on the chest, agitation, exacerbation of sensory and motor blocks, and respiratory failure secondary to pulmonary edema, requiring ventilatory support. Total recovery was observed after 24 hours.ConclusionsEpidurally injected potassium leads to severe clinical manifestations caused by autonomic dysfunction, spinal cord irritation, and possible release of histamine. Despite continuous recommendations, ampule misidentification still happens in hospitals, frequently leading to serious accidents.
Ultrasound-guided subomohyoid suprascapular nerve block and phrenic nerve involvement: a cadaveric dye study
Authors: Sehmbi Herman , Johnson Marjorie , Dhir Shalini 
Published: March 2019

Backgrounds and objectives
The anterior approach to the subomohyoid suprascapular (SOS) nerve is a new, technically easy and reliable regional anesthesia technique for postoperative shoulder analgesia. However, due to its proximity, the injectate may spread to the brachial plexus and phrenic nerve. The goal of this anatomic study with dye injection in the subomohyoid space and subsequent cadaver dissection was to establish the likely spread of local anesthesia and the extent of brachial plexus and phrenic nerve involvement resulting from ultrasound-guided SOS nerve block.

Methods
The suprascapular nerve (SSN) under the inferior belly of omohyoid muscle in the posterior triangle of the neck was identified. Using a contrast dye, 10 ultrasound-guided SOS nerve injections of 5 mL were done bilaterally, in five fresh cadavers. The area was then dissected to evaluate the spread of the contrast dye in the immediate proximity of the brachial plexus, phrenic and SSN.

Results
The SSN and omohyoid muscle were easily identified on each cadaver. SOS nerve staining with contrast dye was seen in 90% of dissections. The superior trunk was stained in 90% and the middle trunk was stained in 80% of dissections. The inferior trunk was stained in 20% of dissections. A spread of dye around the SSN was observed in 90% and the phrenic nerve was mildly stained in 20% of the dissections.

Conclusion
In-plane ultrasound-guided needle injection with a 5 mL volume for SOS block was sufficient to stain the SSN. This conservative volume involved other parts of the brachial plexus and may potentially spread to the phrenic nerve. Further clinical studies are required for confirmation.