bluuebunny/crossref_metadata_2025_split huggingface dataset:
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS IN A CASE OF CONGENITAL RETINAL MACROVESSEL WITH ANOMALOUS RETINAL ANASTOMOSIS ASSOCIATED WITH CONTRALATERAL MYELINATED NERVE FIBERS AND RETINAL VASCULAR ABNORMALITIES
Authors: Preziosa Chiara , Milani Paolo , Ciasca Paola , Bergamini Fulvio , Staurenghi Giovanni , Pellegrini Marco 
Published: March 2019

Purpose:
To describe a case of congenital retinal macrovessel complicated by cystoid macular edema associated with contralateral myelinated retinal nerve fibers and retinal vascular abnormalities studied with optical coherence tomography angiography (OCTA).

Methods:
Case report.

Results:
A healthy 25-year-old woman with decreased vision in her right eye was found to have a congenital retinal venous macrovessel in the macula associated with cystoid edema. In the contralateral amblyopic eye, the examination revealed a tuft of myelinated retinal nerve fibers along the superotemporal vascular arcade associated with superficial vascular abnormalities. A complete multi-imaging examination was obtained, including fundus color photography, fluorescein angiography, indocyanine green angiography, optical coherence tomography (OCT), and optical coherence tomography angiography. At 1-week follow-up, the optical coherence tomography displayed spontaneous resolution of the edema that remained stable at consecutive 1-month follow-up.

Conclusion:
Congenital retinal macrovessels can be associated with other ocular developmental anomalies. Vascular complications can occur, leading to macular edema and retinal ischemia. Optical coherence tomography angiography can be useful for the diagnosis and follow-up of this condition.
Preventive hypothermia as a neuroprotective strategy for paclitaxel-induced peripheral neuropathy
Authors: Beh Suet Theng , Kuo Yu-Min , Chang Wun-Shaing Wayne , Wilder-Smith Einar , Tsao Chia-Hui , Tsai Chia-Hua , Chen Li-Tzong , Liao Lun-De 
Published: March 2019

Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a severe adverse effect that occurs secondary to anticancer treatments and has no known preventive or therapeutic strategy. Therapeutic hypothermia has been shown to be effective in protecting against central and peripheral nervous system injuries. However, the effects of therapeutic hypothermia on CIPN have rarely been explored. We induced lower back hypothermia (LBH) in an established paclitaxel-induced CIPN rat model and found that the paclitaxel-induced impairments observed in behavioral, electrophysiological, and histological impairments were inhibited by LBH when applied at an optimal setting of 24°C to the sciatic nerve and initiated 90 minutes before paclitaxel infusion. Lower back hypothermia also inhibited the paclitaxel-induced activation of astroglia and microglia in the spinal cord and macrophage infiltration into and neuronal injury in the dorsal root ganglia and sciatic nerves. Furthermore, LBH decreased the local blood flow and local tissue concentrations of paclitaxel. Finally, in NOD/SCID mice inoculated with cancer cells, the antiproliferative effect of paclitaxel was not affected by the distal application of LBH. In conclusion, our findings indicate that early exposure to regional hypothermia alleviates paclitaxel-induced peripheral neuropathy. Therapeutic hypothermia may therefore represent an economical and nonpharmaceutical preventive strategy for CIPN in patients with localized solid tumors.
Psychiatric Nurse Practitioner Residents Improve Quality and Mental Health Outcomes for Veterans Through Measurement-Based Care
Authors: McGuinness Teena M. , Richardson Jessica W. , Nicholson W. Chance , Carpenter Jennifer , Cleveland Cynthia , Rodney Kanini Z. , Harper Doreen C. 
Published: March 2019

ABSTRACT

Introduction:
Measurement-based care (MBC) is commonly used to manage medical illness, whereas only about 20% of psychiatric care providers use MBC. One aim of the partnership between the Birmingham Veterans Affairs Medical Center (BVAMC) and the University of Alabama at Birmingham School of Nursing (UAB SON) is to provide MBC to Veterans. The goal is to describe the efficacy of MBC in the treatment of Veterans by psychiatric-mental health nurse practitioner (PMHNP) residents.

Purpose:
By teaching PMHNP residents evidence-based assessment, they gain tools to shorten time to remission of depression, anxiety, and posttraumatic stress disorder.

Methods:
Residents administered the Patient Stress Questionnaire (PSQ), an MBC tool that assesses depression, anxiety, trauma-related symptoms, and alcohol use, to patients of the Residency Continuity Clinic (RCC). Patient Stress Questionnaire scores from March 2016 to May 2018 were analyzed using paired t tests.

Results:
Analysis revealed a downward trend in PSQ scores over time, suggesting improvement in psychiatric symptoms. Depressive and anxiety symptoms decreased significantly.

Conclusions/Implications:
This quality project highlights the utility of MBC by PMHNP residents in an RCC. Measurement-based care tools can be quickly and easily administered with little impact on workflow. Use of validated screening tools can enhance care, engage patients, and improve patient outcomes.
Contextual Factors Associated With Quality Improvement Success in a Multisite Ambulatory Setting
Authors: Douglas Lindsey C. , Heo Moonseong , Azad Namita , Racine Andrew D. , Rinke Michael L. 
Published: March 2019

ABSTRACT
The Model for Understanding Success in Quality (MUSIQ) is a framework of contextual factors for quality improvement (QI) projects. We sought to determine which MUSIQ contextual factors were associated with successful QI initiatives. In a cross-sectional survey study, at a 21-site, ambulatory, urban primary care network, a modified MUSIQ survey tool questionnaire was administered to QI team members. The primary analysis associated objective measures of QI success with MUSIQ contextual factors. Objective QI success was defined as reaching goal percentages of adult patients with diabetes achieving glycated hemoglobin less than 8% and/or pediatric patients who had received combination toddler vaccines. Objective outcomes were compared with a subjective, self-reported outcome measure of QI success because previous literature found subjective outcomes were associated with specific MUSIQ factors. In the 143 survey responses collected, across 21 sites, no contextual factors from the MUSIQ survey were associated with either the adult or pediatric objective measure of QI project success. In a post hoc analysis, objective and subjective measures of success were often not associated and/or negatively correlated. In conclusion, contextual factors were not associated with objective measures of QI outcomes, in contrast to previous studies finding associations with subjective QI outcome measures.
PD-1 immunotherapy in pancreatic cancer: current status
Authors: Pu Ning , Lou Wenhui , Yu Jun 
Published: March 2019

Abstract
Pancreatic ductal adenocarcinoma is the known kind of tumor biologically featured as high malignant degree, lack of effective methods for diagnosis and treatment, which reflects its unpleasant prognosis. Recently, with the breakthrough of burgeoning therapeutic methods, the flush of dawn for pancreatic cancer nearly arrives. Nowadays, besides surgery, neoadjuvant chemoradiotherapy, tumor vaccine therapy, and immunotherapy all show their active situation and obtain certain clinical efficacy, but that is still limited to pancreatic cancer. However, the appearance and development of programmed cell death-1 (PD-1) immune checkpoint inhibitor may final improve survival of pancreatic cancer. This article aims to deeply understand the value of PD-1 immune checkpoint inhibitor in pancreatic cancer and validly provide the evidence for treatment by means of performing a systematic review on the current status in the fields of the mechanism and application of anti-PD-1 in pancreatic cancer, associations with surgery, PD-1-related side effects and prospections.
Recommendations to Increase Neuromuscular Electrical Stimulation Training Intensity During Quadriceps Treatments for Orthopedic Knee Conditions
Authors: Bremner Cody B. , Holcomb William R. , Miller Michael G. 
Published: March 2019

Abstract:
Neuromuscular electrical stimulation (NMES) is often used by clinicians as a therapeutic adjunct to improve quadriceps strength deficits following orthopedic knee conditions. The efficacy of NMES treatments is primarily dependent on the NMES training intensity, which is a direct result of NMES-induced torque production. The importance of NMES training intensity is well known, yet adequate NMES training intensities are often difficult to achieve due to a variety of limitations associated with NMES (eg, fatigue and patient discomfort). This article provides recommendations that a clinician can use to increase NMES training intensity when strengthening the quadriceps with NMES for orthopedic knee conditions. These recommendations should allow forceful contractions that can be sustained over a treatment with multiple repetitions without the rapid decline in force that is typically seen when NMES is used.
Improving perceptions of patient safety through standardizing handoffs from the emergency department to the inpatient setting: a systematic review
Authors: Alimenti Darcy , Buydos Sarah , Cunliffe Lindsay , Hunt Alexandra 
Published: March 2019

ABSTRACT

Background and purpose:
Patient handoffs have long been identified as a potentially challenging time for patients because poor communication produces numerous complications. This is especially true with regards to patient care handoffs between areas such as the emergency department (ED) and inpatient setting. The purpose of this systematic review is to analyze existing literature pertaining to standardized handoffs between the ED and inpatient setting and its effect on perceived patient safety to guide future research, clinical practice, and patient safety.

Methods:
A review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were selected using predetermined inclusion/exclusion criteria: primary research and patient handoff from the ED to the inpatient setting. Quality assessment of the studies was completed using The Joanna Briggs Institute critical appraisal tool.

Conclusion:
Existing studies demonstrate the potential for increased perception of patient safety as well as provider satisfaction when appropriate staff education and standardized handoff tools are implemented. There is a lack of data on the standardization of handoff tools between the ED and inpatient setting and their impact on perceived patient safety.

Implications for practice:
The combination of provider education and implementation of standardized handoff tools in the ED positively affects perceptions of patient safety and provider satisfaction. Hospital administrations should strongly consider incorporating standardized handoff tools into practice.
Thematic analysis of nurse practitioners use of clinical decision support tools and clinical mobile apps for prescriptive purposes
Authors: Dodson Crystal Heath , Baker Elizabeth , Bost Kirsten 
Published: March 2019

ABSTRACT

Background and purpose:
An obstacle to clinical implementation of precision medicine is the absence of easily accessible peer-reviewed, comprehensive clinical practice guidelines. Therefore, an easily accessible format is needed to propel the adoption of these guidelines by healthcare providers. An understanding of the process providers take to prescribe medications will inform development of clinical decision support tools, specifically related to precision medicine. Successful use of mobile applications will depend on the buy-in from healthcare providers. The purpose of this study was to assess perceptions of trustworthiness surrounding clinical decision support tools and mobile applications through interviews with nurse practitioners.

Methods:
A descriptive, qualitative research design was used. A sample of 10 nurse practitioners who actively prescribe medication was used within the study.

Conclusions:
The participants mentioned both negative and positive attitudes regarding these prescribing techniques. Overall four themes emerged from this thematic analysis: the use of pharmacists to help with current prescribing practices, reliance on the EMR as a clinical decision support tool, lack of mobile app use in clinical practice, but the desire to have these resources if they were affordable and reliable.

Implications for practice:
The participants were aware of the use of mobile apps for clinical decision support, but the adoption of these tools was limited due to the perceived lack of affordability and reliability. Therefore, to overcome these barriers to adoption of a mobile app related to precision medicine, affordability and transparent construction of an app grounded in credible sources must be developed.
Efficacy of the Well-Being Index to identify distress and stratify well-being in nurse practitioners and physician assistants
Authors: Dyrbye Liselotte N. , Johnson Pamela O. , Johnson LeAnn M. , Halasy Michael P. , Gossard Andrea A. , Satele Daniel , Shanafelt Tait 
Published: March 2019

ABSTRACT

Background and purpose:
To evaluate the ability of the Well-Being Index (WBI) to stratify distress and well-being (high quality of life [QOL]) in nurse practitioners and physician assistants (NPs and PAs) and identify those whose degree of distress place them at an increased risk for medical error or turnover.

Methods:
A national sample of NPs and PAs completed a survey that included the WBI and instruments to measure QOL, fatigue, burnout, recent suicidal ideation, medical error, and intent to leave the current job.

Conclusions:
Overall, 1,576 of 4,106 (38.4%) NPs and PAs completed the survey. Those NPs and PAs with low mental QOL, extreme fatigue, recent suicidal ideation, or burnout had less favorable WBI scores (all p < .0001). Using a prevalence of low overall QOL among APPs of 14.4% as the pretest probability, the WBI score can reduce the posttest probability of low QOL to 2% or increase it to 64.7%. As the WBI score worsened, the posttest probability of high overall QOL decreased from 73% to 8.2%. Also, WBI score stratified the NPs and PAs likelihood of reporting recent medical errors and intent to leave his or her current job.

Implications for practice:
The WBI is a useful screening tool to stratify distress and well-being in APPs across a variety of domains and identify those NPs and PAs whose degree of distress may increase the risk of medical error or turnover.
Management of ketosis-prone type 2 diabetes mellitus
Authors: Smolenski Stefan , George Nancy M. 
Published: March 2019

ABSTRACT
Diabetic ketoacidosis (DKA) has largely been considered unique to type 1 diabetes because of the absolute lack of insulin production secondary to beta-cell dysfunction. However, a relatively new diabetes subtype known as ketosis-prone type 2 diabetes mellitus (DM) may also elicit diabetic ketoacidosis. Ketosis-prone type 2 DM shares a similar pathophysiology as type 2 DM, but presents initially with signs and symptoms consistent with type 1 DM. Patients with ketosis-prone type 2 DM often present with elevated glucose levels of 500–700 mg/dl, elevated ketone levels, and elevations in hemoglobin A1C. Unlike DKA seen in type 1 DM, they do not exhibit autoantibodies to beta cells. The similarity with type 1 DM exists in their impaired insulin secretion, which, when combined with extreme insulin resistance, will lead to ketoacidosis. Despite the initial clinical presentation that resembles type 1 DM, patients may not require lifelong insulin and achieve appropriate glycemic control with oral agents. Nurse practitioners must recognize the clinical picture of ketosis-prone type 2 DM and use a multifaceted approach, encouraging dietary changes, increased physical activity, and medication adherence to build the self-management skills of the patient and ultimately decrease the long-term disease burden.
Evaluating quality metrics of patients with type 2 diabetes managed by nurse practitioners in two family nurse practitioner-owned clinics
Authors: Wright Wendy L. , Bachmann Jade P. , Murphy Nicole , Gifford Lauren , Strowman Shelley , White Patricia 
Published: March 2019

ABSTRACT

Background:
Diabetes is a major health concern in the U.S. with increasing prevalence. There are limited data on nurse practitioner (NP) roles in diabetes management and clinical patient outcomes in relation to national standards of care. This project aimed to identify rates of American Diabetes Association (ADA) guideline adherence of two NP-owned and operated practices during an ongoing four-year quality improvement project.

Methods:
Methods: Electronic health records of 83 – 112 patients (depending on the year) ages > 18 years with type 2 diabetes were reviewed. Mean A1C and rates of adherence to ADA standards were compared from 2013 to 2017 and to national and state data.

Conclusions:
Findings demonstrated that diabetes management provided by NPs consistently adhered to national ADA standards of care and met or exceeded national data. This four-year ongoing quality improvement project has led to the implementation of practice modifications that continue to improve patient outcomes through increased adherence to ADA guidelines.

Implications for practice:
Strategies which improve adherence to ADA standards of care by NPs are essential. Identifying rates of adherence and implementing quality improvement strategies can significantly improve the quality of care provided to patients with diabetes.
Using a Laryngeal Mask Airway During Percutaneous Dilatational Tracheostomy is Safe and Obviates the Need for Paralytics
Authors: Sonti Rajiv , Sanley Michael , Vinayak Ajeet 
Published: March 2019

Background:
Bedside percutaneous tracheostomy (PT) placement in critically ill patients is performed in a variety of ways, largely driven by institutional preference. We have recently transitioned to primarily extubating the patient and placing a laryngeal mask airway (LMA) before tracheostomy insertion in lieu of retracting the endotracheal tube (ETT) in place. This allows for lower sedative use and provides a superior view of the operative field. Here, we seek to describe the safety and efficiency of that approach.

Methods:
This is a single-center cross-sectional study from 2014 to 2016 comparing patients who underwent PT with the ETT in place retracted to the proximal larynx versus those who were extubated and had a LMA placed. Procedural length, sedative totals, and safety outcomes were recorded.

Results:
In total, 125 patients underwent PT during the study period, 75 via a LMA and 50 via existing ETT. There was no difference in procedural duration (LMA: 53.5±21.4 min vs. ETT: 50.4±16.8; P=0.41), total complications (LMA: 29.3% vs. 16%; P=0.09) or major complications (4% in both groups). Cisatracurium use was significantly lower in the LMA arm (LMA: 1.0±3.6 mg vs. ETT: 11.5±5.9 mg; P<0.01).

Conclusion:
Replacing the ETT with an LMA before PT is equally safe, does not increase total procedural duration, and all but eliminates the need for paralytic agents.
Fiberoptic Bronchoscopic Balloon Dilatation of Bronchial Stenosis in Children
Authors: Köse Mehmet , Hangül Melih , Erkan Gözde Nur , Narin Nazmi 
Published: March 2019

Background:
Bronchial stenosis and treatment with balloon dilatation are rarely experienced in children. The aim of this study was to investigate the results of fiberoptic bronchoscopic balloon dilatation (BBD) in children.

Methods:
Between January 2016 and March 2018, 7 children diagnosed as having bronchial stenosis and who underwent BBD as the first treatment option were enrolled in the study.

Results:
A total of 10 BBDs were performed in 7 patients with a median age of 10 months. Underlying causes were as follows: prolonged intubation and prematurity in 4 patients, extubation failure in 2 patients, and recurrent pneumonia and malignancy in 1 patient. The only complication was laceration, seen in 2 patients. The patients were symptom free for 11 months.

Conclusion:
BBD is safe, effective, and might be the first-line treatment option for children with bronchial stenosis.
First Implant-Induced Changes in Rostral Brainstem Impair Second Implant Outcomes in Sequential Bilateral Cochlear Implant Children With Long Inter-Implant Delay
Authors: Kishimoto Ippei , Yamazaki Hiroshi , Naito Yasushi , Moroto Saburo , Yamazaki Tomoko 
Published: March 2019

Hypothesis:
Long-term unilateral use of a cochlear implant (CI) induces abnormal maturation of the rostral brainstem innervating the contralateral ear.

Background:
In sequential bilateral CI children with long inter-implant delay, both sides of auditory cortices were dominantly activated by the first CI, but mechanisms of this abnormal development of the auditory system remain unclear.

Methods:
Fifteen sequential bilateral CI children with long delay (mean ± SD, 28.7 ± 12.1 mo) underwent electrically evoked auditory brainstem response (EABR) testing using each of the first and second CI (CI1 and CI2, respectively), immediately after the second implantation. CI1 and CI2 were implanted at age of 23.7 ± 9.6 and 53.1 ± 12.1 months (mean ± SD), respectively. Apical-to-basal difference in electrically evoked interwave III-V latencies (eIII-eV slope) which decreases with implant use was compared between the CI1 and CI2 sides. Their speech perception scores were evaluated 3 years after the second implantation.

Results:
eIII-eV slopes evoked by the CI2 showed less mature pattern than those by the CI1. This CI2 versus CI1 difference in eIII-eV slopes, however, reduced as the inter-implant delay was prolonged, suggesting CI1-induced maturation of the rostral brainstem innervating the second ear before the second implantation. The smaller CI2 versus CI1 difference in eIII-eV slopes at the second implantation was correlated to poorer outcomes using the CI2 than the CI1.

Conclusions:
In this population, long-term unilateral CI use induced re-organization of the rostral brainstem innervating the second ear, which affected hearing outcomes using the CI2. Evaluation of eIII-eV slopes at the second implantation may be useful to predict hearing outcomes with CI2.
Video Head Impulse Test in Vestibular Schwannoma: Relevance of Size and Cystic Component on Vestibular Impairment
Authors: Constanzo Felipe , Teixeira Bernardo Corrêa de Almeida , Sens Patricia , Ramina Ricardo 
Published: March 2019

Objectives:
Tumor factors that influence vestibular function in vestibular schwannoma (VS) have not been properly described. We evaluated whether cystic VSs have different vestibular function than solid VS. Tumor size on vestibular function was also evaluated.

Study Design:
Cross-sectional study.

Setting:
Tertiary referral center.

Patients:
Forty-one cases of sporadic, untreated VS.

Intervention:
Evaluation with video head impulse test and MRI.

Main Outcome Measures:
Tumors were classified as solid, heterogeneous, or cystic and by size using the Hannover classification. Vestibulo-ocular reflex (VOR) gain was correlated to tumor size and cystic status.

Results:
Large VS had worse VOR gain than small lesions (p < 0.001). Cystic lesions had lower VOR gain than all other tumors (p = 0.001), Hannover T3 and T4 (p = 0.014), Hannover T4 (p = 0.015), solid tumors (p < 0.001), solid Hannover T3 and T4 (p = 0.003), and solid Hannover T4 (p = 0.008). Heterogeneous VSs had lower VOR gain compared to solid tumors (p = 0.02), solid Hannover T3 and T4 (p = 0.08), and solid Hannover T4 (p = 0.14). Heterogeneous and cystic VSs had lower VOR gain than solid tumors (p < 0.001), solid Hannover T3 and T4 (p = 0.004), and solid Hannover T4 (p = 0.02). VOR gain of solid T4 lesions was not significantly lower than solid Hannover T1-T3 (p = 0.33).

Conclusion:
Cystic status is directly associated with a worse vestibular dysfunction. Size did not significantly impact vestibular function in solid VS.