bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and implementation of a mobile device-based pediatric electronic decision support tool as part of a national practice standardization project
Authors: McCulloh Russell J , Fouquet Sarah D , Herigon Joshua , Biondi Eric A , Kennedy Brandan , Kerns Ellen , DePorre Adrienne , Markham Jessica L , Chan Y Raymond , Nelson Krista , Newland Jason G 
Published: May 2018

Abstract

Objective
Implementing evidence-based practices requires a multi-faceted approach. Electronic clinical decision support (ECDS) tools may encourage evidence-based practice adoption. However, data regarding the role of mobile ECDS tools in pediatrics is scant. Our objective is to describe the development, distribution, and usage patterns of a smartphone-based ECDS tool within a national practice standardization project.

Materials and Methods
We developed a smartphone-based ECDS tool for use in the American Academy of Pediatrics, Value in Inpatient Pediatrics Network project entitled “Reducing Excessive Variation in the Infant Sepsis Evaluation (REVISE).” The mobile application (app), PedsGuide, was developed using evidence-based recommendations created by an interdisciplinary panel. App workflow and content were aligned with clinical benchmarks; app interface was adjusted after usability heuristic review. Usage patterns were measured using Google Analytics.

Results
Overall, 3805 users across the United States downloaded PedsGuide from December 1, 2016, to July 31, 2017, leading to 14 256 use sessions (average 3.75 sessions per user). Users engaged in 60 442 screen views, including 37 424 (61.8%) screen views that displayed content related to the REVISE clinical practice benchmarks, including hospital admission appropriateness (26.8%), length of hospitalization (14.6%), and diagnostic testing recommendations (17.0%). Median user touch depth was 5 [IQR 5].

Discussion
We observed rapid dissemination and in-depth engagement with PedsGuide, demonstrating feasibility for using smartphone-based ECDS tools within national practice improvement projects.

Conclusions
ECDS tools may prove valuable in future national practice standardization initiatives. Work should next focus on developing robust analytics to determine ECDS tools’ impact on medical decision making, clinical practice, and health outcomes.
An investigation of sepsis surveillance and emergency treatment on patient mortality outcomes: An observational cohort study
Authors: Amland Robert C , Sutariya Bharat B 
Published: May 2018

Abstract

Objective
To determine the prevalence of initiating the sepsis 3-h bundle of care and estimate effects of bundle completion on risk-adjusted mortality among emergency department (ED) patients screened-in by electronic surveillance.

Materials and Methods
This was a multiple center observational cohort study conducted in 2016. The study population was comprised of patients screened-in by St. John Sepsis Surveillance Agent within 4 h of ED arrival, had a sepsis bundle initiated, and admitted to hospital. We built multivariable logistic regression models to estimate impact of a 3-h bundle completed within 3 h of arrival on mortality outcomes.

Results
Approximately 3% ED patients were screened-in by electronic surveillance within 4 h of arrival and admitted to hospital. Nearly 7 in 10 (69%) patients had a bundle initiated, with most bundles completed within 3 h of arrival. The fully-adjusted risk model achieved good discrimination on mortality outcomes [area under the receiver operating characteristic 0.82, 95% confidence interval (CI) 0.79–0.85] and estimated 34% reduced mortality risk among patients with a bundle completed within 3 h of arrival compared to non-completers.

Discussion
The sepsis bundle is an effective intervention for many vulnerable patients, and likely to be completed within 3 h after arrival when electronic surveillance with reliable alert notifications are integrated into clinical workflow. Beginning at triage, the platform and sepsis program enables identification and management of patients with greater precision, and increases the odds of good outcomes.

Conclusion
Sepsis surveillance and clinical decision support accelerate accurate recognition and stratification of patients, and facilitate timely delivery of health care.
Surgical Outcomes Following Repeat Transsphenoidal Surgery for Nonfunctional Pituitary Adenomas: A Retrospective Comparative Study
Authors: Bakhsheshian Joshua , Wheeler Sarah , Strickland Ben A , Pham Martin H , Rennert Robert C , Carmichael John , Weiss Martin , Zada Gabriel 
Published: May 2018

Abstract

BACKGROUND
Endonasal transsphenoidal surgery (ETSS) remains the preferred treatment for recurrent or residual nonfunctional pituitary adenomas (NFPAs). However, surgical complications and outcomes with repeat ETSS are unclear.

OBJECTIVE
To compare outcomes from primary and repeat ETSS in patients with NFPAs.

METHODS
Retrospective review of ETSS for NFPAs at USC University Hospital and LAC + USC Medical Center between 2000 and 2015. Patients with ≥3-mo follow-up data were included. Patients were categorized as primary or repeat ETSS. Patient and tumor characteristics were compared preoperatively, and postoperative outcomes were analyzed.

RESULTS
Two hundred sixty-eight patients (89%) met the inclusion criteria (primary ETSS = 211 and repeat ETSS = 57) with a mean follow-up time of 38 mo (range 3-235 mo). Both groups had similar demographics, endocrine function, and tumor characteristics. Surgical complication rates were similar and no mortalities were observed. Repeat ETSS patients had a higher rate of new postoperative panhypopituitarism (primary ETSS: 0.5% vs repeat ETSS: 7.1%, P = .011), lower rates of gross total resection (GTR; primary ETSS: 59.2% vs repeat ETSS: 26.3%, P = .001), and greater rates of postoperative radiosurgery (36.8% vs 24.2%, P = .009). At 2-yr follow-up, progression-free survival on MRI was similar in both groups (primary ETSS: 97.9% vs repeat ETSS: 95.4%, log-rank test P = .807).

CONCLUSION
At experienced tertiary pituitary centers, repeat ETSS for NFPAs was associated with a similar incidence of surgical complications as primary ETSS. However, repeat ETSS carried a higher rate for worsening endocrine dysfunction and a lower rate of GTR.
MIRIS observation of near-infrared diffuse Galactic light
Authors: Onishi Yosuke , Sano Kei , Matsuura Shuji , Jeong Woong-Seob , Pyo Jeonghyun , Kim Il-Jong , Seo Hyun Jong , Han Wonyong , Lee DaeHee , Moon Bongkon , Park Wonkee , Park Younsik , Kim MinGyu , Matsumoto Toshio , Matsuhara Hideo , Nakagawa Takao , Tsumura Kohji , Shirahata Mai , Arai Toshiaki , Ienaka Nobuyuki 
Published: May 2018

Abstract
We report near-infrared (IR) observations of high Galactic latitude clouds to investigate diffuse Galactic light (DGL), which is starlight scattered by interstellar dust grains. The observations were performed at 1.1 and 1.6 μm with a wide-field camera instrument, the Multi-purpose Infra-Red Imaging System (MIRIS) onboard the Korean satellite STSAT-3. The DGL brightness is measured by correlating the near-IR images with a far-IR 100 μm map of interstellar dust thermal emission. The wide-field observation of DGL provides the most accurate DGL measurement achieved to-date. We also find a linear correlation between optical and near-IR DGL in the MBM32 field. To study interstellar dust properties in MBM32, we adopt recent dust models with and without μm-sized very large grains and predict the DGL spectra, taking into account the reddening effect of the interstellar radiation field. The result shows that the observed color of the near-IR DGL is closer to the model spectra without very large grains. This may imply that dust growth in the observed MBM32 field is not active owing to the low density of its interstellar medium.
Intraneural Ultrasound-guided Sciatic Nerve Block
Authors: Cappelleri Gianluca , Ambrosoli Andrea Luigi , Gemma Marco , Cedrati Valeria Libera Eva , Bizzarri Federico , Danelli Giorgio Francesco 
Published: May 2018

Abstract

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Both extra- and intraneural sciatic injection resulted in significant axonal nerve damage. This study aimed to establish the minimum effective volume of intraneural ropivacaine 1% for complete sensory-motor sciatic nerve block in 90% of patients, and related electrophysiologic variations.

Methods
Forty-seven consecutive American Society of Anesthesiologists physical status I-II patients received an ultrasound-guided popliteal intraneural nerve block following the up-and-down biased coin design. The starting volume was 15 ml. Baseline, 5-week, and 6-month electrophysiologic tests were performed. Amplitude, latency, and velocity were evaluated. A follow-up telephone call at 6 months was also performed.

Results
The minimum effective volume of ropivacaine 1% in 90% of patients for complete sensory-motor sciatic nerve block resulted in 6.6 ml (95% CI, 6.4 to 6.7) with an onset time of 19 ± 12 min. Success rate was 98%. Baseline amplitude of action potential (mV) at ankle, fibula, malleolus, and popliteus were 8.4 ± 2.3, 7.1 ± 2.0, 15.4 ± 6.5, and 11.7 ± 5.1 respectively. They were significantly reduced at the fifth week (4.3 ± 2.1, 3.5 ± 1.8, 6.9 ± 3.7, and 5.2 ± 3.0) and at the sixth month (5.9 ± 2.3, 5.1 ± 2.1, 10.3 ± 4.0, and 7.5 ± 2.7) (P < 0.001 in all cases). Latency and velocity did not change from the baseline. No patient reported neurologic symptoms at 6-month follow-up.

Conclusions
The intraneural ultrasound-guided popliteal local anesthetic injection significantly reduces the local anesthetic dose to achieve an effective sensory-motor block, decreasing the risk of systemic toxicity. Persistent electrophysiologic changes suggest possible axonal damage that will require further investigation.
External Validation of the Adult Spinal Deformity (ASD) Frailty Index (ASD-FI) in the Scoli-RISK-1 Patient Database
Authors: Miller Emily K. , Lenke Lawrence G. , Neuman Brian J. , Sciubba Daniel M. , Kebaish Khaled M. , Smith Justin S. , Qiu Yong , Dahl Benny T. , Pellisé Ferran , Matsuyama Yukihiro , Carreon Leah Y. , Fehlings Michael G. , Cheung Kenneth M. , Lewis Stephen , Dekutoski Mark B. , Schwab Frank J. , Boachie-Adjei Oheneba , Mehdian Hossein , Bess Shay , Shaffrey Christopher I. , Ames Christopher P. 
Published: May 2018

Study Design.
Analysis of a prospective multicenter database.

Objective.
To assess the ability of the recently created Adult Spinal Deformity (ASD) Frailty Index (ASD-FI) to predict odds of major complications and length of hospital stay for patients who had more severe preoperative deformity and underwent more invasive ASD surgery compared with patients in the database used to create the index.

Summary of Background Data.
Accurate preoperative estimates of risk are necessary given the high complication rates currently associated with ASD surgery.

Methods.
Patients were enrolled by participating institutions in Europe, Asia, and North America from 2009 to 2011. ASD-FI scores were used to classify 267 patients as not frail (NF) (<0.3), frail (0.3–0. 5), or severely frail (SF) (>0.5). Multivariable logistic regression, adjusted for preoperative and surgical covariates such as operative time and blood loss, was performed to determine the relationship between ASD-FI category and incidence of major complications, overall incidence of complications, and length of hospital stay.

Results.
The mean ASD-FI score was 0.3 (range, 0–0.7). We categorized 105 patients as NF, 103 as frail, and 59 as SF. The adjusted odds of developing a major complication were higher for SF patients (odds ratio = 4.4; 95% CI 2.0, 9.9) compared with NF patients. After adjusting for covariates, length of hospital stay for SF patients increased by 19% (95% CI 1.4%, 39%) compared with NF patients. The odds of developing a major complication or having increased length of stay were similar between frail and NF patients.

Conclusion.
Greater patient frailty, as measured by the ASD-FI, is associated with a longer hospital stay and greater risk of major complications among patients who have severe preoperative deformity and undergo invasive surgical procedures.

Level of Evidence: 2
Incidence and Risk Factors for Instrumentation-related Complications After Scoliosis Surgery in Pediatric Patients With NF-1
Authors: Yao Ziming , Li Hao , Zhang Xuejun , Li Chengxin , Qi Xinyu 
Published: May 2018

Study Design.
Retrospective cohort study.

Objective.
To assess the incidence and risk factors of instrumentation-related complication (IRC) in pediatric patients surgically treated for neurofibromatosis type 1 (NF-1) dystrophic scoliosis.

Summary of Background Data.
Surgical management including growing rods technique and early definitive fusion has been recommended to avoid progression of NF-1 scoliosis. However, no study has yet investigated the incidence and risk factors of IRC in these surgical interventions.

Methods.
Data of 59 pediatric NF-1 patients who had been surgically treated for dystrophic scoliosis were retrospectively reviewed. All of their clinical and radiographic data were collected. We evaluated potential risk factors, including age, sex, curve type, preoperative Cobb angle, kyphosis angle and spinal length, and surgical procedure. The univariate analysis and multivariate logistic regression analysis were performed to identify the risk factors associated with IRC.

Results.
Seventeen (28.8%) patients suffered 19 IRCs, including seven cases of curve progression, three cases of screw dislodgement, three cases of adding-on phenomenon, two cases of rod breakage, two cases of proximal junctional kyphosis, one case of cap loosing, and one case of pedicle cutting. The univariate logistic regression analysis revealed age<9, kyphosis≥50°, and growing-rod techniques the significant risk factors (P < 0.05). Binomial logistic regression analysis demonstrated two independent risk factors of IRC, including kyphosis≥50° (OR: 8.23; P = 0.025) and application of growing-rod technique (OR: 8.75; P = 0.032).

Conclusion.
17/59 (28.8%) patients suffered IRCs and age less than 9 years, kyphosis more than 50° and application of growing-rod are three risk factors for IRC after surgical treatment of NF-1 dystrophic scoliosis. Identification of these risk factors aids in stratifying preoperative risk to reduce IRC incidence. In addition, the results could be used in counseling patients and their families during the consent process.

Level of Evidence: 3
Management of Airway Obstruction in Infants With Pierre Robin Sequence
Authors: Runyan Christopher M. , Uribe-Rivera Armando , Tork Shahryar , Shikary Tasneem A. , Ehsan Zarmina , Weaver K. Nicole , Hossain Md Monir , Gordon Christopher B. , Pan Brian S. 
Published: May 2018

Background:
Pierre Robin sequence (PRS)-related airway obstruction is often treated surgically; however, objective measures predicting the need for surgery are poorly defined.

Methods:
A retrospective chart review was performed on 171 neonates with PRS. Infants were grouped based upon intervention modality: nonsurgical (conservative) or surgical [mandibular distraction osteogenesis (MDO) or tracheostomy]. Demographic data, physical examination findings, and study results were compared between groups to determine risk factors for surgical intervention, and to predict long-term success or failure of those interventions.

Results:
The most significant, objective risk factor among those receiving surgery was a poor preintervention sleep study [obstructive index (OI): 42.4 versus 12.9 for the conservative treatment group; P < 0.001]. Only 11% of those treated conservatively had an OI >20, whereas 67.5% of those treated surgically met this severity measure. Of those receiving surgery, tracheostomy was associated with neurologic impairment (P = 0.030) and low birth weight (P = 0.046) compared with the MDO group. Together with syndromic status, these risk factors were useful for predicting failure of MDO to avoid subsequent tracheostomy (test sensitivity and specificity were 64.2% and 100.0%, respectively). No long-term differences in speech or micrognathia were detected between the 3 groups; however, those treated conservatively or with MDO had improved long-term feeding and airway obstruction outcomes compared with the tracheostomy group.

Conclusions:
Surgical intervention for PRS-related tongue-based airway obstruction should be strongly considered with an OI >20. Tracheostomy should be reserved for complex patients with concomitant syndromic diagnosis, neurologic impairment, and low birth weight.
Achieving Guideline-Driven High-Intensity Statin Dose in Cardiac Rehabilitation Patients With Coronary Artery Disease
Authors: Lin Jonathan , Banathy Alexandra , Winters Carla , Andersen Lars , Hudson Cindy , Testa Heidi , Reardon Joy , Alagona Peter 
Published: May 2018

Purpose:
The 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults recommends high-intensity statin therapy in patients aged ≤75 y with clinical coronary artery disease (CAD). The effectiveness of cardiac rehabilitation (CR) in lipid management and guideline adherence is unknown. The purpose of this study is to determine whether CR participation affects guideline-driven achievement for statin use.

Methods:
This multicenter retrospective study evaluated statin utilization in patients pre- and post-CR between January 1, 2014, and August 31, 2015. Records for patients with known CAD who completed 18 or more CR sessions were reviewed for statin-drug use and dose before and after CR and documented statin intolerance.

Results:
Of the total 468 patients, 76% were male with mean age ± SD = 66.0 ± 10.8 y and range of 32 to 89 y. Patients aged ≤75 y (n = 375) showed a modest but statistically significant increase (P = .0006) in high-intensity statin use post-CR (56.3%-61.1%). Males demonstrated a significant increase in high-intensity statin use (P = .0005). Of the 146 patients aged ≤75 y not on high-intensity statins post-CR, only 21 had history of statin intolerance. Of the subjects aged >75 y (n = 93), 91% were already on high- or moderate-intensity statins with no significant change during CR.

Conclusions:
Patients aged ≤75 y following CR completion increased high-intensity statin use but only by 4.8% and 33% of subjects were inadequately treated. The updated 2013 treatment recommendations simplified statin use, yet substantial data continue to reveal that guideline achievement even post-CR remains limited.
The More, the Better? The Usefulness of Brimonidine as the Fourth Antiglaucoma Eye Drop
Authors: Bro Tomas , Lindén Christina 
Published: May 2018

Purpose:
The purpose of this article was to study the intraocular pressure (IOP)-lowering effect of adding brimonidine as the fourth antiglaucoma medication to a preexisting therapy of 3 topical drugs.

Methods:
This was a retrospective, register-based, cohort study of medical records and computerized medical information comprising 1 county in Sweden. The main outcome measure was change in IOP after brimonidine addition. Short-term and long-term effects were evaluated.

Results:
Of 4910 patients on antiglaucoma medication, 69 (1.4%) initiated a treatment with brimonidine as the fourth drug during 2014. Fifty-three patients were eligible for analysis. Forty-six patients tolerated the treatment. Among them, short-term IOP decreased by 17% (confidence interval, 10%-25%; P<0.001) after a mean of 46 days (SD, 50 d). Twenty-eight patients, that is, 53% of the eligible, remained on unchanged therapy after a mean follow-up time of 368 days (SD, 61 d). The long-term mean IOP decrease in this group was 20% (confidence interval, 11%-29%; P<0.0001). An IOP reduction of at least 20% was reached by 28 and 14 patients, in the short-term and long-term follow-ups, respectively.

Conclusions:
Brimonidine has the potential to reduce the IOP significantly even when used as the fourth drug. In the short-term, half of the patients reached the target IOP reduction (≥20%). After 1 year, a quarter of the eligible patients had had a sustained, uneventful effect. Thus, brimonidine as the fourth adjunctive antiglaucoma drop seems a valuable option for a minority of patients.
Clinical indications associated with opioid initiation for pain management in Ontario, Canada: a population-based cohort study
Authors: Pasricha Sachin V. , Tadrous Mina , Khuu Wayne , Juurlink David N. , Mamdani Muhammad M. , Paterson J. Michael , Gomes Tara 
Published: May 2018

Abstract
Concerns over prescription opioids contributing to high levels of opioid use disorder and overdose have led policymakers and clinicians to seek means to reduce inappropriate and high-dose initial prescriptions. To inform such efforts, we sought to describe the clinical indications associated with opioid initiation and the characteristics of the initial prescriptions and patients through a retrospective population-based cohort study. Our cohort included Ontarians initiating prescription opioids for pain management between April 1, 2015, and March 31, 2016. We identified the apparent clinical indication for opioid initiation by linking prescription drug claims to procedural and diagnostic information on health service records on the day of, and 5 days preceding prescription. Outcomes included initial opioid type, prescription duration, and daily dose (in milligram morphine equivalents), stratified either by indication or indication cluster. Among 653,993 individuals, we successfully classified 575,512 (88.0%) people initiating opioids into 23 clinical indications in 6 clusters: dental (23.2%); postsurgical (17.4%); musculoskeletal (12.0%); trauma (11.2%); cancer/palliative care (6.5%); and other less frequent indications (17.7%). Individuals with postsurgical pain received the highest daily doses (40.5% with greater than 50 milligram morphine equivalent), and those with musculoskeletal pain received more initial prescriptions with a duration exceeding 7 days (34.2%). Opioids are initiated for a wide range of indications with varying doses and durations; yet, those who initiated opioids for postsurgical and musculoskeletal pain received the greatest doses and durations of therapy, respectively. These findings may help tailor and prioritize efforts to promote more appropriate opioid prescribing.