bluuebunny/crossref_metadata_2025_split huggingface dataset:
General Principles for Preoperative Planning and Microsurgical Treatment of Pediatric Brain Arteriovenous Malformations: 2-Dimensional Operative Video
Authors: Penn David L , Wu Kyle C , Presswood Kayla R , Riordan Coleman P , Scott R Michael , Smith Edward R 
Published: August 2018

Abstract
Children with arteriovenous malformations (AVMs) are at cumulative, life-long risk of debilitating and fatal intracranial hemorrhage, especially with syndromes such as hereditary hemorrhagic telangiectasia. Cerebral angiography is the gold standard for diagnosis and allows simultaneous adjunctive embolization limiting radiation and contrast exposure and intraoperative blood loss, important in pediatric patients with low blood volume. Microsurgical resection of low-grade AVMs offers cure with minimal morbidity. The plasticity of the pediatric brain may allow resection of AVMs near eloquent regions. Multidisciplinary care offers the best outcomes in these cases. Discussion of the operative plan with all team members at the start of surgery is carried out. Confirmation that blood products are present and that the microscope, additional suction, and surgical clips are available is performed. A generous craniotomy is created, adequately exposing the lesion. The dura is carefully opened to avoid injury to draining veins. Circumferential dissection and isolation of the AVM is performed, coagulating small arterial feeders, dissecting to the lesion's apex to coagulate, and divide major deep feeders. Once all feeders have been obliterated, venous drainage is disconnected. Indocyanine green distinguishes arterial feeders from arterialized veins and confirms complete resection. Since 2008, all of our patients undergo perioperative angiography in our dedicated suite, greatly improving resection rates. Strict blood pressure control and close neurological monitoring in the intensive care unit is performed postoperatively. In conclusion, microsurgical resection of AVMs can be performed safely with low rates of morbidity. Protocols for preoperative evaluation and planning appear to improve outcomes.
Anonymous video is permitted when done without identifying patient related information.
Interhemispheric Approaches to Arteriovenous Malformations: 3-Dimensional Operative Video
Authors: Agarwal Vijay , Barrow Daniel L 
Published: August 2018

Abstract
We present 2 illustrative cases of interhemispheric approaches to right sided arteriovenous malformations (AVMs). The first patient is a healthy 54-yr-old female who presented with left-sided hearing loss and pulsatile tinnitus, and was neurologically intact. Imaging demonstrated a right sided interhemispheric AVM, fed by the anterior cerebral artery with superficial venous drainage to the superior sagittal sinus. The AVM was thought to be asymptomatic and the patient chose to have her AVM treated surgically to eliminate future risk of hemorrhage. We elected to approach this lesion via a contralateral interhemispheric approach to avoid retraction of the right hemisphere. Intraoperative angiogram demonstrated complete obliteration of the malformation and the patient was neurologically intact postoperatively. The second patient is a 41-yr-old healthy male who presented with progressive bifrontal headaches and was also neurologically intact. Imaging revealed a right interhemispheric AVM fed by the anterior cerebral artery and with superficial venous drainage to the superior sagittal sinus. Although the patient's headaches may have been related, the patient's decision to undergo surgical resection was primarily to eliminate future risk of hemorrhage. The difference with this patient was that imaging revealed the presence of two draining veins on the left side that would potentially be injured via a contralateral approach. As a result, we elected to approach this lesion ipsilaterally. Intraoperative angiogram showed complete obliteration of the malformation with intact venous drainage, and the patient was neurologically intact postoperatively. Contralateral vs ipsilateral interhemispheric approaches are compared and contrasted.
Integrating Social Media Into an Online Academic Program
Authors: Smith Shelly , Buchanan Holly 
Published: August 2018

Abstract
There is a noticeable gap in the literature regarding the programmatic integration of social media into health sciences education. Networked participatory scholarship theory supports the use of social media in higher education; associated benefits include promoting student engagement and real-time dissemination. This article describes the integration of social media use in a graduate online doctoral nursing program; specifically, blogging, microblogging, and ePortfolio integration are presented. The purpose is to improve students' utilization of social media as a professional tool.
Evaluating Adherence to Guideline-Based Quality Indicators for Postpartum Hemorrhage Care in the Netherlands Using Video Analysis
Authors: Woiski Mallory , de Visser Suzan , van Vugt Helena , Dijkman Anneke , Schuitemaker Nico , van Meir Claudia , Middeldorp Johanna , Huisjes Anjoke , Mol Ben W. , Molkenboer Jan , Moonen-Delarue Desiree , Oudijk Martijn , van Rheenen-Flach Leonie , Rijnders Robert , Pernet Paula , Porath Martina , de Wit Sander , Grol Richard , Scheepers Hubertina , Hermens Rosella 
Published: August 2018

OBJECTIVE:
To assess adherence to the national postpartum hemorrhage guideline and Managing Obstetric Emergencies and Trauma course instructions and its determinants in the Netherlands.

METHODS:
A prospective observational multicenter study in 16 Dutch hospitals analyzing data from medical records of 398 women at high risk for postpartum hemorrhage, of which 293 were supplemented with data from prospective video recordings. Adherence to guideline-based quality indicators for prevention, management, and organization of postpartum hemorrhage care was measured. Indicators for prevention and management of postpartum hemorrhage were categorized according to the amount of blood loss (less than 500, greater than 500, greater than 1,000, and greater than 2,000 mL).

RESULTS:
Overall, a lack of adherence was observed, particularly for the actions to be undertaken with blood loss greater than 1,000 mL (69 patients). Actions were not or only taken in a later stage when the blood loss had already increased to greater than 2,000 mL (21 patients). In almost 41% (n=119/293) of the deliveries, no active management was performed, and in almost 80% (n=89/112), vital signs were not monitored (blood loss greater than 500 mL) or monitored too late with respect to blood loss. The video recordings showed that in general the actual care given was considerably underreported in medical records. Postpartum hemorrhage care in the hospitals was well organized. Fifteen hospitals had a local postpartum hemorrhage protocol, and in 12 hospitals, team trainings were organized. Regarding the determinants, high-risk patient identification and type of hospital (university vs nonuniversity hospital) were mostly associated with better adherence.

CONCLUSION:
This study showed low adherence to the guideline-based quality indicators, indicating a problem with Dutch quality care. The unique video observations provided additional, valuable information at which level improvement can be made. A tailor-made implementation strategy to improve quality of postpartum hemorrhage care has been developed.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT00928863.
Implementation of a Quality Improvement Initiative to Decrease Opioid Prescribing After Cesarean Delivery
Authors: Prabhu Malavika , Dubois Heloise , James Kaitlyn , Leffert Lisa R. , Riley Laura E. , Bateman Brian T. , Henderson Marie 
Published: August 2018

OBJECTIVE:
To assess whether a multiphase, departmental quality improvement effort decreases opioid prescribing and increases multimodal analgesic use after cesarean delivery.

METHODS:
This is a prospective quality improvement study. In phase 1 of the protocol, discharge providers implemented counseling regarding expectations for pain, typical need for opioids, and importance of multimodal nonopioid analgesic use and used shared decision-making to determine the number of opioids prescribed. Patients could select up to a maximum of 30 tablets of 5 mg oxycodone (or equivalent opioid), lower than the previous routine discharge prescription of 40 opioid tablets. The primary outcome was the mean (SD) number of opioid tablets prescribed on discharge with secondary outcomes including opioid refill rate within 30 days of discharge and rates of nonopioid analgesic prescriptions on discharge. In phase 2, using these results, we adjusted the protocol's maximum opioid prescription to 25 opioid tablets, but no other aspects of the protocol were changed. All data were analyzed with t test and χ2 analyses.

RESULTS:
Data from 624 women who underwent cesarean deliveries were analyzed. Opioids, most commonly oxycodone, were prescribed after 95% of all cesarean deliveries. The mean (SD) number of opioid tablets prescribed decreased from 33.2 (9.3) to 26.5 (6.7; P<.01) with the implementation of phase 1 having no effect on the opioid refill rate, 8.9% vs 8.1% (P=.79). These results allowed adjustment of the maximum recommended prescription to 25 opioid tablets, introducing phase 2 of the study, during which the mean (SD) number of opioid tablets prescribed further decreased from 24.9 (7.5) to 21.5 (6.3; P<.01) with no effect on the opioid refill rate, 6.3% vs 5.1% (P=.72). Overall, this represents a 35% decrease in opioid prescribing (P<.01). Rates of ibuprofen prescribing were 98% or higher throughout the study, but rates of acetaminophen prescribing increased from 32.6% before phase 1 to 92.0% after phase 2 (P<.001).

CONCLUSION:
Implementation of a multiphase quality improvement protocol to decrease opioid prescribing, combined with iterative review of discharge data, resulted in a significant decrease in the number of opioid tablets prescribed after cesarean delivery.
Paracervical Block for Intrauterine Device Placement Among Nulliparous Women
Authors: Mody Sheila K. , Farala John Paul , Jimenez Berenice , Nishikawa Moena , Ngo Lynn L. 
Published: August 2018

OBJECTIVE:
To investigate whether a 20-mL buffered 1% lidocaine paracervical block decreases pain during intrauterine device (IUD) placement.

METHODS:
In a randomized, single-blind, placebo-controlled trial, women were assigned to receive either a 20-mL buffered 1% lidocaine paracervical block or no block before IUD placement. The primary outcome was pain with IUD placement measured on a 100-mm visual analog scale. Our sample size had 80% power (α=0.05) to detect a 20-mm difference in visual analog scale scores with a SD of 28 mm. Secondary outcomes included pain with speculum placement, paracervical block administration, tenaculum placement, 5 minutes postprocedure, and overall pain perception.

RESULTS:
From October 7, 2014, through October 26, 2017, 64 women were enrolled and analyzed (33 in the paracervical block arm, 31 in the no-block arm). There were no differences in baseline demographics between the groups. Women who received the paracervical block reported less pain with IUD placement compared with women who received no block (median visual analog scale score of 33 mm vs 54 mm, P=.002). Pain was significantly less in the intervention group for uterine sounding (30 mm vs 47 mm, P=.005), 5 minutes after placement (12 mm vs 27 mm, P=.005), and overall pain perception (30 mm vs 51 mm, P=.015). Participants who received the paracervical block experienced more pain with block administration compared with placebo (30 mm vs 8 mm, P=.003). There was no perceived pain difference for speculum insertion (10 mm vs 6 mm, P=.447) or tenaculum placement (15 mm vs 10 mm, P=.268).

CONCLUSION:
A 20-mL buffered 1% lidocaine paracervical block decreases pain with IUD placement (primary outcome), uterine sounding (secondary outcome), and 5 minutes after placement (secondary outcome). Although paracervical block administration can be painful, perception of pain for overall IUD placement procedure is lower compared with no block.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02219308.
Association of a Health Care Provider Review Meeting With Cesarean Delivery Rates
Authors: Skeith Ashley E. , Valent Amy M. , Marshall Nicole E. , Pereira Leonardo M. , Caughey Aaron B. 
Published: August 2018

OBJECTIVE:
To examine the association of a quality improvement effort that was mediated through weekly review of all criteria for cesarean delivery on cesarean delivery prevalence and indications.

METHODS:
We conducted a retrospective cohort study using a natural experiment model that compared two timeframes, from 2009 to 2013, at a single institution. We introduced a weekly retrospective review conference to discuss all cesarean deliveries in 2010 that continued over time. The conferences were attended by obstetric care providers, anesthesiology, and labor and delivery nurses. Date of delivery was dichotomized by those delivering before July 1, 2010, and those delivering after. We included women with term singleton vertex gestations in our study population and then examined the rates of cesarean delivery by date of delivery. We then examined indications for the cesarean deliveries during the study period based on surgeon documentation. χ2 tests were used for statistical comparisons and a P value of <.05 was used to indicate statistical significance.

RESULTS:
There were 5,541 term singleton cephalic births during the study period. The rate of cesarean delivery declined significantly after our intervention in all women (22.2% vs 27.4%, P<.001) and nulliparous women (23.3% vs 30.9%, P<.001). The adjusted odds ratio of cesarean delivery in all women as related to time cohort is 0.68 (95% CI 0.58–0.79) and 0.56 (95% CI 0.44–0.70) in nulliparous women. We examined indications for the 1,315 cesarean deliveries during the study period by date of delivery. The indications of active-phase arrest, second-stage arrest, failed induction, repeat cesarean delivery, and maternal request decreased significantly between delivery cohorts in all women (P<.001) and in nulliparous women specifically (P<.001). Between delivery cohorts, we found that the prevalence of labored indications for cesarean delivery decreased more than nonlabored indications.

CONCLUSION:
Implementation of a weekly review conference was associated with a reduction in both overall cesarean delivery prevalence and labored indications at our institution.
Timing of Delivery in Women With Chronic Hypertension
Authors: Ram Maya , Berger Howard , Geary Michael , McDonald Sarah D. , Murray-Davis Beth , Riddell Catherine , Hasan Haroon , Barrett Jon , Melamed Nir ,   for the Diabetes, Obesity and Hypertension in Pregnancy Research Network (DOH-NET) and the Southern Ontario Obstetrical Network (SOON) Investigators
Published: August 2018

OBJECTIVE:
To assess whether routine induction of labor at 38 or 39 weeks in women with chronic hypertension is associated with the risk of superimposed preeclampsia or cesarean delivery.

METHODS:
We conducted a retrospective population-based study of women with chronic hypertension who had a singleton hospital birth at 38 0/7 weeks of gestation of gestation in Ontario, Canada, between 2012 and 2016. Women who underwent induction of labor at 38 0/7 to 38 6/7 weeks of gestation for chronic hypertension (n=281) were compared with those who were managed expectantly during that week and remained undelivered at 39 0/7 weeks of gestation (n=1,606). Separately, women who underwent induction of labor at 39 0/7 to 39 6/7 weeks of gestation for chronic hypertension (n=259) were compared with women who remained undelivered at 40 0/7 weeks of gestation (n=801).

RESULTS:
Of 534,529 women gave birth during the study period, 6,054 (1.1%) had chronic hypertension and 2,420 met the inclusion criteria. Women managed expectantly at 38 or 39 weeks of gestation were at risk of new-onset superimposed preeclampsia (19.2% [308/1,606] and 19.0% [152/801], respectively) and eclampsia (0.6% [10/1,606] and 0.7% [6/801], respectively), and more than half underwent induction of labor later in gestation (56.8% and 57.8%, respectively). The risk of cesarean delivery in the induction groups was lower (38 weeks of gestation) or similar (39 weeks of gestation) to that observed in women managed expectantly at the corresponding weeks (38 weeks of gestation: 17.1% vs 24.0%, adjusted relative risk 0.74 [95% CI 0.57–0.95]; 39 weeks of gestation: 20.1% vs 26.0%, adjusted relative risk 0.90 [95% CI 0.69–1.17]).

CONCLUSION:
Our findings suggest that in women with isolated chronic hypertension, induction of labor at 38 or 39 weeks of gestation may prevent severe hypertensive complications without increasing the risk of cesarean delivery.
Disparities in Human Papillomavirus Vaccine Completion Rates Among Females in an Integrated Health Care System
Authors: Freeman Alexandra (Jana) H. , Gamboa Cristina , Darbinian Jeanne A. , Littell Ramey D. , Torrente Sandra 
Published: August 2018

OBJECTIVE:
To estimate the rate of human papillomavirus (HPV) vaccine completion by race and ethnicity.

METHODS:
In this retrospective cohort study, we analyzed females aged 11–26 years who initiated HPV vaccination from 2008 through 2012 in a community-based health care system in California. Vaccine completion was defined as having received at least three injections. Demographic data including age, race, ethnicity, and language preferences were obtained. Among Hispanic patients, acculturation was categorized as low or high using written and spoken Spanish vs English language as a proxy. Age groups were defined as younger adolescents (11–14 years), teens (15–17 years), and young adults (18–26 years). Bivariate analyses using χ2 tests and age-adjusted logistic regression were performed.

RESULTS:
Among 102,052 females who initiated HPV vaccination, a total of 41,847 (41%) completed the series. Younger adolescents had the highest completion rates (43.4%, P<.001) vs teens and young adults (37.4% and 38.0%, respectively). By race and ethnicity, Asian patients had the highest completion rates (49.5%, 95% CI 48.8–50.2), and the lowest rates were seen among black and Hispanic patients (28.7% [95% CI 27.8–29.6] and 38.9% [95% CI 38.3–39.5], respectively). Among Hispanic patients, the adjusted odds for vaccine completion was 1.2-fold higher for the low acculturated vs the highly acculturated group (adjusted odds ratio 1.23 [95% CI 1.16–1.31]).

CONCLUSION:
More than half of the females who initiated HPV vaccination did not complete the series, and black and Hispanic patients were least likely to have completed the series. Among Hispanic patients, the highest acculturated group had the lowest completion rate. These disparities emphasize the need for cancer prevention across all racial and ethnic groups.
Prevalence of Maternal Hepatitis C Virus Infection in Ohio
Authors: Rossi Robert M. , Warshak Carri R. 
Published: August 2018

OBJECTIVE:
To quantify the rising prevalence of maternal hepatitis C virus (HCV) infection in Ohio during the peak of the opioid epidemic and to identify maternal characteristics and obstetric outcomes associated with maternal HCV infection.

METHODS:
We conducted a population-based retrospective cohort study of all live births in Ohio (2006–2015). Frequency of maternal HCV infection as reported on birth certificates was compared across each year of the study period. Maternal, obstetric, and neonatal characteristics were compared between women with HCV infection in pregnancy with those without HCV infection. Multivariate logistic regression estimated the relative association between HCV infection and various maternal characteristics and obstetric outcomes.

RESULTS:
During the 10-year study period, there were 7,069 reported cases of maternal HCV infection at the time of delivery among 1,463,506 (0.5%) live births in Ohio. The rate of maternal HCV infection increased 631% between 2006 and 2015, from 1.6 to 11.7 cases per 1,000 live births (relative risk [RR] 7.6, CI 6.6–8.7, P<.001). After adjusting for various confounders, demographic characteristics associated with HCV infection included cigarette smoking (adjusted RR 8.6, CI 8.0–9.1), Medicaid insurance (adjusted RR 3.6, CI 3.3–3.8), and white, non-Hispanic race (adjusted RR 3.2, 95% CI 2.9–3.5). Coinfection during pregnancy with hepatitis B, gonorrhea, chlamydia, syphilis, and herpes simplex virus infection was also associated with maternal HCV infection. Obstetric and neonatal outcomes associated with maternal HCV infection included cesarean delivery, fetal intolerance of labor, preterm birth, maternal intensive care unit admission, blood transfusion, small for gestational age (less than the 10th percentile), neonatal intensive care unit admission, need for assisted neonatal ventilation, and infant death.

CONCLUSION:
Maternal HCV infection has increased more than sevenfold over the past decade in Ohio. Our findings highlight a dramatic rise in maternal HCV infection that parallels the opioid epidemic within Ohio and in neighboring Appalachian states.
Safety and Complications Associated With MRI-Conditional External Fixators in Patients With Tibial Plateau Fractures: A Case Series
Authors: Gillig Jonathan D. , Goode Russell D. , Campfield Brian , Crim Julia R. , Crist Brett D. 
Published: August 2018

Objectives:
To address the safety of obtaining magnetic resonance imaging (MRI) in patients with temporary knee-spanning external fixators placed for tibial plateau fractures.

Design:
Institutional Review Board–approved retrospective review.

Setting:
Level 1 trauma center.

Patients/Participants:
Records were reviewed on patients with knee-spanning external fixators applied during staged management of tibial plateau fractures from 2009 to 2015 and who also had an MRI performed.

Main Outcome Measurements:
Complications associated with the MRI; secondary outcomes were pain scores, narcotic requirements, and fracture healing.

Results:
A total of 56 patients with 57 fractures were included, and 55 scans (96.5%) were completed without complication. Two scans (3.5%) were stopped prematurely for patient-reported pain and subjective warmth of the external fixator. For all 57 studies, pain scores and narcotic usage were unchanged, and all fractures healed without complication.

Conclusions:
Knee-spanning external fixator placement does not preclude MRI for patients with tibial plateau fractures. MRIs can be safely performed on patients with external fixators if patients are educated before imaging. Even in the small percentage of patients who experienced discomfort, there were no long-term complications.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.