bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is Lateral Femoral Nailing Associated With Increased Intensive Care Unit Days? A Propensity-Matched Analysis of 848 Cases
Authors: Reahl G. Bradley , O'Hara Nathan N. , Coale Max , O'Hara Lyndsay M. , Castillo Renan , O'Toole Robert V. , Slobogean Gerard P. 
Published: August 2017

Objective:
The purpose of this study is to determine if lateral patient position during femoral nailing is associated with increases in intensive care unit (ICU) length of stay (LOS) or ventilator days when compared with femoral nailing in a supine position.

Design:
Retrospective cohort study.

Setting:
Level 1 trauma center.

Patients/Participants:
Patients with femoral shaft fractures treated with intramedullary fixation were identified. Propensity matching was performed to minimize selection bias using factors thought to be associated with surgeon selection of supine nailing at our institution (Injury Severity Score, Abbreviated Injury Score brain, and bilateral fractures). After matching, 848 patients were included in the analysis.

Intervention:
Femoral nailing in the lateral position compared with the supine position.

Main Outcome Measurements:
Our primary outcome measure was ICU LOS. Ventilator days were the secondary outcome.

Results:
Treating patients with femoral nailing in the lateral position was associated with a 1.88 days (95% confidence interval, 0.73–3.02; P = 0.001) reduction in ICU LOS in our adjusted model. Intramedullary nailing in the lateral position was associated with a 1.29 days (95% confidence interval, −0.12 to 2.69) decrease in postoperative time on a ventilator. However, this finding was not statistically significant (P = 0.07).

Conclusion:
Lateral femoral nailing was associated with decreased ICU LOS (P = 0.001) even after accounting for selection bias using propensity score matching. Our data indicate that lateral femoral nailing is likely not associated with the increased risk of pulmonary complication.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Tissue Engineered Bone Differentiated From Human Adipose Derived Stem Cells Inhibit Posterolateral Fusion in an Athymic Rat Model
Authors: Saifi Comron , Bernhard Jonathan , Shillingford Jamal N. , Petridis Petros , Robinson Samuel , Guo X. Edward , Weidenbaum Mark , Lehman Ronald A. , An Howard S. , Lenke Lawrence G. , Vunjak-Novakovic Gordana , Laratta Joseph L. 
Published: August 2017

Study Design.
Biological augmentation spinal arthrodesis trial in athymic rats.

Objective.
To assess the efficacy of tissue-engineered bone to promote L4-L5 intertransverse process fusion in an athymic rat model.

Summary of Background Data.
Each year in the United States, over 400,000 spinal fusion surgeries are performed requiring bone graft. The current gold standard for posterolateral lumbar fusion is autogenous iliac crest bone graft (ICBG), but the harvesting of ICBG is associated with increased operative time and significant complications. This being the case, an alternative cost-effective bone graft source is needed.

Methods.
Bovine bone cores were sterilized and decellularized for scaffold production. Human adipose derived mesenchymal stem cells (ADSC) were obtained and verified by tridifferentiation testing and seeded onto dried scaffolds. The seeded cores were cultured for 5 weeks in culture medium designed to mimic endochondral ossification and produce hypertrophic chondrocytes. Single-level intertransverse process fusions were performed at the L4-L5 level of 31 athymic rats. Fifteen rats were implanted with the hypertrophic chondrocyte seeded scaffold and 16 had scaffold alone. Half of the study rats were sacrificed at 3 weeks and the other half at 6 weeks. Spinal fusion was assessed using 2D and 3D micro computed tomography (μCT) analysis and tissue histology.

Results.
At 3 weeks, none of the tissue engineered rats had partial or complete fusion, whereas 62.5% of the decellularized rats fused and another 12.5% had partial fusions (P = 0.013). At 6 weeks, none of the tissue engineered rats fused and 50% had partial fusions, whereas 87.5% of the decellularized rats fused (P = 0.002).

Conclusion.
Tissue engineered bone composed of hypertrophic chondrocytes inhibits posterolateral fusion in an athymic rat model and therefore does not represent a promising cost-effective bone graft substitute.

Level of Evidence: N/A
Less is More in Diabetic Neuropathy Diagnosis: Comparison of Quantitative Sudomotor Axon Reflex and Skin Biopsy
Authors: Abuzinadah Ahmad R. , Kluding Patricia , Wright Douglas , D'Silva Linda , Ryals Janelle , Hendry Bill , Jawdat Omar , Herbelin Laura , McVey April L. , Barohn Richard J. , Dimachkie Mazen M. , Pasnoor Mamatha 
Published: August 2017

Abstract

Objectives:
To compare the frequency of abnormalities in epidermal nerve fiber density (ENFD) and quantitative sudomotor axon reflex (QSART) in patients with diabetic distal symmetric polyneuropathy (DSPN).

Methods:
Nerve conduction studies, ENFD, and QSART data were obtained pre- and postexercise, in patients enrolled in a prospective diabetic neuropathy study. McNemar's test was applied to compare the yield of ENFD and QSART.

Results:
Eighteen patients (58 ± 4 years) were enrolled, with 36 data collection points. In diabetic DSPN and diabetic large fiber DSPN (DSPN-L), abnormal ENFD (77% and 100% respectively) is more frequent than abnormal QSART (39% and 35%, respectively) (P value = 0.001 in diabetic DSPN and P value = 0.0002 in diabetic DSPN-L), whereas in diabetic small fiber DSPN (DSPN-S), both tests have similar yields (47%).

Conclusions:
ENFD has a high diagnostic yield in diabetic DSPN and DSPN-L. Including QSART data adds little to the sensitivity of EFND in DSPN-S.
A NOVEL LARGE HOMOZYGOUS DELETION IN THE CELLULAR RETINALDEHYDE-BINDING PROTEIN GENE (RLBP1) IN A PATIENT WITH RETINITIS PUNCTATA ALBESCENS
Authors: Bagheri Saghar , Pantrangi Madhulatha , Sodhi Simrat K. , Bagheri Sayeh , Oellers Patrick , Scholl Hendrik P. N. 
Published: August 2017

Purpose:
To report the phenotypic and genotypic data of a patient with retinitis punctata albescens carrying a novel deletion in the RLBP1 gene.

Results:
A woman of Iranian descent in her forties with a history of progressive visual deterioration since early childhood exhibited phenotypic features of retinitis punctata albescens with multiple white dots in the posterior pole and macular atrophy in both eyes. The microarray analysis identified a ∼2.160 kb homozygous deletion corresponding to a minimum deletion boundary of chr15q26.1:89,756,882-89,759,041/GRCh37 (hg19), which encompasses exon 6 of the RLBP1 gene.

Conclusion:
We describe a novel large homozygous deletion in the RLBP1 gene encoding the cellular retinaldehyde-binding protein in a patient of Iranian descent with retinitis punctata albescens. Genotype–phenotype studies may provide more information about the functions of the RLBP1 encoding proteins and the disease course, because RLBP1 mutations are associated with high phenotypic variability and are therefore a necessity for future tailored individual therapies.
Rabbit Model of Corneal Endothelial Injury Established Using the Nd:YAG Laser
Authors: Zhang Weijie , Hu Yang , Lu Linna , Liu Yan , Yang Xiaodan , Sun Hao , Ruan Jing , Chen Junzhao , Yao Qinke , Yan Chenxi , Gu Ping , Fu Yao , Shao Chunyi , Fan Xianqun 
Published: August 2017

Purpose:
To develop a new rabbit model of corneal endothelial injury using a neodymium-doped yttrium aluminum garnet (Nd:YAG) laser.

Methods:
The corneal endothelia of 2 groups of New Zealand white rabbits were treated with an Nd:YAG laser in a uniformly scattered fashion. Rabbits in group A underwent laser burns on the whole corneal endothelium, including the limbus area, whereas rabbits in group B were subjected to laser burns in the central 9-mm diameter zone of the endothelium. Slit-lamp biomicroscopy, optical coherence tomography, applanation tonometry, confocal microscopy, scanning electron microscopy, and histological examinations were performed during 4 weeks of follow-up.

Results:
In both groups, dotted or focal corneal endothelium defects were directly observed. The stroma was intact. Right after laser application, a series of clinical manifestations appeared, including subepithelial and stromal edema, increased central corneal thickness, and corneal opacity. Laser burn had more notable effects in group A than in group B. In both groups, we observed no damage to the intraocular structures, and intraocular pressure was normal after laser treatment.

Conclusions:
Nd:YAG laser treatment in a 9-mm diameter zone of the endothelium can effectively induce bullous keratopathy in a rabbit, whereas treatment for the entire corneal endothelium maintains bullous keratopathy for a longer period. The procedure is simple and reproducible, and it retains normal intraocular structures. This study provided a promising model for future research into endothelial cell damage and for the development of new therapies.
Risk Management of Hospitalized Psychiatric Patients Taking Multiple QTc-Prolonging Drugs
Authors: Vandael Eline , Vandenberk Bert , Willems Rik , Reyntens Johan , Vandenberghe Joris , Foulon Veerle 
Published: August 2017

Abstract

Purpose/Background
Drug-related QTc prolongation has been linked with Torsade de Pointes and sudden cardiac death. The objective of this study was to investigate the impact of starting an additional QTc-prolonging drug on the QTc interval of psychiatric inpatients.

Methods
An observational study was performed between May 2011 and December 2014 in 6 Belgian psychiatric hospitals. Inpatients who were already taking 1 QTc-prolonging drug or more could be included in the study when an additional QTc-prolonging drug was started. Electrocardiograms were performed at baseline and follow-up. Demographic, medical, medication, and laboratory data were collected. A risk score was used to estimate the risk of QTc prolongation based on patient-specific risk factors. A cutoff value of 8 points was set as high risk for QTc prolongation.

Results
One hundred fifty-two patients (44.7% women; mean age, 44 [SD, 17] years) were included who received a prescription for an additional QTc-prolonging drug. There was a small but significant difference (P = 0.032) in mean QTc interval between baseline (409.1 [SD, 21.8] milliseconds) and follow-up (411.8 [SD, 21.7] milliseconds). Three patients developed a prolonged QTc interval in the follow-up electrocardiogram (QTc, ≥450 [men]/470 [women] milliseconds); 8 patients had a delta QTc of 30 milliseconds or longer. No cases of torsade de pointes or sudden cardiac death were identified. Fifty-eight patients (38.2%) had a risk score of 8 or higher; these patients had a significantly longer QTc interval at follow-up than did patients with a risk score of lower than 8 (P < 0.001).

Implications/Conclusions
Only a limited number of patients developed a prolonged QTc interval after the start of an additional QTc-prolonging drug. Nevertheless, it is still important to screen for high-risk patients at baseline. A risk score can help to select high-risk patients and to stimulate an appropriate and feasible risk management of QTc prolongation in psychiatry.
The Doctrine of Deliberate Indifference: Reed vs. Krajca
Authors: Oviedo Astrid D. 
Published: August 2017

ABSTRACT
Facts of the Reed v. Krajca case are presented in which plaintiffs filed a lawsuit for civil damages under the doctrine of deliberate indifference and defendant, Nurse Krajca, invoked qualified immunity in a motion for summary judgment. The Court of Appeal's decision and the dissenting opinion on the issue of deliberate indifference are discussed. This case report provides a concrete example of how the doctrine of deliberate indifference was interpreted by the Court of Appeal and becomes a springboard for analysis and discussion for nurses to guide their practice.
Disease-Specific Care: Spine Surgery Program Development
Authors: Koerner Katie , Franker Lauren , Douglas Barbara , Medero Edgardo , Bromeland Jennifer 
Published: August 2017

ABSTRACT
Minimal literature exists describing the process for development of a Joint Commission comprehensive spine surgery program within a community hospital health system. Components of a comprehensive program include structured communication across care settings, preoperative education, quality outcomes tracking, and patient follow-up. Organizations obtaining disease-specific certification must have clear knowledge of the planning, time, and overall commitment, essential to developing a successful program. Health systems benefit from disease-specific certification because of their commitment to a higher standard of service. Certification standards establish a framework for organizational structure and management and provide institutions a competitive edge in the marketplace. A framework for the development of a spine surgery program is described to help guide organizations seeking disease-specific certification. In developing a comprehensive program, it is critical to define the program’s mission and vision, identify key stakeholders, implement clinical practice guidelines, and evaluate program outcomes.
Comprehensive Treatment Strategy for Chronic Low Back Pain in a Patient with Bilateral Transfemoral Amputations Integrating Changes in Prosthetic Socket Design
Authors: Mazzone Brittney , Yoder Adam , Zalewski Brian , Wyatt Marilynn , Sheu Robert 
Published: August 2017

ABSTRACT

Introduction
Wounded service members with amputations undergo a complex rehabilitation regimen that can often become complicated by skin breakdown, heterotopic ossification (HO), and pain of the residual limb, contralateral limb, or low back. These complications can impact prosthetic socket fit, decreasing one's functional independence, and potentially negatively impact quality of life. The purpose of this report is to present a case involving the treatment of HO along with prosthetic socket modifications, with the intention to address low back pain (LBP), in a patient with bilateral transfemoral amputations.

Materials and Methods
The patient experienced traumatic bilateral amputations as a result of an improvised explosive device blast. He was initially fit with ischial containment sockets to provide stability and enhance early mobility. He became a community ambulator but was experiencing LBP and issues with HO. After extensive HO resection, a multidisciplinary discussion took place to determine the best way to diminish LBP by improving spinopelvic alignment while restoring function. It was decided to refit the patient with subischial containment sockets. Subjective questionnaires and three-dimensional gait analysis were used to quantify results.

Results
After HO resection and prosthetic socket modifications, the patient's complaints of LBP decreased, along with subjective improvements in the Oswestry Disability Index and Short Musculoskeletal Functional Assessment. During upright standing, anterior pelvic tilt decreased from 27.6° to 18.1°. During walking, excursion of the trunk relative to the pelvis decreased in all planes after changing prosthetic socket design to subischial and completing 6 months of rehabilitation: from 24.0° to 17.6° in the frontal plane, 12.4° to 7.8° in the sagittal plane, and 23.1° to 19.1° in the transverse plane.

Conclusions
A multidisciplinary team approach to the care of patients with bilateral transfemoral amputations can help to improve functional outcomes. For this patient with nonradicular, mechanical LBP, a subischial prosthetic socket design that minimized intrusion on the pelvis had a significant influence on static and dynamic sagittal spinopelvic alignment and overall outcomes. In the end, contributions by orthopedic and plastic surgeons, pain management strategies by a physical medicine and rehabilitation physician, rehabilitation by a physical therapist, and prosthetic modifications all played a role in reduction of this patient's LBP. Among the numerous interventions provided to this patient, including surgical revisions, prosthetic socket design, prosthetic alignment, and physical therapy, it is hypothesized that the change in prosthetic socket design from ischial containment to subischial had a significant, long-lasting impact on LBP and function.
The Maternal Infant Microbiome
Authors: Dunn Alexis B. , Jordan Sheila , Baker Brenda J. , Carlson Nicole S. 
Published: August 2017

Abstract
The human microbiome plays a role in maintaining health, but is also thought to attenuate and exacerbate risk factors for adverse maternal–child health outcomes. The development of the microbiome begins in utero; however, factors related to the labor and birth environment have been shown to influence the initial colonization process of the newborn microbiome. This “seeding” or transfer of microbes from the mother to newborn may serve as an early inoculation process with implications for the long-term health outcomes of newborns. Studies have shown that there are distinct differences in the microbiome profiles of newborns born vaginally compared with those born by cesarean. Antibiotic exposure has been shown to alter the microbial profiles of women and may influence the gut microbial profiles of their newborns. Considering that the first major microbial colonization occurs at birth, it is essential that labor and birth nurses be aware of factors that may alter the composition of the microbiome during the labor and birth process. The implications of various activities and factors unique to the labor and birth environment that may influence the microbiome of women and newborns during the labor and birth process (e.g., route of birth, antibiotic use, nursing procedures) are presented with a focus on the role of labor nurses and the potential influence of nursing activities on this process.
Provider Approachability: An All-Staff Survey Approach to Creating a Culture of Safety
Authors: Deyo-Svendsen Mark E. , Palmer Karl B. , Albright Jill K. , Phillips Michael R. , Schilling Keith A. , Cabrera Svendsen Matthew E. 
Published: August 2017

Objectives
A culture-of-safety survey of our hospital staff revealed fear-based reluctance to question those in authority. We aimed to examine provider approachability (words and actions that promote trust and reduce or eliminate fear of interaction).

Methods
Providers and staff completed an anonymous facility-wide survey (survey 1) regarding perceptions of provider approachability. Results were safely communicated to providers, and improvement resources were offered. A follow-up survey (survey 2 [S2]) was performed.

Results
The survey participation rate was 59% (389/658). Eighty-four percent of providers had improved scores in S2. Mean top-box scores improved from 0.63 to 0.76 (P < .001). Providers deemed less approachable by nonprovider staff were also deemed less approachable by their peers (r = 0.82; survey 1). Forty-four percent reported improvement in the safety culture in S2. Twenty-eight percent of providers reported making efforts to improve how they were perceived by others.

Conclusions
Provider approachability surveys are a safe, effective method of assessing and encouraging positive interactions that promote trust and influence positive communication. The process created an opportunity to identify and assist providers who were less approachable.
Simulation Training for Residents Focused on Mechanical Ventilation
Authors: Spadaro Savino , Karbing Dan Stieper , Fogagnolo Alberto , Ragazzi Riccardo , Mojoli Francesco , Astolfi Luca , Gioia Antonio , Marangoni Elisabetta , Rees Stephen Edward , Volta Carlo Alberto 
Published: August 2017

Introduction
Advances in knowledge regarding mechanical ventilation (MV), in particular lung-protective ventilation strategies, have been shown to reduce mortality. However, the translation of these advances in knowledge into better therapeutic performance in real-life clinical settings continues to lag. High-fidelity simulation with a mannequin allows students to interact in lifelike situations; this may be a valuable addition to traditional didactic teaching. The purpose of this study is to compare computer-based and mannequin-based approaches for training residents on MV.

Methods
This prospective randomized single-blind trial involved 50 residents. All participants attended the same didactic lecture on respiratory pathophysiology and were subsequently randomized into two groups: the mannequin group (n = 25) and the computer screen–based simulator group (n = 25). One week later, each underwent a training assessment using five different scenarios of acute respiratory failure of different etiologies. Later, both groups underwent further testing of patient management, using in situ high-fidelity simulation of a patient with acute respiratory distress syndrome.

Results
Baseline knowledge was not significantly different between the two groups (P = 0.72). Regarding the training assessment, no significant differences were detected between the groups. In the final assessment, the scores of only the mannequin group significantly improved between the training and final session in terms of either global rating score [3.0 (2.5–4.0) vs. 2.0 (2.0–3.0), P = 0.005] or percentage of key score (82% vs. 71%, P = 0.001).

Conclusions
Mannequin-based simulation has the potential to improve skills in managing MV.
Transcranial Direct Current Stimulation to the Right Temporoparietal Junction for Social Functioning in Autism Spectrum Disorder
Authors: Esse Wilson Joan , Quinn Davin K. , Wilson J. Kevin , Garcia Christopher M. , Tesche Claudia D. 
Published: August 2017

Objectives
While there is evidence of improved social functioning after applying transcranial direct current stimulation (tDCS) at the right temporoparietal junction (rTPJ) in individuals who are healthy, no current studies have investigated the use of tDCS at the rTPJ to improve social functioning in individuals with autism spectrum disorder (ASD). This case investigates the use of tDCS applied to the rTPJ to target social functioning in a high-functioning adult with ASD.

Methods
The authors present a case of an 18-year old patient with ASD treated successfully with tDCS; 1.5 mA of tDCS was applied once a day for 30 minutes for 8 consecutive days with the anode electrode over rTPJ (CP6 in the 10/10 electroencephalogram system) and the cathode electrode placed on the ipsilateral deltoid. Behavioral outcome was assessed using the Autism Treatment Evaluation Checklist prior to tDCS, after the final tDCS session, and at 2 months after tDCS. An additional, informal follow-up was also made 1 year after tDCS.

Results
Autism Treatment Evaluation Checklist showed substantial improvement in social functioning from baseline to post-tDCS, which was maintained at 2 months. The patient also reported lessened feelings of anger and frustration over social disappointments. Informal follow-up 1 year after stimulation indicates that the patient continues to maintain many improvements.

Conclusions
Anodal tDCS to the rTPJ may represent an effective treatment for improving social functioning in ASD, with a larger clinical trial needed to validate this effect.