bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hospitalizations for Respiratory Syncytial Virus Among Adults in the United States, 1997–2012
Authors: Pastula Susan T. , Hackett Judith , Coalson Jenna , Jiang Xiaohui , Villafana Tonya , Ambrose Christopher , Fryzek Jon 
Published: January 2017

Abstract

Background
Respiratory syncytial virus (RSV) is an established cause of serious lower respiratory disease in children, but the burden in adults is less well studied.

Methods
We conducted a retrospective study of hospitalizations among adults ≥20 years from the 1997–2012 National Inpatient Sample. Trends in RSV admissions were described relative to unspecified viral pneumonia admissions. Hospitalization severity indicators were compared among immunocompromised RSV, non-immunocompromised RSV, and influenza admissions.

Results
An estimated 28237 adult RSV hospitalizations occurred, compared with 652818 influenza hospitalizations; 34% were immunocompromised individuals. Respiratory syncytial virus and influenza patients had similar age, gender, and race distributions, but RSV was more often diagnosed in urban teaching hospitals (73.0% for RSV vs 34.6% for influenza) and large hospitals (71.9% vs 56.4%). Respiratory syncytial virus hospitalization rates increased from 1997 to 2012, particularly for those ≥60, increasing from 0.5 to 4.6 per 100000, whereas unspecified pneumonia admission rates decreased significantly (P &lt; .001). Immunocompromised patients with RSV hospitalization had significantly higher inpatient mortality (P = .013), use of mechanical ventilation (P = .016), mean length of stay (LOS) (P &lt; .001), and mean cost (P &lt; .001) than non-immunocompromised RSV hospitalizations. Overall, RSV hospitalizations were more severe than influenza hospitalizations (6.2% mortality for RSV vs 3.0% for influenza, 16.7% vs 7.2% mechanical ventilation, mean LOS of 6.0 vs 3.6 days, and mean cost of $38828 vs $14519).

Conclusions
Respiratory syncytial virus hospitalizations in adults are increasing, likely due to increasing recognition and diagnosis. The burden of RSV in adults deserves attention. Although there are fewer hospitalizations than influenza, those that are diagnosed are on average more severe.
Diagnosis in France of a Non-Toxigenic tox Gene-Bearing Strain of Corynebacterium diphtheriae in a Young Male Back From Senegal
Authors: Billard-Pomares Typhaine , Rouyer Cécile , Walewski Violaine , Badell-Ocando Edgar , Dumas Marc , Zumelzu Coralie , Jaureguy Françoise , Brisse Sylvain , Caux Frédéric , Bouchaud Olivier , Carbonnelle Etienne 
Published: January 2017

Abstract
Cutaneous diphtheria is uncommon in Europe. In this study, we report a case of imported cutaneous infection due to a non-toxigenic but tox gene-bearing (NTTB) strain of Corynebacterium diphtheriae. The NTTB strains are recognized as emerging pathogens across Europe, and physicians and bacteriologists should be aware of the circulation of these strains.
Use of Activity Space in a Tuberculosis Outbreak: Bringing Homeless Persons Into Spatial Analyses
Authors: Worrell Mary Claire , Kramer Michael , Yamin Aliya , Ray Susan M. , Goswami Neela D. 
Published: January 2017

Abstract

Background
Tuberculosis (TB) causes significant morbidity and mortality in US cities, particularly in poor, transient populations. During a TB outbreak in Fulton County, Atlanta, GA, we aimed to determine whether local maps created from multiple locations of personal activity per case would differ significantly from traditional maps created from single residential address.

Methods
Data were abstracted for patients with TB disease diagnosed in 2008–2014 and receiving care at the Fulton County Health Department. Clinical and activity location data were abstracted from charts. Kernel density methods, activity space analysis, and overlay with homeless shelter locations were used to characterize case spatial distribution when using single versus multiple addresses.

Results
Data were collected for 198 TB cases, with over 30% homeless US-born cases included. Greater spatial dispersion of cases was found when utilizing multiple versus single addresses per case. Activity spaces of homeless and isoniazid (INH)-resistant cases were more spatially congruent with one another than non-homeless and INH-susceptible cases (P &lt; .0001 and P &lt; .0001, respectively).

Conclusions
Innovative spatial methods allowed us to more comprehensively capture the geography of TB-infected homeless persons, who made up a large portion of the Fulton County outbreak. We demonstrate how activity space analysis, prominent in exposure science and chronic disease, supports that routine capture of multiple location TB data may facilitate spatially different public health interventions than traditional surveillance maps.
Risk Factors and Clinical Outcomes Associated with Perioperative Transfusion-associated Circulatory Overload
Authors: Clifford Leanne , Jia Qing , Subramanian Arun , Yadav Hemang , Schroeder Darrell R. , Kor Daryl J. 
Published: January 2017

Abstract

Background
Transfusion-associated circulatory overload remains underappreciated in the perioperative environment. The authors aimed to characterize risk factors for perioperative transfusion-associated circulatory overload and better understand its impact on patient-important outcomes.

Methods
In this case–control study, 163 adults undergoing noncardiac surgery who developed perioperative transfusion-associated circulatory overload were matched with 726 transfused controls who did not develop respiratory complications. Univariate and multivariable logistic regression analyses were used to evaluate potential risk factors for transfusion-associated circulatory overload. The need for postoperative mechanical ventilation, lengths of intensive care unit and hospital stay, and mortality were compared.

Results
For this cohort, the mean age was 71 yr and 56% were men. Multivariable analysis revealed the following independent predictors of transfusion-associated circulatory overload: emergency surgery, chronic kidney disease, left ventricular dysfunction, previous β-adrenergic receptor antagonist use, isolated fresh frozen plasma transfusion (vs. isolated erythrocyte transfusion), mixed product transfusion (vs. isolated erythrocyte transfusion), and increasing intraoperative fluid administration. Patients who developed transfusion-associated circulatory overload were more likely to require postoperative mechanical ventilation (73 vs. 33%; P < 0.001) and experienced prolonged intensive care unit (11.1 vs. 6.5 days; P < 0.001) and hospital lengths of stay (19.9 vs. 9.6 days; P < 0.001). Survival was significantly reduced (P < 0.001) in transfusion recipients who developed transfusion-associated circulatory overload (1-yr survival 72 vs. 84%).

Conclusions
Perioperative transfusion-associated circulatory overload was associated with a protracted hospital course and increased mortality. Efforts to minimize the incidence of transfusion-associated circulatory overload should focus on the judicious use of intraoperative blood transfusions and nonsanguineous fluid therapies, particularly in patients with chronic kidney disease, left ventricular dysfunction, chronic β-blocker therapy, and those requiring emergency surgery.
RETINAL DETACHMENT ASSOCIATED WITH PERIPAPILLARY STAPHYLOMA IMAGED WITH SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY
Authors: Kunita Daisuke , Inoue Makoto , Koto Takashi , Hirakata Akito 
Published: January 2017

Purpose:
To examine a rhegmatogenous retinal detachment (RRD) associated with a peripapillary staphyloma with swept source optical coherence tomography (SS-OCT) before and after vitrectomy and circumferential photocoagulation.

Methods:
The SS-OCT images including the montage images of two patients with a RRD associated with peripapillary staphylomas were analyzed. A 34-year-old woman (Case 1) and a 70-year-old woman (Case 2) both noticed temporal visual field defects in their left eyes. Ophthalmoscopy showed a retinal detachment in the nasal quadrant without any peripheral breaks in both patients. The best-corrected visual acuity was 20/20 with -8.5 diopters in Case 1 and 20/25 with -7.0 diopters and moderate cataract in Case 2. SS-OT was used to follow the clinical course of the RRD.

Results:
Preoperatively, retinal tears were detected nasal to the optic disk within the excavated staphyloma in the SS-OCT images. A posterior vitreous detachment was not present in Case 1 but was present in Case 2. The glial tissue at the edge of the excavated staphyloma was removed from both eyes, and the subretinal fluid was drained internally through the retinal breaks. Hemicircumferential photocoagulation was performed at the nasal edge of the staphyloma, and the retina was reattached in both eyes. Postoperative SS-OCT montage images showed retinal reattachment but a detachment was still present within the staphyloma.

Conclusion:
Vitreous surgery was effective for an RRD associated with a peripapillary staphyloma. Examinations by SS-OCT can follow the changes in the RRD and the excavated lesion of a peripapillary staphyloma.
Retinal Oximetry in Subjects With Glaucomatous Hemifield Asymmetry
Authors: Yap Zhu Li , Ong Charles , Lee Yi Fang , Tsai Andrew , Cheng Clarissa , Nongpiur Monisha E. , Perera Shamira A. 
Published: January 2017

Purpose:
Although some studies suggest a strong link between retinal vessel oxygenation and damage to the retinal nerve fiber layer (RNFL) seen in glaucoma, it has yet to be conclusively proven. This study compares intraocular retinal oximetry in glaucomatous eyes displaying asymmetrically affected hemifields across different subgroups of glaucoma, namely primary angle closure glaucoma (PACG), primary open-angle glaucoma (POAG), and normal tension glaucoma (NTG).

Methods:
In this prospective cross-sectional study, 99 patients (PACG, n=28; POAG, n=37; NTG, n=34) underwent retinal oxygenation and vessel caliber measurements using the Oxymap T1 Retinal Oximeter, Cirrus optical coherence tomography, and Humphrey visual field testing. For the comparison between different subtypes of glaucoma, an analysis of variance with Bonferroni method was performed. Intraeye differences were compared with a paired t test. Determination of the more affected and less affected hemifield was made using the Humphrey visual field pattern deviation plot.

Results:
Considering the mean deviation and Advanced Glaucoma Interventional Study score, the visual field defects were milder in NTG as compared with POAG and PACG (P<0.05).
Arteriole diameter was smaller in the more affected hemifield compared with the less affected hemifield in patients with PACG (109.30±18.07 vs. 120.57±17.92; P=0.023) and NTG (109.36±13.79 vs. 117.46±17.72; P=0.04). The more affected hemifield had a significantly thinner RNFL than the less affected hemifield in patients across all 3 groups, though this was only significant in PACG (P=0.02) and NTG patients (P<0.01). In all 3 groups, although the less affected hemifield tended to have a marginally higher arteriole and venule oxygen saturation than the more affected hemifield, no statistical significance was reached. There were no significant differences in arteriovenous difference between the more and less affected hemifield in all 3 groups.

Conclusions:
In our study, localized visual field losses were not associated with changes in retinal oximetry but were associated with narrower retinal arteriolar diameters in PACG and NTG. The RNFL was thinner in the more affected hemifield in these 2 groups but this was not so marked in the POAG sample, possibly limiting our ability to find a difference in arteriolar diameter there.
Baby Shampoo Versus Povidone-Iodine or Isopropyl Alcohol in Reducing Eyelid Skin Bacterial Load
Authors: Garcia Giancarlo A. , Nguyen Christine V. , Yonkers Marc A. , Tao Jeremiah P. 
Published: January 2017

Purpose:
Baby shampoo is used as an alternative surgical skin preparation, but the evidence supporting its use is scarce with no descriptions of efficacy in the periocular region. The authors compare the efficacy of baby shampoo, povidone-iodine (PI, Betadine) and isopropyl alcohol (IA) in reducing eyelid skin bacterial load.

Methods:
Prospective, randomized, comparative, and interventional trial. Bacterial load on adult, human eyelid skin was quantitated before and after cleansing with 1) dilute baby shampoo, 2) 10% PI, or 3) 70% IA. Paired skin swabs were collected from a 1 cm2 area of the upper eyelid of subjects before and after a standardized surgical scrub technique. Samples were cultured on 5% sheep blood agar for 24 hours. The number of colony forming units (CFU) was assessed and bacterial load per square centimeter of eyelid skin was quantified.

Results:
Baseline and postcleansing samples were assessed from 42 eyelids of 42 subjects (n = 14 for each of baby shampoo, PI, and IA). Before cleansing, similar amounts of bacterial flora were grown from all specimens (median log CFU/cm2 = 2.04 before baby shampoo, 2.01 before PI, 2.11 before IA; p > 0.05). All 3 cleansing agents significantly reduced the bacterial load (p < 0.01 for each). There was no statistically significant difference in postcleansing bacterial load between the 3 cleansing agents (median log CFU/cm2 = 0.48 after baby shampoo, 0.39 after PI, 0.59 after IA; p > 0.05). Change from baseline in bacterial load was statistically similar for all 3 agents (median reduction in log CFU/cm2 = 1.28 with baby shampoo, 1.57 with PI, 1.40 with IA; p > 0.05). These corresponded to bacterial load reductions of 96.3%, 96.6%, and 98.4% for baby shampoo, PI, and IA, respectively.

Conclusions:
Baby shampoo achieved comparable diminution in eyelid skin bacterial load to PI or IA. These data suggest baby shampoo may be an effective preoperative cleansing agent.
Short article: Impact of genetic variation in the vasopressin 1a receptor on the development of organ failure in patients admitted for acute decompensation of liver cirrhosis
Authors: Kerbert Annarein J.C. , Schaapman Jelte J. , van der Reijden Johan J. , Amorós Navarro Àlex , McCormick Aiden , van Hoek Bart , Arroyo Vicente , Ginès Pere , Jalan Rajiv , Vargas Victor , Stauber Rudolf , Verspaget Hein W. , Coenraad Minneke J. 
Published: January 2017

Background
Vasopressin receptor-mediated vasoconstriction is considered to be involved in the pathogenesis of organ failure in acute-on-chronic liver failure (ACLF).

Patients and methods
We studied the association between six single nucleotide polymorphisms (SNPs) of the vasopressin 1a receptor gene and the development of organ failure in 826 patients admitted for acute decompensation of liver cirrhosis (n=641) or ACLF (n=185).

Results
No associations were found for SNPs with the presence of circulatory or renal failure. A C>T mutation in SNP rs7308855 and a T>A mutation in SNP rs7298346 showed an association with the presence of coagulation failure in the entire population (n=61, P=0.024 and 0.060, respectively) and in the subgroup of patients with ACLF (n=44, P=0.081 and 0.056, respectively).

Conclusion
Genetic variation in the vasopressin 1a receptor was found not to be associated with circulatory or renal failure, but with the presence of coagulation failure in patients with acute decompensation of liver cirrhosis and ACLF.
Electronic Health Record Data Versus the National Health and Nutrition Examination Survey (NHANES)
Authors: Funk Luke M. , Shan Ying , Voils Corrine I. , Kloke John , Hanrahan Lawrence P. 
Published: January 2017

Background:
Estimating population-level obesity rates is important for informing policy and targeting treatment. The current gold standard for obesity measurement in the United States—the National Health and Nutrition Examination Survey (NHANES)—samples <0.1% of the population and does not target state-level or health system-level measurement.

Objective:
To assess the feasibility of using body mass index (BMI) data from the electronic health record (EHR) to assess rates of overweight and obesity and compare these rates to national NHANES estimates.

Research Design:
Using outpatient data from 42 clinics, we studied 388,762 patients in a large health system with at least 1 primary care visit in 2011–2012.

Measures:
We compared crude and adjusted overweight and obesity rates by age category and ethnicity (white, black, Hispanic, Other) between EHR and NHANES participants. Adjusted overweight (BMI≥25) and obesity rates were calculated by a 2-step process. Step 1 accounted for missing BMI data using inverse probability weighting, whereas step 2 included a poststratification correction to adjust the EHR population to a nationally representative sample.

Results:
Adjusted rates of obesity (BMI≥30) for EHR patients were 37.3% [95% confidence interval (95% CI), 37.1–37.5] compared with 35.1% (95% CI, 32.3–38.1) for NHANES patients. Among the 16 different obesity class, ethnicity, and sex strata that were compared between EHR and NHANES patients, 14 (87.5%) contained similar obesity estimates (ie, overlapping 95% CIs).

Conclusions:
EHRs may be an ideal tool for identifying and targeting patients with obesity for implementation of public health and/or individual level interventions.
Advanced Practice Providers’ Perceptions of Patient Workload
Authors: Kapu April N. , McComiskey Carmel A. , Buckler Lacey , Derkazarian Jennifer , Goda Tammy , Lofgren Maria A. , McIlvennan Colleen K. , Raaum Julie , Selig Patricia M. , Sicoutris Corinna , Todd Barbara , Turner Vicki , Card Elizabeth , Wells Nancy 
Published: January 2017

OBJECTIVE:
This study examines data collected from a survey of advanced practice providers’ (APPs’) perceptions of reasonable versus actual APP-to-patient ratios and other factors that affect workload burden in both inpatient and outpatient clinical settings.

BACKGROUND:
Advanced practice providers provide accessible, cost-effective, and quality care in a growing number of specialty practices across multiple patient care settings. They are caring for higher volumes of patients and assuming more responsibilities while continuing to navigate highly complex healthcare systems. Limited evidence or benchmark data exist that would assist in determining optimal workload and staffing models that include APPs.

METHODS:
A group of advanced practice leaders developed and distributed a 43-question survey of workload factors to a highly diverse APP workforce.

RESULTS:
There were 1466 APPs across 37 areas of practice who responded to the survey distributed in 14 separate organizations. The perceived reasonable workload was lower than the actual workload for 22 specialty practice areas. The analysis included years of experience as an APP, work hours, on-call commitment, nonclinical responsibilities, and time spent in documentation, direct patient care, and performing procedures.

CONCLUSIONS:
There is a consensus among APPs, within their practice area, about what constitutes a reasonable patient assignment, despite the variability in APP experience, organizational culture, processes, and patient acuity.
Nursing Peer Review Perceptions and Practices
Authors: Whitney Kevin , Haag-Heitman Barbara , Chisholm Margery , Gale Sharon 
Published: January 2017

OBJECTIVE:
This study sought to understand chief nurse executive perceptions of nursing peer review (NPR) and current NPR practices in their organizations to provide insights and recommendations for the path forward to a robust NPR approach nationally.

BACKGROUND:
Nursing peer review is a key component of professional nursing practice focused on self-regulation and improving quality and safety. Despite its known benefits, NPR is not broadly disseminated, and how it is currently used and perceived is not well understood.

METHODS:
A causal-comparison study design was used. A 25-question, Web-based survey was administered to collect data variables.

RESULTS:
Chief nurse executives perceived NPR as important in improving quality and safety; however, its prevalence was low. Chief nurse executives also reported NPR practices not aligned with the American Nurses Association (ANA) NPR guidelines.

CONCLUSIONS:
Results suggest that knowledge gaps exist regarding NPR’s purpose, outcomes, and alignment with the ANA peer review guidelines. Interventions are needed to address these gaps to further advance NPR adoption nationally.
A Leadership Education and Development Program for Clinical Nurses
Authors: Fitzpatrick Joyce J. , Modic Mary Beth , Van Dyk Jennifer , Hancock K. Kelly 
Published: January 2017

OBJECTIVE:
The Leadership Education and Development (LEAD) Program was designed to transform care at the bedside by empowering clinical nurses as leaders.

BACKGROUND:
The heart of LEAD was enhancing communication skills of clinical nurses with clinical colleagues and, most importantly, patients and families. Key concepts of leadership/management were included: personal awareness, personal leadership skills/abilities, leading change, leading others individually and in teams, enhancing the patient/provider experience, and the leadership role in outcomes management.

METHODS:
A quantitative, longitudinal, survey design was used with 2 cohorts. The program consisted of six 4-hour sessions for 3 to 6 months. Leadership practices were measured before program implementation, at the end of the program, and 3 months after program completion.

RESULTS:
There were significant increases in leadership practices sustained 3 months after program completion. A range of other outcome measures was included.

CONCLUSIONS:
There is a need for additional leadership development programs for clinical nurses.
A Pilot Study
Authors: Fountain Donna M. , Thomas-Hawkins Charlotte 
Published: January 2017

OBJECTIVE:
The aim of this study was to test the reliability and validity of the Psychological Conditions Scale (PCS), a measure of drivers of engagement in hospital-based nurses.

BACKGROUND:
Research suggests drivers of engagement are positive links to patient, employee, and hospital outcomes. Although this scale has been used in other occupations, it has not been tested in nursing.

METHODS:
A cross-sectional, methodological study using a convenience sample of 200 nurses in a large Magnet® hospital in New Jersey.

RESULTS:
Cronbach’s α’s ranged from .64 to .95. Principal components exploratory factor analysis with oblique rotation revealed that 13 items loaded unambiguously in 3 domains and explained 76% of the variance. Mean PCS scores ranged from 3.62 to 4.68 on a 5-point Likert scale.

CONCLUSIONS:
The scale is an adequate measure of drivers of engagement in hospital-based nurses. Leadership efforts to promote the facilitators of engagement are recommended.