bluuebunny/crossref_metadata_2025_split huggingface dataset:
Video Colposcopy for Reducing Patient Anxiety During Colposcopy
Authors: Hilal Ziad , Alici Ferizan , Tempfer Clemens B. , Seebacher Veronika , Rezniczek Günther A. 
Published: July 2017

OBJECTIVE:
To test whether video colposcopy reduces anxiety among patients undergoing colposcopy.

METHODS:
In a prospective, randomized multicenter trial, we compared video colposcopy and no video colposcopy in a one-to-one ratio. Situation-specific anxiety was measured before (S1) and after (S2) colposcopy using the State-Trait Anxiety Inventory. The primary endpoint was the reduction of the situation-specific anxiety scores (ΔS=S2–S1). Secondary endpoints were pain during and 10 minutes after colposcopy, general unpleasantness, anxiety during colposcopy, satisfaction with the information about the procedure, and overall satisfaction (11-item visual analog scales). Analysis was by intention to treat. A sample size of 104 per group (n=208) was planned to achieve 80% power to detect a difference of 4.8 with a SD of 12.3 in the primary outcome.

RESULTS:
Between August 2016 and March 2017, 225 women were randomized. The mean ΔS was −10.3±11.3 SD in 111 women in the video colposcopy group and −10.3±11.0 SD in 105 women without video colposcopy (P=.50). The secondary endpoints pain during examination (median 2 [interquartile range 1–3] compared with 2 [1–4]; P=.91), pain 10 minutes after examination (1 [0–3] compared with 1 [0–2.5]; P=.24), general unpleasantness (3 [1–5] compared with 3 [1–5]; P=.90), anxiety during examination (3 [1–5] compared with 3 [1–5]; P=.61), satisfaction with the information about the procedure (10 [9–10] compared with 10 [9–10]; P=.88), and overall satisfaction (10 [9–10] compared with 10 [9–10]; P=.54) were also not different between the two study groups. In a multivariate linear regression analysis, study center (P=.028), body mass index (P=.033), and smoking status (P=.025) independently affected the reduction of anxiety.

CONCLUSION:
Video colposcopy does not reduce anxiety in women undergoing colposcopy.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02697175.
Paracervical Block for Laminaria Insertion Before Second-Trimester Abortion
Authors: Soon Reni , Tschann Mary , Salcedo Jennifer , Stevens Katelyn , Ahn Hyeong Jun , Kaneshiro Bliss 
Published: July 2017

OBJECTIVE:
To evaluate the efficacy of a paracervical block to decrease pain during osmotic dilator insertion before second-trimester abortion.

METHODS:
In this double-blind, randomized trial, 41 women undergoing Laminaria insertion before a second-trimester abortion received either a paracervical block with 18 mL 1% lidocaine and 2 mL sodium bicarbonate or a sham block. Women were between 14 and 23 6/7 weeks of gestation. The primary outcome was pain immediately after insertion of Laminaria. Women assessed their pain on a 100-mm visual analog scale. Secondary outcomes included assessment of pain at other times during the insertion procedure and overall satisfaction with pain control. To detect a 25-mm difference in pain immediately after Laminaria insertion, at an α of 0.05 and 80% power, we aimed to enroll 20 patients in each arm.

RESULTS:
From May 2015 to December 2015, 20 women received a paracervical block and 21 received a sham block. Groups were similar in demographics, including parity, history of surgical abortion, and number of Laminaria placed. The paracervical block reduced pain after Laminaria insertion (median scores 13 mm [interquartile range 2–39] compared with 54 mm [interquartile range 27–61], P=.01, 95% CI −47.0 to −4.0). Women who received a paracervical block also reported higher satisfaction with overall pain control throughout the entire Laminaria insertion procedure (median scores 95 mm [interquartile range 78–100] compared with 70 mm [interquartile range 44–90], P=.05, 95% CI 0.0–37.0).

CONCLUSION:
Paracervical block is effective at reducing the pain of Laminaria insertion. Additionally, a paracervical block increases overall patient satisfaction with pain control during Laminaria placement.

CLINICAL TRIAL REGISTRATION:
ClinicalTrials.gov, NCT02454296.
Retrograde Femoral Nailing Using Percutaneous Reduction Techniques
Authors: Pettett Brett J. , Avery Matthew C. , Ostrum Robert F. 
Published: July 2017

Summary:
Femoral shaft fractures are commonly treated with closed reduction and reamed intramedullary nailing. However, some reductions are difficult to obtain or maintain, especially in muscular or large patients. When closed methods fail to achieve reduction, percutaneous techniques are extremely useful. In addition, the use of either permanent or temporarily placed blocking implants offer a minimally invasive option for improving sagittal and coronal plane alignment. In the accompanying video, we describe our method of percutaneous reduction techniques in the setting of a comminuted femoral shaft fracture treated with a retrograde femoral intramedullary nail.
Femoral Nonunion With Iliac Crest Bone Graft
Authors: Konda Sanjit R. , Christiano Anthony , Fisher Nina , Leucht Philipp , Egol Kenneth A. 
Published: July 2017

Purpose:
Fracture nonunion is a common problem for today's orthopaedic surgeon. However, many techniques are currently available for the treatment of long-bone nonunion. This video demonstrates the use of iliac crest bone graft and plate stabilization in the setting of a hypertrophic femoral nonunion.

Methods:
Treatment of femoral nonunion after intramedullary nail fixation using compression plating and bone grafting is a reliable technique for reducing pain, improving function, and achieving radiographic union. Furthermore, the use of autologous bone graft, in particular iliac crest bone graft, has provided reliable clinical results.

Results:
In this video, we present the case of a hypertrophic femoral nonunion treated with supplemental bone grafting in addition to plate and screw fixation.

Conclusions:
Although femoral nonunions are a relatively rare occurrence, they can be reasonably treated using stabilization and supplemental bone grafting. Iliac crest bone graft provides for excellent results when used for treatment of a fracture nonunion.
Multiple Rib Nonunion: Open Reduction and Internal Fixation and Iliac Crest Bone Graft Aspirate
Authors: Kaplan Daniel J. , Begly John , Tejwani Nirmal 
Published: July 2017

Purpose:
Rib fractures are a common chest injury that can typically be treated nonoperatively. However, a percentage of these will go on to nonunion, either because of unique characteristics of the fracture itself or because of a variety of poor healing factors of the host. If a patient has continued symptomology beyond 3 months, surgeons may consider operative management.

Methods:
Although isolated resection of fibrous scar tissue from the nonunion site may be sufficient in some cases, it may also be necessary to provide additional structural integrity to the rib depending on the extent of the fracture pattern and resection. This goal can be achieved operatively with rib plating and bone grafting to promote healing.

Results:
This video demonstrates the use of plating in the treatment of rib nonunion. It begins with relevant background information on rib fractures and nonunions, then details the approach, open reduction and internal fixation of 3 ribs using plates and bone graft aspirate. Pearls and pitfalls are included during the surgical technique aspect of the video to both help guide surgeons new to the procedure and provide potentially advantageous technical details to more experienced surgeons.
Retiform Purpura After Transcatheter Arterial Chemoembolization: A Case Report
Authors: Hansen Trevor , Olsen Keith , White Kevin , Keller Jesse 
Published: July 2017

Abstract:
Cutaneous complications secondary to transcatheter arterial chemoembolization (TACE) are exceptionally rare and may occur because of nontarget embolization of terminal vessels supplying the skin. We present a patient who developed painful retiform purpura on the right flank shortly after TACE for treatment of hepatocellular carcinoma. Biopsy revealed intravascular tan to yellow amorphous spherical structures within the dermis, confirming the presence of foreign material within these vessels. The authors review the literature and discuss previous cases of skin lesions manifesting after TACE, as well as potential factors influencing the probability of cutaneous complications. Histopathologic findings described in similar cases are presented. Prophylactic measures and attempted treatments to reduce likelihood of long-term injury are also reviewed. An awareness that cutaneous injury is a rare, but potential complication of transcatheter arterial embolization, as well as an understanding of management options is important for any provider using this procedure.
Does physician leadership affect hospital quality, operational efficiency, and financial performance?
Authors: Tasi Michael C. , Keswani Aakash , Bozic Kevin J. 
Published: July 2017

Background:
With payers and policymakers’ focus on improving the value (health outcomes achieved per health care dollar spent) of health care delivery, physicians are increasingly taking on senior leadership/management positions in health care organizations (Carsen & Xia, 2006). Little research has been done to understand the impact of physician leadership on the delivery of care.

Purpose:
The aim of this study was to examine whether hospital systems led by physicians were associated with better U.S. News and World Report (USNWR) quality ratings, financial performance, and operating efficiency as compared with those led by nonphysician managers.

Methodology:
Cross-sectional analysis of nationally representative data from Medicare Cost Reports and the USNWR on the 115 largest U.S. hospitals was performed. Bivariate analysis of physician-led and non-physician-led hospital networks included three categories: USNWR quality ratings, hospital volume, and financial performance. Multivariate analysis of hospital leadership, percent operating margin, inpatient days per hospital bed, and average quality rating was subsequently performed.

Results:
Hospitals in physician-led hospital systems had higher quality ratings across all specialties and more inpatient days per hospital bed than did non-physician-led hospitals; however, there were no differences in the total revenue or profit margins between the groups. Physician leadership was independently associated with higher average quality ratings and inpatient days per bed.

Conclusions:
Large hospital systems led by physicians in 2015 received higher USNWR ratings and bed usage rates than did hospitals led by nonphysicians, with no differences in financial performance. This study suggests that physician leaders may possess skills, qualities, or management approaches that positively affect hospital quality and the value of care delivered.

Practice Implications:
Hospital quality and efficiency ratings vary significantly and can impact consumer decisions. Hospital systems may benefit from the presence of physician leadership to improve the quality and efficiency of care delivered to patients. In addition, medical education should help prepare physicians to take on leadership roles in hospitals and health systems.
Quantitative sensory testing response patterns to capsaicin- and ultraviolet-B–induced local skin hypersensitization in healthy subjects: a machine-learned analysis
Authors: Lötsch Jörn , Geisslinger Gerd , Heinemann Sarah , Lerch Florian , Oertel Bruno G. , Ultsch Alfred 
Published: July 2017

AbstractThe comprehensive assessment of pain-related human phenotypes requires combinations of nociceptive measures that produce complex high-dimensional data, posing challenges to bioinformatic analysis. In this study, we assessed established experimental models of heat hyperalgesia of the skin, consisting of local ultraviolet-B (UV-B) irradiation or capsaicin application, in 82 healthy subjects using a variety of noxious stimuli. We extended the original heat stimulation by applying cold and mechanical stimuli and assessing the hypersensitization effects with a clinically established quantitative sensory testing (QST) battery (German Research Network on Neuropathic Pain). This study provided a 246 × 10-sized data matrix (82 subjects assessed at baseline, following UV-B application, and following capsaicin application) with respect to 10 QST parameters, which we analyzed using machine-learning techniques. We observed statistically significant effects of the hypersensitization treatments in 9 different QST parameters. Supervised machine-learned analysis implemented as random forests followed by ABC analysis pointed to heat pain thresholds as the most relevantly affected QST parameter. However, decision tree analysis indicated that UV-B additionally modulated sensitivity to cold. Unsupervised machine-learning techniques, implemented as emergent self-organizing maps, hinted at subgroups responding to topical application of capsaicin. The distinction among subgroups was based on sensitivity to pressure pain, which could be attributed to sex differences, with women being more sensitive than men. Thus, while UV-B and capsaicin share a major component of heat pain sensitization, they differ in their effects on QST parameter patterns in healthy subjects, suggesting a lack of redundancy between these models.
Mandatory Reporting of Intimate Partner Violence: An Ethical Dilemma for Forensic Nurses
Authors: Walker Rosalyn M. 
Published: July 2017

ABSTRACT
Nearly all states and provinces have laws mandating licensed healthcare professionals to report to law enforcement suspicions and allegations of the abuse of children, older adults, and disabled persons and all incidents of violence by a deadly weapon. However, a few states in the United States additionally mandate providers to report all injuries resultant from reported or suspected domestic/intimate partner violence. This can present a challenge to forensic nurses seeking to protect patient confidentiality and autonomy. This challenge becomes further compounded when a patient desiring to remain anonymous reports sexual assault by their partner, accompanied by bodily injury. This case report explores one such scenario that occurred in a rural Colorado Emergency Department, the issues this presents to forensic nurses, and possible responses.
Long-term Outcome of Short Metallic Stents for Lobar Airway Stenosis
Authors: Fruchter Oren , Abed El Raouf Bayya , Rosengarten Dror , Kramer Mordechai R. 
Published: July 2017

Background:
Whereas stents are considered an excellent treatment for proximal central major airway stenosis, the value of stenting for distal lobar airway stenosis is still controversial. Our aim was to explore the short-term and long-term outcome of metallic stents placed for benign and malignant lobar airway stenosis.

Methods:
Between July 2007 and July 2014, 14 patients underwent small airway stent insertion. The clinical follow-up included serial semiannual physical examinations, pulmonary function tests, imaging, and bronchoscopy.

Results:
The etiologies for airway stenosis were: early post-lung transplantation bronchial stenosis (N=5), sarcoidosis (N=1), amyloidosis (N=1), anthracofibrosis (N=1), right middle lobe syndrome due to external lymph node compression (N=1), lung cancer (N=4), and stenosis of the left upper lobe of unknown etiology (N=1). Stents were placed in the right upper lobe bronchus (N=2), right middle lobe bronchus (N=6), left upper lobe bronchus (N=4), linguar bronchus (N=1), and left lower lobe bronchus (N=1). The median follow-up period ranged from 2 to 72 months (median 18 mo). Immediate relief of symptoms was achieved in the vast majority of patients (13/14, 92%). Out of 10 patients with benign etiology for stenosis, 9 (90%) experienced sustained and progressive improvement in pulmonary function tests and clinical condition.

Conclusions:
We describe our positive experience with small stents for lobar airway stenosis; further prospective trials are required to evaluate the value of this novel modality of treatment.
The expanding role of scapular free-flaps
Authors: Tang Alice L. , Bearelly Shethal , Mannion Kyle 
Published: July 2017

Purpose of review
The review evaluates the expanding role of scapular free flaps and its application in various complex head and neck defects.

Recent findings
The recent literature published focuses on the use of three-dimensional modeling for maxillectomy defects, expanded uses in both the megaflap, the various application of the scapular tip flap, and the feasibility of osseointegrated implants.

Summary
The subscapular system of flaps remains a versatile option in head and neck reconstruction. It continues to be one of the best options for large defects requiring generous soft tissue, muscle, and bone. Three-dimensional modeling is currently being applied to complex maxillary defects resulting in increased accuracy and efficiency of reconstruction. Expanded uses have also adopted the latissimus dorsi muscle in conjunction with the scapular bony flap to be used in large defects with resulting decreased fistula rates. Finally, there is sufficient evidence that supports the use of dental implantation into the scapula bone with successful retention rates.
Evaluation and management of syndromic congenital hearing loss
Authors: Casazza Geoffrey , Meier Jeremy D. 
Published: July 2017

Purpose of review
The purpose of this review is to review the evaluation and management of children with syndromic hearing loss. Specific syndromes and the impact of those syndromes on managing hearing loss will be discussed.

Recent findings
Improved molecular testing has increased the ability to identify syndromes-associated hearing loss. Accurate diagnosis of syndromic hearing loss can guide discussions regarding prognosis and appropriate management options for the hearing impairment.

Summary
A significant portion of childhood hearing loss is associated with a syndrome. Depending on the syndrome, surgical intervention including a bone-anchored hearing aid or cochlear implant may be helpful. In the future, targeted gene therapies may become a viable option for treating syndromic hearing loss.
A Rare Case of Pancreatic Tuberculosis
Authors: Catalya Stephen , Tulpule Sunil , Arshed Sabrina , Nai Qiang , Sen Shuvendu 
Published: July 2017

Abstract
Tuberculosis remains a major public health concern, although it has reportedly shown a decline in prevalence both in the United States and abroad in recent years. The focus on diagnosing and treating tuberculosis is on pulmonary tuberculosis. Meanwhile, pancreatic tuberculosis remains exceedingly rare, accounting for less than 5% (Gastroenterol Rep (Oxf), 2014;2:154–157) of all tuberculosis cases in the developing world. A literature review shows that the head is primarily affected in pancreatic tuberculosis (Gastroenterol Rep (Oxf), 2014;2:154–157).
The Emerging Role of Endoscopists in Treating Unresectable Pancreatic Cancer
Authors: Tsen Adrianne , Van Norman Matthew , Atluri Sreedevi , Rosenkranz Laura 
Published: July 2017

Abstract
Pancreatic adenocarcinoma is the eighth leading cause of cancer deaths worldwide in men and ninth leading cause in women. Surgical resection offers the only chance of potential cure; however, only 9.4% of patients present at the localized, resectable stage, whereas the rest present at the locally advanced or metastatic, unresectable stages. Because of the guarded outcomes following systemic chemoradiation and the associated systemic toxicities, locoregional therapies have recently gained popularity. Various endoscopic techniques (endoscopic ultrasound [EUS]–guided ablative therapies, fine-needle instillation of antitumor agents, stereotactic body radiation therapy with EUS-guided fiducial marker placement, and EUS-guided brachytherapy) have been explored over the past several years. Endoscopic therapy plays a role in the treatment of unresectable pancreatic adenocarcinoma. Its minimal invasiveness and increased precision of delivering oncologic treatments under EUS guidance render it as a favorable option for patients who do not benefit from surgical resection. New endoscopic therapies are currently under investigation, and the emerging role of the endoscopist in the treatment of unresectable pancreatic cancer continues to grow.
Interfacility Transport Shock Index Is Associated With Decreased Survival in Children
Authors: Jennings Ryan M. , Kuch Bradley A. , Felmet Kathryn A. , Orr Richard A. , Carcillo Joseph A. , Fink Ericka L. 
Published: July 2017

Background
Shock index, the ratio of heart rate to systolic blood pressure that changes with age, is associated with mortality in adults after trauma and in children with sepsis. We assessed the utility of shock index to predict sepsis diagnosis and survival in children requiring interfacility transport to a tertiary care center.

Methods
We studied children aged 1 month to 21 years who had at least 2 sets of vital signs recorded during interfacility transport to the Children’s Hospital of Pittsburgh by our critical care transport team. Subjects were divided into 4 age groups: group 1 (<1 year), group 2 (1–3 years), group 3 (4–11 years), and group 4 (≥12 years). Children were also grouped into sepsis or nonsepsis group based on the International Classification of Diseases, Ninth Revision categories. Primary outcome was survival to hospital discharge.

Results
Of 3519 children studied, 493 (14%) had sepsis. Initial shock index decreased with increasing age: group 1, 1.45 ± 0.42 (mean ± SD); group 2, 1.35 ± 0.32; group 3, 1.20 ± 0.34; and group 4, 1.00 ± 0.32 (P < 0.001). Initial shock index was increased in children with sepsis versus those with no sepsis overall and in all age groups (all P < 0.05). Initial shock index showed a trend for association with survival in univariate analysis (P = 0.05) but was not associated with survival in a multivariable logistic regression. Highest quartile of shock index was associated with need for intensive care unit admission posttransport.

Conclusions
Increased shock index in children requiring intrafacility transport was associated with hospital discharge diagnosis of sepsis but not hospital survival.
Transitions of Care
Authors: Genovesi Andrea Lynn , Olson Lenora M. , Telford Russell , Fendya Diana , Schenk Ellen , Morrison-Quinata Theresa , Edgerton Elizabeth A. 
Published: July 2017

Objective
Every year, emergency medical services agencies transport approximately 150,000 pediatric patients between hospitals. During these transitions of care, patient safety may be affected and contribute to adverse events when important clinical information is missing, incomplete, or inaccurate. Written interfacility transfer policies are one way to standardize procedures and facilitate communication between the hospitals leading to improved patient safety and satisfaction for children and families.

Methods
We assessed the presence and components of written interfacility transfer guidelines and agreements for pediatric patients via a survey sent to US hospital emergency department (ED) nurse managers during 2010 and 2013.

Results
Although there was an increase in the presence of written interfacility transfer guidelines and agreements, a third of hospitals did not have either by 2013, and only 50% had guidelines with all recommended pediatric components. Hospitals with medium and low ED pediatric patient volumes were less likely to have written guidelines or agreements compared with hospitals with high volume. Hospitals with advanced pediatric resources, such as a pediatric emergency care coordinator or EDs designated approved for pediatrics, were more likely to have guidelines or agreements than less resourced hospitals.

Conclusions
Although there was improvement over time, opportunities exist for increasing the presence of written interfacility transfer guidelines as well as agreements for pediatric patients. Further studies are needed to demonstrate whether improved delivery of patient care is associated with the presence of written interfacility transfer guidelines and agreements and to identify other elements in the process to ensure optimal pediatric patient care.