bluuebunny/crossref_metadata_2025_split huggingface dataset:
ICU Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research
Authors: Nates Joseph L. , Nunnally Mark , Kleinpell Ruth , Blosser Sandralee , Goldner Jonathan , Birriel Barbara , Fowler Clara S. , Byrum Diane , Miles William Scherer , Bailey Heatherlee , Sprung Charles L. 
Published: July 2016

Objectives:
To update the Society of Critical Care Medicine’s guidelines for ICU admission, discharge, and triage, providing a framework for clinical practice, the development of institutional policies, and further research.

Design:
An appointed Task Force followed a standard, systematic, and evidence-based approach in reviewing the literature to develop these guidelines.

Measurements and Main Results:
The assessment of the evidence and recommendations was based on the principles of the Grading of Recommendations Assessment, Development and Evaluation system. The general subject was addressed in sections: admission criteria and benefits of different levels of care, triage, discharge timing and strategies, use of outreach programs to supplement ICU care, quality assurance/improvement and metrics, nonbeneficial treatment in the ICU, and rationing considerations. The literature searches yielded 2,404 articles published from January 1998 to October 2013 for review. Following the appraisal of the literature, discussion, and consensus, recommendations were written.

Conclusion:
Although these are administrative guidelines, the subjects addressed encompass complex ethical and medico-legal aspects of patient care that affect daily clinical practice. A limited amount of high-quality evidence made it difficult to answer all the questions asked related to ICU admission, discharge, and triage. Despite these limitations, the members of the Task Force believe that these recommendations provide a comprehensive framework to guide practitioners in making informed decisions during the admission, discharge, and triage process as well as in resolving issues of nonbeneficial treatment and rationing. We need to further develop preventive strategies to reduce the burden of critical illness, educate our noncritical care colleagues about these interventions, and improve our outreach, developing early identification and intervention systems.
Management of Attention-Deficit/Hyperactivity Disorder by Developmental-Behavioral Pediatricians: A DBPNet Study
Authors: Harstad Elizabeth , Blum Nathan , Gahman Amy , Shults Justine , Chan Eugenia , Barbaresi William ,   on behalf of the DBPNet Steering Committee
Published: July 2016

Abstract:

Objective:
To describe practice patterns for developmental-behavioral pediatricians (DBPs) practicing within Developmental-Behavioral Pediatrics Research Network (DBPNet) academic medical centers providing follow-up for children with attention-deficit/hyperactivity disorder (ADHD) and determine how well they adhere to American Academy of Pediatrics ADHD Clinical Practice Guidelines.

Methods:
Seventy-eight DBPs at 12 academic medical centers participating in the DBPNet were asked to complete follow-up encounter surveys for patients with ADHD or autism spectrum disorder seen from 12/2011 through 6/2012. Data regarding patient characteristics, comorbid conditions, and medication management were obtained at the time of each visit.

Results:
Fifty-seven DBPs completed 301 ADHD follow-up encounter surveys; 75.3% of patients were male with mean age 9.57 years (SD = 3.3). Race/ethnicity was primarily white/non-Hispanic with similar numbers on private insurance (41.5%) versus Medicaid (45.5%). DBPs identified comorbid learning disorders in 27.6% of children ≥6 years. Only 58.3% of children <6 years received counseling/behavioral therapy or had it recommended during the visit. DBPs primarily (90.6%) prescribed medications FDA-approved for ADHD treatment and growth was monitored for >98% of visits during which stimulants were prescribed. Parent- and teacher-completed rating scales were reviewed/completed during 43.9% and 37.8% of visits, respectively. There were no child or physician factors consistently associated with variation in practice patterns.

Conclusion:
Developmental-behavioral pediatricians practicing within DBPNet medical centers adhere to the recommended medication prescribing practices for ADHD, including use of FDA-approved medications and monitoring growth. However, DBPs within DBPNet do not consistently review ADHD rating scales or recommend behavioral counseling for children <6 years of age as recommended.
Repeated OnabotulinumtoxinA Treatment of Glabellar Lines at Rest Over Three Treatment Cycles
Authors: Carruthers Alastair , Carruthers Jean , Fagien Steven , Lei Xiaofang , Kolodziejczyk Julia , Brin Mitchell F. 
Published: July 2016

BACKGROUND
OnabotulinumtoxinA has demonstrated the ability to eliminate mild glabellar lines at rest; however, less is known regarding the effect of repeat treatment on more severe lines at rest.

OBJECTIVE
To assess the effect of repeated onabotulinumtoxinA treatment for reduction of glabellar lines at rest.

METHODS
Subjects 18 to 75 years old with at least mild glabellar lines at rest, as assessed by the validated Facial Wrinkle Scale (FWS) with photonumeric guide (score ≥ 1), received 3 treatments of 20 U onabotulinumtoxinA 4 months apart (N = 225). “Response” was defined as elimination of glabellar lines at rest (FWS score = 0) at any time point (Days 7, 30, 60, 90, and 120). Effect of treatment cycle on response was analyzed using repeated measures logistic regressions (p < .05).

RESULTS
Most subjects were female (85%) and white (88%) (age range: 35–54 years). The likelihood of significant response was as follows: for all subjects combined (odds ratio [OR]: 1.31), for subjects with mild resting lines at baseline (OR: 1.49), and for older women (≥55 years) with mild resting lines at baseline (OR: 2.22). Of all subjects, 76% responded after 1 treatment, and 45% responded in all 3 cycles.

CONCLUSION
Subjects repeatedly treated with onabotulinumtoxinA showed progressive improvement in glabellar lines at rest.
Nasal Reconstruction: Extending the Limits
Authors: Rezaeian Farid , Corsten Marcus , Haack Sebastian , Gubisch Wolfgang M. , Fischer Helmut 
Published: July 2016

Summary:
Reconstructing the 3-dimensional structure of the nose requires the maintenance of its aesthetic form and function. Restoration of the correct dimension, projection, skin quality, symmetrical contour, and function remains problematic. Consequently, modern approaches of nasal reconstruction aim at rebuilding the units rather than just covering the defect. However, revising or redoing a failed or insufficient reconstruction remains very challenging and requires experience and creativity. Here, we present a very particular case with a male patient, who underwent 37 operations elsewhere and presented with a failed nasal reconstruction. We describe and illustrate the complex steps of the nasal rereconstruction, including the reconstruction of the forehead donor site, surgical delay procedures for lining, and the coverage with a third paramedian forehead flap.
Financial performance, employee well-being, and client well-being in for-profit and not-for-profit nursing homes: A systematic review
Authors: Bos Aline , Boselie Paul , Trappenburg Margo 
Published: July 2016

Background:Expanding the opportunities for for-profit nursing home care is a central theme in the debate on the sustainable organization of the growing nursing home sector in Western countries.Purposes:We conducted a systematic review of the literature over the last 10 years in order to determine the broad impact of nursing home ownership in the United States. Our review has two main goals: (a) to find outwhich topicshave been studied with regard to financial performance, employee well-being, and client well-being in relation to nursing home ownership and (b) to assessthe conclusions related to these topics. The review results in two propositions on the interactions between financial performance, employee well-being, and client well-being as they relate to nursing home ownership.Methodology/Approach:Five search strategies plus inclusion and quality assessment criteria were applied to identify and select eligible studies. As a result, 50 studies were included in the review. Relevant findings were categorized as related to financial performance (profit margins, efficiency), employee well-being (staffing levels, turnover rates, job satisfaction, job benefits), or client well-being (care quality, hospitalization rates, lawsuits/complaints) and then analyzed based on common characteristics.Findings:For-profit nursing homes tend to have better financial performance, but worse results with regard to employee well-being and client well-being, compared to not-for-profit sector homes. We argue that the better financial performance of for-profit nursing homes seems to be associated with worse employee and client well-being.Practical Implications:For policy makers considering the expansion of the for-profit sector in the nursing home industry, our findings suggest the need for a broad perspective, simultaneously weighing the potential benefits and drawbacks for the organization, its employees, and its clients.
Loss-of-function polymorphisms in the organic cation transporter OCT1 are associated with reduced postoperative tramadol consumption
Authors: Stamer Ulrike M. , Musshoff Frank , Stüber Frank , Brockmöller Jürgen , Steffens Michael , Tzvetkov Mladen V. 
Published: July 2016

Abstract
The organic cation transporter OCT1 (SLC22A1) mediates uptake and metabolism of the active tramadol metabolite (+)O-desmethyltramadol in the liver. In this study, the influence of OCT1 genetic polymorphisms on pharmacokinetics and analgesic efficacy of tramadol in patients recovering from surgery was analyzed in addition to the CYP2D6 genotype. Postoperative patients who received tramadol through patient-controlled analgesia were enrolled. Genotypes resulting in 0, 1, or 2 active OCT1 alleles were determined as well as CYP2D6 genotypes. The primary endpoint was the 24-hour postoperative tramadol consumption in patients with 0 vs at least 1 active OCT1 allele. Secondary endpoint was the OCT1-dependent plasma concentration (areas under the concentration–time curves) of the active tramadol metabolite (+)O-desmethyltramadol. Of 205 patients, 19, 82, and 104 carried 0, 1, and 2 active OCT1 alleles, respectively. Cumulative tramadol consumption through patient-controlled analgesia was lowest in patients with 0 active OCT1 allele compared with the group of patients with 1 or 2 active alleles (343 ± 235 vs 484 ± 276 mg; P = 0.03). Multiple regression revealed that the number of active OCT1 alleles (P = 0.014), CYP2D6 (P = 0.001), pain scores (P < 0.001), and the extent of surgery (0.034) had a significant influence on tramadol consumption. Plasma areas under the concentration–time curves of (+)O-desmethyltramadol were 111.8 (95% confidence interval: 63.4-160.1), 80.2 (65.1-95.3), and 64.5 (51.9-77.2) h·ng·mL−1 in carriers of 0, 1, or 2 active OCT1 alleles (P = 0.03). Loss of OCT1 function resulted in reduced tramadol consumption and increased plasma concentrations of (+)O-desmethyltramadol in patients recovering from surgery. Therefore, analyzing OCT1 next to CYP2D6 genotype might further improve future genotype-dependent dose recommendations for tramadol.
Genetic variants associated with thermal pain sensitivity in a paediatric population
Authors: Matic Maja , van den Bosch Gerbrich E. , de Wildt Saskia N. , Tibboel Dick , van Schaik Ron H.N. 
Published: July 2016

AbstractPain sensitivity is an inherited factor that varies strongly between individuals. We investigated whether genetic polymorphisms in the candidate genesCOMT,OPRM1,OPRD1,TAOK3,TRPA1,TRPV1, andSCN9Aare contributing to experimental pain variability between children. Our study included 136 children and adolescents (8-18 years). Cold and heat pain thresholds were determined with a Thermal Sensory Analyzer. Women and young children were significantly more sensitive to pain (P< 0.05). After correction for age, gender, reaction time, and correction for multiple testing,OPRM1118A>G G-allele carriers (AG and GG) rated the hot stimulus as significantly less painful than didOPRM1118A>G AA genotyped individuals (2[1-5] vs 7 [3-9], respectively;P= 0.00005). Additionally,OPRM1118G allele carriers reached more frequently the minimum temperature limit (44% vs 17%, respectively;P= 0.003) and maximum temperature limit (52% vs 24%, respectively;P= 0.0052), indicative for lower pain sensitivity. The combined genotype, based on expected pain sensitivity,OPRM1118AA/COMT472 GA or AA genotyped children, was associated with lower pain thresholds (ie, higher pain sensitivity) than were theOPRM1118GA or GG/COMT472GG genotyped children. This is the first study reporting on genetic variants and experimental thermal pain in children and adolescents.OPRM1rs1799971 and the combinedOPRM1/COMTgenotype could serve as biomarkers for pain sensitivity.
Young children's ability to report on past, future, and hypothetical pain states: a cognitive-developmental perspective
Authors: Jaaniste Tiina , Noel Melanie , von Baeyer Carl L. 
Published: July 2016

Abstract
Children are at times asked by clinicians or researchers to rate their pain associated with their past, future, or hypothetical experiences. However, little consideration is typically given to the cognitive-developmental requirements of such pain reports. Consequently, these pain assessment tasks may exceed the abilities of some children, potentially resulting in biased or random responses. This could lead to the over- or under-treatment of children's pain. This review provides an overview of factors, and specifically the cognitive-developmental prerequisites, that may affect a child's ability to report on nonpresent pain states, such as past, future, or hypothetical pain experiences. Children's ability to report on past pains may be influenced by developmental (age, cognitive ability), contextual (mood state, language used by significant others), affective and pain-related factors. The ability to mentally construct and report on future painful experiences may be shaped by memory of past experiences, information provision and learning, contextual factors, knowledge about oneself, cognitive coping style, and cognitive development. Hypothetical pain reports are sometimes used in the development and validation of pain assessment scales, as a tool in assessing cognitive-developmental and social-developmental aspects of children's reports of pain, and for the purposes of training children to use self-report scales. Rating pain associated with hypothetical pain scenarios requires the ability to recognize pain in another person and depends on the child's experience with pain. Enhanced understanding of cognitive-developmental requirements of young children's pain reports could lead to improved understanding, assessment, and treatment of pediatric pain.
Improving Care Transitions Across Healthcare Settings Through a Human Factors Approach
Authors: Werner Nicole E. , Gurses Ayse P. , Leff Bruce , Arbaje Alicia I. 
Published: July 2016

Abstract:
After more than two decades of research focused on care transition improvement and intervention development, unfavorable outcome measures associated with care transitions across healthcare settings persist. Readmissions rates remain an important outcome to target for intervention, adverse events associated with care transitions continue to be an issue, and patients are often dissatisfied with the quality of their care. Currently, interventions to improve care transitions are disease specific, require substantial financial investments in training allied healthcare professionals, or focus primarily on hospital-based discharge planning with mixed results. This complex situation requires a method of evaluation that can provide a comprehensive, in-depth, and context-driven investigation of potential risks to safe care transitions across healthcare settings, which can lead to the creation of effective, usable, and sustainable interventions. A systems' approach known as Human Factors and Ergonomics (HFE) evaluates the factors in a system that affect human performance. This article describes how HFE can complement and further strengthen efforts to improve care transitions.
The Effect of an Interprofessional Heart Failure Education Program on Hospital Readmissions
Authors: Clarkson Julia N. , Schaffer Susan D. , Clarkson Joshua J. 
Published: July 2016

Abstract:
Heart failure (HF) is an increasing concern to public health, affecting approximately 5.1 million Americans and costing the United States over $32 billion annually. Compounding the concern, research has exposed the significant problem of hospital readmissions for the HF population, with an estimated 25% of HF patients are rehospitalized within 30 days of discharge. This project focuses on an education-based strategy designed to decrease hospital readmissions for this at-risk population. In particular, an interprofessional outpatient educational program (Heart Failure University [HFU]) was initiated to reduce healthcare costs and increase the quality of care for HF patients at a large private hospital in Florida. A retrospective case–control study was conducted to compare 30-day hospital readmissions of patients who attended HFU to patients who received standard education. Results indicated a significant association between HFU attendance and reduced 30-day hospital readmissions (χ2 [1, N = 106] = 5.68, p = .02). Strengthening this effect, the results showed patients who attended HFU had a significantly greater functional disability than those who did not attend (t(104) = 2.40, p = .018). These findings corroborate with current research on transitional care interventions and emphasize the importance of interprofessional, educational-based disease management programs for the HF population.
Applying Lean Techniques to Reduce Intravenous Waste Through Premixed Solutions and Increasing Production Frequency
Authors: Lin Alex C. , Penm Jonathan , Ivey Marianne F. , Deng Yihong , Commins Monica 
Published: July 2016

Background:
This study aims to use lean techniques and evaluate the impact of increasing the use of premixed IV solutions and increased IV production frequency on IV waste.

Methods:
Study was conducted at a tertiary hospital pharmacy department in three phases. Phase I included evaluation of IV waste when IV production occurred three times a day and eight premixed IV products were used. Phase II increased the number of premixed IV products to 16. Phase III then increased IV production to five times a day.

Results:
During Phase I, an estimate of 2,673 IV doses were wasted monthly, accounting for 6.14% of overall IV doses. This accounted for 688 L that cost $60,135. During Phase II, the average monthly IV wastage reduced significantly to 1,069 doses (2.84%), accounting for 447 L and $34,003. During Phase III, the average monthly IV wastage was further decreased to 675 doses (1.69%), accounting for 78 L and $3,431. Hence, a potential annual saving of $449,208 could result from these changes.

Conclusion:
IV waste was reduced through the increased use of premixed solutions and increasing IV production frequency.
Silver Sulfadiazine or Biobrane Dressings
Authors: Hodnett Carly W. 
Published: July 2016

Background
In the treatment of partial thickness burns in pediatrics, silver sulfadiazine (SSD) has been widely used. Biobrane, a biosynthetic dressing, has gained popularity for treatment as well for its promotion of epithelial growth. Nonetheless, there is limited information on the comparison of SSD and Biobrane for the treatment of partial-thickness burns in children. This literature review aimed to provide objective data on increased epithelial growth and decreased infection risk of SSD and Biobrane.

Purpose
The aim of this study was to conduct a literature review to examine the use of Biobrane dressings in comparison with SSD for the treatment of partial-thickness burns in children to improve epithelial growth and decrease risk of infection as compared with SSD.

Results
Seven systemic reviews were included in the literature review. Evidence showed that there was limited high-quality evidence to confirm the effectiveness of Biobrane compared with SSD in the pediatric population with partial thickness burns in regard to fewer dressing changes, improved healing time, and reduced wound infections. Some evidence exists showing Biobrane's ease in use and improved healing time when compared with SSD.

Recommendations for Practice
Future research is necessary to investigate Biobrane and SSD within large pediatric burn populations to establish its effectiveness and provide high-quality evidence for the treatment of pediatric partial-thickness burns.
Corticosteroids Versus Pentoxifylline for Severe Alcoholic Hepatitis
Authors: Njei Basile , Do Albert , McCarty Thomas R. , Fortune Brett E. 
Published: July 2016

Introduction:
Despite the significant morbidity and mortality associated with alcoholic hepatitis, a consensus or generally accepted therapeutic strategy has not yet been reached. The purpose of this analysis was to evaluate the effects of corticosteroids and pentoxifylline on short-term mortality, incidence of hepatorenal syndrome, and sepsis in patients with severe alcoholic hepatitis.

Materials and Methods:
We conducted a comprehensive search of the Cochrane library, PUBMED, Scopus, EMBASE, and published proceedings from major hepatology and gastrointestinal meetings from January 1970 to June 2015. All relevant articles irrespective of language, year of publication, type of publication, or publication status were included. Two independent reviewers extracted data and scored publications; a third investigator adjudicated discrepancies. The κ scores were measured to assess the agreement between the 2 initial reviewers. The review and meta-analyses were performed following the recommendations of The Cochrane Collaboration. Conventional meta-analysis and Trial sequential analysis were performed. GRADEpro version 3.6 was used to appraise the quality of epidemiologic evidence.

Results:
A total of 14 studies satisfied inclusion criteria comparing corticosteroids, pentoxifylline, or placebo. Compared with placebo, corticosteroids reduced 28-day mortality (RR=0.53; 95% CI, 0.33-0.84; P=0.006). There was no statistically significant difference in short-term mortality between pentoxifylline and placebo (RR=0.74; 95% CI, 0.46-1.18; P=0.21). Neither corticosteroids nor pentoxifylline impacted the incidence of hepatorenal syndrome or sepsis. Trial sequential analysis confirmed the results of our conventional meta-analysis.

Conclusions and Relevance:
Corticosteroids demonstrated a decrease in 28-day mortality in patients with severe alcoholic hepatitis. The evidence from this study is insufficient to support any recommendations regarding the mortality benefit of pentoxifylline in severe alcoholic hepatitis.