bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Role of Documentation Quality in Anesthesia-Related Closed Claims
Authors: Wilbanks Bryan A. , Geisz-Everson Marjorie , Boust Rebecca R. 
Published: June 2016

Clinical documentation is a critical tool in supporting care provided to patients. Sound documentation provides a picture of clinical events that can be used to improve patient care. However, many other uses for clinical documentation are equally important. Such documentation informs clinical decision support tools, creates a legal record of patient care, assists in financial reimbursement of services, and serves as a repository for secondary data analysis. Conversely, poor documentation can impair patient safety and increase malpractice risk exposure by reflecting poor or inaccurate information that ultimately may guide patient care decisions.
Through an examination of anesthesia-related closed claims, a descriptive qualitative study emerged, which explored the antecedents and consequences of documentation quality in the claims reviewed. A secondary data analysis utilized a database generated by the American Association of Nurse Anesthetists Foundation closed claim review team. Four major themes emerged from the analysis. Themes 1, 2, and 4 primarily describe how poor documentation quality can have negative consequences for clinicians. The third theme primarily describes how poor documentation quality that can negatively affect patient safety.
Effective Listening
Authors: Watson Kittie W. 
Published: June 2016

ABSTRACT:
For many nurses, especially when workloads are high, it can be difficult to listen carefully to patients. Federally mandated Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys that help determine insurance reimbursement are asking patients how carefully their nurses listened. For Christian nurses, effective listening demonstrates the compassion, understanding, and care modeled by Jesus. An exploration of Jesus' responses reveals five ways Christ effectively listened to people that can guide nurses.
Dose–Response Relationships of Multisensory Intervention on Hospitalized Patients With Chronic Schizophrenia
Authors: Cheng Sunny Chieh , Hsu Wen-Shin , Shen Shu-Hua , Hsu Mei-Chi , Lin Mei-Feng 
Published: June 2016

ABSTRACT

Background:
Patients with chronic schizophrenia often show negative emotional responses because of cognitive impairment. Multisensory stimulation therapy has been shown effective in improving cognitive and emotional functions in cognitively impaired patients with dementia. However, very few studies have applied this multisensory intervention to patients with chronic schizophrenia. Furthermore, it is not known whether a dose–response relationship exists between the frequency and efficacy of this intervention.

Purpose:
The objective of this study was to evaluate the relationship between the effects and dose–response of the multisensory intervention on patients with chronic schizophrenia in a mental rehabilitation hospital.

Methods:
A crossover study design with a sample size of 60 was conducted. Participants were divided equally between an experimental group and a control group. The experimental group received the intervention in a multisensory stimulation room. Six sessions of the 30-minute sensory intervention were conducted on experimental group participants, who were allowed to select their preferred stimulants. In contrast, the control group received routine care only. After a 2-week washout period, participants in the experimental group were reassigned to the control group, and those in the control group were reassigned to the experimental group. Standardized questionnaires were applied to evaluate psychotic symptoms, emotional responses, and well-being of all participants. The NeXus-4 model wireless biofeedback system was used to measure the psychological–physiological parameters of participants at baseline and after the first, third, and sixth sessions of the multisensory intervention. A generalized estimating equation model was used to analyze the effects of the intervention

Results:
Although multisensory stimulation therapy had no significant effect on psychotic symptoms and well-being, this intervention may improve the negative emotional reactions of patients. In particular, the intervention significantly reduced the subjective anxiety level of participants and stabilized their objective respiratory and heart rates. Moreover, a positive correlation was found between the efficacy of the treatment and the frequency of the intervention.

Conclusions/Implications for Practice:
Evidence from this study validated the multisensory stimulation therapy protocol. Therefore, this protocol may be incorporated into clinical interventions to improve quality of care and to alleviate the negative emotions of patients with chronic schizophrenia.
Professional Values, Job Satisfaction, and Intent to Leave Among Nursing Managers
Authors: Kantek Filiz , Kaya Ayla 
Published: June 2016

ABSTRACT

Background:
The professional values that are typically attributed to nursing managers influence the behaviors of staff nurses as well as of nursing managers. Therefore, the efficient planning and implementation of nursing services require that nursing managers raise their awareness of professional nursing values.

Purpose:
This study aims to investigate the correlations between professional values, job satisfaction, and intent to leave the job and the institution.

Methods:
This descriptive and cross-sectional study was conducted on 216 nursing managers in nine different hospitals in Turkey. The data were collected using a personal information form, Nursing Professional Values Scale, Minnesota Job Satisfaction Questionnaire, and scales on intent to leave the job and the institution.

Results:
Results indicate a positive correlation between the professional values of nurses and their job satisfaction and suggest a negative correlation between professional values and intent to leave the job and the institution. Furthermore, agency was found to be a determinant of job satisfaction.

Conclusions:
Strong professional values were found to increase job satisfaction and decrease the intent to leave the job and the institution.
Vitamin D and critical illness outcomes
Authors: Christopher Kenneth B. 
Published: June 2016

Purpose of review
Although low vitamin D levels have been shown to be a risk factor for adverse outcomes in critical care, it is not clear to date if supplementation can alter such outcomes in all ICU patients. The focus of vitamin D research now is on interventional trials to identify a critically ill patient subset who may benefit from high-dose vitamin D supplementation.

Recent findings
The VITdAL-ICU trial, a randomized, double-blind, placebo-controlled, single center trial of 475 heterogeneous critically ill patients, did not show improvement in hospital length of stay or overall mortality but did demonstrate in a secondary outcome that high-dose oral vitamin D3 improved mortality in patients with severe vitamin D deficiency.

Summary
Vitamin D supplementation may represent a personalized and targeted therapy for critical illness. Vitamin D regulates over 1000 genes in the human genome, and the mechanism of action is influenced by gene polymorphisms and epigenetics. The study of the metabolomics, transcriptomics and epigenetics of vitamin D status and supplementation holds promise generating insights into critical illness outcomes.
A Mixture of 3 Bifidobacteria Decreases Abdominal Pain and Improves the Quality of Life in Children With Irritable Bowel Syndrome
Authors: Giannetti Eleonora , Maglione Marco , Alessandrella Annalisa , Strisciuglio Caterina , De Giovanni Donatella , Campanozzi Angelo , Miele Erasmo , Staiano Annamaria 
Published: June 2016

Goals:
We assessed the efficacy of a probiotic mixture of Bifidobacterium infantis M-63, breve M-16V, and longum BB536 in improving abdominal pain (AP) and quality of life (QoL) in children with irritable bowel syndrome (IBS) and functional dyspepsia (FD).

Background:
AP-associated functional gastrointestinal disorders, particularly IBS and FD, are common in pediatrics, and no well-established treatment is currently available. Although probiotics have shown promising results in adults, data in children are heterogeneous.

Study:
Forty-eight children with IBS (median age, 11.2 y; range, 8 to 17.9 y) and 25 with FD (age, 11.6 y; range, 8 to 16.6 y) were randomized to receive either a mixture of 3 Bifidobacteria or a placebo for 6 weeks. After a 2-week “washout” period, each patient was switched to the other group and followed up for further 6 weeks. At baseline and follow-up, patients completed a symptom diary and a QoL questionnaire. AP resolution represented the primary outcome parameter.

Results:
In IBS, but not in FD, Bifidobacteria determined a complete resolution of AP in a significantly higher proportion of children, when compared with placebo (P=0.006), and significantly improved AP frequency (P=0.02). The proportion of IBS children with an improvement in QoL was significantly higher after probiotics than after placebo (48% vs. 17%, P=0.001), but this finding was not confirmed in FD.

Conclusions:
In children with IBS a mixture of Bifidobacterium infantis M-63, breve M-16V, and longum BB536 is associated with improvement in AP and QoL. These findings were not confirmed in FD subjects. Trial identifier: NCT02566876 (http://www.clinicaltrial.gov).
Characteristics and Clinical Outcomes of Duodenal Neoplasia in Japanese Patients With Familial Adenomatous Polyposis
Authors: Yachida Tatsuo , Nakajima Takeshi , Nonaka Satoru , Nakamura Keiko , Suzuki Haruhisa , Yoshinaga Shigetaka , Oda Ichiro , Moriya Yoshihiro , Masaki Tsutomu , Saito Yutaka 
Published: June 2016

Background:
After colorectal cancer and desmoid tumors, duodenal adenocarcinoma is the next leading cause of death in familial adenomatous polyposis (FAP) patients, but it has not been thoroughly investigated.

Patients and Methods:
To investigate the clinical course of duodenal neoplasia, including adenoma and cancer, we investigated 77 Japanese FAP patients treated at the National Cancer Center Hospital, Tokyo, Japan. We evaluated the clinicopathologic features, Spigelman severity score, and management of duodenal neoplasms. Data were acquired from a prospectively enrolled database.

Results:
Fifty-one (66%) of the 77 FAP patients had duodenal neoplasia during this observational period, and 47 of 51 patients had extra-ampulla duodenal neoplasia; 42 (58%) had duodenal neoplasms (extra-ampulla), 4 had duodenal adenomas with high-grade dysplasia (HGD), and 1 had invasive carcinoma. Among the 45 patients (extra-ampulla) with duodenal adenoma with HGD or low-grade dysplasia, 8 (18%) patients were treated using endoscopic resection (ER). During the short observation period, ER was performed only in HGD cases. None of the patients died from duodenal neoplasia. In total, during the surveillance period, duodenal HGD was detected in 5 (63%) of 8 patients graded as Spigelman stage IV; HGD was not detected in stage 0 (n=33), I (n=0), II (n=12), or III (n=20) patients.

Conclusions:
Short-interval endoscopic surveillance and appropriate ER may help prevent duodenal invasive carcinoma. In addition, there was little development of invasive carcinoma during the follow-up. The Spigelman classification is beneficial for the risk assessment of duodenal neoplasia in Japanese FAP patients.
Clinical Characteristics and the Dietary Response in Celiac Disease Patients Presenting With or Without Anemia
Authors: Saukkonen Johanna , Kaukinen Katri , Koivisto Anna-Maija , Mäki Markku , Laurila Kaija , Sievänen Harri , Collin Pekka , Kurppa Kalle 
Published: June 2016

Background and Aims:
It remains unclear as to what are the clinical characteristics associated with the presence of anemia at celiac disease diagnosis, and how these are affected by a gluten-free diet. We investigated these issues in a prospective study.

Methods:
Clinical and demographic data, small-bowel mucosal histology, serology, and laboratory parameters, body mass index (BMI), and bone mineral density (BMD) both at diagnosis and after 1 year on a gluten-free diet were investigated in 163 adults with celiac disease. Gastrointestinal symptoms and psychological well-being were evaluated by validated Gastrointestinal Symptom Rating Scale and Psychological General Well-Being questionnaires. All study variables were compared between participants with and without anemia at celiac disease diagnosis.

Results:
Altogether, 23% of the patients had anemia at diagnosis. Anemic patients were more often women (P=0.001) and had more gastrointestinal symptoms (P=0.004) and were less often screen detected (P=0.009). Further, they had higher celiac antibody values (P=0.007) and a lower total iron (P<0.001), BMI (P=0.003), and density of mucosal γδ+ intraepithelial lymphocytes (P=0.033). After 1 year on a gluten-free diet, the anemia group had a lower mucosal villous height-crypt depth ratio (P=0.008) and BMI (P=0.050), and higher antibody values (P=0.012) and densities of CD3+ (P=0.008) and αβ+ intraepithelial lymphocytes (P=0.022). There was no significant difference between the groups in their bone mineral density, Gastrointestinal Symptom Rating Scale and Psychological General Well-Being.

Conclusions:
Celiac patients with anemia had more severe disease than nonanemic patients in terms of the serology and a lower BMI. Further, they evinced a slower histologic response to the dietary treatment. An early diagnosis and careful follow-up are important in these patients.
Effect of Treatment Education Based on the Roy Adaptation Model on Adjustment of Hemodialysis Patients
Authors: Kacaroglu Vicdan Ayse , Gulseven Karabacak Bilgi 
Published: June 2016

Background:The Roy Adaptation Model examines the individual in 4 fields: physiological mode, self-concept mode, role function mode, and interdependence mode. Hemodialysis treatment is associated with the Roy Adaptation Model as it involves fields that might be needed by the individual with chronic renal disease.Purpose:This research was conducted as randomized controlled experiment with the aim of determining the effect of the education given in accordance with the Roy Adaptation Model on physiological, psychological, and social adaptation of individuals undergoing hemodialysis treatment.Design and Methods:This was a random controlled experimental study. The study was conducted at a dialysis center in Konya-Aksehir in Turkey between July 1 and December 31, 2012. The sample was composed of 82 individuals—41 experimental and 41 control.Results:In the second interview, there was a decrease in the systolic blood pressures and body weights of the experimental group, an increase in the scores of functional performance and self-respect, and a decrease in the scores of psychosocial adaptation. In the control group, on the other hand, there was a decrease in the scores of self-respect and an increase in the scores of psychosocial adaptation. The 2 groups were compared in terms of adaptation variables and a difference was determined on behalf of the experimental group.Conclusion:The training that was provided and evaluated for individuals receiving hemodialysis according to 4 modes of the Roy Adaptation Model increased physical, psychological, and social adaptation.
Comprehensive Analysis of Donor-Site Morbidity following Free Thoracodorsal Artery Perforator Flap Harvest
Authors: Lee Kyeong-Tae , Kim Ara , Mun Goo-Hyun 
Published: June 2016

Background:
The authors evaluated donor-site morbidity following free thoracodorsal artery perforator flap harvest comprehensively and investigated patient-and operation-related factors that might contribute to adverse outcomes.

Methods:
A retrospective analysis was conducted for all cases of free thoracodorsal artery perforator flap reconstruction performed between January of 2002 and December of 2014. Donor-site morbidity was evaluated in three aspects: postoperative complications, scar-related problems, and functional impairment. The Quick-Disabilities of the Arm, Shoulder and Hand questionnaire was administered postoperatively to assess donor-site function.

Results:
A total of 293 patients were analyzed. The median follow-up period was 19.0 months. Donor-site complications developed in 33 patients (11.3 percent). Wound dehiscence (7.4 percent) and seroma (3.0 percent) were the most common complications. Harvesting thoracodorsal artery perforator flaps on multiple perforators or segmental latissimus dorsi muscle-chimeric flaps increased the rate of seroma formation but did not affect other donor-site morbidities significantly. Patient American Society of Anesthesiologists classification was a significant predictor of wound dehiscence and overall donor-site complications. Thirty-one patients (10.6 percent) had scar-related problems, including 18 hypertrophic and 13 widened scars. A transverse skin paddle design had a significant protective effect on developing scar-related problems, compared with the nontransverse design. The mean Quick-Disabilities of the Arm, Shoulder and Hand questionnaire score was 2.68 (range, 0 to 18.2), and 90 percent of patients scored less than 10. Flap dimensions were positively correlated with the questionnaire score.

Conclusions:
The present study suggests that the free thoracodorsal artery perforator flap is associated with low donor-site morbidity and minimal dysfunction. Careful consideration of patient condition and thoughtful planning could further minimize donor-site morbidity.

CLINICAL QUESTION/LEVEVL OF EVIDENCE:
Therapeutic, IV.
Educational Exposure to Transgender Patient Care in Plastic Surgery Training
Authors: Morrison Shane D. , Chong H. Jonathan , Dy Geolani W. , Grant David W. , Wilson Stelios C. , Brower Jonathan P. , Vedder Nicholas B. , Berli Jens U. , Friedrich Jeffrey B. 
Published: June 2016

Background:
Gender dysphoria is estimated to occur in up to 0.9 percent of the U.S. population. With increasing awareness and decreasing stigma surrounding transgender issues, it is predicted that more patients will begin to seek medical and surgical transition. This study aims to determine the current state of transgender-related education in U.S. plastic surgery residency programs and to evaluate trainee perceptions regarding the importance of such training.

Methods:
Plastic surgery trainees from a representative sample of 21 U.S. training programs were asked to complete a cross-sectional eight-question survey between November of 2015 and January of 2016. Respondents were queried regarding demographics, transgender curricular exposure (didactic versus clinical), and perceived importance of training opportunities in transgender patient care.

Results:
A total of 322 residents or fellows responded to the survey (80 percent response rate) from four U.S. Census regions. Sixty-four percent of respondents had education on or direct exposure to transgender patient care during residency. Among those with experiences in gender-confirming surgery, more than half were exposed to chest and genital surgery. Overall, the majority of respondents believed that training in gender-confirming surgery is important, and 72 percent endorsed the necessity for gender-confirming surgery fellowship training opportunities.

Conclusions:
A significant number of plastic surgery trainees are exposed to transgender patient care, although exposure type is variable. The majority of trainees endorsed the importance of residency and fellowship training in gender-confirming surgery. To better serve the transgender population, formal fellowship training in gender-confirming surgery should be offered.
Development of an Emergency Department Trigger Tool Using a Systematic Search and Modified Delphi Process
Authors: Griffey Richard Thomas , Schneider Ryan M. , Adler Lee M. , Capp Roberta , Carpenter Christopher R. , Farmer Brenna M. , Groner Kathyrn Y. , Hodkins Sheridan , McCammon Craig A. , Powell Jonathan T. , Sather Jonathan E. , Schuur Jeremiah D. , Shapiro Marc J. , Sharp Brian R. , Venkatesh Arjun K. , Vrablik Marie C. , Wiler Jennifer L. 
Published: June 2016

Objective
This study aimed to develop an emergency department (ED) trigger tool to improve the identification of adverse events in the ED and that can be used to direct patient safety and quality improvement. This work describes the first step toward the development of an ED all-cause harm measurement tool by experts in the field.

Methods
We identified a multidisciplinary group of emergency medicine safety experts from whom we solicited candidate triggers. We then conducted a modified Delphi process consisting of 4 stages as follows: (1) a systematic literature search and review, including an independent oversampling of review for inclusion, (2) solicitation of empiric triggers from participants, (3) a Web-based survey ranking triggers on specific performance constructs, and (4) a final in-person meeting to arrive at consensus triggers for testing. Results of each step were shared with participants between each stage.

Results
Among an initial 804 unique articles found using our search criteria, we identified 94 that were suitable for further review. Interrater reliability was high (κ = 0.80). Review of these articles yielded 56 candidate triggers. These were supplemented by 58 participant-submitted triggers yielding a total of 114 candidate triggers that were shared with team members electronically along with their definitions. Team members then voted on each measure via a Web-based survey, ranking triggers on their face validity, utility for quality improvement, and fidelity (sensitivity/specificity). Participants were also provided the ability to flag any trigger about which they had questions or they felt merited further discussion at the in-person meeting. Triggers were ranked by combining the first 2 categories (face validity and utility), and information on fidelity was reviewed for decision making at the in-person meeting. Seven redundant triggers were eliminated. At an in-person meeting including representatives from all facilities, we presented the 50 top-ranked triggers as well as those that were flagged on the survey by 2 or more participants. We reviewed each trigger individually, identifying 41 triggers about which there was a clear agreement for inclusion. Of the seven additional triggers that required subsequent voting via e-mail, 5 were adopted, arriving at a total of 46 consensus-derived triggers.

Conclusions
Our modified Delphi process resulted in the identification of 46 final triggers for the detection of adverse events among ED patients. These triggers should be pilot field tested to quantify their individual and collective performance in detecting all-cause harm to ED patients.