bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the “Early” Use of Albumin in Children with Extensive Burns: A Randomized Controlled Trial*
Authors: Müller Dittrich Maria Helena , Brunow de Carvalho Werther , Lopes Lavado Edson 
Published: April 2016

Objective:
To compare early versus delayed albumin resuscitation in children with burns in terms of clinical outcome and response.

Design:
Randomized controlled trial.

Setting:
Burn center at a tertiary care teaching hospital.

Patients:
Forty-six children aged 1–12 years with burns greater than 15–45% total body surface area admitted within 12 hours of burn injury.

Interventions:
Fluid resuscitation was based on the Parkland formula (3 mL/kg/% total body surface area), adjusted according to urine output. Patients received 5% albumin solution between 8 and 12 hours post burn in the intervention group (n = 23) and 24 hours post burn in the control group (n = 23). Both groups were assessed for reduction in crystalloid fluid infusion during resuscitation, development of fluid creep, and length of hospital stay.

Measurements and Main Results:
There was no difference between groups regarding age, weight, sex, % total body surface area, cause of burn, or severity scores. The median crystalloid fluid volume required during the first 3 days post burn was lower in the intervention than in the control group (2.04 vs 3.05 mL/kg/% total body surface area; p = 0.025 on day 1; 1.2 vs 1.71 mL/kg/% total body surface area; p = 0.002 on day 2; and 0.82 vs 1.3 mL/kg/% total body surface area; p = 0.002 on day 3). The median urine output showed no difference between intervention and control groups (2.1 vs 2.0 mL/kg/hr; p = 0.152 on day 1; 2.58 vs 2.54 mL/kg/hr; p = 0.482 on day 2; and 2.9 vs 3.0 mL/kg/hr; p = 0.093 on day 3). Fluid creep was observed in 13 controls (56.5%) and in one patient (4.3%) in the intervention group. The median length of hospital stay was 18 days (range, 15–21 d) for controls and 14 days (range, 10–17 d) in the intervention group (p = 0.004).

Conclusions:
Early albumin infusion in children with burns greater than 15–45% total body surface area reduced the need for crystalloid fluid infusion during resuscitation. Significantly fewer cases of fluid creep and shorter hospital stay were also observed in this group of patients.
Impact of an Offline Pain Management Protocol on Prehospital Provider Self-Efficacy
Authors: Jaeger April , Dudley Nanette , Holsti Maija , Sheng Xiaoming , Gurley Kristin Lauria , Adelgais Kathleen 
Published: April 2016

Background
Pain in children is inadequately treated in the prehospital setting despite the reported recognition by prehospital providers (PHPs) of pain treatment as an important part of patient care. The impact of pediatric pain management protocol (PPP) implementation on PHP self-efficacy (SE), a measure congruent with performance, is unknown.

Objective
The aim of this study was to evaluate the impact of PPP implementation and pain management education on PHP SE.

Methods
This was a prospective study evaluating the change in PHP SE after a PPP was implemented. Prehospital providers were randomized to 3 groups: protocol introduction alone, protocol introduction with education, and protocol introduction with education and a 3-month interim review. Prehospital provider SE was assessed for pain management given 3 age-based scenarios. Self-efficacy was measured with a tool that uses a ranked ordinal scale ranging from “certain I cannot do it” (0) to “completely certain I can do it” (100) for 10 pain management actions: pain assessment (3), medication administration (4), dosing (1), and reassessment (2). An averaged composite score (0-100) was calculated for each of the 3 age groups (adult, child, toddler). Paired-sample t tests compared post-PPP and 13-month scores to pre-PPP scores.

Results
Of 264 PHPs who completed initial surveys, 142 PHPs completed 13-month surveys. Ninety-three (65%) received education with protocol review, and 49 (35%) had protocol review only. Self-efficacy scores increased over the study period, most notably for pain assessment. This increase persisted at 13 months for child (6.6 [95% confidence interval {CI}, 1.4–11.8]) and toddler pain assessment (22.3 [95% CI, 16.4–28.3]). Composite SE scores increased immediately for all age groups (adult, 3.1 [95% CI, 1.3–4.9]; child, 6.1 [95% CI, 3.8–8.5]; toddler, 12.0 [95% CI, 9.5–14.5]) and persisted at 13 months for the toddler group alone (7.0 [95% CI, 4.3–9.7]). There was no difference between groups who received protocol review alone compared with those with education or education plus a 3-month interim review.

Conclusions
After a pain management protocol was introduced, SE scores among PHPs increased immediately and remained elevated for some individual actions involved in pain management, most notably pain assessment. Prehospital provider pain assessment SE scores declined 13 months after protocol introduction for adults, but remained elevated compared with baseline for the pediatric age groups.
Pediatric Emergency Medicine Online Curriculum Improves Resident Knowledge Scores, But Will They Use It?
Authors: Little-Wienert Kim , Hsu Deborah , Torrey Susan , Lemke Daniel , Patel Binita , Turner Teri , Doughty Cara 
Published: April 2016

Objective
Shift work on a pediatric emergency medicine (PEM) rotation makes didactic scheduling difficult, thereby limiting teaching opportunities. These constraints make this rotation an ideal setting to supplement resident education with an online curriculum. We aimed to determine if implementation of an online curriculum during a resident PEM rotation improves posttest performance and increases satisfaction with resident educational experience.

Methods
This was a prospective before/after study of pediatric and emergency medicine residents on a 1-month rotation in a tertiary care pediatric emergency department. A curriculum was developed consisting of 17 online modules. In the first 5 months of the study, 42 control residents received traditional bedside teaching. In the last 12 months, 80 intervention residents completed at least 8 modules during their rotation. Both groups completed a pretest at rotation start and a posttest and end-of-rotation survey at rotation end.

Results
Control group pretest and posttest scores were not significantly different. In the intervention group, posttest scores were significantly increased compared with pretest scores (68 vs 59, P < 0.01). A low percentage of residents completed the study. Only 42% of the 189 residents enrolled in the intervention group completed the posttest and 28% completed the survey.

Conclusions
Implementing an online PEM curriculum significantly improved knowledge. As residency programs face new duty hour requirements, online curricula may provide an effective way to supplement teaching. However, to capitalize on this self-directed curriculum, the low participation rates in this study suggest we must first determine and establish ways to overcome barriers to online learning.
Radiologic Safety Events Within a Pediatric Emergency Medicine Network
Authors: Blumberg Stephen M. , Mahajan Prashant V. , O'Connell Karen J. , Chamberlain James M. , Shaw Kathy N. , Ruddy Richard M. , Lichenstein Richard , Funai Tomohiko , Lillis Kathleen A. 
Published: April 2016

Objectives
The aim of this study was to describe the epidemiology of radiologic safety events using an analysis of deidentified incident reports (IRs) collected within a large multicenter pediatric emergency medicine network.

Methods
This study is a report of a planned subanalysis of IRs that were classified as radiologic events. The parent study was performed in the PECARN (Pediatric Emergency Care Applied Research Network). Incident reports involving radiology were classified into subtypes: delay in test, delay in results, misread or changed reading, wrong patient, wrong site, or other. The severity of radiology-related incidents was characterized. Contributing factors were identified and classified as environmental, equipment, human (employee), information technology systems, parent or guardian, or systems based.

Results
Two hundred three (7.0%) of the 2906 IRs submitted during the study period involved radiology. Eighteen of the hospitals submitted at least 1 IR and 15 of these hospitals reported at least 1 radiologic event. The most common type of radiologic event was misread/changed reading, which accounted for over half of all IRs (50.3%). Human factors were the most frequent contributing factor identified and accounted for 67.6% of all factors. The severity of events ranged from unsafe conditions to events with temporary harm that required hospitalization.

Conclusions
We described the epidemiology of radiology-related IRs from a large multicenter pediatric emergency research network. The study identified specific themes regarding types of radiologic errors, including the systems issues and the contributing factors associated with those errors. Results from this analysis may help identify effective intervention strategies to ameliorate the frequency of radiology-related safety events in the emergency department setting.
Axillary and Tympanic Temperature Measurement in Children and Normal Values for Ages
Authors: Oguz Fatma , Yildiz Ismail , Varkal Muhammet Ali , Hizli Zeynep , Toprak Sadik , Kaymakci Kevser , Saygili Seha Kamil , Kilic Ayşe , Unuvar Emin 
Published: April 2016

Aim
The aim of the study was define the normal values of tympanic and axillary body temperature in healthy children.

Methods
This observational cross-sectional study was performed in healthy children aged 0 to 17 years who visited the ambulatory general pediatric of Istanbul Medical Faculty.

Results
Of 1364 children, 651 (47.7%) were girls and 713 were boys, the mean (SD, range) age was 72.5 (53.6, 1–204) months. The mean (SD) axillary body temperature was 36.04°C (0.46°C; minimum, 35.0°C; maximum, 37.6°C). The 95th and 99th percentiles were 36.8°C and 37.0°C, respectively. The mean (SD) tympanic body temperature was 36.91°C (0.46°C; minimum, 35.15°C; maximum, 37.9°C). The 95th and 99th percentiles were 37.6°C and 37.8°C, respectively. There were statistically significant differences between sexes for only tympanic body temperatures. Both axillary and tympanic body temperatures were statistically higher in 0 to 2 months compared with other age groups. For this age group, the 99th percentile was 37.5°C for axillary and 37.85°C for tympanic temperature.

Conclusions
Axillary and tympanic body temperatures should be considered as fever when they are more than 37.0°C and 37.8°C, respectively. For 0 to 2 months, fever is 37.5°C and 37.85°C in axillary and tympanic temperatures, respectively.
Effect of Knee Orthoses on Hamstring Contracture in Children With Cerebral Palsy: Multiple Single-Subject Study
Authors: Laessker-Alkema Kristina , Eek Meta Nyström 
Published: April 2016

Purpose:
To examine the effect of knee orthoses on extensibility of the hamstrings in children with spastic cerebral palsy (CP).

Methods:
The short-term effects of knee orthoses on passive range of motion (ROM), spasticity, and gross motor function of the hamstrings. Ten children with spastic CP, aged 5 to 14 years, at Gross Motor Function Classification System levels I to V, were followed. The orthoses were worn for a minimum of 30 minutes day, 5 days per week, during the intervention period of 8 weeks.

Results:
Visual analysis using the Two Standard Deviation Band Method supported improvements in passive ROM for all 20 hamstring muscles and in 12 of 14 knee extension measurements. Analyses with the Wilcoxon signed rank test confirm the individual results and support a significant increase in hamstring muscles (P = .005) and knee extension (right: P =.028; left: P =.018) compared with baseline.

Conclusions:
In children with spastic CP, 8 weeks of treatment with knee orthoses can improve extensibility of the hamstrings.
Long-Term Patency of Lymphovenous Anastomoses: A Systematic Review
Authors: Tourani Saam S. , Taylor G. Ian , Ashton Mark W. 
Published: April 2016

Background:With advancements in technology and microsurgical techniques, lymphovenous anastomosis has become a popular reconstructive procedure in the treatment of chronic lymphedema. However, the long-term patency of these anastomoses is not clear in the literature.Methods:A systematic review of the MEDLINE and EMBASE databases was performed to assess the reported long-term patency of lymphovenous anastomoses.Results:A total of eight studies satisfied the inclusion criteria. Pooled data from four similar experiments in normal dogs showed an average long-term (≥5 months) patency of 52 percent. The only experiment in dogs with chronic lymphedema failed to show any long-term patency.Conclusions:The creation of peripheral lymphovenous anastomoses with a moderate long-term patency rate has become technically possible. However, the long-term results in chronic lymphedema are limited.
Examining the Crux of Autonomic Dysfunction in Posttraumatic Stress Disorder: Whether Chronic or Situational Distress Underlies Elevated Heart Rate and Attenuated Heart Rate Variability
Authors: Dennis Paul A. , Dedert Eric A. , Van Voorhees Elizabeth E. , Watkins Lana L. , Hayano Junichiro , Calhoun Patrick S. , Sherwood Andrew , Dennis Michelle F. , Beckham Jean C. 
Published: April 2016

ABSTRACT

Objective
Posttraumatic stress disorder (PTSD) has been linked to elevated heart rate (HR) and reduced heart rate variability (HRV) in cross-sectional research. Using ecological momentary assessment and minute-to-minute HRV/HR monitoring, we examined whether cross-sectional associations between PTSD symptom severity and HRV/HR were due to overall elevations in distress levels or to attenuated autonomic regulation during episodes of acute distress.

Methods
Two hundred nineteen young adults (18–39 years old), 99 with PTSD, underwent 1 day of Holter monitoring and concurrently reported distress levels via ecological momentary assessment. Using multilevel modeling, we examined the associations between momentary distress and the 5-minute means for low-frequency (LF) and high-frequency (HF) HRV and HR immediately following distress ratings, and whether PTSD symptom severity moderated these associations.

Results
Compared with the controls, participants with PTSD recorded higher ambulatory distress (mean [standard deviation] = 1.7 [0.5] versus 1.2 [0.3], p < .001) and HR (87.2 [11.8] versus 82.9 [12.6] beats/min, p = .011), and lower ambulatory LF HRV (36.9 [14.7] versus 43.7 [16.9 ms, p = .002) and HF HRV (22.6 [12.3] versus 26.4 [14.6] milliseconds, p = .043). Overall distress level was not predictive of HR or HRV (p values > .27). However, baseline PTSD symptom severity was associated with elevated HR (t(1257) = 2.76, p = .006) and attenuated LF (t(1257) = −3.86, p < .001) and HF (t(1257) = −2.62, p = .009) in response to acute momentary distress.

Conclusions
Results suggest that PTSD is associated with heightened arousal after situational distress and could explain prior findings associating PTSD with HR/HRV. Implications for treatment and cardiovascular risk are discussed.
Brief Report: APOL1 Renal Risk Variants Are Associated With Chronic Kidney Disease in Children and Youth With Perinatal HIV Infection
Authors: Purswani Murli U. , Patel Kunjal , Winkler Cheryl A. , Spector Stephen A. , Hazra Rohan , Seage George R. , Mofenson Lynne , Karalius Brad , Scott Gwendolyn B. , Van Dyke Russell B. , Kopp Jeffrey B. ,   for the Pediatric HIV/AIDS Cohort Study
Published: April 2016

Abstract:

APOL1 renal risk alleles are associated with chronic kidney disease (CKD) in adults, with the strongest effect being for HIV-associated nephropathy. Their role in youth with perinatal HIV-1 infection (PHIV) has not been studied. In a nested case–control study of 451 PHIV participants in the Pediatric HIV/AIDS Cohort Study, we found a 3.5-fold increased odds of CKD in those carrying high-risk APOL1 genotypes using a recessive model [95% confidence interval (CI): 1.2 to 10.0]. We report an unadjusted incidence of 1.2 CKD cases/100 person-years (95% CI: 0.5 to 2.5) in PHIV youth carrying APOL1 high-risk genotypes, with important implications for sub-Saharan Africa.
Sizanani: A Randomized Trial of Health System Navigators to Improve Linkage to HIV and TB Care in South Africa
Authors: Bassett Ingrid V. , Coleman Sharon M. , Giddy Janet , Bogart Laura M. , Chaisson Christine E. , Ross Douglas , Jacobsen Margo M. , Robine Marion , Govender Tessa , Freedberg Kenneth A. , Katz Jeffrey N. , Walensky Rochelle P. , Losina Elena 
Published: April 2016

Background:
A fraction of HIV-diagnosed individuals promptly initiate antiretroviral therapy (ART). We evaluated the efficacy of health system navigators for improving linkage to HIV and tuberculosis (TB) care among newly diagnosed HIV-infected outpatients in Durban, South Africa.

Methods:
We conducted a randomized controlled trial (Sizanani Trial, NCT01188941) among adults (≥18 years) at 4 sites. Participants underwent TB screening and randomization into a health system navigator intervention or usual care. Intervention participants had an in-person interview at enrollment and received phone calls and text messages over 4 months. We assessed 9-month outcomes via medical records and the National Population Registry. Primary outcome was completion of at least 3 months of ART or 6 months of TB treatment for coinfected participants.

Results:
Four thousand nine hundred three participants were enrolled and randomized; 1899 (39%) were HIV-infected, with 1146 (60%) ART-eligible and 523 (28%) TB coinfected at baseline. In the intervention, 212 (39% of outcome-eligible) reached primary outcome compared to 197 (42%) in usual care (RR 0.93, 95% CI: 0.80 to 1.08). One hundred thirty-one (14%) HIV-infected intervention participants died compared to 119 (13%) in usual care; death rates did not differ between arms (RR 1.06, 95% CI: 0.84 to 1.34). In the as-treated analysis, participants reached for ≥5 navigator calls were more likely to achieve study outcome.

Conclusions:
∼40% of ART-eligible participants in both study arms reached the primary outcome 9 months after HIV diagnosis. Low rates of engagement in care, high death rates, and lack of navigator efficacy highlight the urgency of identifying more effective strategies for improving HIV and TB care outcomes.
War-Related Abduction and History of Incarceration Linked to High Burden of HIV Among Female Sex Workers in Conflict-Affected Northern Uganda
Authors: Goldenberg Shira M. , Muzaaya Godfrey , Akello Monica , Nguyen Paul , Birungi Josephine , Shannon Kate 
Published: April 2016

Objective:
Sex workers (SWs) in sub-Saharan Africa face a disproportionate HIV burden and growing concerns of severe human rights violations. Given the dearth of evidence on the burden and correlates of HIV among SWs in sub-Saharan Africa, particularly within conflict-affected settings, we examined the relationship between structural determinants (eg, war-related abduction, incarceration) and HIV infection among conflict-affected SWs in Northern Uganda.

Design:
Cross-sectional community-based research study among female SWs in conflict-affected Gulu, Northern Uganda.

Methods:
Interview questionnaires and voluntary HIV testing were conducted with participants recruited through SW/peer-led outreach and time–location sampling from 2011 to 2012. HIV prevalence was calculated, and bivariable and multivariable logistic regression was used to identify independent associations with HIV seroprevalence.

Results:
Of 400 SWs, 135 (33.75%) were HIV seropositive; of whom one-third were new/previously undiagnosed HIV infections. In multivariable analysis, after adjusting for age of sex work entry and education, lifetime incarceration (adjusted odds ratio: 1.93, 95% confidence interval: 1.17 to −3.20) was independently associated with HIV seroprevalence, and history of wartime abduction (adjusted odds ratio: 1.62, 95% confidence interval: 1.00 to 2.63) was marginally associated (P = 0.051).

Conclusions:
This study documented a high rate of undiagnosed HIV infections and associations between war-related human rights violations, incarceration, and a heavy HIV burden among SWs in conflict-affected Northern Uganda. These findings highlight the serious harms of conflict and criminalization of marginalized women in sub-Saharan African contexts. SW-led interventions that address conflict experiences and policy shifts to promote a rights-based approach to HIV prevention and care remain critically needed.
Learning Neonatal Intubation Using the Videolaryngoscope
Authors: Assaad Michael-Andrew , Lachance Christian , Moussa Ahmed 
Published: April 2016

Introduction
The use of the videolaryngoscope (VL) facilitates intubation in adults and children, but experience in neonates is scarce. The objective of this study was to compare the VL with the classic laryngoscope (CL) in acquiring the skill of neonatal endotracheal intubation (ETI) and evaluate transferability of skill from VL to CL. We hypothesize that, on a neonatal mannequin, the VL will be superior to the CL with regard to success rate and that the skill will be transferred from VL to CL.

Methods
A randomized controlled trial was held at Sainte-Justine Hospital’s simulation center. Third- and fourth-year medical students were randomized into group A, which used VL for the first phase and CL for the second phase, and group B, which used CL for both phases. Each subject performed 9 ETI on 3 simulated neonatal airways in each phase.

Results
Thirty-four students performed 612 intubations. Success in group A was higher than in group B in the first phase of the study (96.5% vs. 84.6%, P < 0.001). During phase 2, group A’s success did not change significantly (91.7% vs. 96.5%, P = 0.07). Time to successful intubation was longer using the VL (27.6 vs. 15.6 seconds, P < 0.001), but there was no difference in phase 2 (12.5 vs. 10.2 seconds, P = 0.24). There were no esophageal intubations using the VL.

Conclusions
Success rate of ETI on mannequins was improved, and esophageal intubations decreased while learning ETI using the VL compared with the CL. Once ETI is learned on mannequins using the VL, this skill is transferrable to the CL.
Technical, Oncological, and Functional Safety of Bilateral Axillo-Breast Approach (BABA) Robotic Total Thyroidectomy
Authors: Bae Dong S. , Suh Byoung J. , Park Jong K. , Koo Do H. 
Published: April 2016

Background:
The aim of this study was to identify whether bilateral axillo-breast approach (BABA) robotic total thyroidectomy (RoTT) is technically, oncologically, and functionally safe.

Materials and Methods:
One hundred eighteen patients underwent BABA robotic thyroidectomy between July 2010 and February 2013. Ninety-one (77.1%) patients underwent RoTT, and 27 (22.9%) underwent robotic unilateral lobectomy.

Results:
RoTT (n=91) resulted in lower rate of surgical complication and in higher rate of transient hypocalcemia comparing with robotic unilateral lobectomy (n=27) (35.16% vs. 3.7%; P<0.013), but not in a permanent hypocalcemia, transient, or permanent recurrent laryngeal nerve palsy (2.2% vs. 0%; P=1.000, 3.3% vs. 0%; P=1.000, and 0% vs. 0%; P=NS), respectively. Successful remnant ablation rate for the patients with RoTT was 100% on a subsequent 6 months follow-up. No significant differences between 2 groups existed in mean Voice Handicap Index-10 scores during postoperative 6 months (P=0.308).

Conclusions:
BABA RoTT might be oncologically safe as well as technically and functionally safe procedure.