bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bedside Placement of the Postpyloric Tube in Infants
Authors: Clifford Patricia , Ely Elizabeth , Heimall Lauren 
Published: November 2016

Background:
Patients in the neonatal intensive care unit are a vulnerable population with specific nutritional requirements, which include increased protein and caloric needs for adequate growth. Some infants cannot tolerate gastric feeds and need to have postpyloric feeds to grow. Placement of a postpyloric tube can be done by gastric insufflation. Gastric insufflation is a technique where air is inserted into the stomach as a nasogastric tube is advanced through the pylorus to the duodenum. There is research to support this technique in pediatrics, but scant evidence exists for placement of postpyloric tubes in the infant population.

Purpose:
The aim of this quality improvement practice project was to determine whether the current practice for postpyloric tube placement by the bedside nurses in the neonatal intensive care unit is safe and effective.

Methods:
Data were prospectively collected on 38 infants requiring placement of 60 postpyloric tubes over an 8-week period.

Results:
The results indicate a success rate of 95.6% for tube placement when a subset of infants diagnosed with congenital diaphragmatic hernia (CDH) (n = 15) was excluded. Six (40%) of the 15 infants with CDH had postpyloric tubes placed successfully. Nursing years of experience did not affect successful postpyloric tube placement.

Implications for Practice:
The postpyloric tube placement policy was modified as a result of findings from this project. Placement of a postpyloric tube with one attempt by the bedside nurse was safe and effective in most preterm infants in our care excluding patients with CDH. The new policy reduced infants' exposure to radiation due to a decrease in the number of x-rays in comparison to interventional radiology placement.

Implications for Research:
Further research should be done by units that primarily care for low birth-weight premature infants.
An Innovative Program to Support Internationally Educated Health Professionals and Their Instructors: Role of the Clinical Practice Facilitator
Authors: Daniel Sylvia , Lee Annemarie L. , Switzer-McIntyre Sharon , Evans Cathy 
Published: November 2016

Introduction:
Internationally educated health professionals immigrating to other countries may experience difficulty in clinical practice, due to linguistic and cultural factors. An important element of bridging is the opportunity for internationally educated health professionals to practice in a clinical environment. To support these health professionals and their clinical instructors, a Clinical Practice Facilitator (CPF) role was created. This study aimed to examine the CPF from internationally educated health professionals and clinical instructors' perspective.

Methods:
A quantitative survey was conducted with two cohorts (2013 and 2015) of internationally educated physical therapists and clinical instructors who were asked about the nature of interaction with CPFs, mentor, and education roles and the benefits and challenges of the role.

Results:
Thirty-five internationally educated physical therapists and 37 clinical instructors participated and were satisfied with the interaction with CPFs via face-to-face or e-mail communication. There was strong agreement (>80%) that the CPF educator role was to facilitate learner's reflection on clinical practice while the mentor role (>70%) was to answer questions, provide feedback, and investigate clinical concerns and conflicts. There was insufficient time for access to CPFs and resolution of learners' learning needs. There were differences (P = 0.04) in perspective on the benefit of the CPF in assisting with cultural differences.

Discussion:
An innovative CPF role provided support encouragement, clinical, and professional advice. There were discordant views regarding the benefits of the CPF role in addressing cultural issues, which requires further examination.
Miller's Pyramid and Core Competency Assessment: A Study in Relationship Construct Validity
Authors: Williams Betsy White , Byrne Phil D. , Welindt Dillon , Williams Michael V. 
Published: November 2016

Introduction:
Continuous professional development relies on the link between performance and an educational process aimed at improving knowledge and skill. One of the most broadly used frameworks for assessing skills is Miller's Pyramid. This Pyramid has a series of levels of achievement beginning with knowledge (at the base) and ending with routine application in the clinical setting.

Methods:
The purpose of this study was to determine the degree of convergence of two measurement methods, one based on Miller's framework, the second using the Accreditation Council for Graduate Medical Education/American Board of Medical Specialties (ACGME/ABMS) Core Competency framework. The data were gathered from the faculty of a large, Midwestern regional health care provider and hospital system. Data from 264 respondents were studied. The 360° data were from raters of physicians holding supervisory roles in the organization. The scale items were taken from an instrument that has been validated for both structure and known group prediction.

Results:
The Miller scale was purposely built for this application. The questions were designed to describe each level of the model. The Miller scale was reduced to a single dimension. This result was then regressed on the items from the 360° item ratings. Results of a multivariate analysis of variance isolated a significant relationship between the Miller's Pyramid score and the competency items (P < 0.001).

Discussion:
These findings demonstrate a relationship between measures based on Miller's framework and behavioral measures based on the ABMS/ACGME core competencies. Equally important is the finding that while they are related they are not identical. These findings have implications for continuous professional development programing design.
Transfer of Mindfulness Training to the Work Setting: A Qualitative Study in a Health Care System
Authors: Lyddy Christopher J. , Schachter Yotam , Reyer Amy , Julliard Kell 
Published: November 2016

Introduction:
Mindfulness training is now commonly offered as professional development for health care practitioners. Understanding how health care practitioners adopt mindfulness practices is limited, which poses a hurdle to the development of effective mindfulness training programs. To explore how health professionals use and perceive mindfulness practices at work, we conducted an exploratory qualitative study at a large multicomponent inner-city health system.

Methods:
All participants were self-selected health professionals who attended at least one mindfulness training. Training content was derived from the Tergar Meditation Community's nonsectarian Joy of Living program and focused on calming the mind using a flexible and broadly applicable approach. Transcribed interview data were examined using thematic analysis.

Results:
Individuals receiving mindfulness training varied substantially in their subsequent adoption and utilization of these practices. Interviewees' experiences overall suggest that the workplace presents a relatively challenging but nonetheless viable environment for being mindful. Health care workers relied on more informal practice models than on formal meditation practice routines while at work. Factors reported by some individuals to inhibit effective mindfulness practice supported mindfulness for others, and overall displayed equivocal effects.

Discussion:
Adoption and integration of mindfulness practices within the workplace are feasible yet vary significantly by practice type, situation, and the individual. Greater understanding of how individuals adopt workplace mindfulness training could improve future intervention research while clarifying optimal mindfulness training approaches.
Organizational Perspectives on Rapid Response Team Structure, Function, and Cost
Authors: Smith Patricia L. , McSweeney Jean 
Published: November 2016

Background:
Understanding how an organization determines structure and function of a rapid response team (RRT), as well as cost evaluation and implications, can provide foundational knowledge to guide decisions about RRTs.

Objectives:
The objectives were to (1) identify influencing factors in organizational development of RRT structure and function and (2) describe evaluation of RRT costs.

Methods:
Using a qualitative, ethnographic design, nurse executives and experts in 15 moderate-size hospitals were interviewed to explore their decision-making processes in determining RRT structure and function. Face-to-face interviews were audio recorded and transcribed verbatim and verified for accurateness. Using content analysis and constant comparison, interview data were analyzed. Demographic data were analyzed using descriptive statistics.

Results:
The sample included 27 participants from 15 hospitals in 5 south-central states. They described a variety of RRT responders and functions, with the majority of hospitals having a critical care charge nurse attending all RRT calls for assistance. Others described a designated RRT nurse with primary RRT duties as responder to all RRT calls. Themes of RRT development from the data included influencers, decision processes, and thoughts about cost.

Discussion:
It is important to understand how hospitals determine optimal structure and function to enhance support of quality nursing care. Determining the impact of an RRT on costs and benefits is vital in balancing patient safety and limited resources. Future research should focus on clarifying differences between team structure and function in outcomes as well as the most effective means to estimate costs and benefits.
MINIMAL ENDOILLUMINATION LEVELS AND DISPLAY LUMINOUS EMITTANCE DURING THREE-DIMENSIONAL HEADS-UP VITREORETINAL SURGERY
Authors: Adam Murtaza K. , Thornton Sarah , Regillo Carl D. , Park Carl , Ho Allen C. , Hsu Jason 
Published: November 2016

Purpose:
To determine minimal endoillumination levels required to perform 3-dimensional heads-up vitreoretinal surgery and to correlate endoillumination levels used for measurements of heads-up display (HUD) luminous emittance.

Methods:
Prospective, observational surgical case series of 10 patients undergoing vitreoretinal surgery. Endoillumination levels were set to 40% of maximum output and were decreased at set intervals until the illumination level was 0%. Corresponding luminous emittance (lux) of the HUD was measured 40 cm from the display using a luxmeter (Dr. Meter, Model #LX1010BS).

Results:
In 9 of 10 cases, the surgeon felt that they could operate comfortably at an endoillumination level of 10% of maximum output with corresponding HUD emittance of 14.3 ± 9.5 lux. In the remaining case, the surgeon felt comfortable at a 3% endoillumination level with corresponding HUD emittance of 15 lux. Below this threshold, subjective image dimness and digital noise limited visibility. Endoillumination levels were correlated with luminous emittance from the 3-dimensional HUD (P < 0.01). The average coefficient of variation of HUD luminance was 0.546. There were no intraoperative complications.

Conclusion:
With real-time digital processing and automated brightness control, 3-dimensional HUD platforms may allow for reduced intraoperative endoillumination levels and a theoretically reduced risk of retinal phototoxicity during vitreoretinal surgery.
MACULAR PERIVENOUS RETINAL WHITENING AND PRESUMED RETINO–CILIARY SPARING IN A RECURRENT CENTRAL RETINAL VEIN OCCLUSION ASSOCIATED WITH THE ANTIPHOSPHOLIPID SYNDROME AND CRYOGLOBULINEMIA
Authors: Sebrow Dov B. , Jung Jesse J. , Horowitz Jason , Odel Jeffrey G. , Freund K. Bailey 
Published: November 2016

Purpose:
Macular perivenous retinal whitening results from hypoperfusion-induced ischemia of the middle retina that can occur in central retinal vein occlusion (CRVO). We describe an unusual case of recurrent CRVO with macular perivenous retinal whitening and retino–ciliary venous sparing in the setting of 2 prothrombotic diseases, antiphospholipid syndrome and Type II cryoglobulinemia.

Methods:
A 50-year-old man presented with intermittent loss of vision in his right eye related to a recurrent CRVO. Color photography, optical coherence tomography, and fluorescein angiography were performed and compared with those obtained during a previous CRVO that occurred 6 years earlier in the same eye.

Results:
On presentation, visual acuity was hand motion in the right eye, 20/30 in the left eye. Funduscopic examination of the right eye showed vascular tortuosity, scattered retinal hemorrhages, and retinal whitening in the macula. Optical coherence tomography showed hyperreflectivity of the middle layers of the retina that correlated with the areas of retinal whitening. A discrete area of retinal sparing was noted in the superonasal macula that, on fluorescein angiography, corresponded to the distribution of a single retino–ciliary vein. A review of retinal imaging obtained during the patient's previous CRVO showed similar but more subtle findings of retino–ciliary sparing. Laboratory testing revealed antiphospholipid syndrome and Type II cryoglobulinemia. As the patient's CRVO progressed and subsequently stabilized after treatment in the following months, this area of venous sparing remained the only functional, nonischemic retinal tissue in his macula. Presumably, this vein possessed privileged and uncompromised blood flow by circumventing the occluded venous circulation.

Conclusion:
Macular perivenous retinal whitening should be considered in the differential diagnosis of retinal whitening and occurs in CRVO secondary to hypoperfusion-induced middle retinal ischemia. To our knowledge, this case represents the first description of retino–ciliary venous sparing of the retina in CRVO.
Truncation of In Situ Baerveldt Glaucoma Drainage Device for Treatment of Late Persistent Postoperative Hypotony
Authors: Chen Philip P. 
Published: November 2016

Purpose:
To describe a new technique to treat late persistent hypotony after Baerveldt glaucoma drainage device surgery.

Methods:
Review of 2 cases treated with in situ truncation of one or both wings of the Baerveldt device, combined with permanent but releasable tube occlusion.

Results:
Two eyes with persistent hypotony underwent in situ truncation of one or both wings of the Baerveldt device with resolution of hypotony. Recurrence of elevated intraocular pressure (IOP) in both cases required reversal of tube occlusion, after which the IOP has remained both well controlled and sufficiently elevated to avoid complications of hypotony over 13 and 43 months.

Conclusions:
In situ truncation of Baerveldt drainage device with permanent, releasable tube occlusion offers a safe and effective intervention for eyes with late hypotony, and also allows for maintenance of IOP control long term.
An Original Supporting Frame for Early Mobilization after Lower-Limb Amputation for Musculoskeletal Tumor
Authors: Zati Alessandro , Cavazzuti Lorenzo , Okita Yusuke , Mariani Elisabetta , Benedetti Maria Grazia 
Published: November 2016

ABSTRACT

Background
To facilitate early walking in persons with lower-limb amputations for musculoskeletal tumors, we developed an original supporting frame to use with a commercial pneumatic bag.

Technique
The frame has adjustable modular components for persons with transfemoral and transtibial amputations. We applied it from the fourth day after amputation within the standard rehabilitation program and pain treatment. We assessed the feasibility of using this frame and its safety in 15 oncological participants with lower-limb amputations. Clinical and functional outcomes were assessed at the end of the rehabilitation program and at a mean (SD) of 90 (54) days after amputation.

Results
All the patients could safely use this frame. No wound problems were encountered, no worsening of pain was registered, and clinical and functional evaluation showed a good functional performance.

Conclusion
The use of the original device, conceived for the optimal adjustability with respect to the individual patient sizes and tested in a group of oncological participants with lower-limb amputations, was demonstrated to be feasible and safe
Prevalence and epidemiology of hepatitis D among patients with chronic hepatitis B virus infection: a report from Northern Spain
Authors: Ordieres Carlos , Navascués Carmen A. , González-Diéguez María L. , Rodríguez Mercedes , Cadahía Valle , Varela María , Rodrigo Luis , Rodríguez Manuel 
Published: November 2016

Background
The incidence of hepatitis delta virus (HDV) infection has decreased during the last decades. However, an increasing trend has been reported recently.

Patients and methods
We carried out a case–control study to analyze changes in its prevalence in 1215 chronic hepatitis B virus (HBV) patients, diagnosed consecutively in a tertiary center, between 1983 and 2012. According to the year of diagnosis, patients were distributed into two groups: A [1983–1997 (n=786)] and B [1998–2012 (n=429)].

Results
The prevalence of anti-HDV was 8.2% (9.4% in group A and 6.1% in group B) (P=0.04). Multivariate regression revealed that intravenous drug use [odds ratio (OR) 261.0; 95% confidence interval (CI), 28.7–2368.5; P<0.001], blood transfusion (OR 28.0; 95% CI, 2.7–295.9; P=0.03), anti-HIV(+) (OR 4.8; 95% CI, 1.6–14.5; P=0.004), and high alanine aminotransferase (OR 14.4; 95% CI, 3.4–60.6; P<0.001) were associated independently with the presence of anti-HDV in group A, whereas in group B, it was associated with immigration (OR 20.0; 95% CI, 4.7–84.9; P<0.001), intravenous drug use (OR 683.5; 95% CI, 52.7–8855.7; P<0.001), promiscuous sexual activity (OR 22.6; 95% CI, 2.2–228.5; P=0.008), and high alanine aminotransferase (OR 3.4; 95% CI, 1.1–10.0; P=0.02).

Conclusion
Although a significant decrease in the prevalence of HDV infection has been observed, it is still above 5%. Immigration and sexual transmission have emerged as new risk factors for HDV infection.
Inflammation, remodeling, and other factors affecting HDL cholesterol efflux
Authors: Ronsein Graziella E. , Vaisar Tomáš 
Published: November 2016

Purpose of review
The ability of HDL to promote cholesterol efflux from macrophages is a predictor of cardiovascular risk independent of HDL cholesterol levels. However, the molecular determinants of HDL cholesterol efflux capacity (CEC) are largely unknown.

Recent findings
The term HDL defines a heterogeneous population of particles with distinct size, shape, protein, and lipid composition. Cholesterol efflux is mediated by multiple pathways that may be differentially modulated by HDL composition. Furthermore, different subpopulations of HDL particles mediate CEC via specific pathways, but the molecular determinants of CEC, either proteins or lipids, are unclear. Inflammation promotes a profound remodeling of HDL and impairs overall HDL CEC while improving ATP-binding cassette transporter G1-mediated efflux. This review discusses recent findings that connect HDL composition and CEC.

Summary
Data from recent animal and human studies clearly show that multiple factors associate with CEC including individual proteins, lipid composition, as well as specific particle subpopulations. Although acute inflammation remodels HDL and impairs CEC, chronic inflammation has more subtle effects. Standardization of assays measuring HDL composition and CEC is a necessary prerequisite for understanding the factors controlling HDL CEC. Unraveling these factors may help the development of new therapeutic interventions improving HDL function.
Inherited and acquired disorders of magnesium homeostasis
Authors: Wolf Matthias Tilmann Florian 
Published: November 2016

Purpose of review
Magnesium (Mg2+) imbalances are frequently overlooked. Hypermagnesemia usually occurs in preeclamptic women after Mg2+ therapy or in end-stage renal disease patients, whereas hypomagnesemia is more common with a prevalence of up to 15% in the general population. Increasing evidence points toward a role for mild-to-moderate chronic hypomagnesemia in the pathogenesis of hypertension, type 2 diabetes mellitus, and metabolic syndrome.

Recent findings
The kidneys are the major regulator of total body Mg2+ homeostasis. Over the last decade, the identification of the responsible genes in rare genetic disorders has enhanced our understanding of how the kidney handles Mg2+. The different genetic disorders and medications contributing to abnormal Mg2+ homeostasis are reviewed.

Summary
As dysfunctional Mg2+ homeostasis contributes to the development of many common human disorders, serum Mg2+ deserves closer monitoring. Hypomagnesemic patients may be asymptomatic or may have mild symptoms. In severe hypomagnesemia, patients may present with neurological symptoms such as seizures, spasms, or cramps. Renal symptoms include nephrocalcinosis and impaired renal function. Most conditions affect tubular Mg2+ reabsorption by disturbing the lumen-positive potential in the thick ascending limb or the negative membrane potential in the distal convoluted tubule.
Prevalence and Impact of Functional Abdominal Pain Disorders in Children With Inflammatory Bowel Diseases (IBD‐FAPD)
Authors: Watson Kevin L. , Kim Sandra C. , Boyle Brendan M. , Saps Miguel 
Published: November 2016

ABSTRACTObjectives:We sought to describe the prevalence of the overlap of functional abdominal pain disorders (FAPDs) in children with inflammatory bowel diseases (IBDs), a condition we have designated as IBD‐FAPD. We also aimed to describe the psychological profile of this group, and to assess predictors of disease and the impact of IBD‐FAPD on quality of life.Methods:This cross‐sectional prospective study included patients ages 8 to 18 years with a diagnosis of IBD. Disease activity was assessed by physician's global assessment, laboratory studies, and abbreviated Pediatric Crohn's Disease Activity Index or Pediatric Ulcerative Colitis Activity Index scoring. Age‐appropriate validated questionnaires were used to diagnose FAPDs according to the Rome III criteria, depression, anxiety symptoms, and quality of life.Results:There were 128 patients recruited. Eighty‐one (63%) completed questionnaires (36 girls; 45 boys; mean age 14.4 ± 2.6 years) (62 Crohn disease, 19 ulcerative colitis). The prevalence of IBD‐FAPD in clinical remission was 26% (17 Crohn disease, 4 ulcerative colitis; 95% confidence interval: 20.6%–79.4%), with significantly more girls having IBD‐FAPD (P = 0.038). Anxiety symptoms were in 14.3% of patients with IBD‐FAPD (P = 0.06) and depression in 23.8% (P = 0.006). The average Pediatric Quality of Life Inventory Gastrointestinal Symptoms score for the IBD‐FAPD group was significantly lower than those without FAPDs (71 vs 86.5, P = 0.008).Conclusions:In our cohort, the prevalence of IBD‐FAPD was 26%. This is the first study to assess all FAPDs using the Rome III criteria and to demonstrate increased anxiety, depression, and worse quality of life in children with IBD‐FAPD. The identification of patients predisposed to IBD‐FAPD may allow implementing strategies that could improve symptoms and quality of life.