bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prime Time for Shared Decision Making
Authors: Spatz Erica S. , Krumholz Harlan M. , Moulton Benjamin W. 
Published: September 2017

(Abstracted from JAMA 2017;317(13):1309–1310)
Washington State passed legislation in 2007 incentivizing shared decision making as an alternative option to traditional forms and procedures for informed consent for certain procedures. This requires patients to sign an attestation that they used a certified decision aid and discussed risks, benefits, and alternatives.
Implementing a Health System–wide Patient Blood Management Program with a Clinical Community Approach
Authors: Frank Steven M. , Thakkar Rajiv N. , Podlasek Stanley J. , Ken Lee K. H. , Wintermeyer Tyler L. , Yang Will W. , Liu Jing , Rotello Leo C. , Fleury Thomas A. , Wachter Pat A. , Ishii Lisa E. , Demski Renee , Pronovost Peter J. , Ness Paul M. 
Published: September 2017

Abstract

Background
Patient blood management programs are gaining popularity as quality improvement and patient safety initiatives, but methods for implementing such programs across multihospital health systems are not well understood. Having recently incorporated a patient blood management program across our health system using a clinical community approach, we describe our methods and results.

Methods
We formed the Johns Hopkins Health System blood management clinical community to reduce transfusion overuse across five hospitals. This physician-led, multidisciplinary, collaborative, quality-improvement team (the clinical community) worked to implement best practices for patient blood management, which we describe in detail. Changes in blood utilization and blood acquisition costs were compared for the pre– and post–patient blood management time periods.

Results
Across the health system, multiunit erythrocyte transfusion orders decreased from 39.7 to 20.2% (by 49%; P < 0.0001). The percentage of patients transfused decreased for erythrocytes from 11.3 to 10.4%, for plasma from 2.9 to 2.2%, and for platelets from 3.1 to 2.7%, (P < 0.0001 for all three). The number of units transfused per 1,000 patients decreased for erythrocytes from 455 to 365 (by 19.8%; P < 0.0001), for plasma from 175 to 107 (by 38.9%; P = 0.0002), and for platelets from 167 to 141 (by 15.6%; P = 0.04). Blood acquisition cost savings were $2,120,273/yr, an approximate 400% return on investment for our patient blood management efforts.

Conclusions
Implementing a health system-wide patient blood management program by using a clinical community approach substantially reduced blood utilization and blood acquisition costs.
Hip Surveillance for Children With Cerebral Palsy: A Survey of the POSNA Membership
Authors: Shore Benjamin J. , Shrader Michael W. , Narayanan Unni , Miller Freeman , Graham H. Kerr , Mulpuri Kishore 
Published: September 2017

Background:
Currently, hip surveillance programs for children with cerebral palsy exist in Europe, Australasia, and parts of Canada, but a neuromuscular hip surveillance program has yet to be adopted in the United States. The purpose of this study was to report the current orthopaedic practice of hip surveillance in children with cerebral palsy, identify areas of practice variation, and suggest steps moving forward to generate guidelines for national neuromuscular hip surveillance.

Methods:
The entire membership of the Pediatric Orthopaedic Society of North America (POSNA) was surveyed in 2016 for information regarding their practice for hip surveillance in children with cerebral palsy. Detailed information regarding timing, frequency, and practice of hip surveillance was obtained in answers to 26 different questions.

Results:
A survey response rate of 27% was obtained (350/1300 members) during the study period. The majority of respondents treated pediatric patients exclusively (97%), worked in an academic practice (70%), and was affiliated with a university (76%). In total, 18% (69/350) of respondents followed a regular cerebral palsy hip surveillance program, about half of whom (44%, 30/69) had adopted the Australian guidelines. Respondents agreed that a dislocated hip in a child with cerebral palsy was painful (90% agreement) and should be prevented by hip surveillance (93% agreement). Furthermore, 93% of respondents indicated they would follow a national surveillance program if one was in place. Age (79%), Gross Motor Function Classification System (81%), and migration percentage (MP) (78%) were all identified as critical elements to a hip surveillance program. The majority of respondents felt that a hip “at risk” for hip displacement had a MP between 20% and 30% (57% of respondents), whereas surgery should be utilized once the MP exceeded 40% (50% of respondents).

Conclusions:
Results from this survey demonstrate 90% of respondents agree that a dislocated hip could be painful and 93% would follow a national surveillance program if available. At a societal level, we have the ability to standardize cerebral palsy hip surveillance, thereby decreasing practice variation and improving quality of care delivery.

Levels of Evidence:
Level V.
Eye Protection: Survey of Dermatologists and Office Staff
Authors: Pate David A. , Kampp Jeremy T. 
Published: September 2017

BACKGROUND
Splash injuries to mucosal membranes during procedures have been well documented in dermatology and carry a potential risk of blood-borne virus transmission. The risk to the ocular mucosa can be minimized with proper eye protection.

OBJECTIVE
To examine the prevalence of wearing eye protection during dermatologic procedures by physicians, trainees, and office staff in dermatology.

METHODS
A Cross-sectional observational study of US dermatologists, residents, nurses, and medical assistants was performed regarding eye protection during dermatologic procedures.

RESULTS
The rates of wearing eye protection in every dermatologic procedure are as follows: dermatologists 42.3%, residents/fellows 39.6%, and nurses/medical assistants 25%. Ninety-eight percent of respondents thought blood-borne illnesses could be transmitted by splash injury. The rates of having splash injury during your career are as follows: dermatologists 73.1%, residents/fellows 16.7%, and nurses/medical assistants 50%. The rates of having a splash injury within the last year are as follows: dermatologists 11.5%, residents/fellows 8.3%, and nurses/medical assistants 35.7%.

CONCLUSION
The use of eye protection is an important component of the personal protective equipment to help prevent transmission of blood-borne illnesses. Dermatologists and staff should strive to increase awareness and the use of face masks with eye shields or face mask with separate eye protection in every dermatologic procedure.
MC225, a Novel Probe for P-glycoprotein PET Imaging at the Blood–brain Barrier: In Vitro Cardiovascular Safety Evaluation
Authors: Fusi Fabio , Durante Miriam , Gorelli Beatrice , Perrone Maria Grazia , Colabufo Nicola Antonio , Saponara Simona 
Published: September 2017

Abstract:
The P-glycoprotein (P-gp) substrate MC225, at concentrations ≤10 nM, is a valuable radiotracer for positron emission tomography imaging of P-gp function in rats and mice. The aim of this study was to evaluate its potential toxic hazard toward the cardiovascular system through an in-depth analysis of its effects on rat aorta rings, on CaV1.2 channel current (ICa1.2) of A7r5 cells and on Langendorff-perfused rat heart. In aortic rings, MC225 relaxed phenylephrine-induced contraction in a concentration-dependent and endothelium-independent manner, with an IC50 value of about 1 μM. At concentrations ≥3 μM, it antagonized the response to cumulative concentrations of K+. MC225, 1 and 10 μM, inhibited ICa1.2 by 15% and 31%, respectively, without affecting either current activation or inactivation kinetics. In Langendorff-perfused rat hearts, only 10 μM MC225 significantly decreased left ventricular pressure and increased coronary perfusion pressure while reducing heart rate and prolonging the cardiac cycle length as well as the atrioventricular conduction time (PQ interval) on the electrocardiogram. Lower concentrations of the drug were ineffective. These findings demonstrate that MC225-induced cardiovascular effects took place at concentrations that are at least 2 orders of magnitude higher than those allowing in vivo measurement of P-gp function. Therefore, MC225 represents a promising positron emission tomography tool for in vivo straightforward P-gp quantification.
Antibiotic Use in Hospitalized Children With Respiratory Viruses Detected by Multiplex Polymerase Chain Reaction
Authors: Goriacko Pavel , Saiman Lisa , Zachariah Philip 
Published: September 2017

Background:
Multiplex polymerase chain reaction–based methods are increasingly used to detect respiratory pathogens in children. While rapid identification of viruses has been shown to reduce antibiotic use, the impact of detecting specific viruses on antibiotic utilization has not been ascertained. This study compared antibiotic utilization among hospitalized children who tested positive for different respiratory viruses at admission.

Methods:
A single-center study of hospitalized children under 21 years of age who tested positive at admission for at least 1 respiratory virus by multiplex polymerase chain reaction from October 1, 2012 to October 1, 2015 was performed. Multivariable logistic regression was used to determine the association of testing positive for specific viruses with the use of antibiotics for ≥ 2 days, adjusted for demographic and clinical characteristics.

Results:
The study included 1416 patients with a median age of 2.1 years (interquartile range: 0.6–6.2 years). Patients positive for influenza (odds ratio: 2.0, 95% confidence interval: 1.1–3.4) and human metapneumovirus (odds ratio: 2.0, 95% confidence interval: 1.1–3.7) were more likely to receive ≥ 2 days of treatment compared with patients positive for respiratory syncytial virus (RSV). Other variables affecting prolonged use of antibiotics included respiratory support, primary nonrespiratory diagnosis, complex comorbid conditions and admission to the intensive care unit.

Conclusions:
Providers are more likely to use antibiotics in non-RSV–infected patients compared with RSV. These trends likely represent concern about bacterial superinfection and may reflect lack of familiarity with these pathogens.
Cannabis constituent synergy in a mouse neuropathic pain model
Authors: Casey Sherelle L. , Atwal Nicholas , Vaughan Christopher W. 
Published: September 2017

Abstract
Cannabis and its psychoactive constituent Δ9-tetrahydrocannabinol (THC) have efficacy against neuropathic pain, however, this is hampered by their side effects. It has been suggested that co-administration with another major constituent cannabidiol (CBD) might enhance the analgesic actions of THC and minimise its deleterious side effects. We examined the basis for this phytocannabinoid interaction in a mouse chronic constriction injury (CCI) model of neuropathic pain. Acute systemic administration of THC dose-dependently reduced CCI-induced mechanical and cold allodynia, but also produced motor incoordination, catalepsy, and sedation. Cannabidiol produced a lesser dose-dependent reduction in allodynia, but did not produce the cannabinoid side effects. When co-administered in a fixed ratio, THC and CBD produced a biphasic dose-dependent reduction in allodynia. At low doses, the THC:CBD combination displayed a 200-fold increase in anti-allodynic potency, but had lower efficacy compared with that predicted for an additive drug interaction. By contrast, high THC:CBD doses had lower potency, but greater anti-allodynic efficacy compared with that predicted for an additive interaction. Only the high dose THC:CBD anti-allodynia was associated with cannabinoid side effects and these were similar to those of THC alone. Unlike THC, the low dose THC:CBD anti-allodynia was not cannabinoid receptor mediated. These findings demonstrate that CBD synergistically enhances the pain-relieving actions of THC in an animal neuropathic pain model, but has little impact on the THC-induced side effects. This suggests that low dose THC:CBD combination treatment has potential in the treatment of neuropathic pain.
Technology Solutions to Support Care Continuity in Home Care: A Focus Group Study
Authors: Dowding Dawn W. , Russell David , Onorato Nicole , Merrill Jacqueline A. 
Published: September 2017

Background:
Elevated hospital readmission rates from home care are an indicator of poor care quality, and rates are particularly high for patients with heart failure. Readmissions may be avoided by optimizing continuity of care.

Purpose:
To explore perceptions among home care clinicians of the barriers they face and the information they need to improve care continuity for patients with heart failure.

Methods:
Focus groups were conducted with teams of home care clinicians at a large certified home healthcare agency in the Northeastern United states.

Results:
In total, there were 61 participants across 6 focus groups. Three overarching themes emerged: continuity of care and communication on care transitions, maintaining continuity of care during a home care episode (with subthemes tracking signs and symptoms and patient teaching), and health information technology (HIT) characteristics to support communication and care continuity.

Conclusions:
Our study highlights areas of improvement for HIT solutions that could support care delivery for patients with heart failure in a home care setting.

Implications:
Home care agencies planning to introduce technology can use these findings to assess if and how potential systems can support nurses to provide continuity of care across healthcare organizations and home care visits.
Current opinion in otolaryngology: update on vascular injuries in craniomaxillofacial fractures
Authors: Illing Elisa , Burgin Sarah Jo , Schmalbach Cecelia E. 
Published: September 2017

Purpose of review
The primary purpose of this chapter is to define current recommendations for vascular work-up of patients with craniomaxillofacial (CMF) trauma with emphasis on imaging to include intraoperative fluorescence, angiography, and surgical exploration. The second goal is to review current management recommendations for observation versus surgical exploration based on the neck zones of injury.

Recent findings
Over the past two decades, endovascular techniques are increasingly utilized, particularly in zones I and III of the neck. Additionally, modern advances in radiographic technology have allowed for selective exploration of penetrating zone II injuries. A high suspicion for blunt cerebrovascular injury should be maintained for patients with high-speed deceleration mechanisms of injury, with a majority of patients managed with medical therapy or conservative monitoring over surgical intervention.

Summary
CMF fractures are associated with vascular injuries to the intracranial carotid system, extracranial carotid system, or vertebral artery system. A thorough understanding of at risk patients, optimal work-up, and timely treatment algorithms is imperative given the devastating sequellae of stroke and death.
It Is Time for Routine Screening for Perinatal Mood and Anxiety Disorders in Obstetrics and Gynecology Settings
Authors: Accortt Eynav Elgavish , Wong Melissa S. 
Published: September 2017

Importance
Women are 2 to 3 times more likely than men to experience depression in their lifetime, and the greatest risk occurs during the reproductive years. As an obstetrics and gynecology physician or provider, you will likely encounter women who are at risk of development or relapse of a mental disorder during this vulnerable time.

Objective
The aim of this review is to examine theory and research on mood and anxiety disorders during the perinatal period with an emphasis on screening recommendations.

Evidence Acquisition
A PubMed and PsycINFO search for English-language publications about perinatal mood and anxiety disorders and screening was performed and included studies on subtopics.

Results
The literature reviewed suggests that perinatal mood and anxiety symptoms are prevalent and have significant consequences, and best practices for early detection are through routine depression and anxiety screening in the obstetrics setting. This includes overcoming barriers to care and use of liaison services to potentially reduce risk.

Conclusions and Relevance
High-quality prenatal care systems should develop the capacity for depression and anxiety risk assessment and treatment. Providers should routinely screen using validated screening tools, provide maternal mental health education, and be aware of the various medical, psychological, and complementary approaches for treating mood and anxiety disorders, to best guide and refer patients. The use of this practice will increase the quality of life in pregnant women with depression and anxiety and may help to reduce the likelihood of adverse birth outcomes, postpartum mental health problems, and adverse effects on offspring.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After completing this activity, the learner should be better able to name 3 adverse birth outcomes related to prenatal symptoms of depression and anxiety; identify symptoms, prevalence, and consequences of depression and anxiety in pregnancy and postpartum; and contrast and apply reliable, valid, and widely used screening tools to assess for depression and anxiety and practice appropriate referral for this population.
Screening for Preeclampsia: US Preventive Services Task Force Recommendation Statement
Authors: Bibbins-Domingo Kirsten , Grossman David C. , Curry Susan J. , Barry Michael J. , Davidson Karina W. , Doubeni Chyke A. , Epling John W. , Kemper Alex R. , Krist Alex H. , Kurth Ann E. , Landefeld C. Seth , Mangione Carol M. , Phillips William R. , Phipps Maureen G. , Silverstein Michael , Simon Melissa A. , Tseng Chien-Wen 
Published: September 2017

(Abstracted from JAMA 2017;317(16):1661–1667)
Approximately 4% of pregnancies in the United States are affected by preeclampsia, defined as new-onset hypertension (or worsening hypertension in patients with existing hypertension) after 20 weeks' gestation, combined with either new-onset proteinuria or other symptoms involving multiple organ systems. This disorder is associated with poor maternal and fetal outcomes, including maternal mortality, maternal stroke, low birth weight, and stillbirth.
Epidemiology of Admissions From the Emergency Department Among Febrile Infants Younger Than 90 Days in the United States, 2002 to 2012
Authors: Nguyen Diana K. , Fleischman Ross J. , Friedlander Scott , Zangwill Kenneth M. 
Published: September 2017

Background and Objectives
Febrile infants younger than 90 days are often subjected to invasive diagnostic evaluation and hospitalization to monitor for serious bacterial infection (SBI) despite recent changes in SBI risk and advances in diagnostics. Nationwide provider practices, over time, are unknown for this group. Our objective was to determine the likelihood of admission and associated complications of care for such infants, particularly those at lowest risk for SBI.

Methods
This is a retrospective cohort study including multisite emergency department (ED) visits using administrative data from the Pediatric Emergency Care Applied Research Network Core Data Project. We examined uncomplicated febrile infants younger than 90 days seen in the ED from 2002 to 2012 who did not have an explicit infectious diagnosis, critical illness, or chronic condition.

Results
We identified 38,224 infants, among whom, 11,600 (31%) were admitted. We observed a 3% increase in ED admission every year during the study period (P < 0.05). Age less than 30 days and black race were independent predictors of admission (P < 0.01). We identified 227 complications of care in the ED. Among those with a specified cause, 49% were attributed to antibiotic use or procedures related to the diagnosis and empiric treatment of suspected infection.

Conclusions
Despite the decreasing risk of SBI and diagnostic advances during the study period, the odds of hospital admission increased for febrile infants at low risk for sepsis. We also provide first data on therapeutic and diagnostic test–related adverse events in this setting. These data provide further justification for a consensus guideline on management of such infants.
Abusive Injuries Are Worse Than Vehicular Injuries
Authors: Robertson Brian D. , Abbe Marisa , Pelletier Jamie , Hennes Halim 
Published: September 2017

Objectives
The objective of this study was to compare the injury severity and outcome of motor vehicle and nonaccidental traumatic injuries and examine trends in mortality rates over time.

Methods
We reviewed data from 2005 to 2013 from a level 1 pediatric trauma center including demographics, injury severity, and outcomes. Primary outcomes of interest were mortality rates and hospital length of stay.

Results
Injury severity scores were significantly worse for nonaccidental traumas (NATs) (P < 0.001) compared with motor vehicle collisions and motor pedestrian collisions. Nonaccidental traumas were also found to have significantly longer length of stay and higher fatality rates (P < 0.001). Significant differences were also found for the types of injuries sustained for head, extremity, trunk, and other injuries (P < 0.001), and for internal injuries (P < 0.01. Admission rates also dropped for both motor vehicle collisions and motor pedestrian collisions across the 9-year period (P < 0.001) but remained stable for NATs.

Conclusion
In this study population, more severe injuries, higher mortality rates, and longer hospital stays were observed in pediatric NAT compared with those sustained through vehicular means. Furthermore, we observed statistically significant declines in motor vehicle–related injuries compared with NAT.
The Effect of External Thermomechanical Stimulation and Distraction on Reducing Pain Experienced by Children During Blood Drawing
Authors: Inal Sevil , Kelleci Meral 
Published: September 2017

Abstract
This study aimed to investigate the sole and combined effects of external thermomechanical stimulation and distraction in pain relief of children during blood drawing.
This is a randomized clinical trial. The sample consisted of 218 children aged 6 to 12 years who were randomly assigned to 4 groups: group 1 received no intervention, group 2 received external thermomechanical stimulation using Buzzy, group 3 received distraction via DistrACTION Cards, and group 4 received a combination of both external thermomechanical stimulation and distraction. Preprocedural anxiety was assessed through observers' observations using the Children's Anxiety and Pain Scale. Children's pain levels were assessed by themselves, observers, and parents, as reported using the Faces Pain Scale–Revised. Preprocedural anxiety did not differ significantly (P > 0.05). When the 3 study groups were compared with the control group, all 3 groups had significantly lower pain levels than the control group (P < 0.001). The lowest pain level was measured in the combined condition (Buzzy and DistrACTION Cards). The mean score of the device group was lower than the distraction group.