bluuebunny/crossref_metadata_2025_split huggingface dataset:
Morbidity and Mortality of a Cohort of Peruvian HIV-infected Children 2003–2012
Authors: Baker Amira N. , Bayer Angela M. , Viani Rolando M. , Kolevic Lenka , Sim Myung-Shin , Deville Jaime G. 
Published: December 2017

Background:
Data on pediatric HIV in Peru are limited. The National Institute of Child Health (Instituto Nacional de Salud del Niño: INSN) cares for the most HIV-infected children under the age of 18 years in the country. We describe the outcomes of children seen at INSN’s HIV clinic over the 10 years when antiretroviral therapy and prevention of mother-to-child transmission (PMTCT) interventions became available in 2004.

Methods:
We conducted a retrospective review of INSN HIV clinic patients between 2003 and 2012. Deidentified data were collected and analyzed.

Results:
A total of 280 children were included: 50.0% (140/280) were male; 80.0% (224/280) lived in metropolitan Lima. Perinatal transmission was the mode of HIV infection in 91.4% (256/280) of children. Only 17% (32/191) of mothers were known to be HIV-infected at delivery; of these mothers, 41% (13/32) were receiving antiretroviral therapy at delivery, 72% (23/32) delivered by Cesarean section and 47% (15/32) of their infants received antiretroviral prophylaxis. Median age at HIV diagnosis for all children was 35.7 months (interquartile range 14.5–76.8 months), and 67% (143/213) had advanced disease (clinical stage C). After HIV diagnosis, the most frequent hospitalization discharge diagnoses were bacterial pneumonia, chronic malnutrition, diarrhea, anemia and tuberculosis. Twenty-four patients (8.6%) died at a median age of 77.4 months.

Conclusions:
Most cases of pediatric HIV were acquired via perinatal transmission; few mothers were diagnosed before delivery; and among mothers with known HIV status, PMTCT was suboptimal even after national PMTCT policy was implemented. Most children were diagnosed with advanced disease. These findings underscore the need for improving early pediatric HIV diagnosis and treatment, as well as PMTCT strategies.
Immediate and Long-term Hearing Outcomes With the Middle Cranial Fossa Approach for Vestibular Schwannoma Resection
Authors: Ahmed Sameer , Arts H. Alexander , El-Kashlan Hussam , Basura Gregory J. , Thompson B. Gregory , Telian Steven A. 
Published: December 2017

Objective:To analyze the immediate postoperative and long-term hearing outcome data in patients who have undergone hearing preservation attempts with the middle cranial fossa (MCF) approach for the resection of sporadic vestibular schwannoma.Study Design:Retrospective review of a surgical patient cohort.Setting:Tertiary academic referral center.Patients:Adult patients with unilateral sporadic vestibular schwannoma.Intervention:Surgical treatment with a MCF approach.Main Outcome Measure:Comparison of pre- and postoperative audiometric data in accordance with the 1995 and 2012 American Academy of Otolaryngology/Head and Neck Surgery guidelines on reporting hearing outcomes and with a word recognition score only scale. Long-term hearing outcome data were analyzed in the following postoperative groups: 3 to 5, 6 to 8, 9 to 11, and 12+ years after surgery.Results:From 1999 to 2016, 174 patients underwent the MCF approach and 155 of them met inclusion criteria for analysis of hearing outcome data. Class A or B hearing was preserved in 70% of the entire cohort after recovery. Seventy-one patients with measurable hearing met criteria for long-term data analysis. The rate of American Academy of Otolaryngology/Head and Neck Surgery class A or B hearing preservation was 82% at 3 to 5 years and declined thereafter. The rate of word recognition score class I or II hearing preservation was 98% at 3 to 5 years and declined less rapidly thereafter. Patients with preoperative Class A hearing had significantly higher rates of successful hearing preservation at all postoperative intervals.Conclusion:Delayed hearing loss occurs in a progressively increasing fashion but speech understanding remains durable for a majority of patients whose hearing is initially preserved with the MCF approach.
Effect of Prophylactic Medication on Associated Dizziness and Motion Sickness in Migraine
Authors: Lee Seung-Han , Jeong Seong-Hae , Kim Ji-Soo , Kim Hyo-Jung , Choi Kwang-Dong , Choi Jae-Hwan , Oh Sun-Young , Park Ji-Yun , Kim Dong Uk , Kim Byung-Kun 
Published: December 2017

Objective:
To determine the efficacy of prophylactic medications for migraine in reducing associated dizziness and motion sickness.

Study Design:
Multicenter prospective observational study.

Setting:
Nationwide 9 Dizziness Clinics in South Korea.

Patients:
One hundred thirty-eight patients who required a preventive medication for migraine accompanied by dizziness and motion sickness.

Intervention:
At least one of the prophylactic medications was prescribed among the beta-blockers, calcium channel blockers, tricyclic antidepressants, and antiepileptic drugs.

Main Outcome Measure:
For 3 months from the index visit, the patients had monthly assessments of the headache (frequency and duration), dizziness handicap inventory, University of California Los Angeles dizziness questionnaire, vertigo symptom scale, and motion sickness score.

Results:
The prophylactic medications significantly improved the headache profiles, all three parameters of dizziness (dizziness handicap inventory, University of California Los Angeles dizziness questionnaire, and vertigo symptom scale), and severity of motion sickness (p < 0.001).

Conclusion:
The prophylactic medication for migraine also improves associated dizziness and motion sickness as well as the headaches.
Electrophysiological Evaluation of the Facial Muscles in Congenital Unilateral Lower Lip Palsy
Authors: Baba Shintaro , Kondo Kenji , Yamasoba Tatsuya 
Published: December 2017

Objectives:
Congenital unilateral lower lip palsy (CULLP) is a congenital facial asymmetry in which one corner of the mouth does not dip downward symmetrically (Kobayashi, 1979). We analyzed the electrophysiological findings in cases of CULLP to understand the facial nerve mechanisms underlying this pathological condition.

Methods:
The electrophysiological findings in 20 patients with CULLP including an electroneuronography (ENoG) of the orbicularis oris muscle, nerve excitability test (NET) results, and the blink reflex (BR) were analyzed.

Results:
Of 21 patients with CULLP, 20 underwent ENoG, 12 underwent a NET, and 14 underwent a BR examination. Nine of 19 patients with CULLP showed higher ENoG amplitude in the affected side than in the unaffected side. In four patients, the ENoG amplitude in the affected side was similar to that in the unaffected side whereas six patients had higher ENoG amplitude in the unaffected side. All patients showed a normal BR response and only one patient had a left–right difference in the NET response in the marginal mandibular branch. NET also demonstrated that the muscular twitch appeared on the lower lip of the affected side.

Conclusion:
These results suggested that in CULLP, each of the facial nerve branches including the marginal mandibular branch appeared to function within normal parameters. The marginal mandibular branch of the facial nerve, which usually innervates the depressor anguli oris and depressor labii inferioris muscles, may innervate adjacent muscles as well, such as the orbicularis oris muscle, during prenatal development.
Limitations of teaching endoscopy
Authors: Sonnenberg Amnon 
Published: December 2017

Background and aim
Endoscopic procedures of the gastrointestinal tract represent a category of diagnostic tests that considerably rely on skills and dexterity of a human tester. The present analysis aimed to delineate factors that affect the success of teaching endoscopy and potentially limit the acquisition of new skills and knowledge.

Methods
The performance of the endoscopist is described in terms of sensitivity and specificity. The outcomes of sequential testing and acquisition of new knowledge are calculated using matrix algebra. Teaching is modeled as an iterative process with an incremental improvement in a fellow’s performance matrix.

Results
As a diagnostician, an endoscopist cannot measure beyond his/her own level of competence. The cognition and endoscopic skills of both the fellow and the attending physician determine how fast the fellow’s endoscopic performance improves over time. The better the fellow’s and the attending’s abilities are to recognize and amend residual deficiencies, the faster the fellow’s endoscopic performance improves. Severe or even complete diagnostic incompetence by either party can draw out the training process or even result in a complete standstill, respectively.

Conclusion
The description of endoscopic performance in terms of test characteristics provides valuable insights into the influence of endoscopic performance characteristics on the outcome of endoscopy and on the constraints of teaching endoscopic skills.
Six Nursing Care Problems in Hospitals
Authors: Eglseer Doris , Hödl Manuela , Lohrmann Christa 
Published: December 2017

Background:
Investigations on the quality of nursing care relating to various care problems are rare.

Purpose:
This study assessed the (1) fulfillment of structural indicators, (2) application of nursing interventions as process indicators, and (3) prevalence rate as outcome indicators with regard to various care problems.

Methods:
A cross-sectional multicenter study was conducted in 30 Austrian hospitals with 2878 patients.

Results:
The highest number of structural quality indicators was fulfilled for pressure ulcers, falls, restraints, and pain. In malnutrition and urinary incontinence, a lack of structural indicators was observed. Most interventions were offered to patients with pressure ulcers or those who had experienced a fall. The lowest frequency of nursing interventions was seen in malnourished and incontinent persons.

Conclusion:
There is a need for the national adaptation of guidelines for malnutrition and urinary incontinence. This may increase the frequency of evidence-based nursing interventions.
Systems Addressing Frail Elder Care
Authors: Ansryan Lianna Zaven , Aronow Harriet Udin , Borenstein Jeff Edward , Mena Viola , Haus Flora , Palmer Katherine , Chan Ellen , Swanson Jane W. , Mass Sharon , Rosen Bradley , Braunstein Glenn David , Burnes Bolton Linda 
Published: December 2017

OBJECTIVE
The aim of this article is to describe the Systems Addressing Frail Elder (SAFE) Care model, features of the interprofessional team and reengineered workflow, and details of the intervention.

BACKGROUND
Older inpatients are vulnerable to adverse events related to frailty. SAFE Care, an interprofessional team-based program, was developed and evaluated in a cluster randomized controlled trial (C-RCT). Results found reduced length of stay and complications. The purpose of this article is to support and encourage the replication of this innovation or to help facilitate implementation of a similar process of organizational change.

METHODS
This was a review of model features and intervention data abstracted from electronic health records.

RESULTS
Salient features of team composition, training, and workflow are presented. The C-RCT intention-to-treat sample included 792 patients, of whom 307 received the SAFE Care huddle intervention. The most frequent problem was mobility (85.7%), and most frequent recommendation was fall precautions protocol (83.1%).

CONCLUSIONS
The SAFE Care model may provide a standardized framework to approach, assess, and address the risks of hospitalized older adults.
Targeted Interventions to Advance a Culture of Inquiry at a Large, Multicampus Hospital Among Nurses
Authors: Carter Eileen J. , Rivera Reynaldo R. , Gallagher Kelly A. , Cato Kenrick D. 
Published: December 2017

OBJECTIVES
The aim of this study is to assist nurse leaders in developing innovative structures to foster a culture of inquiry among professional nurses.

BACKGROUND
Critical to nurse’s engagement in evidence-based practice (EBP) is a culture of inquiry, in which nurses critically evaluate patient care activities and actively review existing evidence to address identified clinical issues. A bundle of structural interventions was implemented across a large, multisite hospital to advance a culture of inquiry. We measured the impact of these interventions on nurses' library use and on nurses' knowledge, attitudes, and practices towards EBP.

METHODS
Structural interventions included: 1) EBP and Research Committee meetings, in which nurses were educated on how to formulate a clinical question and critically appraise a research article; 2) Academic Partners Program, in which nurse academicians provided scholarly mentorship and guidance during monthly committee meetings; 3) hiring of clinical nurse scientists who provided 1-on-1 education and mentorship to clinical nurses in EBP and research; and 4) a Nurse Residency Program partnership, in which newly graduated nurses were required to complete an EBP project. We examined the impact of these structural interventions on nurses' use of library resources and nurses' knowledge, attitudes, and practices toward EBP.

RESULTS
The implementation of structural interventions to support nurses' engagement in EBP was associated with a significant increase in the number of nurse-generated library consultative requests over time. Results showed high levels of nurse knowledge, attitudes, and practices in EBP.

CONCLUSIONS
Nurse leaders may advance a culture of inquiry by providing the infrastructure to support EBP activities and by empowering nurses to question and seek answer to identified practice questions. Infrastructures should include access to scientific articles and partnerships with schools of nursing. Additional research is needed to validate nurse library use as a measure of nurse engagement in EBP.
The Appraisal of Nursing Practice
Authors: Becker Heather , Meraviglia Marty , Seo Jin (EunJin) , Ndlovu Chipo , Kimmel Lois , Rowin Toni 
Published: December 2017

OBJECTIVE
We describe the development of the Appraisal of Nursing Practice (ANP) and present initial psychometric data.

BACKGROUND
Although measures of new nurses' confidence in clinical practice exist, psychometrically sound observational tools that assess a broad range of nursing competencies are needed.

METHODS
Based on the Quality and Safety Education for Nurses competencies, the 37-item ANP covers person-centered care, teamwork and collaboration, evidence-based practice/quality improvement, safety, informatics, professionalism, and overall satisfaction (with the new nurse's functioning). Cognitive interviewing was used to refine the items. Assessment of interrater reliability and a field test in a new nurse residency program were conducted.

RESULTS
Interrater reliability and internal consistency reliability were generally acceptable. Scores increased significantly for nurses as they moved through a nurse residency program.

CONCLUSIONS
The ANP can help nursing administrators identify areas where nurse residents are building needed competencies versus areas that need more work to achieve desired competency outcomes.
Reducing Childhood Admissions to the PICU for Poisoning (ReCAP2) by Predicting Unnecessary PICU Admissions After Acute Intoxication
Authors: Patel Meral M. , Travers Curtis D. , Stockwell Jana A. , Numur Ezaldeen A. , Geller Robert J. , Kamat Pradip P. , Grunwell Jocelyn R. 
Published: December 2017

Objective:
To derive and validate clinical prediction models to identify children at low risk of clinically significant intoxications for whom intensive care admission is unnecessary.

Design:
Retrospective review of data in the National Poison Data Systems from 2011 to 2014 and Georgia Poison Center cases from July to December 2016.

Setting:
United States PICUs and poison centers participating in the American Association of Poison Control Centers from 2011 to 2016.

Patients:
Children 18 years and younger admitted to a United States PICU following an acute intoxication.

Interventions:
None.

Measurements and Main Results:
The primary study outcome was the occurrence of clinically significant intoxications defined a priori as organ system–based clinical effects that require intensive care monitoring and interventions. We analyzed 70,364 cases. Derivation (n = 42,240; 60%) and validation cohorts (n = 28,124; 40%) were randomly selected from the eligible population and had similar distributions of clinical effects and PICU interventions. PICU interventions were performed in 1,835 children (14.1%) younger than 6 years, in 374 children (15.4%) 6–12 years, and in 4,446 children (16.5%) 13 years and older. We developed highly predictive models with an area under the receiver operating characteristic curve of 0.834 (< 6 yr), 0.771 (6–12 yr), and 0.786 (≥13 yr), respectively. For predicted probabilities of less than or equal to 0.10 in the validation cohorts, the negative predictive values were 95.4% (< 6 yr), 94.9% (6–12 yr), and 95.1% (≥ 13 yr). An additional 700 patients from the Georgia Poison Center were used to validate the model and would have reduced PICU admission by 31.4% (n = 110).

Conclusions:
These validated models identified children at very low risk of clinically significant intoxications for whom pediatric intensive care admission can be avoided. Application of this model using Georgia Poison Center data could have resulted in a 30% reduction in PICU admissions following intoxication.
An Assessment of Information Exchange Practices, Challenges, and Opportunities to Support US Disease Surveillance in 3 States
Authors: Garcia Macarena C. , Garrett Nedra Y. , Singletary Vivian , Brown Sheereen , Hennessy-Burt Tamara , Haney Gillian , Link Kimberly , Tripp Jennifer , Mac Kenzie William R. , Yoon Paula 
Published: December 2017

Background:
State and local public health agencies collect and use surveillance data to identify outbreaks, track cases, investigate causes, and implement measures to protect the public's health through various surveillance systems and data exchange practices.

Purpose:
The purpose of this assessment was to better understand current practices at state and local public health agencies for collecting, managing, processing, reporting, and exchanging notifiable disease surveillance information.

Methods:
Over an 18-month period (January 2014-June 2015), we evaluated the process of data exchange between surveillance systems, reporting burdens, and challenges within 3 states (California, Idaho, and Massachusetts) that were using 3 different reporting systems.

Results:
All 3 states use a combination of paper-based and electronic information systems for managing and exchanging data on reportable conditions within the state. The flow of data from local jurisdictions to the state health departments varies considerably. When state and local information systems are not interoperable, manual duplicative data entry and other work-arounds are often required. The results of the assessment show the complexity of disease reporting at the state and local levels and the multiple systems, processes, and resources engaged in preparing, processing, and transmitting data that limit interoperability and decrease efficiency.

Conclusions:
Through this structured assessment, the Centers for Disease Control and Prevention (CDC) has a better understanding of the complexities for surveillance of using commercial off-the-shelf data systems (California and Massachusetts), and CDC-developed National Electronic Disease Surveillance System Base System. More efficient data exchange and use of data will help facilitate interoperability between National Notifiable Diseases Surveillance Systems.
Assessment of the Sustainability Capacity of a Coordinated Approach to Chronic Disease Prevention
Authors: Moreland-Russell Sarah , Combs Todd , Polk LaShaun , Dexter Sarah 
Published: December 2017

Objective:
This article outlines some factors that influenced the sustainability capacity of a coordinated approach to chronic disease prevention in state and territory health departments.

Design:
This study involved a cross-sectional design and mixed-methods approach. Quantitative data were collected using the Program Sustainability Assessment Tool (PSAT), a 40-item multiple-choice instrument that assesses 8 domains of sustainability capacity (environmental support, funding stability, partnerships, organizational capacity, program evaluation, program adaptation, communications, and strategic planning). Qualitative data were collected via phone interviews.

Participants:
The PSAT was administered to staff and stakeholders from public health departments in 50 US states, District of Columbia, and Puerto Rico, who were involved in the implementation of coordinated chronic disease programs. Phone interviews were conducted with program coordinators in each state.

Main Outcome Measure(s):
Sustainability score patterns and state-level categorical results, as well as strengths and opportunities for improvement across the 8 program sustainability domains, were explored.

Results:
On average, programs reported the strongest sustainability capacity in the domains of program adaptation, environmental support, and organizational capacity, while funding stability, strategic planning, and communications yielded lowest scores, indicating weakest capacity. Scores varied the most by state in environmental support and strategic planning.

Conclusion:
The PSAT results highlight the process through which states approached the sustainability of coordinated chronic disease initiatives. This process included an initial focus on program evaluation and partnerships with transfer of priority to long-term strategic planning, communications, and funding stability to further establish coordinated chronic disease efforts. Qualitative interviews provided further context to PSAT results, indicating that leadership, communications, partnerships, funding stability, and policy change were perceived as keys to success of the transition. Integrating these findings into future efforts may help those in transition establish greater sustainability capacity. The PSAT results and interviews provide insight into the capacity for sustainability for programs transitioning from traditional siloed programs to coordinated chronic disease programs.