bluuebunny/crossref_metadata_2025_split huggingface dataset:
Current Methods of Evaluating Speech-Language Outcomes for Preschoolers With Communication Disorders: A Scoping Review Using the ICF-CY
Authors: Cunningham Barbara Jane , Washington Karla N. , Binns Amanda , Rolfe Katelyn , Robertson Bernadette , Rosenbaum Peter 
Published: February 2017

PurposeThe purpose of this scoping review was to identify current measures used to evaluate speech-language outcomes for preschoolers with communication disorders within the framework of the International Classification of Functioning, Disability and Health–Children and Youth Version (ICF-CY; World Health Organization, 2007).MethodThe review involved 5 phases outlined by Arksey and O'Malley (2005) and further developed by Levac, Colquhoun, and O'Brien (2010): (a) articulating the research question; (b) identifying relevant studies; (c) selecting studies; (d) charting the data; and (e) collating, summarizing, and reporting the results. The ICF-CY was used to frame the measures included.ResultsA total of 214 relevant peer-reviewed publications were included in the review. Most publications used measures to evaluate changes in outcomes for Activities (65%), followed by measures evaluating changes in Body Functions (20%), and finally measures evaluating changes at the level of Participation (15%). There has been a slight increase in the evaluation of Participation-based outcomes in the past 4 years (2012–2015).ConclusionThe review revealed a dearth of measures in the pediatric speech-language literature that address Participation-based outcomes. The authors strongly advocate for the use of Participation-based outcome measures to detect meaningful change in the lives of children and families.
Preventing Pressure Injuries in Neonates Undergoing Therapeutic Hypothermia for Hypoxic-Ischemic Encephalopathy
Authors: Luton Alexandra , Hernandez Jae , Patterson Clive “Robert” , Nielsen-Farrell Jill , Thompson Anita , Kaiser Jeffrey R. 
Published: February 2017

Background:
Hospital-acquired pressure injuries (HAPIs) can be caused by multiple factors including pressure, shear, friction, moisture/incontinence, device-related pressure, immobility, inactivity, and nutritional deficits. Along with immobility, medical device-related (MDR) HAPIs are a primary cause of pressure injury in neonates, as the clinical practice setting has become increasingly technologically advanced. It is estimated that up to 50% of HAPIs are MDR in pediatric patients. Neonates are at particular risk for HAPI because of their specific anatomical, physiological, and developmental vulnerabilities. A specific example of confluent factors that may increase risk for HAPI is the application of therapeutic hypothermia (TH) and continuous electroencephalography monitoring for neonates with hypoxic-ischemic encephalopathy (HIE).

Interventions:
An interprofessional team collaborated to expand upon existing evidence-based standards of care to address the needs of this specific population within the neonatal intensive care unit (NICU). Interventions centered on revision of current protocols, with efforts to optimize product selection, hardwire assessment practices, and refine documentation of patient care and outcomes.

Methods:
The team primarily utilized plan-do-study-act (PDSA) cycles to test and refine specific methods and strategies to reduce HAPIs. Tested solutions were adopted, adapted, or abandoned.

Results:
A sustained zero HAPI rate in the HIE population resulted. The team continues to collect, report, and utilize near-miss data to continue to refine the process as new risks are identified.

Implications for Practice:
Recognizing the unique skin protection needs of special populations within the NICU, such as those undergoing TH, is crucial. When evidence-based standards of care fail to adequately meet such needs, a collaborative approach to identifying, testing, and implementing population-specific solutions is essential.

Implications for Research:
A paucity of literature regarding the unique skin protection needs for babies undergoing TH exists. Work should be done to better describe the influence of TH on skin integrity, with the goal of identifying population-specific protective measures.
Neonatal Resuscitation Program Rolling Refresher
Authors: Cepeda Brito Jose R. , Hughes Patrick G. , Firestone Kimberly S. , Ortiz Figueroa Fabiana , Johnson Karan , Ruthenburg Terra , McKinney Robyn , Gothard M. David , Ahmed Rami 
Published: February 2017

Background:
Structured training courses have shown to improve patient outcomes; however, guidelines are inconsistently applied in up to 50% of all neonatal resuscitations. This is partly due to the fact that psychomotor skills needed for resuscitation decay within 6 months to a year from the completion of a certification course. Currently, there are no recommendations on how often refresher training should occur to prevent skill decay.

Purpose:
Improve provider proficiency and confidence in the performance of neonatal resuscitation with a focus on chest compression effectiveness.

Methods:
The study recruited neonatal intensive care unit providers (n = 25). A simulation-based Neonatal Resuscitation Program (NRP) curriculum was developed and executed. Training sessions were delivered utilizing in situ simulations at varying time intervals. Pre- and postconfidence surveys and practicum skill scores were collected and evaluated by a content expert. Categorical data were summarized by frequency and percentage and tested for distributional equality via Pearson chi-square tests or Fisher exact tests depending on cell sample size distribution. All statistical tests were 2-sided with P < .05 considered statistically significant.

Results:
Provider overall confidence and rate of chest compressions improved; however, there was no statistically significant difference between groups. Rolling refresher training at varied time intervals did not demonstrate statistically significant differences in chest compression quality among NRP providers.

Implications for Practice:
Rolling refresher training more frequently than every 6 months may not provide added benefit to NRP providers.

Implications for Research:
Additional research is needed to determine optimal refresher training frequency to prevent skill decay.
Reconstruction of Symptomatic Congenital Anterior Cruciate Ligament Insufficiency
Authors: Sachleben Brant C. , Nasreddine Adam Y. , Nepple Jeffrey J. , Tepolt Frances A. , Kasser James R. , Kocher Mininder S. 
Published: February 2017

Background:
Hypoplasia or congenital absence of the anterior cruciate ligament (ACL) is a rare disorder occurring in ∼1 in every 6000 births. Although some patients with hypoplasia or agenesis of the ACL may not complain of instability, others desire to participate in more demanding activities that require the stability of a competent ACL. There are limited reports of surgical treatment of this patient population. The purpose of this study was to report ACL reconstruction in a case series of patients with symptomatic congenital ACL deficiency.

Methods:
A retrospective medical record review of the surgical treatment of 14 knees (13 patients) with congenital absence of the ACL at a tertiary care institution from 1995 to 2012 was performed. Patients with a minimum of 1 year of clinical follow-up were eligible for inclusion.

Results:
The mean age at time of surgery was 12.6 (range, 3 to 22), including 6 patients <12 years of age. Mean follow-up was 2.9 years (range, 1 to 6.6). Nine of 13 patients (69%) had underlying congenital abnormalities/associated syndromes. Preoperative Lachman and pivot shift examination was International Knee Documentation Committee grade C or D in all but 1 knee. ACL reconstruction was performed with combined intra-articular/extra-articular physeal sparing reconstruction with iliotibial band (n=5), autograft hamstring (n=2) or bone-patellar tendon-bone (n=3), or allograft (n=4). Multiligament reconstruction of associated ligamentous deficiency was performed in 7 knees (50%). Postoperative Lachman and pivot shift testing was International Knee Documentation Committee (IKDC) grade A or B in all but 1 knee. One patient with congenital absence of multiple knee ligaments required revision ACL reconstruction surgery, with concurrent first-time posterior cruciate ligament reconstruction, due to persistent instability. None required revision surgery due to graft tear at a minimum of 1-year follow-up.

Conclusions:
Surgical stabilization of symptomatic congenital ACL insufficiency, with associated ligamentous reconstruction as required on a case-by-case basis, results in improved stability at early clinical follow-up, with low complication rates.

Level of Evidence:
Level IV—retrospective case series.
Valgus Hip Osteotomy in Children With Spondyloepiphyseal Dysplasia Congenita: Midterm Results
Authors: Bayhan Ilhan A. , Abousamra Oussama , Rogers Kenneth J. , Bober Michael B. , Miller Freeman , Mackenzie William G. 
Published: February 2017

Background:
Coxa vara has been frequently reported in spondyloepiphyseal dysplasia congenita (SEDC), and proximal femoral osteotomy has been described as a useful treatment. The aim of this study was to discuss the clinical, radiographic, and gait outcomes after valgus extension osteotomy of the proximal femur. Changes of lumbar lordosis, associated with coxa vara correction, are reported as well as the outcome differences between different ages.

Methods:
Records of children with SEDC, who were followed at our institution between 2004 and 2014, were reviewed; and children had hip surgery were identified. Hip pain and passive range of motion, radiographic neck shaft angle (NSA), and Hilgenreiner trochanteric (H-T) angle, sagittal spinopelvic parameters, and gait data were recorded. Preoperative and last follow-up data were compared. Outcomes were also compared between 3 age groups.

Results:
Of the 79 children with SEDC, 26 children (12 boys and 14 girls) had hip osteotomy in 48 hips. Mean age at surgery was 9.6 years and the mean follow-up was 5 years. Preoperative hip pain was noted in 30 hips. At the last follow-up, 3 hips were painful at the extreme range of motion. Passive range of motion, NSA, and H-T improved postoperatively. Although NSA was maintained over the follow-up, H-T deterioration was noted. Spinopelvic measurements changed significantly and gait data remained stable except pelvic tilt that reduced significantly after surgery. The changes of radiographic measurements in each age group were similar to the total group of patients.

Conclusions:
In children with SEDC, surgical correction of coxa vara, by proximal femoral valgus osteotomy, is an effective treatment that improves hip pain and range of motion in addition to the radiographic alignment of the proximal femur and the sagittal spinopelvic alignment. Children are expected to maintain their level of function after surgery and to have good results over the midterm regardless of their age at surgery.

Level of Evidence:
Level IV—therapeutic study.
Time to Return to School After 10 Common Orthopaedic Surgeries Among Children and Adolescents
Authors: Willimon Samuel C. , Johnson Marjorie M. , Herzog Mackenzie M. , Busch Michael T. 
Published: February 2017

Background:
Return to school among adolescents is often overlooked in orthopaedic outcome studies. The purpose was to measure the time missed from school after 10 common orthopedic surgeries.

Methods:
Patients, 5 to 19 years old enrolled in elementary, middle, or high school, who underwent treatment for fixation of type III supracondylar humerus fracture, midshaft femur fracture fixation, isolated anterior cruciate ligament reconstruction, isolated partial menisectomy, adolescent idiopathic scoliosis fusion, closed reduction of both-bone forearm fracture, arthroscopic Bankart repair, hip arthroscopy with femoroacetabular impingement correction, limb length discrepancy correction, or surgical fixation of slipped capital femoral epiphysis during the 2014/2015 and 2015/2016 school years were identified for this Institutional Review Board-approved study. All patients were contacted after surgery to determine date of return to school, number of days in session, and number of school days missed.

Results:
Two hundred six patients met the inclusion criteria for this study. Mean age at time of surgery was 13.0±3.8 years. There were 105 males (51%). Mean time to return to school overall was 13.0±15.2 days. Very few students (n=9; 4%) did not miss any school days during recovery from the procedure of interest. The average number of days missed from school for males was 6.6 days compared with 8.4 days in females (P=0.20). There was no difference between patients aged 5 to 12 years compared with those aged 13 to 19 years (7.1 vs. 7.7 d, respectively; P=0.69). On average, patients who underwent closed reduction of a both-bone forearm fracture returned to school the quickest following surgery (3.4±1.2 d) and missed the least amount of in-session school days (1.9±0.9 d), and those who underwent adolescent idiopathic scoliosis fusion were out of school the longest (42.3±21.4 d) and missed the greatest number of in-session school days (27.6±14.7 d).

Conclusions:
Information regarding average time missed from school for 10 common orthopaedic surgeries can be used by clinicians to counsel patients and their families regarding expected recovery time.

Level of Evidence:
Level IV.
Toddler’s Fractures: Time to Weight-bear With Regard to Immobilization Type and Radiographic Monitoring
Authors: Bauer Jennifer M. , Lovejoy Steven A. 
Published: February 2017

Background:
The toddler’s fracture is a common pediatric nondisplaced spiral tibia fracture that is considered stable with a course of immobilization. However, there is no widely accepted type of immobilization, expected time to weight-bear, nor guidelines for radiographic monitoring. We aimed to compare immobilization type with respect to displacement and time to weight-bear, as well as determine the usefulness of follow-up radiographs.

Methods:
A 3-year retrospective chart review of all children aged 9 months to 4 years who had a lower leg radiograph was performed. Those who fulfilled the criteria of a nondisplaced spiral tibia fracture, without fibula or physeal injury, were included in data collection, as were subjects with a negative initial radiograph that were treated presumptively as a toddler’s fracture. Subjects were compared with regard to clinical and radiographic presentation; initial and subsequent immobilization; and clinical and radiographic follow-up.

Results:
There were 606 subjects with lower leg radiographs, with 192 meeting study criteria: 117 (61%) with an initially visible fracture and 75 (39%) without. Of the 75 without initially visible fractures, 70 (93%) had robust periosteal reaction on follow-up, and none were diagnosed as anything further. At final follow-up, 184 (96%) were known to be weight-bearing, with 98% of these by 4 weeks. There was an earlier return to weight-bear for those initially treated in a boot compared with short leg cast (2.5 vs. 2.8 wk, P=0.04), but there were no other differences between immobilization type. No fractures displaced at any time point, including 7 that had received no immobilization. Patients received an average of 2.5 two-radiograph series; no radiographs were noted to affect treatment decisions in follow-up.

Conclusions:
In our cohort, initial immobilization of a toddler’s fracture in a boot may allow faster return to weight-bearing, but fractures were universally stable regardless of immobilization type, and nearly all regained weight-bearing by 4 weeks. This reliable healing suggests that immobilization type can be at the physician and family’s discretion, and that radiographic follow-up may be unnecessary for treatment planning.

Level of Evidence:
Level III—this is a retrospective comparative study.
The Influence of Aspiration Volume on the Number of Osteoblastic Progenitors Obtained From Bone Marrow in Children
Authors: Yandow Suzanne M. , Van de Velde Samuel K. , Siebert Jeanne , Perkins Sherrie L. 
Published: February 2017

Background:
Autologous bone marrow aspirates are utilized to treat various conditions in children. The biological value of bone marrow aspirate depends on the concentration of competent osteoblastic progenitors present in the aspirate. It has been shown in adults that increasing bone marrow aspiration volume beyond 2 mL decreases the concentration of osteoblast progenitor cells because of dilution of the sample with peripheral blood. The effect of varying bone marrow aspiration volumes on the osteoblast cell content has not been determined in children.

Methods:
In total, 21 children (3 male and 18 female patients, age range 8 mo to 14 y) scheduled for pelvic osteotomy were included in the study. Three separate bone marrow aspirates of 1, 5, and 10 mL were obtained from the anterior superior iliac crest. Total number of nucleated cells was counted per aspirate and the prevalence of alkaline phosphatase–positive colony-forming units was determined per million nucleated cells.

Results:
We measured a significant, proportional increase in the total number of nucleated bone marrow precursor cells between the 1 and 5 mL samples (mean±SD, 27±13 and 152±78 million nucleated cells, respectively; P<0.0001). When the aspiration volume doubled from 5 to 10 mL the total number of nucleated cells was 178±76 million (P=0.17). A proportional increase from 2214 alkaline phosphatase–positive colony-forming units in the 1 mL sample to 14,100 alkaline phosphatase–positive colony-forming units in the 5 mL sample was observed. However, the number of colony-forming units per aspirate decreased to 11,880 in the 10 mL sample.

Conclusions:
These data demonstrate that in children aspiration up to 5 mL bone marrow from the iliac crest yields a proportional increase in osteoblastic progenitor cells per aspirate. Increasing the aspiration volume beyond 5 mL results in hemodilution, rather than further selection of osteoblastic material.

Clinical Relevance:
These data provide clinicians with a guideline for optimizing aspiration volume of bone marrow in children.

Level of Evidence:
Level II—development of diagnostic criteria on basis of consecutive patients.
Radiographic Assessment of Guided Growth: The Correlation Between Screw Divergence and Change in Anatomic Alignment
Authors: Sweeney Kyle R. , Shi Weilong J. , Gottschalk Michael B. , Kappa Jason E. , Bruce Robert W. , Fletcher Nicholas D. 
Published: February 2017

Background:
Assessment of changes in anatomic alignment following guided growth traditionally utilizes full-length standing radiographs which subjects patients to larger radiation doses than does a single anteroposterior radiograph of the knee. In an effort to minimize radiation exposure, the present study sought to determine whether changes in screw divergence (SD) of the 2-hole tension band plate used for hemiepiphysiodesis reliably predicts change in alignment.

Methods:
A retrospective review was conducted involving all patients with genu varum or genu valgum treated with hemiepiphysiodesis at a single institution. Preoperative anatomic alignment of the femur, using anatomic lateral distal femoral angle (aLDFA) and anatomic femoral-tibial angle (aTFA), and intraoperative divergence of hemiepiphysiodesis screws were compared with postoperative imaging. Linear regression analysis determined the relationship between changes in SD and changes in alignment, and multivariate regression analysis explored the relationship between the angular changes being measured and various demographic factors.

Results:
Linear regression analysis revealed that for every 1 degree change in SD there was a resultant 1.80 degrees of change in aTFA and 2.11 degrees of change in aLDFA. Change in aTFA is predicted by the equation: ∆aTFA=0.41×|∆SD|+1.39. The change in aLDFA was predicted by the equation ∆aLDFA=0.27×∆SD+1.84 with a R2 of 0.31. ∆aTFA and ∆SD had a correlation coefficient of 0.68 (95% confidence interval, 0.54-0.78.) ∆aLDFA and ∆SD had a correlation coefficient of 0.56 (95% confidence interval, 0.42-0.68). ∆SD and sex were the only 2 independent predictors for ∆aLDFA and ∆aTFA as determined by multivariate regression analysis.

Conclusion:
Change in coronal plane anatomic alignment in patients being treated for genu valgum or genu varum with hemiepiphysiodesis can be reasonably estimated by measuring the change in SD. Therefore, when following patients postoperatively, focal radiographic imaging of the knee can be utilized in lieu of standing full-length limb radiographs to limit radiation to the pelvis in this sensitive patient population.

Level of Evidence:
Level III—retrospective comparative study.
Predicting Late Follow-up and Understanding Its Consequences in Growth Modulation for Pediatric Lower Limb Deformities
Authors: Lawing Cheryl , Margalit Adam , Ukwuani Gift , Sponseller Paul D. 
Published: February 2017

Background:
Growth modulation with implants facilitates correction of angular deformities and limb-length discrepancies (LLDs) in children. Close follow-up is necessary when using growth modulation to prevent overcorrection. We examined factors associated with late follow-up and overcorrection rates in patients with late versus timely follow-up.

Methods:
This was a retrospective review of growth modulation procedures in children at 1 institution from 2000 through 2014. Procedures were assigned to the following categories on the basis of deformity: ankle valgus, genu valgum, genu varum, knee flexion contractures, and LLDs. Radiographic and clinical parameters were assessed. Late follow-up was defined as delaying a recommended appointment by ≥6 months. Loss to follow-up was defined as failure to return for a recommended postoperative appointment. Associations were evaluated using the following tests: χ2, Fisher exact, analysis of variance, Mann-Whitney U, and logistic regression. Statistical significance was set at P<0.05.

Results:
Of the 112 patients, there were 41 cases of genu valgum, 23 of ankle valgus, 18 each of genu varum and LLD, and 12 of knee flexion contractures. Twenty-two patients had late follow-up. Another 22 patients were lost to follow-up with retained implants. Patients with late follow-up had significantly higher odds of experiencing overcorrection deformities versus patients with timely follow-up (odds ratio, 19.2; 95% confidence interval, 5.2-71.4; P<0.005). The only deformity for which there was a significant difference in final alignment between patients with timely versus late follow-up was genu valgum (P<0.005). Late follow-up was associated with having a primary language other than English (P=0.05) and being obese/overweight (P=0.004).

Conclusions:
Late follow-up and loss to follow-up were common, occurring in 39% of patients combined. Late follow-up was associated with overcorrection in guided-growth procedures, as were overweight/obesity and primary language other than English.

Level of Evidence:
Level IV—retrospective case series.