bluuebunny/crossref_metadata_2025_split huggingface dataset:
Current views on the pathogenesis of Sjögren's syndrome
Authors: Pontarini Elena , Lucchesi Davide , Bombardieri Michele 
Published: December 2017

Purpose of review
The purpose of this review is to provide an insight into the pathophysiological mechanisms involved in the pathogenesis of primary Sjögren's Syndrome (pSS), highlighting recent findings with potential therapeutic repercussions.

Recent findings
In the last 2 years, epigenetic analyses provided new insights into pSS pathogenesis. Characterization of DNA methylation patterns, chromatin structures and microRNA confirmed the importance of aberrant interferon and B-cell responses in the development of the disease. The formation of ectopic B-cell follicles with germinal centers is now a well recognized pathogenic mechanism within salivary glands of pSS. In the context of ectopic germinal centers reaction, T/B-cell interactions, that is regarding T-helper 17 and T-follicular helper cells, and their respective counterparts, T-regulatory and T-follicular regulatory cells, appear particularly relevant in pSS pathogenesis as their imbalance is associated with a dysregulation of B-cell dynamics and the production of autoantibodies.

Summary
Advances in the understanding of pSS pathogenesis have paved the way for clinical trials with novel biologic agents targeting immune pathways regulating T/B-cell interactions and downstream B-cell activation. Reverse translation from these studies provides invaluable novel information of the mechanisms sustaining autoimmunity and chronic inflammation in pSS.
Epidemiology of osteoarthritis: literature update
Authors: Vina Ernest R. , Kwoh C. Kent 
Published: December 2017

Purpose of review
The purpose of this review is to highlight recent studies of osteoarthritis epidemiology, including research on prevalence, disease impact, and potential risk factors.

Recent findings
Osteoarthritis is highly prevalent in the United States and around the globe. It is a leading cause of disability and can negatively impact people's physical and mental well being. Healthcare resources and costs associated with managing the disease can be substantial. There is increasing evidence that there are different osteoarthritis phenotypes that reflect different mechanisms of the disease. Various person-level risk factors are recognized, including sociodemographic characteristics (e.g. female sex, African-American race), genetic predispositions, obesity, diet-related factors, and high bone density/mass. Joint-level risk factors include specific bone/joint shapes, thigh flexor muscle weakness, joint malalignment, participation in certain occupational/sports activities, and joint injury. Recent studies have enhanced our understanding of preradiographic lesions associated with osteoarthritis.

Summary
Application of these new findings may allow us to develop innovative strategies and novel therapies with the purpose of preventing new disease onset and minimizing disease progression.
C1-C2 Pedicle Screw Fixation for Pediatric Atlantoaxial Dislocation: Initial Results and Long-term Follow-up
Authors: Chen Zhi-Da , Wu Jin , Lu Cheng-Wu , Zeng Wen-Rong , Huang Zhuan-Zhi , Lin Bin 
Published: December 2017

Background:
There are few studies reporting the use of atlantoaxial pedicle screws and the long-term effects of C1-C2 posterior fusion in children. Our study is to investigate the initial results of C1-C2 pedicle screw fixation for pediatric atlantoaxial dislocation (AAD) and assessed spontaneous change of postoperative radiography after a long-term follow-up period.

Methods:
Posterior pedicle screw fixations were performed in 21 pediatric patients with AAD. All the patients underwent implant removal 1 year after their initial surgery and had regular follow-up with an average duration of 76.4 months (range, 52 to 117 mo). Clinical and radiographic data were then collected and compared.

Results:
Frankel Grade was significantly improved at 3 months follow-up compared with pretreatment values. All patients had good bony fusion at a mean of 4.2±0.9 months (range, 3 to 6 mo) after treatment. None of the patients experienced worsening neurological symptoms or injury to the vertebral artery. However, 2 cases experienced minor complications. Following removal of the implants, no spinal deformities or subaxial instabilities were found. The mean angle of sagittal curvature increased from 12.1±2.4 degrees (range, 0 to 22 degrees) immediately postoperatively to 19.1±2.7 degrees (range, 6 to 31 degrees) at the final follow-up (P>0.05).

Conclusions:
The results demonstrated that C1-C2 pedicle screw fixation could achieve satisfactory initial results for the management of the pediatric AAD. Moreover, removal of the metal implant after bony fusion did not increase the risk of spinal deformity or subaxial instability at long-term follow-up.
Osteofibrous Dysplasia of the Tibia in Children: Outcome Without Resection
Authors: Westacott Daniel , Kannu Peter , Stimec Jennifer , Hopyan Sevan , Howard Andrew 
Published: December 2017

Background:
The proposed association between osteofibrous dysplasia and adamantinoma has led some to advocate resection of the entire lesion, which can require major subsequent reconstruction. However, this link remains unproven and there is some support in more recent literature for a less aggressive approach. This study aims to describe our experience managing pediatric tibial osteofibrous dysplasia with such an approach and to report functional outcomes in children treated thus.

Methods:
A total of 28 cases of osteofibrous dysplasia in 25 patients were managed at a referral center for pediatric bone tumors with observation in the first instance, then limited surgical intervention if required to address pain and deformity. Surgery aimed to restore stability and alignment without excising the lesion. Clinical records provided basic clinical outcome measures involving walking, recreation, orthoses and school/work participation and patients provided a Musculoskeletal Tumour Society score (MSTS) where contactable.

Results:
Mean age at presentation was 6.0 years and mean follow-up was 8.3 years. Only 8 patients required surgery. According to basic outcome measures, 13 patients were symptom-free. About 15 patients (17 cases) provided a MSTS and the mean score was 24 of 30. No transformation to adamantinoma was observed. Those who presented at a younger age and with bilateral disease more often required surgery and remained symptomatic.

Conclusions:
A less aggressive approach to pediatric tibial osteofibrous dysplasia achieves good functional outcomes and patient satisfaction in most cases. Surgery is required in the minority of cases. Transformation to adamantinoma was not observed in this series. We recommend patient education, clinical observation and reactive intervention if required, rather than proactive resection and reconstruction.

Level of Evidence:
Level IV—case series.
A Quality Improvement Initiative Reduces Cast Complications in a Pediatric Hospital
Authors: Balch Samora Julie , Samora Walter P. , Dolan Kevin , Klingele Kevin E. 
Published: December 2017

Background:
Casts, while frequently used as routine treatment in pediatric orthopaedic practice, are not without complications. At our large tertiary care pediatric hospital, the baseline rate of all casting complications was 5.6 complications per 1000 casts applied (0.56%). We tested the hypothesis that we could use quality improvement (QI) methodology to decrease the overall cast complication rate and improve patient care.

Methods:
We initiated a QI program implementing concepts derived from the Institute for Healthcare Improvement models, including Plan-Do-Study-Act cycles, to decrease our cast complication rate. A resident casting education program was developed with a competency “checklist” to ensure that casts are applied, bivalved, and removed in a safe and standardized manner to prevent patient harm. AquaCast Saw Stop Protective Strips were required to be applied with every cast application. A review of our facility’s processes and procedures determined adequate measures were in place to effectively manage inventory and maintenance of cast-saw blades.

Results:
With the multimodal QI intervention, our cast complication rate was reduced to 1.61 complications per 1000 applications, a >90% improvement.

Conclusions:
Implementation of QI concepts to perform a QI initiative resulted in a shift toward fewer cast complications, leading to overall improved patient care at a large tertiary pediatric hospital.

Level of Evidence:
Level II—prospective cohort study.
Psychosocial Factors and Surgical Outcomes in Adult Spinal Deformity
Authors: Toombs Courtney S. , Paul Justin C. , Lonner Baron S. 
Published: December 2017

Study Design.
Retrospective analysis of a prospectively collected, national inpatient hospital database.

Objective.
We aimed to investigate comorbid psychiatric disorders in the adult spinal deformity (ASD) population. We hypothesized that a high incidence of comorbid psychiatric disorders in ASD would negatively impact perioperative outcomes.

Summary of Background Data.
Patients with adult spinal fusion (ASF) suffer from severe back pain and often depression. Psychiatric comorbidities in the ASD population are not well understood, despite the apparent psychological effects of spinal deformity–related self-image.

Methods.
The Nationwide Inpatient Sample databases from 2001 to 2009 were queried for patients ages 18 years or older with in-hospital stays including a spine arthrodesis. Patients were divided into two groups: ASD (diagnosis of scoliosis, excluding neuromuscular and congenital) and all other ASF. Subjects were further stratified by presence of a comorbid psychiatric diagnosis. Differences between each surgical group in psychiatric frequency and complications were calculated using analysis of variance, adjusted for operative complexity. A binary logistic regression analyzed the association between psychiatric diagnoses and likelihood of complications.

Results.
A total of 3,366,352 ASF and 219,975 ASD patients were identified. The rate of comorbid psychiatric diagnoses in ASD was significantly higher (23.5%) compared to ASF patients (19.4%, P < 0.001). Complication rates were higher for ASD compared to ASF; patients without a psychiatric diagnosis had lower (or comparable) complication rates than psychiatric patients, across all disorder categories. Patients with psychotic disorders and dementia showed more complications than controls; patients with mood, anxiety and alcohol disorders showed fewer.

Conclusion.
Psychiatric comorbidities are more common in the ASD population than in adult fusion patients. ASD and ASF patients with the most common psychiatric disorders (mood, anxiety, and alcohol abuse) are not at increased risk for complications compared to controls. Those patients with psychotic disorders and dementia are at a significant risk for increased complications and surgeons should be aware of these specific risks.

Level of Evidence: 2
Posterolateral Diskectomies for Treatment of Pediatric Spinal Deformities
Authors: Jain Amit , Sullivan Brian T. , Hassanzadeh Hamid , Hsu Nigel N. , Sponseller Paul D. 
Published: December 2017

Study Design.
Retrospective.

Objective.
To investigate the indications, radiographic outcomes, and complications in children with spinal deformities treated with posterolateral diskectomy with posterior fusion (PLDF), and to compare them against those of patients treated with anteroposterior spinal fusion (APSF).

Summary of Background Data.
A novel technique for treating large, rigid spinal deformities in children has been proposed, consisting of PLDF at the apex of the deformity using an all-posterior approach.

Methods.
We evaluated records of all patients 21 years or younger who underwent treatment for spinal deformity between 2010 and 2015 by one surgeon using PLDF (n = 56) or APSF (n = 21).

Results.
The indications for PLDF were large, rigid curves (37 patients); focal curves with severe rotation (10 patients); or large curves with open triradiate cartilage (nine patients). PLDF patients had a mean (± standard deviation) of 3 ± 1 diskectomies and 14 ± 3 posterior spinal levels fused. Compared with the APSF group, the PLDF group had significantly greater major curve correction (86% vs. 57%, P = 0.006), less blood transfused (mean, 2.5 ± 2.6 vs. 4.0 ± 3.3 units, P = 0.038), and a lower rate of staged surgery (1.8% vs. 86%, P < 0.001). There were no significant differences between the PLDF and APSF groups in T1-S1 length gained (mean, 6.2 ± 3.4 vs. 6.6 ± 8.8 cm, respectively; P = 0.77) or in the rate of major complications (P = 0.557).

Conclusion.
PLDF is an effective alternative to APSF for treating children with severe spinal deformities. It is effective for treating large, rigid curves with severe rotation and may be useful for treating large curves in children with open triradiate cartilage.

Level of Evidence: 4
Septic Cardiomyopathy
Authors: Beesley Sarah J. , Weber Gerhard , Sarge Todd , Nikravan Sara , Grissom Colin K. , Lanspa Michael J. , Shahul Sajid , Brown Samuel M. 
Published: December 2017

Objectives:
To describe, with an emphasis on clinical applications, what is known about the pathophysiology, management, and implications of septic cardiomyopathy in the adult ICU.

Data Sources and Study Selection:
A PubMed literature review was performed for relevant articles. Only articles in English that studied human adults with sepsis were included.

Data Extraction and Data Synthesis:
Multiple competing definitions for septic cardiomyopathy hinder understanding of this entity. Although many patients with sepsis develop cardiac dysfunction, the impact of septic cardiomyopathy on prognosis and therapy remains to be demonstrated. Treatment of septic cardiomyopathy is aimed at treating the underlying sepsis and providing specific supportive care for cardiogenic shock when present.

Conclusions:
Septic cardiomyopathy is an important contributor to organ dysfunction in sepsis. Guided treatment of septic cardiomyopathy may affect patients’ prognosis, especially when their cardiac index is substantially decreased. The implication of septic cardiomyopathy for both short- and long-term outcomes is an important area for future investigation.
Practice Patterns and Outcomes Associated With Early Sedation Depth in Mechanically Ventilated Patients: A Systematic Review and Meta-Analysis*
Authors: Stephens Robert J. , Dettmer Matthew R. , Roberts Brian W. , Ablordeppey Enyo , Fowler Susan A. , Kollef Marin H. , Fuller Brian M. 
Published: December 2017

Objectives:
Emerging data suggest that early deep sedation may negatively impact clinical outcomes. This systematic review and meta-analysis defines and quantifies the impact of deep sedation within 48 hours of initiation of mechanical ventilation, as described in the world’s literature. The primary outcome was mortality. Secondary outcomes included hospital and ICU lengths of stay, mechanical ventilation duration, and delirium and tracheostomy frequency.

Data Sources:
The following data sources were searched: MEDLINE, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews and Effects, Cochrane Database of Systematic Reviews databases, ClinicalTrials.gov, conference proceedings, and reference lists.

Study Selection:
Randomized controlled trials and nonrandomized studies were included.

Data Extraction:
Two reviewers independently screened abstracts of identified studies for eligibility.

Data Synthesis:
Nine studies (n = 4,521 patients) published between 2012 and 2017 were included. A random effects meta-analytic model revealed that early light sedation was associated with lower mortality (9.2%) versus deep sedation (27.6%) (odds ratio, 0.34 [0.21–0.54]). Light sedation was associated with fewer mechanical ventilation (mean difference, –2.1; 95% CI, –3.6 to –0.5) and ICU days (mean difference, –3.0 (95% CI, –5.4 to –0.6). Delirium frequency was 28.7% in the light sedation group and 48.5% in the deep sedation group, odds ratio, 0.50 (0.22–1.16).

Conclusions:
Deep sedation in mechanically ventilated patients, as evaluated in a small number of qualifying heterogeneous randomized controlled trials and observational studies, was associated with increased mortality and lengths of stay. Interventions targeting early sedation depth assessment, starting in the emergency department and subsequent ICU admission, deserve further investigation and could improve outcome.
CPD and KT: Models Used and Opportunities for Synergy
Authors: Sargeant Joan , Borduas Francine , Sales Anne , Klein Doug , Lynn Brenna , Stenerson Heather 
Published: December 2017

Abstract:
The two fields of continuing professional development (CPD) and knowledge translation (KT) within the health care sector, and their related research have developed as somewhat parallel paths with limited points of overlap or intersection. This is slowly beginning to change. The purpose of this paper is to describe and compare the dominant conceptual models informing each field with the view of increasing understanding and appreciation of the two fields, how they are similar and where they differ, and the current and potential points of intersection. The models include the “knowledge-to-action” (KTA) cycle informing KT, models informing CPD curriculum design and individual self-directed learning, and the Kirkpatrick model for evaluating educational outcomes. When compared through the perspectives of conceptual designs, processes, and outcomes, the models overlap. We also identify shared gaps in both fields (eg, the need to explore the influence of the context in which CPD and KT interventions take place) and suggest opportunities for synergies and for moving forward.
Integrating Essential Components of Quality Improvement into a New Paradigm for Continuing Education
Authors: Van Hoof Thomas J. , Meehan Thomas P. 
Published: December 2017

Abstract:
Continuing education (CE) that strives to improve patient care in a complex health care system requires a different paradigm than CE that seeks to improve clinician knowledge and competence in an educational setting. A new paradigm for CE is necessary in order to change clinician behavior and to improve patient outcomes in an increasingly patient-centered, quality-oriented care context. The authors assert that a new paradigm should focus attention on an expanded and prioritized list of educational outcomes, starting with those that directly affect patients. Other important components of the paradigm should provide educational leaders with guidance about what interventions work, reasons why interventions work, and what contextual factors may influence the impact of interventions. Once fully developed, a new paradigm will be helpful to educators in designing and implementing more effective CE, an essential component of quality improvement efforts, and in supporting policy trends and in promoting CE scholarship. The purpose of this article is to rekindle interest in CE theory and to suggest key components of a new paradigm.
12 Hour Shifts
Authors: Kupperschmidt Betty 
Published: December 2017

ABSTRACT:
Concern is reported about the negative outcomes of 12-hour shifts for nurses, including sleep-deprived fatigue, negative neurobehavioral outcomes, and patient safety. However, 12-hour shifts remain the prevailing staffing method. When should the concern for nurses' health and well-being be factored into staffing decisions? If the 12-hour model was used more wisely, that is, nurses were not working too much and/or too long, would there be a need for change? Will nurses and researchers pursue ways to address the negative outcomes of 12-hour shifts?
Learning Cultural Humility Through Stories and Global Service-Learning
Authors: Matthew Stephanie , Hockett Eloise , Samek Linda 
Published: December 2017

ABSTRACT:
Service-learning experiences are utilized by nursing programs to increase cultural learning for students. Through storytelling, the concept of cultural humility can be explained to students preparing for upcoming intercultural experiences. This case study describes the experience of nursing students and educators on their first service-learning trip to Kenya, and how intercultural issues were navigated as students developed cultural humility. The story now is shared in preparation for subsequent international student nursing trips. The utilization of storytelling can be a model for others preparing for service-learning experiences.
Preparing Clinical Nurses for Nursing Research
Authors: Pittroff Gail Elaine , Hendricks-Ferguson Verna L. 
Published: December 2017

ABSTRACT:
The importance of academic nurse researchers partnering with clinical nurses for clinical research has been well articulated. A 4-hour training program designed to equip staff nurses to become fully engaged researchers in a palliative care end of life communication-focused research study resulted in enriched human caring skills and professional growth. Results indicate that the training (didactic lecture, group reflection, role-playing) was adequate to prepare the nurses to deliver the study protocol. Relevance for primary investigators, nurses, clinical institutions, those interested in partnered research, and professional growth are discussed.
Reflections on Global Service Learning in India
Authors: Simon Elizabeth B. 
Published: December 2017

ABSTRACT:
Global service learning is an action-oriented, pedagogical approach that engages students in the core values of academic excellence, social relevance, personal transformation, intentional diversity, and cultural competence. The experience of students and nurse educators who have participated in global service-learning trips to India is relayed, along with the healthcare system of several Indian states.
Workplace Incivility in Nursing
Authors: Phillips Gwenda Smith , MacKusick Carol Isaac , Whichello Ramona 
Published: December 2017

ABSTRACT:
A literature review was conducted to evaluate existing knowledge of incivility in the nursing workplace through the lens of nursing ethics and spirituality. Study articles presented a consistent theme of improved organizational commitment and job satisfaction when spirituality was injected into the workplace. It seems plausible to suggest a positive correlation between spirituality and more civil environments in nursing workplaces.
Disruptive Behavior, Global Developmental Delay, and Obesity in a 5-Year-Old Boy with a Chromosome Microduplication
Authors: Braddock Adam , del Campo Miguel , Reiff Michael I. , Stein Martin T. 
Published: December 2017

CASE:
Ryan is a 5-year-old boy who was seen in a Developmental Behavioral Pediatrics clinic for disruptive behavior and developmental delay. His medical history was notable for a tethered spinal cord repaired at age 4 months, alternating exotropia with multiple surgeries, and obesity (body mass index at 99%). Ryan's development was globally delayed. He sat at age 10 months and walked at 24 months. An Autism Diagnostic Observation Schedule-Toddler module (ADOS-T) was completed at age 19 months and demonstrated little-to-no concern for autism spectrum disorder.
Ryan's parents described behavioral challenges including hyperactivity, impulsivity, aggression toward him self and others, severe tantrums, a short attention span, and difficulty sleeping. They also endorsed repetitive behaviors including head rocking, walking in circles, and perseverative speech. Expressive language was significantly limited. There was no family history of autism or intellectual disability.
Ryan's physical examination was notable for alternating exotropia, hypertelorism, upslanting palpebral fissures, and obesity. His speech was limited to 1-word utterances. Neurological and general examinations were normal.
He was referred for repeat psychological testing at age 5 years. The ADOS-2 (Module 2) was consistent with a classification of autism with a high level of autism-related symptoms. A fragile X test was negative, and microarray demonstrated a microduplication in the region of 2p25.3 including the myelin transcription factor 1–like gene.