bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-Term Outcomes After ICU Admission Triage in Octogenarians
Authors: Andersen Finn H. , Flaatten Hans , Klepstad Pål , Follestad Turid , Strand Kristian , Krüger Andreas J. , Hahn Michael , Buskop Christian , Rime Anne-Karin , Kvåle Reidar 
Published: September 2016

Objective:
To describe ICU admission triage and outcomes in octogenarians.

Design:
Multicenter prospective observational study.

Setting:
Three nonuniversity hospitals and three university hospitals in Norway.

Patients:
Patients 80 years old or older who were referred for ICU admission from November 2013 to October 2014.

Interventions:
None.

Measurements and Main Results:
Of the 355 included patients, 105 (29.6%) were refused ICU treatment. Risk factors for ICU refusal in patients considered “too ill/old” were advanced age and low functional status. Risk factors for ICU refusal in patients considered “too well” were advanced age, male sex, university hospital admission, comorbidity, and low Simplified Acute Physiology Score 3. Overall ICU survival was 71.6%. Hospital and 1-year survival were 56.0% and 40.0% in the ICU-admitted, 65.2% and 50.0% in the nonadmitted patients considered too well, and 32.7% and 11.5% in patients considered too ill/old, respectively. The adjusted Kaplan-Meier curves showed significantly lower survival for nonadmitted patients considered too ill/old than for ICU-admitted patients and nonadmitted patients considered too well. At follow-up, triage patients had lower health-related quality of life than an age- and sex-matched control group in the domains of self-care, usual care, and anxiety and depression, and a lower EuroQol visual analog scale scores.

Conclusions:
Overall, 29.6% of the patients were refused ICU treatment. The adjusted survival analyses showed a significantly higher survival for ICU-admitted octogenarians than for nonadmitted patients who were considered too ill/old, indicating a benefit of ICU admission. Overall, the follow-up of triage patients showed lower health-related quality of life than an age- and sex-matched control population.
Improving ICU-Based Palliative Care Delivery: A Multicenter, Multidisciplinary Survey of Critical Care Clinician Attitudes and Beliefs
Authors: Wysham Nicholas G. , Hua May , Hough Catherine L. , Gundel Stephanie , Docherty Sharron L. , Jones Derek M. , Reagan Owen , Goucher Haley , Mcfarlin Jessica , Cox Christopher E. 
Published: September 2016

Objective:
Addressing the quality gap in ICU-based palliative care is limited by uncertainty about acceptable models of collaborative specialist and generalist care. Therefore, we characterized the attitudes of physicians and nurses about palliative care delivery in an ICU environment.

Design:
Mixed-methods study.

Setting:
Medical and surgical ICUs at three large academic hospitals.

Participants:
Three hundred three nurses, intensivists, and advanced practice providers.

Measurements and Main Results:
Clinicians completed written surveys that assessed attitudes about specialist palliative care presence and integration into the ICU setting, as well as acceptability of 23 published palliative care prompts (triggers) for specialist consultation. Most (n = 225; 75%) reported that palliative care consultation was underutilized. Prompting consideration of eligibility for specialist consultation by electronic health record searches for triggers was most preferred (n = 123; 41%); only 17 of them (6%) felt current processes were adequate. The most acceptable specialist triggers were metastatic malignancy, unrealistic goals of care, end of life decision making, and persistent organ failure. Advanced age, length of stay, and duration of life support were the least acceptable. Screening led by either specialists or ICU teams was equally preferred. Central themes derived from qualitative analysis of 65 written responses to open-ended items included concerns about the roles of physicians and nurses, implementation, and impact on ICU team–family relationships.

Conclusions:
Integration of palliative care specialists in the ICU is broadly acceptable and desired. However, the most commonly used current triggers for prompting specialist consultation were among the least well accepted, while more favorable triggers are difficult to abstract from electronic health record systems. There is also disagreement about the role of ICU nurses in palliative care delivery. These findings provide important guidance to the development of collaborative care models for the ICU setting.
Autologous Fat Transfer for Breast Augmentation: A Review
Authors: Al Sufyani Mohammed A. , Al Hargan Abdullah H. , Al Shammari Nayf A. , Al Sufyani Mohannad A. 
Published: September 2016

BACKGROUND
The use of autologous fat transfer for breast augmentation is still controversial due to ongoing concerns regarding its efficacy and safety, most notably, concerns about breast cancer risk and detection.

OBJECTIVE
To summarize the current knowledge on the safety and efficacy of autologous fat transfer for breast augmentation with focus on clinical techniques, outcome, and complications.

METHODS
A thorough search of the literature was conducted using the terms autologous fat transfer, autologous fat grafting, and breast augmentation in the Medline and Embase databases, and relevant English and German language articles were included.

RESULTS
Findings were categorized in a step-by-step approach to the fat grafting procedure divided into technique (harvesting, processing, and injection), postoperative care, graft viability enhancement, outcome, complications, and breast cancer risk.

CONCLUSION
Autologous fat transfer for breast augmentation is not yet standardized. Therefore, outcomes vary widely depending on the surgeon's expertise. The majority of reported complications are of low morbidity, and based on available data, the procedure has a good long-term safety profile. Although there is no evidence that fat grafting increases breast malignancy risk, long-term follow-up is required.
The Efficacy of Massage in Reducing Nodule Formation After Poly-l-Lactic Acid Administration for Facial Volume Loss: A Randomized, Evaluator-Blinded Clinical Trial
Authors: Wu Douglas C. , Goldman Mitchel P. 
Published: September 2016

BACKGROUND
The risk of nodule formation following poly-l-lactic acid (PLLA) injections for facial volume loss is well known. Traditionally, post-treatment massage according to the 5-5-5 rule (5 times per day for 5 minutes for 5 days) has been applied to mitigate this risk. However, such a regimen may be onerous for patient compliance. Using currently accepted injection technique and product dilution, the efficacy of massage for nodule prevention has never been formally evaluated.

OBJECTIVE
To evaluate the efficacy of massage in reducing the incidence of nodule formation post-PLLA injection.

MATERIALS AND METHODS
After obtaining informed consent, 20 subjects with facial lipoatrophy were enrolled in this randomized, evaluator-blinded clinical trial. Each subject was treated with 1 vial of PLLA each month for 3 months. Vials were diluted with 1 mL of 1% lidocaine and 7 ml of bacteriostatic water, shaken with a vortex and refrigerated for 24 to 48 hours before injection. Ten subjects were instructed to massage the treated areas according to the 5-5-5 rule and 10 subjects did not perform any massage post-treatment. Six-month follow-up data were collected for treatment efficacy and adverse events.

RESULTS
No nodules were reported by subjects or detected by the blinded evaluator regardless of massage status. Significant improvements in facial lipoatrophy were detected 1, 3, and 6 months after the final treatment session and were not statistically different between the 2 groups.

CONCLUSION
Using currently recommended guidelines for product preparation and injection, the application of massage post-PLLA facial treatment does not have a significant impact on nodule formation or treatment efficacy.
Is There Inequity in Hospital Care Among Patients With Acute Coronary Syndrome Who Are Proficient and Not Proficient in English Language?
Authors: Hyun Karice K. , Redfern Julie , Woodward Mark , Briffa Tom , Chew Derek P. , Ellis Chris , French John , Astley Carolyn , Gamble Greg , Nallaiah Kellie , Howell Tegwen , Lintern Karen , Clark Robyn , Wechkunanukul Kannikar , Brieger David 
Published: September 2016

Background:
The provision of equitable acute coronary syndrome (ACS) care in Australia and New Zealand requires an understanding of the sources of variation in the provision of this care.

Objective:
The aim of this study was to compare the variation in care and outcomes between ACS patients with limited English proficiency (LEP) and English proficiency (EP) admitted to Australian and NZ hospitals.

Methods:
Data were collected from 4387 suspected/confirmed ACS patients from 286 hospitals between May 14 and 27, 2012, who were followed for 18 months. We compared hospital care and outcomes according to the proficiency of English using logistic regressions.

Results:
The 294 LEP patients were older (70.9 vs 66.3 years; P < .001) and had higher prevalence of hypertension (71.1% vs 62.8%; P = .004), diabetes (40.5% vs 24.3%; P < .001), and renal impairment (16.3% vs 11.1%; P = .007) compared with the 4093 EP patients. Once in hospital, there was no difference in receipt of percutaneous coronary intervention (57.0% vs 55.4%; P = .78) or coronary artery bypass graft surgery (10.5% vs 11.5%; P = .98). After adjustment for medical history, there were no significant differences (P > .05) between the 2 groups in the risk of major adverse cardiovascular events and/or all-cause death during the index admission and from index admission to 18 months.

Conclusions:
These results suggest that LEP patients admitted to Australian or New Zealand hospitals with suspected ACS may not experience inequity in hospital care and outcomes.
Psychometrics of the Zarit Burden Interview in Caregivers of Patients With Heart Failure
Authors: Al-Rawashdeh Sami Y. , Lennie Terry A. , Chung Misook L. 
Published: September 2016

Background:
Identification of family caregivers who are burdened by the caregiving experience is vital to prevention of poor outcomes associated with caregiving. The Zarit Burden Interview (ZBI), a well-known measure of caregiving burden in caregivers of patients with dementia, has been used without being validated in caregivers of patients with heart failure (HF).

Purpose:
The purpose of this study is to examine the reliability and validity of the ZBI in caregivers of patients with HF.

Methods:
A total of 124 primary caregivers of patients with HF completed survey questionnaires. Caregiving burden was measured by the ZBI. Reliability was examined using Cronbach’s α and item-total/item-item correlations. Convergent validity was examined using correlations with the Oberst Caregiving Burden Scale. Construct validity was demonstrated by exploratory factor analysis and known hypothesis testing (ie, the hypothesis of the association between caregiving burden and depressive symptoms).

Results:
Cronbach’s α for the ZBI was .921. The ZBI had good item-total (r = 0.395–0.764) and item-item (mean r = 0.365) correlations. Significant correlations between the ZBI and the Oberst Caregiving Burden Scale (r = 0.466 for the caregiving time subscale and 0.583 for the caregiving task difficulty subscale; P < .001 for both) supported convergent validity. Four factors were identified (ie, consequences of caregiving, patient’s dependence, exhaustion with caregiving and uncertainty, and guilt and fear for the patient’s future) using factor analysis, which are consistent with previous studies. Caregivers with high burden scores had significantly higher depressive symptoms than did caregivers with lower burden scores (7.0 ± 6.8 vs 3.1 ± 4.3; P < .01).

Conclusion:
The findings provide evidence that the ZBI is a reliable and valid measure for assessing burden in caregivers of patients with HF.
Perceptions and Acceptability of Receiving SMS Self-care Messages in Chinese Patients With Heart Failure
Authors: Li Xiao , Chen Chen , Qu Mo-Ying , Li Zhi , Xu Ying , Duan Xue-Fei , Chen Xi , Zhang Qing , You Gui-Ying 
Published: September 2016

Background:
Self-care is critical for postdischarge heart failure (HF) patients. Short message service (SMS) is a promising way to promote HF self-care.

Objective:
The aim of this study is to investigate knowledge status in Chinese HF patients, as well as the acceptance of SMS as a way to improve self-care.

Methods:
A survey using a self-developed questionnaire was conducted in patients with decompensated HF 2 days before discharge.

Results:
A total of 540 patients completed the survey. Among them, only 69.8% and 63.3% of patients were aware of their HF status and medication regimen, respectively. A total of 95.6% patients were willing to receive SMS. Patient himself/herself, caregiver, or both patient and caregiver were almost equally selected as the preferred receiver of SMS. Educational and/or reminder SMS was considered “very helpful” by 50.2% of the patients as a way of promoting self-care, similar to that of telephone education and brochure education. “Take your medicine”, “avoid getting flu,” and “keep follow-up” were regarded as the most important self-care contents, whereas “weigh yourself every day” and “restrict fluid intake” were considered the least important.

Conclusion:
As a way of promoting HF self-care, SMS intervention combining educational and reminder function might be well accepted by HF patients in China. The status of HF, medication, weight control, and fluid restriction should be emphasized during the practice. Caution should be drawn as the survey was not tested elsewhere. Further clinical trials would be conducted to examine the effect of SMS intervention on self-care behaviors and outcomes of HF patients.
Demographic, Clinical, and Health System Characteristics Associated With Pain Assessment Documentation and Pain Severity in U.S. Military Patients in Combat Zone Emergency Departments, 2010–2013
Authors: Blackman Virginia Schmied , Cooper Bruce A. , Puntillo Kathleen , Franck Linda S. 
Published: September 2016

Emergency department (ED) pain assessment documentation in trauma patients is critical to ED pain care. This retrospective, cross-sectional study used trauma registry data to evaluate U.S. military combat zone trauma patients injured between 2010 and 2013 requiring ≥ 24-hr inpatient care. Study aims were to identify the frequency of combat zone ED pain assessment documentation and describe pain severity. Secondary aims were to construct statistical models to explain variation in pain assessment documentation and pain severity.Pain scores were documented in 60.5% (n= 3,339) of the 5,518 records evaluated. The proportion of records with ED pain scores increased yearly. Pain assessment documentation was associated with documentation of ED vital signs, comprehensive facility, more recent year, prehospital (PH) heart rate of 60–100 beats/min, ED Glasgow Coma Scale score of 15 vs. 14, blunt trauma, and lower injury severity score (ISS).Pain severity scores ranged from 0 to 10; mean = 5.5 (SD= 3.1); median = 6. Higher ED pain scores were associated with Army service compared with Marine Corps, no documented PH vital signs, higher PH pain score, ED respiratory rate < 12 or >16, moderate or severe ISS compared with minor ISS, treatment in a less-equipped facility, and injury in 2011 or 2012 vs. 2010. The pain severity model explained 20.4% of variance in pain severity.Overall, frequency of pain assessment documentation in combat-zone EDs improved yearly, but remained suboptimal. Pain severity was poorly predicted by demographic, clinical, and health system variables available from the trauma registry, emphasizing the importance of individual assessment.
Implementation and Evaluation of a Team Simulation Training Program
Authors: Rice Yvonne , DeLetter Mary , Fryman Lisa , Parrish Evelyn , Velotta Cathie , Talley Cynthia 
Published: September 2016

Background:
Care of the trauma patient requires a well-coordinated intensive effort during the golden hour to optimize survival.

Purpose:
We hypothesized that this program would improve knowledge, satisfaction, self-confidence, and simulated team performance.

Methods:
A pre-, post-test design with N = 7 BSN nurses, 21 years of age, less than 2 years of intensive care unit and nursing experience.

Setting:
Trauma intensive care unit, single-center academic Level 1 trauma center.

Results:
Improvement was shown in perception of team structure (paired t test 13.71–12.57; p = .0001) and communication (paired t test 14.85–12.14; p = .009). Improvement was shown in observed situation monitoring (paired t test 17.42–25.28; p = .000), mutual support (paired t test 12.57–18.57; p = .000), and communication (paired t test 15.42–25.00; p = .001). A decrease was shown in attitudes of mutual support (paired t test 25.85–19.71; p = .04) and communication (paired t test 26.14–23.00; p = .001). Mean satisfaction scores were 21.5 of a possible 25 points. Mean self-confidence scores were 38.83 out of a possible 40 points.

Discussion:
Simulation-based team training improved teamwork attitudes, perceptions, and performance. Team communication demonstrated significant improvement in 2 of the 3 instruments. Most participants agreed or strongly agreed that they were satisfied with simulation and had gained self-confidence.
Congestive Adenopathy
Authors: Shweihat Yousef R. , Perry James , Etman Yasser , Gabi Ala , Hattab Yousef , Al-Ourani Mohammad , Santhanam Prasanna , Bartter Thaddeus 
Published: September 2016

Background:
Endosonography has improved our ability to reach thoracic lymph nodes and to diagnose pathologic conditions with nodal involvement and has lowered the threshold for biopsy. The purpose of this study was to avoid unnecessary procedures, it is important to recognize benign adenopathy. Congestive heart failure (CHF) is both common and a common cause of adenopathy. The purpose of this study was to study the association between CHF and adenopathy and to describe the typical presentation of congestive adenopathy.

Methods:
We performed a retrospective correlation of computed tomographic (CT) and laboratory findings for patients admitted to hospital with a diagnosis of CHF.

Results:
Of 500 patients admitted with a diagnosis of CHF, 215 appeared to have CT scans of the chest, and not to have a potentially confounding etiology of adenopathy. The incidence of adenopathy in this study group was 68%. Pulmonary edema on CT and pleural effusion were both significantly associated with adenopathy (P<0.01 for both). The pattern of congestive adenopathy was one of enlargement of several mediastinal nodes and less likely to involve hilar nodes and single stations in isolation.

Conclusion:
Congestive adenopathy is common in patients with evidence for acute volume overload. The pattern of presentation should allow clinicians to recognize congestive adenopathy and to separate it from other adenopathy for which biopsy might be appropriate.
Diagnostic Yield of Electromagnetic Navigation Bronchoscopy Using a Curved-tip Catheter to Aid in the Diagnosis of Pulmonary Lesions
Authors: Mukherjee Sumit , Chacey Michael 
Published: September 2016

Background:
Electromagnetic navigation bronchoscopy (ENB) may aid in the diagnosis of solitary pulmonary lesions with a lower complication rate than conventional diagnostic modalities. A curved-tip catheter is now available for use with ENB; however, the diagnostic yield of this device has not been previously reported.

Methods:
A single-center, single-operator retrospective chart review was performed on patients who underwent ENB for the diagnosis of pulmonary lesions. A curved-tip catheter was used in all procedures; angle options were chosen depending on lesion location. After navigation to the target lesion, fine-needle aspiration, brushings, biopsies, and bronchoalveolar lavage were performed in all patients. Correct localization was confirmed with fluoroscopy.

Results:
Thirty-one consecutive patients underwent ENB between February and October 2014. The mean lesion size was 1.8 cm (range, 0.4 to 4.0 cm) and 35% were in the right upper lobe. The probe tip was navigated to the target lesion in all cases. A diagnosis was obtained in 30/31 patients (96.8%). Twenty-two (71%) had a definitive histologic diagnosis of malignancy. One case was nondiagnostic requiring a repeat fine-needle aspiration. The remaining 8 nonmalignant cases were followed radiologically and demonstrated no progression of lesion size through at least 1 year. Fiducials were placed in 48% of cases. There were 2 pneumothoraces (6.5%), one of which required chest tube placement (3.2%).

Conclusions:
This study suggests that the curved-tip catheter is a useful modality for diagnosing peripheral pulmonary lesions with ENB. The diagnostic yield of ENB using this catheter was superior to that reported in other studies utilizing straight catheters.
Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma: age is not a problem
Authors: Ziogas Dimitrios C. , Papadatos-Pastos Dionysios , Thillai Kiruthikah , Korantzis Ippokratis , Chowdhury Ruhe , Suddle Abid , O’Grady John , Al-Khadimi Gillian , Allen Natalie , Heaton Nigel , Ross Paul J. , Sarker Debashis 
Published: September 2016

Objective
Sorafenib is the standard of care for patients with advanced hepatocellular carcinoma (HCC), but data on its use in the elderly are inconclusive.

Methods
All consecutive HCC patients who were treated in our institution with sorafenib since its licensing were included in the analysis. Patients were divided into two groups: (A) up to 75 and (B) older than 75 years old. Our endpoints were overall survival (OS) and time to treatment failure (TTF) because of disease progression or toxicity. Safety parameters and the prognostic effect of HCC characteristics were also investigated.

Results
Data from 190 patients (157 men), median age 66 (26–87) years, were studied (A=151 and B=39). No significant difference in OS and TTF was detected between the two groups [7.1 (5.5–8.7) vs. 10.4 (6.5–14.3) months, P=0.360 and 4.2 (2.3–6.2) vs. 5.6 (3.1–8.1) months, P=0.369, respectively]. Incidence of toxicities at all grades and dose reductions were comparable between groups A and B. In a multivariate setting, patients with Child–Pugh B score at baseline were associated with a higher risk of death (adjusted hazard ratio=2.17, 95% confidence interval:1.24–3.79, P=0.007) and treatment failure (adjusted hazard ratio=4.64, 95% confidence interval: 2.55–8.42, P=0.001) and had shorter OS and TTF compared with patients with a Child–Pugh A (P=0.004 and P<0.001, respectively).

Conclusion
Elderly patients with advanced HCC, when treated with sorafenib, have an equivalent clinical outcome with similar toxicity rates as their younger counterparts. Age alone should not be a discriminating factor for the management of advanced HCC with sorafenib.