bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Outcomes and Intraocular Pressure Control After Scleral-glued Intraocular Lens Insertion in Eyes With Pseudoexfoliation
Authors: Ragam Ashwinee , Ritterband David C. , Waisbren Emily C. , Mathew-Padiyedathu Julia , Kang Joann , Seedor John A. 
Published: December 2017

Purpose:
To analyze clinical outcomes and intraocular pressure control following scleral-glued intraocular lens (IOL) fixation in eyes with pseudoexfoliation (PXF).

Methods:
A retrospective chart review and outcome analysis was performed on a series of eyes undergoing glue-assisted, scleral-fixated (scleral-glued) IOL insertion in the setting of PXF and poor or absent capsular support.

Results:
In total, 28 eyes were included in the study. The indications for scleral-glued IOL fixation included late endocapsular IOL dislocation (21/28, 75%), exchange for iris-fixated IOL due to complication (4/28, 14%), subluxed crystalline lens (2/28, 7%), and aphakia after complicated cataract surgery (1/28, 4%). In total, 15/28 (54%) eyes had diagnosed preexisting glaucoma at the time of scleral-glued surgery. The most common postoperative complication was ocular hypertension requiring escalation of medical management, which occurred in 8/28 (29%) eyes. At final follow-up, corrected distance visual acuity was equivalent to or improved from preoperative measurements in 25/28 (89%) eyes.

Conclusions:
The scleral-glued surgery is a good option for fixating an IOL in eyes with PXF and poor zonular integrity or absent capsular support. Special attention should be placed on intraocular pressure control following surgery, which can be less predictable in PXF eyes with or without preexisting glaucoma.
Clinical Characteristics and Risk Factors of Long-term Central Venous Catheter–associated Bloodstream Infections in Children
Authors: Moon Hye Min , Kim Suji , Yun Ki Wook , Kim Hyun-young , Jung Sung Eun , Choi Eun Hwa , Lee Hoan Jong 
Published: December 2017

Background:
Central line–associated bloodstream infections (CLABSIs) account for significant morbidity and mortality in patients with long-term central venous catheters (CVCs). This study was performed to identify the characteristics and risk factors of CLABSIs among children with long-term CVCs.

Methods:
A retrospective review of children who had a long-term CVC in Seoul National University Children’s Hospital between 2011 and 2015 was performed. Data on patient demographics, the isolated pathogens and the status of CVC placement were collected. Clinical variables were compared between subjects with and without CLABSIs to determine the risk factors for CLABSIs.

Results:
A total of 629 CVCs were inserted in 499 children during the 5-year period. The median age at insertion was 6.0 years (14 days–17.9 years), and hemato-oncologic disease was the most common underlying condition (n = 497, 79.0%). A total of 235 CLABSI episodes occurred in 155 children, with a rate of 0.93 per 1,000 catheter days. The most common pathogens were Klebsiella pneumoniae (n = 64, 27.2%), coagulase-negative staphylococci (n = 40, 17.0%) and Staphylococcus aureus (n = 28, 12.0%). In the univariate analysis, the gender, underlying disease, catheter characteristics and insertion technique did not increase the risk for CLABSI. In both the univariate and logistic regression analyses, patients with prior BSIs (odds ratio 1.66; 95% confidence interval: 1.090–2.531; P = 0.018) were more likely to have a CLABSI.

Conclusions:
CLABSI prevention is of particular concern for children with a prior BSI. Furthermore, the antimicrobial resistance of major pathogens should be monitored to enable the empiric selection of appropriate antibiotics in patients with long-term CVCs.
Undergraduate Nursing Students’ Perceptions of Individuals With Drug Use Problems
Authors: Mahmoud Khadejah F. , Terhorst Lauren , Lindsay Dawn , Puskar Kathryn R. , Mitchell Ann M. 
Published: December 2017

Abstract
The Drug and Drug Problems Perception Questionnaire (DDPPQ) is a multidimensional instrument that measures healthcare providers’ attitudes toward working with patients who use drugs. Five- and six-subscale versions of the DDPPQ have been published. Although the reliability of the DDPPQ subscales was reported to be satisfactory, the factor structure of either version was not validated by a confirmatory factor analysis. The aim of this study was to examine the internal factor structure of the 22-item DDPPQ instrument using a sample of undergraduate nursing students. This study was a secondary analysis that utilized baseline data from the Addiction Training for Nurses using Screening, Brief Intervention, and Referral to Treatment Program. The DDPPQ was administrated during the undergraduate nursing students’ junior year in a single university setting in southwestern Pennsylvania. A sample of 473 students was used in this study. The sample was split equally to conduct both principal component analysis (n = 237) and confirmatory factor analysis (n = 236). On average, the sample had a mean age of 22.9 years and was predominantly female (87.2%) and Caucasian (90.9%). A principal component analysis revealed that a five-factor structure had the best fit after the removal of two items. Reliabilities of the five subscales ranged from α = .696 to α = .904. Thus, a five-factor structure with removal of Items 9 and 19 is recommended when using the DDPPQ with undergraduate nursing students.
Analysis of Health Behavior Theories for Clustering of Health Behaviors
Authors: Choi Seung Hee , Duffy Sonia A. 
Published: December 2017

Abstract

Objectives:
The objective of this article was to review the utility of established behavior theories, including the Health Belief Model, Theory of Reasoned Action, Theory of Planned Behavior, Transtheoretical Model, and Health Promotion Model, for addressing multiple health behaviors among people who smoke. It is critical to design future interventions for multiple health behavior changes tailored to individuals who currently smoke, yet it has not been addressed.

Methods:
Five health behavior theories/models were analyzed and critically evaluated. A review of the literature included a search of PubMed and Google Scholar from 2010 to 2016. Two hundred sixty-seven articles (252 studies from the initial search and 15 studies from the references of initially identified studies) were included in the analysis.

Result:
Most of the health behavior theories/models emphasize psychological and cognitive constructs that can be applied only to one specific behavior at a time, thus making them not suitable to address multiple health behaviors. However, the Health Promotion Model incorporates “related behavior factors” that can explain multiple health behaviors among persons who smoke.

Conclusion:
Future multiple behavior interventions guided by the Health Promotion Model are necessary to show the utility and applicability of the model to address multiple health behaviors.
Psychosocial Factors Affecting Smartphone Addiction in University Students
Authors: Aker Servet , Şahin Mustafa Kürşat , Sezgin Serap , Oğuz Gülay 
Published: December 2017

Abstract
Smartphone addiction is a recent concern that has resulted from the dramatic increase in worldwide smartphone use. The purpose of this cross-sectional study was to evaluate psychosocial factors affecting smartphone addiction in university students. The study was performed among students at the Ondokuz Mayis University Samsun School of Health (Samsun, Turkey) on October–December 2015. Four hundred ninety-four students possessing smartphones and agreeing to participate were included. A sociodemographic data form produced by the authors and consisting of 10 questions was administered together with a questionnaire involving the Smartphone Addiction Scale-Short Version (SAS-SV), the Flourishing Scale, the General Health Questionnaire, and the Multidimensional Scale of Perceived Social Support. The questionnaires were applied in a class environment at face-to-face interviews. SAS-SV scores of 6.47% of students were “significantly higher” than the participating group mean SAS-SV score. Multiple regression analysis revealed that depression, anxiety and insomnia, and familial social support statistically, significantly predicted smartphone addiction. Further studies of smartphone addiction in different age groups and with different educational levels are now needed.
Cervical Injuries in Drowning Cases
Authors: Boussaid Maroua , Mesrati Mohamed Amin , Mahjoub Yosra , Haj Salem Nidhal , Zakhama Abdelfateh , Chadly Ali , Moussa Adnen , Aissaoui Abir 
Published: December 2017

Abstract
Discovery of bruises in the muscles of the neck and a fracture of the hyoid bone in a body recovered from water makes the diagnosis and the determination of the manner of death difficult.
The aims of this work are to report a case of a drowned body with cervical injuries and to highlight the importance of interpreting these findings accurately.
A 39-year-old woman was found dead face down in a 6-m deep well with a 3-m water level. She was mentally disturbed and had a history of suicide attempts. In fact, she had previously attempted to jump into that well in an attempt to put an end to her life. The autopsy revealed bruises in the muscles of the neck and a bruise associated with a fracture of the left horn of the hyoid bone.
The mechanism for the origin of drowning-related neck injuries will be discussed.
Evaluating the Implementation Barriers of an Intranasal Fentanyl Pain Pathway for Pediatric Long-Bone Fractures
Authors: Arnautovic Tamara , Sommese Kathryn , Mullan Paul C. , Frazier Steven Barron , Vazifedan Turaj , Ramirez Dana Erikson 
Published: December 2017

ObjectivesThis study aimed to assess physician comfort, knowledge, and implementation barriers regarding the use of intranasal fentanyl (INF) for pain management in patients with long-bone fractures in a pediatric emergency department (ED) with an INF pain pathway.MethodsA retrospective chart review was conducted of patients, 3 to 21 years old, in our ED with an International Classification of Diseases-9th Revision code for a long-bone fracture from September 1, 2013, to August 31, 2015. Patients were divided into 4 groups: (1) received INF on the pathway appropriately; (2) “missed opportunities” to receive INF, defined as either INF was ordered and then subsequently canceled (for pain ratings, ≥6/10), or INF was ordered, cancelled, and intravenous (IV) morphine given, or INF was not ordered and a peripheral IV line was placed to give IV morphine as first-line medication; (3) peripheral IV established upon ED arrival; (4) no pain medication required. Additionally, a survey regarding practice habits for pain management was completed to evaluate physician barriers to utilization of the pathway.ResultsA total of 1374 patients met the inclusion criteria. Missed opportunities were identified 41% of the time. Neither younger patient age nor more years of physician experience in the ED were associated with increased rates of missed opportunities. The survey (95% response rate) revealed greater comfort with and preference for IV morphine over INF.ConclusionsThe high rate of missed opportunities, despite the implementation of an INF pain pathway, indicates the need for further exploration of the barriers to utilization of the INF pain pathway.
Burnout Rates in Pediatric Emergency Medicine Physicians
Authors: Patterson Jasmine , Gardner Alison 
Published: December 2017

Objective
Burnout is a syndrome in which a reduced sense of personal accomplishment, depersonalization, and emotional exhaustion develop in response to prolonged stress. It is well known that physicians suffer high rates of burnout; emergency medicine physicians experience significantly increased rates of burnout, whereas physicians in other specialties, like pediatrics, may be spared. Pediatric emergency medicine physicians are on the frontline of care for the critically ill child, which could put them at high risk for burnout. This study evaluates the rate of burnout in pediatric emergency medicine physicians.

Methods
We conducted a survey assessing burnout using a sample of pediatric emergency medicine physicians who subscribe to an open Listserv server maintained by Brown University. Burnout was measured using a validated instrument, the Maslach Burnout Inventory-Human Services Survey, which was distributed by e-mail to the study group.

Results
Respondents averaged a score of 9 (95% confidence interval [CI], 8–10), 23 (95% CI, 21–25), and 39 (95% CI, 38–40) in the subscales of depersonalization, emotional exhaustion, and personal accomplishment, respectively. This placed our cohort into the average range for all subscales. The percentage of respondents who scored in the high levels of burnout (moderate to high scores in both depersonalization and emotional exhaustion and low to moderate scores in personal accomplishment) was 25% (95% CI, 18–32).

Conclusions
Unlike previous literature showing burnout prevalence in excess of 60% in emergency medicine physicians and 38% in pediatricians, our pediatric emergency medicine physicians fared better with only 25% (95% CI, 18–32), showing elevated levels of burnout.
The Predictors for Positive Yield Abdominal Computed Tomography in Pediatric Abdominal Trauma
Authors: Alzahem Abdulrahman M. , Soundappan Soundappan S.V. , Cass Daniel T. 
Published: December 2017

Objectives
Abdominal computed tomography (ACT) use in the initial evaluation of pediatric abdominal trauma is liberal in most instances. The aim of this study was to identify the predictors for a positive yield ACT scan in this population.

Methods
A prospective, cohort, single-center observational study was conducted at Children’s Hospital at Westmead, New South Wales, from January 2008 to June 2015 on 240 pediatric abdominal trauma patients who had abdominal computed tomography. Clinical, laboratory, imaging, and interventional variables were explored with univariate and multivariate analyses among children who sustained abdominal trauma.

Results
Of 240 patients, positive ACT scans were found in 161 patients (67%), 112 patients (47%) had intra-abdominal injury, and 20 patients (8%) required invasive therapeutic interventions. Mortality rate was 1.7% (4 patients) due to nonabdominal causes. Multivariate analyses revealed that increasing age (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.02–1.24; P = 0.024), high injury severity score (OR, 1.14; 95% CI, 1.07–1.21; P < 0.001), abnormal abdominal examination (OR, 5.95; 95% CI, 2.08–17.01; P = 0.001), elevated alanine aminotransferase greater than 125 IU/L (OR, 46.28; 95% CI, 2.81–762.49; P = 0.007), abnormal pelvic radiograph (OR, 14.03; 95% CI, 2.39–82.28; P = 0.003), presence of gross hematuria (OR, 4.14; 95% CI, 1.04–18.23; P = 0.044), low initial hematocrit level (less than 30%) (OR, 8.51; 95% CI, 1.14–63.70; P = 0.037), and positive focused assessment with sonography for trauma (OR, 2.61; 95% CI, 1.01–7.28; P = 0.048) remained significantly associated with abnormal ACT scan. In contrast, those who required scanning of other body region(s) were less likely to have abnormal ACT scan (OR, 0.34; 95% CI, 0.14–0.86; P =0.022).

Conclusions
Integrating the abdominal examination findings, relevant laboratory values, and focused assessment with sonography for trauma results with the physicians’ suspicion may aid in stratifying patients for ACT scan. Further efforts should be made to decrease number of normal ACT scans; yet not to increase the number of delayed or missed injures with its inherent morbidity and mortality.
Recurrent Lower Eyelid Ectropion After Graft Surgery Using Autogenous Palmaris Longus Tendon
Authors: Komatsu Koji , Matsuda Hiromichi , Takahashi Yasuhiro , Nakano Tadashi 
Published: December 2017

Abstract
A 78-year-old male experienced right lower eyelid ectropion following right facial trauma from a fall 5 years ago, for which he underwent autogenous palmaris longus tendon graft surgery at another clinic. Recurrence was noted 3 years after surgery. On first examination, there was outward turning of the lateral half of the right lower eyelid margin. We performed a lateral tarsal strip procedure with removal of the graft. Intraoperatively, the lateral part of the graft was located along the inferior tarsal border, whereas the medial part was located on the tarsal surface. The lateral stump had bifurcated; 1 branch had passed through a bony hole drilled at the base of the rim; and both branches had been ligated together on the rim surface. The medial side had been fixed to the medial canthal tendon. Postoperatively, the apposition of eyelid and ocular surface was good, and the patient experienced no recurrence after 1 year.
Noncompliance with American College of Surgeons Committee on Trauma recommended criteria for full trauma team activation is associated with undertriage deaths
Authors: Tignanelli Christopher J. , Vander Kolk Wayne E. , Mikhail Judy N. , Delano Matthew J. , Hemmila Mark R. 
Published: December 2017

BACKGROUND
The appropriate triage of acutely injured patients within a trauma system is associated with improved rates of mortality and optimal resource utilization. The American College of Surgeons Committee on Trauma (ACS-COT) put forward six minimum criteria (ACS-6) for full trauma team activation (TTA). We hypothesized that ACS-COT–verified trauma center compliance with these criteria is associated with low undertriage rates and improved overall mortality.

METHODS
Data from a state-wide collaborative quality initiative was used. We used data collected from 2014 through 2016 at 29 ACS verified Level I and II trauma centers. Inclusion criteria are: adult patients (≥16 years) and Injury Severity Score of 5 or less. Quantitative data existed to analyze four of the ACS-6 criteria (emergency department systolic blood pressure ≤ 90 mm Hg, respiratory compromise/intubation, central gunshot wound, and Glasgow Coma Scale score < 9). Patients were considered to be undertriaged if they had major trauma (Injury Severity Score > 15) and did not receive a full TTA.

RESULTS
51,792 patients were included in the study. Compliance with ACS-6 minimum criteria for full TTA varied from 51% to 82%. The presence of any ACS-6 criteria was associated with a high intervention rate and significant risk of mortality (odds ratio, 16.7; 95% confidence interval, 15.2–18.3; p < 0.001). Of the 1,004 deaths that were not a full activation, 433 (43%) were classified as undertriaged, and 301 (30%) had at least one ACS-6 criterion present. Undertriaged patients with any ACS-6 criteria were more likely to die than those who were not undertriaged (30% vs. 21%, p = 0.001). Glasgow Coma Scale score less than 9 and need for emergent intubation were the ACS-6 criteria most frequently associated with undertriage mortality.

CONCLUSION
Compliance with ACS-COT minimum criteria for full TTA remains suboptimal and undertriage is associated with increased mortality. These data suggest that the most efficient quality improvement measure around triage should be ensuring compliance with the ACS-6 criteria. This study suggests that practice pattern modification to more strictly adhere to the minimum ACS-COT criteria for full TTA will save lives.

LEVEL OF EVIDENCE
Care management, level III.
Impact of venorrhaphy and vein ligation in isolated lower-extremity venous injuries on venous thromboembolism and edema
Authors: Manley Nathan R. , Magnotti Louis J. , Fabian Timothy C. , Croce Martin A. , Sharpe John P. 
Published: December 2017

BACKGROUND
Following venous injury, venorrhaphy can restore outflow, although it risks thrombosis and venous thromboembolism (VTE). Vein ligation is a faster option, although it potentially risks extremity edema. The purpose of this study was to evaluate the management of venous injury on VTE and extremity edema in patients with isolated lower-extremity venous injuries.

METHODS
Patients with common iliac, external iliac, and femoral venous injuries over a 10-year period were stratified by age, shock, management of venous injury, injury severity, and timing and type of anticoagulation. Outcomes included development of extremity edema and VTE (pulmonary embolism, deep venous thrombosis). Outcomes were then evaluated to determine risk factors for symptomatic lower-extremity edema and VTE by the management of venous injuries.

RESULTS
Eighty-four patients were identified: 20 common iliac, 27 external iliac, 37 femoral. Forty-nine underwent vein repair and 35 underwent vein ligation. Ninety-three percent were male with a mean Injury Severity Score and Glasgow Coma Scale score of 17 and 14, respectively. Venous thromboembolism occurred in 18 (21%), 15 (18%) deep venous thrombosis, and 4 (5%) pulmonary embolisms. Thirty-two (38%) patients developed lower-extremity edema. Those who underwent vein ligation had a greater degree of shock on presentation (RBC transfusions, 14 vs. 8 units; p = 0.03) and were more likely to receive prophylactic fasciotomies (60% vs. 33%, p = 0.01). There was no difference in time to or type of chemoprophylaxis between patients who underwent vein repair and those who received vein ligation. However, patients with vein ligation had fewer episodes of VTE (9% vs. 31%, p = 0.02) with no difference in symptomatic lower-extremity edema (37% vs. 39%, p = 0.88) or amputation rates (0% vs. 2%, p = 0.99).

CONCLUSION
Vein repair had a higher incidence of VTE while providing no additional benefit in reducing symptomatic extremity edema compared to ligation in patients suffering venous injury. Ligation of most extremity venous injuries can be performed without increasing patient morbidity.

LEVEL OF EVIDENCE
Therapeutic study, level IV.
Hereditary thrombophilia in trauma patients with venous thromboembolism: Is routine screening necessary?
Authors: Cannon Kathleen A. , Badiee Jayraan , Brill Jason B. , Olson Erik J. , Sise Michael J. , Bansal Vishal , Sise C.Beth , Shackford Steven R. 
Published: December 2017

BACKGROUND
Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), remains a common complication following trauma. The role of hereditary thrombophilia (HT) in posttraumatic VTE is unknown. In the general population with a first-time DVT, Factor V Leiden (FVL) and prothrombin G20210A mutation (PGM) are the most common types of HT with an incidence of 20% to 25% and 6% to 18%, respectively. The objective of this study was to identify the incidence of FVL and PGM in posttraumatic VTE to determine whether routine screening for HT in trauma should be performed.

METHODS
We conducted a prospective observational study at our Level I trauma center from 2013 to 2016 when 70 patients with posttraumatic DVT and PE were screened for FVL and PGM. Demographics, injury characteristics, and established risk factors for VTE were collected for each patient. Statistical analysis was performed to compare patients with and without HT.

RESULTS
The incidence of FVL and PGM in posttraumatic VTE was 1.4% and 5.7%, respectively. All HT-positive patients had a DVT and one had an associated PE. Both the individual risk factors and the total number of risk factors for VTE were similar between the HT-positive group and the HT-negative group.

CONCLUSION
There was a lower incidence of FVL and PGM in patients with posttraumatic DVT than in patients with a first-time DVT in the general population. HT does not appear to significantly contribute to posttraumatic VTE in our trauma population. Further research is warranted to determine whether routine screening for HT in trauma should be performed.

LEVEL OF EVIDENCE
Epidemiological study, level III; Care management/therapeutic study, level IV.