bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mass Spectrometry Imaging Can Distinguish on a Proteomic Level Between Proliferative Nodules Within a Benign Congenital Nevus and Malignant Melanoma
Authors: Lazova Rossitza , Yang Zhe , El Habr Constantin , Lim Young , Choate Keith Adam , Seeley Erin H. , Caprioli Richard M. , Yangqun Li 
Published: March 2017

Abstract:
Histopathological interpretation of proliferative nodules occurring in association with congenital melanocytic nevi can be very challenging due to their similarities with congenital malignant melanoma and malignant melanoma arising in association with congenital nevi. We hereby report a diagnostically challenging case of congenital melanocytic nevus with proliferative nodules and ulcerations, which was originally misdiagnosed as congenital malignant melanoma. Subsequent histopathological examination in consultation by one of the authors (R.L.) and mass spectrometry imaging analysis rendered a diagnosis of congenital melanocytic nevus with proliferative nodules. In this case, mass spectrometry imaging, a novel method capable of distinguishing benign from malignant melanocytic lesions on a proteomic level, was instrumental in making the diagnosis of a benign nevus. We emphasize the importance of this method as an ancillary tool in the diagnosis of difficult melanocytic lesions.
Vibration Anesthesia for Pain Reduction During Intralesional Steroid Injection for Keloid Treatment
Authors: Park Kui Young , Lee Yohan , Hong Ji Yeon , Chung Won Soon , Kim Myeung Nam , Kim Beom Joon 
Published: March 2017

BACKGROUND
Patients suffer significant pain during intralesional steroid injection treatment for keloids and hypertrophic scars. Vibration anesthesia has been shown to effectively and safely alleviate pain sensations, likely by reducing pain transmission from peripheral receptors to the brain.

OBJECTIVE
The objective was to evaluate the efficacy, safety, and patient satisfaction associated with vibration anesthesia for reducing pain during intralesional corticosteroid injection.

METHODS
The authors recruited 40 patients with 58 keloids who were scheduled to undergo intralesional triamcinolone acetonide (TA) injections. Half of each keloid was injected with concomitant vibration anesthesia, whereas the other half was injected without vibration anesthesia. Pain experienced by patients during both procedures was assessed according to visual analog scale (VAS) score. The authors also assessed procedure safety.

RESULTS
The mean VAS score during intralesional TA injection therapy without vibration was 5.88 ± 2.34. By contrast, the same patients yielded a mean VAS score during intralesional TA injection therapy with vibration of 3.28 ± 1.85; the difference between the mean scores was significant (p < .05). Thirty-nine (97.5%) patients tolerated this therapy well.

CONCLUSION
Vibration anesthesia is a promising option for reducing pain during keloid treatment with intralesional steroid injection.
ULTRAWIDEFIELD AUTOFLUORESENCE IN ABCA4 STARGARDT DISEASE
Authors: Klufas Michael A. , Tsui Irena , Sadda SriniVas R. , Hosseini Hamid , Schwartz Steven D. 
Published: March 2017

Purpose:
To report the ultrawidefield fundus autofluorescence (UWF-FAF) patterns in ABC4A Stargardt disease.

Methods:
A retrospective cohort study of patients with a clinical diagnosis of Stargardt disease, confirmed ABCA4 genotype, and ultrawidefield fundus autofluorescence imaging using an Optos P200Tx. Four independent graders evaluated the images. Ultrawidefield fundus autofluorescence images were evaluated for the presence of posterior pole and peripheral findings, and were classified into one of three types (Type I: lesions confined to the macula with no peripheral findings; Type II: macular atrophy with flecks only in the periphery; Type III: macular atrophy and varying degrees of peripheral atrophy).

Results:
Ultrawidefield fundus autofluorescence was performed on 58 eyes of 29 patients. Reviews of images revealed the presence of peripheral (outside the 55° view of standard nonwidefield FAF imaging) alterations on UWF-FAF in 76% of eyes. Overall, the UWF-FAF pattern was classified as Type I in 24% eyes (14/58), Type II in 24% (14/58), and Type III in 52% (30/58). The most common genetic mutations were c.2588G>C (6/29 patients, 20.7%), and c.5882G>A (5/29 patients, 17.2%).

Conclusion:
Ultrawidefield fundus autofluorescence reveals peripheral changes in the majority of patients with Stargardt disease. Peripheral FAF changes may have implications for diagnosis, prognosis, and management of individual patients with Stargardt disease.
Intention to Use mHealth in Older Adults With Heart Failure
Authors: Cajita Maan Isabella , Hodgson Nancy A. , Budhathoki Chakra , Han Hae-Ra 
Published: March 2017

Background:
mHealth, or the use of mobile technology in healthcare, is becoming increasingly common. In heart failure (HF), mHealth has been associated with improved self-management and quality of life. However, it is known that older adults continue to lag behind their younger counterparts when it comes to mobile technology adoption.

Objective:
The primary aim of this study was to examine factors that influence intention to use mHealth among older adults with HF.

Methods:
An adapted Technology Acceptance Model was used to guide this cross-sectional, correlational study. Convenience sampling was used to identify participants from a large university hospital and online.

Results:
A total of 129 older adults with HF participated in the study. Social influence (β = 0.17, P = .010), perceived ease of use (β = 0.16, P < .001), and perceived usefulness (β = 0.33, P < .001) were significantly associated with intention to use mHealth even after controlling for potential confounders (age, gender, race, education, income, and smartphone use). Perceived financial cost and eHealth literacy were not significantly associated with intention to use mHealth.

Conclusions:
Researchers should consider using the participatory approach in developing their interventions to ensure that their mHealth-based interventions will not only address the patient’s HF self-management needs but also be easy enough to use even for those who are less technology savvy.
Update on the risks of benign adrenocortical incidentalomas
Authors: Di Dalmazi Guido 
Published: March 2017

Purpose of review
Recent studies highlighted the association between adrenocortical incidentalomas and several comorbidities. This review summarizes the most recent evidence showing the potential risks related to adrenocortical tumors classified as nonfunctioning adrenal incidentalomas (NFAIs) or associated with clinically autonomous cortisol secretion (ACS).

Recent findings
Alterations in glucose metabolism are a common finding in patients with ACS (30% of the cases). As shown in nonrandomized trials, surgical treatment may improve or cure diabetes in 52% of patients. Cross-sectional studies showed that NFAIs are also associated with insulin resistance. In a recent long-term retrospective study, patients with NFAI were at increased risk of developing prediabetes/diabetes during follow-up. Similarly, a prospective study showed that the incidence of prediabetes was higher also in tumors converting from NFAI to ACS. Patients with ACS are at increased risk of cardiovascular events and related mortality. Some cardiovascular markers were altered in patients with NFAI, even if a cause–effect relationship is not readily evident. Finally, 13% of NFAIs have increased risk of developing ACS during long-term follow-up.

Summary
Patients with NFAI are at increased risk of developing alterations of glucose metabolism, whereas those with ACS or NFAI who converted to ACS over time are at risk for cardiovascular diseases.
Role of targeted biopsy under magnifying endoscopy with narrow band imaging may be not necessary: a prospective diagnostic accuracy study
Authors: Zhang Qing-Wei , Zhou Ying , Zhang Jing-Jing , Li Hai-Yan , Song Jie-Ying , Ge Zhi-Zheng , Li Xiao-Bo 
Published: March 2017

Background and aims
Targeted biopsy under the guidance of magnifying endoscopy with narrow band imaging (ME-NBI) has higher accuracy than endoscopic forceps biopsy (EFB) in the differential diagnosis of cancerous lesions from noncancerous lesions. The aims of this study were to validate diagnostic efficacy of targeted biopsy under the guidance of ME-NBI (MNTB) and further evaluate whether it is necessary to perform MNTB when combined with ME-NBI.

Methods
This study prospectively analyzed 211 gastric lesions of suspected cancerous tissues. The sensitivity, specificity, positive predictive value, and negative predictive value of EFB, ME-NBI, MNTB, EFB plus ME-NBI, and MNTB plus ME-NBI for the diagnosis of cancerous lesions were determined, respectively. The accuracy, sensitivity, specificity of EFB and MNTB, EFB plus ME-NBI, and MNTB plus ME-NBI were also compared, respectively.

Results
The accuracy, sensitivity, and specificity with 95% confidence intervals were 68.2% (61.4–74.4%), 62.3% (54.1–69.9%), 84.2% (71.6–92.1%) for EFB, 75.4% (68.9–80.9%), 72.7% (64.9–79.4%), 82.5% (69.6–90.8%) for MNTB, 76.8% (70.4–82.2%), 73.4% (65.5–80.0%), 86.0% (73.7–93.3%) for ME-NBI, 82.0% (76.0–86.8%), 85.7% (79.0–90.6%), 71.9% (58.3–82.6%) for EFB plus ME-NBI, 84.8% (79.1–89.3%), 89.6% (83.4–93.8%), and 71.9% (58.3–82.6%) for MNTB plus ME-NBI, respectively. The sensitivity of MNTB was significantly higher than that of EFB (P=0.048). There was no significant difference in the sensitivity (P=0.307), specificity (P=1.000), and accuracy (P=0.337) between EFB plus ME-NBI and MNTB plus ME-NBI.

Conclusion
Although MNTB has a higher diagnostic efficacy than EFB in the diagnosis of cancerous lesions, it may be not necessary to perform MNTB when combined with ME-NBI.
Pathophysiology of the Gut and the Microbiome in the Host Response
Authors: Lyons John D. , Coopersmith Craig M. 
Published: March 2017

Objective:
To describe and summarize the data supporting the gut as the motor driving critical illness and multiple organ dysfunction syndrome presented at the National Institute of Child Health and Human Development MODS Workshop (March 26–27, 2015).

Data Sources:
Summary of workshop keynote presentation.

Study Selection:
Not applicable.

Data Extraction:
Presented by an expert in the field, the data assessing the role of gastrointestinal dysfunction driving critical illness were described with a focus on identifying knowledge gaps and research priorities.

Data Synthesis:
Summary of presentation and discussion supported and supplemented by relevant literature.

Conclusions:
The understanding of gut dysfunction in critical illness has evolved greatly over time, and the gut is now often considered as the “motor” of critical illness. The association of the gut with critical illness is supported by both animal models and clinical studies. Initially, the association between gut dysfunction and critical illness focused primarily on bacterial translocation into the bloodstream. However, that work has evolved to include other gut-derived products causing distant injury via other routes (e.g., lymphatics). Additionally, alterations in the gut epithelium may be associated with critical illness and influence outcomes. Gut epithelial apoptosis, intestinal hyperpermeability, and perturbations in the intestinal mucus layer have all been associated with critical illness. Finally, there is growing evidence that the intestinal microbiome plays a crucial role in mediating pathology in critical illness. Further research is needed to better understand the role of each of these mechanisms and their contribution to multiple organ dysfunction syndrome in children.
Monitoring Severity of Multiple Organ Dysfunction Syndrome: New and Progressive Multiple Organ Dysfunction Syndrome, Scoring Systems
Authors: Typpo Katri V. , Lacroix Jacques R. 
Published: March 2017

Objective:
To describe the diagnostic criteria of new and progressive multiple organ dysfunction syndrome and scoring systems that might be used to assess and monitor the severity and progression of multiple organ dysfunction syndrome in children presented as part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development MODS Workshop (March 26–27, 2015).

Data Sources:
Literature review, research data, and expert opinion.

Study Selection:
Not applicable.

Data Extraction:
Moderated by an experienced expert from the field, issues relevant to the monitoring of the severity of multiple organ dysfunction syndrome including new and progressive multiple organ dysfunction syndrome and scoring systems were presented, discussed, and debated with a focus on identifying knowledge gaps and research priorities.

Data Synthesis:
Summary of presentations and discussion supported and supplemented by relevant literature.

Conclusions:
Many sets of diagnostic criteria of multiple organ dysfunction syndrome are presently available. All are useful, but their diagnostic and predictive value can be improved. Several types of diagnostic criteria are candidates to describe the severity and to monitor the progression of cases of multiple organ dysfunction syndrome, which include existing scores of organ dysfunction: Pediatric Logistic Organ Dysfunction, version 2, daily Pediatric Logistic Organ Dysfunction, version 2, organ failure-free days, etc. If a new set of diagnostic criteria of multiple organ dysfunction syndrome is created, its value must be validated. Furthermore, the epidemiology of multiple organ dysfunction syndrome based on these new diagnostic criteria must be compared with the epidemiology found with the preexisting sets of diagnostic criteria. The reliability as well as the added values of additional or new candidate markers of organ dysfunction and multiple organ dysfunction syndrome severity must be studied and compared.
Pediatric Multiple Organ Dysfunction Syndrome: Promising Therapies
Authors: Doctor Allan , Zimmerman Jerry , Agus Michael , Rajasekaran Surender , Bubeck Wardenburg Juliane , Fortenberry James , Zajicek Anne , Mairson Emma , Typpo Katri 
Published: March 2017

Objective:
To describe the state of the science, identify knowledge gaps, and offer potential future research questions regarding promising therapies for children with multiple organ dysfunction syndrome presented during the Eunice Kennedy Shriver National Institute of Child Health and Human Development Workshop on Pediatric Multiple Organ Dysfunction Syndrome (March 26–27, 2015).

Data Sources:
Literature review, research data, and expert opinion.

Study Selection:
Not applicable.

Data Extraction:
Moderated by an expert from the field, issues relevant to the association of multiple organ dysfunction syndrome with a variety of conditions were presented, discussed, and debated with a focus on identifying knowledge gaps and research priorities.

Data Synthesis:
Summary of presentations and discussion supported and supplemented by relevant literature.

Conclusions:
Among critically ill children, multiple organ dysfunction syndrome is relatively common and associated with significant morbidity and mortality. For outcomes to improve, effective therapies aimed at preventing and treating this condition must be discovered and rigorously evaluated. In this article, a number of potential opportunities to enhance current care are highlighted including the need for a better understanding of the pharmacokinetics and pharmacodynamics of medications, the effect of early and optimized nutrition, and the impact of effective glucose control in the setting of multiple organ dysfunction syndrome. Additionally, a handful of the promising therapies either currently being implemented or developed are described. These include extracorporeal therapies, anticytokine therapies, antitoxin treatments, antioxidant approaches, and multiple forms of exogenous steroids. For the field to advance, promising therapies and other therapies must be assessed in rigorous manner and implemented accordingly.
Evaluating the Impact of the Healthy Beginnings System of Care Model on Pediatric Emergency Department Utilization
Authors: Tan Cheryl H. , Gazmararian Julie 
Published: March 2017

Objective
The aim of this study was to evaluate whether enrollment in the Healthy Beginnings System of Care (SOC) model is associated with a decrease in emergency department (ED) visits among children aged 6 months to 5.5 years.

Methods
A retrospective, longitudinal study of ED utilization was conducted among children enrolled in the Healthy Beginnings SOC model between February 2011 and May 2013. Using medical records obtained from a children’s hospital in Atlanta, the rate of ED visits per quarter was examined as the main outcome. A multilevel, multivariate Poisson model, with family- and child-level random effects, compared ED utilization rates before and after enrollment. Adjusted rate ratios and 95% confidence intervals were calculated after controlling for sociodemographic confounders.

Results
The effect of SOC enrollment on the rate of ED visits differed by income level of the primary parent. The rate of ED visits after enrollment was not significantly different than the rate of ED visits before enrollment for children whose primary parent had an annual income of less than $5000 (P = 0.298), $20,000 to $29,999 (P = 0.199), or $30,000 or more (P = 0.117). However, for the children whose primary parent’s annual income was $5000 to $19,999, the rate of ED visits after enrollment was significantly higher than the rate of ED visits before enrollment (adjusted rate ratio, 1.48; 95% confidence interval, 1.17–1.87).

Conclusions
Enrollment in the SOC model does not appear to decrease the rate of ED visits among enrolled children. Additional strategies, such as education sessions on ED utilization, are needed to reduce the rate of ED utilization among SOC-enrolled children.
Laryngeal Injury in a Male Lacrosse Player
Authors: Murtagh-Kurowski Eileen , Gittelman Michael A. , Arjmand Ellis 
Published: March 2017

Abstract
Lacrosse has become increasingly popular among US children and teens. Because a lacrosse ball can serve as a projectile, neck injuries, although uncommon, can cause a severe and long-lasting injury. We report the case of a 16-year-old adolescent who experienced direct neck trauma while playing lacrosse. The clinical presentation, treatment strategies, and intubation considerations are reviewed. Finally, a call to action to prevent future, similar injuries is discussed.
Informing the Design of a New Pragmatic Registry to Stimulate Near Miss Reporting in Ambulatory Care
Authors: Pfoh Elizabeth R. , Engineer Lilly , Singh Hardeep , Hall Laura Lee , Fried Ethan D. , Berger Zackary , Wu Albert W. 
Published: March 2017

Objective
Ambulatory care safety is of emerging concern, especially in light of recent studies related to diagnostic errors and health information technology-related safety. Safety reporting systems in outpatient care must address the top safety concerns and be practical and simple to use. A registry that can identify common near misses in ambulatory care can be useful to facilitate safety improvements. We reviewed the literature on medical errors in the ambulatory setting to inform the design of a registry for collecting near miss incidents.

Methods
This narrative review included articles from PubMed that were: 1) original research; 2) discussed near misses or adverse events in the ambulatory setting; 3) relevant to US health care; and 4) published between 2002 and 2013. After full text review, 38 studies were searched for information on near misses and associated factors. Additionally, we used expert opinion and current inpatient near miss registries to inform registry development.

Results
Studies included a variety of safety issues including diagnostic errors, treatment or management-related errors, communication errors, environmental/structural hazards, and health information technology (health IT)–related concerns. The registry, based on the results of the review, updates previous work by including specific sections for errors associated with diagnosis, communication, and environment structure and incorporates specific questions about the role of health information technology.

Conclusions
Through use of this registry or future registries that incorporate newly identified categories, near misses in the ambulatory setting can be accurately captured, and that information can be used to improve patient safety.
Medication Safety in Two Intensive Care Units of a Community Teaching Hospital After Electronic Health Record Implementation: Sociotechnical and Human Factors Engineering Considerations
Authors: Carayon Pascale , Wetterneck Tosha B. , Cartmill Randi , Blosky Mary Ann , Brown Roger , Hoonakker Peter , Kim Robert , Kukreja Sandeep , Johnson Mark , Paris Bonnie L. , Wood Kenneth E. , Walker James M. 
Published: March 2017

Objective
The aim of the study was to assess the impact of Electronic Health Record (EHR) implementation on medication safety in two intensive care units (ICUs).

Methods
Using a prospective pre-post design, we assessed 1254 consecutive admissions to two ICUs before and after an EHR implementation. Each medication event was evaluated with regard to medication error (error type, medication-management stage) and impact on patient (severity of potential or actual harm).

Results
We identified 4063 medication-related events either pre-implementation (2074 events) or post-implementation (1989 events). Although the overall potential for harm due to medication errors decreased post-implementation only 2 of the 3 error rates were significantly lower post-implementation. After EHR implementation, we observed reductions in rates of medication errors per admission at the stages of transcription (0.13–0, P < 0.001), dispensing (0.49–0.16, P < 0.001), and administration (0.83–0.56, P = 0.011). Within the ordering stage, 4 error types decreased post-implementation (orders with omitted information, error-prone abbreviations, illegible orders, failure to renew orders) and 4 error types increased post-implementation (orders of wrong drug, orders containing a wrong start or stop time, duplicate orders, orders with inappropriate or wrong information). Within the administration stage, we observed a reduction of late administrations and increases in omitted administrations and incorrect documentation.

Conclusions
Electronic Health Record implementation in two ICUs was associated with both improvement and worsening in rates of specific error types. Further safety improvements require a nuanced understanding of how various error types are influenced by the technology and the sociotechnical work system of the technology implementation. Recommendations based on human factors engineering principles are provided for reducing medication errors.