bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical and MRI Outcomes After Surgical Treatment of Osteochondral Lesions of the Talus in Skeletally Immature Children
Authors: Jurina Andrija , Dimnjaković Damjan , Mustapić Matej , Smoljanović Tomislav , Bojanić Ivan 
Published: March 2016

Background:
The literature on the osteochondral lesion of the talus (OLT) in skeletally immature children is scarce and little is known about the clinical outcomes and the radiologic appearance of these lesions after surgical treatment. The aim of this study was to assess mid-term clinical and magnetic resonance imaging (MRI) outcomes after arthroscopic microfracture (AM) of OLT in skeletally immature children.

Methods:
Thirteen patients with OLT treated by AM before skeletal maturity were included in the study. The Berndt and Harty outcome question, the Single Assessment Numeric Evaluation question, and the Martin questionnaire were used to obtain patients’ subjective satisfaction with their operated ankle. Functional outcomes preoperatively and postoperatively were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score. MRI scans were performed postoperatively using a magnetic resonance observation of cartilage repair tissue (MOCART) scoring system for 11 ankles.

Results:
The median age was 15 years (range, 13 to 16 y) and the median follow-up period was 5.6 years (range, 3.8 to 13.6 y). According to the Berndt and Harty outcome question, good clinical results were reported in 10 (76.9%) and fair in 3 (23.1%) patients. The postoperative AOFAS score was significantly improved when compared with the preoperative AOFAS score, with a mean increase of 35 points (P<0.001). The overall MOCART score was 65 (range, 10 to 75). MRI variables of the MOCART scoring system showed no association with clinical outcomes.

Conclusions:
AM seems to be an effective surgical method for the treatment of OLT in skeletally immature children.

Level of Evidence:
Level IV—therapeutic studies, case series.
Maternal Origin and Risk of Neonatal and Maternal ICU Admission*
Authors: Medcalf Karyn E. , Park Alison L. , Vermeulen Marian J. , Ray Joel G. 
Published: March 2016

Objectives:
To evaluate maternal world region of birth, as well as maternal country of origin, and the associated risk of admission of 1) a mother to a maternal ICU, 2) her infant to a neonatal ICU, or 3) both concurrently to an ICU.

Design:
Retrospective population-based cohort study.

Setting:
Entire province of Ontario, Canada, from 2003 to 2012.

Patients:
All singleton maternal-child pairs who delivered in any Ontario hospital.

Measurements and Main Results:
We explored how maternal world region of birth, and specifically, maternal country of birth for the top 25 countries, was associated with the outcome of 1) neonatal ICU, 2) maternal ICU, and 3) both mother and newborn concurrently admitted to ICU. Relative risks were adjusted for maternal age, parity, income quintile, chronic hypertension, diabetes mellitus, obesity, dyslipidemia, drug dependence or tobacco use, and renal disease. Compared with infants of Canadian-born mothers (110.7/1,000), the rate of neonatal ICU admission was higher in immigrants from South Asia (155.2/1,000), Africa (140.4/1,000), and the Caribbean (167.3/1,000; adjusted relative risk, 1.41; 95% CI, 1.36–1.46). For maternal ICU, the adjusted relative risk was 1.79 (95% CI, 1.43–2.24) for women from Africa and 2.21 (95% CI, 1.78–2.75) for women from the Caribbean. Specifically, mothers from Ghana (adjusted relative risk, 2.71; 95% CI, 1.75–4.21) and Jamaica (adjusted relative risk, 2.74; 95% CI, 2.12–3.53) were at highest risk of maternal ICU admission. The risk of both mother and newborn concurrently admitted to ICU was even more pronounced for Ghana and Jamaica.

Conclusions:
Women from Africa and the Caribbean and, in particular, Ghana and Jamaica, are at higher risk of admission to ICU around the time of delivery, as are their newborns.
Mechanical Ventilation and Diaphragmatic Atrophy in Critically Ill Patients: An Ultrasound Study
Authors: Zambon Massimo , Beccaria Paolo , Matsuno Jun , Gemma Marco , Frati Elena , Colombo Sergio , Cabrini Luca , Landoni Giovanni , Zangrillo Alberto 
Published: March 2016

Objective:
Mechanical ventilation contributes to diaphragmatic atrophy and dysfunction, and few techniques exist to assess diaphragmatic function: the purpose of this study was to quantify diaphragm atrophy in a population of critically ill mechanically ventilated patients with ultrasound and to identify risk factors that can worsen diaphragmatic activity.

Design:
Prospective observational study.

Setting:
ICU of a 1,200-bed university hospital.

Patients:
Newly intubated adult critically ill patients.

Interventions:
Diaphragm thickness in the zone of apposition was measured daily with ultrasound, from the first day of mechanical ventilation till discharge to the main ward.

Measurements and Main Results:
Daily atrophy rate (ΔTdi/d) was calculated as the reduction in percentage from the previous measurement. To analyze the difference in atrophy rate (ΔTdi/d), ventilation was categorized into four classes: spontaneous breathing or continuous positive airway pressure; pressure support ventilation 5–12 cm H2O (low pressure support ventilation); pressure support ventilation greater than 12 cm H2O (high pressure support ventilation); and controlled mechanical ventilation. Multivariate analysis with ventilation support and other clinical variables was performed to identify risk factors for atrophy. Forty patients underwent a total of 153 ultrasonographic evaluations. Mean (sd) ΔTdi/d was –7.5% (12.3) during controlled mechanical ventilation, –5.3% (12.9) at high pressure support ventilation, –1.5% (10.9) at low pressure support ventilation, +2.3% (9.5) during spontaneous breathing or continuous positive airway pressure. At multivariate analysis, only the ventilation support was predictive of diaphragm atrophy rate. Pressure support predicted diaphragm thickness with coefficient –0.006 (95% CI, –0.010 to –0.002; p = 0.006).

Conclusions:
In critically ill mechanically ventilated patients, there is a linear relationship between ventilator support and diaphragmatic atrophy rate.
Long-Term Quality of Life Among Survivors of Severe Sepsis: Analyses of Two International Trials*
Authors: Yende Sachin , Austin Shamly , Rhodes Andrew , Finfer Simon , Opal Steven , Thompson Taylor , Bozza Fernando A. , LaRosa Steven P. , Ranieri V. Marco , Angus Derek C. 
Published: March 2016

Objectives:
To describe the quality of life among sepsis survivors.

Design:
Secondary analyses of two international, randomized clinical trials (A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis [derivation cohort] and PROWESS-SHOCK [validation cohort]).

Setting:
ICUs in North and South America, Europe, Africa, Asia, and Australia.

Patients:
Adults with severe sepsis. We analyzed only patients who were functional and living at home without help before sepsis hospitalization (n = 1,143 and 987 from A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis and PROWESS-SHOCK, respectively).

Interventions:
None.

Measurements and Main Results:
In A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis and PROWESS-SHOCK, the average age of patients living at home independently was 63 and 61 years; 400 (34.9%) and 298 (30.2%) died by 6 months. In A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis, 580 patients had a quality of life measured using EQ-5D at 6 months. Of these, 41.6% could not live independently (22.7% were home but required help, 5.1% were in nursing home or rehabilitation facilities, and 5.3% were in acute care hospitals). Poor quality of life at 6 months, as evidenced by problems in mobility, usual activities, and self-care domains were reported in 37.4%, 43.7%, and 20.5%, respectively, and the high incidence of poor quality of life was also seen in patients in PROWESS-SHOCK. Over 45% of patients with mobility and self-care problems at 6 months in A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis died or reported persistent problems at 1 year.

Conclusions:
Among individuals enrolled in a clinical trial who lived independently prior to severe sepsis, one third had died and of those who survived, a further one third had not returned to independent living by 6 months. Both mortality and quality of life should be considered when designing new interventions and considering endpoints for sepsis trials.
Using Supervised Machine Learning to Classify Real Alerts and Artifact in Online Multisignal Vital Sign Monitoring Data*
Authors: Chen Lujie , Dubrawski Artur , Wang Donghan , Fiterau Madalina , Guillame-Bert Mathieu , Bose Eliezer , Kaynar Ata M. , Wallace David J. , Guttendorf Jane , Clermont Gilles , Pinsky Michael R. , Hravnak Marilyn 
Published: March 2016

Objective:
The use of machine-learning algorithms to classify alerts as real or artifacts in online noninvasive vital sign data streams to reduce alarm fatigue and missed true instability.

Design:
Observational cohort study.

Setting:
Twenty-four–bed trauma step-down unit.

Patients:
Two thousand one hundred fifty-three patients.

Intervention:
Noninvasive vital sign monitoring data (heart rate, respiratory rate, peripheral oximetry) recorded on all admissions at 1/20 Hz, and noninvasive blood pressure less frequently, and partitioned data into training/validation (294 admissions; 22,980 monitoring hours) and test sets (2,057 admissions; 156,177 monitoring hours). Alerts were vital sign deviations beyond stability thresholds. A four-member expert committee annotated a subset of alerts (576 in training/validation set, 397 in test set) as real or artifact selected by active learning, upon which we trained machine-learning algorithms. The best model was evaluated on test set alerts to enact online alert classification over time.

Measurements and Main Results:
The Random Forest model discriminated between real and artifact as the alerts evolved online in the test set with area under the curve performance of 0.79 (95% CI, 0.67–0.93) for peripheral oximetry at the instant the vital sign first crossed threshold and increased to 0.87 (95% CI, 0.71–0.95) at 3 minutes into the alerting period. Blood pressure area under the curve started at 0.77 (95% CI, 0.64–0.95) and increased to 0.87 (95% CI, 0.71–0.98), whereas respiratory rate area under the curve started at 0.85 (95% CI, 0.77–0.95) and increased to 0.97 (95% CI, 0.94–1.00). Heart rate alerts were too few for model development.

Conclusions:
Machine-learning models can discern clinically relevant peripheral oximetry, blood pressure, and respiratory rate alerts from artifacts in an online monitoring dataset (area under the curve > 0.87).
Potential Influence of Advance Care Planning and Palliative Care Consultation on ICU Costs for Patients With Chronic and Serious Illness*
Authors: Khandelwal Nita , Benkeser David C. , Coe Norma B. , Curtis J. Randall 
Published: March 2016

Objectives:
To estimate the potential ICU-related cost savings if in-hospital advance care planning and ICU-based palliative care consultation became standard of care for patients with chronic and serious illness.

Design and Setting:
Decision analysis using literature estimates and inpatient administrative data from Premier.

Patients:
Patients with chronic, life-limiting illness admitted to a hospital within the Premier network.

Interventions:
None.

Measurements and Main Results:
Using Premier data (2008–2012), ICU resource utilization and costs were tracked over a 1-year time horizon for 2,097,563 patients with chronic life-limiting illness. Using a Markov microsimulation model, we explored the potential cost savings from the hospital system perspective under a variety of scenarios by varying the interventions’ efficacies and availabilities. Of 2,097,563 patients, 657,825 (31%) used the ICU during the 1-year time horizon; mean ICU spending per patient was 11.3k (sd, 17.6k). In the base-case analysis, if in-hospital advance care planning and ICU-based palliative care consultation were systematically provided, we estimated a mean reduction in ICU costs of 2.8k (sd, 14.5k) per patient and an ICU cost saving of 25%. Among the simulated patients who used the ICU, the receipt of both interventions could have resulted in ICU cost savings of 1.9 billion, representing a 6% reduction in total hospital costs for these patients.

Conclusions:
In-hospital advance care planning and palliative care consultation have the potential to result in significant cost savings. Studies are needed to confirm these findings, but our results provide guidance for hospitals and policymakers.
Nutritional Status Based on Body Mass Index Is Associated With Morbidity and Mortality in Mechanically Ventilated Critically Ill Children in the PICU*
Authors: Bechard Lori J. , Duggan Christopher , Touger-Decker Riva , Parrott J. Scott , Rothpletz-Puglia Pamela , Byham-Gray Laura , Heyland Daren , Mehta Nilesh M. 
Published: March 2016

Objective:
To determine the influence of admission anthropometry on clinical outcomes in mechanically ventilated children in the PICU.

Design:
Data from two multicenter cohort studies were compiled to examine the unique contribution of nutritional status, defined by body mass index z score, to 60-day mortality, hospital-acquired infections, length of hospital stay, and ventilator-free days, using multivariate analysis.

Setting:
Ninety PICUs from 16 countries with eight or more beds.

Patients:
Children aged 1 month to 18 years, admitted to each participating PICU and requiring mechanical ventilation for more than 48 hours.

Measurements and Main Results:
Data from 1,622 eligible patients, 54.8% men and mean (sd) age 4.5 years (5.1), were analyzed. Subjects were classified as underweight (17.9%), normal weight (54.2%), overweight (14.5%), and obese (13.4%) based on body mass index z score at admission. After adjusting for severity of illness and site, the odds of 60-day mortality were higher in underweight (odds ratio, 1.53; p < 0.001) children. The odds of hospital-acquired infections were higher in underweight (odds ratio, 1.88; p = 0.008) and obese (odds ratio, 1.64; p < 0.001) children. Hazard ratios for hospital discharge were lower among underweight (hazard ratio, 0.71; p < 0.001) and obese (hazard ratio, 0.82; p = 0.04) children. Underweight was associated with 1.3 (p = 0.001) and 1.6 (p < 0.001) fewer ventilator-free days than normal weight and overweight, respectively.

Conclusions:
Malnutrition is prevalent in mechanically ventilated children on admission to PICUs worldwide. Classification as underweight or obese was associated with higher risk of hospital-acquired infections and lower likelihood of hospital discharge. Underweight children had a higher risk of mortality and fewer ventilator-free days.
Induction Therapy for Locally Advanced, Resectable Esophagogastric Cancer
Authors: Boland Patrick M. , Meyer Joshua E. , Berger Adam C. , Cohen Steven J. , Neuman Tzahi , Cooper Harry S. , Olszanski Anthony J. , Davey Monica , Cheng Jonathan D. , Lebenthal Abraham , Burtness Barbara A. , Scott Walter J. , Astsaturov Igor A. 
Published: March 2016

Objectives:
Preoperative chemotherapy and radiation for localized esophageal cancer produces cure rates near 30% when combined with surgical resection. Vandetanib, a small molecule receptor tyrosine kinase inhibitor of VEGFR-2, VEGFR-3, RET, and EGFR, demonstrated synergy with radiation and chemotherapy in preclinical models. We conducted a phase I study to assess the safety and tolerability of vandetanib when combined with preoperative chemoradiation in patients with localized esophageal carcinoma who were surgical candidates.

Methods:
Patients with stage II-III esophageal and gastroesophageal junction carcinoma without prior therapy were enrolled in a 3+3 phase I design. Patients received once-daily vandetanib (planned dosing levels of 100, 200, and 300 mg) with concomitant daily radiotherapy (1.8 Gy/d, 45 Gy total) and chemotherapy, consisting of infusional 5-FU (225 mg/m2/d over 96 h, weekly), paclitaxel (50 mg/m2, days 1, 8, 15, 22, 29) and carboplatin (AUC of 5, days 1, 29).

Results:
A total 9 patients were enrolled with 8 having either distal esophageal or gastroesophageal junction carcinomas. All patients completed the planned preoperative chemoradiation and underwent esophagectomy. Nausea (44%) and anorexia (44%) were the most common acute toxicities of any grade. One grade 4 nonhematologic toxicity was observed (gastrobronchial fistula). One additional patient suffered a late complication, a fatal aortoenteric hemorrhage, not definitively related to the investigational regimen. Five (56%) patients achieved a pathologic complete response. Three (33%) additional patients had only microscopic residual disease. Five (56%) patients remain alive and disease free with a median follow-up of 3.7 years and median overall survival of 3.2 years. The maximum tolerated dose was vandetanib 100 mg/d.

Conclusions:
Vandetanib at 100 mg daily is tolerable in combination with preoperative chemotherapy (5-FU, paclitaxel, carboplatin) and radiation therapy with encouraging efficacy worthy of future study.
Anterior Segment Biometry of the Accommodating Intraocular Lens and its Relationship With the Amplitude of Accommodation
Authors: Leng Lin , Chen Qi , Yuan Yimin , Hu Di , Zhu Dexi , Wang Jianhua , Yu Ayong , Lu Fan , Shen Meixiao 
Published: March 2016

Objectives:
To evaluate the anterior segment biometry of the Tetraflex accommodating intraocular lens (AIOL) and the contribution of forward movement to the amplitude of accommodation (AMP).

Methods:
Patients who underwent phacoemulsification with implantation of Tetraflex AIOLs and control nonaccommodating intraocular lenses were imaged by custom-built, long scan depth spectral-domain optical coherence tomography at relaxed and maximal accommodative states. Anterior segment biometry was performed and correlated with the clinical manifestation including AMP.

Results:
Patients in the Tetraflex group showed better distance-corrected near visual acuity (logMAR 0.43±0.10 vs. logMAR 0.51±0.10, P<0.05) and greater AMP (1.99±0.58 diopters [D] vs. 1.59±0.45 D, P<0.05) compared with the control group. The measurement of the postoperative anterior chamber depth (ACD) during accommodation showed a forward movement of the AIOLs in 16 eyes (69.6%). Compared with the control group, a greater proportion of cases in the Tetraflex group experienced forward movement (χ2 test, P<0.001). The AMP in the AIOL group negatively correlated with changes in postoperative ACD during accommodation (r=−0.47, P<0.05), whereas AMP in the control group negatively correlated with postoperative pupil diameter (r=−0.57, P<0.05).

Conclusions:
The Tetraflex AIOLs seemed to have a tendency for forward movement; however, the slight forward axial shifts of the Tetraflex AIOL during natural accommodation may not produce a clinically relevant change in optical power.
Chinese Version of Psychometric Evaluation of Self-Reflection and Insight Scale on Taiwanese Nursing Students
Authors: Chen Shu-Yueh , Lai Chen-Chun , Chang Hui-Mei , Hsu Hui-Chen , Pai Hsiang-Chu 
Published: March 2016

ABSTRACT

Background:
Self-reflection (also known as reflection) is an internal process that is difficult to perceive or assess. An instrument that is able to measure self-reflection may serve as a resource for educators to assess the learning process of students and to tailor education approaches to student needs.

Purpose:
The aim of this study was to translate the Self-Reflection and Insight Scale (SRIS) into Chinese and evaluate its psychometric properties for use with Taiwanese nursing students.

Methods:
For this cross-sectional study, nursing students were recruited from two nursing schools in southern Taiwan in two phases: Phase 1, which included 361 fourth-year students, and Phase 2, which included 703 fifth-year students. Data were collected in December 2012 and May 2013 using the Chinese version of the SRIS (SRIS-C), Taiwan Critical Thinking Disposition Inventory, and the Perceived Identity as a Nurse Questionnaire, which was developed by the author. In Phase 1, exploratory factor analysis was used to explore the factor structure of the SRIS-C in the fourth-year student participants. In Phase 2, confirmatory factor analysis was used to determine the fitness of the model for the fifth-year student participants.

Results:
Eight items were deleted from the original SRIS to create the SRIS-C. Thus, the Chinese-version measure had 12 items and two factors (self-reflection and insight) that fit the data well. The Cronbach’s alpha coefficients for the total scale and its two subscales were .79, .87, and .83, respectively. The 3-week test–retest reliability was .74. SRIS-C scores correlated significantly with scores on the Taiwan Critical Thinking Disposition Inventory and the Perceived Identity as a Nurse Questionnaire, indicating good convergent validity for the SRIS-C.

Conclusions:
The current study showed that the SRIS-C has sound psychometric properties. This instrument provides nurse educators with information that may be used to evaluate the self-reflection and insight of students and to develop interventions to effectively improve these skills in Chinese-language-based nursing education.
Impaired Kidney Function and Associated Factors Among Rural Adults With Disabilities in Taiwan
Authors: Chen Chu-Yeh , Chiu Wen-Nan , Lin Yu-Chen , Jane Sui-Hwi , Chiang Hsin-Hung , Chen Mei-Yen 
Published: March 2016

ABSTRACT

Background:
The results of numerous studies indicate that people with disabilities seek more healthcare than those who are not disabled, particularly for conditions such as chronic kidney disease, cardiovascular disease, and obesity. However, little is known about the incidence of impaired kidney function and its associated factors among adults with disabilities in Taiwan.

Purpose:
The aim of this study was to explore the prevalence and factors associated with impaired kidney function among adults with disabilities.

Methods:
This descriptive study was nurse led and was conducted as part of a health promotion program for disadvantaged rural adults with disabilities in Chiayi County, Taiwan. Health screening and a health needs survey were conducted between July and December 2013. Kidney function, physiological biomarkers, health-related behaviors, and demographic characteristics were examined.

Results:
Eight hundred ten rural adults with disabilities were enrolled. The most common disabilities included physical-related disability (33.1%), intellectual-related disability (26.7%), and hearing and vision impairment (18.6%). The prevalence of impaired kidney function in this population was 85%. According to classification for chronic kidney disease, 68.6% were in Stages 1–2, and 16.8% were in Stages 3–4. Univariate analysis showed that impaired kidney function was significantly associated with lower educational level (p < .001), hearing or vision impairment (p < .001), being overweight or obese (p < .05), high systolic blood pressure (p < .01), fasting blood glucose (p < .001), total cholesterol (p < .001), total triglyceride (p < .05), older age (p < .001), smoking (p < .05), chewing betel nuts (p = .001), and low levels of participation in social activities (p < .05). The final logistic regression model showed that residents with disabilities who were older or had less education, high fasting blood glucose, and high total cholesterol tended to have impaired kidney function after adjustment for other potential confounding variables.

Conclusions/Implications for Practice:
Most participants showed impaired kidney function. The factors that were found to relate significantly to this impairment include being overweight, having hyperlipidemia, having hypertension, having high fasting blood glucose, and having an unhealthy lifestyle. Because of the lack of symptoms during the early stages of chronic kidney disease, a community-based health promotion program for these factors is an important element in health advocacy for this vulnerable population.