bluuebunny/crossref_metadata_2025_split huggingface dataset:
Magnet hospital recognition in hospital systems over time
Authors: Lasater Karen B. , Richards Michael R. , Dandapani Nikila B. , Burns Lawton R. , McHugh Matthew D. 
Published: June 2017

Background:
Magnet hospitals are recognized for nursing excellence and high-value patient outcomes, yet little is known about which and when hospitals pursue Magnet recognition. Concurrently, hospital systems are becoming a more prominent feature of the U.S. health care landscape.

Purpose:
The aim of the study was to examine Magnet adoption among hospital systems over time.

Approach:
Using American Hospital Association surveys (1998–2012), we characterized the proportion of Magnet hospitals belonging to systems. We used hospital level fixed-effects regressions to capture changes in a given system hospital’s Magnet status over time in relation to a variety of conditions, including prior Magnet adoption by system affiliates and nonaffiliates in local and geographically distant markets and whether these relationships varied by degree of system centralization.

Results:
The proportion of Magnet hospitals belonging to a system is increasing. Prior Magnet adoption by a hospital within the local market was associated with an increased likelihood of a given system hospital becoming Magnet, but the effect was larger if there was prior adoption by affiliates (7.4% higher likelihood) versus nonaffiliates (2.7% higher likelihood). Prior adoption by affiliates and nonaffiliates in geographically distant markets had a lesser effect. Hospitals belonging to centralized systems were more reactive to Magnet adoption of nonaffiliate hospitals as compared with those in decentralized systems.

Conclusions:
Hospital systems take an organizational perspective toward Magnet adoption, whereby more system affiliates achieve Magnet recognition over time.

Practice Implications:
The findings are relevant to health care and nursing administrators and policymakers interested in the diffusion of an empirically supported organizational innovation associated with quality outcomes, particularly in a time of increasing hospital consolidation and system expansion. We identify factors associated with Magnet adoption across system hospitals and demonstrate the importance of considering diffusion of organizational innovations in relation to system centralization. We suggest that decentralized system hospitals may be missing potential benefits of such organizational innovations.
ACUTE EXUDATIVE PARANEOPLASTIC POLYMORPHOUS VITELLIFORM MACULOPATHY DURING VEMURAFENIB AND PEMBROLIZUMAB TREATMENT FOR METASTATIC MELANOMA
Authors: Sandhu Harpal S. , Kolomeyer Anton M. , Lau Marisa K. , Shields Carol L. , Schuchter Lynn M. , Nichols Charles W. , Aleman Tomas S. 
Published: June 2017

Purpose:
To describe a patient with BRAF mutation-positive cutaneous melanoma who developed acute exudative polymorphous vitelliform maculopathy during vemurafenib and pembrolizumab treatment for metastatic melanoma.

Methods:
Retrospective case report documented with wide-field fundus imaging, spectral domain optical coherence tomography, and fundus autofluorescence imaging.

Results:
A 55-year-old woman with bilateral ductal breast carcinoma and BRAF mutation-positive metastatic cutaneous melanoma complained of bilateral blurred vision within 5 days of starting vemurafenib (BRAF inhibitor). She had been on pembrolizumab (program death receptor antibody) and intermittently on dabrafenib (BRAF inhibitor) and trametinib (MEK inhibitor), and had a normal ophthalmologic examination. On presentation three weeks after the introduction of vemurafenib, her visual acuity had declined to 20/40 in both eyes. Her examination showed diffuse elevation of the fovea with multifocal yellow–white, crescent-shaped subretinal deposits within the macula of both eyes and bilateral neurosensory retinal detachments by spectral domain optical coherence tomography. Discontinuation of vemurafenib and introduction of difluprednate and dorzolamide led to a gradual resolution (over four months) of the neurosensory detachments with recovery of vision.

Conclusion:
This case report suggests that acute exudative polymorphous vitelliform maculopathy may be directly associated with the use of BRAF inhibitors as treatment for metastatic cutaneous melanoma, or indirectly by triggering autoimmune–paraneoplastic processes. Future identification of similar associations is required to unequivocally link vemurafenib and/or pembrolizumab to acute exudative polymorphous vitelliform maculopathy in metastatic melanoma.
Probable Donor-Derived Cytomegalovirus Disease After Keratolimbal Allograft Transplantation
Authors: Cheung Albert Y. , Govil Amit , Friedstrom Scott R. , Holland Edward J. 
Published: June 2017

Purpose:
To report a case of probable donor-derived cytomegalovirus (CMV) infection after keratolimbal allograft (KLAL) transplantation.

Methods:
Observational case report.

Results:
A 41-year-old man with a history of aniridic keratopathy and limbal stem cell deficiency underwent KLAL in his right eye. Preoperatively, he was negative for CMV IgG and IgM. Postoperatively, he was maintained on tacrolimus and mycophenolate mofetil for systemic immunosuppression; he was also on prophylactic valganciclovir (for CMV) and trimethoprim/sulfamethoxazole (for pneumocystis pneumonia) for 1 month. Approximately 5 weeks postoperatively, he developed a nonproductive cough, rhinorrhea, and dyspnea. His condition did not improve with oral azithromycin or levofloxacin. He developed worsening symptoms over the next 2 weeks despite therapy. The serum CMV polymerase chain reaction was positive, and he was readministered valganciclovir with subsequent resolution of symptoms.

Conclusions:
We present the first case of CMV disease in a seronegative patient who received a presumed CMV-seropositive donor KLAL. Similar to solid organ transplantation, prophylactic and therapeutic management of CMV infection is necessary in the setting of systemic immunosuppression.
Endothelial Cell Loss in Diabetic and Nondiabetic Eyes After Cataract Surgery
Authors: He Xu , Diakonis Vasilios F. , Alavi Yasamin , Yesilirmak Nilufer , Waren Daniel , Donaldson Kendall 
Published: June 2017

Purpose:
To assess and compare the changes in endothelial cell density in diabetic and nondiabetic patients after routine phacoemulsification cataract surgery.

Setting:
Bascom Palmer Eye Institute, Miller School of Medicine, Miami, FL, USA.

Design:
Retrospective nonrandomized cohort study.

Methods:
This retrospective study included diabetic and nondiabetic patients who underwent phacoemulsification by a single surgeon (K.D.) between September 2013 and March 2016. The main outcome measures were cumulative dissipated energy (CDE) and percentage of endothelial cell loss (ECL). Comparative analysis of CDE and percentage of ECL between the 2 patient groups was performed and then repeated based on the degree of diabetic control (hemoglobin A1c).

Results:
The study included 66 eyes of 55 diabetic and 67 eyes of 65 nondiabetic patients. Mean CDE was 7.8 ± 7.1 joules, and the 1-month mean percentage of ECL was 15% ± 14% in the diabetic group. Mean CDE was 6.6 ± 3.8 joules, and the 1-month mean percentage of ECL was 11% ± 11% in the nondiabetic group. The CDE was not significantly different between both groups. The percent decrease in ECL was statistically higher in the diabetic group than in the nondiabetic group (P = 0.03). The degree of diabetic control, based on hemoglobin A1c greater or less than 7, did not yield a significant difference in CDE or percentage ECL.

Conclusions:
Diabetic patients demonstrated increased ECL when compared with nondiabetic patients after cataract surgery. However, the role of diabetic control in reducing ECL remains unclear.
Clinical Characteristics of Allergy to Hymenoptera Stings
Authors: Visitsunthorn Nualanong , Kijmassuwan Teera , Visitsunthorn Kittipos , Pacharn Panchama , Jirapongsananuruk Orathai 
Published: June 2017

Objective
The purpose of this study was to evaluate the clinical characteristics of allergy to stings from the Hymenoptera order of insects in a hospital in Thailand.

Methods
A descriptive retrospective analytical study was carried out in inpatients and outpatients suffering from Hymenoptera stings from 2009 to 2013 in Siriraj Hospital.

Results
Medical records of 386 patients with an allergy to Hymenoptera stings were evaluated. Anaphylaxis was more common in patients younger than 15 years, who comprised 22.3% of patients in this study. The most common sting type was from wasps (58.3%). Eighty-five percent of patients sought medical treatment less than 24 hours after being stung. A systemic reaction and anaphylaxis were found in 9.9% and 4.4% of subjects, respectively. In 17 patients with anaphylaxis, only 11 patients (64.7%) received an epinephrine (adrenaline) injection as treatment, and only 8 (47.1%) received epinephrine autoinjectors or epinephrine-prefilled syringes to prevent a possible subsequent severe reaction. Significantly more patients younger than 15 years received epinephrine for prevention of an allergic reaction than did those older than 15 years (87.5% vs 11.7%, P < 0.001). Antibiotics were given to 43.0% of patients.

Conclusions
Anaphylaxis from Hymenoptera stings was more common in children than in adults. Only half of the patients visited the emergency room within 1 hour of being stung. Overuse of antibiotics and underuse of epinephrine were found. More information about Hymenoptera stings should be provided to the public, and the use of epinephrine should be encouraged in the case of severe reactions and anaphylaxis.
Interpersonal behavior in anticipation of pain: a naturalistic study of behavioral mimicry prior to surgery
Authors: Ashton-James Claire E. , Tybur Joshua M. , Forouzanfar Tymour 
Published: June 2017

Abstract

Introduction:
Social relationships facilitate coping with pain, but research suggests that it may be difficult to galvanize social support during an episode of acute pain.

Objectives:
The current research examined whether social connections are optimized in the anticipation of pain by observing patients' mimicry of an interaction partner prior to surgery. We hypothesized that when controlling for their current experience of pain, patients' anticipation of pain would be associated with greater mimicry of an interaction partner.

Methods:
Sixty-five patients were interviewed in the waiting room of a maxillofacial surgery unit prior to the removal of an impacted wisdom tooth. Patients' spontaneous mimicry of an interviewer was observed. Patients then rated the quality and intensity of their anticipated pain, as well as the intensity of their current pain and their affective distress.

Results:
Anticipated pain, current pain, and affective distress were positively correlated. Current pain was associated with less frequent mimicry of an interaction partner. The zero-order correlation between anticipated pain and mimicry did not reach conventional levels of significance; however, when controlling for current pain, anticipated pain predicted more frequent mimicry of an interaction partner. The relationship between anticipated pain and mimicry was not explained by affective distress.

Conclusion:
This is the first study to demonstrate that anticipated and current pain relate to behavioral mimicry in divergent ways. Further research is needed to investigate whether the current pattern of results generalizes to other interpersonal behaviors that facilitate social bonds.
Early Fibrinolysis Associated with Hemorrhagic Progression Following Traumatic Brain Injury
Authors: Karri Jay , Cardenas Jessica C. , Matijevic Nena , Wang Yao-Wei , Choi Sangbum , Zhu Liang , Cotton Bryan A. , Kitagawa Ryan , Holcomb John B. , Wade Charles E. 
Published: June 2017

ABSTRACT

Background:
Progressive hemorrhagic injury (PHI) is common in patients with severe traumatic brain injury (TBI) and is associated with worse outcomes. PHI pathophysiology remains poorly understood and difficult to predict. We performed an exploratory analysis aimed at identifying markers in need of further investigation to establish their predictive value in PHI following TBI.

Methods:
We performed a retrospective chart review of prospectively collected data from 424 highest-level activation trauma patients from January 2012 through December 2013. Patients with severe TBI, defined as head acute injury scale (AIS) score ≥3 and intracranial hemorrhage (ICH) on initial CT, were included. Stable hemorrhage (SH) and PHI was determined by measuring ICH expansion on repeat CT within 6 h. Of 424 patients evaluated, 72 met inclusion criteria. Twenty-five patients had repeated samples available and were dichotomized into SH (n = 6, 24%) and PHI (n = 19, 76%). Levels of plasminogen, urokinase and tissue plasminogen activators (uPA, tPA), plasminogen activator inhibitor-1, α2-antiplasmin (α2AP), and D-Dimers (DD) were measured upon admission and 2, 4, and 6 h later.

Results:
Longitudinal models identified tPA and DD as positively associated and α2AP inversely associated with PHI. High DD levels are strongly associated with developing PHI over time. Using the full TBI cohort of N = 72, receiver operating curve analysis provided a cutoff of 3.04 μg/mL admission DD to distinguish SH from PHI patients.

Conclusion:
Our findings support a relationship between markers of fibrinolysis in polytrauma patients with severe TBI and PHI, warranting further investigation into the potential for novel, predictive biomarkers.
Role of Hemorrhagic Shock in Experimental Polytrauma
Authors: Denk Stephanie , Weckbach Sebastian , Eisele Philipp , Braun Christian K. , Wiegner Rebecca , Ohmann Julia J. , Wrba Lisa , Hoenes Felix M. , Kellermann Philipp , Radermacher Peter , Wachter Ulrich , Hafner Sebastian , McCook Oscar , Schultze Anke , Palmer Annette , Braumüller Sonja , Gebhard Florian , Huber-Lang Markus 
Published: June 2017

ABSTRACT
Hemorrhagic shock (HS) after tissue trauma increases the complication and mortality rate of polytrauma (PT) patients. Although several murine trauma models have been introduced, there is a lack of knowledge about the exact impact of an additional HS. We hypothesized that HS significantly contributes to organ injury, which can be reliably monitored by detection of specific organ damage markers. Therefore we established a novel clinically relevant PT plus HS model in C57BL/6 mice which were randomly assigned to control, HS, PT, or PT+HS procedure (n = 8 per group). For induction of PT, anesthetized animals received a blunt chest trauma, head injury, femur fracture, and soft tissue injury. HS was induced by pressure-controlled blood drawing (mean arterial blood pressure of 30 mmHg for 60 min) and mice then resuscitated with ionosterile (4 × volume drawn), monitored, and killed for blood and organ harvesting 4 h after injury. After HS and resuscitation, PT+HS mice required earlier and overall more catecholamine support than HS animals to keep their mean arterial blood pressure. HS significantly contributed to the systemic release of interleukin-6 and high mobility group box 1 protein. Furthermore, the histological lung injury score, pulmonary edema, neutrophil influx, and plasma clara cell protein 16 were all significantly enhanced in PT animals in the presence of an additional HS. Although early morphological changes were minor, HS also contributed functionally to remote acute kidney injury but not to early liver damage. Moreover, PT-induced systemic endothelial injury, as determined by plasma syndecan-1 levels, was significantly aggravated by an additional HS. These results indicate that HS adds to the systemic inflammatory reaction early after PT. Within hours after PT, HS seems to aggravate pulmonary damage and to worsen renal and endothelial function which might overall contribute to the development of early multiple organ dysfunction.
Carers and breathlessness
Authors: Farquhar Morag 
Published: June 2017

Purpose of review
Informal carers play a key role in supporting patients living with breathlessness in advanced disease, but with considerable impacts on their own well being. The purpose was to review recent advances in our understanding of the caring role in refractory breathlessness, its impacts on carers, and interventions to support them.

Recent findings
A systematic literature search resulted in 28 included articles that could be mapped to four broad areas of carer enquiry: the carer role (n = 6), role impact (n = 7), carer support (n = 11) and carer views (n = 4). Search terms focused on breathlessness, but few of the included articles were exclusively on breathlessness: most were disease-related, predominantly chronic obstructive pulmonary disease (COPD). There were a range of methodologies, including four systematic reviews; UK studies were most common.

Summary
Carers of patients with breathlessness take on a role characterized by uncertainty, largely unsupported by healthcare professionals (HCPs). HCP acknowledgement of these carers, their contribution and the impact of the caring role, is lacking. The patient–carer dyad should be considered the unit of care. Carer intervention should be individualized, supporting carers as clients and coworkers. There was a dearth of studies recruiting via primary care, focusing on conditions other than COPD and longitudinal work.
Advanced Neuroimaging Techniques: Basic Principles and Clinical Applications
Authors: Griauzde Julius , Srinivasan Ashok 
Published: June 2017

Abstract:
Advanced neuroimaging techniques are increasingly being implemented in clinical practice as complementary tools to conventional imaging because they can provide crucial functional information about the pathophysiology of a variety of disorders. Therefore, it is important to understand the basic principles underlying them and their role in diagnosis and management. In this review, we will primarily focus on the basic principles and clinical applications of perfusion imaging, diffusion imaging, magnetic resonance spectroscopy, functional MRI, and dual-energy computerized tomography. Our goal is to provide the reader with a basic understanding of these imaging techniques and when they should be used in clinical practice.
Short- and Long-term Cognitive Outcomes in Patients With Major Depression Treated With Electroconvulsive Therapy
Authors: Vasavada Megha M. , Leaver Amber M. , Njau Stephanie , Joshi Shantanu H. , Ercoli Linda , Hellemann Gerhard , Narr Katherine L. , Espinoza Randall 
Published: June 2017

Objectives
The risk of cognitive impairment is a concern for patients with major depressive disorder receiving electroconvulsive therapy (ECT). Here, we evaluate the acute, short-term and long-term effects of ECT on tests of processing speed, executive function, memory, and attention.

Methods
Forty-four patients with major depressive disorder receiving ECT (61% right unilateral, 39% mixed right unilateral–bitemporal, left unilateral, and/or bitemporal lead placement) underwent a cognitive battery prior to ECT (T1), after 2 sessions (T2), and at the end of the index (T3). Thirty-two patients returned for a 6-month follow-up (T4). Thirty-three control subjects were assessed at 2 times approximately 4 weeks apart (C1 and C2).

Results
At baseline, patients showed deficits in processing speed, executive function, and memory compared with control subjects. Including depression severity and lead placement covariates, linear mixed-model analysis showed significant improvement in only processing speed between T1 and T3 and between T1 and T4 in patients. An acute decline in attention and verbal memory was observed at T2, but performance returned to baseline levels at T3. Longitudinal cognitive outcomes did not differ in patients defined as ECT responders/nonresponders.

Limitations
Episodic memory was not measured, and medications were not controlled between T3 and T4. Control subjects also showed improvements in processing speed, suggesting practice effects for some measures.

Conclusions
In this naturalistic ECT treatment study, results show that the initiation of ECT may transiently affect memory and executive function, but cognition is largely unaffected during and after ECT. Whereas some functions might improve, others will at least remain stable up to 6 months following the ECT index.
The PRIDE Study and the Conduct of Electroconvulsive Therapy
Authors: Rasmussen Keith G. 
Published: June 2017

Abstract
The recently published PRIDE study (prolonging remission in the depressed elderly) constitutes an important contribution to electroconvulsive therapy (ECT) technique, from the standpoint of both the index course to treat depressive symptoms and the post–remission continuation period to prevent relapse. This study was probably the last large, National Institute of Mental Health–funded, multisite ECT technical study for some time to come, so extracting clinically relevant recommendations is worthwhile. In this commentary, the author discusses evidence from this trial relevant to several important clinical index and continuation ECT technical issues and elaborates several unanswered questions deserving further consideration.
Mutational signatures of DNA mismatch repair deficiency inC. elegansand human cancers
Authors: Meier B , Volkova NV , Hong Y , Schofield P , Campbell PJ , Gerstung M , Gartner A 
Published: June 2017

ABSTRACTThroughout their lifetime cells are subject to extrinsic and intrinsic mutational processes leaving behind characteristic signatures in the genome. DNA mismatch repair (MMR) deficiency leads to hypermutation and is found in different cancer types. While it is possible to associate mutational signatures extracted from human cancers with possible mutational processes the exact causation is often unknown. Here we useC. elegansgenome sequencing ofpms-2andmlh-1knockouts to reveal the mutational patterns linked toC. elegansMMR deficiency and their dependency on endogenous replication errors and errors caused by deletion of the polymerase ε subunitpole-4. Signature extraction from 215 human colorectal and 289 gastric adenocarcinomas revealed three MMR-associated signatures, one of which closely resembles theC. elegansMMR spectrum and strongly discriminates microsatellite stable and unstable tumors (AUC=98%). A characteristic difference between human andC. elegansMMR deficiency is the lack of elevated levels of NCG>NTG mutations inC. elegans, likely caused by the absence of cytosine (CpG) methylation in worms. The other two human MMR signatures may reflect the interaction between MMR deficiency and other mutagenic processes, but their exact cause remains unknown. In summary, combining information from genetically defined models and cancer samples allows for better aligning mutational signatures to causal mutagenic processes.