bluuebunny/crossref_metadata_2025_split huggingface dataset:
It's in Your Hands
Authors: Chandonnet Celeste J. , Boutwell Kristan M. , Spigel Nadine , Carter Judith , DeGrazia Michele , Ozonoff Al , Flaherty Kathleen 
Published: October 2017

Background:
Health care–associated infections contribute to increased morbidity and mortality, increased resource use, higher costs, and extended hospitalizations. Proper hand hygiene (HH) is essential to health care–associated infection prevention. Low compliance among parents in our neonatal intensive care unit (NICU) was identified and prompted development of an HH initiative.

Objective:
The objective of this quality improvement project was to improve parent HH practices with the ultimate goal of achieving 100% compliance with parent HH.

Methods:
Between December 2011 and November 2014, our NICU Infection Prevention Committee developed and implemented the parent/family HH initiative entitled “It's in Your Hands” and created learning materials based on the World Health Organization and Centers for Disease Control and Prevention recommendations. Materials included information sheets, posters, stickers, and checklists. Audits, based on the World Health Organization's Five Moments for Hand Hygiene, were performed several times per week to monitor compliance.

Results:
Before the intervention, only 71% (n = 1143) of all observed parents and family members performed proper HH. After the intervention, proper HH increased to 89% (n = 939). An average compliance of 89% was maintained throughout the intervention phase.

Discussion:
This initiative led to sustained improvements in HH compliance among NICU parents. It has empowered parents to speak up and request proper HH from health care providers when interacting with their child. This initiative has been adopted as a hospital-wide standard of care.
Validated LC-MS/MS Method for the Simultaneous Determination of Amlodipine and Its Major Metabolites in Human Plasma of Hypertensive Patients
Authors: Taguchi Reina , Naito Takafumi , Sato Hikaru , Kawakami Junichi 
Published: October 2017

Background:
No information on the pharmacokinetic characteristics of amlodipine (AML) metabolites is available. This study aimed to develop a method based on isocratic liquid chromatography coupled to tandem mass spectrometry for the simultaneous determination of AML and its 2 major metabolites, dehydroamlodipine (DH-AML) and O-des[2-aminoethyl]-O-carboxymethyl DH-AML (CM-DH-AML), and to use it for monitoring this drug in hypertensive patients.

Methods:
Acetonitrile-deproteinized plasma specimens were separated using an octadecyl-silica column (3-μm particle size) with a mobile phase consisting of 50% methanol containing 0.15% of formic acid in water. The run time was 9 minutes. The mass spectrometer was run in the positive ion electrospray ionization mode. This method was applied for the determination of AML and its metabolites in plasma samples from patients treated with this drug.

Results:
The calibration curves in human plasma of AML, DH-AML, and CM-DH-AML were linear over the concentration ranges of 0.5–64, 1–64, and 0.5–64 ng/mL, respectively, and their lower limits of quantification were 0.5, 1, and 0.5 ng/mL, respectively. Their extraction recovery rates and matrix factors in human plasma were 94.8%–109.0% and 97.0%–101.4%, respectively. The intra-assay and interassay imprecisions and accuracies were within 10.8% and 95.4%–111.2%, respectively. The plasma concentration ranges of AML, DH-AML, and CM-DH-AML were 6.5–20.9, 1.4–10.9, and 5.6–38.3 ng/mL, respectively.

Conclusions:
The present method with acceptable analytical performance can be helpful for monitoring the plasma concentration of AML, including the determination of its metabolites in patients with hypertension.
EFFECT OF PATIENTS' CLINICAL INFORMATION ON THE DIAGNOSIS OF AND DECISION TO TREAT RETINOPATHY OF PREMATURITY
Authors: Gschlieber Andreas , Stifter Eva , Neumayer Thomas , Moser Elisabeth , Papp Andrea , Pircher Niklas , Dorner Guido , Egger Stefan , Vukojević Nenad , Oberacher-Velten Isabel , Schmidt-Erfurth Ursula 
Published: October 2017

Purpose:
To evaluate the effect of patients' clinical information on experts' diagnoses of retinopathy of prematurity (ROP) and decisions to treat.

Methods:
Seven experts assessed wide-field fundus photographs of eyes of 52 premature infants of ≤30 weeks' gestational age or ≤1,500 g birthweight (BW) for ROP diagnosis (stage, plus disease, and aggressive posterior ROP) and the necessity for treatment for 2 days. On Day 1, they were masked to all patient data. On Day 2, they were given information on gestational age and BW.

Results:
A significant shift in the experts' ratings toward a less aggressive ROP grading stage (P = 0.006) and less frequent decision for intervention (P = 0.021) was observed after receipt of patients' clinical information. This was truer for heavier/less premature infants (gestational age ≥ 28 0/7 weeks or BW ≥ 900 g) than those with very low BWs/high prematurity (gestational age < 24 0/7 weeks or BW < 600 g) (ROP stage P = 0.009 vs. P = 0.399, treatment decision P = 0.022 vs. P = 0.648).

Conclusion:
These results suggest knowledge of patients' clinical information influences the grading of ROP disease and decision for treatment. Retinopathy of prematurity staging seemed to be set at a lower level and the decision for treatment at a higher threshold for heavier/less premature babies. Our findings may have implications for further refinements in ROP assessment.
INTRAVITREAL INJECTION OF AIR FOR THE TREATMENT OF VITREOMACULAR TRACTION
Authors: Primavera Vito , Agea Luciana , Cicinelli Maria Vittoria , Centoducati Teresa , Alessio Giovanni , Querques Giuseppe 
Published: October 2017

Purpose:
To study the efficacy of a single intravitreal injection of air as a valuable alternative to current treatment options (conservative, pharmacological, and surgical) in patients with symptomatic, focal vitreomacular traction.

Methods:
Interventional, nonrandomized clinical study including a consecutive series of patients who underwent a single injection of 0.3 mL of air for vitreomacular traction. Each patient underwent best-corrected visual acuity, and spectral domain optical coherence tomography before and after the procedure. Mean maximal horizontal vitreomacular adhesion and a maximal foveal thickness were measured manually.

Results:
Four eyes of four patients, all males, were included in the study. Mean age was 71 ± 6.7 years; mean best-corrected visual acuity was 0.3 ± 0.08 logarithm of the minimum angle of resolution (logMAR) (20/40 Snellen equivalent). One month following treatment, complete resolution of vitreomacular traction was achieved in 100% of eyes. Mean visual acuity postinjection was 0.18 ± 0.09 logMAR (20/32 Snellen equivalent) (Student's t test for repeated measures P = 0.03). No correlation has been found between horizontal vitreomacular adhesion and best-corrected visual acuity or maximal foveal thickness and best-corrected visual acuity (P = 0.7 and P = 0.9, respectively).

Conclusion:
Intravitreal injection of air could offer a minimally invasive, low-cost alternative treatment in patients with symptomatic, persisting vitreomacular traction. Additional studies on a larger number of patients are required.
Amniotic Membrane Grafts to Reduce Pterygium Recurrence
Authors: Rosen Ronald 
Published: October 2017

Purpose:
To demonstrate the long-term outcome of pterygium surgery with adjunctive amniotic membrane transplantation (AMT) and intraoperative mitomycin C (MMC) in a large case series.

Methods:
Medical records were retrieved for this noncomparative retrospective study of all patients who had pterygium excision with adjunctive AMT and intraoperative MMC, from October 2010 to June 2016 with at least 6 months of follow-up.

Results:
There were a total of 556 eyes of 535 patients (291 males and 244 females) with average age of 51.9 ± 13 years who had pterygium excision (527 primary and 29 recurrent). For an average follow-up period of 17.3 ± 0.8 months (range 6–74 months), corneal recurrence occurred in 20 eyes (3.6%) and conjunctival recurrence in 12 (2.2%) in a total of 32 eyes (5.8%). Eleven eyes (2%) underwent reoperation. Other complications included granuloma (0.5%), diplopia (1.1%), and steroid-induced ocular hypertension (4.3%).

Conclusions:
Adjunctive use of AMT and short exposure of MMC can reduce recurrence after pterygium surgery. The procedure is less tedious and less time consuming, resulting in early recovery while saving the conjunctiva for future surgeries.
Measurement of Optic Disc Cup Surface Depth Using Cirrus HD-OCT
Authors: Kim Young Kook , Ha Ahnul , Lee Won June , Jeoung Jin Wook , Park Ki Ho 
Published: October 2017

Purpose:
To introduce the measurement method of optic disc cup surface depth using spectral-domain optical coherence tomography (SD-OCT) and then evaluate the rates of cup surface depression at 3 different stages of glaucoma.

Materials and Methods:
We retrospectively identified 52 eyes with preperimetric glaucoma, 56 with mild-or-moderate glaucoma and 50 with severe glaucoma and followed them for at least 48 months. Eyes were imaged using SD-OCT (Cirrus HD-OCT) at 12-month intervals. The mean cup surface depth was calculated using the following formula: Cup volume/(disc area×average cup-to-disc ratio2)−200 μm.

Results:
The rates of mean cup surface depression (μm/y) were significantly greater in mild-or-moderate glaucoma (−7.96±1.03) than in preperimetric (−3.11±0.61) and severe glaucoma (−0.70±0.12; all P<0.001). The percentile rates of mean cup surface depression (%/y) were significantly greater than those of average of retinal nerve fiber layer (RNFL) thinning (%/y) in preperimetric glaucoma (−1.64±0.12 vs. −1.11±0.07; P<0.001) and mild-or-moderate glaucoma (−4.20±0.33 vs. −3.14±0.19; P<0.001); and conversely, in severe glaucoma, mean cup surface depth changed slower than did average RNFL thickness (−0.64±0.06 vs. −0.75±0.08%/y; P<0.001).

Conclusions:
In early-to-moderate glaucoma, the cup surface depth changed faster than did the RNFL thickness. These results signify the possibility that SD-OCT–based estimation of cup surface depth might be useful for monitoring of glaucoma development and progression.
Late Reduction of Cocaine Cravings in a Randomized, Double-Blind Trial of Aripiprazole vs Perphenazine in Schizophrenia and Comorbid Cocaine Dependence
Authors: Beresford Thomas , Buchanan Jennifer , Thumm Elizabeth Brie , Emrick Chad , Weitzenkamp David , Ronan Patrick J. 
Published: October 2017

AbstractPurposeCo-occurring schizophrenia spectrum disorder andInternational Statistical Classification of Diseases, 10th Revisioncocaine dependence present a particularly destructive constellation that is often difficult to treat. Both conditions raise dopamine transmission effects in the brain. Traditional neuroleptics block dopamine receptors, whereas aripiprazole modulates dopamine activity as an agonist/antagonist. We tested whether dopamine modulation is superior to dopamine blocking in dual-diagnosis patients.MethodsIn a randomized, double-blind, comparison design, cocaine-dependent schizophrenic subjects actively using cocaine received either aripiprazole or perphenazine in an 8-week trial. Primary outcome targeted cocaine-free urine sample proportions, whereas cocaine craving scores were a secondary variable.ResultsSubjects (N = 44) randomized (n = 22 per group) did not differ at baseline. The proportion of cocaine-free urine samples did not differ by medication group. Contrasting weeks 3 to 5 vs 6 to 8 revealed significant late reductions in craving with aripiprazole. On the respective 5-point subscales, craving intensity decreased by 1.53 ± 0.43 (P< 0.0005) points, craving frequency by 1.4 ± 0.40 (P> 0.0004) points, and craving duration by 1.76 ± 0.44 (P> 0.0001) points.ConclusionsA drug effect of aripiprazole on craving items appeared at week 6 of treatment, on average, and was not seen before that length of drug exposure. The data suggest that dopamine modulation reduces cocaine cravings but requires an acclimation period. To understand the mechanism of action better, a trial of depot aripiprazole may be useful. Clinically, a reduction in craving potentially offers a clearer focus for ongoing behavioral treatment. It may also offer a longer-term treatment effect with respect to the severity of relapse.
S100P in Duodenal Fluid Is a Useful Diagnostic Marker for Pancreatic Ductal Adenocarcinoma
Authors: Matsunaga Taketo , Ohtsuka Takao , Asano Koichi , Kimura Hideyo , Ohuchida Kenoki , Kitada Hidehisa , Ideno Noboru , Mori Yasuhisa , Tokunaga Shoji , Oda Yoshinao , Guha Sushovan , Raimondo Massimo , Nakamura Masafumi , Tanaka Masao 
Published: October 2017

Objectives
The development of an effective screening method for pancreatic ductal adenocarcinoma (PDAC) is of paramount importance. This study assessed the diagnostic utility in pancreatic diseases of duodenal markers during upper gastrointestinal endoscopy (GIE) or endoscopic ultrasonography.

Methods
This study prospectively enrolled 299 consecutive participants, including 94 patients with PDACs, 144 patients with other pancreatic diseases, and 61 normal individuals as control subjects. All subjects underwent upper GIE or endoscopic ultrasonography either at Kyushu University Hospital (Fukuoka, Japan) or the Mayo Clinic (Jacksonville, Fla) from October 2011 to July 2014. Duodenal fluid (DF) was collected without secretin stimulation and of carcinoembryonic antigen and S100 calcium-binding protein P (S100P) concentrations were measured.

Results
Concentrations of S100P in DF were significantly higher in patients with PDAC and chronic pancreatitis than in control subjects (P < 0.01). A logistic regression model that included age found that the sensitivity and specificity of S100P concentration in diagnosing stages 0/IA/IB/IIA PDAC were 85% and 77%, respectively, with an area under the receiver operating characteristic curve of 0.82. Carcinoembryonic antigen concentrations in DF of patients with pancreatic disease did not differ significantly from control subjects.

Conclusions
Analysis of S100P concentration in DF, in combination with routine screening upper GIE, may facilitate the detection of PDAC.
Pediatric Weight Errors and Resultant Medication Dosing Errors in the Emergency Department
Authors: Hirata Kristin M. , Kang Ann H. , Ramirez Gina V. , Kimata Chieko , Yamamoto Loren G. 
Published: October 2017

Background
An accurate weight is critical for dosing medications in children. Weight errors can lead to medication-dosing errors.

Objectives
This study examined the frequency and consequences of weight errors occurring at 1 children's hospital and 2 general hospitals.

Methods
Using an electronic medical record database, 79,000 emergency department encounters of children younger than 5 years were analyzed. Extreme weights were first identified using weight percentiles. Encounters with potential weight errors were further evaluated using a retrospective chart review to determine whether a weight error and medication-dosing error occurred.

Results
The percentage of weight errors of total encounters at all 3 institutions was low (0.63% on average), but a large proportion of weight errors led to subsequent medication-dosing errors (34% on average). The children's hospital did not have clinically significantly lower occurrences of weight errors or weight-based medication errors. Common weight errors included the weight in pounds being substituted for the weight in kilograms and decimal placement errors.

Conclusions
Weight errors were uncommon at the 3 emergency departments that we studied, but they led to weight-based medication-dosing errors that had the potential to cause harm.
Research on Somatization and Somatic Symptom Disorders: Ars longa, vita brevis
Authors: Dimsdale Joel E. 
Published: October 2017

ABSTRACT
The new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition defines somatic symptom and related disorders as long-standing somatic symptoms that are associated with disproportionate thoughts, feelings, and behaviors, irrespective of whether or not a medical cause for these symptoms can be determined. In this Special Section of Psychosomatic Medicine, several articles address diagnostic issues and the central nervous system correlates of somatic symptom and related disorder and document new developments in its treatment.
Diagnostic Value of Magnetic Resonance Neurography in Cervical Radiculopathy
Authors: Schwarz Daniel , Kele Henrich , Kronlage Moritz , Godel Tim , Hilgenfeld Tim , Bendszus Martin , Bäumer Philipp 
Published: October 2017

Objective
The aim of this study was to assess the imaging appearance and diagnostic value of plexus and peripheral nerve magnetic resonance neurography (MRN) in cervical radiculopathy.

Materials and Methods
This prospective study was approved by our institutional ethics committee and written informed consent was obtained from all participants. A total of 24 patients were included with a diagnosis of cervical radiculopathy based on clinical examination, supporting electrophysiological examinations and spinal imaging consistent with the clinical syndrome. All patients then underwent a high-resolution MRN protocol including the brachial plexus from nerve roots to plexus cords using a 3-dimensional turbo spin echo with variable flip angle short tau inversion recovery and sagittal-oblique T2-weighted spectral adiabatic inversion recovery sequence, and ulnar, median, and radial nerves at the upper arm and elbow in T2-weighted fat saturated sequences. Two readers independently rated plexus elements regarding the presence of lesions at neuroforaminal levels, roots, trunks, and cord segments. Median, ulnar, and radial nerves were likewise rated. Findings were then compared to a referenced standard of cervical radiculopathy that was defined as the combined diagnosis of clinical syndrome including supporting electrophysiological exams and matching positive spinal imaging, and diagnostic performance parameters were calculated. Additional quantitative and qualitative analysis assessed peripheral nerve caliber and normalized T2-signal at arm level in cervical radiculopathy and compared them to 25 inflammatory neuropathy controls.

Results
Cervical radiculopathy resulted in distinct plexus lesion patterns for each level of neuroforaminal stenosis. Overall, brachial plexus MRN in cervical radiculopathy reached a sensitivity of 81%, a specificity of 96%, a positive predictive value of 87%, and overall diagnostic accuracy of 87%. Initial spinal magnetic resonance imaging showed multiple positive findings for clinically unaffected root levels and resulted in a specificity of 69%, a positive predictive value of 54%, and an overall diagnostic accuracy of 78%.
T2-weighted peripheral nerve lesions were detected in 79% of cervical radiculopathy cases and imitated imaging appearance of inflammatory neuropathies both quantitatively and qualitatively.

Conclusions
Complementing spine imaging in cervical radiculopathy with brachial plexus MRN can improve diagnostic accuracy by increasing specificity and positive predictive value. T2-weighted lesions of peripheral nerves can be caused by cervical radiculopathy, which must be considered a relevant diagnostic pitfall in MRN of peripheral neuropathies.
Operationalizing Healthcare Simulation Psychological Safety
Authors: Henricksen Jared W. , Altenburg Catherine , Reeder Ron W. 
Published: October 2017

Introduction
Despite efforts to prepare a psychologically safe environment, simulation participants are occasionally psychologically distressed. Instructing simulation educators about participant psychological risks and having a participant psychological distress action plan available to simulation educators may assist them as they seek to keep all participants psychologically safe.

Methods
A Simulation Participant Psychological Safety Algorithm was designed to aid simulation educators as they debrief simulation participants perceived to have psychological distress and categorize these events as mild (level 1), moderate (level 2), or severe (level 3). A prebrief dedicated to creating a psychologically safe learning environment was held constant. The algorithm was used for 18 months in an active pediatric simulation program. Data collected included level of participant psychological distress as perceived and categorized by the simulation team using the algorithm, type of simulation that participants went through, who debriefed, and timing of when psychological distress was perceived to occur during the simulation session. The Kruskal-Wallis test was used to evaluate the relationship between events and simulation type, events and simulation educator team who debriefed, and timing of event during the simulation session.

Results
A total of 3900 participants went through 399 simulation sessions between August 1, 2014, and January 26, 2016. Thirty-four (<1%) simulation participants from 27 sessions (7%) were perceived to have an event. One participant was perceived to have a severe (level 3) psychological distress event. Events occurred more commonly in high-intensity simulations, with novice learners and with specific educator teams. Simulation type and simulation educator team were associated with occurrence of events (P < 0.001). There was no association between event timing and event level.

Conclusions
Severe psychological distress as categorized by simulation personnel using the Simulation Participant Psychological Safety Algorithm is rare, with mild and moderate events being more common. The algorithm was used to teach simulation educators how to assist a participant who may be psychologically distressed and document perceived event severity.
Exposure to Simulated Mortality Affects Resident Performance During Assessment Scenarios
Authors: Goldberg Andrew , Samuelson Stefan , Khelemsky Yury , Katz Daniel , Weinberg Alan , Levine Adam , Demaria Samuel 
Published: October 2017

Background
The utility of simulated mortality remains controversial in the literature. We therefore sought primarily to determine whether there was a difference in performance for residents exposed to varying levels of simulated mortality during training scenarios. As a secondary objective, we also sought to determine whether their self-reported anxiety levels, attitudes toward, and engagement in the simulated encounters differed based on group assignment.

Methods
Fifty junior anesthesiology residents were randomized to one of the three simulation cohorts. The residents were broken into groups that either always experienced simulated patient survival (never death), always experienced simulated mortality (always death), or had a variable result based on performance (variable death). All residents experienced 12 identical training simulations with only the predetermined outcome as the variable. Residents were brought back 6 weeks after initial training for four assessment scenarios and subsequently rated on nontechnical skills and anxiety levels.

Results
Residents in the always and never death groups showed no difference in nontechnical skills using the Anesthetists' Nontechnical Skills Score before and after the simulations. Residents in the variable death group, however, had improved nontechnical skill scores when brought back for the assessment (45.2 vs 41.5 and 42.9 respectively, P = 0.01). Although all three groups had higher State-Trait Anxiety Index scores from baseline after training, only the always death group had higher anxiety scores during the assessment (43 vs 37 vs 37 P = 0.008).

Conclusions
We found that participants who experienced simulated mortality that was variably delivered, and more directly related to performance, performed better on later assessment scenarios.