bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nursing Interventions for Identifying and Managing Acute Dysphagia are Effective for Improving Patient Outcomes: A Systematic Review Update
Authors: Hines Sonia , Kynoch Kate , Munday Judy 
Published: May 2016

Abstract

Background: Dysphagia, or difficulty in swallowing, is a serious and life-threatening medical condition that affects a significant number of individuals with acute neurological impairment, largely from stroke. Dysphagia is not generally considered a major cause of mortality; however, the complications that result from this medical condition, namely, aspiration pneumonia and malnutrition, are among the most common causes of death in the older adults. Methods: This is an update of an existing systematic review. The standard systematic review methods of the Joanna Briggs Institute were used. Methods were specified in advance in a published protocol. A wide range of databases were searched for quantitative research articles examining the effectiveness of nursing interventions to identify and manage dysphagia in adult patients with acute neurological dysfunction, published between 2008 and 2013. Results: Four new studies were added in this update, for a total of 15 included studies. Strong evidence was found to show that nurse-initiated dysphagia screening is effective for reducing chest infections in patients with dysphagia (odds ratio [OR] = 0.45, 95% CI [0.33, 0.62], p < .00001). Nurse-initiated dysphagia screening by trained nurses may be effective for detection of dysphagia, and training nurses in dysphagia screening improves the number and accuracy of screens conducted. The presence of formal dysphagia guidelines in a health facility is likely to reduce inpatient deaths (OR = 0.60, 95% CI [0.43, 0.84], p = .003) and chest infections (OR = 0.68, 95% CI [0.51, 0.90], p = .008); however, it does not appear that formal guidelines have an effect on length of stay. Conclusions: Nurse-initiated dysphagia screening for patients with acute neurological dysfunction is effective for a range of important patient outcomes. The presence of formal guidelines for the identification and management of dysphagia may have a significant effect on serious adverse outcomes such as chest infections and death. Training nurses to conduct dysphagia screening will improve patient outcomes.
Childhood diabetes in Africa
Authors: Piloya-Were Thereza , Sunni Muna , Ogle Graham D. , Moran Antoinette 
Published: May 2016

Purpose of review
This review summarizes the current state of diabetes in African children.

Recent findings
Type 1 diabetes is the most common form of pediatric diabetes in Africa. Significant improvements have been achieved over the last 6 years, including the training of more than 60 pediatric endocrinologists who are now practicing in 14 African nations, greater training of other healthcare providers, increased availability of insulin through the efforts of philanthropic organizations and industry, modestly better availability of testing supplies, and the introduction of patient education materials in native languages. However, there is still a long way to go before the standard-of-care available to children in resource-rich nations is available to children with diabetes in Africa.

Summary
Here, we review the known epidemiology, pathophysiology, complications, and treatment of diabetes in children in Africa.
The Impact of Integrated Case Management on Health Services Use and Spending Among Nonelderly Adult Medicaid Enrollees
Authors: Sabik Lindsay M. , Bazzoli Gloria J. , Carcaise-Edinboro Patricia , Chandan Priya , Harpe Spencer E. 
Published: May 2016

Background:
Medicaid plans, whose patients often have complex medical, social, and behavioral needs, seek tools to effectively manage enrollees and improve access to quality care while containing costs.

Objectives:
The aim of this study is to examine the effects of an integrated case management (ICM) program operated by a Medicaid managed care plan on health service use and spending for nonelderly, nonpregnant adults.

Research Design:
We estimate the relationship between intensity of ICM program involvement and changes in utilization and spending for patients who participated in ICM. We examine whether effects differ between high-risk and lower-risk individuals and between the early and late stages of the program, given that the latter relied on more targeted and patient-centered approaches. Specifically, we estimate linear regressions modeling changes in utilization and spending outcomes as a function of number of program contacts, conditional on number of days over which contacts occurred, as well as individual-level covariates and case manager fixed effects.

Results:
In the late ICM program period, we observe significant decreases in outpatient utilization associated with program involvement intensity among high-risk ICM participants. We also observe decreases in spending associated with program involvement intensity among the lower-risk group in the late period, although there is no significant impact on spending among high-risk enrollees.

Conclusions:
ICM can be a successful strategy for impacting health services use and spending. Our findings suggest that careful program targeting, well-structured client engagement, and direct one-on-one contact are vitally important for achieving program objectives.
Dental Care in an Equal Access System Valuing Equity
Authors: Boehmer Ulrike , Glickman Mark , Jones Judith A. , Orner Michelle B. , Wheler Carolyn , Berlowitz Dan R. , Kressin Nancy R. 
Published: May 2016

Background:
Racial disparities in dental care have previously been shown in the Veterans Health Administration (VA)—a controlled access setting valuing equitable, high-quality care.

Objectives:
The aim of this study is to examine current disparities in dental care by focusing on the receipt of root canal therapy (RCT) versus tooth extraction.

Research Design:
This is a retrospective analysis of data contained in the VA’s electronic health records. We performed logistic regressions on the independent measures along with a facility-specific random effect, using dependent binary variables that distinguished RCT from tooth extraction procedures.

Subjects:
VA outpatients who had at least 1 tooth extraction or RCT visit in the VA in fiscal year 2011.

Measures:
A dependent binary measure of tooth extraction or RCT. Other measures are medical record data on medical comorbidities, dental morbidity, prior dental utilization, and demographic characteristics.

Results:
The overall rate of preferred tooth-preserving RCT was 18.1% during the study period. Black and Asian patients were most dissimilar with respect to dental morbidity, medical and psychological disorders, and black patients had the least amount of eligibility for comprehensive dental care. After adjustment for known confounding factors of RCT, black patients had the lowest RCT rates, whereas Asians had the highest.

Conclusions:
Current quality improvement efforts and a value to improve the equity of care are not sufficient to address racial/ethnic disparities in VA dental care; rather more targeted efforts will be needed to achieve equity for all.
Unnecessary Emergency Transfers for Evaluation by a Plastic Surgeon: A Burden to Patients and the Health Care System
Authors: Drolet Brian C. , Tandon Vickram J. , Ha Austin Y. , Guo Yifan , Phillips Benjamin Z. , Akelman Edward , Schmidt Scott T. 
Published: May 2016

Background:
Plastic surgeons are frequently consulted for hand and facial injuries, and patients are often transferred to trauma centers for evaluation of these problems. The authors sought to identify the frequency and impact of “unnecessary” transfers for emergency evaluation by a plastic surgeon at a Level I trauma center.

Methods:
The authors reviewed more than 32,000 consecutive emergency department encounters at their institution between April of 2009 and April of 2013 and found 1181 patients transferred for evaluation by plastic surgery. Using a retrospective chart review, necessity of transfer was determined based on the intervention performed at the authors’ institution and the availability of resources at the transferring site.

Results:
Of all the patients referred for “emergency” evaluation, 860 (74.1 percent) were unnecessary. Transfers for hand-related issues were more likely to be coded as unnecessary compared with referrals for facial trauma and infection (76 percent versus 66 percent; p < 0.001). The average time from referral to discharge from the emergency department was 412 minutes. The expense for these unnecessary transfers exceeded $4.6 million.

Conclusions:
This is the first intervention-based study evaluating the impact of unnecessary transfer for evaluation of hand and facial emergencies. Using a framework based on objective outcomes, the authors found that fewer than one-third of patients required emergent transfer for evaluation by a plastic surgeon, and almost half did not receive an intervention following transfer. Based on patient time and financial expenses for these unnecessary evaluations, improvements could be made in both quality and cost of care by limiting inappropriate emergency department referrals.
Surgical Management of Polyostotic Craniofacial Fibrous Dysplasia: Long-Term Outcomes and Predictors for Postoperative Regrowth
Authors: Boyce Alison M. , Burke Andrea , Cutler Peck Carolee , DuFresne Craig R. , Lee Janice S. , Collins Michael T. 
Published: May 2016

Background:
The mainstay of treatment for craniofacial fibrous dysplasia is surgical; however, optimal indications and techniques are poorly understood, particularly in polyostotic disease and McCune-Albright syndrome. This study investigated surgical indications and risk factors for recurrence in a large cohort.

Methods:
One hundred thirty-three craniofacial fibrous dysplasia subjects in a natural history study were evaluated. Radiographic studies, operative reports, and clinical records were reviewed.

Results:
Thirty-six subjects underwent 103 craniofacial procedures (mean, 2.8 operations per subject), with 13.5 ± 10.5-year follow-up (range, 0 to 39 years). The most common indication was craniofacial deformity (n = 61 operations), including 36 initial operations (59 percent) and 26 reoperations (41 percent). Mean time to reoperation was 3.4 ± 3.2 years (range, 0.3 to 13.3 years). Regrowth occurred after 42 operations (68 percent), and was more frequent after operations in subjects with McCune-Albright syndrome growth hormone excess [22 of 25 operations (88 percent)] than without growth hormone excess [15 of 36 operations (58 percent); p = 0.02]. Of 11 subjects with growth hormone excess, nine (82 percent) were undiagnosed at the time of their initial operation. Regrowth was more frequent after debulking procedures [31 of 38 (82 percent)] than after more aggressive reconstructions [nine of 20 (45 percent); p = 0.007]. Eleven subjects underwent treatment for aneurysmal bone cysts, with recurrence in one subject. Eleven subjects underwent biopsies and none had complications or regrowth.

Conclusions:
Craniofacial fibrous dysplasia regrowth and reoperation are common, particularly after debulking procedures. Outcomes are favorable for aneurysmal bone cysts and biopsies. McCune-Albright syndrome growth hormone excess is a risk factor for regrowth, and may be underdiagnosed in surgical patients. Surgeons should be aware of appropriate screening for endocrinopathies in fibrous dysplasia. These findings highlight the importance of a multidisciplinary approach to craniofacial fibrous dysplasia, and individualized care with long-term follow-up.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Simultaneous Scalp, Skull, Kidney, and Pancreas Transplant from a Single Donor
Authors: Selber Jesse C. , Chang Edward I. , Clemens Mark W. , Gaber Lilian , Hanasono Matthew M. , Klebuc Michael , Skoracki Roman J. , Trask Todd , Yu Peirong , Gaber A. Osama 
Published: May 2016

Background:
Vascularized composite allotransplantation is an emerging field, but the complications of lifelong immunosuppression limit indications. Vascularized composite allotransplantation in solid organ recipients represents a unique opportunity because immunosuppression has already been accepted. This report of a simultaneous scalp, skull, kidney, and pancreas transplant represents both the first skull-scalp transplant and combination of a vascularized composite allotransplantation with double organ transplantation.

Methods:
A previous recipient of a kidney-pancreas transplant presented with osteoradionecrosis of the calvaria and a large area of unstable scalp following successful, curative treatment of a scalp tumor. His kidney and pancreas functions were also critically poor. A multidisciplinary, multi-institutional plan was developed to perform a simultaneous scalp, skull, and repeated kidney and pancreas transplantation, all from a single donor.

Results:
Eighteen months after the patient was listed with the United Network for Organ Sharing, a donor was identified and the multiorgan vascularized composite allotransplantation was performed. Twenty physicians and 15 hours were required to perform donor and recipient procedures. The patient recovered well and was discharged on postoperative day 15. He has had one episode of scalp rejection confirmed by biopsy and treated successfully. His creatinine value is currently 0.8 mg/dl, from 5.0 mg/dl, and his blood glucose levels are normal without supplemental insulin. Aesthetic outcome is very satisfactory. The patient is now 1 year post-transplantation and doing well.

Conclusions:
Vascularized composite allotransplantation in solid organ recipients is an expansion of current indications to already immunosuppressed patients. Rejection of the vascularized composite allotransplant without solid organ rejection can occur and is treatable. Methodical planning, an interdisciplinary approach, and careful management of all organs are critical to success.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Breast Cancer–Related Lymphedema: Quality of Life after Lymph Node Transfer
Authors: De Brucker Ben , Zeltzer Assaf , Seidenstuecker Katrin , Hendrickx Benoit , Adriaenssens Nele , Hamdi Moustapha 
Published: May 2016

Background:
Breast cancer–related lymphedema affects multiple aspects of patients’ daily lives. The main aim of this study was to assess the impact of vascularized lymph node transfer on the quality of life in patients with lymphedema.

Methods:
Between 2007 and 2012, 25 female patients with breast cancer–related lymphedema underwent vascularized lymph node transfer. In 22 cases, the patients underwent a simultaneous deep inferior epigastric artery perforator flap breast reconstruction based on the superficial circumflex iliac artery. The influence on quality of life was evaluated using the Upper Limb Lymphedema-27 questionnaire, which includes physical, psychological, and social dimensions. The authors also investigated risk factors for lymphedema, such as body mass index, smoking, age, and time between start of lymphedema and vascularized lymph node transfer, and their impact on quality of life.

Results:
Twenty-one patients (84 percent) had an improvement of quality of life after vascularized lymph node transfer. The mean physical, psychological, and social scores were significantly improved postoperatively (p < 0.001). Risk factors for the development of lymphedema did not influence quality of life among patients with breast cancer–related lymphedema. Skin infections disappeared in 50 percent of the cases. Eleven patients (44 percent) discontinued compression therapy at a mean postoperative time interval of 29 months (range, 8 to 64 months). In the other patients (56 percent), the average frequency of compression therapy decreased from three sessions to one session per week.

Conclusion:
Vascularized lymph node transfer significantly improves quality of life among patients with breast cancer–related lymphedema.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Revisions in Implant-Based Breast Reconstruction: How Does Direct-to-Implant Measure Up?
Authors: Clarke-Pearson Emily M. , Lin Alex M. , Hertl Catherine , Austen William G. , Colwell Amy S. 
Published: May 2016

Background:
Immediate direct-to-implant breast reconstruction is increasingly performed for breast cancer treatment or prevention. The advantage over traditional tissue expander/implant reconstruction includes the potential for fewer surgical procedures.

Methods:
Retrospective, single-institution, three-surgeon review identified patients undergoing implant-based reconstruction from 2006 to 2011.

Results:
Six hundred eighty-two reconstructions were performed in 432 women with an average follow-up of 5 years. Four hundred sixty-five were direct-to-implant reconstructions with acellular dermal matrix while 217 were tissue expander/implant reconstructions without acellular dermal matrix. The overall revision rate in direct-to-implant reconstruction was 20.9 percent. There was no difference in total revision rates between direct-to-implant and tissue expander reconstruction (20.9 percent versus 20.3 percent; p = 0.861). Subgroup analysis showed no difference in revision for malposition (3.4 percent versus 5.5 percent; p = 0.200), size change (6.7 percent versus 5.5 percent; p = 0.569), fat grafting (8.6 percent versus 9.7 percent; p = 0.647), or capsular contracture (4.5 percent versus 3.2 percent; p = 0.429). Multivariable logistic regression analysis showed complications were associated with higher rates of revision for malposition or size in both groups (OR, 2.8; 95 percent CI, 1.56 to 5.13; p = 0.001). Smoking, preoperative irradiation, skin necrosis, and one surgeon were associated with higher rates of fat grafting, whereas increasing body mass index was associated with lower rates. Postoperative radiotherapy and hematoma were predictive of revision for capsular contracture.

Conclusions:
The 5-year revision rate in this series of direct-to-implant reconstruction was approximately 21 percent and similar to the revision rate in tissue expander/implant reconstruction. Surgical complications, radiotherapy, and the surgeon influenced the rate of revision similarly in both groups.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Application of Computed Tomography Angiography Mapping and Located Template for Accurate Location of Perforator in Head and Neck Reconstruction with Anterolateral Thigh Perforator Flap
Authors: Shen Yi , Huang Jian , Dong Min-jun , Li Jun , Ye Wei-min , Sun Jian 
Published: May 2016

Background:
The authors introduce a new method of preoperative computed tomography angiography mapping and virtual and printed located template for accurate location of perforators in the anterolateral thigh perforator flap for head and neck reconstruction.

Methods:
Between April and December of 2014, a cohort study was performed with 29 patients who underwent head and neck reconstruction with anterolateral thigh perforator flaps. Computed tomography angiography images were processed for maximum intensity projection and volume rendering to obtain and evaluate the perforator information. The virtual and printed templates with grid were used to transfer the perforator information for intraoperative guidance during flap harvest. The preoperative angiography results were compared with the high-frequency color Doppler results and with the intraoperative real-time findings to evaluate the accuracy of computed tomography angiography mapping.

Results:
The source vessel, origin, location, direction, number, and caliber of the perforators were determined by preoperative computed tomography angiography mapping. All of the perforator data were accurately mapped on a virtual template and printed on the located template to guide flap harvest. The flap was actually used and survived successfully in 20 patients. The results for perforators identified by mapping were more accurate than those for perforators identified by Doppler. There was no significant difference between the preoperative computed tomography angiography results and the intraoperative findings (p > 0.05).

Conclusions:
The role of preoperative computed tomography angiography mapping in guiding anterolateral thigh perforator flap harvest and reducing the unpredictable risk of surgery is acceptable. Located virtual and printed template with grid can transform preoperative computed tomography angiography information to the intraoperative setting accurately and easily.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Diagnostic, II.
Management of the Salivary Glands and Facial Nerve in Face Transplantation
Authors: Frautschi Russell , Rampazzo Antonio , Bernard Steven , Djohan Risal , Papay Francis , Gharb Bahar Bassiri 
Published: May 2016

Background:
Since the first face transplant in 2005, 35 cases have been performed worldwide with acceptable graft survival and satisfactory return of function and appearance. With increasing experience, it is emerging that the salivary glands can contribute to the challenges encountered in the perioperative period.

Methods:
A comprehensive review of the literature regarding management of the salivary glands and facial nerve in facial transplantation was performed. Data gathered included inclusion or exclusion of submandibular and parotid glands in the recipient and allograft, extent of mucosal inclusion in the allograft, salivary complications and treatment, level and method of facial nerve repair, and motor nerve outcomes.

Results:
Information on salivary gland management was available for 25 cases. Undesirable salivary events were documented in 12 cases (48 percent). The source of complications was the parotid in five cases (42 percent), a combination of the parotid and submandibular glands in three cases (25 percent), and minor salivary glands in four cases (33 percent). Postoperative botulinum toxin injections resolved salivary collections in four cases. Facial nerve continuity was restored at the level of the trunk/primary divisions (66 percent) or the terminal branches (34 percent), with inclusion of the whole parotid dictating a trunk repair and exclusion of the parotid dictating a terminal branch repair.

Conclusions:
The salivary glands warrant increased attention in surgical planning and postoperative care. Exclusion of the salivary glands from the facial allograft with repair of the terminal branches of the facial nerve appears to be preferable. Botulinum toxin should be considered for prophylaxis and treatment of salivary collections.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.