bluuebunny/crossref_metadata_2025_split huggingface dataset:
Developing Interactive Antimicrobial Stewardship and Infection Prevention Curricula for Diverse Learners: A Tailored Approach
Authors: Nori Priya , Madaline Theresa , Munjal Iona , Bhar Shubha , Guo Yi , Seo Susan K. , Porrovecchio Andrea , Gancher Elizabeth , Nosanchuk Joshua , Pirofski Liise-anne , Ostrowsky Belinda 
Published: July 2017

Abstract

Background
To impart principles of antimicrobial stewardship (AS) and infection prevention and control (IPC), we developed a curriculum tailored to the diverse aptitudes of learners at our medical center.

Methods
We integrated case-based modules, group learning activities, smartphone applications (apps), decision support tools, and prescription audit and feedback into curricula of the medical school, medicine residency program, infectious diseases (ID) fellowship program, and hospital medicine program operations. Interventions were implemented in 2012–2016 using a quasi-experimental before-and-after study design, and this was assessed using pre- and postintervention surveys or audit of antibiotic prescriptions.

Results
Over 180 medical students participated in the AS and IPC seminars. After smartphone app introduction, 69% reported using the app as their preferred source of antibiotic information. Approximately 70% of students felt comfortable prescribing antibiotics for a known infection compared with 40% at baseline (P = .02), and approximately 83% were able to identify the appropriate personal protective equipment for specific scenarios. Approximately 99% agreed that they have a role in promoting patient safety and preventing healthcare-associated infections as medical students. At 20 months, appropriateness of trainee antibiotic prescriptions increased by 20% (P &lt; .01). Almost all ID fellows indicated that the AS and IPC seminar was a vital training supplement. Uptake of internist antibiotic recommendations using AS decision support tools was approximately 70%.

Conclusions
All 5 interventions addressed learning objectives and knowledge gaps and are applicable across a range of environments. Evaluating long-term impact of our curriculum is the focus of future study.
Power, policy, and top income shares
Authors: Huber Evelyne , Huo Jingjing , Stephens John D 
Published: July 2017

Abstract
The rise of the super-rich has attracted much political and academic attention in recent years. However, there have been few attempts to explain the cross-national along with the temporal variation in the rise of top incomes. Drawing on the World Wealth and Income Database, we study the income share of the top 1% in current postindustrial democracies from 1960 to 2012. We find that extreme income concentration at the top is a predominantly political phenomenon, not the result of increasing marginal productivity of top managers in markets of increasing size. Top income shares are largely unrelated to economic growth, increased knowledge-intensive production, export competitiveness, financialization and wealth accumulation, though they are related to stock market capitalization. Instead, they are closely associated with political and policy changes such as union density and centralization, secular-right governments, top marginal tax rates and investment in public tertiary education.
Investigating the Impact of Different Suspicion of Infection Criteria on the Accuracy of Quick Sepsis-Related Organ Failure Assessment, Systemic Inflammatory Response Syndrome, and Early Warning Scores*
Authors: Churpek Matthew M. , Snyder Ashley , Sokol Sarah , Pettit Natasha N. , Edelson Dana P. 
Published: July 2017

Objective:
Studies in sepsis are limited by heterogeneity regarding what constitutes suspicion of infection. We sought to compare potential suspicion criteria using antibiotic and culture order combinations in terms of patient characteristics and outcomes. We further sought to determine the impact of differing criteria on the accuracy of sepsis screening tools and early warning scores.

Design:
Observational cohort study.

Setting:
Academic center from November 2008 to January 2016.

Patients:
Hospitalized patients outside the ICU.

Interventions:
None.

Measurements and Main Results:
Six criteria were investigated: 1) any culture, 2) blood culture, 3) any culture plus IV antibiotics, 4) blood culture plus IV antibiotics, 5) any culture plus IV antibiotics for at least 4 of 7 days, and 6) blood culture plus IV antibiotics for at least 4 of 7 days. Accuracy of the quick Sepsis-related Organ Failure Assessment score, Sepsis-related Organ Failure Assessment score, systemic inflammatory response syndrome criteria, the National and Modified Early Warning Score, and the electronic Cardiac Arrest Risk Triage score were calculated for predicting ICU transfer or death within 48 hours of meeting suspicion criteria. A total of 53,849 patients met at least one infection criteria. Mortality increased from 3% for group 1 to 9% for group 6 and percentage meeting Angus sepsis criteria increased from 20% to 40%. Across all criteria, score discrimination was lowest for systemic inflammatory response syndrome (median area under the receiver operating characteristic curve, 0.60) and Sepsis-related Organ Failure Assessment score (median area under the receiver operating characteristic curve, 0.62), intermediate for quick Sepsis-related Organ Failure Assessment (median area under the receiver operating characteristic curve, 0.65) and Modified Early Warning Score (median area under the receiver operating characteristic curve 0.67), and highest for National Early Warning Score (median area under the receiver operating characteristic curve 0.71) and electronic Cardiac Arrest Risk Triage (median area under the receiver operating characteristic curve 0.73).

Conclusions:
The choice of criteria to define a potentially infected population significantly impacts prevalence of mortality but has little impact on accuracy. Systemic inflammatory response syndrome was the least predictive and electronic Cardiac Arrest Risk Triage the most predictive regardless of how infection was defined.
Online Family Problem Solving for Pediatric Traumatic Brain Injury: Influences of Parental Marital Status and Participation on Adolescent Outcomes
Authors: Raj Stacey P. , Zhang Nanhua , Kirkwood Michael W. , Taylor H. Gerry , Stancin Terry , Brown Tanya M. , Wade Shari L. 
Published: July 2017

Objective:
To examine the moderating effects of parent marital status and participation on efficacy of an online family problem-solving intervention for pediatric traumatic brain injury (TBI).

Methods:
Participants were 132 adolescents (12-17 years) who had sustained a recent (<6 months) TBI and their parents. Participants were randomly assigned to the intervention (Counselor-Assisted Problem Solving, CAPS) or an Internet resource comparison (IRC) condition. CAPS was designed to support families in the initial phase following TBI, by teaching problem-solving skills and addressing common challenges. To examine the moderating effect of parent marital status, participants were divided into 4 groups (ie, CAPS married household, CAPS unmarried household, IRC married household, and IRC unmarried household). Family income and caregiver education were controlled in analyses.

Results:
Parent marital status moderated treatment effects on adolescent externalizing behavior problems. Adolescents from married households in CAPS displayed fewer behavior problems at 6 and 18 months postbaseline compared with adolescents from unmarried households in CAPS. Among married CAPS families, there were no differences in outcomes among families where 1 or 2 parents actively participated.

Conclusions:
Web-based interventions for pediatric TBI, such as CAPS, are a viable option for some although not all families. Further research is needed to investigate factors that influence efficacy to match families to the most beneficial treatments.
Risk of Cancer Recurrence Among Individuals Exposed to Antitumor Necrosis Factor Therapy
Authors: Micic Dejan , Komaki Yuga , Alavanja Aleksandar , Rubin David T. , Sakuraba Atsushi 
Published: July 2017

Background:
Patients with immune-mediated disorders such as ankylosing spondylitis, inflammatory bowel disease, psoriasis and rheumatoid arthritis are increasingly treated with tumor necrosis factor (TNF) inhibitors. The safety of anti-TNF therapy in patients with a history of cancer requires further evaluation. We conducted a systematic review and a meta-analysis of observational studies including patients with a history of cancer exposed to anti-TNF therapy assessing for a risk of new cancer or cancer recurrence.

Materials and Methods:
A computerized literature search of MEDLINE, Google scholar, and Cochrane Database of Systematic Reviews was performed through September 1, 2015. Study characteristics, quality, and risk of bias were assessed. Random-effects model meta-analyses were used to estimate the risk of new cancer development or cancer recurrence.

Results:
Nine English-language observational studies including patients with a history of cancer and exposed to anti-TNF therapy were idenitifed. The pooled incidence rate ratio of new or recurrent cancer among individuals with a history of cancer exposed to anti-TNF therapy was not significantly different compared with control therapies (incidence rate ratio, 0.90; 95% confidence interval, 0.59-1.37). Subgroup analyses were performed according to disease type, underlying cancer diagnosis, time to initiation of anti-TNF therapy and study quality. Heterogeneity of study populations, heterogeneity of the included cancer subtypes and utilization of observational studies limits the study quality.

Conclusions:
The risk of new cancer or cancer recurrence among patients with a history of cancer and use of anti-TNF therapy is similar to the risk with nonbiological disease modifying therapies. These results support the use of anti-TNF medications in select populations despite prior diagnosis of cancer.
Race, Age, and Geography Impact Hepatitis C Genotype Distribution in the United States
Authors: Gordon Stuart C. , Trudeau Sheri , Li Jia , Zhou Yueren , Rupp Loralee B. , Holmberg Scott D. , Moorman Anne C. , Spradling Philip R. , Teshale Eyasu H. , Boscarino Joseph A. , Daida Yihe G. , Schmidt Mark A. , Lu Mei 
Published: July 2017

Goals:
To determine the impact of geography and patient characteristics on hepatitis C virus (HCV) genotype and subtype distribution in a large sample of patients under routine clinical care

Background:
HCV genotype impacts disease course and response to treatment. Although several studies have reported genotype distribution within specific US populations, there are no comprehensive descriptions in large, geographically diverse cohorts.

Study:
Using data from the Chronic Hepatitis Cohort Study, we present the distribution of HCV genotypes (GT) and subtypes (ST) among a racially diverse cohort of over 8000 HCV-infected patients from four large US health systems.

Results:
Genotype distribution varied significantly by geographic and demographic factors. In age-adjusted analyses, African American patients had significantly higher prevalence of GT1 (85%) than other racial categories, largely driven by a markedly higher proportion of GT1 subtype b (∼34%) than in Asian/other (24%) and white (21%) patients. GT3 represented an increasing proportion of infections as birth decade progressed, from 4% in patients born before 1946 to 18% of those born after 1976. Within the cohort of “living/uncured” patients, highly elevated alanine aminotransferase (>2 times the upper limit of normal) was significantly more common in GT3 patients, whereas Fibrosis-4 Index scores indicative of cirrhosis were most common in the combined group of GT4&6 patients.

Conclusion:
Distribution of HCV genotypes and subtypes in the United States is more variable than suggested by previous national-level estimates and single-center studies. “Real-world” prevalence data may improve targeting of prevention, screening, and treatment efforts for hepatitis C.
Risk Factors for 30-day Hospital Readmission for Diverticular Hemorrhage
Authors: Rubin Jonah N. , Shoag Daniel , Gaetano John N. , Micic Dejan , Sengupta Neil 
Published: July 2017

Introduction:
The 2010 Affordable Care Act introduced the Hospital Readmissions Reduction Program to reduce health care utilization. Diverticular disease and its complications remain a leading cause of hospitalization among gastrointestinal disease. We sought to determine risk factors for 30-day hospital readmissions after hospitalization for diverticular bleeding.

Materials and Methods:
We utilized the 2013 National Readmission Database sponsored by the Agency for Healthcare Research and Quality focusing on hospitalizations with the primary or secondary discharge diagnosis of diverticular hemorrhage or diverticulitis with hemorrhage. We excluded repeat readmissions, index hospitalizations during December and those resulting in death. Our primary outcome was readmission within 30 days of index hospital discharge. Secondary outcomes of interest included medical and procedural comorbid risk factors. The data were analyzed using logistic regression analysis.

Results:
In total, 29,090 index hospitalizations for diverticular hemorrhage were included. There were 3484 (12%) 30-day readmissions with recurrent diverticular hemorrhage diagnosed in 896 (3%).
Index admissions with renal failure [odds ratio (OR), 1.31; 95% confidence interval (CI), 1.19-1.43], congestive heart failure (OR, 1.30; 95% CI, 1.17-1.43), chronic pulmonary disease (OR, 1.19; 95% CI, 1.09-1.29), coronary artery disease (OR, 1.12; 95% CI, 1.03-1.21), atrial fibrillation (OR, 1.12; 95% CI, 1.02-1.22) cirrhosis (OR, 1.95; 95% CI, 1.29-2.93, performance of blood transfusion (OR, 1.23; 95% CI, 1.15-1.33), and abdominal surgery (OR, 1.24; 95% CI, 1.03-1.49) had increased risk of 30-day readmission.

Conclusions:
The 30-day readmission rate for diverticular hemorrhage was 12% with multiple identified comorbidities increasing readmission risk.
Decreasing Stress and Burnout in Nurses
Authors: Magtibay Donna L. , Chesak Sherry S. , Coughlin Kevin , Sood Amit 
Published: July 2017

OBJECTIVE
The study’s purpose was to assess efficacy of blended learning to decrease stress and burnout among nurses through use of the Stress Management and Resiliency Training (SMART) program.

BACKGROUND
Job-related stress in nurses leads to high rates of burnout, compromises patient care, and costs US healthcare organizations billions of dollars annually. Many mindfulness and resiliency programs are taught in a format that limits nurses’ attendance.

METHODS
Consistent with blended learning, participants chose the format that met their learning styles and goals; Web-based, independent reading, facilitated discussions. The end points of mindfulness, resilience, anxiety, stress, happiness, and burnout were measured at baseline, postintervention, and 3-month follow-up to examine within-group differences.

RESULTS
Findings showed statistically significant, clinically meaningful decreases in anxiety, stress, and burnout and increases in resilience, happiness, and mindfulness.

CONCLUSIONS
Results support blended learning using SMART as a strategy to increase access to resiliency training for nursing staff.
System-Level Shared Governance Structures and Processes in Healthcare Systems With Magnet®-Designated Hospitals
Authors: Underwood Carlisa M. , Hayne Arlene N. 
Published: July 2017

OBJECTIVE
The purpose was to identify and describe structures and processes of best practices for system-level shared governance in healthcare systems.

BACKGROUND
Currently, more than 64.6% of US community hospitals are part of a system. System chief nurse executives (SCNEs) are challenged to establish leadership structures and processes that effectively and efficiently disseminate best practices for patients and staff across complex organizations, geographically dispersed locations, and populations.

METHODS
Eleven US healthcare SCNEs from the American Nurses Credentialing Center’s repository of Magnet®-designated facilities participated in a 35-multiquestion interview based on Kanter’s Theory of Organizational Empowerment.

RESULTS
Most SCNEs reported the presence of more than 50% of the empowerment structures and processes in system-level shared governance.

CONCLUSIONS
Despite the difficulties and complexities of growing health systems, SCNEs have replicated empowerment characteristics of hospital shared governance structures and processes at the system level.
Associations of Organizational Safety Practices and Culture With Physical Workload, Perceptions About Work, and Work-Related Injury and Symptoms Among Hospital Nurses
Authors: Lee Soo-Jeong , Lee Joung Hee 
Published: July 2017

OBJECTIVEThe study aim was to examine the relationships of organizational safety practices with nurses’ perceptions about job and risk and experiences of work-related injury and symptoms.BACKGROUNDNursing professions report high rates of work-related injuries. Organizational safety practices have been linked to workers’ safety outcomes and perceptions about work.METHODSThis study analyzed data from a random sample of 280 California RNs in a cross-sectional statewide survey. Data were collected by both postal and online surveys.RESULTSHigher perceptions of organizational safety practices (safety climate, ergonomic practices, people-oriented culture) were significantly associated with lower physical workload, lower job strain, higher job satisfaction, lower risk perception, and lower work-related injury and symptom experiences. Ergonomic practices and people-oriented culture were associated with less intention of leaving job.CONCLUSIONSOrganizational safety practices may play a pivotal role in improving positive perceptions about jobs, reducing injury risks, and promoting nurse retention.
Time of Admission to the PICU and Mortality*
Authors: McCrory Michael C. , Spaeder Michael C. , Gower Emily W. , Nakagawa Thomas A. , Simpson Sean L. , Coleman Mary A. , Morris Peter E. 
Published: July 2017

Objectives:
To evaluate for any association between time of admission to the PICU and mortality.

Design:
Retrospective cohort study of admissions to PICUs in the Virtual Pediatric Systems (VPS, LLC, Los Angeles, CA) database from 2009 to 2014.

Setting:
One hundred and twenty-nine PICUs in the United States.

Patients:
Patients less than 18 years old admitted to participating PICUs; excluding those post cardiac bypass.

Interventions:
None.

Measurements and Main Results:
A total of 391,779 admissions were included with an observed PICU mortality of 2.31%. Overall mortality was highest for patients admitted from 07:00 to 07:59 (3.32%) and lowest for patients admitted from 14:00 to 14:59 (1.99%). The highest mortality on weekdays occurred for admissions from 08:00 to 08:59 (3.30%) and on weekends for admissions from 09:00 to 09:59 (4.66%). In multivariable regression, admission during the morning 06:00–09:59 and midday 10:00–13:59 were independently associated with PICU death when compared with the afternoon time period 14:00–17:59 (morning odds ratio, 1.15; 95% CI, 1.04–1.26; p = 0.006 and midday odds ratio, 1.09; 95% CI; 1.01–1.18; p = 0.03). When separated into weekday versus weekend admissions, only morning admissions were associated with increased odds of death on weekdays (odds ratio, 1.13; 95% CI, 1.01–1.27; p = 0.03), whereas weekend admissions during the morning (odds ratio, 1.33; 95% CI, 1.14–1.55; p = 0.004), midday (odds ratio, 1.27; 95% CI, 1.11–1.45; p = 0.0006), and afternoon (odds ratio, 1.17; 95% CI, 1.03–1.32; p = 0.01) were associated with increased risk of death when compared with weekday afternoons.

Conclusions:
Admission to the PICU during the morning period from 06:00 to 09:59 on weekdays and admission throughout the day on weekends (06:00–17:59) were independently associated with PICU death as compared to admission during weekday afternoons. Potential contributing factors deserving further study include handoffs of care, rounds, delays related to resource availability, or unrecognized patient deterioration prior to transfer.
Creating a Controlled Arterio-Venous Shunt by Reversing the Extracorporeal Membrane Oxygenation Blood Flow: A Strategy for Weaning Patients Off Veno-Arterial Extracorporeal Membrane Oxygenation
Authors: Mattke Christian Adrian , Haisz Emma , Pandya Nischal , Black Anthony , Venugopal Prem 
Published: July 2017

Objectives:
To assess whether reversing the veno-arterial extracorporeal membrane oxygenation blood flow (thereby creating a controlled arterio-venous shunt) can be used to wean children off extracorporeal membrane oxygenation. The standard practice for weaning patients off VA extracorporeal membrane oxygenation is to gradually reduce the blood flows delivered through the extracorporeal membrane oxygenation pump to a minimum level followed by either insertion of an “arterio-venous bridge” and clamping of the blood flow to the patient or direct decannulation. “Pump controlled retrograde flow trial off” is a technique where the revolutions in the centrifugal pump are reduced to the point where the patient will drive the blood retrograde through the extracorporeal membrane oxygenation circuit, effectively turning the circuit into a controlled arterio-venous shunt. The revolutions per minute control the amount of shunt flow. This eliminates any cardiorespiratory support the extracorporeal membrane oxygenation circuit may provide to the patient.

Design:
Feasibility study.

Setting:
Pediatric intensive care.

Patients:
Extracorporeal membrane oxygenation-dependent pediatric patients, who were ready for weaning, and possible separation from extracorporeal membrane oxygenation entered the trial.

Intervention:
Pump controlled retrograde flow trial off.

Measurement and Main Results:
During 2016, pump controlled retrograde flow trial off was used in 17 patients, for a total of 23 episodes. One episode was unsuccessful in a patient with a body weight of 2.2 kg, where cardiac output was insufficient to provide blood flow to both body and extracorporeal membrane oxygenation circuit, though from 2.8 kg body weight upward, the technique was tolerated. The duration of pump controlled retrograde flow trial off was 15 minutes to 2.5 hours. Five cases led to a continuation of the extracorporeal membrane oxygenation run, as they were not ready to be decannulated. Fifteen patients were decannulated after the pump controlled retrograde flow trial off. No patient needed to be recommenced on extracorporeal membrane oxygenation after decannulation.

Conclusions:
Pump controlled retrograde flow trial off is an easy to use and easily reversible technique to assess patient readiness for separation from extracorporeal membrane oxygenation. Given pump controlled retrograde flow trial off can easily be stopped and—in our experience—is not associated with complications, it lowers the threshold to attempt coming off extracorporeal membrane oxygenation and facilitates accurate assessment of whether a patient will need further ongoing extracorporeal membrane oxygenation support.