bluuebunny/crossref_metadata_2025_split huggingface dataset:
Application of Sepsis Definitions to Pediatric Patients Admitted With Suspected Infections in Uganda*
Authors: Wiens Matthew O. , Larson Charles P. , Kumbakumba Elias , Kissoon Niranjan , Ansermino J. Mark , Singer Joel , Wong Hubert , Ndamira Andrew , Kabakyenga Jerome , Moschovis Peter , Kiwanuka Julius 
Published: April 2016

Objectives:
Acute infectious diseases are the most common cause of under-5 mortality. However, the hospital burden of nonneonatal pediatric sepsis has not previously been described in the resource poor setting. The objective of this study was to determine the prevalence of sepsis among children 6 months to 5 years old admitted with proven or suspected infection and to evaluate the presence of sepsis as a predictive tool for mortality during admission.

Design:
In this prospective cohort study, we used the pediatric International Consensus Conference definition of sepsis to determine the prevalence of sepsis among children admitted to the pediatric ward with a proven or suspected infection. The diagnosis of sepsis, as well as each individual component of the sepsis definition, was evaluated for capturing in-hospital mortality.

Setting:
The pediatric ward of two hospitals in Mbarara, Uganda.

Patients:
Admitted children between 6 months and 5 years with a confirmed or suspected infection.

Interventions:
None.

Measurements and Main Results:
One thousand three hundred seven (1,307) subjects with a confirmed or suspected infection were enrolled, and 65 children died (5.0%) during their admission. One thousand one hundred twenty-one (85.9%) met the systemic inflammatory response syndrome criteria, and therefore, they were defined as having sepsis. The sepsis criteria captured 61 deaths, demonstrating a sensitivity and a specificity of 95% (95% CI, 90–100%) and 15% (95% CI, 13–17%), respectively. The most discriminatory individual component of the systemic inflammatory response syndrome criteria was the leukocyte count, which alone had a sensitivity of 72% and a specificity of 56% for the identification of mortality in hospital.

Conclusions:
This study is among the first to quantify the burden of nonneonatal pediatric sepsis in children with suspected infection, using the international consensus sepsis definition, in a typical resource-constrained setting in Africa. This definition was found to be highly sensitive in identifying those who died but had very low specificity as most children who were admitted with infections had sepsis. The systemic inflammatory response syndrome–based sepsis definition offers little value in identification of children at high risk of in-hospital mortality in this setting.
Parent Satisfaction With Communication Is Associated With Physician’s Patient-Centered Communication Patterns During Family Conferences*
Authors: October Tessie W. , Hinds Pamela S. , Wang Jichuan , Dizon Zoelle B. , Cheng Yao I. , Roter Debra L. 
Published: April 2016

Objectives:
To evaluate the association between physician’s patient-centered communication patterns and parental satisfaction during decision-making family conferences in the PICU.

Design:
Single-site, cross-sectional study.

Setting:
Forty-four–bed PICUs in a free-standing children’s hospital.

Participants:
Sixty-seven English-speaking parents of 39 children who participated in an audiorecorded family conference with 11 critical care attending physicians.

Measurements and Main Results:
Thirty-nine family conferences were audiorecorded. Sixty-seven of 77 (92%) eligible parents were enrolled. The conference recordings were coded using the Roter Interaction Analysis System and a Roter Interaction Analysis System–based patient-centeredness score, which quantitatively evaluates the conversations for physician verbal dominance and discussion of psychosocial elements, such as a family’s goals and preferences. Higher patient-centeredness scores reflect higher proportionate dialogue focused on psychosocial, lifestyle, and socioemotional topics relative to medically focused talk. Parents completed satisfaction surveys within 24 hours of the conference. Conferences averaged 45 minutes in length (sd, 19 min), during which the medical team contributed 73% of the dialogue compared with parental contribution of 27%. Physicians dominated the medical team, contributing 89% of the team contribution to the dialogue. The majority of physician speech was medically focused (79%). A patient-centeredness score more than 0.75 predicted parental satisfaction (β = 12.05; p < 0.0001), controlling for the length of conference, child severity of illness, parent race, and socioeconomic status. Parent satisfaction was negatively influenced by severity of illness of the patient (β = –4.34; p = 0.0003), controlling for previously mentioned factors in the model.

Conclusions:
Parent-physician interactions with more patient-centered elements, such as increased proportions of empathetic statements, question asking, and emotional talk, positively influence parent satisfaction despite the child’s severity of illness.
Early Electroencephalographic Background Features Predict Outcomes in Children Resuscitated From Cardiac Arrest*
Authors: Topjian Alexis A. , Sánchez Sarah M. , Shults Justine , Berg Robert A. , Dlugos Dennis J. , Abend Nicholas S. 
Published: April 2016

Objectives:To determine 1) whether early electroencephalographic background features were associated with survival and neurologic outcomes among children resuscitated from cardiac arrest and not treated with therapeutic hypothermia and 2) if addition of electroencephalographic background to commonly used clinical criteria is more predictive of outcome than clinical criteria alone.Design:Retrospective study.Setting:PICU and Cardiac ICUs of a tertiary children’s hospital.Patients:Patients resuscitated from in-hospital or out-of-hospital cardiac arrest who underwent clinically indicated electroencephalographic monitoring and were not treated with therapeutic hypothermia.Interventions:None.Measurements and Main Results:One-hundred twenty-eight patients underwent electroencephalographic monitoring within 1 day of return of spontaneous circulation. Background category was normal in four subjects (3%), slow-disorganized in 58 subjects (45%), discontinuous-burst suppression in 24 subjects (19%) and attenuated-flat in 42 subjects (33%). Forty-six subjects (36%) had a reactive electroencephalography. Twenty subjects (15%) had a seizure during electroencephalographic monitoring. Absence of reactivity (p< 0.001) and seizures (p= 0.04) were associated with worse electroencephalographic background category. After controlling for covariates, for each incrementally worse background score, the odds of death was 3.63 (95% CI, 2.18–6.0;p< 0.001) and the odds of unfavorable neurologic outcome was 4.38 (95% CI, 2.51–7.17;p= 0.001).Conclusions:Worse electroencephalographic background early after resuscitation from both in-hospital and out-of-hospital cardiac arrest is associated with increased odds of death and unfavorable neurologic outcomes at hospital discharge. These electroencephalographic background patterns may be used in addition to clinical criteria to support prognostic decision making.
Listeria Meningitis in an Immunocompetent Child
Authors: Villa Giovanna , Diana Maria Cristina , Solari Nicoletta , Bandettini Roberto , Sorrentino Stefania , Loy Anna , Losurdo Giuseppe , Renna Salvatore 
Published: April 2016

Abstract

Listeria monocytogenes is a facultative anerobic, gram-positive bacillus that is isolated from the soil, vegetables, and wild or domestic animals. Listeria infection is usually found in the older adults, immunocompromised patients, pregnant women, and newborns, whereas it is rare in healthy infants and children. Listeria monocytogenes may cause meningitis, meningoencephalitis, brain abscess, pyogenic arthritis, osteomyelitis, and liver abscess in children. The course of meningoencephalitis by Listeria is often severe and even fatal. Complications such as acute hydrocephalus, brain abscess, and spine abscess can develop, and the mortality associated with listeriosis is significantly high. We present a case of a previously healthy 7-year-old boy who developed Listeria monocytogenes meningitis.
The Current Status of Development and Implementation of Medical Emergency Response Plan in Schools
Authors: Nishiuchi Tatsuya , Kinoshita Rie , Kubota Yoshie , Paul Moses , Hiraide Atsushi 
Published: April 2016

Background
Automated external defibrillators (AEDs) have been widely distributed at schools in Japan. We have demonstrated that ventricular fibrillation accounted for 68% of nontraumatic sudden cardiac arrest (SCA) in schools, suggesting that a well-prepared medical emergency response plan (MERP) for schools would improve the outcomes of SCA patients. However, it is uncertain if the MERP has been well developed or implemented in Japanese schools.

Methods and Results
We conducted a cross-sectional study of schools in Osaka using a postal questionnaire. Survey items included type of school, number of students, school staff and teaching staff, number of AEDs used and the place of installation, cardiopulmonary resuscitation (CPR) training to school staff, MERP development and implementation, and the number of SCA cases they experienced. The response rate to this survey was 44% (764 of 1728 schools). Every school except for 4 have installed at least 1 AED. Thirty-six percent of schools, however, have not yet developed and implemented a MERP for SCA. Moreover, 49% of schools surveyed have not conducted a rehearsal training session for SCA in the previous 3 years, although 95% of schools provided CPR training courses to school staff. A total of 15 schools have experienced 16 presumed or actual SCA cases in the study period. Of the 15 schools, 6 schools reported that bystanders experienced psychological stress.

Conclusions
A MERP for SCA has not yet been fully developed and implemented in the schools surveyed in our study despite widely distributed AEDs and CPR training.
Current Situation of Treatment for Anaphylaxis in a Japanese Pediatric Emergency Center
Authors: Ninchoji Takeshi , Iwatani Sota , Nishiyama Masahiro , Kamiyoshi Naohiro , Taniguchi-Ikeda Mariko , Morisada Naoya , Ishibashi Kazuto , Iijima Kazumoto , Ishida Akihito , Morioka Ichiro 
Published: April 2016

Objective
Anaphylaxis is a systemic allergic reaction that sometimes requires prompt treatment with intramuscular adrenaline. The aim of the study was to investigate the current situation regarding anaphylaxis treatment in a representative pediatric primary emergency facility in Japan.

Methods
We retrospectively examined the medical records dating from April 2011 through March 2014 from Kobe Children's Primary Emergency Medical Center, where general pediatricians work on a part-time basis. Clinical characteristics and current treatments for patients with anaphylaxis who presented to the facility were investigated. Furthermore, we compared the clinical characteristics between anaphylaxis patients given intramuscular adrenaline and those not given it.

Results
During the study period, 217 patients were diagnosed with anaphylaxis. The median Sampson grade at the time of visit was 2, and 90 patients (41%) were grade 4 or higher. No patients received self-intramuscular injected adrenaline before arrival at our emergency medical center because none of the patients had been prescribed it. Further treatment during the visit was provided to 128 patients (59%), with only 17 (8%) receiving intramuscular adrenaline. Patients given intramuscular adrenaline had significantly lower peripheral saturation of oxygen at the visit (P = 0.025) and more frequent transfer to a referral hospital (P < 0.001) than those not given intramuscular adrenaline.

Conclusions
Education for Japanese pediatric practitioners and patients is warranted, because no patients used self-intramuscular injected adrenaline as a prehospital treatment for anaphylaxis, and only severely affected patients who needed oxygen therapy or hospitalization received intramuscular adrenaline in a pediatric primary emergency setting.
Marijuana Misadventures in Children
Authors: Heizer Justin W. , Borgelt Laura M. , Bashqoy Ferras , Wang George S. , Reiter Pamela D. 
Published: April 2016

Objectives
This study aimed to explore a dose-response relationship of delta-9-tetrahydrocannabinol (THC) in THC-naïve children after unintentional acute exposure and compare clinical outcomes with non-naïve children.

Methods
A retrospective review was performed on children aged 31 days to 20 years who presented to Children's Hospital Colorado for care related to acute THC toxicity. The children were divided into groups based on exposure: group 1 (THC naïve) and group 2 (THC non-naïve).

Results
A total of 38 children (age, 3.5 [3] years) met inclusion for group 1 and an equal number of children (age, 15.1 [3.9] years) met the criteria for comparison in group 2. Eight naïve patients had documentation of estimated THC dose ingested (mean [SD], 7.13 [5.8] mg/kg; range, 2.9–19.5 mg/kg). A direct relationship between estimated oral THC dose, level of medical intervention required, and hospital disposition was observed. Lethargy/somnolence was more common in the naïve group (84% vs. 26%, P < 0.0001) whereas problems in cognition, perception, and behavior were more common in the non-naïve group (4% vs 11%, P = 0.01). The duration of clinical effect and length of hospital stay were longer in the naïve group (19.3 vs 5.0 hours, P < 0.0001) and (0.73 vs 0.19 days, P < 0.0001) respectively.

Conclusions
There seems to be a direct relationship between the estimated oral THC dose (mg/kg), hospital disposition, and level of medical intervention required. Symptoms and duration of effects after THC exposure varied based on the route of exposure, age of patient, and history of previous THC experience.
Acellular Dermal Matrix–Assisted Direct-to-Implant Breast Reconstruction and Capsular Contracture: A 13-Year Experience
Authors: Salzberg C. Andrew , Ashikari Andrew Y. , Berry Colleen , Hunsicker Lisa M. 
Published: April 2016

Background:
Use of acellular dermal matrix for implant-based breast reconstruction appears to be associated with a lower incidence of capsular contracture compared with standard reconstruction. The majority of acellular dermal matrix studies were, however, of short duration; thus, long-term incidence of capsular contracture with acellular dermal matrix use is unknown.

Methods:
Patients undergoing acellular dermal matrix–assisted breast reconstruction from December of 2001 to May of 2014 at two institutions were evaluated. Cumulative incidence of capsular contracture was determined by the performing surgeon. A retrospective chart review was performed on prospectively gathered data on patient-, breast-, surgery-, and implant-related characteristics that were analyzed as potential risk factors for the development of capsular contracture.

Results:
A total of 1584 breast reconstructions in 863 patients were performed. Mean follow-up of patients was 4.7 years; 45 percent of patients had greater than or equal to 5 years of follow-up. The cumulative incidence of capsular contracture was 0.8 percent. Smaller implant size (<400 ml) and postoperative radiotherapy were significantly associated with an increased risk of capsular contracture, but the incidence of capsular contracture was 1.9 percent in irradiated breasts. All capsular contractures developed within the first 2 years, with no new events with longer follow-up.

Conclusions:
In this long-term study, the cumulative incidence of capsular contracture with acellular dermal matrix–assisted reconstruction remains low, even in irradiated breasts. Capsular contracture appears to be an early event, and longer follow-up does not appear to increase the incidence, suggesting that acellular dermal matrix may truly mitigate the development of capsular contracture as opposed to delaying its occurrence.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Clinical Implications of the Extension of Platysmal Fibers on the Middle and Lower Face
Authors: Bae Jung-Hee , Youn Kwan-Hyun , Hu Kyung-Seok , Lee Joo-Heon , Tansatit Tanvaa , Kim Hee-Jin 
Published: April 2016

Background:
Despite the area of insertion of the facial portion of the platysma being broad and highly variable, the details of its pattern of extension and morphology are not well described in the medical literature. The aim of this study was to clarify the extension patterns of the platysma on the middle and lower face by topographic examination and detailed dissection.

Methods:
A detailed dissection was performed in the cheek region of 34 cadaveric specimens. The anatomical aspects of the extent of the platysma were classified according to its area of coverage on the cheek.

Results:
The location of the posterior fibers of the platysma passing behind the mandibular angle were located 17.1 ± 8.8 mm (mean ± SD) from the mandibular angle. The platysma was classified into patterns (A, B-1, B-2, and C) according to its coverage area: in type A (8.8 percent), areas S1 to S2, M1 to M3, and I1 to I3 were partially covered by the platysma; in type B-1 (58.8 percent), areas M1 to M3 and I1 to I3 were partially covered; in type B-2 (26.5 percent), areas M1 to M2 and I1 to I3 were partially covered; and in type C (5.9 percent), areas I1 to I3 were partially covered.

Conclusion:
The description of the extent of the facial portion of the platysma presented in this article provides detailed anatomical knowledge regarding the midface, and represents fundamentally important knowledge for surgeons conducting rhytidectomy and other facial operations.
Anatomical Study of the Axillary Nerve: Description of a Surgical Blind Zone
Authors: Maldonado Andrés A. , Howe Benjamin M. , Lawton Rich , Bishop Allen T. , Shin Alexander Y. , Spinner Robert J. 
Published: April 2016

Background:
The aim of this study was to quantify the length of the axillary nerve that is able to be dissected through a standard anterior (deltopectoral) and posterior approach. The authors hypothesize that a segment of the axillary nerve cannot be reached using both approaches simultaneously.

Methods:
Axillary nerves of five frozen cadavers were dissected using an anterior and posterior approach. A first surgical clip marked the most visible distal part of the nerve from the deltopectoral approach; a second surgical clip marked the most proximal part from the posterior approach. The two surgical clips were localized with a shoulder radiograph. The authors performed measurements of the different axillary nerve segments.

Results:
In all specimens, there were three zones of the axillary nerve: zone A (anterior), the nerve segment from the origin of the axillary nerve to the first surgical clip, located at the level of the triangle formed by the subscapularis muscle (medial), conjoined tendon (lateral), and axillary fat (inferior); zone B (blind), the nerve segment not reachable through both approaches, from the first to the second surgical clip; and zone C (circumflex), the nerve segment from the second surgical clip (located at the level of the quadrilateral space) to entry into the deltoid muscle. The mean length of the blind zone was 1.6 cm. This blind zone was found 1 to 2 cm from the glenohumeral joint.

Conclusion:
The authors have described a segment of the axillary nerve that cannot be evaluated through anterior and posterior combined approaches.
Multiplexing and Beyond in Biobehavioral Research
Authors: Mills Paul J. , Peterson Christine T. 
Published: April 2016

ABSTRACT
In contrast to traditional singleplex assays that provide values for only a single analyte in a single biological sample, multiplex assays are a time- and resource-efficient high-throughput approach that provides the opportunity to determine numerous analytes within a single- and small-sample volume. In this editorial on an article by Dorn et al. in this issue of Psychosomatic Medicine, we provide a brief description of the advantages and challenges related to multiplex assays. Although the use of multiplexing as a tool has been relatively limited in biobehavioral research, more recent studies are taking advantage of this technology to obtain deeper insight into regulatory patterns in health and disease states. Multiplex approaches range from several targets to global target profiling that importantly enable unbiased biomarker and pathway discovery.
Behavioral Interventions for Tobacco Use in HIV-Infected Smokers: A Meta-Analysis
Authors: Keith Asheena , Dong Yuelei , Shuter Jonathan , Himelhoch Seth 
Published: April 2016

Context:
Smoking is responsible for increased morbidity and mortality in HIV-infected smokers.

Objective:
To assess the efficacy of behavioral interventions for smoking cessation among HIV-infected smokers compared with the standard care.

Data sources:
PubMed, Cochrane, CINHAL, PsychINFO, and Google Scholar were searched for randomized controlled trials published in English.

Study selection:
Eligibility criteria were randomized controlled trials with targeted behavioral interventions compared with standard of care (or enhanced standard of care) aimed at promoting abstinence in HIV-infected smokers. A total of 17,384 articles were found and 17,371 were excluded; 13 full text articles were obtained and reviewed, and 8 met the eligibility criteria (Κ = 0.94).

Data extraction:
The primary outcome was expired carbon monoxide–verified 7-day point prevalence abstinence rates. Adequate sequence generation and freedom from incomplete or selective outcome reporting was used to assess study quality.

Results:
A total of 1822 subjects from 8 studies yielded a statistically significant effect of behavioral interventions in increasing abstinence in HIV-infected smokers with a moderate effect size (relative risk: 1.51; 95% confidence interval: 1.17 to 1.95). Those studies with interventions of 8 sessions or more had a large effect size for abstinence (relative risk: 2.88; 95% confidence interval: 1.89 to 4.61). When stratified by the number of sessions, there was no heterogeneity.

Conclusions:
Targeted behavioral smoking cessation interventions are efficacious. Interventions consisting of 8 sessions or more had the greatest treatment efficacy.