bluuebunny/crossref_metadata_2025_split huggingface dataset:
Explaining performance in health care: How and when top management competencies make the difference
Authors: Vainieri Milena , Ferrè Francesca , Giacomelli Giorgio , Nuti Sabina 
Published: April 2017

Background:
One of the most distinctive management competencies is related to the ability to structure the strategic vision, develop long-term plans, and communicate them efficiently to the employees in order to empower them to enact. These managerial competencies in complex organizations are strongly related to the capacity to engage professionals as a predictor of high-performing organizations.

Purpose:
The aim of this study was to investigate the relationship between top management competencies, information sharing, and organizational performance in public health care system and to look at the management role in assuring information sharing on organizational strategies to achieve professionals’ engagement.

Methodology/Approach:
This relationship is empirically tested using the longitudinal data of public health care organizations from the Tuscany Region (Italy). The top management competencies and information sharing are evaluated by the heads of the departments. While information sharing refers to the organizational level (e.g., to convey the objectives), managerial competencies refer to the individual level (e.g., to manage conflict). A random effect regression model is estimated using average responses by the health organization. Data come from the multidimensional performance evaluation system (2008 to 2014 years).

Results:
Findings show that managerial competencies are positively associated to organizational performance. Moreover, managerial competencies are strongly linked to the information sharing process developed into the organizations. In particular, managerial competencies play a significant role on whole performance, and results are mediated by the use of mature information sharing instruments such as benchmarking of performance results.

Conclusion:
Systematic information sharing process regarding performance results, goals, and organizational structure provided by top management seems an effective strategy to engage professionals. Control variables suggest that top management tenure and turnover do not have an effect, whereas bigger health care organizations seem to negatively influence this relation.

Practice Implications:
Information sharing is the basis for clinicians’ engagement and adds value to organizational performance.
CLINICOPATHOLOGIC CORRELATION OF RETINAL ANGIOMATOUS PROLIFERATION TREATED WITH RANIBIZUMAB
Authors: Skalet Alison H. , Miller Audra K. , Klein Michael L. , Lauer Andreas K. , Wilson David J. 
Published: April 2017

Purpose:
To describe histopathologic features of an eye with retinal angiomatous proliferation (RAP) secondary to age-related macular degeneration treated with serial ranibizumab injections and to correlate these findings with spectral domain optical coherence tomography.

Methods:
Histopathologic features from serial sections through the globe of a 93-year-old man with age-related macular degeneration were studied and compared with spectral domain optical coherence tomography images obtained 7 weeks before his death.

Results:
The pathologic correlate of ranibizumab-treated RAP was a circumscribed, branching paucicellular vascular complex extending from the inner plexiform layer to Bruch membrane. The histopathologic findings corresponded to an area of hyperreflectivity on spectral domain optical coherence tomography imaging, substantiating the reported tomographic appearance of RAP lesions. A frank anastomosis with choroidal or retinal vasculature was not seen in this treated RAP lesion. There was a lack of retinal pigment epithelium underlying the lesion in an area of retinal pigment epithelium detachment. The elastic portion of Bruch membrane appeared intact. Treatment with ranibizumab over an extended period of time may have been associated with a loss of cellularity of the RAP lesion.

Conclusion:
In a patient with ARMD extensively treated with ranibizumab, color fundus photography, fluorescein angiography and SD-OCT images of RAP correlated histopathologically with a paucicellular intraretinal vascular complex.
Macular Ganglion Cell and Retinal Nerve Fiber Layer Thickness in Children With Refractive Errors—An Optical Coherence Tomography Study
Authors: Goh Jody P. , Koh Victor , Chan Yiong Huak , Ngo Cheryl 
Published: April 2017

Purpose:
To study the distribution of macular ganglion cell-inner plexiform layer (GC-IPL) thickness and peripapillary retinal nerve fiber layer (RNFL) thickness in children with refractive errors.

Materials and Methods:
Two hundred forty-three healthy eyes from 139 children with refractive error ranging from −10.00 to +5.00 D were recruited from the National University Hospital Eye Surgery outpatient clinic. After a comprehensive ocular examination, refraction, and axial length (AL) measurement (IOLMaster), macular GC-IPL and RNFL thickness values were obtained with a spectral domain Cirrus high definition optical coherence tomography system (Carl Zeiss Meditec Inc.). Only scans with signal strength of >6/10 were included. Correlation between variables was calculated using the Pearson correlation coefficient. A multivariate analysis using mixed models was done to adjust for confounders.

Results:
The mean spherical equivalent refraction was −3.20±3.51 D and mean AL was 24.39±1.72 mm. Average, minimum, superior, and inferior GC-IPL were 82.59±6.29, 77.17±9.65, 83.68±6.96, and 81.64±6.70 μm, respectively. Average, superior, and inferior peripapillary RNFL were 99.00±11.45, 123.20±25.81, and 124.24±22.23 μm, respectively. Average, superior, and inferior GC-IPL were correlated with AL (β=−2.056, P-value 0.000; β=−2.383, P-value 0.000; β=−1.721, P-value 0.000), but minimum GC-IPL was not (β=−1.056, P-value 0.115). None of the RNFL parameters were correlated with AL.

Conclusions:
This study establishes normative macular GC-IPL and RNFL thickness in children with refractive errors. Our results suggest that high definition optical coherence tomography RNFL parameters and minimum GC-IPL are not affected by AL or myopia in children, and therefore warrants further evaluation in pediatric glaucoma patients.
A prospective, multisite, international validation of the Complex Regional Pain Syndrome Severity Score
Authors: Harden R. Norman , Maihofner Christian , Abousaad Elias , Vatine Jean-Jacques , Kirsling Amy , Perez Roberto S.G.M. , Kuroda Maxine , Brunner Florian , Stanton-Hicks Michael , Marinus Johan , van Hilten Jacobus J. , Mackey Sean , Birklein Frank , Schlereth Tanja , Mailis-Gagnon Angela , Graciosa Joe , Connoly Sara B. , Dayanim David , Massey Michael , Frank Hadas , Livshitz Anatoly , Bruehl Stephen 
Published: April 2017

Abstract
Clinical diagnosis of complex regional pain syndrome (CRPS) is a dichotomous (yes/no) categorization, a format necessary for clinical decision making. Such dichotomous diagnostic categories do not convey an individual's subtle gradations in the severity of the condition over time and have poor statistical power when used as an outcome measure in research. This prospective, international, multicenter study slightly modified and further evaluated the validity of the CRPS Severity Score (CSS), a continuous index of CRPS severity. Using a prospective design, medical evaluations were conducted in 156 patients with CRPS to compare changes over time in CSS scores between patients initiating a new treatment program and patients on stable treatment regimens. New vs stable categorizations were supported by greater changes in pain and function in the former. Results indicated that CSS values in the stable CRPS treatment group exhibited much less change over time relative to the new treatment group, with intraclass correlations nearly twice as large in the former. A calculated smallest real difference value revealed that a change in the CSS of ≥4.9 scale points would indicate real differences in CRPS symptomatology (with 95% confidence). Across groups, larger changes in CRPS features on the CSS over time were associated in the expected direction with greater changes in pain intensity, fatigue, social functioning, ability to engage in physical roles, and general well-being. The overall pattern of findings further supports the validity of the CSS as a measure of CRPS severity and suggests it may prove useful in clinical monitoring and outcomes research.
Modulation of brainstem activity and connectivity by respiratory-gated auricular vagal afferent nerve stimulation in migraine patients
Authors: Garcia Ronald G. , Lin Richard L. , Lee Jeungchan , Kim Jieun , Barbieri Riccardo , Sclocco Roberta , Wasan Ajay D. , Edwards Robert R. , Rosen Bruce R. , Hadjikhani Nouchine , Napadow Vitaly 
Published: April 2017

Abstract
Migraine pathophysiology includes altered brainstem excitability, and recent neuromodulatory approaches aimed at controlling migraine episodes have targeted key brainstem relay and modulatory nuclei. In this study, we evaluated the impact of respiratory-gated auricular vagal afferent nerve stimulation (RAVANS), a novel neuromodulatory intervention based on an existing transcutaneous vagus nerve stimulation approach, in the modulation of brainstem activity and connectivity in migraine patients. We applied 3T–functional magnetic resonance imaging with improved in-plane spatial resolution (2.62 × 2.62 mm) in episodic migraine (interictal) and age- and sex-matched healthy controls to evaluate brain response to RAVANS (gated to either inhalation or exhalation) and sham stimulation. We further investigated RAVANS modulation of tactile trigeminal sensory afference response in the brainstem using air-puff stimulation directed to the forehead during functional magnetic resonance imaging. Compared with sham and inhalatory-gated RAVANS (iRAVANS), exhalatory-gated RAVANS (eRAVANS) activated an ipsilateral pontomedullary region consistent with nucleus tractus solitarii (NTS). During eRAVANS, NTS connectivity was increased to anterior insula and anterior midcingulate cortex, compared with both sham and iRAVANS, in migraine patients. Increased connectivity was inversely correlated with relative time to the next migraine attack, suggesting clinical relevance to this change in connectivity. Poststimulation effects were also noted immediately after eRAVANS, as we found increased activation in putative pontine serotonergic (ie, nucleus raphe centralis) and noradrenergic (ie, locus coeruleus) nuclei in response to trigeminal sensory afference. Regulation of activity and connectivity of brainstem and cortical regions involved in serotonergic and noradrenergic regulation and pain modulation may constitute an underlying mechanism supporting beneficial clinical outcomes for eRAVANS applied for episodic migraine.
Nociceptor interleukin 10 receptor 1 is critical for muscle analgesia induced by repeated bouts of eccentric exercise in the rat
Authors: Alvarez Pedro , Bogen Oliver , Green Paul G. , Levine Jon D. 
Published: April 2017

Abstract
Delayed-onset muscle soreness is typically observed after strenuous or unaccustomed eccentric exercise. Soon after recovery, blunted muscle soreness is observed on repeated eccentric exercise, a phenomenon known as repeated bout effect (RBE). Although regular physical activity decreases muscle hyperalgesia, likely because of increased production of the anti-inflammatory cytokine interleukin-10 (IL-10) in the skeletal muscle, whether IL-10 also contributes to the antinociceptive effect of RBE is unknown. Furthermore, whether IL-10 attenuates muscle hyperalgesia by acting on muscle nociceptors remains to be established. Here, we explored the hypothesis that blunted muscle nociception observed in RBE depends on a local effect of IL-10, acting on IL-10 receptor 1 (IL-10R1) expressed by muscle nociceptors. Results show that after a second bout of eccentric exercise, rats exhibited decreased muscle hyperalgesia, indicative of RBE, and increased expression of IL-10 in the exercised gastrocnemius muscle. Although knockdown of IL-10R1 protein in nociceptors innervating the gastrocnemius muscle by intrathecal antisense oligodeoxynucleotide did not change nociceptive threshold in naive rats, it unveiled latent muscle hyperalgesia in rats submitted to eccentric exercise 12 days ago. Furthermore, antisense also prevented the reduction of muscle hyperalgesia observed after a second bout of eccentric exercise. These data indicate that recovery of nociceptive threshold after eccentric exercise and RBE-induced analgesia depend on a local effect of IL-10, acting on its canonical receptor in muscle nociceptors.
An Assessment of the Continuing Education Needs of Nurse Practitioners Who Manage Patients With Psoriasis
Authors: Barnes Justin A. , Hwang Sharon , Scalici Samantha , Merwin Patti , Kramerman Inessa , Weinberg Jeffrey M. , Cerenzia Wendy 
Published: April 2017

ABSTRACT

Introduction
Psoriasis affects 2%–3% of the U.S. population and can have a profound impact on patient quality of life. Nurse practitioners (NPs) have a key role in managing psoriasis, and they need to stay current in this rapidly evolving area. Continuing education programs can increase the capabilities of NPs; however, these programs must target the areas of greatest educational need. This study was conducted to identify and quantify educational needs among NPs related to psoriasis.

Methods
Practice patterns of NPs were assessed using a case vignette survey, a validated method of assessing clinician practice patterns. The survey instrument presented two patient cases followed by questions presenting choices for severity assessment, treatment approach, and assessment of comorbidity risks.

Results
Several important educational gaps were identified by this study. NPs generally treat patients appropriately based on the perceived level of disease severity; however, approximately half of NPs underestimated disease severity in both patient cases, setting up the possibility of undertreatment. Additional gaps were identified in assessing risks of common psoriasis comorbidities.

Conclusions
The results of this study will allow for the design of optimally targeted continuing education programs, which in turn will enhance the capabilities of NPs who manage patients with psoriasis.
Collegiate Student Athletes With History of ADHD or Academic Difficulties Are More Likely to Produce an Invalid Protocol on Baseline ImPACT Testing
Authors: Manderino Lisa , Gunstad John 
Published: April 2017

Objective:
Attention deficit hyperactivity disorder (ADHD) and other academically-relevant diagnoses have been suggested as modifiers of neurocognitive testing in sport-related concussion, such as Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). These preexisting conditions may suppress ImPACT scores to the extent that they are indistinguishable from low scores because of poor effort. The present study hypothesized that student athletes with history of ADHD or academic difficulties produce lower ImPACT composite scores and are more likely to produce invalid protocols than those without such conditions.

Design:
Cross-sectional study.

Setting:
Midsized public university.

Participants:
Nine hundred forty-nine National College Athletic Association athletes (average age = 19.2 years; 6.8% ADHD, 5.6% Academic Difficulties, 2.0% comorbid ADHD/Academic Difficulties).

Independent Variables:
Three seasons of baseline ImPACT protocols were analyzed. Student athletes were grouped using self-reported histories of ADHD or academic difficulties taken from ImPACT demographic questions.

Dependent Variables:
ImPACT composite scores and protocol validity.

Results:
Student athletes in the academic difficulties and comorbid groups performed worse on ImPACT composite scores (Pillai's Trace = 0.05), though this pattern did not emerge for those with ADHD. Student athletes with comorbid history were more likely to produce an invalid baseline (10.5% invalid) (χ2 (2) = 11.08, P = 0.004). Those with ADHD were also more likely to produce an invalid protocol (7.7% invalid, compared with 2.6% in student athletes with no history) (χ2 (2) = 10.70, P = 0.005).

Conclusions:
These findings suggest that student athletes reporting comorbid histories or histories of academic difficulties alone produce lower ImPACT composite scores, and that those with comorbid histories or histories of ADHD alone produce invalid protocol warnings more frequently than student athletes without such histories. Future studies should further examine invalid score thresholds on the ImPACT, especially in student athletes with conditions that may influence test performance.

Clinical Relevance:
Student athletes with history of ADHD or academic difficulties may more frequently fall below validity score thresholds, suggesting caution in interpreting test performance.
Rapid Infliximab Infusion in Children
Authors: Lev‐Tzion Raffi , Assa Amit , Yerushalmi Baruch , Lahad Avishay , Friedman Mira , Ledder Oren , Turner Dan 
Published: April 2017

ABSTRACTPediatric data on rapid infliximab infusion are scarce. We report our experience with a 1‐hour rapid infusion protocol, prescribed in 3 pediatric inflammatory bowel disease units during 18 to 26 months. Children treated with infliximab for inflammatory bowel disease using a standard 2‐ to 3‐hour infusion protocol were switched to a 1‐hour protocol if they had received at least 4 standard duration infusions with no infusion reactions, there was no recent dose increase and no more than 10 weeks had elapsed since the previous infusion. A total of 102 children received infliximab infusions during the study period (85 Crohn disease; mean age 14.6 ± 2.6 years) of whom 63 were switched to the rapid infusions. Seven patients on the rapid protocol (11%) and 6 patients on the standard protocol (15%) had infusion reactions (P = 0.55). Consistent with adult data, our study indicates that a 1‐hour infliximab protocol in selected patients offers a safe alternative to the traditional 2‐ to 3‐hour infusions.
Shaped versus Round Implants in Breast Reconstruction: A Multi-Institutional Comparison of Surgical and Patient-Reported Outcomes
Authors: Khavanin Nima , Clemens Mark W. , Pusic Andrea L. , Fine Neil A. , Hamill Jennifer B. , Kim H. Myra , Qi Ji , Wilkins Edwin G. , Kim John Y. S. 
Published: April 2017

Background:
Since the 2012 approval of shaped implants, their use in breast reconstruction has increased in the United States. However, large-scale comparisons of complications and patient-reported outcomes are lacking. The authors endeavored to compare surgical and patient-reported outcomes across implant types.

Methods:
The Mastectomy Reconstruction Outcomes Consortium database was queried for expander/implant reconstructions with at least 1-year postexchange follow-up (mean, 18.5 months). Outcomes of interest included postoperative complications, 1-year revisions, and patient-reported outcomes. Bivariate and mixed-effects regression analyses evaluated the effect of implant type on patient outcomes.

Results:
Overall, 822 patients (73.5 percent) received round and 297 patients (26.5 percent) received shaped implants. Patients undergoing unilateral reconstructions with round implants underwent more contralateral symmetry procedures, including augmentations (round, 18.7 percent; shaped, 6.8 percent; p = 0.003) and reductions (round, 32.2 percent; shaped, 20.5 percent; p = 0.019). Shaped implants were associated with higher rates of infection (shaped, 6.1 percent; round, 2.3 percent; p = 0.002), that remained significant after multivariable adjustment. Other complication rates did not differ significantly between cohorts. Round and shaped implants experienced similar 2-year patient-reported outcome scores.

Conclusions:
This prospective, multicenter study is the largest evaluating outcomes of shaped versus round implants in breast reconstruction. Although recipients of round implants demonstrated lower infection rates compared with shaped implants, these patients were more likely to undergo contralateral symmetry procedures. Both implant types yielded comparable patient-reported outcome scores. With appropriate patient selection, both shaped and round implants can provide acceptable outcomes in breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
A Prospective Randomized Trial Comparing the Effects of Lidocaine in Breast Reduction Surgery
Authors: Christie Brian M. , Kapur Sahil , Kempton Steve J. , Hanson Summer E. , Ma Yue , Rao Venkat K. 
Published: April 2017

Background:
Use of dilute epinephrine tumescent solution in breast reduction surgery has been shown to significantly decrease operative blood loss without increasing perioperative complications. Lidocaine is commonly added to epinephrine to decrease postoperative pain. Evidence supporting this practice, however, is limited, and lidocaine toxicity has been reported.

Methods:
With institutional review board approval, patients undergoing bilateral breast reduction surgery were assigned to receive either tumescent saline solution with epinephrine (1:1 million) (group 1), or tumescent saline solution with epinephrine (1:1 million) and lidocaine (0.05%) (group 2). Tumescent solution (500 ml) was infiltrated just before skin incision. Wise pattern reduction with an inferior pedicle was used in all cases. A nurse in the postanesthesia care unit documented immediate postoperative pain and intravenous narcotic use. Patients used a survey to record postoperative pain, nausea/vomiting, and narcotic use for the first 24 hours. Results were analyzed using analysis of variance and logistic regression models.

Results:
Forty consecutive patients were enrolled (20 in each group). There was no statistical difference between groups 1 and 2 in total intravenous narcotic use (0.89 versus 0.55; p = 0.10), 24-hour narcotic use (32.19 versus 29.47; p = 0.71), peak pain scores both in the postanesthesia care unit (5.47 versus 4.47; p = 0.24) and 24 hours postoperatively surgery (6.44 versus 6.68; p = 0.78), and 24-hour nausea/vomiting counts [group 1, OR, 1.11 (p = 0.87); group 2, OR, 1.87 (p = 0.51)]. There were no hospital admissions in either group.

Conclusions:
The addition of lidocaine to tumescent solution does not significantly affect postoperative pain following breast reduction surgery. Considering potential risks and added costs, this practice may not be of benefit.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, I.