bluuebunny/crossref_metadata_2025_split huggingface dataset:
Moderate IV Fluid Resuscitation Is Associated With Decreased Sepsis Mortality
Authors: Corl Keith A. , Levy Mitchell M. , Holder Andre L. , Douglas Ivor S. , Linde-Zwirble Walter T. , Alam Aftab 
Published: August 2024

OBJECTIVES:
Significant practice variation exists in the amount of resuscitative IV fluid given to patients with sepsis. Current research suggests equipoise between a tightly restrictive or more liberal strategy but data is lacking on a wider range of resuscitation practices. We sought to examine the relationship between a wide range of fluid resuscitation practices and sepsis mortality and then identify the primary driver of this practice variation.

DESIGN:
Retrospective analysis of the Premier Healthcare Database.

SETTING:
Six hundred twelve U.S. hospitals.

PATIENTS:
Patients with sepsis and septic shock admitted from the emergency department to the ICU from January 1, 2016, to December 31, 2019.

INTERVENTIONS:
The volume of resuscitative IV fluid administered before the end of hospital day- 1 and mortality.

MEASUREMENTS AND MAIN RESULTS:
In total, 190,682 patients with sepsis and septic shock were included in the analysis. Based upon patient characteristics and illness severity, we predicted that physicians should prescribe patients with sepsis a narrow mean range of IV fluid (95% range, 3.6–4.5 L). Instead, we observed wide variation in the mean IV fluids administered (95% range, 1.7–7.4 L). After splitting the patients into five groups based upon attending physician practice, we observed patients in the moderate group (4.0 L; interquartile range [IQR], 2.4–5.1 L) experienced a 2.5% reduction in risk-adjusted mortality compared with either the very low (1.6 L; IQR, 1.0–2.5 L) or very high (6.1 L; IQR, 4.0–9.0 L) fluid groups p < 0.01). An analysis of within- and between-hospital IV fluid resuscitation practices showed that physician variation within hospitals instead of practice differences between hospitals accounts for the observed variation.

CONCLUSIONS:
Individual physician practice drives excess variation in the amount of IV fluid given to patients with sepsis. A moderate approach to IV fluid resuscitation is associated with decreased sepsis mortality and should be tested in future randomized controlled trials.
Surgical Strategies to Manage Stromal Interface Irregularity Following Deep Anterior Lamellar Keratoplasty
Authors: Lucisano Andrea , Mancini Alessandra , Taloni Andrea , Giannaccare Giuseppe , Yu Angeli Christy , Carnevali Adriano , Scalzo Giovanna Carnovale , Scorcia Vincenzo 
Published: August 2024

Purpose:
The purpose of this study was to describe the various surgical approaches to manage stromal interface irregularity following deep anterior lamellar keratoplasty (DALK).

Methods:
This interventional case series included patients requiring repeat keratoplasty procedures for stromal interface opacity and/or irregularity following DALK. The following surgical techniques with the aim of restoring transparency and regularity of the central optical zone and improving visual acuity in eyes that underwent unsuccessful DALK were performed: 1) simple anterior lamellar graft exchange, 2) repeat DALK with pneumatic dissection, 3) repeat DALK with deepening of manual lamellar dissection, 4) small diameter stripping of the central stroma–endothelium–Descemet complex and its replacement with a new endothelial lamella, and 5) 2-piece microkeratome-assisted mushroom penetrating keratoplasty. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), slit-lamp examination, tonometry, and anterior corneal tomography were evaluated preoperatively, as well as 3, 6, and 12 months after surgery. Intraoperative and postoperative complications were recorded.

Results:
Preoperative BCVA was less than 20/200 and improved to 20/40 or better in all cases, reaching 20/20 in 1 patient. Corneal clarity was restored in all eyes, and no recurrence of underlying disease was observed. No intraoperative or postoperative complications were reported.

Conclusions:
This case series describes several successful surgical approaches to improve the transparency and regularity of stromal interface obtained after a DALK procedure; the choice of the technique should be customized for the single eyes to still maintain the advantages of lamellar or minimally invasive grafts.
A Psychometric Development and Evaluation of the Flow State Scale for Caregiving Tasks Among Clinical Nurses
Authors: LIN Jong-Ni , SU Pin-Yen , WANG Lin-Hua , WANG Jing-Jy , Wang Chi-Jane 
Published: August 2024

ABSTRACT

Background
The extensive research already conducted in numerous non-healthcare disciplines has consistently demonstrated the effectiveness of flow in alleviating work-related stress and boosting employee engagement in the workplace. Despite the potential benefits to nursing of improving flow, no valid instrument is currently available to measure the work-related flow experience of clinical nurses.

Purpose
This study was designed to develop the Flow State Scale for Caregiving Tasks (FSS-CT) and to evaluate its psychometric properties in the context of clinical nurses.

Methods
This study, guided by the flow theory of Mihaly Csikszentmihalyi (1975), employed a three-phase approach to developing and evaluating the psychometric properties of the FSS-CT. Five hundred thirty-six full-time clinical nurses working in hospitals of various levels in Taiwan were recruited via cluster random sampling to participate in an anonymous online survey. The content validity of the developed scale was established through expert panel verification, criterion-related validity was assessed by correlating the scale with the Work-related Flow Inventory, and construct validity was evaluated via explanatory and confirmatory factor analyses. Scale reliability was determined using Cronbach's α coefficient.

Results
The FSS-CT, a 12-item Likert scale comprising four domains, was developed. These domains capture the elements of nurses' work-related flow, including professional confidence, merging of action and awareness, balance between skill and challenge, and autotelic experience. The FSS-CT demonstrated high content validity (content validity index > .90) and satisfactory criterion-related validity (coefficient = .55, p < .001). Furthermore, the scale was found to have excellent internal consistency (Cronbach's α = .91). Factor analyses yielded a four-factor structure accounting for 69.34% of the total variance, indicating a good fit for the final model based on recommended goodness-of-fit indices.

Conclusions
The FSS-CT is a viable and dependable instrument for assessing the work-related flow experiences of nurses, with the measured outcomes offering to nursing administrators valuable insights into or directions for personnel development and work allocation initiatives.
Hereditary multiple exostoses with cervical spine involvement: a case report
Authors: Roy Ujjawal , Rouniyar Sangam , Adhikari Bikash Chandra , Rimal Kushal , Zoowa Ronit 
Published: August 2024

Introduction and Importance:
Hereditary multiple exostoses (HME) is a rare genetic disorder characterized by the formation of multiple benign bone tumors known as osteochondromas. Management of HME involves a multidisciplinary approach encompassing surgical expertise and genetic counseling. This case report highlights the significance of such an approach in optimizing outcomes for patients with HME, emphasizing the importance of individualized treatment strategies and future management.

Case Presentation:
We present the case of a 12-year-old male patient with a history of HME, who presented with symptoms including progressively enlarging and painful mass at the posterior aspect of his neck since last year. Surgical intervention was undertaken to address symptomatic lesions, focusing on preserving joint function and alleviating discomfort. The surgical approach involved careful consideration of lesion characteristics and their impact on surrounding structures.

Clinical Discussion:
The case shows the importance of a tailored surgical approach in managing symptomatic osteochondromas associated with HME, highlighting the need for careful consideration of lesion characteristics and their impact on joint function. By integrating surgical expertise with genetic counseling, clinicians can optimize outcomes while addressing familial implications and ensuring informed decision-making.

Conclusion:
This case report illustrates the significance of a multidisciplinary approach encompassing surgical intervention and genetic counseling in the management of hereditary multiple exostoses. Through individualized treatment strategies and informed decision-making, clinicians can optimize outcomes for patients with HME while providing comprehensive support and guidance for future management.
Managing neurofibromatosis type I and vision impairment in a resource-limited setting: a case study and multidisciplinary approach
Authors: Adhikari Pratik , Bhujel Nabin 
Published: August 2024

Background:
Neurofibromatosis type I (NF1) is a genetic disorder characterized by the development of multiple benign tumors along nerves in the skin, brain, and other parts of the body. It is associated with a range of clinical manifestations, including skin lesions, neurofibromas, and ocular abnormalities, which can significantly impact a patient’s quality of life. Management of NF1 is particularly challenging in resource-limited settings due to limited access to diagnostic and therapeutic resources.

Clinical presentation:
A 62-year-old woman with a known history of NF1 presented with progressive visual impairment. Her condition began in childhood with multiple hyperpigmented skin macules, which developed into numerous cutaneous tumors over time. Examination revealed numerous neurofibromas, café-au-lait spots, and axillary freckling. Significant visual impairment was caused by large fibromas on her eyelids. Histological analysis confirmed benign nerve tissue tumors.

Clinical discussion:
The management strategy in this resource-limited setting focused on regular monitoring, patient education, symptomatic treatment, and multidisciplinary care. Despite the limitations, the patient’s condition was managed effectively through these adapted strategies. The importance of genetic testing for confirmation and further management was noted but not performed due to resource constraints.

Conclusion:
This case highlights the complexities of managing NF1 in resource-limited settings, emphasizing the need for adaptable management approaches. Multidisciplinary care and patient education were crucial in improving the patient’s quality of life. This case underscores the importance of early diagnosis and intervention to prevent complications like visual impairment.
Urachal carcinoma initially presenting only as a liver metastasis, a diagnostic and therapeutic challenge: first case in literature
Authors: Bashour George , Hneino George , Zaher Zain Aldin , Dway Ali , Michael Georges , Alshehabi Zuheir 
Published: August 2024

Introduction:
Urachal carcinomas are uncommon malignant neoplasms comprising only 0.01% of all adult cancers. Most patients were aged from 58 to 64 years at diagnosis with 60 years being the median. It usually metastasizes to the lungs (22%), bones (22%), and liver (16%).

Presentation:
We report a case of a 71-year-old female patient who initially presented with two large liver masses and a small nodule on the anterior side of the bladder. The symptoms were nonspecific with abdominal discomfort. The final diagnosis of urachal adenocarcinoma was finalized with a biopsy of the bladder mass. The patient initially received six doses of FOLFOX6 without improvement and then Gem-Carbo, showing improvement after six doses. Finally, the patient received two doses of FOLFIRI-B with no response and kept deteriorating and died after 19 months of treatment.

Discussion:
About 90% of patients are symptomatic and hematuria is the most typical presenting symptom at diagnosis. The low incidence and the histopathologic similarities to adenocarcinoma from various sources pose a difficulty in recognizing the tumor. Our study presents the only case of a urachal carcinoma first manifesting with abdominal mass resulting from liver metastasis with no prior symptoms of urological origins. Also, our study presents the first attempt of using FLOFIRI-B to treat metastatic UraC.

Conclusion:
This case highlights the necessity for clinicopathological correlation to make the correct diagnosis and the challenges in the treatment which urges the need for further research to identify more effective treatment strategies for this rare cancer.
Optimizing the methodology for the assessment of bulbar conjunctival lissamine green staining
Authors: Ghorbani-Mojarrad Neema , Vianya-Estopa Marta , Martin Eilidh , Sweeney Laura E. , Terry Louise , Huntjens Byki , Wolffsohn James S. ,   on behalf of the BUCCLE Research Group
Published: August 2024

SIGNIFICANCE
When using lissamine green for bulbar conjunctival evaluation, the most staining was observed with two applications of the same strip in the same eye, wetted with a drop of saline. The first application was 5 seconds after wetting the strip, and the second was 1 minute later, followed by immediate viewing. This suggests that bulbar staining should be viewed before the lid wiper region.

PURPOSE
This study aimed to optimize the assessment of lissamine green staining of the bulbar conjunctiva by investigating the application technique and subsequent observation period.

METHODS
Twenty-two participants with dry eye (as defined by the Tear Film and Ocular Surface Society Dry Eye Workshop II) were recruited to trial five application methods in randomized order: (1) application immediately after wetting a single strip, (2) application 5 seconds after wetting a single strip, (3) application 10 seconds after wetting a single strip, (4) consecutive single application of sodium fluorescein followed by lissamine green 5 seconds after wetting, and (5) two applications using the same lissamine green strip 5 seconds after wetting, 1 minute apart. Slit-lamp photography of the conjunctiva was performed immediately following application and at 30, 60, 90, and 300 seconds after application. Three experienced (masked) practitioners independently quantified the visible punctate spots and graded the staining intensity within the images in a random order.

RESULTS
Values for punctate spot count (F = 6.29, p<0.0001) and lissamine green staining intensity (F = 6.29, p<0.0001) varied significantly between the different application methods. Using two applications of the same lissamine green strip, 1 minute apart, in the same eye resulted in the greatest values for both punctate spot count and lissamine green staining intensity. Lissamine green staining decreased with time for both spot count (F = 18.87, p<0.0001) and lissamine green staining intensity (F = 11.33, p<0.0001), with the most staining found immediately after application followed by a gradual decline. There was no evidence of any interaction effect between time and application method for either measure (p>0.05 for both).

CONCLUSIONS
The optimal approach for assessing bulbar conjunctival lissamine green staining involves two applications of a whole infused drop resting on the same strip for 5 seconds, applied 1 minute apart. The ocular surface should be viewed immediately after application to maximize the conjunctival staining observed.
Fatal Moans and Bones in Crohn's
Authors: Opara Joyce , Jarrell Heather , Jackson Nicole R. 
Published: August 2024

Abstract
Heterotopic mesenteric ossification (HMO) represents a rare reactive condition characterized by abnormal bone formation within the mesentery. HMO's etiology remains enigmatic, with proposed triggers including trauma-induced metaplasia or bone fragment dislodgment from other sites during abdominal surgery. With fewer than 100 documented cases in the literature, much about this condition remains unknown. In this report, we present a notable case of HMO in a 43-year-old man with a history of severe Crohn's disease and multiple abdominal surgeries. Following a period of unresponsiveness at home, he was admitted to the intensive care unit, where he received palliative care due to a poor prognosis. An autopsy revealed mature, benign bone fragments within the mesentery, alongside severe dehydration, likely exacerbated by decreased oral intake and medication cessation related to his ostomy. Although antemortem imaging revealed HMO, it was misattributed to contrast versus calcification. This case underscores the importance of clinician awareness regarding HMO, particularly its potential implications in inflammatory bowel disease. Early recognition and interdisciplinary collaboration among radiologists, pathologists, and clinicians are paramount in optimizing patient outcomes. Further research is warranted to elucidate this intriguing pathology's pathogenesis and best management strategies.
Extracorporeal Cardiopulmonary Resuscitation Use Among Children With Cardiac Disease in the ICU: A Meta-Analysis and Meta-Regression of Data Through March 2024
Authors: Sperotto Francesca , Daverio Marco , Amigoni Angela , Gregori Dario , Dorste Anna , Kobayashi Ryan L. , Thiagarajan Ravi R. , Maschietto Nicola , Alexander Peta M. 
Published: August 2024

OBJECTIVE:
Epidemiologic data on extracorporeal cardiopulmonary resuscitation (ECPR) use in children with cardiac disease after in-hospital cardiac arrest (IHCA) are lacking. We aimed to investigate trends in ECPR use over time in critically ill children with cardiac disease.

DATA SOURCES:
We performed a secondary analysis of a recent systematic review (PROSPERO CRD42020156247) to investigate trends in ECPR use in children with cardiac disease. PubMed, Web of Science, Embase, and Cumulative Index to Nursing and Allied Health Literature were screened (inception to September 2021). For completeness of this secondary analysis, PubMed was also rescreened (September 2021 to March 2024).

STUDY SELECTION:
Observational studies including epidemiologic data on ECPR use in children with cardiac disease admitted to an ICU.

DATA EXTRACTION:
Data were extracted by two independent investigators. The risk of bias was assessed using the National Heart Lung and Blood Institutes Quality Assessment Tools. Random-effects meta-analysis was used to compute a pooled proportion of subjects undergoing ECPR; meta-regression was used to assess trends in ECPR use over time.

DATA SYNTHESIS:
Of the 2664 studies identified, 9 (17,669 patients) included data on ECPR use in children with cardiac disease. Eight were cohort studies, 1 was a case-control, 8 were retrospective, 1 was prospective, 6 were single-center, and 3 were multicenter. Seven studies were included in the meta-analysis; all were judged of good quality. By meta-analysis, we found that a pooled proportion of 21% (95% CI, 15–29%) of pediatric patients with cardiac disease experiencing IHCA were supported with ECPR. By meta-regression adjusted for category of patients (surgical vs. general cardiac), we found that the use of ECPR in critically ill children with cardiac disease significantly increased over time (p = 0.026).

CONCLUSIONS:
About one-fifth of critically ill pediatric cardiac patients experiencing IHCA were supported with ECPR, and its use significantly increased over time. This may partially explain the increased trends in survival demonstrated for this population.
A Comparison of Telesimulation Using the Virtual Resus Room and In Situ Simulation in Pediatric Emergency Medicine
Authors: Hrdy Michael , Faig Walter , Ren Dennis , Lee Brian , Tay Khoon-Yen , Guttadauria Brittany , Zaveri Pavan , Lavoie Megan , Zhao Xian 
Published: August 2024

Objectives
During the COVID-19 pandemic, there was a marked shift toward telesimulation in medical education. Limited studies exist comparing the effectiveness of online and offline simulation education. The goals of this study are to evaluate active learners' perceived effectiveness of telesimulation versus in situ simulation and to identify potential shortcomings of existing online teaching platforms.

Methods
Through participant evaluations after a simulation, we compared telesimulation using the Virtual Resus Room (VRR) to in situ simulation in the domains of (1) self-efficacy, (2) fidelity, (3) educational value, and (4) teaching quality. Study subjects included medical and pharmacy residents and medical students completing their pediatric emergency medicine rotation at two children's hospitals as well as nurses, nurse practitioners, and physician assistants who were recently hired and orienting to their new roles in the emergency department. Learners used a modified Michigan Standard Simulation Experience Scale to evaluate either a telesimulation or in situ simulation case. Survey responses were compared using Wilcoxon rank sum tests with Bonferroni correction for multiple comparisons.

Results
In overall assessment, in situ simulation was rated higher than telesimulation. There were significant differences noted related to perceived realism, utility in training device-related skills, and utility in training team-building skills. All P values were less than 0.0036. There were no significant differences between simulation types in perception of physical examination fidelity, instructor adequacy, or self-efficacy.

Conclusions
Telesimulation using the VRR is comparable to in situ simulation in learners' perception of improvement in self-efficacy and of teaching quality for pediatric emergency medicine topics. However, participants felt less able to practice tactile and communication skills virtually. Further innovation is needed to improve learners' experience with fidelity and educational value.
Ommaya Reservoir–Assisted Treatment for Giant Cystic Solid Craniopharyngioma in Children
Authors: Shao Qiang , Xiao Kai , Xu Hao , Hu Fei , Pan Li , Chen Yang , Zhang Yang Ming , Chen Lang 
Published: August 2024

Objective:
In children with giant cystic solid craniopharyngioma (CP), the Ommaya reservoir was implanted in the CP cavity, and the cystic fluid was continuously drained for 5 days before the tumor resection.

Methods:
An 11-year-old male patient was admitted to the hospital due to vision loss for 1 year, intermittent headache, vomiting for 6 months, and frequent urination for 2 months. Besides, magnetic resonance imaging of the head showed cystic solid lesions in the sellar region, suprasellar, and bilateral frontal lobes, with a size of 96.0×82.6×76.0 mm. Before the surgical resection, an Ommaya reservoir was implanted within the tumor cavity. The drainage was continued for 5 days and was 39 to 50 mL (43.80 ± 4.67 mL). Following the tumor shrank, a craniotomy was performed.

Results:
Following surgical treatment, the CP was entirely removed. The child subsequently developed hypothyroidism and hypocortisolism, for which hormone replacement therapy was administered. No tumor recurrence was observed after 3 years of follow-up.

Conclusion:
The treatment of giant cystic solid CP in children is challenging. Preoperative implantation of the Ommaya reservoir, continuous drainage of cystic fluid, shrinkage of the tumor, and reduction of tumor tension are beneficial for tumor resection.