bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hospital Readmission in Children With Complex Chronic Conditions Discharged From Subacute Care
Authors: Jurgens Valerie , Spaeder Michael C. , Pavuluri Padmaja , Waldman Zev 
Published: May 2014

Objectives:Children with complex chronic conditions (CCC) are responsible for a disproportionate number of hospital readmissions. This study sought to determine 30-day hospital readmission rates in children with CCC discharged from a rehabilitation and transitional care hospital and to identify factors associated with increased risk of readmission.Methods:We conducted a retrospective cohort study identifying children with CCC discharged over an 18-month period from a subacute care facility staffed by hospitalists from a freestanding children’s hospital. The primary outcome measure was readmission to the referring acute care hospital within 30 days of the subacute discharge.Results:Of the 272 discharged patients meeting inclusion criteria as children with at least 1 CCC, 19% had at least 1 readmission within 30 days of discharge. On univariate analysis, readmission was associated with the number of home medications (P = .001), underlying chronic respiratory illness (P &lt; .001), home apnea or pulse oximetry monitor use (P = .02), tracheostomy and/or ventilator dependence (P = .003), length of stay (P = .04), and number of follow-up appointments (P = .02). On multivariate analysis, the number of discharge medications was associated with increased odds of readmission (odds ratio: 1.11 [95% confidence interval: 1.03–1.20]; P = .01). Receiver operating curve analysis identified a cutoff of 8 medications as most associated with readmission; in patients discharged with ≥8 medications, the hospital readmission rate was 29%.Conclusions:This is the first known study that investigated hospital readmission rates in children with CCC discharged from a subacute facility and specifically identified the number of discharge medications as a significant risk factor for readmission.
Administrative Data Misclassifies and Fails to Identify Nephrotoxin-Associated Acute Kidney Injury in Hospitalized Children
Authors: Schaffzin Joshua K. , Dodd Caitlin N. , Nguyen Hovi , Schondelmeyer Amanda , Campanella Suzanne , Goldstein Stuart L. 
Published: May 2014

Objectives:
Nephrotoxin exposure is a common cause of acute kidney injury (AKI) in hospitalized children. AKI detection relies on regular serum creatinine (SCr) screening among exposed patients. We sought to determine how well administrative data identify hospitalized noncritically ill children with nephrotoxic medication-associated AKI in the contexts of incomplete and complete screening.

Methods:
We conducted a single-center retrospective cohort study among noncritically ill hospitalized children. We compared administrative data sensitivity to that among a separate cohort for whom adequate screening was defined as daily SCr measurement. For the original cohort, nephrotoxin exposure was defined as exposure to ≥3 nephrotoxins at once or ≥3 days of aminoglycoside therapy. AKI was defined by the change in SCr (pediatric-modified Risk Injury Failure Loss End-Stage Renal Disease [pRIFLE] criteria) or discharge code. Adequate SCr screening was defined as 2 measurements obtained ≤96 hours apart. Administrative data and laboratory values were merged to compare AKI by discharge code and pRIFLE criteria.

Results:
747 of 1472 (50.7%) nephrotoxin-exposed patients were adequately screened; 82 (11.0%) had AKI by pRIFLE criteria, 52 (7.0%) by discharge code. Sensitivity of nephrotoxin-associated AKI diagnosis by discharge code compared with pRIFLE criteria was 23.2% (95% confidence interval = 14.0–32.3). In the comparison cohort, 70 (26.8%) patients had AKI by pRIFLE criteria and 26 (10.0%) by discharge code; sensitivity was 21.4% (95% confidence interval = 11.8%–31.0%).

Conclusions:
pRIFLE criteria identified more patients than were identified by discharge code. Identifying patients with nephrotoxin-associated AKI by discharge code, even in the presence of complete AKI detection, underrepresents the true incidence of nephrotoxin-associated AKI in hospitalized children.
Fellowship Program Directors Perspectives on Fellowship Training
Authors: Freed Gary L. , Dunham Kelly M. , Moran Lauren M. , Spera Laura , McGuinness Gail A. , Stevenson David K. 
Published: May 2014

BACKGROUND:
Recently the American Board of Pediatrics has undertaken an effort to examine the components and structure of pediatric fellowship training. To provide the current status of training programs and the perspectives of those in positions of leadership regarding fellowship training, a study of all fellowship program directors in the United States was undertaken.

METHODS:
We conducted a mail survey of all 719 pediatric fellowship program directors in the United States.

RESULTS:
The response rate was 82.2%. Fellowship directors were almost evenly divided regarding whether they believe that there is a need to change the expected amount of clinical training time in their own subspecialty, with 51% stating the amount was appropriate and 48% believing it should be increased. Fewer than half (42%) of program directors believe that the amount of scholarly training time should be the same for all fellows in their subspecialty regardless of career path (ie, primarily clinical versus primarily research). The majority (58%) stated that regardless of career path, the required training for all fellows in their own subspecialty should remain 3 years. Only one-third of program directors strongly believed that quality improvement activities were an important component of fellowship training.

CONCLUSIONS:
Variation exists among fellowship program directors in their perceptions of the goals and structure of fellowship training. Determining the best way to both account for and recognize the specific nuances of each subspecialty, while maintaining a common set of standards for the profession, will be an important and ongoing effort into the future.
Specialty Specific Comparisons Regarding Perspectives on Fellowship Training
Authors: Freed Gary L. , Dunham Kelly M. , Moran Lauren M. , Spera Laura , McGuinness Gail A. , Stevenson David K. 
Published: May 2014

BACKGROUND:
As part of a recent effort by the American Board of Pediatrics to examine fellowship training, a task force was established to review the components of training and develop recommendations for any modifications deemed necessary. To inform the task force, several studies were undertaken to gain insights and perspectives from current fellows, those who had completed fellowship training, and program directors regarding their experiences and the perceived value of their training. This article provides the findings for each subspecialty in tables that allow comparison with all other subspecialties for each study population.

METHODS:
All data were first analyzed for missing or incomplete response patterns. Frequency distributions of all findings were prepared for each specific subspecialty. Next, χ2 statistics were used to compare each subspecialty with the others. A P value &lt;.05 was considered significant.

RESULTS:
Results for each question for each study population are shown in the tables, provided in the online data supplement. Supplemental Tables 1–29 are for program directors, Supplemental Tables 30–48 are for current fellows, Supplemental Tables 49–76 are for recent fellowship graduates, and Supplemental Tables 77–99 are for midcareer subspecialists.

CONCLUSIONS:
There are significant differences between the subspecialties in their perceptions of a variety of issues involving fellowship training.
Pediatric Subspecialty Fellowship Clinical Training Project: Current Fellows
Authors: Freed Gary L. , Dunham Kelly M. , Moran Lauren M. , Spera Laura , McGuinness Gail A. , Stevenson David K. 
Published: May 2014

BACKGROUND:The American Board of Pediatrics certifies physicians in general pediatrics and 14 pediatric subspecialties. Historically, all subspecialties have a standard pathway of training that is 3 years in duration to ensure time for both clinical and scholarly training and experience. In 2004, the American Board of Pediatrics expanded the scope for scholarly activity in fellowship training to include the assignment of each fellow to a Scholarship Oversight Committee and the completion of a scholarly activities core curriculum across subspecialties.METHODS:We conducted a national survey of all current fellows in 13 pediatric subspecialties who took the subspecialty in-training examination (N = 3551). Overall, 86% of all pediatric fellows in the United States sit for the examination.RESULTS:The majority (65%; N = 2178) believe the minimum 12-month expectation for clinical training is appropriate for their specific subspecialty. The majority of fellows (59%; N = 1984) do not agree that the amount of scholarly activity should be the same for all fellows in their respective subspecialties regardless of career path (ie, primarily clinical versus primarily research). Half (50%; N = 1661) posited that the required duration of training, regardless of career path, should remain at 3 years.CONCLUSIONS:Balancing the components of subspecialty training is an important and probably never-ending quest. As changes in the health care system and care delivery organization continue, what we expect and need from our subspecialists, from the perspectives of the profession, the health care delivery system, and the public, will probably vary over time.
Efficacy of orally administered maropitant citrate in preventing vomiting associated with hydromorphone administration in dogs
Authors: Hay Kraus Bonnie L. 
Published: May 2014

Abstract
Objective—To evaluate the effectiveness of orally administered maropitant citrate in preventing vomiting after hydromorphone hydrochloride administration in dogs.
Design—Randomized, blinded, prospective clinical study.
Animals—40 dogs with American Society of Anesthesiologists status of I or II, > 6 months of age, and weighing between 24 and 58.2 kg (52.8 and 128.04 lb).
Procedures—Dogs were randomly selected to receive maropitant (2.0 to 4.0 mg/kg [0.9 to 1.8 mg/lb]) or placebo (lactose monohydrate) orally 2 hours prior to receiving hydromorphone (0.1 mg/kg [0.045 mg/lb], IM). A blinded observer recorded the occurrence of vomiting or signs of nausea (eg, salivation or lip-licking) during a 30-minute period after hydromorphone administration. Two-tailed Fisher exact tests were used to compare the incidences of vomiting and signs of nausea with or without vomiting between treatment groups.
Results—Of the 20 dogs receiving maropitant, none vomited but 12 (60%) developed signs of nausea. Of the 20 dogs receiving placebo, 5 (25%) vomited and 11 (55%) developed signs of nausea; overall, 16 of 20 (80%) dogs in the placebo treatment group vomited or developed signs of nausea. Compared with the effects of placebo, maropitant significantly decreased the incidence of vomiting but not signs of nausea in dogs administered hydromorphone.
Conclusions and Clinical Relevance—Among the 40 study dogs, the incidence of vomiting associated with hydromorphone administration was 25%. Oral administration of maropitant prevented vomiting but not signs of nausea associated with hydromorphone administration in dogs.
Comparison of rectal and axillary temperatures in dogs and cats
Authors: Goic Joana B. , Reineke Erica L. , Drobatz Kenneth J. 
Published: May 2014

Abstract
Objective—To compare rectal versus axillary temperatures in dogs and cats.
Design—Prospective observational study.
Animals—94 dogs and 31 cats.
Procedures—Paired axillary and rectal temperatures were measured in random order with a standardized method. Animal signalment, initial complaint, blood pressure, blood lactate concentration, and variables associated with vascular perfusion and coat were evaluated for associations with axillary and rectal temperatures.
Results—Axillary temperature was positively correlated with rectal temperature (ρ = 0.75 in both species). Median axillary temperature (38.4°C [101.1°F] in dogs, and 38.4°C [101.2°F] in cats) was significantly different from median rectal temperature in dogs (38.9°C [102.0°F]) but not in cats (38.6°C [101.5°F]). Median rectal-axillary gradient (difference) was 0.4°C (0.7°F; range, −1.3° to 2.3°C [−2.4° to 4.1°F]) in dogs and 0.17°C (0.3°F; range −1.1° to 1.6°C [−1.9° to 3°F]) in cats. Sensitivity and specificity for detection of hyperthermia with axillary temperature were 57% and 100%, respectively, in dogs and 33% and 100%, respectively, in cats; sensitivity and specificity for detection of hypothermia were 86% and 87%, respectively, in dogs and 80% and 96%, respectively, in cats. Body weight (ρ = 0.514) and body condition score (ρ = 0.431) were correlated with rectal-axillary gradient in cats.
Conclusions and Clinical Relevance—Although axillary and rectal temperatures were correlated in dogs and cats, a large gradient was present between rectal temperature and axillary temperature, suggesting that axillary temperature should not be used as a substitute for rectal temperature.
Clinical findings in dogs with incidental adrenal gland lesions determined by ultrasonography: 151 cases (2007–2010)
Authors: Cook Audrey K. , Spaulding Kathy A. , Edwards John F. 
Published: May 2014

Abstract
Objective—To determine the prevalence of and clinical features associated with incidental adrenal gland lesions (IAGLs) discovered during abdominal ultrasonography in dogs.
Design—Retrospective case series.
Animals—151 dogs with an IAGL and 400 control dogs.
Procedures—Reports of ultrasonographic examinations of the abdomen of dogs performed during a 3.5-year period were reviewed. Adrenal glands were classified as having an IAGL if a nodule or mass was described or the width of either gland was ≥ 10 mm. For dogs with an IAGL, information regarding signalment, concurrent disorders, and outcome was obtained from the medical record. Findings were compared with those in a control population of 400 dogs examined during the same period.
Results—An IAGL was detected in 151 of 3,748 (4%) dogs. Dogs with an IAGL were significantly older (median age, 11.25 years) and heavier (median body weight, 21 kg [46.2 lb]) than the control population (median age, 9.5 years; median body weight, 14 kg [30.8 lb]). Malignant tumors were reported in 6 of 20 (30%) dogs that underwent adrenal glandectomy or necropsy and had a maximum IAGL dimension that ranged from 20 to 46 mm; benign lesions all had a maximum dimension < 20 mm. Various coincidental conditions were reported in dogs with an IAGL, including nonadrenal gland malignant neoplasia in 43 (28.5%) dogs.
Conclusions and Clinical Relevance—IAGLs were more likely in dogs ≥ 9 years of age. On the basis of this small data set, malignancy should be suspected for IAGLs ≥ 20 mm in maximum dimension.
Use of a motorized morcellator for elective bilateral laparoscopic ovariectomy in standing equids: 30 cases (2007–2013)
Authors: Lund Caleb M. , Ragle Claude A. , Lutter J. Dylan , Farnsworth Kelly D. 
Published: May 2014

Abstract
Objective—To describe the use of a motorized morcellator for elective bilateral laparoscopic ovariectomy in standing equids and to evaluate long-term outcome.
Design—Retrospective case series.
Animals—30 equids (20 horses, 9 mules, and 1 pony).
Procedures—Medical records of equids undergoing elective bilateral laparoscopic ovariectomy from 2007 to 2013 were evaluated. Cases were selected on the basis of use of a motorized morcellator for ovary extraction. Data collected included age, breed, reason for surgery, surgery date, surgical approach, intraoperative complications, surgery and morcellation times, postoperative complications, and duration of hospitalization. Long-term follow-up was obtained by telephone interview with owners, and included effectiveness at resolving original reason for surgery, time to return to usual activity, incision site appearance, signs of estrus after surgery, and overall owner satisfaction.
Results—30 equids underwent laparoscopic bilateral ovariectomy with the morcellator technique. Median surgery time was 102 minutes (range, 47 to 150 minutes). Median single ovary morcellation time was 3.5 minutes (range, 2 to 8 minutes). Intraoperative complications occurred in 2 of 30 cases and included iatrogenic organ damage (uterus; 1) and persistent hemorrhage (1). Nineteen of 20 mares for which long-term follow-up was available returned to their previous use at a median of 60 days after surgery (range, 21 to 180 days).
Conclusions and Clinical Relevance—Results of the present study indicated that use of a mechanical morcellator with a 2-portal technique for bilateral laparoscopic ovariectomy in clinically normal equids eliminated the need for a larger laparotomy incision as well as a third portal. Few complications occurred, and clients were satisfied with the procedure. The morcellator technique may offer advantages over other techniques but should only be used by experienced laparoscopic surgeons following adequate training.
Functional and Social Limitations After Facial Palsy: Expanded and Independent Validation of the Italian Version of the Facial Disability Index
Authors: Pavese Chiara , Cecini Miriam , Camerino Nora , De Silvestri Annalisa , Tinelli Carmine , Bejor Maurizio , Dalla Toffola Elena 
Published: May 2014

Background
The Facial Disability Index (FDI) is widely used for self-assessment of functional impairment and quality of life in patients with facial palsy.

Objective
The study aim was to complete the validation of the FDI by generating an Italian version (IT-FDI) and evaluating its clinimetric properties.

Design
This was a longitudinal, observational measurement study.

Methods
The questionnaire was translated, cross-culturally adapted, and administered to 100 consecutive participants (outpatients) with facial palsy. The clinical severity of facial palsy, impairments in physical and social function, and quality of life were evaluated with the Sunnybrook Facial Grading System, IT-FDI, and 12-Item Short-Form Health Survey.

Results
The IT-FDI showed excellent test-retest reliability for every item and for total scores (intraclass correlation coefficients of .93 and .84 for physical function subscale and social/well-being function subscale, respectively). The IT-FDI confirmed the high internal consistency of the original version, with theta coefficients of .82 for the physical function subscale and .78 for the social/well-being function subscale. The physical function subscale correlated with the Sunnybrook Facial Grading System composite score (r=.44), and the social/well-being function subscale correlated with the 12-Item Short-Form Health Survey mental component (r=.55). The IT-FDI confirmed the good responsiveness of the original version, as expressed by effect size, standardized response mean, and responsiveness ratio of, respectively, 1, 1.03, and 1.21 for the physical function subscale and 0.75, 0.83, and 1.15 for the social/well-being function subscale.

Limitations
Responsiveness was evaluated with a limited number of participants.

Conclusions
The results demonstrated the test-retest reliability for all items of the FDI and confirmed its internal consistency, construct validity, and responsiveness with an independent and larger clinical subset. This study completes the validation of the FDI and provides the first validated questionnaire in Italian for assessment of disability and quality of life specifically in patients with facial palsy.
Evaluation of complications and neurological deficits with three-column spine reconstructions for complex spinal deformity: a retrospective Scoli-RISK-1 study
Authors: Kelly Michael P. , Lenke Lawrence G. , Shaffrey Christopher I. , Ames Christopher P. , Carreon Leah Y. , Lafage Virginie , Smith Justin S. , Shimer Adam L. 
Published: May 2014

Object
The goal in this study was to evaluate the risk factors for complications, including new neurological deficits, in the largest cohort of patients with adult spinal deformity to date.

Methods
The Scoli-RISK-1 inclusion criteria were used to identify eligible patients from 5 centers who were treated between June 1, 2009, and June 1, 2011. Records were reviewed for patient demographic information, surgical data, and reports of perioperative complications. Neurological deficits were recorded as preexisting or as new deficits. Patients who underwent 3-column osteotomies (3COs) were compared with those who did not (posterior spinal fusion [PSF]). Between-group comparisons were performed using independent samples t-tests and chi-square analyses.

Results
Two hundred seven patients were identified—75 who underwent PSF and 132 treated with 3CO. In the latter group, patients were older (58.9 vs 49.4 years, p < 0.001), had a higher body mass index (29.0 vs 25.8, p = 0.029), smaller preoperative coronal Cobb measurements (33.8° vs 56.4°, p < 0.001), more preoperative sagittal malalignment (11.7 cm vs 5.4 cm, p < 0.001), and similar sagittal Cobb measurements (45.8° vs 57.7°, p = 0.113). Operating times were similar (393 vs 423 minutes, p = 0.130), although patients in the 3CO group sustained higher estimated blood loss (2120 vs 1700 ml, p = 0.066). Rates of new neurological deficits were similar (PSF: 6.7% vs 3CO: 9.9%, p = 0.389), and rates of any perioperative medical complication were similar (PSF: 46.7% vs 3CO: 50.8%, p = 0.571). Patients who underwent vertebral column resection (VCR) were more likely to sustain medical complications than those treated with pedicle subtraction osteotomy (73.7% vs 46.9%, p = 0.031), although new neurological deficits were similar (15.8% vs 8.8%, p = 0.348). Regression analysis did not reveal significant predictors of neurological injury or complication from collected data.

Conclusions
Despite higher estimated blood loss, rates of all complications (49.3%) and new neurological deficits (8.7%) did not vary for patients who underwent complex reconstruction, whether or not a 3CO was performed. Patients who underwent VCR sustained more medical complications without an increase in new neurological deficits. Prospective studies of patient factors, provider factors, and refined surgical data are needed to define and optimize risk factors for complication and neurological deficits.