bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nutrition support, carbohydrate feeding and insulin sensitivity in the critically ill patient: a complex relationship
Authors: Doola Ra’eesa , Dupuis Claire , Preiser Jean-Charles 
Published: May 2024

Purpose of review
This review aims to summarize recent studies that highlight the complex relationship between nutrition, carbohydrate, insulin provision and glycaemic control in the critically ill patient population.

Recent findings
Results of observational studies concur to support early hypoglycaemia and persisting hyperglycaemia as life-threatening events. In contrast, interventional studies indicate that early macronutrient restriction appears to reduce the benefits related to insulin therapy. This restriction is however associated with improved outcomes in itself. The potential role of modified enteral solutions as an adjunctive treatment to attenuate hyperglycaemia warrants further research. The selection of a therapeutic modality may also differ according to the characteristics of the setting, such as the nurse-to-patient ratio, the type and accuracy of meters, including near-continuous glucose monitoring and the availability of computer-guided protocols.

Summary
There appears to be significant interplay between nutrition, including carbohydrate provision, blood glucose control and clinical outcomes. Individualized care is probably needed to define the optimal glucose target and nutritional intervention. This can differ according to the preexistence of chronic hyperglycaemia, the timing from the onset of critical illness and the clinical condition itself.
The role of telehealth in the delivery of oral and maxillofacial surgery services at a level 6 hospital in New South Wales Australia during COVID-19 – the John Hunter Hospital experience: a commentary, review and cautionary tale for the future
Authors: Welham Annabelle , Tan-Gore Eileen , Taylor Rebekah 
Published: May 2024

Purpose of review
The objective of this article is to understand the uptake in use of Telehealth services during the COVID-19 pandemic as a way to provide compelling impetus for further research and promotion of Telehealth in general. A data review of Outpatient Department data from 2020 to 2023, as compiled by the Surgical Outcomes improvement Unit.

Recent findings
Telehealth was widely adopted during the COVID-19 pandemic for clinicians to provide healthcare to patients whilst adhering to strict lockdown guidelines aimed at limiting exposure and spread of the respiratory virus. There has been minimal analysis, however, of the ethical and legal implications of telemedicine. Whilst it seems that access to care is improved via telehealth, there are subtle, inherent barriers intrinsic to it.

Summary
There was a significant increase in the use of audio and audiovisual aids in the delivery of Oral and Maxillofacial Outpatient care during the COVID-19 period. Further analysis and improvements need to be made to the system before it can be considered as sufficient and adequate. Where there is rapid adoption of Telehealth in the delivery of Oral and Maxillofacial Surgery Services, there must be concurrent rigorous review and update of systems in order to address the key areas of patient safety and accuracy of treatment.
From Institution to Community
Authors: Granek Barry , Barberio Angelo , Mattel Pamela 
Published: May 2024

Purpose/Objective:
Coordinated Behavioral Care began using its Pathway Home program to serve a subset of New York State Adult Home Settlement class members. Through its multidisciplinary team approach, Pathway Home is utilizing its multiphase model in assisting individuals with Serious Mental Illness leaving an Adult Home to successfully transition and remain in the community.

Primary Practice Setting:
The Pathway Home program is a community-based service and serves class members wherever is needed to assist in their recovery and transition from an Adult Home. This includes meeting class members in Adult Homes and various settings in the community.

Findings/Conclusions:
The New York State Adult Home Settlement presents a variety of systemic, care management, and individual member challenges. Adding the Pathway Home approach to an already existing, yet insufficient care management model strengthens the initiative's goal to transition and retain members safely into the community. Through the approach's adaptability and flexibility in providing community-based care, Pathway Home's successful cross-system collaboration is worthy of replication for other high need populations.

Implications for Case Management Practice:
A programmatic review for Pathway Home Adult Home+ teams gleaned the following key points for the field to consider in future care management practices. Class member self-efficacy and cross-system collaboration are essential in facilitating a class member's move into the community. Member choice and educating class members on their rights to move and options as well as community exposure prior to transition are important in assessing how a member fares outside of the Adult Home. Members determining their own care can reduce the risk of adverse outcomes and reinstitutionalization. Current low-touch care management programs are insufficient for members with complex needs living in institutions. These care management programs need to be augmented with a whole person approach, delivered by a multidisciplinary team.
Comparison of Length of Stay Between Children Admitted to an Observation Versus Inpatient Unit
Authors: Lim Czer Anthoney Enriquez , Bailey Jennifer , Oh Julie , Ibia Imikomobong , Eiting Erick , Barnett Barbara , Calderon Yvette , Cowan Ethan 
Published: May 2024

Objectives
Many children who require hospitalization are ideal candidates for care in pediatric observation units (POUs) rather than inpatient pediatric units. Differences in outcomes between children cared for in these 2 practice settings have not been thoroughly evaluated.

Methods
In this retrospective cohort study, children aged 0 to 18 years admitted to a POU at a community hospital or inpatient unit at a children's hospital were enrolled if they met specific clinical criteria. Information regarding the current illness, medical history, and hospital course was collected. Hospital length of stay (LOS) was analyzed as the primary outcome; secondary outcomes included conversion to inpatient care for the POU group and return to pediatric emergency department within 7 days. Subgroup analysis was conducted on children presenting with respiratory illnesses. Propensity scores were used as a predictor in the final model.

Results
One hundred eighty-one admissions, 92 to POU and 89 to an inpatient unit, were analyzed. Mean LOS was 24.4 hours (95% confidence interval [CI], 21.7–27.1) for observation and 43.2 hours (95% CI, 37.8–48.6) for inpatient (P < 0.01). Among the 126 children admitted for respiratory illnesses, the mean LOS was 32.3 hours (95% CI, 26.0–38.6) for observation and 48.1 hours (95% CI, 42.2–54.0) for inpatient (P < 0.01). Survival analysis demonstrated a 1.61 (95% CI, 1.07–2.42) fold shorter time to discharge among children admitted to observation compared with inpatient (P = 0.02) and a 1.70 (95% CI, 1.07–2.71) fold shorter time to discharge from observation compared with inpatient for respiratory illnesses (P = 0.03). Within 7 days of discharge, 2 (2%) patients from the observation group and 1 (1%) from the inpatient group returned to the pediatric emergency department.

Conclusions
These findings suggest that POU may provide the means toward efficient care for children in community settings with illnesses requiring brief hospitalizations. Future work including prospective investigations is needed to ascertain the generalizability of these findings.
Emergency Department Triage Chief Complaints Among Children Evaluated for Physical Abuse Concerns
Authors: Fortin Kristine , Wood Joanne N. , Udell Sean M. , Christian Cindy W. 
Published: May 2024

Objectives
The aims of this study were to describe chief complaints provided at emergency department triage for young children ultimately given a diagnosed with injuries concerning for physical abuse and compare chief complaints by hospital child protection team assessment (abuse most likely, accident most likely, undetermined) among children younger than 2 years who were the subject of a report to child protective services.

Methods
This is a retrospective review of children evaluated by the child protection team at an urban children's hospital over a 5-year period. Children younger than 2 years who were the subject of a report to child protective services for suspected physical abuse were included. Chief complaints noted in emergency department triage notes were categorized as follows: 1, medical sign or symptom; 2, accidental trauma incident; 3, identified injury; 4, concern for abuse; or 5, multiple unrelated complaints. Child protection team assessments were categorized as follows: 1, abuse most likely; 2, accident most likely; or 3, undetermined. We used descriptive statistics and tests of association (χ2, Fisher exact, Kruskal-Wallis).

Results
Median age of the 422 children included was 4.9 months. Child protection team assessment was abuse most likely in 44%, accident most likely in 23%, and undetermined in 34%. Chief complaints in the overall sample were 39% medical, 29% trauma incident, 16% injury, 10% abuse concern, and 6% multiple unrelated. When the abuse most likely and accident most likely groups were compared, medical chief complaints were more common in the former (47% vs 19%, P < 0.001), whereas trauma incident chief complaints were more common in the latter (19% vs 64%, P < 0.001). Most common medical complaints in the abuse most likely group were altered mental status, abnormal limb use, swelling, pain, apnea, and vomiting.

Conclusion
Many children found to have injuries concerning for abuse (47%) present without mention of trauma, injury, or abuse concern as part of the chief complaint. Our findings suggest important topics to include in training physicians about recognition of abuse.
Characterizing Point-of-Care Ultrasound Credentialing in Pediatric Emergency Departments
Authors: Brant Julia Aogaichi , D'Amico Beth , Orsborn Jonathan , Toney Amanda G. , Lam Samuel H.F. , Mickley Megan , Ambroggio Lilliam 
Published: May 2024

Objective
It is unclear which pediatric emergency departments (PEDs) have a point-of-care ultrasound (POCUS) credentialing process or if this process is consistent per expert guidelines. Our objective was to describe formalized POCUS credentialing processes across PEDs that are active in the pediatric emergency medicine POCUS (P2) Network.

Methods
A survey was developed from nationally recommended credentialing guidelines. This anonymous survey was sent out to the P2 Network comprising more than 230 members involved in pediatric POCUS. The survey was analyzed using descriptive analysis with counts and percentages.

Results
A total of 36 PEDs responded to the survey. All departments had a faculty member in charge of maintaining the credentialing process, and all faculty members had POCUS education available; 88.6% of education was scheduled didactics or bedside teaching. There were 80.6% of PEDs that had a process for internally credentialing faculty. Some PEDs offered protected education for POCUS, however, 44.8% had <50% of their faculty credentialed. There were 4 PEDs that offered incentives for completion of POCUS credentialing including salary bonuses; only 1 offered shift buy down as incentive. That PED had 100% of its faculty credentialed. All PEDs performed quality assurance on POCUS scans done in the ED, most done weekly. Billing for scans occurred in 26 PEDs. Skin/soft tissue and focused assessment with sonography for trauma were the 2 most common applications credentialed.

Conclusions
Among PEDs surveyed, there was a lack of standardization of POCUS resources and components of credentialing. Incentives may be beneficial in improving credentialing faculty and standardizing the credentialing process.
Impact of a Strategy for Improving Early Management of Acute Pain in the Pediatric Emergency Department
Authors: Storch-De-Gracia Pilar , Salido Débora , Molina Alberto , Notario Javier , Tubal Perez-Perez Jose 
Published: May 2024

Objectives
The objective of this study was to measure the impact of an intervention on pain treatment in a pediatric emergency department (ED). The application of interventions to improve pain management in DE has demonstrated diverse effects so far, most of them successful.

Methods
This is a quasi-experimental before-and-after, longitudinal, prospective study.
Patients were collected between January 2020 and December 2021. Principal outcome was the number of patients with moderate or severe pain who received analgesia before 30 minutes to the ED arrival. The intervention consisted of several training sessions for nursing staff, pediatricians, and trauma physicians.

Results
A total of 515 patients were enrolled, 230 during preintervention period and 285 during postintervention period. The percentage of patients receiving analgesia before 30 minutes increased from 24% to 29% and before 60 minutes increased from 31% to 42%. Time to analgesia administration decreased from 43 to 39 minutes.
Only 254 patients (49%) received analgesia at some point during their stay in the ED, 137 (26.6%) before 30 minutes and 193 (37.5%) before 60 minutes. The probability of receiving analgesia was greater in patients seen by a pediatrician rather than an orthopedist (59%–37%). Metamizole was the most commonly used drug (48%), followed by ibuprofen and acetaminophen.

Conclusions
The application strategies to enhance early pain treatment in the ED can improve analgesia administration. Training strategies aimed at healthcare personnel working in the ED can change the way they work and achieve clear benefits for the patient. The treatment of pain in the ED should begin as soon as possible, and in this objective, the involvement of the nursing staff is a priority, because they are the professional who has the best opportunity for the detection and treatment of pain from the moment of triage.
Effect of Routine Child Physical Abuse Screening Tool on Emergency Department Efficiency
Authors: Shahi Niti , Meier Maxene , Reppucci Marina L. , Pickett Kaci L. , Phillips Ryan , McLean Marissa , Moulton Steven L. , Lindberg Daniel M. 
Published: May 2024

Objectives
Physical abuse is a significant cause of morbidity and mortality for children. Routine screening by emergency nurses has been proposed to improve recognition, but the effect on emergency department (ED) workflow has not yet been assessed. We sought to evaluate the feasibility of routine screening and its effect on length of stay in a network of general EDs.

Methods
A 2-question child physical abuse screening tool was deployed for children <6 years old who presented for care in a system of 27 general EDs. Data were compared for the 6 months before and after screening was deployed (4/1/2019–10/2/2019 vs 10/3/2019–3/31/2020). The main outcome was ED length of stay in minutes.

Results
There were 14,133 eligible visits in the prescreening period and 16,993 in the screening period. Screening was completed for 13,404 visits (78.9%), with 116 (0.7%) screening positive. The mean ED length of stay was not significantly different in the prescreening (95.9 minutes) and screening periods (95.2 minutes; difference, 0.7 minutes; 95% CI, −1.5, 2.8). Among those who screened positive, 29% were reported to child protective services. On multivariable analysis, implementation of the screening tool did not impact overall ED length of stay. There were no significant differences in resource utilization between the prescreening and screening periods.

Conclusions
Routine screening identifies children at high risk of physical abuse without increasing ED length of stay or resource utilization. Next steps will include determining rates of subsequent serious physical abuse in children with or without routine screening.
Is Serratus Posterior Superior Intercostal Plane Block a Novel Indication for the Management of Pain in Thoracic Acute Herpes Zoster? A Case Report
Authors: Balcı Fatih , Tekcan Muhammed Nail , Gündoğdu Oğuz , Avcı Onur 
Published: May 2024

Abstract
Postherpetic neuralgia results from varicella-zoster virus reactivation post–chickenpox infection, manifesting as persistent and severe pain lasting a minimum of 3-mo post–herpes zoster onset. Traditional postherpetic neuralgia management comprises antiviral, analgesic medications, corticosteroids, and various agents. Ultrasound-guided nerve blocks have recently emerged as a promising postherpetic neuralgia treatment. In a case involving a 58-year-old man with severe thoracic herpes zoster lesions, the serratus posterior superior intercostal plane block was employed under ultrasound guidance, significantly reducing pain scores and enhancing quality of recovery. This study underscores serratus posterior superior intercostal plane block’s secure, effective role in managing thoracic herpes zoster, and mitigating postherpetic neuralgia risk. This case report represents the pioneering application of serratus posterior superior intercostal plane block for postherpetic neuralgia, offering a promising avenue for relieving patients suffering from this condition.
Predictors of Spasticity 3–6 Mos After Stroke
Authors: McIntyre Amanda , Teasell Robert , Saikaley Marcus , Miller Thomas 
Published: May 2024

Objective
The aim of the study is to identify predictors of poststroke spasticity (modified Ashworth Scale scores, ≥1) at 3–6 mos after stroke.

Design
A 5-yr (2015–2020) retrospective cohort of patients who attended inpatient stroke rehabilitation in Southwestern Ontario, Canada, were included. Sociodemographic, clinical, stroke-related, rehabilitation-related, and outcome measure data were extracted from paper charts and electronic databases.

Results
Of the 922 individuals attending inpatient stroke rehabilitation, 606 (55.8% males; mean age = 70.9 ± 14.2 yrs) returned for an outpatient visit. Most patients had a first ever (n = 518; 85.5%), ischemic (n = 470; 77.6%) stroke with hemiplegia (n = 449, 74.1%). A total of 20.3% (n = 122) of patients had developed poststroke spasticity by 4 mos after stroke. A binary logistic regression significantly predicted poststroke spasticity (χ2(6) = 111.696, P < 0.0001) with good model fit (χ2(8) = 12.181, P = 0.143). There were six significant poststroke spasticity predictors: hemorrhagic stroke (P = 0.049), younger age (P < 0.001), family history of stroke (P = 0.015), Functional Independence Measure admission score (P < 0.001), use of selective serotonin reuptake inhibitors (P = 0.044), and hemiplegia (P < 0.001).

Conclusions
Patients should be monitored closely for poststroke spasticity after discharge from stroke rehabilitation and throughout the care continuum.
Current Strategies for Treatment of Mandibular Fractures With Plate Osteosynthesis: A European Prospective Study
Authors: Sobrero Federica , Roccia Fabio , Omedè Michela , Merlo Francesca , Dubron Kathia , Politis Constantinus , Rabufetti Alessandro , Scolozzi Paolo , Ramieri Guglielmo , Birk Anže , Vesnaver Aleš , Rizvi Ali O. , Laverick Sean , Jelovac Drago , Konstantinovic Vitomir S. , Vilaplana Valentines , Roig Antonio Mari , Goetzinger Maximilian , Bottini Gian Battista , Knežević Predrag , Dediol Emil , Kordić Mario , Sivrić Anamaria , Derkuş Fatma Eriş , Yilmaz Utku Nezih , Ganasouli Dimitra , Zanakis Stylianos N. 
Published: May 2024

Purpose:
The training and preferences of surgeons influence the type of surgical treatment for mandibular fractures. This multicentre prospective study analyzed the current treatment strategies and outcomes for mandibular fractures with open reduction and internal fixation (ORIF).

Material and Methods:
This prospective study included patients aged ≥16 years who underwent ORIF for mandibular fractures in 12 European maxillofacial centers. Age, sex, pretrauma dental status, fracture cause, site and type, associated facial fractures, surgical approach, plate number and thickness (≤1.4 or ≥1.5 mm), duration of postoperative maxillomandibular fixation, occlusal and infective complications at 6 weeks and 3 months, and revision surgeries were recorded.

Results:
Between May 1, 2021 and April 30, 2022, 425 patients (194 single, 182 double, and 49 triple mandibular fractures) underwent ORIF for 1 or more fractures. Rigid osteosynthesis was performed for 74% of fractures and was significantly associated with displaced (P=0.01) and comminuted (P=0.03) fractures and with the number of nonsurgically treated fracture sites (P=0.002). The angle was the only site associated with nonrigid osteosynthesis (P<0.001). Malocclusions (5.6%) and infective complications (5.4%) were not associated with osteosynthesis type.

Conclusion:
Rigid osteosynthesis was the most frequently performed treatment at all fracture sites, except the mandibular angle, and was significantly associated with displaced and comminuted fractures and the number of nonsurgically treated fracture sites. No significant differences were observed regarding postoperative malocclusion or infections among osteosynthesis types.
Central venous-to-arterial carbon dioxide partial pressure difference as a guiding parameter for cardiotonic drug administration in patients with early-stage septic shock
Authors: Qu Ya-Qian , Shen Xiao-Hui , Zhao Qian , Guo Hui , Li Xu-Rui , Li Jian-Guo , Zang Hui-Ling , Qin Jing 
Published: May 2024

Abstract

Objective
This study aimed to investigate the effect of the central venous-to-arterial carbon dioxide partial pressure difference (Pcv-aCO2) on the administration of cardiotonic drugs in patients with early-stage septic shock.

Methods
A retrospective study was conducted on 120 patients suffering from septic shock. At admission, the left ventricular ejection fraction (LVEF) and Pcv-aCO2 of the patients were obtained. On the premise of mean arterial pressure (MAP) ≥ 65 mmHg, the patients were divided into two groups according to the treatment approaches adopted by different doctors—Control group: LVEF ≤50%; Observation group: Pcv-aCO2 ≥ 6. Both groups received cardiotonic therapy.

Results
The two groups of patients had similar general conditions and pre-resuscitation conditions (P > 0.05). Compared to the Control group, the Observation group had a higher MAP, Lac clearance rate, and urine output after six hours of resuscitation (P < 0.05), but a lower absolute value of Lac, total fluid intake in 24 hours, and a lower number of patients receiving renal replacement therapy during hospitalization (P < 0.05). After six hours of resuscitation, the percentages of patients meeting central venous oxygen saturation and central venous pressure targets were not significantly different between the Control and Observation groups (P > 0.05). There was no difference in the 28-day mortality rate between the two groups (P > 0.05).

Conclusion
Pcv-aCO2 is more effective than LVEF in guiding the administration of cardiotonic drugs in the treatment of patients with septic shock.