bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementing Guidelines for NICU Parent Presence
Authors: Horner Susan , Benbrook Keri , Hoffman Melissa , Libutti Lauren 
Published: November 2023

Background:
Relationships between parents and infants are essential for mitigating stressors encountered in neonatal intensive care units (NICUs) and are supported by parent presence and engagement.

Purpose:
The purpose of this study was to compare NICU parent and infant outcomes pre- and postimplementation of an intervention aimed at increasing parent presence and engagement in the NICU. This family-centered care intervention consisted of communicating specific guidelines for parent presence.

Methods:
Data related to parent presence, skin-to-skin care, and breastfeeding; parental stress; infant outcomes including weight gain, length of stay, feeding status at discharge, and stress; and unit-level outcomes were collected from a convenience sample of 40 NICU families recruited preimplementation and compared with data for 38 NICU families recruited postimplementation of specific guidelines for parent presence. To establish comparability of groups, infants were assigned scores using the Neonatal Medical Index.

Results:
Parent presence, engagement in skin-to-skin care, and breastfeeding rates were not significantly different between groups. Stress-related outcomes were significantly decreased in NICU mothers, fathers, and infants, and infant feeding outcomes were improved in the postintervention group.

Conclusions:
Specific guidelines for parent presence may represent an invitation for parents to engage with their NICU infants and may positively impact parent and infant stress.
Functional Follow-Up After Cystectomy and Urinary Diversion: A Narrative Review
Authors: Kaufmann Ernest , Black Peter C. , Catto James W. F. , Djaladat Hooman , Ghodoussipour Saum , Hamilton-Reeves Jill M. , Jensen Bente Thoft , Kassouf Wassim , Lauridsen Susanne Vahr , Lerner Seth P. , Llorente Carlos , Loftus Katherine , Lucca Ilaria , Martini Alberto , Preston Mark A. , Psutka Sarah P. , Sfakianos John P. , Shah Jay , Wettstein Marian Severin , Williams Stephen B. , Daneshmand Siamak , Fankhauser Christian D. ,   on Behalf of the Enhanced Recovery After Surgery (ERAS) Cystectomy Committee
Published: November 2023

Abstract

Introduction:
Follow-up after urinary diversion aims to detect functional complications to prevent harm and improve quality of life.

Methods:
We conducted a literature search and reviewed guidelines and institutional follow-up protocols.

Results:
We included 14 studies providing data of 3282 patients. Functional complications can be seen in up to 90% of all patients within 15 years after urinary diversion and mainly include impairment of urinary or sexual function as well as renal/metabolic disturbances, but only limited evidence supporting any functional follow-up recommendation was identified. Current guideline recommendation should be rephrased to ensure routine implementation of functional follow-up investigation.

Discussion:
Future research is required to assess whether, which, and how follow-up protocols after cystectomy affect functional results to inform optimal surveillance procedures after treatment.

Patient Summary:
In this review of recommended follow-up protocols after cystectomy, we observed different recommendations and discuss future research areas.
Kidney function assessment in the geriatric population
Authors: Muzaale Abimereki , Khan Adnan , Glassock Richard J. , Tantisattamoa Ekamol , Ahdoot Rebecca S. , Al Ammary Fawaz 
Published: November 2023

Purpose of review
Kidney function declines with normal aging. But it also declines with the progression of some diseases. This review calls for a more nuanced interpretation of kidney function in the geriatric population, who may have frailty and comorbidities.

Recent findings
GFR declines with healthy aging kidneys. Aging kidney changes include decreased cortical volume, senescent global glomerulosclerosis, and reduced nephron numbers. Yet normal aging is not associated with increased glomerular volume or single-nephron GFR. The prevalence of GFR less than 60 ml/min/1.73 m2 in the geriatric population is high. However, the decline in GFR with normal aging may not reflect true CKD without albuminuria. Although the risk of ESKD and mortality increases in all age groups when eGFR less than 45 ml/min/m2, there is no significant increased relative risk of ESKD and mortality in the geriatric population when eGFR 45–59 ml/min/m2 in the absence of albuminuria. Innovative approaches are needed to better estimate GFR and define CKD in the geriatric population.

Summary
The expected GFR decline in the geriatric population is consistent with normal aging kidney changes. To avoid CKD overdiagnosis and unnecessary referrals to nephrology for possible CKD, age-adapted definitions of CKD in the absence of albuminuria are needed.
Current status of weight bias and stigma in pediatrics and the need for greater focus on populations at risk
Authors: Waldrop Stephanie W. , Wang Daisy , Kancherla Devin , Stanford Fatima Cody 
Published: November 2023

Purpose of review
Obesity is one of the most common pediatric chronic conditions in the United States, affecting approximately 20% of American youth and is more common amongst Black, Latino, and Indigenous and low socioeconomic populations. The condition places children and adolescents at increased risk of physical and mental health conditions partly mediated by the weight bias and stigmatization experienced during the potentially vulnerable periods of childhood and adolescence.

Recent findings
Weight bias and the resulting stigma are pervasive in society. Children have been shown to internalize this bias and its devaluation, which have been shown to contribute to worsening metabolic and mental health outcomes independently. Studies suggest weight stigmatization more adversely affects Black, Latino, and Indigenous children, suggesting the potential for adverse synergistic effects of these historical biases on such youth.

Summary
Addressing childhood obesity successfully across all racial, ethnic, and socioeconomic lines requires addressing weight bias and stigma. Steps toward this end include collaborative efforts to promote cross-cultural competence and upstander bias education and training for those who care for children, person-centered communication, and a culture of inclusivity across governmental, healthcare, educational, entertainment, and advertising sectors.
Narrative review: food as medicine across the pediatric age continuum
Authors: Fischer Laura , Muleta Hemen , Essel Kofi 
Published: November 2023

Purpose of reviewPoor diet and food insecurity contribute to the dramatic rise in diet-related chronic disease and increasing cost of healthcare. The Food as Medicine (FAM) framework describes food-based interventions designed to prevent, manage, and treat diet-related diseases. However, FAM interventions have not been widely implemented or evaluated in pediatric populations, so critical questions remain about their optimal delivery and design, efficacy, and funding opportunities. We have reviewed the recent literature and offer insights into potential funding and implementation strategies for pediatric healthcare providers.Recent findingsData from adult and population-level interventions provide evidence that FAM interventions positively impact diet quality, food security, health outcomes, and healthcare utilization and cost in adults and households with children. Evidence from recent pediatric-based FAM interventions and population data from recent changes to federal nutrition programs support the use of food-based interventions to improve child diet quality, food insecurity, and potentially impact long-term health and healthcare utilization and cost.SummaryApplying the entire spectrum of evidence-based FAM interventions in pediatric settings from prenatal to adolescent stages will offer the greatest opportunity to ensure all children have access to enough healthful food so they can achieve their highest potential in life.
The Impact of Race on Pancreatic Cancer Treatment and Survival in the Nationwide Veterans Affairs Healthcare System
Authors: Khalaf Natalia , Xu Ann , Nguyen Wenker Theresa , Kramer Jennifer R. , Liu Yan , Singh Hardeep , El-Serag Hashem B. , Kanwal Fasiha 
Published: November 2023

Objectives
Among patients with pancreatic cancer, studies show racial disparities at multiple steps of the cancer care pathway. Access to healthcare is a frequently cited cause of these disparities. It remains unclear if racial disparities exist in an integrated, equal access public system such as the Veterans Affairs healthcare system.

Methods
We identified all patients diagnosed with pancreatic adenocarcinoma in the national Veterans Affairs Central Cancer Registry from January 2010 to December 2018. We examined the independent association between race and 3 endpoints: stage at diagnosis, receipt of treatment, and survival while adjusting for sociodemographic factors and medical comorbidities.

Results
We identified 8529 patients with pancreatic adenocarcinoma, of whom 79.5% were White and 20.5% were Black. Black patients were 19% more likely to have late-stage disease and 25% less likely to undergo surgical resection. Black patients had 13% higher mortality risk compared with White patients after adjusting for sociodemographic characteristics and medical comorbidities. This difference in mortality was no longer statistically significant after additionally adjusting for cancer stage and receipt of potentially curative treatment.

Conclusions
Equal access to healthcare might have reduced but failed to eliminate disparities. Dedicated efforts are needed to understand reasons underlying these disparities in an attempt to close these persistent gaps.
Organ Donation in Canadian PICUs: A Cross-Sectional Survey, 2021–2022*
Authors: Lee Laurie A. , Martin Dori-Ann , Mahoney Meagan , James Lee , Avitzur Yaron , Carroll Allison , Piggott Bailey , Tomlinson Christopher , Urschel Simon , Hamiwka Lorraine 
Published: November 2023

OBJECTIVES:
To understand contemporary pediatric organ donation programs in Canadian PICUs, including: policies and practices, data collection and reporting, and system and process barriers.

DESIGN:
A cross-sectional survey carried out 2021–2022.

SETTING:
Canadian PICUs affiliated with a donor physician network.

SUBJECTS:
Pediatric intensivists identified as the donation program lead, or most knowledgeable about donation for their institution.

MEASUREMENTS AND MAIN RESULTS:
A 19-item survey was developed through collaboration with stakeholders from the organ donation and transplantation community within Canada. Domains and items were generated and reduced iteratively during an in-person workshop. Pretesting and pilot testing were completed to ensure readability, flow, clinical sensibility, and construct validity. Fifteen of 16 (94%) invited Canadian PICUs from seven provinces completed the survey representing 88% (15/18) of all noncardiac Canadian PICUs. Surveys were completed between June 2021 and September 2022. All units support donation after death by neurologic criteria (DNC); 14 of 15 indicated donation policies were in place and 1 of 15 indicated no policy but the ability to facilitate donation. Thirteen of 15 units (87%) support donation after death by circulatory criteria (DCC) with policies in place, with 11 of 13 of these indicating routine support of donation opportunities. The majority (13/15) of units identified a donation champion. Of the 16 identified champions across these centers, 13 were physicians and were registered nurses or nurse practitioners. Eight of 13 units (62%) with donation champions had positions supported financially, of which 5 units came from the Organ Donation Organization and the other 3 came from the provincial health authority. Finally, only 3 of 15 PICU donation programs have a pediatric donation committee with family involvement. Variability exists in identification (including determination of death practices), referral, and approach for donation between units.

CONCLUSIONS:
Although all Canadian PICUs support donation after DNC donation, and most support donation after DCC, variability exists in the identification, referral, and approach of potential donors. There is a notable lack of family involvement in pediatric donation programs. There are many opportunities for standardization of PICU donation programs which may result in improved rates of pediatric organ donation in Canada.
Effects of the First Year of the COVID-19 Pandemic on Utilization of Emergency Medical Services in Maryland
Authors: Hossain Sharmin , Jackson Alice , Burkom Howard , Boyd Christine 
Published: November 2023

Background:
The opioid epidemic in the United States has devastated the lives of individuals and imposed decades-long opportunity costs on the community.

Methods:
We analyzed Emergency Medical Services (EMS) data from the Maryland Department of Health installation of the Electronic Surveillance System for Early Notification of Community-Based Epidemics (ESSENCE) to assess the impact of COVID-19 on EMS call volume and how COVID-19 impacted patients' decisions whether to accept transport to a hospital following an EMS call.

Results:
The rate of patients accepting transportation via EMS to a hospital emergency department (ED) declined for both opioid-related and non–opioid-related calls from prepandemic (before April 2020) to mid-pandemic (mid-March 2020 to mid-April 2020). The opioid-related call volume increased more from pre- to mid-pandemic for male patients than for female patients, and this “gender gap” had not returned to prepandemic levels by April 2021.

Conclusion:
Consistent with reports from other states, the pandemic worsened the opioid crisis in Maryland, impacting some populations more than others while also decreasing the likelihood that individuals experiencing an opioid-related overdose would seek further medical care following an EMS call.
External validation of novel Revised Intensity Battle Score and comparison of static rib fracture scoring systems
Authors: Buchholz Carl J. , D’Aquila Madeline L. , Lollar Daniel I. 
Published: November 2023

BACKGROUND
This study aims to compare and externally validate the previously developed Revised Intensity Battle Score (RIBS) against other proposed scores for predicting poor outcomes after rib fractures.

METHODS
An external validation set was assembled retrospectively, comprising 1,493 adult patients with one or more rib fractures admitted to a Level 1 trauma center between 2019 and 2022. The following rib fracture scores were calculated for each patient: RIBS, Injury Severity Score, Rib Fracture Score, Chest Trauma Score, and Battle score. Each was investigated to assess utility in predicting mortality, intensive care unit upgrade, unplanned intubation and ventilator days. Performance was measured by area under the receiver operating characteristic curve.

RESULTS
Of the 1,493 patients who met inclusion criteria, 239 patients (16%) experienced one of more of the investigated outcomes. Generally, scores performed best at predicting mortality and ventilator days. The RIBS stood out as best predicting “any complication” (AUC = 0.735) and “>7 ventilator days” (AUC = 0.771).

CONCLUSION
The RIBS represents an externally validated triage score in patients with rib fractures and compares favorably to other static scoring systems. Use of this score as a triage tool may allow stratifying patients who may benefit from direct intensive care unit admission, neuraxial anesthesia and aggressive respiratory care. Next steps include prospective investigation of how pairing these interventions with score directed triage impacts outcomes

LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level IV.
Impact of Co-occurring Cancer-Related and Wound-Specific Symptoms on Functional Performance Among Patients With Advanced Cancer and Malignant Fungating Wounds
Authors: Tilley Charles P. , Yu Gary , Comfort Christopher , Li Zujun , Axelrod Deborah , Colon-Cavallito Kim , Wholihan Dorothy , Fu Mei Rosemary 
Published: November 2023

PURPOSE:
The purpose of this study was to examine the impact of co-occurring symptoms in patients with advanced cancer and malignant fungating wounds (MFWs) on palliative and functional performance, and the feasibility of collecting self-reported data in this population.

DESIGN:
This was an exploratory, observational study. Quantitative surveys and qualitative semistructured interviews using a phenomenological approach were employed.

SUBJECTS AND SETTING:
The sample comprised 5 adults with advanced breast, oral, and ovarian cancer and MFWs. Participants were recruited from an urban outpatient cancer center, hospice, and wound center located in the Northeastern United States.

METHODS:
Demographic and clinical characteristics were collected, and self-reported symptom and functional performance data measured. Descriptive statistics, T scores, confidence intervals, and standard deviation were calculated for quantitative data. One-to-one semistructured interviews were conducted by the first author to gain deeper understanding of participants' symptom experience. Qualitative data were analyzed using an iterative and inductive thematic data analysis method to identify major themes.

RESULTS:
The mean cancer-related and wound-specific symptom occurrence was 17 (SD = 5.56) and 4 (SD = 1.26), respectively. Distressing, extensive co-occurring symptom burdens were experienced by all participants; they also reported poor functional performance and diminished palliative performance. Qualitative findings supported quantitative results.

CONCLUSIONS:
Findings suggest that co-occurring cancer-related and wound-specific symptoms have incremental and negative impact on functional performance. The use of multiple data collection methods was feasible, including self-reported data in this advanced cancer population.
A Scoping Literature Review on Patient Education in Intermittent Catheterization
Authors: Quallich Susanne , Lajiness Michelle , Engberg Sandra , Gray Mikel 
Published: November 2023

PURPOSE:
To summarize evidence related to (1) research studies examining patient/caregiver educational interventions related to intermittent self/caregiver catheterization (ISC), (2) studies examining issues related to teaching ISC, and (3) evidence-based clinical practice guidelines addressing ISC.

PROBLEM:
Avoiding lower urinary tract trauma during catheter insertion, adequate frequency of catheterization, and complete emptying of the bladder are essential to prevent and reduce complications associated with ISC. Consequently, proper patient/caregiver education is essential to achieving good outcomes.

METHODS:
Scoping review of literature.

SEARCH STRATEGY:
We searched PubMed, EMBASE, and CINAHL databases, and the reference lists of background and included studies for quantitative and qualitative research studies and professional and healthcare organization–generated evidence-based clinical practice guidelines published between 2005 and September 2021. Eleven studies and 2 clinical practice guidelines met our eligibility criteria and are included in the review.

FINDINGS:
Research conducted in the United States examining the effectiveness of educational interventions for patients needing ongoing ISC is extremely limited. The single study identified was a small pilot feasibility study. Eight studies examining issues potentially related to patient/caregiver ISC education were identified, suggesting that catheter characteristics, patient barriers, and complications, particularly urinary tract infections, adherence, and upper extremity function, are important considerations when developing education interventions. The small number of studies and limitations in the methodologies limit the current evidence base to support patient/caregiver education about ISC. We also identified 2 evidence-based guidelines generated by European professional organizations that included recommendations related to ISC education.

CONCLUSIONS:
Additional research is needed to support the development of patient/caregiver educational interventions and to examine their effectiveness.
Improved Performance With the Micro-Hole Zone Intermittent Catheter
Authors: Landauro Malene Hornbak , Tentor Fabio , Pedersen Troels , Jacobsen Lotte , Bagi Per 
Published: November 2023

PURPOSE:
To assess the performance of a new urinary intermittent catheter (IC) prototype designed with a micro-hole drainage zone compared to a conventional eyelet catheter (CEC) in terms of flow-stop, bladder emptying, and hematuria.

DESIGN:
Randomized controlled crossover studies.

SUBJECT AND SETTING:
The sample comprised 15 male healthy volunteers (HV) and 15 IC users, along with 15 female HV and 15 IC users. The age range was lower for HV participants than for IC users (range: 20-57 years for HV vs 21-82 years for IC users). The study setting was the Department of Urology, located in Rigshospitalet, Copenhagen.

METHODS:
Number of flow-stop incidents, residual urine volume at first flow-stop (RV1), and dipstick hematuria were measured during and after catheterization by a health care professional (HCP) and by IC-users. Results from the 3 studies were combined for HV and IC users on RV1 and number of flow-stop incidents but separated on sex. For incidents of hematuria, an effect of underlying condition was assumed, and a combined analysis on sex was performed, separating HV and IC users.

RESULTS:
When compared to the micro-hole drainage zone design, catheterizations with CEC resulted in a significantly higher mean RV1 (mean difference: 49 mL in males and 32 mL in females, both P < .001) and average number of flow-stop incidents (8 and 21 times more frequent for males and females, respectively, both P < .001). The likelihood for hematuria was 5.84 higher with CEC than with micro-hole drainage hole design, P = .053, during normal micturition in HV postcatheterization. No serious adverse events were reported.

CONCLUSION:
The micro-hole drainage zone catheter provides IC users fewer premature flow-stops. This design feature reduces modifiable urinary tract infection risk factors, such as residual urine and micro-trauma; additional research is needed to determine its effects on bladder health.