bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Retrospective Analysis of Ischemic Stroke Patients Supports That Very Early Mobilization Within 24 Hours After Intravenous Alteplase Is Safe and Possibly Beneficial
Authors: Yanase Lisa , Clark Diane , Baraban Elizabeth , Stuchiner Tamela 
Published: October 2023

ABSTRACT

BACKGROUND: Stroke care guidelines recommend early mobilization of acute ischemic stroke patients, but there are sparse data regarding early mobilization of stroke patients receiving thrombolytic therapy. We developed the Providence Early Mobility for Stroke (PEMS) protocol to mobilize patients to their highest individual tolerance within 24 hours of stroke admission in 2010, and it has been in continuous use at our primary and comprehensive stroke centers for over a decade. In this study, we evaluated the PEMS protocol in all patients treated with intravenous alteplase without endovascular treatment. METHODS: This retrospective study includes 318 acute ischemic stroke patients treated with alteplase who were admitted to 2 urban stroke centers between January 2013 and December of 2017 and were mobilized with the PEMS protocol within 24 hours of receiving alteplase. Safety of PEMS was assessed by change in National Institutes of Health Stroke Scale at 24 hours by time first mobilized. Using multivariate and logistic regression models, we analyzed time first mobilized and 90-day modified Rankin scale (mRS). RESULTS: Median time first mobilized was 9 hours from administration of alteplase. For every hour delay in mobilization, the odds of being slightly or moderately disabled (mRS, 2-3) at 90 days increased by 7% (adjusted odds ratio, 1.07; P = .004), and the odds of being severely disabled or dead (mRS, 4-6) at 90 days increased by 7% (adjusted odds ratio, 1.07; P = .02). In addition, for every hour delay in mobilization, 24-hour National Institutes of Health Stroke Scale increased by 1.8%. DISCUSSION: Our results support that the PEMS protocol is safe, and possibly beneficial, for acute ischemic stroke patients treated with intravenous alteplase. Our protocol differs from other very early mobility protocols because it does not prescribe a “dose” of activity. Instead, each patient was mobilized to his/her individual highest degree as soon as it was safe to do so.
Associations of Delirium to Posthospital Outcomes After Acute Stroke: A Scoping Review
Authors: Young Bethany C. , Rhoten Bethany A. 
Published: October 2023

ABSTRACT

Background: Delirium is a common and distressing manifestation of acute brain dysfunction that is associated with poor outcomes in various critically ill patient populations. Although patients with acute stroke experience delirium, understanding of delirium in this population is limited. The purpose of this scoping review is to describe existing evidence about delirium and associations with posthospital outcomes after acute stroke. Methods: Arksey and O'Malley's 5-stage framework was used to perform a scoping review. PubMed, CINAHL, and EMBASE electronic databases were searched. Outcome domains of interest included mortality, cognitive function, physical function, mental health, and quality of life. Full-text, peer-reviewed articles with adult stroke sample populations (acute ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage) were included. Results: Nineteen articles, involving 5611 unique patients, were included. Most sample populations included patients with either acute ischemic stroke or intracerebral hemorrhage. Heterogeneous research aims, methods, and outcome measures limit the ability to compare specific findings across studies. However, included studies suggest higher mortality at 12 months, worse cognition, and greater functional impairment in patients who have experienced acute stroke and delirium. Limited information regarding associations of delirium with posthospital mental health outcomes and quality of life precluded the ability to analyze these relationships and warrants further investigation. Conclusion: This review suggests concerning findings about associations of delirium to posthospital outcomes after acute stroke. Better characterization of delirium after acute stroke and analysis of its impact on long-term outcomes are needed.
The Impact of Primary Care Practice Structural Capabilities on Nurse Practitioner Burnout, Job Satisfaction, and Intent to Leave
Authors: Schlak Amelia , Poghosyan Lusine , Rosa William E. , Mathew Shiyon , Liu Jianfang , Martsolf Grant , Flandrick Kathleen , Chen Julius L. 
Published: October 2023

Background:Lack of structure for care delivery (ie, structural capabilities) has been linked to lower quality of care and negative patient outcomes. However, little research examines the relationship between practice structural capabilities and nurse practitioner (NP) job outcomes.Objectives:We investigated the association between structural capabilities and primary care NP job outcomes (ie, burnout, job dissatisfaction, and intent to leave).Research Design:Secondary analysis of 2018-2019 cross-sectional data.Subjects:A total of 1110 NPs across 1002 primary care practices in 6 states.Measures:We estimated linear probability models to assess the association between structural capabilities and NP job outcomes, controlling for NP work environment, demographics, and practice features.Results:The average structural capabilities score (measured on a scale of 0–1) across practices was 0.6 (higher score indicates more structural capabilities). After controlling for potential confounders, we found that a 10-percentage point increase in the structural capabilities score was associated with a 3-percentage point decrease in burnout (P<0.001), a 2-percentage point decrease in job dissatisfaction (P<0.001), and a 3-percentage point decrease in intent to leave (P<0.001).Conclusions:Primary care NPs report lower burnout, job dissatisfaction, and intent to leave when working in practices with greater structural capabilities for care delivery. These findings suggest that efforts to improve structural capabilities not only facilitate effective care delivery and benefit patients but they also support NPs and strengthen their workforce participation. Practice leaders should further invest in structural capabilities to improve primary care provider job outcomes.
Intensive Case Management to Reduce Hospital Readmissions
Authors: Shade Kate , Hidalgo Paulina , Arteaga Manuel , Rowland Janet , Huang Winnie 
Published: October 2023

Purpose of Study:
Hospital readmissions burden the U.S. health care system, and they have negative effects on patients and their families. The primary aim of this study was to pilot an intensive case management (ICM) intervention to reduce 30-day hospital readmissions. A secondary aim was to obtain patient- and caregiver-reported reasons for readmission.

Primary Practice Setting:
The setting was a vertically integrated health care system located in Northern California.

Methodology and Sample:
This pilot quality improvement project occurred over a 4-month period. The intervention was delivered by master's degree students in nurse case management through an academic–clinical partnership. Patients hospitalized with a 30-day readmission were offered the ICM intervention. A total of 36 patients were identified and 20 accepted. Patient and/or caregiver was interviewed to identify reasons for their readmission. Data were collected about pre–/post–health care utilization including subsequent 30-day readmission. Mixed methods were used to analyze the findings.

Results:
Thirteen of 20 enrolled patients received the weekly ICM intervention for at least 30 days. Seven declined further contact before 30 days. Patient-reported reasons for readmission included being discharged too soon, poor communication among providers and with patients/families, lack of understanding about disease management and/or treatment options, and inadequate support. Several patients believed that their readmission was unavoidable due to the complexity of their illnesses. We compared 30-day readmissions for those who participated in and those who declined the ICM intervention, finding that those who received the ICM intervention had a lower readmission rate than those who did not receive the intervention (35% vs. 37.5%).
Research on the balanced geographic allocation of medical facilities in Shenzhen City based on the hierarchical medical system
Authors: Yang Xiaochun , Zhuang Haobin , Miao Wenjie , Hong Wuyang , Zhang Li 
Published: October 2023

Abstract

Objective:
Based on the hierarchical medical system, this study evaluated the accessibility of medical facilities (MFs), analyzed their geographic allocation, and put forward suggestions for the balanced allocation of MFs in Shenzhen.

Methods:
This study implemented a 2-step floating catchment area method to evaluate the accessibility of MFs. Statistical and spatial analysis methods were used to analyze the spatial characteristics and service equity of accessibility in Shenzhen.

Results:
The spatial allocation of the accessibility of low-level MFs in Shenzhen was characterized by the emergence of point-like high-accessibility areas in a large low-accessibility area. Here, there is the problem of insufficient service capacity, which limits the implementation of the hierarchical medical system. The spatial characteristics of the accessibility of high-level MFs in Shenzhen included a high degree of agglomeration, large differences inside and outside the original special economic zone, and large areas with weak accessibility. There was a spatial imbalance in the overall accessibility of MFs, wherein individuals with higher incomes typically have better and more equitable accessibility.

Conclusions:
A balanced geographic allocation of MFs can ensure the implementation of the hierarchical medical system and enhance the equity of medical services. Strategies for balanced geographic allocation of MFs are proposed as follows: comprehensively improving the service capacity and construction standards of community healthcare centers; promoting the construction of primary hospitals and community hospitals in areas with a high population density; establishing additional secondary hospitals and tertiary hospitals in areas with low accessibility to high-level MFs; and encouraging coordinated urban development and MFs construction.
Point-of-Care Ultrasound of a Pediatric Gastric Trichobezoar
Authors: Chiang Elaine , Balasubramanian Shriman , Rabiner Joni E. 
Published: October 2023

Abstract
This case report describes a previously healthy pediatric patient with acute onset of abdominal pain and distention who was found to have an epigastric mass on physical examination. Point-of-care ultrasound (POCUS) demonstrated a large gastric mass with ultrasonographic features consistent with a trichobezoar. After POCUS was performed, trichophagia was confirmed on history, and the patient went to the operating room for removal of a large trichobezoar. We conclude POCUS may be helpful for evaluation of epigastric masses and diagnosis of gastric trichobezoars. We review the ultrasound technique, sonographic findings, and literature regarding ultrasound diagnosis of trichobezoars.
Rehabilitation improves persistent symptoms of COVID-19: a non-randomized, controlled, open study in Brazil
Authors: Campos Maria Cristine , Nery Tatyana , Speck Ana Elisa , Arpini Maiqueli , Antunes Moisés Moraes , de Bem Alves Ana Cristina , de Souza Santos Naiara , Matos Maria Paula Pereira , Schmidt Nelson , Bicca Letícia Roehe , Panisson Camila Mascarelo , Freitas Mariana Alves , Diefenthaeler Fernando , Kuriki Heloyse Uliam , Damin Vanessa , Da Rosa Rodrigo Oliveira , Gress Josiane Bueno , Schneider Ione Jayce Ceola , Vieira Danielle Soares Rocha , Arcêncio Livia , Aguiar Aderbal S. 
Published: October 2023

ABSTRACT

Objective
This study aimed to investigate the effects of an 8-week face-to-face rehabilitation program on subjects with persistent symptoms of COVID-19 compared to a remote monitoring group.

Design
Clinical, non-randomized, controlled, and open study. The face-to-face supervised rehabilitation lasted eight consecutive weeks, twice a week. The remote monitoring group received health guidance. The allocation was carried out by preference due to the emergency period without vaccination during the pandemic. Fatigue, dyspnea (Pulmonary Functional Status and Dyspnea Questionnaire), and exercise capacity (Incremental Shuttle Walk Test) were the primary outcome measures. Lung function, functional status (Post-COVID-19 Functional Status), symptoms of anxiety and depression (Hospital Anxiety and Depression Scale), attention (d2-R), memory (Rey's Auditory-Verbal Learning Test), handgrip strength, and knee extensor strength were secondary outcome measures.

Results
37 subjects (24.3% hospitalized) completed the baseline and final assessment, rehabilitation [n = 22, 40.8 (SD 10.0) years, 54.5% female], or remote guidance [n = 15, 45.4 (SD 10.5) years, 40% female]. Both groups showed improved fatigue and exercise capacity. Exercise rehabilitation improved dyspnea, anxiety, attention, and short-term memory.

Conclusion
Rehabilitation is essential for dyspnoea in subjects with persistent symptoms of COVID-19 while fatigue naturally reverses.
Efficacy of a Decision Aid in Breast Cancer Patients Considering Immediate Reconstruction: Results of a Randomized Controlled Trial
Authors: ter Stege Jacqueline A. , Woerdeman Leonie A. E. , Kieffer Jacobien M. , Sherman Kerry A. , Agelink van Rentergem Joost A. , van Duijnhoven Frederieke H. , van Huizum Martine A. , Gerritsma Miranda A. , Kuenen Marianne , Corten Eveline M. L. , Kimmings Nikola (A. N.) , Ruhé Quinten (P. Q.) , Krabbe-Timmerman Irene S. , van’t Riet Martijne , Hahn Daniela E. E. , Witkamp Arjen J. , Oldenburg Hester S. A. , Bleiker Eveline M. A. 
Published: October 2023

Background:
Breast cancer patients face complex decisions about immediate breast reconstruction (BR) after mastectomy. The authors evaluated the efficacy of an online decision aid in improving the decision-making process, decision quality, and health outcomes in breast cancer patients considering immediate BR.

Methods:
In a multicenter, randomized, controlled trial, patients were allocated to either the intervention group, receiving care as usual with access to an online decision aid, or the control group, receiving care as usual with an information leaflet. The primary outcome was decisional conflict. Secondary outcomes assessed the process of decision-making (eg, preparation for decision-making, satisfaction with information), decision quality (decision regret, knowledge), and health outcomes (eg, satisfaction with BR outcomes, body image). Patients completed questionnaires at time (T) 0 (baseline); T1 (1 week after consultation with a plastic surgeon); and T2 (3 months) and T3 (12 months) after surgery.

Results:
The authors included 250 patients. Decisional conflict decreased over time in both groups, with no between-group differences. Intervention participants felt better prepared for decision-making than controls (P = 0.002). At T2, 87% of intervention participants were very satisfied with the information about BR, compared with 73% of control participants (P = 0.011). No significant between-group differences were observed in any other outcome.

Conclusions:
The authors’ online decision aid was as effective in reducing decisional conflict as an information leaflet about immediate BR after mastectomy. However, the decision aid substantially improved the decision-making process by better preparing breast cancer patients for decisions about immediate BR.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
Outcomes of the Use of Fresh-Frozen Costal Cartilage in Rhinoplasty
Authors: Hanna Steven A. , Mattos David , Datta Shaishav , Reish Richard G. 
Published: October 2023

Background:
Rhinoplasty is made more challenging when there is insufficient septal cartilage for use as graft material. Several autologous and homologous graft options have been used in the past, although each comes with its own set of challenges. Fresh-frozen costal cartilage (FFCC) is an increasingly popular alternative that yields the benefits of homologous tissue while having a lower theoretical risk profile. Given the relatively novel nature of this option, the authors analyzed the complication rates of Musculoskeletal Transplant Foundation FFCC.

Methods:
A retrospective chart review of the use of FFCC in rhinoplasty in the senior author’s (R.G.R.) practice was conducted between March of 2018 to December of 2021. A total of 282 cases were reviewed and analyzed for rates of infection, warping, and resorption. Patients with a minimum of 12 months of follow-up were included.

Results:
The mean age of the study group was 35.8 years, and 27 male and 255 female patients were included. Forty cases were primary rhinoplasties; the remaining 242 were revisions. The mean follow-up period was 20.3 months. Six patients (2.1%) required empiric antibiotics postoperatively; no patient had clinical signs of warping, resorption, or displacement, and 6 patients (2.1%) required operative revision unrelated to the FFCC.

Conclusions:
This study provides follow-up data on the complication profile of FFCC in rhinoplasty. Acute infection, warping, and resorption rates were found to be no greater than rhinoplasty complication rates when autologous or homologous tissue is used. FFCC is a safe, convenient, and patient-centered option for graft tissue in rhinoplasty.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
The Synergistic Effect of Full-Spectrum Light Therapy and Transient Immunosuppressants Prolonged Allotransplant Survival
Authors: Liu Keng-Fan , Ramachandran Savitha , Chang Chao-Wei , Chen Rong-Fu , Huang Chao-hsin , Huang Han-Ting , Lee Chia-Chun , Li Yun-Ting , Kuo Yur-Ren 
Published: October 2023

Background:
The lifelong administration of immunosuppressants remains the largest drawback in vascularized composite allotransplantation (VCA). Therefore, developing alternative strategies to minimize the long-term use of immunosuppressive agents is crucial. This study investigated whether full-spectrum bright light therapy (FBLT) combined with short-term immunosuppressant therapy could prolong VCA survival in a rodent hindlimb model.

Methods:
Hindlimb allotransplantation was conducted from Brown-Norway to Lewis rats, and the rats were divided into 4 groups. Group 1 did not receive treatment as a rejection control. Group 2 received FBLT alone. Group 3 was treated with short-term antilymphocyte serum (ALS) and cyclosporine A (CsA). Group 4 was administered short-term ALS/CsA combined with FBLT for 8 weeks. Peripheral blood and transplanted tissues were collected for analysis.

Results:
The results revealed median survival time of FBLT alone (group 2) did not increase allograft survival compared with the control (group 1). However, in group 4, FBLT combined with short-term ALS/CsA, median composite tissue allograft survival time (266 days) was significantly prolonged compared with groups 1 (11 days), 2 (10 days), and 3 (41 days) (P < 0.01). Group 4 also showed a significant increase in regulatory T cells (P = 0.04) and transforming growth factor-β1 levels (P = 0.02), and a trend toward a decrease in interleukin-1β levels (P = 0.03) at 16 weeks after transplantation as compared with control (group 1).

Conclusions:
FBLT combined with short-term immunosuppressants prolonged allotransplant survival by modulating T-cell regulatory functions and antiinflammatory cytokine expression. This approach could be a potential strategy to increase VCA survival.

Clinical Relevance Statement:
Full-spectrum light therapy could be a potential strategy to increase vascularized composite allotransplant survival.
Predictors of Postoperative Diplopia following Orbital Fracture Repair in Adults
Authors: Hassan Bashar , Yoon Joshua , Er Seray , Resnick Eric , Yusuf Cynthia , Liang Fan , Yang Robin , Grant Michael 
Published: October 2023

Background:
Postoperative diplopia is reported in up to 52% of orbital bone fracture (OBF) repair. Evidence on these risk factors is based on low-quality data, single-institution studies, and small sample sizes. Our study is the largest and first multicenter study to determine the predictors of postoperative diplopia following OBF repair.

Methods:
The authors conducted a retrospective review of patients who underwent OBF repair at 2 centers from 2015 to 2019. The authors’ primary outcome was the incidence or persistence of postoperative diplopia at least 2 weeks after OBF repair. Descriptive statistics were calculated. Multivariable logistic regression was performed to determine significant predictors of postoperative diplopia.

Results:
Of 254 patients, the median age was 36.1 years (interquartile range, 27.8 to 50.7 years), and the median follow-up was 79.5 days (interquartile range, 40.3 to 157.3 days). The most common postoperative ocular symptom was diplopia (51 of 254 [20.1%]). Patients who had preoperative limited ocular motility or enophthalmos had greater odds of developing postoperative diplopia, compared with patients who did not have these preoperative symptoms (adjusted ORs, 2.33 [95% CI, 1.03 to 5.24] and 2.35 [95% CI, 1.06 to 5.24], respectively). Patients who had combined orbital floor and medial wall and moderate OBF (>2-cm2 defect or >3-mm displacement) on preoperative computed tomographic scan had greater odds (adjusted ORs, 2.16 [95% CI, 1.04 to 4.46] and 3.77 [95% CI, 1.44 to 9.83], respectively) of developing postoperative diplopia, compared with patients without these preoperative computed tomographic findings.

Conclusion:
During primary assessment of the patient with OBF, preoperative ocular signs and symptoms, fracture severity, and location of OBF are key predictors of postoperative diplopia.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
LITERATURE REVIEW ON INTERVENTIONS FOR PREVENTION OF UNPLANNED EXTUBATION IN NICU PICU: A PHILOSOPHY OF NURSING SCIENCE
Authors: Mariyam Mariyam , Rumambo Pandin Moses Glorino , Fitriani Netty Prasetiya 
Published: October 2023

ABSTRACTIntroductionOne of the complications of endotracheal tube (ETT) installation is unplanned extubation (UE). UE is an initial inappropriate removal of an ETT by a patient or medical personnel. This literature review are to describe interventions to prevent unplanned extubation in NICU and PICU.MethodLiterature review searches using Sciencedirect, Google Scholar and Pubmed. The keywords used in searching articles were unplanned extubation PICU NICU. The search criteria were publication year 2017-2023, quasi-experimental design and full text.ResultThe results show that actions that can reduce the incidence of UE are standardization interventions for ETT safety, protocols for moving patients (patient transportation), and collaborative interventions for providing sedation.Conclusionstandardization of ETT safety, protocols for moving patients (patient transport), and collaboration in providing sedation can be used to reduce unplanned extubation.