bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimizing Resident Education during Family-centered Rounds: An Educational Improvement Initiative
Authors: Calardo Sarah J. , Tomlinson Lesya , Bhatia Darshita , Weis Amy , Port Courtney 
Published: February 2023

Introduction:
Family-centered rounding (FCR) allows the medical team to partner with patients in medical decision-making, improving communication, and enhancing safety. However, FCR may compromise aspects of the resident education experience. In a survey of pediatric residents at our children’s hospital, only 20% felt FCR provided the best educational experience. We designed this project to increase the percentage of residents with a positive perception of the educational experience on FCR from 20% to 80% in 6 months.

Methods:
This project utilized The Model for Improvement and sequential plan-do-study-act cycles. A needs assessment identified educational activities negatively impacted by FCR. We then designed a hybrid FCR process with formal presentations outside patient rooms followed by traditional bedside FCR. Our primary measure was the percentage of residents positively perceiving the FCR educational experience. Our balancing measures included rounding duration and family satisfaction and comprehension.

Results:
Residents who perceive FCR to be the best educational experience improved from a baseline of 21% to 76%, with a calculated response rate of 79%. Patients receiving FCR remained above 80%. All surveyed families understood their care plans and remained satisfied with the information provided, although 21% were concerned about the number of people present on rounds during the COVID-19 pandemic. Forty-three percent of hospitalist rounds exceeded the allotted time.

Conclusions:
The hybridization of FCR to include formal presentations may improve the resident learning experience while preserving family satisfaction and comprehension.
Endotracheal Tube Cuff Pressures in the Operating Room of a Pediatric Hospital: A Quality Improvement Initiative
Authors: Moon Kelly M. , Donaworth Sherry , Hagele Molly S. , Kim Stephani S. , Willer Brittany L. , Tobias Joseph D. 
Published: February 2023

Introduction:
Endotracheal tube (ETT) cuff pressures are frequently out of the recommended range of 20–30 cm H2O. This can lead to multiple iatrogenic complications ranging from cough, sore throat, and tracheal edema to more serious medical issues such as tracheal stenosis, aspiration, nerve injuries, and tracheal rupture. Additionally, current methods to inflate ETT cuffs vary between anesthesia providers and are not consistent in the recommended range. The objective of this quality improvement project was to increase the percentage of cuff pressures between 20 and 30 cm H2O.

Methods:
Four plan-do-study-act (PDSA) cycles were completed in the operating rooms at Nationwide Children’s Hospital over 9 months to assess ways to improve the accuracy of obtaining recommended ETT cuff pressures. Control charts were used to evaluate the primary outcome measure.

Results:
Preimplementation, ETT cuff pressures were out of the recommended range 76% of the time. Cuff pressures were out of the recommended range 64% of the time with the addition of the air method, 84% of the time in the tidal volume ratio cycle, and 50% of the time using the removal of air technique. The removal of air method was the most effective in achieving cuff pressures within the recommended pressure range (P < 0.001).

Conclusions:
Using quality improvement methodology, the percentage of ETT cuff pressures falling within the recommended pressure range increased using the removal of air technique. This approach is a simple and practical method that can be easily implemented in the clinical setting and would provide additional safety in the anesthetic management of pediatric patients.
A Quality Improvement Initiative to Improve After-visit Summary Distribution in Orthopedic Outpatient Clinics
Authors: Williamson Jayme , Holstine Jessica , Balch Samora Julie 
Published: February 2023

Introduction:
Communication and patient education are key to effective healthcare encounters and improved health outcomes. The after-visit summary (AVS) is an integral communication and education tool for patients and families. Without effective communication, gaps in comprehension may result in decreased satisfaction with medical encounters, lack of adherence to recommended treatment plans, missed appointments, and increased malpractice claims.

Methods:
We initiated a quality improvement (QI) initiative implementing concepts derived from the Institute for Healthcare Improvement (IHI) model, including plan-do-study-act cycles, to increase AVS distribution rates in a high-volume, fast-paced ambulatory pediatric orthopedic clinic. Interventions included staff education and training, trainee instruction, enlistment of electronic medical record superusers to enhance the distribution process, and provision of regular, transparent communication of individual and team performance. The impact of interventions was measured using a p-chart.

Results:
There was a consistent improvement in the rate of AVS distribution with each intervention implemented. The distribution rate on project initiation was 81.9%, with a final rate of 95.7%. The most statistically significant shift occurred following the final intervention, which included sharing unblinded individual performance data.

Conclusion:
Our data demonstrate that a dedicated QI program using IHI methodology improved AVS distribution rates in a pediatric orthopedic clinic. Consistently distributing the AVS affords our patients and families a better opportunity to review pertinent visit information, education, medication changes, and upcoming appointments.
Arriving Safely: Decreasing Rapid Escalations in Care for Incoming Transported Pediatric Patients
Authors: Zheng Christie , Gibson Cynthia , Jeong Hyungjoo , Port Courtney 
Published: February 2023

Introduction:
Accurate inpatient placement at the level of care needed for incoming transported patients can present challenges that may result in a rapid escalation in care following admission to the general inpatient unit. The Pediatric Early Warning System (PEWS) score is useful for early recognition of clinical deterioration. Therefore, we aimed to reduce rapid escalations in care for incoming transported patients via the implementation of an escalation algorithm with a goal of 80% PEWS score completion rate during transport within 6 months.

Methods:
We created an escalation algorithm utilizing PEWS scores and direct lines of communication between emergency medical technicians and receiving physicians. Audit and feedback increased the adoption of the process. We defined rapid escalations as transfer to a higher level of care within 6 hours of admission.

Results:
PEWS score completion increased from a mean of 48% to 70%. This result varied by emergency medical technician crew level of care. Eleven percent (n = 114) of PEWS scores required physician notification, 20% (n = 23) of which resulted in interventions en route. There were no differences in rapid escalation rates over time, but it remained low at <2% of all incoming transported patients. Some crew members report improved communication with hospital providers and feel more empowered to speak up when a patient’s assessment is not as expected following algorithm implementation.

Conclusions:
This project improved PEWS score completion and maintained a low rate of rapid escalations of care among incoming transfers.
Key Drivers Associated with Effective Sepsis Care on a Surgical Unit
Authors: Koehler Richele , Burke Meghan , Rolison Elise , Newman Jennifer , Lockwood Justin M 
Published: February 2023

Background:
In 2020, we observed an increase in inpatient postoperative patient deteriorations. Preliminary case reviews suggested gaps in sepsis care.

Objectives:
To identify key drivers associated with effective care escalation and sepsis care in the inpatient surgical setting as part of the initial planning phase of a large improvement initiative.

Methods:
Our multidisciplinary team included surgical nurses, surgical providers, medical providers, patient safety experts, subject matter experts in pediatric sepsis, and subject matter experts in escalation of care. This team formally reviewed cases involving postoperative deterioration to identify causes of gaps in sepsis care and applied its learnings to the development of a key driver diagram. Themes from the key driver diagram included (1) Enhance recognition of deterioration and subsequent escalation of care and (2) Optimize postoperative patient placement. The team hosted a mini-Kaizen event with frontline team members focused on the first theme, the output of which included consensus agreement on two focus areas (Escalation Chain of Command & Shared Situation Awareness) and a fishbone diagram to identify/prioritize opportunities in postoperative care escalation.

Results:
Causes of gaps in sepsis care included barriers to care escalation that could limit generalizability of sepsis resources to the inpatient surgical setting. Figure 1 shows the key driver diagram.

Conclusion:
We aim to highlight challenges associated with postoperative sepsis care in an inpatient pediatric surgical setting.
Value Added from Same-day Discharge after Appendectomy for Children with Simple Appendicitis
Authors: Juviler Peter , Wilson Nicole A. , Livingston Michael H. , Levatino Elizabeth , Bowden Acacia , Meyers Jeffrey M. , Tesini Brenda , Gleason Cassandra , Pegoli Walter , Arca Marjorie J. , Wakeman Derek 
Published: February 2023

Introduction:
Same-day discharge of children after appendectomy for simple appendicitis is safe and associated with enhanced parent satisfaction. Our general pediatric surgeons aimed to improve the rate of same-day discharge after appendectomy for simple appendicitis.

Methods:
We implemented a clinical practice guideline in September 2019. A surgeon-of-the-week service model and the urgent operating room started in November 2019 and January 2020, respectively. Data for children with simple appendicitis from our academic medical center were gathered prospectively using National Surgical Quality Improvement Program-Pediatric. Patient outcomes before intervention implementation (n = 278) were compared with patients following implementation (n = 264).

Results:
The average monthly percentage of patients discharged on the day of surgery increased in the postimplementation group (32% versus 75%). Median postoperative length of stay decreased [16.5 hours (interquartile range, 15.9) versus 4.4 hours (interquartile range, 11.7), P < 0.001], and the proportion of patients discharged directly from the postoperative anesthesia care unit increased (22.8% versus 43.6%; P < 0.001). There were no differences in balancing measures, including the return to the emergency department and readmission. Fewer children were discharged home on oral antibiotics after implementation (6.8% versus 1.5%, P = 0.002), and opioid prescribing at discharge remained low (2.5% versus 1.1%, P = 0.385).

Conclusions:
Using quality improvement methodology and care standardization, we significantly improved the rate of same-day discharge after appendectomy for simple appendicitis without impacting emergency department visits or readmissions. As a result, our health care system saved 140 hospital days over the first 21 months.
Electroencephalographic characteristics of children and adolescents with chronic musculoskeletal pain
Authors: Ocay Don Daniel , Teel Elizabeth F. , Luo Owen D. , Savignac Chloé , Mahdid Yacine , Blain-Moraes Stefanie , Ferland Catherine E. 
Published: February 2023

Abstract

Introduction:
The pathophysiology of pediatric musculoskeletal (MSK) pain is unclear, contributing to persistent challenges to its management.

Objectives:
This study hypothesizes that children and adolescents with chronic MSK pain (CPs) will show differences in electroencephalography (EEG) features at rest and during thermal pain modalities when compared with age-matched controls.

Methods:
One hundred forty-two CP patients and 45 age-matched healthy controls (HCs) underwent a standardized thermal tonic heat and cold stimulations, while a 21-electrode headset collected EEG data. Cohorts were compared with respect to their EEG features of spectral power, peak frequency, permutation entropy, weight phase-lag index, directed phase-lag index, and node degree at 4 frequency bands, namely, delta (1–4 Hz), theta (4–8 Hz), alpha (8–13 Hz), and beta (13–30 Hz), at rest and during the thermal conditions.

Results:
At rest, CPs showed increased global delta (P = 0.0493) and beta (P = 0.0002) power in comparison with HCs. These findings provide further impetus for the investigation and prevention of long-lasting developmental sequalae of early life chronic pain processes. Although no cohort differences in pain intensity scores were found during the thermal pain modalities, CPs and HCs showed significant difference in changes in EEG spectral power, peak frequency, permutation entropy, and network functional connectivity at specific frequency bands (P < 0.05) during the tonic heat and cold stimulations.

Conclusion:
This suggests that EEG can characterize subtle differences in heat and cold pain sensitivity in CPs. The complementation of EEG and evoked pain in the clinical assessment of pediatric chronic MSK pain can better detect underlying pain mechanisms and changes in pain sensitivity.
Real-world data and evidence in pain research: a qualitative systematic review of methods in current practice
Authors: Vollert Jan , Kleykamp Bethea A. , Farrar John T. , Gilron Ian , Hohenschurz-Schmidt David , Kerns Robert D. , Mackey Sean , Markman John D. , McDermott Michael P. , Rice Andrew S.C. , Turk Dennis C. , Wasan Ajay D. , Dworkin Robert H. 
Published: February 2023

Abstract
The use of routinely collected health data (real-world data, RWD) to generate real-world evidence (RWE) for research purposes is a growing field. Computerized search methods, large electronic databases, and the development of novel statistical methods allow for valid analysis of data outside its primary clinical purpose. Here, we systematically reviewed the methodology used for RWE studies in pain research. We searched 3 databases (PubMed, EMBASE, and Web of Science) for studies using retrospective data sources comparing multiple groups or treatments. The protocol was registered under the DOI:10.17605/OSF.IO/KGVRM. A total of 65 studies were included. Of those, only 4 compared pharmacological interventions, whereas 49 investigated differences in surgical procedures, with the remaining studying alternative or psychological interventions or epidemiological factors. Most 39 studies reported significant results in their primary comparison, and an additional 12 reported comparable effectiveness. Fifty-eight studies used propensity scores to account for group differences, 38 of them using 1:1 case:control matching. Only 17 of 65 studies provided sensitivity analyses to show robustness of their findings, and only 4 studies provided links to publicly accessible protocols. RWE is a relevant construct that can provide evidence complementary to randomized controlled trials (RCTs), especially in scenarios where RCTs are difficult to conduct. The high proportion of studies reporting significant differences between groups or comparable effectiveness could imply a relevant degree of publication bias. RWD provides a potentially important resource to expand high-quality evidence beyond clinical trials, but rigorous quality standards need to be set to maximize the validity of RWE studies.
A Sixteen-year Review of Clinical Practice Patterns in Liposuction Based on Continuous Certification by the American Board of Plastic Surgery
Authors: Stein Michael J. , Sasson Daniel C. , Harrast John , Alderman Amy , Matarasso Alan , Gosain Arun K. 
Published: February 2023

Background:
The American Board of Plastic Surgery (ABPS) has collected data on cosmetic surgery tracers as part of the Continuous Certification (CC) process since 2005. These data offer valuable information on national trends in clinical practice. The present study was performed to analyze evolving trends in Suction-Assisted Liposuction (SAL) from the ABPS cosmetic tracer procedures.

Methods:
Tracer data was review from 2005 to 2021 and grouped into an “early cohort (EC)” from 2005-2014 and a “recent cohort (RC)” from 2015-2021. Fisher’s exact tests and two-sample t-tests compared patient demographics, surgical techniques, and complication rates.

Results:
Data from 2810 SAL cases were included (1150 EC, 1660 RC). In-office procedures have increased (36%EC vs 41%RC, p<0.01), while the use of general anesthesia has remained the same (63%EC vs. 62%RC, p=0.01). Power-assisted liposuction (PAL) has increased in popularity (24%EC vs. 40%RC, p<0.001) while ultrasound-assisted (UAL) has decreased (5% vs. 2%, p<0.0001). The volume of lipoaspirate is increasing (1150cc EC vs. 1660cc RC, p<0.0001). With respect to body areas treated, the abdomen (64% EC vs. 69% RC, p<0.01), flank (60%EC vs. 64%RC, p<0.05), and back (22%EC vs. 34%RC, p<0.0001) have increased, while thighs (36%EC vs. 23%RC, p<0.0001) and knees (8%EC vs. 5%RC, p<0.01) have decreased. Position changes from prone to supine are more common (30%EC vs. 37%RC, p<0.0001) and surgeons are reporting more SAL of multiple areas in one case (28%EC vs. 36%RC, p<0.0001). Perioperative heparin use has significantly increased (2%EC vs. 7%RC, p<0.0001) during liposuction.

Conclusions:
This study highlights evolving trends in the clinical practice of liposuction over the last 16 years. We find that liposuction is becoming increasingly common in an outpatient setting and being performed concomitantly with other procedures. Despite multiple emerging technologies, the popularity of PAL is increasing. While adverse actions have not significantly increased with these changes the authors stress careful pre-operative evaluation of patients to identify factors that increase the risk of complications, especially those associated with combined procedures and liposuctions of multiple areas.
Predictors for Necrosis after Single Digital Replantation: a Retrospective Analysis of 946 Patients
Authors: Wang Tao , Xiong Fei , Tan Ji Yang , Qiu Yang , Mi Jing-Yi 
Published: February 2023

Study design:
A retrospective study

Objective:
Digital necrosis (DN) is a serious complication after replantation. However, predisposing factors, as reported less, remain controversial. The purpose of this study is to explore risk factors of necrosis after single digital replantation.

Methods:
Patients who underwent single digital replantations in our hospital between June. 2014 and October 2020 were included. We regarded DN as the failure group (FG) and digital survive as the success group (SG). The factors were conducted by univariate and multivariate analysis.

Results:
The survival rate in our study was 78.8% (745 of 946). The results of univariate analysis showed that there were significant differences in the levels of D-Dimer (1st), menstrual cycle, injury level, and starting and finishing time of surgery between different groups. In multivariate analysis, age, injury level, duration of surgery, and D-dimer (1 st) were identified as the risk factors for DN in the entire and male population. Additionally, regarding male patients, ischemia time was also found to be a risk factor for DN. In terms of female patients, the menstrual period and menopause were related to DN.

Conclusions:
Many factors, including age, ischemia time, injury level, menstrual period, menopause, and duration of surgery, were related to DN after digital replantation. D-dimer (1 st) was first found as a predicted factor for DN. In addition, these results also showed that the starting and ending times of surgery were associated with DN by univariate analysis. Preoperative measures should be taken to lower the incidence of DN.
Management of the Inferior Alveolar Nerve in Large Sagittal Split Advancements: To Free or Not?
Authors: Massenburg Benjamin B. , Tolley Philip D. , Ettinger Russell E. , Susarla Srinivas M. 
Published: February 2023

Purpose:
To evaluate whether neurosensory recovery of the inferior alveolar nerve (IAN) is influenced by its location following sagittal split osteotomy (SSO) in patients undergoing large mandibular movements.

Methods:
This was a prospective, split-mouth study of skeletally mature patients undergoing BSSO. Patients were included as study subjects if they underwent BSSO for mandibular advancement > 10 mm and, following the splits, the IAN was freely entering the distal segment (IANDI) on one side and within the proximal segment (IANPR) on the other. Descriptive, bivariate, and Kaplan-Meier statistics were computed.

Results:
The study sample included 13 subjects (8 female, mean age 18.7 ± 1.8 years) undergoing 26 SSOs. Eleven subjects underwent bimaxillary surgery; 10 had simultaneous genioplasty. The mean mandibular movement was 12.2 ± 1.4 mm and was not significantly different between sides (p = 0.43). All subjects achieved FSR bilaterally within 1 year of surgery. There was no difference in the median times to FSR based upon the location of the IAN (IANDI = 105 days vs IANPR = 126 days, p = 0.57).

Conclusion:
In SSO for mandibular advancement with movements > 10 mm, leaving the IAN within the proximal segment may not impact time to FSR.
Diagnosis and Management of Pseudoblepharoptosis in Eastern Asians: A Commonly Observed But Easily Overlooked Type of Blepharoptosis
Authors: Zhou Xianyu , He Jizhou , Yang Jun , Liu Fei 
Published: February 2023

Background:
Pseudoblepharoptosis, which is characterized by ptotic eyelid appearance with normal levator function, is a common abnormality observed in Eastern Asians. Misdiagnosis of pseudoblepharoptosis may lead to inappropriate treatments and unwanted complications. Using the data obtained from a modified levator function examination, this study sought to improve the diagnosis and explore the appropriate treatment of pseudoblepharoptosis based on the typical eyelid anatomy of Eastern Asians.

Methods:
This retrospective study included patients with drooping and bulky eyelids who had been preoperatively diagnosed between January 2018 and December 2018 using a modified approach. Debulking of the retro-orbicularis oculus fat and orbital septum fat and release of the ligament-like structure were performed to correct pseudoblepharoptosis without manipulating the levator muscle. The functional and aesthetic outcomes were evaluated postoperatively.

Results:
The proposed modified approach was significantly more accurate than the traditional technique. Of the patients, 78 (84.8%) and 9 (9.8%) showed good and moderate cosmetic outcomes, respectively. The margin reflex distance 1 value significantly improved from 1.74±0.87 mm preoperatively to 4.56±0.71 mm postoperatively (P<0.05). Moreover, 179 (97.3%) of the 184 eyelids examined achieved adequate correction.

Conclusions:
The modified levator function examination approach used in this study may help improve the diagnosis of pseudoblepharoptosis. Surgical intervention focused on correcting the bulky and drooping upper eyelids and orbital septum may lead to satisfactory outcomes in Eastern Asians with pseudoblepharoptosis without manipulating the levator muscle.