bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Unprecedented ICU Capacity Strain, As Experienced During the COVID-19 Pandemic, Impact Patient Outcome?
Authors: Wilcox M. Elizabeth , Rowan Kathryn M. , Harrison David A. , Doidge James C. 
Published: February 2022

OBJECTIVES:
To determine whether patients admitted to an ICU during times of unprecedented ICU capacity strain, during the COVID-19 pandemic in the United Kingdom, experienced a higher risk of death.

DESIGN:
Multicenter, observational cohort study using routine clinical audit data.

SETTING:
Adult general ICUs participating the Intensive Care National Audit & Research Centre Case Mix Programme in England, Wales, and Northern Ireland.

PATIENTS:
One-hundred thirty-thousand six-hundred eighty-nine patients admitted to 210 adult general ICUs in 207 hospitals.

INTERVENTIONS:
Multilevel, mixed effects, logistic regression models were used to examine the relationship between levels of ICU capacity strain on the day of admission (typical low, typical, typical high, pandemic high, and pandemic extreme) and risk-adjusted hospital mortality.

MEASUREMENTS AND MAIN RESULTS:
In adjusted analyses, compared with patients admitted during periods of typical ICU capacity strain, we found that COVID-19 patients admitted during periods of pandemic high or pandemic extreme ICU capacity strain during the first wave had no difference in hospital mortality, whereas those admitted during the pandemic high or pandemic extreme ICU capacity strain in the second wave had a 17% (odds ratio [OR], 1.17; 95% CI, 1.05–1.30) and 15% (OR, 1.15; 95% CI, 1.00–1.31) higher odds of hospital mortality, respectively. For non-COVID-19 patients, there was little difference in trend between waves, with those admitted during periods of pandemic high and pandemic extreme ICU capacity strain having 16% (OR, 1.16; 95% CI, 1.08–1.25) and 30% (OR, 1.30; 95% CI, 1.14–1.48) higher overall odds of acute hospital mortality, respectively.

CONCLUSIONS:
For patients admitted to ICU during the pandemic, unprecedented levels of ICU capacity strain were significantly associated with higher acute hospital mortality, after accounting for differences in baseline characteristics. Further study into possible differences in the provision of care and outcome for COVID-19 and non-COVID-19 patients is needed.
Science of Learning Strategy Series: Article 3, Interleaving
Authors: Van Hoof Thomas J. , Sumeracki Megan A. , Madan Christopher R. 
Published: February 2022

Abstract:
Interleaving is an evidence-based, learning-science strategy that is relevant to the planning and implementation of continuing professional development (CPD). Mixing related but different areas of study forces the brain to reconcile the relationship between the areas while understanding each area well. By doing so, interleaving increases the likelihood of mastery and memory. Research from cognitive psychology and neuroscience provides the rationale for interleaving, and examples of its implementation in health profession education have begun to appear in the literature. If utilized appropriately, some common CPD interventions can leverage interleaving. Through increased understanding, CPD participants can benefit from interleaving by making more-informed educational choices, and CPD planners can benefit in efforts to improve educational activities.
Haploidentical hematopoietic stem cell transplantation may improve long-term survival for children with high-risk T-cell acute lymphoblastic leukemia in first complete remission
Authors: Zhang Yongzhan , Bai Lu , Cheng Yifei , Lu Aidong , Wang Yu , Wu Jun , Zhang Xiaohui , Zuo Yingxi , Xu Lanping , Jia Yueping , Huang Xiaojun , Zhang Leping 
Published: February 2022

Abstract

Background:
The role of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children with high-risk (HR) T-cell acute lymphoblastic leukemia (T-ALL) in first complete remission (CR1) is still under evaluation. Moreover, relapse is the main factor affecting survival. This study aimed to explore the effect of allo-HSCT (especially haploidentical HSCT [haplo-HSCT]) on improving survival and reducing relapse for HR childhood T-ALL in CR1 and the prognostic factors of childhood T-ALL in order to identify who could benefit from HSCT.

Methods:
A total of 74 newly diagnosed pediatric T-ALL patients between January 1, 2012 and June 30, 2018 were enrolled in this retrospective study. Patients were stratified into the low-risk chemotherapy cohort (n = 16), HR chemotherapy cohort (n = 31), and HR transplant cohort (n = 27). Characteristics, survival outcomes, and prognostic factors of all patients were then analyzed.

Results:
Patient prognosis in the HR chemotherapy cohort was significantly worse than that in the low-risk chemotherapy cohort (5year overall survival [OS]: 58.5% vs. 100%, P = 0.003; 5-year event-free survival [EFS]: 54.1% vs. 83.4%, P = 0.010; 5-year cumulative incidence of relapse [CIR]: 45.2% vs. 6.3%, P = 0.011). In HR patients, allo-HSCT improved the 5-year EFS and CIR compared to that of chemotherapy (5-year EFS: 80.1% vs. 54.1%, P = 0.041; 5-year CIR: 11.6% vs. 45.2%, P = 0.006). The 5-year OS was higher in the HR transplant cohort than that in the HR chemotherapy cohort (81.0% vs. 58.5%, P = 0.084). Minimal residual disease re-emergence was an independent risk factor for 5-year OS, EFS, and CIR; age ≥10 years was an independent risk factor for OS and EFS; and high white blood cell count was an independent risk factor for EFS and CIR.

Conclusion:
Allo-HSCT, especially haplo-HSCT, could effectively reduce relapse of children with HR T-ALL in CR1.
Endocrine Mucin-Producing Sweat Gland Carcinoma: Emerging Evidence of Multicentric Cutaneous Origin and Occasional Concurrence With Analogous Breast Tumors
Authors: Ravi Priyanka Y. , Walsh Noreen M. , Archibald Curtis , Pasternak Sylvia 
Published: February 2022

Introduction:
Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a low-grade carcinoma with predilection for the eyelid. It is analogous to solid papillary carcinoma of the breast with both expressing neuroendocrine markers and the potential to progress to invasive mucinous carcinoma (IMC). Although over 80 cases of EMPSGC have been reported, few multicentric cases have been described in the literature. In this article, we report 9 cases of EMPSGC including 3 with multicentric disease.

Methods:
A computerized search was performed for EMPSGC and IMC of the eyelid from January 2000 to February 2021. Records were reviewed for age, sex, tumor location, and clinical impression.

Results:
Eight EMPSGC (7 associated with IMC) and 1 IMC of the eyelid were identified. Lesions were slightly more common in men (55%) than women. The mean age of presentation was 76 years (range, 59–98 years). Lesions ranged from 2.5 to 12 mm. Three cases had multicentric synchronous lesions on the skin. Histologically, these were well-circumscribed dermal tumors with solid or partially cystic nodules. Tested tumors expressed at least 1 neuroendocrine marker and were positive for CK7, ER/PR, 1 or more of GCDFP-15, mammaglobin, and GATA-3. One case had an associated IMC of the breast, and another case was associated with an intraductal papilloma of the breast in a man. There was no evidence of metastasis.

Conclusion:
EMPSGC is a low-grade adnexal neoplasm, commonly affecting the eyelid of the elderly. Lesions often progress to IMC, metastases being exceptionally rare. EMPSGC can be bilateral and multicentric. Concurrence with breast neoplasms has been observed and deserves investigation.
Metastatic Basal Cell Carcinoma: An Unexpected Diagnosis in a Young Patient With Back Pain
Authors: Krooks Jolie , Wilhelm Alyeesha B. , Yassi Usama , Campbell Gerald 
Published: February 2022

Abstract:
Basal cell carcinoma (BCC) portends a notoriously favorable prognosis in most patients with morbidity limited to localized destruction and recurrence. Metastatic BCC (mBCC) is an unexpected outcome affecting less than 1% of patients with a known primary lesion and predominantly involves regional lymph nodes. Reports of isolated bone involvement and spinal cord compression are rare. In the cases we identified in the literature, patients presented with massive primary lesions on the trunk that had been present for years and that were often still present at the time of diagnosis. Additionally, histology of distant metastatic lesions typically reveals aggressive subtypes. Herein, we report a case of mBCC in a patient with a history of BCC involving the cheek; the lesion was excised more than 10 years ago. He was referred to our institution for acutely worsening back pain and multifocal neurologic deficits. Clinical symptoms and radiographic findings demonstrated isolated bone involvement, with multiple lytic bone lesions and spinal cord compression noted on imaging studies. Biopsy revealed nests of small basaloid cells with peripheral palisading and immunohistochemical staining consistent with the unexpected diagnosis of mBCC, nodular subtype. Our case illustrates that a historically resected primary lesion may cause distant metastasis after a decade and that nonaggressive subtypes can also be implicated. We also provide insight into the potential pathogenesis of this manifestation.
Describing Occupational Health Nursing Interventions and Outcomes in Hair Stylist Apprentices With Hand Eczema Using the Omaha System as a Framework
Authors: Aktas Emine , Esin M. Nihal , Monsen Karen A. 
Published: February 2022

ABSTRACT
The Omaha System is one of the most applicable classification systems and can be used effectively to recognize occupational health nurse(s) in practice. Describing occupational health nurse interventions and outcomes can be an example for planning care in a specific case such as hair stylist apprentices with hand eczema symptoms by using the Omaha System. The study consists of 15 cases. The “Turkish-Nordic Occupational Skin Questionnaire” was used for data collection related to eczema symptoms. The assessment was made by using electronic health record system based on the Omaha System. For the 15 cases, 113 problems and 624 nursing interventions were reported. According to the Omaha System's Problem Classification Scheme, the frequently diagnosed problems were skin (100%), neighborhood/workplace safety (100%), health care supervision (67%), respiration (53%), and pain (40%). The identified intervention categories were 98.5% about teaching, guidance, and counseling; 89.2% about surveillance; and 6.4% about case management. The occupational health nursing outcomes scores were more likely to show higher level after the intervention (p < .05). The Omaha System can be effectively used in occupational healthcare settings for specific cases in workplaces.
Elevated lipoprotein(a) levels as an independent predictor of long-term recurrent events in patients with acute coronary syndrome: an observational, retrospective cohort study
Authors: Yang Si-qi , Liu Han-xiong , Yu Xiu-qiong , Tong Lin , Chen Xu , Qi Ling-yao , Cui Cai-yan , Cheng Lian-chao , Cai Lin 
Published: February 2022

Background
Whether lipoprotein(a) [Lp(a)] is associated with recurrent cardiovascular events (RCVEs) still remains controversial. The present study aimed to investigate the prognostic value of Lp(a) for long-term RCVEs and each component of it in people with acute coronary syndrome (ACS).

Methods
This multicenter, observational and retrospective study enrolled 765 ACS patients at 11 hospitals in Chengdu from January 2014 to June 2019. Patients were assigned to low-Lp(a) group [Lp(a) < 30 mg/dl] and high-Lp(a) group [Lp(a) ≥ 30 mg/dl]. The primary and secondary endpoints were defined as RCVEs and their elements, including all-cause death, nonfatal myocardial infarction (MI), nonfatal stroke and unplanned revascularization.

Results
Over a median 17-month follow-up, 113 (14.8%) patients presented with RCVEs were reported, among which we observed 57 (7.5%) all-cause deaths, 22 (2.9%) cases of nonfatal stroke, 13 (1.7%) cases of nonfatal MI and 33 (4.3%) cases of unplanned revascularization. The incidences of RCVEs and revascularization in the high-Lp(a) group were significantly higher than those in the low-Lp(a) group (P < 0.05), whereas rates of all-cause death, nonfatal stroke and nonfatal MI were not statistically different (P > 0.05). Kaplan–Meier analysis also revealed the same trend. Multivariate Cox proportional hazards analysis showed that 1-SD increase of Lp(a) was independently associated with both the primary endpoint event [hazard ratio (HR), 1.285 per 1-SD; 95% confidence interval (CI), 1.112–1.484; P < 0.001] and revascularization (HR, 1.588 per 1-SD; 95% CI, 1.305–1.932; P < 0.001), but not with the other secondary events.

Conclusion
Increased Lp(a) is an independent predictor of RCVEs and unplanned revascularization in patients with ACS.
A model to predict inhospital mortality in patients with cirrhosis, ascites and hyponatremia
Authors: Thuluvath Paul J. , Alukal Joseph J. , Zhang Talan 
Published: February 2022

Background and objective
Hypervolemic hyponatremia is a late complication of portal hypertension. Hyponatremia is associated with a higher mortality in hospitalized patients. In this study, we evaluated the risk factors for inhospital mortality and developed a mortality prediction model in patients with cirrhosis and hyponatremia.

Methods
Using the national inpatient sample data for years 2016 and 2017, we identified cirrhotic patients hospitalized with ascites and hyponatremia (n = 9153). We identified independent risk factors of inhospital mortality and developed a prediction model in a training group and assessed its accuracy in a validation group. To enhance the clinical utility, we further stratified patients into low-, intermediate-, and high-risk mortality risk groups using cutoff points selected by decision tree analysis.

Results
The inhospital mortality in our cohort was 10.2% (n = 846). Multivariable analysis showed that age at least 65 years, variceal bleeding, sepsis, coagulopathy, and acute-on-chronic liver failure (ACLF defined as two or more organ failures) were independent risk factors for mortality. The prediction model using these five risk factors had an AUROC of 0.80 [95% confidence interval (CI), 0.78–0.82] for the training data and 0.83 (95% CI, 0.80–0.86) for the validation data. The mortality risks in the low-, intermediate-, and high-risk groups were 4% (95% CI, 3–4), 29% (95% CI, 28–33), and 43% (95% CI, 37–50), respectively.

Conclusion
We have developed a clinically meaningful inhospital prognostic model with excellent discrimination that will enable clinicians to risk stratify hospitalized patients with hyponatremia, ascites, and cirrhosis.
Adherence to regular surveillance visits for hepatocellular carcinoma in patients with chronic hepatitis C virus infection who achieved sustained virologic response
Authors: Toyoda Hidenori , Yasuda Satoshi , Shiota Shohei , Kumada Takashi , Tanaka Junko 
Published: February 2022

Objective
Patients with chronic hepatitis C virus (HCV) infection who achieve sustained virologic response (SVR) to anti-HCV therapy, that is the eradication of HCV, are recommended to continue regular hospital visits for the surveillance of hepatocellular carcinoma (HCC) that can develop after SVR. However, it is unclear how well patients with SVR adhere to post-SVR follow-up over the long term. We investigated this adherence and the factors associated with it.

Methods
Medical record data on regular hospital visits were reviewed in 1329 patients with no history of HCC who achieved SVR by anti-HCV therapy. At the time of SVR confirmation, all patients were advised to continue regular visits, and the risk of post-SVR HCC was explained. The adherence rate of post-SVR follow-up and associated factors were analyzed.

Results
Adherence rates decreased continuously over time, as follows: 76.6% at 5 years, 62.4% at 10 years, 48.8% at 15 years, and 35.3% at 20 years after SVR. Adherence rates did not differ based on the degree of baseline liver fibrosis and were significantly lower in patients who achieved SVR by interferon (IFN)-free therapy and those with HCV genotype 2b.

Conclusion
Adherence to post-SVR follow-up decreased over the long term, and rates differed by patient background. Adherence was especially poor in patients who achieved SVR by IFN-free therapy, and therefore, strategies are necessary to encourage these patients to maintain their regular schedule of hospital visits.
Dynamic Reconstruction of Facial Paralysis in Craniofacial Microsomia
Authors: Zuo Kevin J. , Heinelt Martina , Ho Emily S. , Forrest Christopher R. , Zuker Ronald M. , Borschel Gregory H. 
Published: February 2022

Background:
Craniofacial microsomia is associated with maxillomandibular hypoplasia, microtia, soft-tissue deficiency, and variable severity of cranial nerve dysfunction, most often of the facial nerve. This study evaluated the incidence of facial paralysis in patients with craniofacial microsomia and outcomes after free functioning muscle transfer for dynamic smile reconstruction.

Methods:
A single-center, retrospective, cross-sectional study was performed from 1985 to 2018 to identify pediatric patients with craniofacial microsomia and severe facial nerve dysfunction who underwent dynamic smile reconstruction with free functioning muscle transfer. Preoperative and postoperative facial symmetry and oral commissure excursion during maximal smile were measured using photogrammetric facial analysis software.

Results:
This study included 186 patients with craniofacial microsomia; 41 patients (21 male patients, 20 female patients) had documented facial nerve dysfunction (22 percent) affecting all branches (51 percent) or the mandibular branch only (24 percent). Patients with severe facial paralysis (n = 8) underwent smile reconstruction with a free functioning muscle transfer neurotized either with a cross-face nerve graft (n = 7) or with the ipsilateral motor nerve to masseter (n =1). All patients achieved volitional muscle contraction with improvement in lip symmetry and oral commissure excursion (median, 8 mm; interquartile range, 3 to 10 mm). The timing of orthognathic surgery and facial paralysis reconstruction was an important consideration in optimizing patient outcomes.

Conclusions:
The authors’ institution’s incidence of facial nerve dysfunction in children with craniofacial microsomia is 22 percent. Free functioning muscle transfer is a reliable option for smile reconstruction in children with craniofacial microsomia. To optimize outcomes, a novel treatment algorithm is proposed for craniofacial microsomia patients likely to require both orthognathic surgery and facial paralysis reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Orbital and Periorbital Dysmorphology in Untreated Pfeiffer Syndrome
Authors: Lu Xiaona , Forte Antonio Jorge , Allam Omar , Park Kitae Eric , Wilson Alexander , Alperovich Michael , Steinbacher Derek M. , Tonello Cristiano , Alonso Nivaldo , Persing John A. 
Published: February 2022

Background:
Visual impairment secondary to orbital and periorbital dysmorphology is frequent in Pfeiffer syndrome patients. The etiopathogenesis of this aberrancy, however, remains unclear.

Methods:
Untreated Pfeiffer syndrome patients (n = 31) and normal control subjects (n = 43) were compared. Craniometric and volumetric analyses related to the orbital and periorbital anatomy were performed using Materialise (Leuven, Belgium) software.

Results:
Overall, orbital cavity volume of Pfeiffer patients is reduced by 28 percent (p < 0.001), compared to normal, starting before 3 months of age (p = 0.004). Globe volume was diminished by 10 percent (p = 0.041) before 3 months of age, yet tended to catch up thereafter. However, the retrobulbar soft-tissue volume remained smaller beyond 1 year of age (17 percent, p = 0.003). Globe volume projection beyond the bony orbit increased in all observed ages (82 percent, p < 0.001). The volumes of sphenoid bone, maxilla, and mandible proportionately were restricted by 24 to 25 percent (p = 0.003 to 0.035) before 3 months of age. The volume of maxilla and mandible gradually approximate normal; however, the sphenoid bone volume in Pfeiffer patients remains less than normal (p = 0.002) into childhood. The anteroposterior length of both the zygoma and the maxilla was reduced by 14 percent (p < 0.001). Anterior positioning of the zygoma is less by 23 percent (p < 0.001) in Pfeiffer patients overall, with anterior positioning of maxilla reduced similarly by 23 percent (p < 0.001).

Conclusions:
Pfeiffer syndrome patients develop decreased retrobulbar soft-tissue and globe volume, along with a restricted orbital cavity volume in infancy. Significant hypoplasia of the sphenoid bone is associated with more severe central facial (maxilla) retrusion, compared to lateral facial structures (zygoma).

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.
Transverse Distraction Osteogenesis for Posterior Narrowing of the Cranial Vault
Authors: Kalmar Christopher L. , Zapatero Zachary D. , Kosyk Mychajlo S. , Carlson Anna R. , Swanson Jordan W. , Taylor Jesse A. , Bartlett Scott P. 
Published: February 2022

Summary:
Although conventional posterior vault distraction osteogenesis is known to achieve the greatest improvement in intracranial volume, anteroposterior expansion of the cranial vault is not always ideal in certain head shapes. Transverse posterior vault distraction osteogenesis is an alternative reconstructive strategy in patients presenting with recalcitrant multisuture craniosynostosis resulting in scaphocephaly with posterior narrowing. The authors present a multimedia demonstration of placing the cranial hinge points at the superior anterior aspect of the bone segments in order to achieve increased intracranial volume and significant improvement in posterior head shape, while preserving normal anterior skull dimensions.
Does Root Cause Analysis Improve Patient Safety? A Systematic Review at the Department of Veterans Affairs
Authors: Shah Freny , Falconer Elissa A. , Cimiotti Jeannie P. 
Published: February 2022

Background and Objectives:
While root cause analysis (RCA) is used to analyze medical errors with a systems approach, evidence demonstrating its effectiveness in reducing patient harm remains sparse. The heterogeneity of the RCA methodology at different health care organizations has posed challenges to studying its value. The Department of Veterans Affairs (VA) has an established and standardized RCA approach, making it an ideal context to study RCA's impact. This review assessed whether implemented interventions recommended by RCAs were effective in mitigating preventable adverse events at the VA.

Methods:
PubMed, Web of Science, CINAHL and Business Source were searched for studies on RCAs performed at the VA that evaluated effectiveness of interventions and were published between 2010 and 2020. The Appraisal Tool for Cross-sectional Studies (AXIS) was used to assess bias of bias.

Results:
The majority of studies eliminated during our eligibility process reported on RCAs without attention to their specific impact on patient safety. Ten retrospective studies met inclusion criteria and were part of the final review. Studies were grouped into adverse events related to incorrect surgical/invasive procedures, suicides, falls with injury, and all-cause adverse events. Six studies reported on effectiveness by demonstrating quantitative changes in adverse events over time or by location following a specific intervention. Four studies reported on the effectiveness of implemented interventions using a facility-based rating of “much better” or “better.”

Conclusions:
Of the studies included in this review, all reported improvements following interventions implemented after RCAs, but with variability in study definitions and methodology to assess effectiveness. Increased reporting of outcomes following RCAs, with an emphasis on quantitative patient-related outcome measures, is needed to demonstrate the impact and value of the RCA.