bluuebunny/crossref_metadata_2025_split huggingface dataset:
Restructuring Care Teams Within a Neonatal Intensive Care Unit
Authors: Ward C , Chinnery H , Landry MA , OBlenes S , Kumaran K 
Published: September 2022

Abstract
BACKGROUND: Organizing care teams in a large neonatal intensive care unit (NICU) is a challenge. In our pod-based model, babies were assigned a care team based on acuity and bed location. They were frequently moved between teams to accommodate nursing assignments, causing an imbalance in patient census and acuity across teams. As part of a larger process improvement project, we implemented and studied an alternate model for assigning patients to a care team.
OBJECTIVES: The objective of this project was to improve consistency of patient care and to balance the workload across the three care teams in the NICU.
DESIGN/METHODS: The setting is a 69 bed tertiary teaching NICU with approximately 1300 admissions a year. Three clinical teams share day to day assignment of a combination of these level III and level II pods. A multidisciplinary subgroup conducted a two hour Kaizen (brain storming) event with a larger group of stake-holders during which the decision was made to assign babies to a care team based on current workload of each team. The care teams follow each patient from admission to discharge, regardless of the baby’s location within the unit instead of moving babies between teams. Education communication, feedback strategies regarding the process change were formulated and executed by the sub-group. The new method was piloted for a period of three months. Objective data was collected regarding patient movement, patient acuity, census balance, and rounds time. Qualitative data was collected through staff and family surveys. ignments, causing an imbalance in patient census and acuity across teams. As part of a larger process improvement project, we implemented and studied an alternate model for assigning patients to a care team.
RESULTS: Forty percent of babies admitted to the NICU crossed care teams during their stay prior to the process change while 0.3% changed teams after the change. The number of moves per patient decreased from 1.4 to 1.27. The variability in both census and acuity was diminished following implementation of the changes. The daily average number of man-hours to complete daily rounds decreased from 47.5 before the change to 40.5 after the change. There was a 35% response rate to the staff survey with an overall positive response to the changes with regards to improving the patient and family experience. The family satisfaction survey showed a trend toward increased satisfaction following the change.
CONCLUSION: Process improvement methods can be used to successfully change how care teams are structured in a tertiary NICU.
Current Practices and Use of Simulation in Neonatal Resuscitation Program Courses Across Canada
Authors: McMullen J , Kalaniti K , Campbell D 
Published: September 2022

Abstract
BACKGROUND: Simulation is an effective tool in medical education. The extent and manner in which simulation is used within Neonatal Resuscitation Program (NRP) courses across Canada is currently unknown. In order to improve NRP education, current practices must be better understood.
OBJECTIVES: To characterize current practices and use of simulation in NRP courses across Canada.
DESIGN/METHODS: A REDCap survey, consisting of questions about instructor demographics, practices in NRP instruction and use of simulation, was developed and distributed to all NRP instructors across Canada. Simple statistics were used to tabulate responses and the chi-squared test was used to assess differences in simulation use between different types of instructors.
RESULTS: Five hundred sixty nine of 1390 (40.9%) NRP instructors completed the survey. Participants included 88 (15.5%) physicians, 74 (13.0%) respiratory therapists, 345 (60.6%) registered nurses and 28 (4.9%) nurse practitioners. Two hundred fifty eight (45.4%) worked in institutions providing Level III care. Overall, 560 (98.4%) respondents used simulation, of which only 176 (31.4%) reported using high-technology simulation. Only 180 (31.6%) instructors who used simulation reported having received formal training in high-technology simulation. When asked about the role of simulation in NRP instruction, 545 (95.8%) agreed or strongly agreed that simulation is a valuable educational tool in NRP instruction, but only 219 (39.1%) felt comfortable using high-technology simulation. There was no difference in use of high-technology simulation between physician and non-physician instructors (I2 0.90, p=0.34). Of the instructors who used high-technology simulation, 160 (90.9%) and 134 (76.1%) had learners and instructors, respectively, from multiple healthcare disciplines present in some or all sessions. There was a non-significant trend towards higher use of interprofessional learners among physician instructors (I2 3.8, p=0.052). An impressive 554 (98.9%) debriefed after some or all simulation sessions, with only 295 (51.8%) instructors having received formal training in debriefing techniques.
CONCLUSION: Almost all NRP instructors use simulation and feel that it is valuable, though few have received formal training and feel comfortable using high-technology simulation. Most simulation use is low-technology, in keeping with the Canadian Paediatric Society (CPS) recommendations, though the optimal methods of use of simulation in NRP instruction are not known. The majority of instructors debrief with learners, as recommended by the CPS, though only half have had training in debriefing. The results of this study support further investigation into the optimal type of simulation in NRP teaching and more formal education in simulation and debriefing for NRP instructors.
Changes to Antibiotic Use After the Introduction of an Antimicrobial Stewardship Program in a Neonatal Intensive Care Unit
Authors: Leifso K , Dow K , McKnight S , Sheth P , Tomalty L 
Published: September 2022

Abstract
BACKGROUND: Inappropriate or prolonged antibiotic use in neonatal intensive care units can lead to the emergence of antibiotic resistant bacteria as well as complications such as invasive candidiasis and necrotizing enterocolitis. An antimicrobial stewardship program (ASP) was introduced in our level II/III neonatal intensive care unit (NICU) with the goal of optimizing patient safety and outcomes with respect to antimicrobial use as well as to reduce the risk of infection or colonization by antimicrobial resistant organisms (AROs). The ASP included a pediatric infectious diseases physician, a neonatologist or delegate, a microbiologist and a pharmacist who met twice weekly to review all admitted neonates who had been receiving antibiotics for more than 24 hours.
OBJECTIVES: In order to evaluate the effectiveness of ASP interventions, we conducted a retrospective review of antibiotic use in the NICU comparing the two years before the ASP and the first year of the ASP operation.
DESIGN/METHODS: Antimicrobial use from the two years prior and one year following the ASP start date of December 1st, 2014 was compared. All neonates who received antimicrobials between the dates of December 1st, 2012 and November 30th, 2015 were included in the review. Antifungal and antiviral use were excluded. Antibiotic start and stop dates were collected from the patient charts. After the start of the ASP, antibiotic start and stop dates were obtained from the computerized pharmacy database. Overall days of therapy (DOTs) and antibiotic-specific DOTs, were calculated per 1000 patient-days.
RESULTS: In the first year, 109 reviews were performed on 70 neonates. The pediatric ID service was already following 25 babies leaving 84 reviews. Changes were recommended in 43 (51%) instances. Discontinuation of antibiotics was recommended in 26 (60%), reduced length of therapy or decreased spectrum of antibiotic in 10 (24%), and ID consultation in 9 (21%). Overall and selected antibiotic exposure in the NICU is presented in Table 1 (See page e79).
CONCLUSION: Introduction of an ASP reduced the overall exposure to antimicrobials in the NICU. Marked reductions in third-generation cepha-losporin and vancomycin use were observed in the first year of the ASP.
Integrated Neonatal Support with Placental Transfusion and Resuscitation (Inspire): A Feasibility Study
Authors: Irvine L , Thomas S , Mehrem A Abou , Singhal N , Kowal D , Soraisham A , Cooper S , Stritzke A , Murthy P 
Published: September 2022

Abstract
BACKGROUND: Compromised neonates do not receive placental transfusion (PT), but receive immediate cord clamping to facilitate resuscitation. Animal studies suggest possible benefit of resuscitation during PT.
OBJECTIVES: To study the feasibility of initiating resuscitative care during PT for 90s in preterm infants.
DESIGN/METHODS: We designed a mobile, battery powered resuscitation platform (iNSPiRe) that contains a scale, warm gel mattress, oxygen and air tanks, blender, T piece resuscitator, pulse oximeter (PO), and suction device (Fig. 1). Resuscitative care included initial steps, and respiratory support at 30s following Neonatal Resuscitation Program guidelines. Thermoregulation was maintained using a hat, warmed blankets, and gel mattress. Heart rate was auscultated at 30, 60 and 90s. PO was placed on the right wrist/hand. The cord was clamped at 90s. The baby and platform were mobilized from mother’s bedside to a radiant warmer by one provider, while another provider maintained respiratory support. Once on the warmer, axillary temperature (AT) was measured. Resuscitation interventions and management during first 24 hours were recorded.
RESULTS: Seven infants born vaginally, median (range) gestational age (GA) was 30 weeks (28 to 36) and birth weight 1500g (1270 to 2650), were managed using iNSPiRe. Table 1 shows time (T) to initiate interventions, cord pH and Apgar scores. Five infants received continuous positive airway pressure (CPAP) and one received positive pressure ventilation; none had hypotension, pneumothorax, or received surfactant. No incidence of intraventricular hemorrhage.
CONCLUSION: It is feasible to commence resuscitative care during PT in infants ≥30 weeks' GA for 90s. Further research is needed to assess the feasibility in smaller and sicker preterm infants.
Parental Satisfaction Towards Autism Spectrum Disorder Diagnostic Assessment Process for Children 12-39 Months.
Authors: Lemay JF , Langenberger S 
Published: September 2022

Abstract
BACKGROUND: To address lengthy delays in accessing diagnostic assessment for Autism Spectrum Disorder (ASD), our ASD services underwent a review of the service model in 2013-2014. In addition to establishing a formal ASD Diagnostic Clinic, the diagnostic evaluation process for children 12-39 months was re-designed. A major implemented change as part of our diagnostic process was the Pre- and Post-diagnosis parent information sessions.
OBJECTIVES: To assess the satisfaction level for parents of children being evaluated through our new ASD diagnostic process for children 12-39 months.
DESIGN/METHODS: This evaluation was done through two different surveys: 1) a validated, standardized telephone survey (average 15 minutes) was administered by an experienced nurse to parents whose child was diagnosed with ASD (January 2014-June 2015) based on the new ASD diagnostic process. Parents were asked to retrospectively evaluate their experience undergoing the new diagnostic assessment process; 2) a subgroup of parents completed a written survey to evaluate the Pre- and Post-diagnosis parent information sessions (of note: survey was given at the end of these educational sessions).
RESULTS: 1) Telephone questionnaire: a total of 68/96 parents were surveyed (71% overall response rate; &gt;90% mothers). Percentage of strongly agree/agree answers were obtained to these statements: a) better awareness of your child’s needs: 78%; b) receiving useful ASD information and educational materials: 90% c) overall process met needs: 77%; d) overall experience: 80%; e) parents having early intervention support since the ASD diagnostic assessment given to their child: 91%; 2) In regards to the educational sessions (Pre-diagnosis ([n=44] & Post ASD Diagnosis [n=33]), the responses to questions on the delivery, content and materials presented revealed &gt;90% level of satisfaction. Challenges to attending theses educational sessions were less than we anticipated.
CONCLUSION: The level of satisfaction to our ‘new’ ASD diagnostic process for children 12-39 months, as reported by parents, was very good. Parents felt the Pre- & Post-educational sessions were positive and valuable. This Quality Improvement initiative, redesigning the ASD diagnostic assessment process, has been validated by families.
Multiple occurrences of Callinectes sapidus larvae on Gulf of Mexico Chrysaora chesapeakei
Authors: Frolova Alexandra , Muffett Kaden , Miglietta Maria Pia 
Published: September 2022

Abstract
The commercially important Atlantic blue crab, Callinectes sapidus, recruits to bays and estuarine habitats from planktonic megalopal larvae throughout the eastern United States. These megalopae engage in vertical and horizontal swimming to reach a location of primary settlement, most commonly seagrass beds. These benthic habitats provide food and shelter for the megalopae as they metamorphose into juveniles. These benefits may be gained from planktonic association as well. Across 4 years and multiple sites in the Northwestern Gulf of Mexico, we record Callinectes megalopae and small juveniles actively clinging to Chrysaora chesapeakei (the Chesapeake Bay Nettle) medusae. Up to 301 individual megalopae were recorded on a single jellyfish. This establishes that C. chesapeakei is used as transport and temporary nursery habitat by the C. sapidus megalopae. This report brings light to a mid-water interaction of a commercially valuable crustacean and a seasonal scyphozoan that may facilitate juvenile recruitment.
A Closer Look at Localized and Distant Pressure Pain Hypersensitivity in People With Lower Extremity Overuse Soft-Tissue Painful Conditions: A Systematic Review and Meta-Analysis
Authors: Plaza-Manzano Gustavo , Fernández-de-las-Peñas César , Cleland Joshua A , Arias-Buría José L , Jayaseelan Dhinu J , Navarro-Santana Marcos J 
Published: September 2022

Abstract

Objective
The nociceptive pain processing of soft-tissue overuse conditions is under debate because no consensus currently exists. The purpose of this meta-analysis was to compare pressure pain thresholds (PPTs) in symptomatic and distant pain-free areas in 2 groups: participants with symptomatic lower extremity overuse soft-tissue conditions and controls who were pain free.

Methods
Five databases were searched from inception to December 1, 2021, for case–control studies comparing PPTs between individuals presenting with symptomatic lower extremity tendinopathy/overuse injury and controls who were pain free. Data extraction included population, diagnosis, sample size, outcome, type of algometer, and results. The methodological quality (Newcastle-Ottawa Quality Assessment Scale) and evidence level (Grading of Recommendations Assessment, Development, and Evaluation) were assessed. Meta-analyses of symptomatic, segmental related, and distant pain-free areas were compared.

Results
After screening 730 titles and abstracts, a total of 19 studies evaluating lower extremity overuse conditions (Achilles or patellar tendinopathy, greater trochanteric pain syndrome, plantar fasciitis, and iliotibial band syndrome) were included. The methodological quality ranged from fair (32%) to good (68%). Participants with lower extremity overuse injury had lower PPTs in both the painful and nonpainful areas, mirrored test-site, compared with controls (affected side: mean difference [MD] = −262.92 kPa, 95% CI = 323.78 to −202.05 kPa; nonaffected side: MD = −216.47 kPa, 95% CI = −304.99 to −127.95 kPa). Furthermore, people with plantar fasciitis showed reduced PPTs in the affected and nonaffected sides at segmental-related (MD = −176.39 kPa, 95% CI = −306.11 to −46.68 kPa) and distant pain-free (MD = −97.27 kPa, 95% CI = 133.21 to −61.33 kPa) areas compared with controls.

Conclusion
Low- to moderate-quality evidence suggests a reduction of PPTs at the symptomatic area and a contralateral/mirror side in lower extremity tendinopathies and overuse conditions compared with pain-free controls, particularly in plantar fasciitis and greater trochanteric pain syndrome. Participants with plantar fasciitis showed a reduction of PPTs on the affected and non-affected sides at a segmental-related area (very low-quality evidence) and at a remote asymptomatic area (moderate-quality evidence).

Impact
Some overuse peripheral pain conditions may be more associated with pressure pain sensitivity than others. Accordingly, examination and identification of conditions more peripherally, centrally, or mixed mediated could potentially lead to more specific and different treatment strategies.
Physical Therapist Telehealth Delivery at 1 Year Into COVID-19
Authors: Miller Matthew J , Pak Sang S , Keller Daniel R , Gustavson Allison M , Barnes Deborah E 
Published: September 2022

Abstract

Objective
The purpose of this study was to examine telehealth physical therapy utilization 1 year into the COVID-19 pandemic and identify factors that influence physical therapists’ delivery of telehealth in an urban academic medical center.

Methods
Electronic medical record data were extracted within the dates of interest (March 22, 2021 to May 15, 2021), the proportion of physical therapy sessions delivered via telehealth were identified, and patient characteristics were compared by telehealth volume (0 vs ≥1 session, 1 vs &gt;1 session). Qualitative data also were collected from physical therapists via semi-structured interviews, and a directed content analysis was conducted, informed by the Capability, Opportunity, Motivation, and Behavior model, to identify factors influencing telehealth delivery.

Results
Telehealth was used for 3793 of 8038 (47.2%) physical therapist sessions, and 1028 unique patients had at least 2 physical therapist sessions (without telehealth: 6.6% [n = 68], telehealth once: 39.1% [n = 402], telehealth more than once: 54.3% [n = 558]). Patients without telehealth were older, non-English speaking, had non-commercial insurance, and had at least 1 chronic health condition. Patients with telehealth more than once had a neurologic diagnosis and lived farther from the treating clinic. Capabilities that influenced telehealth delivery were physical therapist clinical skills and knowledge, technical proficiency, telehealth-specific interpersonal skills, and cognitive flexibility. Factors external to physical therapists—including the environment, patient equipment and technology proficiency, physical therapist equipment, clinic factors, and patient and referring provider perspectives—also influenced telehealth delivery. Finally, patient needs and telehealth as a beneficial tool guided physical therapist intention to use telehealth.

Conclusion
Sustained telehealth utilization outcomes 1 year into the COVID-19 pandemic and an interaction among physical therapist, patient, and environmental factors support the long-term potential of telehealth physical therapy in an urban academic medical center.

Impact
These findings support the long-term potential of telehealth approaches and can be used to inform telehealth physical therapist training programs and clinical implementation, future research, and health policy.
Individual participant data meta-analysis of metabolomics on sustained knee pain in primary osteoarthritis patients
Authors: Costello Christie A , Rockel Jason S , Liu Ming , Gandhi Rajiv , Perruccio Anthony V , Rampersaud Y Raja , Mahomed Nizar N , Rahman Proton , Randell Edward W , Furey Andrew , Kapoor Mohit , Zhai Guangju 
Published: September 2022

Abstract

Objectives
Knee pain is the major driver for OA patients to seek healthcare, but after pursuing both conservative and surgical pain interventions, ∼20% of patients continue to report long-term pain following total knee arthroplasty (TKA). This study aimed to identify a metabolomic signature for sustained knee pain after TKA to elucidate possible underlying mechanisms.

Methods
Two independent cohorts from St John’s, NL, Canada (n = 430), and Toronto, ON, Canada (n = 495) were included in the study. Sustained knee pain was assessed using the WOMAC pain subscale (five questions) at least 1 year after TKA for primary OA. Those reporting any pain on all five questions were considered to have sustained knee pain. Metabolomic profiling was performed on fasted pre-operative plasma samples using the Biocrates Absolute IDQ p180 kit. Associations between metabolites and pair-wise metabolite ratios with sustained knee pain in each individual cohort were assessed using logistic regression with adjustment for age, sex and BMI. Random-effects meta-analysis using inverse variance as weights was performed on summary statistics from both cohorts.

Results
One metabolite, phosphatidylcholine (PC) diacyl (aa) C28:1 (odds ratio = 0.66, P = 0.00026), and three metabolite ratios, PC aa C32:0 to PC aa C28:1, PC aa C28:1 to PC aa C32:0, and tetradecadienylcarnitine (C14:2) to sphingomyelin C20:2 (odds ratios = 1.59, 0.60 and 1.59, respectively; all P &lt; 2 × 10−5), were significantly associated with sustained knee pain.

Conclusions
Though further investigations are needed, our results provide potential predictive biomarkers and drug targets that could serve as a marker for poor response and be modified pre-operatively to improve knee pain and surgical response to TKA.
Association Between Human Blood Metabolome and the Risk of Psychiatric Disorders
Authors: Jia Yiming , Hui Li , Sun Lulu , Guo Daoxia , Shi Mengyao , Zhang Kaixin , Yang Pinni , Wang Yu , Liu Fanghua , Shen Ouxi , Zhu Zhengbao 
Published: September 2022

AbstractBackground and HypothesisTo identify promising drug targets for psychiatric disorders, we applied Mendelian randomization (MR) design to systematically screen blood metabolome for potential mediators of psychiatric disorders and further predict target-mediated side effects.Study DesignWe selected 92 unique blood metabolites from 3 metabolome genome-wide association studies (GWASs) with totally 147 827 participants. Summary statistics for bipolar disorder (BIP), attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), major depressive disorder (MDD), schizophrenia (SCZ), panic disorder (PD), autistic spectrum disorder (ASD), and anorexia nervosa (AN) originated from the Psychiatric Genomics Consortium, involving 1 143 340 participants. Mendelian randomization (MR) analyses were conducted to estimate associations of blood metabolites with psychiatric disorders. Phenome-wide MR analysis was further performed to predict side effects mediated by metabolite-targeted interventions.ResultsEight metabolites were identified associated with psychiatric disorders, including five established mediators: N-acetylornithine (BIP: OR, 0.72 [95% CI, 0.66–0.79]; SCZ: OR, 0.74 [0.64–0.84]), glycine (BIP: OR, 0.62 [0.50–0.77]), docosahexaenoic acid (MDD: OR, 0.96 [0.94–0.97]), 3-Hydroxybutyrate (MDD: OR, 1.14 [1.08–1.21]), butyrylcarnitine (SCZ: OR, 1.22 [1.12–1.32]); and three novel mediators: 1-arachidonoylglycerophosphocholine (1-arachidonoyl-GPC)(BIP: OR, 0.31 [0.23–0.41]), glycoproteins (BIP: OR, 0.94 [0.92–0.97]), sphingomyelins (AN: OR, 1.12 [1.06–1.19]). Phenome-wide MR analysis showed that all identified metabolites except for N-acetylornithine and 3-Hydroxybutyrate had additional effects on nonpsychiatric diseases, while glycine, 3-Hydroxybutyrate, N-acetylornithine, and butyrylcarnitine had no adverse side effects.ConclusionsThis MR study identified five established and three novel mediators for psychiatric disorders. N-acetylornithine, glycine, 3-Hydroxybutyrate, and butyrylcarnitine might be promising targets against psychiatric disorders with no predicted adverse side effects.