bluuebunny/crossref_metadata_2025_split huggingface dataset:
Genome-Informed Multiplex Conventional PCR for Identification and Differentiation of Xanthomonas citri pv. citri Subpathotypes, the Causal Agents of Asiatic Citrus Canker
Authors: Yasuhara-Bell Jarred , Santillana Gem , Robène Isabelle , Pruvost Olivier , Nakhla Mark , Mavrodieva Vessela 
Published: August 2022

Asiatic citrus canker, one of the most important diseases of citrus, is caused by Xanthomonas citri pv. citri. It has high economic impact and can spread easily, and the disease is difficult to manage; it is a quarantine organism in many citrus-producing countries. X. citri pv. citri has been separated into three subpathotypes (A, A*, Aw) that differ in host range and geographical distribution, thus creating a need to differentiate subpathotypes for surveillance and disease management. Availability of useful diagnostic tools is the cornerstone of successful surveillance, quarantine, and eradication measures. In this study, a multiplex conventional PCR (cPCR) assay was developed for detection and subpathotype determination of X. citri pv. citri. Assay specificity was assessed by four different labs on a total of 146 X. citri pv. citri and 58 other Xanthomonas isolates. The assay demonstrated high analytical sensitivity, specificity, and selectivity. False negatives were observed with A Lineage 2 strains, and potential false positives were observed for X. citri pv. bilvae. Combined with a simple extraction protocol, the assay has been deployed successfully at the Plant Protection and Quarantine Plant Pathogen Confirmatory Diagnostics Laboratory. This assay has proven useful for differentiating Asiatic citrus canker subpathotypes from symptomatic citrus tissue. [Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Creating a Comprehensive Hospital-Based Skin and Wound Care Program to Improve Outcomes and Decrease Pressure Injuries
Authors: Capitulo Kathleen Leask 
Published: August 2022

ABSTRACT
The author describes implementing a comprehensive skin and wound care program during her tenure as chief nurse executive to address challenges related to a lack of expert resources and knowledge of pressure injury (PI) prevention and treatment. This multifaceted program included the creation of a comprehensive, interprofessional, evidence-based skin and wound care committee; establishing a “Wound Board” for case presentations and expert consultation; providing educational programs; streamlining the processes for product evaluation, procurement, and use; decreasing costs; and hiring additional wound, ostomy, and continence nurse specialists. As a result, hospital-acquired PI incidence dropped significantly.
Tracheostomy Thursday: Journey of a Staff-driven COVID-19 Initiative to International Recognition
Authors: Gallagher Mary Anne , Torrieri Lisa Anne 
Published: August 2022

ABSTRACT

OBJECTIVE
To use evidence-based practice and an interprofessional approach to improve outcomes for adult patients with tracheostomies and enhance staff knowledge during the COVID-19 pandemic.

METHODS
The core interprofessional Tracheostomy Thursday team included staff nurses, respiratory therapists, and nursing leadership who collaborated with surgeons and materials management staff at an urban academic medical center in New York, the epicenter of the COVID-19 pandemic in the US. The team implemented hospital-wide bedside rounds on all adults with tracheostomies. Skin and safety assessments were performed with peer-to-peer coaching. Data were collected and analyzed to understand areas of improvement.

RESULTS
After 6 months of hospital-wide rounding, implementation of a bedside tracheostomy safety checklist, and a continued interprofessional approach, safety measures increased by 48%, and preventive dressing use increased by 24% with improvement in preventing tracheostomy-related medical device-related pressure injuries. The team’s work was professionally recognized through institutional policy change, conference poster presentations, and Sigma’s international excellence award.

CONCLUSION
Bundling an interprofessional approach, staff education, bedside rounds, and standard preventive measures was key to the team’s success. A bedside safety checklist fostered team communication and supported direct care nurses in managing individuals with a new tracheostomy.
Perioperative Neurofilament Light Plasma Concentrations and Cognition before and after Cardiac Surgery: A Prospective Nested Cohort Study
Authors: Brown Charles H. , Lewis Alexandria , Probert Julia , Parish Michelle , Tian Jing , Mandal Kaushik , Everett Allen , Colantuoni Elizabeth , Kamath Vidyulata , Hogue Charles , Moghekar Abhay 
Published: August 2022

Background
Neurofilament light is a marker of neuronal injury and can be measured in blood. Postoperative increases in neurofilament light have been associated with delirium after noncardiac surgery. However, few studies have examined the association of neurofilament light changes with postdischarge cognition in cardiac surgery patients, who are at highest risk for neuronal injury and cognitive decline. The authors hypothesized that increased neurofilament light (both baseline and change) would be associated with worse neuropsychological status up to 1 yr after cardiac surgery.

Methods
This observational study was nested in a trial of cardiac surgery patients, in which blood pressure during bypass was targeted using cerebral autoregulation monitoring. Plasma concentrations of neurofilament light were measured at baseline and postoperative day 1. Neuropsychological testing was performed at baseline, 1 month after surgery, and 1 yr after surgery. Primary outcomes were baseline and change from baseline in a composite z-score of all cognitive tests.

Results
Among 167 patients, cognitive outcomes were available in 80% (134 of 167) and 61% (102 of 167) at 1 month and 1 yr after surgery, respectively. The median baseline concentration of neurofilament light was 18.2 pg/ml (interquartile range, 13.4 to 28.1), and on postoperative day 1 was 28.5 pg/ml (interquartile range, 19.3 to 45.0). Higher baseline log neurofilament light was associated with worse baseline cognitive z-score (adjusted slope, –0.60; 95% CI, –0.90 to –0.30; P < 0.001), no change in z-score from baseline to 1 month (0.11; 95% CI, –0.19 to 0.41; P = 0.475), and improvement in z-score from baseline to 1 yr (0.56; 95% CI, 0.31 to 0.81; P < 0.001). Whereas some patients had an improvement in cognition at 1 yr and others a decline, an increase in neurofilament light from baseline to postoperative day 1 was associated with a greater decline in cognition at 1 yr.

Conclusions
Higher baseline neurofilament light concentration was associated with worse baseline cognition but improvement in cognition at 1 yr. A postoperative increase in neurofilament light was associated with a greater cognitive decline at 1 yr.

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Incisional and Surrounding Periarticular Soft Tissue Management With Negative Pressure Therapy
Authors: De Leon Jorge C. , Karia Ravi A. 
Published: August 2022

Summary:
Periarticular injuries of the lower extremity are known for wound healing and infection complications. The role for incisional negative pressure wound therapy for lower extremity periarticular fractures has expanded over the last 10 years in hopes of minimizing complications. To date, there is no standardized published protocol of how negative pressure wound therapy is best used in lower extremity periarticular fractures. A review of strategies to decrease complications associated with the operative management of lower extremity periarticular fractures to include the use of incisional negative pressure wound therapy is presented.
Evolution of Negative Pressure Wound Therapy in Orthopaedic Trauma
Authors: Agarwal Animesh 
Published: August 2022

Summary:
Negative Pressure Wound Therapy (NPWT) has evolved from open wound management to now include closed incision management. It has been a major advance in the management of open wounds and closed incisional wounds especially in orthopaedic trauma surgery. Because of the success of NPWT in the late 1990s and early 2000s, surgeons began using NPWT with adjuncts on closed incisions as a way to help prevent surgical wound dehiscence especially in at-risk patients for wound problems. It has been well established that obesity, diabetes, and smoking in addition to other comorbidities increase the risk of wound dehiscence and surgical site infections in orthopaedic patients. It is widely used for open wound management, often associated with open fractures, and in the mitigation of risk of surgical site infections over closed incisions (incisional negative pressure wound therapy). Newer systems allow the use of various topical wound solutions to be instilled in conjunction with NPWT, termed NPWTi-d. This has shown promising results in difficult wounds that may be resistant to standard NPWT. This article reviews the evolution and use of NPWT in orthopaedic trauma.
Spinal Post-traumatic Deformity
Authors: De Gendt Erin E.A. , Schroeder Greg D. , Joaquim Andrei , Tee Jin , Kanna Rishi M. , Kandziora Frank , Dhakal Gaurav R. , Vialle Emiliano N. , El-Sharkawi Mohammad , Schnake Klaus J. , Rajasekaran Shanmuganathan , Vaccaro Alex R. , Muijs Sander P.J. , Benneker Lorin M. , Oner F. Cumhur 
Published: August 2022

Study Design:Survey among spine experts.Objective:To investigate the different views and opinions of clinically relevant spinal post-traumatic deformity (SPTD).Summary of Background Data:There is no clear definition of clinically relevant SPTD. This leads to a wide variation in characteristics used for diagnosis and treatment indications of SPTD. To understand the current concepts of SPTD a survey was conducted among spine trauma surgeons.Methods:Members of the AO Spine Knowledge Forum Trauma participated in an online survey. The survey was divided in 4 domains: Demographics, criteria to define SPTD, risk factors, and management. The data were collected anonymously and analyzed using descriptive statistics, absolute, and relative frequencies. Consensus on dichotomous outcomes was set to 80% of agreement.Results:Fifteen members with extensive experience in treatment of spinal trauma participated, representing the 5 AO Spine Regions. Back pain was the only criterion for definition of SPTD with complete agreement. Consensus (≥80%) was reached for kyphotic angulation outside normative ranges and impaired function. Eighty-seven percent and 100% agreed that a full-spine conventional radiograph was necessary in diagnosing and treating SPTD, respectively. The “missed B-type injury” was rated at most important by all but 1 participant. There was no agreement on other risk factors leading to clinically relevant SPTD. Concerning the management, all participants agreed that an asymptomatic patient should not undergo surgical treatment and that neurological deficit is an absolute surgical indication. For most of the participants the preferred surgical treatment of acute injury in all spine regions but the subaxial region is posterior fixation.Conclusion:Some consensus exists among leading experts in the field of spine trauma care concerning the definition, diagnosis, risk factors, and management of SPTD. This study acts as the foundation for a Delphi study among the global spine community.
Advanced Triage Protocol: The Role of an Automated Lactate Order in Expediting Rapid Identification of Patients at Risk of Sepsis in the Emergency Department
Authors: Baum Andrew , Carr Brendan G. , Perman Sarah M. , Barger Jennifer , Goyal Munish , Gaieski David F. 
Published: August 2022

OBJECTIVES:
We undertook a process improvement initiative to expedite rapid identification of potential sepsis patients based on triage chief complaint, vital signs, and initial lactate level.

DESIGN:
Prospective cohort study.

SETTING:
Seven hundred-bed tertiary care hospital with ≅65,000 patient visits/yr.

PATIENTS:
Patients presenting to emergency department (ED) triage who met the following criteria: greater than or equal to two of the three systemic inflammatory response syndrome criteria assessable in triage, a chief complaint suggestive of infection, emergency severity index 2 or 3, and ambulatory to ED.

INTERVENTIONS:
A computer-generated lactate order was created, staff education and resources increased, and point-of-care lactate testing was introduced.

MEASUREMENTS AND MAIN RESULTS:
Primary endpoints include the following: percent of patients having a lactate level drawn, percent of lactate samples resulting before room placement, and time intervals from triage to lactate blood draw and to lactate result. Secondary endpoints were percentage of patients admitted to the hospital, percentage admitted to the ICU, and in-hospital mortality. Six thousand nine hundred six patients were included: 226 historic controls (HCs) and 6,680 intervention group patients. The mean serum lactate level was 1.77 ± 1.18 mmol/L. The percentage of patients having a lactate resulted increased from 27.4% in the HC period to 79.6%. The percentage of these lactate results available while the patient was still in the waiting room increased from 0.4% during the HC period to 33.7% during Phase 5 (p < 0.0001). In the intervention period, time from triage to lactate result decreased (78.1–63.4 min; p < 0.0001) and time to treatment room decreased (59.3–39.6 min; p < 0.0001).

CONCLUSIONS:
Implementation of a computerized lactate order using readily available data obtained during ED triage, combined with point-of-care lactate testing, improves time to lactate blood draw and lactate result in patients at risk for severe sepsis. Initial lactate levels correlated with admission to the hospital, admission to the ICU, and in-hospital mortality.
Predicting urine culture results in candidates for lithotripsy
Authors: Gofrit Ofer N. , Abudi Roey , Lorber Amitay , Duvdevani Mordechai 
Published: August 2022

Abstract

Background
Urological guidelines assert that “urine culture should be obtained” before surgical management of ureteral or kidney stones. Thus, many surgeries are delayed by 1–3 days until the results of urine culture are available. During this time, the patient frequently experience pain and possible kidney damage. We investigated the hypothesis that it is possible to predict the results of urine culture in candidates for surgical intervention using parameters that are accessible immediately upon admission.

Materials and methods
A database of 1000 patients who underwent either percutaneous nephrolithotomy (PCNL) or ureteroscopy/retrograde intrarenal surgery was analyzed. Eleven parameters potentially related to urinary infections and accessible to the clinician at the emergency department were correlated with the preoperative urine culture results.

Results
Of the patients, 234 (23.4 %) had positive cultures. On multivariate analysis, only sex, hydronephrosis grade, and history of previous nephrolithotomy were significantly associated with a positive preoperative urine culture. The risk of a positive culture can be easily determined from a simple table or an Excel-based calculator. This risk could be as low as 0.45% for a man without a history of PCNL and no hydronephrosis (4% in a woman with similar parameters) or as high as 79.5% in a man with a history of PCNL and hydronephrosis (85% in a woman with similar parameters).

Conclusions
The risk of preoperative positive urine culture can be predicted using 3 parameters that are accessible upon admission. In low-risk cases, prompt surgical treatment can be provided, eliminating the anticipation time for urine culture results.
Completion of Social Drivers of Health Screenings in Pediatric Practices Participating in a Quality Improvement Initiative
Authors: Brennan Luke , Evans Madeline , Michaeli Gabrielle , Pandita Pooja , Patel Shraya , Powell Kayla , Putnam-Johnson Hannah , Chong Alexander , Stelzner Sarah , Casavan Kara 
Published: August 2022

ABSTRACT:

Objectives:
The Indiana Chapter of the American Academy of Pediatrics (INAAP) participated in a national quality improvement project led by the AAP called Addressing Social Health and Early Childhood Wellness, which sought to screen for and address social drivers of health (SDoH), socioemotional development, and perinatal depression in pediatric practices through practice and system improvement. This project aims to evaluate positive SDoH screenings and subsequent referrals from participating Indiana practices.

Methods:
Ten pediatric practices in mid-central Indiana participated in this collaboration between July 2020 and July 2021 and submitted information about clinic resources, patient demographics, and process measures. Monthly chart reviews of well-child visits assessed completion of SDoH screenings, discussion of screening results with families, and referrals for positive screens. Composite measures of performance were developed from chart review.

Results:
Measures showed significant improvements in SDoH screening and identified opportunities for improvement in the care continuum. SDoH screenings of eligible patients significantly increased from 21% to 62% on average (p = 0.0002). Needed referrals fulfilled increased from 37% to 57% (p = 0.003) on average. Interestingly, no significant improvement was seen in referring patients who screened positive (81% vs 89%, p = 0.0949).

Conclusion:
This project provided a framework for successful development and efficient integration of screening and referral processes into clinic workflow. Implementing Plan-Do-Study-Act cycles, monthly chart reviews, and collaborative meetings facilitated increased documentation of screening, counseling, and referral for positive SDoH screens in participating practices. Future analysis should measure health outcomes and social and community capital derived by health systems and patients from such interventions.
Transcutaneous CO2 Pressure Monitoring Increases Salvage Rates after Free Tissue Transplantation for Extremity Reconstruction
Authors: Nakano Takahiko , Kudo Toshiya , Sano Yoshitomo , Minehara Hiroaki , Suzuki Masao , Aoki Kohei , Matsushita Takashi 
Published: August 2022

Background:
Although free tissue transplantation (FTT) is an essential technique in extremity functional reconstruction, postoperative blood flow disturbance is one of the critical complications leading to transplanted tissue necrosis. Early detection of this complication may prevent tissue failure by prompt improvement of blood flow. The aim of this study was to determine whether transcutaneous carbon dioxide pressure (TcPCO2) monitoring increases the salvage rates after FTT.

Methods:
We retrospectively reviewed 75 consecutive patients who underwent FTT for extremity reconstruction with TcPCO2 monitoring postoperatively between December 2016 and September 2021.

Results:
Extremity reconstruction was performed in 53 cases due to trauma, 20 cases due to infection, and two cases due to tumor resection for tissue defects. The overall success rate of the FTT was 98.7%, with 13 complications. Of the 11 patients who underwent reoperation, nine had thrombosis and two had vascular strangulation. However, when reoperation was decided, none of the reoperation cases still exhibited any deterioration in the Doppler or clinical assessment. All reoperated cases were salvaged. Of the two patients who did not undergo reoperation, one had failed flaps and one had partial skin necrosis. With a TcPCO2 cutoff value of 70 mm Hg, the sensitivity and specificity for detecting complications due to impaired blood flow were 100% and 93.5%, respectively.

Conclusions:
TcPCO2 monitoring was performed after FTT for extremity reconstruction, and all cases of reoperation were salvaged. TcPCO2 monitoring can detect impaired postoperative blood flow critically earlier than clinical assessments and may increase salvage rates of transplanted tissue.
Perichondrial Arthroplasty Revisited: Technical Pearls
Authors: Lafreniere Ann-Sophie , Saayman Mariëlle , Lessard Antoine , Schrag Christiaan , Yeung Justin K. 
Published: August 2022

Summary:
Articular cartilage damage has been a longstanding challenge in hand surgery. Because of its limited ability to heal on its own and its predictable impact on bone resulting in degenerative osteoarthritis, surgical intervention is often mandated, through arthrodesis or implant arthroplasty. In this article, we revisit the perichondrial arthroplasty, a two-stage joint resurfacing technique using autologous rib perichondrium. It is indicated for posttraumatic osteoarthritic changes with or without stiffness and deviation, rheumatoid arthritis, and congenital joint malformation and/or ankylosis. This long-lasting method allows for a functional, pain-free joint that avoids both the immobility of arthrodesis and the long-term complications associated with implants.
Impact of Baseline Estimated Glomerular Filtration Rate Using CKD-EPI Equation on Long-term Prognosis of STEMI Patients: A Matter of Small Increments!
Authors: Sadre-Bafghi Seyed-Ali , Mohebi Mehrnaz , Hadi Fatemeh , Parsaiyan Hanieh , Memarjafari Mohammadreza , Tayeb Roya , Ghodsi Saeed , Sheikh-Sharbafan Reza , Poorhosseini Hamidreza , Salarifar Mojtaba , Alidoosti Mohammad , Haji-Zeinali Ali-Mohammad , Amirzadegan Alireza , Aghajani Hassan , Jenab Yaser , Hosseini Zahra 
Published: August 2022

Background:
Baseline biomarkers including glomerular filtration rate (GFR) guide the management of patients with ST-segment elevation myocardial infarction (STEMI). GFR is a tool for prediction of adverse outcomes in these patients.

Objectives:
We aimed to determine the prognostic utility of estimated GFR using Chronic Kidney Disease Epidemiology Collaboration in a cohort of STEMI patients.

Methods:
A retrospective cohort was designed among 5953 patients with STEMI. Primary endpoint of the study was major adverse cardiovascular events. GFR was classified into 3 categories delineated as C1 (<60 mL/min), C2 (60–90), and C3 (≥ 90).

Results:
Mean age of the patients was 60.38 ± 5.54 years and men constituted 78.8% of the study participants. After a median of 22 months, Multivariate Cox-regression demonstrated that hazards of major averse cardiovascular event, all-cause mortality, cardiovascular mortality, and nonfatal myocardial infarction were significantly lower for subjects in C3 as compared with those in C1. Corresponding hazard ratios (HRs) for mentioned outcomes regarding C3 versus C1 were (95% confidence interval) were (HR = 0.852 [0.656–0.975]; P = 0.035), (HR = 0.425 [0.250–0.725]; P = 0.002), (HR = 0.425 [0.242–0.749]; P = 0.003), and (0.885 [0.742–0.949]; P = 0.003), respectively. Normal GFR was also associated with declined in-hospital mortality with HR of C3 versus C1: 0.299 (0.178–0.504; P < 0.0001).

Conclusions:
Baseline GFR via Chronic Kidney Disease Epidemiology Collaboration is associated with long-term cardiovascular outcomes following STEMI.