bluuebunny/crossref_metadata_2025_split huggingface dataset:
A 27-GAUGE TROCAR-ASSISTED INTRASCLERAL INTRAOCULAR LENS FIXATION TECHNIQUE USING A SILICONE MICROTUBE
Authors: Miura Shinji , Akashi Azusa , Fujiwara Ritsuko 
Published: April 2022

Purpose:
This study aimed to describe a novel technique to facilitate intrascleral fixation of the intraocular lens (IOL).

Methods:
Two 27-gauge trocars were placed at an angle of 180° and a distance of 2 mm from the corneal limbus. A silicone microtube with an external diameter of 0.2 mm was introduced through a sclerocorneal incision and withdrawn via a trocar using retinal forceps. The tips of the IOL haptics were connected to the microtube. After the implantation of the IOL into the chamber, the haptics were externalized through the scleral site by pulling the microtubes. Each tip of the haptics was flanged and buried into the scleral tunnel.

Results:
The IOL was successfully placed with this method without any complications.

Conclusion:
This study presented a novel technique for intrascleral IOL fixation using a silicone microtube. We believe that our technique might increase surgical safety and help decrease the operative time for both anterior and posterior segment techniques.
CRYSTALLINE RETINOPATHY IN A 6-YEAR-OLD BOY WITH HISTORY OF HIGH-DOSE TAMOXIFEN USE
Authors: Mathew Namita E. , Kozak Jennifer , Jayasundera Kanishka Thiran , Jain Nieraj , Prabhu Shreya S. 
Published: April 2022

Background/Purpose:
To report a case of crystalline retinopathy following high-dose tamoxifen use in a pediatric patient.

Methods:
Observational case report.

Results:
A 6-year-old boy with history of more than 80-g cumulative tamoxifen use over 25 months for the treatment of atypical teratoid/rhabdoid tumor of the posterior fossa presented with a 4-month history of blurred vision. Fundus examination demonstrated multiple superficial foveal refractile opacities in each eye, and spectral optical coherence tomography revealed numerous punctate hyperreflective deposits located within the inner retina. These findings were suggestive of tamoxifen retinopathy.

Conclusion:
To our knowledge, this is the first report of multimodal retinal imaging of tamoxifen retinopathy in a pediatric patient. Given the risk of permanent vision loss, ophthalmic baseline screening and monitoring should be considered for children receiving tamoxifen.
Using technology to bridge the transition from pediatric to adult health care
Authors: Miller Cashmere 
Published: April 2022

ABSTRACT

Background:
There are unique challenges presented during the transition from pediatric to adult health care for adolescents with chronic medical conditions, and many do not transition smoothly. Although there is little research on how mobile applications can influence the transition process specifically, research shows technology, in general, can be advantageous to the transition process for adolescents. Ample literature exists on how adolescents are avid users of technology.

Local Problem:
The Children's Medical Services program in a large urban county in the southern United States lacked an efficient system for transitioning the care of children with special needs to the adult health care setting.

Methods:
Qualitative semistructured interviews and pre–post tests were conducted with 23 adolescent participants with chronic medical conditions. Multiple choice questions elicited information from four categories: knowledge of medical condition, organization/health care system navigation, identified adult health care provider, and awareness of available resources.

Interventions:
A novel website and smartphone application designed to aid adolescents and young adults during transition were developed.

Results:
Gain scores from pre–post tests showed an increase in all 4 sections of the survey: knowledge of medical condition—21% increase, organization/health care system navigation—15.3% increase, identified health care provider—32% increase, and awareness of available resources—19.3% increase. All 23 adolescent participants reported that the application would be useful for managing their health information.

Conclusions:
Smartphone applications can be helpful for adolescents in their transition into adult health care. Such applications also have potential to increase confidence and independence in managing health care needs.
A Scoping Review of Pharmacological Management of Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection in 2021
Authors: Carson Erin , Hemenway Alice N. 
Published: April 2022

Background:
Postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC), or long-COVID, are signs and symptoms that persist after the acute phase of Coronavirus disease 2019 infection has passed. PASC is newly recognized, and research is ongoing to answer questions about pathology, symptoms, diagnosis, and optimal treatment.

Areas of Uncertainty:
Use of pharmacologic treatment for symptoms of PASC is currently evolving. This scoping review aims to assess medical literature for any evidence supporting or refuting use of any medications to specifically treat PASC.

Data Sources:
PubMed, EMBASE, Web of Science, and gray literature sources were searched for any study of medication use for PASC. Studies were included if they described medication use in patients with PASC. There were no exclusion criteria based on study type or if results were reported. Studies were divided into completed works and ongoing research.

Results:
Fifty-two records were included in final analysis from an initial 3524 records found, including 2 randomized controlled trials, 7 prospective, open-label or observational studies, 14 case reports or case series, 1 survey, 1 correspondence, 1 retrospective analysis, and 26 studies in progress. Seven of the 26 completed works investigate ivabradine or beta-blockers, whereas 7 investigate local or systemic corticosteroids. Three investigate multi-ingredient nutritional supplements. The other 9 completed works as well as the 26 studies in progress investigate a wide variety of other treatments including drugs in development, drugs used for other conditions, herbals, supplements, and vitamins.

Conclusions:
There is limited, but evolving, literature on medication treatment for PASC. Providers who opt to use pharmacologic therapy for PASC need to be vigilant in their knowledge of these evolving data.
Sleep Apnea Screening in Children With Sickle Cell Anemia
Authors: Flores Oria Carlos A. , Stark James M. , Mosquera Ricardo A. , Brown Deborah L. , Menon Neethu M. , Sharma Kamal P. , Gonzales Traci , Nguyen Trinh , Jon Cindy K. , Emanuel Hina , Yadav Aravind 
Published: April 2022

Background:
Screening for obstructive sleep apnea (OSA) is recommended by current guidelines in children with sickle cell anemia (SCA), but no specific approach is described. The Pediatric Sleep Questionnaire (PSQ) is a validated detection tool for OSA in children. We assessed the utility of PSQ to screen for OSA in children with concomitant SCA and snoring.

Materials and Methods:
A prospective study, in children 4 to 18 years old with SCA. Subjects were assessed for snoring and PSQ administered at the same visit. All children with snoring were then referred for polysomnography.

Results:
A total of 106 subjects were screened. Habitual snoring prevalence was 51/106 (48.1%). In the snoring group, OSA was detected in 83.9% (apnea-hypopnea index [AHI] ≥1.0/h) and 22.6% (AHI ≥5.0/h), respectively. Sensitivity and specificity of PSQ in children with snoring was 46.2% and 20.0% (AHI ≥1.0/h), and 57.1% and 50.0% (AHI ≥5.0/h), respectively. Physician assessment for snoring had a high sensitivity of 70.3% but low specificity of 58.4% (AHI ≥1.0/h), and 87.5% and 41.5% (AHI ≥5.0/h), respectively.

Conclusion:
PSQ is a poor screening tool for detection of OSA in those children with SCA who snore. Physician assessment for snoring could however be an initial approach before polysomnography.
Persons Who Engage in Self-Harm While in the Emergency Department
Authors: Lawrence Ryan E. , Krumheuer Aaron , Loh Ryan , Stanley Barbara , Simpson Scott A. 
Published: April 2022

Abstract
Some patients engage in self-harm behaviors while in the emergency department. Risk factors for self-harm have been described for inpatient and outpatient/community settings, but not among emergency department patients. Authors conducted case-control, retrospective reviews of medical records and incident reports for emergency department patients in two academic medical centers. Variables were analyzed using conditional logistic regression. There were 113 individuals who engaged in self-harm while in the emergency department and 226 individuals who did not. Four variables were significant in the final model: a history of nonsuicidal self-harm (odds ratio [OR], 4.28; 95% confidence interval [CI], 1.95–9.41), opioid use in the prior 2 weeks (OR, 2.89; CI, 1.19–7.02), current manic episode (OR, 3.59; CI, 1.33–9.70), and a history of seizures (OR, 4.19; CI, 1.16–15.14). Risk of self-harm while in the emergency department may be mitigated with interventions that support adaptive coping skills, promptly address pain and withdrawal symptoms, and treat mania.
A Prospective, Descriptive Study on Awake Self-prone in Hospitalized COVID-19 Patients
Authors: Kapoor Rajat , Rader Tiffany , Dillon Jill , Jaydev FNU , Horvath Dawn , Little Aubrey , Vickery Jessica , DiPerna Christen , Brittain Lynne , Rahman Omar 
Published: April 2022

Purpose/Aims
Healthcare workers internationally continue to look for innovative ways to improve patient outcomes and optimize resource utilization during the coronavirus disease 2019 (COVID-19) pandemic. Proning awake, nonintubated patients has been suggested as a potential intervention in critical care. The aim of this study is to provide a multidisciplinary approach to safely perform awake self-prone positioning in the acute care setting.

Design
This is a prospective, descriptive study.

Method
Patients with COVID-19 were screened and enrolled within 48 hours of a positive test. After approval from the primary team, patients were provided education materials by a multidisciplinary team on the self-prone intervention. Visual cues were placed in the room. Patients were requested to maintain a diary of hours of prone positioning. Patients' baseline characteristics, admission vitals, daily oxygen requirements, and level of care were collected.

Results
Of 203 patients screened, 31 were enrolled. No pressure-related injury or catheter (intravenous or urinary) displacement was identified. Eighty-one percent of patients spent less than 8 hours a day in prone positioning. Among patients enrolled, none required invasive ventilation or died.

Conclusions
Awake self-proning can be performed safely in patients given a diagnosis of COVID-19 in the acute care setting with a multidisciplinary team.
CLE3AR Study
Authors: Steere Lee 
Published: April 2022

Problem/Purpose
Intraluminal thrombotic catheter occlusions are associated with a greater risk of delayed treatment, morbidity, and mortality and higher healthcare costs.

Methods
The Vascular Access Specialist Team at Hartford Hospital used Lean Six Sigma methodology to identify and address waste, variability, and defects associated with occlusion management.

Interventions
Beginning in 2015, all central venous catheter occlusions in acute inpatient care were assessed by a vascular access nurse specialist. First, the decisions to treat with tissue plasminogen activator were determined using a catheter patency algorithm. Second, negative displacement needleless connectors were replaced by antireflux needleless connectors to reduce unintentional blood reflux and other complications associated with intraluminal thrombotic catheter occlusion.

Results
A total of 159 934 central line days were reported between 2014 and 2020. The hospital achieved a 71.3% reduction in annual tissue plasminogen activator used for occlusions over the study period. There was a sustained decrease in annual average needleless connector consumption of 41% after switching to antireflux needleless connectors in 2015. The 5-year cost savings for these 2 interventions were estimated to be $356 005.

Conclusions
Lean occlusion management interventions were associated with reduced pharmacy use, medical supply waste, and spending, which have been sustained for over a 5-year period.
Pediatric Residency Preparedness for Pediatric Emergency Medicine Fellowship
Authors: Malik Rabia N. , Langhan Melissa L. 
Published: April 2022

Objective
The aim of the study was to examine the perception of pediatric emergency medicine (PEM) program directors (PDs), associate PDs (APDs) and first-year fellows regarding the preparedness of new PEM fellows who have graduated from pediatric residency programs.

Methods
Unique surveys were created and electronically distributed to PEM PDs/APDs and first-year PEM fellows. Individual and institutional demographic information was collected. Using a 5-point Likert scale, survey items centered the perceived preparedness of first-year PEM fellows within 5 domains: professionalism, independence/autonomy, psychomotor skills, clinical evaluation and management, and academia/scholarship.

Results
Forty percent (48/119) of eligible PDs and APDs and 56% (82/147) of eligible first-year PEM fellows responded. Most PDs/APDs strongly agreed or agreed that incoming fellows perform adequately in areas of professionalism, independence/autonomy, and clinical evaluation and management. The PDs/APDs perceived fellows to be less prepared in the academia/scholarship domain and several psychomotor skills. Most first-year PEM fellows perceived themselves as prepared in areas of professionalism and clinical evaluation and management. Fellows had varied feelings of preparedness in the domains of independence/autonomy, psychomotor skills, and academia/scholarship. Overall, most PDs/APDs (54%) and fellows (84%) feel that pediatric residency training was strong or very strong.

Conclusions
Most respondents in both groups felt that in general, pediatric residency programs adequately train residents for PEM fellowship. Both groups felt that the strengths of general pediatric training were among the domains of professionalism and clinical evaluation and management, whereas psychomotor skills and academia and scholarship were areas of improvement. These findings may be used by general pediatric residency and PEM fellowship programs to guide curriculum development.
A Comparison of Motorized and Nonmotorized Scooter Injuries in Pediatric Patients Seen in US Emergency Departments
Authors: Magee Lacey C. , Chan Calvin , Talwar Divya , Maguire Kathleen J. , Horn B. David 
Published: April 2022

Objectives
We sought to characterize and compare trends in pediatric injuries sustained on motorized and nonmotorized scooters across the United States, to assess the use of safety equipment in children presenting with scooter-related injuries, and provide strategies for injury prevention.

Methods
The National Electronic Injury Surveillance System was queried for motorized and nonmotorized scooter–related pediatric injuries from 2014 to 2018 in patients ages 6 to 12 years. Patient demographics, diagnosis, injury location, and narrative of the incident were collected. Bivariate and regression analyses were used to determine demographic and social associations of injury characteristics.

Results
An estimated 146,000 (11,452 motorized and 134,548 nonmotorized) injuries occurred in children ages 6 to 12 years over the 5 years. Three of 4 injuries occurred in children younger than 10 years, and most injuries occurred in males (56%).
From 2014 to 2018, the nationwide estimated incidence of motorized scooter injuries increased by 112.1%, while that of nonmotorized scooter injuries decreased by 40.3%.
Upper extremity injuries were most common with nonmotorized scooters (44.4% of all injuries), while lower extremity injuries were most common with motorized scooters (39.5% of all injuries). Head and neck injuries accounted for 27.4% of nonmotorized scooter injuries and 23.4% of motorized scooter injuries. The number of concussions in motorized scooters increased from 0.4% in 2014 to 2.7% in 2018, while concussions in nonmotorized scooters decreased from 3.5% to 2.7%. Helmets were mentioned in the medical record in 6.6% of the cases. Of these, 60.5% reported no use of helmet at the time of injury.

Conclusions
From 2014 to 2018, the number of motorized scooter injuries increased by 112.1% in the pediatric population ages 6 to 12 years, whereas nonmotorized scooter injuries decreased by 40.3%. In more than 60% of the cases that mentioned a helmet, the child injured was recorded as not wearing a helmet. The rise in pediatric injuries associated with motorized scooters in contrast with the reduction of injuries associated with nonmotorized scooters highlights the need for novel public health policies and interventions promoting helmet use with motorized scooters in the pediatric population.
Sepsis Electronic Decision Support Screen in High-Risk Patients Across Age Groups in a Pediatric Emergency Department
Authors: Witting Celeste S. , Simon Norma-Jean E. , Lorenz Doug , Murphy Julia S. , Nelson Jill , Lehnig Katherine , Alpern Elizabeth R. 
Published: April 2022

Objective
This study aimed to compare the performance of a pediatric decision support algorithm to detect severe sepsis between high-risk pediatric and adult patients in a pediatric emergency department (PED).

Methods
This is a retrospective cohort study of patients presenting from March 2017 to February 2018 to a tertiary care PED. Patients were identified as high risk for sepsis based on a priori defined criteria and were considered adult if 18 years or older. The 2-step decision support algorithm consists of (1) an electronic health record best-practice alert (BPA) with age-adjusted vital sign ranges, and (2) physician screen. The difference in test characteristics of the intervention for the detection of severe sepsis between pediatric and adult patients was assessed at 0.05 statistical significance.

Results
The 2358 enrolled subjects included 2125 children (90.1%) and 233 adults (9.9%). The median ages for children and adults were 3.8 (interquartile range, 1.2–8.6) and 20.1 (interquartile range, 18.2–22.0) years, respectively. In adults, compared with children, the BPA alone had significantly higher sensitivity (0.83 [95% confidence interval {CI}, 0.74–0.89] vs 0.72 [95% CI, 0.69–0.75]; P = 0.02) and lower specificity (0.11 [95% CI, 0.07–0.19] vs 0.48 [95% CI, 0.45–0.51; P < 0.001). With the addition of provider screen, sensitivity and specificity were comparable across age groups, with a lower negative predictive value in adults compared with children (0.66 [95% CI, 0.58–0.74] vs 0.77 [95% CI, 0.75–0.79]; P = 0.005).

Conclusions
The BPA was less specific in adults compared with children. With the addition of provider screen, specificity improved; however, the lower negative predictive value suggests that providers may be less likely to suspect sepsis even after automated screen in adult patients. This study invites further research aimed at improving screening algorithms, particularly across the diverse age spectrum presenting to a PED.
Impaired conditioned pain modulation was restored after a single exercise session in individuals with and without fibromyalgia
Authors: Alsouhibani Ali , Hoeger Bement Marie 
Published: April 2022

Abstract

Introduction:
Exercise is an effective nonpharmacological intervention for individuals with fibromyalgia syndrome (FMS); however, considerable variability is observed in their pain response after a single exercise session that could be due to differences in baseline central pain inhibition (ie, conditioned pain modulation [CPM]).

Objectives:
This study examined the effect of isometric exercise on CPM in people with FMS and control participants. A subaim was to identify whether pain inhibition after exercise was due to differences in baseline CPM.

Methods:
Twenty-one individuals with FMS (50.5 ± 14.9 years) and 22 age-matched and sex-matched controls (49.2 ± 13.3 years) participated in a familiarization session and 2 randomized experimental sessions: (1) low-intensity isometric exercise and (2) quiet rest control. Conditioned pain modulation was measured before and after each experimental session. In addition, body composition and physical activity levels were collected to determine potential group differences.

Results:
Both groups had comparable body composition and physical activity levels and reported similar exercise-induced hypoalgesia (increase in pressure pain thresholds) at the exercising muscle (quadriceps muscle) and systemically (deltoid muscle). Both groups had a decrease in CPM after exercise and quiet rest; however, in both FMS and control participants with impaired baseline CPM, there was an increase in CPM at the deltoid muscle after exercise.

Conclusion:
In persons with low CPM, irrespective of health status, isometric exercise enhanced CPM at a site distal from the exercising muscle. Our results support the use of isometric exercise when initiating an exercise program especially for individuals with impaired CPM.
A Prospective, Matched Comparison of Health-Related Quality of Life in Bariatric Patients following Truncal Body Contouring
Authors: Elfanagely Omar , Rios-Diaz Arturo J. , Cunning Jessica R. , Othman Sammy , Morris Martin , Messa Charles , Broach Robyn B. , Fischer John P. 
Published: April 2022

Background:
Massive weight loss after bariatric surgery can lead to excess skin associated with functional and aesthetic sequelae. Access to the benefit provided by body contouring procedures may be limited by insurance approval, which does not consider health-related quality of life. The aim of this study was to quantify the benefit in health-related quality of life for patients who undergo body contouring procedures after massive weight loss.

Methods:
Patients evaluated for postbariatric body contouring procedures were systematically identified and prospectively surveyed using the BODY-Q. Health-related quality-of-life change for each functional scale was compared between those who underwent body contouring procedures (operative group, preoperatively versus postoperatively) and those who did not (nonoperative group, preoperatively versus resurvey) using t tests. Propensity score matching allowed the authors to balance baseline demographics, comorbidities, physical symptoms, and risk factors between cohorts.

Results:
Fifty-seven matched patients were analyzed (34 operative versus 23 nonoperative). No significant difference in age, body mass index, time between surveys, or preoperative BODY-Q scores existed between cohorts. The surgical group demonstrated a significant improvement in 10 out of 11 BODY-Q functional scales. The nonoperative group realized no improvements and, in the interim, had a significant deterioration in four BODY-Q scales.

Conclusions:
Postbariatric body contouring procedures represent a critical and final step in the surgical weight loss journey for patients and are associated with significant improvements in health-related quality of life. Further deterioration in psychosocial and sexual health-related quality of life occurs in patients who do not undergo body contouring procedures following bariatric surgery. This study provides prospective comparative data that validate the field’s standard intervention and justification for insurance approval.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.