bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Work of Mothering in the NICU
Authors: Ringham Cathy , McNeil Deborah , Benzies Karen M. 
Published: April 2022

Background:
Integrating parents into the care of their infants in the neonatal intensive care unit (NICU) is vital for both parents and infants. Yet, parents are often not fully involved in important decision-making and care, even when practices are family- and patient-centered. Alberta Family Integrated Care (FICare) is a model of care designed to support integration of parents into their infant's care.

Purpose:
The aim of this study was to describe and examine how mothers' work was coordinated by institutional processes when participating in Alberta FICare.

Methods:
We used institutional ethnography to analyze written entries in Alberta FICare parent journals to show points of tension mothers experienced in the NICU.

Results:
We illustrated the institutional activities that intersect with parental work of being present in the NICU. We argue that the journal text and the primary discourses that mothers are tuned to organize the way they knew and thought about their infant. Managing everyday NICU rules, navigating constant and unexpected changes, and the work of feeding their infant created tension. Mothers focused on milk supply, weight gain, and transition from gavage to nipple feeds. We show how mothers' activities were coordinated by practices that prioritize progression toward discharge rather than supporting them through the roller coaster of emotions and practical challenges of being present in the NICU.

Implications for Practice:
This illustration of institutional systems and processes may assist practitioners to understand the barriers mothers face when caring for their infants in the NICU.
Cardiovascular Protection Associated With Cilostazol, Colchicine, and Target of Rapamycin Inhibitors
Authors: Adeva-Andany María M. , Fernández-Fernández Carlos , Carneiro-Freire Natalia , Castro-Quintela Elvira , Vila-Altesor Matilde , González-Lucán Manuel 
Published: April 2022

Abstract:
An alteration in extracellular matrix (ECM) production by vascular smooth muscle cells is a crucial event in the pathogenesis of vascular diseases such as aging-related, atherosclerosis and allograft vasculopathy. The human target of rapamycin (TOR) is involved in the synthesis of ECM by vascular smooth muscle cells. TOR inhibitors reduce arterial stiffness, blood pressure, and left ventricle hypertrophy and decrease cardiovascular risk in kidney graft recipients and patients with coronary artery disease and heart allograft vasculopathy. Other drugs that modulate ECM production such as cilostazol and colchicine have also demonstrated a beneficial cardiovascular effect. Clinical studies have consistently shown that cilostazol confers cardiovascular protection in peripheral vascular disease, coronary artery disease, and cerebrovascular disease. In patients with type 2 diabetes, cilostazol prevents the progression of subclinical coronary atherosclerosis. Colchicine reduces arterial stiffness in patients with familial Mediterranean fever and patients with coronary artery disease. Pathophysiological mechanisms underlying the cardioprotective effect of these drugs may be related to interactions between the cytoskeleton, TOR signaling, and cyclic adenosine monophosphate (cAMP) synthesis that remain to be fully elucidated. Adult vascular smooth muscle cells exhibit a contractile phenotype and produce little ECM. Conditions that upregulate ECM synthesis induce a phenotypic switch toward a synthetic phenotype. TOR inhibition with rapamycin reduces ECM production by promoting the change to the contractile phenotype. Cilostazol increases the cytosolic level of cAMP, which in turn leads to a reduction in ECM synthesis. Colchicine is a microtubule-destabilizing agent that may enhance the synthesis of cAMP.
Influencing Factors for Cardiometabolic Risk in Korean Adolescents Based on 2010–2015 Data From the Korea National Health and Nutrition Examination Survey
Authors: Lee Yeo Jin , Hwang Seon Young 
Published: April 2022

Background
High academic stress and physical inactivity in Korean adolescents increase cardiometabolic risk factors, such as obesity, making it crucial to identify the factors influencing their risk.

Objective
Our aims were to determine differences in the prevalence of metabolic syndrome and its 5 components in Korean adolescents according to gender and to identify the influencing factors for cardiometabolic risk (individual risk factor ≥ 1).

Methods
Data related to adolescents from the Korean National Health and Nutrition Examination Survey (2010–2015) were assessed. Bivariate analyses to compare distribution and logistic regression analyses to examine the influencing factors were performed.

Results
Cardiometabolic risk (≥1 risk factor) was found in 33.2% and 32.6% of male and female adolescents, respectively, and metabolic syndrome (≥3 risk factors) was found in 2.0% and 2.3%, respectively. Among male adolescents, cardiometabolic risk was 1.66 times higher for the group that did not perform strength exercises (P = .007). For female adolescents, the cardiometabolic risk was 2.44 times higher in 16- to 18-year-olds than in 12- to 15-year-olds (P < .001) and 1.50 times higher in the non–aerobic-exercise group (P = .030). Central obesity (waist-to-height ratio ≥ 0.47) increased cardiometabolic risk by 5.71 and 13.91 times in male and female adolescents, respectively (P < .001).

Conclusion
To reduce cardiometabolic risk profiles and future cardiovascular risk in Korean adolescents, school-based physical activity programs should be actively provided not only for students with central obesity but also for students who lack aerobic or strength exercises.
Effect of a Home-Based Mobile Health App Intervention on Physical Activity Levels in Patients With Heart Failure
Authors: Saleh Zyad T. , Elshatarat Rami A. , Elhefnawy Khadega Ahmed , Helmi Elneblawi Nora , Abu Raddaha Ahmad H. , Al-Za'areer Majed S. , Mofdy Almarwani Abdulaziz , Alzahrani Naif S. , Aqel Ahmad A. , Shawashi Tagreed O. , Tayeh Mohammad 
Published: April 2022

Background
The use of mobile health applications (apps) is an effective strategy in supporting patients' self-management of heart failure (HF) in home settings, but it remains unclear whether they can be used to reduce sedentary behaviors and increase overall physical activity levels.

Aim
The aims of this study were to determine the effect of an 8-week home-based mobile health app intervention on physical activity levels and to assess its effects on symptom burden and health-related quality of life.

Method
In this study, we collected repeated-measures data from 132 participants with HF (60.8 ± 10.47 years) randomized into a usual care group (n = 67) or an 8-week home-based mobile health app intervention group (n = 65). The intervention was tailored to decrease the time spent in sedentary behavior and to increase the time spent in physical activities performed at light or greater intensity levels. Physical activity levels were monitored for 2 weeks before the intervention and during the 8-week intervention using the Samsung mobile health app. Heart failure symptom burden and health-related quality of life were assessed at baseline, 2 weeks from baseline assessment, and immediately post intervention.

Results
At week 8, all participants in the intervention group demonstrated an increase in the average daily step counts above the preintervention counts (range of increase: 2351–7925 steps/d). Only 29 participants (45%) achieved an average daily step count of 10 000 or higher by week 6 and maintained their achievement to week 8 of the intervention. Repeated-measures analysis of variance showed a significant group-by-time interaction, indicating that the intervention group had a greater improvement in physical activity levels, symptom burden, and health-related quality of life than the usual care group.

Conclusion
Home-based mobile health app–based interventions can increase physical activity levels and can play an important role in promoting better HF outcomes.
A Clinical Nurse Specialist–Led Quality Improvement Initiative to Identify Barriers to Adherence to a Bundle for Central Line Maintenance
Authors: Harlan Melissa Dawn , Kennell Jamilyn Sue , Lucas Wendy , Ren Dianxu , Tuite Patricia K. 
Published: April 2022

Purpose
This clinical nurse specialist–led quality improvement project identified barriers to adherence to a bundle for central line maintenance and examined the relationship between increased bundle adherence and central line–associated bloodstream infections.

Project Description
Oncology and critical care nurses were surveyed to identify barriers to adherence to a bundle for central line maintenance. Targeted initiatives based on survey responses were implemented focusing on antimicrobial bathing, increasing confidence in an evidence-based bundle, and its ability to reduce infections. Adherence and central line–associated bloodstream infection rates were monitored at baseline and at 3, 9, and 15 months post intervention.

Outcomes
Adherence to bundle elements improved post intervention in 4 areas in critical care units: correctly labeling catheter dressings, maintaining an occlusive dressing, clamping unused catheter lumens, and daily antimicrobial bathing. In oncology units, adherence improved in clamping unused lumens and daily antimicrobial bathing. At 9 months post intervention, infection rates decreased from 6.08 to 1.48 in critical care units and 3.13 to 0.30 in oncology units.

Conclusions
Identifying unit-specific barriers to adherence to bundles for central line maintenance and implementing targeted initiatives to reduce barriers increase adherence and prevent central line infections.
Autologous Gluteal Augmentation with Parasacral Perforator-Pedicled Propeller Flaps
Authors: Bekara Farid , Chaput Benoit , Ciucur Elena , de Boutray Marie , Boccara David , Bertheuil Nicolas , Herlin Christian 
Published: April 2022

Background:
De-epithelialized flaps have been used in gluteal contouring over the last three decades, but most improve the projection rather than the upper quadrants. The authors provide a detailed description of their method of gluteal augmentation using parasacral perforator-pedicled propeller flaps. This technique achieves a volumetric increase and maximal buttock projection at the midlevel and in the medial half of the buttocks.

Methods:
Between January and December of 2019, a series of 18 patients on whom a lower body lift with a parasacral perforator-pedicled propeller flap had been performed by the senior author (F.B.) were prospectively evaluated. Postoperatively, the satisfaction rate was assessed using a 10-point analog scale (1 = unsatisfied, 10 = very satisfied) by the patient and by two independent surgeons based on photographs taken 1 year after surgery.

Results:
Eighteen patients underwent this procedure. Their mean age was 32.2 ± 5.6 years (range, 24 to 40 years). The mean flap length was 20.3 cm, their mean width was 10.4 cm, and the mean thickness was 3.4 cm. The authors noted only two minor complications, one seroma and two skin dehiscences that healed without surgery. The rate of satisfaction as assessed by the patients was 8.3 out of 10 (±1.1), and by surgeons, 7.9 and 8.1.

Conclusion:
This article describes a gluteal autoaugmentation flap technique using parasacral perforator-pedicled propeller flaps to increase projection and volume in the inferomedial gluteal region after lower body lift.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
A Rare Pitfall in Bone Mineral Densitometry
Authors: Araz Mine , Sutcu Gizem , Surucu Kara llknur , Eminoglu Tuba , Ozkan Elgin 
Published: April 2022

Abstract
We report a rare case of type 3 Gaucher disease presenting with calcified mesenteric lymph nodes that interfere with bone mineral densitometric measurements.
Multicystic Biliary Hamartoma With Xanthogranulomatous Inflammation on 18F-FDG PET/CT
Authors: Shono Nahomi , Otomi Yoichi , Otsuka Hideki , Shinya Takayoshi , Harada Masafumi 
Published: April 2022

Abstract
A 70-year-old man with a liver tumor was pathologically diagnosed with multicystic biliary hamartoma with xanthogranulomatous inflammation. Plain CT revealed an inhomogeneous low-density liver tumor, measuring 43 × 35 mm. Dynamic contrast-enhanced CT revealed a cyst, measuring approximately 15 mm, with a ring-shaped enhancement, within the tumor. There was delayed enhancement on the outer portion of the tumor. Mild peripheral bile duct dilation was also observed. 18F-FDG PET/CT showed focal high uptake with an SUVmax of 5.2 near the cyst. The findings of this case mimicked that of intrahepatic cholangiocellular carcinoma.
Extranodal NK/T-Cell Lymphoma With Widespread Cutaneous and Subcutaneous Involvement on 18F-FDG PET/CT
Authors: Filizoglu Nuh , Ozguven Salih , Ones Tunc , Turoglu Halil Turgut , Erdil Tanju Yusuf 
Published: April 2022

Abstract
Nasal-type extranodal natural killer/T-cell lymphoma is an aggressive rare type of lymphoma that mostly affects the nasal cavity and adjacent areas. However, some patients can present with distant nodal or extranodal involvement including the Waldeyer ring, gastrointestinal tract, genitourinary organs, lung, thyroid, skin, or adrenal glands. Herein, we present a unique case of extranodal natural killer/T-cell lymphoma with widespread cutaneous and subcutaneous involvement on 18F-FDG PET/CT.
A Novel Method for Establishing Functional Change in Older Adults With Cognitive Impairment
Authors: González David A. , Resch Zachary J. , Gonzales Mitzi M. , Soble Jason R. 
Published: April 2022

Objective:
The aim was to set syndrome stage-specific (eg, cognitively unimpaired, severe dementia) metrics for functional change.

Methods:
We selected 18,097 individuals who participated in 2 National Alzheimer’s Coordinating Center visits between June 2005 and May 2020, with completed collateral rating of functioning on activities of daily living assessed by the Functional Activities Questionnaire.
Both distribution-based (ie, regression-based reliable change indices) and anchor-based (ie, typical change associated with advancing a syndromal stage for clinically meaningful difference) methods were applied for individuals classified as: unimpaired cognition, mild cognitive impairment, mild dementia, moderate dementia, or severe dementia.

Results:
There were marked differences in the distribution of functional ratings depending on their syndromal stage. There were also differences in the functional change associated with advancing across different syndromal stages. These informed stage-specific metrics for reliable change indices and clinically meaningful differences.

Conclusions:
Our indices provide a hitherto unavailable method that allows clinicians to determine whether observed functional change is reliable or meaningful based on syndromal stage.
Statewide Episode Spending Variation of Mastectomy for Breast Cancer
Authors: Hughes Tasha M , Ellsworth Brandon , Berlin Nicholas L , Sinco Brandy , Bredbeck Brooke , Baskin Alison , Wang Ton , Nathan Hari , Dossett Lesly A 
Published: April 2022

BACKGROUND:
Centralizing complex cancer operations, such as pancreatectomy and esophagectomy, has been shown to increase value, largely due to reduction in complications. For high-volume operations with low complication rates, it is unknown to what degree value varies between facilities, or by what mechanism value may be improved. To identify possible opportunities for value enhancement for such operations, we sought to describe variations in episode spending for mastectomy with a secondary aim of identifying patient- and facility-level determinants of variation.

STUDY DESIGN:
Using the Michigan Value Collaborative risk-adjusted, price-standardized claims data, we evaluated mean spending for patients undergoing mastectomy at 74 facilities (n = 7,342 patients) across the state of Michigan. Primary outcomes were 30- and 90-day episode spending. Using linear mixed models, facility- and patient-level factors were explored for association with spending variability.

RESULTS:
Among 7,342 women treated across 74 facilities, mean 30-day spending by facility ranged from $11,129 to $20,830 (median $14,935). Ninety-day spending ranged from $17,303 to $31,060 (median $23,744). Patient-level factors associated with greater spending included simultaneous breast reconstruction, bilateral surgery, length of stay, and readmission. Among women not undergoing reconstruction, variation persisted, and length of stay, bilateral surgery, and readmission were all associated with increased spending.

CONCLUSION:
Michigan hospitals have significant variation in spending for mastectomy. Reducing length of stay through wider adoption of same-day discharge for mastectomy and reducing the frequency of bilateral surgery may represent opportunities to increase value, without compromising patient safety or oncologic outcomes.
Delphi Consensus on Intraoperative Technical/Surgical Aspects to Prevent Surgical Site Infection after Colorectal Surgery
Authors: Ruiz-Tovar Jaime , Boermeester Marja A , Bordeianou Liliana , Chang George J , Gorgun Emre , Justinger Christoph , Lawson Elise H , Leaper David J , Mahmoud Najjia N , Mantyh Christopher , McGee Michael F , Nfonsam Valentine , Rubio-Perez Ines , Wick Elizabeth C. , Hedrick Traci L 
Published: April 2022

BACKGROUND:
Previous studies have focused on the development and evaluation of care bundles to reduce the risk of surgical site infection (SSI) throughout the perioperative period. A focused examination of the technical/surgical aspects of SSI reduction during CRS has not been conducted. This study aimed to develop an expert consensus on intraoperative technical/surgical aspects of SSI prevention by the surgical team during colorectal surgery (CRS).

STUDY DESIGN:
In a modified Delphi process, a panel of 15 colorectal surgeons developed a consensus on intraoperative technical/surgical aspects of SSI prevention undertaken by surgical personnel during CRS using information from a targeted literature review and expert opinion. Consensus was developed with up to three rounds per topic, with a prespecified threshold of ≥70% agreement.

RESULTS:
In 3 Delphi rounds, the 15 panelists achieved consensus on 16 evidence-based statements. The consensus panel supported the use of wound protectors/retractors, sterile incision closure tray, preclosure glove change, and antimicrobial sutures in reducing SSI along with wound irrigation with aqueous iodine and closed-incision negative pressure wound therapy in high-risk, contaminated wounds.

CONCLUSIONS:
Using a modified Delphi method, consensus has been achieved on a tailored set of recommendations on technical/surgical aspects that should be considered by surgical personnel during CRS to reduce the risk of SSI, particularly in areas where the evidence base is controversial or lacking. This document forms the basis for ongoing evidence for the topics discussed in this article or new topics based on newly emerging technologies in CRS.
Efficacy of Near-Infrared Fluorescence-Guided Hepatectomy for the Detection of Colorectal Liver Metastases: A Randomized Controlled Trial
Authors: He Kunshan , Hong Xiaopeng , Chi Chongwei , Cai Chaonong , An Yu , Li Peiping , Liu Xialei , Shan Hong , Tian Jie , Li Jian 
Published: April 2022

BACKGROUND:
The application of indocyanine green fluorescence–guided hepatectomy for liver metastases from colorectal cancer is in the preliminary stage of clinical practice; thus, its efficacy needs to be determined. This study compared the number of intrahepatic colorectal liver metastases detected intraoperatively and postoperative recovery data between patients who underwent traditional hepatectomy (nonindocyanine green group) and traditional hepatectomy plus intraoperative indocyanine green fluorescence imaging (indocyanine green group).

STUDY DESIGN:
Between January 2018 and March 2020, patients with potentially resectable colorectal liver metastases were randomly assigned to the nonindocyanine green or indocyanine green group. The number of intrahepatic colorectal liver metastases identified intraoperatively and based on postoperative recovery data were compared between both groups.

RESULTS:
Overall, we recruited 80 patients, among whom 72 eligible patients were randomly assigned. After allocation, 64 patients, comprising 32 in each group, underwent the allocated intervention and follow-up. Compared with the nonindocyanine green group, the mean number of intrahepatic colorectal liver metastases identified intraoperatively in the indocyanine green group was significantly greater (mean [standard deviation], 3.03 [1.58] vs 2.28 [1.35]; p = 0.045), the postoperative hospital stay was shorter (p = 0.012) and the 1-year recurrence rate was also lower (p = 0.017). Postoperative complications and 90-day mortality were comparable, with no statistical differences.

CONCLUSIONS:
Indocyanine green fluorescence imaging significantly increases the number of intrahepatic colorectal liver metastases identified and reduces postoperative hospital stay and 1-year recurrence rate without increasing hepatectomy-related complications and mortality rates.
Intraoperative Cytologic Sampling for Resected Pancreatic and Periampullary Adenocarcinoma with Implications for Locoregional Recurrence-Free Survival
Authors: Papai Emily , Nevler Avinoam , Solomides Charalambos , Shergill Mandeep S , Yeo Theresa P , Cannaday Shawnna , Yeo Charles J , Winter Jordan M , Lavu Harish 
Published: April 2022

BACKGROUND:
We hypothesized that pancreatic and periampullary adenocarcinoma recurrence after surgical resection may be affected by the shedding of malignant epithelial cells during surgical dissection and that this may have implications for disease recurrence and survival.

STUDY DESIGN:
In this ongoing, investigator-initiated prospective randomized controlled trial, patients with pancreatic and periampullary adenocarcinoma were randomized intraoperatively, postresection into 3 study arms: peritoneal lavage using 10 L normal saline or distilled water, or control group with no lavage. Peritoneal fluid was sampled for cytologic analysis (cytospin, cellblock, immunohistochemistry-Ber-EP4 antibody) at 4 stages: (1) abdominal entry pre-dissection, (2) resection bed after tumor extirpation, (3) ex vivo resected specimen, and (4) resection bed postlavage.

RESULTS:
Between April 2016 and May 2018, 193 patients who underwent randomization for the study also underwent the described cytologic sampling. Of these, 167 patients (86.5%) were ultimately found to have pancreatic or periampullary adenocarcinoma. Before dissection (1) on cytospin analysis, 4.9% were positive, which rose to 10.2% intraoperatively (2), 16.7% ex vivo (3), and decreased to 4.3% (4) after lavage. Lymph node metastasis, margin involvement, and perineural invasion did not correlate with locoregional recurrence (LR). Tumor cells in the ex vivo cytospin (3) correlated with LR (odds ratio 3.8 [95% CI 1.6 to 9.2], p = 0.005) and LR disease-free survival (p = 0.007). Cox regression analysis revealed ex vivo cytospin positivity to be strongly associated with poorer LR disease-free survival (hazard ratio 2.26 [95% CI 1.16 to 4.42], p = 0.017).

CONCLUSIONS:
Cytologic sampling from ex vivo specimen irrigation after surgical resection of pancreatic and periampullary adenocarcinoma may have implications for LR, survival, and treatment, suggesting a possible cancer cell shedding phenotype.