Implementation of a Standardized Data-Collection System for Comprehensive Appraisal of Cleft Care.

Objective: Our objective is to describe the process of adapting a conceptual framework into a practical toolkit for one cleft team.

Design: This is a single-arm implementation study in a single institution.

Setting: Implementation took place at a mid-sized multidisciplinary clinic for patients with cleft lip and/or palate (CL/P) from urban/suburban and rural areas across North Carolina and neighboring states.

Assessing the Impact of an Order Panel Utilizing Weight-Based Insulin and Standardized Monitoring of Blood Glucose for Patients With Hyperkalemia.

Intravenous insulin with glucose is used in urgent treatment for hyperkalemia but has a significant risk of hypoglycemia. The authors developed an order panel within the electronic health record system that utilizes weight-based insulin dosing and standardized blood glucose monitoring to reduce hypoglycemia. As initial evaluation of this protocol, the authors retrospectively compared potassium and blood glucose lowering in patients treated with the weight-based (0.

An Emerging Integrated Middle-Range Theory on Asian Women's Leadership in Nursing.

Introduction: Asian cultures reflect patriarchal cultural values and attitudes, which likely have influenced women leaders in their countries differently from women in Western cultures. However, virtually no leadership theories have been developed to reflect the experiences and development of nursing leaders from Asian cultures. The purpose of this article is to present an emerging integrated middle-range theory on Asian women's leadership in nursing.

Preoperative Imaging Findings and Cost in Adults With Postlingual Deafness Prior to Cochlear Implant.

Objective: To assess the imaging findings of computed topography (CT) and magnetic resonance imaging (MRI) in adults with postlingual deafness and otherwise normal clinical history and physical exam. Additionally, determine the influence and implications of these findings with respect to surgical outcomes and cost.

Study Design: Retrospective case review.

Influence of Diagnosis and Other Factors on Patients' Expectations of Foot and Ankle Surgery.

Background: Many patient factors have been associated with higher or lower expectations of orthopedic surgery. In foot and ankle surgery, the diverse diagnoses seen may also influence expectations. The aim of this study was to investigate the relationship between diagnosis and patients' preoperative expectations of elective foot and ankle surgery.

β-Arrestin-2-Dependent Signaling Promotes CCR4-mediated Chemotaxis of Murine T-Helper Type 2 Cells.

Allergic asthma is a complex inflammatory disease that leads to significant healthcare costs and reduction in quality of life. Although many cell types are implicated in the pathogenesis of asthma, CD4 T-helper cell type 2 (Th2) cells are centrally involved. We previously reported that the asthma phenotype is virtually absent in ovalbumin-sensitized and -challenged mice that lack global expression of β-arrestin (β-arr)-2 and that CD4 T cells from these mice displayed significantly reduced CCL22-mediated chemotaxis.

Efficacy and Safety of Subcutaneous Neostigmine for Ileus, Acute Colonic Pseudo-obstruction, or Refractory Constipation.

Background: Neostigmine is traditionally administered intravenously for treatment of acute colonic pseudo-obstruction (ACPO), though use is associated with administration constraints and adverse effects.

Objective: To evaluate whether an alternative route of administration for neostigmine via subcutaneous (SQ) delivery is safe and effective in a broad cohort of medical and surgical patients.

Methods: This multicenter, retrospective observational study included adult patients administered SQ neostigmine for ileus, ACPO, or refractory constipation.

Transesophageal Echocardiography Use in Diagnosis and Management of Embolized Intravascular Foreign Bodies.

The increasing use of endovascular interventions coupled with the large number of published case series detailing complications attest to the likelihood that anesthesiologists will encounter a case of intravascular foreign body embolization during their careers. Transesophageal echocardiography is essential to the diagnosis and management of traumatic and intravascular foreign bodies embolized to the heart because it can identify not only the foreign body but also hemodynamically significant lesions to radiolucent anatomic structures prior to and during surgical exploration. In this case presentation, we review how intraoperative transesophageal echocardiography facilitated the intraoperative assessment and management of a post-liver transplant patient who underwent open surgical removal of migrated inferior vena cava stent from the right ventricle with concomitant tricuspid valve annuloplasty.

Noteworthy Literature Published in 2017 for Thoracic Transplantation Anesthesiologists.

Thoracic organ transplantation constitutes a significant proportion of all transplant procedures. Thoracic solid organ transplantation continues to be a burgeoning field of research. This article presents a review of remarkable literature published in 2017 regarding perioperative issues pertinent to the thoracic transplant anesthesiologists.

Health Literacy and Participation Among Older Adult Patients With Heart Failure in Korean Culture.

Introduction: In South Korea, approximately 40% of older adults are reported to have low health literacy. The purpose of this study was to evaluate the relationship between health literacy and patient participation among Korean older adults with heart failure.

Method: This cross-sectional descriptive study involved 145 Korean patients at one prominent medical center in South Korea.

Keeping care connected: e-Consultation program improves access to nephrology care.

Introduction: Health systems are seeking innovative solutions to improve specialty care access. Electronic consultations (eConsults) allow specialists to provide formal clinical recommendations to primary care providers (PCPs) based on patient chart review, without a face-to-face visit.

Methods: We implemented a nephrology eConsult pilot program within a large, academic primary care practice to facilitate timely communication between nephrologists and PCPs.

Echocardiographic Guidance for Surgical Excision of the Intracardiac Component of a Pheochromocytoma.

Pheochromocytomas are rare neuroendocrine tumors, with published incidence of 2 to 8 cases per million patients per year. The extension of these tumors into the vena cava and right atrium is rarely seen. Transesophageal echocardiography may be invaluable to delineate tumor extent and characteristics, which in turn may provide a useful tool to guide intraoperative surgical approach to these uncommon masses.

Next-Generation Single-Use Ureteroscopes: An In Vitro Comparison.

Introduction: Single-use ureteroscopes have been gaining popularity in recent years. We compare the optics, deflection, and irrigation flow of two novel single-use flexible ureteroscopes-the YC-FR-A and the NeoFlex-with contemporary reusable and single-use flexible ureteroscopes.

Methods: Five flexible ureteroscopes, YC-FR-A (YouCare Tech, China), NeoFlex (Neoscope, Inc.

Feasibility of a Clinic-Community Partnership to Treat Childhood Obesity.

Background: "Bull City Fit" is a childhood obesity treatment partnership between Duke Children's pediatric weight management clinic and Durham Department of Parks and Recreation.

Objectives: Report on feasibility and implementation, characteristics of participants, and predictors of attendance.

Methods: Mixed methods study consisting of (1) a retrospective cohort analysis (n = 171) reporting demographic, attendance, and clinical data and (2) structured focus groups among stakeholders to identify implementation facilitators and barriers.

Midterm Outcomes of a Fixed-Bearing Total Ankle Arthroplasty With Deformity Analysis.

Background: We present our results with an INBONE I (Wright Medical, Memphis, TN) prosthesis that have a minimum of 4 to 10 years of follow-up and include a preoperative deformity analysis on outcomes.

Methods: A consecutive series of 149 patients, from 2007 to 2011, at a single institution were enrolled. Pain and patient-reported function were assessed preoperatively and at yearly follow-ups.

Cognitive and Interpersonal Features of Intellectual Humility.

Four studies examined intellectual humility-the degree to which people recognize that their beliefs might be wrong. Using a new Intellectual Humility (IH) Scale, Study 1 showed that intellectual humility was associated with variables related to openness, curiosity, tolerance of ambiguity, and low dogmatism. Study 2 revealed that participants high in intellectual humility were less certain that their beliefs about religion were correct and judged people less on the basis of their religious opinions.

Time-Dependent Effects on Synovial Fluid Composition During the Acute Phase of Human Intra-articular Ankle Fracture.

Background: The study objective was to examine the effect of time and fracture severity on the undiluted synovial fluid (SF) microenvironment during the acute phase following intra-articular fracture (IAF) of the human ankle.

Methods: Ankle SF from 54 patients with an acute IAF was analyzed for concentrations of 10 cytokines, 5 matrix metalloproteinases, 2 products of cartilage catabolism, and combined products of heme metabolism. All analytes were correlated with time from fracture and further analyzed for an effect of 3 time subgroups (0-2 days, 3-9 days, and ≥10 days) corresponding to timepoints for clinical ankle fracture interventions.

Projecting Survival in Papillary Thyroid Cancer: A Comparison of the Seventh and Eighth Editions of the American Joint Commission on Cancer/Union for International Cancer Control Staging Systems in Two Contemporary National Patient Cohorts.

Background: This study aims to compare the seventh and eighth editions of the American Joint Commission on Cancer/Union for International Cancer Control (AJCC/UICC) tumor, node, metastasis staging system for patients with papillary thyroid cancer (PTC) in two national patient cohorts.

Methods: Adult PTC patients undergoing surgery were selected from the Surveillance, Epidemiology and End Results (SEER) program (2004-2012) and the National Cancer Database (2004-2012). Staging criteria for the seventh and eighth AJCC/UICC editions were applied separately to each cohort.

Participation of Racial and Ethnic Minorities in Technology-Based Interventions to Self-Manage Type 2 Diabetes: A Scoping Review.

Purpose: Strategies to decrease societal and cultural barriers for ethnic minorities to participate in health research are well established. However, limited data are available regarding participation of ethnic minorities in mobile and Internet technology-based interventions to self-manage type 2 diabetes where health disparities are predominant. Thus, the purpose was to understand the participation of ethnic minorities in technology-based intervention programs to manage type 2 diabetes.

Contemporary Demographic, Treatment, and Geographic Distribution Patterns for Disorders of Sex Development.

This study aimed to describe the demographic characteristics, hospital utilizations, patterns of inpatient surgical management, and the overall state/regional variation in surgery rate among patients with disorders of sex development (DSD). We analyzed the Nationwide Inpatient Sample from 2001 to 2012 for patients younger than 21 years. DSD-related diagnoses and procedures were identified via International Classification of Diseases, Ninth Revision (ICD-9) codes.

Quantitative diffusion tensor imaging analysis does not distinguish pediatric canines with mucopolysaccharidosis I from control canines.

Purpose We compared fractional anisotropy and radial diffusivity measurements between pediatric canines affected with mucopolysaccharidosis I and pediatric control canines. We hypothesized that lower fractional anisotropy and higher radial diffusivity values, consistent with dysmyelination, would be present in the mucopolysaccharidosis I cohort. Methods Six canine brains, three affected with mucopolysaccharidosis I and three unaffected, were euthanized at 7 weeks and imaged using a 7T small-animal magnetic resonance imaging system.