bluuebunny/crossref_metadata_2025 huggingface dataset:
Carpal Tunnel Syndrome as Sentinel for Harmful Hand Activities at Work
Authors: Tabatabaeifar Sorosh , Svendsen Susanne Wulff , Frost Poul
Published: March 2020

Objective:

Evaluate incidence rates (IRs) of carpal tunnel syndrome (CTS) as sentinels to identify job groups with high hand-wrist exposures.

Methods:

A nationwide register-based cohort study of all born in Denmark. During follow-up 2010 to 2013, we identified first-time CTS diagnoses. We established job groups, calculated sex-specific age-standardized IRs (SIRs) per job group. We linked occupational codes with a job exposure matrix, calculated mean hand load estimate per job group, and plotted hand load against the SIRs.

Results:

We followed 1,171,580 men and 1,137,854 women for 4,046,851 and 3,994,987 person-years; identified 4405 cases among men, 7858 among women; obtained crude IRs of 10.9 and 19.7 per 10,000 person-years. For both sexes, there was a positive association between SIRs and hand load.

Conclusions:

Higher SIRs pointed to job groups with higher hand load. Elevated SIRs of CTS may serve as sentinels of harmful hand activities.
The association between the fibrinogen-to-albumin ratio and coronary artery disease severity in patients with stable coronary artery disease
Authors: Celebi Savas , Ozcan Celebi Ozlem , Berkalp Berkten , Amasyali Basri
Published: March 2020

Objective

Fibrinogen-to-albumin ratio (FAR) is an inexpensive and easily measurable novel inflammatory index that has been found to be associated with atherosclerosis. In this study, we aimed to investigate the association between the FAR and coronary artery disease (CAD) severity in patients with stable CAD.

Methods

In total, 356 consecutive patients with CAD were classified into three groups, those with a low Synergy between percutaneous coronary intervention and the Taxus and Cardiac Surgery Study (SYNTAX) score (≤22), those with an intermediate SYNTAX score (23≥ SYNTAX score ≤32) and those with a high SYNTAX score (>32).

Results

We determined that there were significant differences in the mean age (P < 0.001), male gender (P = 0.008), serum fibrinogen (P = 0.03), low-density lipoprotein cholesterol (P < 0.001) and FAR (P < 0.001) among the SYNTAX score groups. A strong positive correlation was detected between FAR and SYNTAX score (r = 0.899; P < 0.001), and the cutoff level of FAR for high SYNTAX score was 82 (sensitivity of 82%, specificity of 88.3% and an area under the curve of 0.826).

Conclusion

The novel inflammatory index, FAR, is significantly associated with the severity of CAD in patients with stable CAD.
Long-term scintigraphic and clinical follow up in patients with differentiated thyroid cancer and iodine avid bone metastases
Authors: Talaat Omnia Mohamed , Ali Ismail Mohamed , Abolyazid Sherif Maher , Abdelmaksoud Bader , Nasr Ibrahim Mansour
Published: March 2020

Aim

The aim of this study was to evaluate the long-term overall therapy outcomes and clinicopathological risk factors in patients with differentiated thyroid cancer (DTC) and iodine avid bone metastases.

Methods

Our study included 93 patients [female to male ratio (2:1)]. All patients were subjected to clinical examination, laboratory assessment, I-131 whole body scan, and neck ultrasound. Iodine avid metastases were treated with successive radioactive iodine-131 (RAI-131) doses. The overall response was defined as complete response (CR), incomplete response (IR) [partial response (PR) and stable disease (SD)], and progressive disease (PD).

Results

Fifty-four patients had follicular carcinoma and 39 with papillary type. Isolated bone metastases, bone and lung metastases, and multi-organ metastases were found in 45, 34, and 14 patients, respectively. The overall CR, PR, SD, and PD were found in 8.6%, 28%, 46.2%, and 17.2% patients, respectively. Adjunctive radiotherapy resulted in more CR, IR, and low PD rates compared to RAI-131 therapy (9.0%, 78.3%, 12.7% vs. 7.9%, 56.8%, and 23.7%, respectively) (P = 0.03). The overall survival rate was 88.2% and median follow-up period was 123 months. Female patients, papillary carcinoma, and single focal lesion had better overall response rate. Males, extrathyroidal extension, vascular invasion, and lymph nodes metastases had increased PD and decreased global response rates.

Conclusion

Despite of low CR rate (8.6%), most patients with DTC and iodine avid bone metastases had SD (46.2%) and long lived (88.2%). Adjunctive radiotherapy reduced PD and improved outcome. Males, extra thyroid extension and vascular invasion were bad prognostic factors.
Interprofessional Evidence-Based Strategies to Enhance Provider and Patient Interactions During Electronic Health Record Use
Authors: Misto Kara , Padula Cynthia , Dame Linda , Molloy Patricia A. , Nimmagadda Jayashree
Published: March 2020

The purpose of this study was to develop and disseminate evidence-based interprofessional strategies to enhance provider–patient interactions, including ethical issues, that arise during electronic documentation. An interprofessional simulation scenario was implemented with students, and strategies developed were then used to train hospital staff. Nurses reported being significantly more likely to use the interprofessional strategies after completing the program. Interprofessional simulation and training is an effective method to address challenges that arise during electronic health record use.
Exercise-Induced Brain Excitability Changes in Progressive Multiple Sclerosis: A Pilot Study
Authors: Chaves Arthur R. , Devasahayam Augustine J. , Kelly Liam P. , Pretty Ryan W. , Ploughman Michelle
Published: March 2020

Background and Purpose:

Even a single bout of aerobic exercise (AE) enhances corticospinal excitability (CSE), a biomarker of neuroplasticity. Because neurodegeneration limits capacity for neuroplasticity, it is not clear whether AE would induce CSE changes in people with progressive multiple sclerosis (MS).

Methods:

People with progressive MS (n = 10) requiring ambulatory assistive devices completed a graded maximal exercise test. Dual-energy x-ray absorptiometry was used to quantify body fat and lean mass. Before and following one 40-minute AE session using body weight–supported (<10% support) treadmill at moderate intensity, CSE was measured using transcranial magnetic stimulation. Variables included resting and active motor thresholds, motor evoked potential (MEP) amplitudes, recruitment curves, and length of the cortical silent period (CSP).

Results:

Aerobic exercise reduced inhibition (shorter CSP) and increased excitation (increased MEP amplitude) only in the hemisphere corresponding to the stronger hand. Controlling for age, higher fitness and lower body fat significantly predicted exercise-induced reduction in resting motor threshold (ΔR
2 = +0.458, P = 0.046) and CSP (ΔR
2 = +0.568, P = 0.030), respectively.

Discussion and Conclusions:

Despite high levels of disability, capacity for exercise-induced neuroplasticity was retained among people with progressive MS. The hemisphere contralateral to the weaker hand was resistant to exercise-induced CSE changes, suggesting less neuroplastic potential. Lower fitness and higher body fat were associated with diminished exercise-induced CSE benefits, suggesting that therapists should consider interventions aimed at improving fitness and combating sedentarism to ultimately enhance the benefits of exercise on the brain.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A302).
Evaluation of Two Strategies for Alleviating the Impact on the Circadian Cycle of Smartphone Screens
Authors: Teran Emiliano , Yee-Rendon Cristo-Manuel , Ortega-Salazar Jesus , De Gracia Pablo , Garcia-Romo Efrain , Woods Russell L.
Published: March 2020

SIGNIFICANCE

Electronic display devices used before bed may negatively affect sleep quality through the effects of short-wavelength (blue) light on melatonin production and the circadian cycle. We quantified the efficacy of night-mode functions and blue-light–reducing lenses in ameliorating this problem.

PURPOSE

The purpose of this study was to compare the radiation produced by smartphones that reaches the eye when using night-mode functions or blue-light–reducing spectacle lenses.

METHODS

Radiant flux of 64 smartphones was measured with an integrating sphere. The retinal illuminance was calculated from the radiant flux of the smartphones. For the night-mode functions, the spectra produced by the smartphones were measured. The transmittance of four blue-light–reducing spectacle lenses, which filter light with either antireflective coatings or tints, was measured using a spectrometer. To determine the impact of blue-light–reducing spectacles, the radiant flux of the smartphone was weighted by the transmission spectrum of these glasses. Visual and nonvisual (circadian) parameters were calculated to compute the melatonin suppression values (MSVs) through a logistic fitting of previously published data. The MSV was used as the figure of merit to evaluate the performance of blue-light spectacles and smartphone night-mode functions.

RESULTS

Night-mode functions in smartphones reduced MSVs by up to 93%. The warmest mode produced the least suppression. Blue-light–reducing spectacles reduced melatonin suppression by 33%, the coated lenses being more efficient than tinted lenses.

CONCLUSIONS

All smartphones in this study emit radiant power in the short-wavelength region of the visible spectrum. Such smartphones may impair the regulation of circadian cycles at nighttime. The activation of night-mode functions was more efficient than the commercially available blue-light–reducing spectacle lenses in reducing the amount of short-wavelength light (up to 2.25 times). These results can be extrapolated to most electronic devices because they share the same type of white radiant sources with smartphones.
Classification of Keratoconus Based on Anterior Corneal High-order Aberrations: A Cross-validation Study
Authors: Ortiz-Toquero Sara , Fernandez Itziar , Martin Raul
Published: March 2020

SIGNIFICANCE

Placido disc–based videokeratography is one of the most extensively used methods for corneal topographic assessments in keratoconus. Anterior corneal wavefront analysis has been demonstrated to be an effective tool to manage keratoconus eyes. However, currently, there is no clinically adequate classification system for keratoconus.

PURPOSE

The aim of this study was to analyze the usefulness of anterior corneal high-order aberrations in keratoconus classification provided by Placido disc–based videokeratography conducting a cross-validation analysis.

METHODS

Corneal topography of 70 normal and 77 keratoconic eyes (divided according to the Amsler-Krumeich classification [n = 21, stage 1; n = 30, stage 2; and n = 26, stage 3]) was assessed using Placido disc–based videokeratography (Oculus Keratograph [Oculus Optikgeräte GmbH, Wetzlar, Germany]). Receiver operating characteristic curve analysis was used to compare the mean values of coma, trefoil, tetrafoil, secondary astigmatism, spherical aberration, and coma-like, third-, and fourth-order root mean square (RMS) to calculate cutoff values, sensitivity, and specificity to discriminate between normal and stage 1 keratoconus eyes and between each keratoconus stage after cross-validation analysis.

RESULTS

All wavefront aberrations were significantly different between the normal and keratoconus groups (P ≤ .01). The coma and third-order RMS values (cutoff values, 0.367 and 0.359 μm, respectively) provide better sensitivity (99 and 100%, respectively) and specificity (100%) to discriminate keratoconus (stage 1) from healthy eyes compared with trefoil, tetrafoil, secondary astigmatism, spherical aberration, and coma-like and fourth-order RMS values (sensitivity >84% and specificity >57%). The coma and third-order RMS values showed the highest specificity (100%) and great sensitivity (90 and 87%, respectively) to differentiate between stages 1 and 2 and good sensitivity (97 and 100%) and specificity (81 and 88%) to differentiate between stages 2 and 3.

CONCLUSIONS

Anterior corneal high-order aberrations, specifically coma and third-order RMS, could be useful in keratoconus diagnosis and topographical classification. These new cutoff values could improve different stages of keratoconus eyes discrimination.
Efficacy of Swept-source Optical Coherence Tomography in Axial Length Measurement for Advanced Cataract Patients
Authors: Chirapapaisan Chareenun , Srivannaboon Sabong , Chonpimai Pratuangsri
Published: March 2020

SIGNIFICANCE

A major limitation of standard time-domain optical coherence tomography–based biometers (TD-OCT) is an inability to measure the axial length (AL) in advanced cataract. A new device that uses swept-source optical coherence tomography (SS-OCT) allows better light penetration. Hence, a considerable number of cataract patients who failed AL measurement by TD-OCT can be recovered by SS-OCT.

PURPOSE

The purposes of this study were to evaluate the efficacy of an SS-OCT for AL measurement in advanced cataract patients and to identify characteristics of lens opacity that impede the AL measurement.

METHODS

Advanced cataract patients who were unable to obtain AL measurement using a standard TD-OCT-based optical biometer (IOLMaster500; Carl Zeiss Meditec, Jena, Germany) were recruited in this study. The AL was remeasured using SS-OCT (IOLMaster700), followed by measurement with immersion ultrasonography (IU). The percentage of patients who achieved AL measurement by SS-OCT was recorded. The AL obtained from SS-OCT was then verified by comparing with the AL derived from IU. The cataract type of each patient was classified according to standard Lens Opacity Classification III score. The association between characteristics of cataract and successful AL measurement by SS-OCT was analyzed.

RESULTS

Sixty-four eyes that failed AL measurement from TD-OCT were included. Fifty-six eyes (87.5%) were able to be measured by SS-OCT (95% confidence interval, 77.23 to 93.53%). The AL obtained by SS-OCT showed very high agreement with those derived from IU (intraclass correlation coefficient, 0.99). There was no statistically significant correlation between characteristics of lens opacity and the capability of SS-OCT for AL measurement (P> .05). However, there was a trend toward an inability to measure the AL in cataracts with a high grade of lens opacity.

CONCLUSIONS

The efficacy of SS-OCT–based optical biometer was excellent. Of the patients with advanced cataract who failed the AL measurement by TD-OCT, 87.5% could be recovered by SS-OCT. However, there was no specific type of lens opacity associated with a failure of AL measurement using SS-OCT.
Work of Breathing in Mechanically Ventilated Preterm Neonates*
Authors: Vervenioti Aggeliki , Fouzas Sotirios , Tzifas Sotirios , Karatza Ageliki A. , Dimitriou Gabriel
Published: March 2020

Objectives:

To compare the imposed work of breathing by means of pressure-time product of the diaphragm in newborn infants receiving different modes of mechanical ventilation.

Design:

Prospective observational crossover study.

Setting:

Tertiary care neonatal unit.

Patients:

Forty preterm newborns (gestational age ≤ 37 wk) in the phase of weaning from mechanical ventilation.

Interventions:

Participants were ventilated in assist control, synchronized intermittent mandatory ventilation, and intermittent mandatory ventilation mode, in a crossover manner. The combination synchronized intermittent mandatory ventilation–pressure support (SIMV–PS) at 50% (SIMV–PS50) and 75% (SIMV–PS75) of the difference between peak inflating and positive end-expiratory pressure, was also applied in a subset of infants (n = 11). Each mode was maintained for 30 minutes. Transdiaphragmatic pressure was obtained by digital subtraction of esophageal from gastric pressure (both measured using a dual pressure-tipped catheter), and pressure-time product of the diaphragm was computed by integration of transdiaphragmatic pressure over inspiratory time.

Measurements and Main Results:

The pressure-time product of the diaphragm was 224.2 ± 112.8 in the intermittent mandatory ventilation mode, 165.8 ± 58.8 in the synchronized intermittent mandatory ventilation mode, and 125.5 ± 61.8 cm H2O × s × min–1 in the assist control mode; all values were significantly different to each other (p < 0.0001). The pressure-time product of the diaphragm difference between assist control and intermittent mandatory ventilation, and assist control and synchronized intermittent mandatory ventilation was negatively related to postmenstrual age (regression coefficient, –0.365; p = 0.020 and –0.341; p = 0.031, respectively). In the SIMV–PS subcohort, the pressure-time product of the diaphragm was significantly higher in the intermittent mandatory ventilation mode as compared with assist control (p < 0.0001) or SIMV–PS75 (p = 0.0027), and in the synchronized intermittent mandatory ventilation mode as compared with assist control (p = 0.0301).

Conclusions:

In preterm infants, patient-triggered ventilation modalities result in lower work of breathing than intermittent mandatory ventilation, while the assist control mode is also associated with lower pressure-time product of the diaphragm compared with synchronized intermittent mandatory ventilation. The difference in the imposed diaphragmatic workload between these ventilation modalities was inversely related to postmenstrual age, implying that less mature infants benefit more from assist control-based ventilation strategies.
Circulating Neurofilament Light Chain Is Associated With Survival After Pediatric Cardiac Arrest*
Authors: Kirschen Matthew P. , Yehya Nadir , Graham Kathryn , Kilbaugh Todd , Berg Robert A. , Topjian Alexis , Diaz-Arrastia Ramon
Published: March 2020

Objectives:

To characterize neurofilament light levels in children who achieved return of spontaneous circulation following cardiac arrest compared with healthy controls and determine an association between neurofilament light levels and clinical outcomes.

Design:

Retrospective cohort study.

Setting:

Academic quaternary PICU.

Patients:

Children with banked plasma samples from an acute respiratory distress syndrome biomarker study who achieved return of spontaneous circulation after a cardiac arrest and healthy controls.

Interventions:

None.

Measurements and Main Results:

Neurofilament light levels were determined with a highly sensitive single molecule array digital immunoassay. Patients were categorized into survivors and nonsurvivors and into favorable (Pediatric Cerebral Performance Category score of 1–2 or unchanged from baseline) or unfavorable (Pediatric Cerebral Performance Category score of 3–6 or Pediatric Cerebral Performance Category score change ≥1 from baseline). Associations between neurofilament light level and outcomes were determined using Wilcoxon rank-sum test. We enrolled 32 patients with cardiac arrest and 18 healthy controls. Demographics, severity of illness, and baseline Pediatric Cerebral Performance Category scores were similar between survivors and nonsurvivors. Healthy controls had lower median neurofilament light levels than patients after cardiac arrest (5.5 [interquartile range 5.0–8.2] vs 31.0 [12.0–338.6]; p < 0.001). Neurofilament light levels were higher in nonsurvivors than survivors (78.5 [26.2–509.1] vs 12.4 [10.3–28.2]; p = 0.012) and higher in survivors than healthy controls (p = 0.009). The four patients who survived with a favorable outcome had neurofilament light levels that were not different from patients with unfavorable outcomes (21.9 [8.5––35.7] vs 37.2 [15.4–419.1]; p = 0.60) although two of the four patients who survived with favorable outcomes had progressive encephalopathies with both baseline and postcardiac arrest Pediatric Cerebral Performance Category scores of 4.

Conclusions:

Neurofilament light is a blood biomarker of hypoxic–ischemic brain injury and may help predict survival and neurologic outcome after pediatric cardiac arrest. Further study in a larger, dedicated cardiac arrest cohort with serial longitudinal measurements is warranted.
Central Venous Catheter Utilization and Complications in the Pediatric Cardiac ICU: A Report From the Pediatric Cardiac Critical Care Consortium (PC4)*
Authors: DiPietro Lisa M. , Gaies Michael , Banerjee Mousumi , Donohue Janet E. , Zhang Wenying , DeSena Holly C. , Graham Eric M. , Sasaki Jun , Moga Michael-Alice , Prodhan Parthak , Goldstein Stuart L. , Tabbutt Sarah , Cooper David S.
Published: March 2020

Objectives:

Current central venous catheter utilization in patients within pediatric cardiac ICUs is not well elucidated. We aim to describe current use of central venous catheters in a multi-institutional cohort and to explore the prevalence and risk factors for central line–associated thrombosis and central line–associated bloodstream infections.

Design:

Observational analysis.

Setting:

Pediatric Cardiac Critical Care Consortium hospitals.

Patients:

Hospitalizations with at least one cardiac ICU admission from October 2013 to July 2016.

Interventions:

None.

Measurements and Main Results:

There were 17,846 hospitalizations and 69% included greater than or equal to one central venous catheter. Central venous catheter use was higher in younger patients (86% neonates). Surgical hospitalizations included at least one central venous catheter 88% of the time compared with 35% of medical hospitalizations. The most common location for central venous catheters was internal jugular (46%). Central venous catheters were in situ a median of 4 days (interquartile range, 2–10). There were 248 hospitalizations (2% overall, 1.8% medical, and 2.1% surgical) with at least one central line–associated thrombosis (271 total thromboses). Thrombosis was diagnosed at a median of 7 days (interquartile range, 4–14) after catheter insertion. There were 127 hospitalizations (1% overall, 1.4% medical, and 1% surgical) with at least one central line–associated bloodstream infection (136 total infections) with no association with catheter type or location. Central line–associated bloodstream infection was diagnosed at a median of 19 days (interquartile range, 8–36) after catheter insertion. Significant risk factors for central line–associated thrombosis and central line–associated bloodstream infection were younger age, greater surgical complexity, and total catheter days.

Conclusions:

Utilization of central venous catheters in pediatric cardiac ICUs differs according to indication for hospitalization. Although thrombosis and central line–associated bloodstream infection are infrequent complications of central venous catheter use in cardiac ICU patients, these events can have important short- and long-term consequences for patients. Total central venous catheter line days were the only modifiable risk factor identified. Future study must focus on understanding central venous catheter practices in high-risk patient subgroups that reduce the prevalence of thrombosis and central line–associated bloodstream infection.
The Course of Posttraumatic Stress in Children: Examination of Symptom Trajectories and Predictive Factors Following Admission to Pediatric Intensive Care*
Authors: Le Brocque Robyne M. , Dow Belinda L. , McMahon Hayley , Crothers Anna L. , Kenardy Justin A. , Williams Tara J. , Long Debbie A.
Published: March 2020

Objectives:

This study investigated trauma symptom trajectories of children 2–16 years old following admission to pediatric intensive care and identified factors that predicted a child’s trauma symptom trajectory.

Design:

Prospective longitudinal design.

Setting:

Two tertiary care PICUs in Brisbane, Qld, Australia.

Patients:

Children 2–16 years old admitted to PICU for longer than 8 hours.

Measurements Main Results:

Maternal reported child posttraumatic stress symptoms (n = 272) on the Trauma Symptom Checklist for Young Children were used to assess posttraumatic stress symptoms up to 12 months post admission. Semiparametric group-based trajectory analyses were completed to identify patterns over time. Age, gender, length of stay, premorbid functioning, maternal perceived threat to life, and maternal acute distress were assessed as potential risk factors. Three likely trajectory groups were identified. The majority of children were resilient (83.8%); however, a significant minority experienced chronic symptoms (12.9%) or elevated stress symptoms which resolved quickly (3.3%). After controlling for other variables, maternal report of premorbid internalizing behavior significantly predicted both chronic (odds ratio, 6.3) and recovery (odds ratio, 38.0) trajectories. Maternal acute distress significantly predicted child chronic symptom trajectories (odds ratio, 5.2).

Conclusions:

Children with elevated trauma symptoms postintensive care need timely and effective intervention. The majority of children with high levels of acute symptoms will continue to have chronic, ongoing posttraumatic stress symptoms. In addition, acute maternal distress and preexisting internalizing child behavior predict ongoing psychologic distress after discharge from the PICU. Screening in the acute period post-PICU admission may identify children likely to experience ongoing chronic posttraumatic distress symptoms and enable targeted treatment of children at risk. This is the first study to examine symptom trajectories in children following pediatric intensive care admission and includes a sample of very young children.
Dexmedetomidine for Prolonged Sedation in the PICU: A Systematic Review and Meta-Analysis*
Authors: Daverio Marco , Sperotto Francesca , Zanetto Lorenzo , Coscini Nadia , Frigo Anna Chiara , Mondardini Maria Cristina , Amigoni Angela
Published: March 2020

Objectives:

We aimed to systematically describe the use of dexmedetomidine as a treatment regimen for prolonged sedation in children and perform a meta-analysis of its safety profile.

Data Sources:

PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, ClinicalTrials.gov, and CINAHL were searched from inception to November 30, 2018.

Study Selection:

We included studies involving hospitalized critically ill patients less than or equal to 18 years old receiving dexmedetomidine for prolonged infusion (≥ 24 hr).

Data Extraction:

Data extraction included study characteristics, patient demographics, modality of dexmedetomidine use, associated analgesia and sedation details, comfort and withdrawal evaluation scales, withdrawal symptoms, and side effects.

Data Synthesis:

Literature search identified 32 studies, including a total of 3,267 patients. Most of the studies were monocentric (91%) and retrospective (88%); one was a randomized trial. Minimum and maximum infusion dosages varied from 0.1–0.5 µg/kg/hr to 0.3–2.5 µg/kg/hr, respectively. The mean/median duration range was 25–540 hours. The use of a loading bolus was reported in eight studies (25%) (range, 0.5–1 µg/kg), the mode of weaning in 11 (34%), and the weaning time in six of 11 (55%; range, 9–96 hr). The pooled prevalence of bradycardia was 2.6% (n= 10 studies; 14/387 patients; 95% CI, 0.3–7.3;I2= 75%), the pooled prevalence incidence of bradycardia was 2.6% (n= 10 studies; 14/387 patients; 95% CI, 0.3–7.3;I2= 75%), the pooled incidence of hypotension was 6.1% (n= 8 studies; 19/304 patients; 95% CI, 0.8–15.9;I2= 84%). Three studies (9%) reported side effects’ onset time which in all cases was within 12 hours of the infusion starting.

Conclusions:

High-quality data on dexmedetomidine use for prolonged sedation and a consensus on correct dosing and weaning protocols in children are currently missing. Infusion of dexmedetomidine can be considered relatively safe in pediatrics even when longer than 24 hours.
Efficacy and Safety of Dexmedetomidine for Prolonged Sedation in the PICU: A Prospective Multicenter Study (PROSDEX)*
Authors: Sperotto Francesca , Mondardini Maria C. , Dell’Oste Clara , Vitale Francesca , Ferrario Stefania , Lapi Maria , Ferrero Federica , Dusio Maria P. , Rossetti Emanuele , Daverio Marco , Amigoni Angela
Published: March 2020

Objectives:

We sought to evaluate dexmedetomidine efficacy in assuring comfort and sparing conventional drugs when used for prolonged sedation (≥24 hr) in critically ill patients, by using validated clinical scores while systematically collecting drug dosages. We also evaluated the safety profile of dexmedetomidine and the risk factors associated with adverse events.

Design:

Observational prospective study.

Setting:

Nine tertiary-care PICUs.

Patients:

Patients less than 18 years who received dexmedetomidine for greater than or equal to 24 hours between January 2016 and December 2017.

Interventions:

None.

Measurements and Main Results:

One-hundred sixty-three patients (median age, 13 mo; interquartile range, 4–71 mo) were enrolled. The main indication for dexmedetomidine use was as an adjuvant for drug-sparing (42%). Twenty-three patients (14%) received dexmedetomidine as monotherapy. Seven percent of patients received a loading dose. The median infusion duration was 108 hours (interquartile range, 60–168 hr), with dosages between 0.4 (interquartile range, 0.3–0.5) and 0.8 µg/kg/hr (interquartile range, 0.6–1.2 µg/kg/hr). At 24 hours of dexmedetomidine infusion, values of COMFORT-B Scale (n = 114), Withdrawal Assessment Tool-1 (n = 43) and Cornell Assessment of Pediatric Delirum (n = 6) were significantly decreased compared with values registered immediately pre dexmedetomidine (p < 0.001, p < 0.001, p = 0.027). Dosages/kg/hr of benzodiazepines, opioids, propofol, and ketamine were also significantly decreased (p < 0.001, p < 0.001, p = 0.001, p = 0.027). The infusion was weaned off in 85% of patients, over a median time of 36 hours (interquartile range, 12–48 hr), and abruptly discontinued in 15% of them. Thirty-seven percent of patients showed hemodynamic changes, and 9% displayed hemodynamic adverse events that required intervention (dose reduction in 79% of cases). A multivariate logistic regression model showed that a loading dose (odds ratio, 4.8; CI, 1.2–18.7) and dosages greater than 1.2 µg/kg/hr (odds ratio, 5.4; CI, 1.9–15.2) increased the odds of hemodynamic changes.

Conclusions:

Dexmedetomidine used for prolonged sedation assures comfort, spares use of other sedation drugs, and helps to attenuate withdrawal syndrome and delirium symptoms. Adverse events are mainly hemodynamic and are reversible following dose reduction. A loading dose and higher infusion dosages are independent risk factors for hemodynamic adverse events.
Patient Safety Threats in Information Management Using Health Information Technology in Ambulatory Cancer Care: An Exploratory, Prospective Study
Authors: Pfeiffer Yvonne , Zimmermann Chantal , Schwappach David L. B.
Published: March 2020

Background

Cancer care is complex, involving highly toxic drugs, critically ill patients, and various different care providers. Because it is important for clinicians to have the latest and complete information about the patient available, this study focused on patient safety issues in information management developing from health information technology (HIT) use in oncology ambulatory infusion centers.

Objective

The aim was to exploratively and prospectively assess patient safety risks from an expert perspective: instead of retrospectively analyzing safety events, we assessed the information management hazards inherent to the daily work processes; instead of asking healthcare workers at the front line, we used them as information sources to construct our patient safety expert view on the hazards.

Methods

The work processes of clinicians in three ambulatory infusion centers were assessed and evaluated based on interviews and observations with a nurse and a physician of each unit. The 125 identified patient safety issues were described and sorted into thematic groups.

Results

A broad range of patient safety issues was identified, such as data fragmentation, or information islands, meaning that patient data are stored across different cases or software and that different professional groups do not use the same set of information.

Conclusions

The current design and implementation of HIT systems do not support adequate information management: clinicians needed to play very close attention and improvise to avoid errors in using HIT and treat cancer patients safely. It is important to take the clinical front-end practice into account when evaluating or planning further HIT improvements.
Missed Nursing Care in a Sample of High-Dependency Italian Nursing Home Residents: Description of Nursing Care in Action
Authors: Campagna Sara , Basso Ines , Vercelli Elisa , Ranfone Marco , Dal Molin Alberto , Dimonte Valerio , Di Giulio Paola
Published: March 2020

Objective

The aim of the study was to describe omitted or delayed nursing care (i.e., missed nursing care [MNC]) in a sample of Italian nursing homes (NHs).

Methods

Nurses from 50 NHs located in Northern Italy selected the 20 most dependent residents in their care and reported instances of MNC for three to five consecutive shifts. They described the type of MNC, its cause(s), management, recurrence, and severity of possible consequences for the resident. Information on the residents and the NH was also collected. The instances of MNC were classified as potentially avoidable/preventable or not.

Results

Overall, 266 (85.3%) of 312 nurses participated and 1000 residents were observed during 381 shifts (164 mornings, 164 afternoons, and 53 nights); 101 (38%) nurses reported 223 instances of MNC among 175 residents (17.5%). Ninety-seven omissions and 109 delays occurred during the day shift (56 omissions were delegated to the next shift). The most frequent MNC was drug administration (n = 71, 34.5%). In 24 (44.4%) of 54 instances of delayed drug administration, the delay was less than 30 minutes. Nurses rated approximately 20% of MNC (n = 41) as highly severe because of the discomfort caused to the resident, the clinical impact, or the repetitiveness of the situation. Nurses ascribed almost half of MNC (n = 100, 48.5%) to inadequate staffing, and they categorized 26 (11.6%) instances of MNC as unavoidable.

Conclusions

The number of nurse-reported instances of MNC we reported was much lower than that previously collected with available instruments. Most MNC did not impact the comfort and safety of residents. A certain proportion of MNC was unavoidable.
Ten-Year Trend in Polypharmacy in the Lausanne Population
Authors: Abolhassani Nazanin , Vollenweider Peter , Waeber Gérard , Marques-Vidal Pedro
Published: March 2020

Background

Aging and associated morbidities place individuals at higher risk of polypharmacy and drug-drug interactions (DDIs). How polypharmacy and DDIs change with aging is important for public health management.

Objectives

The aim of the study was to assess the 10-year trends in prevalence of polypharmacy and potential DDIs in a population-based sample.

Methods

Baseline (2003–2006) and follow-up (2014–2016) data were obtained from a sample of 4512 participants (baseline age range = 35–75 y, 55.1% women) from the population of Lausanne, Switzerland. Polypharmacy and polyactive drug use were defined by the regular use of five or more medications and five or more pharmacologically active substances, respectively. Drug-drug interactions were defined according to the criteria of the Geneva University Hospital.

Results

The percentage of participants taking at least one drug increased from 56.1% to 79.5% (P < 0.001). Among participants taking drugs, number of medications increased from 2.6 ± 1.9 (mean ± standard deviation) to 3.8 ± 2.9 after 10.9-year follow-up (P < 0.001); the corresponding values for active substances were 2.7 ± 2.0 and 4.0 ± 3.0 (P < 0.001). The prevalence of polypharmacy and polyactive substance use increased from 7.7% to 25.0% and from 8.8% to 27.1%, respectively (P < 0.001). The presence of at least one potential DDI increased from less than 1% to almost one sixth of all participants.

Conclusions

In a community-dwelling sample, the prevalence of polypharmacy and polyactive substance use tripled during a 10.9-year follow-up, with an even greater increase in the prevalence of potential DDIs. Increasing rates of polypharmacy and DDIS warns the importance of preventing potential DDIs throughout healthcare system through various interventions.
Does Mastoid Pneumatization Affect Facial Canal Dimensions and Distances of Facial Tympanic Segment–Scutum and Lateral Semicircular Canal–Scutum?
Authors: Inal Mikail , Bayar Muluk Nuray , Asal Neşe , Şahan Mehmet Hamdi , Şimşek Gökçe , Arıkan Osman Kürşat
Published: March 2020

Objectives

In the present study, we investigated whether mastoid pneumatization affects facial canal dimensions and distances of facial tympanic segment and scutum, and lateral semicircular (LSS) canal and scutum.

Methods

One hundred sixty-one temporal multidetector computed tomography scans were reviewed. Patients with unilateral sclerotic mastoid pneumatization (no aeration) (group 1, n = 81) and unilateral total mastoid pneumatization (100.0% aeration) (group 2, n = 80) were included. Facial canal dimensions at the labrythine, tympanic, and mastoid segments; facial canal dehiscence and length; and facial tympanic segment–scutum and LSS canal–scutum distances were evaluated.

Results

In the present study, facial canal dimensions of labyrinthine, tympanic, and mastoid segments in total pneumatized mastoid group were significantly lower than sclerotic mastoids on axial and coronal images (P< 0.05). Facial tympanic segment and scutum distance of the sclerotic mastoid group was significantly lower than those of the total pneumatized mastoid group (P< 0.05). However, LSS canal–scutum distance was not different between both groups (P> 0.05). The LSS canal–scutum distance of the females was lower than those of the males (P< 0.05). Facial canal dehiscence ratio was 11.3% and 11.1% in sclerotic and total pneumatized mastoids, respectively. The mean ± SD length of the dehiscence was 2.46 ± 1.29 mm in pneumatized mastoids and 1.92 ± 0.68 mm in sclerotic mastoids.

Conclusions

In cholesteatoma cases, scutum erosion may occur. Because facial tympanic segment and scutum distance decreased in sclerotic mastoids compared with completely pneumatized ones, maximum care must be taken in the operations for avoiding to damage facial canal and nerve. Revision cases may be more difficult because of distorted anatomy. However, in pneumatized mastoids, the mean length of the facial canal was more than 2 mm, which must be kept in mind during operations.
Noninvasive Quantitative Plaque Analysis Identifies Hemodynamically Significant Coronary Arteries Disease
Authors: Yin Peiyan , Dou Guanhua , Yang Xia , Wang Xi , Shan Dongkai , He Bai , Jing Jing , Jin Qinhua , Chen Yundai , Yang Junjie
Published: March 2020

Objective:

To evaluate the diagnostic performance of automated quantitative analysis by coronary computed tomography angiography (CCTA) in identifying lesion-specific hemodynamic abnormality.

Methods:

A total of 132 patients (mean age, 61 y; 86 men) with 169 vessels (with 30% to 90% diameter stenosis), who successively underwent invasive coronary angiography with evaluation of fractional flow reserve (values ≤0.8 were defined as lesion-specific hemodynamic abnormalities), were analyzed by CCTA. CCTA images were quantitatively analyzed using automated software to obtain the following index: maximum diameter stenosis (MDS%); maximum area stenosis (MAS%); lesion length (LL); volume and burden (plaque volume×100 per vessel volume) of total plaque (total plaque volume [TPV], total plaque burden [TPB]), calcified plaque (calcified plaque volume [CPV], calcified plaque volume burden [CPB]), noncalcified plaque (noncalcified plaque volume [NCPV], noncalcified plaque volume burden [NCPB]), lipid plaque (lipid plaque volume [LPV], lipid plaque burden [LPB]), and fibrous plaque (fibrotic plaque volume [FPV], fibrotic plaque burden [FPB]); napkin-ring sign (NRS); remodeling index (RI); and eccentric index (EI). Logistic regression and area under the receiver operating characteristics (AUC) were used for statistical analysis.

Results:

Fractional flow reserve ≤0.80 was found in 57 (33.73%) of the 169 vessels. Vessels with hemodynamic significance had greater MDS% (64.43%±8.69% vs. 57.33%±9.95%, P<0.001), MAS% (73.18%±8.56% vs. 64.66%±8.95%, P<0.001), and lipid plaque burden (12.75% [9.73%, 19.56%] vs. 9.41% [4.10%, 15.70%], P=0.01) compared with vessels with normal hemodynamics. In multivariable logistic regression analysis, MAS% >68% (odds ratio: 7.20, 95% confidence interval [CI]=2.89-17.91, P<0.001) and LPB >10.03% (odds ratio=4.32, 95% CI=1.36-13.66, P=0.01) were significant predictors of hemodynamic abnormalities. In predicting lesion-specific hemodynamic abnormalities, the AUC was 0.77 (95% CI=0.70-0.85) for MAS% versus 0.71 (95% CI=0.63-0.79) for MDS% (P<0.05), 0.66 (95% CI=0.58-0.74) for LPV (P<0.05), 0.66 (95% CI=0.58-0.74) for LPB (P<0.05), and 0.63 (95% CI=0.54-0.71) for TPB (P<0.05). The AUC of MAS%+LPB (0.83, 95% CI=0.76-0.89) was significantly improved compared with that of MAS% (0.77, 95% CI=0.70-0.85, P<0.05).

Conclusions:

Compared with MDS% and the volume burdens of plaque compositions, MAS% has a higher diagnostic accuracy for coronary hemodynamic abnormalities in the precise quantitative analysis of coronary plaques on the basis of CT. Furthermore, MAS%+LPB might improve the diagnostic accuracy beyond MAS% alone.
Is Peroral Endoscopic Myotomy a Potential Therapy for Esophageal Absent Contractility?
Authors: Zhao Qiaosu , Chen Pangyu , Wang Xiaojian , Ye Hua , Zhang Xuesong , Song Yufei , Zhang Xie
Published: March 2020

Aim:

Peroral endoscopic myotomy (POEM) is recommended for the endoscopic treatment of achalasia and esophageal junction outflow obstruction (EGJOO); however, absent contractility, a subtype of peristalsis disorders classified by the Chicago Classification of esophageal motility v3.0, has no effective treatment. The purpose of this study was to assess the efficacy of POEM in absent contractility, in the part of the patients presents with dysphagia.

Methods:

We conducted a single-center retrospective study at a tertiary referral center. We included 30 patients who mainly complain with dysphagia, and they underwent POEM from January 2013 to December 2018. The data of high-resolution esophageal manometry was collected before and after POEM. They were divided into 3 groups: EGJOO, Achalasia, and Absent contractility according to the Chicago Classification of esophageal motility v3.0 before POEM. Telephone follow-up was made in February 2019 to obtain Eckardt scores and weight changes.

Results:

We found that both Eckardt scores and integrated relaxation pressure decreased post-POEM in the 3 groups (P<0.05). Eckardt score was significantly lower in the EGJOO group than in the Absent contractility group (P=0.004) post-POEM. The difference of Eckardt Score was higher in the EGJOO group (P=0.010) and the Achalasia group (P=0.007) than in the Absent contractility group, as was weight gain (P=0.023; P=0.002).

Conclusions:

These findings suggest that POEM is an effective endoscopic procedure for patients with EGJOO and achalasia. Furthermore, POEM can significantly improve symptoms in patients with absent contractility, although less so than for the other 2 groups. POEM is a potential therapy for absent contractility patients presenting with dysphagia.
Hypothermic Ex Situ Perfusion of Human Limbs With Acellular Solution for 24 Hours
Authors: Haug Valentin , Kollar Branislav , Tasigiorgos Sotirios , Endo Yori , Kauke Martin , Safi Ali-Farid , Veeramani Anamika , Abdulrazzak Obada , Bausk Bruce , Walt David , Pomahac Bohdan
Published: March 2020

Background.

Machine perfusion (MP) has evolved as a promising approach for the ex situ preservation in organ transplantation. However, the literature on the use of MP in human vascularized composite allografts is scarce. The aim of this study was to evaluate the effects of hypothermic MP with an acellular perfusate in human upper extremities and compare with the current gold standard of static cold storage (SCS).

Methods.

Six upper extremities were assigned to either MP (n = 3) or SCS (n = 3) conditions for 24 h. MP-extremities were perfused with oxygenated Steen solution at a constant pressure of 30 mm Hg and 10°C.

Results.

Median total ischemia time was 213 min (range, 127–222 min). Myoglobin, creatine-kinase (CK) showed increased levels at the start of MP (medians: myoglobin: 4377 ng/mL, CK: 1442 U/L), peaking 6 h after perfusate exchange (medians: myoglobin: 9206 ng/mL, CK: 3995 U/L) at timepoint 24. Lactate levels decreased from a median of 6.9–2.8 mmol/L over time. Expression of hypoxia-inducible factor 1-alpha peaked in the SCS-group after 8 h, followed by a decrease. Increased hypoxia-inducible factor 1-alpha expression in the MP group was delayed until 20 h. Perfusion pressure, temperature, and circuit flow were maintained at median of 30.88 mm Hg, 9.77°C, and 31.13 mL/min, respectively. Weight increased 1.4% in the SCS group and 4.3% in the MP group over 24 h.

Conclusions.

Hypothermic ex situ perfusion with an oxygenated acellular Steen solution may extend the allowable extracorporeal preservation time by a factor of 4–6 compared to SCS and holds promise to be beneficial for vascularized composite allograft recipients and victims of traumatic major limb amputation.
Deep learning-enabled phenotyping reveals distinct patterns of neurodegeneration induced by aging and cold-shock
Authors: Saberi-Bosari Sahand , Flores Kevin B. , San-Miguel Adriana
Published: March 2020

Access to quantitative information is crucial to obtain a deeper understanding of biological systems. In addition to being low-throughput, traditional image-based analysis is mostly limited to error-prone qualitative or semi-quantitative assessment of phenotypes, particularly for complex subcellular morphologies. In this work, we apply deep learning to perform quantitative image-based analysis of complex neurodegeneration patterns exhibited by the PVD neuron inC. elegans. We apply a Convolutional Neural Network algorithm (Mask R-CNN) to identify neurodegenerative sub-cellular protrusions that appear after cold-shock or as a result of aging. A multiparametric phenotypic profile captures the unique morphological changes induced by each perturbation. We identify that acute cold-shock-induced neurodegeneration is reversible and depends on rearing temperature, and importantly, that aging and cold-shock induce distinct neuronal beading patterns.
Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1
Authors: van Doremalen Neeltje , Bushmaker Trenton , Morris Dylan H. , Holbrook Myndi G. , Gamble Amandine , Williamson Brandi N. , Tamin Azaibi , Harcourt Jennifer L. , Thornburg Natalie J. , Gerber Susan I. , Lloyd-Smith James O. , de Wit Emmie , Munster Vincent J.
Published: March 2020

To the Editor

A novel human coronavirus, now named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, referred to as HCoV-19 here) that emerged in Wuhan, China in late 2019 is now causing a pandemic1. Here, we analyze the aerosol and surface stability of HCoV-19 and compare it with SARS-CoV-1, the most closely related human coronavirus.2 We evaluated the stability of HCoV-19 and SARS-CoV-1 in aerosols and on different surfaces and estimated their decay rates using a Bayesian regression model (see Supplementary Appendix). All experimental measurements are reported as mean across 3 replicates.