bluuebunny/crossref_metadata_2025 huggingface dataset:
Doppler Echocardiographic Indices Are Specific But Not Sensitive to Predict Pulmonary Artery Occlusion Pressure in Critically Ill Patients Under Mechanical Ventilation
Authors: Mercado Pablo , Maizel Julien , Marc Julien , Beyls Christophe , Zerbib Yoann , Zogheib Elie , Titeca-Beauport Dimitri , Joris Magalie , Kontar Loay , Riviere Antoine , Bonef Olivier , Soupison Thierry , Tribouilloy Christophe , de Cagny Bertrand , Slama Michel
Published: December 2020

OBJECTIVES:

The objective of this study was to prospectively evaluate the ability of transthoracic echocardiography to assess pulmonary artery occlusion pressure in mechanically ventilated critically ill patients.

DESIGN:

In a prospective observational study.

SETTING:

Amiens University Hospital Medical ICU.

PATIENTS:

Fifty-three mechanically ventilated patients in sinus rhythm admitted to our ICU.

INTERVENTION:

Transthoracic echocardiography was performed simultaneously to pulmonary artery catheter.

MEASUREMENTS AND MAIN RESULTS:

Transmitral early velocity wave recorded using pulsed wave Doppler (E), late transmitral velocity wave recorded using pulsed wave Doppler (A), and deceleration time of E wave were recorded using pulsed Doppler as well as early mitral annulus velocity wave recorded using tissue Doppler imaging (E′). Pulmonary artery occlusion pressure was measured simultaneously using pulmonary artery catheter. There was a significant correlation between pulmonary artery occlusion pressure and lateral ratio between E wave and E′ (E/E′ ratio) (r = 0.35; p < 0.01), ratio between E wave and A wave (E/A ratio) (r = 0.41; p < 0.002), and deceleration time of E wave (r = –0.34; p < 0.02). E/E′ greater than 15 was predictive of pulmonary artery occlusion pressure greater than or equal to 18 mm Hg with a sensitivity of 25% and a specificity of 95%, whereas E/E′ less than 7 was predictive of pulmonary artery occlusion pressure less than 18 mm Hg with a sensitivity of 32% and a specificity of 81%. E/A greater than 1.8 yielded a sensitivity of 44% and a specificity of 95% to predict pulmonary artery occlusion pressure greater than or equal to 18 mm Hg, whereas E/A less than 0.7 was predictive of pulmonary artery occlusion pressure less than 18 mm Hg with a sensitivity of 19% and a specificity of 94%. A similar predictive capacity was observed when the analysis was confined to patients with EF less than 50%. A large proportion of E/E′ measurements 32 (60%) were situated between the two cut-off values obtained by the receiver operating characteristic curves: E/E′ greater than 15 and E/E′ less than 7.

CONCLUSIONS:

In mechanically ventilated critically ill patients, Doppler transthoracic echocardiography indices are highly specific but not sensitive to estimate pulmonary artery occlusion pressure.
Use of Personal Health Records to Support Diabetes Self-management
Authors: Fisher-Grace Khaliah , Turk Melanie T. , Anthony Mary K. , Chia Lichun (Rebecca)
Published: December 2020

More than 30 million persons in the United States have diagnosed or undiagnosed diabetes. Persons with chronic types of diabetes must learn self-management principles and techniques and perform self-care behaviors to reduce the risk of diabetes-related complications. An electronic personal health record is one type of technology commonly used to support diabetes self-management. This integrative review examines research on how personal health records incorporate or address the American Association of Diabetes Educators self-care behaviors, diabetes-related psychosocial concerns, and the diabetes-related clinical quality-of-care measures of hemoglobin A1c, low-density lipoprotein cholesterol, and blood pressure. In the majority of studies reviewed, participants showed improvement in the self-care behavior or physiological outcome examined. Findings were inconclusive about the impact of personal health record use on diabetes distress. Results also revealed a lack evidence of patient specific factors influencing intention to use a personal health record for management of type 2 diabetes mellitus. Despite evidence that personal health record use improves diabetes self-management, they are underutilized. Implications for practice include understanding what influences intention to use a personal health record. Further research is also needed to determine the impact of personal health record use on diabetes distress.
Incremental value of carotid elasticity modulus using shear wave elastography for identifying coronary artery disease in patients without carotid plaque
Authors: Wang Yonghuai , Zhao Cuiting , Meng Pingping , Yu Yao , Li Guangyuan , Kong Fanxin , Mu Lixin , Yang Jun , Ma Chunyan
Published: December 2020

Background:

Shear wave elastography (SWE) directly quantifies the local arterial wall stiffness by calculating the elastic modulus. However, whether carotid wall elastic modulus can predict obstructive coronary artery disease (CAD) is not well known. We aimed to investigate the value of carotid wall elastic modulus measured using SWE in identifying obstructive CAD.

Materials and methods:

We prospectively enrolled 61 patients without carotid plaque referred for clinically indicated coronary angiography. Twenty-seven (44.3%) patients were diagnosed with obstructive CAD (≥50% coronary stenosis). The elastic modulus of common carotid artery was quantified using SWE. Ankle--brachial index (ABI) and echocardiographic global cardiac calcium score (GCCS) were measured.

Results:

Patients with obstructive CAD had significantly higher elastic modulus than those without obstructive CAD. The maximum elastic modulus (EMmax) was independently associated with obstructive CAD after adjusting for the Framingham risk score, ABI, and GCCS. EMmax had the highest area under the curve (AUC) to identify obstructive CAD (AUC 0.70; P = 0.003). In the nested models, the model based on the Framingham risk score and ABI (χ
2 = 3.74) improved by adding GCCS (χ
2 = 9.95) and further improved by adding EMmax (χ2 = 15.86). Adding EMmax to the combined ABI and GCCS model increased integrated discrimination index from 0.10 to 0.19.

Conclusion:

Carotid wall elastic modulus measured using SWE is a useful predictor of obstructive CAD in patients without carotid plaque. We demonstrated the incremental and independent value of carotid wall elastic modulus in identifying obstructive CAD compared with clinical risk factors and other imaging predictors, including ABI and GCCS.

Video abstract:

Please see the video, in Supplemental Digital Content 1, http://links.lww.com/HJH/B551 for more insights from the authors.
Reconstruction of Enriched Uranium Released to Air from the Former Apollo Facility, Apollo, Pennsylvania
Authors: Caffrey Emily A. , Voillequé Paul G. , Rood Arthur S. , Grogan Helen A. , Mohler H. Justin , Meyer Kathleen R. , Till John E.
Published: December 2020

The former Apollo facility converted enriched uranium hexafluoride into uranium oxide for shipment to nuclear fuel fabrication plants from 1957 to 1983. This paper describes quantification of the source term from the Apollo facility in terms of quantities of uranium released, particle size, and solubility characteristics. Releases occurred through stacks, rooftop vents, and an incinerator that operated from 1964 to 1969. Incidental and accidental releases are addressed as part of this analysis. Atmospheric releases of uranium from plant operations were estimated from stack sampling and production records. Roof vents, both filtered and unfiltered, were the major emission points from the plant. The total estimated release of uranium activity (including 234U, 235U, and 238U) to the air was 28 GBq. Measurements by others found that the releases were primarily associated with large particles and that their solubility was variable but generally low (Class Y). The release estimates presented here and those findings were incorporated into a sophisticated atmospheric transport model to estimate atmospheric concentrations and soil contamination levels due to the releases and to reconstruct historical doses to individuals that lived in the vicinity of the former Apollo facility.
TRENDS IN INTRAVITREAL CORTICOSTEROID AGENT USE BY US OPHTHALMOLOGISTS IN MEDICARE BENEFICIARIES AND ASSOCIATION WITH PHYSICIAN–INDUSTRY INTERACTIONS
Authors: Watane Arjun , Kalavar Meghana , Yannuzzi Nicolas A. , Kuriyan Ajay E. , Sridhar Jayanth
Published: December 2020

Purpose:

To report trends of intravitreal corticosteroid use and explore the relationship between career experience, reported industry payments, and prescribing habits.

Methods:

A retrospective review of ophthalmologists who administered intravitreal dexamethasone implants (DEX) and triamcinolone acetonide (TA) injections between August 2013 and December 2017.

Results:

A total of 1,070 US ophthalmologists were reimbursed by Medicare for 522,804 DEX injections and 2.6 million TA injections. There was a significant positive trend in the number of DEX (P = 0.01), but not TA, injections per year. Mid-career and late-career physicians performed significantly greater total injections on average compared with early-career physicians (both P < 0.001). Early-career physicians performed a greater proportion of DEX injections than late-career physicians (P = 0.006). Industry payments were positively associated with the proportion of DEX used and inversely correlated with the proportion of TA administered (P < 0.001). On multivariate analysis, years in practice, number of payments, and total value of payments were significantly associated with the number of DEX injections administered (all P < 0.001).

Conclusion:

From 2013 to 2017, the use of DEX increased, whereas TA use remained stable. There was a positive association between DEX use and physician–industry interactions, which may be explained by seniority and experience. This study does not define a causal relationship.
Lacrimal Drainage Systems Injured During Repair of Orbital Fractures
Authors: Vahdani Kaveh , Rose Geoffrey E.
Published: December 2020

Implant placement for inferomedial orbital fractures through a lower fornix approach requires wide access, with the incision extended in the retrocaruncular line; the lacrimal drainage system is at risk of injury with both the incision and implant. The authors describe the radiologic and surgical findings for 5 patients in whom maxillofacial repair of periorbital fractures was associated with immediate postoperative epiphora; 1 patient also had a fistula between the implant and lower fornix. All patients had marked and early improvement of lacrimal drainage symptoms where uncomplicated open dacryocystorhinostomy or canaliculidacryocystorhinostomy was combined with removal of the offending orbital implants and neighboring screws. All implants were incorrectly positioned (projecting into the ethmoid sinus or inferior orbital fissure) and/or comprised materials of unnecessary size and rigidity for the underlying fracture. Fractures involving the orbital walls (but not rims) can usually be addressed with thin and pliable implants and without screw fixation.
Real-time imaging of airflow patterns and impact of infection control measures in ophthalmic practice: a pandemic perspective
Authors: Srivastava Samaresh , Vasavada Vaishali , Vasavada Abhay R. , Sudhalkar Aditya , Kothari Abhishek , Vasavada Shail A.
Published: December 2020

Purpose:

To analyze exhaled airflow patterns in a clinical scenario and the impact of infection control practices and room air circulation in context of the COVID-19 pandemic.

Setting:

Raghudeep Eye Hospital, India.

Design:

Experimental study.

Methods:

Ten patients attending ophthalmic outpatient clinic (OPD) and operating room (OR) were included. Using Schlieren imaging, exhaled airflow patterns were documented with/without an N95 mask or face shield during respiratory activities. Recordings were performed with and without room air conditioning turned on. Exhaled airflow patterns in OPD and OR when using vs not using these infection control measures and the impact of room air circulation on these were compared.

Results:

Five patients each in OPD and OR were included. There was a forward stream of exhaled air from the patient's mouth/nose during all respiratory activities. An N95 mask dampened its intensity and forward transmission. Taping the mask around the nasal bridge further reduced airflow leakage. A mechanical barrier in front of the patient's face blocked forward propagation of the exhaled airflow. Turning on a forceful and direct draft of air over the surgeon's working area dampened and diverted the exhaled airflow away from the surgeons' breathing area. This effect was particularly pronounced in the OR, with the overhead laminar airflow.

Conclusions:

Using high force airflow with the draft facing downward can dampen and divert the exhaled airflow away from healthcare providers. Using masks/mechanical barriers and taping the mask reduces potential dissemination of aerosols and, thereby, human and surface contamination.
Wavefront-guided myopic laser in situ keratomileusis with a high-resolution Hartmann-Shack aberrometer and a new nomogram
Authors: Maloney Robert K. , Kraff Colman R. , Coleman Stephen C.
Published: December 2020

Purpose:

To evaluate visual, refractive, aberrometric, and patient-reported outcomes of wavefront-guided (WFG) myopic laser in situ keratomileusis (LASIK) using a high-resolution Hartmann-Shack aberrometer (iDesign Advanced WaveScan system) with a new nomogram and to determine whether the new nomogram resolved the mild undercorrection that occurs with the manufacturer's default settings.

Setting:

Three private LASIK practices.

Design:

Prospective, open-label, noncomparative, multicenter study.

Methods:

One hundred ninety eyes of 95 patients underwent bilateral WFG LASIK for the correction of myopia or myopic astigmatism. A new nomogram was used, which effectively adjusted the wavefront-measured refraction sphere up or down to equal the manifest refraction sphere. Patients were followed up for 6 months.

Results:

Eighty-four patients completed the final follow up. At 6 months, 162 (96.4%) of 168 eyes achieved monocular uncorrected distance visual acuity of 20/20 or better. No eye lost 2 or more lines of corrected distance visual acuity. The safety and efficacy indices were 1.12 and 1.09, respectively; 164 (98%) of 168 eyes had manifest refraction spherical equivalent within ±0.50 diopters (D) of emmetropia, and 154 (92%) of 168 eyes had residual manifest refractive astigmatism of 0.50 D or less. Fewer patients experienced burning, stinging, soreness, and irritation postoperatively than preoperatively. Eighty-one (96%) of 84 patients reported improved quality of life.

Conclusions:

WFG myopic LASIK using a high-resolution Hartmann-Shack aberrometer and a new nomogram resolved the undercorrection with the manufacturer’s default settings. The treatment was safe and effective with excellent visual and refractive outcomes, high patient satisfaction, and improved quality of life.
Ocular biometry with swept-source optical coherence tomography
Authors: Montés-Micó Robert , Pastor-Pascual Francisco , Ruiz-Mesa Ramón , Tañá-Rivero Pedro
Published: December 2020

This study aimed to summarize the outcomes reported when swept-source optical coherence tomography (SS-OCT) is used for ocular biometry. A literature search was performed to identify publications reporting clinical outcomes of patients measured with commercial SS-OCT. Twenty-nine studies were included in this review. A comprehensive analysis of the available data was performed, focusing on parameters used for intraocular lens (IOL) power calculation in cataract surgery, including keratometry, central corneal thickness, white-to-white distance, anterior chamber depth, lens thickness, axial length, IOL power, and pupil diameter. Different metrics for repeatability, reproducibility, and agreement between devices were analyzed. In general, SS-OCT biometers provide excellent repeatability and reproducibility outcomes; however, the differences obtained for some parameters measured in agreement studies should be carefully analyzed to validate the interchangeability between devices. The good outcomes reported lead us to conclude that optical biometers based on SS-OCT technology are likely to become the gold standard for ocular biometry.
COVID-19 Infections Among Healthcare Personnel in the United States Veterans Health Administration, March to August, 2020
Authors: Oda Gina , Sharma Aditya , Lucero-Obusan Cynthia , Schirmer Patricia , Sohoni Pooja , Holodniy Mark
Published: December 2020

Objective:

We investigated COVID-19 infection and death among healthcare personnel (HCP) in the United States Veterans Health Administration.

Methods:

HCP with positive Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) reverse transcription polymerase chain reaction tests between March 1 and August 31, 2020 were included. Risk ratios were calculated for sex, age, race/ethnicity, Veteran status, occupation category, facility of employment by inpatient COVID-19 test percent positivity and death.

Results:

Five thousand nine hundred twenty five HCP were COVID-19-infected out of 131,606 tested (4.5% positivity). Highest risk for COVID-19 infection included: HCP working in hospitals with more than 15% inpatient COVID-19 test positivity, nursing staff, non-Hispanic Black, and Hispanic or Latino HCP and HCP who were Veterans. Among 18 HCP who died after COVID-19 infection, male sex, age more than or equal to 65 years, and Veteran status were significant risk factors.

Conclusions:

Robust national surveillance testing methods are needed to accurately monitor HCP COVID-19 infections and deaths to improve HCP safety.
Determining nurse practitioner core competencies using a Delphi approach
Authors: Chan Tracey Elizabeth , Lockhart Joan Such , Schreiber James B. , Kronk Rebecca
Published: December 2020

Background:

Competency-based education (CBE) has been recommended for nurse practitioner (NP) education. To implement CBE, existing NP core competencies need to be reduced in number and refined.

Purpose:

This study refined and reduced redundancy in the National Organization of Nurse Practitioner Faculties (NONPF) and the American Association of Colleges of Nursing (AACN) NP core competencies through the consensus of experts in NP practice. This study used the currentNP Core Competencies(NONPF, 2017), theEssentials of Doctoral Education for Advanced Nursing Practice(AACN, 2006), and theCommon Advanced Practice Registered Nurse Doctoral-Level Competencies(AACN, 2017a) because these documents are the competencies-accredited NP programs commonly used in curriculum development. The primary aim of this study was to refine and reduce redundancy of these competencies; a secondary aim was to ensure that the final competencies were clear and measurable.

Methods:

A Delphi approach was used to reach consensus among an expert panel who reviewed the core competencies via an online questionnaire. Descriptive statistics were used to calculate median and interquartile ranges; content analysis was conducted with qualitative data.

Results:

Consensus was reached after 3 rounds and resulted in 49 final core competencies.

Implications for practice:

This study provides the NP community with a manageable list of relevant, clear, and measurable competencies that faculty members can use to implement CBE in their programs.
Trends in Extracorporeal Membrane Oxygenation Application and Outcomes in Korea
Authors: Jang Eun Jin , Jung Sun-Young , Lee Hyun Joo , Kim Myo-Song , Na Kwon Joong , Park Samina , Park In Kyu , Kang Chang Hyun , Kim Young Tae
Published: December 2020

The use of extracorporeal membrane oxygenation (ECMO) is increasing despite the limited evidence in survival benefit. This study aimed to analyze the changes of in-hospital mortality, medical costs, and other outcomes in ECMO therapy. We used 2004–2017 data from a nationwide healthcare administrative claims database in Korea. Overall, 14,775 ECMO procedures were performed in 14,689 patients at 112 hospitals. We found a 170-fold and a 334-fold increase in the number of ECMO procedures and related costs, respectively. For indications, the performance of ECMO for heart or lung transplantation and respiratory failure increased, whereas that for cardiovascular surgery decreased. The duration of ECMO increased from a median of 3 days (IQR, 2–5 days) in 2004 to 4 days (IQR, 2–9 days) in 2017. The overall in-hospital mortality rate was 68.6%, and this improved over time, especially for lung transplantation and respiratory failure patients. Bleeding-related complications and the transfusion amount also decreased. Hospitals with higher case volume showed better survival outcomes. The median cost per procedure and per day was 26,538 USD (IQR, 14,646–47,862 USD) and 1,560 USD (IQR, 903–2,929 USD), respectively, and increased with time. A trend toward greater resource use and better outcomes requires additional cost-effective analysis based on indications.
Core outcomes sets for studies evaluating critical illness and patient recovery
Authors: Dinglas Victor D. , Cherukuri Sai P.S. , Needham Dale M.
Published: December 2020

Purpose of review

Given the growing body of critical care clinical research publications, core outcome sets (COSs) are important to help mitigate heterogeneity in outcomes assessed and measurement instruments used, and have potential to reduce research waste. This article provides an update on COS projects in critical care medicine, and related resources and tools for COS developers.

Recent findings

We identified 28 unique COS projects, of which 15 have published results as of May 2020. COS topics relevant to critical care medicine include mechanical ventilation, cardiology, stroke, rehabilitation, and long-term outcomes (LTOs) after critical illness. There are four COS projects for coronavirus disease 2019 (COVID-19), with a ‘meta-COS’ summarizing common outcomes across these projects. To help facilitate COS development, there are existing resources, standards, guidelines, and tools available from the Core Outcome Measures in Effectiveness Trials Initiative (www.comet-initiative.org/) and the National Institutes of Health-funded Improve LTO project (www.improvelto.com/).

Many COS projects have been completed in critical care, with more on-going COS projects, including foci from across the spectrum of acute critical care, COVID-19, critical care rehabilitation, and patient recovery and LTOs. Extensive resources are accessible to help facilitate rigorous COS development.
Role of anabolic testosterone agents and structured exercise to promote recovery in ICU survivors
Authors: Wischmeyer Paul E. , Suman Oscar E. , Kozar Rosemary , Wolf Steven E. , Molinger Jeroen , Pastva Amy M.
Published: December 2020

Purpose of review

ICU survivors frequently suffer significant, prolonged physical disability. ‘ICU Survivorship’, or addressing quality-of-life impairments post-ICU care, is a defining challenge, and existing standards of care fail to successfully address these disabilities. We suggest addressing persistent catabolism by treatment with testosterone analogues combined with structured exercise is a promising novel intervention to improve ‘ICU Survivorship’.

Recent findings

One explanation for lack of success in addressing post-ICU physical disability is most ICU patients exhibit severe testosterone deficiencies early in ICU that drives persistent catabolism despite rehabilitation efforts. Oxandrolone is an FDA-approved testosterone analogue for treating muscle weakness in ICU patients. A growing number of trials with this agent combined with structured exercise show clinical benefit, including improved physical function and safety in burns and other catabolic states. However, no trials of oxandrolone/testosterone and exercise in nonburn ICU populations have been conducted.

Critical illness leads to a catabolic state, including severe testosterone deficiency that persists throughout hospital stay, and results in persistent muscle weakness and physical dysfunction. The combination of an anabolic agent with adequate nutrition and structured exercise is likely essential to optimize muscle mass/strength and physical function in ICU survivors. Further research in ICU populations is needed.
Postcritical illness vulnerability
Authors: Prescott Hallie C. , Sussman Jeremy B. , Wiersinga W. Joost
Published: December 2020

Purpose of review

Critical illness survivorship is associated with new and worsening physical, cognitive, and emotional status. Survivors are vulnerable to further health set-backs, most commonly because of infection and exacerbation of chronic medical conditions. Awareness of survivors’ challenges are important given the anticipated rise in critical illness survivors because of SARS-CoV-2 viral sepsis.

Recent findings

Studies continue to document challenges of critical illness survivorship. Beyond the cognitive, physical, and mental health sequelae encompassed by postintensive case syndrome, patients commonly experience persistent immunosuppression, re-hospitalization, inability to resume prior employment, and reduced quality of life. Although recommended practices for enhancing recovery from sepsis are associated with better outcomes, only a minority of patients receive all recommended practices. ICU follow-up programs or peer support groups remain important interventions to learn about and address the multifaceted challenges of critical illness survivorship, but there is little evidence of benefit to date.

Survivors of sepsis and critical illness commonly experience impaired health status, reduced quality of life, and inability to return to prior employment. Although the challenges of critical illness survivorship are increasingly well documented, there are relatively few studies on enhancing recovery. Future studies must focus on identifying best practices for optimizing recovery and strategies to promote their implementation.
Noninvasive ventilation and high-flow nasal oxygen for acute respiratory failure: is less more?
Authors: Thille Arnaud W. , Coudroy Rémi , Frat Jean-Pierre
Published: December 2020

Purpose of review

High-flow nasal oxygen and noninvasive ventilation (NIV) are two strategies representing an alternative to standard oxygen in the management of respiratory failure.

Recent findings

Although high-flow nasal oxygen has shown promising results in patients with de-novo acute respiratory failure, further large clinical trials are needed to determine the best oxygenation strategy. As NIV may have deleterious effects, especially in patients generating strong inspiratory efforts, protective NIV using higher levels of positive-end expiratory pressure, more prolonged sessions and additional interfaces such as helmets should be assessed in the future. Whereas NIV is the first-line ventilation strategy in patients with acute exacerbation of chronic lung diseases, high-flow nasal oxygen could be an alternative to NIV after partial reversal of respiratory acidosis. To prevent severe hypoxemia during intubation of hypoxemic patients or to prevent postextubation respiratory failure in patients at high-risk of reintubation, NIV is the best strategy for preoxygenation or immediately after extubation in ICUs.

New large-scale clinical trials are needed to compare high-flow nasal oxygen with standard oxygen in patients with de-novo acute respiratory failure to determine the reference treatment. After which, more protective NIV could be assessed among the more severe patients.
Mechanical ventilation of the healthy lungs: lessons learned from recent trials
Authors: Simonis Fabienne D. , Juffermans Nicole P. , Schultz Marcus J.
Published: December 2020

Purpose of review

Although there is clear evidence for benefit of protective ventilation settings [including low tidal volume and higher positive end-expiratory pressure (PEEP)] in patients with acute respiratory distress syndrome (ARDS), it is less clear what the optimal mechanical ventilation settings are for patients with healthy lungs.

Recent findings

Use of low tidal volume during operative ventilation decreases postoperative pulmonary complications (PPC). In the critically ill patients with healthy lungs, use of low tidal volume is as effective as intermediate tidal volume. Use of higher PEEP during operative ventilation does not decrease PPCs, whereas hypotension occurred more often compared with use of lower PEEP. In the critically ill patients with healthy lungs, there are conflicting data regarding the use of a higher PEEP, which may depend on recruitability of lung parts. There are limited data suggesting that higher driving pressures because of higher PEEP contribute to PPCs. Lastly, use of hyperoxia does not consistently decrease postoperative infections, whereas it seems to increase PPCs compared with conservative oxygen strategies.

In patients with healthy lungs, data indicate that low tidal volume but not higher PEEP is beneficial. Thereby, ventilation strategies differ from those in ARDS patients.
The role of basal 18F-FDG PET/CT maximum standard uptake value and maximum standard uptake change in predicting pathological response in breast cancer patients receiving neoadjuvant chemotherapy
Authors: Akdeniz Nadiye , Kömek Halil , Küçüköner Mehmet , Kaplan Muhammet A. , Urakçi Zuhat , Oruç Zeynep , Işikdoğan Abdurrahman
Published: December 2020

Objective

The aim of this study was to determine the role of 18F-FDG PET/CT in predicting pathological response among patients diagnosed with local or locally advanced breast cancer and receiving neoadjuvant chemotherapy (NAC).

Methods

Basal SUVmax value were analyzed in 212 patients and 142 of these patients had posttreatment SUVmax value. Overall pathological complete response (pCRC) was defined as no evidence of residual invasive cancer in breast (pCRB) and axilla (pCRA). Basal SUVmax value of the breast (SUVmaxBI) and axilla (SUVmaxAI) and change in SUVmax of the breast (ΔSUVmaxB) and axilla (ΔSUVmaxA) were measured. The optimal cutoff value of SUVmax and ΔSUVmax were determined by receiver operating characteristic curve analysis.

Results

The number of patients with pCRB was 85 (40.1%), pCRA was 76 (42.5%) and pCRC was 70 (33%). In the artificial neural network-based analysis the ΔSUVmaxB (100%) was the most important variable for predicting pCRB. ΔSUVmaxA (100%) was the most important variable in estimation of pCRA. When pCRC was evaluated, the highest relation was found with ΔSUVmaxB. When the ΔSUVmaxB cutoff value for pCRB and pCRC accepted as ≤−87.9%, its sensitivity was 82.3 and 82.4%, and specificity was 72.5% and 65.9%, respectively (P < 0.001 and P < 0.001, respectively). When the ΔSUVmaxA cutoff value for pCRA and pCRC accepted as ≤−86.6%, its sensitivity was 94.3% and 97.6%, and specificity was 31.3% and 28.2%, respectively (P = 0.017 and P = 0.024, respectively).

Conclusion

Albeit varies according to the molecular subtypes of the breast cancer during NAC, ΔSUVmax value seems to be the most strong factor associated with pCR.
Diet and cancer of the esophagus and stomach
Authors: Tay Shu Wen , Li James Weiquan , Fock Kwong Ming
Published: December 2020

Purpose of review

Dietary factors have been linked to cancers. This review focuses on several nutrients, which have strong evidence showing increase in cancer risks in the esophagus and stomach.

Recent findings

Obesity is an important risk factor in upper gastrointestinal cancers. High sugar content in food and sugary drinks are the main drivers of obesity. Proinflammatory diet is another dietary factor, which is increasingly recognized as being associated with esophageal and gastric cancer.

Cancer has been predicted to be the leading cause of death in this century. Cancers of the esophagus and stomach are the six and third most common cause of death worldwide. Although Helicobacter pylori infection is a known cause of gastric cancer, obesity is a leading contributor to esophageal adenocarcinoma. Epidemiological data have shown that dietary factors are associated with the two cancers. Observational, case control, animal and recent large cohort studies have identified associations between dietary factors and upper gastrointestinal cancer. Data are also emerging from studies, which look at dietary patterns, such as reduction in the Dietary Inflammatory Index, as well as adherence to a modified Mediterranean diet, and its association with the incidence of esophageal and gastric cancer.
Autoimmune hepatitis: from immunopathogenesis to diagnostic and therapeutic innovation
Authors: Weiler-Normann Christina , Lohse Ansgar W.
Published: December 2020

Purpose of review

To understand the pathogenesis of autoimmune hepatitis (AIH) and the accuracy of diagnosis and treatment options that have improved lately. We summarize the latest research.

Recent findings

Concerning pathogenesis of AIH, different groups have identified pieces of the puzzle that fit together well: An altered microbiome in the gut results in a proinflammatory response in the liver. This response is built by type II natural killer cells and CD4 T cells with an inflammatory phenotype and marked tumor necrosis factor production. When looking specifically at autoantigenic CD4 T cells, these have a B-helper phenotype on transcriptomic analysis. This explains not only elevation of immunoglobulins in AIH, but also mechanistically the effect of anti-B-cell substances in treatment. Diagnosis is now facilitated by an improved diagnostic score for AIH also recognizing modern techniques for autoantibody detection. Treatment in the future will increasingly be focused on reducing dosage and duration of steroid exposition. In addition, B-cell-targeted treatments have been evaluated with considerable success.

Research in the past 18 months has improved the understanding of pathogenesis and thereby opened a number of possible treatment options. In addition, steroid use is cautioned by the recent findings.
Iron deficiency: a modern primer to diagnosis and management
Authors: Alexandre Leo , Chan Simon S.M.
Published: December 2020

Purpose of review

Iron deficiency with anemia (IDA) and without anemia remain a diagnostic and management challenge. Iron deficiency has a broad spectrum of causes, including gastrointestinal malignancy. The purpose of this review is to summarize the value and limitations of current methods to diagnose iron deficiency and underline the relevance of contemporaneous evidence to guide the pretest probability of gastrointestinal disease.

Recent findings

A number of biomarkers for iron deficiency exist, and all have their caveats. Serum ferritin remains the most pragmatic means of diagnosing iron deficiency. Hepcidin holds future promise as a marker of iron status during inflammatory states. Men and postmenopausal women with IDA have the highest overall prevalence of gastrointestinal malignancy (∼11%), while premenopausal women with IDA (<1.5%) and those with iron deficiency without anemia (<0.5%) have a very low risk. Noninvasive investigation with fecal immunochemical test and fecal calprotectin hold promise to guide further investigations in lower risk groups.

Confirmation of iron deficiency remains a challenge. Appropriate risk stratification is the key to guiding judicious gastrointestinal investigation. Use of noninvasive tests may play an important role in lower risk groups. Risk prediction tools applicable to relevant populations are required.
Can computational fluid dynamic models help us in the treatment of chronic rhinosinusitis
Authors: Singh Narinder Pal , Inthavong Kiao
Published: December 2020

Purpose of review

The aim of this study was to review the recent literature (January 2017–July 2020) on computational fluid dynamics (CFD) studies relating to chronic rhinosinusitis (CRS), including airflow within the pre and postoperative sinonasal cavity, virtual surgery, topical drug and saline delivery (sprays, nebulizers and rinses) and olfaction.

Recent findings

Novel CFD-specific parameters (heat flux and wall shear stress) are highly correlated with patient perception of nasal patency. Increased ostial size markedly improves sinus ventilation and drug delivery. New virtual surgery tools allow surgeons to optimize interventions. Sinus deposition of nasal sprays is more effective with smaller, low-inertia particles, outside of the range produced by many commercially available products. Saline irrigation effectiveness is improved using greater volume, with liquid entering sinuses via ‘flooding’ of ostia rather than direct jet entry.

CFD has provided new insights into sinonasal airflow, air-conditioning function, the nasal cycle, novel measures of nasal patency and the impact of polyps and sinus surgery on olfaction. The deposition efficiency of topical medications on sinus mucosa can be markedly improved through parametric CFD experiments by optimising nasal spray particle size and velocity, nozzle angle and insertion location, while saline irrigation effectiveness can be optimized by modelling squeeze bottle volume and head position. More sophisticated CFD models (inhalation and exhalation, spray particle and saline irrigation) will increasingly provide translational benefits in the clinical management of CRS.
The nonoperative treatment of osteochondritis dissecans of the knee
Authors: Wall Eric J. , Brtko Karen
Published: December 2020

Purpose of review

The purpose of this review is to update the reader on the controversial subject of osteochondritis dissecans (OCD) with a focus on nonoperative treatment indications, methods, and success rate.

Recent findings

Work by an international multicenter study group ROCK (Research in OsteoChondritis of the Knee) will be reviewed including new classifications systems of healing, arthroscopy, radiographs, and MRI, along with new evidence on off-loading bracing compared to restricted weight bearing.

The paucity of evidence behind OCD treatment of the knee can lead to confusion for doctors, patients, and parents. The present review will bring more clarity to the subject.
Do pediatric shoulder fractures benefit from surgery?
Authors: Thomson Jennifer E. , Edobor-Osula O. Folorunsho
Published: December 2020

Purpose of review

We aimed to review considerations, current treatment options, and complications in the management of pediatric proximal humerus fractures.

Recent findings

Recent literature has shown an increased incidence of operative management of proximal humerus fractures. With increased age, and increased deformity, studies report excellent outcomes after operative treatment. Still, patients under the age of 12 and with Neer grade I and II fractures are consistently treated nonoperatively.

Indications for operative management of proximal humerus fractures in skeletally immature patients have become increasingly widened. Current literature emphasizes the stratification of patients based on displacement, angulation, and shortening, with overall positive outcomes. Each case should be considered on individual bases, accounting for both radiographic parameters, developmental stages of patients, and potential complications. In the authors’ opinion, adolescent patients with Neer Horowitz 3 and 4 fractures surgical management should be considered. In younger patients with nonoperative management, even with significant displacement, is the mainstay of treatment because of the tremendous remodeling potential of the proximal humerus in children.

Video abstract

http://links.lww.com/MOP/A56
New concepts in chronic antibody-mediated kidney allograft rejection: prevention and treatment
Authors: Mayer Katharina A. , Doberer Konstantin , Eskandary Farsad , Halloran Philip F. , Böhmig Georg A.
Published: December 2020

Purpose of review

Chronic antibody-mediated rejection (AMR) is a cardinal cause of transplant failure, with currently no proven effective prevention or treatment. The present review will focus on new therapeutic concepts currently under clinical evaluation.

Recent findings

One interesting treatment approach may be interference with interleukin-6 (IL-6) signaling to modulate B-cell immunity and donor-specific antibody (DSA) production. Currently, a large phase III randomized controlled trial is underway to clarify the safety and efficacy of clazakizumab, a high-affinity anti-IL-6 antibody, in chronic AMR. A prevention/treatment strategy may be costimulation blockade using belatacept to interfere with germinal center responses and DSA formation. In a recent uncontrolled study, belatacept conversion was shown to stabilize renal function and dampen AMR activity. Moreover, preliminary clinical results suggest efficacy of CD38 antibodies to deplete plasma and natural killer cells to treat AMR, with anecdotal reports demonstrating at least transient resolution of active rejection.

There are promising concepts on the horizon for the prevention and treatment of chronic AMR. The design of adequately powered placebo-controlled trials to clarify the safety and efficacy of such new therapies, however, remains a big challenge, and will rely on the definition of precise surrogate endpoints predicting long-term allograft survival. Mapping the natural history of AMR would greatly help the understanding of who would derive benefits from treatment.
Probiotics for the Management of Infantile Colic
Authors: Simonson Jennifer , Haglund Kristin , Weber Emma , Fial Alissa , Hanson Lisa
Published: December 2020

Background:

Colic is defined as periods of inconsolable crying, fussing, or irritability that have no apparent cause and present in healthy infants under 5 months of age. Although colic is a benign and self-limiting condition, it can be distressing to parents and there are few robust treatment interventions. This systematic review explored the evidence for administration of probiotics to prevent or decrease symptoms of colic.

Methods:

Literature searches were conducted in PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Library, and Web of Science.

Sample:

Twenty articles were included: 15 randomized controlled trials and 5 meta-analyses.

Results:

Based on the evidence in this systematic review, the oral administration of probiotics to breastfed infants with colic resulted in at least a 50% reduction in crying time compared with placebo. Efficacy of probiotics to reduce colic symptoms in formula-fed infants needs further study. In this review, we did not find evidence to support or refute efficacy of probiotics to prevent infantile colic. Clinical Implication: Probiotics (especially the strain Lactobacillus reuteri DSM 17938) can safely be recommended if parents desire a treatment option for their infants with colic.
Psychogenic Nonepileptic Seizures in Patients With Epilepsy
Authors: Kishk Nirmeen , Raafat Omnia , Abdou Hoda , Nawito Amani , Shamloul Reham Mohamed , Belal Mai , El-Makawi Shirin
Published: December 2020

Psychogenic nonepileptic seizures (PNES) represent management challenges, especially if associated with epilepsy. We aimed to evaluate patients with mixed epilepsy (true and PNES) and compare them with pure epilepsy to identify predictors of psychogenic seizures. This study included 40 patients with pure epilepsy and 40 patients with mixed epilepsy matched in age and sex. Patients underwent neurological assessment, semistructured psychiatric clinical interview, and video electroencephalogram monitoring. We found that unemployment, divorce, and seizure frequency were higher in mixed epilepsy, as well as history of family dysfunction, child adversity, and depressive and dissociative disorders. Both groups were similar regarding family history for seizures and personality dysfunction scores. Family dysfunction, child adversity, and depressive disorders were predictors of PNES. We recommend early evaluation for social instability, family dysfunction, child adversity, and depressive disorders in epileptic patients with higher seizure frequency to avoid misdiagnosis of false drug-resistant epilepsy and enhance proper management.
Depression After Open Heart Surgery
Authors: Ai Amy L. , Smyth Susan S.
Published: December 2020

Postoperative depression is a multifaceted condition that can limit quality of life and potentially decrease the survival benefits of open heart surgery (OHS). We postulated that sex, pre-event character strengths, medical, and certain surgery indicators would predict post-event/myocardial infarction depression. To identify predictors, we collected three-wave survey data from 481 OHS patients at a large academic referral institution (age, 62+; female, 42%) and included key medical and surgical information. The final model (F[7, N = 293] = 28.15, p < 0.001, R
2 = 0.408) accounted for over two fifths of the variance in post-OHS depression. Pre-event/OHS optimism mitigated post-OHS depression. Being female, older, living alone, longer surgical perfusion time, absence of left main disease greater than 50%, and pre-OHS depression were associated with the increased likelihood of post-OHS depression. Our findings suggest that teaching optimism to OHS patients might be beneficial in reducing the risk of postoperative depression and that female patients should be monitored more closely for the development of depression through an interdisciplinary approach.
National Study on Faculty and Administrators' Perceptions of Civility and Incivility in Nursing Education
Authors: Clark Cynthia M. , Landis Tullamora T. , Barbosa-Leiker Celestina
Published: December 2020

Background

Incivility among nursing faculty and administrators lowers morale, damages relationships, and threatens workplace health and productivity.

Purpose

This national study examined nursing faculty and administrators' perceptions of civility and incivility in nursing education, ways to address the problem, and psychometric properties of the Workplace Incivility/Civility Survey (WICS).

Methods

A convergent mixed-methodological study was used to conduct the study. A factor analysis and other reliability analyses were conducted on the WICS.

Results

Respondents included 1074 faculty and administrators who identified types and frequency of incivility, severity and contributors to the problem, reasons for avoiding incivility, and strategies to improve civility. Eight themes of uncivil behaviors were garnered. The WICS was shown to be a psychometrically sound instrument to measure civility and incivility.

Conclusion

This study reported faculty and administrators' perceptions of civility and incivility in nursing education and provided evidence-based strategies to prevent and address the problem.
Assessment of Muscle Activation of Caregivers Performing Dependent Transfers With a Novel Robotic-Assisted Transfer Device Compared With the Hoyer Advance
Authors: Blaauw Eline R. , Greenhalgh Mark , Vegter Riemer , Bass Sarah , Kulich Hailee , Grindle Garrett G. , Cooper Rosemarie , Koontz Alicia M. , Cooper Rory A.
Published: December 2020

Objective

The purpose of this study was to compare muscle activity in caregivers while using a novel robotic-assisted transfer device (Strong Arm) to a clinical standard of care (Hoyer Advance).

Design

A quasi-experimental design was used in which 20 caregivers (33 ± 15 yrs old) performed transfers with three surfaces (toilet, bench, and shower chair) with the Strong Arm and Hoyer Advance. Transfer completion time (seconds), peak percentage surface electromyography (EMG), and integrated EMG of the bilateral erector spinae, latissimus dorsi, pectoralis major and anterior deltoid were measured.

Results

Caregivers required less transfer time when transferring from wheelchair to surface using the Hoyer Advance (P = 0.011, f = 0.39). For the lower back, significantly lower peak percentage EMGs were found using Strong Arm in 50% and for the integrated EMG in 25% of the cases, with the remaining cases showing no significant differences. For the shoulder, significantly lower peak percentage EMG values were found using Strong Arm in 19% of transfers and lower integrated EMG was found in 25% of transfers when using the Hoyer Advance, with the remaining cases showing no significant differences.

Conclusion

Although back muscle activation during Strong Arm transfers is statistically, but not clinically, lower, additional features that couple with significantly lower muscle activation make it an alternative to the clinical standard for further research and possible clinical applicability.