bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of water-based vitamin E solution versus placebo in the prevention of retinopathy of prematurity in very low birth weight infants
Authors: Romero-Maldonado Silvia , Montoya-Estrada Araceli , Reyes-Muñoz Enrique , Guzmán-Grenfell Alberto Martín , Torres-Ramos Yessica Dorin , Sánchez-Mendez Mario David , Tolentino-Dolores Maricruz , Salgado-Valladares Manuel Bernardo , Belmont-Gómez Aurora , Najéra Nayelli , Ceballos Guillermo , Cardona-Pérez Jorge Arturo , Hicks Juan José , Mancilla-Ramírez Javier
Published: August 2021

Background:

Vitamin E has antioxidant properties, which help in scavenging free radicals, thereby reducing oxidation of lipids and proteins. This study aims to evaluate the efficacy of oral vitamin E supplementation in preventing retinopathy of prematurity (ROP) in very low birth weight (VLBW) infants with respiratory distress syndrome (RDS) and decreasing oxidative stress 15 and 28 days post-intervention.

Methods:

Ninety VLBW infants were randomly assigned to two groups:

Each group received 25 IU of vitamin E (T) or placebo (C).

Results:

The incidence of ROP in groups T and C was 12.5% (n=6) and 31% (n = 13), respectively (RR: 0.40; 95% CI: 0.10–0.96). There were no differences in mortality between groups. As expected, the vitamin E concentration was significantly increased 28 days post-intervention in group T.

Conclusion:

Oral supplementation with vitamin E may effectively prevent ROP development in VLBW infants with RDS. Oxidative damage markers were significantly lower, whereas total antioxidant capacity was increased in group T. However, levels of other antioxidants as vitamin A and C were not measured in two groups.
Comparison of 2 effect-site concentrations of remifentanil with midazolam during percutaneous transluminal balloon angioplasty under monitored anesthesia care
Authors: Lai Hou-Chuan , Tsai Yi-Ting , Huang Yi-Hsuan , Wu Ke-Li , Huang Ren-Chih , Lin Bo-Feng , Chan Shun-Ming , Wu Zhi-Fu
Published: August 2021

Background:

Until now, target-controlled infusion of remifentanil with midazolam in percutaneous transluminal balloon angioplasty for dysfunctional hemodialysis fistulas has not been described. Here, we investigate 2 effect-site concentrations of remifentanil with intermittent bolus midazolam for percutaneous transluminal balloon angioplasty under monitored anesthesia care.

Methods:

A prospective, randomized controlled trial including patients who received a percutaneous transluminal balloon angioplasty between March 2019 and March 2021 was conducted. Group 1 and Group 2 were, respectively, administered an initial effect-site concentration of remifentanil of 1.0 and 2.0 ng/mL by a target-controlled infusion pump with Minto model. In both groups, maintenance of the effect-site concentration of remifentanil was adjusted upward and downward by 0.5 ng/mL with intermittent bolus midazolam to keep the Observer's Assessment of Alertness/Sedation scale between 2 and 4, mean arterial pressure and heart rate at baseline levels ± 30%, and patient comfort (remaining moveless). The primary outcome was to determine the appropriate effect-site concentration of remifentanil for the procedure in terms of patient comfort (remaining moveless), hemodynamic conditions, and adverse events. Secondary endpoints included the total dosage of anesthetics and total times of target-controlled infusion pump adjustments.

Results:

A total of 40 patients in Group 1 and 40 patients in Group 2 were eligible for analysis. Most parameters were insignificantly different between 2 groups, except Group 1 having higher peripheral oxygen saturation, while local anesthetic injection compared with Group 2. In addition, Group 1 patients had less apnea with desaturation (peripheral oxygen saturation < 90%; 0 vs 6, P = .034), less remifentanil consumption (189.65 ± 69.7 vs 243.8 ± 76.1 μg, P = .001), but more intraoperative movements affecting the procedure (14 vs 4; P = .016), total times of target-controlled infusion pump adjustment [2 (1-4) vs 1 (1–2), P < .001] compared with Group 2.

Conclusion:

In percutaneous transluminal balloon angioplasty for dysfunctional hemodialysis fistulas, target-controlled infusion with remifentanil Minto model target 2.0 ng/mL with 3 to 4 mg midazolam use provided appropriate hemodynamic conditions, sufficient sedation and analgesia, and acceptable apnea with desaturation.
Percutaneous pinning with interphalangeal joint locked in phalanx fractures
Authors: Liu Shibo , Sun Bo , Wang Pei , Fu Shijie
Published: August 2021

Background:

The purpose of the study was to compare the operation time, the fracture healed time, the postoperative function recovery between the techniques that temporary locking of the interphalangeal joint and traditional manual reduction in the treatment of percutaneous pinning of the phalanx fractures.

Methods:

Patients with phalanx fractures from January 2015 to January 2018 who were admitted to our hospital were retrospectively reviewed. Patients received surgery with traditional manual or temporary locking of the interphalangeal joint reduction. The information of patients, including age, gender, the length of the operation, the fracture healed time, the postoperative function recovery, complication, and length of postoperative hospital stay, was collected. All of the information were evaluated and compared between the 2 groups. All of the surgery were performed by 2 experienced hand surgeons of our department. The patients in the 2 groups were followed up for an average of 6 months after surgery.

Results:

All patients completed the operation and were followed up completely. There was no significant difference in baseline data between the 2 groups (P > .05). The observation group who received surgery with the interphalangeal joint locked technique had significantly shorter in operative time than the control group (P < .05). And postoperative complications in the observation group were significantly less than those in the control group (P < .05). However, the postoperative functional recovery in both groups was no significant difference between the 2 groups (P > .05). And there were no significant differences in the fracture healed time and length of postoperative hospital stay between the 2 groups (P > .05).

Conclusion:

Both surgical techniques can enable patients to achieve good function, but the technique of interphalangeal joint locked is effective in the treatment of the phalanx fractures, as it is characterized by short operations and a quick recovery. However, this technique is only suitable for extra-articular phalanx fractures that the AO/ASIF classification of type A2.3 and less than 2 weeks, not for other phalanx fractures.
Prognostic value of HHLA2 expression in solid tumors
Authors: Zhang Chuanmeng , Xu Jie , Ye Jun , Zhang Xiaohong
Published: August 2021

Background:

Human endogenous retrovirus-H long terminal repeat-associating protein 2 (HHLA2), a newly discovered member of the B7 family, is overexpressed in numerous tumors. However, the prognostic impact of HHLA2 in human cancers remains controversial. Thus, we performed this meta-analysis to explore the prognostic value of HHLA2 in Chinese patients with solid tumors.

Methods:

PubMed, Embase, Web of Science, Chinese National Knowledge Infrastructure, and WanFang databases were systematically searched for eligible studies that evaluated the impact of HHLA2 on overall survival (OS) in patients with cancer. Hazard ratios (HRs) and 95% confidence intervals (CIs) were combined to evaluate the association between HHLA2 expression and OS in solid tumors. Odds ratios (ORs) and 95% CIs were pooled to assess the correlation between HHLA2 expression and clinicopathological characteristics in solid tumors.

Results:

A total of 12 studies, including 15 cohorts and 1747 patients, were included in this meta-analysis. We found that high HHLA2 expression was significantly associated with shorter OS (HR = 1.65, 95% CI: 1.12–2.43). Subgroup analysis by cancer type demonstrated that high HHLA2 expression was associated with poor OS in patients with clear cell renal cell carcinoma (HR = 3.42, 95% CI: 2.39–4.91), gastric cancer (HR = 2.03, 95% CI: 1.31–3.16), intrahepatic cholangiocarcinoma (HR = 1.77, 95% CI: 1.24–2.53), lung cancer (HR = 2.14, 95% CI: 1.33–3.44) and other cancer types (HR = 2.08, 95% CI: 1.34–3.24), but not in patients with epithelial ovarian cancer (HR = 0.52, 95% CI: 0.08–3.56). Nevertheless, high HHLA2 expression was associated with better OS in patients with pancreatic ductal adenocarcinoma (HR = 0.45, 95% CI: 0.32–0.64). Furthermore, high HHLA2 expression was associated with old age (OR = 1.30, 95% CI: 1.03–1.63), lymph node metastasis (OR = 1.99, 95% CI: 1.41–2.81), and vascular invasion (OR = 1.69, 95% CI: 1.18–2.42).

Conclusions:

HHLA2 may serve as a potential prognostic biomarker for solid tumors in Chinese population, by predict the prognosis of cancer patients based on their tumor types.
Difference in the results of repair made with single or double rows according to the shape and size of the tear in arthroscopic rotator cuff surgery
Authors: Karakus Ozgun , Karaman Ozgur , Sari Ahmet Sinan , Saygi Baransel
Published: August 2021

The aim of this study was to evaluate the effect on the results of patients applied with arthroscopic full layer total layer rotator cuff repair made according to the shape and size of the tear.

The study included a total of 120 patients applied with arthroscopic full layer rotator cuff repair as single or double row repair. The patients were separated into 3 groups of 40 according to the shape of the tear, as Group A (crescent type), Group B (U type), and Group C (L type).

The mean age of the whole sample was 66.68 ± 6.86 years (range, 50–81 years). A statistically significant difference was determined between the groups in respect of constant murley (CM), American shoulder and elbow surgeons score (ASES), and University of California Los Angeles score (UCLA) scores (P < .05). The scores of Group A of all the scales were found to be higher than those of Group C (P < .05). In single row and double row repair of small and medium-sized tears of all shapes, no significant difference was determined in respect of the CM and UCLA scores (P > .05).

No significant difference was determined between single and double row repair of crescent type tears of all sizes. In large U-shaped tears, the CM, ASES, and UCLA scores were determined to be high in double row repair.
Postpartum extracorporeal membrane oxygenation of a woman with COVID-19-related acute respiratory distress syndrome
Authors: Huang Weizhao , Cheng Zhou , Liao Xiaozu , Wang Liqiang , Wen Junlin , Li Jianwei , Jiang Haiming , Yuan Yong , Li Binfei
Published: August 2021

Introduction:

Patients with coronavirus disease (COVID-19) may develop acute respiratory distress syndrome (ARDS). There have been few reports of postpartum woman with ARDS secondary to COVID-19 who required respiratory support using veno-venous extracorporeal membrane oxygenation (ECMO). We present the case of a 31-year-old woman who was admitted to hospital at 35 weeks gestation with ARDS secondary to COVID-19 and required ECMO during the postpartum period.

Patient concerns:

The patient had obvious dyspnea, accompanied by chills and fever. Her dyspnea worsened and her arterial oxygen saturation decreased rapidly.

Diagnosis:

ARDS secondary to COVID-19.

Interventions:

Emergency bedside cesarean section. Medications included immunotherapy (thymosin α 1), antivirals (lopinavir/ritonavir and ribavirin), antibiotics (imipenem-cilastatin sodium and vancomycin), and methylprednisolone. Ventilatory support was provided using invasive mechanical ventilation. This was replaced by venous-venous ECMO 5 days postpartum. ECMO management focused on blood volume control, coagulation function adjustment, and airway management.

Outcomes:

The patient was successfully weaned for ECMO and the ventilator and made a good recovery.

Conclusion:

Special care, including blood volume control, coagulation function adjustment, and airway management, should be provided to postpartum patients with ARDS secondary to COVID-19 who require ECMO support.
The current management of alveolar soft part sarcomas
Authors: Chang Xiaojing , Li Yuehong , Xue Xiaoying , Zhou Huandi , Hou Liubing
Published: August 2021

Objective:

Alveolar soft part sarcomas (ASPS) which has high potential ability of metastasis, is a rare and slowly growing malignant tumor, and mainly primary localized in limbs. To date, little is known about the best treatment of ASPS. This study aims to review the current management and advance of ASPS.

Methods:

WANFANG MED ONLINE, CNKI, and NCBI PUBMED were used to search literature spanning from 1963 to 2020, and all cases of ASPS about “ASPS, diagnosis, treatment, surgery, radiotherapy, chemotherapy, target therapy or immune therapy” with detailed data were included.

Results:

Complete surgical resection remained the standard management strategy, radiotherapy was reported to be used for the patients of micro- or macroscopical incomplete residue or the surgical margin was questionable. Chemotherapy was controversial. Some target drugs and immune checkpoint inhibitors had produced antitumor activity.

Conclusion:

Complete surgical resection is the cure treatment for ASPS, and adjuvant chemotherapy is not recommended excepted clinical trials. For the patients with micro- or macroscopical incomplete residue, radiotherapy should be appreciated. Furthermore, for recurrence, distant metastasis, and refractory of ASPS, combination therapy, especially combination with multiple target agents and/or immune checkpoint inhibitors may prolong survival time.
Comparison of emergency department utilization trends between the COVID-19 pandemic and control period
Authors: Kang Soo , Ahn Tae Kyu , Seo Young Ho , Suh Young Ju , Paik Jin Hui
Published: August 2021

Infectious disease pandemics has a great impact on the use of medical facilities. The purpose of this study was to analyze the effects of coronavirus disease 2019 (COVID-19) on the use of emergency medical facilities in the Republic of Korea. This single-center, retrospective observational study was conducted in a tertiary teaching hospital located in Incheon Metropolitan City, Republic of Korea. We set the pandemic period as February 19, 2020 to April 18, 2020, and the control period was set to the same period in 2018 and 2019. All consecutive patients who visited the emergency department (ED) during the study period were included. Patients were divided into 3 groups according to age (pediatric patients, younger adult patients and older adult patients). The total number, demographics, clinical data, and diagnostic codes of ED patients were analyzed. The total number of ED patients in the pandemic period was lower than that in the control period, which was particularly pronounced for pediatric patients. The proportion of patients who used the 119 ambulances increased in all 3 groups (P 
= .002, P < .001, and P = .001), whereas the proportion of patients who visited on foot was decreased (P 
= .006, P < .001, and P = .027). In terms of diagnostic codes, a significant decrease was observed in the proportion of certain infectious or parasitic diseases (A00-B99), and respiratory diseases (J00-J99) in the pediatric and younger adult patient groups (P < .001 and P < .001, respectively). The COVID-19 pandemic reduced the number of ED patients; however, the proportion of patients using ambulances increased. In particular, the proportion of patients with diagnostic codes for infectious and respiratory diseases significantly decreased during the pandemic period.
Maintenance treatment of combination with bevacizumab vs single agent for advanced non-squamous non-small cell lung cancer
Authors: Kong Ying , Hong Liang , Xu Xiaocheng , Xu Jia
Published: August 2021

Background:

When the patients of advanced non-squamous non-small cell lung cancer (NSCLC) have achieved remission by induction therapy, it is controversial that combination with bevacizumab is used as maintenance therapy. Pemetrexed is a classic drug for maintenance therapy, is bevacizumab the superiority to pemetrexed is also unclear. This meta-analysis aims to evaluate the effectiveness and safety of advanced non-squamous NSCLC in the maintenance treatment.

Method:

From the establishment as of December 6, 2020, PubMed, Embase, and Cochrane electronic databases were searched and the American Society of Clinical Oncology, European Society of Medical Oncology, and National Comprehensive Cancer Network databases in the past 10 years. The application of combination with bevacizumab, pemetrexed was studied in clinical trials of maintenance treatment for advanced NSCLC. The extracted data include progression-free survival (PFS), overall survival (OS), and grade 3–4 adverse events (AE).

Results:

Seven clinical trials we screened, 6 were phase III RCTs, and a cohort trial, including 3298 patients. Compared with bevacizumab and pemetrexed, PFS of combination with bevacizumab was significantly improved (hazard ratio [HR] = 0.71, 95% confidence interval [CI] = 0.65–0.77, P < .00001), but OS was not improved (HR = 0.93, 95% CI = 0.85–1.01, P = .10). Compared with bevacizumab and pemetrexed, no significant difference of PFS (HR = 0.87, 95% CI = 0.69–1.09, P = .21), and OS (HR = 0.87, 95% CI = 0.72–1.05, P = .15) was found. A higher incidence of grade 3–4 AE occurred in combination with bevacizumab (odds ratio = 1.63, 95% CI = 1.35–1.97, P < .00001).

Conclusions:

PFS was significantly improved in patients with advanced non-squamous NSCLC who use bevacizumab combination with single-agent as maintenance treatment, but it does not translate into the advantages of OS; compared with bevacizumab, no PFS and OS benefits were found. A higher incidence of grade 3–4 AE occurred in combination with bevacizumab than pemetrexed and bevacizumab.
Potential value of tripartite motif-containing 59 as a biomarker for predicting the prognosis of patients with lung cancer
Authors: Guo Jianfei , Min Ke , Deng Lichun
Published: August 2021

Background:

In recent years, related studies have revealed that tripartite motif-containing 59 (TRIM59) is related to the prognosis of lung cancer. However, these results have not been proved by any evidence. Therefore, this study evaluated the relationship between TRIM59 and the prognosis of lung cancer by carrying out meta-analysis. In addition, we explored the mechanism and related pathways of TRIM59 in lung cancer through bioinformatics analysis.

Methods:

Comprehensive literature search was performed in China National Knowledge Infrastructure, Chinese Biomedical literature Database, Chinese Scientific and Journal Database, Wan Fang, Web of Science, PubMed, and EMBASE databases, and eligible studies were obtained based on the inclusion and exclusion criteria. The pooled hazard ratios and odds ratios were applied to assess the clinical value of TRIM59 expression for overall survival and clinicopathological features. Meanwhile, meta-analysis was conducted on the Stata 16.0. The mRNA expression level of TRIM59 in lung cancer was analyzed using Oncomine and Gene Expression Profiling Interactive Analysis (GEPIA) database. Gene Set Enrichment Analysis (GSEA) was used to predict the signaling pathways that TRIM59 might be involved in. The correlation between the expression level of TRIM59 in lung cancer and the abundance of immune cell invasion was analyzed by TIMER database. The survival analysis was verified by Kaplan–Meier Plotter database.

Results:

The results of this meta-analysis would be submitted to peer-reviewed journals for publication.

Conclusion:

In this study, the application of meta-analysis and bioinformatics analysis will provide evidence support for the study on the prognosis and mechanism of TRIM59 in lung cancer.
Effectiveness and safety of acupuncture in treating sleep disturbance in dementia patients
Authors: Kwon Chan-Young , Lee Boram , Ha Da-Jung
Published: August 2021

Background:

Dementia is of increasing importance, as it is a major public health problem worldwide. Sleep disturbance is common in dementia patients and may be associated with worse cognitive symptoms or behavioral and psychological symptoms of dementia. Non-pharmacological approaches, such as acupuncture, for treating this clinical condition are gaining importance. This study aimed to comprehensively search and analyze randomized controlled clinical trials (RCTs) of acupuncture in treating sleep disturbance or sleep disorders in dementia patients

Methods:

A comprehensive search was conducted from 12 electronic databases on December 2, 2020. We included RCTs reporting the effectiveness and safety of acupuncture in treating sleep disorders or disturbance in dementia patients. The methodological quality of the included studies was assessed using the Cochrane Collaboration's risk-of-bias tool.

Results:

Five articles with four original RCTs met the inclusion criteria. These studies reported clinical data suggesting that adjuvant acupuncture for hypnotics, and ear acupressure in dementia patients with sleep disorders or sleep disturbance may have clinical benefits in certain sleep-related parameters and total effective rate (TER). Only 1 study reported the safety profile of the intervention, and no acupuncture-related adverse reactions were reported. Some studies compared 2 kinds of acupuncture methods, and found that specific acupuncture methods were superior to conventional acupuncture in improving sleep-related parameters, cognitive function and TER. The methodological quality of the included clinical studies was not high.

Conclusions:

There were limited acupuncture studies on this topic. Given the number of studies included and their sample size, methodological quality, and heterogeneities, clinically relevant conclusions could not be drawn. Further clinical studies are needed in this field considering its urgency and importance.
Comparison of topical and intravenous Tranexamic acid for high tibial osteotomy
Authors: Bian Jichao , Deng Bin , Wang Zhimeng , Yuan Long , Li Sen , Zhao Xiaowei , Zhang Yuanmin , Wang Guodong
Published: August 2021

High tibial osteotomy (HTO) is a promising surgery that can treat osteoarthritis of the medial septum of the knee. However, the extensive release of soft tissue and the osteotomy gap may produce intraoperative and postoperative bone bleeding. Tranexamic acid (TXA) is an effective blood management strategy, as it competitively inhibits the activation process of plasminogen and prevents fibrinolytic enzymes from degrading fibrin. Therefore, we compared the operative bone bleeding of patients who underwent HTO who received either intravenous (IV) or topical TXA in this research.

The medical records of a total of 191 patients (including 72 who received IV TXA, 64 who received topical TXA and 55 control patients) who received open-wedge HTO were retrospectively reviewed from January 2016 to August 2019. There were no obvious demographic differences between the groups. Here, we used independent parameters to assess the efficacy of topical and IV TXA in reducing blood loss.

Compared with the IV TXA group, patients receiving topical TXA therapy had greater blood loss (622 ± 231 ml versus 451 ± 231 ml, mean difference 171 mL [95% CI, 87–254]; p < 0.001). The hemoglobin concentration of the IV TXA group was obviously higher than that of the topical medication group. No patients had thromboembolic complications during the entire study period.

In our study, it seemed that either IV or topical use of TXA might reduce blood loss after open-wedge HTO, and the blood loss and amount of drainage in the IV TXA group showed huge decreases compared to those in the topical group.
Analysis of factors influencing improvement of idiopathic flatfoot
Authors: Shin Byung-Joon , Lee Kyoung Min , Chung Chin Youb , Sung Ki Hyuk , Chun Dong-il , Hong Chang Hwa , Kim Jun Bum , Kwon Sai-Won , Kim Woo Jong , Song Min Gon , Yoon Sung Joon , Jung Ki Jin
Published: August 2021

Idiopathic flatfoot is common in infants and children, and patients with this condition are frequently referred to pediatric orthopedic clinics. Flatfoot is a physiologic process, and that the arch of the foot elevates spontaneously in most children during the first decade of life. To achieve a consensus as the rate of spontaneous improvement of flatfoot, the present study aimed to estimate the rate of spontaneous improvement of flatfoot and to analyze correlating factors.

We reviewed the records of patients examined between May 2013 and May 2019 so as to identify those factors associated with idiopathic flatfoot below 12 years of age. We included patients with who had been followed for >6 months, and those for whom ≥2 (anteroposterior and lateral) weight-bearing bilateral radiographs of the foot had been obtained. The progression rates of the anteroposterior (AP) talo-first metatarsal angle, talonavicular coverage angle, lateral talo-first metatarsal angle, and calcaneal pitch angle were adjusted by multiple factors using a linear mixed model, with sex, body mass index, and Achilles tendon contracture as the fixed effects and age and each subject as the random effects.

We found that 4 of the radiographic measurements improved as patients grew older. The AP talo-first metatarsal angle, talonavicular coverage angle, and the lateral talo-first metatarsal angle decreased, while the calcaneal pitch angle increased. The AP talo-first metatarsal angle (P < .001), talonavicular coverage angle (P < .001), and lateral talo-first metatarsal angle (P < .001) improved significantly; however, the calcaneal pitch angle (P = .367) did not show any significant difference. In general, the flatfeet showed an improving trend; after analyzing the factors, no sex difference was observed (P = .117), while body mass index (P < .001) and Achilles tendon contracture (P < .001) showed a negative correlation.

The study demonstrated that children's flatfeet spontaneously improved at the age of 12 years. It would be more beneficial if the clinician shows the predicted appearance of the foot at the completion of growth by calculating the radiographic indices and identifying the correlating factors in addition to explaining that flatfoot may gradually improve. This will prevent unnecessary medical expenses and the psychological adverse effects to the children caused by unnecessary treatment.
Differences between dedicated and not dedicated hospice physicians in symptoms and signs improvement among advanced cancer patients
Authors: Chung Jae Ho , Kim Sun Hyun , Suh Sang-Yeon , Cheng Shao-Yi , Mori Masanori , Yamaguchi Takashi , Chen Ping-Jen , Morita Tatsuya , Tsuneto Satoru
Published: August 2021

The hospice and palliative care can improve the symptoms and signs of terminal cancer patients. The purposes of this study are how to improve terminally ill cancer patients’ symptoms and signs and how the dedicated palliative care service effects on these improvements.

From January 2017 to March 2019, among 919 terminally ill cancer patients admitted to the palliative care units in 11 hospitals of South Korea, we analyzed 334 patients with prospective cohort method and categorized them into non-dedicated hospice care group of 234 and dedicated hospice care group of 100.

Symptoms improvement of dyspnea, fatigue, drowsiness, and dry mouth during the first week of admission were respectively 298 (89.2%), 25 (7.5%), 204 (61.1%), 76 (22.8%). Signs improvement of myoclonus, respiratory secretion, leg edema, and ascites between admission and a week after were 5 (1.5%), 41 (12.3%), 47 (14.1%), 12 (3.6%). Significant differences between dedicated hospice care physician group and non-dedicated hospice care physician group were shown in drowsiness (67.5% vs 46%, P < .001) and respiratory secretion (15% vs 6%, P < .028). Compared to non-dedicated care group, the odds ratio for more than 2 symptoms or signs was 1.78 (95% confidence interval, 1.05–3.02) in the dedicated care group after adjusting confounding variables.

In conclusion, terminally ill cancer patients who received palliative or hospice service showed significant improvement in symptoms and signs. And, family doctors (dedicated hospice physician group) performed better than oncologists (non-dedicated physician group).
Relative contribution of vitamin D deficiency to subclinical atherosclerosis in Indian context
Authors: Mantha Srinivas , Tripuraneni Sudha Lakshmi , Fleisher Lee A. , Roizen Michael F. , Mantha Venkat Ramana Rao , Dasari Prasada Rao
Published: August 2021

Asian Indians have a genetic predisposition to atherothrombotic risk. common carotid intima-media thickness (CCIMT) measured by ultrasound is a quantitative marker for atherosclerotic burden and a derived variable, that is, “CCIMT statistical Z-score (Z-score)” is useful for better quantification. The association between vitamin D deficiency and atherosclerosis is inconclusive. Since, vitamin D deficiency is highly prevalent in India, there is a need to study its relative contribution to subclinical atherosclerotic burden.

This prospective cross-sectional study (n = 117) in apparently healthy individuals aged 20 to 60 years sought to identify the determinants of CCIMT Z score with CCIMT measured by “echo-tracking” method. A multivariable linear regression analysis was done with CCIMT Z score as dependent variable and the following as independent variables: age, body mass index, waist-to-height ratio, total cholesterol to HDL ratio (TC-HDL ratio), serum vitamin D3 levels (ng/mL), sex, diabetes mellitus, current cigarette smoking status. A diagnostic prediction model was also developed with a threshold value of 1.96 for CCIMT Z score.

The mean (SD) for calendar age (y) was 40 (8). There were 26 (22.22%) individuals in sample with CCIMT Z score ≥1.96 (advanced stage) of whom 14 (23.33%) were <40 y (n = 60). The mean score was 1.28 (90th percentile) in the entire sample. Vitamin D3 deficiency with a mean (SD) blood level (ng/mL) of 14.3 (6.4) was noted and prevalence of deficiency was 81%. The final model was

CCIMT Z-score = 0.80 +  (0.841 × current smoking = 1) + (0.156 × TC-HDL ratio) – (0.0263 × vitamin D3 blood level in ng/mL).

The decreasing order of association is smoking, TC-HDL ratio, and vitamin D3. With the model, likelihood ratio (95% CIs) was better for positive test 3.5 (1.23–9.94) than that for a negative test 0.83 (0.66–1.02).

Internal validation with Bootstrap resampling revealed stability of baseline diagnostic variables.

There is substantial subclinical atherosclerotic burden in Indian setting with independent contribution by vitamin D deficiency. The model is valuable in “ruling-in” of the underlying advanced atherosclerosis. The study is limited by convenient sampling and lack of external validation of the model.
Gait characteristics during crossing over obstacle in patients with glaucoma using insole foot pressure
Authors: Lee Han-Suk , Lee Koon-Ja , Kim Jeong-Lae , Leem Hyun-Sung , Shin Hyun-Jin , Kwon Hyeok Gyu
Published: August 2021

Background:

Glaucoma, is the most common cause of irreversible visual deficits, presents as an injury to the optic nerve and it is mainly associated with elevated intraocular pressure. The main symptom of glaucoma is a reduction of the visual field, which is usually a source of complaint at the advanced stage of disease. Because of visual deficit, gait dysfunctions, including low gait speed and increased bumping into objects, postural sway, and falling are occurred. Many studies have used stopwatch or motion-sensing devices to report on gait function following glaucoma. However, there are few reports on gait dysfunction assessed by examining foot pressure. This study investigated gait ability following glaucoma according to different gait conditions by assessing foot pressure.

Methods:

Thirty older adults (15 in the sex- and age-matched normal group and 15 in the glaucoma group) were recruited for this study. All participants were walked under 2 different gait conditions in an F-scan system and the subject’ assessments were randomly assigned to rule out the order effect. Conditions included: gait over an obstacle in a straight 6 m path, gait in a straight path without an obstacle in the 6 m path. Gait variables included cadence, gait cycle, stance time, center of force (COF) deviation, and COF excursion. About 10 minutes were taken for gait evaluation.

Results:

When walking without an obstacle on a 6 m path, there were significant differences between the 2 groups in gait speed, cadence, gait cycle, and stance time (P < .05). There were significant differences when walking with an obstacle on a 6 m path (P < .05). Two-way analysis of variance showed significant effects associated with “glaucoma” not gait condition on all outcomes except for COF deviation and excursion. Also, there was no the interaction effect between “glaucoma” and “gait condition.”

Conclusion:

We demonstrated that glaucoma patients selected the gait strategy such as lower gait function in both gait conditions particularly, slower gait speed and cadence and longer gait cycle and stance time, as determined by examining foot pressure. We believe that our results could help to improve the quality of life of patients with glaucoma.
Resuming anticoagulation in patients with atrial fibrillation experiencing intracranial hemorrhage
Authors: Wu Victor Chien-Chia , Huang Yi-Chun , Chen Shao-Wei , Liu Chi-Hung , Chang Chun-Wei , Chen Ching-Chang , Chang Shang-Hung , Lin Ming-Shyan , Lee Tsong-Hai , Chen Mien-Cheng , Hsieh I-Chang , Chu Pao-Hsien , Lin Yu-Sheng
Published: August 2021

Globally, 32% to 70% patients with atrial fibrillation (AF) are prescribed oral anticoagulants (OACs) with warfarin for stroke prevention. However, patients with AF on OACs may experience intracranial hemorrhage (ICH), which presents a treatment dilemma. We therefore investigated whether resuming OACs in these patients is beneficial. Electronic medical records of patients with AF on OACs discharged with ICH between 2001 and 2013 were retrieved from the Taiwan National Health Insurance Research Database for analysis. We excluded patients who were <20 years old, who were not using OACs 6 months prior to ICH, or who had a CHA2DS2-VASc score of ≤1. We also excluded patients who died during admission for ICH, with follow-up for <6 weeks after discharge, or who started OAC >6 weeks after ICH diagnosis. The remaining patients were categorized into those who resumed OAC and those who discontinued OAC. Propensity score matching was performed between the 2 groups. Primary outcomes were mortality/ischemic stroke (IS)/systemic embolism (SE), IS/SE, and recurrent ICH at 6 months and 1 year. After the exclusion criteria were applied, 604 eligible patients (408 discontinued OAC and 196 resumed OAC within 6 weeks) were included in this study, and 186 patients in each group were 1:1 matched. Patients who resumed OAC had significantly lower mortality/IS/SE (hazard ratio [HR] = 0.39, 95% confidence interval [CI] = 0.20–0.76) and IS/SE (HR = 0.12, 95% CI = 0.03–0.53) at 6-month follow-up than patients who discontinued OAC. In addition, patients who resumed OAC had significantly lower mortality/IS/SE (HR = 0.56, 95% CI = 0.34–0.93) and IS/SE (HR = 0.26, 95% CI = 0.09–0.75) at 1-year follow-up. No difference in recurrent ICH was noted between the 2 groups. In conclusion, in patients with AF on OACs with ICH, resuming anticoagulant use was associated with significantly lower risks of composite outcomes of mortality/IS/SE and IS/SE than patients who discontinued OACs. No difference in recurrent ICH was observed between the 2 groups.
Emerging Treatment Strategies in Pancreatic Cancer
Authors: Trunk Andrew , Miotke Laura , Nevala-Plagemann Christopher , Verdaguer Helena , Macarulla Teresa , Garrido-Laguna Ignacio
Published: August 2021

Pancreatic ductal adenocarcinoma (PDAC) is one of the main causes of cancer death in well-developed countries. Therapeutic advances in PDAC to date have been modest. Recent progress to understand the molecular landscape of the disease has opened new treatment opportunities for a small subset of patients, frequently those with KRAS wild-type disease. Novel treatment strategies in PDAC include, among others, the use of nanotechnology and metabolic reprogramming. In addition, new strategies are being investigated, which are designed to overcome the resistance to checkpoint inhibitors, targeting DNA repair pathways including mismatch repair, increasing antigen presentation through the use of vaccines, targeting various signaling pathways, and reprogramming the tumor microenvironment. Here, we review the landscape of PDAC treatment strategies and some of these new agents.
Text or Not to Text? A Narrative Review of Texting as a Case Management Intervention
Authors: Sobers-Butler Keisia
Published: August 2021

Purpose:

To review current literature on texting as a sustainable intervention of case management in the outpatient setting.

Findings:

Texting, as a case management intervention, provides the medically complex client with a pathway to achieve care plan goals. Texting increases adherence, communication, and self-management. It can increase client enrollment in disease management programs, while providing support, flexibility, convenience, cost savings, and increased participation.

Implications for Case Management Practice:

In current practice, such as management of the coronavirus (COVID-19), other pandemics, or natural/environmental disasters, texting is a solution-focused intervention that can deliver and retrieve real-time information to a medically complex population. It can link patients to resources and increase outreach, efficiency, quality, and coordination of care. Texting can promote adherence to appointments, increase medication compliance and disease management interventions, and provide motivational change messages. However, there are legal and regulatory concerns that carry potential consequences and implications that should be approached judiciously (Mellette, 2015). Texting is not one size fits all; it can cause HIPAA breeches, hinder communication with certain populations, confuse health messaging, and replace human communication, thereby reducing staffing in practice.
A Case Manager's Resilient Reality
Authors: Powell Suzanne K.
Published: August 2021

Case managers are a ubiquitous group of professionals whom others rely upon when times are difficult. October 10–16, 2021, is National Case Management Week. Although 2020 tested us to the core, we can celebrate our week with pride and satisfaction.
Pregnant and Parenting Women's Experiences with Substance Use Disorder
Authors: Wright Mary Ellen , Temples Heide S. , Shores Emily , Chafe Olivia , Lannamann Rebekkah , Lautenschlager Carla
Published: August 2021

Purpose:

The purpose of the study was to describe and analyze the experience of women with substance use disorder during pregnancy and parenting to inform health care services that promote recovery.

Study Design:

Interviews of pregnant or parenting women with substance use disorder were used in this qualitative descriptive study.

Methods:

Participants were recruited from two recovery centers serving pregnant or parenting women with substance use disorder. Participants called a study cellphone to speak with the researchers about their substance use and recovery. Four independent reviewers conducted thematic analysis and were facilitated by Atlas.ti qualitative analysis program.

Results:

N = 15 women called the study cellphone; 10 met inclusion criteria and were interviewed. Researchers coded 81 themes with the common occurrence of prior trauma, multiple substances used, stigma and judgment from others, and having children as a motivation to seeking recovery. Co-occurrence of themes of positive social support and the pursuit of recovery was identified.

Clinical Implications:

Positive social support co-occurring with recovery supports the need for strengthened social support structures. Health care professionals should intentionally address the culture of caring for pregnant and parenting women with substance use disorder through education, practice, advocacy, and research.
Identifying, Assessing, and Treating Korsakoff Syndrome Patients
Authors: Westermeyer Joseph John , Soukup Beverly , Mayer Jessica , Lee Kathryn
Published: August 2021

Objectives consist of updating published reports on the recognition, assessment, and care of patients with Wernicke-Korsakoff syndrome (WKS). Methods included defining relevant terms, describing core clinical phenomena, conducting meaningful reviews for latter-day WKS publications, and selecting instructive case examples. Findings covered epidemiology, precipitants, neuroimaging studies, alternate learning strategies in WKS, adjunctive treatments, and promising research. In conclusion, patients, their family members, clinicians, and public health experts should benefit from this updated knowledge. Countries with substantial alcohol consumption should consider emulating Holland in designating WKS research centers, founding regional clinical facilities, and funding multidisciplinary expert teams.
Evaluation of Antibiotic Allergies in Surgical Patients
Authors: Larry Rachel C. , Bertram Christie M.
Published: August 2021

Antibiotic administration in the perioperative period is the foundation of preventing surgical site infections. β-Lactam antibiotics, notably the first-generation cephalosporin cefazolin, are the drugs of choice for this indication. However, reported antibiotic allergies often result in the use of suboptimal alternative agents that can lead to an increased risk of infection and adverse effects. A comprehensive allergy history and risk stratification should be completed preoperatively to determine whether or not a patient can be rechallenged with a β-lactam antibiotic and what testing may be necessary prior to administration. Nursing staff can play a critical role in understanding the implications and management of reported antibiotic allergies in surgical patients in order to optimize patient care.
Clinical Nurse Specialist
Authors: Gabbard Erika R. , Klein Deborah , Vollman Kathleen , Chamblee Tracy B. , Soltis Lisa M. , Zellinger Mary
Published: August 2021

OBJECTIVES

To describe the role of the clinical nurse specialist, an advanced practice registered nurse in the intensive care setting. The value and impact of the clinical nurse specialist role as a member of the ICU is presented along with a review of clinical nurse specialist education, licensure, and certification requirements as well as a description of the clinical nurse specialist role, scope of practice, and competencies. In addition, a selected review of clinical nurse specialist–led quality improvement and research that resulted in improved patient outcomes is provided.

DATA SOURCES

Review of published medical and nursing literature and expert opinion guidance from a collaborative effort between the Society of Critical Care Medicine, American Association of Critical Care Nurses, and National Association of Clinical Nurse Specialists.

STUDY SELECTION

Not applicable.

DATA EXTRACTION

Not applicable.

DATA SYNTHESIS

Not applicable.

CONCLUSIONS

The utilization of a clinical nurse specialist, an advanced practice role, in the ICU is a unique and valuable approach for organizations who strive to move evidence into sustainable practice and drive quality through an interprofessional approach. The valuable contributions made by the clinical nurse specialist efficiently and effectively meet the needs of patients, clinicians, and organizations while improving patient outcomes and optimizing cost avoidance strategies, which further lower economic demands on the healthcare system.
Environmental Life Cycle Assessment in Medical Practice: A User’s Guide
Authors: McGinnis Sean , Johnson-Privitera Camron , Nunziato Jaclyn D. , Wohlford Sara
Published: August 2021

Importance

The environmental impacts of medical practice are becoming more important as the unsustainable activities of global societies continue to damage the environment and contribute to health problems. Life cycle assessment (LCA) is a methodology to quantify a wide range of environmental impacts, including global warming, over the full life cycle of products, processes, and systems, to allow for data-driven environmental decisions.

Objective

This article introduces the concepts, terminology, and methodology of LCA using examples from the medical industry. It provides guidance and best practices for the standard steps of an LCA study.

Evidence Acquisition

A review of the literature was done to provide examples of the use of LCA and carbon footprints in medicine. Hypothetical medical products were modeled using LCA software to illustrate the capabilities and limitations of this method.

Results

Life cycle assessment examples in medicine illustrate the ability of this method to compare environmental impacts for products that perform the same function. They also highlight the relative scale of damage across all life cycle phases for a variety of environmental impact categories. Resources have also been provided for various useful LCA tools.

Conclusions and Relevance

Life cycle assessment can provide medical practitioners with quantified environmental metrics in order to make decisions that minimize the environmental impacts of medical products, processes, and systems. Carbon footprints are LCA studies that focus only on the impact of climate change. Life cycle assessment is expected to grow as a tool for environmental decisions in medical practice.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completion of this article, the reader should be better able to describe how environment impacts can occur throughout the different phases of the life cycle of a medical product or process; explain how product life cycle inputs/outputs are translated into quantified environmental impacts; identify the concept of a carbon footprint and differentiate it from an LCA; and summarize several of the main environmental impact categories considered in LCA studies.
Associations of Maternal Cardiovascular Health in Pregnancy With Offspring Cardiovascular Health in Early Adolescence
Authors: Perak Amanda M. , Lancki Nicola , Kuang Alan , Labarthe Darwin R. , Allen Norrina B. , Shah Svati H. , Lowe Lynn P. , Grobman William A. , Lawrence Jean M. , Lloyd-Jones Donald M. , Lowe William L. , Scholtens Denise M.
Published: August 2021

(Abstracted from JAMA 2021;325:658–668)

The gestational period during pregnancy may be an opportune time to influence not only the health of the mother but also the long-term health of the offspring. Risk factors, such as obesity and diabetes, during pregnancy have been independently associated with higher risks of poor cardiovascular health (CVH).