bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterizing Critical Care Pharmacy Services Across the United States
Authors: MacLaren Robert , Roberts Russel J. , Dzierba Amy L. , Buckley Mitchell , Lat Ishaq , Lam Simon W.
Published: May 2021

OBJECTIVES:

Involvement of clinical pharmacists in the ICU attenuates costs, avoids adverse drug events, and reduces morbidity and mortality. This survey assessed services and activities of ICU pharmacists.

Design:

A 27-question, pretested survey.

SETTING:

1,220 U.S. institutions.

Subjects:

Critical care pharmacists.

Interventions:

Electronic questionnaire of pharmacy services and activities across clinical practice, education, scholarship, and administration.

Measurements and Main Results:

A total of 401 (response rate of 35.4%) surveys representing 493 ICUs were completed. Median daily ICU census was 12 (interquartile range, 6–20) beds with 1 (interquartile range, 1–1.5) pharmacist full-time equivalent per ICU. Direct clinical ICU pharmacy services were available in 70.8% of ICUs. Pharmacists attended rounds 5 days (interquartile range, 4–5 d) per week with a median patient-to-pharmacist ratio of 17 (interquartile range, 12–26). The typical workweek consisted of 50% (interquartile range, 40–60%) direct ICU patient care, 10% (interquartile range, 8–16%) teaching, 8% (interquartile range, 5–18%) order processing, 5% (interquartile range, 0–20%) direct non-ICU patient care, 5% (interquartile range, 2–10%) administration, 5% (interquartile range, 0–10%) scholarship, and 0% (interquartile range, 0–5%) drug distribution. Common clinical activities as a percentage of the workweek were reviewing drug histories (28.5%); assessing adverse events (27.6%); and evaluating (26.1%), monitoring (23.8%), and managing (21.4%) drug therapies. Services were less likely to occur overnight or on weekends. Telemedicine was rarely employed. Dependent prescriptive authority (per protocol or via practice agreements) was available to 51.1% of pharmacists and independent prescriptive authority was provided by 13.4% of pharmacists. Educational services most frequently provided were inservices (97.6%) and experiential training of students or residents (89%). Education of ICU healthcare members was provided at a median of 5 times/mo (interquartile range, 3–15 times/mo). Most respondents were involved with ICU or departmental policies/guidelines (84–86.8%) and 65.7% conducted some form of scholarship.

Conclusions:

ICU pharmacists have diverse and versatile responsibilities and provide several key clinical and nonclinical services. Initiatives to increase the availability of services are warranted.
ICU Survivors Experience of ICU Diaries: An Ancillary Qualitative Analysis of the ICU Diary Study
Authors: Flahault Cécile , Trosdorf Mathilde , Sonrier Marie , Vioulac Christel , Fasse Léonor , Timsit Jean-François , Bailly Sébastien , Garrouste-Orgeas Maité
Published: May 2021

OBJECTIVES:

To investigate patients’ experience of ICU diaries 6 months after ICU discharge among survivors. This study was designed to add insight into a large randomized study, which found no benefit of the ICU diary to post-traumatic stress disorder among critically ill patients having received mechanical ventilation.

DESIGN:

A preplanned qualitative substudy of patients receiving an ICU diary written by ICU caregivers and families. Six months after ICU discharge, survivors were contacted by a psychologist for a telephone interview using a semi-directive guide.

SETTING:

Thirty-five French ICUs.

PATIENTS:

All ICU survivors having received an ICU diary.

INTERVENTION:

An ICU diary written by both ICU staff and families.

MEASUREMENTS AND MAIN RESULTS:

Among the 332 patients randomized in the intervention group (having had an ICU diary filled by both ICU staff and families), 191 (57.7%) were alive at 6 months and 101 of 191 (52.9%) participated in a telephone interview. They were (median [interquartile range]) 64 years old (53–70 yr old); 65 (64.4%) were men, and 79 (78.2%) were medical patients. Duration of ICU stay was 13 days (8–21 d). Three themes were derived from the thematic analysis: 1) reading the diary: between emotion and pain, 2) how the diary helped, and 3) the bittersweet representation of the diary. For half of the patients, the diary is a good memory of difficult times (55/101, 54.5%), others seem to be more ambivalent about it (28/101, 27.8%), and 37 of 101, 36.6% see it as a painful representation of a time to be forgotten.

CONCLUSIONS:

When reading their ICU diaries, ICU survivors experienced mixed emotions, related to family messages, medical caregiving, and to the severity of their illness. Patients described diaries as a help or a hindrance to recovery, depending on their wish to remember the period or move on from it.
Incidence rates of oral cavity and oropharyngeal cancers among men: a comparison of active-duty military and general populations
Authors: Bytnar Julie A. , Shriver Craig D. , Zhu Kangmin
Published: May 2021

Objectives

This study compared oral cavity and oropharyngeal cancer incidence rates and trends among men in the active-duty military and the general population of the USA.

Methods

Data were from the Department of Defenses’ Automated Central Tumor Registry (ACTUR) and the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER-9) registries. Age-adjusted oral cavity and oropharyngeal cancer incidence rates among men aged 20-59 from 1990-2013 were compared between ACTUR and SEER populations.

Results

The age-adjusted oral cancer incidence rate was lower in ACTUR than SEER (IRR = 0.89, 95% confidence interval (CI), 0.81–0.98). Incidence was lower in ACTUR for oral cavity cancer (IRR = 0.75, 95% CI, 0.66–0.89) and remained lower when stratified by age and race. ACTUR oropharyngeal cancer rates were higher than SEER among Whites (IRR = 1.19, 95% CI, 1.01–1.39) and men aged 40–59 (IRR = 1.18, 95% CI, 1.00–1.39). Oropharyngeal cancer increased for both populations over time, whereas oral cavity cancer increased in ACTUR but decreased in SEER.

Conclusion

Rates were lower in ACTUR than SEER for oral cavity, but not for oropharyngeal cancer. Temporal oral cancer incidence patterns differed between the two populations. This study provides clues for more research on possible variations between these two populations and related factors.
Prominent Blasts in Primary Cutaneous CD4+ Small/Medium T-Cell Lymphoproliferative Disorder. A Reconsideration of Diagnostic Criteria
Authors: Bakr Farrah , Wain E. Mary , Wong Sharon , Palmer Roy , Robson Alistair
Published: May 2021

Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder (PCSM-LPD), recently downgraded from a T-cell lymphoma, is a poorly characterized histopathological entity. Presenting as a solitary lesion that often grows rapidly, it may raise suspicion for a cutaneous B-cell lymphoma. However, classically, the dermal lymphoid proliferation is predominantly CD4+ with a follicular T-helper profile and a smaller B-cell fraction. Diagnostic uncertainty may arise when B cells are present in large numbers, a B-cell clone is present, or large cell populations are seen. To meet the diagnostic criterion of PCSM-LPD, large cells should not constitute more than 30% of the infiltrate. The 2 cases presented in this article caused diagnostic uncertainty owing to the observation of high numbers of large cells and in one case the presence of a B-cell clone, on the background of otherwise typical clinicopathological features of PCSM-LPD. We review the literature specifically regarding the prevalence of large cell populations and their immunophenotypic characteristics and in light of this discuss whether a current diagnostic criterion should be reconsidered.
A Retrospective Study of the Safety and Efficacy of a Radial Diode Laser Probe in the Management of Pilonidal Sinus Disease
Authors: Bonito Frederico , Cerejeira Diogo , Goulão João , de Assunção Gonçalves José
Published: May 2021

BACKGROUND

Recently, the interest in minimally invasive techniques in the management of the pilonidal sinus has been rising. The main goal is to avoid the prolonged recovery period associated with traditional surgeries.

OBJECTIVE

To evaluate the safety and efficacy of a radial diode laser probe in the destruction of the pilonidal sinus.

METHODS

Twenty-seven patients with pilonidal sinus were treated with a radial 1,470-nm diode laser between July 2018 and August 2020 and were examined retrospectively. Charts were reviewed and patients were questioned by telephone about their postlaser recovery period.

RESULTS

Twenty-five patients were included. The overall success rate was 84%. Recurrence rate was 9.5%, after a mean follow-up of 8.3 months. The mean duration of analgesia intake was 2.5 days, and the mean period required to return to daily activities was 5.8 days. Sixteen percent of the patients developed a small postoperative hemorrhage as a complication.

CONCLUSION

This study demonstrated that radial diode laser is safe, effective, and associated with a low recurrence rate in the treatment of mild pilonidal sinus disease. Dermatologists can perform it easily in the outpatient clinic, with minimal postoperative pain and a fast return to the patients' daily activities.
Sentinel Lymph Node Biopsy in High-Risk Cutaneous Squamous Cell Carcinoma: Analysis of a Large Size Retrospective Series
Authors: Tremblay-Abel Valérie , Poulin Marc-Antoine , Blouin Marie-Michèle , Parent François , Perron Émilie
Published: May 2021

BACKGROUND

One of the most important prognostic factors for mortality in cutaneous squamous cell carcinoma (cSCC) is the development of nodal metastasis. There is no consensus regarding which patient with cSCC should be offered sentinel lymph node biopsy (SLNB).

OBJECTIVE

This study aimed to establish the rate of positive SLNBs among patients with high-risk cSCCs and to identify which high-risk features are associated with a positive SLNB.

METHODS

Five-year retrospective case series in an academic tertiary care center reviewing 93 SLNBs.

RESULTS

Of the 93 SLNBs performed, 5 (5.4%) were positive. Three patients (3/5) had neck dissection and one (1/5) had radiation therapy, with no recurrence at the time of last follow-up. A tumor diameter ≥2 cm, a tumor depth >6 mm or below subcutaneous fat, perineural invasion of nerves with a diameter ≥0.1 mm, moderate or poor histological differentiation, lymphovascular invasion, and immunosuppression were associated with a positive SLNB. All tumors with a positive SLNB were classified as T2b according to the Brigham and Women's Hospital (BWH) tumor staging.

LIMITATIONS

Retrospective study and absence of a control group.

CONCLUSION

Sentinel lymph node biopsy can be considered for BWH T2b and T3 tumors. However, more randomized controlled studies are needed.
Intraocular Pressure Variations After Intravitreal Injections Measured With an Implanted Suprachoroidal Telemetry Sensor
Authors: Meduri Enrico , Gillmann Kevin , Mansouri Kaweh
Published: May 2021

Purpose:

Intravitreal injections (IVIs) may create transient intraocular pressure (IOP) elevation. This report describes continuous IOP fluctuations following multiple IVI measured with a permanent implantable sensor.

Patients and Methods:

We report the case of a 49-year-old white glaucomatous male with refractory macular edema secondary to central retinal vein occlusion in his left eye who underwent deep sclerectomy combined with the implantation of a suprachoroidal tonometry sensor. Serial IOP measurements were performed immediately before and after each IVI over a 1-year period.

Results:

During the first 7 months following deep sclerectomy, IOP remained below 10 mm Hg. During this period, mean IOP before each injection was 2.1±2.6 mm Hg, and each IVI caused a reduction of 1.2±0.8 mm Hg on average, with a maximum reduction of 2.7 mm Hg, before IOP normalized within 50 minutes to 24 hours. From 7 months postoperatively, mean IOP increased to the low teens. During this period, mean IOP before each injection was 9.9±1.8 mm Hg, and each IVI caused an increase of 15.8±11.7 mm Hg on average, with a maximum increase of 44.8 mm Hg, before IOP normalized within 20 minutes to 4 hours.

Conclusions:

During the initial postoperative phase, IVI may cause acute reduction in IOP, either through subconjunctival leaks or increased filtration secondary to increased fluid pressure. Several months after surgery, this effect subsides and IOP spikes sharply immediately after each IVI, suggesting the resolution of the initial mechanism, most likely through scarring and fibrosis.
Deep Learning-based Diagnosis of Glaucoma Using Wide-field Optical Coherence Tomography Images
Authors: Shin Younji , Cho Hyunsoo , Jeong Hyo Chan , Seong Mincheol , Choi Jun-Won , Lee Won June
Published: May 2021

Purpose:

(1) To evaluate the performance of deep learning (DL) classifier in detecting glaucoma, based on wide-field swept-source optical coherence tomography (SS-OCT) images. (2) To assess the performance of DL-based fusion methods in diagnosing glaucoma using a variety of wide-field SS-OCT images and compare their diagnostic abilities with that of conventional parameter-based methods.

Methods:

Overall, 675 eyes, including 258 healthy eyes and 417 eyes with glaucoma were enrolled in this retrospective observational study. Each single-page wide-field report (12×9 mm) of wide-field SS-OCT imaging provides different types of images that reflect the state of the eyes. A DL-based automated diagnosis system was proposed to detect glaucoma and identify its stage based on such images. We applied the convolutional neural network to each type of image to detect glaucoma. In addition, 2 fusion strategies, fusion by convolution network (FCN) and fusion by fully connected network (FFC) were developed; they differ in terms of the level of fusion of features derived from convolutional neural networks. The diagnostic models were trained using 382 and 293 images in the training and test data sets, respectively. The diagnostic ability of this method was compared with conventional parameters of the thickness of the retinal nerve fiber layer and ganglion cell complex.

Results:

FCN achieved an area under the receiver operating characteristic curve (AUC) of 0.987 (95% confidence interval, CI: 0.968-0.996) and an accuracy of 95.22%. In contrast, FFC achieved an AUC of 0.987 (95% CI, 0.971-0.998) and an accuracy of 95.90%. Both FCN and FFC outperformed the conventional method (P<0.001). In detecting early glaucoma, both FCN and FFC achieved significantly higher AUC and accuracy than the conventional approach (P<0.001). In addition, the classification performance of the DL-based fusion methods in identifying the 5 stages of glaucoma is presented via a confusion matrix.

Conclusion:

DL protocol based on wide-field OCT images outperformed the conventional method in terms of both AUC and accuracy. Therefore, DL-based diagnostic methods using wide-field OCT images are promising in diagnosing glaucoma in clinical practice.
Inhibition of transient receptor potential vanilloid 1 and transient receptor potential ankyrin 1 by mosquito and mouse saliva
Authors: Derouiche Sandra , Li Tianbang , Sakai Yuya , Uta Daisuke , Aoyagi Seiji , Tominaga Makoto
Published: May 2021

Arthropods are the largest group of living organisms, and among them, mosquitoes spread parasites and viruses causing deadly diseases. They can easily spread these pathogens because of their painless skin piercing. Although the lack of pain is mainly due to the thinness of their fascicle, it is possible that mosquito saliva, which is discharged during their piercing, might also contribute to it. If mosquito saliva contains antinociceptive substances, it should act on the sensory neurons innervating the epidermis where there are several ion channels that can detect noxious stimuli, such as the transient receptor potential (TRP) channels. We found that mosquito head homogenates and mouse saliva inhibit TRP vanilloid 1 (TRPV1) and TRP ankyrin 1 (TRPA1) channels, either heterologously expressed in HEK293T cells or endogenously expressed in native mouse sensory neurons. Among the different substances contained in mosquito head homogenates or mouse saliva, we have also identified sialorphin as a candidate antinociceptive peptide because it showed similar inhibition effects on TRPV1 and TRPA1. Finally, we confirmed the antinociceptive effects of mosquito head homogenates, mouse saliva, and sialorphin in vivo by observing decreased pain-related behaviors in mice coinjected with these substances. Similar inhibitory effects of mosquito head homogenates and mouse saliva on TRPV1 and TRPA1 suggest that the antinociceptive effects of saliva are universal, which could explain why many animals including humans often lick their wounds. These findings would lead to the development of novel and safe antinociceptive agents.
Social and Structural Barriers to Primary Care Access Among Women Living With HIV in Metro Vancouver, Canada: A Longitudinal Cohort Study
Authors: Deering Kathleen N. , Chong Louise , Duff Putu , Gurney Lulu , Magagula Patience , Wiedmeyer Mei-ling , Chettiar Jill , Braschel Melissa , D'Souza Karan , Shannon Kate
Published: May 2021

This study examines correlates of being unable to access primary care in the past 6 months among cisgender (cis) and trans women living with HIV (WLWH). Data were drawn from a longitudinal community-based cohort study of WLWH (ages 14+) in Metro Vancouver, Canada (2014–2017). Of 291 participants contributing 914 observations, 15.5% reported being unable to access primary care at baseline. In multivariable analysis, increased odds of being unable to access primary care was associated with (a) having im/migrated to Canada, and, in the past 6 months, (b) identifying as gender minority, (c) experiencing physical or sexual violence, (d) having suicidal ideation or attempts. Decreased odds were associated with recently accessing HIV-specific resources. Our findings suggest that primary health care for WLWH should address high levels of violence and mental health conditions as well as barriers to services for gender minority and im/migrant WLWH.
Long-Term, Multicenter Results With the First Transcutaneous Bone Conduction Implant
Authors: Sprinzl Georg , Lenarz Thomas , Hagen Rudolf , Baumgartner Wolf Dieter , Keintzel Thomas , Keck Tilmann , Riechelmann Herbert , Magele Astrid , Salcher Rolf , Maier Hannes , Mlynski Robert , Radeloff Andreas , Rak Kristen , Riss Dominik , Liepins Rudolfs , Hamzavi Sasan , Rasse Thomas , Potzinger Peter , Schmutzhard Joachim , Zorowka Patrick , Mittmann Philipp , Böheim Klaus , Todt Ingo
Published: May 2021

Objective:

Investigation of long-term safety and performance of an active, transcutaneous bone conduction implant in adults and children up to 36 months post-implantation.

Study Design:

Prospective, single-subject repeated-measures design.

Setting:

Otolaryngology departments of eight German and Austrian hospitals.∗†‡§||¶#∗∗†† Affiliations listed above that did not participate in the study.‡‡§§||||¶¶.

Patients:

Fifty seven German-speaking patients (49 adults and eight children) suffering from conductive or mixed hearing loss, with an upper bone conduction threshold limit of 45 dB HL at frequencies between 500 and 3000 Hz.

Intervention:

Implantation of the Bonebridge transcutaneous bone conduction hearing implant (tBCI).

Main Outcome Measures:

Patients’ audiometric pure tone averages (PTA4) (0.5, 1, 2, 4 kHz) thresholds (air conduction, bone conduction, and sound field) and speech perception (word recognition scores [WRS] and speech reception thresholds [SRT50%]) were tested preoperatively and up to 36 months postoperatively. Patients were also monitored for adverse events and administered quality-of-life questionnaires.

Results:

Speech perception (WRS: pre-op: 17.60%, initial activation [IA]: 74.23%, 3M: 83.65%, 12M: 83.46%, 24M: 84.23%, 36M: 84.42%; SRT50%: pre-op: 65.56 dB SPL, IA: 47.67 dB SPL, 3M: 42.61 dB SPL, 12M: 41.11 dB SPL, 24M: 41.74 dB SPL, 36M: 42.43 dB SPL) and sound field thresholds (pre-op: 57.66 dB HL, IA: 33.82 dB HL, 3M: 29.86 dB HL, 12M: 28.40 dB HL, 24M: 28.22 dB HL, 36M: 28.52 dB HL) improved significantly at all aided postoperative visits. Air and bone conduction thresholds showed no significant changes, confirming preservation of patients’ residual unaided hearing. All adverse events were resolved by the end of the study.

Conclusions:

Safety and performance of the tBCI was demonstrated in children and adults 36 months postoperatively.
What If the Destination Is Transplant? Outcomes of Destination Therapy Patients Who Were Transplanted
Authors: Atluri Pavan , Silvestry Scott C. , Teuteberg Jeffrey J. , Milano Carmelo A. , Selzman Craig H. , Cowger Jennifer A.
Published: May 2021

We sought to characterize patients who underwent heart transplant (HTx) following destination therapy (DT) implant in the combined ENDURANCE/ENDURANCE Supplemental Trials (DT/DT2). A post hoc analysis of the DT/DT2 trials was performed. Baseline characteristics and adverse events between the HTx and no-HTx cohorts were analyzed. Reasons for transplant were examined. Time to HTx was compared with contemporaneous HVAD BTT trial patients. Of the 604 DT/DT2 HVAD patients, 80 (13%) underwent HTx. The HTx cohort was younger (53.6 ± 11.1 vs. 65.2 ± 10.8, P < 0.0001) with fewer Caucasians (60.0% vs. 76.5%, P = 0.002), less ischemic cardiomyopathy (42.5% vs. 58.8%, P = 0.01), and atrial fibrillation (38.8% vs. 54.4%, P = 0.01). The HTx cohort had longer 6-minute walk distances (183.6 vs. 38.0 m, P = 0.02). Most HTx in DT/DT2 were categorized as elective (n = 63, 79%) and, of these, 70% were due to modification of behavioral issues and weight loss. Adverse events were the main indication for urgent HTx (n = 17, 21%). Median times to HTx were longer in DT/DT2 (550.0 days) versus BTT/lateral (285.2 days). In this post hoc analysis of the DT/DT2 trials, over 1 in 10 underwent heart transplantation within 3 years of HVAD support. In DT therapy patients, consideration for transplant following DT VAD implant may be feasible.
Ventilation Parameters Before Extracorporeal Membrane Oxygenator and In-Hospital Mortality in Children: A Review of the ELSO Registry
Authors: Polito Angelo , Dupuis-Lozeron Elise , Barbaro Ryan , Rimensberger Peter C.
Published: May 2021

The aim of this study was to evaluate the impact of pre-extracorporeal membrane oxygenation (ECMO) ventilatory parameters with in-hospital mortality in children with pediatric acute respiratory distress syndrome undergoing ECMO for respiratory indication. In this retrospective analysis of the Extracorporeal Life Support Organization (ELSO) Registry, all pediatric patients (≥29 days to ≤18 years) who required ECMO for respiratory indications were screened. The primary outcome was in-hospital mortality. From 2013 to 2017, 2,727 pediatric ECMO runs with a respiratory indication were reported to the ELSO registry. Overall mortality was 37%. Oxygenation Index (OI) and duration of mechanical ventilation (MV) before ECMO deployment were both independently associated with in-hospital mortality. No threshold effect for OI was observed. Pre-ECMO positive end-expiratory pressure and delta pressure levels were respectively lower and higher than recommended. Mortality rates for OI values between 4 and 60 and above oscillated between 32% and 45%. Children within a wider range of pre-ECMO OI (either below or above 40) might be considered as reasonable candidates for ECMO deployment. Larger, prospective multicenter studies to confirm the discriminatory ability of OI are warranted.
Effects of Continuous-Flow Left Ventricular Assist Device Therapy on Peripheral Vascular Function
Authors: Kaya Ersin , Kocabas Umut , Simsek Evrim , Nalbantgil Sanem , Kahraman Umit , Engin Cagatay , Yagdi Tahir , Ozbaran Mustafa , Akilli Azem
Published: May 2021

The peripheral vascular effects of continuous-flow left ventricular assist device (CF-LVAD) implantation are still unclear. The aim of the current study was to determine peripheral vascular function before and after implantation of CF-LVAD in patients with end-stage heart failure (HF), and to compare this data to age- and sex-matched chronic heart failure with reduced ejection fraction (HFrEF) patients. Forty-three consecutive end-stage HF patients (New York Heart Association [NYHA] class III/IV; three women and 40 men; mean age 53 ± 11 years) who planned to receive CF-LVAD implantation comprised the LVAD patient population, and their clinical characteristics, preoperative and third postoperative month peripheral vascular function assessment data including flow-mediated dilation (FMD) and pulsatility index (PI) assessed by ultrasound Doppler in brachial artery were compared to age- and sex-matched chronic, stable HFrEF patients (NYHA class II; five women and 30 men; mean age 51 ± 10 years). After CF-LVAD implantation, median FMD decreased from 5.4 to 3.7% (p < 0.001), and median PI decreased from 6.9 to 1.4 (p < 0.001). In patients with end-stage HF before CF-LVAD implantation, FMD and PI were significantly lower compared to the chronic HFrEF patients (FMD: 5.4% ± 0.9% vs. 7.6% ± 1.1%; p < 0.001, respectively) and (PI: 6.9 ± 1.3 vs. 7.4 ± 1.2; p = 0.023, respectively). The current study revealed impaired peripheral vascular function in the end-stage HF patients compared to stable HFrEF patients, and documented the deterioration of peripheral vascular function after CF-LVAD implantation. These results suggest that impaired peripheral vascular function in the CF-LVAD patients compared to preoperative assessment is a consequence of the nonpulsatile blood flow due to the continuous-flow mechanical support.
Hemolysis Testing In Vitro: A Review of Challenges and Potential Improvements
Authors: von Petersdorff-Campen Kai , Schmid Daners Marianne
Published: May 2021

Many medical devices such as cardiopulmonary bypass systems, mechanical heart valves, or ventricular assist devices are intended to come into contact with blood flow during use. In vitro hemolysis testing can provide valuable information about the hemocompatibility of prototypes and thus help reduce the number of animal experiments required. Such tests play an important role as research and development tools for objective comparisons of prototypes and devices as well as for the extrapolation of their results to clinical outcomes. Therefore, it is important to explore and provide new ways to improve current practices. In this article, the main challenges of hemolysis testing are described, namely the difficult blood sourcing, the high experimental workload, and the low reproducibility of test results. Several approaches to address the challenges identified are proposed and the respective literature is reviewed. These include the replacement of blood as the “shear-sensitive fluid” by alternative test fluids, the replacement of sparse, manual sampling and blood damage assessment by a continuous and automated monitoring, as well as an analysis of categories and causes of variability in hemolysis test results that may serve as a structural template for future studies.
Right Ventricular Global Longitudinal Strain as a Predictor of Acute and Early Right Heart Failure Post Left Ventricular Assist Device Implantation
Authors: Liang Lusha W. , Jamil Alisha , Mazurek Jeremy A. , Urgo Kimberly A. , Wald Joyce , Birati Edo Y. , Han Yuchi
Published: May 2021

Early right heart failure (RHF) occurs in up to 40% of patients following left ventricular assist device (LVAD) implantation and is associated with increased morbidity and mortality. The most recent report from the Mechanical Circulatory Support-Academic Research Consortium (MCS-ARC) working group subdivides early RHF into early acute RHF and early postimplant RHF. We sought to determine the effectiveness of right ventricular (RV) longitudinal strain (LS) in predicting RHF according to the new MCS-ARC definition. We retrospectively analyzed clinical and echocardiographic data of patients who underwent LVAD implantation between 2015 and 2018. RVLS in the 4-chamber (4ch), RV outflow tract, and subcostal views were measured on pre-LVAD echocardiograms. Fifty-five patients were included in this study. Six patients (11%) suffered early acute RHF, requiring concomitant RVAD implantation intraoperatively. Twenty-two patients (40%) had postimplant RHF. RVLS was significantly reduced in patients who developed early acute and postimplant RHF. At a cutoff of −9.7%, 4ch RVLS had a sensitivity of 88.9% and a specificity of 77.8% for predicting RHF and area under the receiver operating characteristic curve of 0.86 (95% confidence interval 0.76–0.97). Echocardiographic RV strain outperformed more invasive hemodynamic measures and clinical parameters in predicting RHF.
Fluid Balance Management Informs Renal Replacement Therapy Use During Pediatric Extracorporeal Membrane Oxygenation: A Survey Report From the Kidney Intervention During Extracorporeal Membrane Oxygenation Group
Authors: Gorga Stephen M. , Lima Lisa , Askenazi David J. , Bridges Brian C. , Cooper David S. , Paden Matthew L. , Zappitelli Michael , Gist Katja M. , Gien Jason , Jetton Jennifer G. , Murphy Heidi J. , Fleming Geoffrey M. , Selewski David T. , Basu Rajit K.
Published: May 2021

Fluid overload (FO) and acute kidney injury (AKI) occur commonly in children supported with extracorporeal membrane oxygenation (ECMO). Continuous renal replacement therapy (CRRT) may be used to manage AKI and FO in children on ECMO. In 2012, our group surveyed ECMO centers to begin to understand the practice patterns around CRRT and ECMO. Since then, more centers are initiating ECMO for increasingly diverse indications and an increased volume of research quantifies the detrimental impacts of AKI and FO. We, therefore, investigated practice patterns of CRRT utilization during ECMO in children. A multi-point survey instrument was distributed to 116 international neonatal and pediatric ECMO centers. Sixty of 116 (51.7%) international neonatal and pediatric ECMO centers responded. All reports using CRRT on ECMO, compared with 75% from the 2012 survey. Eighty-five percent use CRRT to treat or prevent FO, an increased from 59%. The modality of CRRT therapy differed between in-line (slow continuous ultrafiltration, 84.4%) and machine-based (continuous venovenous hemodiafiltration, 87.3%) methods. Most (65%) do not have protocols for fluid management, AKI, or CRRT on ECMO. Trialing off CRRT is dictated by physician preference in 90% (54/60), with varying definitions of success. In this survey study, we found that CRRT use during pediatric ECMO has increased since 2012 with fluid management representing the predominant indication for initiation. Despite the expanded utilization of CRRT with ECMO, there remains significant practice variation in terms of method, modality, indication, the timing of initiation, fluid management, and discontinuation.
Electrophysiologic Changes and Their Effects on Ventricular Arrhythmias in Patients with Continuous-Flow Left Ventricular Assist Devices
Authors: Celik Mehmet , Emiroglu Mehmet Yunus , Bayram Zubeyde , Izci Servet , Karagoz Ali , Akbal Ozgur Yasar , Kahyaoglu Muzaffer , Kup Ayhan , Yilmaz Yusuf , Kirali Mehmet Kaan , Ozdemir Nihal
Published: May 2021

Ventricular arrhythmias (VAs) continue even after left ventricular assist device (LVAD) implantation. The effect of LVAD on VAs is controversial. We investigated electrophysiologic changes after LVAD and its effects on VAs development. A total of 107 implantable cardioverter-defibrillator (ICD) patients, with LVAD, were included in this study. Electrocardiographic parameters including QRS duration (between the beginning of the QRS complex and the end of the S wave), QT duration (between the first deflection of the QRS complex and the end of the T wave) corrected QT (QTc), QTc dispersion, fragmented QRS (F-QRS), and ICD recordings before, and post-LVAD first year were analyzed. All sustained VAs were classified as polymorphic ventricular tachycardia (PVT) or monomorphic VT (MVT). The QRS, QT, QTc durations, and QTc dispersion had decreased significantly after LVAD implantation (p < 0.001 for all). Also MVT increased significantly from 28.9% to 49.5% (p = 0.019) whereas PVT decreased from 27.1% to 4.67% (p = 0.04) compared to pre-LVAD period. A strong correlation was found between QT shortening and the decrease in PVT occurrence. Besides, the increase in the F-QRS after LVAD was associated with post-LVAD de nova MVT development. Finally, F-QRS before LVAD was found as an independent predictor of post-LVAD late VAs in multivariate analysis. Pre-existing or newly developed F-QRS was associated with post-LVAD late VAs, and it may be used to determine the risk of VAs after LVAD implantation.
Artificial intelligence in functional urology: how it may shape the future
Authors: Bentellis Imad , Guérin Sonia , Khene Zine-Eddine , Khavari Rose , Peyronnet Benoit
Published: May 2021

Purpose of review

The aim of the present manuscript is to provide an overview on the current state of artificial intelligence (AI) tools in either decision making, diagnosis, treatment options, or outcome prediction in functional urology.

Recent findings

Several recent studies have shed light on the promising potential of AI in functional urology to investigate lower urinary tract dysfunction pathophysiology but also as a diagnostic tool by enhancing the existing evaluations such as dynamic magnetic resonance imaging or urodynamics. AI may also improve surgical education and training because of its automated performance metrics recording. By bringing prediction models, AI may also have strong therapeutic implications in the field of functional urology in the near future. AI may also be implemented in innovative devices such as e-bladder diary and electromechanical artificial urinary sphincter and could facilitate the development of remote medicine.

Over the past decade, the enthusiasm for AI has been rising exponentially. Machine learning was well known, but the increasing power of processors and the amount of data available has provided the platform for deep learning tools to expand. Although the literature on the applications of AI technology in the field of functional urology is relatively sparse, its possible uses are countless especially in surgical training, imaging, urodynamics, and innovative devices.
Disparities in Nurse Job Dissatisfaction and Intent to Leave
Authors: Carthon J. Margo Brooks , Travers Jasmine L. , Hounshell Danielle , Udoeyo Idorenyin , Chittams Jesse
Published: May 2021

OBJECTIVE

To determine if Black nurses are more likely to report job dissatisfaction and whether factors related to dissatisfaction influence differences in intent to leave.

BACKGROUND

Minority nurses report higher job dissatisfaction and intent to leave, yet little is known about factors associated with these differences in community settings.

METHOD

Cross-sectional analysis of 11 778 nurses working in community-based settings was conducted. Logistic regression was used to estimate the association among race, job satisfaction, and intent to leave.

RESULTS

Black nurses were more likely to report job dissatisfaction and intent to leave. Black nurses' intent to leave decreased in adjusted models that accounted for dissatisfaction with aspects of their jobs including salary, advancement opportunities, autonomy, and tuition benefits.

CONCLUSION

Nurse administrators may find opportunities to decrease intent to leave among Black nurses through focused efforts to target areas of dissatisfaction.
The Nurse Manager's Experience of Moral Distress
Authors: Whitehead Phyllis B. , Carter Kimberly Ferren , Garber Jeannie S. , Epstein Beth
Published: May 2021

The purpose of this study was to describe the moral distress experiences of nurse managers. Moral distress has been studied among direct patient care providers including nurses and physicians. The moral distress experience among nurse managers is less understood. We conducted a qualitative descriptive study with 19 nurse managers from 5 healthcare institutions in Virginia. Interview data were analyzed using a directed content analysis, as the structural components of the moral distress phenomenon are already known. Participants suffered moral distress when they were unable to achieve or maintain effective unit function and felt caught in the middle between their units' and employees' needs and organizational directives. System-level causes of moral distress are common among nurse managers. Future research should involve measurement of moral distress among nurse managers and exploration of effective interventions.
Terminal Ileum Perforation
Authors: Duffy Michael , Kesha Kilak , Glenn Charley , Stables Simon , Tse Rexson Datquen
Published: May 2021

Intestinal perforation is an uncommon complication and presentation of verocytotoxigenic Escherichia coli (VTEC) infection in individuals with Prader-Willi syndrome (PWS). The common site of perforation from VTEC infection is in the colon (and almost exclusively in the pediatric population), whereas PWS is in the stomach. Terminal ileum perforation is uncommon and is not reported in either these 2 conditions. We report a death from terminal ileum perforations in an adult who had PWS and was infected with VTEC. Potential reasons why the perforation occurred at this rare location, rather than in other more common location, in an adult are discussed.
Validation of Septic Knee Monoarthritis Prediction Rule in a Lyme Disease Endemic Area
Authors: Grant Duncan S. , Neville Desiree N. , Levas Michael , Balamuth Fran , Garro Aris C. , Bennett Jonathan E. , Thompson Amy D. , Kharbanda Anupam B. , Lyons Todd W. , Nigrovic Lise E. ,   for Pedi Lyme Net
Published: May 2021

Objective

In Lyme disease endemic areas, Lyme and septic arthritis often present similarly. A published septic knee arthritis clinical prediction rule includes 2 high-risk predictors: absolute neutrophil count of 10,000 cells/mm3 or greater and erythrocyte sedimentation rate of 40 mm/h or greater. The objective of the study was to externally validate this prediction rule in a multicenter prospective cohort.

Methods

We enrolled a prospective cohort of children with knee monoarthritis undergoing evaluation for Lyme disease at 1 of 8 Pedi Lyme Net emergency departments located in endemic areas. We defined a case of septic arthritis with a positive synovial fluid culture or a synovial fluid white blood cell count of 50,000 or greater per high powered field with a positive blood culture and Lyme arthritis with a positive or equivocal C6 EIA, followed by a positive supplemental immunoblot. Other children were classified as having inflammatory arthritis. We report the performance of the septic arthritis clinical prediction rule in our study population.

Results

Of the 543 eligible children, 13 had septic arthritis (2.4%), 234 Lyme arthritis (43.1%), and 296 inflammatory arthritis (54.5%). Of the 457 children (84.2%) with available laboratory predictors, all children with septic arthritis were classified as high risk (sensitivity, 100%; 95% confidence interval [CI], 77.2%–100%; specificity, 68.1%; 95% CI, 63.6–73.3; negative predictive value, 278/278 [100%]; 95% CI, 98.6%–100%). Of the 303 low-risk children, 52 (17.2%) underwent diagnostic arthrocentesis.

Conclusions

The septic knee arthritis clinical prediction rule accurately distinguished between septic and Lyme arthritis in an endemic area. Clinical application may reduce unnecessary invasive diagnostic procedures.
Inclusion of Albumin in the Initial Resuscitation of Adult Patients with Medical Sepsis or Septic Shock: a Propensity Score-Matched Analysis
Authors: Liu Chang , Li Heyi , Peng Zhiyong , Hu Bo , Dong Yue , Gao Xiaolan , Frank Ryan D. , Kashyap Rahul , Gajic Ognjen , Kashani Kianoush B.
Published: May 2021

Introduction:

The impact of albumin resuscitation on sepsis outcomes is debated, particularly in the initial phase of resuscitation. We aimed to investigate the association between albumin use in the initial 6 h of resuscitation and subsequent outcomes in adult septic patients.

Methods:

This single-center, retrospective, propensity score-matched cohort study included adult patients admitted to intensive care units (ICUs) with sepsis or septic shock from January 1, 2006, to May 4, 2018, at a tertiary referral hospital. We compared two groups based on albumin receipt within the initial six resuscitation hours (albumin group vs. non-albumin group). We performed a 1:2 propensity score matching to assess shock-free time in ICU as the primary outcome.

Results:

Of 2,732 patients with medical sepsis, 286 cases in the albumin group were matched with 549 individuals in the non-albumin group. Compared to the non-albumin group, the albumin group required more intravenous fluids and had higher net fluid balance, lower mean arterial pressure, and lower serum base excess level in the initial 6 and 24 h of resuscitation. Shock-free time, ICU and hospital length of stay, and 28-day mortality were not different between albumin and non-albumin groups (56 vs. 66 h, P = 0.18; 3.5 days vs. 3.7 days, P = 0.61; 9.1 days vs. 9.5 days, P = 0.27; 36% vs. 32%, P = 0.25, respectively).

Conclusions:

Using albumin during the initial 6 h of resuscitation was not associated with benefits in clinical outcomes of patients with medical sepsis.
Cost savings from managing hypertension in primary health care clinics in Kuwait
Authors: Odeh Ayah , Aljunid Syed Mohamed , Al-Wotayan Rihab , Annaka Mahmoud , Mari Mohammad Al
Published: May 2021

Background

Generic medications are one of the most common solutions for bringing down pharmaceutical costs for both patients and health care providers. Efforts to increase uptake of generics include policies to support generic substitution and prescription. The aim of this study is to estimate the total cost of drugs prescribed by physicians in selected primary health care centers for managing hypertension and the potential cost savings from substituting generic drugs for branded ones

Methods and Findings

One thousand patients with hypertension were randomly selected from the Primary Care Information System database from among patients who sought treatment at three primary health care centers from Al-Jahra governorate in Kuwait from January to December 2018. Generic antihypertensive drugs were substituted for branded ones, and cost savings were calculated by referring to the International Drug Price Indicator Guide. The mean age of 1,000 patients was 57.01 (SD = 11.82) years. Most (57.4%) of the patients were females, and 50.2% were Kuwaitis. The mean number of drugs per prescription was 1.78 (SD = 1.25; range: 1 to 9 drugs). The total number of drugs prescribed was 1,781, with a total cost of KD 10,093 and with a mean of KD 10.09 (SD = 7.34). Only 71 generic drugs had been prescribed, making the generic prescription rate 4.0%. The total number of antihypertensive drugs prescribed was 1,206 (mean: 1.21; SD = 0.46), with a cost of KD 7,678.5 (mean = KD 7.68; SD = 4.06) and with ACE inhibitors as the most prescribed class at 32.19%. Eight hundred ninety antihypertensive drugs were substituted for 774 patients at estimated cost savings of KD 5,675; that is, substituting generic drugs reduced antihypertensive drug cost by 74%.

Conclusion

Generic drug prescription appears to be low among primary care physicians in health care centers in Kuwait, but these centers could see substantial cost savings from substituting generic antihypertensive drugs for branded ones. Active interventions are needed to encourage generic prescription among health practitioners to reduce the overall pharmaceutical expenditures.
Thalamic white matter macrostructure and subnuclei volumes in Parkinson’s disease depression
Authors: Bhome R , Zarkali A , Cole JH , Weil RS
Published: May 2021

Objective

Depression is a common non-motor feature of Parkinson’s disease (PD) which confers significant morbidity and is often challenging to treat. The thalamus is a key component in the basal ganglia - thalamocortical network critical to pathogenesis of PD and depression but the precise thalamic subnuclei involved in PD depression have not yet been identified and may even represent potential therapeutic targets.

Methods

We performed structural and diffusion weighted imaging on 76 participants with PD to evaluate the relationship between PD depression and grey and white matter thalamic subnuclear changes. We used a thalamic segmentation method to divide the thalamus into its 50 constituent subnuclei (25 each hemisphere). We used fixel based analysis of diffusion weighted imaging data to calculate mean fibre cross section (FC) for white matter tracts connected to each subnucleus and assessed volume and FC at baseline and 14-20 months follow-up. A generalised linear mixed model was used to evaluate the relationship between depression, subnuclei volume and mean FC for each of the 50 thalamic subnuclei, adjusting for age, gender, intracranial volume and time.

Results

We found that depression scores in PD were associated with lower right pulvinar anterior (PuA) subnucleus volume. Antidepressant use was associated with higher right PuA volume suggesting a possible protective effect of treatment. After follow-up, depression scores were associated with decreases in white matter tract macrostructure across almost all tracts connected to thalamic subnuclei.

Conclusion

We demonstrate that depression is associated with right thalamic PuA subnucleus volume loss and widespread thalamic white matter macrostructural changes, but that antidepressants may protect against volume loss in PD depression. Our work provides mechanistic insights for depression in PD, suggests possible benefits of actively treating depression, and a potential target for therapeutic intervention to the PuA subnucleus for PD depression.
The predictive value of interictal scalp EEG findings in aiding the detection of malformations of cortical development in temporal lobe epilepsy and impact on surgical planning
Authors: Fuchs Jeffrey W. , Shlobin Nathan A. , Hopkins Benjamin S. , Husain Zehra , Cloney Michael B. , Tyrtova Evgeniya , Farooque Pue , Templer Jessica W. , Bandt S. Kathleen
Published: May 2021

Background: Complete resection of focal malformations of cortical development (MCD) has been recognized as crucial for the success of epilepsy surgery. However, many of these lesions escape detection using even state-of-the-art epilepsy protocol MRI imaging. This study evaluates the concurrence of radiographic and histopathologic findings of MCD in patients with refractory temporal lobe epilepsy (TLE) and defines the predictive value of EEG findings in the detection of MCD.
Materials and Methods: Pre-operative MRI, scalp VEEG, and post-operative surgical pathology reports from 34 consecutive patients treated for refractory TLE by surgical resection over a ten year period were included in analysis. Radiographic findings of MCD were correlated with histopathologic findings of MCD and compared against pre-operative interictal scalp EEG findings.
Results: 66.7% of focal cortical dysplasias (FCD) identified on pathology and all cases of mild MCD (mMCD) were missed on pre-operative MRI. The description of a rhythmic or continuous interictal abnormality on pre-operative VEEG corresponds to a sensitivity of 73.1% and a specificity of 62.5% in detecting either FCD or mMCD. Of the patients who had a radiographically occult FCD, 80% had either a continuous or rhythmic interictal abnormality described in the interpretation of their pre-operative VEEG.
Conclusion: This study highlights the high prevalence of MCDs in refractory TLE and the high rate of missed MCDs on pre-operative MRI. Findings here suggest that pre-operative scalp EEG may be able to provide additional information in the pre-operative detection of MCDs and therefore inform surgical decision making.