bluuebunny/crossref_metadata_2025 huggingface dataset:
High-pressure artificial pneumothorax promotes invasion and metastasis of oesophageal cancer cells
Authors: Jiang Tian , Lin Miao , Zhan Cheng , Zhao Mengnan , Yang Xinyu , Li Ming , Feng Mingxiang
Published: February 2019

OBJECTIVES

This study aimed to investigate the viability, apoptosis, invasion and metastasis of oesophageal cancer cells in a simulated artificial pneumothorax model and to explore its potential mechanism of action.

METHODS

Oesophageal cancer cells were subjected to a simulated thoracoscopic CO2 pneumothorax environment with different pressures and exposure times (low-pressure group: 8 mmHg 1 h or 8 mmHg 4 h; high-pressure group: 12 mmHg 1 h). Cell viability, apoptosis, invasive capacity and mRNA expression of adhesion- and metastasis-related molecules in each group were detected. To explore in greater detail the potential reasons for the changes in biological behaviour under the high-pressure CO2 environment, we designed 3 additional experimental groups: (i) high-pressure group, (ii) hypoxia group and (iii) pH decrease group. An miRNA microarray analysis was performed by comparing 2 paired samples of cells from the high-pressure group and the control group.

RESULTS

Treatment with high-pressure CO2 pneumothorax significantly increased the cell viability (P < 0.001) and the cell invasion (P < 0.001). Significantly higher expression of adhesive- and metastasis-related molecules was also observed. Further experiments indicated that the high-pressure CO2 pneumothorax might increase cell invasion and metastasis through the high pressure and decreased pH. The miRNA microarray analysis results suggested that several potential pathways related to cancer development: the RhoA pathway, the PI3K-Akt signalling pathway and the MAPK signalling pathway.

CONCLUSIONS

The application of high-pressure CO2 pneumothorax promoted the invasion and metastasis of oesophageal cancer cells through high pressure and decreased pH. This process might be related to several signalling pathways.
The impact of health information technology on the management and follow-up of test results – a systematic review
Authors: Georgiou Andrew , Li Julie , Thomas Judith , Dahm Maria R , Westbrook Johanna I
Published: February 2019

Objective

To investigate the impact of health information technology (IT) systems on clinicians’ work practices and patient engagement in the management and follow-up of test results.

Materials and Methods

A search for studies reporting health IT systems and clinician test results management was conducted in the following databases: MEDLINE, EMBASE, CINAHL, Web of Science, ScienceDirect, ProQuest, and Scopus from January 1999 to June 2018. Test results follow-up was defined as provider follow-up of results for tests that were sent to the laboratory and radiology services for processing or analysis.

Results

There are some findings from controlled studies showing that health IT can improve the proportion of tests followed-up (15 percentage point change) and increase physician awareness of test results that require action (24–28 percentage point change). Taken as whole, however, the evidence of the impact of health IT on test result management and follow-up is not strong.

Discussion

The development of safe and effective test results management IT systems should pivot on several axes. These axes include 1) patient-centerd engagement (involving shared, timely, and meaningful information); 2) diagnostic processes (that involve the integration of multiple people and different clinical settings across the health care spectrum); and 3) organizational communications (the myriad of multi- transactional processes requiring feedback, iteration, and confirmation) that contribute to the patient care process.

Conclusion

Existing evidence indicates that health IT in and of itself does not (and most likely cannot) provide a complete solution to issues related to test results management and follow-up.
Electrophysiological and behavioral responses of Bradysia odoriphaga (Diptera: Sciaridae) to volatiles from its Host Plant, Chinese Chives (Allium tuberosum Rottler ex Spreng)
Authors: Yang Yuting , Su Qi , Shi Linlin , Chen Gong , Zeng Yang , Shi Caihua , Zhang Youjun
Published: February 2019

Bradysia odoriphaga Yang et Zhang is a serious belowground pest of Chinese chives (Allium tuberosum). Our previous studies have indicated that B. odoriphaga females prefer to oviposit near the roots of Chinese chives rather than the roots of other plants, and that the performance (longevity and fecundity) of B. odoriphaga offspring was better on Chinese chives than on Lettuce (var. ramosa Hort.), Onion (Allium cepa) and Potato (Solanum tuberosum) but little is known about how the volatiles released by Chinese chives affect the host-finding and oviposition behaviors of B. odoriphaga. Here, we used gas chromatography-mass spectrometry and determined that Chinese chives releases the following volatiles: methyl allyl disulfide, β-myrcene, cis-ocimene, diallyl disulfide, nonane, n-dodecane, n-tetradecane, and n-hexadecane; quantities released were highest for methyl allyl disulfide and diallyl disulfide. In addition to eliciting strong responses in females in electroantennography assays, the latter two sulfur compounds and their mixtures attracted females in Y-tube olfactometer assays. The addition of methyl allyl disulfide, diallyl disulfide, or a mixture of the two compounds at a 1:5 ratio to chive plants increased oviposition when compared to control plants. These results indicate that methyl allyl disulfide and diallyl disulfide, either alone or in combination, influence the host-seeking behavior of B. odoriphaga.
A Kantian Account of Emotions as Feelings1
Authors: Cohen Alix
Published: February 2019

The aim of this paper is to extract from Kant's writings an account of the nature of the emotions and their function – and to do so despite the fact that Kant neither uses the term ‘emotion’ nor offers a systematic treatment of it. Kant's position, as I interpret it, challenges the contemporary trends that define emotions in terms of other mental states and defines them instead first and foremost as ‘feelings’. Although Kant's views on the nature of feelings have drawn surprisingly little attention, I argue that the faculty of feeling has the distinct role of making us aware of the way our faculties relate to each other and to the world. As I show, feelings are affective appraisals of our activity, and as such they play an indispensable orientational function in the Kantian mind. After spelling out Kant's distinction between feeling and desire (§2), I turn to the distinction between feeling and cognition (§3) and show that while feelings are non-cognitive states, they have a form of derived-intentionality. §4 argues that what feelings are about, in this derived sense, is our relationship to ourselves and the world: they function as affective appraisals of the state of our agency. §5 shows that this function is necessary to the activity of the mind insofar as it is orientational. Finally, §6 discusses the examples of epistemic pleasure and moral contentment and argues that they manifest the conditions of cognitive and moral agency respectively.
H i galaxies with little star formation: an abundance of LIERs
Authors: Parkash Vaishali , Brown Michael J I , Jarrett T H , Fraser-McKelvie A , Cluver M E
Published: February 2019

We present a sample of 91 H i galaxies with little or no star formation, and discuss the analysis of the integral field unit (IFU) spectra of 28 of these galaxies. We identified H i galaxies from the H i Parkes All-Sky Survey Catalog (HICAT) with Wide-field Infrared Survey Explorer (WISE) colours consistent with low specific star formation (<10−10.4 yr−1), and obtained optical IFU spectra with the Wide-Field Spectrograph (WiFeS). Visual inspection of the PanSTARRS, Dark Energy Survey, and Carnegie-Irvine imaging of 62 galaxies reveals that at least 32 galaxies in the sample have low levels of star formation, primarily in arms/rings. New IFU spectra of 28 of these galaxies reveals 3 galaxies with central star formation, 1 galaxy with low-ionization nuclear emission-line regions (LINERs), 20 with extended low-ionization emission-line regions (LIERs), and 4 with high excitation Seyfert (Sy) emission. From the spectroscopic analysis of H i selected galaxies with little star formation, we conclude that 75 per cent of this population are LINERs/LIERs.
Evident black hole-bulge coevolution in the distant universe
Authors: Yang(杨光) G , Brandt W N , Alexander D M , Chen(陳建廷) C-T J , Ni(倪清泠) Q , Vito F , Zhu(朱飞凡) F-F
Published: February 2019

Observations in the local universe show a tight correlation between the masses of supermassive black holes (SMBHs; MBH) and host-galaxy bulges (Mbulge), suggesting a strong connection between SMBH and bulge growth. However, direct evidence for such a connection in the distant universe remains elusive. We have studied sample-averaged SMBH accretion rate ($\overline{\rm BHAR}$) for bulge-dominated galaxies at z = 0.5–3. While previous observations found $\overline{\rm BHAR}$ is strongly related to host-galaxy stellar mass (M⋆) for the overall galaxy population, our analyses show that, for the bulge-dominated population, $\overline{\rm BHAR}$ is mainly related to SFR rather than M⋆. This ${\overline{\rm BHAR}}$–SFR relation is highly significant, e.g. 9.0σ (Pearson statistic) at z = 0.5–1.5. Such a $\overline{\rm BHAR}$–SFR connection does not exist among our comparison sample of galaxies that are not bulge dominated, for which M⋆ appears to be the main determinant of SMBH accretion. This difference between the bulge-dominated and comparison samples indicates that SMBHs only coevolve with bulges rather than the entire galaxies, explaining the tightness of the local MBH−Mbulge correlation. Our best-fitting ${\overline{\rm BHAR}}$–SFR relation for the bulge-dominated sample is ${\log \overline{\rm BHAR}= \log \mathrm{SFR} - (2.48\pm 0.05)}$ (solar units). The best-fitting $\overline{\rm BHAR}/\mathrm{SFR}$ ratio (10−2.48) for bulge-dominated galaxies is similar to the observed MBH/Mbulge values in the local universe. Our results reveal that SMBH and bulge growth are in lockstep, and thus non-causal scenarios of merger averaging are unlikely the origin of the MBH−Mbulge correlation. This lockstep growth also predicts that the MBH−Mbulge relation should not have strong redshift dependence.
Factors in the Building of Effective Patient–Provider Relationships in the Context of Fibromyalgia
Authors: Chen Annie T , Swaminathan Aarti
Published: February 2019

Objective

Fibromyalgia patients face particular challenges in building relationships with health care providers. In this study, we examine, from patients’ perspectives, factors that influence the formation of effective patient–provider relationships.

Design

This research employed a qualitative approach to analyze data collected from a study that employed semistructured interviews.

Methods

Multiple methods were used to recruit 23 fibromyalgia patients for interviews. Semistructured interviews were conducted to explore how participants’ information behaviors, including their communication with and relationships to providers, changed over time. The interview data were analyzed using a qualitative analytic method based on interpretative phenomenological analysis and constructivist grounded theory.

Results

We identified three important factors that influenced the building of effective relationships: patients and providers’ interactions involving information, identifying health care providers that fit patients’ needs, and realizing shared responsibilities. With regard to information, we described three important themes: information gaps, providers as educators/facilitators, and collaborative information behavior.

Conclusions

Understanding of the key elements of relationship development between patients and providers can be utilized in various ways to improve clinical care. First, the knowledge gained in this study can inform the design of patient education materials that assist patients to identify providers that fit their needs, prepare for consultations, and develop realistic expectations for providers. The findings of this study can also inform the design of resources and tools to enable clinicians to communicate and relate better with their patients.
A systematic review and meta-analysis of infection risk with small molecule JAK inhibitors in rheumatoid arthritis
Authors: Bechman Katie , Subesinghe Sujith , Norton Sam , Atzeni Fabiola , Galli Massimo , Cope Andrew P , Winthrop Kevin L , Galloway James B
Published: February 2019

Objectives

To evaluate the risk of serious infection (SI) and herpes zoster (HZ) in rheumatoid arthritis patients receiving JAK inhibitors.

Methods

We conducted a systematic literature review and meta-analysis of phase II and III randomized controlled trials of tofacitinib (5 mg bid), baricitinib (4 mg od) and upadacitinib (15 mg od). Patient-exposure years were calculated. A per-protocol analysis was applied, incorporating follow-up time from patients randomized to placebo who cross into the treatment arm. Pooled incidence rates per 100 person-years of SI and HZ were calculated. Incidence rate ratios (IRRs) of drug vs placebo were compared using a meta-synthesis approach.

Results

Twenty-one studies were included in the meta-analysis; 11 tofacitinib (5888 patients), six baricitinib (3520 patients) and four upadacitinib studies (1736 patients). For SI, the incidence rates were 1.97 (95% CI: 1.41, 2.68), 3.16 (95% CI: 2.07, 4.63) and 3.02 (95% CI: 0.98, 7.04), respectively. The IRRs comparing treatment arm to placebo were statistically non-significant: 1.22 (95% CI: 0.60, 2.45), 0.80 (95% CI: 0.46, 1.38) and 1.14 (95% CI: 0.24, 5.43), respectively. For HZ, the incidence rates were 2.51 (95% CI: 1.87, 3.30), 3.16 (95% CI: 2.07, 4.63) and 2.41 (95% CI: 0.66, 6.18), respectively. The IRR of HZ comparing baricitinib with placebo was 2.86 (95% CI: 1.26, 6.50). Non-significant IRRs were seen with tofacitinib and upadacitinib: 1.38 (95% CI: 0.66, 2.88) and 0.78 (95% CI: 0.19, 3.22), respectively. Indicator opportunistic infections excluding HZ were too rare to provide meaningful incidence rates.

Conclusion

The absolute SI rates were low. However across the JAK inhibitors, the incidence of HZ is higher than expected for the population (3.23 per 100 patient-years). While the risk was numerically greatest with baricitinib, indirect comparisons between the drugs did not demonstrate any significant difference in risk.

Systematic review registration number

Prospero 2017 CRD4201707879.
Silicone Foam Dressing for Prevention of Sacral Deep Tissue Injuries Among Cardiac Surgery Patients
Authors: Strauss Robyn , Preston Ave , Zalman Demetra C. , Rao Aditi D.
Published: February 2019

OBJECTIVE:

To evaluate the effect of silicone foam dressings, placed preoperatively, on the incidence of postoperative sacral deep-tissue pressure injuries.

DESIGN, SETTING, AND PATIENTS:

An uncontrolled before-and-after quality improvement method was used. Within a single, urban academic medical center, consecutively admitted adult cardiac surgery patients were included in the pre- and postintervention groups; only those receiving elective procedures were included.

INTERVENTION:

Nurses applied a sacral silicone foam dressing preoperatively. This dressing was maintained on the patient’s sacrum intraoperatively and postoperatively for up to 5 days in the intensive care and step-down units.

MAIN RESULTS:

This project demonstrated a clinically significant decrease (P < .02) in the incidence of postoperative sacral deep-tissue pressure injuries from 2.3% (preintervention, n = 300) to 0% (postintervention, n = 224). These results were sustained for 24 months after the trial was completed.

CONCLUSIONS:

The use of silicone foam dressings may be an effective prophylactic intervention to reduce the incidence of perioperative deep-tissue pressure injuries among cardiac surgery patients, a high-risk population.
Opioid use disorder during pregnancy
Authors: Carter Lillian C. , Read Molly A. , Read Laura , Nicholas Joyce S. , Schmidt Eric
Published: February 2019

Women with opioid use disorder who become pregnant are a particularly vulnerable population and require a comprehensive treatment approach for mother and fetus. Research is continuing on opioid use disorder, effects of opioid use on the fetus, and best treatment approaches. This article reviews current recommendations and guidelines for treatment.
CE: Type 2 Diabetes: A Pharmacologic Update
Authors: Keresztes Patricia , Peacock-Johnson Annette
Published: February 2019

Of the more than 30 million Americans who have diabetes mellitus, as many as 95% have type 2 diabetes. While interventions for type 2 diabetes include modifying diet and exercise, pharmacologic therapy is a mainstay in diabetes treatment. In recent years, with the addition of new medications and medication classifications, pharmacologic therapy for type 2 diabetes has changed dramatically. Nurses need to understand the many pharmacologic agents and combination therapies now in use. This article includes established as well as more recently introduced type 2 diabetes medications, as well as nursing implications regarding patient education and the monitoring of patients for adverse effects.
Family Caregivers and the Decisions They Make
Authors: Kennedy Maureen Shawn
Published: February 2019

More education, support, and preparation are needed.
Adapting the Nurse Manager Role to Attract Generation X and Millennial Nurses
Authors: Moyo Muriel R.
Published: February 2019

The coming wave of baby boomer retirements presents a challenge—and an opportunity.
The American Life Span Gets Shorter
Authors: Sofer Dalia
Published: February 2019

The data reflect more deaths from suicide and drug overdose.
Rethinking Health Care to Spur Competition
Authors: Potera Carol
Published: February 2019

Changing scope-of-practice laws is one approach.
Technology Is Transforming Work for Nurses and Care for Patients
Authors: Kritz Fran
Published: February 2019

Robots, artificial intelligence, and digital displays are among the changes.
FDA Issues Safety Alert for Leukemia Drug
Authors: Aschenbrenner Diane S.
Published: February 2019

The Food and Drug Administration is alerting health care providers about the need for early recognition and management of differentiation syndrome, a potentially lethal condition that can occur in patients receiving enasidenib (Idhifa) for acute myeloid leukemia.

The rapid proliferation and differentiation of myeloid cells produces the signs and symptoms of differentiation syndrome, which include acute respiratory distress, fever, and peripheral edema with weight gain.
An Evidence-Based Approach to Precepting New Nurses
Authors: Barba Michael , Valdez-Delgado Krystal , VanFosson Christopher A. , Caldwell Nicole W. , Boyer Susan , Robbins Johnnie , Mann-Salinas Elizabeth A.
Published: February 2019

While developing a standardized approach to orient new staff in the U.S. Army Institute of Surgical Research Burn Center at Fort Sam Houston in Texas, nurse leaders identified the need to also standardize preceptor selection and instruction. A multidisciplinary research team conducted a two-year pilot project based on the evidence-based Vermont Nurses in Partnership Clinical Transition Framework, which provides a structured method for preceptor selection, development, and evaluation. Minimum preceptor qualifications; preceptor validation processes; and modifiable, unit-specific coaching tools were established. The authors previously published a description of the preceptor program implementation process and their findings. In this article, they discuss lessons learned during the project, highlighting the challenges and obstacles encountered when implementing this preceptorship program.
Using a Fall Prevention Checklist to Reduce Hospital Falls: Results of a Quality Improvement Project
Authors: Johnston Madeline , Magnan Morris A.
Published: February 2019

Purpose: This quality improvement (QI) initiative aimed to promote patient safety by improving adherence to an existing hospita-approved fall prevention protocol. Specific aims of the initiative were to evaluate the impact of using a fall prevention checklist on (1) the implementation of a bundle of 14 specific interventions (the fall prevention protocol) and (2) the incidence of falls on participating units.

Methods: A QI team conducted a 26-day fall prevention initiative. Data were collected on day and night shifts for 13 days each. We evaluated the effect of using a new 14-item checklist based on the existing hospitalapproved fall prevention protocol on the nursing staff's adherence to each intervention and on the incidence of falls on the test unit. Oncoming staff used the checklist during change-of-shift handoffs to determine whether all prevention interventions were in place before accepting care of the patient. The incidence of falls was tracked daily.

Results: Thirty-seven nursing staff members (RNs and nursing assistants) participated in the pilot study and completed 90 fall prevention checklists. The most frequently missed intervention was setting the bed alarm, which was set incorrectly 19% of the time. There were no patient falls during the pilot study.

Conclusion: By evaluating staff use of the fall prevention checklist, the QI team identified frequently missed prevention interventions and areas for improvement in the hospital's fall prevention protocol. A more comprehensive test of the fall prevention checklist's impact on fall prevention is needed.
Mortality and Readmission Rates at Top-Ranked vs. Nonranked Hospitals
Authors: Rosenberg Karen
Published: February 2019

According to this study:

Thirty-day mortality rates for acute myocardial infarction (AMI), heart failure, and coronary artery bypass grafting (CABG) were lower and patient satisfaction ratings higher at U.S. News and World Report’s top-ranked hospitals for cardiovascular care compared with nonranked hospitals.

Notably, 30-day readmission rates were higher for heart failure in the top-ranked hospitals and similar for AMI and CABG compared with nonranked facilities.
In Pursuit of Value-Based Maternity Care
Authors: Sudhof Leanna , Shah Neel T.
Published: February 2019

Value-based care has become the new paradigm for clinical practice, with significant implications for maternity services, where there is a large opportunity to provide better care at lower cost. Childbirth is the most common reason for hospitalization in the United States and represents the single largest category of hospital-based expenditures. At the same time, the United States ranks low among developed countries on measures of maternal and neonatal health, suggesting that we are not using resources optimally. Improving the value of maternity services will require public policies that measure and pay for quality rather than quantity of care. Equally important, clinicians will need to employ new strategies to deliver value, including considering prices, individualizing the use of new technologies, prioritizing team-based approaches to care, bridging pregnancy and contraception counseling, and engaging expecting families in new ways.
The Incidence of Pin Tract Infections and Septic Arthritis in Percutaneous Distal Femur Pinning
Authors: Murgai Rajan R. , Compton Edward , Illingworth Kenneth D. , Kay Robert M.
Published: February 2019

Background:

Retrograde percutaneous pinning often involves intra-articular pin placement. Classic teaching has cautioned about the risk of septic arthritis with intra-articular pins, although an incidence has not been reported for this complication. The purpose of this study was to determine the incidence of pin tract infections and septic arthritis following retrograde percutaneous pinning of the distal femur.

Methods:

A retrospective review identified patients who underwent retrograde percutaneous pinning of the distal femur for osteotomy or physeal fracture fixation at a tertiary pediatric hospital from 2006 to 2017 and had at least 3 months follow-up. The incidence of pin site infections and septic arthritis was determined.

Results:

In total, 163 patients met criteria, 142 patients with osteotomies and 21 with physeal fractures. The mean pin duration was 33.2±9.0 days (range: 18 to 68 d). Pin duration of ≥30 days was associated with an increased rate of pin tract infections (11.2% vs. 1.4%, P=0.01). The incidence of pin tract infections was 6.7% (11/163), including 9.5% (2/21) in those with fractures and 6.3% (9/142) following osteotomy (P=0.64). There were no cases of septic arthritis. Of the 11 patients with pin tract infections, 9 were treated successfully with oral antibiotics and 2 patients (1.2%) underwent surgical intervention for infection. Treatment of pin infections with oral antibiotics alone was successful in all 7 patients whose pins were removed within 35 days of surgery, but in only 2 of 4 whose pins were removed later (P=0.11). Of the 2 patients who required irrigation and debridement, one had a superficial pin site infection and retained subcutaneous pin and the other had a pin tract abscess and osteomyelitis at the osteotomy site.

Conclusions:

Of 163 patients who underwent retrograde percutaneous pinning of the distal femur, no patient developed septic arthritis and the incidence of pin site infections was 6.7% (11/163). Intra-articular retrograde percutaneous pinning of the distal femur is a safe technique with a low risk of septic arthritis.

Level of Evidence:

Level III—case-control study.
Choosing Wisely in Critical Care: Results of a National Survey From the Critical Care Societies Collaborative*
Authors: Kleinpell Ruth , Sessler Curtis N. , Wiencek Clareen , Moss Marc
Published: February 2019

Objectives:

Over-utilization of tests, treatments, and procedures is common for hospitalized patients in ICU settings. American Board of Internal Medicine Foundation’s Choosing Wisely campaign tasked professional societies to identify sources of overuse in specialty care practice. The purpose of this study was to assess how critical care clinicians were implementing the Critical Care Societies Collaborative Choosing Wisely recommendations in clinical practice.

Design:

Descriptive survey methodology with use of Research Electronic Data Capture (https://projectredcap.org/) sent via email newsletter blast or to individual emails of the 150,000 total members of the organizations.

Setting:

National survey.

Subjects:

ICU physicians, nurses, advanced practice providers including nurse practitioners and physician assistants, and pharmacist members of four national critical care societies in the United States.

Interventions:

None.

Measurements and Main Results:

A six-question survey assessed what Choosing Wisely recommendations had been implemented in ICU settings and if the impact was assessed. A total of 2,520 responses were received from clinicians: nurses (61%; n = 1538), physicians (25.9%; n = 647), advanced practice providers (10.5%; n = 263), and pharmacists (2.1%; n = 52), reflecting a 1.6% response rate of the total membership of 150,000 clinicians. Overall, 1,273 respondents (50.6%) reported they were familiar with the Choosing Wisely campaign. Respondents reported that Choosing Wisely recommendations had been integrated in a number of ways including being implemented in clinical care (n = 817; 72.9%), through development of a specific clinical protocol or institutional guideline (n = 736; 65.7%), through development of electronic medical record orders (n = 626; 55.8%), or with integration of longitudinal tracking using an electronic dashboard (n = 213; 19.0%). Some respondents identified that a specific quality improvement initiative was developed related to the Choosing Wisely recommendations (n = 468; 41.7%), or that a research initiative had been conducted (n = 156; 13.9%).

Conclusions:

The results provide information on the application of the Choosing Wisely recommendations to clinical practice from a small sample of critical care clinicians. However, as only half of the respondents report implementation, additional strategies are needed to promote the Choosing Wisely recommendations to make impactful change to improve care in ICU settings.
Sepsis Surveillance Using Adult Sepsis Events Simplified eSOFA Criteria Versus Sepsis-3 Sequential Organ Failure Assessment Criteria*
Authors: Rhee Chanu , Zhang Zilu , Kadri Sameer S. , Murphy David J. , Martin Greg S. , Overton Elizabeth , Seymour Christopher W. , Angus Derek C. , Dantes Raymund , Epstein Lauren , Fram David , Schaaf Richard , Wang Rui , Klompas Michael
Published: February 2019

Objectives:

Sepsis-3 defines organ dysfunction as an increase in the Sequential Organ Failure Assessment score by greater than or equal to 2 points. However, some Sequential Organ Failure Assessment score components are not routinely recorded in all hospitals’ electronic health record systems, limiting its utility for wide-scale sepsis surveillance. The Centers for Disease Control and Prevention recently released the Adult Sepsis Event surveillance definition that includes simplified organ dysfunction criteria optimized for electronic health records (eSOFA). We compared eSOFA versus Sequential Organ Failure Assessment with regard to sepsis prevalence, overlap, and outcomes.

Design:

Retrospective cohort study.

Setting:

One hundred eleven U.S. hospitals in the Cerner HealthFacts dataset.

Patients:

Adults hospitalized in 2013-2015.

Interventions:

None.

Measurements and Main Results:

We identified clinical indicators of presumed infection (blood cultures and antibiotics) concurrent with either: 1) an increase in Sequential Organ Failure Assessment score by 2 or more points (Sepsis-3) or 2) 1 or more eSOFA criteria: vasopressor initiation, mechanical ventilation initiation, lactate greater than or equal to 2.0 mmol/L, doubling in creatinine, doubling in bilirubin to greater than or equal to 2.0 mg/dL, or greater than or equal to 50% decrease in platelet count to less than 100 cells/μL (Centers for Disease Control and Prevention Adult Sepsis Event). We compared area under the receiver operating characteristic curves for discriminating in-hospital mortality, adjusting for baseline characteristics. Of 942,360 patients in the cohort, 57,242 (6.1%) had sepsis by Sequential Organ Failure Assessment versus 41,618 (4.4%) by eSOFA. Agreement between sepsis by Sequential Organ Failure Assessment and eSOFA was good (Cronbach’s alpha 0.81). Baseline characteristics and infectious diagnoses were similar, but mortality was higher with eSOFA (17.1%) versus Sequential Organ Failure Assessment (14.4%; p < 0.001) as was discrimination for mortality (area under the receiver operating characteristic curve, 0.774 vs 0.759; p < 0.001). Comparisons were consistent across subgroups of age, infectious diagnoses, and comorbidities.

Conclusions:

The Adult Sepsis Event’s eSOFA organ dysfunction criteria identify a smaller, more severely ill sepsis cohort compared with the Sequential Organ Failure Assessment score, but with good overlap and similar clinical characteristics. Adult Sepsis Events may facilitate wide-scale automated sepsis surveillance that tracks closely with the more complex Sepsis-3 criteria.
Clonidine, an α2 adrenergic receptor agonist, disrupts reconsolidation of a cocaine-paired environmental memory
Authors: Denny Rachel R. , Unterwald Ellen M.
Published: February 2019

Environmental cues can elicit robust cocaine reward memories, contributing to relapse to cocaine abuse. Memories can be manipulated pharmacologically by interfering with reconsolidation after reactivation. Clonidine, an α2 noradrenergic receptor agonist, was tested for its ability to block reconsolidation of cocaine environmental-paired memory. Male Sprague-Dawley rats completed an 8-day cocaine place conditioning procedure to establish a cocaine place preference. Cocaine memory was reactivated by exposure to the cocaine-paired environment in a drug-free state, followed immediately by administration of clonidine (10 or 50 µg/kg) or vehicle. Cocaine place preference was retested 24 h and 1 week later. Clonidine significantly attenuated the previously established cocaine place preference when tested 1 or 7 days later. To investigate the generalizability of this effect to other drug classes, morphine conditioned place preference was tested. Clonidine administration after morphine memory reactivation did not significantly alter the expression of morphine place preference. These results suggest that clonidine can interfere with reconsolidation of cocaine memory and may be a useful approach to reduce relapse.
Number of ECG Replicates and QT Correction Formula Influences the Estimated QT Prolonging Effect of a Drug
Authors: van der Wall Hein Evert Christiaan , Gal Pim , Kemme Michiel J. B. , van Westen G.J.P. , Burggraaf J.
Published: February 2019

Introduction:

The present analysis addressed the effect of the number of ECG replicates extracted from a continuous ECG on estimated QT interval prolongation for different QT correction formulas.

Methods:

For 100 healthy volunteers, who received a compound prolonging the QT interval, 18 ECG replicates within a 3-minute window were extracted from 12-lead Holter ECGs. Ten QT correction formulas were deployed, and the QTc interval was controlled for baseline and placebo and averaged per dose level.

Results:

The mean prolongation difference was >4 ms for single and >2 ms for triplicate ECG measurements compared with the 18 ECG replicate mean values. The difference was <0.5 ms after 14 replicates. By contrast, concentration–effect analysis was independent of replicate count and also of the QT correction formula.

Conclusion:

The number of ECG replicates impacted the estimated QT interval prolongation for all deployed QT correction formulas. However, concentration–effect analysis was independent of both the replicate number and correction formula.
A Comparative Effectiveness Review
Authors: van Rotterdam Joan , Hensley Michael , Hazelton Michael
Published: February 2019

Background:

Cardiac and pulmonary rehabilitation have been shown to reduce the symptoms of disease, as well as reducing health care utilization. To ensure the continuation of these programs, patient outcome measures (POMs) are essential to map treatment effectiveness. This review is a comparative effectiveness literature review of studies with a pre- to post-POM assessment of responsiveness (ie, change in health status over time).

Methods:

A quality review of the literature included not only randomized controlled trials but also parallel studies, as well as all observational and retrospective trials. This review included a list of articles and their characteristics; a quality assessment of the literature and a list of POMs utilized in this setting were assessed for responsiveness.

Results:

There was inconsistency in the literature with the measurement of responsiveness or effect size. The most commonly used POM was the SF-36; however, it was found to be less responsive to change in health status pre- to post-rehabilitation, particularly in the mental domain of this instrument. The most responsive POM in this setting was the Global Mood Scale.

Conclusion:

The surveyed literature found no “gold standard” POM for either cardiac rehabilitation or pulmonary rehabilitation but there was some preference for the disease-specific POMs; however, some of these instruments lose their discriminatory power at the end of the rehabilitation period. This literature review found that a Likert scale is more responsive than a dichotomous scale and that a simple questionnaire is more responsive in a pre- to post-setting than a complex questionnaire.
Exercise Training in Patients With Non–Small Cell Lung Cancer During In-Hospital Chemotherapy Treatment
Authors: Rutkowska Anna , Jastrzebski Dariusz , Rutkowski Sebastian , Żebrowska Aleksandra , Stanula Arkadiusz , Szczegielniak Jan , Ziora Dariusz , Casaburi Richard
Published: February 2019

Purpose:

The aim of this study was to perform a randomized trial to assess the impact of exercise training in patients with non–small cell lung cancer during chemotherapy on several outcomes in comparison to a control group (CG).

Methods:

The exercise training group (ETG) consisted of 20 patients and the CG consisted of 10 patients. In the ETG, a 4-wk in-hospital exercise training program was performed in 2-wk cycles interspersed with consecutive rounds of chemotherapy with cytostatic drugs. The exercise training program was individualized and included warm-up, respiratory muscle exercise, training on a cycle ergometer or treadmill, and Nordic walking. CG participants were assessed before and after 6 wk of chemotherapy alone.

Results:

Comparing pre- and post-intervention values, the ETG demonstrated an increase in 6-min walk distance (486 ± 92 vs 531 ± 103 m,P= .01). In a battery of physical performance tests: Up and Go Test (6.3 ± 1.0 vs 6.0 ± 1.1 sec,P= .01); chair stand (13.3 ± 2.8 vs 14.3 ± 3.4 repetitions,P= .001); and arm curl (18.4 ± 3.1 vs 20.4 ± 3.5 repetitions,P= .001) all improved significantly. Spirometry values also improved: FEV1% predicted (76 ± 16 vs 84 ± 15,P= .01), FVC % predicted (87 ± 14 vs 95 ± 13,P= .01), and FEV1/FVC (73 ± 13% vs 76 ± 12%,P= .04). The exercise training was well tolerated, without any adverse events due to exercise. There were no significant improvements in the CG.

Conclusions:

This study suggests that planned, individualized, and supervised exercise programs in patients with advanced lung cancer during chemotherapy are a practical and beneficial intervention for enhancing mobility and physical fitness.
Evaluating a Community-Placed and Clinically Integrated Community Health Worker Program
Authors: Njeru Jane W. , Ridgeway Jennifer L. , Asiedu Gladys B. , Radecki Breitkopf Carmen , Gunderson Jean M. , Quirindongo-Cedeño Onelis , O'Brien Michael W. , Nelson Tara M. , Buzard Ron , Wieland Mark L.
Published: February 2019

Community health worker (CHW) programs can act as bridges between patients and health care teams, but the complexity and variability of program components and outcomes make them difficult to evaluate. This evaluation used a realist approach to identify underlying mechanisms and contextual factors associated with successful implementation of a community-placed CHW program affiliated with a primary care practice in the Midwest United States. The analysis identified mechanisms by which stakeholders built trust, self-efficacy, and empowerment to improve patient-centered outcomes and experiences. It also identified conditions that support activation of these mechanisms, including the ability of CHWs to make home visits, effective communication between members of the care team across settings, and clarity about the role of the CHW relative to other support services for patients. This type of context-mechanism-outcome evaluation facilitated development of recommendations responsive to local context.
Insights From Organized Crime for Disorganized Health Care
Authors: Wasson John H.
Published: February 2019

During college and medical school, the author's summer employment acquainted him with members of organized crime families. After a full career as a primary care clinician and geriatrician with research on improving health care delivery, the author opines that several insights from organized crime should be of interest to health care professionals: (1) don't damage the host; (2) protect the brand; and (3) lead necessary adaption. From these insights, the author presents symptoms of failure evidenced by the US health care system, followed by several adaptations that would reduce the system's costs, improve its image, and address future challenges.
The Current State of Physician Assistant Pain Curriculum: A National Survey
Authors: Yealy Johnna K. , Martinasek Mary , Doran Todd
Published: February 2019

Purpose

Insufficient pain management and inappropriate use of pain medication are problems across the health care spectrum. Recent clinical practice guidelines and standardized core curricula have been developed to combat the deficiencies in pain education to ensure that health care professionals are proficient in assessing and managing pain; however, the extent to which physician assistant (PA) programs have implemented these in their training programs is unclear. The purpose of this study was to determine the magnitude of pain education in current PA programs in the United States, including how pain medicine instruction is incorporated into the curriculum, time spent teaching about pain management, the methods used, and barriers to providing pain medicine education.

Methods

Data from the 2016 Physician Assistant Education Association's Support to Advance Research grant, which allowed the inclusion of questions in the annual program survey, were analyzed. The response rate was 100%. Descriptive statistics were used to describe results. Nonparametric statistics used the Mann-Whitney U test and Kruskal-Wallis analysis to assess mean ranks and calculate effect sizes.

Results

Of the 209 programs surveyed, 14% reported that pain management is not included in the curriculum, and 3% reported that it is a stand-alone module. The reason most often cited to explain lack of curriculum was insufficient time (39%), and 32% reported that it is not mandated by the program accreditors. Further analysis included assessment of differences in pain medicine curriculum by program housing, academic health science center status, and geography.

Conclusions

Eighty-six percent of programs include pain education in their curriculum, suggesting that PA programs recognize the importance of pain education. The methods of instruction and topics included across programs are inconsistent. As the first comprehensive benchmark of pain medicine education for PAs, this study shows that although most programs address pain curriculum, opportunities exist to improve pain training in PA programs in the United States.
The Benefit of a Flexible Ankle-Foot Orthosis on Balance and Walking Ability in Persons With Late Effects of Polio: A Mixed-Methods Study
Authors: Brogårdh Christina , Espelund Christina , Lexell Jan
Published: February 2019

Introduction

Many persons with late effects of polio (LEoP) have muscle weakness in the lower limbs, which affects their balance and walking ability. Although an ankle-foot orthosis (AFO) is commonly prescribed for these persons, there is limited knowledge if an AFO improves their balance and walking ability in terms of speed, distance, and perceived safety. The aims of this study were 1) to assess if a flexible AFO improves dynamic balance as well as indoor and outdoor walking in persons with mild to moderate LEoP and 2) to describe the participants' own perceptions of walking ability and safety, as well as advantages and disadvantages with an AFO.

Materials and Methods

A mixed-methods, repeated-measures, crossover design was used. Nineteen participants were assessed at two test occasions, with and without an AFO, with a 1-week interval. Dynamic balance was evaluated with the timed up and go (TUG) test and walking ability by the 10-m fast gait speed (FGS) tests, the 6-minute walk test (6MWT), and timed walking over a 340-m-long pathway outdoors. The Borg Rating of Perceived Exertion (RPE) scale was used to assess perceived exertion. The participants' perceptions of their walking ability and safety as well as advantages and disadvantages with an AFO were evaluated with questionnaires.

Results

The AFO significantly improved (P < 0.05) gait speed, outdoor walking, and reduced perceived exertion at one of the test occasions, but had no effect on dynamic balance (P > 0.6). A majority perceived significantly improved walking ability (P < 0.05) and increased walking safety (P < 0.01) with the AFO. Perceived advantages of the AFO were feelings of increased stability and walking distance and reduced risk of falling. Disadvantages were that it could be difficult to put on and uncomfortable to wear.

Conclusions

A flexible AFO marginally improves walking ability in persons with LEoP, as assessed quantitatively, but the subjective benefit of walking ability and safety suggests that a flexible AFO can be useful to improve daily functioning. In the future, the design of the AFOs needs to be more user-friendly.
Screening of schizophrenia associated miRNAs and the regulation of miR-320a-3p on integrin β1
Authors: Wang Yuhan , Wang Jie , Guo Tianhong , Peng Ying , Wang Kaizheng , Bai Kezhen , Huang Yuanshuai
Published: February 2019

Schizophrenia is one of the most severe chronic psychiatric disorders, which lacks of objective and effective diagnosis and observation indicators.

In this work, the serum miRNA profiles of schizophrenic patients were analyzed. Targets of abnormal miRNAs, and their regulatory mechanisms were studied. A miRNA array was used to analyze the serum from 3 schizophrenic patients without treatment, 3 clinically cured patients and 3 healthy controls. The findings from the array were confirmed by real-time PCR in a larger cohort, including 59 patients and 60 healthy controls. The candidate miRNAs were analyzed using bioinformatics tools. Their potential targets were studied through in vitro cellular experiments.

MiR-320a-3p and miR-320b were found to be down-regulated in patients compared with cured patients and controls in the miRNA array, which was also confirmed by real-time PCR in the larger cohort. Integrin β1 (ITG β1) was found to be one of the targets of miR-320a-3p. An enzyme-linked immune sorbent assay demonstrated that the ITG β1 concentration increased significantly in the patients’ serum, and the in vitro study confirmed that miR-320a-3p targeted the 3′ UTR of ITG β1 mRNA and reduced its expression.

Our results demonstrated that the regulatory effect of miR-320a-3p on its target ITG β1 might play an important role in schizophrenia pathogenesis, which could be a potential pathway for schizophrenia diagnosis and therapy.
The prescription pattern of initial treatment for type 2 diabetes in Beijing from 2011 to 2015
Authors: Wang Xiaowen , Cao Yaying , Wu Yao , Yang Chao , Song Jing , Tian Yaohua , Wang Mengying , Li Man , Wu Yiqun , Hu Yonghua
Published: February 2019

The purpose of this study was to describe the prescription pattern of initial treatment for type 2 diabetes (T2DM) in Beijing from 2011 to 2015.

We selected 790,339 newly diagnosed outpatients with T2DM from the Beijing Medical Claim Data for Employees database between January 2011 and December 2015. The percentages of different treatments and agents were calculated from the patients’ 1st prescriptions. Subgroup analyses were conducted for primary, secondary, and tertiary hospital settings.

The initial treatments given to 57.7%, 30.7%, and 11.7% of patients were oral hypoglycemic agent (OHA) monotherapy, OHA polytherapy, and insulin, respectively. Alpha-glucosidase inhibitors (AGIs) (43.0%) were the most commonly used agents for monotherapy, followed by metformin (35.5%) and sulfonylureas (14.9%). AGIs were most commonly used in primary hospitals (52.0%), while metformin was prescribed most often in secondary (37.6%) and tertiary (41.8%) hospitals. From 2011 to 2015, there were increases in the use of AGIs (40.1–41.1%, P < .001) and metformin (34.0–40.4%, P < .001), but a decrease in the use of sulfonylureas (18.1–12.8%, P < .001). Similar trends were seen in the different hospital settings. Metformin plus an AGI, a sulfonylurea plus an AGI, and metformin plus a sulfonylurea were the most common OHA polytherapy combinations. The use of metformin plus an AGI increased from 13.8% in 2011 to 19.7% in 2015 (P < .001), while the use of a sulfonylurea plus an AGI, and metformin plus a sulfonylurea, did not change significantly.

Half of newly diagnosed patients with T2DM received an initial treatment of OHA monotherapy. Although the use of metformin increased from 2011 to 2015, both AGIs and metformin were the most commonly prescribed agents. The patterns differed from those of most other countries and identification of the underlying reasons will require further investigation.