bluuebunny/crossref_metadata_2025 huggingface dataset:
Does the Interval Between Hysterectomy and Start of Adjuvant Radiation Treatment Influence Survival in Women With Endometrial Carcinoma?
Authors: Ghanem Ahmed I. , Modh Ankit , Burmeister Charlotte , Mahmoud Omar , Elshaikh Mohamed A.
Published: May 2020

Objective:

The objective of this study was to analyze the impact of the time interval (TI) between hysterectomy and initiation of adjuvant radiation treatment (ART) on overall survival (OS) among women with early stage endometrial carcinoma (EC) using the National Cancer Database (NCDB).

Materials and Methods:

The NCDB was queried for women with the International Federation of Gynecology and Obstetrics (FIGO) stage I to II EC who underwent hysterectomy followed by ART. We examined the prognostic impact of TI on OS using the cutoff ≤8 or >8 weeks to initiate radiation treatment (RT). Two groups of patients were created. Kaplan-Meier curves were created for OS analysis. Predictors of OS were identified.

Results:

A total 16,520 women were identified. The median follow-up time for the entire cohort was 59.1 months. Median age was 63 years, and 82% were FIGO stage I. Pelvic external beam RT alone was used in 9569 (58%) and vaginal brachytherapy alone in 4265 women (26%). In total, 10,040 women (61%) received RT ≤8 weeks. Delay in initiating RT >8 weeks was associated with shorter 5-year OS (P=0.048). Independent predictors of shorter OS includes older age, African American race, higher comorbidity burden, higher tumor grade, the presence of lymphovascular invasion and stage II tumors. Although TI in initiating RT was a significant predictor for OS in univariate analysis, its independent significance of OS was lost on multivariate analysis (P=0.28).

Conclusion:

Our study suggests that TI between hysterectomy and initiation of ART was not an independent predictor of OS in women with early stage EC.
Let's talk chronic disease: can differentiated service delivery address the syndemics of HIV, hypertension and diabetes?
Authors: Bygrave Helen , Golob Lina , Wilkinson Lynne , Roberts Teri , Grimsrud Anna
Published: May 2020

Purpose of review

Differentiated service delivery (DSD) for HIV provides an approach to scaling services that are client-centred and aims to address client challenges whilst reducing the burden on health systems. With access to antiretroviral therapy, people living with HIV are living longer and increasingly present with comorbid conditions, such as hypertension and diabetes. This review presents the syndemic burden of HIV, hypertension and diabetes and highlights opportunities and challenges to leveraging DSD across diseases.

Recent findings

Prevalence of hypertension and diabetes in the eight highest HIV prevalence countries ranges between 20-24% (31.9% in those >50 years old) and 4–10%, respectively. Service delivery models addressing the concurrent syndemics focus primarily on integration of services. Two DSD examples were found where people living with HIV and other comorbidities had their care and treatment supported in healthcare worker-led facility-based adherence clubs.

Key enablers that have supported DSD for HIV such as simplified algorithms, optimized formulations, secure drug supply, and strengthened monitoring and evaluation systems are lacking for hypertension and diabetes and thus pose a major challenge to leveraging DSD models for people with syndemic conditions. However, the DSD approach may also catalyse opportunities to provide person-centred care for these syndemics and more implementation research in this area is warranted.
Role of Circular RNAs in Cardiovascular Disease
Authors: Kishore Raj , Garikipati Venkata N. S. , Gonzalez Carolina
Published: May 2020

Circular RNAs (circRNAs) have recently been identified as a new class of long noncoding RNAs with gene regulatory roles. These covalently closed transcripts are generated when the pre-mRNA splicing machinery back splices to join a downstream 5′ splice site to an upstream 3′ splice site. CircRNAs are naturally resistant to degradation by exonucleases and have long half-lives compared with their linear counterpart that potentially could serve as biomarkers for disease. Recent evidence highlights that circRNAs may play an essential role in cardiovascular injury and repair. However, our knowledge of circRNA is still in its infancy with limited direct evidence to suggest that circRNA may play critical roles in the mechanism and treatment of cardiac dysfunction. In this review, we focus on our current understanding of circRNA in the cardiovascular system.
Helix B Surface Peptide Protects Cardiomyocytes From Hypoxia/Reoxygenation-induced Autophagy Through the PI3K/Akt Pathway
Authors: Lin Yongluan , Huang Song , Chen Yequn , Wu Zhuomin , Liang Zhanbo , Zou Muping , Chen Chang
Published: May 2020

Background:

Helix B surface peptide (HBSP) is a newly discovered tissue-protective erythropoietin derivative that provides benefits after myocardial ischemia/reperfusion. This study explores the cardioprotective effects of HBSP in myocardial cells in response to hypoxia/reoxygenation injury and its potential mechanism.

Methods:

In this study, rat ventricular (H9c2) cell cultures were established and pretreated with HBSP. H9c2 cardiomyocytes were randomly assigned to the control, H/R, H/R + LY294002 (a PI3K inhibitor), HBSP + H/R, and HBSP + H/R + LY294002 groups. The pretreated cardiomyocytes underwent H/R, and the cardiomyocytes were monitored for viability through a CCK-8 assay, whereas flow cytometry was used to test cell apoptosis. Orgotein Superoxide Dismutase (SOD) and lactate dehydrogenase (LDH) expression were monitored by SOD and LDH kits, respectively. The expression of LC3 autophagosomes was determined by immunocytochemistry. The expression of LC3II/LC3I, p-Mammalian Target of Rapamycin (mTOR) mTOR, mTOR, Beclin 1, p-PI3K, PI3K p-Akt, and Akt was determined by Western blotting.

Results:

HBSP increased cell viability and reduced SOD and LDH production, and it also reduced H/R-induced cell apoptosis. Moreover, the expression of the autophagy-related proteins (LC3II/LC3I) was inhibited by HBSP, whereas the expression of p-PI3K, p-Akt, and p-mTOR was enhanced. However, the PI3K inhibitor (LY294002) notably abolished these effects in H9c2 cells.

Conclusions:

HBSP inhibits excessive autophagy and apoptosis induced by H/R by activating the PI3K/Akt pathway. HBSP may potentially be a therapeutic intervention for myocardial ischemia/reperfusion injury.
Hypertension in cardiac transplant recipients: tackling a new face of an old foe
Authors: Campbell Patrick T. , Krim Selim R.
Published: May 2020

Purpose of review

Systemic hypertension (HTN) is a common complication arising in the heart transplant recipient. This article aims to review the most current literature and update readers on the epidemiology, pathophysiology and management of HTN in heart transplant patients.

Recent findings

In contrast to the general nontransplant hypertensive patient population, traditional risk factors, including family history of HTN, obesity and diabetes, play a minor role in the genesis of posttransplant HTN. Dysregulation in sodium and water balance, vascular stiffness, endothelial dysfunction, abnormal cardiorenal neural reflexes resulting from immunosuppression and cardiac denervation seem to be the predominant factors leading to postheart transplant HTN. Calcineurin inhibitors induced nephrotoxicity and steroid use further contributes to posttransplant HTN.

Owing to the paucity of data, particularly randomized controlled trials to guide the evaluation and management of HTN in the cardiac transplant patients, much of the available data come from the renal transplant population. The choice of antihypertensive should be based on timing related to transplantation and patient's comorbidities. Although calcium channel blockers and loop diuretics are the preferred agents in the early postheart transplant period, angiotensin-converting-enzyme inhibitors and angiotensin receptor blockers may be beneficial in the late postheart transplant period especially in the setting of diabetes and in the presence of proteinuria.
Cardiovascular effects of preeclampsia
Authors: Neerukonda Smitha , Shariati Farnoosh , Hart Taylor , Stewart Merrill , Elkayam Uri , Qamruddin Salima
Published: May 2020

Purpose of review

Preeclampsia complicates 3–5% of first and 15% of subsequent pregnancies. This study reviews the evidence of increase cardiovascular risk in these women.

Recent findings

Women with preeclampsia are at two-fold higher risk for development of coronary artery disease, stroke and death, and four-fold increased risk of heart failure. Preeclampsia developed in early part of pregnancy confers greater risk than later in pregnancy. Common factors that predispose women to preeclampsia also confer high risk for developing cardiovascular disease include obesity, metabolic abnormalities, dyslipidaemia, insulin resistance, heightened inflammatory responses, hypercoagulable states and endothelia dysfunction.

Patients with preeclampsia should be screened at regular intervals by a preventive cardiologist and treated accordingly.
Reorganizing the treatment of cardiovascular disease in response to coronavirus disease 2019; time for the polypill?
Authors: Floyd Christopher N. , Wierzbicki Anthony S.
Published: May 2020

Purpose of review

The coronavirus disease 2019 (COVID-19) pandemic has forced a redesign of healthcare services. Resource reallocation will have consequences on the routine management of chronic diseases, including cardiovascular disease (CVD). We consider how to mitigate potential adverse effects.

Recent findings

Combination therapy is well established in hypertension. Many guidelines recommend dual antihypertensive therapy as the initial treatment step as this results in faster blood pressure control, albeit with limited evidence of improved outcomes. Control of CVD risk factors through multiclass combination therapy (the polypill) was proposed many years ago. This approach has not been adopted by Western healthcare systems despite improving surrogate outcomes. Recently, the PolyIran trials have demonstrated improved CVD outcomes without increased adverse events, in both primary and secondary prevention.

The COVID-19 pandemic allows models of chronic healthcare to be rethought. Current practices are resource-intensive and there is a need to simplify titration and monitoring protocols in CVD. Moving toward the use of polypill combinations allied with telehealth consultations may be one solution.
Incidence and risk factors for progression from prehypertension to hypertension: a 12-year Korean Cohort Study
Authors: Yu Eun Sun , Hong Kwan , Chun Byung Chul
Published: May 2020

Objectives:

This study evaluated the incidence and risk factors for progression from prehypertension to hypertension among middle-aged and elderly Korean adults.

Methods:

A total of 115 456 participants with prehypertension in 2003–2004 were selected from the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) Program. All participants were followed until 2015. Potential risk factors for progression to hypertension were evaluated using the chi-squared test or t-test. A Cox proportional hazards model was used to predict the risk of progression to hypertension according to sex. The incidence of hypertension in the prehypertension group was evaluated by calculating the incidence density during the entire follow-up period.

Results:

During the follow-up period, 48 919 participants experienced progression to hypertension, which corresponded to incidence densities of 45.82/1000 person-years among men and 53.57/1000 person-years among women. Among both men and women, progression to hypertension was predicted by an elevated BMI, family history of hypertension, history of diabetes mellitus, and older age. Among men, progression to hypertension was associated with frequent drinking and high alanine aminotransferase levels. Among women, progression to hypertension was associated with high hemoglobin levels and low household income.

Conclusion:

This study identified various risk factors for progression from prehypertension to hypertension among middle-aged and elderly Korean adults. This information may help researchers develop comprehensive and effective strategies for managing prehypertension.
Ocular Findings in Pontine Tegmental Cap Dysplasia
Authors: Mehner Lauren C. , Jung Jennifer L. , Maloney John A. , McCourt Emily A.
Published: May 2020

Purpose:

To describe the ocular complications experienced by patients with pontine tegmental cap dysplasia (PTCD) and the management strategies used to care for these children.

Methods:

Subjects with PTCD were recruited through social media advertisement and completed a survey gathering information on potential ocular problems related to the patient's PTCD disease and any current or previous treatments.

Results:

Twenty-two patients or guardians completed the survey. Neurotrophic cornea was the most common ocular diagnosis (82%), followed by facial palsy (59%), dry eye syndrome (59%), and blepharitis (55%). Other diagnoses included cortical visual impairment (27%), strabismus (27%), amblyopia (18%), and nystagmus (18%). Common treatment modalities included lubricating eye drops (59%) or ointment (50%), contact lenses (14%), punctal plugs (27%), glasses (45%), and patching (18%). The most common surgical interventions were temporary or permanent tarsorrhaphy (64%) and amniotic membrane grafts (23%). In total, 68% of families reported self-injury to eyes and 91% reported the child to be primarily a visual learner.

Conclusions:

PTCD is a newly described, very rare disorder with a variety of vision-threatening ocular manifestations. It is essential that the ophthalmologist be aware of the potential for neurotrophic cornea because timely treatment could prevent corneal scarring, perforation, and blindness.
Temporal redistribution of cap and residual stromal thickness after SMILE
Authors: Olsen Markus V. , Lyngstadaas Anne V. , Zhou Wen , Stojanovic Aleksandar , Utheim Tor P. , Wang Xiaorui , Badian Reza A. , Chen Xiangjun
Published: May 2020

Purpose:

To investigate corneal sublayer alterations during the postoperative period after small-incision lenticule extraction (SMILE).

Setting:

Synslaser clinic, Oslo, Norway.

Study design:

Retrospective.

Methods:

Patients who underwent SMILE for treating myopia were included. The thicknesses of the corneal epithelium, cap, stromal part of the cap (StromaCap), residual stromal bed (StromaRes), and total stroma (StromaTot) were measured using spectral-domain optical coherence tomography at 1 day, 1 week, 1 month, 3 months, and 6 months postoperatively. Postoperative changes in the corneal sublayer thicknesses were analyzed and correlated with changes in spherical equivalence and anterior and posterior keratometry (K).

Results:

The study was based on analyses of the right eyes of 51 patients. From 1 day to 6 months postoperatively, the corneal epithelium, cap, StromaCap, StromaRes, and StromaTot thicknesses increased from 54.4 ± 4.0 µm to 57.3 ± 5.2 µm; 137.1 ± 5.5 µm to 140.3 ± 5.1 µm; 82.7 ± 5.9 µm to 82.8 ± 6.3 µm; 375.0 ± 40.8 µm to 381.4 ± 30.6 µm; and 457.6 ± 41.1 µm to 462.1 ± 36.7 µm, respectively. Between 1 month and 6 months postoperatively, the increase in anterior K correlated significantly with the thickening of the cap (r = 0.37, P = .03) and the stromal component of the cap (r = 0.36, P = .04) within the central cornea.

Conclusions:

The post-SMILE remodeling behavior between the anterior (StromaCap) and posterior (StromaRes) stroma were dissimilar. There was a significant correlation between changes in anterior K and the central cap and the stromal component of the cap. This might be because of biomechanical changes, tissue remodeling, and wound healing or a combination of some or all of the aforementioned processes.
Regional variations in cardiovascular risk factors and access to care among US veterans with cardiovascular disease
Authors: Srivastava Pallavi , Butler Javed , Shroyer A. Laurie , Templeton Rebecca , Parikh Puja B.
Published: May 2020

Background

It remains unclear whether cardiovascular risk factors and access to healthcare for veterans with cardiovascular disease (CVD) vary among US regions. This study sought to determine the extent of regional variations in cardiovascular risk factors and access to medical care in a cohort of veterans with CVD in the USA.

Methods

The 2016 Centers for Disease Control Behavioral Risk Factor Surveillance Survey was utilized to identify a cohort of veteran patients with CVD. Participants were classified based on four US regions: (1) Northeast, (2) Midwest, (3) South, and (4) West. We compared demographic data, medical history, and access to care for veterans of each US region. The outcomes of interest included financial barriers to medical care and annual medical checkup.

Results

Among the 13 835 veterans, 18.3% were from the Northeast, while 23.5, 37.1, and 21.1% were from the Midwest, South, and West, respectively. Veterans of each region differed significantly with respect to demographic characteristics, prior medical history, and access to care. Rates of financial barriers to medical care were similar across the four regions (7.3 vs. 7.1 vs. 8.0 vs. 6.9%, P = 0.203). Veterans from the West had the lowest rates of medical checkup within the past year (91.7 vs. 89.5 vs. 91.4 vs. 86.6%). On multivariate analysis, the Midwest [odds ratio (OR) 0.69; 95% CI, 0.53–0.89] and West (OR 0.53; 95% CI 0.41–0.68) regions were independently associated with lower rates of medical checkup within the past year compared to the Northeast.

Conclusions

In this observational study involving US veterans with CVD, cardiovascular risk factors and frequency of annual medical checkup differed amongst each US region. Further large-scale studies examining the prevalence of impaired access to care and quality of care in US veterans with CVD are warranted.
Clinical progress of auxiliary liver transplantation
Authors: Li Jiang , Tian Da-zhi , Jiang Wen-tao , Shen Zhong-yang
Published: May 2020

After half a century of development, auxiliary liver transplantation (ALT) technology gradually matured and major indications of ALT have been gradually expanded. This review summarized the history of ALT and introduced indications for ALT which including metabolic liver disease, fulminant hepatic failure, highly sensitized kidney transplantation, prevention of hepatic resection of small hepatic syndrome, etc.; at the same time, the hot issues related to ALT were discussed, including the regulation of hepatic portal blood flow of transplanted liver and residual liver, how to treat the graft liver and remaining liver on second stage. Additionally, the expansion of indications for ALT which included the implementation of ALT for patients with liver cancer and ALT for patients with liver cirrhosis was discussed. It was believed that ALT can greatly alleviate the contradiction of insufficient source of graft liver.
Fatigue in inflammatory bowel disease: a problematic ailment
Authors: Qazi Taha
Published: May 2020

Purpose of review

Fatigue, a protean complaint encompassing both physical, mental exhaustion but also demotivation, has shown to effect quality of life in patients with inflammatory bowel disease (IBD). Here we present a review of the literature as it relates to IBD-associated fatigue. Moreover, we present the common causes attributed to fatigue and present an algorithmic approach to the assessment of fatigue. Finally, we report data regarding potential management strategies for IBD-associated fatigue.

Recent findings

Unfortunately, owing to its multidimensional nature and multifactorial causes, patients with IBD may continue to report fatigue despite optimization of disease management, replenishment of nutritional deficiencies, or management of coexistent disorders. Management likely requires a multidisciplinary approach.

The majority of patients with IBD report fatigue symptoms both in setting of active disease but also during the course of remission. Fatigue is a multidimensional complaints, and management likely requires a multidisciplinary approach. Herein, we present a framework for the management and assessment of fatigue in IBD.
Integration of telemedicine into clinical practice for inflammatory bowel disease
Authors: George Lauren A. , Dominic Maria Rose , Cross Raymond K.
Published: May 2020

Purpose of review

In the context of the rising incidence and complexity of inflammatory bowel disease (IBD), telehealth offers new ways to support remote and efficient delivery of healthcare services. The aim of this review is to assess the current status of telehealth services in the management of IBD and challenges to adopting telehealth in clinical practice.

Recent findings

Different modalities of telehealth such as virtual clinics and remote patient monitoring have been studied in many IBD centers. They are found to be associated with high patient acceptance, decreased healthcare costs, improved quality of life, treatment adherence, and disease knowledge among patients. The major challenges encountered in the integration of telemedicine into clinical practice include risks to patient privacy and confidentiality, requirement for informed consent, lack of uniform reimbursement policies, operational difficulties, provider acceptance, and licensing.

Telehealth is an effective, efficient, and low-cost intervention that can address increasingly complex care of patients with IBD. However, for telemedicine to be adopted widely, new policies and reforms need to reduce the burden of physician licensing in multiple states, allow for receipt of all telehealth services in the patient's home or office, and require reimbursement for services on par with an office visit.
Protection of hematopoietic stem cells from stress-induced exhaustion and aging
Authors: Singh Shweta , Jakubison Brad , Keller Jonathan R.
Published: May 2020

Purpose of review

Hematopoietic stem cells (HSCs) are defined by their ability to self-renew and differentiate to replenish all blood lineages throughout adult life. Under homeostasis, the majority of HSCs are quiescent, and few stem cells are cycling to sustain hematopoiesis. However, HSCs can be induced to proliferate and differentiate in response to stress signals produced during infection, inflammation, chemotherapy, radiation, bone marrow transplantation, and aging. Recent evidence suggests that acute and chronic stress impact the number and function of HSCs including their ability to repopulate and produce mature cells. This review will focus on how chronic stress affects HSC biology and methods to mitigate HSC loss during chronic hematopoietic stress.

Recent findings

Quiescent HSCs exit dormancy, divide, and differentiate to maintain steady-state hematopoiesis. Under conditions of acute stress including infection or blood loss some HSCs are pushed into division by cytokines and proinflammatory stimuli to differentiate and provide needed myeloid and erythroid cells to protect and reconstitute the host; after which, hematopoiesis returns to steady-state with minimal loss of HSC function. However, under conditions of chronic stress including serial bone marrow transplantation (BMT), chronic inflammation, and genotoxic stress (chemotherapy) and aging, HSCs are continuously induced to proliferate and undergo accelerated exhaustion. Recent evidence demonstrates that ablation of inhibitor of DNA binding 1 (Id1) gene can protect HSCs from exhaustion during chronic proliferative stress by promoting HSC quiescence.

Increasing our understanding of the molecular processes that protect HSCs from chronic proliferative stress could lead to therapeutic opportunities to prevent accelerated HSC exhaustion during physiological stress, genotoxic stress, BMT, and aging.
Concurrent Imatinib Dosing With High-dose Methotrexate Leads to Acute Kidney Injury and Delayed Methotrexate Clearance in Pediatric Patients With Philadelphia Chromosome-positive B-Cell Acute Lymphoblastic Leukemia
Authors: Pommert Lauren , Liberio Nicole , Ng John S. , Egelund Tosha A. , Siver Molly J. , Katzenstein Howard M. , Burke Michael J.
Published: May 2020

Imatinib, a tyrosine kinase inhibitor has improved survival in pediatric patients with Philadelphia chromosome-positive B-cell acute lymphoblastic leukemia. There are no formal drug interactions listed between methotrexate and tyrosine kinase inhibitors. Four pediatric patients with Philadelphia chromosome-positive B-cell acute lymphoblastic leukemia had delayed methotrexate clearance during their first cycle of high-dose methotrexate while receiving imatinib, resulting in acute kidney injury. For subsequent high-dose methotrexate cycles, imatinib was withheld resulting in decreased acute kidney injury, shorter time to methotrexate clearance, less toxicity, and shorter hospitalizations. For pediatric patients with acute lymphoblastic leukemia receiving imatinib, we recommend escalated supportive care measures including increased hyperhydration and leucovoruin frequency. For patients with toxicities secondary to delayed clearance or need for glucarpidase, we recommend holding imatinib with subsequent high-dose methotrexate courses.
A Nationwide Italian Cross-sectional Study on Nursing Students' Perceived Workplace Safety During Clinical Practice
Authors: Gonella Silvia , Brugnolli Anna , Bosco Alice , Mansutti Irene , Canzan Federica , Randon Giulia , Saiani Luisa , Terzoni Stefano , Zannini Lucia , Destrebecq Anne , Dimonte Valerio , Grassetti Luca , Palese Alvisa
Published: May 2020

Background

Nursing students' perception of a safe clinical working environment may impact the development of professional skills and progression in the profession.

Purpose

The aims of this study were to describe to what extent nursing students perceive the working environments as safe during their most recent clinical rotation and to explore factors associated with their perception of a safe workplace environment.

Methods

A nationwide Italian cross-sectional study involving 9607 students in 27 universities across 95 three-year nursing programs was performed in 2015-2016, and secondary analyses were run in 2019.

Results

The workplace environment was perceived by students as only a little (n = 2598 [27.0%]), to some extent (n = 4048 [42.1%]), and always (n = 2555 [26.0%]) safe; 406 (4.2%) students reported to have never felt that the workplace as safe. At the multivariate level, factors promoting students' perception of a safe clinical environment were a setting offering higher (a) learning opportunities, (b) safety and nursing care quality, (c) quality of tutorial strategies, and (d) self-directed learning opportunities.

Conclusions

Nursing faculty should assess the quality of clinical settings before deciding on environments for students' learning experience.
Using Simulation Evaluation for Prelicensure Nursing Program Review
Authors: Thomas Christine M. , Yocom Danielle , Kaulback Michelle , Meehan Carolyn D.
Published: May 2020

Background

Faculty in a prelicensure baccalaureate nursing program were interested in establishing a process for use of simulation for the evaluation of program outcomes.

Problem

Several infrastructure barriers existed for the implementation of simulation for a fair, valid, and reliable student evaluation.

Approach

Faculty chose to evaluate student performance in simulation to examine student achievement of program outcomes.

Conclusions

The project informed curricular decisions moving forward, helped faculty to standardize scenarios, and outlined a process of establishing validity and reliability that could be implemented in the future for student evaluation.
The Effects of Interdisciplinary Bedside Rounds on Patient Centeredness, Quality of Care, and Team Collaboration: A Systematic Review
Authors: Heip Tine , Van Hecke Ann , Malfait Simon , Van Biesen Wim , Eeckloo Kristof
Published: May 2020

Background

Research indicates that having multiple healthcare professions and disciplines simultaneously at the patient’s bedside improves interprofessional communication and collaboration, coordination of care, and patient-centered shared decision-making. So far, no review has been conducted, which included qualitative studies, explores the feasibility of the method, and looks at differences in definitions.

Objectives

The aim of the study was to explore available evidence on the effects of interdisciplinary bedside rounds (IBRs) on patient centeredness, quality of care and team collaboration; the feasibility of IBRs; and the differences in definitions.

Data Sources

PubMed, Web of Science, and Cochrane databases were systematically searched. The reference lists of included articles and gray literature were also screened. Articles in English, Dutch, and French were included. There were no exclusion criteria for publication age or study design.

Study Appraisal and Synthesis Methods

The included (N = 33) articles were critically reviewed and assessed with the Downs and Black checklist. The selection and summarizing of the articles were performed in a 3-step procedure, in which each step was performed by 2 researchers separately with researcher triangulation afterward.

Conclusions and Implications of Key Findings

Interdisciplinary bedside round has potentially a positive influence on patient centeredness, quality of care, and team collaboration, but because of a substantial variability in definitions, design, outcomes, reporting, and a low quality of evidence, definitive results stay uncertain. Perceived barriers to use IBR are time constraints, lack of shared goals, varied responsibilities of different providers, hierarchy, and coordination challenges. Future research should primarily focus on conceptualizing IBRs, in specific the involvement of patients, before more empiric, multicentered, and longitudinal research is conducted.
Wide Variation in Unplanned Extubation Rates Related to Differences in Operational Definitions
Authors: Ndakor Sussan Mbi , Pezzano Chad J. , Spilman Lynn , Geis Gina , Munshi Upender , Dunton Cheryl , Pinheiro Joaquim M. B.
Published: May 2020

Objectives

Unplanned extubation (UE) rate is a patient safety metric for which there are varied and inconsistently interpreted definitions. We aimed to test the sensitivity of UE rates to the application of different operational definitions.

Methods

We analyzed neonatal intensive care unit (NICU) quality improvement data on UE events defined inclusively as “any extubation that was not performed electively, or not previously intended for that time.” Unplanned extubations were classified as involving an endotracheal tube (ETT) that was either objectively “dislodged” or “removed” without proof of prior dislodgement. We used descriptive statistics to explore how UE rates vary when applying alternate UE definitions.

Results

For 33 months, 241 UEs were documented, 70% involving dislodged tubes and 30% ETTs removed by staff. Among dislodged ETTs, only 9% were found completely externalized, whereas 77% were at an adequate depth but in the esophagus. Thirteen percent of events occurred outside the NICU and 13% were initially unreported. The overall UE rate was 4.9/100 ventilator days. If the least inclusive definition was used (i.e., counting only “self-extubations” by patients, requiring reintubation, and occurring within the NICU), 83% of UEs would have been excluded.

Conclusions

Most UEs in our NICU population involved staff either removing ETTs from the trachea or partly removing them after internal dislodgement. In settings where ETTs removed by staff are not counted, UE rates may be substantially lower and associated risks underestimated. An inclusive, patient-centric operational definition along with a standardized classification would allow benchmarking, while enabling targeted approaches to minimize locally predominant causes of UEs.
Medication Order Errors at Hospital Admission Among Children With Medical Complexity
Authors: Blaine Kevin , Wright John , Pinkham Amy , O’Neill Margaret , Wilkerson Sarah , Rogers Jayne , McBride Sarah , Crofton Charis , Grodsky Sarah , Hall David , Mauskar Sangeeta , Akula Vinita , Khan Alisa , Mercer Alexandra , Berry Jay G.
Published: May 2020

Objectives

We sought to characterize the nature and prevalence of medication order errors (MOEs) occurring at hospital admission for children with medical complexity (CMC), as well as identify the demographic and clinical risk factors for CMC experiencing MOEs.

Methods

Prospective cohort study of 1233 hospitalizations for CMC from November 1, 2015, to October 31, 2016, at 2 children’s hospitals. Medication order errors at admission were identified prospectively by nurse practitioners and a pharmacist through direct patient care. The primary outcome was presence of at least one MOE at hospital admission. Statistical methods used included χ2 test, Fisher exact tests, and generalized linear mixed models.

Results

Overall, 6.1% (n = 75) of hospitalizations had ≥1 MOE occurring at admission, representing 112 total identified MOEs. The most common MOEs were incorrect dose (41.1%) and omitted medication (34.8%). Baclofen and clobazam were the medications most commonly associated with MOEs. In bivariable analyses, MOEs at admission varied significantly by age, assistance with medical technology, and numbers of complex chronic conditions and medications (P < 0.05). In multivariable analysis, patients receiving baclofen had the highest adjusted odds of MOEs at admission (odds ratio, 2.2 [95% confidence interval, 1.2–3.8]).

Conclusions

Results from this study suggest that MOEs are common for CMC at hospital admission. Children receiving baclofen are at significant risk of experiencing MOEs, even when orders for baclofen are correct. Several limitations of this study suggest possible undercounting of MOEs during the study period. Further investigation of medication reconciliation processes for CMC receiving multiple chronic, home medications is needed to develop effective strategies for reducing MOEs in this vulnerable population.
Risk Factors Associated With the Progression From Acute to Chronic Neuropathic Pain After Burn-Related Injuries
Authors: Klifto Kevin M. , Dellon Arnold Lee , Hultman Charles Scott
Published: May 2020

Background

Pain, unrelated to the initial thermal trauma itself, can result after burn injury and prolong the recovery/rehabilitation phase of the patient's care. This pain, after discharge from the burn unit, may be acute and self-limiting or chronic and contribute to long-term patient morbidity. The purposes of this study were to compare burn patients who had, after discharge from the burn unit, only acute pain with burn patients who developed chronic, neuropathic pain (CNP) and to determine risks factors for progression from acute to chronic pain in the setting of a burn center.

Methods

A single-center, retrospective chart review of patients admitted to the adult burn center was performed from January 1, 2014, to January 1, 2019. Patients included were older than 15 years, sustained a burn injury, and admitted to the burn unit. Chronic pain was defined as pain lasting greater than 6 months after discharge from the burn unit. Pain descriptors included shooting, stabbing, sharp, burning, tingling, numbness, throbbing, pruritus, intermittent, and/or continuous dysesthetic sensations after the burn. Patients were excluded if they had preexisting neuropathic pain due to an underlying medical illness or previous surgery.

Results

During a 5-year period, of the 1880 admissions to the burn unit, 143 burn patients developed post–initial-onset pain as a direct result of their burn. Of the 143 patients with acute pain, pain resolved in 30 patients, whereas pain progressed to CNP in 113 patients (79%). Patient follow-up was a median (interquartile range [IQR]) of 26.5 (10–45) months. Patients whose pain progressed to CNP had significantly greater percent total body surface area burns (median [IQR], 6 [3–25] vs 3 [1–10]; P = 0.032), had more full-thickness burns (66/113 [58%] vs 8/30 [27%] patients, P = 0.004), had surgery (85/113 [75%] vs 16/30 [53%] patients, P = 0.042), had more surgical procedures (median [IQR], 2 [1–6] vs 1 [0–3], P = 0.002), and developed more complications (32/113 [28%] vs 2/30 [7%] patients, P = 0.014) compared with those with acute neuropathic pain, respectively.

Conclusions

Burn patients who progressed from having acute to CNP had significantly greater percent total body surface area burns, had more full-thickness burns, had surgery, had more surgical procedures, and developed more complications compared with burn patients with only acute pain.
Coincidence of COVID-19 Infection and Smell—Taste Perception Disorders
Authors: Cetinkaya Erdem Atalay
Published: May 2020

Many reports by physicians and patients during the 2019 to 2020 pandemic indicate that COVID-19 is associated with elevated levels of odor and taste perception disorders (anosmia, hyposmia, ageusia, and/or dysgeusia). Recent increase in olfactory dysfunction in patients referred to ear nose and throat clinics and COVID-19 infection at the same time encouraged us to examine anosmic/hyposmic patients to establish any association between these signs. It has been shown that the COVID-19 virus exploits the uses angiotensin-converting enzyme 2 receptor to obtain cell entry. This result increases the interest to examine the expression of angiotensin-converting enzyme 2 in neurological tissue, and to assess the possible contribution of damage. This mini review provides fundamental knowledge on coincidence of COVID-19 infection and smell—taste perception disorders from an objective perspective.
Preliminary Experience With Inertial Movement Technology to Characterize Endotracheal Intubation Kinematics
Authors: Carlson Jestin N. , Cho Sohyung , Ohu Ikechukwu P. N. , Griffin Russell E. , Ko Hoo Sang , Lim Chiho , Wang Henry E.
Published: May 2020

Background

Endotracheal intubation (ETI) is an important emergency intervention. Only limited data describe ETI skill acquisition and often use bulky technology, not easily transitioned to the clinical setting. In this study, we used small, portable inertial detection technology to characterize intubation kinematic differences between experienced and novice intubators.

Methods

We performed a prospective study including novice (<10 prior clinical ETI) and experienced (>100 clinical ETI) emergency providers. We tracked upper extremity motion with roll, pitch, and yaw using inertial measurement units (IMU) placed on the bilateral hands and wrists of the intubator. Subject performed 6 simulated emergency intubations on a mannequin. Using machine learning algorithms, we determined the motions that best discriminated experienced and novice providers.

Results

We included data on 12 novice and 5 experienced providers. Four machine learning algorithms (artificial neural network, support vector machine, decision tree, and K-nearest neighbor search) were applied. Artificial neural network had the greatest accuracy (95% confidence interval) for discriminating between novice and experienced providers (91.17%, 90.8%–91.5%) and was the most parsimonious of the tested algorithms. Using artificial neural network, information from 5 movement features (right hand, roll amplitude; right hand, pitch amplitude; right hand, yaw standard deviation; left hand, yaw standard deviation; left hand, pitch frequency of peak amplitude) was able discriminated experienced from novice providers.

Conclusions

Novice and experienced providers have different ETI movement patterns and can be distinguished by 5 specific movements. Inertial detection technology can be used to characterize the kinematics of emergency airway management.
Lasting Symptoms After Esophageal Resection (LASER)
Authors: Markar Sheraz R. , Zaninotto Giovanni , Castoro Carlo , Johar Asif , Lagergren Pernilla , Elliott Jessie A. , Gisbertz Suzanne S. , Mariette Christophe , Alfieri Rita , Huddy Jeremy , Sounderajah Viknesh , Pinto Eleonora , Scarpa Marco , Klevebro Fredrik , Sunde Berit , Murphy Conor F. , Greene Christine , Ravi Narayanasamy , Piessen Guillaume , Brenkman Hylke , Ruurda Jelle P. , Van Hillegersberg Richard , Lagarde Sjoerd , Wijnhoven Bas , Pera Manuel , Roig José , Castro Sandra , Matthijsen Robert , Findlay John , Antonowicz Stefan , Maynard Nick , McCormack Orla , Ariyarathenam Arun , Sanders Grant , Cheong Edward , Jaunoo Shameen , Allum William , Van Lanschot Jan , Nilsson Magnus , Reynolds John V. , van Berge Henegouwen Mark I. , Hanna George B.
Published: May 2020

Objective:

To identify the most prevalent symptoms and those with greatest impact upon health-related quality of life (HRQOL) among esophageal cancer survivors.

Background:

Long-term symptom burden after esophagectomy, and associations with HRQOL, are poorly understood.

Patients and Methods:

Between 2010 and 2016, patients from 20 European Centers who underwent esophageal cancer surgery, and were disease-free at least 1 year postoperatively were asked to complete LASER, EORTC-QLQ-C30, and QLQ-OG25 questionnaires. Specific symptom questionnaire items that were associated with poor HRQOL as identified by EORTC QLQ-C30 and QLQ-OG25 were identified by multivariable regression analysis and combined to form a tool.

Results:

A total of 876 of 1081 invited patients responded to the questionnaire, giving a response rate of 81%. Of these, 66.9% stated in the last 6 months they had symptoms associated with their esophagectomy. Ongoing weight loss was reported by 10.4% of patients, and only 13.8% returned to work with the same activities.

Three LASER symptoms were correlated with poor HRQOL on multivariable analysis; pain on scars on chest (odds ratio (OR) 1.27; 95% CI 0.97–1.65), low mood (OR 1.42; 95% CI 1.15–1.77) and reduced energy or activity tolerance (OR 1.37; 95% CI 1.18–1.59). The areas under the curves for the development and validation datasets were 0.81 ± 0.02 and 0.82 ± 0.09 respectively.

Conclusion:

Two-thirds of patients experience significant symptoms more than 1 year after surgery. The 3 key symptoms associated with poor HRQOL identified in this study should be further validated, and could be used in clinical practice to identify patients who require increased support.
Reduced inflammatory response and accelerated functional recovery following sciatic nerve crush lesion in CXCR3-deficient mice
Authors: Jeub Monika , Siegloch Philipp Arne , Nitsch Louisa , Zimmermann Julian , Mueller Marcus M.
Published: May 2020

Despite the regenerative capacity of the peripheral nerve system (PNS), functional recovery after mechanical nerve trauma is often incomplete, resulting in motor, sensory, and autonomic deficits. The elucidation of key molecules involved in trauma-induced Wallerian degeneration and the ensuing regeneration processes is a prerequisite for the development of disease modifying drugs. The chemokine (C-X-C motif) receptor 3 (CXCR3) has been implicated in the recruitment of macrophages, the major immune cell population during the process of Wallerian degeneration. In this study, we examined whether deletion of CXCR3 affects macrophage recruitment, the expression of the proinflammatory cytokine tumor necrosis factor (TNF)- α and the CXCR3 agonist interferon gamma-induced protein 10 (CXCL10), and functional recovery in the sciatic nerve crush model. CXCR3–/– mice displayed significantly reduced macrophage counts preceded by diminished expression of CXCL10 and TNF- α. Furthermore, functional recovery of sciatic nerve motor function was significantly accelerated. In summary, these data indicate that the deletion of CXCR3 leads to a diminished inflammatory response and an accelerated functional recovery following sciatic nerve crush injury. Therefore, CXCR3 may be an interesting target for therapeutic interventions after traumatic nerve lesions.
World vaping update
Authors: Striley Catherine W. , Nutley Sara K.
Published: May 2020

Purpose of review

Although death and injury related to e-cigarette use and vaping products has decreased since the peak in 2019, concern over the popularity of electronic nicotine delivery systems (ENDS – a term which includes vape pens, electronic or e-cigarettes, and products that produce vapor for inhaling rather than combusting to produce smoke) continues. ENDS are used as an aid to quit smoking and for harm reduction.

Recent findings

This review covers peer-reviewed literature from January 2019 through February 2020 on vaping (the process of using ENDS). Prevalence, risk factors for use, and health risks and benefits from use predominated. Policy articles, commentaries and editorials were excluded from review. E-cigarette or vaping product use-associated lung injury (EVALI)-related injury and death were in the news and literature this year. Because most EVALI-related injury and death occurred among young people who had vaped tetrahydrocannabinol (THC), data from the Healthy Minds (United States) study are reviewed to consider variation in risk factors for vaping THC compared with nicotine.

Findings provide up-to-date information on vaping as a way to consume a drug, whether THC or nicotine. Harm reduction benefits were shown in a year-long follow-up of smoking cessation; harms continue to accumulate, including from passive consumption.
Consistency in the strength of laterality in male, but not female, guppies across different behavioural contexts
Authors: McLean Stephanie , Morrell Lesley J.
Published: May 2020

Laterality, the division of brain functions into separate hemispheres, is widespread across animal taxa. Lateralized individuals exhibit cognitive advantages yet substantial variation in laterality exists, particularly between the sexes. Why variation is maintained is unknown as few studies consider differences in lateralized behaviours between the sexes, and their underlying selection pressures, across different contexts. We investigated if
Poecilia reticulata
exhibited sex differences in the direction, strength and consistency of lateralization. We assessed the turning preferences of individuals detouring around a barrier to view visual stimuli representative of different behavioural contexts: an artificial object of familiar colour, an opposite sex conspecific and a no stimulus control. While no sex differences were evident in the direction or strength of laterality, consistency in the strength of laterality varied between the sexes. Individuals of both sexes consistently detoured in one direction, but the strength of laterality exhibited by males was more predictable than females across contexts. This suggests that predictability of lateralization across ecologically relevant scenarios represents a key, but previously unexplored, source of variation between the sexes.
A radiomics approach to artificial intelligence in echocardiography: Predicting post-operative right ventricular failure
Authors: Shad Rohan , Quach Nicolas , Fong Robyn , Langlotz Curt P. , Kong Sandra , Kasinpila Patpilai , Amsallem Myriam , Haddad Francois , Shudo Yasuhiro , Woo Y. Joseph , Teuteberg Jeffrey , Hiesinger William
Published: May 2020

In this study, we describe a novel ‘radiomics’ approach to an echocardiography artificial intelligence system that enables the extraction of hundreds of thousands of motion parameters per echocardiography video. We apply this AI system to the clinical problem of predicting post-operative right ventricular failure (RV failure) in heart failure patients receiving implantable circulatory life support systems. Post-operative RV failure is the single largest contributor to short-term mortality in patients with left ventricular assist devices (LVAD); yet predicting which patient is at risk of developing this complication in the pre-operative setting, has remained beyond the abilities of experts in the field. We report results on testing datasets using a standard 10-fold cross validation. The AUC for the AI system trained using the Stanford LVAD dataset was 0.860 (95% CI 0.815-0.905; n = 290 patients) using pre-operative echocardiograms alone. We further show that our system outperforms board certified clinicians equipped with both contemporary risk scores (AUC 0.502 - 0.584) and independently measured echocardiographic metrics (0.519 – 0.598).