bluuebunny/crossref_metadata_2025 huggingface dataset:
A case report of cocaine abuse, acute coronary syndrome, and eroded plaque: stent or not stent?
Authors: Muñoz Pousa Isabel , Hernández Ubaldo , Jiménez Díaz Victor A
Published: May 2021

Background

Intracoronary imaging techniques have allowed characterizing atherosclerotic plaques morphologically in patients with the acute coronary syndrome (ACS). Although the main feature described is plaque rupture, the use of optical coherence tomography has made it possible to objectify that the eroded plaque is not uncommon in this setting.

Case summary

We presented a case of a 45-year-old man with active smoking and cocaine user, admitted to the emergency department for chest pain. The electrocardiogram showed ST-segment elevation myocardial infarction (STEMI) in the inferior leads. Emergent coronary angiography was performed, showing thrombotic occlusion of mid-distal right coronary artery. After successful thromboaspiration, no areas of significant angiographic stenosis were observed. Optical coherence tomography imaging at the occlusion site revealed an eroded plaque and a remaining small thrombusburden. Conservative management without stent implantation was decided. Treatments consisted of an acute phase glycoprotein IIb/IIIa inhibitor and subsequently dual antiplatelet therapy with Aspirin (ASA) and Ticagrelor 90 mg b.i.d. for 12 months. The patient remains asymptomatic and uneventful at 9-month follow-up.

Discussion

Young age, history of active smoking, and cocaine use are common clinical features in patients with ACS due to an eroded plaque. These patients frequently display a STEMI with the involvement of a single coronary vessel. Optical coherence tomography imaging aids to a precise diagnosis and to define a proper treatment.
Prediction of right ventricular failure after left ventricular assist device implantation in patients with heart failure: a meta-analysis comparing echocardiographic parameters
Authors: Chriqui Louis-Emmanuel , Monney Pierre , Kirsch Matthias , Tozzi Piergiorgio
Published: May 2021

OBJECTIVES

Between 10% and 40% of patients who receive a left ventricular assistance device (LVAD) suffer from right ventricular failure (RVF) shortly after the device is implanted. Patients with post-LVAD RVF tend to have poor outcomes. Only a few predictive factors concerning the right ventricle (RV) have been investigated. Our goal was to search for non-invasive variables that correlate with RV function, focusing on echocardiographic parameters of the RV.

METHODS

We selected 3 parameters: tricuspid annular plane systolic excursion, right ventricular fractional area change and right ventricular global longitudinal strain. We searched the literature and pooled relevant studies in a meta-analysis. Finally, we performed a statistical analysis to confirm whether each parameter was a reliable predictor of RVF after LVAD implantation.

RESULTS

We retained 19 articles involving a total of 1561 patients. We found a pooled standardized mean deviation of −0.13 cm for the tricuspid annular plane systolic excursion, with the lower and upper tails of −0.21 and −0.04 cm, respectively. Concerning the right ventricular fractional area change, the averaged standardized mean deviation was equal to −2.61%, with the lower and upper extremities of −4.12% and −1.09%, respectively. Finally, regarding the global longitudinal strain, the standardized mean deviation was equal to −2.06% with an uncertainty value between −3.23% and −0.88%.

CONCLUSIONS

The tricuspid annular plane systolic excursion could be a reliable parameter in RVF prediction. The right ventricular fractional area change and global longitudinal strain are likely to be stronger predictors of RVF after LVAD implantation. Prospective studies should be carried out to confirm this observation.
Evaluating the optimization of the use of sedating antihistamines in a community pharmacy: a retrospective quality improvement study in Singapore
Authors: Kua Chong-Han , Lee Shawn Rong En , Cheng Sarah Shi Theng , Lin Joanne Fang Yun , Wang Hui , Lee Grace Wai Fong
Published: May 2021

Objectives

This study aimed to retrospectively assess whether community pharmacy customers accepted the pharmacist’s recommendations for the selection of an antihistamine based on medicine optimization guidelines.

Methods

A retrospective study was conducted on the implementation of an antihistamine use optimization guide for patients who were seeking first-generation antihistamines between July and December 2019 across forty-five community pharmacies in Singapore. The primary outcome measure was the acceptance rate of ceasing or substituting first-generation antihistamine with a second-generation antihistamine. Secondary measures included the reduction in types of first-generation antihistamines used, adverse drug-related events reported, intended use of antihistamines and the types of recommendations.

Key findings

During the study period, 2328 patients fulfilled the inclusion criteria, out of which 523 patients agreed to optimize their use of sedating first-generation antihistamines. Chlorpheniramine (95.2%) was the most widely accepted first-generation antihistamine for optimization, with 59.6% of the users experiencing adverse events, the most common being drowsiness (53.2%). The main indication of use was allergic conditions (allergic rhinitis or atopic dermatitis) (70.3%). After implementation of the guide, most interventions were direct substitution (72.8%) with a less-sedating antihistamine, followed by gradual tapering (22.6%). Loratadine, a second-generation antihistamine, was most frequently (51.4%) used to substitute first-generation antihistamines. The optimization guide can potentially reduce adverse effects in 59.6% (297 patients) of chlorpheniramine users, which were mainly drowsiness (265 patients; 53.2%) and dry mouth (14 patients; 2.8%).

Conclusions

This study highlighted the importance of assessing and reducing potentially inappropriate first-generation antihistamine self-use and that a guided approach and substitution with less-sedating antihistamines can be employed in the community pharmacy setting.
Transpiration efficiency: insights from comparisons of C4 cereal species
Authors: Vadez Vincent , Choudhary Sunita , Kholová Jana , Hash C Tom , Srivastava Rakesh , Kumar A Ashok , Prandavada Anand , Anjaiah Mukkera
Published: May 2021

We have previously reported that there is a tight link between high transpiration efficiency (TE; shoot biomass per unit water transpired) and restriction of transpiration under high vapor pressure deficit (VPD). In this study, we examine other factors affecting TE among major C4 cereals, namely species’ differences, soil type, and source–sink relationships. We found that TE in maize (10 genotypes) was higher overall than in pearl millet (10 genotypes), and somewhat higher than in sorghum (16 genotypes). Overall, transpiration efficiency was higher in high-clay than in sandy soil under high VPD, but the effect was species-dependent with maize showing large variations in TE and yield across different soil types whilst pearl millet showed no variation in TE. This suggested that species fitness was specific to soil type. Removal of cobs drastically decreased TE in maize under high VPD, but removal of panicles did not have the same effect in pearl millet, suggesting that source–sink balance also drove variations in TE. We interpret the differences in TE between species as being accounted for by differences in the capacity to restrict transpiration under high VPD, with breeding history possibly having favored the source–sink balance in maize. This suggests that there is also scope to increase TE in pearl millet and sorghum through breeding. With regards to soil conditions, our results indicate that it appears to be critical to consider hydraulic characteristics and the root system together in order to better understand stomatal regulation and restriction of transpiration under high VPD. Finally, our results highlight the importance of sink strength in regulating transpiration/photosynthesis, and hence in influencing TE.
Validation of a Machine Learning Model for Early Shock Detection
Authors: Pinevich Yuliya , Amos-Binks Adam , Burris Christie S , Rule Gregory , Bogojevic Marija , Flint Isaac , Pickering Brian W , Nemeth Christopher P , Herasevich Vitaly
Published: May 2021

Objectives

The objectives of this study were to test in real time a Trauma Triage, Treatment, and Training Decision Support (4TDS) machine learning (ML) model of shock detection in a prospective silent trial, and to evaluate specificity, sensitivity, and other estimates of diagnostic performance compared to the gold standard of electronic medical records (EMRs) review.

Design

We performed a single-center diagnostic performance study.

Patients and setting

A prospective cohort consisted of consecutive patients aged 18 years and older who were admitted from May 1 through September 30, 2020 to six Mayo Clinic intensive care units (ICUs) and five progressive care units.

Measurements and main results

During the study time, 5,384 out of 6,630 hospital admissions were eligible. During the same period, the 4TDS shock model sent 825 alerts and 632 were eligible. Among 632 hospital admissions with alerts, 287 were screened positive and 345 were negative. Among 4,752 hospital admissions without alerts, 78 were screened positive and 4,674 were negative. The area under the receiver operating characteristics curve for the 4TDS shock model was 0.86 (95% CI 0.85-0.87%). The 4TDS shock model demonstrated a sensitivity of 78.6% (95% CI 74.1-82.7%) and a specificity of 93.1% (95% CI 92.4-93.8%). The model showed a positive predictive value of 45.4% (95% CI 42.6-48.3%) and a negative predictive value of 98.4% (95% CI 98-98.6%).

Conclusions

We successfully validated an ML model to detect circulatory shock in a prospective observational study. The model used only vital signs and showed moderate performance compared to the gold standard of clinician EMR review when applied to an ICU patient cohort.
Brain Function Changes Induced by Intermittent Sequential Pneumatic Compression in Patients With Stroke as Assessed by Functional Near-Infrared Spectroscopy
Authors: Xie Hui , Xu Gongcheng , Huo Congcong , Li Wenhao , Zhao Haihong , Lv Zeping , Li Zengyong
Published: May 2021

Objective

Intermittent sequential pneumatic compression (ISPC) can effectively promote cerebral perfusion and collateral blood supply in patients with stroke. However, the effects of ISPC on cerebral oscillations are still unclear.

Methods

The tissue concentration of oxyhemoglobin and deoxyhemoglobin oscillations were measured by functional near-infrared spectroscopy under resting and ISPC conditions in 27 right-handed adult patients with stroke. Five characteristic frequency signals (I, 0.6–2 Hz; II, 0.145–0.6 Hz; III, 0.052–0.145 Hz; IV, 0.021–0.052 Hz; and V, 0.0095–0.021 Hz) were identified using the wavelet method. The wavelet amplitude (WA) and laterality index (LI) were calculated to describe the frequency-specific cortical activities.

Results

The ISPC state of patients with ischemic stroke showed significantly increased WA values of the ipsilesional motor cortex (MC) in the frequency intervals III (F37 = 8.017), IV (F37 = 6.347), and V (F37 = 5.538). There was no significant difference in the WA values in the ISPC state compared with the resting state in patients with hemorrhagic stroke. Also, the LI values of the prefrontal cortex and MC in patients decreased more obviously in the ISPC state than in the resting state despite no significant difference.

Conclusion

The significantly increased WA values in the frequency intervals III, IV, and V in the MC of patients with ischemic stroke might be related to cortical activity in the MC in addition to increased cerebral perfusion. The decreased LI values in the prefrontal cortex and MC indicated that the ISPC may have had a positive effect on the functional rehabilitation of these regions.

Impact

This study provides a method for assessing the effects of ISPC on cerebral oscillations, and the results benefit the optimization of ISPC parameters in personalized treatment for the functional recovery of patients with stroke.
Effects of drying and providing supplemental oxygen to piglets at birth on rectal temperature over the first 24 h after birth
Authors: Vande Pol Katherine D , Tolosa Andres F , Bautista Raphael O , Willard Naomi C , Gates Richard S , Shull Caleb M , Brown Catherine B , Alencar Stephan A S , Lents Clay A , Ellis Michael
Published: May 2021

Neonatal piglets can experience both a decrease in body temperature and hypoxia, increasing risks for pre-weaning mortality. This research evaluated the effects of drying and providing supplemental oxygen to newborn piglets on rectal temperature (RT) over the first 24 h after birth. The study used a CRD with three Intervention Treatments (IT; applied at birth): Control (no intervention), Drying (dried using a desiccant), Oxygen [dried using a desiccant and placed in a chamber (at 40% oxygen concentration) for 20 min]. A total of 42 litters (485 piglets) were randomly allotted to treatments at the start of farrowing. At birth, each piglet was given a numbered ear tag, weighed, and the treatment was applied; RT was measured at 0, 20, 30, 45, 60, 120, and 1440 min after birth. Blood was collected from one piglet from each birth weight quartile within each litter at 24 h after birth to measure plasma immunocrit concentration. There was no effect (P > 0.05) of IT on piglet RT at 0 or 1440 min after birth. Between 20 and 60 min after birth, piglet RT was lower (P ≤ 0.05) for the Control than the Drying treatment, with the Oxygen treatment being intermediate and different (P ≤ 0.05) from the other two IT. The effect of piglet birth weight on responses to IT were evaluated by classifying piglets into Birth Weight Categories (BWC): Light (<1.0 kg), Medium (1.0 to 1.5 kg), or Heavy (>1.5 kg). There were IT by BWC interactions (P ≤ 0.05) for piglet RT at all measurement times between 20 and 120 min after birth. Relative to the Control, the effects of the Drying and Oxygen treatments on RT were greater (P ≤ 0.05) for Light than heavier piglets. Plasma immunocrit concentrations tended (P = 0.07) to be greater for piglets on the Control treatment compared to the other two IT and were lower (P ≤ 0.05) for Light than Heavy piglets, with Medium piglets being intermediate and different (P ≤ 0.05) to the other BWC. In conclusion, drying piglets at birth reduced the extent and duration of RT decline in piglets in the early postnatal period compared to undried piglets, especially for those of low birth weight. However, the combination of drying and placing piglets in an oxygen-rich environment provided no additional benefit over drying alone.
The multisystem inflammatory syndrome in children and its association to SARS-CoV-2
Authors: Piekarski Florian , Steinbicker Andrea U. , Armann Jakob P.
Published: May 2021

Purpose of review

Multisystem inflammatory syndrome in children (MIS-C)/pediatric inflammatory multisystem syndrome (PIMS) is a new and serious disease that occurs in temporal association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We describe the clinical presentation, diagnosis, and treatment recommendations.

Recent finding

To date, no randomized prospective studies have been published; recommendations are based on some observational studies, case reports, and expert opinions. The article provides an overview of the most important publications, presents the current results of the German Registry for PIMS and expert recommendations for treatment.

MIS-C PIMS is a new syndrome that is associated with a variety of virus infections, and also with SARS-CoV-2. The main characteristics are fever, multiple organ dysfunction due to a hyper-inflammatory state. In particular, cardiac dysfunction and severe shock. A high proportion of patients require intensive medical care, but the absolute number of children with SARS-CoV-2 MIS-C is low. Medical therapy is based on pathophysiologic considerations and is not evidence-based. Immunoglobulins, steroids and biologics are used and lead to effective treatment. Therefore, the mortality rate is very low. Patients usually recover within days, sequelae are reported only in a minority of cases.
Impact of the Opioid Epidemic and Associated Prescribing Restrictions on People Who Live With Chronic Noncancer Pain in Canada
Authors: Kaboré Jean-Luc , Pagé M. Gabrielle , Martel Marc O. , Dassieu Lise , Hudspith Maria , Moor Gregg , Sutton Kathryn , Roy Jean-Sébastien , Williamson Owen D. , Choinière Manon
Published: May 2021

Objectives:

Little is known about the consequences of the opioid epidemic on people living with chronic noncancer pain (CNCP). This study examined this issue in people who lived in the most impacted province by opioid overdoses in Canada (British Columbia [BC]) or one of the least impacted (Quebec [QC]), and examined the factors associated with opioid use.

Materials and Methods:

This cross-sectional study was carried out in adults living in BC (N=304) and QC (N=1071) who reported CNCP (≥3 months) and completed an online questionnaire that was tailored to their opioid status.

Results:

Almost twice as many participants in BC as in QC were proposed to cease their opioid medication in the past year (P<0.001). The proportion who reported having hoarded opioids in fear of not being able to get more in the future was also significantly higher in BC (P<0.001) compared with QC. In addition, they were significantly more likely to have had their opioid dose decreased than those in QC (P=0.001). No significant association was found between opioid discontinuation and province of residence. Two-thirds of the BC participants felt that the media coverage of the opioid crisis was very to extremely detrimental to CNCP patients in general, this percentage being significantly higher than in QC (P<0.001).

Discussion:

The opioid epidemic and associated prescribing restrictions have had harmful effects on Canadians with CNCP. The clinical community, the general public, and the media need to be aware of these negative consequences to decrease patients’ stigmatization and minimize inadequate treatment of CNCP.
Relationship Between Moral Distress and Intent to Leave a Position Among Neonatal Intensive Care Nurses
Authors: Hally Suzanne M. , Settle Margaret , Nelson Brett D.
Published: May 2021

Background:

The phenomenon of moral distress is prevalent in the literature, but little is known about the experiences of nurses working in the neonatal intensive care unit (NICU). In addition, a paucity of literature exists exploring the relationship between moral distress and intent to leave a position in NICU nurses.

Purpose:

To explore the phenomenon of moral distress in NICU nurses using the Measure of Moral Distress for Health Care Professionals (MMD-HP) survey.

Methods:

A cross-sectional, descriptive, correlational study was conducted nationally via an electronic survey distributed to NICU nurses who are members of National Association of Neonatal Nurses (NANN). Participants were asked to electronically complete the MMD-HP survey between March 27 and April 8, 2020.

Findings:

A total of 75 NICU nurses completed the survey, and 65 surveys were included for data analysis. Five situations from the survey had a composite MMD-HP score of more than 400. Results indicated that 41.5% of the NICU nurses surveyed considered leaving a clinical position due to moral distress, and 23.1% of the nurses surveyed left a position due to moral distress.

Implications

for Practice: NICU nurses experiencing high MMD-HP scores are more likely to leave a position. Further research is needed to develop strategies useful in mitigating moral distress in and prevent attrition of NICU nurses.

Implications for Research:

Many NICU nurses experiencing high levels of moral distress have left positions or are considering leaving a clinical position. Longitudinal interventional studies are vital to understand, prevent, and address the root causes of moral distress experienced by NICU nurses.
Effectiveness of e-Learning on Neonatal Nurses' Pain Knowledge and Pain Measurement Skills
Authors: Ozawa Mio , Yokoo Kyoko , Sumiya Takahiro , Kawano Reo
Published: May 2021

Background:

Reported benefits of virtual programs include user satisfaction and feasibility to train nurses to utilize pain scales. However, the effectiveness of the virtual neonatal pain management program on nurses' knowledge and scoring skill acquisition has not been examined.

Purpose:

This study developed a comprehensive virtual program on neonatal pain management and examined its effectiveness on nurses' knowledge and skill acquisition of selected pain scales.

Methods:

Evidence-based content was designed as a virtual program and pre-and posttests to examine skill and knowledge acquisition were developed and validated. Analysis of covariance was used to assess the differences from pre- to posttest based on the intensity of participants' involvement while examining the overall effectiveness of the program.

Results:

A total of 115 nurses representing 7 hospitals completed the virtual neonatal pain management program, and 52 nurses completed the posttest. The Student paired t test showed an increase in posttest scores from pretest scores among participants. Participants' final degrees and years of experience were not related to posttest scores. The analysis of covariance showed that the high study group had a significantly higher amount of change in total scores and pain measurement skill scores than the low study group on the posttest.

Implications for Practice:

The virtually delivered neonatal pain management program can be useful for nurses' attainment of knowledge and skills for managing neonatal pain, including an appropriate use of selected scoring tools.

Implications for Research:

It is necessary to examine how organizational unit attendance rate for e-learning and posttest results are related to patient outcomes.

Video Abstract available at:

https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=46
A Systematic Review of the Effects of Skin-to-Skin Contact on Biomarkers of Stress in Preterm Infants and Parents
Authors: Forde Dorothy , Fang Min Lin , Miaskowski Christine
Published: May 2021

Background:

Premature infants and their parents experience significant stress related to separation and lifesaving procedures. While evidence suggests that skin-to-skin contact (SSC) is a stress-reducing intervention for both neonates and parents, the mechanisms that underlie its efficacy are not well understood.

Objective:

Purpose of this systematic review is to summarize the current state of knowledge on changes in biomarkers (ie, oxytocin [OT], cortisol, hypoxanthine, xanthine, uric acid, and allantoin), associated with SSC in premature infants and parents, that may reflect physiologic responses to stress.

Methods:

A comprehensive literature search was conducted from 1990 to 2020. Studies were selected using prespecified inclusion and exclusion criteria.

Results:

Of the 175 studies identified, only 19 are included in this review. Ten studies evaluated only infants, 2 evaluated only parents, and 7 evaluated for changes in biomarkers in both infants and parents. Cortisol was the most common biomarker evaluated. While changes in infants' cortisol levels were highly variable, in 55% of the parent studies, parent cortisol levels decreased following SSC. In both parents and infants, OT levels decreased following SSC. Only 1 study found that allantoin levels were significantly lower in infants who received SSC.

Implications for Practice and Research:

While evidence suggests the numerous benefits of SSC, additional research is needed to identify the optimal biomarker to determine the mechanisms that underlie these effects. The use of novel biomarkers (eg, gene expression changes microbiome) may provide new insights into the mechanisms that underlie the efficacy of SSC.

Video Abstract available at:
https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=48
Barriers to Kangaroo Care in the NICU
Authors: Saltzmann April M. , Sigurdson Krista , Scala Melissa
Published: May 2021

Background:

Despite its benefits, parents in the neonatal intensive care unit (NICU) face significant barriers to kangaroo care (KC). Clinician-reported barriers to KC include staff education, environment, and equipment among others; however, parent-perceived barriers are underexplored.

Purpose:

To examine parental understanding of KC, parental perception of experiences with KC, and parental views on the key factors that help or hinder KC.

Methods:

This is an observational, mixed-methods study that used an author-developed survey to assess parental feelings, perceived importance, and barriers to KC. Likert scale responses were analyzed using descriptive statistics. Free-text responses were analyzed using thematic analysis. A comparison of results was made between parents receiving and not receiving infant mental health services.

Results:

Fifty (N = 50) parents completed surveys. Eighty percent of parents stated they wanted more information on KC. Common barriers to KC were reported by parents, such as issues with space/environment. The most frequently reported barrier when asked openly was fear of hurting their infant. Ninety-six percent of parents believed that KC helped their emotional well-being. Parents receiving mental health services reported more fear but results did not reach significance.

Implications for Practice and Research:

The frequency with which factors are reported as important to parents may allow a prioritization of barriers to KC, which may help focus quality improvement initiatives. The results of this study underscore the vital role nurses play in supporting KC. Additional attention needs to be given to the mental health of NICU parents and its impact on care practices.
Abdominal wall endometriosis: an update in diagnosis, perioperative considerations and management
Authors: Allen Sarah E. , Rindos Noah B. , Mansuria Suketu
Published: May 2021

Purpose of review

Abdominal wall endometriosis (AWE) is rare with limited evidence guiding diagnosis and treatment. The purpose of this review is to provide an update of the diagnosis, perioperative considerations, and treatment of AWE.

Recent findings

Recent studies further characterize presenting symptoms and locations of AWE. Prior abdominal surgery remains the greatest risk factor for the development of AWE. Newer evidence suggests that increasing BMI may also be a risk factor. Ultrasound is first-line imaging for diagnosis. Magnetic resonance image is preferred for surgical planning for deep or extensive lesions. Laparotomy with wide local excision is considered standard treatment for AWE with great success. Novel techniques in minimally invasive surgery have been described as effective for the treatment of AWE. A multidisciplinary surgical approach is often warranted for successful excision and reapproximation of skin and/or fascial defects. Noninvasive therapies including ultrasonic ablation or cryotherapy are also emerging as promising treatment strategies in select patients.

Recent studies provide further evidence to guide diagnosis through physical exam and imaging as well as pretreatment planning. Treatment options for AWE are rapidly expanding with novel approaches in minimally invasive and noninvasive therapies now available.
Hypertension in kidney transplantation: a consensus statement of the ‘hypertension and the kidney’ working group of the European Society of Hypertension
Authors: Halimi Jean-Michel , Ortiz Alberto , Sarafidis Pantelis A. , Mallamaci Francesca , Wuerzner Grégoire , Pisano Anna , London Gérard , Persu Alexandre , Rossignol Patrick , Sautenet Bénédicte , Ferro Charles , Boletis John , Kanaan Nada , Vogt Liffert , Bolignano Davide , Burnier Michel , Zoccali Carmine
Published: May 2021

Hypertension is common in kidney transplantation recipients and may be difficult to treat. Factors present before kidney transplantation, related to the transplantation procedure itself and factors developing after transplantation may contribute to blood pressure (BP) elevation in kidney transplant recipients. The present consensus is based on the results of three recent systematic reviews, the latest guidelines and the current literature. The current transplant guidelines, which recommend only office BP assessments for risk stratification in kidney transplant patients should be reconsidered, given the presence of white-coat hypertension and masked hypertension in this population and the better prediction of adverse outcomes by 24-h ambulatory BP monitoring as indicated in recent systematic reviews. Hypertension is associated with adverse kidney and cardiovascular outcomes and decreased survival in kidney transplant recipients. Current evidence suggests calcium channel blockers could be the preferred first-step antihypertensive agents in kidney transplant patients, as they improve graft function and reduce graft loss, whereas no clear benefit is documented for renin–angiotensin system inhibitor use over conventional treatment in the current literature. Randomized control trials demonstrating the clinical benefits of BP lowering on kidney and major cardiovascular events and recording patient-related outcomes are still needed. These trials should define optimal BP targets for kidney transplant recipients. In the absence of kidney transplant-specific evidence, BP targets in kidney transplant recipients should be similar to those in the wider chronic kidney disease population.
The effect of heart rate and pulse pressure on mean arterial pressure: the combined formula for calculation of mean arterial pressure
Authors: Kaypakli Onur , Özgeyik Mehmet
Published: May 2021

Background

We demonstrate a new formula to predict mean arterial pressure (MAP) using corrections of the key factors associated with the inaccuracy of the standard formula: heart rate (HR) and pulse pressure (PP).

Methods

A total of 99 patients (50 men, 49 women; mean age 52.5 ± 10.3 years), who underwent elective coronary angiography, were enrolled in our study. The arterial pressure was measured in the aortic root. MAP was measured digitally by the area-under-the-pressure-time curve method. We evaluated the accuracy of four different formulas: the standard formula, the formula of Razminia et al., the formula of Meaney et al. and the combined formula.

Results

PP coefficient deviation of the standard formula was negatively correlated with PP (R = −0,561, P < 0.001), and positively correlated with HR (R = 0,298, P = 0.003). Both R and R
2 values of the combined formula were higher than previous formulas. Accuracy parameters of the combined formula [root mean square error (RMSE): 1.801 mmHg, mean square residuals (MSR): 3.244 mmHg2, Akaike information criterion (AIC): 401.4] were superior to the standard formula (RMSE: 1.902 mmHg, MSR: 3.620 mmHg2, AIC: 412.3), the formula of Razminia et al. (RMSE: 2.022 mmHg, MSR: 4.089 mmHg2, AIC: 424.3) and the formula of Meaney et al. (RMSE: 2.137 mmHg, MSR: 4.568 mmHg2, AIC: 435.3). In the multivariate linear regression analysis, the combined formula was the only method that independently predicts the measured MAP (beta = 0,990, P < 0.001).

Conclusion

The combined formula is superior to previous formulas for accurately predicting MAP.
Rates of Disenrollment From Medicare Advantage Plans Are Higher for Racial/Ethnic Minority Beneficiaries
Authors: Martino Steven C. , Mathews Megan , Damberg Cheryl L. , Mallett Joshua S. , Orr Nate , Ng Judy H. , Agniel Denis , Tamayo Loida , Elliott Marc N.
Published: May 2021

Background:

Each year, about 10% of Medicare Advantage (MA) enrollees voluntarily switch to another MA contract, while another 2% voluntarily switch from MA to fee-for-service Medicare. Voluntary disenrollment from MA plans is related to beneficiaries’ negative experiences with their plan, disrupts the continuity of care, and conflicts with goals to reduce Medicare costs. Little is known about racial/ethnic disparities in voluntary disenrollment from MA plans.

Objective:

The objective of this study was to investigate differences in rates of voluntary disenrollment from MA plans by race/ethnicity.

Subjects:

A total of 116,770,319 beneficiaries enrolled in 736 MA plans in 2015.

Methods:

Differences in rates of disenrollment across racial/ethnic groups [Asian or Pacific Islander (API), Black, Hispanic, and White] were summarized using 4 types of logistic regression models: adjusted and unadjusted models estimating overall differences and adjusted and unadjusted models estimating within-plan differences. Unadjusted overall models included only racial/ethnic group probabilities as predictors. Adjusted overall models added age, sex, dual eligibility, disability, and state of residence as control variables. Between-plan differences were estimated by subtracting within-plan differences from overall differences.

Results:

Adjusted rates of disenrollment were significantly (P<0.001) higher for Hispanic (+1.2 percentage points), Black (+1.2 percentage points), and API beneficiaries (+2.4 percentage points) than for Whites. Within states, all 3 racial/ethnic minority groups tended to be concentrated in higher disenrollment plans. Within plans, API beneficiaries voluntarily disenrolled considerably more often than otherwise similar White beneficiaries.

Conclusion:

These findings suggest the need to address cost, information, and other factors that may create barriers to racial/ethnic minority beneficiaries’ enrollment in plans with lower overall disenrollment rates.
Aligning Health Care and Social Services to Reduce Hospitalizations and Emergency Department Visits
Authors: Akiya Kelley , Fisher Elisa , Wells Annie , Li Yan , Peck Christine , Pagán José A.
Published: May 2021

Background:

Integration of social services in health care delivery is increasingly recognized as a potential strategy for improving health and reducing the use of acute care services. Collaborative models that provide older adults with case management, linkages to social services, and assistance with health care navigation have emerged as promising strategies.

Objective:

The objective of this study was to evaluate the Community Care Connections (CCC) program, a cross-sector collaboration designed to align social and health care services for older adults.

Research Design:

We compared hospitalizations and emergency department (ED) visits 90 days after enrollment with a propensity score–matched group of non-CCC patients. Subgroup analyses were also conducted for adults with hypertension, diabetes, and high cholesterol.

Subjects:

A total of 1004 patients enrolled in CCC between June 1, 2016, and November 15, 2018, and 1004 matched patients from the same metropolitan area.

Measures:

Mean hospitalizations and ED visits per patient 90 days after CCC enrollment.

Results:

Mean hospitalizations were lower among CCC patients 90 days after enrollment than among non-CCC adults [difference=−0.039, 95% confidence interval (CI): −0.077 to −0.001, P=0.044]. They were also lower among CCC patients with hypertension (difference=−0.057, 95% CI: −0.103 to −0.010, P=0.017). However, 90 days after enrollment mean ED visits were higher among CCC patients relative to non-CCC adults (difference=0.238, 95% CI: 0.195–0.281, P<0.001).

Conclusions:

Connecting older adults to social services while being served by the health care system may lead to decreases in hospitalizations. Cross-sector partnerships that address social and economic needs may reduce the use of costly health care services.
Trends in Pediatric Patient-Ventilator Asynchrony During Invasive Mechanical Ventilation
Authors: Blokpoel Robert G. T. , Burgerhof Johannes G. M. , Markhorst Dick G. , Kneyber Martin C. J.
Published: May 2021

OBJECTIVES:

To explore the level and time course of patient-ventilator asynchrony in mechanically ventilated children and the effects on duration of mechanical ventilation, PICU stay, and Comfort Behavior Score as indicator for patient comfort.

DESIGN:

Secondary analysis of physiology data from mechanically ventilated children.

SETTING:

Mixed medical-surgical tertiary PICU in a university hospital.

PATIENTS:

Mechanically ventilated children 0–18 years old were eligible for inclusion. Excluded were patients who were unable to initiate and maintain spontaneous breathing from any cause.

MEASUREMENTS AND MAIN RESULTS:

Twenty-nine patients were studied with a total duration of 109 days. Twenty-two study days (20%) were excluded because patients were on neuromuscular blockade or high-frequency oscillatory ventilation, yielding 87 days (80%) for analysis. Patient-ventilator asynchrony was detected through analysis of daily recorded ventilator airway pressure, flow, and volume versus time scalars. Approximately one of every three breaths was asynchronous. The percentage of asynchronous breaths significantly increased over time, with the highest prevalence on the day of extubation. There was no correlation with the Comfort Behavior score. The percentage of asynchronous breaths during the first 24 hours was inversely correlated with the duration of mechanical ventilation. Patients with severe patient-ventilator asynchrony (asynchrony index > 10% or > 75th percentile of the calculated asynchrony index) did not have a prolonged duration of ventilation.

CONCLUSIONS:

The level of patient-ventilator asynchrony increased over time was not related to patient discomfort and inversely related to the duration of mechanical ventilation.
Coping Mechanisms Mitigate Psychological Stress in Patients With Rheumatologic Diseases During the COVID-19 Pandemic
Authors: Wang Xin A. , Duculan Roland , Mancuso Carol A.
Published: May 2021

Background

Coping with stress is part of self-managing systemic rheumatic diseases. Our objective was to assess stress and coping during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

During the pandemic in New York City, patients taking disease-modifying antirheumatic drugs answered open-ended questions about the pandemic's effects on daily life and their rheumatic condition. Themes of stress and coping were discerned from volunteered responses. Patients also completed the standard Generalized Anxiety Disorder (GAD-7) scale/PROMIS Anxiety surveys. Anxiety scores were independent variables in multivariable analyses with stress and coping themes as combined dependent variables.

Results

Of the 112 patients interviewed (86% women; mean age, 50 years), 72 volunteered COVID-19–related stress on their rheumatic condition, home, work, and finances. Patients volunteering stress were younger, had disease longer, were taking more than 1 medication, had worse GAD-7 scores and a positive anxiety screen, and had worse PROMIS scores that were significantly worse than population norms (all comparisons, p ≤ 0.01; all variables remained associated in multivariable analyses). Fourty-one patients volunteered coping mechanisms including support from others, engaging in activities, and resilience already establish in dealing with rheumatic diseases. Of these, 18 volunteered both coping and stress and 23 volunteered coping and no stress. Patients in the latter (coping-only) group were more likely to be older, taking only 1 medication, and had better GAD-7 and PROMIS scores (all comparisons, p ≤ 0.02). In multivariable analysis, older age (p = 0.02) and lower GAD-7 (p = 0.03) or PROMIS scores (p = 0.03) remained associated.

Conclusions

Patients reported stress and coping due to the COVID-19 pandemic. Analyses with standard anxiety measures demonstrated lower anxiety in patients who volunteered coping mechanisms.
Frontoethmoidal Encephalomeningocele Correction by Medial Orbital Composite-Unit Translocation Technique: 13 Years of Siriraj Hospital Experience
Authors: Chaisrisawadisuk Sarut , Boonvisut Sriprasit
Published: May 2021

Frontoethmoidal encephalomeningocele (FEEM) is a congenital anomaly involving herniation of the glial tissues and the meninges. Our unit implemented single-stage repair in 1996, and this was followed by the introduction of the medial orbital composite-unit translocation (MOCUT) technique for encephalocele repair in 2001. This report describes the long-term outcomes of patients who underwent the MOCUT technique. Data were collected on 32 patients operated on between 2005 and 2018. A full analysis was subsequently made of the data from 4 selected patients who had been monitored for at least 5 years, and their age-related anterior interorbital distances were compared. Two of the patients, who had simple forms of FEEM, demonstrated improvements in their intercanthal and anterior interorbital distances, whereas telecanthus was experienced by the 2 other cases, both of whom had complex FEEM types. We recommend using the MOCUT technique for simple types of FEEM (especially Type IA) and patients whose medial canthal ligaments are still anatomically attached to the medial orbits.
One-Year Craniofacial Surgery Fellowship at Chang Gung Memorial Hospital
Authors: Bhandari Kishor
Published: May 2021

Residency trainings in oral and maxillofacial surgery, plastic surgery, or otolaryngology do not sufficiently cover all aspects of craniofacial surgery to enable fresh graduates to independently practice as craniofacial surgeons. Fellowship trainings are almost mandatory to gain added skills and knowledge in the subspecialty. There are limited number of fellowship centers around the globe that accept international fellows, provide an excellent hands-on experience, arrange free accommodation and pay stipend to the selected candidates. The author presents his critical review of 1-year craniofacial surgery fellowship at Chang Gung Memorial Hospital, Taiwan, sponsored by Noordhoff Craniofacial Foundation (NCF), during which he rotated in pediatric craniofacial surgery unit for five and half months, orthognathic surgery unit for 4 months and craniofacial trauma and reconstruction unit for two and half months. The surgical log is presented along with critical review of individual postings, pearls of the overall fellowship along with suggestions for interested candidates to join the fellowship.
Posterior Cranial Vault Manifestations in Nonsyndromic Sagittal Craniosynostosis
Authors: Chaisrisawadisuk Sarut , Moore Mark H.
Published: May 2021

Sagittal synostosis is the most common type of craniosynostosis. Sagittal suture fusion causes restriction of biparietal cranial vault growth, with expansion of the growing brain causing frontal bossing, an occipital bullet, and an elongated head shape. Due to the absence of studies focusing on the posterior cranial vault pattern in isolated sagittal craniosynostosis, we organized this study to characterize the posterior part of the cranial vault and its association with sagittal craniosynostosis. A retrospective study was conducted of isolated sagittal craniosynostosis patients who had undergone total cranial vault remodeling at the Cleft and Craniofacial South Australia (formerly known as the Australian Craniofacial Unit) between January 2018 and February 2020. Preoperative three-dimensional computed tomography (3D-CT) images were reviewed. The following parameters were evaluated: the cephalic index, lambdoid suture shape, lambdoid suture line pattern, presence of wormian bones along the lambdoid sutures and occipital fontanelle, presence of the mendosal suture, and angle at the tip of the join between the 2 lambdoid sutures. Thirty-nine 3D-CT scans of 32 males and 7 females were evaluated. The mean age when the patients underwent the 3D-CT imaging was 6.72 ± 7.9 months. A high prevalence of mendosal sutures (74.4%) was significantly found in sagittal craniosynostosis. Adult-like types of lambdoid suture interdigitating patterns were also significantly associated with young patients with sagittal craniosynostosis. No associations between the remaining parameters and particular synostoses were revealed.
The Application of Ball Shaped Diced Conchal Cartilage Wrapped With Dermofat in Tip Plasty
Authors: Khan Galina , Park Kyong Chan , Park EunSoo
Published: May 2021

Background:

Based on previous reports, in comparison with Caucasian, nose anatomy has features that have to be considered by surgeons during the tip augmentation in Asian patients. Weak alar cartilages, thick soft-tissue envelope, and bifid-like tip in most cases. This case report demonstrates our experience of using ball-shaped diced conchal cartilage during the tip plasty in Asian patients.

Case report:

Twenty-seven-year-old female patient underwent tip plasty augmentation with ball shaped diced cartilage wrapped with dermofat. There were no complications in postoperative period.

Discussion:

Based on the Asian nasal anatomy features, surgeons commonly use septal extension graft in tip projection and derotation. However, it is still challenging to perform it in patients with septal cartilage insufficiency. In this case report, the authors introduce the alternative surgical option for nasal tip augmentation. The ball shaped cartilage autologous implant can be successfully used in tip plasty.
The Most Disruptive Publications in Craniofacial Surgery (1954–2014)
Authors: Horen Sydney R. , Hansdorfer Marek A. , Kronshtal Roxolana , Dorafshar Amir H. , Becerra Adan Z.
Published: May 2021

Background:

Emphasis on the quantification and qualification of scientific literature has increased over recent years. The newly validated disruption score is a bibliometric measure that identifies groundbreaking research that eclipses prior research in a specific field of study.

Materials and Methods:

The 100 most disruptive craniofacial surgery publications were identified through query of the 4 top craniofacial journals and 10 of the most prominent Plastic and Reconstructive Surgery journals, looking at craniofacial specific publications.

Results:

Presented is the compilation and analysis of the 100 most disruptive publications in the field of craniofacial surgery compared to the 100 most cited publications between 1954 and 2014. Plastic and Reconstructive Surgery had the most papers in the top 100 (n = 56) followed by Journal of Oral and Maxillofacial Surgery (n = 22), and British Journal of Surgery (n = 12). The correlation coefficient between disruption scores and citation counts was –0.001 and –0.07 among all papers, and the top 100 most disruptive papers, respectively. For craniofacial journals, Journal of Craniofacial Surgery had the highest average disruption score for all published papers. The most common decade represented in the top 100 was the 1980's (n = 32) and the least common was the 2000's (n = 14). Randomized controlled trials did not comprise a large amount of either the most disruptive (n = 1) or most cited (n = 2) lists.

Conclusions:

This is the first use of disruption index score to describe craniofacial surgery research. The disruption score can help recognize paradigm shifts and innovative research in this unique surgical subspecialty.