bluuebunny/crossref_metadata_2025 huggingface dataset:
Severe iron deficiency anemia in the paediatric emergency department: A retrospective study
Authors: Speckert Matthew , Ramic Lana , Mitsakakis Nicholas , Bijelić Vid , Liebman Mira , Leung Elaine
Published: October 2022

Background

Transfusion is discouraged in hemodynamically stable children with severe iron deficiency anemia (IDA). Intravenous (IV) iron sucrose (IS) could be an alternative for some patients; however, there is a paucity of data on its use in the paediatric emergency department (ED).

Methods

We analyzed patients presenting with severe IDA at the Children’s Hospital of Eastern Ontario (CHEO) ED between September 1, 2017, and June 1, 2021. We defined severe IDA as microcytic anemia <70 g/L and either a ferritin <12 ng/mL or a documented clinical diagnosis.

Results

Of 57 patients, 34 (59%) presented with nutritional IDA and 16 (28%) presented with IDA secondary to menstrual bleeding. Fifty-five (95%) patients received oral iron. Thirteen (23%) patients additionally received IS and after 2 weeks, the average Hgb was similar to transfused patients. The median time for patients receiving IS without PRBC transfusion to increase their Hgb by at least 20 g/L was 7 days (95%CI 0.7 to 10.5 days). Of 16 (28%) children who were transfused with PRBC, there were three mild reactions, and one patient who developed transfusion associated circulatory overload (TACO). There were two mild and no severe reactions to IV iron. There were no return visits to the ED due to anemia in the following 30 days.

Conclusions

Management of severe IDA with IS was associated with a rapid rise in Hgb without severe reactions or returns to ED. This study highlights a strategy for management of severe IDA in hemodynamically stable children that spares them the risks associated with PRBC transfusion. Paediatric specific guidelines and prospective studies are needed to guide the use of IV iron in this population.
Cumulative Environmental Risk in Early Life: Associations With Schizotypy in Childhood
Authors: O’Hare Kirstie , Watkeys Oliver , Whitten Tyson , Dean Kimberlie , Laurens Kristin R , Tzoumakis Stacy , Harris Felicity , Carr Vaughan J , Green Melissa J
Published: October 2022

Background and Hypothesis

Psychotic disorders are associated with a growing number of recognized environmental exposures. Cumulative exposure to multiple environmental risk factors in childhood may contribute to the development of different patterns of schizotypy evident in early life. Hypotheses were that distinct profiles of schizotypy would have differential associations with a cumulative score of environmental risk factors.

Study Design

We prospectively examined the relationship between 19 environmental exposures (which had demonstrated replicated associations with psychosis) measured from the prenatal period through to age 11 years, and 3 profiles of schizotypy in children (mean age = 11.9 years, n = 20 599) that have been established in population data from the New South Wales-Child Development Study. Multinomial logistic regression was used to examine associations between membership in each of 3 schizotypy profiles (true schizotypy, introverted schizotypy, and affective schizotypy) and exposure to a range of 19 environmental risk factors for psychosis (both individually and summed as a cumulative environmental risk score [ERS]), relative to children showing no risk.

Results

Almost all environmental factors were associated with at least 1 schizotypy profile. The cumulative ERS was most strongly associated with the true schizotypy profile (OR = 1.61, 95% CI = 1.52–1.70), followed by the affective (OR = 1.33, 95% CI = 1.28–1.38), and introverted (OR = 1.32, 95% CI = 1.28–1.37) schizotypy profiles.

Conclusions

Consistent with the cumulative risk hypothesis, results indicate that an increased number of risk exposures is associated with an increased likelihood of membership in the 3 schizotypy profiles identified in middle childhood, relative to children with no schizotypy profile.
Causal relationships of excessive daytime napping with atherosclerosis and cardiovascular diseases: a Mendelian randomization study
Authors: Chen Jiayun , Chen Jie , Zhu Tianren , Fu Yuanyuan , Cheongi Io Hong , Yi Kexin , Wang Hui , Li Xue
Published: October 2022

Study Objectives

Previous observational studies have found conflicting evidence on the relationship between daytime napping and incident cardiovascular diseases (CVDs), but it remains unclear whether these associations present causality. This study aims to verify whether and why there is a causal relationship between these parameters, and whether there is an etiological basis.

Methods

A two-sample Mendelian randomization analysis was performed using 79 single nucleotide polymorphisms associated with daytime napping. Summary-level data for coronary atherosclerosis, peripheral atherosclerosis, total CVD, and five CVD outcomes were obtained from the FinnGen study. Meta-analyses were aimed at investigating the relationships of excessive daytime napping with total CVD, coronary heart disease, myocardial infarction (MI), and stroke incidence. Subgroup, network meta-analysis (NMA) and trial sequential analysis (TSA) were also performed in this study.

Results

The inverse-variance weighted method demonstrated that a genetic predisposition to more frequent daytime napping was significantly associated with higher odds of coronary atherosclerosis (odds ratio [OR] = 1.55, 95% confidence interval [CI]: 1.11 to 2.17), MI (OR = 1.63, 95% CI: 1.06 to 2.50), and heart failure (OR = 1.80, 95%CI: 1.28 to 2.52). In NMA, an increased risk of developing CVD in people who napped for more than 60 min a day than those who did not nap was demonstrated and then supported by TSA results (summary relative risk = 1.98, 95% CI: 1.39 to 2.82).

Conclusion

Habitual daytime napping is causally associated with an increased risk of incident CVD primarily via the development of coronary atherosclerosis. An average napping duration of more than 60 min is associated with an elevated risk of CVD in all participants.
Research on the comfort degradation mechanism of high-speed railway passengers: a field study using dynamic interface pressure
Authors: Peng Yong , Sun Dayan , Fan Chaojie , Wu Zhifa , Yi Shengen , Peng Yuexiang , Liu Yingjun
Published: October 2022

Discomfort caused by long-term sitting decreases the passenger experience and may lead to musculoskeletal diseases, and this has become one of the main problems for passengers of high-speed railways. However, the comfort degradation mechanism during long-term sitting in high-speed railways is still unknown. This study aimed to reveal passengers’ sitting comfort degradation mechanism in high-speed railways. By carrying out long-term sitting tests on high-speed trains running on the Shanghai-Kunming line, the dynamic interface pressure and subjective comfort including overall and regional comfort of seven participants were obtained. Machine learning models and statistical analysis methods were combined for data analysis to reveal the effect of regional comfort and the contribution of sitting duration during the process of sitting comfort degradation. The results show that overall comfort is most significantly influenced by the comfort of the shoulders, waist and buttocks. The seats play different roles before and after 20 minutes during long-term sitting and there is a lag between the fatigue occurring and being offset. Therefore, the structure of seats affects overall comfort by affecting important regional comfort, and a long-term sitting test is necessary for accurate seat assessment. The comfort degradation mechanism can be used to define standards for long-term sitting comfort or provide guidance for seat evaluation, and the design and evaluation plan mentioned in this article for second-class seats can be applied to other cases with limited accommodating space.
Quality-Improvement Initiative for Expedited Partner Therapy Provision in an Obstetrics and Gynecology Office
Authors: Vasudeva Isha , Hartnett Janice , Bondi Laura , Newmark Alexis , Lindsay Sarah
Published: October 2022

(Abstracted from Obstet Gynecol 2022;140:305–310)

Women of childbearing age are disproportionately affected by sexually transmitted infections (STIs), which lead to pelvic inflammatory disease and infertility, and have other serious implications. Sexual partners of patients diagnosed with gonorrheal or chlamydial infections are at high risk of STIs.
Impacted Fetal Head During Second Stage Caesarean Birth: A Prospective Observational Study
Authors: Jones Nia Wyn , Mitchell Eleanor J. , Wakefield Natalie , Knight Marian , Dorling Jon , Thornton Jim G. , Walker Kate F.
Published: October 2022

(Abstracted from Eur J Obstet Gynecol Reprod Biol 2022;272:77–81)

The rate of cesarean delivery (CD) at full cervical dilation in the second stage of labor is rising. During this stage, the risk of maternal and neonatal complications is greater because the baby's head may be engaged deeply in the pelvis, a condition known as impacted fetal head.
US Incidence of Late-Preterm Steroid Use and Associated Neonatal Respiratory Morbidity After Publication of the Antenatal Late Preterm Steroids Trial, 2015–2017
Authors: Clapp Mark A. , Melamed Alexander , Freret Taylor S. , James Kaitlyn E. , Gyamfi-Bannerman Cynthia , Kaimal Anjali J.
Published: October 2022

(Abstracted from JAMA Netw Open 2022;5:e2212702)

In 2016, the antenatal late preterm steroids (ALPS) trial found that corticosteroids reduced the risk of respiratory complications in late-preterm neonates by 20%. The publication of this large-scale randomized clinical trial built upon previous findings that the antenatal administration of steroids decreased neonatal respiratory morbidity.
The Reckoning: The Return of Genomic Results to 1444 Participants Across the eMERGE3 Network
Authors: Leppig Kathleen A. , Rahm Alanna Kulchak , Appelbaum Paul , Aufox Sharon , Bland Sarah T. , Buchanan Adam , Christensen Kurt D. , Chung Wendy K. , Clayton Ellen Wright , Crosslin David , Denny Josh , DeVange Shannon , Gordon Adam , Green Robert C. , Hakonarson Hakon , Harr Margaret H. , Henrikson Nora , Hoell Christin , Holm Ingrid A. , Kullo Iftikhar J. , Jarvik Gail P. , Lammers Philip E. , Larson Eric B. , Lindor Noralane M. , Marasa Maddalena , Myers Melanie F. , Perez Emma , Peterson Josh F. , Pratap Siddharth , Prows Cynthia A. , Ralston James D. , Rasouly Hila Milo , Roden Dan M. , Sharp Richard R. , Singh Rajbir , Shaibi Gabriel , Smith Maureen E. , Sturm Amy , Thiese Heidi A. , Van Driest Sara L. , Williams Janet , Williams Marc S. , Wynn Julia , Blout Zawatsky Carrie L. , Wiesner Georgia L.
Published: October 2022

(Abstracted from Genet Med 2022;24:1130–1138)

As increased accessibility to genetic testing contributes to finding more individuals with genetic predispositions to a specific conditions or diseases, National Institutes of Health–sponsored networks grow in importance when considering the identification and subsequent management of these conditions. The American College of Genetics and Genomics (ACMG) designated 59 genes (this is now higher with subsequent versions of the guideline) as highly actionable owing to availability of effective medical management guidelines for individuals with detected disease-causing variants in one of these genes.
Regional anaesthesia: what surgical procedures, what blocks and availability of a “block room”?
Authors: Nanda Arwien , Van de Velde Marc
Published: October 2022

Purpose of review

With an expected rise in day care procedures with enhanced recovery programs, the use of specific regional anaesthesia can be useful. In this review, we will provide insight in the used regional block and medication so far known and its applicability in a day care setting.

Recent findings

Regional anaesthesia has been improved with the aid of ultrasound-guided placement. However, it is not commonly used in the outpatient setting. Old, short acting local anaesthetics have found a second life and may be especially beneficial in the ambulatory setting replacing more long-acting local anaesthetics such as bupivacaine.

To improve efficiency, a dedicated block room may facilitate the performance of regional anaesthesia. However, cost-efficacy for improved operating time, patient care and hospital efficiency has to be established.

Regional anaesthesia has proven to be beneficial in ambulatory setting. Several short acting local anaesthetics are favourable over bupivacaine in the day care surgery. And if available, there are reports of the benefit of an additional block room used in a parallel (monitored) care of patients.
Scheduling staff for ambulatory anaesthesia
Authors: Dexter Franklin , Epstein Richard H.
Published: October 2022

Purpose of review

In this study, we summarize six articles published from January 2020 through June 2022 covering anaesthesia staff scheduling and consider their relevance to ambulatory surgery. Staff scheduling refers to the planned shift length of each person working on specific dates.

Recent findings

Increasing shift lengths compensates for COVID-19 pandemic staffing issues by reducing patient queues and mitigating the impact of staff absence from SAR-CoV-2 infection. Reduced labour costs can often be achieved by regularly scheduling more practitioners than expected from intuition. Probabilities of unscheduled absences, estimated using historical data, should be incorporated into staff scheduling calculations. Anesthetizing locations, wherein anaesthesiologists are scheduled, may need to be revised if the practitioner is lactating to facilitate uninterrupted breast milk pumping sessions. If room assignments are based on the educational value for residents, then schedule other practitioners based on residents’ expected work hours, not their planned shift lengths. Mixed integer programming can be used effectively to reduce variability among resident physicians in workloads during their rotations.

Readers can reasonably select among these studies and benefit from the one or two applicable to their facilities’ characteristics and work hours.
Extension of patient safety initiatives to perioperative care
Authors: Arnal-Velasco Daniel , Paz-Martín Daniel
Published: October 2022

Purpose of review

Patient safety has significantly improved during the intraoperative period thanks to the anesthesiologists, surgeons, and nurses. Nowadays, it is within the perioperative period where most of the preventable harm happened to the surgical patient. We aim to highlight the main issues and efforts to improve perioperative patient safety focusing and the relation to intraoperative safety strategies.

Recent findings

There is ongoing research on perioperative safety strategies aiming to initiate multidisciplinary interventions on early stages of the perioperative period as well as an increasing focus on preventing harm from postoperative complications.

Any patient safety strategy to be implemented needs to be framed beyond the operating room and include in the intervention the whole perioperative period.
Lung transplantation for coronavirus disease 2019 associated severe acute respiratory distress syndrome
Authors: Garza-Castillon Rafael , Bharat Ankit
Published: October 2022

Purpose of review

The purpose of this review is to analyze the most recent and relevant literature involving lung transplantation for coronavirus disease 2019 (COVID-19) associated acute respiratory distress syndrome (ARDS), the pathological mechanisms of lung injury, selection criteria and outcomes.

Recent findings

Pathological analysis of lungs after COVID-19 ARDS has shown architectural distortion similar to that observed in explanted lungs from patients undergoing lung transplantation for end-stage lung diseases such as emphysema. Short-term outcomes after lung transplantation for COVID-19 associated respiratory failure are comparable to those performed for other indications.

Lung transplantation after COVID-19 ARDS is a potentially life-saving procedure for appropriately selected patients with no evidence of lung function recovery despite maximal treatment. Lung transplantation should be ideally performed in high-volume centers with expertise.
Feasibility of a Brief Intervention to Decrease Harmful Alcohol Use Among Methadone Maintenance Treatment Clients in Shanghai: A Randomized Controlled Trial
Authors: Gong Yao , Zhang Lei , Long Jiang , Wu Qianying , Zhang Jingying , Bao Jiayi , Du Jiang , Du Zheyi
Published: October 2022

Objectives

In this study, we aimed to examine the prevalence of alcohol consumption among methadone maintenance treatment (MMT) clients in Shanghai and to determine whether a brief intervention (BI) affects drinking among them.

Methods

A total of 837 clients from 14 local MMT clinics were invited to complete the Alcohol Use Disorders Identification Test (AUDIT). One hundred one were included in the study and randomly assigned to the BI group or the control group. Clients in the BI group received a BI and general health education, whereas clients in the control group received the general health education only. Baseline and postintervention assessments were conducted by using the AUDIT, the Drinking Attitude Questionnaire, the Depression Module of the Patient Health Questionnaire, the Generalized Anxiety Disorder Scale, and the General Well-Being Schedule.

Results

Two hundred fifty-nine (30.9%) reported drinking during the last year, and 103 (12.3%) met the criteria for harmful use. At the 3-month follow-up, the AUDIT scores of the 2 groups were significantly decreased, and the time effect was statistically significant (F = 6.224, P = 0.018), but there was no group difference in AUDIT scores (F = 1.953, P = 0.172). Both groups had a main time effect of time on the improvement of depression (F = 8.044, P = 0.008), anxiety (F = 9.650, P = 0.004), and general well-being (F = 5.056, P = 0.033). However, there was no statistical difference between the 2 groups (P > 0.05), and no statistical difference in the time (F = 1.738, P = 0.198) and group (F = 0.658, P = 0.424) effect of drinking attitude.

Conclusions

Alcohol consumption is common among MMT clients in China. Brief intervention, in its current form, could not effectively help them reduce their alcohol consumption.
Effect of Antacid Use on Immune Checkpoint Inhibitors in Advanced Solid Cancer Patients: A Systematic Review and Meta-analysis
Authors: Deng Ruiyi , Zhang Hua , Li Yuan , Shi Yanyan
Published: October 2022

The influence of antacids use on immune checkpoint inhibitor (ICI) efficacy remains unclear. A systematic review and meta-analysis was performed to evaluate the effect of proton pump inhibitors (PPIs) and histamine-2-receptor antagonists (H2RAs) on ICI efficacy in advanced solid cancer patients. A systematic literature search in PubMed, EMBASE, and Web of Science was performed to retrieve studies investigating the effect of antacid use on ICI efficacy. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and immune-related adverse events were measured using hazard ratios (HRs) or odds ratios (ORs). Thirty studies enrolling 16,147 advanced cancer patients receiving ICI treatment were included. The pooled analysis indicated that PPI use was associated with shorter OS (HR=1.40, 95% CI, 1.25–1.57) and PFS (HR=1.34, 95% CI, 1.19–1.52) in advanced cancer patients treated with ICIs. PPI use did not show effect on ORR or immune-related adverse event of advanced cancer patients receiving ICI treatment. OS, PFS, and ORR did not differ between H2RA users and non-H2RA users. In subgroup analyses, PPI use was associated with shorter OS and PFS in NSCLC and urothelial carcinoma patients and in patients treated with anti–programmed cell death 1 or anti–programmed cell death ligand 1 monotherapy. In addition, ICI efficacy was different in the antacid exposure time frame subgroups. In conclusion, PPI use has a negative effect on OS and PFS among advanced cancer patients receiving ICI treatment. PPIs should be cautiously administered among advanced cancer patients treated with ICI. The safety of H2RAs and the influence of H2RAs on ICI efficacy need further investigation.
Orthotopic murine xenograft model of uveal melanoma with spontaneous liver metastasis
Authors: Ramos Raquel , Cabré Eduard , Vinyals Antònia , Lorenzo Daniel , Ferreres Josep R. , Varela Mar , Gomá Montse , Paules Maria José , Gutierrez Cristina , Piulats Josep M. , Fabra Àngels , Caminal José M.
Published: October 2022

Uveal melanoma is the most common intraocular malignancy in adults. Despite the effective primary treatment, up to 50% of patients with uveal melanoma will develop metastatic lesions mainly in the liver, which are resistant to conventional chemotherapy and lead to patient’s death. To date, no orthotopic murine models of uveal melanoma which can develop spontaneous metastasis are available for preclinical studies. Here, we describe a spontaneous metastatic model of uveal melanoma based on the orthotopic injection of human uveal melanoma cells into the suprachoroidal space of immunodeficient NSG mice. All mice injected with bioluminescent OMM2.5 (n = 23) or MP41 (n = 19) cells developed a primary tumor. After eye enucleation, additional bioluminescence signals were detected in the lungs and in the liver. At necropsy, histopathological studies confirmed the presence of lung metastases in 100% of the mice. Liver metastases were assessed in 87 and in 100% of the mice that received OMM2.5 or MP41 cells, respectively. All tumors and metastatic lesions expressed melanoma markers and the signaling molecules insulin-like growth factor type I receptor and myristoylated alanine-rich C-kinase substrate, commonly activated in uveal melanoma. The novelty of this orthotopic mouse xenograft model is the development of spontaneous metastases in the liver from the primary site, reproducing the organoespecificity of metastasis observed in uveal melanoma patients. The faster growth and the high metastatic incidence may be attributed at least in part, to the severe immunodeficiency of NSG mice. This model may be useful for preclinical testing of targeted therapies with potential uveal melanoma antimetastatic activity and to study the mechanisms involved in liver metastasis.
Major Clinical Features and Epidemic Characteristics of Erosive Vulvar Lichen Planus: A Retrospective Analysis of 40 Patients
Authors: Shao Ya-Kun , Sun Kai-Lyu , Yang Min , Liu Wan , Fu Yu , Chang Jian-Min
Published: October 2022

Objective:

A retrospective analysis of erosive vulvar lichen planus (EVLP) was performed to raise awareness on this chronic, deforming, and painful vulvar disease.

Methods:

This observational retrospective study involved 40 patients with EVLP among 1368 patients with vulvar disease from 2017 to 2020. The patients’ vulvar clinical features and extra-vulvar mucosal involvement were investigated. The patients’ pain and quality of life were evaluated with the numeric rating scale (NRS) and the Dermatology Life Quality Index (DLQI), respectively.

Results:

EVLP accounted for 2.9% (40/1,368) of all cases of vulvar disease, and the median age at onset was 42 years. Erosion mostly occurred on the labia minora and introitus. Half (20/40) of the patients had extra-vulvar mucosal involvement. Seventeen (42.5%) patients had oral lichen planus, and seven (17.5%) patients were diagnosed with vulvovaginal-gingival syndrome. The NRS score showed that 47.5% (19/40) of patients experienced mild pain whereas 12.5% (5/40) described the pain as severe. Thirty-one patients (77.5%, 31/40) had dyspareunia, and nine patients had aggravated pain after sexual intercourse. The mean DLQI score was 9.1 ± 6.0, with 37.5% (15/40) of patients indicating that EVLP had severely affected their lives.

Conclusion:

EVLP can affect the quality of women’s lives and cause severe deformations and painful architectural changes. The description of the characteristics of EVLP in this report will benefit the diagnosis and early treatment of this disease.
Effect of Hypoxemia on Outcome in Respiratory Failure Supported With Extracorporeal Membrane Oxygenation: A Cardinality Matched Cohort Study
Authors: Warren Alex , McKie Mikel A. , Villar Sofía S. , Camporota Luigi , Vuylsteke Alain
Published: October 2022

Venovenous extracorporeal membrane oxygenation (ECMO) is recommended in adult patients with refractory acute respiratory failure (ARF), but there is limited evidence for its use in patients with less severe hypoxemia. Prior research has suggested a lower PaO2/FiO2 at cannulation is associated with higher short-term mortality, but it is unclear whether this is due to less severe illness or a potential benefit of earlier ECMO support. In this exploratory cardinality-matched observational cohort study, we matched 668 patients who received venovenous ECMO as part of a national severe respiratory failure service into cohorts of “less severe” and “very severe” hypoxemia based on the median PaO2/FiO2 at ECMO institution of 68 mmHg. Before matching, ICU mortality was 19% in the ‘less severe’ hypoxemia group and 28% in the “very severe” hypoxemia group (RR for mortality = 0.69, 95% CI 0.54–0.88). After matching on key prognostic variables including underlying diagnosis, this difference remained statistically present but smaller: (23% vs. 30%, RR = 0.76, 95% CI 0.59–0.99). This may suggest the observed survival benefit of venovenous ECMO is not solely due to reduced disease severity. Further research is warranted to examine the potential role of ECMO in ARF patients with less severe hypoxemia.
Extracting Mural and Volumetric Growth Patterns of Platelet Aggregates on Engineered Surfaces by Use of an Entity Tracking Algorithm
Authors: Kang Junhyuk , Jayaraman Anjana , Antaki James F. , Kirby Brian J.
Published: October 2022

Thrombosis is a major complication that can occur in both blood-contacting devices and regions and in regions of vascular damage. Microfluidic devices are popular templates to model various thrombogenic settings and to assess conditions that lead to bulk channel occlusion. However, area-averaged measurements miss the opportunity to extract real-time information on thrombus evolution and early dynamics of thrombus formation and propagation, which result in late-stage bulk channel occlusion. To clarify these dynamics, we have developed a standalone tracking algorithm that uses consecutive image connectivity and minimal centroid distance mappings to uniquely index all appearing thrombi in fluorescence time-lapse videos http://links.lww.com/ASAIO/A887, and http://links.lww.com/ASAIO/A888. This leads to measurements of all individual aggregates that can in turn be studied as ensembles. We applied tracking to fluorescence time-lapse videos http://links.lww.com/ASAIO/A887, and http://links.lww.com/ASAIO/A888 of thrombosis across both collagen-functionalized substrate and across the surface of a roughened titanium alloy (Ti6Al4V) at a shear rate of 4000 s-1. When comparing ensemble-averaged measurements to area-averaged metrics, we unveil immediate, steady thrombus growth at early phases on collagen surfaces and unstable thrombus attachment to roughened Ti6Al4V surfaces on Ti6Al4V surfaces. Additionally, we introduce tracked thrombus eccentricity and fluorescence intensity as additional volumetric measures of thrombus growth that relate back to the primary thrombosis mechanism at play. This work advocates for the complementation of surface macrostate metrics with characteristic thrombus microstate growth patterns to accurately predict critical thrombosis events.
Coronavirus disease 2019 aftermath: psychological trauma in ICU healthcare workers
Authors: Wahlster Sarah , Hartog Christiane
Published: October 2022

Purpose of review

We aim to describe the extent of psychological trauma and moral distress in healthcare workers (HCW) working in the intensive care unit (ICU) during the coronavirus disease 2019 (COVID-19) pandemic. Specifically, we review reports on prevalence of mental health symptoms, highlight vulnerable populations and summarize modifiable risk factors associated with mental health symptoms in ICU HCW.

Recent findings

The pandemic has resulted in a multitude of closely intertwined professional and personal challenges for ICU HCW. High rates of posttraumatic stress disorder (14–47%), burnout (45–85%), anxiety (31–60%), and depression (16–65%) have been reported, and these mental health symptoms are often interrelated. Most studies suggest that nurses and female HCW are at highest risk for developing mental health symptoms. The main personal concerns associated with reporting mental health symptoms among ICU HCW were worries about transmitting COVID-19 to their families, worries about their own health, witnessing colleagues contract the disease, and experiencing stigma from their communities. Major modifiable work-related risk factors were experiencing poor communication from supervisors, perceived lack of support from administrative leadership, and concerns about insufficient access to personal protective equipment, inability to rest, witnessing hasty end-of-life decisions, and restriction of family visitation policies.

The COVID-19 pandemic has severely impacted ICU HCW worldwide. The psychological trauma, manifesting as posttraumatic stress disorder, burnout, anxiety, and depression, is substantial and concerning. Urgent action by lawmakers and healthcare administrators is required to protect ICU HCW and sustain a healthy workforce.
Providing respiratory and ventilation care in the face of shifting evidence: current opinion in critical care
Authors: Giammarioli Benedetta , Burns Karen E.A. , Patel Bhakti K. , Sklar Michael C.
Published: October 2022

Purpose of review

To review the clinical problem and noninvasive treatments of hypoxemia in critically-ill patients with coronavirus disease 2019 pneumonia and describe recent advances in evidence supporting bedside decision making.

Recent findings

High-flow nasal oxygen and noninvasive ventilation, along with awake prone positioning are potentially helpful therapies for acute hypoxemic respiratory failure. High-flow nasal oxygen therapy has been widely implemented as a form of oxygen support supported by prepandemic randomized controlled trials showing possible benefit over noninvasive ventilation. Given the sheer volume of patients, noninvasive ventilation was often required, and based on a well conducted randomized controlled trial there was a developing role for helmet-interface noninvasive. Coupled with noninvasive supports, the use of awake prone positioning demonstrated physiological benefits, but randomized controlled trial data did not demonstrate clear outcome superiority.

The use of noninvasive oxygen strategies and our understanding of the proposed mechanisms are evolving. Variability in patient severity and physiology may dictate a personalized approach to care. High-flow nasal oxygen may be paired with awake and spontaneously breathing prone-positioning to optimize oxygen and lung mechanics but requires further insight before widely applying to clinical practice.
Modern surgical treatment of azoospermia
Authors: Brant Aaron , Schlegel Peter N.
Published: October 2022

Purpose of review

To review noteworthy research from the last 2 years on surgical management of azoospermia.

Recent findings

The recommended treatments for nonobstructive and obstructive azoospermia have not appreciably changed. However, recent level-1 evidence has reinforced superiority of micro-dissection testicular sperm extraction over sperm aspiration in men with nonobstructive azoospermia, and several studies have identified genetic and other clinical factors that may aid in selecting candidates for testicular sperm extraction. Machine learning technology has shown promise as a decision support system for patient selection prior to sperm retrieval as well a tool to aid in sperm identification from testis tissue.

Most men with obstructive azoospermia who desire fertility can be offered either surgical reconstruction or sperm retrieval. For men with nonobstructive azoospermia, sperm retrieval with microdissection testicular sperm extraction remains the gold standard treatment. Uncovering more genetic causes of nonobstructive azoospermia may aid in properly counseling and selecting patients for microdissection testicular sperm extraction. Neural networks and deep learning may have a future role in patient selection for surgical sperm retrieval and postprocedural sperm identification.
Acute Liver Failure in Dengue: A Common but Overlooked Entity in Pediatric Patients in Tropical Countries
Authors: Dogra Surabhi , Kumar Karunesh , Malhotra Smita , Jerath Nameet , Sibal Anupam
Published: October 2022

Objective:

The objective of the study is to estimate the incidence of acute liver failure (ALF) in dengue infection, understand the demographic and biochemical profiles, and identify prognostic factors associated with mortality.

Methodology:

This is a retrospective observational study. We evaluated the data of all pediatric dengue patients admitted over the last 5 years in our hospital to identify patients who fulfilled the criteria for pediatric ALF. Demographic profile, and biochemical and radiological parameters were assessed. Their outcomes and mortality data were analyzed to identify prognostic factors.

Results:

Thirty children with dengue infection were identified to have developed a during the ALF study period which was 29.1% (30 of 103) of all our ALF admissions. A total of 189 children with dengue infection needed admission during the same period and 15.8% (30 of 189) of them developed ALF. The mean duration of onset of ALF was 5.4 days after fever onset. Twenty-two patients (73%) survived, and 8 patients expired. High creatinine, low albumin level, and multisystemic involvement were identified as poor prognostic markers in those patients who did not survive.

Conclusion:

ALF is common in admitted severe dengue patients. A significant proportion of acute liver patients in endemic countries can be attributed to dengue infection. Low serum albumin, high creatinine, and multi-organ dysfunction during acute illness can be used as prognostic markers in these children. Multicentric prospective studies are needed to validate these results.
Conceptualizing the Value of Pediatric Concurrent Hospice Care
Authors: Sharp Whitney Stone , Svynarenko Radion , Fornehed Mary Lou Clark , Cozad Melanie J. , Malpass Jessica Keim , Mack Jennifer W. , Hinds Pamela S. , Mooney-Doyle Kim , Mendola Annette , Lindley Lisa C.
Published: October 2022

Given that pediatric concurrent hospice care has been available for more than a decade, it is appropriate to seek an understanding of the value of this care delivery approach. Value is the cost associated with achieving beneficial health outcomes. In pursuit of this goal, the current literature on pediatric concurrent hospice care was synthesized and used to develop a model to explain its value. Because of its relevance, the Value Assessment Framework was used to conceptualize the value of pediatric concurrent hospice care. This framework gauges the value of a health care service through 2 components: long-term effect and short-term affordability. The framework considers comparative clinical effectiveness, cost-effectiveness, other benefits or disadvantages, contextual considerations, and potential budget impact. Evidence from the literature suggested that the value of concurrent care depended on clinical outcomes evaluated, costs examined, medical services used, care coordinated, context considered, and budget impacted. The literature demonstrated that pediatric concurrent hospice care does offer significant value for children and their families. The conceptual model highlighted the need for a comprehensive approach to assessing value. The model is a useful framework for future research examining the value of concurrent hospice care.
Self-Injury During COVID-19
Authors: Lewis Stephen P. , Kenny Therese E. , Pritchard Tyler R. , Labonte Lindsay , Heath Nancy L. , Whitley Rob
Published: October 2022

Concerns have been raised about the impact of the COVID-19 pandemic on individuals with lived experience of nonsuicidal self-injury (NSSI). Yet, few efforts have explored this. Accordingly, using a mixed-methods approach, we sought to examine whether emerging adults who have self-injured experienced changes in NSSI urges and behavior during the pandemic and what may have accounted for these changes. To do so, university students with lived experience of NSSI completed online questions asking about NSSI and self-reported changes in urges and behavior since the onset of COVID-19. They then answered open-ended questions asking what contributed to these changes and how they have coped during this timeframe. Approximately 80% of participants reported no change or a decrease in NSSI urges and behavior. Participants discussed removal from stressors (e.g., social stress) that previously evoked NSSI, as well as having time for self-care and to develop resilience as accounting for this. Nevertheless, some participants reported challenges amid the pandemic (i.e., exacerbated stress, isolation); approximately one fifth of participants reported increases in NSSI urges and behavior. Our findings add to recent evidence that many individuals with prior mental health difficulties, including NSSI, can demonstrate resilience in the face of collective adversity. Research and clinician implications are discussed.
Employee Assistance Programs
Authors: Doran Michelle
Published: October 2022

As the focus on nurse well-being evolves, an important consideration is the role of an organization's employee assistance program (EAP). Employee assistance programs are historically underused by employees and are not understood in terms of the depth of services and partnerships they can offer. Nurse executives have a key role in maximizing EAP services and utilization as ones who refer staff and who can influence and decide on an EAP partner and related programs and services. This column discusses how EAPs can be a significant tool for nurse leaders in supporting employees.
Next Generation of Nurses
Authors: Tussing Todd E. , Chipps Esther , Tornwall Joni
Published: October 2022

As healthcare faces the great resignation, it is important that nurse leaders understand the impact of generational variations in the recruitment of nursing staff. This article discusses the specific characteristics of millennials and Generation Z nurses and offers suggestions for tailoring recruitment strategies for these 2 generational groups.
Future Catastrophic Event Preparation
Authors: Robinson Karen R. , Gierach Michelle , Wolles Brenda , McClellan Coreen , Bartelt Samantha , Hodge Janel
Published: October 2022

Nurses play an important role in pandemic and disaster response, often at a personal cost to their overall well-being. Interviews with 19 frontline COVID-19 nurses helped illuminate priority focus areas involving nurses in the planning process, providing clear communication and offering mental health services. These recommendations align with and reinforce conclusions and recommendations from The Future of Nursing 2020-2030 Report.
Nursing Strategic Imperatives
Authors: Rao Aditi D. , Trotta Rebecca L. , Rabelais Em , Reich Jessie , Mattioni Colleen , Cunningham Regina S.
Published: October 2022

Strategic plans provide a roadmap for value creation by outlining key priorities that, when executed successfully, enhance quality and efficiency. Nurses are uniquely positioned to inform strategic planning because of their understanding of clinical operations and consumer needs. This article describes a multiphase process for engaging nurses, at all levels, in developing, implementing, and revising a nursing strategic plan over a 5-year period.
Management and Long-Term Outcomes of Patients With Recurrent Stroke-Like Episodes After Cranial Radiotherapy
Authors: Neth Bryan J. , Lachance Daniel H. , Uhm Joon H. , Ruff Michael W.
Published: October 2022

Background:

Recurrent Stroke-Like Episodes of transient negative neurologic symptoms are a long-term consequence of cranial radiation therapy (RT) that may lead to significant functional impairment and worsen quality of life. We assessed management patterns and clinical course at our institution to assess optimal management strategy and understand long-term outcomes.

Methods:

We conducted a retrospective review of all patients with recurrent negative neurologic symptoms after cranial RT who were treated at Mayo Clinic (Rochester), with follow-up extending through October 2021 with a goal of assessing for clinical change in the setting of medical management. Descriptive statistics and Fisher exact tests were performed for group comparisons.

Results:

Twenty-five patients were included. Median age at diagnosis was 28.7 years (range: 3.0 to 65.8). Median time from RT to symptom onset was 14.6 years (range: 3.3 to 30.5). The most common presentations included hemiparesis (56%), visual field (33%) and hemisensory (22%) loss, and aphasia (22%). Therapeutics used specifically for management of recurrent episodes included antiseizure medications (92%), antiplatelets (68%), verapamil (52%), statins (48%), glucocorticoids (24%), antivirals (20%), and angiotensin converting enzyme inhibitor/ Angiotensin receptor blockers (16%). Antivirals were less commonly used in patients with cessation (Fisher exact, P=0.0235). Progressive encephalopathy was more commonly seen in those without cessation (Fisher exact, P=0.0072), and in all patients who died at last follow-up.

Conclusions:

Although retrospective experience from a single institution, our cohort represents one of the largest with management data reported for this complex clinical scenario. We hope that our findings may be used as a reference for clinicians in the management of this challenging clinical scenario.
Modification of the Association Between Frequent Aspirin Use and Ovarian Cancer Risk: A Meta-Analysis Using Individual-Level Data From Two Ovarian Cancer Consortia
Authors: Hurwitz Lauren M. , Townsend Mary K. , Jordan Susan J. , Patel Alpa V. , Teras Lauren R. , Lacey James V. , Doherty Jennifer A. , Harris Holly R. , Goodman Marc T. , Shvetsov Yurii B. , Modugno Francesmary , Moysich Kirsten B. , Robien Kim , Prizment Anna , Schildkraut Joellen M. , Berchuck Andrew , Fortner Renée T. , Chan Andrew T. , Wentzensen Nicolas , Hartge Patricia , Sandler Dale P. , O’Brien Katie M. , Anton-Culver Hoda , Ziogas Argyrios , Menon Usha , Ramus Susan J. , Pearce Celeste Leigh , Wu Anna H. , White Emily , Peters Ulrike , Webb Penelope M. , Tworoger Shelley S. , Trabert Britton
Published: October 2022

(Abstracted from J Clin Oncol 2022; doi: 10.1200/JCO.21.01900)

Ovarian cancer is the deadliest gynecologic cancer because of its nonspecific symptom presentation and lack of early detection or prevention strategies. Chronic inflammation has been demonstrated to play a key role in the molecular mechanisms driving ovarian cancer.
Antibiotic Prescribing Patterns and Guideline Concordance for Uncomplicated Urinary Tract Infections Among Adult Women in the US Military Health System
Authors: Kikuchi Jacqueline Y. , Banaag Amanda , Koehlmoos Tracey P.
Published: October 2022

(Abstracted from JAMA Network Open 2022;5(8):e2225730)

The most commonly diagnosed outpatient infection in the United States are urinary tract infections (UTIs). In 2011, increasing rate of antimicrobial resistance led the Infectious Diseases Society of America (IDSA) to update their international clinical practice guidelines for the treatment of acute uncomplicated cystitis in premenopausal women.
Corneal Confocal Analysis after Scleral Lens Wear in Keratoconus Patients: A Pilot Study
Authors: Serramito-Blanco María , Cañadas Pilar , Villa-Collar Cesar , Carracedo Gonzalo
Published: October 2022

SIGNIFICANCE

Scleral lenses rely on the scleroconjunctival region without bearing the cornea, which could improve the symptoms and modify the corneal nerve plexus morphology.

PURPOSE

This study aimed to evaluate symptoms and changes in corneal nerve plexus morphology and density of Langerhans cells in keratoconus patients with and without intrastromal corneal ring before and after scleral lens wear.

METHODS

Sixteen scleral lens wearers with keratoconus were recruited for this short-term experimental pilot study. Subjects were divided into two groups: keratoconus group and intrastromal corneal ring segment group. All subjects were examined in two visits: baseline (before scleral lens wear) and after 6 months of scleral lens wear, after lens removal. The Schirmer I test, the Ocular Surface Disease Index, tear breakup time, and in vivo confocal microscopy were evaluated.

RESULTS

The mean age was 42.33 ± 11.27 years. A significant decrease in tear breakup time was found in the total group (P = .01, Wilcoxon) compared with baseline. Ocular Surface Disease Index score had decreased after 6 months of scleral lens wear in the keratoconus with intrastromal corneal ring segment subgroup (P = .03, Wilcoxon) and in the total group (P = .001, Wilcoxon). No statistical changes in nerve density, tortuosity, and ramification were found for either the total group or the subgroup. However, the mean nerve length was higher in all groups, especially in the keratoconus subgroup (P = .03, Wilcoxon) after 6 months of scleral lens wear. Regarding optical density, the total group showed a significant increase after 6 months of wearing (P = .02, Wilcoxon). Finally, Langerhans cell density was not statistically different in any group.

CONCLUSIONS

These results suggest that scleral lens wearing improves the symptoms and increased the mean length nerves after 6 months of wear use in keratoconus patients.
The burden and impact of chronic cough in severe disease
Authors: Emilsson Össur Ingi
Published: October 2022

Purpose of review

Chronic cough is common in severe diseases, such as COPD, interstitial lung disease, lung cancer and heart failure, and has a negative effect on quality of life. In spite of this, patients with cough sometimes feel their cough is neglected by healthcare workers. This review aims to briefly describe cough mechanisms, highlight the burden chronic cough can be for the individual, and the clinical impact of chronic cough.

Recent findings

Chronic cough is likely caused by different mechanisms in different diseases, which may have therapeutic implications. Chronic cough, in general, has a significant negative effect on quality of life, both with and without a severe comorbid disease. It can lead to social isolation, recurrent depressive episodes, lower work ability, and even conditions such as urinary incontinence. Cough may also be predictive of more frequent exacerbations among patients with COPD, and more rapid lung function decline in idiopathic pulmonary fibrosis. Cough is sometimes reported by patients to be underappreciated by healthcare.

Chronic cough has a significant negative impact on quality of life, irrespective of diagnosis. Some differences are seen between patients with and without severe disease. Healthcare workers need to pay specific attention to cough, especially patients with severe disease.