bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ceftolozane/Tazobactam for the Treatment of Osteomyelitis Due to Multidrug-Resistant Pseudomonas aeruginosa
Authors: Gerlach Anthony T. , Goff Debra A. , Bazan Jose A. 
Published: November 2019

Abstract
We conducted a retrospective study of 18 patients who were treated with ceftolozane/tazobactam (C/T) for greater than 48 hours for multidrug-resistant Pseudomonas aeruginosa (MDR-PA) osteomyelitis. Osteomyelitis was diagnosed by imaging, presence of systemic inflammatory signs and symptoms, elevated C-reactive protein, and positive culture for MDR-PA. Clinical cure was defined as complete or partial resolution of signs and symptoms of infection without need for escalation of antimicrobials during inpatient and outpatient therapy. The cohort was mostly male (81.2%) with a median age of 58.5 (53.5–68.5) years. The majority had polymicrobial osteomyelitis (77.8%) and a previous episode of osteomyelitis (83.3%). Clinical cure was achieved in 50% of patients, and C/T was well tolerated. These preliminary data suggest C/T maybe an option for treating patients with MDR-PA osteomyelitis, but more data are needed.
Impact of Vaccination on Morbidity and Mortality in Adults Hospitalized With Influenza A, 2014–2015
Authors: Kaselitz Timothy B. , Martin Emily T. , Power Laura E. , Cinti Sandro 
Published: November 2019

Background
Influenza A is a significant cause of in-hospital morbidity and mortality in the United States. While vaccination has proven the most effective means of preventing infection, data examining its impact on patients hospitalized with influenza A are lacking. This is particularly true during seasons when there is poor vaccine matching, such as the 2014–2015 season. We hypothesize that vaccination is associated with less in-hospital morbidity and mortality among adults hospitalized with influenza A in a large tertiary hospital during the 2014–2015 season.

Methods
A retrospective chart review was conducted on all adults hospitalized with influenza A during the 2014–2015 season. Adjusting for confounders, multivariable logistic regression analyses were performed to examine the relationship between vaccination status and a variety of serious clinical outcomes.

Results
Of 217 adults hospitalized with influenza A, 118 were vaccinated (54%). Serious outcomes were frequent; 14 patients (7%) died, 31 (14%) required intensive care unit admission, and 27 (12%) required mechanical ventilation. Adjusting for sociodemographic and clinical confounders, we show that vaccinated patients were significantly less likely to die (odds ratio [OR], 0.29; 95% confidence interval [CI], 0.09–0.99), require mechanical ventilation (OR, 0.35; 95% CI, 0.14–0.83), and suffer a severe outcome (intensive care unit admission or death) (OR, 0.41; 95% CI, 0.19–0.87).

Discussion
Vaccination during the 2014–2015 season was associated with reduced morbidity and mortality among adults hospitalized with influenza A, despite the poor vaccine matching recognized during that season. Our findings suggest that during seasons with poor vaccine matching vaccination may afford protection against poor outcomes in patients hospitalized with influenza A.
Streamlining to Oral β-Lactam Versus Fluoroquinolone as Definitive Therapy for Enterobacteriaceae Bacteremia
Authors: Fong Karen , Dubrovskaya Yanina , Siegfried Justin , Papadopoulos John , Pham Vinh , (Polly) Jen Shin-Pung 
Published: November 2019

Background
Oral treatment strategies for Enterobacteriaceae bacteremia (EB) are controversial. Fluoroquinolones (FQs) may be preferred for their high bioavailability, but β-lactams (BLs) should be explored as an additional option for EB treatment because of concerns of FQ resistance and adverse effects.

Methods
This retrospective study compared clinical characteristics and outcomes in patients with EB treated with oral BL versus FQ between January 2013 and July 2017. Adult patients with their first incidence of EB and transitioned from intravenous antibiotics to either study antibiotic class were included. The primary outcome assessed a composite of recurrence, superinfection, Clostridioides difficile colitis, emergence of multidrug-resistant organisms, infection-related readmission, and all-cause mortality within 90 days of EB treatment.

Results
A total of 173 patients were included (BL, n = 59; FQ, n = 114). The median age was 70 years, Pitt bacteremia score was 2 (range = 0–7), and Charlson Comorbidity Index was 5 (0–12). Urinary source of infection was most common (57%). Most oral BL courses used cefpodoxime (63%). Of note among baseline differences between groups, more patients receiving FQ versus BL had a presence of abscess (11% vs 0%, P = 0.01). The primary composite outcome occurred in 15 patients (25%) receiving BL and 28 patients (25%) on FQ (P = 0.901). Multivariate analysis identified urological complications, bacteremia onset in the intensive care unit, and the Charlson Comorbidity Index as independent predictors of the primary outcome.

Conclusions
Clinical outcomes were similar between those treated with oral BL compared with FQ. Oral BL may be considered for definitive treatment of EB.
Acute Parotitis Due to Candida glabrata
Authors: Shingde Rashmi V. , Kim Tae Jun , Givney Rodney C. , de Waal Patrick , Berry Catherine 
Published: November 2019

AbstractThis report describes the case of a 60-year-old man who developed acute parotitis with abscess formation. The causative agent of the parotid abscess wasCandida glabrata, which is an unusual cause of salivary gland pathology because it typically inhabits the oral cavity as a commensal microorganism. Acute parotitis occurs most often in elderly patients who are debilitated by systemic disease or as a postoperative complication. This case is interesting because the patient was immunocompetent and had no obvious risk factors for fungal parotitis other than poor dentition.
Recurrent Bacteremia Due to an Infected Inferior Vena Cava Graft in a Patient With Metastatic Renal Cell Carcinoma
Authors: Patel Raj H. , Denham James D. , Ramsakal Asha , Nanjappa Sowmya , Greene John N. 
Published: November 2019

Abstract
Bacteremia is a potentially life-threatening infection especially in cancer patients or immunocompromised individuals. Surgically implanted devices, such as inferior vena cava grafts, can often become compromised by bacterial biofilm production and serve as a nidus for recurrent, persistent infections such as bacteremia. Recurrent bacteremia suggests the presence of an undrained abscess or endovascular infection. We present a case wherein a 60-year-old man diagnosed as having renal cell carcinoma (status after pancreaticoduodenectomy) developed recurrent bacteremia with multiple enteric pathogens over a 2-year period because of an infected vascular graft.
The profile of the onco-hematology patient in the palliative care: 4 years of experience
Authors: Couto Maria Eduarda , Oliveira Isabel , Mariz Mário , Ferraz Gonçalves José 
Published: November 2019

Abstract

Objectives:
Most of the palliative care (PC) patients have oncologic diseases, being hematologic tumors a small part of them. According to the literature, onco-hematologic (OH) patients should be individualized from those with solid tumors for the specialized care required along their disease course. This study aims to review the casuistry of OH patients referred to PC in a specialized oncologic hospital and help to understand better how hematologists can improve the care of these patients.

Methods:
We analyzed all OH patients referred to the PC service in 1 oncologic hospital along 42 months, through consultation of their clinical files.

Results:
A total of 179 patients were reviewed (52.% males, median age of 71 years): 48.6% had non-Hodgkin lymphoma, 26.3% had multiple myeloma, 10.6% had acute leukemia, 14.5% had other OH diseases; 88.2% were treated for their OH disease (96.2% with chemotherapy, 28.5% radiotherapy, and 21.5% hematopoietic stem cell transplant). The referral was heterogeneous among physicians (27.4% by 1 physician). Most patients were firstly observed as inpatients (55.3%) and 17.9% in the outpatient consult. At the end of the study, 98.9% of the patients died (88.7% in the hospital, 10.2% at home). The median time between the end of treatment and referral do PC was 46 days and between referral and death was 16 days. We also reviewed medical prescription in the last month of life and we noticed that most invasive orders were requested by hematologists (as antibiotic prescription, imaging, and biopsy studies).

Significance of results:
This study demonstrated that OH patients should be referred earlier to PC and that a more intensive team work needs to be practiced between PC and hematologists. More educational programs for healthcare workers on this issue are needed in order to guarantee a more effective assistance in the appropriate time.
Prodopaminergic Drugs for Treating the Negative Symptoms of Schizophrenia
Authors: Sabe Michel , Kirschner Matthias , Kaiser Stefan 
Published: November 2019

Abstract

Background
The negative symptoms of schizophrenia pose a heavy burden on patients and relatives and represent an unmet therapeutic need. The observed association of negative symptoms with impaired reward system function has stimulated research on prodopaminergic agents as potential adjunctive treatments.

Methods
We conducted a systematic review and meta-analysis of published randomized controlled trials of amphetamine, methylphenidate, modafinil, armodafinil, lisdexamphetamine, L-dopa, levodopa, bromocriptine, cabergoline, quinagolide, lisuride, pergolide, apomorphine, ropinirole, pramipexole, piribedil, and rotigotine augmentation in schizophrenia and schizoaffective disorder.
Medline, EMBASE, and several other databases as well as trial registries were searched for placebo-controlled trials.

Results
Ten randomized controlled trials were included in the meta-analysis, 6 trials on modafinil, 2 on armodafinil, 1 on L-dopa, and 1 on pramipexole. Overall, prodopaminergic agents did not significantly reduce negative symptoms. Restricting the analysis to studies requiring a minimum threshold for negative symptom severity, modafinil/armodafinil showed a significant but small effect on negative symptoms. A subset of studies allowed for calculating specific effects for the negative symptom dimensions diminished expression and amotivation, but no significant effect was found. Prodopaminergic agents did not increase positive symptom scores.

Conclusions
The currently available evidence does not allow for formulating recommendations for the use of prodopaminergic agents for the treatment of negative symptoms. Nevertheless, the observed improvement in studies defining a minimum threshold for negative symptom severity in the absence of an increase in positive symptoms clearly supports further research on these agents.
Exploring the Prevalence of Clozapine Phenotypic Poor Metabolizers in 4 Asian Samples
Authors: Ruan Can-Jun , Wang Chuan-Yue , Tang Yi-Lang , Lin Shih-Ku , Lee Seung-Tae , Hong Kyung Sue , Rajkumar Anto P. , Jacob Kuruthukulangara S. , de Leon Jose 
Published: November 2019

Abstract

Purpose/Background
Clozapine clearance is influenced by sex, smoking status, ethnicity, coprescription of inducers or inhibitors, obesity, and inflammation. In 126 Beijing inpatients, we measured repeated trough steady-state serum concentrations and identified 4% (5/126) who were phenotypical poor metabolizers (PMs); none were ultrarapid metabolizers (UMs). They were defined as being 2 SDs beyond the means of total clozapine concentration/dose ratios stratified by sex and smoking. Using this definition, this study explores the prevalence of PMs and UMs using data from 4 already published Asian samples. Three samples were East Asian (Beijing 2, Taipei, and Seoul); one was from South India (Vellore).

Findings/Results
The prevalence of phenotypical PMs ranged from 2% to 13%, but inflammation was not excluded. The prevalence was 7% (14/191) for Beijing 2, 11% (8/70) for Taipei, 13% (9/67) for Seoul, and 2% (2/101) for the Vellore sample. Five phenotypic PMs appeared to be associated with extreme obesity. Phenotypic UM prevalence ranged from 0% to 1.6% but may be partly explained by lack of adherence. A Vellore phenotypic UM appeared to be associated with induction through high coffee intake.

Implications/Conclusions
Approximately 10% of Asians may be clozapine PMs and may need only 50 to 150 mg/d to get therapeutic concentrations. Future studies combining gene sequencing for new alleles with repeated concentrations and careful control of confounders including inhibitors, inflammation, and obesity should provide better estimations of the prevalence of phenotypic clozapine PMs across races. Clozapine UM studies require excluding potent inducers, careful supervision of compliance in inpatient settings, and multiple serum concentrations.
Updates on Preclinical and Translational Neuroscience of Mood Disorders
Authors: Mischel Nicholas A. , Kritzer Michael D. , Patkar Ashwin A. , Masand Prakash S. , Szabo Steven T. 
Published: November 2019

AbstractBackgroundThe development of new-generation antidepressants comes at a time of great clinical need when the global burden of depression, suicide, and other psychiatric conditions continues to increase. Our current treatment armamentarium is limited by the time delay needed for antidepressant effects and the significant number of patients who do not show an adequate response to antidepressants. The past 2 decades of psychiatric research has revealed that ketamine, known to be used only as an anesthetic and drug of abuse and to produce experimental models of psychosis, is effective at subanesthetic doses to ameliorate clinical depression.MethodsWe performed a systematic search of PubMed/MEDLINE indexed reports to identify clinical and translational research done with ketamine for purposes of treating depression.ResultsWe will first present the rationale for investigating ketamine and otherN-methyl-d-aspartate receptor antagonists as a novel class of glutamate system targeting antidepressants. We will summarize putative molecular pathways underlying mood disorders and outline a brief history of investigation into ketamine as a treatment for depression. Recent clinical/translational evidence of ketamine's rapid-acting antidepressant mechanism will be critically reviewed in detail.ConclusionsAt the end of this review, we will opine on the role of ketamine and derivatives in clinical practice.
Using Simulation and Competency Assessment to Decrease Inappropriate Referrals to a Comprehensive Vascular Access Team
Authors: Nguyen Somali , Jones Allison , Polancich Shea , Poe Terri , Garrigan April , Talley Michele 
Published: November 2019

ABSTRACT
This department column highlights translation of research into health care quality practice. Achieving the highest quality of health care requires attention to creating and sustaining process efficiencies through the development of bedside provider competencies that result in workflow improvements and positive patient outcomes. An improvement intervention aimed at decreasing unnecessary referrals to a comprehensive vascular access team (CVAT) resulted in a 21% reduction in inappropriate consults to the team in approximately 6 weeks. The purpose of this article is to describe a simulation and competency assessment intervention aimed at increasing staff nurse proficiency in the emergency department for placing ultrasound-guided intravascular catheters, thereby reducing the number of inappropriate referrals to a CVAT team.
Pain Control and Positioning in Children Following Selective Dorsal Rhizotomy Surgery
Authors: Coble Janette , Steurer Lisa M. , Balakas Karen , Ercole Patrick M. 
Published: November 2019

ABSTRACT

BACKGROUND
A practice was changed to elevate the head of bed from day 1 to day 3 on children after selective dorsal rhizotomy (SDR) surgery to improve pain control. Multiple methods to address pain post SDR include a continuous epidural infusion, medication administration, and repositioning/distraction. The length of time for the patient to remain flat was increased to potentially improve pain management. However, no studies in the literature were found to support the practice change. Nurses inquired whether this change resulted in optimal pain control. The primary research aim was to determine whether the change in positioning resulted in a difference in pain control.

METHODS
A retrospective cohort design was used to compare pain medication administered before and after the practice change. Patients between the ages of 2 and 15 years and admitted to the neuroscience unit after SDR surgery were included. Data were electronically retrieved to record the amount of medications given for pain. Descriptive and univariate statistics were used to detect differences.

RESULTS
The retrospective component of the study analyzed a total of 385 patients. There were no statistically significant differences between the number of intermittent doses of medication administered for pain between the 2 groups (P = .661).

DISCUSSION
Results support return to practice of 1 day of flat time. Nurses perceive that lying flat contributes to child and parent anxiety and limits options for distraction; therefore, decreasing flat time may lower anxiety without affecting pain control. These results are limited to postsurgical SDR patients but have implications for postoperative positioning and pain management. On the basis of these results, the neurosurgeon changed practice to zero days of flat time.
Testing Feasibility of a Mobile Application to Monitor Fatigue in People With Multiple Sclerosis
Authors: Newland Pamela , Oliver Brant , Newland John M. , Thomas Florian P. 
Published: November 2019

ABSTRACT

BACKGROUND
Fatigue is a significant and burdensome symptom for patients with multiple sclerosis and is associated with other symptoms, signs, and decreased quality of life.

METHODS
A prospective pilot study was conducted with a convenience sample (n = 34) of patients with relapsing-remitting multiple sclerosis using a phone application, FatigueApp.com, to collect data on patient-reported outcome measures (Patient-Reported Outcomes Measurement Information System [PROMIS]).

RESULTS
FatigueApp feasibility was good, with the ability to collect data on self-reported fatigue and other symptoms using PROMIS measures.

CONCLUSIONS
This study showed that using a phone application with PROMIS may be useful in the future to provide estimates of fatigue and other variables to facilitate clinical monitoring of fatigue for neurology clinic settings.
Effect of a Clinical Case-Study Course on Physician Assistant and Pharmacy Students' Interprofessional Care Competencies
Authors: Mazur Ziemowit , Hanes Scott D. , Kern Daniel 
Published: November 2019

Purpose
To examine how the implementation of a year-long interprofessional clinical case course for pharmacy and physician assistant (PA) students affects student self-reported interprofessional collaboration-related competencies in 6 skill areas (communication, collaboration, roles and responsibilities, collaborative patient/family-centered approach, conflict management/resolution, and team functioning) and whether outcomes differed between the 2 professions.

Methods
Pharmacy and PA students completed the Interprofessional Collaborative Competency Attainment Survey (ICCAS) at the beginning and end of a year-long interprofessional, team-based clinical case course. Survey results were compared using a mixed-design analysis of variance model to determine the effect the course had on students' self-reported competencies of interprofessional care and whether the outcomes differed between student groups.

Results
One-hundred fifteen students completed both the presurvey and postsurvey. Significant improvement in student self-reported team-based behaviors were noted in 11 of the 20 ICCAS items, and results were similar among student groups.

Conclusion
This study demonstrates that an interactive, interprofessional clinical case course can positively change student self-reported team-based behaviors.
Ultrasound-Guided Fasciotomy for Chronic Exertional Compartment Syndrome: A Case Report
Authors: Finnoff Jonathan T. , Johnson Wade 
Published: November 2019

Abstract:
Chronic exertional compartment syndrome (CECS) is characterized by an excessive increase in intracompartmental muscle pressures after exercise. Athletes with CECS report pain, pressure, and occasionally neurologic symptoms in the affected compartment during exercise that abates with rest. Although many treatment options have been proposed, athletes often require a fasciotomy to return to unrestricted sports participation. Surgical success rates vary; complications are not uncommon; and after surgery, it usually takes athletes 6 or more weeks to return to unrestricted impact activities. This case report describes a new ultrasound-guided fasciotomy technique for the treatment of anterior leg compartment CECS. The procedure required a 3 mm incision, was performed in the office under local anesthesia, and allowed the athlete to resume running within 1 week of the procedure. Although the preliminary results of this study are promising, further translational research is required before the widespread adoption of this procedure is recommended.
Predictors of Distant Metastasis and Survival in Adenoid Cystic Carcinoma of the External Auditory Canal
Authors: Zhang Yibo , Liu Hongyan , Wu Qianru , Wang Shuyi , Dai Chunfu 
Published: November 2019

Objective:
To analyze the predictors of both distant metastasis and survival in patients with adenoid cystic carcinoma of the external auditory canal.

Study Design:
Retrospective patient review.

Setting:
A single university hospital.

Patients:
Eighty-two cases with adenoid cystic carcinoma of the external auditory canal were referred to our institution between 2004 and 2016.

Main Outcome Measures:
Distant metastasis was detected by lung computed tomography, proton emission tomography computed tomography, or histopathologic examination of tissue samples. Distant metastasis predictors were analyzed using Student's t tests and χ2 tests. The log-rank tests of Kaplan–Meier survival curves were used to evaluate survival differences.

Results:
During a median follow-up of 36 months (range, 6–162 mo), distant metastasis developed in 25 patients. The occurrence of distant metastasis was significantly associated with histopathologic subtype, T classification, and local recurrence (p < 0.05). The 1-, 10-, 20-, and 25-year cumulative survival rates in the patents with DM were 95.7, 95.7, 71.7, and 0%, respectively, and all survival rates were 100% for the 57 patients without distant metastasis (p = 0.115). Median survival time after occurrence of distant metastasis was 13 months (range, 1–120 mo). Prognosis was better with solely lung metastasis than with metastases to other visceral organs or bone (p < 0.05).

Conclusions:
Distant metastasis appeared to result in a poorer prognosis, occurrence of distant metastasis was significantly associated with local recurrence, extensive surgery is recommended to achieve local control and reduce distant metastasis risk. Routine follow-up investigations for detecting distant metastasis are warranted for patients with an increased risk for distant metastasis.