bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dexmedetomidine versus propofol sedation in reducing delirium among older adults in the ICU
Authors: Pereira Jarett V. , Sanjanwala Rohan M. , Mohammed Mohammed K. , Le Me-Linh , Arora Rakesh C. 
Published: December 2019

BACKGROUND
Delirium is common in the ICU, with incidence rates reported to be upwards of 70%. Due to the significant morbidity and mortality associated with delirium, it is hypothesised that a delirium-free sedative agent will improve outcomes in older adults admitted to the ICU.

OBJECTIVES
To assess if dexmedetomidine sedation is associated with a reduction in ICU delirium among older adults, and to evaluate its risks and benefits compared with propofol sedation.

DESIGN
Systematic review of randomised controlled trials and cohort studies with meta-analyses.

DATA SOURCES
Articles published from database inception to 8 April 2019 were retrieved from Medline, EMBASE, Evidence-based Medicine Reviews, International Pharmaceutical Abstracts, Scopus, ClinicalTrials.gov and WHO Trials.

ELIGIBILITY
Studies were included if they compared dexmedetomidine sedation with propofol in the ICU, reported the incidence of delirium as an outcome and had a mean/median sample age of at least 60. Studies that examined dexmedetomidine and propofol use intra-operatively or as part of general anaesthesia were excluded.

RESULTS
Dexmedetomidine sedation was associated with a lower incidence of delirium when compared with propofol: seven studies, n=1249; risk ratio 0.70; 95% confidence interval (CI) 0.52 to 0.95; P = 0.02. There was no statistically significant difference in the incidence of bradycardia: three studies, n=278; risk ratio 1.52; 95% CI 0.85 to 2.72; P = 0.16, and hypotension: six studies, n=867 patients; risk ratio 1.12; 95% CI 0.86 to 1.45; P = 0.42. Dexmedetomidine sedation did not reduce hospital length of stay, ICU length of stay or duration of mechanical ventilation compared with propofol.

CONCLUSION
Compared with propofol, dexmedetomidine sedation in the ICU is associated with lower delirium incidence among older adults with no significant increase in adverse events. In older adult ICU patients at risk of developing delirium, sedation with dexmedetomidine should be considered. Further research is warranted to elucidate and explain the mechanisms underlying this process, and to confirm our findings with large, multicentre trials.

TRIAL REGISTRATION
The study protocol has been registered in PROSPERO (CRD42018099339).
Pre-induction checklists and discomfort in patients. An observational study
Authors: Nabecker Sabine , Schwendimann Désirée , Theiler Lorenz , Pedersen Tina , Greif Robert 
Published: December 2019

BACKGROUND
Since the WHO release of the Safe Surgery Saves Lives Program in 2008, peri-operative checklists minimise errors and improve patient safety worldwide. Anaesthesia professionals are often reluctant to use these checklists in front of patients because they fear causing patients’ discomfort before anaesthesia and surgery.

OBJECTIVE
To assess and compare the subjective level of patient discomfort caused by the use of pre-induction checklists with the patient discomfort estimated by anaesthesia providers.

DESIGN
Prospective observational study.

SETTING
The current single-centre trial included 110 anaesthesia providers and 125 nonpremedicated ear, nose and throat or maxillofacial surgery patients in Switzerland from June to August 2016. Inclusion criterion: signed general research consent. Exclusion criteria: received premedication, less than 18 years old, day-care patients, dementia or other mental illnesses.

INTERVENTIONS
Anaesthesia healthcare providers and patients before surgery and on the first postoperative day were asked to rate three statements:

MAIN OUTCOME MEASURES
All statements were rated on a 100-mm visual analogue scale, where 0 meant no agreement and 100 meant total agreement.

RESULTS
Patients overwhelmingly agreed that anaesthesia providers should use checklists in front of them. Anaesthesia providers rated the patient discomfort much higher than actually perceived by patients. Both, patients and anaesthesia providers rated the possibility of reducing the risk of errors high.

CONCLUSION
Patients experience far less discomfort observing the use of pre-induction checklists than anaesthesia providers expect. Patients value the potential safety benefit significantly higher than anaesthesia providers. These results further support the implementation of peri-operative checklists in the operating room environment.

TRIAL REGISTRATION
The current observational study had no intervention, therefore, was not registered.
COMPARING INTRAVITREAL AIR AND GAS FOR THE TREATMENT OF VITREOMACULAR TRACTION
Authors: Gruchociak Sophie , Djerada Zoubir , Afriat Mickael , Chia Valen , Santorini Melissa , Denoyer Alexandre , Arndt Carl 
Published: December 2019

Purpose:
To compare the effect of intravitreal injections of air with gas on vitreomacular traction (VMT) release and attempt to analyze predictive factors for success.

Methods:
The medical records of patients with symptomatic VMT undergoing intravitreal injections (0.3 mL) of either octafluoropropane (C3F8) or air were retrospectively reviewed. The VMT release (primary end point) and the best-corrected visual acuity (secondary end point) were noted 1 month after injection. At baseline and 1 month after the injection, a macular optical coherence tomography was performed.

Results:
Twenty-four eyes of 22 patients were included. Vitreomacular traction was released in 10 cases, 7 among 11 C3F8-injected eyes (63%) and 3 among 13 air-injected eyes (23%) (P = 0.045). In eyes with released VMT, ETDRS improved from 61 ± 35 (0–100) to 65 ± 37 (0–100) 1 month after the injection (P = 0.03). All patients with VMT release had a horizontal vitreomacular adhesion of less than 600 µm. Five eyes (23%) underwent vitrectomy after the injection of gas or air.

Conclusion:
Posterior vitreous detachment in VMT can be observed with both air and gas injection with a low complication rate. The occurrence of VMT release observed with air seemed to be less frequent than that observed with gas.
Timeliness of Nursing Care Delivered by Stroke Certified Registered Nurses as Compared to Non–Stroke Certified Registered Nurses to Hyperacute Stroke Patients
Authors: Fant Grace N. , Lakomy Janet M. 
Published: December 2019

ABSTRACT
In this retrospective, nonexperimental, comparative descriptive design using convenience sampling, the timeliness of care delivered by 11 Stroke Certified Registered Nurses (SCRNs) to 95 hyperacute stroke patients (last known well of 4.5 hours or less) on the acute stroke protocol set by Target: Stroke Phase II Campaign Manual was compared with that of 13 non-SCRNs in a small, rural, level III stroke facility in the southwestern region of the United States. There was statistical significance in the total timeliness of care delivered by SCRNs to hyperacute stroke patients as compared with the non-SCRNs (t = −4.109, P = .001) and acute stroke protocol goal times for door to stroke team activation (t = −3.291, P = .001), door to computed tomography (t = −4.020, P < .001), door to teleneurology initiation (t = −4.020, P < .001), and door to alteplase administration (t = −3.367, P = .004). Limitations included sample size, nursing documentation, and nurses studying for the SCRN examination. It was concluded that, at this facility, SCRNs had a statistically significant difference in the timeliness of care delivered to hyperacute stroke patients on meeting protocol time goals. The SCRNs also met all protocol goals, and the non-SCRNs did not meet the door-to-teleneurology initiation and door-to-alteplase administration goals. Future studies should include a larger sample size and stroke patient outcomes.
Discrepancy Among Self-Reported Adherence, Prescription Refills, and Actual Anticoagulant Control
Authors: CHIU Pai-En , TSAO Hsuan-Ming , TSAI Chuan-Hsiu 
Published: December 2019

ABSTRACT

Background
Patients must adhere to their prescribed warfarin regimens and regularly monitor the anticoagulation effect to maintain therapeutic levels. The ability to evaluate regimen adherence accurately is crucial to the success of patient coaching. However, prevention of thromboembolic events is challenging when the association between medication adherence and the actual amount of anticoagulant agent taken cannot be determined.

Purpose
This study used self-reported medication taken and prescription refills to (a) verify warfarin medication adherence and (b) assist clinicians to determine the discrepancy between medication adherence and anticoagulant control efficacy.

Methods
This study was conducted at a national-university-affiliated hospital in Yilan County, Taiwan. Structured questionnaires and medical record reviews were adopted. A 100-point visual analog scale was used to measure the reported adherence of participants, whereas medication refill adherence was compared against self-reported adherence. Finally, degree of adherence was evaluated based on time in therapeutic range.

Results
This study included 192 participants. Half (n = 94, 49%) were women, and the mean age was 69.6 years. Mean scores were 92.2% for the visual analog scale and 87.3% for medication refill adherence. Medication adherence correlated significantly with age, as reflected in the visual analog scale scores (p < .05). The participants who were receiving polypharmacy with five types of medicines or less attained higher visual analog scale scores, whereas participants who were on warfarin for 2–12 months exhibited higher medication refill adherence. Time in therapeutic range correlated negatively with age, although stability improved with therapy duration.

Conclusions/Implications for Practice
Despite their high self-reported adherence levels, patients of advanced age require careful monitoring of their time in therapeutic range. The participants in this study who were on warfarin for a relatively longer time exhibited higher stability in the therapeutic range, despite their low medication refill adherence. The results of this study suggest that patient age, duration of warfarin therapy, and polypharmacy are factors associated with medication adherence. The findings may facilitate future assessments of warfarin adherence in patients as well as the implementation of more effective clinical nursing procedures and management practices.
Retrospective Examination of Class Attendance on Corporately Sponsored Weight Loss Programming
Authors: Earnest Conrad P. , Church Timothy S. 
Published: December 2019

Objective:
To examine the effect of class participation in participants enrolled in a corporate sponsored commercial weight loss program.

Methods:
We examined 111,262 participants for percent weight loss (primary outcome) using general linear models and weight loss relative to class participation (secondary outcome).

Results:
We observed a significant trend (P < 0.001) for achieving significant weight loss for the entire cohort who lost 3.65% (99% CI, 3.62, 3.69) body weight. Individuals taking ≥4 classes (n = 87,346) lost 4.97% (99% CI, 4.53, 4.61). Those taking ≥9 classes (n = 74,525) achieved 4.95% (99% CI, 4.93, 5.01) weight loss. Similar patterns for men and women were observed within each analysis.

Conclusion:
Overall, participants lost a clinically beneficial (≥3%) amount of weight following class participation and greater class attendance produced a greater weight loss percentage approaching clinical significance (≥5%).
Comparison of the selected parameters of the anterior segment of the eye between femtosecond laser-assisted cataract surgery, microincision cataract surgery, and conventional phacoemulsification
Authors: Chlasta-Twardzik Edyta , Nowińska Anna , Wylęgała Edward 
Published: December 2019

Abstract
The purpose of our study was to compare the selected parameters of the anterior segment of the eye in patients after femtosecond laser-assisted cataract surgery (FLACS) with the results of microincision cataract surgery (MICS) and conventional phacoemulsification surgery (CPS). This single-center prospective randomized comparative observational study included 87 patients. Patients were randomly selected into group A (FLACS), group B (MICS) and group C (control group). All the surgeries were performed by the same experienced surgeon. Preoperative and postoperative parameters were evaluated: best-corrected visual acuity (BCVA), endothelial cell density (ECD), endothelial cell loss percentage (ECL%), central corneal thickness (CCT), central anterior and posterior corneal astigmatism induction, posterior corneal elevation map were measured. Intraoperative parameters: effective phacoemulsification time (EPT), balanced salt solution use (BSS use), total surgical time and suction time were analyzed. Examination was performed preoperatively and on the first, seventh day, one and six months postoperatively. The follow up period was 6 months. There was no statistically significant difference in BCVA, central anterior and posterior astigmatism induction between studied groups. The ECL% was statistically significant lower in the group A on the 7th day, 1 month and 6-months postoperatively (P < .05). The CCT was statistically significant lower in the group A and in the group B than in the group C on the 7th postoperative day (P = .002). However, in the 6 months follow-up there was no statistically significant difference in the CCT between studied groups (P = .133). We observed statistically significant difference in change of the posterior corneal elevation map at the periphery assessed within the 90° to 120°meridian range between group A, group B and group C at every timepoint postoperatively (P < .05). The EPT and BSS use were statistically significant lower whilst total surgery time was statistically significant higher in the FLACS group (P < .05). To conclude in the 6 months follow-up there was statistically significant difference found between eyes undergoing FLACS, MICS and CPS with respect to the posterior corneal elevation map assessed within the studied range, ECL%, EPT, BSS use and total surgery time. Postoperative BCVA, central anterior and posterior astigmatism induction, CCT were comparable between studied groups.
Demographic and clinical profiles of admitted psychiatric patients of the East London Mental Health Unit in the Eastern Cape, South Africa
Authors: Madala-Witbooi Nombulelo J , Adeniyi Oladele Vincent 
Published: December 2019

Abstract
Integration of psychiatric care at the Primary Health Care (PHC) could be an important strategy towards addressing the shortages of in-patient mental health care services in South Africa. This study describes the profiles of admitted psychiatric patients at the East London Mental Health Unit (ELMHU) of the Eastern Cape from January 2016 to December 2016.
In this retrospective cross-sectional study, an audit of medical records of all psychiatric in-patients managed at the ELMHU during the study period was undertaken. Simple descriptive and inferential statistics were used to describe the profiles and examine the associations with the common psychiatric conditions.
Of the participants with complete data (n = 186), the majority were males (n = 108); single (72.6%) and had secondary education (45.7%). The majority of in-patients were psychotic (38%), violent (31%), manic (16%) or suicidal (9.2%) at the time of admission. Patients who were 35 years and above, resided in urban areas, and presented with suicidal and depressive symptoms were more likely to be admitted voluntarily. Schizophrenia (31.6%), cannabis-related psychiatric disorders (31.6%), bipolar Type-1 disorder (21.9%) and alcohol related disorders (15.5%) were the main reasons for admission. There was a significant association between demographic characteristics and the common psychiatric disorders of the patients.
Schizophrenia, bipolar 1 disorder, cannabis-related disorders and alcohol-related disorders are the predominant disorders leading to in- patient mental health care services being utilized in the study setting. Findings might inform training of health care workers at the PHCs with a view to integrating mental health care services in the Eastern Cape.
The expressions and prognostic implications of Twist and E-cadherin in adenocarcinomas of the gastroesophageal junction and proximal gastric carcinoma
Authors: Sun Shengbo , Gong Qing 
Published: December 2019

Abstract
Twist and E-cadherin are crucial for the development of different types of cancer; however, their clinical significance in adenocarcinoma of the gastroesophageal junction (AGE) remains unknown. Here, we investigated the correlation between the expression of Twist and E-cadherin and their impact on the clinical outcomes and prognosis of patients with AGE and proximal gastric carcinoma (PGC).
Using immunohistochemistry, we determined the expression of Twist and E-cadherin in the tissue samples of patients with AGE and PGC. The correlation of the expression of Twist and E-cadherin with the clinicopathological factors was assessed by using the chi-square test, Fisher exact test, and non-parametric Mann–Whitney U test. The Kaplan–Meier method along with the log-rank test and Cox proportional-hazards model were used to evaluate the correlation of Twist and E-cadherin expression with the overall survival (OS) of patients.
Overall, 94 patients with AGE (n = 45, 47.87%) or PGC (n = 49, 52.13%) who underwent primary tumor resection were included in this study. The median follow-up period was 40.5 months. We observed a significant difference in the smoking status (P < .001) and differentiation grade (P = .004) between patients with AGE and PGC. There was a significant association of a high Twist expression with T stage (only in PGC, P = .008), lymph node metastasis (AGE, P = .075; PGC, P = .051), and advanced pathological stages (AGE, P = .019; PGC, P = .006). A low E-cadherin expression showed similar results; however, it was not significantly associated with the advanced pathological stages of AGE (P = .372). A low E-cadherin expression was significantly associated with a low differentiation grade of AGE (P = .002). In addition, a significant inverse relationship was observed between Twist and E-cadherin expression. The Kaplan–Meier survival analysis and Cox regression analysis revealed that a high Twist expression and low E-cadherin expression were independent prognostic factors for short OS of patients with AGE or PGC.
A high Twist expression or low E-cadherin expression was associated with unfavorable clinicopathological factors and independently predicted short OS of patients with AGE or PGC.
A nomogram for preoperative prediction of lymphatic infiltration in colorectal cancer
Authors: Wu Guo , Liu Jun-Gang , Huang Xiao-Liang , Wei Chun-Yin , Jeen PC Franco , Xie Wei-Shun , Chen Shao-Mei , Zhang Chu-Qiao , Tang Wei-Zhong 
Published: December 2019

Abstract
Lymphatic infiltration (LI) is a key factor affecting the treatment of patients with colorectal cancer (CRC). Thus, the aim of this study was to develop and validate a nomogram for individual preoperative prediction of LI in patients with CRC.
We conducted a retrospective analysis of 664 patients who received their initial diagnosis of CRC at our center. Those patients were allocated to a training dataset (n = 468) and a validation dataset (n = 196). The least absolute shrinkage and selection operator regression model was used for data dimension reduction and feature selection. The nomogram was constructed from the training dataset and internally verified using the concordance index (C-index), calibration, area under the receiver operating characteristic curve and decision curve analysis (DCA).
The enhancement computed tomography reported N1/N2 classification, preoperative tumor differentiation, elevated carcinoembryonic antigen, and carbohydrate antigen19-9 level were selected as variables for the prediction nomogram. Encouragingly, the nomogram showed favorable calibration with C-index 0.757 in the training cohort and 0.725 in validation cohort. The DCA signified that the nomogram was clinically useful. The Kaplan–Meier survival curve showed that patients with LI had a worse prognosis and could benefit from postoperative adjuvant chemotherapy.
Use common clinicopathologic factors, a non-invasive scale for individualized preoperative forecasting of LI was established conveniently. LI prediction has great significance for risk stratification of prognosis and treatment of resectable CRC.
Delivering the diluted contrast agent with saline via a spiral flow tube improves arterial enhancement for contrast enhancement of magnetic resonance angiography of the neck
Authors: Hamaguchi Akiyoshi , Fujima Noriyuki , Hamaguchi Naoko , Hayashi Tetsuji , Kodera Shuichi 
Published: December 2019

Abstract
A contrast agent can be pushed by a saline solution more effectively through a spiral flow tube than through a conventional T-shaped tube in contrast-enhanced magnetic resonance angiography (CEMRA). To compare the degree of contrast enhancement and signal stability in the carotid artery by using CEMRA between a spiral flow tube and a T-shaped tube.
A total of 100 patients were analyzed in this retrospective study. The first 50 patients underwent CEMRA of the carotid artery with the T-shaped tube, while the last 50 patients used the spiral flow tube. Gadoterate meglumine was diluted with saline to make a total volume of 20 mL. Injection was performed with a bolus rate of 2.5 mL/s for 8 seconds. Five regions of interest (ROIs) were placed on the contrast-enhanced area in each carotid artery and the signal intensity (SI) in the ROI was used for the analysis. The ROIs on the brain stem were also placed and the average SI in this ROI was used as a reference signal. The enhancement of the artery (E
artery) was calculated as a normalized signal using the following equation: E
artery = SI in the ROI of the carotid bifurcation/SI in the ROI of the brain stem. Signal homogeneity in the contrast-enhanced area (SHenhance) was assessed by calculating the coefficient of variation from the SI in the 5 ROIs. The value of SHenhance and E
artery between the data obtained from the spiral flow tube and the T-shaped tube were compared. P-values <.05 were considered significant.
We found a significant difference in SHenhance between the data obtained from the spiral flow tube (0.20 ± 0.060) and the T-shaped tube (0.24 ± 0.056) (P = .001). The E
artery values significantly increased by 15% (spiral flow tube, median 14.1 with interquartile range [IQR] 11.8–15.4 vs T-shaped tube, median 12.3 IQR 11.3–14.0, P = .02) using the spiral flow tube.
These findings suggest that, by using the Spiral flow tube, the homogeneity of the contrast-enhanced signal intensity in the carotid artery was significantly improved without decreasing the signal intensity in CEMRA.
Acupuncture for patients with atopic dermatitis
Authors: Liu Yijiang , Cui Hai , Du Ruosang , Zhang Lu , Yuan Hongwen , Zhang Xiaohui , Zheng Shumei 
Published: December 2019

Abstract

Background:
The systematic review protocol is aim to evaluate the efficacy and safety of acupuncture in the treatment of atopic dermatitis (AD).

Methods:
We will search the database on the Cochrane Library, PubMed, Medline, Excerpta Medica Database, Chinese Biomedical Literature Database, PsychINFO, China National Knowledge Infrastructure, Wanfang data, Chinese Scientific Journal Database, including studies and published systematic review in the reference list and grey. And will use Cochrane Collaboration's tools to evaluate the risk of bias of the included randomized controlled trials. The Review Manager 5.3 will be used to synthesize collected data.

Results:
This study will assess the safety and effectiveness based on current evidence of acupuncture for AD, especially scoring atopic dermatitis, eczema area, and severity index, patient-oriented eczema measure, and quality of life.

Conclusion:
This study will provide high-quality recently evidence for evaluating the efficacy of acupuncture for patients with AD.
PROSPERO registration number: CRD42019135919.