bluuebunny/crossref_metadata_2025_split huggingface dataset:
Moral distress perspectives among interprofessional intensive care unit team members
Authors: Vincent Heather , Jones Deborah J , Engebretson Joan 
Published: May 2020

Aim: To examine interprofessional healthcare professionals’ perceptions of triggers and root causes of moral distress. Design: Qualitative description of open-text comments written on the Moral Distress Scale–Revised survey. Methods: A subset of interprofessional providers from a parent study provided open-text comments that originated from four areas of the Moral Distress Scale–Revised, including the margins of the 21-item questionnaire, the designated open-text section, shared perceptions of team communication and dynamics affecting moral distress, and the section addressing an intent to leave a clinical position because of moral distress. Open-text comments were captured, coded, and divided into meaning units and themes using systematic text condensation. Participants: Twenty-eight of the 223 parent study participants completing the Moral Distress Scale–Revised shared comments on situations contributing to moral distress. Results: All 28 participants working in the four medical center intensive care units reported feelings of moral distress. Feelings of moral distress were associated with professional anguish over patient care decisions, team, and system-level factors. Professional-level contributors reflected clinician concerns of continuing life support measures perceived not in the patient’s best interest. Team and unit-level factors were related to poor communication, bullying, and a lack of collegial collaboration. System-level factors included clinicians feeling unsupported by senior administration and institutional culpability as a result of healthcare processes and system constraints impeding reliable patient care delivery. Ethical considerations: Approval was obtained from the Institutional Review Board (IRB) of the University of Texas Health IRB and the organization in which the study was conducted. Conclusion: Moral distress was associated with feelings of anguish, professional intimidation, and organizational factors that impacted the delivery of ethically based patient care. Participants expressed a sense of awareness that they may experience ethical dilemmas as a consequence of the changing reality of providing healthcare within complex healthcare systems. Strategies to combat moral distress should target team and system interventions designed to improve interprofessional collaboration and support professional ethical values and moral commitments of all healthcare providers.
Ethical perspectives in communication in cancer care: An interpretative phenomenological study
Authors: Melis Paola , Galletta Maura , Gonzalez Cesar Ivan Aviles , Contu Paolo , Herrera Maria Francisca Jimenez 
Published: May 2020

Background: In cancer care, many clinical contexts still lack a good-quality patient–health professional communication about diagnosis and prognosis. Information transmission enables patients to make informed choices about their own healthcare. Nevertheless, disclosure is still an ethically challenging clinical problem in cancer care. High-quality care can be achieved by understanding the perspectives of others. The perspective of patients, their caregivers, physicians and nurses have seldom been simultaneously studied. Objective: To investigate the phenomenon of diagnosis and prognosis-related communication as experienced by patients, their caregivers, and both their attending nurses and physicians, to enlighten meanings attached to communication by the four parties. Methods: A qualitative study using interpretative phenomenological analysis was performed. Participants and research context: Purposive sampling of six patients, six caregivers, seven nurses and five physicians was performed in two oncological hospitals in Italy. Ethical considerations: Local Ethics Committee approved the study. It was guided by the ethical principles of voluntary enrolment, anonymity, privacy and confidentiality. Results: Three main themes were identified: (a) the infinite range of possibilities in knowing and willing to know, (b) communication with the patient as a conflicting situation and (c) the bind of implicit and explicit meaning of communication. Conclusion: The interplay of meanings attached by patients, their caregivers, and their attending oncologist and nurse to communication about diagnosis and prognosis revealed complexities and ambiguities not yet settled. Physicians still need to solve the ethical tensions in their caring relationship with patients to really allow them ‘to choose with dignity and being aware of it’. Nurses need to develop awareness about their role in diagnosis and prognosis-related communication. This cognizance is essential not just to assure consistency of communication within the multi-disciplinary team but mostly because it allows and enables the moral agent to take its own responsibilities and be accountable for them.
Standard Versus Extended Duration Direct-Acting Antiviral Therapy in Hepatitis C Patients With Slow Response to Treatment
Authors: McKnight Ashley H. , Townsend Mary L. , Hashem Mohamed G. , Naggie Susanna , Park Lawrence P. , Britt Rachel B. 
Published: May 2020

Background: Response-guided hepatitis C therapy was standard with interferon-based regimens but is not used for direct-acting antivirals (DAAs). Week 4 viral kinetics may predict sustained virological response (SVR) with DAAs, but it is unclear whether extending therapy in slow responders affects outcomes. Objectives: The primary objective was to compare SVR rates between traditional and extended duration groups. Secondary objectives were to compare SVR rates among subgroups and to determine factors associated with SVR. Methods: This institutional review board–approved, retrospective, single-center study identified patients with chronic hepatitis C virus (HCV) infection with detectable week 4 HCV RNA who were treated with DAAs. Patients were excluded for early discontinuation, treatment regimen not recommended first-line, or missing HCV RNA labs. Patients were stratified into traditional and extended duration groups. The primary end point was SVR. Secondary end points included factors associated with SVR and rationale for extension of therapy duration. Results: A total of 363 patients were included; 58 (16%) received extended therapy. Patients were primarily genotype 1a (70%) and treatment naïve (80%). More than half had advanced fibrosis or cirrhosis. SVR12 rates were 100% in the extended duration group and 96.7% in the traditional duration group ( P = 0.37). There were no associations with SVR and prespecified patient-specific factors. Sample size was limited. Conclusion and Relevance: Based on these findings, a recommendation for extension of therapy cannot be made for patients with detectable HCV RNA at week 4 of treatment at this time. Cost analyses may help guide recommendations to re-treat rare failures versus extend therapy in all slow responders.
Incidence and Risk Factors of Acute Kidney Injury in Patients Receiving Concomitant Vancomycin and Continuous-Infusion Piperacillin/Tazobactam: A Retrospective Cohort Study
Authors: Blair Kameron , Covington Elizabeth W. 
Published: May 2020

Background: During a recent shortage of small-volume parenteral solutions, some hospitals administered piperacillin/tazobactam via continuous infusion to utilize larger fluid volumes. Although the incidence of acute kidney injury (AKI) is well documented for patients receiving intermittent or extended-infusion piperacillin/tazobactam with concomitant vancomycin, no literature exists documenting the incidence of AKI in patients receiving continuous-infusion piperacillin/tazobactam. Objective: The objective of this study is to examine the incidence and predictors of AKI in patients who received continuous-infusion piperacillin/tazobactam with concomitant intermittent-infusion vancomycin (VPT-CI) at a community hospital. Methods: A retrospective cohort study was performed on patients who received VPT-CI between December 2017 and March 2018. Patients were eligible for inclusion if they were at least 19 years of age and received at least 48 hours of combination therapy. The primary outcome was incidence of AKI. The secondary outcome was an assessment of patient and treatment characteristics to determine predictors of AKI. Results: A total of 120 patients were included in the study. The incidence of AKI in patients who received VPT-CI was 31.7%. Based on binary logistic regression analysis, risk factors associated with increased risk of AKI included admission to the intensive care unit and baseline creatinine clearance less than 60 mL/min. Conclusion and Relevance: The incidence of AKI for VPT-CI found in this study was comparable to that found with intermittent and extended-infusion piperacillin/tazobactam with concomitant vancomycin in prior literature. Additional research should further analyze risk factors for the development of AKI for patients on concomitant vancomycin and piperacillin/tazobactam therapy.
Dosing errors in total parenteral nutrition prescriptions at a specialized cancer care hospital of Lahore: The role of clinical pharmacist
Authors: Akbar Zunaira , Saeed Hamid , Saleem Zikria , Andleeb Sidra 
Published: May 2020

Study objective To determine the role of pharmacist in identifying the frequency of errors in total parenteral nutrition prescriptions in cancer patients for the years 2015 and 2016. Total parenteral nutrition has a high potential for medical errors because of its complex composition, thus leading to severe complications. Pharmacist review of the prescriptions reduces the risk of inappropriate prescribing, preparation, and administration of parenteral nutrition. Methodology An observational study was performed by collecting data of total parenteral nutrition prescriptions of 71 patients for the last two years from Pharmacy Department of specialized cancer care hospital. Results It was found that the frequency of dosing errors and incomplete prescriptions was higher in 2015 compared to 2016. Additionally, the frequency of macro and micronutrients dosing errors were higher in adults (23.4% and 66.2%) compared to pediatrics (14.6% and 46.6%). Furthermore, the frequency of illegible prescriptions was higher (5.03%) in year 2016 as compared to year 2015 (1.64%). Nevertheless, such dose interventions improved patient’s weight (20%) and promoted enteral feeding (42.3%). Major complication was hypophosphatemia (39.4%) followed by hyperglycemia (10%) and catheter-induced infection, i.e. sepsis (4.2%). Conclusion In conclusion, data suggested that pharmacist played instrumental role in identifying and rectifying total parenteral nutrition dosing errors for both micronutrients and macronutrients—with higher frequency in 2015 compared to 2016, leading to improvements in total parenteral nutrition-related complications and switches to enteral feeding.
Renal Biopsy Prognostic Findings in Children With Atypical Hemolytic Uremic Syndrome
Authors: Yüksel Selçuk , Işık Gönül İpek , Canpolat Nur , Gökçe İbrahim , Özlü Sare Gülfem , Özçakar Zeynep Birsin , Ozaltin Fatih , Söylemezoğlu Oğuz 
Published: May 2020

Background The aim of this study was to investigate the histopathological findings in kidney biopsies in children with atypical hemolytic uremic syndrome (aHUS) and to determine whether specific pathological findings in aHUS have a prognostic value. Methods Renal biopsy specimens of 29 patients who were recorded in the national Turkish aHUS registry database were available for review. Histopathological findings were compared with the clinical and laboratory features at the presentation and the final outcome. Results The mean age at presentation and follow-up period was 4.9 ± 3.9 and 3.9 ± 3.0 years, respectively. The median time interval from the first symptom to biopsy was 10 days. Vascular thrombosis and interstitial fibrosis were significantly related to chronic kidney disease (CKD) requiring dialysis or kidney transplantation during follow-up (5.6-fold, for both). Glomerular necrosis, cortical necrosis, and glomerular sclerosis were markedly associated with CKD without dialysis (6.2-fold, 13.3-fold, and 8.8-fold, respectively). However, presence of endothelial swelling, subendothelial widening, and fragmented erythrocytes was found to be correlated with a favorable final outcome. Conclusions Presence of vascular thrombosis, cortical necrosis, and glomerular sclerosis in histopathological evaluation correlated with developing CKD. Chronic changes in the interstitial compartment were also related to poor prognosis, a finding that has been shown for the first time in pediatric aHUS cases.
Evaluation of prevention of ventilator-associated infections in four Australian intensive care units
Authors: Ciampoli Natasha , Bouchoucha Stephane , Currey Judy , Hutchinson Ana 
Published: May 2020

Background: Effective approaches to practice improvement require development of tailored interventions in collaboration with knowledge users. Objectives: To explore critical care nurses’ knowledge and adherence to best practice guidelines for management of patients with an artificial airway to minimise development of ventilator-associated pneumonia. Methods: A cross-sectional study was undertaken across four intensive care units that involved three phases: (1) survey of critical care nurses regarding their current practice; (2) observation of respiratory care delivery; and (3) chart audit. Key care processes evaluated were: (1) technique and adherence to standard precautions when performing endotracheal suction, cuff pressure checks and extubation; and (2) frequency of endotracheal suctioning and mouth care. Results: Observational and chart audit data on the provision and documentation of respiratory care were collected for 36 nurse/patient dyads. Forty-six nurses were surveyed and the majority responded that endotracheal suctioning and mouth care should be performed ‘as required’ or every 2 hours (h). During observations of practice, no patient received mouth care every 2 h, nor had documentation of such. Inconsistent adherence to standard precautions and hand hygiene during respiratory care provision was observed. Chart audit indicated that nurses varied in the frequency of suctioning consistent with documented clinical assessment findings. Conclusion: Although nurses had good knowledge for the management of artificial airways, this was not consistently translated into practice. Gaps were identified in relation to respiratory related infection prevention, the prevention of micro-aspiration of oropharyngeal secretions and in the provision of mouth care.
Evaluation of Performance and Tolerability of Nebulized Hyaluronic Acid Nasal Hypertonic Solution in the Treatment of Chronic Rhinosinusitis
Authors: Monzani Daniele , Molinari Giulia , Gherpelli Chiara , Michellini Laura , Alicandri-Ciufelli Matteo 
Published: May 2020

Background Nasal solutions are part of the recommended therapy of chronic rhinosinusitis (CRS). Formulations containing hyaluronic acid (HA) may represent a promising topical treatment in CRS patients in light of the anti-inflammatory and protective effect of HA on the sinonasal mucosa. Objective Primary aim was to evaluate the performance of a new nebulized HA nasal hypertonic solution in the relief of symptoms of CRS. Secondarily, evaluation of symptoms improvement, endoscopic nasal findings, and safety profile were assessed. Methods A monocenter, single arm, not controlled, premarket clinical trial on a new nasal solution containing HA was performed. All the included patients had a history of previously diagnosed or recurrent CRS or they had received a clinical diagnosis of CRS defined, according to the European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Each patient was evaluated on 3 visits. Endoscopic nasal examination and Nasal Obstruction Symptom Evaluation Instrument questionnaire filling were performed during each visit. Patients’ adherence to treatment and overall satisfaction, patients’ and investigator’s global evaluation of performance, and safety parameters were also assessed. Results Eighty patients were enrolled. The use of the investigated HA nasal solution revealed to be significantly effective in the relief of symptoms of CRS. According to daily patients’ diaries, several signs and symptoms significantly improved after therapy. The comparison between endoscopic assessments before and after treatment confirmed improvement of the condition in at least 75% of patients. Seventy-four percent of the patients were quite or very satisfied with the treatment and 80% reported an improvement. The investigator’s global assessment of performance was in agreement with this view, as more than 80% of the patients were considered clinically improved. Conclusions The use of the investigated new nebulized HA nasal hypertonic solution is an effective and safe the treatment of CRS.
Severity of Rhinosinusitis: Comparison Between Visual Analog Scale Given by Patients and Otorhinolaryngologists
Authors: Zhao Li , Yu Ke Na , Tan Jian Li , Zhang Hai Ling , Jin Peng , Zi Xiao Xue , Tu Yan Yi , Li Tao , Zhou Xiang Min , Shi Li , Wang De Yun 
Published: May 2020

Background Visual Analog Scale (VAS) as determined by the patient is recommended by the European Position Paper on Rhinosinusitis and Nasal Polyps 2012 in evaluation of the total severity of the chronic rhinosinusitis (CRS) patients’ symptoms. Objective To evaluate the correlation between evaluations performed by otorhinolaryngologists and CRS patients with commonly used systems. Methods Scores of VAS and Sino-Nasal Outcome Test-20 (SNOT-20) Chinese version were obtained from 110 CRS patients with nasal polyps (CRSwNPs, n = 61) and without nasal polyps (CRSsNPs, n = 49) before surgery, which were compared with scores of Lund–Kennedy endoscopic staging system, the Lund–Mackay computed tomography (CT) staging system, and VAS from 3 attending otorhinolaryngologists. Results The median VAS scores given by CRS patients (6.0; 4.25–7.5) do not correlate significantly with the VAS scores by the 3 otorhinolaryngologists (5.5; 4.83–6.5) with a correlation coefficient of .218 (−0.146 to 0.466). For CRS patients, there was only a moderate correlation between scores of VAS and the SNOT-20 ( r = .37), and no significant difference of VAS scores between CRSwNP and CRSsNP, and between unilateral and bilateral nasal polys. For otorhinolaryngologists, a higher median VAS score was found in CRSwNP (6.0; 5.17–7.0), especially in bilateral (6.0; 5.0–7.08) and revision surgery (6.08; 5.33–7.63). The VAS scores of otorhinolaryngologists correlated significantly with the Lund–Mackay CT score ( r = .7536) and Lund–Kennedy endoscopic staging ( r = .5947). Conclusions VAS scores between patients and physicians are not correlated significantly in this study, but they fall within the same therapeutic range and do not change the clinical management of the patients.
Comparison of Human Platelet Lysate versus Fetal Bovine Serum for Expansion of Human Articular Cartilage–Derived Chondroprogenitors
Authors: Kachroo Upasana , Zachariah Shikha Mary , Thambaiah Augustine , Tabasum Aleya , Livingston Abel , Rebekah Grace , Srivastava Alok , Vinod Elizabeth 
Published: May 2020

Purpose Articular chondroprogenitors, a suitable contender for cell-based therapy in cartilage repair, routinely employ fetal bovine serum (FBS) for expansion and differentiation. The possibility of transplant rejections or zoonoses transmissions raise a need for xeno-free alternatives. Use of human platelet lysate (hPL), a nutrient supplement abundant in growth factors, has not been reported for human chondroprogenitor expansion thus far. Our aim was to compare the biological profile of chondroprogenitors grown in hPL versus FBS. Methods Chondroprogenitors were isolated from 3 osteoarthritic knee joints. Following differential fibronectin adhesion assay, passage 0 cells grown in (a) 10% FBS and (b) 10% hPL were considered for assessment of growth kinetics, surface marker expression, gene expression, and trilineage differentiation. Latent transforming growth factor–β1 (TGFβ1) levels were also measured for each culture medium used. Results Cellular proliferation was significantly higher in cells grown with hPL ( P < 0.01). Surface marker expression was comparable except in CD-146 where hPL group had significantly higher values ( P = 0.03). Comparison of mRNA expression revealed notably low values of collagen I, collagen X, aggrecan, and collagen II ( P < 0.05). Trilineage differentiation was seen in both groups with higher alizarin red uptake noted in hPL. There were also significantly higher levels of latent TGFβ1 in the medium containing hPL as compared to FBS. Conclusions This is the first in vitro xeno-free study to affirm that hPL can serve as an optimal growth supplement for expansion of articular chondroprogenitors, although an in-depth assessment of resident growth factors and evaluation of different dilutions of hPL is required to assess suitability for use in translational research.
Mechanical forces alter endothelin‐1 signaling: comparative ovine models of congenital heart disease
Authors: Zhu Terry , Chiacchia Samuel , Kameny Rebecca J. , Garcia De Herreros Antoni , Gong Wenhui , Raff Gary W. , Boehme Jason B. , Maltepe Emin , Lasheras Juan C. , Black Stephen M. , Datar Sanjeev A. , Fineman Jeffrey R. 
Published: May 2020

The risk and progression of pulmonary vascular disease in patients with congenital heart disease is dependent on the hemodynamics associated with different lesions. However, the underlying mechanisms are not understood. Endothelin‐1 is a potent vasoconstrictor that plays a key role in the pathology of pulmonary vascular disease. We utilized two ovine models of congenital heart disease: (1) fetal aortopulmonary graft placement (shunt), resulting in increased flow and pressure; and (2) fetal ligation of the left pulmonary artery resulting in increased flow and normal pressure to the right lung, to investigate the hypothesis that high pressure and flow, but not flow alone, upregulates endothelin‐1 signaling. Lung tissue and pulmonary arterial endothelial cells were harvested from control, shunt, and the right lung of left pulmonary artery lambs at 3–7 weeks of age. We found that lung preproendothelin‐1 mRNA and protein expression were increased in shunt lambs compared to controls. Preproendothelin‐1 mRNA expression was modestly increased, and protein was unchanged in left pulmonary artery lambs. These changes resulted in increased lung endothelin‐1 levels in shunt lambs, while left pulmonary artery levels were similar to controls. Pulmonary arterial endothelial cells exposed to increased shear stress decreased endothelin‐1 levels by five‐fold, while cyclic stretch increased levels by 1.5‐fold. These data suggest that pressure or an additive effect of pressure and flow, rather than increased flow alone, is the principal driver of increased endothelin signaling in congenital heart disease. Defining the molecular drivers of the pathobiology of pulmonary vascular disease due to differing mechanical forces will allow for a more targeted therapeutic approach.