bluuebunny/crossref_metadata_2025_split huggingface dataset:
Direction and Magnitude of Change in Plateau From Peak Pressure During Inspiratory Holds Can Identify the Degree of Spontaneous Effort and Elastic Workload in Ventilated Patients
Authors: Kyogoku Miyako , Shimatani Tatsutoshi , Hotz Justin C. , Newth Christopher J. L. , Bellani Giacomo , Takeuchi Muneyuki , Khemani Robinder G. 
Published: November 2020

OBJECTIVES:
Inspiratory holds with measures of airway pressure to estimate driving pressure (elastic work) are often limited to patients without respiratory effort. We sought to evaluate if measures of airway pressure during inspiratory holds could be used for patients with spontaneous respiratory effort during mechanical ventilation to estimate the degree of spontaneous effort and elastic work.

DESIGN:
We compared the direction and degree of change in airway pressure during inspiratory holds versus esophageal pressure through secondary analysis of physiologic data.

SETTING:
ICUs at Children’s Hospital Los Angeles.

PATIENTS:
Children with pediatric acute respiratory distress syndrome with evidence of spontaneous respiration while on pressure control or pressure support ventilation.

INTERVENTIONS:
Inspiratory hold maneuvers.

MEASUREMENTS AND MAIN RESULTS:
From airway pressure, we defined “plateau – peak pressure” as Pmusc, index, which was divided into three categories for analysis (< –1 [“negative”], between –1 and 1 [“neutral”], and > 1 cm H2O [“positive”]). A total of 30 children (age 36.8 mo [16.1–70.3 mo]) from 65 study days, comprising 118 inspiratory holds were included. Pmusc, index was “negative” in 29 cases, was “neutral” in 17 cases, and was “positive” in 72 cases. As Pmusc, index went from negative to neutral to positive, there was larger negative deflection in esophageal pressure –5.0 (–8.2 to 1.9), –5.9 (–7.6 to 4.3), and –10.7 (–18.1 to 7.9) cm H2O (p < 0.0001), respectively. There was a correlation between max negative esophageal pressure and Pmusc, index (r = –0.52), and when Pmusc, index was greater than or equal to 7 cm H2O, the max negative esophageal pressure was greater than 10 cm H2O. There was a stronger correlation between Pmusc, index and markers of elastic work from esophageal pressure (r = 0.84).

CONCLUSIONS:
The magnitude of plateau minus peak pressure during an inspiratory hold is correlated with the degree of inspiratory effort, particularly for those with high elastic work. It may be useful to identify patients with excessively high effort or high driving pressure.
Efficacy and safety of the long-acting fusion inhibitor albuvirtide in antiretroviral-experienced adults with human immunodeficiency virus-1: interim analysis of the randomized, controlled, phase 3, non-inferiority TALENT study
Authors: Su Bin , Yao Cheng , Zhao Qing-Xia , Cai Wei-Ping , Wang Min , Lu Hong-Zhou , Chen Yuan-Yuan , Liu Li , Wang Hui , He Yun , Zheng Yu-Huang , Li Ling-Hua , Chen Jin-Feng , Yu Jian-Hua , Zhu Biao , Zhao Min , Sun Yong-Tao , Lun Wen-Hui , Xia Wei , Sun Li-Jun , Dai Li-Li , Jiang Tai-Yi , Wang Mei-Xia , Zheng Qing-Shan , Peng Hai-Yan , Wang Yao , Lu Rong-Jian , Hu Jian-Hua , Xing Hui , Shao Yi-Ming , Xie Dong , Zhang Tong , Zhang Fu-Jie , Wu Hao 
Published: November 2020

Abstract

Background
Albuvirtide is a once-weekly injectable human immunodeficiency virus (HIV)-1 fusion inhibitor. We present interim data for a phase 3 trial assessing the safety and efficacy of albuvirtide plus lopinavir-ritonavir in HIV-1-infected adults already treated with antiretroviral drugs.

Methods
We carried out a 48-week, randomized, controlled, open-label non-inferiority trial at 12 sites in China. Adults on the World Health Organization (WHO)-recommended first-line treatment for >6 months with a plasma viral load >1000 copies/mL were enrolled and randomly assigned (1:1) to receive albuvirtide (once weekly) plus ritonavir-boosted lopinavir (ABT group) or the WHO-recommended second-line treatment (NRTI group). The primary endpoint was the proportion of patients with a plasma viral load below 50 copies/mL at 48 weeks. Non-inferiority was prespecified with a margin of 12%.

Results
At the time of analysis, week 24 data were available for 83 and 92 patients, and week 48 data were available for 46 and 50 patients in the albuvirtide and NRTI groups, respectively. At 48 weeks, 80.4% of patients in the ABT group and 66.0% of those in the NRTI group had HIV-1 RNA levels below 50 copies/mL, meeting the criteria for non-inferiority. For the per-protocol population, the superiority of albuvirtide over NRTI was demonstrated. The frequency of grade 3 to 4 adverse events was similar in the two groups; the most common adverse events were diarrhea, upper respiratory tract infections, and grade 3 to 4 increases in triglyceride concentration. Renal function was significantly more impaired at 12 weeks in the patients of the NRTI group who received tenofovir disoproxil fumarate than in those of the ABT group.

Conclusions
The TALENT study is the first phase 3 trial of an injectable long-acting HIV drug. This interim analysis indicates that once-weekly albuvirtide in combination with ritonavir-boosted lopinavir is well tolerated and non-inferior to the WHO-recommended second-line regimen in patients with first-line treatment failure.

Trial registration
ClinicalTrials.gov Identifier: NCT02369965; https://www.clinicaltrials.gov.
Chinese Clinical Trial Registry No. ChiCTR-TRC-14004276; http://www.chictr.org.cn/enindex.aspx
A Review of Neuronal Pathways Associated With Consciousness
Authors: Mulkey Malissa , Everhart D. Erik , Gencarelli Amy , Sorrell Anne , Kim Sungham 
Published: November 2020

ABSTRACT

INTRODUCTION: Accurate communication of information regarding fluctuations in level of consciousness is critical. It is, important for nurses to understand terms related to consciousness to appropriately assess and implement plans of care. CONTENT: Although the neurobiology of consciousness is complex and multifaceted, consciousness can be conceptualized as having 2 distinct but interrelated dimensions: arousal and awareness. The different levels of consciousness are thought to fall on a continuum ranging from being fully awake to coma. CONCLUSION: This article focuses on the terms of consciousness, awareness, and arousal along with nursing implications where appropriate.
Embolic Stroke of Undetermined Source: A Primer for Nursing
Authors: Sutherly Loretta J. , Belair Trina , Nahab Fadi 
Published: November 2020

ABSTRACT

BACKGROUND: Cryptogenic stroke has been used to identify ischemic strokes with no identified cause; however, this classification is limited by the lack of a standardized and thorough evaluation. Embolic Stroke of Undetermined Source is used to define those strokes with no identified cause after a standardized diagnostic workup. METHODS: We conducted a literature review from January 1, 2014, to July 31, 2020 including the term “ESUS.” RESULTS: Embolic stroke of undetermined source accounts for approximately 25% of ischemic strokes and is used to classify patients with no identified cause of stroke despite routine brain imaging, noninvasive vascular imaging of the head and neck, a minimum of 24 hours of cardiac monitoring, and echocardiography. Studies have shown that these strokes may be caused by occult atrial fibrillation, occult malignancy, and other hypercoagulable states but are often identified after hospital discharge. The risk of recurrent stroke in ESUS patients remains high at 4.5% per year on single antiplatelet therapy. Ongoing research aims to identify biomarkers that can identify ESUS subgroups who may benefit from alternative antithrombotic therapies. CONCLUSION: Because of the complexity of the evaluation and the uncertainty associated with an unknown cause of stroke, neuroscience nurses caring for these patients should be familiar with ESUS and educate the patient about the condition and the importance of complying with all prescribed treatments, tests, and subsequent follow-up appointments after discharge.
Pancreatic Fungal Infection in Patients With Necrotizing Pancreatitis
Authors: Singh Ritu R. , Mitchell William , David Yakira , Cheesman Antonio , Dixon Rebekah E. , Nagula Satish , DiMaio Christopher J. , Greenwald David A. , Kumta Nikhil A. 
Published: November 2020

Goal:
The goal of this study was to study the incidence of fungal infection in necrotizing pancreatitis (NP) and its impact on mortality.

Background:
Infected pancreatic necrosis is a major contributor to morbidity and mortality in patients with NP. While pancreatic fungal infection (PFI) has frequently been identified in patients with NP, its effect on the clinical outcomes is unclear.

Materials and Methods:
A literature search was performed in Medline (Ovid), Embase (Ovid), and the Cochrane library. All prospective and retrospective studies that examined the incidence of fungal infection in NP with subgroup mortality data were included. For fungal infection of NP, studies with fungal isolation from pancreatic necrotic tissue were included. Newcastle Ottawa Scale and Joanna Briggs Institute’s critical appraisal tool were used for bias assessment.

Results:
Twenty-two studies comprising 2151 subjects with NP were included for the quantitative analysis. The mean incidence of fungal infection was 26.6% (572/2151). In-hospital mortality in the pooled sample of NP patients with PFI (N=572) was significantly higher [odds ratio (OR)=3.95, 95% confidence interval (CI): 2.6-5.8] than those without PFI. In a separate analysis of 7 studies, the mean difference in the length of stay between those with and without fungal infection was 22.99 days (95% CI: 14.67-31.3). The rate of intensive care unit admission (OR=3.95; 95% CI: 2.6-5.8), use of prophylactic antibacterials (OR=2.76; 95% CI: 1.31-5.81) and duration of antibacterial therapy (mean difference=8.71 d; 95% CI: 1.33-16.09) were all significantly higher in patients with PFI. Moderate heterogeneity was identified among the studies on estimating OR for mortality (I
2=43%) between the 2 groups.

Conclusions:
PFI is common in patients with NP and is associated with increased mortality, intensive care unit admission rate, and length of stay. Further prospective studies are needed to better understand the pathophysiology of PFIs and to determine the role for preemptive therapeutic strategies, such as prophylactic antifungal therapy.
Knowledge of 5-aminosalicylic acid nephrotoxicity and adherence to kidney function monitoring of patients with inflammatory bowel disease
Authors: Weislinger Lucie , Guillo Lucas , D’Amico Ferdinando , Danese Silvio , Achit Hamza , Ayav Carole , Guillemin Francis , Peyrin-Biroulet Laurent , Frimat Luc 
Published: November 2020

Background and aim
5-Aminosalicylic acid (5-ASA) nephrotoxicity is a rare and idiosyncratic condition in patients with inflammatory bowel disease (IBD), which may lead to end-stage kidney failure. Kidney function monitoring is recommended in clinical practice to prevent this complication. However, no data is available regarding the knowledge and adherence of patients with IBD to this monitoring.

Methods
As a part of routine practice, patients with IBD under treatment or previously treated with 5-ASA were systematically interviewed about knowledge of 5-ASA nephrotoxicity and adherence to kidney function monitoring. We reported here the experience among the first 103 consecutive patients seen in a French referral center.

Results
A total of 103 patients (93.2% ulcerative colitis, 5.8% Crohn’s disease, and 1% unclassified colitis) were analyzed. Among them, 70% were informed about the need for kidney function monitoring, and in most cases, information was provided by their gastroenterologist (94.4%). The adherence rate to monitoring was very high (84.7%). Monitoring consisted of serum creatinine and estimated glomerular filtration rate in most cases (97.2%), while 24-h proteinuria was less frequently used (69.4%). These tests were performed twice or ≥3 times per year by 44.4 and 41.7% of patients, respectively. One case of isolated elevation of proteinuria related to 5-ASA treatment was observed.

Conclusion
We reported for the first time that patients with IBD are well informed and adherent to kidney function monitoring of treatment with 5-ASA. The monitoring performed by their treating physician was generally in accordance with current recommendations.
Management of primary biliary cholangitis: results from a large real-life observational study in France and Belgium
Authors: Pariente Alexandre , Chazouilleres Olivier , Causse Xavier , Hanslik Bertrand , Arpurt Jean-Pierre , Henrion Jean , Rosa Isabelle , Renou Christophe , Garioud Armand , Corpechot Christophe ,   on behalf of DESCRIPT and DESCRIPT Study Groups
Published: November 2020

Background and aims:
To assess the characteristics, care, treatment response, and outcomes of primary biliary cholangitis (PBC) patients recently followed-up by hepato-gastroenterologists in various French and Belgian healthcare settings.

Methods:
This retrospective cohort study included patients with PBC who recently visited 79 hepato-gastroenterologists in France and Belgium. Data were collected at the time of diagnosis and at last visit and were compared according to biochemical response (BR) to ursodeoxycholic acid (UDCA) (BR), using Paris I–II criteria, and clinical outcomes.

Results:
A total of 436 patients (mean age at diagnosis 57 years, 88% females, median follow-up 5.2 years) were included. Liver biopsy, transient elastography, or none of these two procedures were performed at baseline in 216 (50%), 194 (45%), and 107 (25%) patients, respectively. Late-stage disease (histological stage III or IV, or transient elastography ≥9.6 kPa, or bilirubin >17 µM and albumin <35 g/L, or platelets <150.000/µl, or unequivocal signs of portal hypertension or cirrhosis) was reported in 37% of patients. UDCA was taken by 95% of patients (27% had suboptimal dosage). Inadequate BR was observed in 37% of patients. Clinicians overestimated disease control. Liver-related complications occurred in 9% of patients. Bilirubin and albumin independently predicted inadequate BR; advanced disease stage and inadequate BR independently predicted complications.

Conclusions:
Recently followed-up French and Belgian patients with PBC had homogeneous management. Late stage at diagnosis and inadequate BR were reported in around 40% of patients. Disease control was frequently overestimated by clinicians. Disease stage and BR were the main prognostic factors.
Incremental value of regional wall motion abnormalities for detecting obstructive coronary artery disease by rest-only electrocardiogram-gated single-photon emission computerized tomography myocardial perfusion imaging in suspected coronary artery disease patients
Authors: Liu Bao , Yu Wenji , Wang Jianfeng , Shao Xiaoliang , Zhang Feifei , Yang Minfu , Yang Xiaoyu , Wu Zhifang , Li Sijin , Shi Yunmei , Wang Bing , Xu Yiduo , Wang Yuetao 
Published: November 2020

Objective
The purpose of this study was to determine whether regional wall motion (WM) abnormalities by rest-only 99mtechnetium-sestamibi (99mTc-MIBI) electrocardiogram (ECG)-gated single-photon emission computerized tomography (SPECT) myocardial perfusion imaging (MPI) had incremental diagnostic value for detecting obstructive coronary artery disease (CAD) in suspected CAD patients.

Methods
This study retrospectively studied 255 consecutive suspected CAD patients who underwent rest-only ECG-gated SPECT MPI and were performed coronary angiography within 3 months. Obstructive CAD was defined as ≥70% narrowing of the inner diameter of the left anterior descending coronary artery, left circumflex coronary artery and right coronary artery or their main branches and ≥50% narrowing of the left main coronary artery. QPS and QGS were used to assess rest perfusion and WM. Summed rest score ≥4 and summed motion score ≥2 exhibited in two consecutive segments in one territory was considered abnormal.

Results
The sensitivity of the combination of perfusion and regional WM abnormalities was significantly higher than perfusion alone for detecting obstructive CAD (46.8% vs. 30.9%; P < 0.001), with similar specificity (91.9% vs. 95.0; P = 0.063). The global chi-square value of combination of perfusion and WM increased from 31.40 to 50.71 (P < 0.001) compared to perfusion. The sensitivity of combination of perfusion and WM for detecting obstructive CAD in patients with multivessel disease was higher than single-vessel disease (56.1% vs. 25.0%; P < 0.001), with similar specificity.

Conclusion
Regional WM abnormalities at rest, as shown by rest-only 99mTc-MIBI ECG-gated SPECT MPI, have additional diagnostic value over perfusion alone for detecting obstructive CAD in suspected CAD patients.
Correlates of Aerobic and Strength Exercise in Korean Cancer Patients
Authors: An Ki-Yong , Kang Dong-Woo , Courneya Kerry S. 
Published: November 2020

Background
Understanding the prevalence and correlates of exercise in Korean cancer patients is important to improve their health-related fitness and quality of life.

Objective
The aim of this study was to examine the prevalence and correlates of aerobic and strength exercise in Korean cancer patients.

Methods
Overall, 640 cancer patients from the Korea National Health and Nutrition Examination Survey 2014–2016 were categorized as meeting the exercise guidelines as follows: (a) neither, (b) strength only, (c) aerobic only, or (d) combined. Correlates included demographic, medical, health-related fitness, and quality of life variables. Univariate and stepwise multinomial logistic regression were used for statistical analyses.

Results
Over 70% of Korean cancer patients did not meet either exercise guideline. Higher education was associated with being more likely to meet the combined (odds ratio [OR], 4.69; P < .001), aerobic-only (OR, 3.58; P < .001), and strength-only (OR, 1.87; P = .042) guidelines. Higher hand-grip strength (per 10 kg) was associated with being more likely to meet the combined (OR, 1.78; P = .003) and strength-only (OR, 1.73; P < .001) guidelines. Older age (per 10 years) was associated with being less likely to meet the combined (OR, 0.69; P = .009) and aerobic-only (OR, 0.59; P < .001) guidelines and more likely to meet the strength-only guideline (OR, 1.46; P = .004).

Conclusions
Exercise levels are very low among Korean cancer patients and are correlated with age, education, and physical strength.

Implications for Practice
Oncology nurses in Korea should consider promoting exercise to cancer patients, especially older, less educated, and physically weaker patients.
Standardizing Outcome Assessment in Parkinson Disease: A Knowledge Translation Project
Authors: Yorke Amy M. , Trojanowski Suzanne , Fritz Nora E. , Ludwa Angee , Schroeder Matthew 
Published: November 2020

Background and Purpose:
Rehabilitation therapists do not consistently utilize standardized outcome measures. The purpose of this study was to develop and implement a tailored knowledge translation (KT) intervention to facilitate application of standardized outcome measures used in patients with Parkinson disease (PD) receiving outpatient rehabilitation.

Methods:
Four clinics within a hospital-based outpatient system including physical therapists (n = 7) and occupational therapists (n = 2) collaborated with researcher clinicians. A mixed-methods study, using the knowledge to action (KTA) framework, was executed to standardize the assessment battery completed on patients with PD. The project was titled iKNOW-PD (integrating KNOWledge translation for Parkinson Disease).

Results:
Four measures were selected for iKNOW-PD (9-Hole Peg Test, miniBESTest, 10-m walk test, and 5 times sit-to-stand). A multimodal intervention that overcame specific identified barriers (equipment, time) was implemented to ensure successful uptake. Consistency of utilizing iKNOW-PD measures on initial evaluation and discharge, across therapists and clinics, was evaluated. Therapists significantly increased the use of iKNOW-PD measures from 1.9 to 3.1 on initial evaluation (P < 0.001). The 10-meter walk test demonstrated the greatest uptake (>50%) from pre-iKNOW-PD to post-iKNOW-PD.

Discussion and Conclusions:
Standardizing outcome assessment for persons with PD in an outpatient setting can be successfully implemented. Overcoming identified barriers and capitalizing on facilitators promoted the uptake of standardized outcomes. Following the 6-month intervention period, therapists endorsed an improvement in their application of standardized measures and labeled iKNOW-PD as a positive experience that allowed them to minimize variability in practice.

Video Abstract available for more insights from the authors (see the Video, Supplemental Content 1, available at: http://links.lww.com/JNPT/A329).
Optimizing respondent-driven sampling to find undiagnosed HIV-infected people who inject drugs
Authors: McFall Allison M. , Lau Bryan , Latkin Carl , Srikrishnan Aylur K. , Anand Santhanam , Vasudevan Canjeevaram K. , Mehta Shruti H. , Solomon Sunil S. 
Published: November 2020

Objective:
We evaluated whether identification of undiagnosed HIV-infected people who inject drugs (PWID) via respondent-driven sampling (RDS) can be enhanced through a precision RDS (pRDS) approach.

Design/methods:
First, using prior RDS data from PWID in India, we built a prediction algorithm for recruiting undiagnosed HIV-infected PWID. pRDS was tested in Morinda, Punjab where participants were randomly assigned to standard or pRDS. In the standard RDS approach, all participants received two recruitment coupons. For pRDS, the algorithm determined an individual's probability of recruiting an undiagnosed PWID, and individuals received either two (low probability) or five (high probability) coupons. Efficiency in identifying undiagnosed HIV-infected PWID for the RDS approaches was evaluated in two ways: the number needed to recruit (NNR) and identification rate/week.

Results:
Predictors of recruiting undiagnosed PWID included HIV/HCV infection, network size, syringe services utilization, and injection environment. 1631 PWID were recruited in Morinda. From the standard RDS approach, 615 were recruited, including 39 undiagnosed; from pRDS, 1012 were recruited, including 77 undiagnosed. In pRDS, those with higher predicted probability were more likely to recruit others with HIV/HCV co-infection, undiagnosed and viremic HIV, and who utilized services. pRDS had a significantly higher identification rate of undiagnosed PWID (1.5/week) compared with the standard (0.8/week). The NNR for pRDS (13.1) was not significantly lower than the standard approach (15.8).

Conclusion:
pRDS identified twice as many undiagnosed and viremic PWID significantly faster than the standard approach. Leveraging RDS or similar network-based strategies should be considered alongside other strategies to ensure meeting UNAIDS targets.