bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Fentanyl Epidural Analgesia Affect Breastfeeding: A Prospective Cohort Study
Authors: Mahomed K. , Wild K. , Brown C. , Green A. 
Published: November 2020

(Aust N Z J Obstet Gynaecol. 2019;59:819–824)
Breastfeeding has clear short-term and long-term benefits and is widely recommended. The majority of mothers in Australia (77%) request epidural analgesia for labor. As a result, concerns have been voiced about the possible effects of epidural fentanyl on success with breastfeeding. Fentanyl is often used with bupivacaine for epidural labor analgesia to decrease the dose of local anesthetic needed and minimize motor block. However, it may depress neonatal reflexes associated with swallowing or sucking and could thus negatively affect breastfeeding success. In 2016, a systematic review assessed the effects of epidural labor analgesia on breastfeeding. Mixed results were found, and the investigators had difficulty comparing studies due to varied study designs. This current study aimed to clarify the association between epidural fentanyl and breastfeeding, including any dose effects, in a well-defined population of nulliparous women who had just delivered vaginally and planned to breastfeed.
Postoperative Analgesic Effectiveness of Quadratus Lumborum Block for Cesarean Delivery under Spinal Anesthesia
Authors: Hussain Nasir , Brull Richard , Weaver Tristan , Zhou Meiqin , Essandoh Michael , Abdallah Faraj W. 
Published: November 2020

Background
Spinal morphine is the mainstay of postcesarean analgesia. Quadratus lumborum block has recently been proposed as an adjunct or alternative to spinal morphine. The authors evaluated the analgesic effectiveness of quadratus lumborum block in cesarean delivery with and without spinal morphine.

Methods
Randomized trials evaluating quadratus lumborum block benefits in elective cesarean delivery under spinal anesthesia were sought. Three comparisons were considered: spinal morphine versus spinal morphine and quadratus lumborum block; spinal morphine versus quadratus lumborum block; and no block or spinal morphine versus quadratus lumborum block. The two coprimary outcomes were postoperative (1) 24-h cumulative oral morphine equivalent consumption and (2) pain at 4 to 6 h. Secondary outcomes included area under the curve pain, time to analgesic request, block complications, and opioid-related side effects.

Results
Twelve trials (924 patients) were analyzed. The mean differences (95% CIs) in 24-h morphine consumption and pain at 4 to 6 h for spinal morphine versus spinal morphine and quadratus lumborum block comparison were 0 mg (−2 to 1) and −0.1 cm (−0.7 to 0.4), respectively, indicating no benefit. For spinal morphine versus quadratus lumborum block, these differences were 7 mg (−2 to 15) and 0.6 cm (−0.7 to 1.8), respectively, also indicating no benefit. In contrast, for no block or spinal morphine versus quadratus lumborum block, improvements of −18 mg (−28 to −7) and −1.5 cm (−2.4 to −0.6) were observed, respectively, with quadratus lumborum block. Finally, for no block or spinal morphine versus quadratus lumborum block, quadratus lumborum block improved area under the 48-h pain curve by −4.4 cm · h (−5.0 to −3.8), exceeding the clinically important threshold (3.96 cm · h), but no differences were observed in the other comparisons.

Conclusions
Moderate quality evidence suggests that quadratus lumborum block does not enhance analgesic outcomes when combined with or compared with spinal morphine. However, the block improves postcesarean analgesia in the absence of spinal morphine. The clinical utility of this block seems limited to situations in which spinal morphine is not used.

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Cutaneous Cephalic Neurocristic Hamartoma on the Head With Melanocytic, Cartilage, Blood Vessel, Neural, and Bony Tissue
Authors: Stieler Karola Maria , Röwert-Huber Joachim , Vogt Annika , Meyer Lutz , Ulrike Blume-Peytavi 
Published: November 2020

Abstract:
We report on a congenital tumor of the face and scalp in a male newborn, histologically proven to contain melanocytes, cartilage, and bone, vascular, and neural tissue as part of a pigmented congenital tumor. Thus, this tumor was classified as a cutaneous cephalic neurocristic hamartoma.
Dysregulated Hepatic Expression of Glucose Transporter Type-1, Toll-Like Receptor 4, and Nuclear Factor Kappa B in Estrogen-Induced Cholestasis Pregnant Rats with Placental Ischemia-Reperfusion Stress
Authors: Zhou Fan , Chen Huafang , Shan Dan , Wu Yuxia , Chen Qian , Hu Yayi 
Published: November 2020

Abstract

Objective:
This study aimed at investigating the expression of nuclear factor kappa B (NF-κB) and mammalian target of rapamycin (mTOR) related signal pathways in liver tissues of intrahepatic cholestasis of pregnancy animal models.

Methods:
Estrogen (EE)-induced cholestasis and a placental ischemia-reperfusion (IR) model were established in pregnant rats. All pregnant rats were divided into four groups by random number table: EE-IR group (n = 6), EE-sham group (n = 6), control-IR group (n = 6) and control-sham group (n
= 6). Liver expression of mTOR, its upstream regulator DNA damage response-1 (REDD1), and downstream factor glucose transporter type-1 (GLUT1), accompanied by NF-κB (p65 is the most important component), its activator toll-like receptor 4 (TLR4), and inhibitor IκBα, were detected by western blot analysis and real-time polymerase chain reaction. The intergroup comparisons were performed with a one-way analysis of variance, the comparisons among groups were analyzed with the nonparametric Kruskal-Wallis test.

Results:
Giving pregnant rats EE alone reduced the hepatic expression of IκBα (0.72 ± 0.20 vs. 1.01 ± 0.07, P = 0.008). Meanwhile, giving pregnant rats placental IR alone increased liver levels of REDD1 (3.24 ± 0.98 vs. 1.06 ± 0.24, P = 0.025), GLUT1 (2.37 ± 0.82 vs. 1.09 ± 0.10, P = 0.039), TLR4 (2.12 ± 0.29 vs. 1.20 ± 0.28, P = 0.010), and p65 (2.09 ± 0.85 vs. 1.04 ± 0.06, P = 0.023), and decreased hepatic mTOR (0.50 ± 0.07 vs. 1.01 ± 0.03, P = 0.001) and IκBα (0.61 ± 0.08 vs. 1.01 ± 0.07, P = 0.014) expression. Subjecting EE-treated rats to placental IR did not further alter liver levels of GLUT1 (2.02 ± 0.45 vs. 1.79 ± 0.39, P = 0.240), TLR4 (2.10 ± 0.74 vs. 1.60 ± 0.36, P = 0.129), or p65 (2.41 ± 0.83 vs. 1.65 ± 0.46, P = 0.145), whereas it did decrease hepatic mTOR (0.42 ± 0.09 vs. 0.90 ± 0.14, P = 0.008) and IκBα (0.43 ± 0.09 vs. 0.72 ± 0.20, P = 0.004) expression and enhance REDD1 expression (4.46 ± 0.65 vs. 2.05 ± 0.47, P = 0.009). Placental IR stress did impact the hepatic expression of REDD1-mTOR-GLUT1 and TLR4/NF-κB/IκBα in pregnant rats.

Conclusion:
Placental IR-induced hepatic GLUT1, TLR4, and p65 alternation, which responded efficiently in control rats, were impaired in EE-induced ICP rats.
Effect of VTILVOT variation rate on the assessment of fluid responsiveness in septic shock patients
Authors: Wang Jinzhong , Zhou Dexing , Gao Yi , Wu Zhongyong , Wang Xiaozhi , Lv Chuanzhu 
Published: November 2020

Abstract
This study aimed to assess the predictive value of velocity time integral (VTI) of the left ventricular outflow tract (LVOT) on volume expansion test (VET) as an indicator of volume responsiveness in septic shock patients. Septic shock patients undergoing mechanical ventilation were recruited. The hemodynamic parameters before and after VE were monitored by pulse indicated continuous cardiac output (PiCCO) and echocardiography. Heart rate, cardiac index (CI), mean arterial pressure (MAP), central venous pressure, stroke volume variation (SVV), CI and variation of pulse pressure (PPV), and the changes in cardiac parameters (Dheart rate, Dmean arterial pressure, Dcentral venous pressure, DSVV, DCI, and DPPV) were determined. The relationships of hemodynamic parameters and their changes with DVTI were further evaluated with Pearson relation analysis. The value of these parameters in fluid responsiveness prediction was evaluated by using the receiver operating characteristic (ROC) curve analysis. Results showed that 44 VETs were performed in 44 septic shock patients with responsiveness in 24 patients and non-responsiveness in 20. The CI increased by ≥ 15% in responsive patients, but by<15% in non-responsive patients after VET. There were significant differences in the SVV and PPV after VET between responsive and non-responsive groups. DSVV, DPPV, and DCI were positively related to DVTI. The area under ROC curve (AUC) for SVV in fluid responsiveness prediction was 0.80, and the sensitivity and specificity of SVV were 66.5% and 95%, respectively, when the cut-off value was 24.8%. The AUC for PPV in fluid responsiveness prediction was 0.843, and the sensitivity and specificity of PPV were 83.3% and 75%, respectively, when the cut-off value was 25.8%. The AUC for DVTILVOT in fluid responsiveness prediction was 0.956, and the sensitivity and specificity were 87.5% and 95%, respectively, when the cut-off value was 15.9%. In conclusion, DVTILVOT is effective to predict fluid responsiveness after VET in mechanical ventilation patients with septic shock. It may serve as a new, noninvasive and functional hemodynamic parameter with the same accuracy to SVV.
Comparative efficacy of seven exercise interventions for symptoms of depression in college students
Authors: Guo Shengyu , Liu Feiyue , Shen Jing , Wei Min , Yang Yan 
Published: November 2020

Abstract

Background:
Depression among college students is common, exercise interventions are valued as one of the most widely prescribed interventions for depressed college students, however, it is especially difficult for university administrators to determine which exercise intervention is most effective, and efficacy of exercise interventions among depressed college students have not been evaluated.

Objectives:
To systematically review and compare the efficacy of 7 exercise interventions for decrease symptoms of depression in college students.

Method:
A network of meta-analysis (NMA) was conducted to fill the objectives. Five relatived electronic databases were searched for the related articles.

Eligibility criteria:
Randomized controlled trials comparing the efficacy of 7 Exercise interventions with usual care of college students with depression were included in the review.

Main outcomes:
The primary outcome of the present study was standardized mean difference (SMD) and the mean change of depressive symptoms.

Results:
Fourteentrials were identified, including 2010 depressed college students. The result of direct meta-analysis of this review indicated exercise interventions overall had a significantly lower mean depression scores (SMD = −1.13) when compared with usual care. The result of NMA indicated when comparing with badminton intervention, yoga (SMD = −7.7, 95%CI: −14 to −0.93) and Tai chi (SMD = −9.4, 95%CI: −16 to −2.7) can significantly decrease depression scores of the depressed college students. The rank of 7 exercise interventions with respect to efficiently decrease symptom of depressed undergraduates was Tai chi > Yoga > Volleyball > Dance > Run > Basketball > Badminton, respectively.

Conclusions:
Tai chi exhibited the highest probability that became the most efficacy intervention among the comparions, and Yoga showed the second most effectiveness to alleviate depressive symptoms of depressed college students, and dance ranks the third, followed by run, volleyball, basketball, and badminton respectively.
Image quality improvement of single-shot turbo spin-echo magnetic resonance imaging of female pelvis using a convolutional neural network
Authors: Misaka Tomofumi , Asato Nobuyuki , Ono Yukihiko , Ota Yukino , Kobayashi Takuma , Umehara Kensuke , Ota Junko , Uemura Masanobu , Ashikaga Ryuichiro , Ishida Takayuki 
Published: November 2020

Abstract
We have developed a deep learning-based approach to improve image quality of single-shot turbo spin-echo (SSTSE) images of female pelvis. We aimed to compare the deep learning-based single-shot turbo spin-echo (DL-SSTSE) images of female pelvis with turbo spin-echo (TSE) and conventional SSTSE images in terms of image quality.
One hundred five and 21 subjects were used as training and test sets, respectively. We performed 6-fold cross validation. In the training process, low-quality images were generated from TSE images as input. TSE images were used as ground truth images. In the test process, the trained convolutional neural network was applied to SSTSE images. The output images were denoted as DL-SSTSE images. Apart from DL-SSTSE images, classical filtering methods were adopted to SSTSE images. Generated images were denoted as F-SSTSE images. Contrast ratio (CR) of gluteal fat and myometrium and signal-to-noise ratio (SNR) of gluteal fat were measured for all images. Two radiologists graded these images using a 5-point scale and evaluated the image quality with regard to overall image quality, contrast, noise, motion artifact, boundary sharpness of layers in the uterus, and the conspicuity of the ovaries. CRs, SNRs, and image quality scores were compared using the Steel-Dwass multiple comparison tests.
CRs and SNRs were significantly higher in DL-SSTSE, F-SSTSE, and TSE images than in SSTSE images. Scores with regard to overall image quality, contrast, noise, and boundary sharpness of layers in the uterus were significantly higher on DL-SSTSE and TSE images than on SSTSE images. There were no significant differences in the CRs, SNRs, and respective scores between DL-SSTSE and TSE images. The score with regard to motion artifacts was significantly higher on DL-SSTSE, F-SSTSE, and SSTSE images than on TSE images. The score with regard to the conspicuity of ovaries was significantly higher on DL-SSTSE images than on F-SSTSE, SSTSE, and TSE images (P < .001).
DL-SSTSE images showed higher image quality as compared with SSTSE images. In comparison with conventional TSE images, DL-SSTSE images had acceptable image quality while keeping the advantage of the motion artifact-robustness and acquisition time efficiency in SSTSE imaging.
Monokine induced by gamma interferon for detecting pulmonary tuberculosis
Authors: Li Yang , He Dengqi , Che Yinfu , Zhao Xinchen 
Published: November 2020

Abstract

Backgrounds:
Pulmonary tuberculosis (PTB) is an oldest-known and most formidable disease. The standard microbiology culture is time-wasting. Monokine induced by gamma interferon (MIG) has been reported as a new biomarker to auxiliarily detect PTB. In our study, we used meta-analysis to assess the diagnostic value of MIG for PTB.

Methods:
PubMed, Embase, Web of Science, and Cochrane Library were searched for relative records up to April 2, 2020. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, area under the curve, and summary receiver operating characteristic curve were estimated.

Results:
Eight studies including 1487 participants were included. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of MIG for detecting PTB were 84%, 84%, 5.19, and 0.19, respectively. The diagnostic odds ratio and area under the curve were 27.88 and 0.90, respectively, indicating a good diagnostic ability of MIG. Meta-regression analysis showed that human immunodeficiency virus status might be a source of heterogeneity (P = .02).

Conclusions:
Our results showed that MIG had a good diagnostic value for PTB.
Roles, Training, and Qualifications of a Case Manager in the Canadian Health Care Industry
Authors: Mwandala Tobias 
Published: November 2020

Purpose:
The purpose of this article is to explore primary roles, training, competencies, and qualifications of a case manager in the Canadian health care industry and how to improve case management practice in Canada.

Primary Practice Setting:
Case managers' primary practice setting investigated in this article is the Canadian health care industry, which includes clinics, hospitals, continuing care, short-term and long-term care facilities, as well as palliative and end-of-life care settings.

Conclusion:
The main role of case managers is to help clients meet their goals. Assessment, monitoring, interpersonal communication, and collaboration are essential roles and competencies of case managers. Many case managers come from regulated health care professions and have prior years of professional experience, and many of them come from a nursing profession. This article is a narrative review based on the current literature about case managers' roles, training, and competencies in the Canadian health care industry and how to improve Canadian case management practice. Certification and standardization of case managers in Canada are needed to better understand the roles, training, and qualifications of case managers in the Canadian health care industry.

Implications for Case Management Practice:
Case managers require skills in assessment, monitoring, cultural competency, interpersonal communication, collaboration, coordinating, and advocating for resources and services to meet clients' goals in the health care industry. Case managers must also consider how to combat and address other social determinants of health such as a client's social economic status, literacy, income, employment, and working conditions that influence client's health. Ongoing professional development for case managers is fundamental in achieving effective case management practice. Finally, it is important to have case management certification in Canada in order to better understand case manager's roles and qualifications in the Canadian health care industry.
Reducing Frequency of Emergency Department and Inpatient Visits Through Focused Case Management
Authors: Sathyanarayanan Shrieraam , Zhou Biting , Maxey Matthew 
Published: November 2020

Purpose of Study:
To evaluate whether the Oklahoma State University (OSU) Health Access Network's (HAN's) case management program is effective in reducing the attendance of frequent users to the emergency department (ED) and inpatient department.

Primary practice setting:
This is a 2-year retrospective pre/post-case management analysis. Emergency department usage data from 2013 to 2016 of the OSU HAN contracted clinics are used in this study. This study involves case management interventions for high ED users and high-risk patients. The patients in the study must be enrolled in SoonerCare choice to be case managed.

Methodology and Sample:
Patients who visited the ED 3 times or more in 12 months prior to their HAN enrollment and patients with 12 months of data preenrollment and postenrollment were included in the study. A historical control was used to compare ED and inpatient use per patient per month pre- and post-HAN case management. Chi-square and Wilcoxon's signed-rank tests were used to assess the data.

Results:
A total of 29 patients met the inclusion criteria. The number of ED and inpatient visits was reduced after HAN intervention (181 vs. 110, p < .001; 35 vs. 11, p < .001). The ED and inpatient use per patient per month reduced significantly from 0.52 to 0.31 (p < .001) and 0.10 to 0.03 (p < .01), respectively.

Implications for Case Management Practice:
This study suggests that continuous case management and implementation of various care plans with frequent follow-up are effective in reducing the cost of care and subsequent ED and inpatient visits.
Community and Case Management Interventions to Address Social Determinants of Health in Infectious Disease
Authors: Moreo Kathleen 
Published: November 2020

Purpose/Objectives:
Professional case managers are responsible to conduct education, counseling, and other interventions that address the unique needs and gaps of the patients and families they serve. Social determinants of health (SDH) can impact barriers to patient care and outcomes that may go undetected among underserved populations without reliable data. This article describes an implementation science study using patient and provider-informed data and designed interventions to mitigate barriers in SDH related to hepatitis B virus (HBV).

Primary Practice Settings:
Case managers and other health care team members in community health clinics examined discordances in their own patients' and providers' beliefs about patients' barriers to HBV care. Data were then used to help identify and engage unique strategies in education, counseling, and clinic outreach to improve outcomes in HBV and lessen barriers to care among at-risk minority populations.

Findings/Conclusions:
Findings from data and information conducted among the clinic patients and health care team members revealed many important barriers in key aspects of SDH occurring in each clinic. As a result, case managers and other health care team members were able to examine distinct differences in what they predicted their patients would say versus what patients actually answered about SDH aspects of their care experiences, including barriers in access to care, health monitoring, and treatment of HBV.

Implications for Case Management Practice:
The study and data results have implications for case management practice that may also be applied to other infectious diseases. Implications include patient and community outreach strategies to improve access to care; resource management techniques to improve referrals and disease monitoring; and ongoing and improved education and counseling to change behaviors associated with infectious disease prevention, screening, and linkage to care.
Acute Care Management During a Pandemic
Authors: Chovanec Kelli , Howard Nicole R. 
Published: November 2020

Purpose/Objectives:
During the global pandemic of Covid-19, the hospital setting transitional care management was challenged by the complexities of the rapidly changing health care environment, requiring the implementation of an innovative approach to hospital discharge planning. The purpose of this article is to review the experiences of an integrated urban health system, exploring the strategic tactics to ensure effective communication between team members, patient and family engagement in discharge planning, establishing and maintaining trust, connecting patients to appropriate next level of care services, and providing transitional care management support.

Primary Practice Settings:
The Covid-19 pandemic response stimulated the rapid transformation of the acute care management model amidst the tremendous challenge of meeting the discharge planning needs of the hospitalized population in one large, urban, integrated health care system.

Findings/Conclusions:
Patients transitioning to the community setting following discharge are vulnerable and at risk for adverse sequelae, and transitional care management that does not end when the patient leaves the hospital setting is integral to promoting positive patient outcomes (Naylor, Aiken, Kurtzman, Olds, & Hirschman, 2011). The care management approach during the pandemic in one health care system precipitously shifted to an entirely virtual, remote model, and the team continued to provide transitional care support for hospitalized patients to avoid the common pitfalls that are associated with unfavorable outcomes.

Implications for Case Management Practice:
The insights gleaned from one health system's experiences during the pandemic are transferable to other facets of care management in routine circumstances, with emphasis on the avoidance of the common care management snares that lead to less than optimal patient outcomes. The development and implementation of multifaceted interventions, with the goals of supporting health-promoting behavior changes and self-care capacity for at risk populations, are relevant in the current health care environment.