bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of rectus sheath block vs. spinal anaesthesia on time-to-readiness for hospital discharge after trans-peritoneal hand-assisted laparoscopic live donor nephrectomy
Authors: Bhatia Kailash , Columb Malachy , Wadsworth Richard , Macnab William , Jepegnanam Chandran , Campbell Tunde , Van Dellen David 
Published: October 2020

BACKGROUND
The role of spinal anaesthesia in patients having a transperitoneal hand-assisted laparoscopic donor nephrectomy in an enhanced recovery setting has never been investigated.

OBJECTIVE
We explored whether substituting a rectus sheath block (RSB) with spinal anaesthesia, as an adjunct to a general anaesthetic technique, influenced time-to-readiness for discharge in patients undergoing hand-assisted laparoscopic donor nephrectomy.

DESIGN
Prospective randomised open blinded end-point (PROBE) study with two parallel groups.

SETTING
Tertiary University Hospital.

PATIENTS
Ninety-seven patients undergoing a trans-peritoneal hand-assisted laparoscopic donor nephrectomy.

INTERVENTION
Patients (n=52) were randomly assigned to receive a general anaesthetic and a surgical RSB with 2 mg kg−1 of levobupivacaine at the time of surgical closure or a spinal anaesthetic with hyperbaric bupivacaine 12.5 mg and diamorphine 0.5 mg (n=45) before general anaesthesia.

PRIMARY OUTCOME
The primary outcome was the time-to-readiness for discharge following surgery.

RESULTS
Median [IQR] times-to-readiness for discharge were 75 [56 to 83] and 79 [67 to 101] h for RSB and spinal anaesthesia and there was no significant difference in times-to-readiness for discharge (median difference 4 (95% CI, 0 to 20h; P
= 0.07)). There were no significant differences in pain scores at rest (P
= 0.91) or on movement (P = 0.66). Median 24-h oxycodone consumptions were similar (P
= 0.80). Nausea and vomiting scores were similar (P = 0.57) and urinary retention occurred in one vs. four patients with RSB and spinal anaesthesia, respectively (P
= 0.077).

CONCLUSION
Substitution of RSB with spinal anaesthesia using 12.5 mg hyperbaric bupivacaine and 0.5 mg diamorphine, together with a general anaesthetic failed to confer any benefit on time-to-discharge readiness following transperitoneal hand-assisted laparoscopic donor nephrectomy. RSB provided similar analgesia in the immediate postoperative period with a low frequency of side-effects in this cohort.

TRIAL REGISTRATION
ClinicalTrial.gov identifier: NCT02700217.
Development of a High-Throughput Quantification Method for Pazopanib Using Ultra-Performance Liquid Chromatography-Tandem Mass Spectrometry and Its Clinical Application in Patients With Soft Tissue Tumors
Authors: Shiraiwa Ken , Suzuki Yosuke , Tanaka Kazuhiro , Kawano Masanori , Iwasaki Tatsuya , Matsumoto Asami , Tanaka Ryota , Tatsuta Ryosuke , Tsumura Hiroshi , Itoh Hiroki 
Published: October 2020

Background:
Pazopanib is widely used to treat renal cell carcinomas and soft tissue tumors in Japan. Pazopanib has significant therapeutic efficacy but it is associated with frequent severe adverse effects. Therapeutic drug monitoring (TDM) may help to prevent adverse effects. A more convenient and rapid pazopanib assay is desirable for the application of TDM in clinical settings. In this study, the authors developed a high-throughput method for quantifying pazopanib in human plasma using ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS).

Methods:
After a simple solid-phase extraction step using a 96-well plate, pazopanib was analyzed by UHPLC-MS/MS in the positive electrospray ionization mode.

Results:
The novel method fulfilled the requirements of the US Food and Drug Administration and the European Medicines Agency guidelines for assay validation, and the lower limit of quantification was 0.5 mcg/mL. The calibration curves were linear over the concentration range of 0.5–100 mcg/mL. The average recovery rate was 102.0% ± 3.9% (mean ± SD). The precision was below 5.0%, and the accuracy was within 12.0% for all quality control levels. Matrix effect varied between 90.9% and 97.1%. This assay was successfully applied to TDM of pazopanib trough concentrations in 3 patients treated with the drug for soft tissue tumors.

Conclusions:
The authors succeeded in developing a novel high-throughput UHPLC-MS/MS method for quantifying pazopanib in human plasma. This method can be applied to TDM of patients receiving pazopanib in clinical settings.
CHORIOCAPILLARIS FLOW DEFICITS AS A RISK FACTOR FOR PROGRESSION OF AGE-RELATED MACULAR DEGENERATION
Authors: Corvi Federico , Tiosano Liran , Corradetti Giulia , Nittala Muneeswar Gupta , Lindenberg Sophiana , Alagorie Ahmed Roshdy , McLaughlin John Adam , Lee Thomas K. , Sadda Srinivas R. 
Published: October 2020

Purpose:
To evaluate the association between choriocapillaris (CC) flow deficits and structural optical coherence tomography biomarkers and the progression of intermediate age-related macular degeneration (iAMD) to complete retinal pigment epithelial and outer retinal atrophy.

Methods:
Retrospective analysis of consecutive patients with iAMD with a minimum follow-up of 12 months. Odds ratios of intraretinal hyperreflective foci, hyporeflective drusen cores, subretinal drusenoid deposits, the presence of drusen volume ≥0.03 mm3 within a central 3-mm circle, fellow eye with late stage of AMD, and CC flow deficits at baseline and months of follow-up were estimated from logistic regression.

Results:
A total of 112 eyes with iAMD were included. Eyes that progressed were significantly more likely to show intraretinal hyperreflective foci, hyporeflective drusen cores, and drusen volume ≥0.03 mm3. The CC flow deficit was also significantly greater in eyes that developed complete retinal pigment epithelial and outer retinal atrophy. Intraretinal hyperreflective foci, hyporeflective drusen cores, drusen volume ≥0.03 mm3, and higher CC flow deficits were significantly and independently associated with the development of complete retinal pigment epithelial and outer retinal atrophy.

Conclusion:
The CC flow deficit was significantly greater in iAMD eyes that progressed to complete retinal pigment epithelial and outer retinal atrophy and remained an independent risk factor when structural optical coherence tomography biomarkers were considered. CC flow deficits may be useful for enhancing risk stratification and prognostication of patients with iAMD.
Defining catastrophic brain injury in children leading to coma and disorders of consciousness and the scope of the problem
Authors: LaRovere Kerri L. , Tasker Robert C. 
Published: October 2020

Purpose of review
Severe brain injury in children resulting in coma and disorders of consciousness (DOC) is a catastrophic event for the life and function of children and their families. The present article summarizes the recently published pediatric literature on validated diagnostic assessments, potential predictors of recovery, and outcome measures used in children with catastrophic brain injury (CBI). Literature search terms included variants of consciousness, diagnostic tests, predictors of outcome, and outcome measures.

Recent findings
Developmentally appropriate diagnostic tools, outcome predictors, and outcome measures are lacking for children with CBI leading to coma and DOC. Individual case prognosis relies on serial clinical examinations and experience. Evidence regarding optimal diagnosis of the highest level of consciousness and management of children with CBI is needed. Global efforts through the ongoing Curing Coma Campaign are aimed at: developing common data elements for information capture; streamlining the classification of coma endotypes; describing trajectories with biomarkers to monitor recovery or disease progression; and devising effective treatments for adults and children.

Summary
Standardized, developmentally appropriate diagnostic and outcome assessments for CBI in children are needed. Future research should use these content standards to update our understanding of children with CBI leading to coma and DOC, and evaluate effective practices using acute adjunctive and rehabilitation therapies.
Community Health Centers Primary Care Physicians' Asthma Management Perception of Uninsured Patients
Authors: Bynum Mary 
Published: October 2020

Purpose of Study:
Explore the perceptions of primary care physicians (PCPs) from community health care centers (CHCs) in Franklin County, Ohio, regarding factors that contribute to their inability to consistently provide sustainable asthma management services to their uninsured patient population.

Primary Practice Setting:
Asthmatic patients are not consistently receiving sustainable asthma management in CHCs in Ohio. Primary care physicians in CHCs play a pivotal role in closing health care gaps for asthmatic patients. To minimize the barriers that impede the efforts of PCPs to control asthma for their uninsured patients, asthma disease management programs that include case management services in CHCs in Franklin County, Ohio, are needed.

Methodology and Sample:
A convenience sample of 4 PCPs from 2 CHCs in Franklin County, Ohio, was interviewed face-to-face. Interviews, direct observation, and previously published research were the sources of data utilized for this study.

Results:
Results indicated that 75% of participants did not use standard guidelines while treating their patients. Physician time constraints and access to affordable medication were identified as some of the barriers to providing sustainable asthma management services.

Implications for Case Management:
Asthma is a complex chronic disease. Disease case managers not only are capable of coordinating health care services for a variety of patient populations but are also effective in managing complex diseases such as asthma for disadvantaged populations. Evidence-based case management models are needed to support PCPs in CHCs. Without the inclusion of asthma-specific case managers as part of the care delivery structure, CHCs may continue to provide subpar disease management services for uninsured asthmatic patients.
Pregnant Women's Reports of the Impact of COVID-19 on Pregnancy, Prenatal Care, and Infant Feeding Plans
Authors: Burgess Adriane , Breman Rachel Blankstein , Bradley Dani , Dada Sophia , Burcher Paul 
Published: October 2020

Abstract

Purpose:
The aim of this study is to describe how the COVID-19 (coronavirus) pandemic has affected pregnancy, prenatal maternity care practices, and infant feeding plans among pregnant persons in the United States.

Study Design:
Cross-sectional descriptive study using an app-based survey.

Methods:
A link to the survey was sent via email to users of the Ovia Pregnancy app on May 20, 2020 and was open for 1 week. Participants were asked to complete the survey as it applied to their pregnancy, breastfeeding, and maternity care received during the COVID-19 pandemic, beginning approximately February 2020 through the time of the survey. There were 258 respondents who completed the survey.

Results:
The majority (96.4%; n = 251) of pregnant women felt they received safe prenatal care during this time period. Slightly less 86.3% (n = 215) felt they received adequate prenatal care during this time period. 14.2% (n = 33) reported changing or considering changing the location where they planned to give birth due to COVID-19. Of those who reported they had begun purchasing items for their baby, 52.7% reported that the COVID-19 pandemic has affected their ability to get items they need for their baby.

Clinical Implications:
Although it is imperative to implement policies that reduce risk of transmission of COVID-19 to pregnant women and health care providers, it is necessary for health care providers and policy makers to listen to the collective voices of women during pregnancy about how COVID-19 has affected their birth and infant feeding plans and their perception of changes in prenatal care.
Philtral Ridge Projection in Repaired Unilateral Cleft Lip: Three-Dimensional Anthropometry
Authors: Ganske Ingrid M. , Langa Olivia C. , Mulliken John B. 
Published: October 2020

Background:
Cleft surgeons try to construct a philtral ridge during primary repair of a cleft lip, but rarely document the results. The authors used three-dimensional photogrammetry to measure projection of philtral ridges after closure of the common forms of unilateral labial cleft.

Methods:
This is a retrospective study of patients with unilateral complete, incomplete (moderate and severe), and microform cleft lip repaired by one surgeon from 2000 to 2013. Cleft type determined the technique for building a philtral ridge. The relative elevation of the ridge on the cleft versus noncleft side was measured on three-dimensional childhood photographs at two locations along the philtrum: just above the Cupid’s bow and at the midlabial level.

Results:
Thirty-four patients were evaluated at a mean age of 9.25 years. All cleft types exhibited greater projection at the philtral midlabial level compared with the Cupid’s bow level. The authors found a trend toward a more prominent cleft side philtral ridge in microforms. In incomplete cleft lips, there was slightly greater philtral ridge projection in severe forms repaired after a preliminary nasolabial adhesion compared with those repaired in a single stage. There was similar projection of the cleft side ridge in two-stage complete and single-stage repaired incomplete lips.

Conclusions:
It is possible to construct a philtral ridge that is as prominent as the noncleft side in all types of unilateral cleft lip. Increased muscle thickness may explain the slightly increased philtral ridge projection in patients with an incomplete cleft repaired in two stages compared to one-stage closure.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Medication Errors in Anesthesiology: Is It Time to Train by Example? Vignettes Can Assess Error Awareness, Assessment of Harm, Disclosure, and Reporting Practices
Authors: Duffy Caoimhe C. , Bass Gary A. , Duncan James , Lyons Barry , O’Dea Angela 
Published: October 2020

Background
Perioperative medication errors (MEs) are complex, multifactorial, and a significant source of in-hospital patient morbidity. Anesthesiologists’ awareness of error and the potential for harm is not well understood, nor is their attitude to reporting and disclosure. Anesthesiologists are not routinely exposed to medication safety training.

Methods
Ten clinical vignettes, describing an ME or a near miss, were developed using eDelphi consensus. An online survey instrument presented these vignettes to anesthesiologists along with a series of questions assessing error awareness, potential harm severity, the likelihood of reporting, and the likelihood of open disclosure to the patient. The study also explored the influence of prior medication safety training.

Results
Eighty-nine anesthesiologists from 14 hospitals across Ireland (53.9% were residents, and 46.1% were attendings) completed the survey. Just 35.6% of anesthesiologists recalled having had medication safety training, more commonly among residents than attendings, although this failed to reach significance (P < 0.081). Medication error awareness varied with the vignette presented. Harm severity assessment was positively associated with error awareness. The likelihood of patient disclosure and incident reporting was both low and independent of harm severity assessment.

Conclusions
Perioperative ME awareness and assessment of potential harm by anesthesiologists is variable. Self-reported rates of incident reporting and error disclosure fall short of the standards that might apply in an environment focused on candor and safety. An extensive education program is required to raise awareness of error and embed appropriate reporting and disclosure behaviors. Vignettes, designed by consensus, may be valuable in the delivery of such a curriculum.
Unresolved issues in the identification and treatment of carbapenem-resistant Gram-negative organisms
Authors: Kois Abigail K. , Nicolau David P. , Kuti Joseph L. 
Published: October 2020

Purpose of review
Carbapenem-resistant organisms (CROs), including Pseudomonas aeruginosa, Acinetobacter baumannii and Enterobacterales, are a threat worldwide. This review will cover mechanisms of resistance within CROs and challenges with identification and treatment of these organisms while pointing out unresolved issues and ongoing challenges.

Recent findings
The treatment of CROs has expanded through newer therapeutic options. Guided utilization through genotypic and phenotypic testing is necessary in order for these drugs to target the appropriate mechanisms of resistance and select optimal antibiotic therapy.

Summary
Identification methods and treatment options need to be precisely understood in order to limit the spread and maximize outcomes of CRO infections.
Prevalence and Predictors of Urinary Incontinence at 1 Year Postpartum
Authors: Giugale Lauren E. , Moalli Pamela A. , Canavan Timothy P. , Meyn Leslie A. , Oliphant Sallie S. 
Published: October 2020

Objectives
Postpartum urinary incontinence estimates range from 13% to 47%. Clinical factors associated with incontinence 1 year after first delivery are varied. We assessed the prevalence of and factors associated with urinary incontinence in primiparous women at 12 months postpartum.

Methods
Ancillary analysis of 99 nulliparous women from a prospective cohort study that assessed participants during the first and third trimesters and 12 months postpartum. Our primary outcome was urinary incontinence 12 months postpartum. Women were asked “How often do you experience urine leakage?” and considered to have urinary incontinence if a response other than “never” was reported. We collected vaginal swabs for assessment of matrix metalloproteinase-9 activity, a measure of tissue remodeling. Bivariable and logistic regression analyses were used to compare women with and without postpartum urinary incontinence.

Results
Of 99 primiparous women, 55% (n = 54) reported urinary incontinence at 12 months postpartum. Logistic regression demonstrated that urinary incontinence during pregnancy (odds ratio, 34.3; 95% confidence interval, 7.9–149.2) and a decrease in matrix metalloproteinase 9 activity between the first and third trimesters (odds ratio, 19.34; 95% confidence interval, 3.47–107.84) were associated with postpartum urinary incontinence. The sensitivity and specificity of urinary incontinence during pregnancy for predicting postpartum urinary incontinence were 87% and 67%, respectively. The positive and negative predictive values were 76% and 81%, respectively.

Conclusions
Urinary incontinence affected 55% of primiparous women at 12 months postpartum. Urinary incontinence during pregnancy was strongly associated with postpartum incontinence. Importantly, vaginal tissue protease activity during pregnancy represents a possible mechanism for and biomarker of postpartum urinary incontinence.
A Retrospective Study of Ultrasound Accuracy for the Diagnosis of Chronic Inflammatory Demyelinating Polyneuropathy
Authors: Crump Nicholas H. , Cartwright Michael S. 
Published: October 2020

Introduction:
Ultrasound is emerging as a useful tool for the evaluation of immune-mediated neuropathies because it can provide high-resolution anatomic information to complement electrodiagnostic data. Nerve enlargements are commonly found in chronic inflammatory demyelinating polyneuropathy (CIDP), and their presence likely useful in diagnosis, particularly if multifocal.

Methods:
In this study, the authors undertook a retrospective chart review to identify ultrasound findings in patients with CIDP previously studied in a single busy neurodiagnostic laboratory.

Results:
Of the 50 cases identified from 2000 to 2017, individuals with a confirmed diagnosis of CIDP (21 cases) were more likely to have multiple sites of enlargement, as well as more pronounced nerve enlargement, than patients who were subsequently found to have an alternate cause of neuropathy (22 cases). The presence of any moderately enlarged nerve segment predicted definite CIDP with sensitivity of 81% and specificity 77%.

Conclusion:
This study demonstrates that ultrasound can be of diagnostic utility in patients with suspected CIDP, even when conducted in a nonstandardized real-world setting.
Neurological Prognostication Using Raw EEG Patterns and Spectrograms of Frontal EEG in Cardiac Arrest Patients
Authors: Choi Wook Jin , Lee Jae Hoon , Kim Sang Ho 
Published: October 2020

Purpose:
We investigated which raw EEG and spectrogram patterns in frontal EEG predict poor neurological outcomes in patients with hypoxic ischemic encephalopathy after cardiac arrest.

Methods:
This multicenter, prospective, observational study included 52 patients with anoxic brain injury after cardiac arrest. Raw EEGs and spectrograms (color density spectral arrays) measured with hardwired frontal EEG monitoring were used to predict poor prognosis. Neurological variables upon admission, raw EEG patterns, including highly malignant and malignant EEG patterns, and changes in frequency and amplitude from color density spectral arrays were investigated.

Results:
All patients exhibiting highly malignant EEG patterns died, and malignant EEG patterns were significant predictors of poor prognosis as the area under the receiver operating characteristic curve was 0.83 to 0.86. Irregular high-voltage waves in the high-frequency beta band in continuous background EEGs were associated with poor prognosis (P = 0.022). Malignant EEG patterns including high-voltage and high-frequency beta waves were significantly stronger predictors of poor prognosis than the absence of ventricular fibrillation and pupil reflex, delayed length of anoxic time, and lower Glasgow coma scale score (odds ratio, 9; P = 0.035). Compared with prognostication using malignant EEG patterns alone, the area under the receiver operating characteristic curve of results incorporating high-voltage and high-frequency beta waves was 0.84 (vs. 0.83) at day 1, 0.88 (vs. 0.85) at day 2, 0.92 (vs. 0.86) at day 3, and 0.99 (vs. 0.86) at day 4.

Conclusions:
Frontal EEG monitoring is useful for predicting poor neurological outcomes. Brain function monitoring using both raw EEG patterns and color density spectral arrays is more helpful for predicting poor prognosis than raw EEG alone.
Mathematical modelling evolutionarily stable behavior of zooplankton with state constraints
Authors: Kuzenkov O. , Ryabova E. , Garcia A. , Kostromina O. 
Published: October 2020

AbstractThe purpose of this work is to create mathematical base and software for solving the problem of finding an evolutionarily stable strategy of zooplankton diel vertical migrations and explaining the observed effects in aquatic ecosystems using this software (in particular, in the northeastern part of the Black Sea). An essential feature of this study is the inclusion in the mathematical model of state constraints on the strategy of behavior, which reflect the vertical limited zone of zooplankton habitat. The presence of state constraints creates the main mathematical difficulties for solving the optimal control problem used in the analysis of the model.The general methodological basis for defining evolutionarily stable behavior is the Darwinian principle “survival of the fittest”. However, it remains a problem to construct a mathematical expression for the fitness function of hereditary elements. The efforts of the authors were aimed at creating a software package that allows predicting the evolutionarily stable behavior of zooplankton based on the actual universal extreme principle. The created software package includes, as a main component, a computational module for solving the set optimal control problem with state constraints.