bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Shoulder Dystocia Outcomes With Teamwork and Deliberate Practice [26S]
Authors: Seif Karl E. , Nies Barbara , Dada Adedayo , Donlan Amy , Marko Emily 
Published: October 2020

INTRODUCTION:
The management of shoulder dystocia requires coordinated time-sensitive teamwork. A complication of performing the posterior arm delivery is neonatal humerus fracture. The study objective was to determine the effectiveness of teaching shoulder dystocia management using simulation aimed at teamwork and communication, with a focus on deliberate practice of posterior arm delivery skills.

METHODS:
A prospective pre/post educational study design was used to assess effectiveness of a curriculum designed for labor and delivery personnel using simulation for the coordinated team management of shoulder dystocia. A portable task trainer was used to practice safe delivery of the posterior arm including inserting the provider hand on the side of the fetal chest and splinting of the humerus. Outcomes were measured using performance assessment scores, safety culture surveys and the rate of neonatal humerus fractures in shoulder dystocias over one year. Internal review board exemption was obtained. Paired t-tests and repeated measures were used for data analysis.

RESULTS:
Teamwork drills were held with 166 multi-disciplinary participants in a large obstetrical hospital over one year. Statistically significant improvement occurred in knowledge (pre 64.01%, post 94.22%, p<0.0001), performance (pre 61.83%, post 92.86%, p<0.0001) and safety culture surveys (pre 3.27, post 1.57, p<0.0001, 1=high, 5=low). Compared with the year prior to the study, the rate of neonatal humerus fractures in shoulder dystocias was reduced by 42.86%, (pre 5.51%, post 3.88%, p<0.0001).

CONCLUSION:
Simulation training improved teamwork performance during shoulder dystocia emergencies. Deliberate practice of posterior arm delivery skills significantly reduced the rate of neonatal humerus fractures.
A Quality Improvement Project Comparing Two Treatments for Deep-Tissue Pressure Injuries to Feet and Lower Legs of Long-term Care Residents
Authors: Henson Autumn , Kennedy-Malone Laurie 
Published: October 2020

ABSTRACT

OBJECTIVE
To retrospectively examine clinical outcomes from a feasibility study that compared two treatment options for deep-tissue pressure injuries (DTPIs), including the clinical indicators increasing the risk of deteriorating DTPIs among long-term care residents.

METHODS
A retrospective chart audit of 40 DTPIs from 33 long-term care residents in two long-term care facilities was conducted to compare (1) polymeric membrane dressings (PMDs) with offloading and (2) a skin barrier film with offloading.

RESULTS
Of the 13 DTPIs treated with PMDs, only 23% deteriorated to a stage 3 or 4 pressure injury (PI), whereas of the 27 DTPIs treated with skin barrier film, 41% deteriorated to a stage 3 or 4 PI. The clinical factors found to increase the risk of developing and deteriorating DTPIs included weight loss, hypoalbuminemia, debility, dementia, coronary artery disease, and cerebrovascular disease.

CONCLUSIONS
The PMD group’s DTPIs evolved into fewer open PIs despite having higher percentages of clinical indicators for DTPIs. The project findings support the use of PMD dressings for DTPIs; however, more robust research is warranted.
Informed Application of the Standards on Support Surface Performance for Clinically Meaningful Use
Authors: Sylvia Cynthia , Gruccio Paula , Jordan Rosalyn , Morello Susan Smith , Thurman Kristen 
Published: October 2020

ABSTRACT

BACKGROUND
The Support Surface Standards Initiative (S3I) has evolved with the goal of standardizing language and performance evaluation of support surfaces. There is a consumer need for education about support surface standards to transfer new information with clinical relevance.

OBJECTIVE
To develop a framework for meaningful dialogue through consensus building that drives value-based purchasing, propose a clinically relevant path for understanding how to apply data from the standards into critical interprofessional analysis and support surface selection, and navigate the first tier of a process targeted as an educational initiative within the Standards Committee.

METHODS
The authors purposively sampled the S3I Tissue Integrity Group with a semi-structured qualitative survey to identify the essential components of support surfaces standard performance testing. A two-phase interview and review process was implemented within the larger S3I group to achieve consensus on content for knowledge transfer, with a threshold of 80% agreement within the Standards Committee.

RESULTS
Meaningful consensus was achieved on content associated with knowledge transfer of standards data. These standards will function as reliable benchmarks, enabling consumers to compare individual characteristics of one support surface to another. Product comparison will be based on the single characteristics of support surfaces and how those characteristics are relevant to the specific needs of the individual patient or patient populations, transferred in language that is meaningful to end users of the standards.

CONCLUSIONS
The consensus process facilitated construction of a clinically relevant, interprofessional framework for the product selection process within the Standards Committee. It will enable the next tier of educational dissemination beyond the Standards Committee to a broader base of consumers to engage in value-based purchasing with enhanced understanding of support surface performance characteristics.
Microecology research: a new target for the prevention of asthma
Authors: Shi Hong-Lei , Lan Yu-Hao , Hu Zheng-Chuan , Yan Zi-Ning , Liu Ze-Zhong , Kadier Xiriaili , Ma Li , Yu Jin-Yan , Liu Jing 
Published: October 2020

Abstract
The incidence and prevalence of asthma have increased remarkably in recent years. There are lots of factors contributing to the occurrence and development of asthma. With the improvement of sequencing technology, it has been found that the microbiome plays an important role in the formation of asthma in early life. The roles of the microbial environment and human microbiome in the occurrence and development of asthma have attracted more and more attention. The environmental microbiome influences the occurrence of asthma by shaping the human microbiome. The specific mechanism may be related to the immune regulation of Toll-like receptors and T cells (special Tregs). Intestinal microbiome is formed and changed by regulating diet and lifestyle in early life, which may affect the development and maturation of the pulmonary immune system through the intestinal-pulmonary axis. It is well-recognized that both environmental microbiomes and human microbiomes can influence the onset of asthma. This review aims to summarize the recent advances in the research of microbiome, its relationship with asthma, and the possible mechanism of the microbiome in the occurrence and development of asthma. The research of the microbial environment and human microbiome may provide a new target for the prevention of asthma in children who have high-risk factors to allergy. However, further study of “when and how” to regulate microbiome is still needed.
Secukinumab demonstrates high efficacy and a favorable safety profile over 52 weeks in Chinese patients with moderate to severe plaque psoriasis
Authors: Cai Lin , Zhang Jian-Zhong , Yao Xu , Gu Jun , Liu Quan-Zhong , Zheng Min , Zhang Shi-Fa , Xu Jin-Hua , Li Cheng-Xin , Cheng Hao , Guo Qing , Pan Wei-Li , Li Shen-Qiu , Li Ruo-Yu , Guo Zai-Pei , Song Zhi-Qi , Li Shan-Shan , Dong Xiu-Qin , Wang Linda , Fu Rong , Regnault Pascaline , Charef Pascal , Mazur Rafal , Patekar Manmath 
Published: October 2020

Abstract

Background:
Psoriasis is a chronic inflammatory skin disease, affecting about 0.6% of the Chinese population. Many patients are not well controlled by conventional treatments, thus there is need for new treatment regimens. In this study, we assessed the efficacy and safety of secukinumab in Chinese patients with moderate to severe plaque psoriasis.

Methods:
This study was a 52-week, multicentre, randomized, double-blind, placebo-controlled, parallel-group, Phase 3 trial. A sub-population of study participants (≥18 years) of Chinese ethnicity were randomized to receive subcutaneous injections of 300 or 150 mg secukinumab, or placebo. The co-primary endpoints were psoriasis area severity index (PASI) 75 and Investigator's Global Assessment (IGA) 0/1 at Week 12.

Results:
A total of 441 Chinese patients were enrolled in this study. Co-primary outcomes were achieved; 300 and 150 mg secukinumab were superior to placebo as shown in the proportion of patients that achieved PASI 75 (97.7% and 87.2% vs. 3.7%, respectively; P < 0.001), and IGA 0/1 (82.3% and 69.7% vs. 2.7%; P < 0.001) at Week 12. Treatment efficacy was maintained until Week 52. There was no increase in overall adverse events with secukinumab relative to placebo throughout the 52-week period.

Conclusion:
Secukinumab is highly effective and well tolerated in Chinese patients with moderate to severe plaque psoriasis.

Trial Registration:
ClinicalTrials.gov, NCT03066609; https://clinicaltrials.gov/ct2/show/record/NCT03066609.
Non–Vitamin K Antagonist Oral Anticoagulants and Factors Influencing the Ischemic and Bleeding Risk in Elderly Patients With Atrial Fibrillation: A Review of Current Evidence
Authors: Patti Giuseppe , Haas Sylvia 
Published: October 2020

Abstract:
Non–vitamin K antagonist oral anticoagulants (NOACs) are a widely prescribed treatment to prevent stroke in patients with nonvalvular atrial fibrillation, and a therapy and preventative measure to prevent recurrences following venous thromboembolism. Optimal use of NOACs requires a thorough knowledge of the pharmacology of these drugs, as well as an understanding of patient factors affecting their use. The 4 NOACs—dabigatran, apixaban, edoxaban, and rivaroxaban are available in a range of doses suitable for differing indications and with a variety of dose reduction criteria. Identification of the correct dose is one of the key challenges in the individualization of treatment. Elderly patients with atrial fibrillation are at a greater risk of both ischemic and bleeding events than younger patients. Consequently, it is essential to achieve balance in anticoagulation strategies. Medication adherence to NOACs is important for safe and effective treatment, particularly in elderly populations. A growing body of evidence shows that once-daily dosing improves adherence and persistence to therapy, without having an impact on bleeding risk.
Plasma Concentrations and Cardiovascular Effects of Citalopram Enantiomers After Oral Versus Infusion Citalopram Therapy in Dextromethorphan-Mephenytoin-Phenotyped Patients With Major Depression
Authors: Baumann Pierre , Bertschy Gilles , Ramseier Fritz , Nil Rico 
Published: October 2020

Background:
Authors compared plasma concentrations of citalopram (CIT) enantiomers and their metabolites in patients with depression administered either intravenously (IV) or as oral racemic CIT. Then, plasma concentrations were related to the metabolism of probes used for phenotyping patients with depression for CYP2C19 and CYP2D6 activity and cardiovascular functions.

Methods:
Dextromethorphan–mephenytoin-phenotyped patients with depression were administered racemic CIT (days 1 and 2: 20 mg/d; days 3–10: 40 mg/d) either orally or as a slow-drop infusion for 10 days and were then orally administered the drug for another 32 days. Blood probes were collected at the time of minimal and maximal concentrations on day 10, immediately before and 2 hours after drug administration, and on days 21 and 42. Plasma CIT and its metabolites were assayed by stereoselective high-performance liquid chromatography.

Results:
The following concentrations (ng/mL) were noted in the group receiving active IV infusion (IV-POS group, n = 27) of racemic CIT on day 10, before drug administration: escitalopram (S-CIT): 24 ± 10.2; R-citalopram (R-CIT): 45 ± 14.5; S-desmethyl-CIT: 13 ± 4.4; and R-desmethyl-CIT: 17 ± 8.2. In patients receiving oral administration (POS-POS group, n = 25), the values were 30 ± 12.7, 51 ± 17.4, 13 ± 4.6, and 17 ± 7.9 ng/mL, respectively. In the IV-POS group, 3 patients were poor dextromethorphan (CYP2D6) metabolizers; in the POS-POS group, one was a poor mephenytoin (CYP2C19) metabolizer. On day 10, before CIT treatment, S/R-CIT and S/R-mephenytoin ratios were significantly correlated, determined at baseline. Overall, CIT reduced the heart rate but did not significantly modify QTc. No relationship was found between any cardiovascular parameters and pharmacokinetic and pharmacogenetic data.

Conclusions:
Owing to CIT's high bioavailability, the plasma concentrations of its enantiomers remained largely independent on the administration route. CYP2C19 preferentially demethylated S-CIT after CIT therapy.
Two-year outcomes from the PARTNER 3 trial: where do we stand?
Authors: Muller Moran Hellmuth R. , Eikelboom Rachel , Lodewyks Carly , Yan Weiang , Zelentsov Ivan , Arora Rakesh C. , Yamashita Michael H. 
Published: October 2020

Purpose of review
The PARTNER 3 trial was conducted to compare outcomes after transcatheter aortic valve replacement (TAVR) with a balloon-expandable valve and surgical aortic valve replacement (SAVR) in individuals at low surgical risk with aortic stenosis. Recently reported rates of death, stoke and valve thrombosis in the TAVR arm have raised concerns about the longevity of this intervention in low-risk individuals. It is incumbent on all members of the Heart Team to understand the potential consequences of these findings.

Recent findings
TAVR was initially superior to SAVR at 1 year for a primary composite endpoint of death, stroke and rehospitalization. Results at 2 years now indicate noninferiority. Potential causative factors, comparisons with other transcatheter valves and implications for patients, providers and trainees are explored. Recommendations are additionally provided regarding TAVR and SAVR in individuals with aortic stenosis.

Summary
Concerns regarding the longevity of TAVR in low-risk individuals notwithstanding, results from PARTNER 3 indicate that TAVR is at least noninferior to SAVR out to 2 years. Longer follow-up will be required to determine whether these newly founded concerns are justifiable.
Simplified blood pressure measurement approaches and implications for hypertension screening: the Atherosclerosis Risk in Communities study
Authors: Lu Yifei , Tang Olive , Brady Tammy M. , Miller Edgar R. , Heiss Gerardo , Appel Lawrence J. , Matsushita Kunihiro 
Published: October 2020

Objectives:
Averaging multiple blood pressure (BP) measurements is recommended for hypertension (HTN) screening but can be impractical, especially in resource-constrained settings. We aimed to explore the implications of fewer BP measurements on BP classification and subsequent cardiovascular disease (CVD) risk.

Methods:
We studied 8905 middle-aged participants without diagnosed HTN and quantified misclassified HTN (≥140/90 mmHg) by simplified BP approaches (e.g. single 1st BP, single 2nd BP, mainly 1st but 2nd BP if 1st was in a certain range) vs. the reference standard of the average of 2nd and 3rd BP. We also assessed CVD risk related to HTN status.

Results:
There were 823 participants classified as HTN by the standard approach. With single 1st BP, 2.8% of non-HTN were overidentified as HTN, and 18.3% of HTN were identified as not having HTN. The corresponding estimates with single 2nd BP were 2.1 and 6.4%. Similar estimates were seen when 2nd BP was used if 1st BP at least 130/80 (1.9 and 8.1%), with only 27.8% requiring 2nd BP. Two thousand, one hundred and seventy-eight CVD cases were documented in this population over 30 years. HTN by either the standard approach or any of the simplified approaches conferred higher CVD risk vs. consistent no HTN by both approaches.

Conclusion:
In those without diagnosed HTN, a simplified BP measurement approach using the 2nd BP only when the 1st BP is at least 130/80 could reduce the total number of BP measurements by more than 50%, identify HTN with limited misclassification (2–8%), and predict CVD risks reasonably well.
Associations of Intussusception With Adenovirus, Rotavirus, and Other Pathogens: A Review of the Literature
Authors: Burnett Eleanor , Parashar Umesh D. , Tate Jacqueline E. 
Published: October 2020

Background:
Intussusception is the leading cause of acute intestinal obstruction in infants. Intussusception is mostly idiopathic, but infectious pathogens are sometimes implicated. In addition, live oral rotavirus vaccines have been associated with intussusception.

Methods:
We searched the literature published between January 1, 1990, and March 16, 2020, to describe the association between intussusception among infants and young children and various pathogens, particularly adenovirus and wild rotavirus. We tallied the number of evaluations reporting a statistically significant positive association, no association and a protective association by pathogen, using any statistical method. We also calculated the median reported odds ratios (OR) of intussusception with adenovirus and rotavirus.

Results:
We identified 3793 records on intussusception from the literature; 17 evaluations from 15 countries that evaluated 52 pathogens were included in the analysis. All 14 evaluations of adenovirus reported a statistically significant positive association with intussusception; the median OR from 9 evaluations was 3.7 (interquartile range, 3.3, 8.2). Nine of 12 evaluations assessing rotavirus found no statistically significant association, 1 found a positive association and 2 reported a protective effect; the median OR from 12 evaluations was 0.9 (interquartile range, 0.2, 1.8). No consistent relationship was observed between any other pathogens and intussusception.

Conclusions:
We documented a consistent association of intussusception with adenovirus, but no relationship between wild-type rotavirus and intussusception. Future research should focus on better understanding the mechanisms of intussusception with infectious pathogens, including following a rotavirus vaccination.
Comparison of Rapid Antidepressant and Antisuicidal Effects of Intramuscular Ketamine, Oral Ketamine, and Electroconvulsive Therapy in Patients With Major Depressive Disorder
Authors: Kheirabadi Dorna , Kheirabadi Gholam Reza , Mirlohi Zahra , Tarrahi Mohammad Javad , Norbaksh Amir 
Published: October 2020

Abstract

Purpose/Background
This study was devised to compare the antidepressant and antisuicidal effects of oral and intramuscular (IM) ketamine versus electroconvulsive therapy (ECT).

Methods/Procedures
In our pilot study, 45 patients with major depressive disorder (based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria) in the age range of 18 to 70 years who were determined suitable candidates for ECT got randomly divided into 3 equal groups. Each group received one of these treatment modalities: 0.5 mg/kg of IM ketamine; 1 mg/kg of oral ketamine; and ECT in 6 to 9 sessions during 3 weeks. Depression and suicidal ideation scores were recorded using the Hamilton Depression Rating Scale and the Beck Scale for Suicidal Ideation, respectively, at baseline, 24 hours, 1 week, 2 weeks, and 3 weeks within the intervention. The measurements were repeated 1 week and 1 month after the end of the intervention as well. Vital signs and adverse effects were noted. Finally, satisfaction levels of patients for each method were recorded and compared between groups.

Findings/Results
The Hamilton Depression Rating Scale and the Beck Scale for Suicidal Ideation scores significantly improved in all groups compared with baseline with no significant differences between the 3 groups. The adverse effects for ketamine-consuming groups such as dissociative symptoms were brief and transient, whereas memory loss for the ECT group remained up to 1 month in some patients. Ketamine-receiving groups preferred it more than ECT.

Implications/Conclusions
Oral and IM ketamine probably have equal antidepressant in addition to more antisuicidal effects compared with ECT but had less cognitive adverse effects and higher preference by patients. Thereby, ketamine can be an alternative method in the treatment of patients with severe and/or suicidal MDD.
Older Patients With Hepatocellular Carcinoma Are Less Knowledgeable About Survivorship Issues
Authors: Winters Adam C. , Viramontes Matthew , Buch Adam , Najarian Lisa , Yum Jung , Yang Liu , Saab Sammy 
Published: October 2020

Background and Aims:
As the incidence and survival for hepatocellular carcinoma increase, the number of patients having been treated for liver cancer would be expected to increase as well. Little is known about the experience of the survivors of hepatocellular carcinoma.

Methods:
The authors conducted a 3-tool survey of hepatocellular carcinoma survivors at a large, academic, and tertiary referral medical center to assess potential areas of disparities in the survivorship experience. The instruments aimed to assess knowledge of survivorship issues (Perceived Efficacy in Patient‐Physician Interactions Questionnaire-1), preparedness for the survivorship experience (Perceived Efficacy in Patient‐Physician Interactions Questionnaire-2), and self-efficacy in procuring medical information while navigating the patient-provider relationship (Perceived Efficacy in Patient‐Physician Interactions Questionnaire). The authors compared mean test scores for each instrument, with higher scores indicating a more positive response, by patient characteristics and used s linear regression model to examine associations between sociodemographics and survey scores.

Results:
In total, 110 patients took at least 1 survey. In the multiple linear regression model, the authors found that for every increase in patient age by 10 years, knowledge of survivorship issues decreased by a total score of 1.3 (P=0.02). In this model, the authors found no significant differences between male and female respondents, English and non-English speakers, and liver transplant recipients and nonliver transplant recipients. Survivors who had completed a 4-year college degree had significantly higher knowledge of survivorship issues than those who did not use χ2 testing, but this finding did not maintain significance in the multiple linear regression model.

Conclusions:
In a population of 110 ethnically diverse hepatocellular carcinoma survivors, the authors found older patients had gaps in knowledge of survivorship issues. Particular attention should be paid to older populations during liver cancer treatment.
Involvement of MTHFR rs1801133 in the Susceptibility of Acute Lymphoblastic Leukemia: A Preliminary Study
Authors: Frikha Rim , Turki Fatma , Frikha Fakher , Elloumi Moez , Rebai Tarek 
Published: October 2020

Background:
Acute lymphoblastic leukemia (ALL), a common blood cancer, is characterized by the interaction between genetic and environmental factors. Several variants of the Methylenetetrahydrofolate reductase (MTHFR), mainly the C677T (rs1801133), may affect susceptibility to ALL.

Aim of the Study:
The authors conducted this case-control study to evaluate the relationship between this variant of the MTHFR gene and the risk of ALL.

Materials and Methods:
Forty-one patients with ALL and 35 non-ALL controls recruited in this study were genotyped utilizing polymerase chain reaction-restriction fragment length polymorphism methodology.

Results:
The MTHFR 677CT genotype was significantly more frequently found in patients with ALL having a 2-fold increase in risk (P <0.01).

Conclusion:
Our results suggest that rs1801133 of MTHFR is a predictive risk marker to ALL in Tunisian ALL.