bluuebunny/crossref_metadata_2025_split huggingface dataset:
What is new in catheter use and catheter infection prevention in the ICU
Authors: Buetti Niccolò , Tabah Alexis , Timsit Jean-François , Zingg Walter 
Published: December 2020

Purpose of review
Short-term intravascular catheters are instrumental in the care of critically ill patients. Despite their benefits, they also are potential entries for systemic infections. There is a growing body of literature on catheter use and the prevention of intravascular catheter infections in intensive care. This review highlights major recent contributions to the topic and put them into perspective to recommendations on best practice procedures.

Recent findings
Many studies published in the last years have evaluated prevention strategies applying technology and addressing behavior change. Skin disinfection with 2% alcoholic chlorhexidine-gluconate (CHG) and CHG-impregnated dressings are increasingly used in clinical practice. However, the role of universal CHG bathing remains controversial. A number of new and innovative technologies are in development. Recent qualitative research offers new perspectives about behavior change interventions to improve implementation.

Summary
Many options for effective intravascular catheter infection prevention are currently available. A number of recent systematic reviews and meta-analyses not only confirmed measures targeting best practice and technology at catheter insertion and catheter care but also challenged interventions, such as CHG bathing. More focus should be put to implementation strategies.
Biomarkers in acute respiratory distress syndrome
Authors: Jabaudon Matthieu , Blondonnet Raiko , Ware Lorraine B. 
Published: December 2020

Purpose of review
This article provides an overview of protein biomarkers for acute respiratory distress syndrome (ARDS) and their potential use in future clinical trials.

Recent findings
The protein biomarkers studied as indices of biological processes involved in the pathogenesis of ARDS may have diagnostic and/or prognostic value. Recently, they also proved useful for identifying ARDS phenotypes and assessing heterogeneity of treatment effect in retrospective analyses of completed clinical trials.

Summary
This article summarizes the current research on ARDS biomarkers and provides insights into how they should be integrated as prognostic and predictive enrichment tools in future clinical trials.
n – 3 Docosapentaenoic acid: the iceberg n – 3 fatty acid
Authors: Ghasemi Fard Samaneh , Cameron-Smith David , Sinclair Andrew J. 
Published: December 2020

Purpose of review
Docosapentaenoic acid (DPA) is a minor omega-3 fatty acid (FA) which has been frequently overlooked in lipid research. This review examines the biochemical and physiological outcomes of human trials which have used pure preparations of DPA (n − 3 DPA) and also recent developments in specialized proresolving lipid mediators (SPMs) derived from n − 3 DPA.

Recent findings
There have been only been two human studies and eleven animal studies with pure n − 3 DPA. The doses of n − 3 DPA used in the human trials have been 1–2 g/day. n − 3 DPA abundance is increased in blood lipid fractions within 3–4 days of supplementation. n − 3 DPA has the potential for unique properties, with a greater similarity in biological functioning with docosahexaenoic acid (DHA), than eicosapentaenoic acid (EPA). Despite the typically low levels of n − 3 DPA in most tissue lipids relative to EPA and DHA, unique SPMs, such as resolvins, maresins and protectins of the n − 3 DPA type, are involved in resolution of inflammation and regulating immune function.

Summary
We suggest that measurement of blood levels of n − 3 DPA gives no indication of its broad biological roles, but that the true functionality of this enigmatic n − 3 polyunsaturated fatty acid (PUFA) remains obscure until more is known about the properties of the unique DPA-derived SPMs.
Should evidence generated in well developed countries inform critical care nutrition in all countries?
Authors: Dixit Subhal , Uyar Mehmet , Khatib Khalid , Demirag Kubilay 
Published: December 2020

Purpose of review
Critically ill patients who survive the ICU face issues such as reduced quality of life and increased disability and nutritional therapy during ICU stay may be used to reduce these adverse effects. Although evidence and guidelines are available to direct clinical nutrition for ICU patients, critical care practices and settings differ substantially between developed and developing countries.

Recent findings
The implementation of evidence generated in well developed countries regarding critical care nutrition depends heavily on factors such as operation model, the structure of the unit, different care processes, hospital size and country income.

Summary
Guidelines and evidence generated by various societies, agencies and trials, which are focused towards developed world may not be fully appropriate and executable in the developing world. Also, the developing world is heterogenous. Hence, ‘one size fits all’ approach may not be appropriate. A holistic approach to guideline and evidence generation and its appropriate utilization in the developing world is binding on caregivers in both the developing and developed world so as to benefit the critically ill patient.
Local and Intra-articular Administration of Nonsteroidal Anti-inflammatory Drugs for Pain Management in Orthopedic Surgery
Authors: Bernthal Nicholas M. , Hart Christopher M. , Sheth Ketan R. , Bergese Sergio D. , Ho Hung S. , Apfel Christian C. , Stoicea Nicoleta , Rojhani Allen , Jahr Jonathan S. 
Published: December 2020

Background:
Although growing evidence demonstrates the benefits of locally administered nonsteroidal anti-inflammatory drugs (NSAIDs) for postoperative pain management, there is ongoing debate regarding NSAID use in orthopedic surgery.

Areas of Uncertainty:
Current data largely support a local site of NSAID action and suggest that effective pain control can be achieved with delivery of NSAIDs intra-articularly (IA) and/or locally at the site of injury, where they can block peripheral production of inflammatory mediators and may desensitize nociceptors. Improvements in postoperative pain control with locally administered NSAIDs have been widely reported in the total joint arthroplasty literature and may offer benefits in patient's undergoing arthroscopic procedures and those with osteoarthritis as well. The purpose of this review is to examine the available evidence in the literature regarding the efficacy and safety profile of the use of local and IA NSAIDs in orthopedic surgery.

Data Sources:
Narrative literature review using keywords, expert opinion, either during or from live conference.

Therapeutic Advances:
Local and IA administration of NSAIDs for pain management in orthopedic surgery.

Conclusion:
There is convincing evidence that NSAIDs administered locally in and around the joint reduce postoperative pain scores and opioid consumption in patients undergoing total joint arthroplasty, yet further research is required regarding the risks of potential chondrotoxicity and the inhibition of bone and soft-tissue healing with locally administered NSAIDs.
Impact of ultra-processed food consumption on metabolic health
Authors: Costa de Miranda Renata , Rauber Fernanda , Levy Renata Bertazzi 
Published: December 2020

Purpose of review
Ultra-processed foods (UPF) have been associated with poor diet quality and adverse health outcomes. Our aim in this review is to summarize recent research assessing the impact of UPF consumption, classified according to the NOVA system, on outcomes related to metabolic health.

Recent findings
Thirty recent studies with different design, quality and target population have investigated the impact of UPF consumption on parameters related to metabolic health, which were organized into: metabolic syndrome; body weight change and obesity indicators; blood pressure and hypertension; glucose profile, insulin resistance and type 2 diabetes; other metabolic risks and cardiovascular diseases and mortality. Most of the studies demonstrated adverse associations between high UPF consumption and metabolic health, mainly those with robust design and involving adults.

Summary
Most of the latest findings have revealed an adverse impact of high UPF consumption on metabolic health, including cardiovascular diseases and mortality. Scientific evidence is accumulating towards the necessity of curbing UPF consumption worldwide at different life stages. Nevertheless, other studies are needed to confirm the causality between UPF consumption and metabolic health in diverse scenarios and to better elucidate all likely mechanisms involved in this relationship.
Rewriting the playbook: infection prevention practices to mitigate nosocomial severe acute respiratory syndrome coronavirus 2 transmission
Authors: Scaggs Huang Felicia , Schaffzin Joshua K. 
Published: December 2020

Purpose of review
Given the limited evidence and experience with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), this novel pathogen has challenged the field of infection prevention. Despite uncertainty, infection prevention principles and experience with similar diseases have helped guide how to best protect providers and patients against disease acquisition.

Recent findings
Guidance to date has relied on data from SARS-CoV-1 and MERS-CoV to guide practices on patient isolation and personal protective equipment (PPE) use. Although a face mask and eye protection are likely adequate for most clinical scenarios, published guidelines for PPE can be confusing and conflicting. Consensus for what constitutes a high-risk aerosol-generating procedure (AGP) is lacking, but most agree providers performing procedures such as bronchoscopy, intubation, and cardiopulmonary resuscitation would likely benefit from the use of an N95 respirator and eye protection.

Summary
Needed research to elucidate the predominant SARS-CoV-2 mode of transmission is not likely to be completed in the immediate future. Recommendations for PPE to mitigate procedure-associated risk remain controversial. Nonetheless, implementation of existing measures based on basic infection prevention principles is likely to prevent transmission significantly.
Variations in DNA methylation and allograft rejection
Authors: Boer Karin , Hesselink Dennis A. , Baan Carla C. 
Published: December 2020

Purpose of review
DNA methylation is involved in gene transcription and as such important for cellular function. Here, the literature on DNA methylation in relation to acute rejection is summarized with a focus on the potential clinical utility of DNA methylation for monitoring transplant rejection.

Recent findings
The tight transcriptional control of DNA methylation in immune cell function, e.g. demethylation in regulatory T-cell-specific genes for stable immunosuppressive capacities, suggests an important role for DNA methylation variations in the antidonor-directed immune response. Until today, differentially methylated DNA in immune cells, however, has not been described at the moment of allograft rejection. The ability to locus-specific modify DNA methylation could facilitate the generation of stable cells for cellular therapy purposes. The unique cell-specific characteristics of DNA methylation provide the opportunity to identify its cellular origin. Examining methylation of cell-free DNA in blood or urine may serve as a ‘liquid biopsy’ enabling minimally invasive detection of allograft rejection.

Summary
Actual research publications on DNA methylation in relation to allograft rejection are scarce, which makes it challenging to determine its potential clinical value. Extensive research is needed to investigate the value of DNA methylation in early recognition, diagnosis, and/or successful treatment of allograft rejection.
Psychiatric Medication Changes Associated With Increased Rate of Medical Readmissions in Patients With Serious Mental Illness
Authors: Germack Hayley D. , Weissinger Guy , Bizhanova Zhadyra , Martsolf Grant R. 
Published: December 2020

Abstract
To identify the impact of postdischarge psychiatric medication changes on general medical readmissions among patients with serious mental illness (SMI; bipolar disorder, major depressive disorder, and schizophrenia), claims from a 5% national sample of Medicare fee-for-service (FFS) beneficiaries hospitalized between 2013 and 2016 were studied. A total of 165,490 Medicare FFS beneficiaries with SMI 18 years or older with at least 1 year of continuous Medicare enrollment were identified. Within 30 days of discharge from index admission, 47.4% experienced a psychiatric medication change—including 75,892 beneficiaries experiencing a deletion and 55,713 experiencing an addition. After adjusting for potential confounders, those with a medication change experienced an 10% increase in the odds of 30-day readmission (odds ratio, 1.10; SE, 0.019; p < 0.001). Comorbid drug use disorder was also associated with an increased odds of readmission after controlling for other covariates. These findings suggest important factors that clinicians should be aware of when discharging patients with SMI.
Nurse Educators
Authors: Ruth-Sahd Lisa A. , Grim Rodney 
Published: December 2020

Background
Professional quality of life (ProQoL) is the balance between compassion satisfaction (CS) and compassion fatigue (CF). The experience of CF results from secondary traumatic stress stemming from compassionate caregiving and burnout.

Purpose
This study sought to identify the ProQoL of nurse educators and what conditions for work effectiveness affect this ProQoL.

Methods
An email survey link was sent to nurse educators from the northeastern region of the United States asking for participation. This included demographics, the ProQoL Version 5, and the Conditions for Work Effectiveness Questionnaire version II (CWEQ-II).

Results
The 211 nurse educators reported relatively high CS and relatively low burnout and secondary traumatic stress. When the measures of the CWEQ-II increased, so did their CS. In addition, as the measures of the CWEQ-II increased, their secondary traumatic stress and burnout decreased.

Conclusions
Findings suggest that conditions for work effectiveness such as access to opportunity, resources, information, support, and formal and informal power have a relationship to the nurse educator's ProQoL.
Objective Structured Clinical Examinations as a Method of Competency Evaluation in a Primary Care Nurse Practitioner Program
Authors: Hickey Mary T. 
Published: December 2020

Background
Objective structured clinical examinations (OSCEs) are an effective method of instruction and evaluation. Their use in nurse practitioner (NP) programs as a means of evaluation warrants further exploration.

Purpose
The purpose of this project was to test the applicability and feasibility of implementation of OSCEs as a means of formative evaluation in a primary care NP program and to determine student feedback about the experience.

Methods
This project evaluated the implementation of an educational intervention using 2 previously developed and tested OSCE scenarios with standardized patients.

Results
Mean scores were computed for the subcategories, as well as for global rating scores on the OSCE. Strong correlations were found across categories within the scenario; no correlations were found between scenarios. Moderate intraclass correlation coefficients were achieved. Student feedback about the experience, including perceived competence and confidence, was overwhelmingly positive.

Conclusions
This project demonstrates success of a pilot OSCE program.
Early Mobilization in a PICU: A Qualitative Sustainability Analysis of PICU Up!*
Authors: Patel Ruchit V. , Redivo Juliana , Nelliot Archana , Eakin Michelle N. , Wieczorek Beth , Quinn Julie , Gurses Ayse P. , Balas Michele C. , Needham Dale M. , Kudchadkar Sapna R. 
Published: December 2020

Objectives:
To identify staff-reported factors and perceptions that influenced implementation and sustainability of an early mobilization program (PICU Up!) in the PICU.

Design:
A qualitative study using semistructured phone interviews to characterize interprofessional staff perspectives of the PICU Up! program. Following data saturation, thematic analysis was performed on interview transcripts.

Setting:
Tertiary-care PICU in the Johns Hopkins Hospital, Baltimore, MD.

Subjects:
Interprofessional PICU staff.

Interventions:
None.

Measurements and Main Results:
Fifty-two staff members involved in PICU mobilization across multiple disciplines were interviewed. Three constructs emerged that reflected the different stages of PICU Up! program execution: 1) factors influencing the implementation process, 2) staff perceptions of PICU Up!, and 3) improvements in program integration. Themes were developed within these constructs, addressing facilitators for PICU Up! implementation, cultural changes for unitwide integration, positive impressions toward early mobility, barriers to program sustainability, and refinements for more robust staff and family engagement.

Conclusions:
Three years after implementation, PICU Up! remains well-received by staff, positively influencing role satisfaction and PICU team dynamics. Furthermore, patients and family members are perceived to be enthusiastic about mobility efforts, driving staff support. Through an ongoing focus on stakeholder buy-in, interprofessional engagement, and bundled care to promote mobility, the program has become part of the culture in the Johns Hopkins Hospital PICU. However, several barriers remain that prevent consistent execution of early mobility, including challenges with resource management, sedation decisions, and patient heterogeneity. Characterizing these staff perceptions can facilitate the development of solutions that use institutional strengths to grow and sustain PICU mobility initiatives.
Acute Peripheral and/or Cutaneous Ischemic Syndrome
Authors: Santiago Mittermayer B. , Paz Adriane 
Published: December 2020

Abstract
In daily practice, the frequent appearance of limb and/or skin necrosis, which we term “acute peripheral and/or cutaneous ischemic syndrome” (APCIS), can be a manifestation of numerous underlying diseases, or it can sometimes be a clinical phenomenon whose etiology is undefined even after a wide investigation. The mechanisms for the development of APCIS include vessel wall abnormalities (atherosclerosis, vasculitis, and calciphylaxis), embolic processes (infectious endocarditis, atrial myxoma, and cholesterol emboli), local thrombotic injuries (genetic or acquired thrombophilias and heparin- and warfarin-induced ischemia), dysproteinemias (cryoglobulinemia and cryofibrinogenemia), or venous limb gangrene. Here, we report 5 illustrative cases of APCIS with different pathogenetic mechanisms, thereby highlighting some clinical conditions that cause APCIS that may be of special interest for rheumatologists, such as antiphospholipid syndrome, primary and secondary vasculitis, and cryoproteinemias. Furthermore, we describe a large spectrum of other causes of APCIS beyond the scope of rheumatology. Because there are no validated guidelines for APCIS, we tentatively propose an initial diagnostic workup and a therapeutic approach based on full-dose anticoagulation and immunosuppressive therapy.
Preconception Obstetrics and Rheumatology Consultation
Authors: Javinani Ali , Radmard Fatemeh , Razavinia Fatemeh Sadat , Masoumi Maryam 
Published: December 2020

Background
Autoimmune rheumatic disorders are a group of illnesses that significantly affect pregnancy outcomes.

Aim
The aim of this study was to evaluate the incidence and risk factors of spontaneous abortion and its association with maternal medical care in women with autoimmune rheumatic diseases.

Methods
In this medical record review study, we recruited patients who were referred to our clinic from September 2014 to September 2019. All confirmed pregnancies (based on a positive pregnancy test and sonogram) were included. Binary logistic regression was applied to construct the statistical model.

Findings
The present study involved 97 women (215 total confirmed pregnancies) who were diagnosed with 7 different autoimmune rheumatic disorders. The rate of spontaneous abortion was 28.8%. In the univariate analysis, the preconception obstetrics and rheumatology consultation were negatively associated with spontaneous abortion (p < 0.001; odds ratio [OR], 0.255; 95% confidence interval [CI], 0.136–0.480; and p < 0.001; OR, 0.042; 95% CI, 0.015–0.122, respectively). Perinatal obstetric care had a significant protective effect (p < 0.001; OR, 0.260; 95% CI, 0.139–0.486). The multivariate analysis showed that the preconception rheumatology consultation (p = 0.003; OR, 0.062; 95% CI, 0.010–0.393) was negatively associated with spontaneous abortions. The presence of active diseases before pregnancy (p = 0.005; OR, 9.978; 95% CI, 2.023–49.223), anti-SSA/Ro (p < 0.001; OR, 22.927; 95% CI, 4.921–106.818), and anticardiolipin IgM (p = 0.004; OR, 298.207; 95% CI, 6.209–14,323.037) were associated with a heightened risk of spontaneous abortion.

Conclusions
A collaborative work carried out by maternal-fetal medicine specialists and rheumatologists could remarkably improve pregnancy outcomes.
Incidental Finding of Bilateral Thalamic Glioma on 99mTc TRODAT-1 SPECT/CT
Authors: Kuo Ni-Chun , Hu Chin , Chiu Yu-Li , Peng Nan-Jing , Chan Hung-Pin 
Published: December 2020

Abstract

99mTc-TRODAT-1 SPECT/CT has been used to evaluate parkinsonian disorders. We present an interesting case of a 63-year-old woman with progressive tremulousness over the left side of the body for 6 months. Bilateral thalamic glioma with reduced uptake was shown on 99mTc-TRODAT-1 SPECT/CT. Secondary parkinsonism was impressed in this case.
Metastatic Medulloblastoma
Authors: ArunRaj Sreedharan Thankarajan , Kumar Arunav , KP Haresh , Mohan Nikhil , Gupta Subhash , Tripathi Madhavi , Bal Chandrasekhar 
Published: December 2020

Abstract
We describe the utility of molecular imaging with 18F-FDG and 68Ga-DOTANOC PET for treatment response assessment in a case of metastatic medulloblastoma. 18F-FDG and 68Ga-DOTANOC PET/CT revealed extensive metastases to bone and bone marrow. Patient subsequently had an excellent response to systemic chemotherapy which was evidenced by resolution of tracer-avid skeletal lesions on both FDG and DOTANOC PET/CT.