bluuebunny/crossref_metadata_2025_split huggingface dataset:
Attitudes Towards and Management of Opioid-induced Hyperalgesia
Authors: Kum Elena , Buckley Norman , de Leon-Casasola Oscar , Lema Mark , Busse Jason W. 
Published: February 2020

Objectives:
Opioid-induced hyperalgesia (OIH) is a phenomenon whereby opioids increase patients’ pain sensitivity, complicating their use in analgesia. We explored practitioners’ attitudes towards, and knowledge concerning diagnosis, risk factors, and treatment of OIH.

Materials and Methods:
We administered an 18-item cross-sectional survey to 850 clinicians that managed chronic pain with opioid therapy.

Results:
The survey response rate was 37% (318/850). Most respondents (240/318, 76%) reported they had observed patients with OIH in their practice, of which 38% (84/222) reported OIH affected >5% of their chronic pain patients. The majority (133/222, 60%) indicated that OIH could result from any dose of opioid therapy. The most commonly endorsed chronic pain conditions associated with the development of OIH were fibromyalgia (109/216, 51%) and low back pain (91/216, 42%), while 42% (91/216) indicated that no individual chronic pain condition was associated with greater risk of OIH. The most commonly endorsed opioids associated with the development of OIH were oxycodone (94/216, 44%), fentanyl (86/216, 40%), and morphine (84/216, 39%); 27% (59/216) endorsed that no specific opioid was more likely to result in OIH. Respondents commonly managed OIH by opioid dose reduction (147/216, 68%), administering a nonopioid adjuvant (133/216, 62%), or discontinuing opioids (95/216, 44%).

Discussion:
Most clinicians agreed that OIH is a complication of opioid therapy, but were divided regarding the prevalence of OIH, etiological factors, and optimal management.
Artifact Processing Methods Influence on Intraoperative Hypotension Quantification and Outcome Effect Estimates
Authors: Pasma Wietze , Peelen Linda M. , van Buuren Stef , van Klei Wilton A. , de Graaff Jurgen C. 
Published: February 2020

Abstract

Background
Physiologic data that is automatically collected during anesthesia is widely used for medical record keeping and clinical research. These data contain artifacts, which are not relevant in clinical care, but may influence research results. The aim of this study was to explore the effect of different methods of filtering and processing artifacts in anesthesiology data on study findings in order to demonstrate the importance of proper artifact filtering.

Methods
The authors performed a systematic literature search to identify artifact filtering methods. Subsequently, these methods were applied to the data of anesthesia procedures with invasive blood pressure monitoring. Different hypotension measures were calculated (i.e., presence, duration, maximum deviation below threshold, and area under threshold) across different definitions (i.e., thresholds for mean arterial pressure of 50, 60, 65, 70 mmHg). These were then used to estimate the association with postoperative myocardial injury.

Results
After screening 3,585 papers, the authors included 38 papers that reported artifact filtering methods. The authors applied eight of these methods to the data of 2,988 anesthesia procedures. The occurrence of hypotension (defined with a threshold of 50 mmHg) varied from 24% with a median filter of seven measurements to 55% without an artifact filtering method, and between 76 and 90% with a threshold of 65 mmHg. Standardized odds ratios for presence of hypotension ranged from 1.16 (95% CI, 1.07 to 1.26) to 1.24 (1.14 to 1.34) when hypotension was defined with a threshold of 50 mmHg. Similar variations in standardized odds ratios were found when applying methods to other hypotension measures and definitions.

Conclusions
The method of artifact filtering can have substantial effects on estimates of hypotension prevalence. The effect on the association between intraoperative hypotension and postoperative myocardial injury was relatively small. Nevertheless, the authors recommend that researchers carefully consider artifacts handling and report the methodology used.

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Intraabdominal Pressure Targeted Positive End-expiratory Pressure during Laparoscopic Surgery
Authors: Mazzinari Guido , Diaz-Cambronero Oscar , Alonso-Iñigo Jose Miguel , Garcia-Gregorio Nuria , Ayas-Montero Begoña , Ibañez Jose Luis , Serpa Neto Ary , Ball Lorenzo , Gama de Abreu Marcelo , Pelosi Paolo , Maupoey Javier , Argente Navarro Maria Pilar , Schultz Marcus J. 
Published: February 2020

Abstract

Background
Pneumoperitoneum for laparoscopic surgery is associated with a rise of driving pressure. The authors aimed to assess the effects of positive end-expiratory pressure (PEEP) on driving pressure at varying intraabdominal pressure levels. It was hypothesized that PEEP attenuates pneumoperitoneum-related rises in driving pressure.

Methods
Open-label, nonrandomized, crossover, clinical trial in patients undergoing laparoscopic cholecystectomy. “Targeted PEEP” (2 cm H2O above intraabdominal pressure) was compared with “standard PEEP” (5 cm H2O), with respect to the transpulmonary and respiratory system driving pressure at three predefined intraabdominal pressure levels, and each patient was ventilated with two levels of PEEP at the three intraabdominal pressure levels in the same sequence. The primary outcome was the difference in transpulmonary driving pressure between targeted PEEP and standard PEEP at the three levels of intraabdominal pressure.

Results
Thirty patients were included and analyzed. Targeted PEEP was 10, 14, and 17 cm H2O at intraabdominal pressure of 8, 12, and 15 mmHg, respectively. Compared to standard PEEP, targeted PEEP resulted in lower median transpulmonary driving pressure at intraabdominal pressure of 8 mmHg (7 [5 to 8] vs. 9 [7 to 11] cm H2O; P = 0.010; difference 2 [95% CI 0.5 to 4 cm H2O]); 12 mmHg (7 [4 to 9] vs.10 [7 to 12] cm H2O; P = 0.002; difference 3 [1 to 5] cm H2O); and 15 mmHg (7 [6 to 9] vs.12 [8 to 15] cm H2O; P < 0.001; difference 4 [2 to 6] cm H2O). The effects of targeted PEEP compared to standard PEEP on respiratory system driving pressure were comparable to the effects on transpulmonary driving pressure, though respiratory system driving pressure was higher than transpulmonary driving pressure at all intraabdominal pressure levels.

Conclusions
Transpulmonary driving pressure rises with an increase in intraabdominal pressure, an effect that can be counterbalanced by targeted PEEP. Future studies have to elucidate which combination of PEEP and intraabdominal pressure is best in term of clinical outcomes.

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Classification of Current Procedural Terminology Codes from Electronic Health Record Data Using Machine Learning
Authors: Burns Michael L. , Mathis Michael R. , Vandervest John , Tan Xinyu , Lu Bo , Colquhoun Douglas A. , Shah Nirav , Kheterpal Sachin , Saager Leif 
Published: February 2020

Abstract

Background
Accurate anesthesiology procedure code data are essential to quality improvement, research, and reimbursement tasks within anesthesiology practices. Advanced data science techniques, including machine learning and natural language processing, offer opportunities to develop classification tools for Current Procedural Terminology codes across anesthesia procedures.

Methods
Models were created using a Train/Test dataset including 1,164,343 procedures from 16 academic and private hospitals. Five supervised machine learning models were created to classify anesthesiology Current Procedural Terminology codes, with accuracy defined as first choice classification matching the institutional-assigned code existing in the perioperative database. The two best performing models were further refined and tested on a Holdout dataset from a single institution distinct from Train/Test. A tunable confidence parameter was created to identify cases for which models were highly accurate, with the goal of at least 95% accuracy, above the reported 2018 Centers for Medicare and Medicaid Services (Baltimore, Maryland) fee-for-service accuracy. Actual submitted claim data from billing specialists were used as a reference standard.

Results
Support vector machine and neural network label-embedding attentive models were the best performing models, respectively, demonstrating overall accuracies of 87.9% and 84.2% (single best code), and 96.8% and 94.0% (within top three). Classification accuracy was 96.4% in 47.0% of cases using support vector machine and 94.4% in 62.2% of cases using label-embedding attentive model within the Train/Test dataset. In the Holdout dataset, respective classification accuracies were 93.1% in 58.0% of cases and 95.0% among 62.0%. The most important feature in model training was procedure text.

Conclusions
Through application of machine learning and natural language processing techniques, highly accurate real-time models were created for anesthesiology Current Procedural Terminology code classification. The increased processing speed and a priori targeted accuracy of this classification approach may provide performance optimization and cost reduction for quality improvement, research, and reimbursement tasks reliant on anesthesiology procedure codes.

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One-year Results of a Factorial Randomized Trial of Aspirin versus Placebo and Clonidine versus Placebo in Patients Having Noncardiac Surgery
Authors: Sessler Daniel I. , Conen David , Leslie Kate , Yusuf Salim , Popova Ekaterina , Graham Michelle , Kurz Andrea , Villar Juan Carlos , Mrkobrada Marko , Sigamani Alben , Biccard Bruce M. , Meyhoff Christian S. , Parlow Joel L. , Guyatt Gordon , Xavier Denis , Chan Matthew T. V. , Kumar Priya A. , Forget Patrice , Malaga German , Fleischmann Edith , Amir Mohammed , Torres David , Wang C. Y. , Paniagua Pilar , Berwanger Otavio , Srinathan Sadeesh , Landoni Giovanni , Manach Yannick Le , Whitlock Richard , Lamy André , Balasubramanian Kumar , Gilron Ian , Turan Alparslan , Pettit Shirley , Devereaux P. J. 
Published: February 2020

Abstract

Background
The authors previously reported that perioperative aspirin and/or clonidine does not prevent a composite of death or myocardial infarction 30 days after noncardiac surgery. Moreover, aspirin increased the risk of major bleeding and clonidine caused hypotension and bradycardia. Whether these complications produce harm at 1 yr remains unknown.

Methods
The authors randomized 10,010 patients with or at risk of atherosclerosis and scheduled for noncardiac surgery in a 1:1:1:1 ratio to clonidine/aspirin, clonidine/aspirin placebo, clonidine placebo/aspirin, or clonidine placebo/aspirin placebo. Patients started taking aspirin or placebo just before surgery; those not previously taking aspirin continued daily for 30 days, and those taking aspirin previously continued for 7 days. Patients were also randomly assigned to receive clonidine or placebo just before surgery, with the study drug continued for 72 h.

Results
Neither aspirin nor clonidine had a significant effect on the primary 1-yr outcome, a composite of death or nonfatal myocardial infarction, with a 1-yr hazard ratio for aspirin of 1.00 (95% CI, 0.89 to 1.12; P = 0.948; 586 patients [11.8%] vs. 589 patients [11.8%]) and a hazard ratio for clonidine of 1.07 (95% CI, 0.96 to 1.20; P = 0.218; 608 patients [12.1%] vs. 567 patients [11.3%]), with effect on death or nonfatal infarction. Reduction in death and nonfatal myocardial infarction from aspirin in patients who previously had percutaneous coronary intervention at 30 days persisted at 1 yr. Specifically, the hazard ratio was 0.58 (95% CI, 0.35 to 0.95) in those with previous percutaneous coronary intervention and 1.03 (95% CI, 0.91to 1.16) in those without (interaction P = 0.033). There was no significant effect of either drug on death, cardiovascular complications, cancer, or chronic incisional pain at 1 yr (all P > 0.1).

Conclusions
Neither perioperative aspirin nor clonidine have significant long-term effects after noncardiac surgery. Perioperative aspirin in patients with previous percutaneous coronary intervention showed persistent benefit at 1 yr, a plausible sub-group effect.

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Does Iso-mechanical Power Lead to Iso-lung Damage?
Authors: Vassalli Francesco , Pasticci Iacopo , Romitti Federica , Duscio Eleonora , Aßmann David Jerome , Grünhagen Hannah , Vasques Francesco , Bonifazi Matteo , Busana Mattia , Macrì Matteo Maria , Giosa Lorenzo , Reupke Verena , Herrmann Peter , Hahn Günter , Leopardi Orazio , Moerer Onnen , Quintel Michael , Marini John J. , Gattinoni Luciano 
Published: February 2020

Abstract

Background
Excessive tidal volume, respiratory rate, and positive end-expiratory pressure (PEEP) are all potential causes of ventilator-induced lung injury, and all contribute to a single variable: the mechanical power. The authors aimed to determine whether high tidal volume or high respiratory rate or high PEEP at iso-mechanical power produce similar or different ventilator-induced lung injury.

Methods
Three ventilatory strategies—high tidal volume (twice baseline functional residual capacity), high respiratory rate (40 bpm), and high PEEP (25 cm H2O)—were each applied at two levels of mechanical power (15 and 30 J/min) for 48 h in six groups of seven healthy female piglets (weight: 24.2 ± 2.0 kg, mean ± SD).

Results
At iso-mechanical power, the high tidal volume groups immediately and sharply increased plateau, driving pressure, stress, and strain, which all further deteriorated with time. In high respiratory rate groups, they changed minimally at the beginning, but steadily increased during the 48 h. In contrast, after a sudden huge increase, they decreased with time in the high PEEP groups. End-experiment specific lung elastance was 6.5 ± 1.7 cm H2O in high tidal volume groups, 10.1 ± 3.9 cm H2O in high respiratory rate groups, and 4.5 ± 0.9 cm H2O in high PEEP groups. Functional residual capacity decreased and extravascular lung water increased similarly in these three categories. Lung weight, wet-to-dry ratio, and histologic scores were similar, regardless of ventilatory strategies and power levels. However, the alveolar edema score was higher in the low power groups. High PEEP had the greatest impact on hemodynamics, leading to increased need for fluids. Adverse events (early mortality and pneumothorax) also occurred more frequently in the high PEEP groups.

Conclusions
Different ventilatory strategies, delivered at iso-power, led to similar anatomical lung injury. The different systemic consequences of high PEEP underline that ventilator-induced lung injury must be evaluated in the context of the whole body.

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Neonatal Nurses' Self-reported Practices, Knowledge, and Attitudes Toward Use of Maternal Voice for Preterm Infants
Authors: Williamson Selena , McGrath Jacqueline M. 
Published: February 2020

Background/Significance:
Infants born extremely premature (<1500 g) often experience lengthy stays in the challenging environment of the neonatal intensive care unit (NICU) separated from their parents.

Purpose:
The purpose of this study was to explore nurses' knowledge, attitude, and use of maternal voice as a therapeutic intervention for preterm infants in the NICU.

Methods:
Neonatal nurses (n = 117) completed an online survey about the use of maternal voice in their individual units. Questions included: (1) previous knowledge surrounding use of maternal voice in the NICU; (2) their attitudes about using maternal voice recordings and/or live maternal speech as an intervention; (3) whether their unit had the necessary equipment and environment conducive to using the therapy; (4) average amount of time parents were in the NICU with their neonate; and (5) in what situations they would personally encourage the use of maternal recordings (during procedures, rounds, etc).

Results:
Of those responding, 73.3% of nurse (n = 117) respondents agreed they were willing to incorporate maternal recordings into caregiving, with 80.8% indicating they were open to learning and employing different therapies to improve parental involvement in infant care.

Implications for Practice:
When the appropriate equipment is available, neonatal nurses are interested and willing to use alternative therapies that incorporate parental participation into direct caregiving as well as utilizing maternal voice recordings.

Implications for Research:
Further research with larger, more diverse samples is needed to determine the current knowledge, attitudes, and practices of maternal voice recordings by NICU nurses. Future research can also focus on barriers to utilization of the therapy during daily care.
Perioperative Safety of Surgery for Pelvic Organ Prolapse in Elderly and Frail Patients
Authors: Chapman Graham C. , Sheyn David , Slopnick Emily A. , Hijaz Adonis K. , Mahajan Sangeeta T. , Mangel Jeffrey , El-Nashar Sherif A. 
Published: February 2020

OBJECTIVE:
To evaluate the effects of old age and frailty on complication rates after surgery for pelvic organ prolapse.

METHODS:
The American College of Surgeons' National Surgical Quality Improvement Program database was used to identify patients who underwent surgery for prolapse from 2010 to 2017. We compared our control group (45–64 years, index population) to those aged 65–79 years (elderly) and 80 years and older (very elderly). Frailty was assessed using the National Surgical Quality Improvement Program Modified Frailty Index-5. The primary outcome was the composite rate of serious complications and mortality.

RESULTS:
We analyzed 27,403 patients in the index population, 20,567 in the elderly group, and 3,088 in the very elderly group. The composite rate of serious complications in the index population was 4.5%, compared with 4.7% in the elderly group (odds ratio [OR] 1.0, 95% CI 0.9–1.1) and 9.0% in the very elderly group (OR 2.1, 95% CI 1.8–2.4). Compared with the index group, the very elderly group had notably elevated risks of cardiac complications (OR 11.9, 95% CI 6.2–23.0), stroke (OR 26.6, 95% CI 5.4–131.8), and mortality (OR 39.9, 95% CI 8.6–184.7). On multivariate logistic regression, the only age group independently associated with serious complications was the very elderly group (adjusted odds ratio [aOR] 2.01, 95% CI 1.8–2.3). The Modified Frailty Index-5 score was independently predictive of complications (aOR 1.4, 95% CI 1.1–2.0). Stratified analysis using interaction terms revealed the Modified Frailty Index-5 score to be predictive of complications in the elderly age group (aOR 2.5, 95% CI 1.3–4.6), but not in the very elderly group.

CONCLUSION:
Serious complications surrounding prolapse surgery increase substantially in the cohort of patients older than 80 years of age, independent of frailty and medical or surgical risk factors.
Long-term Device Outcomes of Mesh Implants in Pelvic Organ Prolapse Repairs
Authors: Chughtai Bilal , Mao Jialin , Asfaw Tirsit S. , Heneghan Carl , Rardin Charles R. , Sedrakyan Art 
Published: February 2020

OBJECTIVE:
To evaluate the longer-term safety and reintervention outcomes of mesh implants in pelvic organ prolapse (POP) repairs.

METHODS:
We conducted a population-based cohort study of women undergoing POP repairs in inpatient and outpatient surgical settings between 2008 and 2016 in New York State. Multivariable logistic regression was used based on patient and procedural characteristics and hospital volume between mesh and nonmesh groups to obtain propensity scores for each individual. Long-term safety events and reinterventions were assessed using time-to-event analysis.

RESULTS:
We identified 54,194 women undergoing POP repairs (12,989 with mesh, and 41,205 without mesh). Mean age was 59.8 (±13.1) years, and median follow-up was 4.7 years (interquartile range, 2.4–6.8 years). In the propensity score-matched 12,284 pairs of women, POP repair with mesh was associated with a higher risk of reintervention when compared with POP repair without transvaginal mesh (hazard ratio 1.40, 95% CI 1.27–1.54, P<.001). The estimated risk of undergoing a reintervention at 5 years was 8.8% (95% CI 8.2–9.3%) in the mesh group and 6.3% (5.9–6.8%) in the nonmesh group. Among patients who had reinterventions, 18.5% of those operated with mesh had a reintervention related to mesh-related complications.

CONCLUSION:
Even though transvaginal mesh has been removed from the market, the risk of mesh complications did not diminish over time and these women warrant close follow-up. Continued surveillance of mesh in POP repairs is essential to ensure safety for the women who have already been implanted.
Risk Calculator to Predict Cesarean Delivery Among Women Undergoing Induction of Labor
Authors: Rossi Robert M. , Requarth Erin , Warshak Carri R. , Dufendach Kevin R. , Hall Eric S. , DeFranco Emily A. 
Published: February 2020

OBJECTIVE:
To develop and validate a predictive risk calculator for cesarean delivery among women undergoing induction of labor.

METHODS:
We performed a population-based cohort study of all women who had singleton live births after undergoing induction of labor from 32 0/7 to 42 6/7 weeks of gestation in the United States from 2012 to 2016. The primary objective was to build a predictive model estimating the probability of cesarean delivery after induction of labor using antenatal factors obtained from de-identified U.S. live-birth records. Multivariable logistic regression estimated the association of these factors on risk of cesarean delivery. K-fold cross validation was performed for internal validation of the model, followed by external validation using a separate live-birth cohort from 2017. A publicly available online calculator was developed after validation and calibration were performed for individual risk assessment. The seven variables selected for inclusion in the model by magnitude of influence were prior vaginal delivery, maternal weight at delivery, maternal height, maternal age, prior cesarean delivery, gestational age at induction, and maternal race.

RESULTS:
From 2012 to 2016, there were 19,844,580 live births in the United States, of which 4,177,644 women with singleton gestations underwent induction of labor. Among these women, 800,423 (19.2%) delivered by cesarean. The receiver operating characteristic curve for the seven-variable model achieved an area under the curve (AUC) of 0.787 (95% CI 0.786–0.788). External validation demonstrated a consistent measure of discrimination with an AUC of 0.783 (95% CI 0.764–0.802).

CONCLUSION:
This validated predictive model uses seven variables that were obtainable from the patient's medical record and discriminates between women at increased or decreased risk of cesarean delivery after induction of labor. This risk calculator, found at https://ob.tools/iol-calc, can be used in addition to the Bishop score by health care providers in counseling women who are undergoing an induction of labor and allocating appropriate resources for women at high risk for cesarean delivery.