bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and External Validation of an Online Clinical Prediction Model for Augmented Renal Clearance in Adult Mixed Critically Ill Patients: The Augmented Renal Clearance Predictor
Authors: Gijsen Matthias , Huang Chao-yuan , Flechet Marine , Van Daele Ruth , Declercq Peter , Debaveye Yves , Meersseman Philippe , Meyfroidt Geert , Wauters Joost , Spriet Isabel 
Published: October 2020

Objectives:
Augmented renal clearance might lead to subtherapeutic plasma levels of drugs with predominant renal clearance. Early identification of augmented renal clearance remains challenging for the ICU physician. We developed and validated our augmented renal clearance predictor, a clinical prediction model for augmented renal clearance on the next day during ICU stay, and made it available via an online calculator. We compared its predictive performance with that of two existing models for augmented renal clearance.

Design:
Multicenter retrospective registry-based cohort study.

Setting:
Three Belgian tertiary care academic hospitals.

Patients:
Adult medical, surgical, and cardiac surgery ICU patients.

Interventions:
None.

Measurements and Main Results:
Development of the prediction model was based on clinical information available during ICU stay. Out of 33,258 ICU days, we found augmented renal clearance on 19.6% of all ICU days in the development cohort. We retained six clinical variables in our augmented renal clearance predictor: day from ICU admission, age, sex, serum creatinine, trauma, and cardiac surgery. We assessed performance by measuring discrimination, calibration, and net benefit. We externally validated the final model in a single-center population (n = 10,259 ICU days). External validation confirmed good performance with an area under the curve of 0.88 (95% CI 0.87–0.88) and a sensitivity and specificity of 84.1 (95% CI 82.5–85.7) and 76.3 (95% CI 75.4–77.2) at the default threshold probability of 0.2, respectively.

Conclusions:
Augmented renal clearance on the next day can be predicted with good performance during ICU stay, using routinely collected clinical information that is readily available at bedside. Our augmented renal clearance predictor is available at www.arcpredictor.com.
Adjustable 6-0 polypropylene flanged technique for scleral fixation, part 2: repositioning of subluxated IOLs
Authors: Assia Ehud I. , Wong John X.H. 
Published: October 2020

Purpose:
To describe the technique of modified adjustable flange scleral fixation using 6-0 polypropylene sutures for repositioning of subluxated intraocular lenses (IOLs).

Setting:
Center for Applied Eye Research, Meir Medical Center, and the Ein-Tal Eye Center, Israel.

Design:
Case series.

Methods:
Subluxated capsular-fixated posterior chamber IOLs are secured to the sclera using 6-0 polypropylene sutures looped around the IOL haptics. This method can be performed for any type of IOL: hydrophobic, hydrophilic, silicone, or poly(methyl methacrylate); 1-piece or 3-piece; and with either closed-loop or open-loop haptics. It can also be used in conjunction with capsular stabilizing devices.

Results:
In the 18 cases performed, successful repositioning with stable and central fixation of the IOLs was achieved. One eye required a repeated surgery due to suture slippage. The eyes recovered relatively quickly with noted quiescence as early as 1 week postoperatively. Patients did not complain of ocular irritation from the subconjunctival flange up to the 6-month follow-up period. In 1 case, a flange was exposed postoperatively but the patient refused additional intervention and developed intraocular infection 7 months postoperatively.

Conclusions:
The adjustable 6-0 polypropylene flanged technique for IOL repositioning and scleral fixation was a relatively quick and simple method for management of subluxated IOLs. Complete coverage of the flange by conjunctiva and Tenon layer must be confirmed at the end of surgery.
Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic
Authors: Spatz Diane Lynn , Froh Elizabeth B. 
Published: October 2020

Abstract
For new families giving birth in a hospital setting, the COVID-19 pandemic has presented numerous challenges to their birth, breastfeeding, and postpartum experiences. We present experiences of three first-time, healthy mothers and their babies, as they gave birth in the hospital and were breastfeeding during the start of the pandemic in Philadelphia, PA. Each case is framed in the mother's prenatal goals, infant feeding intentions, birth, breastfeeding, and postpartum experiences. Shared concerns and experiences among the three participants are described in five key areas: 1) Recommendations changing every day, 2) Guilt, concern, and stress, 3) In-person versus telehealth visits, 4) Missing time with family and friends, and 5) Silver linings. Through these mothers' experiences, nurses and other health care providers can learn from their perceptions and events and proactively work to ensure we provide sound anticipatory guidance, enhance our communication, and improve provision of evidence-based lactation care and support.
Tenofovir alafenamide vs. tenofovir disoproxil fumarate: an updated meta-analysis of 14 894 patients across 14 trials
Authors: Pilkington Victoria , Hughes Sophie L. , Pepperrell Toby , McCann Kaitlyn , Gotham Dzintars , Pozniak Anton L. , Hill Andrew 
Published: October 2020

Background:
Both tenofovir disoproxil fumarate (TDF)/emtricitabine and tenofovir alafenamide (TAF)/emtricitabine demonstrate excellent efficacy and safety overall, but concerns remain over specific changes in markers of bone and renal function. Lower plasma tenofovir concentrations are seen with TAF and in unboosted regimens. We assess TAF vs. TDF safety with and without booster coformulation.

Methods:
A previous systematic review was updated with recent clinical trials. TAF vs. TDF efficacy and safety were compared in boosted and unboosted subgroups. Efficacy was measured by viral suppression. Key safety endpoints included all adverse events, serious adverse events, Grades 3–4 adverse events and adverse event discontinuation. Further specific renal and bone markers were also assessed.

Results:
A total of 14 clinical trials comparing TDF and TAF regimens were identified. A significant difference (P = 0.0004) in efficacy was shown in the boosted subgroup in favour of TAF, but no difference was seen in the unboosted subgroup. There were no significant differences between TAF and TDF for any of the key safety endpoints analysed. No differences were seen for the bone markers analysed. No difference was found for renal tubular events. There was a difference in risk for discontinuation due to renal adverse events when boosted (P = 0.03), but none when unboosted.

Conclusion:
Across all main safety endpoints, no differences between TAF and TDF are seen. Boosted TDF regimens were associated with lesser comparative efficacy than boosted TAF and a higher risk of renal event discontinuation. However, modern antiretroviral regimens are more commonly unboosted. This study finds no difference in efficacy or safety in unboosted TAF vs. TDF.
Changes in weight and BMI with first-line doravirine-based therapy
Authors: Orkin Chloe , Elion Richard , Thompson Melanie , Rockstroh Juergen K. , Alvarez Bognar Fernando , Xu Zhi J. , Hwang Carey , Sklar Peter , Martin Elizabeth A. 
Published: October 2020

Objective:
To evaluate changes in weight and BMI in adults with HIV-1 at 1 and 2 years after starting an antiretroviral regimen that included doravirine, ritonavir-boosted darunavir, or efavirenz.

Design:
Post-hoc analysis of pooled data from three randomized controlled trials.

Methods:
We evaluated weight change from baseline, weight gain at least 10%, and increase in BMI after 48 and 96 weeks of treatment with doravirine, ritonavir-boosted darunavir, or efavirenz-based regimens. Risk factors for weight gain and metabolic outcomes associated with weight gain were also examined.

Results:
Mean (and median) weight changes were similar for doravirine [1.7 (1.0) kg] and ritonavir-boosted darunavir [1.4 (0.6) kg] and were lower for efavirenz [0.6 (0.0) kg] at week 48 but were similar across all treatment groups at week 96 [2.4 (1.5), 1.8 (0.7), and 1.6 (1.0) kg, respectively]. No significant differences between treatment groups were found in the proportion of participants with at least 10% weight gain or the proportion with BMI class increase at either time point. Low CD4+ T-cell count and high HIV-1 RNA at baseline were associated with at least 10% weight gain and BMI class increase at both timepoints, but treatment group, age, sex, and race were not.

Conclusion:
Weight gains over 96 weeks were low in all treatment groups and were similar to the average yearly change in adults without HIV-1. Significant weight gain and BMI class increase were similar across the treatment groups and were predicted by low baseline CD4+ T-cell count and high baseline HIV-1 RNA.
What is the Treatment Role of Transpapillary Cholecystostomy for Delayed Cholecystectomy in the Coexistence of Acute Cholecystitis and Cholangitis
Authors: Gumusoglu Alpen Y. , Kabuli Hamit A. , Kones Osman , Karabulut Mehmet , Akbulut Sezer , Akarsu Cevher , Peker Kivanc D. , Adas Gokhan 
Published: October 2020

Introduction:
This study aims to investigate the role of main bile duct drainage and gallbladder transpapillary drainage in the treatment of patients who diagnosed with acute cholecystitis and acute cholangitis because of choledocholithiasis.

Materials and Methods:
Patients who were admitted to the hospital with the diagnosis of acute cholecystitis between January 2018 and December 2019, have hyperbilirubinemia in their laboratory tests, and who were diagnosed with choledochal stone by magnetic resonance imaging and magnetic resonance cholangiopancreatography imaging because of the findings of cholangitis were included in this study. These patients underwent endoscopic retrograde cholangiopancreatography (ERCP) and choledochus stone extraction procedure and gallbladder drainage with the transpapillary pigtail. The demographic data, success rates, and complications of the patients were evaluated.

Results:
A total of 19 patients were included in the study. Choledochus was cannulated in all patients, but gallbladder drainage could not be achieved in 2 patients. These 2 patients were recorded under the unsuccessful method use. Although 2 patients could not be operated because of high comorbidity (American Society of Anesthesiologists IV), they underwent percutaneous cholecystostomy because of the development of cholecystitis arising from an obstruction in the pigtail catheter in the 11th and 12th weeks. Treatments of the remaining 15 patients and subsequent cholecystectomy procedures were successful. The mean age of the patients was 54.52 years. Of the patients, 9 were female and 6 were male. In the 6th week of follow-up, 15 patients underwent laparoscopic cholecystectomy with ERCP 1 day after removal of the stent and pigtail catheter.

Conclusions:
Transpapillary cholecystectomy with ERCP is a successful method of treatment in patients with acute cholecystitis with the symptoms of cholangitis because of choledochal stone.
An Analysis of Free-hand Targeting in Laparoscopic Liver Microwave Ablation
Authors: Li Pengpeng , Erten Ozgun , Akbulut Serkan , Gokceimam Mehmet , Berber Eren 
Published: October 2020

Background:
Recently, new technologies have been developed for antenna placement in laparoscopic liver tumor ablation (LLTA). At this point, it is important to analyze the efficacy of free-hand targeting to identify deficiencies and opportunities for improvement.

Methods:
This was an institutional review board-approved retrospective study. Video recordings of 30 consecutive patients with 77 lesions who underwent LLTA were reviewed. Tumor-specific anatomic and targeting-related parameters were analyzed using χ2, t test, and regression analyses.

Results:
Neuroendocrine metastasis was the dominant tumor type, with median tumor size 1.4 cm (range, 0.5 to 5.2). In total, 41 (53%) tumors were superficial and 36 (47%) deep. In 68 lesions (88%), an optimal targeting was achieved with first attempt, without a need for repositioning; whereas 9 lesions (12%) required repositioning of antenna. For 37% (15/41) of superficial and 56% (20/36) of deep lesions, a straight avascular needle trajectory was not present, requiring steering of the antenna around vascular and biliary structures. All procedures were completed laparoscopically without bleeding or biliary complications. Local treatment recurrence rate in follow-up was 10% (n=8).

Conclusions:
This study shows that in experienced hands, LLTA through free-hand technique is safe and efficacious, providing an accurate targeting with the first pass in 90% of tumors. Although newer technology is being developed to guide less-experienced surgeons in needle targeting, it should be kept in mind that a straight trajectory is not available for 1/3 of superficial and half of deep lesions. Hence, ablation surgeons need to develop free-hand skills to avoid possible hemorrhagic and biliary complications in LLTA.
Combined head and abdominal blunt trauma in the hemodynamically unstable patient: What takes priority?
Authors: Jakob Dominik A. , Benjamin Elizabeth R. , Cho Jayun , Demetriades Demetrios 
Published: October 2020

BACKGROUND
The management of hypotensive patients with severe combined head and abdominal trauma is challenging, regarding the need, timing, and sequence of craniotomy or laparotomy. The purpose of the present study was to determine whether rare situations requiring craniotomy prior to laparotomy can be identified on admission with simple clinical parameters. We hypothesized that hypotension is rarely associated with the need of a combined procedure, especially in patients with mildly depressed consciousness.

METHODS
National Trauma Data Bank study, including adult blunt trauma patients with combined severe head (Abbreviated Injury Scale score, ≥ 3) and abdominal injury (Abbreviated Injury Scale score, ≥ 3). Data collection included demographic and clinical characteristics, laparotomy, and craniotomy within 24 hours of admission, types of intracranial pathologies, survival, and hospital stay. Multivariate regression analysis was used to determine factors predictive for the need of both operative procedures.

RESULTS
Of 25,585 patients with severe combined head and abdominal trauma, 8,744 (34.2%) needed only laparotomy, 534 (2.1%) only craniotomy, and 394 (1.5%) required both procedures within 24 hours of admission. In the subgroup of 4,667 hypotensive patients, 2,421 (51.9%) underwent only laparotomy, 54 (1.2%) only craniotomy, and 79 (1.7%) both procedures within 24 hours of admission. Only 5 (0.7%) of 711 hypotensive patients with Glasgow Coma Scale (GCS) score above 8 who required a laparotomy also needed a craniotomy. Among clinical parameters available on patient’s arrival, GCS score of 7 to 8 was independently associated with the highest need for craniotomy in hypotensive patients requiring laparotomy (odds ratio, 7.94; p = 0.004).

CONCLUSION
The need for craniotomy in patients with severe combined head and abdominal injury requiring exploratory laparotomy is very low. In hypotensive patients requiring laparotomy, GCS score of 7 to 8 was an independent predictor of the need for craniotomy. In hemodynamically unstable patients with a GCS score greater than 8, it may be safer to proceed with a laparotomy first and address the head with a computed tomography scan at a later stage.

LEVEL OF EVIDENCE
Therapeutic, Level IV.
Duration of Supplemental Oxygen Requirement and Predictors in Severe COVID-19 Patients in Ethiopia: A Survival Analysis
Authors: Leulseged Tigist W. , Hassen Ishmael S. , Edo Mesay G. , Abebe Daniel S. , Maru Endalkachew H. , Zewde Wuletaw C. , Chamiso Nigat W. , Jagema Tariku B. 
Published: October 2020

ABSTRACTBackgroundWith the rising number of new cases of COVID-19, understanding the oxygen requirement of severe patients assists in identifying at risk groups and in making an informed decision on building hospitals capacity in terms of oxygen facility arrangement. Therefore, the study aimed to estimate time to getting off supplemental oxygen therapy and identify predictors among COVID-19 patients admitted to Millennium COVID-19 Care Center in Ethiopia.MethodsA prospective observational study was conducted among 244 consecutively admitted COVID-19 patients from July to September, 2020. Kaplan Meier plots, median survival times and Log-rank test were used to describe the data and compare survival distribution between groups. Cox proportional hazard survival model was used to identify determinants of time to getting off supplemental oxygen therapy, where hazard ratio (HR), P-value and 95%CI for HR were used for testing significance and interpretation of results.ResultsMedian time to getting off supplemental oxygen therapy among the studied population was 6 days (IQR, 4.3-20.0). Factors that affect time to getting off supplemental oxygen therapy were age group (AHR=0.52,95%CI=0.32,0.84, p-value=0.008 for ≥70 years) and shortness of breath (AHR=0.71,95%CI=0.52,0.96, p-value=0.026).ConclusionsAverage duration of supplemental oxygen therapy requirement among COVID-19 patients was 6 days and being 70 years and older and having shortness of breath were found to be associated with prolonged duration of supplemental oxygen therapy requirement. This result can be used as a guide in planning institutional resource allocation and patient management to provide a well-equipped care to prevent complications and death from the disease.
The Statistical Monitoring by Adaptive RMSTD Tests: an efficient, informative, and customizable method for the complete internal quality control intended for low-frequent sampling of control measures
Authors: Beier Christian 
Published: October 2020

AbstractTwo control mechanisms are relevant to perform an internal quality assurance: a permissible limit LSMC applied to single measures of control samples and a retrospective statistical analysis to detect increased imprecision and baseline drifts. A common statistical metric is the root mean square (total) deviation (RMSD/RMSTD). To focus on recent changes under low-frequent sampling conditions, the monitored amount of retrospective data is usually very small. Unfortunately, the calculated RMSTD of a small data set with n<50 samples has a significant statistical uncertainty that needs to be considered in adequate limit definitions. In particular, the minimum reasonable limit LRMSTD(n), applied to the RMSTD of a series of n samples, decreases from LSMC (e.g., 2.33*standard_deviation+bias) for n=1 towards Ltrue_RMSTD for n→∞ (long-term statistics). Two mathematical approaches were derived to reliably estimate an optimal function to adjust LRMSTD(n) to small sample sizes.This knowledge led to the development of a new quality-control method: the Statistical Monitoring by Adaptive RMSTD Tests (SMART). SMART requires just one mandatory limit (either LSMC or Ltrue_RMSTD) per analyte. By definition of up to 7 possible alert levels, SMART can early recognize and evaluate both the significance of a single outlier and establishing critical trends or shifts in recent SMC data. SMART is intended to efficiently monitor and evaluate small amounts of control data.
The Characteristics of Health Care Workers with COVID-19 and Relationship Between COVID-19 Mortality and BCG/Tuberculosis History: a multi-center study
Authors: Torun Ş , Özkaya Ş , Şen N , Kanat F , Karaman I , Yosunkaya Ş , Dikiş Ö Ş , Asan A , Eroğlu S A , Atal S S , Ayten Ö , Aksel N , Ermiş H , Özçelik N , Demirelli M , Kara İ , Sümer Ş , Marakoğlu K , Üzer F , Uyar Y , Çiçek T , Ünsal Z E , Vatansev H , Yıldırım B B , Kuruoğlu T , Atilla A , Ersoy Y , Kandemir B , Durduran Y , Cihan F G , Demirbaş N , Yıldırım F , Akcay M S 
Published: October 2020

AbstractBackgroundToday, COVID-19 pandemic has brought countries’ health services into sharp focus. Despite the low incidence of cases(1.2%) and high mortality rate(2.4%) among Turkish population, the low mortality rate(0.3%) despite the high incidence(11.5%) declared in healthcare workers drew our group’s attention. Therefore, we aimed to report the characteristics of infected health-care workers and investigate the relationship between BCG vaccine and tuberculosis history with COVID-19 mortality in infected health-care worker population.MethodThis study was conducted in three hospitals to assess the clinical presentations, disease severity and correlation with BCG vaccine and tuberculous history in COVID-19 positive health-care workers by an online questionnaire platform. The relationship between characteristics and tuberculosis history were investigated according to hospitalization status of the patients.ResultTotal of 465 infected healthcare workers included in the study. The rate of history of direct care and contact to tuberculosis patient, presence of previous tuberculosis treatment and BCG scar, presence of radiological infiltrations was significantly higher in hospitalized healthcare workers. The ratio of direct care and direct contact to the patient with tuberculosis, and presence of family history of tuberculosis were statistically significantly higher in patients with radiological infiltrations.ConclusionAlthough COVID-19 risk and incidence are higher among healthcare workers compared to the normal population due to higher virus load, this study brings evidence for the fact that the lower mortality rate seen in infected healthcare workers might be due to healthcare workers’ frequent exposure to tuberculosis bacillus and the mortality-reducing effects of BCG vaccine, despite the higher hospitalization rate and radiological infiltrations due to over-triggered immune system.