bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cutaneous Angiosarcoma of Head and Neck – A Single-Centre Analysis
Authors: Wollina Uwe , Koch André , Hansel Gesina , Schönlebe Jacqueline , Lotti Torello , Vojvodic Aleksandra 
Published: November 2019

BACKGROUND: Cutaneous angiosarcoma of the head and neck region is a subtype of cutaneous angiosarcoma with an unfavourable prognosis. Diagnosis is often delayed.
PATENTS AND METHODS: The setting is an Academic Teaching Hospital Skin Cancer Center. Eight Caucasian patients could be identified, 5 men and 3 women. Delay to diagnosis was between 12 to 4 months (mean 7.8 ± 2.9 months). The diagnosis was confirmed in all cases by histopathology and immunohistochemistry. Hematoxylin-eosin, Giemsa, PAS, iron and reticulin stains were performed. Endothelial markers such as CD31, CD34, and Ki67 for proliferation assessment were used in all tumours. Other markers used included pan-cytokeratin (CK), CK7, CK20, ERG, CD 40 and c-MYC. Tumours were classified as localised versus multifocal or diffuse form. Tumour staging was performed according to the 8th edition of the AJCC. The mean age of patients was 79 years ± 26.4 years. The male to female ratio was 1.7. Tumour classification was diffuse in 2 patients, multilocular in one and localised in 5 patients. In 5 of 8 patients, a multimodal treatment was performed, one had radiotherapy alone, in another patient surgery was performed, and radiotherapy is planned. The mean OS was 26.4 months ± 24.5 months.
CONCLUSION: Cutaneous angiosarcoma of the head and neck is an aggressive tumour with a poor prognosis. Although surgery remains a cornerstone of treatment, the tumour size at first presentation may be too large, and the elderly patients maybe not suitable for extensive surgery. Therefore, multimodal treatment with adjuvant radiotherapy and/ or chemotherapy is necessary. Multimodal treatment offers a better outcome than radiotherapy or chemotherapy alone. Stealth liposomal encapsulated doxorubicin is a therapeutic option for elderly patients with improved safety compared to conventional doxorubicin.
Entrevista com Katemari Diogo Rosa
Authors: Casagrande Lindamir Salete , Freitas Lucas Bueno de 
Published: November 2019

Chegou a hora de apresentarmos a primeira entrevista com uma mulher negra (acho que já passou da hora, mas enfim, agora aconteceu.) e ela é Katemari Diogo Rosa, Física e professora da Universidade Federal da Bahia. Katemari nos conta sobre sua trajetória de vida na qual percebe-se que foi um caminho de muito trabalho e dedicação. As conquistas não foram fáceis, mas foram muito importantes. Katemari é uma pessoa inspiradora, e como o mundo está precisando de inspiração! Nas próximas páginas vocês poderão conhecer um pouco mais dessa mulher negra, que eu considero vitoriosa e exemplar. Ela nos mostra que, por mais que haja dificuldades, há motivos para seguir na luta. Em sua fala, percebe-se uma mulher confiante e otimista, características fundamentais para se inserir, manter e crescer em uma sociedade que, muitas vezes, se mostra machista, racista, homofóbica, misógina, ou seja, plena de preconceitos. Katemari, tão generosamente nos atendeu e despendeu de seu tempo para responder a essa entrevista e contribuir com os Cadernos de Gênero e Tecnologia, fato que agradecemos imensamente. Convidamos a todas e todos a esta leitura na certeza de que será um momento agradável, enriquecedor e inspirador.
The Use of Cold Compression Dressings After Total Knee Replacement: A Randomized Controlled Trial
Authors: Webb J M , Williams D , Ivory J P , Day S , Williamson D M 
Published: November 2019

ABSTRACT
This prospective, controlled study compared cold compressive dressings with wool and crepe in the postoperative management of patients undergoing total knee replacement (TKR). Forty TKR patients were assessed for blood loss, pain, swelling, and range of motion. Patients in the cold compression group had less blood loss through suction drainage (982 ml versus 768 ml). A higher proportion of patients in the treatment group did not require blood transfusion postoperatively. Mean opiate requirements were lower in the cold compression group (0.57 versus 0.71 mg/kg/48 hours). The cold compression device appeared to reduce blood loss and pain following TKR.
Exposure of Intensive Care Unit Nurses to Nitric Oxide and Nitrogen Dioxide During Therapeutic Use of Inhaled Nitric Oxide in Adults With Acute Respiratory Distress Syndrome
Authors: Qureshi Mohammed A. , Shah Nipurn J. , Hemmen Carol W. , Thill Mary C. , Kruse James A. 
Published: November 2019

• Background Although low concentrations of inhaled nitric oxide may by therapeutic, both nitric oxide and its oxidation product nitrogen dioxide are potentially toxic. The threshold limits for time-weighted average concentrations of nitric oxide and nitrogen dioxide issued by the American Conference of Governmental Industrial Hygienists are 25 and 3 ppm, respectively. The concentrations of these gases in the breathing space of hospital personnel during administration of nitric oxide to adult patients have not been reported.• Methods Air was sampled from the breathing zone of intensive care unit nurses via collar-mounted tubes during the nurses’ routine duties attending patients who were receiving inhaled nitric oxide at 5 or 20 ppm. The exhaust ports of the mechanical ventilators were left open to the room. Nitric oxide and nitrogen dioxide were chemically assayed as nitrite from sorbent tubes by using spectrophotometry. Ambient nitric oxide levels were measured at sequential distances from the ventilator by using chemiluminescence.• Results The time-weighted average concentrations of inspired gas for nurses during inhaled nitric oxide treatment were 0.45 ppm or less for nitric oxide and less than 0.29 ppm for nitrogen dioxide. Nitric oxide levels at the ventilator during delivery at 20 ppm were 9.2 ppm, but dropped off markedly beyond 0.6 m (2 ft), to a mean of about 30 ppb.• Conclusion Inhaled nitric oxide therapy at doses up to 20 ppm does not appear to pose a risk of excessive occupational exposure to nitric oxide or nitrogen dioxide to nurses during routine delivery of critical care.
Improving Family Communications at the End of Life: Implications for Length of Stay in the Intensive Care Unit and Resource Use
Authors: Ahrens Tom , Yancey Valerie , Kollef Marin 
Published: November 2019

• Background Inadequate communication persists between healthcare professionals and patients and patients’ families in intensive care units. Unwanted or ineffective treatments can occur when patients’ goals of care are unknown or not honored, increasing costs and care. Having the primary physician provide medical information and then having a physician and clinical nurse specialist team improve opportunities for patients and their families to process that information could improve the situation. This model has not been tested for its effect on patients’ outcomes and resource utilization.• Objectives To evaluate the effect of a communication team that included a physician and a clinical nurse specialist on length of stay and costs for patients near the end of life in the intensive care unit.• Methods During a 1-year period, patients judged to be at high risk for death (N = 151) were divided into 2 groups: 43 patients who were cared for by the medical director teamed with a clinical nurse specialist and 108 patients who received standard care, provided by an attending physician.• Results Compared with the control group, patients in the intervention group had significantly shorter stays in both the intensive care unit (6.1 vs 9.5 days) and the hospital (11.3 vs 16.4 days) and had lower fixed ($15 559 vs $24 080) and variable ($5087 vs $8035) costs.• Conclusions Use of a physician and a clinical nurse specialist focused on improving communication with patients and patients’ families reduced lengths of stay and resource utilization.
Risk of Colonization of Central Venous Catheters: Catheters for Total Parenteral Nutrition Vs Other Catheters
Authors: Dimick Justin B. , Swoboda Sandra , Talamini Mark A. , Pelz Robert K. , Hendrix Craig W. , Lipsett Pamela A. 
Published: November 2019

• Background Infected central venous catheters cause morbidity and mortality.• Objective To compare the risk for colonization of central venous catheters used for total parenteral nutrition with that of catheters used for other purposes.• Methods Retrospective review of prospectively acquired data on 260 patients with a stay in a surgical intensive care unit longer than 3 days. Single-lumen catheters used solely for total parenteral nutrition were inserted into the subclavian vein and cared for by a dedicated team. Catheters for other purposes were placed and cared for by other staff. Catheters were cultured if clinical findings suggested infection.• Results Of 854 central venous catheters, 61 (7%) were used for total parenteral nutrition. During 4712 catheter days of observation, 89 catheters of all types were colonized. Risk factors for colonization included duration of catheterization (P &lt; .001), having 3 or more lumens (hazard ratio, 1.7; 95% CI, 1.1–2.6), pulmonary artery catheterization (hazard ratio, 1.7; 95% CI, 1.1–2.7), and placement in the internal jugular vein (hazard ratio, 1.6; 95% CI, 1.1–2.5). Catheters used for total parenteral nutrition (hazard ratio, 0.14; 95% CI, 0.04–0.57) and those in the subclavian vein (hazard ratio, 0.51; 95% CI, 0.3–0.8) were at lower risk of colonization. In a multivariate Cox model, the only significant factor was a 5-fold lower risk of infection for catheters used for total parenteral nutrition (hazard ratio, 0.19; 95% CI, 0.04–0.83).• Conclusion Rates of colonization were lowest for catheters used solely for total parenteral nutrition, suggesting that a team approach improves patients’ care.
Evaluation of Chemical Dot Thermometers for Measuring Body Temperature of Orally Intubated Patients
Authors: Potter Patricia , Schallom Marilyn , Davis Susan , Sona Carrie , McSweeney Maryellen 
Published: November 2019

• Background Recent research indicates that oral measurement of body temperature is a reliable option in orally intubated patients. In situations such as protective isolation, where dedicated electronic thermometers are not available, are single-use chemical dot thermometers an acceptable alternative?• Objective To determine the accuracy of single-use chemical dot thermometers in orally intubated adult patients.• Methods Subjects included a convenience sample of 85 adult patients admitted to 1 of 2 intensive care units (surgical trauma and neuroscience). For each patient, oral temperatures were measured concurrently (within 5 minutes) with a chemical dot thermometer and an electronic thermometer. The sequence of temperature measurements was alternated with each subsequent patient. Both thermometers were placed in the same posterior sublingual pocket opposite the side of the endotracheal tube.• Results Measurements obtained with electronic and single-use chemical dot thermometers correlated strongly (r = 0.937). With the chemical dot thermometer, body temperature was overestimated in 11.8% of the measurements and underestimated in 10.8% of the measurements by 0.4°C or more. The difference between oral temperatures measured with the 2 different thermometers was not related to the patient’s age, sex, or sublingual pocket location or to the order of thermometer use.• Conclusion The chemical dot thermometer is useful and reliable for measuring body temperature of orally intubated patients. When measurements of body temperature have important consequences for decisions about treatment, clinicians should use an electronic thermometer to confirm measurements made with a chemical dot thermometer.
Paramedic and Emergency Department Care of Stroke: Baseline Data From a Citywide Performance Improvement Study
Authors: Wojner Anne W. , Morgenstern Lewis , Alexandrov Andrei V. , Rodriguez Diana , Persse David , Grotta James C. 
Published: November 2019

• Background Rapid diagnosis and transport by paramedics and efficient, effective emergency management are essential to improving care of acute stroke patients.
• Objectives To measure the performance of paramedics and emergency departments providing care for patients with suspected acute stroke.
• Methods Two stroke centers and 4 other hospitals where most patients with acute stroke in Houston, Tex, are admitted participated. Hospital and paramedic performance data were collected prospectively on 446 patients with suspected acute stroke transported by paramedics between September 1999 and February 2000.
• Results Paramedics had a sensitivity of 66%, specificity of 98%, and overall accuracy of 72% in diagnosing stroke. For patients with suspected stroke, 58.5% arrived in the emergency department within 120 minutes of symptom onset; in confirmed cases, that percentage was 67%. Mean total transport time was 42.2 minutes and was significantly longer (P &lt; .001) to inner-city hospitals (44 minutes) than to suburban, community-based centers (39 minutes). Door to computed tomography times were significantly (P &lt; .001) shorter for the 2 stroke centers than the other hospitals. Overall thrombolysis treatment rate among patients with confirmed ischemic stroke was 7.4% (range, 0–19.4%); treatment rates at the 2 stroke centers were 5.9% and 19.4%.
• Conclusions More than half of patients with suspected stroke arrive at hospitals while thrombolytic treatment is still feasible. Although the current rate for thrombolytic treatment in Houston exceeds the national rate, performance of paramedics and hospitals in treating acute stroke can be improved by increasing efficiency and standardizing medical practices.
Management of Patients in the Intensive Care Unit: Comparison Via Work Sampling Analysis of an Acute Care Nurse Practitioner and Physicians in Training
Authors: Hoffman Leslie A. , Tasota Frederick J. , Scharfenberg Carmella , Zullo Thomas G. , Donahoe Michael P. 
Published: November 2019

• Background Little is known about aspects of practice that differ between acute care nurse practitioners and physicians that might affect patients’ outcomes.• Objective To determine if time spent in work activities differs between an acute care nurse practitioner and physicians in training (pulmonary/critical care fellows) managing patients’ care in a step-down medical intensive care unit.• Methods Work sampling techniques were used to collect data when the nurse practitioner had 6 months’ or less experience in the role (T1), after the nurse practitioner had 12 months’ experience in the role (T2), and when physicians in training provided care on a rotational schedule (nurse practitioner not present, T3). These data were used to estimate the time spent in direct management of patients, coordination of care, and nonunit activities.• Results Results for T1 and T2 were similar. When T2 and T3 were compared, the nurse practitioner and the physicians in training spent approximately half their time in activities directly related to management of patients (40% vs 44%, not significantly different). The nurse practitioner spent more time in activities related to coordination of care (45% vs 18%; P &lt; .001) and less time in nonunit activities (15% vs 37%; P &lt; .001).• Conclusion The nurse practitioner and the physicians in training spent a similar proportion of time performing required tasks. Because of training requirements, physicians spent more time than the nurse practitioner in nonunit activities. Conversely, the nurse practitioner spent more time interacting with patients and patients’ families and collaborating with health team members.
Comparison of 3 Methods of Detecting Acute Respiratory Distress Syndrome: Clinical Screening, Chart Review, and Diagnostic Coding
Authors: Howard April E. , Courtney-Shapiro Carrie , Kelso Lynn A. , Goltz Michele , Morris Peter E. 
Published: November 2019

• Background Although the incidence of acute respiratory distress syndrome has been studied, few researchers have prospectively assessed the search tool used to identify cases.
• Methods For 5 months, all patients admitted to a medical intensive care unit in a teaching hospital were evaluated daily to determine whether criteria for acute respiratory distress syndrome were met, and physicians’ progress notes and discharge summaries for these prospectively identified patients were reviewed for mention of the syndrome. Discharge forms were reviewed for the codes (International Classification of Diseases, Ninth Revision) specific to acute respiratory distress syndrome (518.82 or 518.85).
• Results Of 314 patients admitted, 65 prospectively met the criteria for acute respiratory distress syndrome. Of these 65 patients, 31 had acute respiratory distress syndrome mentioned in their progress notes, and 4 of the 31 were subsequently assigned a code of 518.82 or 518.85. Patients with a physician’s notation for acute respiratory distress syndrome in their charts had a higher mortality (22/31 [71%]) than did the patients with no such notation (10/34 [29%]). This difference could not be accounted for by differences in length of stay, mean age, score on Acute Physiology and Chronic Health Evaluation III, or number of days in the unit before meeting the criteria.
• Conclusions The incidence of acute respiratory distress syndrome is underestimated when based on either diagnostic coding or physicians’ notes without testing of the accuracy of coding. Both physicians and medical record coding specialists may require training in use of terms related to acute respiratory distress syndrome.
Nocturnal Care Interactions with Patients in Critical Care Units
Authors: Tamburri Linda M. , DiBrienza Roseann , Zozula Rochelle , Redeker Nancy S. 
Published: November 2019

• Background Sleep deprivation is common in critically ill patients and may have long-term effects on health outcomes and patients’ morbidity. Clustering nocturnal care has been recommended to improve patients’ sleep.• Objectives To (1) examine the frequency, pattern, and types of nocturnal care interactions with patients in 4 critical care units; (2) analyze the relationships among these interactions and patients’ variables (age, sex, acuity) and site of admission to the intensive care unit; and (3) analyze the differences in patterns of nocturnal care activities among the 4 units.• Methods A randomized retrospective review of the medical records of 50 patients was used to record care activities from 7 PM to 7 AM in 4 critical care units.• Results Data consisted of interactions during 147 nights. The mean number of care interactions per night was 42.6 (SD 11.3). Interactions were most frequent at midnight and least frequent at 3 AM. Only 9 uninterrupted periods of 2 to 3 hours were available for sleep (6% of 147 nights studied). Frequency of interactions correlated significantly with patients’ acuity scores (r = 0.32, all Ps &lt; .05). A sleep-promoting intervention was documented for only 1 of the 147 nights, and 62% of routine daily baths were provided between 9 PM and 6 AM.• Conclusions The high frequency of nocturnal care interactions left patients few uninterrupted periods for sleep. Interventions to expand the period around 3 AM when interactions are least common could increase opportunities for sleep.
Pain Levels Experienced With Activities After Cardiac Surgery
Authors: Milgrom Lesley B. , Brooks Jo Ann , Qi Rong , Bunnell Karen , Wuestefeld Susie , Beckman Daniel 
Published: November 2019

• Background Acute pain is common after cardiac surgery and can keep patients from participating in activities that prevent postoperative complications. Accurate assessment and understanding of pain are vital for providing satisfactory pain control and optimizing recovery.• Objectives To describe pain levels for 5 activities expected of patients after cardiac surgery on postoperative days 1 to 6 and changes in pain levels after chest tube removal and extubation.• Methods Adults who underwent cardiac surgery were asked to rate the pain associated with various types of activities on postoperative days 1 to 6. Pain levels were compared by postoperative day, activity, and type of cardiac surgery. Pain scores before and after chest tube removal and extubation also were analyzed.• Results Pain scores were higher on earlier postoperative days. The order of overall pain scores among activities (P &lt; .01) from highest to lowest was coughing, moving or turning in bed, getting up, deep breathing or using the incentive spirometer, and resting. Changes in pain reported with coughing (P=.03) and deep breathing or using the incentive spirometer (P = .005) differed significantly over time between surgery groups. After chest tubes were discontinued, patients had lower pain levels at rest (P = .01), with coughing (P=.05), and when getting up (P=.03).• Conclusions Pain relief is an important outcome of care. A comprehensive, individualized assessment of pain that incorporates activity levels is necessary to promote satisfactory management of pain.
Appropriately Timed Analgesics Control Pain Due to Chest Tube Removal
Authors: Puntillo Kathleen , Ley S. Jill 
Published: November 2019

• Background Pain during chest tube removal can be moderately to severely intense and distressful to patients. Little evidence-based research has guided clinicians in attempts to alleviate such pain.• Objective To test pharmacological and nonpharmacological interventions to alleviate pain during chest tube removal in cardiac surgery patients.• Methods Four interventions were tested in 74 patients in a randomized, double-blind study: (1) 4 mg intravenous morphine and procedural information; (2) 30 mg intravenous ketorolac and procedural information; (3) 4 mg intravenous morphine plus procedural and sensory information; and (4) 30 mg intravenous ketorolac plus procedural and sensory information. Analgesics were administered to correspond to peak effect, and scripted information was provided. Pain intensity and pain distress were measured before analgesic administration, immediately after chest tube removal, and 20 minutes later. Pain quality was measured immediately after chest tube removal. Level of sedation was measured before and 20 minutes after chest tube removal. Repeated-measures analyses of variance were used to test differences among groups over time.• Results Pain intensity, pain distress, and sedation levels did not differ significantly among groups. However, procedural pain intensity (mean 3.26, SD 3.00) and pain distress (mean 2.98, SD 3.18) scores for all were low. Patients remained alert, regardless of which analgesic was administered.• Conclusions If used correctly, either an opioid (morphine) or a nonsteroidal anti-inflammatory (ketorolac) can substantially reduce pain during chest tube removal without causing adverse sedative effects. Thus, clinicians may choose among several safe and effective analgesic interventions during chest tube removal.
Comparison of Cardiac Output Determined by Bioimpedance, Thermodilution, and the Fick Method
Authors: Engoren Milo , Barbee Daniel 
Published: November 2019

• Background Cardiac output can be determined by using a variety of methods.• Objectives To determine the precision and bias between 3 methods for determining cardiac output: bioimpedance, thermodilution, and the Fick method.• Methods Cardiac output was determined by using bioimpedance via neck and thorax patches and thermodilution via pulmonary artery catheter in 46 patients in the intensive care unit. A subset of 15 patients also had cardiac output determined by using the Fick method.• Results Mean (SD) cardiac output in all patients was 6.3 (2.2) L/min by thermodilution and 5.6 (2.0) L/min by bioimpedance. In the 15 patients in whom all 3 methods were used, mean cardiac output was 6.0 (1.7) L/min by thermodilution, 5.3 (1.7) L/min by bioimpedance, and 8.6 (4.5) L/min by the Fick method. Bias and precision (mean difference ± 2 SDs) were 0.7 ± 2.9 L/min between thermodilution and bioimpedance, 1.7 ± 3.8 L/min between the Fick method and thermodilution, and 2.4 ± 4.7 L/min between the Fick method and bioimpedance.• Conclusion Bioimpedance, thermodilution, and Fick determinations of cardiac outputs are not interchangeable in a heterogenous population of critically ill patients.