bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dispensing a Naloxone Kit at Hospital Discharge: A Retrospective QI Project
Authors: Train Meghan K. , Patel Nilbhi , Thapa Kriti , Pasho Marissa , Acquisto Nicole M. 
Published: November 2020

ABSTRACT

Purpose:
The aim of this quality improvement (QI) project was to increase the coprescription of naloxone kits at patient discharge as a harm reduction strategy to combat the opioid epidemic. An interdisciplinary team identified hospitalized medical patients who were at high risk for an opioid overdose or opioid-related adverse event.

Methods:
Led by a physician champion, an interdisciplinary QI team composed of physicians (MDs and doctors of osteopathic medicine), advanced practice providers (NPs and physician assistants), RNs, care coordinators, social workers, and pharmacists developed and implemented a naloxone distribution program on one medical unit at an academic tertiary care center. The team developed and implemented criteria to identify high-risk patients, workflow for patient screening, staff and patient education programs, and processes for naloxone kit delivery to the patient's bedside. Data on naloxone kit distribution from the seven months prior to implementation (March 2018 to September 2018) and the seven months after implementation (October 2018 to April 2019) were evaluated and are reported descriptively.

Results:
Two patients preimplementation and 64 patients postimplementation received a naloxone kit at discharge. In the postimplementation group, common reasons for identifying a patient as at high risk for an overdose or adverse event were a prescription for a pain medication at a daily dosage greater than or equal to 50 morphine milligram equivalents (50% of patients), concomitant opioid and benzodiazepine use (19%), history of substance use disorder (11%), and medication-assisted treatment (9%). Most patients in the postimplementation group (86%) received a naloxone kit at a personal cost of $1 or less.

Conclusion:
This unit-based pilot project was successful in identifying patients at high risk for an opioid overdose or opioid-related adverse event and in providing naloxone kits and education at hospital discharge.
Posttraumatic osteoarthritis: what have we learned to advance osteoarthritis?
Authors: Watt Fiona E. 
Published: November 2020

Purpose of review
Current thinking in the study of posttraumatic osteoarthritis (PTOA) is overviewed: the osteoarthritis which follows acute joint injury. The review particularly highlights important publications in the last 18 months, also reflecting on key older literature, in terms of what have we have we learned and have yet to learn from PTOA, which can advance the osteoarthritis field as a whole.

Recent findings
PTOA is a mechanically driven disease, giving insight into mechanical drivers for osteoarthritis. A mechanosensitive molecular tissue injury response (which includes activation of pain, degradative and also repair pathways) is triggered by acute joint injury and seen in osteoarthritis. Imaging features of PTOA are highly similar to osteoarthritis, arguing against it being a different phenotype. The inflammatory pathways activated by injury contribute to early joint symptoms. However, later structural changes appear to be dissociated from traditional measures of synovial inflammation.

Summary
PTOA remains an important niche in which to understand processes underlying osteoarthritis and seek interventional targets. Whether PTOA has true molecular or clinical differences to osteoarthritis as a whole remains to be understood. This knowledge is important for a field where animal modelling of the disease relies heavily on the link between injury and osteoarthritis.
Lowest Instrumented Vertebra Selection in Posterior Cervical Fusion
Authors: Labrum Joseph T. , Khan Inamullah , Archer Kristin R. , Abtahi Amir M. , Stephens Byron F. 
Published: November 2020

Study Design.
Retrospective.

Objective.
The purpose of this study is to evaluate the effect of posterior cervical fusion lowest instrumented vertebra (PCF LIV) selection on incidence of mechanical failure, revision surgery, and patient-reported outcomes (PROs).

Summary of Background Data.
Recent studies indicate that the LIV in PCF may contribute to the risk of mechanical failure. To date, the evidence available to guide spine surgeons in the selection of PCF LIV remains limited.

Methods.
All patients undergoing PCF at a single institution were prospectively entered into a spine registry which was retrospectively queried. Data collection included demographics, pathology, operative variables, construct LIV, outcomes of mechanical failure, revision surgery, and patient-reported disability, pain, and quality of life.

Results.
Of 438 patients undergoing PCF from 2006 to 2019, 106 patients had an LIV of C7, T1, or T2, a minimum of 1-year follow-up, and met all study inclusion criteria. LIV cohorts were C7 LIV (36), T1 LIV (42), and T2 LIV (28). There were no between-group differences in patient demographics, operative variables, or postoperative follow-up across the three LIV cohorts. Mechanical failure rates for C7, T1, and T2 LIV were 30.6%, 23.8%, and 0%, respectively (P = 0.007). Revision rates for C7, T1, and T2 LIV were 25.0%, 11.9%, and 0%, respectively (P = 0.013). No difference was noted in average time to revision/failure between C7 (39.68 months) and T1 (29.85 months) LIV cohorts. No differences in baseline, 3-month, and 12-month postoperative PRO measures were noted in the C7 and T1 LIV cohort when compared to the T2 LIV cohort.

Conclusion.
The findings in this study indicate that PCF LIV selection may play a significant role in the development of mechanical complications and need for revision surgery. T2 LIV selection demonstrated a significantly lower rate of mechanical failure and revision surgery. Postoperative PROs up to 36 months are needed to evaluate effect of LIV selection on PROs.

Level of Evidence: 3
The Use of Mechanical Cardiopulmonary Resuscitation May Be Associated With Improved Outcomes Over Manual Cardiopulmonary Resuscitation During Inhospital Cardiac Arrests
Authors: Crowley Conor P. , Wan Emily S. , Salciccioli Justin D. , Kim Edy 
Published: November 2020

Objectives:
We aimed to investigate the impact of mechanical cardiopulmonary resuscitation devices over manual cardiopulmonary resuscitation on outcomes from inhospital cardiac arrests.

Design:
Restrospective review.

Setting:
Single academic medical center.

Participants:
Data were collected on all patients who suffered cardiac arrest from December 2015 to November 2019.

Main Outcomes and Measures:
Primary end point was return of spontaneous circulation. Secondary end points included survival to discharge and survival to discharge with favorable neurologic outcomes.

Results:
About 104 patients were included in the study: 59 patients received mechanical cardiopulmonary resuscitation and 45 patients received manual cardiopulmonary resuscitation during the enrollment period. Return of spontaneous circulation rate was 83% in the mechanical cardiopulmonary resuscitation group versus 48.8% in the manual group (p = 0.009). Survival-to-discharge rate was 32.2% in the mechanical cardiopulmonary resuscitation group versus 11.1% in those who received manual cardiopulmonary resuscitation (p = 0.02). Of the patients who survived to discharge and received mechanical cardiopulmonary resuscitation, 100% (n = 19) had a favorable neurologic outcome versus 40% (two out of five) of patients who survived and received manual cardiopulmonary resuscitation (p = 0.005).

Conclusions:
Our findings demonstrate a significant association of improved outcomes with mechanical cardiopulmonary resuscitation over manual cardiopulmonary resuscitation during inhospital cardiac arrests. Mechanical cardiopulmonary resuscitation may improve rates of return of spontaneous circulation, survival to discharge, and favorable neurologic outcomes.
Accuracy of Heparin-Binding Protein in Diagnosing Sepsis: A Systematic Review and Meta-Analysis
Authors: Wu Yi-Luen , Yo Chia-Hung , Hsu Wan-Ting , Qian Frank , Wu Bo-Sheng , Dou Qing-Li , Lee Chien-Chang 
Published: November 2020

OBJECTIVES:
Existing studies evaluating the accuracy of heparin-binding protein for the diagnosis of sepsis have been inconsistent. We conducted a systematic review and meta-analysis to assess the totality of current evidence regarding the utility of heparin-binding protein to diagnose sepsis in patients with presumed systemic infection.

DATA SOURCE:
PubMed, Embase, the China National Knowledge infrastructure, and WangFang electronic database were searched from inception to December of 2019.

STUDY SELECTION:
Two independent reviewers identified eligible studies. Cohort and case-control studies, which measured serum levels of heparin-binding protein among adult patients with suspected sepsis, were eligible for inclusion.

DATA EXTRACTION:
Two reviewers independently extracted data elements from the selected studies. A bivariate random-effects meta-analysis model was used to synthesize the prognostic accuracy measures. Risk of bias of studies was assessed with Quality Assessment of Diagnostic Accuracy Studies 2 tool.

DATA SYNTHESIS:
We identified 26 studies with 3,868 patients in the meta-analysis. Heparin-binding protein had a pooled sensitivity of 0.85 (95% CI, 0.79–0.90) and a pooled specificity of 0.91 (95% CI, 0.82–0.96) for the diagnosis of sepsis. There was low heterogeneity between the studies (I

2
= 12%), and no evidence of publication bias was detected. Heparin-binding protein had a higher sensitivity and specificity when compared with procalcitonin (0.75 [95% CI, 0.62–0.85] and 0.85 [95% CI, 0.73–0.92]) as well as C-reactive protein (0.75 [95% CI, 0.65–0.84] and 0.71 [95% CI, 0.63–0.77]). Serial measurements of heparin-binding protein also showed that heparin-binding protein levels rose significantly at least 24 hours before a diagnosis of sepsis.

CONCLUSIONS:
The diagnostic ability of heparin-binding protein is favorable, demonstrating both high sensitivity and specificity in predicting progression to sepsis in critically ill patients. Future studies could assess the incremental value that heparin-binding protein may add to a multimodal sepsis identification and prognostication algorithm for critically ill patients.
De Novo Renal Failure and Clinical Outcomes of Patients With Critical Coronavirus Disease 2019
Authors: Forest Stephen J. , Michler Robert E. , Skendelas John P. , DeRose Joseph J. , Friedmann Patricia , Parides Michael K. , Forest Stefanie K. , Chauhan Dhaval , Goldstein Daniel J. 
Published: November 2020

Objectives:
To describe the characteristics and outcomes associated with concomitant renal and respiratory failure in patients with critical coronavirus disease 2019.

Design, Setting, and PATIENTS:
This is a case series of patients from a U.S. healthcare system in New York City. All adult patients (≥ 18 yr) admitted to the hospital with positive coronavirus disease 2019 testing between March 10, 2020, and March 31, 2020, who required mechanical ventilatory support were included. Patients who remained hospitalized were followed through May 1, 2020.

Interventions:
Renal replacement therapy included at least one session of dialysis, continued venovenous hemofiltration, or peritoneal dialysis.

Measurements and Main Results:
Baseline characteristics, laboratory markers, 30-day in-hospital outcomes, ventilator days, and survival to discharge were included. Multivariate predictors for mortality and need for renal replacement therapy were identified. A total of 330 patients were included in this analysis and were most commonly greater than or equal to 70 years (40%), male (61%), Black or African American (41%), and Hispanic or Latino (38%). Renal replacement therapy was required in 101 patients (29%), most commonly among Blacks or African Americans (50%). Elevated d-dimer, C-reactive protein, and procalcitonin were associated with renal replacement therapy, compared with the nondialysis cohort. Overall, 243 patients (74%) died and 56 (17%) were discharged from the hospital, of which 9 (3%) required renal replacement therapy. Male sex (odds ratio, 2.0; 1.1–3.5; p = 0.020), Black race (odds ratio, 1.8; 1.0–3.1; p = 0.453), and history of hypertension (odds ratio, 2.7; 1.3–5.4; p = 0.005) were predictors for requiring renal replacement therapy. Risk factors for in-hospital mortality included age greater than or equal to 60 years (odds ratio, 6.2; 3.0–13.0; p < 0.0001), male sex (odds ratio, 3.0; 1.4–6.4; p = 0.004), and body mass index greater than or equal to 30 kg/m2 (odds ratio, 2.1; 1.0–4.4; p = 0.039). Concomitant renal failure in critical coronavirus disease 2019 was not a significant predictor of death (odds ratio, 2.3; 0.98–5.5; p = 0.057).

Conclusions:
This case series concludes that respiratory failure conveys significant mortality risk in patients with coronavirus disease 2019 and that survival with concomitant renal failure is rare.
Determinants of healing among patients with coronavirus disease 2019: the results of the SARS-RAS study of the Italian Society of Hypertension
Authors: Mancusi Costantino , Grassi Guido , Borghi Claudio , Carugo Stefano , Fallo Francesco , Ferri Claudio , Giannattasio Cristina , Grassi Davide , Letizia Claudio , Minuz Pietro , Muiesan Maria Lorenza , Perlini Stefano , Pucci Giacomo , Rizzoni Damiano , Salvetti Massimo , Sarzani Riccardo , Sechi Leonardo , Veglio Franco , Volpe Massimo , Iaccarino Guido 
Published: November 2020

Objective:
The burst of COVID-19 epidemics in Italy prompted the Italian Society of Hypertension to start an observational study to explore the characteristics of the hospitalized victims of the disease. The current analysis aimed to investigate the predictors of healing among Italian COVID-19 patients. We also assessed the effect of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers on the outcome.

Methods:
We designed a cross-sectional, observational, multicenter, nationwide survey in Italy to explore the demographic and clinical characteristics of patients with confirmed COVID-19 infection. We analyzed information from 2446 charts of Italian patients admitted for certified COVID-19 in 27 hospitals. Healing from COVID-19 infection, defined as two consecutive negative swabs, was reported in 544 patients (22.2%), 95% of them were hospitalized.

Results:
Age and Charlson Comorbidity Index were significantly lower in healing compared with nonhealing patients (63 ± 15 vs. 69 ± 15 and 2 ± 2 vs. 3 ± 2, both P < 0.05). In multivariable regression model, predictors of healing were younger age (OR: 0.99; 95% CI 0.98–0.99, P = 0.0001), absence of chronic kidney disease (OR: 0.35; 95% CI 0.17–0.70, P = 0.003) or heart failure (OR: 0.44; 95% CI, 0.28–0.70, P = 0.001). In the subgroup of patients suffering from hypertension and/or heart failure (n = 1498), no differences were observed in the use of ACE inhibitors and angiotensin receptor blockers.

Conclusion:
Our study demonstrated that younger age and absence of comorbidities play a major role in determining healing in patients with COVID-19. No effects of ACE inhibitors and angiotensin receptor blockers on the outcome was reported.
Longitudinal sleep characteristics and hypertension status: results from the Wisconsin Sleep Cohort Study
Authors: Moon Chooza , Hagen Erika W. , Johnson Heather M. , Brown Roger L. , Peppard Paul E. 
Published: November 2020

Aims:
Sleep characteristics such as short sleep duration or sleep-disordered breathing are established predictors of hypertension. However, few studies have used in-lab polysomnography with a longitudinal design to measure how hypertension is associated with different sleep stages over time. The purpose of this study is to examine whether hypertension is associated with the longitudinal course of sleep quality over time.

Methods:
The current study evaluated data from the Wisconsin Sleep Cohort Study, which consists of 1525 adults in a community-based population of middle-aged to older adults followed for approximately 12–25 years. Sleep characteristics were objectively measured using polysomnography and subjectively assessed using a self-report questionnaire on insomnia complaints. We used linear mixed-effects regression models and cumulative logit models to assess whether the interaction of hypertension and time is associated with objective and subjective sleep.

Results:
We found people with hypertension exhibited a greater decline in total sleep time in rapid eye movement sleep (%) over time than those without hypertension (P < 0.05). Individuals with hypertension had less decline in % N3 sleep over time than those without hypertension (P < 0.05). Among the subjective insomnia complaints, our findings indicate hypertensive individuals have a higher probability of having higher levels of ‘difficulties in falling asleep’ compared with people without hypertension.

Conclusion:
These findings suggest that hypertension is associated with modified longitudinal changes of objective and subjective sleep characteristics.
Relations of aortic stiffness with arterial damage beyond brachial pressure are both dependent and independent of central arterial pulsatile load
Authors: Motau Tshegofatso H. , Norton Gavin R. , Mmopi Keneilwe N. , Bello Hamza , Peterson Vernice R. , Libhaber Carlos , Sadiq Eitzaz , Naran Ravi , Da Silva Fernandes Daniel , Masiu Mohlabani , Mthembu Nonhlanhla , Gomes Monica , Monareng Taalib , Abdool-Carrim Talib , Veller Martin , Cassimjee Ismail , Peters Ferande , Modi Girish , Sareli Pinhas , Woodiwiss Angela J. 
Published: November 2020

Aim:
We aimed to determine whether the impact of aortic stiffness on atherosclerotic or small vessel end organ damage beyond brachial blood pressure depends in-part on stiffness-induced increases in central arterial pressures produced by an enhanced resistance to flow (characteristic impedance, Zc).

Methods:
We studied 1021 participants, 287 with stroke or critical limb ischaemia, and 734 from a community sample with atherosclerotic or small vessel end organ measures. Central arterial haemodynamics were determined from arterial pressure (SphygmoCor) and velocity and diameter assessments in the outflow tract (echocardiography).

Results:
Although Zc and carotid–femoral pulse wave velocity (PWV) were correlated (P < 0.0001), these relations were not independent of confounders (P = 0.90). Both Zc and hence central arterial pressures generated by the product of Zc and aortic flow (Q) (PQxZc), as well as PWV were independently associated with carotid intima–media thickness, estimated glomerular filtration rate (eGFR), endothelial activation markers [vascular cell adhesion molecule-1 (V-CAM-1)] and events. With further adjustments for brachial pulse pressure (PP) or SBP, PWV and PQxZc were both associated with eGFR and V-CAM-1. Relationships between PWV and eGFR or V-CAM-1 were independent of PQxZc (P < 0.05) and relationships between PQxZc and eGFR and V-CAM-1 were independent of PWV (P < 0.005). Similarly, with adjustments for confounders and brachial PP or SBP, across the full adult lifespan, both aortic PWV and PQxZc were increased in those with arterial events (P < 0.005). Relationships between PWV and events were again independent of PQxZc (P < 0.005) and between PQxZc and events were independent of PWV (P < 0.0001).

Conclusion:
Beyond brachial blood pressure, the impact of aortic stiffness on arterial damage involves effects that are both dependent (proximal aortic Zc and hence PQxZc) and independent (full aortic length indexed by PWV) of central arterial pulsatile load. Hence, PWV and brachial PP may be insufficient to account for all of the damage mediated by increases in aortic stiffness.
Familial tendency for hypertension is associated with increased vascular stiffness
Authors: Wexler Yehuda , Avivi Ishay , Barak Lanciano Sapir , Haber Kaptsenel Ella , Bishara Hana , Palacci Hagar , Chaiat Chen , Nussinovitch Udi 
Published: November 2020

Objective:
Hypertension is the leading cause of cardiovascular disease and premature death. New methods for early detection of hypertension and its consequences can reduce complications arising from uncontrolled hypertension. Pulse-wave velocity (PWV), a measure of arterial stiffness, has been recognized as a valuable tool in assessing risk for cardiovascular complications, although its use in clinical practice is currently limited. Here we examine whether brachial--ankle PWV (baPWV) and femoral--ankle PWV (faPWV) are elevated in nonhypertensive volunteers, with and without a history of familial hypertension.

Methods:
Volunteers were recruited and questioned as to their medical background and family history. Participants were divided into two groups based on history of familial hypertension and were measured for baPWV and faPWV. Carotid--femoral PWV was computed from these measurements.

Results:
A total of 82 healthy nonhypertensive volunteers (mean age 31.4 ± 9.6) were recruited. Among the study cohort, 43.7% had a history of familial hypertension. There were no between-group differences in any other clinical or demographic characteristics. Both baPWV and faPWV were significantly elevated in volunteers with a history of familial hypertension (10.86 ± 1.69 vs. 9.68 ± 1.52 m/s, P < 0.004, and 7.01 ± 1.65 vs. 6.28 ± 1.26 m/s, P < 0.028, respectively).

Conclusion:
Volunteers with a history of familial hypertension present with elevated baPWV and faPWV. This is suggestive of increased central and peripheral arterial stiffness in susceptible individuals before the onset of hypertension. Routine measurement of these parameters may allow for early intervention and risk stratification, especially in persons with a history of familial hypertension.
Late-onset Neonatal Infections 1997 to 2017 Within a Cohort in Western Sweden—The Last 21 Years of a 43-Year Surveillance
Authors: Gudjonsdottir Margrét Johansson , Hentz Elisabet , Adlerberth Ingegerd , Tessin Ingemar , Trollfors Birger , Elfvin Anders 
Published: November 2020

Background:
The objective of the study was to assess the epidemiology of late-onset (LO) neonatal invasive infections with surveillance covering 43 years, starting from 1975.

Methods:
Observational epidemiologic, retrospective study including a cohort of infants born in western Sweden in 1997–2017, who had a positive blood and cerebral spinal fluid culture between 3 and 120 days of age. A comparison was made of the incidence between 1997–2007 and 2008–2017. Data on LO infections during 3–27 days of life were assessed from 1975.

Results:
A total of 473 cases of LO infections were registered in 437 patients. The incidence increased from 2.0 to 3.1/1000 live births (LB) between 1997–2007 and 2008–2017 (P < 0.001). The increase in incidence was most pronounced among infants born <28 weeks gestation (from 255 to 398/1000 LB, P < 0.001). The most frequent pathogens were Staphylococcus aureus (25%), coagulase-negative staphylococci (17%), and Escherichia coli (13%). Infections due to group B Streptococci rose from 0.16/1000 LB to 0.33 (P = 0.03). During the whole surveillance period from 1975 to 2017, there were 579 cases between 3 and 27 days of life. Although the incidence increased in 2008–2017 to 1.9/1000 LB after first declining in 1997–2007, the case-fatality rate continued to decline from 27/284 (9.5%) between 1975 and 1996 to 6/182 (3.3%) in 2008 and 2017 (P = 0.01).

Conclusions:
The incidence of LO neonatal invasive infections increased during the study period (1997–2017), but the case-fatality rate remained lower than in the previous surveillance period (1975–1996). Further surveillance and interventions with focus on prevention is critical to counteract the increasing incidence among high-risk infants.