bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Antibiotic Discontinuation Strategies on Mortality and Infectious Complications in Critically Ill Septic Patients: A Meta-Analysis and Trial Sequential Analysis*
Authors: Arulkumaran Nishkantha , Khpal Muska , Tam Karen , Baheerathan Aravindhan , Corredor Carlos , Singer Mervyn 
Published: February 2020

Objective:
To investigate methods of antibiotic duration minimization and their effect on mortality and infectious complications in critically ill patients.

Data Sources:
A systematic search of PubMed, Embase (via Ovid), clinicaltrials.gov, and the Cochrane Central Register of Controlled Trials (via Wiley) (CENTRAL, Issue 2, 2015).

Study Selection:
Randomized clinical trials comparing strategies to minimize antibiotic duration (days) for patients with infections or sepsis in intensive care.

Data Extraction:
A systematic review with meta-analyses and trial sequential analyses of randomized clinical trials. Dichotomous data are presented as relative risk (95% CIs) and p value, and continuous data are presented as mean difference (CI) and p value.

Data Synthesis:
We included 22 randomized clinical trials (6,046 patients). Strategies to minimize antibiotic use included procalcitonin (14 randomized clinical trials), clinical algorithms (two randomized clinical trials), and fixed-antibiotic duration (six randomized clinical trials). Procalcitonin (–1.23 [–1.61 to –0.85]; p < 0.001), but not clinical algorithm–guided antibiotic therapy (–7.41 [–18.18 to 3.37]; p = 0.18), was associated with shorter duration of antibiotic therapy. The intended reduction in antibiotic duration ranged from 3 to 7 days in fixed-duration antibiotic therapy randomized clinical trials. Neither procalcitonin-guided antibiotic treatment (0.91 [0.82–1.01]; p = 0.09), clinical algorithm–guided antibiotic treatment (0.67 [0.30–1.54]; p = 0.35), nor fixed-duration antibiotics (1.21 [0.90–1.63]; p = 0.20) were associated with reduction in mortality. Z-curve for trial sequential analyses of mortality associated with procalcitonin-guided therapy did not reach the trial sequential monitoring boundaries for benefit, harm, or futility (adjusted CI, 0.72–1.10). Trial sequential analyses for mortality associated with clinical algorithm and fixed-duration treatment accumulated less than 5% of the required information size. Despite shorter antibiotic duration, neither procalcitonin-guided therapy (0.93 [0.84–1.03]; p = 0.15) nor fixed-duration antibiotic therapy (1.06 [0.74–1.53]; p = 0.75) was associated with treatment failure.

Conclusions:
Although the duration of antibiotic therapy is reduced with procalcitonin-guided therapy or prespecified limited duration, meta-analysis and trial sequential analyses are inconclusive for mortality benefit. Data on clinical algorithms to guide antibiotic cessation are limited.
Prognostic Significance of Preoperative Prognostic Nutritional Index in Patients Undergoing Nephrectomy for Nonmetastatic Renal Cell Carcinoma
Authors: Kim Se Joong , Kim Sun Il , Cho Dae Sung 
Published: February 2020

Objective:The objective of this study was to assess the value of a preoperative Prognostic Nutritional Index (PNI) for predicting the survival of patients with nonmetastatic renal cell carcinoma (RCC) treated with partial or radical nephrectomy.Materials and Methods:The medical records of 480 patients with RCC who underwent partial or radical nephrectomy at 2 institutions between June 1994 and July 2017 were retrospectively reviewed. After the exclusion of 21 patients with lymph node or distant metastasis, the data of 459 patients with nonmetastatic RCC were included. The PNI was calculated using a combination of serum albumin level and lymphocyte count in the peripheral blood, as described previously. The prognostic significance of various clinicopathologic variables, including the PNI, was assessed in univariate and multivariate analyses.Results:The univariate analysis identified anemia, PNI, tumor size, T stage, Fuhrman nuclear grade, sarcomatoid differentiation, and lymphovascular invasion as significant prognostic factors of recurrence-free survival (RFS) and cancer-specific survival (CSS). In the multivariate analysis, anemia (P=0.010), PNI (P<0.001), tumor size (P<0.001), T stage (P<0.001), Fuhrman nuclear grade (P=0.023), sarcomatoid differentiation (P=0.003), and lymphovascular invasion (P=0.005) were independent prognostic factors for RFS, versus anemia (P=0.020), PNI (P=0.002), tumor size (P<0.001), T stage (P<0.001), sarcomatoid differentiation (P<0.001), and lymphovascular invasion (P=0.018) for CSS.Conclusions:The PNI is an independent prognostic factor for RFS and CSS in patients with nonmetastatic RCC treated with partial or radical nephrectomy. It may, therefore, be a useful tool for predicting recurrence and survival in these patients.
Cosmetic Tattooing and Early Onset Basal Cell Carcinoma: A Population-based Case–Control Study from New Hampshire
Authors: Barton Dorothea Torti , Zens Michael S. , Marmarelis Eleni L. , Gilbert-Diamond Diane , Karagas Margaret R. 
Published: February 2020

Background:
Cosmetic tattoos use dyes with carcinogenic potential. Skin cancers arising in tattoos have been reported.

Methods:
We investigated whether risk of early onset basal cell carcinoma was related to the site and colors of cosmetic tattoos as part of a population-based case–control study of cases (ages 25–50 years), identified from a state-wide surveillance system, and age- and gender-matched controls, selected from driver’s license records, randomly assigned an anatomic site of the cases.

Results:
One hundred fifty-six cases (17%) with early onset basal cell carcinoma and 213 controls (26%) reported cosmetic tattoos. Among those with tattoos, the adjusted odds ratio of basal cell carcinoma at the tattoo site compared to another site was 1.8 (95% confidence interval = 1.0, 3.2). We observed the strongest associations for yellow and green tattoo colors.

Conclusion:
Our preliminary findings support the possibility of an enhanced risk of early onset basal cell carcinomas at the site of cosmetic tattoos.
The Tenons’ Layer Reposition Approach of Trabeculectomy: A Longitudinal Case Series of a Mixed Group of Glaucoma Patients
Authors: Chan Poemen P. , Wong Liam Y.N. , Chan Tommy C.Y. , Lai Gilda , Baig Nafees 
Published: February 2020

Synopsis:
This 1-year prospective study demonstrated that the Tenon’s layer reposition approach of trabeculectomy could achieve zero leakage rate, minimal rate of transient hypotony without compromising the surgical outcome.

Purpose:
The purpose of this study was to investigate the effectiveness and safety of a Tenon’s layer reposition approach of trabeculectomy.

Methods:
A prospective, noncomparative case series of 30 eyes of 30 Chinese patients with mixed types of glaucoma who underwent fornix-based trabeculectomy combined with intraoperative mitomycin C application. During the conjunctival flap closure, the Tenons’ layer was identified, separated, and anchored on to the sclera surface with 8/0 vicryl, followed by conjunctival closure with 10/0 nylon as a separate layer. All patients were followed up for 1 year. Assessment including intraocular pressure (IOP), vertical cup-disc ratio measurement, best-corrected visual acuity, and visual field examination were performed before and after the operation. Qualified and complete success was defined as IOP of ≤21 mm Hg in 2 consecutive visits with or without medication, respectively. Outcomes were evaluated using scattered plot and Kaplan-Meier survival curve.

Results:
Twenty-one eyes (70%) and 28 eyes (93.3%) achieved complete and partial success at 1 year, respectively. There was a significant reduction of IOP (28.5±9.6 to 15.5±2.6 mm Hg, P<0.001) and medication use (4.4±0.9 to 0.8±1.2 bottles/eye, P<0.001). There were no significant changes in best-corrected visual acuity, vertical cup-disc ratio, and visual field indices. No wound leak was identified throughout the study. The procedure did not induce significant astigmatic change. Other postoperative complications, including 2 eyes (6.7%) with transient hypotony and 1 eye (3.3%) required cataract surgery, were of relatively low rate.

Conclusion:
The Tenon’s layer reposition approach of performing trabeculectomy is a safe and efficacious procedure for Chinese subjects with different types of glaucoma.
Tear Meniscus Imaging by Anterior Segment-Optical Coherence Tomography in Medically Controlled Glaucoma
Authors: Agnifili Luca , Brescia Lorenza , Scatena Barbara , Oddone Francesco , Figus Michele , Perna Fabiana , Doronzo Emanuele , D’Ugo Erminia , Mastropasqua Leonardo 
Published: February 2020

Purpose:
The purpose of this study was to investigate the tear meniscus in medically controlled glaucoma patients (MCGP) using anterior segment-optical coherence tomography (AS-OCT).

Materials and Methods:
Fifty-six MCGP, 24 patients with evaporative dry eye (EDE), and 30 healthy subjects (controls), were enrolled. MCGP were divided into group 1 (14 eyes): β-blockers; group 2 (14 eyes): prostaglandin analogs; group 3 (28 eyes) ≥2 drugs. Ocular Surface Disease Index (OSDI) questionnaire, tear film break-up time, corneal fluorescein staining, Schirmer Test I, and tear meniscus height (lower and upper: L-TMH, U-TMH) and area (L-TMA, U-TMA) using AS-OCT, were performed.

Results:
OSDI score was higher (P<0.05) in patients with EDE and in group 3 compared with groups 1, 2, and controls. No significant differences were found between group 3 and patients with EDE for all clinical parameters. L-TMA was significantly lower in groups 1 to 3 (P<0.05) and in EDE patients (P<0.001) compared with controls, and it was lower in group 3 and in EDE patients compared with groups 1 and 2 (P<0.05). L-TMH was lower in groups 1 to 3 and in EDE patients compared with controls (P<0.001), and in EDE patients and in group 3 compared with groups 1 and 2 (P<0.05). U-TMA was lower in EDE and MCGP groups compared with controls (P<0.05). L-TMA and L-TMH negatively correlated with OSDI score (P<0.01, r=−0.379 and P<0.01, r=−0.352, respectively).

Conclusions:
AS-OCT permits a noninvasive and reliable tear meniscus imaging in medically controlled glaucoma, depicting the glaucoma-related ocular surface disease as a dry eye disease–like condition. Thus, reduced values of TMH and TMA can be proposed as structural indicators of glaucoma therapy–related ocular surface disease.
Detection of Respiratory Viruses in the Clinical Outcome of Children With Fever and Neutropenia
Authors: Cerdeira Barreiro Natalia , Santiago-García Begoña , Casas Inmaculada , Pozo Francisco , Santos Sebastián Mar , Navarro Marisa , Mata Cristina , Garrido-Colino Carmen , Catalán Pilar , Hernández-Rupérez Belén , Huerta Jorge , Rincón-López Elena , Beléndez Cristina , García-Morín Marina , Cela Elena , Hernández-Sampelayo Teresa , Saavedra-Lozano Jesús 
Published: February 2020

Background:
Several evidence-based guidelines for the management of children with febrile neutropenia (FN) have been published, with special focus in bacterial and fungal infections. However, the role of acute respiratory infections caused by respiratory viruses (RV) has not been clearly established. The aim of this study was to evaluate the epidemiology, clinical presentation and outcome of acute respiratory infections in children with FN.

Methods:
Patients, <18 years of age admitted to the Pediatric Oncology-Hematology Unit after developing FN between November 2010 and December 2013, were prospectively included in the study. Children were evaluated by clinical examination and laboratory tests. Nasopharyngeal sample was obtained for detection of RV.

Results:
There was a total of 112 episodes of FN in 73 children admitted to the hospital during a 32-month period. According to disease severity, 33% of the episodes were considered moderate or severe. Rhinovirus was the most frequently detected RV (66.6%; 24/36), followed by parainfluenza. On regard to clinical outcome, RV-infected children developed fewer episodes of moderate or severe FN compared with non-RV infected children (16.7% vs. 33.3%; P = 0.08).

Conclusions:
A great proportion of children with FN admitted to a tertiary hospital had a RV isolation. The rate of this RV isolation was significantly higher when a rapid molecular test was used compared with conventional microbiologic methods. Rhinovirus was the most frequently isolated, although its role as an active agent of acute infection was not clear. Children with FN and a RV isolate had a lower rate of severe disease.
The Incidence of Tuberculosis in Infants, Siaya District, Western Kenya
Authors: Nduba Videlis , Kaguthi Grace , van’t Hoog Anna H. , Mitchell Ellen M. H. , Borgdorff Martien 
Published: February 2020

Background:
Infants are a target population for new tuberculosis (TB) vaccines. TB incidence estimates are needed to guide the design of trials. To determine the TB incidence and cohort retention among young children using comprehensive diagnostic methods in a high burden area.

Methods:
Infants 0–42 days were enrolled. Through 4 monthly follow-up and unscheduled (sick) visits up to the age of 2 years, infants with presumptive TB based on a history of contact, TB symptoms or pre-determined hospitalization criteria were admitted to a case verification ward. Two induced sputa and gastric aspirates were collected for culture and GeneXpert. Mantoux and HIV tests were done. Clinical management was based on the Keith Edwards score. Cases were classified into microbiologically confirmed or radiologic, diagnosed by blinded expert assessment. Cox regression was used to identify risk factors for incident TB and study retention.

Results:
Of 2900 infants enrolled, 927 (32%) developed presumptive TB, 737/927 (80%) were investigated. Sixty-nine TB cases were diagnosed (bacteriologic and radiologic). All TB incidence was 2/100 person-years of observation (pyo) (95% CI: 1.65–2.65). Nine were bacteriologic cases, incidence 0.3/100 pyo. The radiologic TB incidence was 1.82/100 pyo. Bacteriologic TB was associated with infant HIV infection, higher Keith Edwards scores. Completeness of 4-month vaccinations and HIV infection were positively associated with retention.

Conclusions:
TB incidence was high. An all TB endpoint would require a sample size of a few thousand children, but tens of thousands, when limited to bacteriologic TB.
The Influence of Caregiver Preparedness on Caregiver Contributions to Self-care in Heart Failure and the Mediating Role of Caregiver Confidence
Authors: Vellone Ercole , Biagioli Valentina , Durante Angela , Buck Harleah G. , Iovino Paolo , Tomietto Marco , Colaceci Sofia , Alvaro Rosaria , Petruzzo Antonio 
Published: February 2020

Background
Caregiver contributions (CC) to heart failure (HF) self-care maintenance (ie, CC to maintaining HF stability) and management (ie, CC to dealing with HF signs and symptoms) improve patient outcomes, but it is unknown whether caregiver preparedness influences CC to self-care and whether caregiver confidence mediates this process.

Objectives
We evaluated the influence of caregiver preparedness on CC to HF self-care maintenance and management and the mediating role of caregiver confidence.

Methods
This is a secondary analysis of the MOTIVATE-HF study. Patients were 18 years or older, with a diagnosis of HF in New York Heart Association classes II to IV, who had insufficient self-care and did not have severe cognitive impairment. Patients' informal caregivers were those people inside or outside the family who gave most of the informal care to the patients. We used the Caregiver Preparedness Scale and the Caregiver Contribution to Self-Care of HF Index. We tested a path analysis model and the indirect effects.

Results
Caregivers (n = 323) were 55 (SD, 15) years old on average and predominantly female (77%). The path analysis showed that higher scores in caregiver preparedness were associated with higher scores in caregiver confidence. In turn, higher caregiver confidence was associated with higher CC to self-care maintenance and management. Caregiver confidence mediated the association between caregiver preparedness and CC to self-care maintenance and management.

Conclusions
Caregiver confidence may play a role in CC to self-care. Interventions to improve CC to HF self-care should not only be focused on improving caregiver preparedness but also should consider the role of caregiver confidence.
Adults Living With a Retro-auricular Left Ventricular Assist Device as Destination Therapy
Authors: Luciani Michela , Trenta Alessia Martina , Jack Susan Michelle , Moro Massimo , Patella Sara , Di Mauro Stefania , Ausili Davide 
Published: February 2020

Background
Increasingly, there is a trend toward the use of left ventricular assist devices (LVADs) for treating advanced heart failure, as both bridge-to-transplant therapy and destination therapy. Living with an LVAD profoundly influences patients' lives. Only a few study authors investigated the experience of people with abdominal LVADs, and nothing is known about the unique experience of those with retro-auricular LVADs.

Objective
The aim of this study was to explore and describe experiences and lifestyle adjustments in adults with retro-auricular LVADs implanted as destination therapy.

Methods
Interpretive description methodology was used to explore the experiences of a purposeful sample of 10 individuals with retro-auricular LVADs implanted as destination therapy. Data were collected using in-depth semistructured interviews. Data collection and analysis were simultaneous. Triangulation, journaling, and the “thoughtful clinician test” were used to increase trustworthiness of the findings.

Results
Three primary themes describing the experience of people with retro-auricular LVADs were developed: “a new life,” “self-care,” and “resilience”; in addition, a crosscutting theme was identified: “support system.” This article focuses on the theme “a new life,” described as a continuum of events. Individuals with advanced heart failure struggle with symptom burden and consider the implantation of the device as the final option to delay death; then, they wait for the surgery that represents a turning point, after which they begin to recover through a process of adjustment until they reach a new normality.

Conclusions
Living with a retro-auricular LVAD impacts every aspect of people's lives. Knowing their experiences can help clinicians to develop targeted interventions and offer tailored support.
Examining Adherence to Medication in Patients With Atrial Fibrillation
Authors: Taylor Elaina Charlotte , O'Neill Mark , Hughes Lyndsay D. , Bennett Peter , Moss-Morris Rona 
Published: February 2020

Background/ObjectivesThis study examined whether beliefs about medicines, drug attitudes, and depression independently predicted anticoagulant and antiarrhythmic adherence (focusing on the implementation phase of nonadherence) in patients with atrial fibrillation (AF).MethodsThis cross-sectional study was part of a larger longitudinal study. Patients with AF (N = 118) completed the Patient Health Questionnaire-8. The Beliefs about Medicines Questionnaire, Drug Attitude Inventory, and Morisky-Green-Levine Medication Adherence Scale (self-report adherence measure), related to anticoagulants and antiarrhythmics, were also completed. Correlation and multiple logistic regression analyses were conducted.ResultsThere were no significant differences in nonadherence to anticoagulants or antiarrhythmics. Greater concerns (r= 0.23,P= .01) were significantly, positively associated with anticoagulant nonadherence only. Depression and drug attitudes were not significantly associated with anticoagulant/antiarrhythmic adherence. Predictors reliably distinguished adherers and nonadherers to anticoagulant medication in the regression model, explaining 14% of the variance, but only concern beliefs (odds ratio, 1.20) made a significant independent contribution to prediction (χ2= 11.40,P= .02, withdf= 4). When entered independently into a regression model, concerns (odds ratio, 1.24) significantly explained 10.3% of the variance (χ2= 7.97,P= .01, withdf= 1). Regressions were not significant for antiarrhythmic medication (P= .30).ConclusionsSpecifying medication type is important when examining nonadherence in chronic conditions. Concerns about anticoagulants, rather than depression, were significantly associated with nonadherence to anticoagulants but not antiarrhythmics. Anticoagulant concerns should be targeted at AF clinics, with an aim to reduce nonadherence and potentially modifiable adverse outcomes such as stroke.
How Healthcare Professionals in Cardiac Care Address Depressive Symptoms
Authors: Westas Mats , Lundgren Johan , Mourad Ghassan , Neher Margit , Johansson Peter 
Published: February 2020

Background
Depressive symptoms are common in patients with cardiovascular disease (CVD) and are associated with a poorer quality of life and prognosis. Despite the high prevalence and negative consequences, the recognition of depressive symptoms is low. More knowledge about patients' perceptions of how depressive symptoms are addressed by healthcare professionals is therefore needed.

Objectives
The aim of this study was to explore the experiences of patients with CVD of how healthcare professionals address and manage depressive symptoms in clinical cardiac care encounters.

Methods
A qualitative, semistructured interview study was performed. Data were analyzed using inductive thematic analysis.

Results
In total, 20 patients with CVD previously treated for depressive symptoms were included (mean age, 62 [range, 34–79] years; 45% women). Three main themes emerged: (1) “not being seen as a whole person,” (2) “denying depressive symptoms,” and (3) “being provided with help.” The patients perceived that healthcare professionals mainly focused on somatic symptoms and disregarded their need for help for depressive symptoms when patients raised the issue. Some patients stated that they received help for depressive symptoms, but this depended on the patients' own ability to communicate their needs and/or having social support that could alert them to the importance of doing so. Patients also described that they downplayed the burden of depressive symptoms and/or did not recognize themselves as having depressive symptoms.

Conclusion
Depressive symptoms were overlooked in patients with CVD, and psychological needs had not been met. A good ability to address needs and having good social support were useful for receiving help with depressive symptoms.
How does Organizational Climate Motivate Employee Safe and Healthy Behavior in Small Business?
Authors: Schwatka Natalie V. , Sinclair Robert R. , Fan Wenyi , Dally Miranda , Shore Erin , Brown Carol E. , Tenney Liliana , Newman Lee S. 
Published: February 2020

Objective:
This study evaluates the motivational processes between employee occupational safety and health climates and behaviors using the Theory of Self-Determination in a sample of diverse small businesses.

Methods:
We used cross-sectional data to assess whether employee safety/health intrinsic, identified, and external motives mediate the relationship between safety/health climate and behavior.

Results:
All three types of motivation mediated the relationship between safety and health climates and behaviors.

Conclusion:
Small businesses seeking to engage employees in Total Worker Health efforts should build strong safety and health climates because of their influence on employees’ motivation to participate in health promoting and health protective programs.