bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative Predictors of Better Long-term Functional Ability and Decreased Pain Following LSS Surgery
Authors: Tuomainen Iina , Pesonen Janne , Rade Marinko , Pakarinen Maarit , Leinonen Ville , Kröger Heikki , Airaksinen Olavi , Aalto Timo 
Published: January 2020

Study Design.
A prospective observational 10-year follow-up study.

Objective.
This study aimed to examine preoperative predictors for better surgical outcomes in patients with lumbar spinal stenosis (LSS) 10 years after surgery.

Summary of Background Data.
LSS is a leading cause of low back surgery in patients older than 65 years. Limited data are available for predictors of long-term surgical outcomes in patients with LSS.

Methods.
At the baseline, 102 patients with LSS underwent decompressive surgery, and 72 of the original study sample participated in a 10-year follow-up study. Study patients filled out a questionnaire preoperatively, and follow-up data were collected at 3 months, 6 months, 1 year, 2 years, 5 years, and 10 years postoperatively. Surgical outcomes were evaluated in terms of disability with the Oswestry Disability Index (ODI) and pain with the visual analog scale (VAS). Predictors in the models were nonsmoking status, absence of previous lumbar surgery, self-rated health, regular use of painkillers for symptom alleviation, and BMI. Statistical analyses included longitudinal associations, subgroup analyses, and cross-sectional analyses.

Results.
Using multivariate analysis, statistically significant predictors for lower ODI and VAS scores at 10 years were nonsmoking status, absence of previous lumbar surgery, better self-rated health, and regular use of painkillers for <12 months. Patients who smoked preoperatively or had previous lumbar surgery experienced more pain and disability at the 10-year follow-up.

Conclusion.
These study results can enhance informed decision-making processes for patients considering surgical treatment for LSS by showing preoperative predictors for surgical outcomes up to 10 years after surgery. Smokers and patients with previous lumbar surgery showed a decline in surgical benefits after 5 years.

Level of Evidence: 3
Demographic Shifts, Case Mix, Activity, and Outcome for Elderly Patients Admitted to Adult General ICUs in England, Wales, and Northern Ireland
Authors: Jones Andrew , Toft-Petersen Anne P. , Shankar-Hari Manu , Harrison David A. , Rowan Kathryn M. 
Published: January 2020

Objectives:
Major increases in the proportion of elderly people in the population are predicted worldwide. These population increases, along with improving therapeutic options and more aggressive treatment of elderly patients, will have major impact on the future need for healthcare resources, including critical care. Our objectives were to explore the trends in admissions, resource use, and risk-adjusted hospital mortality for older patients, admitted over a 20-year period between 1997 and 2016 to adult general ICUs in England, Wales, and Northern Ireland.

Design: Retrospective analysis of national clinical audit database.Setting:
The Intensive Care National Audit & Research Centre Case Mix Programme Database, the national clinical audit for adult general ICUs in England, Wales, and Northern Ireland.

Patients:
All adult patients 16 years old or older admitted to adult general ICUs contributing data to the Case Mix Programme Database between January 1, 1997, and December 31, 2016.

Measurements and Main Results:
The annual number, trends, and outcomes for patients across four age bands (16–64, 65–74, 75–84, and 85+ yr) admitted to ICUs contributing to the Case Mix Programme Database from 1997 to 2016 were examined. Case mix, activity, and outcome were described in detail for the most recent cohort of patients admitted in 2015–2016. Between 1997 to 2016, the annual number of admissions to ICU of patients in the older age bands increased disproportionately, with increases that could not be explained solely by general U.K. demographic shifts. The risk-adjusted acute hospital mortality decreased significantly within each age band over the 20-year period of the study. Although acute severity at ICU admission was comparable with that of the younger age group, apart from cardiovascular and renal dysfunction, older patients received less organ support. Older patients stayed longer in hospital post-ICU discharge, and hospital mortality increased with age, but the majority of patients surviving to hospital discharge returned home.

Conclusions:
Over the past two decades, elderly patients have been more commonly admitted to ICU than can be explained solely by the demographic shift. Importantly, as with the wider population, outcomes in elderly patients admitted to ICU are improving over time, with most patients returning home.
Reversibility of Acute Kidney Injury in Medical ICU Patients: Predictability Performance of Urinary Tissue Inhibitor of Metalloproteinase-2 x Insulin-Like Growth Factor-Binding Protein 7 and Renal Resistive Index
Authors: Garnier Fanny , Daubin Delphine , Larcher Romaric , Bargnoux Anne-Sophie , Platon Laura , Brunot Vincent , Aarab Yassir , Besnard Noémie , Dupuy Anne-Marie , Jung Boris , Cristol Jean-Paul , Klouche Kada 
Published: January 2020

Objectives:
Urinary biomarkers and renal Doppler sonography remain considered as promising tools to distinguish transient from persistent acute kidney injury. The performance of the urinary biomarker, tissue inhibitor of metalloproteinase-2 x insulin-like growth factor-binding protein 7 and of renal resistive index to predict persistent acute kidney injury showed contradictory results. Our aim was to evaluate the performance of tissue inhibitor of metalloproteinase-2 x insulin-like growth factor-binding protein 7 and renal resistive index in predicting reversibility of acute kidney injury in critically ill patients.

Design:
Prospective observational study.

Setting:
Twenty-bed medical ICU in an university hospital.

Patients:
Consecutive patients with acute kidney injury.

Intervention:
None.

Measurements and Main Results:
Renal resistive index was measured within 12 hours after admission, and urinary tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 was measured at H0, H6, H12, and H24. Renal dysfunction reversibility was evaluated at day 3. Receiver operating characteristic curves were plotted to evaluate diagnostic performance of renal resistive index and tissue inhibitor of metalloproteinase-2 x insulin-like growth factor-binding protein 7 to predict a persistent acute kidney injury. Overall, 100 patients were included in whom 50 with persistent acute kidney injury. Renal resistive index was higher in persistent acute kidney injury group. Urinary tissue inhibitor of metalloproteinase-2 x insulin-like growth factor-binding protein 7 was not significantly different at each time between both groups. The performance of tissue inhibitor of metalloproteinase-2 x insulin-like growth factor-binding protein 7 was poor with respectively an area under the receiver operating characteristic curves of 0.57 (95% CI, 0.45–0.68), 0.58 (95% CI, 0.47–0.69), 0.61 (95% CI, 0.50–0.72), and 0.57 (95% CI, 0.46–0.68) at H0, H6, H12, and H24. The area under the receiver operating characteristic curve for renal resistive index was 0.93 (95% CI, 0.89–0.98). A renal resistive index greater than or equal to 0.685 predicting persistent acute kidney injury with 78% (95% CI, 64–88%) sensitivity and 90% (95% CI, 78–97%) specificity.

Conclusions:
Renal resistive index had a good performance for predicting the reversibility of acute kidney injury in critically ill patients. Urinary tissue inhibitor of metalloproteinase-2 x insulin-like growth factor-binding protein 7 was unable to differentiate transient from persistent acute kidney injury.
Mesenchymal Stromal Cells Protect the Blood-Brain Barrier, Reduce Astrogliosis, and Prevent Cognitive and Behavioral Alterations in Surviving Septic Mice
Authors: Silva Adriano Y. O. , Amorim Érica A. , Barbosa-Silva Maria C. , Lima Maiara N. , Oliveira Helena A. , Granja Marcelo G. , Oliveira Karina S. , Fagundes Paula M. , Neris Rômulo L. S. , Campos Raquel M. P. , Moraes Carolina A. , Vallochi Adriana L. , Rocco Patricia R. M. , Bozza Fernando A. , Castro-Faria-Neto Hugo C. , Maron-Gutierrez Tatiana 
Published: January 2020

Objectives:
Survivors of sepsis are frequently left with significant cognitive and behavioral impairments. These complications derive from nonresolving inflammation that persists following hospital discharge. To date, no study has investigated the effects of mesenchymal stromal cell therapy on the blood-brain barrier, astrocyte activation, neuroinflammation, and cognitive and behavioral alterations in experimental sepsis.

Design:
Prospective, randomized, controlled experimental study.

Setting:
Government-affiliated research laboratory.

Subjects:
Male Swiss Webster mice (n = 309).

Interventions:
Sepsis was induced by cecal ligation and puncture; sham-operated animals were used as control. All animals received volume resuscitation (1 mL saline/mouse subcutaneously) and antibiotics (meropenem 10 mg/kg intraperitoneally at 6, 24, and 48 hours). Six hours after surgery, mice were treated with mesenchymal stromal cells IV (1 × 105 cells in 0.05 mL of saline/mouse) or saline (0.05 mL IV).

Measurements and Main Results:
At day 1, clinical score and plasma levels of inflammatory mediators were increased in cecal ligation and puncture mice. Mesenchymal stromal cells did not alter clinical score or survival rate, but reduced levels of systemic interleukin-1β, interleukin-6, and monocyte chemoattractant protein-1. At day 15, survivor mice completed a battery of cognitive and behavioral tasks. Cecal ligation and puncture mice exhibited spatial and aversive memory deficits and anxiety-like behavior. These effects may be related to increased blood-brain barrier permeability, with altered tight-junction messenger RNA expression, increased brain levels of inflammatory mediators, and astrogliosis (induced at day 3). Mesenchymal stromal cells mitigated these cognitive and behavioral alterations, as well as reduced blood-brain barrier dysfunction, astrocyte activation, and interleukin-1β, interleukin-6, tumor necrosis factor-α, and interleukin-10 levels in vivo. In cultured primary astrocytes stimulated with lipopolysaccharide, conditioned media from mesenchymal stromal cells reduced astrogliosis, interleukin-1β, and monocyte chemoattractant protein-1, suggesting a paracrine mechanism of action.

Conclusions:
In mice who survived experimental sepsis, mesenchymal stromal cell therapy protected blood-brain barrier integrity, reduced astrogliosis and neuroinflammation, as well as improved cognition and behavior.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN PATIENTS WITH RETINITIS PIGMENTOSA–ASSOCIATED CYSTOID MACULAR EDEMA
Authors: Yeo Joon Hyung , Kim Yoon Jeon , Yoon Young Hee 
Published: January 2020

Purpose:
To investigate the microstructure of cystoid macular edema (CME) in retinitis pigmentosa (RP) and the associated vascular changes using optical coherence tomography (OCT) angiography.

Methods:
In this retrospective study, we included 42 eyes of 21 patients with RP and age-similar normally sighted controls who underwent both OCT and optical coherence tomography angiography. Using OCT, spatial distribution of CME and the retinal layer, which CME located, was examined. Optical coherence tomography angiography images of the superficial capillary plexus and deep capillary plexus were obtained. Foveal and parafoveal flow densities in each layer and foveal avascular zone area were measured.

Results:
Of the 42 eyes with RP, 32 had CME. All CMEs were located in the inner nuclear layer and limited to the parafovea. The outer nuclear layer/ganglion cell layer was involved in 12 eyes (37.5%). Compared with RP without CME, RP with CME (RP-CME) did not show significant differences in flow density or extent of vascular disruption within the superficial capillary plexus, deep capillary plexus, or foveal avascular zone areas.

Conclusion:
RP-CME was mostly located in the inner nuclear layer of the parafoveal macula, without vascular disruption in optical coherence tomography angiography. Our findings may support the hypothesis that the pathogenesis of RP with CME differs from retinal vascular CME triggered by compromised deep capillary plexus.
OPACIFICATION OF A SCLERAL-SUTURED AKREOS AO60 INTRAOCULAR LENS: SURGICAL TECHNIQUE FOR REMOVAL
Authors: Lavine Jeremy A. , Sharma Sumit 
Published: January 2020

Purpose:
To report a case of an opacified scleral-sutured Akreos intraocular lens (IOL) and discuss the technique for surgical removal.

Methods:
A 27-year-old man presented with blurry vision in the right eye 1 year after trauma, pars plana vitrectomy, glaucoma tube shunt surgery, and a scleral-sutured Akreos AO60 IOL. Examination demonstrated a visual acuity of 20/300, a persistently dilated pupil, 360° of peripheral anterior synechiae, and an opacified IOL. The patient underwent IOL explantation.

Results:
Owing to the expected granulation of the Gore-Tex suture, an external approach for suture ligation was not attempted. The suture was identified and ligated nasally with forceps and IOL cutting scissors. The Gore-Tex suture was granulated into the ciliary body temporally and was unable to be identified. The eyelets of the Akreos IOL were ligated to remove the IOL.

Conclusion:
Granulation of the Gore-Tex suture into the ciliary body and sclera requires an internal approach for ligation of the suture or eyelets to remove an opacified scleral-sutured Akreos IOL.
Reducing Diabetic Ketoacidosis Intensive Care Unit Admissions Through an Electronic Health Record-Driven, Standardized Care Pathway
Authors: Edholm Karli , Lappé Katie , Kukhareva Polina , Hopkins Christy , Hatton Nathan D. , Gebhart Benjamin , Nyman Heather , Signor Emily , Davis Mikyla , Kawamoto Kensaku , Johnson Stacy A. 
Published: January 2020

ABSTRACT
Diabetic ketoacidosis (DKA) is a common condition, with wide variation in admission location and clinical practice. We aimed to decrease intensive care unit (ICU) admission for DKA by implementing a standardized, electronic health record-driven clinical care pathway that used subcutaneous insulin, rather than a continuous insulin infusion, for patients with nonsevere DKA. This is a retrospective, observational preintervention to postintervention study of 214 hospital admissions for DKA that evaluated the effect of our intervention on clinical, safety, and cost outcomes. The primary outcome was ICU admission, which decreased from 67.0% to 41.7% (p < .001). Diabetes nurse educator consultation increased from 45.3% to 63.9% (p = .006), and 30-day Emergency Department (ED) return visit decreased from 12.3% to 2.8% (p = .008). Time to initiation of basal insulin increased from 18.19 ± 1.25 hours to 22.47 ± 1.76 hours (p = .05) and reopening of the anion gap increased from 4.7% to 13.9% (p = .02). No changes in ED length of stay (LOS), hospital LOS, hypoglycemia, treatment-induced hypokalemia, 30-day hospital readmission, or inpatient mortality were observed. The implementation of a standardized DKA care pathway using subcutaneous insulin for nonsevere DKA resulted in decreased ICU use and increased diabetes education, without affecting patient safety.
The role of coexisting cardiovascular disease on disease severity in patients with inflammatory bowel disease
Authors: Mantaka Aikaterini , Tsoukali Emmanouela , Fragkaki Maria , Karmiris Konstantinos , Viazis Nikos , Mantzaris Gerassimos J. , Koutroubakis Ioannis E. 
Published: January 2020

Objectives:
Chronic inflammation has been implicated in the pathogenesis of atherosclerosis and cardiovascular disease. Data linking the severity of inflammatory bowel disease to coexisting cardiovascular disease are scarce. The aim of the present study was to investigate whether inflammatory bowel disease patients with coexistent cardiovascular disease have more severe disease.

Methods:
We included 103 inflammatory bowel disease patients with coexisting cardiovascular disease compared to 206 age- and sex-matched inflammatory bowel disease patients without cardiovascular disease derived from three referral inflammatory bowel disease Centers. Traditional cardiovascular disease factors and parameters of inflammatory bowel disease severity were compared between the two groups.

Results:
Cardiovascular disease was diagnosed after the inflammatory bowel disease diagnosis in 56.6% of cases. No significant difference was found in the prevalence of surrogate markers of severity (inflammatory bowel disease-related surgeries, hospitalizations, biologics or immunosuppressants’ use, and persistent CRP elevation) between inflammatory bowel disease patients with and without cardiovascular disease. There was no difference between cardiovascular disease patients diagnosed before and after inflammatory bowel disease onset. All traditional risk factors (hypertension, dyslipidemia, smoking, obesity, diabetes mellitus) were significantly more common in cardiovascular disease patients. Cardiovascular disease patients had a trend for lower rates of multiple hospitalizations (16.5% vs. 24.3%, P = 0.05) and inflammatory bowel disease-related surgeries (P = 0.09).

Conclusion:
The inflammatory burden possibly plays a less important role in the development of cardiovascular disease in inflammatory bowel disease patients but future larger prospective studies are needed.
Noninvasive assessment of liver fibrosis in a real-world cohort of patients with known or suspected chronic liver disease using 2D-shear wave elastography
Authors: Petzold Golo , Bremer Sebastian C.B. , Knoop Richard F. , Amanzada Ahmad , Raddatz Dirk , Ellenrieder Volker , Ströbel Philipp , Kunsch Steffen , Neesse Albrecht 
Published: January 2020

Objectives
We aimed to investigate the diagnostic accuracy of liver stiffness measurement (LSM) by 2D-shear wave elastography (2D-SWE, GE, Logiq E9) in patients with known or suspected chronic liver disease and to define cutoff values for the different stages of fibrosis.

Methods
First, we retrospectively enrolled 21 patients in a pilot study and validated the results in a prospective cohort of 70 patients between May 2017 and February 2019. In all patients, LSM and liver biopsy were performed. We analyzed the diagnostic accuracy of LSM for the different fibrosis stages and examined the impact of additional clinical parameters on LSM.

Results
The success rate of LSM was 88.6%. In the prospective cohort, optimal cutoff values for F ≥ 1, F ≥ 2, F ≥ 3 and F = 4 were 6.24, 7.86, 8.05 and 10.74 kPa [area under the receiver operating characteristic curve (AUROC) 0.831, 0.913, 0.996 and 0.954]. In both cohorts and in the subgroup of patients with nonalcoholic fatty liver disease (NAFLD) (n = 35), a cutoff value of 8.05 kPa differentiates patients with advanced fibrosis (F ≥ 3) and patients with no or mild fibrosis (F0–F2) with high diagnostic accuracy (AUROC 0.995–1.000). Parameters such as age, sex, BMI, bilirubin- and alanine aminotransferase-level had no significant impact on LSM.

Conclusion
LSM by 2D-SWE is an excellent method to differentiate between patients with advanced fibrosis (F ≥ 3) and patients with no or mild fibrosis (F ≤ 2). We were able to show this also in a subgroup of patients with NAFLD.
Promoting Bedside Nurse-Led Research Through a Dedicated Neuroscience Nursing Research Fellowship
Authors: Stutzman Sonja , Olson DaiWai , Supnet Charlene , Harper Caryn , Brown-Cleere Shelley , McCulley Becky , Goldberg Mark 
Published: January 2020

OBJECTIVE:
We hypothesized that nurses would benefit from the fellowship model traditionally used to engage physicians in clinical research. The Neuroscience Nursing Research Center (NNRC) fellowship program was created as a model for engaging nurses at all levels of clinical practice to become active in clinical research.

BACKGROUND:
The NNRC was established in 2013 as a novel approach to promote bedside nurses as primary investigators in clinical research.

METHODS:
The NNRC developed 4 pathways to nursing research success: research fellowship, student-nurse internship, didactic training, and research consultation.

RESULTS:
Fellows have enrolled more than 900 participants in 14 studies. Nurses have presented more than 20 abstracts at 12 conferences and submitted 11 manuscripts for publication. The NNRC has provided research training to more than 150 nurses.

CONCLUSIONS:
The NNRC program is successful in engaging nurses in research. It shows promise to continue to develop nursing research that is applicable to clinicians and thus improve patient care.
Evaluation of a Hospital-Based Pneumonia Nurse Navigator Program
Authors: Seldon Lisa E. , McDonough Kelly , Turner Barbara , Simmons Leigh Ann 
Published: January 2020

PURPOSE:
The aim of this study is to evaluate the effectiveness of a hospital-based pneumonia nurse navigator program.

DESIGN:
This study used a retrospective, formative evaluation.

METHODS:
Data of patients admitted from January 2012 through December 2014 to a large community hospital with a primary or secondary diagnosis of pneumonia, excluding aspiration pneumonia, were used. Data included patient demographics, diagnoses, insurance coverage, core measures, average length of stay (ALOS), disposition, readmission rate, financial outcomes, and patient barriers to care were collected. Descriptive statistics and parametric testing were used to analyze data.

RESULTS:
Core measure performance was sustained at the 90th percentile 2 years after the implementation of the navigator program. The ALOS did not decrease to established benchmarks; however, the SD for ALOS decreased by nearly half after implementation of the navigator program, suggesting the program decreased the number and length of extended stays. Charges per case decreased by 21% from 2012 to 2014. Variable costs decreased by 4% over a 2-year period, which increased net profit per case by 5%. Average readmission payments increased by 8% from 2012 to 2014, and the net revenue per case increased by 8.3%.

CONCLUSION:
The pneumonia nurse navigator program may improve core measures, reduce ALOS, and increase net revenue. Future evaluations are necessary to substantiate these findings and optimize the cost and quality performance of navigator programs.
Implementation of Quiet Time for Noise Reduction on a Medical-Surgical Unit
Authors: Applebaum Diane , Calo Oriana , Neville Kathleen 
Published: January 2020

OBJECTIVE:
The objective of this evidence-based investigation is to determine the efficacy of a quiet-time intervention to reduce noise in the hospital setting.

BACKGROUND:
For many reasons, noise continues to increase in the hospital setting.

METHODS:
In a descriptive comparative design, using a convenience sample of hospitalized patients, 80 patients were assessed on their perceptions of noise using the Patient Survey on Noise During Hospital Stay.

RESULTS:
Data revealed favorable responses to quiet time, with 70% of subjects reporting quiet-time intervention to be effective in reducing noise. Sixty percent of participants felt that 1 hour of quiet time helped to facilitate a quieter, more restful environment for the whole day.

CONCLUSION:
A quiet-time intervention is effective in addressing patient perception of noise while in the acute care hospital setting.