bluuebunny/crossref_metadata_2025_split huggingface dataset:
Self-reported alcohol consumption in doctors
Authors: Savage E , Sowole L , Shah S , Mirza Z , Cotzias C 
Published: May 2020

Abstract

Background
The UK government has prioritized reducing the harmful effects of excessive alcohol consumption on mental and physical well-being.

Aims
To assess self-reported alcohol consumption amongst doctors at an acute London Trust.

Methods
An opportunistic, anonymous, survey was conducted by Postgraduate Education Fellows over 2 weeks in December 2018. This included all grades of doctors from Foundation Year One to Consultant. The survey consisted of nine questions, modified from the alcohol use disorders identification test (AUDIT) and CAGE questionnaire.

Results
Of 446 doctors within our institution, 109 completed the survey (24%). Fourteen per cent of those surveyed abstained from alcohol, 21% drank monthly or less, 31% drank between two to four times per month, 25% drank two to three times per week and 9% drank greater than four times per week. In the preceding 2 years, 9% reported being unable to do what was expected of them on at least one occasion due to alcohol. Five per cent were concerned about alcohol affecting their performance. Two per cent were annoyed by criticism of their drinking, 9% felt guilty about drinking and 4% needed an eye-opener. Eighteen per cent wanted to reduce their alcohol consumption; however, 43% of the 109 doctors surveyed were uncertain where to seek help.

Conclusions
Twenty per cent of surveyed doctors reported consuming potentially hazardous levels of alcohol and 18% of respondents wanted to cut down. Forty-three per cent were unaware of sources of support. Our findings suggest a role for collaboration between Occupational Health departments and Postgraduate Education teams to support doctors misusing alcohol.
A brief sleep focused psychoeducation program for sleep-related outcomes in new mothers: a randomized controlled trial
Authors: Kempler Liora , Sharpe Louise A , Marshall Nathaniel S , Bartlett Delwyn J 
Published: May 2020

Abstract

Study Objectives
Poor sleep is commonly problematic during pregnancy and postpartum and is associated with depression. This trial investigated the efficacy of prenatal brief, group sleep psychoeducation in improving postpartum maternal sleep, and depression.

Methods
A total of 215 healthy expectant first-time mothers were cluster randomized (1:1) to receive either a 2 × 1.5 h psychoeducation intervention and a set of booklets, or a set of booklets only. Participants completed questionnaires during pregnancy (pre-intervention), and 6 weeks and 4 months postpartum. A post hoc subset of questionnaires was collected at 10 months postpartum. The primary hypothesis was the intervention group would have improved postpartum sleep quality, and reduced levels of insomnia symptoms, fatigue, and daytime sleepiness compared to the control group. Secondary outcomes included depression, anxiety, and stress.

Results
Linear mixed model analyses failed to confirm a group by time interaction on primary or secondary outcomes across all time points. There was no effect of the intervention on outcomes at 6 weeks, or 10 months postpartum. A significant time by group interaction was found at 4 months, favoring the intervention for sleep quality (p = 0.03) and insomnia symptoms (p = 0.03), but not fatigue or daytime sleepiness.

Conclusions
Prenatal sleep psychoeducation did not produce a sustained effect on maternal sleep throughout the postpartum period. There was little evidence of benefits on depressive symptoms.

Clinical Trial Registration
ACTRN12611000859987
The Continued Crisis of Maternal Mortality: Is Consolidation of Care the Answer?
Authors: Kacmar R.M. , Mhyre J.M. 
Published: May 2020

(Anesth Analg. 2020;130:49–51)
There is a concerning trend of maternal mortality among nonwhite, impoverished, publicly insured women compared with white populations, and a patient’s care center could be a contributing factor to that mortality. Researchers have noted that high-risk medical centers who serve socially vulnerable populations tend to have poorer maternal outcomes, while white women frequently deliver in hospitals that have lower rates of severe maternal morbidity. Because of this imbalance, in-depth analysis is necessary to determine if higher morbidity rates can be attributed solely to the high-risk case rate in a certain area, or if some facilities provide a lower quality of care.
Sonographic Lower Uterine Segment Thickness After Prior Cesarean Section to Predict Uterine Rupture: A Systematic Review and Meta-analysis
Authors: Swift B.E. , Shah P.S. , Farine D. 
Published: May 2020

(Anaesthesia. 2019;74:850–855)
The rate of trial of labor after cesarean (TOLAC) in the United States has markedly dropped over the past few decades. Uterine rupture is the most serious complication associated with TOLAC, with the risk ranging from 0.52% for women in spontaneous labor to 2.45% for women undergoing labor induction with prostaglandin. This risk may be contributing to the declining rate of TOLAC. Sonographic measurement of the lower uterine segment thickness has been evaluated by several prospective studies, but the cutoff values for recommending TOLAC in these studies have differed due to varying ultrasound methodologies. This study analyzed the ultrasound methodology used in each study and then conducted a meta-analysis of the predictive value of sonographic measurement of the lower uterine segment thickness for uterine rupture during labor.
Trial of Labor After Cesarean Section in Risk Pregnancies: A Population-based Cohort Study
Authors: Lehmann S. , Baghestan E. , Børdahl P.E. , Irgens L.M. , Rasmussen S.A. 
Published: May 2020

(Acta Obstet Gynecol Scand. 2019;98:894–904)
Increased risk of adverse outcomes is higher in cases of unsuccessful trial of labor after cesarean (TOLAC) compared with a successful vaginal delivery or a planned repeat cesarean delivery. While identifying factors that could predict TOLAC failure is of clinical interest, there has been a lack of research on the risk of TOLAC failure in the setting of specific medical conditions other than diabetes and hypertensive disorders. This study aimed to investigate medical conditions as potential risk factors for TOLAC failure in Norway, which has a high TOLAC rate of ∼70%. TOLAC failure rates were also compared between women who did and did not undergo labor induction.
The Comparative Accuracy of a Handheld and Console Ultrasound Device for Neuraxial Depth and Landmark Assessment
Authors: Carvalho B. , Seligman K.M. , Weiniger C.F. 
Published: May 2020

(Int J Obstet Anesth. 2019;39:68–73)
Historically, anesthesiologists have inserted neuraxial blocks for labor analgesia using surface landmarks as references to identify the interspaces and midline. There may be a number of advantages in using a neuraxial ultrasound device before the insertion procedure. Some benefits of ultrasound imaging include the ease of identifying the lumbar interspace level and ideal needle insertion site as well as the ability to estimate the depth to the epidural space. Previous studies have also reported that use of ultrasound resulted in fewer epidural failures, needle insertions, and needle redirections. While anesthesiologists have historically used laptop or console ultrasound machines to assist with neuraxial procedures, the portable handheld Accuro (AU; Rivanna Medical, Charlottesville, VA) device is a promising alternative for ultrasound imaging during lumbar epidural placements. It contains a proprietary algorithm that estimates the depth to the epidural space. The AU has not been compared with more complex ultrasound devices. This current study was conducted to compare the ultrasound-estimated depth to the epidural space as measured by the AU to depth measurements obtained with a console ultrasound (GU) device.
Do Epidural Catheter Size and Flow Rate Affect Bolus Injection Pressure in Different Programmed Intermittent Epidural Bolus Regimens? An In Vitro Study
Authors: Krawczyk P. , Piwowar P. , Sałapa K. , Lonc T. , Andres J. 
Published: May 2020

(Anesth Analg. 2019;129:1587–1594)
Epidural analgesia is the most effective technique for labor analgesia, and programmed intermittent epidural bolus (PIEB) is a modality for delivering epidural analgesia that is becoming increasingly popular. However, the optimal settings for the PIEB technique have not been established. This study was undertaken to examine combinations of catheter types and pump characteristics and how they might influence epidural bolus injection pressure and the triggering of pump alarms. The investigators hypothesized that higher gauge catheters plus increased flow rates would increase the bolus injection pressure.
Neonatal Developmental and Behavioral Outcomes of Immediate Delivery Versus Expectant Monitoring in Mild Hypertensive Disorders of Pregnancy: 2-Year Outcomes of the HYPITAT-II Trial
Authors: Zwertbroek E.F. , Franssen M.T.M. , Broekhuijsen K. , Langenveld J. , Bremer H. , Ganzevoort W. , van Loon A.J. , van Pampus M.G. , Rijnders R.J.P. , Sikkema M.J. , Scherjon S.A. , Woiski M.D. , Mol B.W.J. , van Baar A.L. , Groen H. 
Published: May 2020

(Am J Obstet Gynecol. 2019;221:154.e1–154.e11)
Immediate delivery is the preferred strategy for managing hypertensive disorders of pregnancy at term, which affects 10% of pregnancies worldwide. In pregnancies affected by hypertensive disorders before term, the adverse consequences of preterm birth for the neonate must be weighed against the benefits of immediate delivery for the mother. The Hypertension and Preeclampsia Intervention Trial at near Term (HYPITAT-II) studied this scenario and concluded immediate delivery was not justified in women with a mild hypertensive disorder diagnosed preterm. As preterm birth is associated with long-term neurodevelopmental problems, the aim of this study was to compare the offspring of mothers with late preterm hypertensive disorders at 2 years for neurodevelopmental and behavioral outcomes based on whether the mother was randomized to immediate delivery or expectant monitoring.
Delivery Outcome After Trial of Labor in Nulliparous Women 40 Years or Older: A Nationwide Population-based Study
Authors: Ankarcrona  , Altman D. , Wikström A. , Jacobsson B. , Wendel S.B. 
Published: May 2020

(Acta Obstet Gynecol Scand. 2019; 98:1195–1203)
Over the last 3 decades, more and more women in high-income countries have postponed childbirth until the age of 40 or older. Women of advanced maternal age are more likely to undergo labor induction, which may be associated with risk of labor complications, such as intrapartum cesarean delivery and adverse neonatal outcomes. Therefore, obstetricians are unsure how to advise nulliparous women 40 years or older on labor and delivery method. These investigators conducted their study to compare delivery mode and risks of anal sphincter injury and 5-minute Apgar score <7 in older women (40 y or older) compared with women 25 to 29 years old for both labor induction and spontaneous onset of labor.
Resident Competency and Proficiency in Combined Spinal-Epidural Catheter Placement is Improved Using a Computer-Enhanced Visual Learning Program: A Randomized Controlled Trial
Authors: Nixon H.C. , Stariha J. , Farrer J. , Wong C.A. , Maisels M. , Toledo P. 
Published: May 2020

(Anesth Analg. 2019;128:999–1004)
The apprenticeship model is still the most common method for residents to learn the technical skill of placing a spinal-epidural catheter. However, this method has its drawbacks, as on average it takes 45 to 60 attempts for a student to achieve a 90% success rate. While other methods have also been explored to teach this skill, such as watching videos of the procedure before attempting it, this study proposed that E-learning is a valid method to enhance anesthesiology education.
Efficacy of Intrathecal Fentanyl for Cesarean Delivery: A Systematic Review and Meta-analysis of Randomized Controlled Trials With Trial Sequential Analysis
Authors: Uppal  , Retter S. , Casey M. , Sancheti S. , Matheson K. , McKeen D.M. 
Published: May 2020

(Anesth Analg. 2020;130:111–125)
Cesarean delivery procedures have become more popular over the past few decades, and spinal anesthesia is a commonly used method of anesthesia for that operation. A majority of surveyed members of the Society for Obstetric Anesthesia and Perinatology stated that they preferred to administer hyperbaric 0.75% bupivacaine spinal anesthesia for cesarean deliveries, while a smaller percentage of anesthesiologists reported adding fentanyl, morphine, or a combination of both to an intrathecal bupivacaine solution. The addition of intrathecal opioids to spinal anesthesia medication has been reported to be effective for pain relief in some cases, but researchers are still unsure of the benefits, drawbacks, and optimal dosages of these medications. These investigators conducted their systematic review and meta-anlaysis to analyze the effectiveness of fentanyl both alone and in combination with morphine when added to intrathecal bupivacaine anesthesia during a cesarean delivery.
The Impact of a Transversus Abdominis Plane Block Including Clonidine Versus Intrathecal Morphine on Nausea and Vomiting After Caesarean Section: A Randomized Controlled Trial
Authors: Dereu D , Savoldelli G.L. , Mercier Y. , Combescure C. , Mathivon S. , Rehberg B. 
Published: May 2020

(Eur J Anaesthesiol. 2019;36:575–582)
Pain management within the first 36 hours after cesarean section can have significant impact on postoperative maternal health and satisfaction. Inadequate pain relief may be associated with delayed breastfeeding and increased risk of postoperative complications. In addition, persistent pain at the 2-week postpartum mark is a risk factor for ongoing pain at 3 months postpartum as well as postpartum depression. Anesthesiologists often administer intrathecal morphine (ITM) during spinal anesthesia to manage postcesarean pain, but this approach often results in side effects such as postoperative nausea and vomiting (PONV) and pruritus; these adverse effects can considerably reduce maternal satisfaction. The current investigators conducted this study to determine if a transversus abdominis plane (TAP) block that included both local anesthetic and clonidine was a better pain management treatment compared with ITM in terms of PONV occurrence, other adverse effects, analgesic efficacy, and postoperative recovery quality.
Using interpreters for Deaf patients and patients with limited English proficiency
Authors: Brown Heather L. 
Published: May 2020

ABSTRACT
Communication breakdowns with patients who do not use English as their primary language can hurt the patient-provider relationship and leave patients at risk for health disparities and adverse reactions. An estimated 36 million patients in the United States identify as Deaf and more than 60 million patients prefer to speak a language other than English in primary communication. This article discusses the unique needs of patients who are Deaf or have limited English proficiency, and how to provide qualified interpreters to help improve patient communication and care.
The show must go on: an update on clinical experiences and clinical studies on novel pharmaceutical developments for the treatment of atopic dermatitis
Authors: Honstein Tatjana , Werfel Thomas 
Published: May 2020

Purpose of review
This review reports on published clinical studies (full publications) with novel therapeutic agents on the treatment of atopic dermatitis with a focus on the last 2 years.

Recent findings
Atopic dermatitis is a T-cell driven complex inflammatory skin disease. The secretion of cytokines involving not only particularly Th2 but also Th17 and Th22 cell subsets provides a broad spectrum of potential therapeutical targets. A couple of studies on atopic dermatitis with new therapeutical antibodies that target not only the Th2 cytokines IL-4, IL-13, IL- 31 but also additional targets, such as TSLP, IL-22 or IL-33, and innovative small molecules binding to the histamine-4 receptor, the phosphodiesterase-4, the aryl hydrocarbon receptor or downstream molecules like Janus kinases have recently been published with promising results on symptoms and signs of atopic dermatitis.

Summary
Applications of newly developed drugs in clinical studies or already in daily practice show a substantial progress in the treatment of moderately to severely affected patients with atopic dermatitis not responsive to standard topical treatments with corticosteroids or topical calcineurin inhibitors alone. Moreover, novel treatment approaches generate new knowledge about (anti)inflammatory effects of immune modulations in atopic dermatitis and the heterogeneity of patient subgroups, which may stimulate further innovations in this field.
The effect of neuromuscular electrical stimulation on function outcome measures following muscle fatigue: a systematic review
Authors: Day James , Newman Joseph 
Published: May 2020

Background:
The ability to recover after bouts of fatigue caused by high-intensity physical activity is one of the greatest challenges in sports medicine and exercise science. Neuromuscular electrical stimulation has been used with the theory that it decreases blood metabolites more quickly and therefore decreases recovery time. This systematic review analyzed primary research articles that investigated functional outcomes related to the use of neuromuscular electrical stimulation as a recovery modality.

Methods:
SportsDiscus, US National Library of Medicine (PubMed), and Current Nursing and Allied Health Literature (CINAHL) were used to search “neuromuscular electrical stimulation” OR “nmes” OR “electric* stimulation” OR “electrostimulation” AND “recovery” OR “muscle recovery” AND “athlete*.” Articles had to contain results from functional tests following fatigue and needed to compare these results between a neuromuscular electrical stimulation group and a passive recovery or control group.

Results:
One-hundred sixty-two subjects participated in the 11 studies evaluated in the review. Functional outcome measures were obtained in various methods throughout the study. There were inconsistent findings between the studies, with a tendency for the intervention to be ineffective.

Conclusions:
Inconsistencies between the studies likely attributed to the unclear findings of the review. Several protocols were used throughout the various studies causing multiple variables that could not be isolated. Electrode placement, stimulation frequency and intensity, and functional testing protocols were the major difference between studies that led to the inconsistent findings. Although neuromuscular electrical stimulation is often used as a recovery modality, research findings are mixed regarding its effectiveness as an intervention for recovery.

Level of Evidence:
Level I.
Osteoporosis epidemiology using international cohorts
Authors: Zhang Jean , Dennison Elaine , Prieto-Alhambra Daniel 
Published: May 2020

Purpose of review
The field of osteoporosis research has been active for the past 20 years and has allowed significant advancement in the management of osteoporosis. This review will give an overview of the latest data from international cohorts that relate to current and recent osteoporosis research.

Recent findings
The clinical diagnosis of osteoporosis relies heavily on bone mineral density (BMD) measured at femoral neck or spine and although BMD has excellent predictive value for future fractures, fracture risk assessment has evolved over the years, resulting in the birth of fracture prediction tools. Fracture risk factors not currently featured in these tools are being considered for inclusion, including imminent risk fracture following a sentinel fracture, number of falls, and previous vertebral fractures. Data from groups with comorbidities such as chronic obstructive pulmonary disease are helping us understand how to best manage patients with multiple comorbidities. Finally, the prevalence of vertebral fracture in the older general population and other selected populations has been explored, alongside the global burden of osteoporosis and its consequences.

Summary
Our understanding of osteoporosis continues to expand, but knowledge gaps remain.
A 3D Parameter Can Guide Concave Rod Contour for the Correction of Hypokyphosis in Adolescent Idiopathic Scoliosis
Authors: Kluck Dylan , Newton Peter O. , Sullivan Thomas Barrett , Yaszay Burt , Jeffords Megan , Bastrom Tracey P. , Bartley Carrie E. 
Published: May 2020

Study Design.
Retrospective.

Objective.
To evaluate the effect of preoperative rod shape on 3D spinal deformity correction.

Summary of Background Data.
Differential rod contouring is a surgeon-dependent process based on an estimate of 3D deformity correction sought and the flexibility of the spine. An objective measure to this otherwise subjective scoliosis correction technique is lacking.

Methods.
A series of adolescent idiopathic scoliosis (AIS) patients with right, thoracic major curves, preoperative rod contour tracings, and EOS imaging was evaluated. All patients underwent posterior spinal fusion with 5.5 mm steel rods contoured prior to insertion. 3D reconstructions were generated pre- and postoperatively using sterEOS software (EOS Imaging) and imported into MATLAB (Mathworks) for analysis. A new measurement of the maximum perpendicular distance from the preinsertion concave rod contour to the preoperative 3D sagittal spinal reconstruction was defined as rod to 3D spine distance (RSD). Linear regressions were used to identify relationships between pre and postoperative parameters, including RSD and 3D thoracic kyphosis.

Results.
Ninety-nine patients were included. Average preoperative concave rod angle decreased from (48 ± 10°) preoperatively to 26 ± 6° postoperatively (P < 0.001) for an average flattening of ∼20°. Average convex rod angle increased from 30 ± 6° to 34 ± 5° (P < 0.001). Average preoperative thoracic curve magnitude and apical vertebral rotation were 57 ± 8° and 16 ± 5° and decreased to 11 ± 6° and 5 ± 6° (P < 0.001). Average 2D and 3D thoracic kyphosis increased from 19 ± 14° and 2 ± 12° to 27 ± 6° and 22 ± 5° (P < 0.001). Preoperative RSD strongly correlated with 3D thoracic kyphosis change (P < 0.001, r = 0.796, R
2 = 0.633).

Conclusion.
On average, the concave rod flattened ∼20° after connection to the spine. Similarly, kyphosis increased ∼20° following rod insertion. A strong correlation was identified between RSD and 3D thoracic kyphosis restoration. This novel 3D parameter can guide the degree of concave rod bend necessary to achieve a desired increase in thoracic kyphosis in AIS.

Level of Evidence: 2