bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence and Influencing Factors of Medical Adhesive-Related Skin Injury in Critically Ill Patients
Authors: Zhang Yu , Wang Shuo , Zhang Xiaoxue , Zhang Wenting , Wang Xinran 
Published: April 2020

ABSTRACT

OBJECTIVE
To determine the incidence and influencing factors of medical adhesive-related skin injury (MARSI) among ICU patients.

METHODS
Study authors enrolled patients admitted to two ICUs at a class 3, grade A hospital in Beijing between January and June 2018 in this prospective cohort study. A data collection sheet was designed, and the data were collected by querying the electronic medical record and via direct assessment. Univariate and multivariate logistic regression analyses were performed to identify factors that independently influenced MARSI incidence. The STROBE checklist was used.

RESULTS
In total, 39 of 356 patients (27 men and 12 women with an average age of 61.51 ± 17.49 years) developed MARSI, an incidence of 10.96%. The median time from admission to MARSI occurrence was 26 days. Multivariate logistic regression analysis revealed that the ICU length of stay, Braden Scale score, and mechanical ventilation all independently influenced incidence. The Braden Scale score (odds ratio [OR], 0.758; 95% confidence interval [CI], 0.636-0.904; P < .05) was a protective factor against MARSI, with higher scores indicating lower risk. The ICU length of stay (OR, 1.098; 95% CI, 1.061-1.136; P < .05) and mechanical ventilation (OR, 3.373; 95% CI, 0.889-12.795; P < .05) were independent risk factors for MARSI.

CONCLUSIONS
The incidence of MARSI in ICU patients was relatively high. Awareness of MARSI should be increased among medical staff, and proper skin care should be provided to prevent and treat MARSI effectively.
Stress Management Training Improves Overall Performance during Critical Simulated Situations
Authors: Sigwalt Florent , Petit Guillaume , Evain Jean-Noel , Claverie Damien , Bui Monique , Guinet-Lebreton Angélique , Trousselard Marion , Canini Frédéric , Chassard Dominique , Duclos Antoine , Lehot Jean-Jacques , Rimmelé Thomas , Lilot Marc 
Published: April 2020

Background
High-fidelity simulation improves participant learning through immersive participation in a stressful situation. Stress management training might help participants to improve performance. The hypothesis of this work was that Tactics to Optimize the Potential, a stress management program, could improve resident performance during simulation.

Methods
Residents participating in high-fidelity simulation were randomized into two parallel arms (Tactics to Optimize the Potential or control) and actively participated in one scenario. Only residents from the Tactics to Optimize the Potential group received specific training a few weeks before simulation and a 5-min reactivation just before beginning the scenario. The primary endpoint was the overall performance during simulation measured as a composite score (from 0 to 100) combining a specific clinical score with two nontechnical scores (the Ottawa Global Rating Scale and the Team Emergency Assessment Measure scores) rated for each resident by four blinded independent investigators. Secondary endpoints included stress level, as assessed by the Visual Analogue Scale during simulation.

Results
Of the 134 residents randomized, 128 were included in the analysis. The overall performance (mean ± SD) was higher in the Tactics to Optimize the Potential group (59 ± 10) as compared with controls ([54 ± 10], difference, 5 [95% CI, 1 to 9]; P = 0.010; effect size, 0.50 [95% CI, 0.16 to 0.91]). After specific preparation, the median Visual Analogue Scale was 17% lower in the Tactics to Optimize the Potential group (52 [42 to 64]) than in the control group (63 [50 to 73]; difference, −10 [95% CI, −16 to −3]; P = 0.005; effect size, 0.44 [95% CI, 0.26 to 0.59].

Conclusions
Residents coping with simulated critical situations who have been trained with Tactics to Optimize the Potential showed better overall performance and a decrease in stress level during high-fidelity simulation. The benefits of this stress management training may be explored in actual clinical settings, where a 5-min Tactics to Optimize the Potential reactivation is feasible prior to delivering a specific intervention.

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Magnesium and Bladder Discomfort after Transurethral Resection of Bladder Tumor
Authors: Park Jun-Young , Hong Jun Hyuk , Kim Doo-Hwan , Yu Jihion , Hwang Jai-Hyun , Kim Young-Kug 
Published: April 2020

Background
Catheter-related bladder discomfort occurs because of involuntary contractions of the bladder smooth muscle after urinary catheterization. Magnesium is associated with smooth muscle relaxation. This study hypothesized that among patients having transurethral resection of bladder tumor, magnesium will reduce the incidence of postoperative moderate-to-severe catheter-related bladder discomfort.

Methods
In this double-blind, randomized study, patients were randomly allocated to the magnesium group (n = 60) or the control group (n = 60). In magnesium group, a 50 mg/kg loading dose of intravenous magnesium sulfate was administered for 15 min, followed by an intravenous infusion of 15 mg · kg−1 · h−1 during the intraoperative period. Patients in the control group similarly received normal saline. The primary outcome was the incidence of catheter-related bladder discomfort above a moderate grade at 0 h postoperatively. None, mild, moderate, and severe catheter-related bladder discomfort at 1, 2, and 6 h postoperatively, patient satisfaction, and magnesium-related adverse effects were also assessed.

Results
The incidence of catheter-related bladder discomfort above a moderate grade at 0 h postoperatively was significantly lower in the magnesium group than in the control group (13 [22%] vs. 46 [77%]; P < 0.001; relative risk = 0.283; 95% CI, 0.171 to 0.467; absolute risk reduction = 0.55; number needed to treat = 2); similar results were observed for catheter-related bladder discomfort above a moderate grade at 1 and 2 h postoperatively (5 [8%] vs. 17 [28%]; P = 0.005; relative risk = 0.294; 95% CI, 0.116 to 0.746; and 1 [2%] vs. 14 [23%]; P < 0.001; relative risk = 0.071; 95% CI, 0.010 to 0.526, respectively). Patient satisfaction on a scale from 1 to 7 was significantly higher in the magnesium group than in the control group (5.1 ± 0.8 vs. 3.5 ± 1.0; P < 0.001; 95% CI, 1.281 to 1.919). Magnesium-related adverse effects were not significantly different between groups.

Conclusions
Magnesium reduced the incidence of catheter-related bladder discomfort above a moderate grade and increased patient satisfaction among patients having transurethral resection of bladder tumor.

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Procedures Performed by Advanced Practice Providers Compared With Medical Residents in the ICU: A Prospective Observational Study
Authors: Kreeftenberg Herman G. , Aarts Jeroen T. , Bindels Alexander J. G. H. , van der Meer Nardo J. M. , van der Voort Peter H. J. 
Published: April 2020

Objective:
To assess the frequency and safety of procedures performed by advanced practice providers and medical residents in a mixed-bed ICU.

Design:
A prospective observational study where consecutive invasive procedures were studied over a period of 1 year and 8 months. The interventions were registered anonymously in an online database. Endpoints were success rate at first attempt, number of attempts, complications, level of supervision, and teamwork.

Setting:
A 33-bedded mixed ICU.

Subjects:
Advanced practice providers and medical residents.

Interventions:
Registration of the performance of tracheal intubation, central venous and arterial access, tube thoracostomies, interhospital transportation, and electrical cardioversion.

Measurement and Main Results:
A full-time advanced practice provider performed an average of 168 procedures and a medical resident an average of 68. The advanced practice provider inserted significant more radial, brachial, and femoral artery catheters (66% vs 74%, p = 0.17; 15% vs 12%, p = 0.14; 18% vs 14%, p = 0.14, respectively). The median number of attempts needed to successfully insert an arterial catheter was lower, and the success rate at first attempt was higher in the group treated by advanced practice providers (1.30 [interquartile range, 1–1.82] vs 1.53 [interquartile range, 1–2.27], p < 0.0001; and 71% vs 54%, p < 0.0001). The advanced practice providers inserted more central venous catheters (247 vs 177) with a lower median number of attempts (1.20 [interquartile range, 1–1.71] vs 1.33 [interquartile range, 1–1.86]) and a higher success rate at first attempt (81% vs 70%; p < 0.005). The number of intubations by advanced practice providers was 143 and by medical residents was 115 with more supervision by the advanced practice provider (10% vs 0%; p = 0.01). Team performance, as reported by nursing staff, was higher during advanced practice provider procedures compared with medical resident procedures (median, 4.85 [interquartile range, 4.85–5] vs 4.73 [interquartile range, 4.22–5]). Other procedures were also more often performed by advanced practice providers. The complication rate in the advanced practice provider–treated patient group was lower than that in the medical resident group.

Conclusions:
Advanced practice providers in critical care performed procedures safe and effectively when compared with medical residents. Advanced practice providers appear to be a valuable addition to the professional staff in critical care when it comes to invasive procedures.
Assessing the Course of Organ Dysfunction Using Joint Longitudinal and Time-to-Event Modeling in the Vasopressin and Septic Shock Trial
Authors: Harhay Michael O. , Gasparini Alessandro , Walkey Allan J. , Weissman Gary E. , Crowther Michael J. , Ratcliffe Sarah J. , Russell James A. 
Published: April 2020

Objectives:
Non-mortality septic shock outcomes (e.g., Sequential Organ Failure Assessment score) are important clinical endpoints in pivotal sepsis trials. However, comparisons of observed longitudinal non-mortality outcomes between study groups can be biased if death is unequal between study groups or is associated with an intervention (i.e., informative censoring). We compared the effects of vasopressin versus norepinephrine on the Sequential Organ Failure Assessment score in the Vasopressin and Septic Shock Trial to illustrate the use of joint modeling to help minimize potential bias from informative censoring.

Design:
Secondary analysis of the Vasopressin and Septic Shock Trial data.

Setting:
Twenty-seven ICUs in Canada, Australia, and United States.

Subjects:
Seven hundred sixty-three participants with septic shock who received blinded vasopressin (n = 389) or norepinephrine infusions (n = 374).

Measurements and Main Results:
Sequential Organ Failure Assessment scores were calculated daily until discharge, death, or day 28 after randomization. Mortality was numerically higher in the norepinephrine arm (28 d mortality of 39% vs 35%; p = 0.25), and there was a positive association between higher Sequential Organ Failure Assessment scores and patient mortality, characteristics that suggest a potential for bias from informative censoring of Sequential Organ Failure Assessment scores by death. The best-fitting joint longitudinal (i.e., linear mixed-effects model) and survival (i.e., Cox proportional hazards model for the time-to-death) model showed that norepinephrine was associated with a more rapid improvement in the total Sequential Organ Failure Assessment score through day 4, and then the daily Sequential Organ Failure Assessment scores converged and overlapped for the remainder of the study period.

Conclusions:
Short-term reversal of organ dysfunction occurred more rapidly with norepinephrine compared with vasopressin, although differences between study arms did not persist after day 4. Joint models are an accessible methodology that could be used in critical care trials to assess the effects of interventions on the longitudinal progression of key outcomes (e.g., organ dysfunction, biomarkers, or quality of life) that may be informatively truncated by death or other censoring events.
Surface profiles of new-generation IOLs with improved intermediate vision
Authors: Tognetto Daniele , Cecchini Paolo , Giglio Rosa , Turco Gianluca 
Published: April 2020

Purpose:
To evaluate the surface profile of different new-generation intraocular lenses (IOLs) designed to improve intermediate vision.

Setting:
Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.

Design:
Prospective experimental laboratory study.

Methods:
One higher-order aspheric monofocal IOL (Tecnis Eyhance ICB00) and 2 extended depth-of-focus (EDOF) IOLs (Tecnis Symfony ZXR00, Mini Well Ready) were examined and compared with monofocal IOLs with the same platform (Sensar AAB00, Tecnis ZCB00, Mini 4 Ready) using contact profilometry. Raw profiles were obtained and compared. The best-fit circle was then subtracted from each raw profile to highlight differences.

Results:
The new higher-order aspheric IOL presented a peculiar profile, which appeared similar to the conventional monofocal IOL based on the same platform, with just minimal differences in the central design. One of the EDOF IOLs showed a diffractive design. The EDOF IOL based on spherical aberration presented a central steepening surrounded by a symmetric lateral change in depths.

Conclusions:
Improved intermediate vision can be achieved by means of different optic designs. Unlike the traditional EDOF and multifocal IOLs based on a diffractive design, the profiles of new-generation IOLs are characterized by smooth and progressive changes of the superficial geometry.
Scholarly Productivity Among Doctor of Physical Therapy Faculty in the United States
Authors: Myers Bradley J. , Tudini Frank T. , Sawyer Scot M. 
Published: April 2020

Introduction.
Doctor of Physical Therapy (DPT) faculty members are expected to participate in scholarly endeavors that contribute to the knowledge of our profession. There is currently limited evidence describing the level of productivity among DPT faculty throughout the country or how it is influenced by various factors. The purpose of this project is to describe the scholarly productivity of DPT faculty members within the United States and how it is influenced by the highest earned degree, academic rank, and institutional Carnegie classification.

Methods.
The authors extracted the faculty information from the web sites of all accredited DPT programs in the United States. A systematic search query was performed, using Google Scholar, on each identified faculty member. Bibliometric values related to scholarly productivity were collected including the number of papers and citations along with the h-index, g-index, and e-index for each author. Data were analyzed through nonparametric methods to identify how highest earned degree, academic rank, and institutional classification affected scholarly productivity.

Results.
A total of 2,961 faculty members were identified, although only 2,468 (83.4%) were used for the analysis. Median bibliometric values included publications = 7, citations = 42, h-index = 2, g-index = 5, and e-index = 5.4. Overall scholarly productivity varied with the highest earned degree and academic rank with moderate effect size, and institutional classification with low to moderate effect size.

Discussion and Conclusion.
This is the first national study of DPT educators describing the bibliometrics of the DPT professoriate. Individual and institutional factors appear to influence scholarly productivity of individual faculty members. The data yielded by this study can aide faculty members along with internal and external stakeholders in developing meaningful targets for scholarly productivity.
Regional perfusion monitoring in shock
Authors: Noitz Matthias , Szasz Johannes , Dünser Martin W. 
Published: April 2020

Purpose of review
Despite restoration of adequate systemic blood flow in patients with shock, single organs may remain hypoperfused. In this review, we summarize the results of a literature research on methods to monitor single organ perfusion in shock. We focused on methods to measure heart, brain, kidney, and/or visceral organ perfusion. Furthermore, only methods that can be used in real-time and at the bedside were included.

Recent findings
We identified studies on physical examination techniques, electrocardiography, echocardiography, contrast-enhanced ultrasound, near-infrared spectroscopy, and Doppler sonography to assess single organ perfusion.

Summary
Physical examination techniques have a reasonable negative predictive value to exclude single organ hypoperfusion but are nonspecific to detect it. Technical methods to indirectly measure myocardial perfusion include ECG and echocardiography. Contrast-enhanced ultrasound can quantify myocardial perfusion but has so far only been used to detect regional myocardial hypoperfusion. Near-infrared spectroscopy and transcranial Doppler sonography can be used to assess cerebral perfusion and determine autoregulation thresholds of the brain. Both Doppler and contrast-enhanced ultrasound techniques are novel methods to evaluate renal and visceral organ perfusion. A key limitation of most techniques is the inability to determine adequacy of organ blood flow to meet the organs’ metabolic demands.
Optimal ventilator settings after return of spontaneous circulation
Authors: Eastwood Glenn M. , Nichol Alistair 
Published: April 2020

Purpose of review
To describe current practice, recent advances in knowledge and future directions for research related to the post return of spontaneous circulation (ROSC) ventilatory management of cardiac arrest patients.

Recent findings
Out-of-hospital cardiac arrest (OHCA) is a major public health problem with an estimated incidence of approximately one per 1000 persons per year. A priority of intensive care management of resuscitated OHCA patients is to reduce secondary reperfusion injury. Most OHCA patients are mechanically ventilated. Most of these require mechanical ventilation as they are unconscious and for oxygen (O2) management and carbon dioxide (CO2) control. Low levels of O2 and CO2 following OHCA is associated with poor outcome. Recently, very high fraction of inspired oxygen has been associated with poor outcomes and elevated CO2 levels have been associated with improved neurological outcomes. Moreover, it is increasingly being appreciated that the ventilator may be a tool to adjust physiological parameters to enhance the chances of favourable outcomes. Finally, ventilator settings themselves and the adoption of protective ventilation strategies may affect lung–brain interactions and are being explored as other avenues for therapeutic benefit.

Summary
Current evidence supports the targeting of normal arterial O2 and CO2 tensions during mechanical ventilation following ROSC after cardiac arrest. Use of protective lung strategies during mechanical ventilation in resuscitated cardiac arrest patients is advocated. The potential therapeutic benefits of conservative O2 therapy, mild hypercapnia and the optimal ventilator settings to use post-ROSC period will be confirmed or refuted in clinical trials.
Hydrocephalus in Guillain barre syndrome
Authors: Abdulaziz Ammar Taha Abdullah , Zhou Dong , Li Jin Mei 
Published: April 2020

Abstract

Rationale:
Guillian-Barré syndrome (GBS) is a devastating autoimmune disorder characterized by progressive ascending weakness, areflexia with or without autonomic and sensory disturbances. Hydrocephalus is a rare but well-documented complication in patients with GBS. However, due to the rarity of this condition, no treatment guideline for GBS with hydrocephalus is currently available.

Patient concerns:
We describe a 23-year old woman with a history of bilateral limbs pain followed by dysarthria, dysphagia, severe quadriplegia 0/5, areflexia, loss of consciousness and dysautonomia. Neuroimaging studies revealed enlarged lateral ventricles; while Electromyography demonstrated demyelination and nerve injury. Lumbar puncture results showed elevated protein level 2.6 g/L; normal glucose and cell count.

Diagnosis:
GBS with hydrocephalus.

Interventions:
The patient was started on intravenous immunoglobulin for 5 consecutive days followed by endotracheal intubation and supportive therapy including osmotherapy and CSF drainage.

Outcomes:
At 2 months after admission, the patient stopped choking and had a significant improvement in muscles’ strength (grade 4) and pain; then was discharged. On 1 year post-discharge follow-up, CT has revealed a significant improvement of hydrocephalus, and the patient has completely returned to the normal baseline.

Lessons:
Respiratory failure is the strongest predictor of concurrent hydrocephalus in patients with GBS. The prognosis of hydrocephalus in patients with GBS is usually good, and it can be medically treated; thereby shunt surgery is rarely required.
Prognostic impact of red blood cell distribution width in pulmonary hypertension patients
Authors: Liu Jie , Yang Jiao , Xu Shuanglan , Zhu Yun , Xu Shuangyan , Wei Li , Qian Panpan , Lv Yuanyuan , Zhang Chunfang , Xing Xiqian , Deng Yishu 
Published: April 2020

Abstract
Elevated red blood cell distribution width (RDW) may correlate with a worse prognosis in pulmonary hypertension (PH), though results to date are inconsistent. The goal of this study is to detect the impact of RDW on the prognosis of PH.
PubMed and EMBASE databases were searched from their inception to July 22, 2019 for relevant publications reporting the relationship between RDW and the prognosis of PH. A meta-analysis was performed, and the heterogeneity across the included studies was evaluated using I
2 and Q statistics. We conducted sensitivity and subgroup analyses to detect sources of heterogeneity. In addition, potential publication bias was evaluated by Begg's and Egger's tests.
In total, 1236 publications were retrieved, and 7 eligible publications with 666 PH patients were included in our meta-analysis. The results suggested that increased RDW can predict worse prognosis in PH (hazard ratio (HR) = 1.27, 95% confidence interval (CI) 1.11–1.45). According to subgroup analysis, study design, region, various endpoints, time of follow-up, and patient age were not sources of heterogeneity. In addition, RDW showed prognostic value in retrospective studies (HR = 1.32, 95%CI 1.15–1.51) but not in prospective studies (HR = 1.14, 95%CI 0.78–1.67). Additionally, RDW may serve as a predictive biomarker of PH in Europe (HR = 1.33, 95%CI 1.18–1.49) but not in Asia (HR = 1.20, 95%CI 0.90–1.58). Further analysis indicated that the prognostic value of RDW was influenced by patient age (>44 years: HR = 1.34, 95%CI 1.17–1.55; ≤44 years: HR = 1.20, 95%CI 0.90–1.58) and follow-up (<3 years, HR = 1.36, 95%CI 0.53–3.47; ≥3 years, HR = 1.29, 95%CI 1.14–1.45).
RDW provides important prognostic information for PH patients, and this measure may be used to optimize patient management and guide clinical treatment.
PROSPERO registration number: CRD42019122636.