bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and validation of an instrument to measure nursing workload in the postanaesthesia care unit
Authors: Idoffsson Åsa , Olsson Charlotte , Holmén Anders , Granberg-Axell Anetth , Chew Michelle S. 
Published: August 2020

BACKGROUND
There are no instruments specifically developed for the measurement of nursing workload in postanaesthesia care units (PACUs). An objective and valid instrument is essential for planning work flow and staffing in this unique hospital environment that encompasses elements of elective and acute postsurgical care. Previous studies show that increased workload is associated with increased complication rates in ICUs. Thus, workload assessment may be an important tool for improving postsurgical outcomes.

OBJECTIVE
The aim of this study was to develop and validate a postanaesthesia workload instrument (PAWI) for measurement of workload in PACUs for adults above 18 years of age.

DESIGN
Development and validation consisted of three parts: Delphi consensus to establish content validity; internal validation including feasibility, face validity and inter-rater reliability testing; and national external validation consisting of feasibility, inter-rater reliability, criterion validity, construct and face validities.

SETTING
PACUs in nine university and regional hospitals in Sweden.

RESULTS
The final instrument consisted of 11 workload domains. The response rate was 98% and overall feasibility of PAWI was 100%. Content and face validity were demonstrated by consensus after two Delphi rounds. In national external validation, good agreement between experts was demonstrated with Cohen's κ greater than 0.75 in nine domains and 0.6 to 0.74 in the remaining two domains. A significant relationship was seen between PAWI and the nine equivalents of nursing manpower use score (NEMS) (r = 0.439, P < 0.001). There were no floor or ceiling effects. There was a significant association between PAWI points and American Society of Anesthesiologists’ (ASA) physical status grade (P = 0.007) but not between PAWI points and age.

CONCLUSION
We developed and validated PAWI, an instrument for objectively measuring workload in postanaesthesia care units. PAWI demonstrated good feasibility and metric properties.
First pass success of tracheal intubation using the C-MAC PM videolaryngoscope as first-line device in prehospital cardiac arrest compared with other emergencies
Authors: Hossfeld Bjoern , Thierbach Sylvi , Allgoewer Andreas , Gaessler Holger , Helm Matthias 
Published: August 2020

BACKGROUND
Successful airway management is a priority in the resuscitation of critically ill or traumatised patients. Several studies have demonstrated the importance of achieving maximum first pass success, particularly in prehospital advanced airway management.

OBJECTIVE
To compare success rates of emergency intubations between patients requiring cardiopulmonary resuscitation (CPR) for cardiac arrest (CPR group) and other emergencies (non-CPR group) using the C-MAC PM videolaryngoscope.

DESIGN
Ongoing analysis of prospective collected prehospital advanced airway management core variables.

SETTING
Single helicopter emergency medical service (HEMS) ‘Christoph 22’, Ulm Military Hospital, Germany, May 2009 to July 2018.

PATIENTS
We included all 1006 HEMS patients on whom prehospital advanced airway management was performed by board-certified anaesthesiologists on call at HEMS ‘Christoph 22’.

INTERVENTIONS
The C-MAC PM was used as the first-line device. The initial direct laryngoscopy was carried out using the C-MAC PM without the monitor in sight. After scoring the direct laryngoscopic view according to the Cormack and Lehane grade, the monitor was folded within the sight of the physician and tracheal intubation was performed using the videolaryngoscopic view without removing the blade.

MAIN OUTCOME MEASURES
The primary outcome was successful airway management. Secondary outcomes were the patient's position during airway management, necessity for suction, direct and videolaryngoscopic view according to Cormack and Lehane grading, as well as number of attempts needed for successful intubation.

RESULTS
A patent airway was achieved in all patients including rescue techniques. There was a lower first pass success rate in the CPR group compared with the non-CPR group (84.4 vs. 91.4%, P = 0.01). In the CPR group, direct laryngoscopy resulted more often in a clinically unfavourable (Cormack and Lehane grade 3 or 4) glottic view (CPR vs. non-CPR-group 37.2 vs. 26.7%, P = 0.0071). Using videolaryngoscopy reduced the clinically unfavourable grading to Cormack and Lehane 1 or 2 (P < 0.0001). The odds of achieving first pass success were approximately 12-fold higher with a favourable glottic view than with an unfavourable glottic view (OR 12.6, CI, 6.70 to 23.65).

CONCLUSION
Airway management in an anaesthesiologist-staffed HEMS is associated with a high first pass success rate but even with skilled providers using the C-MAC PM videolaryngoscope routinely, patients who require CPR offer more difficulties for successful prehospital advanced airway management at the first attempt.

TRIAL REGISTRATION
German Clinical trials register (drks.de) DRKS00020484
Multivariable haemodynamic approach to predict the fluid challenge response
Authors: Messina Antonio , Romano Salvatore M. , Ozdemirkan Aycan , Persona Paolo , Tarquini Riccardo , Cammarota Gianmaria , Romagnoli Stefano , Della Corte Francesco , Bennett Victoria , Monge García Manuel I. , Cecconi Maurizio , Payen Didier 
Published: August 2020

BACKGROUND
Beat-to-beat stroke volume (SV) results from the interplay between left ventricular function and arterial load. Fluid challenge induces time-dependent responses in cardiac performance and peripheral vascular and capillary characteristics.

OBJECTIVE
To assess whether analysis of the determinants of the haemodynamic response during fluid challenge can predict the final response at 10 and 30 min.

DESIGN
Observational multicentric cohort study.

SETTING
Three university ICUs.

PATIENTS
85 ICU patients with acute circulatory failure diagnosed within the first 48 h of admission.

INTERVENTION(S)
The fluid challenge consisted of 500 ml of Ringer's solution infused over 10 min. A SV index increase at least 10% indicated fluid responsiveness.

MAIN OUTCOME MEASURES
The SV, pulse pressure variation (PPV), arterial elastance, the systolic–dicrotic pressure difference (SAP-Pdic) and cardiac cycle efficiency (CCE) were measured at baseline, 1, 2, 3, 4, 5, 10, 15 and 30 min after the start of the fluid challenge. All haemodynamic data were submitted to a univariable logistic regression model and a multivariable analysis was then performed using the significant variables given by univariable analysis.

RESULTS
The multivariable model including baseline PPV, and the changes of arterial elastance at 1 min and of the CCE and SAP-Pdic at 5 min when compared with their baseline values, correctly classified 80.5% of responders and 90.7% of nonresponders at 10 min. For the response 30 min after starting the fluid challenge, the model, including the changes of PPV, CCE, SAP-Pdic at 5 min and of arterial elastance at 10 min compared with their baseline values, correctly identified 93.3% of responders and 91.4% of nonresponders.

CONCLUSION
In a selection of mixed ICU patients, a statistical model based on a multivariable analysis of the changes of PPV, CCE, arterial elastance and SAP-Pdic, with respect to baseline values, reliably predicts both the early and the late response to a standardised fluid challenge.

TRIAL REGISTRATION
ACTRN12617000076370.
Serratus anterior plane block for video-assisted thoracoscopic surgery
Authors: De Cassai Alessandro , Boscolo Annalisa , Zarantonello Francesco , Piasentini Eleonora , Di Gregorio Guido , Munari Marina , Persona Paolo , Zampirollo Stefano , Zatta Matteo , Navalesi Paolo 
Published: August 2020

BACKGROUND
The serratus anterior plane block (SAPb) is a promising interfascial plane technique able to provide profound thoracic analgesia. As only a few studies with quite small patient samples are presently available, the analgesic efficacy of adding SAPb to general anaesthesia in video-assisted thoracoscopic surgery (VATS), compared with general anaesthesia only, remains unclear.

OBJECTIVES
Our primary aim was to assess the analgesic efficacy of SAPb for VATS peri-operative pain control. The secondary aims were to evaluate differences in postoperative opioid use, intra-operative hypotension, postoperative side-effects and complications, time to chest tube removal, length of hospital stay.

DESIGN
Systematic review of randomised controlled trials (RCTs) with meta-analyses.
DATA SOURCES PubMed, Web of Science, Google Scholar and the Cochrane Library, searched up to 6 December 2019.
ELIGIBILITY CRITERIA RCTs including adult patients undergoing VATS who received single shot SAPb (cases), compared with general anaesthesia (controls).

RESULTS
Seven RCTs, with a total of 489 patients were included. SAPb reduced pain scores peri-operatively, compared with controls: 6 h [mean difference −1.86, 95% confidence interval (CI) −2.35 to −1.37, P < 0.001]; 12 h (mean difference −1.45, 95% CI −1.66 to −1.25, P < 0.001); 24 h (mean difference −0.98, 95% CI −1.40 to −0.56, P < 0.001). SAPb also reduced the use of postoperative opioids (mean difference: −4.81 mg of intravenous morphine equivalent, 95% CI −8.41 to −1.22, P < 0.03) and decreased the incidence of nausea and vomiting (risk ratio 0.53, 95% CI 0.36 to 0.79, P < 0.002).

CONCLUSION
Compared with general anaesthesia only and if no other locoregional techniques are used, SAPb significantly reduces postoperative pain and nausea and vomiting in patients undergoing VATS. Grading of Recommendations Assessment, Development and Evaluation rating are, nonetheless, quite low, due to high heterogeneity. Well designed and properly powered RCTs are necessary to confirm these preliminary findings.
The effect of oral Δ-9-tetrahydrocannabinol on the minimal alveolar concentration of sevoflurane
Authors: Müller Johannes , Plöchl Walter , Reiter Birgit , Stimpfl Thomas , Graf Alexandra , Baron-Stefaniak Joanna , Infanger Lukas , Hamp Thomas 
Published: August 2020

BACKGROUND
Cannabis has increasingly been used for medical and recreational purposes. The main pharmacological compound in cannabis is tetrahydrocannabinol (THC), which has sedative, anxiolytic and analgesic effects. In some animal models, THC has also been shown to reduce the minimum alveolar concentration (MAC) of halothane and cyclopropane, but its effect on sevoflurane, currently the most commonly used inhalational anaesthetic agent, has not been investigated.

OBJECTIVE
To investigate the effect of THC on the MAC of sevoflurane in rats.

METHODS
Observer-blinded, randomised controlled trial.

SETTING
Centre for Biomedical Research of the Medical University of Vienna, 2019.

INDIVIDUALS
Thirty-eight adult Wistar rats.

INTERVENTIONS
The rats were allocated randomly into one of two groups. Group A received THC 10 mg kg−1 and group B received the corresponding volume of placebo via gastric gavage (administration through a tube placed in the distal oesophagus). The rats were then individually anaesthetised in an airtight sevoflurane-flooded chamber, and the MAC in both groups was determined using Dixon's up-and-down method. Blood samples were drawn to measure serum concentrations of THC.

MAIN OUTCOME MEASURES
The primary outcome was the MAC of sevoflurane in Groups A and B.

RESULTS
The bootstrap estimate of the MAC of sevoflurane was 2.1 (95% confidence interval 1.8 to 2.4) vol% in the THC group and 2.8 (95% confidence interval 2.7 to 2.9) vol% in the placebo group, corresponding to a significant MAC reduction of 26% in response to THC.

CONCLUSION
Gastric administration of THC 10 mg kg−1 significantly reduced the MAC of sevoflurane by 26%.

TRIAL REGISTRATION
Not applicable.
A New Application of Sohrabi Albedo Neutron Dosimeters around a Plasma Focus Device
Authors: Sohrabi Mehdi , Soltani Zahra 
Published: August 2020

Abstract
A new application of the Sohrabi albedo neutron dosimeters is reported for the first time for determination of very low-level neutron ambient dose equivalents on and around a 3.5 kJ plasma focus device (PFD). The Sohrabi dosimeters basically use a polycarbonate track detector as bare and/or in contact with 10B convertor(s) under special cadmium cover arrangements. Its sensitivity was improved by using enriched 10B under new cadmium arrangements in order to detect epithermal neutrons in addition to fast and thermal neutrons. Results of 12 dosimeters installed externally around the PFD at different azimuthal (φ) and polar (θ) angles showed that azimuthal (φ) fast, epithermal, thermal, and total neutron ambient dose equivalents were symmetric and isotropic, respectively, with values 55.15 ± 8.36, 1.36 ± 02, 0.53 ± 03, and 57.04 ± 8.62 μSv/shot at ~25 cm from anode top. Polar (θ) neutron ambient dose equivalent values on z-axis relative to 90o angle were relatively higher. Results of 38 dosimeters placed on PFD facility walls for workplace monitoring and on a BOMAB phantom at operator’s location for personal dose equivalent determination showed values below minimum detection limits after exposure to 130 PFD shots. However, an operator’s personal dose equivalents at ~1.0 and ~3.0 m from the anode top were estimated to be, respectively, ~13.7 and ~1.52 mSv y−1 using azimuthal angle (φ) values if the PFD operates, for example, up to 20 shots per day for 200 d y−1. Even under such an extreme assumption, annual personal dose equivalent is still much below 20 mSv, the annual ICRP dose limit for workers.
Proteus mirabilis Keratitis: Risk Factors, Clinical Features, Treatment Outcomes, and Microbiological Characteristics
Authors: Mo Shelley , Durrani Asad F. , Safiullah Zaid , Kowalski Regis P. , Jhanji Vishal 
Published: August 2020

Purpose:
To characterize the risk factors, clinical presentations, management choices, and outcomes of Proteus mirabilis keratitis.

Methods:
In this retrospective study, 26 culture-proven cases of P. mirabilis infections were diagnosed and treated between 1998 and 2019 at the University of Pittsburgh Medical Center. Medical records were available for 14 keratitis cases and were reviewed for demographic information, ocular risk factors, and treatment outcomes.

Results:
Sixteen eyes of 14 patients were included in the study. The average age was 47.8 ± 19.3 years, with a median follow-up time of 6 months. The most common ocular risk factors were poor ocular surface and contact lens use in 57.1% and 42.9% of cases, respectively. Eleven of the 14 patients (78.6%) had positive corneal cultures, and 13 of the 14 patients (92.9%) had positive conjunctiva or eyelid cultures. All isolates were susceptible to ciprofloxacin, ofloxacin, moxifloxacin, gatifloxacin, and cefazolin. Surgical intervention was required in 4 patients (28.6%). Average LogMAR visual acuity was 1.3 ± 1.0 at presentation and 0.9 6 ± 1.0 at the most recent follow-up visit.

Conclusions:

Proteus mirabilis is an uncommon cause of microbial keratitis. Patients with poor ocular surface and those who use contact lens are at increased risk for developing this cause of keratitis. Empiric treatment with fortified antibiotics or fluoroquinolones seemed to provide effective coverage for P. mirabilis.
Measurement Reliability for Keratitis Morphology
Authors: Kriegel Matthias F. , Loo Jessica , Farsiu Sina , Prajna Venkatesh , Tuohy Megan , Kim Kyeong Hwan , Valicevic Autumn N. , Niziol Leslie M. , Tan Huan , Ashfaq Hamza A. , Ballouz Dena , Woodward Maria A. 
Published: August 2020

Purpose:
To evaluate the reliability of manual annotation when quantifying cornea anatomical and microbial keratitis (MK) morphological features on slit-lamp photography (SLP) images.

Methods:
Prospectively enrolled patients with MK underwent SLP at initial encounter at 2 academic eye hospitals. Patients who presented with an epithelial defect (ED) were eligible for analysis. Features, which included ED, corneal limbus (L), pupil (P), stromal infiltrate (SI), white blood cell (WBC) infiltration at the SI edge, and hypopyon (H), were annotated independently by 2 physicians on SLP images. Intraclass correlation coefficients (ICCs) were applied for reliability assessment; dice similarity coefficients (DSCs) were used to investigate the area overlap between readers.

Results:
Seventy-five MK patients with an ED received SLP. DSCs indicate good to fair annotation overlap between graders (L = 0.97, P = 0.80, ED = 0.94, SI = 0.82, H = 0.82, WBC = 0.83) and between repeat annotations by the same grader (L = 0.97, P = 0.81, ED = 0.94, SI = 0.85, H = 0.84, WBC = 0.82). ICC scores showed good intergrader (L = 0.98, P = 0.78, ED = 1.00, SI = 0.67, H = 0.97, WBC = 0.86) and intragrader (L = 0.99, P = 0.92, ED = 0.99, SI = 0.94, H = 0.99, WBC = 0.92) reliabilities. When reliability statistics were recalculated for annotated SI area in the subset of cases where both graders agreed WBC infiltration was present/absent, intergrader ICC improved to 0.91 and DSC improved to 0.86 and intragrader ICC remained the same, whereas DSC improved to 0.87.

Conclusions:
Manual annotation indicates usefulness of area quantification in the evaluation of MK. However, variability is intrinsic to the task. Thus, there is a need for optimization of annotation protocols. Future directions may include using multiple annotators per image or automated annotation software.
Postoperative Changes in Central Corneal Thickness and Intraocular Pressure in a Prospective Cohort of Congenital Cataract Patients
Authors: Chang Pingjun , Kou Jiaojiao , Zhang Bing , Wang Jiajun , Tian Tong , Zhao Yun-e 
Published: August 2020

Purpose:
To evaluate changes in central corneal thickness (CCT) and intraocular pressure (IOP) in children after surgery for congenital cataracts and to investigate the association between CCT and IOP.

Methods:
For this prospective observational cohort study, we recruited patients undergoing surgery for unilateral or bilateral congenital cataracts. CCT and IOP were measured before surgery and 1, 3, 6, 12, and 24 months after surgery.

Results:
Seventy-six children (152 eyes) were enrolled; 33 eyes were unaffected by cataracts, 77 were aphakic, and 42 were pseudophakic. In aphakic eyes, mean CCT increased by 31.14 ± 44.32 μm at 12 months postoperation and 33.09 ± 35.42 μm at 24 months postoperation; this increase was significantly higher than that in pseudophakic eyes 12 months after surgery (8.36 ± 19.91 μm; P < 0.001) and 24 months after surgery (0.31 ± 14.19 μm; P = 0.024). However, no significant differences in IOP were found between the different phakic states at 12 and 24 months postoperation (P = 0.672 and P = 0.080, respectively). There were also no significant differences in CCT and IOP before and after surgery in the unaffected eyes.

Conclusions:
Mean CCT peaked at 12 months, and the mean IOP remained normal in both the aphakic and pseudophakic eyes during this study. CCT and IOP were positively correlated, regardless of the phakic status or age, a relationship which suggests that both parameters should be monitored closely in postsurgical patients for up to 12 months and in this time, may impact the ability to diagnose glaucoma.
Normative Values of Various Pentacam HR Parameters for Pediatric Corneas
Authors: Hashem Ahmed Osama , Roshdy Maged Maher , Wahba Sherine Shafik , Saleh Mohamed Ibrahim , Elkitkat Rania Serag 
Published: August 2020

Purpose:
To provide a normative database of several Pentacam parameters for a healthy pediatric population.

Methods:
This was a retrospective study conducted at Al Watany Eye Hospitals, Cairo, Egypt. We explored the Pentacam HR database and collected the data of 432 normal right eyes of children and teenagers aged 3 to 18 years. The subjects were classified into the following 3 groups: group 1 (3–6 years, 17 eyes), group 2 (6–12 years, 126 eyes), and group 3 (12–18 years, 289 eyes). The parameters of the study cohort were compared with those of a healthy adult cohort.

Results:
The mean age of the study cohort was 13.5 (13.2–13.8) years. There were significant differences in the following indices among the 3 age groups: anterior chamber (depth and volume), curvature (index of height decentration, index of vertical asymmetry, and center keratoconus index), elevation (front and back elevations from the best fit toric ellipsoid), and pachymetric (minimum and average pachymetric progression indices and average Ambrosio relational thickness) parameters (P values 0.001, 0.001, 0.002, 0.04, <0.001, <0.001, 0.03, 0.02, 0.01, and 0.03, respectively).

Conclusions:
There were significant differences in the normative values of several Pentacam indices between the pediatric and adult cohorts. Based on this finding, it is more credible to incorporate separate software cutoff values for pediatric patients. However, because there were no clinically significant differences in the parameters of the pediatric subgroups, there is no need to consider a separate cutoff value for each pediatric age range.
Treatment of Severe Infectious Keratitis With Scleral Contact Lenses as a Reservoir of Moxifloxacin 0.5%
Authors: Polania-Baron Eduardo J. , Santana-Cruz Omar , Lichtinger Alejandro , Graue-Hernandez Enrique O. , Navas Alejandro 
Published: August 2020

Purpose:
To report the outcomes of using scleral contact lenses as antibiotic reservoirs as a therapeutic approach in a case series of severe infectious keratitis and to discuss the clinical potential.

Methods:
This was a prospective consecutive case series study of 12 eyes treated for infectious keratitis at the “Conde de Valenciana” Institute of Ophthalmology. A scleral lens (SL) filled with 0.5% moxifloxacin was used as a reservoir and replaced every 24 hours until epithelization was complete or the culture report and/or antibiogram demonstrated either a microorganism not susceptible to or resistant to moxifloxacin.

Results:
The study included 12 eyes of 12 patients (7 women; 58.33%; average age of 63 ± 20.11 years). All patients completed at least 1 month of follow-up. Patients had a diagnosis of infectious keratitis, and the SL was fitted on initial consultation. Of the 12 eyes, 7 had culture-positive bacterial infection, 2 eyes were mycotic, and 3 eyes had no culture growth. In 3 eyes, SL was discontinued because of the lack of response (one eye) and to the presence of mycotic infection (2 eyes). All infections resolved favorably at the final follow-up.

Conclusions:
The use of SLs could be an alternative for antibiotic impregnation and treatment of infectious keratitis. No complications or side effects were observed related to the use of the scleral contact lens as a reservoir for the antibiotic. This treatment modality could offer a comfortable treatment for the patient, ensuring good impregnation and maintenance of antibiotic concentrations during the 24-hour wear periods.