bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric burn resuscitation, management, and recovery for the pediatric anesthesiologist
Authors: Sofia Joseph , Ambardekar Aditee 
Published: May 2020

Purpose of review
The purpose of this article is to summarize literature in pediatric burn resuscitation and management that is relevant to the pediatric anesthesiologist. The scope of the literature is expanding as long-term survival in even the most critically ill, burn-injured children has increased.

Recent findings
Longstanding variations in the care of burn-injured children exist despite decades of experience in burn care management. There seems to be a discomfort outside major burn centers in the triage, evaluation, and assessment of burned children. This is evidenced by the prevalence of ‘unnecessary intubations’, continued overestimation of total body surface area injured, and subsequent fluid administration disproportionate to injury leading to over-resuscitation. Techniques, such as virtual reality and regional anesthesia are increasingly available and serve adjuncts to pharmacologic therapies for anxiolysis and analgesia. Such techniques reduce opioid utilization while maintaining patient comfort and satisfaction particularly during wound dressing changes. Questions about transfusion threshold and ratio of blood products remain topics of ongoing research.

Summary
Literature review continues to reveal underpowered or retrospective analyses of these very important questions. Public health burden caused by burns warrants rigorous, prospective studies to take the best care of these patients and portend the best long-term outcomes. Collaboration amongst pediatric anesthesiologists who care for these children is necessary to develop and execute powered studies to answer important questions.
Practice horizons in pediatric nonoperating room anesthesia
Authors: Setiawan Christopher Tan , Landrigan-Ossar Mary 
Published: May 2020

Purpose of reviewAnesthesia outside the operating room is rapidly expanding for adult and pediatric patients. Anesthesia clinicians practicing in this area need a good understanding of the challenges of the NORA environment and the anesthetic risks and perioperative implications of practice so that they can deliver safe care to their patients.Recent findingsRecent reports from large patient databases have afforded anesthesiologists a greater understanding of the risk of NORA when compared to anesthesia in the operating room. Descriptions of advances in team training with the use of simulation have allowed the development of organized procedural teams. With an emphasis on clear communication, an understanding of individual roles, and a patient-centered focus, these teams can reliably develop emergency response procedures, so that critical moments are not delayed in an environment remote from usual assistance.SummaryWith appropriate attention to organizational concerns (i.e. team environment, safety protocols) and unrelenting focus on patient safety, anesthesiologists can assist in safely providing the benefit of cutting-edge technical advancements to pediatric patients in these challenging environments.
Preoperative considerations for Jehovah's Witness patients: a clinical guide
Authors: Chae Christina , Okocha Obianuju , Sweitzer BobbieJean 
Published: May 2020

Purpose of review
Jehovah's Witnesses have religious beliefs that preclude transfusion of blood products and certain medical interventions. This presents a unique dilemma and ethical challenge to healthcare providers, especially in a surgical setting.

Recent findings
The growing number of followers of this faith warrants a deeper look at the ethical, legal, and clinical implications of their beliefs. Advances in patient blood management now allow timely optimization before surgery.

Summary
Anticipating the challenges associated with managing and optimizing patients who refuse blood products allows for more favorable outcomes in the preoperative period.
Do Sex Differences Among Adults With Opioid Use Disorder Reflect Sex-specific Vulnerabilities? A Study of Behavioral Health Comorbidities, Pain, and Quality of Life
Authors: Rhee Taeho Greg , Peltier MacKenzie R. , Sofuoglu Mehmet , Rosenheck Robert A. 
Published: May 2020

Objectives:
Studies suggest that men and women have different vulnerabilities to a number of substance use disorders (SUDs). We examined whether differences between women and men with opioid use disorder (OUD) are significantly different from those without OUD for selected sociodemographic and health outcomes.

Methods:
We used a cross-sectional survey design using data from 2012 to 2013 National Epidemiological Survey on Alcohol and Related Conditions Wave III, which surveyed nationally representative samples of non-institutionalized adults (n = 36,309 unweighted). Past-year OUD and other behavioral co-morbidities were defined using DSM-5 criteria. In bivariate analyses, we investigated sex differences in socio-demographic factors, behavioral co-morbidities, pain, and health-related quality of life (HRQOL) between women and men with past-year OUD, and then those without past-year OUD. We further used logistic regression analyses to evaluate interactions between effect of sex and past-year OUD status on behavioral co-morbidities, pain, and HRQOL.

Results:
When extrapolated, about 2.1 million US adults met diagnostic criteria for past-year OUD. Women with OUD had a higher likelihood of having several past-year psychiatric disorders, and a lower likelihood of having any past-year SUDs compared to male counterparts. However, similar relationships were observed among those without OUD and significant interaction effects were not found on behavioral co-morbidities, pain, and HRQOL, indicating that general sex differences are not specific to OUD.

Conclusions:
Although sex differences are not specific to OUD, concurrent disorders are not uncommon among women, as well as men, with OUD. There is a need to treat concurrent behavioral health conditions from a multimorbidity perspective in the treatment of OUD in both sexes.
Computerized Cognitive Behavioral Therapy for Substance Use Disorders in a Specialized Primary Care Practice: A Randomized Feasibility Trial to Address the RT Component of SBIRT
Authors: Tetrault Jeanette M. , Holt Stephen R. , Cavallo Dana A. , O’Connor Patrick G. , Gordon Melissa A. , Corvino Joanne K. , Nich Charla , Carroll Kathleen M. 
Published: May 2020

Objectives:
Screening, Brief Intervention, and Referral to Treatment (SBIRT) has demonstrated efficacy for addressing unhealthy alcohol use in primary care, yet recent research indicates weaker efficacy for drug use as well as very limited success in referral to specialty care for patients with substance use disorder (SUD). Technology-based interventions for SUD delivered in primary care settings are a potential strategy of efficiently delivering treatment to those who need it.

Methods:
We conducted a randomized clinical trial evaluating feasibility, satisfaction, and substance use outcomes for 58 individuals with SUD. Participants being treated in a primary care practice which provides integrated addiction treatment were randomized to standard care or standard care plus access to a web-based SUD intervention (computer-based training in cognitive behavioral therapy, or CBT4CBT). Self-reported substance use and urine toxicology screens were assessed at 8 weeks after randomization.

Results:
Uptake of CBT4CBT in this setting was high; 77% of those assigned to this condition accessed the program at least once; of those, 77% completed all 7 modules. Satisfaction with the program was very high. Participants reported >90% days abstinent for all classes of drugs; with no significant differences between conditions.

Conclusions:
This study demonstrates feasibility of implementing technology-based treatments in primary care settings to address weak follow-through with the referral component of SBIRT. The overall positive outcomes in this specialized, integrated treatment setting may have undercut the ability to demonstrate differential effects on substance use; results suggest evaluation in less specialized primary care settings is warranted.

Trial Registration:
clinicaltrials.gov NCT03013478
Genetic variability in postoperative nausea and vomiting
Authors: Klenke Stefanie , Frey Ulrich H. 
Published: May 2020

BACKGROUND
Postoperative nausea and vomiting (PONV) is the most frequent side effect following anaesthesia. Predisposition to developing PONV is multifactorial with patient risk factors and anaesthetic techniques both being contributory. However, there is also a genetic susceptibility to PONV, and several studies have aimed to identify polymorphisms contributing to a genetic PONV risk.

OBJECTIVE
We summarised previous published studies investigating genetic contribution to PONV risk.

DESIGN
Systematic review without meta-analysis.

DATA SOURCE
We searched MEDLINE until June 2019.

ELIGIBILITY CRITERIA
Articles were chosen for review when PONV and polymorphisms were included. Exclusion criteria were reviews/meta-analysis/comments, articles not in the English language, nonappropriate content (e.g. PONV not as primary aim of the study, study investigated opioid-induced nausea) or if articles were pharmacogenetic studies addressing treatment of PONV.

RESULTS
A total of 59 studies were screened and 14 articles were reviewed including one genome-wide association study (GWAS). Seven studies were performed in East Asians, and seven in Caucasians. Seventeen polymorphisms have been positively associated with PONV in at least one study. Allele frequency of the investigated polymorphisms differs widely between the ethnicities. Furthermore, the anaesthesia regimen and the postoperative time point at which the association with PONV was reported were quite different. Only two polymorphisms, the CHRM3 rs2165870 and the KCNB2 rs349358 (both first associated with PONV in a GWAS), have been significantly associated with PONV incidence in Caucasians in independent studies.

CONCLUSION
There is a genetic susceptibility to the development of PONV. Two single nucleotide polymorphisms (SNPs), the CHRM3 rs2165870 and the KCNB2 rs349358 SNP, seem to have a major influence on PONV incidence, at least in Caucasians. Both SNPs were primarily identified in a GWAS and this association may lead to a better understanding of the disease aetiology. Further high-quality studies are needed to reveal more insights in genetic PONV susceptibility, particularly so in non-Caucasian ethnicities.
Hypertension and diabetes mellitus: highlights of a complex relationship
Authors: Yildiz Mehmet , Esenboğa Kerim , Oktay Ahmet Afşin 
Published: May 2020

Purpose of review
Herein, we provide a review of the recent literature on the epidemiological and pathophysiological relationship between hypertension (HTN) and diabetes mellitus, along with prognostic implications and current treatment concepts.

Recent findings
Diabetes mellitus affects ∼10% of US adults. The prevalence of HTN in adults with diabetes mellitus was 76.3% or 66.0% based on the definitions used by guidelines. There exist differences among major society guidelines regarding the definition of HTN and target blood pressure (BP) levels. Recent basic and clinical research studies have shed light on pathophysiologic and genetic links between HTN and diabetes mellitus. Randomized controlled trials over the past 5 years have confirmed the favorable BP and cardiovascular risk reduction by antidiabetic agents.

Summary
HTN and diabetes mellitus are ‘silent killers’ with rising global prevalence. The development of HTN and diabetes mellitus tracks each other over time. The coexistence of both clinical entities synergistically contributes to micro- and macro-vasculopathy along with cardiovascular and all-cause mortality. Various shared mechanisms underlie the pathophysiological relationship between HTN and diabetes mellitus. Moreover, BP reduction with lifestyle interventions and antihypertensive agents is a primary target for reducing cardiovascular risk among patients with HTN and diabetes mellitus.
Sympathetic neural abnormalities in type 1 and type 2 diabetes: a systematic review and meta-analysis
Authors: Grassi Guido , Biffi Annalisa , Dell’Oro Raffaella , Quarti Trevano Fosca , Seravalle Gino , Corrao Giovanni , Perseghin Gianluca , Mancia Giuseppe 
Published: May 2020

Background:
Microneurographic recordings of muscle sympathetic nerve activity (MSNA) have shown that sympathetic activation may characterize diabetes mellitus. However, it is recognized that comorbidities and metabolic abnormalities frequently associated with both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) diabetes affect MSNA, generating potential confounding effects and making the association between sympathetic activation and diabetes mellitus still a controversial matter.

Methods:
The present meta-analysis evaluated 11 microneurographic studies enrolling 314 diabetes mellitus patients and healthy controls, and MSNA was chosen as the main variable of interest. Collection of the data included indirect adrenergic markers such as heart rate and venous plasma noradrenaline, together with hemodynamic, anthropometric and metabolic variables.

Results:
A total of 11 microneurographic studies were evaluated including 314 diabetes mellitus patients and controls. Diabetes mellitus displayed MSNA significantly greater than controls (mean difference amounting to 8.1, 95% confidence interval 1.21–15.08, P < 0.05). This difference was ascribed to T2DM, since T1DM patients displayed MSNA values superimposable to controls. In T2DM MSNA was directly related to age (r = 0.83, β = 0.82, P < 0.04) and plasma insulin (r = 1.00, β = 2.25, P < 0.01) but not to other variables.

Conclusion:
T2DM-related sympathetic activation is detectable even when obesity, hypertension and metabolic syndrome are excluded; not found in T1DM; not associated with anthropometric and hemodynamic variables; and related to plasma insulin.
The prognostic importance of right ventricular remodeling and the circadian blood pressure pattern on the long-term cardiovascular outcome
Authors: Tadic Marijana , Cuspidi Cesare , Celic Vera , Petrovic Olga , Pencic Biljana , Mancia Giuseppe , Grassi Guido , Ivanovic Branislava 
Published: May 2020

Objective:
We sought to investigate the predictive value of right ventricular (RV) remodeling and 24-h blood pressure (BP) patterns on long-term cardiovascular prognosis in the initially untreated hypertensive patients.

Methods:
The current study included 505 initially untreated hypertensive patients who were consequently included in this study from 2007 to 2012. All the patients underwent laboratory analysis, 24-h BP monitoring and echocardiographic examination at baseline. The patients were followed for a median period of 9 years. The adverse outcome was defined as the hospitalization due to cardiovascular events (atrial fibrillation, myocardial infarction, myocardial revascularization, heart failure, stroke, or cardiovascular death).

Results:
During the 9-year follow-up period adverse cardiovascular events occurred in 82 hypertensive patients. Night-time SBP, the nondipping BP pattern, left ventricle hypertrophy, RV hypertrophy, right atrial enlargement, RV diastolic dysfunction, and RV systolic dysfunction were associated with adverse cardiovascular events. Nevertheless, night-time SBP, the nondipping BP pattern, mitral E/e′, left ventricle hypertrophy, and RV hypertrophy were the only independent predictors of cardiovascular events. When all four BP patterns were included in the model, only the reverse dipping BP pattern was an independent predictor of cardiovascular events.

Conclusion:
The present investigation showed that RV hypertrophy and the reverse dipping BP pattern were independent long-term predictors of the cardiovascular outcome. Detailed echocardiographic evaluation and 24-h ambulatory blood pressure monitoring should be performed even in low-risk hypertensive patients.
Global burden of hypertension among people living with HIV in the era of increased life expectancy: a systematic review and meta-analysis
Authors: Bigna Jean Joel , Ndoadoumgue Aude Laetitia , Nansseu Jobert Richie , Tochie Joel Noutakdie , Nyaga Ulrich Flore , Nkeck Jan René , Foka Audrey Joyce , Kaze Arnaud D. , Noubiap Jean Jacques 
Published: May 2020

Background:
Although HIV infection and antiretroviral therapy (ART) increase the risk for hypertension in people living with HIV (PLHIV), the global and regional burden of hypertension in PLHIV is not well characterized.

Methods:
In this systematic review and meta-analysis, we searched multiple databases for studies reporting on hypertension in PLHIV and conducted between 2007 and 2018. Meta-analysis through random-effect models served to obtain the pooled prevalence estimates. Heterogeneity was assessed via the χ2 test on Cochran's Q statistic.

Results:
We included 194 studies (396 776 PLHIV from 61 countries). The global prevalence of hypertension was 23.6% [95% confidence interval (95% CI: 21.6–25.5)] with substantial heterogeneity. The regional distribution was Western and Central Europe and North America [28.1% (95% CI: 24.5–31.9)], West and Central Africa [23.5% (16.6–31.0)], Latin America and the Caribbean [22.0% (17.8–26.5)], Eastern and Southern Africa [19.9% (17.2–22.8)], and Asia and Pacific [16.5% (12.5–21.0)]; P = 0.0007. No study originated from the Middle East and North Africa, and Eastern Europe and Central Asia regions. The prevalence was higher in high-income countries than others (P = 0.0003) and higher in PLHIV taking ART than those ART-naive (P = 0.0003). The prevalence increased over time (mainly driven by Eastern and Southern Africa) and with age. There was no difference between men and women. We estimated that in 2018, there were 8.9 (95% CI: 8.3–9.6) million cases of hypertension in PLHIV globally, among whom 59.2% were living in Sub-Saharan Africa.

Conclusion:
Cost-effective strategies to curb the dreadful burden of hypertension among PLHIV are needed.
The Experience of a Neurocritical Care Admission and Discharge for Patients and Their Families: A Qualitative Analysis
Authors: Rath Kelly , Kreitzer Natalie , Schlichter Erika , Lopez Omar , Ferioli Simona , Ngwenya Laura B. , Foreman Brandon 
Published: May 2020

ABSTRACT

INTRODUCTION: A qualitative assessment of discharge resource needs is important for developing evidence-based care improvements in neurocritically ill patients. METHODS: We conducted a quality improvement initiative at an academic hospital and included all patients admitted to the neuroscience intensive care unit (ICU) during an 18-month period. Telephone assessments were made at 3 to 6 months after admission. Patients or caregivers were asked whether they had adequate resources upon discharge and whether they had any unanswered questions. The content of responses was reviewed by a neurointensivist and a neurocritical care nurse practitioner. A structured codebook was developed, organized into themes, and applied to the responses. RESULTS: Sixty-one patients or caregivers responded regarding access to resources at discharge with 114 individual codable responses. Responses centered around 5 themes with 23 unique codes: satisfied, needs improvement, dissatisfied, poor post-ICU care, and poor health. The most frequently coded responses were that caregivers believed their loved one had experienced an unclear discharge (n = 11) or premature discharge (n = 12). Two hundred four patients or caregivers responded regarding unanswered questions or additional comments at follow-up, with 516 codable responses. These centered around 6 themes with 26 unique codes: positive experience, negative experience, neutral experience, medical questions, ongoing medical care or concern, or remembrance of time spent in the ICU. The most frequent response was that caregivers or patients stated that they received good care (n = 115). Multiple concerns were brought up, including lack of follow-up after hospitalization (n = 15) and dissatisfaction with post-ICU care (n = 15). CONCLUSIONS: Obtaining qualitative responses after discharge provided insight into the transition from critical care. This could form the basis for an intervention to provide a smoother transition from the ICU to the outpatient setting.
Palliative care for pediatric intensive care patients and families
Authors: Rothschild Charles B. , Derrington Sabrina F. 
Published: May 2020

Purpose of review
Children with medical or surgical critical illness or injury require skillful attention to physical, emotional, psychological, and spiritual needs, whereas their families need support and guidance in facing life-threatening or life-changing events and gut-wrenching decisions. This article reviews current evidence and best practices for integrating palliative care into the pediatric intensive care unit (PICU), with a focus on surgical patients.

Recent findings
Palliative care is best integrated in a tiered approach, with primary palliative care provided by the PICU and surgical providers for all patients and families, including basic symptom management, high-quality communication, and end-of-life care. Secondary and tertiary levels of care involve unit or team-based ‘champions’ with additional expertise, and subspecialty palliative care teams, respectively. PICU and surgical providers should be able to provide primary palliative care, to identify patients and families for whom a palliative care consult would be helpful, and should be comfortable introducing the concept of palliative care to families.

Summary
This review provides a framework and tools to enable PICU and surgical providers to integrate palliative care best practices into patient and family care.
Update and breakthrough in cardiac xenotransplantation
Authors: Brenner Paolo , Mihalj Maks 
Published: May 2020

Purpose of review
Considerable advancements have been made in the field of cardiac xenotransplantation in the recent years, achieving prolonged survival of the life-supporting cardiac xenograft and paving the way toward first clinical implications.

Recent findings
The combination of genetic modifications and novel immunosuppression with costimulation blockade, as well as supporting therapy with antiinflammatory treatment, growth prevention, and adaptation of the heart procurement system to reduce myocardial ischemia and reperfusion injury improves the overall cardiac xenograft function and overall survival in nonhuman primates. Through the newly identified xenoantigens and novel gene-editing techniques, further genetic modification of the porcine xenografts should be explored, to ensure clinical safety.

Summary
With continuous progress in all fields of cardiac xenotransplantation, first clinical use in humans seems accomplishable. To ensure the clinical safety and to conform to the ethical regulations, further investigation of the infectious and immunological implications on humans should be explored prior to first clinical use. The first clinical use of cardiac xenotransplantation will be limited to only highly selected patients.