bluuebunny/crossref_metadata_2025_split huggingface dataset:
Two Concomitant Right Nonrecurrent Laryngeal Nerves Encountered During Thyroidectomy (Type 4 Course): Reported for the First Time
Authors: Mohammed Ayad Ahmad , Arif Sardar Hassan 
Published: April 2020

Introduction: The recurrent laryngeal nerve gains its name because after branching from the vagus nerve, it turns superiorly (recur) around the subclavian artery on the right and around the ligamentum arteriosum on the left, the nonrecurrent nerve has a straight direct course to the larynx and doesn’t follow this course. It presents mostly on the right side. The presence of this variation places the nerve at higher risk of injury during neck surgery especially thyroid operations. Case Presentation: A 45-year-old lady presented with painless thyroid enlargement for 1 year. Thyroid examination showed a 3-cm firm nodule at the right thyroid lobe with normal thyroid function tests. Right thyroid lobectomy was done and the histopathology showed a benign follicular lesion. During surgery, we discovered 2 nonrecurrent laryngeal nerves at the right side which were arising from the vagus nerve and both were entering the larynx. Conclusion: Failure in identification of the nerve or overlooking the possibility of the non-recurrent laryngeal nerve may result in a serious sequelae of nerve damage, ipsilateral injury may lead to permanent hoarseness and bilateral injury may result in severe dyspnea or aphonia. Currently, there are 3 types of nonrecurrent laryngeal nerve courses. Type 1 passes near to the superior thyroid vessels. Type 2 (2A) passes parallel to the inferior thyroid artery and has a transverse course above it. Type 3 (2B) passes parallel to the inferior thyroid artery and transversely between branches of or under the inferior thyroid artery, we can add to this classification type 4, which are 2 nonrecurrent laryngeal nerves (double nerves) passing above and parallel to the inferior thyroid artery.
Application of response surface methodology for optimization of zinc elimination from a polluted soil using tartaric acid
Authors: Alman-Abad Zahra Sheikhi , Pirkharrati Hossein , Asadzadeh Farrokh , Maleki-Kakelar Mahdi 
Published: April 2020

Heavy metal wastes generated from mining activities are a major concern in developing countries such as Iran. Increasing concentrations of these metals in the soil make up a severe health hazard due to their non-degradability and toxicity. In this study, batch washing experiments were conducted in order to investigate the removal efficiency of zinc by biodegradable chelates, tartaric acid. For this purpose, soil samples were collected from the zinc contaminated soil in the region of the Angouran, Zanjan, Iran. Hence, optimization of batch washing conditions followed using a three-level central composite design approach based on the response surface methodology. The results demonstrated that the effects of pH, tartaric acid concentration, and interaction between selective factors on the zinc removal efficiency were all positive and significant (P < 0.05). An optimum zinc removal efficiency of 89.35 ±2.12% was achieved at tartaric acid concentration of 200 mM l−1, pH of 4.46, and incubation time of 120 min as the optimal conditions. Accordingly, response surface methodology is appropriately capable to determine and optimize chemical soil washing process to remediate heavy metal polluted soil.
Pharmacological Treatment of Mood Disorders and Comorbid Addictions: A Systematic Review and Meta-Analysis: Traitement Pharmacologique des Troubles de L’humeur et des Dépendances Comorbides: Une Revue Systématique et une Méta-Analyse
Authors: Stokes Paul R. A. , Jokinen Tahir , Amawi Sami , Qureshi Mutahira , Husain Muhammad Ishrat , Yatham Lakshmi N. , Strang John , Young Allan H. 
Published: April 2020

Objective: Addiction comorbidity is an important clinical challenge in mood disorders, but the best way of pharmacologically treating people with mood disorders and addictions remains unclear. The aim of this study was to assess the efficacy of pharmacological treatments for mood and addiction symptoms in people with mood disorders and addiction comorbidity. Methods: A systematic search of placebo-controlled randomized controlled trials investigating the effects of pharmacological treatments in people with bipolar disorder (BD) or major depressive disorder (MDD), and comorbid addictions was performed. Treatment-related effects on mood and addiction measures were assessed in a meta-analysis, which also estimated risks of participant dropout and adverse effects. Results: A total of 32 studies met systematic review inclusion criteria. Pharmacological therapy was more effective than placebo for improving manic symptoms (standardized mean difference [SMD] = −0.15; 95% confidence interval [95% CI], −0.29 to −0.02; P = 0.03) but not BD depressive symptoms (SMD = −0.09; 95% CI, −0.22 to 0.03; P = 0.15). Quetiapine significantly improved manic symptoms (SMD = −0.23; 95% CI, −0.39 to −0.06; P = 0.008) but not BD depressive symptoms (SMD = −0.07; 95% CI, −0.23 to 0.10; P = 0.42). Pharmacological therapy was more effective than placebo for improving depressive symptoms in MDD (SMD = −0.16; 95% CI, −0.30 to −0.03; P = 0.02). Imipramine improved MDD depressive symptoms (SMD = −0.58; 95% CI, −1.03 to −0.13; P = 0.01) but Selective serotonin reuptake Inhibitors (SSRI)-based treatments had no effect (SMD = −0.06; 95% CI, −0.30 to 0.17; P = 0.60). Pharmacological treatment improved the odds of alcohol abstinence in MDD but had no effects on opiate abstinence. Conclusions: Pharmacological treatments were significantly better than placebo in improving manic symptoms, MDD depressive symptoms, and alcohol abstinence but were not better for bipolar depression symptoms. Importantly, quetiapine was not more effective than placebo in improving bipolar depression symptoms nor were SSRI’s for the treatment of MDD depression. Our findings highlight the need for further high-quality clinical trials of treatments for mood disorders and comorbid addictions.
Use of Physician-Estimated and Patient Self-Reported Weights to Guide Initial Fluid Resuscitation in Emergency Department Patients With Suspected Sepsis
Authors: Lessing Jeremy K. , Ford William J. H. , Steel Peter A. , Clark Sunday , Sharma Rahul , Arbo John E. 
Published: April 2020

Background: Knowledge of patient weight is required to guide initial intravenous fluid therapy for patients with sepsis-associated hypotension or elevated lactate. Previous studies have shown patients are better estimators of their weight than medical providers are; critically ill patients, however, may be unable to provide this information. Objectives: This study compares the accuracy of physician-estimated and patient self-reported weights to subsequent inpatient bed/stretcher scale weights for guiding initial protocol-based intravenous fluid therapy in the treatment of emergency department patients with suspected sepsis. Methods: Adult patients presenting with a suspected diagnosis of severe sepsis to a large, urban, academic emergency department had either physician-estimated or patient self-reported weights recorded on presentation. All patients had subsequent inpatient bed/stretcher scale weights recorded on the first day of hospitalization. Results: Physician-estimated and patient self-reported weights linearly correlated ( P < .001) with inpatient bed/stretcher scale weights. Median accuracy error for physicians (5.4% [2.0-10.1]) and patients (3.9% [1.6-6.4]) was not significantly different ( P = .28). Physician-estimated and patient self-reported weights accuracy was determined at multiple levels: within 5% (46%, 57%, respectively), 10% (75%, 90%), 15% (90%, 95%), and 20% (100%, 95%) error tolerances, as well accurate estimates within 5 kg (69.2%, 70.0%). Conclusions: Both physician-estimated and patient self-reported weights are reliable when calculating initial protocol-based intravenous fluid resuscitation for emergency department patients with sepsis.
Practicing CPR: A Qualitative Analysis of Resident Motivation
Authors: Harwayne-Gidansky Ilana , Balmer Dorene F. , Doughty Cara B. , Scarlatos Lori L. , Chang Todd , Lee Song Joo 
Published: April 2020

Background. For uncommon events in medicine, such as pediatric CPR, more frequent training is associated with improved performance among healthcare providers and physicians in training. Gamified learning may facilitate motivation to practice CPR, though studies to support this are lacking. Intervention. Residents were interviewed to understand motivating factors for CPR practice outside of a traditional classroom certification setting. Methods. We used a qualitative study design within a larger multinational study. Semi-structured, one-on-one interviews were completed with pediatric residents using a constructivist approach. Transcripts were reviewed independently by two authors (IHG, JLS). Results. The inductive framework gradually moved away from gamification and towards that of self-determination. Participating residents reported several types of intrinsic and extrinsic motivational drivers towards practicing CPR, such as practicing CPR to prepare, or as a connection to clinical practice. Some themes were amotivational, such as performance anxiety, and detracted from their drive to practice. Despite a gamification design to this curriculum, these components were rarely mentioned. These themes related to achieving Maslow’s three psychological needs of autonomy, relatedness and competence. Conclusion. The motivation to practice CPR among residents aligns with the self-determination theory. By stimulating intrinsic motivating factors, future curriculum design may better motivate residents to practice CPR.
Palliative Care in a Death-Denying Culture: Exploring Barriers to Timely Palliative Efforts for Heart Failure Patients in the Primary Care Setting
Authors: Crimmins Rebecca M. , Elliott Lydia , Absher Darren T. 
Published: April 2020

Context: Heart failure (HF) is a complex, life-limiting disease that is prevalent and burdensome. All major cardiology societies and international clinical practice guidelines recommend the integration of palliative care (PC) interventions alongside usual HF management. Objectives: The purpose of this review of the literature was to evaluate the various barriers to the early initiation of PC for HF patients in the primary care setting. Methods: An integrative literature review was conducted in order to assess and incorporate the diverse sources of literature available. An EBSCO search identified relevant articles in the following databases: Medline complete, Academic Search Premier, CINAHL, PsycINFO, Cochrane Library, and SocINDEX. The search was limited to full text, peer reviewed, English only, and published between 2010 and 2019. Results: Barriers to the integration of PC for HF patients include poor communication between provider/patient and interdisciplinary providers, the misperception and miseducation of what PC is and how it can be incorporated into patient care, the unpredictable disease trajectory of HF, and the limited time allowed for patient care in the primary care setting. Conclusion: The results of this review highlight a lack of communication, time, and knowledge as barriers to delivering PC. Primary care providers caring for patients with HF need to establish an Annual Heart Failure Review to meticulously evaluate symptoms and allow the time for communication involving prognosis, utilize a PC referral screening tool such as the Needs Assessment Tool: Progressive Disease-Heart Failure, and thoroughly understand the benefits and appropriate integration of PC.
Making Glove Decision Less of a White Knuckling Experience: A Systematic Review and Inventory of Glove Accelerator Contents
Authors: Lopushinsky Kaitlyn M. , Gill Navjeet , Shea Whitney K. , Elliott John F. , Straube Sebastian , Dytoc Marlene T. 
Published: April 2020

Background Accelerators in medical gloves are a common cause of allergic contact dermatitis among healthcare workers. Objective A systematic review of medical and nursing literature, patch testing reports, and chemical analyses of gloves was conducted to assess accelerator contents reported in the literature and to identify accelerator-free gloves. Methods A systematic literature search was performed in OVID Medline and OVID EMBASE. Hand-searching of reference lists of articles in the field and author input generated the remainder of articles assessed. Results We present an inventory of accelerator contents of gloves and accelerator-free glove options as reported in the literature as a clinical reference tool to assist allergen-free glove selection for individuals suffering from allergic contact dermatitis due to rubber accelerators. Limitations Pertinent limitations of our review include lack of predefined study exclusion criteria and screening of the studies identified in the search by 1 review author only. Conclusion The glove inventory we provide summarizes the available literature regarding medical and surgical glove accelerator content, describing gloves both by brand and manufacturer as well as by accelerators.
«Jeg får et helt annet innblikk»: Fagpersoners erfaringer med familieorientert praksis i rusbehandling
Authors: Kalsås Øyvind Reehorst , Selbekk Anne Schanche , Ness Ottar 
Published: April 2020

Aim: Family members’ lives and health are seriously affected by alcohol- and drug addiction in close relationships, and research on addiction treatment shows that outcome of treatment is better when family is involved, both for the patient and family member. In Norway, there are clear political and professional guidelines in favour of involvement of family/significant others in the course of treatment, however, there are few addiction treatment services in Norway who comprehensively do so. The aim of this study is to explore therapists’ experiences from involving family and significant others in interdisciplinary specialised addiction treatment (TSB), within an in-patient clinic in Norway. The research question is: What significance do therapists emphasise from involving family members within interdisciplinary specialised inpatient addiction treatment, and which professional and ethical challenges arise with such involvement? Method: The data was gathered through two focus-group interviews and analysed with thematic analysis. Results: The main findings of the analysis are: (1) “A solid treatment structure for family involvement is central to family-oriented work”, (2) “Substantial positive effects for both patient, family member and therapist are attributed to family-oriented treatment focus”, and (3) “New dilemmas and challenges arise as a consequence of emphasising family-oriented work”. Conclusion: The article gives insights in how treatment practice that involves family and network members can be organised, what can be achieved with such involvement, which challenges and dilemmas can arise, and discusses how these insights challenges language, ethics and judicial framework for addiction treatment.
Early rehabilitation in cardiology – heart failure: The ERIC-HF protocol, a novel intervention to decompensated heart failure patients rehabilitation
Authors: Delgado Bruno Miguel , Lopes Ivo , Gomes Bárbara , Novo André 
Published: April 2020

Background: Decompensated heart failure patients are characterised by functional dependence and low exercise tolerance. Aerobic exercise can improve symptoms, functional capacity and an increase in exercise tolerance. However, the benefits of early rehabilitation have not yet been validated. Objective: To evaluate the safety and feasibility of an aerobic exercise training programme in functional capacity of decompensated heart failure patients. Methodology: A single centre, parallel, randomised controlled, open label trial, with 100 patients. The training group (TG, n=50) performed the training protocol and the control group (CG, n=50) performed the usual rehabilitation procedures. The London chest activity of daily living (LCADL) scale, the Barthel index (BI) and the 6 minute walking test (6MWT) at discharge were used to evaluate the efficacy of the protocol. Safety was measured by the existence of adverse events. Results: The mean age of the patients was 70 years, 20% were New York Heart Association (NYHA) class IV and 80% NYHA class III at admission. The major heart failure aetiology was ischaemic (35 patients) and valvular disease (25 patients). There were no significant differences between groups at baseline in terms of sociodemographic or pathophysiological characteristics. There was a statistically significant difference of 54.2 meters for the training group ( P=0.026) in the 6MWT and at LCADL 12 versus 16 ( P=0.003), but the BI did not: 96 versus 92 ( P=0.072). No major adverse events occurred. Conclusions: The training protocol demonstrated safety and efficacy, promoting functional capacity. This study elucidated about the benefits of a systematised implementation of physical exercise during the patient’s clinical stabilisation phase, which had not yet been demonstrated. Trial registration: Clinicaltrials.gov NCT03838003, URL: https://clinicaltrials.gov/ct2/show/NCT03838003 .
Safety and Feasibility of Simultaneous Transcarotid Revascularization With Flow Reversal and Coronary Artery Bypass Grafting for Concomitant Carotid Artery Stenosis and Coronary Artery Disease
Authors: Williams Zachary , Olivere Lindsey A. , Gilmore Brian , Weissler Hope , Cox Mitchell W. , Long Chandler , Shortell Cynthia K. , Schroder Jacob , Southerland Kevin W. 
Published: April 2020

Objective: The management of patients with combined severe carotid artery and coronary artery disease (CAD) is controversial. Transcarotid stenting with flow reversal (TCAR) is a novel hybrid technique for carotid revascularization. We sought to investigate the safety and feasibility of simultaneous TCAR and coronary artery bypass grafting (CABG) for concomitant carotid and CAD. Methods: A single-institution, retrospective study of patients with critical carotid artery stenosis and symptomatic CAD who underwent simultaneous TCAR-CABG was completed. The primary outcomes were technical success, perioperative stroke, death, and hemorrhage. Results: Four patients underwent TCAR-CABG. All patients were male with a mean age of 64. Technical success was achieved in all cases. There were no perioperative strokes or deaths. There were no reexplorations for hemorrhage. Conclusions: Transcarotid stenting with flow reversal-CABG is a technically feasible hybrid approach for simultaneous carotid and coronary revascularization. It should be part of the vascular surgeon’s armamentarium for coexisting carotid and coronary disease. Further research focused on patient selection and perioperative antiplatelet management is warranted prior to the widespread adoption of this technique.
Cost analysis of materials used in the endovascular treatment of unruptured intracranial aneurysms in Mexico
Authors: Figueroa-Sanchez Jose A , Ferrigno Ana S , Hinojosa-González David E , Salgado-Garza Gustavo , Martinez Hector R , Caro-Osorio Enrique , Garza-Garcia Jesus G 
Published: April 2020

Background To prevent the potentially fatal consequences of intracranial aneurysmal rupture, exclusion from the circulation can be achieved through an endovascular approach. However, the elevated cost of such procedures can be prohibitive for patients in low resource settings. The objective of this study is to identify the factors that modify the cost of the materials used for endovascular treatment of unruptured intracranial aneurysms. Methods Medical records of patients who underwent an endovascular treatment for unruptured intracranial aneurysms between June 2013 and June 2019 in a hospital located in Northeast Mexico were reviewed. Descriptive statistics of the cost of consumable materials used during the procedure was performed, and a regression model was undertaken to examine potential associations between the studied variables and total cost of the intervention. Results A total of 128 patients were included in this analysis. The average intervention cost was $21,687.22 USD. The variables associated with increased material cost were aneurysm size (p = 0.03), aneurysm neck size (p < 0.001), and aneurysm localization in the cavernous segment of the internal carotid artery (p = 0.01). Other variables such as patient age and sex, other aneurysm localizations, laterality of the aneurysm, performing neurointerventionalist, and presence of intervention complications were not statistically significant. Conclusions To our knowledge, this is the first study that examines the variables associated with the material cost of endovascular treatment of unruptured intracranial aneurysms. Awareness of which elements are important drivers of materials’ costs provides a strategic advantage when making hospital administrative decisions and attempting to improve access to endovascular treatment in countries of low income.
Relation of vascular dilator function and cardiac autonomic function with coronary angiography findings in patients with non-ST segment elevation acute coronary syndrome
Authors: Lanza Gaetano Antonio , Ruscio Eleonora , Ingrasciotta Gessica , Felici Tamara , Filice Monica , De Vita Antonio , Tremamunno Saverio , Villano Angelo , Crea Filippo 
Published: April 2020

Abstract

Background
A sizeable number of patients with a diagnosis of non-ST segment elevation acute coronary syndrome show non-obstructive coronary artery disease. In this study we assessed whether differences in vascular and cardiac autonomic function exist between non-ST segment elevation acute coronary syndrome patients with obstructive or non-obstructive coronary artery disease.

Methods and results
Systemic endothelium-dependent and independent vascular dilator function (assessed by flow-mediated dilation and nitrate-mediated dilation of the brachial artery, respectively) and cardiac autonomic function (assessed by time-domain and frequency-domain heart rate variability parameters) were assessed on admission in 120 patients with a diagnosis of non-ST segment elevation acute coronary syndrome. Patients were divided into two groups according to coronary angiography findings: (a) 59 (49.2%) with obstructive coronary artery disease (≥50% stenosis in any epicardial arteries); (b) 61 (50.8%) with non-obstructive coronary artery disease. No significant differences between the two groups were found in both flow-mediated dilation (5.03 ± 2.6 vs. 5.40 ± 2.5%, respectively; P = 0.37) and nitrate-mediated dilatation (6.79 ± 2.8 vs. 7.30 ± 3.4%, respectively; P = 0.37). No significant differences were also observed between the two groups both in time-domain and frequency-domain heart rate variability variables, although the triangular index tended to be lower in obstructive coronary artery disease patients (30.2 ± 9.5 vs. 33.9 ± 11.6, respectively; P = 0.058). Neither vascular nor heart rate variability variables predicted the recurrence of angina, requiring emergency room admission or re-hospitalisation, during 11.3 months of follow-up.

Conclusions
Among patients admitted with a diagnosis of non-ST segment elevation acute coronary syndrome we found no significant differences in systemic vascular dilator function and cardiac autonomic function between those with obstructive coronary artery disease and those with non-obstructive coronary artery disease.