bluuebunny/crossref_metadata_2025_split huggingface dataset:
Associations of Preoperative Self-rated Symptoms of Anxiety and Depression on Length of Hospital Stay and Long-term Quality of Life in Patients Undergoing Cardiac Surgery
Authors: Gorini Alessandra , Giuliani Mattia , L'Acqua Camilla , Barbieri Simone , Sisillo Erminio , Veglia Fabrizio , Tremoli Elena 
Published: April 2021

Background
Anxiety and depression are often associated with cardiovascular diseases. Nevertheless, few study authors have investigated psychological effects on immediate and long-term cardiac surgery–related outcomes, such as surgical complications, length of hospital stay (LOS), and long-term health-related quality of life (HRQoL).

Objectives
The aims of this study were to (a) investigate the role of preoperative symptoms of anxiety and depression in predicting LOS in a sample of surgical patients and (b) evaluate the impact of preoperative symptoms of anxiety and depression on the patients' HRQoL 3 months after surgery.

Methods
One hundred fifty-one patients waiting for surgery were included. To evaluate symptoms of anxiety and depression, the Hospital Anxiety and Depression Scale was used. Multiple regression analyses were conducted to evaluate the impact of both clinical and psychological factors on LOS, whereas quantile regression was performed to assess their effect on the patients' HRQoL 3 months after surgery.

Results
The multiple regression shows that EuroSCORE, length of endotracheal intubation, and anxiety symptoms predict LOS. The multiple quantile regression analyses also show that both symptoms of anxiety and depression predict a negative HRQoL up to 3 months after surgery.

Conclusion
Preoperative symptoms of anxiety predict the patients' LOS, and both symptoms of anxiety and depression predict a scarce HRQoL 3 months after cardiac surgery. These results suggest the need for implementing presurgical in-hospital screening procedures for both symptoms of anxiety and depression. Finally, focused psychological interventions should be implemented for reducing inpatients' hospital LOS and improving their future quality of life.
Exercise Interventions to Improve Pelvic Floor Muscle Functioning in Older Women With Urinary Incontinence: A Systematic Review
Authors: Fricke Anja , Lark Sally D. , Fink Philip W. , Mundel Toby , Shultz Sarah P. 
Published: April 2021

Background:
An estimated 200 million people worldwide live with urinary incontinence, and women are more affected than men. The World Health Organization and the International Continence Society recommend pelvic floor muscle training to treat urinary incontinence in women.

Objective:
The purpose of this systematic review was to examine pelvic floor muscle function and understand its impact on urinary incontinence in women older than 50 years.

Methods:
Medline, PsycINFO, Webscience, CINAHL, and Scopus were searched for articles from 1988 to May 2019. Included studies had a comparison or control group, exercise intervention aimed to train the pelvic floor musculature, women 50 years and older, and had been published in peer-reviewed journals.

Results:
Eight studies were included in this review. Exercise interventions included home-based as well as supervised pelvic floor muscle-strengthening, and indirect pelvic floor muscle-strengthening exercises via co-contraction of surrounding muscles. All interventions were able to improve pelvic floor muscle strength as well as urinary incontinence symptoms, with bigger improvements found in supervised interventions.

Conclusion:
This review has shown that exercise interventions targeting the pelvic floor muscles may be effective in improving pelvic floor muscle strength, urinary incontinence symptoms, and even quality of life measures. Exercise interventions that were supervised or included some type of biofeedback device showed greater and faster improvements than interventions without additional assistance.
The medical treatment of cardiogenic shock: cardiovascular drugs
Authors: De Backer Daniel , Arias Ortiz Julian , Levy Bruno 
Published: April 2021

Purpose of review
To discuss the use of vasopressors and inotropes in cardiogenic shock.

Recent findings
The classic form or cardiogenic shock requires administration of inotropic and/or vasopressor agents to try to improve the impaired tissue perfusion. Among vasopressors various alpha-adrenergic agents, vasopressin derivatives and angiotensin can be used. The first-line therapy remains norepinephrine as it is associated with minimal adverse effects and appears to be associated by the best outcome in network meta-analyses. On the contrary, epinephrine is associated with an increased incidence of refractory shock and observational studies suggest an increased risk of death. Vasopressin may be an excellent alternative in tachycardiac patients or in the presence of pulmonary hypertension. Concerning inotropic agents, dobutamine is the first-line agent but levosimendan is an excellent alternative or additional agent in cases not responding to dobutamine. The impact on outcome of inotropic agents remains controversial.

Summary
Recent studies have refined the position of the various vasopressor and inotropic agents. Norepinephrine is recommended as first-line vasopressor agent by various guidelines. Among inotropic agents, selection between the agents should be individualized and based on the hemodynamic response.
Maryland’s Global Budget Revenue Program
Authors: Xie Liyang , Boudreaux Michel , Franzini Luisa 
Published: April 2021

Background:
In 2014, Maryland implemented the Global Budget Revenue (GBR) program to reduce unnecessary hospital utilization and contain spending. Little is known about its impact on pediatric health outcomes and high-cost services that are primarily financed by payers other than Medicare.

Objective:
The aim was to examine the impact of the GBR program on neonatal intensive care unit (NICU) admission and infant mortality.

Research Design:
We conducted a difference-in-differences analysis comparing changes of NICU admissions and infant mortality in Maryland with changes in 20 comparison states (including DC), before and after implementation of the GBR program. Effects were estimated for all infants and for risk groups defined by birthweight and gestation.

Subjects:
A total of 11,965,997 newborns in Maryland and the comparison states was identified using US birth certificate data from 2011 to 2017.

Measures:
NICU admissions, the infant mortality rate, and the neonatal mortality rate.

Results:
The GBR program was associated with a 1.26 percentage points (−16.8%, P=0.03) decline in NICU admissions over three full years of implementation. Reductions were driven by fewer admissions among moderately low to normal birthweight (1500–3999 g) and moderately preterm to term (32–41 wk) infants. The effects for very-low birthweight and very preterm infants were small and not statistically precise. There was no significant change in infant or neonatal mortality rates.

Conclusions:
Maryland’s hospitals reacted to the GBR program by reducing NICU services for infants that did not have clear observed clinical need. Our results suggest that GBR constrained high-cost services, without adversely affecting infant mortality.
Electronic Health Record Usability
Authors: Kutney-Lee Ann , Brooks Carthon Margo , Sloane Douglas M. , Bowles Kathryn H. , McHugh Matthew D. , Aiken Linda H. 
Published: April 2021

Background:
Electronic health record (EHR) usability issues represent an emerging threat to the wellbeing of nurses and patients; however, few large studies have examined these relationships.

Objective:
To examine associations between EHR usability and nurse job (burnout, job dissatisfaction, and intention to leave) and surgical patient (inpatient mortality and 30-day readmission) outcomes.

Methods:
A cross-sectional analysis of linked American Hospital Association, state patient discharge, and nurse survey data was conducted. The sample included 343 hospitals, 1,281,848 surgical patients, and 12,004 nurses. Logistic regression models were used to assess relationships between EHR usability and outcomes, before and after accounting for EHR adoption level (comprehensive vs. basic or less) and other confounders.

Results:
In fully adjusted models, nurses who worked in hospitals with poorer EHR usability had significantly higher odds of burnout [odds ratio (OR), 1.41; 95% confidence interval (CI), 1.21–1.64], job dissatisfaction (OR, 1.61; 95% CI, 1.37–1.90) and intention to leave (OR, 1.31; 95% CI, 1.09–1.58) compared with nurses working in hospitals with better usability. Surgical patients treated in hospitals with poorer EHR usability had significantly higher odds of inpatient mortality (OR, 1.21; 95% CI, 1.09–1.35) and 30-day readmission (OR, 1.06; 95% CI, 1.01–1.12) compared with patients in hospitals with better usability. Comprehensive EHR adoption was associated with higher odds of nurse burnout (OR, 1.14; 95% CI, 1.01–1.28).

Conclusion:
Employing EHR systems with suboptimal usability was associated with higher odds of adverse nurse job outcomes and surgical patient mortality and readmission. EHR usability may be more important to nurse job and patient outcomes than comprehensive EHR adoption.
Determination of tumour dose response threshold and implication on survival in patients with HCC treated with Y90 radiation segmentectomy: a simple semi-quantitative analysis
Authors: Cheng Bernard , Sethi Ila , Villalobos Alex , Wagstaff William , Schuster David M. , Bercu Zachary , Brandon David , Kokabi Nima 
Published: April 2021

Purpose
To evaluate the relationship between Yttrium-90 (Y90) tumour dose and response rate in patients with hepatocellular carcinoma (HCC) who undergo Y90 radiation segmentectomy (Y90-RS) and to determine implication on overall survival (OS).

Materials and methods
Post Y90-RS Bremsstrahlung single-photon emission computed tomography/CT of 105 HCC patients with 110 treatments performed with glass microspheres was retrospectively analysed. The dose-volume histogram of the targeted tumour was determined with commercially available dosimetry software. Tumour response at 3 months was evaluated using modified Response Evaluation Criteria in Solid Tumours. Tumour dose thresholds associated with the objective response with 80% specificity were then used to evaluate implication on OS using Kaplan–Meier estimation and log-rank analysis.

Results
Tumour dose thresholds to predict objective response with 80% specificity were the following: maximum tumour dose (748 Gy), mean tumour dose (568 Gy), minimum tumour dose of 30% tumour volume (608 Gy), minimum tumour dose of 50% tumour volume (565 Gy), minimum tumour dose of 70% tumour volume (464 Gy) and minimum tumour dose of 100% tumour volume (213 Gy). These parameters all significantly predicted tumour response with areas under the ROC curve of >0.6. Mean tumour dose of ≥250 Gy predicted median OS of 43.67 vs. 17.87 months for others (P = 0.026). Minimum dose ≥180 Gy to 100% of tumour volume predicted median OS of 44.93 vs. 35.87 months for others (P = 0.043).

Conclusion
In patients with HCC undergoing Y90-RS, mean tumour dose ≥250 Gy and minimum tumour dose of ≥180 Gy to 100% of tumour volume are both significantly correlated with higher objective tumour response and prolonged survival.
Thickened liquids: do they still have a place in the paediatric dysphagia toolkit?
Authors: Stewart Alexandra , Burr Samantha 
Published: April 2021

Purpose of review
Use of thickened fluids has long been a cornerstone of dysphagia management. However, clinicians and researchers are increasingly questioning their effectiveness and highlighting potential harms. This review aims to present the current state of the evidence for use of thickened fluids in children.

Recent findings
The relationship between aspiration and respiratory infection is complex. The role of thickened fluids in improving respiratory health is limited and contradictory. A high level of variability exists in all aspects of thickened fluid use. Little is known about patient and family perspectives on meaningful endpoints for intervention.

Summary
Clinicians should be open and transparent in their decision making with patients and families, acknowledging the limited evidence and the need for individualised care. Further research is needed to establish the efficacy of thickened fluid use in children with regard to improvements in respiratory health, fluid intake and child and family wellbeing.
Maternal postpartum depression: risk factors, impacts, and interventions for the NICU and beyond
Authors: Shovers Samuel M. , Bachman Sara S. , Popek Leah , Turchi Renee M. 
Published: April 2021

Purpose of review
Postpartum depression (PPD) negatively impacts caregivers, infants, siblings, and entire families. Mothers with infants admitted to the neonatal intensive care unit (NICU) face additional risk for PPD, coupled with risk factors extending beyond a NICU admision. The novelty of this review is the focus on maternal PPD for mothers with infants admitted to the NICU. Interventions aimed at limiting and preventing PPD in this population include: prenatal and postpartum depression screening, PPD symptom awareness and monitoring, and trauma-informed care.

Recent findings
PPD, the most frequent complication of childbirth, affects approximately 10–15% of mothers worldwide. Prevalence rates increase to 40% for mothers whose infant is admitted to the NICU. PPD can affect maternal and child health across the life course and predispose future generations to a myriad of developmental, psychosocial, and physical challenges. Prevalence rates are higher for racial and ethnic minorities, immigrant and refugee populations, and mothers in rural locations. Trauma-informed care is suggested at individual and organizational levels, leading to better care for those with and without previous trauma exposure.

Summary
Increasing PPD symptom awareness, screening for PPD, and connecting to resources should begin during prenatal visits. Care teams should discuss barriers to obtaining resources for mothers, children, and families to improve access and support.
Solitary Adult Rib Langerhans Cell Histiocytosis Evaluated by 18F-FDG PET/CT
Authors: Wang Qixin , Yang Songsong , Tang Wenxin , Liu Hanxiang , Chen Yue 
Published: April 2021

Abstract
Langerhans cell histiocytosis (LCH) is a rare proliferative histiocytic disorder. It mainly occurs in the pediatric population, whereas it is rarely reported in adults. Herein, we reported a case of a patient with isolated rib LCH, which showed elevated 18F-FDG uptake. Our case showed that 18F-FDG PET/CT can be a potential tool in the evaluation of LCH.
Multiple Primary Osseous B-Lymphoblastic Lymphoma/Leukemia Shown on Bone Scintigraphy
Authors: Wen Ming , Peng Xiao-Juan , Huang Jian-Min , Wei Ling-Ge , Xie Peng 
Published: April 2021

Abstract
Primary osseous B-lymphoblastic lymphoma/leukemia is very rare, especially multiple bones involved. Herein, we reported the bone scintigraphy findings in a 16-year-old adolescent boy with a 20-day history of right thigh pain caused by B-lymphoblastic lymphoma/leukemia. Multiple abnormal MDP-avid foci were noted on 99mTc-MDP bone scintigraphy. Interestingly, the CT images of corresponding lesions were unrevealing. Finally, the B-lymphoblastic lymphoma/leukemia was confirmed by pathology and immunohistochemistry.
The Challenge of Staging Breast Cancer With PET/CT in the Era of COVID Vaccination
Authors: Brown Adam Harry , Shah Sweni , Groves Ashley M. , Wan Simon , Malhotra Anmol 
Published: April 2021

Abstract
We report a case series of biopsy-proven reactive axillary lymph nodes, which were avid on FDG PET/CT in breast cancer patients post COVID-19 vaccination. With 4 cases presenting in a consecutive 10-day period, it became apparent that metabolically active axillary lymphadenopathy is an adverse effect of COVID-19 vaccines, currently being deployed worldwide. This may lead to patients undergoing unnecessary biopsy. We have started taking a COVID-19 vaccine status history before PET/CT. If enlarged/metabolically active axillary nodes are identified in the ipsilateral vaccinated arm, then axillary ultrasound at 4 weeks is suggested.
DOTATATE -Avid Bilateral Axilla and Subpectoral Lymphadenopathy Induced From COVID-19 mRNA Vaccination Visualized on PET/CT
Authors: Lu Yang 
Published: April 2021

Abstract
A 64-year-old woman with malignant carcinoid tumor of the ileum received right ileocolectomy 9 years ago. Series follow-up imaging studies including most recent 68Ga-DOTATATE PET/CT scan in June 2020 have been negative for disease. Current 68Ga-DOTATATE PET/CT scan showed new cluster of bilateral axillary and subpectoral lymphadenopathy with normal CT morphology, but with avid DOTATATE uptake. There was no other abnormal DOTATATE-avid lesion or suspicious CT image findings. The medical history revealed that the patient received 2 doses of COVID-19 (coronavirus disease 2019) mRNA vaccine at bilateral upper arm deltoid muscles at 21 and 42 days prior to the PET/CT examination, respectively.
Improving trauma tertiary survey performance and missed injury identification using an education-based quality improvement initiative
Authors: Holmstrom Amy L. , Ott Katherine C. , Weiss Hannah K. , Ellis Ryan J. , Hungness Eric S. , Shapiro Michael B. , Yang Anthony D. 
Published: April 2021

BACKGROUND
Performance of a trauma tertiary survey (TTS) reduces rates of missed injuries, but performance has been inconsistent at trauma centers. The objectives of this study were to assess whether quality improvement (QI) efforts would increase the frequency of TTS documentation and determine if TTS documentation would increase identification of traumatic injuries. Our hypothesis was that QI efforts would improve documentation of the TTS.

METHODS
Before-and-after analysis of QI interventions at a level 1 trauma center was performed. The interventions included an electronic template for TTS documentation, customized educational sessions, and emphasis from trauma leadership on TTS performance. The primary outcome was documentation of the TTS. Detection of additional injuries based on tertiary evaluation was a secondary outcome. Associations between outcomes and categorical patient and encounter characteristics were assessed using χ2 tests.

RESULTS
Overall, 592 trauma encounters were reviewed (296 preimplementation and 296 postimplementation). Trauma tertiary survey documentation was significantly higher after implementation of the interventions (30.1% preimplementation vs. 85.1% postimplementation, p < 0.001). Preimplementation documentation of the TTS was less likely earlier in the academic year (14.3% first academic quarter vs. 46.5% last academic quarter, p < 0.001), but this temporal pattern was no longer evident postimplementation (88.5% first academic quarter vs. 77.9% last academic quarter, p = 0.126). Patients were more likely to have a missed traumatic injury diagnosed on TTS postimplementation (1.7% in preimplementation vs. 5.7% postimplementation, p = 0.009).

CONCLUSION
Documentation of the TTS and missed injury detection rates were significantly increased following implementation of a bundle of QI interventions. The association between time of year and documentation of the TTS was also attenuated, likely through reduction of the resident learning curve. Targeted efforts to improve TTS performance may improve outcomes for trauma patients at teaching hospitals.

LEVEL OF EVIDENCE
Care management, Level IV.
Cryoprecipitate attenuates the endotheliopathy of trauma in mice subjected to hemorrhagic shock and trauma
Authors: Barry Mark , Trivedi Alpa , Miyazawa Byron Y. , Vivona Lindsay R. , Khakoo Manisha , Zhang Haoqian , Pathipati Praneeti , Bagri Anil , Gatmaitan Michelle G. , Kozar Rosemary , Stein Deborah , Pati Shibani 
Published: April 2021

BACKGROUND
Plasma has been shown to mitigate the endotheliopathy of trauma. Protection of the endothelium may be due in part to fibrinogen and other plasma-derived proteins found in cryoprecipitate; however, the exact mechanisms remain unknown. Clinical trials are underway investigating early cryoprecipitate administration in trauma. In this study, we hypothesize that cryoprecipitate will inhibit endothelial cell (EC) permeability in vitro and will replicate the ability of plasma to attenuate pulmonary vascular permeability and inflammation induced by hemorrhagic shock and trauma (HS/T) in mice.

METHODS
In vitro, barrier permeability of ECs subjected to thrombin challenge was measured by transendothelial electrical resistance. In vivo, using an established mouse model of HS/T, we compared pulmonary vascular permeability among mice resuscitated with (1) lactated Ringer’s solution (LR), (2) fresh frozen plasma (FFP), or (3) cryoprecipitate. Lung tissue from the mice in all groups was analyzed for markers of vascular integrity, inflammation, and inflammatory gene expression via NanoString messenger RNA quantification.

RESULTS
Cryoprecipitate attenuates EC permeability and EC junctional compromise induced by thrombin in vitro in a dose-dependent fashion. In vivo, resuscitation of HS/T mice with either FFP or cryoprecipitate attenuates pulmonary vascular permeability (sham, 297 ± 155; LR, 848 ± 331; FFP, 379 ± 275; cryoprecipitate, 405 ± 207; p < 0.01, sham vs. LR; p < 0.01, LR vs. FFP; and p < 0.05, LR vs. cryoprecipitate). Lungs from cryoprecipitate- and FFP-treated mice demonstrate decreased lung injury, decreased infiltration of neutrophils and activation of macrophages, and preserved pericyte-endothelial interaction compared with LR-treated mice. Gene analysis of lung tissue from cryoprecipitate- and FFP-treated mice demonstrates decreased inflammatory gene expression, in particular, IL-1β and NLRP3, compared with LR-treated mice.

CONCLUSION
Our data suggest that cryoprecipitate attenuates the endotheliopathy of trauma in HS/T similar to FFP. Further investigation is warranted on active components and their mechanisms of action.