bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Tocilizumab Dosing Is Associated With Improved Survival in Critically Ill Patients Infected With Severe Acute Respiratory Syndrome Coronavirus-2
Authors: Petrak Russell M. , Van Hise Nicholas W. , Skorodin Nathan C. , Fliegelman Robert M. , Chundi Vishnu , Didwania Vishal , Han Alice , Harting Brian P. , Hines David W. 
Published: March 2021

Objectives:
To identify the most efficacious timing for tocilizumab administration in critically ill patients infected with severe acute respiratory syndrome coronavirus-2.

Design:
Observational multicenter cohort study.

Setting:
A total of 23 acute care hospitals in four states.

Patients:
One-hundred eighteen patients admitted between March 13, 2020, and April 16, 2020. Eighty-one patients received tocilizumab, and 37 were untreated and served as a control group.

Measurements and Main Results:
The main outcome was mortality and was analyzed by timing of tocilizumab dosing. Early dosing was defined as a tocilizumab dose administered prior to or within 1 day of intubation. Late dosing was defined as a dose administered greater than 1 day after intubation. A control group that was treated only with standard of care, and without tocilizumab, was used for comparison. Early tocilizumab therapy was associated with a statistically significant decrease in mortality as compared to patients who were untreated (p = 0.003). Dosing tocilizumab late was associated with an increased mortality compared with the untreated group (p = 0.006).

Conclusions:
Early tocilizumab administration was associated with decreased mortality in critically ill severe acute respiratory syndrome coronavirus-2 patients, but a potential detriment was suggested by dosing later in a patient’s course.
Patient-Level Barriers and Facilitators to Early Mobilization and the Relationship With Physical Disability Post–Intensive Care
Authors: Potter Kelly , Miller Sarah , Newman Susan 
Published: March 2021

Background
Early mobilization (EM) is associated with reduced physical disability post–intensive care (PD PIC). Yet, contextual factors facilitate or impede delivery of EM in the intensive care unit (ICU). Only 45% of ICUs in the United States routinely practice EM despite its recognized benefits.

Objectives
To analyze the evidence on the relationship between critical care EM, PD PIC, and personal (patient-level) factors, using the theoretical lens of the World Health Organization's International Classification of Functioning, Disability, and Health (ICF).

Method
The Whittemore and Knafl methodology for integrative reviews and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) reporting guidelines were followed. Qualitative, quantitative, and mixed-methods studies (n = 38) that evaluated EM and 1 or more domains of the World Health Organization ICF were included. Quality was appraised using the Mixed-Methods Appraisal Tool. Study characteristics were evaluated for common themes and relationships. The ICF domains and subdomains pertaining to each study were synthesized.

Results
Early mobilization delivery was influenced by personal factors. Deeper sedation level, the presence of delirium, higher patient acuity, the presence of medical devices, and patient weight were identified barriers to EM delivery. Patient engagement in EM was associated with improved delivery. Patients who enjoyed rehabilitation were more likely to demonstrate improvement in functional impairment than those who did not enjoy rehabilitation.

Discussion
Early mobilization is associated with reduced PD PIC, yet numerous contextual factors affect the delivery of EM in the ICU. Further study of patient-level factors and EM must explore the relationship between patient engagement, baseline demographics, and functional status at ICU admission, patient-level considerations for decisions to mobilize, and EM in the ICU. This research is critical to improving the delivery of EM in the ICU and reducing PD PIC.
Health Care Professional Students’ Perceptions of Teamwork and Roles After an Interprofessional Critical Care Simulation
Authors: Davis Jenna , Zulkosky Kristen , Ruth-Sahd Lisa A. , Frank Eva M. , Dommel Lynne , Minchhoff Dolores , Uhrich Karen 
Published: March 2021

Background
Educational opportunities for health care professional students to learn collaborative communication and the roles and responsibilities of other disciplines are minimal unless faculty are intentional about facilitating this interdisciplinary learning.

Objectives
The aim of this study was to determine how a simulation-enhanced interprofessional education (Sim-IPE) teaching strategy fostered communication and interdisciplinary awareness between students from multiple disciplines.

Method
This pretest-posttest design surveyed undergraduate students from 5 disciplines. The Student Perceptions of Interprofessional Clinical Education-Revised tool examined students' perceptions of teamwork and roles after an in-depth, multistate critical care simulation experience.

Results
All students' perceptions of teamwork increased after the Sim-IPE. More experience in the health care field is associated with an increased perception of teamwork and roles/responsibilities.

Discussion
On the basis of these findings, the critical care Sim-IPE was an effective teaching strategy to increase the perception of roles and responsibilities of interprofessional critical care team members with applicability to many other specialty topics.
Critical Incidents Involving the Medical Emergency Team
Authors: Danielis Matteo , Destrebecq Anne , Terzoni Stefano , Palese Alvisa 
Published: March 2021

Background
Medical emergency teams (METs), which have been established in several countries, contribute to a reported decrease in deteriorated patients' in-hospital mortality. To date, no data have been published on critical incidents that occurred in METs affecting patients' safety.

Objectives
The aim of the study was to identify and describe critical incidents that occurred during METs' activities in a large academic Italian hospital.

Methods
The data, which were stored in the official incident reporting system of the hospital and included all critical incidents that occurred and were reported in anonymous and voluntary forms over a 5-year period, were retrospectively analyzed.

Results
Overall, 17 critical incidents emerged, during both the team alert stage (n = 10) and its performance (n = 7), with approximately 3 events per year and an incident rate of 1.7 for every 1000 MET interventions.

Discussion
Medical emergency teams' critical incidents are rare and mainly due to the lack of compliance with protocols and of training and supplies, which require appropriate educational and organizational strategies.
Malignant transformation arising from mature ovarian cystic teratoma
Authors: Qin Li , Zhao Tao , Liu Xin , Wang Hongli , Gu Xin , Chen Dian , Wang Zaiping , He Du 
Published: March 2021

Abstract
Malignant transformation arising in mature cystic teratoma (MT-MCT) is a rare neoplasm of the ovary. Herein, we aimed to evaluate the clinicopathological features and treatment outcome of the Han Chinese women with MT-MCT.
In this retrospective study, the clinical data of patients who had been surgically treated from January 2000 to November 2019 and in whom the diagnosis of MCT was confirmed based on the pathology were included. Fourteen patients with MT-MCT from a total of 569 cases (2.46% incidence) of MCT were reviewed.
The mean age of patients with MT-MCT was 51.3 (range, 31–71) years, while the mean age of patients with MCT was 45.3 (range, 17–62) years. Upon gross examination, the mean size of MT-MCT was 14.0 (range, 11–25) cm, whereas the mean size of MCT was 7.5 (range, 4–10) cm. Primary surgical staging was performed in all cases. Complete cytoreduction and suboptimal surgical resection were performed in 12 (85.7%) and 2 (14.3%) cases, respectively. Thirteen patients with malignant transformation of squamous cell carcinoma (SCC) whose Federation International of Gynecology and Obstetrics stage was >1 received chemotherapy, comprising carboplatin and paclitaxel. Response to the chemotherapy regimen was complete in 12 patients; 1/12 patients died within the median follow-up period of 16.5 months. The 5-year overall survival rate and disease-free survival rates were 31.2% and 31.6%, respectively.
From the data generated, we conclude that the rate of MT-MCT increases with age. The MT-MCT was much higher in women of postmenopausal age than in younger women. We described our experience of successfully treating patients with malignant transformation of SCC with primary surgical staging and adjuvant chemotherapy (cisplatin, paclitaxel, bleomycin, and etoposide) that might improve survival in patients with advanced-stage disease.
Effect of Taijiquan assisted rehabilitation for breast cancer patients
Authors: Zhao Sihua , Lian Rongna , Zhang Ruinian , Wang Fanghong , Chen Hao , Wan Run 
Published: March 2021

Abstract

Background:
Taijiquan, as a supplementary and alternative method, has attracted more and more attention in the treatment of breast cancer. But up to now, no systematic review has been performed to evaluate the efficacy of Taijiquan in the treatment of breast cancer. In this study, Cochrane systematic review method will be used to evaluate the effect of Taijiquan in the rehabilitation process of breast cancer patients after treatment.

Methods:
PubMed, Embase. com, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and SinoMed will be searched to identify relevant studies up to May 31, 2021. We will include randomized controlled trials (RCTs) of the application of Taijiquan in post-treatment breast cancer patients. We will use the Cochrane bias risk assessment tool to assess the quality of included RCTs. We will use Stata 13.0 to perform pairwise meta-analyses using the inverse variance method. Subgroup analyses and sensitivity analyses will be conducted to investigate the sources of heterogeneity.

Results:
The results of this study will be published in a peer-reviewed journal.

Conclusion:
This study will comprehensively evaluate the efficacy of Taijiquan in the rehabilitation treatment of breast cancer. The results of this study will provide high-quality evidence to support clinical practice and guidelines development.
Accurate measurement of colorectal polyps using computer-aided analysis
Authors: Su Ruizhang , Liu Jie , Wu Bifang , Xie Yun , Zhang Yi , Zhang Wen , Zhang Yongxiu , Wan Man , Tian Zhaoxu , Hu Yiqun 
Published: March 2021

Introduction
As we know, the majority of colorectal cancers are thought to evolve from colorectal adenomas. In this study, we explored the use of Computer-aided diagnosis (CAD) in the detection of colorectal polyps and the estimation of their sizes, which is important for the diagnosis and management of colorectal cancer.

Materials and methods
As the distance between colonoscopy and lesion increases, magnification tends to decrease. Therefore, the size of colorectal polyps can be calculated by taking into account the captured image and the shooting distance. In this study, the fitting curve of the magnification of electronic colonoscopy was obtained by simulating intestinal tract and polyps in vitro. Then, the distance was artificially controlled in the endoscopic operation, and the image was taken at a preset distance. The CAD system was then trained on the overall shape of colorectal polyps. Image segmentation was employed to accurately identify colorectal polyps. Finally, on the basis of the magnification factor, the real value of polyps was predicted from the shooting distance and the segmentation image size.

Results
The CAD system can automatically calculate the range of colorectal polyps and calculate the true size of the colorectal polyps according to the magnification of the corresponding distance.

Conclusions
In this study, we developed a method of accurately estimating the size of colorectal polyps. This approach is compatible with many devices, which would expand its range of applications. This method has the potential for application in other areas of clinical diagnosis.
Population Health Rounds: A Novel Vehicle for Training in Population Medicine and Clinical Preventive Medicine
Authors: Jadotte Yuri T. , Lane Dorothy S. 
Published: March 2021

Context:
Preventive medicine residents must train in population medicine (including analytics and population health) and clinical preventive medicine (including screening, behavioral counseling, and chemoprophylaxis). Yet, opportunities to perform both functions concurrently for the same population are scarce. Residents must also master the art of preventive medicine, but they often lack an established community of practice that provides a continuous forum to do so. This project explored Population Health Rounds as a novel vehicle to optimize preventive medicine residency training.

Program Description:
Modeled after traditional medical rounds, Population Health Rounds consist of a 1-hour weekly meeting engaging preventive medicine residents and supervising attendings at Stony Brook Medicine in both population medicine and clinical preventive medicine concurrently, including patient case discussions and targeted population health analytics.

Evaluation and Results:
Because of the pandemic, the rounds have predominantly focused on COVID-19 and its effects on the hospital employee population. In addition to providing direct patient care to COVID-19–positive and exposed employees, residents have analyzed data on this population and made recommendations to hospital leadership based on COVID-19's institutional epidemiology, including incidence, prevalence, and predictive factors. A formative qualitative survey of resident perceptions offers insights on the value and learning outcomes of this new model.

Discussion and Conclusion:
Factors that may impact the implementation, sustainability, and feasibility of this model are discussed. The preventive medicine residency program is commissioned to address gaps in clinical preventive services for the patient-centered medical home tied to the sponsoring institution's family medicine practice. Additional plans are underway to expand the rounds to other clinical contexts, such as lifestyle medicine in the occupational setting, and for targeted populations, such as the underserved. Replication of the Population Health Rounds model is recommended to determine its effectiveness.
Multicenter Randomized Controlled Trial of Pelvic Floor Muscle Training with a Motion-based Digital Therapeutic Device versus Pelvic Floor Muscle Training Alone for Treatment of Stress-predominant Urinary Incontinence
Authors: Weinstein Milena M. , Collins Sarah , Quiroz Lieschen , Anger Jennifer T. , Paraiso Marie Fidela R. , DeLong Jessica , Richter Holly E. 
Published: March 2021

Objective
To determine whether use of an intravaginal motion-based digital therapeutic device for pelvic floor muscle training (PFMT) was superior to PFMT alone in women with stress-predominant urinary incontinence (SUI).

Methods
A multicenter, randomized-controlled trial was conducted where women with SUI or SUI-predominant mixed urinary incontinence were treated with either PFMT using the device (intervention group) or PFMT alone (control group). Primary outcomes, measured at 8 weeks, included change in Urinary Distress Inventory, short-version and improvement in the Patient Global Impression of Improvement, defined as “much better” or “very much better.” Participants also completed Pelvic Organ Prolapse and Colorectal-anal Distress Inventories, Pelvic-Floor-Impact Questionnaire and a 3-day bladder diary. Primary analysis used a modified intention-to-treat approach. Statistical analysis used Student t test and χ2 test. The trial was prematurely halted due to device technical considerations.

Results
Seventy-seven women were randomized, and final analysis included 61 participants: 29 in intervention and 32 in control group. There was no statistical difference in Urinary Distress Inventory, short-version scores between the intervention (−13.7 ± 18.7) and the control group (−8.7 ± 21.8; P = 0.85), or in Patient Global Impression of Improvement (intervention 51.7% and control group 40.6%; P = 0.47). Pelvic Organ Prolapse and Colorectal-anal Distress Inventories and Pelvic-Floor-Impact Questionnaire scores improved significantly more in the intervention group than the control group (all P < 0.05). Median number of SUI episodes decreased from baseline to 8 weeks by −1.7 per-day [(−3)-0] in the intervention group and −0.7[(−1)-0] in the control group, (P = 0.047).

Conclusions
In this prematurely terminated trial, there were no statistically significant differences in primary outcomes; however, PFMT with this digital therapeutic device resulted in significantly fewer SUI episodes and greater improvement in symptom-specific quality of life outcomes. A larger powered trial is underway.
Limited recovery from post-acute sequelae of SARS-CoV-2 (PASC) at eight months in a prospective cohort
Authors: Darley DR , Dore GJ , Byrne A , Plit M , Brew BJ , Kelleher A , Matthews GV 
Published: March 2021

AbstractThere is increasing recognition of the prolonged illness following acute coronavirus disease 2019 (COVID-1). In a longitudinal cohort of 99 patients, 32% reported persistent symptoms and 19% had Long COVID (Defined as fatigue or dyspnoea or chest tightness) at median 240 days after initial infection. There was no significant improvement in symptoms or measures of health-related quality of life between 4 and 8-month assessments. In multivariable analysis, female gender (OR 3.2, 95%CI 1.3-7.8, p=0.01) and acute COVID-19 hospitalisation (OR 3.8, 95% 1.1-13.6, p=0.04) were independently associated with Long COVID at 8-months. Only 80% patients reported full recovery at 8 months. Further research is required to understand the immunologic correlates of abnormal recovery and the long-term significance.
Upregulated miR-200c may increase the risk of obese individuals to severe COVID-19
Authors: Papannarao Jayanthi Bellae , Schwenke Daryl O , Manning Patrick , Katare Rajesh 
Published: March 2021

AbstractObesity is a risk factor for coronavirus disease 2019 (COVID-19) infection, the prevalence of obese individuals admitted with COVID-19 ranging between 30 and 60%. Herein we determined whether early changes in microRNAs (miRNAs) could be the underlying molecular mechanism increasing the risk of obese individuals to COVID-19 infection. Quantitative real-time PCR analysis of plasma samples for circulating miRNAs showed a significant upregulation of miR-200c and a small increase in miR-let-7b obese individuals. This was associated with significant downregulation of angiotensin-converting enzyme 2 (ACE2). Both the miRNAs are the direct targets of ACE2, the specific functional receptor for severe acute respiratory syndrome coronavirus 2. Correlation analysis confirmed a significant negative correlation between ACE2 and both the miRNAs. Recent studies showed that despite being the functional receptor, inhibition/downregulation of ACE2 did not reduce the severity of COVID-19 infection. In contrast, increased angiotensin II following inhibition of ACE2 may increase the severity of the disease. Taken together, our novel results identify that upregulation of miR-200c may increase the susceptibility of obese individuals to COVID-19. Considering miRNA are the earliest molecular regulators, circulating miR-200c could be a potential biomarker in the early identification of those at the risk of severe COVID-19.
Half Year Longitudinal Seroprevalence of SARS-CoV-2-antibodies and Rule Compliance in German Hospital Employees
Authors: Herzberg Jonas , Vollmer Tanja , Fischer Bastian , Becher Heiko , Becker Ann-Kristin , Sahly Hany , Honarpisheh Human , Guraya Salman Yousuf , Strate Tim , Knabbe Cornelius 
Published: March 2021

AbstractIntroductionCOVID-19, caused by SARS-CoV-2, is an occupational health risk especially for healthcare employees. This study was designed to determine the longitudinal seroprevalence of specific immunglobolin-G (IgG)-antibodies in employees in a hospital setting.MethodsAll employees including healthcare and non-healthcare workers in a secondary care hospital were invited to participate in this single-center study. After an initial screening, a 6 months follow-up was done which included serological examination for SARS-CoV-2-IgG-antibodies and a questionnaire for self-reported symptoms, self-perception and thoughts about the local and national hygiene and pandemic plans.ResultsThe seroprevalence of SARS-CoV-2-IgG-antibodies was 0.74% among 406 hospital employees (95% confidence interval) (0.75% in healthcare workers, 0.72% in non-healthcare workers), initially recruited in April 2020, in their follow-up blood specimen in October 2020.In this study, 30.54% of the participants reported using the official German corona mobile application and the majority were content with the local and national rules in relation to Coronavirus restrictions.DiscussionAt the 6 months follow-up, the 0.74% seroprevalence was below the reported seroprevalence of 1.35% in the general German population. The prevalence in healthcare workers in direct patient care compared with those without direct patient contact did not differ significantly.
The implementation of a virtual ward using digital solutions informing community clinicians in early supported discharge of patients with SARS-Cov2 respiratory symptoms from an acute hospital setting
Authors: Swift J , Harris Z , Woodward A , O’Kelly NI , Barker C , Ghosh S 
Published: March 2021

AbstractObjectivesTo assess the short run successes and challenges of the implementation of a digitally supported accelerated acute hospital discharge scheme for patients admitted with Covid-19.DesignAnalysis of the safety, resource use and health outcomes within the virtual service for the first 65 patients that have been discharged from a virtual respiratory ward.SettingCommunity based intervention using digital technology and a multi-disciplinary team of specialist clinicians to monitor patients at home.Participants65 patients discharged from hospital followed until discharge from the virtual ward.Results24.6% of 65 patients had symptoms that were coded red (urgent response required) in CliniTouch Vie in the first day after hospital discharge falling to 7.7% on their final day on the virtual ward; p=0.049. Reductions in red days decreased significantly over time, from 33.8% of patients in their first three days to 10.8% in their final three days; all patients p=0.002. Four patients were re-admitted to hospital, all for clotting disorders. There was one death within this group, which following senior clinical review was deemed to be unrelated to infection with Covid-19.The most important gain for Glenfield hospital was in expediting the rapid discharge of patients admitted with Covid-19 into a supported environment and the freeing up of beds. On 15th January, 48% of beds were taken up with patients admitted with Covid-19 symptoms.In November 2020, immediately prior to the launch of the virtual ward, the mean length of stay for patients who did not access high dependency care or oxygen was 5.5 (+/-1.3) days. The mean length of stay in patients discharged into the virtual ward thereafter was 3.3 (+/-0.4) days; relative reduction, 40.3% (p<0.001).The cost of care provision in the virtual ward was 8,662 UK Pounds in total and 133.26 UK pounds per patient. The estimated overall savings were 68,052 UK Pounds and the mean saving per patient was estimated at £1,047 UK Pounds.ConclusionsThe virtual ward appeared to assist with earlier discharges, had a low rate of clinically necessary re-admissions, the safety of patients was not compromised and whilst cost savings were not the primary objective, it seemed to also reduce overall resource use and costs.