bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differences in Family Involvement in the Bedside Care of Patients in the ICU Based on Self-Identified Race
Authors: Nunez Eduardo R. , Villa Gianluca , McFadden Rory , Palmisciano Amy , Lanini Iacopo , O’Mahony Sean , Curtis J. Randall , Levy Mitchell M. , Amass Timothy 
Published: March 2021

Objectives:
Being a caregiver for a patient in the ICU can place emotional burden on families and engaging families in caregiving can reduce psychological distress. Our goal was to observe support methods used by families in the ICU and identify differences between race/ethnicity.

Design:
A secondary analysis of a multicenter before-and-after clinical trial.

Setting:
Three hospitals in Chicago, Providence, and Florence, Italy.

Participants:
Family members of patients admitted to the ICU.

Interventions:
In the primary study, an intervention was designed to engage families in seven domains that were based on the five physical senses (taste, touch, sight, smell, and sound), personal care, and spiritual care of the patient. During the control phase, nursing staff observed and recorded if they witnessed families participating in support methods unprompted.

MEASUREMENTS AND MAIN RESULTS:
We compared the use of support methods among families from different races, categorized by race as either White, Black, or other using generalized estimating equation population-averaged logistic regression analysis. A total of 133 patients and 226 family members were enrolled in the control arm of the primary study, with patients being 71.2% White, 17% Black, and 11.8% other. Compared with Whites, families who identified their race Black or other may be more likely to participate in support methods that included personal care, touch, or spiritual care. Families who identified as Black may also be more likely to incorporate audio or sound. There were no differences in the categories of sight, smell, or taste.

Conclusions:
Our study identifies racial differences in the use of bedside support methods in the ICU. Guiding families in a culturally congruent and open-minded manner may have the potential to decrease family distress and improve the experience for families in the ICU.
Emerging systemic antitarget treatment for differentiated thyroid carcinoma
Authors: Basté Neus , Mora Mireia , Grau Juan José 
Published: March 2021

Purpose of review
We review the new systemic treatment strategies for differentiated thyroid carcinoma, as well as the acquaintance of its molecular biology.

Recent findings
Multiple kinase inhibitor drugs have become the standard therapy for thyroid cancer, albeit several adverse effects. In the last few years, new molecules have raised with an overall safety profile. Most of them, are considered targeted therapies directed toward driven-molecules alterations, such as neurotrophic tyrosine kinase receptor (NTRK) inhibitors for NTRK-fusion thyroid cancer and rearranged during transfection (RET) inhibitors for RET-fusion thyroid cancer. Recently, promising outcomes and safety data have been presented. Furthermore, other novel strategies for advanced thyroid carcinoma are currently investigated in clinical trials.
The ability to provide precision medicine to patients in routine clinical settings depends on the availability of molecular profiling test at their cancer centers. The impossibility to perform molecular characterization could turn out to be a diagnostic and treatment limitation for some patients.

Summary
The treatment of advanced differentiated thyroid carcinoma has undergone rapid evolution in the last decade. An emerging treatment era is coming. From now to then, we will need to face the different types of diagnostic tools for molecular characterization, their interpretation and, finally the access to targeted therapies.
COVID-19 and supportive cancer care: key issues and opportunities
Authors: Ashbury Fredrick D. 
Published: March 2021

Purpose of review
The disruption to people's lives, including financial impacts, morbidity and loss of life caused by the Coronavirus disease (COVID-19) pandemic requires a dramatic transformation of cancer care delivery, including supportive care. This paper focuses on issues of supportive care in the context of the pandemic, and the extent to which these issues will impact supportive cancer care post-COVID-19.

Recent findings
Cancer care, including supportive care delivery, has had to be dramatically altered during the COVID-19 pandemic, including reallocation of human resources, repurposing of existing physical space, amplified use of telehealth and other remote patient monitoring technologies, changes to treatment and follow-up care patient schedules, among others. These changes have resulted in psychosocial sequelae for cancer patients (including anxiety, stress, loss of control), financial toxicity, and risk of disengagement from treatment and follow-up care.

Summary
COVID-19 has seriously disrupted cancer treatment and supportive care for patients and survivors. This paper highlights implications for clinical practice during and post-COVID-19, including the durability of practice adaptations and opportunities for research into mechanisms to support supportive care post the pandemic, including the advancement of eHealth technologies and alternative models of care that integrate community resources, primary care and allied health disciplines.
Dexmedetomidine vs. total intravenous anaesthesia in paediatric emergence delirium
Authors: Petre Maria-Alexandra , Levin David N. , Englesakis Marina , Maynes Jason T. , Pechlivanoglou Petros , Aoyama Kazuyoshi 
Published: March 2021

BACKGROUND
Emergence delirium is a common complication in paediatric anaesthesia associated with significant morbidity. Total intravenous anaesthesia (TIVA) and intra-operative dexmedetomidine as an adjuvant to sevoflurane anaesthesia can both reduce the incidence of emergence delirium compared with sevoflurane alone, but no studies have directly compared their relative efficacy.

OBJECTIVE
The study objective was to compare the effects of TIVA and dexmedetomidine on the incidence of paediatric emergence delirium.

STUDY DESIGN
The current study is a systematic review and network meta-analysis (NMA) of randomised controlled trials.

DATA SOURCES
We conducted a systematic search of 12 databases including Medline (Ovid) and Web of Science (Clarivate Analytics) from their respective inception to December 2020.

ELIGIBILITY
Inclusion criteria were randomised controlled trials of paediatric patients undergoing general anaesthesia using sevoflurane, sevoflurane with dexmedetomidine or TIVA. Data were extracted by two reviewers according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and analysed using NMA methodology. Risk ratios and 95% credible intervals (CrI) were calculated for all outcomes [emergence delirium, postoperative nausea and vomiting (PONV), and time to emergence and extubation]. The protocol was registered with PROSPERO (CRD42018091237).

RESULTS
The systematic review returned 66 eligible studies comprising 5257 patients with crude median emergence delirium incidences of 12.8, 9.1 and 40% in the dexmedetomidine with sevoflurane, TIVA and sevoflurane alone groups, respectively. NMA indicated that compared with TIVA, sevoflurane with adjuvant dexmedetomidine decreased the incidence of emergence delirium without statistical difference (risk ratio 0.88, 95% CrI 0.61 to 1.20, low quality of evidence), but resulted in a higher incidence of PONV (risk ratio: 2.3, 95% CrI 1.1 to 5.6, low quality of evidence).

CONCLUSION
Clinical judgement, considering the patient's risk factors for the development of clinically significant outcomes such as emergence delirium and PONV, should be used when choosing between TIVA and sevoflurane with adjuvant dexmedetomidine. These findings are limited by the low quality of evidence (conditional recommendation).
The use of high flow nasal oxygen in a patient with Duchenne muscular dystrophy with severe restrictive lung disease requiring dental extractions: a case report
Authors: Desjardins Danielle , Zuo Leila W. 
Published: March 2021

Presentation:
A 22-year-old man with Duchenne muscular dystrophy (DMD) presented for removal of impacted third molars in his baseline health status. Comorbidities included decreased mobility, restrictive lung disease [forced vital capacity (FVC) 35% at baseline], adrenal insufficiency, and obstructive sleep apnea.

Anesthetic challenge:
General anesthetics are problematic in this population. The airway is typically compromised by macroglossia. Patients have reduced functional residual capacity, so time to desaturation after induction is reduced; in patients with FVC<50% there is high risk of postoperative pulmonary complications. Those with FVC<30% face further increased risk. The use of depolarizing neuromuscular blockade is contraindicated due to the risk of hyperkalemia. Residual nondepolarizing neuromuscular blockade could compromise postoperative pulmonary status further. Controversy remains regarding use of inhaled anesthetics, but they are generally avoided given the risk of rhabdomyolysis. In addition, DMD patients often have cardiomyopathy, further complicating management. The overall challenge was to avoid general anesthetics in this patient.

How it was done:
After a full discussion with the patient and family, we decided sedation with local anesthetic was the safest anesthetic plan. As a safeguard, inhaled anesthetics were removed, the machine was flushed, and filters were placed in the circuit; a Glidescope was available. We proceeded with moderate sedation with propofol and dexmedetomidine infusions. Given his reduced pulmonary function and need for oral access, the patient was placed on high-flow nasal cannula to provide supplemental oxygen and provide positive end-expiratory pressure. Opioids were kept to a minimum: 50 mcg fentanyl was given with local anesthetic injection. The anesthetic and dental teams talked the patient through his discomfort for much of the procedure. Music of the patient’s choosing was played. Overall the patient did well with a combination of sedation, local anesthesia, and coaching by the surgery and anesthesia teams. He was discharged same day without noted complications of anesthesia.

Conclusion:
Preparation for this apparently “simple” case in a complex patient was key to our success. By addressing the known pulmonary changes in DMD, we employed high-flow nasal cannula in a dental surgery—a new use for this device. By using all the tools available to us as anesthesiologists we were able to avoid an intubation and the possibility of a prolonged hospital stay for our patient.
Scoring Endoscopy in Pediatric Inflammatory Bowel Disease
Authors: Norsa Lorenzo , Ferrari Alberto , Arrigo Serena , Bramuzzo Matteo , Deganello Saccomani Marco , Di Nardo Giovanni , Illiceto Maria Teresa , Miele Erasmo , Paci Monica , Romano Claudio , Romeo Erminia , Daperno Marco , Oliva Salvatore ,   Endoscopy group of the Italian society of pediatric Gastroenterology Hepatology and Nutrition (SIGENP)
Published: March 2021

ABSTRACTObjectives and study:There is a large interobserver variability in evaluating mucosal lesions of inflammatory bowel disease (IBD), especially in pediatric patients. This multicenter prospective observational study aims to evaluate interobserver agreement (IOA) among pediatric endoscopists in assigning validated IBD endoscopic scores in children.Methods:Fifteen videos of follow‐up ileocolonoscopies in children with IBD were recorded and selected as cases. Eleven pediatric endoscopists from different centers blindly evaluated all videos and calculated scores: either Ulcerative Colitis Endoscopic Index of Severity (UCEIS) or Simple Endoscopic Score for Crohn Disease (SES‐CD). Scores from all reviewers were compared in order to calculate IOA for general videos and specific sections. Scores from an expert adult reader were used to calculate possible reviewer's characteristics affecting scores’ reliability.Results:Intraclass correlation was 0.298 (95% confidence interval [CI]: 0.13–0.55) for ulcerative colitis (UC) and 0.266 (0.11–0.52) for Crohn disease (CD). When a disease activity categorization was adopted (remission, mild, moderate, severe activity) Fleiss kappa coefficient was 0.408 (0.29–0.53) for UC and 0.552 (0.43–0.73) for CD. When stratified by item, vascular pattern of UC was the most reliable item IC: 0.624 (0.321–0.854). In multivariable analysis, none of the reviewer's characteristics affected the readers’ errors.Conclusions:This multicenter study shows low agreement among pediatric endoscopists in evaluating endoscopic scores in children with IBD. By using disease activity categorization, agreement slightly increased, mostly for CD. All readers showed a low‐grade concordance with the expert adult gastroenterologist's evaluations. Future‐specific training programs should be considered to increase IOA in using IBD endoscopic activity scores.
Long‐Term Results of Laparoscopic Adjustable Gastric Banding in French adolescents
Authors: Yska Hemmo A.F. , Khen‐Dunlop Naziha , Lacaille Florence , Dabbas Myriam 
Published: March 2021

ABSTRACTObjectives:To investigate the long‐term follow‐up (FU) and effectivity of laparoscopic adjustable gastric banding (LAGB) in a French adolescent cohort.Methods:We retrospectively analyzed the results of LAGB at our institution. We collected information on FU, adjustable gastric banding (AGB) status, weight‐related parameters, and comorbidity at multiple timepoints.Results:Fifty‐six patients (77% female) with a mean age of 16.5 years and a mean body mass index (BMI) of 45 kg/m2 underwent LAGB over a period of 12 years. The mean postpediatric FU was 23 months. FU decreased progressively from 96% at 3 years to 54% and 29% at 6 and 9 years, respectively. The loss to FU was 39% at last contact. AGB was removed in 17 patients (30%) and 12 patients (21%) underwent a second bariatric procedure. Mean BMI decreased by 11 kg/m2 at last contact (P < 0.001). The prevalence of most comorbidities also decreased significantly after 3 years. The mean excess weight loss (to reach a BMI of 25 kg/m2) was 47% during the first year postsurgery and further increased to 55% at last contact.Conclusion:Overall, AGB resulted in significant weight loss; however, the increase in heterogeneity suggests that LAGB is more effective in some individuals than in others in the long‐term. This study confirmed that LAGB is a valuable bariatric procedure in adolescents, either as a long term‐term efficient or bridging method that would be replaced at the time of transition to adult care. The importance of a standardized long‐term follow‐up should always be emphasized.
Peginterferon Alfa‐2a (40KD) Plus Lamivudine or Entecavir in Children With Immune‐Tolerant Chronic Hepatitis B
Authors: Mieli‐Vergani Giorgina , Bansal Sanjay , Daniel James F. , Kansu Aydan , Kelly Deirdre , Martin Carmen , Tizzard Sarah , Wirth Stefan , Zhou Julian , Vergani Diego 
Published: March 2021

ABSTRACTObjective:Treatment guidelines for chronic hepatitis B (CHB) do not recommend antiviral therapy for patients in the immune‐tolerant phase of the disease, which generally occurs in children who acquire hepatitis B virus (HBV) vertically and may last for decades. On the basis of promising results of a pilot study, we conducted a randomized, controlled, multicenter study to evaluate the efficacy and safety of antiviral therapy in children and adolescents with immune‐tolerant CHB.Methods:Fifty‐nine children aged 3 to <18 years hepatitis B e antigen‐positive with an HBV DNA titer >20,000 IU/mL and persistently normal alanine aminotransferase levels were randomized to 56 weeks of antiviral therapy with an oral nucleoside analogue [entecavir or lamivudine], combined with subcutaneous peginterferon alfa‐2a from week 8, or 80 weeks of untreated observation. The primary efficacy outcome was hepatitis B surface antigen loss 24 weeks post‐treatment in the antiviral therapy group or at the end of observation in the control group.Results:Enrollment was terminated after the results of two similar studies showed that similar antiviral regimens were ineffective in children and adults with immune‐tolerant CHB. At 24 weeks post‐treatment, 1 of 26 patients in the antiviral treatment group experienced HBsAg loss (vs none of 33 patients in the control group). No serious treatment‐related adverse events were reported, and no patients discontinued treatment because of adverse events.Conclusions:The antiviral regimen evaluated in this trial had an acceptable tolerability profile, but was ineffective in children and adolescents with immune‐tolerant CHB.
International trauma care: initial European approaches during the COVID 19 pandemic
Authors: Chesser Tim J.S. , Handley Robert , Kloos Johannes , De Wachter Gerrit , Putzeys Guy , Gómez-Vallejo Jesús , Sánchez-Pérez Coral , Chana-Rodríguez Francisco , Raggini Filippo , Pari Carlotta , Paderni Stefania , Contini Achille , Belluati MD Alberto , Daskalakis Ioannis , Sperelakis Ioannis , Kostakos Athanasios , Tosounidis Theodoros H. , Halvachizadeh MD Sascha , Pape MD Hans-Christoph , Bouillon Bertil , de Bruin Berend-Jan , Ponsen Keesjan J. 
Published: March 2021

Abstract
The world was not prepared for the global of pandemic in early 2020 with the arrival of COVID 19. Europe has some of the most developed health care systems in the world and this article explains the initial response to the pandemic from an orthopaedic and trauma viewpoint from 8 nations. Italy reported the first cluster in February, which then rapidly spread around the continent, requiring a rapid reorganization of services. The reports highlight how elective surgery was universally stopped, surgical services were reconfigured, and new practices, such as the widespread use of telemedicine, may well become permanent. It also emphasizes how the pandemic has re-educated us on the importance of a consistent and central approach to deal with a global health crisis, and how medical services need to remain flexible and responsive to new ways of working.
Effects of Covid-19 on orthopaedic trauma services: early experiences in South Africa and Israel
Authors: Maqungo Sithombo , Duma Mlekeleli , Laubscher Maritz , Davidson Amit , Bala Miklosh , Weil Yoram A. 
Published: March 2021

Abstract
South Africa and Israel have significantly different health systems. As South Africa is geographically 500 times as large and has a population nearly 7 times as large as the state of Israel, major differences in the challenges and subsequent handling of the pandemic between these countries were to be expected. South Africa's challenges included being under-resourced, particularly related to trauma, and severe and radical measures had to be undertaken that included extended strict lockdowns, bans on alcohol sales, and cancellation of the majority of the elective surgery during this initial period of the pandemic. Although Israel is much smaller and thereby theoretically easier to control, a complex political situation created difficulties and delays in controlling the pandemic after the initial response, leading to a second wave and additional lockdown. Although massively engaged initially, the Israeli trauma systems had continued functioning almost normally throughout the COVID-19 crisis.
Variability in the Hemodynamic Response to Fluid Bolus in Pediatric Septic Shock
Authors: Ranjit Suchitra , Natraj Rajeswari , Kissoon Niranjan , Thiagarajan Ravi R. , Ramakrishnan Balasubramaniam , Monge García M. Ignacio 
Published: March 2021

OBJECTIVES:
Fluid boluses are commonly administered to improve the cardiac output and tissue oxygen delivery in pediatric septic shock. The objective of this study is to evaluate the effect of an early fluid bolus administered to children with septic shock on the cardiac index and mean arterial pressure, as well as on the hemodynamic response and its relationship with outcome.

Design, Setting, Patients, and Interventions:
We prospectively collected hemodynamic data from children with septic shock presenting to the emergency department or the PICU who received a fluid bolus (10 mL/kg of Ringers Lactate over 30 min). A clinically significant response in cardiac index-responder and mean arterial pressure-responder was both defined as an increase of greater than or equal to 10% 10 minutes after fluid bolus.

MEASUREMENTS AND MAIN RESULTS:
Forty-two children with septic shock, 1 month to 16 years old, median Pediatric Risk of Mortality-III of 13 (interquartile range, 9–19), of whom 66% were hypotensive and received fluid bolus within the first hour of shock recognition. Cardiac index- and mean arterial pressure-responsiveness rates were 31% and 38%, respectively. We failed to identify any association between cardiac index and mean arterial pressure changes (r = 0.203; p = 0.196). Cardiac function was similar in mean arterial pressure- and cardiac index-responders and nonresponders. Mean arterial pressure-responders increased systolic, diastolic, and perfusion pressures (mean arterial pressure – central venous pressure) after fluid bolus due to higher indexed systemic vascular resistance and arterial elastance index. Mean arterial pressure-nonresponders required greater vasoactive-inotrope support and had higher mortality.

CONCLUSIONS:
The hemodynamic response to fluid bolus in pediatric septic shock was variable and unpredictable. We failed to find a relationship between mean arterial pressure and cardiac index changes. The adverse effects of fluid bolus extended beyond fluid overload and, in some cases, was associated with reduced mean arterial pressure, perfusion pressures and higher vasoactive support. Mean arterial pressure-nonresponders had increased mortality. The response to the initial fluid bolus may be helpful to understand each patient’s individualized physiologic response and guide continued hemodynamic management.
Of mice, microglia, and (wo)men: a case series and mechanistic investigation of hydroxychloroquine for complex regional pain syndrome
Authors: Haight Elena S. , Johnson Emily M. , Carroll Ian R. , Tawfik Vivianne L. 
Published: March 2021

Abstract

Introduction:
Complex regional pain syndrome (CRPS) is a condition that occurs after minor trauma characterized by sensory, trophic, and motor changes. Although preclinical studies have demonstrated that CRPS may be driven in part by autoinflammation, clinical use of immune-modulating drugs in CRPS is limited. Hydroxychloroquine (HCQ) is a disease-modifying antirheumatic drug used to treat malaria and autoimmune disorders that may provide benefit in CRPS.

Objectives:
To describe the use of HCQ in patients with refractory CRPS and investigate possible mechanisms of benefit in a mouse model of CRPS.

Methods:
We initiated HCQ therapy in 7 female patients with refractory CRPS undergoing treatment at the Stanford Pain Management Center. We subsequently undertook studies in the mouse tibial fracture–casting model of CRPS to identify mechanisms underlying symptom reduction. We evaluated behavior using mechanical allodynia and spinal cord autoinflammation by immunohistochemistry and enzyme-linked immunosorbent assay.

Results:
We treated 7 female patients with chronic, refractory CRPS with HCQ 200 mg twice daily for 2 months, followed by 200 mg daily thereafter. Two patients stopped HCQ secondary to lack of response or side effects. Overall, HCQ significantly improved average numerical rating scale pain from 6.8 ± 1.1 before HCQ to 3.8 ± 1.9 after HCQ treatment. In the tibial fracture–casting mouse model of CRPS, we observed reductions in allodynia, paw edema, and warmth following daily HCQ treatment starting at 3 weeks after injury. Spinal cord dorsal horn microglial activation and cytokine levels were also reduced by HCQ treatment.

Conclusion:
Together, these preclinical and clinical results suggest that HCQ may benefit patients with CRPS at least in part by modulating autoinflammation and support further investigation into the use of HCQ for CRPS.