bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology, Outcomes, and Trends of Patients With Sepsis and Opioid-Related Hospitalizations in U.S. Hospitals*
Authors: Alrawashdeh Mohammad , Klompas Michael , Kimmel Simeon , Larochelle Marc R. , Gokhale Runa H. , Dantes Raymund B. , Hoots Brooke , Hatfield Kelly M. , Reddy Sujan C. , Fiore Anthony E. , Septimus Edward J. , Kadri Sameer S. , Poland Russell , Sands Kenneth , Rhee Chanu 
Published: June 2021

OBJECTIVES:
Widespread use and misuse of prescription and illicit opioids have exposed millions to health risks including serious infectious complications. Little is known, however, about the association between opioid use and sepsis.

DESIGN:
Retrospective cohort study.

SETTING:
About 373 U.S. hospitals.

Patients:
Adults hospitalized between January 2009 and September 2015.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Sepsis was identified by clinical indicators of concurrent infection and organ dysfunction. Opioid-related hospitalizations were identified by the International Classification of Diseases, 9th Revision, Clinical Modification codes and/or inpatient orders for buprenorphine. Clinical characteristics and outcomes were compared by sepsis and opioid-related hospitalization status. The association between opioid-related hospitalization and all-cause, in-hospital mortality in patients with sepsis was assessed using mixed-effects logistic models to adjust for baseline characteristics and severity of illness.
The cohort included 6,715,286 hospitalizations; 375,479 (5.6%) had sepsis, 130,399 (1.9%) had opioid-related hospitalizations, and 8,764 (0.1%) had both. Compared with sepsis patients without opioid-related hospitalizations (n = 366,715), sepsis patients with opioid-related hospitalizations (n = 8,764) were younger (mean 52.3 vs 66.9 yr) and healthier (mean Elixhauser score 5.4 vs 10.5), had more bloodstream infections from Gram-positive and fungal pathogens (68.9% vs 47.0% and 10.6% vs 6.4%, respectively), and had lower in-hospital mortality rates (10.6% vs 16.2%; adjusted odds ratio, 0.73; 95% CI, 0.60–0.79; p < 0.001 for all comparisons). Of 1,803 patients with opioid-related hospitalizations who died in-hospital, 928 (51.5%) had sepsis. Opioid-related hospitalizations accounted for 1.5% of all sepsis-associated deaths, including 5.7% of sepsis deaths among patients less than 50 years old. From 2009 to 2015, the proportion of sepsis hospitalizations that were opioid-related increased by 77% (95% CI, 40.7–123.5%).

CONCLUSIONS:
Sepsis is an important cause of morbidity and mortality in patients with opioid-related hospitalizations, and opioid-related hospitalizations contribute disproportionately to sepsis-associated deaths among younger patients. In addition to ongoing efforts to combat the opioid crisis, public health agencies should focus on raising awareness about sepsis among patients who use opioids and their providers.
Pathophysiologic Signature of Impending ICU Hypoglycemia in Bedside Monitoring and Electronic Health Record Data: Model Development and External Validation
Authors: Horton William B. , Barros Andrew J. , Andris Robert T. , Clark Matthew T. , Moorman J. Randall 
Published: June 2021

OBJECTIVES:
We tested the hypothesis that routine monitoring data could describe a detailed and distinct pathophysiologic phenotype of impending hypoglycemia in adult ICU patients.

DESIGN:
Retrospective analysis leading to model development and validation.

SETTING:
All ICU admissions wherein patients received insulin therapy during a 4-year period at the University of Virginia Medical Center. Each ICU was equipped with continuous physiologic monitoring systems whose signals were archived in an electronic data warehouse along with the entire medical record.

PATIENTS:
Eleven thousand eight hundred forty-seven ICU patient admissions.

INTERVENTIONS:
The primary outcome was hypoglycemia, defined as any episode of blood glucose less than 70 mg/dL where 50% dextrose injection was administered within 1 hour. We used 61 physiologic markers (including vital signs, laboratory values, demographics, and continuous cardiorespiratory monitoring variables) to inform the model.

MEASUREMENTS AND MAIN RESULTS:
Our dataset consisted of 11,847 ICU patient admissions, 721 (6.1%) of which had one or more hypoglycemic episodes. Multivariable logistic regression analysis revealed a pathophysiologic signature of 41 independent variables that best characterized ICU hypoglycemia. The final model had a cross-validated area under the receiver operating characteristic curve of 0.83 (95% CI, 0.78–0.87) for prediction of impending ICU hypoglycemia. We externally validated the model in the Medical Information Mart for Intensive Care III critical care dataset, where it also demonstrated good performance with an area under the receiver operating characteristic curve of 0.79 (95% CI, 0.77–0.81).

CONCLUSIONS:
We used data from a large number of critically ill inpatients to develop and externally validate a predictive model of impending ICU hypoglycemia. Future steps include incorporating this model into a clinical decision support system and testing its effects in a multicenter randomized controlled clinical trial.
Association Between an Increase in Serum Sodium and In-Hospital Mortality in Critically Ill Patients*
Authors: Grim Chloe C. A. , Termorshuizen Fabian , Bosman Robert J. , Cremer Olaf L. , Meinders Arend Jan , Nijsten Maarten W. N. , Pickkers Peter , de Man Angelique M. E. , Schultz Marcus J. , van Vliet Peter , Weigel Joachim D. , Helmerhorst Hendrik J. F. , de Keizer Nicolette F. , de Jonge Evert 
Published: June 2021

OBJECTIVES:
In critically ill patients, dysnatremia is common, and in these patients, in-hospital mortality is higher. It remains unknown whether changes of serum sodium after ICU admission affect mortality, especially whether normalization of mild hyponatremia improves survival.

DESIGN:
Retrospective cohort study.

SETTING:
Ten Dutch ICUs between January 2011 and April 2017.

Patients:
Adult patients were included if at least one serum sodium measurement within 24 hours of ICU admission and at least one serum sodium measurement 24–48 hours after ICU admission were available.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
A logistic regression model adjusted for age, sex, and Acute Physiology and Chronic Health Evaluation-IV–predicted mortality was used to assess the difference between mean of sodium measurements 24–48 hours after ICU admission and first serum sodium measurement at ICU admission (Δ48 hr-[Na]) and in-hospital mortality. In total, 36,660 patients were included for analysis. An increase in serum sodium was independently associated with a higher risk of in-hospital mortality in patients admitted with normonatremia (Δ48 hr-[Na] 5–10 mmol/L odds ratio: 1.61 [1.44–1.79], Δ48 hr-[Na] > 10 mmol/L odds ratio: 4.10 [3.20–5.24]) and hypernatremia (Δ48 hr-[Na] 5–10 mmol/L odds ratio: 1.47 [1.02–2.14], Δ48 hr-[Na] > 10 mmol/L odds ratio: 8.46 [3.31–21.64]). In patients admitted with mild hyponatremia and Δ48 hr-[Na] greater than 5 mmol/L, no significant difference in hospital mortality was found (odds ratio, 1.11 [0.99–1.25]).

CONCLUSIONS:
An increase in serum sodium in the first 48 hours of ICU admission was associated with higher in-hospital mortality in patients admitted with normonatremia and in patients admitted with hypernatremia.
Age at Primary Cleft Lip Repair: A Potential Bellwether Indicator for Pediatric Surgery
Authors: Vanderburg Richard , Alonso Nivaldo , Desai Priya , Donkor Peter , Mossey Peter , Stieber Erin , V. Mehendale Felicity 
Published: June 2021

Background:
The bellwether procedures described by the Lancet Commission on Global Surgery represent the ability to deliver adult surgical services after there is a clear and easily made diagnosis. There is a need for pediatric surgery bellwether indicators. A pediatric bellwether indicator would ideally be a routinely performed procedure, for a relatively common condition that, in itself, is rarely lethal at birth, but that should ideally be treated with surgery by a standard age. Additionally, the condition should be easy to diagnose, to minimize the confounding effects of delays or failures in diagnosis. In this study, we propose the age at primary cleft lip (CL) repair as a bellwether indicator for pediatric surgery.

Method:
We reviewed the surgical records of 71,346 primary cleft surgery patients and ultimately studied age at CL repair in 40,179 patients from 73 countries, treated by Smile Train partners for 2019. Data from Smile Train’s database were correlated with World Bank and WHO indicators.

Results:
Countries with a higher average age at CL repair (delayed access to surgery) had higher maternal, infant, and child mortality rates as well as a greater risk of catastrophic health expenditure for surgery. There was also a negative correlation between delayed CL repair and specialist surgical workforce numbers, life expectancy, percentage of deliveries by C-section, total health expenditure per capita, and Lancet Commission on Global Surgery procedure rates.

Conclusion:
These findings suggest that age at CL repair has potential to serve as a bellwether indicator for pediatric surgical capacity in Lower- and Middle-income Countries.
Prevalence and Antimicrobial Resistance of Bacteria in Children With Acute Otitis Media and Ear Discharge
Authors: Hullegie Saskia , Venekamp Roderick P. , van Dongen Thijs M. A. , Hay Alastair D. , Moore Michael V. , Little Paul , Schilder Anne G. M. , Damoiseaux Roger A. M. J. 
Published: June 2021

Background:
Of children with acute otitis media (AOM), 15%–20% present with acute onset ear discharge due to a spontaneous perforation of the tympanic membrane (AOMd). This review aims to quantify the prevalence and antimicrobial resistance (AMR) status of bacteria in children with AOMd in the pneumococcal conjugate vaccine (PCV) era.

Methods:
Systematic searches were performed in PubMed, EMBASE and Cochrane Library from inception to June 7, 2019. Two reviewers extracted relevant data and assessed risk of bias independently. All English studies reporting any prevalence and/or AMR data of bacterial middle ear isolates from children with AOMd were included. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal checklist.

Results:
Of 4088 unique records retrieved, 19 studies (10,560 children) were included. Overall quality was judged good. Streptococcus pneumoniae (median 26.1%, range 9.1%–47.9%), Haemophilus influenzae (median 18.8%, range 3.9%–55.3%), Staphylococcus aureus (median 12.3%, range 2.3%–34.9%) and Streptococcus pyogenes (median 11.8%, range 1.0%–30.9%) were the most prevalent bacteria. In 76.0% (median, range 48.7%–100.0%, 19 studies, 1,429 children) any bacterium was identified. AMR data were sparse and mainly limited to S. pneumoniae. We found no evidence of a clear shift in the prevalence of bacteria and AMR over time.

Conclusions:
In children with AOMd, S. pneumoniae and H. influenzae are the 2 predominant bacteria, followed by S. aureus and S. pyogenes in the post-PCV era. AMR data are sparse and no clearly change over time was observed. Ongoing surveillance of the microbiology profile in children with AOMd is warranted to guide antibiotic selection and to assess the impact of children’s PCV status.
Use of the Whole Country Insulin Consumption Data in Israel to Determine the Prevalence of Type 1 Diabetes in Children <5 Years of Age Before and During Rotavirus Vaccination
Authors: Blumenfeld Orit , Lawrence Gabriella , Shulman Lester M. , Laron Zvi 
Published: June 2021

Background:
Recent studies showed that rotavirus vaccination may affect the prevalence of type 1 diabetes (T1D). The aim of the study was to determine the prevalence of early childhood (<5 years) T1D before and during the introduction of rotavirus vaccination in Israel by syndromic surveillance.

Methods:
Data on insulin purchases reported by Israel’s four Health Maintenance Organizations (HMOs) were retrieved from the National Program for Quality Indicators in Community Healthcare.

Results:
During the prevaccination years (2002–2007), a steady increase in insulin purchases was reported in the young (<5 years). The period percent change (PC) of children <5 years old diagnosed with T1D inferred from purchased insulin prescriptions increased by 50.0%, and the annual percent change (APC) increased by 10.0% (p = 0.01). During the period of free, universal Rotavirus vaccination (2011–2018), the PC for T1D diagnoses among children <5 years of age decreased by 3.8% with an APC of −2.5% (p = 0.14). There was a significant difference (p = 0.002) between the increasing trend in insulin use before vaccination versus the decreasing trend after vaccination.

Conclusion:
Rotavirus vaccination correlated with attenuation of the increasing rate in the prevalence of T1D in <5-year-old children in Israel.
Establishing Benchmarks for Antimicrobial Use in Canadian Children’s Hospitals
Authors: Blackburn Julie , Barrowman Nicholas , Bowes Jennifer , Tsampalieros Anne , Le Saux Nicole 
Published: June 2021

Background:
Point prevalence surveys (PPS) are potentially useful to measure antimicrobial use across institutions. The objectives of the study were to describe and compare antimicrobial use between pediatric hospitals in Canada.

Methods:
Fifteen pediatric hospitals all with pediatric infectious diseases service participated in 2 single-day PPS in 2018/19. Children <18 years of age who were inpatients were included. Age, service, clinical diagnosis as well as name, route, and start date for each antimicrobial was collected. Antibiotics were grouped according to the World Health Organization AWaRe classification.

Results:
There were 3924 inpatient patients-days representing 2729 children and 1195 infants in neonatal intensive care units (NICU) surveyed. Among non-NICU patients, 1210 (44.3%) received 1830 antimicrobials of which 73.9% were for empiric or pathogen-directed therapy and 25.6% for prophylaxis. The mean proportion of core Access and Watch group antibiotics was 45.8% and 63.5%, respectively, with no differences in means between tertiary and quaternary care sites. Among 1195 infants in NICU, 19.7% received 410 antimicrobials of which 17.1% were for prophylaxis and a mean of 45.4% were Watch group antibiotics. Of patients admitted for community-acquired pneumonia, 32.7% received penicillin or aminopenicillins only with variability among sites.

Conclusions:
PPS of antimicrobial use in Canadian pediatric hospitals revealed a high proportion of Watch group (broader spectrum) antibiotics, even among children with community-acquired pneumonia. This study demonstrates the feasibility of PPS to document antimicrobial use and potentially to use this data to establish goals for decreasing both overall and Watch group antibiotics.
Prescribing Tamoxifen in Patients With Mood Disorders
Authors: Carmassi Claudia , Cordone Annalisa , Dell'Oste Valerio , Pedrinelli Virginia , Pardini Francesco , Simoncini Marly , Dell'Osso Liliana 
Published: June 2021

Abstract

Purpose/Background
Tamoxifen is a selective estrogen receptor modulator widely used for treatment and prevention of estrogenic receptor–positive breast cancer. Tamoxifen is an object of growing interest in psychopharmacology as an antimanic drug, because it inhibits the protein kinase C, a molecular target of bipolar disorder. Consistently, the potential depressive effect of tamoxifen has been repeatedly reported.

Methods/Procedures
This article systematically reviews studies examining tamoxifen impact on mood, exploring either its potential therapeutic use as antimanic agent or its potential depressive effect.

Findings
Eight studies explored tamoxifen antimanic properties, all, but one, reported a rapid and efficacious antimanic action. As to the depressive effect, 9 cohort studies emerged among which 4 pointed out an increased risk of depression. Seven case reports described the onset or exacerbation of depressive episodes besides 1 case series study reported a high rate of depressive symptoms. In addition, 1 case report study described a tamoxifen-induced manic episode.

Implications/Conclusions
The present review highlights tamoxifen treatment as a possible trigger of mood symptoms onset or exacerbation in vulnerable patients. Accordingly, patients with a history of mood disorders may require a close clinical surveillance during tamoxifen use. At the same time, the use of tamoxifen as an antimanic agent in psychiatric settings requires caution, as available evidence came from small-sample studies with short observation time. More studies are needed to define how long-term tamoxifen use may affect the course of bipolar disorder.
Neonatal Nurses' Perceptions of Palliative Care in the Neonatal Intensive Care Unit
Authors: Chin Susan Di Nonno , Paraszczuk Ann Marie , Eckardt Patricia , Bressler Toby 
Published: June 2021

Abstract

Purpose:
Neonatal palliative care is widely endorsed as an essential aspect of neonatal intensive care unit (NICU) practice, yet inconsistencies in its use continue to exist. We examined neonatal nurses' perceptions of barriers and facilitators to palliative care in their NICU setting.

Study Design and Methods:
A cross-sectional design using the Neonatal Palliative Care Attitude Scale (NiPCAS™©) was administered using an online survey distributed to neonatal nurses through the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) and National Association of Neonatal Nurses (NANN). Parametric statistical analyses were conducted to explore relationships between unit policy and neonatal palliative care (NPC) education, and the nurses' perceptions.

Results:
Ninety-nine of 1,800 AWHONN members who identified as NICU nurses completed the survey, representing a response rate of 5.5% and 101 of 4,000 NANN members who subscribe to the MYNANN message boards completed the survey, reflecting a 2.5% response rate. N = 200 surveys were completed with minimal data missing, resulting in a final sample of 200. Exploratory factor analysis yielded these subconstructs: Unit Culture, Resources, and Perceived Inappropriate Care. Barriers identified were Perceived Inappropriate Care and Societal Understanding of NPC. A positive correlation was noted for NiPCAS™© scores and unit culture support (r(185) = .66, n = 187, p < .01), unit NPC policy (r(184) = .446, n = 186, p < .01), and NPC education (r(185) = .373, n = 187, p < .01).

Clinical Implications:
Nurses who work in a NICU with an NPC policy and who have received palliative care education demonstrated more favorable attitudes toward NPC. Policy and educational programs are important strategies to promote high-quality care for high-risk infants and their families.
Relationship Between Infant Tongue-Tie and Maternal Wellbeing
Authors: Hill Rebecca R. , Wong John , Parikh Gayatri S. 
Published: June 2021

Abstract

Background:
Tongue-tie is a mild oral anomaly that can cause feeding challenges, especially for breastfeeding mothers and infants. Delayed diagnosis may place mothers at increased risk of stress and impaired mother–infant bonding when feeding does not go as planned. The purpose of this study was to explore the risk for altered maternal wellbeing (e.g., stress and maternal–infant bonding) in mothers of infants with tongue-tie-using-a mixed-methods, cross-sectional study.

Methods:
We recruited mothers from two sites to participate in a survey about their experiences with tongue-tie: Facebook™ tongue-tie support group and a local pediatric dental office where frenotomy is commonly performed. Inclusion criteria were mothers 18 or older; able to read, write, and understand English. Infants were under the age of 1 year when diagnosed with tongue-tie. The survey contained both selection and open-text entry questions. Maternal–infant bonding was assessed using the Postpartum Bonding Questionnaire and maternal stress was measured using the Parental Stress Scale.

Results:

N = 113 mothers participated. Findings suggest that mothers of infants with tongue-tie report increased stress, especially when a diagnosis of tongue-tie is delayed. After correction, maternal wellbeing, the breastfeeding relationship, and maternal report of infant temperament improved.

Clinical Implications:
Early assessment, diagnosis, and management of tongue-tie are important. Partner support is helpful in fostering the mother–infant relationship. Future research is needed to understand barriers to appropriate referrals and delay in treatment of tongue-tie.
Cotinine Fluctuation in Maternal Saliva During and After Pregnancy
Authors: Gwon Seok Hyun , Jeong Suyong , Bullock Linda 
Published: June 2021

Abstract

Purpose:
The purpose of this study was to determine maternal cotinine levels in saliva at the first (T-1) and third trimesters of pregnancy (T-2), and postpartum (T-3) among women who reported smoking a consistent number of cigarettes. The goal was to generate data to provide suggestions about how nurses can improve patient outcomes for women who smoke.

Methods:
Saliva cotinine values obtained from the randomized controlled trial (BabyBEEP) were used for this secondary analysis. We examined variations in saliva cotinine between the first and third trimesters of pregnancy and postpartum among light and heavy smokers. Cotinine values for pregnant smokers who were in the control group (not randomized to any intervention) and reported smoking the same range of cigarettes during and after pregnancy were used for the analyses (n = 43). Descriptive statistics and repeated-measures ANOVA were used for analyses.

Results:
There were differences in maternal saliva cotinine levels across the different time points and between the groups. There was a significant interaction effect between time and group. Cotinine decreased from T-1 to T-2 in heavy smokers and increased from T-2 to T-3 among both light and heavy smokers. Cotinine at T-3 was higher than T-1 among light smokers.

Clinical Implications:
Findings support accelerated nicotine metabolism during pregnancy and need for smoking cessation efforts throughout pregnancy to help women stay smoke free during postpartum.
HIV General Population Surveys: Shedding Light on the Status of HIV Epidemics and Informing Future Actions
Authors: Porter Laura , Bello George , Nkambule Rejoice , Justman Jessica 
Published: June 2021

Abstract:
Nationally representative household surveys of the general population can provide critical assessments of the status of HIV epidemics and the impact of national HIV programs. With lessons learned from earlier surveys, PEPFAR has supported HIV-focused surveys in high burden countries to measure known HIV status, access to HIV treatment, and viral suppression, and, by using novel HIV recency assays, to estimate HIV incidence. The results from the initial population-based HIV impact assessments have transformed global HIV programming, demonstrating unexpected progress in population viral suppression and the persistent burden of high HIV incidence among adolescent girls and young women. The findings highlight the importance of tailoring programs to engage men more effectively in HIV testing and treatment. The collection of manuscripts summarized in this overview of the Supplement describe the methods and selected key findings from the initial population-based HIV impact assessment surveys. Taken together, the efforts described in these manuscripts have advanced survey and laboratory capacity and guided HIV programs toward the goal of ending the global epidemic.