bluuebunny/crossref_metadata_2025_split huggingface dataset:
Investigating the Psychometric Properties of the Pieper-Zulkowski Pressure Ulcer Knowledge Test among Nurses in Iran
Authors: Moharramzadeh Habibeh , Heidarzadeh Mehdi , Aghamohammadi-Kalkhoran Masoomeh 
Published: February 2021

ABSTRACT

OBJECTIVE
To evaluate the psychometric properties of the Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT) in Iranian nurses.

METHODS
A convenience sample of 323 nurses and 161 nursing students from the Ardabil University of Medical Sciences in Iran agreed to participate in the study. To determine the psychometric properties of the PZ-PUKT content and differential validity, item analysis (difficulty and discriminative indices), internal consistency, and test-retest were performed.

RESULTS
Because the total PZ-PUKT score for critical care nurses (39.84 ± 7.10) was higher compared with general nurses (37.01 ± 8.47) and nursing students (24.59 ± 12.95), the differential validity of the tool was confirmed. The mean difficulty indices of questions with and without considering the “I don’t know” option were 0.53 and 0.65, respectively, and 0.27 and 0.13 for discriminative index. Cronbach α coefficient was .92 for the 72-item test. The correlation coefficient between test and retest for 30 nurses was 0.81.

CONCLUSIONS
This study showed that the Persian version of the PZ-PUKT is valid and reliable for use in Iran. It can be used in education and research to assess nurses’ knowledge as well as to evaluate the effectiveness of training programs on prevention and care of pressure injuries.
The wage gap in the PA profession
Authors: Marvel Susan Shiland 
Published: February 2021

ABSTRACT
The wage gap between men and women in the physician assistant (PA) profession has followed the evolution of trends and cultural shifts in both medicine and the broader US workforce. Although the gap has narrowed both nationally and, more specifically, within the PA profession, female PAs make on average $11,000 (or 6%) less than their male counterparts. The rate at which the wage gap is closing in the United States has slowed indicating that the remaining causes of the problem are subtle and difficult to address. This article discusses contributing factors such as implicit bias, workplace culture, modern family structure in the context of outdated expectations, female PA self-undervaluing, and weak consequences for violation of existing labor laws. Solutions may include legislation to further protect and empower women in the workplace, campaigns from PA professional organizations that can influence the profession's cultural landscape and empower PAs to know their worth, PA educators including contract negotiation as part of the curriculum, and employers addressing systemic hiring processes that undervalue female PAs.
Effect of Prophylactic Negative Pressure Wound Therapy vs Standard Wound Dressing on Surgical-Site Infection in Obese Women After Cesarean Delivery: A Randomized Clinical Trial
Authors: Tuuli Methodius G. , Liu Jingxia , Tita Alan T. N. , Longo Sherri , Trudell Amanda , Carter Ebony B. , Shanks Anthony , Woolfolk Candice , Caughey Aaron B. , Warren David K. , Odibo Anthony O. , Colditz Graham , Macones George A. , Harper Lorie 
Published: February 2021

(Abstracted from JAMA 2020;324:1180–1189)
Surgical-site infection is a significant cause of morbidity, lengthening hospital stays and contributing to health care costs. Cesarean delivery increases the risk of surgical site infection, and obesity contributes to this risk because obese pregnant women are more likely to have cesarean deliveries.
Ovulation Inhibition With A New Vaginal Ring Containing Trimegestone
Authors: Duijkers Ingrid J. M. , Klipping Christine , Draeger Corinna , Schug Barbara S. , Dax Annika , Friedrich Maika , Nickisch Klaus 
Published: February 2021

(Abstracted from Contraception 2020;102:237–242)
Women receiving combined hormonal contraceptives (CHCs) are at increased risk of stroke, myocardial infarction, or venous thromboembolism, whereas those receiving progestogen-only preparations for contraception have little or no increased risk of these complications. However, the progestogen-only pills (POPs) currently marketed in the United States all have drawbacks.
Forebrain Acetylcholine Modulates Isoflurane and Ketamine Anesthesia in Adult Mice
Authors: Leung L. Stan , Chu Liangwei , Prado Marco A. M. , Prado Vania F. 
Published: February 2021

Background
Cholinergic drugs are known to modulate general anesthesia, but anesthesia responses in acetylcholine-deficient mice have not been studied. It was hypothesized that mice with genetic deficiency of forebrain acetylcholine show increased anesthetic sensitivity to isoflurane and ketamine and decreased gamma-frequency brain activity.

Methods
Male adult mice with heterozygous knockdown of vesicular acetylcholine transporter in the brain or homozygous knockout of the transporter in the basal forebrain were compared with wild-type mice. Hippocampal and frontal cortical electrographic activity and righting reflex were studied in response to isoflurane and ketamine doses.

Results
The loss-of-righting-reflex dose for isoflurane was lower in knockout (mean ± SD, 0.76 ± 0.08%, n = 18, P = 0.005) but not knockdown (0.78 ± 0.07%, n = 24, P = 0.021), as compared to wild-type mice (0.83 ± 0.07%, n = 23), using a significance criterion of P = 0.017 for three planned comparisons. Loss-of-righting-reflex dose for ketamine was lower in knockout (144 ± 39 mg/kg, n = 14, P = 0.006) but not knockdown (162 ± 32 mg/kg, n = 20, P = 0.602) as compared to wild-type mice (168 ± 24 mg/kg, n = 21). Hippocampal high-gamma (63 to 100 Hz) power after isoflurane was significantly lower in knockout and knockdown mice compared to wild-type mice (isoflurane-dose and mouse-group interaction effect, F[8,56] = 2.87, P = 0.010; n = 5 to 6 mice per group). Hippocampal high-gamma power after ketamine was significantly lower in both knockout and knockdown mice when compared to wild-type mice (interaction effect F[2,13] = 6.06, P = 0.014). The change in frontal cortical gamma power with isoflurane or ketamine was not statistically different among knockout, knockdown, and wild-type mice.

Conclusions
These findings suggest that forebrain cholinergic neurons modulate behavioral sensitivity and hippocampal gamma activity during isoflurane and ketamine anesthesia.

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What We Already Know about This Topic

What This Article Tells Us That Is New
Cervical Vestibular Evoked Myogenic Potentials That Are Absent at 500 Hz But Present at 1000 Hz Are Characteristic of Endolymphatic Hydrops-Related Disease
Authors: Fujimoto Chisato , Kinoshita Makoto , Ichijo Kentaro , Oka Mineko , Kamogashira Teru , Sugasawa Keiko , Kawahara Takuya , Yamasoba Tatsuya , Iwasaki Shinichi 
Published: February 2021

Objectives:
It remains unclear whether the dominance of 1000 Hz responses over responses at 500 Hz in cervical vestibular evoked myogenic potentials (cVEMPs) are characteristic of endolymphatic hydrops (EH), due to the presence of patients with absent responses at both frequencies. The purpose of the present study is to examine whether the dominant cVEMP responses at 1000 Hz over 500 Hz are characteristic findings of EH-related diseases among patients who show various cVEMP findings.

Design:
We retrospectively reviewed the medical records of 470 consecutive patients who underwent cVEMP testing with short-tone bursts at both 500 Hz and 1000 Hz. We categorized the cVEMP responses of these 470 patients into the following five groups: (group 1) present responses at both frequencies bilaterally, (group 2) present responses at 500 Hz but absent at 1000 Hz on at least one side, (group 3) absent responses at 500 Hz but present at 1000 Hz on at least one side, (group 4) absent responses at both frequencies on one side and present at both frequencies on the other side, and (group 5) absent responses at both frequencies bilaterally. We compared the proportion of EH-related diseases between each group and the other four groups and then investigated any increased or decreased disease incidence in each group.

Results:
In group 3, the proportion of EH-related disease was significantly higher (p < 0.01), and the incidence of an EH-related disease was greatly increased (standard residual value > 3).

Conclusions:
cVEMPs that are absent at 500 Hz and present at 1000 Hz may be characteristic of EH-related disease.
Cost-effectiveness of Corrective Fusion Surgeries for Adult Spinal Deformities
Authors: Arima Hideyuki , Hasegawa Tomohiko , Yamato Yu , Kato Masashi , Yoshida Go , Banno Tomohiro , Oe Shin , Mihara Yuki , Ushirozako Hiroki , Yamada Tomohiro , Watanabe Yuh , Ide Koichiro , Nakai Keiichi , Kurosu Kenta , Matsuyama Yukihiro 
Published: February 2021

Study Design.
Retrospective cohort study.

Objective.
The aim of this study was to summarize the cost-effectiveness of surgical treatment for adult spinal deformity (ASD) according to the operative method over 2 years postoperatively.

Summary of Background Data.
Extensive corrective fusion surgery for ASD requires numerous expensive implants, greatly contributing toward the national medical expenses. Previous national studies reported high complication rates in spinal surgeries using instrumentation. However, the cost-effectiveness of such procedures has not been scrutinized.

Methods.
In total, 173 ASD patients (151 women; mean age 69.1 years) who underwent corrective fusion between 2010 and 2017 were included. Cost-effectiveness was evaluated according to the cost of obtaining 1 quality-adjusted life year (QALY). Patients were divided into three groups: the “corrective fusion surgery using multiple Grade 2 osteotomy” (Grade-2) group, three-column osteotomy group (three-column), and lateral lumbar interbody fusion (LLIF) group.

Results.
The average medical cost for the initial surgery was USD 72,240, and that during the 2 years after the initial surgery was USD 76,294. The medical expenses for the initial surgery and those over the 2 years were higher in the LLIF group. The cumulative improvement in QALY over the 2 years did not significantly differ among the groups (0.13, 0.15, and 0.18 in the Grade-2, three-column, and LLIF groups, respectively). Cost/QALY 2 years after the surgery was USD 509,370, 518,406, and 463,798 in the Grade-2, three-column, and LLIF groups, respectively.

Conclusion.
We summarized the medical costs and cost-effectiveness of three different surgical methods for ASD in patients with different backgrounds over 2 years postoperatively. The medical expense for the initial surgery was highest in the LLIF group, and the cumulative improvement in QALY over the 2 years tended to be higher in the LLIF group, but the difference was not significant; the overall cost-effectiveness was lowest in the LLIF group.

Level of Evidence: 3
Measuring the Appropriateness of Spinal Manipulation for Chronic Low Back and Chronic Neck Pain in Chiropractic Patients
Authors: Coulter Ian D. , Herman Patricia M. , Kommareddi Mallika , Hurwitz Eric L. , Shekelle Paul G. 
Published: February 2021

Study Design.
RAND/UCLA Appropriateness Method (RUAM) applied to chiropractic manipulation for patients with chronic low-back pain (CLBP) and chronic neck pain (CNP).

Objective.
Determine the rate of appropriate care provided by US chiropractors.

Summary of Background Data.
Spinal manipulation has been shown effective for CLBP and CNP but may not be appropriate for all patients with these conditions.

Methods.
Ratings of the appropriateness of spinal and cervical manipulation previously developed by two RUAM expert panels were applied to data abstracted from random samples of patient charts from chiropractors in six US regions to determine the appropriateness of manipulation for each patient.

Results.
Of 125 chiropractors sampled, 89 provided charts that could be abstracted. Of the 2128 charts received, 1054 were abstracted. Charts received but not abstracted included 460 that were unusable (e.g., illegible), and 555 did not have CLBP or CNP. Across the abstracted charts 72% had CLBP, 57% had CNP, and 29% had both; 84% of patients with CLBP and 86% with CNP received manipulation. Patients with CLBP who had minor neurologic findings, sciatic nerve irritation, or no joint dysfunction were significantly less likely to receive manipulation. Patients with CNP who had substantial trauma etiology, no joint dysfunction, or no radiographs were significantly less likely to receive manipulation. Most manipulation for CLBP (64%) was appropriate and most manipulation for CNP (93%) was for patients where appropriateness was uncertain or equivocal. The proportions of patients receiving inappropriate manipulation for either condition were low (1%–3%) as were the numbers of patients presenting to these chiropractors for which manipulation was inappropriate.

Conclusion.
Chiropractors in this US sample tend to provide manipulation to very few patients with CLBP or CNP for which it is inappropriate. However, more research is needed to determine which patients with CNP benefit from manipulation.

Level of Evidence: 4
The Rare Occurrence of Reoperation After Cervical Laminoplasty
Authors: Barkley Ariana S. , Eaton Jessica , Carroll Kate , Sullivan Liam T. , Zhang Fangyi , Ravanpay Ali 
Published: February 2021

Study Design:
Retrospective cohort study.

Objective:
To determine the rate of recurrent or adjacent-level stenosis requiring reoperation after single-door cervical laminoplasty for spondylotic myelopathy at our institution.

Summary of Background Data:
Adjacent-level stenosis requiring reoperation is a commonly evaluated condition for anterior or posterior arthrodesis, however, there are few studies that evaluate adjacent-level stenosis in the case of cervical laminoplasty.

Methods:
Retrospective review of adults undergoing cervical laminoplasty for spondylotic myelopathy between January 2005 and May 2018 at our institution. Demographics, symptom duration, stenotic levels, preoperative and postoperative Medical Research Council motor, American Spinal Injury Association, modified Japanese Orthopaedic Association scores, and Nurick grade were obtained. Postoperative data included presence of C5 palsy, infection rate, alleviation or persistence of symptoms, and rate of recurrent or adjacent-level stenosis.

Results:
A total of 102 patients underwent cervical laminoplasty; mean age was 56.7 years (±12.96). Most were men (n=76, 74.5%), with myelopathy (n=64, 63.4%), C4 (n=94, 93.1%), and C5 (n=92, 91.1%) cervical stenosis; mean symptom duration was 55 days (7 d to 2.8 y). Average follow-up was 6.4 months (±3.4). After surgery, there was statistically significant improvement in Nurick grade (3.1±2.2 vs. 2.7±2.4, P=0.002) and modified Japanese Orthopaedic Association score (11.4±3.7 vs. 13.9±3.6, P<0.001); American Spinal Injury Association scores also improved (P<0.001). Rate of postoperative C5 palsy was 7.8% (n=8); postoperative infection rate was 1.96% (n=2). Reoperation rate was 4.9% (n=5); reoperation for recurrent or adjacent-level stenosis was 1.96% (n=2).

Conclusions:
Recurrent or adjacent-level stenosis requiring reoperation after cervical laminoplasty is rare. Longitudinal studies are needed to verify correlation between motion preservation and incidence of adjacent or recurrent stenosis.

Level of Evidence:
Level III—treatment benefits: nonrandomized controlled cohort/follow-up study.
Exaggerated Microvascular Vasodilating Responses in Cirrhotic Patients With Septic Shock*
Authors: Hariri Geoffroy , Urbina Tomas , Lavillegrand Jean-Rémi , Gasperment Maxime , Mazerand Sandie , Abdelmalek Abdelkrim , Bigé Naïke , Baudel Jean-Luc , Guidet Bertrand , Maury Eric , Ait-Oufella Hafid 
Published: February 2021

OBJECTIVES:
Cirrhosis is associated with hemodynamic and vascular disorders. However, microvascular reactivity of cirrhotic patients in the context of sepsis has poorly been investigated.

DESIGN:
Prospective observational study.

SETTING:
Medical ICU in a tertiary teaching hospital.

PATIENTS:
We prospectively included adult patients admitted in the ICU for septic shock with and without cirrhosis. After initial resuscitation, global hemodynamic parameters were recorded and skin microvascular reactivity to local acetylcholine iontophoresis was measured.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Thirty patients with septic shock were included (60% male), 10 with cirrhosis and 20 without, with a median age of 61 years (54–74 yr). Cirrhotic patients were mainly classed as Child-Pugh C (80%) and all of them had ascites. Sequential Organ Failure Assessment score and ICU mortality of cirrhotic patients were higher than the noncirrhotic patients, respectively (6.5 [5.0–8.3] vs 11.5 [9.0–14.0]; p < 0.01; 15% vs 70%; p < 0.01). Peripheral tissue perfusion and global hemodynamic parameters were not different between the cirrhotic and noncirrhotic patients but arterial lactate level was three times higher in patients with cirrhosis (6.0 mmol/L [3.9–8.0 mmol/L] vs 2.0 mmol/L [0.9–3.5 mmol/L]; p < 0.01). Basal skin microvascular blood flow was not statistically different between the groups (4.94 perfusion units [3.45–8.73 perfusion units] vs 6.95 perfusion units [5.24–8.38 perfusion units]; p = 0.29). After acetylcholine simulation, skin microvascular blood flow increased more in cirrhotic patients than in noncirrhotic patients (644% [217–966%] vs 169% [73–505%], p = 0.03). Global microvascular reactivity was seven times higher in cirrhotic patients (area under the curve, 16,412 perfusion units [13,898–19,041 perfusion units] vs 2,664 perfusion units [969–4,604 perfusion units]; p < 0.001).

CONCLUSIONS:
We identified an exaggerated vasodilating microvascular response in cirrhotic patients with septic shock. Such a result may explain vasopressor resistance and paves the way for future therapeutic trials, targeting nitric oxide pathway specifically in this population.
Safety and Efficacy of Human Chorionic Gonadotropin Hormone-Derivative EA-230 in Cardiac Surgery Patients: A Randomized Double-Blind Placebo-Controlled Study
Authors: van Groenendael Roger , Beunders Remi , Hemelaar Pleun , Hofland Jan , Morshuis Wim J. , van der Hoeven Johannes G. , Gerretsen Jelle , Wensvoort Gert , Kooistra Emma J. , Claassen Wout J. , Waanders Denise , Lamberts Maud G. A. , Buijsse Leonie S. E. , Kox Matthijs , van Eijk Lucas T. , Pickkers Peter 
Published: February 2021

OBJECTIVES:
To determine the safety and efficacy of human chorionic gonadotropin hormone-derivative EA-230 in cardiac surgery patients. Cardiac surgery induces systemic inflammation and may impair renal function, affecting patient outcome. EA-230 exerted immunomodulatory and renoprotective effects in preclinical models and was safe and showed efficacy in phase I and II human studies.

DESIGN:
Double-blinded, placebo-controlled, randomized study.

SETTING:
Collaboration of the Cardiothoracic Surgery, Anesthesiology, and the Intensive Care departments of a tertiary hospital in the Netherlands.

PATIENTS:
One hundred eighty patients undergoing an on-pump coronary artery bypass procedure with or without concomitant valve surgery.

INTERVENTIONS:
Ninety mg/kg/hr EA-230 or placebo administered during surgery.

MEASUREMENTS AND MAIN RESULTS:
During the study, no safety concerns emerged. EA-230 did not modulate interleukin-6 plasma concentrations (area under the curve 2,730 pg/mL × hr [1,968–3,760] vs 2,680 pg/mL × hr [2,090–3,570] for EA-230 and placebo group, respectively; p = 0.80). Glomerular filtration rate increased following surgery (mean ± sem increase in the EA-230 vs placebo groups: glomerular filtration rateiohexol measured using iohexol plasma clearance: 19 ± 2 vs 16 ± 2 mL/min/1.73 m2; p = 0.13 and estimated glomerular filtration rate with the Modification of Diet in Renal Disease equation using creatinine: 6 ± 1 vs 2 ± 1 mL/min/1.73 m2; p = 0.01). The “injury” stage of the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease criteria for acute kidney injury was 7% in the EA-230 group versus 18% in the placebo group (p = 0.07). In addition, EA-230-treated patients had a less positive fluid balance compared with placebo-treated patients (217 ± 108 vs 605 ± 103 mL; p = 0.01), while the use of vasoactive agents was similar in both groups (p = 0.39). Finally, hospital length of stay was shorter in EA-230 treated patients (8 d [7–11] vs 10 d [8–12]; p = 0.001). Efficacy results were more pronounced in patients that had longer duration of surgery and thus longer duration of study drug infusion.

CONCLUSIONS:
EA-230 was safe in patients undergoing on-pump cardiac surgery. It did not modulate interleukin-6 plasma concentrations but appeared to exert beneficial renal and cardiovascular effects and shortened in-hospital length of stay.
Effects of Prone Positioning on Venous Return in Patients With Acute Respiratory Distress Syndrome*
Authors: Lai Christopher , Adda Imane , Teboul Jean-Louis , Persichini Romain , Gavelli Francesco , Guérin Laurent , Monnet Xavier 
Published: February 2021

OBJECTIVES:
To examine the effects of prone positioning on venous return and its determinants such as mean systemic pressure and venous return resistance in patients with acute respiratory distress syndrome.

DESIGN:
Prospective monocentric study.

SETTINGS:
A 25-bed medical ICU.

PATIENTS:
About 22 patients with mild-to-severe acute respiratory distress syndrome in whom prone positioning was decided.

INTERVENTIONS:
We obtained cardiac index, mean systemic pressure, and venous return resistance (the latter two estimated through the heart-lung interactions method) before and during prone positioning. Preload responsiveness was assessed at baseline using an end-expiratory occlusion test.

MEASUREMENTS AND MAIN RESULTS:
Prone positioning significantly increased mean systemic pressure (from 24 mm Hg [19–34 mm Hg] to 35 mm Hg [32–46 mm Hg]). This was partly due to the trunk lowering performed before prone positioning. In seven patients, prone positioning increased cardiac index greater than or equal to 15%. All were preload responsive. In these patients, prone positioning increased mean systemic pressure by 82% (76–95%), central venous pressure by 33% (21–59%), (mean systemic pressure – central venous pressure) gradient by 144% (83–215)%, while it increased venous return resistance by 71% (60–154%). In 15 patients, prone positioning did not increase cardiac index greater than or equal to 15%. In these patients, prone positioning increased mean systemic pressure by 28% (18–56%) (p < 0.05 vs. patients with significant increase in cardiac index), central venous pressure by 21% (7–54%), (mean systemic pressure – central venous pressure) gradient by 28% (23–86%), and venous return resistance by 37% (17–77%). Eleven of these 15 patients were preload unresponsive.

CONCLUSIONS:
Prone positioning increased mean systemic pressure in all patients. The resulting change in cardiac index depended on the extent of increase in (mean systemic pressure – central venous pressure) gradient, of preload responsiveness, and of the increase in venous return resistance. Cardiac index increased only in preload-responsive patients if the increase in venous return resistance was lower than the increase in the (mean systemic pressure –central venous pressure) gradient.