bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dexamethasone for the treatment of established postoperative nausea and vomiting
Authors: Czarnetzki Christoph , Albrecht Eric , Desmeules Jules , Kern Christian , Corpataux Jean-Baptiste , Gander Sylvain , van Kuijk Sander M.J. , Tramèr Martin R. 
Published: November 2021

BACKGROUND
Dexamethasone is widely used for the prevention of postoperative nausea and vomiting (PONV) but little is known about its efficacy for the treatment of established PONV.

OBJECTIVE
To test the antiemetic efficacy of intravenous dexamethasone for the treatment of established PONV in adults undergoing surgery under general anaesthesia and to determine whether there is dose-responsiveness.

DESIGN
The DexPonv trial is a multicentre, placebo-controlled, randomised, double-blind, dose-finding study. Inclusion of patients was between September 2012 and November 2017. Follow-up for PONV symptoms was for 24 h. Thirty days postoperatively, patients were contacted by study nurses for any information on postoperative bleeding and infection.

SETTING
Four public hospitals in Switzerland.

PATIENTS
A total of 803 adults scheduled for elective surgery without any antiemetic prophylaxis signed the consent form; 714 were included. Among those, 319 had PONV and 281 patients were eventually randomised (intention to treat population and safety set). The per protocol set consisted of 260 patients.

INTERVENTIONS
Patients with PONV symptoms (including retching) were randomised to a single intravenous dose of dexamethasone 3, 6 or 12 mg or matching placebo.

MAIN OUTCOME MEASURES
The primary endpoint was the absence of further nausea or vomiting (including retching), within 24 h after administration of the study drug.

RESULTS
Dexamethasone was ineffective during the first 24 h, whatever the dosage, compared to placebo, even when the model was adjusted for known risk factors (P = 0.170). There were no differences in the time to treatment failure or the quality of sleep during the first night. There was a positive correlation between the dose of dexamethasone and blood glucose concentrations (P < 0.001), but not with bleeding risk, wound infections or other adverse effects.

CONCLUSION
This randomised trial failed to show anti-emetic efficacy of any of the tested intravenous regimens of dexamethasone for the treatment of established PONV in adults undergoing surgery under general anaesthesia.

TRIAL REGISTRATION
clinicaltrials.gov (NCT01975727).
Peri-interventional outcome study in the elderly in Europe
Authors:   POSE-Study group∗
Published: November 2021

OBJECTIVES
The aim of this study was to describe the 30-day mortality rate of patients aged 80 years and older undergoing surgical and nonsurgical procedures under anaesthesia in Europe and to identify risk factors associated with mortality.

DESIGN
A prospective cohort study.

SETTING
European multicentre study, performed from October 2017 to December 2018. Centres committed to a 30-day recruitment period within the study period.

PATIENTS
Nine thousand four hundred and ninety-seven consecutively recruited patients aged 80 years and older undergoing any kind of surgical or nonsurgical procedures under anaesthesia.

MAIN OUTCOME MEASURES
The primary outcome was all-cause mortality within 30 days after procedure described by Kaplan–Meier curves with 95% CI. Risk factors for 30-day mortality were analysed using a Cox regression model with 14 fixed effects and a random centre effect.

RESULTS
Data for 9497 patients (median age, 83.0 years; 52.8% women) from 177 academic and nonacademic hospitals in 20 countries were analysed. Patients presented with multimorbidity (77%), frailty (14%) and at least partial functional dependence (38%). The estimated 30-day mortality rate was 4.2% (95% CI 3.8 to 4.7). Among others, independent risk factors for 30-day mortality were multimorbidity, hazard ratio 1.87 (95% CI 1.26 to 2.78), frailty, hazard ratio 2.63 (95% CI 2.10 to 3.30), and limited mobility, hazard ratio 2.19 (95% CI 1.24 to 3.86). The majority of deaths (76%) occurred in hospital. Mortality risk for unplanned ICU admission was higher, hazard ratio 3.57 (95% CI 2.38 to 5.26) than for planned ICU admission, hazard ratio 1.92 (95% CI 1.47 to 2.50). Compared with other studies, the in-hospital complication rates of 17.4 and 3.9% after discharge were low. Admission to a unit with geriatric care within 30 days after the intervention was associated with a better survival within the first 10 days.

CONCLUSIONS
The estimated 30-day mortality rate of 4.2% was lower than expected in this vulnerable population.

TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03152734, https://clinicaltrials.gov.
Adverse drug reactions to herbal medicines
Authors: Routledge Philip A. , Bracchi Robert 
Published: November 2021

Summary
Herbal medicines may cause adverse drug reactions (ADRs) due to effects of known constituent(s), substitution with other herbal ingredients, or contamination or adulteration with additional substances. Healthcare professionals (HCPs) should always take a full medicines history, including use of herbal medicines and other complementary products (e.g., food supplements and other dietary supplements).
A range of resources are available to inform HCPs and the public/patients/ carers about possible ADRs associated with herbal medicines. HCPs and the public/patients also need to be made aware of the importance of reporting suspected ADRs to the appropriate regulatory agency. Good safety surveillance systems can thus help to ensure that those who choose to take herbal medicines are able to do so with acceptable safety.
Barriers and Facilitators in the Clinical Implementation of Beta-Lactam Therapeutic Drug Monitoring in Critically Ill Patients: A Critical Review
Authors: Abdulla Alan , van den Broek Puck , Ewoldt Tim M. J. , Muller Anouk E. , Endeman Henrik , Koch Birgit C. P. 
Published: November 2021

Background:
With increasing knowledge of beta-lactam pharmacodynamics and interpatient and intrapatient variability in pharmacokinetics, the usefulness of therapeutic drug monitoring (TDM) is becoming increasingly clear. However, little research has been conducted to identify potential barriers and facilitators in the clinical implementation of beta-lactam TDM. This study provides an overview of the current practices of beta-lactam TDM and barriers and facilitators in its implementation.

Methods:
A systematic search was conducted using the Ovid MEDLINE database in April 2021, without restrictions on the publication date. All studies reporting the implementation of beta-lactam antibiotic TDM in critically ill patients through questionnaires or surveys were included in this review.

Results:
Six eligible studies were identified from 215 records, all of which were cross-sectional. All studies identified barriers and facilitators in the implementation of beta-lactam TDM in critically ill patients. The main barriers were insufficient knowledge about various aspects regarding the implementation of beta-lactam TDM and the unavailability of assays. Furthermore, a delay in the acquisition of TDM results reduces the probability of physicians altering drug dosages. Finally, doubts about the cost-effectiveness and clinical effectiveness of beta-lactam TDM in critically ill patients hinder broad implementation. Moreover, to improve the willingness of physicians to use beta-lactam TDM, collaboration between physicians and clinical pharmacists and clinical microbiologists should be strengthened.

Conclusions:
Although the evidence for application of beta-lactam TDM continues to grow, its clinical implementation remains limited. To enable optimal implementation of these antibiotics in critically ill patients, several barriers need to be overcome regarding logistics, equipment availability, clinical evidence, and proof of cost-effectiveness.
“Elimination of Hepatitis by 2030”: Present Realities and Future Projections
Authors: Akbar Sheikh Mohammad Fazle , AL-Mahtab Mamun , Khan Sakirul , Yoshida Osamu , Hiasa Yoichi 
Published: November 2021

Abstract
Each year, viral hepatitis and its complications affect millions of patients and cause one-and-a-half million deaths. To deal with this immense public health burden, international organizations have, as part of their sustainable development goals, set up the plan “Elimination of Hepatitis by 2030,” which has been ratified by most countries. The plan's aims include the prevention of different hepatitis viruses and the treatment of existing patients. However, a mid-term analysis revealed that lest novel maneuvers are adopted, some of the plan's objectives may not be attained. While new infections seem to be contained by vaccines and other public health measures, the persistent reservoir of chronic hepatitis viruses –hepatitis B virus (HBV) and hepatitis C virus (HCV) – may not be properly addressed. Although antiviral therapy against chronic HCV infection is promising, chronic-HBV-infected persons may not be properly handled. There are about 296 million chronic hepatitis B (CHB) patients in the world, and only 10% of them are aware of their infection. Thus, the undetected CHB patients should be found, and a proper approach should be devised to address this issue, especially in developing countries that harbor the main bulk of CHB patients. In addition, there is no finite therapy for CHB patients, and the safety and efficacy of the existing drugs are also questionable. This indicates the need for novel drugs for CHB patients. In light of this, this study aimed to offer measures that could discover the millions of undetected patients and address the need for developing innovative drugs for CHB patients and thus substantiate the “Elimination of Hepatitis by 2030” plan.
Evidence for engagement of the nucleus of the solitary tract in processing intestinal chemonociceptive input irrespective of conscious pain response in healthy humans
Authors: Beckers Abraham B. , van Oudenhove Lukas , Weerts Zsa Zsa R.M. , Jacobs Heidi I.L. , Priovoulos Nikos , Poser Benedikt A. , Ivanov Dimo , Gholamrezaei Ali , Aziz Qasim , Elsenbruch Sigrid , Masclee Ad A.M. , Keszthelyi Daniel 
Published: November 2021

Abstract
Neuroimaging studies have revealed important pathomechanisms related to disorders of brain–gut interactions, such as irritable bowel syndrome and functional dyspepsia. More detailed investigations aimed at neural processing in the brainstem, including the key relay station of the nucleus of the solitary tract (NTS), have hitherto been hampered by technical shortcomings. To ascertain these processes in more detail, we used multiecho multiband 7T functional magnetic resonance imaging and a novel translational experimental model based on a nutrient-derived intestinal chemonociceptive stimulus. In a randomized cross-over fashion, subjects received duodenal infusion of capsaicin (the pungent principle in red peppers) and placebo (saline). During infusion, functional magnetic resonance imaging data and concomitant symptom ratings were acquired. Of 26 healthy female volunteers included, 18 were included in the final analysis. Significantly increased brain activation over time during capsaicin infusion, as compared with placebo, was observed in brain regions implicated in pain processing, in particular the NTS. Brain activation in the thalamus, cingulate cortex, and insula was more pronounced in subjects who reported abdominal pain (visual analogue scale > 10 mm), as compared with subjects who experienced no pain. On the contrary, activations at the level of the NTS were independent of subjective pain ratings. The current experimental paradigm therefore allowed us to demonstrate activation of the principal relay station for visceral afferents in the brainstem, the NTS, which was engaged irrespective of the conscious pain response. These findings contribute to understanding the fundamental mechanism necessary for developing novel therapies aimed at correcting disturbances in visceral afferent pain processing.
Design and Production of Low-Cost 3D-Printed Transtibial Prosthetic Sockets
Authors: van der Stelt Merel , Verhulst Arico , Slump Cornelis H. , Papenburg Marco , Grobusch Martin P. , Brouwers Lars , Maal Thomas J.J. 
Published: November 2021

ABSTRACT

Introduction
Only 5% to 15% of individuals with amputation living in low- and middle-income countries (LMICs) have access to proper prostheses. Mainly, prosthetic costs are too high, and facilities are not within reach. Measurement and production of traditional prosthetic sockets are time-consuming, labor-intensive, and highly dependent on the experience and skills of the personnel involved.

Materials and Methods
This report describes the workflow to produce low-cost patella tendon bearing transtibial prosthetic sockets. Using computer-aided design (CAD) and computer-aided manufacturing (CAM), transtibial prostheses can be easily produced in rural areas. The size of the residual limb was scanned with a handheld 3D-scanner (Einscanner Pro Plus), and the sockets were printed using fused filament fabrication (FFF) with an Ultimaker S5. The foot was made locally, and the other prosthetic parts were imported. The 3D-printed socket costs US $20 (excluding value-added tax [VAT]). The total material cost of the prosthesis, including the other prosthetic materials, amounts to approximately US $100 (excluding VAT). Assuming the asset cost of the devices, the costs of one local employee, overhead expenses, a profit margin, and the VAT included, a 3D-printed prosthesis could be sold for US $170.

Conclusions
This report provides a blueprint to produce low-cost 3D-printed transtibial prosthetic sockets. Further research will be conducted to replace the imported prosthetic parts for local products and to automatize the digital design process.

Clinical Relevance
With this workflow, prosthetic sockets can be produced consistently, which makes it a suitable method in LMICs.
Classification of Muscle Inertial Motion and Electromyographic Activity Integration to Improve Accuracy in Pattern Recognition
Authors: Arantes Ana Paula Bittar Britto , Bressan Nadja 
Published: November 2021

ABSTRACT

Introduction
Over the years, several studies have been published reporting the use of distinct sources of information used for pattern recognition that can be translated into commands to control human-machine interface system, for example, electromyography (EMG), pressure sensors, and accelerometers. Studies using muscle motion patterns and its combination with EMG in the context of pattern recognition for evaluation of the muscles and human-machine interface system in able-bodied individuals and limb-absent subjects are scarce.

Material and Methods
In this context, this research presents the assessment of the classification of patterns formed by features extracted from both muscle motion and electromyographic signals. Data sets were collected from both arms of five unilateral transradial limb-absent subjects and seven able-bodied subjects in the control group. The features from the EMG and the muscle motion such as amplitude, frequency, predictability, and variability of the signals were estimated.

Results
The results were presented in terms of the sensitivity, specificity, precision, and accuracy of the classifier. The combination of both measurements, EMG and muscle motion, defined the six basic movements for limb-absent subjects within an accuracy of 98% ± 1% for the sound forearm against 96% ± 4% for the amputated forearm.

Conclusions
For future work, it is expected that the strategy of classification and the combination of inertial and electromyographic activity will be used in actual scenarios for the controlling of artificial limbs and other applications related to human-machine interaction.

Clinical Relevance
The use of inertial sensors may increase the usability and accuracy of systems used for diagnosing, training, therapy, or controlling devices such as orthoses and prostheses.
Impact of Vulvar Cancer Surgery on Quality of Sex Life: A Review of Literature
Authors: Zeitoun Jeremie , Calvary Marjolaine , Bonneau Claire , Rouzier Roman 
Published: November 2021

Objectives
Vulvar cancer is a gynecological cancer for which posttreatment morbidity must be known to propose the appropriate medical strategy. The objectives of this article were to review and to summarize the available studies evaluating the impact of vulvar surgery on the quality of sex life.

Materials and Methods
We searched MEDLINE abstracts (source PubMed) and included all studies published between 1990 and 2020 that evaluated the impact of vulvar surgery on the patients’ sex life. Articles were selected in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. We evaluated the quality of the studies using the “study quality assessment tools” established by the National Heart Lung and Blood Institute and the health-related quality-of-life score. Summary statistics were used to report the results of the studies selected.

Results
A total of 41 articles were screened, and 15 studies were included in this review. Two questionnaires, that is, European Organization for Research and Treatment of Cancer QLC C30 and Female Sexual Function Index, were used in 60% of the studies. The quality of the studies was heterogeneous. None of them had a high level of evidence. Eleven of the 16 studies reported an impairment of quality of sex life, mainly related to the size of the initial lesion and the type of surgery performed. Preoperative sexual status, that is, active sex life, age, and morbidity seemed to be important factors.

Conclusions
None of the studies had a high level of evidence, and their methodological quality was heterogeneous. More powerful studies using validated questionnaires are necessary. Because this is essential surgery, patients should be informed that if it impacts their sexual life, management strategies will be part of their postoperative care.
Neglected analytes in the 24-h urine: ammonium and sulfate
Authors: Asplin John R. 
Published: November 2021

Purpose of review
Evaluation of the kidney stone patient includes measurement of 24 h urine chemistries. This review summarizes the application of physiologic principles to the interpretation of urine chemistries, using sulfate and ammonium to estimate diet acid load, and the renal response.

Recent findings
There has been increased recognition of the need to measure urine ammonium excretion in the clinical setting in order to understand renal acid excretion. Some 24 h urine kidney stone panels include ammonium measurements, providing an opportunity to apply this measurement to clinical practice. In order to better interpret ammonium excretion, one needs an estimate of dietary acid load to understand the driving forces for ammonium excretion. Sulfate is also included in some kidney stone panels and functions as an estimate of diet acid load. Combining these analytes with urine pH, the clinician can quickly estimate dietary stone risk as well as potential bowel disease, acidification disorders, and the presence of urease producing bacteria; all of which can affect stone risk.

Summary
Measurement of ammonium and sulfate excretion along with urine pH provide important insights into the acid/alkali content of diet, presence and severity of bowel disease, presence of renal acidification disorders, and urinary infection.
Cardiovascular risk stratification in the noncardiac solid organ transplant candidate
Authors: Truby Lauren K. , Mentz Robert J. , Agarwal Richa 
Published: November 2021

Purpose of review
Solid organ transplantation (SOT) has become a widely accepted therapy for end-stage disease across the spectrum of thoracic and abdominal organs. With contemporary advances in medical and surgical therapies in transplantation, candidates for SOT are increasingly older with a larger burden of comorbidities, including cardiovascular disease (CVD). CVD, in particular, is a leading cause of morbidity and mortality in SOT candidates with end-stage disease of noncardiac organs [1].

Recent findings
Identification of coronary artery disease (CAD), heart failure, and valvular disease are important in noncardiac SOT to ensure both appropriate peri-transplant management and equitable organ allocation. Although the American College of Cardiology (ACC) and the American Heart Association (AHA) have published guidelines and recommendations for the perioperative cardiovascular evaluation of patients undergoing noncardiac surgery, the implications of both symptomatic and asymptomatic CVD differ in patients with end-stage organ failure being considered for SOT when compared to the general population.

Summary
Herein, we review the epidemiology, diagnosis, and evidence for the management of CVD in kidney and liver transplantation, combining current guidelines from the 2012 ACC/AHA scientific statement on cardiac disease evaluation in SOT with more contemporary evidenced-based algorithms.
Adolescent Male Receptivity of and Preferences for Sexual Health Interventions in the Emergency Department
Authors: Chernick Lauren S. , Wallace Brendan K. , Potkin Maxmoore T. , Bell David L. , Dayan Peter S. 
Published: November 2021

Objective
Male adolescents frequently present to the emergency department (ED) and many participate in behaviors increasing their risk of sexually transmitted infections and unintended pregnancies. Although the ED visit may represent an intervention opportunity, how best to design and deliver a sexual health intervention matching the preferences of adolescent male users is unclear. Our objective was to explore receptivity to and preferences for sexual health interventions among adolescent male ED patients.

Methods
In this qualitative study, we asked sexually active male ED patients aged 14 to 21 years about their attitudes toward ED-based sexual health interventions and preferences for intervention modalities. Participants interacted with an early prototype of a digital intervention to gather specific feedback. Enrollment continued until saturation of key themes. Interviews were recorded, transcribed, and coded based on thematic analysis using NVivo.

Results
Participants (n = 42) were predominantly 18 to 21 years (63%) and Hispanic (79%). Although most (71%) had sex in the prior 3 months, 45% did not use a condom at last intercourse and 17% had impregnated a partner. Participants viewed the ED visit as unused time without distracting influences, suitable for educational sexual health interventions. They considered ED-based digital interventions a reliable and confidential source of information. Engaging interventions allowed user control and provided novel and relatable content.

Conclusions
Adolescent male ED patients are receptive to ED-based digital sexual health interventions. These identified preferences should be considered when designing future user-informed sexual health interventions for the ED setting.