bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utilizing Frequency and Severity of Injury to Identify Injury Prevention Priorities in the Community
Authors: Budd Matthew , Hofman Nancy , Corpron Cyndy 
Published: January 2021

Background
Trauma centers are charged with identifying injury prevention priorities in the community. Hospitals frequently use system and regional injury data based on frequency of injury mechanisms to establish injury prevention priorities.

Objective
This study was conducted to provide insight into how the Injury Prevention Priority Score (IPPS) can be utilized to prioritize injury prevention activities with considerations of both frequency and severity of injury.

Methods:
This descriptive study utilizes a retrospective review of 6,824 patients 15 years and older at one Level I trauma center between July 1, 2014, and June 30, 2019. A previously described and validated IPPS was calculated for injury mechanisms to compare the overall trauma burden for each cause. The IPPS is presented as a T-score with a mean of 50 and a standard deviation of 10.

Results:
In this sample, most injuries (57.1%) occur to those 65 years or older, and the most common injuries are from a fall (66.5%) or were from a motor vehicle occupant (13.3%). The fall group had an average severity of injury, but the frequency was five times higher than the next highest group. The pedestrian and firearm groups had the highest severity, and their IPPSs were the second and third highest.

Conclusions
Injury priorities should not be based on frequency of injury alone. Use of the IPPS provides additional objective data regarding injury prevention priorities in the community. The IPPS has most commonly been used to evaluate pediatric injury prevention needs but effectively evaluates injury prevention needs throughout the lifespan.
Driving high-functioning clinical teams: An advanced practice registered nurse and physician assistant optimization initiative
Authors: Brooks Paula B. , Fulton Megan E. 
Published: January 2021

ABSTRACT

Background:
Rapid changes in the health care marketplace are driving health care systems to modify operations by which the advanced practice registered nurse (APRN) and physician assistant (PA) clinicians serve patients. By identifying more effective and efficient utilization workflows, organizations can meet these demands resulting in high-functioning clinical teams.

Local problem:
With the growing number of APRNs and PAs within a large academic medical center, there was a recognized need to establish effective and efficient utilization practices for these health care providers.

Methods:
Directors of the Advanced Practice Provider Best Practice Center developed an internal nurse practitioner (NP)/certified nurse midwife (CNM)/clinical nurse specialist (CNS)/PA assessment service in which evaluations were conducted to optimize APRN and PA practice at the clinical/department level. This assessment excluded certified registered nurse anesthetists.

Interventions:
Thirty-two clinical areas were evaluated between September 2016 and May 2019. This included an NP/CNM/CNS/PA survey and over 200 individual NP/CNM/CNS and PA provider interviews. Assessments addressed utilization, billing practices, professional development, and communication among team members.

Results:
Qualitative and quantitative reports were compiled. Many common themes were identified. These were broken down into three major categories: productivity, clinical operations, and professional development/support.

Conclusions:
Several recommendations were presented to department leaders regarding NP/CNM/CNS/PA practice. Those departments who implemented several of the recommendations showed positive outcomes. This was evidenced by increased financial gain (increased relative value units, increase in revenue generated), increased patient access (increased clinic densities), and overall NP/CNM/CNS/PA satisfaction.
Low Thyroid-stimulating Hormone Levels Are Associated With Annoying Tinnitus in Adult Women: Korea National Health and Nutrition Examination Surveys
Authors: Kim So Young , Min Chanyang , Kim Hyung-Jong , Choi Hyo Geun 
Published: January 2021

Objective:
This study aimed to investigate the relationship between thyroid function and tinnitus.

Study Design:
A cross-sectional study.

Setting:
The Korean National Health and Nutrition Examination Survey from 2013 was used.

Patients and Interventions:
A total of 1,165 participants ≥ 40 years old who were surveyed for the presence of tinnitus and underwent thyroid function tests were included. The presence of discomfort from tinnitus was defined as annoying tinnitus. The control group included participants with “no tinnitus” or “no discomfort from tinnitus.” The participants were divided into the annoying tinnitus group and the control group.

Main Outcome Measures:
The associations of free thyroxine and thyroid-stimulating hormone (TSH) with annoying tinnitus were analyzed using logistic regression with complex sampling methods. Subgroup analyses were performed according to sex.

Results:
The low TSH level group had 2.35-fold greater odds of annoying tinnitus than the control group (95% confidence interval  = 1.10–5.12, p = 0.027). Even in patients with a normal free thyroxine level, a low TSH level was related to 2.78-fold higher odds of annoying tinnitus (95% confidence interval  = 1.21–6.38, p = 0.016). In subgroup analyses, this association was apparent in the female subgroup. The male subgroup did not show a relationship between low TSH levels and annoying tinnitus.

Conclusions:
Subclinical hyperthyroidism was related to an increased risk of annoying tinnitus. This relationship was apparent in the female subgroup.
Epinephrine for cardiac arrest: knowns, unknowns and controversies
Authors: Soar Jasmeet 
Published: January 2021

Purpose of review
The aim of this study was to describe our knowledge about the use of epinephrine in cardiac arrest and discuss the unknowns and current controversies.

Recent findings
A recent large, well conducted, double-blind, randomized placebo-controlled trial of over 8000 patients with out-of-hospital cardiac arrest (PARAMEDIC-2) showed that epinephrine increased return of spontaneous circulation and survival to hospital discharge. The trial's secondary outcomes have raised concerns that epinephrine increases the number of brain damaged survivors. Systematic review and meta-analysis suggest that epinephrine has more pronounced effects for nonshockable rhythms, when given early, and probably increases the number of both good and poor survivors. There remains uncertainty about the optimal use of epinephrine in terms of patient groups, rhythms, dose and timing.

Summary
Epinephrine still has a role in the treatment of cardiac arrest; the best way to use epinephrine remains uncertain.
COVID-19: a new burden of respiratory disease among South African miners?
Authors: Naidoo Rajen N. , Jeebhay Mohamed F. 
Published: January 2021

Purpose of review
Mineworkers in South Africa experience a triple burden of disease due to their distinct work experience. Silicosis increases their risk of tuberculosis (TB), exacerbated by the HIV epidemic. Work-related factors are likely to increase transmission, severity, and post infection sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Understanding these relationships is important to control the impact of the epidemic.

Recent findings
SARS-CoV-2 infection rates among mineworkers exceed the population rates in the provinces in which those mines are located. Migrant work, living in crowded hostels, working in narrow poorly ventilated shafts mainly underground constitute important factors that increase transmission risk. Mineworkers continue to experience high levels of silica exposure. The prevalences of silicosis, HIV and pulmonary TB, remain high. Interstitial lung disease, pulmonary TB, and HIV have all been associated with poorer outcomes of SARS-CoV-2 infections. Mineworkers with post infection respiratory sequelae are likely to lose their jobs or lose income, due to the physically demanding nature of underground minework.

Summary
Further research into the unique work-related risk factors in mining that influence the COVID-19 epidemic is crucial for optimizing current interventions. Reducing SARS-CoV-2 infection transmission, health monitoring of infected and vulnerable workers, and following up of postinfection outcomes is essential to protect the respiratory health of miners.
New guidelines for severe community-acquired pneumonia
Authors: Martin-Loeches Ignacio , Torres Antoni 
Published: January 2021

Purpose of review
We highlight the recent advances in the guidelines for treating patients with severe community-acquired pneumonia (sCAP).

Recent findings
sCAP is a significant cause of hospital admissions. We performed an extensive review of the literature, covering studies from the last several years, to summarise the most important points in the diagnosis and treatment of patients hospitalised with sCAP.

Summary
sCAP is associated with a high clinical burden. Therefore, deep knowledge is necessary for its management. In general, diagnosis, treatment and management are based on many published guidelines. However, the mortality rate is still unacceptably high, indicating the need for clear recommendations in the management of patients with sCAP. The choice of empirical antibiotic therapy for sCAP depends on multiple factors, such as national and local antimicrobial susceptibility data and the characteristics of the patients, including their risk factors for acquiring infections caused by multidrug-resistant pathogens. Currently, there are several published international guidelines. The aim of this review is to explore the areas that require further knowledge and new recommendations for current clinical practice.
Impact of laparoscopic cholecystectomy on the complexity of endoscopic retrograde cholangiopancreatography
Authors: Seleem Waseem M. , Hanafy Amr S. , Abd-Elsalam Sherief , Badawi Rehab 
Published: January 2021

Background and objectives
A scarce number of researches discussed the impact of cholecystectomies on the anatomy of common bile duct (CBD) and intern if this will affect the difficulty of endoscopic retrograde cholangiopancreatography (ERCP). The objective of present study was to assess the impact of complicated cholecystectomy on the complexity and safety of the ERCP procedure

Study design
A total of 100 patients were enrolled after meeting the following inclusion criteria – study group (group A): 50 patients with previous history of complicated laparoscopic cholecystectomy and control group (group B): 50 patients with previous noncomplicated laparoscopic cholecystectomy. ERCP was performed and complexity was judged by a number of cannulation attempts, ERCP time, pancreatic cannulation and post-ERCP pancreatitis.

Results
The study revealed prolonged ERCP procedure duration in noncomplicated cholecystectomy (24.2 ± 8.5 min) and it was significantly more prolonged in complicated cholecystectomy (39.6 ± 10.7 min; P = 0.03). The trials of cannulation attempts were significantly higher in the study group with complicated cholecystectomy (P = 0.009). Pancreatic duct cannulation was frequently higher in the complicated cholecystectomy group (P = 0.03). Difficult or failed stone extraction was significantly prevalent in the complicated cholecystectomy group and the occurrence of post-ERCP pancreatitis (PEP) was significantly higher than the control group.

Conclusion
ERCP after complicated laparoscopic cholecystectomy is more complex with increased duration liability of complications.
Real-world clinical and endoscopic outcomes after one year tofacitinib treatment in ulcerative colitis
Authors: Straatmijer Tessa , van Gennep Sara , Duijvestein Marjolijn , Ponsioen Cyriel I.J. , Gecse Krisztina B. , D’Haens Geert R. , Löwenberg Mark 
Published: January 2021

Objective
Tofacitinib, an oral Janus kinase inhibitor, is approved for the treatment of moderate to severe ulcerative colitis (UC). We evaluated clinical and endoscopic efficacy, safety and drug survival of tofacitinib up to one year in a real-world cohort.

Methods
In this retrospective cohort study, 36 UC patients were included who received tofacitinib. The primary outcome was combined with steroid-free clinical remission [Simple Clinical Colitis Activity Index (SCCAI) ≤2] and endoscopic improvement (Mayo score ≤1) at 52 weeks. Secondary outcomes included clinical (SCCAI drop ≥3) and endoscopic response (Mayo score drop ≥1), biochemical remission [fecal calprotectin (FC) ≤150 mg/kg and C-reactive protein ≤5 mg/L), safety and drug survival.

Results
Median disease duration was 7 (3–14) years and 89 and 42% of patients failed prior anti-tumor necrosis factor (anti-TNF) and vedolizumab treatment, respectively. Combined corticosteroid-free clinical remission and endoscopic improvement were observed in 8/36 patients (22%), 6/35 (17%) and 12/31 (39%), at 16, 36 and 52 weeks, respectively. Corresponding combined clinical and endoscopic response rates were 15/36 (42%), 12/35 (34%), 15/31 (48%) and biochemical remission rates were 11/33 (33%), 10/32 (31%) and 10/29 (34%). Nine infections (two herpes zoster) led to dose reduction or (temporary) drug withdrawal. Permanent withdrawal occurred in 14/36 patients (33%) after a median duration of 9 (5–30) weeks. Drug survival at 1 year was 60%. Patients that failed anti-TNF were less likely to discontinue tofacitinib treatment early compared to patients without prior anti-TNF use (hazard ratio 0.20, 95% confidence interval 0.06–0.65).

Conclusion
In a refractory UC population, combined steroid-free clinical remission and endoscopic improvement were found in 39% of patients at 1 year.
The age, bilirubin and albumin (ABA) index: a novel noninvasive index for predicting liver fibrosis in patients with chronic hepatitis C infection
Authors: Yilmaz Baris , Kayadibi Huseyin , Yeniova Abdullah O. , Koseoglu Huseyin , Simsek Zahide 
Published: January 2021

Aim
It was to assess the diagnostic performance characteristics of a novel index, (ABA), which utilizes age, bilirubin and albumin to predict significant and severe fibrosis, and cirrhosis in patients with chronic hepatitis C infection.

Methods
A total of 114 patients were included in this study. The liver biopsies were graded using the Ishak scoring system. Diagnostic performance of the ABA index was compared to aspartate aminotransferase (AST) to alanine aminotransferase ratio, age platelet index, AST to platelet ratio index, γ-glutamyl transpeptidase (GGT) to platelet ratio index, FIB-4, FibroQ, Goteborg University Cirrhosis Index, King’s score, GGT/international normalization ratio, platelet to lymphocyte ratio, neutrophil to lymphocyte ratio, white blood cell to platelet distribution width ratio and mean platelet volume to platelet distribution width ratio (MPV/PDW) by receiver operating characteristics (ROC) curve analysis.

Results
The ABA index was formulated as 1.5 + (0.065 × age) + (1.85 × bilirubin) − (1.65 × albumin) according to the multivariate logistic regression analysis. According to the ROC curve analyses, the ABA index had the area under these ROC curves (AUROCs) of 0.805 [95% confidence interval (CI), 0.727–0.883] for significant fibrosis, 0.874 (95% CI, 0.804–0.943) for severe fibrosis and 0.895 (95% CI, 0.828–0.961) for cirrhosis.

Conclusion
The ABA index was found to be superior to other evaluated noninvasive indexes of liver fibrosis by use of the cutoff point of 0 and 1. These findings should be confirmed by prospective and multicenter studies in patients with chronic hepatitis C infection.
The Attitudes and Beliefs of Family Physicians Regarding the Use of Medical Cannabis, Knowledge of Side Effects, and Barriers to Use: A Comparison Between Residents and Specialists
Authors: Abo Ziad Ramzi , Grynbaum Mirta Beatriz , Peleg Roni , Treister-Goltzman Yulia 
Published: January 2021

Background:
Israel has a regulated system with clearly defined indications for treatment with medical cannabis.

Study Question:
The main question was whether family physicians in southern Israel face barriers/knowledge gaps in prescribing cannabis for medical indications. The secondary question was whether there was a difference between residents and specialists in family medicine.

Study Design:
A questionnaire-based cross-sectional study.

Measures and Outcomes:
Attitudes of the participating physicians on the use of medical cannabis; comparison of attitudes of specialists in family medicine and residents on the use of medical cannabis.

Results:
One hundred and fifty-two family physicians participated in the study including 48 residents. More than 78% supported the use of medical cannabis and about 63% supported it's legalization. About 84% of the physicians believed that medical cannabis helped cancer patients and 82% believed it helped in the chronic pain. Only 28.3% believed that family physicians should recommend the use of medical cannabis. The physicians were well aware of the psychiatric (82%) and the neurological (78%) adverse effects of medical cannabis. Most (68%) were not willing to prescribe medical cannabis. No socio-demographic characteristic was associated with willingness to prescribe cannabis. About 95% of the physicians believed that the main barrier to recommending treatment was its potential for abuse, 66% percent—the danger that it would leak to the general public. About 60% of the specialists were not prepared to undergoing training in the prescription of medical cannabis compared with 31% of the residents (P = 0.004).

Conclusions:
Family physicians are concerned about recommending medical cannabis. It is encouraging that residents are motivated to undergo training to prescribe medical cannabis. There remain medical indications and adverse effects that family physicians are less aware of. Further studies should focus on effective ways to improve the level of physicians' knowledge on the issue.
Regulation of vascular tone and blood pressure by singlet molecular oxygen in inflammation
Authors: Stanley Christopher P. , Stocker Roland 
Published: January 2021

Purpose of review
The principle aim of this review is to prompt vascular researchers interested in vascular inflammation and oxidative stress to consider singlet molecular oxygen (1O2) as a potentially relevant contributor. A secondary goal is to propose novel treatment strategies to address haemodynamic complications associated with septic shock.

Recent findings
Increased inflammation and oxidative stress are hallmarks of a range of vascular diseases. We recently showed that in systemic inflammation and oxidative stress associated with models of inflammation including sepsis, the tryptophan catabolizing enzyme indoleamine 2,3-dioxygenase-1 (Ido1) contributes to hypotension and decreased blood pressure through production of singlet molecular oxygen (1O2). Once formed, 1O2 converts tryptophan bound to Ido1 to a vasoactive hydroperoxide which decreases arterial tone and blood pressure via oxidation of a specific cysteine residue of protein kinase G1α.

Summary
These works show, for the first time, that 1O2 contributes to arterial redox signalling and that Ido1 contributes to the regulation of blood pressure through production of a novel tryptophan-derived hydroperoxide, thus presenting a new signalling pathway as novel target in the treatment of blood pressure disorders such as sepsis.
Prognostic mutation constellations in acute myeloid leukaemia and myelodysplastic syndrome
Authors: Iacobucci Ilaria , Mullighan Charles G. 
Published: January 2021

Purpose of review
In the past decade, numerous studies analysing the genome and transcriptome of large cohorts of acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS) patients have substantially improved our knowledge of the genetic landscape of these diseases with the identification of heterogeneous constellations of germline and somatic mutations with prognostic and therapeutic relevance. However, inclusion of integrated genetic data into classification schema is still far from a reality. The purpose of this review is to summarize recent insights into the prevalence, pathogenic role, clonal architecture, prognostic impact and therapeutic management of genetic alterations across the spectrum of myeloid malignancies.

Recent findings
Recent multiomic-studies, including analysis of genetic alterations at the single-cell resolution, have revealed a high heterogeneity of lesions in over 200 recurrently mutated genes affecting disease initiation, clonal evolution and clinical outcome. Artificial intelligence and specifically machine learning approaches have been applied to large cohorts of AML and MDS patients to define in an unbiased manner clinically meaningful disease patterns including, disease classification, prognostication and therapeutic vulnerability, paving the way for future use in clinical practice.

Summary
Integration of genomic, transcriptomic, epigenomic and clinical data coupled to conventional and machine learning approaches will allow refined leukaemia classification and risk prognostication and will identify novel therapeutic targets for these still high-risk leukaemia subtypes.
The Need for Manual Skills in an Automated World to Obtain Timely Blood Pressures in Trauma Patients
Authors: Farner-Cordell Carly , Bitton Alexandre , Eeten Katelyn , Schmidt Cory , Brenden Misty 
Published: January 2021

Background:
Obtaining the first blood pressure (BP) during adult trauma team activations was often delayed. A review of patient charts revealed that the average time to first documented BP was 6.6 minutes when using an automatic BP cuff.

Purpose:
The purpose was to determine whether taking the initial BP using a manual cuff decreases the time it takes to obtain the first BP.

Method:
The Iowa Model Revised was used as the framework for this project.

Intervention:
An algorithm was developed, and staff were educated and validated on their ability to obtain manual BPs. A 2-month practice change pilot was launched on adult full and partial trauma team activations.

Results:
It was determined that taking a BP manually during adult trauma resuscitations was more efficient, allowing for earlier determination of patient status.

Conclusion:
Obtaining the initial BP manually was 54% more timely and led to an evidence-based practice change.
Improving Antibiotic Administration Rate for Patients With Sepsis in the Emergency Department
Authors: Hatozaki Chie , Sakuramoto Hideaki , Okamoto Mayu , Nakajima Hisao , Shimojo Nobutake , Inoue Yoshiaki 
Published: January 2021

Background:
Previous studies have demonstrated that delayed antibiotic administration increases the risk of mortality in patients with sepsis.

Local Problem:
In the emergency department, the antibiotic administration rate within 1 and 3 hours for patients with suspected sepsis was low.

Methods/Interventions:
We implemented an educational intervention with the nursing staff, which included training sessions and feedback, to ensure early detection and management of patients with suspected sepsis. Antibiotic administration rates were compared before and after education.

Results:
A total of 503 patients were included. The antibiotic administration rate improved as the phases continued (1 hour: from 5.2% to 15.6%, P = .004; 3 hours: from 35.6% to 49.7%, P = .04; 6 hours: from 74.1% to 89.1%, P = .002). The time to initial antibiotic administration also improved from 229 to 185 minutes (P < .001).

Conclusions:
Nurse-initiated quality improvement improved the early administration of antibiotics for patients with suspected sepsis.