bluuebunny/crossref_metadata_2025_split huggingface dataset:
Creation of a dedicated line team for critically ill patients with COVID-19: A multidisciplinary approach to maximize resource utilization during the COVID-19 pandemic
Authors: Nawathe Pooja , Wong Robert , Pollock Gabriel , Green Jack , Kissen Michael , Ng Phillip , Cohen Samuel , Barron Joel , Robert Stephen , Slingwine Christy , Frank Paul , Navab Kaveh , Kim Doran , Yang Michael , Gouvea Tyler , Johnson Calvin , Pedraza Isabel , Zahn Evan 
Published: February 2021

Background: Pandemics create challenges for medical centers, which call for innovative adaptations to care for patients during the unusually high census, to distribute stress and work hours among providers, to reduce the likelihood of transmission to health care workers, and to maximize resource utilization. Methods: We describe a multidisciplinary vascular access team’s development to improve frontline providers’ workflow by placing central venous and arterial catheters. Herein we describe the development, organization, and processes resulting in the rapid formation and deployment of this team, reporting on notable clinical issues encountered, which might serve as a basis for future quality improvement and investigation. We describe a retrospective, single-center descriptive study in a large, quaternary academic medical center in a major city. The COVID-19 vascular access team included physicians with specialized experience in placing invasive catheters and whose usual clinical schedule had been lessened through deferment of elective cases. The target population included patients with confirmed or suspected COVID-19 in the medical ICU (MICU) needing invasive catheter placement. The line team placed all invasive catheters on patients in the MICU with suspected or confirmed COVID-19. Results and conclusions: Primary data collected were the number and type of catheters placed, time of team member exposure to potentially infected patients, and any complications over the first three weeks. Secondary outcomes pertained to workflow enhancement and quality improvement. 145 invasive catheters were placed on 67 patients. Of these 67 patients, 90% received arterial catheters, 64% central venous catheters, and 25% hemodialysis catheters. None of the central venous catheterizations or hemodialysis catheters were associated with early complications. Arterial line malfunction due to thrombosis was the most frequent complication. Division of labor through specialized expert procedural teams is feasible during a pandemic and offloads frontline providers while potentially conferring safety benefits.
Intraosseous vascular access using the EZ-IO can be safely maintained in the adult proximal humerus and proximal tibia for up to 48 h: Report of a clinical study
Authors: Philbeck Thomas E , Puga Tatiana A , Montez Diana F , Davlantes Chris , DeNoia Emanuel P , Miller Larry J 
Published: February 2021

Background: Historically, intraosseous (IO) vascular access devices cleared to market by the US FDA have been restricted to 24-h use. An observational study was conducted to determine the safety of IO access for a period up to 48 h in adult volunteers. Methods: A 2-arm randomized, stratified, parallel assignment, prospective interventional study was conducted at ICON Early Phase Services in San Antonio, Texas, United States. Study subjects were adult volunteers who were healthy or with a history of mild to moderate renal disease and/or controlled diabetes. Subjects were randomized to receive IO access (Arrow EZ-IO Vascular Access System, Teleflex Medical Incorporated, Morrisville, NC, USA) in the proximal humerus or the proximal tibia and maintain the indwelling catheter for 48 h. Subjects were monitored for the entire dwell time. A culture specimen was drawn from the indwelling catheter tip before removal and insertion site x-rays were taken. Results: 121 subjects were randomized: 79 healthy, 39 with diabetes, and three with diabetes and renal insufficiency. The mean catheter dwell time was 48.0 ± 0.2 h. Overall first attempt success rate was 98.4%. Infusion pain was the most commonly reported adverse event. There were no serious complications or unanticipated adverse events. Conclusions: This is the first known study examining the safety of IO access over a 48-h dwell time. The study corroborates the literature findings, demonstrates device safety, and provides evidence supporting the extended indication for a dwell time to 48 h in adult patients. IO placement and infusion best practices/guidelines were confirmed or established.
The limited effectiveness of bedside positive pressure irrigation on pistol projectile wound contaminant: A biomechanics study
Authors: Colen Alexander J , Boyd Sara K , Nielsen Ryan C , Ali Reehan M , Brossy Kelley J , Ablove Robert 
Published: February 2021

Background Pistol caliber gunshot wounds (PC GSW) are the most common mode of firearm injury treated in the civilian emergency setting, but there is a paucity of data guiding best practice treatment. The goal of this study was to examine the effect of bedside positive pressure irrigation (PPI) on removal of gross debris from PC GSW. Methods Fourteen bovine shanks were prepared with metal impregnated fabric placed in front of the impending impact zones to mimic radio-opaque clothing-like material. They were then shot with a 9 mm bullet from a distance of 3 meters. Specimens were imaged three separate times with standardized computer tomography: immediately after impact, after 250 ml irrigation, and after a total of 750 ml of irrigation. Scanned images were examined for change in radio-opaque contamination at both the entry site and within the wound cavity. Results No samples demonstrated a decrease of debris contamination within the cavity of the wound after 250 ml of irrigation and only one did after 750 ml. Six (42.86%) samples demonstrated a shift of debris without decrease in cavity contamination after 250 ml of irrigation and ten after 750 ml total irrigation. Five samples demonstrated decrease in debris at the entry site of the gunshot projectile wound after 250 ml of irrigation and two showed further superficial decrease with additional irrigations up to 750 ml. No statistically significant differences were found between 250 ml and 750 ml PPI treatments in both superficial and cavity contamination categories. Conclusion Positive pressure irrigation with up to 750 ml of 0.9% normal saline at a rate of 20 ml/sec has limited effect on the removal of gross debris within the cavity of pistol caliber gunshot wounds. The data within this study bring into question the benefits of attempted removal of pistol caliber gunshot wound contaminants utilizing bedside positive pressure irrigation.
The emotional experience of caregiving in dementia: Feelings of guilt and ambivalence underlying narratives of family caregivers
Authors: Caputo Andrea 
Published: February 2021

Objective The aim of this study was to explore narrative domains of family caregivers’ emotional experiences, beyond intentional and explicitly reported contents, and to examine their associations with subjects defining characteristics, such as gender, kinship, duration of caregiving, and burden levels. Methods The study participants were 17 Italian family caregivers (88.23% women) with a mean age of 59.14 years ( SD = 7.76), who provided their loved ones affected by dementia with in-home care. Structured interviews and Caregiver Burden Inventory were administered according to a mixed method design. A computer-aided text analysis was used which allowed the detection of shared narrative domains (cluster analysis) and latent factors organizing the contraposition between them (multiple correspondence analysis). Findings Five narrative domains emerged which were respectively referred to as perceived formal support (14.38% of the overall textual corpus), devotion (33.56%), anger (13.70%), sense of loss (18.49%), and feeling of uncertainty (19.86%). Kinship, duration of caregiving, and burden levels were differently associated with such domains. Two latent factors dealing with feelings of guilt and ambivalence explained 62.92% of overall data variance. Conclusion Guilt feelings should be carefully taken into account in support intervention with caregivers, with specific regard to stress and anger management. As well, a greater focus on caregivers’ emotion regulation and on the promotion of their problem-solving skills is needed when faced with contrasting beliefs about care decisions or role conflicts.
A Randomized, Controlled, Parallel-Group, Trial on the Effects of Melatonin on Fatigue Associated with Breast Cancer and Its Adjuvant Treatments
Authors: Sedighi Pashaki Abdolazim , Mohammadian Kamal , Afshar Saeid , Gholami Mohammad Hadi , Moradi Abbas , Javadinia Seyed Alireza , Keshtpour Amlashi Zahra 
Published: February 2021

Objective: Fatigue associated with malignant conditions and their treatments is a disabling condition. This trial assessed the anti-fatigue effects of melatonin coadministration during adjuvant treatment of patients with the breast cancer. Material and Methods: Patients with breast cancer were randomly assigned to receive melatonin or placebo during adjuvant chemotherapy and radiotherapy. Thirty-seven patients were randomly enrolled in each group. The mean ages of patients in the intervention and control groups were 50.47 ± 10.79 and 46.05 ± 10.55 years, respectively ( P = .223). The intervention group received oral melatonin (18 mg/day) from 1 week before until 1 month after the adjuvant radiotherapy. The level of fatigue was assessed before and after intervention using Brief Fatigue Inventory (BFI) in both groups. To analyze data, the Student’s t-test and the Chi-square test were used at a significance level of P ≤ .05. Results: The BFI score was similar before the intervention in both groups, however, after the intervention, it was significantly lower in the melatonin group ( P < .001). Moreover, the frequency of severe fatigue in the melatonin group was significantly lower than in the placebo group after intervention (42.1% vs 83.3%, P < .001). Conclusion: Coadministration of melatonin during adjuvant chemotherapy and radiotherapy of women with breast cancer decreased the levels of fatigue associated with the malignant condition and its treatments.
Effect of On-Site Cardiac Surgery Program on General Thoracic Surgery Outcomes
Authors: Nguyen Andrew B. , Selevany Mariam , Turner Amber L. , Langan Russell C. , Sesti Joanna , Paul Subroto 
Published: February 2021

Objective Limited data exist exploring the relationship between multispecialty surgical collaboration and outcomes in general thoracic surgery. To address this, the Nationwide Inpatient Sample (NIS) was analyzed to determine whether the presence of an on-site cardiac surgery program is associated with improved general thoracic surgery outcomes. Methods The NIS (1999-2008) was utilized to identify 389,959 patients who had a lobectomy, pneumonectomy, or esophagectomy. Short-term outcomes of patients undergoing these procedures were compared between hospitals with and without an on-site cardiac surgery program. Univariate and multivariate analyses were performed to determine patient and hospital predictors of mortality and morbidity. Results During the study period, patients undergoing lobectomy ( n = 314,130), pneumonectomy ( n = 34,860), or esophagectomy ( n = 40,969) were identified. Univariate analysis demonstrated lower mortality for lobectomy ( P < 0.001) and esophagectomy ( P < 0.001) but not pneumonectomy ( P = 0.344) in hospitals with a cardiac surgery program. All-cause morbidity was significantly lower for all 3 procedures in hospitals with a cardiac surgery program. However, multivariate analysis demonstrated that a cardiac surgery program was not an independent predictor when adjusted for known confounders, particularly procedure volume and hospital academic teaching status. Conclusions The presence of an on-site cardiac surgery program is not in and of itself associated with improved general thoracic surgery outcomes. The presence of a cardiac surgery program is likely a surrogate for other known predictors of improved outcomes such as hospital teaching status and procedure volume.
Clinician engagement in the ADAPTABLE (Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-Term Effectiveness) trial
Authors: Kochar Ajar , Summers Mary B , Benziger Catherine P , Marquis-Gravel Guillaume , DeWalt Darren A , Pepine Carl J , Gupta Kamal , Bradley Steven M , Dodson John A , Lampert Brent C , Robertson Holly , Polonsky Tamar S , Jones W Schuyler , Effron Mark B 
Published: February 2021

Background: ADAPTABLE (Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-Term Effectiveness) is a pragmatic clinical trial examining high-dose versus low-dose aspirin among patients with cardiovascular disease. ADAPTABLE is leveraging novel approaches for clinical trial conduct to expedite study completion and reduce costs. One pivotal aspect of the trial conduct is maximizing clinician engagement. Methods/Results: Clinician engagement can be diminished by barriers including time limitations, insufficient research infrastructure, lack of research training, inadequate compensation for research activities, and clinician beliefs. We used several key approaches to boost clinician engagement such as empowering clinician champions, including a variety of clinicians, nurses and advanced practice providers, periodic newsletters and coordinated team celebrations, and deploying novel technological solutions. Specifically, some centers generated electronic health records–based best practice advisories and research dashboards. Future large pragmatic trials will benefit from standardization of the various clinician engagement strategies especially studies leveraging electronic health records–based approaches like research dashboards. Financial or academic “credit” for clinician engagement in clinical research may boost participation rates in clinical studies. Conclusion: Maximizing clinician engagement is important for the success of clinical trials; the strategies employed in the ADAPTABLE trial may serve as a template for future pragmatic studies.
Inflammatory cytokines, high-sensitivity C-reactive protein, and risk of one-year vascular events, death, and poor functional outcome after stroke and transient ischemic attack
Authors: Coveney S , Murphy S , Belton O , Cassidy T , Crowe M , Dolan E , de Gaetano M , Harbison J , Horgan G , Marnane M , McCabe JJ , Merwick A , Noone I , Williams D , Kelly PJ 
Published: February 2021

Background Inflammation driven by pro-inflammatory cytokines is a new therapeutic target in coronary disease. Few data exist on the association of key upstream cytokines and post-stroke recurrence. In a prospective cohort study, we investigated the association between pivotal cytokines, high-sensitivity C-reactive protein (hsCRP) and one-year outcomes. Methods BIO-STROKETIA is a multi-center prospective cohort study of non-severe ischemic stroke (modified Rankin score ≤ 3) and transient ischemic attack. Controls were patients with transient symptoms attending transient ischemic attack clinics with non-ischemic final diagnosis. Exclusion criteria were severe stroke, infection, and other pro-inflammatory disease; hsCRP and cytokines (interleukin (IL) 6, IL-1β, IL-8, IL-10, IL-12, interferon-γ (IFN-γ), tumor-necrosis factor-α (TNF-α)) were measured. The primary outcome was one-year recurrent stroke/coronary events (fatal and non-fatal). Results In this study, 680 patients (439 stroke, 241 transient ischemic attack) and 68 controls were included. IL-6, IL-1β, IL-8, IFN-γ, TNF-α, and hsCRP were higher in stroke/transient ischemic attack cases (p ≤ 0.01 for all). On multivariable Cox regression, IL-6, IL-8, and hsCRP independently predicted one-year recurrent vascular events (adjusted hazard ratios (aHR) per-quartile increase IL-6 1.31, confidence interval (CI) 1.02–1.68, p = 0.03; IL-8 1.47, CI 1.15–1.89, p = 0.002; hsCRP 1.28, CI 1.01–1.62, p = 0.04). IL-6 (aHR 1.98, CI 1.26–3.14, p = 0.003) and hsCRP (aHR 1.81, CI 1.20–2.74, p = 0.005) independently predicted one-year fatality. IL-6 and hsCRP (adjusted odds ratio per-unit increase 1.02, CI 1.01–1.04) predicted poor functional outcome, with a trend for IL-1β (p = 0.054). Conclusion Baseline inflammatory cytokines independently predicted late recurrence, supporting a rationale for randomized trials of anti-inflammatory agents for prevention after stroke and suggesting that targeted therapy to high-risk patients with high baseline inflammation may be beneficial.
Day case laparoscopic cholecystectomy: Identifying patients for a ‘COVID-Cold’ isolated day-case unit during the pandemic
Authors: Hinchcliffe Zoe , Mohamed Imran , Lala Anil 
Published: February 2021

Background The UK practice of laparoscopic cholecystectomy has reduced during the COVID-19 pandemic due to cancellation of non-urgent operations. Isolated day-case units have been recommended as ‘COVID-cold’ operating sites to resume surgical procedures. This study aims to identify patients suitable for day case laparoscopic cholecystectomy (DCLC) at isolated units by investigating patient factors and unexpected admission. Method Retrospective analysis of 327 patients undergoing DCLC between January and December 2018 at Ysbyty Gwynedd (District General Hospital; YG) and Llandudno General Hospital (isolated unit; LLGH), North Wales, UK. Results The results showed that 100% of DCLCs in LLGH were successful; 71.4% of elective DCLCs were successful at YG. Increasing age ( p = 0.004), BMI ( p = 0.01), ASA Score ( p = 0.006), previous ERCP ( p = 0.05), imaging suggesting cholecystitis ( p = 0.003) and thick-walled gallbladder ( p = 0.04) were significantly associated with failed DCLC on univariate analysis. Factors retaining significance (OR, 95% CI) after multiple regression include BMI (1.82, 1.05–3.16; p = 0.034), imaging suggesting cholecystitis (4.42, 1.72–11.38; p = 0.002) and previous ERCP (5.25, 1.53–18.00; p = 0.008). Postoperative complications are comparable in BMI <35kg/m2 and 35–39.9kg/m2. Conclusions Current patient selection for isolated day unit is effective in ensuring safe discharge and could be further developed with greater consideration for patients with BMI 35–39.9kg/m2. As surgical services return, this helps identify patients suitable for laparoscopic cholecystectomy at isolated COVID-free day units.
Concentric-Only Versus Touch-and-Go Bench Press One-Repetition Maximum in Men and Women
Authors: García-Ramos Amador , Janicijevic Danica , Jukic Ivan 
Published: February 2021

Background: One-repetition maximum (1RM) tests are time-consuming, and they might not always be logistically possible or warranted due to increased risk of injury when performed incorrectly or by novice athletes. Repetitions-to-failure tests are a widespread method of predicting the 1RM, but its accuracy may be compromised by several factors such as the type of exercise, sex, training history, and the number of repetitions completed in the test. Hypothesis: The touch-and-go bench press would provide a higher 1RM than the concentric-only bench press for both genders regardless of whether the 1RM was obtained by the direct or repetitions-to-failure method and the error in the 1RM prediction would be positively correlated with the number of repetitions performed to failure and negatively correlated with the 1RM strength and resistance training experience. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: A total of 113 adults (87 men and 26 women) were tested on 2 sessions during the concentric-only and touch-and-go bench press. Each session consisted of an incremental loading test until reaching the 1RM load, followed by a repetitions-to-failure test. Results: The 1RM was higher for the touch-and-go bench press using both the direct (men, 7.80%; women, 7.62%) and repetitions-to-failure method (men, 8.29%; women, 7.49%). A significant, although small, correlation was observed between the error in the estimation of the 1RM and the number of repetitions performed ( r = 0.222; P < 0.01), 1RM strength ( r = −0.169; P = 0.01), and resistance training experience ( r = −0.136; P = 0.05). Conclusion: The repetitions-to-failure test is a valid method of predicting the 1RM during the concentric-only and touch-and-go bench press variants. However, the accuracy of the prediction could be compromised with weaker and less experienced individuals and if more than 10 repetitions are completed during the repetitions-to-failure test. Clinical Relevance: The repetitions-to-failure test does not require any sophisticated equipment and enables a widespread use in different training environments.
The Effect of Straight-Line Long-Toss Versus Ultra-Long-Toss Throwing on Passive Glenohumeral Range of Motion Recovery After Pitching
Authors: Luo T. David , Sciascia Aaron D. , Stone Austin V. , Gwam Chukwuweike U. , Grimes Christopher A. , Strahm Jeffrey G. , Mannava Sandeep , Naugher G. Lane , Waterman Brian R. , Freehill Michael T. 
Published: February 2021

Background: Repetitive throwing in baseball pitchers can lead to pathologic changes in shoulder anatomy, range of motion (notably glenohumeral internal rotation deficit), and subsequent injury; however, the ideal strengthening, recovery, and maintenance protocol of the throwing shoulder in baseball remains unclear. Two strategies for throwing shoulder recovery from pitching are straight-line long-toss (SLT) throwing and ultra-long-toss (ULT) throwing, although neither is preferentially supported by empirical data. Hypothesis: ULT will be more effective in returning baseline internal rotation as compared with SLT in collegiate pitchers after a pitching session. Study Design: Cohort study. Level of Evidence: Level 3. Methods: A total of 24 National Collegiate Athletic Association Division I baseball pitchers with mean age 20.0 ± 1.1 years were randomized to either the ULT group (n = 13; 9 right-hand dominant, 4 left-hand dominant) or SLT group (n = 11; 10 right-hand dominant, 1 left-hand dominant). Measurements (dominant and nondominant, 90° abducted external rotation [ER], internal rotation [IR], and total range of motion [TROM]) were taken at 5 time points across 3 days: before and immediately after a standardized bullpen session on day 1; before and immediately after a randomized standardized ULT or SLT session on day 2; and before practice on Day 3. Results: ULT demonstrated significantly greater final ER compared with baseline (+10°; P = 0.05), but did not demonstrate significant IR changes. Similarly, SLT demonstrated significantly greater post-SLT ER (+12°; P = 0.02) and TROM (+12°; P = 0.01) compared with baseline, but no significant IR changes. Final ER measurements were similar between ULT (135° ± 14°) and SLT (138° ± 10°) ( P = 0.59). There was also no statistically significant difference in final IR between ULT (51° ± 14°) and SLT (56° ± 8°) ( P = 0.27). Conclusion: The routine use of postperformance, ULT throwing to recover from range of motion alterations, specifically IR loss, after a pitching session is not superior to standard, SLT throwing. Based on these findings, the choice of postpitching recovery throwing could be player specific based on experience and comfort. Clinical Relevance: The most effective throwing regimens for enhancing performance and reducing residual impairment are unclear, and ideal recovery and maintenance protocols are frequently debated with little supporting data. Two strategies for throwing shoulder recovery from pitching are SLT and ULT throwing. These are employed to help maintain range of motion and limit IR loss in pitchers. The routine use of ULT throwing for recovery and to limit range of motion alterations after a pitching session is not superior to SLT throwing.