bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of clinical decision support therapeutic interchanges on hospital discharge medication omissions and duplications
Authors: Maxwell Erin , Amerine James , Carlton Glenda , Cruz Jennifer L , Pappas Ashley L , Heindel Gregory A 
Published: May 2021

Abstract

Purpose
Automatic therapeutic substitution (ATS) protocols are formulary tools that allow for provider-selected interchange from a nonformulary preadmission medication to a formulary equivalent. Previous studies have demonstrated that the application of clinical decision support (CDS) tools to ATS can decrease ATS errors at admission, but there are limited data describing the impact of CDS on discharge errors. The objective of this study was to describe the impact of CDS-supported interchanges on discharge prescription duplications or omissions.

Methods
This was a single-center, retrospective cohort study conducted at an academic medical center. Patients admitted between June 2017 and August 2019 were included if they were 18 years or older at admission, underwent an ATS protocol–approved interchange for 1 of the 9 included medication classes, and had a completed discharge medication reconciliation. The primary outcome was difference in incidence of therapeutic duplication or omission at discharge between the periods before and after CDS implementation.

Results
A total of 737 preimplementation encounters and 733 postimplementation encounters were included. CDS did not significantly decrease the incidence of discharge duplications or omissions (12.1% vs 11.2%; 95% confidence interval [CI], –2.3% to 4.2%) nor the incidence of admission duplication or inappropriate reconciliation (21.4% vs 20.7%; 95% CI, –3.4% to 4.8%) when comparing the pre- and postimplementation periods. Inappropriate reconciliation was the primary cause of discharge medication errors for both groups.

Conclusion
CDS implementation was not associated with a decrease in discharge omissions, duplications, or inappropriate reconciliation. Findings highlight the need for thoughtful medication reconciliation at the point of discharge.
Enhanced stress-resilience training for surgical trainees
Authors: Luton O W , James O P , Mellor K , Eley C , Hopkins L , Robinson D B T , Lebares C C , Powell A G M T , Lewis W G , Egan R J 
Published: May 2021

Abstract

Introduction
Core surgical training programmes are associated with a high risk of burnout. This study aimed to assess the influence of a novel enhanced stress-resilience training (ESRT) course delivered at the start of core surgical training in a single UK statutory education body.

Method
All newly appointed core surgical trainees (CSTs) were invited to participate in a 5-week ESRT course teaching mindfulness-based exercises to develop tools to deal with stress at work and burnout. The primary aim was to assess the feasibility of this course; secondary outcomes were to assess degree of burnout measured using Maslach Burnout Inventory (MBI) scoring.

Results
Of 43 boot camp attendees, 38 trainees completed questionnaires, with 24 choosing to participate in ESRT (63.2 per cent; male 13, female 11, median age 28 years). Qualitative data reflected challenges delivering ESRT because of arduous and inflexible clinical on-call rotas, time pressures related to academic curriculum demands and the concurrent COVID-19 pandemic (10 of 24 drop-out). Despite these challenges, 22 (91.7 per cent) considered the course valuable and there was unanimous support for programme development. Of the 14 trainees who completed the ESRT course, nine (64.3 per cent) continued to use the techniques in daily clinical work. Burnout was identified in 23 trainees (60.5 per cent) with no evident difference in baseline MBI scores between participants (median 4 (range 0–11) versus 5 (1–11), P = 0.770). High stress states were significantly less likely, and mindfulness significantly higher in the intervention group (P &lt; 0.010); MBI scores were comparable before and after ESRT in the intervention cohort (P = 0.630, median 4 (range 0–11) versus 4 (1–10)).

Discussion
Despite arduous emergency COVID rotas ESRT was feasible and, combined with protected time for trainees to engage, deserves further research to determine medium-term efficacy.
The Significance of Space: Experiences of Arab Social Work Professionals with EAGALA Equine-Assisted Learning
Authors: Moshe-Grodofsky Merav , Allassad Alhuzail Nuzha 
Published: May 2021

Abstract
The value of equine-assisted interventions that promote growth and learning is increasingly recognised in professional practice. The aim of this study was to examine how equine-assisted intervention enhanced personal and professional growth for social work professionals. Arab social workers from the social service department in the Bedouin city Hura, Israel participated in three workshops based on the Equine Assisted Growth and Learning Association (EAGALA) model. Observations conducted through the workshops, debriefing sessions with participants and fourteen in-depth semi-structured interviews were analysed. Analysis exposed the importance of space in promoting development. Specifically, participants described the value of space for self-reflection, the importance of the space within and between relationships and space as a site for team building. Changes amongst the participants from dependence on external instruction to autonomous decision making, enhanced spontaneous activity with the horses and mutual assistance were identified. This is the first equine-assisted learning workshop and research conducted with social workers in Israel. The results highlight the value of equine-assisted learning as a new avenue to help grow social work professionals as they continue to work with their clientele. Results suggest that there is potential for equine-assisted interventions to support social workers internationally.
Substantial decline in hospital admissions for heart failure accompanied by increased community mortality during COVID-19 pandemic
Authors: Shoaib Ahmad , Van Spall Harriette G C , Wu Jianhua , Cleland John G F , McDonagh Theresa A , Rashid Muhammad , Mohamed Mohamed O , Ahmed Fozia Z , Deanfield John , de Belder Mark , Gale Chris P , Mamas Mamas A 
Published: May 2021

Abstract

Aims
We hypothesized that a decline in admissions with heart failure during COVID-19 pandemic would lead to a reciprocal rise in mortality for patients with heart failure in the community.

Methods and results
We used National Heart Failure Audit data to identify 36 974 adults who had a hospital admission with a primary diagnosis of heart failure between February and May in either 2018, 2019, or 2020. Hospital admissions for heart failure in 2018/19 averaged 160/day but were much lower in 2020, reaching a nadir of 64/day on 27 March 2020 [incidence rate ratio (IRR): 0.40, 95% confidence interval (CI): 0.38–0.42]. The proportion discharged on guideline-recommended pharmacotherapies was similar in 2018/19 compared to the same period in 2020. Between 1 February–2020 and 31 May 2020, there was a 29% decrease in hospital deaths related to heart failure (IRR: 0.71, 95% CI: 0.67–0.75; estimated decline of 448 deaths), a 31% increase in heart failure deaths at home (IRR: 1.31, 95% CI: 1.24–1.39; estimated excess 539), and a 28% increase in heart failure deaths in care homes and hospices (IRR: 1.28, 95% CI: 1.18–1.40; estimated excess 189). All-cause, inpatient death was similar in the COVID-19 and pre-COVID-19 periods [odds ratio (OR): 1.02, 95% CI: 0.94–1.10]. After hospital discharge, 30-day mortality was higher in 2020 compared to 2018/19 (OR: 1.57, 95% CI: 1.38–1.78).

Conclusion
Compared with the rolling daily average in 2018/19, there was a substantial decline in admissions for heart failure but an increase in deaths from heart failure in the community. Despite similar rates of prescription of guideline-recommended therapy, mortality 30 days from discharge was higher during the COVID-19 pandemic period.
Successful uterine-sparing surgical management in a patient with a large multi-fibroid uterus
Authors: Holden Lucy M 
Published: May 2021

Abstract
Uterine fibroids are a common gynaecological condition. A key factor when deciding on surgical approach for fibroid management is a patient’s age and desire for fertility with uterine-sparing treatment generally recommended in women who are aiming for future pregnancies. This case report discusses a woman who presented with a very large multi-fibroid uterus. In this case, a hysterectomy was recommended due to safety concerns however, this advice was declined as the patient desired uterine preservation. Fertility testing showed that the patient was not peri-menopausal and abdominal myomectomy was safely performed to good effect. This case report outlines the surgical approach undertaken, in addition to considerations for fertility and pregnancy management.
Nephrotoxicity of immune checkpoint inhibitor therapy: a pharmacovigilance study
Authors: Haeuser Lorine , Marchese Maya , Cone Eugene B , Noldus Joachim , Bayliss George , Kilbridge Kerry Laing , Trinh Quoc-Dien 
Published: May 2021

Abstract

Background
Immune checkpoint inhibitor (ICI) therapy has demonstrated impressive clinical benefits across cancers. However, adverse drug reactions (ADRs) occur in every organ system, often due to autoimmune syndromes. We sought to investigate the association between ICI therapy and nephrotoxicity using a pharmacovigilance database, hypothesizing that inflammatory nephrotoxic syndromes would be reported more frequently in association with ICIs.

Methods
We analyzed VigiBase, the World Health Organization pharmacovigilance database, to identify renal ADRs (rADRs), such as nephritis, nephropathy and vascular disorders, reported in association with ICI therapy. We performed a disproportionality analysis to explore if rADRs were reported at a different rate with one of the ICI drugs compared with rADRs in the entire database, using an empirical Bayes estimator as a significance screen and defining the effect size with a reporting odds ratio (ROR).

Results
We found 2341 rADR for all examined ICI drugs, with a disproportionality signal solely for nephritis [ROR = 3.67, 95% confidence interval (CI) 3.34–4.04]. Examining the different drugs separately, pembrolizumab, nivolumab and ipilimumab + nivolumab combination therapy had significantly higher reporting odds of nephritis than the other ICI drugs (ROR = 4.54, 95% CI 3.81–5.4; ROR = 3.94, 95% CI 3.40–4.56; ROR 3.59, 95% CI 2.71–4.76, respectively).

Conclusions
Using a pharmacovigilance method, we found increased odds of nephritis when examining rADRs associated with ICI therapy. Pembrolizumab, nivolumab and a combination of ipilimumab + nivolumab showed the highest odds. Clinicians should consider these findings and be aware of the increased risk of nephritis, especially in patients treated with pembrolizumab, when administering ICI therapy.
Standardized Treatment and Assessment Pathway Improves Mortality in Adults With Methicillin-resistant Staphylococcus aureus Bacteremia: STAPH Study
Authors: Alosaimy Sara , Lagnf Abdalhamid M , Morrisette Taylor , Jorgensen Sarah C J , Trinh Trang D , Zasowski Evan J , Scipione Marco R , Zhao Jing J , Mynatt Ryan , Herbin Shelbye , Dhar Sorabh , Chopra Teena , Janisse James , Rebold Nicholas , Pogue Jason M , Rybak Michael J 
Published: May 2021

Abstract

Background
Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) management remains challenging for clinicians. Numerous in vitro studies report synergy when vancomycin (VAN) and daptomycin (DAP) are combined with beta-lactams (BLs), which has led to clinical implementation of these combinations. While shorter durations of bacteremia have often been reported, there has been no significant impact on mortality.

Methods
The Detroit Medical Center (DMC) developed and implemented a clinical pathway algorithm for MRSA BSI treatment in 2016 that included the early use of BL combination therapy with standard of care (VAN or DAP) and a mandatory Infectious Diseases consultation. This was a retrospective, quasi-experimental study at the DMC between 2013 and 2020. Multivariable logistic regression was used to assess the independent association between pathway implementation and 30-day mortality while adjusting for confounding variables.

Results
Overall, 813 adult patients treated for MRSA BSI were evaluated. Compared with prepathway (PRE) patients (n = 379), those treated postpathway (POST; n = 434) had a significant reduction in 30-day and 90-day mortality: 9.7% in POST vs 15.6% in PRE (P = .011) and 12.2% in POST vs 19.0% in PRE (P = .007), respectively.
The incidence of acute kidney injury (AKI) was higher in the PRE compared with the POST group: 9.6% vs 7.2% (P = .282), respectively. After adjusting for confounding variables including Infectious Diseases consult, POST was independently associated with a reduction in 30-day mortality (adjusted odds ratio [aOR], 0.608; 95% CI, 0.375–0.986).

Conclusions
Implementation of an MRSA BSI treatment pathway with early use of BL reduced mortality with no increased rate of AKI. Further prospective evaluation of this pathway approach is warranted.
Modeling Poliovirus Surveillance and Immunization Campaign Quality Monitoring Costs for Pakistan and Afghanistan for 2019–2023
Authors: Kalkowska Dominika A , Pallansch Mark A , Cochi Stephen L , Thompson Kimberly M 
Published: May 2021

Abstract

Background
The Global Polio Eradication Initiative (GPEI) Strategic Plan for 2019–2023 includes commitments to monitor the quality of immunization campaigns using lot quality assurance sampling surveys (LQAS) and to support poliovirus surveillance in Pakistan and Afghanistan.

Methods
We analyzed LQAS and poliovirus surveillance data between 2016 and 2020, which included both acute flaccid paralysis (AFP) case-based detection and the continued expansion of environmental surveillance (ES). Using updated estimates for unit costs, we explore the costs of different options for future poliovirus monitoring and surveillance for Pakistan and Afghanistan.

Results
The relative value of the information provided by campaign quality monitoring and surveillance remains uncertain and depends on the design, implementation, and performance of the systems. Prospective immunization campaign quality monitoring (through LQAS) and poliovirus surveillance will require tens of millions of dollars each year for the foreseeable future for Pakistan and Afghanistan.

Conclusions
LQAS campaign monitoring as currently implemented in Pakistan and Afghanistan provides limited and potentially misleading information about immunization quality. AFP surveillance in Pakistan and Afghanistan provides the most reliable evidence of transmission, whereas ES provides valuable supplementary information about the extent of transmission in the catchment areas represented at the time of sample collection.
Monoclonal Antibodies for Early Treatment of COVID-19 in a World of Evolving SARS-CoV-2 Mutations and Variants
Authors: Pogue Jason M , Lauring Adam S , Gandhi Tejal N , Marshall Vincent D , Eschenauer Gregory A , Nagel Jerod L , Baang Ji Hoon , Zhou Shiwei , Valesano Andrew L , Petty Lindsay A 
Published: May 2021

Abstract
Monoclonal antibodies targeting the receptor binding domain (RBD) of severe acute respiratory syndrome coronavirus 2 spike protein are important outpatient treatment options in coronavirus disease 2019 to mitigate progression of disease and prevent hospitalization. The impact of different RBD mutations on the efficacy of the available monoclonal antibodies and processes for incorporating this impact into treatment algorithms are ill defined. Herein, we synthesize the data surrounding the impact of key RBD mutations on the efficacy of US Food and Drug Administration Emergency Use Authorized monoclonal antibodies and describe our approach at Michigan Medicine at monitoring mutation frequency in circulating virus and developing an algorithm that incorporates these data into outpatient treatment pathways.
tDCS effect on prosocial behavior: a meta-analytic review
Authors: Yuan Bo , Tolomeo Serenella , Yang Chunliang , Wang Ying , Yu Rongjun 
Published: May 2021

Abstract
Previous studies have shown that transcranial direct current stimulation (tDCS) could potentially promote prosocial behaviors. However, results from randomized controlled trials are inconsistent. The current meta-analysis aimed to assess the effects of anodal and cathodal tDCS using single-session protocols on prosocial behaviors in healthy young adults and explore potential moderators of these effects. The results showed that compared with sham stimulation, anodal (excitatory) stimulation significantly increased (g = 0.27, 95% CI [0.11, 0.43], Z = 3.30, P = 0.001) and cathodal (inhibitory) stimulation significantly decreased prosocial behaviors (g = −0.19, 95% CI [−0.39, −0.01], Z = −1.95, P = 0.051) using a multilevel meta-analytic model. These effects were not significantly modulated by stimulation parameters (e.g. duration, intensity and site) and types of prosocial behavior. The risk of publication bias for the included effects was minimal, and no selective reporting (e.g. P-hacking) was found in the P-curve analysis. This meta-analysis showed that both anodal and cathodal tDCS have small but significant effects on prosocial behaviors. The current study provides evidence that prosocial behaviors are linked to the activity of the ‘social brain’. Future studies are encouraged to further explore whether tDCS could effectively treat social dysfunctions in psychiatry disorders.
Changes of renal transporters in the kinetic process of VCM-induced nephrotoxicity in mice
Authors: Li Hongjing , Yang Qiaoling , Gui Mingzhu , Ding Lili , Yang Li , Sun Huajun , Li Zhiling 
Published: May 2021

Abstract
Renal transporters involved in tubular excretion pathway are considered to be the key concern in drug evaluations in nephrotoxicity. However, the relationship between the alternation of renal transporters and the kinetic process of vancomycin (VCM)-induced nephrotoxicity has not been fully elucidated. The present study investigated the alteration of renal transporters expression in the kinetic process of VCM-induced nephrotoxicity in mice. C57BL/6 mice were administrated with normal saline or VCM for 7 days. Biochemical and pathological analyses were conducted to investigate the nephrotoxicity induced by VCM administration. Renal oxidative status, plasma, and kidney content of VCM were monitored. Quantitative real-time polymerase chain reaction and immunohistochemistry analyses were performed to analyze the expression of renal transporters. Finally, our data showed that the exposure of VCM (400 mg/kg) caused a slight nephrotoxicity in mice, whereas exposure of VCM (600 mg/kg) resulted in the severe nephrotoxicity in mice as evidenced by biochemical parameters and renal morphological changes. In addition, the accumulation of VCM in kidney is higher than plasma. Interestingly, VCM (600 mg/kg, body weight) resulted in the induction of Oct2–Mate1 and Oat1/3–Mrp2/Mrp4/Bcrp pathways. However, VCM (400 mg/kg, body weight) caused the induction of Oct2–Mate1/Mate2 and Oat1/3–Mrp4/Bcrp pathways. The changes of renal transporters in association with the kinetic process of VCM-induced nephrotoxicity may exert important practical implications for its optimal use in clinic.
Predictors of SARS CoV-2 Infection Among Healthcare Workers: The Impact of Community-Hospital Gradient
Authors: Pınarlık Fatihan , Genç Zeliha , Tekin Süda , Kapmaz Mahir , Ergönül Önder 
Published: May 2021

AbstractAimWe aimed to detect the risk factors for SARS-CoV-2 infection among healthcare workers (HCWs) in 2020, before vaccination era.MethodsWe surveyed the SARS-CoV-2 infection among the HCWs in a hospital by screening of antibody levels and detection of viral RNA by reverse transcription polymerase chain reaction (RT-PCR) between May 2020 to December 2020. Occupational and non-occupational potential predictors of disease were surveyed for the HCWs included in this study.ResultsAmong 1925 personnel in the hospital, 1732 were included to the study with the response rate of 90%. Overall seroprevalence was 15% at the end of 2020, before vaccinations started. In multivariate analysis, being janitorial staff (OR:2.24, CI:1.21-4.14, p=0.011), being medical secretary (OR: 4.17, CI: 2.12-8.18, p<0.001), having at least one household member with COVID-19 diagnosis (OR:8.98, CI: 6.64-12.15, p<0.001) and number of household members >3 (OR:1.67, CI:1.26-2.22, p<0.001) were found to be significantly associated with SARS-CoV-2 infection.ConclusionBy the end of 2020, just before the era of vaccination and variants, seroprevalence was 15% among HCWs. Medical secretary and janitorial staff were under increased risk of SARS-CoV-2 infection. Community-hospital gradient can explain the mode of transmission for infection among HCWs. In the setting of this study, community measures were less strict, whereas hospital infection control was adequate and provided necessary personal protective equipment. Increasing risk in larger households and households with diagnosed COVID-19 patient indicates community acquired transmission of the infection.
Diagnostic Accuracy in Bronchial Carcinoid tumors is Dependent of Biopsy Size
Authors: Reuling E.M.B.P. , Naves D.D. , Daniels J.M.A. , Dickhoff C. , Kortman P.C. , Broeckaert M.A.M.B. , Plaisier P.W. , Thunnissen Erik , Radonic T. 
Published: May 2021

AbstractObjectiveRecently, 60% discordancy was reported for distinction between typical carcinoid and atypical carcinoid in preoperative biopsy compared to the resection specimen. This study investigated the impact of biopsy surface size, obtained with flexible and rigid bronchoscopy, on diagnostic accuracy of typical and atypical carcinoid.MethodsBiopsy-resection paired specimens of patients referred for treatment to Amsterdam University Medical Centers were retrieved. Bronchial biopsies were obtained either by flexible or rigid biopsy. The definitive diagnosis was based on the resection specimen. Diagnosis according to the 2015 WHO classification, mitoses and necrosis in biopsy and resection specimen, were independently re-evaluated by two pathologists.ResultsAfter screening 298 patients, 64 biopsy-resection pairs with available tissue were included of which 34 (53%) were biopsied with flexible and 30 (47%) with rigid biopsy. In 35 (55%) patients, the tumor classification between the biopsy and resection specimen was concordant. The discordance in the remaining 29 cases (45%) was caused by misclassification of atypical as typical carcinoid in bronchoscopy specimens, predominantly in small flexible biopsies (59%, p=0.021). Of biopsies measuring <2 mm2, 79% were classified as discordant and 52% of the discordant biopsies measured <4 mm2.ConclusionHistological classification in central carcinoid tumors is discordant in 45% of the biopsies, with increasing diagnostic accuracy in larger biopsies. Distinguishing carcinoid tumor into typical or atypical carcinoid on biopsies <4 mm2 should be discouraged. A cumulative biopsy surface of at least 4 mm2 tumor is preferred to increase the diagnostic accuracy which helps in optimal treatment planning.