bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical significance of changes in serum inflammatory factors in patients with chronic obstructive pulmonary disease and pulmonary infection
Authors: Zhou Jun , Jin Feng , Wu Feng 
Published: May 2021

Background Chronic obstructive pulmonary disease (COPD) is often accompanied by pulmonary infection, inflammatory responses, decreased immunity, and decreased lung function. The relationships among the pulmonary inflammation index (PII), lung function, and immunity in COPD patients with pulmonary infection remain unclear. Methods This retrospective observational study enrolled 234 participants (patients with COPD and pulmonary infection, patients with COPD without pulmonary infection, and healthy individuals) from January 2017 to December 2019. Results Levels of interleukin (IL)-6 were lower and levels of IL-8 were higher in patients with COPD and pulmonary infection. Levels of white blood cells (WBCs), C-reactive protein (CRP), IL-6, IL-8, tumor necrosis factor (TNF)-α and CD8+ cells were higher, while levels of CD3+ and CD4+ cells, the CD4+/CD8+ ratio, forced expiratory volume in 1 s (FEV1), FEV1 % predicted (FEV1%pred), and FEV1/forced vital capacity (FVC) (FEV1%FVC) were lower in patients with COPD and pulmonary infection. Levels of WBCs, CRP, IL-6, IL-8, and TNF-α were negatively associated with FEV1, FEV1%pred and FEV1%FVC. Conclusions Patients with COPD and pulmonary infection have high PIIs, decreased immunity, and poor lung function. PII is closely related to lung function and may represent a useful biomarker for the assessment of patients with COPD and pulmonary infection.
Perceived occupational competence and value among university students with premenstrual dysphoric disorder
Authors: Pekçetin Serkan , Özdinç Sevgi , Ata Hilal , Can Hilal Başak , Sermenli Aydın Nimet , Taş Dürmüş Pelin , Çalıyurt Okan 
Published: May 2021

Introduction Premenstrual dysphoric disorder (PMDD) is defined as a mental health issue and is assessed using DSM-V diagnostic criteria. Premenstrual dysphoric disorder comprises emotional, behavioral, and physical symptoms that occur in the premenstrual phase and resolve shortly after the start of menstruation. These symptoms and functional impairment may negatively affect occupational competence and value. This study investigated perceived occupational competence and value in university students with premenstrual dysphoric disorder. Methods This cross-sectional study was performed at a public university with 35 students with PMDD and 35 age-matched students without PMDD. Occupational competence and value were evaluated using the Occupational Self-Assessment (OSA). Results There was a significant difference between the groups in OSA competence score ( p < 0.05), while there was no significant difference in OSA value score ( p > 0.05). Conclusion This study demonstrated that university students with PMDD experience more occupational competence challenges than peers without PMDD. Further studies should be performed to determine the role of occupational therapy in the rehabilitation of PMDD.
Factors Influencing Transcultural Self-Efficacy Among Nurses With Foreign Patient Care Experience
Authors: Ham HyunJung , Tak Sunghee H. 
Published: May 2021

Introduction As the cultural diversity among patients increases, it becomes important for nurses to be prepared and efficient in providing culturally congruent care. The purpose of this study is to examine the factors influencing transcultural self-efficacy (TSE) among Korean nurses. Methodology A descriptive cross-sectional survey was used, and 131 nurses with foreign patient–care experience were recruited from a university tertiary hospital Results The mean TSE score of participants was 5.27 out of 10 ( SD = 1.50). The practical subscale of TSE was the lowest, while the affective subscale was the highest. A regression analysis revealed that education level, cultural competence, and intergroup anxiety are predictors explaining 58.8% of its variance ( F = 27.5, p < .001). Discussion A low level of TSE causes avoidant behavior and ineffective communication in foreign patient care, resulting in unsatisfactory clinical performance. Effective education programs and administration guidelines may be critical for nurses to improve their TSE.
Biotin-induced thyroid stimulating hormone aberrations in the setting of immunotherapy
Authors: N Ridgway Forrest , A Gold Kathryn , C Barnachea Linda 
Published: May 2021

Introduction Immune checkpoint inhibitors are associated with immune-mediated thyroid disease and other endocrinopathies. Biotin is an over-the-counter supplement known to interfere with lab assays, including thyroid function tests. Biotin-induced complications with lab monitoring during immunotherapy have not been previously reported. Case report We present a case of a 68-year old woman with hypothyroidism after initiating immune checkpoint blockade therapy and abnormal laboratory monitoring values while concurrently taking biotin supplements. Management & outcome: The patient was initiated on levothyroxine with subsequent dose increases over a period of weeks with resolution of symptoms and normalization of free thyroxine levels. Thyroid stimulating hormone (TSH) levels appeared to remain elevated until biotin supplements were held and levels normalized. Discussion The purpose of this report is to provide the first known incidence of biotin complicating the routine monitoring of immune checkpoint inhibitors with elevated TSH levels and to alert providers to elicit accurate medication histories regarding over-the-counter supplements.
Reduced critical care demand with early CPAP and proning in COVID-19 at Bradford: A single-centre cohort
Authors: Lawton Tom , Wilkinson Kate , Corp Aaron , Javid Rabeia , MacNally Laura , McCooe Michael , Newton Elizabeth 
Published: May 2021

Background Guidance in COVID-19 respiratory failure has favoured early intubation, with concerns over the use of CPAP. We adopted early CPAP and self-proning, and evaluated the safety and efficacy of this approach. Methods This retrospective observational study included all patients with a positive COVID-19 PCR, and others with high clinical suspicion. Our protocol advised early CPAP and self-proning for severe cases, aiming to prevent rather than respond to deterioration. CPAP was provided outside critical care by ward staff supported by physiotherapists and an intensive critical care outreach program. Data were analysed descriptively and compared against a large UK cohort (ISARIC). Results 559 patients admitted before 1 May 2020 were included. 376 were discharged alive, and 183 died. 165 patients (29.5%) received CPAP, 40 (7.2%) were admitted to critical care and 28 (5.0%) were ventilated. Hospital mortality was 32.7%, and 50% for critical care. Following CPAP, 62% of patients with S:F or P:F ratios indicating moderate or severe ARDS, who were candidates for escalation, avoided intubation. Figures for critical care admission, intubation and hospital mortality are lower than ISARIC, whilst critical care mortality is similar. Following ISARIC proportions we would have admitted 92 patients to critical care and intubated 55. Using the described protocol, we intubated 28 patients from 40 admissions, and remained within our expanded critical care capacity. Conclusion Bradford’s protocol produced good results despite our population having high levels of co-morbidity and ethnicities associated with poor outcomes. In particular we avoided overloading critical care capacity. We advocate this approach as both effective and safe.
Emergent urinary decompression in acute stone-related urinary obstruction: A systematic review and meta-analysis
Authors: Hinojosa-Gonzalez David Eugenio , Torres-Martinez Mauricio , Villegas-De Leon Sergio Uriel , Galindo-Garza Cecilia , Roblesgil-Medrano Andres , Alanis-Garza Cordelia , Gonzalez-Bonilla Eduardo , Barrera-Juarez Eduardo , Flores-Villalba Eduardo 
Published: May 2021

Introduction: Emergent urinary decompression through percutaneous nephrostomy (PCN) or ureteric stent (URS) remains a mainstay in the management of urethral calculi-related obstruction with associated signs of infection or renal injury. Available evidence has shown similar performance, and current guidelines endorse both treatment strategies. Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analysis criteria up until August 2020. Studies included data on stone size and location, operative time, complications, length of stay, analgesic consumption, quality of life (QoL), and clinical outcomes between URS and PCN. Results: Ten studies with a total population of 772, of which 420 were treated with URS and 352 with PCN, were included. No statistical difference in operative time between both techniques was found. Nevertheless, length of stay in PCN was longer than in USR, with a mean difference of −1.87 days ((95% CI −2.69 to −1.06), Z=4.50, p=0.00001). No differences were found in the time to normalization of temperature or white blood cell counts. There were no significant differences in success rates, with an overall odds ratio (OR) of 0.60 ((95% CI 0.26 to −1.40), Z=1.17, p=0.24), or spontaneous passage after emergent drainage between groups. Complication rates ranged from 5% to 25% in URS and from 0% to 38% in PCN. In the studied population, out of the 157 patients from four studies describing complications, only 5% of URS procedures presented complications compared to 2% in PCN, showing a relatively low complication rate for either group (OR=2.07 (95% CI 0.89–4.84), Z=1.68, p=0.09). Differences in QoL were not significant. Conclusion: Both methods are equally effective, with no clear advantage for PCN over URS. Level of evidence: IV
Testing the accuracy of a novel digital peak flow meter aligned with a smartphone app compared to a lab spirometer: A pilot work
Authors: Sakkatos Panagiotis , Williams Andrew 
Published: May 2021

Background A new digital peak flow meter, known as Smart Peak Flow (SPF), has been developed to monitor asthma patients’ peak expiratory flow (PEF) at home. It is connected wirelessly to any type of smartphone and it is used by asthma patients to self-monitor progress of their clinical condition. Thus evaluation of the SPF’s ability to provide accurate PEF values is essential. The aim of this pilot work was to provide preliminary in-vivo data about the measurement agreement between the SPF and a lab spirometer for a first time. Methods PEF measurements were obtained by 9 healthy adults as this pilot work was terminated earlier than it was expected due to COVID-19 restrictions. PEF readings (n=27) were recorded by the comparable devices at the same time during three different expiratory maneuvers performed by each participant. The Bland and Altman plot was used to assess the agreement. Results Good agreement between the SPF and the lab spirometer was found with the mean bias being estimated 0.29 L/min. The lower and upper limits of agreement (LOA) were estimated 30.03 L/min and −30.61 L/min respectively. Conclusion Due to a small sample size, no firm conclusions can be drawn regarding the SPF’s accuracy. However the current promising results encourage further testing in the future.
Analysis of Sagittal Thoracic Inlet Measures in Relation to Anterior Access to the Cervicothoracic Junction
Authors: Baker Joseph F. 
Published: May 2021

Study Design: Retrospective radiographic study. Objective: The aim of this study was to define the association between thoracic inlet measures in relation to anterior access to the cervicothoracic junction. Methods: Trauma CT scans in patients >16 years were analyzed. The projection angle (PA), defined as the angle subtended by a line along the superior endplate of the vertebral body and the line from the anterosuperior corner of the vertebral body to the manubrium, was measured at C7, T1 and T2; angles were positive if the projection was above the manubrium. Thoracic inlet angle (TIA), thoracic inlet distance (TID) and pelvic incidence (PI) were measured. Results: 65 scans were assessed (33 males; mean age 47.7 years (s.d. 8.7)). The mean TIA 79.9° (s.d. 13.4°; range 52.6° – 112.2°), mean TID 66.1 mm (s.d. 6.6 mm) and mean PI was 50.5° (s.d. 10.2°). Mean values for the projection angles at C7, T1 and T2 were 24.2°, 7.6° and −8.3° respectively. PA were positive in 95% at C7, 73% at T1 and 30% at T2. PA at each level correlated significantly with age (mean r=−0.371; P = .015) and TIA (mean r=−0.916; P < .001) but neither TID nor PI. TIA correlated with age (r = 0.328; P = .008). Conclusions: The projection angles of the CTJ vertebrae are influenced by thoracic inlet angle and a lesser degree age. Understanding sagittal spinal parameters in the CTJ can aid in planning surgical strategy and approach.
Bony Stress and Its Association With Intervertebral Disc Degeneration in the Lumbar Spine: A Systematic Review of Clinical and Basic Science Studies
Authors: Chepurin Daniel , Chamoli Uphar , Diwan Ashish D. 
Published: May 2021

Study Design: Translational review encompassing basic science and clinical evidence. Objectives: Multiple components of the lumbar spine interact during its normal and pathological function. Bony stress in the lumbar spine is recognized as a factor in the development of pars interarticularis defect and stress fractures, but its relationship with intervertebral disc (IVD) degeneration is not well understood. Therefore, we conducted a systematic review to examine the relationship between bony stress and IVD degeneration. Methods: Online databases Scopus, PubMed and MEDLINE via OVID were searched for relevant studies published between January 1980-February 2020, using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Two authors independently analyzed the data, noting characteristics and biases in various studies. Results: Thirty-two articles were included in the review: 8 clinical studies, 9 finite element modeling studies, 3 in-vivo biomechanical testing studies, and 12 in-vitro biomechanical testing studies. Of the 32 articles, 19 supported, 4 rejected and 9 made no conclusion on the hypothesis that there is a positive associative relationship between IVD degeneration and bony stress. However, sufficient evidence was not available to confirm or reject a causal relationship. Conclusions: Most studies suggest that the prevalence of IVD degeneration increases in the presence of bony stress; whether a causal relationship exists is unclear. The literature recommends early diagnosis and clinical suspicion of IVD degeneration and bony stress. Longitudinal studies are required to explore causal relationships between IVD degeneration and bony stress.
Hypochlorous Acid 0.01% vs Povidone-Iodine 5% for Ocular Antisepsis
Authors: Hejkal Thomas W. , Maloley Lauren A. , Kaddoura Layan 
Published: May 2021

Purpose: An alternative ocular antiseptic is needed for patients who do not tolerate povidone-iodine (PI). The purpose of this study is to compare the antimicrobial effect of hypochlorous acid (HA) 0.01% with PI 5% applied topically to the ocular surface. Methods: Swabs of the inferior conjunctiva and posterior lower eyelid margin of 40 patients were taken from both eyes and plated onto blood agar plates. One eye was treated with HA and the other with PI, and swabs were taken after 1-minute exposure. The eye treated with PI was rinsed with sterile saline and another swab was taken. Colony-forming units (CFUs) were recorded after 2 days. Patients rated the level of irritation after treatment in each eye. Results: HA and PI both gave significant reduction in CFUs from baseline ( P < .001 for HA and P = .002 for PI). The mean reduction in logCFU ± 95% CI was 0.850 ± 0.387 or greater for HA and 0.749 ± 0.385 or greater for PI; this was equivalent to a mean reduction of 7.1-fold or greater or 86% or greater (95% CI, 66%-94%) for HA and 5.6-fold or greater or 82% or greater (95% CI, 57%-93%) for PI. CFUs increased in 17 eyes after saline rinse. PI caused substantial irritation in 31 of the 40 participants, whereas no individuals had any irritation from topical HA. Conclusions: Both HA and PI were effective in reducing ocular bacterial load. Unlike PI, HA was not irritating to the eye. Saline rinse after topical PI may increase bacterial counts in some individuals.
Focused ultrasound enhances the anesthetic effects of topical lidocaine in rats
Authors: Kim Hyun-Chul , Lee Wonhye , Böhlke Mark , Yoon Kyungho , Yoo Seung-Schik 
Published: May 2021

Abstract
Background
High-intensity ultrasound has been used to induce acoustic cavitation in the skin and subsequently enhances skin permeability to deliver hydrophobic topical medications including lidocaine. In contrast, instead of changing skin permeability, pulsed application of low-intensity focused ultrasound (FUS) has shown to non-invasively and temporarily disrupt drug-plasma protein binding, thus has potential to enhance the anesthetic effects of hydrophilic lidocaine hydrochloride through unbinding it from serum/interstitial α1-acid glycoprotein (AAG).

Methods
FUS, operating at fundamental frequency of 500 kHz, was applied pulse-mode (55-ms pulse duration, 4-Hz pulse repetition frequency) at a spatial-peak pulse-average intensity of 5 W/cm2. In vitro equilibrium dialysis was performed to measure the unbound concentration of lidocaine (lidocaine hydrochloride) from dialysis cassettes, one located at the sonication focus and the other outside the sonication path, all immersed in phosphate-buffered saline solution containing both lidocaine (10 µg/mL) and human AAG (5 mg/mL). In subsequent animal experiments (Sprague-Dawley rats, n = 10), somatosensory evoked potential (SSEP), elicited by electrical stimulations to the unilateral hind leg, was measured under three experimental conditions—applications of FUS to the unilateral thigh area at the site of administered topical lidocaine, FUS only, and lidocaine only. Skin temperature was measured before and after sonication. Passive cavitation detection was also performed during sonication to evaluate the presence of FUS-induced cavitation.

Results
Sonication increased the unbound lidocaine concentration (8.7 ± 3.3 %) from the dialysis cassette, compared to that measured outside the sonication path (P < 0.001). Application of FUS alone did not alter the SSEP while administration of lidocaine reduced its P23 component (i.e., a positive peak at 23 ms latency). The FUS combined with lidocaine resulted in a further reduction of the P23 component (in a range of 21.8 − 23.4 ms after the electrical stimulations; F(2,27) = 3.2 − 4.0, P < 0.05), indicative of the enhanced anesthetic effect of the lidocaine. Administration of FUS neither induced cavitation nor altered skin conductance or temperature, suggesting that skin permeability was unaffected.

Conclusions
Unbinding lidocaine from the plasma proteins by exposure to non-thermal low-intensity ultrasound is attributed as the main mechanism behind the observation.
American Society of Anesthesiologists Physical Status Classification as a reliable predictor of postoperative medical complications and mortality following ambulatory surgery: an analysis of 2,089,830 ACS-NSQIP outpatient cases
Authors: Foley Colin , Kendall Mark C. , Apruzzese Patricia , De Oliveira Gildasio S. 
Published: May 2021

Abstract
Background
Seventy percent of surgical procedures are currently performed in the outpatient setting. Although the American Society of Anesthesiologists (ASA) Physical Classification ability to predict risk has been evaluated for in-patient surgeries, an evaluation in outpatient surgeries has yet to be performed. The major goal of the current study is to determine if the ASA classification is an independent predictor for morbidity and mortality for outpatient surgeries.

Methods
The 2005 through 2016 NSQIP Participant Use Data Files were queried to extract all patients scheduled for outpatient surgery. ASA PS class was the primary independent variable of interest. The primary outcome was 30-day medical complications, defined as having one or more of the following postoperative outcomes: (1) deep vein thrombosis, (2) pulmonary embolism, (3) reintubation, (4) failure to wean from ventilator, (5) renal insufficiency, (6) renal failure, (7) stroke, (8) cardiac arrest, (9) myocardial infarction, (10) pneumonia, (11) urinary tract infection, (12) systemic sepsis or septic shock. Mortality was also evaluated as a separate outcome.

Results
A total of 2,089,830 cases were included in the study. 24,777 (1.19%) patients had medical complications and 1,701 (0.08%) died within 30 days. ASA PS IV patients had a much greater chance of dying when compared to healthy patients, OR (95%CI) of 89 (55 to 143), P < 0.001. Nonetheless, over 30,000 ASA PS IV patients had surgery in the outpatient setting. Multivariable analysis demonstrated a stepwise independent association between ASA PS class and medical complications (C statistic = 0.70), mortality (C statistic = 0.74) and readmissions (C statistic = 0.67). Risk stratifying ability was maintained across surgical procedures and anesthesia techniques.

Conclusions
ASA PS class is a simple risk stratification tool for surgeries in the outpatient setting. Patients with higher ASA PS classes subsequently developed medical complications or mortality at a greater frequency than patients with lower ASA PS class after outpatient surgery. Our results suggest that the ambulatory setting may not be able to match the needs of high-risk patients.
A systematic scoping review of approaches to teaching and assessing empathy in medicine
Authors: Zhou Yi Cheng , Tan Shien Ru , Tan Chester Guan Hao , Ng Matthew Song Peng , Lim Kia Hui , Tan Lorraine Hui En , Ong Yun Ting , Cheong Clarissa Wei Shuen , Chin Annelissa Mien Chew , Chiam Min , Chia Elisha Wan Ying , Lim Crystal , Wijaya Limin , Chowdhury Anupama Roy , Kwek Jin Wei , Fong Warren , Somasundaram Nagavalli , Ong Eng Koon , Mason Stephen , Krishna Lalit Kumar Radha 
Published: May 2021

AbstractBackgroundEmpathy is pivotal to effective clinical care. Yet, the art of nurturing and assessing empathy in medical schools is rarely consistent and poorly studied. To inform future design of programs aimed at nurturing empathy in medical students and doctors, a review is proposed.MethodsThis systematic scoping review (SSR) employs a novel approach called the Systematic Evidence Based Approach (SEBA) to enhance the reproducibility and transparency of the process. This 6-stage SSR in SEBA involved three teams of independent researchers who reviewed eight bibliographic and grey literature databases and performed concurrent thematic and content analysis to evaluate the data.ResultsIn total, 24429 abstracts were identified, 1188 reviewed, and 136 included for analysis. Thematic and content analysis revealed five similar themes/categories. These comprised the 1) definition of empathy, 2) approaches to nurturing empathy, 3) methods to assessing empathy, 4) outcome measures, and 5) enablers/barriers to a successful curriculum.ConclusionsNurturing empathy in medicine occurs in stages, thus underlining the need for it to be integrated into a formal program built around a spiralled curriculum. We forward a framework built upon these stages and focus attention on effective assessments at each stage of the program. Tellingly, there is also a clear need to consider the link between nurturing empathy and one’s professional identity formation. This foregrounds the need for more effective tools to assess empathy and to better understand their role in longitudinal and portfolio based learning programs.