bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective Evaluation of the First Mitomycin C Augmented Needle Revision in Patients With Failed Nonpenetrating Deep Sclerectomy
Authors: Gutiérrez-Ortiz Consuelo , Moreno-Salgueiro Agustín , Rodrigo-Rey Sara , González-Mesa Ana , Pérez-Rico Consuelo 
Published: January 2021

Precis:
At 6 months the procedure achieved a 33.89% drop in intraocular pressure (IOP), had an overall success rate of 57.15%, and did not change the best-corrected visual acuity. Achieving <8 mm Hg of IOP the day after the procedure may be a prognostic success indicator.

Purpose:
The purpose of this study was to evaluate the first mitomycin C (MMC)-augmented needle revision in patients with failed nonpenetrating deep sclerectomy (NPDS) and factors associated with its success.

Materials and Methods:
This prospective, nonrandomized comparative trial included 21 consecutive patients (21 eyes) who underwent their first MMC needling revision of failed NPDS blebs. The success was defined as absolute if the IOP decreased >20% from the preoperative value without antiglaucoma treatment and as qualified if that level was achieved with antiglaucoma medications. Preoperative and postoperative factors were evaluated for an association with postoperative success using Kaplan-Meier analysis.

Results:
A significant reduction in mean IOP from preoperative levels was evident at the end of the follow-up. The overall surgical success rate was 57.15%. On the basis of Kaplan-Meier survival analysis, we found that patients whose IOP on the following day of the procedure was <8 mm Hg had a higher success rate than those whose 1-day postoperative IOP was higher. These patients had a percentage of success of 100%, 84.6%, and 76.9% at 1-, 3-, and 6-month postoperative follow-up, respectively.

Conclusion:
The IOP level on the first postoperative day could be considered a prognostic indicator of success in needling revision performed in failed NPDS.
The role of albumin–bilirubin grade in determining the outcomes of patients with very early-stage hepatocellular carcinoma
Authors: Chang Chung-Yu , Wei Cheng-Yi , Chen Ping-Hsien , Hou Ming-Chih , Chao Yee , Chau Gar-Yang , Lee Rheun-Chuan , Huang Yi-Hsiang , Su Yu-Hui , Wu Jaw-Ching , Su Chien-Wei 
Published: January 2021

Background:
Patients with hepatocellular carcinoma (HCC) and with a single tumor <2 cm in size are classified as having Barcelona Clinic Liver Cancer (BCLC) stage 0 HCC. We aimed to investigate the role of the albumin–bilirubin (ALBI) grade in predicting outcomes in patients with BCLC stage 0 HCC.

Methods:
We retrospectively enrolled patients with BCLC stage 0 HCC in Taipei Veterans General Hospital from 2007 to 2015. Prognostic factors were analyzed using a Cox proportional hazards model and propensity score matching (PSM) analysis.

Results:
There were 420 patients enrolled, including 207 with ALBI grade 1, and 213 with ALBI grade 2 or 3. After a median follow-up of 60.0 months (interquartile range, 37.2–84.6 months), 179 patients died. The cumulative 5-year overall survival (OS) rates were 80.6% in patients with ALBI grade 1 and 53.7% in those with ALBI grade 2 or 3, respectively (p < 0.001). Multivariate analysis showed that age >65 years, negative hepatitis B surface in serum, creatinine >1.0 mg/dL, platelet count ≤105/mm3, tumor size >1.5 cm, nonsurgical resection (SR) therapy, and higher ALBI grade were independent risk factors related to poor OS. Patients who underwent SR had a better OS and recurrence-free survival than those who received radiofrequency ablation, which was confirmed by a multivariate analysis and PSM analysis.

Conclusion:
The ALBI grade can determine OS for patients with BCLC stage 0 HCC. SR can also provide a better outcome than nonsurgical treatment.
The differences in nurses’ willingness to discuss palliative care with patients and their family members
Authors: Lin Yi-Hsuan , Lin Ming-Hwai , Chen Chun-Ku , Yang Che , Chuang Ya-Ting , Shyu Chuen-Huei , Lin Huei-Jin , Chen Hui-Fang , Yang Wan-Ling , Chen Ya-Jyun , Chen Tzeng-Ji , Hwang Shinn-Jang , Chang Hsiao-Ting 
Published: January 2021

Background:
This study aimed to evaluate the differences in nurses’ willingness to discuss palliative care with terminally ill patients and their family members.

Methods:
The participants were randomly recruited from registered staff nurses ≥20 years of age who were responsible for clinical inpatient care in a tertiary hospital in northern Taiwan. A semi-structured questionnaire was administered to evaluate nurses’ experiences of discussing do-not-resuscitate (DNR) decisions and their willingness to discuss palliative care with terminal patients and their family members. The differences in nurses’ experiences regarding DNR and willingness to discuss palliative care with terminally ill patients and their family members were compared using the Chi-square test. Logistic regressions were used to analyze factors associated with nurses’ willingness to discuss palliative care with patients and their families.

Results:
More participants had experienced initiating discussions about DNR with patients’ families than with patients (72.2% vs 61.9%, p < 0.001). Unadjusted logistic regression analysis showed that the experiences of actively initiating DNR discussions with patients were a significant factor associated with palliative care discussion with patients (odds ratio [OR] = 2.91, 95% confidence interval [CI]: 1.09–7.79). On the other hand, the experiences of actively initiating DNR discussions with patients and with patients’ families were significant factors associated with palliative care discussion with patients’ families (OR = 3.84, 95% CI: 1.22–12.06 and OR = 3.60, 95% CI: 1.19–10.90, respectively). After adjusting for covariates, no significant factors were found to be independently associated with nurses’ willingness to discuss palliative care with patients and their family members.

Conclusion:
There are significant differences in nurses’ willingness to discuss palliative care with patients and their family members. Further research is needed to evaluate factors associated with nurses’ willingness to discuss palliative care with patients and their families to facilitate these discussions and protect patients’ autonomy.
The Role of Organizational Slack in Buffering Financially Distressed Hospitals from Market Exits
Authors: Puro Neeraj , Borkowski Nancy , Feyereisen Scott , Hearld Larry , Carroll Nathaniel , Byrd James , Smith Dean , Ghiasi Akbar 
Published: January 2021

EXECUTIVE SUMMARY
Financial distress is a persistent problem in U.S. hospitals, leading them to close at an alarming rate over the past two decades. Given the potential adverse effects of hospital closures on healthcare access and public health, interest is growing in understanding more about the financial health of U.S. hospitals. In this study, we set out to explore the extent to which relevant organizational and environmental factors potentially buffer financially distressed hospitals from closure, and even at the brink of closure, enable some to merge with other hospitals. We tested our hypotheses by first examining how factors such as slack resources, environmental munificence, and environmental complexity affect the likelihood of survival versus closing or merging with other organizations. We then tested how the same factors affect the likelihood of merging relative to closing for financially distressed hospitals that undergo one of these two events. We found that different types of slack resources and environmental forces impact different outcomes. In this article, we discuss the implications of our findings for hospital stakeholders.
COVID-19 Risk Management and Emotional Reactions to COVID-19 Among School Teachers in Denmark
Authors: Nabe-Nielsen Kirsten , Fuglsang Nina Vibe , Larsen Inge , Nilsson Charlotte Juul 
Published: January 2021

Objectives:
We explored teachers’ emotional reactions to the COVID-19 pandemic, and the association between COVID-19 risk management and these emotional reactions.

Methods:
We used cross-sectional data from 2665 teachers working at public schools. Participants responded to a questionnaire in May 2020. The analyses were adjusted for sex, age, cohabitation, and region.

Results:
Knowledge about adequate test behavior and feeling secure regarding colleagues’ actions to hinder spread of virus were associated with less frequent emotional reactions. Lack of access to personal protective equipment and exposure to infected pupils, parents or colleagues were associated with more frequent emotional reactions.

Conclusion:
Similar to other groups of frontline employees, teachers experience negative emotional reactions to the COVID-19 pandemic. Gaining knowledge about teachers’ worries and fears during pandemics is an important first step enabling leaders and occupational health professionals to address these.
“This Is Me!” Perceptions of Older Adult Simulated Participants in an Aging and Injury Simulation Experience
Authors: Lee Deborah A. , Maxwell Cathy A. , Miller Sally 
Published: January 2021

Background:
Older adults played the role of frail and prefrail geriatric trauma patients in a frailty-focused communication workshop for nurses. Although subjects played a role (acting) as simulated participants (SPs) for simulation, workshop content and role-play also applied to them personally. We aimed to explore the effect that learning frailty-focused content, scripts, and portrayal of prefrail and frail older adults has on older adult SPs.

Methods:
Qualitative focus group. Participants included older adults older than 70 years (N = 6).

Procedure:
Focus group questions pertained to (1) the SP experience, (2) thoughts and emotions throughout the SP experience, and (3) applicability of workshop content and SP experience to personal life. The focus group lasted 90 min, was digitally recorded, and transcribed verbatim. Authors independently coded transcripts to identify categories and supporting quotations. Categories and subcategories were condensed and modified through iterative discussions. Descriptive content analysis was utilized for data analysis.

Results:
Six categories and 2 subcategories emerged, including (1) inevitability of aging: not playing a role (sub: inevitability of death), (2) shifting perceptions: how aging impacts thought and actions, (3) time as a factor: getting information sooner, (4) changing behavior/safety: mental recalibration, (5) attitude as a determining factor (sub: loss of independence), and (6) sharing information with others.

Conclusion:
The study supports the use of frailty-focused communication with older adults to prompt contemplation of aging and frailty and eventual decline/death. Providing information earlier in the aging trajectory enables time for behavior change that can prevent and delay frailty and mitigate untoward outcomes (falls, hospitalizations).
Burnout and Anxiety Among Trauma Nursing Specialties in a Rural Level I Trauma Center
Authors: Cook Alan , Sigler Carly , Allen LaDonna , Peters Jo Ann , Guthrie Christiana , Marroquin Michele , Ndetan Harrison , Singh Karan P. , Murry Jason , Norwood Scott , Philley Julie V. 
Published: January 2021

Background:
Burnout and anxiety compromise physical and mental well-being of nurses and jeopardize patient safety. Personal, professional, and workplace characteristics have been associated with burnout and anxiety across diverse practice settings, yet none in rural, community trauma centers. We sought to identify the severity and predictors of burnout and anxiety in the trauma nursing staff of a rural Level I trauma center.

Methods:
A convenience sample of trauma nurses from the emergency department (ED), intensive care unit (ICU), and trauma ward was voluntarily surveyed using a demographic questionnaire, the Maslach Burnout Inventory (MBI) subscales: depersonalization (DP), emotional exhaustion (EE), and reduced personal accomplishment, as well as the Generalized Anxiety Disorder seven-item (GAD-7) scale. Multivariable linear regression identified the significant predictors of burnout and anxiety.

Results:
Ninety-six nurses completed surveys (response rate: 83.5%). Married or divorced status, and ICU or trauma ward job assignments were associated with significantly lower adjusted DP scores. Thus, the model-predicted score for a single ED nurse was 15 versus a predicted score of 7 for a divorced ICU or trauma ward nurse, p < .001 for each group. The GAD-7 model demonstrated that race/ethnicity (Asian compared with White, coefficient: −5.06, p = .03), number of children (2 compared with 0, coefficient: −2.54, p = .02), and job tenure (5–10 years vs. <2, coefficient: −3.18, p = .01) were each associated with fewer GAD-7 points.

Conclusion:
Depersonalization and anxiety vary across the trauma nursing workforce based on identifiable personal and work-related risk factors. Group-specific, targeted interventions are needed to effectively reduce burnout and anxiety in trauma nursing staff.
Nurse-Driven Universal Concussion Screening: A Quality Improvement Initiative
Authors: Downie Katie , Cunningham Aaron , Jafri Mubeen 
Published: January 2021

Background:
The purpose of this study was to provide an evaluation of a performance improvement initiative that operationalized universal concussion screening for all pediatric trauma admissions at a Level I pediatric trauma center. Mild traumatic brain injury may be difficult to identify in injured children. We implemented a screening tool to identify the risk for concussion after traumatic injury and to improve access to cognitive evaluation and intervention in children. Prior to implementation of our screening tool, children admitted without obvious head injury or those younger than 12 years were not being screened for concussion risk.

Methods:
We employed a nurse-driven screening tool, derived from the Centers for Disease Control and Prevention Acute Concussion Evaluation, on all pediatric trauma patients ages 0–17 years. The screening tool identifies symptoms of physical, cognitive, sleep, or emotional deficits and prompts a cognitive evaluation with concussion education. The tool was administered by nursing and tracked in the electronic medical record.

Results:
Key stakeholders were interviewed to identify workflow barriers and education gaps following implementation. Enhancements to the electronic medical record and refocused nursing education improved compliance from 41% in the first 12 months to 91% at 24 months post-implementation (p < .001). The increasing number of evaluations additionally resulted in overall more cognitive evaluations as an initial step in identifying and treating previously unrecognized traumatic brain injury.

Conclusions:
A pediatric concussion screening tool is simple to administer, applies to all developmental ages, and improves diagnostic capture of traumatic brain injury in pediatric trauma when administered by nurses with support through the electronic medical record.
Coronary artery calcium score and risk of cardiovascular events without established coronary artery disease: a systemic review and meta-analysis
Authors: Abuzaid Ahmed , Saad Marwan , Addoumieh Antoine , Ha Le Dung , Elbadawi Ayman , Mahmoud Ahmed N. , Elgendy Akram , Abdelaziz Hesham K. , Barakat Amr F. , Mentias Amgad , Adeola Oluwaseun , Elgendy Islam Y. , Qasim Atif , Budoff Matthew 
Published: January 2021

Background
Coronary artery calcium (CAC) is an indicator of atherosclerosis, and the CAC score is a useful noninvasive assessment of coronary artery disease.

Objective
To compare the risk of cardiovascular outcomes in patients with CAC > 0 versus CAC = 0 in asymptomatic and symptomatic population in patients without an established diagnosis of coronary artery disease.

Methods
A systematic search of electronic databases was conducted until January 2018 for any cohort study reporting cardiovascular events in patients with CAC > 0 compared with absence of CAC.

Results
Forty-five studies were included with 192 080 asymptomatic 32 477 symptomatic patients. At mean follow-up of 11 years, CAC > 0 was associated with an increased risk of major adverse cardiovascular and cerebrovascular events (MACE) compared to a CAC = 0 in asymptomatic arm [pooled risk ratio (RR) 4.05, 95% confidence interval (CI) 2.91–5.63, P < 0.00001, I
2 = 80%] and symptomatic arm (pooled RR 6.06, 95% CI 4.23–8.68, P < 0.00001, I
2 = 69%). CAC > 0 was also associated with increased risk of all-cause mortality in symptomatic population (pooled RR 7.94, 95% CI 2.61-24.17, P < 0.00001, I
2 = 85%) and in asymptomatic population CAC > 0 was associated with higher all-cause mortality (pooled RR 3.23, 95% CI 2.12–4.93, P < 0.00001, I
2 = 94%). In symptomatic population, revascularization in CAC > 0 was higher (pooled RR 15, 95% CI 6.66–33.80, P < 0.00001, I
2 = 72) compared with CAC = 0. Additionally, CAC > 0 was associated with more revascularization in asymptomatic population (pooled RR 5.34, 95% CI 2.06–13.85, P = 0.0006, I
2 = 93). In subgroup analysis of asymptomatic population by gender, CAC > 0 was associated with higher MACE (RR 6.39, 95% CI 3.39–12.84, P < 0.00001).

Conclusion
Absence of CAC is associated with low risk of cardiovascular events compared with any CAC > 0 in both asymptomatic and symptomatic population without coronary artery disease.
Nutrition in the critically ill surgical patient
Authors: Puzio Thaddeus J. , Kozar Rosemary A. 
Published: January 2021

Purpose of reviewThe aim of this study was to discuss recent findings related to providing adequate and well tolerated nutrition to the critically ill surgical patient.Recent findingsThe majority of nutritional studies in the critically ill have been performed on well nourished patients, but validated scoring systems can now identify high nutrition risk patients. Although it remains well accepted that early enteral nutrition with protein supplementation is key, mechanistic data suggest that hypocaloric feeding in septic patients may be beneficial. For critically ill patients unable to tolerate enteral nutrition, randomized pilot data demonstrate improved functional outcomes with early supplemental parenteral nutrition. Current guidelines also recommend early total parenteral nutrition in high nutrition risk patients with contraindications to enteral nutrition. When critically ill patients require low or moderate-dose vasopressors, enteral feeding appears well tolerated based on a large database study, while randomized prospective data showed worse outcomes in patients receiving high-dose vasopressors.SummaryCurrent evidence suggests early enteral nutrition with protein supplementation in critically ill surgical patients with consideration of early parenteral nutrition in high nutrition risk patients unable to achieve nutrition goals enterally. Despite established guidelines for nutritional therapy, the paucity of data to support these recommendations illustrates the critical need for additional studies.
New imaging techniques in AKI
Authors: Selby Nicholas M. , Duranteau Jacques 
Published: January 2021

Purpose of review
Acute kidney injury (AKI) is a common complication in critically ill patients. Understanding the pathophysiology of AKI is essential to guide patient management. Imaging techniques that inform the pathogenesis of AKI in critically ill patients are urgently needed, in both research and ultimately clinical settings. Renal contrast-enhanced ultrasonography (CEUS) and multiparametric MRI appear to be the most promising imaging techniques for exploring the pathophysiological mechanisms involved in AKI.

Recent findings
CEUS and MRI can be used to noninvasively and safely evaluate renal macrocirculation and microcirculation and oxygenation in critical ill patients. These techniques show that a decrease in renal blood flow, particularly cortical blood flow, may be observed in septic AKI and may contribute to its development. MRI may be a valuable method to quantify long-term renal damage after AKI that cannot currently be detected using standard clinical approaches.

Summary
CEUS and multiparametric renal MRI are promising imaging techniques but more evidence is needed to show how they can first be more widely used in a research setting to test key hypotheses about the pathophysiology and recovery of AKI, and then ultimately be adopted in clinical practice to guide patient management.
Real-time glomerular filtration rate: improving sensitivity, accuracy and prognostic value in acute kidney injury
Authors: Schneider Antoine G. , Molitoris Bruce A. 
Published: January 2021

Purpose of review
Acute kidney injury (AKI) is common and associated with high patient mortality, and accelerated progression to chronic kidney disease. Our ability to diagnose and stratify patients with AKI is paramount for translational progress. Unfortunately, currently available methods have major pitfalls. Serum creatinine is an insensitive functional biomarker of AKI, slow to register the event and influenced by multiple variables. Cystatin C, a proposed alternative, requires long laboratory processing and also lacks specificity. Other techniques are either very cumbersome (inuline, iohexol) or involve administration of radioactive products, and are therefore, not applicable on a large scale.

Recent findings
The development of two optical measurement techniques utilizing novel minimally invasive techniques to quantify kidney function, independent of serum or urinary measurements is advancing. Utilization of both one and two compartmental models, as well as continuous monitoring, are being developed.

Summary
The clinical utility of rapid GFR measurements in AKI patients remains unknown as these disruptive technologies have not been tested in studies exploring clinical outcomes. However, these approaches have the potential to improve our understanding of AKI and clinical care. This overdue technology has the potential to individualize patient care and foster therapeutic success in AKI.
Prevention, diagnosis, and management of venous thromboembolism in the critically ill surgical and trauma patient
Authors: Torres Crisanto , Haut Elliott R. 
Published: January 2021

Purpose of review
Venous thromboembolism (VTE), which encompasses deep vein thrombosis and pulmonary embolism, is common among trauma patients and critically ill surgical patients admitted to the ICU. Critical care surgical patients are at an extremely high risk for VTE and the related morbidity and mortality associated with it. The present review aims to provide an overview of the importance of identifying risk factors, prescribing effective prohylaxis, accurate diagnosis, and timely appropriate treatment for trauma and critically ill surgical patients with VTE in the ICU.

Recent findings
VTE is a healthcare burden among critically ill surgical patients that is mostly preventable through adherence to prophylactic protocols that aim to recognize VTE risk factors while simultaneously providing guidance to appropriate timing and administration prophylaxis regimens. Newer pharmacologic therapies for prophylaxis and treatment, diagnostic modalities, and indications for therapy of VTE have continued to evolve.

Summary
Critical care surgical and trauma patients represent a population that are at a heightened risk for VTE and associated complications. Appropriate screening, prevention strategies, accurate diagnosis, and timely administration of appropriate treatment must be utilized to reduce morbidity and mortality.