bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intravenous Patient-controlled Analgesia Versus Thoracic Epidural Analgesia After Open Liver Surgery
Authors: Hausken John , Fretland Åsmund Avdem , Edwin Bjørn , Andersen Marit Helen , Dagenborg Vegar Johansen , Bjørnelv Gudrun Maria Waaler , Kristiansen Ronny , Røysland Kjetil , Kvarstein Gunnvald , Tønnessen Tor Inge 
Published: January 2019

Objective:
We conducted a randomized, controlled, noninferiority trial to investigate if intravenous, multimodal, patient-controlled analgesia (IV-PCA) could be noninferior to multimodal thoracic epidural analgesia (TEA) in patients undergoing open liver surgery.

Summary Background Data:
The increasing use of minimally invasive techniques and fast track protocols have questioned the position of epidural analgesia as the optimal method of pain management after abdominal surgery.

Methods:
Patients operated with open liver resection between February 2012 and February 2016 were randomly assigned to receive either IV-PCA enhanced with ketorolac/diclofenac (IV-PCA, n = 66) or TEA (n = 77) within an enhanced recovery after surgery protocol. Noninferiority would be declared if the mean pain score on the numeric rating scale (NRS) for postoperative days (PODs) 0 to 5 in the IV-PCA group was no worse than the mean pain score in the TEA group by a margin of <1 point on an 11-point scale (0–10).

Results:
The primary endpoint, mean NRS pain score was 1.7 in the IV-PCA group and 1.6 in the TEA group, establishing noninferiority. Pain scores were lower in the TEA group on PODs 0 and 1, but higher or equal on PODs 2 and 5. Postoperative hospital stay was significantly shorter for patients in the IV-PCA group (74 vs 104 h, P < 0.001). The total opioid consumption during the first 3 days was significantly lower in the IV-PCA group.

Conclusions:
IV-PCA was noninferior to TEA for the treatment of postoperative pain in patients undergoing open liver resection.
Best practices on team communication: interprofessional practice in oncology
Authors: D’Alimonte Laura , McLaney Elizabeth , Di Prospero Lisa 
Published: January 2019

Purpose of review
Good communication is the cornerstone of interprofessional care teams providing optimized quality patient care. Over the last decade, advances in technology have provided tools to improve communication; however, opportunities still exist for innovation and implementation.

Recent findings
The literature suggests that interprofessional education and assessment of team communication are fundamental in supporting collaborative care. The literature favours an interactive, team-based approach (e.g. simulation) to learning about communication, in which communication competencies and behaviours are practiced explicitly in an open, feedback-rich environment.

Summary
Key elements of excellence in communication are embedded in three priority recommendations: first, the team must adopt a practice strategy that leverages accessible and timely communication second, the team must be open to initial and ongoing training within the domain of ‘effective communication’ third, communication must be the cornerstone to producing a high-performing team that will provide the best care possible.
The role of splanchnic congestion and the intestinal microenvironment in the pathogenesis of advanced heart failure
Authors: Polsinelli Vincenzo B. , Marteau Lara , Shah Sanjiv J. 
Published: January 2019

Purpose of review
Right-sided heart failure, which is often present in the setting of advanced heart failure, is associated with cardiac cachexia, the cardiorenal syndrome, and adverse outcomes. Improved understanding of venous congestion of the splanchnic circulation, which may play a key role in the pathogenesis of right-sided heart failure, could lead to novel therapeutics to ameliorate heart failure. Here we provide an overview of right-sided heart failure, splanchnic hemodynamics, fluid homeostasis, and the intestinal microenvironment. We review recent literature to describe pathophysiologic mechanisms and possible therapeutics.

Recent findings
Several possible mechanisms centered around upregulation of sodium–hydrogen exchanger-3 (NHE3) may form a causal link between right ventricular dysfunction, splanchnic congestion, and worsening heart failure. These include an anaerobic environment in enterocytes, resulting in reduced intracellular pH; increased sodium absorption by the gut via NHE3; decreased pH at the intestinal brush border thus altering the gut microbiome profile; increased bacterial synthesis of trimethylamine N-oxide; and decreased bacterial synthesis of short-chain fatty acids causing abnormal intestinal barrier function.

Summary
Splanchnic congestion in the setting of right-sided heart failure may serve an important role in the pathogenesis of advanced heart failure, and further exploration of these mechanisms may lead to new therapeutic advances.
Lessons Learned From a Review of Malpractice Litigations Involving Obstetric Anal Sphincter Injury in the United States
Authors: Kim Edward K. , Lovejoy David A. , Patterson Danielle , Handa Victoria L. 
Published: January 2019

Objective
The aim of this article is to review all litigations involving obstetric anal sphincter injury (OASIS) in the United States to highlight the most common allegations and factors that aided the involved obstetricians and gynecologists (ob/gyns).

Methods
We used Lexis Nexis, a comprehensive legal database, to search all publicly available high-profile federal and state level litigations related to OASIS.

Results
Of 68 cases that resulted and reviewed, 19 were deemed to be pertinent to the question being addressed. These 19 cases occurred between 1964 and 2011 and all alleged medical negligence. Among these 19 cases, 6 were ruled in favor of the plaintiffs, with most of them being awarded an amount ranging from US $110,000 to US $841,810.80. All 6 cases involved episiotomy. Thorough medical recordkeeping, comprehensive discharge instructions and counseling, and timely evaluation and referral to a female pelvic medicine and reconstructive surgery specialist were the key factors that aided the ob/gyns facing these litigations.

Conclusions
Avoidance of episiotomy, thorough medical recordkeeping, comprehensive discharge instruction and counseling, and timely evaluation and referral to a female pelvic medicine and reconstructive surgery specialist may help an ob/gyn prevail in OASIS-related litigations.
Urinary Incontinence and Pelvic Organ Prolapse Knowledge, Care-Seeking, and Embarrassment in Women Planning Bariatric Surgery: A Cross-sectional Study
Authors: Paka Chandhana , Hallock Jennifer L. , Trock Bruce , Steele Kimberley , James Wright E. 
Published: January 2019

Objective
The objective of this study was to assess whether patients seeking bariatric surgery were at least as proficient in urinary incontinence (UI) and pelvic organ prolapse (POP) knowledge as the general population. Our secondary objective was to determine care-seeking and impact of embarrassment on knowledge of pelvic floor disorders (PFDs).

Methods
An anonymous survey was administered to adult women who attended a bariatric surgery information session from May 2015 to January 2016. The comprehensive survey included multiple data points and the Prolapse and Incontinence Knowledge Quiz. The study population was compared with a general population described in a previously published study.

Results
Three hundred fifteen participants completed the survey (88% response rate). Mean ± SD age was 41.1 ± 11.3 years (range, 18–69 years), and mean body mass index was 47.4 ± 9.6 kg/m2 (range, 26.7–104.5 kg/m2). A total of 196 women (62.2%) had at least one bothersome PFD symptom. The study population was at least as proficient in UI knowledge as the general population (P < 0.0001), but not for POP knowledge (P < 0.946). Among participants with symptomatic PFD, 91.7% of those with UI symptoms and 70% of those with POP symptoms reported that they would seek care. There was a difference in knowledge proficiency between women who were and were not embarrassed to discuss UI (P = 0.77) or POP (P = 0.99).

Conclusions
The study population demonstrated less POP knowledge than the general population, but not for UI knowledge. A high proportion of women with UI or POP symptoms would seek care, but embarrassment to discuss UI or POP negatively impacted knowledge.
Lower Urinary Tract Symptoms in a Chronic Pelvic Pain Population
Authors: Sammarco Anne G. , Kobernik Emily K. , Haefner Hope K. , Till Sara R. , Berger Mitchell B. 
Published: January 2019

Objectives
This study aimed to characterize the prevalence of lower urinary tract symptoms in a chronic pain population.

Methods
In this observational cohort study, patients referred to a female pelvic pain clinic completed several validated questionnaires assessing bladder symptoms, central sensitization, pain symptoms, depression, anxiety, and neuropathic pain. Patients diagnosed as having interstitial cystitis were excluded. Patient demographic characteristics and survey responses were compared across American Urological Association Symptom Index (AUA-SI) severity categories. Multivariable logistic regression was performed to identify independent predictors of moderate-to-severe AUA-SI scores.

Results
A total of 177 patients were included in the analysis. American Urological Association Symptom Index data showed that 48.8% of patients had mild, 31.2% had moderate, and 20.0% had severe symptoms. Patients reporting moderate or severe AUA-SI scores had higher mean Central Sensitization Inventory (CSI) scores (46.7 ± 16.0 vs 32.9 ± 13.8, P < 0.0001), McGill scores (median, 25 [interquartile range, 16–38] vs 13 [5–27]; P = 0.0003), Patient-Reported Outcomes Measurement Information System depression T-scores (median, 53.9 [interquartile range, 46.2–61.6] vs 51.2 [37.1–55.3]; P = 0.009), Pelvic Pain and Urgency/Frequency Symptoms Scale scores (18.4 ± 6.2 vs 12.5 ± 5.4, P < 0.0001), and Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs scores (median, 10.5 [interquartile range, 3.0–16.5] vs 6.0 [1.0–12.0]; P = 0.02). The odds of moderate-to-severe AUA-SI symptoms were higher with a positive PUF and CSI score and were lower with a diagnosis of vestibular pain.

Conclusions
There is a high prevalence of lower urinary tract symptoms among patients with chronic pelvic pain. Vestibulodynia was associated with lower odds of bladder symptoms. High PUF and CSI scores were significantly associated with moderate-to-severe bladder symptoms.
Gel-Infused Translabial Ultrasound in the Evaluation of Female Urethral Stricture
Authors: Sussman Rachael D. , Kozirovsky Mariana , Telegrafi Shpetim , Peyronnet Benoit , Palmerola Ricardo , Smilen Scott , Pape Dominique M. , Rosenblum Nirit , Nitti Victor W. , Brucker Benjamin M. 
Published: January 2019

Objectives
The aims of this study were to describe our technique of gel-infused translabial ultrasound (GITLUS) to assess the female urethra for stricture and to highlight its utility when compared with other diagnostic techniques.

Methods
Consecutive patients presenting with prior diagnosis and/or suspicion for female urethral stricture underwent evaluation with uroflowmetry, postvoid residual, video urodynamics, and cystoscopy at the surgeon's discretion. All patients underwent GITLUS; 8-MHz curvilinear and 6-MHz linear high-frequency transducers were used to image the urethra from meatus to bladder neck while instilling 20 mL of lidocaine jelly to distend the urethra. Stricture location, length, caliber, and presence of periurethral fibrosis were assessed. Two healthy volunteers underwent GITLUS to serve as a comparison.

Results
Eight patients with suspected stricture underwent GITLUS. In all cases, GITLUS identified and characterized stricture and demonstrated periurethral fibrosis. Two healthy volunteers underwent GITLUS, which demonstrated a patent urethra and no evidence of fibrosis. Cystoscopy and video urodynamics on patients with stricture did not perform as well at identifying and fully assessing strictures. Six patients underwent definitive surgical repair, and GITLUS findings were confirmed. One patient had a postoperative GITLUS demonstrating resolution of the stricture and periurethral fibrosis.

Conclusions
Gel-infused translabial ultrasound is a novel and accurate technique that in this small series appeared to identify and further characterize female urethral stricture in cases where it was utilized. Further research is needed to determine its role in preoperative planning and in providing a definitive diagnosis of stricture when other studies are equivocal.
Blunt small bowel perforation (SBP): An Eastern Association for the Surgery of Trauma multicenter update 15 years later
Authors: Fakhry Samir M. , Allawi Ahmed , Ferguson Pamela L. , Michetti Christopher P. , Newcomb Anna B. , Liu Chang , Brownstein Michelle R. 
Published: January 2019

BACKGROUND
Previous work demonstrated diagnostic delays in blunt small bowel perforation (SBP) with increased mortality and inability of scans to reliably exclude the diagnosis. We conducted a follow-up multicenter study to determine if these challenges persist 15 years later.

METHODS
We selected adult cases with blunt injury, International Classification of Diseases, Ninth Revision or current procedural terminology (CPT) indicating small bowel surgery, no other major injury and at least one abdominal computed tomography (CT) within initial 6 hours. Controls had blunt trauma with abdominal CT but not SBP. After institutional review board approval, data from each center were collected and analyzed.

RESULTS
Data from 39 centers (from October 2013 to September 2015) showed 127,919 trauma admissions and 94,743 activations. Twenty-five centers were Level 1. Centers submitted 77 patients (mean age, 39; male, 68%; mean length of stay, 11.3 days) and 131 controls (mean age, 44; male, 64.9%; length of stay, 3.6 days). Small bowel perforation cases were 0.06% of admissions and 0.08% of activations. Mean time to surgery was 8.7 hours (median, 3.7 hours). Initial CT showed free air in 31 cases (43%) and none in controls. Initial CT was within normal in three cases (4.2%) and 84 controls (64%). Five cases had a second scan; two showed free air (one had an initial normal scan). One death occurred among the patients (mortality, 1.4%; and time to surgery, 16.9 hours). Regression analysis showed sex, abdominal tenderness, distention, peritonitis, bowel wall thickening, free fluid, and contrast extravasation were significantly associated with SBP.

CONCLUSIONS
Blunt SBP remains relatively uncommon and continues to present a diagnostic challenge. Trauma centers have shortened time to surgery with decreased case mortality. Initial CT scans continue to miss a small number of cases with potentially serious consequences. We recommend (1) intraperitoneal abnormalities on CT scan should always evoke high suspicion and (2) strong consideration of additional diagnostic/therapeutic intervention by 8 hours after arrival in patients who continue to pose a clinical challenge.

LEVEL OF EVIDENCE
Observational study, level III.
Extracorporeal potassium binding for the management of hyperkalemia in an anephric model of crush injury
Authors: Hoareau Guillaume L. , Beyer Carl A. , Wilson Christopher , Kashtan Harris , Wishy Andrew , Grayson J. Kevin , Walker Lauren , Ross James D. , Stewart Ian J. 
Published: January 2019

BACKGROUND
Potassium-binding polymers have shown promising results in an anephric porcine hyperkalemia model. The benefits of the polymer in a clinically relevant injury model remain unknown. We hypothesized that potassium-binding cartridges would control serum potassium concentration in a porcine hemorrhagic shock model with supraceliac aortic occlusion and a limb crush injury.

METHODS
Ten Yorkshire-cross swine were anesthetized and instrumented. Pigs underwent splenectomy and bilateral nephrectomy. Hemorrhagic shock was induced for 30 minutes while a leg compression device was applied. Pigs underwent supraceliac aortic occlusion for 60 minutes and were resuscitated with shed blood. The leg compression device was removed 20 minutes after balloon deflation. After 20 minutes of reperfusion, animals were randomized to extracorporeal circulation with (treatment) or without (control) the potassium binding cartridges. In both groups, blood was circulated through a hemodialyzer with a peristaltic pump. In the treatment group, the ultrafiltrate was diverted from the hemodialyzer through cartridges containing the polymer and returned to the extracorporeal circuit. Animals were resuscitated with 0.9% saline boluses and a norepinephrine infusion. The change in serum potassium concentration (ΔK) was calculated as serum [K+]T390 − serum [K+]T0.

RESULTS
There was a significant difference in serum potassium concentration between groups (p < 0.001). ΔK was significantly higher in the control than the treatment group (3.75 [3.27–4.42] and 1.15 [0.62–1.59] mmol/L, respectively; p = 0.03). There were no differences in mean arterial pressure (p = 0.14), isotonic crystalloids requirement (p = 0.51), or norepinephrine dose (p = 0.83) between groups. Serum lactate concentration was significantly higher in the control group (p < 0.001). At the end of the experiment, the [K+] was reduced by 25% (24.9%–27.8%) across the cartridges.

CONCLUSION
The cartridges controlled serum potassium concentrations without dialysate and retained potassium binding capabilities over 4 hours. There were no deleterious effects on hemodynamic parameters. Those cartridges might be beneficial adjuncts for hyperkalemia management in austere environments.

LEVEL OF EVIDENCE
Translational science study, level I.
Massive transfusion in the pediatric population: A systematic review and summary of best-evidence practice strategies
Authors: Kamyszek Reed W. , Leraas Harold J. , Reed Christopher , Ray Candice M. , Nag Uttara P. , Poisson Jessica L. , Tracy Elisabeth T. 
Published: January 2019

BACKGROUND
Pediatric patients require massive transfusion (MT) in a variety of settings. Multiple studies of adult MT support balanced ratio transfusion to improve outcomes; however, it is unclear if these findings can be extrapolated to pediatric populations. The use of balanced transfusion ratios, MT protocols, hemostatic adjuncts, and even the definition of a MT in children are all open questions. This review presents details of care from current practices in pediatric MT and summarizes practice strategies while providing insight from our single-center experience.

METHODS
PubMed, EMBASE, and Web of Science were searched using MeSH index and free-text terms for articles from 1946 to 2017. Articles were independently reviewed by two reviewers. Studies were assessed for definition of MT, factors predicting MT, MT complications, blood product ratios, hemostatic adjuncts, protocol logistics, and clinical outcomes.

RESULTS
A heterogeneous composite of 29 articles was included in the analysis. Of these, 45% reported a formal transfusion protocol or adopted one during the study. Seven unique definitions of pediatric MT were reported; the most common was >1 total blood volume within 24 hours. A total of 18,369 patients were assessed, and 1,163 received MT (6.3%). Overall mortality for patients requiring MT in studies reporting mortality was high (range 14.7% to 51.2%). We identified 14 patients receiving MT at our center with an age range of 8 months to 18 years and average transfusion of 38.1 mL/kg red blood cells (range: 22.1 mL/kg to 156.7 mL/kg).

CONCLUSIONS
Current practices of pediatric MT demonstrate a variety of site-specific interventions with a persistently high mortality rate. A national focus on improving techniques of MT in children has the potential to save the lives of these children.

LEVEL OF EVIDENCE
Systematic review, levels IV and V.
Lifesaving interventions in blackout conditions using night vision technology: Come to the dark side
Authors: Derickson Michael J. , Kuckelman John P. , Phillips Cody J. , Barron Morgan R. , Marko Shannon T. , Eckert Matthew J. , Martin Matthew J. , Cuadrado Daniel G. 
Published: January 2019

BACKGROUND
During military combat operations and civilian night-time aeromedical transport, medical providers are frequently required to perform lifesaving interventions (LSIs) in low-light environments. Because definitive surgical care is often delayed until a white light environment is permissible, we sought to determine if night optical device (NOD) technology could enable surgical capabilities in blackout conditions.

METHODS
Using a crossover design, six surgeons performed 11 different procedures on six swine, three in normal light conditions (LC) and 3 in blackout conditions (BC) using two-chamber NODs after familiarization with the procedures in both conditions on manikins. Successful completion and procedural times were compared between groups.

RESULTS
Blackout conditions were confirmed with ambient light reading of 0.2 lux during BC versus 3962.9 lux for LC (p < 0.001). There were no significant differences in success rates for any procedure. There were no differences in operative times between BC and LC for extremity tourniquet placement, femoral artery cut-down and clamping, resuscitative thoracotomy, or percutaneous resuscitative endovascular balloon occlusion of the aorta placement. The following procedures took significantly longer in BC vs. LC: Focused Assessment with Sonography for Trauma examination (98 seconds vs. 62 seconds), peripheral IV placement (140 seconds vs. 35 seconds), intraosseous access (51 seconds vs. 26 seconds), jugular vein cut-down and access (237 seconds vs. 104 seconds), laparotomy and packing (71 seconds vs. 51 seconds), stapled splenectomy (137 seconds vs. 74 seconds), resuscitative endovascular balloon occlusion of the aorta placement via cutdown (1,008 seconds vs. 338 seconds), and cricothyroidotomy (177 seconds vs. 109 seconds) (all p < 0.05).

CONCLUSION
Lifesaving interventions can be safely and effectively performed in blackout conditions using NODs, although increased difficulty with select procedure types was identified. Focused training and technological improvements to currently available devices are needed.

LEVEL OF EVIDENCE
Basic science.