bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sepsis Surveillance Using Adult Sepsis Events Simplified eSOFA Criteria Versus Sepsis-3 Sequential Organ Failure Assessment Criteria*
Authors: Rhee Chanu , Zhang Zilu , Kadri Sameer S. , Murphy David J. , Martin Greg S. , Overton Elizabeth , Seymour Christopher W. , Angus Derek C. , Dantes Raymund , Epstein Lauren , Fram David , Schaaf Richard , Wang Rui , Klompas Michael 
Published: February 2019

Objectives:
Sepsis-3 defines organ dysfunction as an increase in the Sequential Organ Failure Assessment score by greater than or equal to 2 points. However, some Sequential Organ Failure Assessment score components are not routinely recorded in all hospitals’ electronic health record systems, limiting its utility for wide-scale sepsis surveillance. The Centers for Disease Control and Prevention recently released the Adult Sepsis Event surveillance definition that includes simplified organ dysfunction criteria optimized for electronic health records (eSOFA). We compared eSOFA versus Sequential Organ Failure Assessment with regard to sepsis prevalence, overlap, and outcomes.

Design:
Retrospective cohort study.

Setting:
One hundred eleven U.S. hospitals in the Cerner HealthFacts dataset.

Patients:
Adults hospitalized in 2013-2015.

Interventions:
None.

Measurements and Main Results:
We identified clinical indicators of presumed infection (blood cultures and antibiotics) concurrent with either: 1) an increase in Sequential Organ Failure Assessment score by 2 or more points (Sepsis-3) or 2) 1 or more eSOFA criteria: vasopressor initiation, mechanical ventilation initiation, lactate greater than or equal to 2.0 mmol/L, doubling in creatinine, doubling in bilirubin to greater than or equal to 2.0 mg/dL, or greater than or equal to 50% decrease in platelet count to less than 100 cells/μL (Centers for Disease Control and Prevention Adult Sepsis Event). We compared area under the receiver operating characteristic curves for discriminating in-hospital mortality, adjusting for baseline characteristics. Of 942,360 patients in the cohort, 57,242 (6.1%) had sepsis by Sequential Organ Failure Assessment versus 41,618 (4.4%) by eSOFA. Agreement between sepsis by Sequential Organ Failure Assessment and eSOFA was good (Cronbach’s alpha 0.81). Baseline characteristics and infectious diagnoses were similar, but mortality was higher with eSOFA (17.1%) versus Sequential Organ Failure Assessment (14.4%; p < 0.001) as was discrimination for mortality (area under the receiver operating characteristic curve, 0.774 vs 0.759; p < 0.001). Comparisons were consistent across subgroups of age, infectious diagnoses, and comorbidities.

Conclusions:
The Adult Sepsis Event’s eSOFA organ dysfunction criteria identify a smaller, more severely ill sepsis cohort compared with the Sequential Organ Failure Assessment score, but with good overlap and similar clinical characteristics. Adult Sepsis Events may facilitate wide-scale automated sepsis surveillance that tracks closely with the more complex Sepsis-3 criteria.
Number of ECG Replicates and QT Correction Formula Influences the Estimated QT Prolonging Effect of a Drug
Authors: van der Wall Hein Evert Christiaan , Gal Pim , Kemme Michiel J. B. , van Westen G.J.P. , Burggraaf J. 
Published: February 2019

Introduction:
The present analysis addressed the effect of the number of ECG replicates extracted from a continuous ECG on estimated QT interval prolongation for different QT correction formulas.

Methods:
For 100 healthy volunteers, who received a compound prolonging the QT interval, 18 ECG replicates within a 3-minute window were extracted from 12-lead Holter ECGs. Ten QT correction formulas were deployed, and the QTc interval was controlled for baseline and placebo and averaged per dose level.

Results:
The mean prolongation difference was >4 ms for single and >2 ms for triplicate ECG measurements compared with the 18 ECG replicate mean values. The difference was <0.5 ms after 14 replicates. By contrast, concentration–effect analysis was independent of replicate count and also of the QT correction formula.

Conclusion:
The number of ECG replicates impacted the estimated QT interval prolongation for all deployed QT correction formulas. However, concentration–effect analysis was independent of both the replicate number and correction formula.
A Comparative Effectiveness Review
Authors: van Rotterdam Joan , Hensley Michael , Hazelton Michael 
Published: February 2019

Background:Cardiac and pulmonary rehabilitation have been shown to reduce the symptoms of disease, as well as reducing health care utilization. To ensure the continuation of these programs, patient outcome measures (POMs) are essential to map treatment effectiveness. This review is a comparative effectiveness literature review of studies with a pre- to post-POM assessment of responsiveness (ie, change in health status over time).Methods:A quality review of the literature included not only randomized controlled trials but also parallel studies, as well as all observational and retrospective trials. This review included a list of articles and their characteristics; a quality assessment of the literature and a list of POMs utilized in this setting were assessed for responsiveness.Results:There was inconsistency in the literature with the measurement of responsiveness or effect size. The most commonly used POM was the SF-36; however, it was found to be less responsive to change in health status pre- to post-rehabilitation, particularly in the mental domain of this instrument. The most responsive POM in this setting was the Global Mood Scale.Conclusion:The surveyed literature found no “gold standard” POM for either cardiac rehabilitation or pulmonary rehabilitation but there was some preference for the disease-specific POMs; however, some of these instruments lose their discriminatory power at the end of the rehabilitation period. This literature review found that a Likert scale is more responsive than a dichotomous scale and that a simple questionnaire is more responsive in a pre- to post-setting than a complex questionnaire.
Exercise Training in Patients With Non–Small Cell Lung Cancer During In-Hospital Chemotherapy Treatment
Authors: Rutkowska Anna , Jastrzebski Dariusz , Rutkowski Sebastian , Żebrowska Aleksandra , Stanula Arkadiusz , Szczegielniak Jan , Ziora Dariusz , Casaburi Richard 
Published: February 2019

Purpose:The aim of this study was to perform a randomized trial to assess the impact of exercise training in patients with non–small cell lung cancer during chemotherapy on several outcomes in comparison to a control group (CG).Methods:The exercise training group (ETG) consisted of 20 patients and the CG consisted of 10 patients. In the ETG, a 4-wk in-hospital exercise training program was performed in 2-wk cycles interspersed with consecutive rounds of chemotherapy with cytostatic drugs. The exercise training program was individualized and included warm-up, respiratory muscle exercise, training on a cycle ergometer or treadmill, and Nordic walking. CG participants were assessed before and after 6 wk of chemotherapy alone.Results:Comparing pre- and post-intervention values, the ETG demonstrated an increase in 6-min walk distance (486 ± 92 vs 531 ± 103 m,P= .01). In a battery of physical performance tests: Up and Go Test (6.3 ± 1.0 vs 6.0 ± 1.1 sec,P= .01); chair stand (13.3 ± 2.8 vs 14.3 ± 3.4 repetitions,P= .001); and arm curl (18.4 ± 3.1 vs 20.4 ± 3.5 repetitions,P= .001) all improved significantly. Spirometry values also improved: FEV1% predicted (76 ± 16 vs 84 ± 15,P= .01), FVC % predicted (87 ± 14 vs 95 ± 13,P= .01), and FEV1/FVC (73 ± 13% vs 76 ± 12%,P= .04). The exercise training was well tolerated, without any adverse events due to exercise. There were no significant improvements in the CG.Conclusions:This study suggests that planned, individualized, and supervised exercise programs in patients with advanced lung cancer during chemotherapy are a practical and beneficial intervention for enhancing mobility and physical fitness.
The Current State of Physician Assistant Pain Curriculum: A National Survey
Authors: Yealy Johnna K. , Martinasek Mary , Doran Todd 
Published: February 2019

Purpose
Insufficient pain management and inappropriate use of pain medication are problems across the health care spectrum. Recent clinical practice guidelines and standardized core curricula have been developed to combat the deficiencies in pain education to ensure that health care professionals are proficient in assessing and managing pain; however, the extent to which physician assistant (PA) programs have implemented these in their training programs is unclear. The purpose of this study was to determine the magnitude of pain education in current PA programs in the United States, including how pain medicine instruction is incorporated into the curriculum, time spent teaching about pain management, the methods used, and barriers to providing pain medicine education.

Methods
Data from the 2016 Physician Assistant Education Association's Support to Advance Research grant, which allowed the inclusion of questions in the annual program survey, were analyzed. The response rate was 100%. Descriptive statistics were used to describe results. Nonparametric statistics used the Mann-Whitney U test and Kruskal-Wallis analysis to assess mean ranks and calculate effect sizes.

Results
Of the 209 programs surveyed, 14% reported that pain management is not included in the curriculum, and 3% reported that it is a stand-alone module. The reason most often cited to explain lack of curriculum was insufficient time (39%), and 32% reported that it is not mandated by the program accreditors. Further analysis included assessment of differences in pain medicine curriculum by program housing, academic health science center status, and geography.

Conclusions
Eighty-six percent of programs include pain education in their curriculum, suggesting that PA programs recognize the importance of pain education. The methods of instruction and topics included across programs are inconsistent. As the first comprehensive benchmark of pain medicine education for PAs, this study shows that although most programs address pain curriculum, opportunities exist to improve pain training in PA programs in the United States.
The Benefit of a Flexible Ankle-Foot Orthosis on Balance and Walking Ability in Persons With Late Effects of Polio: A Mixed-Methods Study
Authors: Brogårdh Christina , Espelund Christina , Lexell Jan 
Published: February 2019

ABSTRACT

Introduction
Many persons with late effects of polio (LEoP) have muscle weakness in the lower limbs, which affects their balance and walking ability. Although an ankle-foot orthosis (AFO) is commonly prescribed for these persons, there is limited knowledge if an AFO improves their balance and walking ability in terms of speed, distance, and perceived safety. The aims of this study were 1) to assess if a flexible AFO improves dynamic balance as well as indoor and outdoor walking in persons with mild to moderate LEoP and 2) to describe the participants' own perceptions of walking ability and safety, as well as advantages and disadvantages with an AFO.

Materials and Methods
A mixed-methods, repeated-measures, crossover design was used. Nineteen participants were assessed at two test occasions, with and without an AFO, with a 1-week interval. Dynamic balance was evaluated with the timed up and go (TUG) test and walking ability by the 10-m fast gait speed (FGS) tests, the 6-minute walk test (6MWT), and timed walking over a 340-m-long pathway outdoors. The Borg Rating of Perceived Exertion (RPE) scale was used to assess perceived exertion. The participants' perceptions of their walking ability and safety as well as advantages and disadvantages with an AFO were evaluated with questionnaires.

Results
The AFO significantly improved (P < 0.05) gait speed, outdoor walking, and reduced perceived exertion at one of the test occasions, but had no effect on dynamic balance (P > 0.6). A majority perceived significantly improved walking ability (P < 0.05) and increased walking safety (P < 0.01) with the AFO. Perceived advantages of the AFO were feelings of increased stability and walking distance and reduced risk of falling. Disadvantages were that it could be difficult to put on and uncomfortable to wear.

Conclusions
A flexible AFO marginally improves walking ability in persons with LEoP, as assessed quantitatively, but the subjective benefit of walking ability and safety suggests that a flexible AFO can be useful to improve daily functioning. In the future, the design of the AFOs needs to be more user-friendly.
Screening of schizophrenia associated miRNAs and the regulation of miR-320a-3p on integrin β1
Authors: Wang Yuhan , Wang Jie , Guo Tianhong , Peng Ying , Wang Kaizheng , Bai Kezhen , Huang Yuanshuai 
Published: February 2019

Abstract
Schizophrenia is one of the most severe chronic psychiatric disorders, which lacks of objective and effective diagnosis and observation indicators.
In this work, the serum miRNA profiles of schizophrenic patients were analyzed. Targets of abnormal miRNAs, and their regulatory mechanisms were studied. A miRNA array was used to analyze the serum from 3 schizophrenic patients without treatment, 3 clinically cured patients and 3 healthy controls. The findings from the array were confirmed by real-time PCR in a larger cohort, including 59 patients and 60 healthy controls. The candidate miRNAs were analyzed using bioinformatics tools. Their potential targets were studied through in vitro cellular experiments.
MiR-320a-3p and miR-320b were found to be down-regulated in patients compared with cured patients and controls in the miRNA array, which was also confirmed by real-time PCR in the larger cohort. Integrin β1 (ITG β1) was found to be one of the targets of miR-320a-3p. An enzyme-linked immune sorbent assay demonstrated that the ITG β1 concentration increased significantly in the patients’ serum, and the in vitro study confirmed that miR-320a-3p targeted the 3′ UTR of ITG β1 mRNA and reduced its expression.
Our results demonstrated that the regulatory effect of miR-320a-3p on its target ITG β1 might play an important role in schizophrenia pathogenesis, which could be a potential pathway for schizophrenia diagnosis and therapy.
The prescription pattern of initial treatment for type 2 diabetes in Beijing from 2011 to 2015
Authors: Wang Xiaowen , Cao Yaying , Wu Yao , Yang Chao , Song Jing , Tian Yaohua , Wang Mengying , Li Man , Wu Yiqun , Hu Yonghua 
Published: February 2019

Abstract
The purpose of this study was to describe the prescription pattern of initial treatment for type 2 diabetes (T2DM) in Beijing from 2011 to 2015.
We selected 790,339 newly diagnosed outpatients with T2DM from the Beijing Medical Claim Data for Employees database between January 2011 and December 2015. The percentages of different treatments and agents were calculated from the patients’ 1st prescriptions. Subgroup analyses were conducted for primary, secondary, and tertiary hospital settings.
The initial treatments given to 57.7%, 30.7%, and 11.7% of patients were oral hypoglycemic agent (OHA) monotherapy, OHA polytherapy, and insulin, respectively. Alpha-glucosidase inhibitors (AGIs) (43.0%) were the most commonly used agents for monotherapy, followed by metformin (35.5%) and sulfonylureas (14.9%). AGIs were most commonly used in primary hospitals (52.0%), while metformin was prescribed most often in secondary (37.6%) and tertiary (41.8%) hospitals. From 2011 to 2015, there were increases in the use of AGIs (40.1–41.1%, P < .001) and metformin (34.0–40.4%, P < .001), but a decrease in the use of sulfonylureas (18.1–12.8%, P < .001). Similar trends were seen in the different hospital settings. Metformin plus an AGI, a sulfonylurea plus an AGI, and metformin plus a sulfonylurea were the most common OHA polytherapy combinations. The use of metformin plus an AGI increased from 13.8% in 2011 to 19.7% in 2015 (P < .001), while the use of a sulfonylurea plus an AGI, and metformin plus a sulfonylurea, did not change significantly.
Half of newly diagnosed patients with T2DM received an initial treatment of OHA monotherapy. Although the use of metformin increased from 2011 to 2015, both AGIs and metformin were the most commonly prescribed agents. The patterns differed from those of most other countries and identification of the underlying reasons will require further investigation.
Epidemiological characteristics and factors influencing falls among elderly adults in long-term care facilities in Xiamen, China
Authors: Zhang Liangwen , Zeng Yanbing , Weng Chenziheng , Yan Jiajin , Fang Ya 
Published: February 2019

Abstract
Falling in the elderly is an important social issue, especially for those who are in long-term care (LTC) facilities, in addition to being a significant economic burden. This study aims to investigate the epidemiological characteristics and identify the factors influencing falls in LTC residents.
We enrolled 260 participants aged 60+ years by multistage sampling across 13 LTC facilities in Xiamen, China, in 2016. Epidemiological characteristics and falls were observed and recorded during a 12-month period using a revised FROP-Com Scale. Multiple logistic regression modeling was performed to determine the factors influencing falls.
A total of 218 (83.8%) valid questionnaires were returned. 152 falls (range 1–7, mean 0.7 ± 1.3 falls/person/y) occurred in the previous year, with 69 residents (31.7%) experiencing 1 or more falls. Most participants who fell were female (71%), living in cities (85.5%), had a higher BMI (22.1 ± 4.2), and had a chronic disease (99.9%). Of all falls, 39.1% occurred in the bedroom and 26.1% in the bathroom, 58% during daytime hours between 6:00 am and noon. Thirty-six percent of falls resulted in an injury (e.g., bruises and fractures). The principal reason for falling was due to slipping (23.2%). There were 2 interactions on fall rate between ADL and feet and footwear (OR = 3.120, P<.001; OR = 3.010, P = .007 in Models 1 and 3), and between ADL and cognitive status (OR = 4.401, P<.001; OR = 4.101, P = .005 in Models 2 and 3). Multiple regression analysis indicated that ADL, balance and gait, medical conditions, cognitive status, living environment, feet and footwear and sensory loss were factors influencing falls among elderly adults in LTC facilities.
Falls occur frequently and mostly unwitnessed among elderly adults in LTC facilities, highlighting the need for more effective and individualized fall prevention. Fall efficacy enhancing programs for nursing home residents should take degree of self-care, chronic diseases, sensory loss, foot injuries, cognitive impairment, living environment, and gender into account.
Long-term prevention of catheter-associated urinary tract infections among critically ill patients through the implementation of an educational program and a daily checklist for maintenance of indwelling urinary catheters
Authors: Menegueti Mayra Gonçalves , Ciol Marcia A. , Bellissimo-Rodrigues Fernando , Auxiliadora-Martins Maria , Gaspar Gilberto Gambero , Canini Silvia Rita Marin da Silva , Basile-Filho Anibal , Laus Ana Maria 
Published: February 2019

Abstract

Background:
Removing an indwelling urinary catheter as soon as possible is the cornerstone of catheter-associated urinary tract infections (CAUTI) prevention. However, implementing this measure may be challenging in clinical settings. To evaluate the impact of implementing a healthcare workers (HCWs) educational program and a daily checklist for indwelling urinary catheter indications among critical patients on the incidence of CAUTI.

Methods:
This was a quasi-experimental study performed in a general intensive care unit of a tertiary-care hospital over a 12 years period, from January 1, 2005 to December 31, 2016. Rates of urinary catheter use and incidence density of CAUTI were monthly evaluated following the Centers for Disease Control and Prevention (CDC) criteria throughout the study period. Phase I (2005–2006) was the pre-intervention period. In phase II (2007–2010), HCWs routine training on CAUTI prevention was performed twice-a-year. In phase III (2011–2014), we implemented a daily checklist for indwelling urinary catheter indications, in addition to the biannual training. In phase IV, (2015–2016) the biannual training was replaced by training only newly hired HCWs and the daily checklist was maintained.

Results:
The mean rate of urinary catheter utilization decreased from phase I to phase IV (73.1%, 74.1%, 54.9%, and 45.6%, respectively). Similarly, the incidence density of CAUTI decreased from phase I to phase IV (14.9, 7.3, 3.8, and 1.1 per 1000 catheter-days, respectively).

Conclusions:
HCWs education and daily evaluation of indwelling urinary catheter indications were highly effective in reducing the rates of catheter utilization as well as the incidence density of CAUTI.
The role of robotic gait training and tDCS in Friedrich ataxia rehabilitation
Authors: Portaro Simona , Russo Margherita , Bramanti Alessia , Leo Antonio , Billeri Luana , Manuli Alfredo , La Rosa Gianluca , Naro Antonino , Calabrò Rocco Salvatore 
Published: February 2019

Abstract

Rationale:
Friedrich ataxia (FA) is the most common inherited neurodegenerative cerebellar ataxic syndrome. In patients with FA, physiotherapy is highly recommended to improve motor function outcome. Cerebellar transcranial direct current stimulation (tDCS) has been demonstrated to be effective in improving symptoms by modulating cerebellar excitability. Recently, robotic rehabilitation with Lokomat-Pro has been used to treat motor impairment in ataxic syndromes by “modulating” cortical plasticity and cerebello-motor connectivity.

Patient concerns:
A 29-year-old Italian male with FA, come to our Institute to undergo intensive rehabilitation training. He presented a moderate-to-severe spastic tetraparesis, brisk deep tendon reflexes, moderate dysarthria, occasional difficulty in speaking, and mild delay in swallowing. He was able to stand for at least 10 seconds in the natural position with constant support, and thus he used a wheelchair.

Diagnosis:
Tetraparesis in a young patient with FA.

Interventions:
The effects of a stand-alone robotic gait training with Lokomat-Pro preceded by cerebellar anodal tDCS (a-tDCS) versus Lokomat-Pro preceded by cathodal-tDCS (c-tDCS) are compared.

Outcomes:
The coupled approach (i.e., tDCS and Lokomat) demonstrated better improvement in functional motor outcomes on the Scale for the Assessment and Rating of Ataxia (SARA).

Lessons:
Although only a single case is described, we found that the combined neuromodulation-neurorobotic approach could become a promising tool in the rehabilitation of cerebellar ataxias, possibly by shaping cerebello-cerebral plasticity and connectivity.