bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased Heat Generation in Postcardiac Arrest Patients During Targeted Temperature Management Is Associated With Better Outcomes*
Authors: Uber Amy J. , Perman Sarah M. , Cocchi Michael N. , Patel Parth V. , Ganley Sarah E. , Portmann Jocelyn M. , Donnino Michael W. , Grossestreuer Anne V. 
Published: April 2018

Objectives:
Assess if amount of heat generated by postcardiac arrest patients to reach target temperature (Ttarget) during targeted temperature management is associated with outcomes by serving as a proxy for thermoregulatory ability, and whether it modifies the relationship between time to Ttarget and outcomes.

Design:
Retrospective cohort study.

Setting:
Urban tertiary-care hospital.

Patients:
Successfully resuscitated targeted temperature management–treated adult postarrest patients between 2008 and 2015 with serial temperature data and Ttarget less than or equal to 34°C.

Interventions:
None.

Measurements and Main Results:
Time to Ttarget was defined as time from targeted temperature management initiation to first recorded patient temperature less than or equal to 34°C. Patient heat generation (“heat units”) was calculated as inverse of average water temperature × hours between initiation and Ttarget × 100. Primary outcome was neurologic status measured by Cerebral Performance Category score; secondary outcome was survival, both at hospital discharge. Univariate analyses were performed using Wilcoxon rank-sum tests; multivariate analyses used logistic regression. Of 203 patients included, those with Cerebral Performance Category score 3–5 generated less heat before reaching Ttarget (median, 8.1 heat units [interquartile range, 3.6–21.6 heat units] vs median, 20.0 heat units [interquartile range, 9.0–33.5 heat units]; p = 0.001) and reached Ttarget quicker (median, 2.3 hr [interquartile range, 1.5–4.0 hr] vs median, 3.6 hr [interquartile range, 2.0–5.0 hr]; p = 0.01) than patients with Cerebral Performance Category score 1–2. Nonsurvivors generated less heat than survivors (median, 8.1 heat units [interquartile range, 3.6–20.8 heat units] vs median, 19.0 heat units [interquartile range, 6.5–33.5 heat units]; p = 0.001) and reached Ttarget quicker (median, 2.2 hr [interquartile range, 1.5–3.8 hr] vs median, 3.6 hr [interquartile range, 2.0–5.0 hr]; p = 0.01). Controlling for average water temperature between initiation and Ttarget, the relationship between outcomes and time to Ttarget was no longer significant. Controlling for location, witnessed arrest, age, initial rhythm, and neuromuscular blockade use, increased heat generation was associated with better neurologic (adjusted odds ratio, 1.01 [95% CI, 1.00–1.03]; p = 0.039) and survival (adjusted odds ratio, 1.01 [95% CI, 1.00–1.03]; p = 0.045) outcomes.

Conclusions:
Increased heat generation during targeted temperature management initiation is associated with better outcomes at hospital discharge and may affect the relationship between time to Ttarget and outcomes.
Longer-Term Effectiveness and Tolerability of Adjunctive Open Lurasidone in Patients With Bipolar Disorder
Authors: Miller Shefali , Do Dennis , Gershon Anda , Wang Po W. , Hooshmand Farnaz , Chang Lauren S. , Ketter Terence A. 
Published: April 2018

Abstract

Purpose
To retrospectively assess lurasidone effectiveness/efficacy/tolerability in bipolar disorder (BD) patients.

Methods
Outpatients assessed with Systematic Treatment Enhancement Program for BD Affective Disorders Evaluation received naturalistically administered (primarily adjunctive) open lurasidone while monitored at visits with the Systematic Treatment Enhancement Program for BD Clinical Monitoring Form.

Results
Sixty-one patients (32 type I, 26 type II, 3 type not otherwise specified; mean ± SD age, 45.1 ± 14.0 years; 63.9% were female) received lurasidone with 3.1 ± 1.4 (≥2 in 88.5%, monotherapy in only 3.3%) other nonanxiolytic/hypnotic prescription psychotropics, started during syndromal depression in 57.4%, subsyndromal depression in 23.0%, and euthymia in 19.7%. Lurasidone was taken for median 126 days, with final dose 55.6 ± 30.8 mg/d. By final visit taking lurasidone, syndromal depression rate decreased by nearly one-half to 31.1%, and euthymia rate more than doubled to 42.6%, whereas subsyndromal depression rate was unchanged at 23.0%. Clinical Global Impressions–BD-Overall Severity improved significantly only in patients with baseline syndromal depression. Seventy-seven percent of patients discontinued lurasidone after median 103 days, because of adverse events in 54.1% (most often akathisia, sedation/somnolence, nausea, and weight gain), inefficacy in 16.4%, and other reasons in 6.6%; 12.1% had equal to or greater than 7% weight gain, and 3.3% developed hypomania. Limitations to this study were the open design and demographically homogeneous (relatively affluent, predominantly white female) small sample taking complex pharmacotherapy.

Conclusions
In American specialty clinic BD outpatients, adjunctive longer-term lurasidone commonly relieved syndromal depression and maintained euthymia, suggesting possible effectiveness/efficacy. However, lurasidone was discontinued in 54.1% because of adverse events, suggesting tolerability limitations in these challenging patients, nearly 90% of whom were already taking at least 2 other nonanxiolytic/hypnotic prescription psychotropics.
Comedication of Valproic Acid Is Associated With Increased Metabolism of Clozapine
Authors: Hommers Leif , Scharl Magdalena , Hefner Gudrun , Hohner Matthias , Fischer Matthias , Pfuhlmann Bruno , Deckert Jürgen , Unterecker Stefan 
Published: April 2018

Abstract

Objectives
Valproic acid and clozapine are drugs commonly used in the treatment of schizophrenic and schizoaffective disorders. Pharmacokinetic interactions of valproic acid with several drugs are well known, yet results concerning the interaction with clozapine are inconsistent.

Methods
Steady-state dose-corrected serum concentrations of clozapine and its main metabolite norclozapine were retrospectively analyzed in 45 patients receiving both clozapine and valproic acid. Controls were matched for sex, age, smoking, comedication, and inflammatory response.

Results
The group receiving comedication with valproic acid showed significantly lower median dose-corrected serum concentrations of norclozapine (0.44 [0.27–0.58] (ng/mL)/(mg/d) vs 0.78 [0.60–1.07] (ng/mL)/(mg/d)) as well as metabolite to parent compound ratios (0.40 [0.36–0.47] vs 0.71 [0.58–0.84]) by approximately 44%. Dose-corrected serum concentrations of clozapine were not significantly lower. The effect of valproic acid was independent of sex and smoking.

Conclusions
Comedication with valproic acid accelerated metabolism of clozapine with predominant effects on the degradation of norclozapine. Therapeutic drug monitoring should be applied to guide individual patient responses upon initiation of comedication.
Facilitators and Barriers to the Implementation of iSPRINT: A Sport Injury Prevention Program in Junior High Schools
Authors: Richmond Sarah A. , Donaldson Alex , Macpherson Alison , Bridel William , van den Berg Carla , Finch Caroline F. , Hagel Brent , Emery Carolyn A. 
Published: April 2018

Objectives:
Sport injury is the leading cause of hospitalization in Canadian youth and represents a high burden to the health care system. This study aims to describe the facilitators and barriers to implementation of a sport injury prevention program in junior high school physical education (known as iSPRINT), previously shown to reduce the risk of sport-related injury in youth (age, 11-15 years).

Methods:
Focus group data were mapped onto constructs from the Consolidated Framework for Implementation Research (CFIR). Four schools that implemented iSPRINT participated in this study. Forty-seven key stakeholders (teachers, students, principals) participated in 9 semistructured focus groups and 4 interviews. The CFIR was used to guide the focus group discussions, data coding, and analysis using a qualitative content analysis approach.

Results:
Of the 22 applicable CFIR constructs, 16 were identified in the transcripts. The most significant facilitators to successful implementation efforts included evidence strength and quality, adaptability, implementation climate, culture, and having a high level of compatibility facilitated successful implementation efforts. Barriers to implementation included intervention complexity, planning, and readiness for implementation. Constructs that acted as both a facilitator and a barrier, depending on the context, were self-efficacy, execution, and individual identification with the organization.

Conclusions:
Participants in this study reported positive attitudes about implementing iSPRINT, citing evidence strength, adaptability, and constructs related to the organizational setting that contributed to successful implementation. Potential improvements include modifying certain program components, decreasing the number of components, and reducing the equipment required.
Cardiac output monitoring: how to choose the optimal method for the individual patient
Authors: Saugel Bernd , Vincent Jean-Louis 
Published: April 2018

Purpose of review
To review the different methods available for the assessment of cardiac output (CO) and describe their specific indications in intensive care and perioperative medicine.

Recent findings
In critically ill patients, persistent circulatory shock after initial resuscitation is an indication for the assessment of CO to monitor the response to fluids and vasoactive agents. In patients with circulatory shock associated with right ventricular dysfunction, pulmonary artery hypertension, or acute respiratory distress syndrome, invasive CO monitoring using indicator dilution methods is indicated. Calibrated and uncalibrated pulse wave analysis enable absolute or relative CO changes to be monitored in real-time during the assessment of fluid responsiveness. In patients undergoing open-heart and thoracic aortic surgery, transesophageal echocardiography is recommended. In selected cardiac surgery patients, advanced hemodynamic monitoring using thermodilution methods can be considered. In high-risk noncardiac surgical patients, invasive pulse wave analysis or esophageal Doppler should be used for perioperative hemodynamic management.

Summary
Various invasive, minimally invasive, and noninvasive methods to assess CO are available. A profound understanding of the different CO monitoring methods is key to define indications for CO monitoring in the individual critically ill or surgical patient.
Hepatitis B virus reactivation in patients with resolved hepatitis B virus infection receiving chemotherapy or immunosuppressive therapy
Authors: Su Yi-Chia , Lin Pei-Chin , Yu Hsien-Chung , Wu Chih-Chien 
Published: April 2018

Background
The role of antiviral prophylaxis before chemotherapy or immunosuppressive therapy to prevent hepatitis B virus (HBV) reactivation in patients with resolved HBV infection [hepatitis B surface antigen (HBsAg) negative, hepatitis B core antibody (anti-HBc) positive] is unclear. This study aimed to evaluate the efficacy of prophylactic antiviral therapy and outcomes of HBsAg-negative, anti-HBc-positive patients who received chemotherapy or immunosuppressive therapy.

Patients and methods
We retrospectively evaluated the medical records of HBsAg-negative, anti-HBc-positive patients who underwent chemotherapy or immunosuppressive therapy from January 2013 through November 2016 at a single institute in southern Taiwan.

Results
Among 1000 included HBsAg-negative, anti-HBc-positive patients, the rate of hepatitis B surface antibody (anti-HBs) seropositivity before chemotherapy or immunosuppressive therapy was 76.6%. Twenty-six patients received a prophylactic oral antiviral agent (one telbuvudine, two lamivudine, 22 entecavir, and one tenofovir). Seven (0.7%) patients were diagnosed with HBV reactivation during or after chemotherapy courses. In multivariate Cox regression analysis, an rituximab-based regimen (hazard ratio: 11.74; 95% confidence interval: 1.62–84.94; P=0.02) and baseline anti-HBs-positive status (hazard ratio: 0.17; 95% confidence interval: 0.04–0.8; P=0.03) were significant predictive factors for HBV reactivation. Among anti-HBs-negative recipients of rituximab-based chemotherapy, HBV reactivation was observed in zero of nine patients who received prophylactic antiviral therapy and three (33.3%) of nine patients who did not.

Conclusion
Negative anti-HBs status and rituximab-containing regimens are both important factors for predicting chemotherapy or immunosuppressive therapy-related HBV reactivation in patients with resolved HBV infection. Therefore, antiviral prophylaxis should be considered in this patient population.
Triptorelin for Fertility Preservation in Adolescents Treated With Chemotherapy for Cancer
Authors: Meli Mariaclaudia , Caruso-Nicoletti Manuela , La Spina Milena , Nigro Luca Lo , Samperi Piera , D’Amico Salvatore , Bellia Francesco , Miraglia Vito , Licciardello Maria , Cannata Emanuela , Marino Silvia , Cimino Carla , Puglisi Federica , Valvo Laura Lo , Pezzulla Agnese , Russo Giovanna , Di Cataldo Andrea 
Published: April 2018

Background:
Triptorelin, a gonadotropin releasing hormone analogue, can be administered to postpubertal female individuals with cancer who receive chemotherapy to obtain menstrual suppression and decrease the risk of hemorrhage caused by thrombocytopenia. Our goal was to assess whether triptorelin also has a protective role against the gonadotoxicity of chemotherapy.

Patients and Methods:
This retrospective observational study includes all postmenarchal female patients who presented to our Unit from 2000 to 2015 and received chemotherapy for cancer. They were administered depot triptorelin. We evaluated long-term ovarian function in order to detect clinical signs of ovarian damage, miscarriages, and pregnancies. Laboratory follow-up consisted in dosing serum follicle stimulating hormone, luteinizing hormone, prolactin, estradiol, and progesterone. Ultrasound of the ovaries was performed as well.

Results:
Of 36 evaluable patients, 9 received hematopoietic stem cell transplantation (HSCT). The remaining 27 patients maintained normal ovarian function at clinical, laboratory, and ultrasound assessment. Five of them achieved spontaneous physiological pregnancy. Four of the 9 patients who underwent HSCT developed premature ovarian failure.

Conclusion:
Our study suggests that gonadotropin releasing hormone-a administered during chemotherapy can prevent premature ovarian failure in patients treated without HSCT and that it is not enough to preserve the ovarian function during HSCT. Hence, a prospective randomized trial with a larger population would be recommended.
Unique Autonomic Responses to Pain in Yoga Practitioners
Authors: Cotton Valerie A. , Low Lucie A. , Villemure Chantal , Bushnell M. Catherine 
Published: April 2018

ABSTRACT

Objective
Autonomic nervous system activity is associated with neurobehavioral aspects of pain. Yogis use breathing, relaxation, and mindfulness to tolerate pain, which could influence autonomic responses. To evaluate how the link between autonomic responses and pain is altered by other factors, we compared perceptual and autonomic responses to pain between yogis and controls.

Methods
Nineteen yogis and 15 controls rated warm and painfully hot stimuli (1-cm2 thermode on calf), with visual anticipatory cues indicating certainly painful, certainly nonpainful, or uncertainly either painful or nonpainful. Heart rate, skin conductance, respiration, and blood pressure were measured.

Results
At baseline, yogis breathed slower and deeper than did controls, with no differences in other autonomic measures. During the task, perceptual ratings did not differ between groups in either the certain or uncertain conditions. Nevertheless, yogis had higher phasic skin conductance responses in anticipation of and response to all stimuli, but particularly during painful heat in uncertain contexts (uncertain: 0.46 [0.34] μS; certain: 0.37 [0.28] μS; t(18) = 3.962, p = .001). Furthermore, controls showed a decrease in heart rate to warm (−2.51 [2.17] beats/min) versus painful stimuli (0.83 [1.63] beats/min; t(13) = 5.212, p < .001) and lower respiratory sinus arrhythmia during pain compared with warm trials, whereas yogis had similar reactions to painful and nonpainful stimuli.

Conclusions
Autonomic responses to pain differed in yogis and healthy volunteers, despite similar pain ratings. Thus, autonomic reactivity to pain may be altered by environmental and psychological factors throughout an individual's life.
A Multicenter Collaboration for Simulation-Based Assessment of ACGME Milestones in Emergency Medicine
Authors: Salzman David H. , Watts Hannah , Williamson Kelly , Sergel Michelle , Dobiesz Valerie , DeGarmo Noah , Vora Samreen , Sharp Louis J. , Wang Ernest E. , Gisondi Michael A. 
Published: April 2018

Summary Statement
In 2014, the six allopathic emergency medicine (EM) residency programs in Chicago established an annual, citywide, simulation-based assessment of all postgraduate year 2 EM residents. The cases and corresponding assessment tools were designed by the simulation directors from each of the participating sites. All assessment tools include critical actions that map directly to numerous EM milestones in 11 different subcompetencies. The 2-hour assessments provide opportunities for residents to lead resuscitations of critically ill patients and demonstrate procedural skills, using mannequins and task trainers respectively. More than 80 residents participate annually and their assessment experiences are essentially identical across testing sites. The assessments are completed electronically and comparative performance data are immediately available to program directors.
Learners' Perceptions During Simulation-Based Training
Authors: Duch Christensen Margrethe , Oestergaard Doris , Dieckmann Peter , Watterson Leonie 
Published: April 2018

Introduction
Remotely facilitated simulation-based training (RF-SBT) is less positively appraised than face-to-face, locally facilitated simulation-based training (LF-SBT), despite being considered as an acceptable alternative. This study compared the perceptions of learners after RF-SBT and LF-SBT to explain differences between the two and identify relevant theories that would guide future practice.

Methods
Telephone interviews were conducted with 21 newly graduated doctors and nurses who completed a standardized simulation course delivered in both RF-SBT and LF-SBT formats.

Results
Participants reported that both SBT formats to be highly beneficial, however, were less positive about RF-SBT. They described a range of psychosocial and cognitive responses that explained their positive and negative attitudes to different aspects of the training. These perceptions, occurring across both formats, included a sense of the following: belonging to instructor and group, surveillance, responsibility, realism, contextual understanding, conscious mental effort, control of attention, and engagement with task. Participants associated these perceptions and ensuing attitudes to SBT with factors arising during, and/or existing before, the SBT as if in an input-output process model. The former ‘enabling’ factors related to human interaction, technology, and instructional design, whereas the latter ‘precursor’ factors reflected pre-existing attributes of the participants and instructors. These findings are supported by several theoretical models of which the technology acceptance model is arguably the best fit.

Conclusions
Locally facilitated simulation-based training is easier to use and experience than RF-SBT; however, the latter's negative impact may be concealed by SBT's overarching very high perceived value. The technology acceptance model is an appropriate conceptual model to explain these processes.
Reduced Access to Liver Transplantation in Women: Role of Height, MELD Exception Scores, and Renal Function Underestimation
Authors: Allen Alina M. , Heimbach Julie K. , Larson Joseph J. , Mara Kristin C. , Kim W. Ray , Kamath Patrick S. , Therneau Terry M. 
Published: April 2018

Background
Sex-based disparities in liver transplantation (LT) are incompletely understood. We assessed the role of height, Model for End-Stage Liver Disease (MELD), MELD-Na, and exception points in the disparate access to LT.

Methods
Adults waitlisted for LT at Organ Procurement and Transplantation Network between 2002 and 2013 were included. Covariates associated with likelihood of LT were analyzed by Cox proportional model. In a separate cohort of waitlisted adults with glomerular filtration rate measurement by iothalamate clearance (n = 611), we determined the number of creatinine-derived MELD points in men versus women, across all ranges of glomerular filtration rate. The impact of correcting the MELD score deficit in women on LT was modeled.

Results
Among 90 720 Organ Procurement and Transplantation Network registrants, women had higher mortality than men (4 years after listing: 22% vs 18%, P < 0.0001), and lower likelihood of LT (49% vs 58%, P < 0.0001); women were 20% less likely to be transplanted (hazard ratio, 0.80; 95% confidence interval, 0.78-0.81). Differences in height and MELD exception scores accounted for most of the LT deficit in women (hazard ratio, 0.91; 95% confidence interval, 0.89-0.94). Women received between 1 and 2.4 fewer creatinine-derived MELD points than men with similar renal dysfunction. MELD-Na worsened the gender disparity. Addition of 1 or 2 MELD points to women significantly impacted LT access.

Conclusions
Differences in height and MELD exception points explained most of the sex-based disparity in LT. Additionally, MELD score underestimated disease severity in women by up to 2.4 points and MELD Na exacerbated this disparity. The degree of underestimation based on MELD had significant impact on allocation.
Pancreas Transplantation From Pediatric Donors: A Single-Center Experience
Authors: Spaggiari Mario , Di Bella Caterina , Di Cocco Pierpaolo , Campara Maya , Galen Kelly , Gheza Federico , Oberholzer Jose , Benedetti Enrico , Tzvetanov Ivo 
Published: April 2018

Background
Pancreas allografts from pediatric donors are considered less suitable due to the increased risk of surgical complications and reduced islet cell mass that may compromise function.

Methods
All pancreatic transplants, procured from donors younger than 18 years, between January 2007 and March 2017, were included in the analysis. The grafts were subdivided into 3 groups by donor's weight: less than 30 kg, 30 to 60 kg, greater than 60 kg. Analysis of patient and graft survival was done between the groups, and subsequently between the pediatric cohort and the adult-donor control group.

Results
Sixty-three pediatric-donor pancreas transplants were performed. The mean donor age and weight were of 12.10 ± 4.13 years and 47.8 ± 21.3 kg. Excellent metabolic control was achieved in 59 (93.65%) patients at the time of discharge and at a mean 5 year follow up, with the average hemoglobin A1c of 5.30 ± 0.61% and blood glucose level of 102.75 ± 20.70 mg/dL in those with a functioning graft. Nine graft losses were registered, of which one (1.6%) was due to arterial thrombosis. Eight (12.7%) patients experienced rejection. Overall graft survival and patient survival were of 85.7% and 92.1%, respectively, at a median follow-up of 37.07 months (minimum, 0.19 to maximum, 119.57). No differences among the 3 groups were identified. Long-term patient and allograft survival was comparable to that of the adult-donor pancreatic transplants.

Conclusions
Pediatric-donor pancreas demonstrated excellent short-term outcomes with no surgical complications and promising long-term outcomes despite the smaller islet mass. Pancreata from pediatric donors should not be marginalized and can offset worsening organ shortage.