bluuebunny/crossref_metadata_2025_split huggingface dataset:
Presepsin As a Biomarker for Evaluating Prognosis and Early Innate Immune Response of Out-of-Hospital Cardiac Arrest Patients After Return of Spontaneous Circulation
Authors: Qi Zhijiang , Zhang Qiang , Liu Bo , Shao Fei , Li Chunsheng 
Published: April 2019

Objectives:
After return of spontaneous circulation, patients who experienced out-of-hospital cardiac arrest present an impaired innate immune response that resembles sepsis. Presepsin, a new biomarker for sepsis, has not been studied in out-of-hospital cardiac arrest patients. This study explored the role of presepsin in evaluating the prognosis and early innate immune alteration of out-of-hospital cardiac arrest patients after return of spontaneous circulation by observing presepsin levels, CD14, and human leukocyte antigen-DR expression on monocytes.

Design:
Retrospective analysis.

Setting:
The emergency department of an urban university tertiary hospital.

Participants:
One hundred sixty-five out-of-hospital cardiac arrest patients with return of spontaneous circulation more than 12 hours, and 100 healthy individuals.

Interventions:
None.

Measurements and Main Results:
Plasma presepsin and procalcitonin levels were tested after resuscitation (day 0) and on days 1 and 3 after return of spontaneous circulation. Presepsin levels were higher in out-of-hospital cardiac arrest patients than in healthy individuals. In the first 3 days, presepsin and procalcitonin levels were persistently lower in 28-day survivors and patients with favorable neurologic outcome patients than in 28-day nonsurvivors and patients with unfavorable neurologic outcome. On days 0, 1, and 3, different cut-off values of presepsin showed prognostic value for 28-day mortality and favorable neurologic outcomes similar to procalcitonin. CD14 and human leukocyte antigen-DR expression on monocytes were analyzed by flow cytometry. Compared with controls, CD14 expression in out-of-hospital cardiac arrest patients increased on day 1 and began to decrease on day 3, whereas human leukocyte antigen-DR+ monocyte percentages decreased on days 1 and 3. Presepsin and procalcitonin had a low positive correlation with CD14 expression and a strong negative correlation with human leukocyte antigen-DR+ monocyte percentages on day 1.

Conclusions:
Plasma presepsin concentrations are independent prognostic factors for out-of-hospital cardiac arrest patients after return of spontaneous circulation and are correlated with abnormal CD14 and human leukocyte antigen-DR expression on monocytes. Monitoring presepsin levels may be helpful for evaluating the prognosis and impaired innate immune response in the early period after return of spontaneous circulation.
Cost-Effectiveness Studies in the ICU: A Systematic Review*
Authors: Wilcox M. Elizabeth , Vaughan Kelsey , Chong Christopher A. K. Y. , Neumann Peter J. , Bell Chaim M. 
Published: April 2019

Objectives:
Cost-effectiveness analyses are increasingly used to aid decisions about resource allocation in healthcare; this practice is slow to translate into critical care. We sought to identify and summarize original cost-effectiveness studies presenting cost per quality-adjusted life year, incremental cost-effectiveness ratios, or cost per life-year ratios for treatments used in ICUs.

Design:
We conducted a systematic search of the English-language literature for cost-effectiveness analyses published from 1993 to 2018 in critical care. Study quality was assessed using the Drummond checklist.

Setting:
Critical care units.

Patients or Subjects:
Critical care patients.

Interventions:
Identified studies with cost-effectiveness analyses.

Measurements and Main Results:
We identified 97 studies published through 2018 with 156 cost-effectiveness ratios. Reported incremental cost-effectiveness ratios ranged from –$119,635 (hypothetical cohort of patients requiring either intermittent or continuous renal replacement therapy) to $876,539 (data from an acute renal failure study in which continuous renal replacement therapy was the most expensive therapy). Many studies reported favorable cost-effectiveness profiles (i.e., below $50,000 per life year or quality-adjusted life year). However, several therapies have since been proven harmful. Over 2 decades, relatively few cost-effectiveness studies in critical care have been published (average 4.6 studies per year). There has been a more recent trend toward using hypothetical cohorts and modeling scenarios without proven clinical data (2014–2018: 19/33 [58%]).

Conclusions:
Despite critical care being a significant healthcare cost burden there remains a paucity of studies in the literature evaluating its cost effectiveness.
Sleep and Work in ICU Physicians During a Randomized Trial of Nighttime Intensivist Staffing*
Authors: Bakhru Rita N. , Basner Mathias , Kerlin Meeta Prasad , Halpern Scott D. , Hansen-Flaschen John , Rosen Ilene M. , Dinges David F. , Schweickert William D. 
Published: April 2019

Objectives:
To compare sleep, work hours, and behavioral alertness in faculty and fellows during a randomized trial of nighttime in-hospital intensivist staffing compared with a standard daytime intensivist model.

Design:
Prospective observational study.

Setting:
Medical ICU of a tertiary care academic medical center during a randomized controlled trial of in-hospital nighttime intensivist staffing.

Patients:
Twenty faculty and 13 fellows assigned to rotations in the medical ICU during 2012.

Interventions:
As part of the parent study, there was weekly randomization of staffing model, stratified by 2-week faculty rotation. During the standard staffing model, there were in-hospital residents, with a fellow and faculty member available at nighttime by phone. In the intervention, there were in-hospital residents with an in-hospital nighttime intensivist. Fellows and faculty completed diaries detailing their sleep, work, and well-being; wore actigraphs; and performed psychomotor vigilance testing daily.

Measurements and Main Results:
Daily sleep time (mean hours [sd]) was increased for fellows and faculty in the intervention versus control (6.7 [0.3] vs 6.0 [0.2]; p < 0.001 and 6.7 [0.1] vs 6.4 [0.2]; p < 0.001, respectively). In-hospital work duration did not differ between the models for fellows or faculty. Total hours of work done at home was different for both fellows and faculty (0.1 [< 0.1] intervention vs 1.0 [0.1] control; p < 0.001 and 0.2 [< 0.1] intervention vs 0.6 [0.1] control; p < 0.001, respectively). Psychomotor vigilance testing did not demonstrate any differences. Measures of well-being including physical exhaustion and alertness were improved in faculty and fellows in the intervention staffing model.

Conclusions:
Although no differences were measured in patient outcomes between the two staffing models, in-hospital nighttime intensivist staffing was associated with small increases in total sleep duration for faculty and fellows, reductions in total work hours for fellows only, and improvements in subjective well-being for both groups. Staffing models should consider how work duration, sleep, and well-being may impact burnout and sustainability.
Novel Risk Factors for Posttraumatic Stress Disorder Symptoms in Family Members of Acute Respiratory Distress Syndrome Survivors*
Authors: Lee Robert Y. , Engelberg Ruth A. , Curtis J. Randall , Hough Catherine L. , Kross Erin K. 
Published: April 2019

Objectives:
Family members of ICU survivors report long-term psychologic symptoms of posttraumatic stress disorder. We describe patient- and family-member risk factors for posttraumatic stress disorder symptoms among family members of survivors of acute respiratory distress syndrome.

Design:
Prospective cohort study of family members of acute respiratory distress syndrome survivors.

Setting:
Single tertiary care center in Seattle, Washington.

Subjects:
From 2010 to 2015, we assembled an inception cohort of adult acute respiratory distress syndrome survivors who identified family members involved in ICU and post-ICU care. One-hundred sixty-two family members enrolled in the study, corresponding to 120 patients.

Interventions:
None.

Measurements and Main Results:
Family members were assessed for self-reported psychologic symptoms 6 months after patient discharge using the Posttraumatic Stress Disorder Checklist-Civilian Version, the Patient Health Questionnaire 9-item depression scale, and the Generalized Anxiety Disorder 7-item scale. The primary outcome was posttraumatic stress disorder symptoms, and secondary outcomes were symptoms of depression and anxiety. We used clustered multivariable logistic regression to identify patient- and family-member risk factors for psychologic symptoms. Posttraumatic stress disorder symptoms were present in 31% (95% CI, 24–39%) of family participants. Family member risk factors for posttraumatic stress disorder symptoms included preexisting mental health disorders (adjusted odds ratio, 3.22; 95% CI, 1.42–7.31), recent personal experience of serious physical illness (adjusted odds ratio, 3.07; 95% CI, 1.40–6.75), and female gender (adjusted odds ratio, 5.18; 95% CI, 1.74–15.4). Family members of previously healthy patients (Charlson index of zero) had higher frequency of posttraumatic stress disorder symptoms (adjusted odds ratio, 2.25; 95% CI, 1.06–4.77). Markers of patient illness severity were not associated with family posttraumatic stress disorder symptoms.

Conclusions:
The prevalence of long-term posttraumatic stress disorder symptoms among family members of acute respiratory distress syndrome survivors is high. Family members with preexisting mental health disorders, recent experiences of serious physical illness, and family members of previously healthy patients are at increased risk for posttraumatic stress disorder symptoms.
The Clinical Spectrum of New-Onset Status Epilepticus
Authors: Chakraborty Tia , Hocker Sara 
Published: April 2019

Objectives:
There is a paucity of data on patients with new-onset status epilepticus in patients without a prior history of epilepsy; we aimed to describe clinical characteristics and assess variables predictive of outcomes.

Design:
Retrospective cohort.

Setting:
Quaternary academic medical center.

Patients:
Adult patients with new-onset status epilepticus.

Methods:
Retrospective review of adults with new-onset status epilepticus admitted to Mayo Clinic, Rochester MN between January 1, 1990, and December 31, 2015, was performed. Patient demographics, status epilepticus etiology, Status Epilepticus Severity Score, and status epilepticus classification per the Status Epilepticus Severity Score were recorded. Six-month mortality and functional outcomes defined as modified Rankin scale (≥3 at last follow-up was considered poor) were primary outcomes. Refractory status epilepticus was a secondary outcome.

Interventions:
None.

Measurements and Main Results:
One-hundred seventy-seven patients were included. Status epilepticus was convulsive in 124 (70.1%) and nonconvulsive in 53 (29.9%); 96 cases (54.2%) were refractory status epilepticus. Mean age at onset was 63 ± 18 years; 52.5% were greater than or equal to 65 years. Etiologies were acute in 50.8%, progressive in 18.1%, remote in 19.2%, and unknown in 11.9% patients. Six-month mortality was 32.2%, and 70.1% had poor modified Rankin scale at mean follow-up 3.1 ± 3.5 years. Age greater than or equal to 65 was a significant predictor of poor functional outcome and 6-month mortality. Loss of consciousness, status epilepticus classification, or age greater than or equal to 65 did not predict progression to refractory status epilepticus. Progression to refractory status epilepticus did not impact functional outcome or mortality at last follow-up.

Conclusions:
Poor outcomes in new-onset status epilepticus were associated with older age as well as predominantly progressive or remote symptomatic disease. Further prospective investigations assessing the course and outcomes of these patients would be useful in management and prognostication.
Repeatability and Agreement of a Swept-Source Optical Coherence Tomography–Based Biometer IOLMaster 700 Versus a Scheimpflug Imaging–Based Biometer AL-Scan in Cataract Patients
Authors: Chan Tommy C.Y. , Wan Kelvin H. , Tang Fang Yao , Wang Yu Meng , Yu Marco , Cheung Carol 
Published: April 2019

Purpose:
To compare the repeatability and agreement between a swept-source biometer and a Scheimpflug biometer in cataract patients.

Methods:
Three consecutive measurements were obtained using a swept-source biometer (IOLMaster 700) and a Scheimpflug biometer (AL-Scan) in 52 eyes of 52 patients. Keratometry, central corneal thickness (CCT), anterior chamber depth (ACD), axial length, and white-to-white (WTW) distance were recorded. Astigmatism values were transformed into vector components of J0 and J45. Intraoperator repeatability was analyzed using intraclass correlation coefficients (ICCs) and reproducibility coefficients (RCs). Agreement of measurements between the two devices was evaluated using the Bland–Altman method.

Results:
The IOLMaster 700 showed higher ICCs and lower RCs for the mean keratometry (Km) (P≤0.018), CCT (P≤0.027), and ACD (P≤0.001) measurements, whereas the AL-Scan showed higher ICC and lower RC for the J45 vector component of astigmatism at the 2.4-mm zone (P≤0.034). Both the devices had excellent repeatability (ICC=0.999) in axial length measurement. Systematic differences were found in Km, CCT, ACD, and WTW (P≤0.018) between the devices. The mean difference for Km was −0.196 and −0.144 D measured at the 2.4-mm zone and 3.3-mm zone, respectively. The corresponding mean difference for CCT, ACD, and WTW distance was 14.92 μm, −0.017 mm, and 0.283 mm, respectively. These differences led to a statistically significant but clinically insignificant difference in the prediction of intraocular lens power.

Conclusions:
This study showed significant differences in anterior segment measurement repeatability and agreement between a swept-source biometer and a Scheimpflug biometer in eyes with cataract.
The Clinical Use of Eyelash Manipulation in the Diagnosis of Demodex folliculorum Blepharitis
Authors: Murphy Orla , O' Dwyer Veronica , Lloyd-McKernan Aoife 
Published: April 2019

Objectives:
To compare the efficacy of using an eyelash manipulation technique to the traditional eyelash epilation and subsequent microscopic examination technique, when investigating for the presence of Demodex folliculorum in a clinical setting.

Methods:
Four hundred twenty-eight eyelashes of 107 subjects were chosen to compare the quantity of D. folliculorum visible on eyelash manipulation with the slitlamp biomicroscope to that counted on microscopic examination of the same epilated eyelash. One eyelash from each eyelid was rotated with sterile forceps in situ, and the number of D. folliculorum seen emerging from the follicle was counted. The same eyelash was then epilated, and the number of D. folliculorum on the epilated eyelash was counted. Data were analyzed to check for agreement between the two techniques.

Results:
Intraclass correlation coefficient showed moderately good agreement for assessing the quantity of D. folliculorum (0.78) between the techniques. However, the Bland–Altman plot suggested that consistently higher quantities were found on eyelash manipulation. The overall mean quantity of D. folliculorum was also greater on eyelash manipulation (1.45 mites; range, 0–13 mites) than on microscopic examination of the epilated eyelash (0.81 mites; range, 0–16; P= <0.001). Weighted kappa (κw=0.56) indicated weak levels of agreement between the two methods for addressing severity of infestation.

Conclusion:
Eyelash manipulation exhibited larger quantities of D. folliculorum than complete epilation of the eyelash. In a clinical setting, complete eyelash epilation is not necessary to accurately detect Demodex blepharitis requiring treatment.
Orthokeratology With a New Contact Lens Design in Hyperopia: A Pilot Study
Authors: Sánchez-García Alicia , Batres-Valderas Laura , Piñero David P. 
Published: April 2019

Purpose:
To evaluate the preliminary clinical outcomes of a new contact lens design for orthokeratology in hyperopia.

Methods:
Prospective pilot study including 8 hyperopic eyes of 4 nonpresbyopic patients (24–44 years) undergoing orthokeratology with the Alexa H contact lens (Tiedra Pharmaceutical, Madrid, Spain), which is an aspheric pentacurve design. Visual, refractive, corneal topographic, and aberrometric changes were evaluated during a 1-month follow-up. Likewise, the presence of ocular surface alterations was evaluated by slit-lamp biomicroscopy during this follow-up.

Results:
Mean noncyclopegic sphere decreased significantly from a mean prefitting value of 2.94±0.95 D to mean values of 1.18±1.19 (P=0.01) and 0.25±0.85 D (P=0.04) at 1 week and 1 month of lens wear, respectively. Statistically significant changes were detected at 1 week of use of the lenses in keratometry (P=0.03), asphericity (Q) (P=0.01), and the Zernike term for corneal spherical aberration (SA) (P=0.01). However, no significant changes were observed in uncorrected (P=0.68) and best-corrected distance visual acuity (P=0.18). Superficial corneal staining was observed after the first night of use in only 1 patient who was resolved spontaneously. Likewise, the induction of a “toroid-like” topographic pattern leading to poor visual outcome and suboptimal correction was observed in four eyes at the beginning of the treatment. This condition was solved in all cases by reducing the lens diameter.

Conclusion:
The Alexa H lens seems to be useful for providing an orthokeratologic correction of hyperopia, with generation of increased negative Q and SA, and central steepening. However, fitting guides must be improved to avoid suboptimal outcomes as those related to the “toroid-like” topographic pattern defined.
Therapeutic Implications of Inherited Thrombophilia in Pregnancy
Authors: Trasca Livia Florentina , Patrascu Natalia , Bruja Ramona , Munteanu Octavian , Cirstoiu Monica , Vinereanu Dragos 
Published: April 2019

Background:
Inherited (hereditary) thrombophilia is a genetic disorder that affects coagulation, being responsible for more than 60% of idiopathic (spontaneous or unprovoked) thromboembolic events. Association of inherited thrombophilia with pregnancy increases the risk of thromboembolic disease, and it may be related to many complications, such as preeclampsia, recurrent miscarriage intrauterine growth restriction, early detachment of placenta, and prematurity.

Areas of Uncertainty:
Interpretation of a positive test for thrombophilia in pregnant women is difficult because they have many natural changes in the coagulation system. Genetic diagnosis of thrombophilia, after a thrombotic event or during a pregnancy complication, has a major importance, not only to define its etiology but also to determine the duration of anticoagulant treatment and risk stratification for prophylaxis treatment.

Data sources:
Literature search was performed using electronic database (PubMed) between April 1981 and November 2018. We used different keywords and MeSH terms to generate the most relevant results related to the inherited thrombophilia and its impact on pregnancy.

Results:
Screening for inherited thrombophilia in young women is recommended in case of personal history of venous thromboembolism, first-degree relatives with a history of high-risk thrombophilia, or personal history of second-trimester miscarriage. Decision to recommend thromboprophylaxis with anticoagulant treatment in pregnant women with inherited thrombophilia is determined by history of venous thromboembolism, type and associated risk of inherited thrombophilia, and presence of additional risk factors. Low-molecular-weight heparins are the preferred agents for prophylaxis in pregnancy, while the doses vary depending on thrombophilia type, personal history, and associated risk factors.

Conclusions:
Association between 2 procoagulant conditions, inherited thrombophilia and pregnancy, has an important impact for the mother and fetus. This review will summarize the impact of each inherited prothrombotic factor on cardiovascular and pregnancy outcomes and will discuss the role of anticoagulation treatment for women diagnosed with inherited thrombophilia.
Development of an Antibiotic Guideline for Children With Suspected Ventilator-Associated Infections*
Authors: Shein Steven L. , Karam Oliver , Beardsley Andrew , Karsies Todd , Prentice Elizabeth , Tarquinio Keiko M. , Willson Douglas F. 
Published: April 2019

Objectives:
To develop a guideline for the decision to continue or stop antibiotics at 48–72 hours after their initiation in children with suspected ventilator-associated infection.

Design:
Prospective, multicenter observational data collection and subsequent development of an antibiotic guideline.

Setting:
Twenty-two PICUs.

Patients:
Children less than 3 years old receiving mechanical ventilation who underwent clinical testing and initiation of antibiotics for suspected ventilator-associated infection.

Interventions:
None.

Measurements and Main Results:
Phase 1 was a prospective data collection in 281 invasively ventilated children with suspected ventilator-associated infection. The median age was 8 months (interquartile range, 4–16 mo) and 75% had at least one comorbidity. Phase 2 was development of the guideline scoring system by an expert panel employing consensus conferences, literature search, discussions with institutional colleagues, and refinement using phase 1 data. Guideline scores were then applied retrospectively to the phase 1 data. Higher scores correlated with duration of antibiotics (p < 0.001) and higher PEdiatric Logistic Organ Dysfunction 2 scores (p < 0.001) but not mortality, PICU-free days or ventilator-free days. Considering safety and outcomes based on the phase 1 data and aiming for a 25% reduction in antibiotic use, the panel recommended stopping antibiotics at 48–72 hours for guideline scores less than or equal to 2, continuing antibiotics for scores greater than or equal to 6, and offered no recommendation for scores 3, 4, and 5. The acceptability and effect of these recommendations on antibiotic use and outcomes will be prospectively tested in phase 3 of the study.

Conclusions:
We developed a scoring system with recommendations to guide the decision to stop or continue antibiotics at 48–72 hours in children with suspected ventilator-associated infection. The safety and efficacy of the recommendations will be prospectively tested in the planned phase 3 of the study.