bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective Study of the Effectiveness of Paroxetine on the Onset of Posttraumatic Stress Disorder, Depression, and Health and Functional Outcomes After Trauma
Authors: Borrelli Joseph , Starr Adam , Downs Dana L. , North Carol S. 
Published: October 2018

Objectives:
To determine whether the administration of medication for posttraumatic stress disorder (PTSD) to injured trauma survivors prevents or mitigates PTSD.

Design:
Double-blinded, placebo-controlled.

Setting:
Level I trauma center.

Patients:
One hundred twenty patients admitted for traumatic orthopaedic injury.

Intervention:
Either paroxetine or placebo starting 2 weeks postinjury.

Main Outcome Measurements:
PTSD symptoms were measured with the PTSD Checklist for DSM-IV. The Quick Inventory of Depressive Symptomatology (QIDS) assessed the presence and severity of DSM-IV-TR major depressive symptoms. The SF-36 measured postinjury quality of life and social functioning. The Short Musculoskeletal Functional Assessment rated postinjury musculoskeletal function.

Results:
The paroxetine group did not differ from the placebo group in proportions with PTSD as assessed at the 6- or 12-month follow-up or in proportions with major depression symptoms since the injury as assessed at the 3-month follow-up. The groups also did not differ at the 8-week follow-up in the amount of change from baseline in QIDS scores. The paroxetine group had a marginally greater increase from baseline in SF-36 functioning score at the 12-month follow-up as compared with the placebo group and a marginally greater reduction from baseline in Short Musculoskeletal Functional Assessment musculoskeletal functioning at the 12-month follow-up as compared with the placebo group.

Conclusions:
These results suggest the potential for psychotropic medication to prevent or reduce posttraumatic stress symptoms and to improve the function and health of trauma patients. Further research is needed to confirm paroxetine's use for this purpose.

Level of Evidence:
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Vitamin D to Prevent Lung Injury Following Esophagectomy—A Randomized, Placebo-Controlled Trial*
Authors: Parekh Dhruv , Dancer Rachel C. A. , Scott Aaron , D’Souza Vijay K. , Howells Phillip A. , Mahida Rahul Y. , Tang Jonathan C. Y. , Cooper Mark S. , Fraser William D. , Tan LamChin , Gao Fang , Martineau Adrian R. , Tucker Olga , Perkins Gavin D. , Thickett David R. 
Published: October 2018

Objectives:
Observational studies suggest an association between vitamin D deficiency and adverse outcomes of critical illness and identify it as a potential risk factor for the development of lung injury. To determine whether preoperative administration of oral high-dose cholecalciferol ameliorates early acute lung injury postoperatively in adults undergoing elective esophagectomy.

Design:
A double-blind, randomized, placebo-controlled trial.

Setting:
Three large U.K. university hospitals.

Patients:
Seventy-nine adult patients undergoing elective esophagectomy were randomized.

Interventions:
A single oral preoperative (3–14 d) dose of 7.5 mg (300,000 IU; 15 mL) cholecalciferol or matched placebo.

Measurements and Main Results:
Primary outcome was change in extravascular lung water index at the end of esophagectomy. Secondary outcomes included Pao
2:Fio
2 ratio, development of lung injury, ventilator and organ-failure free days, 28 and 90 day survival, safety of cholecalciferol supplementation, plasma vitamin D status (25(OH)D, 1,25(OH)2D, and vitamin D-binding protein), pulmonary vascular permeability index, and extravascular lung water index day 1 postoperatively. An exploratory study measured biomarkers of alveolar-capillary inflammation and injury. Forty patients were randomized to cholecalciferol and 39 to placebo. There was no significant change in extravascular lung water index at the end of the operation between treatment groups (placebo median 1.0 [interquartile range, 0.4–1.8] vs cholecalciferol median 0.4 mL/kg [interquartile range, 0.4–1.2 mL/kg]; p = 0.059). Median pulmonary vascular permeability index values were significantly lower in the cholecalciferol treatment group (placebo 0.4 [interquartile range, 0–0.7] vs cholecalciferol 0.1 [interquartile range, –0.15 to –0.35]; p = 0.027). Cholecalciferol treatment effectively increased 25(OH)D concentrations, but surgery resulted in a decrease in 25(OH)D concentrations at day 3 in both arms. There was no difference in clinical outcomes.

Conclusions:
High-dose preoperative treatment with oral cholecalciferol was effective at increasing 25(OH)D concentrations and reduced changes in postoperative pulmonary vascular permeability index, but not extravascular lung water index.
Beyond Low Tidal Volume Ventilation: Treatment Adjuncts for Severe Respiratory Failure in Acute Respiratory Distress Syndrome
Authors: Fielding-Singh Vikram , Matthay Michael A. , Calfee Carolyn S. 
Published: October 2018

Objectives:
Despite decades of research, the acute respiratory distress syndrome remains associated with significant morbidity and mortality. This Concise Definitive Review provides a practical and evidence-based summary of treatments in addition to low tidal volume ventilation and their role in the management of severe respiratory failure in acute respiratory distress syndrome.

Data Sources:
We searched the PubMed database for clinical trials, observational studies, and review articles describing treatment adjuncts in acute respiratory distress syndrome patients, including high positive end-expiratory pressure strategies, recruitment maneuvers, high-frequency oscillatory ventilation, neuromuscular blockade, prone positioning, inhaled pulmonary vasodilators, extracorporeal membrane oxygenation, glucocorticoids, and renal replacement therapy.

Study Selection and Data Extraction:
Results were reviewed by the primary author in depth. Disputed findings and conclusions were then reviewed with the other authors until consensus was achieved.

Data Synthesis:
Severe respiratory failure in acute respiratory distress syndrome may present with refractory hypoxemia, severe respiratory acidosis, or elevated plateau airway pressures despite lung-protective ventilation according to acute respiratory distress syndrome Network protocol. For severe hypoxemia, first-line treatment adjuncts include high positive end-expiratory pressure strategies, recruitment maneuvers, neuromuscular blockade, and prone positioning. For refractory acidosis, we recommend initial modest liberalization of tidal volumes, followed by neuromuscular blockade and prone positioning. For elevated plateau airway pressures, we suggest first decreasing tidal volumes, followed by neuromuscular blockade, modification of positive end-expiratory pressure, and prone positioning. Therapies such as inhaled pulmonary vasodilators, glucocorticoids, and renal replacement therapy have significantly less evidence in favor of their use and should be considered second line. Extracorporeal membrane oxygenation may be life-saving in selected patients with severe acute respiratory distress syndrome but should be used only when other alternatives have been applied.

Conclusions:
Severe respiratory failure in acute respiratory distress syndrome often necessitates the use of treatment adjuncts. Evidence-based application of these therapies in acute respiratory distress syndrome remains a significant challenge. However, a rational stepwise approach with frequent monitoring for improvement or harm can be achieved.
Effects of Polyethylene Glycol-20k on Postresuscitation Myocardial and Cerebral Function in a Rat Model of Cardiopulmonary Resuscitation
Authors: Yang Jin , Xiao Yan , Quan Eugenie Y. , Hu Zhangle , Guo Qinyue , Miao Changqing , Bradley Jennifer L. , Peberdy Mary A. , Ornato Joseph P. , Mangino Martin J. , Tang Wanchun 
Published: October 2018

Objectives:
Polyethylene glycol-20k is a hybrid cell impermeant that reduces ischemia injury and improves microcirculatory flow during and following low flow states through nonenergy-dependent water transfer in the microcirculation. We investigated the effects of polyethylene glycol-20k on postresuscitation microcirculation, myocardial and cerebral function, and duration of survival in a rat model of cardiopulmonary resuscitation.

Design:
Ventricular fibrillation was induced in 20 male Sprague Dawley rats and untreated for 6 minutes. Animals were randomized into two groups (n = 10 for each group): polyethylene glycol-20k and control. Polyethylene glycol-20k (10% solution in saline, 10% estimated blood volume) and vehicle (saline) were administered at the beginning of cardiopulmonary resuscitation by continuous IV infusion. Resuscitation was attempted after 8 minutes of cardiopulmonary resuscitation.

Setting:
University-Affiliated Research Laboratory.

Subjects:
Sprague Dawley Rats.

Interventions:
Polyethylene glycol-20k.

Measurements and Main Results:
Buccal microcirculation was measured at baseline, 1, 3, and 6 hours after return of spontaneous circulation using a side-stream dark-field imaging device. Myocardial function was measured by echocardiography at baseline and every hour postresuscitation for 6 hours. The animals were then returned to their cage and observed for an additional 72 hours. Neurologic Deficit Scores were recorded at 24, 48, and 72 hours after resuscitation. Postresuscitation ejection fraction, cardiac output, and myocardial performance index were significantly improved in animals treated with polyethylene glycol-20k (p < 0.05). Perfused buccal vessel density and microcirculatory flow index values were significantly higher at all time points in the polyethylene glycol-20k group compared with the control group. Postresuscitation cerebral function and survival rate were also significantly improved in animals that received polyethylene glycol-20k.

Conclusions:
Administration of polyethylene glycol-20k following cardiopulmonary resuscitation improves postresuscitation myocardial and cerebral function, buccal microcirculation, and survival in a rat model of cardiopulmonary resuscitation.
Peripherally Inserted Central Catheters in the ICU: A Retrospective Study of Adult Medical Patients in 52 Hospitals
Authors: Govindan Sushant , Snyder Ashley , Flanders Scott A. , Chopra Vineet 
Published: October 2018

Objectives:
To quantify variation in use and complications from peripherally inserted central catheters placed in the ICU versus peripherally inserted central catheters placed on the general ward.

Design:
Retrospective cohort study.

Setting:
Fifty-two hospital Michigan quality collaborative.

Patients:
Twenty-seven–thousand two-hundred eighty-nine patients with peripherally inserted central catheters placed during hospitalization.

Measurements and Main Results:
Descriptive statistics were used to summarize patient, provider, and device characteristics. Bivariate tests were used to assess differences between peripherally inserted central catheters placed in the ICU versus peripherally inserted central catheters placed on the ward. Multilevel mixed-effects generalized linear models adjusting for patient and device factors with a logit link clustered by hospital were used to examine the association between peripherally inserted central catheter complications and location of peripherally inserted central catheter placement. Variation in ICU peripherally inserted central catheter use, rates of complications, and appropriateness of use across hospitals was also examined. Eight-thousand two-hundred eighty patients (30.3%) received peripherally inserted central catheters in the ICU versus 19,009 (69.7%) on the general ward. The commonest indication for peripherally inserted central catheter use in the ICU was difficult IV access (35.1%) versus antibiotic therapy (53.3%) on wards. Compared with peripherally inserted central catheters placed in wards, peripherally inserted central catheters placed in the ICU were more often multilumen (59.5% vs 39.3; p < 0.001) and more often associated with a complication (odds ratio, 1.30; 95% CI, 1.18–1.43; p < 0.001). Substantial variation in ICU peripherally inserted central catheter use and outcomes across hospitals was observed, with median peripherally inserted central catheter dwell time ranging from 3 to 38.5 days (p < 0.001) and complications from 0% to 40.2% (p < 0.001). Importantly, 87% (n = 45) of ICUs reported median peripherally inserted central catheter dwell times less than or equal to 14 days, a duration where traditional central venous catheters, not peripherally inserted central catheters, are considered appropriate by published criteria.

Conclusions:
Peripherally inserted central catheter use in the ICU is highly variable, associated with complications and often not appropriate. Further study of vascular access decision-making in the ICU appears necessary.
Systemic Inflammatory Response Syndrome as Predictor of Poor Outcome in Nontraumatic Subarachnoid Hemorrhage Patients
Authors: Rass Verena , Gaasch Max , Kofler Mario , Schiefecker Alois Josef , Ianosi Bogdan-Andrei , Rhomberg Paul , Beer Ronny , Pfausler Bettina , Gizewski Elke R. , Thomé Claudius , Schmutzhard Erich , Helbok Raimund 
Published: October 2018

Objectives:
Subarachnoid hemorrhage is a life-threatening disease associated with high mortality and morbidity. A substantial number of patients develop systemic inflammatory response syndrome. We aimed to identify risk factors for systemic inflammatory response syndrome development and to evaluate the role of systemic inflammatory response syndrome on patients’ outcome.

Design:
Retrospective observational cohort study of prospectively collected data.

Setting:
Neurocritical care unit at a tertiary academic medical center.

Patients:
Two-hundred and ninety-seven consecutive nontraumatic subarachnoid hemorrhage patients admitted to the neurologic ICU between 2010 and 2017.

Interventions:
Systemic inflammatory response syndrome was diagnosed based on greater than or equal to two criteria (hypo-/hyperthermia, tachypnea, leukopenia/leukocytosis, tachycardia) and defined as early (≤ 3 d) and delayed (days 6–10) systemic inflammatory response syndrome burden (systemic inflammatory response syndrome positive days within the first 10 d). Using multivariate analysis, risk factors for the development of early and delayed systemic inflammatory response syndrome and the relationship of systemic inflammatory response syndrome with poor 3-month functional outcome (modified Rankin Scale score ≥ 3) were analyzed.

Measurements and Main Results:
Seventy-eight percent of subarachnoid hemorrhage patients had early systemic inflammatory response syndrome, and 69% developed delayed systemic inflammatory response syndrome. Median systemic inflammatory response syndrome burden was 60% (interquartile range, 10–90%). Risk factors for early systemic inflammatory response syndrome were higher admission Hunt and Hess grade (odds ratio, 1.75; 95% CI, 1.09–2.83; p = 0.02), aneurysm clipping (odds ratio, 4.84; 95% CI, 1.02–23.05; p = 0.048), and higher modified Fisher Scale score (odds ratio, 1.88; 95% CI, 1.25–2.89; p = 0.003). Hunt and Hess grade and pneumonia were independently associated with delayed systemic inflammatory response syndrome development. Systemic inflammatory response syndrome burden (area under the curve, 0.84; 95% CI, 0.79–0.88) had a higher predictive value for 3-month poor outcome compared with early systemic inflammatory response syndrome (area under the curve, 0.76; 95% CI, 0.70–0.81; p < 0.001).

Conclusions:
Systemic inflammatory response syndrome is common after subarachnoid hemorrhage and independently contributes to poor functional outcome. Systemic inflammatory response syndrome burden more accurately predicts poor outcome than early systemic inflammatory response syndrome.
Evaluation of a Measurement System to Assess ICU Team Performance*
Authors: Dietz Aaron S. , Salas Eduardo , Pronovost Peter J. , Jentsch Florian , Wyskiel Rhonda , Mendez-Tellez Pedro Alejandro , Dwyer Cynthia , Rosen Michael A. 
Published: October 2018

Objective:
Measuring teamwork is essential in critical care, but limited observational measurement systems exist for this environment. The objective of this study was to evaluate the reliability and validity of a behavioral marker system for measuring teamwork in ICUs.

Design:
Instances of teamwork were observed by two raters for three tasks: multidisciplinary rounds, nurse-to-nurse handoffs, and retrospective videos of medical students and instructors performing simulated codes. Intraclass correlation coefficients were calculated to assess interrater reliability. Generalizability theory was applied to estimate systematic sources of variance for the three observed team tasks that were associated with instances of teamwork, rater effects, competency effects, and task effects.

Setting:
A 15-bed surgical ICU at a large academic hospital.

Subjects:
One hundred thirty-eight instances of teamwork were observed. Specifically, we observed 88 multidisciplinary rounds, 25 nurse-to-nurse handoffs, and 25 simulated code exercises.

Interventions:
No intervention was conducted for this study.

Measurements and Main Results:
Rater reliability for each overall task ranged from good to excellent correlation (intraclass correlation coefficient, 0.64–0.81), although there were seven cases where reliability was fair and one case where it was poor for specific competencies. Findings from generalizability studies provided evidence that the marker system dependably distinguished among teamwork competencies, providing evidence of construct validity.

Conclusions:
Teamwork in critical care is complex, thereby complicating the judgment of behaviors. The marker system exhibited great potential for differentiating competencies, but findings also revealed that more context specific guidance may be needed to improve rater reliability.
Outcomes of Older Hospitalized Patients Requiring Rapid Response Team Activation for Acute Deterioration
Authors: Fernando Shannon M. , Reardon Peter M. , McIsaac Daniel I. , Eagles Debra , Murphy Kyle , Tanuseputro Peter , Heyland Daren K. , Kyeremanteng Kwadwo 
Published: October 2018

Objectives:
Rapid response teams are groups of healthcare providers that have been implemented by many hospitals to respond to acutely deteriorating patients admitted to the hospital wards. Hospitalized older patients are at particular risk of deterioration. We sought to examine outcomes of older patients requiring rapid response team activation.

Design:
Analysis of a prospectively collected registry.

Setting:
Two hospitals within a single tertiary care level hospital system between 2012 and 2016.

Patients:
Five-thousand nine-hundred ninety-five patients were analyzed. Comparisons were made between older patients (defined as ≥ 75 yr old) and younger patients.

Interventions:
None.

Measurements and Main Results:
All patient information, outcomes, and rapid response team activation information were gathered at the time of rapid response team activation and assessment. The primary outcome was in-hospital mortality, analyzed using multivariate logistic regression. Two-thousand three-hundred nine were older patients (38.5%). Of these, 835 (36.2%) died in-hospital, compared with 998 younger patients (27.1%) (adjusted odds ratio, 1.83 [1.54–2.18]; p < 0.001). Among patients admitted from home, surviving older patients were more likely to be discharged to a long-term care facility (adjusted odds ratio, 2.38 [95% CI, 1.89–3.33]; p < 0.001). Older patients were more likely to have prolonged delay to rapid response team activation (adjusted odds ratio, 1.79 [1.59–2.94]; p < 0.001). Among patients with goals of care allowing for ICU admission, older patients were less likely to be admitted to the ICU (adjusted odds ratio, 0.66 [0.36–0.79]), and less likely to have rapid response team activation during daytime hours (adjusted odds ratio, 0.73 [0.62–0.98]; p < 0.001).

Conclusions:
Older patients with in-hospital deterioration requiring rapid response team activation had increased odds of death and long-term care disposition. Rapid response team activation for older patients was more likely to be delayed, and occur during nighttime hours. These findings highlight the worse outcomes seen among older patients with in-hospital deterioration, identifying areas for future quality improvement.
Talking Tots and the Terrible Twos: Early Language and Disruptive Behavior in Toddlers
Authors: Roberts Megan Y. , Curtis Philip , Estabrook Ryne , Norton Elizabeth S. , Davis Matthew M. , Burns James , Briggs-Gowan Margaret , Petitclerc Amelie , Wakschlag Lauren S. 
Published: October 2018

ABSTRACT:

Objective:
The goal of this article is to investigate the association between the 2 most commonly reported parental concerns about young children—disruptive behavior (e.g., irritable, aggressive, and noncompliant behaviors) and language delay in toddlers. To test for salient subgroup differences, individual differences by the sex of the child and family poverty status were examined.

Methods:
Participants included 1259 mothers of children between 18 and 36 months of age. Mothers completed questions about their child's language development and disruptive behavior. Information regarding poverty status as well as child age and sex were also collected.

Results:
Stronger language skills were associated with fewer disruptive behaviors for children between 18 and 36 months of age. This negative association was stronger for females than for males (b = −0.243; t[1251] = −3.555; p < 0.001) and stronger for children living in poverty than for those above the poverty line (b = −2.04; t[1251] = −2.531; p = 0.011).

Conclusion:
Findings from our study suggest a developmental co-occurrence pattern that begins at a very early age. Individual differences suggest that there is substantial heterogeneity in these patterns; longitudinal investigation is needed to uncover causal pathways and underlying mechanisms. Awareness of the association between these 2 developmental domains, about which parents frequently express concerns, is critical to maximizing early detection and intervention.
The association of an alpha2C adrenoreceptor gene polymorphism with vasomotor symptoms in African American women
Authors: Aharon Devora A. , Friedman Elissa Gretz , Overbey Jessica R. , McLaughlin Maryann , Langaee Taimour , Thurston Rebecca C. 
Published: October 2018

Abstract

Objective:
The alpha2C adrenoreceptor deletion 322-325 (ADRA2C del 322-325) polymorphism has been associated with autonomic activity and thermoregulation, which are implicated in the vasomotor symptom (VMS) mechanism. The ADRA2C del (322-325) has higher prevalence in African American women, a group known to experience more frequent and bothersome VMS. We assessed whether the ADRA2C del (322-325) genotype is associated with increased frequency of VMS in African American women.

Methods:
DNA samples from African American (N = 400) women participating in the Study of Women's Health Across the Nation (SWAN) were genotyped for the ADRA2C del (322-325) polymorphism. Longitudinal data on VMS were obtained from the SWAN repository. The relation of ADRA2C del (322-325) genotypes (deletion/deletion [D/D]; insertion/deletion [I/D]; insertion/insertion [I/I]) with VMS over the menopausal transition for up to 12 years of follow-up was examined using generalized estimating equations. Primary models considered the outcome of frequent VMS (6 or more days in the prior 2 wk vs VMS <6 d in the prior 2 wk) by stage of menopause.

Results:
Four hundred DNA samples from African American women were included. Seventy-five women (18.8%) were found to carry the homozygous variant allele (D/D). There was no significant difference in the trajectory of frequent VMS over the menopausal transition between women with D/D and I/I + I/D genotypes (P = 0.39).

Conclusions:
In this preliminary study among African American women in SWAN, ADRA2C del (322-325) was not significantly related to self-reported VMS. Further studies are warranted to help us understand the role of the adrenergic system in the physiology of VMS to tailor medical therapy to patient needs.