bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of Antidepressant Use With Drug-Related Extrapyramidal Symptoms
Authors: Guo Michael Y. , Etminan Mahyar , Procyshyn Ric M. , Kim David D. , Samii Ali , Kezouh Abbas , Carleton Bruce C. 
Published: June 2018

AbstractBackgroundAntidepressants are one of the most prescribed classes of medications. A number of case reports have linked these drugs to extrapyramidal symptoms (EPSs), but no large epidemiologic study to date has examined this association. We sought to quantify the association of EPSs with different antidepressants by undertaking a large pharmacoepidemiologic study.MethodsA nested case-control study was conducted using a large health claims database in the United States from June 2006 to December 2015. Subjects with a diagnosis of primary Parkinson disease and those who received prescriptions of levodopa, ropinirole, pramipexole, domperidone, metoclopramide, entacapone, benztropine, selegiline, rasagiline, diphenhydramine, trihexyphenidyl, typical and atypical antipsychotics, and tricyclic antidepressants were excluded. Cases were followed to the first billing code for an extrapyramidal event or last date of enrollment in the cohort. For each case, 10 control subjects were matched by follow-up time, calendar time, and age through density-based sampling. Rate ratios were computed using conditional logistic regression adjusting for other covariates.ResultsWe identified 3,838 subjects with EPSs compared with 38,380 age-matched control subjects. Rate ratios with respect to EPSs were as follows: duloxetine, 5.68 (95% confidence interval [CI], 4.29–7.53); mirtazapine, 3.78 (95% CI, 1.71–8.32); citalopram, 3.47 (95% CI, 2.68–4.50); escitalopram, 3.23 (95% CI, 2.44–4.26); paroxetine, 3.07 (95% CI, 2.15–4.40); sertraline, 2.57 (95% CI, 2.02–3.28); venlafaxine, 2.37 (95% CI, 1.71–3.29); bupropion, 2.31 (95% CI, 1.67–3.21); and fluoxetine, 2.03 (95% CI, 1.48–2.78).ConclusionsThis observational study demonstrates a harmful association between the incidence of Parkinson disease or associated EPSs and use of the antidepressants duloxetine, mirtazapine, citalopram, escitalopram, paroxetine, sertraline, venlafaxine, bupropion, and fluoxetine.
Sleep Deprivation in Neurointensive Care Unit Patients From Serial Neurological Checks: How Much Is Too Much?
Authors: McLaughlin Diane C. , Hartjes Tonja M. , Freeman William D. 
Published: June 2018

ABSTRACT

Objective: Hourly neurological examinations are frequently performed in the neurointensive care unit (NICU) to quickly detect neurological deterioration. These examinations require the patient to be awakened hourly for days disrupting the sleep cycle and potentially causing neurological deterioration through sleep deprivation and the development of delirium. This pilot study’s aim was to describe the prevalence of neurologic deterioration and delirium in patients receiving hourly neuro checks. Design: A 6-month prospective observational cohort study was conducted within the NICU at Mayo Clinic Florida. Twenty subjects were enrolled between July 24, 2016, and January 30, 2017. Results: Neurological deterioration as defined as a decrease in Glasgow Coma Scale score of 2 or more, an increase in National Institute of Health Stroke Scale score by 4 or more, or a change in Confusion Assessment Method score for use in intensive care unit patients from negative to positive occurred in 19 of 20 patients (95%) for a total of 67 events, with most patients having multiple events. Seventy-five percent of the subjects experienced a decrease in Glasgow Coma Scale score of 2 or more at least once during the study period. The largest number of events occurred within the first 24 hours (39%). Surprisingly, 75% of the subjects also developed delirium. Forty percent of the subjects demonstrating neurological deterioration received computed tomography imaging to evaluate the change. Sixty-seven percent lacked deterioration evident on computed tomography imaging, and the deterioration was not attributed to medication effect or seizure by an experienced provider. Conclusions: Neurological deterioration is prevalent in the NICU population. Although hourly neurological examinations may be beneficial in the acute phase of neurological injury, prolonged use may be paradoxically harmful due to sleep deprivation.
Cerebral Amyloid Angiopathy: A Different Kind of Stroke
Authors: Ruth-Sahd Lisa , Schneider Melissa 
Published: June 2018

ABSTRACT
When a patient presents with stroke-type symptoms, the correct diagnosis is imperative to determine appropriate treatment. Cerebral amyloid angiopathy (CAA), a buildup of amyloid proteins on the brain artery walls, is a cause of intracerebral hemorrhage. Improved diagnostic criteria and enhanced neuroimaging have resulted in earlier detection of CAA, which will hopefully lead to better outcomes for these patients. More research is being conducted, and neuroscience nurses need to stay informed about this condition to be able to appropriately care for and educate their patients who are diagnosed with CAA.
Safety of Electromagnetic Navigation Bronchoscopy in Patients With COPD
Authors: Towe Christopher W. , Nead Michael A. , Rickman Otis B. , Folch Erik E. , Khandhar Sandeep J. , Perry Yaron , Linden Philip A. 
Published: June 2018

Background:
Electromagnetic navigation bronchoscopy (ENB) aids in the localization of lung lesions for biopsy and/or to guide fiducial or dye marking for stereotactic radiation or surgical localization. This study assessed ENB safety in patients with chronic obstructive pulmonary disease (COPD) and/or poor lung function.

Methods:
NAVIGATE is a prospective, multicenter, observational study of ENB. This substudy analyzed the 1-month follow-up of the first 1000 enrolled subjects. COPD was determined by medical history. Pulmonary function testing (PFT) results were collected if available within 30 days of the procedure. Procedure-related complications were captured.

Results:
The analysis included 448 subjects with COPD and 541 without COPD (COPD data missing in 11). One-month follow-up was completed in 93.3%. Subjects with COPD tended to be older, male, and have history of tobacco exposure, asthma, and recent pneumonia. Nodule size, location, and procedure time were similar between groups. There was no statistically significant difference in the procedure-related composite complication rate between groups (7.4% with COPD, 7.8% without COPD, P=0.90). Common Terminology Criteria for Adverse Events scale grade ≥2 pneumothorax was not different between groups (2.7% with COPD, 3.7% without COPD, P=0.47). COPD was not a significant multivariate predictor of complications. Severity of forced expiratory volume in 1 second (FEV1) or diffusing capacity of the lung for carbon monoxide impairment was not associated with increased composite procedure-related complications (ppFEV1
P=0.66, ppDLCO P=0.36).

Conclusion:
In this analysis, complication rates following ENB procedures were not increased in patients with COPD or poor pulmonary function. Because pneumothorax risk is not elevated, ENB may be the preferred method to biopsy peripheral lung lesions in patients with COPD and/or poor pulmonary function testing.
Changing paradigms in metabolic support and nutrition therapy during critical illness
Authors: van Zanten Arthur R.H. 
Published: June 2018

Purpose of review
To summarize the most recent advances in acute metabolic care and critical care nutrition.

Recent findings
Recent research has demonstrated unknown consequences of high protein and amino acid administration in the early phase of ICU stay associated with dysregulated glucagon release leading to hepatic amino acid breakdown and suggested adverse effects on autophagy and long-term outcome. Progress has been made to measure body composition in the ICU. Refeeding hypophosphatemia and refeeding syndrome are common during critical illness, phosphate monitoring is essential after the start of nutrition therapy, and caloric restriction is recommendable in these patients.
In recent studies, enteral nutrition is no longer superior to parenteral nutrition and signals of harm using the enteral route in shock have been suggested. However, during extracorporeal life support, enteral nutrition seems well tolerated. Intermittent or bolus enteral feeding seems an exciting concept concerning its potential anabolic effects. Studies on vitamin C, thiamine, and corticosteroid combinations suggest potential to improve outcome.

Summary
These new findings will probably change the practice of metabolic and nutrition therapy in critical illness and challenge paradigms advocated for long.
Mechanical circulatory devices in acute heart failure
Authors: Pineton de Chambrun Marc , Bréchot Nicolas , Combes Alain 
Published: June 2018

Purpose of review
Temporary circulatory support (TCS) with short-term mechanical circulatory support (MCS) devices is increasingly used as a salvage therapy for patients with refractory cardiogenic shock. This article provides an overview of current devices, their indications and management, and discusses results of recent case series and trials.

Recent findings
Percutaneous active MCS devices (Impella, TandemHeart…) and venoarterial extracorporeal membrane oxygenation (VA-ECMO) are utilized as a bridge to ‘decision’ that includes weaning after cardiac function recovery, transplantation, long-term MCS and withdrawal in case of futility. VA-ECMO is considered the first-line TCS since it allows rapid improvement in oxygenation, is less expensive, and is also suitable for patients with biventricular failure. Combining Impella or intra-aortic balloon pump support with ECMO might decrease left ventricular pressure and improve outcomes. Sepsis-associated cardiomyopathy, massive pulmonary embolism, arrhythmic storm and Takotsubo-like cardiomyopathy are among emerging indications for TCS.

Summary
TCS have become the cornerstone of the management of patients with cardiogenic shock, although the evidence supporting their efficacy is limited. VA-ECMO is considered the first-line option, with a growing number of accepted and emerging indications. Randomized clinical trials are now needed to determine the respective place of different MCS devices in cardiogenic shock treatment strategies.
Association of Financial Literacy With Hospitalization in Community-dwelling Older Adults
Authors: James Bryan D. , Wilson Robert S. , Shah Raj C. , Yu Lei , Arvanitakis Zoe , Bennett David A. , Boyle Patricia A. 
Published: June 2018

Background:
Lowering the likelihood of hospitalization in older adults is a major public health goal for modern health care systems. Emerging data suggest that financial literacy is an important determinant of health outcomes in old age, but the relationship with hospitalization has not been explored.

Objective:
To test the hypothesis that better financial literacy is related to lower risk of hospitalization in older persons.

Design:
Prospective cohort study.

Participants:
Data came from community-dwelling older adults (n=388) without dementia enrolled in the Rush Memory and Aging Project.

Main Measures:
Participants underwent detailed assessment of financial literacy and cognition. Data on hospitalizations were obtained from linked Medicare claims records (MedPAR file).

Results:
Over an average of 1.8 years, 117 participants (30%) were hospitalized, and a third of those hospitalized experienced multiple hospitalizations. In a modified Poisson regression model adjusted for age, sex, education, and cognition, better financial literacy was associated with lower risk of hospitalization. In a model further adjusted for income, physical activity, body mass index, smoking, social network size, chronic conditions, basic and instrumental activities of daily living disability, and depressive symptoms, the association was unchanged. Secondary analyses showed the association was primarily driven by conceptual knowledge rather than numeracy.

Conclusions:
Higher financial literacy is related to a lower risk of hospitalization in older persons without dementia, after adjusting for cognitive, health, functional, and socioeconomic factors. The ability to understand and utilize financial concepts may represent a potentially modifiable risk factor for hospitalization in later life.
Contemporary considerations in concurrent endoscopic sinus surgery and rhinoplasty
Authors: Steele Toby O. , Gill Amarbir , Tollefson Travis T. 
Published: June 2018

Purpose of reviewCharacterize indications, perioperative considerations, clinical outcomes and complications for concurrent endoscopic sinus surgery (ESS) and rhinoplasty.Recent findingsChronic rhinosinusitis and septal deviation with or without inferior turbinate hypertrophy independently impair patient-reported quality of life. Guidelines implore surgeons to include endoscopy to accurately evaluate patient symptoms. Complication rates parallel those of either surgery (ESS and rhinoplasty) alone and are not increased when performed concurrently. Operative time is generally longer for joint surgeries. Patient satisfaction rates are high.SummaryConcurrent functional and/or cosmetic rhinoplasty and ESS is a safe endeavor to perform in a single operative setting and most outcomes data suggest excellent patient outcomes. Additional studies that include patient-reported outcome measures are needed.
Advances in Diagnostic and Intraoperative Molecular Imaging of Pancreatic Cancer
Authors: Tummers Willemieke S. , Willmann Juergen K. , Bonsing Bert A. , Vahrmeijer Alexander L. , Gambhir Sanjiv S. , Swijnenburg Rutger-Jan 
Published: June 2018

AbstractPancreatic ductal adenocarcinoma (PDAC) has a dismal prognosis. To improve outcomes, there is a critical need for improved tools for detection, accurate staging, and resectability assessment. This could improve patient stratification for the most optimal primary treatment modality. Molecular imaging, used in combination with tumor-specific imaging agents, can improve established imaging methods for PDAC. These novel, tumor-specific imaging agents developed to target specific biomarkers have the potential to specifically differentiate between malignant and benign diseases, such as pancreatitis. When these agents are coupled to various types of labels, this type of molecular imaging can provide integrated diagnostic, noninvasive imaging of PDAC as well as image-guided pancreatic surgery. This review provides a detailed overview of the current clinical imaging applications, upcoming molecular imaging strategies for PDAC, and potential targets for imaging, with an emphasis on intraoperative imaging applications.
A Multifaceted Intervention to Reduce Pediatric Acid‐Suppressant Prescriptions for Gastroesophageal Reflux
Authors: Steutel Nina F. , Langendam Miranda W. , Benninga Marc A. , Jansen Minke E.P. , Tabbers Merit M. 
Published: June 2018

ABSTRACTObjective:Acid‐suppressant prescriptions for children have increased over past decades, despite guideline recommendations to prescribe prudently. Acid suppressants are often ineffective and may lead to side effects. We aimed to reduce inappropriate acid‐suppressant prescriptions for gastroesophageal reflux in a tertiary care setting through active implementation of national guideline recommendations and to evaluate intervention effect.Methods:Implementation consisted of 2 steps. First, all pediatric clinicians in an academic hospital received information on appropriate acid‐suppressant prescribing, a link to an online national guideline application and summary card with important evidence‐based recommendations—Wise Choices. Hereafter, clinicians prescribing acid suppressants were contacted to provide feedback on indications and to assess their knowledge of the guideline and Wise Choices. The pharmacy database supplied prescription data before, during, and after this intervention.Results:During the study period prescriptions ranged from 115 to 201/month. Ten months postintervention, a nonsignificant decrease of 4 prescriptions/month was measured (95% confidence interval −49–41). Of the 78 prescribers 76 were successfully contacted: 63% were familiar with the guideline and 45% with Wise Choices. Thirty percent of prescriptions were for gastroesophageal reflux symptoms.Conclusion:This multifaceted implementation strategy did not lead to a significant difference in acid‐suppressant prescriptions by tertiary care clinicians of whom the majority was familiar with the gastroesophageal reflux disease guideline. Future studies should clarify, which implementation strategies are most effective in reducing inappropriate prescribing of acid suppressants for children. Uniform registration of prescriptions and indications in a national database will enable monitoring of the intervention effect.
Neurologic Outcomes After Extracorporeal Membrane Oxygenation: A Systematic Review
Authors: Boyle Katharine , Felling Ryan , Yiu Alvin , Battarjee Wejdan , Schwartz Jamie McElrath , Salorio Cynthia , Bembea Melania M. 
Published: June 2018

Objectives:
The goal of this systematic review of the literature was to summarize neurologic outcomes following neonatal and pediatric extracorporeal membrane oxygenation.

Data Sources:
We conducted electronic searches of PubMed, Scopus, Web of Science, CINAHL, Cochrane, and EMBASE.

Study Selection:
Inclusion criteria included publication dates 2000–2016, patient ages 0–18 years, and use of standardized measures to evaluate outcomes after extracorporeal membrane oxygenation.

Data Extraction:
We identified 3,497 unique citations; 60 full-text articles were included in the final review.

Data Synthesis:
Studies evaluated patients with congenital diaphragmatic hernia (7), cardiac disease (8), cardiac arrest (13), and mixed populations (32). Follow-up was conducted at hospital discharge in 10 studies (17%) and at a median of 26 months (interquartile range, 8–61 mo) after extracorporeal membrane oxygenation in 50 studies (83%). We found 55 outcome measures that assessed overall health and function (4), global cognitive ability (7), development (4), motor function (5), adaptive function (2), behavior/mood (6), hearing (2), quality of life (2), school achievement (5), speech and language (6), learning and memory (4), and attention and executive function (8). Overall, 10% to as many as 50% of children scored more than 2 sds below the population mean on cognitive testing. Behavior problems were identified in 16–46% of children tested, and severe motor impairment was reported in 12% of children. Quality of life of former extracorporeal membrane oxygenation patients evaluated at school age or adolescence ranged from similar to healthy peers, to 31–53% having scores more than 1 sd below the population mean.

Conclusions:
This systematic review of the literature suggests that children who have undergone extracorporeal membrane oxygenation suffer from a wide range of disabilities. A meta-analysis was not feasible due to heterogeneity in pathologies, outcome measures, and age at follow-up, underscoring the importance of developing and employing a core set of outcomes measures in future extracorporeal membrane oxygenation studies.
Bone Marrow Fat Physiology in Relation to Skeletal Metabolism and Cardiometabolic Disease Risk in Children With Cerebral Palsy
Authors: Whitney Daniel G. , Peterson Mark D. , Devlin Maureen J. , Caird Michelle S. , Hurvitz Edward A. , Modlesky Christopher M. 
Published: June 2018

AbstractIndividuals with cerebral palsy exhibit neuromuscular complications and low physical activity levels. Adults with cerebral palsy exhibit a high prevalence of chronic diseases, which is associated with musculoskeletal deficits. Children with cerebral palsy have poor musculoskeletal accretion accompanied by excess bone marrow fat, which may lead to weaker bones. Mechanistic studies to determine the role of bone marrow fat on skeletal growth and maintenance and how it relates to systemic energy metabolism among individuals with cerebral palsy are lacking. In this review, we highlight the skeletal status in children with cerebral palsy and analyze the existing literature on the interactions among bone marrow fat, skeletal health, and cardiometabolic disease risk in the general population. Clinically vital questions are proposed, including the following: (1) Is the bone marrow fat in children with cerebral palsy metabolically distinct from typically developing children in terms of its lipid and inflammatory composition? (2) Does the bone marrow fat suppress skeletal acquisition? (3) Or, does it accelerate chronic disease development in children with cerebral palsy? (4) If so, what are the mechanisms? In conclusion, although inadequate mechanical loading may initiate poor skeletal development, subsequent expansion of bone marrow fat may further impede skeletal acquisition and increase cardiometabolic disease risk in those with cerebral palsy.
“The Invisible Staff”: A Qualitative Analysis of Environmental Service Workers’ Perceptions of the VA Clostridium difficile Prevention Bundle Using a Human Factors Engineering Approach
Authors: Yanke Eric , Moriarty Helene , Carayon Pascale , Safdar Nasia 
Published: June 2018

Objectives
Using a novel human factors engineering approach, the Systems Engineering Initiative for Patient Safety model, we evaluated environmental service workers’ (ESWs) perceptions of barriers and facilitators influencing adherence to the nationally mandated Department of Veterans Affairs Clostridium difficile infection (CDI) prevention bundle.

Methods
A focus group of ESWs was conducted. Qualitative analysis was performed employing a visual matrix display to identify barrier/facilitator themes related to Department of Veterans Affairs CDI bundle adherence using the Systems Engineering Initiative for Patient Safety work system as a framework.

Results
Environmental service workers reported adequate cleaning supplies/equipment and displayed excellent knowledge of CDI hand hygiene requirements. Environmental service workers described current supervisory practices as providing an acceptable amount of time to clean CDI rooms, although other healthcare workers often pressured ESWs to clean rooms more quickly. Environmental service workers reported significant concern for CDI patients’ family members as well as suggesting uncertainty regarding the need for family members to follow infection prevention practices. Small and cluttered patient rooms made cleaning tasks more difficult, and ESW cleaning tasks were often interrupted by other healthcare workers. Environmental service workers did not feel comfortable asking physicians for more time to finish cleaning a room nor did ESWs feel comfortable pointing out lapses in physician hand hygiene.

Conclusions
Multiple work system components serve as barriers to and facilitators of ESW adherence to the nationally mandated Department of Veterans Affairs CDI bundle. Environmental service workers may represent an underappreciated resource for hospital infection prevention, and further efforts should be made to engage ESWs as members of the health care team.