bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increasing Access to Palliative Care Services in the Intensive Care Unit
Authors: McCarroll Caitlin Marie 
Published: March 2018

Background
The Institute of Medicine's report, Dying in America, highlights the critical need for the widespread implementation of palliative care to improve end-of-life care.1 Approximately 20% of all deaths in America occur during or shortly after an intensive care unit (ICU) admission2; therefore, it is important for critical care units to have systems in place to facilitate patient access to palliative care services.1,3,4

Objectives
The aim of this quality improvement (QI) project was to develop and implement a palliative care screening tool using evidence-based triggers to help increase the proportion of palliative care consultations in the ICU setting.

Methods
A QI project was designed and implemented in a 14-bed medical-surgical ICU in the southeastern United States using the Plan-Do-Study-Act cycle.5 A palliative care screening tool was developed by an interdisciplinary team of key stakeholders in the ICU using evidence-based triggers, and staff were educated on the intervention. The proportion of ICU patients who received a palliative care consultation was compared preintervention and postintervention to determine whether the QI project contributed to an increased proportion of palliative care consultations.

Results
The proportion of palliative care consultations among patients admitted to the ICU by the pulmonary critical care team increased from 1 of 10 preintervention to 3 of 10 postintervention, resulting in a promising increase in patients receiving palliative care services consistent with evidence-based recommendations.

Conclusion
The use of an evidence-based screening tool to trigger palliative care consultation in the ICU setting can aid in increasing the proportion of critical care patients who receive a palliative care referral. The increase in the proportion of palliative care referrals by the pulmonary critical care service warrants expansion of the intervention to include additional medical subspecialists who frequently admit patients in this ICU setting. Further assessment of the intervention is warranted to determine whether the screening tool can aid in increasing palliative care consultations for more patients admitted to the hospital’s ICU.
Outcomes of Trabeculectomy and Glaucoma Drainage Devices for Elevated Intraocular Pressure After Penetrating Keratoplasty
Authors: Yakin Mehmet , Eksioglu Umit , Yalniz-Akkaya Zuleyha , Uzman Selma , Singar-Ozdemir Evin , Gultekin Kemal , Demirok Gulizar , Yalvac Ilgaz , Ornek Firdevs , Burcu Ayse 
Published: March 2018

Purpose:
To assess and compare the outcomes of trabeculectomy with and without antimetabolites (AMs) and glaucoma drainage devices (GDDs) in the management of elevated intraocular pressure (IOP) after penetrating keratoplasty (PK).

Methods:
Data of 84 eyes of 81 patients who underwent trabeculectomy (12 eyes without an AM and 42 eyes with an AM) or GDD implantation (30 eyes) after PK were reviewed retrospectively. The main outcome measures were IOP control, corneal graft survival, and postoperative ocular complications.

Results:
At the final visit, IOP success (<22 mm Hg) was 58.3% in trabeculectomy alone, 64.3% in trabeculectomy with an AM (TrabAM), and 86.7% in GDD groups (P = 0.047). The median time from surgery to IOP failure was 1 month after trabeculectomy alone, 13 months after TrabAM, and 20 months after GDD implantation (P = 0.042). The cumulative probability of IOP success rates at 1 and 3 years postoperatively was as follows: 66.7% and 57.1% in trabeculectomy alone, 80.6% and 64.8% in TrabAM, and 92.3% and 84.6 in GDD groups (P = 0.063). The cumulative probability of corneal graft survival rates at 1 and 3 years postoperatively was as follows: 70.0% and 60.0% in trabeculectomy alone, 76.7% and 67.7% in TrabAM, and 65.8% and 52.6% in GDD groups (P = 0.549).

Conclusions:
GDDs are more successful than trabeculectomy in controlling IOP in eyes that have undergone PK, but they tend to have low corneal graft survival rates. Trabeculectomy without an AM has limited success and may be considered in a limited number of patients with a low risk for bleb failure.
Efficacy and Safety of Echinocandins for the Treatment of Invasive Candidiasis in Children
Authors: Tsekoura Magdalini , Ioannidou Maria , Pana Zoi-Dorothea , Haidich Anna-Bettina , Antachopoulos Charalampos , Iosifidis Elias , Kolios George , Roilides Emmanuel 
Published: March 2018

Background:Echinocandins are recommended for the treatment of suspected or confirmed invasive candidiasis (IC) in adults. Less is known about the use of echinocandins for the management of IC in children. The aim of this study was to investigate the overall efficacy and safety of echinocandin class in neonatal and pediatric patients with IC.Methods:PubMed, Cochrane Central, Scopus and Clinical trial registries were searched up to July 27, 2017. Eligible studies were randomized controlled trials that evaluated the efficacy and safety of any echinocandin versus agents of other antifungal classes for the treatment of IC in pediatric patients. The primary outcome was treatment success with resolution of symptoms and signs, and absence of IC. In the meta-analysis a random effects model was used, and the odds ratio (OR) and 95% confidence intervals (CIs) were calculated.Results:Four randomized clinical trials (324 patients), 2 confirmed IC (micafungin vs. liposomal amphotericin B (L-AmB) and caspofungin vs. L-AmB) and 2 empirical therapy trials (caspofungin vs. deoxycholate amphotericin B and caspofungin vs. L-AmB) were included. There was no significant difference between echinocandins and comparator in terms of treatment success (OR = 1.61, 95% CI: 0.74–3.50) and incidence of treatment-related adverse events (OR = 0.70, 95% CI: 0.39–1.26). However, fewer children treated with echinocandins discontinued treatment because of adverse events than amphotericin B formulations (OR = 0.26, 95% CI: 0.08–0.82,P= 0.02).Conclusions:In the treatment of IC in children, echinocandins show non-inferior efficacy compared with amphotericin B formulations with fewer discontinuations than in comparator arm.
Reduction of Inappropriate Antimicrobial Prescriptions in a Tertiary Neonatal Intensive Care Unit After Antimicrobial Stewardship Care Bundle Implementation
Authors: Ting Joseph Y. , Paquette Vanessa , Ng Karen , Lisonkova Sarka , Hait Valoria , Shivanada Sandesh , Tilley Peter , Osiovich Horacio , Roberts Ashley 
Published: March 2018

Background:
Our objective was to evaluate the appropriateness of antibiotic prescriptions in the neonatal intensive care unit using standardized criteria and determine the effects of an antimicrobial stewardship program (ASP) on patterns of antibiotic usage.

Methods:
A retrospective audit of antibiotic use from July 2010 to June 2013 was conducted, focusing on prescriptions of vancomycin, cefotaxime, meropenem and linezolid for >3 calendar-days. We evaluated the appropriateness of each course of antibiotic treatment based on the Centers for Disease Control and Prevention 12-Step Guidelines to Prevent Antimicrobial Resistance (steps 4, 6 and 9). An ASP was introduced in August 2014, and the same audit criteria were applied to review antimicrobial use in the subsequent 12 months.

Results:
In the pre-ASP era, 26.3%, 12.1%, 11.4% and 0% of meropenem, cefotaxime, vancomycin and linezolid courses, respectively, were inappropriate. The most common instance of inappropriate utilization included failure to use narrow-spectrum antimicrobials when appropriate. After the introduction of ASP program, 22.2%, 7.5%, 5.4% and 0% of meropenem, cefotaxime, vancomycin and linezolid courses, respectively, were inappropriate. The numbers of inappropriate antibiotic-days/1000 days of therapy with meropenem, cefotaxime and vancomycin changed from 1.89 to 1.96 [rate ratio (RR), 1.04 (0.70–1.52)], 3.56 to 1.73 [RR, 0.49 (0.33–0.71)] and 2.70 to 1.01 [RR, 0.37 (0.22–0.60)], respectively. In subgroup analysis, very low birth weight infants (birth weight, <1500 g) showed no improvement in the rates of inappropriate antibiotic prescriptions.

Conclusions:
In this study, we found that ASP initiatives can be applied in neonatal populations to reduce inappropriate antimicrobial prescriptions, though a different approach may be needed among very low birth weight infants.
Associations between onset of effort-reward imbalance at work and onset of musculoskeletal pain: analyzing observational longitudinal data as pseudo-trials
Authors: Halonen Jaana I. , Virtanen Marianna , Leineweber Constanze , Rod Naja H. , Westerlund Hugo , Magnusson Hanson Linda L. 
Published: March 2018

Abstract
Existing evidence of an association between effort-reward imbalance (ERI) at work and musculoskeletal pain is limited, preventing reliable conclusions about the magnitude and direction of the relation. In a large longitudinal study, we examined whether the onset of ERI is associated with subsequent onset of musculoskeletal pain among those free of pain at baseline, and vice versa, whether onset of pain leads to onset of ERI. Data were from the Swedish Longitudinal Occupational Survey of Health (SLOSH) study. We used responses from 3 consecutive study phases to examine whether exposure onset between the first and second phases predicts onset of the outcome in the third phase (N = 4079). Effort-reward imbalance was assessed with a short form of the ERI model. Having neck-shoulder and low back pain affecting life to some degree in the past 3 months was also assessed in all study phases. As covariates, we included age, sex, marital status, occupational status, and physically strenuous work. In the adjusted models, onset of ERI was associated with onset of neck-shoulder pain (relative risk [RR] 1.51, 95% confidence interval [CI] 1.21-1.89) and low back pain (RR 1.21, 95% CI 0.97-1.50). The opposite was also observed, as onset of neck-shoulder pain increased the risk of subsequent onset of ERI (RR 1.36, 95% CI 1.05-1.74). Our findings suggest that when accounting for the temporal order, the associations between ERI and musculoskeletal pain that affects life are bidirectional, implying that interventions to both ERI and pain may be worthwhile to prevent a vicious cycle.
Design and Rationale of the Cognitive Intervention to Improve Memory in Heart Failure Patients Study
Authors: Pressler Susan J. , Giordani Bruno , Titler Marita , Gradus-Pizlo Irmina , Smith Dean , Dorsey Susan G. , Gao Sujuan , Jung Miyeon 
Published: March 2018

Background:
Memory loss is an independent predictor of mortality among heart failure patients. Twenty-three percent to 50% of heart failure patients have comorbid memory loss, but few interventions are available to treat the memory loss. The aims of this 3-arm randomized controlled trial were to (1) evaluate efficacy of computerized cognitive training intervention using BrainHQ to improve primary outcomes of memory and serum brain-derived neurotrophic factor levels and secondary outcomes of working memory, instrumental activities of daily living, and health-related quality of life among heart failure patients; (2) evaluate incremental cost-effectiveness of BrainHQ; and (3) examine depressive symptoms and genomic moderators of BrainHQ effect.

Methods:
A sample of 264 heart failure patients within 4 equal-sized blocks (normal/low baseline cognitive function and gender) will be randomly assigned to (1) BrainHQ, (2) active control computer-based crossword puzzles, and (3) usual care control groups. BrainHQ is an 8-week, 40-hour program individualized to each patient's performance. Data collection will be completed at baseline and at 10 weeks and 4 and 8 months. Descriptive statistics, mixed model analyses, and cost-utility analysis using intent-to-treat approach will be computed.

Conclusions:
This research will provide new knowledge about the efficacy of BrainHQ to improve memory and increase serum brain-derived neurotrophic factor levels in heart failure. If efficacious, the intervention will provide a new therapeutic approach that is easy to disseminate to treat a serious comorbid condition of heart failure.
Associations of Vitamin D Intake and Sleep Quality With Cognitive Dysfunction in Older Adults With Heart Failure
Authors: Song Eun Kyeung , Wu Jia-Rong 
Published: March 2018

Background:
Low vitamin D intake and poor sleep quality are independently associated with cognitive dysfunction in healthy older adults. However, the relationships among vitamin D intake, sleep quality, and cognitive dysfunction are unknown in older adults with heart failure (HF).

Purpose:
The aim of this study was to determine the relationships of vitamin D intake and sleep quality with cognitive dysfunction in older adults with HF.

Methods:
A total of 160 older adults with HF completed the Mini-Mental State Examination to assess cognitive function. Vitamin D deficiency was defined as less than 15 mcg/day of average intake determined using a 3-day food diary and use of dietary supplements. Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI). Hierarchical regressions and mediation analysis were used for data analysis.

Results:
Thirty-four patients (21.2%) had severe cognitive dysfunction (total Mini-Mental State Examination score ≤ 19), 88 (55%) had vitamin D deficiency, and 120 (75%) reported poor sleep quality (total PSQI score > 5). Increased daily vitamin D intake (β = 0.305, P < .001) and poorer sleep quality indicated by the total PSQI score (β = −0.312, P < .001) were associated with cognitive function. Vitamin D deficiency was associated with poor sleep quality (odds ratio, 2.22; P = .033). In mediation analysis, the relationship between vitamin D deficiency and cognitive function was mediated by sleep quality among older adults with HF.

Conclusions:
Both vitamin D deficiency and poor sleep quality are associated with cognitive dysfunction in older adults with HF. Interventions should be tested to target patients with poor sleep quality to improve cognitive function, particularly in those with vitamin D deficiency.
Association Between a Physical Activity Vital Sign and Cardiometabolic Disease in High-Risk Patients
Authors: Nelson Vicki R. , Masocol Robert V. , Ewing Joseph A. , Johnston Sheri , Hale Allyson , Wiederman Michael , Asif Irfan M. 
Published: March 2018

Objective:
To determine the association between the physical activity vital sign (PAVS) and markers of cardiometabolic disease.

Design:
Patients were assessed through the PAVS, a validated tool self-reporting the frequency and duration of physical activity. Patients were categorized into 3 groups: inactive (0 minutes per week), underactive (1-149 minutes per week), and active (>150 minutes per week). Associations were tested between the PAVS and the cardiometabolic disease biomarkers of body mass index, hemoglobin A1c (A1c), blood pressure, and low-density lipoprotein (LDL) using one-way analyses of variance.

Setting:
High-risk family medicine residency clinic.

Participants:
Two thousand three hundred twenty-one adult patients (age ≥ 18 years).

Results:
Participants reported a mean of 97.87 (SD = 149.35) minutes per week of exercise. Overall, 50.1% reported physical inactivity, 25.7% were underactive, and 24.3% were active. Younger individuals (P < 0.001) and men (P < 0.05) reported more physical activity than older individuals and women. Patients who reported being active were significantly less likely to be overweight (P < 0.05), obese (P < 0.05), or hypertensive (P < 0.05), but there was no association with A1c or LDL levels.

Conclusions:
This is the first investigation to examine the PAVS in a high-risk population. In these patients, reported levels of physical inactivity are 150% higher than other clinical settings, and the PAVS is only associated with improvements in 2 of 4 major cardiometabolic risk factors. For this group, self-reported levels of physical activity may need to be higher for cardiovascular benefits to be realized in all 4 cardiometabolic domains. The PAVS offers health professionals an opportunity to encourage lifestyle-based interventions to reduce cardiovascular risk, but refinements may be necessary to address this population.
Should Emergency Department Attendances be Used With or Instead of Readmission Rates as a Performance Metric?
Authors: Honeyford Kate , Aylin Paul , Bottle Alex 
Published: March 2018

Background:
Hospital readmissions are common and are viewed as unfavorable. They are commonly used as a measure of quality of care and, in the United States and England, are associated with financial penalties. Readmissions are not the only possible return-to-acute-care metric; patients may also attend emergency departments (EDs).

Objective:
To assess hospital-level return-to-acute-care metrics using statistical criteria.

Research Design:
Patient readmissions and/or ED attendances were aggregated to produce risk-standardized hospital rates. Return-to-acute-care rates at 7, 30, 90, and 365 days were assessed using key statistical properties: (i) variability between hospitals; (ii) the relative contribution of patient and nonpatient factors to variation; and (iii) the statistical power to detect performance differences.

Subjects:
We had pseudonymized administrative data on all inpatient hospital admissions and ED attendances in National Health Service hospitals in England between April 2009 and March 2011. Patients with an inpatient stay for chronic obstructive pulmonary disorder or heart failure were eligible for inclusion.

Measures:
ED attendances and readmissions for patients discharged from an inpatient stay for chronic obstructive pulmonary disorder or heart failure.

Results:
Interhospital variation was greatest for ED attendance; in addition, readmission was more strongly determined by patient characteristics than was ED attendance or both combined. Because of smaller numbers, the statistical power to detect differences in rates at 7 days for any indicator was limited.

Conclusions:
Despite the current emphasis on readmissions, we found that ED attendance within 30 days has more desirable statistical properties and therefore the potential to be a useful metric when comparing hospitals.
Classical and alternative roles for autophagy in lipid metabolism
Authors: Zhang Xiangyu , Evans Trent D. , Jeong Se-Jin , Razani Babak 
Published: March 2018

Purpose of review
Intracellular lipid metabolism is a complex interplay of exogenous lipid handling, trafficking, storage, lipolysis, and export. Recent work has implicated the cellular degradative process called autophagy in several aspects of lipid metabolism. We will discuss both the classical and novel roles of autophagy and the autophagic machinery in this setting.

Recent findings
The delivery of lipid droplets to lysosomes for hydrolysis, named lipophagy, was the first described functional role for autophagy in lipid metabolism. The molecular machinery and regulation of this selective form of macroautophagy is beginning to be discovered and has the potential to shed enormous light on intracellular lipolysis. Yet, the autophagic machinery appears to also be coopted for alternative roles that include interaction with cytosolic lipolysis pathways, supply and expansion of lipid droplets, and lipoprotein trafficking. Additionally, lesser studied forms of autophagy called microautophagy and chaperone-mediated autophagy have distinct roles in lipid handling that also intersect with classical macroautophagy. The integration of current knowledge in these areas into a holistic understanding of intracellular lipid metabolism will be a goal of this review.

Summary
As the field of autophagy has evolved and expanded to include functional roles in various aspects of cellular degradation, so has its role in intracellular lipid metabolism. Understanding the mechanisms underlying these classical and alternative roles of autophagy will not only enhance our knowledge in lipid biology but also provide new avenues of translation to human lipid disorders.
Chapter 2. ESPGHAN
Authors: Lentze Michael J. , Auricchio Salvatore , Cadranel Samy , Milla Peter J. , Kelly Deirdre , McNeish Alexander S. , Rey Jean , Schmitz Jacques , Strandvik Birgitta , Taminiau Jan , Visakorpi Jarmo 
Published: March 2018

ABSTRACTThirty‐six founding members from Europe were present in 1968, when the European Society of Paediatric Gastroenterology (ESGA) had its first meeting in Paris. The aim was to create a forum for presentations and discussions of research activities in paediatric gastroenterology in Europe. At the second meeting of ESGA 1969 in Interlaken, an important landmark was set for all gastroenterologists in the world. In this conference, the first ever criteria for “the Diagnosis of Coeliac Disease” (CD) were established. In 1990, the revised criteria for the diagnosis of CD were published. After the introduction of new noninvasive techniques, like tissue transglutaminase 2‐antibodies and the HLADQ2/HLADQ8 determinations in blood, “new” criteria for the diagnosis of CD were published in 2012 by the European society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Close collaboration of ESPGHAN and the North American Society of Paediatric Gastroenterology, Hepatology and Nutrition led to mutual meetings. The first combined meeting was 1978 in Paris, followed by meetings in New York, Amsterdam, Houston, and last in Toulouse. The first World Congress of Paediatric Gastroenterology took place in Boston 2000 followed by congresses in Paris, Iguazu, Taipeh, and Toronto. The creation of specialised committees (Nutrition Committees, GI‐Committee, and Hepatology‐Committee) enabled the society to elaborate numerous guidelines for standards in the diagnosis and treatment of diseases within the subspecialties. The Journal of Paediatric Gastroenterology and Nutrition, as organ of ESPGHAN and the North American Society of Paediatric Gastroenterology, Hepatology and Nutrition since 1991, serves as the voice for these worldwide accepted guidelines. Growing educational activities with summer schools, the Young Investigator Forum and the creation of working groups have distributed our current knowledge among the younger generation and led to fruitful reports, guidelines, and syllabus. In 1992, ESPGHAN was 1 of the founding 7 members of the United European Gastroenterology Federation (UEGF), which developed into a successful organisation for gastroenterology in Europe. This year we celebrate the 50th anniversary of ESPGHAN at our annual Meeting in Geneva.
Chapter 4. The Relationship Between the European and North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition
Authors: Lifschitz Carlos H. , Vanderhoof Jon , Winter Harland , Guandalini Stefano , Klish William , Grand Richard , Walker Allan , Perman Jay 
Published: March 2018

ABSTRACTThis chapter is based on the memories of those who shaped the relationship between the European and the North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition. The first joint meeting of the 2 Societies took place in Paris in 1978, followed by 1 in New York in 1985, 1 in Amsterdam in 1990, 1 in Houston in 1994, and the last one in Toulouse in 1998. The formation of the Federation of the International Societies for Pediatric Gastroenterology, Hepatology and Nutrition (FISPGHAN) preceded the First World Congress of all Societies, which took place in Boston in 2000. The success of this meeting was followed by world congresses in Paris in 2004, Iguassu in 2008, Taiwan in 2012, and Montreal in 2016. NASPGHAN and ESPGHAN jointly took on the direction of the Journal of Pediatric Gastroenterology and Nutrition in 1991. Communication between the 2 Societies is extremely active, with members participating in many joint projects.