bluuebunny/crossref_metadata_2025_split huggingface dataset:
The ABCDE Bundle
Authors: Pinto Floriana , Biancofiore Gianni 
Published: October 2016

Background:
The ABCDE (
A
wakening and
B
reathing coordination of daily sedation and ventilator removal trials;
C
hoice of sedative or analgesic exposure;
D
elirium monitoring and management; and
E
arly mobility and exercise) bundle is a multidisciplinary set of evidence-based practices for improving patient outcomes in the intensive care unit. Nurses are critical to all the bundle’s requirements. Therefore, understanding their knowledge, attitudes, and perception of the different bundle’s components might help for an easier implementation into everyday clinical practice.

Objective:
The aim of this study was to assess nurses’ knowledge, utility, and perception of the ABCDE bundle.

Methods:
An anonymous questionnaire with closed-end questions was administered to the nurses working at the intensive care unit (ICU) of a nationwide teaching hospital.

Results:
Only the 41.6% of the respondents declared to be aware of the bundle; however, the majority of them (67%) agreed with its potential capability of improving patients’ outcomes after reviewing a document as they completed a survey. In addition, 71% of responders judged the Sedation Awakening Trial and the Spontaneous Breathing Trial easy to understand, and 80% found the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the ICU useful to asses and monitor delirium. However, 48% reported that they did not currently use them. Fifty-one percent of respondents reported that they were not aware of or had used the Exercise/Mobility Safety Screen. Fifty-three respondents reported that multidisciplinary rounds were not performed at their ICU but judged them as a positive activity. Only 34% of the respondents considered the ABCDE bundle applicable at their own ICU.

Discussion:
A substantial need for educational improvement and cultural change is needed. The results of this study may help other facilities to identify contextual and professionals-related factors possibly hindering the bundle’s implementation.
HIGH MYOPIA AND DIABETIC RETINOPATHY
Authors: Bazzazi Nooshin , Akbarzadeh Siamak , Yavarikia Minoo , Poorolajal Jalal , Fouladi Daniel F. 
Published: October 2016

Purpose:
To examine an association between high myopia and diabetic retinopathy (DR) in diabetic patients with high myopic anisometropia.

Methods:
A total of 116 white diabetic patients (232 eyes) with high myopia (spherical equivalent > −5.00 diopters, D) anisometropia (difference ≥ −6 D) were enrolled in this cross-sectional, contralateral eye study. The frequency of DR was compared between the high myopic and the contralateral eyes.

Results:
Compared with the fellow eyes, DR was significantly less frequent in high myopic side (27.6% vs. 100%, P < 0.001; relative risk, 0.28 with 95% confidence interval of 0.21–0.37). Similar significant trends were found for the incidence of nonproliferative (27.6% vs. 69%, P < 0.001) and proliferative DR (0% vs. 31%, P < 0.001). Diabetic retinopathy was also less severe in the same group.

Conclusion:
Using a contralateral eye study design prevented the influence of potential confounding factors inherent in similar previous case–control studies. On this basis, a protective role for high myopia against DR was established.
DOME-SHAPED MACULOPATHY: ENHANCED VISUALIZATION WITH RADIAL OPTICAL COHERENCE TOMOGRAPHY SCANS
Authors: Christenbury Joseph G. , Phasukkijwatana Nopasak , Tan Anna , Freund K. Bailey , Sarraf David 
Published: October 2016

Purpose:
To describe two cases of dome-shaped macula (DSM) and serous macular detachment, the diagnosis of which was enhanced with a radial optical coherence tomography (OCT) scanning protocol.

Methods:
Retrospective case series of DSM associated with serous macular detachment. Multimodal retinal imaging was performed including spectral domain OCT with a radial scan protocol and en face OCT angiography. Anatomical outcomes before and after therapy are presented.

Results:
Two cases of DSM associated with serous macular detachment are described. The dome-shaped macular bulge was more clearly elicited as the cause of serous macular detachment with the employment of a radial OCT scanning protocol. Subretinal fluid resolved in both cases using either intravitreal aflibercept injection or half-fluence photodynamic therapy. En face OCT angiography of the choroid demonstrated reduction in the caliber of choroidal vessels after treatment.

Conclusion:
A radial OCT scanning protocol should be considered in eyes with suspicion of DSM, especially in myopic eyes with subretinal fluid. Intravitreal aflibercept therapy or photodynamic therapy may be considered as a treatment for serous macular detachment because of DSM.
VITRECTOMY FOR PHACOANAPHYLACTIC GLAUCOMA SECONDARY TO POSTERIOR CAPSULAR RUPTURE IN AN ADULT WITH PERSISTENT HYPERPLASTIC PRIMARY VITREOUS
Authors: Brennan Nicholas , Petrou Petros , Reekie Ian , Pasu Saruban , Kinsella Matthew , Da Cruz Lyndon 
Published: October 2016

Purpose:
Persistent hyperplastic primary vitreous (PHPV) is a developmental anomaly in which the normal regression of the primary vitreous and hyaloid vasculature does not occur. In the literature, there are a few cases of PHPV in adulthood. We report the novel presentation of phacoanaphylactic glaucoma secondary to posterior capsular rupture in an adult with PHPV. We discuss the best management of this condition with a review of the literature on this topic.

Methods:
Case report and literature review.

Results:
Medical management was unsuccessful in this case and vitrectomy and fragmatome lensectomy improved vision from PL to counting fingers.

Conclusion:
This case is unusual in the age of the patient in question as PHPV usually presents in childhood, as such there are few accounts in the literature to guide optimum management of adult PHPV. We suggest that surgical management of late-presenting PHPV should be considered to improve functional outcome.
RETINAL DEEP CAPILLARY PLEXUS ISCHEMIA IN A CASE WITH ANTIPHOSPHOLIPID SYNDROME
Authors: Arf Serra , Sayman Muslubas Isil , Hocaoglu Mumin , Karacorlu Murat 
Published: October 2016

Purpose:
To report visualization of a case of retinal deep capillary plexus ischemia with antiphospholipid syndrome.

Methods:
A 53-year-old woman was referred with a 1-week history of sudden onset of decreased vision in the right eye. Her symptoms were evaluated by clinical examination, infrared reflectance, fundus autofluorescence, fluorescein angiography, spectral-domain optical coherence tomography, microperimetry, and multifocal electroretinography.

Results:
The patient's visual acuity on presentation was 0.4 (Snellen) in the right eye and 0.7 in the left eye. Spectral-domain optical coherence tomography showed increased reflectivity of inner nuclear and inner plexiform layers of the right eye. Laboratory evaluation revealed abnormal titers of lupus anticoagulant antibodies. After 6 months, her visual acuity was finger counting at 1 m in the right eye and 0.4 in the left eye. Spectral-domain optical coherence tomographic image demonstrated a diffuse thinning of those retinal layers in the right eye. These findings are consistent with the clinical characteristics of retinal deep capillary ischemia in association with antiphospholipid syndrome.

Conclusion:
Deep capillary ischemia has some characteristic findings, and on spectral-domain optical coherence tomography, outcomes in conjunction with multimodal imaging are helpful for the diagnosis of the acute and the chronic stages of retinal deep capillary plexus ischemia.
Comparison of Different Measurement Tools and Dimensional Parameters of Pterygium to Investigate its Impact on Refractive Indices and Ocular Aberrations
Authors: Gumus Koray , Guven Aysegul , Altinkaynak Miray , Keskin Merve 
Published: October 2016

Objectives:
The aim of this study was to compare different measurement tools and parameters, including a new computer-assisted image processing technique for the quantitative analysis of the percentage of pterygium on the corneal surface, horizontal/vertical lengths obtained using slitlamp beam and surgical compass.

Methods:
A total of 21 pterygia of 17 patients were included in the study. The pterygia were measured by three different methods: a slitlamp beam, a surgical compass, and a new computer-assisted image processing method. Refractive indices and higher-order aberrations were analyzed in all cases.

Results:
The new computer-assisted image processing technique revealed excellent intraclass correlation coefficients for intraobserver and interobserver reliability (0.999 and 0.995, respectively). However, horizontal and vertical lengths revealed more deviation between the measurements obtained with slitlamp beam and surgical compass. Although uncorrected visual acuity did not show any significant correlation between horizontal and vertical lengths of pterygia measured by either slitlamp beam or surgical compass, it was correlated with the digital pterygium ratio (rho, 0.462; P=0.035). All ocular aberration (total, higher-order, coma, trefoil, quatrefoil, spherical, and higher-order astigmatism) Root-mean-square values more strongly correlated with higher percentage values of pterygium that covers the cornea, measured by the new computer-assisted image processing technique.

Conclusion:
The percentage of pterygium covering the corneal surface seems to be more associated with the pterygium-related visual disturbances than with horizontal and vertical lengths measured by conventional techniques. Moreover, the new computer-assisted image processing technique can accurately and reliably measure the percentage extension of pterygium on cornea.
Investigating generalizability of results from a randomized controlled trial of the management of chronic widespread pain: the MUSICIAN study
Authors: Jones Gareth T. , Jones Elizabeth A. , Beasley Marcus J. , Macfarlane Gary J. ,   On behalf of the MUSICIAN study team
Published: October 2016

Abstract
The generalisability of randomised controlled trials will be compromised if markers of treatment outcome also affect trial recruitment. In a large trial of chronic widespread pain, we aimed to determine the extent to which randomised participants represented eligible patients, and whether factors predicting randomisation also influenced trial outcome. Adults from 8 UK general practices were surveyed to determine eligibility for a trial of 2 interventions (exercise and cognitive behavioural therapy [CBT]). Amongst those eligible, logistic regression identified factors associated with reaching the randomisation step in the recruitment process. The main trial analysis was recomputed, weighting for the inverse of the likelihood of reaching the randomisation stage, and the numbers needed to treat were calculated for each treatment. Eight hundred eighty-four persons were identified as eligible for the trial, of whom 442 (50%) were randomised. Several factors were associated with the likelihood of reaching the randomisation stage: higher body mass index (odds ratio: 1.99; 0.85-4.61); more severe/disabling pain (1.90; 1.21-2.97); having a treatment preference (2.11; 1.48-3.00); and expressing positivity about interventions offered (exercise: 2.66; 1.95-3.62; CBT: 3.20; 2.15-4.76). Adjusting for this selection bias decreased the treatment effect associated with exercise and CBT but increased that observed for combined therapy. All were associated with changes in numbers needed to treat. This has important implications for the design and interpretation of pain trials generally.
Identifying patients with chronic widespread pain in primary care
Authors: Mansfield Kathryn E. , Sim Julius , Croft Peter , Jordan Kelvin P. 
Published: October 2016

Abstract
Chronic widespread pain (CWP) is common in the general population. It is unclear how people reporting this problem present in primary care; they may regularly consult for regional pains without being recognized as having a generalized condition. Our objectives were to determine the prevalence of people consulting in primary care for musculoskeletal conditions in different body regions on different occasions (recurrent regional pain consultation), the proportion with diagnosed generalized pain and survey-reported widespread pain, and if they have features characteristic of CWP. Phase 1 used electronic records from 12 general practices in North Staffordshire (Consultations in Primary Care Archive) from 2005 to 2009. Phase 2 used linked self-reported health and primary health care data from 8286 people aged >50 years in 8 general practices (North Staffordshire Osteoarthritis Project) between 2002 and 2005. In Phase 1, 11% of registered patients fulfilled criteria for recurrent regional pain consultation. Three-quarters had no recorded CWP-related generalized pain condition (eg, fibromyalgia). In Phase 2, 53% of recurrent regional pain consulters had survey-reported widespread pain and 88% had consulted for somatic symptoms. Self-reported general health was worse in recurrent regional pain consulters than in single-region consulters and poorest in those who also reported persistent widespread pain. Recurrent regional pain consulters are a heterogeneous group of frequent consulters sharing features with CWP (eg, somatic symptoms) but including those less severely affected. They lie on the spectrum of polysymptomatic distress characteristic of CWP and represent a group whose needs may be better met by earlier diagnosis of multisite pain.
Laser acupuncture reduces pain in pediatric kidney biopsies: a randomized controlled trial
Authors: Oates Aris , Benedict Kelly A. , Sun Karen , Brakeman Paul R. , Lim Jessica , Kim Cynthia 
Published: October 2016

Abstract
Evaluate laser acupuncture (LA) as an adjuvant therapy in pain management during percutaneous kidney biopsy procedure in children and adolescents. This prospective, double-blinded, randomized controlled trial enrolled patients aged 7 to 26 years admitted to a children's hospital for percutaneous kidney biopsy. Patients received LA to treatment points (acupuncture group) or sham points (control group) before the procedure. The laser delivered a dose of 42 J/cm2 over 10 acupoints. Patients and parents rated the pain during and after the biopsy, and change in pain scores were calculated for each patient. Anxiety, vital signs, sedation medication, and patient's biopsy experience were secondary outcomes. Sixty-nine treatments (33 in the acupuncture group and 36 in the control group) were eligible for analysis. Patients in the acupuncture group reported a significantly improved change in the pain score after the biopsy compared with the controls (0.8 vs −0.5, P = 0.044). Patients in the acupuncture group had a statistically significant decrease in procedure vital signs including heart rate (−1.8 vs 5.6, P = 0.043) and respiratory rate (−2.4 vs 0.4, P = 0.045) when compared with controls. Parents also perceived a correspondingly greater improvement in their child's pain for those in the acupuncture group compared with the controls (2.3 vs 0.3, P = 0.04). Adjunctive LA significantly improved pain after pediatric percutaneous kidney biopsies.
Temporal change in headache and its contribution to the risk of developing first-onset temporomandibular disorder in the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) study
Authors: Tchivileva Inna E. , Ohrbach Richard , Fillingim Roger B. , Greenspan Joel D. , Maixner William , Slade Gary D. 
Published: October 2016

Abstract
While cross-sectional studies have demonstrated an association between headache and temporomandibular disorder (TMD), whether headache can predict the onset of TMD is unknown. The aims of this study were to evaluate the contribution of headache to the risk of developing TMD and describe patterns of change in headache types over time. An initially TMD-free cohort of 2410 persons with low frequency of headache completed quarterly questionnaires assessing TMD and headache symptoms over a median 3.0-year follow-up period. First-onset TMD was confirmed by clinical examination in 199 participants. Baseline reports of migraine (hazard ratio [HR] = 1.67, 95% confidence interval [CI]: 1.06-2.62) or mixed headache types (HR = 4.11, 95% CI: 1.47-11.46), or headache frequency (HR = 2.13, 95% CI: 1.31-3.48) predicted increased risk of developing TMD. In addition, headache dynamics across the follow-up period before the TMD onset were evaluated in a nested case–control study where 248 incident TMD cases were matched to 191 TMD-free controls. Both headache prevalence and frequency increased across the observation period among those who developed TMD but not among controls. Patients with TMD were more likely to experience worsening in the headache type compared with that by controls, eg, prevalence of definite migraine among TMD cases increased 10-fold. Among all headache types experienced by patients with TMD before the TMD onset, migraine had the highest odds of progression relative to remission (odds ratio = 2.8, 95% CI: 1.6-4.8), whereas for controls this ratio was significant only for the tension-type headache (odds ratio = 2.1, 95% CI: 1.2-3.9). The important clinical implication of these findings is that adequate treatment of migraine may reduce the risk for developing TMD.
SIRT1 attenuates neuropathic pain by epigenetic regulation of mGluR1/5 expressions in type 2 diabetic rats
Authors: Zhou Cheng-Hua , Zhang Ming-Xing , Zhou Sha-Sha , Li Huan , Gao Jian , Du Lei , Yin Xiao-Xing 
Published: October 2016

Abstract
Accumulating evidence has demonstrated that epigenetic modification-mediated changes in pain-related gene expressions play an important role in the development and maintenance of neuropathic pain. Sirtuin 1 (SIRT1), a nicotinamide adenine dinucleotide (NAD+)-dependent deacetylase, is involved in the development of chronic pain. Moreover, SIRT1 may be a novel therapeutic target for the prevention of type 2 diabetes mellitus (T2DM). But the role of SIRT1 in T2DM-induced neuropathic pain remains unknown. In this study, we found that spinal SIRT1 expression and activity were downregulated significantly in high-fat-fed/low-dose streptozotocin-induced neuropathic pain rats. SIRT1 localized in spinal neurons but not in astrocytes or microglia. Furthermore, the expressions of metabotropic glutamate receptor (mGluR1) and mGluR5, which play a key role in central sensitization and neuropathic pain, and H3 acetylation levels at Grm1/5 (encoding mGluR1/5) promoter regions were increased in diabetic neuropathic pain rats. SIRT1 activator SRT1720 reversed thermal hyperalgesia and mechanical allodynia and spinal neuronal activation in diabetic neuropathic pain rats. Concurrently, increased expressions of mGluR1/5 and H3 acetylation levels at Grm1/5 promoter regions were reversed by SIRT1 activation. In addition, knockdown of SIRT1 by Ad-SIRT1-shRNA induced pain behaviors and spinal neuronal activation in normal rats, which was accompanied by the increased expressions of mGluR1/5 and H3 acetylation levels at Grm1/5 promoter regions. Therefore, we concluded that SIRT1-mediated epigenetic regulation of mGluR1/5 expressions was involved in the development of neuropathic pain in type 2 diabetic rats.
Emergency readmission following acute upper gastrointestinal bleeding
Authors: Strömdahl Martin , Helgeson Johan , Kalaitzakis Evangelos 
Published: October 2016

Objective
To assess the occurrence, clinical predictors, and associated mortality of all-cause emergency readmissions after acute upper gastrointestinal bleeding (AUGIB).

Patients and methods
All patients with AUGIB from an area of 600 000 inhabitants in Sweden admitted in a single institution in 2009–2011 were retrospectively identified. All medical records were scrutinized and relevant data (such as comorbid illness and medications, endoscopy, rebleeding, inhospital mortality, and 30-day emergency readmission) were extracted. The Charlson comorbidity index was calculated.

Results
A total of 174 out of 1056 patients discharged alive following AUGIB (16.5%) had an emergency readmission within 30 days. Nineteen percent of readmissions were because of rebleeding, whereas the rest were because of other reasons, mainly bacterial infections (9.8%) and cardiovascular events (8%). Inhospital mortality did not differ significantly between index admissions and readmissions (13.7 vs. 9.8%, P=0.181). In logistic regression analysis, only a higher Charlson comorbidity index [odds ratio (OR): 1.154, 95% confidence interval (CI): 1.056–1.261] was related to emergency readmission. Bisphosphonate use (OR: 3.933, 95% CI: 1.264–12.233), previous AUGIB (OR: 2.407, 95% CI: 1.157–5.009), and length of stay at index admission (>5 days; OR: 0.246, 95% CI: 0.093–0.649) were found to be independent predictors of postdischarge rebleeding.

Conclusion
All-cause emergency readmission following AUGIB is frequent. It is related to rebleeding in one-fifth of cases and mortality is similar to that in index admissions. The presence of comorbid illness appears to predict readmissions. Reduced length of stay and bisphosphonate use appear to be important, potentially modifiable, predictors of postdischarge rebleeding.
2016 Update for the Rogers’ Textbook of Pediatric Intensive Care: Recognition and Initial Management of Shock
Authors: Fitzgerald Julie C. , Weiss Scott L. , Kissoon Niranjan 
Published: October 2016

Objective:
To review important articles in the field of pediatric shock and pediatric septic shock published subsequent to the Fifth Edition of the Rogers’ Textbook of Pediatric Intensive Care.

Data Sources:
The U.S. National Library of Medicine PubMed (www.ncbi.nlm.nih.gov/pubmed) was searched for combination of the term “pediatric” and the following terms: “sepsis, septic shock, shock, antibiotics, extracorporeal membrane oxygenation, and steroid.” The abstract lists generated by these searches were screened for potential inclusion. The authors were also aware of a number of key recent articles in pediatric shock, and these were also screened.

Study Selection and Data Extraction:
Promising articles published subsequent to the fifth edition of the textbook were included based on the consensus of the authors and via the peer review process.

Data Extraction:
Articles were grouped by category. Each author was assigned categories and extracted data from articles in that category. All authors contributed to final review of extracted data.

Data Synthesis:
Articles in the following categories were included: epidemiology and recognition of shock; laboratory markers of shock; antimicrobial therapy; vasoactive therapy; extracorporeal therapies; mortality patterns, prediction, and risk stratification; bundled approaches to shock recognition and management; and corticosteroid use.

Conclusion:
Research efforts in pediatric shock have largely centered on pediatric septic shock, with significant progress in the understanding of sepsis epidemiology, the use of extracorporeal therapies in critically ill children with sepsis, the role of hyperlactatemia and risk stratification in pediatric septic shock, and the impact of bundled care for pediatric sepsis, including evaluation of individual bundle elements such as the optimal timing of antibiotic administration and vasoactive medication choice. A consistent theme in the literature is the beneficial role of a bundled approach to septic shock recognition and management to improve both care and outcomes.