bluuebunny/crossref_metadata_2025_split huggingface dataset:
Case Volume-Outcomes Associations Among Patients With Severe Sepsis Who Underwent Interhospital Transfer*
Authors: Ofoma Uchenna R. , Dahdah John , Kethireddy Shravan , Maeng Daniel , Walkey Allan J. 
Published: February 2017

Objectives:
Case volume-outcome associations bolster arguments to regionalize severe sepsis care, an approach that may necessitate interhospital patient transfers. Although transferred patients may most closely reflect care processes involved with regionalization, associations between sepsis case volume and outcomes among transferred patients are unclear. We investigated case volume-outcome associations among patients with severe sepsis transferred from another hospital.

Design:
Serial cross-sectional study using the Nationwide Inpatient Sample.

Setting:
United States nonfederal hospitals, years 2003–2011.

Patients:
One hundred forty-one thousand seven hundred seven patients (weighted national estimate of 717,732) with severe sepsis transferred from another acute care hospital.

Interventions:
None.

Measurements and Main Results:
We examined associations between quintiles of annual hospital severe sepsis case volume for the receiving hospital and in-hospital mortality among transferred patients with severe sepsis. Secondary outcomes included hospital length of stay and total charges. Transferred patients accounted for 13.2% of hospitalized severe sepsis cases. In-hospital mortality was 33.2%, with median length of stay 11 days (interquartile range, 5–22), and median total charge $70,722 (interquartile range, $30,591–$159,013). Patients transferred to highest volume hospitals had higher predicted mortality risk, greater number of acutely dysfunctional organs, and lower adjusted in-hospital mortality when compared with the lowest-volume hospitals (odds ratio, 0.80; 95% CI, 0.67–0.90). In stratified analysis (p < 0.001 for interaction of case volume by organ failure), mortality benefit associated with case volume was limited to patients with single organ dysfunction (n = 48,607, 34.3% of transfers) (odds ratio, 0.66; 95% CI, 0.55–0.80). Treatment at highest volume hospitals was significantly associated with shorter adjusted length of stay (incidence rate ratio, 0.86; 95% CI, 0.75–0.98) but not costs (% charge difference, 95% CI: [–]18.8, [–]37.9 to [+]0.3).

Conclusions:
Hospital mortality was lowest among patients with severe sepsis who were transferred to high-volume hospitals; however, case volume benefits for transferred patients may be limited to patients with lower illness severity.
Evaluation of Reperfusion Pulmonary Edema by Extravascular Lung Water Measurements After Pulmonary Endarterectomy
Authors: Stéphan François , Mazeraud Aurélien , Laverdure Florent , Camous Julien , Fadel Elie 
Published: February 2017

Objectives:
Reperfusion pulmonary edema is a specific complication of pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. Extravascular lung water measurement may be valuable for diagnosing reperfusion pulmonary edema. The primary objective of this study was to describe and assess the clinical significance of extravascular lung water variations after pulmonary endarterectomy.

Design:
Prospective observational study.

Setting:
Nineteen-bed cardiothoracic ICU.

Patients:
Consecutive patients who were hemodynamically stable after pulmonary endarterectomy were divided into two groups based on whether their preoperative pulmonary vascular resistance indicated severe or nonsevere chronic thromboembolic pulmonary hypertension (> 900 or ≤ 900 dynes·s/cm5, respectively).

Interventions:
Hemodynamic variables obtained by right heart catheterization and transpulmonary thermodilution measurements were recorded 1 hour, 1 day, and 2 days after pulmonary endarterectomy. Extravascular lung water was indexed to predicted body weight (EVLWPBW).

Measurements and Main Results:
We studied 31 patients. Overall, 26 patients (84%) experienced reperfusion pulmonary edema during the first 72 hours after pulmonary endarterectomy. EVLWPBW significantly increased between the first hour after pulmonary endarterectomy and day 2 (10.2 ± 2.6 vs 11.4 ± 3.6; p = 0.03). EVLWPBW measured at the first hour after pulmonary endarterectomy is closely associated with reperfusion pulmonary edema occurrence in the next 48 hours (area under the receiver-operating characteristics curve = 0.88 ± 0.07). EVLWPBW correlated with duration of mechanical ventilation (ρ = 0.59; p < 0.0001) and ICU stay (ρ = 0.52; p < 0.0001). Patients with severe chronic thromboembolic pulmonary hypertension (n = 15) had higher EVLWPBW values at day 2 compared with those without (n = 16) (13.2 ± 3.6 vs 9.7 ± 2.7 mL/kg; p = 0.004). Cardiac output was measured simultaneously by pulmonary artery catheter and aortic transpulmonary thermodilution on 92 occasions; agreement was good, with a bias of 0.50 ± 0.95 L/min (95% CI, –1.36–2.36).

Conclusions:
Accurate extravascular lung water measurements were obtained after pulmonary endarterectomy. Extravascular lung water may prove valuable for diagnosing reperfusion pulmonary edema after pulmonary endarterectomy and had prognostic value. Extravascular lung water values were significantly higher in patients with severe compared with nonsevere chronic thromboembolic pulmonary hypertension.
Differences in Utilization of Life Support and End-of-Life Care for Medical ICU Patients With Versus Without Cancer
Authors: Koff Geoffrey , Vaid Urvashi , Len Edward , Crawford Albert , Oxman David A. 
Published: February 2017

Objectives:
To explore differences in the utilization of life support and end-of-life care between patients dying in the medical ICU with cancer compared with those without cancer.

Design:
Retrospective review of 403 deaths or hospice transfers in the medical ICU from January 1, 2012, to June 30, 2013.

Setting:
Urban tertiary care university hospital.

Patients:
Consecutive medical ICU deaths or hospice transfers over an 18-month period.

Interventions:
None.

Measurements and Main Results:
One hundred eighty-two patients (45%) had a diagnosis of active cancer and 221 (55%) did not. Despite similar severity of illness, there were significant differences in the use of life support and end-of-life care. Patients without cancer had longer medical ICU length of stay (median, 5 vs 4 d; p = 0.0495), used mechanical ventilation more often and for longer (83.7% vs 70.9%, p = 0.002; 4 vs 3 d, p = 0.017), and initiated dialysis more frequently (26.7% vs 14.8%; p = 0.0038). Patients without active cancer had family meetings later (median, 3 vs 2 d; p = 0.001), less frequent palliative care consultation (17.6% vs 32.4%; p = 0.0006), and took longer to transition to do not resuscitate or comfort care (median, 4 vs 3 d; p = 0.048).

Conclusions:
Among patients dying in the medical ICU, the diagnosis of active cancer influences the intensity of life support utilization and the quality of end-of-life care. Patients with active cancer use less life support and may receive better end-of-life care than similar patients without cancer. These differences are likely due to biases or misunderstandings about the trajectory of advanced nonmalignant disease among patients, families, and perhaps providers.
Increased Time to Initial Antimicrobial Administration Is Associated With Progression to Septic Shock in Severe Sepsis Patients
Authors: Whiles Bristol B. , Deis Amanda S. , Simpson Steven Q. 
Published: February 2017

Objectives:
To determine if time to initial antimicrobial is associated with progression of severe sepsis to septic shock.

Design:
Retrospective cohort.

Setting:
Six hundred fifty-six bed urban academic medical center.

Patients:
Emergency department patients greater than or equal to 18 years old with severe sepsis and/or septic shock and antimicrobial administration within 24 hours. Patients with shock on presentation were excluded.

Interventions:
Not available.

Measurements and Main Results:
We identified 3,929 severe sepsis patients, with overall mortality 12.8%. Nine hundred eighty-four patients (25.0%) progressed to septic shock. The median time to antimicrobial was 3.77 hours (interquartile range = 1.96–6.42) in those who progressed versus 2.76 hours (interquartile range = 1.60–4.82) in those who did not (p < 0.001). Multivariate logistic regression demonstrated that male sex (odds ratio = 1.18; 95% CI, 1.01–1.36), Charlson Comorbidity Index (odds ratio = 1.18; 95% CI, 1.11–1.27), number of infections (odds ratio = 1.05; 95% CI, 1.02–1.08), and time to first antimicrobial (odds ratio = 1.08; 95% CI, 1.06–1.10) were associated with progression. Each hour until initial antimicrobial administration was associated with a 8.0% increase in progression to septic shock. Additionally, time to broad-spectrum antimicrobial was associated with progression (odds ratio = 1.06; 95% CI, 1.05–1.08). Time to initial antimicrobial was also associated with in-hospital mortality (odds ratio = 1.05; 95% CI, 1.03–1.07).

Conclusions:
This study emphasizes the importance of early, broad-spectrum antimicrobial administration in severe sepsis patients admitted through the emergency department, as longer time to initial antimicrobial administration is associated with increased progression of severe sepsis to septic shock and increased mortality.
Causes and Consequences of Treatment Variation in Moderate and Severe Traumatic Brain Injury: A Multicenter Study
Authors: Cnossen Maryse C. , Polinder Suzanne , Andriessen Teuntje M. , van der Naalt Joukje , Haitsma Iain , Horn Janneke , Franschman Gaby , Vos Pieter E. , Steyerberg Ewout W. , Lingsma Hester 
Published: February 2017

Objectives:
Although guidelines have been developed to standardize care in traumatic brain injury, between-center variation in treatment approach has been frequently reported. We examined variation in treatment for traumatic brain injury by assessing factors influencing treatment and the association between treatment and patient outcome.

Design:
Secondary analysis of prospectively collected data.

Setting:
Five level I trauma centers in the Netherlands (2008–2009).

Patients:
Five hundred three patients with moderate or severe traumatic brain injury (Glasgow Coma Scale, 3–13).

Interventions:
We examined variation in seven treatment parameters: direct transfer, involvement of mobile medical team, mechanical ventilation, intracranial pressure monitoring, vasopressors, acute neurosurgical intervention, and extracranial operation.

Measurements and Main Results:
Data were collected on patient characteristics, treatment, and 6-month Glasgow Outcome Scale-Extended. Multivariable logistic regression models were used to assess the extent to which treatment was determined by patient characteristics. To examine whether there were between-center differences in treatment, we used unadjusted and adjusted random effect models with the seven treatment parameters as dependent variables. The influence of treatment approach in a center (defined as aggressive and nonaggressive based on the frequency intracranial pressure monitoring) on outcome was assessed using multivariable random effect proportional odds regression models in those patients with an indication for intracranial pressure monitoring. Sensitivity analyses were performed to test alternative definitions of aggressiveness. Treatment was modestly related to patient characteristics (Nagelkerke R
2 range, 0.12–0.52) and varied widely among centers, even after case-mix correction. Outcome was more favorable in patients treated in aggressive centers than those treated in nonaggressive centers (OR, 1.73; 95% CI, 1.05–3.15). Sensitivity analyses, however, illustrated that the aggressiveness-outcome association was dependent on the definition used.

Conclusions:
The considerable between-center variation in treatment for patients with brain injury can only partly be explained by differences in patient characteristics. An aggressive treatment approach may imply better outcome although further confirmation is required.
RBC Transfusion Improves Cerebral Oxygen Delivery in Subarachnoid Hemorrhage
Authors: Dhar Rajat , Zazulia Allyson R. , Derdeyn Colin P. , Diringer Michael N. 
Published: February 2017

Objectives:
Impaired oxygen delivery due to reduced cerebral blood flow is the hallmark of delayed cerebral ischemia following subarachnoid hemorrhage. Since anemia reduces arterial oxygen content, it further threatens oxygen delivery increasing the risk of cerebral infarction. Thus, subarachnoid hemorrhage may constitute an important exception to current restrictive transfusion practices, wherein raising hemoglobin could reduce the risk of ischemia in a critically hypoperfused organ. In this physiologic proof-of-principle study, we determined whether transfusion could augment cerebral oxygen delivery, particularly in vulnerable brain regions, across a broad range of hemoglobin values.

Design:
Prospective study measuring cerebral blood flow and oxygen extraction fraction using 15O-PET. Vulnerable brain regions were defined as those with baseline oxygen delivery less than 4.5 mL/100 g/min.

Setting:
PET facility located within the Neurology/Neurosurgery ICU.

Patients:
Fifty-two patients at risk for delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage with hemoglobin 7–13 g/dL.

Interventions:
Transfusion of one unit of RBCs over 1 hour.

Measurements and Main Results:
Baseline hemoglobin was 9.7 g/dL (range, 6.9–12.9), and cerebral blood flow was 43 ± 11 mL/100 g/min. After transfusion, hemoglobin rose from 9.6 ± 1.4 to 10.8 ± 1.4 g/dL (12%; p < 0.001) and oxygen delivery from 5.0 (interquartile range, 4.4–6.6) to 5.5 mL/100 g/min (interquartile range, 4.8–7.0) (10%; p = 0.001); the response was comparable across the range of hemoglobin values. In vulnerable brain regions, transfusion resulted in a greater (16%) rise in oxygen delivery associated with reduction in oxygen extraction fraction, independent of Hgb level (p = 0.002 vs normal regions).

Conclusions:
This study demonstrates that RBC transfusion improves cerebral oxygen delivery globally and particularly to vulnerable regions in subarachnoid hemorrhage patients at risk for delayed cerebral ischemia across a wide range of hemoglobin values and suggests that restrictive transfusion practices may not be appropriate in this population. Large prospective trials are necessary to determine if these physiologic benefits translate into clinical improvement and outweigh the risk of transfusion.
Sodium Bicarbonate Versus Sodium Chloride for Preventing Contrast-Associated Acute Kidney Injury in Critically Ill Patients: A Randomized Controlled Trial
Authors: Valette Xavier , Desmeulles Isabelle , Savary Benoit , Masson Romain , Seguin Amélie , Sauneuf Bertrand , Brunet Jennifer , Verrier Pierre , Pottier Véronique , Orabona Marie , Samba Désiré , Viquesnel Gérald , Lermuzeaux Mathilde , Hazera Pascal , Dutheil Jean-Jacques , Hanouz Jean-Luc , Parienti Jean-Jacques , du Cheyron Damien 
Published: February 2017

Objectives:
To test whether hydration with bicarbonate rather than isotonic sodium chloride reduces the risk of contrast-associated acute kidney injury in critically ill patients.

Design:
Prospective, double-blind, multicenter, randomized controlled study.

Setting:
Three French ICUs.

Patients:
Critically ill patients with stable renal function (n = 307) who received intravascular contrast media.

Interventions:
Hydration with 0.9% sodium chloride or 1.4% sodium bicarbonate administered with the same infusion protocol: 3 mL/kg during 1 hour before and 1 mL/kg/hr during 6 hours after contrast medium exposure.

Measurements and Main Results:
The primary endpoint was the development of contrast-associated acute kidney injury, as defined by the Acute Kidney Injury Network criteria, 72 hours after contrast exposure. Patients randomized to the bicarbonate group (n = 151) showed a higher urinary pH at the end of the infusion than patients randomized to the saline group (n = 156) (6.7 ± 2.1 vs 6.2 ± 1.8, respectively; p < 0.0001). The frequency of contrast-associated acute kidney injury was similar in both groups: 52 patients (33.3%) in the saline group and 53 patients (35.1%) in the bicarbonate group (absolute risk difference, –1.8%; 95% CI [–12.3% to 8.9%]; p = 0.81). The need for renal replacement therapy (five [3.2%] and six [3.9%] patients; p = 0.77), ICU length of stay (24.7 ± 22.9 and 23 ± 23.8 d; p = 0.52), and mortality (25 [16.0%] and 24 [15.9%] patients; p > 0.99) were also similar between the saline and bicarbonate groups, respectively.

Conclusions:
Except for urinary pH, none of the outcomes differed between the two groups. Among ICU patients with stable renal function, the benefit of using sodium bicarbonate rather than isotonic sodium chloride for preventing contrast-associated acute kidney injury is marginal, if any.
Antipyretic Therapy in Critically Ill Septic Patients: A Systematic Review and Meta-Analysis
Authors: Drewry Anne M. , Ablordeppey Enyo A. , Murray Ellen T. , Stoll Carolyn R. T. , Izadi Sonya R. , Dalton Catherine M. , Hardi Angela C. , Fowler Susan A. , Fuller Brian M. , Colditz Graham A. 
Published: February 2017

Objective:This meta-analysis aimed to examine the impact of antipyretic therapy on mortality in critically ill septic adults.Data Sources:Literature searches were implemented in Ovid Medline, Embase, Scopus, Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, and ClinicalTrials.gov through February 2016.Study Selection:Inclusion criteria were observational or randomized studies of septic patients, evaluation of antipyretic treatment, mortality reported, and English-language version available. Studies were excluded if they enrolled pediatric patients, patients with neurologic injury, or healthy volunteers. Criteria were applied by two independent reviewers.Data Extraction:Two reviewers independently extracted data and evaluated methodologic quality. Outcomes included mortality, frequency of shock reversal, acquisition of nosocomial infections, and changes in body temperature, heart rate, and minute ventilation. Randomized and observational studies were analyzed separately.Data Synthesis:Eight randomized studies (1,507 patients) and eight observational studies (17,432 patients) were analyzed. Antipyretic therapy did not reduce 28-day/hospital mortality in the randomized studies (relative risk, 0.93; 95% CI, 0.77–1.13;I2= 0.0%) or observational studies (odds ratio, 0.90; 95% CI, 0.54–1.51;I2= 76.1%). Shock reversal (relative risk, 1.13; 95% CI, 0.68–1.90;I2= 51.6%) and acquisition of nosocomial infections (relative risk, 1.13; 95% CI, 0.61–2.09;I2= 61.0%) were also unchanged. Antipyretic therapy decreased body temperature (mean difference, –0.38°C; 95% CI, –0.63 to –0.13;I2= 84.0%), but not heart rate or minute ventilation.Conclusions:Antipyretic treatment does not significantly improve 28-day/hospital mortality in adult patients with sepsis.
Electrodiagnostic Characterization of Hereditary Neuropathy With Liability to Pressure Palsies
Authors: Takahashi Sachiko , Chum Marvin , Kimpinski Kurt 
Published: February 2017

Abstract

Objectives:
The study objective was electrodiagnostic characterization of a large cohort of patients with genetically confirmed hereditary neuropathy with liability to pressure palsies (HNPP).

Methods:
A retrospective review was conducted on all patients with HNPP seen at the neuromuscular clinic (London, Canada) from 1977 to 2015. Clinical data obtained included patient characteristics, examination findings, and nerve conduction study results.

Results:
A total of 46 patients were analyzed. The mean age and median disease duration were 42.6 and 5.0 years, respectively. Most patients had abnormalities on sural nerve conduction studies. The most common focal neuropathies at compressive sites were ulnar nerve at the elbow (85.7%), distal median nerve at the wrist (84.4%), and fibular nerve at the fibular head (36.7%). Distal median neuropathy was associated with a mean terminal latency of 6.64 milliseconds.

Conclusions:
The presence of polyneuropathy, median terminal motor latency prolongation, and multiple compressive neuropathies are the most common findings associated with HNPP.
Diagnostic Criteria for Small Fiber Neuropathy
Authors: Blackmore Derrick , Siddiqi Zaeem A. 
Published: February 2017

AbstractObjectives:Despite its relative common occurrence, definitive diagnosis of small fiber neuropathy (SFN) remains problematic. In practice, patients with pain, numbness, and/or paresthesias in their lower limbs are diagnosed with SFN if found to have dissociated sensory loss in their feet, that is, impaired pinprick perception (PP) but relatively preserved vibration. We sought to assess the sensitivity and specificity of clinical examination and various diagnostic tools available for screening SFN.Methods:Medical records of 56 patients diagnosed with SFN were reviewed. Diagnosis was based on symptoms, detailed neurological examination that included PP, and abnormal results on at least one testing modality—quantitative sudomotor axon reflex (sweat) test (QSART), quantitative sensory testing (QST), and heart rate variability (HRV) testing.Results:Sensitivity of PP was relatively consistent between modalities of about 63% in presence of appropriate sensory symptoms. Laboratory testing diagnosed 88% of patients when both QSART and QST are employed. QST was most sensitive for detection of SFN with the heat-pain testing having higher sensitivity than cooling. Heart rate variability testing revealed low correlation across all groups.Conclusions:The diagnostic yield for SFN increases by combining clinical features with various testing modalities. In symptomatic patients, we propose the following diagnostic criteria for diagnosis of SFN:Definite SFN—abnormal neurological examination and both QSART and QST;Probable SFN—abnormal neurological examination, and either QSART or QST;Possible SFN—abnormal neurological exam, QSART, or QST.
Outcome Measures in Myasthenia Gravis: Incorporation Into Clinical Practice
Authors: Muppidi Srikanth 
Published: February 2017

Abstract
The development of validated assessment tools for evaluating disease status and response to interventions in patients with myasthenia gravis (MG) has been driven by clinical studies of emerging MG therapies. However, only a small proportion of MG-focused neurology practices have adopted these assessment tools for routine clinical use. This article reviews the suitability of 5 assessment instruments for incorporation into clinical practice, which should be driven by their ability to contribute to improved patient outcomes, and to be implemented within practice personnel and resource constraints. It is recommended that assessments based on both physician-evaluated and patient-reported outcomes be selected, to adequately evaluate both point-in-time symptom load and functional impact of MG symptoms over time. Provider resource allocation and reimbursement issues may be the most significant roadblocks to successful ongoing use of these tools; to that end, the addition of regular assessments to MG standards of care is recommended.
Whole Exome Sequencing Identifies Atypical Welander Distal Myopathy in Patient
Authors: Gass Jennifer , Blackburn Patrick , Jackson Jessica , Harris Kimberly , Selcen Duygu , Dimberg Elliot , Atwal Paldeep 
Published: February 2017

Abstract
Welander distal myopathy is a rare autosomal dominant disorder characterized by muscle weakness in the hands and feet. Exome sequencing of affected families discovered a segregating p.Glu384Lys pathogenic variant in TIA-1 as the main genetic cause of Welander distal myopathy. TIA-1 encodes an RNA-binding protein which serves as a key component of stress granules. This protein also regulates splicing and translation of mRNA. Our patient developed progressive weakness in his hands and feet during his late 40s that was misdiagnosed as a neuropathy that caused muscle atrophy. Follow-up genetic testing revealed a p.Glu384Lys pathogenic variant in TIA-1, and he was then diagnosed with Welander distal myopathy. Our case report underlines the importance of electrodiagnostic and genetic testing of patients.