bluuebunny/crossref_metadata_2025_split huggingface dataset:
P35 Impact of IV to oral antibiotic switch optimization on nurse time and plastic waste at the Royal Cornwall Hospital Trust
Authors: Tan Michelle , Powell Neil , Hearsey Daniel 
Published: August 2024

Abstract

Background
IV to oral switch (IVOS) is an important antimicrobial stewardship intervention with benefits that include a lower risk of bloodstream and catheter-related infections, reduced equipment costs, lower carbon footprint and reduced hospital length-of-stay as well as releasing nursing time to care for patients.1–3 We quantified the impact of more prompt IVOS on nurse drug administration time and unrecyclable waste generated from IV antibiotic administration.

Methods
Data were collected during three lunchtime drug administration rounds each week on the Acute Medical Unit (AMU) and the Emergency Surgical Unit (ESU) over a 4 week period in December 2023. A trainee pharmacist timed how long it took nurses to make up and administer both IV and oral antibiotic doses. Data collected included: antibiotic name, antibiotic route, IV antibiotic administration method (if applicable), time taken for drug preparation, time taken for preparation and to set up for administration. Photographs of the waste generated were obtained for each antibiotic. To estimate the potential for reducing excess IV doses, and to estimate potential nurse time savings, we used the Trust’s IVOS CQUIN data to estimate excess IV antibiotic use and EPMA IV administration data to quantify the number of IV antibiotic doses administered during the study period.

Results
The preparation and administration of 56 antibiotics (34 IVs and 22 orals) was observed for 53 patients. The mean time to prepare and administer IV infusions was 10:27 min and 5:53 min for IV bolus injections. Oral antibiotics took 2:42 min. During the audited month, a total of 24 248 doses of IV antibiotics were administered across all inpatient wards at RCHT, which equates to 782 doses per day. According to our data, 782 doses of IV antibiotics administration would require approximately 136 h of nursing time every single day. Based on our IVOS CQUIN data, approximately 11% (86 doses) of IV antibiotics could be switched to oral. This equates to 86 doses of IV antibiotics which could be saved and changed to oral which could save approximately 12 h of nursing time every day.

Conclusions
Optimizing IV to oral switching could save 12 h of nursing time every day. In addition, we could reduce our carbon footprint by reducing the generation of non-reusable plastic produced in the process of administering IV antibiotics compared with oral antibiotics.
Analysis of random induced dynamic response of rural roads considering friction effect and nonlocal effect under the load of construction vehicles
Authors: Wang Guobing , Yang Feiyue , Wu Wenli , Wang Hui 
Published: August 2024

Abstract
The objective of this paper is to propose a novel computational model for solving the problem of accurately evaluating the randomly induced road vibration response of engineering vehicles traveling on rural roads. The computational model, first, focuses on the unique pavement characteristics of rural roads, constructs a tire grounding function model and innovatively introduces a dynamic friction factor, and successfully develops a coupled stochastic excitation system model for the interaction between the dynamic loads of 1/4 vehicle tires and the pavement of rural roads by applying the power spectral density function of the rural roads and combining it with the elastic roller model of the vehicle tires. Second, considering the nonlocal superposition effect of the soil skeleton of the roadbed, a coupled vibration response model of a 1/4 automobile rural road is successfully developed, and a validation method is given. Finally, the coupled vibration response characteristics of engineering vehicles and rural roads under random excitation at different speeds are analyzed. The analysis results show that the model proposed in this paper can well predict the degree and influence the range of rural road vibration caused by random excitation of construction vehicles traveling at any speed.
Challenges faced by public sector community pharmacists in interior cities of Brazil during the early phase of COVID-19 pandemic: a qualitative study
Authors: Foggiatto Giovana , Garabeli Aline Ansbach , Possagno Gerusa Clazer Halila , Pontarolo Roberto , Benetoli Arcelio 
Published: August 2024

Abstract

Objectives
This study explored the experiences and perceptions of public sector pharmacists in primary healthcare during the early phase of the coronavirus disease 2019 (COVID-19) pandemic in nine small and medium-sized cities in the interior state of Paraná, Brazil.

Methods
Fourteen individual semi-structured online interviews were conducted using Google Meet®. Employing convenience sampling followed by “snowball” recruitment, audio-recorded interviews were transcribed verbatim and thematically analyzed through an inductive approach.

Key findings
Four major themes and two subthemes emerged: (i) workplace and service changes, (i.a) use of social media and remote communication; (ii) working conditions, (ii.b) supply and use of personal protective equipment; (iii) irrational use of medicines against COVID-19; and (iv) mental health.

Conclusion
Pharmacists reported a lack of preparation, centralization, and coordination, leading to overwhelming workloads and stress. However, they demonstrated resilience in delivering care and promoting rational medicine use. This study offers valuable insights into supporting stakeholders in managing abrupt changes in primary healthcare delivery.
A Physician Attack on the FDA—Will the Supreme Court Reduce Access to Mifepristone?
Authors: Watson K , Malina D 
Published: August 2024

(N Engl J Med. 2024;390(6);563–567. doi: 10.1056/NEJMms2312012.)
In 1965, Ms R. traveled from Denver to have a legal abortion in Japan due to concerns about an illegal US abortion being unsafe. Today, more than 80% of women who get abortions are 11 weeks pregnant or less, and as such, may legally take abortion medication (mifepristone and misoprostol pills) at home. However, options will become much more limited if the Supreme Court decides in favor of antiabortion physicians who have sued the Food and Drug Administration (FDA) to revoke its approval and regulation of mifepristone.
Angiogenic Biomarkers in Preeclampsia
Authors: Burwick RM , Rodriguez MH 
Published: August 2024

(Obstet Gynecol. 2024;143(4):515–523. doi:10.1097/AOG.0000000000005532)
Preeclampsia, a dangerous condition affecting 3% to 4% of pregnancies in the United States, causes significant maternal and neonatal complications worldwide. Monitoring for severe features is crucial for timely intervention. While it often develops from nonsevere hypertensive disorders, recent advancements include the use of 2 angiogenic biomarkers, soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF), to predict its onset and severity. These biomarkers have been integrated into diagnostic assays in various regions, including Europe and parts of Asia and the Americas. The Food and Drug Administration (FDA) recently authorized the sFlt-1/PlGF test (KRYPTOR Test System) for use in the United States to aid in assessing the risk of progression to severe preeclampsia in hospitalized pregnant women. However, it is emphasized that these tests should complement, not replace, clinical judgment.
Neonatal Seizures
Authors: Yozawitz E 
Published: August 2024

(N Engl J Med. 2023;388:1692–1700. doi: 10.1056/NEJMra2300188)
Seizures that occur within 4 weeks of the birth of a term infant or 44 weeks of corrected gestational age for preterm infants are defined as neonatal seizures, and the incidence is estimated at 2.29 per 1000 live births. Recent reports have described the incidence as higher among preterm infants. There are 2 classifications of neonatal seizures, epileptic, and provoked; provoked seizures are not considered epilepsy, do not require long-term treatment, and are usually attributable to hypoxic ischemic encephalopathy, stroke, or infection. This article is a review of the clinical presentation, evaluation, and treatment of neonatal seizures, along with a brief background of neonatal epilepsy syndromes and prognosis and complications of seizures in this population.
Evaluation of the “Sip Til Send” Regimen Before Elective Caesarean Delivery Using Bedside Gastric Ultrasound: A Paired Cohort Pragmatic Study
Authors: Harnett C , Connors J , Kelly S , Tan T , Howle R 
Published: August 2024

(Eur J Anaesthesiol. 2024;41(2):129–135. doi: 10.1097/EJA.0000000000001926)
Preoperative fasting is commonly recommended to prevent the risk of pulmonary aspiration of gastric contents during anesthesia. The European Society of Anaesthesiology and Intensive Care (ESAIC) advises fasting for 6 hours for solids and 2 hours for liquids prior to surgery (eg, caesarean delivery, CD). However, a long fasting period can impart both maternal and neonatal risk. As such, the liberal drinking “Sip Til Send” protocol has been widely used in the United Kingdom and Ireland with no associated pulmonary aspiration cases reported. This study aimed to assess residual gastric volumes in nonlaboring parturients presenting for elective CD and compare volumes in fasted patients to volumes after the same patients were allowed liberal oral hydration. The authors hypothesized there would be no significant difference in gastric volumes.
A Study of the Pharmacokinetics and Pharmacodynamics of Oxytocin at Elective Cesarean Delivery
Authors: Monks DT , Singh PM , Kagan L , Palanisamy A 
Published: August 2024

(Anaesthesia. 2023;78(11):1347–1353. doi: 10.1111/anae.16109)
Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide. The most common uterotonic agent used to prevent and treat PPH is oxytocin. In up to 38.8% of cases, oxytocin is unable to produce adequate uterine contractility and more uterotonic agents are required. Precise oxytocin dosing is ideal to balance PPH prevention/treatment and also avoid significant adverse side effects that can arise from high doses of oxytocin. While many factors contribute to the correct dosage for each individual, pharmacokinetic and pharmacodynamic data could assist in determining dosing for individual patients to both maximize desired effects and minimize adverse ones. This study was designed to obtain pharmacokinetic data to optimize the adjustment of oxytocin doses by patient weight, as well as to evaluate the relationship between serum oxytocin concentration and uterotonic and hemodynamic effects of the medication.
The Role of Transvaginal Ultrasound in the Third-Trimester Evaluation of Patients at High Risk of Placenta Accreta Spectrum at Birth
Authors: Jauniaux E , Hussein AM , Thabet MM , Elbarmelgy RM , Elbarmelgy RA , Jurkovic D 
Published: August 2024

(Am J Obstet Gynecol. 2023;229(4):445.e1–445.e11. doi: 10.1016/j.ajog/2023.05.004)
Identifying high-risk placenta accreta spectrum (PAS) patients prenatally reduces maternal complications and hemorrhagic morbidity at birth. Expert multidisciplinary management decreases massive transfusion and reoperation. Ultrasound, utilized initially in 1982, screens high-risk PAS cases effectively and standardized prenatal scanning with enhances outcomes. Recent expert consensus via Delphi survey supports seven key transabdominal ultrasound (TAU) signs for PAS risk assessment. Transvaginal sonography (TVS) is a vital tool for the evaluation of cervical and lower uterine segment anatomy and expert opinion supports the use of TVS as a supplement to current prenatal assessment for PAS. This study evaluated the utility of third trimester TVS to predict surgical outcomes in patients with high suspicion for PAS.
Association Between Socioeconomic Status With Pregnancy and Neonatal Outcomes: An International Multicenter Cohort
Authors: Maher GM , Ward LJ , Hernandez L , Kublickas M , Duvekot JJ , McCarthy FP , Khashan AS , Kublickiene K 
Published: August 2024

(Acta Obstet Gynecol Scand. 2023;102(11):1459–1468. doi: 10.1111/aogs.14659)
Many studies have shown that socioeconomic factors have large impacts on many areas of life including education, unemployment, housing security, nutrition, and reduced access to health care. In addition, low-socioeconomic indicators have been linked to pregnancy complications for both mother and neonate and have persisted even in areas with universal health care systems. However, other studies have shown an absence of association with socioeconomic status for outcomes such as low birthweight and preterm birth. Previous literature has suggested that assessing individual-level socioeconomic factors and their association with pregnancy outcomes may provide better understanding than area-based analysis. This study was designed to evaluate associations of individual-level socioeconomic factors (education, employment, relationship status, and income) with adverse pregnancy and neonatal outcomes (gestational hypertension, preeclampsia, gestational diabetes, emergency cesarean delivery, preterm birth, post-term delivery, small for gestational age, and Apgar score).
Neonatal Hypoxic-Ischemic Encephalopathy and Hypothermia Treatment
Authors: Arnautovic T , Sinha S , Laptook AR 
Published: August 2024

(Obstet Gynecol. 2024;143(1):67–81. doi: 10.1097/AOG.0000000000005392)
Neonatal hypoxic-ischemic encephalopathy (HIE) is a significant condition linked to mortality and long-term disabilities such as cognitive impairment, cerebral palsy, seizures, and sensory deficits. It falls under neonatal encephalopathy, a broader syndrome characterized by various neurologic dysfunctions, including altered consciousness, respiratory difficulties, and impaired reflexes. This syndrome can arise from multiple causes, including HIE, brain malformations, strokes, genetic disorders, and infections. HIE alone accounts for approximately half of neonatal encephalopathy cases, highlighting its clinical importance due to its association with serious outcomes. HIE can occur suddenly, without warning, and its treatment historically relied on supportive care alone. However, recent research highlights a critical time window in the first hours to days posthypoxia-ischemia, during which hypothermia therapy can mitigate brain injury. This article aims to inform obstetricians about neonatal encephalopathy, particularly HIE, and the role of hypothermia treatment.
National, Regional, and Global Estimates of Preterm Birth in 2020, With Trends From 2010: A Systematic Analysis
Authors: Ohuma EO , Moller A-B , Bradley E , Chakwera S , Hussain-Alkhateeb L , Lewin A , Okwaraji YB , Mahanani WR , Johansson EW , Lavin T , Fernandez DE , Domínguez GG , de Costa A , Cresswell JA , Krasevec J , Lawn JE , Blencowe H , Requejo J , Moran AC 
Published: August 2024

(Lancet. 2023;402(10409):1261–1271. doi:10.1016/S0140-6736(23)00878-4)
An analysis of global data from 2010 to 2020 found that there was not a measurable change in the rate of preterm births during that period. The analysis, led by the World Health Organization and UNICEF, is the first data published on preterm birth rates since 2015. The new estimates are crucial for understanding the burden of preterm births around the world and for determining where resources can best be targeted.
Risk Factors for Recurrence of Postdural Puncture Headache Following an Epidural Blood Patch: A Retrospective Cohort Study
Authors: Tomala S , Savoldelli GL , Pichon I , Haller G 
Published: August 2024

(Int J Obstet Anesth. 2023;56:103925. doi: 10.1016/j.ijoa.2023.103925)
Neuraxial anesthesia is a commonly used technique during childbirth. Postdural puncture headache (PDPH) is a notable complication, occurring in a minority of patients but with the potential to lead to severe short and long-term adverse outcomes. Definitive treatment typically involves an epidural blood patch (EBP), although it may not always be successful, with some patients requiring multiple procedures. Risk factors for EBP failure remain uncertain, with conflicting findings regarding the timing and volume of blood injected. This study aimed to assess the incidence and risk factors for EBP failure in a substantial patient cohort, providing insights into improving outcomes for patients undergoing this procedure.
Role of Cosyntropin in the Prevention of Postdural Puncture Headache: A Propensity-matched Retrospective Analysis
Authors: Liu M , Mitchell A , Palanisamy A , Singh PM 
Published: August 2024

(Int J Obstet Anesth. 2023;56:103922. doi: 10.1016/j.ijoa.2023.103922)
Postdural puncture headache (PDPH) frequently follows unintended dural puncture during epidural placement in obstetric patients, affecting up to 85% of cases and significantly impacting maternal well-being. PDPH can lead to prolonged hospital stays and even chronic headaches. Preventive measures like bed rest and hydration have shown limited efficacy, while medications like adrenocorticotropic hormone and cosyntropin offer potential relief, albeit with inconclusive evidence. Prophylactic use of cosyntropin has shown promise in reducing PDPH incidence and severity, possibly by enhancing analgesia and increasing cerebrospinal fluid production. However, this finding lacks replication in other trials, and widespread recommendation is lacking due to methodological limitations. Conducting randomized controlled trials in this context is challenging. This study retrospectively investigated the effectiveness of prophylactic cosyntropin in reducing PDPH incidence and severity in obstetric patients, aiming to address the gap in evidence regarding its use.
Embracing Labor Neuraxial Analgesia as a Tool to Reduce Health Inequities and Hemorrhage-related Maternal Morbidity
Authors: Bauer ME , Admon LK 
Published: August 2024

(Anesthesiology. 2023;139(6):717–718. doi: 10.1097/ALN.0000000000004783)
The United States has higher rates of maternal morbidity and mortality in comparison to all other developed nations with health inequities affecting marginalized groups. Obstetric hemorrhage is one of the main factors that contribute to both maternal morbidity and mortality, and further interventions are needed to help minimize these events.
Five-year Follow-up of a Prospective Food and Drug Administration Investigational Device Exemption Trial Evaluating a PEEK-on-Ceramic Cervical Disk Replacement
Authors: Guyer Richard D. , Bae Hyun , Coric Domagoj , Nunley Pierce D. , Musacchio Michael , Sasso Rick C. , Ohnmeiss Donna D. 
Published: August 2024

Study Design.
Prospective trial comparing the investigation group to propensity-matched historic control group.

Objective.
To evaluate five-year results of single-level PEEK-on-ceramic cervical total disc replacement (TDR) compared with a propensity-matched anterior cervical discectomy and fusion (ACDF) control group.

Summary of Background Data.
Cervical TDR has gained acceptance as a treatment for symptomatic disk degeneration. The design and materials used in these devices continue to evolve.

Materials and Methods.
Data were collected in the Food and Drug Administration Investigational Device Exemption trial for the PEEK-on-ceramic Simplify Cervical Artificial Disc (n=150) with comparison to a propensity-matched ACDF control group (n=117). All patients were treated for single-level cervical disk degeneration with radiculopathy and/or myelopathy. Clinical outcome was based on composite clinical success (CCS), Neck Disability Index (NDI), visual analog scales (VAS) assessing pain, reoperations, and satisfaction. Radiographic measures included segmental range of motion (ROM), disk space height, and heterotopic ossification (HO). Evaluations were performed preoperatively and postoperatively within two and six weeks, and three, six, 12 months, and annually thereafter.

Results.
At five-year follow-up, CCS was significantly greater with TDR than ACDF (91.1% vs. 74.6%; P<0.01). In the TDR group, the mean NDI score was 63.3 preoperatively, reduced significantly to 23.1 at six weeks, and remained below 20 throughout the five-year follow-up. In the ACDF group, the mean preoperative NDI score was 62.4, decreasing to 33.7 at six weeks, and ranged from 25.9 to 21.5 throughout follow-up. Mean NDI scores were significantly lower in TDR group at all postoperative points (P<0.05). Mean TDR ROM was 7.3o preoperatively and 10.1o at five years. Bridging HO occurred in 9%. With TDR, there were six reoperations (4.0%) versus 11 (9.4%) with ACDF (P>0.40).

Conclusions.
PEEK-on-ceramic TDR produced significantly improved outcomes maintained throughout five-year follow-up that were similar or superior to ACDF, supporting TDR in appropriately selected patients.
Understanding Causes of Death in Patients With Acute Respiratory Distress Syndrome: A Narrative Review
Authors: Bromley Susan E. , Shakery Kaweh , Vora Pareen , Atabaki Artin , Reimer Thomas , McDermott Lawrence , Hajizadeh Negin 
Published: August 2024

OBJECTIVES:
To provide a comprehensive summary of the published data on cause of death in patients with acute respiratory distress syndrome (ARDS).

DATA SOURCES:
PubMed (January 2015 to April 2024), bibliographies of relevant articles, and ARDS Network and Prevention & Early Treatment of Acute Lung Injury (PETAL) network websites.

STUDY SELECTION:
Observational studies and clinical trials that reported on cause of death in greater than or equal to 30 patients with ARDS, not obtained from death certificates. Animal studies, case reports, review articles, study protocols, and studies in pediatrics were excluded.

DATA EXTRACTION:
Causes of death among ARDS patients who died were extracted and tabulated along with other pertinent study characteristics.

DATA SYNTHESIS:
We identified 15 observational studies (nine non-COVID ARDS, five COVID-related ARDS; one both) and five clinical trials (all non-COVID ARDS). Mutually exclusive prespecified categories were used for recording the cause of death in only eight studies although studies differed in the categories included and their definitions. When multiple organ failure was a predetermined category, it was the most common cause of death recorded (~50% of deaths), followed by respiratory causes with proportions varying from 16% to 42% depending on nomenclature (e.g., refractory hypoxemia, pulmonary causes) and definitions. However, the largest observational study in non-COVID ARDS (964 deaths), did not include multiple organ failure as a predetermined category, and found that pulmonary failure (42%) and cardiac failure (37%) were the most common causes of death. In COVID-related ARDS observational studies, pulmonary reasons were the most reported cause of death (up to 88%).

CONCLUSIONS:
Few studies have reported cause of death in patients with ARDS. In those that do, cause of death categories and definitions used are heterogeneous. Further research is needed to see whether a more rigorous and unified approach to assigning and reporting cause of death in ARDS would help identify more relevant endpoints for the assessment of targeted treatments in clinical trials.