bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pragmatic Approach to In Situ Simulation to Identify Latent Safety Threats Before Moving to a Newly Built ICU
Authors: Sarwal Aarti , Morris Nicholas A. , Crumpler Janet , Gordon Terri , Saunders Ian , Johnson James E. , Carter Jeff E. 
Published: March 2024

OBJECTIVES:
Transitions to new care environments may have unexpected consequences that threaten patient safety. We undertook a quality improvement project using in situ simulation to learn the new patient care environment and expose latent safety threats before transitioning patients to a newly built adult ICU.

DESIGN:
Descriptive review of a patient safety initiative.

SETTING:
A newly built 24-bed neurocritical care unit at a tertiary care academic medical center.

SUBJECTS:
Care providers working in neurocritical care unit.

INTERVENTIONS:
We implemented a pragmatic three-stage in situ simulation program to learn a new patient care environment, transitioning patients from an open bay unit to a newly built private room-based ICU. The project tested the safety and efficiency of new workflows created by new patient- and family-centric features of the unit. We used standardized patients and high-fidelity mannequins to simulate patient scenarios, with “test” patients created through all electronic databases. Relevant personnel from clinical and nonclinical services participated in simulations and/or observed scenarios. We held a debriefing after each stage and scenario to identify safety threats and other concerns. Additional feedback was obtained via a written survey sent to all participants. We prospectively surveyed for missed latent safety threats for 2 years following the simulation and fixed issues as they arose.

MEASUREMENTS AND MAIN RESULTS:
We identified and addressed 70 latent safety threats, including issues concerning physical environment, infection prevention, patient workflow, and informatics before the move into the new unit. We also developed an orientation manual that highlighted new physical and functional features of the ICU and best practices gleaned from the simulations. All participants agreed or strongly agreed that simulations were beneficial. Two-year follow-up revealed only two missed latent safety threats.

CONCLUSIONS:
In situ simulation effectively identifies latent safety threats surrounding the transition to new ICUs and should be considered before moving into new units.
Impact of Early Mobilization Within the Intensive Care Unit After Coronary Artery Bypass Grafting: A Systematic Review
Authors: Thomas Bini , Morgan Sandra , Smith James M. 
Published: March 2024

Purpose:
Coronary artery bypass grafting (CABG) surgery treats complications from coronary artery diseases, and its recovery traditionally consisted of bedrest. Recent research emphasizes the benefits of early mobilization for hospitalized patients. However, the functional outcomes and effectiveness of early mobilization for persons within the intensive care units after CABG has not been investigated thus far. The objective of this review was to determine the effectiveness of early mobilization in reducing hospital and intensive care unit length of stay (LoS) and improving functional outcomes of persons after CABG.

Methods:
This study was registered with PROSPERO and followed PRISMA guidelines. PubMed, Embase, CINAHL, and PEDro databases were searched using MeSH terms. Studies with early mobilization interventions for adults in the intensive care unit after CABG that recorded outcomes of LoS or functioning were included. Methodological quality was measured using the PEDro scale and Oxford Level of Evidence.

Results:
This systematic review collectively addressed 2280 participants through 14 studies in 7 countries. The initiation time frames for early mobilization varied, with the majority beginning within 24 to 48 hours after surgery and interventions were heterogenous. Early mobility was found to be effective in reducing atelectasis, improving oxygen saturation, and decreasing time spent on mechanical ventilation. Among early mobilization participants, the LoS was reduced in all studies; intensive care unit LoS decreased by one day or greater in 6 of 14 studies, and hospital LoS decreased by one day or greater in 5 of 7 studies.

Conclusions:
Data analysis found that early mobilization achieved better functional outcomes. It was found that implementing early mobilization led to decreased intensive care and hospital lengths of stay, reduced atelectasis and pleural effusion, and improved functional and respiratory outcomes in persons who underwent CABG surgery.
Changes in Perampanel Pharmacokinetics and Cytochrome P450 3A4 Activity Before, During, and After Pregnancy
Authors: Yamamoto Yoshiaki , Akita Naoto , Nogimoto Hiroki , Suzuki Wakana , Imai Katsumi , Takahashi Yukitoshi , Kagawa Yoshiyuki 
Published: March 2024

Abstract:
This study evaluated perampanel pharmacokinetics and cytochrome P450 3A4 (CYP3A4) activity, assessed using the level of 4β-hydroxycholesterol (4β-OHC) as an endogenous biomarker of CYP3A4, before, during, and after pregnancy in a woman with epilepsy and compared these measurements with those from a control group of nonpregnant women with epilepsy. A 21-year-old pregnant woman was being treated with perampanel (serum concentration: 1120 ng/mL), lacosamide, and lamotrigine. After the first trimester, the lamotrigine concentration decreased markedly; however, the perampanel concentration remained almost unchanged (range, 1130–1320 ng/mL). Similarly, serum 4β-OHC levels did not change during pregnancy (before pregnancy, 78.2 ng/mL; during pregnancy, 62.2–83.2 ng/mL). To compare these measurements with those in nonpregnant women, we enrolled 27 nonpregnant women with epilepsy (age range, 16–40 years). In the control patients, we found a strong negative correlation between the concentration-to-dose ratio of perampanel and the 4β-OHC level (r = −0.78, P < 0.001). As there was no significant change in CYP3A4 activity, we concluded that the serum perampanel concentration did not change significantly before, during, or after pregnancy. More patients need to be studied to confirm these early results.
A randomized multicenter trial of a chronic disease management intervention for decompensated cirrhosis. The Australian Liver Failure (ALFIE) trial
Authors: Wigg Alan J. , Narayana Sumudu , Woodman Richard J. , Adams Leon A. , Wundke Rachel , Chinnaratha Mohamed A. , Chen Bin , Jeffrey Gary , Plummer Joan-Lee , Sheehan Vanessa , Tse Edmund , Morgan Joanne , Huynh Dep , Milner Margery , Stewart Jeffrey , Ahlensteil Golo , Baig Asma , Kaambwa Billingsley , Muller Kate , Ramachandran Jeyamani 
Published: March 2024

Background and Aims:
Improving the care of decompensated cirrhosis is a significant clinical challenge. The primary aim of this trial was to assess the efficacy of a chronic disease management (CDM) model to reduce liver-related emergency admissions (LREA). The secondary aims were to assess model effects on quality-of-care and patient-reported outcomes.

Approach and Results:
The study design was a 2-year, multicenter, randomized controlled study with 1:1 allocation of a CDM model versus usual care. The study setting involved both tertiary and community care. Participants were randomly allocated following a decompensated cirrhosis admission. The intervention was a multifaceted CDM model coordinated by a liver nurse. A total of 147 participants (intervention=75, control=71) were recruited with a median Model for End-Stage Liver Disease score of 19. For the primary outcome, there was no difference in the overall LREA rate for the intervention group versus the control group (incident rate ratio 0.89; 95% CI: 0.53–1.50, p=0.666) or in actuarial survival (HR=1.14; 95% CI: 0.66–1.96, p=0.646). However, there was a reduced risk of LREA due to encephalopathy in the intervention versus control group (HR=1.87; 95% CI: 1.18–2.96, p=0.007). Significant improvement in quality-of-care measures was seen for the performance of bone density (p<0.001), vitamin D testing (p<0.001), and HCC surveillance adherence (p=0.050). For assessable participants (44/74 intervention, 32/71 controls) significant improvements in patient-reported outcomes at 3 months were seen in self-management ability and quality of life as assessed by visual analog scale (p=0.044).

Conclusions:
This CDM intervention did not reduce overall LREA events and may not be effective in decompensated cirrhosis for this end point.
Efficacy of a Novel Antibiotic Drug Combination Toward Multidrug-Resistant Ocular Pathogens
Authors: Gowtham Lakshminarayanan , Wozniak Rachel A. F. , Dunman Paul M. , Sheba Esther , Garg Prashant , Joseph Joveeta 
Published: March 2024

Purpose:
Antimicrobial resistance is a global health threat, compounded by the reduction in the discovery of new antibiotics. A repurposed drugs-based approach could provide a viable alternative for the treatment of multidrug-resistant (MDR) bacterial infections. In this study, we sought to evaluate the in vitro efficacy of a novel drug combination, polymyxin B/trimethoprim (PT) + rifampin on MDR isolates from patients with bacterial keratitis in India.

Methods:
Forty-three isolates, which included 20 Staphylococcus aureus, 19 Pseudomonas aeruginosa, 3 Pseudomonas stutzeri, and 1 Acinetobacter baumannii, were evaluated for their antibiotic resistance by minimum inhibitory concentration (MIC). Fractional Inhibitory Concentration Index (FICI) testing was performed to measure the antimicrobial impact of PT + rifampin in combination.

Results:
Among S. aureus isolates, 100% were resistant to at least 1 antibiotic class, 12 (60%) were MDR, and 14 (70%) were classified as methicillin-resistant. Among the gram-negative isolates, >90% were classified as MDR. Fractional Inhibitory Concentration (FIC) testing revealed that PT + rifampin was effective in completely inhibiting growth of all isolates while also displaying additive or synergistic activity in approximately 70% of the strains. Mean FICI values were 0.753 ± 0.311 and 0.791 ± 0.369 for S. aureus and gram-negative isolates, respectively, and a >2-fold reduction in MIC was measured for both PT and rifampin when tested in combination versus alone.

Conclusions:
Our data demonstrate the ability of PT + rifampin to eliminate all isolates tested, even those conferring MDR, highlighting the promise of this drug combination for the treatment of bacterial keratitis.
Drug-Induced Liver Injury During a Glaucoma Neuroprotection Clinical Trial
Authors: Shukla Aakriti Garg , Cioffi George A. , Liebmann Jeffrey M. 
Published: March 2024

Abstract:
There are several ongoing, worldwide clinical trials with a cumulative target enrollment of over 1300 participants on the role of nicotinamide (a specific form of vitamin B3) as a therapeutic neuroprotective treatment for glaucoma. We describe a serious adverse event of drug-induced liver injury (DILI) likely related to the use of 3 g/day nicotinamide in a glaucoma clinical trial (clinicaltrials.gov identifier: NCT05695027) based in the United States. This report is important to share with the medical community, as other participants in glaucoma nicotinamide trials globally may have similar adverse events and many patients are using nicotinamide as a health supplement without medical supervision. We recommend that investigators, physicians, and patients remain vigilant about DILI as they seek novel vision-preserving neuroprotective therapies.
The Increase in Household Transmission of Pertussis Associated With Diagnostic Delays
Authors: Arakkal Alan T. , Cavanaugh Joseph E. , Polgreen Philip M. , Miller Aaron C. 
Published: March 2024

Background:
Pertussis is a highly contagious respiratory illness that can be especially dangerous to young children. Transmission of pertussis often occurs in household settings and is impacted by the timing of treatment and postexposure chemoprophylaxis. This study analyzes the risk for secondary household transmission and if delays in diagnosing pertussis increased the risk for household transmission.

Methods:
We conducted 2 population-based studies using a large nationally representative administrative claims database. The first study utilized a stratified monthly incidence model to compare the incidence of pertussis among enrollees exposed to a family member with pertussis versus those not exposed. The second study was conducted at a household level following the index case of pertussis in each household. We identified diagnostic delays in the initial household case and used a logistic regression model to evaluate if such delays were associated with a greater risk for transmission.

Results:
The incidence rate ratio of pertussis was 938.99 [95% confidence interval (CI): 880.19–1001.73] among enrollees exposed to a family member with pertussis relative to those not exposed. The odds of secondary household transmission in households where the index case experienced a diagnostic delay was 5.10 (CI: 4.44–5.85) times the odds of transmission when the index case was not delayed. We found that longer delays were associated with a greater risk for secondary household transmission (P < 0.0001).

Conclusions:
There is a high rate of secondary transmission of pertussis in household settings. Diagnostic delays increase the likelihood that pertussis will transmit in the household.
Is SARS-CoV-2 Now More Like the Seasonal Coronaviruses Following Its Evolution?
Authors: Bayhan Gülsüm İclal , Altan Işıl , Mercan Halise , Özkaya Parlakay Aslınur , Coşkun Zehra Nihan , Dinç Bedia , Gülhan Belgin , Kanık-Yüksek Saliha 
Published: March 2024

Background:
SARS-CoV-2 has evolved significantly since the beginning of the COVID-19 pandemic. COVID-19 mortality has decreased due to increased population immunity and possibly the reduced intrinsic severity of the new variants. SARS-CoV-2 is now considered an endemic virus, but the extent to which its clinical findings resemble those of seasonal coronaviruses (sCoV) is not fully understood.

Methods:
Pediatric patients under 18 years of age who were sent for SARS-CoV-2 polymerase chain reaction real-time reverse transcription polymerase chain reaction between January 1, 2022 and January 14, 2023 and whose results were positive were included in this study. To include only symptomatic COVID-19 patients in the study, asymptomatic patients who were positive in their screening tests were excluded. For the sCoV patients’ group, patients who had a respiratory viral polymerase chain reaction assay between January 10, 2022 and January 11, 2023 and were positive for any type of sCoV were included in the study. The 2 groups were compared for clinical and laboratory characteristics.

Results:
The study included 213 patients with COVID-19 and 194 patients with sCoV infection. Fever was a more common symptom in patients with COVID-19. sCoV was associated with lower respiratory involvement while increasing age was protective. The likelihood of hospitalization was decreased by increasing age but increased by the presence of comorbid conditions and lower respiratory tract involvement. The type of virus had no effect on the likelihood of hospitalization.

Conclusions:
In conclusion, sCoV infections carry a higher risk for lower respiratory involvement than COVID-19, and COVID-19 has a milder course than sCoV infections in children.
Enterococcal Central Nervous System Infections in Children: A 22 Years’ Experience in a Tertiary Center and Review of the Literature
Authors: Schnapp Aviad , Elber-Dorozko Sergei , Temper Violeta , Gordon Oren , Averbuch Dina 
Published: March 2024

Background:
Enterococcal meningitis in children is rare, and its clinical presentation, laboratory characteristics and outcomes are not well defined.

Methods:
We conducted a retrospective analysis of Enterococcal meningitis cases during 2002–2023 at our tertiary center.

Results:
We identified 10 cases in children 2 weeks to 15 years old (median age: 8 months). Seven children were males and 9 had comorbidities, including a ventriculoperitoneal shunt in 5 children. All children with shunt infections presented with nonspecific signs and symptoms. While 8 children presented with fever, only 3 had signs of meningeal irritation and altered consciousness. Cerebrospinal fluid pleocytosis was evident in almost all children with a median of 173 cells/mL. Nine cases were due to Enterococcus faecalis, and 1 case was due to E. faecium. All 5 children with ventriculoperitoneal shunt underwent shunt removal and replacement. All children recovered without documented sequelae.

Conclusions:
Enterococcal meningitis is rare, especially in healthy neonates. It typically occurs following neurosurgical interventions and may only present with fever and shunt malfunction, without overt meningeal signs and with mild inflammation. The prognosis is favorable.
Effects of reduction in intraocular pressure after trabeculotomy on axial length and intraocular lens selection
Authors: Kanda Satoru , Fujishiro Takashi , Karakawa Ayako , Nakagawa Suguru , Ishii Kiyoshi 
Published: March 2024

Purpose:
To investigate the relationship between intraocular pressure (IOP) and axial length (AL) and to compare the refractive predicted error in patients who have undergone cataract surgery alone or in combination with trabeculotomy.

Setting:
Hospital.

Design:
Single-center, retrospective, case–control.

Methods:
The medical records of patients who had undergone cataract surgery alone or in combination with trabeculotomy using the Tanito microhook were retrospectively reviewed. Patients were grouped into cataract surgery alone (CAT) or cataract surgery combined with trabeculotomy (LOT) groups. Demographic data, preoperative and postoperative IOP and AL, and surgically induced astigmatism (SIA) were analyzed before and 1 month postoperatively to evaluate the interplay between IOP, AL, and refractive outcomes.

Results:
52 eyes (52 patients) underwent LOT, and 67 eyes (67 patients) underwent CAT. The mean IOP at baseline did not differ between the groups; the change in IOP (dIOP) was significantly higher in the LOT group than in the CAT group. The mean AL at baseline and the change in AL (dAL) were 24.0 ± 1.2 mm and 0.16 ± 0.11 mm, respectively, in the LOT group, and 23.8 ± 1.1 mm and 0.11 ± 0.070 mm, respectively, in the CAT group. The difference in dAL was also significant. In the LOT group, dIOP and dAL were significantly correlated. The mean SIA vectors did not significantly differ between the groups.

Conclusions:
AL decreased because of the reduction in IOP after cataract surgery combined with trabeculotomy. Consequently, the refractive target error was greater, and the postoperative refractive outcome showed a tendency toward hyperopia.
The role of robotic-assisted surgery in the management of rectal cancer: a systematic review and meta-analysis
Authors: Zhang Chenxiong , Tan Hao , Xu Han , Ding Jiaming 
Published: March 2024

Background:
Rectal cancer poses a significant global health burden. There is a lack of concrete evidence concerning the benefits of robotic-assisted surgery (RAS) for rectal cancer surgery as compared to laparoscopic and open techniques. To address this gap, we conducted a meta-analysis to assess the intraoperative, postoperative, and safety outcomes of robotic surgery in this context.

Research methodology:
A search of MEDLINE, Scopus and the Cochrane Library. Randomized and non-randomized studies up to February 2, 2024 comparing robotic surgery versus laparoscopic or open surgery for rectal cancer. The outcomes of interest were operative time, blood loss, harvested lymph nodes, conversion rate, postoperative hospital stay, survival to hospital discharge, urinary retention rate, and anastomotic leakage rate. A random-effects meta-analysis was performed to pool means and dichotomous data to derive weighted mean differences and odds ratios, respectively.

Results:
A total of 56 studies were shortlisted after the study selection process with a total of 25 458 rectal cancer patients. From the intraoperative outcomes, RAS was significantly associated with an increased operative time (WMD: 41.04, P<0.00001), decreased blood loss (WMD: −24.56, P<0.00001), decreased conversion rates (OR: 0.39, P<0.00001), lesser stay at the hospital (WMD: −1.93, P<0.00001), and no difference was found in lymph nodes harvested. Similarly, RAS group had a significantly greater survival to hospital discharge (OR: 1.90, P=0.04), decreased urinary retention rate (OR: 0.59, P=0.002), and no difference was seen in anastomotic leakage rate.

Conclusion:
RAS demonstrates favorable outcomes for rectal cancer patients, contributing to global prevention and control efforts, health promotion, and addressing non-communicable disease risk factors. Further research and public awareness are needed to optimize RAS utilization in this context.
Metabolic tumor burden as a prognostic indicator after neoadjuvant chemotherapy in pancreatic cancer
Authors: Lee Woohyung , Oh Minyoung , Kim Jae Seung , Sung Minkyu , Hong Kwangpyo , Kwak Bong Jun , Park Yejong , Jun Eunsung , Song Ki Byung , Hwang Dae Wook , Lee Jae Hoon , Yoo Changhoon , Kim Kyu-pyo , Park Inkeun , Jeong Jae Ho , Chang Heung-Moon , Ryoo Baek-Yeol , Lee Jung Bok , Kim Song Cheol 
Published: March 2024

Background:
There is no standardized assessment for evaluating response although neoadjuvant chemotherapy (NAT) is widely accepted for borderline resectable or locally advanced pancreatic cancer (BRPC or LAPC). This study was aimed to evaluate NAT response using positron emission tomography (PET) with 2-deoxy-2-[fluorine-18]fluoro-D-glucose (18F-FDG-PET/CT) parameters alongside carbohydrate antigen (CA) 19-9 levels.

Methods:
Patients who underwent surgery after NAT for BRPC and LAPC between 2017 and 2021 were identified. The study assessed the prognostic value of PET-derived parameters after NAT, determining cutoff values using the K-adaptive partitioning method. It created four groups based on the elevation or normalization of PET parameters and CA19-9 levels, comparing survival between these groups.

Results:
Of 200 eligible patients, FOLFIRINOX and gemcitabine-based NAT was administered in 166 and 34 patients, respectively (mean NAT cycles, 8.3). In a multivariate analysis, metabolic tumor volume (MTV) demonstrated the most robust performance in assessing response [hazard ratio (HR) 3.11, 95% confidence interval (CI) 1.73–5.58, P<0.001] based on cutoff value of 2.4. Patients with decreased MTV had significantly better survival than those with elevated MTV among individuals with CA19-9 levels less than 37 IU/l (median survival; 35.5 vs. 20.9 months, P<0.001) and CA19-9 levels at least 37 IU/l (median survival; 34.3 vs. 17.8 months, P=0.03). In patients suspected to be Lewis antigen negative, the predictive performance of MTV was found to be limited (P=0.84).

Conclusion:
Elevated MTV is an influential prognostic factor for worse survival, regardless of post-NAT CA19-9 levels. These results could be helpful in identifying patients with a poor prognosis despite normalization of CA19-9 levels after NAT.