bluuebunny/crossref_metadata_2025_split huggingface dataset:
Monitoring of Argatroban in Critically Ill Patients: A Prospective Study Comparing Activated Partial Thromboplastin Time, Point-of-Care Viscoelastic Testing with Ecarin Clotting Time and Diluted Thrombin Time to Mass Spectrometry
Authors: Heubner Lars , Oertel Reinhard , Tiebel Oliver , Mehlig-Warnecke Nicole , Beyer-Westendorf Jan , Mirus Martin , Roessler Martin , Renner Bertold , Spieth Peter Markus 
Published: October 2023

Background
The direct thrombin inhibitor argatroban is indicated for the treatment of heparin-induced thrombocytopenia II, but it is also used off-label to treat critically ill patients presenting with heparin resistance, severe antithrombin deficiency, or hypercoagulability. Direct drug monitoring is not routinely available, and argatroban dosing is mainly based on global coagulation assays such as activated partial thromboplastin time (PTT) or diluted thrombin time (TT), both of which have limitations in patients with hypercoagulability.

Methods
Blood samples were obtained from critically ill patients treated with argatroban. Activated PTT and diluted TT were measured with a STA R Max3 analyzer (STAGO Deutschland GmbH, Germany) using an argatroban-calibrated kit. Ecarin clotting time was measured using a point-of-care viscoelastic test device. Liquid chromatography with tandem mass spectrometry was performed using a reversed-phase column, a solvent gradient, and an API4000 mass spectrometer with electrospray. Correlation was described using Pearson correlation coefficient r and Bayesian multilevel regression to estimate relationships between outcomes and covariates.

Results
From June 2021 to March 2022, 205 blood samples from 22 patients were analyzed, allowing for 195 activated PTT–liquid chromatography with tandem mass spectrometry comparisons, 153 ecarin clotting time–liquid chromatography with tandem mass spectrometry comparison, and 105 diluted TT–liquid chromatography with tandem mass spectrometry comparisons. Compared to liquid chromatography with tandem mass spectrometry, performance of argatroban quantification was best for diluted TT (r = 0.91), followed by ecarin clotting time (r = 0.58) and activated PTT (r = 0.48). Regression analysis revealed that patients with sepsis were more prone to argatroban overdosing (coefficient, 4.194; 95% credible interval, 2.220 to 6.792).

Conclusions
Although activated PTT monitoring of argatroban is the most commonly used test, in critically ill patients, diluted TT provides more precise measurements. Alternately, point-of-care viscoelastic ecarin clotting time also provides guidance for argatroban dosing to identify overdosing if available. The data also suggested that patients with sepsis are at greater risk for argatroban overdosing.

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A Novel Fluorescence-Based Leak Test Method for Rectal Anastomoses Using Aerosolized Indocyanine Green
Authors: Kondo Akihiro , Yokota Naoya , Kobayashi Nobuya , Feng Dongping , Asano Eisuke , Kumamoto Kensuke , Kobara Hideki , Okano Keiichi 
Published: October 2023

BACKGROUND:
The intraoperative air leak test is commonly performed during rectal surgery to evaluate anastomotic integrity. However, its drawbacks include occasional difficulties in visualizing the exact point of the leak while maintaining the pelvis under saline, the need for repeat testing to identify the leak point, and a lack of continuous visualization of the leak point.

OBJECTIVE:
We aimed to evaluate the feasibility and clinical applicability of using aerosolized indocyanine green, a fluorescent tracer, for detecting rectal anastomotic leakage.

DESIGN:
Animal pre-clinical study.

SETTING:
Animal laboratory at Kagawa University.

PATIENTS:
Six healthy adult female beagles were included.

INTERVENTIONS:
An anastomotic leakage model with a single air leak point was created in each dog. Indocyanine green was aerosolized using a nebulizer kit with a stream of carbon dioxide flowing at 1.5–2.0 L/min. The aerosol was administered into the rectum transanally, and laparoscopic observations were performed.

MAIN OUTCOME MEASURES:
Air leak points were observed using a near-infrared fluorescence laparoscope, following which the presence of corresponding indocyanine green fluorescence was verified.

RESULTS:
Aerosolized indocyanine green was visualized laparoscopically at all anastomosis sites but not elsewhere. The median time from the administration of the aerosol to its visualization was 4.5 s. Pathological examinations were performed 4 weeks post-surgery in all dogs, and no histological abnormalities related to aerosolized indocyanine green administration were observed at the anastomosis sites.

LIMITATIONS:
The leak points were surgically created and did not occur naturally.

CONCLUSIONS:
Visualization of air leaks at the sites of rectal anastomosis was laparoscopically achievable by administering aerosolized indocyanine green transanally into the rectum in our canine model. This novel fluorescent leak test could be a valid alternative to established methods.
Clinical Experience of a Smart Articulating Digital Device for Transanal Minimally Invasive Surgery
Authors: Khan Mohammad Faraz , Kearns Emma , Cahill Ronan A. 
Published: October 2023

BACKGROUND:
The constrained access associated with transanal minimally invasive surgery has led surgeons to deploy robotic-assisted platforms to offset inherent maneuverability limitations and, perhaps, skills deficits.

IMPACT OF INNOVATION:
A handheld, powered 5-mm lightweighted laparoendoscopic electromechanical digital device (HandX, HumanXtensions, Israel) with hardware and software components that convert surgical hand movements precisely to the instrument’s articulating tip and enable robotic transanal minimally invasive surgery with full tip roticulation for hook diathermy and suturing.

TECHNOLOGY, MATERIALS, AND METHODS:
After bench and biomedical model training, HandX was used in 3 transanal minimally invasive surgery procedures (2 male patients and 1 female patient, mean age 66.3 years). The rectal lesions averaged 30 mm in maximum dimension and were located posteriorly (n = 2) and laterally (n = 1) a mean of 3 cm from the anal verge. Standard transanal minimally invasive surgery setup and instrumentation (Gelport Path, Applied Medical with Airseal, and Conmed) were used, adding the HandX device for circumferential lesion marking and hemostatic full-thickness excision as well as defect suturing where appropriate.

PRELIMINARY RESULTS:
All procedures were completed without undue prolongation (operating times <1 hour) despite nuisance hemorrhoidal bleeding in 1 patient. All lesions were fully excised, with 2 being T1 cancers and 1 tubulovillous adenoma with high-grade dysplasia. All patients were discharged within 48 hours postoperatively (1 experienced secondary hemorrhage on postoperative day 5).

CONCLUSIONS AND FUTURE DIRECTIONS:
HandX capably facilitated endoscopic robot-like instrument movement for transanal minimally invasive surgery without disrupting workflows. With time dedicated to instrument understanding and training, HandX increased dexterity with a small operating room footprint and may offer greater cost-effectiveness than other platforms.
Combined Robotic Ventral Mesh Rectopexy and Sacrocolpopexy for Multicompartmental Pelvic Organ Prolapse
Authors: Devane Liam , Ranson Stacy , Bustamante-Lopez Leonardo Alfonso , Uwah Martin , Kudish Bela , Kow Natha , Hoff John , Monson John R.T. , deBeche-Adams Teresa 
Published: October 2023

BACKGROUND:
Multispecialty management should be the preferred approach for the treatment of pelvic floor dysfunction, as there is often multicompartmental prolapse.

OBJECTIVE:
To assess the safety of combined robotic ventral-mesh rectopexy and either uterine or vaginal fixation for treatment of multicompartmental pelvic organ prolapse at our institution.

DESIGN:
Retrospective analysis.

SETTINGS:
Tertiary referral academic center.

PATIENTS:
All patients who underwent a robotic approach and combined procedure and discussed at a biweekly pelvic floor multidisciplinary team meeting.

MAIN OUTCOME MEASURES:
Operative time, intraoperative blood loss and complications. Postoperative pelvic organ prolapse quantification score, length of stay, 30-day morbidity, and readmission.

RESULTS:
From 2018 to 2021, there were 321 operations for patients with multicompartmental prolapse. Mean age was 63.4 years. The predominant pelvic floor dysfunction was rectal prolapse in 170 cases (60%). Pelvic organ prolapse quantification scores were II in 146 patients (53%), III in 121 (44%), and IV in 9 (3%); 315 of the 323 cases included robotic ventral mesh rectopexy (98%). Sacrocolpopexy or sacrohysteropexy was performed in 281 patients (89%). Other procedures included 175 hysterectomies (54%), 104 oophorectomies (32%), 151 sling procedures (47%), 149 posterior repairs (46%), and 138 cystocele repairs (43%). The operative time for ventral mesh rectopexy was 211 minutes and combined pelvic floor reconstruction 266 minutes. Average length of stay was 1.6 days. Eight patients were readmitted within 30 days, 1 with a severe headache and 7 patients with postoperative complications (2.5%): pelvic collection, perirectal collection both requiring radiologic drainage. Four complications required reoperation: epidural abscess, small-bowel obstruction, missed enterotomy requiring resection, and urinary retention requiring sling revision. There were no mortalities.

LIMITATIONS:
Retrospective single-center study.

CONCLUSIONS:
A combined robotic approach for multicompartmental pelvic organ prolapse is a safe and viable procedure with a relatively low rate of morbidity and no mortality. This is the highest volume series of combined robotic pelvic floor reconstruction in the literature and demonstrates a low complication rate and short length of stay.
Efficacy of Jiao's scalp acupuncture in combination with Xiangshao granules on chronic tension-type headache with concomitant nonalcoholic fatty liver disease in climacteric women
Authors: Pei Feng , Hu Wei-Jia , Zhao Yu-Liang 
Published: October 2023

Abstract

Objective
This study aimed to assess the efficacy of Jiao's scalp acupuncture in combination with Xiangshao granules on chronic tension-type headache (CTTH) with concomitant nonalcoholic fatty liver disease (NAFLD) in climacteric women.

Methods
In this study, we enrolled 150 climacteric women with CTTH and concomitant NAFLD. The participants were divided into three groups based on the random number table: medication group, acupuncture group, and acupuncture-medication group. Treatment continued for 2 months. The efficacy of CTTH was assessed based on the visual analog scale/score (VAS). The influence on NAFLD was assessed based on body mass index (BMI), controlled attenuation parameter (CAP), and the ratio of hepatic-splenic computed tomography (CT) value. The Participant Health Questionnaire-9 (PHQ-9) score was compared among the three groups.

Results
A total of 123 participants completed the trial, including 37 participants in the medication group, 41 participants in the acupuncture group, and 45 participants in the acupuncture-medication group. Results are summarized hereinafter. (1) The total clinical efficiency rates of the medication group, acupuncture group, and acupuncture-medication group were 89.19% (33 of 37), 90.24% (37 of 41), and 95.65% (44 of 46), respectively. (2) Except for the BMI of the medication group (P = 0.063), a significant difference in VAS, BMI, CAP, the ratio of hepatic-splenic CT value, and PHQ-9 score was found in the three groups (P < 0.01). (3) There was a significant difference in VAS, BMI, CAP, and PHQ-9 among the three groups (P < 0.01), with those in the acupuncture-medication group being superior. No difference in the ratio of hepatic-splenic CT value was found (P = 0.440). (4) The efficacy differed significantly among the three groups (χ
2 = 8.130, P = 0.017), and it was significantly superior in the acupuncture-medication group (P = 0.008, P = 0.013).

Conclusions
Jiao's scalp acupuncture, in combination with Xiangshao granules, was superior in treating CTTH in climacteric women compared with either acupuncture or medication. Jiao's scalp acupuncture, in combination with Xiangshao granules, was superior in subsiding the negative moods in participants with CTTH and concomitant NAFLD.
Exploration of the association between menopausal symptoms, gastrointestinal symptoms, and perceived stress: survey-based analysis
Authors: Brimienė Ieva , Šiaudinytė Monika , Burokas Aurelijus , Grikšienė Ramunė 
Published: October 2023

Abstract

Objective
The study aimed to evaluate the relationship between menopausal symptoms, gastrointestinal symptoms, and experienced stress in women from premenopause to postmenopause.

Methods
We conducted a cross-sectional study using an anonymous survey that included questions on demographics, health (gynecological, gastrointestinal), and lifestyle (physical activity, sleep, etc) factors, the Perceived Stress Scale (PSS), and the Menopause-Specific Quality of Life Questionnaire (MENQOL).

Results
Data of 693 participants aged 50.1 ± 3.2 years were analyzed. We found that the MENQOL total score increased depending on the stages of reproductive aging (P < 0.001) and positively correlated with PSS scores (r = 0.47, P < 0.001). Age, reproductive stage, body mass index (BMI), PSS score, diagnosis of depression or anxiety disorder, physical activity, and frequency of defecation appeared to have significant association with the total MENQOL score (P < 0.05). The analysis within separate MENQOL domains revealed that PSS score and diagnosis of depression or anxiety disorder were associated with higher scores in all MENQOL domains (P < 0.05) except sexual. Physical activity and the values of the Bristol stool form scale were related to the vasomotor items (P < 0.05). The frequency of defecation was an independent contributor to the psychosocial and sexual domains (P < 0.05). BMI, physical activity, and frequency of defecation were associated with physical symptoms (P < 0.05).

Conclusions
Perceived stress and some gastrointestinal symptoms in women were associated with menopausal symptoms. Reproductive stages, physical activity, BMI, and previously diagnosed depression or anxiety disorder were related to the intensity of menopausal symptoms. However, further research is needed to confirm the relationship between stress, gastrointestinal, and menopausal symptoms.
Implementing a Discharge Follow-up Phone Call Program Reduces Readmission Rates in an Integrated Health System
Authors: Lukanski Amy , Watters Shelley , Bilderback Andrew L. , Buchanan Dan , Hodges Jacob C. , Burwell David , Triola Amy , Marroquin Oscar C. , Martin Susan C. , Zapf Rachel L. , Kip Paula L. , Minnier Tami E. 
Published: October 2023

ABSTRACT
In this study, we sought to determine the effect of implementing a large-scale discharge follow-up phone call program on hospital readmission rates. Previous work has shown that patients with unaddressed concerns during discharge have significantly higher rates of care complications and hospital readmissions. This study is an observational quality improvement project completed from April 17, 2020 to January 31, 2022 at 22 hospitals in a large, integrated academic health system. A nurse-led scripted discharge follow-up phone call program was implemented to contact all patients discharged from inpatient care within 72 hours of discharge. Readmission rates were tracked before and after project implementation. Over a 21-month span, 137,515 phone calls were placed, and 57.92% of patients were successfully contacted within 7 days of discharge. The 7-day readmission rate for contacted patients was 2.91% compared with 4.73% for noncontacted patients. The 30-day readmission rate for contacted patients was 11.00% compared with 12.17% for noncontacted patients. We have found that discharge follow-up phone calls targeting patients decreases risk of readmission, which improves overall patient outcomes.
Hospital Adaptions to Mitigate the COVID-19 Pandemic Effects on MARQUIS Toolkit Implementation and Sustainability
Authors: Rhoten Bethany , Jones Abigail C. , Maxwell Cathy , Stolldorf Deonni P. 
Published: October 2023

ABSTRACT

Objective:
To explore the perceived effects of COVID-19 on MARQUIS toolkit implementation and sustainability, challenges faced by hospitals in sustaining medication reconciliation efforts, and the strategies used to mitigate the negative effects of the pandemic.

Data Sources and Study Settings:
Primary qualitative data were extracted from a Web-based survey. Data were collected from hospitals that participated in MARQUIS2 (n = 18) and the MARQUIS Collaborative (n = 5).

Study Design:
A qualitative, cross-sectional study was conducted.

Data Collection/Data Extraction:
Qualitative data were extracted from a Research Electronic Data Capture survey databased and uploaded into an Excel data analysis template. Two coders independently coded the data with a third coder resolving discrepancies.

Principal Findings:
Thirty-one team members participated, including pharmacists (n = 20; 65%), physicians (n = 9; 29%), or quality-improvement (QI) specialists (n = 2; 6%) with expertise in medication reconciliation (MedRec) (14; 45%) or QI (10; 32%). Organizational resources were limited, including funding, staffing, and access to pharmacy students. To support program continuation, hospitals reallocated staff and used new MedRec order sets. Telemedicine, workflow adaptations, leadership support, QI team involvement, and ongoing audits and feedback promoted toolkit sustainability.

Conclusions:
COVID-19 affected the capacity of hospitals to sustain the MARQUIS toolkit. However, hospitals adapted various strategies to sustain the toolkit.
Impact of an STI Diagnosis on People Living With HIV in La Romana, Dominican Republic: A Cross-Sectional, Qualitative, Descriptive Study
Authors: Sanabria Gabriella , Stonbraker Samantha , Bateman Mark , Halpern Mina , Amesty Silvia 
Published: October 2023

Abstract
The objective of this study was to explore how receiving a sexually transmitted infection (STI) diagnosis affects subsequent STI knowledge and sexual risk behavior among key populations in La Romana, Dominican Republic (DR) who participated in a parent study 12 to 24 months before the current study. Nine participants, with a mean age of 37 years (range 20-54 years) and a female majority (89%), who were recruited from the parent study completed in-depth interviews, questionnaires assessing STI knowledge, and received STI testing. Interviews were analyzed using qualitative descriptive methodology and questionnaire data, comparing individual's responses between the parent and current studies. Participants reported safer sexual behaviors after original STI diagnosis, such as more frequent condom use. Questionnaires showed improvement in STI knowledge between the parent and current studies. Three participants had an STI reinfection. Findings warrant further exploration into more comprehensive and targeted STI treatment methods for key populations in the DR.
Weight bias reduction intervention among nurse practitioner students using simulation-based experiences
Authors: Oliver Tracy L. , Burrell Sherry A. , Furman Gail E. , Diewald Lisa K. , Mariani Bette , Starck Megan R. , Shenkman Rebecca 
Published: October 2023

ABSTRACT
Few nurse practitioner (NP) programs include obesity and weight bias education in their curriculum. However, NPs will likely provide care for people living with obesity, many of whom have been discriminated against based on their weight by previous providers, and many NP students may feel unprepared to navigate weight management competently. This pilot study included a weight bias reduction (WBR) intervention, which included a simulation-based experience (SBE) with a standardized participant (SP) and educational activities embedded within the NP curriculum. Nineteen NP students participated in this pilot study, but only seven students had matching data for preintervention to postintervention scores. There were no statistically significant differences in preintervention and postintervention Attitudes Toward Obese Persons (ATOP) or Beliefs About Obese Persons (BAOP) scores. Despite this small sample size and not achieving statistical significance, SBE-SP holds promise to depict realistic patient encounters to improve NPs' attitudes and beliefs toward persons with obesity and to reduce weight bias. Therefore, incorporating SBE-SP may be a feasible component of the NP curriculum.
Follow-Up After PICU Discharge for Patients With Acquired Brain Injury: The Role of an Abbreviated Neuropsychological Evaluation and a Return-to-School Program*
Authors: Williams Cydni N. , Hall Trevor A. , Baker Victoria A. , Chertow Daniel J. , Vanderlind W. Michael , Bosworth Christopher C. , Hartman Mary E. 
Published: October 2023

OBJECTIVES:
To present the results of an abbreviated testing protocol used to screen for neurocognitive and psychological sequelae of critical illness among PICU survivors with acquired brain injury in our post-discharge follow-up programs and describe our process for facilitating this population’s return to academic life.

DESIGN:
Retrospective cohort study.

SETTING:
Neurocritical care follow-up programs at two U.S. academic, tertiary medical/surgical PICUs.

PATIENTS:
Children greater than 4 years old enrolled in the neurocritical care follow-up programs (n = 289) at these institutions who underwent neurocognitive and psychological testing between 2017 and 2021.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
One month after discharge from the hospital, nearly half of the children and/or their parents (48%) in our neurocritical care follow-up programs identified some type of emotional or behavioral concern compared to their premorbid state, and 15% reported some type of cognitive concern. On evaluation, 35% of the children were given a new neurocognitive diagnosis. Neurocognitive domains regulated by the executive functioning system were the most commonly affected, including attention (54%), memory (31%), and processing speed (27%). One-quarter of the children were given a new psychological diagnosis, most commonly post-traumatic stress disorder or stress-related symptoms (12%). Over 80% of patients in the programs were given new recommendations for school, for both new academic services and new classroom accommodations. Over half of children (57%) were referred for comprehensive follow-up neuropsychological evaluation.

CONCLUSIONS:
Abbreviated neurocognitive and psychological evaluation successfully identifies the same deficits commonly found among PICU survivors who undergo longer, more complete testing protocols. When combined with services aimed at successfully reintegrating PICU survivors back to school, this focused evaluation can provide an effective and efficient means of screening for cognitive and emotional deficits among PICU survivors and establish a rationale for early academic support upon the child’s return to school.