bluuebunny/crossref_metadata_2025_split huggingface dataset:
Barriers to Organ Donation
Authors: Holthe Erlend , Husby Vigdis S. 
Published: October 2023

Background
An increasing number of patients affected by organ failure can be treated with organ transplantation. The need for organs available for transplantation is critical and patients die while on the transplant list. Intensive care unit (ICU) nurses are essential in facilitating organ donation through their ceaseless bedside care for potential organ donors and their families.

Aims and objectives
The aim of this study was to describe the challenges faced by ICU nurses in the organ donation process.

Design
A descriptive qualitative study design was used.

Method
Semistructured individual interviews of 9 ICU nurses from 1 university hospital were performed. Data were analyzed using Malterud's systematic text condensation.

Results
Three themes describe the core of the results: (1) practical tasks, (2) challenging care for the next of kin, and (3) ethical and emotional challenges.

Conclusions
Practical tasks represent challenges in the organ donation process that are not previously revealed. Actions to address these challenges should be prioritized to promote organ donation. Simulation-based training may optimize practical aspects of the organ donation process and implementation of simulation-based training should be assessed by future research.
Resuscitation Team Members' Perceptions of Supporting Parents During Cardiopulmonary Resuscitation of Children
Authors: Ghavi Arezoo , Hassankhani Hadi , Powers Kelly 
Published: October 2023

Introduction
Supporting parents is a crucial part of family-centered care in pediatric and neonate resuscitation.

Objectives
The aim of this systematic review was to appraise and synthesize studies conducted to determine resuscitation team members' perspectives of support for parents during pediatric and neonate resuscitation.

Methods
The PRISMA model guided the systematic literature search of Google Scholar, PubMed, MEDLINE, CINAHL, Cochrane, and Scopus for studies published until May 2022. The authors independently screened all titles, abstracts, and full-text articles for eligibility. There was agreement about screened articles for inclusion. Full texts of all potentially relevant studies were evaluated for the rigor of the study design, sample, and analysis. This review included quantitative, qualitative, and mixed-methods studies. The quality of evidence across the included studies was assessed using the risk of bias in non-randomized studies of interventions (ROBINS-I) tool as part of GRADE’s (Recommendations Assessment, Development, and Evaluations) certainty rating process.

Results
There were 978 articles located. After reviewing for relevancy, 141 full-text articles were assessed, and 13 articles met criteria and were included in this review (4 quantitative, 7 qualitative, and 2 mixed-methods design). Five themes were revealed to summarize resuscitation team members' perspectives of parental support in pediatric resuscitation: providing information to parents, family facilitator, emotional support, presence of parents during resuscitation, and spiritual and religious support.

Conclusions
The results of this systematic review can be used to improve support for parents by informing the education of resuscitation team members and clarifying policies and guidelines of resuscitation team roles to include support for parents.
A National Survey of Stress and Burnout in Critical Care Nurses
Authors: Villarante Delwin Millan , O'Donoghue Sharon C. , Medeiros Monica , Milton Erin , Walsh Kayley , O'Donoghue Ashley L. , Celi Leo Anthony , Hayes Margaret M. , Dilibero Justin 
Published: October 2023

Background
Critical care nurses (CCNs) experience a higher level of stress and burnout than nurses in other specialties. Approximately 50% of CCNs are mildly stressed, and almost 20% are moderately stressed. Prolonged periods of stress can lead to burnout, which has been shown to have deleterious effects on quality and patient safety.

Objectives
The purpose of this study is to determine the prevalence of burnout among a national sample of CCNs and the association with environmental factors.

Methods
A national survey of CCNs working in the United States was implemented using an exploratory descriptive design. The anonymous survey was developed iteratively according to best practices of survey design. The survey included the Perceived Stress Scale and the Copenhagen Burnout Inventory tool. Pretesting and pilot testing were conducted with CCN specialists, and the survey was revised based on their feedback. An anonymous link was distributed to respondents using convenience sampling through social media and further disseminated via snowball sampling.

Results
Two hundred seventy nurses responded to the survey. The mean (SD) Perceived Stress Scale score in the study population was 18.5 (6.4), indicating moderate stress. The mean (SD) Copenhagen Burnout Inventory score was 61.9 (16.5), indicating moderate burnout. Our study found that the overall health of the work environment was one of the most important factors associated with both stress and burnout.

Conclusions
This study has demonstrated the relationship between the health of the work environment and burnout among CCNs. It is imperative that health care organizations evaluate and implement strategies to optimize the health of the work environment to mitigate burnout and its negative sequelae on the nurse, patient, and system.
Use of Prophylactic High-Dose Statin Therapy to Reduce Contrast-Induced Acute Kidney Injury in Adults Undergoing Acute Coronary Angiography
Authors: Jones Judith E. , Tuite Patricia , Guttendorf Jane 
Published: October 2023

Background
Development of contrast-induced acute kidney injury (CI-AKI) is associated with increased morbidity, mortality, hospital length of stay, and overall health care costs.

Objectives
The purpose of this project was to evaluate a clinical practice change—the addition of high-dose statin therapy to standard renal protection measures—in adults undergoing acute cardiac catheterization procedures and assessing its effect on CI-AKI.

Method
The evaluation was a pretest/posttest descriptive design. Adult patients undergoing acute cardiac catheterization procedures were evaluated for the rate of CI-AKI before (10 months preimplementation, N = 283) and after (10 months postimplementation, N = 286) a recent practice change that added high-dose statin therapy (within 24 hours of dye exposure) to a standard renal protection bundle (intravenous fluids, maximum dye calculations, and avoidance of nephrotoxic medications). Outcomes included the rate of CI-AKI, stage of acute kidney injury, need for new hemodialysis, discharge disposition (alive or died in the hospital), and hospital length of stay.

Results
Patients in the postintervention group that received renal protection bundle with high-dose statin had significantly lower incidence of CI-AKI (10.1% pre vs 3.2% post; P < .001). There were no significant differences in hospital length of stay, need for new hemodialysis, or mortality. Administration of high-dose statin within 24 hours of the cardiac catheterization procedure improved significantly (19.4% pre vs 74.1% post; P < .001). Adherence to all 5 components of the renal bundle improved post intervention (17% pre vs 73.4% post; P < .001).

Discussion
The addition of a high-dose statin in addition to existing renal protective measures in patients with acute cardiac procedures is associated with a decreased incidence of CI-AKI.
Cocaine Nose Correction: A Nonsurgical Approach Using a Novel Hyaluronic Acid Filler
Authors: Jalali Arash 
Published: October 2023

Background:
The use of hyaluronic acid (HA) fillers for correcting nasal deformities offers an increasingly popular alternative to surgical rhinoplasty. However, this can sometimes be extremely challenging, for example, in patients with a permanent defect in the nasal septum secondary to chronic drug use.

Methods:
We report a case in which nonsurgical intervention with a high G’ HA filler was used therapeutically to improve the permanent nasal disfigurement of an individual with previous long-term drug use (now in remission)

Results:
This approach led to high levels of patient satisfaction and empowerment in her personal and professional life. Despite the high risk in this case, only immediate minor complications were recorded, including temporary edema and ecchymoses, and these resolved spontaneously

Conclusions:
Nonsurgical treatment using an appropriate HA filler may offer a safe and effective option in selected patients with nasal deformities resulting from pathological conditions.
A Novel Approach to Intraluminal Mitomycin C Instillation for Treatment of High Grade Nonmuscle Invasive Upper Tract Urothelial Carcinoma
Authors: Ellis Elizabeth , Messing Edward 
Published: October 2023

Abstract

Introduction and Objective:
We present a novel technique for intrapelvicalyceal mitomycin C (MMC) instillation mixed with a contrast agent for treatment of high-grade nonmuscle invasive upper tract urothelial carcinoma in patients in whom nephroureterectomy would render them dialysis-dependent.

Methods:
After incomplete endoscopic resection, the patient underwent 3 intrapelvicalyceal instillations of MMC mixed with iopamidol, each 2 weeks apart.

Results:
Treatment has had a durable response for over 2 years after treatment.

Conclusions:
Intraluminal MMC mixed with iopamidol is an approach which helps to avoid pyelovenous backflow and provides visual confirmation that the drug is in adequate contact with the tumor.
Bone health in children undergoing solid organ transplantation
Authors: Pinto Bianca , Muzumdar Radhika , Hecht Baldauff Natalie 
Published: October 2023

Purpose of review
Pediatric solid organ transplant recipients are a unique and growing patient population who are at risk for metabolic bone disease both before and after transplantation.

Recent findings
The odds of sustaining a fracture in adulthood are significantly higher if an individual has sustained at least one childhood fracture, therefore, close monitoring before and after transplant is essential. Emerging data in patients with chronic kidney disease mineral and bone disorder (CKD-MBD) and hepatic osteodystrophy highlights the role of fibroblast growth factor 23 in the pathogenesis of metabolic bone disease in these conditions. While dual X-ray absorptiometry (DXA) is the most widely used imaging modality for assessment of bone mass in children, quantitative computer tomography (QCT) is an emerging modality, especially for patients with glucocorticoid-induced osteoporosis.

Summary
Solid organ transplantation improves organ function and quality of life; however, bone mineral density can decline following transplantation, particularly during the first three to six months. Immunosuppressive medications, including glucocorticoids, are a major contributing factor. Following transplant, treatment should be tailored to achieve mineral homeostasis, correct nutritional deficiencies, and improve physical conditioning. In summary, early identification and treatment of metabolic bone disease can improve the bone health status of pediatric transplant recipients as they enter adulthood.

Video abstract

http://links.lww.com/MOP/A71
Critical Care Utilization in Children With Cancer: U.S. Pediatric Health Information System Database Cohort 2012–2021
Authors: Rogerson Colin M. , Rowan Courtney M. 
Published: October 2023

OBJECTIVES:To determine changes in pediatric oncology hospitalizations requiring intensive care over the period 2012–2021.DESIGN:Retrospective study of hospital admission.SETTING:Registry data from 36 children’s hospitals in the U.S. Pediatric Health Information Systems database.PATIENTS:Children 18 years or younger admitted to any of 36 hospitals with an oncology diagnosis.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:There were a total of 55,827 unique patients accounted for 281,221 pediatric oncology hospitalizations over the 10-year period, and 16.6% of hospitalizations included admission to the PICU. Hospitalizations and PICU admissions steadily increased over this decade. Between 2012 and 2016, 15.1% of oncology hospitalizations were admitted to the PICU compared with 18.0% from 2017 to 2021 (difference 2.9% [95% CI, 2.6–3.2%]p≤ 0.0001). Support with invasive mechanical ventilation also increased over time with 3.7% during 2012–2016 compared with 4.1% from 2017 to 2021 (difference 0.4% [95% CI, 0.2–0.5%]p≤ 0.0001). Similar results were seen with cardiorespiratory life support using extracorporeal membrane oxygenation (difference 0.05% [95% CI, 0.02–0.07%]p= 0.0002), multiple vasoactive agent use (difference 0.3% [95% CI, 0.2–0.4%]p< 0.0001), central line placement (difference 5.3% [95% CI, 5.1–5.6%],p< 0.001), and arterial line placement (difference 0.4% [95% CI, 0.3–0.4%],p< 0.001). Year-on-year case fatality rate was unchanged over time (1.3%), but admission to the PICU during the second 5 years, compared with the first 5 years, was associated with lower odds of mortality (difference 0.7% [95% CI, 0.3–1.1%]) (odds ratio 0.82 [95% CI, 0.75–0.90%]p< 0.001).CONCLUSIONS:The percentage of pediatric oncology hospitalizations resulting in PICU admission has increased over the past 10 years. Despite the increasing use of PICU admission and markers of acuity, and on comparing 2017–2021 with 2012–2016, there are lower odds of mortality.
Mpox severity and associated hospitalizations among people with HIV and related immunosuppression in Brazil
Authors: Silva Mayara S.T. , Coutinho Carolina , Torres Thiago S. , Peixoto Eduardo M. , Bastos Matheus O. , Mesquita Maira B. , Tavares Isabel C.F. , Andrade Hugo B. , Reges Paula P.S. , Martins Pedro S. , Echeverría-Guevara Amanda , Moreira Ronaldo I. , Lessa Flavia Cristina S. , Hoagland Brenda , Nunes Estevão P. , Cardoso Sandra W. , Veloso Valdilea G. , Grinsztejn Beatriz 
Published: October 2023

Objectives:
This study aimed to analyze characteristics of mpox hospitalization in a Brazilian cohort, further exploring the impact of HIV on mpox-related outcomes and hospitalization.

Design:
We conducted a descriptive analysis, comparing characteristics of individuals diagnosed with mpox according to hospitalization and HIV status, and described the mpox cases among those living with HIV.

Methods:
This was a single-center, prospective cohort study conducted at a major infectious diseases referral center in Rio de Janeiro, Brazil, that enrolled participants older than 18 years of age diagnosed with mpox. Information was collected on standardized forms, including data on sociodemographic, behavioral, clinical and laboratory characteristics. For comparisons, we used chi-squared, Fisher's exact and the Moods median tests whenever appropriate.

Results:
From June to December, 2022, we enrolled 418 individuals diagnosed with mpox, of whom 52% were people with HIV (PWH). PWH presented more frequently with fever, anogenital lesions and proctitis. The overall hospitalization rate was 10.5% (n = 43), especially for pain control. Among hospitalized participants, PWH had more proctitis and required invasive support. Mpox severity was related to poor HIV continuum of care outcomes and low CD4+ cell counts. All deaths (n = 2) occurred in PWH with CD4+ less than 50 cells/μl.

Conclusion:
HIV-related immunosuppression likely impacts mpox clinical outcomes. This is of special concern in settings of poor adherence and late presentation to care related to socioeconomic inequalities, such as Brazil. The HIV continuum of care must be taken into account when responding to the mpox outbreak.
Differentiating Macrovascular and Microvascular Ischemia Using Fractal Analysis of Dynamic Myocardial Perfusion Stress-CT
Authors: Michallek Florian , Nakamura Satoshi , Kurita Tairo , Ota Hideki , Nishimiya Kensuke , Ogawa Ryo , Shizuka Takehito , Nakashima Hitoshi , Wang Yi-Ning , Ito Tatsuro , Sakuma Hajime , Dewey Marc , Kitagawa Kakuya 
Published: October 2023

Objectives
Fractal analysis of dynamic myocardial stress computed tomography perfusion imaging (4D-CTP) has shown potential to noninvasively differentiate obstructive coronary artery disease (CAD) and coronary microvascular disease (CMD). This study validates fractal analysis of 4D-CTP in a multicenter setting and assesses its diagnostic accuracy in subgroups with ischemia and nonobstructed coronary arteries (INOCA) and with mild to moderate stenosis.

Materials and Methods
From the AMPLIFiED multicenter trial, patients with suspected or known chronic myocardial ischemia and an indication for invasive coronary angiography were included. Patients underwent dual-source CT angiography, 4D-CTP, and CT delayed-enhancement imaging. Coronary artery disease, CMD, and normal perfusion were defined by a combined reference standard comprising invasive coronary angiography with fractional flow reserve, and absolute or relative CT-derived myocardial blood flow. Nonobstructed coronary arteries were defined as ≤25% stenosis and mild to moderate stenosis as 26%–80%.

Results
In 127 patients (27% female), fractal analysis accurately differentiated CAD (n = 61, 23% female), CMD (n = 23, 30% female), and normal perfusion (n = 34, 35% female) with a multiclass area under the receiver operating characteristic curve (AUC) of 0.92 and high agreement (multiclass κ = 0.89). In patients with ischemia (n = 84), fractal analysis detected CAD (n = 61) over CMD (n = 23) with sensitivity of 95%, specificity of 74%, accuracy of 89%, and AUC of 0.83. In patients with nonobstructed coronary arteries (n = 33), INOCA (n = 15) was detected with sensitivity of 100%, specificity of 78%, accuracy of 88%, and AUC of 0.94. In patients with mild to moderate stenosis (n = 27), fractal analysis detected CAD (n = 19) over CMD with sensitivity of 84%, specificity of 100%, accuracy of 89%, and AUC of 0.95.

Conclusions
In this multicenter study, fractal analysis of 4D-CTP accurately differentiated CAD and CMD including subgroups with INOCA and with mild to moderate stenosis.
SARS-CoV-2 N protein-induced Dicer, XPO5, SRSF3, and hnRNPA3 downregulation causes pneumonia
Authors: Luo Yu-Wei , Zhou Jiang-Peng , Ji Hongyu , Zheng Anqi , Wang Xin , Dai Zhizheng , Luo Zhicheng , Cao Fang , Wang Xing-Yue , Bai Yunfang , Chen Di , Chen Yueming , Wang Qi , Yang Yaying , Zhang Xinghai , Chiu Sandra , Huang Ai-Long , Tang Kai-Fu 
Published: October 2023

AbstractAge is a major risk factor for coronavirus disease (COVID-19)-associated severe pneumonia and mortality; however, the underlying mechanism remains unclear. Herein, we investigated whether age-related deregulation of RNAi components and RNA splicing factors affects COVID-19 severity. Decreased expression of RNAi components (Dicer and XPO5) and splicing factors (SRSF3 and hnRNPA3) correlated with increased severity of COVID-19 and SARS-CoV-2 nucleocapsid (N) protein-induced pneumonia. N protein induced autophagic degradation of Dicer, XPO5, SRSF3, and hnRNPA3, repressing miRNA biogenesis and RNA splicing and inducing DNA damage, proteotoxic stress, and pneumonia. Dicer, XPO5, SRSF3, and hnRNPA3 were downregulated with age in mouse lung tissues. Older mice experienced more severe N protein-induced pneumonia than younger mice. However, treatment with a poly(ADP-ribose) polymerase inhibitor (PJ34) or aromatase inhibitor (anastrozole) relieved N protein-induced pneumonia by restoring Dicer, XPO5, SRSF3, and hnRNPA3 expression. These findings will aid in developing improved treatments for SARS-CoV-2-associated pneumonia.
Utilizing an acute hyperthermia-induced seizure test and pharmacokinetic studies to establish optimal dosing regimens in a mouse model of Dravet syndrome
Authors: Mensah Jeffrey A. , Johnson Kristina , Freeman Tia , Reilly Christopher A. , Rower Joseph E. , Metcalf Cameron S. , Wilcox Karen S. 
Published: October 2023

AbstractObjectiveThe current standard of care for Dravet Syndrome includes polytherapy after inadequate seizure control with one or more monotherapy approaches. Treatment guidelines are often based on expert opinions, and finding an optimal balance between seizure control and adverse drug effects can be challenging. This study utilizes efficacy and pharmacokinetic analysis of a second-line treatment regimen that combines clobazam and sodium valproate with an add-on drug as a proof-of-principle approach to establish an effective therapeutic regimen in a preclinical mouse model of Dravet Syndrome.MethodWe evaluated the efficacy of add-on therapies stiripentol, cannabidiol, lorcaserin, or fenfluramine to clobazam and sodium valproate against hyperthermia-induced seizures inScn1aA1783V/WTmice. Clobazam, N-desmethyl clobazam (an active metabolite of clobazam), sodium valproate, stiripentol, and cannabidiol concentrations were quantified in plasma and brain using liquid chromatography-tandem mass spectrometry for the combinations deemed effective against hyperthermia-induced seizures. The concentration data were used to calculate pharmacokinetic parameters via non-compartmental analysis in Phoenix WinNonLin.ResultsHigher doses of stiripentol or cannabidiol, in combination with clobazam and sodium valproate, were effective against hyperthermia-induced seizures inScn1aA1783V/WTmice. InScn1aWT/WTmice, brain clobazam and N-desmethyl clobazam concentrations were higher in the triple-drug combinations than in the clobazam monotherapy. Stiripentol and cannabidiol brain concentrations were greater in the triple-drug therapy than when given alone.InterpretationA polypharmacy strategy may be a practical preclinical approach to identifying efficacious compounds for Dravet Syndrome. The drug-drug interactions between compounds used in this study may explain the potentiated efficacy of some combination therapies.Graphical AbstractKey findingsThe hyperthermia-induced seizure assay inScn1aA1783V/WTmice can identify efficacious antiseizure medications. A triple-drug administration paradigm was designed that mimics clinical standards for add-on therapies in DS. Stiripentol and cannabidiol were effective against hyperthermia-induced seizures when co-administered with clobazam and sodium valproate. Potential drug-drug interactions between compounds may explain the potentiated antiseizure effect in triple-drug therapies. The triple-drug “add-on” therapy approach may be a valuable preclinical strategy for screening investigational compounds for DS, an assay offered at the ETSP.