bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of Early Versus Late Tracheostomy in Patients With COVID-19: A Multinational Cohort Study
Authors: Harrell Shreckengost Constance S. , Foianini Jorge Esteban , Moron Encinas Karen Milenka , Tola Guarachi Hugo , Abril Katrina , Amin Dina , Berkowitz David , Castater Christine Aisha , Douglas J. Miller , Grant April A. , Khullar Onkar Vohra , Lane Andrea Nichole , Lin Alice , Niroula Abesh , Nizam Azhar , Rashied Ammar , Reitz Alexandra W. , Roser Steven M. , Spychalski Julia , Arap Sérgio Samir , Bento Ricardo Ferreira , Ciaralo Pedro Prosperi Desenzi , Imamura Rui , Kowalski Luiz Paulo , Mahmoud Ali , Mariani Alessandro Wasum , Menegozzo Carlos Augusto Metidieri , Minamoto Hélio , Montenegro Fábio Luiz M. , Pêgo-Fernandes Paulo Manoel , Santos Jones , Utiyama Edivaldo Massozo , Sreedharan Jithin K. , Kalchiem-Dekel Or , Nguyen Jonathan , Dhamsania Rohan K. , Allen Kerianne , Modzik Adrian , Pathak Vikas , White Cheryl , Blas Juan , Talal El-Abur Issa , Tirado Gabriel , Yánez Benítez Carlos , Weiser Thomas G. , Barry Mark , Boeck Marissa , Farrell Michael , Greenberg Anya , Miller Phoebe , Park Paul , Camazine Maraya , Dillon Deidre , Smith Randi N. 
Published: February 2023

Objectives:
Timing of tracheostomy in patients with COVID-19 has attracted substantial attention. Initial guidelines recommended delaying or avoiding tracheostomy due to the potential for particle aerosolization and theoretical risk to providers. However, early tracheostomy could improve patient outcomes and alleviate resource shortages. This study compares outcomes in a diverse population of hospitalized COVID-19 patients who underwent tracheostomy either “early” (within 14 d of intubation) or “late” (more than 14 d after intubation).

Design:
International multi-institute retrospective cohort study.

Setting:
Thirteen hospitals in Bolivia, Brazil, Spain, and the United States.

Patients:
Hospitalized patients with COVID-19 undergoing early or late tracheostomy between March 1, 2020, and March 31, 2021.

Interventions:
Not applicable.

Measurements and Main Results:
A total of 549 patients from 13 hospitals in four countries were included in the final analysis. Multivariable regression analysis showed that early tracheostomy was associated with a 12-day decrease in time on mechanical ventilation (95% CI, −16 to −8; p < 0.001). Further, ICU and hospital lengths of stay in patients undergoing early tracheostomy were 15 days (95% CI, −23 to −9 d; p < 0.001) and 22 days (95% CI, −31 to −12 d) shorter, respectively. In contrast, early tracheostomy patients experienced lower risk-adjusted survival at 30-day post-admission (hazard ratio, 3.0; 95% CI, 1.8−5.2). Differences in 90-day post-admission survival were not identified.

Conclusions:
COVID-19 patients undergoing tracheostomy within 14 days of intubation have reduced ventilator dependence as well as reduced lengths of stay. However, early tracheostomy patients experienced lower 30-day survival. Future efforts should identify patients most likely to benefit from early tracheostomy while accounting for location-specific capacity.
Organ Donation From Patients on Extracorporeal Membrane Oxygenation at the Time of Death
Authors: Fainberg Nina A. , Morrison Wynne E. , West Sharon , Hasz Richard , Kirschen Matthew P. 
Published: February 2023

OBJECTIVES:
To describe the clinical characteristics and organ donation rate of patients supported by extracorporeal membrane oxygenation (ECMO) at the time of death.

DESIGN:
Retrospective observational study. Pearson chi-square and Fisher exact tests were used in statistical analyses.

SETTING:
One hundred twenty-seven acute care hospitals in New Jersey, Pennsylvania, and Delaware.

PATIENTS:
Adult and pediatric patients who were on ECMO at the time of referral to a large organ procurement organization (OPO) between 2016 and 2020.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Nineteen thousand nine hundred thirty patients were referred to the OPO between November 2016 and September 2020, of which 5,034 were medically suitable potential donors. Of this cohort, 143 patients were supported on ECMO at the time of OPO referral and 141 were included in analyses (median age 47 yr, 60% male). Thirty-three percent (46/141, median age 48 yr, 52% male) donated organs, compared with 50% of non-ECMO patients (p ≤ 0.0005). ECMO and non-ECMO patients had organs recovered but not transplanted at similar rates (11% vs 10%, p = 0.8). There were no significant differences in sex (p = 0.16) or ethnicity (p = 0.50) between organ donor and nondonor groups. Fifty-one percent (21/41) of organ donors donated after circulatory death and 49% (20/41) after brain death. Patients declared dead by neurologic criteria were more likely to donate (51%) than those declared dead by circulatory criteria (21%, p < 0.001). Frequency of cardiac arrest prior to ECMO was similar between donors and nondonors (p = 0.68). Thirty-nine percent (16/41) of donors had an out-of-hospital cardiac arrest (OHCA) and 51% (21/41) were cannulated via extracorporeal cardiopulmonary resuscitation (ECPR). The most common reason patients were not donors was that family declined (57%).

CONCLUSIONS:
One-third of patients referred to the OPO on ECMO at the time of death donated organs. While donation occurred less frequently after ECMO, ECMO and non-ECMO patients had organs used rather than discarded at a similar rate. Patients successfully donated following OHCA and/or ECPR. Clinicians should not consider ECMO a barrier to organ donation.
Nutritional Support in Children Meeting the At-Risk for Pediatric Acute Respiratory Distress Syndrome Criteria
Authors: Pei Theodore T. , Shein Steven L. , Cheifetz Ira M. , Slain Katherine N. 
Published: February 2023

IMPORTANCE:
Pediatric acute respiratory distress syndrome (PARDS) is a prevalent condition in the PICU with a high morbidity and mortality, but effective preventative strategies are lacking.

OBJECTIVES:
To examine associations between early enteral nutrition (EN) and PICU outcomes in a cohort of children meeting the 2015 Pediatric Acute Lung Injury Consensus Conference “at-risk” for pediatric acute respiratory distress syndrome (ARF-PARDS) criteria.

DESIGN, SETTING, AND PARTICIPANTS:
This was a single-center, electronic health record-based retrospective chart review. We included children less than or equal to 18 years-old admitted to our mixed medical-surgical PICU from January 2017 to December 2018 who met ARF-PARDS criteria within 48 hours of admission. Children were categorized as receiving “early” EN if feeds were initiated within 48 hours of admission. All others were categorized as “delayed” EN.

MAIN OUTCOMES AND MEASURES:
Extracted data included demographics, illness characteristics including primary diagnosis and Pediatric Risk of Mortality (PRISM) III score, respiratory support and oxygenation indices, nutritional data, and PICU length of stay (LOS). The primary outcome of interest was subsequent diagnosis of PARDS.

RESULTS:
Of 201 included children, 152 (75.6%) received early EN. The most common admission diagnoses were pneumonia, bronchiolitis, and influenza. Overall, 21.4% (n = 43) of children developed PARDS. Children receiving early EN had a subsequent diagnosis of PARDS less often then children receiving delayed EN (15.1% vs 40.8%; p < 0.001), an association that persisted after adjusting for patient demographics and illness characteristics, including PRISM III and diagnosis (adjusted odds ratio, 0.24; 95% CI, 0.10–0.58; p = 0.002). Early EN was also associated with a shorter PICU LOS in univariate analysis (2.2 d [interquartile range, 1.5–3.4 d] vs 4.2 d [2.7–8.9 d]; p < 0.001).

CONCLUSIONS AND RELEVANCE:
In this single-center, retrospective cohort study, compared with children with ARF-PARDS who received late EN, those who received early EN demonstrated a reduced odds of subsequent diagnosis of PARDS, and an unadjusted reduction in PICU LOS when compared with delayed EN. Prospective studies should be designed to confirm these findings.
Hospital Strain and Variation in Sepsis ICU Admission Practices and Associated Outcomes
Authors: Anesi George L. , Dress Erich , Chowdhury Marzana , Wang Wei , Small Dylan S. , Delgado M. Kit , Bayes Brian , Barreda Fernando X. , Halpern Scott D. , Liu Vincent X. 
Published: February 2023

OBJECTIVES:
To understand how strain-process-outcome relationships in patients with sepsis may vary among hospitals.

DESIGN:
Retrospective cohort study using a validated hospital capacity strain index as a within-hospital instrumental variable governing ICU versus ward admission, stratified by hospital.

SETTING:
Twenty-seven U.S. hospitals from 2013 to 2018.

PATIENTS:
High-acuity emergency department patients with sepsis who do not require life support therapies.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
The mean predicted probability of ICU admission across strain deciles ranged from 4.9% (lowest ICU-utilizing hospital for sepsis without life support) to 61.2% (highest ICU-utilizing hospital for sepsis without life support). The difference in the predicted probabilities of ICU admission between the lowest and highest strain deciles ranged from 9.0% (least strain-sensitive hospital) to 45.2% (most strain-sensitive hospital). In pooled analyses, emergency department patients with sepsis (n = 90,150) experienced a 1.3-day longer median hospital length of stay (LOS) if admitted initially to the ICU compared with the ward, but across the 27 study hospitals (n = 517-6,564), this effect varied from 9.0 days shorter (95% CI, –10.8 to –7.2; p < 0.001) to 19.0 days longer (95% CI, 16.7–21.3; p < 0.001). Corresponding ranges for inhospital mortality with ICU compared with ward admission revealed odds ratios (ORs) from 0.16 (95% CI, 0.03–0.99; p = 0.04) to 4.62 (95% CI, 1.16–18.22; p = 0.02) among patients with sepsis (pooled OR = 1.48).

CONCLUSIONS:
There is significant among-hospital variation in ICU admission rates for patients with sepsis not requiring life support therapies, how sensitive those ICU admission decisions are to hospital capacity strain, and the association of ICU admission with hospital LOS and hospital mortality. Hospital-level heterogeneity should be considered alongside patient-level heterogeneity in critical and acute care study design and interpretation.
The Effect of a Home-delivered Protein-rich Meal Service on Quality of Life in Oncological Patients Undergoing Chemotherapy
Authors: IJmker-Hemink Vera E. , Kooijman Nina , Kamm Yvonne J. L. , Koornstra Rutger H. T. , Timmer-Bonte Johanna N. H. , Wanten Geert J. A. , van den Berg Manon G. A. 
Published: February 2023

Background:
Patients undergoing oncological treatment may experience a variety of symptoms that interfere with their ability to eat and enjoy meals. This compromises their nutritional status and impairs quality of life (QOL).

Objective:
Compare a home-delivered protein-rich service as a therapeutic measure to patients undergoing chemotherapy with usual care.

Methods:
Randomized clinical trial enrolling patients (n = 148) receiving chemotherapy. The intervention group received 6 protein-rich dishes per day for 3 weeks, the control group maintained their usual diet. QOL, energy and protein intake, nutritional and functional status, physical performance, symptom burden, and caregiver QOL were assessed.

Results:
No difference in QOL was found between the groups but QOL in the gastrointestinal and gynecological tumor groups increased by 8.4 points (95% confidence interval [CI] 1.0-15.8; P < .05) after the intervention, while scores in other tumor groups did not change. Significant effects were observed in energy intake (21%; 95% CI 10.4-32.1) and Short Physical Performance Battery (0.28; 95% CI 0.2-0.8) in the intervention group.

Conclusions:
In patients with cancer undergoing chemotherapy, a home-delivered protein-rich meal service did not improve QOL for the total group but QOL significantly improved in the subpopulation with abdominal cancer.

Implications for Practice:
Future research should focus on vulnerable patients with a high risk for malnutrition and symptoms, such as gastrointestinal and gynecological malignancies, considering the beneficial results in this subgroup.

Foundational:
A home-delivered protein-rich meal service is feasible in patients with cancer while undergoing chemotherapy. QOL increased in gastrointestinal and gynecological cancer patients receiving this meal service.
Different behaviour of target-controlled infusion pumps despite apparently using the same Schnider pharmacokinetic model
Authors: Soehle Martin , Wolter Andreas , Thudium Marcus , Frede Stilla , Coburn Mark 
Published: February 2023

BACKGROUND
Target-controlled infusion (TCI) pumps deliver an initial bolus of drug to achieve a preset drug target concentration quickly.

OBJECTIVE
We investigated whether differences exist in the initial bolus dose between different TCI pumps despite apparently using the same pharmacokinetic (PK) model.

DESIGN
Observational study.

SETTING
Laboratory data from a German University Hospital. Experiments were performed between February 2019 and September 2020.

PARTICIPANTS
Four TCI pumps set to the Schnider model in effect-site mode with a target propofol concentration of 3.5 μg ml−1 were studied. The algorithms of two pumps employed a fixed equilibration rate constant (k
e0) of 0.456 min−1 (Perfusor® Space® and Injectomat TIVA Agilia®), while the other two used a fixed time to peak concentration (t
peak) of 1.6 min (Alaris® PK and Syramed® μSP6000). Pump performance was assessed on 13 virtual patients with different combinations of age, sex, height and weight: the initial propofol dose injected was measured on a high precision scale.

MAIN OUTCOME MEASURES
Propofol bolus dose, as if delivered for anaesthesia induction.

RESULTS
A small difference in propofol bolus doses was observed for some simulations: for example, 56.4 ± 1.2 and 59.7 ± 0.2 mg with a Syramed μSP6000 and an Alaris pharmacokinetic pump, respectively, in a virtual 54-year old man with a height of 170 cm and a weight of 74 kg. In contrast, significant differences were found in other simulated patients: for example, 72.0 ± 1.0 and 111.9 ± 1.2 mg (P < 0.001) using a Perfusor Space and an Alaris TCI pump in a virtual 60-year-old, obese man with a height of 182 cm and a weight of 139 kg.

CONCLUSIONS
Discrepancies in the initial bolus dose can be explained by differences in k
e0. Anaesthetists should be aware that differences exist in the implementation of the Schnider model between manufacturers, which could lead to disparities in the initial propofol bolus in some patients.
Willingness and associated factors of comprehensive abortion services provision by health care professionals in selected public health facilities of Addis Ababa, Ethiopia
Authors: Sahile Addisu T. , Bekele Getabalew E. , Bibiso Kidist , Gebremariam Zewdu M. 
Published: February 2023

Background:
Globally, abortion-related maternal deaths significantly decreased, but the opposite was true for Sub-Saharan Africa, where there was a significant increment in abortion-related maternal deaths. Health care providers are in constant conflict with the legalization of abortion, for viewing induced abortion as immoral.

Objective:
To assess the willingness and associated factors of comprehensive abortion care among health care professionals in Public health facilities of Bole Sub-City, Addis Ababa, Ethiopia, 2021.

Methods:
An institution-based cross-sectional study was undertaken among 367 health care professionals from April 1 to August 30, 2021. Willingness was measured as willing and not willing, as well as the level of agreement to provide abortion care under justifiable conditions. The data were collected by a structured and pretested self-administered questionnaire. Binary (bivariate and multivariate) logistics regression was used for the identification of predictors of willingness with its respective 95% CI and a P-value of <0.05 statistically significant levels. The finding was presented in texts and tables.

Findings:
A total of 367 study participants were involved in the study giving a response rate of 100%. The overall level of willingness was 42.3% (95% CI: 37.25%–47.35%). Being male [adjusted odds ratio (AOR): 1.987, 95% CI: 1.111–3.551, P<0.05], having a lower weekly religious attendance (AOR: 2.88; 95% CI: 1.687–4.930, P<0.001), and perceiving unsafe abortion as a health problem (AOR: 6.15; 95% CI: 3.79–9.97; P<0.05) were predictors associated with an increased level of willingness.

Conclusions and Recommendations:
A low level of willingness to provide comprehensive abortion was observed in the study. Being male, having a lower religious attendance, and having the perception that unsafe abortion is a health problem were predictors associated with an increased level of willingness to provide comprehensive abortion care. Stakeholders, government, and policymakers were recommended to work on the identified predictors of willingness in the study settings.
Observational analysis of criteria for a difficult airway alert
Authors: Milne Andrew D. , Dobson Gregory R. , Forbes Stewart J. 
Published: February 2023

Introduction:
Difficult airway alerts are a tool used to document difficulties encountered with the patient’s airway and assist with future management. There is no universally accepted criterion as to who should get a difficult airway alert and the indication for these alerts may be changing with the proliferation of videolaryngoscopes. The purpose of this study was to characterize the airway events that were encountered in patients who had been assigned a difficult airway alert by staff anesthesiologists.

Methods:
This retrospective study analyzed the airway details of patients who were assigned a difficult airway letter at an academic teaching institution between November 2011 and January 2016. Electronic records of intraoperative airway management and difficult airway letters were reviewed for the methods used, difficulties encountered, and what recommendations were provided for future airway management.

Results:
A cohort of 107 adult patients (62 males and 45 females) issued difficult airway letters identified for analysis. The mean age (SD) of the cohort was 57 (±13) years, and the mean body mass index was 31 (±7) kg/m2. Direct laryngoscopy failed in 68 of 89 cases, with 77 reported grade III views and 9 grade IV views. Videolaryngoscopy (VL) was used successfully in 63 cases, with 8 documented VL failures. Ten patients were intubated awake with a flexible bronchoscope (FB), and 6 cases were managed using an asleep FB technique. The most common methods suggested for future airway management were VL (57 cases) or either awake or asleep FB (31 cases).

Conclusions:
Patients with difficult direct laryngoscopy were predominant in this cohort who were assigned a difficult airway alert. Many of the difficult airways were successfully managed using VL, however, FB was required in some cases. Staff preferentially recommended VL over flexible bronchoscopy for future management of the known difficult airway.
Multiple Cases of Facial Disfigurement From Filler Use and One Injector
Authors: Parikh Alomi O. , Conger Jordan R. , Sibug Saber Maria E. , Samimi David , Burnstine Michael A. 
Published: February 2023

Purpose:
To present a case of facial disfigurement from an injectable permanent filler and describe the consequences to patients exposed to the same injector (common source outbreak).

Methods:
Case report and discussion of a common source outbreak after a group of persons developed complications years after permanent filler given by one injector.

Results:
A 39-year-old transgender model underwent polymethylmethacrylate (Artefill) facial filler injections to the lips, cheeks, and chin in 2018. A year later, the patient presented to the emergency room with severe facial swelling and difficulty breathing. Treatments have included 4 surgeries to remove filler and scar tissue and chronic low-dose oral steroid therapy. Upon questioning the patient, 6 additional people suffered from similar facial swelling years after injection by the same injector. The injector cannot be located.

Conclusions:
Care must be taken in giving all facial fillers, particularly permanent ones. When one source patient is identified, questioning the patient’s knowledge of others affected is critical to help manage an epidemic problem and to report a rogue injector. Physicians have a duty to investigate and report such cases.
Severity stages of chronic nodular prurigo: analysis of associated itch intensity and quality of life impairment
Authors: Zeidler Claudia , Pereira Manuel P. , Storck Michael , Suer Aysenur , Ständer Sonja 
Published: February 2023

Introduction:
Chronic nodular prurigo (CNPG) is a pruritic neuroinflammatory skin disease characterized by the presence of multiple pruriginous nodules. Previous psychometric analyzes showed the presence of moderate to severe pruritus and a considerable impairment of quality of life. A detailed study of these parameters in relation to the severity of the disease defined by the number of lesions is lacking.

Methods:
A total of 131 adult patients with CNPG were included. The number of pruriginous lesions and disease stage was determined by using the Prurigo Activity and Severity (PAS) scale and the prurigo-specific Investigator’s Global Assessment (IGA) scale. Patient-reported outcomes comprised pruritus intensity (worst itch intensity of the previous 24 h using the numerical rating scale; WI-NRS/24 h) and the impairment of quality of life (ItchyQol, Dermatology Life Quality Index; DLQI).

Results:
The counted and estimated number of pruriginous nodules correlated strongly with each other (r=0.82; P<0.001), moderately with the WI-NRS/24 h (counted number: r=0.44, P<0.001; estimated number: r=0.45, P<0.001) and with the DLQI score (counted number: r=0.40, P<0.001; estimated number: r=0.38, P<0.001). The severity groups of the CNPG, as defined by the IGA scale, correlated strongly with the WINRS/24 h and DLQI scores. With increasing severity of CNPG, increasing pruritus intensity and DLQI/ItchyQoL scores were recorded.

Conclusion:
The correlation between objective (disease stage) and subjective (itch intensity, quality of life) CNPG disease parameters argues for a representative disease severity characterization via physician assessments using either PAS or IGA.