bluuebunny/crossref_metadata_2025_split huggingface dataset:
Estimated mortality with early empirical antibiotic coverage of methicillin-resistant Staphylococcus aureus in hospitalized patients with bacterial infections: a systematic review and meta-analysis
Authors: Carey George B , Holleck Jürgen L , Ein Alshaeba Samer , Jayakrishnan Ritujith , Gordon Kirsha S , Grimshaw Alyssa A , Gunderson Craig G 
Published: March 2023

Abstract

Objectives
We performed a systematic review and meta-analysis to estimate the effect of early active empirical antibiotics for MRSA on mortality, both in patients admitted with MRSA infections and in patients admitted with common infectious syndromes, for whom the causative pathogen may not have been MRSA.

Methods
A systematic literature search was conducted using Embase, MEDLINE, PubMed, Web of Science, Cochrane, Scopus and Google Scholar from the earliest entry through to 26 April 2022. We included studies of patients hospitalized with culture-proven MRSA infections that compared mortality rates depending on whether patients received active empirical antibiotics. The primary outcome was the adjusted OR for mortality with early active empirical antibiotics. After performing random-effects meta-analysis, we estimated the absolute risk reduction in mortality with initial empirical MRSA coverage for common infectious syndromes based on the prevalence of MRSA and baseline mortality rate for each syndrome, as reported in the medical literature.

Results
Of an initial 2136 unique manuscripts, 37 studies (11 661 participants) met our inclusion criteria. Fifteen studies (6066 participants) reported adjusted OR of mortality. The pooled adjusted OR for mortality was 0.64 (95% CI, 0.48–0.84), favouring active empirical antibiotics. The estimated absolute mortality benefit was 0% for patients with pneumonia, 0.1% (95% CI, 0.04–0.2) for non-critically ill patients with soft tissue infections, 0.04% (95% CI, 0.01–0.05) for non-critically ill patients with urinary tract infections, 0.6% (95% CI, 0.2–1.0) for patients with septic shock, and 1.0% (95% CI, 0.3–1.4) for patients with catheter-related infections admitted to ICUs.

Conclusions
For the three most common infections in the hospital, the absolute benefit on mortality of empirical antibiotics against MRSA is 0.1% or less. Meaningful benefit of empirical antimicrobials against MRSA is limited to patients with approximately 30% mortality and 10% prevalence of MRSA. Avoiding empirical antibiotics against MRSA for low-risk infections would substantially reduce the use of anti-MRSA therapy.
I’m Suffocating
Authors: Bell Daniel 
Published: March 2023

Abstract
Dyspnea is an uncomfortable abnormal awareness of breathing and hails as one of the most frightening sensations for patients to experience and one that is distressing to not only the patient but families, lay caregivers and professional caregivers. Whether in the context of known life-threatening illness, benign illness, or undifferentiated illness, dyspnea has a significant impact on well-being and deserves prompt efforts at alleviation. Dyspnea may be acute or chronic and can have a significant negative impact on quality of life and well-being in serious illness. Given the many mechanisms of dyspnea, applying a multimodal approach involving pharmacological, nonpharmacological, and mechanical therapeutic options can prove synergistic to both disease-modifying care and symptomatic relief.
All Stopped Up
Authors: Brachman Laura 
Published: March 2023

Abstract
There are a number of palliative devices and therapies employed in advanced illness to alleviate symptoms and improve quality of life. The decision to use these devices is inextricably related to goals of care (GOC). These goals are usually met when the devices work well. However, if a complication arises, the patient may present to the emergency department. While a simple intervention may allow the patient to return home with the device intact, on occasion a revisiting of GOC and whether they are being met may be indicated. This chapter will present a road map for evaluating how to proceed in the face of malfunction of a number of devices commonly used in palliative care. Sometimes a straightforward intervention will allow the patient to return home on the same path, while other times, particularly if goals are not being met, a different way forward must be considered.
Endotracheal Tube Selection
Authors: Horvath Balazs , Kloesel Benjamin 
Published: March 2023

Abstract
Endotracheal tube selection not only is determined by several factors that are related to the developmental stage of the pediatric patient, but also is influenced by both coexisting pathology and the type of the planned intervention. As the understanding of the pediatric airway anatomy changed, cuffed endotracheal tubes were introduced to a much younger patient population, including neonates. However, it has remained important to select the right size tube for age and airway anatomy, and specialized high-volume/low-pressure cuffed endotracheal tubes must be considered for pediatric patients. This chapter reviews the fundamentals of proper endotracheal tube selection for neonates, infants, and children.
Warming Devices
Authors: Brzozowski Eric , Ohliger Shelley 
Published: March 2023

Abstract
Temperature monitoring and regulation are necessary for any general or regional anesthetic lasting longer than 30 minutes to avoid perioperative hypothermia. This chapter discusses methods of heat transfer and warming devices that are frequently used by anesthesia providers to improve temperature control, specifically in the pediatric patient. Commonly used methods of temperature regulation include insulation, forced air warmers, radiant warmers, intravenous fluid warmers, water mattresses, airway heating and humidification, and cardiopulmonary bypass. The risks, benefits, and efficiency of various warming devices are discussed. By the end of this chapter, anesthesia providers will have a better understanding of mechanisms used to regulate temperature in the perioperative setting.
Agents, Techniques, and Mapleson Circuits
Authors: Sinton Jamie W. 
Published: March 2023

Abstract
Children have very elastic blood vessels, higher body water content, shorter stature, and therefore lower blood pressure due to the effects of scaling. The hemodynamic effects of inhaled, intravenous, and awake spinal anesthetics are examined. Children often undergo induction of general anesthesia via inhalation with sevoflurane. However, some populations of children either require or benefit from total intravenous anesthesia (TIVA), either entirely or thereafter. This chapter explains some details regarding differences in hemodynamic effect and the side-effect profile for inhaled anesthetic versus TIVA. Next, anesthetic drug effects are discussed in the context of how they differ from effects in adults.
Otolaryngology
Authors: Ford Timothy , Abd-Elsayed Alaa 
Published: March 2023

Abstract
Pediatric otolaryngology procedures constitute a diverse set of procedures, each with different degrees of invasiveness and special anesthetic considerations. Patients undergoing otolaryngologic surgery can have potentially life-threatening upper airway obstruction or have severe pulmonary insufficiency requiring diagnostic or therapeutic procedures. Even in patients without life-threatening pathology, common to the majority of these surgical procedures is their proximity to the airway, requiring the pediatric anesthesiologist to develop strategic approaches to mitigate the risk of perioperative airway complications.
Neurosurgery
Authors: Latin Itamar , Rubin Kasia 
Published: March 2023

Abstract
Children undergoing pediatric neurosurgical procedures require specific evaluation of the complex disease pathologies leading up to the procedure in addition to the standard process utilized for any complex surgery, including airway evaluation, laboratory panels, birth history, family history, and NPO (nothing by mouth, fasting) status. The preoperative evaluation for a craniotomy must bear in mind why the cranial vault needs entering. The acuity of symptom onset and extent of symptoms is of primary concern. Both craniotomy and hydrocephaly assessment include the need for examination of the intracranial pressure. Intraoperative management for pediatric neurosurgical cases is based on the underlying pathology and understanding of these processes. Postoperative care goals are similar to the adult population, maintaining neurologic stability as much as possible while providing appropriate analgesia and hemodynamic stability.
Thoracic Surgery
Authors: Lazar Alina 
Published: March 2023

Abstract
Lung isolation is challenging in children. It is usually accomplished by advancing the endotracheal tube into the nonsurgical mainstem bronchus or using a bronchial blocker or double-lumen tumen, the latter being reserved for older children. Common complications of single-lung ventilation are hypoxia, hypercarbia, loss of lung isolation, and airway obstruction. The management of postoperative pain in patients with pectus excavatum undergoing a Nuss procedure is difficult. Various anesthetic techniques have been used, including multimodal analgesia and regional blocks. Anterior mediastinal tumors can cause severe airway and vascular compression, which are exacerbated by general anesthesia, particularly in children. Tumor biopsy using a local anesthetic technique is preferable, if possible. General anesthesia should be undertaken only after a thorough preoperative assessment. Maintenance of spontaneous respiration during anesthesia, airway stenting with a rigid bronchoscope, and changing the patient’s position in case of cardiopulmonary decompensation are important elements of anesthesia planning.
Pediatric Sedation
Authors: Rubin Kasia 
Published: March 2023

Abstract
Sedation allows a child to be more relaxed during a medical procedure and will likely not have any memories of the procedure. Painful procedures require analgesia as well. Common procedures for which pediatric patients request sedation include cardiac catheterization, interventional or diagnostic radiology, dental procedures, gastroendoscopy, and short painful procedures, including dressing changes or other wound care. There are different levels of sedation that may allow a child to be conscious and relaxed or asleep, but maintain a patent airway. Sedation of children is often different from that of adults, as a child’s ability to control his or her own behavior is very different from of an adult, and an increased depth of sedation is necessary to complete a procedure. Most critically, children quickly pass from an intended level of sedation to a deeper level, increasing the possibility of oversedation.
Dystocia, Malposition, and Malpresentation
Authors: Feinstein Diana , Miele Daniella 
Published: March 2023

Abstract
Malposition, malpresentation, and shoulder dystocia are complications affecting the delivery of a fetus. A spontaneous vaginal delivery ideally occurs with the fetus in a head-down and flexed position and the occiput anterior. This position is beneficial as it minimizes the fetal head diameter and puts the body in an optimal position to pass through the maternal pelvis. Deviation from this positioning complicates the delivery. Fetal malposition describes a rotated fetus and increases maternal and fetal complications. Malpresentation is a noncephalic or nonvertex fetal position. Breech position is the most common malpresentation, and most often leads to a cesarean section delivery. A shoulder dystocia is an obstetrical emergency and increases the risk of fetal and maternal morbidity.
Trial of Labor After Cesarean Delivery
Authors: Al-Jindi Piotr , Hussain Nasir 
Published: March 2023

Abstract
Trial of labor after a previous cesarean (TOLAC) delivery is proposed to meet patients’ needs and decrease maternal mortality compared with repeated cesarean section. TOLAC provides an option for the delivering mother to experience a vaginal delivery. However, this risk is higher if the TOLAC fails, and cesarean section is required after the TOLAC. TOLAC carries around a 1% risk of uterine rupture. The most sensitive sign of uterine rupture is fetal bradycardia, detected by fetal heart tone monitoring. Epidural analgesia does not delay the diagnosis of uterine rupture. Uterine rupture is an obstetric emergency, and efforts should concentrate on resuscitation while the patient is prepared for emergency laparotomy.
Chemical and Biological Warfare
Authors: Horoszczak Cassian , Watt Stacey 
Published: March 2023

Abstract
Chemical and biological warfare agents pose as major health threats in not only modern warfare, but also their potential use in domestic terrorism. Chemical warfare agents can be categorized into toxic agents (which includes nerve agents and cyanide salts), incapacitating agents, and incendiary/burn-causing agents. Nerve agents function as anticholinesterase inhibitors, causing a cholinergic toxidrome, which is treated with atropine and pralidoxime following exposure. Cyanide inactivates cytochrome oxidase, resulting in cellular anoxia and is treated with a first-line combination of sodium thiosulfate and hydroxocobalamin. The Centers for Disease Control and Prevention categorizes bioagents with the potential for bioterrorism use into three categories. Category A includes high-priority agents that pose a risk to national security; these include anthrax, botulism, plague, smallpox, tularemia, and viral hemorrhagic fever. Categories B and C include mid-to-lower priority agents with potential for major health impacts.
Organ Donors and Procurement
Authors: Gyorfi Michael J. , Abd-Elsayed Alaa 
Published: March 2023

Abstract
Organ donation can be broken down by the type of donor. The majority of organs are procured after neurologic death (brain death). Organs can also be donated after circulatory death and even from living donors. Each method of donation has various physiologic derangements and challenges that must be overcome to preserve the organ for a successful donation. The need for organs vastly outnumbers the available organs for donation. Standardized criteria for donation and management have been shown to increase the quality and the number of suitable grafts. Communication between the surgical team and anesthesiologist is paramount for optimizing organ survival.
Medication Errors
Authors: Hanna Joseph Salama , Saad Ramsey 
Published: March 2023

Abstract
Adverse drug events (ADEs) comprise the largest single category of adverse events experienced by hospitalized patients, accounting for about 19% of all injuries. At least a quarter of all medication-related injuries are preventable. Preventable ADEs include errors made by the clinician and systematic errors. The occurrence of ADEs is associated with increased morbidity and mortality, prolonged hospitalizations, and higher costs of care. A medication error is any mistake in the intended use of a medication (e.g., wrong medication, wrong dose, or infusion of the wrong medication into the wrong place, as with a connection error). The perioperative period is a high-risk setting for such errors. This chapter reviews the basic definitions of medication errors as well as methods used for detection and prevention.
Crisis Management and Teamwork
Authors: Lagrew Mollie K. , Giordano Christopher 
Published: March 2023

Abstract
Anesthesiology was the first medical specialty to adopt and apply the concept of crisis resource management (CRM), modeled after the aviation industry, with the goal of increasing patient safety by reducing human error. A paradigm shift in education from a focus on technical skills toward incorporating what are now known as nontechnical skills (NTSs) occurred over 30 years ago, equipping anesthesiologists with the necessary tools to handle complex situations. Much of the groundbreaking work for CRM and NTSs in anesthesia was introduced by Gaba and colleagues and further developed by Salas, who explored team cognition and team training requirements that could also be extended to improve healthcare systems. This chapter focuses on some of those foundational tools that can be implemented to improve crisis management and teamwork.
Six Sigma and Lean Operations for the Anesthesiologist
Authors: Curcuru Caitlin N. , Kurian Dinesh J. 
Published: March 2023

Abstract
As specialists in perioperative management, anesthesiologists have a unique set of skills to drive quality improvement in healthcare. Two complementary methods that have been used to improve many aspects of healthcare are Six Sigma and Lean. Using a five-phase approach to identify and control sources of variation, Six Sigma operates on the principle that inadequacies in system processes stem from undesirable variation. Six Sigma aims to identify and correct undesired process variation. Lean methodology’s operating principle is that waste is commonly used to cover up process problems. By focusing on eliminating waste, problems can be uncovered and corrected. Lean focuses on eight such sources of waste. Each methodology has a slightly different focus on how to achieve quality improvement. Lean and Six Sigma can be used to direct interventions to improve healthcare delivery, quality, and efficiency.
Barriers to Quality Improvement
Authors: Saad Ramsey , Hanna Joseph Salama 
Published: March 2023

Abstract
Quality improvement has contributed to safety in the operating room over the past few decades. Changes to safety have come from developing fail-safe equipment, advances in engineering, process improvement to minimize the chance of human error, and improvement in communication. Change is not an easy process. This applies to quality improvement as well. Change is a process that involves a change in the culture and team effort on behalf of the entire institution. Barriers may be related to provider, patient, or institutional factors. Quality improvement is a continuous process, and there yet remains to be room for improvement. This chapter outlines the most common challenges to improvement and suggestions to overcome these challenges.
Federal Regulatory Requirements and Quality Payment Programs
Authors: Saad Ramsey , Hanna Joseph Salama 
Published: March 2023

Abstract
The field of anesthesiology has advanced significantly over the past few decades. This has been partly due to various quality improvement measures adopted by various institutions and on a national level as well. There has been a nationwide trend to adjust payments based on quality metrics. This applies to anesthesia as well. The two most common quality payment programs are the Merit-Based Incentive Payment System (MIPS) and an alternative payment model (APM). The anesthesiologist ideally should be familiar with the different payment programs as there may be a direct financial impact related to the metrics. This chapter outlines the different quality payment programs and how these can affect providers in the field of anesthesiology.
Skin cancers
Authors: Ajithkumar Thankamma 
Published: March 2023

Abstract
Radiotherapy has an established role in the management of non-melanoma skin cancers. Radiotherapy alone is curative in early-stage disease basal cell and squamous cell carcinoma, whereas it is used in combination with surgery in patients with advanced disease. In early-stage disease, the choice between radiotherapy and surgery depends on careful consideration of cosmetic and functional outcomes and patient preference. This chapter discusses the features of different types of skin cancers, the role of radiotherapy, and practical details on radiotherapy planning. It also summarizes the evidence underpinning current clinical practice. The radiotherapeutic management of Kaposi’s sarcoma, cutaneous angiosarcoma, and keloid is also discussed.
Gynaecological cancers
Authors: Ajithkumar Thankamma 
Published: March 2023

Abstract
Radiotherapy has an established role in the curative, adjuvant, and palliative treatment of cervical cancer. Definitive chemo-radiotherapy is curative in 70-75% of patients with stage IIB and 30-50% of patients with stage III cervical cancer. While surgery is the primary treatment of choice for endometrial cancer, selected patients are considered for adjuvant radiotherapy and a group of patients with medically inoperable early-stage disease are considered for primary radiotherapy. This chapter discusses the clinical and imaging features of different gynaecological cancers, the role of radiotherapy for tumours arising in different sites, and practical details on radiotherapy planning. It also summarizes the evidence underpinning current clinical practice.
Sarcomas
Authors: Ajithkumar Thankamma 
Published: March 2023

Abstract
Sarcomas, which comprise less than 1% of malignant tumours, are heterogeneous cancers with different biology and characteristic genetic abnormalities. The common subtypes of soft tissue sarcoma are leiomyosarcoma, liposarcoma, synovial sarcoma, rhabdomyosarcoma, fibrosarcoma, and malignant peripheral nerve sheath tumours whereas the common types bone sarcomas are Ewing’s sarcoma, osteosarcoma and chondrosarcoma. Radiotherapy has an established role in the management of adult soft-tissue sarcomas, and Ewing’s sarcoma. In other histological subtypes, the role of radiotherapy is individualized. This chapter discusses the clinical and imaging features of different sarcomas, the role of radiotherapy, and practical details on radiotherapy planning. It also summarizes the evidence underpinning current clinical practice.
Neural and behavioural dynamics of the individual and collective self(s)
Authors: Huepe David , Canales-Johnson Andrés , Rivera-Rei Álvaro , Ibanez Agustín , Bekinschtein Tristan A. 
Published: March 2023

ABSTRACTUsually considered as internal representations of self-concepts, the individual-self and the collective-self have been primarily studied in social and personality psychology while the experimental and theoretical advances of the cognitive and neurophysiological mechanisms of these self-representations are poorly understood. Two competing hypotheses emerge to understand their structure: first, each self-representation corresponds to a specific and independent dimension of self-concept and is therefore conceptualized as separate cognitive components and different brain networks are predicted; and second, both “selfs”, collective and individual, are part of the same structure and interdependent, sharing similar networks and showing a hierarchical organization from a core-self. Both perspectives have some support from current theories in social psychology but are still speculative and faintly supported by empirical evidence. To test this, we designed an experiment using sentences that would activate the individual or collective-self representations in 80 healthy right-handed participants. We use reaction times during a decision-making task, in combination with individualism/collectivism scales and characterize the neural dynamics throughout the experiment using event-related potentials and fronto-parietal informational connectivity networks. Participants reacted slower to the collective than individual self conditions and showed differences in neural activity and information Integration level that distinguished between each type of self. More importantly, the neural integration measure representing the core-self (subtraction between individual and collective wSMI) was only associated with the individualism scores but not collectivism, lending further support for the core-self perspective. We interpret that the collective self, in the broader sense, is a part of the self-concept and therefore probably assembled from the core-self.