bluuebunny/crossref_metadata_2025_split huggingface dataset:
Topical Intervention of Natural Products Applied in Patients with Pressure Injuries: A Scoping Review
Authors: Ouchi Janaina Daniel , Pereira Regina Mara Silva , Okuyama Cristina Eunice 
Published: February 2023

ABSTRACT

OBJECTIVE
Pressure injuries (PIs) represent a major medical and nursing problem in individuals with decreased or limited mobility. This scoping review aimed to map the controlled clinical trials with topical interventions of natural products applied to patients with PIs and to verify the existence of phytochemical similarities among these products.

DATA SOURCES
This scoping review was developed according to the JBI Manual for Evidence Synthesis. Controlled trials were searched in the following electronic databases from their inceptions until February 1, 2022: Cochrane Central Register of Controlled Trials, EMBASE, PubMed, SciELO, Science Direct, and Google Scholar.

STUDY SELECTION
Studies involving individuals with PIs, individuals treated with topical natural products compared to a control treatment, and outcomes with wound healing or wound reduction were included in this review.

DATA EXTRACTION
The search identified 1,268 records. Only six studies were included in this scoping review. Data were independently extracted using a template instrument from the JBI.

DATA SYNTHESIS
The authors summarized the characteristics of the six included articles, synthesized outcomes, and compared similar articles. Honey and Plantago major dressings were the topical interventions that significantly reduced wound size. The literature suggests that the effect on wound healing of these natural products may be related to the presence of phenolic compounds.

CONCLUSIONS
The studies included in this review show that natural products can positively impact the healing of PIs. However, there are limited controlled clinical trials addressing natural products and PIs in the literature.
Accuracy of Thermographic Imaging in the Early Detection of Pressure Injury: A Systematic Review
Authors: Baron Miriam Viviane , Hernandes Martins Paulo Ricardo , Brandenburg Cristine , Koepp Janine , Reinheimer Isabel Cristina , dos Santos Amanda Corrêa , dos Santos Michele Paula , Mantilla Santamaria Andres Felipe , Miliou Thomas , da Costa Bartira Ercília Pinheiro 
Published: February 2023

ABSTRACT

OBJECTIVE
To verify the accuracy of thermographic images in the early detection of pressure injury (PI) in adult patients.

DATA SOURCES
Between March 2021 and May 2022, researchers searched 18 databases for relevant articles using nine keywords. In total, 755 studies were evaluated.

STUDY SELECTION
Eight studies were included in the review. Studies were included if they evaluated individuals older than 18 years who were admitted to any healthcare setting; were published in English, Spanish, or Portuguese; examined the accuracy of thermal imaging in the early detection of PI, including suspected stage 1 PI or deep tissue injury; and they compared the region of interest to another area or control group, or to the Braden Scale or Norton Scale. Animal studies and reviews, studies with contact infrared thermography, and those including stages 2, 3, 4, and unstageable PIs were excluded.

DATA EXTRACTION
Researchers examined sample characteristics and assessment measures related to image capture, including environmental, individual, and technical factors.

DATA SYNTHESIS
Across the included studies, sample sizes ranged from 67 to 349 participants, and patients were followed up for periods ranging from a single assessment up to 14 days, or until the appearance of a PI, discharge, or death. Evaluation with the infrared thermography identified temperature differentials between regions of interest and/or in comparison with risk assessment scales.

CONCLUSIONS
Evidence on the accuracy of thermographic imaging in the early detection of PI is limited.
Neonatal Electroencephalogram Electrode-Related Pressure Injury Prevention Quality Improvement Study
Authors: Blazier Laura A. , Boyle Frances A. , Cooper Kristin L. , Wing Sarah E. , Stefanescu Beatrice M. 
Published: February 2023

ABSTRACT

OBJECTIVE
To lengthen the days between electroencephalogram electrode-related pressure injury (EERPI) to 100 EERPI-free days in 6 months of study implementation with a goal to maintain 200 EERPI-free days thereafter (≤1 EERPI event/year).

METHODS
This quality improvement study took place in a level IV neonatal ICU over three epochs spanning 2 years: epoch 1 or baseline (January-June 2019), epoch 2 or implementation of intervention (July-December 2019), and epoch 3 or sustainment (January-December 2020). A daily electroencephalogram (EEG) skin assessment tool, introduction in practice of a flexible hydrogel EEG electrode, and successive rapid-cycle staff-education sessions were key interventions of the study.

RESULTS
Seventy-six infants were monitored for 214 continuous EEG (cEEG) days, of which six (13.2%) developed EERPI in epoch 1. Eighty infants were monitored for 193 cEEG days, of which two (2.5%) developed EERPI in epoch 2. One hundred thirty-nine infants were monitored for 338 cEEG days, and none developed EERPI in epoch 3. There was no statistical difference with respect to the median cEEG days among study epochs. A G-chart of EERPI-free days showed an increase in EERPI-free days from an average of 34 days in epoch 1 to 182 days in epoch 2 and 365 days (or zero harm) in epoch 3. Skin erythema from EEG electrodes was noted during the study.

CONCLUSIONS
The structured study interventions eliminated EERPI events in infants monitored with cEEG. Preventive intervention at the cEEG-electrode level coupled with skin assessment successfully reduced EERPIs in neonates.
Emulating Target Trials to Avoid Immortal Time Bias – An Application to Antibiotic Initiation and Preterm Delivery
Authors: Caniglia Ellen C. , Zash Rebecca , Fennell Christina , Diseko Modiegi , Mayondi Gloria , Heintz Jonathan , Mmalane Mompati , Makhema Joseph , Lockman Shahin , Mumford Sunni L. , Murray Eleanor J. , Hernández-Díaz Sonia , Shapiro Roger 
Published: February 2023

Background:
Randomized trials in pregnancy are extremely challenging, and observational studies are often the only option to evaluate medication safety during pregnancy. However, such studies are often susceptible to immortal time bias if treatment initiation occurs after time zero of follow-up. We describe how emulating a sequence of target trials avoids immortal time bias and apply the approach to estimate the safety of antibiotic initiation between 24 and 37 weeks gestation on preterm delivery.

Methods:
The Tsepamo Study captured birth outcomes at hospitals throughout Botswana from 2014 to 2021. We emulated 13 sequential target trials of antibiotic initiation versus no initiation among individuals presenting to care <24 weeks, one for each week from 24 to 37 weeks. For each trial, eligible individuals had not previously initiated antibiotics. We also conducted an analysis susceptible to immortal time bias by defining time zero as 24 weeks and exposure as antibiotic initiation between 24 and 37 weeks. We calculated adjusted risk ratios (RR) and 95% confidence intervals (CI) for preterm delivery.

Results:
Of 111,403 eligible individuals, 17,009 (15.3%) initiated antibiotics between 24 and 37 weeks. In the sequence of target trials, RRs (95% CIs) ranged from 1.04 (0.90, 1.19) to 1.24 (1.11, 1.39) (pooled RR: 1.11 [1.06, 1.15]). In the analysis susceptible to immortal time bias, the RR was 0.90 (0.86, 0.94).

Conclusions:
Defining exposure as antibiotic initiation at any time during follow-up after time zero resulted in substantial immortal time bias, making antibiotics appear protective against preterm delivery. Conducting a sequence of target trials can avoid immortal time bias in pregnancy studies.
Postpartum Aeromonas hydrophila Peritonitis and Bacteremia
Authors: Zimilover Adam , Wang Taylor , Sheppard Acacia , Hirschberg Carly I. , Epstein Marcia 
Published: February 2023

Abstract

Aeromonas species can be the source of severe infections in immunocompromised individuals. We present a case of a 35-year-old pregnant patient who developed postpartum septic shock and acute decompensated heart failure in the setting of Aeromonas hydrophilia peritonitis and bacteremia. Her severe presentation was thought to have occurred secondary to underlying liver dysfunction and preeclampsia. We additionally discuss the common presentations and sources of Aeromonas infections along with risk factors for severe systemic disease.
Leuconostoc lactis Bacteremia and Neutropenic Fever
Authors: Bush Larry M. , Williams Justin 
Published: February 2023

Abstract
The epidemiology of bacteremic infections in neutropenic patients has shifted from a previous majority involving gram-positive cocci to an increasing preponderance of gram-negative Enterobacteriaceae species and Pseudomonas aeruginosa. Recommended empiric antimicrobial treatment regimens include an antipseudomonal β-lactam or carbapenem agent while considering risk factors for the possibility of extended-spectrum β-lactamase– or carbapenemase-producing organisms. The addition of vancomycin is generally reserved for the chance of gram-positive cocci infection, principally in patients with central intravascular catheters or soft tissue infections. Persistent or breakthrough bacteremia despite receiving this glycopeptide drug should prompt the clinician to contemplate not only the possibility of vancomycin-resistant enterococci, but also other organisms that possess intrinsic resistance vancomycin, including Leuconostoc species.
A review of the scope of direct-to-consumer sexually transmitted infection testing services offered on the internet
Authors: Manca Ellie , Van der Pol Barbara , Exten Cara , Pinto Casey N. 
Published: February 2023

Abstract

Background
The prevalence of sexually transmitted infections (STIs) is at an all-time high. Direct-to-consumer STI testing services may help alleviate this undue health burden. These products are sold online and rarely require interaction with a healthcare professional (HCP). Vendors offer STI self-collection kits or prescriptions for HCP specimen collection. The objective was to understand the scope of direct-to-consumer STI testing services offered and provide recommendations for consumers and industry.

Methods
Seven volunteers searched for “STD tests” on Google from February 1 through March 31, 2021 and shared their top three results. The study team extracted data from consumer-facing information on each website. Descriptive statistics and thematic qualitative analyses were performed.

Results
Twenty vendors were identified. Most vendors (95%) used Clinical Laboratory Improvement Amendments (CLIA)-certified or College of American Pathologists (CAP) accredited laboratories. Analyses distinguished between STI self-collection kits (n = 9) using independent laboratories and HCP specimen collection (n = 10) which used commercial laboratories (n = 1 offered both). The STI self-collection kits were cheaper per test and bundle on average (eg, $79.00 vs $106.50 for chlamydia/gonorrhea), and more closely aligned with clinical recommendations compared with the HCP specimen collection options. Websites often contained inaccurate or misleading information (n = 13), often promoting testing outside of the recommendations.

Conclusions
Direct-to-consumer STI testing services are part of an emerging market lacking regulation. Consumers should select vendors offering prescriptions for HCP specimen collection at CAP accredited and CLIA-certified laboratories. Vendors should provide a screening tool to assess individual patient risk prior to test purchase.
Protecting Sleep Hygiene in the PICU: A Quality Improvement Project
Authors: Dean Nathan P. , Bhattarai Sopnil , Rooney Sara , Gaskell Christy P. 
Published: February 2023

OBJECTIVES:
To increase the number of nights without sleep interruptions for routine tasks in recovering PICU patients.

DESIGN:
Prospective quality improvement project.

SETTING:
Single-center, free-standing, tertiary children’s hospital.

PATIENTS:
Patients admitted to the PICU for greater than 72 hours and eligible for early mobilization.

INTERVENTIONS:
A multidisciplinary sleep hygiene team was created to improve sleep hygiene in critically ill patients eligible for early mobilization. This team rewrote local nursing policies to avoid routine tasks between 11 pm and 5 am. The team provided periodic control chart updates to staff detailing progress made protecting sleep. Discussions of sleep hygiene were added to the daily goal sheet and a sleep hygiene order set was created. Finally, the PICU quality dashboard was modified to show whether a sleep hygiene order set was initiated in eligible patients.

MEASUREMENTS AND MAIN RESULTS:
Routine tasks were defined as daily chest radiographs, baths, routine tracheostomy care, central line dressing changes, twice daily medications, weights, and Foley care. After a year of data collection, avoidance of routine pupillary examinations was added to the sleep protection criteria. Baseline data was collected for 2 months prior to the creation of the sleep hygiene team. Screening of eligible patients occurred 1 week each month. The data were analyzed utilizing control charts. Baseline data demonstrated 32% of PICU patients without sleep interruptions. The centerline increased to 58% after the initial interventions but dropped to 33% after inclusion of pupillary checks. Following the introduction of the daily goal sheet, sleep hygiene order set, and tracking on the quality board, 49% of patients went without interruptions.

CONCLUSIONS:
The initiation of a sleep hygiene team along with retiming routine tasks, daily discussions on rounds with the daily goal sheet, introduction of a sleep hygiene order set, and transparent tracking improved the percentage of patients with protected sleep.
Improvement in Multidisciplinary Provider Rounding (Surgical Rounds) in the Pediatric Cardiac ICU: An Application of Lean Methodology*
Authors: Brown Tyler N. , Justice Lindsey , Malik Farhan , Lehenbauer David , O’Donnell Alan , Brown James M. , Powers Tricia , Neogi Smriti , Cooper David S. , Mah Kenneth E. 
Published: February 2023

Objectives:
Provider-only, combined surgical, and medical multidisciplinary rounds (“surgical rounds”) are essential to achieve optimal outcomes in large pediatric cardiac ICUs. Lean methodology was applied with the aims of identifying areas of waste and nonvalue-added work within the surgical rounds process. Thereby, the goals were to improve rounding efficiency and reduce rounding duration while not sacrificing critical patient care discussion nor delaying bedside rounds or surgical start times.

Design:
Single-center improvement science study with observational and interventional phases from February 2, 2021, to July 31, 2021.

Setting:
Tertiary pediatric cardiac ICU.

Participants:
Cardiothoracic surgery and cardiac intensive care team members participating in daily “surgical” rounds.

Interventions:
Implementation of technology automation, creation of work instructions, standardization of patient presentation content and order, provider training, and novel role assignment.

Measurements and Main Results:
Sixty-one multidisciplinary rounds were observed (30 pre, 31 postintervention). During the preintervention period, identified inefficiencies included prolonged preparation time, redundant work, presentation variability and extraneous information, and frequent provider transitions. Application of targeted interventions resulted in a 26% decrease in indexed rounds duration (2.42 vs 1.8 min; p = 0.0003), 50% decrease in indexed rounds preparation time (0.53 vs 0.27 min; p < 0.0001), and 66% decrease in transition time between patients (0.09 vs 0.03 min; p < 0.0001). The number of presenting provider changes also decreased (9 vs 4; p < 0.0001). Indexed discussion duration did not change (1 vs 0.98 min; p = 0.08) nor did balancing measures (bedside rounds and surgical start times) change (8.5 vs 9 min; p = 0.89 and 38 vs 22 min; p = 0.09).

Conclusions:
Lean methodology can be effectively applied to multidisciplinary rounds in a joint cardiothoracic surgery/cardiac intensive care setting to decrease waste and inefficiency. Interventions resulted in decreased preparation time, transition time, presenting provider changes, total rounds duration indexed to patient census, and anecdotal improvements in provider satisfaction.
Recently Acquired Blood-borne Virus Infections in Australian Deceased Organ Donors: Estimation of the Residual Risk of Unexpected Transmission
Authors: Dutch Martin J. , Seed Clive R. , Cheng Anthea , Kiely Philip , Patrick Cameron J. , Opdam Helen I. , Knott Jonathan C. 
Published: February 2023

Background:
Unexpected donor-derived infections of hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV are rare but important potential complications of deceased organ transplantation. The prevalence of recently acquired (yield) infections has not been previously described in a national cohort of Australian deceased organ donors. Donor yield infections are of particularly significance, as they can be used to gain insights in the incidence of disease in the donor pool and in turn, estimate the risk of unexpected disease transmission to recipients.

Methods:
We conducted a retrospective review of all patients who commenced workup for donation in Australia between 2014 and 2020. Yield cases were defined by having both unreactive serological screening for current or previous infection and reactive nucleic acid testing screening on initial and repeat testing. Incidence was calculated using a yield window estimate and residual risk using the incidence/window period model.

Results:
The review identified only a single yield infection of HBV in 3724 persons who commenced donation workup. There were no yield cases of HIV or HCV. There were no yield infections in donors with increased viral risk behaviors. The prevalence of HBV, HCV, and HIV was 0.06% (0.01–0.22), 0.00% (0–0.11), and 0.00% (0–0.11), respectively. The residual risk of HBV was estimated to be 0.021% (0.001–0.119).

Conclusions:
The prevalence of recently acquired HBV, HCV, and HIV in Australians who commence workup for deceased donation is low. This novel application of yield-case-methodology has produced estimates of unexpected disease transmission which are modest, particularly when contrasted with local average waitlist mortality. Supplemental Visual Abstract;
http://links.lww.com/TXD/A503.
Protection From Second Warm Ischemic Injury Using a Thermal Barrier Bag in Kidney Transplantation
Authors: Ide Kentaro , Nakano Ryosuke , Imaoka Yuki , Sakai Hiroshi , Ono Kosuke , Tanimine Naoki , Tahara Hiroyuki , Ohira Masahiro , Ueda Keiko , Hirata Taizo , Kobayashi Eiji , Ohdan Hideki 
Published: February 2023

Background.
Second warm ischemic injury during vascular anastomosis not only adversely affects immediate posttransplant function but also affects long-term patient and graft survival. We developed a pouch-type thermal barrier bag (TBB) composed of a transparent, biocompatible insulation material suitably designed for kidneys and conducted the first-in-human clinical trial.

Methods.
A living-donor nephrectomy was performed using a minimum skin incision procedure. After back table preparation, the kidney graft was placed inside the TBB and preserved during vascular anastomosis. The graft surface temperature was measured before and after vascular anastomosis using a noncontact infrared thermometer. After completion of the anastomosis, the TBB was removed from the transplanted kidney before graft reperfusion. Clinical data, including patient characteristics and perioperative variables, were collected. The primary endpoint was safety, which was assessed by evaluating adverse events. The secondary endpoints were the feasibility, tolerability, and efficacy of the TBB in kidney transplant recipients.

Results.
Ten living-donor kidney transplant recipients with a median age of 56 y (range, 39–69 y) were enrolled in this study. No serious adverse events related to the TBB were observed. The median second warm ischemic time was 31 (27–39) min, and the median graft surface temperature at the end of anastomosis was 16.1 °C (12.8–18.7 °C).

Conclusions.
TBB can maintain transplanted kidneys at a low temperature during vascular anastomosis, which contributes to the functional preservation of transplanted kidneys and stable transplant outcomes.
A Cost-Effectiveness Model to Determine Ostomy-Related Costs of Care and Health Outcomes Among People With an Ostomy in Canada Using a Ceramide-Infused Skin Barrier
Authors: LeBlanc Kimberly , Furtado Stephanie , Mings Deborah , Martin Melanie , Evans Michele , Eaves Deanna , Skountrianos George 
Published: February 2023

PURPOSE:
The aim of this study was to determine whether a difference exists in the financial impact of the use of a 2-piece ceramide-infused skin barrier (CIB) versus standard of care barrier (SOC) in Ontario and Alberta using a cost-effectiveness model over a 1-year period for people with a fecal or urinary ostomy.

DESIGN:
A cost-effectiveness model adapted from a previously published work.

SUBJECTS AND SETTING:
The model was populated with data inputs from a hypothetical cohort of 1000 individuals in Ontario and 4000 in Alberta. Model results were assessed for robustness via the use of deterministic and probabilistic sensitivity analyses. The provinces of Ontario and Alberta were chosen because cost data were readily accessible. The combined population of these provinces accounts for 50% of Canada's population.

RESULTS:
An expected cost savings of Can$443.13 (US $322.60) and Can$243.84 (US $177.52) per user for the hypothetical cohort of 1000 individuals in Ontario and 4000 in Alberta per year was obtained for those using a CIB versus a non-infused skin barrier in Ontario and Alberta, respectively. The incremental cost effectiveness ratio (ICER) of CIB to SOC per peristomal skin complication (PSC) avoided and per quality-adjusted life day (QALD) gained was approximately Can$2702 (US $1967)/PSC and Can$1266 (US $922)/QALD for Ontario and approximately Can$1487 (US $1083)/PSC and Can$697 (US $507)/QALD for Alberta. Analysis indicated CIBs remained cost-effective across all sensitivity analyses performed.

CONCLUSIONS:
Finding suggest that a CIB is cost-effective when compared to a barrier not infused with ceramide when applied to persons with an ostomy and residing in the provinces of Alberta and Ontario.