bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of positive end-expiratory pressure upregulation on the right ventricle in critical patients with acute respiratory distress syndrome: an observational cohort study
Authors: Liu Hui , Song Mengjie , Wang Li , Xiao Jianguo , Zhou Feihu 
Published: March 2023

Abstract

Background
This study aimed to investigate the influence of positive end-expiratory pressure (PEEP) on the right ventricle (RV) of mechanical ventilation–assisted patients through echocardiography.

Methods
Seventy-six patients assisted with mechanical ventilation were enrolled in this study. Positive end-expiratory pressure was upregulated by 4 cm H2O to treat acute respiratory distress syndrome, wherein echocardiography was performed before and after this process. Hemodynamic data were also recorded. All variables were compared before and after PEEP upregulation. The effect of PEEP was also evaluated in patients with and without decreased static lung compliance (SLC).

Results
Positive end-expiratory pressure upregulation significantly affected the RV function. Remarkable differences were observed in the following: Tei index (P = 0.027), pulmonary artery pressure (P = 0.039), tricuspid annular plane systolic excursion (P = 0.014), early wave/atrial wave (P = 0.002), diaphragm excursion (P < 0.001), inferior vena cava collapsing index (P < 0.001), and SLC (P < 0.001). There were no significant changes in heart rate, respiratory rate, central venous pressure, mean arterial pressure, and base excess (P > 0.05). Furthermore, the cardiac output of the RV was not significantly affected. In patients with decreased SLC (n = 41), there were more significant changes in diaphragm excursion (P < 0.001), inferior vena cava collapse index (P = 0.025), pulmonary artery pressure (P < 0.001), and tricuspid annular plane systolic excursion (P = 0.007) than in those without decreased SLC (n = 35).

Conclusion
Positive end-expiratory pressure upregulation significantly affected the RV function of critically ill patients with acute respiratory distress syndrome, especially in those with decreased SLC.
Novel Antiplatelet Activity of Ginsenoside Re Through the Inhibition of High Shear Stress–Induced Platelet Aggregation
Authors: Huang Xiaojing , Zhang Tiancong , Gao Xuemei , Huan Xuanrong , Li Yuan 
Published: March 2023

Abstract
Bleeding is one of the most serious side effects of antiplatelet drugs. Efforts have been made to find new antiplatelet agents without bleeding complications. Shear-induced platelet aggregation (SIPA) occurs only under pathological conditions and is a promising target for overcoming bleeding problems. This work demonstrates that the ginsenoside Re selectively inhibits platelet aggregation induced by high shear stress. Human platelets were exposed to high shear stress using microfluidic chip technology, and aggregation, activation, and phosphatidylserine (PS) exposure were measured. The Von Willebrand Ristocetin Cofactor (vWF:RCo) assay and western blot were used to evaluate the effect of the vWF-GPⅠb/PI3K/Akt signal pathway. The coagulation and bleeding risk were evaluated by measuring the coagulation parameters PT, APTT, TT, and thromboelastography. The 3-dimensional morphology of platelet aggregates was observed by a microscopic 3-dimensional imaging. Re was a potent inhibitor of SIPA, with an IC50 of 0.071 mg/mL. It effectively blocked shear stress–induced platelet activation without any significant toxicity. It was highly selective against SIPA, effectively inhibiting vWF–GPIb and the downstream PI3K/Akt signaling pathway. Most importantly, Re did not affect normal blood coagulation and did not increase the risk of bleeding. In conclusion, Re inhibits platelet activation through the inhibition of the vWF-GPIb/PI3K/Akt pathway. Thus, it might be considered as a new antiplatelet drug in the prevention of thrombosis without increasing the risk of bleeding.
RETINAL VASCULITIS OR VASCULAR OCCLUSION AFTER BROLUCIZUMAB FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Wykoff Charles C. , Matsumoto Hidetaka , Barakat Mark R. , Karcher Helene , Lozama Anthony , Mayhook Andrew , Oshagbemi Olorunfemi A. , Zorina Olessia , Hassan Tarek S. , Khanani Arshad M. , Heier Jeffrey S. 
Published: March 2023

Purpose:
Retinal vasculitis or vascular occlusion (RV/RO) have been reported after brolucizumab for neovascular age-related macular degeneration. This systematic literature review evaluated RV/RO events after brolucizumab in real-world practice.

Methods:
Systematic literature searches identified 89 publications; 19 were included.

Results:
Publications described 63 patients (70 eyes) with an RV/RO event following brolucizumab. Mean age was 77.6 years and 77.8% of patients were women; 32 eyes (45.7%) received one brolucizumab injection before RV/RO. Mean (range) time to event from last brolucizumab injection was 19.4 (0–63) days, with 87.5% of events occurring within 30 days. Among eyes with preevent and postevent visual acuity (VA) assessments, 22/42 eyes (52.4%) showed unchanged (±0.08 logMAR) or improved vision from last recorded preevent assessment at latest follow-up, whereas 15/42 eyes (35.7%) showed ≥0.30 logMAR (≥15 letters) VA reduction. Patients with no VA loss were on average slightly younger and had a higher proportion of nonocclusive events.

Conclusion:
Most RV/RO events reported after brolucizumab in early real-world practice occurred in women. Among eyes with VA measurements, approximately half experienced VA loss; overall, about one-third had VA reduction of ≥0.30 logMAR at latest follow-up, with indications of regional variations.
Evolution of the Chief Medical Officer Role in Teaching Hospitals and Health Systems
Authors: Onyango Rebecca , Baker Matthew C. , Faerberg Jennifer , Haberman Merle , McCoy Rosha , Orlowski Janis 
Published: March 2023

SUMMARY

Goal:
Clinical physician leaders have become an increasingly important asset to hospitals and hospital systems in a changing healthcare environment. Specifically, the role of the chief medical officer (CMO) has expanded and evolved amid the shift to value-based payment models and sharpened focus on patient safety, quality, community engagement, and equity in healthcare, as well as a global pandemic. In light of these changes, this study examined the transformation of CMOs and similar roles and evaluated the current needs, challenges, and responsibilities of clinical leaders today.

Methods:
The primary data source used in this analysis was a survey fielded to 391 clinical leaders in 290 Association of American Medical Colleges–member hospitals and health systems in 2020. In addition, this study compared responses to the 2020 survey with findings from two prior iterations of the survey from 2005 and 2016. The surveys collected information regarding demographics, compensation, administrative titles, qualifications for the position, and the scope of the role, among other questions. All surveys consisted of multiple-choice, free response, and rating questions. The analysis was conducted using frequency counts and percentage distributions.

Principal Findings:
Thirty percent of eligible clinical leaders responded to the 2020 survey. Twenty-six percent of the clinical leader respondents identified as female. Ninety-one percent of the CMOs were members of the senior management team in their hospital or health system. CMOs reported that they were responsible for five hospitals, on average, with 67% indicating they were responsible for more than 500 physicians.

Practical Applications:
This analysis provides hospital and health systems with insight into the expanding scope and complexity of CMOs as they take on greater leadership responsibilities within their institutions amidst a shifting healthcare landscape. In reflecting on our results, hospital leaders can understand the current needs, barriers, and responsibilities of today's clinical leaders.
When States Mandate Hospital Community Benefit Reports, Provision Increases
Authors: Zare Hossein , Logan Corinne , Anderson Gerard F. 
Published: March 2023

SUMMARYGoal:We examined the variation in community benefit and charity care reporting standards mandated by states to determine whether state-mandated community benefit and charity care reporting is associated with greater provision of these services.Methods:We used 2011–2019 data from IRS Form 990 Schedule H for 1,423 nonprofit hospitals to create a sample of 12,807 total observations. Random effects regression models were used to examine the association between state reporting requirements and community benefit spending by nonprofit hospitals. Specific reporting requirements were analyzed to determine whether certain requirements were associated with increased spending on these services.Principal Findings:Nonprofit hospitals in states that required reports spent a higher percentage of total hospital expenditures on community benefits (9.1%,SD= 6.2%) compared to states without these requirements (7.2%,SD= 5.7%). A similar association between the percentage of charity care and total hospital expenditures (2.3% and 1.5%) was found. The greater number of reporting requirements was associated with lower levels of charity care provision, as hospitals allocated more resources to other community benefits.Practical Applications:Mandating the reporting of specific services is associated with greater provision of certain specific services, but not all. A concern is that when many services must be reported, the provision of charity care might be reduced as hospitals choose to allocate their community benefit dollars to other categories. As a result, policymakers may want to focus their attention on the services they most want to prioritize.
Organization-Level Factors Associated With Burnout
Authors: Thompson Helaina G. , Askelson Natoshia M. , Bucklin Rebecca , Gauthreaux Nicole , Faber Elizabeth , Ball Coltin , Yang Suejin , Steere Eliza 
Published: March 2023

ObjectiveTo understand how micropolitan public health workers (PHWs) experienced burnout antecedents during the COVID-19 pandemic.MethodsWe conducted in-depth guided discussions with 34 representatives from 16 micropolitan public health departments using semistructured, open-ended questions about departments' experiences during the COVID-19 pandemic. We coded discussion transcripts to develop themes according to the Six Areas of Worklife model.ResultsPHWs described antecedents of burnout that stemmed from organizational and external forces, most notably within the workload, control, reward, and values dimensions of the Six Areas of Worklife model, as well as instances of workplace violence.ConclusionsOur findings support organization-level approaches to reducing and preventing burnout in the micropolitan public health workforce. We discuss addressing specific dimensions of the Six Areas of Worklife model when designing burnout solutions for this essential workforce.
The role of omega-3 polyunsaturated fatty acids in the intensive care unit
Authors: Singer Pierre , Calder Philip C. 
Published: March 2023

Purpose of reviewThis review provides an update on the actions of omega-3 polyunsaturated fatty acids (PUFAs) and presents the most recent findings from trials in patients in the intensive care unit (ICU) setting including relevant meta-analyses. Many specialized pro-resolving mediators (SPMs) are produced from bioactive omega-3 PUFAs and may explain many of the beneficial effects of omega-3 PUFAs, although other mechanisms of action of omega-3 PUFAs are being uncovered.Recent findingsSPMs resolve inflammation, promote healing and support antiinfection activities of the immune system. Since publication of the ESPEN guidelines, numerous studies further support the use of omega-3 PUFAs. Recent meta-analyses favor the inclusion of omega-3 PUFAs in nutrition support of patients with acute respiratory distress syndrome or sepsis. Recent trials indicate that omega-3 PUFAs may protect against delirium and liver dysfunction in patients in the ICU, although effects on muscle loss are unclear and require further investigation. Critical illness may alter omega-3 PUFA turnover. There has been significant discussion about the potential for omega-3 PUFAs and SPMs in treatment of coronavirus disease 2019.SummaryEvidence for benefits of omega-3 PUFAs in the ICU setting has strengthened through new trials and meta-analyses. Nevertheless, better quality trials are still needed. SPMs may explain many of the benefits of omega-3 PUFAs.
Do omega-3 fatty acids increase risk of atrial fibrillation?
Authors: Bork Christian S. , Myhre Peder L. , Schmidt Erik B. 
Published: March 2023

Purpose of the review
To summarize the findings from recent observational follow-up studies and randomized trials of plant- and marine omega-3 fatty acids on the risk of atrial fibrillation (AF).

Recent findings
Recent randomized cardiovascular outcome trials have indicated that supplements with marine omega-3 fatty acids may be associated with a higher risk of AF, and a meta-analysis has suggested that marine omega-3 fatty acid supplements were associated with a 25% higher relative risk of AF. Also, a recent large observational study reported a modest higher risk of AF in habitual users of marine omega-3 fatty acid supplements. However, recent observational biomarker studies of circulating and adipose tissue content of marine omega-3 fatty acids have in contrast reported a lower risk of AF. Very limited knowledge exists on the role of plant-derived omega-3 fatty acids and AF.

Summary
Marine omega-3 fatty acid supplements may increase the risk of AF, whereas biomarkers reflecting consumption of marine omega-3 fatty acids have been linked to a lower risk of AF. Clinicians should inform patients that marine omega-3 fatty acid supplement may increase AF risk, and this should be taking into account when discussing pros and cons of taking supplements with marine omega-3 fatty acids.
Nutritional regulation of hepatic de novo lipogenesis in humans
Authors: Cross Eloise , Dearlove David J. , Hodson Leanne 
Published: March 2023

Purpose of reviewDe novolipogenesis (DNL) is a metabolic process occurring mainly within the liver, in humans. Insulin is a primary signal for promoting DNL; thus, nutritional state is a key determinant for upregulation of the pathway. However, the effects of dietary macronutrient composition on hepatic DNL remain unclear. Nor is it clear if a nutrition-induced increase in DNL results in accumulation of intra-hepatic triglyceride (IHTG); a mechanism often proposed for pathological IHTG. Here, we review the latest evidence surrounding the nutritional regulation of hepatic DNL.Recent findingsThe role of carbohydrate intake on hepatic DNL regulation has been well studied, with only limited data on the effects of fats and proteins. Overall, increasing carbohydrate intake typically results in an upregulation of DNL, with fructose being more lipogenic than glucose. For fat, it appears that an increased intake of n-3 polyunsaturated fatty acids downregulates DNL, whilst, in contrast, an increased dietary protein intake may upregulate DNL.SummaryAlthough DNL is upregulated with high-carbohydrate or mixed-macronutrient meal consumption, the effects of fat and protein remain unclear. Additionally, the effects of different phenotypes (including sex, age, ethnicity, and menopause status) in combination with different diets (enriched in different macronutrients) on hepatic DNL requires elucidation.
Health-care–Related Practices in Virtual Behavioral Health Treatment for Major Depression Before and During the COVID-19 Pandemic
Authors: Weinfield Nancy S. , Tavel Heather M. , Goodrich Glenn , McCracken Courtney E. , Basra Sundeep , Gander Jennifer C. , Davis Teaniese L. , Ritzwoller Debra P. , Roblin Douglas W. 
Published: March 2023

Background:
The abrupt shift to virtual care at the onset of the COVID-19 pandemic had the potential to disrupt care practices in virtual behavioral health encounters. We examined changes over time in virtual behavioral health-care-related practices for patient encounters with diagnoses of major depression.

Methods:
This retrospective cohort study utilized electronic health record data from 3 integrated health care systems. Inverse probability of treatment weighting was used to adjust for covariates across 3 time periods, prepandemic (January 2019–March 2020), peak-pandemic shift to virtual care (April 2020–June 2020), and recovery of health care operations (July 2020–June 2021). First virtual follow-up behavioral health department encounters after an incident diagnostic encounter were examined for differences across the time periods in rates of antidepressant medication orders and fulfillments, and completion of patient-reported symptoms screeners in service of measurement-based care.

Results:
Antidepressant medication orders declined modestly but significantly in 2 of the 3 systems during the peak-pandemic period but rebounded during the recovery period. There were no significant changes in patient fulfillment of ordered antidepressant medications. Completion of symptom screeners increased significantly in all 3 systems during the peak-pandemic period and continued to increase significantly in the subsequent period.

Conclusions:
A rapid shift to virtual behavioral health care was possible without compromising health-care-related practices. The transition and subsequent adjustment period have instead been marked by improved adherence to measurement-based care practices in virtual visits, signaling a potential new capacity for virtual health care delivery.
The Predictive Value of a Modified Frailty Index on Perioperative Morbidity and Mortality Following Otologic Surgery
Authors: Quinn Kevin J. , Ma Yuchi , Carli Matthew , Coelho Daniel H. 
Published: March 2023

Objectives:
Recently, determinants of frailty have become an increasingly recognized perioperative risk stratification tool. This study examines the predictive value of a 5-factor modified frailty index (mFI-5) on perioperative morbidity and mortality in patients undergoing otologic surgery, with a subgroup analysis based on surgery site.

Study Design:
Cross-sectional analysis.

Setting:
National surgical quality improvement program dataset 2005–2019.

Patients:
Current procedural terminology (CPT) codes were used to identify patients undergoing all otologic surgeries.

Interventions:
Otologic surgeries as indicated by CPT codes, including external ear, middle ear/mastoid, implants, and inner ear/facial nerve subgroups.

Main Outcome Measures:
Primary outcomes examined in this study included rates of overall complications and life-threatening complications within 30 days after surgery. Overall complications included superficial surgical site infections (SSI), deep incisional SSI, readmission, deep vein thrombosis, life-threatening complications, and mortality. Life-threatening complications included those classified as Clavien-Dindo grade IV: cerebrovascular accident, mechanical ventilation for more than 48 hours, reintubation, pulmonary embolism, acute renal failure, cardiac arrest, and myocardial infarction.

Results:
A total of 16,859 patients who underwent otologic surgery were identified, resulting in a cohort that was 47.5% male with an average age of 47.6 years (17.1 SD). Multivariable regression analysis of the entire cohort demonstrated a score of 3 or more on the mFI-5 was independently predictive of all postoperative complications (odds ratio (OR): 2.02, P < 0.0001). However, subgroup analysis showed that only “external ear” surgery correlated with mFi-5 (OR 8.03, P = 0.013).

Conclusions:
Higher frailty scores as measured by the mFI-5 correlate with postoperative morbidity and mortality after otologic surgery, though subgroup analysis reveals an association only with cases performed on the external ear. These findings suggest that for most otologic surgery, the mFI-5 frailty score is not predictive of postoperative complications.
The Infant KIdney Dialysis and Utrafiltration (I-KID) Study: A Stepped-Wedge Cluster-Randomized Study in Infants, Comparing Peritoneal Dialysis, Continuous Venovenous Hemofiltration, and Newcastle Infant Dialysis Ultrafiltration System, a Novel Infant Hemodialysis Device
Authors: Lambert Heather , Hiu Shaun , Coulthard Malcolm G. , Matthews John N. S. , Holstein Eva-Maria , Crosier Jean , Agbeko Rachel , Brick Thomas , Duncan Heather , Grant David , Mok Quen , Nyman Andrew Gustaf , Pappachan John , Boucher Chris , Bulmer Joe , Chisholm Denise , Cromie Kirsten , Emmet Victoria , Feltbower Richard G. , Ghose Arunoday , Grayling Michael , Harrison Rebecca , Kennedy Ciara A. , McColl Elaine , Morris Kevin , Norman Lee , Office Julie , Parslow Roger , Pattinson Christine , Sharma Shriya , Smith Jonathan , Steel Alison , Steel Rachel , Straker Jayne , Vrana Lamprini , Walker Jenn , Wellman Paul , Whitaker Mike , Wightman Jim , Wilson Nina , Wirz Lucy , Wood Ruth 
Published: March 2023

Objectives:
Renal replacement therapy (RRT) options are limited for small babies because of lack of available technology. We investigated the precision of ultrafiltration, biochemical clearances, clinical efficacy, outcomes, and safety profile for a novel non-Conformité Européenne-marked hemodialysis device for babies under 8 kg, the Newcastle Infant Dialysis Ultrafiltration System (NIDUS), compared with the current options of peritoneal dialysis (PD) or continuous venovenous hemofiltration (CVVH).

Design:
Nonblinded cluster-randomized cross-sectional stepped-wedge design with four periods, three sequences, and two clusters per sequence.

Setting:
Clusters were six U.K. PICUs.

Patients:
Babies less than 8 kg requiring RRT for fluid overload or biochemical disturbance.

Interventions:
In controls, RRT was delivered by PD or CVVH, and in interventions, NIDUS was used. The primary outcome was precision of ultrafiltration compared with prescription; secondary outcomes included biochemical clearances.

Measurements and Main Results:
At closure, 97 participants were recruited from the six PICUs (62 control and 35 intervention). The primary outcome, obtained from 62 control and 21 intervention patients, showed that ultrafiltration with NIDUS was closer to that prescribed than with control: sd controls, 18.75, intervention, 2.95 (mL/hr); adjusted ratio, 0.13; 95% CI, 0.03–0.71; p = 0.018. Creatinine clearance was smallest and least variable for PD (mean, sd) = (0.08, 0.03) mL/min/kg, larger for NIDUS (0.46, 0.30), and largest for CVVH (1.20, 0.72). Adverse events were reported in all groups. In this critically ill population with multiple organ failure, mortality was lowest for PD and highest for CVVH, with NIDUS in between.

Conclusions:
NIDUS delivers accurate, controllable fluid removal and adequate clearances, indicating that it has important potential alongside other modalities for infant RRT.