bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extubation of the potentially difficult airway in the intensive care unit
Authors: Joffe Aaron , Barnes Christopher R. 
Published: February 2022

Purpose of review
Extubation in the intensive care unit (ICU) is associated with a failure rate requiring reintubation in 10–20% patients further associated with significant morbidity and mortality. This review serves to highlight recent advancements and guidance on approaching extubation for patients at risk for difficult or failed extubation (DFE).

Recent findings
Recent literature including closed claim analysis, meta-analyses, and national society guidelines demonstrate that extubation in the ICU remains an at-risk time for patients. Identifiable strategies aimed at optimizing respiratory mechanics, patient comorbidities, and airway protection, as well as preparing an extubation strategy have been described as potential methods to decrease occurrence of DFE.

Summary
Extubation in the ICU remains an elective decision and patients found to be at risk should be further optimized and planning undertaken prior to proceeding. Extubation for the at-risk patient should be operationalized utilizing easily reproducible strategies, with airway experts present to guide decision making and assist in reintubation if needed.
Labor Market Attachment 2 Years After Colorectal Cancer Surgery
Authors: Juul Therese , Laurberg Søren , Andersen Niels T. , Nielsen Claus V. , Maribo Thomas , Emmertsen Katrine J. , Pedersen Pernille 
Published: February 2022

Objectives:
To investigate the association between clinical/sociodemographic factors and labor market attachment, and to estimate employment probability 2 years after colorectal cancer (CRC) surgery.

Background:
A rising prevalence of younger CRC survivors commands a stronger focus on labor market attachment. The association between clinical factors like type of surgery and CRC survivors’ labor market attachment remains poorly investigated.

Methods:
National registries provided information on employment status and clinical/sociodemographic variables for all 20- to 60-year-old CRC patients without previous cancer diagnosed in Denmark from 2001 to 2014, undergoing surgery and being attached to the labor market. Associations between clinical/sociodemographic factors and labor market attachment were investigated in multiple logistic regression analyses.

Results:
A total of 5755 CRC patients were included. Two years after surgery, 59.7% were working. Factors significantly associated with a higher probability of working were being in the 46 to 50 years age group, male gender, higher educational level, no comorbidity, working at the time of diagnosis, lower Union for International Cancer Control stage, and undergoing surgery in the most recent of four time-periods. Two years after undergoing surgery, the probability of working was significantly higher for left-sided than for right-sided colon resections, higher for low anterior resection (LAR)/high tumor than for LAR/low tumor, and higher for abdominoperineal resection than for Hartmann’s procedure. Of the 4798 (86.8%) patients alive 2 years after surgery, 68.8% were working, 7.8% had retired, whereas 23.4% were on temporary benefits, sick leave, or disability pension.

Conclusions:
Clinical/sociodemographic factors were associated with the probability of working 2 years after surgery. This knowledge can be used to inform patients and target interventions towards patients with low post-CRC probability of working.
Tidal Volume–Dependent Activation of the Renin-Angiotensin System in Experimental Ventilator-Induced Lung Injury*
Authors: Mao Xinjun , Krenn Katharina , Tripp Thomas , Tretter Verena , Reindl-Schwaighofer Roman , Kraft Felix , Podesser Bruno K. , Zhu Yi , Poglitsch Marko , Domenig Oliver , Abraham Dietmar , Ullrich Roman 
Published: February 2022

OBJECTIVES:
Ventilator-induced lung injury (VILI) is a major contributor to morbidity and mortality in critically ill patients. Mechanical damage to the lungs is potentially aggravated by the activation of the renin-angiotensin system (RAS). This article describes RAS activation profiles in VILI and discusses the effects of angiotensin (Ang) 1–7 supplementation or angiotensin-converting enzyme (ACE) inhibition with captopril as protective strategies.

DESIGN:
Animal study.

SETTING:
University research laboratory.

SUBJECTS:
C57BL/6 mice.

INTERVENTIONS:
Anesthetized mice (n = 12–18 per group) were mechanically ventilated with low tidal volume (LVT, 6 mL/kg), high tidal volume (HVT, 15 mL/kg), or very high tidal volume (VHVT, 30 mL/kg) for 4 hours, or killed after 3 minutes (sham). Additional VHVT groups received infusions of 60 μg/kg/hr Ang 1–7 or a single dose of 100 mg/kg captopril.

MEASUREMENTS AND MAIN RESULTS:
VILI was characterized by increased bronchoalveolar lavage fluid levels of interleukin (IL)-6, keratinocyte-derived cytokine, and macrophage inflammatory protein-2 (MIP2). The Ang metabolites in plasma measured with liquid chromatography tandem mass spectrometry showed a strong activation of the classical (Ang I, Ang II) and alternative RAS (Ang 1–7, Ang 1–5), with highest concentrations found in the HVT group. Although the lung-tissue ACE messenger RNA expression was unchanged, its protein expression showed a dose-dependent increase under mechanical ventilation. The ACE2 messenger RNA expression decreased in all ventilated groups, whereas ACE2 protein levels remained unchanged. Both captopril and Ang 1–7 led to markedly increased Ang 1–7 plasma levels, decreased Ang II levels, and ACE activity (Ang II/Ang I ratio), and effectively prevented VILI.

CONCLUSIONS:
VILI is accompanied by a strong activation of the RAS. Based on circulating Ang metabolite levels and tissue expression of RAS enzymes, classical ACE-dependent and alternative RAS cascades were activated in the HVT group, whereas classical RAS activation prevailed with VHVT ventilation. Ang 1–7 or captopril protected from VILI primarily by modifying the systemic RAS profile.
Etiology, Treatments, and Outcomes of Patients With Severe Community-Acquired Pneumonia in a Large U.S. Sample*
Authors: Haessler Sarah , Guo Ning , Deshpande Abhishek , Zilberberg Marya D. , Lagu Tara , Lindenauer Peter K. , Imrey Peter B. , Rothberg Michael B. 
Published: February 2022

OBJECTIVES:
Compare the clinical practice and outcomes in severe community-acquired pneumonia (sCAP) patients to those in non-sCAP patients using guideline-defined criteria for sCAP.

DESIGN:
Retrospective observational cohort study.

SETTING:
One hundred seventy-seven U.S. hospitals within the Premier Healthcare Database.

PATIENTS:
Hospitalized adult (≥ 18 yr old) patients with pneumonia.

MEASUREMENTS AND MAIN RESULTS:
Adult patients (≥ 18 yr old) with a principal diagnosis of pneumonia or a secondary diagnosis of pneumonia paired with a principal diagnosis of sepsis or respiratory failure were included. Patients with at least one guideline-defined major criterion for severe pneumonia were compared with patients with nonsevere disease. Among 154,799 patients with pneumonia, 21,805 (14.1%) met criteria for sCAP. They had higher organ failure scores (1.9 vs 0.63; p < 0.001) and inpatient mortality (22.0 vs 5.0%; p < 0.001), longer lengths of stay (8 vs 5 d; p < 0.001), and higher costs ($20,046 vs $7,543; p < 0.001) than those with nonsevere disease. Patients with sCAP had twice the rate of positive blood cultures (10.0% vs 4.5%; p < 0.001) and respiratory cultures (34.2 vs 21.1%; p < 0.001) and more often had isolates resistant to first-line community-acquired pneumonia antibiotics (10% of severe vs 3.1% of nonsevere; p < 0.001). Regardless of disease severity, Streptococcus pneumoniae was the most common pathogen recovered from blood cultures and Staphylococcus aureus and Pseudomonas species were the most common pathogens recovered from the respiratory tract. Although few patients with sCAP had cultures positive for a resistant organism, 65% received vancomycin and 42.8% received piperacillin-tazobactam.

CONCLUSIONS:
sCAP patients had worse outcomes and twice the rate of culture positivity. S. aureus and S. pneumoniae were the most common organisms in respiratory and blood specimens, respectively. Although only recommended for sCAP patients, nearly all pneumonia patients received blood cultures, a quarter of nonsevere patients received sputum cultures, and treatment with broad-spectrum agents was widespread, indicating fertile ground for antimicrobial and diagnostic stewardship programs.
Multimorbidity patterns and association with mortality in 0.5 million Chinese adults
Authors: Fan Junning , Sun Zhijia , Yu Canqing , Guo Yu , Pei Pei , Yang Ling , Chen Yiping , Du Huaidong , Sun Dianjianyi , Pang Yuanjie , Zhang Jun , Gilbert Simon , Avery Daniel , Chen Junshi , Chen Zhengming , Lyu Jun , Li Liming 
Published: February 2022

Abstract

Background:
Few studies have assessed the relationship between multimorbidity patterns and mortality risk in the Chinese population. We aimed to identify multimorbidity patterns and examined the associations of multimorbidity patterns and the number of chronic diseases with the risk of mortality among Chinese middle-aged and older adults.

Methods:
We used data from the China Kadoorie Biobank and included 512,723 participants aged 30 to 79 years. Multimorbidity was defined as the presence of two or more of the 15 chronic diseases collected by self-report or physical examination at baseline. Multimorbidity patterns were identified using hierarchical cluster analysis. Cox regression was used to estimate the associations of multimorbidity patterns and the number of chronic diseases with all-cause and cause-specific mortality.

Results:
Overall, 15.8% of participants had multimorbidity. The prevalence of multimorbidity increased with age and was higher in urban than rural participants. Four multimorbidity patterns were identified, including cardiometabolic multimorbidity (diabetes, coronary heart disease, stroke, and hypertension), respiratory multimorbidity (tuberculosis, asthma, and chronic obstructive pulmonary disease), gastrointestinal and hepatorenal multimorbidity (gallstone disease, chronic kidney disease, cirrhosis, peptic ulcer, and cancer), and mental and arthritis multimorbidity (neurasthenia, psychiatric disorder, and rheumatoid arthritis). During a median of 10.8 years of follow-up, 49,371 deaths occurred. Compared with participants without multimorbidity, cardiometabolic multimorbidity (hazard ratios [HR] = 2.20, 95% confidence intervals [CI]: 2.14 − 2.26) and respiratory multimorbidity (HR = 2.13, 95% CI:1.97 − 2.31) demonstrated relatively higher risks of mortality, followed by gastrointestinal and hepatorenal multimorbidity (HR = 1.33, 95% CI:1.22 − 1.46). The mortality risk increased by 36% (HR = 1.36, 95% CI: 1.35 − 1.37) with every additional disease.

Conclusion:
Cardiometabolic multimorbidity and respiratory multimorbidity posed the highest threat on mortality risk and deserved particular attention in Chinese adults.
Population genetic polymorphisms of pharmacogenes in Zimbabwe, a potential guide for the safe and efficacious use of medicines in people of African ancestry
Authors: Mbavha Bianza T. , Kanji Comfort R. , Stadler Nadina , Stingl Julia , Stanglmair Andrea , Scholl Catharina , Wekwete William , Masimirembwa Collen 
Published: February 2022

Objective
Pharmacogenomics (PGx) is a clinically significant factor in the safe and efficacious use of medicines. While PGx knowledge is abundant for other populations, there are scarce PGx data on African populations and is little knowledge on drug–gene interactions for medicines used to treat diseases common in Africa. The aim of this study was to use a custom-designed open array to genotype clinically actionable variants in a Zimbabwean population. This study also identified some of the commonly used drugs in Zimbabwe and the associated genes involved in their metabolism.

Methods
A custom-designed open array that covers 120 genetic variants was used to genotype 522 black Zimbabwean healthy volunteers using TaqMan-based single nucleotide polymorphism genotyping. Data were also accessed from Essential Drugs’ List in Zimbabwe (EDLIZ), and the medicines were grouped into the associated biomarker groups based on their metabolism. We also estimated the national drug procurement levels for medicines that could benefit from PGx-guided use based on the data obtained from the national authorities in Zimbabwe.

Results
The results demonstrate the applicability of an open-array chip in simultaneously determining multiple genetic variants in an individual, thus significantly reducing cost and time to generate PGx data. There were significantly high frequencies of African-specific variants, such as the CYP2D6*17 and *29 variants and the CYP2B6*18 variant. The data obtained showed that the Zimbabwean population exhibits PGx variations in genes important for the safe and efficacious use of drugs approved by the EDLIZ and are procured at significantly large amounts annually. The study has established a cohort of genotyped healthy volunteers that can be accessed and used in the conduct of clinical pharmacogenetic studies for drugs entering a market of people of predominantly African ancestry.

Conclusion
Our study demonstrated the potential benefit of integrating PGx in Zimbabwe for the safe and efficacious use of drugs that are commonly used.
Obesity and abdominal obesity are risk factors for airway obstructive diseases in Korean women: nationwide population-based cohort study
Authors: Lee Chung-Woo , Kim HyunJin , Nam Myung Ji , Choi Yeon Joo , Han Kyungdo , Jung Jin-Hyung , Kim Do-Hoon , Park Joo-Hyun 
Published: February 2022

Abstract

Objective:
Existing studies show that women are more susceptible to chronic obstructive pulmonary disease (COPD) and asthma, and that obesity affects the risk of these airway obstructive diseases. We aimed to determine the effect of body mass index (BMI) and waist circumference (WC) on COPD and asthma development in premenopausal and postmenopausal women.

Methods:
This nationwide population-based cohort study included 1,644,635 women ages ≥30 years without diagnosis of COPD or asthma, who underwent national cancer screening in 2009. We classified them as premenopausal and postmenopausal women based on their menopause status at the time of cancer screening. Baseline BMI and WC were measured, and they were classified into five BMI groups (<18.5 kg/m2, 18.5-23 kg/m2, 23-25 kg/m2, 25-30 kg/m2, and ≥30 kg/m2) and WC groups (<60 cm, 65-75 cm, 75-85 cm, 85-95 cm, and ≥95 cm). The hazard ratios (HRs) for COPD and asthma were measured for each group.

Results:
Regardless of the menopausal status, the high BMI and WC groups had a significantly higher COPD and asthma incidence than that of the normal group, and the HRs increased further with increases in BMI and WC. However, the HR in the underweight group was significantly higher among the postmenopausal women. The HR for asthma in the obese group was significantly higher for both premenopausal and postmenopausal women. The HR for COPD was significantly higher in the group with a WC of ≥95 cm for both premenopausal and postmenopausal women, respectively; the HR for asthma was also significantly higher in this group.

Conclusions:
Obesity and abdominal obesity are risk factors for COPD and asthma in premenopausal and postmenopausal Korean women. Controlling weight and maintaining a healthy body shape can help prevent COPD and asthma in women.
Effectiveness of an individualized comprehensive rehabilitation program in women with chronic knee osteoarthritis: a randomized controlled trial
Authors: López Laura López , Benítez Paula Obeso , López Jesús Casilda , Martos Irene Cabrera , Torres Janet Rodríguez , Santiago María Granados , Valenza Marie-Carmen 
Published: February 2022

Abstract

Objective:
To evaluate the short- and medium-term effects of an 8-week individualized comprehensive rehabilitation program in women with chronic knee osteoarthritis as regards functionality, physical performance, and perceived health status.

Methods:
Women with chronic knee osteoarthritis were randomly assigned to the aquatic training group or to the individualized comprehensive rehabilitation (ICR) group. The main outcomes were functionality assessed with the Western Ontario and McMaster Universities Osteoarthritis Index, physical performance assessed with the Timed Up and Go test and the Stair Climbing Test, and perceived health status evaluated with the European Quality of Life- 5 Dimensions questionnaire. Participants were assessed after the treatment and at 3-month follow-up.

Results:
Forty participants were included in the study. After the treatment, there were no significant between- group differences. At 3-month follow-up, there were significant between-group differences in functionality (stiffness P = 0.049, function P = 0.005, and total subscores P = 0.048) and physical performance (Timed Up and Go P = 0.031 and Stair Climbing Test P = 0.046) in favor of the ICR group.

Conclusion:
An 8-week ICR program improved functionality, physical performance, and perceived health status compared with an aquatic training program in women with chronic knee osteoarthritis.
Rapid Deployment of Technology: Patient and Staff Empowerment at Houston Methodist
Authors: Schwartz Roberta 
Published: February 2022

SUMMARY
Digital innovations are arriving in healthcare at an increasing rate. Electronic medical records provided the foundation for this growth, and now thousands of technology companies are servicing every aspect of healthcare. Since 2018, Houston Methodist has been cultivating digital disruption, working to speed up the development of new initiatives. As our digital innovation has grown exponentially over the past few years, we have kept the patient at the center of all activities. We hold the philosophy that patient empowerment should be a process whereby patients understand their role and have access to knowledge that enables them to engage with their providers in a bidirectional relationship. Patient empowerment in the patient room, in care pathways, and in opioid reduction demonstrate the success of our approach with strongly positive outcomes. Importantly, the efforts are not only appreciated by our patients, but also widely embraced by our clinicians.
The Digital Transformation of a Metropolitan New York Health System
Authors: Mammen Adrin 
Published: February 2022

SUMMARY
Digital transformation strategies in healthcare are presenting unique ways to support patient acquisition and retention efforts. Montefiore Health System is on a multiyear, multipronged digital transformation journey with interventions centered on improving access to care.
Our patients can search for a provider, schedule a visit, get details about their visit, and check in through a welcoming digital front door. Asynchronous e-communication and video visits have also been implemented, and these added options are optimized by technologies including a new provider data management tool to support an enhanced provider directory, electronic health record system integration with online scheduling, telehealth/virtual care, and text message communications. Combined, these tactics support a positive patient experience. Happier patients are more likely to return for the care they need to improve their health and maintain wellness. In addition, digital solutions can alleviate administrative burdens, which can improve employee engagement and satisfaction.
While the lack of access to technology as a social determinant of health can present challenges in our diverse market, Montefiore has developed a respectful process to meet patients where they are in an era of consumer-driven healthcare. The process sets forth various approaches to bridge healthcare’s digital divide. The route is sequenced in a digital transformation road map to ensure that Montefiore remains competitive, provides value with operational efficiencies, and delivers the innovative care that is necessary in today’s healthcare landscape.
Asthma guidelines: comparison of the National Heart, Lung, and Blood Institute Expert Panel Report 4 with Global Initiative for Asthma 2021
Authors: Tan Laren D. , Alismail Abdullah , Ariue Barbara 
Published: February 2022

Purpose of review
Asthma continues to be a prevalent respiratory disease that affects lives within the United States and worldwide. Clinical asthma guidelines based on scientific evidence on testing and therapeutic interventions are needed to control this disease better. To meet this need, the NAEPP (National Asthma Education and Prevention Program) and GINA (Global Initiative for Asthma) were formed to assist with best practice diagnosis and treatments for asthma. This paper reviews the subtle differences and similarities between the most recent recommendations put forth by NAEPP 2020 and GINA 2021, mainly examining the six selected topics, as well as methodology, guidance on emerging topics, and implementation.

Recent findings
In December 2020, the National Asthma Education and Prevention Program Coordinating Committee released their focused update on fraction of exhaled nitric oxide, indoor allergen mitigation, inhaled corticosteroids, long-acting muscarinic antagonists, allergen immunotherapy, and bronchial thermoplasty. The Global Initiative for Asthma comprehensive document is published annually as a framework for all nations. Therefore, it is timely to consider the National Asthma Education and Prevention Program Coordinating Committee 2020 in relation to the GINA 2021.

Summary
The comparison provides a better understanding of evidence-based recommendations for asthma. The NAEPP 2020 and GINA 2021 will equip providers with the knowledge to provide their patients with the best and most updated asthma care.
Potential options to expand the intestinal donor pool: a comprehensive review
Authors: Clarysse Mathias , Dubois Antoine , Vanuytsel Tim , Pirenne Jacques , Ceulemans Laurens J. 
Published: February 2022

Purpose of review
Intestinal donation is currently restricted to ‘perfect’ donors, as the intestine is extremely vulnerable to ischemia. With generally deteriorating donor quality and increasing indications for intestinal transplantation (ITx), the potential to safely increase the donor pool should be evaluated.

Recent findings
Increasing awareness on intestinal donation (often forgotten) and cautiously broadening the strict donor criteria (increasing age, resuscitation time and ICU stay) could expand the potential donor pool. Donors after circulatory death (DCD) have so far not been considered for ITx, due to the particularly detrimental effect of warm ischemia on the intestine. However, normothermic regional perfusion might be a well tolerated strategy to render the use of DCD intestinal grafts feasible. Furthermore, machine perfusion is under continuous development and might improve preservation of the intestine and potentially offer a platform to modulate the intestinal graft. Lastly, living donation currently represents only a minority of all ITxs performed worldwide. Various studies and registry analysis show that it can be performed safely for the donor and successfully in the recipient.

Summary
Several potential strategies are available to expand the current intestinal donor pool. Most of them require further investigation or technical developments before they can be implemented in the clinical routine.