bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Prone Position in COVID-19 Patients on Extracorporeal Membrane Oxygenation*
Authors: Massart Nicolas , Guervilly Christophe , Mansour Alexandre , Porto Alizée , Flécher Erwan , Esvan Maxime , Fougerou Claire , Fillâtre Pierre , Duburcq Thibault , Lebreton Guillaume , Para Marylou , Stephan François , Hraiech Sami , Ross James T. , Schmidt Matthieu , Vincentelli André , Nesseler Nicolas ,   for the Extracorporeal Membrane Oxygenation for Respiratory Failure and/or Heart failure related to Severe Acute Respiratory Syndrome Coronavirus 2 (ECMOSARS) Investigators
Published: December 2022

OBJECTIVES:
Prone positioning and venovenous extracorporeal membrane oxygenation (ECMO) are both useful interventions in acute respiratory distress syndrome (ARDS). Combining the two therapies is feasible and safe, but the effectiveness is not known. Our objective was to evaluate the potential survival benefit of prone positioning in venovenous ECMO patients cannulated for COVID-19–related ARDS.

DESIGN:
Retrospective analysis of a multicenter cohort.

PATIENTS:
Patients on venovenous ECMO who tested positive for severe acute respiratory syndrome coronavirus 2 by reverse transcriptase polymerase chain reaction or with a diagnosis on chest CT were eligible.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
All patients on venovenous ECMO for respiratory failure in whom prone position status while on ECMO and in-hospital mortality were known were included. Of 647 patients in 41 centers, 517 were included. Median age was 55 (47–61), 78% were male and 95% were proned before cannulation. After cannulation, 364 patients (70%) were proned and 153 (30%) remained in the supine position for the whole ECMO run. There were 194 (53%) and 92 (60%) deaths in the prone and the supine groups, respectively. Prone position on ECMO was independently associated with lower in-hospital mortality (odds ratio = 0.49 [0.29–0.84]; p = 0.010). In 153 propensity score-matched pairs, mortality rate was 49.7% in the prone position group versus 60.1% in the supine position group (p = 0.085). Considering only patients alive at decannulation, propensity-matched proned patients had a significantly lower mortality rate (22.4% vs 37.8%; p = 0.029) than nonproned patients.

CONCLUSIONS:
Prone position may be beneficial in patients supported by venovenous ECMO for COVID-19–related ARDS but more data are needed to draw definitive conclusions.
Transfusion practices in patients with advanced cancer: a retrospective study in a palliative care service
Authors: Marote Sara , Marinho Joana , Silva Maria Cândida , Ferraz Gonçalves José 
Published: December 2022

Abstract

Background:
Anemia is highly prevalent in patients with advanced cancer and adversely affects the quality of life. There are limited data on the frequency, clinical utility, and effectiveness of red blood cell (RBC) transfusions, and no randomized controlled clinical trials or clinical practice guidelines are available. The aim of this study was to evaluate clinician practices on RBC transfusion in an oncologic palliative care service and its impact on patients' symptoms, adverse events, and overall survival.

Methods:
This is a retrospective analysis of all patients with advanced cancer who received RBC transfusions admitted for 3 years. Preblood counts, the reason for transfusion, subjective benefit, and objective outcomes were listed.

Results:
We identified 179 patients who underwent RBC transfusions. The mean age was 67 years, and 60% were male. We found a total of 435 RBC units in 301 transfusion episodes. Asthenia/fatigue was the most frequent symptom (68%). The mean pretransfusion hemoglobin (Hb) was 6.85 g/dL, and 48% of patients had a Hb above 7 g/dL. The symptomatic benefit was achieved in 36% of patients. Adverse events were reported in 4%, with a 30-day survival rate of 57%. A statistically significant association was found between Eastern Cooperative Oncology Group performance status (ECOG-PS) and the symptomatic benefit (P = .005). Hb level pretransfusion, ECOG-PS, and symptomatic benefits with transfusions were significantly associated with survival.

Conclusion:
This study suggests that patients with advanced cancer with a higher functioning level may benefit more from RBC transfusion. Post-transfusion symptomatic benefits and pretransfusion ECOG-PS and Hb levels are independent predictors of survival. Further studies are needed to develop validated measures of objective functional changes to evaluate transfusions' clinical impact and identify patients most likely to benefit from it.
The prognostic impact of magnesium in acute heart failure is different according to the presence of diabetes mellitus
Authors: Cidade-Rodrigues Catarina , Cunha Filipe M. , Elias Catarina , Carreira Marta , Barroso Isaac , Bettencourt Paulo , Lourenço Patrícia 
Published: December 2022

Abstract

Background:
Hypermagnesemia predicts mortality in chronic heart failure (HF); however, in acute HF, magnesium does not seem to be outcome-associated. Diabetes mellitus (DM) frequently associates with altered magnesium status. We hypothesized that DM might influence the prognostic impact of magnesium in acute HF.

Methods:
This is a retrospective cohort study of hospitalized patients with acute HF. Patients without data on admission serum magnesium were excluded. Follow-up: 1 year from hospital admission. Primary end point: all-cause mortality. Patients were divided according to median serum magnesium (1.64 mEq/L). The Kaplan-Meier survival method was used to determine survival curves according to magnesium levels. The analysis was stratified according to the presence of DM. A multivariable Cox regression analysis was used to study the prognostic impact of magnesium.

Results:
We studied 606 patients. The mean age was 76 ± 12 years, 44.1% were male, 50.7% had DM, and 232 (38.3%) died during follow-up. Median magnesium was 1.64 (1.48–1.79) mEq/L. Patients with magnesium ≥1.64 mEq/L had higher 1-year mortality [141 (46.4%) vs 91 (30.1%), P < .001]. After adjustments for age, sex, history of atrial fibrillation, systolic blood pressure, heart rate, ischemic etiology, B-type natriuretic peptide, estimated glomerular filtration rate, alcohol consumption, antihyperglycaemic agents or glycated hemoglobin, admission glycemia, New York Heart Association class IV, and severe left ventricle systolic dysfunction, serum magnesium ≥1.64 mEq/L was associated with higher mortality only in patients with DM: HR 1.89 (95% confidence interval: 1.19–3.00), P = .007, and 1.27 (95% confidence interval: 0.83–1.94) and P = .26 for non-DM patients. The results were similar if magnesium was analyzed as a continuous variable. Per 0.1 mEq/L increase in magnesium levels, patients with DM had 13% increased risk of 1-year mortality.

Conclusions:
Higher magnesium levels were associated with worse prognosis only in HF patients with DM.
The Role of the Hand Surgery Consultant in the Care of the Football Athlete
Authors: Rettig Lance A. , Rettig Arthur C. 
Published: December 2022

Purpose:
Return–to–play safely focusing on care for professional athletes. Variability on when return-to-play is possible due to differences in dexterity requirements of player's position and upper extremity injuries. This study covers the importance of trust between players and healthcare providers in the incident of upper extremity injury and aspects of when return-to-play is favorable.

Material and Methods:
The methods and materials used in this study were a collection of case reviews and documentation of injuries reported by national leagues. A retrospective review from 2000 to 2012 reviewing case series reported by the NFL Injury Surveillance System (NFL ISS). The case reviews included player activity, external bracing, and clinical notes. The review extracted from the National football league surveyed injuries over a 10-year period from 1996 – 2005. The National Football league's surveillance database was used focusing on the type of injury, the athlete's position, and the type of activity that was occurring at the time of injury.

Results:
The 7 included articles reported most injuries occurred in defensive players. The majority of injuries were sustained while tackling. Additionally, the 7 articles included a discussion of injury types including those of the hand, wrist, forearm, and elbow. Treatment plans were also reviewed catering to the type of injury. Players who were treated non-operatively missed a mean of 25 days and players who were treated operatively missed a mean of 46 days.

Conclusion:
The importance of communication between surgeons, coaches, players, and general managers of teams is vital in caring for injured players. All parties need to be aware of how much time players will miss and the best management techniques to take to get them back on the playing field.
Development of a Long-Term Cross-Sectoral Case and Care Management Manual for Patients With Severe Multiple Sclerosis and Their Caregivers
Authors: Müller Anne , Dillen Kim , Dojan Thomas , Ungeheuer Solveig , Goereci Yasemin , Dunkl Veronika , Voltz Raymond , Löcherbach Peter , Warnke Clemens , Golla Heidrun 
Published: December 2022

Purpose/Objectives:
Care and case management (CCM) aims to provide optimal care for patients and their caregivers on an individual and superordinate level of health care providers and authorities. To facilitate a clear and systematic CCM process as part of a clinical study intervention, a semistructured manual is the prerequisite.

Primary Practice Setting(s):
The ongoing COCOS-MS (Communication, Coordination and Security for People with Multiple Sclerosis) study is a randomized controlled Phase II clinical intervention study. The CCM manual is being tested on the intervention group consisting of severely affected individuals with multiple sclerosis (MS; Expanded Disability Status Scale [EDSS] >5) and their caregivers receiving CCM for 12 months in addition to standard care. The intervention comprises monthly personal visits and weekly telephone calls during which the CCM manual is applied.

Findings/Conclusions:
The CCM manual has been developed on the basis of previous literature and well-established questionnaires following theoretical aspects and prior scientific work covering individual domains of life of people with MS. Within the COCOS-MS study, its feasibility is being tested meticulously. It allows for a standardized assessment while being tailored to the individual. At the end of the intervention period, it will be analyzed statistically and qualitatively. Consequently, conclusions can be drawn as to whether the CCM manual is feasible or has to be adapted for use in standard care after analyzation.

Implications for Case Management Practice:
The CCM manual serves as a tool for the continuous, long-term, cross-sectoral care for patients suffering from severe MS and their caregivers. The manual provides guidance in adequately addressing patients' complex symptoms, problems, and needs, as well as assessing existing resources both at the individual patient level and at a superordinate level.
Structured Outpatient Diabetes Education and Telehealth Follow-up to Improve HbA1c
Authors: Harris-Hardaway Marina B. , Novotny Nancy L. , Sawyer Jennifer Dana , Schmitt Erin 
Published: December 2022

Background:
More than 10% of Americans have diabetes, with higher rates in Hispanics and African Americans. National Healthy People 2030 goals for expected decrease in HbA1c levels have not been met.

Local Problem:
No standardized diabetes education or follow-up existed at a free clinic. Patients exhibited diabetic self-management inadequacies and elevated HbA1c levels.

Methods:
A pre/postimplementation study design was used to evaluate changes in HbA1c levels, medication adherence, missed appointments, and emergency department visits.

Interventions:
Structured diabetes education and follow-up text/phone messages for patients with HbA1c levels 8% or higher were implemented over 3 months.

Results:
Outcome data were available for 27 of the 34 participants. Postimplementation, there was a significant 1.7% decrease in mean HbA1c levels (P < .001). No significant differences were found for the other outcome measures.

Conclusions:
Structured diabetes education and follow-up text/phone messages in a free clinic improved patients' HbA1c levels.
Medication discharge teaching in pediatric hematopoietic stem cell transplantation: teaching characteristics, caregiver perceptions, and postdischarge adherence
Authors: Szulczewski Lauren , Carmody Julia K. , Tillery Rachel , Nelson Adam S. , Pai Ahna L. H. 
Published: December 2022

Abstract

Background:
Hematopoietic stem cell transplantation (HCT) is an arduous but necessary treatment for many otherwise incurable diseases. It involves a complex medication regimen that is linked to significant clinical outcomes and must be learned by families before discharge. The purpose of this study was to qualitatively explore medication discharge teaching factors and to examine associations between those factors and caregiver self-perceived knowledge and efficacy.

Methods:
Nineteen video-recorded medication discharge teachings, conducted by hematopoietic stem cell transplantation pharmacists, were coded to identify elements of discharge teaching, including information presented, communication, and environmental factors. Caregivers also completed a semistructured interview and a short measure to assess caregiver efficacy regarding their child's medication regimen.

Results:
Pharmacists were consistent in their review of the names, dosages, and frequency of the medications being prescribed. However, there was variability regarding information provided about adherence, specific learnings (ie, how to read/fill syringe), and behavioral strategies to promote adherence (ie, adjust timing to fit family's schedule). Immediately and 1 week after the teaching, caregivers reported high levels of confidence regarding their ability to understand and manage their child's medication regimen.

Conclusion:
Teaching families about the prescribed medication regimen is a critical component of the discharge process. The current findings suggest that increasing the consistency with which information is provided to families regarding the effective management of the medication regimen could potentially be a method to facilitate adherence.
Adverse Events in Pediatric Critical Care Nonsurvivors With a Low Predicted Mortality Risk: A Multicenter Case Control Study*
Authors: Verlaat Carin W. , Zegers Marieke , Klein Richard , van Waardenburg Dick , Kuiper Jan Willem , Riedijk Maaike , Kneyber Martin , Timmers Brigitte , van Heerde Marc , Hazelzet Jan A. , van der Hoeven Johannes , Lemson Joris ,   for the PICE registry (Pediatric Intensive Care Evaluation)/SKIC (Dutch Collaborative PICU Research Network)
Published: December 2022

OBJECTIVES:
Some patients with a low predicted mortality risk in the PICU die. The contribution of adverse events to mortality in this group is unknown. The aim of this study was to estimate the occurrence of adverse events in low-risk nonsurvivors (LN), compared with low-risk survivors (LS) and high-risk PICU survivors and nonsurvivors, and the contribution of adverse events to mortality.

DESIGN:
Case control study. Admissions were selected from the national Dutch PICU registry, containing 53,789 PICU admissions between 2006 and 2017, in seven PICUs. PICU admissions were stratified into four groups, based on mortality risk (low/high) and outcome (death/survival). Random samples were selected from the four groups. Cases were “LN.” Control groups were as follows: “LS,” “high-risk nonsurvivors” (HN), and “high-risk survivors” (HS). Adverse events were identified using the validated trigger tool method.

SETTING:
Patient chart review study.

PATIENTS:
Children admitted to the PICU with either a low predicted mortality risk (< 1%) or high predicted mortality risk (≥ 30%).

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
In total, 419 patients were included (102 LN, 107 LS, 104 HN, and 106 HS). LN had more complex chronic conditions (93.1%) than LS (72.9%; p < 0.01), HN (49.0%; p < 0.001), and HS (48.1%; p < 0.001). The occurrence of adverse events in LN (76.5%) was higher than in LS (13.1%) and HN (47.1%) (p < 0.001). The most frequent adverse events in LN were hospital-acquired infections and drug/fluid-related adverse events. LN suffered from more severe adverse events compared with LS and HS (p < 0.001). In 30.4% of LN, an adverse event contributed to death. In 8.8%, this adverse event was considered preventable.

CONCLUSIONS:
Significant and preventable adverse events were found in low-risk PICU nonsurvivors. 76.5% of LN had one or more adverse events. In 30.4% of LN, an adverse event contributed to mortality.
The Use and Impact of Diaries in PICUs and Neonatal ICUs: A Scoping Review
Authors: Low Sherry Zhi Qing , Kirk Angela , Mok Yee Hui , Lee Jan Hau 
Published: December 2022

OBJECTIVE:
Several studies have investigated the impact of diaries in adult ICUs, which have been used as a tool to support recall and reduce post-traumatic stress disorder in patients and their families. We conducted a scoping review to determine the definition of ICU diaries, and the extent, range, and nature of research conducted on NICU and PICU diaries, describe their use and impact, as well as identify gaps in knowledge and areas for future research.

DATA SOURCES:
The following databases were searched from inception to March 2022: Cumulated Index to Nursing and Allied Health Literature, Cochrane Library, Embase, PubMed, and American Psychological Association PsycINFO. Searches were also conducted in the following gray literature databases: Google Scholar, University of South Australia, and WorldCat.

STUDY SELECTION:
All studies that discussed the use and impact of diaries or journals involving patients (<18 yr old) in PICUs and NICUs and/or their family members were included.

DATA SYNTHESIS:
Sixteen studies were identified. Most studies defined diaries as daily entries written by nurses and/or family members regarding the patient’s condition during their ICU admission. The majority reported that diaries were beneficial to children and their families as they helped to fill in memory gaps, provided a means to express their feelings, and served as effective health communication tools. Several gaps were identified: extent of the use of diaries as a means of communication, the significance of diaries as a coping mechanism for bereaved parents, and the impact of PICU diaries on the children, their families, and healthcare professionals.

CONCLUSIONS:
There is a paucity of data on the use of NICU and PICU diaries. Nonetheless, the limited data revealed that NICU and PICU diaries were beneficial to children and their families. Our review demonstrated a heterogeneity in the terminology, content, use of photos, and the author/s of the NICU and PICU diaries. Further research is needed to investigate the impact of the use of NICU and PICU diaries on patient-reported outcomes.
Intraoperative Use of Albumin in Major Noncardiac Surgery: Incidence, Variability, and Association With Outcomes
Authors: Lazzareschi Daniel V. , Fong Nicholas , Mavrothalassitis Orestes , Whitlock Elizabeth L. , Chen Catherine L. , Chiu Catherine , Adelmann Dieter , Bokoch Michael P. , Chen Lee-Lynn , Liu Kathleen D. , Pirracchio Romain , Mathis Michael R. , Legrand Matthieu ,   for the MPOG Collaborators
Published: December 2022

Background:
The impact of albumin use during major surgery is unknown, and a dearth of evidence governing its use in major noncardiac surgery has long precluded its standardization in clinical guidelines.

Objective:
In this study, we investigate institutional variation in albumin use among medical centers in the United States during major noncardiac surgery and explore the association of intraoperative albumin administration with important postoperative outcomes.

Methods:
The study is an observational retrospective cohort analysis performed among 54 U.S. hospitals in the Multicenter Perioperative Outcomes Group and includes adult patients who underwent major noncardiac surgery under general anesthesia between January 2014 and June 2020. The primary endpoint was the incidence of albumin administration. Secondary endpoints are acute kidney injury (AKI), net-positive fluid balance, pulmonary complications, and 30-day mortality. Albumin-exposed and albumin-unexposed cases were compared within a propensity score-matched cohort to evaluate associations of albumin use with outcomes.

Results:
Among 614,215 major surgeries, predominantly iso-oncotic albumin was administered in 15.3% of cases and featured significant inter-institutional variability in use patterns. Cases receiving intraoperative albumin involved patients of higher American Society of Anesthesiologists physical status and featured larger infused crystalloid volumes, greater blood loss, and vasopressor use. Overall, albumin was most often administered at high-volume surgery centers with academic affiliation, and within a propensity score-matched cohort (n=153,218), the use of albumin was associated with AKI (aOR 1.24, 95% CI 1.20–1.28, P<0.001), severe AKI (aOR 1.45, 95% CI 1.34–1.56, P<0.001), net-positive fluid balance (aOR 1.18, 95% CI 1.16–1.20, P<0.001), pulmonary complications (aOR 1.56, 95% CI 1.30–1.86, P<0.001), and 30-day all-cause mortality (aOR 1.37, 95% CI 1.26–1.49, P<0.001).

Conclusions:
Intravenous albumin is commonly administered among noncardiac surgeries with significant inter-institutional variability in use in the United States. Albumin administration was associated with an increased risk of postoperative complications.
Racial Disparity in Placement of Intracranial Pressure Monitoring: A TQIP Analysis
Authors: Zebley James A , Estroff Jordan M , Forssten Maximilian Peter , Leighton Nicolas , Bass Gary Alan , Sarani Babak , Mohseni Shahin 
Published: December 2022

BACKGROUND:
The Brain Trauma Foundation recommends intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (TBI). Race is associated with worse outcomes after TBI. The reasons for racial disparities in clinical decision-making around ICP monitor placement remain unclear.

STUDY DESIGN:
We queried the TQIP database from 2017 to 2019 and included patients 16 years or older, with blunt severe TBI, defined as a head abbreviated injury score 3 or greater. Exclusion criteria were missing race, those without signs of life on admission, length of stay 1 day or less, and AIS of 6 in any body region. The primary outcome was ICP monitor placement, which was calculated using a Poisson regression model with robust SEs while adjusting for confounders.

RESULTS:
A total of 260,814 patients were included: 218,939 White, 29,873 Black, 8,322 Asian, 2,884 American Indian, and 796 Native Hawaiian or Other Pacific Islander. Asian and American Indian patients had the highest rates of midline shift (16.5% and 16.9%). Native Hawaiian or Other Pacific Islanders had the highest rates of neurosurgical intervention (19.3%) and ICP monitor placement (6.5%). Asian patients were found to be 19% more likely to receive ICP monitoring (adjusted incident rate ratio 1.19; 95% CI 1.06 to 1.33; p = 0.003], and American Indian patients were 38% less likely (adjusted incident rate ratio 0.62; 95% CI 0.49 to 0.79; p < 0.001), compared with White patients, respectively. No differences were detected between White and Black patients.

CONCLUSIONS:
ICP monitoring use differs by race. Further work is needed to elucidate modifiable causes of this difference in the management of severe TBI.