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Diagnostic accuracy of stroke volume variation for predicting fluid responsiveness in children undergoing cardiac surgery: a systematic review and meta-analysis.

Paediatr Anaesth 2021 Apr 21. Epub 2021 Apr 21.

Department of Intensive Care Unit, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Dong Lake District, Nanchang, 330000, Jiangxi Province, China.

Background: Stroke volume variation (SVV) appears to be reliable for predicting fluid responsiveness (FR) in adults and its predictive value in paediatric patients has been recently reported. However, its predictive value in children undergoing cardiac surgery is unclear.

Methods: A review and meta-analysis were performed on the diagnostic utility of SVV for predicting FR in children undergoing cardiac surgery. Read More

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Tales of two study designs in patients with chronic kidney failure The case of the protein-energy wasting (PEW) - inflammation syndromic complex.

J Intern Med 2021 Apr 21. Epub 2021 Apr 21.

Nephrology, Dialysis and Renal Transplantation Unit, Grande Ospedaliera Metropolitano, Reggio Cal, Italy.

Chronic kidney failure (CKF) is among the chronic conditions with the highest risk of death. In fact, the life expectancy of these patients is inferior to that of patients with cancers. Protein-energy wasting (PEW) and inflammation (I) are common and usually concurrent conditions in CKF. Read More

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Surgical Outcomes of Non-Small Cell Lung Cancer in Single-Zone N2 in the Aortopulmonary Zone.

Thorac Cardiovasc Surg 2021 Apr 21. Epub 2021 Apr 21.

Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Seoul, Korea.

Objectives:  We evaluate the surgical outcome of clinically single-zone N2 lung cancer limited to aortopulmonary zone (AP zone; lymph node #5 or #6).

Patients And Methods:  We performed a retrospective analysis of patients with non-small cell lung cancer, in whom mediastinal lymph node metastasis was confined to AP zone.

Results:  A total of 84 patients who underwent upfront surgery were included in final analysis. Read More

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Heater-Cooler Devices and Risk of Contamination during Cardiac Surgery.

Thorac Cardiovasc Surg 2021 Apr 21. Epub 2021 Apr 21.

Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller University of Jena, Jena, Germany.

Background:  Heater-cooler devices (HCD) have been implicated in a cardiosurgical contamination scenario causing prosthetic valve endocarditis.

Aim:  We characterized contamination of new HCDs and assessed the risk of intraoperative microorganism transmission from the HCD to the operating field.

Methods:  We initially acquired four new FlexTherm and then four new Maquet HCU40 HCDs and assessed occurrence and speed of microbial contamination (including mycobacteria) assessing swab and water samples from the device. Read More

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[Treatment of a Patient with a Pronounced Cytokine Storm in Severe COVID-19 Pneumonia using a Hemoadsorption in Combination with the Administration of tocilizumab].

Pneumologie 2021 Apr 21. Epub 2021 Apr 21.

Klinikum Würzburg Mitte gGmbH, Standort Missioklinik, Medizinische Klinik mit Schwerpunkt Pneumologie & Beatmungsmedizin.

Despite growing experience due to increasing patient numbers, the intensive care treatment of patients with severe COVID-19 pneumonia continues to be a particular challenge in individual cases, which may also therefore legitimize individualized therapeutic attempts. In this context, the so-called hyperinflammation syndrome characterized by a cytokine storm accompanied by a massive increase in inflammatory markers such as interleukin(IL)-6, represents such a situation. This case report describes the therapeutic approach of using the IL-6-specific antibody tocilizumab in combination with hemoadsorption therapy (CytoSorb) in a 58-year-old male patient with severe COVID-19 pneumonia. Read More

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How to Improve Information Technology to Support Healthcare to Address the COVID-19 Pandemic: an International Survey with Health Informatics Experts.

Yearb Med Inform 2021 Apr 21. Epub 2021 Apr 21.

Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada.

Objectives: To identify the ways in which healthcare information and communication technologies can be improved to address the challenges raised by the COVID-19 pandemic.

Methods: The study population included health informatics experts who had been involved with the planning, development and deployment of healthcare information and communication technologies in healthcare settings in response to the challenges presented by the COVID-19 pandemic. Data were collected via an online survey. Read More

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Primary Care Informatics Response to Covid-19 Pandemic: Adaptation, Progress, and Lessons from Four Countries with High ICT Development.

Yearb Med Inform 2021 Apr 21. Epub 2021 Apr 21.

Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.

Objective: Internationally, primary care practice had to transform in response to the COVID pandemic. Informatics issues included access, privacy, and security, as well as patient concerns of equity, safety, quality, and trust. This paper describes progress and lessons learned. Read More

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Trials and Tribulations: mHealth Clinical Trials in the COVID-19 Pandemic.

Yearb Med Inform 2021 Apr 21. Epub 2021 Apr 21.

Graduate School of Biomedical Engineering, The University of New South Wales, Sydney, Australia.

Introduction: Mobile phone-based interventions in cardiovascular disease are growing in popularity. A randomised control trial (RCT) for a novel smartphone app-based model of care, named TeleClinical Care - Cardiac (TCC-Cardiac), commenced in February 2019, targeted at patients being discharged after care for an acute coronary syndrome or episode of decompensated heart failure. The app was paired to a digital sphygmomanometer, weighing scale and a wearable fitness band, all loaned to the patient, and allowed clinicians to respond to abnormal readings. Read More

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Managing Pandemics with Health Informatics: Successes and Challenges.

Yearb Med Inform 2021 Apr 21. Epub 2021 Apr 21.

Clinical Informatics Center, UT Southwestern, Medical Center, Dallas, TX, USA.

Introduction: The novel COVID-19 pandemic struck the world unprepared. This keynote outlines challenges and successes using data to inform providers, government officials, hospitals, and patients in a pandemic.

Methods: The authors outline the data required to manage a novel pandemic including their potential uses by governments, public health organizations, and individuals. Read More

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Data Quality of Chemotherapy-Induced Nausea and Vomiting Documentation.

Appl Clin Inform 2021 Mar 21;12(2):320-328. Epub 2021 Apr 21.

School of Nursing, Columbia University, New York, New York, United States.

Objective:  The objective of the study was to characterize the completeness and concordance of the electronic health record (EHR) documentation of cancer symptoms among multidisciplinary health care professionals.

Methods:  We examined the EHRs of children, adolescents, and young adults who received highly emetogenic chemotherapy and characterized the completeness and concordance of chemotherapy-induced nausea and vomiting (CINV) documentation by clinician type and by the International Classification of Diseases 10th Revision (ICD-10) coding choice.

Results:  The EHRs of 127 patients, comprising 870 patient notes, were abstracted and reviewed. Read More

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[New aspects in Fournier's gangrene - a rapid review].

Aktuelle Urol 2021 Apr 21. Epub 2021 Apr 21.

Universitätsmedizin Rostock, Urologische Klinik und Poliklinik, Rostock.

Fournier's gangrene (FG) is a sporadic, life-threatening, necrotising infection affecting the perineum, perineal region and genitals. Published literature provides hints that the outcome of this disease has failed to improve in recent years. We have therefore performed a rapid evidence synthesis by searching the database MEDLINE. Read More

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[Non-metastatic castration-resistant prostate cancer (M0CRPC) - Apalutamide in high-risk M0CRPC: case reports from the SPARTAN study and the apalutamide compassionate use program].

Aktuelle Urol 2021 Apr 21. Epub 2021 Apr 21.

Universitätsklinikum Münster, Urology, Münster.

The occurrence of distant metastases represents a prognostically unfavourable turning point in non-metastatic castration-resistant prostate cancer (M0CRPC). M0CRPC patients with a short PSA doubling time have a particularly high risk of progression. For a long time, there was no further treatment option for these patients apart from watchful waiting while maintaining classic androgen deprivation therapy (ADT). Read More

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[Concepts for diagnosis, course and fall risk assessment in neurological gait disorders].

Fortschr Neurol Psychiatr 2021 Apr 21. Epub 2021 Apr 21.

Klinikum der Universität München, Deutsches Schwindel- und Gleichgewichtszentrum.

Quantitative gait assessment is increasingly applied in the diagnosis, disease monitoring, and risk stratification of neurological gait disorders. However, it is unclear, which measurement approaches, examination conditions, and gait characteristics are appropriate for answering specific clinical questions. The aim of this review was to provide generally applicable concepts and strategies for the measurement, analysis, and interpretation of gait function in the clinical context and to discuss their implementation in clinical practice. Read More

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Tissue Retraction for Head and Neck Radiotherapy in Edentulous Patients.

Int J Prosthodont 2021 Mar-Apr;34(2):261-266

Tissue retraction devices (TRDs) are used for head and neck radiotherapy to displace soft tissues and fixate the mandible. They can increase the accuracy of irradiation and reduce its side effects, such as oral mucositis. However, no method has been described for fabrication of TRDs in edentulous patients. Read More

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Esthetic Outcomes of Implant-Supported Single Crowns Related to Abutment Type and Material: A Systematic Review.

Int J Prosthodont 2021 Mar-Apr;34(2):229-249

Purpose: To systematically review the influence of abutment material and configuration on the soft tissue esthetic outcomes of implant-supported single crowns (iSCs) after 3 years.

Materials And Methods: An electronic search on MEDLINE (PubMed) from January 2000 to July 2019 was conducted for clinical trials with no language restrictions. The focus question was: In partially edentulous patients with iSCs, does the abutment material (metal vs ceramic) or the configuration (standardized vs customized) have an effect on the soft tissue esthetic outcomes? Randomized controlled trials, controlled clinical trials, and prospective or retrospective case series with at least 10 patients and a minimum of 3 years of follow-up were included. Read More

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Medium- and Long-Term Survival Rates of Implant-Supported Single and Partial Restorations at a Maximum Follow-up of 12 Years: A Retrospective Study.

Int J Prosthodont 2021 Mar-Apr;34(2):183-191

Purpose: To present medium- and long-term biologic outcomes of implant-supported single-tooth restorations and fixed partial dentures and to analyze their correlations with prosthesis and patient characteristics.

Materials And Methods: The records of patients treated with implant-supported fixed restorations between 2004 and 2019 reporting the presence or absence of peri-implantitis and/or implant failure were analyzed. The cumulative survival rate (%) over time was calculated, as well as the cumulative prevalence of units free of peri-implantitis. Read More

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Effects of Different Therapeutic Modalities on the Clicking Sound and Quantitative Assessment of the Vertical and Lateral Mandibular Movements of Patients with Internal Derangements of the Temporomandibular Joint.

Int J Prosthodont 2021 Mar-Apr;34(2):173-182

Purpose: To compare the efficacy of low-dose laser therapy to that of conservative treatment using two different occlusal splints (stabilization and anterior repositioning splints) in patients with internal derangements of the temporomandibular joint (TMJ).

Materials And Methods: The study population consisted of patients with disc displacement with reduction diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I and Axis II. In addition, disc displacement with reduction was confirmed in all patients using TMJ ultrasonography. Read More

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Translucent Zirconium Dioxide and Lithium Disilicate: A 3-Year Follow-up of a Prospective, Practice-Based Randomized Controlled Trial on Posterior Monolithic Crowns.

Int J Prosthodont 2021 Mar-Apr;34(2):163-172

Purpose: To systematically evaluate and compare the clinical performance of lithium disilicate (LDS)- and zirconium dioxide (ZrO)-based ceramic monolithic crowns in the posterior dentition.

Materials And Methods: Treatment was administered by two experienced general dental practitioners in two public dental health care clinics. Forty-four patients received 60 crowns randomized to be either LDS or ZrO and cemented with resin cement. Read More

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Kidney cancer management 3.0: can artificial intelligence make us better?

Curr Opin Urol 2021 Apr 20. Epub 2021 Apr 20.

Division of Urologic Oncology Department of Pathology Department of Diagnostic Imaging, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.

Purpose Of Review: Artificial intelligence holds tremendous potential for disrupting clinical medicine. Here we review the current role of artificial intelligence in the kidney cancer space.

Recent Findings: Machine learning and deep learning algorithms have been developed using information extracted from radiomic, histopathologic, and genomic datasets of patients with renal masses. Read More

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Why Some Nurses Obtain Specialty Certification and Others Do Not.

J Nurs Adm 2021 May;51(5):249-256

Author Affiliations: Assistant Professor (Dr Dierkes), Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pennsylvania; Postdoctoral Fellow (Dr Schlak), School of Nursing, Columbia University, New York, New York; and Predoctoral Fellow (Ms French), Associate Director (Dr McHugh), and Director (Dr Aiken), Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia.

Objective: The aim of this study was to determine whether there are modifiable characteristics of nurses and hospitals associated with nurse specialty certification.

Background: Hospitals, nurses, and patients benefit from nurse specialty certification, but little actionable evidence guides administrators seeking higher hospital certification rates.

Methods: This is a cross-sectional, secondary data analysis of 20 454 nurses in 471 hospitals across 4 states. Read More

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Initial Choice of Spinal Manipulative Therapy for Treatment of Chronic Low Back Pain Leads to Reduced Long-term Risk of Adverse Drug Events Among Older Medicare Beneficiaries.

Spine (Phila Pa 1976) 2021 Apr 19. Epub 2021 Apr 19.

Southern California University of Health Sciences, Whittier, CA Geisel School of Medicine at Dartmouth, Hanover, NH.

Study Design: Retrospective observational study.

Objective: Opioid Analgesic Therapy (OAT) and Spinal Manipulative Therapy (SMT) are evidence-based strategies for treatment of chronic low back pain (cLBP), but the long-term safety of these therapies is uncertain. The objective of this study was to compare OAT versus SMT with regard to risk of adverse drug events (ADEs) among older adults with cLBP. Read More

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TRanexamic Acid In Pediatric Scoliosis Surgery (TRIPSS): A Prospective Randomized Trial Comparing High Dose and Low Dose Tranexamic Acid in Adolescent Idiopathic Scoliosis (AIS) Undergoing Posterior Spinal Fusion Surgery.

Spine (Phila Pa 1976) 2021 Apr 19. Epub 2021 Apr 19.

Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

Study Design: Prospective randomized double-blinded trial.

Objective: The objective of this study is to determine the efficacy of high dose versus low dose tranexamic acid (TXA) in adolescent idiopathic scoliosis (AIS) corrective surgery.

Summary Of Background Data: Corrective surgery for AIS is associated with significant blood loss. Read More

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Significant Variation in Blood Transfusion Practice Persists following Idiopathic Adolescent Scoliosis Surgery.

Spine (Phila Pa 1976) 2021 Apr 19. Epub 2021 Apr 19.

Department of Trauma and Orthopaedics, Mater Misericordiae University Hospital, Dublin, Ireland Department of Orthopaedics, University of North Carolina, Chapel Hill, North Carolina Department of Orthopedic Surgery, University of Rochester, Rochester, New York The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH University of Rochester Medical Center, Surgical Health Outcomes & Research Enterprise (SHORE), Rochester, NY.

Study Design: Retrospective Case Control Study.

Objective: To review current transfusion practise following AIS surgery and assess risks of complication from transfusion in this cohort.

Summary Of Background Data: No study to date has investigated variation in blood transfusion practices across surgeons and hospitals following Adolescent Idiopathic Scoliosis (AIS) surgery. Read More

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Bone Metabolism in the Healing Process of Lumbar Interbody Fusion-Temporal changes of bone turnover markers.

Spine (Phila Pa 1976) 2021 Apr 19. Epub 2021 Apr 19.

Spine Center, Hakodate Central General Hospital, Hakodate, Japan Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.

Study Design: Prospective longitudinal study.

Objective: The aim of this study was to evaluate temporal changes of bone turnover markers (BTMs) after lumbar spinal fusion in patients without osteoporosis.

Summary Of Background Data: Radiological studies are the standard method to monitor bony fusion, but they do not allow a timely assessment of bone healing. Read More

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Telemedicine for adult congenital heart disease patients during the first wave of COVID-19 era: a single center experience.

J Cardiovasc Med (Hagerstown) 2021 Apr 20. Epub 2021 Apr 20.

Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario A. Gemelli IRCCS Catholic University of the Sacred Heart Department of Pediatric Cardiology and Cardiac Surgery - Bambino Gesù Hospital, Rome, Italy.

Aim: To summarize our experience on the implementation of a telemedicine service dedicated to adult congenital heart disease (ACHD) patients during the lockdown for the first wave of COVID-19.

Methods: This is a prospective study enrolling all ACHD patients who answered a questionnaire dedicated telematic cardiovascular examination.

Results: A total of 289 patients were enrolled, 133 (47%) were male, 25 (9%) were affected by a genetic syndrome. Read More

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Prevalence and predictors of persistent sinus rhythm after elective electrical cardioversion for atrial fibrillation.

J Cardiovasc Med (Hagerstown) 2021 Apr 20. Epub 2021 Apr 20.

Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy.

Aims: To evaluate the prevalence and predictors of persistent sinus rhythm in a recent cohort of unselected patients undergoing electrical cardioversion for atrial fibrillation.

Methods: We enrolled all consecutive patients undergoing elective electrical cardioversion for atrial fibrillation between January 2017 and December 2018. We analysed baseline clinical and echocardiographic data as well as pharmacological antiarrhythmic therapy. Read More

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An Integrated Mental Health and Acute Care Clinical Rotation on a Dedicated Education Unit.

Nurse Educ 2021 Mar 30. Epub 2021 Mar 30.

Author Affiliations: Clinical Instructor (Ms Walsh and Ms Pfeifer), Research Professor (Dr Higgins), and Associate Clinical Professor (Dr Robertson), Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia; and Unit Manger (Ms Goodson), Emory Decatur Hospital, Decatur, Georgia.

Background: Traditional mental health clinical experiences expose students to an environment that may not prepare them to address mental health needs in hospital settings.

Purpose: The purpose is of this project was to evaluate the implementation of an integrated mental health and acute care clinical model on a dedicated education unit (DEU).

Methods: In this pilot project, students provided dually focused medical and mental health care on assigned patients. Read More

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Evaluation of the Use of Diverse Mental Health Simulation in Nursing Students' Learning Experience: An International Multisite Study.

Nurse Educ 2021 Mar 30. Epub 2021 Mar 30.

Clinical Assistant Professor (Dr Ozkara San), NYU Rory Meyers College of Nursing, New York; and Associate Professor (Dr Dikec) and Assistant Professor (Dr Ata), Department of Psychiatric Nursing, and Professor (Dr Sendir), Department of Fundamental Nursing, Hamidiye Faculty of Nursing, University of Health Sciences, Istanbul, Turkey.

Background: Simulated patients (SPs) in mental health nursing education provide a unique approach to assist student development in complex assessment skills.

Purpose: The purpose of this international multisite study was to evaluate the use of two diverse mental health SP simulation scenarios on nursing students' satisfaction and self-confidence in learning to care for patients with mental health disorders in the United States (n = 70) and Turkey (n = 90).

Methods: A multisite cross-sectional study design was used. Read More

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Management of small bowel adenocarcinoma: making the most of the available evidence to inform routine practice.

Curr Opin Oncol 2021 Apr 20. Epub 2021 Apr 20.

University Hospital Antwerp, Edegem Antwerp University, Antwerp, Belgium.

Purpose Of Review: Small bowel adenocarcinoma (SBA) is a rare disease, for which few studies have been conducted so far. Therefore, most treatment recommendations have been extrapolated from trials in colorectal cancer. In this review, we revise available data that could improve the management of SBA, with a particular focus on systemic therapy. Read More

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Anal squamous cell carcinoma: standards of care, new data and ongoing clinical trials.

Curr Opin Oncol 2021 Apr 20. Epub 2021 Apr 20.

Medical Oncology Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', Naples, Italy Department of Medical Oncology, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium.

Purpose Of Review: To summarize current standards of care, discuss results of recent studies and present ongoing clinical trials for anal squamous cell carcinoma (ASCC).

Recent Findings: Over the last year, no practice changing studies have been reported in the setting of localised ASCC. A number of retrospective analyses, however, have provided practice-informing data, such as those confirming the negative impact of low compliance to chemoradiotherapy (CRT) on patient outcomes. Read More

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