Comparing the Effects of the Induction of Anesthesia with Etomidate to the Induction of Anesthesia with Midazolam on the Incidence of In-Hospital Mortality: A Scoping Review

Purpose/Background The induction of anesthesia using hypnotic sedatives, such as etomidate and midazolam, is common practice. Etomidate and midazolam are commonly employed in the induction of anesthesia in the septic patient population, each with its unique advantages and drawbacks. This scoping review aims to synthesize evidence on the effects of anesthetic induction with etomidate versus midazolam in adult septic patients, focusing on the incidence of mortality and associated adverse effects during hospitalization. The purpose is to establish a standard of care for anesthetic induction in this population. Methods A literature review was conducted from September 2022 to March 2023 utilizing CINAHL Complete, SCOPUS, Access Medicine, Cochrane Library, and PubMed databases. Over 100 articles were found utilizing our keywords, which included induction agent, etomidate, midazolam, critical illness, sepsis, septic shock, severe sepsis, mortality, and hospital length of stay. Of these, 25 articles met the author’s inclusion criteria and underwent Rapid Critical Appraisal (RCA) to assess the quality and validity of the studies. This appraisal yielded ten articles that were further synthesized and classified by their level of evidence table. Results Ten studies were examined to assess the effects of etomidate and midazolam on septic patients. The results showed that when etomidate is used to induce anesthesia in septic patients, it can lead to increased in-hospital mortality rates and longer ICU and hospital lengths of stay. Additionally, six studies found that etomidate can cause adrenal gland suppression. On the other hand, midazolam was associated with lower mortality rates when used to induce anesthesia in septic patients. However, there is insufficient data concerning its ability to produce profound anesthesia in septic patients without causing undesirable hemodynamic changes. Based on the available data, midazolam is considered to be the safer option for inducing anesthesia in septic patients. Implications for Nursing Practice The results of the scoping review support that etomidate usage is linked to longer stays in the ICU and hospital and higher hospital-wide mortality compared to midazolam. These findings indicate that the use of midazolam to induce anesthesia in septic patients is preferred but not without risks to patients. Anesthesia personnel should be educated when utilizing midazolam, blood pressure should be monitored closely, and timely intervention should be conducted to prevent hemodynamic changes. The results of this scoping review highlight the need for a standard of care to be established on what medications to use during the induction of anesthesia in septic patients. Further research is needed to guide nurse anesthesia practice for improved septic patient outcomes

Path integral Monte Carlo simulations for rigid rotors and their application to water

In this work the path integral formulation for rigid rotors, proposed by M\"user and Berne [Phys. Rev. Lett. {\bf 77}, 2638 (1996)], is described in detail. It is shown how this formulation can be used to perform Monte Carlo simulations of water. Our numerical results show that whereas some properties of water can be accurately reproduced using classical simulations with an empirical potential which, implicitly, includes quantum effects, other properties can only be described quantitatively when quantum effects are explicitly incorporated. In particular, quantum effects are extremely relevant when it comes to describing the equation of state of the ice phases at low temperatures, the structure of the ices at low temperatures, and the heat capacity of both liquid water and the ice phases. They also play a minor role in the relative stability of the ice phases.Comment: to appear in Molecular Physics (2011

Hepatitis C Virus Screening Strategies to Improve Early Identification and Treatment: ​ A Scoping Review​

Purpose/Background Hepatitis C virus (HCV) is the most common bloodborne infection in the United States (Ludden et al., 2022). Sadly, over half of the individuals living with chronic HCV are unaware of their condition (Halket et al., 2022). Due to rising numbers, HCV screening guidelines have been updated to recommend that every adult be screened at least once (Patel et al, 2021). Despite these guidelines, screening rates remain low. This scoping review aims to examine current research on HCV screening and strategies to improve early diagnosis and treatment. Methods This review began with a literature search using CINAHL and PubMed and the key phrases hepatitis C, screening, birth cohort, CDC, electronic medical record (EMR), and lifestyle risk. Inclusion criteria were publication within the last five years, English language, and full-text availability. Seven of the 28 articles meeting this criteria were selected based on their applicability, high-quality, and rigor. Specific data points were abstracted from these articles and compiled in an Excel spreadsheet. Results Three studies that evaluated the effectiveness of universal screening versus risk and/or birth cohort screening found that universal screening resulted in higher screening rates. EMR interventions based on risk and/or birth cohort were evaluated in six of the studies, with all six reporting increased screening rates. Additionally, one study found that screening rates increased when EMR-based interventions were paired with provider education. Implications for Nursing Practice The results of this review suggest that application of universal screening and the incorporation of EMR-based interventions lead to an appreciable increase in HCV screening and diagnosis, but studies that implement these interventions based on universal screening guidelines are needed. Most importantly, this review revealed that healthcare providers and patients need education on current screening guidelines, testing, and treatment so HCV can be diagnosed and treated early

Pediatric Cardiac Xenotransplantation: Recommendations for the Ethical Design of Clinical Trials

For children with complex congenital heart problems, cardiac allotransplantation is sometimes the best therapeutic option. However, availability of hearts for pediatric patients is limited, resulting in a long and growing waitlist, and a high mortality rate while waiting. Cardiac xenotransplantation has been proposed as one therapeutic alternative for neonates and infants, either in lieu of allotransplantation or as a bridge until an allograft becomes available. Scientific and clinical developments in xenotransplantation appear likely to permit cardiac xenotransplantation clinical trials in adults in the coming years. The ethical issues around xenotransplantation of the heart and other organs and tissues have recently been examined, but to date, only limited literature is available on the ethical issues that are attendant with pediatric heart xenotransplantation. Here, we summarize the ethical issues, focusing on (i) whether cardiac xenotransplantation should proceed in adults or children first, (ii) pediatric recipient selection for initial xenotransplantation trials, (iii) special problems regarding informed consent in this context, and (iv) related psychosocial and public perception considerations. We conclude with specific recommendations regarding ethically informed design of pediatric heart xenotransplantation trials

DNA origami protection and molecular interfacing through engineered sequence-defined peptoids

DNA nanotechnology has established approaches for designing programmable and precisely controlled nanoscale architectures through specific Watson−Crick base-pairing, molecular plasticity, and intermolecular connectivity. In particular, superior control over DNA origami structures could be beneficial for biomedical applications, including biosensing, in vivo imaging, and drug and gene delivery. However, protecting DNA origami structures in complex biological fluids while preserving their structural characteristics remains a major challenge for enabling these applications. Here, we developed a class of structurally well-defined peptoids to protect DNA origamis in ionic and bioactive conditions and systematically explored the effects of peptoid architecture and sequence dependency on DNA origami stability. The applicability of this approach for drug delivery, bioimaging, and cell targeting was also demonstrated. A series of peptoids (PE1–9) with two types of architectures, termed as “brush” and “block,” were built from positively charged monomers and neutral oligo-ethyleneoxy monomers, where certain designs were found to greatly enhance the stability of DNA origami. Through experimental and molecular dynamics studies, we demonstrated the role of sequence-dependent electrostatic interactions of peptoids with the DNA backbone. We showed that octahedral DNA origamis coated with peptoid (PE2) can be used as carriers for anticancer drug and protein, where the peptoid modulated the rate of drug release and prolonged protein stability against proteolytic hydrolysis. Finally, we synthesized two alkyne-modified peptoids (PE8 and PE9), conjugated with fluorophore and antibody, to make stable DNA origamis with imaging and cell-targeting capabilities. Our results demonstrate an approach toward functional and physiologically stable DNA origami for biomedical applications

A one-year trial of lamivudine for chronic hepatitis B

Background and Methods: In preliminary trials, lamivudine, an oral nucleoside analogue, has shown promise for the treatment of chronic hepatitis B. We conducted a one-year double-blind trial of lamivudine in 358 Chinese patients with chronic hepatitis B. The patients were randomly assigned to receive 25 mg of lamivudine (142 patients), 100 mg of lamivudine (143), or placebo (73) orally once daily. The patients underwent liver biopsies before entering the study and after completing the assigned treatment regimen. The primary end point was a reduction of at least two points in the Knodell necroinflammatory score. Results: Hepatic necroinflammatory activity improved by two points or more in 56 percent of the patients receiving 100 mg of lamivudine, 49 percent of those receiving 25 mg of lamivudine, and 25 percent of those receiving placebo (P<0.001 and P=0.001, respectively, for the comparisons of lamivudine treatment with placebo). Necroinflammatory activity worsened in 7 percent of the patients receiving 100 mg of lamivudine, 8 percent of those receiving 25 mg, and 26 percent of those receiving placebo. The 100mg dose of lamivudine was associated with a reduced progression of fibrosis (P=0.01 for the comparison with placebo) and with the highest rate of hepatitis B e antigen (HBeAg) seroconversion (loss of HBeAg, development of antibody to HBeAg, and undetectable HBV DNA) (16 percent), the greatest suppression of HBV DNA (98 percent reduction at week 52 as compared with the base-line value), and the highest rate of sustained normalization of alanine aminotransferase levels (72 percent). Ninety-six percent of the patients completed the study. The incidence of adverse events was similar in all groups, and there were few serious events. Conclusions: In a one-year study, lamivudine was associated with substantial histologic improvement in many patients with chronic hepatitis B. A daily dose of 100 mg was more effective than a daily dose of 25 mg.published_or_final_versio

Virtual Community Health Workers: Outreach Calls During COVID-19

The “Clinical Experience” program at the Sidney Kimmel Medical College, established in 2017, provides pre-clerkship students with an opportunity to identify and address patients’ needs for social determinants of health (SDoH). The COVID-19 pandemic led to a suspension of the student program in the clinical environment, but the CHWs continued to address patients’ social needs from a remote setting. In the absence of established best practices regarding patient outreach calls from a remote setting, we sought to develop an effective workflow that would mask the CHWs’ personal cell phones while leading to fewer “unable to reach” scenarios and improved case resolution rates

Pneumococcal carriage in sub-Saharan Africa--a systematic review.

BACKGROUND: Pneumococcal epidemiology varies geographically and few data are available from the African continent. We assess pneumococcal carriage from studies conducted in sub-Saharan Africa (sSA) before and after the pneumococcal conjugate vaccine (PCV) era. METHODS: A search for pneumococcal carriage studies published before 2012 was conducted to describe carriage in sSA. The review also describes pneumococcal serotypes and assesses the impact of vaccination on carriage in this region. RESULTS: Fifty-seven studies were included in this review with the majority (40.3%) from South Africa. There was considerable variability in the prevalence of carriage between studies (I-squared statistic = 99%). Carriage was higher in children and decreased with increasing age, 63.2% (95% CI: 55.6-70.8) in children less than 5 years, 42.6% (95% CI: 29.9-55.4) in children 5-15 years and 28.0% (95% CI: 19.0-37.0) in adults older than 15 years. There was no difference in the prevalence of carriage between males and females in 9/11 studies. Serotypes 19F, 6B, 6A, 14 and 23F were the five most common isolates. A meta-analysis of four randomized trials of PCV vaccination in children aged 9-24 months showed that carriage of vaccine type (VT) serotypes decreased with PCV vaccination; however, overall carriage remained the same because of a concomitant increase in non-vaccine type (NVT) serotypes. CONCLUSION: Pneumococcal carriage is generally high in the African continent, particularly in young children. The five most common serotypes in sSA are among the top seven serotypes that cause invasive pneumococcal disease in children globally. These serotypes are covered by the two PCVs recommended for routine childhood immunization by the WHO. The distribution of serotypes found in the nasopharynx is altered by PCV vaccination

Academic neurosurgery in the UK: present and future directions.

Academic neurosurgery encompasses basic science and clinical research efforts to better understand and treat diseases of relevance to neurosurgical practice, with the overall aim of improving treatment and outcome for patients. In this article, we provide an overview of the current and future directions of British academic neurosurgery. Training pathways are considered together with personal accounts of experiences of structured integrated clinical academic training and unstructured academic training. Life as an academic consultant is also described. Funding is explored, for the specialty as a whole and at the individual level. UK academic neurosurgical organisations are highlighted. Finally, the UK's international standing is considered