No abstract

There is increasing evidence that widespread cortical cerebral blood flow deficits occur early in the course of Parkinson’s disease. Although cerebral blood flow measurement has been suggested as a potential biomarker for early diagnosis of Parkinson’s disease, as well as a means for tracking response to treatment, the relationship of cerebral blood flow to α-synucleinopathy, a major pathological hallmark of Parkinson’s disease, remains unclear. Therefore, we performed arterial spin-labeling magnetic resonance imaging and diffusion tensor imaging on transgenic mice overexpressing human wild-type α-synuclein and age-matched controls to measure cerebral blood flow and degenerative changes. As reported for early-stage Parkinson’s disease, α-synuclein mice exhibited a significant reduction in cortical cerebral blood flow, which was accompanied by motor coordination deficits and olfactory dysfunction. Although no overt degenerative changes were apparent in diffusion tensor imaging images, magnetic resonance imaging volumetric analysis revealed a significant reduction in olfactory bulb volume, similar to that seen in Parkinson’s disease patients. Our data, representing the first report of cerebral blood flow deficit in an animal model of Parkinson’s disease, suggest a causative role for α-synucleinopathy in cerebral blood flow deficits in Parkinson’s disease. Thus, α-synuclein transgenic mice comprise a promising model to study Parkinson’s disease-related mechanisms of cerebral blood flow deficits and to investigate further its utility as a potential biomarker for Parkinson’s disease.

Review question / Objective: The objective of this review is to examine if and how interventional studies on handoffs of patients from the operating room (OR) to the intensive care unit (ICU) analyze interventional sustainability and their impacts on patient outcomes. Eligibility criteria: Inclusion criteria for studies were as follows: (1) publication of the study as a full-text manuscript in a peer-reviewed journal and (2) description of an intervention to standardize the OR to ICU handoff. Information sources: Information sources are the following electronic databases: ABI Inform, Business Source Complete and HealthBusiness FullText (EBSCO), CINAHL, ClinicalTrials.Gov, Cochrane Review, EMBASE, Ovid Medline, PubMed, Scopus, and Web of Science.

Background: Operating room (OR) to the intensive care unit (ICU) handoff standardization is a well-studied intervention to decrease preventable patient harm. We conducted a systematic review to synthesize findings about OR to ICU handoff intervention sustainability and the impact on handoff interventions on patient outcomes, neither of which are well described in recent reviews of OR to ICU handoff studies.Methods: Inclusion criteria included full papers (i.e., not abstracts) describing original research with intervention descriptions. There were no exclusion criteria. We searched 10 electronic bibliographic databases (including PubMed, Scopus, and eight others) for studies published between 1995 and October 2021 describing OR to ICU handoffs. We used the Cochrane Consumers and Communication Review Group Study Quality Guide to present and synthesize results using the criteria pertaining to the study format and PRISMA guidelines for reporting.Results: Our search yielded 41 papers published between 2007-2021. Thirteen (31.7%) of the studies described a sustainability period following the initial implementation phase that lasted 3-96 months. All studies with a sustainability period showed continued improvement of at least one study outcome. Nine studies measured patient outcomes, including unplanned or early extubations, delayed dosing of antibiotics, unspecified post-surgical complications, ICU-level patient mortality, among others. Of these, 7 (77.8%) reported statistical significance improvement of patient outcomes, but none were able to establish causation. Two studies reported no difference in any patient outcomes.Discussion: Interpretation of the evidence was limited by the risk of recall bias, Hawthorne effect, sampling bias, response bias, and no blinding of participants or personnel. Collectively, the evidence from all the studies examined is subject to both publication and selective reporting within studies. Overall, the studies demonstrate improvement in information exchange and clinician satisfaction with standardization but have not shown to cause improvement in patient outcomes. Only a few of these studies have focused on the sustainability of handoff standardization conventions. Overall, the field is heavily dominated by cardiac research and is lacking in sustainability research and patient outcome-correlated research.Other: Funding: The primary source of funding for this review was institutional funds.Register name: INPLASYRegister number: INPLASY202220035