bluuebunny/crossref_metadata_2025 huggingface dataset:
Penn Medicine Lancaster General Health’s Ambulatory Care Evolution
Authors: Bergen Jan L. , Wynne Susan
Published: November 2020

Hospital and health system leaders alike are increasing their efforts to implement an ambulatory care strategy. The move is understandable: Innovative and well-funded competitors are entering their markets, payers are demanding lower-cost options, and patients are seeking affordability and convenience.

Healthcare organizations must consider several imperatives when identifying a long-term ambulatory strategy that is both successful and sustainable. The rise of value-based care and emerging market and competitive trends are among the important considerations that call for a strategy that is affordable, responds to consumer expectations, and ensures that care is coordinated and optimal.

Penn Medicine Lancaster General Health (LG Health) strategically transformed its ambulatory services over three decades. Early on, the system focused on providing services in and around its urban flagship hospital. Increased competition, new technologies, market growth, and other influences eventually led the system to expand its depth and breadth while aggregating many of its ambulatory services in a single suburban location designed to optimize efficiency, prioritize clinical coordination, and enhance patient and physician satisfaction.

The system built on that foundation by creating a network of ambulatory locations featuring four service delivery models. Each features distinct facility sizes, physician types, patient groups, and services. In addition, LG Health continues to build the technological and operational capabilities to deliver telehealth services that have become more established in the wake of the COVID-19 pandemic.

The investments made, experiences studied, and lessons learned by LG Health since 1990 and during the uncertain course of the current pandemic continue to guide its ambulatory strategy.
Teachers' Perspectives on Strength-Based and Deficit-Based Instruments for Assessing Socioemotional Development in Early Childhood
Authors: Sjö Nina Madsen , Kiil Astrid , Jensen Peter
Published: November 2020

This study compares teachers' perspectives on three assessment instruments for socioemotional development in early childhood, which differ in their emphasis on strengths and difficulties in this domain: the Caregiver-Teacher Report Form (C-TRF), the Strengths and Difficulties Questionnaire, Teacher version (SDQ-T), and the Social Emotional Assessment Measure (SEAM). We examine the teachers' views on the clarity, relevance, and acceptability, as well as estimating average completion times, of the three questionnaires in the context of Danish childcare. Overall, the SEAM was rated better able to convey the child's strengths, was more acceptable by teachers than the C-TRF and SDQ-T, and provided a better basis for talking with parents. Given its content and acceptability, we conclude this strength-based measure strongly merits inclusion in child assessment of socioemotional development.
Surviving and Thriving
Authors: Tann Cally J. , Kohli-Lynch Maya , Nalugya Ruth , Sadoo Samantha , Martin Karen , Lassman Rachel , Nanyunja Carol , Musoke Margaret , Sewagaba Margaret , Nampijja Margaret , Seeley Janet , Webb Emily L.
Published: November 2020

Global attention on early child development, inclusive of those with disability, has the potential to translate into improved action for the millions of children with developmental disability living in low- and middle-income countries. Nurturing care is crucial for all children, arguably even more so for children with developmental disability. A high proportion of survivors of neonatal conditions such as prematurity and neonatal encephalopathy are affected by early child developmental disability. The first thousand days of life is a critical period for neuroplasticity and an important window of opportunity for interventions, which maximize developmental potential and other outcomes. Since 2010, our group has been examining predictors, outcomes, and experiences of neonatal encephalopathy in Uganda. The need for an early child intervention program to maximize participation and improve the quality of life for children and families became apparent. In response, the “ABAaNA early intervention program,” (now re-branding as ‘Baby Ubuntu’) a group participatory early intervention program for young children with developmental disability and their families, was developed and piloted. Piloting has provided early evidence of feasibility, acceptability, and impact and a feasibility trial is underway. Future research aims to develop programmatic capacity across diverse settings and evaluate its impact at scale.
A case report of somatic symptom disorder as first manifestation of semantic dementia
Authors: Ochoa Fernando , Farrand Sarah , Den Ouden Lauren , Shivji Natasha , Velakoulis Dennis , Kelso Wendy
Published: November 2020

Semantic dementia (SD) is a progressive neurodegenerative disorder in which patients present a loss of meaning of words, objects, and concepts. SD has been linked with alexisomia, as well as somatic symptom disorder (SSD). A 65 year-old patient with a 2-year history of daily episodes of pulsatile head and chest sensations followed by prostration with maintained awareness was diagnosed with SSD. The patient was subsequently admitted into an epilepsy unit to exclude the diagnosis of epileptic seizures. Clinical, neuropsychological, and neuroimaging assessments were consistent with the diagnosis of probable SD. This case report presents a patient whose first manifestation of SD was SSD, thus highlighting the importance of both careful clinical and neurocognitive enquiry, and caution in diagnosing SSD in later life. This case outlines the association between SD and somatic symptoms, providing insight into the nature of alexisomia and the emergence of SSD in SD.
Nutrition and Preventative Medicine Across the Lifespan: Implementation of a Physician Assistant Team-Based Learning Curriculum on Pediatric Preventative Medicine
Authors: Patel Shivani J. , Cafferty Patrick , Klein Melissa , Statile Angela M.
Published: November 2020

Purpose

Physician assistants (PAs) will increasingly fill an important primary care gap in pediatrics. This study implemented a pediatric preventative care curriculum using a team-based learning (TBL) strategy and then evaluated the effect on first-year PA students' knowledge and attitudes toward TBL as a teaching method.

Methods

The curriculum was developed and implemented during a one-semester course. Students completed knowledge-based questions precourse and postcourse; the mean scores for individual students were then compared using a paired t test. Descripted statistics were used to analyze the postcourse survey that evaluated students' attitudes toward TBL.

Results

Of the 31 PA students who participated, 27 (87%) completed the surveys and were included in the analysis. The mean correct pretest and posttest scores were 17/39 and 31/39, respectively, resulting in a change of 14 points (p < .05). The majority of students (85%) rated TBL as effective, and most students (75%) reported that it led to retention of the presented content.

Conclusions

A TBL-based curriculum in pediatric preventative care was effective in increasing PA student knowledge, and the students reported it as effective. This strategy could be considered for other PA courses.
Physical Therapy Management in Recurrent Urinary Tract Infections: A Case Report
Authors: Divine Kate , McVey Lisa
Published: November 2020

Background:

Pelvic floor dysfunction is linked to urinary incontinence (UI) and urinary tract infections (UTIs). Recurrent UTIs can affect an individual's quality of life, especially emotionally. Literature examining the conservative management of recurrent UTI is mostly in the pediatric and neurologic populations, not the general adult population. Therefore, the purpose of this case report is to describe the physical therapy (PT) management of a patient with a 10-year history of uncomplicated UTIs and UI.

Case Description:

This case describes the management for a 50-year-old woman referred to PT for UI, UTIs, urinary urgency/frequency, and pelvic pain. PT interventions included bladder retraining, surface electromyography biofeedback, electrical stimulation, therapeutic exercises, patient education, and a progressive home exercise program.

Outcomes:

Following 6 PT sessions over a 6-week period, the patient reported decreased urinary symptoms and resolution of UI. The Urinary Impact Questionnaire (UIQ) improved by 18% and the Focus on Therapeutic Outcomes Pelvic Floor Dysfunction Questionnaire (FOTO PFDI) improved by 8%. The patient reported no recurrence of UTIs at 3 months post-discharge.

Discussion:

A PT program designed to improve pelvic floor strength and coordination may have contributed to a decrease in UTI frequency and elimination of UI within a 3-month time frame. PT could provide a conservative treatment option for uncomplicated recurrent UTI and UI to improve the social/emotional impacts of symptoms and reduce antibiotic use. Future studies are needed to see the long-term effects of PT on UTI frequency.

Informed Consent:

This study was approved and exempt from a local intuitional review board.

A video abstract for this article is available at: http://links.lww.com/JWHPT/A39.
The COVID-19 Outbreak and Subjects With Mental Disorders Who Presented to an Italian Psychiatric Emergency Department
Authors: Montalbani Benedetta , Bargagna Paride , Mastrangelo Martina , Sarubbi Salvatore , Imbastaro Benedetta , De Luca Gabriele Pasquale , Anibaldi Gaia , Erbuto Denise , Pompili Maurizio , Comparelli Anna
Published: November 2020

We performed a retrospective study from January to May 2020 to establish the sociodemographic and clinical characteristics of patients with mental health problems who arrived at an Italian emergency department during the COVID-19 outbreak. We divided the sample into two groups taking as a watershed March 11, when the World Health Organization announced COVID-19 outbreak as a pandemic. Chi-square/t-tests, adjusted p values (Bonferroni method), and regression analysis were performed. Patients who arrived at the emergency department during the lockdown decreased by 56%; showed greater active suicidal ideation, more tension, and more severe psychopathological state; were living alone more frequently; and were taking home treatment mainly based on second-generation antipsychotics. According to our study, it seems that patients with mental disorders have consulted psychiatric services less frequently during the pandemic, but the economic, health, and social distress may be linked with an increase in suicidal risk and the severity of the psychopathological state.
Metabolic Dynamics and Prediction of Gestational Age and Time to Delivery in Pregnant Women
Authors: Liang Liang , Rasmussen Marie-Louise Hee , Piening Brian , Shen Xiaotao , Chen Songjie , Röst Hannes , Snyder John K. , Tibshirani Robert , Skotte Line , Lee Norman C. Y. , Contrepois Kévin , Feenstra Bjarke , Zackriah Hanyah , Snyder Michael , Melbye Mads
Published: November 2020

(Abstracted from Cell 2020;181:1680–1692)

Pregnancy is a vital time period for both mothers and fetuses, and obstetric care can greatly increase positive outcomes of mothers and children. Accurate prediction of gestational age is one of the many important components of care during pregnancy.
Impact of Pediatric Emergency Care Applied Research Network Rules on Admission, Cranial Computed Tomography and Skull X-ray Rates in a Central European Hospital
Authors: Poyntner Lukas , Simma Burkhard
Published: November 2020

Objectives

Mild head injury is a common cause of pediatric emergency department visits. Cranial computed tomography (CCT) is the diagnostic standard, although it involves inherent radiation risks. Pediatric Emergency Care Applied Research Network (PECARN) clinical prediction rules were developed to reduce the number of CCT scans. They provide a guideline for CCT use in mild head injuries, based on clinical parameters.

Our study aims to evaluate the impact of PECARN rules on hospital admission and CCT rate in children with mild head injury.

Methods

In this retrospective study, we investigated 729 children with mild head injury presenting in the pediatric emergency department between 2012 and 2016. We compared 2 groups, before and after implementation of PECARN criteria in clinical routine.

Results

Of 729 included patients (417 male; 5.6 ± 4.8 years;) 380 were seen prior to implementation of the PECARN rules, compared to 349 patients afterwards. Overall admissions to the ward decreased significantly from 83.9% (n = 319) to 71.3% (n = 249) (P < 0.001), a 31.3% reduction. Calculated from all pediatric admissions, the rate of patients with mild head injury fell from 6.0% to 4.3% (P < 0.001).

We recorded a nonsignificant decrease in the CCT rate, from 14.7% to 13.2% (P = 0.555).

No readmissions were recorded.

Conclusions

Our results show a significant reduction in the rate of hospital admission following implementation of the PECARN rules in our hospital. Already low, the CCT rate did not change after implementation.

The PECARN rules appear to be safe because no readmissions were recorded.
Use of Inotropics by Peripheral Vascular Line in the First Hour of Treatment of Pediatric Septic Shock: Experience at an Emergency Department
Authors: Kohn-Loncarica Guillermo , Hualde Gabriela , Fustiñana Ana , Monticelli María Fernanda , Reinoso Graciela , Cortéz Miguel , Segovia Leonardo , Mareco-Naccarato Gustavo , Rino Pedro
Published: November 2020

Objective

Mortality in pediatric septic shock remains unacceptably high. Delays in vasopressor administration have been associated with an increased risk of mortality. Current treatment guidelines suggest the use of a peripheral vascular line (PVL) for inotropic administration in fluid-refractory septic shock when a central vascular line is not already in place. The aim of this study was to report local adverse effects associated with inotropic drug administration through a PVL at a pediatric emergency department setting in the first hour of treatment of septic shock.

Methods

A prospective, descriptive, observational cohort study of patients with septic shock requiring PVL inotropic administration was conducted at the pediatric emergency department of a tertiary care pediatric hospital. For the infusion and postplacement care of the PVL for vasoactive drugs, an institutional nursing protocol was used.

Results

We included 49 patients; 51% had an underlying disease. Eighty-four percent of the children included had a clinical “cold shock.” The most frequently used vasoactive drug was epinephrine (72%). One patient presented with local complications.

Conclusions

At our center, infusion of vasoactive drugs through a PVL was shown to be safe and allowed for adherence to the current guidelines for pediatric septic shock.
Evaluation of Patient Reported Gastroesophageal Reflux Severity at Baseline and at 1-year After Bariatric Surgery
Authors: Ehlers Anne P. , Thumma Jyothi R. , Finks Jonathan F. , Carlin Arthur M. , Ghaferi Amir A. , Varban Oliver A.
Published: November 2020

Objective:

To assess patient-reported gastroesophageal reflux disease (GERD) severity before and after SG and Roux-en-Y gastric bypass (RYGB).

Summary of Background Data:

Development of new-onset or worsening GERD symptoms after bariatric surgery varies by procedure, but there is a lack of patient-reported data to help guide decision-making. Methods: Retrospective cohort study of patients undergoing bariatric surgery in a statewide quality collaborative between 2013 and 2017. We used a validated GERD survey with symptom scores ranging from 0 (no symptoms) to 5 (severe daily symptoms) and included patients who completed surveys both at baseline and 1-year after surgery (n = 10,451). We compared the rates of improved and worsened GERD symptoms after SG and RYGB.

Results:

Within our study cohort, 8680 (83%) underwent SG and 1771 (17%) underwent RYGB. Mean baseline score for all patients was 0.94. Patients undergoing SG experienced similar improvement in GERD symptoms when compared to RYGB (30.4% vs 30.8%, P = 0.7015). However, SG patients also reported higher rates of worsening symptoms (17.8% vs 7.5%, P < 0.0001) even though they were more likely to undergo concurrent hiatal hernia repair (35.1% vs 20.0%, P<0.0001). More than half of patients (53.5%) did not report a change in their score.

Conclusions:

Although SG patients reported higher rates of worsening GERD symptoms when compared to RYGB, the majority of patients (>80%) in this study experienced improvement or no change in GERD regardless of procedure. Using clinically relevant patient-reported outcomes can help guide decisions about procedure choice in bariatric surgery for patients with GERD.
Fetal Risk Stratification and Outcomes in Children with Prenatally Diagnosed Lung Malformations
Authors: Kunisaki Shaun M. , Saito Jacqueline M. , Fallat Mary E. , Peter Shawn D. St. , Lal Dave R. , Karmakar Monita , Deans Katherine J. , Gadepalli Samir K. , Hirschl Ronald B. , Minneci Peter C. , Helmrath Michael A. ,   for the Midwest Pediatric Surgery Consortium
Published: November 2020

Objective:

The aim of this study was to assess current clinical outcomes in children with prenatally diagnosed congenital lung malformations (CLMs) and to identify prenatal characteristics associated with adverse outcomes.

Summary Background Data:

Despite a wide spectrum of clinical disease, the identification of fetal CLM subgroups at increased risk for hydrops and respiratory compromise at delivery has not been well defined.

Methods:

A retrospective cohort study was conducted using an operative database of prenatally diagnosed CLMs managed at 11 children’s hospitals from 2009 to 2016. Statistical analyses were performed using nonparametric bivariate or multivariable logistic regression.

Results:

Three hundred forty-four children were analyzed. Fifteen (5.5%) fetuses were managed with maternal steroids in the setting of hydrops, and prenatal surgical intervention was uncommon (1.7%). Seventy-five (21.8%) had respiratory symptoms at birth, and 34 (10.0%) required neonatal lung resection. Congenital pulmonary airway malformation volume ratio (CVR) measurements were recorded in 169 (49.1%) cases and were significantly associated with perinatal outcome, including hydrops, respiratory distress at birth, need for supplemental oxygen, neonatal ventilator use, and neonatal resection (P < 0.001). An initial CVR ≤1.4 was significantly correlated with a reduced risk for hydrops [area under the curve (AUC), 0.93; 95% confidence interval (CI), 0.87–1.00]. A maximum CVR <0.9 (AUC, 0.72; 95% CI, 0.67–0.85) was associated with a low risk for respiratory symptoms at birth.

Conclusions:

In this large, multi-institutional study, an initial CVR ≤ 1.4 identifies fetuses at very low risk for hydrops, and a maximum CVR < 0.9 is associated with asymptomatic disease at birth. These findings represent an opportunity for standardization and quality improvement for prenatal counseling and delivery planning.
Gastrectomy Versus Esophagectomy for Gastroesophageal Junction Tumors
Authors: Jezerskyte Egle , Mertens Alexander C. , Dieren Susan van , Eshuis Wietse J. , Sprangers Mirjam A. G. , van Berge Henegouwen Mark I. , Gisbertz Suzanne S. ,   on behalf of the Dutch Upper Gastrointestinal Cancer Audit (DUCA) group
Published: November 2020

Objective:

Investigate long-term survival, morbidity, mortality, and pathology results in patients following esophagectomy or total gastrectomy for gastroesophageal junction (GEJ) cancer.

Background:

Both a total gastrectomy and an esophagectomy may be valid treatment options in patients with GEJ cancer. Which procedure results in the most optimal patient outcome is not well studied. The aim of this study was to investigate the long-term survival, morbidity, mortality, and pathology results in patients following esophagectomy or total gastrectomy for GEJ cancer.

Methods:

A retrospective comparative cohort study of prospectively collected data from the Dutch Upper GI Cancer Audit combined with survival data of the Dutch medical insurance database was performed. Patients with GEJ cancer in whom a total gastrectomy or an esophagectomy was performed between 2011 and 2016 were compared. The primary outcome was 3-year overall survival. Postoperative morbidity, mortality, 3-year conditional survival, radicality of resection, and lymph node yield were secondary endpoints.

Results:

A total of 871 patients were included: 790 following esophagectomy and 81 following gastrectomy. The 3-year overall survival was 35.8% after esophagectomy and 28.4% after gastrectomy (hazard ratio 1.2, 95% confidence interval 0.721–1.836, P = 0.557). Postoperative morbidity, mortality, radicality of resection, lymph node yield, and 3-year conditional survival did not differ significantly between groups.

Conclusion:

A total gastrectomy and an esophagectomy for GEJ cancer show largely comparable results with regard to long-term survival, postoperative morbidity, mortality, and pathology results. If both procedures are feasible, other parameters such as surgeon’s experience and quality of life should be considered when planning for surgery.
Identifying a Basket of Surgical Procedures to Standardize Global Surgical Metrics
Authors: Odland Maria L. , Nepogodiev Dmitri , Morton Dion , Martin Janet , Bekele Abebe , Ghosh Dhruva , Ademuyiwa Adesoji O. , Davies Justine I. , Weiser Thomas G.
Published: November 2020

Objective:

We aimed to define a globally applicable list of surgical procedures, or “basket,” which could represent a health system's capacity to provide surgical care and standardize global surgical measurement.

Summary of Background Data:

Six indicators have been proposed to assess access to safe, affordable, timely surgical and anesthesia care, with a focus on laparotomy, cesarean section, and treatment of open fracture. However, comparability, particularly for these procedures, has been limited by a lack of definitional clarity and their overly broad scope.

Methods:

We conducted a 3 round international expert Delphi exercise between April and June 2019 using REDCap to identify a set of procedures representative of surgical capacity. To be included, procedures had to be important for treating common conditions, well-defined, and impactful (ie, well-recognized clinical or functional benefit). Procedures were eliminated or prioritized in each round, and those noted as “extremely” or “very important” by ≥50% of respondents in round 3 were included in the final “basket.”

Results:

Altogether 331 respondents from 78 countries participated in the Delphi process. A final basket of 32 procedures representing disease categories in trauma, cancer, congenital anomalies, maternal/reproductive health, aging, and infection were identified for inclusion to assess surgical capacity.

Conclusions:

This surgical basket facilitates a more standardized assessment of a country's surgical system. Further testing and refinement will likely be needed, but this basket can be used immediately to guide ongoing monitoring and evaluation of global surgery capacities to improve and strengthen surgery and anesthesia care.
The Safety and Efficacy of Tracheostomy in Patients Diagnosed With COVID-19
Authors: Krishnamoorthy Subhash , Polanco Antonio , Coleman Natasha , Prigoff Jake , Sturm Joshua , Blitzer David , Erwin Clinton , D’Ovidio Frank , Lemaitre Philippe , Troob Scott , Hills Susannah , Stanifer Bryan Payne
Published: November 2020

Objective:

To determine the optimal surgical strategy for performing tracheostomy in COVID-19 patients.

Background:

Many ventilated COVID-19 patients require prolonged ventilation. We do not know if tracheostomy will improve their care. Given the paucity of data on this topic, the optimal surgical approach has yet to be elucidated.

Methods:

This is a cohort study of 143 ventilator dependent COVID-19 patients undergoing tracheostomy at an academic medical center from April 15th to May 15th, 2020, with follow up until June 1, 2020. We included adult patients admitted to a NYC medical center with COVID-19 who required invasive mechanical ventilation for greater than 2 weeks who were unable to be extubated and determined to have reasonable chance of recovery and fit defined tracheostomy candidate criteria. Patients underwent either a percutaneous tracheostomy (PT) or open surgical tracheostomy (ST) performed by 1 of 3 surgical services.

Results:

One hundred forty-three patients underwent tracheostomy, 58 (41%) via a ST, and 85 (59%) via a PT. There were no significant differences in patient characteristics between the 2 groups, except that more patients who had a history of extracorporeal membrane oxygenation underwent PT (11% vs 2%, P = 0.049). There were no statistical differences observed between the PT and ST groups with regard to bleeding complications (3.5%vs 10.3%, P = 0.099), tracheostomy related complications (5.9% vs 8.6%, P = 0.528), inpatient death (12% vs 5%, P = 0.178), discharge from hospital (39% vs 36%, P = 0.751) or surgeon illness (0% vs 0%, P = 1).

Conclusion and Relevance:

The rapid formation of a multi-disciplinary team allows for the efficient evaluation and performance of a large volume of tracheostomies in a resource-limited setting. Bedside tracheostomy in COVID-19 does not cause additional harm to patients if performed after 2 weeks from intubation. It also seems to be safe for proceduralists to perform in this timeframe. The manner of tracheostomy does not change outcomes significantly if it is performed safely and efficiently.
Can the Risk Analysis Index for Frailty Predict Morbidity and Mortality in Patients Undergoing High-risk Surgery?
Authors: Wan Michelle A. , Clark James M. , Nuño Miriam , Cooke David T. , Brown Lisa M.
Published: November 2020

Objective:

To determine the effectiveness of the revised Risk Analysis Index (RAI-rev), administrative Risk Analysis Index (RAI-A), cancer-corrected Risk Analysis Index [RAI-rev (cancer-corrected)], and 5-variable modified Frailty Index for predicting 30-day morbidity and mortality in patients undergoing high-risk surgery.

Background:

There are several frailty composite measures, but none have been evaluated for predicting morbidity and mortality in patients undergoing high-risk surgery.

Methods:

Using the National Surgical Quality Improvement Program database, we performed a retrospective study of patients who underwentcolectomy/proctectomy, coronary artery bypass graft (CABG), pancreaticoduodenectomy, lung resection, or esophagectomy from 2006 to 2017. RAI-rev, RAI-A, RAI-rev (cancer corrected), and 5-variable modified Frailty Index scores were calculated. Pearson's chi-square tests and C-statistics were used to assess the predictive accuracy of each score’s logistic regression model.

Results:

In the cohort of 283,545 patients, there were 178,311 (63%) colectomy/proctectomy, 38,167 (14%) pancreaticoduodenectomy, 40,328 (14%) lung resection, 16,127 (6%) CABG, and 10,602 (3%) esophagectomy cases. The RAI-rev was a fair predictor of mortality in the total cohort (C-statistic, 0.71, 95% CI 0.70–0.71, P < 0.001) and for patients who underwent colectomy/proctectomy (C-statistic 0.73, 95% CI 0.72–0.74, P < 0.001) and CABG (C-statistic 0.70, 95% CI 0.68–0.73, P < 0.001), but a poor predictor of mortality in all other operation cohorts. The RAI-A was a fair predictor of mortality for colectomy/proctectomy patients (C-statistic 0.74, 95% CI 0.73– 0.74, P < 0.001). All indices were poor predictors of morbidity. The RAI-rev (cancer corrected) did not improve the accuracy of morbidity and mortality prediction.

Conclusion:

The presently studied frailty indices are ineffective predictors of 30-day morbidity and mortality for patients undergoing high-risk operations.
Global Epidemiology of Chronic Venous Disease
Authors: Salim Safa , Machin Matthew , Patterson Benjamin O. , Onida Sarah , Davies Alun H.
Published: November 2020

Objective:

To provide an updated estimate of the global prevalence of CVD and to comprehensively evaluate risk factors associated with this condition.

Background:

CVD is an important cause of morbidity internationally, but the global burden of this condition is poorly characterized. The burden of CVD must be better characterized to optimize service provision and permit workforce planning to care for patients with different stages of CVD.

Methods:

A systematic search in Ovid MEDLINE and Embase (1946–2019) identified 1271 articles. Full-text, English language articles reporting on the epidemiology of CVD in a general adult population were included. Data extraction was performed by 2 independent reviewers, in accordance with a preregistered protocol (PROSPERO: CRD42019153656). STATA and Review Manager were used for quantitative analysis. A crude, unadjusted pooled prevalence was calculated for each Clinical (C) stage in the Clinical, Etiologic, Anatomic, Pathophysiologic classification and across different geographical regions. Qualitative analysis was performed to evaluate associated risk factors in CVD.

Results:

Thirty-two articles across 6 continents were identified. Nineteen studies were included in the overall pooled prevalence for each Clinical (C) stage; pooled estimates were: C0 s: 9%, C1: 26%, C2: 19%, C3: 8%, C4: 4%, C5: 1%, C6: 0.42%. The prevalence of C2 disease was highest in Western Europe and lowest in the Middle East and Africa. Commonly reported risk factors for CVD included: female sex (OR 2.26, 95% confidence intervals 2.16–2.36, P < 0.001), increasing age, obesity, prolonged standing, positive family history, parity, and Caucasian ethnicity. There was significant heterogeneity across the included studies.

Conclusions:

CVD affects a significant proportion of the population globally; however, there is significant heterogeneity in existing epidemiological studies.
The Impact of the Affordable Care Act on Trauma Outcomes in At-Risk Groups
Authors: Lester Erica L. W. , Dvorak Justin E. , Maluso Patrick J. , Tatebe Leah C. , Widder Sandy , Bokhari Faran
Published: November 2020

Objective:

Analyze the impact of the Affordable Care Act (ACA) on trauma outcomes at a population level and within at-risk subgroups.

Background:

Trauma disproportionately affects the uninsured. Compared to the insured, uninsured patients have worse functional outcomes and increased mortality. The goal of the ACA was to increase access to insurance.

Methods:

An interrupted time series was conducted using data from the National Inpatient Sample database between 2011 and 2016. Data from Alberta, Canada was used as a control group. Mortality, length of stay, and probability of discharge home with or without home health care was examined using monthly time intervals, with January 2014 as the intervention time. Single and multiple group interrupted time series were conducted. Subgroup analyses were conducted using income quartiles and race.

Results:

After the intervention, there was a monthly reduction in mortality of 0.0148% (P < 0.01) in the American cohort: there was no change in the Canadian cohort. The White subgroup experienced a mortality reduction: the non-White subgroup did not. There was no significant change in length of stay or discharge home rate at a population level. There was a monthly increase in the probability of discharge with home health (0.0247%: P < 0.01); this was present in the lower-income quartiles and both race groups. The White subgroup had a higher rate of utilization of home health pre-ACA, and this discrepancy persisted post-ACA.

Conclusions:

The ACA is associated with improved mortality and increased use of home health services. Discrepancies amongst racial groups and income quartiles are present.
Survival After Trimodality Therapy in Patients With Locally Advanced Esophagogastric Adenocarcinoma
Authors: Sihag Smita , Nobel Tamar , Hsu Meier , De La Torre Sergio , Tan Kay See , Janjigian Yelena Y. , Ku Geoffrey Y. , Tang Laura H. , Wu Abraham J. , Maron Steven B. , Bains Manjit S. , Jones David R. , Molena Daniela
Published: November 2020

Objective:

To evaluate whether pCR exclusively defines major pathologic response to treatment with improved survival.

Summary Background Data:

pCR after trimodality therapy for EAC is infrequent but associated with improved prognosis. Yet most clinical trials and correlative studies designate pCR as the primary endpoint.

Methods:

We analyzed our prospectively maintained database for patients who underwent trimodality therapy for locally advanced esophageal adeno-carcinoma between 1995 and 2017. Overall survival (OS) was examined by percentage TR in the primary tumor bed and pathologic nodal stage (ypN0) using Kaplan-Meier plots. Optimal thresholds of TR for differentiating patients in terms of OS were investigated with descriptive plots using restricted cubic spline functions; associations were quantified using Cox multivariable analysis.

Results:

Among 788 patients, median follow-up was 37.5 months (range, 0.4210.6); median OS was 48.3 months (95% CI, 42.2–58.8). Absence of residual nodal disease was independently associated with improved survival (P < 0.001). Survival curves for 90% to 99% TR and 100% TR were similar, and a change in probability of improved OS was observed at 90% TR. On multivariable analysis, combining 90% to 99% and 100% TR was independently associated with improved OS, compared with 50% to 89% and <50% TR.

Conclusions:

ypN0 status is the strongest indicator of major pathologic response to trimodality therapy, in addition to >90% TR in the primary tumor bed. These findings may allow the definition of major pathologic response to be expanded, from pCR to > 90% TR and ypN0. This has meaningful implications for future clinical trials and correlative studies.
Bariatric Surgery Lowers the Risk of Major Cardiovascular Events
Authors: Brown Andrew M. , Yang Jie , Zhang Xiaoyue , Docimo Salvatore , Pryo Aurora D. , Spaniolas Konstantinos
Published: November 2020

Objective:

This study examines the impact of bariatric surgery on the risk of myocardial infarction, stroke, and a composite of cardiovascular outcomes in a large population cohort. Additionally, the impact of different bariatric surgery procedures on cardiovascular outcomes is assessed and compared.

Summary Background Data:

Bariatric surgery has been shown to improve comorbid conditions that are associated with cardiovascular disease and death. Few large studies have examined the impact of bariatric surgery on cardiovascular outcomes, and specifically compared the different bariatric procedures.

Methods:

A retrospective, observational, matched-cohort study was conducted in adult patients with obesity in New York state from 2006 to 2012. Patients were stratified into 2 groups, based on utilization of bariatric surgery. Patients were further subgrouped based on the types of primary bariatric surgery. The primary endpoint was the development of specific cardiovascular events – myocardial infarction (MI), and stroke; as well as a composite of both events.

Results:

A total of 328,807 patients, including 60,445 who had undergone bariatric surgery, and 268,362 matched nonsurgical controls were the study cohort for comparing surgical and nonsurgical patients. The risk of composite cardiovascular events decreased in the surgical group [hazards ratio (HR) = 0.48, 95% confidence intervals (CI): 0.45–0.51], as did the risk of MI (HR = 0.39, 95% CI: 0.35–0.42), and stroke (HR = 0.55, 95% CI: 0.51–0.59). Among the surgical cohort, sleeve gastrectomy patients had a higher risk of developing MI, stroke, and any type of cardiovascular event than gastric bypass patients.

Conclusions:

Bariatric surgery is associated with decreased risk of significant cardiovascular events compared to nonsurgical controls. In this exploratory analysis, gastric bypass was associated with a lower risk of all cardiovascular events than sleeve gastrectomy.
Low to Moderate Risk Non-orthopedic Surgical Patients Do Not Benefit From VTE Chemoprophylaxis
Authors: Sutzko Danielle C. , Obi Andrea T. , Kamdar Neil , Karamkar Monita , Wakefield Thomas W. , Osborne Nicholas H. , Henke Peter K.
Published: November 2020

This retrospective cohort study analyzes venous thromboembolism (VTE) incidence, morbidity, and mortality amongst postsurgical patients with and without VTE chemoprophylaxis within a quality collaborative. Postoperative thromboprophylaxis was broadly applied, yet was associated with no decrease in VTE, without affecting transfusion or mortality. Predictors of breakthrough VTE development despite evidence-based thromboprophylaxis are identified.

Objective:

We hypothesized that a high rate of prescription of VTE chemoprophylaxis would be associated with decreased VTE incidence and mortality.

Summary Background Data:

Recommendations for VTE prevention in surgical patients include chemoprophylaxis based upon preoperative risk stratification.

Methods:

This retrospective cohort study analyzed VTE incidence, morbidity, and mortality amongst postsurgical patients with and without VTE chemoprophylaxis between April 2013 and September 2017 from 63 hospitals within the Michigan Surgical Quality Collaborative. A VTE risk assessment survey was distributed to providers. Bivariate and multivariate comparisons were made, as well as using propensity score matched cohorts to determine if VTE chemoprophylaxis was associated with decreased VTE events. Hospitals were compared using risk-reliability adjusted VTE prophylaxis and postoperative VTE event rates.

Results:

Within the registry, 80% of practitioners reported performing formal VTE risk assessment. Amongst 32,856 operations, there were 480 (1.46%) postoperative VTE, and an overall mortality of 609 (1.85%) patients. Using a propensity matched cohort, we found that rates of VTE were similar in those receiving unfractionated heparin or low molecular weight heparin compared to those not receiving chemoprophylaxis (1.22 vs 1.13%, P = 0.57). When stratified further by VTE risk scoring, even the highest risk patients did not have an associated lower VTE rate (3.68 vs 4.22% P = 0.092). Postoperative transfusion (8.28 vs 7.50%, P = 0.057) and mortality (2.00% vs 1.62%, P = 0.064) rates were similar amongst those receiving and those not receiving chemoprophylaxis. No correlation was found between postoperative VTE chemoprophylaxis application and hospital specific risk adjusted postoperative VTE rates.

Conclusions:

In modern day postsurgical care, VTE remains a significant occurrence, despite wide adoption of VTE risk assessment. Although postoperative VTE chemoprophylaxis was broadly applied, after adjusting for confounders, no reduction in VTE was observed in at-risk surgical patients.
Upfront Small Bowel Resection for Small Bowel Neuroendocrine Tumors With Synchronous Metastases
Authors: Bennett Sean , Coburn Natalie , Law Calvin , Mahar Alyson , Zhao Haoyu , Singh Simron , Zuk Victoria , Myrehaug Sten , Gupta Vaibhav , Levy Jordan , Hallet Julie
Published: November 2020

Objective:

We examined the impact of upfront small bowel resection (USBR) for metastatic small bowel neuroendocrine (SB-NET) compared to nonoperative management (NOM) on long-term healthcare utilization and survival outcomes.

Summary of Background Data:

The role of early resection of the primary tumor in metastatic SB-NET remains controversial. Conflicting data exist regarding its clinical and survival benefits.

Methods:

This is a population-based retrospective matched comparative cohort study of adults diagnosed with synchronous metastatic SB-NET between 2001 and 2017 in Ontario. USBR was defined as resection within 6 months of diagnosis. Primary outcomes were subsequent unplanned acute care admissions and small bowel-related surgery. Secondary outcome was overall survival. USBR and NOM patients were matched 2:1 using a propensity-score. We used time-to-event analyses with cumulative incidence

functions and univariate Andersen-Gill regression for primary outcomes. Evalue methods assessed the potential for residual confounding.

Results:

Of 1000 patients identified, 785 had USBR. The matched cohort included 348 patients with USBR and 174 with NOM. Patients with USBR had lower 3-year risk of subsequent admissions (72.6% vs 86.4%, P < 0.001) than those with NOM, with hazard ratio 0.72 (95% confidence interval 0.570.91). USBR was associated with lower risk of subsequent small bowel-related surgery (15.4% vs 40.3%, P < 0.001), with hazard ratio 0.44 (95% confidence interval 0.29–0.67).
E
-values indicated it was unlikely that the observed risk estimates could be explained by an unmeasured confounder. Sensitivity analysis excluding emergent resections to define USBR did not alter the results.

Conclusions:

USBR for SB-NETs in the presence of metastatic disease was associated with better patient-oriented outcomes of decreased subsequent admissions and interventions, compared to NOM. USBR should be considered for metastatic SB-NETs.
Identification of alkylsalicylic acids in Lentisk oil (Pistacia lentiscusL.) and cytotoxicity on Human Normal Dermal Fibroblasts
Authors: Benalia Nabiha , Boumechhour Abdenour , Ortiz Sergio , Echague Cristian A. , Rose Thorsten , Fiebich Bernd L. , Chemat Smain , Michel Sylvie , Deguin Brigitte , Dahamna Saliha , Boutefnouchet Sabrina
Published: November 2020

Pistacia lentiscusL. (Anacardiaceae) is widely distributed in the Mediterranean basin. Its fruit oil is used in traditional medicine to treat burns, skin impairments as well as inflammatory diseases as soothing massage or internal use. An increased interest is spotted lately with several commercial brands are spun portraying the benefits of this oil but with no stringent regulations to ascertain its safe use as an edible or cosmeceutical product. This work concerned the investigation of secondary metabolites presents inPistacia lentiscusfruits oil using both GC-MS and HPLC-DAD-MS technics, and the evaluation of cytotoxicity on human normal dermal fibroblasts to assess safety of use as cosmetic ingredient. This study stands as the first one to report the identification of alkylsalicylic acids in fruits oil and unsaponifiable fraction ofPistacia lentiscusfruit oil which calls for therefore, quantification of alkylsalicylic acids, known as skin irritants, inPistacia lentiscusoil, used as nutraceuticals or cosmeceuticals by manufacturers.
Incidence of SARS-CoV-2 infection among asymptomatic frontline health workers in Los Angeles County, California
Authors: Halbrook Megan , Gadoth Adva , Martin-Blais Rachel , Grey Ashley , Contreras Deisy , Kashani Saman , Kazan Clayton , Kane Brian , Tobin Nicole H. , Fulcher Jennifer A. , Brooker Sarah L. , Kitchen Scott G. , Faure-Kumar Emmanuelle , Yang Otto O. , Ferbas Kathie G. , Aldrovandi Grace M. , Rimoin Anne W.
Published: November 2020

Beginning April 8, 2020, we enrolled 1787 frontline heath workers who were asymptomatic for COVID-19 into a longitudinal surveillance study. During that time 4 healthcare workers and 6 first responders tested positive for SARS-CoV-2 by RT-PCR. Additionally, 43 healthcare workers and 55 first responders had detectable IgG antibodies to SARS-CoV-2.
Chalcid Hymenopteran parasitoidDirhinus giffardiiSilvestri proficiently disturbed house fly production
Authors: Rauf Imran , Memon Raza Muhammad , Khuhro Niaz Hussain , Khan Imtiaz Ahmed
Published: November 2020

Objectives

Man is always conscious about his health, and is well being challenged by many diseases. These diseases are directly causing hazards and most of them are transmitted through a vector. These vectors (mostly insects) have the ability to transfer / spread pathogenic organisms and that have the potential to cause severe epidemics. The house fly,Musca domestica(Diptera: Muscidae) plays a leading role in spreading more than 100 human and animal diseases. House fly is an eternal issue and mostly the management tactics rely on the use of chemicals either as spray, fumigants or baits. Unauthenticated behavior of these chemicals creates lethal effects on biological ecosystem, furthermore these measures may not be an effective options for outdoor management. For natural and safe option, bio-control strategy is being utilized to make environment healthy and clean. The present study was a part of such effort to use this strategy and validate the biological performance of the potential pupal parasitoidDirhinus giffardiiSilvestri against house fly and provide alternative and safe control of filthy flies. This is the first report on parasitism potential ofD. giffardiiSilvestri against house fly.

Results

TheD. giffardiiSilvestri, 1913 (Hymenoptera: Chalcididae), early reported as an effective pupal parasitoid of tephritid flies, here in the case presented, showed overall 70% reduction in the house fly population by parasitizing pupae. The parasitism efficiency and longevity of hymenopteran parasitoid was remarkably noted two-fold higher on house fly pupae as compared to primary hosts (Tephritids). An amazing results were recorded on house fly parasitism, where, female production was increased one fold as compared to tephritids. Furthermore, sex ratio of the resultant progeny was also confirmed the dominancy of female by 74% as compared to males. Based on the unique and remarkable findings we therefore conclude thatD. giffardiiis the best bio-control agent for controlling house flies and provide healthy, clean and ecofriendly environment.
Effects of Endogenous Angiotensin II on Abdominal Aortic Aneurysms and Atherosclerosis in Angiotensin II-infused Mice
Authors: Kukida Masayoshi , Sawada Hisashi , Ohno-Urabe Satoko , Howatt Deborah A. , Moorleghen Jessica J. , Poglitsch Marko , Daugherty Alan , Lu Hong S.
Published: November 2020

Angiotensin II (AngII), a major effector of the renin-angiotensin system, exerts critical roles in regulating vascular function. AngII infusion induces abdominal aortic aneurysms (AAAs) and exacerbates atherosclerosis in hypercholesterolemic mice. We determined the effects of AngII infusion on endogenous AngII regulation and AngII-mediated AAAs and atherosclerosis. AngII infusion increased renal, but not plasma, AngII concentrations in male mice. AngI concentrations were decreased modestly in kidney, but more profoundly in plasma, during AngII infusion. Bovine AngII (DRVYVHPF) has one amino acid difference from mouse AngII (DRVYIHPF) that can be distinguished by LC-MS/MS. Therefore, we determined exogenous versus endogenous peptides in mice infused with bovine AngII. Bovine AngII infusion reduced endogenous renal AngII concentrations. To determine whether the residual endogenous AngII exerted an effect on AAAs and atherosclerosis in mice infused with AngII, aliskiren (a direct renin inhibitor) was administered to AngII-infused male LDL receptor deficient mice. Although aliskiren did not attenuate AAAs in AngII-infused mice, atherosclerotic lesion size was reduced. In conclusion, endogenous AngII concentrations are reduced during AngII infusion but still contribute to atherosclerosis, but not AAA, in AngII-infused hypercholesterolemic mice.