bluuebunny/crossref_metadata_2025 huggingface dataset:
National Landscape of Hospitalizations in Patients with Left Ventricular Assist Device. Insights from the National Readmission Database 2010–2015
Authors: Lemor Alejandro , Michaels Alexander , Al-Darzi Waleed , Hernandez Gabriel A. , Nasr Youssef , Villablanca Pedro , Blumer Vanessa , Tita Cristina , Williams Celeste T. , Selektor Yelena , Lanfear David E. , Lindenfeld JoAnn , Cowger Jennifer
Published: February 2020

The number of patients with left ventricular assist devices (LVAD) has increased over the years and it is important to identify the etiologies for hospital admission, as well as the costs, length of stay and in-hospital complications in this patient group. Using the National Readmission Database from 2010 to 2015, we identified patients with a history of LVAD placement using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code V43.21. We aimed to identify the etiologies for hospital admission, patient characteristics, and in-hospital outcomes. We identified a total of 15,996 patients with an LVAD, the mean age was 58 years and 76% were males. The most common cause of hospital readmission after LVAD was heart failure (HF, 13%), followed by gastrointestinal (GI) bleed (11.8%), device complication (11.5%), and ventricular tachycardia/fibrillation (4.2%). The median length of stay was 6 days (3–11 days) and the median hospital costs was $12,723 USD. The in-hospital mortality was 3.9%, blood transfusion was required in 26.8% of patients, 20.5% had acute kidney injury, 2.8% required hemodialysis, and 6.2% of patients underwent heart transplantation. Interestingly, the most common cause of readmission was the same as the diagnosis for the preceding admission. One in every four LVAD patients experiences a readmission within 30 days of a prior admission, most commonly due to HF and GI bleeding. Interventions to reduce HF readmissions, such as speed optimization, may be one means of improving LVAD outcomes and resource utilization.
Update in adult community-acquired pneumonia: key points from the new American Thoracic Society/Infectious Diseases Society of America 2019 guideline
Authors: Metlay Joshua P. , Waterer Grant W.
Published: February 2020

Purpose of review

The American Thoracic Society and Infectious Diseases Society of America recently released their joint guideline for the diagnosis and treatment of adults with community-acquired pneumonia (CAP). The co-chairs of the guideline committee provide a summary of the guideline process, key recommendations from the new guideline and future directions for CAP research.

Recent findings

The guideline committee included 14 experts from the two societies. Sixteen questions for the guideline were selected using the PICO format. The GRADE approach was utilized to review the available evidence and generate recommendations. The recommendations included expanded microbiological testing for patients suspected of drug-resistant infections, empiric first-line therapy recommendations for outpatients and inpatients including use of beta-lactam monotherapy for uncomplicated outpatients, elimination of healthcare-associated pneumonia as a treatment category, and not recommending corticosteroids as routine adjunct therapy.

CAP is a major cause of morbidity and mortality. Effective antibiotic therapy is available and remains largely empirical. New diagnostic tests and treatment options are emerging and will lead to guideline updates in the future.
The bone mineral density of hip joint was reduced in the initial stage of ankylosing spondylitis?
Authors: Cai Peng Li , Yan Yun Yu , Wei Wei , Chen Xiao Shuai , Zhao Jian , Zhang Ze Kun , Zhang Ping
Published: February 2020

The osteoporosis was common complication of ankylosing spondylitis (AS), but it was frequently unrecognized in the initial stage of the disease. This study was to compare areal bone mineral density (BMD) of hip joints in early AS patients with that in healthy controls, to explore the progress of bone loss in cortex and spongiosa in early AS.

Quantitative computed tomography (QCT) of hip was performed in 60 AS patients (modified New York criteria for AS, with grade 2 sacroiliitis in computed tomography) and 57 healthy controls. The QCT measurements of AS patients were compared with the measurements of healthy controls.

The AS patients had lower areal BMD in cortical bone and total bone of proximal femur in early AS patients (P < .01), than the controls. But there were not significant different of areal BMD in spongiosa of proximal femur between the early AS patients and healthy controls. Strong correlations were found between body mass index BMI, areal BMD in cortical bone (r

s
 = 0.410, P < .001; r

s
 = 0.422, P < .001) and total bone (r

s
 = 0.368, P < .001; r

s
 = 0.266, P = .003) both in AS patients and healthy controls.

The results indicate that osteopenia/osteoporosis is general in early stage of AS. What is more, the osteopenia/osteoporosis in cortex is earlier than in spongiosa of proximal femur in early AS.
Functional health literacy among left-behind students in senior high schools in an ethnic minority area
Authors: Cheng Linan , Chen Qian , Zhang Feng ying , Wu Wenwen , Cui Wenxiang , Hu Xiuying
Published: February 2020

To verify the validity of functional health literacy scale and analyze what influences functional health literacy.

Using convenience sampling method based on cross-sectional data to select 589 left-behind senior high-school students in an ethnic minority area, using the functional health literacy scale.

The scale results were relatively strong, and the absolute fitness index, value-added fitness index, and simple fitness index reached the fitness standards. The overall functional health literacy score was (0.65 ± 0.12), which falls within the upper middle class. Gender(t = 2.40, P < .05), ethnicity (t = 4.28, P < .001), place of residence (t =  = 4.51, P < .001), mother's education level (F = 3.608, P < .05), self-assessment of grades for 1 year (F = 25.781, P < .001), and whether the participant liked the health education content (F = 9.416, P < .001) had impacts on overall functional health literacy.

The study results show that relatively satisfactory reliability and validity and can be applied further analysis for improving students functional health literacy levels.
Photobiomodulation therapy and transcutaneous electrical nerve stimulation on chronic neck pain patients
Authors: Rampazo Érika Patrícia , de Andrade Ana Laura Martins , da Silva Viviane Ribeiro , Back Cláudio Gregório Nuernberg , Liebano Richard Eloin
Published: February 2020

Introduction:

Chronic neck pain is a common musculoskeletal disorder that is associated with functional disability and decreased of quality of life. Electrophysical agents are commonly used to relieve pain, however the effects of combined use of these agents are little studied. The objective is to investigate the efficacy of photobiomodulation and electrical stimulation to relieve pain, both in isolation and combined.

Materials and methods:

This a 4-arm randomized placebo-controlled trial with patient and evaluator blinded. This study will be performed in Department of Physical Therapy at Federal University of São Carlos, São Carlos/SP, Brazil. One hundred and forty-four patients with chronic neck pain will be randomized into 4 groups: active photobiomodulation therapy with active electrical stimulation, active photobiomodulation therapy, active electrical stimulation, or placebo treatment. They will receive 10 sessions of treatment. Primary outcome: pain intensity (measured by pain numerical rating scale) posttreatment. Secondary outcomes: pain during movement, neck disability, range of motion, pressure pain threshold, temporal summation, conditioned pain modulation, depressive symptoms, pain catastrophizing, quality of life, analgesic intake, and global perceived effect at posttreatment (10 sessions). Pain intensity and global perceived effect will also be measured after 6 weeks randomization.

Discussion:

The findings of this study might clarify the importance of using the photobiomodulation therapy and transcutaneous electrical nerve stimulation for patients with chronic neck pain.

Trial registration:

NCT04020861. https://clinicaltrials.gov/ct2/show/NCT04020861?term=NCT04020861&draw=2&rank=1.
Failure of Less-Invasive Stabilization System (LISS) plating for periprosthetic distal femur fractures
Authors: Tian Zhen-Jiang , Liu Yan-Jie , Chen Bo-Jian , Wang Jun , Niu Cai-Li , Feng En-Hui , Mai Xiu-Jun , Huang Yong-Ming
Published: February 2020

Rationale:

Less-Invasive Stabilization System (LISS) plate is an internal fixation commonly used for the periprosthetic distal femur fractures. Failure associated with LISS plate has been rarely reported, and the reasons for LISS plate failure are multitudinous. Various advantages have been reported, but failures continue.

Patient concerns:

We present 3 cases illustrating the failure of Less-Invasive Stabilization System (LISS) plating for periprosthetic distal femur fractures. The shaft screws of the LISS plate broke in 2 cases, and the plate placement was incorrect in 1 case. Early weight bearing, obesity, osteoporosis, and lateral collateral ligament injury due to incorrect plate placement constituted the etiologies of LISS plate failure.

Diagnosis:

Failure of Less-Invasive Stabilization System (LISS) plating for periprosthetic distal femur fractures after Total knee arthroplasty.

Interventions:

Three patients underwent Less-Invasive Stabilization System plates removal with replacement of the total knee arthroplasty revision surgery with rotating hinged knee prosthesis.

Outcomes:

After completing the total knee arthroplasty revision surgery, all patients underwent regular follow-up examinations. Case 2 could walk unaided, without pain, final union was confirmed for both case 1 and case 3.

Conclusion:

Less-Invasive Stabilization System (LISS) plate provides satisfactory results in periprosthetic fractures after Total knee arthroplasty (TKA). The LISS plate has many advantages, but failures continue to occur. The causes for failure were early weight bearing, obesity, osteoporosis, and lateral collateral ligament (LCL) injury due to incorrect plate placement in our series. We recommend that protection or properly delay of weight-bearing, active anti-osteoporosis treatment, and intraoperative fluoroscopy are the effective methods to avoid failure.
Seattle protocol vs narrow band imaging guided biopsy in screening of Barrett's esophagus in gastroesophageal reflux disease patients
Authors: Elsheaita Ahmed , El-Bially Mohamed Ahmed , Shamseya Mohammed Mohammed , Ahmed Sanaa Shawky , Madkour Marwa Ahmed , Shamseya Ayman Mohammed , Nouh Hanan Hosny
Published: February 2020

Barrett's esophagus has 0.5% to 7% risk of progression to esophageal adenocarcinoma. The method of obtaining biopsies to diagnose Barrett's is challenging. Seattle protocol has been considered as the gold standard, however its difficulty limits its applicability in practice. Narrow band imaging guided biopsy has been proposed as an alternative.

To investigate the accuracy, sensitivity, specificity and applicability of Narrow band guided biopsy as a screening tool for Barret's esophagus in gastroesophageal reflux patients.

Endoscopy was done in 2 different sessions 2 weeks apart for 100 patients in Alexandria, Egypt. Patients had at least one of the following: Chronic Gastroesophageal reflux disease, frequent Gastroesophageal reflux disease, or two or more risk factors for Barrett's esophagus. All patients with known Barrett's esophagus were excluded.

Seventeen patients had Barrett's esophagus either by one of the two techniques or by both, 4 patients by both methods, 7 patients by narrow band imaging alone and 6 patients by Seattle protocol alone (P < .001, κ = 0.461). Sensitivity, specificity, negative predictive value and positive predictive value for Seattle protocol were 58.8%, 100%, 92.2%, 100% vs 76.5%, 100%, 95.4%, 100% respectively for narrow band imaging. A mean of 7.73 samples/patient was taken in Seattle protocol vs 3.42 samples in narrow band imaging (P < .001). A mean of 8.63 minutes was consumed in Seattle protocol vs 2.65 minutes in narrow band imaging (P < .001).

Narrow band imaging guided biopsy might have higher accuracy, sensitivity and negative predictive value as well as fewer number of biopsies and shorter time of the procedure compared to Seattle protocol which might increases its applicability as screening protocol for Barrett's esophagus. However, further larger multicentric studies are needed.
Evaluation and validation of the prognostic value of nutrition and immunity parameters in gastric cancer after R0 resection
Authors: Xue Wenbo , Xu Xuezhong , Tan Yulin , Wang Yibo , Wang Hao , Xu Yixin , Xi Cheng , Jiang Peng , Ding Wei
Published: February 2020

Precise predictive tools are critical for choosing the individualized treatment protocols and follow-up procedures for patients with gastric cancer (GC). In this study, we aimed to evaluate and validate the prognostic abilities of preoperative nutrition and immunity parameters in GC after curative R0 resection.

We established two nomograms based on 437 patients who underwent curative radical gastrectomy for gastric cancer to predict the postoperative overall survival (OS) and recurrence-free survival (RFS), and then compared the predictive accuracy and discriminative ability of the nomograms with the TNM stage systems for GC. An internal validation cohort of 141 patients and an external validation cohort of 116 patients were used to validate the result.

The independent predictive factors for OS or RFS, including T stage, N stage, differentiated degree, neutrophil monocyte lymphocyte ratio (NMLR) and albumin globulin ratio (AGR) were used to establish the 2 nomograms. The C-index of the OS nomogram was 0.802, which was higher than that of the AGR, the NMLR and the TNM stage. The C-index of the RFS nomogram was 0.850, which was higher than that of the AGR, the NMLR and the TNM stage. Analogously, the areas under the receiver operating characteristics curves (AUROCs, 0.920 for OS and 0.897 for RFS, respectively) of the two nomograms were higher than that of the NMLR, the AGR and the TNM stage. In the internal validation cohort, the C-indexes of the OS and RFS nomograms were 0.812 and 0.826, respectively. In the external validation cohort, the C-indexes of the OS and RFS nomograms were 0.866 and 0.880, respectively.

The proposed nomograms including nutrition and immunity parameters were proved to have excellent predictive ability in survival and recurrence for patients with GC after R0 resection.
Association between vitamin D deficiency and cognitive function in the elderly Korean population
Authors: Lee Do Hun , Chon Jinmann , Kim Yong , Seo Yun Kyung , Park Eo Jin , Won Chang Won , Soh Yunsoo
Published: February 2020

It is well known that vitamin D (VitD) plays an important role in bone and calcium metabolism in the human body. VitD has additional roles in the body including modulation of cell growth, neurogenesis, neuroprotection, detoxification, immune function, and reduction of inflammation. Recent studies reveal insufficiency of VitD as a risk factor for cognitive decline or dementia. VitD has a role in normal brain function; insufficiency of VitD may lead to decreased memory and cognitive function.

Using 2 years of baseline data from Korean frailty and aging cohort study, 2990 subjects (1415 men and 1575 women) were recruited. A short form of Korean version of the consortium to establish a registry for Alzheimer disease (CERAD-K), an assessment of cognitive status in patients with dementia was used. Among CERAD-K tests, we included word list memory/recall/recognition, digit span (forward, backward), trail making test (TMT) A, and mini-mental state examination in the Korean version of the CERAD assessment packet (MMSE-KC). Serum samples were collected and 25-hydroxyvitamin D (25(OH)D) was measured. Serum 25(OH)D concentrations were classified into clinically relevant categories as: deficient (<10 nmol/L), insufficient (10–30 nmol/L), and sufficient (≥30 nmol/L).

The mean age of participants was 76.5 ± 3.9 years, and 52.7% were women. Among 2990 participants, 119 (4.0%) were classified as 25(OH)D deficient and 2253 (75.3%) as insufficient. Only 618 (20.7%) participants were sufficient for 25(OH)D. Among them performance in MMSE-KC, TMT A, and digit span tests was better in sufficient, insufficient, and deficient groups, which was statistically significant (P < .05). However, in multivariable regression analysis after adjusting for age, sex, body mass index, education, center, seasonality, physical activity, and alcohol use, association between 25(OH)D and cognitive function was not statistically significant.

Although, when comparing VitD levels, there were differences in cognitive tests among the groups, fully adjusted analysis did not show any association. This result suggests that cognition was not affected by VitD levels alone but also population and sociological variables. In a fully adjusted model, there was no statistically significant association between VitD and cognitive function in the elderly Koreans in logistic regression analysis.
Edaravone reduces depression severity in patients with symptomatic intracranial stenosis and is associated with the serum expression of sex hormones
Authors: Kong Zhaohong , Jiang Jian , Deng Ming , Zhang Zhaohui , Wang Gaohua
Published: February 2020

Objective:

To investigate the effect of edaravone on depression relief in symptomatic patients with intracranial stenosis and its relationship with the expression of sex hormones.

Methods:

We recruited 112 patients with symptomatic intracranial arterial stenosis from Renmin Hospital, Wuhan University, between October 2014 and October 2017. All patients were divided into the traditional or experimental (traditional treatment + intravenous infusion of edaravone 30 mg twice a day for 14 days) treatment groups. The general clinical data were collected, and neurological functional recovery using the Modified Rankin Scale (mRS) and National Institute of Health stroke scale (NIHSS) scores were recorded. Symptom Checklist 90 (SCL-90) was used to assess the general psychological changes of the patient, followed by the 24 Hamilton Depression Scale (HAMD) to examine the incidence of post-stroke depression (PSD). This divided the patients into the mild, moderate, and severe depression groups. Next, we measured the serum protein expression of the sex hormones estradiol (E2), testosterone (T), follicle stimulating hormone (FSH), prolactin (PRL), and luteinizing hormone (LH).

Results:

The mRS and NIHSS scores were significantly lower in the experimental group than in the control group (P < .05). There was no significant difference in SCL90 score before intervention (P > .05); the scores were significantly lower in the experimental group after intervention (P < .05). There was a significant difference in SCL-90 and HAMD scores between groups before treatment (P < .05), with significantly lower scores in the experimental group post-treatment (P < .05). The incidence of depression was significantly reduced in the experimental group post-treatment. Furthermore, the expression of E2 and FSH was significantly higher (P < .01) and lower (P < .001), respectively, in women than in men in the experimental group post-treatment. Interestingly, the expression of T was significantly lower in men in the experimental group post-treatment (P < .001).

Conclusion:

Edaravone significantly improved the clinical efficacy of stent implantation in intracranial artery stenosis treatment by alleviating depression and reducing the incidence of PSD.
Prognostic impact of lymph node status in patients after total pancreatectomy for pancreatic ductal adenocarcinoma
Authors: Zheng Zhen-Jiang , Wang Mo-Jin , Tan Chun-Lu , Chen Yong-Hua , Ping Jie , Liu Xu-Bao
Published: February 2020

The optimal number of examined lymph nodes (ELN) for staging and impact of nodal status on survival following total pancreatectomy (TP) for pancreatic ductal adenocarcinoma (PDAC) is unclear. The aim of this study was to evaluate the prognostic impact of different lymph node status after TP for PDAC.

The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients who underwent TP for PDAC from 2004 to 2015. We calculated overall survival (OS) of these patients using Kaplan–Meier analysis and Cox proportional hazards model.

Overall, 1291 patients were included in the study, with 869 node-positive patients (49.5%). A cut-off points analysis revealed that 19, 19, and 13 lymph nodes best discriminated OS for all patients, node-negative patients, and node-positive patients, respectively. Higher number of ELN than the corresponding cut-off points was an independent predictor for better prognosis [all patients: hazard ratios (HR) 0.786, P = .002; node-negative patients: HR 0.714, P = .043; node-positive patients: HR 0.678, P < .001]. For node-positive patients, 1 to 3 positive lymph nodes (PLN) correlated independently with better survival compared with those with 4 or more PLN (HR 1.433, P = .002). Moreover, when analyzed in node-positive patients with less than 13 ELN, neither the number of PLN nor lymph node ratio (LNR) was associated with survival. However, when limited node-positive patients with at least 13 ELN, univariate analyses showed that both the number of PLN and LNR were associated with survival, whereas multivariate analyses demonstrated that only number of PLN was consistently associated with survival (HR 1.556, P = .004).

Evaluation at least 19 lymph nodes should be considered as quality metric of surgery in patients who underwent TP for PDAC. For node-negative patients, a minimal number of 19 lymph nodes is adequate to avoid stage migration. For node-positive patients, PLN is superior to LNR in predicting survival after TP, predominantly for those with high number of ELN.
Successful combination of endoscopic and laparoscopic removal of multiple ingested needles
Authors: Tsuruya Kota , Chino Osamu , Tanaka Yoichi , Shimma Yoshimasa , Tsuda Shingo , Kikuchi Masahiro , Shiozawa Hirokazu , Aoki Jun , Nakamura Tomoki , Hanashi Tomoko , Suzuki Takayoshi , Matsushima Masashi
Published: February 2020

Rationale:

Foreign body (FB) ingestion is a relatively common clinical situation in the emergency department. However, multiple sharply pointed foreign bodies located in different organs are rare conditions and no definite treatment guidelines has been established.

Patient concerns:

A 31-year-old amateur magician visited the outpatient clinic with a chief complaint of epigastric discomfort. He might have accidentally swallowed some needles while practicing a magic trick 2 days before.

Diagnosis:

Imaging tests revealed 1 needle was stuck in the left liver lobe through the stomach wall, 1 was in the third portion of the duodenum, 3 were in the ascending colon, and 2 were in the transverse colon.

Interventions:

A needle in the duodenum and 5 in the colon were removed by endoscopy. The needle stuck in the liver from the stomach was not visible inside the stomach and was successfully removed by laparoscopy a few days later.

Outcomes:

The patient was able to tolerate an oral diet and was discharged on postoperative day 4 without any complications.

Lessons:

Developing a treatment plan in cases of multiple sharp FB may be difficult. A multidisciplinary team of endoscopists and surgeons is needed to determine the best possible treatment plan. This experience illustrates the importance of the planning of the sequence and method of removal of multiple foreign bodies from the gastrointestinal tract.
The Perceived Ostomy Educational Needs of Pediatric Patients With Inflammatory Bowel Disease and Their Caregivers
Authors: David Jennie G. , Moreno Steffany , Daniel Rhea , Pall Harpreet
Published: February 2020

Inflammatory bowel disease (IBD) is a chronic disease causing inflammation of the gastrointestinal tract. Some patients require ostomy surgery to optimize their health. This study assessed perceived medical and psychosocial educational needs related to ostomy surgery in pediatric patients with IBD. This mixed‐methods study included qualitative interviews of pediatric patients and caregivers with demographic/medical variables obtained from medical records. Participants (n = 8) had an average age of 15.62 years (standard deviation = 2.97). Mean length of diagnosis was 4.5 years (standard deviation = 3.6 years). Interviews were transcribed and coded. Qualitative coding of narratives identified main codes of Ostomy Surgery, Preoperative Concerns, Postoperative Concerns, Education Preferences, and Social Concerns, with various subcodes. Codes captured unfamiliarity with the ostomies, preferences for education from a medical provider, and psychosocial concerns. Results suggest pediatric patients with IBD have limited understanding of ostomies and limited insight into educational preferences. These findings highlight the importance of developmentally appropriate information for accessible ostomy education.
Venous Thromboembolism in a Transgender Adolescent on Testosterone Therapy: A Case Report and Literature Review
Authors: Fan Elaine M. , Gordner Chelsea , Luty Joanna
Published: February 2020

The incidence of pediatric venous thromboembolism (VTE) has been increasing in the past few decades and can be associated with significant mortality and morbidity. There are known risk factors associated with VTE, including estrogen therapy. However, the relationship between testosterone and VTE remains unclear. Here, we present a 17-year-old female-to-male transgender patient without a history of inherited thrombophilia, who developed pulmonary embolism while receiving testosterone injections for gender dysphoria. Despite the limited data on testosterone and the risk of VTE, health care providers should counsel patients and family about the possible increased risk of VTE when starting testosterone.
Conversations and Beyond
Authors: van Nieuw Amerongen-Meeuse Joke C. , Schaap-Jonker Hanneke , Westerbroek Gerlise , Anbeek Christa , Braam Arjan W.
Published: February 2020

This study examines religious/spiritual (R/S) care needs and their possible determinants among mental health patients in the Netherlands. Patients in a Christian (CC, n = 100) and a secular (SC, n = 101) mental health clinic completed a questionnaire. Analysis revealed three factors on the R/S care needs measure: (1) “R/S conversations,” (2) “R/S program and recovery,” and (3) “R/S similar outlook on life.” The presence of R/S care needs was predicted by the following: site (CC versus SC), R/S involvement, and religious strain. Most commonly, unmet R/S care needs were explanation about R/S and illness by the practitioner, prayer with a nurse, conversations about religious distress with a nurse, conversation when R/S conflicts with treatment, help in finding a congregation, and contact between chaplain and practitioner. “R/S similar outlook on life” was equally important to patients with and without R/S involvement. Patients appreciate a match in worldview with health professionals, either religious or secular.
Decreasing the Duration of Discharge Antibiotic Treatment Following Inpatient Skin and Soft Tissue Abscess Drainage
Authors: Erdem Guliz , Buckingham Don , Drewes Kevin , Kenney Brian , Gibson Annika , Gallup Nathaniel , Barson William
Published: February 2020

Introduction:

Skin and soft tissue abscesses do not require prolonged systemic antimicrobial treatment following drainage. We aimed to decrease the duration of discharge antibiotic treatment to less than 5 days following inpatient incision and drainage of uncomplicated abscesses.

Methods:

A new treatment protocol that defined uncomplicated abscesses, as well as inclusion and exclusion criteria, was created to monitor the accurate duration of prescribed therapy at discharge. We implemented a treatment algorithm that takes into account the epidemiologic changes in microbial etiologies and the presence of systemic findings for patients after surgical incision and drainage. We used control charts to assess the impact of the interventions.

Results:

Four hundred and eighteen patients were discharged following abscess drainage from our inpatient infectious diseases unit in 2016. The patients were 3 months to 21 years of age. Only 72 (17%) patients had prescribed discharge antibiotic treatment courses that were less than 5 days [range 0–31 days, median 8 days (IQR 6, 9)], and the average prescribed course at discharge was 8.6 days. During the study period, we significantly decreased the average duration of discharge antibiotics to 7.3 days in all patients (P = 0.0016, 95% CI: −2.1036 to −0.4964, difference of means −1.3). The discharge treatment duration of patients with uncomplicated abscess was shorter at 4.7 days [range 0–9 days, median 5 days, (IQR 3, 5)]. Prescription compliance to less than 5 days treatment course at discharge increased from the baseline of 17% to 42% overall.

Conclusions:

Standardizing definitions of uncomplicated skin and soft tissue abscesses was critical to the success of this project. In addition to possible improved treatment adherence and decreased side effects, our protocol led to decreased patient care costs with no documented changes in readmission rates.
Quantifying Cortical Resilience in Experimental, Clinical, and Epidemiological Studies: A Conceptually Grounded Method Using Noninvasive Brain Stimulation
Authors: Hall Peter A. , Erickson Kirk I. , Lowe Cassandra J. , Sakib Mohammad N.
Published: February 2020

Objective

Cortical resilience can be defined as the ability of the cortex of the human brain to rebound efficiently from perturbation. This concept is important in both research and clinical practice contexts. However, no direct measure of cortical resilience exists. Inhibitory variants of repetitive transcranial magnetic stimulation, such as continuous theta burst stimulation, provide a standardized method for inducing a perturbation; when coupled with the assessment of recovery rate from the perturbation, such a paradigm might provide a standardized measure of cortical resilience. This article describes a standardized method for quantifying cortical resilience using theta burst stimulation protocols.

Methods

A descriptive overview of a method for assessing cortical resilience is presented. Links are drawn between critical facets of the resilience construct and the protocol described.

Results

The Cortical Challenge and Recovery Test (CCaRT) method makes use of existing stimulation parameters and cognitive testing paradigms to provide a flexible and conceptually meaningful measure of cortical resilience.

Conclusions

The CCaRT paradigm is potentially useful in research and contexts where cortical resilience is to be measured. The CCaRT paradigm has applicability to epidemiological studies and laboratory experimentation as well as diagnostic practice and clinical trial outcome measures.
The Protagonism of the Brazilian Health Regulatory System in the Evolution of Patient Safety in the Country: History, Dilemmas, and Current Challenges
Authors: Santana Heiko T. , Costa Magda M. M. , Nogueira Maria Dolores S. P. , dos Santos Ana Clara R. B. , Carvalho André A. , Morelo Luana T. , Ribeiro Cleide F. M. , de Sousa Fabiana C. , de Moura Humberto L. C. A. , Barros Lilian de S. , de Oliveira Luciana S. C. , Gonçalves Mara R. S.
Published: February 2020

Objective

This article aims to identify and analyze the legal and regulatory frameworks with an interface with patient safety, considering the historical path of the patient safety policy in Brazil.

Methods

This is a historical review based on the relevant literature to the topic such as papers, legislation, and official documents with an interface with public health policies from 1988 to 2019. We also performed a documentary search to include data from the Brazilian Health Regulatory Agency (ANVISA) such as normative and nonnormative regulatory instruments. After organizing the data, the process of content analysis was performed.

Results

We debated initially the historical aspects of sanitary surveillance of health services in addition to main actions taken by the Brazilian Health Regulatory System, which includes sanitary regulation and patient safety challenges. We identified a diversity of regulations published by ANVISA in the past decade related to patient safety, in addiction to sanitary actions. These initiatives culminated in the establishment of the National Patient Safety Program in 2013, followed by other health improvements, such as surveillance, incidents monitoring, and safe practices self-assessment.

Conclusions

The regulation and sanitary actions directed to patient safety in Brazil have increased after the creation of ANVISA. In the face of this activities, the social role played by the Brazilian Health Regulatory System toward the advancement in the field of risk minimization in health services can be highlighted as a protagonist in the process of promoting patient safety.
Viral Rebound Among Persons With Diagnosed HIV Who Achieved Viral Suppression, United States
Authors: Craw Jason A. , Beer Linda , Tie Yunfeng , Jaenicke Tom , Shouse R. Luke , Prejean Joseph
Published: February 2020

Background:

Some persons who achieve viral suppression may later experience viral rebound, potentially putting them at risk for transmitting HIV. We estimate the prevalence of, and describe factors associated with, viral rebound among adults with diagnosed HIV in the United States who had ≥2 viral load tests in a 12-month period.

Setting:

The Medical Monitoring Project is an annual cross-sectional survey about the experiences and needs of adults with diagnosed HIV sampled from the National HIV Surveillance System.

Methods:

We analyzed interview and medical record data from 3 Medical Monitoring Project cycles spanning June 2015—May 2018. We analyzed viral load results from the 12-month period before the interview among persons with ≥2 viral load tests who achieved viral suppression. Data were weighted based on known probabilities of selection, adjusted for patient nonresponse, and poststratified to known population totals from the National HIV Surveillance System.

Results:

Among those with ≥2 viral load tests who achieved viral suppression, 7.5% demonstrated viral rebound. In multivariable analyses, viral rebound was higher among non-Hispanic blacks, persons ages 18–39, persons with public insurance, persons recently experiencing homelessness, persons with higher numbers of viral load tests, persons who missed HIV care appointments, and persons with suboptimal adherence to antiretroviral therapy.

Conclusions:

Viral rebound varied by sociodemographic and clinical characteristics. HIV providers can monitor persons at greatest risk for viral rebound and link patients with ancillary services or evidence-based interventions to help them remain virally suppressed. Our findings can inform strategies and interventions implemented under the Ending the HIV Epidemic initiative.
Machine Learning and Deep Neural Networks
Authors: Eberhard Matthias , Alkadhi Hatem
Published: February 2020

Artificial intelligence (AI) algorithms are dependent on a high amount of robust data and the application of appropriate computational power and software. AI offers the potential for major changes in cardiothoracic imaging. Beyond image processing, machine learning and deep learning have the potential to support the image acquisition process. AI applications may improve patient care through superior image quality and have the potential to lower radiation dose with AI-driven reconstruction algorithms and may help avoid overscanning. This review summarizes recent promising applications of AI in patient and scan preparation as well as contrast medium and radiation dose optimization.
The Use of Ultrasound Guidance for the Treatment of Raynaud Disease of the Hand With Botulinum Toxin
Authors: Lobb David C. , Pierce Jennifer , Perry Michael , DeGeorge Brent
Published: February 2020

Background

This study sought to examine the feasibility and effectiveness of the use of ultrasound (US) as a clinical adjunct in the delivery of botulinum toxin for the treatment of Raynaud disease of the hand.

Methods

One cadaver hand was injected with a colored simulation material using the current traditional surface anatomy approach, whereas an additional cadaver hand was injected using US guidance. The hands were dissected and areas of distribution of the simulation material were evaluated. Five patients diagnosed with Raynaud disease were treated with botulinum toxin using US guidance and data using the Patient-Reported Outcomes Measurement Information System Upper Extremity were collected.

Results

The cadaver hand injected with a colored simulation material using US guidance demonstrated significantly reduced surface area of muscle infiltrated compared with the cadaver hand injected using the traditional surface anatomy approach (16 cm2 vs 37 cm2, P < 0.001).

All 5 patients treated with botulinum toxin using US guidance reported significant improvement in symptoms and function after injection (P < 0.05), where zero patients reported intrinsic hand weakness.

Conclusions

The use of US significantly improves the accuracy of delivery of a surrogate dye in a cadaver model of Raynaud disease, whereas its use clinically results in at least as effective a treatment as the landmark approach, but with less botulinum toxin required to achieve the clinical effect.
Real-world Outcomes With Rituximab-based Therapy for Posttransplant Lymphoproliferative Disease Arising After Solid Organ Transplant
Authors: Burns David M. , Clesham Katherine , Hodgson Yan A. , Fredrick Lynsey , Haughton Joanna , Lannon Michelle , Hussein Hayder , Shin Jin-Sup , Hollows Robert J. , Robinson Lisa , Byrne Catherine , McNamara Christopher , Vydianath Bindu , Lennard Anne L. , Fields Paul , Johnson Rod , Wright Josh , Fox Christopher P. , Cwynarski Kate , Chaganti Sridhar
Published: February 2020

Background.

Optimal upfront therapy for posttransplant lymphoproliferative disease (PTLD) arising after solid organ transplant remains contentious. Rituximab monotherapy (R-Mono) in unselected patients has shown a lack of durable remissions. Cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP)-based chemotherapy confers improved response rates, although concerns exist about toxicity.

Methods.

This multicenter retrospective study reports outcomes for adults with biopsy-proven B-cell PTLD treated initially with R-Mono or Rituximab plus CHOP (R-CHOP). Selection of therapy was made according to physician preference.

Results.

Among 101 patients, 41 received R-Mono and 60 had R-CHOP. Most (93%) had undergone renal or liver transplantation. R-CHOP showed a trend toward improved complete (53% versus 71%; P = 0.066) and overall (75% versus 90%; P = 0.054) response rates. In the R-Mono group, 13 of 41 (32%) subsequently received chemotherapy, while 25 of 41 (61%) remained progression-free without further therapy. With median follow-up of 47 months, overall survival (OS) was similar for R-Mono and R-CHOP, with 3-year OS of 71% and 63%, respectively (P = 0.722). Non-PTLD mortality was 3 of 41 (7%) and 4 of 60 (7%) within 12 months of R-Mono or R-CHOP, respectively. The International Prognostic Index was statistically significant, with low- (0–2 points) and high-risk (≥3 points) groups exhibiting 3-year OS of 78% and 54%, respectively (P = 0.0003). In low-risk PTLD, outcomes were similar between therapies. However, in high-risk disease R-Mono conferred an inferior complete response rate (21% versus 68%; P = 0.006), albeit with no impact on survival.

Conclusions.

Our data support R-Mono as initial therapy for PTLD arising after renal or liver transplantation. However, upfront R-CHOP may benefit selected high-risk cases in whom rapid attainment of response is desirable.
Pressure Injuries of the Nose and Columella in Preterm Neonates Receiving Noninvasive Ventilation via a Specialized Nasal Cannula
Authors: Boyar Vita
Published: February 2020

PURPOSE:

The aims of this study were to measure the incidence and severity of nasal septum injury in premature infants receiving continuous positive airway pressure (CPAP) via a noninvasive thin-walled cannula, and to evaluate the effect of a polyvinyl chloride foam barrier dressing in reducing these injuries.

DESIGN:

Retrospective chart review, comparison cohort study.

SUBJECTS AND SETTING:

The sample comprised 235 neonates with a gestational age of 28 weeks or younger. Their mean gestational age was 26 weeks (range 22-28 weeks) and mean birth weight was 840 g (range 430-1320 g). The study setting was a level 4, regional neonatal intensive care unit housed in a 200-bed freestanding children's hospital located in the Northeastern United States.

METHODS:

Data were collected during 3 periods. During all 3 data collection periods, we used a soft, thin-walled nasal cannula, with a relatively short, binasal prong interphase and small diameter tubing connected to a ventilator circuit capable of transmitting positive airway pressure in neonates. During data collection periods 1 and 3, we used a polyvinyl foam barrier dressing as a preventive intervention against nasal skin damage; specifically, we placed a precut barrier on the prongs to protect the nasal skin. One side of the barrier foam has an adhesive surface, which was placed against the prongs. Study period 2 differed; during this period neonates were treated with the nasal cannula without the foam barrier based on manufacturer experience suggesting the foam barrier is not needed for prevention of skin damage. Pressure injuries (PIs) that occurred during each study period were staged according to National Pressure Ulcer Advisory Panel definitions.

RESULTS:

Eighty neonates were evaluated during study period 1 (thin-walled nasal cannula plus foam barrier). We evaluated 27 neonates during period 2 (thin-walled nasal cannula and no foam barrier) and 128 were evaluated during study period 3 (thin-walled nasal cannula plus foam barrier). Six neonates (7%) developed PIs during period 1, and 2 (1.5%) developed during study period 3. All were stage 1 and 2 PIs, no full-thickness injuries, also referred to as columella necrosis developed during use of the thin-walled nasal cannula in combination with the foam barrier dressings. In contrast, 13 PIs (48%) of neonates managed during data collection period 2 (thin-walled nasal cannula with no foam barrier) developed PI, and 40% experienced stage 3 PI or columella necrosis. This difference reflects a 6-fold increase in nasal injury occurred when nasal continuous positive airway pressure (NCPAP) was administered without use of the protective barrier dressing.

CONCLUSION:

We found clinically relevant difference in the occurrences of nasal PI in neonates managed with NCPAP; occurrences of stage 3 PI were 6-fold higher when a thin-walled cannula was used without a protective foam barrier dressing.
Emergence of Visual Center-Periphery Spatial Organization in Deep Convolutional Neural Networks
Authors: Mohsenzadeh Yalda , Mullin Caitlin , Lahner Benjamin , Oliva Aude
Published: February 2020

Research at the intersection of computer vision and neuroscience has revealed hierarchical correspondence between layers of deep convolutional neural networks (DCNNs) and cascade of regions along human ventral visual cortex. Recently, studies have uncovered emergence of human interpretable concepts within DCNNs layers trained to identify visual objects and scenes. Here, we asked whether an artificial neural network (with convolutional structure) trained for visual categorization would demonstrate spatial correspondences with human brain regions showing central/peripheral biases. Using representational similarity analysis, we compared activations of convolutional layers of a DCNN trained for object and scene categorization with neural representations in human brain visual regions. Results reveal a brain-like topographical organization in the layers of the DCNN, such that activations of layer-units with central-bias were associated with brain regions with foveal tendencies (e.g. fusiform gyrus), and activations of layer-units with selectivity for image backgrounds were associated with cortical regions showing peripheral preference (e.g. parahippocampal cortex). The emergence of a categorical topographical correspondence between DCNNs and brain regions suggests these models are a good approximation of the perceptual representation generated by biological neural networks.
Interpreting Deep Neural Networks Beyond Attribution Methods: Quantifying Global Importance of Genomic Features
Authors: Koo Peter K. , Ploenzke Matt
Published: February 2020

Despite deep neural networks (DNNs) having found great success at improving performance on various prediction tasks in computational genomics, it remains difficult to understand why they make any given prediction. In genomics, the main approaches to interpret a high-performing DNN are to visualize learned representations via weight visualizations and attribution methods. While these methods can be informative, each has strong limitations. For instance, attribution methods only uncover the independent contribution of single nucleotide variants in a given sequence. Here we discuss and argue for global importance analysis which can quantify population-level importance of putative features and their interactions learned by a DNN. We highlight recent work that has benefited from this interpretability approach and then discuss connections between global importance analysis and causality.
Mining Pathway Associations from Networks of Mutual Exclusivity Interactions
Authors: Liany Herty , Lin Yu , Jeyasekharan Anand , Rajan Vaibhav
Published: February 2020

Study of pairwise genetic interactions such as mutual exclusivity or synthetic lethality has led to the development of targeted anticancer therapies, and mining the network of such interactions is a common approach used to obtain deeper insights into the mechanism of cancer. A number of useful graph clustering-based tools exist to mine interaction networks. These tools find subgraphs or groups of genes wherein each gene belongs to a single subgraph. However, a gene may be present in multiple groups – for instance, a gene can be involved in multiple signalling pathways. We develop a new network mining algorithm, that does not impose this constraint and can provide a novel pathway-centric view. Our approach is based on finding edge-disjoint bipartite subgraphs of highest weights in an input network of genes, where edge weights indicate the significance of the interaction and each set of nodes in every bipartite subgraph is constrained to belong to a single pathway. This problem is NP-hard and we develop an Integer Linear Program to solve this problem. We evaluate our algorithm on breast and stomach cancer data. Our algorithm mines dense between-pathway interactions that are known to play important roles in cancer and are therapeutically actionable. Our algorithm complements existing network mining tools and can be useful to study the mutational landscape of cancer and inform therapy development.