bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Acetaminophen, NSAIDs, Gabapentinoids, and Their Combinations on Postoperative Pulmonary Complications After Total Hip or Knee Arthroplasty
Authors: Ohnuma Tetsu , Raghunathan Karthik , Ellis Alan R , Whittle John , Pyati Srinivas , Bryan William E , Pepin Marc J , Bartz Raquel R , Krishnamoorthy Vijay
Published: January 2020

Objective

Multimodal analgesia has gained popularity in total hip arthroplasty (THA) and total knee arthroplasty (TKA), but large multicenter studies evaluating specific analgesic combinations are lacking.

Design

A retrospective study using the Premier Healthcare Database (2009–2014).

Subjects

Adults who underwent elective primary THA or TKA.

Methods

We categorized day-of-surgery analgesic exposure using eight mutually exclusive categories: acetaminophen (Ac), nonsteroidal anti-inflammatory drugs (Ns), gabapentinoids (Ga; gabapentin or pregabalin), Ac+Ns, Ac+Ga, Ns+Ga, Ac+Ns+Ga, and none of the three drugs. Multilevel models measured associations of the analgesic categories with a composite of postoperative pulmonary complications (PPCs).

Results

Among 863,139 patients, 75.2% received at least one of the three drugs. In multilevel models, compared with none of the three drugs, Ga use was associated with increased odds of PPCs when used alone (adjusted odds ratio [aOR] = 1.35, 95% confidence interval [CI] = 1.27 to 1.44), combined with Ac (aOR = 1.16, 95% CI = 1.08 to 1.26), or combined with Ns (aOR = 1.28, 95% CI = 1.21 to 1.34). In contrast, the Ac+Ns pair was associated with decreased odds of PPCs (OR = 0.86, 95% CI = 0.83 to 0.90) and lower opioid consumption. Ac+Ns+Ga was not associated with PPCs, whereas it was associated with the lowest opioid consumption on the day of surgery.

Conclusions

Gabapentinoids, alone and in single combination with either acetaminophen or nonsteroidal anti-inflammatory drugs, were associated with higher PPCs, whereas the Ac+Ns pair was associated with fewer PPCs and an opioid-sparing effect. Ac+Ns+Ga was not associated with PPCs, whereas it was associated with the lowest opioid consumption on the day of surgery.
Effect of Manual Therapy and Therapeutic Exercise Applied to the Cervical Region on Pain and Pressure Pain Sensitivity in Patients with Temporomandibular Disorders: A Systematic Review and Meta-analysis
Authors: La Touche Roy , Martínez García Sergio , Serrano García Beatriz , Proy Acosta Alejandro , Adraos Juárez Daniel , Fernández Pérez Juan José , Angulo-Díaz-Parreño Santiago , Cuenca-Martínez Ferran , Paris-Alemany Alba , Suso-Martí Luis
Published: January 2020

Objective

To assess the effectiveness of cervical manual therapy (MT) on patients with temporomandibular disorders (TMDs) and to compare cervico-craniomandibular MT vs cervical MT.

Design

Systematic review and meta-analysis (MA).

Methods

A search in PubMed, EMBASE, PEDro, and Google Scholar was conducted with an end date of February 2019. Two independent reviewers performed the data analysis, assessing the relevance of the randomized clinical trials regarding the studies’ objectives. The qualitative analysis was based on classifying the results into levels of evidence according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE).

Results

Regarding cervical MT, MA included three studies and showed statistically significant differences in pain intensity reduction and an increase in masseter pressure pain thresholds (PPTs), with a large clinical effect. In addition, the results showed an increase in temporalis PPT, with a moderate clinical effect. MA included two studies on cervical MT vs cervico-craniomandibular MT interventions and showed statistically significant differences in pain intensity reduction and pain-free maximal mouth opening, with a large clinical effect.

Conclusions

Cervical MT treatment is more effective in decreasing pain intensity than placebo MT or minimal intervention, with moderate evidence. Cervico-craniomandibular interventions achieved greater short-term reductions in pain intensity and increased pain-free MMO over cervical intervention alone in TMD and headache, with low evidence.
The Dynamics of the Differential Policing of Distinct Social Groups: Towards a Modern Model of Policing in Diverse Societies
Authors: Yuval Fany
Published: January 2020

This study investigates the different dynamics undermining the relationships between the police and four distinct groups of Israeli citizens—Arabs, ultra-Orthodox Jews, and immigrants from Ethiopia and Russia. The comparative analysis reveals the sources of inequality in policing, its characteristics, and results. The structural equation modelling elucidates that procedural justice and the effectiveness of the police shape the moral alignment between the groups and the police. These factors have different effects on the groups’ identification with the state. The results underscore the considerable importance of the government’s role in guaranteeing social inclusion and the sharing of common values. The findings may help in designing a set of reforms and training programmes—not just a single reform—suited to the special needs of each group, to cope with the challenges of equal policing in an era of global social instability.
Quantum Cohomology and Closed-String Mirror Symmetry for Toric Varieties
Authors: Smith Jack
Published: January 2020

We give a short new computation of the quantum cohomology of an arbitrary smooth (semiprojective) toric variety $X$, by showing directly that the Kodaira–Spencer map of Fukaya–Oh–Ohta–Ono defines an isomorphism onto a suitable Jacobian ring. In contrast to previous results of this kind, $X$ need not be compact. The proof is based on the purely algebraic fact that a class of generalized Jacobian rings associated to $X$ are free as modules over the Novikov ring. When $X$ is monotone the presentation we obtain is completely explicit, using only well-known computations with the standard complex structure.
Monthly Payment Targeting and the Demand for Maturity
Authors: Argyle Bronson S , Nadauld Taylor D , Palmer Christopher J
Published: January 2020

We document three phenomena we jointly refer to as monthly payment targeting. First, using data from 500,000 used auto loans and discontinuities in contract terms offered by hundreds of lenders, we show that demand is more sensitive to maturity than to interest rate, consistent with consumers managing payment size when making debt decisions. Second, many consumers appear to employ segregated mental accounts, spending exogenous payment savings on larger loans. Third, consumers bunch at round number monthly payment amounts, consistent with heuristic budgeting. That these patterns hold in subsamples of likely constrained and unconstrained borrowers challenges liquidity constraints as a complete explanation.
Treat to target and prevention of subclinical atherosclerosis in psoriatic arthritis—which target should we choose?
Authors: Cheng Isaac T , Li Edmund K , Wong Priscilla C , Law Mei Yan , Yim Isaac C , Lai Billy T , Ying Shirley K , Kwok Kitty Y , Li Martin , Li Tena K , Lee Jack J , Szeto Cheuk-Chun , Yan Bryan P , Lee Alex P , Tam Lai-Shan
Published: January 2020

Objective

PsA patients who achieved sustained minimal disease activity (sMDA) had less subclinical atherosclerosis progression. The vascular effects of achieving other potential treatment targets, including the PsA Disease Activity Score (PASDAS) and the Disease Activity in PsA (DAPSA) score, remained uncertain. This study aimed to compare the vascular effects of achieving different treatment targets in PsA patients.

Method

This is a post hoc analysis of a 2 year treat-to-target study aimed at MDA. A total of 101 consecutive PsA patients without overt cardiovascular disease were recruited. High-resolution carotid ultrasound and arterial stiffness markers were assessed annually. Low disease activity (LDA) was defined as MDA, DAPSA ≤14 or PASDAS ≤3.2. Sustained disease control was defined as achieving these targets at each visit from month 12 until month 24.

Results

Ninety patients [52 male (57.8%), age 50 years (s.d. 11)] who completed 24 months of follow-up were included in this analysis. A total of 44%, 48% and 45% of patients achieved sustained DAPSA LDA (sDAPDA-LDA), sustained PASDAS LDA (sPASDAS-LDA) and sMDA, respectively. Patients who achieved sMDA had significantly less progression of carotid intima-media thickness than those who did not (P = 0.031). Using multivariate analysis, achieving sMDA and sPASDAS-LDA had a protective effect on plaque progression, less increase in total plaque area, reduced mean intima-media thickness and reduced augmentation index after adjusting for covariates. In contrast, no significant differences in the progression of vascular parameters were demonstrated between patients who did or did not achieve sDAPSA-LDA.

Conclusion

Achieving sMDA/sDASPAS-LDA, but not sDAPSA-LDA, was associated with a protective effect in subclinical atherosclerosis and arterial stiffness progression. A multidimensional domain of disease control might be better in minimizing cardiovascular risk in PsA.
AUTOMATIC BRAIN DOSE ESTIMATION IN COMPUTED TOMOGRAPHY USING PATIENT DICOM IMAGES
Authors: Gharbi Souha , Labidi Salam , Mars Mokhtar
Published: January 2020

This study aims to develop an Automatic Brain Dose Estimation (ABDE) methodology for head computed tomography examinations. The ABDE is to be applied first to an anthropomorphic Alderson phantom to obtain a Correction factor (Cf) between the ABDE and the direct absorbed brain dose using dosemeters positioned within the anthropomorphic phantom. Then, in order to estimate the correct brain dose for patient, the Cf was multiplied by the mean ABDE values for each patient. Results were compared to those registered with a mathematical simulation phantom using CT-Expo V 2.4 software. Results showed no significant difference between the correct ABDE values and the CT–Expo values with a mean percent difference of 2.54 ± 0.01%. In conclusion, ABDE yields a correct estimation of brain dose, taking into account the size and attenuation of the irradiated region. Thus, it is clinically recommended for accurate patient brain dose assessment.
Let it be: mindful acceptance down-regulates pain and negative emotion
Authors: Kober Hedy , Buhle Jason , Weber Jochen , Ochsner Kevin N , Wager Tor D
Published: January 2020

Mindfulness training ameliorates clinical and self-report measures of depression and chronic pain, but its use as an emotion regulation strategy—in individuals who do not meditate—remains understudied. As such, whether it (i) down-regulates early affective brain processes or (ii) depends on cognitive control systems remains unclear. We exposed meditation-naïve participants to two kinds of stimuli: negative vs. neutral images and painful vs. warm temperatures. On alternating blocks, we asked participants to either react naturally or exercise mindful acceptance. Emotion regulation using mindful acceptance was associated with reductions in reported pain and negative affect, reduced amygdala responses to negative images and reduced heat-evoked responses in medial and lateral pain systems. Critically, mindful acceptance significantly reduced activity in a distributed, a priori neurologic signature that is sensitive and specific to experimentally induced pain. In addition, these changes occurred in the absence of detectable increases in prefrontal control systems. The findings support the idea that momentary mindful acceptance regulates emotional intensity by changing initial appraisals of the affective significance of stimuli, which has consequences for clinical treatment of pain and emotion.
Adaptation of Biotrophic Leaf Pathogens to Fertilization-Mediated Changes in Plant Traits: A Comparison of the Optimization Principle to Invasion Fitness
Authors: Précigout Pierre-Antoine , Robert Corinne , Claessen David
Published: January 2020

One of the conclusions of evolutionary ecology applied to agroecosystem management is that sustainable disease management strategies must be adaptive to overcome the immense adaptive potential of crop pathogens. In this context, knowledge of how pathogens adapt to changes in cultural practices is necessary. In this article we address the issue of the evolutionary response of biotrophic crop pathogens to changes in fertilization practices. For this purpose, we compare predictions of latent period evolution based on three empirical fitness measures (seasonal spore production, within-season exponential growth rate, and area under disease progress curves [AUDPCs]) with predictions based on the concept of invasion fitness from adaptive dynamics. We use pairwise invisibility plots to identify the evolutionarily stable strategies (ESSs) of the pathogen latent period. We find that the ESS latent period is in between the latent periods that maximize the seasonal spore production and the within-season exponential growth rate of the pathogen. The latent periods that maximize the AUDPC are similar to those of the ESS latent periods. The AUDPC may therefore be a critical variable to determine the issue of between-strain competition and shape pathogen evolution.
Soft Tissue Masses of the Hand and Wrist: Systematic Approach to Imaging Evaluation
Authors: Kephart David A. , Cecava Nathan D. , Bui-Mansfield Liem T.
Published: January 2020

Hand and wrist soft tissue masses comprise a special subset of soft tissue masses. Lesion prevalence always should be considered. The World Health Organization tumor database reveals soft tissue masses of the hand and wrist are much more common than osseous lesions. In clinical practice, pseudotumors are much more common than neoplasms. Benign tumors of soft tissue are much more common than malignant tumors, with an annual incidence of benign tumors of up to 3000 per million population.1 Malignant sarcomas are extremely rare (50 cases per million per year).1 Understanding available imaging modalities and imaging characteristics of hand and wrist soft tissue masses will assist in formulating a short and relevant differential diagnosis.
Response to cabozantinib in renal cell carcinoma with cardiac metastases
Authors: Stellato Marco , Cursano Maria Concetta , Citarella Fabrizio , Pantano Francesco , Russano Marco , Dell’ Aquila Emanuela , Vincenzi Bruno , Tonini Giuseppe , Santini Daniele
Published: January 2020

In metastatic renal cell carcinoma (mRCC) patients, cardiac metastases are a rare and often a post-mortem finding. Clinical manifestations of cardiac metastases have a late onset and include pericardial effusions, heart failure and embolic phenomena. Treatment of cardiac metastasis is not yet standardized, and few data are available about the efficacy of TKI on treatment of cardiac metastases in mRCC patients. In this report, we describe the case of a 66-year-old male who presented with mRCC with lung and cardiac metastases treated with cabozantinib, a multikinase inhibitor that was administered in second line after disease progression with sunitinib. To date, there are no data about the safety and efficacy of cabozantinib in mRCC with cardiac metastasis. In a real word analysis, cabozantinib demonstrated to be associated to a modest risk of developing left ventricular heart failure. It is unknown if this risk is higher in mRCC population with cardiac metastases. We report the first evidence of efficacy and safety of cabozantinib in cardiac mRCC patients, probably due to its specific inhibition of several molecular intracellular pathways. Additional molecular and clinical studies are needed before well tolerated and efficacy of cabozantinib treatment for these patients can be fully understood.
Costs and Cost-Utility of Critical Care and Subsequent Health Care: A Multicenter Prospective Study*
Authors: Jukarainen Sakari , Mildh Henriikka , Pettilä Ville , Häkkinen Unto , Peltola Mikko , Ala-Kokko Tero , Reinikainen Matti , Vaara Suvi T.
Published: January 2020

Objectives:

The number of critical care survivors is growing, but their long-term outcomes and resource use are poorly characterized. Estimating the cost-utility of critical care is necessary to ensure reasonable use of resources. The objective of this study was to analyze the long-term resource use and costs, and to estimate the cost-utility, of critical care.

Design:

Prospective observational study.

Setting:

Seventeen ICUs providing critical care to 85% of the Finnish adult population.

Patients:

Adult patients admitted to any of 17 Finnish ICUs from September 2011 to February 2012, enrolled in the Finnish Acute Kidney Injury (FINNAKI) study, and matched hospitalized controls from the same time period.

Interventions:

None.

Measurements and Main Results:

We primarily assessed total 3-year healthcare costs per quality-adjusted life-years at 3 years. We also estimated predicted life-time quality-adjusted life-years and described resource use and costs. The costing year was 2016. Of 2,869 patients, 1,839 (64.1%) survived the 3-year follow-up period. During the first year, 1,290 of 2,212 (58.3%) index episode survivors were rehospitalized. Median (interquartile range) 3-year cumulative costs per patient were $49,200 ($30,000–$85,700). ICU costs constituted 21.4% of the total costs during the 3-year follow-up. Compared with matched hospital controls, costs of the critically ill remained higher throughout the follow-up. Estimated total mean (95% CI) 3-year costs per 3-year quality-adjusted life-years were $46,000 ($44,700–$48,500) and per predicted life-time quality-adjusted life-years $8,460 ($8,060–8,870). Three-year costs per 3-year quality-adjusted life-years were $61,100 ($57,900–$64,400) for those with an estimated risk of in-hospital death exceeding 15% (based on the Simplified Acute Physiology Score II).

Conclusions:

Healthcare resource use was substantial after critical care and remained higher compared with matched hospital controls. Estimated cost-utility of critical care in Finland was of high value.
Decision-making Factors Associated With Telehealth Adoption by Patients With Heart Failure at Home
Authors: Woo Kyungmi , Dowding Dawn W.
Published: January 2020

Telehealth has been reported to be effective in helping patients with heart failure manage their symptoms at home. Despite this, the adoption rate for telehealth among home care patients with heart failure is low, and there is limited research on reasons for this. This study was undertaken to explore factors associated with patients' decisions to adopt telehealth at home. A qualitative descriptive study underpinned by the Unified Theory of Acceptance Use of Technology model was conducted using semi-structured telephone interviews with patients with heart failure (N = 20) referred for telehealth. Interviews were analyzed using a mixture of deductive and inductive coding. Among the theoretical model elements, the perceived usefulness of the technology (performance expectancy), the availability of clinical/technical support (facilitating conditions), and the opinion of other individuals important to the patient (social influence) were associated with telehealth initiation. However, the ease of use (effort expectancy) was not an associated factor. Other factors such as experience, knowledge, confidence, satisfaction, and attitudes were also associated with the decision. Identification of factors related to higher telehealth initiation rates can be used to inform individualized care planning by nurses. Knowledge of such associations can inform referral process to improve the efficiency and utilization of telehealth.
Improving Shared Decision-making and Treatment Planning Through Predictive Modeling
Authors: Koszalinski Rebecca S. , Khojandi Anahita , Ramshaw Bruce
Published: January 2020

Abdominal wall hernia repair, including ventral hernia repair, is one of the most common general surgical procedures. Nationally, at least 350 000 ventral hernia repairs are performed annually, and of those, 150 000 cases were identified as incisional hernias. Outcomes are reported to be poor, resulting in additional surgical repair rates of 12.3% at 5 years and as high as 23% at 10 years. Healthcare costs associated with ventral hernia repair are estimated to exceed $3 billion each year. Additionally, ventral hernia repair is often complex and unpredictable when there is a current infection or a history of infection and significant comorbidities. Accordingly, a predictive model was developed using a retrospectively collected dataset to associate the pre- and intra-operative characteristics of patients to their outcomes, with the primary goal of identifying patients at risk of developing complications a priori in the future. The benefits and implications of such a predictive model, however, extend beyond this primary goal. This predictive model can serve as an important tool for clinicians who may use it to support their clinical intuition and clarify patient need for lifestyle modification prior to abdominal wall reconstruction. This predictive model can also support shared decision-making so that a personalized plan of care may be developed. The outcomes associated with use of the predictive model may include surgical repair but may suggest lifestyle modification coupled with less invasive interventions.
Semaphorin 3A-hypoxia inducible factor 1 subunit alpha co-overexpression enhances the osteogenic differentiation of induced pluripotent stem cells-derived mesenchymal stem cells in vitro
Authors: Li Jing-Yi , Wang Ting-Ting , Li Chong , Wang Zhi-Fang , Li Shan , Ma Li , Zheng Li-Li
Published: January 2020

Background:

Mesenchymal stem or stromal cells (MSCs) derived from the induced pluripotent stem cells (iPSCs) have uniform biological activity, which makes the clinical application of MSCs in bone repair possible. Culturing the iPSC-MSCs onto osteoconductive materials is a promising tissue engineering-based strategy in bone regeneration. The aim of this work was to evaluate the effects of semaphorin 3A (Sema3A) and hypoxia inducible factor 1 subunit alpha (HIF1α) co-overexpression on the survival and osteogenic differentiation of iPSC-MSCs.

Methods:

Sema3A and HIF1α were linked together with the three (GGGGS; G, glycine; S, serine) peptide fragment, and their co-expression in iPSC-MSCs was mediated by a lentiviral vector. The fusion protein retained the immune reactivity for both Sema3A and HIF1α as determined with Western blotting. iPSC-MSCs were infected with overexpression lentivirus (oeLenti) as negative control, oeLenti-Sema3A, oeLenti-HIF1α or oeLenti-Sema3A-HIF1α lentiviruses.

Results:

Sema3A overexpression alone promoted the osteogenic differentiation of iPSC-MSCs (the activity and/or expression of osteoblast markers, such as alkaline phosphatase, osteopontin, and osteocalcin, were upregulated), and suppressed cell survival. The Sema3A-HIF1α fusion protein showed a comparable osteoconductive effect to that of Sema3A without reducing cell survival. We further seeded iPSC-MSCs modified by SemaA-HIF1α overexpression onto hydroxyapatite (HA) scaffolds, and evaluated their growth and differentiation on this three-dimensional material. Additional data indicated that, as compared to iPSC-MSCs cultured in ordinary two-dimensional dishes, cells cultured in HA scaffolds grew (blank vs. HA scaffolds: 0.83 vs. 1.39 for survival) and differentiated better (blank vs. HA scaffolds: 11.29 vs. 16.62 for alkaline phosphatase activity).

Conclusion:

Modifying iPSC-MSCs with pro-osteogenic (Sema3A) and pro-survival (HIF1α) factors may represent a promising strategy to optimize tissue engineering-based strategy in bone repair.
Gene-diet interaction of FTO-rs9939609 gene variant and hypocaloric diet on glycemic control in overweight and obese adults: a systematic review and meta-analysis of clinical trials
Authors: Parastouei Karim , Rostami Hosein , Ramezani Amirhossein Ahmadi , Tavakoli Hamidreza , Alipour Meysam
Published: January 2020

Background:

The hypocaloric diets improve glycemic status in obese individuals, but the response to hypocaloric diets in fat mass and obesity-associated gene (FTO)-rs9939609 gene variant is unknown. This systematic review and meta-analysis aimed to assess the gene-diet interaction of FTO-rs9939609 gene variant and hypocaloric diets on glycemic control in overweight and obese adults.

Methods:

Cochrane Central Register of Controlled Trials, PubMed, ISI Web of Science, Embase, Scopus, and Google scholar were searched up to December 2018, for relevant clinical trials. Mean changes in fasting blood sugar (FBS), serum insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) were extracted.

Results:

The pooled analysis of nine studies showed that there was no significant difference between AA/AT and TT genotypes in FBS (weighted mean difference [WMD] = 0.01, 95% confidence interval [CI]: –1.08, 1.10, P = 0.984) and serum insulin (WMD = 0.20, 95% CI: –0.85, 1.26; P = 0.707) after intervention hypocaloric diets. The overweight/obese participants in AA/AT group showed the greatest reduction in HOMA-IR compared with TT genotype following intervention, and this difference was not statistically significant (WMD = –0.38, 95% CI: –0.94, 0.16, P = 0.167).

Conclusion:

This meta-analysis suggests that there was no significant difference between AA/AT and TT genotypes of FTO-rs9939609 on FBS, serum insulin level, and insulin resistance in response to hypocaloric diets.
Recent progress in Helicobacter pylori treatment
Authors: Hu Yi , Zhu Yin , Lu Nong-Hua
Published: January 2020

The main challenge in the field of Helicobacter pylori (H. pylori) infection is antibiotic resistance, which influences the efficacy of eradication regimens. Bismuth-containing quadruple therapy has been confirmed as an effective regimen for eradicating H. pylori, especially in strains with antibiotic resistance. High-dose proton-pump inhibitor-amoxicillin dual therapy could decrease the use of unnecessary antibiotics, which is a promising alternative approach. Adjuvant therapy (specific probiotic or vitamin) also showed good results, although more evidence is needed. Novel anti-H. pylori drugs are needed, and the establishment of the H. pylori database is an effective way to acknowledge the real-time information of H. pylori management. This review provides the recent progress of H. pylori treatment, and further studies are needed to address the role of different regimens in improving H. pylori eradication rate, especially in strains with antibiotics resistance.
Intra-operative cell salvage for cesarean delivery: a retrospective study using propensity score matched analysis
Authors: Wu Xi , Yao Shang-Long , Wu Jing , Li Cheng-Ying , Xia Lei-Ming
Published: January 2020

Background:

Obstetric hemorrhage is a major cause of maternal death during cesarean delivery. The objective of this retrospective observational study was to evaluate the efficacy and safety of intra-operative cell salvage (IOCS) in cesarean section.

Methods:

We included a total of 361 patients diagnosed with central placenta previa who underwent cesarean section from May 2016 to December 2018. In this study, 196 patients received autologous transfusion using IOCS (IOCS group) and 165 patients accepted allogeneic blood transfusion (ABT group). Propensity score matched analysis was performed to balance differences in the baseline variables between the IOCS group and ABT group. Patients in the IOCS group were matched 1:1 to patients in the ABT group.

Results:

After propensity score matching, 137 pairs of cases between the two groups were successfully matched and no significant differences in baseline characteristics were found between the IOCS group and ABT group. Patients in the IOCS group were associated with significantly shorter length of hospital stay, compared with ABT group (8.9 ± 4.1 days vs. 10.3 ± 5.2 days, t = −2.506, P = 0.013). The postoperative length of hospital stay was 5.3 ± 1.4 days for patients in the IOCS group and 6.6 ± 3.6 days for those in the ABT group (t = −4.056, P < 0.001). The post-operative hemoglobin level in the IOCS group and ABT group was 101.3 ± 15.4 and 96.3 ± 16.6 g/L, respectively, which were significantly different (t = 2.615, P = 0.009). Allogeneic red blood cell transfusion was significantly lower at 0 unit (range: 0–11.5 units) in the IOCS group when compared with 2 units (range: 1–20 units) in the ABT group (P < 0.001).

Conclusions:

This retrospective observational study using propensity score matched analysis suggested that IOCS was associated with shorter length of postoperative hospital stay and higher post-operative hemoglobin levels during cesarean delivery.
Sustainers: Hospitals with sustained superior performance
Authors: Al- Amin Mona , Hefner Jennifer L. , Hogan Tory Harper , Li Kate
Published: January 2020

Purpose

The purpose of this article was to investigate the organizational and market-level variables associated with sustained superior hospital performance on Value-Based Purchasing total performance scores (TPS).

Methodology

TPS for 2014 through 2017 was obtained from the Centers for Medicare & Medicaid Services Hospital Compare website. Market-level data were from the 2017 Area Health Resource File, and hospital-level data were from the 2014 American Hospital Association Annual Survey database. We specified a logistic regression model to identify significant predictors of hospitals with sustained superior performance on TPS, that is, “sustainers.”

Principal Findings

Only 8.4% of hospitals were classified as sustainers. Hospitals located in rural markets with a high Medicare Advantage penetration had a higher likelihood of being classified as sustainers. High RN staffing levels, lower Medicare share of inpatient days, not-for-profit ownership, and small size were all significant organizational predictors of sustained superior performance.

Conclusions

Both modifiable characteristics, such as nurse staffing levels, and nonmodifiable characteristics, such as rural markets and small hospital size, are associated with the likelihood of hospitals sustaining superior performance over time.

Practice Implications

Managers need to carefully examine their staffing levels as they pursue interventions to sustain high TPS overtime. Moreover, factors such as Medicare share of inpatient days and size need to be considered when understanding barriers to sustained performance on Value-Based Purchasing domains.
Microscope-Integrated Optical Coherence Tomography–Guided Autologous Full-Thickness Neurosensory Retinal Autograft for Large Macular Hole–Related Total Retinal Detachment
Authors: Singh Ankur , Dogra Mohit , Singh Simar Rajan , Moharana Bruttendu , Tigari Basavraj , Singh Ramandeep
Published: January 2020

Purpose:

To evaluate the feasibility and utility of microscope-integrated optical coherence tomography in patients undergoing full-thickness neurosensory retinal autograft for refractory macular hole (MH)-associated retinal detachment.

Methods:

We analyzed two eyes of two patients who had undergone a neurosensory retinal autograft for large MH associated retinal detachment. Both cases had microscope-integrated optical coherence tomography–guided placement and sizing of the retinal autograft. Time taken for obtaining microscope-integrated optical coherence tomography images, morphology of the retinal autograft (intraoperative and postoperative), and anatomic and functional outcomes were noted.

Results:

The first case had optic disc pit–related maculopathy with a large MH and total retinal detachment. She had undergone a vitrectomy with internal limiting membrane peeling elsewhere. The second patient had a treatment-naive large MH with total retinal detachment. Both patients underwent vitrectomy with microscope-integrated optical coherence tomography–guided autologous neurosensory retinal autograft placement and silicone oil tamponade. At 6 months and 3 months follow-up, respectively, both patients had closed MHs, attached retinas, and improvement in visual acuity.

Conclusion:

Microscope-integrated optical coherence tomography provides intraoperative visualization of MHs and provides real-time feedback regarding dimensions of the retinal autograft, thus aiding in accurate sizing of the graft. This ensures that the autograft fits snugly in the MH, thereby restoring macular structure and improving visual acuity.
Oncogenic GOPC-ROS1 Fusion Identified in a Congenital Glioblastoma Case
Authors: Whiteway Susan L. , Betts Aaron M. , O’Neil Erika R. , Green Adam L. , Gilani Ahmed , Orr Brent A. , Mathis Derek A.
Published: January 2020

Congenital glioblastoma (GBM) is a rare brain tumor of infancy. While histologically they resemble pediatric and adult GBM, growing evidence suggests a distinct molecular profile. We report the case of a 7-day-old infant female with congenital GBM found to harbor a GOPC-ROS1 fusion. She underwent surgical resection, moderate-intensity chemotherapy without radiation, and remains disease-free 4 years from completion of therapy. While the frequency of this mutation is not known, the identification of this oncogenic driver may provide insight into the pathogenesis of GBM in this age group and may serve as a molecular target for select patients.
Body Composition in Egyptian Children With Transfusion-dependent Thalassemia: The Impact of Nutrition and Metabolic Profile
Authors: Elalfy Mohsen S. , Ebeid Fatma S.E. , El Gendy Yasmin G. , Zaki Mona M. , Kalifa Amna S.A.
Published: January 2020

Background:

Growth failure is a common complication in children with beta-thalassemia major (β-TM) that has persisted despite major treatment advances. It could stem from malnutrition, especially in those who live in poor countries and who have inadequate nutrient intake.

Aim:

The aim of this study was to assess the influence of nutrition on growth, total body composition, and metabolic profile in Egyptian children with β-TM.

Subjects and Methods:

This cross-sectional study included 200 children with β-TM and 50 age-matched and sex-matched healthy children. All subjects underwent full clinical assessment, which included assessment of growth and total body composition using anthropometric measurements (weight, height, mid-arm circumference, skinfold thickness, and body mass index) and bioelectric impedance analysis device (TANITA SC330). Nutritional assessment was performed using 24-hour dietary recall. Fasting serum insulin, C-peptide, and fasting serum lipid profile (high-density lipoprotein, low-density lipoprotein, cholesterol, and triglyceride) were measured.

Results:

Children with β-TM had a significantly lower mean value of the daily consumption of the studied nutrient elements including kilocalories, protein, carbohydrate, calcium, and phosphorus (P<0.001). β-TM had a negative impact on anthropometric measures; the mean of all measurements recorded in children with β-TM was significantly lower than that in the control group (P<0.001). Children with β-TM had a significant abnormality in lipid profile, with higher triglyceride levels and lower cholesterol, low-density lipoprotein, and high-density lipoprotein than controls. They had significantly lower serum insulin and C-peptide. Age, sex, serum ferritin, and caloric intake have a significant impact on body composition in children with β-TM.

Conclusion:

Regular assessment of nutrition is crucial for the health of children with β-TM.
Dextromethorphan Administration on Day 0 and Day 7 for Secondary Prevention of Methotrexate-induced Neurotoxicity in Childhood Acute Lymphoblastic Leukemia: A Retrospective Case Series
Authors: Fustino Nicholas J. , Juhl Kathryn , Leister John
Published: January 2020

Acute lymphoblastic leukemia is the most common malignancy in children. Long-term survival exceeds 90%; however, therapy-induced toxicity remains a concern. Methotrexate neurotoxicity (MTX-NT) is common, often necessitating alterations in chemotherapy regimens. Dextromethorphan has been used as an abortive and prophylactic treatment for MTX-NT. The authors report a case series of 7 pediatric patients with acute lymphoblastic leukemia with prior episodes of MTX-NT given a single dose of dextromethorphan (1 to 2 mg/kg) on the day of MTX administration and 7 days later. No subsequent episodes of MTX-NT occurred after 40 intravenous and 81 intrathecal administrations. This specific regimen of secondary prophylaxis may prevent MTX-NT.
The Relationship Between Medication Attitudes and Medication Adherence Behavior in Adults With Bipolar Disorder
Authors: Levin Jennifer B. , Aebi Michelle E. , Howland Molly , Barboza Marina , Eskew Logan , Tatsuoka Curtis , Cassidy Kristin A. , Sajatovic Martha
Published: January 2020

The relationship between medication attitudes and adherence as well as reliable measures of medication attitudes need further study. This study examined the psychometric properties of the Attitudes Toward Mood Stabilizers Questionnaire (AMSQ) in bipolar participants and the relationship between medication attitudes and adherence, measured by the self-reported Tablets Routine Questionnaire (TRQ). Inclusion criteria included mood stabilizer treatment and 20% or more medication nonadherence. Measures were given pretreatment and posttreatment. Average age was 47 years; majority were female (69%), African American (67%), and unmarried (53%). AMSQ's test-retest reliability was ρ = 0.73 (p < 0.001). AMSQ correlated with TRQ (r
s = 0.20, p < 0.01) at baseline. Factor analysis identified three factors: positive/favorable attitudes, negative/critical attitudes, and unintentional nonadherence. Change in AMSQ across time correlated with change in TRQ. The AMSQ is valid psychometrically and is sensitive to change. Medication attitudes are related to adherence behavior. Interventions should include targeting specific domains of medication attitudes, such as illness knowledge.
A Unique Strategy to Address Nurse Leader Fatigue
Authors: Hill Terry , Cherry Barbara , LeClair-Smith Colleen , Williams Tammy
Published: January 2020

A quality improvement process was implemented within a large, tertiary healthcare organization to develop and implement a roundtable culture as part of a fatigue risk management system focused on mitigating nurse leader fatigue and stress. Strategies to form trusting collaboration and reduce leader attrition were initiated and assessed for effectiveness. Results show measurable decreases in reported levels of stress and attrition. Acute, chronic, and persistent fatigue continue to challenge those in leadership roles.
An Outcomes Evaluation of an Innovation Studio on Interprofessional Learning, Job Satisfaction, and Intent to Stay Among Clinicians
Authors: Raderstorf Tim , Melnyk Bernadette Mazurek , Ackerman Michael , Bibyk Steven
Published: January 2020

OBJECTIVE

Evaluate the use of the Innovation Studio on interprofessional collaboration and attitudes toward interprofessional learning, job satisfaction, and intent to stay.

BACKGROUND

The healthcare workforce is experiencing high burnout rates, and providers are unsatisfied with their work. Evidence supports that interprofessional collaboration is a key strategy to increase job satisfaction and intent to stay in healthcare professionals. The Innovation Studio is a tool to engage healthcare providers in interprofessional collaboration.

METHODS

A pretest/posttest evaluation of the Innovation Studio with 14 healthcare professionals was conducted with self-reported scores on job satisfaction, readiness for interprofessional learning, and intent to stay as outcomes.

RESULTS

Positive effects were found on interprofessional learning and intent to stay, but not job satisfaction. Eleven interprofessional projects were developed. Responses to open-ended questions indicated satisfaction with the Innovation Studio.

CONCLUSIONS

The Innovation Studio was successful in stimulating numerous interprofessional projects and had a positive effect on interprofessional learning and intent to stay.
Simple, Frequent Indicator for Personal Identification—Postmortem and Antemortem Abdominal Computed Tomography Findings of a Charred Body
Authors: Nakamura Mami , Idota Nozomi , Shintani-Ishida Kaori , Hitosugi Masahito , Ikegaya Hiroshi
Published: January 2020

Postmortem personal identification in forensic science is performed using various methods. However, severely burnt bodies are hard to identify using odontological or skeletal features because of carbonization, and sometimes DNA profiling is impracticable because of the unavailability of the relatives. We present a case of a burn victim found after a house fire. Personal identification was attempted, but the body was heavily charred to the bones and the use of physical appearance was impracticable. There were no known relatives or personal belongings of the deceased for comparison of DNA typing. We obtained a series of abdominal computed tomography (CT) scans taken antemortem and found bilateral multiple renal cysts, left renal artery calcification, and a big right inguinal hernia, which matched the deceased's postmortem CT findings and autopsy findings. To date, studies of identification by CT have acted for a rise in precision, but they require complicated calculation or high graphical methods. Calcification of the arteries or renal cysts seen in our case are very common lesions present in many adults with abundant variation; thus, they may be helpful as simple indicators for identification.
Implementation of a Pediatric Emergency Telemedicine Program
Authors: Kim Ji Won , Friedman Jonathan , Clark Sunday , Hafeez Baria , Listman David , Lame Maria , Eid Dona Alma Bou , Sharma Rahul , Platt Shari
Published: January 2020

Objectives

Our goal was to describe the experiences after the launch of a pediatric emergency telemedicine program at a large, urban, academic medical center.

Methods

We launched 3 unique pediatric emergency telemedicine programs at an urban, academic medical center: direct-to-consumer pediatric virtual urgent care, pediatric emergency department (PED) telemedicine follow-up, and telemedicine medical screening examination in the PED.

Results

We evaluated 84 patients via direct-to-consumer pediatric virtual urgent care with the most common chief complaint related to fever, dermatologic, or respiratory systems; we referred 12% to the PED, and 20% of those required hospital admission. We evaluated 38 patients via PED telemedicine follow-up; we referred 19% back to the PED, and 43% of those required hospital admission. Median duration for a telemedicine encounter was 10 minutes. We screened 3809 patients in the PED using telemedicine medical screening examination.

Conclusions

We offer a description of an innovative and comprehensive new pediatric emergency telemedicine program implemented at a large, urban, academic medical center. Our initial findings demonstrate short visit times, antibiotic stewardship, and low rates of PED referral and subsequent admission for patients who use a telemedicine service. We plan to further examine the impact of pediatric emergency telemedicine on the care of children as our program expands.
Managing Diagnostic Uncertainty in Pediatric Sepsis Quality Improvement with a Two-Tiered Approach
Authors: Scott Halden F. , Kempe Allison , Deakyne Davies Sara J. , Krack Paige , Leonard Jan , Rolison Elise , Mackenzie Joan , Wathen Beth , Bajaj Lalit
Published: January 2020

Introduction:

Severe sepsis requires timely, resource-intensive resuscitation, a challenge when a sepsis diagnosis is not confirmed. The overall goals were to create a pediatric sepsis program that provided high-quality critical care in severe sepsis (Sepsis Stat), and, in possible sepsis, flexible evaluation and treatment that promoted stewardship (Sepsis Yellow). The primary aims were to decrease time to antibiotics and the intensive care unit requirement.

Methods:

A 2-tiered clinical pathway was implemented at 6 pediatric emergency departments and urgent care centers, incorporating order sets, education, paging. The Sepsis Stat pathway included 2 nurses, hand delivery of antibiotics, resuscitation room use. The Sepsis Yellow pathway included prioritized orders, standardized procedures, close monitoring, and evaluation of whether antibiotics were warranted.

Results:

From April 2012 to December 2017, we treated 3,640 patients with suspected and confirmed sepsis. Among the 932 severe sepsis patients, the 30-day, in-hospital mortality was 0.9%. Arrival to recognition time improved from 50 to 4 minutes. Recognition to antibiotic time demonstrated an in-control process in our goal range with a median of 43 minutes for Sepsis Stat patients, 59 minutes for Sepsis Yellow patients. The proportion of severe sepsis patients requiring intensive care unit care declined from 45% to 34%. On the Sepsis Yellow pathway, 23% were de-escalated with discharge to home without antibiotics.

Conclusions:

This novel 2-tiered approach to pediatric sepsis quality improvement in varied emergency care settings improved process and outcome measures in severe sepsis while promoting stewardship and de-escalation where appropriate. Matching resources to the degree of illness was important in supporting quality care in potentially septic children.
Comparative Effectiveness of Different Interventions of Perivascular Hyaluronidase
Authors: Lee Won , Oh Wook , Oh Seung Min , Yang Eun-Jung
Published: January 2020

Background:

Soft-tissue necrosis caused by vascular compromise is a frequent and troublesome complication of hyaluronic acid filler injection. Hyaluronidase has been proposed as a treatment for this condition. This study aimed to determine the effective dose and administration interval of hyaluronidase injection in a skin necrosis animal model.

Methods:

New Zealand rabbits were used to simulate the hyaluronic acid–associated vascular occlusion model. Hyaluronic acid filler (0.1 ml) was injected into the central auricular artery to create an occlusion. Three rabbit auricular flaps were injected with 500 IU of hyaluronidase once (group A) and three flaps each were injected at 15-minute intervals with 250 IU of hyaluronidase twice (group B), 125 IU of hyaluronidase four times (group C), 100 IU of hyaluronidase five times (group D), and 75 IU of hyaluronidase seven times (group E), all at 24 hours after occlusion. No intervention was administered after occlusion in the control group. Flap fluorescence angiography was performed immediately after hyaluronidase injection and on postoperative days 2, 4, and 7. Flap necrotic areas were analyzed.

Results:

All control and experimental flaps demonstrated total occlusion after hyaluronic acid injection. The average total survival rate (positive area/total area ×100 percent) of control flaps was 37.61 percent. For experimental groups, the average total survival rates were 74.83 percent, 81.49 percent, 88.26 percent, 56.48 percent, and 60.69 percent in groups A through E, respectively.

Conclusion:

A better prognosis can be obtained by administering repeated doses rather than a single high dose of hyaluronidase.