bluuebunny/crossref_metadata_2025 huggingface dataset:
Am I Disadvantaged? How Applicants Decide Whether to Use the Disadvantaged Status in the American Medical College Application Service
Authors: Lowrance Adam M. , Birnbaum Matthew G.
Published: May 2019

Purpose

To add to the limited research on the Disadvantaged Status, a component in the American Medical College Application Service (AMCAS) primary application, the authors explored how applicants to a medical school between 2014 and 2016 determined whether they were disadvantaged and whether to apply as such.

Method

The authors used case study methodology to explore the experiences of students at a medical school in the Northeast. The authors derived data from transcripts of semistructured interviews with students and the students’ AMCAS applications. Transcripts and applications were analyzed using a constant comparative approach and considered in the context of social comparison and impression management theories.

Results

Overall, the 15 student participants (8 used the Disadvantaged Status) had difficulty determining whether they were disadvantaged and how applying as such would affect their prospects. Contributing factors included ambiguity around both the term disadvantaged and its use in the admissions process. Simply experiencing hardship during childhood was insufficient for most participants to deem themselves disadvantaged. Participants’ decision processes were confounded by the need to rely on social comparisons to determine whether they were disadvantaged and impression management to decide whether to apply as such.

Conclusions

The ambiguous nature of the Disadvantaged Status, comparisons with even more disadvantaged peers, and uncertainty about how shared information might affect admission decisions distorted participants’ understandings of identity within the context of the application. The authors believe that many applicants who have experienced significant hardships/barriers are not using the Disadvantaged Status.
The Validity of Skin Conductance For Assessing Acute Pain in Infants
Authors: Hu Jiale , Modanloo Shokoufeh , Squires Janet E. , Harrold JoAnn , Harrison Denise
Published: May 2019

Objectives:

Measuring pain in infants is important but challenging, as there is no “gold standard.” The measurement of skin conductance (SC) is considered to be a measure of stress and as a surrogate indicator of pain. The objectives of this study were to identify the extent of research conducted and to synthesize the validity evidence of SC for assessing acute pain in infants.

Methods:

The Arksey and O’Malley framework for scoping reviews was followed, and 9 electronic databases were searched. Data were analyzed thematically and presented descriptively including the following main categories: study information/details, sampling information, characteristics of participants and settings, SC outcome measures, and validity evidence.

Results:

Twenty-eight studies with 1061 infants were included, including 23 cross-sectional observation studies and 5 interventional studies. The most studied infants were those with mild severity of illness (n=13) or healthy infants (n=12). The validity evidence of SC was tested in relation to referent pain measures (13 variables), stimuli (13 variables), age (2 variables), and other contextual variables (11 variables). SC was not significantly correlated with vital signs, except for heart rate in 2 of the 8 studies. SC was significantly correlated with the unidimensional behavioral pain assessment scales and crying time rather than with multidimensional measurements. Fourteen of 15 studies (93.3%) showed that SC increased significantly during painful procedures.

Conclusions:

Inconsistent findings on validity of SC exist. Future research should aim to identify the diagnostic test accuracy of SC compared with well-accepted referent pain measures in infants, study the validity evidence of SC in critically ill infants, and utilize rigorous research design and transparent reporting.
Days Alive and Out of Hospital
Authors: Jerath Angela , Austin Peter C. , Wijeysundera Duminda N.
Published: May 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Days alive and out of hospital is a potentially useful patient-centered quality measure for perioperative care in adult surgical patients. However, there has been very limited prior validation of this endpoint with respect to its ability to capture differences in patient-level risk factor profiles and longer-term postoperative outcomes. The main objective of this study was assessment of the feasibility and validity of days alive and out of hospital as a patient-centered outcome for perioperative medicine.

Methods

The authors evaluated 540,072 adults undergoing 1 of 12 major elective noncardiac surgical procedures between 2006 to 2014. Primary outcome was days alive and out of hospital at 30 days, secondary outcomes were days alive and out of hospital at 90 days and 180 days. Unadjusted and risk-adjusted adjusted analyses were used to determine the association of days alive and out of hospital with patient-, surgery-, and hospital-level characteristics. Patients with days alive and out of hospital at 30 days values less than the tenth percentile were also classified as having poor days alive and out of hospital at 30 days. The authors then determined the association of poor days alive and out of hospital at 30 days with in-hospital complications, poor days alive and out of hospital at 90 days (less than the tenth percentile), and poor days alive and out of hospital at 180 days (less than the tenth percentile).

Results

Overall median (interquartile range) days alive and out of hospital at 30, 90, and 180 days were 26 (24 to 27), 86 (84 to 87), and 176 (173 to 177) days, respectively. Median days alive and out of hospital at 30 days was highest for hysterectomy and endovascular aortic aneurysm repair (27 days) and lowest for upper gastrointestinal surgery (22 days). Days alive and out of hospital at 30 days was associated with clinically sensible patient-level factors (comorbidities, advanced age, postoperative complications), but not measured hospital-level factors (academic status, bed size). Of patients with good days alive and out of hospital at 30 days, 477,163 of 486,087 (98%) and 470,093 of 486,087 (97%) remained within this group (greater than the tenth percentile) at days alive and out of hospital at 90 and 180 days.

Conclusions

Days alive and out of hospital is a feasibly measured patient-centered outcome that is associated with clinically sensible patient characteristics, surgical complexity, in-hospital complications, and longer-term outcomes. Days alive and out of hospital forms a novel patient-centered outcome for future clinical trials and observational studies for adult surgical patients.
Atrophy of Diaphragm and Pectoral Muscles in Critically Ill Patients
Authors: Vivier Emmanuel , Roussey Aurore , Doroszewski Fanny , Rosselli Sylvène , Pommier Christian , Carteaux Guillaume , Mekontso Dessap Armand
Published: May 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Muscle atrophy occurs early during critical illnesses. Although diffuse, this atrophy may specifically affect the diaphragm under artificial inactivity accompanying invasive mechanical ventilation. The primary objective of this study was to highlight diaphragm atrophy during the first 5 days of critical illness. Monitoring of pectoral thickness (a nonpostural muscle with mainly phasic function) served as a control.

Methods

Diaphragm and pectoral thicknesses were measured by ultrasound within the first 24 h of admission in 97 critically ill patients, including 62 on mechanical ventilation. Thirty-five patients were reexamined at day 5.

Results

Baseline median (interquartile) values of diaphragm and pectoral thicknesses at day 1 were 2.4 (2.0, 2.9) and 5.9 (4.7, 7.2) mm, respectively (n = 97). Higher values of diaphragm thickness at baseline were positively associated with male sex, chronic obstructive pulmonary disease, and diabetes. Diaphragm and pectoral atrophies (defined as a decrease of 10% or more between day 1 and day 5) were detected in 48% (17 of 35) and 29% (10 of 34) respectively, and were uncorrelated with each other. Diaphragm atrophy was significantly more frequent in patients with septic shock and in those with mechanical ventilation, as compared with their respective counterparts (71% [10 of 14] vs. 33% [7 of 21], P = 0.027 and 71% [17 of 28] vs. 0% [0 of 7], P = 0.004, respectively), whereas pectoral atrophy was more common in patients treated with steroids as compared with their counterparts (58% [7 of 12] vs. 14% [3 of 22], P = 0.006). A statistically significant association between diaphragm atrophy and outcome was not found. Pectoral atrophy seemed associated with less successful weaning from mechanical ventilation at day 14 (12% [1 of 8] vs. 58% [11 of 19], P = 0.043).

Conclusions

Ultrasound enables identification of specific early diaphragm atrophy that affects the majority of mechanically ventilated patients and septic shock patients. Diaphragm atrophy and pectoral muscle atrophy seem to be two unrelated processes.
Measuring Childbirth Outcomes Using Administrative and Birth Certificate Data
Authors: Glance Laurent G. , Hasley Steve , Glantz J. Christopher , Stevens Timothy P. , Faden Eric , Kreso Melissa A. , Pyne Sonia G. , Wissler Richard N. , Fichter Jennifer , Gloff Marjorie S. , Dick Andrew W.
Published: May 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

The number of pregnancy-related deaths and severe maternal complications continues to rise in the United States, and the quality of obstetrical care across U.S. hospitals is uneven. Providing hospitals with performance feedback may help reduce the rates of severe complications in mothers and their newborns. The aim of this study was to develop a risk-adjusted composite measure of severe maternal morbidity and severe newborn morbidity based on administrative and birth certificate data.

Methods

This study was conducted using linked administrative data and birth certificate data from California. Hierarchical logistic regression prediction models for severe maternal morbidity and severe newborn morbidity were developed using 2011 data and validated using 2012 data. The composite metric was calculated using the geometric mean of the risk-standardized rates of severe maternal morbidity and severe newborn morbidity.

Results

The study was based on 883,121 obstetric deliveries in 2011 and 2012. The rates of severe maternal morbidity and severe newborn morbidity were 1.53% and 3.67%, respectively. Both the severe maternal morbidity model and the severe newborn models exhibited acceptable levels of discrimination and calibration. Hospital risk-adjusted rates of severe maternal morbidity were poorly correlated with hospital rates of severe newborn morbidity (intraclass correlation coefficient, 0.016). Hospital rankings based on the composite measure exhibited moderate levels of agreement with hospital rankings based either on the maternal measure or the newborn measure (κ statistic 0.49 and 0.60, respectively.) However, 10% of hospitals classified as average using the composite measure had below-average maternal outcomes, and 20% of hospitals classified as average using the composite measure had below-average newborn outcomes.

Conclusions

Maternal and newborn outcomes should be jointly reported because hospital rates of maternal morbidity and newborn morbidity are poorly correlated. This can be done using a childbirth composite measure alongside separate measures of maternal and newborn outcomes.
Opioid use after ankle fracture surgery: current trends in the United States
Authors: Chen Michael J. , Zhang Steven , DeBaun Malcolm , Fogel Nathaniel , Bishop Julius A. , Gardner Michael J.
Published: May 2019

Background:

The United States opioid epidemic has been declared a national public health emergency. While opioids are frequently prescribed after ankle fracture surgery, the percentage of patients actually requiring them is unknown. Here we compare the annual percentage of patients using an opioid prescription after ankle fracture surgery over the last decade.

Methods:

We retrospectively queried a large private-payer database from 2007-2015 and identified 20,992 opioid-naive patients undergoing ankle fracture surgery. We then measured the annual prevalence of opioid prescriptions over time separated into the immediate postoperative period (between 0 and 6 mo from surgery) and the prolonged period (between 6 and 12 mo from surgery). Linear regression with beta coefficients was calculated.

Results:

The prevalence of patients filling opioid prescriptions between 0 and 6 mo after surgery declined from 28.5% to 21.2% during the study period. The prevalence of patients filling opioid prescriptions between 6 and 12 mo after surgery declined from 2.9% to 2.3% during the study period.

Conclusions:

The percentage of patients utilizing opioid prescriptions after ankle fracture surgery is much lower than expected, suggesting that routine prescriptions given after ankle fracture surgery and other smaller orthopaedic procedures are not likely to be contributing to the epidemic.
Rates and treatments of CrossFit-related injuries at a single hospital system
Authors: Everhart Joshua S. , Kirven James C. , France Thomas J. , Hidden Krystin , Vasileff William Kelton
Published: May 2019

Background:

CrossFit is a new sport with rapidly growing participation rates that utilizes movements from other sports including gymnastics, Olympic weightlifting, and power lifting. We hypothesized that there would be high rates of nonoperative treatment, that treatment patterns would vary by anatomic site of injury, and that rates of surgical treatment would be higher with increasing age and have no association with patient sex among CrossFit athletes.

Methods:

Hospital system-wide electronic medical records from 2010 to 02/2017 were queried for reference to CrossFit or a related term within the clinical notes. For musculoskeletal (MSK) injuries, use of physical therapy, injection, advanced diagnostic imaging (CT or MRI), and surgery were documented.

Results:

Nine hundred and eighty-two CrossFit-related injuries were identified (91.1% MSK injuries, 8.9% non-MSK conditions) (mean age 36.4 yr SD 11.0, 50.3% male) with a >30% yearly increase in cases throughout the study period. Physical therapy was utilized for 76.0% of MSK injuries, 15.8% received an injection, 37.5% underwent advanced imaging, and 15.8% underwent surgery. The most common MSK injury sites were knee, shoulder, and spine. Male sex and later year of injury were independent risk factors for surgery; compared to other MSK injuries, knee injuries had higher surgery risk and spine had a lower risk.

Conclusions:

CrossFit injury volumes at our center have steadily increased as participation rates have increased. Physical therapy was frequently utilized. Surgery rates for MSK injuries varied considerably by anatomic region. Men were more likely to require surgery. The percentage of injuries requiring surgery increased throughout the study period.
Characterization of compliance to weight-bearing protocols and patient weight-bearing behavior during the recovery period in lower extremity fractures: a pilot study
Authors: Lajevardi-Khosh Arad , Stuart Ami , Ackerman Matt , Rothberg David , Kubiak Erik , Petelenz Tomasz , Hitchcock Robert
Published: May 2019

Background:

To promote fracture healing and limit complications, clinicians typically instruct patients with lower extremity fracture to be nonweight or partial-weight bearing or to bear weight as tolerated during the recovery period. Although this practice represents the standard of care, continuous patient compliance to weight-bearing protocols and actual patient weight-bearing progression remain unknown. This study aimed to characterize patient compliance towards weight-bearing protocols and weight-bearing progression during recovery.

Methods:

Eleven patients with lower extremity fracture consented to participate in this observational study. Postoperatively, patients were instructed to follow weight-bearing protocols based upon the treating clinicians’ recommendation. Patients were fitted with an underfoot load monitor integrated into the sole of a walking boot. Continuous load data from each patient were used to quantify the number of days patients were compliant with the weight-bearing protocol.

Results:

Overall, patients were unable to comply to nonweight-bearing and partial-weight-bearing protocols. Patients performed nonweight bearing and partial weight bearing only 24% and 12% of the time, respectively. Patients were most compliant (72%) to the weight bearing as tolerated protocol. Additionally, weight-bearing progressions either consistently increased (46%), remained relatively constant (27%), or remained constant initially and then suddenly increased (27%).

Conclusions:

Continuous compliance data from this study indicate that patients do not comply with weight-bearing protocols. Additionally, the variety of weight-bearing progressions, with limited complications, may suggest that patients are able to self-regulate their weight bearing without compromising healing outcomes.
Surgical Site Infections in Elderly Fragility Hip Fractures Patients Undergoing Warfarin Treatment
Authors: Frenkel Rutenberg Tal , Vitenberg Maria , Yahav Dafna , Spectre Galia , Velkes Steven
Published: May 2019

Objectives:

Surgical site infection (SSI) is a devastating complication of proximal femoral fracture surgery, related with an increased morbidity and mortality. As warfarin treatment has been described as a risk factor for SSI, we aimed to compare patient and SSI characteristics in warfarin and nonanticoagulated patients.

Design:

Retrospective cohort study.

Setting:

Level-1 trauma center.

Patients:

Individuals 65 years of age and older with fragility hip fractures.

Intervention:

Patients were divided into 2 cohorts: warfarin treated (n = 85) or nonanticoagulated (n = 771). Demographics, in-hospital characteristics, laboratory data, prior hospitalizations, recent antibiotic use, and 1-year incidence of SSIs and their characteristics were gathered.

Main Outcome Measures:

Postoperative SSIs.

Results:

Twelve patients (14.1%) from the warfarin group and 21 patients (2.7%) from the noncoagulated group had SSI (P < 0.001). Both groups were comparable in terms of demographics and Charlson comorbidity score. Warfarin-treated patients had reduced white blood and neutrophils counts (10.1 ± 3.2 vs. 11.6 ± 4.0 cells/mm3 and 8.1 ± 3.2 vs. 9.6 ± 3.9 cells/mm3 for both comparisons respectively; P < 0.001 for both). They were more likely to be admitted to a geriatric ward than to orthopedics ward and were delayed to theater (58.5 ± 44.5 vs. 30.6 ± 27.4 hours; P < 0.001). Following surgery, there was no difference in blood transfusions required, in-hospital complications, or time to infection. Rates of prior hospitalizations, antibiotic use, or type of bacteria did not differ.

Conclusions:

Warfarin treatment in fragility hip fracture surgery is correlated with an increased risk for SSI, regardless of in-hospital complications, and hospitalizations before surgery or to the infection itself.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Effect of Dexmedetomidine Added to Preemptive Ropivacaine Infiltration on Postoperative Pain After Lumbar Fusion Surgery
Authors: Li Jing , Yang Jun-Song , Dong Bu-Huai , Ye Jiu-Min
Published: May 2019

Study Design.

A prospective and controlled study of dexmedetomidine added to preemptive ropivacaine infiltration in lumbar fusion surgery.

Objective.

Assessment of dexmedetomidine added to preemptive ropivacaine infiltration for the relief of postoperative pain after lumbar fusion surgery.

Summary of Background Data.

Single local anesthetic preemptive wound infiltration for the relief of postoperative pain does not translate into major or consistent clinical benefits after lumbar fusion surgery. Dexmedetomidine added to local anesthetics prolonged the duration of blockade and enhanced the analgesic in peripheral nerve block. The effect of dexmedetomidine added to preemptive ropivacaine infiltration in lumbar fusion surgery for the relief of postoperative pain has yet not been studied.

Methods.

Fifty-seven patients with elective posterior lumbar fusion were randomly divided into two groups. Five minutes before incision, the skin and subcutaneous tissues were injected with 20 mL 0.5% ropivacaine in group R (n = 28) and 20 mL 0.5% ropivacaine and 1 ug/kg of dexmedetomidine in group RD (n = 29) in two divided doses (i.e., 10 mL per side of the incision line). After the operation, all patients received intravenous morphine for analgesia. The total morphine consumption, the time of first analgesic demand, numbers of PCA analgesia, Visual Analog Scale, and postoperative adverse effects were collected.

Results.

In group RD, cumulative morphine dose and numbers of PCA analgesia in group RD were significantly reduced, the time of first analgesic demand was significantly delayed compared to the group R. Visual Analog Scale in group RD showed a marked reduction at 8 hours, 12 hours, 16 hours after operation and less patients in group RD experienced postoperative nausea or vomiting compared to the group R.

Conclusion.

The addition of dexmedetomidine to preemptive ropivacaine wound infiltration provided a superior analgesic effect, reduced postoperative morphine consumption, and prolonged the time of the first analgesic demand with no serious side effects.

Level of Evidence: 2
Early Enteral Nutrition in Patients Undergoing Sustained Neuromuscular Blockade: A Propensity-Matched Analysis Using a Nationwide Inpatient Database*
Authors: Ohbe Hiroyuki , Jo Taisuke , Matsui Hiroki , Fushimi Kiyohide , Yasunaga Hideo
Published: May 2019

Objectives:

Whether enteral nutrition should be postponed in patients undergoing sustained treatment with neuromuscular blocking agents remains unclear. We evaluated the association between enteral nutrition initiated within 2 days of sustained neuromuscular blocking agent treatment and in-hospital mortality.

Design:

Retrospective administrative database study from July 2010 to March 2016.

Setting:

More than 1,200 acute care hospitals covering approximately 90% of all tertiary-care emergency hospitals in Japan.

Patients:

Mechanically ventilated patients, who had undergone sustained treatment with neuromuscular blocking agents in an ICU, were retrospectively reviewed. We defined patients who received sustained treatment with neuromuscular blocking agents as those who received either rocuronium at greater than or equal to 250 mg/d or vecuronium at greater than or equal to 50 mg/d for at least 2 consecutive days.

Interventions:

Enteral nutrition started within 2 days from the initiation of neuromuscular blocking agents (defined as early enteral nutrition).

Measurements and Main Results:

We identified 2,340 eligible patients during the 69-month study period. Of these, 378 patients (16%) had received early enteral nutrition. One-to-three propensity score matching created 374–1,122 pairs. The in-hospital mortality rate was significantly lower in the early than late enteral nutrition group (risk difference, –6.3%; 95% CI, –11.7% to –0.9%). There was no significant difference in the rate of hospital pneumonia between the two groups (risk difference, 2.8%; 95% CI, –2.7% to 8.3%). Length of hospital stay among survivors was significantly shorter in the early compared with the late enteral nutrition group (risk difference, –11.4 d; 95% CI, –19.1 to –3.7 d). There was no significant difference between the two groups in length of ICU stay or length of mechanical ventilation among survivors.

Conclusions:

According to this retrospective database study, early enteral nutrition may be associated with lower in-hospital mortality with no increase in-hospital pneumonia in patients undergoing sustained treatment with neuromuscular blocking agents.
Necrotic Keratinocytes Are Common in Psoriasis and Have a Predilection to the Upper Epidermis: A Quantitative and Comparative Analysis
Authors: Cloutier Jeffrey M. , Hsi Andy , Camacho Christine , Lazova Rossitza
Published: May 2019

Background:

The most salient histopathological features of psoriasis are epidermal hyperplasia, hypogranulosis, parakeratosis, dilated capillaries in dermal papillae, and intraepidermal and intracorneal neutrophils. Several additional “nonclassic” features of psoriasis have recently been reported, including necrotic keratinocytes (NK). To determine the diagnostic utility of NK, we characterized NK in a large cohort of psoriasis cases compared with psoriasiform spongiotic dermatitis (PSD) and normal skin.

Methods:

NK were quantified in 101 cases of psoriasis, 20 cases of PSD, and 20 cases of normal skin. The location of NK within the lower, middle, or upper thirds of the epidermis was recorded.

Results:

NK were identified in 77/101 (76%) of psoriasis cases. By comparison, NK were seen in 8/20 (40%) cases of PSD and 4/20 (20%) cases of normal skin. The linear concentration of NK was significantly higher in psoriasis (0.36 NK/mm) compared with PSD (0.12 NK/mm) and normal skin (0.03 NK/mm) (P= 0.0009). NK were preferentially located in the upper (58%) and middle (31%) epidermis in psoriasis.

Conclusions:

NK are a common feature of psoriasis and have a predilection to the upper layers of epidermis. Superficial NK may provide additional diagnostic support for psoriasis in challenging or borderline cases.
Triage to Observation
Authors: Williams Julie , Aurora Taruna , Baker Kathy , Thompson Julie , Smallheer Benjamin
Published: May 2019

Objective:

The objective of this study was to evaluate the impact of a rapid admission protocol for chest pain patients presenting to the emergency department (ED) on ED length-of-stay (LOS). In this study, ED LOS was defined as the time from triage check-in until the time the patient physically leaves the ED. The purpose of this quality improvement study was to decrease ED crowding.

Methods:

This is a single-center prospective cohort study performed as a quality improvement initiative. This study implemented a rapid admission protocol for patients who were at moderate risk for a major adverse cardiac event based on the HEART score. When a patient presented to the ED through triage with a chief complaint of chest pain, this protocol allowed the provider-in-triage (PIT) to identify eligible patients for potential rapid admission to the hospital’s clinical decision unit (CDU). The PIT would complete a rapid medical screening examination, initiate the patient’s workup, and call the CDU providers to further evaluate the patient. By identifying these patients early, the lengthy ED chest pain workup contributing to longer ED LOS could then be completed in the CDU.

Results:

The total number of patients seen in the ED over the study period was 34,251. The total number of patients admitted to the CDU during the study period was 1,442. The PIT identified 13 patients for rapid admission to the CDU during the study period. These patients had a statistically significant reduction in ED LOS (P < 0.001). ED LOS was also adjusted to identify delays in patient movement resulting in a statistically significant difference (P < 0.001).

Conclusion:

Implementation of a rapid admission protocol for chest pain patients at moderate risk for a major adverse cardiac event resulted in a reduction in ED LOS. Adjusted ED LOS was also significant, highlighting a delay in patient movement from the ED to the CDU indicating continued barriers affecting ED holding times.
Endovascular Versus Transapical Transcatheter Aortic Valve Replacement: In-hospital Mortality, Hospital Outcomes, and 30-day Readmission. A Propensity Score–matched Analysis
Authors: Lemor Alejandro , Hernandez Gabriel , Bavishi Chirag , Jain Tarun , Patel Nish , Villablanca Pedro , Mawri Sagger , O’Neill William
Published: May 2019

Introduction:

Transapical transcatheter aortic valve replacement (TAVR) is associated with increased morbidity compared with endovascular TAVR. We sought to compare the differences in clinical outcomes between endovascular and transapical TAVR approaches utilizing a propensity score model.

Methods:

Patients undergoing TAVR (International Classification of Diseases, Ninth Revision, Clinical Modification codes 35.05 and 35.06) between January 2011 and November 2014 were identified in the Nationwide Readmissions Database, and a propensity score–matched analysis was performed comparing transapical versus endovascular approach. The primary outcome of interest was in-hospital mortality and 30-day all-cause readmission. We also evaluated trends in use of TAVR over the years.

Results:

We identified 28,302 endovascular TAVR and 7967 transapical TAVR performed during the study period. The propensity score–matching algorithm yielded 7879 well-matched patients in each group. The in-hospital mortality rates were significantly lower in endovascular TAVR compared with transapical TAVR (1.7% vs 6.7%; OR, 0.24; 95% CI, 0.17– 0.35; P < 0.001). The 30-day readmission rate was lower in endovascular TAVR (14.4% vs 16.8%; OR, 0.83; 95% CI, 0.70–0.98; P = 0.036). Use of TAVR increased from 585 (74% endovascular TAVR) in 2011 to 16,801 in 2014 (82.8% endovascular TAVR).

Conclusions:

Endovascular TAVR is associated with significantly lower in-patient mortality and lower readmission rate when compared with transapical TAVR. Heart failure remains the most common cause for readmission after TAVR regardless of approach.
The Associations of Diagnoses of Fatigue and Depression With Use of Medical Services in Patients With Heart Failure
Authors: Heo Seongkum , McSweeney Jean , Tsai Pao-Feng , Ounpraseuth Songthip , Moser Debra K. , Kim JinShil
Published: May 2019

Background:

Fatigue and depression based on self-report and diagnosis are prevalent in patients with heart failure and adversely affect high rates of hospitalization and emergency department visits, which can impact use of medical services. The relationships of fatigue and depression to use of medical services in patients with preserved and reduced left ventricular ejection fraction (LVEF) may differ.

Purpose:

We examined the associations of diagnoses of fatigue and depression with use of medical services in patients with preserved and reduced LVEF, controlling for covariates.

Methods:

Data were collected on fatigue, depression, covariates, and use of medical services. Patients (N = 582) were divided into 2 groups based on LVEF (<40%, reduced LVEF; ≥40%, preserved LVEF). Multiple linear regression analyses were used to analyze the data.

Results:

A diagnosis of fatigue was a significant factor associated with more use of medical services in the total sample (β = .18, P < .001, R
2 = 54%) and patients with reduced LVEF (β = .13, P = .008, R
2 = 54%) and also preserved LVEF (β = .21, P < .001, R
2 = 54%), controlling for all covariates, but a diagnosis of depression was not.

Conclusions:

This study demonstrates the important roles of a diagnosis of fatigue in use of medical services. Thus, fatigue needs to be assessed, diagnosed, and managed effectively.
Sympathetic Markers are Different Between Clinical Responders and Nonresponders After Left Ventricular Assist Device Implantation
Authors: Denfeld Quin E. , Lee Christopher S. , Woodward William R. , Hiatt Shirin O. , Mudd James O. , Habecker Beth A.
Published: May 2019

Background

Clinical response to left ventricular assist devices (LVADs), as measured by health-related quality of life, varies among patients after implantation; however, it is unknown which pathophysiological mechanisms underlie differences in clinical response by health-related quality of life.

Objective

The purpose of this study was to compare changes in sympathetic markers (β-adrenergic receptor kinase-1 [βARK1], norepinephrine [NE], and 3,4-dihydroxyphenylglycol [DHPG]) between health-related quality of life clinical responders and nonresponders from pre– to post–LVAD implantation.

Methods

We performed a secondary analysis on a subset of data from a cohort study of patients from pre– to 1, 3, and 6 months after LVAD implantation. Clinical response was defined as an increase of 5 points or higher on the Kansas City Cardiomyopathy Questionnaire Clinical Summary score from pre– to 6 months post–LVAD implantation. We measured plasma βARK1 level with an enzyme-linked immunosorbent assay and plasma NE and DHPG levels with high-performance liquid chromatography with electrochemical detection. Latent growth curve modeling was used to compare the trajectories of markers between groups.

Results

The mean (SD) age of the sample (n = 39) was 52.9 (13.2) years, and most were male (74.4%) and received LVADs as bridge to transplantation (69.2%). Preimplantation plasma βARK1 levels were significantly higher in clinical responders (n = 19) than in nonresponders (n = 20) (P = .001), but change was similar after LVAD (P = .235). Preimplantation plasma DHPG levels were significantly lower in clinical responders than in nonresponders (P = .002), but the change was similar after LVAD (P = .881). There were no significant differences in plasma NE levels.

Conclusions

Preimplantation βARK1 and DHPG levels are differentiating factors between health-related quality of life clinical responders and nonresponders to LVAD, potentially signaling differing levels of sympathetic stimulation underlying clinical response.
Local Health Department Activities to Reduce Emergency Department Visits for Substance Use Disorders
Authors: Novak Priscilla , Bloodworth Robin , Green Kerry , Chen Jie
Published: May 2019

The Affordable Care Act (ACA) provides financial incentives to prevent substance use disorders (SUDs). Local health departments (LHDs) can receive funds to establish care teams that partner with primary care providers and health systems. This study estimates the potential effect of LHDs on emergency visits for SUDs, using linked data sets from the Healthcare Cost and Utilization Project Emergency Department (ED) sample for the State of Maryland—2012, the National Association of County and City Health Officials Profiles Survey 2013, and Area Health Resource File 2013 to estimate potential effect of LHDs' provision of SUD preventive care and SUD-related policy implementation. Local health department involvement in SUD-related policy during the past 2 years and provision of preventive care for behavioral health in the past year significantly reduced the probability of having a SUD-related ED visit by 11% and 6%, respectively, after controlling for individual characteristics (odds ratio [OR] = 0.89, p < .001; OR = 0.93, p < .001). After adjusting for the individual and contextual factors, LHD involvement in policy was still associated with 14% reduction in SUD-related ED visits (OR = 0.86, p < .001). Results offer insights on the extent to which the LHD activities can possibly affect SUD-related ED visits and provide a foundation for future work to identify effective LHD interventions.
The clinical outcomes of selenium supplementation on critically ill patients
Authors: Zhao Yan , Yang Mengmeng , Mao Zhi , Yuan Rui , Wang Li , Hu Xin , Zhou Feihu , Kang Hongjun
Published: May 2019

Purpose:

Selenium supplementation is a potentially promising adjunctive therapy for critically ill patients, but the results are controversy among studies. Accordingly, we performed this meta-analysis to more clearly detect the efficacy and safety of selenium supplementation on critically ill patients.

Methods:

Systematic literature retrieval was carried out to obtain RCTs on selenium supplementation for critically ill patients up to August 2017. Data extraction and quality evaluation of these studies were performed by 2 investigators. Statistical analyses was performed by RevMan 5.3. Trial sequential analysis (TSA) was conducted to control the risks of type I and type II errors and calculate required information size (RIS).

Results:

Totally 19 RCTs involving 3341 critically ill patients were carried out in which 1694 participates were in the selenium supplementation group, and 1647 in the control. The aggregated results suggested that compared with the control, intravenous selenium supplement as a single therapy could decrease the total mortality (RR = 0.86, 95% CI: 0.78–0.95, P = .002, TSA-adjusted 95% CI = 0.77–0.96, RIS = 4108, n = 3297) and may shorten the length of stay in hospital (MD −2.30, 95% CI −4.03 to −0.57, P = .009), but had no significant treatment effect on 28-days mortality (RR = 0.96, 95% CI: 0.85–1.09, P = .54) and could not shorten the length of ICU stay (MD −0.15, 95% CI −1.68 to 1.38, P = .84) in critically ill patients. Our results also showed that selenium supplementation did not increase incidence of drug-induced side effect compared with the control (RR 1.04, 95% CI 0.83 to 1.30, P = .73).

Conclusions:

The current evidence suggests that the use of selenium could reduce the total mortality, and TSA results showed that our outcome is reliable and no more randomized controlled trials are needed. But selenium supplementation might have no effect on reducing 28-days mortality as well as the incidence of new infections, or on length of stay in ICU or mechanical ventilation. However, the results should be used carefully because of potential limitations.
Elastic fixation of mallet finger fractures using two K-wires
Authors: Chen Qiang , Suo Yan , Pan Danhong , Xie QingPing
Published: May 2019

Rationale:

Mallet finger fracture is a common sports-related injury that may lead to the tearing of extensor tendon and protrusion of a bony fragment located at the base of the distal phalanx. We affirmed that the elastic fixation of with two K-wires technique is a good method to deal with Mallet Finger fractures that fractures could gain effective fixation than the conventional treatment method and avoid surgical incision complication

Patient concerns:

We reported a 33-year-old female patient came to our hospital complaining of mild pain, swelling and her right little finger was deformed because of sport's injury.

Diagnosis:

Acute mallet finger fracture type IV B according to Doyle classification of mallet injuries.

Interventions:

We performed an emergency operation for the elastic fixation of the mallet finger fractures with two K-wires.

Outcomes:

After the surgery, the patient showed functional recovery. No evidence of recurrence was noted 6 months after the operation, and the patient showed no symptoms of sports-related injuries.

Lessons:

We discuss the clinical diagnosis, treatment, and follow-up of the patient and suggest that elastic fixation with two K-wires is a good method to treat mallet finger fractures.
Comparative effect of statins and types of physical exercise on arterial stiffness
Authors: Martínez-Vizcaíno Vicente , Cavero-Redondo Iván , Saz-Lara Alicia , Pozuelo-Carrascosa Diana P. , Notario-Pacheco Blanca , Gómez-Marcos Manuel A. , Álvarez-Bueno Celia
Published: May 2019

Introduction:

The purpose of this study protocol is to provide the methodology for a review to compare the effect of statins vs physical exercise interventions and the effect of different types of physical exercise, on reducing arterial stiffness associated with cardiovascular diseases and mortality.

Methods and analysis:

The literature search will be conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science databases from their inception until July 31, 2019. We will include randomized controlled trials, nonrandomized experimental studies, and controlled pre–post studies assessing the effect in the general population of statins and physical exercise interventions on arterial stiffness measured by pulse wave velocity. The Cochrane Collaboration's tool and the Quality Assessment Tool for Quantitative Studies will be used to assess the risk of bias for studies included in the systematic review. A Bayesian network meta-analysis will be carried out to determine the comparative effect of the different physical exercise interventions and/or statin intervention.

Ethics and dissemination:

This study will generate evidence about the effectiveness of both statins and exercise on reducing arterial stiffness that potentially can be transferred to patients and practitioners. Moreover, in light of the importance of reducing arterial stiffness for preventing cardiovascular disease, the evidence provided by this study will be potentially suitable to be included in cardiovascular clinical practice guidelines.

Strengths and limitations:

This protocol describes the methods of a study examining, using network meta-analysis strategies, the efficacy of statins and different types of exercise on improving arterial stiffness, which is an early marker of atherosclerosis. The results of this study could immediately help clinicians to recommend the best evidence-based intervention to their patients to reduce arterial stiffness and, as a consequence, prevent major complications, such as heart failure, stroke, or myocardial infarction.

Trial registration number:

PROSPERO CRD42019123120
Postoperative adjuvant therapy for resectable esophageal cancer
Authors: Chai Tianci , Shen Zhimin , Zhang Peipei , Lin Yuhan , Chen Sui , Zhang Zhenyang , Lin Wenwei , Kang Mingqiang , Lin Jiangbo
Published: May 2019

Background:

Esophageal cancer is one of the most common malignant tumors, characterized by early metastasis and high degree of malignancy. Its morbidity ranks 7th among all malignant tumors and its mortality ranks 6th. Postoperative adjuvant therapy after esophagectomy can significantly improve the overall survival rate of patients with locally resectable esophageal cancer. With the breakthrough and progress of immunotherapy, the possibility of cure of esophageal cancer is greatly improved. Some clinical trials have reported that programmed death 1 (PD1) and programmed death ligand 1 (PDL1) inhibitors alone, compared with traditional platinum-based chemotherapy, can benefit patients and effectively extend the overall survival period of patients. We will conduct a systematic review and meta-analysis on the comparison of the efficacy of immunotherapy (PD1 and PDL1 inhibitors) alone and traditional platinum-based chemotherapy, so as to provide a reliable basis for clinicians to formulate the best chemotherapy regimen for patients with esophageal cancer after esophagectomy.

Methods:

We will search Pubmed, Medline, Embase, Web of Science, Cancerlit, Google Scholar, and the Cochrane Central Register of Controlled Trials for related studies published before December 1, 2019 without language restrictions. Two review authors will search and assess relevant studies independently. Randomized controlled trials (RCTs) or quasi-RCTs, and prospective cohort studies will be included. We will perform subgroup analysis in sex, age, ethnicity, and tumor stage of esophageal cancer patients.

Results:

The results of this study will be published in a peer-reviewed journal.

Conclusion:

The results of this systematic review and meta-analysis will provide a basis for clinicians to formulate the best chemotherapy regimen for patients, as well as a research clue for clinical researchers in this field. The results of this study will expand the treatment options for esophageal patients, but due to the nature of the disease and intervention, large sample clinical trials are not abundant, so we will include some high-quality small sample trials, which may cause high heterogeneity.

PROSPERO registration number: CRD42019125000.
Online community collaborative map
Authors: Ku Wen-Yuan , Nfor Oswald Ndi , Liu Wen-Hsiu , Tantoh Disline Manli , Hsu Shu-Yi , Wang Lee , Chou Tien-Yin , Liaw Yung-Po
Published: May 2019

The aim of this study was to develop an online collaborative map to enable researchers to locate, explore, and share cancer data.

This 2-scale (global and country-level) cancer map adopts a database-driven model, which was implemented using the Google Map Application Programming Interface (API) and asynchronous JavaScript and XML (AJAX) technology. Seven visualization techniques were used to present data. Data on worldwide cancer mortality between 1950 and 2013 were taken from the International Agency for Research on Cancer (IARC) database. Incidence data were from the IARC CI5plus database. Survival data were from the IARC SURVCAN study. Prevalence data between 1990 and 2017 were from the Institute for Health Metrics and Evaluation's (IHME) catalog while demographic data were from the World Bank Data Catalog. Cancer data for Taiwan between 1991 and 2016 were obtained from the Department of Health and Welfare. This study used visualization techniques that included: a choropleth map to display the prevalence of cancer; a tornado diagram to show the age-standardized mortality rates of all cancers among men and women in 2013; a treemap to show a ranking of cancer mortality data; a sunburst chart to show mortality rates of all cancers by gender; a line chart to show mortality trends for all cancers; a bar chart to show mortality and incidence rates and a heatmap to show variations in cancer across different countries.

The world cancer map generated by this study can be accessed at http://worldmap.csmu-liawyp.tw. Country-level mortality data are presented as crude and age-standardized rates.

We used visualization methodologies and constructed an easily maintainable web-based user interface with cancer data from administrative regions in 150 countries. This serves as a platform that allows researchers to manage and disseminate cancer data.
Gender differences of in-hospital outcomes in patients undergoing percutaneous coronary intervention in the drug-eluting stent era
Authors: Kim Hack-Lyoung , Jang Jae-Sik , Kim Myung-A , Seo Jae-Bin , Chung Woo-Young , Kim Sang-Hyun , Park Seung-Jung , Youn Tae-Jin , Yoon Myeong-Ho , Lee Jae-Hwan , Chang Kiyuk , Jeong Myung Ho , Choi Rak Kyeong , Hong Myeong-Ki , Kim Hyo-Soo
Published: May 2019

Most studies on gender difference of the in-hospital outcome of percutaneous coronary intervention (PCI) were performed in the pre-drug-eluting stents (DES) era. This study was performed to investigate whether gender influences the in-hospital outcome of PCI in the DES era.

A total of 44,967 PCI procedure between January and December of 2014 from the nationwide PCI registry database in Korea were analyzed. The study population was male predominant (70.2%). We examined the association of gender with unadjusted and adjusted in-hospital mortality and composite events of PCI, including mortality, nonfatal myocardial infarction, stent thrombosis, stroke, urgent repeat PCI and bleeding requiring transfusion.

Most of the study patients (91.3%) received DES. The incidence rates of in-hospital mortality (2.95% vs 1.99%, P <.001) and composite events (7.01% vs 5.48%, P <.001) were significantly higher in women compared to men. Unadjusted analyses showed that women had a 1.49 times higher risk of in-hospital mortality and a 1.30 times higher risk of composite events than men (P <.001 for each). After adjustment for potential confounders, female gender was not a risk factor for mortality (P = .258), but the risk of composite events remained 1.20 times higher in women than in men (P = .008).

Among patients undergoing PCI in the contemporary DES era, female gender was associated with an increased risk of in-hospital composite events, but not in-hospital mortality. More careful attention should be emphasized to minimize procedure-related risks and to improve prognosis in women undergoing PCI.