bluuebunny/crossref_metadata_2025 huggingface dataset:
Repeatability of 2 swept-source OCT biometers and 1 optical low-coherence reflectometry biometer
Authors: Fişuş Andreea D. , Hirnschall Nino D. , Ruiss Manuel , Pilwachs Caroline , Georgiev Stefan , Findl Oliver
Published: March 2021

Aim:

To compare the repeatability of 2 swept-source optical coherence tomography (SS-OCT) biometers, IOLMaster 700 (biometer A, Carl Zeiss Meditec AG) and ANTERION (biometer B, Heidelberg Engineering GmbH) and 1 optical low-coherence reflectometry (OLCR) device (biometer C, LENSTAR, LS900; Haag-Streit AG).

Setting:

Department of Ophthalmology, Hanusch Hospital, Vienna Institute for Research in Ocular Surgery—Karl Landsteiner Institute, Vienna, Austria.

Design:

Prospective study that included patients scheduled for cataract surgery.

Method:

Three consecutive measurements were performed with 2 SS-OCT devices and 1 OLCR device. The repeatability of the following biometry variables was compared: keratometry, central corneal thickness, anterior chamber depth (ACD), lens thickness (LT), and axial eye length (AL). To assess the repeatability of each parameter, the within-subject SD (Sw) and coefficient of variation (CoV) were calculated.

Result:

Fifty eyes of 50 patients were included. The CoV values were below 0.5 for all variables, except for ACD and LT for biometer C. The Sw values for mean keratometry were 0.018 for biometer A, 0.083 for biometer B, and 0.137 for biometer C. For the ACD, the Sw values were 0.039 and 0.004 for biometer A and biometer B, respectively, and 0.134 for biometer C. For the AL, the values were 0.006 for biometer A, 0.008 for biometer B, and 0.012 for biometer C.

Conclusions:

All biometry devices included in the analysis presented a high repeatability. The SS-OCT devices showed a higher repeatability performance compared with the OLCR device.
Use of social determinants of health codes in home-based primary care
Authors: Coppa Denise , Winchester Suzy Barcelos , McAlvin Elizabeth , Roberts Mary B. , Maestri Xristin
Published: March 2021

Background:

The Affordable Care Act created funding for nurse practitioner education programs to transform the primary health care workforce through student awareness of how social, political, economic, and environmental factors influence individual and population health. Funding established Academic Clinical Partnerships (ACPs) that created value-based health care models, which improved patient outcomes and decreased hospital and emergency department admissions and health care costs. The ACP established a home-based primary health care (HBPC) program to deliver primary care and collect patient data.

Purpose:

The purposes were to describe the incidence of chronic conditions for HBPC patients and determine associations between chronic conditions and presence of social determinants of health (SDoH).

Methodology:

Nurse practitioner students were assigned to HBPC clinical placements. A convenience sample of 102 high-risk, homebound patients was identified. Nurse practitioners and students recorded deidentified patient data, including ICD-10-CM codes into a Health Insurance Portability and Accountability Act compliant platform. Secondary analysis of patient records assessed for SDoH through Z codes.

Results:

Patients had high incidences of hypertension, diabetes, pulmonary disease, heart disease, chronic pain, mood, and substance abuse disorders. Secondary analysis revealed that 92% of patients had indications for the use of Z codes, but these were not recorded.

Conclusions:

Common Z codes were personal risk factors, housing/economic circumstances, care provider dependency, lifestyle, and family support.

Implications for practice:

By coding for SDoH, providers and agencies can realize higher reimbursement rates in HBPC settings. Nurse practitioners can use this information to provide better treatment recommendations, more accurate diagnoses, and referrals to enhance primary care services to a patient population negatively affected by SDoH.
Cost of Constipation
Authors: Bielefeldt Klaus
Published: March 2021

Goal:

The study was designed to assess drug costs for constipation therapy and to relate costs to markers of functional status.

Background:

Secretagogues have been introduced as new agents for the treatment of constipation. Previously published modeling studies suggested that improved productivity lowers the indirect disease burden and balances the higher drug costs.

Study:

Data were abstracted from the publicly available Medical Expenditure Panel Survey to identify adults with a functional gastrointestinal disorder who received a prescription for laxatives or secretagogues covering >2 days. Demographic data, recorded health care utilization and cost, and markers of functional status were extracted for the years from 2005 to 2017 to determine differences between participants treated with secretagogues or laxatives.

Results:

The cohort of 2006 persons was female predominant [67.8%; age: 56.9 (55.8-57.9) years] and spent $92.89 (75.68-110.10) for medications treating constipation. The use of secretagogues (10.3% of the cohort) was the best independent predictor of constipation treatment costs. Using quality of life measures, perceived limitations in activities or work, and absenteeism, there was no difference between participants receiving laxatives and those taking secretagogues.

Conclusion:

Using survey data designed to be representative of the United States population, the study identified secretagogues as a key cost factor in drug treatment of constipation. The results do not support models suggesting improved role functioning offsets these higher direct expenditures. While prospective comparative studies are needed to more definitively correlate costs with direct or indirect benefits of different agents, limiting the use of more expensive medications to otherwise refractory cases may help to reign in the spiraling health care costs in this country.
Prevalence and Clinical and Endoscopic Characteristics of Cervical Inlet Patch (Heterotopic Gastric Mucosa)
Authors: Yin Yue , Li Hongyu , Feng Ji , Zheng Kexin , Yoshida Eric , Wang Le , Wu Yanyan , Guo Xiaozhong , Shao Xiaodong , Qi Xingshun
Published: March 2021

Background:

Cervical inlet patch (CIP), also called gastric inlet patch, is a heterotopic columnar mucosal island located in the cervical esophagus, which has been under-recognized by clinicians.

Aim:

We conducted a systemic review and meta-analysis to explore the prevalence and clinical and endoscopic characteristics of CIP.

Materials and Methods:

Studies were searched through the PubMed, EMBASE, and Cochrane Library databases. The prevalence of CIP with 95% confidence interval (CI) was pooled by using a random-effect model. The association of CIP with demographics, clinical presentations, and endoscopic features was evaluated by odds ratios (ORs).

Results:

Fifty-three studies including 932,777 patients were eligible. The pooled prevalence of CIP was 3.32% (95% CI=2.86%-3.82%). According to the endoscopic mode, the pooled prevalence of CIP was higher in studies using narrow-band imaging than in those using white light and esophageal capsule endoscopy (9.34% vs. 2.88% and 0.65%). The pooled prevalence of CIP was higher in studies where the endoscopists paid specific attention to the detection of this lesion (5.30% vs. 0.75%). CIP was significantly associated with male (OR=1.24, 95% CI=1.09-1.42, P=0.001), gastroesophageal reflux disease (OR=1.32, 95% CI=1.04-1.68, P=0.03), reflux symptoms (OR=1.44, 95% CI=1.14-1.83, P=0.002), dysphagia (OR=1.88, 95% CI=1.28-2.77, P=0.001), throat discomfort (OR=4.58, 95% CI=1.00-21.02, P=0.05), globus (OR=2.95, 95% CI=1.52-5.73, P=0.001), hoarseness (OR=4.32, 95% CI=1.91-9.78, P=0.0004), cough (OR=3.48, 95% CI=1.13-10.72, P=0.03), Barrett’s esophagus (OR=2.01, 95% CI=1.37-2.94, P=0.0003), and esophagitis (OR=1.62, 95% CI=1.27-2.07, P=0.0001).

Conclusion:

CIP appears to be common by using narrow-band imaging, especially if the endoscopists would like to pay attention to the detection of this lesion. CIP is clearly associated with acid-related symptoms and Barrett’s esophagus.
Estimate of Refractory Reflux Disease in the United States
Authors: Howden Colin W. , Manuel Machelle , Taylor Douglas , Jariwala-Parikh Krutika , Tkacz Joseph
Published: March 2021

Goals:

To update the estimate of the prevalence of refractory gastroesophageal reflux disease (GERD) in the United States, and to assess the clinical and economic differences between patients with and without refractory GERD.

Background:

GERD affects 18% to 28% of the US population, with nearly 40% of GERD patients presenting with refractory symptoms despite ongoing therapy.

Study:

Retrospective analysis of the IBM MarketScan databases between January 2011 and June 2018. Inclusion criteria were prescription fill and subsequent refill of a proton pump inhibitor or H2-receptor antagonist (earliest claim=index date), diagnosis of GERD 60 days preceding and/or following index, continuous insurance enrolment for 12 months preceding/following index, and absence of prior GERD diagnosis or GERD medication. We derived refractory GERD symptom scores for all patients on the basis of a previously published algorithm. Health care costs and comorbidities were assessed for all patients and compared between those with and without refractory GERD.

Results:

In total, 399,017 GERD patients qualified for the study; 103,654 (26%) met our definition of having indications of refractory GERD symptoms. Patients with refractory GERD symptoms reported significantly higher rates of hiatal hernia (25.1% vs. 5.9%), esophagitis (37.3% vs. 11.8%), esophageal stricture (11.3% vs. 1.5%), and dysphagia (26.8% vs. 7.1%; P<0.01 for each). The refractory GERD symptoms cohort incurred ~$10,000 greater health care costs per patient per year compared with patients without refractory GERD symptoms ($26,057±$58,948 vs. $15,285±$39,307; P<0.01).

Conclusions:

Refractory GERD symptoms were associated with a substantial increase in health care costs. Treatments aimed at improving refractory GERD symptoms may mitigate symptom burden, potentially reducing health care expenditure.
Trends in Cirrhosis and Mortality by Age, Sex, Race, and Antiviral Treatment Status Among US Chronic Hepatitis B Patients (2006-2016)
Authors: Lu Mei , Li Jia , Zhou Yueren , Rupp Loralee B. , Moorman Anne C. , Spradling Philip R. , Teshale Eyasu H. , Boscarino Joseph A. , Daida Yihe G. , Schmidt Mark A. , Trudeau Sheri , Gordon Stuart C. ,   for the CHeCS Investigators
Published: March 2021

Background:

Changing US demographics and evolving chronic hepatitis B (CHB) treatments may affect longitudinal trends in CHB-related complications. We studied trends in the prevalence of cirrhosis (past or present) and incidence of all-cause mortality, stratified by patient age, sex, race, and antiviral treatment status, in a sample from US health care systems.

Methods:

Joinpoint and Poisson regression (univariate and multivariable) were used to estimate the annual percent change in each outcome from 2006 to 2016.

Results:

Among 5528 CHB patients, cirrhosis prevalence (including decompensated cirrhosis) rose from 6.7% in 2006 to 13.7% in 2016; overall mortality was unchanged. Overall rates of cirrhosis and mortality were higher among treated patients, but adjusted annual percent changes (aAPC) were significantly lower among treated than untreated patients (cirrhosis: aAPC +2.4% vs. +6.2%, mortality: aAPC −3.9% vs. +4.0%). Likewise, among treated patients, the aAPC for mortality declined −3.9% per year whereas among untreated patients, mortality increased +4.0% per year.

Conclusions:

From 2006 to 2016, the prevalence of cirrhosis among CHB patients doubled. Notably, all-cause mortality increased among untreated patients but decreased among treated patients. These results suggest that antiviral treatment attenuates the progression of cirrhosis and the risk of death among patients with CHB.
The Efficacy of Simethicone With Polyethylene Glycol for Bowel Preparation
Authors: Liu Xin , Yuan Mufa , Li Zhen , Fei Sujuan , Zhao Guodong
Published: March 2021

Background:

Simethicone (SIM) is a commonly used antifoaming agent in the clinic. However, it has not been clarified whether SIM can improve the quality of intestinal preparation and the detection rates of adenomas (ADR) and polyps (PDR). This systematic review and meta-analysis were carried out to mainly evaluate the effect of SIM in bowel preparation for colonoscopy.

Materials and Methods:

An electronic and a manual search of the literature for studies was conducted in PubMed, EMBASE, and Web of Science in all published data before February 1, 2020. The primary outcomes were the quality of bowel preparation and the ADR and PDR. All the data were calculated using a pooled estimate of risk ratio with 95% confidence intervals, and a random-effect model was used for the calculation.

Results:

Eighteen randomized controlled trials with 7187 patients were included in this meta-analysis. Polyethylene glycol (PEG) with SIM improved colon cleansing (P<0.00001), PDR (P=0.006) and the detection rate of lesions in the right colon (P<0.00001) when compared with PEG alone. There was no difference in the ADR (P=0.68), withdrawal time (P=0.06), cecal intubation rate (P=0.98), and cecal intubation time (P=0.65) between 2 groups. The rate of abdominal bloating rate was higher in the PEG group, but there was no significant difference in vomiting (P=0.65), and abdominal pain (P=0.25).

Conclusions:

SIM improves the quality of bowel cleanliness and PDR but not ADR. Besides, SIM improves the detection rate of lesions in the right colon and decreased abdominal bloating, but do not affect vomiting and abdominal pain or cramping.
Osmotic Demyelination Syndrome in Hospitalized Patients With Cirrhosis
Authors: Berry Kacey , Rubin Jessica B. , Lai Jennifer C.
Published: March 2021

Goal:

Characterize prevalence of osmotic demyelination syndrome (ODS) in hospitalized patients with cirrhosis.

Background:

ODS is a serious complication of rapid serum sodium correction. Patients with cirrhosis experience labile sodium levels related to portal hypertension and diuretic use, often with rapid correction—intentional or unintentional—during hospitalizations.

Study:

We used validated International Classification of Diseases, Ninth Revision (ICD-9) codes to identify inpatients 18 years and older with cirrhosis from the 2009-2013 National Inpatient Sample, excluding those with liver transplantation during hospitalization. The primary outcome was ODS (ICD-9 341.8). Baveno IV defined decompensated cirrhosis (stages 3 and 4); Charlson Comorbidity Index identified severe comorbid illness (score >3). Logistic regression modeled factors associated with ODS.

Results:

Of 547,544 adult inpatients with cirrhosis, 94 (0.02%) had ODS. Inpatients with versus without ODS were younger (54 vs. 57 y, P=0.0001), and more likely to have alcohol-related cirrhosis (58% vs. 33%, P<0.0001). ODS did not associate with decompensated cirrhosis (33% vs. 37%, P=0.43), specific complications (ascites 33% vs. 33%, P=0.97; hepatic encephalopathy 24% vs. 17%, P=0.06), or severe comorbid illness (12% vs. 16%, P=0.24). In both univariable and multivariable analysis, age [adjusted odds ratio (ORadj): 0.97, 95% confidence interval (CI): 0.95-0.99], female gender (ORadj: 1.53, 95% CI: 1.01-2.30), Hispanic race (ORadj: 0.41, 95% CI: 0.19-0.89), alcohol-related cirrhosis (ORadj: 2.65, 95% CI: 1.71-4.09), and congestive heart failure (ORadj: 0.37, 95% CI: 0.15-0.95) significantly associated with ODS.

Conclusion:

In hospitalized patients with cirrhosis, ODS is extremely rare, and associated with alcohol-related cirrhosis, younger age, and female gender. ODS is not associated with liver disease severity, specific complications including ascites, or comorbid disease.
A new panenteric capsule endoscopy-based strategy in patients with melena and a negative upper gastrointestinal endoscopy: a prospective feasibility study
Authors: Mussetto Alessandro , Arena Rosario , Fuccio Lorenzo , Trebbi Margherita , Tina Garribba Alessandra , Gasperoni Stefano , Manzi Ilaria , Triossi Omero , Rondonotti Emanuele
Published: March 2021

Objective

patients presenting with melena and nondiagnostic esophagogastroduodenoscopy are usually investigated with colonoscopy and if negative, with small bowel capsule endoscopy. In this pilot study, we tested feasibility and performance of panenteric capsule endoscopy (PCE) in patients presenting with melena and negative esophagogastroduodenoscopy.

Methods

Between January and December 2018, consecutive patients presenting with melena, clinically significant bleeding and negative esophagogastroduodenoscopy were invited to undergo PCE by swallowing PillCam Colon 2 (Medtronic Inc., Dublin, Ireland). PCE results, further diagnostic or therapeutic examinations, rebleeding rates at 30 days and 12 months were recorded.

Results

Out of 128 patients with melena, 23 had negative esophagogastroduodenoscopy. Of them, 12 (8 female, mean age 76 years) underwent PCE, which allowed complete small bowel and colonic evaluation in 12 (100%) and 11 (91.7%) patients, respectively. The small bowel and colon cleansing were adequate in 100 and 83.3%, respectively. No PCE-related complications were observed. The PCE diagnostic yield was 83.3%: significant findings were located in the small bowel, colon or both in 5 (41.7%), 4 (33.3%) and 1 (8.3%) patients, respectively. Device-assisted enteroscopy was performed in 6 (50%) patients. Thirty days and 1 year rebleeding rates were 0 and 18.1%, respectively.

Conclusions

In this proof-of-concept study, PCE was feasible and safe in patients with melena and negative esophagogastroduodenoscopy, identifying the bleeding site in 83% of patients. PCE lead to small bowel therapeutic interventions in 50% of patients, thus avoiding unnecessary standard colonoscopy. Further large prospective randomized studies investigating this strategy are warranted.
Effects of the Affordable Care Act Medicaid Expansion on the Distribution of New General Internists Across States
Authors: Escarce José J. , Wozniak Gregory D. , Tsipas Stavros , Pane Joseph D. , Brotherton Sarah E. , Yu Hao
Published: March 2021

Background:

Some states expanded Medicaid under the Affordable Care Act, boosting their low-income residents’ demand for health care, while other states opted not to expand.

Objective:

The objective of this study was to determine whether the Medicaid expansion influenced the states selected by physicians just completing graduate medical education for establishing their first practices.

Research Design:

Using 2009–2019 data from the American Medical Association Physician Masterfile and information on states’ Medicaid expansion status, we estimated conditional logit models to compare where new physicians located during the 6 years following implementation of the expansion to where they located during the 5 years preceding implementation.

Subjects:

The sample consisted of 160,842 physicians in 8 specialty groups.

Results:

Thirty-three states and the District of Columbia expanded Medicaid by the end of the study period. Compared with preexpansion patterns, we found that physicians in one specialty group—general internal medicine—were increasingly likely to locate in expansion states with time after the expansion. The Medicaid expansion influenced the practice location choices of men and international medical graduates in general internal medicine; women and United States medical graduates did not alter their preexpansion location patterns. Simulations estimated that, between 2014 and 2019, nonexpansion states lost 310 general internists (95% confidence interval, 156–464) to expansion states.

Conclusions:

The Medicaid expansion influenced the practice location choices of new general internists. States that opted not to expand Medicaid under the Affordable Care Act lost general internists to expansion states, potentially affecting access to care for all their residents irrespective of insurance coverage.
Subgroups of High-Risk Veterans Affairs Patients Based on Social Determinants of Health Predict Risk of Future Hospitalization
Authors: Blalock Dan V. , Maciejewski Matthew L. , Zulman Donna M. , Smith Valerie A. , Grubber Janet , Rosland Ann-Marie , Weidenbacher Hollis J. , Greene Liberty , Zullig Leah L. , Whitson Heather E. , Hastings Susan N. , Hung Anna
Published: March 2021

Objective:

Population segmentation has been recognized as a foundational step to help tailor interventions. Prior studies have predominantly identified subgroups based on diagnoses. In this study, we identify clinically coherent subgroups using social determinants of health (SDH) measures collected from Veterans at high risk of hospitalization or death.

Study Design and Setting:

SDH measures were obtained for 4684 Veterans at high risk of hospitalization through mail survey. Eleven self-report measures known to impact hospitalization and amenable to intervention were chosen a priori by the study team to identify subgroups through latent class analysis. Associations between subgroups and demographic and comorbidity characteristics were calculated through multinomial logistic regression. Odds of 180-day hospitalization were compared across subgroups through logistic regression.

Results:

Five subgroups of high-risk patients emerged—those with: minimal SDH vulnerabilities (8% hospitalized), poor/fair health with few SDH vulnerabilities (12% hospitalized), social isolation (10% hospitalized), multiple SDH vulnerabilities (12% hospitalized), and multiple SDH vulnerabilities without food or medication insecurity (10% hospitalized). In logistic regression, the “multiple SDH vulnerabilities” subgroup had greater odds of 180-day hospitalization than did the “minimal SDH vulnerabilities” reference subgroup (odds ratio: 1.53, 95% confidence interval: 1.09–2.14).

Conclusion:

Self-reported SDH measures can identify meaningful subgroups that may be used to offer tailored interventions to reduce their risk of hospitalization and other adverse events.
Quality of Buprenorphine Care for Insured Adults With Opioid Use Disorder
Authors: Anderson Kelly E. , Saloner Brendan , Eckstein Julia , Chaisson Christine E. , Scholle Sarah H. , Niles Lauren , Dy Sydney , Alexander G. Caleb
Published: March 2021

Aim:

The aim of this study was to characterize quality of buprenorphine care for opioid use disorder (OUD) by quantifying buprenorphine initiation, engagement, and maintenance for individuals in a large, diverse, real-world cohort in the United States.

Design:

This was a retrospective cohort analysis.

Setting:

OUD treatment in the outpatient setting.

Participants:

A total of 45,210 commercially insured and Medicare Advantage (MA) enrollees 18 years or older in the OptumLabs Data Warehouse with an index diagnosis of OUD between January 1, 2018 and December 31, 2018.

Interventions:

Treatment with buprenorphine.

Measurements:

We calculated 6 measures of buprenorphine treatment quality. We conducted survival analyses to characterize treatment duration and logistic regressions to evaluate the association between clinical and sociodemographic characteristics and quality.

Findings:

Of 45,210 eligible individuals with OUD, ∼1 in 10 (n=4600, 10.2%) initiated buprenorphine within 365 days following diagnosis (Measure #1) and 2850 individuals (6.3%) initiated buprenorphine within 14 days of diagnosis (Measure #2). Of individuals initiating treatment within 14 days of diagnosis, 1769 (62.1%) had 2 or more buprenorphine claims within 34 days of initiation (Measure #3). Of the 4600 individuals who received buprenorphine, 2300 (50.0%) were maintained in care with 180 days or more of covered buprenorphine treatment during 365 days after diagnosis (Measure #4). Finally, of the 4600 individuals who received buprenorphine, 2543 (55.3%) did not fill any other concurrent opioid analgesic (Measure #5) and 2951 (64.2%) did not fill any concurrent benzodiazepine (Measure #6). Quality was generally lower for individuals with MA compared with commercial coverage and among Hispanic and Black adults compared with White adults.

Conclusion:

Widespread gaps exist in quality of buprenorphine treatment initiation, engagement, and maintenance among commercially insured and MA enrollees with OUD.
Advanced Practice Provider-inclusive Staffing Models and Patient Outcomes in Pediatric Critical Care
Authors: Gigli Kristin H. , Davis Billie S. , Martsolf Grant R. , Kahn Jeremy M.
Published: March 2021

Background:

Pediatric intensive care units (PICUs) are increasingly staffed with advanced practice providers (APPs), supplementing traditional physician staffing models.

Objectives:

We evaluate the effect of APP-inclusive staffing models on clinical outcomes and resource utilization in US PICUs.

Research Design:

Retrospective cohort study of children admitted to PICUs in 9 states in 2016 using the Healthcare Cost and Utilization Project’s State Inpatient Databases. PICU staffing models were assessed using a contemporaneous staffing survey. We used multivariate regression to examine associations between staffing models with and without APPs and outcomes.

Measures:

The primary outcome was in-hospital mortality. Secondary outcomes included odds of hospital acquired conditions and ICU and hospital lengths of stay.

Results:

The sample included 38,788 children in 40 PICUs. Patients admitted to PICUs with APP-inclusive staffing were younger (6.1±5.9 vs. 7.1±6.2 y) and more likely to have complex chronic conditions (64% vs. 43%) and organ failure on admission (25% vs. 22%), compared with patients in PICUs with physician-only staffing. There was no difference in mortality between PICU types [adjusted odds ratio (AOR): 1.23, 95% confidence interval (CI): 0.83–1.81, P=0.30]. Patients in PICUs with APP-inclusive staffing had lower odds of central line-associated blood stream infections (AOR: 0.76, 95% CI: 0.59–0.98, P=0.03) and catheter-associated urinary tract infections (AOR: 0.73, 95% CI: 0.61–0.86, P<0.001). There were no differences in lengths of stay.

Conclusions:

Despite being younger and sicker, children admitted to PICUs with APP-inclusive staffing had no increased odds of mortality and lower odds of some hospital acquired conditions compared with those in PICUs with physician-only staffing. Further research can inform APP integration strategies which optimize outcomes.
Practical insights into stomas in inflammatory bowel disease: what every healthcare provider needs to know
Authors: Estrada Daniel Mauricio Londoño , Benghi Letícia Marx , Kotze Paulo Gustavo
Published: March 2021

Purpose of review

Despite advances in medical and surgical therapy in inflammatory bowel disease (IBD) management, intestinal stomas can be needed in a significant proportion of patients. The impact of stomas in patients’ lives is significant, and the topic is still challenging for different specialties involved in IBD care.

Recent findings

Indications for intestinal ostomies in IBD can occur in elective (malnutrition, anemia, or previous steroids) or emergency (perforation, abdominal abscess, obstruction) settings. Different types of stomas can be used (loop, end, or double loop ostomies) depending on different clinical scenarios. Ileostomies are more frequently needed in IBD patients than colostomies, which may be associated with higher rates of recurrence in Crohn's disease. Only 16.6% of patients with diverting stomas for perianal Crohn's disease have successful transit restoration, and stomas become permanent. Prevention of complications is based on adequate preoperative demarcation and meticulous surgical technique. IBD stoma-related morbidity can occur in up to 70% of patients, are more common in Crohn's disease, and can be classified into early or late complications.

A multidisciplinary approach including gastroenterologists, surgeons, and stoma nurses is essential for IBD patients who will face the challenge of having a stoma during their disease course.
Nursing's Staffing Mandate
Authors: Virkstis Katherine , Herleth Anne , Langr Madeleine , Rewers Lauren , Fennell Eileen
Published: March 2021

The COVID-19 pandemic exhausted the nursing workforce, casting doubt that future supply will meet demand. To preserve their workforces, nursing leaders are offering emotional support to the frontline. Although these efforts are essential, leaders are overlooking an untapped opportunity to safeguard staffing levels: creating a more flexible nursing workforce. In this article, the authors discuss flexible nurse staffing and suggest 4 key opportunities for improvement.
Factors Associated With Job Satisfaction in Medical Oncology Practices
Authors: Friese Christopher R. , Mendelsohn-Victor Kari , Medvec Barbara R. , Ghosh Bidisha , Bedard Louise , Griggs Jennifer J. , Manojlovich Milisa
Published: March 2021

OBJECTIVE

The aim of this study was to examine the factors influencing job satisfaction of nurses, physicians, and advanced practice providers in ambulatory oncology settings.

BACKGROUND

Job satisfaction is essential to clinician well-being and quality of care.

METHODS

In 2017, clinicians from 29 ambulatory medical oncology practices completed anonymous paper questionnaires that examined job satisfaction, clinician-to-clinician communication, and perceptions of patient safety. Linear regression, adjusted for clustered observations, examined the relationship between job satisfaction, clinician communication, and patient safety perceptions.

RESULTS

Of 280 respondents (response rate of 68%), 85% reported that they were satisfied or very satisfied with their current position. Patient safety and accuracy of clinician communication were positively and significantly associated with job satisfaction.

CONCLUSIONS

Although most surveyed clinicians were satisfied, 15% were dissatisfied and reported communication and safety concerns. Leadership efforts to strengthen clinician communication actions and develop positive safety cultures are promising strategies to promote clinician well-being and high-quality cancer care.
Transforming Shared Governance: Toward Professional Governance for Nursing
Authors: O'Grady Tim Porter , Clavelle Joanne T.
Published: March 2021

For more than 40 years, shared governance has supported structural empowerment and engaged nurses in their practice. Although progress has been made in advancing nursing ownership of practice through shared governance, mature nursing autonomy has yet to be achieved. It is time to evolve to professional governance, emphasizing accountability, professional obligation, collateral relationships, and decision making. Nurse leaders are provided with historical context and recommendations for effectively leading professional governance in an empowering work culture.
Factors That Influence Millennial Generation Nurses' Intention to Stay
Authors: Keith Angela C. , Warshawsky Nora , Talbert Steve
Published: March 2021

OBJECTIVE

To synthesize literature exploring the expectations of millennial nurses and factors that influence their retention.

BACKGROUND

Long-anticipated nursing shortages are happening nationwide in part from boomer retirements. These supply issues are expected to worsen because of an aging population who will require complex healthcare going forward. Millennial nurse turnovers, however, represent the biggest threat to supply.

METHODS

This extensive literature review was conducted following published guidelines. Thirteen publications regarding millennials' expectations of work were analyzed.

RESULTS

Millennials expect strong leadership, advancement opportunities, alignment of organizational and personal values, good coworker relationships, healthy work-life balance, recognition, and cutting-edge technology.

CONCLUSIONS

Millennials have specific expectations for work, and they will leave if these go unmet. Findings from this review provide valuable insight into this generation of nurses to help leaders create appropriate retention strategies. The limited literature on this topic highlights the need for more research.
Clinical Application of Chromosome Microarray Analysis in the Diagnosis of Lipomatous Tumors
Authors: Pei Jianming , Flieder Douglas B. , Talarchek Jacqueline N. , Cooper Harry S. , Patchefsky Arthur S. , Wei Shuanzeng
Published: March 2021

Well-differentiated liposarcoma/atypical lipomatous tumor (WDLS/ALT) and dedifferentiated liposarcoma (DDLS) have characteristic supernumerary ring and giant marker chromosomes involving the chromosomal region 12q13-15 which contains MDM2 (12q15), CDK4 (12q14.1), HMGA2 (12q14.3), YEATS4 (12q15), CPM (12q15), and FRS2 (12q15). Detecting MDM2 amplification by fluorescence in situ hybridization (FISH) is considered to be the gold standard for the diagnosis of WDLS/ALT and DDLS. In this study, formalin fixed paraffin embedded clinical specimens (16 liposarcomas and 19 benign lipomatous tumors) were used to detect MDM2 amplification and other chromosomal alterations in WDLS/ALT and DDLS by single nucleotide polymorphism-based chromosome microarray (CMA). All 16 liposarcomas showed MDM2 amplification with a MDM2/cep12 ratio from 2.4 to 8.4 by CMA. Ten (62.5%) of these cases had CDK4/cep12 ratio ≥2.0. All the cases without CDK4 amplification were from the thigh. The MDM2/cep12 ratio of all the benign lipomatous tumors (19/19) was within the normal limits. Twenty-one of the 35 benign lipomatous tumors and liposarcomas were also tested for MDM2 amplification by FISH. All the FISH results were consistent with the CMA results (100%). Along with MDM2 amplification, all 16 liposarcomas (100%) also showed amplification of YEATS4, CPM and FRS2. Only 11 of 16 (69%) cases showed HMGA2 amplification. In conclusion, this study demonstrated that CMA on routine formalin fixed paraffin embedded tissue is a sensitive and specific clinical test for detection of MDM2 gene amplification. Moreover, CMA allows simultaneous detection of genomic changes of interest including CDK4 and others, which provides enriched information for diagnosing lipomatous tumors.
UBE2V2 Positively Correlates With PD-L1 Expression and Confers Poor Patient Survival in Lung Adenocarcinoma
Authors: Hua Zhi-Dan , Liu Xian-Bing , Sheng Jian-Hui , Li Chao , Li Ping , Cai Xiu-Qin , Han Zhi-Qiang
Published: March 2021

This research aims to explore the diagnostic and prognostic value of ubiquitin-conjugating enzyme E2 variant 2 (UBE2V2) in lung adenocarcinoma (LUAD). The expression of UBE2V2 in clinical specimens was evaluated by bioinformatics analyses and immunohistochemistry. Bioinformatics analyses relying on the The Cancer Genome Atlas (TCGA) database suggested the elevated UBE2V2 mRNA levels in LUAD in comparison to adjacent normal tissues. Gene set enrichment analyses and gene ontology term enrichment analyses further showed the involvement of UBE2V2 in the modulation of cell cycle and immune associated signaling. The correlation analyses in TCGA LUAD data set revealed the positive correlation between UBE2V2 and CCNE1, CCNE2, CCNA2, CCNB1, CCNB2, cyclin-dependent kinase (CDK)2, CDK4, and CDK1 at the mRNA level. Moreover, UBE2V2 mRNA levels were positively correlated with PD-L1 mRNA levels, the T classification, and poor survival of LUAD patients, and were negatively correlated with type II interferon response. Consistent with the results obtained from TCGA data mining, immunohistochemistry demonstrated that UBE2V2 protein levels were upregulated in LUAD in comparison to normal tissues and were positively associated with T classification. Intriguingly, a positive correlation between UBE2V2 protein levels and PD-L1 expression was also elucidated in clinical samples. Besides, UBE2V2 expression indicated a poor prognosis in LUAD patients. Our study found that UBE2V2 was identified as an independent prognostic indicator for LUAD and might serve as an alternative target for LUAD treatment.
A Randomized Trial of a Brief Behavioral Intervention for PrEP Uptake Among Men Who Have Sex With Men at Increased Risk for HIV Infection
Authors: Chan Philip A. , Nunn Amy , van den Berg Jacob J. , Cormier Kevin , Sowemimo-Coker Genoviva , Napoleon Siena C. , Arnold Trisha , Moitra Ethan
Published: March 2021

Background:

The aim of this study was to evaluate the efficacy of a novel, brief 2-session behavioral intervention to promote HIV pre-exposure prophylaxis (PrEP) uptake among men who have sex with men (MSM) who are behaviorally at risk for HIV.

Setting:

A pilot randomized controlled trial was conducted at a sexually transmitted infection (STI) clinic to compare a brief motivational interviewing intervention with passive referral only for PrEP uptake.

Methods:

MSM who scored as “high risk” on the HIV Incidence Risk index for MSM was offered a brief (15–20 minutes) motivational interviewing–based intervention at the time of STI testing to address barriers to PrEP uptake, including low risk perception, stigma, side effects, and cost. The initial session was followed by a brief, telephone booster session that lasted <10 minutes. The primary outcome was attending a clinical PrEP appointment and accepting a prescription for PrEP.

Results:

Participants were recruited from an urban STI clinic in the United States. A total of 86 MSM who were behaviorally at risk for HIV were enrolled in the study (N = 43 intervention; N = 43 treatment-as-usual, “TAU”). Participants randomized to the intervention were significantly more likely to attend a clinical appointment and accept a prescription for PrEP, compared with treatment-as-usual (52.3% versus 27.9%, respectively; odds ratio = 3.6; 95% confidence interval: 1.5 to 8.9; P = 0.005).

Conclusions:

A brief behavioral intervention focused on the initial steps in the PrEP care cascade demonstrated preliminary efficacy in promoting uptake among MSM who are behaviorally at risk for HIV.
A Simple Classification of Pancreatic Duct Size and Texture Predicts Postoperative Pancreatic Fistula
Authors: Schuh Fabian , Mihaljevic André L. , Probst Pascal , Trudeau Maxwell T. , Müller Philip C. , Marchegiani Giovanni , Besselink Marc G. , Uzunoglu Faik , Izbicki Jakob R. , Falconi Massimo , Castillo Carlos Fernandez-del , Adham Mustapha , Z’graggen Kaspar , Friess Helmut , Werner Jens , Weitz Jürgen , Strobel Oliver , Hackert Thilo , Radenkovic Dejan , Kelemen Dezso˝ , Wolfgang Christopher , Miao Y. I. , Shrikhande Shailesh V. , Lillemoe Keith D. , Dervenis Christos , Bassi Claudio , Neoptolemos John P. , Diener Markus K. , Vollmer Charles M. , Büchler Markus W.
Published: March 2021

Objective:

The aim of this study was to develop a classification system for pancreas-associated risk factors in pancreatoduodenectomy (PD).

Summary Background Data:

Postoperative pancreatic fistula (POPF) is the most relevant PD-associated complication. A simple standardized surgical reporting system based on pancreas-associated risk factors is lacking.

Methods:

A systematic literature search was conducted to identify studies investigating clinically relevant (CR) POPF (CR-POPF) and pancreas-associated risk factors after PD. A meta-analysis of CR-POPF rate for texture of the pancreas (soft vs not-soft) and main pancreatic duct (MPD) diameter was performed using the Mantel-Haenszel method. Based on the results, the International Study Group of Pancreatic Surgery (ISGPS) proposes the following classification: A, not-soft (hard) texture and MPD >3 mm; B, not-soft (hard) texture and MPD ≤3 mm; C, soft texture and MPD >3 mm; D, soft texture and MPD ≤3 mm. The classification was evaluated in a multi-institutional, international cohort.

Results:

Of the 2917 articles identified, 108 studies were included in the analyses. Soft pancreatic texture was significantly associated with the development of CR-POPF [odds ratio (OR) 4.24, 95% confidence interval (CI) 3.67-4.89, P < 0.01) following PD. Similarly, MPD diameter ≤3 mm significantly increased CR-POPF risk compared with >3 mm diameter MPDs (OR 3.66, 95% CI 2.62–5.12, P < 0.01). The proposed 4-stage system was confirmed in an independent cohort of 5533 patients with CR-POPF rates of 3.5%, 6.2%, 16.6%, and 23.2% for type A-D, respectively (P < 0.001).

Conclusion:

For future pancreatic surgical outcomes studies, the ISGPS recommends reporting these risk factors according to the proposed classification system for better comparability of results.
Towards Patient-centered Decision-making in Breast Cancer Surgery
Authors: Pfob André , Mehrara Babak J. , Nelson Jonas A. , Wilkins Edwin G. , Pusic Andrea L. , Sidey-Gibbons Chris
Published: March 2021

Objective:

We developed, tested, and validated machine learning algorithms to predict individual patient-reported outcomes at 1-year follow-up to facilitate individualized, patient-centered decision-making for women with breast cancer.

Summary of Background Data:

Satisfaction with breasts is a key outcome for women undergoing cancer-related mastectomy and reconstruction. Current decision-making relies on group-level evidence which may lead to suboptimal treatment recommendations for individuals.

Methods:

We trained, tested, and validated 3 machine learning algorithms using data from 1921 women undergoing cancer-related mastectomy and reconstruction conducted at eleven study sites in North America from 2011 to 2016. Data from 1921 women undergoing cancer-related mastectomy and reconstruction were collected before surgery and at 1-year follow-up. Data from 10 of the 11 sites were randomly split into training and test samples (2:1 ratio) to develop and test 3 algorithms (logistic regression with elastic net penalty, extreme gradient boosting tree, and neural network) which were further validated using the additional site’s data.

AUC to predict clinically-significant changes in satisfaction with breasts at 1-year follow-up using the validated BREAST-Q were the outcome measures.

Results:

The 3 algorithms performed equally well when predicting both improved or decreased satisfaction with breasts in both testing and validation datasets: For the testing dataset median accuracy = 0.81 (range 0.73–0.83), median AUC = 0.84 (range 0.78–0.85). For the validation dataset median accuracy = 0.83 (range 0.81–0.84), median AUC = 0.86 (range 0.83–0.89).

Conclusion:

Individual patient-reported outcomes can be accurately predicted using machine learning algorithms, which may facilitate individualized, patient-centered decision-making for women undergoing breast cancer treatment.
Wireless Light-emitting Marker Using Magnetic Field Resonance for Laparoscopic Gastrointestinal Surgery
Authors: Sugiyama Masahiko , Nagao Yoshihiro , Uehara Hideo , Kagawa Masaki , Shin Yuki , Shiokawa Keiichi , Ota Mitsuhiko , Akahoshi Tomohiko , Morita Masaru
Published: March 2021

Background:

In laparoscopic gastrointestinal surgery, the location of the tumor is identified mainly with marking methods, such as ink tattooing and intraoperative gastrointestinal endoscopy and marking with a metal clip followed by confirmation with intraoperative x-ray fluoroscopy. Each method has disadvantages, such as complexity, instability of ink sticks, and radiation exposure. Thus, a simple and less-invasive marking method is needed.

Methods:

We developed a wireless light-emitting marker with a miniature light-emitting diode that uses a magnetic field resonance mechanism. It emits 4 individual colors—red, blue, green, and white. We confirmed the usefulness of this marker system in ex vivo and in vivo animal experiments.

Results:

In the ex vivo experiment in porcine intestines, use of the wireless marker was successful, as each color of emitted light was recognized from outside the intestine. In the live animal experiment, it was confirmed that the light emitted by the marker system was visible in the porcine intestinal tract during laparoscopic surgery. The light emitted by the wireless marker in the intestinal tract was confirmed with a laparoscope in a simulated animal surgery.

Conclusion:

We have developed an innovative, radiation-free and reliable light-emitting marker system that uses a magnetic field resonance mechanism that emits four colors of light during laparoscopic surgery.
Transoral Endoscopic Thyroidectomy Vestibular Approach Versus Endoscopic Thyroidectomy Via Areola Approach for Patients With Unilateral Papillary Thyroid Carcinoma: A Retrospective Study
Authors: Zhang Wei-Dong , Dai Lei , Wang Ying-Chun , Xie Yun-Yun , Guo Jian-Yao , Li Jian-Jun , Wu Xian-Jiang
Published: March 2021

Background:

Endoscopic thyroidectomy via areola approach (ETA) has been widely used in thyroidectomy for many years as it can effectively avoid a scar in the neck. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is newly applied and has gained popularity quickly. This study is to compare the safety and effectiveness of TOETVA and ETA.

Materials and Methods:

A total of 95 patients who underwent TOETVA or ETA with unilateral papillary thyroid carcinoma were enrolled in this study from March 2019 to February 2020. The basic information (such as gender, age), intraoperative hemorrhage, postoperative drainage volume, hospital durations, intraoperative and postoperative complications, operative time, central lymph node dissection time, total number of central lymph nodes, and number of metastatic central lymph nodes were compared.

Results:

The operative time of the TOETVA group was significantly longer than the ETA group (148.11±19.78 vs. 135.90±12.77 min, P<0.05). However, the result was opposite when central lymph node dissection time was compared (10.31±2.93 vs. 12.48±3.55, P<0.05). TOETVA had an advantage on total number of central lymph nodes over ETA (7.82±3.35 vs. 5.26±2.45, P<0.05). No differences were found between the 2 groups on other data.

Conclusion:

TOETVA and ETA have the similarity on surgical safety and effectiveness. TOETVA has its advantage on central lymph node dissection and might be a reasonable alternative for ETA and open surgery in the future.
Neuro-Ophthalmologic Monitoring in the Management of Increased Intracranial Pressure From Leaking Arachnoid Cysts
Authors: Deveney Tatiana K. , Lebas Maud , Lobo Remy R. , Maher Cormac O. , Trobe Jonathan D.
Published: March 2021

Background:

Intracranial arachnoid cysts are common incidental imaging findings. They may rarely rupture, leading to the development of subdural hygromas and high intracranial pressure (ICP). Neurosurgical intervention has been advocated in the past, but recent evidence indicates that most cases resolve spontaneously. The role of neuro-ophthalmologic monitoring in identifying the few cases that have persisting vision-threatening papilledema that justifies intervention has not been emphasized.

Methods:

Retrospective review of 4 cases of leaking arachnoid cysts drawn from the files of the University of Michigan Medical Center (Michigan Medicine) between 2007 and 2018.

Results:

In 1 case, surgery was avoidable as papilledema resolved over time despite lingering imaging features of mass effect. In 3 cases, papilledema persisted with the threat of permanent vision loss, prompting neurosurgical intervention. In one of those cases, the fluid collection was thinly but extensively spread across both hemispheres without brain shift; yet, papilledema was pronounced. Emergent evacuation led to rapid resolution of papilledema and encephalopathy, but with residual optic nerve damage.

Conclusions:

Because constitutional symptoms and even imaging are not always reliable indicators of high ICP in leaking arachnoid cysts, neuro-ophthalmologic monitoring of papilledema is valuable in identifying the cases when neurosurgical intervention is necessary.