bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decision making for transjugular intrahepatic portosystemic stent shunt in refractory ascites and variceal bleeding: MELD, or not MELD, that is the question
Authors: Pitton Michael B. , Zimmermann Tim , Mildenberger Philipp , Weinmann Arndt , Kloeckner Roman , Düber Christoph , Mittler Jens , Hoppe-Lotichius Maria , Otto Gerd 
Published: November 2020

Purpose
The model of end-stage liver disease (MELD) score has been shown to predict 3-month prognosis following transjugular intrahepatic portosystemic stent shunt (TIPS) in liver cirrhosis; however, that score was derived from a mixed cohort, including patients with refractory ascites and variceal bleeding. This study re-evaluates the role of the MELD score and focuses on differences between both groups of patients.

Methods
A total of 301 patients (192 male and 109 female) received TIPS, 213 because of refractory ascites and 88 because of variceal bleeding. Univariate and multivariate Cox analyses were performed to identify predictors of mortality and area under the receiver operator characteristics (AUROC) were used to assess the prognostic capacity of the MELD score and of the results of predictors of the multivariate analyses.

Results
In refractory ascites, age, bilirubin and albumin were independent predictors of mortality. In variceal bleeding, emergency TIPS during ongoing bleeding, concomitant grade III ascites, history of hepatic encephalopathy, spontaneous bacterial peritonitis, bilirubin and platelet count proved significant. AUROCs of the MELD score for 3-month survival yielded 0.543 and 0.836 for refractory ascites and variceal bleeding, respectively (P < 0.001). For 1-year survival, the respective AUROCs yielded 0.533 and 0.767 (P < 0.001). In contrast to MELD, the AUROCs based on the calculated risk scores of this study resulted in 0.660 and 0.876 for 3-month survival, and 0.665 and 0.835 for 1-year survival in patients with ascites and variceal bleeding, respectively.

Conclusion
In refractory ascites, the prognostic capability of MELD is significantly inferior compared to variceal bleeding. The results of our multivariate analyses and AUROC calculations corroborate the impact of different prognostic variables in patients undergoing TIPS for ascites and variceal bleeding.
A Systematic Review of Surveys for Measuring Patient-centered Care in the Hospital Setting
Authors: Handley Sara C. , Bell Sydney , Nembhard Ingrid M. 
Published: November 2020

Background:
Patient-centered care (PCC) is a core component of quality care and its measurement is fundamental for research and improvement efforts. However, an inventory of surveys for measuring PCC in hospitals, a core care setting, is not available.

Objective:
To identify surveys for assessing PCC in hospitals, assess PCC dimensions that they capture, report their psychometric properties, and evaluate applicability to individual and/or dyadic (eg, mother-infant pairs in pregnancy) patients.

Research Design:
We conducted a systematic review of articles published before January 2019 available on PubMed, Web of Science, and EBSCO Host and references of extracted papers to identify surveys used to measure “patient-centered care” or “family-centered care.” Surveys used in hospitals and capturing at least 3 dimensions of PCC, as articulated by the Picker Institute, were included and reviewed in full. Surveys’ descriptions, subscales, PCC dimensions, psychometric properties, and applicability to individual and dyadic patients were assessed.

Results:
Thirteen of 614 articles met inclusion criteria. Nine surveys were identified, which were designed to obtain assessments from patients/families (n=5), hospital staff (n=2), and both patients/families and hospital staff (n=2). No survey captured all 8 Picker dimensions of PCC [median=6 (range, 5–7)]. Psychometric properties were reported infrequently. All surveys applied to individual patients, none to dyadic patients.

Conclusions:
Multiple surveys for measuring PCC in hospitals are available. Opportunities exist to improve survey comprehensiveness regarding dimensions of PCC, reporting of psychometric properties, and development of measures to capture PCC for dyadic patients.
Research progress of sirtuins in renal and cardiovascular diseases
Authors: Wang Wanning , Li Jia , Cai Lu 
Published: November 2020

Purpose of review
Sirtuins are a family of nicotinamide adenine dinucleotide+-dependent enzymes catalyzing target protein deacetylation to modulate cellular metabolism, response to oxidative stress and inflammation, senescence, autophagy and apoptosis. In this review, we provide an overview of recent studies regarding the alterations and roles of sirtuins in a variety of renal and cardiovascular diseases. We are also going to highlight activators and inhibitors of sirtuins in the prevention of these diseases. This will help us to understand how this field may change in the future.

Recent finding
Recent studies have elucidated how physical or diseased conditions alter the expressions and enzyme activity of sirtuins and expounded sexual differences in sirtuins functions. In addition, interventions by targeting sirtuins have been applied in preclinical and clinical studies to prevent or slow the development of related diseases.

Summary
The advantages of female sex in renal and cardiovascular diseases are partially due to the expression and function of sirtuins. Estrogen activates sirtuins and in turn sirtuins promote estrogen receptor signaling. In addition, the hypoglycemic agents, sodium-glucose cotransporter 2 inhibitors protect against diabetic nephropathy at least in part via activating SIRT-1. Although several compounds targeted sirtuins are promising drug candidates in a variety of renal and cardiovascular diseases, well designed large clinical trials are still required to identify their efficacy and safety.
How to inhibit transforming growth factor beta safely in diabetic kidney disease
Authors: Yang Yuxin , Shi Kexin , Patel Devang M. , Liu Fang , Wu Tieqiao , Chai Zhonglin 
Published: November 2020

Purpose of review
Diabetic kidney disease (DKD) is a leading cause of mortality and morbidity in diabetes. This review aims to discuss the major features of DKD, to identify the difficult barrier encountered in developing a therapeutic strategy and to provide a potentially superior novel approach to retard DKD.

Recent findings
Renal inflammation and fibrosis are prominent features of DKD. Transforming growth factor beta (TGFβ) with its activity enhanced in DKD plays a key pathological profibrotic role in promoting renal fibrosis. However, TGFβ is a difficult drug target because it has multiple important physiological functions, such as immunomodulation. These physiological functions of TGFβ can be interrupted as a result of complete blockade of the TGFβ pathway if TGFβ is directly targeted, leading to catastrophic side-effects, such as fulminant inflammation. Cell division autoantigen 1 (CDA1) is recently identified as an enhancer of profibrotic TGFβ signaling and inhibitor of anti-inflammatory SIRT1. Renal CDA1 expression is elevated in human DKD as well as in rodent models of DKD. Targeting CDA1, by either genetic approach or pharmacological approach in mice, leads to concurrent attenuation of renal fibrosis and inflammation without any deleterious effects observed.

Summary
Targeting CDA1, instead of directly targeting TGFβ, represents a superior approach to retard DKD.
Recent developments in antimicrobial therapy for gastrointestinal infections
Authors: Carlson Travis J. , Gonzales-Luna Anne J. , Garey Kevin W. 
Published: November 2020

Purpose of review
This focused, narrative review summarizes human clinical trial data for direct-acting antimicrobials in development for the treatment of gastrointestinal infections that were published in the past 18 months (1 January 2019 to 30 June 2020).

Recent findings
Antimicrobial agents for Clostridioides difficile infection (n = 6), cryptosporidiosis (n = 1), cytomegalovirus infection (n = 3) and Helicobacter pylori infection (n = 1) have completed and/or are undergoing human clinical trials.

Summary
Although this review highlights significant advances in four disease states, many common gastrointestinal pathogens have no antimicrobials in human clinical trials, emphasizing the need for continued prioritization in this field of study.
Religiosity and Spirituality in the Stages of Recovery From Persistent Mental Disorders
Authors: Saiz Jesús , Chen-Chen Xin , Mills Paul J. 
Published: November 2020

Abstract
The impact of religiosity and spirituality (R/S) on mental health and the importance of incorporating R/S in mental health treatment have been previously explored. However, clarification is needed regarding the effects of R/S in the process of recovery from persistent mental disorders (PMDs). This study identifies how different R/S factors correlate with the stages of recovery, while considering individual psychological well-being and perceived social support. Seventy-five individuals who use Madrid's public services for people with PMD completed questionnaires assessing those factors. We found that during the recovery process, R/S correlated with psychological well-being and perceived social support, and that these variables were associated with the five stages of recovery differently. We further identified the importance of gratitude, compassion, inner peace, and connection with life in the recovery process. Overall, our findings highlight the importance of these R/S variables in particular recovery stages for individuals with PMD.
Perceived Adverse Parenting in Childhood and Psychological Distress Among Psychotherapy Patients
Authors: Aafjes-van Doorn Katie , McCollum James , Silberschatz George , Kealy David , Snyder John 
Published: November 2020

Abstract
The way people derive inferences from actual adverse experiences plays an important role in the development of psychopathology. This study aims to examine the mediating role of pathogenic beliefs (i.e., emotion-laden, powerful, painful convictions about self and others) on the relation between perceived adverse parenting behaviors in childhood and subsequent adult psychopathology. Participants (mostly Caucasian and heterosexual) were 204 consecutively admitted patients with a range of psychological difficulties, including depression, anxiety, and interpersonal problems, at a low-fee outpatient clinic. Participants completed standard self-report assessments of perceived parental style, depressive and anxiety symptoms, and a clinically derived measure of pathogenic beliefs. We examined the indirect effects of adverse parenting on anxiety and depressive symptom severity through pathogenic beliefs. Pathogenic beliefs reflecting the unreliability of others significantly mediated the relationship between adverse parenting and anxiety symptoms. The other mediation model is consistent with the theory that perceived adverse parenting contributes to the severity of depressive symptoms through beliefs about not being deserving and other people being unreliable. Within the limitations of the cross-sectional, retrospective, and self-report nature of the data, our results seem to suggest that attending to intermediary subjective beliefs might be important in understanding psychopathology development in the context of childhood adversity. Aiming to modify the beliefs in therapy might modify the symptoms. However, this would remain to be demonstrated through formal intervention research.
An Interprofessional Course on Trauma-Informed Care
Authors: Fiske Elizabeth , Reed Ashcraft Kellie , Hege Adam , Harmon Kristin 
Published: November 2020

Background
Health care professionals need to recognize trauma exposure and provide trauma-informed care. There is a concomitant need to develop resilience when working in this context.

Problem
We recognized the need to educate future health care professionals to provide trauma-informed care, develop resilience skills, and collaborate with other disciplines to provide this care.

Approach
We used a systematic instructional design process and an interprofessional approach to design and deliver the course. We utilized a range of resources and approached the course from micro, meso, and macro perspectives.

Outcomes
Through purposeful design, we developed a course that was well-aligned with our objectives. Assessments provided documentation that students achieved the learning outcomes.

Conclusions
The course educated future health care professionals on trauma-informed care. Students gained valuable experience that will help them contribute to interprofessional teams in the future. Students also practiced resilience techniques essential for health care professionals.
Nursing Students in Crisis Mode
Authors: Savitsky Bella , Findling Yifat , Ereli Anat , Hendel Tova 
Published: November 2020

Background
The COVID-19 pandemic initiated a period of new and difficult challenges for nursing students.

Purpose
The aim of this study was to assess the change in levels of anxiety and ways of coping when the lockdown was being lifted compared with the period of the most severe lockdown restrictions.

Methods
First- to fourth-year nursing students in Israel (N = 244) completed 2 surveys conducted during the initial lockdown and 5 weeks later.

Results
When the restrictions were lightened, the mean anxiety score decreased from 9.3 to 7.5 (P < .0001). Among Muslims students, the trend was the opposite, and anxiety levels increased. Stronger resilience was associated with lower odds for anxiety. Mental disengagement and information seeking were associated with higher anxiety levels.

Conclusions
The pandemic created unparalleled stressful situations for nursing students. Faculty should have heightened awareness of these stressors and act to implement innovative resolutions for the problems that arise.
Complications and the Need for Long-Term Follow-Up after Secondary Speech Surgery: A National and Longitudinal Claims Analysis
Authors: Makar Katelyn G. , Waljee Jennifer F. , Kasten Steven J. , Buchman Steven R. , Vercler Christian J. 
Published: November 2020

Background:
Although most patients attain normal speech after cleft palate repair, up to 20 percent require secondary speech surgery. Despite the frequency of these procedures, complications and rates of subsequent revisions of secondary speech surgery after all procedure types have never been reviewed using national, longitudinal data.

Methods:
The authors examined insurance claims from Clinformatics Data Mart between 2001 and 2017. Cases were categorized as palatal
procedures (i.e., palatoplasty, revision palatoplasty, secondary lengthening, palatal island flap) or pharyngeal procedures (i.e., pharyngeal flap, dynamic sphincter pharyngoplasty) (n = 846). Continuous enrollment from 180 days before to 30 days after surgery was required. Patients were excluded if they underwent palatoplasty, or any surgery at less than 3 years of age, without a speech diagnosis. Outcomes included 30-day complications and rates of subsequent revision secondary speech surgery. Multivariable logistic regression was used to evaluate the relationship between procedure type and complications.

Results:
In this cohort, 52.5 percent underwent pharyngeal procedures, and 47.5 percent underwent palatal procedures. Complications occurred in 10.9 percent of patients and included respiratory complications (4.0 percent), bleeding (1.2 percent), dehiscence (3.6 percent), and critical care episodes (3.0 percent). There was no difference in complications between procedure types (OR, 0.87; 95 percent CI, 0.56 to 1.37; p = 0.56). The subsequent revision rate was 12.7 percent, but was 21.7 percent in patients with 3 years of postoperative enrollment.

Conclusions:
Although complication rates were comparable to those in recent literature, rates of subsequent revisions of secondary speech procedures were high in patients with longer postoperative enrollment. Thus, these patients merit prolonged follow-up, as velopharyngeal dysfunction may recur over time.

Clinical Question/Level of Evidence:
Therapeutic, III.
The Use of Absorbable Mesh in Implant-Based Breast Reconstruction: A 7-Year Review
Authors: Faulkner Heather R. , Shikowitz-Behr Lauren , McLeod Matthew , Wright Eric , Hulsen John , Austen William G. 
Published: November 2020

Background:
Breast reconstruction is most frequently performed using implants or expanders. Adjunctive materials such as acellular dermal matrix and synthetic meshes are used to support the implant or expander. A paucity of large studies exist on the use of synthetic mesh for breast reconstruction.

Methods:
A retrospective chart review of all patients over the past 7 years who had implant reconstruction with synthetic absorbable mesh at the Massachusetts General Hospital was performed. Data were collected on demographic and surgical outcomes. Statistical analysis was performed.

Results:
A total of 227 patients (376 mastectomies) were treated with direct-to-implant subpectoral reconstruction with absorbable mesh from 2011 to 2017. The infection rate was 2.1 percent. The rate of capsular contracture was 4.8 percent. Patients who had radiation therapy either preoperatively or postoperatively had a higher rate of complications, including capsular contracture. Cost savings for using mesh instead of acellular dermal matrix surpassed $1.2 million.

Conclusion:
Synthetic absorbable mesh is a safe alternative to acellular dermal matrix in prosthetic breast reconstruction and provides stable results along with significant cost savings.

Clinical Question/Level of Evidence:
Therapeutic, IV.
Sexual Behavior and Its Determinants During COVID-19 Restrictions Among Men Who Have Sex With Men in Amsterdam
Authors: van Bilsen Ward P. H. , Zimmermann Hanne M. L. , Boyd Anders , Coyer Liza , van der Hoek Lia , Kootstra Neeltje A. , Hoornenborg Elske , Prins Maria , Schim van der Loeff Maarten F. , Davidovich Udi , Matser Amy 
Published: November 2020

Objective:
To investigate the impact of Dutch COVID-19 restrictions on sexual behavior and HIV/sexually transmitted infection (STI) acquisition among men who have sex with men (MSM) participating in the Amsterdam Cohort Studies (ACS) on HIV in Amsterdam.

Methods:
ACS participants complete a questionnaire on sexual behavior and are tested for HIV/STI biannually. They may also be tested at the STI clinic in-between study visits. On May 29, 2020, ACS participants were invited to complete an online questionnaire on health, COVID-19 risk perceptions, and sexual behavior. Determinants of reporting casual sex partners (CSP) during COVID-19 restrictions were examined using logistic regression.

Results:
Of 683 MSM, 353 (52%; median age, 47 years; interquartile range, 38–53 years) completed the questionnaire. Since COVID-19, 73% reported a reduction in the number of CSP. CSP during COVID-19 restrictions were reported by 133 MSM (38%) and, in multivariable analysis, was associated with not having a college/university degree, being single, lower perceived importance of avoiding COVID-19, number of CSP before COVID-19, and current preexposure prophylaxis use (P < 0.05 for all). During COVID-19 restrictions, no HIV infections were diagnosed, and the STI positivity rate was 8%.

Conclusion:
Since COVID-19, the number of CSP decreased among MSM, and there may have been a temporary reduction in HIV/STI transmission. Some MSM were not fully compliant to social distancing regulations and reported CSP, which was related to prior sexual behavior and low perceived importance of avoiding COVID-19. For these men, it is important to maintain accessible HIV/STI-related testing and care during times of lockdown.
90Y Radiosynovectomy in Persistent Synovitis Caused by Knee Replacement
Authors: Liepe Knut , Baehr Marcel 
Published: November 2020

Introduction
After knee replacement, therapy resistant, persistent synovitis is a common issue, which causes effusion and pain, and leads to loosing. It has been hypothesized that radiosynovectomy (RSO) is useful in these patients.

Materials and Methods
A cohort of 55 patients with 57 knee replacements and persistent synovitis underwent RSO using 4.9 ± 0.24 mCi (182 ± 9 MBq) of 90Y-citrate. The number of RSOs ranged from 1 to 4. Bone scans before and 3 months after every RSO were performed. Long-term follow-up ranged from 0.8 to 7.6 years with a mean of 23.2 months. For qualitative analysis, an established 4 steps scoring was used. For quantification, the uptake was determined within the 99mTc-MDP scintigraphy blood pool phase before and after therapy.

Results
Long-term response was in 27% with excellent, 24% good, 30% weak, and 20% no response. The duration of response was 12.0 ± 12.0 months (maximum, 54 months). In patients with repeated treatment, the effect after the first therapy was lesser than in patients who received a single treatment in total. However, 3 months after the last RSO, patients with repeated treatment showed a similar effectiveness than single treated patients. At the end of long-term follow-up, patients with repeated RSOs had a higher effectiveness at similar duration response. In bone scan, 65% of patients showed a reduction of uptake. When comparing subjective and objective response, 78% of patients showed a concordance in both symptoms and scintigraphy. Pilot histological analysis revealed that the synovitis is triggered by small plastic particles.

Conclusions
We concluded that RSO is an effective therapy in patients with knee replacement and persistent synovitis with high long-term response. Repeated treatment leads to a stronger long-time response.
Diffuse Subcutaneous Metabolic Activity in Post Bone Marrow Transplant Hodgkin Lymphoma
Authors: Doroudinia Abtin , Mehrian Payam , Rouhizadeh Alireza , Hosseini Mahsa 
Published: November 2020

AbstractWe present a 14-year-old adolescent boy with Hodgkin lymphoma. He had prior completed chemotherapy with ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) regimen followed by bone marrow transplantation 6 months ago. Currently, he has neither specific clinical complaint nor receiving any specific medication. Follow-up FDG PET/CT scan demonstrated diffuse increased metabolic activity in the entire body subcutaneous tissue. This finding is rarely reported in the literature and may represent an underlying active inflammatory process, most likely attributed to the received treatments. This could impair the diagnostic quality of the scan, affecting the image interpretation, and should be recognized when present.
Quality and Safety in Healthcare, Part LXXXIII
Authors: Harolds Jay A. 
Published: November 2020

Abstract
A safety culture encourages the reporting of mistakes so that all can learn from them and remedy underlying system problems. However, errors will only be reported in a culture in which most types of common human errors are not punished because all humans make errors, and usually there are underlying system problems contributing to this. All healthcare errors must be viewed partly as opportunities to improve. A safety culture includes good leadership, communication, learning, collaboration, mindfulness, medicine that is based on evidence and best practice, and care that is centered on the patient.
Hypermetabolic Cerebral Metastases of Cardiac Myxoma on FDG PET/CT
Authors: Wang Peipei , Hou Guozhu , Li Fang , Cheng Xin 
Published: November 2020

Abstract
A 66-year-old woman with a history of surgical resection of left atrial myxoma 6 months ago presented with multiple brain lesions with MRI. An FDG PET/CT was performed for further evaluation. The images showed that cerebral tumors had variable and increased FDG uptake in general, and no other abnormal FDG-avid lesions were noted. The tumor of right occipital lobe was resected and confirmed as metastatic cardiac myxoma on histology.