bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sepsis Among Medicare Beneficiaries: 1. The Burdens of Sepsis, 2012–2018*
Authors: Buchman Timothy G. , Simpson Steven Q. , Sciarretta Kimberly L. , Finne Kristen P. , Sowers Nicole , Collier Michael , Chavan Saurabh , Oke Ibijoke , Pennini Meghan E. , Santhosh Aathira , Wax Marie , Woodbury Robyn , Chu Steve , Merkeley Tyler G. , Disbrow Gary L. , Bright Rick A. , MaCurdy Thomas E. , Kelman Jeffrey A. 
Published: February 2020

Objectives:To provide contemporary estimates of the burdens (costs and mortality) associated with acute inpatient Medicare beneficiary admissions for sepsis.Design:Analysis of paid Medicare claims via the Centers for Medicare & Medicaid Services DataLink Project.Setting:All U.S. acute care hospitals, excluding federally operated hospitals (Veterans Administration and Defense Health Agency).Patients:All Medicare beneficiaries, 2012–2018, with an inpatient admission including one or more explicit sepsis codes.Interventions:None.Measurements and Main Results:Total inpatient hospital and skilled nursing facility admission counts, costs, and mortality over time. From calendar year (CY)2012–CY2018, the total number of Medicare Part A/B (fee-for-service) beneficiaries with an inpatient hospital admission associated with an explicit sepsis code rose from 811,644 to 1,136,889. The total cost of inpatient hospital admission including an explicit sepsis code for those beneficiaries in those calendar years rose from $17,792,657,303 to $22,439,794,212. The total cost of skilled nursing facility care in the 90 days subsequent to an inpatient hospital discharge that included an explicit sepsis code for Medicare Part A/B rose from $3,931,616,160 to $5,623,862,486 over that same interval. Precise costs are not available for Medicare Part C (Medicare Advantage) patients. Using available federal data sources, we estimated the aggregate cost of inpatient admissions and skilled nursing facility admissions for Medicare Advantage patients to have risen from $6.0 to $13.4 billion over the CY2012–CY2018 interval. Combining data for fee-for-service beneficiaries and estimates for Medicare Advantage beneficiaries, we estimate the total inpatient admission sepsis cost and any subsequent skilled nursing facility admission for all (fee-for-service and Medicare Advantage) Medicare patients to have risen from $27.7 to $41.5 billion. Contemporary 6-month mortality rates for Medicare fee-for-service beneficiaries with a sepsis inpatient admission remain high: for septic shock, approximately 60%; for severe sepsis, approximately 36%; for sepsis attributed to a specific organism, approximately 31%; and for unspecified sepsis, approximately 27%.Conclusion:Sepsis remains common, costly to treat, and presages significant mortality for Medicare beneficiaries.
Detecting Patient Deterioration Using Artificial Intelligence in a Rapid Response System
Authors: Cho Kyung-Jae , Kwon Oyeon , Kwon Joon-myoung , Lee Yeha , Park Hyunho , Jeon Ki-Hyun , Kim Kyung-Hee , Park Jinsik , Oh Byung-Hee 
Published: February 2020

Objectives:
As the performance of a conventional track and trigger system in a rapid response system has been unsatisfactory, we developed and implemented an artificial intelligence for predicting in-hospital cardiac arrest, denoted the deep learning-based early warning system. The purpose of this study was to compare the performance of an artificial intelligence-based early warning system with that of conventional methods in a real hospital situation.

Design:
Retrospective cohort study.

Setting:
This study was conducted at a hospital in which deep learning-based early warning system was implemented.

Patients:
We reviewed the records of adult patients who were admitted to the general ward of our hospital from April 2018 to March 2019.

Interventions:
The study population included 8,039 adult patients. A total 83 events of deterioration occurred during the study period. The outcome was events of deterioration, defined as cardiac arrest and unexpected ICU admission. We defined a true alarm as an alarm occurring within 0.5–24 hours before a deteriorating event.

Measurements and Main Results:
We used the area under the receiver operating characteristic curve, area under the precision-recall curve, number needed to examine, and mean alarm count per day as comparative measures. The deep learning-based early warning system (area under the receiver operating characteristic curve, 0.865; area under the precision-recall curve, 0.066) outperformed the modified early warning score (area under the receiver operating characteristic curve, 0.682; area under the precision-recall curve, 0.010) and reduced the number needed to examine and mean alarm count per day by 69.2% and 59.6%, respectively. At the same specificity, deep learning-based early warning system had up to 257% higher sensitivity than conventional methods.

Conclusions:
The developed artificial intelligence based on deep-learning, deep learning-based early warning system, accurately predicted deterioration of patients in a general ward and outperformed conventional methods. This study showed the potential and effectiveness of artificial intelligence in an rapid response system, which can be applied together with electronic health records. This will be a useful method to identify patients with deterioration and help with precise decision-making in daily practice.
EPIDERMAL GROWTH FACTOR RECEPTOR EXPRESSION IN A CASE OF FOCAL NODULAR GLIOSIS OF THE RETINA
Authors: Tagami Mizuki , Misawa Norihiko , Noma-Ishikura Saki , Honda Satoshi , Kase Satoru , Honda Shigeru 
Published: February 2020

Purpose:
To describe the immunohistochemical profile in a case with focal nodular gliosis (FNG) of the retina.

Methods:
A 56-year-old female patient presented with vitreoretinal tractional syndrome with FNG of the retina. After resection of the retinal tumor tissue during the 25-G pars plana vitrectomy, immunohistochemistry using anti–epidermal growth factor receptor (EGFR), p-53, Ki67, glial fibrillary acid protein (GFAP), CD34, and vascular endothelial growth factor antibodies was performed in the excised tissue of the FNG of the retina.

Results:
Histopathological analysis of the tumor led to a diagnosis of FNG of the retina. Spindle cells of the tumor exhibited strong positive staining for glial fibrillary acid protein, and there was local staining for CD34 in the endothelial cells in the blood vessels. The epidermal growth factor receptor and vascular endothelial growth factor immunoreactivity were strongly observed in the endothelial cells.

Conclusion:
This study demonstrated epidermal growth factor receptor expression in eyes with FNG of the retina. Oncogenic epidermal growth factor receptor might trigger and amplify the expression and function of endothelial vascular endothelial growth factor.
Empyema Necessitans Due to Methicillin-Sensitive Staphylococcus aureus
Authors: DeSuza Kayla , Bush Larry M. 
Published: February 2020

Abstract
Empyema refers to a collection of pus in the pleural cavity. Empyema necessitans is a rare complication of an empyema that refers to an insidious extension of the pus through the parietal pleura into the neighboring subcutaneous tissue of the chest wall or, less often, other thoracic structures. Left untreated, the purulent material may penetrate the chest wall forming a fistula or subcutaneous abscess. Drainage and empiric antimicrobial therapy should be started when the diagnosis is made and adjusted once the infecting organism is identified. Mycobacterium tuberculosis and Actinomyces species, both generally slow-growing microbes, remain the most common pathogens associated with the development of empyema necessitans. Although rarely encountered in the postantibiotic era, acute infections involving pyogenic organisms including Staphylococcus aureus may serve as the etiologic agents associated with this problematic subset of pleural effusion. The majority of reported cases of empyema necessitans due to S. aureus have occurred with strains that are methicillin resistant. This case describes a 70-year-old man who, after a month long of symptoms, presented with empyema necessitans due to methicillin-sensitive S. aureus. This case underscores the importance of diagnosing an empyema and treating early with antibiotics in order to avoid subsequent surgical intervention if and when empyema necessitans should develop.
Clostridioides difficile Infections in Adult and Pediatric Intestinal and Multivisceral Transplant Patients
Authors: Modi Anita , Gonzalez Blanca E. , Brizendine Kyle D. 
Published: February 2020

Background
Solid organ transplant (SOT) recipients are at increased risk of Clostridioides difficile infection (CDI). Studies addressing the epidemiology of CDI in intestinal and multivisceral transplant are limited. Since 2013, our center greatly expanded its intestinal and multivisceral transplant program, providing the consummate opportunity to examine CDI in this vulnerable population.

Methods
We conducted a retrospective study of all intestinal and multivisceral transplant recipients between 2009 and 2018.

Results
We identified 86 patients who underwent a total of 94 transplants. There were 60 isolated intestinal transplants (64%), 21 intestine/pancreas/liver (22%), 10 intestine/pancreas (11%), 2 intestine/pancreas/liver/kidney (2%), and 1 intestine/kidney transplant (1%). All but 3 patients received perioperative metronidazole. Four patients (5%) had CDI before transplant, but none experienced recurrence in the first 6 months posttransplant. Five patients suffered 7 mild-moderate episodes of early CDI (attack rate, 5.9%). Three patients (60%) with early CDI developed rejection, similar to the observed incidence (70%) in patients without CDI. Two patients with early CDI developed recurrent infection; both of these patients underwent intestinal retransplant. Overall, 1-year mortality was similar (20% among patients with early CDI vs. 23% among those without early CDI).

Conclusions
For certain solid organ transplant recipients, an association between CDI and allograft loss, rejection, and mortality has been shown. Although limited by sample size, we observed that early CDI was not associated with those outcomes in the present investigation. Multicenter studies are merited to explore risk factors for CDI and associations with transplant-related outcomes in intestinal and multivisceral transplant recipients.
Five-year outcomes of small-incision lenticule extraction vs femtosecond laser–assisted laser in situ keratomileusis: a contralateral eye study
Authors: Aygün Beril Tülü , Çankaya Kadir İlker , Ağca Alper , Yıldırım Yusuf , Yıldız Burçin Kepez , Sucu Mehmet Emin , Kandemir Beşek Nilay , Demirok Ahmet 
Published: February 2020

Purpose:
To compare the long-term refractive and visual outcomes and the corneal higher-order aberrations of contralateral eyes of patients who received small-incision lenticule extraction (SMILE) in one eye and femtosecond laser–assisted laser in situ keratomileusis (FS-LASIK) in the other eye.

Setting:
Refractive Surgery Clinic of the University of Health Sciences Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey.

Design:
Retrospective case series.

Methods:
The medical files of patients who received SMILE in one eye and FS-LASIK in the contralateral eye for myopia and myopic astigmatism were reviewed. Postoperative examinations at 1 year, 3 years, and 5 years were evaluated. The main outcome measures were the comparison of the refractive and visual outcomes and the effect on corneal higher-order aberrations between the procedures.

Results:
This study included 44 eyes from 22 patients. At the 5-year follow-up, the mean uncorrected distance visual acuity improved to 0.03 ± 0.06 and 0.02 ± 0.05 logarithm of the minimum angle of resolution (range 0.15 to −0.08 and 0.10 to −0.08) for SMILE and FS-LASIK groups, respectively. There was no statistically significant difference between the groups (P = .572). At 5 years, all eyes in both groups were within ±1.00 diopter of attempted spherical equivalent refraction, and no statistically significant difference was found between the intended and achieved correction comparing the groups at any time points. None of the aberrations showed a difference between the groups at any time.

Conclusions:
Both SMILE and FS-LASIK were safe and similar in terms of efficacy and predictability at long-term follow-up for the correction of myopia and myopic astigmatism.
To Be or Not to Be (A Morton's/Interdigital Neuroma): That Is the Question—A Case Series of Lateral Forefoot Pain Localized to the Proper Digital Nerve of the Fifth Toe
Authors: Reisner Jacob H. , Boettcher Brennan J. , Johnson Adam C. , Cummings Nancy M. , Jelsing Elena J. 
Published: February 2020

Abstract:
We present 2 cases where the initial history and examination were similar to a Morton's/interdigital neuroma. In both cases, however, diagnostic ultrasound revealed symptomatic snapping of the proper digital nerve of the fifth toe. The anatomy of the proper digital nerve of the fifth toe may predispose it to a snapping phenomenon. Clinical awareness of this atypical cause of forefoot pain can help guide the diagnosis and treatment in those patients with persistent and refractory lateral forefoot pain and paresthesias.
Attention-Deficit/Hyperactivity Disorder Status and Sex Moderate Mild Traumatic Brain Injury Symptom Severity in Children and Adolescents: Implications for Clinical Management
Authors: Orban Sarah A. , Epstein Jeffery N. , Carr Devon , Logan Kelsey , Gubanich Paul J. , Sidol Craig , Myer Gregory D. 
Published: February 2020

Objective:
To investigate the impact of pediatric mild traumatic brain injury (mTBI), using a broad parent-reported measure, and to determine whether parent-ratings of mTBI symptoms are higher among those with premorbid attention-deficit/hyperactivity disorder (ADHD) and females.

Design:
Retrospective case–control.

Setting:
Hospital-based sports medicine clinic.

Participants:
The retrospective chart review included 1346 (age: M = 13.11 years, SD = 2.6; 61.7% male) pediatric patients with (n = 209) and without (n = 1137) ADHD.

Independent Variables:
Group membership (ADHD vs non-ADHD) and sex (male vs female).

Main Outcome Measures:
Baseline and current Post-Concussion Symptom Inventory–Parent Report Form (PCSI-P) Physical, Emotional, Cognitive, and Fatigue subscale scores. This study used a retrospective chart review; therefore, the hypotheses reported for the current study were formed after data were collected.

Results:
Controlling for patient age and days from mTBI, patients with ADHD had significantly higher retrospective parent-reported pre-mTBI ratings of physical, emotional, and cognitive symptoms (ds = 0.17-0.62) and higher post-mTBI ratings across all 4 symptom domains (ds = 0.18-0.57) than those without ADHD. There was no group × time interaction for any of the PCSI-P subscales. Females overall had higher retrospective parent-reported pre-injury Fatigue and Emotional symptoms (ds = 0.13-0.19) and higher post-mTBI symptoms in all 4 PCSI-P symptom domains (ds = 0.23-0.35), relative to males.

Conclusions:
Attention-deficit/hyperactivity disorder-related postinjury exacerbations in parent-reported symptoms can be explained, in part, by elevated retrospective parent-reported ADHD-related pre-mTBI ratings. These results highlight the importance of assessing a patient's baseline symptoms post-mTBI. These data also indicate that ADHD status and sex should be considered when interpreting mTBI symptom severity during clinical evaluation of concussion.
Impact of Viral Seasonal Outbreaks on Crowding and Health Care Quality in Pediatric Emergency Departments
Authors: Noel Guilhem , Maghoo Ajmal , Piarroux Josephine , Viudes Gilles , Minodier Philippe , Gentile Stéphanie 
Published: February 2020

Abstract
In pediatric emergency departments (PEDs), seasonal viral outbreaks are believed to be associated with an increase of workload, but no quantification of this impact has been published. A retrospective cross-sectional study aimed to measure this impact on crowding and health care quality in PED. The study was performed in 1 PED for 3 years. Visits related to bronchiolitis, influenza, and gastroenteritis were defined using discharge diagnoses. The daily epidemic load (DEL) was the proportion of visits related to one of these diagnoses. The daily mean of 8 crowding indicators (selected in a published Delphi study) was used. A total of 93,976 children were admitted (bronchiolitis, 2253; influenza, 1277; gastroenteritis, 7678). The mean DEL was 10.4% (maximum, 33.6%). The correlation between the DEL and each indicator was significant. The correlation was stronger for bronchiolitis (Pearson R from 0.171 for number of hospitalization to 0.358 for length of stay). Between the first and fourth quartiles of the DEL, a significant increase, between 50% (patients left without being seen) and 8% (patient physician ratio), of all the indicators was observed. In conclusion, seasonal viral outbreaks have a strong impact on crowding and quality of care. The evolution of “patients left without being seen” between the first and fourth quartiles of DEL could be used as an indicator reflecting the capacity of adaptation of an emergency department to outbreaks.
Screening With Reticulocyte Hemoglobin Increased Iron Sufficiency Among NICU Patients
Authors: Morton Sarah U. , Yuen Jenny Chan , Feldman Henry A. , Hashim Emily , Rudie Coral , Lindamood Kristen E. , Caughey Daniel , Moline Mark , Sims Jessica K. , Sola-Visner Martha C. , Leeman Kristen T. 
Published: February 2020

Introduction:
To increase the rate of iron sufficiency among neonatal intensive care unit (NICU) patients from 16% to >35% within 12 months of implementing standardized assessment of reticulocyte hemoglobin (retHE).

Methods:
We implemented a quality improvement (QI) study to improve iron sufficiency in our out-born level III/IV NICU. We screened 2,062 admissions, of which 622 were eligible based on feeding status at discharge. QI interventions included educational efforts and guideline implementation. Our primary outcome measure was the percentage of patients with their discharge retHE measure within the normal range. We also tracked the process measure of the number of retHE tests performed and a balancing measure of the incidence of elevated retHE among patients receiving iron supplementation. Statistical process control (SPC) charts assessed for special cause variation.

Results:
The percentage of patients with a retHe within the normal range was significantly increased from a mean of 20% to 39% on SPC chart analysis. We measured significantly more retHE values after guideline implementation (11/mo to 24/mo) and found no cases of elevated retHE among patients receiving iron supplementation.

Conclusions:
After the implementation of a standardized guideline, a higher rate of iron sufficiency was found in NICU patients at discharge. This work is generalizable to neonatal populations with the potential for a significant impact on clinical practice.
Anxiety Disorders in Patients With Somatic Diseases
Authors: Henning Michaela , Subic-Wrana Claudia , Wiltink Jörg , Beutel Manfred 
Published: February 2020

ABSTRACT

Objective
Anxiety disorders are among the most frequent mental disorders and are associated with a range of short- and long-term impairments and disabilities. Relatively little is known about anxiety disorders in patients with somatic diseases, and the present literature review highlights the current research in this field, data about prevalences of anxiety disorders in patients with somatic diseases, and the effectiveness of interventions. This article also introduces a comprehensive model of inpatient treatment and summarizes the evidence pertinent to this approach.

Methods
A narrative review is presented with regard to prevalence and treatment of anxiety disorders in patients with somatic diseases. The effects of inpatient treatment are illustrated based on a case report.

Results
This review indicates that anxiety disorders are more common in patients with somatic diseases, with prevalence estimates ranging from 2.5% to 55%, than in the general population. Several outpatient treatment options exist, with substantial support for the effectiveness of cognitive behavioral therapy, psychodynamic therapy, and pharmacotherapy. We also provide evidence in support of psychosomatic inpatient treatment for patients with anxiety disorders that are comorbid with somatic diseases.

Conclusions
Anxiety disorders are common in patients with somatic diseases, and several effective treatment options exist, including cognitive behavioral therapy and pharmacological interventions. We also provide support for the effectiveness of inpatient treatment with unique opportunities for multidisciplinary psychosomatic treatment of anxiety disorders with comorbid somatic diseases.
Brief Report: Recent HIV Infection Surveillance in Routine HIV Testing in Nairobi, Kenya: A Feasibility Study
Authors: Welty Susie , Motoku John , Muriithi Chris , Rice Brian , de Wit Mariken , Ashanda Brenda , Waruiru Wanjiru , Mirjahangir Joy , Kingwara Leonard , Bauer Richard , Njoroge David , Karimi Jesse , Njoroge Alice , Rutherford George W. 
Published: February 2020

Background:
Serological tests can distinguish recent (in the prior 12 months) from long-term HIV infection. Integrating recency testing into routine HIV testing services (HTS) can provide important information on transmission clusters and prioritize clients for partner testing. This study assessed the feasibility and use of integrating HIV recency into routine testing.

Methods:
We conducted a multi-method study at 14 facilities in Kenya, and key informant interviews with health care providers. We abstracted clinical record data, collected specimens, tested specimens for recent infection, returned results to participants, and conducted a follow-up survey for those recently infected.

Results:
From March to October 2018, we enrolled 532 clients who were diagnosed HIV-positive for the first time. Of these, 46 (8.6%) were recently infected. Women aged 15–24 years had 2.9 (95% confidence interval: 1.46 to 5.78) times higher adjusted odds of recent infection compared with 15–24-year-old men and those tested within the past 12 months having 2.55 (95% confidence interval: 0.38 to 4.70) times higher adjusted odds compared with those tested ≥12 months previously. Fourteen of 17 providers interviewed found the integration of recency testing into routine HTS services acceptable and feasible. Among clients who completed the follow-up interview, most (92%) felt that the recency results were useful.

Conclusions:
Integrating recent infection testing into routine HTS services in Kenya is feasible and largely acceptable to clients and providers. More studies should be done on possible physical and social harms related to returning results, and the best uses of the recent infection data at an individual and population level.