bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety of trastuzumab after trastuzumab emtansine-induced nodular regenerative hyperplasia: A case report
Authors: Hassan Chadi , Correal Florence , Vézina Gabriel , Yelle Louise , Adam Jean-Philippe 
Published: March 2020

Introduction Trastuzumab emtansine is an antibody-drug conjugate targeting the human epidermal growth factor receptor 2 use in recurrent metastatic breast cancer. Cases of trastuzumab emtansine-induced nodular regenerative hyperplasia are often reported as overt noncirrhotic portal hypertension with ascites and variceal bleeding. Case report We report the case of a 61-year-old woman who present multiple stellate angiomas with gradual increased liver transaminases and reduced platelet count during a 27-months course on trastuzumab emtansine therapy for recurrent metastatic breast cancer. After the nodular regenerative hyperplasia was histologically confirmed, the trastuzumab emtansine was stopped. After two months, trastuzumab was restarted together with exemestane. During trastuzumab therapy, the patient had a normalization of liver transaminases, platelet count and a gradual improvement of her stellate angiomas. Trastuzumab was continued for 15 months without any reoccurrence of nodular regenerative hyperplasia. Management and outcome Nodular regenerative hyperplasia should be suspected after one year of trastuzumab emtansine treatment in patients with signs of portal hypertension without cirrhosis. Definitive cessation of trastuzumab emtansine is required after a diagnosis of nodular regenerative hyperplasia and complete resolution of symptoms generally takes several months. Discussion Based on fundamental studies, nodular regenerative hyperplasia is probably caused by the emtansine (DM1) part of the trastuzumab emtansine. It is still unclear if trastuzumab therapy can be reintroduced after nodular regenerative hyperplasia induced by trastuzumab emtansine, depriving the patient of a HER2-targeted therapy. Only one case reported having given trastuzumab in this situation over one month. In our case, trastuzumab was reintroduced without any complications for a long extent following TDM1-associated nodular regenerative hyperplasia.
Classification, Severity Assessment, and Prevention of Recurrences in Acute Pancreatitis
Authors: Seppänen H. , Puolakkainen P. 
Published: March 2020

Background: Acute pancreatitis is a common disease, the incidence of which is 75–100/100,000/year in Finland. The worldwide incidence of acute pancreatitis is increasing. The identified mildcases usually show rapid recovery with conservative treatment allowing early discharge. Severe cases need early intensive care to reduce the risk of serious complications such as multi-organ failure. The revised Atlanta classification of acute pancreatitis was introduced in 2012–2013. A recurrent acute pancreatitis is defined as two or more well-documented separate attacks of acute pancreatitis with complete resolution in between. Alcoholic pancreatitis is the most common recurrent acute pancreatitis type. Methods: In this review current severity classifications and literature on the prevention of recurrent acute pancreatitis are analyzed. Results: The severity of the disease is classified as mild, moderately severe, and severe acute pancreatitis. Novel entities include acute peripancreatic fluid collections in mild acute pancreatitis and acute necrotic collections in necrotizing acute pancreatitis lesser than 4 weeks after the onset and pancreatic pseudocyst in mild acute pancreatitis and walled-off necrosis in necrotizing acute pancreatitis more than 4 weeks after the onset of the disease. After the first attack of alcohol-induced acute pancreatitis, 46% of the patients develop at least one recurrence within 10- to 20-year follow-up. With repeated intervention against alcohol consumption, it is possible to reduce the recurrences. Removing the gall bladder after biliary pancreatitis is the key preventing recurrences. In mild cases, even during the index admission; in severe cases, it is recommended to wait until the inflammatory changes have resolved. Of total, 59% of the idiopathic pancreatitis had sludge of stones in the gall bladder. In other etiologies, addressing the etiological factor may prevent recurrent acute pancreatitis. Conclusions: This review describes current use of novel severity classifications and also different possibilities to prevent recurrent acute pancreatitis with different etiologies including idiopathic.
Comparison of accuracy of mesiodistal tooth measurements made in conventional study models and digital models obtained from intraoral scan and desktop scan of study models
Authors: Murugesan Arathi , Sivakumar Arvind 
Published: March 2020

Objective: To compare the measured values obtained from the plaster model, digital models created by scanning the plaster models and direct intraoral scanning with the values obtained from direct intraoral measurements. Design: This was a prospective clinical study. Setting: The study was conducted in Department of Orthodontics, Saveetha Dental College and Hospital, Tamil Nadu, India. Participants: Ten patients before the start of orthodontic treatment were selected for the study. Methods: A computer-aided design and manufacturing (CAD-CAM) system is an advanced technology that is being adopted in the field of orthodontics for diagnosis, treatment planning and documentation of patient records. Mesiodistal tooth width measurements of first premolars, canines, lateral incisors and central incisors, and transverse width measurement from mesial pit of right first premolar to mesial pit of left first premolar in both maxilla and mandible were obtained from direct intraoral measurement (gold standard), study model obtained from alginate impression, intraoral scanned image, and desktop scanned image of the study model. Descriptive statistics and ANOVA was performed to find the difference in mean among the groups. Results: A P value > 0.05 was obtained in ANOVA indicating that there is no statistically significant difference in the measurements obtained by either of the methods. Conclusion: Conventional stone models and digital models obtained from intraoral scan and desktop scanning of plaster models are clinically reliable as the variations in measurements obtained from these methods were clinically negligible.
Predictors of self-efficacy among residents of low-income neighborhoods: Implications for social work practice
Authors: Zanbar Lea , Nouman Hani 
Published: March 2020

Summary Assisting the development of clients’ self-efficacy and improving their quality of life by identifying and activating their strengths and resources is at the heart of social work. The present study therefore examines the unique and combined contribution of internal resources (self-esteem, mastery, and hope) and external resources (social support, social competence, and community involvement) to the explanation of the variance in self-efficacy in a needy population. The sample consisted of 400 residents of 30 low-socioeconomic status neighborhoods in Israel, a population that represents the primary clients of welfare services. Findings Hierarchical regression analyses showed that all the internal and external resources predicted higher levels of self-efficacy, save for social support. The fact that social support was not associated with self-efficacy might be explained by the uniquely high levels of social support found for all the participants and the negligible variance in this variable. The finding of a consistently high level of social support in a sample of low-socioeconomic status residents is an important finding in and of itself. Applications Practical recommendations are offered relating to the need for social workers to focus on identifying their clients’ internal and social resources, strengthen existing resources, and create opportunities to enhance those that are lacking.
Automated endoscopic detection and classification of colorectal polyps using convolutional neural networks
Authors: Ozawa Tsuyoshi , Ishihara Soichiro , Fujishiro Mitsuhiro , Kumagai Youichi , Shichijo Satoki , Tada Tomohiro 
Published: March 2020

Background: Recently the American Society for Gastrointestinal Endoscopy addressed the ‘resect and discard’ strategy, determining that accurate in vivo differentiation of colorectal polyps (CP) is necessary. Previous studies have suggested a promising application of artificial intelligence (AI), using deep learning in object recognition. Therefore, we aimed to construct an AI system that can accurately detect and classify CP using stored still images during colonoscopy. Methods: We used a deep convolutional neural network (CNN) architecture called Single Shot MultiBox Detector. We trained the CNN using 16,418 images from 4752 CPs and 4013 images of normal colorectums, and subsequently validated the performance of the trained CNN in 7077 colonoscopy images, including 1172 CP images from 309 various types of CP. Diagnostic speed and yields for the detection and classification of CP were evaluated as a measure of performance of the trained CNN. Results: The processing time of the CNN was 20 ms per frame. The trained CNN detected 1246 CP with a sensitivity of 92% and a positive predictive value (PPV) of 86%. The sensitivity and PPV were 90% and 83%, respectively, for the white light images, and 97% and 98% for the narrow band images. Among the correctly detected polyps, 83% of the CP were accurately classified through images. Furthermore, 97% of adenomas were precisely identified under the white light imaging. Conclusions: Our CNN showed promise in being able to detect and classify CP through endoscopic images, highlighting its high potential for future application as an AI-based CP diagnosis support system for colonoscopy.
Infrared Thermography Follow-Up After Lower Limb Revascularization
Authors: Ilo Arjaleena , Romsi Pekka , Pokela Matti , Mäkelä Jussi 
Published: March 2020

Background: The purpose of this study was with a simple clinical setting to compare skin temperature changes in the feet before and after revascularization and to identify possible correlation between ankle brachial index (ABI) and toe pressure (TP) values and foot skin temperature patient with and without diabetes. Methods: Forty outpatient clinic patients were measured ABI, TP, and the skin temperature using infrared thermography (IRT) at the foot before and after revascularization. Patients in the revascularization group were divided into subgroups depending on whether they had diabetes or not and a wound or not. Results: There were clear correlation between increase of ABI and TP and increase of the mean skin temperature on the feet after revascularization. The temperature was higher and the temperature change was greater among patients with diabetes. Side-to-side temperature difference between the revascularized feet and contralateral feet decreased after treatment. The mean temperature was higher in the feet with wound whether patient had diabetes mellitus or not. Conclusion: The simple, prompt, and noninvasive IRT procedure showed its potential as a follow-up tool among patients with diabetes or peripheral arterial disease and previous lower limb revascularization.
Improving Precision and Confidence of Research Application Through Mediator and Moderator Models
Authors: Pati Debajyoti 
Published: March 2020

Purpose: The purpose of this article is to conceptually discuss moderator and mediator models in healthcare design studies. Background: Healthcare outcomes are many times the result of meaningful interactions between multiple factors from different domains such as physical design, operations, culture, psychology, physiology, and social, among others. Simple multivariate models may not (a) capture these intricate relationships, (b) provide predictive precision, and (c) optimize arguments behind design decisions. Methods: A review of text books and publications on research methods was conducted, along with a review of completed research studies to identify appropriate examples for articulation. Results: An analysis of a nonrandom sample of completed healthcare design studies demonstrates the potential benefits of developing and testing moderator and mediator models in healthcare design studies. Conclusions: Moderator and mediator models may help optimize multifaceted solutions that include simultaneous and parallel interventions in the physical, operational, cultural, psychological, physiological, social, and/or other environments hypothesized to play a role in the outcome of interest.
Outcome of inter-hospital transfer versus direct admission for primary percutaneous coronary intervention: An observational study of 25,315 patients with ST-elevation myocardial infarction from the London Heart Attack Group
Authors: Rathod Krishnaraj S , Jain Ajay K , Firoozi Sam , Lim Pitt , Boyle Richard , Nevett Jo , Dalby Miles C , Kalra Sundeep , Malik Iqbal S , Sirker Alexander , Mathur Anthony , Redwood Simon , MacCarthy Philip A , Wragg Andrew , Jones Daniel A 
Published: March 2020

Background and aims:
In patients with ST-segment elevation myocardial infarction (STEMI), mortality is directly related to time to reperfusion with guidelines recommending patients be delivered directly to centres for primary percutaneous coronary intervention (PCI). The aim of this study was to describe the impact of inter-hospital transfer on reperfusion time and to assess whether or not treatment delays influenced clinical outcomes in comparison with direct admission to a primary PCI centre in a large regional network.

Method and results:
We undertook an observational cohort study of patients with STEMI treated with primary PCI between 2005 and 2015 in London, UK. Patient details were recorded at the time of the procedure in databases using the British Cardiovascular Intervention Society PCI dataset. The primary end-point was all-cause mortality at a median of 4.1 years (interquartile range: 2.2–5.8 years). Secondary outcomes were in-hospital major adverse cardiac events. Of 25,315 patients, 17,560 (69.4%) were admitted directly to a primary PCI centre and 7755 (31.6%) were transferred from a non-primary PCI centre. Patients in the direct admission group were older and more likely to have left ventricular impairment compared with the inter-hospital transfer group. Median time from call for help to reperfusion in transferred patients was 52 minutes longer compared with patients admitted directly (p &lt;0.001). However, call to first hospital admission was similar. Kaplan–Meier analysis demonstrated significantly lower mortality rates in patients who were transferred directed to a primary PCI centre compared with patients who were transferred from a non-PCI centre (17.4% direct vs. 18.7% transfer, p=0.017). Furthermore, after propensity matching, direct admission for primary PCI was still a predictor of all-cause mortality (hazard ratio: 0.89, 95% confidence interval: 0.64–0.95).

Conclusions:
In this large registry of over 25,000 STEMI patients treated by primary PCI survival was better in patients admitted directly to a cardiac centre versus patients transferred for primary PCI, most likely due to longer call to balloon times in patient transferred from other hospitals.
A qualitative research on co-creating care pathways for Sarcoma and GIST by stimulating reflection
Authors: Petit-Steeghs Violet , Schuitmaker-Warnaar Tjerk Jan , Pruijssers Ciska A , van Oortmerssen Gerard , Broerse Jacqueline EW 
Published: March 2020

Introduction Care Pathway Management intends to enhance the quality of care by restructuring care services. As recipients of care, patients have relevant experiential knowledge on the provision of care, but they are rarely involved in Care Pathway Management due to various barriers. This study aims to acquire insights into how patients can be meaningfully involved in Care Pathway Management. Methods A case study was conducted to assess the implementation of patient involvement in the co-creation of the care pathways of Soft Tissue Sarcoma and Gastrointestinal Stromal Tumour at Erasmus MC Cancer Institute (the Netherlands), using the Interactive Learning and Action methodology. Within the pathways, seven patients and eight health professionals were involved. To overcome expected and encountered barriers to involving patients, reflection was stimulated on the care pathways and the development process. Qualitative data were collected via interviews, participatory observations and informal conversations. For analysis, a patient involvement evaluation framework and criteria for knowledge co-creation were used. Results Patients indicated specific improvements for current pathways regarding communication, the assistance of a nurse and integrated care. However, the co-creation process encountered several barriers, including limited opportunities to overcome patients’ knowledge gap on medical care services, limited time and uncertainties about responsibilities. Moreover, participatory reflection to enhance the co-creation process was constrained by power imbalances between patients and health professionals and health professionals’ restricted perceptions of their role. Discussion To enhance the meaningful involvement of patients in Care Pathway Management, constraints in joint reflection on the co-creation process must be overcome.
Mixed-methods study of integration of housing and medical data systems for enhanced service coordination of people with HIV
Authors: Towe Vivian L , Bogart Laura , McBain Ryan , Wagner Lisa , Stevens Clare , Fischer Shira , MacCarthy Sarah 
Published: March 2020

Introduction Housing is a determinant of HIV-related medical outcomes. Care coordination has been successfully used to treat patients with HIV and can be improved through electronic exchange of patient data, including housing data. Methods Primary data were collected from four sites across the U.S., each comprising partnerships between local HIV medical and housing providers. Between March 2017 and May 2018, we conducted a mixed-methods evaluation, focusing on preparatory activities, implementation of tasks related to data integration, and service coordination. Nineteen focus group discussions were conducted with providers, organizational leaders, and clients. Ten interviews were conducted with data system vendors and administrators. Site visits, logs, and progress reports provided information about data integration progress and other activities. Results Key activities included changes to client consent, setting up data use agreements, and planning with data system vendors. Sites selected one of three models: one-way data transmission between two systems, bidirectional transmission between two systems, and integration into one data system. Focus group discussion themes included: challenges of using existing data systems; concerns about the burden of learning a new data system; and potential benefits to providers and client, such as having more time to spend delivering client services. Discussion Using health information technologies to share data has widespread support, but uptake is still met with resistance from end users. The additional level of complexity differentiating this study from others is the exchange of data between service providers and care providers, but sites were able to accomplish this goal by navigating extensive barriers.
Travel Distance Does Not Affect Outcomes in Hip Preservation Surgery: A Case for Centers of Excellence
Authors: Beck Edward C. , Nwachukwu Benedict U. , Lee Elaine K. , Chapman Reagan , Stubbs Allston J. , Gitelis Matthew , Rasio Jonathan , Nho Shane J. 
Published: March 2020

Background: Previous studies have evaluated the effect of distance to high-volume centers on outcomes after joint replacement. However, there is limited evidence on whether this distance has an effect on outcomes after undergoing hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS). Purpose: To determine whether increased distance from a patient’s home to his or her primary orthopaedic clinic has an influence on the ability to achieve the minimal clinically important difference (MCID) on outcome measures after surgery for FAIS. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort analysis was performed on patients undergoing surgery for FAIS by a single surgeon from January 2012 through January 2017. A total of 692 patients were identified and split into 2 groups: driving distance of <50 miles from our institution (referral group) and driving distance of <50 miles from our institution (local group). Preoperative and 2-year postoperative scores on patient-reported outcome measures (PROMs), including the Hip Outcome Score Activities of Daily Living and Sport-Specific subscales, International Hip Outcome Tool–12, and modified Harris Hip Score, were assessed. Patients achieving the MCID on any included PROM were analyzed using a chi-square analysis. Logistic regression was performed to determine whether driving distance and other demographic variables of interest had an effect on achieving the MCID. Study data were analyzed using PatientIQ, a cloud-based research and analytics platform for health care. Results: There were 647 patients who completed 2-year follow-up and were included in the analysis. Of these patients, 116 (17.9%) were identified as being ≥50 miles from their orthopaedic provider, and 531 (82.1%) were identified as having a driving distance of <50 miles. A total of 100 patients (86.2%) in the referral group reached the MCID, and 476 patients (89.6%) in the local group reached the MCID. There was no statistically significant difference in reaching the MCID on any of the included PROMs between the 2 groups ( P = .364). The same result held when controlling for a number of factors including age, body mass index, and adjusted gross income with logistic regression. Conclusion: When controlling for a number of factors including age, body mass index, and adjusted gross income, distance to a high-volume hip arthroscopic surgery center did not have an effect on postoperative outcome scores or achieving the MCID 2 years after undergoing surgery for FAIS.