bluuebunny/crossref_metadata_2025_split huggingface dataset:
A case report of somatic symptom disorder as first manifestation of semantic dementia
Authors: Ochoa Fernando , Farrand Sarah , Den Ouden Lauren , Shivji Natasha , Velakoulis Dennis , Kelso Wendy 
Published: November 2020

Abstract
Semantic dementia (SD) is a progressive neurodegenerative disorder in which patients present a loss of meaning of words, objects, and concepts. SD has been linked with alexisomia, as well as somatic symptom disorder (SSD). A 65 year-old patient with a 2-year history of daily episodes of pulsatile head and chest sensations followed by prostration with maintained awareness was diagnosed with SSD. The patient was subsequently admitted into an epilepsy unit to exclude the diagnosis of epileptic seizures. Clinical, neuropsychological, and neuroimaging assessments were consistent with the diagnosis of probable SD. This case report presents a patient whose first manifestation of SD was SSD, thus highlighting the importance of both careful clinical and neurocognitive enquiry, and caution in diagnosing SSD in later life. This case outlines the association between SD and somatic symptoms, providing insight into the nature of alexisomia and the emergence of SSD in SD.
Nutrition and Preventative Medicine Across the Lifespan: Implementation of a Physician Assistant Team-Based Learning Curriculum on Pediatric Preventative Medicine
Authors: Patel Shivani J. , Cafferty Patrick , Klein Melissa , Statile Angela M. 
Published: November 2020

Purpose
Physician assistants (PAs) will increasingly fill an important primary care gap in pediatrics. This study implemented a pediatric preventative care curriculum using a team-based learning (TBL) strategy and then evaluated the effect on first-year PA students' knowledge and attitudes toward TBL as a teaching method.

Methods
The curriculum was developed and implemented during a one-semester course. Students completed knowledge-based questions precourse and postcourse; the mean scores for individual students were then compared using a paired t test. Descripted statistics were used to analyze the postcourse survey that evaluated students' attitudes toward TBL.

Results
Of the 31 PA students who participated, 27 (87%) completed the surveys and were included in the analysis. The mean correct pretest and posttest scores were 17/39 and 31/39, respectively, resulting in a change of 14 points (p < .05). The majority of students (85%) rated TBL as effective, and most students (75%) reported that it led to retention of the presented content.

Conclusions
A TBL-based curriculum in pediatric preventative care was effective in increasing PA student knowledge, and the students reported it as effective. This strategy could be considered for other PA courses.
Physical Therapy Management in Recurrent Urinary Tract Infections: A Case Report
Authors: Divine Kate , McVey Lisa 
Published: November 2020

Background:
Pelvic floor dysfunction is linked to urinary incontinence (UI) and urinary tract infections (UTIs). Recurrent UTIs can affect an individual's quality of life, especially emotionally. Literature examining the conservative management of recurrent UTI is mostly in the pediatric and neurologic populations, not the general adult population. Therefore, the purpose of this case report is to describe the physical therapy (PT) management of a patient with a 10-year history of uncomplicated UTIs and UI.

Case Description:
This case describes the management for a 50-year-old woman referred to PT for UI, UTIs, urinary urgency/frequency, and pelvic pain. PT interventions included bladder retraining, surface electromyography biofeedback, electrical stimulation, therapeutic exercises, patient education, and a progressive home exercise program.

Outcomes:
Following 6 PT sessions over a 6-week period, the patient reported decreased urinary symptoms and resolution of UI. The Urinary Impact Questionnaire (UIQ) improved by 18% and the Focus on Therapeutic Outcomes Pelvic Floor Dysfunction Questionnaire (FOTO PFDI) improved by 8%. The patient reported no recurrence of UTIs at 3 months post-discharge.

Discussion:
A PT program designed to improve pelvic floor strength and coordination may have contributed to a decrease in UTI frequency and elimination of UI within a 3-month time frame. PT could provide a conservative treatment option for uncomplicated recurrent UTI and UI to improve the social/emotional impacts of symptoms and reduce antibiotic use. Future studies are needed to see the long-term effects of PT on UTI frequency.

Informed Consent:
This study was approved and exempt from a local intuitional review board.
A video abstract for this article is available at: http://links.lww.com/JWHPT/A39.
The COVID-19 Outbreak and Subjects With Mental Disorders Who Presented to an Italian Psychiatric Emergency Department
Authors: Montalbani Benedetta , Bargagna Paride , Mastrangelo Martina , Sarubbi Salvatore , Imbastaro Benedetta , De Luca Gabriele Pasquale , Anibaldi Gaia , Erbuto Denise , Pompili Maurizio , Comparelli Anna 
Published: November 2020

Abstract
We performed a retrospective study from January to May 2020 to establish the sociodemographic and clinical characteristics of patients with mental health problems who arrived at an Italian emergency department during the COVID-19 outbreak. We divided the sample into two groups taking as a watershed March 11, when the World Health Organization announced COVID-19 outbreak as a pandemic. Chi-square/t-tests, adjusted p values (Bonferroni method), and regression analysis were performed. Patients who arrived at the emergency department during the lockdown decreased by 56%; showed greater active suicidal ideation, more tension, and more severe psychopathological state; were living alone more frequently; and were taking home treatment mainly based on second-generation antipsychotics. According to our study, it seems that patients with mental disorders have consulted psychiatric services less frequently during the pandemic, but the economic, health, and social distress may be linked with an increase in suicidal risk and the severity of the psychopathological state.
Metabolic Dynamics and Prediction of Gestational Age and Time to Delivery in Pregnant Women
Authors: Liang Liang , Rasmussen Marie-Louise Hee , Piening Brian , Shen Xiaotao , Chen Songjie , Röst Hannes , Snyder John K. , Tibshirani Robert , Skotte Line , Lee Norman C. Y. , Contrepois Kévin , Feenstra Bjarke , Zackriah Hanyah , Snyder Michael , Melbye Mads 
Published: November 2020

(Abstracted from Cell 2020;181:1680–1692)
Pregnancy is a vital time period for both mothers and fetuses, and obstetric care can greatly increase positive outcomes of mothers and children. Accurate prediction of gestational age is one of the many important components of care during pregnancy.
Impact of Pediatric Emergency Care Applied Research Network Rules on Admission, Cranial Computed Tomography and Skull X-ray Rates in a Central European Hospital
Authors: Poyntner Lukas , Simma Burkhard 
Published: November 2020

Objectives
Mild head injury is a common cause of pediatric emergency department visits. Cranial computed tomography (CCT) is the diagnostic standard, although it involves inherent radiation risks. Pediatric Emergency Care Applied Research Network (PECARN) clinical prediction rules were developed to reduce the number of CCT scans. They provide a guideline for CCT use in mild head injuries, based on clinical parameters.
Our study aims to evaluate the impact of PECARN rules on hospital admission and CCT rate in children with mild head injury.

Methods
In this retrospective study, we investigated 729 children with mild head injury presenting in the pediatric emergency department between 2012 and 2016. We compared 2 groups, before and after implementation of PECARN criteria in clinical routine.

Results
Of 729 included patients (417 male; 5.6 ± 4.8 years;) 380 were seen prior to implementation of the PECARN rules, compared to 349 patients afterwards. Overall admissions to the ward decreased significantly from 83.9% (n = 319) to 71.3% (n = 249) (P < 0.001), a 31.3% reduction. Calculated from all pediatric admissions, the rate of patients with mild head injury fell from 6.0% to 4.3% (P < 0.001).
We recorded a nonsignificant decrease in the CCT rate, from 14.7% to 13.2% (P = 0.555).
No readmissions were recorded.

Conclusions
Our results show a significant reduction in the rate of hospital admission following implementation of the PECARN rules in our hospital. Already low, the CCT rate did not change after implementation.
The PECARN rules appear to be safe because no readmissions were recorded.
Use of Inotropics by Peripheral Vascular Line in the First Hour of Treatment of Pediatric Septic Shock: Experience at an Emergency Department
Authors: Kohn-Loncarica Guillermo , Hualde Gabriela , Fustiñana Ana , Monticelli María Fernanda , Reinoso Graciela , Cortéz Miguel , Segovia Leonardo , Mareco-Naccarato Gustavo , Rino Pedro 
Published: November 2020

Objective
Mortality in pediatric septic shock remains unacceptably high. Delays in vasopressor administration have been associated with an increased risk of mortality. Current treatment guidelines suggest the use of a peripheral vascular line (PVL) for inotropic administration in fluid-refractory septic shock when a central vascular line is not already in place. The aim of this study was to report local adverse effects associated with inotropic drug administration through a PVL at a pediatric emergency department setting in the first hour of treatment of septic shock.

Methods
A prospective, descriptive, observational cohort study of patients with septic shock requiring PVL inotropic administration was conducted at the pediatric emergency department of a tertiary care pediatric hospital. For the infusion and postplacement care of the PVL for vasoactive drugs, an institutional nursing protocol was used.

Results
We included 49 patients; 51% had an underlying disease. Eighty-four percent of the children included had a clinical “cold shock.” The most frequently used vasoactive drug was epinephrine (72%). One patient presented with local complications.

Conclusions
At our center, infusion of vasoactive drugs through a PVL was shown to be safe and allowed for adherence to the current guidelines for pediatric septic shock.
Evaluation of Patient Reported Gastroesophageal Reflux Severity at Baseline and at 1-year After Bariatric Surgery
Authors: Ehlers Anne P. , Thumma Jyothi R. , Finks Jonathan F. , Carlin Arthur M. , Ghaferi Amir A. , Varban Oliver A. 
Published: November 2020

Objective:
To assess patient-reported gastroesophageal reflux disease (GERD) severity before and after SG and Roux-en-Y gastric bypass (RYGB).

Summary of Background Data:
Development of new-onset or worsening GERD symptoms after bariatric surgery varies by procedure, but there is a lack of patient-reported data to help guide decision-making. Methods: Retrospective cohort study of patients undergoing bariatric surgery in a statewide quality collaborative between 2013 and 2017. We used a validated GERD survey with symptom scores ranging from 0 (no symptoms) to 5 (severe daily symptoms) and included patients who completed surveys both at baseline and 1-year after surgery (n = 10,451). We compared the rates of improved and worsened GERD symptoms after SG and RYGB.

Results:
Within our study cohort, 8680 (83%) underwent SG and 1771 (17%) underwent RYGB. Mean baseline score for all patients was 0.94. Patients undergoing SG experienced similar improvement in GERD symptoms when compared to RYGB (30.4% vs 30.8%, P = 0.7015). However, SG patients also reported higher rates of worsening symptoms (17.8% vs 7.5%, P < 0.0001) even though they were more likely to undergo concurrent hiatal hernia repair (35.1% vs 20.0%, P<0.0001). More than half of patients (53.5%) did not report a change in their score.

Conclusions:
Although SG patients reported higher rates of worsening GERD symptoms when compared to RYGB, the majority of patients (>80%) in this study experienced improvement or no change in GERD regardless of procedure. Using clinically relevant patient-reported outcomes can help guide decisions about procedure choice in bariatric surgery for patients with GERD.
Fetal Risk Stratification and Outcomes in Children with Prenatally Diagnosed Lung Malformations
Authors: Kunisaki Shaun M. , Saito Jacqueline M. , Fallat Mary E. , Peter Shawn D. St. , Lal Dave R. , Karmakar Monita , Deans Katherine J. , Gadepalli Samir K. , Hirschl Ronald B. , Minneci Peter C. , Helmrath Michael A. ,   for the Midwest Pediatric Surgery Consortium
Published: November 2020

Objective:
The aim of this study was to assess current clinical outcomes in children with prenatally diagnosed congenital lung malformations (CLMs) and to identify prenatal characteristics associated with adverse outcomes.

Summary Background Data:
Despite a wide spectrum of clinical disease, the identification of fetal CLM subgroups at increased risk for hydrops and respiratory compromise at delivery has not been well defined.

Methods:
A retrospective cohort study was conducted using an operative database of prenatally diagnosed CLMs managed at 11 children’s hospitals from 2009 to 2016. Statistical analyses were performed using nonparametric bivariate or multivariable logistic regression.

Results:
Three hundred forty-four children were analyzed. Fifteen (5.5%) fetuses were managed with maternal steroids in the setting of hydrops, and prenatal surgical intervention was uncommon (1.7%). Seventy-five (21.8%) had respiratory symptoms at birth, and 34 (10.0%) required neonatal lung resection. Congenital pulmonary airway malformation volume ratio (CVR) measurements were recorded in 169 (49.1%) cases and were significantly associated with perinatal outcome, including hydrops, respiratory distress at birth, need for supplemental oxygen, neonatal ventilator use, and neonatal resection (P < 0.001). An initial CVR ≤1.4 was significantly correlated with a reduced risk for hydrops [area under the curve (AUC), 0.93; 95% confidence interval (CI), 0.87–1.00]. A maximum CVR <0.9 (AUC, 0.72; 95% CI, 0.67–0.85) was associated with a low risk for respiratory symptoms at birth.

Conclusions:
In this large, multi-institutional study, an initial CVR ≤ 1.4 identifies fetuses at very low risk for hydrops, and a maximum CVR < 0.9 is associated with asymptomatic disease at birth. These findings represent an opportunity for standardization and quality improvement for prenatal counseling and delivery planning.
Gastrectomy Versus Esophagectomy for Gastroesophageal Junction Tumors
Authors: Jezerskyte Egle , Mertens Alexander C. , Dieren Susan van , Eshuis Wietse J. , Sprangers Mirjam A. G. , van Berge Henegouwen Mark I. , Gisbertz Suzanne S. ,   on behalf of the Dutch Upper Gastrointestinal Cancer Audit (DUCA) group
Published: November 2020

Objective:
Investigate long-term survival, morbidity, mortality, and pathology results in patients following esophagectomy or total gastrectomy for gastroesophageal junction (GEJ) cancer.

Background:
Both a total gastrectomy and an esophagectomy may be valid treatment options in patients with GEJ cancer. Which procedure results in the most optimal patient outcome is not well studied. The aim of this study was to investigate the long-term survival, morbidity, mortality, and pathology results in patients following esophagectomy or total gastrectomy for GEJ cancer.

Methods:
A retrospective comparative cohort study of prospectively collected data from the Dutch Upper GI Cancer Audit combined with survival data of the Dutch medical insurance database was performed. Patients with GEJ cancer in whom a total gastrectomy or an esophagectomy was performed between 2011 and 2016 were compared. The primary outcome was 3-year overall survival. Postoperative morbidity, mortality, 3-year conditional survival, radicality of resection, and lymph node yield were secondary endpoints.

Results:
A total of 871 patients were included: 790 following esophagectomy and 81 following gastrectomy. The 3-year overall survival was 35.8% after esophagectomy and 28.4% after gastrectomy (hazard ratio 1.2, 95% confidence interval 0.721–1.836, P = 0.557). Postoperative morbidity, mortality, radicality of resection, lymph node yield, and 3-year conditional survival did not differ significantly between groups.

Conclusion:
A total gastrectomy and an esophagectomy for GEJ cancer show largely comparable results with regard to long-term survival, postoperative morbidity, mortality, and pathology results. If both procedures are feasible, other parameters such as surgeon’s experience and quality of life should be considered when planning for surgery.
Identifying a Basket of Surgical Procedures to Standardize Global Surgical Metrics
Authors: Odland Maria L. , Nepogodiev Dmitri , Morton Dion , Martin Janet , Bekele Abebe , Ghosh Dhruva , Ademuyiwa Adesoji O. , Davies Justine I. , Weiser Thomas G. 
Published: November 2020

Objective:
We aimed to define a globally applicable list of surgical procedures, or “basket,” which could represent a health system's capacity to provide surgical care and standardize global surgical measurement.

Summary of Background Data:
Six indicators have been proposed to assess access to safe, affordable, timely surgical and anesthesia care, with a focus on laparotomy, cesarean section, and treatment of open fracture. However, comparability, particularly for these procedures, has been limited by a lack of definitional clarity and their overly broad scope.

Methods:
We conducted a 3 round international expert Delphi exercise between April and June 2019 using REDCap to identify a set of procedures representative of surgical capacity. To be included, procedures had to be important for treating common conditions, well-defined, and impactful (ie, well-recognized clinical or functional benefit). Procedures were eliminated or prioritized in each round, and those noted as “extremely” or “very important” by ≥50% of respondents in round 3 were included in the final “basket.”

Results:
Altogether 331 respondents from 78 countries participated in the Delphi process. A final basket of 32 procedures representing disease categories in trauma, cancer, congenital anomalies, maternal/reproductive health, aging, and infection were identified for inclusion to assess surgical capacity.

Conclusions:
This surgical basket facilitates a more standardized assessment of a country's surgical system. Further testing and refinement will likely be needed, but this basket can be used immediately to guide ongoing monitoring and evaluation of global surgery capacities to improve and strengthen surgery and anesthesia care.
The Safety and Efficacy of Tracheostomy in Patients Diagnosed With COVID-19
Authors: Krishnamoorthy Subhash , Polanco Antonio , Coleman Natasha , Prigoff Jake , Sturm Joshua , Blitzer David , Erwin Clinton , D’Ovidio Frank , Lemaitre Philippe , Troob Scott , Hills Susannah , Stanifer Bryan Payne 
Published: November 2020

Objective:
To determine the optimal surgical strategy for performing tracheostomy in COVID-19 patients.

Background:
Many ventilated COVID-19 patients require prolonged ventilation. We do not know if tracheostomy will improve their care. Given the paucity of data on this topic, the optimal surgical approach has yet to be elucidated.

Methods:
This is a cohort study of 143 ventilator dependent COVID-19 patients undergoing tracheostomy at an academic medical center from April 15th to May 15th, 2020, with follow up until June 1, 2020. We included adult patients admitted to a NYC medical center with COVID-19 who required invasive mechanical ventilation for greater than 2 weeks who were unable to be extubated and determined to have reasonable chance of recovery and fit defined tracheostomy candidate criteria. Patients underwent either a percutaneous tracheostomy (PT) or open surgical tracheostomy (ST) performed by 1 of 3 surgical services.

Results:
One hundred forty-three patients underwent tracheostomy, 58 (41%) via a ST, and 85 (59%) via a PT. There were no significant differences in patient characteristics between the 2 groups, except that more patients who had a history of extracorporeal membrane oxygenation underwent PT (11% vs 2%, P = 0.049). There were no statistical differences observed between the PT and ST groups with regard to bleeding complications (3.5%vs 10.3%, P = 0.099), tracheostomy related complications (5.9% vs 8.6%, P = 0.528), inpatient death (12% vs 5%, P = 0.178), discharge from hospital (39% vs 36%, P = 0.751) or surgeon illness (0% vs 0%, P = 1).

Conclusion and Relevance:
The rapid formation of a multi-disciplinary team allows for the efficient evaluation and performance of a large volume of tracheostomies in a resource-limited setting. Bedside tracheostomy in COVID-19 does not cause additional harm to patients if performed after 2 weeks from intubation. It also seems to be safe for proceduralists to perform in this timeframe. The manner of tracheostomy does not change outcomes significantly if it is performed safely and efficiently.
Can the Risk Analysis Index for Frailty Predict Morbidity and Mortality in Patients Undergoing High-risk Surgery?
Authors: Wan Michelle A. , Clark James M. , Nuño Miriam , Cooke David T. , Brown Lisa M. 
Published: November 2020

Objective:
To determine the effectiveness of the revised Risk Analysis Index (RAI-rev), administrative Risk Analysis Index (RAI-A), cancer-corrected Risk Analysis Index [RAI-rev (cancer-corrected)], and 5-variable modified Frailty Index for predicting 30-day morbidity and mortality in patients undergoing high-risk surgery.

Background:
There are several frailty composite measures, but none have been evaluated for predicting morbidity and mortality in patients undergoing high-risk surgery.

Methods:
Using the National Surgical Quality Improvement Program database, we performed a retrospective study of patients who underwentcolectomy/proctectomy, coronary artery bypass graft (CABG), pancreaticoduodenectomy, lung resection, or esophagectomy from 2006 to 2017. RAI-rev, RAI-A, RAI-rev (cancer corrected), and 5-variable modified Frailty Index scores were calculated. Pearson's chi-square tests and C-statistics were used to assess the predictive accuracy of each score’s logistic regression model.

Results:
In the cohort of 283,545 patients, there were 178,311 (63%) colectomy/proctectomy, 38,167 (14%) pancreaticoduodenectomy, 40,328 (14%) lung resection, 16,127 (6%) CABG, and 10,602 (3%) esophagectomy cases. The RAI-rev was a fair predictor of mortality in the total cohort (C-statistic, 0.71, 95% CI 0.70–0.71, P < 0.001) and for patients who underwent colectomy/proctectomy (C-statistic 0.73, 95% CI 0.72–0.74, P < 0.001) and CABG (C-statistic 0.70, 95% CI 0.68–0.73, P < 0.001), but a poor predictor of mortality in all other operation cohorts. The RAI-A was a fair predictor of mortality for colectomy/proctectomy patients (C-statistic 0.74, 95% CI 0.73– 0.74, P < 0.001). All indices were poor predictors of morbidity. The RAI-rev (cancer corrected) did not improve the accuracy of morbidity and mortality prediction.

Conclusion:
The presently studied frailty indices are ineffective predictors of 30-day morbidity and mortality for patients undergoing high-risk operations.