bluuebunny/crossref_metadata_2025_split huggingface dataset:
GAVeCeLT-WoCoVA Consensus on subcutaneously anchored securement devices for the securement of venous catheters: Current evidence and recommendations for future research
Authors: Pinelli Fulvio , Pittiruti Mauro , Van Boxtel Ton , Barone Giovanni , Biffi Roberto , Capozzoli Giuseppe , Crocoli Alessandro , Elli Stefano , Elisei Daniele , Fabiani Adam , Garrino Cristina , Graziano Ugo , Montagnani Luca , Prato Alessio Pini , Scoppettuolo Giancarlo , Zadra Nicola , Zanaboni Clelia , Zerla Pietro , Konstantinou Evangelos , Jones Matt , Rosay Hervé , Simcock Liz , Stas Marguerite , Pepe Gilda 
Published: July 2020

Background: Subcutaneously anchored securement devices (or subcutaneous engineered securement devices) have been introduced recently into the clinical practice, but the number of published studies is still scarce. The Italian Group of Long-Term Central Venous Access Devices (GAVeCeLT)—in collaboration with WoCoVA (World Congress on Vascular Access)—has developed a Consensus about the effectiveness, safety, and cost-effectiveness of such devices. Methods: After the definition of a panel of experts, a systematic collection and review of the literature on subcutaneously anchored securement devices was performed. The panel has been divided in two working groups, one focusing on adult patients and the other on children and neonates. Results: Although the quality of evidence is generally poor, since it is based mainly on non-controlled prospective studies, the panel has concluded that subcutaneously anchored securement devices are overall effective in reducing the risk of dislodgment and they appear to be safe in all categories of patients, being associated only with rare and negligible local adverse effects; cost-effectiveness is demonstrated—or highly likely—in specific populations of patients with long-term venous access and/or at high risk of dislodgment. Conclusion: Subcutaneously anchored securement is a very promising strategy for avoiding dislodgment. Further studies are warranted, in particular for the purpose of defining (a) the best management of the anchoring device so to avoid local problems, (b) the patient populations in which it may be considered highly cost-effective and even mandatory, (c) the possible benefit in terms of reduction of other catheter-related complications such as venous thrombosis and/or infection, and—last but not least—(d) their impact on the workload and stress level of nurses taking care of the devices.
Pre-schoolers Referred to a Child and Adolescent Mental Health Clinic: A Hospital Quality Improvement Report
Authors: Elgen Irene B , Stikholmen Mariell , Gjestad Rolf , Danielsen Inger Lande , Fevang Silje 
Published: July 2020

Objective: Aim of the study was to evaluate the patient pathway from referral to assessment and diagnosis of pre-schoolers referred to a Child and Adolescent Mental Health Clinic (CAMHC) in Norway. Method: Following data were collected retrospectively from medical records over a 2-year study period: data from clinical interviews for diagnostic evaluation, observation findings in kindergartens and the CAMHC, and results from medical examinations. The times taken from referral to first contact with the CAMHC, then to the first evaluation, and finally to diagnosis were assessed. Results: Of 13 402 pre-schoolers, 88 (0.7%) were referred to the CAMHC, of which 15 refused assessment and 69 completed a diagnostic assessment. Of the assessed children, 15 (21%) did not meet any criteria for an International Classification of Diseases, Tenth revision ( ICD-10) diagnosis, 26 (38%) were diagnosed with developmental disorders, and 10 (14%) were given a non-specific diagnosis. For those children without a specific diagnosis, the mean time taken from referral to CAMHC assessment and diagnosis was longer, although not statistically significant, compared with those with a specific diagnosis ( P = .52). No significant correlation between referral symptoms and final diagnosis was found. Conclusions: Pre-schoolers referred to the CAMHC have an increased risk of having developmental disorders. Furthermore, 1 in 5 of the children had comorbidities. We propose more effective health care service by developing an interdisciplinary approach for the management of these children.
Hand X-ray examination in two planes is not required for radiographic assessment of hand osteoarthritis
Authors: Staats Kevin , Sunk Ilse-Gerlinde , Weidekamm Claudia , Kerschbaumer Andreas , Bécède Manuel , Supp Gabriela , Stamm Tanja , Windhager Reinhard , Smolen Josef S. , Bobacz Klaus 
Published: July 2020

Aims: Radiographic imaging is essential in the diagnosis of hand osteoarthritis (HOA); however, it is unknown whether a multiplanar examination would add essential information to dorso-palmar (dp) views alone. This study evaluated whether an additional radiographic view would aid clinicians in the diagnostic process of HOA. Methods: The dp radiographs of both hands from 159 HOA patients were assessed according to the scores described by Kellgren and Lawrence (K/L). In oblique view images, structures similar to classic ostophytes (OPs) were found, namely bony proliferations on the dorsal and/or ventral margins of joints, and were documented as dorsal/ventral OPs (dvOPs). Function and pain were assessed by applying standardised read-out systems. Logistic regression analysis and Mann–Whitney tests were implemented. Results: The presence of dvOPs was associated with the degree of joint damage; however, dp views were sufficient to estimate radiographic changes. Only a few joints showed dvOPs as the only structural alteration; nevertheless, in almost all cases, classical radiographic OA changes were found in dp views of other joints of the same or the contralateral hand. The presence of dvOPs did not affect joint function or pain according to established scores, but was associated with radiographic progression in distal interphalangeal joints. Conclusion: This is the first study to confirm that additional radiographic planes, oblique/lateral views, are not necessary in the diagnostic process in HOA in daily clinical practice. Nevertheless, the presence of dvOPs reflect more severe joint damage and is associated with radiographic progression in HOA; hence, oblique/lateral views could be a useful tool for academic purposes.
The ages and TSH values of patients being prescribed levothyroxine
Authors: Jonklaas Jacqueline , DeSale Sameer 
Published: July 2020

Background: Levothyroxine is a commonly prescribed medication. Some data suggest that levothyroxine may be initiated for mild degrees of hypothyroidism and used without considering age-specific reference ranges or individual patient factors when prescribing. Methods: The electronic medical record of a health care system operating in the Washington, DC and Maryland area was interrogated to determine the number of patients who were being prescribed levothyroxine during the time period 2008–2016, the number of prescriptions supplied to these individuals, an associated diagnosis of hypothyroidism, and whether the prescriptions were new or existing prescriptions. Information was also extracted about the age of patients receiving prescriptions and the thyroid stimulating hormone level documented prior to levothyroxine initiation. Results: Although the number of levothyroxine prescriptions provided annually increased over this time period, when corrected for the number of patients in the database, the percentage of patients receiving levothyroxine prescriptions showed a slight downward trend. Levothyroxine was both most frequently prescribed and frequently initiated in those of ages 50–59 years and 60–69 years. The doses of levothyroxine most commonly prescribed were 50 µg and 100 µg and the pattern of levothyroxine doses being used was unaffected by whether a diagnosis of hypothyroidism was documented or not. Levothyroxine prescription initiation was associated with mean thyroid stimulating hormone values that were modestly elevated and in the range of 7.5–13.8 mIU/L. Conclusion: This analysis showed that although the percentage of patients being prescribed levothyroxine is stable or slightly declining, with most decrement in those without a diagnosis of hypothyroidism, there is nevertheless continued initiation of levothyroxine in those with mild degrees of thyroid stimulating hormone elevation, and in those of older age, raising concerns about both unnecessary treatment and iatrogenic thyrotoxicosis. Such data suggest the need for great consideration of both the degree of thyroid stimulating hormone elevation and the patient context when considering whether treatment of an elevated thyroid stimulating hormone value, versus ongoing monitoring, is indicated.
Computed tomography calcium scoring association and reclassification of clinical cardiovascular risk in asymptomatic Mexican patients
Authors: Vázquez Mézquita Aldo Javier , Williams Michelle Claire , Choza Chenhalls Rafael , Guzmán Martínez Nancy Berenice , Chischistz Condey Ana Patricia , Acosta Falomir Maria José , Téliz Meneses Marco Antonio , Vázquez Sánchez María Nayeli 
Published: July 2020

Objectives: To establish tailored preventive treatment, we studied the ability of coronary artery calcium scoring to reclassify patients with intermediate cardiovascular risk and its association with additional risk factors in our Mexican preventive care center. Materials and methods: In this retrospective cohort study, we analyzed 520 asymptomatic patients from a Mexican primary prevention population between 2014 and 2018. Coronary artery calcium scoring, laboratory results, and anthropometric measurements (abdominal circumference and body mass index) were assessed. The Framingham risk score and American Heart Association/American College of Cardiology (AHA/ACC) atherosclerotic cardiovascular disease risk algorithm were calculated. Correlations between coronary artery calcium scoring, anthropometric measurements, and clinical cardiovascular risk scores were assessed. We assessed the ability of coronary artery calcium scoring to reclassify patients recommended for statin therapy compared with the cardiovascular risk scores. Results: Patients had a mean age of 67.5 years ( SD ± 9.8) and 294 subjects (56.5%) were male. Coronary artery calcium scoring has a positive correlation with age, AHA/ACC atherosclerotic cardiovascular disease risk algorithm, and Framingham risk score ( p < 0.001 for all). Coronary artery calcium scoring was prevalent, occurring in 63.2% of patients with a median Agatston score of 22 with and interquartile range of 178. Male gender, older age, smoking habit, diabetes, and abdominal circumference were independent predictors of coronary artery calcium scoring ( p < 0.001). Coronary artery calcium scoring downwardly reclassified 44.9% of patients in intermediate cardiovascular risk categories by the AHA/ACC atherosclerotic cardiovascular disease risk algorithm and 43.9% by the Framingham risk score. Coronary artery calcium scoring upwardly reclassified 46.8% of patients in intermediate risk categories by the AHA/ACC atherosclerotic cardiovascular disease risk algorithm and 56% by the Framingham risk score. Conclusion: Coronary artery calcium scoring is prevalent in this Mexican primary prevention cohort and has the ability to reclassify a significant percentage of intermediate cardiovascular risk patients.
Effectiveness of Latent TB Screening and Treatment in People Initiating Dialysis in British Columbia, Canada
Authors: Romanowski Kamila , Rose Caren , Cook Victoria J. , Sekirov Inna , Morshed Muhammad , Djurdjev Ognjenka , Levin Adeera , Johnston James C. 
Published: July 2020

Background: People undergoing chronic dialysis are at an increased risk of active tuberculosis (TB). In 2012, the Canadian province of British Columbia began systematically screening people initiating dialysis for latent TB using interferon-gamma release assay (IGRA), and treating when appropriate. Objective: The objective of this study was to compare active TB rate in people who initiated dialysis and were screened using an IGRA compared with those not screened during the same period. Design: Retrospective cohort study. Setting: British Columbia (BC), a Canadian province of 5.0 million people with an active TB incidence of 5.1 per 100 000 population. Participants: All people in BC who initiated at least 90 days of dialysis between January 2012 and May 2017 were included in the study. People were excluded if they were <18 years of age or had a prior history of active TB diagnosis or treatment for latent TB. Methods: A retrospective cohort was created of British Columbians who initiated dialysis between 2012 and 2017. Individuals were stratified into a screened and nonscreened group. Multivariable Cox regression was used to determine the association between latent TB screening and the development of active TB. The primary outcome was incident active TB, either microbiologically confirmed or clinically diagnosed. Results: Of the 3190 people included in the study, 1790 (56.1%) were screened, of which 152 (8.5%) initiated latent TB treatment postscreening. During follow-up, incident active TB was diagnosed in 6 (0.3%) of the 1790 people screened, compared with 11 (0.8%) of the 1400 people who received no screening. In multivariable analysis, latent TB screening and treatment was associated with a significant reduction in the rate of active TB (adjusted hazard ratio = 0.3, 95% confidence interval = 0.1-0.8; P < .01). Limitations: This was an observational retrospective study and the potential for unmeasured confounding should be carefully assessed. Conclusions: These findings suggest that systematically screening and treating people initiating dialysis can significantly decrease the rate of active TB in this high-risk population. Given the importance of screening high-risk groups, the results from this analysis could inform scale-up of TB screening in dialysis programs in other low incidence regions. Trial registration is not applicable as this was a retrospective cohort analysis and not a randomized trial.
Medical Decision-Making in the Physician Hierarchy: A Pilot Pedagogical Evaluation
Authors: Rosasco John , McCarroll Michele L , Gothard M David , Myers Jerry , Hughes Patrick , Schwartz Alan , George Richard L , Ahmed Rami A 
Published: July 2020

Purpose: Recently, the American College of Graduate Medical Education included medical decision-making as a core competency in several specialties. To date, the ability to demonstrate and measure a pedagogical evolution of medical judgment in a medical education program has been limited. In this study, we aim to examine differences in medical decision-making of physician groups in distinctly different stages of their postgraduate career. Methods: The study recruited physicians with a wide spectrum of disciplines and levels of experience to take part in 4 medical simulations divided into 2 categories, abdominal pain (biliary colic [BC] and renal colic [RC]) or chest pain (cardiac ischemia with ST-segment elevation myocardial infarction [STEMI] and pneumothorax [PTX]). Evaluation of medical decision-making used the Medical Judgment Metric (MJM). The targeted selection criteria for the physician groups are administrative physicians (APs), representing those with the most experience but whose current duties are largely administrative; resident physicians (RPs), those enrolled in postgraduate medical or surgical training; and mastery level physicians (MPs), those deemed to have mastery level experience. The study measured participant demographics, physiological responses, medical judgment scores, and simulation time to case resolution. Outcome differences were analyzed using Fisher exact tests with post hoc Bonferroni-adjusted z tests and single-factor analysis of variance F tests with post hoc Tukey honestly significant difference, as appropriate. The significance threshold was set at P < .05. Effect sizes were determined and reported to inform future studies. Results: A total of n = 30 physicians were recruited for the study with n = 10 participants in each physician group. No significant differences were found in baseline demographics between groups. Analysis of simulations showed a significant ( P = .002) interaction for total simulation time between groups RP: 6.2 minutes (±1.58); MP: 8.7 minutes (±2.46); and AP: 10.3 minutes (±2.78). The AP MJM scores, 12.3 (±2.66), for the RC simulation were significantly ( P = .010) lower than the RP 14.7 (±1.15) and MP 14.7 (±1.15) MJM scores. Analysis of simulated patient outcomes showed that the AP group was significantly less likely to stabilize the participant in the RC simulation than MP and RP groups ( P = .040). While not significant, all MJM scores for the AP group were lower in the BC, STEMI, and PTX simulations compared with the RP and MP groups. Conclusions: Physicians in distinctly different stages of their respective postgraduate career differed in several domains when assessed through a consistent high-fidelity medical simulation program. Further studies are warranted to accurately assess pedagogical differences over the medical judgment lifespan of a physician.
Certolizumab-Induced Paradoxical Psoriatic Alopecia
Authors: Ferraresso María Guillermina , Garlatti María Luz Bollea , Perez-Chada Lourdes María , Martin Mariana Soledad , Mazzuoccolo Luis Daniel 
Published: July 2020

Introduction: Biologic drugs have revolutionized the treatment of chronic inflammatory immunologic diseases. However, their use is associated with adverse reactions, including paradoxical adverse events. Tumor necrosis factor (TNF)–associated psoriatic alopecia (TiAPA) is a paradoxical adverse event that has been rarely reported in the literature. Only 1 case secondary to certolizumab has been recently described. Case Presentation: We described a case of scalp alopecia secondary to certolizumab in a 27-year old female patient with Crohn disease. The skin biopsy showed psoriasiform changes and loss of sebaceous lobule compatible with TiAPA. The patient presented significant improvement in the clinical findings and hair regrowth after 4 weeks of treatment with clobetasol unguent 0.05% and discontinuation of certolizumab. Months later she received infliximab for her Crohn disease, achieving good control of the illness until today. Discussion: This is a paradoxical adverse event that has been rarely reported in the literature. Most of the cases were related with infliximab and adalimumab. There is no standard approach for the management of TNF inhibitor–induced psoriasis, but around 20% require discontinuation of treatment. Conclusions: The recognition of anti-TNF drug–induced alopecia has allowed description of a new form of alopecia, clinically and histologically mimicking primary psoriatic alopecia with the recently described finding of loss of sebaceous lobules. Recognizing this form of alopecia can enable effective treatment while allowing, in most cases, anti-TNF therapy to continue.
VWF maturation and release are controlled by 2 regulators of Weibel-Palade body biogenesis: exocyst and BLOC-2
Authors: Sharda Anish V. , Barr Alexandra M. , Harrison Joshua A. , Wilkie Adrian R. , Fang Chao , Mendez Lourdes M. , Ghiran Ionita C. , Italiano Joseph E. , Flaumenhaft Robert 
Published: July 2020

Abstract
von Willebrand factor (VWF) is an essential hemostatic protein that is synthesized in endothelial cells and stored in Weibel-Palade bodies (WPBs). Understanding the mechanisms underlying WPB biogenesis and exocytosis could enable therapeutic modulation of endogenous VWF, yet optimal targets for modulating VWF release have not been established. Because biogenesis of lysosomal related organelle-2 (BLOC-2) functions in the biogenesis of platelet dense granules and melanosomes, which like WPBs are lysosome-related organelles, we hypothesized that BLOC-2–dependent endolysosomal trafficking is essential for WPB biogenesis and sought to identify BLOC-2–interacting proteins. Depletion of BLOC-2 caused misdirection of cargo-carrying transport tubules from endosomes, resulting in immature WPBs that lack endosomal input. Immunoprecipitation of BLOC-2 identified the exocyst complex as a binding partner. Depletion of the exocyst complex phenocopied BLOC-2 depletion, resulting in immature WPBs. Furthermore, releasates of immature WPBs from either BLOC-2 or exocyst-depleted endothelial cells lacked high-molecular weight (HMW) forms of VWF, demonstrating the importance of BLOC-2/exocyst-mediated endosomal input during VWF maturation. However, BLOC-2 and exocyst showed very different effects on VWF release. Although BLOC-2 depletion impaired exocytosis, exocyst depletion augmented WPB exocytosis, indicating that it acts as a clamp. Exposure of endothelial cells to a small molecule inhibitor of exocyst, Endosidin2, reversibly augmented secretion of mature WPBs containing HMW forms of VWF. These studies show that, although BLOC-2 and exocyst cooperate in WPB formation, only exocyst serves to clamp WPB release. Exocyst function in VWF maturation and release are separable, a feature that can be exploited to enhance VWF release.
Hematopoietic cell transplantation in chronic granulomatous disease: a study of 712 children and adults
Authors: Chiesa Robert , Wang Junfeng , Blok Henric-Jan , Hazelaar Sheree , Neven Benedicte , Moshous Despina , Schulz Ansgar , Hoenig Manfred , Hauck Fabian , Al Seraihy Amal , Gozdzik Jolanta , Ljungman Per , Lindemans Caroline A. , Fernandes Juliana F. , Kalwak Krzysztof , Strahm Brigitte , Schanz Urs , Sedlacek Petr , Sykora Karl-Walter , Aksoylar Serap , Locatelli Franco , Stepensky Polina , Wynn Robert , Lum Su Han , Zecca Marco , Porta Fulvio , Taskinen Mervi , Gibson Brenda , Matthes Susanne , Karakukcu Musa , Hauri-Hohl Mathias , Veys Paul , Gennery Andrew R. , Lucchini Giovanna , Felber Matthias , Albert Michael H. , Balashov Dmitry , Lankester Arjan , Güngör Tayfun , Slatter Mary A. 
Published: July 2020

Abstract
Chronic granulomatous disease (CGD) is a primary immunodeficiency resulting in life-threatening infections and inflammatory complications. Allogeneic hematopoietic cell transplantation (allo-HCT) can cure the disease, but the indication to transplant remains controversial. We performed a retrospective multicenter study of 712 patients with CGD who underwent allo-HCT transplantation from March 1993 through December 2018. We studied 635 children (aged &lt;18 years) and 77 adults. Median follow-up was 45 months. Median age at transplantation was 7 years (range, 0.1-48.6). Kaplan-Meier estimates of overall survival (OS) and event-free survival (EFS) at 3 years were 85.7% and 75.8%, respectively. In multivariate analysis, older age was associated with reduced survival and increased chronic graft-versus-host disease. Nevertheless, OS and EFS at 3 years for patients ≥18 years were 76% and 69%, respectively. Use of 1-antigen-mismatched donors was associated with reduced OS and EFS . No significant difference was found in OS, but a significantly reduced EFS was noted in the small group of patients who received a transplant from a donor with a &gt;1 antigen mismatch. Choice of conditioning regimen did not influence OS or EFS. In summary, we report an excellent outcome after allo-HCT in CGD, with low incidence of graft failure and mortality in all ages. Older patients and recipients of 1-antigen-mismatched grafts had a less favorable outcome. Transplantation should be strongly considered at a younger age and particularly in the presence of a well-matched donor.