bluuebunny/crossref_metadata_2025_split huggingface dataset:
What Determines the Quality of Rehabilitation Clinical Practice Guidelines?
Authors: Dijkers Marcel P. , Ward Irene , Annaswamy Thiru , Dedrick Devin , Hoffecker Lilian , Millis Scott R. 
Published: November 2020

Objective
The aim of the study was to determine what factors determine the quality of rehabilitation clinical practice guidelines.

Design
Six databases were searched for articles that had applied the Appraisal of Guidelines for Research & Evaluation II quality assessment tool to rehabilitation clinical practice guidelines. The 573 deduplicated abstracts were independently screened by two authors, resulting in 81 articles, the full texts of which were independently screened by two authors for Appraisal of Guidelines for Research & Evaluation II application to rehabilitation clinical practice guidelines, resulting in a final selection of 40 reviews appraising 504 clinical practice guidelines. Data were extracted from these by one author and checked by a second. Data on each clinical practice guideline included the six Appraisal of Guidelines for Research & Evaluation II domain scores, as well as the two Appraisal of Guidelines for Research & Evaluation II global evaluations.

Results
All six Appraisal of Guidelines for Research & Evaluation II domain scores were statistically significant predictors of overall clinical practice guideline quality rating; D3 (rigor of development) was the strongest and D1 (scope and purpose) the weakest (overall model P < 0.001, R
2 = 0.53). Five of the six domain scores were significant predictors of the clinical practice guideline use recommendation, with D3 the strongest predictor and D5 (applicability) the weakest (overall model P < 0.001, pseudo R
2 = 0.53).

Conclusions
Quality of rehabilitation clinical practice guidelines may be improved by addressing key domains such as rigor of development.
Exploratory Analysis of Racial/Ethnic and Educational Differences in a Randomized Controlled Trial of a Mindfulness-Based Weight Loss Intervention
Authors: Daubenmier Jennifer , Chao Maria T. , Hartogensis Wendy , Liu Rhianon , Moran Patricia J. , Acree Michael C. , Kristeller Jean , Epel Elissa S. , Hecht Frederick M. 
Published: November 2020

ABSTRACT

Objective
People of color and lower socioeconomic groups have higher obesity prevalence, lose less weight compared with Whites and higher socioeconomic groups, and are underrepresented in randomized controlled trials of mindfulness-based interventions. We examined whether mindfulness approaches reduce disparities in weight loss interventions.

Methods
We analyzed data from a randomized controlled trial of 194 participants with obesity (41% participants of color, 36% without college degree) comparing a 5.5-month mindfulness-based weight loss intervention to an active-control with identical diet-exercise guidelines. We assessed attendance, 18-month attrition, and weight change at 6, 12, and 18 months by race/ethnicity and education level using linear mixed models, adjusting for baseline body mass index, age, and education or race/ethnicity, respectively.

Results
Participants without versus with a college degree attended fewer sessions and had higher attrition across interventions. Participants of color attended fewer intervention sessions in the mindfulness compared with the control intervention. Overall, participants of color lost significantly less weight at 12 and 18 months compared with Whites. However, during the 6- to 18-month maintenance period, we found an interaction of intervention arm, race/ethnicity, and time (p = .035), indicating that participants of color compared with Whites regained more weight in the control (0.33 kg/mo; p = .005) but not mindfulness intervention (0.06 kg/mo; p = .62). Participants without a college degree had greater initial weight loss in the mindfulness compared to control intervention from 0 to 6 months (−0.46 kg/mo; p = .039).

Conclusions
Although disparities persist, mindfulness approaches may mitigate some racial/ethnic and socioeconomic differences in weight loss compared with conventional diet-exercise programs.

Trial Registration: Clinicaltrials.gov registration: NCT00960414
Application of a Novel Iterative Denoising and Image Enhancement Technique in T1-Weighted Precontrast and Postcontrast Gradient Echo Imaging of the Abdomen
Authors: Gassenmaier Sebastian , Afat Saif , Nickel Dominik , Kannengiesser Stephan , Herrmann Judith , Hoffmann Rüdiger , Othman Ahmed E. 
Published: November 2020

Objectives
The aim of this study was to investigate the impact of a novel iterative denoising and image enhancement technique in T1-weighted precontrast and postcontrast volume-interpolated breath-hold examination (VIBE) of the abdomen on image quality, noise levels, and diagnostic confidence without change of acquisition parameters.

Materials and Methods
Fifty patients were included in this retrospective, monocentric, institutional review board–approved study after clinically indicated magnetic resonance imaging of the abdomen including T1-weighted precontrast and postcontrast imaging. After acquisition of the standard VIBE (VIBES), images were processed with a novel reconstruction algorithm using the same raw data as for VIBES, resulting in a denoised and enhanced dataset (VIBEDE). Two different radiologists evaluated both datasets in a randomized order regarding sharpness of organs as well as vessels, noise levels, artifacts, overall image quality, and diagnostic confidence using a Likert scale ranging from 1 to 4 with 4 being the best. Furthermore, in the presence of focal liver lesions, the largest lesion was measured in the postcontrast dataset, and lesion detectability was analyzed using a Likert scale (1–4).

Results
Precontrast and postcontrast sharpness of organs and sharpness of vessels were rated significantly superior by both readers in VIBEDE with a median of 4 (interquartile range, 0) compared with VIBES with a median of 3 (1) (all P's < 0.0001). Precontrast and postcontrast noise levels were also rated superior by both readers in VIBEDE with a median of 4 (0) compared with VIBES with a median of 3 (1) for precontrast and a median of 3 (0) (median of 3 [1] for reader 2) for postcontrast imaging (all P's < 0.0001).
Overall image quality was also rated higher with a median of 4 (0) in VIBEDE versus 3 (1) in VIBES (P < 0.0001). Twenty-seven imaging studies contained liver lesions. There was no difference regarding the number and localization between the readers and between VIBES and VIBEDE. Lesion detectability was rated by both readers significantly better in VIBEDE with a median of 4 (0) compared with a median of 4 (1) for reader 1 and a median of 3 (1) for reader 2 (P = 0.001 for reader 1; P < 0.001 for reader 2). Consequently, diagnostic confidence was also significantly superior in VIBEDE versus VIBES with a median of 4 (0) for both (P = 0.001). Interreader agreement resulted in a Cohen κ of 0.76 for precontrast analysis as well as of 0.76 for postcontrast analysis.

Conclusions
Application of a novel iterative denoising and image enhancement technique in T1-weighted VIBE precontrast and postcontrast imaging of the abdomen is feasible, providing superior image quality, noise levels, and diagnostic confidence.
Consensus Conference Statement on the General Use of Near-infrared Fluorescence Imaging and Indocyanine Green Guided Surgery
Authors: Dip Fernando , Boni Luigi , Bouvet Michael , Carus Thomas , Diana Michele , Falco Jorge , Gurtner Geoffrey C. , Ishizawa Takeaki , Kokudo Norihiro , Lo Menzo Emanuele , Low Philip S. , Masia Jaume , Muehrcke Derek , Papay Francis A. , Pulitano Carlo , Schneider-Koraith Sylke , Sherwinter Danny , Spinoglio Giuseppe , Stassen Laurents , Urano Yasuteru , Vahrmeijer Alexander , Vibert Eric , Warram Jason , Wexner Steven D. , White Kevin , Rosenthal Raul J. 
Published: November 2020

Background:
In recent decades, the use of near-infrared light and fluorescence-guidance during open and laparoscopic surgery has exponentially expanded across various clinical settings. However, tremendous variability exists in how it is performed.

Objective:
In this first published survey of international experts on fluorescence-guided surgery, we sought to identify areas of consensus and nonconsensus across 4 areas of practice: fundamentals; patient selection/preparation; technical aspects; and effectiveness and safety.

Methods:
A Delphi survey was conducted among 19 international experts in fluorescence-guided surgery attending a 1-day consensus meeting in Frankfurt, Germany on September 8th, 2019. Using mobile phones, experts were asked to anonymously vote over 2 rounds of voting, with 70% and 80% set as a priori thresholds for consensus and vote robustness, respectively.

Results:
Experts from 5 continents reached consensus on 41 of 44 statements, including strong consensus that near-infrared fluorescence-guided surgery is both effective and safe across a broad variety of clinical settings, including the localization of critical anatomical structures like vessels, detection of tumors and sentinel nodes, assessment of tissue perfusion and anastomotic leaks, delineation of segmented organs, and localization of parathyroid glands. Although the minimum and maximum safe effective dose of ICG were felt to be 1 to 2 mg and >10 mg, respectively, there was strong consensus that determining the optimum dose, concentration, route and timing of ICG administration should be an ongoing research focus.

Conclusions:
Although fluorescence imaging was almost unanimously perceived to be both effective and safe across a broad range of clinical settings, considerable further research remains necessary to optimize its use.
The Impact of Clinical and Pathological Features on Intraductal Papillary Mucinous Neoplasm Recurrence After Surgical Resection
Authors: Pflüger Michael J. , Griffin James F. , Hackeng Wenzel M. , Kawamoto Satomi , Yu Jun , Chianchiano Peter , Shin Eunice , Lionheart Gemma , Tsai Hua-Ling , Wang Hao , Rezaee Neda , Burkhart Richard A. , Cameron John L. , Thompson Elizabeth D. , Wolfgang Christopher L. , He Jin , Brosens Lodewijk A. A. , Wood Laura D. 
Published: November 2020

Objective:
This study aimed to identify risk factors for recurrence after pancreatic resection for intraductal papillary mucinous neoplasm (IPMN).

Summary Background Data:
Long-term follow-up data on recurrence after surgical resection for IPMN are currently lacking. Previous studies have presented mixed results on the role of margin status in risk of recurrence after surgical resection.

Methods:
A total of 126 patients that underwent resection for noninvasive IPMN were followed for a median of 9.5 years. Dedicated pathological and radiological reviews were performed to correlate clinical and pathological features (including detailed pathological features of the parenchymal margin) with recurrence after surgical resection. In addition, in a subset of 32 patients with positive margins, we determined the relationship between the margin and original IPMN using driver gene mutations identified by next-generation sequencing.

Results:
Family history of pancreatic cancer and high-grade IPMN was identified as risk factors for recurrence in both uni- and multivariate analysis (adjusted hazard ratio 3.05 and 1.88, respectively). Although positive margin was not significantly associated with recurrence in our cohort, the size and grade of the dysplastic focus at the margin were significantly correlated with recurrence in margin-positive patients. Genetic analyses showed that the neoplastic epithelium at the margin was independent from the original IPMN in at least 9 of 32 cases (28%). The majority of recurrences (74%) occurred after 3 years, and a significant minority (32%) occurred after 5 years.

Conclusion:
Sustained postoperative surveillance for all patients is indicated, particularly those with risk factors such has family history and high-grade dysplasia.
Expert Consensus Recommendations for Robotic Surgery Credentialing
Authors: Stefanidis Dimitrios , Huffman Elizabeth M. , Collins Justin W. , Martino Martin A. , Satava Richard M. , Levy Jeffrey S. 
Published: November 2020

Objective:
To define criteria for robotic credentialing using expert consensus.

Background:
A recent review of institutional robotic credentialing policies identified significant variability and determined current policies are largely inadequate to ensure surgeon proficiency and may threaten patient safety.

Methods:
Twenty-eight national robotic surgery experts were invited to participate in a consensus conference. After review of available institutional policies and discussion, the group developed a 91 proposed criteria. Using a modified Delphi process the experts were asked to indicate their agreement with the proposed criteria in three electronic survey rounds after the conference. Criteria that achieved 80% or more in agreement (consensus) in all rounds were included in the final list.

Results:
All experts agreed that there is a need for standardized robotic surgery credentialing criteria across institutions that promote surgeon proficiency. Forty-nine items reached consensus in the first round, 19 in the second, and 8 in the third for a total of 76 final items. Experts agreed that privileges should be granted based on video review of surgical performance and attainment of clearly defined objective proficiency benchmarks. Parameters for ongoing outcome monitoring were determined and recommendations for technical skills training, proctoring, and performance assessment were defined.

Conclusions:
Using a systematic approach, detailed credentialing criteria for robotic surgery were defined. implementation of these criteria uniformly across institutions will promote proficiency of robotic surgeons and has the potential to positively impact patient outcomes.
The Association Between Factors Promoting Nonbeneficial Surgery and Moral Distress
Authors: Zimmermann Christopher J. , Taylor Lauren J. , Tucholka Jennifer L. , Buffington Anne , Brasel Karen , Arnold Robert , Cooper Zara , Schwarze Margaret L. 
Published: November 2020

Objective:
To assess the prevalence of moral distress among surgeons and test the association between factors promoting non-beneficial surgery and surgeons’ moral distress.

Summary Background Data:
Moral distress experienced by clinicians can lead to low-quality care and burnout. Older adults increasingly receive invasive treatments at the end of life that may contribute to surgeons’ moral distress, particularly when external factors, such as pressure from colleagues, institutional norms, or social demands, push them to offer surgery they consider non-beneficial.

Methods:
We mailed surveys to 5200 surgeons randomly selected from the American College of Surgeons membership, which included questions adapted from the revised Moral Distress Scale. We then analyzed the association between factors influencing the decision to offer surgery to seriously ill older adults and surgeons’ moral distress.

Results:
The weighted adjusted response rate was 53% (n = 2161). Respondents whose decision to offer surgery was influenced by their belief that pursuing surgery gives the patient or family time to cope with the patient's condition were more likely to have high moral distress (34% vs 22%, P < 0.001), and this persisted on multivariate analysis (odds ratio 1.44, 95% confidence interval 1.02–2.03). Time required to discuss nonoperative treatments or the consulting intensivists’ endorsement of operative intervention, were not associated with high surgeon moral distress.

Conclusions:
Surgeons experience moral distress when they feel pressured to perform surgery they believe provides no clear patient benefit. Strategies that empower surgeons to recommend nonsurgical treatments when they believe this is in the patient's best interest may reduce nonbeneficial surgery and surgeon moral distress.
Failure to Rescue in Emergency General Surgery
Authors: Hanna Kamil , Chehab Mohamad , Bible Letitia , Asmar Samer , Ditillo Michael , Castanon Lourdes , Tang Andrew , Joseph Bellal 
Published: November 2020

Objective:
Compare EGS patient outcomes after index and nonindex hospital readmissions, and explore predictive factors for nonindex readmission.

Background:
Readmission to a different hospital leads to fragmentation of care. The impact of nonindex readmission on patient outcomes after EGS is not well established.

Methods:
The Nationwide Readmissions Database (2017) was queried for adult patients readmitted after an EGS procedure. Patients were stratified and propensity-matched according to readmission destination: index versus nonindex hospital. Outcomes were failure to rescue (FTR), mortality, number of subsequent readmissions, overall hospital length of stay, and total costs. Hierarchical logistic regression was performed to account for clustering effect within hospitals and adjusting for patient- and hospital-level potential confounding factors.

Results:
A total of 471,570 EGS patients were identified, of which 79,127 (16.8%) were readmitted within 30 days: index hospital (61,472; 77.7%) versus nonindex hospital (17,655; 22.3%). After 1:1 propensity matching, patients with nonindex readmission had higher rates of FTR (5.6% vs 4.3%; P < 0.001), mortality (2.7% vs 2.1%; P < 0.001), and overall hospital costs [in $1000; 37 (27–64) vs 28 (21–48); P < 0.001]. Nonindex readmission was independently associated with higher odds of FTR [adjusted odds ratio 1.18 (1.03–1.36); P < 0.001]. Predictors of nonindex readmission included top quartile for zip code median household income [1.35 (1.08–1.69); P < 0.001], fringe county residence [1.08 (1.01–1.16); P = 0.049], discharge to a skilled nursing facility [1.28 (1.20–1.36); P < 0.001], and leaving against medical advice [2.32 (1.81–2.98); P < 0.001].

Conclusion:
One in 5 readmissions after EGS occur at a different hospital. Nonindex readmission carries a heightened risk of FTR.

Level of Evidence:
Level III Prognostic.

Study Type:
Prognostic.
Factors Associated With Postprocedure Opioid Prescribing and Persistent Opioid Use Among Opioid-naive Patients
Authors: Parikh Megha A. , Fabiyi Camille , Mistry Kamila B. 
Published: November 2020

Objective:
Examine factors associated with postprocedure opioid receipt and persistent opioid use among opioid-naive patients in a nationally representative sample.

Summary Background Data:
We used panels 18-20 in the Medical Expenditures Panel Survey (MEPS) between the years 2013 and 2015. Respondents ages 18 and over with any self-reported procedure in the previous year with complete data on the outcome variables for the remainder of the 2-year study period.

Methods:
This prospective observational study used multivariable regression to determine factors associated with postprocedure opioid receipt and persistent opioid use among opioid-naive patients, adjusting for sociodemographic, health, and procedure-related characteristics.

Results:
Adjusted models showed younger age, Western location (AOR = 1.38; 95% CI = 1.02, 1.86), and high-school degree (AOR = 1.60; CI = 1.14, 2.26) were associated with higher odds of postprocedure opioid receipt. Patients who had procedures in an inpatient (AOR: 5.71; CI: 4.31-7.56), outpatient (AOR = 3.77; CI = 2.87,4.95), and dental setting (AOR = 2.86; CI = 1.45, 5.63), and musculoskeletal diagnoses (AOR = 2.23; CI = 1.39, 3.58) and injuries (AOR = 2.04; CI = 1.29, 3.23) were more likely to have postprocedure opioid receipt. Persistent opioid use was associated with Midwest (AOR = 2.06; CI = 1.08, 3.95) and Northeast location (AOR = 2.45; CI = 1.03, 3.95), musculoskeletal diagnosis (AOR = 3.91; CI = 1.23, 8.31), public insurance (AOR = 2.07; CI = 1.23-3.49), and positive depression screener (AOR = 3.36; CI = 2.04, 5.55).

Conclusions:
Procedures account for a large portion of opioid prescriptions among opioid-naive patients. This study provides evidence to inform national guidelines for opioid prescribing and postprocedure pain management.
Pathophysiological Mechanisms of Gastro-esophageal Reflux After Sleeve Gastrectomy
Authors: Johari Yazmin , Lim Gillian , Wickremasinghe Anagi , Yue Helen , Seah Jarrel , Ooi Geraldine , Playfair Julie , Laurie Cheryl , Beech Paul , Yap Kenneth , Hebbard Geoff , Brown Wendy , Burton Paul 
Published: November 2020

Objective:
To evaluate the mechanisms associated with reflux events after sleeve gastrectomy (SG).

Summary Background Data:
Gastro-esophageal reflux (GERD) post-SG is a critical issue due to symptom severity, impact on quality of life, requirement for reoperation, and potential for Barrett esophagus. The pathophysiology is incompletely delineated.

Methods:
Post-SG patients, stratified into asymptomatic and symptomatic, underwent protocolized nuclear scintigraphy (n = 83), 24-hour esophageal pH monitoring, and stationary manometry (n = 143) to characterize reflux patterns. Ten patients underwent fasting and postprandial concurrent manometry and pH for detailed analysis of reflux events.

Results:
Baseline demographics between cohorts were similar: Age 47.2 ± 11.6 versus 44.1 ± 11.3 years (P = 0.121); females 73.2% versus 90.8% (P = 0.005); excess weight loss 53.8 ± 28.1% versus 57.4 ± 25.5% (P = 0.422), follow-up duration 12.3 versus 7.4 months (P = 0.503). Nuclear scintigraphy delineated bolus-induced deglutitive reflux events (29.6% vs 62.5%, P = 0.005) and postprandial reflux events [4 (IQR2) versus 4 (IQR 3) events, P = 0.356]. Total acid exposure was significantly elevated in the symptomatic population (7.7% vs 3.6%, P < 0.001), especially fasting acid exposure (6.0% vs 1.3%, P < 0.001). pH/manometry analysis demonstrated acute elevations of the gastro-esophageal pressure gradient (>10 mm Hg) underpinned most reflux events. Swallow-induced intragastric hyper-pressur-ization was associated with individual reflux events in most patients (90% in fasting state and 40% postprandial).

Conclusions:
We found reflux to be strongly associated with SG and identified 3 unique categories. Bolus-induced deglutitive and postprandial reflux occurred in most patients. Elevated fasting esophageal acid exposure mediated symptoms. Frequent, significant elevation in the gastro-esophageal pressure gradient was the mechanism of reflux and seemed to relate to the noncompliant proximal stomach.