bluuebunny/crossref_metadata_2025_split huggingface dataset:
High Fractions of Large Islets in Human Islet Preparations Detrimentally Affect Posttransplant Outcomes in Streptozotocin-Induced Diabetic Immunodeficient Mice
Authors: Komatsu Hirotake , Salgado Mayra , Gonzalez Nelson , Medrano Leonard , Rawson Jeffrey , Omori Keiko , Qi Meirigeng , Al-Abdullah Ismail , Kandeel Fouad , Mullen Yoko 
Published: May 2020

Objectives
The aim of this study was to determine whether the size of islets isolated from human donors—measured pretransplant—impacts transplantation outcomes in diabetic mice.

Methods
Human islets (1200 islet equivalents) were transplanted into the kidney capsules of streptozotocin-induced diabetic immunodeficient mice. Data from a total of 174 mice that received islets from 45 isolations were analyzed to evaluate the correlation between pretransplant islet size and posttransplant diabetes reversal. Fluorescent images of islet clusters were used to categorize individual islets by size (small, 50–150 μm; medium, 150–250 μm; large, >250 μm), and the fractions of islets in each category were calculated.

Results
The fraction of large islets negatively correlated with diabetes reversal rates. Mice that received islet grafts containing 0% to 5%, 5% to 10%, and more than 10% large islets had diabetes reversal rates of 75%, 61%, and 45%, respectively (P = 0.0112). Furthermore, mice that exhibited diabetes reversal received smaller fractions of large islets than mice that did not (5.5% vs 8.0%, P = 0.0003). Intriguingly, the fractions of medium and small islets did not correlate with diabetes reversal outcomes.

Conclusions
The fraction of large islets is a sensitive predictor of human islet transplantation outcomes in diabetic mice.
Role of Static and Dynamic Intra-abdominal Pressure Monitoring in Acute Pancreatitis
Authors: Goenka Mahesh Kumar , Goenka Usha , Afzalpurkar Shivaraj , Tiwari Subhash Chandra , Agarwal Rachit , Tiwary Indrajeet Kumar 
Published: May 2020

Objective
This study was aimed to determine the relationship between static and dynamic intra-abdominal pressure (IAP) with the mortality and outcome of acute pancreatitis.

Methods
From July 2017 to December 2018, 150 patients admitted at the Institute of Gastrosciences and Liver and diagnosed as acute pancreatitis were included in the study. Intra-abdominal pressure was measured for the first few days, and mean value of day 1 (static IAP) and highest value on day 2 and day 3 (dynamic IAP) were calculated and categorized into intra-abdominal hypertension and abdominal compartment syndrome.

Results
A statistical relationship was observed between static and dynamic IAP with the severity and mortality of acute pancreatitis. Both static and dynamic IAPs tended to be higher in nonsurvivors (83.33% and 88.88%, respectively) compared with survivors (51.51% and 63.63%, respectively). Higher IAP had more severe disease. However, IAP did not correlate with the evidence of sepsis or serum procalcitonin levels.

Conclusion
Determination of static IAP is an easy, useful, and inexpensive method to determine and predict the mortality of acute pancreatitis. Prevention and/or early detection of intra-abdominal hypertension helps in reducing the mortality in acute pancreatitis.
Analysis of 102 Fully Robotic Pancreaticoduodenectomies
Authors: Mejia Alejandro , Shah Jimmy , Vivian Elaina , Acharya Priyanka 
Published: May 2020

Objectives
The value of robotic pancreaticoduodenectomy (RPD) remains undefined. The aim of this retrospective study was to compare and assess clinical outcomes and financial variables of patients undergoing RPD versus open pancreaticoduodenectomy (OPD) at a single high-volume center.

Methods
The study design is a retrospective analysis of a prospectively maintained database of consecutive PD patients from 2013 to 2019. Clinical variables and total hospital charges were evaluated as an unadjusted and adjusted intention-to-treat analysis.

Results
A total of 156 patients (54 OPD, 102 RPD) were identified. In the RPD group, patients were significantly older (P = 0.0304) and had shorter length of stay (mean, 7 vs 11.8 days; P < 0.0001) and longer operative times (mean, 352.7 vs 211.5 minutes; P < 0.0001) compared with OPD. There was no significant difference in 90-day readmissions, bleeding, or complications between OPD and RPD. Adjusted charge analyses show no difference in total charges (P = 0.057).

Conclusions
Robotic pancreaticoduodenectomy is safe, feasible, and valid alternative to OPD. Because of comparable results within each group, randomized trials may be indicated. High-volume RPD centers should collaborate to better understand the differences and advantages over laparoscopic or OPD.
A Nurse Shadowing Program for Physicians
Authors: Johnson Courtney M. , Khan Amir , Stark Sarah , Samee Mohammed 
Published: May 2020

OBJECTIVE
A physician-nurse shadow program was established to improve interdisciplinary collaboration.

BACKGROUND
Ineffective communication between physicians and nurses leads to poor outcomes in patient satisfaction, safety, and associate engagement. Physician unfamiliarity of the nursing process is identified as a root cause.

METHODS
First-year resident physicians shadowed nurses for a 4-hour shift. Residents did not function as a physician during the shadowing experience but participated in nursing workflow and tasks. Participants completed a Likert-scale rating and qualitative survey before and after the shift.

RESULTS
The survey measured confidence in communication and perception of workflow. Confidence levels increased in all areas by 29% for residents and 34% for nurses. Data demonstrated improved physician understanding of nursing workflow and inspired recommendations to enhance communication.

CONCLUSIONS
First-year resident physicians practiced direct communication skills and experienced hands-on nursing care during the shadow program. The initiative provided an environment for mutual learning and interdisciplinary relationship-building.
Antenatal Corticosteroids and Magnesium Sulfate for Improved Preterm Neonatal Outcomes: A Review of Guidelines
Authors: Tsakiridis Ioannis , Mamopoulos Apostolos , Athanasiadis Apostolos , Dagklis Themistoklis 
Published: May 2020

Importance
In cases of anticipated preterm delivery, corticosteroids for fetal lung maturation and magnesium sulfate for fetal neuroprotection may improve neonatal outcomes.

Objective
The aim of this study was to summarize and compare published guidelines from 4 leading medical societies on the administration of antenatal corticosteroids and magnesium sulfate.

Evidence Acquisition
A descriptive review of major national guidelines on corticosteroids and magnesium sulfate was conducted: National Institute for Health and Care Excellence on “Preterm labour and birth,” World Health Organization on “WHO recommendations on interventions to improve preterm birth outcomes,” American College of Obstetricians and Gynecologists on “Antenatal corticosteroid therapy for fetal maturation” and “Magnesium sulfate use in obstetrics,” and Society of Obstetricians and Gynecologists of Canada on “Antenatal corticosteroid therapy for improving neonatal outcomes” and “Magnesium sulphate for fetal neuroprotection.”

Results
A variation in the appropriate timing of administration exists, whereas repeated courses are not routinely recommended for corticosteroids or magnesium sulfate. In addition, the recommendations are the same for singleton and multiple gestations, and no specific recommendation exists according to maternal body mass index. Finally, a variation in guidelines regarding the administration of corticosteroids before cesarean delivery exists.

Conclusions
The adoption of an international consensus on corticosteroids and magnesium sulfate may increase their endorsement by health care professionals, leading to more favorable neonatal outcomes after preterm delivery.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After participating in this activity, the learner should be better able to identify the appropriate indications for the administration of corticosteroids and magnesium sulfate; describe the effectiveness and associated risks of corticosteroids and magnesium sulfate; and explain the timing and schemes of corticosteroids and magnesium sulfate administration.
Patient-Centered Outcomes After Modified Vestibulectomy
Authors: Das Deepanjana , Davidson Emily R. W. , Walters Mark , Farrell Ruth M. , Ferrando Cecile A. 
Published: May 2020

(Abstracted from Obstet Gynecol 2020;135:113–121)
Vulvodynia is a complex gynecologic pain condition characterized by at least 3 months of vulvar pain with no identifiable cause. Symptoms can be categorized as generalized vulvodynia (with unprovoked pain affecting the entire vulvar) or as provoked vestibulodynia (with localized pain at the vestibule).
Identifying Predictors of Physical Abuse Evaluation of Injured Infants
Authors: Eismann Emily A. , Shapiro Robert Allan , Makoroff Kathi L. , Theuerling Jack , Stephenson Nicole , Duma Elena M. , Fain Emily T. , Frey Theresa M. , Riney Lauren C. , Thackeray Jonathan D. 
Published: May 2020

Objectives
To identify predictors of physical abuse evaluation in infants younger than 6 months with visible injury and to determine the prevalence of occult fracture and intracranial hemorrhage in those evaluated.

Methods
Infants 6.0 months or younger who presented with visible injury to a pediatric hospital-affiliated emergency department or urgent care between July 2013 and January 2017 were included. Potential predictors included sociodemographics, treatment site, provider, injury characteristics, and history. Outcome variables included completion of a radiographic skeletal survey and identification of fracture (suspected or occult) and intracranial hemorrhage.

Results
Visible injury was identified in 378 infants, 47% of whom did not receive a skeletal survey. Of those with bruising, burns, or intraoral injuries, skeletal survey was less likely in patients 3 months or older, of black race, presenting to an urgent care or satellite location, evaluated by a non–pediatric emergency medicine-trained physician or nurse practitioner, or with a burn. Of these, 25% had an occult fracture, and 24% had intracranial hemorrhage. Occult fractures were also found in infants with apparently isolated abrasion/laceration (14%), subconjunctival hemorrhage (33%), and scalp hematoma/swelling (13%).

Conclusions
About half of preambulatory infants with visible injury were not evaluated for physical abuse. Targeted education is recommended as provider experience and training influenced the likelihood of physical abuse evaluation. Occult fractures and intracranial hemorrhage were often found in infants presenting with seemingly isolated “minor” injuries. Physical abuse should be considered when any injury is identified in an infant younger than 6 months.
American Indian Reservations and COVID-19: Correlates of Early Infection Rates in the Pandemic
Authors: Rodriguez-Lonebear Desi , Barceló Nicolás E. , Akee Randall , Carroll Stephanie Russo 
Published: May 2020

Objective:
To determine the household and community characteristics most closely associated with variation in COVID-19 incidence on American Indian reservations in the lower 48 states.

Design:
Multivariate analysis with population weights.

Setting:
Two hundred eighty-seven American Indian Reservations and tribal homelands (in Oklahoma) and, as of April 10, 2020, 861 COVID-19 cases on these reservation lands.

Main Outcome Measures:
The relationship between rate per 1000 individuals of publicly reported COVID-19 cases at the tribal reservation and/or community level and average household characteristics from the 2018 5-Year American Community Survey records.

Results:
By April 10, 2020, in regression analysis, COVID-19 cases were more likely by the proportion of homes lacking indoor plumbing (10.83, P = .001) and were less likely according to the percentage of reservation households that were English-only (−2.43, P = .03). Household overcrowding measures were not statistically significant in this analysis (−6.40, P = .326).

Conclusions:
Failure to account for the lack of complete indoor plumbing and access to potable water in a pandemic may be an important determinant of the increased incidence of COVID-19 cases. Access to relevant information that is communicated in the language spoken by many reservation residents may play a key role in the spread of COVID-19 in some tribal communities. Household overcrowding does not appear to be associated with COVID-19 infections in our data at the current time. Previous studies have identified household plumbing and overcrowding, and language, as potential pandemic and disease infection risk factors. These risk factors persist. Funding investments in tribal public health and household infrastructure, as delineated in treaties and other agreements, are necessary to protect American Indian communities.
Using Practice Facilitation to Improve Depression Management in Rural Pediatric Primary Care Practices
Authors: Baum Rebecca A. , Hoholik Suzanne , Maciejewski Heather , Ramtekkar Ujjwal 
Published: May 2020

Introduction:
Depression is a common and serious mental health condition frequently encountered in pediatric primary care. Pediatricians report discomfort in managing depression due in part to limited training and limited access to mental health care, which is accentuated in rural areas.

Methods:
We developed an evidence-based, quality improvement project designed to help pediatricians increase screening and initial management of depression in the primary care setting. We recruited practices from a pediatric accountable care organization as part of a larger quality improvement portfolio that used a practice facilitation model to support practices with data collection and project management. Practitioners received training on quality improvement, depression screening, and a depression management plan (referred to as the depression management bundle). Practices completed Plan-Do-Study-Act cycles to improve their performance.

Results:
We recruited 4 practices in rural Ohio to participate. Screening increased from 0% to 81% within 6 months. All 4 practices measured documentation of the depression management bundle for patients diagnosed with depression. Composite data from these practices showed an increase in documentation from 59% to 86% by month 6.

Conclusions:
This study provides preliminary support for the use of practice facilitation combined with skills training to increase screening and improve documentation of depression management in rural primary care practices, where specialty mental health resources may be limited. Further research is needed to determine if this approach can be successfully disseminated and if patient outcomes improved.
In-Hospital Patient Harm Across Linguistic Groups: A Retrospective Cohort Study of Home Care Recipients
Authors: Reaume Michael , Batista Ricardo , Talarico Robert , Guerin Eva , Rhodes Emily , Carson Sarah , Prud’homme Denis , Tanuseputro Peter 
Published: May 2020

Objective
Research examining the impact of language barriers on patient safety is limited. We conducted a population-based study to determine whether patients whose primary language is not English are more likely to experience harm when admitted to hospitals in Ontario, Canada.

Methods
We used linked administrative health records to establish a retrospective cohort of home care recipients (from 2010 to 2015) who were subsequently admitted to hospital. Patient language (obtained from home care assessments) was coded as English, French, or other. Harmful events were identified using the Hospital Harm Indicator developed by the Canadian Institute for Health Information.

Results
We included 190,724 patients (156,186 Anglophones, 5,110 Francophones, and 29,428 Allophones). There was no significant difference in the unadjusted risk of harm for Francophones compared with Anglophones (relative risk [RR], 0.94; 95% confidence interval [CI], 0.87–1.02). However, Allophones were more likely to experience harm when compared with Anglophones (RR, 1.14; 95% CI, 1.10–1.18). The risk of harm was even greater for Allophones with low English proficiency (RR, 1.18; 95% CI, 1.13–1.24). After adjusting for potential confounders, Anglophones and Allophones were equally likely to experience harm of any type, but Allophones more likely to experience harm from infections and procedures.

Conclusions
Patients whose primary language was not English or French were more likely to experience harm after admission to hospital, especially if they had low English proficiency. For these patients, the risk of harm from infections and procedures persisted in the adjusted analysis, but the overall risk of harm did not.
Incidental Finding of Colon Carcinoma Related to High Uptake in 18F-PSMA-1007 PET
Authors: Arçay Ayça , Eiber Matthias , Langbein Thomas 
Published: May 2020

Abstract
We present a 78-year-old man with suspicion of prostate cancer due to a PSA of 200 ng/mL, who underwent 18F-PSMA-1007 (prostate specific membrane antigen) PET/CT for primary staging. Besides heterogeneous uptake to the prostate, an increased PSMA uptake in the cecum was observed, located in the thickened cecal wall with suspicion of a secondary malignancy. Colonoscopic biopsy followed by hemicolectomy confirmed the diagnosis of colon adenocarcinoma. This case demonstrates the importance of bioptic workup of suspicious findings on PSMA PET/CT, which are unlikely to be related to prostate cancer as PSMA ligand uptake is not exclusively prostate cancer specific.
Peyronie Disease as an Example of Nononcological, Inflammatory Uptake of 18F-Fluorocholine in Patient With Prostate Cancer
Authors: Cegla Paulina , Kubiak Anna , Witkowska Kamila , Czepczyński Rafał 
Published: May 2020

Abstract

18F-fluorocholine PET/CT is commonly used for staging and assessing treatment response in prostate cancer patients. Growing clinical experience has shown that 18F-fluorocholine can actually accumulate in sites of inflammation. We report a rare case of a prostate cancer patient with incidentally detected Peyronie disease.
Effect of Different 131I Dose Strategies for Treatment of Hyperthyroidism on Graves’ Ophthalmopathy
Authors: Ariamanesh Shahrara , Ayati Narjess , Mazloum Khorasani Zahra , Mousavi Zohreh , Kiavash Victoria , Kiamanesh Zahra , Zakavi Seyed Rasoul 
Published: May 2020

Purpose
The study aims to define the effect of different dose strategies on ophthalmic complications in patients with Graves’ disease (GD).

Methods
All the patients with GD and no or inactive ophthalmopathy (clinical activity score; CAS < 3) underwent Snellen chart examination, measurement of proptosis, thyroid volume, and radioactive iodine uptake, and randomized into 1 of 3 groups. In group 1, all the patients received fixed low dose (FLD) of 259 MBq of 131I, whereas in group 2, all the patients received fixed high dose (FHD) of 555 MBq, and in group 3, calculated dose (CD) was administered to deliver 5.55 MBq/g (thyroid weight) of 131I. All examinations were repeated 6 months after treatment. The measurement of thyroid function tests and clinical examination were repeated after 12 months.

Results
We studied 92 patients (58 female and 34 male) with mean age of 38.2 ± 12.0 years. Overall, 29, 32, and 31 patients were studied in FLD, FHD, and CD groups, respectively. The patients in CD received a mean activity of 240.5 MBq. The 3 groups were not significantly different regarding age, sex ratio, radioactive iodine uptake, smoking, visual acuity, and proptosis. The response rate 12 months after radioactive iodine therapy was 66.7%, 94.4%, and 92.9% in FLD, FHD, and CD groups, respectively (P = 0.05). Overall, CAS was increased significantly after treatment. Delta proptosis and delta CAS were increased significantly in FHD group compared with other groups (P < 0.05). The highest increment in proptosis was seen in FHD group.

Conclusions
The administration of 5.55 MBq/g of 131I has fewer ophthalmic complications compared with high fixed dose model and is more effective than low fixed dose strategy.
FDG PET/CT Findings in an Asymptomatic Case of Confirmed COVID-19
Authors: Martineau Patrick , Kidane Biniam 
Published: May 2020

Abstract
In the current and rapidly worsening pandemic, patients with COVID-19 may undergo imaging with FDG PET/CT. Because a significant proportion of infected patients may be asymptomatic, incidental discovery on a PET/CT scan performed for unrelated reasons can occur. Because of the highly infectious nature of this agent, it is important that interpreting physicians be aware of the typical imaging findings to identify potentially affected patients. We present the case of an asymptomatic patient referred for FDG PET/CT imaging of a lung nodule who demonstrated the typical CT findings of COVID-19 infection and was subsequently found to be positive on testing.
Minimizing the Risk of Aerosol Contamination During Elective Lung Resection Surgery
Authors: Rakovich George , Urbanowicz Robert , Issa Rami , Wang Han Ting 
Published: May 2020

Background:
In the setting of the COVID-19 pandemic, the conduct of elective cancer surgery has become an issue because of the need to balance the requirement to treat patients with the possibility of transmission of the virus by asymptomatic carriers. A particular concern is the potential for viral transmission by way of aerosol which may be generated during perioperative care. There are currently no guidelines for the conduct of elective lung resection surgery in this context.

Methods:
A working group composed of 1 thoracic surgeon, 2 anesthesiologists and 1 critical care specialist assessed the risk for aerosol during lung resection surgery and proposed steps for mitigation. After external review, a final draft was approved by the Committee for the Governance of Perioperative and Surgical Activities of the Hôpital Maisonneuve-Rosemont, in Montreal, Canada.

Results:
The working group divided the risk for aerosol into 6 time-points: (1) intubation and extubation; (2) Lung isolation and patient positioning; (3) access to the chest; (4) conduct of the surgical procedure; (5) procedure termination and lung re-expansion; (6) chest drainage. Mitigating strategies were proposed for each time-point.

Conclusions:
The situation with COVID-19 is an opportunity to re-evaluate operating room protocols both for the purposes of this pandemic and similar situations in the future. In the context of lung resection surgery, specific time points during the procedure seem to pose specific risks for the genesis of aerosol and thus should be the focus of attention.