bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does a Long-Term Quality and Safety Curriculum for Health Care Professionals Improve Clinical Practice? An Evaluation of Quality Improvement Projects
Authors: van Tuijl Anne A. C. , Calsbeek Hiske , Wollersheim Hub C. , Laan Roland F. J. M. , Fluit Cornelia R. M. G. , van Gurp Petra J. 
Published: December 2019

Introduction:
Little is known about the effects on clinical practice of continuing education quality and safety curricula. The aim of this study is to gain insight into learning outcomes on the fourth level of the Kirkpatrick evaluation model for systematically deployed quality improvement projects performed by health care professionals during a Masters in Healthcare Quality and Safety in the Netherlands.

Methods:
The researchers reviewed 35 projects led by health care professionals in 16 different hospitals to determine their scopes and effects. Afterward, professionals took an online survey to determine the extent of their project's sustainability and spread.

Results:
Improving health care safety was the most prevalent quality dimension (n = 11, 31%). A positive change was measured by professionals for 64% (n = 35) of the primary outcomes. Statistical significance was measured in 19 (35%) of the outcomes, of which nine (47%) were found to have a statistically significant effect. A minority of professionals (17%) judged their project as sustained by the department, while some stated that the intervention (37%) or the results of the project (11%) had spread.

Discussion:
Although most projects indicated an improvement in their primary outcomes, only a few resulted in statistically significant changes. Teaching professionals in using evaluation methods that take into account the complex context where these projects are performed and teaching them leadership skills is needed to reduce the likelihood of unmeasured outcomes. Analyzing learning experiences of professionals in performing the project is important to see what they learned from performing quality improvement projects, providing experiences that may lead to sustainable effects in future projects.
Menopause and risk of hip fracture in middle-aged Chinese women: a 10-year follow-up of China Kadoorie Biobank
Authors: Peng Ke , Yao Pang , Kartsonaki Christiana , Yang Ling , Bennett Derrick , Tian Maoyi , Li Liming , Guo Yu , Bian Zheng , Chen Yiping , Chen Zhengming , Ivers Rebecca , Woodward Mark , Clarke Robert 
Published: December 2019

Abstract

Objective:
Bone loss is accelerated after menopause in women, as is the risk of hip fracture, but little is known about the importance of age at menopause, time since menopause, and total reproductive years for risk of hip fracture.

Methods:
Between 2004 and 2008, the China Kadoorie Biobank recruited 125,336 postmenopausal women who had a natural menopause and recorded 1,327 incident cases of hip fracture during the first 10 years of follow-up. Multivariable Cox regression was used to estimate hazard ratios and 95% CIs for incident hip fracture for age at menopause, time since menopause, and total reproductive years.

Results:
The mean (SD) age at menopause was 48.8 (4.0) years. Compared with women who reached menopause before age 53 years, women with a later age at menopause had a 22% (95% CI, 11%-35%) lower risk of hip fracture. Compared with women who were <5 years since menopause, those who were 5 to 9, 10 to 14, 15 to 19, and ≥20 years since menopause had hazard ratios of hip fracture of 1.43 (95% CI, 1.01-2.04), 2.10 (95% CI, 1.71-2.57), 2.50 (95% CI, 2.21-2.83), and 2.33 (95% CI, 1.97-2.75), respectively. Women with a longer (≥36 y) versus shorter (<30 y) duration of total reproductive years had a 19% (95% CI, 9-28) lower risk of hip fracture.

Conclusions:
Women with younger age at menopause, longer interval since menopause, or shorter duration of total reproductive years had the highest risks of hip fracture.
A Meta-analysis on the Outcome of Sequential Glaucoma Drainage Implantation
Authors: Yoon Dan , Vajaranant Thasarat 
Published: December 2019

Precis:
A meta-analysis shows that second glaucoma drainage implantation can be effective after a failed drainage implant. There is a need for continued glaucoma medications and the risk of corneal decompensation.

Purpose:
Studies on second glaucoma drainage implantation are small and exploratory. We performed a meta-analysis on the efficacy of second glaucoma drainage implantation.

Materials and Methods:
The intraocular pressure (IOP) and the number of glaucoma medications were compared preoperative to postoperative after second drainage implantation. Kaplan-Meier survival curves were aggregated and compared with the survival curve from the Tube versus Trabeculectomy study.

Results:
Nine studies, all retrospective, were included in the meta-analysis. Our results showed that second drainage implantation significantly lowered the IOP and reduced the number of medications. Most patients still required medications for adequate IOP control. Second drainage implants tended to fail earlier than first drainage implants in the Tube versus Trabeculectomy study. The most common complication after second drainage implants was corneal decompensation.

Conclusions:
Second glaucoma drainage implantation can be considered a viable approach after a failed drainage implant, but patients should be counseled on the need for continued medical therapy and the risk of corneal decompensation.
Hypotony Keratopathy Following Trabeculectomy
Authors: Camp Andrew S. , Weinreb Robert N. 
Published: December 2019

Precis:
Hypotony keratopathy is a potential complication of hypotony following trabeculectomy and successful treatment depends on increasing intraocular pressure (IOP).

Purpose:
To evaluate corneal decompensation in patients following trabeculectomy with adjuvant mitomycin C (MMC). We propose “hypotony keratopathy” as a descriptive term.

Methods:
Patients with trabeculectomy and follow-up performed by the authors were included in this retrospective single-center study. Patients were included if they had evidence of corneal decompensation (Descemet membrane folds or corneal edema) the following trabeculectomy with MMC with concurrent hypotony. Outcome measures included best-corrected visual acuity, average IOP at time of diagnosis, and changes in central corneal thickness. Clinical outcomes for the treatment of hypotony keratopathy were noted when performed.

Results:
A total of 14 eyes from 12 patients were included in the series. Hypotony developed an average of 5 years after trabeculectomy, and hypotony keratopathy was diagnosed 7.5 years after trabeculectomy. Hypotony keratopathy ranged from nonvisually significant Descemet membrane fold without increased corneal thickness to visually significant corneal edema. Best-corrected visual acuity decreased 0 to 6 Snellen lines after diagnosis of hypotony keratopathy. Lower IOP was associated with increased corneal thickness. Vision improved after trabeculectomy revision (6 eyes) and cataract extraction with an intraocular lens implant (1 eye) but did not improve after Descemet stripping automated endothelial keratoplasty (2 eyes).

Conclusions:
Hypotony keratopathy is a poorly described but potentially treatable complication of trabeculectomy with MMC. Hypotony keratopathy may be related to endothelial dysfunction secondary to hypotony.
Solitary Fibrous Tumor of the Orbit: A Case Series With Clinicopathologic Correlation and Evaluation of STAT6 as a Diagnostic Marker
Authors: Blessing Nathan W. , Bermudez-Magner J. Antonio , Fernandez Maria P. , Rosenberg Andrew E. , Dubovy Sander R. , Johnson Thomas E. 
Published: December 2019

Purpose:
To retrospectively describe the clinical characteristics, management, and outcomes of a series of patients with solitary fibrous tumor (SFT) of the orbit and to evaluate signal transducer and activator of transcription 6 (STAT6) as a diagnostic marker.

Methods:
Review of a retrospective, noncomparative, consecutive series of patients treated at a single institution with a histopathologic diagnosis of SFT. Demographic, clinical, and imaging data were collected, and paraffin-embedded tissue sections were stained to evaluate for the presence of STAT6 and other pertinent markers.

Results:
Twenty-one patients were identified. Most presented with painless progressive proptosis or eyelid swelling for less than 6 months. Imaging revealed well-circumscribed, firm, variably vascular contrast-enhancing lesions with low to medium reflectivity on ultrasound. Four tumors were histopathologically malignant. All tumors were primarily excised, and 1 patient required exenteration. Two patients were treated with adjuvant radiation therapy. Six patients had recurrent disease of which 3 underwent repeat excision, and 2 were observed. No metastatic disease or attributable deaths were observed. All lesions with available tissue stained positively for both CD34 and STAT6.

Conclusion:
This is the largest single institution case series of orbital SFT with clinicopathologic correlation and the largest series to confirm the presence of STAT6 in orbital lesions. The management of SFT remains challenging due to unpredictable tumor behavior, and complete excision is the generally recommended treatment. It remains unclear whether a subset of asymptomatic patients with histopathologically benign disease can be durably observed without negative sequelae.
Fluid Infusion Through Chest Tube to Facilitate Pleural Procedures
Authors: Majid Adnan , Rivera Estefania , Sisniega Carlos , Husta Brian , Chee Alex , Parikh Mihir , Holden Van , Kheir Fayez 
Published: December 2019

Background:
Most pleural procedures need the presence of a moderate effusion to allow safe access to the pleural space. We propose a technique to allow safe access in patients with a drained pleural space who require further pleural evaluation or treatment during the same hospital stay.

Methods:
This was a retrospective study. All patients who underwent any pleural intervention with a prior infusion of fluid in the pleural space using a pre-existing chest tube (≤14 Fr) were included. Before the pleural intervention, warm saline was infused into the pleural space through the small-bore chest tube until enough fluid was detected on thoracic ultrasound to allow pleural access. Data on patient demographics, indication for the pleural procedure, and patient outcome was analyzed.

Results:
A total of 22 patients with pleural disease underwent definitive pleural procedure facilitated by fluid infusion. Median volume of fluid infused was 1000 mL (850, 1500 mL). The median time between the initial chest tube insertion and the subsequent definitive pleural procedure was 3 days (2, 7 d). All procedures were completed successfully. One patient had a hemothorax secondary to fluid infusion.

Conclusion:
Fluid infusion through a chest tube is a feasible technique for patients that require a pleural procedure and have minimal fluid after initial pleural drainage. This approach may facilitate pleural procedures, reduce incidence of complications, and expedite the diagnosis and treatment of patients with pleural diseases. Pressure infusers should not be used during this procedure as there is a theoretical increased risk of complications.
Gastrectomy Versus Endoscopic Resection for Patients With Early-stage Gastric Adenocarcinoma
Authors: Yang Jiahui , Ren Mudan , Lu Guifang , Liu Huan , Liu Chuan , Wang Wancong , He Shuixiang 
Published: December 2019

Background:
This study aimed to compare the long-term results of patients who received these therapies.

Materials and Methods:
The Surveillance, Epidemiology, and End Results (SEER) database was queried in this research for data of patients with early gastric adenocarcinoma who underwent gastrectomy or endoscopic resection from 2007 to 2015. Propensity score matching was selected to generate a balanced cohort. Competing-risk regression analysis was carried out on the matched cohort. Cancer-specific mortality (CSM) and other cause-specific mortality (OCSM) were compared using adjusted subdistribution hazard ratios (SHRs).

Results:
In this study, 2214 patients with 191 underwent endoscopic treatment (ET) and 2023 who underwent surgery were identified. After propensity score matching, 474 patients were included in the analysis. The use of ET increased over time in patients, especially for those with cardia diseases. The ratio of 5-year CSM between ET and gastrectomy groups was 13.12% to 14.24% and the ratio of 5-year OCSM between them was 22.48% versus 14.31%. After adjusting for associated clinicopathologic factors, patients in both groups had similar CSM (SHR=0.87, 95% credible interval: 0.47-1.64, P=0.69) and OCSM (SHR=1.59, 95% credible interval: 0.94-2.68, P=0.08) in multivariable analysis.

Conclusion:
The long-term prognosis appears equivalent t in patients with endoscopic resection and gastrectomy.
Biosynthetic Human Insulin and Insulin Analogs
Authors: Rodbard Helena W. , Rodbard David 
Published: December 2019

Background:
Biosynthetic human insulins and analogs have replaced animal insulins and permitted structural modifications to alter the rate of absorption, duration of action, improve reproducibility of effects, and modulate relative efficacy in various target tissues. Several forms of rapidly acting insulins nearly achieve rapid pharmacokinetics and pharmacodynamics similar to first-phase insulin release. There is need for even faster-acting analogs to mimic normal physiology and improve control of postprandial glycemic excursions. Two biosynthetic insulin analogs have sufficiently long duration of action for use as once-daily basal insulins; controversy persists regarding their respective risks of hypoglycemia and relative glycemic variability.

Results:
Basal-bolus therapy and insulin pump therapy, including closed-loop automated insulin delivery, require rapid-acting insulin analogs. The longer acting insulins can provide stable, reproducible basal insulin with reduced rates of hypoglycemia, particularly nocturnal hypoglycemia, greater efficacy in reducing mean glucose and glucose variability while increasing time in glucose target range. Inhalable human insulin provides very rapid action. Premixture of rapid-acting analogs with protamine has been useful for some patients with type 2 diabetes. An insulin analog with preferential efficacy at the liver has been developed and tested clinically but not marketed. Current research is aimed at developing even faster-acting insulin analogs. Long-acting basal insulins coformulated with GLP-1 receptor agonists or with a rapidly acting insulin analog have valuable clinical applications. Excipients, chaperones, local heating of the infusion site, and hyaluronidase have also been used to accelerate the absorption of insulin analogs.

Conclusions:
Biosynthetic human insulins have radically revolutionized management of both type 1 and type 2 diabetes worldwide. The ability to manipulate the structure and formulation of insulin provides for more physiologic pharmacokinetics and pharmacodynamics, enabling improved glycemic control, reduced risk of hypoglycemia, and reduced rates of long-term complications.
Protean Manifestations and Diagnostic Challenges Including Discordance Between Electrodiagnostic-Radiologic Studies in Neurolymphomatosis
Authors: Lorance David K. , Allison James B. , Gardner Juli-Anne , Waheed Waqar 
Published: December 2019

Introduction:
Malignant lymphocytic infiltration of the central nervous system (CNS) and peripheral nervous system (PNS) is diagnostically challenging and informs treatment and prognosis.

Case Report:
We describe the clinical course of a 49-year-old man with CNS and PNS relapse of mantle cell lymphoma and the diagnostic modalities that enabled the diagnosis of neurolymphomatosis.

Conclusion:
This clinical phenotype reinforces previously reported presentations of neurolymphomatosis and the ability of multimodal diagnostics, when combined with clinical suspicion phenotype, to enable diagnosis of malignant lymphocytic infiltration of the CNS and PNS.
Longitudinal Patterns of Sexually Transmitted Infection Risk Based on Psychological Characteristics and Sexual Behavior in Heterosexual Sexually Transmitted Infection Clinic Visitors
Authors: van Wees Daphne A. , Heijne Janneke C.M. , Basten Maartje , Heijman Titia , de Wit John , Kretzschmar Mirjam E.E. , den Daas Chantal 
Published: December 2019

Background
Great heterogeneity in sexually transmitted infections (STI) risk exists, and investigating individual-level characteristics related to changes in STI risk over time might facilitate the development and implementation of effective evidence-based behavior change interventions. The aim of this study was to identify longitudinal patterns of STI risk based on psychological and behavioral characteristics.

Methods
A longitudinal study was conducted among heterosexual STI clinic visitors aged 18 to 24 years. Latent classes based on behavioral and psychological characteristics at baseline, and transitions from 1 latent class to another at 3-week, 6-month, and 1-year follow-up, were identified using latent transition analysis.

Results
Four latent classes were identified that could be differentiated by psychological and behavioral characteristics and STI risk: overall low-risk (10%), insecure high-risk (21%), condom-users (38%), and confident high-risk (31%). Although the majority of the total study population did not move to another latent class over time, the size of the overall low-risk group increased from 10% at baseline to 30% after 1 year. This was mainly due to transitions from the insecure high-risk, condom-users, and confident high-risk class at 3-week follow-up to the overall low-risk class at 6-month follow-up.

Conclusions
Distinct subgroups among heterosexual STI clinic visitors can be differentiated from each other by multiple psychological and behavioral characteristics, and these characteristics reflecting the risk of acquiring STI are consistent over the course of 1 year in most individuals. An integral approach, adapting behavioral interventions to match multiple psychological and behavioral characteristics of high-risk subgroups, might be more effective in controlling STI transmission.
Prospective Study of Doppler Ultrasound Surveillance for Deep Venous Thromboses in 1000 Plastic Surgery Outpatients
Authors: Swanson Eric 
Published: December 2019

Background:
Current guidelines recommend individual risk stratification, chemoprophylaxis, and risk mitigation to prevent venous thromboembolism. However, the evidence for efficacy is lacking in plastic surgery outpatients. Anticoagulation can cause bleeding. Ultrasound technology offers a highly accurate screening method.

Methods:
A prospective study was undertaken among 1000 consecutive cosmetic surgery outpatients who were scanned at three times: before surgery, the day after surgery, and 1 week after surgery (inclusion rate, 93 percent). Intravenous sedation was used, with no muscle relaxation. Compression, Doppler color flow, and waveform analysis were performed on the deep veins of the lower extremities, including the calves. Affected patients were followed with weekly scans. No chemoprophylaxis was ordered. Sequential compression devices were used during the first half of the study.

Results:
Nine deep venous thromboses were detected (0.9 percent). Two thromboses were found on scans performed the day after surgery. Six thromboses were detected on the scan approximately 1 week after surgery. One deep venous thrombosis was detected 35 days after surgery. Eight of the nine patients were prescribed oral anticoagulants. All affected patients recovered fully. The mean time to thrombosis resolution was 4.8 weeks. A logistic regression found no deep venous thrombosis risk reduction from sequential compression devices. Patient age was significantly associated with deep venous thromboses (p < 0.05).

Conclusions:
Ultrasound surveillance offers an effective method for early detection and treatment of postoperative deep venous thromboses. This technology offers an alternative to risk stratification and chemoprophylaxis, which causes iatrogenic bleeding. Sequential compression devices are unnecessary for plastic surgery outpatients undergoing total intravenous anesthesia.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Diagnostic, IV.
The Utility of Preoperative Venous Testing for Lower Extremity Flap Planning in Patients with Lower Extremity Wounds
Authors: Janhofer David E. , Lakhiani Chrisovalantis , Kim Paul J. , Naz Iram , Black Cara K. , Tefera Eshetu A. , Akbari Cameron , Hashmi Amreen , Attinger Christopher E. , Evans Karen Kim 
Published: December 2019

Background:
Although venous thrombosis is a leading cause of flap failure, the majority of lower extremity free flap planning is centered on arterial system evaluation. Preoperative identification of relevant abnormality in lower extremity venous systems by means of duplex ultrasound may aid in the diagnosis of clinically important abnormality that could affect lower extremity flap outcomes.

Methods:
Between November of 2014 and August of 2017, 57 patients underwent preoperative lower extremity venous duplex imaging and free tissue transfer for lower extremity wounds. A retrospective review was performed to describe lower extremity venous pathologic findings, relevant patient demographic data, comorbid conditions, and outcomes. Discovery of venous abnormality helped guide recipient vein selection.

Results:
Fifty-seven consecutive patients underwent 59 free flap operations to treat chronic lower extremity wounds. Venous duplex ultrasonography detected venous insufficiency (defined as >0.5 second of reflux) in 23 patients (39.0 percent), including 16 (27.2 percent) with deep thigh reflux, six (10.2 percent) with superficial calf reflux, and four (6.78 percent) with deep calf reflux. Deep venous thrombosis was found in four patients (6.78 percent) and treated with anticoagulation. The flap success rate was 98.3 percent. Five patients (8.47 percent) progressed to amputation. At a mean follow-up time of 15.1 ± 9.51 months (range, 1.67 to 35.2 months), 53 patients (89.8 percent) were able to continue community ambulation.

Conclusions:
Lower extremity venous duplex testing before free tissue transfer may be useful for optimizing flap recipient vessel selection and for detecting potentially unknown venous abnormality. Development of free flap planning protocols incorporating preoperative vascular imaging is important to achieving good functional outcomes in this comorbid patient population.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Diagnostic, IV.