bluuebunny/crossref_metadata_2025_split huggingface dataset:
National Variation in Elective Colon Resection for Diverticular Disease
Authors: Hawkins Alexander T. , Samuels Lauren R. , Rothman Russell L. , Geiger Timothy M. , Penson David F. , Resnick Matthew J. 
Published: August 2020

Objective:
This study aims to characterize the extent of geographic variation in elective sigmoid resection for diverticulitis and to identify factors associated with observed variation.

Introduction:
National guidelines for treatment of recurrent diverticulitis fail to offer strong recommendations for or against surgical intervention. We hypothesize that healthcare market factors will be significantly associated with geographic variation in colon resection for diverticulitis, a discretionary surgical intervention.

Methods:
We used Center for Medicare Services 100% inpatient Limited Data Set (LDS) files from January 2013 through September 2015 to calculate an observed to expected standardized colon resection ratio for each hospital referral region (HRR). We then analyzed patient, hospital-, and market-level factors associated with variation of colectomy. For each HRR, a Herfindahl-Hirschman index, a measure of market competition, was calculated.

Results:
A total of 19,557 Medicare patients underwent an elective colon resection for diverticulitis at 2462 hospitals over the study period. Standardized colon resection ratios ranged from 0 in the Tuscaloosa HRR to 3.7 in the Royal Oak, MI HRR. Few patient factors were associated with variation, but a number of hospital factors (size, area, profit status, and critical access designation) all were associated with variation. In an analysis of market factors, increased surgeon density, and decreased market competition were associated with higher predicted rates of colon resection.

Conclusion:
We observed pronounced variation (excess of 3-fold) in standardized colon resection ratios for recurrent diverticulitis. Surgeon density and hospital level factors were strongly associated with this variation and may be the main drivers of colonic resection for diverticular disease. Further investigation and stronger national guidelines are needed to optimize patient selection for colectomy.
Locoregional Residual Esophageal Cancer after Neo-adjuvant Chemoradiotherapy and Surgery Regarding Anatomic Site and Radiation Target Fields
Authors: Faiz Zohra , Kats-Ugurlu Gursah , Mui Véronique E. M. , Karrenbeld Arend , Burgerhof Hans G. M. , Plukker John T. M. , Muijs Christel T. 
Published: August 2020

Objective:
Neoadjuvant chemoradiotherapy followed by surgery establishes a considerable pathologic complete response (pCR) in EC. The aim was to determine site of residual tumor and its prognostic impact.

Summary Background Data:
High rates of residual tumor in the adventitial region even inside the radiation fields will influence current decision-making.

Methods:
We evaluated resection specimens with marked target fields from 151 consecutive EC patients treated with carboplatin/paclitaxel and 41.4Gy between 2009 and 2018.

Results:
In radically resected (R0) specimens 19.8% (27/136) had a pCR (ypT0N0) and 14% nearly no response (tumor regression grade: tumor regression grade 4–5). Residual tumor commonly extended in or restricted to the adventitia (43.1%; 47/109), whereas 7.3% was in the mucosa (ypT1a), 16.5% in the submucosa (ypT1b) and 6.4% only in lymph nodes (ypT0N+). Macroscopic residues in R0-specimens of partial responders (tumor regression grade 2-3: N = 90) were found in- and outside the gross tumor volume (GTV) in 33.3% and 8.9%, and only microscopic in- and outside the clinical target volume in 58.9% and 1.1%, respectively. Residual nodal disease was observed proximally and distally to the clinical target volume in 2 and 5 patients, respectively. Disease Free Survival decreased significantly if macroscopic tumor was outside the GTV and in ypT2-4aN+.

Conclusions:
After neoadjuvant chemoradiotherapy, pCR and ypT1aN0 were seen in a limited number of R0 resected specimens (19.8% and 7.3%, respectively), whereas 6.4% had only nodal disease (yT0N+). Disease Free Survival decreased significantly if macroscopic residue was outside the GTV and in responders with only nodal disease. Therefore, we should be cautious in applying wait and see strategies.
Ten-year Evaluation of a Large Retrospective Cohort Treated by Sacral Nerve Modulation for Fecal Incontinence
Authors: Desprez Charlotte , Damon Henri , Meurette Guillaume , Mege Diane , Faucheron Jean-Luc , Brochard Charlène , Lambrescak Elsa , Gourcerol Guillaume , Mion Francois , Wyart Vincent , Sielezneff Igor , Siproudhis Laurent , Etienney Isabelle , Ajamie Nadine , Lehur Paul-Antoine , Duflot Thomas , Bridoux Valérie , Leroi Anne-Marie ,   Club NEMO
Published: August 2020

Objective:
The aim of this study was to assess the effectiveness of sacral nerve modulation (SNM) in a large cohort of patients implanted for at least 10 years, quantify adverse event rates, and identify predictive factors of long-term success.

Summary Background Data:
Few studies have evaluated the long-term success of SNM.

Methods:
Data collected prospectively from patients implanted for fecal incontinence (FI) in 7 French centers between January 1998 and December 2008 were retrospectively analyzed. Patient FI severity scores were assessed before and 10 years after implantation. The main evaluation criterion was the success of SNM defined by the continuation of the treatment without additional therapies. The secondary evaluation criteria were the rate of device revisions and explantations. Preoperative predictors of success at 10 years were sought.

Results:
Of the 360 patients (27 males, mean age: 59 ± 12 years) implanted for FI, 162 (45%) had a favorable outcome 10 years post-implantation, 115 (31.9%) failed, and 83 (23.1%) were lost to follow-up. The favorable outcome derived from the time-to-event Kaplan-Meier curve at 10 years was 0.64 (95% CI 0.58–0.69). FI severity scores were significantly better 10 years post-implantation compared to preimplantation (7.4 ± 4.3 vs 14.0 ± 3.2; P < 0.0001). During the 10-year follow-up, 233 patients (64.7%) had a surgical revision and 94 (26.1%) were explanted. A history of surgery for FI and sex (male) were associated with an increased risk of an unfavorable outcome.

Conclusions:
Long-term efficacy was maintained in approximately half of the FI patients treated by SNM at least 10 years post-implantation.
Prone Positioning for Severe Acute Respiratory Distress Syndrome in COVID-19 Patients by a Dedicated Team
Authors: Doussot Alexandre , Ciceron Floriane , Cerutti Emilie , Salomon du Mont Lucie , Thines Laurent , Capellier Gilles , Pretalli Jean-Baptiste , Evrard Philippe , Vettoretti Lucie , Garbuio Patrick , Brunel Anne-Sophie , Pili-Floury Sebastien , Lakkis Zaher 
Published: August 2020

Objective:
The aim of this study was to define whether rapidly reallocating health care workers not experienced with PP for performing PP in ICU is feasible and safe.

Summary Background Data:
In the setting of severe acute respiratory distress syndrome (ARDS), the use of prone and supine positioning procedures (PP) has been associated with improved oxygenation resulting in decreased mortality. Nevertheless, applying PP is time consuming for ICU staffs that are at risk of mental of physical exhaustion, especially with the constant surge of admitted COVID-19 patients with severe ARDS.

Methods:
This prospective cohort study conducted at a single regional university hospital between March 27 and April 15, 2020. Among 117 patients admitted to ICU, 67 patients (57.3%) presented with proven SARS-CoV-2 infection with severe ARDS requiring PP. After accelerated simulation training, 109 volunteers including surgeons, physicians, nurses and physiotherapists, multiple dedicated teams performed daily multiple PP following a systematic checklist. Patient demographics and PP data were collected. Patient safety and health care workers safety were assessed.

Results:
Among 117 patients admitted to ICU, 67 patients (57.3%) required PP. Overall, 53 (79%) were male, with a median age of 68.5 years and median body mass index of 29.3 kg/m2. A total of 384 PP were performed. Overall, complication occurred in 34 PP (8.8%) and led to PP cancelation in 4 patients (1%). Regarding health care workers safety, four health care workers presented with potential COVID-19 related symptoms and none was positive.

Conclusions:
To overcome the surge of critically ill COVID-19 patients, reallocating health care workers to targeted medical tasks beyond their respective expertise such as PP was safe.
Does Surgical Intensity Correlate With Opioid Prescribing?
Authors: Cho Hoyune E. , Hu Hsou-Mei , Gunaseelan Vidhya , Chen Jung-Sheng , Englesbe Michael J. , Chung Kevin C. , Waljee Jennifer F. 
Published: August 2020

Objective:
To examine the relationship between aspects of surgical intensity and postoperative opioid prescribing.

Summary of Background Data:
Despite the emergence of postoperative prescribing guidelines, recommendations are lacking for many procedures. identifying a framework based on surgical intensity to guide prescribing for those procedures in which guidelines may not exist could inform postoperative prescribing.

Methods:
We used clustering analysis with 4 factors of surgical intensity (intrinsic cardiac risk, pain score, median operative time, and work relative value units) to devise a classification system for common surgical procedures. We used IBM MarketScan Research Database (2010–2017) to examine the correlation between this framework with initial opioid prescribing and rates of refill for each cluster of procedures.

Results:
We examined 2,407,210 patients who underwent 128 commonly performed surgeries. Cluster analysis revealed 5 ordinal clusters by intensity: low, mid-low, mid, mid-high, and high. We found that as the cluster-order increased, the median amount of opioid prescribed increased: 150 oral morphine equivalents (OME) for low-intensity, 225 OME for mid-intensity, and 300 OME for high-intensity surgeries. Rates of refill increased as surgical intensity also increased, from 17.4% for low, 26.4% for mid, and 48.9% for high-intensity procedures. The odds of refill also increased as cluster-order increased; relative to low-intensity procedures, high-intensity procedures were associated with 4.37 times greater odds of refill.

Conclusion:
Surgical intensity is correlated with initial opioid prescribing and rates of refill. Aspects of surgical intensity could serve as a guide for procedures in which guidelines based on patient-reported outcomes are not available.
Surgeons’ Coaching Techniques in the Surgical Coaching for Operative Performance Enhancement (SCOPE) Program
Authors: Pradarelli Jason C. , Yule Steven , Panda Nikhil , Lowery Kurt W. , Lagoo Janaka , Gee Denise W. , Ashley Stanley W. , Waters Peter M. , Gawande Atul A. , Smink Douglas S. 
Published: August 2020

Objective:
To evaluate coaching techniques used by practicing surgeons who underwent dedicated coach training in a peer surgical coaching program.

Background:
Surgical coaching is a developing strategy for improving surgeons’ intraoperative performance. How to cultivate effective coaching skills among practicing surgeons is uncertain.

Methods:
Through the Surgical Coaching for Operative Performance Enhancement (SCOPE) program, 46 surgeons within 4 US academic medical centers were assigned 1:1 into coach/coachee pairs. All attended a 3-hour Surgical Coaching Workshop—developed using evidence from the fields of surgery and education—then received weekly reminders. We analyzed workshop evaluations and audio transcripts of postoperative debriefs between coach/coachee pairs, co-coding themes based on established principles of effective coaching: (i) self-identified goals, (ii) collaborative analysis, (iii) constructive feedback, and (iv) action planning. Coaching principles were cross-referenced with intraoperative performance topics: technical, nontechnical, and teaching skills.

Results:
For the 8 postoperative debriefs analyzed, mean duration was 24.4 min (range 7–47 minutes). Overall, 326 coaching examples were identified, demonstrating application of all 4 core principles of coaching. Constructive feedback (17.6 examples per debrief) and collaborative analysis (16.3) were utilized more frequently than goal-setting (3.9) and action planning (3.0). Debriefs focused more often on nontechnical skills (60%) than technical skills (32%) or teaching-specific skills (8%). Among surgeons who completed the workshop evaluation (82% completion rate), 90% rated the Surgical Coaching Workshop “good” or “excellent.”

Conclusions:
Short-course coach trainings can help practicing surgeons use effective coaching techniques to guide their peers’ performance improvement in a way that aligns with surgical culture.
Efficacy of Intragastric Balloon Placement and Botulinum Toxin Injection in Bariatric Endoscopy
Authors: Kanlioz Murat , Ekici Uğur , Tatli Faik , Karatas Turgay 
Published: August 2020

Background:
To evaluate the results obtained from the combination of intragastric botulinum toxin A (IGBTA), intragastric balloon (IGB), and IGBTA(+)IGB in the treatment of obesity.

Materials and Methods:
Three separate treatment groups were set up. IGBTA, IGB, and IGBTA(+)IGB were administered to Group 1, 2, and 3, respectively. The body mass indexes (BMI) of patients were measured before and 6 months after the treatment. The intragroup and intergroup treatment results have been evaluated. P<0.05 was considered significant.

Results:
The mean BMI decreased by 1.6 kg/m2 in 40 patients who received IGBTA in group 1 (P<0.001), 3.95 kg/m2 in 42 patients who received IGB in group 2 (P<0.001), and 4.9 kg/m2 in 39 patients who received IGBTA and IGB in group 3 (P<0.001) after 6 months of treatment. The intolerance because of the application was the highest in group 3, followed by group 2.

Conclusion:
The treatment was most successful in group 3 followed by group 2 and group 1, respectively. The authors recommend the group 3 treatment, provided that nausea, vomiting, and flatulence have a high index of probability in such a treatment. However, when deciding between group 1 and group 2 treatments, the authors recommend opting for group 2 treatment that shows to be more efficient.
Laparoscopic Ventral Rectopexy for Obstructed Defecation: Functional Results and Quality of Life
Authors: Degasperi Silvia , Scarpa Marco , Zini Oscar , Ruffolo Cesare , Gruppo Mario , Bardini Romeo , Angriman Imerio 
Published: August 2020

Background:
Laparoscopic ventral mesh rectopexy (LVR) is gaining wider acceptance as the preferred procedure to correct internal and external rectal prolapse with obstructed defecation syndrome (ODS) and/or fecal incontinence. The aim of our study was to analyze functional outcome and quality of life (Health-Related Quality of Life) after LVR for symptomatic internal prolapse and/or rectocele with ODS.

Methods:
Prospectively collected data on LVR for internal rectal prolapse were analyzed in 50 consecutive female patients operated between January 2011 and December 2018. In all cases, we performed a LVR according to the D’Hoore technique. Patients had ODS and internal rectal prolapse (grade 3 or 4) confirmed at the defecogram study. We registered only 1 major complication that required surgical treatment (Clavien-Dindo IIIb). The median hospital stay was 4 days [interquartile range (IQR): 2 to 5 d]. Functional results were measured with the Wexner Constipation Score and the 36-Item Short-Form Health Survey, and were analyzed before surgery and after 3, 6, or 12 months.

Results:
After a median follow-up of 16.5 months (IQR: 10 to 44.25 mo), the Wexner Total Score was significantly improved in almost all items passing from 14 (IQR: 11 to 18) to 11 (IQR: 6.25 to 14.75) after surgery (P<0.0001). Incontinence was cured in 8 of 11 patients (P=0.036). Compared with the preoperative score, the 36-Item Short-Form Health Survey score improved, especially for physical activity, varying from 75 to 87.5 (P=0.0156). No worsening of continence status, constipation, or sexual function was observed.

Conclusion:
LVR appears to provide a sustained improvement in Health-Related Quality of Life, constipation, and incontinence in patients with ODS without worsening constipation with low morbidity and recurrence.
A Case-matched Comparative Study of Laparoscopic Versus Open Right Colonic Resection for Colon Cancer: Developing Country Perspectives
Authors: Ammori Basil J. , Kakish Hanna , Asmer Huthaifa , Al-Najjar Hani , Hamed Osama H. , Al Ebous Ali , Dabous Ali , Daoud Faiez , Almasri Mahmoud 
Published: August 2020

Background:
The open approach to right hemicolectomy remains the most widely adopted, whereas laparoscopic surgery is technically more demanding with possible loss of benefit for lengthy procedures compared with open surgery. The aim of this study is to compare the outcomes of the laparoscopic versus open surgery for right colon cancer resections.

Materials and Methods:
Patients who underwent an elective and potentially curative right colectomy for colon cancer between 2015 and 2019 were included and those who underwent emergency surgery, palliative resection, or cytoreductive surgery were excluded. Patients were randomly matched on 1:2 basis for age, disease stage, neoadjuvant chemotherapy, and extent of colectomy (right vs. extended right hemicolectomy, and additional major resection). The analysis was conducted on an intention-to-treat basis. The outcomes were reported as median (range) or percent as appropriate.

Results:
Among 160 patients, 18 were excluded. The final matching included 69 patients. The were no significant differences between the groups regarding patients’ age and sex distribution, tumor size, and preoperative serum albumin and hemoglobin. There were 2 conversions (8.7%) to open surgery. Although the operating time for laparoscopic surgery was longer (200 vs. 140 min, P<0.001), it was associated with less blood loss (50 vs. 100 mL, P=0.001) and shorter primary and total hospital stay (4.1 vs. 6.0 days, P<0.001). There were no differences in the rates of severe complications (0% vs. 13%), reoperations (0% vs. 4.3%), readmissions (13% vs. 8.7%), mortality (0% vs. 2.2%), R
0 resections (95.7% vs. 97.8%), and lymph node retrieval rate (28 in each group).

Conclusion:
The laparoscopic approach to right colon resection for colon cancer is associated with less operative trauma and quicker recovery compared with open surgery and offers an equivalent oncologic resection.
The role and value of family therapy for people living with cancer: a rapid review of recent evidence
Authors: Forbat Liz 
Published: August 2020

Purpose of review
Cancer impacts the whole family and relational system, not just the individual with the diagnosis. The present article identifies and reviews publications in the field of family therapy and cancer since 2019, to describe the theoretical models and techniques applied, and the outcomes achieved.

Recent findings
A search of databases and grey literature led to the identification of five articles from four studies. Four papers described primary research and one summarized a case example. Papers were published by teams in the USA, Sweden and Iceland. Each article described the benefits of adopting a family therapy approach on outcomes such as family communication, bereavement and decreased carer burden. Four papers described specialist family therapists delivering the interventions, and one used oncology nurses drawing on the theories and techniques of family therapy.

Summary
The rarity of family therapy publications in the past year reflects the individual-level approach to cancer which permeates both medicine and talking therapies. The utility of family therapy could be further surfaced through more large-scale studies which thoroughly describe the unique theoretical basis and techniques, alongside outcomes for multiple people within the family system.
Management of cisplatin-associated toxicities in bladder cancer patients
Authors: Desilets Antoine , Adam Jean-Philippe , Soulières Denis 
Published: August 2020

Purpose of reviewCisplatin remains the treatment cornerstone for bladder cancer, either in neoadjuvant or in metastatic (cisplatin-gemcitabine or dose-dense methotrexate, vinblastine, and doxorubicin). Timely and adequate management of cisplatin's adverse events is important in order to avoid dose reductions, treatment delays, or cessation. Over the last years, several randomized studies and updated guidelines have been published on this subject.Recent findingsThe incidence, physiopathology, risk factors, preventive treatment, and optimal management of such complications will be presented, with special focus on cisplatin-associated nausea and vomiting, acute kidney injury (AKI), hypomagnesemia, neurotoxicity, and ototoxicity.SummaryOptimal prevention of cisplatin-associated nausea and vomiting requires an aggressive approach with the use of a four-drug prophylactic regimen (NK1 receptor antagonist, 5-HT3 receptor antagonist, dexamethasone, olanzapine). The use of intensive hydration before and after cisplatin infusion has been the mainstay of AKI prevention. The management of hypomagnesemia and neurotoxicity remains largely symptomatic. In an adult population, no therapy has yet demonstrated benefits in the prevention or treatment of platinum-related ototoxicity.
Heart, lungs, and muscle interplay in worsening activity-related breathlessness in advanced cardiopulmonary disease
Authors: Alberto Neder J. , O’Donnell Denis E. 
Published: August 2020

Purpose of reviewActivity-related breathlessness is a key determinant of poor quality of life in patients with advanced cardiorespiratory disease. Accordingly, palliative care has assumed a prominent role in their care. The severity of breathlessness depends on a complex combination of negative cardiopulmonary interactions and increased afferent stimulation from systemic sources. We review recent data exposing the seeds and consequences of these abnormalities in combined heart failure and chronic obstructive pulmonary disease (COPD).Recent findingsThe drive to breathe increases (‘excessive breathing’) secondary to an enlarged dead space and hypoxemia (largely COPD-related) and heightened afferent stimuli, for example, sympathetic overexcitation, muscle ergorreceptor activation, and anaerobic metabolism (largely heart failure-related). Increased ventilatory drive might not be fully translated into the expected lung–chest wall displacement because of the mechanical derangements brought by COPD (‘inappropriate breathing’). The latter abnormalities, in turn, negatively affect the central hemodynamics which are already compromised by heart failure. Physical activity then decreases, worsening muscle atrophy and dysfunction.SummaryBeyond the imperative of optimal pharmacological treatment of each disease, strategies to lessen ventilation (e.g., walking aids, oxygen, opiates and anxiolytics, and cardiopulmonary rehabilitation) and improve mechanics (heliox, noninvasive ventilation, and inspiratory muscle training) might mitigate the burden of this devastating symptom in advanced heart failure–COPD.