bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevention, Management and Risk Factors for Diarrhoeal Disease in under-Fives in Cape Town
Authors: Freer Joseph , Mahomed Hassan , Westwood Anthony 
Published: June 2020

Abstract

Background
In South Africa, Cape Town’s health facilities are stretched by the volume of cases of diarrhoea during the summer months, particularly with severely dehydrated children, who often require complex inpatient management. The prevalence of severe disease in children living in the settlements around Cape Town is particularly high.

Methods
An observational study of a systematic sample of children under 5 who presented to any primary care facility in Khayelitsha, an informal settlement of Cape Town, with diarrhoea and referred to secondary care between 1 November 2015 and 30 April 2016. We recruited participants from the sub-district office and identified risk factors associated with the index presentation, captured the triage and management of patients in primary care and investigated post-discharge follow-up.

Results
We recruited 87 children into the study, out of a total of 115 cases of severe dehydration. There was a significantly higher number of households in this group with no income than in Khayelitsha overall (65% vs. 47.4%; p &lt; 0.001). In the sample, HIV-exposed, uninfected children were younger than unexposed children (median 9.44 months in exposed vs. 17.36 months in unexposed; p = 0.0015) and were more likely to be malnourished (weight-for-age Z-score; WAZ score &lt; −2) [13 cases exposed vs. 8 cases unexposed (p = 0.04)]. Outreach staff were able to trace only 33.3% of children at home following discharge, yet 65% of children attended follow-up appointments in clinics.

Conclusions
This cohort of children with diarrhoeal disease complicated by severe dehydration was a particularly socially deprived group. The results demonstrating zero vertical transmission of HIV in this very socioeconomically deprived area of Cape Town are encouraging. In the HIV-exposed, uninfected group, children were younger and had a higher prevalence of malnutrition, which should be the subject of future research, especially given existing evidence for immunological differences in children exposed to HIV in utero. Locating children with severe diarrhoea post-discharge was challenging and further research is needed on the cost-effectiveness and outcomes of different follow-up approaches.
Kawasaki disease
Authors: Galuppo Jana , Kowker Alexandra , Rolfs Jenna , Nicholas Joyce , Schmidt Eric 
Published: June 2020

ABSTRACT
Kawasaki disease is an acute systemic febrile vasculitis of medium and small arteries, most often occurring in children under age 5 years. This condition is the most common cause of acquired heart disease in children in the developed world. The cause is unclear but is thought to be a hyperimmune reaction to an infectious agent. Diagnosis is clinical; the classic presentation includes persistent fever, lymphadenopathy, oral mucosal changes, conjunctivitis, and rash. Although the disease technically is self-limiting, treatment with IV immunoglobulin (IVIG) and high-dose aspirin is necessary to prevent cardiac complications, such as coronary artery aneurysm, pericarditis, or myocarditis. This article reviews the pathophysiology, clinical presentation, diagnosis, and treatment of Kawasaki disease.
Adverse Childhood Experiences in Trainees and Physicians With Professionalism Lapses: Implications for Medical Education and Remediation
Authors: Williams Betsy White , Welindt Dillon , Hafferty Frederic W. , Stumps Anna , Flanders Philip , Williams Michael V. 
Published: June 2020

Purpose
Unprofessional behavior, which can include failure to engage, dishonest and/or disrespectful behavior, and poor self-awareness, can be demonstrated by medical trainees and practicing physicians. In the authors’ experience, these types of behaviors are associated with exposure to adverse childhood experiences (ACEs). Given this overlap, the authors studied the percentage of ACEs among trainees and physicians referred for fitness-for-duty evaluations and patterns between the types of ACEs experienced and the reason for referral.

Method
A final sample of 123 cases of U.S. trainees and physicians who had been referred to a Midwestern center for assessment and/or remediation of professionalism issues from 2013 to 2018 was created. Included professionalism lapses fell within 3 categories: boundary violation, disruptive behavior, or potential substance use disorder concerns. All participants completed a psychosocial developmental interview, which includes questions about ACE exposure. Overall rate of reported ACEs and types of ACEs reported were explored.

Results
Eighty-six (70%) participants reported at least 1 ACE, while 27 (22%) reported 4 or more. Compared with national data, these results show significantly higher occurrence rates of 1 or more ACEs and a lower occurrence rate of 0 ACEs. ACEs that predicted reasons for referral were physical or sexual abuse, feeling unwanted or unloved, witnessing abuse of their mother or stepmother, or caretaker substance use.

Conclusions
In this sample, ACE exposure was associated with professionalism issues. Remediating individuals with professionalism issues and exposure to ACEs can be complicated by heightened responses to stressful stimuli, difficulties with collaboration and trust, and decreased self-efficacy. Adoption of a trauma-informed medical education approach may help those that have been impacted by trauma rebuild a sense of control and empowerment. The findings of this study may be useful predictors in identifying those at risk of problematic behavior and recidivism before a sentinel event.
Evidence for Continuing Buprenorphine in the Perioperative Period
Authors: Li Alice H. , Schmiesing Cliff , Aggarwal Anuj K. 
Published: June 2020

Objective:
Given there are conflicting recommendations for the perioperative management of buprenorphine, we conducted a retrospective cohort study of our surgery patients on buprenorphine whose baseline dose had been preoperatively continued, tapered, or discontinued.

Materials and Methods:
We reviewed charts of patients on buprenorphine who had received elective surgery at Stanford Healthcare from January 1, 2013 to June 30, 2016. Our primary outcome of interest was the change in pain score, defined as mean postoperative pain score—preoperative pain score. We also collected data on patients’ tapering procedure and any postoperative nonbuprenorphine opioid requirements.

Results:
Out of ∼1200 patients on buprenorphine, 121 had surgery of which 50 were admitted and included in the study. Perioperative continuation of transdermal buprenorphine resulted in a significantly lower change in pain score postoperatively (0.606±0.878) than discontinuation (4.83±1.23, P=0.012). Among sublingual patients, there was no statistically significant difference in the change in pain score between those who were tapered to a nonzero dose versus discontinued (P=0.55). Continuation of sublingual buprenorphine resulted in fewer nonbuprenorphine scheduled opioid prescriptions than its taper or discontinuation (P=0.028). Finally, tapers were performed with great variability in the tapering team and rate of taper.

Discussion:
On the basis of our findings, we implemented a policy at our institution for the continuation of perioperative buprenorphine whenever possible. Our work reveals crucial targets for the education of perioperative healthcare providers and the importance of coordination among all perioperative services and providers.
ACR–ASTRO Practice Parameter for Communication
Authors: Schechter Naomi R. , Brown Derek W. , Bovi Joseph A. , Dominello Michael M. , Liu Arthur K. , Mattes Malcolm D. , Michalski Jeff M. , Shih Helen A. , Strom Eric , Wilkinson J.B. , Rosenthal Seth A. , Hartford Alan 
Published: June 2020

Aim/Objectives/Background:
Timely, accurate, and effective communications are critical to quality in contemporary medical practices. Radiation oncology incorporates the science and technology of complex integrated radiation treatment delivery and the art of managing individual patients. Through written physical and/or electronic reports and direct communication, radiation oncologists convey critical information regarding patient care, services provided, and quality of care. Applicable practice parameters need to be revised periodically regarding medical record documentation for professional and technical components of services delivered.

Methods:
The ACR–ASTRO Practice Parameter for Communication: Radiation Oncology was revised according to the process described on the American College of Radiology (ACR) Web site (“The Process for Developing ACR Practice Parameters and Technical Standards,” www.acr.org/ClinicalResources/Practice-Parametersand-Technical-Standards) by the Committee on Practice Parameters of the ACR Commission on Radiation Oncology in collaboration with the American Society for Radiation Oncology (ASTRO). Both societies then reviewed and approved the document.

Results:
This practice parameter addresses radiation oncology communications in general, including (a) medical record, (b) electronic, and (c) doctor-patient communications, as well as specific documentation for radiation oncology reports such as (a) consultation, (b) clinical treatment management notes (including inpatient communication), (c) treatment (completion) summary, and (d) follow-up visits.

Conclusions:
The radiation oncologist’s participation in the multidisciplinary management of patients is reflected in timely, medically appropriate, and informative communication with the referring physician and other members of the health care team. The ACR–ASTRO Practice Parameter for Communication: Radiation Oncology is an educational tool designed to assist practitioners in providing appropriate communication regarding radiation oncology care for patients.
Interpretation of chronic pain clinical trial outcomes: IMMPACT recommended considerations
Authors: Smith Shannon M. , Dworkin Robert H. , Turk Dennis C. , McDermott Michael P. , Eccleston Christopher , Farrar John T. , Rowbotham Michael C. , Bhagwagar Zubin , Burke Laurie B. , Cowan Penney , Ellenberg Susan S. , Evans Scott R. , Freeman Roy L. , Garrison Louis P. , Iyengar Smriti , Jadad Alejandro , Jensen Mark P. , Junor Roderick , Kamp Cornelia , Katz Nathaniel P. , Kesslak James Patrick , Kopecky Ernest A. , Lissin Dmitri , Markman John D. , Mease Philip J. , O'Connor Alec B. , Patel Kushang V. , Raja Srinivasa N. , Sampaio Cristina , Schoenfeld David , Singh Jasvinder , Steigerwald Ilona , Strand Vibeke , Tive Leslie A. , Tobias Jeffrey , Wasan Ajay D. , Wilson Hilary D. 
Published: June 2020

Abstract
Interpreting randomized clinical trials (RCTs) is crucial to making decisions regarding the use of analgesic treatments in clinical practice. In this article, we report on an Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) consensus meeting organized by the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks, the purpose of which was to recommend approaches that facilitate interpretation of analgesic RCTs. We review issues to consider when drawing conclusions from RCTs, as well as common methods for reporting RCT results and the limitations of each method. These issues include the type of trial, study design, statistical analysis methods, magnitude of the estimated beneficial and harmful effects and associated precision, availability of alternative treatments and their benefit–risk profile, clinical importance of the change from baseline both within and between groups, presentation of the outcome data, and the limitations of the approaches used.
Preemptive light sedation in intensive care unit may reduce pulmonary complications in geriatrics receiving pancreaticoduodenectomy
Authors: Chen Tien-Hua , Su Cheng-Hsi , Hsiao Chen-Yuan , Kao Shih-Yi , Tsai Pei-Jiun 
Published: June 2020

Background:
Patients undergoing pancreaticoduodenectomy (PD) for periampullary lesions are usually elderly with a high risk of postoperative morbidity and mortality. This retrospective cohort study investigated whether postoperative preemptive light sedation aids in recovery of elderly patients following PD.

Methods:
Ninety-nine geriatric patients undergoing PD at one hospital were enrolled from 2009 to 2018. Patients in the sedation group received mechanical ventilation support and preemptively light sedation with fentanyl and propofol or dexmedetomidine in the first 5 days postoperatively in the intensive care unit (ICU). Patients in the control group underwent early extubation and received morphine for pain control but no postoperative sedatives in the ordinary ward. Patients in the two groups were matched 1:1 using propensity scoring. The postoperative complication rate, surgical mortality, and postoperative hospital length of stay (LOS) were recorded. We also tested inflammation in an immortal human bronchial epithelial cell line.

Results:
After 1:1 matching, 40 patients in the sedation group were compared with 40 patients in the control group. The sedation group had a significantly lower pulmonary complication rate and fewer patients with postoperative gastroparesis. Both groups had similar postoperative hospital LOS and identical surgical mortality rates. Patients in the sedation group had significantly better postoperative quality of life, including less pain and less heartbeat variation. In vitro cell experiments supported the above clinical observations, showing that adequate use of sedatives could significantly elevate the cell viability rate, protect cells from damage, decrease interleukin-6 production, and reduce inflammation.

Conclusion:
Postoperative preemptive light sedation in the ICU in geriatric patients following PD may not only reduce the rates of postoperative pulmonary complications and gastroparesis but also improve postoperative quality of life without prolonging the postoperative hospital LOS.
Smartphone-based diabetic macula edema screening with an offline artificial intelligence
Authors: Hwang De-Kuang , Yu Wei-Kuang , Lin Tai-Chi , Chou Shih-Jie , Yarmishyn Aliaksandr , Kao Zih-Kai , Kao Chung-Lan , Yang Yi-Ping , Chen Shih-Jen , Hsu Chih-Chien , Jheng Ying-Chun 
Published: June 2020

Background:
Diabetic macular edema (DME) is a sight-threatening condition that needs regular examinations and remedies. Optical coherence tomography (OCT) is the most common used examination to evaluate the structure and thickness of the macula, but the software in the OCT machine does not tell the clinicians whether DME exists directly. Recently, artificial intelligence (AI) is expected to aid in diagnosis generation and therapy selection. We thus develop a smartphone-based offline AI system that provides diagnostic suggestions and medical strategies through analyzing OCT images from diabetic patients at the risk of developing DME.

Methods:
DME patients receiving treatments in 2017 at Taipei Veterans General Hospital were included in this study. We retrospectively collected the OCT images of these patients from January 2008 to July 2018. We established the AI model based on MobileNet architecture to classify the OCT images conditions. The confusion matrix has been applied to present the performance of the trained AI model.

Results:
Based on the convolutional neural network with the MobileNet model, our AI system achieved a high DME diagnostic accuracy of 90.02%, which is comparable to other AI systems such as InceptionV3 and VGG16. We further developed a mobile-application based on this AI model available at https://aicl.ddns.net/DME.apk.

Conclusion:
We successful integrated an AI model into the mobile device to provide an offline method to provide the diagnosis for quickly screening the risk of developing DME. With the offline property, our model could help those nonophthalmological healthcare providers in offshore islands or underdeveloped countries.
How to assess the severity of heart failure?
Authors: Kabra Nitin , Cooper Howard A. , Naidu Srihari S. 
Published: June 2020

Purpose of review
Mortality rates for acute decompensated heart failure and cardiogenic shock remain unacceptably high despite advances in medical therapy and mechanical circulatory support. Systems designed to quickly and accurately identify and risk stratify these patients are needed in order to improve survival.

Recent findings
The Society for Cardiovascular Angiography and Interventions developed an expert consensus statement aimed at early identification and assessment of patients with advanced heart failure and cardiogenic shock. Recent studies have validated this novel classification system within several large patient cohorts.

Summary
Assessing the severity of heart failure is a critical step in enabling the targeting of appropriate therapies to the appropriate patients. A novel classification system allows for accurate and reproducible identification and risk stratification.
Kidney and liver dysfunction in cardiogenic shock
Authors: Lassus Johan 
Published: June 2020

Purpose of review
Organ dysfunction is a key feature of cardiogenic shock. Active revascularization and contemporary management in intensive care has improved prognosis in cardiogenic shock, but mortality is still unacceptably high. This review will discuss the prevalence, manifestation, management and clinical impact of kidney and liver dysfunction in cardiogenic shock.

Recent findings
Patients with cardiogenic shock more frequently have several comorbidities that make them at risk of developing multiorgan failure, including renal and liver dysfunction. Kidney and liver injury and dysfunction will markedly increase mortality of patients with cardiogenic shock. Management requires active monitoring of organ function and knowledge of criteria for detection and classification of organ injury. The SOFA score for prediction of mortality in the critically ill incorporates organ injury and can be used also in cardiogenic shock, but risk prediction models specific for cardiogenic shock exist. Biomarkers reflecting different pathways activated in cardiogenic shock correlate with severity of organ dysfunction and may improve risk prediction in cardiogenic shock. Preliminary data suggest that they can even be future treatment targets.

Summary
Monitoring renal and hepatic function and identifying injury and dysfunction of these organs is essential for the management and mortality risk assessment of patients in cardiogenic shock.
Eating disorders in adolescent boys and young men: an update
Authors: Nagata Jason M. , Ganson Kyle T. , Murray Stuart B. 
Published: June 2020

Purpose of review
To review the recent literature on eating disorders and disordered eating behaviors among adolescent boys and young men, including epidemiology, assessment, medical complications, treatment outcomes, and special populations.

Recent findings
Body image concerns in men may involve muscularity, and muscle-enhancing goals and behaviors are common among adolescent boys and young men. Recent measures, such as the Muscularity Oriented Eating Test (MOET) have been developed and validated to assess for muscularity-oriented disordered eating. Medical complications of eating disorders can affect all organ systems in male populations. Eating disorders treatment guidance may lack specificity to boys and men, leading to worse treatment outcomes in these population. Male populations that may have elevated risk of eating disorders and disordered eating behaviors include athletes and racial/ethnic, sexual, and gender minorities.

Summary
Eating disorders and disordered eating behaviors in boys and men may present differently than in girls and women, particularly with muscularity-oriented disordered eating. Treatment of eating disorders in boys and men may be adapted to address their unique concerns.
Obesity and insulin resistance in children
Authors: Tagi Veronica Maria , Chiarelli Francesco 
Published: June 2020

Purpose of review
It is well known that obesity represents the main modifiable risk factor for insulin resistance in children and adolescents; obesity-induced insulin resistance in children is the most important risk factor for developing cardiovascular diseases and type 2 diabetes in adulthood. The mechanisms through which obesity causes insulin resistance are complex and not completely known to date.

Recent findings
In children, global adiposity is the main factor determining insulin resistance. Excessive fatty acids play a determinant role in the pathogenesis of insulin resistance in obese children, inducing an increased production of acetyl-CoA in the liver and enhancing inflammation in adipose tissue. The aetiology of insulin resistance in polycystic ovary syndrome is multifactorial and still debated.

Summary
The aim of this review is to present an updated frame and new insights of the numerous pathways involved in the development of insulin resistance in obese patients, focusing on the peculiarities of children and adolescents. Improving the knowledge of mechanisms through which obesity leads to insulin resistance is fundamental in order to recommend particular follow-up and possible treatment to specific categories of obese children and adolescents.
Precision transplant pathology
Authors: Wood-Trageser Michelle A. , Xu Qinyong , Zeevi Adriana , Randhawa Parmjeet , Lesniak Drew , Demetris Anthony J. 
Published: June 2020

Purpose of review
Transplant pathology contributes substantially to personalized treatment of organ allograft recipients. Rapidly advancing next-generation human leukocyte antigen (HLA) sequencing and pathology are enhancing the abilities to improve donor/recipient matching and allograft monitoring.

Recent findings
The present review summarizes the workflow of a prototypical patient through a pathology practice, highlighting histocompatibility assessment and pathologic review of tissues as areas that are evolving to incorporate next-generation technologies while emphasizing critical needs of the field.

Summary
Successful organ transplantation starts with the most precise pratical donor–recipient histocompatibility matching. Next-generation sequencing provides the highest resolution donor–recipient matching and enables eplet mismatch scores and more precise monitoring of donor-specific antibodies (DSAs) that may arise after transplant. Multiplex labeling combined with hand-crafted machine learning is transforming traditional histopathology. The combination of traditional blood/body fluid laboratory tests, eplet and DSA analysis, traditional and next-generation histopathology, and -omics-based platforms enables risk stratification and identification of early subclinical molecular-based changes that precede a decline in allograft function. Needs include software integration of data derived from diverse platforms that can render the most accurate assessment of allograft health and needs for immunosuppression adjustments.