bluuebunny/crossref_metadata_2025_split huggingface dataset:
Performing MRI Scans on Cochlear Implant and Auditory Brainstem Implant Recipients: Review of 14.5 Years Experience
Authors: Tam Yu Chuen , Lee Jennifer W. Y. , Gair Juliette , Jackson Cay , Donnelly Neil P. , Tysome James R. , Axon Patrick R. , Bance Manohar L. 
Published: January 2020

Objective:
To assess the complication rate of magnetic resonance imaging (MRI) using 1.5 T scanners on cochlear implant (CI) and auditory brainstem implant (ABI) recipients over 14.5 years.

Methods:
Prospective study conducted in a tertiary referral center for cochlear and auditory brainstem implantation, including patients with neurofibromatosis 2. The primary outcome was complications related to MRI scanning in implant recipients, including failure to complete MRI sessions. The secondary outcome was magnet void size due to MRI scanning with magnet in situ.

Results:
Ninety-seven patients (21 ABI recipients, 76 CI recipients of whom 23 were bilateral) underwent a total of 428 MRI sessions consisting of 680 MRI procedures, which generated 2,601 MRI sequences (excluding localizers). Of these, 28/428 (6.5%) MRI sessions were performed with magnet removed, and the remaining 400/428 (93.4%) with the magnet in situ. The overall complication rate per session was 15/428 (3.5%). The majority of complications were accounted for by patient discomfort, in some cases requiring abandoning the scan session, but 5 magnet dislocations were also recorded. There were no cases of implant device failure or excessive demagnetization of the receiver stimulator magnet.
For CI and ABI recipients, the implant caused large voids of around 110 mm × 60 mm with the magnet in situ which reduced to 60 mm × 30 mm when the magnet was removed. However, it was usually possible to visualize the internal acoustic meatus and cerebellopontine angle by positioning the implant package higher and further forward compared with conventional positioning.

Conclusion:
MRI scanning in ABI and CI recipients is generally safe and well tolerated without magnet removal, and carries a low rate of complications. However, patients should be fully informed of the possibility of discomfort, and precautions such as local anesthetic injection and head bandaging may reduce the likelihood of adverse events.
Development of a Preliminary Question Prompt List as a Communication Tool for Adults With Gastroesophageal Reflux Disease
Authors: Kamal Afrin , Katzka David A. , Achkar Edgar , Carlson Dustin , Clarke John , Fass Ronnie , Gyawali Chandra P. , Patel Dhyanesh , Penagini Roberto , Rezaie Ali , Roman Sabine , Savarino Edoardo , Shaheen Nicholas J. , Triadafilopoulos George 
Published: January 2020

Background:
Question prompt lists (QPLs) are structured sets of disease-specific questions intended for patient use, encouraging patients to ask questions to facilitate their consultation with their physician.

Aim:
The aim of this study was to develop a QPL specific to adults with gastroesophageal reflux disease (GERD), created by esophageal experts.

Methods:
The QPL content (78 questions) was derived through a modified Delphi method consisting of 2 rounds. In round 1, 18 esophageal experts provided 5 answers to the prompt “What you wish your patients would ask” and “What questions do patients often not ask, that I wish they would ask?” In round 2, the experts rated each question on a 5-point Likert scale, and responses rated as “essential” or “important,” determined by an a priori threshold of ≥4.0, were accepted for the QPL.

Results:
Twelve esophageal experts participated. Of 143 questions from round 1, 110 (76.9%) were accepted for inclusion in the QPL, meeting a median value of ≥4.0, and, subsequently, it reduced to 78, minimizing redundancy. Median values ranged between 4.0 and 5.0, with the highest agreement median (5.0) for questions asking dosing and timing of proton pump inhibitor therapy, and surveillance in Barrett’s. Questions were categorized into the following categories: “What does this illness mean,” “lifestyle modifications,” “general treatment,” “treatment with proton pump inhibitors,” “What I should expect for my future,” and “Barrett’s.” The largest number of questions covered lifestyle modifications (21.8%), with the highest agreement median (5.0) for “How helpful are lifestyle modifications in GERD?”

Conclusions:
A preliminary GERD-specific QPL, the first of its kind, was developed by esophageal experts. Modification after more patient consultation and feedback is planned in subsequent versions to create a GERD-QPL for eventual use in clinical gastroenterology.
The Relative Importance of Clinical and Socio-demographic Variables in Prognostic Prediction in Non–Small Cell Lung Cancer
Authors: He Jiangping , Zhang James X. , Chen Chin-tu , Ma Yan , De Guzman Raymond , Meng Jianfeng , Pu Yonglin 
Published: January 2020

Background:
Prognostic modeling in health care has been predominantly statistical, despite a rapid growth of literature on machine-learning approaches in biological data analysis. We aim to assess the relative importance of variables in predicting overall survival among patients with non–small cell lung cancer using a Variable Importance (VIMP) approach in a machine-learning Random Survival Forest (RSF) model for posttreatment planning and follow-up.

Methods:
A total of 935 non–small cell lung cancer patients were randomly and equally divided into 2 training and testing cohorts in an RFS model. The prognostic variables included age, sex, race, the TNM Classification of Malignant Tumors (TNM) stage, smoking history, Eastern Cooperative Oncology Group performance status, histologic type, treatment category, maximum standard uptake value of whole-body tumor (SUVmaxWB), whole-body metabolic tumor volume (MTVwb), and Charlson Comorbidity Index. The VIMP was calculated using a permutation method in the RSF model. We further compared the VIMP of the RSF model to that of the standard Cox survival model. We examined the order of VIMP with the differential functional forms of the variables.

Results:
In both the RSF and the standard Cox models, the most important variables are treatment category, TNM stage, and MTVwb. The order of VIMP is more robust in RSF model than in Cox model regarding the differential functional forms of the variables.

Conclusions:
The RSF VIMP approach can be applied alongside with the Cox model to further advance the understanding of the roles of prognostic factors, and improve prognostic precision and care efficiency.
Trends in Contracting and Common Ownership Between Hospice Agencies and Nursing Homes
Authors: Stevenson David G. , Sinclair Nicholas , Zhang Shiyuan , Meneades Laurie M. , Huskamp Haiden A. 
Published: January 2020

Background:
In recent years, policymakers have paid particular attention to the emergence of a robust for-profit hospice sector and increased hospice use by nursing home residents. Previous research has explored financial incentives for nursing home-hospice use, but there has been limited research on nursing home-hospice partnerships and none on the extent of nursing home-hospice common ownership.

Objective:
To describe trends in nursing home-hospice contracting and common ownership and to identify potential tradeoffs in care provided by nursing homes and hospice agencies that share common ownership.

Research Design:
Retrospective cohort study of nursing home-hospice patients between 2005 and 2015.

Results:
Between 2005 and 2015, the number of hospice agencies and nursing homes with common ownership grew substantially, now representing almost 1-in-5 providers in each sector. Relative to individuals using hospice in nursing homes without common ownership, adjusted analyses found that individuals receiving hospice from a commonly owned agency had a greater likelihood of having stays of 90 days or more [odds ratio (OR)=1.06; 95% confidence interval (CI), 1.02–1.10], having a stay resulting in a live discharge (OR=1.06; 95% CI, 1.02–1.11), and having at least 1 registered nurse/licensed practical nurse visit during the last 3 days of life (OR=1.17; 95% CI, 1.05–1.29); these individuals also had a lower mean visit hours per day (−0.07; P=0.003).

Conclusions:
Common ownership between hospice agencies and nursing homes is an emerging trend that reflects a broader push toward consolidation in the health care sector. Our analyses highlight potential concerns relevant to Medicare payment policy and are a first step toward improving our understanding of these trends and their implications.
Quality of Care in Chronic Kidney Disease and Incidence of End-stage Renal Disease in Older Patients
Authors: Fukuma Shingo , Ikenoue Tatsuyoshi , Shimizu Sayaka , Norton Edward C. , Saran Rajiv , Yanagita Motoko , Kato Genta , Nakayama Takeo , Fukuhara Shunichi 
Published: January 2020

Background:
The quality of care received by a growing number of older patients with chronic kidney disease (CKD) has not been adequately examined.

Objective:
The objective of this study was to assess the quality of CKD care among older patients and to clarify its association with the incidence of end-stage renal disease (ESRD).

Research Design:
This was a population-based cohort study.

Subjects:
Older (65 y and above) CKD patients diagnosed between October 2010 and September 2014 from the National Database of Health Insurance Claims of Japan.

Measures:
A composite quality score (QS) of 3 quality measures for CKD care during the 6 months after CKD diagnosis was computed. The validated quality measures included urine testing for proteinuria, nutritional guidance, and nonsteroidal anti-inflammatory drugs avoidance. To assess the association between the QS and ESRD incidence, we used instrumental variable analysis after stratification for the history of diabetes.

Results:
Among the 890,773 older CKD patients, 2.9% progressed to ESRD (incidence rate of 12.5 per thousand person-years). In total, 59.9% underwent urine testing, 4.5% received nutritional guidance, and 91.2% avoided regular use of nonsteroidal anti-inflammatory drugs. An instrumental variable analysis revealed that a higher QS was associated with—lower ESRD incidence in patients diagnosed with diabetes (hazard ratio: 0.25, 95% confidence interval: 0.24–0.27 for each point higher score) but not in patients without a diagnosis of diabetes (hazard ratio: 0.99, 95% confidence interval: 0.92–1.05).

Conclusion:
Among older CKD patients, quality of CKD care varied between patients, and better quality of CKD care was associated with a lower ESRD incidence in patients with diabetes but not in nondiabetic patients.
French Red Cross Volunteer Rescue Workers
Authors: Meudal Julie , Vandentorren Stéphanie , Simeoni Laurent , Denis Céline 
Published: January 2020

Abstract
Few studies have explored the psychological consequences of terrorism on volunteer rescuers. We examined the psychological characteristics of volunteer rescuers after the January 2015 terrorist attacks in France. We analyzed the results of the IMPACTS study regarding the somatic, psychological, and social characteristics of the French Red Cross volunteer rescuers who intervened during these terrorist attacks. We used a standardized questionnaire during a face-to-face interview, 6 to 9 months after the attacks. Forty-one volunteers were included. Nine were presenting anxiety disorders, 11 were displaying recurrent depressive episodes, and five were displaying abusive alcohol consumption. Twenty-seven were provided with a debriefing after their intervention. Half of the most exposed volunteers had no contact with mental health professional 9 months after their intervention. A healthcare protocol, covering short-, medium-, and long-term care, should be systematically proposed to volunteer rescue workers to minimize the risk of chronic psychic posttraumatic disorders.
Strengths–Weaknesses–Opportunities–Threats Analysis for a Pediatric Anesthesia Program
Authors: Eizaga Rebollar Ramón , García Palacios María Victoria , Fernández Mangas María del Carmen , Arroyo Fernández Francisco Javier , Márquez Rodríguez Carlos Miguel , Carnota Martín Ana Isabel , Morales Guerrero Javier , Torres Morera Luis Miguel 
Published: January 2020

Background:
Risk management in healthcare institutions begins by first identifying the potential risks within a certain organization or specific area and then goes on to develop further strategies to reduce harm. The most common tool for this type of analysis is Strengths–Weaknesses–Opportunities–Threats (SWOT).

Methods:
We conducted a SWOT analysis in our pediatric anesthesia program: key factors were identified in a matrix, prioritized in a score table, represented in a graph, and finally analyzed.

Results:
Items obtained partial scores from 20 to 120. The item “lack of clinical protocols” was given greater weight (60) and received a lower value (1), resulting in the highest partial score (60) among the negative key factors and indicating a need for greater efforts to improve this specific aspect.

Conclusion:
The SWOT tool proved effective in identifying safety and quality key factors, and it provided information for initiating an improvement program.
Autologous Breast Reconstruction versus Implant-Based Reconstruction: How Do Long-Term Costs and Health Care Use Compare?
Authors: Lemaine Valerie , Schilz Stephanie R. , Van Houten Holly K. , Zhu Lin , Habermann Elizabeth B. , Boughey Judy C. 
Published: January 2020

Background:
The authors compared long-term health care use and cost in women undergoing immediate autologous breast reconstruction and implant-based breast reconstruction.

Methods:
This study was conducted using the OptumLabs Data Warehouse, which contains deidentified retrospective administrative claims data, including medical claims and eligibility information from a large U.S. health insurance plan. Women who underwent autologous or implant-based breast reconstruction between January of 2004 and December of 2014 were included. The authors compared 2-year use rates and predicted costs of care. Comparisons were tested using the t test.

Results:
Overall, 12,296 women with immediate breast reconstruction were identified; 4257 with autologous (35 percent) and 8039 with implant-based (65 percent) breast reconstruction. The proportion of autologous breast reconstruction decreased from 47.2 percent in 2004 to 32.7 percent in 2014. The mean predicted reconstruction cost of autologous reconstruction was higher than that of implant-based reconstruction in both unilateral and bilateral surgery. Similar results for mean predicted 2-year cost of care were seen in bilateral procedures. However, in unilateral procedures, the 2-year total costs were higher for implant-based than for autologous reconstruction. Two-year health care use rates were higher for implant-based reconstruction than for autologous reconstruction for both unilateral and bilateral procedures. Women undergoing unilateral implant-based reconstruction had higher rates of hospital admissions (30.3 versus 23.1 per 100; p < 0.01) and office visits (2445.1 versus 2283.6 per 100; p < 0.01) than those who underwent autologous reconstruction. Emergency room visit rates were similar between the two methods. Bilateral procedures yielded similar results.

Conclusion:
Although implant-based breast reconstruction is a less expensive index operation than autologous breast reconstruction, it was associated with higher health care use, resulting in similar total cost of care over 2 years.
Effect of Preoperative Patient Education on Opioid Consumption and Well-Being in Breast Augmentation
Authors: Parsa Fereydoun Don , Pavlosky K. Keano , Harbison Gregory , Yim Nicholas , Cheng Justin , Marison Scott R. , Parsa Alan A. 
Published: January 2020

Background:
Perioperative use of opioids is common in surgical practice and frequently results in troublesome opioid-related side effects that often lead to suboptimal postsurgical outcomes. As such, multiple studies have sought to identify alternatives that may reduce reliance on opioid-based perioperative pain management. Recently, it has been shown that patient education and patient involvement in care positively impact surgical outcomes. This study evaluates how patient education regarding the role of endogenous beta-endorphins in reducing pain and the opposing effect of opioid analgesics impacts opioid consumption and mood after surgery.

Methods:
Patients scheduled for breast augmentation were divided into two groups, A and B. Both groups received identical multimodal anesthesia regimens; however, only patients in group B were educated on the role of endogenous beta-endorphins in pain control and mood enhancement, and how opioids block their action.

Results:
Patients in the group receiving preoperative education on the analgesic and mood-enhancing role of endogenous beta-endorphins and how opioids block their action consumed significantly less opioids and had better postsurgical outcomes as determined by self-reported measures of pain level and mood/sense of well-being.

Conclusions:
The findings of this study suggest that opioid use was significantly reduced and patients’ mood/sense of well-being was significantly enhanced when patients received preoperative education on the oppositional relationship between beta-endorphins and opioids. Such patient education may be linked to a significant reduction in opioid use and improved patient mood/sense of well-being, especially when combined with opioid-free multimodal anesthesia.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
Clinical Application of a Patient-Specific, Three-Dimensional Printing Guide Based on Computer Simulation for Rhinoplasty
Authors: Choi Jong Woo , Kim Min Ji , Kang Min Kyu , Kim Sung Chan , Jeong Woo Shik , Kim Don Han , Lee Tae Hoon , Koh Kyung S. 
Published: January 2020

Background:
A practical application of three-dimensional printing technology has been considered a difficult area in rhinoplasty. However, the patient-specific three-dimensionally printed rhinoplasty guide based on the simulation program the authors developed could be a solution for minimizing the gap between simulation and actual surgical results. The aims of this study were to determine how a three-dimensional rhinoplasty guide based on three-dimensional simulation would link the patient to the surgeon to investigate its effectiveness.

Methods:
Fifty patients who underwent rhinoplasty between January of 2017 and February of 2018 were included in this study. The patients were consulted about the desired shape of their nose based on preoperative three-dimensional photography. The confirmed three-dimensional simulation was sent to a manufacturing company for three-dimensionally printed rhinoplasty guides. In the guide group, rhinoplasty was performed based on the three-dimensionally printed rhinoplasty guide, and in the control group, procedures were performed based on the surgeon’s intuition.

Results:
The intraclass correlation coefficient test for comparing the simulated and postoperative measurements showed higher correlation in the three-dimensional printing guide group: higher correlation 11.3 percent in nasal tip projection, 21.6 percent in dorsum height, and 9.8 percent in nasolabial angle. The postoperative result of the nasal dorsum had a statistically significant difference between the two groups (p < 0.05).

Conclusions:
This study demonstrated the usefulness of the three-dimensionally–printed rhinoplasty guide, which delivers the preoperative simulated image in the actual clinical practice of rhinoplasty. This approach could cause a paradigm shift in simulation-based rhinoplasty.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Variability of CD4+ Cell Counts in HIV-1–Uninfected Volunteers Who Are Eligible for a Phase I HIV Vaccine Study
Authors: Stafford Kristen A. , Mayer Bryan T. , Fulp William , Chua Joel , Davis Charles , Gilliam Bruce , Dong Dan , Gallo Robert C. , Sajadi Mohammad M. 
Published: January 2020

Objective:
Vaccines and biologics containing CD4 molecules or HIV-1 gp120 might induce antibodies targeting CD4. We evaluated temporal variability of CD4 levels in healthy volunteers to quantify declines that could indicate true adverse events.

Design:
Prospective observational cohort study of 100 healthy adults without HIV-1 infection from the Baltimore region.

Methods:
Participants enrolled and consented to blood draws for immunologic laboratory panels performed once every 8 weeks for 48 weeks. The primary CD4+ measurements were CD4+ absolute count (cells/mm3) and CD4 percentage (CD4%, total CD4 cells/total lymphocyte cells). CD4 changes over time were modeled using fold changes for CD4+ absolute counts and differences for CD4 percentages.

Results:
Variation of average CD4+ cell counts and percentages were highly participant-specific (P < 0.001 for both). However, changes in both CD4+ measurements over time were stable in the population. We proposed thresholds to flag unusual drops using 1.5 SD estimates, calculated as 1.5-fold declines for CD4+ count and 6.4% declines for CD4 percentage. In this healthy cohort, flagging simultaneous declines in both measurements corresponded to a low false-positive rate (5.26%).

Conclusions:
Normal biological variation in large lymphocytes should be taken into account to establish thresholds for adverse changes in clinical trials. The inherent subject-specific variability in CD4 levels makes establishing absolute cutoffs difficult. However, this study proposes that thresholds for declines using 1.5 SDs from these data (50% in absolute count and 6.4% for CD4 percentage) allow a small false-positive rate (∼5%) that could maintain sensitivity for true adverse events in a clinical trial.
Safety of Atorvastatin in Patients With Stable Systemic Autoimmune Myopathies
Authors: Pires Borges Isabela Bruna , de Oliveira Diego Sales , Misse Rafael Giovani , dos Santos Alexandre Moura , Hong Valéria Aparecida Costa , Bortolotto Luiz Aparecido , Shinjo Samuel Katsuyuki 
Published: January 2020

Background/Objective
Patients with systemic autoimmune myopathies (SAMs) have high prevalence of dyslipidemia and, consequently, possible endothelial dysfunction and vascular stiffness. Our objective was to evaluate the possible benefits on endothelial function and vascular stiffness, as well as adverse effects of atorvastatin in SAMs.

Methods
A pilot longitudinal, double-blind, randomized, placebo-controlled study was conducted. Twenty-four of 242 patients were randomized at a 2:1 ratio to receive atorvastatin (20 mg/d) or placebo for a period of 12 weeks. Demographic data, comorbidities, and clinical and laboratory parameters, as well as endothelial function and arterial stiffness, were evaluated.

Results
Of the 24 randomized patients, 4 patients were excluded, with remaining 20 patients (14 in the atorvastatin group and 6 in the placebo group). The mean age of the patients was 49.0 years, and 75% of the patients were female. At baseline, the demographic data, disease status, treatment, cardiovascular comorbidities, and risk factors were comparable between the atorvastatin and placebo groups. After 12 weeks of follow-up of atorvastatin therapy, no improvements were observed for endothelial function and arterial stiffness in either group (p > 0.05). As expected, a significant reduction in total and low-density lipoprotein cholesterol levels was observed. During the study, no clinical intercurrences or disease relapses were observed in either group.

Conclusions
The atorvastatin drug attenuated low-density lipoprotein cholesterol without worsening clinical outcomes in SAMs. No change was observed for endothelial function and arterial stiffness. Additional studies, with long-term follow-up time and different atorvastatin dosage, are needed to corroborate the results of this study.