bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inaccuracies in Postoperative Inpatient Stays Assumed in the Valuation of Surgical RVUs
Authors: Childers Christopher P. , Maggard-Gibbons Melinda 
Published: May 2020

Objective:
The aim of this study was to assess the accuracy of inpatient postoperative visits assumed in the valuation of surgical relative value units (RVUs).

Summary Background Data:
Medicare reimburses physicians based on the number of RVUs assigned to a service. For surgical procedures with a 10- or 90-day global period, the RVU valuation is based, in part, on a presumed number of inpatient postoperative visits whether or not those visits occur. The Centers for Medicare and Medicaid Services (CMS) have recently proposed changing all surgical procedures to a 0-day global period.

Methods:
We combined 2017 National Surgical Quality Improvement (NSQIP) data with physician time and RVU files from CMS. We then compared the number of inpatient postoperative visits assumed in the valuation to actual length of stay (LOS) information from the surgical registry.

Results:
The analysis included 10 specialties and 601 distinct current procedural terminology codes. The number of patient observations underlying NSQIP LOS estimates ranged from 50 to 57,904. Eighty-three percent of procedures had median NSQIP LOS values that were shorter than the values assumed in the global period. These differences varied by specialty, with the largest discrepancy in neurosurgery. Procedures in this sample were last reviewed, on average, in 2000, with procedures reviewed more recently having more accurate valuations with respect to LOS.

Conclusions:
The number of postoperative visits assumed in the valuation of surgical RVUs is grossly inaccurate. Holding all else equal, removing global periods from surgical RVUs would dramatically reduce surgeon compensation.
Interhospital Variations in Resource Use Intensity for In-hospital Injury Deaths
Authors: Farhat Imen , Moore Lynne , Porgo Teegwendé Valérie , Assy Coralie , Belcaid Amina , Berthelot Simon , Stelfox Henry T. , Gabbe Belinda J. , Lauzier François , Clément Julien , Turgeon Alexis F. 
Published: May 2020

Objective:
Evaluate interhospital variation in resource use for in-hospital injury deaths.

Background:
Significant variation in resource use for end-of-life care has been observed in the US for chronic diseases. However, there is an important knowledge gap on end-of-life resource use for trauma patients.

Methods:
We conducted a multicenter, retrospective cohort study of injury deaths following hospitalization in any of the 57 trauma centers in a Canadian trauma system (2013–2016). Resource use intensity was measured using activity-based costing (2016 $CAN) according to time of death (72 h, 3–14 d, ≥14 d). We used multilevel log-linear regression to model resource use and estimated interhospital variation using intraclass correlation coefficients (ICC).

Results:
Our study population comprised 2044 injury deaths. Variation in resource use between hospitals was observed for all 3 time frames (ICC = 6.5%, 6.6%, and 5.9% for < 72 h, 3–14 d, and ≥14 d, respectively). Interhospital variation was stronger for allied health services (ICC = 18 to 26%), medical imaging (ICC = 4 to 10%), and the ICU (ICC = 5 to 6%) than other activity centers. We observed stronger interhospital variation for patients < 65 years of age (ICC = 11 to 34%) than those ≥65 (ICC = 5 to 6%) and for traumatic brain injury (ICC = 5 to 13%) than other injuries (ICC = 1 to 8%).

Conclusions:
We observed variation in resource use intensity for injury deaths across trauma centers. Strongest variation was observed for younger patients and those with traumatic brain injury. Results may reflect variation in level of care decisions and the incidence of withdrawal of life-sustaining therapies.
Real-Word Effectiveness and Safety of Dimethyl Fumarate in a Multiple Sclerosis Portuguese Population
Authors: Barros Ariana , Sequeira João , de Sousa Ary , Parra Joana , Brum Marisa , Pedrosa Rui , Capela Carlos 
Published: May 2020

Objectives
The aim of this study was to evaluate postmarketing dimethyl fumarate (DMF) safety and effectiveness in a real-world population with relapsing-remitting multiple sclerosis (RRMS).

Methods
This was a retrospective, single-center study with RRMS patients treated with DMF. Demographic, clinical, and imagiological characteristics were analyzed, including annualized relapse rate (ARR), Expanded Disability Status Scale, “No Evidence of Disease Activity 3,” previous treatment, adverse events, treatment duration, and reason for discontinuation. We investigated which baseline variables were associated with clinical and radiological outcomes.

Results
We included 176 patients (70.4% females) with a median on-treatment follow-up time of 25.5 months. In total, 139 patients received prior disease-modifying therapies, and 37 were treatment-naive. Annualized relapse rate decreased by 77.1% in the total population (P < 0.001) and also decreased in the naive, tolerability switch, and efficacy switch groups by 95.8%, 56.7%, and 76.6% (P < 0.001). No Evidence of Disease Activity 3 status after 12 months of DMF treatment was maintained in 69.2% patients. Thirty patients (17%) discontinued treatment because of adverse drug reactions, and 21 (11.9%) because of lack of effectiveness. The occurrence of first relapse during follow-up was associated with higher ARR in the year before DMF start (hazard ratio, 4.833; P < 0.001) and prior exposure to multiple sclerosis treatments (tolerability and efficacy switchers).

Conclusions
In this real-world audit, DMF appeared to be effective and safe for RRMS. Additionally, the study suggested that naive patients strongly benefit from DMF, and DMF also improves ARR in patients who switched from injectable therapies due to tolerability and efficacy issues.
Avoidable and Unavoidable Pressure Injuries Among Residents Living in Nursing Homes
Authors: Palese Alvisa , Zammattio Erica , Zuttion Ranieri , Ferrario Barbara , Ponta Sandra , Gonella Silvia , Comoretto Rosanna 
Published: May 2020

PURPOSE:
The aim of this study was to describe the prevalence of unavoidable pressure injuries (UPIs) in residents of nursing homes (NHs) and characteristics associated with UPIs.

DESIGN:
A retrospective study.

SUBJECTS AND SETTING:
Residents 65 years or older residing in any of 105 NHs in the Friuli Venezia Giulia region of Italy between January and December 2013.

METHODS:
Database search comprised of a multidimensional assessment of NH residents.

RESULTS:
Data from 7950 residents were reviewed, 925 (11.6%) of whom had 1 or more documented pressure injuries (PIs). Among these, 221 (23.9%) residents met criteria for avoidable PIs (APIs) and 704 (76.1%) for UPIs. Residents with UPIs were more frequently hemodynamically unstable, terminally ill, and had medical devices (all Ps < .001) than residents with APIs. Moreover, residents with UPIs showed higher functional, cognitive, and mood impairments compared to residents with APIs (all Ps < .001).

CONCLUSIONS:
Our findings suggest a high prevalence of UPIs compared to APIs among residents residing in NHs in one region of Italy. Additional research is needed to establish the prevalence of UPIs among NH residents country-wide, as well as determine specific criteria that identify UPIs in long-term care settings and increase consistency in prevalence and incidence measurement models.
Stigma and Its Influence on Patients With Temporary Ostomy
Authors: Qin Fang , Zhen Li , Ye Xinmei , Wei Huiqiang , Zhu Mulan , Chen Jiali , Shi Lei 
Published: May 2020

PURPOSE:
The purpose of this study was to explore stigma and its influencing factors in Chinese patients with a temporary ostomy.

DESIGN:
Cross-sectional, descriptive.

SUBJECTS AND SETTING:
Convenience sampling was used to recruit 170 patients living with a temporary ostomy for at least 2 weeks. Participants were recruited from 3 general hospitals in Guangdong province, located in southeastern China.

METHODS:
Respondents completed a questionnaire that included ostomy-related sociodemographic questionnaire, the Social Impact Scale, and the Stoma Self-Efficacy Scale. Multivariate linear regression was used to identify factors influencing stigma.

RESULTS:
Of the 170 questionnaires distributed, 159 (93.5%) respondents who sufficiently completed responses were included in the final analysis. The average score of the Social Impact Scale was 61.63 (SD = 8.39), reflecting a moderate level of stigma, and 27 (17%) experienced high levels of stigma. Multivariate regression analysis revealed that stigma was associated with family relationships (B = 6.139, P = .000), age when ostomy was created (B = −4.038, P = .000), and self-efficacy (B = −0.080, P = .002).

CONCLUSIONS:
The level of stigma in Chinese patients with temporary ostomies is moderate. Multivariate regression analysis identified family relationship, age, and self-efficacy as the main factors that influenced stigma in patients with temporary ostomy.
Estimation of Transmission Potential and Severity of COVID–19 in Romania and Pakistan
Authors: Ozair Muhammad , Hussain Takasar , Hussain Mureed , Awan Aziz Ullah , Baleanu Dumitru 
Published: May 2020

AbstractDuring the outbreak of an epidemic, it is of immense interest to monitor the effects of containment measures and forecast of outbreak including epidemic peak. To confront the epidemic, a simple SIR model is used to simulate the number of affected patients of Coronavirus disease in Romania and Pakistan. The model captures the growth in case onsets and the estimated results are almost compatible with the actual reported cases. Through the calibration of parameters, forecast for the appearance of new cases in Romania and Pakistan is reported till the end of this year by analysing the current situation. The constant level of number of patients and time-to-reach this level is also reported through the simulations. The drastic condition is also discussed which may occur if all the preventive restraints are removed.
Predictions of Covid-19 Related Unemployment On Suicide and All-cause Mortality
Authors: Bhatia Rajiv 
Published: May 2020

AbstractImportanceThe Covid-19 pandemic has driven behavioral and governmental responses with large impacts on economic activity. Estimates of indirect health effects of economic impacts may inform societal action.ObjectiveTo estimate the size of the impact of Covid-19 unemployment on suicides and deaths from all causes.DesignRisk assessment applying of pooled effects hazard ratios from published meta-analyses of observational epidemiological studies, post-Covid-19 unemployment, current labor force composition data, and current age-adjusted mortality rates.ResultsThis risk assessment estimates approximately 9,700 excess annual deaths from suicide and 66,000 annual deaths from all causes among those recently unemployed due to Covid-19.Conclusions and RelevanceIndirect health impacts of societal responses to Covid-19 are identifiable, multiple and quantifiable. Adverse health impacts, such as those from unemployment, may endure longer than those of the Covid-19 pandemic itself. Decision-makers can include indirect health impacts in policy-making calculi for Covid-19 mitigation and suppression strategies.Key PointsQuestionWhat are the expected impacts of post Covid-19 unemployment on excess suicide and premature death.FindingsA risk assessment applying pooled summary risk estimates from meta-analyses of observational studies predicts approximately 9,700 excess annual deaths from suicide and 66,000 annual deaths from all causes among those recently unemployed due to Covid-19.MeaningIndirect health impacts of societal responses to Covid-19 are identifiable, multiple and quantifiable.
Impact of hospitalised patients with COVID-19 taking Renin-Angiotensin-Aldosterone System inhibitors: a systematic review and meta-analysis
Authors: Baral Ranu , White Maddie , Vassiliou Vassilios S 
Published: May 2020

AbstractInhibitors of the Renin-Angiotensin-Aldosterone System (RAAS) notably Angiotensin-Converting Enzyme inhibitors (ACEi) or Angiotensin Receptor Blockers (ARB) have been scrutinised in hypertensive patients hospitalised with coronavirus disease 2019 (COVID-19) following some initial data they might adversely affect prognosis. With an increasing number of COVID-19 cases worldwide and the likelihood of a “second wave” of infection it is imperative to better understand the impact RAAS inhibitor use in antihypertensive covid positive hospitalised patients.A systematic review and meta-analysis of ACEi or ARB in patients admitted with COVID-19 was conducted. PubMed and Embase were searched and six studies were included in the meta-analysis. Pooled analysis demonstrated that 18.3% of the patients admitted with COVID-19 were prescribed ACEi/ARBs (0.183, CI 0.129 to 0.238, p<0.001). The use of RAAS inhibitors did not show any association with ‘critical’ events (Pooled OR 0.833 CI 0.605 to 1.148, p=0.264) or death (Pooled OR 0.650, CI 0.356 to 1.187, p=0.161). In conclusion, our meta-analysis including ‘critical’ events and mortality data on patients prescribed ACEi/ARB and hospitalised with COVID-19, found no evidence to associate ACEi/ARB with death or adverse events.
Sensitivity Optimisation of Tuberculosis Bioaerosol Sampling
Authors: Patterson Benjamin , Dinkele Ryan , Gessner Sophia , Morrow Carl , Kamariza Mireille , Bertozzi Carolyn R. , Kamholz Andrew , Bryden Wayne , Call Charles , Warner Digby F. , Wood Robin 
Published: May 2020

AbstractIntroductionDetection of Mycobacterium tuberculosis (Mtb) in patient-derived bioaerosol is a potential tool to measure source case infectiousness. However, current bioaerosol sampling approaches have reported low detection yields in sputum-positive TB cases. To increase the utility of bioaerosol sampling, we present advances in bioaerosol collection and Mtb identification that improve detection yields.MethodsA previously described Respiratory Aerosol Sampling Chamber (RASC) protocol, or “RASC-1”, was modified to incorporate liquid collection of bioaerosol using a high-flow wet-walled cyclone (RASC-2). Individuals with GeneXpert-positive pulmonary TB were sampled pre-treatment over 60-minutes. Putative Mtb bacilli were detected in collected fluid by fluorescence microscopy utilising DMN-Trehalose. Exhaled air and bioaerosol volumes were estimated using continuous CO2 monitoring and airborne particle counting, respectively. Mtb capture was calculated per exhaled air volume sampled and bioaerosol volume for RASC-1 (n=35) and for RASC-2 (n=21). Empty chamber samples were collected between patients as controls.ResultsThe optimised RASC-2 protocol sampled a median of 258.4L (IQR: 226.9-273.6) of exhaled air per patient compared with 27.5L (IQR: 23.6-30.3) for RASC-1 (p<0.0001). Bioaerosol volume collection was estimated at 2.3nL (IQR: 1.1-3.6) for RASC-2 compared with 0.08nL (IQR: 0.05-0.10) for RASC-1 (p<0.0001). The detection yield of viable Mtb improved from 43% (median 2 CFU, range: 1-14) to 95% (median 20.5 DMN-Trehalose positive bacilli, range: 2-155). These improvements represent a lowering of the limit of detection in the RASC-2 platform to 0.9 Mtb bacilli per 100L of exhaled air from 3.3 Mtb bacilli per 100L (RASC-1).ConclusionThis study demonstrates that technical improvements in particle collection together with sensitive detection enable rapid quantitation of viable Mtb in bioaerosols of sputum positive TB cases. Increased sampling sensitivity may allow future TB transmission studies to be extended to sputum-negative and subclinical individuals, and suggests the potential utility of bioaerosol measurement for rapid intervention in other airborne infectious diseases.
Association between gait speed decline and EEG abnormalities in a cohort of active older adults living in the community
Authors: García-Agustin Daysi , Morgade-Fonte Rosa Ma. , Bobes María A , Galán-García Lídice , Rodríguez-Rodríguez Valia 
Published: May 2020

AbstractBackgroundAge-related gait speed decline is associated with pathological brain changes. Despite EEG sensitivity for detecting alteration in the brain function, its clinical use to evaluate walking disorders is rare. In this study, we examined the association of subclinical gait speed deterioration in older individuals with changes in the EEG frequency composition as a marker of mild cerebral dysfunction.MethodsWe studied the gait speed of 90 physically active, community-dwelling older adults in two different appointments separated by an interval of 6 years. In the last assessment, resting-state EEG was acquired in all participants. After a visual clinical report, the EEG was transformed to the frequency domain, and the energy of each frequency band was compared against normative data.Results63 of 90 older individuals had gait speed deterioration, 87% of which also had an abnormal EEG frequency composition. EEG abnormalities were characterised by an increase in delta and theta bands power, higher than that expected for their age. We found some participants with gait speed decline that also had a decrease in alpha band power. EEG sensitivity for classifying participants with a deterioration in gait speed was 0.86, with a likelihood ratio of 2.9.ConclusionsThe subclinical gait speed decline found in this cohort was associated with significant changes in resting-state EEG frequency composition. The sensitivity of EEG frequency abnormalities for identifying older individuals with deterioration in gait speed supports its inclusion in the assessment pathway of older individuals at risk of developing gait disorders.Key Points-Independent and physically active older individuals had a sub-clinical gait speed deterioration.-Gait speed decline was associated with abnormalities in the EEG frequency composition not expected for their age.-EEG frequency changes had a high sensitivity for classifying older adults with gait speed decline.-Inclusion of quantitative EEG in the assessment pathway of older adults at risk of mobility disorders could serve in the identification of associated mild brain dysfunction and help in decisions related to appropriate clinical management.
Impact of complete lock-down on total infection and death rates: A hierarchical cluster analysis
Authors: Ghosal Samit , Bhattacharyya Rahul , Majumder Milan 
Published: May 2020

AbstractIntroduction and AimsRetarding the spread of SARS-CoV-2 infection by preventive strategies is the first line of management. Several countries have declared a stringent lock-down in order to enforce social distancing and prevent the spread of infection. This analysis was conducted in an attempt to understand the impact of lock-down on infection and death rates over a period of time.Material and MethodsA validated database was used to generate data related to countries with declared lock-down. Simple regression analysis was conducted to assess the rate of change in infection and death rates. Subsequently, a k-means and hierarchical cluster analysis was done to identify the countries that performed similarly. Sweden and South Korea were included as counties without lock-down in a second-phase cluster analysis.ResultsThere was a significant 61% and 43% reduction in infection rates 1-week post lock-down in the overall and India cohorts, respectively, supporting its effectiveness. Countries with higher baseline infections and deaths fared poorly compared to those who declared lock-down early on. Sweden and South Korea fared equally well, as most lock-down countries stemmed the growth of infection and death.ConclusionLock-down has proven to be an effective strategy is slowing down the SARS-CoV-2 disease progression exponentially. However, lessons need to be learned from Sweden and South Korea on arresting the disease progression without imposing such stringent measures.
Intensive care risk estimation in COVID-19 pneumonia based on clinical and imaging parameters: experiences from the Munich cohort
Authors: Burian Egon , Jungmann Friederike , Kaissis Georgios A. , Lohöfer Fabian K. , Spinner Christoph D. , Lahmer Tobias , Treiber Matthias , Dommasch Michael , Schneider Gerhard , Geisler Fabian , Huber Wolfgang , Protzer Ulrike , Schmid Roland M. , Schwaiger Markus , Makowski Marcus R. , Braren Rickmer F. 
Published: May 2020

AbstractThe evolving dynamics of coronavirus disease 2019 (COVID-19) and the increasing infection numbers require diagnostic tools to identify patients at high risk for a severe disease course. Here we evaluate clinical and imaging parameters for estimating the need of intensive care unit (ICU) treatment. We collected clinical, laboratory and imaging data from 65 patients with confirmed COVID-19 infection based on PCR testing. Two radiologists evaluated the severity of findings in computed tomography (CT) images on a scale from 1 (no characteristic signs of COVID-19) to 5 (confluent ground glass opacities in over 50% of the lung parenchyma). The volume of affected lung was quantified using commercially available software. Machine learning modelling was performed to estimate the risk for ICU treatment. Patients with a severe course of COVID-19 had significantly increased IL-6, CRP and leukocyte counts and significantly decreased lymphocyte counts. The radiological severity grading was significantly increased in ICU patients. Multivariate random forest modelling showed a mean ± standard deviation sensitivity, specificity and accuracy of 0.72 ± 0.1, 0.86 ± 0.16 and 0.80 ± 0.1 and a ROC-AUC of 0.79 ± 0.1.The need for ICU treatment is independently associated with affected lung volume, radiological severity score, CRP and IL-6.
The Impact of Neurofeedback on Effective Connectivity Networks in Chronic Stroke Patients
Authors: Giulia Lioi , Adolfo Veliz , Julie Coloigner , Quentin Duché , Simon Butet , Fleury Mathis , Leveque-Le Bars Emilie , Bannier Elise , Lécuyer Anatole , Barillot Christian , Bonan Isabelle 
Published: May 2020

AbstractStroke is a complex motor disease that not only affects perilesional areas but also global brain networks in both hemispheres. Neurofeedback (NF) is a promising technique to enhance neural plasticity and support functional improvement after stroke by means of brain self-regulation. Most of the studies using NF or brain computer interfaces for stroke rehabilitation have assessed treatment effects focusing on motor outcomes and successful activation of targeted cortical regions. However, given the crucial role of large-scale networks reorganization for stroke recovery, it is now believed that assessment of brain connectivity is central to predict treatment response and to individualize rehabilitation therapies. In this study, we assessed the impact of EEG-fMRI NF training on connectivity strength and direction using a Dynamic Causal Modeling approach. We considered a motor network including both ipsilesional and contralesional premotor, supplementary and primary motor areas. Our results in nine chronic stroke patients indicate that NF upregulation of targeted areas (ipsilesional SMA and M1) not only modulated activation patterns, but also had a more widespread impact on fMRI bilateral motor networks. In particular, inter-hemispheric connectivity between premotor and primary motor regions decreased, and ipsilesional self-inhibitory connections were reduced in strength, indicating an increase in activation during the NF motor task. To the best of our knowledge, this is the first work that investigates fMRI connectivity changes elicited by training of localized motor targets in stroke. Our results open new perspectives in the understanding of large-scale effects of NF training and the design of more effective NF strategies, based on the pathophysiology underlying stroke-induced deficits.