bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fatal Hemoperitoneum Due to Isolated Splenic Peliosis
Authors: Podduturi Varsha , Blessing Melissa M. 
Published: August 2020

Abstract
Isolated splenic peliosis is an exceedingly rare condition of unclear etiology characterized by blood filled cyst-like cavities in the primary mononuclear phagocytic organ. People with splenic peliosis are typically asymptomatic. However, splenic peliosis may present as an incidental mass on imaging mimicking a neoplasm during life, or present as sudden death after hemoperitoenum when ruptured, mimicking traumatic injury. Awareness of this condition is important to forensic pathologists so as to provide an accurate cause and manner of death.
Liquid Nitrogen Applied at Point of Sale
Authors: Pinilla Escobar Victoria A. , Granger Caroline J. , Hogan Anthony R. , Thorson Chad M. , Perez Eduardo A. , Sola Juan E. , Brady Ann-Christina 
Published: August 2020

Abstract
The August 30, 2018, US Food and Drug Administration advisory warned consumers to avoid eating, drinking, or handling food products prepared with liquid nitrogen (LN) (US FDA. Safety Alerts & Advisories: FDA Advises Consumers to Avoid Eating, Drinking, or Handling Food Products Prepared with Liquid Nitrogen at the Point of Sale. US Food and Drug Administration). We report on the case of a pediatric patient sustaining gastric perforation after ingestion of LN applied to food at the point of sale in the United States. “Dragon's Breath” is a popular snack of cereal puffs coated in LN giving the allusion of breathing smoke on ingestion. Instructions provided by vendors include avoidance of touching or drinking the liquid in the bottom of the cup. We report on a case of a 9-year-old girl presenting with peritonitis and gross pneumoperitoneum after consumption of Dragon's Breath with injury conferred secondary to LN ingestion. Intraoperative finding of a large perforation along the lesser curvature of the stomach was repaired primarily with an omental overlay. Her postoperative course was complicated by pneumonia and a surgical site infection. She was discharged 13 days after admission. A review of the literature of previous case reports of LN ingestion by intentional or accidental means is provided. This case report and review of the literature bring awareness of the dangers posed to pediatric patients exposed to LN applied at the point of sale.
Physical Medicine and Rehabilitation Residency Quality Improvement and Research Curriculum
Authors: Grover Prateek , Volshteyn Oksana , Carr David B. 
Published: August 2020

Abstract
Physical medicine and rehabilitation residency programs do not demonstrate a uniform level of training and mentorship for resident scholarly activities related in part to variable utilization of standardized curricula. The aim of this study was to design, develop, implement, and evaluate a structured Quality Improvement and Research Curriculum for a physical medicine and rehabilitation residency program in academic year 2015 using standardized methodology. A combination of five-phase project-lifecycle and six-step medical-curriculum development methodologies was used to integrate existing resources into five institutional domains: (1) Patient Safety and Quality Improvement Program; (2) Research Mentorship Program; (3) Rehab in Review; (4) Publication and Presentation Resources, and (5) Research and QI Lecture Series. Dedicated resident-faculty teams were created for individual domains and for the overall curriculum. Written materials developed included scope documents, reporting forms, and tracking tables. A dedicated webpage on the department website served as an accessible resource. A bimonthly Updates newsletter highlighted ongoing resident achievements. Program and resident outcome metrics were evaluated at the mid and end of academic year 2015. Excellent resident and good faculty participation in the curriculum was observed. Resident publication and presentation productivity improved. Time was the biggest barrier to success. Key factors for success included phased implementation, dedicated teams, scope clarity, accessible resources, personnel support, resident champions, and faculty mentorship.
Association of Implementation and Social Network Factors With Patient Safety Culture in Medical Homes: A Coincidence Analysis
Authors: Dy Sydney M. , Acton Ryan M. , Yuan Christina T. , Hsu Yea-Jen , Lai Alden Yuanhong , Marsteller Jill , Ye Faye C. , McGee Nancy , Kharrazi Hadi , Mahabare Darshan , Kim Julia , Gurses Ayse P. , Bittle Mark , Scholle Sarah Hudson 
Published: August 2020

Objectives
The patient-centered medical home (PCMH) may provide a key model for ambulatory patient safety. Our objective was to explore which PCMH and patient safety implementation and social network factors may be necessary or sufficient for higher patient safety culture.

Methods
This was a cross-case analysis study in 25 diverse U.S. PCMHs. Data sources included interviews of a clinician and an administrator in each PCMH, surveys of clinicians and staff, and existing data on the PCMHs’ characteristics. We used coincidence analysis, a novel method based on set theory and Boolean logic, to evaluate relationships between factors and the implementation outcome of patient safety culture.

Results
The coincidence analysis identified 5 equally parsimonious solutions (4 factors), accounting for all practices with higher safety culture. Three solutions contained the same core minimally sufficient condition: the implementation factor leadership priority for patient safety and the social network factor reciprocity in advice-seeking network ties (advice-seeking relationships). This minimally sufficient condition had the highest coverage (5/7 practices scoring higher on the outcome) and best performance across solutions; all included leadership priority for patient safety. Other key factors included self-efficacy and job satisfaction and quality improvement climate. The most common factor whose absence was associated with the outcome was a well-functioning process for behavioral health.

Conclusions
Our findings suggest that PCMH safety culture is higher when clinicians and staff perceive that leadership prioritizes patient safety and when high reciprocity among staff exists. Interventions to improve patient safety should consider measuring and addressing these key factors.
Influence of a Preadmission Procedure-Specific Consent Document on Patient Recall of Informed Consent at 4 Weeks After Total Hip Replacement: A Randomized Controlled Trial
Authors: Power Fiachra Richard , McClean Aine , Cashman James 
Published: August 2020

Objectives
Consent is a legal and ethical requirement for undertaking surgical procedures; however, the literature suggests that there continues to be poor recall among patients of the surgical risks discussed during the consent process. The aim of this study was to evaluate whether the addition of a preadmission procedure-specific consent document would improve patient recall of surgical risks at 4 weeks after total hip replacement in patients consented with a procedure-specific consent form.

Methods
A prospective randomized controlled trial allocated seventy adult patients who were undergoing a primary total hip replacement to either receive (intervention group) or not receive (control group) a preadmission procedure-specific consent document. All patients were also consented with a procedure-specific consent form on the morning of surgery and were contacted 4 weeks later to assess recall of surgical risks.

Results
There was a very poor recall rate seen in both the intervention group (16%) and the control group (13%), with no statistically significant difference between them (P = 0.49). A large number (30%) of patients could not recall a single risk. A subgroup analysis excluding these “consent nonresponders” did show a significantly increased recall rate in the intervention group (24.5% versus 18.25%, P = 0.02).

Conclusions
Patient recall of potential complications of total hip replacement was poor despite the intervention. Although not effective overall, the use of a preadmission procedure-specific consent document did improve recall of potential complications of surgery in a subset of patients. The phenomenon of consent nonresponders is worth exploring in future research.
To What Extent Is the World Health Organization’s Medication Safety Challenge Being Addressed in English Hospital Organizations? A Descriptive Study
Authors: Garfield Sara , Teo Vivien , Chan Li , Vujanovic Biljana , Aftab Ansa , Coleman Bridget , Puaar Seetal , Sen Green Namrita , Franklin Bryony Dean 
Published: August 2020

Objectives
Our study aimed to explore to what extent the priority areas and domains of the World Health Organization (WHO)‘s third Global Patient Safety Challenge were being addressed in a sample of hospital organizations.

Methods
A qualitative approach was taken using a combination of focus groups, semistructured interviews, and documentary analysis in 4 UK teaching hospital organizations. A purposive sampling strategy was adopted with the aim of recruiting health care professionals who would be likely to have knowledge of medication safety interventions that were being carried out at the hospital organizations. Medication safety group meeting notes from 2017 to 2019 were reviewed at the hospital organizations to identify interventions recently implemented, those currently being implemented, and plans for the future. A content analysis was undertaken using the WHO’s third Global Patient Safety Challenge priority areas and domains as deductive themes.

Results
All the domains and priority areas of the WHO Medication Safety Challenge were being addressed at all 4 sites. However, a greater number of interventions focused on “health care professionals” and “systems and practices of medication management” than on “patients and the public.” In terms of the priority areas, the main focus was on “high-risk situations,” particularly high-risk medicines, with fewer interventions in the areas of “transitions of care” and “polypharmacy.”

Conclusions
More work may be needed to address patient and public involvement in medication safety and the priority areas of transitions of care and polypharmacy. Comparative global studies would help build an international picture and allow shared learning.
Master’s Programs in Patient Safety and Health Care Quality Worldwide
Authors: Tekian Ara , Infante Alexander F. , Valenta Annette L. 
Published: August 2020

Objectives
As we approach the 20th anniversary of the Institute of Medicine’s report To Err Is Human: Building a Safer Health System, it is important to assess the progress we have made with respect to patient safety thus far. This study reviews all the existing master’s-level degree programs worldwide and assesses them to determine trends and disagreements.

Methods
Web-based searches were performed using phrases such as “masters,” “education,” “patient safety,” and “healthcare quality.” Communication with programs representatives was used to obtain pertinent data not represented on the programs’ webpages.

Results
Twenty-five programs exist worldwide, 17 of which within North America. These programs are predominantly taught in a part-time format, with many providing an online setting for learning and requiring various forms of scholarship.

Conclusions
Programs varied widely in credit hour structure and duration, as well as primary competencies. This highlights the need for the development of program standards to ensure the quality of such programs, as have been developed in other professional fields. Information pertaining to these programs including similarities, differences, trends, and characteristics is detailed in this section. The existence and development of these programs are paramount to future progression in health care, to prevent future errors by studying previous ones, thus improving health care.
Outcome Measures Reported in Published Clinical Research Studies in Craniosynostosis: A Systematic Review
Authors: Pidgeon Thomas E. , Al Omran Yasser , Farwana Reem , Phan Kevin , Al-Dulaimy Bakir , Radhakrishnan Anand , Kurar Langhit , Szczap Aleksandra , Sujan Mark-Alexander 
Published: August 2020

Context:
The fair comparison of treatment interventions for craniosynostosis across different studies is expected to be impaired by incomplete reporting and the use of inconsistent outcomes.

Objective:
This review assessed the outcomes currently reported in studies of craniosynostosis, and whether these outcomes are formally defined and prespecified in the study methods.

Data Sources, Search Terms, and Study Selection:
Studies were sourced via an electronic, multi-database literature search for “craniosynostosis.” All primary, interventional research studies published from 2011 to 2015 were reviewed.

Data Extraction:
Two independent researchers assessed each study for inclusion and performed the data extraction. For each study, data were extracted on the individual outcomes reported, and whether these outcomes were defined and prespecified in the methods.

Data Synthesis and Results:
Of 1027 studies screened, 240 were included and proceeded to data extraction. These studies included 18,365 patients.
2192 separate outcomes were reported. Of these, 851 outcomes (38.8%) were clearly defined, 1394 (63.6%) were prespecified in the study methods.
“Clinical and functional” was the most commonly reported outcome theme (900 outcomes, 41.1%), and “patient-reported” outcomes the least (7 outcomes, 0.3%).
“Duration of surgery” was the most commonly reported single outcome (reported 80 times). “Cranial index” was the most variably defined outcome (18 different definitions used).

Conclusion:
The outcomes reported following treatment interventions for craniosynostosis are incompletely and variably defined. Improving definitions for these outcomes may aid comparison of different management strategies and improve craniosynostosis care. Suboptimal prespecification of these outcomes in the study methods implied that outcome reporting bias cannot be excluded.
Acute Kidney Injury After Esophageal Cancer Surgery
Authors: Murphy Conor F. , Dunne Talulla , Elliott Jessie A. , Kamarajah Sivesh K. , Leighton James , Evans Richard P. T. , Bundred James , King Sinead , Ravi Narayanasamy , Donohoe Claire L. , Griffin S. Michael , Griffiths Ewen A. , Phillips Alexander W. , Reynolds John V. 
Published: August 2020

Objective:
To determine the incidence, risk factors, and consequences of AKI in patients undergoing surgery for esophageal cancer

Summary of Background Data:
Esophageal cancer surgery is an exemplar of major operative trauma, with well-defined risks of respiratory, cardiac, anastomotic, and septic complications. However, there is a paucity of literature regarding AKI.

Methods:
consecutive patients undergoing curative-intent surgery for esophageal cancer from 2011 to 2017 in 3 high-volume centers were studied. AKI was defined according to the AKI Network criteria. AKI occurred if, within 48 hours postoperatively, serum creatinine rose by 50% or by 0.3 mg/dL (26.5 μmol/L) from preoperative baseline. Complications were recorded prospectively. Multivariable logistic regression determined factors independently predictive of AKI.

Results:
A total of 1135 patients (24.7%:75.3% female:male, with a mean age of 64, a baseline BMI of 27 kg m−2, and dyslipidemia in 10.2%), underwent esophageal cancer surgery, 85% having an open thoracotomy. Overall in-hospital mortality was 2.1%. Postoperative AKI was observed in 208 (18.3%) patients, with AKI Network 1, 2, and 3 in 173 (15.2%), 28 (2.5%), and 7 (0.6%), respectively. Of these, 70.3% experienced improved renal function within 48 hours. Preoperative factors independently predictive of AKI were age [P = 0.027, odds ratio (OR) 1.02 (1.00–1.04)], male sex [P = 0.015, OR 1.77 (1.10–2.81)], BMI at diagnosis [P < 0.001, OR 1.10 (1.07–1.14)], and dyslipidemia [P = 0.002, OR 2.14 (1.34–3.44)]. Postoperatively, AKI was associated with atrial fibrillation (P = 0.013) and pneumonia (P = 0.005). Postoperative AKI did not impact survival outcomes.

Conclusion:
AKI is common but mostly self-limiting after esophageal cancer surgery. It is associated with age, male sex, increased BMI, dyslipidemia, and postoperative morbidity.
Patterns of National Institutes of Health Grant Funding to Surgical Research and Scholarly Productivity in the United States
Authors: Mesquita-Neto Jose Wilson , Dailey William , Macedo Francis I. , Merchant Nipun B. 
Published: August 2020

Objective:
The aim of this study was to assess the contemporary trends in National Institutes of Health (NIH) grants awarded to surgical investigators, including potential disparities.

Background:
The NIH remains the primary public funding source for surgical research in the United States; however, the patterns for grants and grantees are poorly understood.

Methods:
NIH RePORTER was queried for new grants (R01, -03, -21) awarded to Departments of Surgery (DoS). Principal investigators’ (PIs) data were extracted from publicly available information from their institutions’ websites and/or professional social media accounts.

Results:
The NIH awarded 1101 new grants (total: $389,006,782; median: $313,030) between 2008 and 2018. Funding to DoS has doubled in the last 10 years ($22,983,500–2008 to $49,446,076–2018). Midwest/Southeast institutions and surgical oncologists accounted for majority of the grants (31.9% and 24.5%, respectively). Only 24.7% of the projects were led by female PIs, who were predominantly nonphysician PhD scientists (52% vs 37.7% PhD-only male PIs; P = 0.002). During this time, there was a significant increase from 12.4% to 31.7% in grants awarded to PIs with >15 years of experience. These grants were associated with 8215 publications; however, only 13.2% were published in high-impact journals (impact factor ≥10). 4.4% of the grants resulted in patents, and these were associated with higher award amounts ($345,801 vs $311,350; P = 0.030). On multivariate analysis, combined MD/PhD degree [odds ratio (OR) 5.98; 95% confidence interval (CI) 2.18–16.39; P < 0.001] was associated with improved odds of patent creation; conversely, practicing surgeon PIs affected patent creation negatively (OR 0.31; 95% CI 0.11–0.85; P = 0.024).

Conclusion:
In the last decade, a greater proportion of NIH grants in DoS were awarded to more experienced investigators. Disparities exist among grantees, and female investigators are underrepresented, especially among practicing surgeons.
Predictors of Survival After Liver Transplantation in Patients With the Highest Acuity (MELD ≥40)
Authors: Evans Michael D. , Diaz Jessica , Adamusiak Anna M. , Pruett Timothy L. , Kirchner Varvara A. , Kandaswamy Raja , Humphreville Vanessa R. , Leventhal Thomas M. , Grosland Jeffrey O. , Vock David M. , Matas Arthur J. , Chinnakotla Srinath 
Published: August 2020

Objective:
To identify factors that accurately predict 1-year survival for liver transplant recipients with a MELD score ≥40.

Background:
Although transplant is beneficial for patients with the highest acuity (MELD ≥40), mortality in this group is high. Predicting which patients are likely to survive for >1 year would be medically and economically helpful.

Methods:
The Scientific Registry of Transplant Recipients database was reviewed to identify adult liver transplant recipients from 2002 through 2016 with MELD score ≥40 at transplant. The relationships between 44 recipient and donor factors and 1-year patient survival were examined using random survival forests methods. Variable importance measures were used to identify the factors with the strongest influence on survival, and partial dependence plots were used to determine the dependence of survival on the target variable while adjusting for all other variables.

Results:
We identified 5309 liver transplants that met our criteria. The overall 1-year survival of high-acuity patients improved from 69% in 2001 to 87% in 2016. The strongest predictors of death within 1 year of transplant were patient on mechanical ventilator before transplantation, prior liver transplant, older recipient age, older donor age, donation after cardiac death, and longer cold ischemia.

Conclusions:
Liver transplant outcomes continue to improve even for patients with high medical acuity. Applying ensemble learning methods to recipient and donor factors available before transplant can predict survival probabilities for future transplant cases. This information can be used to facilitate donor/recipient matching and to improve informed consent.
Perioperative Broad-spectrum Antibiotics are Associated With Decreased Surgical Site Infections Compared to 1st–3rd Generation Cephalosporins After Open Pancreaticoduodenectomy in Patients With Jaundice or a Biliary Stent
Authors: Kone Lyonell B. , Torres Carolina , Banulescu Mihaela , Maker Vijay K. , Maker Ajay V. 
Published: August 2020

Objective:
Compare the effectiveness of 1st-3rd generation cephalosporins (1st-3rdCE) to broad-spectrum antibiotics in decreasing surgical site infections (SSI) after pancreatectomy.

Summary of Background Data:
SSI is one of the most common complications after pancreatic surgery. Various antibiotic regimens are utilized nationwide with no clear guidelines for pancreatectomy. As we await results of a recently initiated prospective trial, this study retrospectively evaluates over 15,000 patients using the same administrative data abstraction tools as in the trial.

Methods:
All relevant clinical variables were collected from the 2016–2018 targeted-pancreatectomy database from the American College of Surgeon National Surgical Quality Improvement Program. Preoperative antibiotics were initially collected as first-generation cephalosporin, second or third-generation cephalosporin, and broad-spectrum antibiotics (Broad-abx).

Results:
Of the 15,182 patients who completed a pancreatic surgery between 2016 and 2018, 6114 (40%) received a first-generation cephalosporin, 4097 (27%) received a second or third-generation cephalosporin, and 4971 (33%) received Broad-abx. On multivariate analysis, Broad-abx was associated with a decrease in all-type SSI compared to 1st-3rdCE (odds ratio = 0.73–0.77, P < 0.001) after open pancreaticoduodenectomy (PD). There was no difference in SSI between antibiotic-types after distal pancreatectomy. Subgroup multivariate analysis of open PD revealed decrease in all-type SSI with Broad-abx amongst patients with jaundice and/or biliary stent only, regardless of wound protector use (odds ratio = 0.69–0.70, P < 0.001). Propensity score matching of open PD patients with jaundice and/or biliary stent confirmed a decrease in all-type SSI (19% vs 24%, P = 0.001), and organ-space SSI (12% vs 16%, P < 0.001).

Conclusion:
Broad-abx are associated with decreased SSI after open PD and may be preferred specifically for patients with preoperative biliary stent and/ or jaundice.