bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Association Between Endotracheal Tube Size and Aspiration (During Flexible Endoscopic Evaluation of Swallowing) in Acute Respiratory Failure Survivors
Authors: Krisciunas Gintas P. , Langmore Susan E. , Gomez-Taborda Stephanie , Fink Daniel , Levitt Joseph E. , McKeehan Jeffrey , McNally Edel , Scheel Rebecca , Rubio Alix C. , Siner Jonathan M. , Vojnik Rosemary , Warner Heather , White S. David , Moss Marc 
Published: August 2020

Objectives:
To determine whether a modifiable risk factor, endotracheal tube size, is associated with the diagnosis of postextubation aspiration in survivors of acute respiratory failure.

Design:
Prospective cohort study.

Setting:
ICUs at four academic tertiary care medical centers.

Patients:
Two hundred ten patients who were at least 18 years old, admitted to an ICU, and mechanically ventilated with an endotracheal tube for longer than 48 hours were enrolled.

Interventions:
Within 72 hours of extubation, all patients received a flexible endoscopic evaluation of swallowing examination that entailed administration of ice, thin liquid, thick liquid, puree, and cracker boluses. Patient demographics, treatment variables, and hospital outcomes were abstracted from the patient’s medical records. Endotracheal tube size was independently selected by the patient’s treating physicians.

Measurements and Main Results:
For each flexible endoscopic evaluation of swallowing examination, laryngeal pathology was evaluated, and for each bolus, a Penetration Aspiration Scale score was assigned. Aspiration (Penetration Aspiration Scale score ≥ 6) was further categorized into nonsilent aspiration (Penetration Aspiration Scale score = 6 or 7) and silent aspiration (Penetration Aspiration Scale score = 8). One third of patients (n = 68) aspirated (Penetration Aspiration Scale score ≥ 6) on at least one bolus, 13.6% (n = 29) exhibited silent aspiration, and 23.8% (n = 50) exhibited nonsilent aspiration. In a multivariable analysis, endotracheal tube size (≤ 7.5 vs ≥ 8.0) was significantly associated with patients exhibiting any aspiration (Penetration Aspiration Scale score ≥ 6) (p = 0.016; odds ratio = 2.17; 95% CI 1.14–4.13) and with risk of developing laryngeal granulation tissue (p = 0.02).

Conclusions:
Larger endotracheal tube size was associated with increased risk of aspiration and laryngeal granulation tissue. Using smaller endotracheal tubes may reduce the risk of postextubation aspiration.
Myoclonus in Patients With Coronavirus Disease 2019: A Multicenter Case Series
Authors: Anand Pria , Zakaria Asma , Benameur Karima , Ong Charlene , Putman Maryann , O’Shea Sarah , Greer David , Cervantes-Arslanian Anna M. 
Published: August 2020

Objectives:
To describe the risk factors for and outcomes after myoclonus in a cohort of patients with coronavirus disease 2019.

Design:
Multicenter case series.

Setting:
Three tertiary care hospitals in Massachusetts, Georgia, and Virginia.

Patients:
Eight patients with clinical myoclonus in the setting of coronavirus disease 2019.

Interventions & Measurements and Main Results:
Outcomes in patients with myoclonus were variable, with one patient who died during the study period and five who were successfully extubated cognitively intact and without focal neurologic deficits. In five cases, the myoclonus completely resolved within 2 days of onset, while in three cases, it persisted for 10 days or longer. Seven patients experienced significant metabolic derangements, hypoxemia, or exposure to sedating medications that may have contributed to the development of myoclonus. One patient presented with encephalopathy and developed prolonged myoclonus in the absence of clear systemic provoking factors.

Conclusions:
Our findings suggest that myoclonus may be observed in severe acute respiratory syndrome coronavirus 2 infected patients, even in the absence of hypoxia. This association warrants further evaluation in larger cohorts to determine whether the presence of myoclonus may aid in the assessment of disease severity, neurologic involvement, or prognostication.
Timing of Intubation and Mortality Among Critically Ill Coronavirus Disease 2019 Patients: A Single-Center Cohort Study
Authors: Hernandez-Romieu Alfonso C. , Adelman Max W. , Hockstein Maxwell A. , Robichaux Chad J. , Edwards Johnathan A. , Fazio Jane C. , Blum James M. , Jabaley Craig S. , Caridi-Scheible Mark , Martin Greg S. , Murphy David J. , Auld Sara C. 
Published: August 2020

Objectives:
Increasing time to mechanical ventilation and high-flow nasal cannula use may be associated with mortality in coronavirus disease 2019. We examined the impact of time to intubation and use of high-flow nasal cannula on clinical outcomes in patients with coronavirus disease 2019.

Design:
Retrospective cohort study.

Setting:
Six coronavirus disease 2019-specific ICUs across four university-affiliated hospitals in Atlanta, Georgia.

Patients:
Adults with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection who received high-flow nasal cannula or mechanical ventilation.

Interventions:
None.

Measurements and Main Results:
Among 231 patients admitted to the ICU, 109 (47.2%) were treated with high-flow nasal cannula and 97 (42.0%) were intubated without preceding high-flow nasal cannula use. Of those managed with high-flow nasal cannula, 78 (71.6%) ultimately received mechanical ventilation. In total, 175 patients received mechanical ventilation; 44.6% were female, 66.3% were Black, and the median age was 66 years (interquartile range, 56–75 yr). Seventy-six patients (43.4%) were intubated within 8 hours of ICU admission, 57 (32.6%) between 8 and 24 hours of admission, and 42 (24.0%) greater than or equal to 24 hours after admission. Patients intubated within 8 hours were more likely to have diabetes, chronic comorbidities, and higher admission Sequential Organ Failure Assessment scores. Mortality did not differ by time to intubation (≤ 8 hr: 38.2%; 8–24 hr: 31.6%; ≥ 24 hr: 38.1%; p = 0.7), and there was no association between time to intubation and mortality in adjusted analysis. Similarly, there was no difference in initial static compliance, duration of mechanical ventilation, or ICU length of stay by timing of intubation. High-flow nasal cannula use prior to intubation was not associated with mortality.

Conclusions:
In this cohort of critically ill patients with coronavirus disease 2019, neither time from ICU admission to intubation nor high-flow nasal cannula use were associated with increased mortality. This study provides evidence that coronavirus disease 2019 respiratory failure can be managed similarly to hypoxic respiratory failure of other etiologies.
Prognostic Value of Preoperative Imaging
Authors: St. Laurent Jessica D. , Davis Michelle R. , Feltmate Colleen M. , Goodman Annekathryn , Del Carmen Marcella G. , Horowitz Neil E. , Lee Susanna I. , Growdon Whitfield B. 
Published: August 2020

Objective:
18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) increases the sensitivity for preoperative detection of lymph nodes and distant metastases in endometrial cancer. The objective of this investigation was to determine the prognostic value of preoperative PET-CT compared with computed tomography (CT) alone for high-risk endometrial carcinoma.

Materials and Methods:
We performed a retrospective review of high-risk histology endometrial cancer from 2008 to 2015. Clinical variables including surgical procedure, preoperative imaging modality, and outcome were collected. Survival analysis was performed utilizing the Kaplan-Meier and Cox proportional hazards methodologies.

Results:
Of the 555 women treated for high-risk histology endometrial cancer, 88 (16%) had preoperative PET-CT, and 97 (17%) CT without PET available. PET-CT demonstrated positive findings in 37 women (42%) compared with 33 (30%) with preoperative CT alone. PET-CT had a positive predictive value of 96% for nodal metastasis compared with 60% for CT alone. The median follow-up time for the entire cohort was 59 months (range, 12 to 96 mo). Patients with a negative preoperative PET-CT (n=54) had a median progression-free survival (PFS) that was not reached, whereas the median PFS in the PET-CT positive group was 13 months (n=34). Women with a negative PET-CT had a longer median overall survival (OS) not yet reached compared with 34 months in the PET-CT positive cohort (hazard ratio, 2.4; P<0.001). CT findings did not associate with PFS or OS.

Conclusions:
PET-CT demonstrated superior sensitivity for lymph node metastasis and detecting distant disease compared with CT. Preoperative PET-CT, whether positive or negative, offered OS and PFS prognostic value not observed with CT alone.
Racial Disparities in Time to Treatment Initiation and Outcomes for Early Stage Anal Squamous Cell Carcinoma
Authors: Goksu Suleyman Y. , Ozer Muhammet , Kazmi Syed M.A. , Aguilera Todd A. , Ahn Chul , Hsiehchen David , Sanjeevaiah Aravind , Maxwell Mary C. , Beg Muhammad S. , Sanford Nina N. 
Published: August 2020

Objectives:
Although cure rates for early stage anal squamous cell cancer (ASCC) are overall high, there may be racial disparities in receipt of treatment and outcome precluding favorable outcomes across all patient demographics. Therefore, the authors aimed to assess the time to treatment initiation and overall survival (OS) in Black and White patients receiving definitive chemoradiation for early stage ASCC.

Materials and Methods:
The authors identified patients diagnosed with early stage (stage I-II) ASCC and treated with chemoradiation diagnosed between 2004 and 2016 in the National Cancer Database. Clinical and treatment variables were compared by race using the χ2 test, and OS assessed through Cox regression with 1:1 nearest neighbor propensity score matching.

Results:
Among 9331 patients, 90.6% were White. Black patients had longer median time to treatment initiation as compared with White patients (47 vs. 36 d, P<0.001), and on multivariable analysis, the Black race was associated with higher odds of >6 weeks of time to treatment initiation (hazard ratio, 1.78; 95% confidence interval, 1.53-2.08; P<0.001). Furthermore, Black patients had worse OS (5-year survival 71% vs. 77%; P<0.001), which persisted after propensity score matching (P=0.007).

Conclusions:
Black patients had a longer time to treatment initiation and worse OS as compared with White patients with early stage ASCC treated with chemoradiation. Further research is needed to better elucidate the etiologies of these disparities.
Inpatient Palliative Care Use Among Critically III Brain Metastasis Patients in the United States
Authors: Rubens Muni , Ramamoorthy Venkataraghavan , Saxena Anshul , McGranaghan Peter , Bhatt Chintan , Das Sankalp , Shehadeh Nancy , Veledar Emir , Viamonte-Ros Ana , Odia Yazmin , Mehta Minesh P. , Kotecha Rupesh 
Published: August 2020

Objective:
The objective of this study was to understand the trends and characteristics of palliative care delivery among critically ill brain metastasis patients using a nationally representative database.

Materials and Methods:
This study was a retrospective analysis of Nationwide Inpatient Sample data collected during 2005 to 2014. This study included critically ill patients, 18 years and above, diagnosed with brain metastasis, identified using International Classification of Diseases-Ninth Revision-Clinical Modification diagnosis and procedure codes. Multivariable logistic regression models were used for predicting factors associated with inpatient palliative care use.

Results:
Among 18,309 critically ill patients with brain metastasis, 3298 (18.0%) received inpatient palliative care. The rate of inpatient palliative care use among these patients increased from 3.2% to 28.5%, during 2005 to 2014 (P<0.001). Regression analysis showed that hospital teaching status (odds ratio [ORs], 1.45; 95% confidence interval [CI], 1.14-1.84), primaries located in head and neck (OR, 1.42; 95% CI, 1.21-2.05) or lung (OR, 1.32; 95% CI, 1.22-1.44), and primary diagnosis of pneumonia (OR, 1.42; 95% CI, 1.22-1.97) or septicemia (OR, 1.59; 95% CI, 1.30-1.97), were associated with higher palliative care use. Hispanic ethnicity (OR, 0.86; 95% CI, 0.67-0.96), and hospital location in Northeast (OR, 0.73; 95% CI, 0.54-0.96), Midwest (OR, 0.63; 95% CI, 0.45-0.87), or South (OR, 0.64; 95% CI, 0.48-0.86) were associated with lower palliative care use.

Conclusions:
Inpatient palliative care use increased significantly among critically ill patients with brain metastases, though overall rate was low. There were geographical and racial disparities among these patients. Health care providers and policy makers should focus on decreasing these disparities. In addition, hospitals should focus on adopting more palliative care services.
Organizational Change Associated With DPT Curricular Transformation: A Qualitative Study of Faculty Experiences in One Program
Authors: Macauley Kelly , Jette Diane U. , Callahan Janet , Brudvig Tracy J. , Levangie Pamela K. 
Published: August 2020

Introduction.
Faculty perceptions of organizational change and culture shifts created by major curricular revision in higher education have been described. However, there are no similar descriptions for faculty in physical therapist education.

Methods.
All faculty from one Doctor of Physical Therapy program were recruited and agreed to participate in this study (n = 19). A qualitative thematic approach was applied to deidentified transcripts of faculty interviews conducted at the end of the first year (round 1) of a new curriculum and again after all academic courses had been taught at least once (round 2). Independently coded themes were discussed and further refined iteratively. All data and themes were sent to an external reviewer with feedback incorporated into findings.

Results.
Ten themes emerged from the analysis of the interviews—7 from round 1 interviews and 3 additional themes from round 2 interviews, including Convoluted Planning Process, Challenging Management Processes & Structure, Overwhelming Workload, New Pedagogy, Integrated Curricular Structure, Crucial Teamwork and Communication, Insufficient Resources, Evolving Attitudes and Approaches, Personal & Professional Growth, and Cautious Optimism.

Discussion and Conclusion.
The themes that emerged from this study—as well as faculty observations, insights, and concerns—parallel those experienced by non-PT faculty going through similar changes to innovative curricula although with greater levels of angst than evident elsewhere in the literature. The themes also fit the framework by Armenakis and Bedeian that identified 4 common issues across the organizational change literature. Most of our faculty remained hopeful that the original goal of a patient-centered, integrated, active learning curriculum could be reached with continued curricular development and faculty growth. There are increasingly urgent calls to rethink physical therapy education to better prepare graduates for a dynamic health care environment, to respond to emerging biopsychosocial research and pandemic demands, and to reduce graduate indebtedness. These will likely lead to extensive curricular change across programs in the near future. Our findings may facilitate more realistic expectations of physical therapy faculty when facing the challenges of major curriculum change.
Improvement of the frontal QRS-T angle after successful percutaneous coronary revascularization in patients with chronic total occlusion
Authors: Uzun Fatih , Güner Ahmet , Demir Ali Riza , Can Arda , Yalçin Ahmet Arif , Aguş Hicaz Zencirkiran , Kalkan Ali Kemal 
Published: August 2020

Background
The QRS-T angle (QRS-Ta) is a novel marker of myocardial repolarization heterogeneity which is related to adverse cardiovascular events. Our aim in this study was to investigate the effect of successful percutaneous coronary intervention (PCI) on frontal QRS-Ta in patients with chronic total occlusion (CTO).

Materials and methods
A total of 132 patients undergoing PCI for CTO were included in this study. Successful PCI of CTO segment was performed in 84 patients (group 2) while 48 who failed CTO were observed (group 1). Baseline demographic and clinical variables were evaluated and, 12-lead surface ECGs of all subjects were recorded before performing coronary angiography and 1-month and 6-month after the index procedure.

Results
QRS-Ta values significantly decreased during follow-up visits compared to baseline values [92.5 (63.25–110.75); 85.0 (59.0–101.0); 80.0 (53.0–99.0), P < 0.001] in group 2 patients. Moreover, there was no significant difference in frontal QRS-Ta measurements in group 1 patients in their clinical 6-month follow-up [87.0 (48.25–103.0); 86.5 (46.0–101.75); 84.0 (49.0–103.75); P = 0.320]. First month frontal QRS-Ta values [92.5 (63.25–110.75); 85.0 (59.0–101.0), P = 0.002] and sixth month frontal QRS-Ta values [92.5 (63.25–110.75); 80.0 (53.0–99.0), P < 0.001] were lower than baseline values while sixth month values [85.0 (59.0–101.0); 80.0 (53.0–99.0), P = 0.002] was lower compared to first month values. Additionally, a decrease in frontal QRS-Ta was observed regardless of target vessel or Rentrop classification.

Conclusion
Successful percutaneous revascularization of CTO was effective in ventricular repolarization. Frontal QRS-Ta significantly decreased after successful PCI on CTO patients at a 6-month follow-up.
Lipoprotein(a) as a predictor for the presence and severity of premature coronary artery disease: a cross-sectional analysis of 2433 patients
Authors: Shi Yan-Pu , Cao Ye-Xuan , Jin Jing-Lu , Liu Hui-Hui , Zhang Hui-Wen , Guo Yuan-Lin , Gao Ying , Zhu Cheng-Gang , Wu Na-Qiong , Li Jian-Jun 
Published: August 2020

Background
Lipoprotein(a) [Lp(a)] has been emerged as a risk factor for coronary artery disease (CAD), but there is currently insufficient data on the relationship between Lp(a) and premature CAD (PCAD). Thus, this study aimed to examine the association between Lp(a) and PCAD in a Chinese cohort.

Methods
Data on 2433 individuals (male <55 years old and female <65 years old) who underwent coronary angiography from March 2016 to February 2019 were included in this study and were divided into the PCAD group (n = 1751) and non-CAD group (n = 682) according to the angiography results. Their clinical and laboratory parameters were collected, and plasma Lp(a) level was measured by immunoturbidimetry. The severity of CAD was evaluated using Gensini score (GS) and divided into three subgroups. The relationship between plasma Lp(a) levels and the presence and severity of PCAD was analyzed.

Results
The level of plasma Lp(a) in the PCAD group was significantly higher than that in the non-CAD group (P < 0.001). The plasma Lp(a) concentration in the highest GS group was significantly higher than that in the lowest GS group (P < 0.001). Multivariate linear regression analysis showed that elevated plasma Lp(a) levels were correlated with higher GS (b = 0.41, P < 0.001). Multivariate logistic regression showed that elevated plasma Lp(a) levels were independently associated with PCAD (odds ratio = 2.91, P < 0.001). Moreover, elevated plasma Lp(a) levels correlated with higher GS (b = 0.41, P < 0.001).

Conclusion
In this study, Lp(a) concentration was associated with the presence and severity of PCAD, suggesting that Lp(a) may be a marker or target for patients with PCAD.
Endoscopic remission can be predicted by golimumab concentrations in patients with ulcerative colitis treated with the changed label
Authors: Stefanovic Sebastian , Detrez Iris , Compernolle Griet , Brouwers Els , Sever Nejc , Stabuc Borut , Smrekar Natasa , Kurent Tina , Novak Gregor , Kozelj Matic , Ferrante Marc , Gils Ann , Drobne David 
Published: August 2020

Background
In 2018, the European Medicines Agency (EMA) replaced a fixed 50 mg every 4-week maintenance regimen of golimumab for ulcerative colitis (UC) patients weighing <80 kg with new, flexible dosing that allows reactive dose optimization to 100 mg if clinically needed. We analyzed the endoscopic remission rates and pharmacokinetics of this new dosing regimen in real-life settings.

Methods
We prospectively recruited 30 consecutive (17 with body weight <80 kg) patients with UC who received golimumab with the new EMA label. The primary endpoint was endoscopic remission (Mayo ≤1) assessed by centrally-read endoscopy at week 14 and year 1. Golimumab concentrations, measured at nine prespecified timepoints, were correlated with endoscopic remission and identified cut-offs.

Results
Endoscopic remission was achieved in 15/30 (50%) and 10/30 (33%) patients at week 14 and year 1, respectively. Reactive dose optimization to 100 mg maintenance was needed in 13/17 (76%) patients. Golimumab concentrations at week 6 predicted week 14 and year 1 endoscopic remission. Week 6 concentrations >10.7 µg/ml were a strong predictor for achievement and maintenance of endoscopic remission during the first year of treatment, while concentrations <5.1 µg/ml identified the opposite.

Conclusion
One-third of the patients reached and maintained endoscopic remission during the first year of golimumab treatment, but the need for dose optimization to 100 mg every 4 weeks of maintenance was high in patients weighing <80 kg. Golimumab concentrations <5.1 µg/ml at week 6 identified patients who are unlikely to reach and maintain endoscopic remission with the new, flexible EMA label.
Mapping the relationships between inflammatory bowel disease and comorbid diagnoses to identify disease associations
Authors: Waljee Akbar K. , Noureldin Mohamed , Berinstein Jeffrey A. , Cohen-Mekelburg Shirley A. , Wallace Beth I. , Cushing Kelly C. , Hanauer David A. , Keeney-Bonthrone Toby P. , Nallamothu Brahmajee , Higgins Peter D.R. 
Published: August 2020

Background
Massive amounts of patient data are captured daily in electronic medical records (EMR). Utilizing the power of such large data may help identify disease associations and generate hypotheses that can lead to a better understanding of disease associations and mechanisms. We aimed to comprehensively identify and validate associations between inflammatory bowel disease (IBD) and concurrent comorbid diagnoses.

Methods
We performed a cross-sectional study using EMR data collected between 1986 and 2009 at a large tertiary referral center to identify associations with a diagnosis of IBD. The resulting associations were externally validated using the Truven MarketScan database, a large nationwide dataset of private insurance claims.

Results
A total of 6225 IBD patients and 31 125 non-IBD controls identified using EMR data were used to abstract 41 comorbid diagnoses associated with an IBD diagnosis. The strongest associations included Clostridiodes difficile infection, pyoderma gangrenosum, parametritis, pernicious anemia, erythema nodosum, and cytomegalovirus infection. Two IBD association clusters were found, including diagnoses of nerve conduction abnormalities and nonspecific inflammatory conditions of organs outside the gut. These associations were validated in a national cohort of 80 907 patients with IBD and 404 535 age- and sex-matched controls.

Conclusion
We leveraged a big data approach to identify several associations between IBD and concurrent comorbid diagnoses. EMR and big data provide the opportunity to explore disease associations with large sample sizes. Further studies are warranted to refine the characterization of these associations and evaluate their usefulness for increasing our understanding of disease associations and mechanisms.