bluuebunny/crossref_metadata_2025_split huggingface dataset:
Immediate and 1‐Year Outcomes with a Slim Modiolar Cochlear Implant Electrode Array
Authors: Durakovic Nedim , Kallogjeri Dorina , Wick Cameron C. , McJunkin Jonathan L. , Buchman Craig A. , Herzog Jacques 
Published: March 2020

ObjectiveTo explore the immediate and 1‐year outcomes of patients who underwent implantation with the slim modiolar electrode (SME).Study DesignConsecutive case series with chart review.SettingTertiary referral academic center.Subject and MethodsBetween May 2016 and August 2018, a total of 326 cochlear implantations (CIs) were performed. Intraoperative x‐rays were performed in all cases to identify tip rollovers. Scalar location was identified for 76 CIs that had postoperative computed tomography reconstructions. Speech outcomes were measured at 3, 6, and 12 months with consonant‐nucleus‐consonant word and AzBio sentences in quiet and noise (+10‐dB signal‐to‐noise ratio). Preservation of hearing was defined as maintaining a low‐frequency pure tone average ≤80 dB at 250 and 500 Hz.ResultsAmong 326 CIs, 23 (7%) had tip rollovers. Postoperative reconstructions revealed 5 of 76 (6.6%) scalar translocations. A subset of 177 cases met criteria for evaluation of speech perception scores. The marginal mean differences between presurgery and 12 months for speech tests were as follows: consonant‐nucleus‐consonant, 43.7 (95% CI, 39.8‐47.6); AzBio in quiet, 49.7 (95% CI, 44.9‐54.4); and AzBio in noise, 29.9 (95% CI, 25.2‐34.7). Sixty‐one patients were identified with preservable hearing (low‐frequency pure tone average ≤80 dB), and 12 of 61 (20%) preserved hearing at 1 year.ConclusionCI with SME provides reliable scala tympani insertion in a consistent perimodiolar position. An initially increased tip rollover rate improved with case volume and sheath design improvement. For long‐term outcomes, speech performance was comparable to that of other cochlear implants. While hearing preservation for the SME may be better than prior perimodiolar electrodes, consistent outcomes are unlikely.
Long‐Term Outcomes of Thyroid Nodule AFIRMA GEC Testing and Literature Review: An Institutional Experience
Authors: Vora Amy , Holt Shelby , Haque Wasim , Lingvay Ildiko 
Published: March 2020

ObjectiveTo assess outcomes of thyroid nodules analyzed with the AFIRMA gene expression classifier (GEC) and to perform a comprehensive literature review.Study DesignRetrospective analysis of patients with thyroid nodules who underwent AFIRMA GEC testing at our institution.SettingsA tertiary care academic institution.Subjects and MethodsWe collected clinical outcomes for 416 thyroid nodules that were analyzed with AFIRMA GEC between 2011 and 2015, including long‐term follow‐up through 2019. We performed a comprehensive literature review.ResultsThe resection rate for nodules with “suspicious” GEC results was 85% with a positive predictive value of 37%. The resection rate for nodules with “benign” GEC results was 24% with a negative predictive value of 90%. The prevalence of thyroid malignancy in patients with thyroid nodules with indeterminate cytology at our institution during this timeframe was 41%, thus lowering our negative predictive value. Mean follow‐up duration for unresected nodules was 27.8 months. Our resection rates for nodules with “benign” GEC were among the highest reported in the literature.ConclusionsMolecular marker testing of thyroid nodules with indeterminate cytology can aid in the surgical decision making by obviating the need for diagnostic surgery and/or guiding extent of resection. Patients with other indications for surgery may not benefit from such costly testing.
Supportive Care Needs of Patients with Head and Neck Cancer Referred to Palliative Medicine
Authors: Lin Chen , Kang Stephen Y. , Donermeyer Samantha , Teknos Theodoros N. , Wells‐Di Gregorio Sharla M. 
Published: March 2020

ObjectivePatients with head and neck cancer (HNC) face a unique set of unmet needs. A subset of these patients experience symptom control challenges related to their disease burden and treatments. A multidisciplinary approach involving palliative medicine is underutilized but crucial to identify and address these concerns. There is limited information on palliative integration with head and neck oncology.Study DesignCase series with planned data collection.SettingAcademic quaternary care center.Subjects and MethodsWe provide descriptive analyses of patients with HNC, including psychodiagnostic assessment and validated quality‐of‐life screening, from patients’ first encounter at outpatient palliative medicine.ResultsHNC (N = 80) contributed the greatest number of palliative referrals (25%) between 2010 and 2012. This cohort was 74% male and 79% Caucasian with a mean age of 53 years (95% CI, 51.1‐54.9) and with stage IV disease of the oral cavity (28%) or oropharynx (31%). Sixty‐three percent of patients had no evidence of disease. Seventy‐five percent had a psychological history based on DSM‐IV criteria (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), and 70% had a history of substance use disorder. The most distressing quality‐of‐life concerns were pain, housing and financial problems, and xerostomia.ConclusionsPatients with HNC who were referred to palliative medicine are burdened by multiple physical, psychological, substance use, and social challenges. We recommend comprehensive cancer‐specific screening, such as the James Supportive Care Screening, to triage patients to appropriate supportive care services. Palliative care is one of many services that these patients may need, and it should be utilized at any point of the disease trajectory rather than reserved for end‐of‐life care.
Influence of Sevoflurane‐Based Anesthesia versus Total Intravenous Anesthesia on Intraoperative Neuromonitoring during Thyroidectomy
Authors: Li Xiaoxi , Zhang Bin , Yu Ling , Yang Jiaonan , Tan Hongyu 
Published: March 2020

ObjectiveTo examine the influence of sevoflurane‐based combined intravenous and inhaled anesthesia versus propofol‐based total intravenous anesthesia (TIVA) on intraoperative neuromonitoring (IONM) during thyroidectomy.Study DesignA randomized controlled trial.SettingThe present study was conducted in a tertiary hospital.Subjects and MethodsForty patients were randomly assigned to a sevoflurane‐based combined intravenous and inhalation group (group S) or a propofol‐based total intravenous group (group P). Anesthesia was induced with midazolam, sufentanil, propofol, and cisatracurium in both groups and was maintained with sevoflurane and remifentanil in group S and with TIVA with propofol and remifentanil in group P. IONM was performed intermittently according to the IONM formula standard.ResultsThe time until detection of the first positive electromyographic (EMG) signal was significantly longer in group S (median, 41.0 minutes [interquartile range, 37.5‐49.3]) than in group P (37.0 minutes [33.3‐41.5], P =. 028). All patients in group P had a positive EMG signal at initial monitoring, whereas 8 patients (40.0%) in group S did not. The rate of positive EMG signal at initial monitoring was significantly higher in group P than in group S (P =. 006). The amplitude of the evoked potentials at V1, R1, R2, and V2 were similar between the groups.ConclusionCombined intravenous and inhaled anesthesia based on sevoflurane‐remifentanil prolonged the time until detection of a positive EMG signal during IONM as compared with TIVA with propofol‐remifentanil in patients undergoing thyroidectomy.
Determinants of nutritional knowledge, attitude, and practice among southwestern Iranian households: A community-based study
Authors: Naghashpour Mahshid , Mansouri Samaneh , Vadizadeh Ali , Cheraghian Bahman , Fallahi Reza , Vaziri Fateme 
Published: March 2020

Background: Malnutrition is generally due to a lack of nutritional information rather than food deficiency. Therefore, the current knowledge, attitudes, and practice (KAP) of the target audience should be evaluated to eliminate malnutrition. However, KAP varies across demographic status and socioeconomic status (SES). Aim: The associations of nutritional KAP with demographic and socioeconomic variables were evaluated among households living in urban and rural areas of southwestern Iran. Methods: A cross-sectional, population-based study was conducted on 842 household heads (492 urban and 350 rural) using a standardized NUTRIKAP Household Questionnaire. The data evaluating nutritional KAP as well as demographic and socioeconomic information were obtained using a multi-stage cluster sampling method. SES score was also computed. Results: Urban households had a higher level of nutritional knowledge ( p < 0.05) but a lower level of nutritional attitude ( p < 0.001) and practice ( p < 0.001) compared with the rural ones. Rural households with the poorest quintiles of SES were 0.4 times less likely to have good nutritional knowledge (adjusted odds ratio = 0.4, confidence interval: 0.2, 0.9; p < 0.05), compared with higher quintiles. Households with an over-60-years-old household head had significantly higher nutritional attitude ( p < 0.05) and practice ( p <0.01) scores than households with younger ones. Households with male household heads had a higher nutritional practice score compared with households with female ones. Conclusions: These results can indicate the role of demographic and socioeconomic determinants in KAP of Iranian households towards the principle of nutrition and can be effective in prioritizing the implementation of nutritional interventions including nutrition education for them.
Associations Between Initial Clinical Examination and Imaging Findings and Return-to-Sport in Male Athletes With Acute Adductor Injuries: A Prospective Cohort Study
Authors: Serner Andreas , Weir Adam , Tol Johannes L. , Thorborg Kristian , Yamashiro Eduardo , Guermazi Ali , Roemer Frank W. , Hölmich Per 
Published: March 2020

Background: Time to return-to-sport (RTS) after acute adductor injuries varies among athletes, yet we know little about which factors determine this variance. Purpose: To investigate the association between initial clinical and imaging examination findings and time to RTS in male athletes with acute adductor injuries. Study Design: Cohort study (Prognosis); Level of evidence, 2. Methods: Male adult athletes with an acute adductor injury were included within 7 days of injury. Standardized patient history and clinical and magnetic resonance imaging (MRI) examinations were conducted for all athletes. Athletes performed a supervised standardized criteria-based exercise treatment program. Three RTS milestones were defined: (1) clinically pain-free, (2) completed controlled sports training, and (3) first full team training. Univariate and multiple regression analyses were performed to determine the association between the specific candidate variables of the initial examinations and the RTS milestones. Results: We included 81 male adult athletes. The median duration for the 3 RTS milestones were 15 days (interquartile range, 12-28 days), 24 days (16-32 days), and 22 days (15-31 days), respectively. Clinical examination including patient history was able to explain 63%, 74%, and 68% of the variance in time to RTS. The strongest predictors for longer time to RTS were pain on palpation of the proximal adductor longus insertion or a palpable defect. The addition of MRI increased the explained variance with 7%, 0%, and 7%. The strongest MRI predictor was injury at the bone-tendon junction. Post hoc multiple regression analyses of players without the 2 most important clinical findings were able to explain 24% to 31% of the variance, with no added value of the MRI findings. Conclusion: The strongest predictors of a longer time to RTS after acute adductor injury were palpation pain at the proximal adductor longus insertion, a palpable defect, and/or an injury at the bone-tendon junction on MRI. For athletes without any of these findings, even extensive clinical and MRI examination does not assist considerably in providing a more precise estimate of time to RTS.
Does Time for (in)Direct Nursing Care Activities at the End of Life for Patients With or Without Specialized Palliative Care in a University Hospital Differ? A Retrospective Analysis
Authors: Fliedner Monica C. , Hagemann Monika , Eychmüller Steffen , King Cynthia , Lohrmann Christa , Halfens Ruud J. G. , Schols Jos M. G. A. 
Published: March 2020

Background: Nurses’ end of life (EoL) care focuses on direct (eg, physical) and indirect (e,g, coordination) care. Little is known about how much time nurses actually devote to these activities and if activities change due to support by specialized palliative care (SPC) in hospitalized patients. Aims: (1) Comparing care time for EoL patients receiving SPC to usual palliative care (UPC);(2) Comparing time spent for direct/indirect care in the SPC group before and after SPC. Methods: Retrospective observational study; nursing care time for EoL patients based on tacs® data using nonparametric and parametric tests. The Swiss data method tacs measures (in)direct nursing care time for monitoring and cost analyses. Results: Analysis of tacs® data (UPC, n = 642; SPC, n = 104) during hospitalization before death in 2015. Overall, SPC patients had higher tacs® than UPC patients by 40 direct (95% confidence interval [CI]: 5.7-75, P = .023) and 14 indirect tacs® (95% CI: 6.0-23, P < .001). No difference for tacs® by day, as SPC patients were treated for a longer time (mean number of days 7.2 vs 16, P < .001).Subanalysis for SPC patients showed increased direct care time on the day of and after SPC ( P < .001), whereas indirect care time increased only on the day of SPC. Conclusions: This study gives insight into nurses’ time for (in)direct care activities with/without SPC before death. The higher (in)direct nursing care time in SPC patients compared to UPC may reflect higher complexity. Consensus-based measurements to monitor nurses’ care activities may be helpful for benchmarking or reimbursement analysis.
Stability of freeze-dried plasma rich in growth factors eye drops stored for 3 months at different temperature conditions
Authors: Anitua Eduardo , de la Fuente María , Muruzábal Francisco , Merayo-Lloves Jesús 
Published: March 2020

Purpose: The purpose of this study was to analyze the biological content and activity of freeze-dried plasma rich in growth factors eye drops after their storage at 4°C and at room temperature for 3 months with respect to fresh samples (time 0). Methods: Plasma rich in growth factors was obtained after blood centrifugation from three healthy donors. After platelet activation, the obtained plasma rich in growth factors eye drops were lyophilized alone or in combination with lyoprotectant (trehalose), then they were stored for 3 months at room temperature or at 4°C. Several growth factors were analyzed at each storage time and condition. Furthermore, the proliferative and migratory potential of freeze-dried plasma rich in growth factors eye drops kept for 3 months at different temperature conditions was evaluated on primary human keratocytes. Results: The different growth factors analyzed maintained their levels at each time and storage condition. Freeze-dried plasma rich in growth factors eye drops stored at room temperature or 4°C for 3 months showed no significant differences on the proliferative activity of keratocytes in comparison with fresh samples. However, the number of migratory human keratocytes increased significantly after treatment with lyophilized plasma rich in growth factors eye drops kept for 3 months compared to those obtained at time 0. No significant differences were observed between the freeze-dried plasma rich in growth factors eye drops whether mixed or not with lyoprotectant. Conclusion: Freeze-dried plasma rich in growth factors eye drops preserve the main growth factors and their biological activity after storage at room temperature or 4°C for up to 3 months. Lyophilized plasma rich in growth factors eye drops conserve their biological features even without the use of lyoprotectants for at least 3 months.
Comparison of rituximab originator (MabThera®) to biosimilar (Truxima®) in patients with multiple sclerosis
Authors: Perez Thomas , Rico Audrey , Boutière Clémence , Maarouf Adil , Roudot Marjorie , Honoré Stéphane , Pelletier Jean , Bertault-Peres Pierre , Audoin Bertrand 
Published: March 2020

Background: Rituximab’s originator MabThera® or Rituxan® has demonstrated high efficacy in multiple sclerosis (MS). Because of the patent expiration, rituximab biosimilars have been developed. However, because a biosimilar is not the exact copy of the originator, the efficacy and safety of a biosimilar may significantly differ. Objectives: To compare the efficacy and safety of the biosimilar Truxima® and the originator MabThera® in MS. Methods: Consecutive MS patients receiving MabThera® or Truxima® were prospectively followed during 1 year after treatment introduction. Allocation to each treatment depended on the period of introduction and not the physician’s choice. Lymphocyte count, clinical and magnetic resonance imaging (MRI) activity, Expanded Disability Status Scale (EDSS), and adverse events were compared. Results: In total, 105 and 40 patients received MabThera® and Truxima®, respectively. The two groups did not differ in baseline characteristics. Effect on CD19+ lymphocytes and disease activity were similar during follow-up. EDSS remained stable, with no difference between groups. Adverse events were similar between groups. Conclusion: The efficacy and safety of the rituximab biosimilar Truxima® seem equivalent to the originator MabThera® in MS patients. Truxima® could represent a relatively cheap and safe therapeutic alternative to MabThera® and could improve access to highly efficient therapy for MS in low- or middle-income countries.
Reorganizing and integrating public health, health care, social care and wider public services: a theory-based framework for collaborative adaptive health networks to achieve the triple aim
Authors: Steenkamer Betty , Drewes Hanneke , Putters Kim , van Oers Hans , Baan Caroline 
Published: March 2020

Objective Population health management (PHM) refers to large-scale transformation efforts by collaborative adaptive health networks that reorganize and integrate services across public health, health care, social care and wider public services in order to improve population health and quality of care while at the same time reducing cost growth. However, a theory-based framework that can guide place-based approaches towards a comprehensive understanding of how and why strategies contribute to the development of PHM is lacking, and this review aims to contribute to closing this gap by identifying the key components considered to be key to successful PHM development. Methods We carried out a scoping realist review to identify configurations of strategies (S), their outcomes (O), and the contextual factors (C) and mechanisms (M) that explain how and why these outcomes were achieved. We extracted theories put forward in included studies and that underpinned the formulated strategy-context-mechanism-outcome (SCMO) configurations. Iterative axial coding of the SCMOs and the theories that underpin these configurations revealed PHM themes. Results Forty-one studies were included. Eight components were identified: social forces, resources, finance, relations, regulations, market, leadership, and accountability. Each component consists of three or more subcomponents, providing insight into (1) the (sub)component-specific strategies that accelerate PHM development, (2) the necessary contextual factors and mechanisms for these strategies to be successful and (3) the extracted theories that underlie the (sub)component-specific SCMO configurations. These theories originate from a wide variety of scientific disciplines. We bring these (sub)components together into what we call the Collabroative Adaptive Health Network (CAHN) framework. Conclusions This review presents the strategies that are required for the successful development of PHM. Future research should study the applicability of the CAHN framework in practice to refine and enrich identified relationships and identify PHM guiding principles.
Added value of strain elastography in the characterisation of breast lesions: A prospective study
Authors: Sinha Dimpi , Sharma Sukrity , Kundaragi Nischal G , Kale Sudhir Kumar 
Published: March 2020

Background Elastography is a new promising ultrasonographic technique which is used to differentiate benign and malignant breast lesions based on the stiffness of the lesion. Purpose To determine the role of strain elastography in characterisation of breast lesions and to compare the diagnostic performances of strain elastography and conventional ultrasound (US). Methods In total, 113 breast lesions in 100 women were prospectively evaluated by US and strain elastography followed by the histopathological examination. Elastography score based on the Tsukuba colour scale and strain ratio were determined for each lesion. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated for each modality and the diagnostic performances were compared. The best cut-off point was calculated for each of the elastography parameters using the receiver operator curve analysis. Results Out of the 113 lesions, 40 were malignant (35.4%) and 73 were benign (64.6%). The area under the curve for elastography score showed significant difference with that of US: 0.98 versus 0.90 (Difference = 0.08, p =0.02). The elastography parameters were more specific as compared to US (ES-95 and SR-93% vs. 63%, p < 0.05) with a high negative predictive value. The combined use of elastography and US gave better results with 95% sensitivity, 94% specificity, 94% accuracy and negative predictive value reaching 97%. Conclusion Strain elastography is a useful adjunct to conventional ultrasonography. The combined use of strain elastography and ultrasound improves the characterisation of breast lesions and helps in down-staging of assigned BI-RADS category, thereby avoiding unnecessary biopsies. ES is the most useful elastography parameter to differentiate between benign and malignant breast lesions.
Cohort Study of Features Used by Experts to Diagnose Transient Ischemic Attack
Authors: Fitzpatrick Tess , Gocan Sophia , Wang Chu Qi , Bourgoin Aline , Taljaard Monica , Cheng Wei , Dowlatshahi Dar , Stotts Grant , Shamy Michel 
Published: March 2020

Background and Purpose: The diagnosis of transient ischemic attack (TIA) is largely dependent on a process of clinical decision-making that remains poorly characterized in the absence of a validated and accessible biomarker or imaging test. We performed a retrospective chart review to identify variables associated with a final neurologist diagnosis of TIA/stroke. Methods: Records for all patients seen in The Ottawa Hospital’s Stroke Prevention Clinic in 2015 were analyzed for patient and referral characteristics, features of the presenting neurological event, and final diagnosis by a stroke neurologist (classified as definite, possible, or definite not TIA/stroke). Multinomial logistic regression analysis with backward elimination was used to identify variables associated with the final diagnosis. Results: Our inclusion criteria were met by 1894 patients. After backward elimination, 23 potentially important variables were identified, including monocular vision loss (odds ratio [OR]: 30.4, 95% confidence interval [CI]: 14.6-63.3), symptoms of sudden onset (OR: 28.3, 95% CI: 14.2-56.2), unilateral weakness affecting 2 or 3 of face, arm, or leg (OR: 17.7, 95% CI: 9.8-31.7), and homonymous hemianopia (OR: 16.6, 95% CI: 8.1-34.0). Conclusions: Accurate diagnosis of TIA is essential to initiating appropriate secondary stroke prevention therapies. A focus on elements of the patient history most commonly associated with a final diagnosis of TIA/stroke may help to identify patients in greatest need of urgent SPC assessment and allow for the provision of effective and efficient stroke prevention services.