bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adverse Events Among Hospitalized Critically Ill Patients: A Retrospective Cohort Study
Authors: Sauro Khara M. , Soo Andrea , Quan Hude , Stelfox Henry T. 
Published: November 2019

Objective:
The objective of this study was to estimate the frequency and type of adverse events (AEs) among critically ill patients and identify patient and hospital factors associated with AEs and clinical and health care utilization consequences of AEs.

Materials and Methods:
This retrospective cohort study includes patients admitted to 30 intensive care units (ICUs) in Alberta, Canada from May 2014 to April 2017. The main outcome was AEs derived from validated ICD-10, Canadian code algorithms for 18 AEs. Estimates of the proportion and rate of AEs are presented. The association between documented AEs and patient (eg, age, sex, comorbidities) and hospital (eg, ICU site and type, length of stay, readmission) variables are described using regression methods.

Results:
Of 49,447 hospital admissions with admission to ICU, ≥1 AEs were documented in 12,549 (25%) admissions. The most common AEs were respiratory complications (10%) and hospital-acquired infections (9%). AEs were associated with having ≥2 comorbidities [odds ratio (OR)=1.4, 95% confidence interval (CI)=1.3–1.4], being admitted to the ICU from the operating room or another hospital ward (OR=1.8, 95% CI=1.7–2.0 and OR=2.7, 95% CI=2.5–3.0, respectively) and being readmitted to ICU during their hospital stay (OR=4.8, 95% CI=4.7–5.6). Patients with an AE stayed 5.4 days longer in ICU (95% CI=5.2–5.6 d, P<0.001), 18.2 days longer in hospital (95% CI=17.7–18.8 d, P<0.001) and had increased odds of hospital mortality (OR=1.5, 95% CI=1.4–1.6) than those without an AE.

Conclusions:
AEs are common among critically ill patients and certain factors are associated with AEs. Documented AEs are associated with longer stays and increased mortality.
Opportunity or Burden? A Behavioral Framework for Patient Engagement
Authors: Kimerling Rachel , Lewis Eleanor T. , Javier Sarah J. , Zulman Donna M. 
Published: November 2019

Background:
Engaging patients as partners in their care is clinically appealing, yet challenging to implement, and we lack a measurement framework that is applicable to vulnerable populations. To address this gap, we conducted a qualitative study to refine a conceptual framework that reflects an individual’s propensity to engage with care.

Objectives:
Our objectives were to refine the framework’s domains of engagement behavior; identify key behaviors within each domain that describe engagement with providers, health systems or settings; and illustrate examples for each behavior where higher self-efficacy describes an opportunity to enhance engagement, and lower self-efficacy describes difficulties with engagement that risk burden.

Research Design and Sample:
We elicited patient perspectives by conducting individual semistructured interviews with veterans receiving care for mental health and/or chronic conditions from the Veterans Health Administration. Data were analyzed using the framework method.

Results:
The resulting engagement framework encompassed 4 interrelated domains: Self-Management, Health Information Use, Collaborative Communication, and Healthcare Navigation. The propensity to engage with care was conceptualized as the cumulative self-efficacy to engage in behaviors across these domains. Results emphasize the collaborative nature of engagement behaviors and the impact of veteran cultural influences via perceptions of collective efficacy.

Conclusions:
This framework can be applied to judgments regarding a patient’s propensity to engage in care. Because self-efficacy is an individual’s context-specific judgment of their capabilities, this framework may inform health care and social service interventions that aim to engage patients. This maybe especially useful for public sector settings and populations with social risks.
Provider Practice Competition and Adoption of Medicare’s Oncology Care Model
Authors: Jalali Ali , Martin Christopher , Nelson Richard E. , Vanneman Megan E. , Martin Brook I. , Cooney Kathleen A. , Waitzman Norman J. , O’Neil Brock 
Published: November 2019

Background:There is a concern that the Oncology Care Model (OCM), a voluntary bundled payment program, may incentivize mergers and acquisitions among physician practices leading to reduced competition and price increases. These concerns are heightened if OCM is preferentially adopted in competitive health care markets because it could result in reduced competition, but little is known about the characteristics of markets where OCM is adopted.Objective:To measure the association between regional market competition among medical oncologists with the initial adoption of OCM.Research Design:The Herfindahl-Hirschman Index (HHI), a measure of competition, was calculated for hospital referral regions (HRRs) using secondary data from the Centers for Medicare and Medicaid Services. The relationship between HHI and OCM adoption was assessed using a 2-part regression model adjusting for the market-level number of practices, physician density, average practice size, sociodemographic characteristics, and medical resources. A count model on all HRRs was also estimated to assess an overall effect.Subjects:A total of 10,788 physicians in 3,537 practices who billed Medicare for oncology services in 2015.Results:OCM was adopted in 114 (37%) of the 306 HRRs. We found that practices in competitive health care markets were more likely to adopt OCM than in noncompetitive markets. Two-part regression analysis indicated a nonlinear relationship between HHI and OCM adoption. Average practice size, number of practices in an HRR, and the hospital bed rate were positively associated with adoption, whereas the rate of full-time equivalent hospital employees to 1000 residents was negatively associated with adoption.Conclusions:OCM adoption was higher in HRRs with greater competition. Careful monitoring of market-level changes among OCM adopters should be undertaken to ensure that the benefits of the OCM outweigh the negative consequences of possible changes in competition.
Predicting the Cost of Health Care Services
Authors: Huang Xiaotong , Peterson Sandra , Lavergne Ruth , Ahuja Megan , McGrail Kimberlyn 
Published: November 2019

Background:
Case-mix systems and comorbidity indices aggregate clinical information about patients over time and are used to characterize need for health care services. These tools were validated for their original purpose, but those purposes are varied, and they have not been compared directly in the context of predicting costs of health care services.

Objective:
To compare predictions of next-year health care service costs across 4 tools, including: the Johns Hopkins Adjusted Clinical Groups (ACG), the Elixhauser Comorbidity Index, Charlson-Deyo Comorbidity Index, and the Canadian Institute for Health Information (CIHI) population grouper.

Methods:
British Columbia administrative data from fiscal years 2012–2013 were used to generate case-mix variables and the comorbidity indices. Outcome variables include next-year (2013–2014) total, physician, acute care, and pharmaceutical costs, Outcomes were modeled using 2-part models. Performance was compared using adjusted R
2, root mean squared error, and mean absolute error using the predicted and the actual next-year cost.

Results:
Models including the CIHI grouper (239 conditions) and ACG system had similar performance in most cost categories and slightly better fit than Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI). Adding a dummy variable for nonusers in the models for CCI and ECI increased R
2 values slightly.

Conclusions:
All these systems have empirical support for use in predicting health care costs, despite in some cases being developed for other purposes. No system is particularly effective at predicting next-year acute care cost, likely because acute events are often by definition unexpected. The freely available ECI and CCI comorbidity indices implemented using the highest-performing methods developed here may be a good choice in many circumstances.
Chondroradionecrosis of the larynx
Authors: Farneti Daniele , Fabbri Christopher , Prencipe Superga R. 
Published: November 2019

Purpose of review
Purpose of the present review is to revise the literature of the last 18 months, looking for novelties or new trends in diagnosis and therapeutical approaches to a very uncommon complicaton.

Recent findings
Some comorbidities as well as prior surgical laryngeal treatment and lifestyle factors are known to increase tissue susceptibility to radiation injury and to complications due to endotracheal intubation.

Summary
Chondroradionecrosis (CRN) of the larynx is a rare and severe complication of radiotherapy and endotracheal intubation which can be fatal if not managed promptly. In recent years, the trend in oncological surgery is organ preservation even in the advanced stage of laryngeal malignancies. However, in certain stages of squamous cell carcinomas, radiotherapy is necessary as a first or second line of treatment. Endotracheal intubation has also been associated with chondronecrosis and it is thought to be secondary to excessive pressure of the endotracheal tube or its cuff on the cartilage itself. Clinical diagnosis of CRN is extremely difficult and should be placed in differential diagnosis with postradiation outcomes and cancer recurrence. PET is useful, but biopsy is still required to confirm the diagnosis. The use of the laryngeal mask airway should prevent this complication and is a reasonable choice through which to administer general anesthesia in selected patients.
Portal Vein Thrombosis After Total Pancreatectomy and Islet Autotransplant
Authors: Robbins Alexandria J. , Skube Mariya E. , Bellin Melena D. , Dunn Ty B. , Chapman Scott A. , Berry K. Louise , Lusczek Elizabeth , Beilman Gregory J. 
Published: November 2019

Objectives
To determine the rate of portal vein thrombosis (PVT) based on pharmacologic prophylaxis protocol and the impact of PVT on islet graft function after total pancreatectomy with islet autotransplantation (TPIAT).

Methods
We compared the incidence of PVT, postsurgical bleeding, and thrombotic complications in patients undergoing TPIAT between 2001 and 2018 at the University of Minnesota who received either unfractionated heparin (UFH) or enoxaparin for postoperative PVT prophylaxis. Six-month and 1-year graft function was compared between patients who developed PVT and those who did not.

Results
Twelve patients (6.6%) developed a PVT, which resolved by 6 months after TPIAT in 10 patients. There was no statistically significant difference in PVT rate between patients who received UFH or enoxaparin for prophylaxis (P = 0.54). Patients who received enoxaparin developed other thrombotic complications more often (6% vs 0%, P = 0.02). Islet graft function did not differ in patients who developed PVT versus those who did not.

Conclusions
There was no difference between enoxaparin or UFH prophylaxis in preventing PVT, but there may be a higher incidence of other thrombotic complications with enoxaparin. In the setting of routine screening and anticoagulation therapy, PVT is a self-limited process.
Systematic Review and Meta-analysis of Minimally Invasive Pancreatectomies for Solid Pseudopapillary Neoplasms of the Pancreas
Authors: Tan Hwee Leong , Syn Nicholas , Goh Brian K. P. 
Published: November 2019

Objectives
We report the first systematic review and meta-analysis on minimally invasive pancreatectomy (MIP) for solid pseudopapillary neoplasms (SPPN) of the pancreas.

Methods
A systematic review of all studies reporting patient characteristics and outcomes of MIP for SPPN was conducted.

Results
We reviewed 27 studies comprising 149 patients with SPPN managed via MIP. Five were comparative retrospective cohort studies, comprising 46 and 60 patients in the minimally-invasive and open groups, respectively. Tumor size was smaller in the minimally-invasive group (mean difference, −2.20; 95% confidence interval (CI), −3.09 to −1.32; P < 0.001). The MI group had lower intraoperative blood loss (mean difference, −180.19; 95% CI, −344.28 to −16.09; P = 0.03) and transfusion requirement (relative risk, 0.24; 95% CI, 0.06–0.94; P = 0.04), and a shorter time to diet (mean difference, −2.99; 95% CI, −3.96 to −2.03; P < 0.001) and length of stay (mean difference, −3.61; 95% CI, −6.98 to −0.24; P = 0.04). There was no significant difference in operating time, margin positivity, postoperative morbidity, and postoperative pancreatic fistula rates.

Conclusions
Minimally invasive pancreatectomy for SPPN is associated with decreased intraoperative blood loss and transfusion requirements and a shorter postoperative time to diet and hospital stay.
Evaluation of Phase II Trial Design in Advanced Pancreatic Cancer
Authors: Tang Monica , Chen Julia , Goldstein David , Links Matthew , Lord Sarah , Marschner Ian , Simes Robert J. , Lee Chee K. 
Published: November 2019

Objectives
We evaluated how well phase II trials in locally advanced and metastatic pancreatic cancer (LAMPC) meet current recommendations for trial design.

Methods
We conducted a systematic review of phase II first-line treatment trial for LAMPC. We assessed baseline characteristics, type of comparison, and primary end point to examine adherence to the National Cancer Institute recommendations for trial design.

Results
We identified 148 studies (180 treatment arms, 7505 participants). Forty-seven (32%) studies adhered to none of the 5 evaluated National Cancer Institute recommendations, 62 (42%) followed 1, 31 (21%) followed 2, and 8 (5%) followed 3 recommendations. Studies varied with respect to the proportion of patients with good performance status (range, 0%–80%) and locally advanced disease (range, 14%–100%). Eighty-two (55%) studies concluded that investigational agents should progress to phase III testing; of these, 24 (16%) had documented phase III trials. Three (8%) phase III trials demonstrated clinically meaningful improvements for investigational agents. One of 38 phase II trials that investigated biological investigational agents was enriched for a biomarker.

Conclusions
Phase II trials do not conform well to current recommendations for trial design in LAMPC.
Rising Prevalence of Opioid Use Disorder and Predictors for Opioid Use Disorder Among Hospitalized Patients With Chronic Pancreatitis
Authors: Bilal Mohammad , Chatila Ahmed , Siddiqui Mohamed Tausif , Al-Hanayneh Muhannad , Shah Aun Raza , Desai Madhav , Wadhwa Vaibhav , Parupudi Sreeram , Casey Brenna W. , Krishnan Kumar , Hernandez-Barco Yasmin G. 
Published: November 2019

Objectives
We aimed to evaluate the prevalence, impact, and predictors of opioid use disorder (OUD) in hospitalized chronic pancreatitis (CP) patients.

Methods
A retrospective cohort study was performed using the National Inpatient Sample database from 2005 to 2014. Patients with a primary diagnosis of CP and OUD were included. The primary outcome was evaluating the prevalence and trend of OUD in patients hospitalized with CP. Secondary outcomes were to (1) assess the impact of OUD on health care resource utilization and (2) identify predictors of OUD in hospitalized CP patients.

Results
A total of 176,857 CP patients were included, and OUD was present in 3.8% of patients. The prevalence of OUD in CP doubled between 2005 and 2014. Patients with CP who had OUD were found to have higher mean length of stay (adjusted mean difference, 1.2 days; P < 0.001) and hospitalization costs (adjusted mean difference, US $1936; P < 0.001). Independent predictors of OUD in CP patients were obesity, presence of depression, and increased severity of illness.

Conclusions
Opioid use disorder–related diagnoses are increasing among CP patients and are associated with increased health care resource utilization. Our study identifies patients at high-risk for OUD whose pain should be carefully managed.
Reducing Pancreatic Fibrosis Using Antioxidant Therapy Targeting Nrf2 Antioxidant Pathway
Authors: Kojayan Greg Garo , Alizadeh Reza Fazl , Li Shiri , Ichii Hirohito 
Published: November 2019

Abstract
Chronic pancreatitis is the progressive inflammation of the pancreas resulting in the irreversible damage of pancreatic structure and function by means of fibrosis. Chronic pancreatitis is most commonly caused by alcohol consumption, although the direct molecular etiology is unknown. Recent studies suggest oxidative stress as a catalyst for pancreatic stellate cell activation leading to the deposition of collagenous extracellular matrix causing pancreatic fibrosis. We review the effect of oxidative stress on pancreatic fibrogenesis and indicate the molecular pathways involved in preventing oxidant-related cell damage. Likewise, we summarize existing antioxidative therapies for chronic pancreatitis and discuss a novel nuclear factor erythroid 2–related factor 2 activator, dimethyl fumarate, and its potential to reduce fibrogenesis by downregulating pancreatic stellate cell activation.
Activation of the Nuclear Factor-kappa B Signaling Pathway Damages the Epithelial Barrier in the Human Pancreatic Ductal Adenocarcinoma Cell Line HPAF-II
Authors: Su Zhou , Gong Yahui , Yang Huiying , Deng Dehai , Liang Zhihai 
Published: November 2019

Objectives
Injury of the pancreatic duct epithelial barrier plays a critical role in the development of acute pancreatitis. The activity of the nuclear factor-kappa B (NF-κB) pathway is involved in the disruption of the pancreatic duct epithelial barrier. This study investigated how NF-κB impacts the dysfunction of the pancreatic duct epithelial barrier.

Methods
A human pancreatic ductal adenocarcinoma cell line was treated with tumor necrosis factor-alpha (TNF-α) and pyrrolidine dithiocarbamate. The expression levels of p65 and p-p65 were detected to evaluate NF-κB activity. Tricellulin (TRIC) expression levels were measured to assess the change in tight junction (TJ)-related proteins. The expression and localization of myosin light chain kinase (MLCK) were investigated. The structure of TJs and monolayer permeability were also examined.

Results
NF-κB was activated by TNF-α and suppressed by pyrrolidine dithiocarbamate. Activation of NF-κB upregulated the expression levels of TRIC and MLCK. Broadened TJs were observed after NF-κB was activated. Lower monolayer permeability was observed when NF-κB was suppressed.

Conclusions
Activation of the NF-κB pathway induced by TNF-α leads to increased TRIC and MLCK expression, resulting in broadened TJs and high permeability, which contribute to damage to the pancreatic duct epithelial barrier.
Adrenal Insufficiency in Children With Eosinophilic Esophagitis Treated With Topical Corticosteroids
Authors: Bose Paroma , Kumar Sanjay , Nebesio Todd D. , Li Chuwen , Hon Emily C. , Atkins Dan , Furuta Glenn T. , Gupta Sandeep K. 
Published: November 2019

ABSTRACTObjectives:The aim of the study was to identify practices of gastroenterologists screening for adrenal insufficiency (AI) and report prevalence of AI in children with eosinophilic esophagitis (EoE) treated with topical corticosteroids (TCS); compare serum dehydroepiandrosterone sulfate (DHEA‐S) levels to morning serum cortisol (MSC) levels as screening tool for AI.Methods:A multipart study was conducted. In part 1, a survey about screening practices for AI in children with EoE on TCS was sent to gastroenterologists belonging to a PedsGI listserv and to EoE consortia. In part 2, children with EoE on TCS for ≥6 months were prospectively screened for AI with MSC levels. For subjects with a MSC level of <10 μg/dL, a repeat MSC level and/or confirmatory adrenocorticotropic hormone (ACTH) stimulation testing was offered. AI was defined by peak serum cortisol level <18 μg/dL. In part 3, DHEA‐S levels were drawn with MSC levels.Results:Seven percent (16/238) of gastroenterologists screened for AI. Providers in EoE consortia were more likely to screen than nonconsortia providers [9/21(43%) vs 7/217(3%); P = 0.0001]. Thirty‐seven children were prospectively screened for AI, and 51% (19/37) had a low MSC level. Ten patients had a low‐dose ACTH stimulation test (LDST) after 1 or more low MSC levels. Five percent (2/37) of patients were diagnosed with AI. DHEA‐S and MSC levels had a moderate correlation (rs = 0.44, P = 0.03).Conclusions:Gastroenterologists belonging to EoE consortia were more likely to screen for AI. Prevalence of AI in our prospective cohort was 5%. DHEA‐S has a moderate correlation with MSC levels, but more data is required to assess utility as a screening tool for AI.
Differentiation of Colonic Inflammatory Bowel Disease
Authors: Dhaliwal Jasbir , Siddiqui Iram , Muir Jennifer , Rinawi Firas , Church Peter C. , Walters Thomas D. , Griffiths Anne M. 
Published: November 2019

ABSTRACTObjectives:Differentiation of Crohn disease (CD) from ulcerative colitis (UC) is challenging when inflammation is predominantly colonic. The paediatric inflammatory bowel disease (PIBD) classes algorithm was developed to bring consistency to labelling, but used physician‐assigned diagnosis as the criterion standard. We aimed to reassess the PIBD classes using pathology of subsequently resected colon as the criterion standard.Method:Single‐centre study of patients diagnosed with colonic IBD between 2002 and 2017 and subsequently treated with colectomy. Baseline pretreatment data were reviewed and the PIBD classes algorithm was independently applied by 2 reviewers to assign a label of UC/IBD‐unclassified (IBD‐U)/colonic‐CD. Concordance between the algorithm‐based, precolectomy clinical, and pathologic examination of resected colon diagnosis were assessed. Changes in diagnosis during postcolectomy follow‐up were recorded.Results:Sixty‐two children underwent colectomy for medically refractory colonic IBD. Diagnosis based on pathologic review of resected colon CD:4;UC:56;IBDU:2. The clinical, PIBD classes algorithm, and colectomy diagnoses were concordant in 51 of 62 patients (81%, Fleiss kappa 0.48). Precolectomy clinical diagnosis was concordant with colectomy diagnosis in 58 of 62 patients (94%, weighted‐kappa 0.65). The PIBD classes label was concordant with colectomy diagnosis in 51 of 62 patients (82%, weighted‐kappa 0.38); resected colon pathology was typical of UC in 6 patients with PIBD classes label of IBD‐U based on single class 2 feature and in 3 with PIBD classes label of CD based on single class 1 feature.Conclusions:Concordance of PIBD classes algorithm diagnosis applied before colectomy with a diagnostic label based on pathologic examination of a subsequently resected colon is only fair. Caution is needed in stringent application of colonic CD and IBD‐U labels based on presence of single feature.