bluuebunny/crossref_metadata_2025_split huggingface dataset:
Costs and Cost-Utility of Critical Care and Subsequent Health Care: A Multicenter Prospective Study*
Authors: Jukarainen Sakari , Mildh Henriikka , Pettilä Ville , Häkkinen Unto , Peltola Mikko , Ala-Kokko Tero , Reinikainen Matti , Vaara Suvi T. 
Published: January 2020

Objectives:
The number of critical care survivors is growing, but their long-term outcomes and resource use are poorly characterized. Estimating the cost-utility of critical care is necessary to ensure reasonable use of resources. The objective of this study was to analyze the long-term resource use and costs, and to estimate the cost-utility, of critical care.

Design:
Prospective observational study.

Setting:
Seventeen ICUs providing critical care to 85% of the Finnish adult population.

Patients:
Adult patients admitted to any of 17 Finnish ICUs from September 2011 to February 2012, enrolled in the Finnish Acute Kidney Injury (FINNAKI) study, and matched hospitalized controls from the same time period.

Interventions:
None.

Measurements and Main Results:
We primarily assessed total 3-year healthcare costs per quality-adjusted life-years at 3 years. We also estimated predicted life-time quality-adjusted life-years and described resource use and costs. The costing year was 2016. Of 2,869 patients, 1,839 (64.1%) survived the 3-year follow-up period. During the first year, 1,290 of 2,212 (58.3%) index episode survivors were rehospitalized. Median (interquartile range) 3-year cumulative costs per patient were $49,200 ($30,000–$85,700). ICU costs constituted 21.4% of the total costs during the 3-year follow-up. Compared with matched hospital controls, costs of the critically ill remained higher throughout the follow-up. Estimated total mean (95% CI) 3-year costs per 3-year quality-adjusted life-years were $46,000 ($44,700–$48,500) and per predicted life-time quality-adjusted life-years $8,460 ($8,060–8,870). Three-year costs per 3-year quality-adjusted life-years were $61,100 ($57,900–$64,400) for those with an estimated risk of in-hospital death exceeding 15% (based on the Simplified Acute Physiology Score II).

Conclusions:
Healthcare resource use was substantial after critical care and remained higher compared with matched hospital controls. Estimated cost-utility of critical care in Finland was of high value.
Semaphorin 3A-hypoxia inducible factor 1 subunit alpha co-overexpression enhances the osteogenic differentiation of induced pluripotent stem cells-derived mesenchymal stem cells in vitro
Authors: Li Jing-Yi , Wang Ting-Ting , Li Chong , Wang Zhi-Fang , Li Shan , Ma Li , Zheng Li-Li 
Published: January 2020

Abstract

Background:
Mesenchymal stem or stromal cells (MSCs) derived from the induced pluripotent stem cells (iPSCs) have uniform biological activity, which makes the clinical application of MSCs in bone repair possible. Culturing the iPSC-MSCs onto osteoconductive materials is a promising tissue engineering-based strategy in bone regeneration. The aim of this work was to evaluate the effects of semaphorin 3A (Sema3A) and hypoxia inducible factor 1 subunit alpha (HIF1α) co-overexpression on the survival and osteogenic differentiation of iPSC-MSCs.

Methods:
Sema3A and HIF1α were linked together with the three (GGGGS; G, glycine; S, serine) peptide fragment, and their co-expression in iPSC-MSCs was mediated by a lentiviral vector. The fusion protein retained the immune reactivity for both Sema3A and HIF1α as determined with Western blotting. iPSC-MSCs were infected with overexpression lentivirus (oeLenti) as negative control, oeLenti-Sema3A, oeLenti-HIF1α or oeLenti-Sema3A-HIF1α lentiviruses.

Results:
Sema3A overexpression alone promoted the osteogenic differentiation of iPSC-MSCs (the activity and/or expression of osteoblast markers, such as alkaline phosphatase, osteopontin, and osteocalcin, were upregulated), and suppressed cell survival. The Sema3A-HIF1α fusion protein showed a comparable osteoconductive effect to that of Sema3A without reducing cell survival. We further seeded iPSC-MSCs modified by SemaA-HIF1α overexpression onto hydroxyapatite (HA) scaffolds, and evaluated their growth and differentiation on this three-dimensional material. Additional data indicated that, as compared to iPSC-MSCs cultured in ordinary two-dimensional dishes, cells cultured in HA scaffolds grew (blank vs. HA scaffolds: 0.83 vs. 1.39 for survival) and differentiated better (blank vs. HA scaffolds: 11.29 vs. 16.62 for alkaline phosphatase activity).

Conclusion:
Modifying iPSC-MSCs with pro-osteogenic (Sema3A) and pro-survival (HIF1α) factors may represent a promising strategy to optimize tissue engineering-based strategy in bone repair.
Gene-diet interaction of FTO-rs9939609 gene variant and hypocaloric diet on glycemic control in overweight and obese adults: a systematic review and meta-analysis of clinical trials
Authors: Parastouei Karim , Rostami Hosein , Ramezani Amirhossein Ahmadi , Tavakoli Hamidreza , Alipour Meysam 
Published: January 2020

Abstract

Background:
The hypocaloric diets improve glycemic status in obese individuals, but the response to hypocaloric diets in fat mass and obesity-associated gene (FTO)-rs9939609 gene variant is unknown. This systematic review and meta-analysis aimed to assess the gene-diet interaction of FTO-rs9939609 gene variant and hypocaloric diets on glycemic control in overweight and obese adults.

Methods:
Cochrane Central Register of Controlled Trials, PubMed, ISI Web of Science, Embase, Scopus, and Google scholar were searched up to December 2018, for relevant clinical trials. Mean changes in fasting blood sugar (FBS), serum insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) were extracted.

Results:
The pooled analysis of nine studies showed that there was no significant difference between AA/AT and TT genotypes in FBS (weighted mean difference [WMD] = 0.01, 95% confidence interval [CI]: –1.08, 1.10, P = 0.984) and serum insulin (WMD = 0.20, 95% CI: –0.85, 1.26; P = 0.707) after intervention hypocaloric diets. The overweight/obese participants in AA/AT group showed the greatest reduction in HOMA-IR compared with TT genotype following intervention, and this difference was not statistically significant (WMD = –0.38, 95% CI: –0.94, 0.16, P = 0.167).

Conclusion:
This meta-analysis suggests that there was no significant difference between AA/AT and TT genotypes of FTO-rs9939609 on FBS, serum insulin level, and insulin resistance in response to hypocaloric diets.
Recent progress in Helicobacter pylori treatment
Authors: Hu Yi , Zhu Yin , Lu Nong-Hua 
Published: January 2020

Abstract
The main challenge in the field of Helicobacter pylori (H. pylori) infection is antibiotic resistance, which influences the efficacy of eradication regimens. Bismuth-containing quadruple therapy has been confirmed as an effective regimen for eradicating H. pylori, especially in strains with antibiotic resistance. High-dose proton-pump inhibitor-amoxicillin dual therapy could decrease the use of unnecessary antibiotics, which is a promising alternative approach. Adjuvant therapy (specific probiotic or vitamin) also showed good results, although more evidence is needed. Novel anti-H. pylori drugs are needed, and the establishment of the H. pylori database is an effective way to acknowledge the real-time information of H. pylori management. This review provides the recent progress of H. pylori treatment, and further studies are needed to address the role of different regimens in improving H. pylori eradication rate, especially in strains with antibiotics resistance.
Intra-operative cell salvage for cesarean delivery: a retrospective study using propensity score matched analysis
Authors: Wu Xi , Yao Shang-Long , Wu Jing , Li Cheng-Ying , Xia Lei-Ming 
Published: January 2020

Abstract

Background:
Obstetric hemorrhage is a major cause of maternal death during cesarean delivery. The objective of this retrospective observational study was to evaluate the efficacy and safety of intra-operative cell salvage (IOCS) in cesarean section.

Methods:
We included a total of 361 patients diagnosed with central placenta previa who underwent cesarean section from May 2016 to December 2018. In this study, 196 patients received autologous transfusion using IOCS (IOCS group) and 165 patients accepted allogeneic blood transfusion (ABT group). Propensity score matched analysis was performed to balance differences in the baseline variables between the IOCS group and ABT group. Patients in the IOCS group were matched 1:1 to patients in the ABT group.

Results:
After propensity score matching, 137 pairs of cases between the two groups were successfully matched and no significant differences in baseline characteristics were found between the IOCS group and ABT group. Patients in the IOCS group were associated with significantly shorter length of hospital stay, compared with ABT group (8.9 ± 4.1 days vs. 10.3 ± 5.2 days, t = −2.506, P = 0.013). The postoperative length of hospital stay was 5.3 ± 1.4 days for patients in the IOCS group and 6.6 ± 3.6 days for those in the ABT group (t = −4.056, P < 0.001). The post-operative hemoglobin level in the IOCS group and ABT group was 101.3 ± 15.4 and 96.3 ± 16.6 g/L, respectively, which were significantly different (t = 2.615, P = 0.009). Allogeneic red blood cell transfusion was significantly lower at 0 unit (range: 0–11.5 units) in the IOCS group when compared with 2 units (range: 1–20 units) in the ABT group (P < 0.001).

Conclusions:
This retrospective observational study using propensity score matched analysis suggested that IOCS was associated with shorter length of postoperative hospital stay and higher post-operative hemoglobin levels during cesarean delivery.
Sustainers: Hospitals with sustained superior performance
Authors: Al- Amin Mona , Hefner Jennifer L. , Hogan Tory Harper , Li Kate 
Published: January 2020

Purpose
The purpose of this article was to investigate the organizational and market-level variables associated with sustained superior hospital performance on Value-Based Purchasing total performance scores (TPS).

Methodology
TPS for 2014 through 2017 was obtained from the Centers for Medicare & Medicaid Services Hospital Compare website. Market-level data were from the 2017 Area Health Resource File, and hospital-level data were from the 2014 American Hospital Association Annual Survey database. We specified a logistic regression model to identify significant predictors of hospitals with sustained superior performance on TPS, that is, “sustainers.”

Principal Findings
Only 8.4% of hospitals were classified as sustainers. Hospitals located in rural markets with a high Medicare Advantage penetration had a higher likelihood of being classified as sustainers. High RN staffing levels, lower Medicare share of inpatient days, not-for-profit ownership, and small size were all significant organizational predictors of sustained superior performance.

Conclusions
Both modifiable characteristics, such as nurse staffing levels, and nonmodifiable characteristics, such as rural markets and small hospital size, are associated with the likelihood of hospitals sustaining superior performance over time.

Practice Implications
Managers need to carefully examine their staffing levels as they pursue interventions to sustain high TPS overtime. Moreover, factors such as Medicare share of inpatient days and size need to be considered when understanding barriers to sustained performance on Value-Based Purchasing domains.
Microscope-Integrated Optical Coherence Tomography–Guided Autologous Full-Thickness Neurosensory Retinal Autograft for Large Macular Hole–Related Total Retinal Detachment
Authors: Singh Ankur , Dogra Mohit , Singh Simar Rajan , Moharana Bruttendu , Tigari Basavraj , Singh Ramandeep 
Published: January 2020

Purpose:
To evaluate the feasibility and utility of microscope-integrated optical coherence tomography in patients undergoing full-thickness neurosensory retinal autograft for refractory macular hole (MH)-associated retinal detachment.

Methods:
We analyzed two eyes of two patients who had undergone a neurosensory retinal autograft for large MH associated retinal detachment. Both cases had microscope-integrated optical coherence tomography–guided placement and sizing of the retinal autograft. Time taken for obtaining microscope-integrated optical coherence tomography images, morphology of the retinal autograft (intraoperative and postoperative), and anatomic and functional outcomes were noted.

Results:
The first case had optic disc pit–related maculopathy with a large MH and total retinal detachment. She had undergone a vitrectomy with internal limiting membrane peeling elsewhere. The second patient had a treatment-naive large MH with total retinal detachment. Both patients underwent vitrectomy with microscope-integrated optical coherence tomography–guided autologous neurosensory retinal autograft placement and silicone oil tamponade. At 6 months and 3 months follow-up, respectively, both patients had closed MHs, attached retinas, and improvement in visual acuity.

Conclusion:
Microscope-integrated optical coherence tomography provides intraoperative visualization of MHs and provides real-time feedback regarding dimensions of the retinal autograft, thus aiding in accurate sizing of the graft. This ensures that the autograft fits snugly in the MH, thereby restoring macular structure and improving visual acuity.
Body Composition in Egyptian Children With Transfusion-dependent Thalassemia: The Impact of Nutrition and Metabolic Profile
Authors: Elalfy Mohsen S. , Ebeid Fatma S.E. , El Gendy Yasmin G. , Zaki Mona M. , Kalifa Amna S.A. 
Published: January 2020

Background:
Growth failure is a common complication in children with beta-thalassemia major (β-TM) that has persisted despite major treatment advances. It could stem from malnutrition, especially in those who live in poor countries and who have inadequate nutrient intake.

Aim:
The aim of this study was to assess the influence of nutrition on growth, total body composition, and metabolic profile in Egyptian children with β-TM.

Subjects and Methods:
This cross-sectional study included 200 children with β-TM and 50 age-matched and sex-matched healthy children. All subjects underwent full clinical assessment, which included assessment of growth and total body composition using anthropometric measurements (weight, height, mid-arm circumference, skinfold thickness, and body mass index) and bioelectric impedance analysis device (TANITA SC330). Nutritional assessment was performed using 24-hour dietary recall. Fasting serum insulin, C-peptide, and fasting serum lipid profile (high-density lipoprotein, low-density lipoprotein, cholesterol, and triglyceride) were measured.

Results:
Children with β-TM had a significantly lower mean value of the daily consumption of the studied nutrient elements including kilocalories, protein, carbohydrate, calcium, and phosphorus (P<0.001). β-TM had a negative impact on anthropometric measures; the mean of all measurements recorded in children with β-TM was significantly lower than that in the control group (P<0.001). Children with β-TM had a significant abnormality in lipid profile, with higher triglyceride levels and lower cholesterol, low-density lipoprotein, and high-density lipoprotein than controls. They had significantly lower serum insulin and C-peptide. Age, sex, serum ferritin, and caloric intake have a significant impact on body composition in children with β-TM.

Conclusion:
Regular assessment of nutrition is crucial for the health of children with β-TM.
The Relationship Between Medication Attitudes and Medication Adherence Behavior in Adults With Bipolar Disorder
Authors: Levin Jennifer B. , Aebi Michelle E. , Howland Molly , Barboza Marina , Eskew Logan , Tatsuoka Curtis , Cassidy Kristin A. , Sajatovic Martha 
Published: January 2020

Abstract
The relationship between medication attitudes and adherence as well as reliable measures of medication attitudes need further study. This study examined the psychometric properties of the Attitudes Toward Mood Stabilizers Questionnaire (AMSQ) in bipolar participants and the relationship between medication attitudes and adherence, measured by the self-reported Tablets Routine Questionnaire (TRQ). Inclusion criteria included mood stabilizer treatment and 20% or more medication nonadherence. Measures were given pretreatment and posttreatment. Average age was 47 years; majority were female (69%), African American (67%), and unmarried (53%). AMSQ's test-retest reliability was ρ = 0.73 (p < 0.001). AMSQ correlated with TRQ (r
s = 0.20, p < 0.01) at baseline. Factor analysis identified three factors: positive/favorable attitudes, negative/critical attitudes, and unintentional nonadherence. Change in AMSQ across time correlated with change in TRQ. The AMSQ is valid psychometrically and is sensitive to change. Medication attitudes are related to adherence behavior. Interventions should include targeting specific domains of medication attitudes, such as illness knowledge.
An Outcomes Evaluation of an Innovation Studio on Interprofessional Learning, Job Satisfaction, and Intent to Stay Among Clinicians
Authors: Raderstorf Tim , Melnyk Bernadette Mazurek , Ackerman Michael , Bibyk Steven 
Published: January 2020

OBJECTIVE
Evaluate the use of the Innovation Studio on interprofessional collaboration and attitudes toward interprofessional learning, job satisfaction, and intent to stay.

BACKGROUND
The healthcare workforce is experiencing high burnout rates, and providers are unsatisfied with their work. Evidence supports that interprofessional collaboration is a key strategy to increase job satisfaction and intent to stay in healthcare professionals. The Innovation Studio is a tool to engage healthcare providers in interprofessional collaboration.

METHODS
A pretest/posttest evaluation of the Innovation Studio with 14 healthcare professionals was conducted with self-reported scores on job satisfaction, readiness for interprofessional learning, and intent to stay as outcomes.

RESULTS
Positive effects were found on interprofessional learning and intent to stay, but not job satisfaction. Eleven interprofessional projects were developed. Responses to open-ended questions indicated satisfaction with the Innovation Studio.

CONCLUSIONS
The Innovation Studio was successful in stimulating numerous interprofessional projects and had a positive effect on interprofessional learning and intent to stay.
Simple, Frequent Indicator for Personal Identification—Postmortem and Antemortem Abdominal Computed Tomography Findings of a Charred Body
Authors: Nakamura Mami , Idota Nozomi , Shintani-Ishida Kaori , Hitosugi Masahito , Ikegaya Hiroshi 
Published: January 2020

Abstract
Postmortem personal identification in forensic science is performed using various methods. However, severely burnt bodies are hard to identify using odontological or skeletal features because of carbonization, and sometimes DNA profiling is impracticable because of the unavailability of the relatives. We present a case of a burn victim found after a house fire. Personal identification was attempted, but the body was heavily charred to the bones and the use of physical appearance was impracticable. There were no known relatives or personal belongings of the deceased for comparison of DNA typing. We obtained a series of abdominal computed tomography (CT) scans taken antemortem and found bilateral multiple renal cysts, left renal artery calcification, and a big right inguinal hernia, which matched the deceased's postmortem CT findings and autopsy findings. To date, studies of identification by CT have acted for a rise in precision, but they require complicated calculation or high graphical methods. Calcification of the arteries or renal cysts seen in our case are very common lesions present in many adults with abundant variation; thus, they may be helpful as simple indicators for identification.
Implementation of a Pediatric Emergency Telemedicine Program
Authors: Kim Ji Won , Friedman Jonathan , Clark Sunday , Hafeez Baria , Listman David , Lame Maria , Eid Dona Alma Bou , Sharma Rahul , Platt Shari 
Published: January 2020

Objectives
Our goal was to describe the experiences after the launch of a pediatric emergency telemedicine program at a large, urban, academic medical center.

Methods
We launched 3 unique pediatric emergency telemedicine programs at an urban, academic medical center: direct-to-consumer pediatric virtual urgent care, pediatric emergency department (PED) telemedicine follow-up, and telemedicine medical screening examination in the PED.

Results
We evaluated 84 patients via direct-to-consumer pediatric virtual urgent care with the most common chief complaint related to fever, dermatologic, or respiratory systems; we referred 12% to the PED, and 20% of those required hospital admission. We evaluated 38 patients via PED telemedicine follow-up; we referred 19% back to the PED, and 43% of those required hospital admission. Median duration for a telemedicine encounter was 10 minutes. We screened 3809 patients in the PED using telemedicine medical screening examination.

Conclusions
We offer a description of an innovative and comprehensive new pediatric emergency telemedicine program implemented at a large, urban, academic medical center. Our initial findings demonstrate short visit times, antibiotic stewardship, and low rates of PED referral and subsequent admission for patients who use a telemedicine service. We plan to further examine the impact of pediatric emergency telemedicine on the care of children as our program expands.
Managing Diagnostic Uncertainty in Pediatric Sepsis Quality Improvement with a Two-Tiered Approach
Authors: Scott Halden F. , Kempe Allison , Deakyne Davies Sara J. , Krack Paige , Leonard Jan , Rolison Elise , Mackenzie Joan , Wathen Beth , Bajaj Lalit 
Published: January 2020

Introduction:
Severe sepsis requires timely, resource-intensive resuscitation, a challenge when a sepsis diagnosis is not confirmed. The overall goals were to create a pediatric sepsis program that provided high-quality critical care in severe sepsis (Sepsis Stat), and, in possible sepsis, flexible evaluation and treatment that promoted stewardship (Sepsis Yellow). The primary aims were to decrease time to antibiotics and the intensive care unit requirement.

Methods:
A 2-tiered clinical pathway was implemented at 6 pediatric emergency departments and urgent care centers, incorporating order sets, education, paging. The Sepsis Stat pathway included 2 nurses, hand delivery of antibiotics, resuscitation room use. The Sepsis Yellow pathway included prioritized orders, standardized procedures, close monitoring, and evaluation of whether antibiotics were warranted.

Results:
From April 2012 to December 2017, we treated 3,640 patients with suspected and confirmed sepsis. Among the 932 severe sepsis patients, the 30-day, in-hospital mortality was 0.9%. Arrival to recognition time improved from 50 to 4 minutes. Recognition to antibiotic time demonstrated an in-control process in our goal range with a median of 43 minutes for Sepsis Stat patients, 59 minutes for Sepsis Yellow patients. The proportion of severe sepsis patients requiring intensive care unit care declined from 45% to 34%. On the Sepsis Yellow pathway, 23% were de-escalated with discharge to home without antibiotics.

Conclusions:
This novel 2-tiered approach to pediatric sepsis quality improvement in varied emergency care settings improved process and outcome measures in severe sepsis while promoting stewardship and de-escalation where appropriate. Matching resources to the degree of illness was important in supporting quality care in potentially septic children.