bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mild Acute Kidney Injury after Noncardiac Surgery Is Associated with Long-term Renal Dysfunction
Authors: Turan Alparslan , Cohen Barak , Adegboye Janet , Makarova Natalya , Liu Liu , Mascha Edward J. , Qiu Yuwei , Irefin Samuel , Wakefield Brett J. , Ruetzler Kurt , Sessler Daniel I. 
Published: January 2020

Abstract

Background
Perioperative acute kidney injury is common. However, it is unclear whether this merely represents a transient increase in creatinine or has prognostic value. Therefore, the long-term clinical importance of mild postoperative acute kidney injury remains unclear. This study assessed whether adults who do and do not experience mild kidney injury after noncardiac surgery are at similar risk for long-term renal injury.

Methods
This study is a retrospective cohort analysis of adults having noncardiac surgery at the Cleveland Clinic who had preoperative, postoperative, and long-term (1 to 2 yr after surgery) plasma creatinine measurements. The exposure (postoperative kidney injury) and outcome (long-term renal injury) were defined and staged according to the Kidney Disease: Improving Global Outcomes (KDIGO) initiative criteria. The primary analysis was for lack of association between postoperative kidney injury (stage I vs. no injury) and long-term renal injury.

Results
Among 15,621 patients analyzed, 3% had postoperative stage I kidney injury. Long-term renal outcomes were not similar in patients with and without postoperative stage I injury. Specifically, about 26% of patients with stage I postoperative kidney injury still had mild injury 1 to 2 yr later, and 11% had even more severe injury. A full third (37%) of patients with stage I kidney injury therefore had renal injury 1 to 2 yr after surgery. Patients with postoperative stage I injury had an estimated 2.4 times higher odds of having long-term renal dysfunction (KDIGO stage I, II, or III) compared with patients without postoperative kidney injury (odds ratio [95% CI] of 2.4 [2.0 to 3.0]) after adjustment for potential confounding factors.

Conclusions
In adults recovering from noncardiac surgery, even small postoperative increases in plasma creatinine, corresponding to stage I kidney injury, are associated with renal dysfunction 1 to 2 yr after surgery. Even mild postoperative renal injury should therefore be considered a clinically important perioperative outcome.

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Mohs Surgery for SEER Registry-Captured Melanoma In Situ and Rare Cutaneous Tumors: Comparing National Utilization Patterns Before and After Implementation of the Affordable Care Act (2010) and Appropriate Use Criteria (2012)
Authors: Garland Kevin , Condon Sean , Xiong David D. , Crowe David , Knackstedt Thomas J. 
Published: January 2020

BACKGROUND
The Affordable Care Act (ACA) and the appropriate use criteria (AUC) for Mohs micrographic surgery (MMS) had the potential to increase utilization rates of MMS for indicated skin cancers, but it is unknown whether this has occurred.

OBJECTIVE
To determine whether rates of MMS utilization for head and neck melanoma in situ (MIS) and rare cutaneous tumors (RCTs) increased after the implementation of the ACA and AUC publication.

MATERIALS AND METHODS
Retrospective review using data from the SEER database. Melanoma in situ and RCT tumor cases from before and after the ACA and AUC publication were compared.

RESULTS
Twenty-four thousand six hundred seventy-eight cases were analyzed. Mohs micrographic surgery utilization for MIS decreased from 13.9% before the ACA to 12.3% after the ACA (odds ratio 0.87; p = .012). There was no significant change in MMS utilization for MIS after publication of the AUC. There was also no significant change in MMS utilization for treatment of RCT after the ACA or AUC publication. Stratification of patients into age groups younger or older than 65 years did not change utilization rates.

CONCLUSION
Rates of MMS for treatment of MIS and RCT have not increased since the advent of the ACA or AUC. This finding highlights the need for continued efforts to improve access to MMS and to increase education of its utility in treating skin cancer.
Use of an Iris Speculum for Retrolental Membrane Dissection for Stage 5 Prematurity of Retinopathy Complicated With Pupillary Adhesion
Authors: Lyu Jiao , Zhang Qi , Zhao Peiquan 
Published: January 2020

Purpose:
To report a novel use of an iris speculum to assist with membrane dissection and trough separation for stage 5 retinopathy of prematurity–related funnel-shaped tractional retinal detachment complicated with pupillary adhesion.

Methods:
Limbus-based closed vitrectomy and membrane dissection were performed in 10 eyes (9 patients) with stage 5 retinopathy of prematurity–related tractional retinal detachment and pupillary adhesion. After synechiolysis, an iris speculum was positioned to enlarge the pupil for surgical visualization and maintain a neutral iris plane. The retrolental membrane was dissected bimanually and circumferentially along the peripheral trough and then toward the central retina with vertical scissors and end-gripping forceps.

Results:
In all 10 eyes, retrolental membranes were entirely removed and troughs were circumferentially unraveled. Follow-up examinations performed 6 to 18 months postoperatively showed reattachment of the retina in 3 eyes with an open-narrow funnel and 6 of 7 eyes with a narrow–narrow funnel. A near-circular pupil without recurrent pupillary adhesion was preserved in all nine eyes showing retinal reattachment.

Conclusion:
This use of the iris speculum effectively exposes the surgical field for the entire removal of retrolental tissue and interruption of the peripheral trough in stage 5 retinopathy of prematurity–related tractional retinal detachment complicated with pupillary adhesion. The pupil's configuration is well preserved postoperatively.
Immunization Against Hepatitis A in Migrant Children
Authors: Fahrni Olivia , Posfay-Barbe Klara M. , Wagner Noémie 
Published: January 2020

Background:
Hepatitis A is endemic in many countries. Swiss guidelines recommend vaccinating patients native from endemic areas. In Geneva’s Children’s hospital, migrant children are screened and vaccinated if seronegative. Because hepatitis A’s prevalence is decreasing worldwide, more children are seronegative at arrival, highlighting the need for immunization in medical centers and refugee camps and questioning the benefits of systematic serology. Other Swiss hospitals vaccinate regardless of serostatus. This study’s aim is to assess migrant children’s immunity according to origin and age, and the cost-effectiveness of different immunization strategies.

Methods:
We retrospectively analyzed 329 children’s serostatus (1–16 years of age) between 2012 and 2015, using enzyme-linked fluorescent assay method. Serology and vaccine costs were based on local prices. Groups were compared with χ2 test and the age-seropositivity relationship was studied with linear regression.

Results:
The predominant regions were the Eastern Mediterranean and European Regions with mostly negative serologies (71% and 83%) and the African Region with mostly positive serologies (79%). Immunity varied depending on birth country. Regardless of region, seropositivity increased with age (P < 0.001). The most cost-effective vaccination strategy was an individualized approach based on age and origin, reducing costs by 2% compared with serology-guided immunization and by 17% compared with systematic vaccination.

Conclusions:
Many migrant children >5 years old are seronegative and at risk of clinical infection. They need to be immunized. New guidelines according to age and origin should be defined to reduce immunization costs. We recommend systematic vaccination for patients <5 years old or native from low endemicity areas (≤25.7% of seropositivity). For the others, we propose serology-based vaccination.
Measuring Council Health to Transform Shared Governance Processes and Practice
Authors: Hess Robert G. , Bonamer Jennifer I. , Swihart Diana , Brull Stacey 
Published: January 2020

OBJECTIVE
The aim of this study was to develop a valid, reliable instrument to measure the effectiveness of shared governance councils

BACKGROUND
The work of shared governance, that is, the decisions, takes place in its structures, notably, the councils. A literature search yielded no formal instrument for evaluating how these councils function.

METHODS
A 4-phase process was used to generate valid items to measure shared governance council effectiveness, including content validity by experts, a pilot for feasibility, a larger pilot for internal consistency, and an exploratory factor analysis to delineate a final instrument.

RESULTS
More than a dozen experts and participants from nearly 30 healthcare organizations contributed to the final development of the 25-item Council Health Survey instrument. Items for measuring council effectiveness at either the unit or division level were grouped in areas of structure, activities, and membership.

CONCLUSIONS
When evaluating shared governance, nurses should focus on councils themselves, in which much of the work of shared governance occurs.
Quality of End of Life Care in Magnet® and Non-Magnet Hospitals
Authors: Lasater Karen B. , Schlak Amelia E. 
Published: January 2020

OBJECTIVE
To examine whether end-of-life care quality is superior in Magnet® hospitals, a recognition designating nursing excellence.

BACKGROUND
Considerable research shows better patient outcomes in hospitals with excellent nurse work environments, but end-of-life care quality has not been studied in Magnet hospitals.

METHODS
An analysis of cross-sectional data was completed using surveys of nurses and hospitals. Multivariate logistic regression models were used to determine the association between Magnet hospitals and measures of end-of-life care quality.

RESULTS
Overall, nurses report poor quality of end-of-life care in US hospitals. In Magnet hospitals, nurses were significantly less likely to give their hospital an unfavorable rating on end-of-life care.

CONCLUSIONS
Hospital Magnet status may signal better quality in end-of-life care. Administrators looking to improve the quality of end-of-life care may consider improving aspects of nursing that distinguish Magnet hospitals.
Subclinical Peroneal Neuropathy Affects Ambulatory, Community-Dwelling Adults and Is Associated with Falling
Authors: Poppler Louis H. , Yu Jenny , Mackinnon Susan E. 
Published: January 2020

Background:
Peroneal neuropathy with an overt foot drop is a known risk factor for falling. Subclinical peroneal neuropathy caused by compression at the fibular neck is subtler and does not have foot drop. A previous study found subclinical peroneal neuropathy in 31 percent of hospitalized patients. This was associated with having fallen. The purpose of this study was to determine the prevalence of subclinical peroneal neuropathy in ambulatory adults and investigate if it is associated with falling.

Methods:
A cross-sectional study of 397 ambulatory adults presenting to outpatient clinics at a large academic hospital was conducted from 2016 to 2017. Patients were examined for dorsiflexion weakness and signs of localizing peroneal nerve compression to the fibular neck. Fall risk was assessed with the Activities-Specific Balance Confidence Scale and self-reported history of falling. Multivariate logistic regression was used to correlate subclinical peroneal neuropathy with fall risk and a history of falls.

Results:
The mean patient age was 54 ± 15 years and 248 patients (62 percent) were women. Thirteen patients (3.3 percent) were found to have subclinical peroneal neuropathy. After controlling for various factors known to increase fall risk, patients with subclinical peroneal neuropathy were 3.74 times (95 percent CI, 1.06 to 13.14) (p = 0.04) more likely to report having fallen multiple times in the past year than patients without subclinical peroneal neuropathy. Similarly, patients with subclinical peroneal neuropathy were 7.22 times (95 percent CI, 1.48 to 35.30) (p = 0.02) more likely to have an elevated fall risk on the Activities-Specific Balance Confidence fall risk scale.

Conclusion:
Subclinical peroneal neuropathy affects 3.3 percent of adult outpatients and may predispose them to falling.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Efavirenz-Based Antiretroviral Therapy Reduces Artemether–Lumefantrine Exposure for Malaria Treatment in HIV-Infected Pregnant Women
Authors: Hughes Emma , Mwebaza Norah , Huang Liusheng , Kajubi Richard , Nguyen Vy , Nyunt Myaing M. , Orukan Francis , Mwima Moses W. , Parikh Sunil , Aweeka Francesca 
Published: January 2020

Background:
The choice of malaria treatment for HIV-infected pregnant women receiving efavirenz-based antiretroviral therapy must consider the potential impact of drug interactions on antimalarial exposure and clinical response. The aim of this study was to investigate the effects of efavirenz on artemether–lumefantrine (AL) because no studies have isolated the impact of efavirenz for HIV-infected pregnant women.

Methods:
A prospective clinical pharmacokinetic (PK) study compared HIV-infected, efavirenz-treated pregnant women with HIV-uninfected pregnant women in Tororo, Uganda. All women received the standard 6-dose AL treatment regimen for Plasmodium falciparum malaria with intensive PK samples collected over 21 days and 42-days of clinical follow-up. PK exposure parameters were calculated for artemether, its active metabolite dihydroartemisinin (DHA), and lumefantrine to determine the impact of efavirenz.

Results:
Nine HIV-infected and 30 HIV-uninfected pregnant women completed intensive PK evaluations. Relative to controls, concomitant efavirenz therapy lowered the 8-hour artemether concentration by 76% (P = 0.013), DHA peak concentration by 46% (P = 0.033), and day 7 and 14 lumefantrine concentration by 61% and 81% (P = 0.046 and 0.023), respectively. In addition, there were nonsignificant reductions in DHA area under the concentration–time curve0–8hr (35%, P = 0.057) and lumefantrine area under the concentration–time curve0–∞ (34%, P = 0.063) with efavirenz therapy.

Conclusions:
Pregnant HIV-infected women receiving efavirenz-based antiretroviral therapy during malaria treatment with AL showed reduced exposure to both the artemisinin and lumefantrine. These data suggest that malaria and HIV coinfected pregnant women may require adjustments in AL dosage or treatment duration to achieve exposure comparable with HIV-uninfected pregnant women.
Clinical and Economic Impact of Ibalizumab for People With Multidrug-Resistant HIV in the United States
Authors: Millham Lucia R.I. , Scott Justine A. , Sax Paul E. , Shebl Fatma M. , Reddy Krishna P. , Losina Elena , Walensky Rochelle P. , Freedberg Kenneth A. 
Published: January 2020

Background:
We projected the clinical outcomes, cost-effectiveness, and budget impact of ibalizumab plus an optimized background regimen (OBR) for people with multidrug-resistant (MDR) HIV in the United States.

Methods:
Using the Cost-Effectiveness of Preventing AIDS Complications microsimulation model and a health care sector perspective, we compared 2 treatment strategies for MDR HIV: (1) IBA + OBR—ibalizumab plus OBR and (2) OBR—OBR alone. Ibalizumab efficacy and cohort characteristics were from trial data: mean age 49 years, 85% male, and mean CD4 150/µL. Six-month viral suppression was 50% with IBA + OBR and 0% with OBR. The ibalizumab loading dose cost $10,500, and subsequent ibalizumab injections cost $8400/month; OBR cost $4500/month. Incremental cost-effectiveness ratios (ICERs) were calculated using discounted (3%/year) quality-adjusted life years (QALYs) and costs. ICERs ≤$100,000/QALY were considered cost-effective. We performed sensitivity analysis on key parameters and examined budget impact.

Results:
In the base case, 5-year survival increased from 38% with OBR to 47% with IBA + OBR. Lifetime costs were $301,700/person with OBR and $661,800/person with IBA + OBR; the ICER for IBA + OBR compared with OBR was $260,900/QALY. IBA + OBR was not cost-effective even with 100% efficacy. IBA + OBR became cost-effective at base case efficacy if ibalizumab cost was reduced by ≥88%. For an estimated 12,000 people with MDR HIV in the United States, IBA + OBR increased care costs by $1.8 billion (1.5% of total treatment budget) over 5 years.

Conclusions:
For people with MDR HIV lacking other treatment options, ibalizumab will substantially increase survival when effective. Although adding ibalizumab to OBR is not cost-effective, the low number of eligible patients in the United States makes the budget impact relatively small.
Prevalence of and Risk Factors for Low Bone Mineral Density Assessed by Quantitative Computed Tomography in People Living With HIV and Uninfected Controls
Authors: Thomsen Magda T. , Wiegandt Yaffah L. , Gelpi Marco , Knudsen Andreas D. , Fuchs Andreas , Sigvardsen Per E. , Kühl Jørgen T. , Nordestgaard Børge , Køber Lars , Lundgren Jens , Hansen Ann-Brit E. , Kofoed Klaus F. , Jensen Jens-Erik B. , Nielsen Susanne D. 
Published: January 2020

Background:
Low bone mineral density (BMD) has been described in people living with HIV (PLWH). We examined the prevalence of low BMD measured by quantitative computed tomography (QCT), a method that allows 3-dimensional volumetric density measures at the thoracic spine, in well-treated PLWH and uninfected controls and assessed risk factors for reduced BMD.

Methods:
Cross-sectional study including 718 PLWH from the Copenhagen Co-Morbidity in HIV infection (COCOMO) study and 718 uninfected controls matched on age and sex from the Copenhagen General Population Study (CGPS). Trabecular BMD was determined by QCT.

Results:
Median BMD was 144.2 mg/cm3 in PLWH vs. 146.6 mg/cm3 in controls (P = 0.580). HIV status was not associated with BMD in univariable or multivariable linear analyses. However, a higher prevalence of very low BMD (T-score ≤ −2.5) was found in PLWH (17.2% vs. 11.0% in controls, P = 0.003). In unadjusted analysis, HIV was associated with very low BMD (odds ratio 1.68 [95% confidence interval: 1.24–2.27], P = 0.001), but this association was not significant after adjusting for age, sex, smoking, alcohol, body mass index, physical activity, and ethnicity. Previous AIDS-defining disease was associated with lower BMD, but no other associations with HIV-specific variables were identified.

Conclusion:
Using QCT, we found a higher prevalence of very low BMD in PLWH than in controls. However, HIV status was not independently associated with BMD indicating that traditional risk factors contribute to the difference in prevalence of very low BMD. Focus on improvement of lifestyle factors, especially in PLWH with previous AIDS-defining disease, may prevent very low BMD in PLWH.
Stoma-Related Complications Following Ostomy Surgery in 3 Acute Care Hospitals
Authors: Pearson Robert , Knight Stephen R. , Ng James C. K. , Robertson Isabell , McKenzie Clare , Macdonald Angus M. 
Published: January 2020

PURPOSE:
The aim of this study was to evaluate both surgical and patient-centered stomal complications after stoma formation, with emphasis on underreported symptoms and complaints.

DESIGN:
Prospective, single-group study.

SUBJECTS AND SETTING:
Patients undergoing emergency and elective ostomy surgery between January 1, 1999, and June 1, 2016, in 3 acute care hospitals were followed up by stoma care nurse specialists in NHS Lanarkshire, Scotland.

METHODS:
Data were collected on surgery type (emergency or elective), stoma type (ileostomy or colostomy), stoma-related complications including surgical complications (stenosis, retractions, hernia, and prolapse) and so-called “patient-centered” complications (skin changes, odor, leakage, soiling, and nighttime emptying) at 5 time points: 10 days, 3 months, 6 months, 1 year, and 2 years postoperatively. For this study, we report comparisons at 10 days and 2 years, using frequencies reported as percentages.

RESULTS:
Data from 3509 consecutive stoma surgeries were analyzed. Complication rates were similar in both emergency and elective cases. The nighttime symptoms of leakage and soiling were significantly greater in the ileostomy group and worsened over the 2-year period. The parastomal hernia rate was 34.5% at 2 years, a finding more common in the colostomy group (46.4% vs 20.1%, P < .001). However, the rate of clinically significant hernia was similar when comparing the colostomy group with the ileostomy group (3.6% vs 2.2%, P = .38). Emergency stoma surgeries (40.2%) were preoperatively sited compared with 95.9% of elective cases.

CONCLUSIONS:
Our prospective multicenter study demonstrated that stoma-related complications are similar irrespective of whether the stoma was formed via an elective surgery or emergency surgery. Nighttime symptoms of leakage, soiling, and emptying were high post–stoma formation, particularly in the ileostomy group, and worsened over the 2-year period. Findings from our study highlight the presence and persistence of complications. We believe our work highlights the importance of having frequent discussions with patients about making decisions about approaches to reduce complications to enhance patient outcomes.
Importance of adipocyte browning in the evolution of endothermy
Authors: Jastroch Martin , Seebacher Frank 
Published: January 2020

Endothermy changes the relationship between organisms and their environment fundamentally, and it is therefore of major ecological and evolutionary significance. Endothermy is characterized by non-shivering thermogenesis, that is metabolic heat production in the absence of muscular activity. In many eutherian mammals, brown adipose tissue (BAT) is an evolutionary innovation that facilitates non-shivering heat production in mitochondria by uncoupling food-derived substrate oxidation from chemical energy (ATP) production. Consequently, energy turnover is accelerated resulting in increased heat release. The defining characteristics of BAT are high contents of mitochondria and vascularization, and the presence of uncoupling protein 1. Recent insights, however, reveal that a range of stimuli such as exercise, diet and the immune system can cause the browning of white adipocytes, thereby increasing energy expenditure and heat production even in the absence of BAT. Here, we review the molecular mechanisms that cause browning of white adipose tissue, and their potential contribution to thermoregulation. The significance for palaeophysiology lies in the presence of adipose tissue and the mechanisms that cause its browning and uncoupling in all amniotes. Hence, adipocytes may have played a role in the evolution of endothermy beyond the more specific evolution of BAT in eutherians.This article is part of the theme issue ‘Vertebrate palaeophysiology’.