bluuebunny/crossref_metadata_2025_split huggingface dataset:
Right Patient, Right Place, Right Time
Authors: Gough Benjamin L. , Painter Matthew D. , Hoffman Autumn L. , Caplan Richard J. , Peters Cynthia A. , Cipolle Mark D. 
Published: August 2020

Introduction This study sought to compare outcomes of trauma patients taken directly from the field to a Level I trauma center (direct) versus patients that were first brought to a Level III trauma center prior to being transferred to a Level I (transfer) within our inclusive Delaware trauma system. Methods A retrospective review of the Level I center’s trauma registry was performed using data from 2013 to 2017 for patients brought to a single Level I trauma center from 2 surrounding counties. The direct cohort consisted of 362 patients, while the transfer cohort contained 204 patients. Linear regression analysis was performed to investigate hospital length of stay (LOS), while logistic regression was used for mortality, complications, and craniotomy. Covariates included age, gender, county, and injury severity score (ISS). Propensity score weighting was also performed between the direct and transfer cohorts. Results When adjusting for age, gender, ISS, and county, transferred patients demonstrated worse outcomes compared with direct patients in both the regression and propensity score analyses. Transferred patients were at increased risk of mortality (odds ratio [OR] 2.17, CI 1.10-4.37, P = .027) and craniotomy (OR 3.92, CI 1.87-8.72, P < .001). Age was predictive of mortality ( P < .001). ISS was predictive of increased risk of mortality ( P < .001), increased LOS ( P < .001), and craniotomy ( P < .001). Older age, Sussex County, and higher ISS were predictive of patients being transferred ( P < .001). Discussion Delays in the presentation to our Level I trauma center resulted in worse outcomes. Patients that meet criteria should be considered for transport directly to the highest level trauma center in the system to avoid delays in care.
The cost of illiteracy: A causal inference study on how illiteracy affects physical and mental health
Authors: Zhang Qiyang 
Published: August 2020

Objective: The aim of this study was to investigate the impact of illiteracy on physical health and mental health. Design: Matching methods (nearest neighbour matching, Mahalanobis metric matching, and propensity score matching). Setting: Elderly people at least 65 years old in 22 provinces of China. Methods: The analysis used data from Chinese Longitudinal Healthy Longevity Survey (CLHLS). The independent variable was a dummy variable, which was coded as 1 for illiterate or semiliterate, and 0 for literate. Dependent variables were indicators of physical and mental health derived from the survey results. Matching methodologies controlled for confounding variables including age, sex, living sites, access to tap water and financial support. Results: Illiteracy was found to have a significant impact on physical health, exercise habits, anxiety, loneliness and happiness. On average, illiteracy decreased physical health by 19.9%, decreased exercise habits by 7%, increased anxiety by 11.56%, increased loneliness by 17.6% and decreased happiness by 11.3%. Conclusion: Findings confirm the past literature in which illiteracy has been found to be adversely associated with physical and mental health. The analysis uniquely found that illiteracy had a higher cost on mental health as compared to physical health for elderly people in China.
The Relationship Between Place of Birth and Early Breastfeeding Initiation in Indonesia
Authors: Kurniawan Deni W. , Chertok Ilana R. A. , Haile Zelalem T. 
Published: August 2020

Background In many countries, hospital-based births are associated with the early initiation of breastfeeding, within the first hour postpartum, especially where the Baby Friendly Hospital Initiative guidelines have been adopted. While Indonesia has adopted the guidelines, there is a relatively low rate of early breastfeeding initiation in the country. Research Aim To determine the relationship between place of birth and early breastfeeding initiation in Indonesia. Method This study was a retrospective cross-sectional survey using national data from the 2017 Indonesia Demographic and Health Survey ( N = 14,279). The association between place of birth and early breastfeeding initiation was examined using logistic regression models, adjusting for potential confounders. Results The overall prevalence of early breastfeeding initiation in Indonesia was 60.9% with a greater proportion of mothers giving birth in health facilities. In the multivariate model, there was a significant interaction between wealth index, insurance status, and place of birth on the timing of breastfeeding initiation. In the subgroup of mothers residing in middle wealth index households, women who gave birth in clinics and hospitals had lower odds of early breastfeeding initiation compared to those who gave birth at home (0.56; 0.34, 0.90; p = .018) and (0.58; 0.40, 0.85; p = .005), respectively. Conclusions Place of birth was significantly associated with early breastfeeding initiation. There is a need to consider health disparities and to strengthen the implementation of the WHO guidelines, Baby Friendly Hospital Initiative, and International Code of Marketing of Breastmilk Substitutes, to increase early breastfeeding initiation in Indonesia.
Use of topical anaesthesia and peribulbar anaesthesia in Descemets membrane endothelial keratoplasty
Authors: Pilger Daniel , Maier Anna-Karina , Bertelmann Eckart , Joussen Antonia , Torun Necip 
Published: August 2020

Introduction: In instances where peribulbar anaesthesia (PBA) cannot be used, Descemet membrane endothelial keratoplasty (DMEK) surgery can be performed under topical anaesthesia (TA). We evaluated subjective pain and post-operative outcomes of DMEK surgeries performed under PBA and TA. Methods: Sixty pseudophakic patients without history of ocular comorbidities underwent DMEK surgery under either PBA or TA. PBA was performed with a single injection of 6 mL Prilocaine Hydrochloride 2% in combination with 1500 I.U. hyaluronidase. For TA, patients were given 0.4% Oxybuprocaine eye drops followed by a 2% Lidocain Hydrochloride-Gel and an intraoperative injection of a 2% Lidocaine Hydrochloride solution into the anterior chamber. All surgeries were performed by the same surgeon. Subjective pain was measured using a visual analog scale (VAS). Secondary outcomes (BCVA, duration of surgery, endothelial density, rebubbling rate) were recorded during a follow-up period of 3 months. Results: The mean subjective pain of patients in the PBA group was 1.27 (95% CI 0.87–1.68) and 1.64 (95% CI 1.15–2.21) in the TA group. The mean duration of surgery was 402 s (95% CI 356–448) in the PBA group and 427 s (95% CI 371–483) in the TA group, p = 0.477. No major differences were observed in BCVA, endothelium density and rebubbling rate between the two groups. Anaesthesia-related side effects were more frequent in the PAB group than in the TA group. Conclusion: Although levels of subjective pain are lower under PBA than under TA, in selected patients without ocular comorbidities TA can achieve levels of pain acceptable for DMEK surgery.
Comparison of corneal epithelial thickness profile in dry eye patients, keratoconus suspect, and healthy eyes
Authors: Rattan Suzan Amana , Anwar Didar Sddeq 
Published: August 2020

Purpose: To compare the corneal epithelial thickness profile in patients with dry eyes and keratoconus suspect with normal healthy eyes. Methods: The study involved 120 eyes with an age range from 19 to 30 years. Forty eyes had normal corneal topography and no dry eyes. Forty eyes had dry eyes but had normal corneal topography. The last 40 eyes were keratoconus suspect and had no symptoms or signs of dry eyes. Results: Central epithelial thickness was not different statistically for all eyes. ( p-value: 0.1). The superior epithelial thickness was 53.5 µm ±3.1 in the control group, 53.4 µm ±3.5 in the dry eye group, and 53.6 µm ±2.8 in the keratoconus suspect group. No statistically significant difference was found ( p-value = 0.7). The inferior epithelial thickness was 55.7 µm ±3.5 in the control, 57.2 µm ±3.19 in the dry eyes, and 52.2 µm ±3.12 in the KC suspects. There was inferior thickening in the dry eyes and thinning in the KC suspects and this was statistically significant ( p-value < 0.01). Minimum epithelial thickness was 52.8 µm ±2.91 in the control and 53.2 µm ±3.51 in the dry eyes and it was located superiorly for both groups. In the KC suspects, the minimum thickness was 52.3 µm ±3.19 and was located inferiorly. Conclusion: In our study the epithelium appears to be thicker inferiorly in dry eyes and thinner in KC suspects. Displacement of thinnest location on epithelial map may be a helpful early sign of keratoconus. However, follow-up study is necessary to confirm the thinnest location displacement helped in this diagnosis.
Eplerenone for treatment of chronic central serous chorioretinopathy
Authors: Fraenkel Doris , Suffo Shady , Langenbucher Achim , Seitz Berthold , Abdin Alaa Din 
Published: August 2020

Purpose: To assess the morphological and functional outcome of oral eplerenone for treatment of patients with chronic central serous chorioretinopathy (CSC) in a real life experience. Patients and methods: In this retrospective study, we reviewed the clinical files of 30 patients with chronic CSC. All patients were treated with eplerenone for a period of 6 weeks or 3 months depending on the clinical response. Main outcome measures included: best corrected visual acuity (BCVA), central macular thickness (CMT) and height of the subretinal fluid (SRF). Comparisons between responders and non-responders were performed to identify factors that were predictive of the treatment response. Results: All patients were treated with eplerenone 18 ± 20 weeks after onset of the first symptoms. BCVA (LogMAR) improved from 0.2 ± 0.2 to 0.13 ± 0.18 at 6 weeks ( p = 0.01) and to 0.09 ± 0.15 at 3 months ( p = 0.01). Mean CMT decreased from 409 ± 136 to 323 ± 87 µm at 6 weeks ( p = 0.001) and to 298 ± 98 µm at 3 months ( p = 0.01). Mean height of SRF decreased from 153 ± 126 to 73 ± 79 µm at 6 weeks ( p = 0.001) and to 49 ± 88 µm at 3 months ( p = 0.005). Complete resolution of SRF was achieved in 20 patients after 3 months (67%). Reported stress in the medical history was the only statistical significant predictive factor associated with a positive treatment response. Conclusion: This study showed a statistically significant improvement of the best corrected visual acuity and a significant reduction of macular thickness and subretinal fluid in patients with chronic CSC treated with oral eplerenone, especially in patients under stress.
Long-term restoration of corneal sensitivity in neurotrophic keratopathy after rhNGF treatment
Authors: Di Zazzo Antonio , Varacalli Giuseppe , Mori Tommaso , Coassin Marco 
Published: August 2020

Background: To report the long-term effects of the new rhNGF treatment on corneal sensitivity in patients with Cases presentation: We present three cases of corneal ulcers due to NK that were treated with rhNGF. In each patient wound healing evolution was documented by clinical pictures and corneal sensitivity measured by Cochet-Bonnet aesthesiometry. Best corrected visual acuity and Type I Schirmer test were also assessed neurotrophic keratopathy. All patients healed within 8 weeks and NK showed no recurrences in the mean follow-up period of 35 weeks. Each subject showed a significant increase of corneal sensitivity and tear secretion, with concomitant improvement in visual acuity. Conclusion: Corneal sensitivity, measured by Cochet-Bonnet aesthesiometer, markedly increased in all eyes. Further studies are warranted to demonstrate a possible mechanism of nerve restoration with rhNGF treatment.
Bacterial Etiology of Wound Exudates in Tertiary Care Cancer Patients and Antibiogram of the Isolates
Authors: Duwadi Kiran , Khadka Sujan , Adhikari Sanjib , Sapkota Sanjeep , Shrestha Pabitra 
Published: August 2020

Introduction: Patients with malignancies frequently develop infections as a result of surgical procedures and fungating wounds leading to pus formation. This cross-sectional study was conducted to explore the bacteriological spectra of infections of various cancer sites and their antibiotic sensitivity patterns among the patients visiting minor operation theatre (OT) of B.P. Koirala Memorial Cancer Hospital (BPKMCH), Chitwan, Nepal. Methods: Over a period of 3 months from September to November 2018, a total of 183 wound exudates and pus samples were collected and analyzed by standard microbiological procedures. Isolates were identified based on the colony characters, Gram staining and an array of biochemical tests. Antibiotic susceptibility testing was performed by Kirby-Bauer disc diffusion technique according to criteria set by CLSI, 2016. Methicillin resistance in Staphylococcus aureus was tested with the help of cefoxitin using disc diffusion method. Results: Out of the 183 samples, 149 (81.4%) were culture positive. Among 13 different isolates identified, S. aureus (43.0%) was predominant followed by E. coli (14.0%). Higher incidence of bacteria was seen among the males (52.3%), in the age group 51 to 60 years (26.8%) and among the patients undergoing surgical intervention to deal with cancer (34.2%). The prevalence of wound infection was significantly affected by gender, age, and treatment regimen ( P < .01). Out of the total 68 S. aureus isolates, 38 (44.1%) were deemed as Methicillin-resistant Staphylococcus aureus (MRSA). Among the 158 isolates, 85 (53.8%) were multi-drug resistant (MDR). Cefepime was the most effective antibiotic for Gram positive isolates whereas both imipenem and meropenem were found to be equally more effective for Gram negative isolates. Conclusion: This study suggests that patients with malignancies harbor pathogenic bacteria; therefore, prudent use of antibiotics is essential to prevent the emergence of MDR pathogens.
The impact of COVID-19 infection on hip fractures 30-day mortality
Authors: Fadulelmola Ahmed , Gregory Rob , Gordon Gavin , Smith Fiona , Jennings Andrew 
Published: August 2020

Introduction A novel virus, SARS-CoV-2 has caused a fatal global pandemic which particularly affects the elderly and those with co-morbidities. Hip fractures affect elderly populations, necessitate hospital admissions, and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method Data related to seventy-five adult hip fractures admitted to two units during March and April 2020 was reviewed. The mean age was 83.5 years (range 65-98 years) and most (53, 70.7%) were females. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in COVID-19 positive group (10/20, 50%) compared to COVID-19 negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval 17.0-22.5). The mean time from admission to surgery was 43.1 hours and 38.3 hours, in COVID-19 positive and COVID-19 negative groups, respectively. All COVID-19 positive patients had shown symptoms of fever and cough, and all ten cases who died were from hypoxia. Seven (35%) cases had radiological lung findings consistent with viral pneumonitis which resulted in mortality (70% of mortality). 30% (n = 6) contracted the COVID-19 infection in the community and 70% (n = 14) developed symptoms after hospital admission. Conclusion Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest x-ray for patients presenting with hip fractures, helps in early planning of high-risk surgeries and allows counselling of the patients and family using realistic prognosis.
Role of community pharmacists in educating asthmatic patients: A multi-centered cross-sectional study in Ethiopia
Authors: Emiru Yohannes Kelifa , Hammeso Workineh Woldeselassie , Adelo Eyerusalem Shello , Siraj Ebrahim Abdela , Bizuneh Gizachew Kassahun , Adamu Betelhem Anteneh , Yimenu Dawit Kumilachew 
Published: August 2020

Background: Effective asthma management requires a multidisciplinary approach that includes; the physician, the patient, and the patient’s family. Objectives: The current study aimed to assess the roles played by community pharmacists toward asthma control together with the barriers hindering their practice and possible strategies to overcome those barriers. Methods: A multi-centered cross-sectional study was conducted. Data was collected using a structured, self-administered questionnaire adapted from previously conducted studies and customized to fit with the current study setup. The collected data was cleaned, coded, and entered into Statistical Package for Social Sciences (SPSS) version 21 for analysis. Descriptive analysis of the collected data was conducted and the results were presented using frequency tables and graphs. Results: A total of 122 community pharmacy professionals; 63 from Gondar, 26 from Bahir Dar, 15 from Debre Markos, 14 from Woldia, and 4 from Debre birhan participated in the study. About 96 (78.7%) of the participants reported that they teach their patients the basic facts about asthma. More than two-thirds of the participants 85 (69.7%) also reported that they were able to identify and manage the triggering factors of asthma for their patients. Lack of pharmacist time was reported by 78 (63.9%) of the study participants as a major reason for the inadequacy of the counseling service provided. Conclusion: It appears evident that there is a need for continuing professional education and pharmacists to receive additional training to improve their ability to go beyond identifying a problem and suggesting therapeutic options.
Overall Survival of Nonmetastasized NSCLC Patients Treated With Add-On Viscum album L: A Multicenter Real-World Study
Authors: Thronicke Anja , Matthes Burkhard , von Trott Philipp , Schad Friedemann , Grah Christian 
Published: August 2020

Background: Recent data suggest a beneficial effect of add-on treatment with Viscum album L (VA) on the survival in cancer patients. The objective of this study was to compare the impact of standard oncological therapy plus add-on VA treatment (S+VA) versus standard oncological therapy alone (S) on the overall survival (OS) of patients with nonmetastasized non–small cell lung carcinoma (NSCLC). Methods: The multicenter real-world data study was conducted using data from the Network Oncology Clinical Registry. The primary end point was OS. OS and impact on hazard in both treatment groups were compared. Results: A total of 275 patients with stages I to IIIA NSCLC were enrolled (mean age = 67.6 years, 57.2% male patients). No significant difference of OS was observed between both groups. Even though not significant, for a subgroup of unresected patients with stage I NSCLC, adenocarcinoma or squamous cell carcinoma, a medium effect size OS improvement was observed for S+VA compared to S. Conclusions: Our findings support the importance of surgery as the most effective intervention in nonmetastasized NSCLC patients. Add-on VA therapy shows here no additional effect in resected patients. However, a small subgroup analysis suggests a possible role of add-on VA for nonresected subgroups. Our results complement existing knowledge on the clinical impact of add-on VA therapy in NSCLC patients and may serve as hypothesis-generating data for further examinations in this cohort. Further research could be directed towards the role of combined therapy for nonresected early-stage NSCLC.
Innovative Approach for the Prevention of Chemotherapy-Induced Peripheral Neuropathy in Cancer Patients: A Pilot Study With the Hilotherm Device, the Poliambulanza Hospital Experience
Authors: Oneda Ester , Meriggi Fausto , Zanotti Laura , Zaina Elisabetta , Bighè Sara , Andreis Federica , Rueda Sabogal , Zaniboni Alberto 
Published: August 2020

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is an adverse event of taxanes, with no effective prevention or treatment available and a highly negative impact on patient quality of life. The aim of this study is to asses that the constant application of cooled cuffs on the hands and feet prevent and mitigate CIPN. Methods: Patients with breast, gynecologic, and pancreatic cancer who received weekly paclitaxel (PTX), PTX/carboplatin, and nab-paclitaxel (nab-PTX)/gemcitabine for any indication at the therapeutic scheduled dosage were included in this prospective study. Hilotherm Chemo care device forms a closed-loop system with cuffs and tubes through which a coolant flows at a temperature of 10 °C. CIPN was monitored using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (edition 3.0), and the tolerability and side effects were scored by using the Common Terminology Criteria for Adverse Events (T4.03 2017). Results: To date, we have enrolled 64 patients. Of these, 54 (84%) completed all cooling cycles. Continuous cooling was well tolerated by all patients. No patients had grade >2 CIPN or had serious or lasting adverse events as a result of Hilotherapy. The median time to CIPN onset was 77 days for the entire population. Conclusion: Hilotherapy has good effectiveness and tolerability and seems to be able to prevent or reduce the symptoms of CIPN. We are still recruiting patients to obtain more data and to collect data at 3 months after the end of chemotherapy. Prospective studies seem to be warranted.
Augmentation of rotator cuff repair with gelatin–resorcin–formalin glue: a biomechanical study
Authors: McNamara William J , Lam Patrick H , Murrell George AC 
Published: August 2020

Introduction Rotator cuff tendons are typically reattached to the proximal humerus using transosseous sutures or suture anchors. Their primary mode of failure is at the tendon–bone interface. Methods We investigated the addition of an adhesive, gelatin–resorcin–formalin (GRF) glue, to a single-row rotator cuff repair (RCR) on ex vivo sheep models. We hypothesised the addition of GRF glue would increase the repair construct strength. The study consisted of three groups of six sheep infraspinatus tendons with an inverted-mattress stitch, tension-band configuration. Group 1 was the control group where no glue was applied. Group 2 involved applying 2 × 2 cm of GRF glue to the infraspinatus footprint and a 2-min curing time. Group 3 allowed for a 15-min cure time. Results Failure occurred at the tendon–bone–suture interface in 6/6 of the control group, and 4/6 from groups 2 and 3. Failure occurred via the suture pulling out of the anchor in 2/6 of groups 2 and 3. No significant differences were noted between all three groups in ultimate failure load, repair stiffness or total energy to failure (p > 0.05). Discussion The addition of GRF glue to the tendon–bone–suture interface did not enhance RCR strength in an ovine model.