bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hemodynamic responses of resistance exercise performed with repetitions to failure and not to failure in adults with hypertension
Authors: Domingues Lucas B. , Cadore Eduardo L. , Ferrari Rodrigo 
Published: August 2020

Objective
To evaluate and compare the hemodynamic responses of resistance exercise (RE) performed with repetitions to failure vs. not to failure in individuals with hypertension.

Methods
Twenty participants were randomly allocated to perform three experimental sessions: a RE session performed with repetitions to failure (RF); a RE session performed with repetitions not to failure (NRF); and a non-exercise control session (Con). RE sessions were composed of four sets of 10 repetitions in four exercises involving large muscle groups. To ensure that the sets could be performed with RF or NRF, intensities corresponding to 75% and 50% of one-repetition maximum test were adopted in RF and NRF sessions, respectively. The Con was performed in seated rest. Blood pressure and rate-pressure product were measured before, during and after the experimental sessions for 1 h.

Results
SBP and DBP decreased after NRF compared with Con (systolic post 1 h: –7.7 ± 1.1 mmHg, P < 0.001; diastolic post 1 h: –4.2 ± 0.7 mmHg, P = 0.001), and after RF compared with Con (systolic post 1 h: –8.2 ± 1.3 mmHg, P < 0.001; diastolic post 1 h: –7.4 ± 1.4 mmHg, P < 0.001). No significant difference was found in blood pressure between RF and NRF sessions after 1 h. Rate-pressure product was lower during NRF compared with RF (P = 0.001), suggesting a higher cardiovascular demand during the RF session.

Conclusion
The RF and NRF sessions are equally effective to promote post-exercise hypotension. In addition, NRF session can reduce cardiac demand during the exercise and should be recommended in adults with hypertension.
Renal Failure is Associated With Increased Mortality and Hospital Utilization in Patients Admitted With Nonalcoholic Steatohepatitis
Authors: Reja Mishal , Patel Roohi , Pioppo Lauren , Tawadros Augustine , Bhurwal Abhishek , Marino Daniel , Rustgi Vinod 
Published: August 2020

Goals:
We aimed to investigate the mortality and hospital utilization outcomes of hospitalized nonalcoholic steatohepatitis (NASH) patients with and without kidney failure in a nationwide cohort.

Background:
NASH is a common medical condition associated with significant morbidity and mortality. A paucity of data exists regarding the impact of kidney failure (defined as acute and chronic kidney failure) on outcomes of NASH hospitalizations.

Materials and Methods:
We conducted a retrospective cohort study using the 2016 Nationwide Inpatient Sample dataset of adult patients hospitalized for NASH, stratified for the presence of renal failure. The primary outcome was inpatient mortality, predictors were analyzed using multivariate logistic regression. Secondary outcomes were the length of stay and mean total hospitalization charges.

Results:
The overall sample included 7,135,090 patients. Among 6855 patients admitted for NASH, 598 or 8.7% had comorbid kidney failure. After multivariate regression analysis, NASH patients with renal failure had increased in-hospital mortality [odds ratio=28.72, 95% confidence interval (CI): 8.99-91.73], length of stay (β=3.02, 95% CI: 2.54-3.5), total hospital charges (β=$37,045, 95% CI: $31,756.18-$42,335.62). Positive predictors of mortality in the renal failure group were Charlson Comorbidity Index ≥3 [adjusted odds ratio (aOR)=3.46, 95% CI: 1.04-11.51], variceal bleeding (aOR=3.02, 95% CI: 1.06-8.61), and hepatic encephalopathy (aOR=26.38, 95% CI: 1.29-540.56). Predictors of decreased mortality were Medicaid (aOR=0.047, 95% CI: 0.28-0.79) and private insurance (aOR=0.56, 95% CI: 0.38-0.83).

Conclusions:
The prevalence of renal failure in NASH hospitalizations is associated with markedly increased mortality, hospital costs, and length of stay. As a result, clinicians should be vigilant in treating kidney failure in this population.
Impact of Knowledge and Risk Perceptions on Older Adults’ Intention for Surveillance Colonoscopy
Authors: Calderwood Audrey H. , Carter Courtney , Durand Marie-Anne , O’Connor Sharon , Boardman Maureen 
Published: August 2020

Goals:
The authors aimed to characterize older adults’ intentions for future surveillance colonoscopy, knowledge of polyps, and predictors of colonoscopy plans.

Background:
Guidelines recommend that the decision to continue or stop surveillance colonoscopy in older adults with colon polyps be “individualized.” Although older adults want to be included in decision making, how knowledge regarding polyps influences decisions is unknown.

Study:
In collaboration with a rural family medicine practice, the authors invited adults aged 65 years and older with a history of colon adenomas to complete a 14-item survey regarding intention for colonoscopy and knowledge of colon polyps.

Results:
Sixty-seven of 105 (63%) patients completed the survey. The mean age was 72 years. Regarding future surveillance, 53% planned to return, 25% were unsure, and 22% did not plan to return. There were no significant differences in baseline characteristics on the basis of the intention for future colonoscopy. Regarding polyp knowledge, 73% had correct knowledge around how common polyps are; 50% thought that more than half of untreated polyps would become cancerous—an inaccurately elevated perception by 10 folds. Respondents who perceived polyps to have a high malignant potential were more likely to report plans for surveillance colonoscopy (68% vs. 39%; P=0.03).

Conclusions:
In this survey of older adults with a history of polyps, many had a falsely elevated perception of polyps’ potential for cancer that was associated with a higher intention for future colonoscopy. Ensuring older adults have an understanding of the risks of polyps is an essential step toward improving decision making around surveillance colonoscopy.
Integration of Person-Centered Narratives Into the Electronic Health Record
Authors: Coats Heather , Shive Nadia , Doorenbos Ardith Z. , Schmiege Sarah J. 
Published: August 2020

Background
Incorporating a patient’s personal narrative into the electronic health record is an opportunity to more fully integrate the patient’s values and beliefs into care, thus creating opportunities to deliver high-quality/high-value, person-centered care.

Objectives
The aim of the study was to present a study protocol of a narrative intervention to (a) compare the effects of the narrative intervention to usual care on primary outcome of person’s (patient) perceptions of quality of communication, (b) compare the effects of the narrative intervention on secondary outcomes of biopsychosocial well-being, and (c) examine the feasibility and acceptability of the narrative intervention from the perspective of both persons: the patient and the acute care bedside nurse.

Methods
A randomized control trial is being conducted with a targeted enrollment of 80 patient participants and 80 nurse participants. The patient participants include individuals who are admitted to the acute care hospital for either heart failure or end-stage renal disease. An acute care beside nurse who has cared for the patient participant is also enrolled. Through a 1:1 random allocation scheme, stratified by illness, we will enroll 40 in the narrative intervention group and 40 in the usual care group. Patient participants will be assessed for patient-reported outcomes of patient’s perception of quality of communication and biopsychosocial well-being.

Results
The study began in October 2019; 53 potential patient participants have been approached, 21 have enrolled, and 20 have completed the data collection process.

Discussion
The testing and integration of a person-centered narrative into the electronic health record is a novel approach to provide opportunities for improvement in communication between patients and nurses. The results from this study will provide important preliminary knowledge to inform future randomized clinical trials of narrative interventions leading to advances in how to best provide high-value, high-quality, person-centered care for persons living with serious illness.
Technology Utilization in Fall Prevention
Authors: Oh-Park Mooyeon , Doan Thao , Dohle Carolin , Vermiglio-Kohn Valerie , Abdou Andrew 
Published: August 2020

Abstract
Falls, defined as unplanned descents to the floor with or without injury to an individual, remain to be one of the most challenging health conditions. Fall rate is a key quality metric of acute care hospitals, rehabilitation settings, and long-term care facilities. Fall prevention policies with proper implementation have been the focus of surveys by regulatory bodies, including The Joint Commission and the Centers for Medicare and Medicaid Services, for all healthcare settings. Since October 2008, the Centers for Medicare and Medicaid Services has stopped reimbursing hospitals for the costs related to patient falls, shifting the accountability for fall prevention to the healthcare providers. Research shows that almost one-third of falls can be prevented and extensive fall prevention interventions exist. Recently, technology-based applications have been introduced in healthcare to obtain superior patient care outcomes and experience via efficiency, access, and reliability. Several areas in fall prevention deploy technology, including predictive and prescriptive analytics using big data, video monitoring and alarm technology, wearable sensors, exergame and virtual reality, robotics in home environment assessment, and personal coaching. This review discusses an overview of these technology-based applications in various settings, focusing on the outcomes of fall reductions, cost, and other benefits.
Medical Error Disclosure: Developing Evidence-Based Guidelines for Chinese Hospitals
Authors: Gu Xiuzhu , Deng Mingming 
Published: August 2020

Objectives
This study aims to investigate Chinese individuals’ expectations regarding the disclosure of errors that vary in level of harm severity and to develop guidelines for error disclosure.

Methods
A total of 947 valid responses were collected from a questionnaire survey in 2019, and 220 respondents or their family members had experienced medical errors. The respondents were required to indicate their preferences regarding the disclosure of errors that entail moderate and severe harm. Based on their responses and interviews conducted with several patient safety managers, guidelines for medical error disclosure were developed.

Results
Similar preferences were reported for the disclosure of errors that entail moderate and severe harm. They expected a formal disclosure. Furthermore, they wished to be informed about the error through face-to-face communication in a meeting room immediately after error detection. Moreover, they wanted to be provided with all details about the incident. The health care provider who was involved in the incident, the leader of his/her department/team, the patient safety manager, and top management member were expected to attend the meeting. However, there was a significant difference in who was expected to disclose errors that entail moderate (i.e., the health care provider involved in the incident) and severe (i.e., the leader, top management member) harm.

Conclusions
Medical error disclosure is not commonly practiced in Chinese hospitals. Therefore, the proposed guidelines could be the first step toward disclosure supporting. In addition, the present findings underscore the importance of cultural sensitivity and error severity in international error disclosure research and practice.
High Prevalence of Right Ventricular/Left Ventricular Ratio ≥1 Among Patients Undergoing Computed Tomography Pulmonary Angiography
Authors: Hadad Yitzhac , Iluz Moshe , Ziv-Baran Tomer , Shalmon Tamar , Rozenbaum Zach , Berliner Shlomo , Aviram Galit 
Published: August 2020

Aim:
Increased ratio between the right and left ventricular (RV/LV) diameters ≥1 is considered an important imaging marker for risk stratification among patients diagnosed with acute pulmonary embolism (PE). Our goal was to assess the prevalence of RV/LV≥1 among consecutive patients undergoing computed tomography pulmonary angiography, and to compare the prevalence of RV/LV≥1 between patients with and without PE.

Methods:
Retrospective analysis of consecutive patients who underwent computed tomography pulmonary angiography due to clinical suspicion of PE between January 1, 2014 and December 31, 2014. The axial RV/LV diameters were measured. The prevalence of RV/LV ≥1 was compared between patients with and without PE and among PE patients, between those with central versus peripheral PE.

Results:
The final cohort included 862 patients. A total of 142 (16.5%) had PE. RV/LV ≥1 was found in 553 (64.1%) of all patients, of them in 453 (63%) patients without PE and in 100 (70.4%) patients with PE (P=0.117). On multivariate analysis, PE was not significantly associated with RV/LV ≥1 (odds ratio [OR]: 1.4; 95% confidence interval [CI]: 0.9-2.1; P=0.102). There was no significant difference in the prevalence of RV/LV ≥1 among patients with central versus peripheral PE distribution (79.5% vs. 67%, P=0.101). Older age (OR: 1.03; 95% CI: 1.02-1.04; P<0.001) and male gender (OR: 1.51; 95% CI: 1.11-2.03; P=0.008), among all patients, were significantly associated with RV/LV diameter ≥1.

Conclusion:
As RV/LV ≥1 is highly prevalent (64.1%), without a significant difference between those with and without PE, an RV/LV ≥1 might not represent the cardiac response to the acute PE event, but rather the patient’s baseline condition.
The Effect of Arterial Disease Level on Outcomes of Supervised Exercise Therapy for Intermittent Claudication
Authors: van den Houten Marijn M. L. , Jansen Sandra , van der Laan Lijckle , Vriens Patrick W. H. E. , Willigendael Edith M. , Koelemay Mark J. W. , Scheltinga Marc R. M. , Teijink Joep A. W. ,   on behalf of the ELECT Study Group
Published: August 2020

Objective:
To assess whether level of arterial obstruction determines the effectiveness of SET in patients with IC.

Background Data:
Guidelines advocate SET before invasive treatment for IC, but early revascularization remains widespread, especially in patients with aortoiliac disease.

Methods:
Patients were recruited from 10 Dutch centers between October 2017 and October 2018. Participants received SET first, followed by endovascular or open revascularization in case of insufficient effect. They were grouped according to level of stenosis (aortoiliac, femoropopliteal, multilevel, or rest group with no significant stenosis). Changes from baseline walking performance (maximal and functional walking distance on a treadmill test, 6-minute walk test) and vascular quality of life questionnaire-6 at 3 and 6 months were compared, after multivariate adjustment for possible confounders. Freedom from revascularization was estimated with Kaplan-Meier analysis.

Results:
Some 267 patients were eligible for analysis (aortoiliac n = 70, 26%; femoropopliteal n = 115, 43%; multilevel n = 69, 26%; rest n = 13, 5%). No between group differences in walking performance or vascular quality of life questionnaire-6 were found. Mean improvement in maximal walking distance after 6 months was 439 m [99% confidence interval (CI) 297–581], 466 m (99% CI 359–574), 353 m (99% CI 210–496), and 403 m (99% CI 58–749), respectively (P = 0.40). Freedom from intervention was 73.9% for aortoiliac disease and 88.6% for femoropopliteal disease (hazard ratio 2.46, 99% CI 0.96 – 6.30, P = 0.013).

Conclusions:
Short-term effectiveness of SET for IC is not determined by the location of stenosis. Although aortoiliac disease patients improved walking performance and health-related quality of life similarly compared to other arterial disease level groups, they underwent revascularization more often.
Surgical Outcome Results From SWOG S1505
Authors: Ahmad Syed A. , Duong Mai , Sohal Davendra P. S. , Gandhi Namita S. , Beg Muhammad Shaalan , Wang-Gillam Andrea , Wade James L. , Chiorean Elena Gabriela , Guthrie Katherine A. , Lowy Andrew M. , Philip Philip A. , Hochster Howard S. 
Published: August 2020

Objective:
The optimal neoadjuvant therapy for resectable pancreatic ductal adenocarcinoma (PDA) and the impact on surgical outcomes remains unclear.

Methods:
S1505 (NCT02562716) was a randomized phase II study of perioperative chemotherapy with mFOLFIRINOX (Arm 1) or gemcitabine/nab-paclitaxel (Arm 2). Measured parameters included resection rate, margin positivity, pathologic response, and toxicity.

Results:
Between 2015 and 2018, 147 patients were randomized. Of these, 44 (30%) were deemed ineligible (43 by central review). Of the 103 eligible patients, 77 (76%) completed preoperative therapy and underwent surgery; reasons patients did not undergo surgery included toxicity related to preoperative therapy (n = 9), progression (n = 9), or other (n = 7). Of the 77, 73 (95%) underwent successful resection; 21 (29%) required vascular reconstruction, 62 (85%) had negative (R0) margins, and 24 (33%) had a complete or major pathologic response to therapy. The grade 3–5 postoperative complication rate was 16%. Of the 73 patients completing surgery, 57 (78%) started and 46 (63%) completed postoperative therapy. This study represents the first prospective trial evaluating modern systemic therapy delivered in a neoadjuvant/perioperative format for resectable PDA.

Conclusions:
We have demonstrated: (1) Based on the high percentage of enrolled, but ineligible patients, it is clear that adherence to strict definitions of resectable PDA is challenging; (2) Patients can tolerate modern systemic therapy and undergo successful surgical resection without prohibitive perioperative complications; (3) Completion of adjuvant therapy in the perioperative format is difficult; (4) Major pathologic response rate of 33% is encouraging.
Significance of Lymph Node Resection After Neoadjuvant Therapy in Pancreatic, Gastric, and Rectal Cancers
Authors: Arrington Amanda K. , O’Grady Catherine , Schaefer Kenzie , Khreiss Mohammad , Riall Taylor S. 
Published: August 2020

Objective:
Gastrointestinal cancers are increasingly being treated with NAT before surgical resection. Currently, quality metrics are linked to the number of LNs resected to determine subsequent treatment and prognosis. We hypothesize that NAT decreases LN metastasis, downstages patients, and decreases overall lymph node yields (LNY) compared to initial surgical resection. With increasing use of NAT, this brings into question the validity of quality metrics.

Methods:
Gastric (stage II/III), pancreatic (stage I/II/III), and rectal cancers (stage II/III) (2010–2015) treated with surgery with/without NAT were identified in National Cancer Database. We evaluated total LNY and LN metastasis with/without NAT and clinical and pathological stage to evaluate rates of downstaging.

Results: :
A total of 7934 gastric, 15,908 pancreatic, and 21,354 rectal cancer patients were included of which 61.1%, 21.2%, and 85.7% received NAT, respectively. NAT patients were more likely to be downstaged (39.9% vs 11.1% gastric P
< 0.001, 30.6% vs 3.2% pancreatic P
< 0.001, 52.0% vs 16.3% rectal P
< 0.001), have lower LNYs (18.8 vs 19.1 gastric P = 0.239, 18.4 vs 17.5 pancreatic P
< 0.001, 15.7 vs 20.0 rectal P
< 0.001) and have N0 pathologic disease (43.6% vs 26.7% gastric P
< 0.001, 51.1% vs 30.9% pancreatic P
< 0.001, 65.9% vs 49.4% rectal P
< 0.001) when compared to initial surgical resection.

Conclusion:
NAT for gastrointestinal cancers results in overall lower LN yields, lower LN metastases, and significant downstaging of tumors. As all patients undergoing NAT receive multimodality therapy, LN yield recommendations may not be true quality metric changing.
The Increasing Financial Burden of Outpatient Elective Surgery for the Privately Insured
Authors: Billig Jessica I. , Lan Wen-Ching , Chung Kevin C. , Kuo Chang-Fu , Sears Erika D. 
Published: August 2020

Objective:
To examine temporal trends of OOP expenses, total payments, facility fees, and professional fees for outpatient surgery.

Summary Background Data:
Approximately 48 million outpatient surgeries are performed annually with a limited financial understanding of these procedures. High OOP expenses may influence treatment decisions, delay care, and cause financial burden for patients.

Methods:
We conducted a retrospective cohort study of patients with employer-sponsored insurance undergoing common outpatient surgical procedures (cholecystectomy, cataract surgery, meniscectomy, muscle/tendon procedures, and joint procedures) from 2011 to 2017. Total payments for surgical encounters paid by the insurer/employer and patient OOP expenses were calculated. We used multivariable linear regression to predict total payments and OOP expenses, with costs adjusted to the 2017 US dollar.

Results:
We evaluated 5,261,295 outpatient surgeries (2011–2017). Total payments increased by 29%, with a 53% increase in facility fees and no change in professional fees. OOP expenses grew by 50%. After controlling for procedure type, procedures performed in ambulatory surgery centers conferred an additional $2019 in predicted total payments (95%CI:$2002–$2036) and $324 in OOP expenses (95%CI:$319–$328) compared to predicted cost for office-based procedures. Hospital-based procedures cost an additional $2649 in predicted total payments (95%CI:$2632–$2667) and $302 in predicted OOP expenses (95%CI:$297–$306) compared to office procedures.

Conclusion:
Increases in outpatient surgery total payments were driven primarily by facility fees and OOP expenses. OOP expenses are rising faster than total payments, highlighting the transition of costs to patients. Healthcare cost reduction policies should consider the largest areas of spending growth such as facility fees and OOP expenses to minimize the financial burden placed on patients.
Should Radiation Exposure be an Issue of Concern in Children With Multiple Trauma?
Authors: Howard Anthony , West Robert M. , Iball Gareth , Panteli Michalis , Baskshi Mantaran Singh , Pandit Hemant , Giannoudis Peter V. 
Published: August 2020

Objective:
The aims of this study were 3-fold: first, establish the level of radiation exposure experienced by the pediatric trauma patients; second, model the level of risk of developing fatal carcinogenesis; and third, test whether pattern of injury was predictive of the level of exposure.

Summary Background Data:
There are certain conditions that cause children to be exposed to increased radiation, that is, scoliosis, where level of radiation exposure is known. The extent that children are exposed to radiation in the context of multiple traumas remains unclear.

Methods:
Patients below the age of 16 years and with an Injury Severity Score (ISS) ≥10, treated by a Major Trauma Center for the period January 2008 to December 2018 were identified. The following data were extracted for the year following the patient's injury: number, doses, and type of radiological examination.
The sex and age of the patient was taken into account in the calculation of the risk of developing a carcinogenesis.

Results:
The median radiation dose of the 425 patients identified in the 12 months following injury, through both CT and radiographs, was 24.3 mSv. Modeling the predictive value of pattern of injury and other relevant clinical values, ISS was proportionately predictive of cumulative dose received.

Conclusion:
A proportion of younger polytrauma patients were exposed to high levels of radiation that in turn mean an increased risk of carcinogenesis. However, the ISS, age, injury pattern, and length of hospital stay are predictive of both risks, enabling monitoring and patient advisement of the risks.