bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lidocaine–Prilocaine Cream Compared With Injected Lidocaine for Vulvar Biopsy
Authors: Williams Logan K. , Weber Jeremy M. , Pieper Carl , Lorenzo Amelia , Moss Haley , Havrilesky Laura J. 
Published: January 2020

OBJECTIVE:
To compare pain control during vulvar biopsy after either application of 5% lidocaine–prilocaine cream or injection of 1% lidocaine.

METHODS:
In a single-site randomized trial, patients who needed vulvar biopsy on a non–hair-bearing surface were recruited from a gynecologic oncology clinic to compare lidocaine–prilocaine cream (placed at least 10 minutes before biopsy) with lidocaine injection (at least 1 minute prior). A sample size of 53 participants in each arm (N=106) was planned. Pain was recorded using a 100 mm visual analog scale at three time points: baseline, after application of anesthesia, and after biopsy. The primary outcome was highest pain score recorded. Secondary outcomes were pain score at biopsy, patient experience, and tolerability and acceptability. Linear regression was used to compare the primary outcome between arms while controlling for baseline vulvar pain. A convenience analysis was performed in March 2019.

RESULTS:
From October 2018 to March 2019, 38 patients completed informed consent and were randomized. Participants were women with median age of 60 years. Most characteristics between groups were similar. Nineteen were analyzed in the lidocaine–prilocaine group, and 18 were analyzed in the lidocaine injection group. The median highest pain score in the lidocaine–prilocaine group was 20.0 mm vs 56.5 mm in the lidocaine injection group. Controlling for baseline pain, the highest pain score in the lidocaine–prilocaine arm was 25.7 mm lower than in the lidocaine injection arm (95% CI [−45.1 to −6.3]; P<.01). Patients randomized to lidocaine–prilocaine had a significantly better experience than those receiving injected lidocaine (median experience score 2.0 mm vs 17.0 mm; P=.02).

CONCLUSION:
Lidocaine–prilocaine cream before vulvar biopsy resulted in a lower maximum pain score and a significantly better patient rating of the biopsy experience when compared with lidocaine injection. Lidocaine–prilocaine cream, alone, is a reasonable option to use for vulvar biopsy.

CLINICAL TRIAL REGISTRATION:
ClinicalTrials.gov, NCT03654417.
A Risk-Adjusted Model for Ovarian Cancer Care and Disparities in Access to High-Performing Hospitals
Authors: Bristow Robert E. , Chang Jenny , Villanueva Carolina , Ziogas Argyrios , Vieira Veronica M. 
Published: January 2020

OBJECTIVE:
To validate the observed/expected ratio for adherence to ovarian cancer treatment guidelines as a risk-adjusted measure of hospital quality care, and to identify patient characteristics associated with disparities in access to high-performing hospitals.

METHODS:
This was a retrospective population-based study of stage I–IV invasive epithelial ovarian cancer reported to the California Cancer Registry between 1996 and 2014. A fit logistic regression model, which was risk-adjusted for patient and disease characteristics, was used to calculate the observed/expected ratio for each hospital, stratified by hospital annual case volume. A Cox proportional hazards model was used for survival analyses, and a multivariable logistic regression model was used to identify independent predictors of access to high-performing hospitals.

RESULTS:
The study population included 30,051 patients who were treated at 426 hospitals: low observed/expected ratio (n=304) 23.5% of cases; intermediate observed/expected ratio (n=92) 57.8% of cases; and high observed/expected ratio (n=30) 18.7% of cases. Hospitals with high observed/expected ratios were significantly more likely to deliver guideline-adherent care (53.3%), compared with hospitals with intermediate (37.8%) and low (27.5%) observed/expected ratios (P<.001). Median disease-specific survival time ranged from 73.0 months for hospitals with high observed/expected ratios to 48.1 months for hospitals with low observed/expected ratios (P<.001). Treatment at a hospital with a high observed/expected ratio was an independent predictor of superior survival compared with hospitals with intermediate (hazard ratio [HR] 1.06, 95% CI 1.01–1.11, P<.05) and low (HR 1.10, 95% CI 1.04–1.16, P<.001) observed/expected ratios. Being of Hispanic ethnicity (odds ratio [OR] 0.85, 95% CI 0.78–0.93, P<.001, compared with white), having Medicare insurance (OR 0.74, 95% CI 0.68–0.81 P<.001, compared with managed care), having a Charlson Comorbidity Index score of 2 or greater (OR 0.91, 95% CI 0.83–0.99, P<.05), and being of lower socioeconomic status (lowest quintile OR 0.41, 95% CI 0.36–0.46, P<.001, compared with highest quintile) were independent negative predictors of access to a hospital with a high observed/expected ratio.

CONCLUSION:
Ovarian cancer care at a hospital with a high observed/expected ratio is an independent predictor of improved survival. Barriers to high-performing hospitals disproportionately affect patients according to sociodemographic characteristics. Triage of patients with suspected ovarian cancer according to a performance-based observed/expected ratio hospital classification is a potential mechanism for expanded access to expert care.
Comparative Clinical Effectiveness and Safety of Bone Morphogenetic Protein Versus Autologous Iliac Crest Bone Graft in Lumbar Fusion
Authors: Liu Shichao , Wang Yinqing , Liang Zeyan , Zhou Maochao , Chen Chunmei 
Published: January 2020

Study Design.
This is a systematic literature review and meta-analysis.

Objective.
We aimed to evaluate the efficacy and safety of recombinant human bone morphogenetic protein (RhBMP) and autologous iliac crest bone graft (ICBG) in lumbar fusion.

Summary of Background Data.
RhBMP has been emphasized in lumbar fusion due to high fusion success rate. However, ICBG remains the criterion standard graft approach for lumbar fusion. The safety and effectiveness of rhBMP are controversial.

Methods.
Prospective randomized controlled trials were searched from PubMed, EMBASE, and Cochrane Central Register of Controlled Trails by using Medical Subject Headings terms “bone morphogenetic protein," “bone transplantation," and “spinal fusion." Two independent investigators screened eligible studies, assessed the bias of original articles, extracted data including fusion success, Oswestry disability index improvement, improved short form 36 questionnaire scores, adverse events and re-operation, and a subgroup analysis. The GRADE approach was used to grade quality of evidence.

Results.
Twenty randomized controlled trials (2185 patients) met the inclusion criteria. There were higher fusion success rate (odds ratio [OR] 3.79, 95% confidence interval [CI] 1.88–7.63, P = 0.0002), better improvement of Oswestry Disability Index (mean difference 1.54, 95% CI 0.18–2.89, P = 0.03), and lower re-operation rate (OR 0.59, 95% CI 0.43–0.80, P = 0.0007) in rhBMP group. Heterogeneity was obvious in fusion success rate (I

2
= 58%); hence, a subgroup analysis, based on protein type (rhBMP-2 or rhBMP-7), was performed, which suggested that only rhBMP-2 was better than ICBG for lumbar fusion. There was no difference in the incidence of adverse events between rhBMP and ICBG (OR 0.91, 95% CI 0.70–1.18, P = 0.47).

Conclusion.
In lumbar fusion, rhBMP-2 exhibited a higher fusion success rate and reduced the risk of re-operation. No difference in complication rate is between rhBMP (rhBMP-2 and rhBMP-7) and ICBG. We suggest rhBMP especially rhBMP-2 as an effective substitute for ICBG for lumbar fusion.

Level of Evidence: 1
Maternal Risk Modeling in Critical Care—Development of a Multivariable Risk Prediction Model for Death and Prolonged Intensive Care*
Authors: Simpson Nicholas B. , Shankar-Hari Manu , Rowan Kathryn M. , Cecconi Maurizio , von Dadelszen Peter , Huning Emily Y-S. , Magee Laura A. , Payne Beth A. , Quinn Audrey C. , Harrison David A. 
Published: January 2020

Objectives:
We aimed to develop and validate an accurate risk prediction model for both mortality and a combined outcome of mortality and morbidity for maternal admissions to critical care.

Design:
We used data from a high-quality prospectively collected national database, supported with literature review and expert opinion. We tested univariable associations between each risk factor and outcome. We then developed two separate multivariable logistic regression models for the outcomes of acute hospital mortality and death or prolonged ICU length of stay. We validated two parsimonious risk prediction models specific for a maternal population.

Setting:
The Intensive Care National Audit and Research Centre Case Mix Programme is the national clinical audit for adult critical care in England, Wales, and Northern Ireland.

Patients:
All female admissions to adult general critical care units, for the period January 1, 2007–December 31, 2016, 16–50 years old, and admitted either while pregnant or within 42 days of delivery—a cohort of 15,480 women.

Interventions:
None.

Measurements and Main Results:
We aimed to develop and validate an accurate risk prediction model for both mortality and a combined outcome of mortality and morbidity for maternal admissions to critical care. For the primary outcome of acute hospital mortality, our parsimonious risk model consisting of eight variables had an area under the receiver operating characteristic of 0.96 (95% CI, 0.91–1.00); these variables are commonly available for all maternal admissions. For the secondary composite outcome of death or ICU length of stay greater than 48 hours, the risk model consisting of 17 variables had an area under the receiver operating characteristic of 0.80 (95% CI, 0.78–0.83).

Conclusions:
We developed risk prediction models specific to the maternal critical care population. The models compare favorably against general adult ICU risk prediction models in current use within this population.
Glaucoma in pregnancy: an update
Authors: Strelow Bryan , Fleischman David 
Published: January 2020

Purpose of review
Glaucoma management during pregnancy is a complex challenge, which requires balancing the clinical disease of the mother with the potential risks of therapy to the developing child. Because systematic studies are lacking in the pregnant population, this review aims to collect the array of available data from observational studies and case reports to provide the reader with guidance and context for the safety of glaucoma interventions during pregnancy.

Recent findings
Surgical glaucoma is a rapidly expanding field with many new technologies and procedures. We review the surgical options for the gravid patient with reference to traditional procedures like trabeculectomy and tube-shunts, and newer MIGS procedures. When indicated, orphan trabeculectomy, or with collagen matrix implant may be a viable solution for severe glaucoma during pregnancy. Newer MIGS procedures such as the gelatin stent may also provide minimally invasive options for pregnant patients. Two new medications, Vyzulta and Rhopressa, were recently released in 2018 and have limited data to support their safety for use during pregnancy.

Summary
The careful consideration of fetal health in the management of glaucoma during pregnancy is best done as a part of a multidisciplinary team including obstetrics and neonatology. When medication is necessary, steps to minimize systemic absorption should be employed. Surgical management should not be excluded for pregnant patients and may be considered before medical management in some cases to prevent fetal exposures and maternal harm.
Corneal Neurotization: A Review of Pathophysiology and Outcomes
Authors: Park Ji Kwan , Charlson Emily S. , Leyngold Ilya , Kossler Andrea L. 
Published: January 2020

Purpose:
The objective of this study is to provide a systematic review of the clinical outcomes of corneal neurotization and present the pathophysiology of corneal wound healing, neurotrophic keratopathy, and corneal neurotization.

Methods:
A literature review of published articles and meeting abstracts between December 2008 and February 2019 in the English language with the terms “corneal neurotization,” “corneal neurotisation,” “corneal reinnervation,” and “neurotrophic keratopathy” was performed. Reported clinical data before and after corneal neurotization, and surgical techniques, were collected and analyzed.

Results:
A total of 54 eyes that underwent corneal neurotization were identified. Final Logarithm of the Minimum Angle of Resolution (logMAR) best-corrected visual acuity improved to 0.85 (standard deviation [SD] = 0.65) from 1.25 (SD = 0.71) with a mean improvement of 0.41 (SD = 0.55; p < 0.0001). Central corneal sensation measured using Cochet-Bonnet esthesiometer improved from 2.18 mm (SD = 0.4) to 40.10 mm (SD = 18.66) with a mean filament length change of 38.00 mm (SD = 18.95; p < 0.0001). The median time to the reported maximal sensation return was 8 months (interquartile range 6–10). The most common reported limitation to visual recovery was corneal scarring (31.5%). Children (ages 0–17 years) as compared with adults (ages 18–82 years) had significantly greater final central corneal sensation esthesiometry readings, central corneal sensation return, and improvement in the logMAR best-corrected visual acuity (p < 0.011).

Conclusions:
Neurotrophic keratopathy disturbs the homeostatic balance of trophic factors and trigeminal nerve reflexes needed to support ocular surface health and corneal healing. Corneal neurotization can significantly improve corneal sensation and visual acuity and should be considered for the treatment of refractory neurotrophic keratopathy, especially in pediatric populations.
Novel Treatment of Subjective BPPV in the Medically Complex Geriatric Patient
Authors: Stam Daniel , Pernu Jenna 
Published: January 2020

Background and Purpose:
Peripheral vestibular disorders such as benign paroxysmal positional vertigo (BPPV) are a common, yet costly health care burden. In the older adult population, BPPV may go undiagnosed and contribute to a poorer quality of life and increased risk for falls and secondary injury. The presence of both acute and chronic medical complexities increases the challenge clinicians face in examination and evaluation. The purpose of this article is to present a case report of the treatment of subjective BPPV in an older adult with acute contraindications to traditional intervention techniques.

Case Description:
A geriatric patient presented to acute inpatient rehabilitation with multiple comorbidities and orthopedic restrictions after falling down a flight of stairs. The patient described vertiginous symptoms consistent with BPPV.

Intervention and Outcome:
In absence of objective nystagmus, the diagnosis of subjective BPPV was established and the patient was treated using a novel intervention method to accommodate orthopedic restrictions. Positional symptoms were absent during remaining hospital stay and at a 1-week phone follow-up.

Discussion:
In acute settings of practice, therapists are frequently presented with many restrictive factors preventing conventional performance of BPPV diagnosis and treatment. With increased knowledge regarding modification factors, new techniques can be developed to improve clinical outcomes.
Electrocochleography During Translabyrinthine Approach for Vestibular Schwannoma Removal
Authors: Riggs William J. , Fitzpatrick Douglas C. , Mattingly Jameson K. , Harris Michael S. , Hiss Meghan M. , Rajkumar Shashank , Zhan Kevin Y. , Brown Kevin D. , Moberly Aaron C. , Dodson Edward E. , Adunka Oliver F. 
Published: January 2020

Hypothesis:
Intraoperative electrocochleography (ECochG) can differentiate hair cell and neural dysfunction caused by a vestibular schwannoma (VS) and help define the site of lesion as peripheral or central to the spiral ganglion.

Background:
Hearing loss in patients with a VS can be caused by both sensory (cochlear) and neural dysfunction.

Methods:
Round-window ECochG using low and high-frequency tone bursts was performed in 49 subjects with a VS. Responses were analyzed for magnitude, spectrum, and shape of the time waveform. Components examined included the cochlear microphonic, auditory nerve neurophonic, compound action potential (CAP), and summating potential (SP).

Results:
Variability in the summed response magnitudes across frequency, or “total response” (ECochG-TR), varied from 0.1 to 100 μV. Responses were larger for lower frequencies. Subjective estimates revealed a wide range of neural contributions from the auditory nerve neurophonic to low frequencies and the CAP to high frequencies. Cases with larger CAPs had smaller SPs. The correlation of ECochG-TR, with word recognition score (WRS), was moderate (r = 0.67), as well as the correlation between pure-tone averages and ECochG (r = 0.63). The cochlea remained functional in two cases of sudden sensorineural hearing loss with 0% WRS.

Conclusion:
Reduced ECochG-TR and neural activity in many cases indicates both sensory and neural deficits. Smaller SPs when CAPs are present indicate a neural contribution to the SP. Good cochlear function with 0% WRS, and cases of sudden sensorineural hearing loss with retained cochlear function, indicate retrocochlear effects, typically proximal to the spiral ganglion cells.
Rare benign and malignant testicular lesions: histopathology and management
Authors: Kern Sean Q. , Speir Ryan W. , Akgul Mahmut , Cary Clint 
Published: January 2020

Purpose of review
The presence of vascular solid tumors within the testicle is considered to be malignant until proven otherwise. However, it is prudent for clinicians to be aware of rare benign and malignant intratesticular lesions as management can differ from the established treatment algorithms for germ-cell tumors.

Recent findings
Utilizing certain histopathologic findings can assist with the diagnosis of rare testis tumors. Often times the tumor subtypes are an important consideration in the grading and classification of the disease, which drives management. The multidisciplinary management of rare malignant testis tumors at an experienced center seems to provide optimal patient outcomes. Regardless of the primary treatment, prolonged follow-up for sex cord stromal tumors and other rare testis malignancies is advocated due to the delayed metastatic potential.

Summary
The clinical presentation of rare benign and malignant testis tumors is often similar to that of germ-cell tumors. Likewise, imaging characteristics are also often indistinguishable. However, the management of these rare tumors is often different from the well established treatment algorithms of germ-cell tumors. To that end, it is important for the practicing urologist to be familiar with the current principles of these tumor characteristics and the management.
A Multiregion Analysis of Shale Drilling Activity and Rates of Sexually Transmitted Infections in the United States
Authors: Johnson Nicholaus P. , Warren Joshua L. , Elliott Elise G. , Niccolai Linda M. , Deziel Nicole C. 
Published: January 2020

Background
Fossil fuel extraction from deep shale rock formations using new drilling technologies such as hydraulic fracturing has rapidly increased in the Unites States over the past decade. Increases in nonlocal, specialized workers to meet the demands of this complex industry have been suggested to influence the rates of sexually transmitted infections (STIs) in counties with shale drilling activity; these associations may vary geographically. In this multiregion analysis, we examine the associations between shale drilling activity and rates of 3 reportable STIs in Colorado, North Dakota, and Texas, states with active shale drilling.

Methods
We obtained annual reported rates of chlamydia, gonorrhea, and syphilis from the Centers for Disease Control and Prevention, number of active shale wells from Enverus (formerly known as DrillingInfo), and sociodemographic covariates from the US Census Bureau. We used multivariable mixed-effects Poisson regression modeling to estimate rate ratios (RR) with 95% confidence intervals (CIs) adjusted for potential confounders and secular trends.

Results
In Texas, county-years with high drilling activity had 10% increased rates of chlamydia (RR, 1.10; 95% CI, 1.04–1.17) and 15% increased rates of gonorrhea (RR, 1.15; 95% CI, 1.04–1.28), compared with county-years with no drilling. No statistically significant associations were reported for syphilis or for any STIs in Colorado or North Dakota.

Conclusions
Associations between shale drilling and chlamydia and gonorrhea in Texas may reflect increased risk in areas with higher drilling activity and a greater number of major metropolitan areas. Interstate differences highlight the need for local epidemiology to prioritize community health policies.
Drug cost savings resulting from the outpatient pharmacy services collaborating with oncologists at outpatient clinics
Authors: Kamata Hayato , Suzuki Shinya , Demachi Ken , Suzuki Hidetaka , Sugama Yuka , Ikegawa Kiwako , Igarashi Takashi , Yamaguchi Masakazu , Okudera Hiroshi , Tahara Makoto , Kawasaki Toshikatsu 
Published: January 2020

Abstract

Objectives:
Impact of outpatient collaborative pharmacy services performed by pharmacists on drug costs has not yet been reported. Therefore, this study evaluated direct interventions made by pharmacists in the form of prescription proposals that resulted in drug cost savings from outpatient collaborative pharmacy services performed by pharmacists to support outpatient cancer chemotherapy.

Methods:
This was a retrospective cohort study wherein the drug cost savings resulting from the outpatient collaborative pharmacy services performed by 6 pharmacists and physicians from 6 medical departments were calculated and investigated from June 2016 to November 2016. Drug costs as of August 31, 2016 were used to calculate the drug cost savings.

Results:
During the 6-month study period, 6 pharmacists performed outpatient collaborative pharmacy services on weekdays within a span of 120 days for a total of 2177 hours each. The total drug cost savings were ¥6984,637, including ¥5842,061 for anticancer drugs, ¥1086,484 for oral drugs other than anticancer, ¥39,388 for premedications, and ¥16,704 for drugs for abuse. The total cost of the added drugs was ¥3224,227, allocated as follows: nonanticancer medicines, ¥1441,317; supportive medicines for adverse drug reactions in chemotherapy, ¥359,127; premedications for chemotherapy, ¥307,961; and anticancer medicines, ¥1115,822.

Conclusion:
The results of the present study are limited to “pharmacists assisting in reducing drugs by adjusting expensive anticancer drugs through a collaborative effort with physicians via outpatient consultations”; however, it indicated a significant overall health economic effect.