bluuebunny/crossref_metadata_2025_split huggingface dataset:
Type 2 diabetes and the risk of colorectal polyps
Authors: Hsu Po-Ke , Huang Jing-Yang , Su Wei-Wen , Wei James Cheng-Chung 
Published: May 2021

Abstract
The incidence rates of type 2 diabetes mellitus (T2DM) and colorectal polyps have been increasing over the last decades. However, direct associations between T2DM and colorectal polyps have not been extensively reported. We will explore the relationship between T2DM and colorectal polyps.
In the retrospective study, we classified DM and NonDM groups (control) from 993,516 people in Taiwan nationwide population insurance database from the period of 2000 to 2013. We collected data on income and comorbidities through the international classification of diseases, ninth revision—clinical modification (ICD-9-CM) codes.
The T2DM group had a higher incidence rate of colorectal polyps (31.97%, 95% confidence interval [CI] = 30.97–33.28) than the control group (25.9%, 95% CI = 25.1–26.72), and the crude incidence ratio was 1.235 (95% CI = 1.174–1.300). In 13 years of follow-up (2000–2013), T2DM was linked to a significantly higher cumulative probability of colorectal polyps (log-rank test: P = .0001).
Patients with T2DM had a 1.23-fold higher risk of new colorectal polyps than control patients in 13 years of follow-up. We explain the T2DM increases incidence for colorectal polyps in long term follow-up.
Evaluating the conversion to extended-release tacrolimus from immediate-release tacrolimus in liver transplant recipients
Authors: Choi David , Thaker Sarang , West-Thielke Patricia , Elmasri Annesti , Chan Christine 
Published: May 2021

Background
A new formulation of once daily extended-release tacrolimus (LCP-tac, Envarsus XR) was approved for use in the USA for kidney transplant recipients in 2015. There are limited data regarding real-world observations with conversion to LCP-tac in liver transplant recipients.

Methods
We performed a retrospective analysis of liver transplant recipients treated with LCP-tac. Data collection included (1) reasons for switching to LCP-tac; (2) conversion ratio used; (3) kidney function at time of conversion and 3 months after; (4) outcomes of conversion [acute cellular rejection rates and cytomegalovirus (CMV) viremia] within 3 months of conversion.

Results
Average conversion ratio used to achieve therapeutic drug level without further dose adjustment was 1:0.73 (SD 0.11). Median time after transplant was 508 days (IQR 736). Common reasons patients were switched to LCP-tac were from fluctuations in tacrolimus levels (44%) and adverse effect of tremor (32%). Among patients who were switched due to tremors 88% noted significant improvement. There was no difference in serum creatinine (P = 0.55) or glomerular filtration rate (P = 0.64) from baseline to 3 months postconversion. There were no episodes of acute cellular rejections or CMV viremia postconversion.

Conclusion
This observational study demonstrated that conversion of immediate-release tacrolimus to LCP-tac in liver transplant recipients was well tolerated and effective.
Transjugular intrahepatic portosystemic shunt with transhepatic portal vein puncture guided by ultrasound: a technical alternative
Authors: Rêgo Heloísa M.C. , Medronha Eduardo F. , Junior Enio Ziemiecki , Tovo Cristiane V. , de Mattos Angelo A. 
Published: May 2021

Objective
Evaluation of an alternative technique to perform transjugular intrahepatic portosystemic shunt (TIPS), using abdominal ultrasound to guide portal puncture.

Methods
Retrospective analysis of TIPS performed from January 2014 to December 2018 in an interventional radiology service. TIPS were performed according to the classic technique, except at the moment of portal branch puncture, when abdominal ultrasound was used to guide it, visualized its path within the parenchyma in real-time. Qualitative and quantitative variables were analyzed considering a 95% confidence interval and application of the Student’s t-test with a significance level of P < 0.05.

Results
Forty-one TIPS were performed. The technical success rate of ultrasound guidance in portal puncture was 100.0%. After its performance, a reduction in the portosystemic pressure gradient was observed, with an initial gradient average of 18.8 mmHg (12–25 ± 3.6 mmHg) and a final gradient of 9.2 mmHg (5–14 ± 2.4 mmHg). The mean values for the TIPS execution time, fluoroscopy time and the radiation dose, verified through the dose area product, were 65.2 ± 46.7 min, 25 ± 14.1 min and 85.6 ± 70 Gy cm2, respectively. There were no complications related to the inadvertent puncture of nontarget structures or deaths due to complications resulting from TIPS.

Conclusion
The results demonstrate that the portal transhepatic puncture guided by the abdominal ultrasound is an effective and safe procedure and results in time of execution, time of fluoroscopy and radiation dose below the current reference values of the conventional procedure.
Trends and outcomes of infective endocarditis in cirrhosis: a propensity-matched national study
Authors: Garg Rajat , Aggarwal Manik , Ahuja Keerat R. , Singh Amandeep , Sanaka Madhusudan R. , McCullough Arthur 
Published: May 2021

Background
Cirrhosis is the most common cause of liver-related death and bacterial infection is a common comorbidity in cirrhosis. We aimed to study the trends and outcomes of infective endocarditis in cirrhosis.

Methods
A propensity-matched analysis of the National Inpatient Sample database was performed to assess outcomes of infective endocarditis in adult patients (>18 years) from 2004–2013 with and without cirrhosis. Various outcomes were assessed for outcomes of infective endocarditis in cirrhosis. Multivariate regression analysis was performed for predictors of mortality in infective endocarditis.

Results
There has been no significant change in incidence (3.3–3.6%, P = 0.27) and overall mortality (6.3–8.6%, P = 0.42) of infective endocarditis in cirrhosis. After propensity matching, patients with cirrhosis had significantly higher in-hospital mortality (15 vs. 10.6%, P < 0.001) and acute kidney injury (AKI) (31.8 vs. 28.5%, P < 0.001) as compared to no cirrhosis. Microbiological analysis revealed significantly higher rates of streptococci (35.3 vs. 31.9%, P < 0.001) and fungal infective endocarditis (0.03 vs. 0%, P < 0.001) and lower incidence of Gram-negative infective endocarditis (3.9 vs. 6.3%, P < 0.001) in cirrhosis. Cirrhosis patients had significantly less surgical intervention (10.2 vs. 30.3%, P < 0.001) along with overall total cost and length of stay as compared to no cirrhosis. On multivariate analysis, advanced age, AKI, shock and mechanical ventilation were positive predictors of mortality in infective endocarditis patients with cirrhosis patients.

Conclusions
Cirrhosis is an independent predictor of mortality in infective endocarditis with worse outcomes and less surgical intervention. Gram-negative infective endocarditis is lower in cirrhosis, whereas streptococci and fungal infective endocarditis are higher than noncirrhotic patients.
Who are the patients with Crohn’s disease unsuitable to receive an anti-TNFα therapy? Results from a survey of Italian physicians and literature review
Authors: Caprioli Flavio , Daperno Marco , Bravatà Ivana , Brigido Alessia , Frigerio Daniela , Secchi Ottavio , Rispo Antonio 
Published: May 2021

Objectives
Anti-TNFα agents have been a staple of Crohn’s disease treatment for 20 years, but they have weaknesses. New treatments have more recently become available. The aim of this paper is to examine the Crohn’s disease patient population for whom anti-TNF treatments are not preferred and where new mechanisms of action should be considered.

Methods
A representative sample of 100 Italian physicians with documented expertise with biological treatment of moderate-to-severe Crohn’s disease were interviewed. A literature review on Crohn’s disease treatment was also conducted to identify patient populations for whom anti-TNFs are unsuitable.

Results
On the basis of the interviewed physicians, about 9% of moderate-to-severe Crohn’s disease patients were noneligible to anti-TNFα due to contraindication or possible risk of intolerance, while 11% had discontinued anti-TNFα treatment due to complications or intolerance/hypersensitivity. Patients with severe heart disease and at high risk of infections were more frequently considered unsuitable. The proportion of patients considered unsuitable among elderly patients and in those with recurrent infections, cancer, and other comorbidities ranged between 40 and 60%.

Conclusions
We provided additional quantitative and qualitative information to help identify patients who are less suitable to anti-TNF agents, who could benefit from newer biologic agents with different mechanisms of action.
Can 68Ga-PSMA PET/CT-derived prostate-specific membrane antigen expression parameters predict prostate-specific antigen response to enzalutamide treatment?
Authors: Karyağar Savaş , Güven Osman , Karyağar Sevda Sağlampinar , Arici Serdar , Selvi Oğuzhan , Geredeli Çağlayan , Özülker Filiz 
Published: May 2021

Objective
In patients with metastatic castration-resistant prostate cancer (mCRPCa), enzalutamide is administered when docetaxel treatment fails. The purpose of the study was to evaluate the relationship between prostate-specific antigen (PSA) response and metabolic parameters obtained from 68Ga-PSMA PET/CT before treatment in this patient group.

Methods
From February 2018 to May 2020, 34 patients with mCRPCa were enrolled in this study. The association between PSA response (at least 50% decrease compared to the pretreatment value) and quantitative prostate-specific membrane antigen (PSMA) expression parameters such as SUVmax, SUVmean, PSMA-TV (PSMA receptor-expressing tumor volume) and TL-PSMA (total lesion PSMA receptor expression) were evaluated.

Results
Mean SUVmax, SUVmean, PSMA receptor-expressing tumor volume (PSMA-TV) and total lesion PSMA receptor expression (TL-PSMA) values were 33.66 ± 20.42; 8.82 ± 5.03; 319.85 ± 615.12 cm3; and 2894.76 ± 5195.13, respectively. In the posttreatment 12th week, 22 patients (64.7%) had PSA response, while 12 patients (35.3%) were nonresponders. In patients with PSA response, PSMA-TV values were significantly lower than nonresponders (78.37 ± 80.99 cm3 vs. 451.58 ± 734.61 cm3; P = 0.028). But there was no significant difference between responders and nonresponders in terms of age, ISUP grade, SUVmax, SUVmean, TL-PSMA, pretreatment PSA values, presence of local recurrence or metastases at any site.

Conclusion
PSMA-TV values on 68Ga-PSMA PET/CT imaging before starting enzalutamide treatment following docetaxel failure can predict PSA response in patients with mCRPCa.
The Impact of Dedicated Education Model on Nursing Students' Outcomes
Authors: Musallam Eyad , Ali Abeer Alhaj , Nicely Stephanie 
Published: May 2021

Background
Dedicated education units (DEUs) provide an approach to clinical redesign in nursing education. However, the evidence supporting the application of the DEU model has not been systematically reviewed to assess the impact of this model on students' learning outcomes.

Purpose
This integrative review analyzed the evidence on the relationship between the DEU model and nursing students' learning outcomes.

Methods
Electronic databases were searched for articles published between 1998 and 2019. Search terms used were dedicated education unit, academic collaboration, academic-practice partnership, and outcomes. A total of 24 articles informed this review.

Results
Four categories emerged: clinical self-efficacy and confidence, teamwork and collaboration, knowledge and competency, and students' satisfaction.

Conclusion
The main findings support a positive relationship between the DEU model and students' learning outcomes. Research is still needed to investigate the impact of DEU models on students' problem-solving and clinical judgment.
Learning-by-Teaching and Service Learning to Promote Bleeding Control Education
Authors: Courville Katheryn A. , Lowe Anita , Dannelley Brittany , Sellers Jonathan , Deal Belinda 
Published: May 2021

Background:
Stop the Bleed is a free 1-hour class that teaches laypersons to identify and treat life-threatening bleeding. The training requires a 1:10 instructor-to-participant ratio, which creates a resource drain on volunteer instructors. Nursing students are eligible to assist instructors.

Problem:
Our State Legislature mandated that public schools equip themselves with bleeding control kits resulting in thousands of school staff needing training.

Approach:
Our nursing school used a service learning model to aid schools. Nursing students coordinated the program, and student learning occurred through a learning-by-teaching strategy.

Outcomes:
We trained 656 community members, taught in 5 counties, and students received 320 clinical hours. If not for COVID-19 (coronavirus disease 2019), numbers would have been doubled. We developed a sustainable relationship with school nurses. Students rated the program highly with respect to meeting course objectives and preparation for professional practice.

Conclusions:
The program met its goals and will continue.
Detecting Progression in Advanced Glaucoma: Are Optical Coherence Tomography Global Metrics Viable Measures?
Authors: Thenappan Abinaya , Tsamis Emmanouil , Zemborain Zane Z. , La Bruna Sol , Eguia Melvi , Joiner Devon , De Moraes Carlos Gustavo , Hood Donald C. 
Published: May 2021

SIGNIFICANCE
Optical coherence tomography (OCT) summary measures have been suggested as a way to detect progression in eyes with advanced glaucoma. Here, we show that these measures have serious flaws largely due to segmentation errors. However, inspection of the images and thickness maps can be clinically useful.

PURPOSE
This study aimed to test the hypothesis that recently suggested global OCT measures for detecting progression in eyes with advanced progression are seriously affected by segmentation mistakes and other errors that limit their clinical utility.

METHODS
Forty-five eyes of 38 patients with a 24-2 mean deviation worse than −12 dB had at least two spectral domain OCT sessions (0.8 to 4.4 years apart) with 3.5-mm circle scans of the disc and cube scans centered on the fovea. Average (global) circumpapillary retinal nerve fiber layer thickness, G
cRNFL, and ganglion cell plus inner plexiform layer thickness, G
GCLP, were obtained from the circle and cube scan, respectively. To evaluate progression, ΔG
cRNFL was calculated for each eye as the G
cRNFL value at time 2 minus the value at time 1, and ΔG
GCLP was calculated in a similar manner. The b-scans of the six eyes with the highest and lowest ΔG
cRNFL and ΔG
GCLP values were examined for progression as well as segmentation, alignment, and centering errors.

RESULTS
Progression was a major factor in only 7 of the 12 eyes with the most negative values of either ΔG
cRNFL or ΔG
GCLP, whereas segmentation played a role in 8 eyes and was the major factor in all 12 eyes with the largest positive values. In addition, alignment (one eye) and other (three eyes) errors played a secondary role in four of the six eyes with the most negative ΔG
cRNFL values.

CONCLUSIONS
For detecting the progression of advanced glaucoma, common summary metrics have serious flaws largely due to segmentation errors, which limit their utility in clinical and research settings.
Improving Compliance with Dyslipidemia Screening Guidelines in a Single-center U.S. Outpatient Pediatric Cardiology Clinic
Authors: Pradhan Sarah , Dodgen Andrew L. , Snyder Christopher S. 
Published: May 2021

Introduction:
The development of atherosclerotic cardiovascular disease begins in childhood. The American Academy of Pediatrics (AAP) endorsed guidelines recommending universal hyperlipidemia screening of children ages 9–11 and again at 17–21 years. An AAP Periodic Survey of Fellows demonstrated less than half of pediatricians report adherence to these guidelines. This quality improvement initiative’s objective was to improve compliance with AAP hyperlipidemia guidelines in an outpatient pediatric cardiology clinic at a single academic center to 80% over a 2-month time frame.

Methods:
We report the results of an IRB-approved chart review at a single-center outpatient pediatric cardiology practice. We defined pediatric cardiologists’ compliance as documented prior lipid screening, ordering a lipid panel, or documented recommendation for follow-up screening. Two plan-do-study-act (PDSA) cycles were undertaken. The first intervention included an informational session to provide pediatric cardiologists with AAP recommendations. The second intervention involved weekly email reminders and a statement for physicians in the electronic medical record.

Results:
We collected data from 600 individual charts of patients seen over 35 clinic days. We received charts before the first PDSA intervention. Baseline compliance with outpatient hyperlipidemia screening was 0%. After the first PDSA cycle, the average screening rate improved to 49%. After the second PDSA cycle, the average screening rate improved to 89%, and there was a centerline shift in the data, indicating improvement.

Conclusion:
We improved the pediatric cardiologists’ compliance with the AAP-recommended hyperlipidemia screening guidelines from 0% to 89% through 2 intervention cycles. Further efforts may be required to sustain this change.
Training the Trainers in Ultrasound-guided Access to Improve Peripheral Intravenous Catheter Placement among Children Presenting for Anesthesia
Authors: O’Reilly-Shah Vikas N. , Franz Amber , Groenewald Cornelius B. , Collins Michael , Patak Lance S. 
Published: May 2021

Introduction:
Factors predicting difficult peripheral intravenous (PIV) catheter placement in children are known. Ultrasound guidance can decrease the number of attempts required for difficult PIV placement. However, the uptake of this technique among attending anesthesiologists at our institution remained low. This study aimed to reduce the incidence of PIV placement requiring greater than 3 attempts and reduce time to PIV placement by providing training in ultrasound guidance.

Methods:
We implemented an evidence-based difficult IV algorithm and ultrasound-guided PIV placement training for attending pediatric anesthesiologists at a tertiary academic pediatric institution. The algorithm outlined risk factors for difficult IV access, established a goal of 3 or fewer attempts, and recommended early ultrasound use after 1 unanticipated attempt and the first attempt for anticipated difficult IV. Group sessions, including instruction and simulated practice, preceded a period of individual training in the operating room using a punch card to monitor each trainee’s progress while also serving to motivate continued engagement.

Results:
We performed a cross-sectional analysis of consecutive cases from December 1, 2015, to September 30, 2019, comparing a 22-month baseline period (n = 12,581) with the training period (n = 6,725) and the following year (n = 6,557). Cases requiring more than 3 attempts decreased from 4.0% to 2.7% overall and from 10% to 6.2% among patients 24 months or less of age. The time required to establish PIV access was unchanged. Factors associated with increased attempts were identified.

Conclusions:
Implementing a difficult IV algorithm and training among attending pediatric anesthesiologists in ultrasound-guided PIV placement reduced attempts but not the time required to establish PIV access.
Psychological aspects of pain prevention
Authors: Fisher Emma , Eccleston Christopher 
Published: May 2021

Abstract
How to prevent the onset, maintenance, or exacerbation of pain is a major focus of clinical pain science. Pain prevention can be distinctly organised into primary, secondary, and tertiary prevention. Primary prevention describes avoiding hurt or pain, secondary prevention describes reducing pain when pain is unavoidable, and tertiary prevention describes preventing or reducing ongoing negative consequences such as high functional disability or distress due to chronic pain. Each poses separate challenges where unique psychological factors will play a role. In this short review article, we highlight psychological factors important to primary, secondary, and tertiary prevention and provide direction for the field. We present 2 case studies on secondary prevention in children and adolescents and tertiary prevention in adults with chronic pain. Finally, we provide research directions for progression in this field, highlighting the importance of clear theoretical direction, the identification of risk factors for those most likely to develop pain, and the importance of treatment.
Pediatric Trainee Perspectives on the Decision to Disclose Medical Errors
Authors: Lin Matthew , Horwitz Leora , Gross Rachel S. , Famiglietti Hannah , Caplan Arthur 
Published: May 2021

Purpose
The aim of the study was to describe factors that may impact pediatric trainees’ willingness to disclose medical errors using clinical vignettes.

Methods
A single-center cross-sectional anonymous survey of pediatric residents and fellows at a large urban medical center in 2019 was conducted. Trainees were provided with clinical vignettes depicting an error resulting in a serious safety event (SSE), minor safety event (MSE), and near miss safety event (NMSE) and were asked to classify the type of safety event and rate and explain their agreement or disagreement with disclosure. Survey items also evaluated trainees’ personal experiences with errors and disclosure. Descriptive and correlational analyses were used to characterize responses. Qualitative content from open-ended survey questions was analyzed using the constant comparative method.

Results
Of 126 trainees, 42 (33%) completed the survey. All agreed with disclosing the hypothetical error presented in the vignette resulting in an SSE (100%), with rates falling for the MSE (95%) and NMSE (7%). There were no significant associations between disclosure agreement for the vignettes and trainee demographic features, knowledge of safety events, prior personal experiences with errors, and disclosure. Four themes that emerged from qualitative analysis of trainees’ rationales for disclosure or nondisclosure of the vignette errors are harm, parental preferences, ethical principles, and anticipatory guidance.

Conclusions
Trainees had high rates of disclosure for the vignette errors cases that depicted SSEs and MSEs but lower rates for NMSEs. Trainees considered the type and level of harm caused, parental preferences, upholding ethical principles, and the need for anticipatory guidance in their rationales for disclosure or nondisclosure of the vignette errors.