bluuebunny/crossref_metadata_2025_split huggingface dataset:
NPWT Resource Use Compared With Conventional Wound Treatment in Subcutaneous Abdominal Wounds With Healing Impairment After Surgery
Authors: Seidel Dörthe , Lefering Rolf 
Published: June 2021

Objective:
To compare resource utilization of NPWT and CWT for SAWHI after surgery

Summary of Background Data:
NPWT is widely used in the management of complex wounds but high-level evidence of its resource use remains sparse.

Methods:
The multicenter, multinational, randomized clinical SAWHI study enrolled a total of 539 consecutive, compliant adult patients with SAWHI after surgery without fascial dehiscence between August 2, 2011, and January 31, 2018. Patients were randomly assigned to NPWT and CWT stratified by study site and wound size using a centralized web-based tool. Evaluation of direct resource use comprised inpatient and outpatient time, personnel and material for wound treatment, and associated wound-related procedures. The resource use analysis was primarily based on the per protocol population (NPWT 157; CWT 174).

Results:
Although treatment length within 42 days was significantly shorter in the NPWT arm {Mean [Standard deviation (SD)] NPWT 22.8 (13.4); CWT 30.6 (13.3); P < 0.001 U-test}, hospitalization time was shorter with CWT [Mean (SD) NPWT 13.9 (11.1); CWT 11.8 (10.8); P = 0.047 U-test]. Significantly more study participants were outpatient with CWT [N=167 (96.0%)] than with NPWT [N = 140 (89.2%) (P = 0.017)]. Time for dressing changes per study participant [Mean (SD) (min) NPWT N = 133, 196 (221.1); CWT N = 152, 278 (208.2); P < .001 U-test] and for wound-related procedures [Mean (SD) (min) NPWT 167 (195); CWT 266 (313); P < 0.001 U-test] was significantly lower with NPWT.

Conclusions:
NPWT reduces resource use and maybe an efficient treatment alternative to CWT for SAWHI after surgery.
Survival Comparison Between Open and Thoracoscopic Upfront Esophagectomy in Patients With Esophageal Squamous Cell Carcinoma
Authors: Wang Bing-Yen , Lin Ching-Hsiung , Wu Shiao-Chi , Chen Hui-Shan 
Published: June 2021

Background:
The survival outcomes of patients with esophageal squamous cell carcinoma (ESCC) after open or thoracoscopic upfront esophagectomy remained unclear.

Objective:
The aim of this retrospective study was to compare overall survival between open and thoracoscopic esophagectomy for ESCC patients without neoadjuvant chemodatiotherapy (CRT).

Methods:
The Taiwan Cancer Registry was investigated for ESCC cases from 2008 to 2016. We enrolled 2053 ESCC patients receiving open (n = 645) or thoracoscopic (n = 1408) upfront esophagectomy. One-to-two propensity score matching between the two groups was performed. Stage-specific survival was compared before and after propensity score matching. Univariate analysis and multivariate analysis were used to identify risk factors.

Results:
After one-to-two propensity score matching, a total of 1299 ESCC patients with comparable clinic-pathologic features were identified. There were 433 patients in the open group and 866 patients in the thoracoscopic group. The 3-year overall survival of matched patients in the thoracoscopic group was better than that of matched patients in the open group (58.58% vs 47.62%, P = 0.0002). Stage-specific comparisons showed thoracoscopic esophagectomy is associated with better survival than open esophagectomy in patients with pathologic I/II ESCC. In multivariate analysis, surgical approach was still an independent prognostic factor before and after one-to-two propensity score matching.

Conclusion:
This propensity-matched study revealed that thoracoscopic esophagectomy could provide better survival than open esophagectomy in ESCC patients without neoadjuvant CRT.
Risk of Severe Maternal Morbidity After Bariatric Surgery
Authors: Auger Nathalie , Ukah U. Vivian , Monnier Maeva , Bilodeau-Bertrand Marianne , Dayan Natalie 
Published: June 2021

Objective:
We assessed whether bariatric surgery before pregnancy lowers the risk of severe maternal morbidity to a level comparable to no obesity.

Summary of Background Data:
Obesity is a risk factor for severe maternal morbidity, but the potential for bariatric surgery to reduce the risk has not been studied.

Methods:
We analyzed a retrospective cohort of 2,412,075 deliveries between 1989 and 2019 in Quebec, Canada. The main exposure measures were bariatric surgery before pregnancy and obesity without bariatric surgery, compared with no obesity. The outcome was severe maternal morbidity, a composite of life-threatening pregnancy complications. We estimated risk ratios (RR) and 95% confidence intervals (CI) for the association between bariatric surgery and severe maternal morbidity, adjusted for maternal characteristics.

Results:
A total of 2654 deliveries (0.1%) were in women who had bariatric surgery, and 70,041 (29.0 per 1000) were in women who had severe maternal morbidity. Risk of severe maternal morbidity was not significantly elevated for bariatric surgery (RR 1.20; 95% CI 0.98–1.46), but was greater for obesity compared with no obesity (RR 1.60; 95% CI 1.55–1.64). Bariatric surgery was not associated with morbidities such as severe preeclampsia, sepsis, and cardiac complications compared with no obesity, but obesity was associated with elevated risks of these and other severe morbidities. Bariatric surgery was associated, however, with intensive care unit admission, compared with no obesity.

Conclusions:
Pregnant women with prior bariatric surgery have similar risks as nonobese women for most types of severe maternal morbidity, except for intensive care unit admission.
Palliative and Supportive Care Consultation for Patients With Malignant Gastrointestinal Obstruction is Associated With Broad Interdisciplinary Management
Authors: Blumenthaler Alisa N. , Bruera Eduardo , Badgwell Brian D. 
Published: June 2021

Objective:
The aim of this study was to assess rates of palliative care (PC) involvement in the care of patients with malignant gastrointestinal obstruction (GIO) and its influence on interdisciplinary team involvement.

Background:
Malignant GIO is an advanced oncologic diagnosis with associated poor prognosis. Data regarding PC and interdisciplinary team involvement in these patients is lacking.

Methods:
We identified consecutive surgical consultations for GIO in cancer patients at a single institution from August 2017 to July 2019. Clinical characteristics were collected. Rates of PC consultation, ACP discussion, code status change to do not resuscitate, and interdisciplinary service consultation were evaluated.

Results:
We identified 200 patients with consultations for GIO, of whom 114 (57%) had malignant GIO and were included in our study. Of these patients, 95 (83%) had stage IV disease; 68 (60%) had peritoneal metastasis, and 70 (61%) had other intra-abdominal recurrence or metastasis. PC consultation was obtained in 69 patients (61%). PC consultation was associated with higher rates of ACP discussion (64% vs 29%; P < 0.001), code status change to do not resuscitate (30% vs 2%; P < 0.001), nonsurgical procedure (46% vs 11%; P < 0.001), discharge to hospice (30% vs 7%; P < 0.001), and involvement of spiritual care (48% vs 22%; P = 0.01), social work (77% vs 42%, P < 0.001), psychology/psychiatry (42% vs 4%, P < 0.001), nutrition (86% vs 62%, P = 0.006), physical therapy (54% vs 31%, P = 0.02), and occupational therapy (42% vs 16%, P = 0.004).

Conclusions:
PC consultation benefits patients with malignant GIO by facilitating comprehensive interdisciplinary care, ACP discussions, and transition to hospice care, where appropriate. Diagnosis of malignant GIO should be a trigger for PC consultation or, in facilities with limited PC resources, consideration of deliberately broad interdisciplinary consultation.
Early Drain Removal is Safe in Patients With Low or Intermediate Risk of Pancreatic Fistula After Pancreaticoduodenectomy
Authors: Dai Menghua , Liu Qiaofei , Xing Cheng , Tian Xiaodong , Cao Feng , Tang Wenbo , Lv Shaocheng , Ma Yongsu , Zhang Dongxin , Kleeff Jorg , Yang Yinmo , Liu Rong , He Qiang , Li Fei , Li Guangming , Guo Junchao , Liao Quan , Zhao Yupei 
Published: June 2021

Objective:
This multicenter randomized controlled trial was designed to test the hypothesis that early drain removal (EDR) could decrease the incidence of grade 2 to 4 complications for patients undoing pancreaticoduodenectomy (PD) with low or intermediate risk of postoperative pancreatic fistula (POPF).

Background:
The safety and effects of EDR on postoperative complications after PD are still controversial.

Methods:
A multicenter randomized controlled trial at 6 tertiary referral hospitals was carried out (NCT03055676). Patients who met the inclusion criteria, including drain amylase level less than 5000 U/L on postoperative day (POD) 1 and POD 3, and drain output less than 300 mL per day within 3 days after surgery, were enrolled. Patients were then randomized to the EDR group or the routine drain removal (RDR) group. In the EDR group, all drainage tubes were removed on POD3. In the RDR group, drainage tubes were removed on POD 5 or beyond. Primary outcome was the incidence of Clavien-Dindo grade 2 to 4 complications. Secondary outcomes were comprehensive complication index, grade B/C POPF, total medical expenses and postoperative in-hospital stay etc, within 90 days after surgery.

Results:
A total of 692 patients were screened, and 312 patients were eligible for randomization. Baseline characteristics were well balanced between the 2 groups and 96.8% of these 312 patients had low or intermediate risk of POPF, according to the 10-point fistula risk score. A total of 20.5% of the patients in the EDR group suffered at least 1 grade 2 to 4 complication, versus 26.3% in the RDR group (P = 0.229). Multi-variate analysis showed older age (>65 years old) and blood transfusion were independent risk factors for grade 2 to 4 complications. The rate of grade B/C POPF was low in either group (3.8% vs 6.4%, P = 0.305). The comprehensive complication index of the 2 groups was also comparable (20.9 vs 20.9, P = 0.253). Total medical expenses were not significantly different. Postoperative in-hospital stay was clinically similar (15 days vs 16 days, P = 0.010).

Conclusions:
Nearly half of the patients undergoing PD met the inclusion criteria, predicting low incidence of grade B/C POPF and major complications. EDR was safe in these patients but did not significantly decrease major complications.
Automated medical avatar animation for warfighter mission simulation
Authors: Pickle Nathan T. , Zehnbauer Timothy P. , Harrand Vincent J. , Zientara Gary P. , Zhou Xianlian , Roos Paulien E. 
Published: June 2021

BACKGROUND
Virtual representations of human internal anatomy are important for military applications such as protective equipment design, injury severity prediction, thermal analysis, and physiological simulations. High-fidelity volumetric models based on imaging data are typically in static postures and difficult to use in simulations of realistic mission scenarios. This study aimed to investigate a hybrid approach to reposition medical avatars that preserves internal anatomy but allows rapid repositioning of full three-dimensional (3D) meshes.

METHODS
A software framework that accepts a medical avatar in a 3D tetrahedral mesh format representing 72 organs and tissues with an articulated skeleton was developed. The skeleton is automatically resized and associated to the avatar using rigging and skinning algorithms inspired by computer animation techniques. Military relevant motions were used for animations. A motion retargeting algorithm was implemented to apply animation to avatars of various sizes, and a motion blending algorithm was implemented to smoothly transition between movements. These algorithms were incorporated into a path generation tool that accepts initial, intermediate, and final coordinates of a multisegment action along with the specific motion for each segment to synthesize a realistic compound set of movements comprising the animation.

RESULTS
The developed pipeline for dynamic repositioning of medical avatars was demonstrated. Various complex motions were automatically animated. Retargeting was demonstrated on models of varying sizes. Movements along a path were animated to demonstrate smooth motion transitions. Animation of the full 3D avatar mesh ran in real time on a standard desktop personal computer. The repositioning algorithm successfully preserved the shape and volume of rigid structures such as bone.

CONCLUSION
The developed software leverages techniques from various disciplines to create a hybrid approach enabling real-time 3D mesh repositioning appropriate for use in simulated military missions using avatars containing a complete anatomy representation. The workflow is largely automated, enabling rapid evaluation of new mission scenarios.
Performance of a novel temporary arterial shunt in a military-relevant controlled hemorrhage swine model
Authors: Stigall Kyle S. , Sleeter Justin J. , Thomas Sarah B. , Schechtman David W. , Blough Perry E. , Rall Jason M. , Kauvar David S. 
Published: June 2021

BACKGROUND
In military trauma, temporary vascular shunts restore arterial continuity until delayed vascular reconstruction, often for a period of hours. A novel US Air Force–developed trauma-specific vascular injury shunt (TS-VIS) incorporates an accessible side port for intervention or monitoring, which may improve patency under adverse hemodynamic conditions. Our objective was to evaluate TS-VIS patency in the setting of volume-limited resuscitation from hemorrhagic shock.

METHODS
Female swine (70–90 kg) underwent 30% hemorrhage and occlusion of the left external iliac artery for 30 minutes. Animals were allocated to one of three groups (n = 5 per group) by left external iliac artery treatment: Sundt shunt (SUNDT), TS-VIS with arterial pressure monitoring (TS-VIS), or TS-VIS with heparin infusion (10 μ/kg per hour, TS-VISHep). Animals were resuscitated with up to 3 U of whole blood to maintain a mean arterial pressure (MAP) of >60 mm Hg and were monitored for 6 hours. Bilateral femoral arterial flow was continuously monitored with transonic flow probes, and shunt thrombosis was defined as the absence of flow for greater than 5 minutes.

RESULTS
No intergroup differences in MAP or flow were observed at baseline or following hemorrhage. Animals were hypotensive at shunt placement (MAP, 35.5 ± 7.3 mm Hg); resuscitation raised MAP to >60 mm Hg by 26.5 ± 15.5 minutes. Shunt placement required 4.5 ± 1.8 minutes with no difference between groups. Four SUNDT thrombosed (three before 60 minutes). One SUNDT thrombosed at 240 minutes, and two TS-VIS and one TS-VISHep thrombosed between 230 and 282 minutes. Median patency was 21 minutes for SUNDT and 360 minutes for both TS-VIS groups (p = 0.04). While patent, all shunts maintained flow between 60% and 90% of contralateral.

CONCLUSION
The TS-VIS demonstrated sustained patency superior to the Sundt under adverse hemodynamic conditions. No benefit was observed by the addition of localized heparin therapy over arterial pressure monitoring by the TS-VIS side port.
Health Education Intervention for Patients Undergoing Placement of Percutaneous Nephrostomy Tube
Authors: Fernández Cacho Luis Manuel , Ayesa Arriola Rosa 
Published: June 2021

PURPOSE:
The purpose of this study was to compare the economic impact (cost) of percutaneous nephrostomy (PCN) tube care in patients following an educational intervention to no intervention.

DESIGN:
A randomized controlled trial.

SUBJECTS AND SETTING:
The sample comprised 178 patients recruited between May 2017 and April 2019. The study setting was the Marqués de Valdecilla University Hospital located in Cantabria on the northern coast of Spain. Data were collected in the hospital's radiology department.

METHODS:
Participants were randomly allocated to 2 groups: an intervention group received an educational intervention that specifically addressed living with a PCN tube and a control group that received standard instruction. The intervention group received the educational intervention twice, before placement of the nephrostomy and at first tube change (6 weeks later). The main outcome variable was economic impact of the PCN, operationally defined as unscheduled or urgent visits and health care costs related to PCN tube placement.

RESULTS:
When compared to control group subjects, participants who received the educational intervention had fewer urgent (unscheduled) visits (1.9 vs 4.0; P = .004) and lower direct and indirect health care costs reflecting a savings of €5277 (approximately US $6257).

CONCLUSIONS:
The health education intervention reduced costs associated with these additional visits when compared to patients receiving standard postprocedural education.
Timing of cholecystectomy after percutaneous cholecystostomy for acute cholecystitis- A systematic review and meta-analysis
Authors: Vasavada Bhavin , Patel Hardik 
Published: June 2021

AbstractIntroductionThere is a controversy about the optimum timing of cholecystectomy after percutaneous cholecystostomy.This systematic review and meta-analysis aimed to evaluate outcomes of early versus late cholecystectomy after percutaneous cholecystostomy.MethodsThe study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and MOOSE guidelines. Heterogeneity was measured using Q tests and I2 statistics. The random-effects model was used. We evaluated cholecystectomy performed at different periods after percutaneous cholecystostomy within 72 hours or later, within or after one week or percutaneous cholecystostomy, within 10 days or after 10 days, less than 2 weeks or more than 2 weeks, less than 4 weeks or more than 4 weeks, less than 8 weeks or more than 8 weeks as per literature.ResultsSix studies including 18640 patients were included in the final analysis. There was no difference in overall complications within or after 72 hours cholecystectomy group, but mortality and biliary complications were significantly high in the less than 72 hours group (p=0.05 and 0.0002 respectively). There was no difference in mortality, overall complication, biliary tract complications in less than 1 week versus more than 1 week and less than 10 days versus more than 10 days group. Overall complications were significantly less in the less than 2 weeks group compared to the more than 2 weeks group. There was no difference in mortality and biliary tract complications between less than 2 weeks and more than 2 weeks group. Overall complication rate (risk ratio 0.67, p <0.0001), postoperative mortality (risk ratio 0.46, p=0.003), bile duct injury (risk ratio 0.62, p=0.01) was significantly less in earlier than 4-week group. Hospital stay was not significantly different between less than 4 weeks versus more than 4 weeks group. (Mean difference= -2.74, p=0.12). Ove all complication rates were significantly more in less than 8 weeks group. (Risk ratio 1.07, p=0.01). Hospital stay was significantly less in less than 8 weeks group. (Mean difference 0.87, p=0.01).ConclusionEarly cholecystectomy preferably within 4 weeks after percutaneous cholecystostomy is preferable over late cholecystectomy.
Depression and Anxiety Symptoms among General Hospital Employees in need of Mental Health Treatment
Authors: Silva Nilson , Martins da Silva Anderson Sousa , Galvão Lucas Pequeno , Torales Julio , Ventriglio Antonio , Castaldelli-Maia João Mauricio , Baldassin Sergio 
Published: June 2021

AbstractBackgroundDepression and anxiety are common and disabling mental disorders worldwide. It has been described a high prevalence of these disorders among health professionals.AimThis study aimed to investigate the association between occupation and depressive/anxiety symptoms, education levels, among professionals from a Brazilian General Hospital in need of mental health treatment.MethodsThis is a longitudinal twelve-years retrospective study, involving health professionals. Socio-demographic data were collected as well as two standardized scales for depression and anxiety symptoms.ResultsData from 506 employees needing a mental health intervention have been described: mean age was 34.6 years, 46.2% of them worked in the administrative sector, 35.0% were nursing assistants, 7.5% were nursing technicians, 6.7% were nurses, and 4.5% reported other occupations. According to the ICD-10 criteria, the rates of diagnosis of depressive disorders and anxiety disorders were 60.9% and 37%, respectively.ConclusionsThe rate of depression and anxiety is higher among health professionals than the general population. Thus, specific programs of prevention based on resilience, continuing education and health promotion are needed.Highlights-Although 53,9% of studied individuals did not mention any kind of areas of difficulty in the workplace, 32.8% reported difficulties with coworkers or bosses.-According to the ICD-10 criteria, diagnoses of depressive disorders (60.9%) and anxiety disorders (37%) were highly prevalent.-Nursing technicians and nursing assistants reported higher somatic cluster BDI scores than other professionals of technical staff, but they were less inclined to receive a psychiatric diagnosis.
The impact of co-circulating pathogens on SARS-CoV-2/COVID-19 surveillance: How concurrent epidemics may decrease true SARS-CoV-2 percent positivity
Authors: Kovacevic Aleksandra , Eggo Rosalind M. , Baguelin Marc , de Cellès Matthieu Domenech , Opatowski Lulla 
Published: June 2021

AbstractBackgroundCirculation of non-SARS-CoV-2 respiratory viruses during the COVID-19 pandemic may alter quality of COVID-19 surveillance, with possible consequences for real-time analysis and delay in implementation of control measures. Here, we assess the impact of an increased circulation of other respiratory viruses on the monitoring of positivity rates of SARS-CoV-2 and interpretation of surveillance data.MethodsUsing a multi-pathogen Susceptible-Exposed-Infectious-Recovered (SEIR) transmission model formalizing co-circulation of SARS-CoV-2 and another respiratory we assess how an outbreak of secondary virus may inflate the number of SARS-CoV-2 tests and affect the interpretation of COVID-19 surveillance data. Using simulation, we assess to what extent the use of multiplex PCR tests on a subsample of symptomatic individuals can support correction of the observed SARS-CoV-2 percent positive during other virus outbreaks and improve surveillance quality.ResultsModel simulations demonstrated that a non-SARS-CoV-2 epidemic creates an artificial decrease in the observed percent positivity of SARS-CoV-2, with stronger effect during the growth phase, until the peak is reached. We estimate that performing one multiplex test for every 1,000 COVID-19 tests on symptomatic individuals could be sufficient to maintain surveillance of other respiratory viruses in the population and correct the observed SARS-CoV-2 percent positive.ConclusionsThis study highlights that co-circulating respiratory viruses can disrupt SARS-CoV-2 surveillance. Correction of the positivity rate can be achieved by using multiplex PCR, and a low number of samples is sufficient to avoid bias in SARS-CoV-2 surveillance.SummaryCOVID-19 surveillance indicators may be impacted by increased co-circulation of other respiratory viruses delaying control measure implementation. Continued surveillance through multiplex PCR testing in a subsample of the symptomatic population may play a role in fixing this problem.