bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Experience, Characteristics, and Performance of an Acetaminophen Absorption Test in Critically Ill Patients
Authors: Droege Molly E. , Rhoades Abigail G. , Droege Christopher A. , Mosher Daniel R. , Swomley Aaron M. , Ernst Neil E. , Mueller Eric W. 
Published: August 2021

Background:
Altered drug and nutrient absorption presents a unique challenge in critically ill patients. Performing an acetaminophen absorption test (AAT) has been used as a marker for gastric motility and upper small bowel absorption; thus, it may provide objective data regarding enteral absorptive ability in critically ill patients.

Study Question:
What is the clinical experience with AAT when used as a surrogate marker for enteral absorption in critically ill patients?

Study Design:
This single-center, retrospective, cohort study evaluated serum acetaminophen concentrations within 180 minutes following 1-time enteral administration of an AAT. Patients admitted to the surgical and medical intensive care units and medical intensive care units over a 7-year period were evaluated. Groups were defined as positive (acetaminophen concentration of ≥10 mg/L) or negative (acetaminophen concentration of <10 mg/L) AAT.

Measures and Outcomes:
The outcomes were to describe the clinical experience, characteristics, and performance of AAT.

Results:
Forty-eight patients were included. Patients were 58.5 ± 14 years of age, mostly male (58.3%), and admitted to the surgical intensive care unit (66.7%). Median hospital length of stay was 47.5 (27–78.8) days. Thirty-four patients (70.8%) had a positive AAT [median concentration, 14 (12–18) mg/L]. Median time to first detectable concentration was 37 (33–64) minutes. AAT characteristics were similar between the groups including total dose, weight-based dose, time to first and second assays, drug formulation, and site of administration between groups. There were no independent risk factors identified on regression analysis for negative AAT.

Conclusions:
An acetaminophen dose of 15 mg/kg with 2 coordinated serum concentrations approximately 30 and 60 minutes after administration is a reasonable construct for AAT. Future research is needed to assess AAT utility, safety, and clinical outcomes for predicting patient ability to absorb enteral feeds and medications.
Racial Disparities in Preventable Adverse Events Attributed to Poor Care Coordination Reported in a National Study of Older US Adults
Authors: Pinheiro Laura C. , Reshetnyak Evgeniya , Safford Monika M. , Kern Lisa M. 
Published: August 2021

Background:
Previous work found that Black patients experience worse care coordination than White patients.

Objective:
The aim was to determine if there are racial disparities in self-reported adverse events that could have been prevented with better communication.

Research Design:
We used data from a cross-sectional survey that was administered to participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study in 2017–2018.

Subjects:
REGARDS participants aged 65+ years of age who reported >1 ambulatory visits and >1 provider in the prior 12 months (thus at risk for gaps in care coordination).

Measures:
Our primary outcome was any repeat test, drug-drug interaction, or emergency department visit or hospitalization that respondents thought could have been prevented with better communication. We used Poisson models with robust standard error to determine if there were differences in preventable events by race.

Results:
Among 7568 REGARDS respondents, the mean age was 77 years (SD: 6.7), 55.4% were female, and 33.6% were Black. Black participants were significantly more likely to report any preventable adverse events compared with Whites [adjusted risk ratio (aRR): 1.64; 95% confidence interval (CI): 1.42–1.89]. Specifically, Blacks were more likely than Whites to report a repeat test (aRR: 1.77; 95% CI: 1.38–2.29), a drug-drug interaction (aRR: 1.76; 95% CI: 1.46–2.12), and an emergency department visit or hospitalization (aRR: 1.45; 95% CI: 1.01–2.08).

Conclusions:
Black participants were significantly more likely to report a preventable adverse event attributable to poor care coordination than White participants, independent of demographic and clinical characteristics.
Early detection of pancreatic cancer: current state and future opportunities
Authors: Trikudanathan Guru , Lou Emil , Maitra Anirban , Majumder Shounak 
Published: August 2021

Purpose of review
Pancreatic ductal adenocarcinoma (PDAC) is third leading cause of cancer death in the United States, a lethal disease with no screening strategy. Although diagnosis at an early stage is associated with improved survival, clinical detection of PDAC is typically at an advanced symptomatic stage when best in class therapies have limited impact on survival.

Recent findings
In recent years this status quo has been challenged by the identification of novel risk factors, molecular markers of early-stage disease and innovations in pancreatic imaging. There is now expert consensus that screening may be pursued in a cohort of individuals with increased likelihood of developing PDAC based on genetic and familial risk.

Summary
The current review summarizes the known risk factors of PDAC, current knowledge and recent observations pertinent to early detection of PDAC in these risk groups and outlines future approaches that will potentially advance the field.
Can Propofol Be Used to Assess the Presence of the Rectoanal Inhibitory Reflex During Anorectal Manometry Studies?
Authors: Arbizu Ricardo A. , Amicangelo Maureen , Rodriguez Leonel , Nurko Samuel 
Published: August 2021

ABSTRACTObjectives:To study changes in intra‐anal pressure (IAP) and characteristics of the rectoanal inhibitory reflex (RAIR) during anorectal manometry (ARM) in patients undergoing anesthesia induction with propofol.Methods:Prospective study in which ARM was performed at baseline while patients were awake and repeated after propofol‐induced anesthesia. We studied IAP and the presence and characteristics of the RAIR before and after propofol.Results:A total of 27 patients were included (63% male; 9.2 years). Three patients had obstructive symptoms after Hirschsprung disease repair (HSCR), and 24 had intractable constipation. At baseline, the RAIR was present on 21 of 27 patients and absent on 6 of 27. Of the six patients with an absent RAIR, it remained absent in four of six (three known HSCR, and one new diagnosis of IAS achalasia), and two of six had a normal RAIR during propofol. Therefore, RAIR was present in all patients with constipation. The mean resting IAP was significantly lower after propofol. The percentage of IAS relaxation after lower balloon volume inflations was significantly higher during propofol (P < 0.05). No difference was observed over the latency time or the total relaxation time after propofol.Conclusions:Propofol can be used to assess the presence of the RAIR during ARM in children who are uncooperative and undergoing other procedures under anesthesia. On the other hand, propofol significantly reduces the resting IAP and increases the percentage of internal anal sphincter relaxation after balloon distention. These findings may impact the interpretation to decide if an intervention is needed, or if there is a possible spinal neuropathy.
Attitudes and Practices of Pediatric Oncologists Regarding Palliative Care Consultation for Pediatric Oncology Patients
Authors: Parisio Katie N. , Levy Carly D. , Lewis Amanda M. , Schultz Corinna L. 
Published: August 2021

Objective:
We sought to describe palliative care services available to children with cancer along with pediatric oncologists’ current and ideal practices of palliative care involvement in children with cancer.

Design:
A novel survey tool was administered via REDCap to attending pediatric oncologists in the United States. The survey remained open from June to September 2020.

Results:
A total of 265 survey responses were evaluated. Most respondents endorsed that palliative care should “always” be consulted for the following scenarios: new diagnosis of advanced/metastatic disease (53%), uncontrolled symptoms (65%), bone marrow transplant (55%), and relapsed/refractory disease (73%). For those same scenarios, the majority noted the current practice was to “sometimes” or “usually” consult. Most respondents (92.6%) felt that palliative care should be consulted more frequently than they were currently being consulted.

Conclusions:
Compared with the current practice for various pediatric oncology departments, palliative care was not consulted as often as oncologists desired. While barriers to palliative care consultation are outlined in the literature, exploration of how to address them as well as identification of barriers specific to oncologists who are in favor of palliative care consultation are not well-described. Further research exploring these specific barriers is necessary to understand the disconnect between oncologists’ attitudes and palliative care consultation.
Effect of Reiki Therapy on Quality of Life and Fatigue Levels of Breast Cancer Patients Receiving Chemotherapy
Authors: Karaman Seda , Tan Mehtap 
Published: August 2021

Background
The quality of life of patients receiving chemotherapy decreases, and fatigue is one of the most common symptoms. Reiki is used for cancer patients as an energy-based complementary and alternative method.

Objective
The aim of this study was to determine the effect of Reiki therapy on the quality of life and fatigue levels in breast cancer patients receiving chemotherapy.

Methods
This was a pretest-posttest, quasi-experimental study with a control group: 70 patients enrolled with 35 participants in the experimental group and 35 in the control group. The experimental group received 6 sessions of Reiki therapy. The data were collected using a Patient Information Form, the Piper Fatigue Scale, and the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire.

Results
The mean scores on the general well-being subscale in the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire increased in the experimental group and decreased in the control group, whereas the mean scores on the general function and general symptom subscales decreased in the experimental group and increased in the control group. The differences between the groups were statistically significant (P < .001). The mean Piper Fatigue Scale scores of the experimental group decreased, whereas that of the control group increased; the group differences were statistically significant (P < .001).

Conclusion
Reiki can reduce fatigue and increase the quality of life of breast cancer patients receiving chemotherapy.

Implications for Practice
Reiki therapy can be used as a nursing intervention to increase the quality of life and reduce fatigue in breast cancer patients receiving chemotherapy.
Test-retest Reliability of the qReading Method in Normally Sighted Young Adults
Authors: Shepard Timothy G. , Lu Zhong-Lin , Yu Deyue 
Published: August 2021

SIGNIFICANCE
We recently developed a novel Bayesian adaptive method, qReading, to measure reading function. The qReading method has both the efficiency and excellent test-retest reliability in normally sighted young adults to make it an excellent candidate for future studies of its value in diagnosis and longitudinal evaluation of treatment and/or rehabilitation outcomes.

PURPOSE
A novel Bayesian adaptive method, qReading, was recently developed to measure reading function. Here we performed a systematic assessment of the test-retest reliability of the qReading method.

METHODS
The variability of five repeated measurements of the reading curve was examined in two settings: within session and between sessions. For the within-session design, we considered two subpopulations: naive observers and experienced observers. All observers were normally sighted young adults. For each set of data, in addition to examining the intrinsic precision of the qReading method (the half width of the credible interval of the posterior distribution of the estimated performance), we computed four metrics to assess repeatability: standard deviation, Bland-Altman coefficient of repeatability, correlation coefficient, and Fractional Rank Precision.

RESULTS
Extrinsic factors such as observer, time interval between repeated measures, and observer experience all contribute to the variation across measurements. Nevertheless, the four metrics consistently show that the variability across five repeated measurements is small for each set of data. This is true even without taking learning effects into account (standard deviations, ≤0.092 log10 units; Bland-Altman coefficient of repeatability, ≤0.15 (log10)2 units; correlation coefficient, ≥0.91; and Fractional Rank Precision, ≥0.81).

CONCLUSIONS
The qReading method has excellent test-retest reliability in normally sighted young adults.
Accelerating adolescent HIV research in low-income and middle-income countries: evidence from a research consortium
Authors: Tucker Joseph D. , Iwelunmor Juliet , Abrams Elaine , Donenberg Geri , Wilson Erin C. , Blachman-Demner Dara , Laimon Lauren , Taiwo Babafemi O. , Kuhns Lisa M. , John-Stewart Grace C. , Kohler Pamela , Subramanian Sujha , Ayieko James , Gbaja-Biamila Titilola , Oladele David , Obiezu-Umeh Chisom , Chima Kelechi P. , Jalil Emilia M. , Falcao Joana , Ezechi Oliver C. , Kapogiannis Bill G. 
Published: August 2021

Objective:
Many adolescents and young adults (AYA) have unmet HIV prevention needs. We describe the Prevention and Treatment through a Comprehensive Care Continuum for HIV-affected Adolescents in Resource Constrained Settings (PATC3H) consortium organization, transition milestones, and youth engagement strategies. The PATC3H consortium focuses on reducing HIV incidence and related health disparities among AYA.

Design and Methods:
Organizational data were obtained from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and supplemented with a brief survey completed by study principal investigators. Transition from the initial phase (years 1 and 2) to the subsequent phase (years 3 and 5) was contingent on meeting prespecified milestones. We reviewed the structure and function of the research consortium, identified shared elements of transition milestones, and examined common youth engagement strategies.

Results:
The PATC3H consortium supports eight research studies through a milestone transition mechanism. The consortium includes AYA HIV research studies in seven countries – Brazil, Kenya, Mozambique, Nigeria, South Africa, Uganda, and Zambia. The NIH request for applications required transition milestones that included early consultation with stakeholders. The transition milestones required by NIH for the eight studies included early consultation with health and policy stakeholders, pilot intervention data, and commitment from national government stakeholders. All studies provided multiple pathways for AYA engagement, including AYA advisory boards and youth-led research studies.

Conclusion:
Data suggest that requiring milestones to transition to the final phase may have facilitated health and policy stakeholder engagement and enhanced formative assessment of regulatory protocols. These data have implications for designing engaged research studies in low and middle-income countries.
Evidence for Left Atrial Volume Being an Indicator of Adverse Events in Patients With Acute Pulmonary Embolism
Authors: Kirkbride Rachael R. , Heidinger Benedikt H. , Monteiro Filho Antonio C. , Brook Alexander , Tridente Daniela M. , DaBreo Dominique C. , Carroll Brett J. , Matos Jason D. , McCormick Ian C. , Manning Warren J. , Burstein Deborah , Aviram Galit , Litmanovich Diana E. 
Published: August 2021

Purpose:
To assess the association between computed tomography pulmonary angiography (CTPA) atrial measurements and both 30-day pulmonary embolism (PE)-related adverse events and mortality, and non–PE-related mortality, and to identify the best predictors of these outcomes by comparing atrial measurements and widely used clinical and imaging variables.

Patients and Methods:
Retrospective single-center pilot study. Acute PE patients diagnosed on CTPA who also had a transthoracic echocardiogram, electrocardiogram, and troponin T were included. CTPA left atrial (LA) and right atrial (RA) volume and short-axis diameter were measured and compared between outcome groups, along with right ventricular/left ventricular diameter ratio, interventricular septal bowing, tricuspid annular plane systolic excursion, electrocardiogram, and troponin T.

Results:
A total of 350 patients. LA volume and diameter were associated with PE-related adverse events (P≤0.01). LA volume was the only atrial measurement associated with PE-related mortality (P=0.03), with no atrial measurements associated with non–PE-related mortality. Troponin was most associated with PE-related adverse events and mortality (both area under the curve [AUC]=0.77). On multivariate analysis, combination models did not greatly improve PE-related adverse events prediction compared with troponin alone. For PE-related mortality, the best models were the combination of troponin, age, and either LA volume (AUC=0.86) or diameter (AUC=0.87).

Conclusion:
Among patients with acute PE, CTPA LA volume is the only imaging parameter associated with PE-related mortality and is the best imaging predictor of this outcome. Reduced CTPA LA volume and diameter, along with increased RA/LA volume and diameter ratios, are significantly associated with 30-day PE-related adverse events, but not with non–PE-related mortality.
Diagnostic Accuracy and Performance of Artificial Intelligence in Detecting Lung Nodules in Patients With Complex Lung Disease
Authors: Abadia Andres F. , Yacoub Basel , Stringer Natalie , Snoddy Madalyn , Kocher Madison , Schoepf U. Joseph , Aquino Gilberto J. , Kabakus Ismail , Dargis Danielle , Hoelzer Philipp , Sperl Jonathan I. , Sahbaee Pooyan , Vingiani Vincenzo , Mercer Megan , Burt Jeremy R. 
Published: August 2021

Objectives:
The aim of the study is to investigate the performance of artificial intelligence (AI) convolutional neural networks (CNN) in detecting lung nodules on chest computed tomography of patients with complex lung disease, and demonstrate its noninferiority when compared against an experienced radiologist through clinically relevant assessments.

Methods:
A CNN prototype was used to retrospectively evaluate 103 complex lung disease cases and 40 control cases without reported nodules. Computed tomography scans were blindly evaluated by an expert thoracic radiologist; a month after initial analyses, 20 positive cases were re-evaluated with the assistance of AI. For clinically relevant applications: (1) AI was asked to classify each patient into nodules present or absent and (2) AI results were compared against standard radiology reports. Standard statistics were performed to determine detection performance.

Results:
AI was, on average, 27 seconds faster than the expert and detected 8.4% of nodules that would have been missed. AI had a sensitivity of 67.7%, similar to an accuracy reported for experienced radiologists. AI correctly classified each patient (nodules present/absent) with a sensitivity of 96.1%. When matched against radiology reports, AI performed with a sensitivity of 89.4%. Control group assessment demonstrated an overall specificity of 82.5%. When aided by AI, the expert decreased the average assessment time per case from 2:44 minutes to 35.7 seconds, while reporting an overall increase in confidence.

Conclusion:
In a group of patients with complex lung disease, the sensitivity of AI is similar to an experienced radiologist and the tool helps detect previously missed nodules. AI also helps experts analyze for lung nodules faster and more confidently, a feature that is beneficial to patients and favorable to hospitals due to increased patient load and need for shorter turnaround times.
A Retrospective Cohort Study Comparing Traditional Breast Conservation With Oncoplastic Surgery in Breast Cancer Patients After Neoadjuvant Chemotherapy
Authors: Chen Ying , Hao Shuang , Chen Jiajian , Huang Xiaoyan , Cao Ayong , Hu Zhen , Liu Guangyu , Shao Zhimin , Wu Jiong 
Published: August 2021

Background
To better understand the difference between traditional breast-conserving surgery (BCS) and oncoplastic surgery (OPS), we conducted a retrospective cohort study involving breast cancer patients who received neoadjuvant chemotherapy (NAC) and then underwent breast conservation at the Fudan University Shanghai Cancer Center.

Methods
A retrospective chart review was conducted. All breast cancer patients who received NAC and then underwent traditional BCS or OPS at the Fudan University Shanghai Cancer Center from January 1, 2008, to December 31, 2019, were included.

Results
Three hundred ninety-nine breast cancer patients received NAC and underwent traditional BCS, and 99 patients underwent OPS. The average age of the patients in the OPS group was younger than that in the BCS group (43 vs 48 years, P = 0.017). The size of the tumor assessed by ultrasonography at baseline in the OPS group was larger than that in the BCS group (31.3 vs 28.1 mm, P = 0.013). The same trend was observed in the clinical T stage and overall staging assessments before the administration of NAC in these 2 groups. Oncoplastic techniques were more frequently applied when tumors were located in areas with relatively few glands, such as the upper inner quadrant. There were no significant differences in the margins and distributions of pathological types and molecular subtypes between these 2 groups. The rates of pathological complete response were similar in the traditional BCS and OPS groups.

Conclusions
Unlike traditional BCS, in breast cancer patients after NAC, the adoption of oncoplastic techniques makes breast conservation feasible, even in patients with large tumors, late stages, and unfavorable tumor locations.
Comparison of the Modified Moberg Flap Versus First Dorsal Metacarpal Artery Flap for Thumb Pulp Reconstruction
Authors: Durgut Fatih , Ozdemir Ali , Ergin Musa , Güleç Ali , Acar Mehmet Ali 
Published: August 2021

Abstract
We assessed and compared outcomes of 2 different flap techniques for thumb pulp defect reconstruction. Twenty-three patients who underwent modified Moberg and first dorsal metacarpal artery flap because of thumb pulp defect were retrospectively evaluated. Flap survival; venous congestion; cold intolerance; static 2-point discrimination (s2-PD); Semmes-Weinstein monofilament (SWM) test scores; paresthesia; defect size; time to return to work; interphalangeal and metacarpophalangeal joint flexion of the thumb; Disability of the Arm, Shoulder and Hand questionnaire scores; and follow-up time were evaluated. Flap survival, venous congestion, time to return to work, paresthesia, defect size, SWM test scores, range of motion of the proximal interphalangeal and metacarpophalangeal joints, and Disability of the Arm, Shoulder and Hand questionnaire scores were similar in both groups. Cold intolerance and s2-PD were found to be statistically better in the modified Moberg flap group. Although these techniques provided similar results, the modified Moberg was found to be superior in terms of cold intolerance and s2-PD.