bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Palliative Care Is Associated With Reduced Emergency Department Utilization in Pancreatic Cancer
Authors: Bevins Jack , Bhulani Nizar , Goksu Suleyman Y. , Sanford Nina N. , Gao Ang , Ahn Chul , Paulk Mary E. , Terauchi Stephanie , Pruitt Sandi L. , Tavakkoli Anna , Rhodes Ramona L. , Kazmi Syed M.A. , Beg Muhammad S. 
Published: March 2021

Objectives:
Most patients with pancreatic cancer have high symptom burden and poor outcomes. Palliative care (PC) can improve the quality of care through expert symptom management, although the optimal timing of PC referral is still poorly understood. We aimed to assess the association of early PC on health care utilization and charges of care for pancreatic cancer patients.

Materials and Methods:
We selected patients with pancreatic cancer diagnosed between 2000 and 2009 who received at least 1 PC encounter using the Surveillance, Epidemiology, and End Results (SEER)-Medicare. Patients who had unknown follow-up were excluded. We defined “early PC” if the patients received PC within 30 days of diagnosis.

Results:
A total of 3166 patients had a PC encounter; 28% had an early PC. Patients receiving early PC were more likely to be female and have older age compared with patients receiving late PC (P<0.001). Patients receiving early PC had fewer emergency department (ED) visits (2.6 vs. 3.0 visits, P=0.004) and lower total charges of ED care ($3158 vs. $3981, P<0.001) compared with patients receiving late PC. Patients receiving early PC also had lower intensive care unit admissions (0.82 vs. 0.98 visits, P=0.006) and total charges of intensive care unit care ($14,466 vs. $18,687, P=0.01). On multivariable analysis, patients receiving early PC were significantly associated with fewer ED visits (P=0.007) and lower charges of ED care (P=0.018) for all patients.

Conclusions:
Early PC referrals were associated with lower ED visits and ED-related charges. Our findings support oncology society guideline recommendations for early PC in patients with advanced malignancies such as pancreatic cancer.
Prognostic role of the ascending aorta dilatation in patients with arterial hypertension
Authors: Leone Dario , Airale Lorenzo , Bernardi Sara , Mingrone Giulia , Astarita Anna , Cesareo Marco , Sabia Luca , Avenatti Eleonora , Tosello Francesco , Bruno Giulia , Catarinella Cinzia , Venturelli Veronica , Giordana Carlo , Veglio Franco , Vallelonga Fabrizio , Milan Alberto 
Published: March 2021

Background:
Ascending aorta (ASC) dilatation (AAD) is a common finding in arterial hypertension, affecting about 15% of hypertensive patients. AAD is associated with an increase in cardiac and vascular hypertension-related organ damage, but its prognostic role is unknown. The aim of the study was to evaluate the prognostic value of AAD as predictor of cardiovascular events in essential hypertensive patients.

Methods:
Recruited patients underwent two-dimensional transthoracic echocardiography from 2007 to 2013 and followed-up for cardiovascular events until November 2018 by phone call and hospital information system check. ASC diameter and AAD were defined using both absolute and scaled definitions. Four hundred and twenty-three hypertensive patients were included in our study.

Results:
During a median follow-up of 7.4 years (interquartile range 5.6–9.1 years), 52 events were observed. After adjusting for age, sex and BSA, both ASC diameter and AAD definition, according to ARGO-SIIA project, resulted associated with a greater risk of cardiovascular event (both P < 0.010), even after adjusting for major confounders (both P < 0.010). Moreover, we observed that the assessment of ASC improves risk stratification compared with pulse wave velocity alone, and that in absence of AAD, sinus of valsalva dilatation lost any prognostic value (P = 0.262).

Conclusions:
ASC diameter and AAD are both associated with a greater risk of cardiovascular events. ASC should be assessed to optimize risk stratification in hypertensive patients and its dilatation may be considered as a surrogate for vascular organ damage.
The Relationship Between Corneal Biomechanics and Intraocular Pressure Dynamics in Patients Undergoing Intravitreal Injection
Authors: Dackowski Evan K. , Moon Jee-Young , Wang Jessie , Shrivastava Anurag , Schultz Jeffrey S. 
Published: March 2021

Precis:
A higher “corneal resistance factor” (CRF) was associated with greater intraocular pressure (IOP) elevation after intravitreal injection of bevacizumab. Both higher “corneal hysteresis” (CH) and CRF were associated with more rapid IOP recovery postinjection.

Purpose:
The purpose of this study was to evaluate the relationship between measurable corneal biomechanical properties and acute IOP elevation after rapid intraocular volume expansion from the routine intravitreal injection.

Materials and Methods:
A total of 100 patients necessitating unilateral intravitreal injection with 0.05 mL of bevacizumab for retinal pathology were analyzed before injection with Goldmann Applanation Tonometry to measure IOP, Ocular Response Analyzer (ORA) to measure corneal biomechanical properties, and optical biometry to calculate globe measurements. IOP and ORA were measured again within 5 minutes of the injection and then IOP measurements were taken every 10 minutes until the IOP was ≤150% of the preinjection IOP. Linear regression and logistic regression were used to test variables associated with acute IOP increase. A Cox proportional hazard model accounting for preinjection IOP and postinjection IOP was used to test the effect of CH or CRF on the time required to return to 150% of baseline IOP.

Results:
Higher CRF was associated with greater immediate postinjection IOP (P=0.026) elevation. A preinjection IOP>15.5 mm Hg moderately predicted postinjection IOP≥35 mm Hg (area under the receiver operating characteristics curve=0.74). A preinjection IOP>18.5 mm Hg combined with CH poorly predicted postinjection IOP>50 mm Hg (area under the receiver operating characteristics curve=0.67). A higher CH [hazard ratio (HR)=1.24; 95% confidence interval (CI)=1.08-1.42; P=0.002] and preinjection IOP (HR=1.16; 95% CI=1.09-1.22; P<0.001), along with a lower immediate postinjection IOP (HR=0.93; 95% CI=0.90-0.95; P<0.001), were each independently associated with quicker IOP recovery postinjection. Similar results were seen in the Cox model examining CRF and IOP recovery.

Conclusions:
Higher CRF and preinjection IOP were independently associated with greater postinjection IOP elevations. ORA metrics did not greatly strengthen the prediction of patients who would have postinjection IOP>50 mm Hg. Higher CH and CRF were associated with faster IOP recovery after intravitreal injection, demonstrating the dynamic relationship between ocular biomechanical properties and aqueous outflow pathways.
Global Divergence of Antifungal Prescribing Patterns
Authors: Ferreras-Antolin Laura , Bielicki Julia , Warris Adilia , Sharland Mike , Hsia Yingfen 
Published: March 2021

Background:
Globally, invasive fungal diseases (IFDs) have a significant impact in human health. With an increasing pediatric population at risk of IFD, effective antifungal drugs access and affordability should be ensured universally. The aim of our study was to characterize the global antifungal drug use in neonates and children and its variability between countries in different income groups.

Methods:
Data were extracted from the Global Antimicrobial Resistance, Prescribing and Efficacy in Neonates and Children Point Prevalence Survey project, consisting in 1 pilot and four 1-day Point Prevalence Survey between 2015 and 2017. The data had been entered through a study-specific web-based data collection tool.

Results:
From a total of 13,410 children included, 7.8% (1048/13,410) received at least 1 systemic antifungal drug: 9.5% (95% confidence interval: 8.9%–10.1%) in high income countries (HIC) versus 5.0% (95% confidence interval: 4.4%–5.6%) in low-middle income countries (LMIC) (P < 0.01). A significant proportion of patients on antifungals belonged to high-risk group for IFD (67.4%; 706/1048); most of these were managed in HIC (72.8%, P < 0.01). The likelihood of receiving antifungals being in high-risk group was higher in HIC compared with LMIC (ratio of 5.8 vs. 3.4, P < 0.01). Antifungal prophylaxis was more likely prescribed in HIC (67.2% vs. 30.4%, P < 0.01). Fluconazole was the most frequently prescribed drug. The proportional use of fluconazole was higher in LMIC compared with HIC.

Conclusions:
A significant variability of antifungal prescribing patterns was observed. The proportional use of systemic antifungals was twice as high in HIC compared with LMIC. More detailed data on access and antifungal use in limited-resource settings should be explored.
Race to the Top of the Hospital Value-Based Purchasing Program
Authors: Spaulding Aaron , Hamadi Hanadi , Xu Jing , Tafili Aurora , Liu Xinliang 
Published: March 2021

EXECUTIVE SUMMARY
Medicare’s Hospital Valued-Based Purchasing (HVBP) program measures hospitals’ total performance score (TPS); its measurement strategies have changed regularly since its rollout in 2013. Because the program influences care delivery, it is important to examine how the policy has changed hospitals’ behavior and how it may inform future policies. The purpose of this study was to assess the relationship between hospitals’ performance on TPS annually from 2013 to 2018 and organizational characteristics. Using the HVBP TPS from 2013 to 2018 and associated hospital characteristics—hospital size, teaching hospital status, system membership, ownership type, urban/rural location, average percentages of patients from Medicare and Medicaid, operating margins, percentages of inpatient revenue as a proportion of total revenue, and case mix index—we conducted a retrospective cohort study of all U.S. hospitals participating in the HVBP program. Regression and panel analyses found that organizations that were expected to have robust and rigid resources were unable to score in the superior category consistently. In addition, organizations were unable to consistently perform positively over time because of changes in the HVBP program measurement and the required organizational responses. Policymakers should consider the ability of organizations to respond to changes to the HVBP program. Likewise, healthcare managers, particularly those in larger organizations, should seek to remove bureaucracy or allow for greater resource slack to meet these changes.
Transtympanic Sodium Thiosulfate for Prevention of Cisplatin-Induced Ototoxicity: A Randomized Clinical Trial
Authors: Duinkerken Charlotte W. , de Weger Vincent A. , Dreschler Wouter A. , van der Molen Lisette , Pluim Dick , Rosing Hilde , Nuijen Bastiaan , Hauptmann Michael , Beijnen Jos H. , Balm Alfons J.M. , de Boer Jan Paul , Burgers Jacobus A. , Marchetti Serena , Schellens Jan H.M. , Zuur Charlotte L. 
Published: March 2021

Objectives:
To determine safety, feasibility, and preliminary activity of transtympanic injection of sodium thiosulfate (STS) against cisplatin-induced hearing loss (CIHL).
DESIGN Randomized controlled trial.
SETTING Tertiary cancer hospital.
PATIENTS Adults to be treated with high-dose cisplatin (≥ 75 mg/m2).
INTERVENTION Selected by randomization, 0.1 M STS gel on one side and placebo gel on the other side was transtympanically applied to the middle ear 3 hours before cisplatin administration. After amendment, the placebo ear was left untreated.

Main Outcome Measure:
Primary outcome was safety and feasibility. Secondary outcomes included pharmacokinetic analysis of systemic cisplatin and preliminary activity of STS. Clinically relevant CIHL was defined as a ≥ 10 dB threshold shift at pure-tone average 8-10-12.5 kHz (PTA8-12.5). Response to STS was defined as a threshold shift at PTA8-12.5 in the STS-treated ear of ≥ 10 dB smaller than the untreated ear.

Results:
Twelve patients were treated. Average CIHL at PTA8-12.5 was 12.7 dB in untreated ears and 8.8 dB SPL in STS-treated ears (p = 0.403). Four patients did not develop CIHL. Four out of eight patients with CIHL responded to STS: CIHL at PTA8-12.5 in STS-treated ears was 18.4 dB less compared to untreated ears (p = 0.068). Grade 1 adverse events were reported. Pharmacokinetic results were available for 11 patients.

Conclusion:
Transtympanic application of STS was safe and feasible. Based on our pharmacokinetic analysis, we postulate that transtympanic STS does not interfere with the systemically available cisplatin. Our results provide a preliminary proof of concept for transtympanic application of STS in preventing CIHL and warrants further evaluation on a larger scale.
Reducing Sound Exposure During Ocular Vestibular Evoked Myogenic Potential Testing for Superior Semicircular Canal Dehiscence Syndrome
Authors: Zuniga M. Geraldine , Schell Angela , Engst Benjamin G. , Carey John P. 
Published: March 2021

Background:
Ocular vestibular evoked myogenic potentials (oVEMP) testing in response to air-conducted sound (ACS) has excellent sensitivity and specificity for superior semicircular canal dehiscence syndrome (SCDS). However, patients with SCDS may experience vertigo with the test, and recent works recommend minimizing acoustic energy during VEMP testing.

Purpose:
To develop an oVEMP protocol that reduces discomfort and increases safety without compromising reliability.

Methods:
Subjects: Fifteen patients diagnosed with SCDS based on clinical presentation, audiometry, standard VEMP testing, and computed tomography (CT) imaging. There were 17 SCDS-affected ears and 13 unaffected ears. In nine (53%) of the SCDS-affected ears surgical repair was indicated, and SCD was confirmed in each. oVEMPs were recorded in response to ACS using 500 Hz tone bursts or clicks. oVEMP amplitudes evoked by 100 stimuli (standard protocol) were compared with experimental protocols with only 40 or 20 stimuli.

Results:
In all three protocols, oVEMP amplitudes in SCDS-affected ears were significantly higher than in the unaffected ears (p < 0.001). 500 Hz tone bursts evoked oVEMPs with excellent (>90%) sensitivity and specificity in each of the three protocols. However, in the unaffected ears, lowering to 20 stimuli reduced the detection of oVEMP responses in some ears. Following surgical repair, oVEMPs normalized in each of the protocols.

Conclusion:
In oVEMP testing using ACS for SCDS, reducing the number of trials from 100 to 40 stimuli results in a more tolerable and theoretically safer test without compromising its effectiveness for the diagnosis of SCDS. Reducing to 20 stimuli may degrade specificity with clicks.
Predictors of Postoperative Complications in Vestibular Schwannoma Surgery—A Population-Based Study
Authors: Alkins Ryan D. , Newsted Daniel , Nguyen Paul , Campbell Robert J. , Beyea Jason A. 
Published: March 2021

Objective:
To investigate preoperative patient demographics and comorbidities in relation with postsurgical complications following vestibular schwannoma surgery.

Study Design:
Retrospective population-based cohort study.

Setting:
All hospitals in the Canadian province of Ontario.

Patients:
This study includes 1,456 patients who underwent vestibular schwannoma surgery from April 1, 2002 to March 31, 2018 in Ontario, Canada.

Intervention/Outcome Measures:
For all surgical patients, the demographic data, preoperative comorbidities, and postoperative complications were evaluated. Postoperative complications were examined immediately following surgery in the hospital as well as 1 year following the hospital discharge.

Results:
The most common comorbidities in this cohort were hypertension (30.22%), diabetes (9.48%), asthma (13.53%), and chronic obstructive pulmonary disease (6.73%). Diabetes was the most impactful comorbidity and was associated with higher risk of myocardial infarction (RR = 4.58, p < 0.01), pneumonia (RR = 1.80, p = 0.02), dysphagia (RR = 1.58, p < 0.01), and meningitis (RR = 3.62, p < 0.01). Analysis of surgical approaches revealed that the translabyrinthine approach, compared with the open craniotomy approach, was negatively associated with postoperative complications including pneumonia (RR = 0.43, p < 0.01), urinary tract infection (RR = 0.55, p = 0.01), dysphagia (RR = 0.66, p < 0.01), and readmission (RR = 0.45, p < 0.01).

Conclusion:
This study examines patient demographics, preoperative comorbidities, and postoperative complications in patients who have undergone vestibular schwannoma surgery. The results highlight associations between patient characteristics and postoperative outcomes that can aid in preoperative decision-making and counselling.
Cochlear Implant Fixation Techniques: A Systematic Review of the Literature
Authors: Markodimitraki Laura M. , Strijbos Ruben M. , Stegeman Inge , Thomeer Hans G. X. M. 
Published: March 2021

Objective:
Given the lack of consensus on fixation techniques of the cochlear implant, this review aims to create an up-to-date overview of intra- and postoperative complications, focusing on migration of the internal receiver/stimulator (R/S) device and the electrode array.

Data Sources:
On June 29, 2020 we conducted a search in PubMed, Embase, Cochrane, Web of Science, and CINAHL. Keywords were “Cochlear implant,” “complication,” “migration,” and synonyms.

Study Selection:
Studies were considered if: 1) the adult study population consisted of ≥ 10 patients, 2) the R/S device was fixated using the bony well or tight subperiostal pocket technique without bone-anchoring sutures or screws on the implant, and 3) migration of the R/S device or displacement of the electrode array were described as outcomes.

Data Extraction:
Study characteristics, interventions, follow-up, and outcomes were extracted. For critical appraisal, an adapted version of the Newcastle-Ottawa quality assessment scale for cohort studies was used.

Data Synthesis:
Seven studies were included (n = 430 patients). Migration of the R/S device was reported by three studies. Two studies applying the tight pocket technique reported migration rates ranging from 9.0 to 69.2%. One study using the bony bed technique reported migration of 100%, with an average of 2.5 mm. All studies lacked the required standard for comparability, assessment of outcome, and follow-up.

Conclusions and Relevance:
There is currently no evidence of a difference between the bony bed- and tight pocket fixation technique, regarding migration of the R/S device or the electrode array, in adult patients.
Middle Cranial Fossa Approach to Repair Tegmen Dehiscence Using Self-setting Calcium Phosphate Cement: A Retrospective Case Review
Authors: Bulsara Vishal Mahesh , Kim Grace Soon , Fouad Ayman Mohammed , Bulsara Max Kishor , Santa Maria Peter Luke 
Published: March 2021

Objectives:
To review the outcomes of repairing tegmen dehiscence using the middle cranial fossa approach with a self-setting bone cement.

Study Design:
Retrospective case series.

Setting:
Two academic tertiary hospitals.

Patients:
All patients presenting for surgical repair of tegmen dehiscence and with postoperative follow-up for at least 6 months between October 2015 and July 2019.

Intervention:
Surgical repair using a middle cranial fossa approach using a layered reconstruction with temporalis fascia and self-setting calcium phosphate bone cement.

Main Outcome Measures:
Perioperative complications, recurrence of presenting symptoms/disease, hearing, and facial nerve grade.

Results:
The cohort consisted of 22 patients with 23 tegmen dehiscence repairs (1 sequential bilateral repair). There were 16 males and 6 females with an average age at operation of 52.6 years. Repairs were left sided in 9, right sided in 12 patients, and bilateral in 1 patient. No patients had recurrence of presenting symptoms or disease at most recent follow-up. Preoperative hearing was maintained in all patients. Two patients (9% of repairs) experienced delayed partial temporary facial nerve weakness House-Brackman grade 2 and 4 which had recovered by 8 weeks postoperative.

Conclusion:
We demonstrate a technique for repairing tegmen dehiscence of the middle cranial fossa floor that has excellent postoperative outcomes. We highlight potential technical challenges in this approach as well as the need for counseling for potential partial transient facial nerve dysfunction.
Treatment of Long-term Sudden Sensorineural Hearing Loss as an Otologic Migraine Phenomenon
Authors: Goshtasbi Khodayar , Chua Janice T. , Risbud Adwight , Sarna Brooke , Jamshidi Shahrnaz , Abouzari Mehdi , Djalilian Hamid R. 
Published: March 2021

Objectives:
To describe a cohort of patients presenting with long-term sudden sensorineural hearing loss (SSNHL) treated with prophylactic migraine and intratympanic steroid therapy.

Methods:
Patients presenting to a neurotology clinic at least 6 weeks from SSNHL onset were included. All patients received migraine prophylactic medication (nortriptyline, topiramate, and/or verapamil) and lifestyle changes for at least 6 weeks, as well as intratympanic steroid injections, if appropriate.

Results:
Twenty-one patients (43% female) with a mean age of 64 ± 11 years who presented 9 ± 8 months (median = 5) from symptom onset were included. Posttreatment hearing thresholds were significantly improved compared with pretreatment thresholds at 500 Hz (49 ± 19 dB versus 55 ± 20 dB, p = 0.01), 1000 Hz (52 ± 19 dB versus 57 ± 21 dB, p = 0.03), low-frequency pure-tone average (53 ± 15 dB versus 57 ± 17 dB, p = 0.01), and speech-frequency pure-tone average (57 ± 13 dB versus 60 ± 15 dB, p = 0.02). Posttreatment word-recognition-score (WRS) and speech-recognition-threshold (SRT) were also significantly improved (45 ± 28% versus 70 ± 28% and 57 ± 18 dB versus 50 ± 16 dB, respectively, both p < 0.01). Notably, ≥15% improvement in WRS and ≥10 dB improvement in SRT was observed in 13 (68%) and 8 (40%) patients, respectively. Of the 11 patients who presented with initial < 50% WRS, 8 (73%) had improved posttreatment >50% WRS with an average improvement of 39 ± 9%.

Conclusions:
Migraine medications in addition to intratympanic steroid injections significantly improved SRT and hearing frequencies in 40% and 29% of SSNHL patients, respectively, while significant WRS recovery was observed in most (68%) patients. This suggests SSNHL may be an otologic migraine phenomenon, which may be at least partially reversible even after the traditional 30-day postonset window.