bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recanalization of XEN-45 gel stent occlusion with cortical material after phaco-XEN surgery using Nd: YAG laser treatment
Authors: Seo Je Hyun , Lim Su-Ho 
Published: August 2021

Abstract

Introduction:
The XEN Gel Stent (Allergan Inc., CA, USA) has been widely used in minimally invasive glaucoma surgery to lower intraocular pressure considering reasonable efficacy and safety profiles. However, the XEN gel stent could be occluded by fibrin, blood clots, or the iris due to its small lumen design for preventing postoperative hypotony. To date, only a few studies have assessed XEN occlusion after combined phacoemulsification with XEN gel implantation and how to manage this condition. We describe the first case report of XEN gel stent obstruction by cortical material, demonstrated by anterior segment optical coherence tomography (AS-OCT), which resolved effectively after low-energy neodymium-doped yttrium aluminum garnet (Nd: YAG) laser shock wave treatment.

Patient Information:
A 76-year-old Korean male patient underwent uncomplicated phaco-XEN-gel stent implantation and presented with low intraocular pressure (IOP) with a well-functioning filtering bleb during the first postoperative 4 days. On postoperative day 5, the XEN lumen was occluded by the cortical material, with an intraocular pressure elevation of 28 mm Hg. Slit-lamp examination revealed that cortical material was causing a block into the internal ostium of the XEN gel implant. AS-OCT examination also demonstrated the presence of hyper-reflective materials at the intraluminal portion and peritubular portion around the internal ostium of the XEN gel implant.

Diagnosis:
XEN gel stent occlusion with cortical material after Phaco-XEN surgery.

Interventions:
Low-energy Nd: YAG laser shock wave treatment.

Outcomes:
The IOP dropped from 28 mm Hg to 8 mm Hg immediately after treatment. Transient hypotony and a slightly shallow anterior chamber were noted over the 3 days after YAG laser treatment. The IOP continued to be well-controlled until 3 months later (range; 6 - 12 mm Hg).

Conclusions:
To the best of our knowledge, this is the first case report on the efficacy of Nd: YAG laser treatment for recanalization of XEN implant occluded by the cortex. Moreover, AS-OCT could provide additional clinical information for recanalization of the XEN gel stent.
Skeletal muscle metastasis from a gastrointestinal stromal tumor
Authors: Zhu Guangsheng , Sun Wenjia , Liu Yujun , Wang Huabin , Ye Shengwei 
Published: August 2021

Abstract

Rationale:
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Common sites for metastasis are the liver and peritoneum, whereas skeletal muscle metastases are rare.

Patient concerns:
A 59-year-old man with skeletal muscle metastasis was diagnosed during a period of adjuvant imatinib therapy following the recurrence of GIST of the small intestine.

Diagnosis:
The patient was diagnosed with skeletal muscle metastasis of GIST based on immunohistochemistry and molecular pathology analysis results.

Intervention:
Extensive resection of the left thigh tumor was performed. The patient underwent whole-exome sequencing of tissue examination. The results suggest that resistance to imatinib may have been developed, and the patient was therefore administered sunitinib instead.

Outcomes:
Complete remission was observed following sunitinib therapy.

Lessons:
In cases of skeletal muscle metastasis diagnosed during a period of adjuvant imatinib therapy following the recurrence of a GIST of the small intestine, whole exome sequencing may be used to discover more gene variations.
The predictive and prognostic effects of PD-L1 expression on TKI treatment and survival of EGFR-mutant NSCLC
Authors: Lan Bo , Wang Yongfang , Wu Jingni , Wang Kai , Wang Pingli 
Published: August 2021

Abstract
Whether programmed death-ligand 1 (PD-L1) expression could predict the outcome of tyrosine kinase inhibitor (TKI) treatment and prognosis of epidermal growth factor receptor (EGFR)-mutant nonsmall cell lung cancer (NSCLC) is remaining controversial.
Potential studies were search from PubMed, Embase, and Web of Science databases. Pooled odds ratio of objective response rate was used to describe the relationship between PD-L1 expression and primary resistance to EGFR-TKIs. Pooled hazard ratios (HRs) of progression-free survival (PFS) and overall survival (OS) were included to assess the effects of PD-L1 status on the outcome of EGFR-TKI treatment and survival of EGFR-mutant NSCLCs.
Eighteen eligible studies (1986 EGFR-mutant NSCLCs) were included in this meta-analysis. Positive PD-L1 expression correlated with lower objective response rate of EGFR-TKI treatment (odds ratio [95% confidence interval {CI}] = 0.52 [0.28–0.98], P = .043), while PFS (adjusted HR [95% CI] = 1.49 [0.96–1.89], P = .332) and OS (HR [95% CI] = 1.24 [0.70–2.20], P = .456) of EGFR-TKI treatment did not correlated with PD-L1 status. Furthermore, PD-L1 expression was not a predictive biomarker for the OS (HR [95% CI] = 1.43 [0.98–2.08], P = .062) in overall EGFR-mutant cohort.
Positive PD-L1 expression indicated a higher incidence of primary resistance, but did not correlate with the PFS or OS of EGFR-TKI therapy. In addition, PD-L1 expression was unlikely a predictive biomarker for prognosis of EGFR-mutant NSCLCs.
Impact of COVID-19 on the surgical volume of general surgery residents as main surgeons in a National Training Program in Costa Rica
Authors: Rivera-Chavarría Jose Pablo , Gutierrez-Lopez Carlos , Castro-Cordero Jose Antonio , Jimenez-Ramirez Gustavo 
Published: August 2021

Abstract
To quantify the impact of coronavirus disease 19 (COVID-19) on the surgical volume of residents’ medical practice in Costa Rica's General Surgery Residency Program.
The COVID-19 pandemic has caused a significant disruption in people's lives. Health systems worldwide have been forced to adapt to the new normal, which has posed a challenge for medical residency programs, especially in the surgical field.
This transversal study includes the surgical records of all residents of the General Surgery program who worked as main surgeons at the Mexico Hospital of the Costa Rican Social Security between December 23, 2019, and June 25, 2020.
As main surgeons, a total of 10 residents performed 291 pre-pandemic surgeries and 241 pandemic surgeries.
When comparing the distribution of procedures performed by residency levels, it is observed that the postgraduate year -2 increased the number of procedures performed during the pandemic period (pre-pandemic 19% vs pandemic 27%, P = .028). There was no statistically significant difference between the pre-pandemic and pandemic periods in the remaining levels.
When comparing the procedures by unit, a statistically significant decrease was observed in the Endocrine-Abdominal Wall Unit (pre-pandemic 18.3% vs pandemic 5.4%, P < .001). Conversely, a statistically significant increase was identified in Surgical Emergencies Unit procedures (40.0% vs post 51.7%, P = .007). No statistically significant differences were observed in the remaining the Units.
The COVID-19 pandemic had no statistically significant effect on surgeries performed by residents of the General Surgery Residency Program as main surgeons in a national training center in Costa Rica. The Department's timely measures and pro-resident attitude were the key reasons for the above results.
Non-resuscitative first aid training and assessment for junior secondary school students
Authors: Cheng Yee Han , Yeung Chi Yeung , Sharma Amar , So Kit Ying , Ko Hiu Fai , Wong Kevin , Lam Paul , Lee Anna 
Published: August 2021

Abstract
School-based first aid interventions can contribute to the number of adults trained in first aid in the community over time but few studies have examined the effectiveness of teaching non-resuscitative first aid on knowledge, attitudes and skills. Currently, there is no consensus on the optimal content and duration of first aid training for junior secondary students. The aim of this study was to evaluated the effectiveness of a 2.5 hour introductory non-resuscitative first aid course for junior secondary students.
This prospective, single-centre, pre-post study included 140 students (11–13 years old). Students completed a questionnaire on first aid knowledge, attitude towards first aid and self-confidence to perform first aid before and after a training session. Six emergency medicine physicians taught practical first aid skills training. A game-based formative assessment was undertaken where the instructors assessed small teams of students’ role-playing injured classmates and first aid responders (and vice-versa) treating abrasions, ankle sprain, choking and a scald injury.
Few students had prior first aid training (14%). After adjusting for student's age, sex, prior first aid training and format delivery, the course was associated with increased mean knowledge score (pre-training 53%, post-training 88%; mean difference [MD] 35%, 95% CI: 32% to 38%), positive attitudes and more confidence in performing first aid after training (all P < .001). All teams showed a good level of competency in treating simulated injuries with first aid kits.
This brief non-resuscitative first aid course was associated with noticeable and valuable changes in knowledge score and self-confidence level in performing first aid. The game-based formative assessment facilitated a positive learning environment for skill competency evaluation.
Palliation of malignant dysphagia with a segmented self-expanding metal stent
Authors: Wiese Marie-Sophie , Dratsch Thomas , Plum Patrick Sven , Lorenz Florian , Rieck Isabel , Pinto dos Santos Daniel , Alakus Hakan , Bludau Marc , Kleinert Robert , Goeser Tobias , Bruns Christiane Josephine , Chon Seung-Hun 
Published: August 2021

Abstract
Self-expanding metal stents (SEMSs) in different geometric shapes are an established palliative treatment for malignant tumors of the esophagus. Mechanical properties and stent design have an impact on patient comfort, migration rate, and removability. SEMS with a segmented design (segSEMS) have recently become available on the market, promising new biomechanical properties for stent placement in benign and malignant esophageal diseases. In this study, we evaluated recurrent dysphagia, quality of life as well as technical success and complications for segmented SEMS-implantation in a retrospective study in palliative patients with dysphagia caused by malignant tumors of the esophagus.
Between May 2017 and December 2018, patients presented to the interdisciplinary department of endoscopy of the University Hospital Cologne underwent segmented SEMS placement for malignant dysphagia. Patient follow-up was evaluated, and complications were monitored. Quality of life and functional improvement were monitored using the EORTC QLQ-C30 and QLQ-OE18.
A total of 20 consecutive patients (16 men, 4 women; mean age: 65.5, range: 46–82) participated in the study and were treated with 20 segSEMS in total. The success rate of stent placement was 100%. Stent migration occurred in 3 patients (15.0%). Insertion of segSEMS immediately lead to a 48.0% reduction of dysphagia in the first 2 months (P < .001). Pain while eating (odynophagia) could also be significantly reduced by 39.6% over the first 2 months (P < .001).
Implantation of segSEMS is a feasible and effective treatment for dysphagia in palliative patients with malignant tumors of the esophagus, offering immediate relief of symptoms and gain of physical functions.
Endoscopy within 7 days after detecting high calprotectin levels can be useful for therapeutic decision-making in ulcerative colitis
Authors: Yong Ho Min , Park Sung-Jo , Jeon Seong Ran , Park Heesu , Kim Hyun Gun , Lee Tae Hee , Park Junseok , Kim Jin-Oh , Lee Joon Seong , Ko Bong Min , Goong Hyeon Jeong , Park Suyeon 
Published: August 2021

Abstract
The aim of this study was to assess the appropriate time interval to identify the association between the fecal calprotectin (FC) test and endoscopic activity, and to evaluate whether the time interval affects the therapeutic plan adjustment in patients with ulcerative colitis (UC).
This study included 103 patients who underwent FC tests and endoscopic examinations within the past three months. The FC test results classified cases into three groups as follows: moderate to severe (>200, >250, or >300 μg/g), mild (100–200, 100–250, or 100–300 μg/g), and inactive (<100 μg/g) activity. The Mayo endoscopic subscore was used to determine endoscopic activity. Therapeutic plan adjustment included the addition or increased dosage of anti-inflammatory drugs, steroids, immunomodulators, and biologics.
Using the cutoff value for FC of 200 μg/g, the appropriate time interval for dividing the association and non-association between Mayo endoscopic subscore and FC was 7 days (sensitivity, 74.4%; specificity, 50.0%; area under the curve [AUC], 0.6032). When using FC 250 or 300 μg/g, the appropriate time interval was 5.5 days, with a sensitivity of 71.7% and specificity of 49.1 (AUC 0.5862) in FC 250 μg/g, a sensitivity of 69.6%, and a specificity of 47.4 (AUC 0.5549) for FC 300 μg/g. Therapeutic plans changed in 29.1% of patients. In patients with shorter intervals (≤7 days) between the FC test and endoscopy, significant therapeutic plan adjustments were observed in patients with UC (36.5% vs. 17.5%, P = .047).
Although the need for endoscopy within 7 days after detecting high FC (≥ 200 μg/g) was not statistically supported, endoscopy within a shorter interval (≤7 days) in UC patients with high FC can help determine the therapeutic plan.
Critical Success Factors for Addressing Discharge Inefficiency at a Large Academic Medical Center
Authors: Feldman Sue S. , Kennedy Kierstin Cates , Nafziger Sarah M. , Orewa Gregory N. , Kpomblekou-Ademawou Enyonam , Hearld Kristine Ria , Hall Allyson G. 
Published: August 2021

Background:
Delayed discharges can be a systemic issue. Understanding the systemic factors that contribute to discharge inefficiencies is essential to addressing discharge inefficiencies.

Purpose:
This article reports on a Lean Six Sigma approach and the process to identifying inefficiencies and systemic barriers to early discharge in a large US academic medical center.

Methods:
A qualitative methodology guided this project. In particular, direct observation methods were used to help the project team identify factors contributing to discharge inefficiencies.

Results:
Overall, findings suggest that establishing consistent multidisciplinary team communication processes was a contributing factor to reducing the inefficiencies around discharges. On a more granular level, key barriers included disparate communication systems, disruptors (specifically Kaizen bursts), and unique role challenges.

Conclusions:
This article provides a framework for addressing discharge inefficiencies. Because the output of the process, a critical contributor to the overall outcome, is often not analyzed, this analysis provides value to others contemplating the same or similar process toward discharge efficiency.
A Governance Framework to Integrate Longitudinal Clinical and Community Data in a Distributed Data Network: The Childhood Obesity Data Initiative
Authors: Kraus Emily M. , Scott Kenneth A. , Zucker Rachel , Heisey-Grove Dawn , King Raymond J. , Carton Thomas W. , Daley Matthew F. , Deakyne Davies Sara J. , Block Jason P. , Haemer Matthew , Goodman Alyson B. , Garrett Nedra , Davidson Arthur J. 
Published: August 2021

Context:
Integrating longitudinal data from community-based organizations (eg, physical activity programs) with electronic health record information can improve capacity for childhood obesity research.

Objective:
A governance framework that protects individual privacy, accommodates organizational data stewardship requirements, and complies with laws and regulations was developed and implemented to support the harmonization of data from disparate clinical and community information systems.

Participants and Setting:
Through the Childhood Obesity Data Initiative (CODI), 5 Colorado-based organizations collaborated to expand an existing distributed health data network (DHDN) to include community-generated data and assemble longitudinal patient records for research.

Design:
A governance work group expanded an existing DHDN governance infrastructure with CODI-specific data use and exchange policies and procedures that were codified in a governance plan and a delegated-authority, multiparty, reciprocal agreement.

Results:
A CODI governance work group met from January 2019 to March 2020 to conceive an approach, develop documentation, and coordinate activities. Governance requirements were synthesized from the CODI use case, and a customized governance approach was constructed to address governance gaps in record linkage, a procedure to request data, and harmonizing community and clinical data. A Master Sharing and Use Agreement (MSUA) and Memorandum of Understanding were drafted and executed to support creation of linked longitudinal records of clinical- and community-derived childhood obesity data. Furthermore, a multiparty infrastructure protocol was approved by the local institutional review board (IRB) to expedite future CODI research by simplifying IRB research applications.

Conclusion:
CODI implemented a clinical-community governance strategy that built trust between organizations and allowed efficient data exchange within a DHDN. A thorough discovery process allowed CODI stakeholders to assess governance capacity and reveal regulatory and organizational obstacles so that the governance infrastructure could effectively leverage existing knowledge and address challenges. The MSUA and complementary governance documents can inform similar efforts.
The Childhood Obesity Data Initiative: A Case Study in Implementing Clinical-Community Infrastructure Enhancements to Support Health Services Research and Public Health
Authors: King Raymond J. , Heisey-Grove Dawn M. , Garrett Nedra , Scott Kenneth A. , Daley Matthew F. , Haemer Matthew A. , Podila Pradeep , Block Jason P. , Carton Tom , Gregorowicz Andrew J. , Mork K. Peter , Porter Renee M. , Chudnov Daniel L. , Jellison Jim , Kraus Emily M. , Harrison Megan R. , Sucosky Marissa Scalia , Armstrong Sarah , Goodman Alyson B. 
Published: August 2021

Context:
We describe a participatory framework that enhanced and implemented innovative changes to an existing distributed health data network (DHDN) infrastructure to support linkage across sectors and systems. Our processes and lessons learned provide a potential framework for other multidisciplinary infrastructure development projects that engage in a participatory decision-making process.

Program:
The Childhood Obesity Data Initiative (CODI) provides a potential framework for local and national stakeholders with public health, clinical, health services research, community intervention, and information technology expertise to collaboratively develop a DHDN infrastructure that enhances data capacity for patient-centered outcomes research and public health surveillance. CODI utilizes a participatory approach to guide decision making among clinical and community partners.

Implementation:
CODI's multidisciplinary group of public health and clinical scientists and information technology experts collectively defined key components of CODI's infrastructure and selected and enhanced existing tools and data models. We conducted a pilot implementation with 3 health care systems and 2 community partners in the greater Denver Metro Area during 2018-2020.

Evaluation:
We developed an evaluation plan based primarily on the Good Evaluation Practice in Health Informatics guideline. An independent third party implemented the evaluation plan for the CODI development phase by conducting interviews to identify lessons learned from the participatory decision-making processes.

Discussion:
We demonstrate the feasibility of rapid innovation based upon an iterative and collaborative process and existing infrastructure. Collaborative engagement of stakeholders early and iteratively was critical to ensure a common understanding of the research and project objectives, current state of technological capacity, intended use, and the desired future state of CODI architecture. Integration of community partners' data with clinical data may require the use of a trusted third party's infrastructure. Lessons learned from our process may help others develop or improve similar DHDNs.
Sociodemographic Correlates of Self-reported Discrimination in HIV Health Care Settings Among Persons With Diagnosed HIV in the United States, Medical Monitoring Project, 2018–2019
Authors: McCree Donna Hubbard , Beer Linda , Jeffries William L. , Tie Yunfeng , Fagan Jennifer , Crim Stacy M. 
Published: August 2021

Background:
HIV-related discrimination in health care settings is associated with negative health outcomes among persons with HIV (PWH). This article describes and compares differences in the prevalence of self-reported experiences with discrimination in health care settings by sociodemographic and clinical care factors among persons with diagnosed HIV in the United States.

Methods:
We analyzed interview and medical record data collected during June 2018–May 2019 from 3850 PWH who had received HIV care in the past 12 months. We calculated weighted percentages and associated 95% confidence intervals and assessed the association between any experience of discrimination and selected sociodemographic and clinical characteristics using prevalence ratios with predicted marginal means.

Results:
Approximately 25% of PWH who had an HIV care visit in the past 12 months reported experiencing any discrimination. Experiences with discrimination were significantly more prevalent among persons aged 18–29 years (34%); transgender persons (41%); persons of gay (25%), bisexual (31%), or other (40%) sexual orientations; and persons who did not have a regular provider (39%), lived at/below poverty level (28%), were homeless (39%) or incarcerated (37%) in the past 12 months. PWH who experienced discrimination were more likely to have missed at least one HIV care visit, not be taking antiretroviral therapy, and have missed antiretroviral therapy doses. Recent and sustained viral suppression were not significantly associated with experiencing any discrimination.

Conclusions:
Interventions that address the sociocultural and structural factors associated with discrimination in all health care settings are needed to improve health outcomes among PWH and end the HIV epidemic in the United States.