bluuebunny/crossref_metadata_2025_split huggingface dataset:
Opting into the Public List of DATA-Waivered Practitioners: Variations by Specialty, Treatment Capacity, and Practitioner Characteristics
Authors: Nguyen Thuy , Andraka-Christou Barbara , Bradford W. David , Simon Kosali 
Published: October 2021

Objectives
Although increased access to buprenorphine treatment for opioid use disorder is a central policy objective in addressing the US opioid overdose crisis, insufficient capacity for buprenorphine treatment exists relative to treatment need. Little is known about the characteristics of practitioners who opt into the public listing, an online list of Drug Addiction Treatment Act (DATA)-waivered practitioners provided by the US government, as compared to those who do not. In this cross-sectional study, we examined the association of public listing with practitioner demographic data, specialty, and treatment capacity.

Methods
We combined comprehensive prescriber databases including the National Plan and Provider Enumeration System, data on DATA-waivered practitioners, and an online list waivered practitioners in January 2020 using matching algorithms. We used nonadjusted group mean comparisons and multivariate logistic regressions for the statistical analyses of 60,113 US DATA-waivered practitioners.

Results
Publicly listed waivered practitioners tended to have higher patient limits than non-listed practitioners. The proportions of psychiatrists among publicly listed practitioners were significantly lower than those of non-listed practitioners (6.6%, P < 0.001). Nonphysician prescribers, rural practitioners, male practitioners, and practitioners with fewer years of practice are overrepresented among publicly listed waivered practitioners.

Conclusions
As it is easier for patients to find buprenorphine treatment providers who are on this list, the list serves to expand buprenorphine utilization. SAMHSA should encourage providers to opt into the public list, focusing on psychiatrists and prescribers with lower patient limits, consider requiring inclusion in the list, or make inclusion an “opt out” rather than an “opt in” decision.
Preparing Neonatal Nurses for Improved Performance, Professional Development, and National Certification Through Simulation
Authors: Zebreski Laura , Bloodgood Katherine , Wyble Kimberlee 
Published: October 2021

Background:
Code and emergent situations require skilled nursing response wherever they occur. Nurse preparation for code response is an ongoing need in nursing education. The Neonatal Intensive Care Unit (NICU) at Parkland Health and Hospital System in Dallas, Texas, has a team of 3 nurse educators. These educators determined the need for increased nurse confidence, skill, and response in code and emergent situations within the NICU. The education team also recognized the need to increase nurse involvement in professional development activities and preparation for the national certification examination.

Purpose:
The purpose of this article is to describe how a NICU education team, in a level III NICU, trained nurses using simulated scenarios to improve nursing knowledge for national certification, skill, and confidence in code situations and to provide ongoing professional development opportunities within a controlled learning environment.

Methods:
The intervention designed to meet these specific goals for the NICU was the creation of a simulation team (called the “Drill Team”) to facilitate simulated activities created by the NICU education team. This simulation strategy was found to have multiple advantages for content delivery, as multiple learning styles can be incorporated into the simulated activities.

Findings:
Nurses demonstrated improved performance, knowledge acquisition, and knowledge retention after the Drill Team project. Nursing confidence in code performance also increased using this intervention.

Implications for Practice:
This educational intervention can be replicated and utilized in nursing education for all specialties.

Implications for Research:
Further research could be conducted to determine the effectiveness of simulated activities and national certification pass rates.
Lumbar Paraspinal Compartment Syndrome
Authors: Ilyas Haariss , Fagan Claire , Roser Florian , Hebela Nader M. 
Published: October 2021

Background:
Lumbar compartment syndrome is a recognized clinical phenomenon, despite receiving less attention as a clinical entity. Given its rarity, the definitive presentation, diagnosis, and management strategies are not completely agreed upon.

Materials and Methods:
A literature search on PubMed of all case reports of lumbar paraspinal compartment syndromes was conducted. All case reports and reviews were analyzed for patient demographic data, presentation, diagnostic evaluation, treatment, and clinical follow-up.

Results:
A total of 37 cases of lumbar compartment syndrome were identified. Overall, 91.9% occurred in men with an average age of 30.9 years. Weightlifting (n=18, 48.6%) and physical exertion (n=7, 18.9%) accounted for the majority of presentations. In all, 37.8% of cases occurred unilaterally. Creatinine kinase, aspartate aminotransferase, and alanine aminotransferase were notably elevated. Compartment pressure was elevated with an average of 91.8 mm Hg (SD: 44.8 mm Hg). Twenty-two cases were treated operatively (59.5%) and 15 (40.5%) were treated nonoperatively. In total, 19/20 (95.0%) of cases treated operatively reported either resolution of pain or return to baseline activities without limitation, compared with 1/11 (9.1%) treated nonoperatively. This difference between the operative and nonoperative cohort was statistically significant (P<0.0001).

Conclusions:
Lumbar paraspinal compartment syndrome is a rare, but well-documented clinical entity. In all, 67.5% of cases occurred after weightlifting or physical exertion. Overall, 40.5% of cases in the literature were treated nonoperatively. Per our analysis, there is a clinically and statistically significant difference in cases treated operatively versus nonoperatively (95.0% vs. 9.1%, P<0.0001).
Novel Hemorrhagic Risk Score in Elderly Patients with Coronary Artery Disease and Gastrointestinal Malignant Tumor Comorbidity: A 10-year Clinical Inpatient Data Analysis from 2 Medical Centers
Authors: Bao Nandi , Wang Wanling , Wu Huitao , Wang Yabin , Che Hebin , Meng Wenwen , Miao Jiaxin , Han Dong , Yin Fan 
Published: October 2021

Abstract

Objective:
Older patients with comorbidity, such as coronary heart disease (CHD) and malignant gastrointestinal tumors, are at a high risk of bleeding events. However, risk prediction models based on risk factor assessment remain unclear. This study aimed to establish an individualized bleeding risk assessment system based on the analysis of 10-year inpatient clinical big data.

Methods:
Total clinical data of 56,819 patients with CHD and 25,988 patients with malignant digestive tract tumors (admitted from January 2008 to December 2017) were retrospectively collected at the First and Second Medical Centers of Chinese People's Liberation Army General Hospital. Among them, 1307 patients with CHD and malignant digestive tract tumors were screened as the derivation cohort. The dependent variable was the occurrence of major clinical bleeding events. Baseline statistics and hypothesis tests of differences were performed for independent variables according to the occurrence of bleeding. Decision Tree, eXtreme Gradient Boosting (XGBoost), logistic regression, and random forest models were used for comparison. The accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC-ROC) were applied as the criteria for evaluating and verifying model performance. To evaluate this developed model, another cohort comprising 454 patients (admitted from January 2018 to December 2019) was prospectively enrolled as the validation cohort based on the same inclusion and exclusion criteria.

Results:
Among the 64 variables with <50% missing values, the recursive feature elimination method with a random forest model was used to screen the selected variables. The highest accuracy was obtained following the selection of 10 scalars, and the final model was constructed accordingly. XGBoost demonstrated the best performance comprehensively. The AUC-ROC of this model was 0.981, with an accuracy, sensitivity, and specificity of 0.939, 0.950, and 0.927, respectively. In the validation cohort, the AUC-ROC, accuracy, sensitivity, and specificity of the XGBoost model were 0.702, 0.718, 0.636, and 0.725, respectively. The rate of major bleeding events has a positive correlation with the bleeding risk score quintiles. To allow for convenient clinical application, a smartphone application was developed for easy access and calculation (http://fir.master-wx.com/sghr).

Conclusion:
We successfully established a risk model and score for predicting bleeding events in older patients with comorbidity, such as CHD and gastrointestinal cancer.
Cutaneous paraneoplastic presentation of colon cancer in a patient with history of ureterosigmoidostomy
Authors: Swindle Mike , Fernstrum Austin , Sharma Timmie , Mishra Kirtishri , Bukavina Laura , Prunty Megan , Bodner Donald 
Published: October 2021

Abstract
Ureterosigmoidostomy was commonly utilized as a procedure for continent urinary diversion. However, ureterosigmoidostomy is associated with complications such as infection, electrolyte disturbances, and neoplasia development. A 40-year-old Caucasian male presented with acute left flank pain. Past medical history was significant for bladder exstrophy for which ureterosigmoidostomy urinary diversion was performed during childhood. On physical exam, multiple circular erythematous patches were scattered across the forearms that had been presented for 2 years. Cross-sectional imaging demonnttated an ill-defined mass at the site of ureteral implantation with associated severe left hydroureteronephrosis. Endoscopy revealed a mass at the site of ureteral implantation and biopsy demonstrated invasive, poorly differentiated adenocarcinoma. The dermatosis was diagnosed as interstitial granulomatous dermatitis, a rare inflammatory skin condition associated with underlying autoimmune disease or malignancy. Patient elected operative management with left nephrectomy, sigmoidectomy, and ileal conduit diversion. Ihis case demonnttates a rare presentation of cutaneous paraneoplastic syndrome after development of colon cancer after ureterosigmoidostomy. Ureterooolonic urinary diversion has a demonnttaaie risk of neoplasia development at the anastomotic site, requiring routine endoscopic surveillance.
Cardiometabolic Consequences of Targeted Anticancer Therapies
Authors: Guha Avirup , Gong Yan , DeRemer David , Owusu-Guha Jocelyn , Dent Susan F. , Cheng Richard K. , Weintraub Neal L. , Agarwal Neeraj , Fradley Michael G. 
Published: October 2021

Abstract:
Cardiometabolic disease (CMD) is the most common preventable cause of death in the world. A number of components are included in the spectrum of CMD, such as metabolic syndrome/obesity, hyperglycemia/diabetes, dyslipidemia, and hypertension, which are independently associated with cardiovascular disease risk. These conditions often occur together, and patients with cancer frequently undergo treatments that can generate or worsen CMD. This review highlights and presents mechanistic and epidemiological evidence regarding CMD in 4 categories of anticancer medications, namely, mTOR/PI3K-Akt inhibitors, multitargeted tyrosine kinase inhibitor, immune checkpoint inhibitor therapy, and endocrine therapy. Patients taking these medications need careful monitoring during therapy. There is a role for cardio-oncology and onco-primary care specialists in optimally managing patients at risk to mitigate CMD during treatment with these and other investigational anticancer medications.
A Role for Peroxisome Proliferator-Activated Receptor Gamma Agonists in Counteracting the Degeneration of Cardiovascular Grafts
Authors: Assmann Anna Kathrin , Goschmer Daniel , Sugimura Yukiharu , Chekhoeva Agunda , Barth Mareike , Assmann Alexander , Lichtenberg Artur , Akhyari Payam 
Published: October 2021

Abstract:
Aortic valve replacement for severe stenosis is a standard procedure in cardiovascular medicine. However, the use of biological prostheses has limitations especially in young patients because of calcifying degeneration, resulting in implant failure. Pioglitazone, a peroxisome proliferator-activated receptor gamma (PPAR-gamma) agonist, was shown to decrease the degeneration of native aortic valves. In this study, we aim to examine the impact of pioglitazone on inflammation and calcification of aortic valve conduits (AoC) in a rat model. Cryopreserved AoC (n = 40) were infrarenally implanted into Wistar rats treated with pioglitazone (75 mg/kg chow; n = 20, PIO) or untreated (n = 20, controls). After 4 or 12 weeks, AoC were explanted and analyzed by histology, immunohistology, and polymerase chain reaction. Pioglitazone significantly decreased the expression of inflammatory markers and reduced the macrophage-mediated inflammation in PIO compared with controls after 4 (P = 0.03) and 12 weeks (P = 0.012). Chondrogenic transformation was significantly decreased in PIO after 12 weeks (P = 0.001). Calcification of the intima and media was significantly reduced after 12 weeks in PIO versus controls (intima: P = 0.008; media: P = 0.025). Moreover, echocardiography revealed significantly better functional outcome of the AoC in PIO after 12 weeks compared with control. Interestingly, significantly increased intima hyperplasia could be observed in PIO compared with controls after 12 weeks (P = 0.017). Systemic PPAR-gamma activation prevents inflammation as well as intima and media calcification in AoC and seems to inhibit functional impairment of the implanted aortic valve. To further elucidate the therapeutic role of PPAR-gamma regulation for graft durability, translational studies and long-term follow-up data should be striven for.
Stratification Analysis of Statin Effect on Major Adverse Cardiac Events After Percutaneous Coronary Intervention in Patients on Hemodialysis
Authors: Horikoshi Takeo , Nakamura Takamitsu , Yoshizaki Toru , Nakamura Jun , Makino Aritaka , Saito Yukio , Obata Jun-ei , Sawanobori Takao , Takano Hajime , Umetani Ken , Watanabe Akinori , Asakawa Tetsuya , Kugiyama Kiyotaka 
Published: October 2021

Abstract:
The statin use in patients on hemodialysis remains controversial, and no beneficial effects of statin on the reduction of adverse cardiovascular events have been reported in these patients. This study used stratification analysis to examine the clinical factors in patients on hemodialysis who could benefit from statin for secondary prevention. This prospective multicenter study included 234 consecutive patients on hemodialysis with coronary artery disease who underwent successful reperfusion therapy with percutaneous coronary intervention. The patients were followed up for up to 3 years or until the occurrence of major adverse cardiac events (MACEs; defined as a composite of all-cause death and nonfatal myocardial infarction). Inverse probability of treatment weighting adjustment was used to remove the selection bias. During the median follow-up period of 30 months, MACEs occurred in 55 patients. Patients with MACEs had significantly lower statin therapy (P < 0.001). Multivariable Cox proportional hazards analysis showed that the patients on statins had a significantly reduced rate of MACE occurrence [adjusted hazard ratio 0.30 (0.11–0.81), P = 0.02]. The stratification analysis of outcomes according to the presence of clinical factors showed that beneficial effects of statin were associated with man, elderly, lower body mass index, lower abdominal circumference, hypertension, diabetes, higher C-reactive protein, symptomatic heart failure, lower left ventricular function, nonacute coronary syndrome, and shorter stent length. Statin was effective for the prevention of MACEs in patients on hemodialysis who underwent percutaneous coronary intervention. We identified specific clinical factors affecting statin effectiveness for secondary prevention.
Considerations for Inotrope and Vasopressor Use in Critically Ill Patients With Pulmonary Arterial Hypertension
Authors: Adie Sarah K. , Abdul-Aziz Ahmad A. , Ketcham Scott W. , Moles Victor M. 
Published: October 2021

Abstract:
Pulmonary arterial hypertension (PAH) is a rare and progressive cardiopulmonary disease, characterized by pulmonary vasculopathy. The disease can lead to increase pulmonary arterial pressures and eventual right ventricle failure due to elevated afterload. The prevalence of PAH in patients admitted to the intensive care unit (ICU) is unknown, and pulmonary hypertension (PH) in the ICU is more commonly the result of left heart disease or hypoxic lung injury (PH due to left heart disease and PH due to lung diseases and/or hypoxia, respectively), as opposed to PAH. Management of patients with PAH in the ICU is complex as it requires a careful balance to maintain perfusion while optimizing right-sided heart function. A comprehensive understanding of the underlying physiology and underlying hemodynamics is crucial for the management of this population. In this review, we summarized the evidence for use of vasopressors and inotropes in the management of PH and extrapolated the data to patients with PAH. We strongly believe that the understanding of the hemodynamic consequences of inotropes and vasopressors, especially from data in the PH population, can lead to better management of this complex patient population.
Ovariectomy Reduces Vasocontractile Responses of Rat Middle Cerebral Arteries After Focal Cerebral Ischemia
Authors: Rehnström Mimmi , Ahnstedt Hilda , Krause Diana N. , Edvinsson Marie Louise , Haanes Kristian Agmund , Edvinsson Lars 
Published: October 2021

Abstract:
Effects of sex hormones on stroke outcome are not fully understood. A deleterious consequence of cerebral ischemia is upregulation of vasoconstrictor receptors in cerebral arteries that exacerbate stroke injury. Here, we tested the hypothesis that female sex hormones alter vasocontractile responses after experimental stroke in vivo or after organ culture in vitro, a model of vasocontractile receptor upregulation. Female rats with intact ovaries and ovariectomized (OVX) females treated with 17β-estradiol, progesterone, or placebo were subjected to transient, unilateral middle cerebral artery occlusion followed by reperfusion (I/R). The maximum contractile response, measured my wire myography, in response to the endothelin B receptor agonist sarafotoxin 6c was increased in female arteries after I/R, but the maximum response was significantly lower in arteries from OVX females. Maximum contraction mediated by the serotonin agonist 5-carboxamidotryptamine was diminished after I/R, with arteries from OVX females showing a greater decrease in maximum contractile response. Contraction elicited by angiotensin II was similar in all arteries. Neither estrogen nor progesterone treatment of OVX females affected I/R-induced changes in endothelin B– and 5-carboxamidotryptamine–induced vasocontraction. These findings suggest that sex hormones do not directly influence vasocontractile alterations that occur after ischemic stroke; however, loss of ovarian function does impact this process.
Validity and reliability of 1-h automated office blood pressure measurement for the diagnosis of hypertension
Authors: Sisó-Almirall Antoni , Kostov Belchin , Blat Esther , García Noemí , de Andres Berta , Roura Silvia , Sierra-Benito Cristina , Alvira-Balada Maria C. , Colungo Cristina , Benavent-Àreu Jaume , González-de Paz Luis 
Published: October 2021

Aims:
The objective of this study was to examine the validity of 1 h automated office blood pressure measurement for the diagnosis of hypertension.

Methods:
We included patients requiring a hypertension diagnostic test. Participants underwent ambulatory blood pressure monitoring, 1 h automated office blood pressure measurement, office blood pressure measurement and home blood pressure monitoring. The prevalence of hypertension and subtypes were calculated. Mean values of ambulatory blood pressure monitoring were compared with 1 h automated office blood pressure measurement using the correlation coefficient and Bland–Altman graphs. The Kappa concordance index, sensitivity, specificity and diagnostic accuracy were calculated, and the area under the receiver operating characteristic curve was used to establish the diagnostic threshold of the 1-h measurement.

Results:
Of 562 participants, 438 (87.6%) completed the four diagnostic methods. The 1-h method had a sensitivity of 76.6 [95% confidence interval (95% CI): 71.1–81.5], a specificity of 64.8% (95% CI: 57–72.1) and the best diagnostic accuracy (72.1%, 95% CI: 67.7–76.3) compared with the office and home measurements. Moderate-high correlations were observed between DBP (r = 0.73) and SBP (r = 0.58) readings. The 1-h method classified more patients as normotensive (24.4%) and fewer patients with white-coat hypertension (13.3%). A diagnostic threshold of at least 133/83 mmHg for the 1-h method could improve diagnostic accuracy by 2.3%.

Conclusion:
One-hour automated blood pressure measurement is a valid, reliable method for the diagnosis of hypertension in undiagnosed patients. The diagnostic accuracy permits detection of white-coat and masked hypertension. To diagnose hypertension, the 1-h method or conventional home blood pressure monitoring should be used rather than office measurements.

Trial registration:
ClinicalTrials.gov Identifier: NCT03147573.
Compliance with telephone-based lifestyle weight loss programs improves low back pain but not knee pain outcomes: complier average causal effects analyses of 2 randomised trials
Authors: Robson Emma , Kamper Steven J. , Lee Hopin , Palazzi Kerrin , O'Brien Kate M. , Williams Amanda , Hodder Rebecca K. , Williams Christopher M. 
Published: October 2021

Abstract
We conducted a complier average causal effect (CACE) analyses for 2 pragmatic randomised controlled trials. We aimed to assess the effectiveness of telephone-based lifestyle weight loss interventions compared with usual care among compliers. Participants from 2 trials with low back pain (n = 160) and knee osteoarthritis (n = 120) with a body mass index ≥27 kg/m2 were included. We defined adherence to the telephone-based lifestyle weight loss program as completing 60% (6 from 10) of telephone health coaching calls. The primary outcomes for CACE analyses were pain intensity (0-10 Numerical Rating Scale) and disability (Roland Morris Disability Questionnaire for low back pain and Western Ontario and McMaster Universities Osteoarthritis Index for knee osteoarthritis). Secondary outcomes were weight, physical activity, and diet. We used an instrumental variable approach to estimate CACE in compliers. From the intervention groups of the trials, 29% of those with low back pain (n = 23/80) and 34% of those with knee osteoarthritis (n = 20/60) complied. Complier average causal effect estimates showed potentially clinically meaningful effects, but with low certainty because of wide confidence intervals, for pain intensity (−1.4; 95% confidence interval, −3.1, 0.4) and small but also uncertain effects for disability (−2.1; 95% confidence interval, −8.6, 4.5) among compliers in the low back pain trial intervention compared with control but not in the knee osteoarthritis trial. Our findings showed that compliers of a telephone-based weight loss intervention in the low back pain trial generally had improved outcomes; however, there were inconsistent effects in compliers from the knee osteoarthritis trial. Complier average causal effect estimates were larger than intention-to-treat results but must be considered with caution.