bluuebunny/crossref_metadata_2025_split huggingface dataset:
When to Say When—Reasons to Abort Surgery for Congenital Aural Atresia
Authors: Casazza Geoffrey C. , Kesser Bradley W. 
Published: February 2021

Objective:
To determine reasons for premature termination in surgery for congenital aural atresia (CAA).

Study Design:
Retrospective chart review.

Setting:
High-volume tertiary care center.

Patients:
Patients undergoing primary surgical repair of CAA whose surgeries were aborted for various indications.

Intervention:
Patients with CAA who underwent elective aural atresia surgery at the University of Virginia from July 2004 to January 2020 were identified from the medical record and an institutional database of patients with CAA. Patients undergoing revision surgery or surgery not for hearing correction were excluded. All included candidates were noted to be good surgical candidates for atresia repair based on preoperative Jahrsdoerfer score of 6 or greater. Reasons for terminating surgery prematurely were categorized by anatomical constraints (inability to identify middle ear space, position of the facial nerve, or other anatomic abnormality), stapes fixation, and middle ear and/or mastoid inflammatory disease.

Main Outcome Measures:
Reasons for premature termination in CAA surgery.

Results:
Over the interval, 319 patients underwent primary surgery for CAA. Surgery was terminated prematurely without completing the primary objective in 14 patients (4.4%); surgery was terminated in 8 (57%) due to anatomic constraints, 4 (29%) due to stapes fixation, and 2 (14%) due to middle ear space and/or mastoid inflammatory disease.

Conclusions:
Premature termination in surgery for CAA is a rare occurrence with careful study of the preoperative high-resolution computed tomography of the temporal bone. Of the reasons for premature termination, anatomic constraints were the most common. Knowing limitations in surgery—both technical and anatomic—is critical to optimize outcomes and prevent complications.
Otologic Manifestations of Eosinophilic Granulomatosis With Polyangiitis: A Systematic Review
Authors: Ashman Peter E. , Chen Tiffany , Barinsky Gregory L. , Benson Brian , Babu Seilesh , Bojrab Dennis I. , Svider Peter F. 
Published: February 2021

Objective:
To perform a systematic review of the diagnosis, treatment, and management of patients with otologic manifestations of eosinophilic granulomatosis with polyangiitis.

Databases Reviewed:
PubMed, Embase, Cochrane.

Methods:
A systematic search for relevant published literature in PubMed, Cochrane Library, and EMBASE databases was done. Data was collected on demographics, otologic manifestations, specific diagnostic criteria fulfilled, common clinical, and imaging findings as well as medical and surgical treatments received.

Results:
Fifteen articles encompassing 219 patients met inclusion criteria including 8 case reports and 7 case series. The mean age was 52.8 (range of 24–70). The most common otologic presenting symptoms were hearing loss (76%), otitis media with effusion (44%), vertigo (22%), tinnitus (21%), and chronic otitis media (20%). The most common diagnostic criteria observed in these patients were paranasal sinus abnormalities (75%), asthma (66%), and eosinophilia >10% (44%). The most common treatment was systemic steroids (66%), followed by surgery (52%), with myringotomy with tube insertion (M&T) (32%) and endoscopic sinus surgery (21%) being the most prevalent. Thirty-four percent of patients received an immunosuppressive agent. Successful treatments included systemic steroids (23%), surgical modalities (13%) with M&T being the most common (7%), topical nasal steroids (12%), and cyclophosphamide (10%).

Conclusion:
Hearing loss and a middle ear effusion are the most common presenting otologic manifestations of eosinophilic granulomatosis with polyangiitis. Sinonasal disease was more prevalent in patients with otologic manifestations. Primary treatment consists of systemic steroids and immunomodulation. M&T, endoscopic sinus surgery, and local steroid administration can be adjunctive measures to alleviate local disease.

Level of Evidence: Level 1
Impact of diabetes mellitus on the relationship between a Poiseuille-based index and fractional flow reserve in intermediate coronary lesions
Authors: Zuo Wenjie , Zhang Xiaoguo , Carvalho Abdlay , Qu Yangyang , Ji Zhenjun , Tao Zaixiao , Ma Genshan 
Published: February 2021

Background
The ratio of lesion length (LL) to the fourth power of minimal lumen diameter (MLD) (LL/MLD4) is a Poiseuille-based index with good diagnostic accuracy for the detection of coronary lesions with abnormal fractional flow reserve (FFR). We aimed to evaluate the impact of diabetes mellitus (DM) on its performance in intermediate coronary stenoses.

Methods
We performed quantitative coronary angiography and simultaneous FFR measurement in 324 patients (234 non-DM and 90 DM) with 335 coronary lesions. The area under the receiver-operating characteristic curve (AUC) for angiographic parameters was determined, using an FFR value ≤0.80 to indicate the physiological significance of coronary stenoses.

Results
In the non-DM group, FFR was significantly related to percent diameter stenosis (%DS) (R = −0.238) and LL/MLD4 ratio (R = −0.301; P < 0.001 for both). In the DM group, there was no correlation between %DS and FFR, whereas a close-to-threshold correlation was observed for the LL/MLD4 ratio (R = −0.205; P = 0.048). The AUC of LL/MLD4 ratio was significantly different between non-diabetic and diabetic subjects (0.738 vs. 0.540; P = 0.024). Moreover, the LL/MLD4 ratio showed higher AUCs than %DS (0.738 vs. 0.635; P = 0.017) and LL (0.738 vs. 0.634; P = 0.024) in non-diabetic population but this superiority did not exist in diabetic population.

Conclusion
We showed good diagnostic accuracy of LL/MLD4 ratio for identifying ischemic lesions in patients without DM. However, there was an impaired performance in diabetic patients and thus FFR measurement is essential to determine their hemodynamic status.
Oral nutritional supplements, physical activity, and sarcopenia in cancer
Authors: Wang Junjie , Tan Shanjun , Wu Guohao 
Published: February 2021

Purpose of review
Sarcopenia is prevalent in cancer patients and can occur as a result of cancer as well as cancer-related therapies. It is related to high postoperative complications, long hospitalization, slow recovery as well as low tolerance to chemotherapy. Patients with sarcopenia also have poor oncological outcomes. Oral nutritional supplements (ONS) and physical activity have shown great potentials in managing this debilitating condition. We summarized the recent developments in the assessment of sarcopenia and its management with ONS and physical activity.

Recent findings
Many methods were developed to evaluate sarcopenia including muscle quality/quantity measurement and functional tests. Recent studies have shown that ONS and physical training can be used in managing sarcopenia, especially when used together as part of a multimodal intervention. However, barriers such as low awareness and lack of training and support for both patients and healthcare workers still exist and need attention.

Summary
Recent findings highlighted the benefits of identifying sarcopenia and managing those at risk. The details of a multimodal protocol, such as components of nutritional substrates, the intensity of physical exercise, and the use of medication need to be further looked into for an optimum approach. Education and training programs need to be developed to overcome the barriers in managing sarcopenia.
Health Equity Beyond Data
Authors: Cruz Taylor M. , Smith Sheridan A. 
Published: February 2021

Background:
Recent research and policy initiatives propose addressing the social determinants of health within clinical settings. One such strategy is the expansion of routine data collection on patient Race, Ethnicity, and Language (REAL) within electronic health records (EHRs). Although previous research has examined the general views of providers and patients on REAL data, few studies consider health care workers’ perceptions of this data collection directly at the point of care, including how workers understand REAL data in relation to health equity.

Objective:
This qualitative study examines a large integrated delivery system’s implementation of REAL data collection, focusing on health care workers’ understanding of REAL and its impact on data’s integration within EHRs.

Results:
Providers, staff, and administrators expressed apprehension over REAL data collection due to the following: (1) disagreement over data’s significance, including the expected purpose of collecting REAL items; (2) perceived barriers to data retrieval, such as the lack of standardization across providers and national tensions over race and immigration; and (3) uncertainty regarding data’s use (clinical decision making vs. system research) and dissemination (with whom the data may be shared; eg, public agencies, other providers, and insurers).

Conclusion:
Emerging racial disparities associated with COVID-19 highlight the high stakes of REAL data collection. However, numerous barriers to health equity remain. Health care workers need greater institutional support for REAL data and related EHR initiatives. Despite data collection’s central importance to policy objectives of disparity reduction, data mandates alone may be insufficient for achieving health equity.
The Effect of Medicare Shared Savings Program on Readmissions and Variations by Race/Ethnicity and Payer Status (December 9, 2020)
Authors: Kim Yeunkyung , Thirukumaran Caroline , Temkin-Greener Helena , Hill Elaine , Holloway Robert , Li Yue 
Published: February 2021

Objective:
Accountable care organizations in the Medicare Shared Savings Program (MSSP) in the United States attempt to reduce cost and improve quality for their patients by improving care coordination across care settings. We examined the impact of hospital participation in the MSSP on 30-day readmissions for several groups of Medicare inpatients, and by race/ethnicity and payer status.

Main Data Source:
A 2010–2016 Medicare Provider Analysis and Review files.

Research Design:
With propensity score matched sample of MSSP and non-MSSP-participating hospitals, patient-level linear probability models with difference-in-differences approach were used to compare the changes in readmission rates for Medicare fee-for-service patients initially admitted for ischemic stroke, hip fracture, or total joint arthroplasty in MSSP-participating hospitals with non-MSSP-participating hospitals as well as to compare the changes in disparities in readmission rates over time.

Principal Findings:
Hospital participation in MSSP was associated with further reduced readmission rate by 1.1 percentage points (95% confidence interval: −0.02 to 0.00, P<0.05) and 1.5 percentage points (95% confidence interval: −0.03 to 0.00, P=0.08) for ischemic stroke and hip fracture cohorts, respectively, compared with non-MSSP-participating hospitals, after the third year of hospital participation in the MSSP. There was no evidence that MSSP had an impact on racial/ethnic disparities, but increased disparity by payer status (dual vs. Medicare-only) was observed. These findings together suggest that MSSP accountable care organizations may take at least 3 years to achieve reduced readmissions and may increase disparities by payer status.
Indications and limits of postoperative radiotherapy for skin malignancies
Authors: Daniels Christopher P. , Liu Howard Y.-h. , Porceddu Sandro V. 
Published: February 2021

Purpose of review
To provide a summary of the current evidence, with a focus on recent publications, pertaining to indications for postoperative radiation therapy for cutaneous squamous-cell carcinoma (cSCC), basal-cell carcinoma, Merkel-cell carcinoma and melanoma of the head and neck.

Recent findings
Meta-analyses in cSCC and Merkel-cell carcinoma have shown an association between postoperative radiation therapy and overall survival. Prospective phase III data in head and neck cSCC has shown excellent locoregional control following surgery and postoperative radiation therapy. The addition of concurrent cytotoxic chemotherapy to postoperative radiation therapy has not improved outcomes in either of these two entities. Postoperative immune checkpoint inhibition or combined BRAF and MEK blockade in stage-III melanoma improves progression-free survival whereas postoperative radiation therapy does not.

Summary
Further improvement in outcomes with high-risk cSCC and Merkel-cell carcinoma might be achieved with concurrent or sequential immune checkpoint inhibition and postoperative radiation therapy. Postoperative radiation therapy for cutaneous melanoma should be reserved for patients in whom novel systemic therapies are not a treatment option.
Bioengineering for head and neck reconstruction: the role of customized flaps
Authors: Gualtieri Tommaso , Taboni Stefano , Ferrari Marco , Gilbert Ralph 
Published: February 2021

Purpose of review
The purpose of this review is to provide the reader with an overview of the present and future applications of bioengineering for head and neck reconstruction, ranging from the application of Computed Assisted Surgery (CAS) to the most recent advances in 3D printing and tissue engineering.

Recent findings
The use of CAS in head and neck reconstruction has been demonstrated to provide shorter surgical times, improved reconstructive accuracy of bone reconstruction, and achieves better alignment of bone segments in osteotomized reconstructions. Beyond its classical application in bone reconstructions, CAS has demonstrated reliability in the planning and harvesting of soft tissue flaps. To date, literature regarding bioengineering for head and neck reconstruction is mainly focused on in-vitro and animal model experiments; however, some pioneering reports on human patients suggest the potential feasibility of this technology.

Summary
Bioengineering is anticipated to play a key role in the future development of customized flaps for head and neck reconstruction. These technologies are particularly appealing as a new technology to address certain unsolved challenges in head and neck reconstruction.
Glucocorticoids Improve Enteral Feeding Tolerance in Pediatric Short Bowel Syndrome With Chronic Intestinal Inflammation
Authors: Wang Fangfang , Gerhardt Brandi K. , Iwansky Sarah N. , Hobson Brandy , Logan Samantha , Mercer David F. , Quiros‐Tejeira Ruben E. 
Published: February 2021

ABSTRACTObjectives:A group of short bowel syndrome (SBS) patients developed chronic intestinal inflammation while struggling weaning off parenteral nutrition (PN). They did not respond to standard management of SBS and food allergy. We treated them with glucocorticoids and described the outcome.Methods:Our study is a retrospective descriptive study. We reviewed records from the intestinal rehabilitation program from 2006 to 2017. We identified 15 patients whose lab values, pathology results, and clinic notes were reviewed.Results:We had more patients (n = 10) with diagnosis of gastroschisis, and more female patients (n = 9). Seven patients weaned off PN with median treatment duration of 5 months, 5 of which remained on budesonide for significant period of time (median: 7.5 months). One of these 7 patients relapsed, as the patient resumed glucocorticoids because of recurrence of chronic intestinal inflammation. Six of 15 children had significant eosinophils in their initial biopsy, 5 of these children weaned off PN whereas 1 child's gastrointestinal (GI) bleeding stopped. Four patients were not able to decrease PN calorie. Two of these patients’ GI bleeding stopped, the other 2 had normalized histology.Conclusions:For SBS children with histologically confirmed chronic intestinal inflammation, glucocorticoids may help promote enteral feeding tolerance. Glucocorticoids regimen should be chosen individually. Patients are more likely to respond if initial histology has significant eosinophilic infiltration. Patients may need to remain on glucocorticoids for over 6 months.
Alternative Diagnoses in Pediatric Fecal Microbiota Transplant Referral Patients
Authors: Ruan Wenly , Kellermayer Richard 
Published: February 2021

ABSTRACT
The incidence of Clostridioides difficile infection (CDI) has been increasing in the United States. About 10–20% recur after initial treatment, with increasing recurrence following subsequent treatment courses. This sequence can lead to recurrent CDI (rCDI), refractory to conventional therapeutics resulting in the most common indication for fecal microbiota transplantation (FMT). FMT is the most effective microbial therapeutic to date and can cure rCDI in 80–90% of cases. There is growing concern, however, for pathogen transmission through FMT, underscoring the importance of careful recipient selection. In adults referred for FMT with a tentative diagnosis of rCDI, alternative diagnoses were recognized in 25% of patients, but such observation in children is lacking. In this single-center retrospective study, alternative diagnoses (eg, constipation/overflow diarrhea, inflammatory bowel disease) were found in 13 (22.4%) of 58 children who were referred for FMT evaluation for rCDI. Of the patients who were diagnosed with rCDI, 16 (27.6%) did not require FMT.
Dubin-Johnson Syndrome as Differential Diagnosis for Neonatal Cholestasis
Authors: Junge Norman , Goldschmidt Imeke , Wiegandt Jessica , Leiskau Christoph , Mutschler Frauke , Laue Tobias , Ohlendorf Johanna , Stalke Amelie , Hartleben Björn , Stindt Jan , Keitel Verena , Baumann Ulrich , Pfister Eva-Doreen 
Published: February 2021

ABSTRACT

Objectives:
Dubin-Johnson syndrome (DJS) is an autosomal recessive disorder in which multidrug-resistance-associated protein 2 (MRP2) deficiency causes an excretion disorder of conjugated bilirubin from hepatocytes into bile canaliculi. Its clinical presentation as neonatal cholestasis (NC) is rare but represents an important differential diagnosis. We aimed to define DJS-specific characteristics in NC, in particular in contrast to biliary atresia (BA) patients, and to highlight diagnostic tools that can help to avoid invasive diagnostic tests.

Methods:
We performed a review of case records from 2006 to 2020 and compared 4 DJS patients to 26 patients with proven BA consecutively diagnosed from 2014 to 2017. DJS was diagnosed by urine coproporphyrin analysis (UCA) and by genetic analysis (GA) for disease-associated ABCC2 variants.

Results:
Four male patients with NC were diagnosed with DJS by UCA and GA. DJS patients presenting as NC showed significantly lower values for aspartate aminotransferase (AST) (P < 0.001), for alanine aminotransferase (ALT) (P = 0.002) and for gamma-glutamyl transferase (GGT) (P < 0.001) compared with BA patients. Other examinations, however, could not clearly discriminate them (e.g.: stool colour, serum bile acids, total serum bilirubin).

Conclusions:
DJS is not only a rare differential diagnosis in NC with a suspicious phenotype (almost normal AST, ALT) but also shows overlapping features with BA. It should, therefore, be considered in every infant with NC and an atypical liver enzyme pattern to protect patients from unnecessary, invasive examinations. For this, UCA is a fast and reliable diagnostic tool. Confirmation based on GA is recommended. DJS patients have a good long-term prognosis.
Post-Heart Transplant Care Pathway's Impact on Reducing Length of Stay
Authors: Guertin Lisa , Earle Melinda , Dardas Todd , Brown Christopher 
Published: February 2021

Background:
Prolonged length of stay (LOS) has undesirable consequences including increased cost, resource consumption, morbidity, and disruptions in hospital flow.

Local Problem:
A high-volume heart transplant center in the Pacific Northwest had a mean index hospital LOS of 23 days, with a goal of 10 days according to the institutional heart transplant care pathway.

Methods:
A retrospective, regression analysis was used to identify the factors contributing to LOS of 41 post-heart transplant patients.

Interventions:
The post-heart transplant care pathway and order set were modified accordingly and reintroduced to the health care team.

Results:
Factors contributing to LOS included number of days (1) until the first therapeutic calcineurin inhibitor level, (2) until intravenous diuretics were no longer required, and (3) outside of a therapeutic calcineurin inhibitor range. The interventions reduced the mean LOS by 8 days.

Conclusions:
Increased awareness of LOS, education, and consistent use of care pathways can significantly reduce length of stay.
Adopting the Fall Tailoring Interventions for Patient Safety (TIPS) Program to Engage Older Adults in Fall Prevention in a Nursing Home
Authors: Tzeng Huey-Ming , Jansen Lynn S. , Okpalauwaekwe Udoka , Khasnabish Srijesa , Andreas Brenda , Dykes Patricia C. 
Published: February 2021

Background:
Falls are the leading cause of injury-related hospitalizations and deaths among older adults globally.

Local problem:
About 24% of Canadian nursing home residents fall annually. This quality improvement project evaluated the impact of the Fall Tailoring Interventions for Patient Safety (TIPS) program on preventing falls and fall-related injuries among older adult nursing home residents in a subacute care unit in Canada.

Methods:
We used the Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines for reporting. The intervention site is a 15-bed subacute care unit within a government-funded nursing home.

Intervention:
The Fall TIPS program was adapted to a nursing home setting to prevent falls. It provides fall prevention clinical decision support at the bedside.

Results:
The rates of falls and injuries decreased after implementing the Fall TIPS intervention.

Conclusion:
Engaging nursing home older adult residents in fall prevention is crucial in translating evidence-based fall prevention care into clinical practice.
Implementing the Clinical Occurrence Reporting and Learning System
Authors: Goh Hongli Sam , Tan Vivian , Chang Jessy , Lee Chen Na , Zhang Hui 
Published: February 2021

Background:
Most incident reporting systems have been questioned for their effectiveness in improving patient safety as they serve as an administrative reporting system.

Local Problem:
The long-term-care sector faced unique challenges, such an aging population and resource constraints, and its current incident reporting systems lack contextualization to address its needs.

Methods:
This quality improvement project was conducted at a 624-bed nursing home in Singapore from January to September 2019, using the Plan-Do-Study-Act methodology.

Intervention:
The existing incident reporting system (known as Clinical Occurrence Reporting and Learning System—CORALS) was redesigned to facilitate double-loop learning and workplace improvement initiatives.

Results:
The results demonstrated significant improvement in nurses' postintervention knowledge and confidence in handling future adverse events and greater staff awareness and information dissemination on patient safety issues.

Conclusion:
A double-looped system could improve nurses' patient safety awareness and their workplace practices, which would ultimately lead to better patient outcomes.