bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of Comorbidities among Older Head and Neck Cancer Survivors in the United States
Authors: Eytan Danielle F. , Blackford Amanda L. , Eisele David W. , Fakhry Carole 
Published: September 2018

ObjectiveThe aim of this study was to evaluate the prevalence of comorbidities among patients with head and neck squamous cell carcinoma (HNSCC) at the time of their cancer diagnosis and during their survivorship trajectory. The second aim was to evaluate the differences in comorbidities developed according to treatment type received.Study DesignRetrospective cross‐sectional.SettingSEER (Surveillance, Epidemiology, and End Results)–Medicare linked database.Subjects and MethodsIndividuals with a first‐incident primary diagnosis of HNSCC from 2004 to 2011 per the SEER‐Medicare database were included in analysis. The presence or absence of 30 comorbid conditions of interest was identified during distinct periods and analyzed according to treatment with surgery alone, primary (chemo)radiation, or surgery with (chemo)radiation.ResultsThe study population consisted of 10,524 individuals diagnosed with HNSCC, with a mean age of 74.8 years. At diagnosis, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, and diabetes were the most prevalent comorbidities, and they increased over time. The probability of developing treatment‐related comorbidities such as pneumonia, dysphagia, weight loss, malnutrition, and dental issues rose significantly in the short and long term following treatment (P <. 05). By 5 years from cancer diagnosis, patients were most likely to have newly diagnosed hypertension, dysphagia, anemia, and weight loss. Primary surgery alone was associated with a lower risk of diagnosis with these treatment‐related comorbidities, as compared with treatments involving radiation therapy and/or chemotherapy in the primary or adjuvant settings (P <. 05).ConclusionsThere is a large burden of comorbidities among patients following HNSCC treatment, which warrant clinical attention during surveillance.
The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale: A New Measurement Instrument for Prenatal Breastfeeding Self-efficacy
Authors: McKinley Erin M. , Knol Linda L. , Turner Lori W. , Burnham Joy J. , Graettinger Kristine R. , Hernandez-Reif Maria , Leeper James D. 
Published: September 2018

Background: Breastfeeding self-efficacy and breastfeeding intention are two modifiable factors that influence rates of breastfeeding initiation. Research Aims: (1) To develop a scale to measure prenatal breastfeeding self-efficacy, and (2) test its psychometric properties by determining the internal consistency and reliability, and (3) assess the relationships between prenatal breastfeeding self-efficacy and breastfeeding intention. Methods: Cross-sectional prospective one-group survey design was used. A convenience sample of pregnant patients attending an obstetrics and gynecology clinic ( N=124) completed a survey at the recruitment site that assessed demographics, breastfeeding intention, and breastfeeding self-efficacy theory constructs. Retest surveys ( n=14) were taken home and returned to the researcher by mail after completion. Results: Cronbach’s alpha for the 39-item scale was .98 (test) and .97 (retest) with an item-to-total correlation range of .54 to .78. A four-factor solution for the scale was retained. Test-retest indicated each factor was significant and highly correlated: Individual Processes (.88, p < .001), Interpersonal Processes (.893, p < .001), Professional Advice (.919, p < .001), and Social Support (.880, p < .001). Overall prenatal breastfeeding self-efficacy score was highly correlated (.610, p <.001) with breastfeeding intention scores. Conclusions: The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale is a valid and reliable measure of a prenatal women’s self-efficacy in preparation to breastfeed. Measuring the level of self-efficacy could alert prenatal women and health professionals to individual skill sets.
Predictive factors for special care units admission and in-hospital mortality among geriatric patients that presented to the emergency department of a teaching hospital
Authors: Lim Khai Yen , Nik Ab Rahman Nik Hisamuddin 
Published: September 2018

Background: The world population is experiencing ageing and this phenomenon certainly gives significant impact to the social, economic as well as health care services globally. Objectives: This study aimed to determine the prevalence of geriatric patients treated in critical zone in an emergency department of a teaching hospital and the factors associated with special care units admission and in-hospital mortality. Methods: A single-centre prospective cross-sectional study was carried out from 1 January 2016 to 31 December 2016 at the Emergency Department Hospital at Universiti Sains Malaysia, Malaysia. All patients aged 60 years and above were included. Systematic random sampling was used. Variables were analysed using simple and multiple logistic regressions. Results: The total number of patients included in this study was 328, 55.8% were male and the mean age was 70.6 (standard deviation: 7.5) years. The commonly presenting diseases in this study were cardiovascular (31.4%), infectious (29.6%), neurological (14.9%) and respiratory (12.5%). Out of the 328 patients studied, 187 (57.0%) were admitted to general wards and 110 (33.5%) to special care units. A total of 55 patients (16.8%) succumbed within the period of in-hospital treatment. The factors associated with special care units admission were the usage of non-invasive ventilation and the administration of inotropic support. The factors associated with in-hospital mortality were blood urea level, serum albumin level and the application of mechanical ventilation. Conclusion: Geriatric patients who presented to emergency department requiring ventilator and inotropic support had been observed to exhibit worse outcome. The associated factors for special care units admission and in-hospital mortality had been identified, and this will enable better settings cater to the needs for critically ill geriatric patients.
Evaluation of dynamic thiol/disulfide homeostasis in adult patients with community-acquired pneumonia
Authors: Şener Alp , Kurtoğlu Çelik Gülhan , Özhasenekler Ayhan , Gökhan Şervan , Tanrıverdi Fatih , Kocaoğlu Salih , Neşelioğlu Salim , Erdoğan Serpil 
Published: September 2018

Background: Community-acquired pneumonia is an important cause of mortality and morbidity in all age groups. Oxidant and antioxidant mechanisms play an important role in the pathogenesis and mortality of community-acquired pneumonia. Objectives: In this study, the role of thiol/disulfide homeostasis in the diagnosis and prognosis of community-acquired pneumonia was investigated. Methods: This was a prospective, controlled, observational study involving 73 community-acquired pneumonia patients and 68 healthy volunteers. Results: The native thiol and total thiol, which are thiol/disulfide homeostasis components, were significantly lower in the community-acquired pneumonia group. It was also found that the native thiol was lower in the high-risk community-acquired pneumonia group and that the native thiol and total thiol were associated with the Pneumonia Severity Index, CRB65 (confusion, respiratory rate, blood pressure, ⩾65 years old), and CURB65 (confusion, uremia, respiratory rate, blood pressure, ⩾65 years old) scores. The thiol compound levels were also associated with the C-reactive protein and procalcitonin levels. However, there was no significant difference between the survivors and non-survivors in terms of the thiol/disulfide homeostasis parameters. Conclusion: This study demonstrated the important role that oxidative stress plays in the pathogenesis of community-acquired pneumonia. The thiol/disulfide homeostasis biomarkers especially the native thiol and index-1 levels were significantly lower in patients with community-acquired pneumonia. Further studies are needed to investigate the diagnostic and prognostic value of thiol/disulfide homeostasis parameters in community-acquired pneumonia.
Autologous hematopoietic stem cell transplantation improves fatigue in multiple sclerosis
Authors: Bose Gauruv , Atkins Harold L , Bowman Marjorie , Freedman Mark S 
Published: September 2018

Background: Fatigue is a common problem in multiple sclerosis (MS) affecting as many as 90% of patients. The Fatigue Impact Scale (FIS) is a validated measure of fatigue in MS patients. The cause of fatigue in MS is likely multifactorial, with some evidence that ongoing central nervous system (CNS) inflammation is a contributing factor. Immunoablation and autologous hematopoietic stem cell transplantation (aHSCT) have been shown to halt ongoing CNS inflammation. Objective: To investigate whether halting all ongoing inflammation with aHSCT impacts FIS scores in patients with severe MS. Methods: In the Canadian aHSCT study ( ClinicalTrials.gov , NCT01099930), 23 patients underwent aHSCT and had FIS prospectively collected every 6 months for 36 months of follow-up. Change in FIS was analysed by repeated-measures analysis of variance (RMANOVA) with multiple linear regression to determine independent predictors. Results: The median FIS score decreased 36%, from 36 to 23 ( p = 0.001), and four patients had 100% reduction. Improvement in FIS correlated with lower age and Expanded Disability Status Scale at baseline, as well as increased independence as evidenced by a return to gainful employment and even driving. Conclusion: Patients had significantly less fatigue on average after aHSCT. This may serve to better understand the contribution of ongoing CNS inflammation to fatigue peculiar to MS.
Safety and Efficacy of Inferior Vena Cava Reconstruction During Hepatic Resection
Authors: Papamichail M. , Marmagkiolis K. , Pizanias M. , Koutserimpas C. , Heaton N. 
Published: September 2018

Background and Aims: Patients with liver tumors involving the inferior vena cava have a poor outcome without surgery. Liver resection en bloc with inferior vena cava resection and reconstruction is now performed in many centers. The purpose of this study is to investigate the safety and efficacy of inferior vena cava reconstruction during hepatic resection. Materials and Methods: A review of 12 centers reporting 240 patients with combined hepatectomy and inferior vena cava resection and reconstruction for malignant tumors was performed. Sample size, patient characteristics, histological type of the tumor, method of reconstruction, complications, and long-term survival (1-, 2-, and 5-year survival) were evaluated. Results: A total of 240 patients from 12 institutions (male 58%) with mean age 54 years underwent combined liver resection and inferior vena cava resection and reconstruction for colorectal liver metastases (43%), cholangiocarcinomas (26%), hepatocellular carcinomas (19%), leiomyosarcomas (4%), and other tumors (7.9%). Reconstruction included primary closure (35.8%), patch repair (13.3%), or interposition graft (50.8%) In-hospital mortality was 6.25% and overall morbidity was 42.1%. 1- and 10-year survival rates were 79.7% and 28.9%, respectively. Conclusion: Tumors arising in or extending to inferior vena cava that require liver resection should be considered for surgery as it can be performed with an acceptable mortality and morbidity in centers with liver transplantation and hepato-pancreato-biliary facilities.
Social isolation is associated with 90-day rehospitalization due to heart failure
Authors: Saito Hiroshi , Kagiyama Nobuyuki , Nagano Noriko , Matsumoto Kozue , Yoshioka Kenji , Endo Yoshiko , Hayashida Akihiro , Matsue Yuya 
Published: September 2018

Background: Social isolation has been reported to be associated with decreased quality of life and the onset of organic diseases. The objective of this study was to investigate the prevalence of social isolation in patients with heart failure and whether it is associated with rehospitalization. Methods and results: The study included consecutive patients aged ⩾55 years who were hospitalized due to heart failure. Social isolation was assessed using total scores less than 12 on an abbreviated version of the Lubben Social Network Scale. The endpoint was heart failure rehospitalization within 90 days after discharge. Among 148 patients with heart failure (80±8 years old, 51% male), 73 (49%) were socially isolated. The patients with social isolation had similar comorbidities compared with those without social isolation. Heart failure rehospitalization occurred within 90 days for 25 patients and the heart failure rehospitalization rate was significantly higher in the social isolation group ( p=0.036). LASSO (least absolute shrinkage and selection operator) regression confirmed that social isolation was one of the strongest predictors of heart failure rehospitalization, showing larger effects than living alone, being unemployed, and other established risk factors. Conclusion: Half of the patients with heart failure reported social isolation, which had a strong association with heart failure rehospitalization.
The Ubiquitous Orange Traffic Cone: An Observational Study
Authors: Morrison Robert E. 
Published: September 2018

Daily sightings of traffic cones were logged over a six-month period in an attempt to provide data about the frequency and novelty of such encounters, and to yield examples of the variety of uses for cones. Analysis of the data show that traffic cones were seen nearly every day and usually in new situations not previously encountered. Many unique uses were observed, both for hazardous conditions and for non-hazardous purposes. Though impressive in variety and inventiveness, these fall into general categories of use. Due to the multiplicity of purpose and the frequency of encounter it is argued that the public may not always perceive the message intended by the cone owner.
Preventing and treating brain metastases with three first-line EGFR-tyrosine kinase inhibitors in patients with EGFR mutation-positive advanced non-small cell lung cancer
Authors: Su Po-Lan , Wu Yi-Lin , Chang Wei-Yuan , Ho Chung-Liang , Tseng Yau-Lin , Lai Wu-Wei , Su Wu-Chou , Lin Chien-Chung , Yang Szu-Chun 
Published: September 2018

Introduction: Brain metastases (BM) are common in advanced non-small cell lung cancer (NSCLC), and the prognosis is poor with few therapeutic options. This study evaluated the efficacy of three epidermal growth factor receptor–tyrosine kinase inhibitors (EGFR-TKIs) in preventing and treating BM in patients with EGFR mutation-positive advanced NSCLC. Methods: Patients with EGFR mutation-positive advanced NSCLC who visited a tertiary referral center from 1 December 2013 to 30 November 2017 were analyzed retrospectively. They received gefitinib, erlotinib, or afatinib until disease progression, death, or intolerable adverse events. The cumulative incidence of subsequent BM of initial non-BM patients, progression-free survival (PFS), and overall survival (OS) of the BM and non-BM patients were estimated and compared using the Kaplan–Meier and log-rank tests. Results: 306 NSCLC patients were enrolled, with 116, 75, and 115 receiving first-line gefitinib, erlotinib, and afatinib, respectively. The afatinib group had a better PFS [12.7 versus 9.8 months; hazard ratio (HR) 0.59, p  = 0.001] and OS (39.1 versus 22.0 months; HR 0.64, p  = 0.035) than the gefitinib group. Afatinib tended to provide better BM prevention than gefitinib (BM cumulative incidence, HR 0.49; 95% confidence interval 0.34–0.71, p < 0.001) according to a Cox model adjusted for possible confounders. Patients with initial BM had a shorter PFS ( p < 0.001) and OS ( p  = 0.015) than those without initial BM. Among the former, there were no differences in median PFS ( p  = 0.34) and median OS ( p  = 0.46) in the three EGFR-TKI groups. Conclusions: Our data suggested that, compared with gefitinib, afatinib provided better benefits significantly in terms of PFS and OS. Both had the same effectiveness in preventing subsequent BM.
Design of Genuine Birth Environment: Midwives Intuitively Think in Terms of Evidence-Based Design Thinking
Authors: Folmer Mette Blicher , Jangaard Karin , Buhl Henrik 
Published: September 2018

Objective: The objective of this study is to investigate a development project initiated and led by midwives. Background: The aim was to design an environment that could accommodate the wish to support professionalism while creating better and more cohesive patient treatment, improved patient safety, greater efficiency, higher quality, and stronger focus on the patient. Theory: The theoretical and analytical account is conducted within the framework of design thinking (DT), replacing the traditional evidence-based design approach with an evidence-based design thinking (EBDT) process underpinning participatory DT and co-creation. Method: Based on a longitudinal case study on a participatory design process, interviews are conducted. DT principles are used in the analysis of the interviews. Results: Genuineness arises when all users experience that the physical setting optimally underpins the birthing situation. It is essential to make visible the importance of the physical setting to human behavior in any situation. Conclusion: This study shows that midwives intuitively do EBDT. EBDT commands awareness of both research, design, midwifery care, and perspectives on space from women giving birth and their relatives. Collectively, that can provide the genuine scope of a healing birth environment.
Using Discrete Event Simulation (DES) To Support Performance-Driven Healthcare Design
Authors: Cai Hui , Jia Jun 
Published: September 2018

Aim: This article aims to provide a description of fundamental elements of discrete event simulation (DES), the process and the values of applying DES in assisting healthcare design and planning decision-making. More importantly, it explores how new technology such as electronic medical records, real-time location services (RTLS), and other simulation methods such as space syntax analysis (SSA) can facilitate and complement DES. Background: Healthcare administrators increasingly recognize DES as an effective tool for allocating resources and process improvement. However, limited studies have described specifically how DES can facilitate healthcare design. Method: Three case studies were provided to illustrate the value of DES in supporting healthcare design. The first case study used DES to validate a surgical suite design for shorter surgeon walking distance. The second case study used DES to facilitate capacity planning in a clinic through testing the utilization of exam rooms upon various growth scenario. The detailed process data for the current clinic were captured through RTLS tracking. The third case study applied DES in an emergency department for both site selection in master planning and capacity test at various growth scenarios with seasonal volume swing. In addition, SSA was conducted to evaluate the impacts of design on visual surveillance, team communication, and co-awareness. Conclusions: It is recognized that the DES analysis is an effective tool to address the process aspects of healthcare environments and should be combined with post-occupancy evaluation and SSA to address behavioral aspects of operations to provide more solid evidence for future design.
Resection of Inverted Papilloma of the Maxillary Sinus via a Prelacrimal Recess Approach: A Multicenter Retrospective Analysis of Surgical Efficacy
Authors: Zhou Bing , Huang Qian , Sun Jingwu , Li Xuezhong , Zhang Weitian , Cui Shunjiu , Shen Ping-Hung , Wang Chengshuo , Huang Zhenxiao , Dong Yi , Liang Na 
Published: September 2018

Background The intranasal endoscopic prelacrimal recess approach (PLRA) access to all aspects of the maxillary sinus while preserving the inferior turbinate and nasolacrimal duct and its use have been reported in the treatment of many maxillary sinus and lateral skull base diseases. Objective To retrospectively assess the effectiveness of a 10-year multicenter follow-up for the resection of inverted papilloma of the maxillary sinus (IPMS) via a PLRA. Methods A total of 71 patients were admitted and underwent IPMS excision via an intranasal endoscopic PLRA from 2003 to 2013. All patients underwent high-resolution computed tomography scanning of the nasal sinus, and some also underwent magnetic resonance imaging examination. Results Based on the Krouse staging system, all 71 patients belong to T3 staging. The PLRA was employed to remove IPMS in 71 patients. The postoperative pathological examination of the excised tissue revealed inverted papilloma, and cancerization was identified in 3 patients. The median follow-up time was 37.3 months (range: 13–134 months). Of the 71 patients, reoccurrence was seen in 5 patients (7.04%); 5 patients (7.04%) experienced numbness of the upper lid and the ala of the nose and 4 (5.63%) experienced mild collapse of the ala of the nose. Conclusions These multicenter follow-up results demonstrated that the PLRA is a safe and effective method for the excision of primary or recurrent IPMS with lower postoperative complications and recurrent rate.
Traditional approach versus Stewart approach for acid–base disorders: Inconsistent evidence
Authors: Kimura Satoshi , Shabsigh Muhammad , Morimatsu Hiroshi 
Published: September 2018

Purpose: The traditional approach and the Stewart approach have been developed for evaluating acid–base phenomena. While some experts have suggested that the two approaches are essentially identical, clinical researches have still been conducted on the superiority of one approach over the other one. In this review, we summarize the concepts of each approach and investigate the reasons of the discrepancy, based on current evidence from the literature search. Methods: In the literature search, we completed a database search and reviewed articles comparing the Stewart approach with the traditional, bicarbonate-centered approach to November 2016. Results: Our literature review included 17 relevant articles, 5 of which compared their diagnostic abilities, 9 articles compared their prognostic performances, and 3 articles compared both diagnostic abilities and prognostic performances. These articles show a discrepancy over the abilities to detect acid–base disturbances and to predict patients’ outcomes. There are many limitations that could yield this discrepancy, including differences in calculation of the variables, technological differences or errors in measuring variables, incongruences of reference value, normal range of the variables, differences in studied populations, and confounders of prognostic strength such as lactate. Conclusion: In conclusion, despite the proposed equivalence between the traditional approach and the Stewart approach, our literature search shows inconsistent results on the comparison between the two approaches for diagnostic and prognostic performance. We found crucial limitations in those studies, which could lead to the reasons of the discrepancy.