bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative Gabapentin Administration Improves Acute Postoperative Analgesia in Patients Undergoing Craniotomy: A Randomized Controlled Trial
Authors: Zeng Min , Dong Jia , Lin Nan , Zhang Wei , Zhang Kaiying , Peng Kun , Wang Dexiang , Zhao Yan , Peng Yuming , Han Ruquan 
Published: August 2018

Background:
Gabapentin is an adjuvant antiepileptic agent and helps to reduce acute postoperative pain in several surgery settings. However, the effect of gabapentin on postoperative pain from suboccipital or subtemporal craniotomy is not clear.

Methods:
The study was a single-center, randomized, placebo-controlled, and double-blinded trial. A total of 122 patients undergoing elective craniotomy by a suboccipital or subtemporal approach were randomly allocated to a placebo group and gabapentin group. The patients received gabapentin (600 mg, orally) the night before surgery and 2 hours before anesthesia induction in the gabapentin group, and patients received vitamin B in the placebo group. The primary outcome was the postoperative pain score on movement at 24 hours. The secondary outcomes included the pain score at other time points, incidence of nausea and vomiting, sedation, and analgesic consumption.

Results:
Gabapentin significantly decreased the postoperative acute pain scores at rest (P=0.001) and on movement (P=0.000) within 24 hours; however, it did not have an effect at 48 hours. Gabapentin decreased postoperative vomiting (P=0.047) and rescue antiemetic use (P=0.033), whereas it increased the postoperative sedation score at 2 hours (P<0.05). Moreover, gabapentin decreased the mean consumption of intraoperative propofol (0.7 mg/kg/h; P=0.021) and remifentanil (1.3 µg/kg/h; P=0.025); however, it did not influence postoperative opioid consumption.

Conclusions:
Preoperative gabapentin significantly alleviated acute postoperative pain and decreased the incidence of vomiting in patients undergoing suboccipital or subtemporal craniotomy. However, more attention should be paid to early postoperative sedation when multimodal analgesia with gabapentin is administered.
Successful Use of Extracorporeal Membrane Oxygenation for Status Asthmaticus in a Woman With a Periviable Pregnancy
Authors: Clifford Caitlin , Mhatre Mohak , Craigo Sabrina 
Published: August 2018

BACKGROUND:
Status asthmaticus is a severe asthma exacerbation with persistent airway obstruction despite standard therapy. Use of extracorporeal membrane oxygenation (ECMO) as rescue therapy in pregnancy is exceedingly rare. We describe a case of ECMO for treatment of status asthmaticus in woman with a periviable pregnancy culminating in a term delivery.

CASE:
The patient was a 33-year-old woman, gravida 3 para 1, admitted at 23 2/7 weeks of gestation with respiratory failure secondary to status asthmaticus. Venovenous ECMO was initiated and continued for 6 days. After hospital discharge, she had no further respiratory issues. She ultimately developed fetal growth restriction and gestational hypertension and underwent a repeat cesarean delivery at 38 weeks of gestation.

CONCLUSION:
Venovenous ECMO can be used successfully for status asthmaticus during a periviable pregnancy and enable delivery at term.
Ulipristal Acetate for Unscheduled Bleeding in Etonogestrel Implant Users
Authors: Zigler Rachel E. , Madden Tessa , Ashby Caitlin , Wan Leping , McNicholas Colleen 
Published: August 2018

OBJECTIVE:
To evaluate whether ulipristal acetate reduces the number of bleeding days in etonogestrel implant users in a 30-day period as compared with placebo.

METHODS:
We performed a single-center, randomized, double-blind, placebo-controlled trial. Eligible participants were women aged 18–45 years with an etonogestrel implant in place for greater than 90 days and less than 3 years who reported greater than one bleeding episode in a 24-day period. Enrolled participants were randomized to receive 15 mg ulipristal acetate compared with an identical-appearing placebo daily for 7 days. Participants completed daily bleeding diaries using automated text messaging to evaluate whether ulipristal acetate reduces the number of bleeding days as compared with placebo. Secondary outcomes included participant satisfaction with bleeding and the effect of ulipristal acetate on ovulation status. A sample size of 52 per group (n=104) was planned, calculated with an effect size of a 30% reduction in bleeding days, SD of 10 days, and dropout of 15%. Our study was terminated early (N=65) as a result of a U.S. Food and Drug Administration hold, but power was sufficient for analysis. The effect of ulipristal acetate on ovulatory potential was evaluated in a subset with weekly serum progesterone.

RESULTS:
From May 2017 to January 2018, 65 women were allocated to receive 15 mg ulipristal acetate (n=32) or placebo (n=33) daily for 7 days. Demographic characteristics were similar between groups. Women randomized to ulipristal acetate reported 5 fewer days of bleeding over a 30-day reference period after treatment (P=.002). At the conclusion of the 30-day follow-up period, women in the ulipristal acetate group were more satisfied with their bleeding profile than the placebo group (87.5% vs 60%, respectively; P<.001). Serum progesterone levels were nonovulatory in a subset of each group (placebo group range: less than 0.2–1.3 ng/mL; ulipristal acetate group range: less than 0.2–4.4 ng/mL).

CONCLUSION:
Ulipristal acetate is well-tolerated and reduced the number of bleeding days in etonogestrel implant users in our study.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT03118297.
Retrospective Analysis of EMG-evoked Potentials in Cortical Bone Trajectory Pedicle Screws
Authors: Ashayeri Kimberly , Sahasrabudhe Nikhil , Galic Vladimir , Beric Aleksandar , Smith Michael 
Published: August 2018

Study Design:
This is a retrospective analysis of electromyographic (EMG) stimulation thresholds of 64 cortical bone trajectory (CBT) screws.

Objective:
The authors seek to determine whether recordings below stimulation threshold correlate with CBT screw pedicle breach on computed tomographic imaging, and to explore which specific nerve roots are most at risk with this new trajectory.

Summary of Background Data:
Intraoperative EMG monitoring has been utilized to verify accurate placement of pedicle screws. Although CBT screws are becoming increasingly popular, to the authors’ knowledge there are no existing evaluations of the accuracy of intraoperative triggered EMG (tEMG) monitoring in this trajectory.

Materials and Methods:
Retrospective analysis of EMG stimulation thresholds of 64 CBT screws placed in patients at NYU Langone Medical Center from 2015–2017. EMG results including threshold values and muscle group stimulated were correlated with screw positioning determined on postoperative or intraoperative computed tomographic imaging.

Results:
In total, 4.7% of EMG threshold values indicated true breach, 1.6% were falsely positive for breach, 76.5% showed true absence of breach, 17.1% failed to reveal a present breach though 0% of medial breaches were undetected. L4 screws showed tEMG responses from adductor longus in 22%, L5 screws, from rectus femoris in 16.7%, and S1 screws from tibialis anterior in 50%.

Conclusions:
tEMG testing is effective for medial breaches in CBT screws. In addition, there is evidence that bicortical placement of these screws causes lower stimulation values due to distal breach. Importantly, it seems that this is due in part to stimulation of the exiting nerve root at the level above.
Evaluation of Repeated Quick Sepsis-Related Organ Failure Assessment Measurements Among Patients With Suspected Infection*
Authors: Kievlan Daniel R. , Zhang Li A. , Chang Chung-Chou H. , Angus Derek C. , Seymour Christopher W. 
Published: August 2018

Objectives:
Among patients with suspected infection, a single measurement of the quick Sepsis-related Organ Failure Assessment has good predictive validity for sepsis, yet the increase in validity from repeated measurements is unknown. We sought to determine the incremental predictive validity for sepsis of repeated quick Sepsis-related Organ Failure Assessment measurements over 48 hours compared with the initial measurement.

Design:
Retrospective cohort study.

Setting:
Twelve hospitals in southwestern Pennsylvania in 2012.

Patients:
All adult medical and surgical encounters in the emergency department, hospital ward, postanesthesia care unit, and ICU.

Interventions:
None.

Measurements and Main Results:
Among 1.3 million adult encounters, we identified those with a first episode of suspected infection. Using the maximum quick Sepsis-related Organ Failure Assessment score in each 6-hour epoch from onset of suspected infection until 48 hours later, we characterized repeated quick Sepsis-related Organ Failure Assessment with: 1) summary measures (e.g., mean over 48 hr), 2) crude trajectory groups, and 3) group-based trajectory modeling. We measured the predictive validity of repeated quick Sepsis-related Organ Failure Assessment using incremental changes in the area under the receiver operating characteristic curve for in-hospital mortality beyond that of baseline risk (age, sex, race/ethnicity, and comorbidity). Of 37,591 encounters with suspected infection, 1,769 (4.7%) died before discharge. Both the mean quick Sepsis-related Organ Failure Assessment at 48 hours (area under the receiver operating characteristic, 0.86 [95% CI, 0.85–0.86]) and crude trajectory groups (area under the receiver operating characteristic, 0.83 [95% CI, 0.83–0.83]) improved predictive validity compared with initial quick Sepsis-related Organ Failure Assessment (area under the receiver operating characteristic, 0.79 [95% CI, 0.78–0.80]) (p < 0.001 for both). Group-based trajectory modeling found five trajectories (quick Sepsis-related Organ Failure Assessment always low, increasing, decreasing, moderate, and always high) with greater predictive validity than the initial measurement (area under the receiver operating characteristic, 0.85 [95% CI, 0.84–0.85]; p < 0.001).

Conclusions:
Repeated measurements of quick Sepsis-related Organ Failure Assessment improve predictive validity for sepsis using in-hospital mortality compared with a single measurement of quick Sepsis-related Organ Failure Assessment at the time a clinician suspects infection.
Intracrinology and menopause: the science describing the cell-specific intracellular formation of estrogens and androgens from DHEA and their strictly local action and inactivation in peripheral tissues
Authors: Labrie Fernand 
Published: August 2018

Abstract
The secretion of estrogens by the ovaries stops at menopause. Afterward, dehydroepiandrosterone (DHEA) becomes the only source of both estrogens and androgens during all the postmenopausal years. To maintain very low and biologically inactive concentrations of estrogens and androgens in the circulation, DHEA is transformed intracellularly into cell-specific small amounts of estrogens and androgens (except in the endometrium) which then act and are inactivated locally in the same cells, thus avoiding biologically significant systemic exposure to active sex steroids. The secretion of DHEA, however, mainly of adrenal origin, has already decreased by an average of 60% at the time of menopause and it continues to decrease thereafter with a parallel lowering in available intracellular estrogens and androgens. Consequently, after the arrest of estrogen secretion by the ovaries, the loss of DHEA becomes practically responsible for the symptoms and signs of menopause. Replacing what is missing, namely DHEA, at the right place, at the right time, and in the right amount, seems to be the logical and physiological approach for the treatment of menopausal symptoms and signs, as recently demonstrated for pain at sexual activity (dyspareunia), the most bothersome symptom of vulvovaginal atrophy due to menopause.
Successful long-term use of Gellhorn pessary and the effect on symptoms and quality of life in women with symptomatic pelvic organ prolapse
Authors: Mao Meng , Ai Fangfang , Kang Jia , Zhang Ye , Liang Shuo , Zhou Ying , Zhu Lan 
Published: August 2018

Abstract

Objective:
To evaluate the long-term continuation rate of the Gellhorn pessary and its effect on bothersome symptoms and quality of life (QOL) in women with symptomatic pelvic organ prolapse (POP).

Methods:
This was a prospective observational study. Ninety-one women with symptomatic POP were successfully fitted with Gellhorn pessaries (short stem) between June, 2015 and January, 2017. The participants were monitored at 3 and 6 months, and also every 6 months afterwards until February, 2018. Prolapse and urinary symptoms were assessed, and the Pelvic Floor Distress Inventory-20 (PFDI-20) and Pelvic Floor Impact Questionnaire-7 (PFIQ-7) were administered at baseline and at each follow-up visit. Logistic regression was performed to identify independent predictors of discontinued pessary use. McNemar's test and paired t tests were used to evaluate the changes in symptoms and QOL in the continuation group.

Results:
In this study, 58.3% of participants continued to use the pessaries after a median follow-up time of 23.5 months. A total vaginal length <7.5 cm (odds ratio 0.03, 95% confidence interval 0.00-0.35, P = 0.01) was an independent predictor of pessary discontinuation. In the continuation group, almost all prolapse and voiding difficulty symptoms were resolved at the study endpoint. The changes in the urinary and prolapse scales of both the PFIQ-7 (mean [SD] changes were −21.2 [26.6] in the urinary scale and −32.5 [29.5] in the prolapse scale) and PFDI-20 (mean [SD] changes were −15.3 [21.3] in the urinary scale and −29.8 [22.8] in the prolapse scale) achieved clinical significance (effect size >0.5).

Conclusions:
More than half of the patients continued long-term use of the pessary. The Gellhorn pessary can resolve prolapse and voiding difficulty symptoms effectively. In addition, the Gellhorn pessary can significantly improve the QOL of women via long-term use. However, the Gellhorn pessary has a limited effect on defecatory symptoms.
Peripapillary Vessel Density in Glaucomatous Eyes: Comparison Between Pseudoexfoliation Glaucoma and Primary Open-angle Glaucoma
Authors: Park Ji-Hye , Yoo Chungkwon , Girard Michael J.A. , Mari Jean-Martial , Kim Yong Yeon 
Published: August 2018

Purpose:
The aim of this study was to compare the peripapillary vessel density between eyes with pseudoexfoliation glaucoma (PXG) and eyes with primary open-angle glaucoma (POAG).

Methods:
Peripapillary vessel density in the radial peripapillary capillaries was assessed using optical coherence tomography angiography, and compared between patients with PXG and those with POAG, matched for age and mean deviation (MD) of standard automated perimetry. The vessel density was measured between the optic disc margin and 750 μm from the optic disc margin.

Results:
In total, 39 eyes with PXG were matched to 39 eyes with POAG. Mean untreated intraocular pressure was higher in the PXG group than in the POAG group (21.4±6.7 vs. 14.9±2.9 mm Hg; P<0.001), but there was no difference in age, refractive error, visual field MD, or average retinal nerve fiber layer thickness between the 2 groups. However, the average peripapillary vessel density in the radial peripapillary capillaries was lower in the eyes with PXG than in the eyes with POAG. Moreover, there was a significant correlation between peripapillary vessel density and both visual field MD and retinal nerve fiber layer thickness.

Conclusions:
Peripapillary vessel density was lower in eyes with PXG than in eyes with POAG of similar severity.
Delayed-onset Endophthalmitis Following Implantation of a XEN45 Glaucoma Device: A Case Report
Authors: Colás-Tomás Teresa , Pérez-Trigo Silvia 
Published: August 2018

Purpose:
The aim of this study was to present a case of delayed-onset endophthalmitis occurring after the implantation of a XEN45 device.

Patients and Methods:
The patient was a 54-year-old man with bilateral elevated intraocular pressure. The patient underwent placement of a XEN45 implant in his left eye. One month postoperatively the patient required needling with adjuvant mitomycin C. Six months later, the intraocular pressure was well controlled with treatment.

Results:
Eight months after surgery, the patient presented to the emergency room and was diagnosed with left eye endophthalmitis. There was no history of trauma. The presence of erosions could not be thoroughly assessed due to significant conjunctival inflammation and friability, but a scleral necrosis patch was observed around the stent’s subconjunctival pathway. The vitreous culture was positive for Streptococcus oralis. The blood culture was negative, and physical examination excluded any other endogenous cause. Given the poor clinical progression, persistent site of infection, and no visual prognosis, an enucleation was performed.

Conclusions:
In the case presented, we hypothesize a perforation of the conjunctiva as the most probable cause of the patient’s endophthalmitis. This case, together with previous case reports, highlights the importance of periodic patient follow-up after the procedure. However, less invasive and seemingly safer new generation implants for glaucoma surgery are not fully devoid of complications.
Health Beliefs and Medication Adherence in Omanis With Hypertension
Authors: Al-Noumani Huda , Wu Jia-Rong , Barksdale Debra , Knafl George , AlKhasawneh Esra , Sherwood Gwen 
Published: August 2018

Background:
Patients’ health beliefs are essential to improve medication adherence among patients with hypertension.

Objective:
Our objective was to examine the relationship between (1) patients’ beliefs about hypertension, medication, and self-efficacy and medication adherence and (2) medication adherence and blood pressure control in Oman.

Methods:
This cross-sectional study included 215 participants with hypertension. Participants completed 4 questionnaires (Arabic version) to measure medication adherence, beliefs about hypertension severity, beliefs about medication, and self-efficacy. Bivariate and multivariate logistic regression was used to conduct the analyses.

Results:
Higher self-efficacy (odds ratio [OR], 2.59; 95% confidence interval [CI], 1.54–4.37), stronger beliefs about medication necessity (OR, 1.98; 95% CI, 1.21–3.23), increased age (OR, 1.06; 95% CI, 1.03–1.10), and fewer medication concerns (OR, 0.34; 95% CI, 0.20–0.57) were related to high medication adherence. Moreover, uncontrolled blood pressure was less likely in participants with high medication adherence (OR, 0.47; 95% CI, 0.24–0.93).

Conclusions:
Patients’ beliefs are important consideration to improve medication adherence. Clinically, patients’ beliefs should be assessed, and strategies to improve medication adherence should incorporate beliefs as a key component to improve antihypertensive medication adherence. Patient education and counseling regarding hypertension and necessity and side effects of medications are important to maximize positive beliefs and improve medication adherence.
Diagnostic and therapeutic yields of urgent balloon-assisted enteroscopy in overt obscure gastrointestinal bleeding
Authors: Rodrigues Jaime P. , Pinho Rolando , Rodrigues Adélia , Sousa Mafalda , Silva João Carlos , Gomes Catarina , Freitas Teresa , Pinto-Pais Teresa , Carvalho João 
Published: August 2018

Background and aims
Balloon-assisted enteroscopy (BAE) is one of the diagnostic and therapeutic procedures in the algorithm for the evaluation of overt obscure gastrointestinal bleeding (OGIB). There is currently no consensus regarding the role of urgent BAE in overt OGIB. The aims of this study were to compare the diagnostic and therapeutic yields of urgent and nonurgent BAE in patients with overt OGIB.

Patients and methods
We conducted a retrospective, single-center study that included patients who underwent BAE for overt OGIB between January 2010 and December 2017. Urgent BAE was defined as an enteroscopy performed within 72 h of clinical presentation. Demographic, clinical, laboratory, and technical data were reviewed and the diagnostic and therapeutic yields evaluated and compared.

Results
Seventy BAEs were performed in 57 patients with overt OGIB [29 (50.9%) females, mean age: 68.0±11.1 years]. The diagnostic yield of urgent BAE was significantly higher than nonurgent BAE (84.5 vs. 50.0%, P<0.01). The most common diagnosis were angiodysplasias (30%), tumors (15.7%), erosions/ulcers (4.3%), and diverticula (4.3%). Endoscopic therapy was more frequently performed in urgent BAE patients (57.7 vs. 31.8%, P=0.03). The most commonly used endoscopic therapies were argon plasma coagulation (30.0%), hemostatic clips (5.7%), epinephrine injection (5.7%), and polypectomy (2.9%). In terms of urgent BAE, the diagnostic yield was similar when enteroscopy was performed at less than or equal to 24, 48, or 72 h (P>0.05), but the therapeutic yield was higher the earlier the enteroscopy was performed (100, 76.9, and 57.7% at ≤24, ≤48, and ≤72 h respectively; P=0.03).

Conclusion
The diagnostic and therapeutic impact of BAE was higher in an urgent setting. These data support an important role for urgent BAE in overt OGIB.
Organizational Influences on Time Pressure Stressors and Potential Patient Consequences in Primary Care
Authors: McDonald Kathryn M. , Rodriguez Hector P. , Shortell Stephen M. 
Published: August 2018

Background:
Primary care teams face daily time pressures both during patient encounters and outside of appointments.

Objectives:
We theorize 2 types of time pressure, and test hypotheses about organizational determinants and patient consequences of time pressure.

Research Design:
Cross-sectional, observational analysis of data from concurrent surveys of care team members and their patients.

Subjects:
Patients (n=1291 respondents, 73.5% response rate) with diabetes and/or coronary artery disease established with practice teams (n=353 respondents, 84% response rate) at 16 primary care sites, randomly selected from 2 Accountable Care Organizations.

Measures and Analysis:
We measured team member perceptions of 2 potentially distinct time pressure constructs: (1) encounter-level, from 7 questions about likelihood that time pressure results in missing patient management opportunities; and (2) practice-level, using practice atmosphere rating from calm to chaotic. The Patient Assessment of Chronic Illness Care (PACIC-11) instrument measured patient-reported experience. Multivariate logistic regression models examined organizational predictors of each time pressure type, and hierarchical models examined time pressure predictors of patient-reported experiences.

Results:
Encounter-level and practice-level time pressure measures were not correlated, nor predicted by the same organizational variables, supporting the hypothesis of two distinct time pressure constructs. More encounter-level time pressure was most strongly associated with less health information technology capability (odds ratio, 0.33; P<0.01). Greater practice-level time pressure (chaos) was associated with lower PACIC-11 scores (odds ratio, 0.74; P<0.01).

Conclusions:
Different organizational factors are associated with each forms of time pressure. Potential consequences for patients are missed opportunities in patient care and inadequate chronic care support.