bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comorbid Conditions Among Adults 50 Years and Older With Traumatic Brain Injury: Examining Associations With Demographics, Healthcare Utilization, Institutionalization, and 1-Year Outcomes
Authors: Kumar Raj G. , Olsen Jennifer , Juengst Shannon B. , Dams-O'Connor Kristen , O'Neil-Pirozzi Therese M. , Hammond Flora M. , Wagner Amy K. 
Published: March 2019

Objectives:
To assess the relationship of acute complications, preexisting chronic diseases, and substance abuse with clinical and functional outcomes among adults 50 years and older with moderate-to-severe traumatic brain injury (TBI).

Design:
Prospective cohort study.

Participants:
Adults 50 years and older with moderate-to-severe TBI (n = 2134).

Measures:
Clusters of comorbid health conditions empirically derived from non-injury International Classification of Diseases, Ninth Revision codes, demographic/injury variables, and outcome (acute and rehabilitation length of stay [LOS], Functional Independence Measure efficiency, posttraumatic amnesia [PTA] duration, institutionalization, rehospitalization, and Glasgow Outcome Scale–Extended (GOS-E) at 1 year).

Results:
Individuals with greater acute hospital complication burden were more often middle-aged men, injured in motor vehicle accidents, and had longer LOS and PTA. These same individuals experienced higher rates of 1-year rehospitalization and greater odds of unfavorable GOS-E scores at 1 year. Those with greater chronic disease burden were more likely to be rehospitalized at 1 year. Individuals with more substance abuse burden were most often younger (eg, middle adulthood), black race, less educated, injured via motor vehicle accidents, and had an increased risk for institutionalization.

Conclusion:
Preexisting health conditions and acute complications contribute to TBI outcomes. This work provides a foundation to explore effects of comorbidity prevention and management on TBI recovery in older adults.
The Contribution of Social Support, Professional Support, and Financial Hardship to Family Caregiver Life Satisfaction After Traumatic Brain Injury
Authors: Sabella Scott A. , Suchan Christopher S. 
Published: March 2019

Objectives:
(a) To assess whether 3 changeable environmental variables (social support, professional support, and financial hardship) contribute to explaining differences in well-being of family caregivers after traumatic brain injury (TBI), above and beyond the influence of neurobehavioral functioning. (b) To assess the unique and relative contribution of social support, professional support, and financial hardship to life satisfaction of family caregivers.

Participants:
Adult family caregivers (n = 136) of individuals who received inpatient rehabilitation following a TBI.

Measures:
The Social Provisions Scale; Brief Scale of Financial Hardship after Brain Injury; Satisfaction with Life Scale; and adapted scales measuring professional support and neurobehavioral functioning.

Design:
Cross-sectional study using survey methodology.

Results:
Social support, professional support, and financial hardship explained a significant amount of variance in life satisfaction after controlling for neurobehavioral functioning (R
2 change = 0.34, considered a large effect size). Social support and financial hardship were significant unique predictors within the model, but professional support was not.

Conclusion:
Social support and financial hardship are prominent environmental variables that may hold promise for targeted intervention development and testing designed to support family adaptation after TBI.
Estimated Life-Time Savings in the Cost of Ongoing Care Following Specialist Rehabilitation for Severe Traumatic Brain Injury in the United Kingdom
Authors: Turner-Stokes Lynne , Dzingina Mendwas , Shavelle Robert , Bill Alan , Williams Heather , Sephton Keith 
Published: March 2019

Objectives:
To evaluate cost-efficiency of rehabilitation following severe traumatic brain injury (TBI) and estimate the life-time savings in costs of care.

Setting/Participants:
TBI patients (n = 3578/6043) admitted to all 75 specialist rehabilitation services in England 2010–2018.

Design:
A multicenter cohort analysis of prospectively collated clinical data from the UK Rehabilitation Outcomes Collaborative national clinical database.

Main Measures:
Primary outcomes: (a) reduction in dependency (UK Functional Assessment Measure), (b) cost-efficiency, measured in time taken to offset rehabilitation costs by savings in costs of ongoing care estimated by the Northwick Park Dependency Scale/Care Needs Assessment (NPDS/NPCNA), and (c) estimated life-time savings.

Results:
The mean age was 49 years (74% males). Including patients who remained in persistent vegetative state on discharge, the mean episode cost of rehabilitation was £42 894 (95% CI: £41 512, £44 235), which was offset within 18.2 months by NPCNA-estimated savings in ongoing care costs. The mean period life expectancy adjusted for TBI severity was 21.6 years, giving mean net life-time savings in care costs of £679 776/patient (95% CI: £635 972, £722 786).

Conclusions:
Specialist rehabilitation proved highly cost-efficient for severely disabled patients with TBI, despite their reduced life-span, potentially generating over £4 billion savings in the cost of ongoing care for this 8-year national cohort.
Rehabilitation Practices in Patients With Moderate and Severe Traumatic Brain Injury
Authors: Kreitzer Natalie , Rath Kelly , Kurowski Brad G. , Bakas Tamilyn , Hart Kim , Lindsell Christopher J. , Adeoye Opeolu 
Published: March 2019

Objective:
To characterize the indications, timing, barriers, and perceived value of rehabilitation currently provided for individuals with moderate or severe traumatic brain injury (TBI) admitted to the intensive care unit (ICU) based on the perspectives of providers who work in the ICU setting.

Participants:
Members (n = 66) of the Neurocritical Care Society and the American Congress of Rehabilitation Medicine.

Design:
An anonymous electronic survey of the timing of rehabilitation for patients with TBI in the ICU.

Main Measures:
Questions asked about type and timing of rehabilitation in the ICU, extent of family involvement, participation of physiatrists in patient care, and barriers to early rehabilitation.

Results:
Sixty-six respondents who reported caring for patients with TBI in the ICU completed the survey; 98% recommended rehabilitative care while patients were in the ICU. Common reasons to wait for the initiation of physical therapy and occupational therapy were normalization of intracranial pressure (86% and 89%) and hemodynamic stability (66% and 69%).

Conclusions:
The majority of providers caring for patients with TBI in the ICU support rehabilitation efforts, typically after a patient is extubated, intracranial pressure has normalized, and the patient is hemodynamically stable. Our findings describe current practice; future studies can be designed to determine optimal timing, intensity, and patient selection for early rehabilitation.
EVALUATION OF THE EFFECT OF TOPICAL INTERFERON α2b AS A COMPLEMENTARY TREATMENT OF MACULAR EDEMA OF PATIENTS WITH DIABETIC RETINOPATHY
Authors: Afarid Mehrdad , Meshksar Aidin , Salehi Alireza , Safarpour Mohammad Mostafa 
Published: March 2019

Purpose:
The objective of this study is to evaluate the effect of the topical interferon α2b (IFNα2b) as an adjunctive therapy in the treatment of diabetic macular edema.

Method:
This was a randomized controlled clinical trial performed on patients with diabetic macular edema. Fifty eyes of 50 patients (one eye/patient) who were receiving treatment for diabetic macular edema were randomly assigned to get topical IFNα2b 1 MU/mL or artificial tear eye drop as an adjunctive therapy. The primary measure outcomes were best-corrected visual acuity and central macular thickness; the secondary goals were to assess the effect of topical IFNα2b on the intraocular pressure and its potential side effects.

Results:
Baseline demographic data of the two groups were similar. The improvement in visual acuity of patients on IFN was more than the patients on artificial tear by the end of the fourth week (6.85 and 1.45 Early Treatment Diabetic Retinopathy Study letters, respectively, P = 0.001) and the eighth week (6.75 and 1.05 Early Treatment Diabetic Retinopathy Study letters, respectively, P = 0.005). The central macular thickness was also decreased correspondingly by the end of fourth week (53.1 ± 153 µm for patients on IFN and 26.6 ± 119.1 µm for patients on artificial tear, P = 0.497) and eighth week (27.9 ± 67.7 for patients on IFN and 29.2 ± 98 µm for patients on artificial tear, P = 0.957), but it was not statistically significant. Intraocular pressure was decreased on the fourth week in IFN group for 1.7 mmHg ±3 and increased for 0.1 mmHg ±2.3 in the artificial tear group (P = 0.018). No significant side effect was detected with topical IFN drop.

Conclusion:
This study evaluated the short-term effects of topical IFNα2b 1 MU/mL. The drug was well tolerated and may have an effect on improvement of best-corrected visual acuity in patients with diabetic macular edema. It also had an intraocular pressure lowering effect on the studied eyes. However, further studies are needed to confirm this finding.
ASSESSING THE ACCURACY OF A LARGE OBSERVATIONAL REGISTRY OF NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Nguyen Vuong , Leung King Fai Calvin , Nguyen Chu Luan , Squirrell David , Essex Rohan , Arnold Jennifer , Young Stephanie , Barthelmes Daniel , Gillies Mark ,   the Fight Retinal Blindness! Study Group
Published: March 2019

Purpose:
To evaluate the accuracy of an observational database that tracks real-world treatment outcomes for neovascular age-related macular degeneration.

Methods:
We audited 245 randomly sampled eyes from 189 patients with 3,356 visits from 11 doctors in the Fight Retinal Blindness! database. Sex, birth year, previous treatments received, treatment, and visual acuity were validated against the clinical notes. Error rates, the proportion of missed visits (the number of visits present in the patient record but not entered into Fight Retinal Blindness!), the level of agreement using Cohen's kappa (κ) and intraclass correlation coefficients, and positive and negative predictive values were calculated. A visual acuity error was defined as an absolute difference of ≥5 letters.

Results:
The overall error rate was 3.5% (95% confidence interval: 3.1–3.9). The error rate for visual acuity was 5.1% (95% confidence interval: 4.2–5.9) and <5% for the remaining fields. The level of agreement for each field ranged from good to excellent (κ or intraclass correlation ≥ 0.75). The positive predictive value and negative predictive value for visits were 99% and 89%, respectively. The proportion of missed visits was 10.2%.

Conclusion:
Accuracy of the Fight Retinal Blindness! database was good (>95%). The rate of missed visits was high, possibly due to the high burden of retrospective data entry or patients switching practitioners during treatment.
ALTERATION OF OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN A PATIENT WITH OCULAR ISCHEMIC SYNDROME
Authors: Saito Kazuma , Akiyama Hideo , Mukai Ryo 
Published: March 2019

Purpose:
To analyze optical coherence tomography angiography images in ocular ischemic syndrome (OIS) before and after carotid artery stenting.

Methods:
We report the case of an 80-year-old man with a history of hypertension and diabetes mellitus who developed OIS in the right eye due to right internal carotid artery stenosis 2 years earlier. After visual acuity declined in the left eye 2 years later, a neurosurgeon discovered left internal carotid artery stenosis, which led to the diagnosis of OIS in the left eye as well. After carotid artery stenting, improvements were observed in both visual acuity and blood flow as assessed by laser speckle flowgraphy. The area of the foveal avascular zone and density of the retinal vessel at the level of the superficial and deep retinal layers were analyzed using optical coherence tomography angiography before and after treatment.

Results:
Mean superficial foveal avascular zone area was 0.29 mm2 before treatment, decreasing by 29.97% to 0.20 mm2 after treatment. Mean deep foveal avascular zone area was 1.72 mm2 before treatment, decreasing by 20.35% to 1.37 mm2 after treatment. Superficial or deep vessel density increased by 33.4% and 34.3% after treatment, respectively.

Conclusion:
Optical coherence tomography angiography confirmed foveal avascular zone area reduction and increased vessel density in all retinal layers after carotid artery stenting for OIS. These findings suggest that optical coherence tomography angiography may be useful for evaluating blood flow and treatment efficacy in OIS.
Relationship Between Contact Lens and Pinguecula
Authors: Dundar Huseyin , Kocasarac Can 
Published: March 2019

Purpose:
To investigate the effects of contact lens (CL) on the frequency of pinguecula, and the relationship between dry eye disease and pinguecula.

Methods:
Two hundred and 33 cases of soft CL wearers and 230 age-matched nonwearers were enrolled in the study. Schirmer I test (ST) scores and tear break-up time (TBUT) were determined in all participants. A questionnaire including ocular surface disease index (OSDI), age, sex, and duration of CL wear was implemented to the participants before the examination.

Results:
The prevalence of pinguecula was 27.8% (n: 65) in the CL group and 26.5% (n: 61) in the control group. There was no significant difference between the groups (P=0.841). The prevalence of pinguecula increased with age in both groups. There was no significant difference in the prevalence of pinguecula when users were divided into three groups according to the duration of CL wear (P=0.575). The TBUT scores were lower, and the OSDI scores were higher in the CL group. The TBUT scores were lower in patients with pinguecula in both groups. The OSDI scores were higher in the CL group. There was no significant difference regarding the OSDI scores between patients with pinguecula and healthy participants in the CL group; however, OSDI scores were significantly higher in patients with pinguecula in control group. There were no significant differences in the ST scores between the groups, and between patients with pinguecula and healthy participants.

Conclusion:
This is the second study that evaluates the effects of soft CL wearing on pinguecula prevalence. We found that CL wearing does not affect the prevalence of pinguecula. Considering the OSDI scores in patients with pinguecula in the CL group, CL may suppress the irritant symptoms of pinguecula.
Conjunctival Flaps: A Case Series and Review of the Literature
Authors: Oostra Tyler D. , Mauger Thomas F. 
Published: March 2019

Purpose:
The purpose of this study was to examine the outcomes of conjunctival flaps performed at our institution.

Methods:
The medical records of all patients who underwent a total or partial conjunctival flap surgery over the course of a 6-year period from 2010 to 2015 were reviewed to identify the ocular diagnoses and perform a retrospective review of the preoperative and postoperative course.

Results:
Thirty-five patients received a conjunctival flap during the 6-year period, 20 partial flaps and 15 total flaps. Infectious keratitis or corneal ulceration accounted for 25 (71.4%) of the cases. The remaining flaps were performed for corneal perforation, graft rejection, bullous keratopathy, and secondary corneal edema. Seven patients had recession of their flap postoperatively, and 14 went on to have further surgical intervention. Conjunctival flap surgery successfully stabilized the patient's ocular surface in 97.1% of the cases.

Conclusion:
Conjunctival flap surgery is an important and useful surgical option in the treatment of ocular surface disease, especially recalcitrant infectious keratitis and corneal ulcers.
Assessment of Ocular Surface in Patients With Ankylosing Spondylitis
Authors: Oltulu Refik , Turk Huseyin Bugra , Oltulu Pembe , Turk Nazli , Satirtav Gunhal , Gunduz Mehmet Kemal 
Published: March 2019

Purpose:
To evaluate the clinical findings and ocular surface changes in patients with ankylosing spondylitis (AS).

Methods:
This prospective study involved 45 patients with AS (group 1) and 28 healthy subjects (group 2). Patients in group 1 were in the inactive period. The study subjects underwent a complete ophthalmic examination. The right eyes of the subjects in each group were tested for the study including slit-lamp examination, Schirmer I test, tear break-up time (TBUT), conjunctival impression cytology (CIC), and ocular surface disease index (OSDI). Results between the two groups were compared.

Results:
The mean Schirmer I test result was found as 12.2±8 mm in group 1 and 20.3±9.9 mm in group 2 (P<0.001), whereas the mean TBUT value was found as 3.8±1.9 sec in group 1 and 10.1±4.8 sec in group 2 (P<0.001). The OSDI scores were significantly higher in group 1 (36.5±19.4) than in group 2 (9.1±12.9, P<0.001). The CIC scores were significantly higher in group 1 (2.12±0.7) than in group 2 (0.57±0.6, P<0.001). Notably, none of the patients in group 1 showed grade 0 differentiation, and none of the patients in group 2 showed grade 2 or 3 differentiation. The CIC scores were significantly higher in group 1 (2.12±0.7) than in group 2 (0.57±0.6, P<0.001).

Conclusion:
Ocular surface changes, including squamous metaplasia in the bulbar conjunctiva, can be observed in patients with AS.
An Antimicrobial Stewardship Intervention Improves Adherence to Standard of Care for Staphylococcus aureus Bloodstream Infection
Authors: Brock James B. , Cretella David A. , Parham Jason J. 
Published: March 2019

ABSTRACT

Introduction:

Staphylococcus aureus bloodstream infections (SABSI) are a major cause of morbidity and mortality in the United States, and proper management is important to effect cure and prevent metastatic foci of infection. We aimed to utilize our antimicrobial stewardship program (ASP) to improve practices at a large academic hospital system.

Methods:
Our ASP implemented a SABSI educational campaign directed at the hospital medicine, cardiology, and infectious diseases divisions. A stewardship intervention was then begun for all patients with SABSI recommending infectious diseases consultation, transesophageal echocardiography (TEE), source control, and preliminary antibiotic changes. A retrospective review was performed for all SABSI cases 2 years before and after implementation of the SABSI intervention.

Results:
Two hundred forty-three cases before intervention and 259 after intervention were included. An increase in obtaining follow-up negative blood cultures (79.8% vs. 89.6%), infectious diseases consultation (52.7% vs. 86.5%), TEE (25.5% vs. 54.8%), beta-lactam switch for methicillin-susceptible S. aureus (55.2% vs. 74.4%), and source control (41.2% vs. 57.9%) was demonstrated. We demonstrated similar durations of bacteremia, length of stay, relapse, mortality, and rates of infective endocarditis.

Conclusions:
Adherence to standard of care for patients with SABSI can be dramatically improved through provider education, leveraging antimicrobial stewardship resources, and infectious diseases consultation.
Advances of pathological complete response after neoadjuvant therapy for pancreatic cancer
Authors: Yin Lingdi , Miao Yi , Yu Jun 
Published: March 2019

Abstract
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with a poor prognosis. Only 15% to 20% of patients present with a primarily resectable tumor at the time of diagnosis. There has been an increasing interest in the use of neoadjuvant chemotherapy alone or combination with radiotherapy in patients with resectable, borderline resectable, and locally advanced pancreatic cancer. Although the benefit of neoadjuvant therapy on resectable patients remains controversial, around one third of borderline resectable and locally advanced patients could be expected to have resectable tumors following neoadjuvant therapy, with comparable survival as those with primary resectable tumors. A pathological complete response (pCR) in PDAC is an indicator for significantly better survival although it's rather rare. In this review, we present recent progress of pCR and the controversies in pancreatic cancer after neoadjuvant therapy.
Prognostic factors for disease-free survival in patients with pancreatic ductal adenocarcinoma after surgery: a single center experience
Authors: Tian Xiaodong , Li Jisong , Gao Hongqiao , Zhuang Yan , Ma Yongsu , Chen Yiran , Xie Xuehai , Yang Yinmo 
Published: March 2019

Abstract

Objective:
To evaluate the risk factors for the disease-free survival (DFS) of pancreatic ductal adenocarcinoma (PDAC) patients after surgery, and to validate the clinical applicability and prognostic stratification of the 8th edition American Joint Committee on Cancer (AJCC) staging system.

Methods:
A cohort of 185 patients with PDAC who underwent surgical resection in the General Surgery Department of Peking University First Hospital from January 2010 to December 2017 was enrolled retrospectively. The clinicopathological characteristics and survival data were analyzed to find out risk factors correlated to DFS. The survival curves were calculated according to the 8th edition of AJCC staging system.

Results:
Among the 185 PDAC patients, 125 (67.6%) with pancreatic head carcinoma underwent pancreatoduodenectomy or total pancreatectomy, and 60 (32.4%) with tumors located in the pancreatic body and tail underwent distal pancreatectomy and splenectomy. R0 resection was achieved in 97 patients (52.4%), and the R1 and R2 resections rate was 44.9% and 2.7%, respectively. One hundred five patients (56.8%) received postoperative adjuvant chemotherapy. The median overall survival (OS) was 21 (95% confidence interval [CI] 17.7–24.3) months, and median DFS was 15 (95% CI 13.6–16.5) months. Univariate analysis showed that AJCC T and N staging, status of resection margin, grade of tumor differentiation, perineural invasion, intravascular cancer embolus, combined vascular resection, neutrophil-to-lymphocyte ratio (NLR) ≥ 2, carcinoembryonic antigen ≥5 ng/mL, carbohydrate antigen 19-9 (CA 19-9) ≥ 400 U/mL, and without postoperative adjuvant chemotherapy were correlated with shorter DFS. Furthermore, AJCC T3, N1 and N2 staging, R2 resection, low-grade or undifferentiated tumors, combined vascular resection, NLR ≥ 2, CA 19-9 ≥ 400 U/mL, and without postoperative adjuvant chemotherapy were independent risk factors for DFS. Both the DFS and OS curves were well separated by stage using the 8th staging classification.

Conclusions:
The 8th edition of AJCC T, primary tumor; N, regional lymph nodes; M, distant metastasis staging system could predict the prognosis of PDAC accurately. Patients with AJCC T3, N1 and N2 staging, R2 resection, low-grade or undifferentiated tumors, combined vascular resection, NLR ≥ 2, CA 19-9 ≥ 400 U/mL, and without postoperative adjuvant chemotherapy, have a significantly higher risk of tumor recurrence and shorter DFS after surgery. R0 resection and adjuvant chemotherapy could significantly prolong the DFS of PDAC patients.