bluuebunny/crossref_metadata_2025_split huggingface dataset:
Frequency, Risk Factors, Causes, and Consequences of Diagnostic Errors in Critically Ill Medical Patients: A Retrospective Cohort Study
Authors: Bergl Paul A. , Taneja Amit , El-Kareh Robert , Singh Hardeep , Nanchal Rahul S. 
Published: September 2019

Objective:
Diagnostic errors are a source of significant morbidity and mortality but understudied in the critically ill. We sought to characterize the frequency, causes, consequences, and risk factors of diagnostic errors among unplanned ICU admissions.

Design:
We conducted a retrospective cohort study of randomly selected nonsurgical ICU admissions between July 2015 and June 2016.

Setting:
Medical ICU at a tertiary academic medical center.

Subjects:
Critically ill adults with unplanned admission to the medical ICU.

Measurements and Main Results:
The primary investigator reviewed patient records using a modified version of the Safer Dx instrument, a validated instrument for detecting diagnostic error. Two intensivists performed secondary reviews of possible errors, and reviewers met periodically to adjudicate errors by consensus. For each confirmed error, we judged harm on a 1–6 rating scale. We also collected detailed demographic and clinical data for each patient. We analyzed 256 unplanned ICU admissions and identified 18 diagnostic errors (7% of admissions). All errors were associated with harm, and only six errors (33%) were recognized by the ICU team within the first 24 hours. More women than men experienced a diagnostic error (11.7% vs 2.7%; p = 0.015, χ2 test). On multivariable logistic regression analysis, female sex remained independently associated with risk of diagnostic error both at admission (odds ratio, 5.18; 95% CI, 1.34–20.08) and at 24 hours (odds ratio, 11.6; 95% CI, 1.37–98.6). Similarly, Quick Sequential Organ Failure Assessment score greater than or equal to 2 at admission was independently associated with diagnostic error (odds ratio, 5.73; 95% CI, 1.72—19.01).

Conclusions:
Diagnostic errors may be an underappreciated source of ICU-related harm. Women and higher acuity patients appear to be at increased risk for such errors. Further research is merited to define the scope of error-associated harm and to clarify risk factors for diagnostic errors among the critically ill.
ATX-101 (Deoxycholic Acid Injection) Leads to Clinically Meaningful Improvement in Submental Fat: Final Data From CONTOUR
Authors: Behr Kathleen , Kavali Carmen M. , Munavalli Girish , Teller Craig F. , Yoelin Steve , Breshears Laura , Sangha Sara 
Published: September 2019

BACKGROUND
Submental fat (SMF) can negatively affect perceptions of health and attractiveness. The Condition of Submental Fullness and Treatment Outcomes Registry (CONTOUR) was designed to understand SMF treatment in clinical practice.

OBJECTIVE
To report efficacy, treatment characteristics, and safety associated with real-world use of ATX-101 (deoxycholic acid injection).

METHODS
CONTOUR enrolled adults considering treatment for SMF reduction. ATX-101–treated patients who completed the end-of-treatment questionnaire were divided into those who ended treatment because they met their treatment goals (n = 197) and those who did not (n = 196).

RESULTS
Patients who met their goals (a more defined jawline, looking younger, and looking thinner) were more likely to have less SMF at baseline and to receive ≥2 ATX-101 treatments. More patients who met their goals achieved clinically meaningful reduction in SMF and reported increased satisfaction with their appearance (90% vs 57%). Moderate and severe patients' ATX-101 volume was similar for both those who met goals and those who did not, but extreme patients who met their goals required 10 mL more than those patients who did not.

CONCLUSION
Careful patient selection, adequate volume administration, and an appropriate number of treatments (dependent on baseline SMF severity) contribute to successful outcomes with ATX-101.
Assessing the Feasibility of an Alternative Payment Model for Mohs Micrographic Surgery at an Academic Center
Authors: Auh Sogyong , Chitgopeker Pooja , Hammel Josh , Ferguson Nkanyezi , Johnson-Jahangir Hillary , Van Beek Marta 
Published: September 2019

BACKGROUND
Mohs micrographic surgery (MMS) is a cost-effective treatment for nonmelanoma skin cancer that bundles costs for surgical excision, tissue processing, and histopathological interpretation. A comprehensive MMS bundle would include all aspects of an episode of care (EOC), including costs of reconstruction, preoperative, and postoperative care.

OBJECTIVE
To assess the feasibility of an alternative payment model for MMS and reconstruction.

METHODS
Retrospective chart review and payment analysis for 848 consecutive patients with 1,056 tumors treated with MMS. Average Medicare payment of an EOC was compared with bundles based on specific repair types.

RESULTS
The bundle for a flap/graft repair averaged $1,028.08 (confidence interval [CI] 95% $951.37–1,104.79), whereas the bundle for a linear closure (LC) averaged $585.07 (CI 95% $558.75–611.38). The average bundle including all repairs was $730.05 (CI 95% $692.31–767.79), which was statistically significant from both the flap/graft and LC bundles.

CONCLUSION
Bundling surgical repairs with MMS based on an average payment does not represent the heterogeneity of the care provided and results in either underpayment or overpayment for a substantial portion of cases. Consequently, EOC payments bundling MMS and surgical repairs would inaccurately reimburse physicians for work completed. Current payment methodology allows for accurate payment for this already cost-effective therapy.
Rigid Gas-Permeable Contact Lenses Fitting Philosophy for Unilateral Aphakic Infants
Authors: Zhang Xiaoxiao , Zeng Junwen , Zhai Zhou , Li Cong , Yang Xiao 
Published: September 2019

Purpose:
To provide fitting guidelines with suggested powers and base curves (BCs) and diameters for initial rigid gas-permeable (RGP) contact lenses (CLs) selection for unilateral aphakic infants based on age.

Methods:
Records of 52 children (52 eyes) with RGP CLs to unilateral aphakia between 2014 and 2019 were evaluated. Refractive status was assessed by standard retinoscopy. The original BC and diameter were determined by keratometric readings and fluorescein pattern under sedation. Correlation analysis was performed between age and CLs parameters. Linear regression analysis was used to develop a model for estimating power with the help of infant's age. Subgroup analysis was performed by grouping the eyes into four groups according to age. Lens adjustments and adverse events were also evaluated.

Results:
The median age was 9.0 months (interquartile range [IQR], 5.25–13.0 months). The mean power and BC and diameter of the initial RGP CLs were 25.46±4.83 diopters, 7.57±0.40 mm, and 9.48±0.23 mm, respectively. All these parameters showed correlations with infant's age (Pearson r=−0.676, 0.367, and 0.497, respectively; P=0.000, 0.008, and 0.000, respectively). Regression analysis revealed that CL power =31.66 to 0.62×age (P<0.001). The median follow-up was 7.50 months (IQR, 3.0–11.0 months). Lens adjustments took about every 3 months before 1 year of age and every 5 months afterward (F=3.442; P=0.024). The RGP CLs provided ideal fit characteristics, and no severe lens-related adverse event occurred except only one patient had mild conjunctivitis.

Conclusions:
Our empirical RGP CLs fitting philosophy presented that aphakic infant's age can be used to determine the initial lens if accurate biometry cannot be obtained initially.
Long-term Outcomes on de novo Ocular Hypertensive Response to Topical Corticosteroids After Corneal Transplantation
Authors: Raj Akash , Salvador-Culla Borja , Anwar Hamed , Sykakis Evripidis , Figueiredo María Socorro , Figueiredo Francisco Carlos 
Published: September 2019

Purpose:
To determine incidence, demographics, management, and outcomes of topical steroid-induced ocular hypertension after penetrating keratoplasty (PKP) and to establish effects on intraocular pressure (IOP) and graft rejection when alternate corticosteroids are used.

Methods:
A single-center, retrospective review of 568 consecutive PKPs performed between 1997 and 2010 was conducted. Data were collected on demographics, best-corrected visual acuity, surgical indications, lens status, IOP, postoperative management, and incidence of rejection.

Results:
Eighty eyes (14.1%) of 74 patients were included. The most common indication was keratoconus (28.8%). Twenty-seven eyes (33.8%) were phakic, 46 (57.4%) had a posterior chamber intraocular lens, and 7 (8.8%) had an anterior chamber intraocular lens. Mean postoperative IOP increase was only significant in the anterior chamber intraocular lens group (18.7 mm Hg, SD 10.4; P = 0.02). The average time for developing hypertension was 9.8 months (SD 14.8) postoperatively, with an average IOP increase of 13.3 mm Hg (SD 5.9). Prednisolone acetate 1% was switched to rimexolone 1% in 64 eyes (80%) and to fluorometholone 0.1% in 16 eyes (20%), which alone achieved IOP normalization in 26 eyes (32.5%) (P < 0.01). Fifty-four eyes (67.5%) required additional antiglaucoma medication. An average IOP reduction of 12.3 mm Hg (SD 6.9) was achieved at an average of 2.3 months (SD 5.2) after the switch. Seventeen eyes (21%) developed glaucoma and 13 eyes (16.3%) developed graft rejection after switching formulations, with no statistically significant differences between rimexolone and fluorometholone (P > 0.05).

Conclusions:
The use of alternate topical corticosteroids may be considered in cases of steroid-induced ocular hypertension after PKP because they offer good antiinflammatory prophylaxis with reduced hypertensive response.
Prevalence of Novel Candidate Sjögren Syndrome Autoantibodies in the Penn Sjögren's International Collaborative Clinical Alliance Cohort
Authors: Bunya Vatinee Y. , Massaro-Giordano Mina , Vivino Frederick B. , Maguire Maureen G. , Baer Alan N. , Gonzales John A. , Ying Gui-shuang 
Published: September 2019

Purpose:
To evaluate the prevalence of novel candidate autoantibodies associated with Sjögren syndrome (SS) and their ability to identify those with SS among participants with dry eye enrolled in the Sjögren's International Collaborative Clinical Alliance (SICCA) study at the University of Pennsylvania (Penn).

Methods:
All participants previously underwent a full ocular and systemic evaluation for possible SS as part of the SICCA study. An enzyme-linked immunosorbent assay was used to detect IgG, IgA, and IgM autoantibodies to salivary protein 1 (SP-1), parotid secretory protein (PSP), and carbonic anhydrase 6 from previously banked baseline serum samples from SICCA study participants enrolled at Penn. The prevalence rate of each autoantibody, calculated by considering the presence of any isotype as antibody positive, was compared between participants with dry eye with SS (n = 81) or without SS (n = 129) using the Fisher exact test.

Results:
The prevalence of SP-1 IgM autoantibodies was higher in those with SS compared with those without SS (14% vs. 5%; P = 0.03). Similarly, the prevalence of PSP IgA autoantibodies was higher in those with SS compared with non-SS dry eye participants (21% vs. 11%; P = 0.048). There was no statistically significant difference in the prevalence of carbonic anhydrase 6 autoantibodies between those with or without SS (15% vs. 20%; P = 0.36).

Conclusions:
In the Penn SICCA cohort, SP-1 IgM and PSP IgA autoantibodies were more prevalent in the serum of SS-related dry eye participants compared with those without SS. Further longitudinal studies are needed to determine the clinical significance of these findings.
The Development and Evaluation of an Analytical Framework to Explore Student Nurses' Cultural Beliefs of Dementia
Authors: OJO Omorogieva , BROOKE Joanne , CRONIN Camille 
Published: September 2019

ABSTRACT

Background:
People diagnosed with dementia need culturally sensitive, person-centered care to promote their health and well-being. Therefore, healthcare professionals should be able to provide culturally competent care, of which an element is the understanding of their own cultural heritage and how this impacts on their beliefs regarding dementia, as cultural norms and values provide meanings and understanding of chronic conditions such as dementia. This study used focus groups to explore the cultural beliefs of student nurses regarding dementia, generating a large set of qualitative data that required structure and a framework to analyze.

Purpose:
One purpose of this article was to present the methodological analysis, which encompasses the analytical framework. The second purpose was to apply the framework to elicit the cultural beliefs regarding dementia among student nurses from multiple national backgrounds.

Methods:
Focus groups with student nurses from five higher education institutes in England, the Philippines, Slovenia, and New Zealand were conducted, audiotaped, and transcribed verbatim. The qualitative data were analyzed using the framework method of analysis. Data from the focus groups conducted at the two higher education institutes in England were analyzed by encompassed synthesizing, refining, and agreeing on the codes, categories, and themes that were established separately by four researchers. The developed analytical framework was then tested on the qualitative data obtained from the focus groups conducted in Slovenia, the Philippines, and New Zealand.

Results:
The results were presented in three parts: the cultural analytical framework, the process of developing the initial categories/themes, and the final themes that emerged from the data obtained from the focus groups.

Conclusions:
An analytical framework was developed and applied to understand student nurses' cultural values and beliefs of dementia.
A meta-analysis of the effects of probiotics and synbiotics in children with acute diarrhea
Authors: Yang Bo , Lu Ping , Li Mei-Xuan , Cai Xiao-Ling , Xiong Wan-Yuan , Hou Huai-Jing , Ha Xiao-Qin 
Published: September 2019

AbstractObjective:This meta-analysis assessed the effectiveness of probiotics and synbiotics for acute diarrhea (AD) in children and investigated probiotic formulations, types of interventions, and country factors.Methods:Randomized, double-blind, placebo-controlled trials evaluating the effects of probiotics or synbiotics on AD were analyzed. We followed the recommendations of the Cochrane Handbook and the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The risks of systematic errors (bias) and random errors were assessed, and the overall quality of the evidence was evaluated using the Grades of Recommendations Assessment, Development, and Evaluation (GRADE) approach.Results:The meta-analysis included 34 studies with 4911 patients. Five and 29 studies presented the results of synbiotic and probiotic interventions, respectively. After intervention, the durations of diarrhea (weighted mean difference (WMD) = −16.63 [−20.16; −12.51]) and hospitalization (risk ratio (RR) = 0.59 [0.48; 0.73]) were shorter, the stool frequency on day 3 (WMD = −0.98 [−1.55; −0.40]) was decreased, and the incidence of diarrhea lasting 3 days was lower in the probiotic and synbiotic groups than in the control groups. Furthermore, in the subgroup analyses, synbiotics were more effective than probiotics at reducing the durations of diarrhea and hospitalization, and Saccharomyces and Bifidobacterium were more effective than Lactobacillus at reducing the duration of diarrhea.Conclusion:This meta-analysis supports the potential beneficial roles of probiotics and synbiotics for AD in children. Further research is needed to determine problems associated with probiotic/synbiotic mixtures and appropriate dosages.
Open reduction and internal fixation of mandibular condylar fractures
Authors: Kuang Shi-Jun , He Yi-Qing , Zheng You-Hua , Zhang Zhi-Guang 
Published: September 2019

Abstract
The purpose of this study was to compare outcomes of open reduction and internal fixation (ORIF) versus closed reduction (CR) for mandibular condylar fractures.
Patients included in the National Inpatient Sample (NIS) database (2005–2014) who were admitted to the hospital for unilateral mandibular condylar fracture were included in the analysis. Patient characteristics and clinical outcomes were compared between those who received ORIF and those receiving CR. Logistic regression analysis was performed to estimate odds ratios (ORs) for each aspect of the main observed events.
NIS data of 12,303 patients who underwent ORIF and 4310 patients who underwent CR were analyzed. Compared to CR, ORIF had an increased risk of longer hospital stay (adjusted OR [aOR] = 1.78, 95% confidence intervals [CIs] = 1.51–2.09), higher total medical cost (aOR = 2.57, 95% CI = 2.17–3.05), and hematoma development (aOR = 10.66, 95% CI = 1.43–75.59), but had a lower risk of having wound complications (aOR = 0.86, 95% CI = 0.79–0.93).
Patients with mandibular condylar fractures who receive ORIF have greater risk of having an extended hospital stay, higher total medical costs, and hematoma development but lower risk of experiencing wound complications compared to those who receive CR.
Pre-transplant CD200 and CD200R1 concentrations are associated with post-transplant events in kidney transplant recipients
Authors: Oweira Hani , Khajeh Elias , Mohammadi Sara , Ghamarnejad Omid , Daniel Volker , Schnitzler Paul , Golriz Mohammad , Mieth Markus , Morath Christian , Zeier Martin , Mehrabi Arianeb , Sadeghi Mahmoud 
Published: September 2019

Abstract
CD200 is an immunoglobulin superfamily membrane protein that binds to a myeloid cell-specific receptor and induces inhibitory signaling. The aim of this study was to investigate the role of CD200 and its receptor (CD200R1) on kidney transplant (KTx) outcome. In a collective of 125 kidney recipients (University hospital, Heidelberg, Germany), CD200 and CD200R1 concentrations were evaluated immediately before transplantation. Recipient baseline and clinical characteristics and KTx outcome, including acute rejection (AR), acute tubular necrosis, delayed graft function, cytomegalovirus (CMV) and human polyomaviridae (BK) virus infections, and graft loss were evaluated during the first post-transplant year. The association of CD200 and CD200R1 concentrations and CD200R1/CD200 ratios with the outcome of KTx was investigated for the first time in a clinical setting in a prospective cohort. There was a positive association between pre-transplant CD200R1 concentrations and CMV (re)activation (P = .041). Also, increased CD200R1 concentration was associated with a longer duration of CMV infection (P = .049). Both the frequency of AR and levels of creatinine (3 and 6 months after KTx) were significantly higher in patients with an increased CD200R1/CD200 ratio (median: 126 vs 78, P
= .008). Increased pre-transplant CD200R1/CD200 ratios predict immunocompetence and risk of AR, whereas high CD200R1 concentrations predict immunosuppression and high risk of severe CMV (re)activation after KTx.
High expression of cytokeratin CAM5.2 in esophageal squamous cell carcinoma is associated with poor prognosis
Authors: He Shujin , Peng Jie , Li Lei , Xu Ying , Wu Xiaoxiao , Yu Juan , Liu Jianli , Zhang Jinguo , Zhang Renya , Wang Wei 
Published: September 2019

Abstract
Esophageal cancer is a common human malignant tumor with high mortality. Glandular epithelial markers, such as CAM5.2, can be expressed in esophageal squamous cell carcinoma (ESCC), but the clinical significance of these cells in ESCC remains elusive.
Immunohistochemical analysis of CAM5.2 was performed on 604 ESCC specimens using tissue microarray. Our study design and study population used retrospective cohorts based on the hospital information system and pathological information management system which included medical information, date of admission, procedures undergone, registration, examinations, and medication.
In total, positive staining of CAM5.2 was 145 of 604 (24%). Statistical analysis showed that the expression of CAM5.2 had no relationship with sex, age, tumor differentiation, tumor size, tumor-node-metastasis (TNM) classification, and lymph node metastasis, but it was significantly associated with poor prognosis of overall survival (P = .0041) and disease-free survival (P = .0048) in ESCC patients.
Herein, we report for the first time that the high expression of the CAM 5.2 is an independent predictor of poor prognosis in patients with ESCC.
Association between the DRD2 TaqIA gene polymorphism and Parkinson disease risk: an updated meta-analysis
Authors: Yu Ming , Huang Feiran , Wang Wei , Zhao Chen 
Published: September 2019

Abstract

Background:
DRD2 TaqIA polymorphism may be associated with an increased risk of developing Parkinson disease (PD). However, the individual study's results are still inconsistent.

Methods:
A meta-analysis of 4232 cases and 4774 controls from 14 separate studies were performed to explore the possible relationship between the DRD2 TaqIA gene polymorphism and PD. Pooled odds ratios (ORs) for the association and the corresponding 95% confidence intervals (CIs) were evaluated by a fixed-effect model.

Results:
The pooled results revealed a significant association between DRD2 gene TaqIA polymorphism under recessive genetic model (OR: 0.91, 95% CI:0.83,0.99, P = .031) and additive genetic models (OR:0.93,95%CI:0.87,0.99, P = .032), but not associated with PD susceptibility under other genetic models in the whole population. Moreover, subgroups based on ethnicity and genotyping methods showed this association in the Caucasian subgroup under recessive genetic model (OR: 0.85, 95% CI:0.76,0.95, P = .003) and additive genetic models (OR:0.87,95%CI:0.79,0.96, P = .004) were existed. Besides, no significant association was detected under 6 genetic models in the Asian populations and PCR-RFLP subgroup.

Conclusions:
The current meta-analysis suggested that a significant association between DRD2 TaqIA polymorphism and PD under the recessive genetic mode, and additive genetic models, especially in Caucasians.
Expression and significance of urinary microRNA in patients with chronic hepatitis B
Authors: Shang Jia-Wei , Yan Xiu-Li , Zhang Hui , Su Shi-Bing 
Published: September 2019

Abstract
The aim of this study was to investigate the alterations of urinary microRNA (miRNA) expression and explore its clinical significance in patients with chronic hepatitis B (CHB).
The expression levels of urinary miRNA were detected by miRNA microarray and quantitative reverse transcription polymerase chain reaction (qRT-PCR) from 106 CHB and 40 healthy controls (Ctrl) subjects. The correlation between the levels of miRNA expression and clinical characteristics were analyzed. Receiver-operator characteristic (ROC) curves were generated to determine the specificity and sensitivity of each individual miRNA. MiRNAs expression were further measured by PCR from exosomes, which were isolated from urine samples. LX2 cells were transfected with miRNA inhibitor and accumulation of cytoplasmic lipid droplets was analyzed by Oil Red O staining.
miRNA expression profile analysis showed that 22 miRNAs were upregulated and 55 miRNAs were downregulated in CHB patients compared with Ctrl subjects (fold-change>1.5 and P < .05). miR-92b-3p, miR-770-5p, miR-5196-5p, and miR-7855-5p were significantly higher (P < .0001) in CHB subjects than in Ctrl subjects. ROC curve analysis showed that these four miRNAs were sensitive and specific enough to distinguish CHB and Ctrl subjects. The levels of miR-92b-3p expression were negatively correlated with total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and APOA-1. Moreover, in vitro experiments indicated that inhibition of miR-92b-3p increased lipid droplet formation in LX2 cells.
Aberrant expression of miRNAs has been observed in urine of CHB patients. Our findings may provide novel insights into the pathogenesis of CHB and may assist in the diagnosis of patients with CHB.