bluuebunny/crossref_metadata_2025_split huggingface dataset:
Usefulness of guideline recommendations for prognosis in patients with candidemia
Authors: Cuervo Guillermo , Garcia-Vidal Carolina , Puig-Asensio Mireia , Merino Paloma , Vena Antonio , Martín-Peña Almudena , Montejo José Miguel , Ruiz Alba , Lázaro-Perona Fernando , Fortún Jesús , Fernández-Ruiz Mario , Suarez Ana Isabel , Castro Carmen , Cardozo Celia , Gudiol Carlota , Aguado José María , Paño Jose Ramón , Pemán Javier , Salavert Miquel , Garnacho-Montero José , Cisneros José Miguel , Soriano Alex , Muñoz Patricia , Almirante Benito , Carratalà Jordi ,   for the REIPI, the GEMICOMED (SEIMC) and the Spanish CANDI-Bundle Group
Published: October 2018

AbstractWe aimed to analyze whether the lack of inclusion of specific recommendations for the management of candidemia is an independent risk factor for early and overall mortality. Multicenter study of adult patients with candidemia in 13 hospitals. We assessed the proportion of patients on whom nine specific ESCMID and IDSA guidelines recommendations had been applied, and analyzed its impact on mortality. 455 episodes of candidemia were documented. Patients who died within the first 48 hours were excluded. Sixty-two percent of patients received an appropriate antifungal treatment. Either echinocandin or amphotericin B therapy were administered in 43% of patients presenting septic shock and in 71% of those with neutropenia. Sixty-one percent of patients with breakthrough candidemia underwent a change in antifungal drug class. Venous catheters were removed in 79% of cases. Follow-up blood cultures were performed in 72% of cases. Ophthalmoscopy and echocardiogram were performed in 48% and 50% of patients, respectively. Length of treatment was appropriate in 78% of cases. Early (2–7 days) and overall (2–30 days) mortality were 8% and 27.7%, respectively. Inclusion of less than 50% of the specific recommendations was independently associated with a higher early (HR = 7.02, 95% CI: 2.97–16.57; P < .001) and overall mortality (HR = 3.55, 95% CI: 2.24–5.64; P < .001). In conclusion, ESCMID and IDSA guideline recommendations were not performed on a significant number of patients. Lack of inclusion of these recommendations proved to be an independent risk factor for early and overall mortality.
The Facility-Level HIV Treatment Cascade: Using a Population Health Tool in Health Care Facilities to End the Epidemic in New York State
Authors: Ikeda Daniel J , Hollander Leah , Weigl Susan , Sawicki Steven V , Belanger Daniel R , West Nova Y , Brey Magnani Nanette , Wells Christopher G , Gordon Peter , Morne Johanne , Agins Bruce D 
Published: October 2018

Abstract

Background
The HIV treatment cascade is a tool for characterizing population-level gaps in HIV care, yet most adaptations of the cascade rely on surveillance data that are ill-suited to drive quality improvement (QI) activities at the facility level. We describe the adaptation of the cascade in health care organizations and report its use by HIV medical providers in New York State (NYS).

Methods
As part of data submissions to the NYS Department of Health, sites that provide HIV medical care in NYS developed cascades using facility-generated data. Required elements included data addressing identification of people living with HIV (PLWH) receiving any service at the facility, linkage to HIV medical care, prescription of antiretroviral therapy (ART), and viral suppression (VS). Sites also submitted a methodology report summarizing how cascade data were collected and an improvement plan identifying care gaps.

Results
Two hundred twenty-two sites submitted cascades documenting the quality of care delivered to HIV patients presenting for HIV- or non-HIV-related services during 2016. Of 101 341 PLWH presenting for any medical care, 75 106 were reported as active in HIV programs, whereas 21 509 had no known care status. Sites reported mean ART prescription and VS rates of 94% and 80%, respectively, and 60 distinct QI interventions.

Conclusions
Submission of facility-level cascades provides data on care utilization among PLWH that cannot be assessed through traditional HIV surveillance efforts. Moreover, the facility-level cascade represents an effective tool for identifying care gaps, focusing data-driven improvement efforts, and engaging frontline health care providers to achieve epidemic control.
An uncommon cause of vision loss
Authors: Glover Julie M. , Casmaer Monica L. , April Michael D. 
Published: October 2018

ABSTRACT
Leber hereditary optic neuropathy (LHON) is a rare mitochondrial genetic disorder characterized by painless acute or subacute vision loss that develops during adolescence. Clinicians should know how to identify potential LHON and when to refer patients to a neuro-ophthalmologist for diagnosis and treatment. This case highlights the value of a thorough family history in ED patients.
Common causes of congenital stridor in infants
Authors: Clark Christine M. , Kugler Kathryn , Carr Michele M. 
Published: October 2018

ABSTRACT
Stridor is a high-pitched respiratory sound that signals upper airway obstruction. It can be encountered by clinicians in a variety of clinical settings and requires a team-based, interdisciplinary approach. Early recognition is crucial, as the differential diagnosis can be broad, and causes range from benign to life-threatening. This article reviews the most commonly encountered causes of chronic congenital stridor in infants, focusing on the diagnostic approach, pathophysiology, clinical presentation, and management strategies.
Does Incorporating a Measure of Clinical Workload Improve Workplace-Based Assessment Scores? Insights for Measurement Precision and Longitudinal Score Growth From Ten Pediatrics Residency Programs
Authors: Park Yoon Soo , Hicks Patricia J. , Carraccio Carol , Margolis Melissa , Schwartz Alan 
Published: October 2018

Purpose
This study investigates the impact of incorporating observer-reported workload into workplace-based assessment (WBA) scores on (1) psychometric characteristics of WBA scores and (2) measuring changes in performance over time using workload-unadjusted versus workload-adjusted scores.

Method
Structured clinical observations and multisource feedback instruments were used to collect WBA data from first-year pediatrics residents at 10 residency programs between July 2016 and June 2017. Observers completed items in 8 subcompetencies associated with Pediatrics Milestones. Faculty and resident observers assessed workload using a sliding scale ranging from low to high; all item scores were rescaled to a 1–5 scale to facilitate analysis and interpretation. Workload-adjusted WBA scores were calculated at the item level using three different approaches, and aggregated for analysis at the competency level. Mixed-effects regression models were used to estimate variance components. Longitudinal growth curve analyses examined patterns of developmental score change over time.

Results
On average, participating residents (n = 252) were assessed 5.32 times (standard deviation = 3.79) by different raters during the data collection period. Adjusting for workload yielded better discrimination of learner performance, and higher reliability, reducing measurement error by 28%. Projections in reliability indicated needing up to twice the number of raters when workload-unadjusted scores were used. Longitudinal analysis showed an increase in scores over time, with significant interaction between workload and time; workload also increased significantly over time.

Conclusions
Incorporating a measure of observer-reported workload could improve the measurement properties and the ability to interpret WBA scores.
Prognostic Factors for Physical Functioning After Multidisciplinary Rehabilitation in Patients With Chronic Musculoskeletal Pain
Authors: Tseli Elena , Boersma Katja , Stålnacke Britt-Marie , Enthoven Paul , Gerdle Björn , Äng Björn O. , Grooten Wilhelmus J.A. 
Published: October 2018

Objectives:
This systematic review aimed to identify and evaluate prognostic factors for long-term (≥6 mo) physical functioning in patients with chronic musculoskeletal pain following multidisciplinary rehabilitation (MDR).

Materials and Methods:
Electronic searches conducted in MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, and Cochrane CENTRAL revealed 25 original research reports, published 1983-2016, (n=9436). Potential prognostic factors relating to initial pain and physical and psychological functioning were synthesized qualitatively and quantitatively in random effects meta-analyses. The level of evidence (LoE) was evaluated with Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results:

Pain-related factors (intensity and chronicity) were not associated with function/disability at long-term follow-up, odds ratio (OR)=0.84; 95% confidence interval (CI), 0.65-1.07 and OR=0.97; 95% CI, 0.93-1.00, respectively (moderate LoE). A better function at follow-up was predicted by Physical factors; higher levels of initial self-reported functioning, OR=1.07; 95% CI, 1.02-1.13 (low LoE), and Psychological factors; low initial levels of emotional distress, OR=0.77; 95% CI, 0.65-0.92, low levels of cognitive and behavioral risk factors, OR=0.85; 95% CI, 0.77-0.93 and high levels of protective cognitive and behavioral factors, OR=1.49; 95% CI, 1.17-1.90 (moderate LoE).

Discussion:
While pain intensity and long-term chronicity did not predict physical functioning in chronic pain patients after MDR, poor pretreatment physical and psychological functioning influenced the prognosis negatively. Thus, treatment should further target and optimize these modifiable factors and an increased focus on positive, psychological protective factors may perhaps provide an opening for yet untapped clinical gains.
Spinal Cord Stimulators
Authors: Malige Ajith , Sokunbi Gbolabo 
Published: October 2018

Study Design.
A retrospective chart review.

Objective.
The aim of this study was to address and characterize the differences between pain relief obtained from the “trial” versus permanent stimulator in the acute postoperative period (less than 6 weeks).

Summary of Background Data.
After a short stimulator trial (typically less than 7 days), patients who report at least a 50% relief are set up for permanent spinal cord stimulator (SCS) placement. The literature has shown that a subset of patients develop tolerance to these stimulating therapies, often resulting in reduced efficacy of symptom relief as early as 2 years post-permanent implantation.

Methods.
Between the years of 2013 and 2017, 241 patient charts who underwent a successful trial and had a subsequent permanent SCS placed by a fellowship-trained surgeon through an open incision were reviewed. For each patient, demographic information, numerical rating system (NRS) pain scores, Oswestry Disability Index (ODI) scores, and opioid medication usage were recorded and stratified by time-period (before trial, after trial and before permanent placement, and after permanent SCS placement).

Results.
Of the 100 included patients, 60 were female; 60 patients had previous failed lumbar surgery (53%). Placement of trial stimulator (median = 4) decreased pain scores significantly more than permanent spinal cord stimulator did (median = 2) (P = 0.00). No significant difference was seen in ODI score difference between trial and initial scores (median = 4) and final and initial scores (median = 6) (P = 0.64). Finally, a significantly higher decrease in pain medication usage was seen after trial initiation (median = 0) versus after permanent spinal cord stimulator placement (median = 0) (P = 0.028). Twenty-two patients (22%) had reported complications, with 15 complaining of prolonged surgical site pain.

Conclusion.
Discrepancies observed in symptom alleviation between percutaneous trials and permanent placement in the acute 6-week postop period can have a significant effect on patient perceived outcomes. Understanding these issues will help in providing preoperative counseling and managing postoperative expectations.

Level of Evidence: 4
A Stab in the Back: An Unusual Case of Cutaneous Neural Infiltration as a Manifestation of Chronic Lymphoproliferative Disorder of Natural Killer Cells
Authors: Ní Mhaolcatha Sarah , Flynn Aoibheann , Hayes Brian , O'Shea Derville , Bennett Mary , Fitzgibbon James 
Published: October 2018

Abstract:
Chronic lymphoproliferative disorder of natural killer cells (CLPDNK) is a rare heterogenous indolent disorder comprising a persistent peripheral blood cell count of more than ≥2 × 109/L natural killer cells for over 6 months. We report an unusual case of cutaneous neural infiltration as a manifestation of CLPDNK. A 52-year-old woman with a background of CLPDNK was referred to dermatology with a painful rash primarily affecting her back. Skin biopsies revealed a neurotropic atypical lymphoid infiltration. Results of immunohistochemistry studies showed CD8, CD56, granzyme B, perforin positivity, and CD3 negativity in keeping with an atypical neurotropic lymphoid infiltrate consistent with cutaneous involvement by the patient's known CLPDNK. Cutaneous lesions and peripheral neuropathy in patients with CLPDNK have been reported; however, the involvement of cutaneous peripheral nerves as described in our case has not been reported before.
Impact of Food and Drug Administration Approval of Vismodegib on Prevalence of Orbital Exenteration as a Necessary Surgical Treatment for Locally Advanced Periocular Basal Cell Carcinoma
Authors: Sagiv Oded , Ding Stephanie , Ferrarotto Renata , Glisson Bonnie , Altan Mehmet , Johnson Faye , Elamin Yasir , Thakar Sudip D. , Nagarajan Priyadharsini , Esmaeli Bita 
Published: October 2018

Purpose:
To test the hypothesis that the US Food and Drug Administration approval of vismodegib in early 2012 has reduced the prevalence of orbital exenteration for locally advanced periocular basal cell carcinoma (BCC).

Methods:
Following institutional review board approval, the authors reviewed clinical and pathological data of patients with locally advanced periocular BCC (T4 per the eyelid carcinoma classification in the 8th edition of the AJCC Cancer Staging Manual) treated by the senior author during 2006–2018. Patients were grouped into those who were treated before February 2012 (“before vismodegib approval”) and those who presented later (“after vismodegib approval”).

Results:
Forty-two patients with locally advanced periocular BCC were treated during the study period, of whom 31 were men. The median age at presentation was 66 years (range, 43–90). Twenty-two patients had T4a and 20 had T4b tumors. Thirteen patients were treated before and 29 were treated after vismodegib approval. The 2 groups did not differ in age distribution (p = 0.164), sex distribution (p = 0.270), prevalence of recurrent tumor at presentation (p = 0.317), or duration of treatment with vismodegib (p = 0.605). Orbital exenteration was significantly more prevalent in patients treated before vismodegib approval than after (46% vs. 10%, p = 0.016), and vismodegib treatment was significantly more prevalent in patients treated after vismodegib approval than before (when vismodegib was given in clinical trials; 69% vs. 23%, p = 0.008). There was a trend toward more patients retaining their eyes at last follow-up in patients treated after vismodegib approval (83% vs. 54%, p = 0.066).

Conclusions:
The prevalence of orbital exenteration as a necessary surgical procedure in patients with a locally advanced periocular BCC has fallen since the Food and Drug Administration approval of vismodegib. Although vismodegib is not specifically approved for organ-sparing, it has changed the authors’ practice and enabled eye preservation in patients with locally advanced periocular BCC, who would otherwise require an orbital exenteration.
Disseminated Mycobacterium haemophilum Infection and Pneumocystis jirovecii Pneumonia in a Patient Receiving Immunosuppressive Therapy
Authors: Dalia Yoseph , Fahmy Joseph , Khoncarly Sarah , Moore Tyler L. , Myers Joseph P. 
Published: October 2018

Abstract
A 53-year-old woman with mixed connective tissue disease and rheumatoid arthritis on successive treatment regimens consisting of rituximab then adalimumab + prednisone then azathioprine + hydroxychloroquine + prednisone developed multiple tender upper and lower extremity skin lesions followed shortly by dry cough and shortness of breath. Skin biopsy and blood cultures eventually revealed Mycobacterium haemophilum, and transbronchial lung biopsy and bronchial washings revealed Pneumocystis jirovecii pneumonia. The patient was treated with endotracheal intubation, clarithromycin/rifampin/ciprofloxacin, and trimethoprim-sulfamethoxazole and survived, gradually returning to baseline state after hospital course during which she was intubated for 17 days. She survived but continues on lower-dose azathioprine and prednisone for her mixed connective tissue disease and rheumatoid arthritis. We conducted a strict review of the literature for all patients with disseminated M. haemophilum infection and looked for concurrent opportunistic infections. There was only one other patient with concurrent disseminated M. haemophilum infection and P. jirovecii pneumonia. Three patients were diagnosed as having P. jirovecii before having a diagnosis of disseminated M. haemophilum infection. Other concurrent opportunistic infections found were herpesvirus-8–associated Kaposi sarcoma and disseminated histoplasmosis. As physicians become more aware of M. haemophilum and as diagnostic techniques improve and become more widely available, we may see more disseminated M. haemophilum infections and associated opportunistic infections.
Value of Nursing Objective Structured Clinical Examinations
Authors: Goh Hongli Sam , Zhang Hui , Lee Chen Na , Wu Xi Vivien , Wang Wenru 
Published: October 2018

Background
Objective structured clinical examinations (OSCEs) have been used globally in medical education and touted as the “gold standard” for competence-based assessments. However, the value of OSCEs in nursing education has not been extensively evaluated.

Purposes
This review aims to report the global trends in nursing OSCEs; evaluate their validity, reliability, acceptability, and costs; and present the characteristics of validated nursing OSCEs.

Methods
This is a scoping review involving a systematic search in 7 electronic databases.

Results
A total of 204 studies, published between 1982 and 2018, were included in the review. We found that nursing OSCEs were extensively used across various nursing specialties in 33 countries and confirmed their validity, reliability, and acceptability in nursing education.

Conclusions
This review confirms the value of OSCEs in nursing education and presents the underlying characteristics of validated nursing OSCE designs.
Pediatric Bilateral Facial Paralysis
Authors: Wong Kei , Sequeira Sophia , Bechtel Kirsten 
Published: October 2018

Abstract
Pediatric bilateral facial nerve paralysis (FNP) is a rare condition, representing less than 2% of all cases of FNP. The differential diagnosis of FNP is extensive (ranging from infectious, traumatic, neurologic, to idiopathic) and often can present as a diagnostic challenge. In contrast to unilateral presentation, bilateral FNP presents as a manifestation of serious systemic conditions, including meningitis (infectious and neoplastic), brain stem encephalitis, Guillain-Barre syndrome, sarcoidosis, Lyme disease, human immunodeficiency virus infection, leukemia, and vasculitis. In the evaluation of a child who presents with bilateral FNP, history plays the utmost role in the diagnosis. A history of rash consistent with erythema chronicum migrans, recent tick exposure, or travel to a Lyme disease–endemic area is highly suggestive that the facial paralysis is a result of Lyme disease. It is also important to recognize that Lyme disease is emerging as the most common infectious etiology of bilateral FNP in the pediatric population. In this case report, we describe a 16-year-old boy who presented to the emergency department with complaints of headache and bilateral FNP, an unusual presentation of Lyme disease.
The Disturbed Function of Neutrophils at the Early Stage of Fat Grafting Impairs Long-Term Fat Graft Retention
Authors: Liu Kaiyang , Cai Junrong , Li Hongjin , Feng Jingwei , Feng Chuanbo , Lu Feng 
Published: October 2018

Background:
Fat grafting is a popular soft-tissue filler method; however, the mechanism of its survival and regeneration is still not fully understood. Neutrophils are the frontier inflammatory cells and closely associated with tissue regeneration. To understand the role of neutrophils in fat graft retention, we adopted neutrophil depletion and up-regulation models.

Methods:
Mouse inguinal fat (approximately 200 mg) was transferred autologously. The anti-mouse Ly6G antibody and lipopolysaccharides were used in the mouse fat grafting model for neutrophil depletion or activation, respectively. We examined the blood and graft stromal vascular fraction by fluorescence-activated cell sorting in manipulation/control groups. Graft weight, vascularization, and secreted factors were also compared.

Results:
There was a significant reduction/increase of neutrophil counts in the circulation and the transferred fat before day 7 with Ly6G antibody/lipopolysaccharides treatment. Early depletion of neutrophils resulted in incompetent angiogenesis and eventually a poor retention rate (27 ± 8 percent) compared with control (51 ± 10 percent; p < 0.05), whereas up-regulated neutrophils increased the inflammation and reactive oxygen species level, leading to tissue damage and poor retention rate (20 ± 9 percent) compared with control (51 ± 10 percent; p < 0.05). Enhanced macrophage infiltration could be found in both neutrophil depletion and up-regulation groups after week 4.

Conclusions:
Undisturbed neutrophil function is the key to initiating downstream responses of macrophage infiltration, stimulating vessel formation, and regulating inflammation level; thus, it exerts a great impact on the long-term retention rate. Disturbed neutrophil function, either enhanced or weakened, can lead to impaired fat graft retention.
Creation of Clitoral Hood and Labia Minora in Penile Inversion Vaginoplasty in Circumcised and Uncircumcised Transwomen
Authors: Opsomer Dries , Gast Katherine M. , Ramaut Lisa , De Wolf Edward , Claes Karel , Sommeling Casper , Monstrey Stan 
Published: October 2018

Summary:
Gender dysphoria, the incongruence between anatomical sex and gender identity, is estimated to affect 1 percent of the population. Creation of a feminine vulva with labia minora remains a technical challenge for surgeons, especially in circumcised patients. The authors present the technique developed by the senior author (S.M.) that uses prepuce skin in uncircumcised patients or distal shaft skin in circumcised patients for creation of both clitoral hood and labia minora. A retrospective case review was conducted of all penile inversion vaginoplasties performed by the senior author between 2014 and 2016. Patient characteristics, history of circumcision, and revision surgery were recorded. Surgical technique to create and inset the neoclitoris and labia minora in a single-stage penile inversion vaginoplasty is described in detail. A total of 161 penile inversion vaginoplasty operations were performed. Creation of labia minora and clitoral hood was achieved in all patients, with 4.3 percent undergoing an early intervention for bleeding or dehiscence and 5.6 percent requiring late revision surgery for diverted urinary stream. Average length of follow-up was 29 months. Age, hormonal therapy time, body mass index, smoking, and diabetes were the investigated risk factors for postoperative complications, but no significant correlations were found. All patients met the standards of care set forth by the World Professional Association for Transgender Health. Creation of the clitoral hood and labia minora during penile inversion vaginoplasty is achievable in both circumcised and uncircumcised patients, with good aesthetic results and a low revision surgery rate.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.