bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective Evaluation of Utilization Patterns and Prescribing Guidelines of Opioid Consumption Following Orthopedic Foot and Ankle Surgery
Authors: Saini Sundeep , McDonald Elizabeth L. , Shakked Rachel , Nicholson Kristen , Rogero Ryan , Chapter Megan , Winters Brian S. , Pedowitz David I. , Raikin Steven M. , Daniel Joseph N. 
Published: August 2018

Background: Overprescription of narcotic pain medication is a major culprit in the present opioid epidemic plaguing the United States. The current literature on lower extremity opioid usage has limitations and would benefit from additional study. The purpose of our study was to prospectively assess opioid consumption patterns following outpatient orthopedic foot and ankle procedures. Methods: Patients undergoing outpatient orthopedic foot and ankle procedures who met inclusion criteria had the following prospective information collected: patient demographics, preoperative health history, patient-reported outcomes, anesthesia type, procedure type, opioid prescription and consumption details. The morphine equivalent dose was calculated for each prescription and then converted to the equivalent of a 5-mg oxycodone “pill.” Univariable analyses were performed to identify variables with a statistically robust association with opioid consumption for inclusion in a multivariable linear regression. A stepwise backward regression was then performed to identify independent predictors of opioid consumption. Postoperative opioid utilization was reported for 988 patients (mean age: 49 years). Results: Overall, patients consumed a median of 20 pills whereas the median number of pills prescribed was 40. This resulted in a utilization rate of 50% and 20 631 pills left unused. Independent factors associated with higher opioid consumption were anesthesia type ( P < .004), age <60 years ( P < .001), preoperative visual analog scale (VAS) pain report of >6 ( P = .008), and bony procedures ( P = .008); residual standard error 16.73 ( F7,844=14.3, P < .001). Conclusion: Our study found that patients who underwent orthopedic foot and ankle procedures were overprescribed narcotic medication by nearly twice the amount that was actually consumed. Although we identified 4 independent factors associated with opioid consumption, the large residual standard error suggests that there remains a substantial degree of unexplained variance of opioid consumption observed in the patient population. Physicians face a challenging task of setting appropriate protocols when balancing pain relief and generalizable guidelines. Level of Evidence: Level II, prospective observational cohort study.
Overuse and underuse of pegfilgrastim for primary prophylaxis of febrile neutropenia
Authors: Zullo Andrew R , Lou Uvette , Cabral Sarah E , Huynh Justin , Berard-Collins Christine M 
Published: August 2018

Introduction Guidelines recommend pegfilgrastim for primary prophylaxis of febrile neutropenia after highly myelosuppressive chemotherapy. While deviations from guidelines could result in overuse and increased costs, underuse is also a concern and could compromise quality of care. Our objectives were to evaluate guideline adherence and quantify the extent to which physician heterogeneity may influence pegfilgrastim use. Methods We randomly sampled 550 patients from a retrospective cohort of those who received infusions at an academic cancer center between 1 September 2013 and 1 September 2014. Electronic medical and drug dispensing records provided information on patient characteristics, chemotherapy characteristics, prescribing physician, and pegfilgrastim administration. Results We included 154 patients treated by 25 physicians. About half of patients were male and mean age was 61.3 years. Forty (26.1%) patients had no febrile neutropenia risk factors, 62 (40.5%) had one, and 51 (33.3%) had two or more. Thirty patients (19.5%) received pegfilgrastim, of which 12 (40%) received palliative chemotherapy. Nine (60%) of 15 patients on a regimen with a febrile neutropenia risk  ≥ 20% received pegfilgrastim. Pegfilgrastim use significantly varied by cancer type (p < 0.01), chemotherapy regimen (p < 0.001), and regimen febrile neutropenia risk (p < 0.001). Multivariable analysis reaffirmed the association between chemotherapy regimen febrile neutropenia risk ≥ 20% and pegfilgrastim use (odds ratio (OR) = 10.1, 95% confidence interval (CI): 1.6–62.7) and suggested that 31% (95% CI: 8%–71%) of the variation in use was attributable to physician characteristics. Conclusion Pegfilgrastim was potentially overused for palliative chemotherapy and underused for chemotherapy regimens with febrile neutropenia risk ≥ 20%. Successful interventions to modify prescribing practices likely require an understanding of the relationship between specific physician characteristics and pegfilgrastim use.
Evaluation of laboratory disturbance risk when adding low-dose cotrimoxazole for PJP prophylaxis to regimens of high-grade glioma patients taking RAAS inhibitors
Authors: Coppens Roland , Yang Johanna , Ghosh Sunita , Gill John , Chambers Carole , Easaw Jacob C 
Published: August 2018

Background Cotrimoxazole is associated with the development of hyponatremia, hyperkalemia and elevated serum creatinine, especially when combined with inhibitors of the renin–angiotensin–aldosterone system (RAAS). Pneumocystis jirovecii pneumonia (PJP) prophylaxis is the standard of care for high-grade glioma (HGG) patients receiving temozolomide concurrently with radiotherapy, low-dose cotrimoxazole being the preferred agent. Many of these patients are also taking renin–angiotensin–aldosterone system inhibitors, however the risk of significant laboratory disturbance in these patients remains undescribed. Objective We evaluated whether high-grade glioma patients taking renin–angiotensin–aldosterone system inhibitors receiving low-dose cotrimoxazole for Pneumocystis jirovecii pneumonia prophylaxis are at additional risk of laboratory disturbances in comparison with their non-renin–angiotensin–aldosterone system counterparts. Methods We conducted a retrospective chart review of adult neuro-oncology patients treated for WHO Grade III or IV glioma between 2013 and 2016. Patient serum Na, K, creatinine, and eGFR were compared (renin–angiotensin–aldosterone system vs. non-renin–angiotensin–aldosterone system) using the chi-square test. Binary logistic regression analysis was then performed to account for differences between cohorts. Results Of 63 patients (35 non-renin–angiotensin–aldosterone system, 28 renin–angiotensin–aldosterone system), patients in the renin–angiotensin–aldosterone system cohort were more likely to experience a laboratory disturbance (odds ratio=3.17, p = 0.03). Overall, these disturbances were moderate, but were slightly more common and slightly more severe in the renin–angiotensin–aldosterone system cohort. Conclusion Adding low-dose cotrimoxazole for Pneumocystis jirovecii pneumonia prophylaxis to the regimens of patients with high-grade glioma taking renin–angiotensin–aldosterone system inhibitors increases the risk of laboratory disturbances. While these are generally moderate, some patients are at risk of significant electrolyte abnormalities requiring intervention.
Does lumbar arthrodesis compromise outcome of total hip arthroplasty?
Authors: Grammatopoulos George , Dhaliwal Kam , Pradhan Rajib , Parker Simon J M , Lynch Karen , Marshall Robert , Andrade Antonio (Tony) J 
Published: August 2018

Introduction: This matched cohort study aims to determine whether the presence of a spinal arthrodesis (SA) compromises outcome of total hip arthroplasty (THA) and whether the outcome is better if THA is performed before- (THA-1st) or after- SA (THA-2nd). Methods: This is a single centre, multi-surgeon, review of prospective data. Thirty-seven patients (47 hips) that had SA and 1° THA(s), formed the cases (26 THA-1st; 21 THA-2nd). Most cases had 1-level SA ( n = 24). Controls were patients without SA that had THA, over the same period matched for age, gender and prosthesis type. Outcome measures included complication-, revision- rates, Oxford-Hip- and Harris-Hip-Scores (OHS/HHS) (Δ: difference between pre- and post-operative scores). This is a single-centre, multi-surgeon, review of prospective data. Results: At a mean follow-up of 6 years, more complications were seen in cases of THA and SA compared with controls without SA (7 vs. 2) ( p = 0.03). Consequently, more cases were revised ( n = 4) compared with controls ( n = 0) ( p = 0.02). There were no differences in functional outcome between cases and controls ( p = 0.1–0.6). No differences in complications- (4/26 vs. 3/21; p = 1.00) or revision- rates (2/26 vs. 2/21; p = 1.00) were seen between THA-1st and THA-2nd Groups. The THA-1st Group had higher pre- and post-operative OHS/HHS, compared to the THA-2nd Group. However, no significant difference in ΔOHS (24 vs. 17) and ΔHHS (39 vs. 26) were seen between the THA-1st and THA-2nd Groups ( p = 0.1). Conclusions: Patients with THA and SA, had increased rates of revision; but no differences in patient-reported outcome measures (PROMs) were detected. Addressing the hip pathology first may be associated with improved functional outcome.
A Multidisciplinary Preoperative Teaching Session for Women Awaiting Breast Cancer Surgery: A Quality Improvement Initiative
Authors: Ibrahim Marize , Lau Garnet J , Smirnow Nadia , Buono Anna T , Cooke Andrea , Gartshore Kimberley , Loiselle Carmen G , Johnson Kyla 
Published: August 2018

Purpose: Most of the breast cancer diagnoses are recommended for breast surgery. Unfortunately, many patients report preoperative anxiety, which can affect postoperative recovery. Preoperative teaching sessions have been shown to reduce anxiety and improve recovery for the patients with breast cancer. To better support the patients at our cancer center, a multidisciplinary preoperative teaching session was developed and delivered as a quality improvement initiative. Methods: Participants scheduled for breast surgery were invited to attend a group-delivered preoperative teaching session, either for breast-conserving surgery or mastectomy. The sessions were presented by a nurse, occupational therapist, and physiotherapist. Data were collected through a researcher-developed 2-item questionnaire administered before and after sessions to compare self-reported anxiety and knowledge levels, along with qualitative feedback. Results: A total of 94 participants attended the preoperative sessions, piloted over a year. The majority were scheduled for breast-conserving surgery. Wilcoxon signed rank tests showed that after session, self-reported levels of anxiety decreased, whereas levels of knowledge increased. Most participants found the session to be very helpful and would recommend it to other patients/families awaiting surgery. Conclusions: Patients awaiting surgery for breast cancer may be better supported through a multidisciplinary group teaching session by decreasing anxiety and improving knowledge related to the procedure. Future directions could explore the effect of specific session elements on anxiety, knowledge, and postoperative complications using psychometrically sound instruments and additional time points. Implications for cancer survivors: Standardization of these preoperative teaching sessions may enhance breast cancer care, reduce postoperative complications, and improve patient recovery.
Epidemiological Findings of Soccer Injuries During the 2017 Gold Cup
Authors: Chahla Jorge , Sherman Benjamin , Cinque Mark , Miranda Alejandro , Garrett William E. , Chiampas George , O’Malley Hughie , Gerhardt Michael B. , Mandelbaum Bert R. 
Published: August 2018

Background: Surveillance programs are vital to analyze the cause and nature of lesions and ultimately establish protocols of action to lower injury rates. Purpose: To evaluate the adherence of team doctors to an electronic surveillance system and determine the incidence and characteristics of injuries among soccer players participating in the 2017 Gold Cup. Study Design: Descriptive epidemiological study. Methods: All data were collected from the electronic medical reports submitted during each match of the 2017 Gold Cup. Twelve teams participated in the tournament (each with 23 players), for a total of 276 players. A 19-question online survey was filled out by the team physician after each injury. Each report contained the player’s number, the exact time of injury (minute of play), the location and diagnosis of injury as indicated by a previously defined code, and its severity in terms of the number of days of absence from training and match play. Results: The electronic reporting system had a response rate of 100.0%, with 97.2% of questions answered completely. The mean age of injured players was 27 years (range, 21-35 years) and was not statistically significantly different from the overall mean player age ( P > .05). There were no significant differences in the frequency of injuries when analyzed by player position ( P = .743). The overall rate of injuries was 1.04 per match, with the most common injuries being contusions (42.3%), sprains (7.7%), strains (7.7%), and fractures (7.7%). These injuries were more commonly the result of contact (75.0%) than noncontact (25.0%) mechanisms ( P < .001). Injuries most commonly occurred between the 60th and 75th minute of play when comparing all 15-minute time intervals ( P = .004). Conclusion: This study supports the use of electronic injury reporting, which demonstrated a high level of adherence among an international cohort of team physicians and has significant potential for improving injury surveillance and tracking responses to prevention programs. Injury rates in the Gold Cup were similar to those in previous studies and demonstrated the highest rates late in the second half of the game, specifically between the 60th and 75th minute of play.
Red cell distribution width as a predictor multiple organ dysfunction syndrome in patients undergoing heart valve surgery
Authors: Duchnowski Piotr , Hryniewiecki Tomasz , Kuśmierczyk Mariusz , Szymanski Piotr 
Published: August 2018

PURPOSEThe aim of the study was to evaluate the prognostic value of RDW for multiple organ dysfunction syndrome (MODS) in the early postoperative period in patients undergoing valve replacement or repair surgery.METHODSA prospective study was conducted on a group of 713 consecutive patients with haemodynamically significant valvular heart disease who underwent elective valvular surgery. The primary end-point at the 30-day follow-up was postoperative MODS. The secondary end-point was death from all causes in patients with MODS.RESULTSThe postoperative MODS occurred in 72 patients. At multivariate analysis: RDW (OR 1.267; 95% CI 1.113-1.441; p=0.0003), creatinine (OR 1.007; 95% CI 1.001-1.013; p=0.02) and age (OR 1.047; 95% CI 1.019-1.077; p=0.001) remained independent predictors of the primary end-point. Receiver operator characteristics analysis determined a cut-off value of RDW for the prediction of the occurrence of the perioperative MODS at 14.3%. RDW (OR 1.448; 95% CI 1.057-1.984; p=0.02) and age (OR 1.057; 95% CI 1.007-1.117; p=0.04) were associated with an increased risk of death in patients with perioperative MODS.CONCLUSIONSElevated RDW is associated with a higher risk of MODS and death in patients with MODS following heart valve surgery.
Auditory Predictive Coding across Awareness States under Anesthesia: An Intracranial Electrophysiology Study
Authors: Nourski Kirill V. , Steinschneider Mitchell , Rhone Ariane E. , Kawasaki Hiroto , Howard Matthew A. , Banks Matthew I. 
Published: August 2018

The systems-level mechanisms underlying loss of consciousness (LOC) under anesthesia remain unclear. General anesthetics suppress sensory responses within higher-order cortex and feedback connections, both critical elements of predictive coding hypotheses of conscious perception. Responses to auditory novelty may offer promise as biomarkers for consciousness. This study examined anesthesia-induced changes in auditory novelty responses over short (local deviant [LD]) and long (global deviant [GD]) time scales, envisioned to engage preattentive and conscious levels of processing, respectively. Electrocorticographic recordings were obtained in human neurosurgical patients (3 male, 3 female) from four hierarchical processing levels: core auditory cortex, non-core auditory cortex, auditory-related, and PFC. Stimuli were vowel patterns incorporating deviants within and across stimuli (LD and GD). Subjects were presented with stimuli while awake, and during sedation (responsive) and following LOC (unresponsive) under propofol anesthesia. LD and GD effects were assayed as the averaged evoked potential and high gamma (70–150 Hz) activity. In the awake state, LD and GD effects were present in all recorded regions, with averaged evoked potential effects more broadly distributed than high gamma activity. Under sedation, LD effects were preserved in all regions, except PFC. LOC was accompanied by loss of LD effects outside of auditory cortex. By contrast, GD effects were markedly suppressed under sedation in all regions and were absent following LOC. Thus, although the presence of GD effects is indicative of being awake, its absence is not indicative of LOC. Loss of LD effects in higher-order cortical areas may constitute an alternative biomarker of LOC.SIGNIFICANCE STATEMENTDevelopment of a biomarker that indexes changes in the brain upon loss of consciousness (LOC) under general anesthesia has broad implications for elucidating the neural basis of awareness and clinical relevance to mechanisms of sleep, coma, and disorders of consciousness. Using intracranial recordings from neurosurgery patients, we investigated changes in the activation of cortical networks involved in auditory novelty detection over short (local deviance) and long (global deviance) time scales associated with sedation and LOC under propofol anesthesia. Our results indicate that, whereas the presence of global deviance effects can index awareness, their loss cannot serve as a biomarker for LOC. The dramatic reduction of local deviance effects in areas beyond auditory cortex may constitute an alternative biomarker of LOC.
A Neuronal Ensemble in the Rostral Agranular Insula Tracks Cocaine-Induced Devaluation of Natural Reward and Predicts Cocaine Seeking
Authors: Moschak Travis M. , Wang Xuefei , Carelli Regina M. 
Published: August 2018

In substance use disorders, negative affect associated with drug withdrawal can elicit strong drug craving and promote relapse. One brain region implicated in those processes is the rostral agranular insular cortex (RAIC), although precisely how this region encodes negative affect associated with drug seeking is unknown. Here, a preclinical model was used where RAIC activity was examined in male Sprague Dawley rats during intraoral infusions of a sweet (saccharin) paired with impending but delayed access to cocaine self-administration, and for comparative purposes, during the sweet predicting saline self-administration or injection of lithium chloride (LiCl), or during intraoral infusions of a bitter taste (quinine). Consistent with previous work, cocaine-paired saccharin, LiCl-paired saccharin, and quinine all elicited aversive taste reactivity. However, the aversive taste reactivity elicited by the cocaine-paired tastant was qualitatively different from that evoked by the other two agents. Furthermore, differences in taste reactivity were reflected in RAIC cell firing, where distinct shifts in neural signaling were observed specifically after cocaine but not LiCl conditioning. Notably, low motivation for cocaine (indicated by low loading and slower latencies to lever press) was correlated with this shift in RAIC signaling, but aversive (gaping) responses were not. Collectively, these findings indicate that cocaine-paired tastants elicit unique aspects of aversive behaviors that differ from traditional conditioned taste aversion (LiCl) or quinine and that the RAIC plays a role in modulating drug-seeking behaviors driven by drug-induced dysphoria (craving), but not negative affect per se.SIGNIFICANCE STATEMENTIn substance use disorders, negative affect associated with drug cues can elicit craving and promote relapse; however, the underlying neurocircuitry of this phenomenon is unknown. Here, we investigated the role of the rostral agranular insula cortex (RAIC) in these processes using a preclinical model wherein intraoral delivery of a sweet is paired with delayed access to cocaine self-administration. The taste comes to elicit negative affect that predicts heightened drug seeking. Here, we found that a population of RAIC neurons became inhibited during presentation of the cocaine-paired tastant (when negative affect is high) and that this inhibitory neural profile predicted lower drug seeking. These findings suggest that the RAIC may function to oppose cue-induced cocaine craving and help reduce motivation for the drug.
General Transformations of Object Representations in Human Visual Cortex
Authors: Ward Emily J. , Isik Leyla , Chun Marvin M. 
Published: August 2018

The brain actively represents incoming information, but these representations are only useful to the extent that they flexibly reflect changes in the environment. How does the brain transform representations across changes, such as in size or viewing angle? We conducted a fMRI experiment and a magnetoencephalography experiment in humans (both sexes) in which participants viewed objects before and after affine viewpoint changes (rotation, translation, enlargement). We used a novel approach, representational transformation analysis, to derive transformation functions that linked the distributed patterns of brain activity evoked by an object before and after an affine change. Crucially, transformations derived from one object could predict a postchange representation for novel objects. These results provide evidence of general operations in the brain that are distinct from neural representations evoked by particular objects and scenes.SIGNIFICANCE STATEMENTThe dominant focus in cognitive neuroscience has been on how the brain represents information, but these representations are only useful to the extent that they flexibly reflect changes in the environment. How does the brain transform representations, such as linking two states of an object, for example, before and after an object undergoes a physical change? We used a novel method to derive transformations between the brain activity evoked by an object before and after an affine viewpoint change. We show that transformations derived from one object undergoing a change generalized to a novel object undergoing the same change. This result shows that there are general perceptual operations that transform object representations from one state to another.
Ikimokyklinių ugdymo paslaugų įtaka tėvų užimtumui Lietuvoje
Authors: Čižauskaitė Aušra , Gruževskis Boguslavas 
Published: August 2018

[straipsnis, santrauka, reikšminiai žodžiai lietuvių kalba; santrauka ir reikšminiai žodžiai anglų kalba]
Ikimokyklinių ugdymo įstaigų prieinamumas turi didelę įtaką tėvų užimtumui, tačiau šį priklausomybė yra gana sudėtinga ir skirtingai pasireiškia skirtingose visuomenės grupėse. Straipsnyje siekiama ištirti ikimokyklinių ugdymo įstaigų prieinamumo vaidmenį tėvų, auginančių ikimokyklinio amžiaus vaikus, užimtumui Lietuvoje. Tyrimui naudojami Lietuvos 2014 m. pajamų ir gyvenimo sąlygų tyrimo duomenys. Naudojant chi kvadrato testą bei dvinarės logistinės regresijos modelį, tyrimo rezultatai atskleidė, kad vaikų ikimokyklinių ugdymo įstaigų nelankymas turėjo didesnę neigiamą įtaką moterų užimtumo statusui negu vyrų. Tyrimas taip pat parodė, kad svarbų vaidmenį tėvų užimtumui skatinti vaidina ir nemokamai teikiama ne tėvų priežiūra vaikams. Rezultatai taip pat leido kelti prielaidą, kad ikimokyklinių ugdymo įstaigų prieinamumas skatina tėvus dirbti, tačiau tai nebuvo esminė tėvų užimtumo paskata.