bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Timing for Congenital Ptosis Should Not Be Determined Solely by the Presence of Anisometropia
Authors: Chisholm Smith Ann M. , Costakos Deborah M. , Harris Gerald J. 
Published: February 2019

Purpose:
Timing of surgery in children with congenital ptosis is a critical component of care, and anisometropia is frequently cited as an indication for early intervention. The purpose of this study is to evaluate the change in refractive error following surgery for congenital ptosis to better inform decisions regarding the timing of surgery.

Methods:
A retrospective review of clinical records was performed on patients who underwent surgical correction of congenital ptosis in an academic oculoplastic surgery practice from 2002 to 2017. Patients with complete preoperative and postoperative refractive data were included in the study. Changes in refractive error following surgery were analyzed.

Results:
Among 184 pediatric patients who underwent ptosis surgery during the study period, 56 patients (71 eyes) met inclusion criteria. The mean age at surgery was 5.1 years. Mean refractive error change in all the operated eyes was a 0.82 D decrease in spherical equivalent (p = 0.1920) and a 0.40 D increase in cylinder (p = 0.0255). There were no statistically significant changes in spherical equivalent or cylinder in the control eyes.

Conclusions:
The authors data did not show movement toward normalization of refractive error following ptosis surgery. In fact, it showed a statistically significant worsening of astigmatism following surgery. Because refractive error does not improve following surgery, anisometropia should not be the sole indication for early surgery in congenital ptosis.
Barriers and Predictors Associated With Accessing Oral Healthcare Among Patients With Cardiovascular Disease in Australia
Authors: Sanchez Paula , Salamonson Yenna , Everett Bronwyn , George Ajesh 
Published: February 2019

Background
Periodontal disease is associated with cardiovascular disease, and patients should be aware of this risk and seek dental care.

Objective
In this study, the authors sought to identify the barriers and predictors for seeking oral healthcare among patients with cardiovascular disease.

Methods
With the use of a cross-sectional descriptive study design, 307 patients with cardiovascular disease attending cardiac rehabilitation/outpatient cardiac clinics were surveyed between 2016 and 2017 in Sydney, Australia. Survey items included the prevalence of accessing dental services and a new “barriers to seeking frequent dental care” scale.

Results
Most respondents (81%) reported at least 1 oral health problem, yet only 10% received any oral health information and more than half (58%) saw a dentist in the preceding 12 months. The barriers to seeking frequent dental care scale was internally consistent (Cronbach's α = 0.82) with 2 subscales, identified as personal-related and system-related barriers to accessing oral healthcare. Respondents were more likely to have seen a dentist in the previous 12 months if they received oral health information (adjusted odds ratio [AOR], 5.08; 95% confidence interval [CI], 1.62–15.93), had private health insurance (AOR, 3.33; 95% CI, 1.91–5.83), reported low barriers (AOR, 2.68; 95% CI, 1.61–4.47), or were born overseas (AOR, 2.13; 95% CI, 1.25–3.63).

Conclusions
The accessibility and affordability of dental care, as well as lack of oral health awareness, are key barriers and predictors for patients with cardiovascular disease accessing dental care. Greater emphasis on oral health is needed in the cardiac setting, along with appropriate dental referral pathways.
Health Professionals Who Suffer Intimate Partner Violence: A Descriptive, Multicenter, and Cross-Sectional Study
Authors: Carmona-Torres Juan Manuel , Cobo-Cuenca Ana Isabel , Recio-Andrade Beatriz , Dios-Guerra Caridad , Lopez-Soto Pablo Jesús , Hidalgo-Lopezosa Pedro , Rodríguez-Borrego María Aurora 
Published: February 2019

ABSTRACT

Objective
The purpose of this study was to know who are the people who assist women, who work as a health professional in the Spanish Public Health System, when they suffer intimate partner violence (IPV).

Methods
A descriptive, cross-sectional, multicenter study was conducted. The participants were female health professionals (N = 794) working within the Spanish Public Health System. The instrument used was Delgado, Aguar, Castellano, and Luna del Castillo's (2006) scale to measure ill-treatment of women.

Results
Two hundred seventy women suffered IPV (34%). Of the female health professionals who suffered IPV, 25.9% had spoken with someone about the violence, most commonly talking to trusted people (24.3%), a psychologist (24.3%), health professionals (20%), and others (20%). Married female health professionals living with their current or last partner/husband, residing in an urban area, and with their own salary were least likely to speak about their problem.

Conclusion
Female health professionals who suffer IPV usually speak about this problem with trusted people instead of consulting a health professional, which may leave the problem in the private sphere. This can be because of victims not wanting to report the violence for fear of their intimate partner or wanting it to remain private. This may deprive the victims of the help they need. For this reason, the health services should establish screening for IPV not only for their patients but also for their workers.
Use and Outcome of Local Anesthetic Painkilling Injections in Athletes: A Systematic Review
Authors: Gultekin Sinem , Chaker Jomaa Mohammad , Jenkin Rebekah , Orchard John W. 
Published: February 2019

Background:
The use of local anesthetic painkilling injections to improve player availability is common practice in elite-level sport.

Objective:
To document the published use of local anesthetic injections in sport, according to number of injections, sites of injections, and complications reported.

Data Sources:
A systematic search of MEDLINE, Embase, CINAHL, AMED, Cochrane Database of Systematic reviews, SportDiscus, EBSCO Host, and Google Scholar.

Results:
One thousand nine hundred seventy local anesthetic injections reported on 540 athletes in 10 studies (from rugby league, American football, Australian football, and soccer) were reviewed. The most common areas of injection were as follows: the acromioclavicular (AC) joint; hand (including fingers); sternoclavicular joint (including sternum); rib injuries; and iliac crest contusions.

Discussion:
This review found some evidence of long-term safety for a limited number of injection sites (eg, AC joint) and some evidence of immediate complications and harmful long-term consequences for other sites. The quality of evidence is not high, with little long-term data and a lack of independent verification of the effects of the injections. Ideally, long-term follow-up should be conducted to determine whether these injections are safe, with follow-up undertaken independently of the treating physician and team.

Conclusions:
Based on limited publications, there is some evidence of long-term safety; however, there is a lack of clear proof of either absolute safety or long-term harm for many of these procedures. Physicians and players in professional sport should proceed with caution in using local anesthetic injections.
Long-Term Follow-Up of Intratympanic Methylprednisolone Versus Gentamicin in Patients With Unilateral Menière's Disease
Authors: Harcourt Jonny Philip , Lambert Aileen , Wong Phui Yee , Patel Mitesh , Agarwal Kiran , Golding John Foster , Bronstein Adolfo Miguel 
Published: February 2019

Objectives:
To determine whether long term (>48 months) symptomatic vertigo control is sustained in patients with Menière's disease from a previous comparative trial of intratympanic methylprednisolone versus gentamicin, and if the two treatments remain nonsignificantly different at long-term follow-up.

Study Design:
Mail survey recording vertigo frequency in the previous one and six months, further intratympanic treatment received, and validated symptom questionnaires.

Setting:
Outpatient hospital clinic setting.

Patients:
Adult patients with definite unilateral refractory Menière's disease, who previously received intratympanic treatment in a comparative trial.

Intervention:
A survey of trial participants who received intratympanic gentamicin (40 mg/mL) or methylprednisolone (62.5 mg/mL).

Outcome measures:
Primary: number of vertigo attacks in the 6 months prior to receiving this survey compared with the 6 months before the first trial injection. Secondary number of vertigo attacks over the previous 1 month; validated symptom questionnaire scores of tinnitus, dizziness, vertigo, aural fullness, and functional disability.

Results:
Forty six of the 60 original trial patients (77%) completed the survey, 24 from the gentamicin and 22 from the methylprednisolone group. Average follow-up was 70.8 months (standard deviation 17.0) from the first treatment injection. Vertigo attacks in the 6 months prior to receiving the current survey reduced by 95% compared to baseline in both drug groups (intention-to-treat analysis, both p < 0.001). No significant difference between drugs was found for the primary and secondary outcomes. Eight participants (methylprednisolone = 5 and gentamicin = 3) required further injections for relapse after completing the original trial.

Conclusion:
Intratympanic methylprednisolone treatment provides effective long-lasting relief of vertigo, without the known inner-ear toxicity associated with gentamicin. There are no significant differences between the two treatments at long term follow-up.
Risk Factors for Tinnitus in 37,692 Patients Followed in General Practices in Germany
Authors: Kostev Karel , Alymova Svetlana , Kössl Manfred , Jacob Louis 
Published: February 2019

Background:
Tinnitus is frequently associated with a major hearing handicap, which has a significant impact on the quality of life of patients.

Aims:
The goal was to analyze risk factors for tinnitus in patients followed in general practices in Germany.

Methods:
Patients who had received a first tinnitus diagnosis in one of 928 general practices between January 2014 and December 2017 were included in this study. Controls without a tinnitus diagnosis were matched (1:1) to tinnitus cases by age, sex, index year, and physician. In total, 18,846 patients with tinnitus and 18,846 matched controls without tinnitus were included in the present study. Potential risk factors for tinnitus included in the present study were diseases of the ear, diseases of the upper respiratory tract, mental disorders, diseases of the nervous system, endocrine diseases, diseases of the circulatory system, and hemolytic anemias. A multivariate logistic regression with stepwise selection was used to analyze the association between defined diagnoses and tinnitus.

Results:
A total of 20 diseases were significantly associated with tinnitus. The five diagnoses displaying the strongest effect were vestibular neuronitis (odds ratio [OR] = 3.29, 95% confidence interval [CI]: 1.56–6.90), Menière's disease (OR = 3.23, 95% CI: 1.78–5.86), Eustachian salpingitis and obstruction (OR = 2.51, 95% CI: 1.72-3.67), presbycusis (OR = 2.27, 95% CI: 1.93-2.67), and otalgia and ear effusion (OR = 1.99, 95% CI: 1.56–2.53).

Conclusions:
Tinnitus was associated with a wide range of conditions, in particular disorders of the ear.
Poor Health Literacy and Medication Burden Are Significant Predictors for Inadequate Bowel Preparation in an Urban Tertiary Care Setting
Authors: Kunnackal John George , Thuluvath Avesh J. , Carrier Hairong , Ahuja Nitin K. , Gupta Ekta , Stein Ellen 
Published: February 2019

Goals:
The goal of this study was to identify factors impacting the quality of bowel preparation in an urban tertiary care setting.

Background:
Inadequate bowel preparation is encountered in 17% to 32% of colonoscopies performed in the United States. Suboptimal colonic visualization reduces the yield of screening colonoscopies and increases healthcare costs because of longer procedure times and aborted procedures.

Study:
We performed a cross-sectional survey in patients undergoing outpatient colonoscopy within the Johns Hopkins Health System. A Boston Bowel Preparation Score (BBPS) score of <5 was considered inadequate. Fisher’s exact, χ2 tests and univariate and multivariate binary logistic regression were performed to assess the strength of the association for selected factors with a BBPS<5.

Results:
In total, 467 patients (76.3% response rate) completed the survey between August 2017 and October 2017. The median BBPS score was 7, and 81.4% of patients had an adequate bowel preparation (BBPS≥5). There was significant association between bowel preparation adequacy and level of education, health literacy, functional status, income, and medication burden. When adjusted for other factors, poor confidence in filling forms (OR, 24.1; P<0.001), multiple daily prescription medications (OR, 12.49; P=0.02) and poor functional status (OR, 2.82; P=0.03) had the highest odds of predicting inadequate bowel preparation.

Conclusions:
Inadequate bowel preparation is a significant problem accounting for reduced yield of screening and increased health care costs. Poor health literacy, functional status, and number of daily medications are significant factors predicting inadequate bowel preparation in the tertiary care setting.
Antioxidants for Pancreatic Functions in Chronic Pancreatitis
Authors: Singh Namrata , Ahuja Vineet , Sachdev Vikas , Upadhyay Ashish D. , Goswami Ravinder , Ramakrishnan Lakshmy , Dwivedi Supriya , Saraya Anoop 
Published: February 2019

Background:
Antioxidants (AO) supplementation in chronic pancreatitis (CP) has been evaluated for pain. But it is not clear whether AO in CP have an effect on pancreatic functions and other clinical outcomes. We evaluated effect of AO on endocrine function in CP.

Materials and Methods:
Double-blind placebo (PL)-controlled randomized pilot study on 107 patients with CP assigned to receive daily combined AO or PL for 6 months. Primary outcome was: improvement in endocrine function (Homeostasis Model Assessment-Insulin Resistance). Secondary outcome measures were: improvement in C-peptide, Qualitative Insulin Sensitivity Check Index, exocrine pancreatic function (fecal elastase), surrogate markers of fibrosis (platelet-derived growth factor BB, transforming growth factor-β1, α-smooth muscle actin), quality of life (QOL), pain, nutritional status, markers of oxidative stress (OS), AO status, and inflammation.

Results:
There was an increase in levels of serum selenium (107.2±26.9 to 109.7±26.9 vs. 104.1±28.6 to 124.0±33.6 μg/L, P=0.022) and serum vitamin E [0.58 (range, 0.27-3.22) to 0.66 (range, 0.34-1.98) vs. 0.63 (range, 0.28-1.73) to 1.09 (range, 0.25-2.91) mg/dL, P=0.001] in the AO than the PL group. However, no significant differences were observed between groups in any of the primary or secondary outcome measures.

Conclusions:
Supplementation with AO to patients with CP causes a sustained increase in blood levels of AO; however, it has no addition benefit over PL on endocrine and exocrine functions, markers of fibrosis, OS and inflammation, nutritional status, pain and QOL. Further larger studies with adequate sample size are required.
More Severe Deficits in Performance Status at Time of Liver Transplant is Associated With Significantly Higher Risk of Death Following Liver Transplantation
Authors: McCabe Patrick , Gish Robert G. , Cheung Ramsey , Wong Robert J. 
Published: February 2019

Goal:
To evaluate the impact of Karnofsky Performance Status score (KPSS) at the time of liver transplantation (LT) on post-LT survival.

Background:
While the Model for End-Stage Liver Disease (MELD) score is used to prioritize individuals for LT, it does not specifically incorporate functional status into patient assessment for LT.

Methods:
Using 2005 to 2016 United Network for Organ Sharing data, all adults (age 18 y and above) undergoing LT were identified. The association of KPSS at the time of LT (KPSS 1: functional status 80% to 100%, KPSS 2: 60% to 70%, KPSS 3: 40% to 50%, KPSS 4: 10% to 30%) with post-LT survival was evaluated using Kaplan-Meier methods and adjusted multivariate logistic regression models.

Results:
Among 66,397 LT recipients (68% male, 72% non-Hispanic white, 22% hepatocellular carcinoma, median age: 55 to 57), women were more likely to be KPSS 4 at the time of LT compared with men (27.95% vs. 22.79%; P<0.001) and African Americans (25.43% vs. 23.03%; P<0.001) and Hispanics (31.69% vs. 23.03%; P<0.001) were more likely to be KPSS 4 than non-Hispanic whites. Worse KPSS at LT correlated with higher post-LT mortality [compared with KPSS 1: Hazard Ratio (HR) for KPSS 2: 1.16, 95% confidence interval (CI): 1.10-1.22; HR for KPSS 3: 1.40; 95% CI: 1.32-1.49; HR for KPSS 4: 1.67; 95% CI: 1.55-1.79]. This increased mortality seen with worse KPSS was observed among all liver disease etiologies and in patients with and without hepatocellular carcinoma.

Conclusions:
Worse functional status at the time of LT is strongly associated with higher risk of mortality following LT, emphasizing the importance of optimizing performance status in the preoperative period.
Has Increased Rollout of Direct Acting Antiviral Therapy Decreased the Burden of Late Presentation and Advanced Liver Disease in Patients Starting Hepatitis C Virus Therapy in Germany?
Authors: Bischoff Jenny , Boesecke Christoph , Ingiliz Patrick , Berger Florian , Simon Karl-Georg , Lutz Thomas , Schewe Carl K. , Schulze zur Wiesch Julian , Hueppe Dietrich , Christensen Stefan , Mauss Stefan , Baumgarten Axel , Rockstroh Jürgen K. 
Published: February 2019

Goals and Background:
International guidelines recommend prioritized treatment initiation in hepatitis C virus (HCV)-infected patients with advanced liver disease. We aimed to evaluate whether the widespread usage of direct acting antivirals (DAAs) has led to a decrease in late presentation for care.

Study:
Data derived from the multicenter German Hepatitis C Cohort (GECCO) was analyzed. Treatment naive HCV-infected patients initiating DAA-based treatment between January 2014 and September 2017 were included. Advanced liver disease was defined by aspartate aminotransferase to platelet ratio index score ≥1.5, METAVIR≥F3, or FibroScan ≥9.5 kPa. Period prevalence and risk factors for late presentation were evaluated.

Results:
Six hundred fifty-three HCV-monoinfected and 210 HIV/HCV-coinfected patients (mean age, 48.6±12.7 y; 65.5% male) were included. Overall 32.5% of patients had advanced liver disease. In 2014 39.4% of patients presented with advanced liver disease, decreasing to 30.1%, 34.4%, and 26.4% in the years 2015, 2016, and 2017 (P=0.057), respectively. Patients with and without advanced liver disease differed in age (P<0.0001), CD4+ ≤350/µL (P=0.027), genotype (P=0.005), transmission route (P=0.047), body mass index (P<0.001), and time since diagnosis (P=0.007). In the multivariable binary logistic regression analysis GT3, age above 45 years and being diagnosed >2 years ago were positively and HCV transmission through men who have sex with men was negatively associated with advanced liver disease.

Conclusions:
Overall 32.5% of patients presented with advanced liver disease. We observed a trend toward a lower proportion of patients starting treatment late.
GT3, age, years since HCV diagnosis and HCV transmission route were identified as risk factors for presentation with advanced liver disease.
Reflux Symptoms in Gastroparesis
Authors: Jehangir Asad , Parkman Henry P. 
Published: February 2019

Goal:
The goal of this study was to determine the relationship of reflux with gastroparesis (Gp), looking both at symptoms and objective testing.

Background:
Gp patients often experience gastroesophageal reflux symptoms. How the severity of reflux correlates with the severity of Gp is not known.

Study:
Patients referred to our academic center with symptoms of Gp completed the Patient Assessment of Upper Gastrointestinal Symptoms, Hospital Anxiety and Depression Scale, and Patient Health Questionnaire (PHQ)-15. They underwent 4-hour gastric emptying scintigraphy; and, if indicated, high-resolution esophageal manometry and esophageal pH impedance (EpHI).

Results:
Of 755 patients from July 2013 to May 2018, 432 had Gp with Gastroparesis Cardinal Symptom Index (GCSI) total score of 3.2±0.1 (mean±SEM) and heartburn/regurgitation subscore of 2.0±0.1. A fourth (27.1%) of all Gp patients had moderate to very severe heartburn/regurgitation symptoms. Heartburn/regurgitation subscore had strong correlation with GSCI total score (r=0.56, P<0.01), and weak correlation with 4-hour gastric retention (r=0.11, P=0.02). In total, 103 Gp patients underwent EpHI monitoring; time esophageal pH<4 had no correlation with heartburn/regurgitation subscore. Less than half (41.7%) of the patients undergoing EpHI had gastroesophageal reflux disease by EpHI. Gp patients with gastroesophageal reflux disease had more severe 4-hour gastric retention, and more frequently had decreased lower esophageal sphincter resting pressure and esophageal motility disorders. Heartburn/regurgitation subscore had moderate correlation with somatic symptoms, and weak correlations with anxiety and depression.

Conclusions:
The severity of reflux symptoms in Gp has strong correlation with GCSI total score, weak correlation with gastric retention, and no correlation with esophageal pH monitoring.
Trends in Hospital Utilization After Medicaid Expansion
Authors: Admon Andrew J. , Valley Thomas S. , Ayanian John Z. , Iwashyna Theodore J. , Cooke Colin R. , Tipirneni Renuka 
Published: February 2019

Background:
Medicaid expansion was associated with an increase in hospitalizations funded by Medicaid. Whether this increase reflects an isolated payer shift or broader changes in case-mix among hospitalized adults remains uncertain.

Reseearch Design:
Difference-in-differences analysis of discharge data from 4 states that expanded Medicaid in 2014 (Arizona, Iowa, New Jersey, and Washington) and 3 comparison states that did not (North Carolina, Nebraska, and Wisconsin).

Subjects:
All nonobstetric hospitalizations among patients aged 19–64 years of age admitted between January 2012 and December 2015.

Measures:
Outcomes included state-level per-capita rates of insurance coverage, several markers of admission severity, and admission diagnosis.

Results:
We identified 6,516,576 patients admitted during the study period. Per-capita admissions remained consistent in expansion and nonexpansion states, though Medicaid-covered admissions increased in expansion states (274.6–403.8 per 100,000 people vs. 268.9–262.8 per 100,000; P<0.001). There were no significant differences after Medicaid expansion in hospital utilization, based on per-capita rates of patients-designated emergent, admitted via the emergency department, admitted via clinic, discharged within 1 day, or with lengths of stay ≥7 days. Similarly, there were no differences in diagnosis category at admission, admission severity, comorbidity burden, or mortality associated with Medicaid expansion (P>0.05 for all comparisons).

Conclusions:
Medicaid expansion was associated with a shift in payers among nonelderly hospitalized adults without significant changes in case-mix or in several markers of acuity. These findings suggest that Medicaid expansion may reduce uncompensated care without shifting admissions practices or acuity among hospitalized adults.