bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nivolumab in the Treatment of Metastatic Renal Cell Carcinoma
Authors: Raphael Jacques , Sun Zhuolu , Bjarnason Georg A. , Helou Joelle , Sander Beate , Naimark David M. 
Published: May 2018

Introduction:
Nivolumab improves overall survival and health-related quality of life compared with everolimus in metastatic renal cell carcinoma (mRCC). This study assesses the cost-utility of nivolumab from the Canadian health care payer perspective.

Materials and Methods:
To evaluate the cost-utility of nivolumab, a Markov cohort model that incorporated data from the phase 3 CheckMate-025 trial and other sources was developed. The incremental cost per quality-adjusted life month (QALM) gained for nivolumab was calculated. A lifetime horizon was used in the base-case with costs and outcomes discounted 3% annually. The probabilities of progression and death from cancer and utility values were captured from the CheckMate-025 trial. Expected costs were based on Ontario fees and other sources. Scenario and sensitivity analyses were conducted to assess uncertainty.

Results:
Compared with everolimus, nivolumab provided an additional 4.2 QALM at an incremental cost of $34,153. The resulting incremental cost-effectiveness ratio was $8138/QALM gained. Assuming a willingness to pay (WTP) threshold of $4167/QALM ($50,000/quality-adjusted life-year [QALY]), nivolumab was not cost-effective. In 1-way sensitivity analyses, nivolumab cost, median overall survival, and median treatment duration were sensitive to changes. Furthermore, the results were sensitive to the WTP threshold and nivolumab became a cost-effective strategy with a WTP of $8333/QALM ($100,000/QALY).

Conclusions:
Compared with everolimus, nivolumab is unlikely to be cost-effective for the treatment of mRCC from a Canadian health care perspective with its current price assuming a WTP of $50,000/QALY. Although mRCC patients derive a meaningful clinical benefit from nivolumab, considerations should be given to avoid drug wastage and increase the WTP threshold to render this strategy more affordable.
Identifying Clinical Factors Which Predict for Early Failure Patterns Following Resection for Pancreatic Adenocarcinoma in Patients Who Received Adjuvant Chemotherapy Without Chemoradiation
Authors: Walston Steve , Salloum Joseph , Grieco Carmine , Wuthrick Evan , Diaz Dayssy A. , Barney Christian , Manilchuk Andrei , Schmidt Carl , Dillhoff Mary , Pawlik Timothy M. , Williams Terence M. 
Published: May 2018

Objectives:
The role of radiation therapy (RT) in resected pancreatic cancer (PC) remains incompletely defined. We sought to determine clinical variables which predict for local-regional recurrence (LRR) to help select patients for adjuvant RT.

Materials and Methods:
We identified 73 patients with PC who underwent resection and adjuvant gemcitabine-based chemotherapy alone. We performed detailed radiologic analysis of first patterns of failure. LRR was defined as recurrence of PC within standard postoperative radiation volumes. Univariate analyses (UVA) were conducted using the Kaplan-Meier method and multivariate analyses (MVA) utilized the Cox proportional hazard ratio model. Factors significant on UVA were used for MVA.

Results:
At median follow-up of 20 months, rates of local-regional recurrence only (LRRO) were 24.7%, LRR as a component of any failure 68.5%, metastatic recurrence (MR) as a component of any failure 65.8%, and overall disease recurrence (OR) 90.5%. On UVA, elevated postoperative CA 19-9 (>90 U/mL), pathologic lymph node positive (pLN+) disease, and higher tumor grade were associated with increased LRR, MR, and OR. On MVA, elevated postoperative CA 19-9 and pLN+ were associated with increased MR and OR. In addition, positive resection margin was associated with increased LRRO on both UVA and MVA.

Conclusions:
About 25% of patients with PC treated without adjuvant RT develop LRRO as initial failure. The only independent predictor of LRRO was positive margin, while elevated postoperative CA 19-9 and pLN+ were associated with predicting MR and overall survival. These data may help determine which patients benefit from intensification of local therapy with radiation.
Ropivacaine in Breast Augmentation Surgery
Authors: Durán-Vega Héctor César , Ramírez-Montañana Arturo , Gonzalez Galindo Octavio , Medina Gutierrez Andrés , Zapata González Adriana , Gonzalez Galindo Evangelina , Arturo Arellano Silva Iván 
Published: May 2018

Background:
Breast augmentation surgery is still 1 of the most popular procedures in plastic surgery. Like other surgical procedures, it has been traditionally handled with nonsteroidal anti-inflammatory drugs and narcotics, which had many adverse effects; therefore, alternatives with the same effectiveness are being researched. The aim of this study was to investigate the efficacy of ropivacaine breast pocket irrigation during primary breast augmentation surgery to control pain during the first postoperative hours.

Methods:
A multicenter, prospective, double-blind, randomized trial was performed on 52 primary breast augmentation procedures in which patients served as their own control: One breast received ropivacaine pocket irrigation and the other placebo. All patients received an oral analgesic. Pain was evaluated with a visual analogue scale at 30, 60, 90, and 120 minutes postoperatively.

Results:
Pain was significantly less in ropivacaine breast at 90 and 120 minutes postoperatively (P = 0.027 and 0.022, respectively). There was no statistical significance when the type of anesthesia used, general or epidural, was compared (P = 0.33 and P = 0.37 at 90 and 120 minutes, respectively).

Conclusions:
Ropivacaine irrigation in breast pocket is able to diminish early postoperative pain safely, being an alternative to other analgesic methods.
Cardiovascular Disease Risk Among Older Immigrants in the United States
Authors: Sadarangani Tina R. , Chyun Deborah , Trinh-Shevrin Chau , Yu Gary , Kovner Christine 
Published: May 2018

Background:
In the United States, 16 million immigrants are 50 years and older, but little is known about their cardiometabolic health and how to best assess their cardiovascular disease (CVD) risk. Aging immigrants may therefore not be benefitting from advances in CVD prevention.

Objective:
In this study, we estimate and compare CVD risk in a nationally representative sample of aging immigrants using 3 different measures.

Methods:
This was a cross-sectional analysis using National Health and Nutrition Examination Survey data. Immigrants 50 years and older with no history of CVD were eligible. The Framingham Risk Score (FRS), the American College of Cardiology/American Heart Association Pooled Cohort Risk Equation, and presence of metabolic syndrome (MetS) were used to estimate risk. Bivariate statistics were analyzed using SPSS version 23.0 Complex Survey module to account for National Health and Nutrition Examination Survey unique weighting scheme.

Results:
The mean age of the sample was 61.3 years; 40% had hypertension, 17% had diabetes, 10% were smokers, and 95% did not meet the recommended physical activity guidelines. Proportions at an elevated CVD risk were as follows: American College of Cardiology/American Heart Association, 42% female and 76% male; FRS, 17.4% female and 76% male; and MetS, 22% female and 24% male.

Conclusions:
Immigrants had a lower overall risk using MetS and the American College of Cardiology/American Heart Association equation than has been found using these tools in similarly aged samples. The opposite was true for the FRS. The discrepancy between the proportion at risk and those being treated may reflect healthcare access gaps that warrant further investigation. A more holistic approach to risk measurement is needed that accounts for determinants of health that disproportionately affect immigrants, including language and socioeconomic status.
Managing What Is Measured: A Rural Hospital's Experience in Reducing Patient Harm
Authors: Stargell Lucretia F. , Heatherly Stephen L. 
Published: May 2018

ABSTRACT
Effecting improvement in the small, rural hospital setting is often challenging. Harris Regional Hospital (HRH) is a small, acute care hospital in rural western North Carolina acquired by Duke LifePoint Healthcare in August, 2014. Since that time, HRH has been on a quality journey characterized by a data-driven approach to reducing patient harm events. Using a framework that comprised leadership, performance improvement, and cultural development to cultivate an environment of mutual respect and trust, HRH has demonstrated sustained improvement in patient harm events over a 29-month period from January 2015 to June 2017. The purpose of this article is to provide examples of scalable, effective tactics contributing to quality improvement in the rural hospital environment.
Lower Aerobic Endurance Linked to History of Depression in Multiple Sclerosis: Preliminary Observations
Authors: Chapman Kimberly R. , Anderson Jason R. , Calvo Dayana , Pollock Brandon S. , Petersen Jennifer , Gerhart Hayden , Ridgel Angela , Spitznagel Mary Beth 
Published: May 2018

ABSTRACT

Background: Despite the demonstrated benefits of exercise in multiple sclerosis (MS), this population shows low rates of physical activity. Understanding barriers to exercise in persons with MS is important. The current study examined the relationship between lifetime history of depression, current depressive symptoms, and aerobic endurance in persons with relapsing-remitting MS to determine whether depression might be one such barrier. Methods: Thirty-one participants with relapsing-remitting MS self-reported current depressive symptoms and history of depression. Aerobic endurance was assessed via 2-Minute Step Test. Results: Linear regression demonstrated that lifetime history of depression predicted lower aerobic fitness whereas current depressive symptoms did not. Conclusions: Findings suggest a possible role of lifetime depression as a barrier to exercise in MS and highlight the importance of effective treatment of depression in this population to reduce its potential impact on exercise adherence.
The Effect of an Educational Pamphlet on Patient Knowledge of and Intention to Discuss Screening for Obstructive Sleep Apnea in the Acute Ischemic Stroke Population
Authors: Donald Ryan A. , Arays Ruta , Elliott John O. , Jordan Kim 
Published: May 2018

ABSTRACT

Background: The relationship between obstructive sleep apnea (OSA) and stroke is well established, thus supporting the importance of secondary prevention via screening and treatment for acute ischemic stroke survivors. Educational pamphlets are commonly used for patient education; however, none currently available on OSA have evaluated. The aim of this study was to evaluate the effect of a brief educational intervention on patient knowledge and interest in OSA screening. Methods: Adult acute ischemic stroke patients were enrolled into a nonrandomized, single-group, pretest and posttest study. Inclusion criteria included minor or moderate stroke per the National Institutes of Health Stroke Scale score of 1 to 15, with a level of consciousness score of 0. Patients with known dementia or OSA were excluded. After the preintervention survey, patients were given an educational pamphlet reviewing OSA and stroke. A postintervention survey was administered 24 to 72 hours later. Outcomes included an 8-question knowledge test standardized to percentiles, intention to speak with a physician about screening on a 7-point scale (1, not at all likely, to 7, very likely), and perception of the pamphlet’s educational value on a 7-point scale (1, not valuable, to 7, quite valuable). Results: Of 124 eligible patients, 36 consented and 26 completed both preintervention and postintervention surveys. Preintervention knowledge scores averaged 69.7% (SD, 21.3%), postintervention scores averaged 80.8% (SD, 21.0%), P = .005, with an effect size of 1.00. Likelihood of speaking with a physician about OSA testing improved from 3.5 (SD, 2.0) to 5.0 (SD, 1.8), P = .001, with an effect size of 0.89. Pamphlet educational value was scored at 5.2 (SD, 1.7). Conclusions: A brief educational pamphlet written using health literacy concepts was considered valuable and improved patient knowledge and intention to discuss OSA screening with a physician. Further work is needed to determine whether the pamphlet can promote a discussion and referral for OSA screening at the primary care level.
Effect of a Prosthetic Foot with a Hydraulic Ankle Unit on the Contralateral Foot Peak Plantar Pressures in Individuals with Unilateral Amputation
Authors: Moore Raymond 
Published: May 2018

ABSTRACT

Introduction
Since their release, prosthetic feet with integrated hydraulic ankle units have proved a popular prescription choice among individuals with lower-limb amputation. This study evaluates the effect of including this type of prosthetic foot on the peak plantar pressures of the patient’s contralateral foot.

Case Description and Methods
Peak plantar pressures of 14 participants with established K3 activity levels were measured before and after the addition of a prosthetic foot with hydraulic ankle unit using the Amcube pressure plate.

Results
The results showed a statistically significant reduction in contralateral peak plantar pressures with the use of a prosthetic foot containing a hydraulic ankle unit.

Conclusions
The benefits of changing to a prescription including a foot with integrated hydraulic ankle unit can have significant effects on the forces acting on the remaining foot of an individual with amputation.
Amyotrophic Lateral Sclerosis
Authors: Bellomo Tamara L. , Cichminski Lucille 
Published: May 2018

A MOTHER OF THREE teenage children, Mrs. S, 49, presented to her healthcare provider with bilateral leg twitching and weakness, difficulty swallowing, and fatigue that's worsened over the past few weeks. While she was on her daily morning walk, she tripped and fell. She experienced a small laceration to her leg, prompting her visit to the healthcare facility. Her husband said that she'd had periods of slurred speech over the past few months as well. She was alert and oriented, and her vital signs were all within normal limits.
After an exam, her healthcare provider referred her to a neurologist who ordered magnetic resonance imaging (MRI), an electromyogram, and a full bloodwork panel. After multiple visits to rule out other causes, Mrs. S received the devastating diagnosis of amyotrophic lateral sclerosis (ALS).
Autopsy Features of Fatal Donkey Attack
Authors: Fogel Lajos , Varga Gyula , Hubay Marta , Felszeghy Endre , Varga Peter , Byard Roger W. 
Published: May 2018

Abstract
Lethal donkey attacks have very rarely been described. The case of a 65-year-old man who was found deceased on a country road with 2 domestic donkeys nearby is, therefore, reported. Examination of the body revealed contusions and lacerations of the face and scalp, a comminuted fracture of the left maxilla, comminuted fracturing of the right radius and ulna and of the left anterior superior iliac spine, a flail chest, and pulmonary contusions. In addition, there were bite marks on the left thigh, right buttock, right axilla/upper arm, and left cheek which corresponded to the dental arcades of the donkeys. Death had resulted from blunt chest trauma due to an attack by 1 or 2 donkeys. Deaths and serious injuries are much more commonly caused by horses; however, this case shows that even domesticated donkeys may also rarely be capable of inflicting significant trauma and so should be approached with circumspection.
Relationships Between Gross Motor Skills and Social Function in Young Boys With Autism Spectrum Disorder
Authors: Holloway Jamie M. , Long Toby M. , Biasini Fred 
Published: May 2018

Purpose:
The purpose of this study was to examine the relationship between gross motor skills and social function in young boys with autism spectrum disorder.

Methods:
Twenty-one children with autism spectrum disorder participated in the study. The Peabody Developmental Motor Scales Second Edition and the Miller Function and Participation Scales were used to assess gross motor skills. The Social Skills Improvement System Rating Scales was used to assess social function.

Results:
Moderately high correlations were found between overall gross motor and social skills (r = 0.644) and between the core stability motor subtest and overall social skills (r = −0.672). Specific motor impairments in stability, motor accuracy, and object manipulation scores were predictive of social function.

Conclusions:
This study suggests that motor skills and social function are related in young boys with autism. Implications for physical therapy intervention are also discussed.
A Quality Initiative: A System-Wide Reduction in Serious Medication Events Through Targeted Simulation Training
Authors: Hebbar Kiran B. , Colman Nora , Williams Lorisa , Pina Jessica , Davis Lisa , Bost James E. , Jones Halli , Frank Gary 
Published: May 2018

Introduction
Medication administration events (MAEs) are a great concern to the healthcare industry, because they are both common and costly. Pediatric patients pose unique challenges to healthcare systems, particularly regarding the safety of medication administration. Our objectives were to improve adherence to best practices, decrease MAEs, and decrease cost related to error reduction rates by implementing a scenario-based simulation training program for frontline nursing staff in the general care units, emergency departments, and intensive care units within our institution.

Methods
Children's simulation center in conjunction with the medication safety workgroup developed a 2-hour target-specific simulation-based training. This quality initiative focused on implementation of a MAE bundle that included the following three elements: The Five Rights, MedZone, and Independent Double Check. Adherence to the use of bundle elements was monitored via bedside auditing for 18 months after the intervention. This audit was accomplished using an institution-wide MAE reporting system. The 2012 Healthcare Cost and Utilization Project Kids' Inpatient Database and 2014 Children's Hospital Association, Pediatric Health Information System databases were used to estimate cost impact.

Results
A total of 1434 nurses from our intensive care units, emergency departments, and general care inpatient units participated in simulation training. Nursing adherence to the MAE bundle in the 18-month period after simulation increased by 33%, from January 2014 to June 2015. Medication administration event monitoring during the preintervention, intervention, and postintervention periods demonstrated a decrease in error rate from 2.5 events per month to 0.86 events per month This error reduction correlated to an estimated charge savings of $165,000 to $255,000 and a cost impact of $90,000 to $130,000 per year.

Conclusions
Target-specific simulation-based training on a large scale has improved adherence with best practice guidelines and has led to a significant reduction in MAEs.
Short-term Outcomes of Ambulatory Colectomy for 157 Consecutive Patients
Authors: Gignoux Benoit , Gosgnach Marilyn , Lanz Thomas , Vulliez Alexandre , Blanchet Marie-Cecile , Frering Vincent , Faucheron Jean-Luc , Chasserant Philippe 
Published: May 2018

Objective:To evaluate short-term outcomes of laparoscopic colectomy for selected consecutive patients in an ambulatory setting at two institutions.Background:Several studies showed that an enhanced recovery protocol for colorectal surgery reduces postoperative morbidity and mortality, and shortens the length of hospital stay. The development of such a program has allowed us to gradually reduce the length of stay for colorectal surgery, until ambulatory management.Methods:Between February, 2013 and December, 2016, all patients scheduled for elective laparoscopic colectomy and meeting rigorous criteria for ambulatory surgery were included. Outcome was prospectively studied.Results:One hundred fifty-seven patients (70 women) with a median age of 61 years (range 25–82 years) were included. The ambulatory rate for colectomy was 30.5%. Median operative time and length of in-hospital stay were 95 minutes (range 45–232 minutes) and 10.0 hours (range 7–14.7 hours), respectively. The admission rate was 7.0% due to operative difficulties (4 patients), medical reasons (4 patients), and social reasons (3 patients). Outcomes for these patients were uneventful and the median length of hospital stay was 3.1 days (range 1–14 days). An unscheduled consultation was necessary for 30 patients (20.5%). Nine patients required readmission (6.1%), of whom 6 required reoperation (3.8%). The overall 30-day morbidity rate was 24.8%. The mortality rate was 0%.Conclusions:This is the first case of consecutive patients undergoing ambulatory colectomy for malignant or benign disease. We demonstrated the feasibility, safety, and reproducibility of outpatient colectomy for selected patients. In our experience, 30% of patients scheduled for elective colectomy can be managed in an ambulatory setting.
Prognostic Impact of Breast-Conserving Therapy Versus Mastectomy of BRCA1/2 Mutation Carriers Compared With Noncarriers in a Consecutive Series of Young Breast Cancer Patients
Authors: van den Broek Alexandra J. , Schmidt Marjanka K. , van ’t Veer Laura J. , Oldenburg Hester S. A. , Rutgers Emiel J. , Russell Nicola S. , Smit Vincent T. H. B. M. , Voogd Adri C. , Koppert Linetta B. , Siesling Sabine , Jobsen Jan J. , Westenend Pieter J. , van Leeuwen Flora E. , Tollenaar Rob A. E. M. 
Published: May 2018

Objective:
To investigate the effects of different types of surgery on breast cancer prognosis in germline BRCA1/BRCA2 mutation carriers compared with noncarriers.

Summary of Background Data:
Although breast-conserving therapy (breast-conserving surgery followed by radiotherapy) has been associated with more local recurrences than mastectomy, no differences in overall survival have been found in randomized trials performed in the general breast cancer population. Whether breast-conservation can be safely offered to BRCA1/2 mutation carriers is debatable.

Methods:
The study comprised a cohort of women with invasive breast cancer diagnosed <50 years and treated between 1970 and 2003 in 10 Dutch centers. Germline DNA for BRCA1/2 testing of most-prevalent mutations (covering ∼61%) was mainly derived from paraffin-blocks. Survival analyses were performed taking into account competing risks.

Results:
In noncarriers (N = 5820), as well as in BRCA1 (N = 191) and BRCA2 (N = 70) mutation carriers, approximately half of the patients received breast-conserving therapy. Patients receiving mastectomy followed by radiotherapy had prognostically worse tumor characteristics and more often received systemic therapy. After adjustment for these potential confounders, patients who received breast-conserving therapy had a similar overall survival compared with patients who received mastectomy, both in noncarriers (hazard ratio [HR] = 0.95, confidence interval [CI] = 0.85–1.07, P = 0.41) and BRCA1 mutation carriers (HR = 0.80, CI = 0.42–1.51, P = 0.50). Numbers for BRCA2 were insufficient to draw conclusions. The rate of local recurrences after breast-conserving therapy did not differ between BRCA1 carriers (10-year risk = 7.3%) and noncarriers (10-year risk = 7.9%).

Conclusion:
Our results, together with the available literature, provide reassurance that breast-conserving therapy is a safe local treatment option to offer to BRCA1 mutation carriers with invasive breast cancer.