bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety, Feasibility, and Efficacy of Pancolonic Retroflexed Viewing Using a Short-turn Radius Colonoscope
Authors: Robles-Medranda Carlos , Soria-Alcívar Miguel , Oleas Roberto , Vargas María , Ospina Jesenia , Abarca Francisco , Puga-Tejada Miguel , Baquerizo-Burgos Jorge , Pitanga-Lukashok Hannah 
Published: May 2019

Goals:
The goal of this study was to evaluate the safety and feasibility of routine segmental retroflexed withdrawal viewing (RV) of the colon with the RetroView colonoscope.

Materials and Methods:
This was a prospective, single-center, 2-stage diagnostic trial. After cecal intubation, mucosal evaluation by forward viewing (FV) and RV was performed by segment (right, transverse, left, and sigmoid colon, and rectum). Lesions detected during FV were removed and/or marked before retroflexion. Safety and feasibility were measured through adverse event and technical success rates. All lesions detected and removed endoscopically were recorded.

Results:
Two hundred twenty-five patients underwent colonoscopy with the RetroView colonoscope. Retroflexion by segment was successful in the right, transverse, left, and sigmoid colon, and rectum in 98.9%, 100%, 100%, 82.6%, and 100% of cases, respectively. The mean total procedure time was 16.6 minutes. Ninety-four lesions were detected through retroflexion evaluation, for an increase in the lesions’ detection rate of 30.7%. The per-adenoma miss rate of standard colonoscopy (FV) was 35.71%. The adenoma detection rate (ADR) for FV was 16%, whereas, when performing FV and RV, the ADR increased to 24.9%. Adverse events were recorded in 0.4% of cases. Therapeutic procedures were performed successfully through the retroflexed position in 81/225 patients.

Conclusions:
Routine retroflexion evaluation of the colonic mucosa by segment using the RetroView colonoscope is safe and feasible. Retroflexion evaluation increases the detection rate of colonic lesions behind folds, including the number of adenomas per colonoscopy and ADR, offering a complete screening colonoscopy. All therapeutic procedures are feasible through retroflexion.
Acute pancreatitis in end-stage renal disease patients in the USA: a nationwide, propensity score-matched analysis
Authors: Cheungpasitporn Wisit , Thongprayoon Charat , Ungprasert Patompong , Wijarnpreecha Karn , Raimondo Massimo , Kroner Paul T. 
Published: May 2019

Background
Limited data exist regarding the effects of end-stage renal disease (ESRD) on acute pancreatitis (AP). This study aimed to evaluate the association between ESRD and outcomes and resource utilization of AP.

Materials and methods
The 2014 National Inpatient Sample database was used to identify all hospitalized patients with a principal diagnosis of AP. Propensity score matching was performed to create a matched cohort of ESRD and non-ESRD patients. The in-hospital mortality, morbidity, resource utilization and expenditures of AP in ESRD patients were compared to non-ESRD patients. Multivariate analysis was performed for further adjustment for potential confounders.

Results
Of 382 595 AP patients, 7380 ESRD patients and 8050 non-ESRD patients were created after propensity score matching. ESRD patients had more tendency to have hypercalcemia-related or AP-related to other/unspecified causes, whereas non-ESRD patients had more tendency to have alcohol-related, gallstone-related, and hypertriglyceridemia-related AP. In multivariate analysis, ESRD was associated with increased in-hospital mortality, increased length of hospital stay, and increased hospitalization costs and charges. No differences were observed in inpatient morbidity, imaging study use, and procedures performed during hospitalization.

Conclusion
In this large nationwide study using inpatient USA database, we demonstrate higher AP-related mortality, and resource utilization among ESRD patients when compared with non-ESRD patients.
Diabetes mellitus increases the risk of hepatic encephalopathy after a transjugular intrahepatic portosystemic shunt in cirrhotic patients
Authors: Yin Xiaochun , Zhang Feng , Xiao Jiangqiang , Wang Yi , He Qibin , Zhu Hao , Leng Xiafei , Zou Xiaoping , Zhang Ming , Zhuge Yuzheng 
Published: May 2019

Objective
The aim of this study was to examine the effect of diabetes mellitus (DM) on the rate of hepatic encephalopathy (HE) in patients with decompensated liver cirrhosis after the creation of a transjugular intrahepatic portosystemic shunt (TIPS).

Patients and methods
This study retrospectively reviewed 436 consecutive patients with cirrhosis receiving TIPS in our department from 2008 to 2016. By comparing two groups of patients, with or without DM, the incidence of developing overt HE after TIPS, as well as the correlation between diabetes and HE, was analyzed. Data were analyzed using the χ
2-tests, unpaired t-tests, logistic regression, and Kaplan–Meier curves. After the initial data processing, we used a regression model to analyze whether or not DM is associated with the development of HE after TIPS.

Results
Of the 436 patients who underwent TIPS, 85 (19.5%) had diabetes at admission and 126 (28.9%) had HE after TIPS. Patients with DM more frequently had HE compared with those without DM (44.7 vs. 25.1%; P = 0.000). The logistic regression analysis showed that DM (P = 0.015) and age (P = 0.002) were independent risk factors for HE after TIPS. Finally, using the Kaplan–Meier curves, we found that diabetes significantly increases the incidence of overt HE (log-rank P = 0.026).

Conclusion
Similar to old age, DM may increase the risk of HE in cirrhotic patients after the creation of TIPS.
The effect of emergency department delays on 30-day mortality in Central Norway
Authors: Asheim Andreas , Nilsen Sara Marie , Carlsen Fredrik , Eide Næss-Pleym Lars , Uleberg Oddvar , Dale Jostein , Bache-Wiig Bjørnsen Lars P. , Bjørngaard Johan Håkon 
Published: May 2019

Objective:
To assess whether prolonged length of stay in the emergency department was associated with risk of death.

Methods:
We analysed data from 165,183 arrivals at St. Olav’s University Hospital’s emergency department from 2011 to 2018, using an instrumental variable method. As instruments for prolonged length of emergency department stay, we used indicators measured before arrival of the patient. These indicators were used to study the association between prolonged length of emergency department stay and risk of death, being discharged from the emergency department and length of hospitalisation for those who were hospitalised.

Results:
Mean length of stay in the emergency department was 2.9 hours, and 30-day risk of death was 3.4%. Per hour prolonged length of stay in the emergency department, the overall change in risk of death was close to zero, with a narrow 95% confidence interval of −0.5 to 0.7 percentage points. Prolonged emergency department stay was associated with a higher probability of being discharged from the emergency department without admission to the hospital. We found no substantial differences in length of hospitalisation for patients who were admitted.

Conclusion:
In this study, prolonged emergency department stay was not associated with increased risk of death.
Prediction Accuracy With Electronic Medical Records Versus Administrative Claims
Authors: Zeltzer Dan , Balicer Ran D. , Shir Tzvi , Flaks-Manov Natalie , Einav Liran , Shadmi Efrat 
Published: May 2019

Objective:
The objective of this study was to evaluate the incremental predictive power of electronic medical record (EMR) data, relative to the information available in more easily accessible and standardized insurance claims data.

Data and Methods:
Using both EMR and Claims data, we predicted outcomes for 118,510 patients with 144,966 hospitalizations in 8 hospitals, using widely used prediction models. We use cross-validation to prevent overfitting and tested predictive performance on separate data that were not used for model training.

Main Outcomes:
We predict 4 binary outcomes: length of stay (≥7 d), death during the index admission, 30-day readmission, and 1-year mortality.

Results:
We achieve nearly the same prediction accuracy using both EMR and claims data relative to using claims data alone in predicting 30-day readmissions [area under the receiver operating characteristic curve (AUC): 0.698 vs. 0.711; positive predictive value (PPV) at top 10% of predicted risk: 37.2% vs. 35.7%], and 1-year mortality (AUC: 0.902 vs. 0.912; PPV: 64.6% vs. 57.6%). EMR data, especially from the first 2 days of the index admission, substantially improved prediction of length of stay (AUC: 0.786 vs. 0.837; PPV: 58.9% vs. 55.5%) and inpatient mortality (AUC: 0.897 vs. 0.950; PPV: 24.3% vs. 14.0%). Results were similar for sensitivity, specificity, and negative predictive value across alternative cutoffs and for using alternative types of predictive models.

Conclusion:
EMR data are useful in predicting short-term outcomes. However, their incremental value for predicting longer-term outcomes is smaller. Therefore, for interventions that are based on long-term predictions, using more broadly available claims data is equally effective.
Change in Patient Outcomes After Augmenting a Low-level Implementation Strategy in Community Practices That Are Slow to Adopt a Collaborative Chronic Care Model
Authors: Smith Shawna N. , Almirall Daniel , Prenovost Katherine , Liebrecht Celeste , Kyle Julia , Eisenberg Daniel , Bauer Mark S. , Kilbourne Amy M. 
Published: May 2019

Background:
Implementation strategies are essential for promoting the uptake of evidence-based practices and for patients to receive optimal care. Yet strategies differ substantially in their intensity and feasibility. Lower-intensity strategies (eg, training and technical support) are commonly used but may be insufficient for all clinics. Limited research has examined the comparative effectiveness of augmentations to low-level implementation strategies for nonresponding clinics.

Objectives:
To compare 2 augmentation strategies for improving uptake of an evidence-based collaborative chronic care model (CCM) on 18-month outcomes for patients with depression at community-based clinics nonresponsive to lower-level implementation support.

Research Design:
Providers initially received support using a low-level implementation strategy, Replicating Effective Programs (REP). After 6 months, nonresponsive clinics were randomized to add either external facilitation (REP+EF) or external and internal facilitation (REP+EF/IF).

Measures:
The primary outcome was patient 12-item short form survey (SF-12) mental health score at month 18. Secondary outcomes were patient health questionnaire (PHQ-9) depression score at month 18 and receipt of the CCM during months 6 through 18.

Results:
Twenty-seven clinics were nonresponsive after 6 months of REP. Thirteen clinics (N=77 patients) were randomized to REP+EF and 14 (N=92) to REP+EF/IF. At 18 months, patients in the REP+EF/IF arm had worse SF-12 [diff, 8.38; 95% confidence interval (CI), 3.59–13.18] and PHQ-9 scores (diff, 1.82; 95% CI, –0.14 to 3.79), and lower odds of CCM receipt (odds ratio, 0.67; 95% CI, 0.30–1.49) than REP+EF patients.

Conclusions:
Patients at sites receiving the more intensive REP+EF/IF saw less improvement in mood symptoms at 18 months than those receiving REP+EF and were no more likely to receive the CCM. For community-based clinics, EF augmentation may be more feasible than EF/IF for implementing CCMs.
Inheritance of high and low HDL: mechanisms and management
Authors: Sourlas Andreas , Kosmas Constantine E. 
Published: May 2019

Purpose of review
The inverse association between plasma high-density lipoprotein cholesterol (HDL-C) concentration and the incidence of cardiovascular disease (CVD) has been unequivocally proven by many epidemiological studies. There are several genetic disorders affecting HDL-C plasma levels, either providing atheroprotection or predisposing to premature atherosclerosis. However, up to date, there has not been any pharmacological intervention modulating HDL-C levels, which has been clearly shown to prevent the progression of CVD. Thus, clarifying the exact underlying mechanisms of inheritance of these genetic disorders that affect HDL is a current goal of the research, as key roles of molecular components of HDL metabolism and function can be revealed and become targets for the discovery of novel medications for the prevention and treatment of CVD.

Recent findings
Primary genetic disorders of HDL can be either associated with longevity or, in contrast, may lead to premature CVD, causing high morbidity and mortality to their carriers. A large body of recent research has closely examined the genetic disorders of HDL and new promising therapeutic strategies have been developed, which may be proven beneficial in patients predisposed to CVD in the near future.

Summary
We have reviewed recent findings on the inheritance of genetic disorders associated with high and low HDL-C plasma levels and we have discussed their clinical features, as well as information about new promising HDL-C-targeted therapies that are under clinical trials.
Recent developments in lipodystrophy
Authors: Melvin Audrey , Stears Anna , Savage David B. 
Published: May 2019

Purpose of review
Lipodystrophy syndromes have an estimated prevalence of 1.3–4.7 cases per million and as with other rare diseases conducting research can be challenging. The present review highlights recently published work that has provided insights into the field of non-HIV--associated lipodystrophy syndromes.

Recent findings
Lipodystrophies are a heterogenous group of disorders, as such research is often focused on specific subtypes of the condition. The identification of children carrying LMNA mutations has provided insights into the natural history of FPLD2, specifically that the adipose tissue phenotype predates the onset of puberty. Recent reports of PLIN1 heterozygous null variant carriers and the apparent absence of a lipodystrophy phenotype challenges our understanding of the molecular biology of perilipin 1 and its role in the pathogenesis of FPLD4. With a focus on therapeutics, studies delineating the differential responsiveness of PPARγ mutants to endogenous and synthetic ligands has illustrated the potential for pharmacogenetics to inform therapeutic decisions in lipodystrophy related to PPARG mutations, whereas robust human studies have provided insight into the food independent metabolic effects of leptin in lipodystrophy. Finally, rare syndromes of lipodystrophy continue to serve as an exemplar for the contribution of genetically determined adipose tissue expandability to metabolic disease in the general population.

Summary
Lipodystrophy research continues to illuminate our understanding of this rare disease and the possibility that lipodystrophy syndromes and the metabolic syndrome may have shared pathophysiology.
Role of serum amyloid A in atherosclerosis
Authors: Shridas Preetha , Tannock Lisa R. 
Published: May 2019

Purpose of review
Acute phase serum amyloid A (SAA) is persistently elevated in chronic inflammatory conditions, and elevated levels predict cardiovascular risk in humans. More recently, murine studies have demonstrated that over-expression of SAA increases and deficiency/suppression of SAA attenuates atherosclerosis. Thus, beyond being a biomarker, SAA appears to play a causal role in atherogenesis. The purpose of this review is to summarize the data supporting SAA as a key player in atherosclerosis development.

Recent findings
A number of pro-inflammatory and pro-atherogenic activities have been ascribed to SAA. However, the literature is conflicted, as recombinant SAA, and/or lipid-free SAA, used in many of the earlier studies, do not reflect the activity of native human or murine SAA, which exists largely lipid-associated. Recent literatures demonstrate that SAA activates the NLRP3 inflammasome, alters vascular function, affects HDL function, and increases thrombosis. Importantly, SAA activity appears to be regulated by its lipid association, and HDL may serve to sequester and limit SAA activity.

Summary
SAA has many pro-inflammatory and pro-atherogenic activities, is clearly demonstrated to affect atherosclerosis development, and may be a candidate target for clinical trials in cardiovascular diseases.
Diagnosis of Invasive Fungal Infection Among Pediatric Oncology Patients
Authors: Hodgman Erica I. , Compton Jeffrey , Qureshi Faisal G. , Murphy Joseph T. 
Published: May 2019

Introduction:
The diagnosis of pulmonary invasive fungal infection (IFI) in the pediatric oncology patient is challenging. Consensus criteria developed in 2008 state that bronchioalveolar lavage (BAL) results cannot confirm this diagnosis. A video-assisted thoracoscopic biopsy (VATS-biopsy) of lungs has been increasingly used to assist in evaluating these children for IFI. Our goal was to evaluate the impact of BAL and VATS-biopsy results on the management of IFI among pediatric oncology patients.

Methods:
A retrospective review of all oncology patients evaluated for IFI with VATS-biopsy and/or BAL over 9 years was carried out at a single free-standing children’s hospital. The primary outcome was management changes in the use of antifungal therapy on the basis of diagnostic procedure, fungal culture results, lung imaging, and serological markers.

Results:
A total of 102 patients underwent 122 diagnostic evaluations for IFI. Ninety-one workups included only BAL, 17 evaluations involved only VATS-biopsy, and 14 cases involved both BAL and VATS-biopsy. The diagnostic yield of VATS-biopsy (38.7%) was superior to that of BAL (27.6%). There was poor concordance between VATS-biopsy and BAL results in the 14 cases where both were performed. Upon workup completion, IFI was proven in 12 children, probable in 29, and possible in 52. The odds of continuing antifungals increased 3-fold for patients with probable IFI and 12.7 times for those with the proven disease.

Discussion:
On the basis of the inferior diagnostic yield of BAL, we believe that VATS-biopsy may be a more useful diagnostic adjuvant in the diagnosis of IFI in the immunocompromised pediatric oncologic patient population.
Leveraging Technology to Sustain Extraordinary Care
Authors: Clavelle Joanne T. , Sweeney Cynthia D. , Swartwout Ellen , Lefton Cindy , Guney Senem 
Published: May 2019

OBJECTIVE
Meaningful recognition of nurses submitted by patients and families using interactive patient care (IPC) technology was analyzed using artificial intelligence (AI) to identify the themes and behaviors associated with extraordinary nursing.

BACKGROUND
Meaningful recognition positively impacts nursing and organizational outcomes. The use of AI techniques such as natural language processing and machine learning to identify and describe behaviors impacting patient experiences is an emerging science.

METHODS
Nurse recognition comments were collected from a convenience sample of 3 organizations via an IPC inpatient platform and analyzed using the AI techniques of natural language processing, machine learning, sentiment analytics, and corollary dictionaries based on rules of linguistics.

RESULTS
The top theme of nursing recognition comments was courtesy and respect with the behaviors of empathy/compassion, helpfulness, kindness, attentiveness, and emotional comfort. The theme of skills/knowledge was the 2nd most common, with the behaviors of being professional, knowledgeable, keeping track, competence, dedication, and being thorough.

CONCLUSIONS
AI techniques for qualitative analysis of comments collected through IPC reveal nurse themes and behaviors most meaningful to patients and their family members. Nurses can advance the science of AI and guide its evolution so that nurse caring behaviors associated with establishing human connections that positively influence patient and family experience are accurately represented.
Evaluating the Use of High-Reliability Principles to Increase Error Event Reporting
Authors: Duffey Pam , Oliver JoAnn S. , Newcomb Patricia 
Published: May 2019

OBJECTIVE
Assess the relationship between educating caregivers about high-reliability principles and reporting of potential adverse safety events.

BACKGROUND
Persuading caregivers to report potential safety events is challenging. Learning high-reliability principles may help caregivers identify and report potential safety problems.

METHODS
Event reports submitted by caregivers 6 months before and after high-reliability training were examined for event types, event significance, and shift when events occurred. χ
2 Tests assessed relationships between variables.

RESULTS
The number and type of caregiver event reports before and after training were not significantly different; however, clinical process error reports significantly decreased (χ
2 = 9.251, P = .003). There was a significant difference in reports submitted by day and night shifts (χ
2 = 5.942, P = .02).

CONCLUSIONS
Trends suggest staff report actual, rather than potential, events regardless of training. Further research is needed to determine what motivates caregivers to report safety concerns.
System- and Unit-Level Care Quality Outcome Improvements After Integrating Clinical Nurse Leaders Into Frontline Care Delivery
Authors: Bender Miriam , Murphy Elizabeth A. , Cruz Maricela , Ombao Hernando 
Published: May 2019

OBJECTIVE
This study determined whether 1 health system's frontline nursing model redesign to integrate clinical nurse leaders (CNLs) improved care quality and outcome score consistency.

METHODS
Interrupted time-series design was used to measure patient satisfaction with 7 metrics before and after formally integrating CNLs into a Michigan healthcare system. Analysis generated estimates of quality outcome: a) change point; b) level change; and c) variance, pre-post implementation.

RESULTS
The lowest-performing unit showed significant increases in quality scores, but there were no significant increases at the hospital level. Quality metric consistency increased significantly for every indicator at the hospital and unit level.

CONCLUSIONS
To our knowledge, this is the 1st study quantifying quality outcome consistency before and after nursing care delivery redesign with CNLs. The significant improvement suggests the CNL care model is associated with production of stable clinical microsystem practices that help to reduce clinical variability, thus improving care quality.