bluuebunny/crossref_metadata_2025_split huggingface dataset:
Major Adverse Cardiac Events and Mortality Associated with Electroconvulsive Therapy
Authors: Duma Andreas , Maleczek Mathias , Panjikaran Basil , Herkner Harald , Karrison Theodore , Nagele Peter 
Published: October 2018

Abstract

EDITOR’S PERSPECTIVE

What We Already Know about This Topic
The incidence of major adverse cardiac events after electroconvulsive therapy is not known

What This Article Tells Us That Is New
Major adverse cardiac events and death after electroconvulsive therapy are infrequent and occur in about 1 of 50 patients and after about 1 of 200 to 500 electroconvulsive therapy treatments

Background
Cardiac events after electroconvulsive therapy have been reported sporadically, but a systematic assessment of the risk is missing. The goal of this study was to obtain a robust estimate of the incidence of major adverse cardiac events in adult patients undergoing electroconvulsive therapy.

Methods
Systematic review and meta-analysis of studies that investigated electroconvulsive therapy and reported major adverse cardiac events and/or mortality. Endpoints were incidence rates of major adverse cardiac events, including myocardial infarction, arrhythmia, pulmonary edema, pulmonary embolism, acute heart failure, and cardiac arrest. Additional endpoints were all-cause and cardiac mortality. The pooled estimated incidence rates and 95% CIs of individual major adverse cardiac events and mortality per 1,000 patients and per 1,000 electroconvulsive therapy treatments were calculated.

Results
After screening of 2,641 publications and full-text assessment of 284 studies, the data of 82 studies were extracted (total n = 106,569 patients; n = 786,995 electroconvulsive therapy treatments). The most commonly reported major adverse cardiac events were acute heart failure, arrhythmia, and acute pulmonary edema with an incidence (95% CI) of 24 (12.48 to 46.13), 25.83 (14.83 to 45.00), and 4.92 (0.85 to 28.60) per 1,000 patients or 2.44 (1.27 to 4.69), 4.66 (2.15 to 10.09), and 1.50 (0.71 to 3.14) per 1,000 electroconvulsive therapy treatments. All-cause mortality was 0.42 (0.11 to 1.52) deaths per 1,000 patients and 0.06 (0.02 to 0.23) deaths per 1,000 electroconvulsive therapy treatments. Cardiac death accounted for 29% (23 of 79) of deaths.

Conclusions
Major adverse cardiac events and death after electroconvulsive therapy are infrequent and occur in about 1 of 50 patients and after about 1 of 200 to 500 electroconvulsive therapy treatments.
Cervical Spine Movement in a Cadaveric Model of Severe Spinal Instability: A Study Comparing Tracheal Intubation with 4 Different Laryngoscopes
Authors: Romito Jia W. , Riccio Christina A. , Bagley Carlos A. , Minhajuddin Abu , Barden Catherine B. , Michael Meghan M. , Bhoja Ravi , Mootz Brady L. , Skrivanek Gary D. , Klein Kevin W. , McDonagh David L. 
Published: October 2018

Background:
This study compared the Macintosh blade direct laryngoscope, Glidescope, C-Mac d-Blade, and McGrath MAC X-blade video laryngoscopes in 2 cadaveric models with severe cervical spinal instability. We hypothesized that the Glidescope video laryngoscope would allow for intubation with the least amount of cervical spine movement. Our secondary endpoints were glottic visualization and intubation success.

Methods:
In total, 2 fresh cadavers underwent maximal surgical destabilization from the craniocervical junction to the cervicothoracic junction by a neurosurgical spine specialist, with subsequent neutral positioning of the heads with surgical head fixation devices. On each cadaver, 8 experienced anesthesiologists performed four intubations with the 4 laryngoscopes in random order. Lateral radiographic measurements determined vertebral displacement during intubation.

Results:
Cervical spine displacements were not significantly different amongst video laryngoscopes. Cormack-Lehane Grade 1 views were achieved with all attempts with each of the 3 video laryngoscopes; intubation attempts with the Macintosh blade achieved only grade 3 or grade 4 views. Intubation was successful every time with a video laryngoscope but only during 1 of 16 intubation attempts with the Macintosh blade.

Conclusions:
In a cadaveric model with maximally destabilized cervical spines, cervical spine movement was observed during attempted laryngoscopy using each of 3 video laryngoscopes, although there was no significant difference between the laryngoscopes. Given cervical spine displacement occurred, these video laryngoscopes do not prevent cervical spine motion during laryngoscopy. However, with improved glottic visualization and intubation success, video laryngoscopes are superior to the Macintosh blade in both cervical spine safety and intubation efficacy in the model studied.
Radiation Safety Aspects of Iodine-131 metaiodobenzylguanidine (131I mIBG) Therapy Program Startup
Authors: Barnes J.A. , de la Guardia M. , Easley T. , Downs H. , Mims S. , Nielson K. , Granger M. 
Published: October 2018

Abstract
As a medical center without a pre-existing radiopharmaceutical therapy program, it was a daunting endeavor to implement a 131I metaiodobenzylguanidine (mIBG) high-dose treatment regimen. It took several years of planning with hospital administration, vendors, and Texas Department of Health Radiological Control regulators to establish a viable program. Effective communication between physicians, nursing, nuclear medicine, environmental services, maintenance, and other support staff is essential and paramount for the successful execution and continued sustainability of the mIBG therapy program. Besides providing an effective treatment for patients, an additional goal for the program is to keep radiation exposure As Low As Reasonably Achievable (ALARA) for staff and patient caregivers. As such, start-up presented many training, logistical, and radiation safety challenges. The location of the isolation room and shielding specifications were designed to keep radiation exposure to public access areas to less than 2 microsieverts per hour. Before the first patient was treated the policies and procedures for training, radiation safety, product quality control, and infusion process needed to be developed, tested, and approved by various committees. Furthermore, a similar process was required for developing room set-up, post therapy cleanup, and waste storage procedures. Throughout the maturation process of the program, the departments involved have found that our safety culture has continually improved by the re-enforcement of knowledge and lessons learned, as both the ancillary and treatment staff grew more confident in each other’s ability during more patient treatments are performed. This article describes the process and lessons learned during the time leading up to the startup and early years of the mIBG therapy program.
Visualizing High-Order Decay after Disequilibria
Authors: Wilson Charles A. , Hendrickson Katherine R. , Hamideh Amin M. , Matthews Kenneth L. , Wang Wei-Hsung 
Published: October 2018

Abstract
High-order decay equations are often difficult to study without significant care taken with variables and assumptions. As parent and progeny activities evolve over time, the effects of uncertainties and approximations confound the quality and interpretation of results. Of particular concern is the situation when decay equilibrium has been disturbed and progenies have arbitrary initial activities. To address this, code was created using Wolfram Mathematica to visualize the time-activity plots of the high order progenies of naturally occurring radioactive material after secular equilibrium is disturbed. The Bateman equation for an un-replenished parent was expanded to calculate activity vs. time for up to 13 progenies at different initial activities. The code uses the formula of Skrable et al., without parent production, expanded to the 13th progeny with arbitrary initial concentration. The code calculates and plots activity vs. time; it also reports the cumulative disintegrations of each progeny over a user-specified time period for comparison to counting measurements. The code could also be modified to incorporate additional production or branched decay schemes. We believe this code may be useful to health physicists and is intended to be accessible for anyone’s use. This paper presents the code with explanations and examples on how to use it.
SPECKLED HYPOAUTOFLUORESCENCE AS A SIGN OF RESOLVED SUBRETINAL HEMORRHAGE IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Hussnain S. Amal , Dolz-Marco Rosa , Dunaief Joshua L. , Curcio Christine A. , Freund K. Bailey 
Published: October 2018

Purpose:
To describe patterns of hypoautofluorescence in eyes with neovascular age-related macular degeneration occurring after subretinal hemorrhage.

Methods:
This was a retrospective descriptive analysis of neovascular age-related macular degeneration eyes presenting with subretinal hemorrhage over the last 5 years that underwent serial multimodal imaging. A review of color fundus photographs, fundus autofluorescence, near-infrared reflectance, and optical coherence tomography was performed at baseline and all available follow-up visits to document the course and evolution of subretinal hemorrhage in these eyes.

Results:
Eleven eyes of 10 patients (9 female, 1 male; mean age: 84.1 years, range: 72–99 years) with a mean follow-up of 19.8 months (range: 3–68 months) were included. Color fundus photographs showed subretinal hemorrhage that resolved over a mean of 5.5 months. During and after hemorrhage resolution, all eyes showed hypoautofluorescence, which appeared distinct from that due to retinal pigment epithelium loss. Discrete multifocal punctate hyperpigmented lesions were observed in 90% of eyes and were markedly hypoautofluorescent, producing a speckled pattern on fundus autofluorescence.

Conclusion:
Areas of hypoautofluorescence in the absence of retinal pigment epithelium atrophy, often with a speckled pattern, delineate areas of prior subretinal hemorrhage long after its resolution in patients with neovascular age-related macular degeneration. Potential mechanisms for the development of this pattern are proposed.
Geographic and Provider Variations in Ocular Hypotensive Medication Claims Among Medicare Part D Enrollees
Authors: Janetos Timothy M. , French Dustin D. , Beaumont Jennifer L. , Tanna Angelo P. 
Published: October 2018

Purpose:
The purpose of this study was to describe the prescribing patterns of ocular hypotensive medications by ophthalmologists and optometrists in the United States for Medicare beneficiaries.

Materials and Methods:
This cross-sectional observational study examined all Medicare part D claims of ocular hypotensive medications prescribed by practicing ophthalmologists and optometrists in the United States in 2014. Claims rate was calculated as a function of the total number of Medicare part D beneficiaries within a given region. Claims rates were compared between ophthalmologists and optometrists and by region (state, and county level). The coefficient of variation was used to quantify treatment variation at the state level.

Results:
The rates of claims for prescriptions from ophthalmologists were higher nationally than from optometrists by a 6:1 ratio. Claims rates in urban, large and small rural cities were significantly greater for ophthalmologists. Claims rates associated with optometrists were greater in isolated small rural towns. The coefficient of variation at the state level was 52.0 for optometrists, 32.6 for ophthalmologists, and 25.2 for both groups combined.

Conclusions:
Medicare part D claims data for ocular hypotensive medications indicate ophthalmologists used a significantly wider range of medications, derived from more medication classes and treated more patients than optometrists. A larger proportion of ocular hypotensive medication claims were associated with ophthalmologists in urban and suburban regions. The opposite was observed in isolated small rural towns. At the state level, there is a large variation in medication claims rates with the highest rates in New York and Washington, DC.
Microcatheter-assisted Trabeculotomy for Primary Congenital Glaucoma After Failed Glaucoma Surgeries
Authors: Hu Man , Wang Huaizhou , Huang Alex S. , Li Li , Shi Yan , Xu Yongli , Wang Ningli 
Published: October 2018

Purpose:
To evaluate the effectiveness of microcatheter-assisted trabeculotomy (MAT) to treat primary congenital glaucoma after failed previous glaucoma surgeries.

Materials and Methods:
Retrospective, noncomparative, interventional case series conducted at Beijing Tongren Eye Center, China. Outcome measures were compared between 3 groups: successful and complete (≥330 degrees) MAT; successful and partial (<330 degrees) MAT; or cases converted to traditional trabeculotomy when the Schlemm’s canal could not be catheterized >180 degrees. Success was defined as final intraocular pressure ≤21 mm Hg, with (qualified success) or without (complete success) glaucoma medications.

Results:
In total, 74 eyes of 63 consecutive patients were included. MAT was performed in 50 eyes (67.6%). Postoperative intraocular pressure and number of glaucoma drops (17.7±8.6 mm Hg, 0.6±1.2 medications) was significantly less than the preoperative values (35.3±7.2 mm Hg, 2.7±0.8 medications; P<0.001). Cumulative probabilities of qualified and complete success were 84.0% and 80.0% at 3-year follow-up with no difference between complete and partial trabeculotomies. MAT was not successfully performed in 24 eyes (32.4%), requiring conversion to traditional trabeculotomy and associated with greater incidence of previous surgeries (P<0.001), earlier age of disease onset (P=0.024) and worse corneal transparency (P=0.010). Cumulative probabilities of qualified and complete success were 37.0% and 29.2% at 3-year follow-up.

Conclusions:
Both complete and partial MAT achieved significant pressure reduction in cases of primary congenital glaucoma with previous failed glaucoma surgeries in intermediate term.
Social representations of chronic pain in newspapers, online media, and film
Authors: Kugelmann Robert , Watson Kelsey , Frisby Gregory 
Published: October 2018

Abstract
Social representation theory provides a framework for studying how scientific knowledge affects common sense and communication through inquiries into everyday discourse. This qualitative study examined social representations of chronic pain from 4 sources: North American newspapers; “Chronic Illness Cat” memes from the social media web site, Pinterest; video blogs on YouTube; and from a 2014 film, Cake, and interviews and comments concerning it. Using thematic analysis, we first identified social representations found in our 4 sources and others found in 1 or 2 of them. Second, we analyzed the sources for their rhetorical intentions. Vlogs directly and memes indirectly were first-person accounts, self-authorizing statements of the truth of chronic pain, whereas newspaper articles and the film were third-person accounts of pain, the differences between these perspectives affecting what was said. We conclude that the medium shapes the message.
National Testing of the Emergency Department Patient Experience of Care Discharged to Community Survey and Implications for Adjustment in Scoring
Authors: Parast Layla , Mathews Megan , Tolpadi Anagha , Elliott Marc , Flow-Delwiche Elizabeth , Becker Kirsten 
Published: October 2018

Background:
The emergency department (ED) setting is unique and measuring quality of care in the ED requires the development of ED-specific tools. The Emergency Department Patient Experience of Care Discharged to Community Survey was designed to measure patient experience in the ED setting.

Objectives:
Describe results from the Emergency Department Patient Experience of Care Discharged to Community Survey including respondent characteristics and reported patient experience, and examine factors, including mode of survey administration, associated with response propensity and response patterns.

Research Design:
In total, 16,006 discharges were sampled from 50 hospitals nationwide to receive the survey using a mode experiment design. Logistic regression modeled response propensity; linear regression examined associations between response patterns and patient characteristics and mode.

Subjects:
In total, 3122 survey respondents.

Measures:
Measures of patient experience.

Results:
Patients reported that hospitals consistently informed them of the purpose of any new medications (84% yes, definitely), but did not consistently explain their possible side effects (53%). Age, education, health, and arrival by ambulance were significantly associated with response patterns. There were significant differences in response rate by mode: 29% mixed mode, 22% telephone only and 14% mail only. Mode of administration was significantly associated with response patterns whereby patients surveyed using telephone-only or mixed mode tended to respond more positively than those surveyed using mail only.

Conclusions:
There is room for improvement in terms of patient experience in the ED setting. Effects of patient characteristics and survey mode on responses were large enough to necessitate appropriate adjustments if hospitals are to be compared in the future.
Risk Factors Associated With 7- Versus 30-Day Readmission Among Patients With Heart Failure Using the Nationwide Readmission Database
Authors: Pham Phuong N. , Xiao Hong , Sarayani Amir , Chen Ming , Brown Joshua D. 
Published: October 2018

Background:
The 30-day all-cause readmission for heart failure (HF) is a standard measure to evaluate hospital performance. A recent study found that a shorter period after discharge may be more indicative of hospital quality.

Objective:
To compare risk factors for 7- versus 30-day readmission in patients with HF.

Design:
This is a retrospective cohort using the 2014 Nationwide Readmissions Database.

Subjects:
Patients 65 years and older with Medicare coverage discharged after HF admission.

Measures:
The 7- or 30-day all-cause readmissions were the outcomes of interest. HF-related readmissions were secondary outcomes. Covariates included patient characteristics, hospital characteristics, and admission-related information. Hierarchical logistic regression evaluated the association between covariates and readmissions.

Results:
There were N=15,039 all-cause readmissions within 7 days after discharge and N=47,896 within 30 days. Surgical service was a risk factor for 30-day but not 7-day all-cause readmission (odds ratio=1.10, 95% confidence interval=1.05–1.16). Depression, rheumatoid arthritis, liver disease, drug abuse, lymphoma, and psychosis were associated with an increased risk of 30-day all-cause readmission but not 7-day. Longer lengths of stay also had a higher likelihood of all-cause readmission within 30 days compared with 7 days. In contrast, smaller hospital bed size was associated with an increased risk of 7-day all-cause readmission (odds ratio=1.06, confidence interval=1.01–1.12) but not 30-day. Sensitivity analysis with using a 3-day readmission interval showed similar results.

Conclusions:
Risk factors for hospital readmission are slightly different dependent on the measurement interval. In general, hospital-related factors were associated with shorter readmissions intervals while patient factors were more associated with longer intervals.
Counseling in Urogynecology: A Difficult Task, or Simply Good Surgeon-Patient Communication?
Authors: Balzarro Matteo , Rubilotta Emanuele , Goss Claudia , Costantini Elisabetta , Artibani Walter , Sand Peter 
Published: October 2018

(Abstracted from Int Urogynecol J 2018;29:943–948)
Surgical treatments used for pelvic organ prolapse (POP) and urinary incontinence (UI) have markedly changed in recent years. Concomitant with these changes, the patient-physician relationship has evolved over the last several years in large part due to patients asking for more information about their conditions as well as their desire to play an active role in the treatment decision-making process.
Performance of Pediatric Mortality Prediction Scores for PICU Mortality and 90-Day Mortality*
Authors: Jacobs An , Flechet Marine , Vanhorebeek Ilse , Verstraete Sören , Ingels Catherine , Casaer Michael P. , Soto-Campos Gerardo , Verbruggen Sascha C. , Joosten Koen F. , Güiza Fabian , Van den Berghe Greet 
Published: October 2018

Objectives:
The use of mortality prediction scores in clinical trials in the PICU is essential for comparing patient groups. Because of the decline in PICU mortality over the last decades, leading to a shift toward later deaths, recent trials use 90-day mortality as primary outcome for estimating mortality and survival more accurately. This study assessed and compared the performance of two frequently used PICU mortality prediction scores for prediction of PICU and 90-day mortality.

Design:
This secondary analysis of the randomized controlled Early versus Late Parenteral Nutrition in the Pediatric Intensive Care Unit trial compared the discrimination (area under the receiver operating characteristic curve) and calibration of the Pediatric Index of Mortality 3 and the Pediatric Risk of Mortality III scores for prediction of PICU and 90-day mortality.

Setting:
Three participating PICUs within academic hospitals in Belgium, the Netherlands, and Canada.

Patients:
One-thousand four-hundred twenty-eight critically ill patients 0–17 years old.

Interventions:
None.

Measurements and Main Results:
Although Pediatric Index of Mortality 3 only includes information available at the time of PICU admission, thus before any intervention in the PICU, it showed good discrimination (area under the receiver operating characteristic curve, 0.894; 95% CI, 0.892–0.896) and good calibration (no deviation from the diagonal, p = 0.58) for PICU mortality. Pediatric Risk of Mortality III, which involves the worst values for the evaluated variables during the first 24 hours of PICU stay, was statistically more discriminant (area under the receiver operating characteristic curve, 0.920; 95% CI, 0.918–0.921; p = 0.04) but poor in calibration (significant deviation from the diagonal; p = 0.04). Pediatric Index of Mortality 3 and Pediatric Risk of Mortality III discriminated equally well between 90-day mortality and survival (area under the receiver operating characteristic curve, 0.867; 95% CI, 0.866–0.869 and area under the receiver operating characteristic curve, 0.882; 95% CI, 0.880–0.884, respectively, p = 0.77), but Pediatric Risk of Mortality III was not well calibrated (p = 0.04), unlike Pediatric Index of Mortality 3 (p = 0.34).

Conclusions:
Pediatric Index of Mortality 3 performed better in calibration for predicting PICU and 90-day mortality than Pediatric Risk of Mortality III and is not influenced by intervention or PICU quality of care. Therefore, Pediatric Index of Mortality 3 seems a better choice for use in clinical trials with 90-day mortality as primary outcome.
18F-FDG PET/CT of Internal Mammary Lymph Node Hepatocellular Carcinoma Metastases
Authors: Senthil Raja , Ramesh H , Visakh R. Arun , Pratap Thara , Mahadevan Pushpa 
Published: October 2018

Abstract
Hepatocellular carcinoma usually metastasizes to regional abdominal lymph nodes. Distant lymph nodal metastases are relatively rare with most common extra abdominal sites being mediastinum and juxtaphrenic regions. Metastasis to internal mammary lymph nodes is extremely rare, and we present a case of hepatocellular carcinoma with histopathologically proven internal mammary lymph nodal metastasis in the absence of regional abdominal lymph nodal metastases.