bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of an Additional 19-G EBUS-TBNA Needle Increases the Diagnostic Yield of EBUS-TBNA
Authors: Garrison Garth , Leclair Timothy , Balla Agnes , Wagner Sarah , Butnor Kelly , Anderson Scott R. , Kinsey C. Matthew 
Published: June 2018

Background:
Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has an excellent diagnostic yield, there remain cases where the diagnosis is not obtained. We hypothesized that additional sampling with a 19-G EBUS-TBNA needle may increase diagnostic yield in a subset of cases where additional tissue sampling was required.

Methods:
Indications for use of the 19-G needle following 22-G sampling with rapid on-site cytologic examination were: (1) diagnostic uncertainty of the on-site cytopathologist (eg, nondiagnostic, probable lymphoma, etc.), (2) non–small cell lung cancer with probable need for molecular genetic and/or PD-L1 testing, or (3) need for a larger tissue sample for consideration of inclusion in a research protocol.

Results:
A 19-G EBUS-TBNA needle was utilized following standard sampling with a 22-G needle in 48 patients (50 sites) during the same procedure. Although the diagnostic yield between the needles was equivalent, the concordance rate was only 83%. The 19-G determined a diagnosis in 4 additional patients (8%) and provided additional histopathologic information in 6 other cases (12%). Conversely, in 3 cases (6%) diagnostic information was provided only by the 22-G needle. Compared with 22-G EBUS-TBNA alone, sampling with both the 22- and 19-G EBUS needles resulted in an increase in diagnostic yield from 92% to 99% (P=0.045) and a number needed to sample of 13 patients to provide one additional diagnosis. There were no significant complications.

Conclusion:
In select cases where additional tissue may be needed, sampling with a 19-G EBUS needle following standard aspiration with a 22-G needle results in an increase in diagnostic yield.
Endobronchial Valves Therapy for Advanced Emphysema
Authors: Low See-Wei , Lee Justin Z. , Desai Hem , Hsu Chiu-Hsieh , Sam Afshin R. , Knepler James L. 
Published: June 2018

Background:
Trials suggest that bronchoscopic lung volume reduction (BLVR) with endobronchial valve (EBV) implantation may produce similar effects as lung volume reduction surgery, by inducing atelectasis and reducing hyperinflation through a minimally invasive procedure. This study sought to investigate the efficacy and safety of BLVR with EBV for advanced emphysema.

Methods:
We searched PubMed, EMBASE, Web of Science, CINAHL, ClinicalTrials.gov, and Cochrane Library databases for randomized controlled trials comparing EBV implantation versus standard medical treatment or sham bronchoscopy. The main outcome of interest was the percentage change of forced expiratory volume in 1 second.

Results:
Data analyzed from 5 randomized controlled trials with 703 patients revealed improvement in percentage change of forced expiratory volume in 1 second in EBV group compared with control group [weighted mean difference (WMD)=11.43; 95% confidence interval (CI), 6.05-16.80; P<0.0001] and improvement in the St. George’s Respiratory Questionnaire score (WMD=−5.69; 95% CI, −8.67 to −2.70; P=0.0002). There is no difference shown in the 6-minute walking test (WMD=14.12; 95% CI, −4.71 to 32.95; P=0.14). The overall complication rate of EBV was not significantly different except for an increased rate of pneumothorax [relative risk (RR)=8.16; 95% CI, 2.21-30.11; P=0.002), any hemoptysis (RR=5.01; 95% CI, 1.12-22.49; P=0.04)] and valve migration (RR=8.64; 95% CI, 2.01-37.13; P=0.004).

Conclusion:
BLVR using EBV shows short-term improvement in lung function and quality of life, but with increased risk of minor hemoptysis, pneumothorax, and valve migration. Follow-up data on the studies are needed to determine its long-term efficacy.
Refeeding syndrome: relevance for the critically ill patient
Authors: Boot Rianne , Koekkoek Kristine W.A.C. , van Zanten Arthur R.H. 
Published: June 2018

Purpose of review
To provide an overview of recent findings concerning refeeding syndrome (RFS) among critically ill patients and recommendations for daily practice.

Recent findings
Recent literature shows that RFS is common among critically ill ventilated patients. Usual risk factors for non-ICU patients addressed on ICU admission do not identify patients developing RFS. A marked drop of phosphate levels (>0.16 mmol/l) from normal levels within 72 h of commencement of feeding, selects patients that benefit from hypocaloric or restricted caloric intake for at least 48 h resulting in lower long-term mortality.

Summary
RFS is a potentially life-threatening condition induced by initiation of feeding after a period of starvation. Although a uniform definition is lacking, most definitions comprise a complex constellation of laboratory markers (i.e. hypophosphatemia, hypokalemia, hypomagnesemia) or clinical symptoms, including cardiac and pulmonary failure. Recent studies show that low caloric intake results in lower mortality rates in critically ill RFS patients compared with RFS patients on full nutritional support. Therefore, standard monitoring of RFS-markers (especially serum phosphate) and caloric restriction when RFS is diagnosed should be considered. Furthermore, standard therapy with thiamin and electrolyte supplementation is essential.
Speaking Up and Walking Out
Authors: Martino Steven C. , Elliott Marc N. , Mallett Joshua S. , Orr Nate , Gaillot Sarah , Haviland Amelia M. 
Published: June 2018

Background:
Disparities in clinical process-of-care and patient experiences are well documented for Medicare beneficiaries with ≥1 social risk factors. If such patients are less willing to express disagreement with their doctors or change doctors when dissatisfied, these behaviors may play a role in observed disparities.

Objective:
To investigate the association between social risk factors and self-reported likelihood of disagreeing with or changing doctors if dissatisfied among the Medicare fee-for-service population.

Subjects:
Fee-for-service beneficiaries (N=96,317) who responded to the 2014 Medicare Consumer Assessment of Healthcare Providers and Systems survey. Subgroups were defined based on age, education, income, and race/ethnicity.

Methods:
Respondents reported how likely they would be to express disagreement with their doctors and change doctors if dissatisfied (1=very unlikely to 4=very likely; rescaled to 0–100 points). We fit mixed-effect linear regression models predicting these outcomes from social risk factors, controlling for health status and geographic location.

Results:
Beneficiaries who were older, less educated, and had lower incomes were least inclined to express disagreement or change doctors (P<0.001). Compared with non-Hispanic whites, Asian/Pacific Islander (−9.5) and Hispanic (−3.6) beneficiaries said they would be less likely, and black (+2.8) beneficiaries more likely, to express disagreement. Asian/Pacific Islander (−8.7), Hispanic (−5.9), and American Indian/Alaska Native (−3.8) beneficiaries were less inclined than non-Hispanic whites to change doctors (P<0.01).

Discussion:
Reduction in health care disparities may be achieved if doctors and advocates encourage vulnerable patients to express their concerns and perspectives and if communities and caregivers provide support for changing providers when care is poor.
Recurrent Acute Pancreatitis
Authors: Guda Nalini M. , Muddana Venkata , Whitcomb David C. , Levy Philippe , Garg Pramod , Cote Gregory , Uc Aliye , Varadarajulu Shyam , Vege Santhi S. , Chari Suresh T. , Forsmark Chris E. , Yadav Dhiraj , Reddy D. Nageshwar , Tenner Scott , Johnson Colin D. , Akisik Fatih , Saluja Ashok K. , Lerch Markus M. , Mallery J. Shawn , Freeman Martin L. 
Published: June 2018

AbstractRecurrent acute pancreatitis (RAP) is a clinically significant problem globally. The etiology remains unclear in approximately 10% to 15% of patients despite a thorough workup. Data on natural history and efficacy of treatments are limited. We aimed to establish criteria for diagnosis, evaluate the causative factors, and arrive at a consensus on the appropriate workup and management of patients with RAP. The organizing committee was formed, and a set of questions was developed based on the current evidence, controversies, and topics that needed further research. After a vetting process, these topics were assigned to a group of experts from around the world with special interest in RAP. Data were presented as part of a workshop on RAP organized as a part of the annual meeting of the America Pancreatic Association. Pretest and Posttest questions were administered, and the responses were tabulated by the current Grades of Recommendation Assessment, Development and Evaluation system. The consensus guidelines were established in the format of a diagnostic algorithm. Several deficiencies were identified with respect to data on etiology, treatment efficacies, and areas that need immediate research.
Incidental Neuroendocrine Tumor Discovered After Total Pancreatectomy Intended for Islet Autotransplantation
Authors: Serrano Oscar K. , Peterson Kent J. , Mettler Tetyana , Wilhelm Joshua J. , Bellin Melena D. , Beilman Gregory J. , Trikudanathan Guru , Pruett Timothy L. , Dunn Ty B. 
Published: June 2018

Abstract
Total pancreatectomy (TP) is a treatment option for patients experiencing chronic pancreatitis (CP) refractory to medical management. Patients who are candidates for TP benefit from islet autotransplantation (IAT), which preserves available β-cell mass and thereby reduces the risk of brittle diabetes. Malignancy is an absolute contraindication for IAT to prevent the transplantation of occult malignant cells. We present the case of a patient with CP who was approved to undergo TP with IAT (TPIAT) but was intraoperatively discovered to have a pancreatic neuroendocrine tumor. The case illustrates a number of important surgical decision-making considerations for patients undergoing TPIAT and should help guide surgeons should they be presented with this clinical scenario. We stress the importance of vigilance for possible malignancy and to consider an intraoperative biopsy to further investigate unexpected findings that might represent an occult pancreatic malignancy in patients with CP undergoing TPIAT.
Intestinal Microbial and Metabolic Alterations Following Successful Fecal Microbiota Transplant for D‐Lactic Acidosis
Authors: Bulik‐Sullivan Emily C. , Roy Sayanty , Elliott Ryan J. , Kassam Zain , Lichtman Steven N. , Carroll Ian M. , Gulati Ajay S. 
Published: June 2018

ABSTRACTFecal microbiota transplantation (FMT) involves the transfer of stool from a healthy individual into the intestinal tract of a diseased recipient. Although used primarily for recurrent Clostridium difficile infection, FMT is increasingly being attempted as an experimental therapy for other illnesses, including metabolic disorders. D‐lactic acidosis (D‐LA) is a metabolic disorder that may occur in individuals with short bowel syndrome when lactate‐producing bacteria in the colon overproduce D‐lactate. This results in elevated systemic levels of D‐lactate, metabolic acidosis, and encephalopathy. In this study, we report the successful use of FMT for the treatment of recurrent D‐LA in a child who was unresponsive to conventional therapies. Importantly, we also present profiles of the enteric microbiota, as well as fecal D‐/L‐lactic acid metabolites, before and longitudinally after FMT. These data provide valuable insight into the putative mechanisms of D‐LA pathogenesis and its treatment.
Spectrum of Pediatric Autoimmune Liver Disease and Validation of Its Diagnostic Scores in Indian Children
Authors: Sood Vikrant , Lal Bikrant Bihari , Rawat Dinesh , Khanna Rajeev , Rastogi Archana , Bihari Chhagan , Kumar Guresh , Alam Seema 
Published: June 2018

ABSTRACTObjectives:There is limited literature on the spectrum of pediatric autoimmune liver disease (AILD, encompassing both autoimmune hepatitis/AIH and autoimmune sclerosing cholangitis [ASC]) in Asian populations and its diagnostic scores similarly require further validation. This work thus aimed to study the clinical characteristics, and to validate available diagnostic criteria in the local pediatric AILD cohort.Methods:A review of all pediatric AILD cases, presenting over a 6‐year (2011–2017) period was done, along with comparison of the available diagnostic scores: original (1999), simplified (2008) score, and new proposed (2017) score.Results:A total of 85 subjects (AIH = 70 and ASC = 15) were diagnosed as having AILD. Majority of the cases in both groups presented with advanced hepatic disease (portal hypertension and/or hepatic decompensation). Overall 38 (44.7%) subjects had extrahepatic autoimmune disorders. Good outcome (survival with native liver with medically controllable disease), was seen in 80% AIH subjects, while poor outcome (death/need for liver transplantation or LT) was seen in 13% subjects, with similar results in the ASC cohort. All the 3 available scores had area under receiver operating characteristic (AUROC) curves exceeding 0.9 suggestive of excellent discrimination of AILD (to non‐AILD patients), with no statistical difference between them (P >0.05).Conclusions:In Indian subcontinent, pediatric AILD subjects usually present with advanced hepatic disease, but may have a good outcome if timely therapy can be instituted. Associated autoimmune disorders should be carefully screened. There is no difference in the predictive value of the available diagnostic scores for pediatric AILD.
Universal Recommendations for the Management of Acute Diarrhea in Nonmalnourished Children
Authors: Guarino Alfredo , Lo Vecchio Andrea , Dias Jorge Amil , Berkley James A. , Boey Chris , Bruzzese Dario , Cohen Mitchell B. , Cruchet Sylvia , Liguoro Ilaria , Salazar‐Lindo Eduardo , Sandhu Bhupinder , Sherman Philip M. , Shimizu Toshiaki 
Published: June 2018

ABSTRACTObjective:Despite a substantial consistency in recommendations for the management of children with acute gastroenteritis (AGE), a high variability in clinical practice and a high rate of inappropriate medical interventions persist in both developing and developed countries.The aim of this study was to develop a set of clinical recommendations for the management of nonseverely malnourished children with AGE to be applied worldwide.Methods:The Federation of International Societies of Pediatric Gastroenterology, Hepatology, and Nutrition (FISPGHAN) Working Group (WG) selected care protocols on the management of acute diarrhea in infants and children aged between 1 month and 18 years. The WG used a 3‐step approach consisting of: systematic review and comparison of published guidelines, agreement on draft recommendations using Delphi methodology, and external peer‐review and validation of recommendations.Results:A core of recommendations including definition, diagnosis, nutritional management, and active treatment of AGE was developed with an overall agreement of 91% (range 80%–96%). A total of 28 world experts in pediatric gastroenterology and emergency medicine successively validated the set of 23 recommendations with an agreement of 87% (range 83%–95%). Recommendations on the use of antidiarrheal drugs and antiemetics received the lowest level of agreement and need to be tailored at local level. Oral rehydration and probiotics were the only treatments recommended.Conclusions:Universal recommendations to assist health care practitioners in managing children with AGE may improve practitioners’ compliance with guidelines, reduce inappropriate interventions, and significantly impact clinical outcome and health care‐associated costs.
Estimated Impact of Screening on Gonorrhea Epidemiology in the United States: Insights From a Mathematical Model
Authors: Tuite Ashleigh R , Rönn Minttu M , Wolf Emory E , Gift Thomas L , Chesson Harrell W , Berruti Andres , Galer Kara , Menzies Nicolas A , Hsu Katherine , Salomon Joshua A 
Published: June 2018

Background
The burden of gonorrhea infections in the United States is high. There are marked disparities by race/ethnicity and sexual orientation. We quantified the impact of screening and treatment on gonorrhea rates in the US population aged 15 to 39 years for the period 2000 to 2015 and estimated the impact that alternative screening strategies might have had over the same period.

Methods
We developed a national-level transmission model that divides the population by race/ethnicity, preferred gender of sex partners, age, gender, and sexual activity level. We compared our fitted model (“base case”) to 4 alternative strategies: (i) no screening, (ii) full adherence to current screening guidelines, (iii) annual universal screening, or (iv) enhanced screening in groups with the highest infection burden. Main outcomes were incidence, infections averted, and incidence rate ratios by race/ethnicity. Mean values and 95% credible intervals were calculated from 1000 draws from parameter posterior distributions.

Results
The calibrated model reproduced observed trends in gonorrhea, including disparities in infection burden by race/ethnicity. We estimated that screening for gonorrhea from 2000 to 2015 averted 30% (95% credible intervals, 18–44%) of total infections that would otherwise have occurred. All alternative active screening strategies were estimated to further reduce, but not eliminate, gonorrhea infections relative to the base case, with differential impacts on the subpopulations of interest.

Conclusions
Our model results suggest that screening has reduced gonorrhea incidence in the US population. Additional reductions in infection burden may have been possible over this period with increased screening, but elimination was unlikely.
Functional Impairments Associated With Patient Activation Among Community-Dwelling Older Adults
Authors: Na Ling , Kwong Pui L. , Xie Dawei , Pezzin Liliana E. , Kurichi Jibby E. , Streim Joel E. 
Published: June 2018

Objectives
Activity of daily living stages and instrumental activity of daily living stages demonstrated ordered associations with mortality, risk of hospitalization, and receipt of recommended care. This article explores the associations of stages with the following three dimensions of patient activation: self-care efficacy, patient-doctor communication, and health-information seeking. We hypothesized that higher activity of daily living and instrumental activity of daily living stages (greater limitation) are associated with a lower level of patient activation.

Methods
Patient activation factors were derived from the 2004 and 2009 Medicare Current Beneficiary Survey. In this cross-sectional study (N = 8981), the associations of activity limitation stages with patient activation factors were assessed in latent factor models.

Results
Greater activity limitation was in general inversely associated with self-efficacy, patient-doctor communication, and health information seeking, even after adjusting for sociodemographic and clinical characteristics. For instance, the mean of self-care efficacy across activity of daily living stages I–IV (mild, moderate, severe, and complete limitation) compared with stage 0 (no limitation) decreased significantly by 0.17, 0.29, 0.34, and 0.60, respectively. Covariates associated with suboptimal patient activation were also identified.

Discussion
Our study identified multiple opportunities to improve patient activation, including providing support for older adults with physical impairments, at socioeconomic disadvantages, or with psychological or cognitive impairment.
Look-Alike Medication Packages and Patient Safety
Authors: Shao Shih-Chieh , Lai Edward Chia-Cheng , Owang Kok Loon , Chen Hui-Yu , Chan Yuk-Ying 
Published: June 2018

Abstract
Medication errors substantially threaten patient safety, and their prevention requires clinical vigilance. We present a case of taking the wrong drug due to a dispensing error by pharmacists involving medication packaging confusion, and we report how we prevent similar dispensing errors by thorough investigation and intervention. This case emphasizes the need for constant attention by hospital, medical industry, and regulatory authorities to avoid look-alike medication packaging in the interest of medication safety.
Identification of Tracheobronchial Tree Calcifications Using Molecular Imaging Probes
Authors: Al-Zaghal Abdullah , Werner Thomas J. , Høilund-Carlsen Poul F. , Alavi Abass 
Published: June 2018

Abstract
Tracheobronchial calcifications are common in adults and considered as a physiological process of aging with no clinical significance in otherwise asymptomatic, healthy individuals. We are presenting a case of tracheobronchial tree calcifications as detected on 18F-NaF PET/CT in a 75-year-old woman. Many previous publications have reported the accumulation of NaF in extraosseous organs; these observations further set new directions in the evaluation of the metabolic activity of macrocalcification and microcalcification using molecular imaging probes.
Gradenigo Syndrome Induced by Suppurative Otitis Media
Authors: Bozan Nazim , Düzenli Ufuk , Yalinkilic Abdulzaziz , Ayral Abdurrahman , Parlak Mehmet , Turan Mahfuz , Kiroglu Ahmet Faruk 
Published: June 2018

Abstract
Gradenigo syndrome was defined as a clinical triad of otitis media, severe orbito-facial pain, and ipsilateral sixth cranial nerve palsy. It may occur as a complication of either acute or chronic otitis media. Herein, we will report a case of Gradenigo syndrome induced by suppurative chronic otitis media that was promptly diagnosed and aggressively treated.
Investigation of Distances Between the Anterior Nasal Spine and Nasofrontal Beak, Basal Lamella, Skull Base, and Sphenoid Sinus on Paranasal Sinus Computed Tomography
Authors: Alimoglu Yalcin , Topcu Adem 
Published: June 2018

Objective:
The aim of this study was to investigate the distances between the anterior nasal spine and basal lamella (BL), skull base, nasofrontal beak (NfB), and the anterior wall of sphenoid sinus on computed tomography (CT) images.

Methods:
A total of 160 patients who were seen at the otolaryngology clinic of our institution were evaluated with the help of the image processing software of the radiology department. Cases in which bony structures could not be seen clearly because of previous surgery or trauma were excluded. The distance between the anterior nasal spine; and NfB, the closest point of the skull base in the frontal recess (SB1), the closest point of the BL, the intersection of the line with which the distance to the BL was measured with the skull base (SB2) and the closest point of the anterior wall of the sphenoid sinus (Sp) were measured using multiplanar reconstruction.

Results:
The images of 140 patients were examined. NfB, SB1, BL, SB2, and Sp were 5.14 ± 0.46 (4.15–6.38) cm, 5.70 ± 0.48 (4.31–7.03) cm, 4.84 ± 0.44 (3.86–5.98) cm, 6.23 ± 0.50 (5.13–7.35) cm, and 6.14 ± 0.46 (5.04–7.36) cm, respectively.

Conclusion:
In our study group, the distances some of which were reported as constant values in the literature were found to have a range of up to 2 cm. Therefore, if distances between structures are to be used for orientation during endoscopic sinus surgery, they should be better measured preoperatively on paranasal sinus CT scan images instead of using predefined constant values.