bluuebunny/crossref_metadata_2025_split huggingface dataset:
In-office wide-awake hand surgery versus traditional surgery in the operating room: a comparison of clinical outcomes and healthcare costs at an academic institution
Authors: Rabinowitz Justin , Kelly Thomas , Peterson Ann , Angermeier Eric , Kokko Kyle 
Published: July 2019

Background:
Our study compared clinical outcomes and healthcare costs of A1 pulley release performed wide-awake in an office setting to A1 pulley release performed in an operating room with monitored anesthesia care (MAC) at a United States academic institution.

Methods:
A retrospective chart review was performed on consecutive patients who underwent single-digit A1 pulley release wide-awake in an office setting or in an ambulatory surgical center with MAC. Clinical outcomes were assessed using the modified Disabilities Arm Shoulder and Hand (DASH) scores and a telephone questionnaire. Hospital financial records were reviewed for all patients and the summation of professional fee, anesthesiology fee, and hospital fee was calculated to determine healthcare cost. Financial comparisons were stratified by insurance carriers.

Results:
There were 76 patients with complete records: 43 wide-awake, 33 traditional. Both groups had significant improvement in postoperative quick DASH scores. When asked about subsequent surgery, 100% of wide-awake patients and 68% of traditional patients reported they would prefer to be wide-awake. Eighty percent of wide-awake patients said the procedure was less painful or comparable to a procedure at the dentist. Eighty-four percent of wide-awake patients said their experience was better than they expected, compared to 23% of traditional patients. The traditional group had significantly higher total healthcare costs ($2148.62 vs. $607.65), a more than 250% increase in healthcare spending. Professional reimbursement was significantly higher in the wide-awake group ($607.65 vs. $298.83).

Conclusions:
A1 pulley release performed with patients wide-awake in an office setting led to higher patient satisfaction, decreased healthcare spending and higher physician reimbursement than when performed in an operating room with sedation.
Onramp to Scholarship: Putting Clinical Faculty Members on the Path to Academic Productivity
Authors: Cahn Peter S. 
Published: July 2019

Abstract:
Many faculty members in the health professions who come from a clinical background lack the research experience to produce original scholarship. Most faculty development programs focus on supporting individual projects, which helps faculty members who are already pursuing an intellectual question to locate useful resources. Those programs provide limited benefit, however, to faculty members without an identified academic project. An independent, health sciences graduate school designed and implemented a solution to create scholarship groups in which early career faculty members joined ongoing projects led by an experienced investigator. Groups presented internally at a midyear check-in and an end of the academic year poster session. Of the four groups launched in September 2017, three pursued systematic reviews or analyses of existing data. At the end of 9 months, all 4 groups had drafted a manuscript for peer review. Collectively, members of the group had made five poster presentations at national or international conferences and hosted one continuing education workshop. The experience suggests that collaborative projects are a viable form of faculty development to enhance scholarly productivity. Borrowing from the postdoctoral model of scientific mentoring, early career faculty members sacrifice some autonomy of intellectual pursuits in exchange for expert guidance. Senior investigators invest time in coaching novice researchers in exchange for additional intellectual labor and perspectives.
A New Multisource Feedback Tool for Evaluating the Performance of Specialty-Specific Physician Groups: Validity of the Group Monitor Instrument
Authors: Bindels Elisa , Boerebach Benjamin , van der Meulen Mirja , Donkers Jeroen , van den Goor Myra , Scherpbier Albert , Lombarts Kiki , Heeneman Sylvia 
Published: July 2019

Introduction:
Since clinical practice is a group-oriented process, it is crucial to evaluate performance on the group level. The Group Monitor (GM) is a multisource feedback tool that evaluates the performance of specialty-specific physician groups in hospital settings, as perceived by four different rater classes. In this study, we explored the validity of this tool.

Methods:
We explored three sources of validity evidence: (1) content, (2) response process, and (3) internal structure. Participants were 254 physicians, 407 staff, 621 peers, and 282 managers of 57 physician groups (in total 479 physicians) from 11 hospitals.

Results:
Content was supported by the fact that the items were based on a review of an existing instrument. Pilot rounds resulted in reformulation and reduction of items. Four subscales were identified for all rater classes: Medical practice, Organizational involvement, Professionalism, and Coordination. Physicians and staff had an extra subscale, Communication. However, the results of the generalizability analyses showed that variance in GM scores could mainly be explained by the specific hospital context and the physician group specialty. Optimization studies showed that for reliable GM scores, 3 to 15 evaluations were needed, depending on rater class, hospital context, and specialty.

Discussion:
The GM provides valid and reliable feedback on the performance of specialty-specific physician groups. When interpreting feedback, physician groups should be aware that rater classes' perceptions of their group performance are colored by the hospitals' professional culture and/or the specialty.
Antithrombotic Therapy in Patients With Atrial Fibrillation and Coronary Artery Disease Undergoing Percutaneous Coronary Intervention
Authors: Mishra Abhishek , Singh Maninder , Acker Warren W. , Kamboj Sukriti , Sporn Daniel , Stapleton Dwight , Kaluski Edo 
Published: July 2019

Aim:
The objective of this article is to review the contemporary literature on the use of antithrombotic therapy in patients with atrial fibrillation (AF) and coronary artery disease after undergoing percutaneous coronary intervention (PCI). Special consideration was given to the type and duration of therapy, treatment strategies for the elderly (≥65 years of age), and strategies to reduce bleeding.

Methods:
Relevant studies were searched through MEDLINE/PubMed, Web of Science, Cochrane Library, ClinicalTrials.gov, and Google Scholar. Of the 236 publications retrieved, 76 were considered relevant including 35 randomized controlled trials, 17 meta-analyses, 16 observational studies, and 8 published major guidelines.

Results:
Most trials, meta-analyses, and guidelines support 1 month of triple therapy (TT) with an oral anticoagulant (OAC), dual antiplatelet agents (DAPT) with aspirin (ASA)/clopidogrel, and, afterward, dual therapy (DT) with OAC and single antiplatelet agent for an additional 11 months, or alternatively DT alone for 12 months after PCI. Individual consideration is given to the risk and impact of stent thrombosis (ST), thromboembolism, and bleeding. Several trials and meta-analyses have also suggested that shorter DAPT duration (≤6 months) may be safer than longer therapy (≥6 months) when weighing the risk of bleeding with ischemic outcomes, especially with newer generation drug-eluting stents. The selective use of proton-pump inhibitors in patients prone to gastrointestinal bleeding who are subjected to prolonged exposure with TT or DT may be beneficial. In the elderly, the risk of bleeding from TT, compared with DT, outweighs the benefit of reducing ischemic events.

Conclusions:
In conclusion, tailoring therapy to the individual patient is recommended considering the ischemic and bleeding risk as well as the risk of thromboembolism. For most patients with AF, 1 month of TT and subsequently DT for additional 11 months are recommended.
Collaborative Deprescribing in Borderline Personality Disorder: A Narrative Review
Authors: Fineberg Sarah K. , Gupta Swapnil , Leavitt Jacob 
Published: July 2019

Learning objectives
After participating in this activity, learners should be better able to:
• Assess medication management in patients with borderline personality disorder (BPD)
• Evaluate the role of deprescribing as an active intervention in patients with BPD treated with polypharmacy

Abstract
Psychopharmacology in borderline personality disorder (BPD) is complicated by comorbid disorders, substance use, sensitivity to side effects, risk of self-harm through medication misuse, and intense but transient symptoms. Patients’ relationships with medications may range from tenuous to highly enmeshed, and may profoundly influence the response to treatment. For these reasons, awareness of current evidence and flexible approaches are particularly relevant to prescribing in BPD. In this narrative review, we illustrate the current status of medication management in BPD by focusing on polypharmacy. We use a single vignette to explore the limitations of prescribing multiple medications and the factors contributing to polypharmacy. With the same vignette, and using the framework of deprescribing, we describe how medication regimens can be reduced to a necessary minimum. Deprescribing, originally developed in geriatric medicine, is an active intervention that involves a risk-benefit analysis for each medication, keeping in mind the patient’s medical and psychiatric status and his or her preferences and values. Deprescribing lends itself well to use in psychiatry and especially in BPD because of its emphasis on the patient’s preferences and on repeated conversations to revisit and update decisions. In addition to elaborating on the deprescribing framework, we provide recommendations for conducting these critical discussions about medications in BPD, with particular attention to the patient’s relationship to the medication. Finally, we summarize our recommendations and strategies for implementing flexible and responsive medication management for patients with BPD. We suggest areas of future research, including testing the efficacy of targeted intermittent medication treatments.
Increasing Incidence of Concussion: True Epidemic or Better Recognition?
Authors: Langer Laura , Levy Charissa , Bayley Mark 
Published: July 2019

Objectives:To provide updated estimates of the incidence of concussion from all causes diagnosed by all physicians in a large jurisdiction, as previous studies have examined only single causes of injury or from smaller specific populations.Design:Physician Billing and National Ambulatory Care Reporting System (NACRS) databases were used to identify all Ontario residents with a diagnosis of concussion (ICD-9850.0 andICD-10S06.0) made by physicians between 2008 and 2016, excluding those with moderate to severe traumatic brain injury.Results:In total, 1 330 336 people were diagnosed with a concussion between 2008 and 2016. The annual average was 147 815, and 79% were diagnosed in the emergency department. The average annual incidence was 1153 per 100 000 residents. Incidence varied by age, sex, and geography; children younger than 5 years had the highest incidence of concussion, more than 3600 per 100 000 individuals of that age group. Males had higher incidence than females except in older than 65 years age groups. There was a Pearson correlation (+0.669) between sustaining a concussion and living in rural locations.Conclusion:The annual incidence of approximately 1.2% of the population is the highest rate of concussion ever reported thorough sampling methods and may represent a closer estimate of the true picture of concussion. Findings may inform future concussion treatment and healthcare planning.
A Pilot Randomized Controlled Trial of Cognitive-Behavioral Therapy for Insomnia in Adolescents With Persistent Postconcussion Symptoms
Authors: Tomfohr-Madsen Lianne , Madsen Joshua W. , Bonneville Dominique , Virani Shane , Plourde Vickie , Barlow Karen M. , Yeates Keith Owen , Brooks Brian L. 
Published: July 2019

Objective:Cognitive-behavioral therapy for insomnia (CBT-I) is an effective insomnia treatment but has yet to be applied to adolescents with sleep disruption following concussion. This pilot study evaluated CBT-I to improve insomnia in adolescents with protracted concussion recovery.Setting:Tertiary pediatric hospital.Participants:Participants (N= 24) were 12 to 18 years old (M= 15.0, SD = 1.4), 15.1 weeks (SD = 9.2) postinjury, and presenting with sleep disruption and persistent postconcussion symptoms.Design:A single-blind, parallel-group randomized controlled trial (RCT) design comparing 6 weeks of CBT-I and a treatment-as-usual control group. Outcomes were measured before treatment, at treatment completion, and 4 weeks after completion.Main Measures:Primary outcome was Insomnia Severity Index. Secondary outcomes included Pittsburgh Sleep Quality Index, Dysfunctional Beliefs and Attitudes about Sleep Scale, 7-night sleep diary, PROMIS Depression, PROMIS Anxiety, and Health and Behavior Inventory.Results:Adolescents who received CBT-I demonstrated large and clinically significant improvements in insomnia ratings at posttreatment that were maintained at follow-up. They also reported improved sleep quality, fewer dysfunctional beliefs about sleep, better sleep efficiency, shorter sleep-onset latency, and longer sleep time compared with those with treatment as usual. There was also a modest reduction in postconcussion symptoms.Conclusion:In this pilot RCT, 6 weeks of CBT-I produced significant improvement in sleep in adolescents with persistent postconcussion symptoms. A larger trial is warranted.
Associations of Lifetime Traumatic Brain Injury Characteristics With Prospective Suicide Attempt Among Deployed US Army Soldiers
Authors: Campbell-Sills Laura , Stein Murray B. , Liu Howard , Agtarap Stephanie , Heeringa Steven G. , Nock Matthew K. , Ursano Robert J. , Kessler Ronald C. 
Published: July 2019

Objective:To estimate associations of lifetime traumatic brain injury (TBI) characteristics with prospective suicide attempt among US Army soldiers.Method:The Army STARRS (Study to Assess Risk and Resilience in Servicemembers) Pre/Post Deployment Study surveyed 3 Brigade Combat Teams that were deployed to Afghanistan in 2012. Lifetime TBI and past-month postconcussive/post-TBI symptoms were evaluated at predeployment baseline. Recency and number of TBIs were quantified, and TBI severity was classified on the basis of reports of alteration/loss of consciousness and memory lapse. Suicide attempt data came from administrative records and surveys administered after return from deployment. Logistic regression models estimated associations of TBI characteristics with prospective suicide attempt among baseline respondents who were deployed (n= 7677), adjusting for other risk factors including lifetime mental disorder.Results:One hundred three soldiers made a suicide attempt over a median follow-up period of 30 months (weighted prevalence = 1.31% [0.14%]). In the final model estimating joint associations of TBI severity/recency and past-month postconcussive/post-TBI symptoms, only postconcussive/post-TBI symptoms were associated with a higher risk of suicide attempt (per standard score increase: AOR [adjusted odds ratio] = 1.31; 95% CI, 1.05-1.63;P= .012).Conclusions:Among the lifetime TBI characteristics evaluated at predeployment baseline, only past-month postconcussive/post-TBI symptoms were prospectively associated with an increased risk of suicide attempt following deployment. Detection of postconcussive/post-TBI symptoms could facilitate targeting of Army suicide prevention programs.
Utility of HSV Serology for Chronic Corneal Pathology
Authors: Wang John , Cherfan Daniel G. , Goshe Jeffrey M. 
Published: July 2019

Objectives:
The purpose of this study is to determine the utility of obtaining herpes simplex virus (HSV) serology for patients presenting with chronic corneal pathology of unknown etiology for which HSV is a diagnostic consideration.

Methods:
A retrospective analysis was performed of all patients presenting to one cornea specialist (J.M.G.) between August 2011 and April 2018 with a chronic (>6 weeks) corneal condition for which HSV was suspected and serology was performed. Patient demographics, clinical presentation, treatment, final diagnosis, and follow-up duration were recorded.

Results:
Fifty-four patients with a median age of 52 (range: 5–85) years were included in the study. Patients were classified by presenting clinical features as corneal ulcer (46.2%), stromal keratitis (24.1%), superficial keratitis (18.5%), or keratouveitis (11.1%). The seroprevalence of HSV-1 and HSV-2 antibodies were 42.6% and 18.5%, including 5 patients (9.3%) positive for both HSV-1 and HSV-2. Serology impacted management for all patients with negative titers (48.1%), defined as discontinuing antiviral medication, electing not to start antiviral medication, or continuing antiviral medication for a non-HSV etiology (e.g., varicella zoster keratitis). No patients with HSV serology were ultimately diagnosed with HSV keratitis. Median follow-up duration was 1.5 years (range 0.8–6.6 years).

Conclusion:
Although only useful when negative, our study confirms that serology may be useful for excluding HSV as a diagnostic consideration for patients presenting with chronic corneal pathology. The seroprevalence of HSV antibodies for our patient cohort was comparable with previous population-based studies.
Sexual Identity, Adverse Life Experiences, and Cardiovascular Health in Women
Authors: Caceres Billy A. , Markovic Nina , Edmondson Donald , Hughes Tonda L. 
Published: July 2019

Background:
Adverse life experiences (ALE; eg, discrimination and sexual abuse) may contribute to cardiovascular disease (CVD) risk in sexual minority women (SMW), but few studies have tested whether ALE explain the association of sexual identity with cardiovascular health (CVH) markers in women.

Objective:
The aim of this study was to examine sexual identity differences in CVH among women and the role of ALE.

Methods:
In the Epidemiologic Study of Risk in Women, we used multinomial logistic regression to assess sexual identity differences (SMW vs heterosexual women [reference group]) in CVH markers (ideal vs poor, intermediate vs poor) using the American Heart Association's Life's Simple 7 metric and the total score. Next, we tested whether the association of sexual identity with the total CVH score was attenuated by traditional CVD risk factors or ALE.

Results:
The sample consisted of 867 women (395 heterosexual, 472 SMW). Sexual minority women were more likely to have experienced discrimination (P < .001) and lifetime sexual abuse (P < .001) than heterosexual women. Sexual minority women were also less likely to meet ideal CVH criteria for current tobacco use (adjusted odds ratio, 0.43; 95% confidence interval, 0.24–0.73) or intermediate CVH criteria for body mass index (adjusted odds ratio, 0.60; 95% confidence interval, 0.40–0.92). Sexual minority women had a lower cumulative CVH score (B [SE] = −0.35 [0.14], P < .01) than heterosexual women. This difference was not explained by traditional CVD risk factors or ALE.

Conclusions:
Smoking, body mass index, and fasting glucose accounted for much of the CVH disparity due to sexual identity, but those differences were not explained by ALE. Health behavior interventions tailored to SMW should be considered.
Falls in Veterans Healthcare Administration Hospitals: Prevalence and Trends
Authors: Young-Xu Yinong , Soncrant Christina , Neily Julia , Boar Shoshana , Bulat Tatjana , Mills Peter D. 
Published: July 2019

ABSTRACT

Introduction:
To provide up-to-date data on fall prevalence and trends in Veterans Health Administration (VHA) hospitals.

Methods:
Data were collected by the VHA Inpatient Evaluation Center (IPEC) between 2011 and 2017, to establish prevalence and trends of falls and major injuries occurring in acute care/intensive care units (AC/ICU), behavior health (BH), and community living center (CLC)/long-term care, using bed days of care (BDOC) as denominators.

Results:
A total of 204,681 falls were reported (rate = 4.8 falls/1,000 BDOC) during the study period, of which 2,549 (1.2%) resulted in a major injury (rate = 6.0/100,000 BDOC). Fall rates decreased over the 6-year study period for all unit types: 10% decrease for BH (p < .0001), 9% decrease for AC/ICU (p < .0001), and 3% decrease for CLC (p = .0043). Major injury rates remained consistent.

Conclusions:
In this large descriptive study, fall and major injury rates varied by nursing unit type in VHA hospitals. Over the 6-year study period, a clinically and statistically significant decrease in fall rates for BH and AC/ICU units was observed as well as a small but statistically significant decrease in fall rates for CLC units. No trend was observed for major injury rates.
Severe influenza: overview in critically ill patients
Authors: Sarda Cristina , Palma Pedro , Rello Jordi 
Published: July 2019

Purpose of review
Overview of influenza infection, focusing on outcome and complications in critically ill patients. We also discuss relevant elements in immunopathogenesis and their role as predictors of severity.

Recent findings
Pandemic influenza A (H1N1) virus circulates seasonally and remains the predominant subtype among intensive care patients. Mortality in acute respiratory failure (ARF) is around 20%, independent of influenza subtypes. During severe infection, the imbalance between pro-inflammatory and anti-inflammatory molecules, such as Th1 and Th17 cytokines, is associated with complicated infections and mortality. Primary viral pneumonia presents in more than 70% of ICU influenza patients and more than 50% develop acute respiratory distress syndrome. Bacterial secondary infection occurs in 20% of severe cases and Streptococcus pneumoniae and Staphylococcus aureus remain the prevalent pathogens. Myocarditis and late-onset cardiovascular complications are associated with mortality. Antiviral therapy within 48 h after onset, avoidance of corticosteroids and rescue therapies for ARF or myocarditis, such as extracorporeal membrane oxygenation, improve survival.

Summary
The present review summarizes current knowledge on pathogenesis and clinical manifestations of severe influenza. Immunological dysfunction during viral infection correlates with severity and mortality among ICU patients. A theranostics strategy should be implemented to improve outcomes.
Meningitis and encephalitis management in the ICU
Authors: Robinson Christopher P. , Busl Katharina M. 
Published: July 2019

Purpose of review
Management of patients with meningitis and encephalitis oftentimes requires ICU level of care. This article is an update on management for meningitis and encephalitis with focus on clinical care in the ICU. Information provided is based on a review of recent studies with focus on studies since 2017.

Recent findings
Advances in diagnostic and treatment approach for different pathogens are presented. Nosocomial meningitis now constitutes a major part of brain infections seen in ICUs in the developed world. Advances in ICU care of central nervous system (CNS) infections include application of newer diagnostic methods, improved understanding and delivery of antibiotics to the CNS, infection prevention for nosocomial infections, and application of neuromonitoring where indicated.

Summary
Advances in diagnostics and therapeutic approach to CNS infections are continually made. For intensivists, focus on neuromonitoring and brain resuscitation in critically ill patients with CNS infections may present a path to enhance preservation of brain function and improve outcomes.

Video abstract

http://links.lww.com/COCC/A22.