bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Quality-of-Life Comparison of Two Fecal Incontinence Phenotypes: Isolated Fecal Incontinence Versus Concurrent Fecal Incontinence With Constipation
Authors: Cauley Christy E. , Savitt Lieba R. , Weinstein Milena , Wakamatsu May M. , Kunitake Hiroko , Ricciardi Rocco , Staller Kyle , Bordeianou Liliana 
Published: November 2018

BACKGROUND:
Many patients with fecal incontinence report coexisting constipation. This subset of patients has not been well characterized or understood.

OBJECTIVE:
The purpose of this study was to report the frequency of fecal incontinence with concurrent constipation and to compare quality-of-life outcomes of patients with fecal incontinence with and without constipation.

DESIGN:
This was a prospective cohort study. Survey data, including Fecal Incontinence Severity Index, Constipation Severity Instrument, Fecal Incontinence Quality of Life survey (categorized as lifestyle, coping, depression, and embarrassment), Pelvic Organ Prolapse Inventory and Urinary Distress Inventory surveys, and anorectal physiology testing were obtained.

SETTINGS:
The study was conducted as a single-institution study from January 2007 to January 2017.

PATIENTS:
Study patients had fecal incontinence presented to a tertiary pelvic floor center.

MAIN OUTCOME MEASURES:
Quality-of-life survey findings were measured.

RESULTS:
A total of 946 patients with fecal incontinence were identified, and 656 (69.3%) had coexisting constipation. Patients with fecal incontinence with constipation were less likely to report a history of pregnancy (89.2% vs 91.4%; p = 0.001) or complicated delivery, such as requiring instrumentation (9.1% vs 18.1%; p = 0.005), when compared with patients with isolated fecal incontinence. Patients with fecal incontinence with constipation had higher rates of coexisting pelvic organ prolapse (Pelvic Organ Prolapse Inventory: 18.4 vs 8.2; p < 0.01), higher rates of urinary incontinence (Urinary Distress Inventory: 30.2 vs 23.4; p = 0.01), and higher pressure findings on manometry; intussusception on defecography was common. Patients with fecal incontinence with concurrent constipation had less severe incontinence scores at presentation (21.0 vs 23.8; p < 0.001) and yet lower overall health satisfaction (28.9% vs 42.5%; p < 0.001). Quality-of-life scores declined as constipation severity increased for lifestyle, coping, depression, and embarrassment.

LIMITATIONS:
This was a single-institution study, and surgeon preference could bias population and anorectal physiology testing.

CONCLUSIONS:
Patients with fecal incontinence with concurrent constipation represent a different disease phenotype and have different clinical and anorectal physiology test findings and worse overall quality of life. Treatment of these patients requires careful consideration of prolapse pathology with coordinated treatment of coexisting disorders. See Video Abstract at http://links.lww.com/DCR/A783.
The Contributions of Internal Intussusception, Irritable Bowel Syndrome, and Pelvic Floor Dyssynergia to Obstructed Defecation Syndrome
Authors: Cavallaro Paul M. , Staller Kyle , Savitt Lieba R. , Milch Holly , Kennedy Kevin , Weinstein Milena M. , Ricciardi Rocco , Bordeianou Liliana G. 
Published: November 2018

BACKGROUND:Recently, there has been a trend toward surgical management of internal intussusception despite an unclear correlation with constipation symptoms.OBJECTIVE:This study characterizes constipation in patients with obstructed defecation syndrome and identifies whether internal intussusception or other diagnoses such as irritable bowel syndrome may be contributing to symptoms.DESIGN:Patients evaluated for obstructed defecation at a pelvic floor disorder center were studied from a prospectively maintained database. With the use of defecography, patients were classified by Oxford Rectal Prolapse Grade. Coexisting disorders such as enterocele, rectocele, and dyssynergia were also identified. The presence of irritable bowel syndrome was defined using Rome IV criteria, and constipation severity was quantified with the Varma constipation severity instrument.SETTINGS:This study was conducted at a tertiary care university medical center (Massachusetts General Hospital).PATIENTS:The study included 317 consecutive patients with defecography imaging and a completed constipation severity instrument survey from May 2007 to July 2016.MAIN OUTCOME MEASURES:The primary outcome measures were the Varma Constipation Severity Instrument overall score and obstructed defecation subscale score.RESULTS:Of 317 patients evaluated, 95 (30.0%) had no internal intussusception, 126 (39.7%) had intra-rectal intussusception, and 96 (30.3%) had intra-anal intussusception. There was no association between rising grade of internal intussusception and either overall constipation score or obstructed defecation subscale score. Irritable bowel syndrome was associated with an increase in overall constipation score and obstructed defecation subscale score (40.5 ± 13.6 vs 36.0 ± 15.1,p= 0.007, and 22.3 ± 5.8 vs 20.0 ± 6.6,p< 0.001). Multivariate regression found irritable bowel syndrome and dyssynergia to be associated with a significant increase in obstructed defecation subscale scores.LIMITATIONS:The study was limited because it was an observational study from a single center.CONCLUSIONS:Patients referred for surgical management of obstructive defecation syndrome should be screened and treated for irritable bowel syndrome and dyssynergia before considering surgical intervention. SeeVideo Abstractat http://links.lww.com/DCR/A782.
Short- and Long-term Outcomes of Minimally Invasive Versus Open Multivisceral Resection for Locally Advanced Colorectal Cancer
Authors: Nishikawa Takeshi , Nozawa Hiroaki , Kawai Kazushige , Sasaki Kazuhito , Otani Kensuke , Tanaka Toshiaki , Hata Keisuke , Watanabe Toshiaki 
Published: November 2018

BACKGROUND:
Colorectal cancer invading the adjacent organs/structures is detected in 5% to 20% of all surgical interventions performed for the management of colorectal cancer.

OBJECTIVE:
Our purpose is to verify the safety and feasibility of laparoscopic surgery for the treatment of locally advanced colorectal cancer invading the adjacent organs.

DESIGN:
This is a retrospective study.

SETTINGS:
The study was conducted at a single institution in Japan.

PATIENTS:
We compared the morbidity, appropriate oncological resection, and disease-free survival of laparoscopic and open multivisceral resection in patients with colorectal carcinoma in the period between 2007 and 2015.

MAIN OUTCOME MEASURES:
The primary outcome measures were curative resection rate, morbidity rate, and recurrence of laparoscopic and open multivisceral resection in patients with colorectal cancer.

RESULTS:
Thirty-one patients received laparoscopic surgery, and 50 received open surgery. The amount of blood loss was smaller in the laparoscopic group than in the open group (60 vs 595 mL, p < 0.01). Curative surgery was performed in 46 patients of the open group (92.0%) and in 30 patients of the laparoscopic group (96.8%). Days until oral intake (5 vs 7 days, p < 0.01) and postoperative hospital stay (14 vs 19 days, p < 0.01) were shorter in the laparoscopic group. Overall morbidity was not different between the groups (22.5% vs 40.0%). Three-year disease-free survival rates were 62.7% in the open group and 56.7% in the laparoscopic group (p = 0.5776).

LIMITATION:
This study was a retrospective small study conducted at a single institute.

CONCLUSION:
Laparoscopic multivisceral resection may be a safe, less invasive alternative to open surgery, with less blood loss and shorter hospital stay, and was not inferior to open surgery based on long-term oncological end points. See Video Abstract at http://links.lww.com/DCR/A785.
Topical Oxymetazoline for Fecal Incontinence in Patients with Spinal Cord Injury: A Double-Blind Randomized Controlled Crossover Study
Authors: Barak Nir , Gecse Krisztina B. , Takács István 
Published: November 2018

BACKGROUND:
Topical α-agonists contract the internal anal sphincter muscle; therefore, they may serve as treatment for fecal incontinence.

OBJECTIVES:
The aim of this study was to investigate the effect of the α-agonist oxymetazoline 1.0% on fecal incontinence in patients with spinal cord injury.

DESIGN:
This was a double-blind, crossover study. Before randomization, all patients underwent a 1-day, open-label anal manometry and pharmacokinetic study.

SETTINGS:
The study was conducted at the Department of Internal Medicine, Semmelweis University, Hungary.

PATIENTS:
Nineteen patients were enrolled into a randomized double-blind, placebo-controlled clinical trial with 2 arms: placebo for 4 weeks followed by oxymetazoline for 4 weeks, or vice versa, with an interval 2-week washout period, in a crossover trial design. Treatment order was randomly assigned, and fecal incontinence was captured with daily diaries.

MAIN OUTCOME MEASURES:
The primary outcome measured was the number of fecal incontinence episodes in the 8 and 12 hours after drug administration.

RESULTS:
Resting anal pressure increased in response to oxymetzoline (25.2%). The change in the mean fecal incontinence episodes per month (12 hours post drug application) favored oxymetazoline over placebo: 26.3 (SD ±28.4) versus 36 (SD ±39.8) (p = 0.021). When only nongas episodes were included, the mean number of episodes decreased from 10.1 (+4.3) to 6.3 (±2.1) fecal incontinence episodes per month (p = 0.022). No difference was observed in adverse events between treatment and placebo periods. All pharmacokinetic samples were below the detection limit.

LIMITATIONS:
The study was limited by the small number of participants.

CONCLUSIONS:
In this study, oxymetazoline gel presented a clear clinical beneficial effect accompanied by a favorable safety and tolerability profile. Results of the pharmacokinetic analysis indicate that the clinical benefit was mainly due to a local effect of oxymetazoline. Future studies are planned to investigate higher doses of oxymetazoline for this indication. See Video Abstract at http://links.lww.com/DCR/A797.
Female Representation and Implicit Gender Bias at the 2017 American Society of Colon and Rectal Surgeons’ Annual Scientific and Tripartite Meeting
Authors: Davids Jennifer S. , Lyu Heather G. , Hoang Chau M. , Daniel Vijaya T. , Scully Rebecca E. , Xu Ting Y. , Phatak Uma R. , Damle Aneel , Melnitchouk Nelya 
Published: November 2018

BACKGROUND:
Women surgeons are underrepresented in academic surgery and may be subject to implicit gender bias. In colorectal surgery, women comprise 42% of new graduates, but only 19% of Diplomates in the United States.

OBJECTIVE:
We evaluated the representation of women at the 2017 American Society of Colon and Rectal Surgeons Scientific and Tripartite Meeting and assessed for implicit gender bias.

DESIGN:
This was a prospective observational study.

SETTING:
The study occurred at the 2017 Tripartite Meeting.

MAIN OUTCOME MEASURES:
The primary outcome measured was the percentage of women in the formal program relative to conference attendees and forms of address.

METHODS:
Female program representation was quantified by role (moderator or speaker), session type, and topic. Introductions of speakers by moderators were classified as formal (using a professional title) or informal (using name only), and further stratified by gender.

RESULTS:
Overall, 31% of meeting attendees who are ASCRS members were women, with higher percentages of women as Candidates (44%) and Members (35%) compared with Fellows (24%). Women comprised 28% of moderators (n = 26) and 28% of speakers (n = 80). The highest percentage of women moderators and speakers was in education (48%) and the lowest was in techniques and technology (17%). In the 41 of 47 sessions evaluated, female moderators were more likely than male moderators to use formal introductions (68.7% vs 54.0%, p = 0.02). There was no difference when female moderators formally introduced female versus male speakers (73.9% vs 66.7%, p = 0.52); however, male moderators were significantly less likely to formally introduce a female versus male speaker (36.4% vs 59.2%, p = 0.003).

LIMITATIONS:
Yearly program gender composition may fluctuate. Low numbers in certain areas limit interpretability. Other factors potentially influenced speaker introductions.

CONCLUSIONS:
Overall, program representation of women was similar to meeting demographics, although with low numbers in some topics. An imbalance in the formality of speaker introductions between genders was observed. Awareness of implicit gender bias may improve gender equity and inclusiveness in our specialty. See Video Abstract at http://links.lww.com/DCR/A802.
Outcomes for Ulcerative Colitis With Delayed Emergency Colectomy Are Worse When Controlling for Preoperative Risk Factors
Authors: Leeds Ira L. , Sundel Margaret H. , Gabre-Kidan Alodia , Safar Bashar , Truta Brindusa , Efron Jonathan E. , Fang Sandy H. 
Published: November 2018

BACKGROUND:
Increasing evidence supports immediate colectomy in acute fulminant ulcerative colitis in comparison with ongoing medical management. Prior studies have been limited to inpatient-only administrative data sets or single-institution experiences.

OBJECTIVE:
The purpose of this study was to compare outcomes of early versus delayed emergency colectomy in patients admitted with ulcerative colitis flares while controlling for known preoperative risks and acuity.

DESIGN:
This is a cohort study of patients undergoing emergent total abdominal colectomies for ulcerative colitis compared by the timing of surgery.

SETTING:
Adult patients undergoing an emergent total abdominal colectomy for ulcerative colitis, 2005 to 2015, were identified in the American College of Surgeons National Surgical Quality Improvement Program database.

PATIENTS:
Patients undergoing total abdominal colectomy with an operative indication of ulcerative colitis admitted on a nonelective basis were selected.

MAIN OUTCOME MEASURE:
The primary outcomes measured were 30-day National Surgical Quality Improvement Program-reported mortality and postoperative complications, and early operation within 2 days of admission.

RESULTS:
We identified 573 total abdominal colectomies after propensity score matching. Median time to surgery was 1 hospital day in the early group versus 6 hospital days in the delayed group (p < 0.001). Early operation was associated with a lower mortality rate (4.9% versus 20.3% in matched groups, p < 0.001) and lower complication rate (64.5% versus 72.0%, p = 0.052). Multivariable logistic regression with propensity weighting of mortality on preoperative risk factors demonstrated that early surgery is associated with an 82% decrease in the odds of death compared with delayed surgery (p < 0.001). Regression of morbidity on preoperative risk factors demonstrated that early surgery is associated with a 35% decrease in the odds of a complication with delayed surgery (p = 0.034).

LIMITATIONS:
Quality improvement data were used for clinical research questions.

CONCLUSIONS:
Patients undergoing immediate surgical intervention for acute ulcerative colitis have decreased postoperative complications and mortality rates. Rapid and early transitioning from medical to surgical management may benefit those expected to require surgery on the same admission. See Video Abstract at http://links.lww.com/DCR/A800.
Update in the use and evaluation of poly (ADP-ribose) polymerase inhibitors in epithelial ovarian cancer: current and pending clinical research
Authors: Washington Christina , Gunderson Camille C. , Moore Kathleen N. 
Published: November 2018

Purpose of review
This review will provide an update of recently presented clinical data as well as discuss ongoing trials focused on the incorporation of poly (ADP-ribose) polymerase inhibitors (PARPi) into the treatment paradigm for ovarian cancer.

Recent findings
As of this publication, PARPi have indications in many parts of the globe as maintenance therapy following response to platinum-based chemotherapy in the setting of platinum-sensitive recurrence. In addition, in the United States, two PARPi have indications as monotherapy treatment for recurrent ovarian cancer in patients with a BRCA mutation and at least two prior lines of therapy. Exciting data was published in October 2018, demonstrating an unprecedented benefit to utilization of olaparib following response to front-line platinum-based chemotherapy among patients with a BRCA mutation and this data is expected to expand the indication for olaparib globally.

Summary
Ongoing studies will seek to expand the benefit of PARPi beyond the BRCA population in front-line therapy as well as to overcome inherent and acquired resistance to PARPi with studies of novel combinations with antiangiogenesis agents, immune-oncology agents and chemotherapy. These efforts may identify more settings and populations in which PARPi provide clinical benefit.
The “Butterfly” Wrap: A Simplified Technique for Consistent Prosthesis Coverage in Prepectoral Breast Reconstruction
Authors: Hill Elspeth J.R. , Buck Donald W. 
Published: November 2018

Background:
Here, we describe our simple, systematic, reproducible, and effective method for prosthesis coverage in prepectoral breast reconstruction.

Methods:
Our Butterfly Wrap is a simple technique, which provides prosthesis coverage with a single sheet of acellular dermal matrix (ADM) in a reproducible and elegant manner. The wrap design creates an anatomic tear-shaped pocket to guide expansion and encourage lower pole fullness, without ADM folding or bunching for optimal incorporation and minimal overlap. Further, it minimizes waste, allowing for smaller sheets of ADM to be used per breast, and can easily be performed in minimal time on the back table while the mastectomies are being performed, as a means of minimizing cost.

Results:
Our technique can be applied to effectively cover all shapes and sizes of expanders and implants, both teardrop and round. As a result, the surgeon need only focus on the critical nuances of prosthesis-based prepectoral breast reconstruction, without the anxiety of how to wrap the prosthesis and what size of ADM to use.

Conclusions:
The Butterfly Wrap is a simple, systematic, reproducible, and effective method for prosthesis coverage in prepectoral reconstruction.
Objective and Patient-reported Assessments of Skin Grafts and Keystone Flaps—A Pilot Retrospective Cohort Study
Authors: Dobbs Thomas D. , Jovic Thomas H. , Jessop Zita M. , Kyle Amanda , Hutchings Hayley A. , Whitaker Iain S. 
Published: November 2018

Background:
The keystone perforator island flap provides a versatile form of reconstruction. Perceived benefits include better donor-recipient color match, less contour defect, and fewer complications. To date, there has been no high-quality evidence comparing keystone flaps to split-thickness skin grafts (SSG) from both a qualitative and quantitative point of view.

Methods:
The Objective and Patient Reported Assessments of Skin grafts versus Keystone flap cohort study compares keystone flaps with SSGs for the reconstruction of skin cancer defects. Patient-reported outcome measures were collected using the EuroQol 5 dimension scale and Patient and Observer Scar Assessment Scale (POSAS) questionnaires. Objective assessments of skin quality were assessed with the Courage and Khazaka system. Cost analysis was also performed.

Results:
Thirty-eight patients were studied: 20 keystone flaps and 18 SSGs. The keystone group had higher EuroQol 5 dimension scale scores (keystone median = 1.0; SSG median = 0.832; P = 0.641) indicating better general quality of life and lower POSAS scores indicating better disease/condition specific quality of life (keystone mean = 27.7; SSG mean = 35.7; P = 0.323). Observer POSAS scores were significantly lower in the keystone group compared with the SSG group (keystone mean = 10.889; SSG mean = 17.313; P < 0.001). Preservation of sensation was significantly better in keystone flaps (P = 0.006). There was an average £158/$207 (15%) saving when performing a keystone flap.

Conclusion:
This pilot study demonstrates a number of possible benefits of keystone flaps over SSGs. The results demonstrate the need for further research comparing these reconstructive options. We propose a prospective, controlled study using the methods developed in this pilot study.
Neoadjuvant Vismodegib and Mohs Micrographic Surgery for Locally Advanced Periocular Basal Cell Carcinoma
Authors: González Abel R. , Etchichury Dardo , Gil Maria E. , del Aguila Roxana 
Published: November 2018

Introduction:
Vismodegib has shown a significant response rate in locally advanced periocular basal cell carcinoma. Long-term monotherapy is very difficult to accomplish due to primary or secondary resistance and side effects that limit the length of treatment. The use of Vismodegib as neoadjuvant followed by Mohs micrographic surgery is an option.

Purpose:
To report the use of neoadjuvant Vismodegib as an option for operable locally advanced basal cell carcinoma followed by Mohs surgery.

Patients and Methods:
The authors treated 8 locally advanced periocular basal cell carcinomas. Mean age was 76, and 6 of 8 were women. Mean size was 18 mm (12–30). Three were recurrent after surgery. Maximal clinical response was obtained at 4.8 months. Patients were operated at the mean time of 7.3 months.

Results:
Seven patients (87.5%) had a complete response and 1 (12.5%) progressed. Mohs micrographic surgery allowed to confirm a complete histologic response in 5 of 6 (83.3%) cases, and 1 patient refused surgery. All 7 patients are disease free after a mean follow-up of 12.4 months. All patients experienced adverse events. The most common included dysgeusia (100%) and muscle spasms (100%). Weight loss was present in 75% of the patients with a mean loss of 12.6 pounds and hair loss was seen in 50%. Only 1 (12.5%) patient withdraw from treatment because of intolerable muscle spasms.

Conclusions:
The authors believe there is a clear role for Vismodegib as neoadjuvant in locally advanced periocular basal cell carcinoma, even in operable cases. Specific indications beyond those already approved should be further discussed. Prospective studies to assess the combination of neoadjuvant Vismodegib followed by Mohs micrographic surgery in locally advanced periocular basal cell carcinoma with long-term follow-up are needed.
Sexual Misconduct Policies at Institutes of Higher Education: An Integrative Review
Authors: McNair Katelyn T. , Fantasia Heidi Collins , Harris Allyssa L. 
Published: November 2018

ABSTRACT
Although federal legislation designed to advance sexual misconduct policies at institutes of higher education (IHEs) has been in effect for decades, recent national attention has put more pressure on IHEs to combat sexual violence on their campuses. Thus, the past few years have yielded significant research that examines federal compliance, dissemination, and perception of IHE sexual misconduct policies. This integrative review was conducted to assess sexual misconduct policies in the United States and the potential to prevent and combat sexual violence at IHEs through these policies. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and using a quality assessment tool to ensure rigor, eight studies were synthesized. Findings indicate that IHE sexual misconduct policies vary widely and that most IHEs lack transparent, legislation-compliant policies. There remains a need for research examining the association between sexual misconduct policy, campus climate, and students' behavior, so as to better inform future sexual misconduct interventions and IHE policies. Forensic nurses may be key stakeholders in policy development that is currently missing from the literature.