bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sexual Functioning in Hyperprolactinemic Patients Treated With Cabergoline or Bromocriptine
Authors: Krysiak Robert , Okopień Bogusław 
Published: May 2018

Background:
Elevated prolactin levels were found to be associated with impaired sexuality.

Study Question:
The aim of the study was to compare the impact of bromocriptine and cabergoline on sexual functioning in both genders.

Study Design:
The study enrolled 39 young women and 18 young men receiving bromocriptine treatment. In 19 women and 8 men, because of poor tolerance, bromocriptine was replaced with cabergoline, whereas the remaining ones continued bromocriptine treatment.

Measures and Outcomes:
Apart from measuring serum levels of prolactin and insulin sensitivity, at the beginning of the study and 16 weeks later, all included patients completed questionnaires evaluating female or male sexual functioning (Female Sexual Function Index; International Index of Erectile Function-15).

Results:
Irrespective of the gender, posttreatment prolactin levels were lower in cabergoline-treated patients than in bromocriptine-treated patients. Baseline sexual functioning did not differ between patients well and poorly tolerating bromocriptine treatment. Neither in men nor in women receiving bromocriptine, posttreatment sexual functioning differed from baseline one. In both genders, cabergoline improved sexual desire. Moreover, in men, the drug improved erectile and orgasmic function, whereas in women, it improved sexual arousal. All these effects correlated with the impact of this drug on prolactin levels and on insulin sensitivity.

Conclusions:
Cabergoline is superior to bromocriptine in affecting male and female sexual functioning and should be preferred in hyperprolactinemic men and women with sexual dysfunction.
Homeless Status, Postdischarge Health Care Utilization, and Readmission After Surgery
Authors: Titan Ashley , Graham Laura , Rosen Amy , Itani Kamal , Copeland Laurel A. , Mull Hillary J. , Burns Edith , Richman Joshua , Kertesz Stefan , Wahl Tyler , Morris Melanie , Whittle Jeffery , Telford Gordon , Wilson Mark , Hawn Mary 
Published: May 2018

Introduction:
Homeless Veterans are vulnerable to poor care transitions, yet little research has examined their risk of readmission following inpatient surgery. This study investigates the predictors of surgical readmission among homeless relative to housed Veteran patients.

Methods:
Inpatient general, vascular, and orthopedic surgeries occurring in the Veterans Health Administration from 2008 to 2014 were identified. Administrative International Classification of Diseases, Ninth Revision, Clinical Modification codes and Veterans Health Administration clinic stops were used to identify homeless patients. Bivariate analyses examined characteristics and predictors of readmission among homeless patients. Multivariate logistic models were used to estimate the association between homeless experience and housed patients with readmission following surgery.

Results:
Our study included 232,373 surgeries: 43% orthopedic, 39% general, and 18% vascular with 5068 performed on homeless patients. Homeless individuals were younger (56 vs. 64 y, P<0.01), more likely to have a psychiatric comorbidities (51.3% vs. 19.4%, P<0.01) and less likely to have other medical comorbidities such as hypertension (57.1% vs. 70.8%, P<0.01). Homeless individuals were more likely to be readmitted [odds ratio (OR), 1.43; confidence interval (CI), 1.30–1.56; P<0.001]. Discharge destination other than community (OR, 0.57; CI, 0.44–0.74; P<0.001), recent alcohol abuse (OR, 1.45; CI, 1.15–1.84; P<0.01), and elevated American Society Anesthesiologists classification (OR, 1.86; CI, 1.30–2.68; P<0.01) were significant risk factors associated with readmissions within the homeless cohort.

Conclusions:
Readmissions are higher in homeless individuals discharged to the community after surgery. Judicious use of postoperative nursing or residential rehabilitation programs may be effective in reducing readmission and improving care transitions among these vulnerable Veterans. Relative costs and benefits of alternatives to community discharge merit investigation.
Predischarge and Postdischarge Risk Factors for Hospital Readmission Among Patients With Diabetes
Authors: Karunakaran Abhijana , Zhao Huaqing , Rubin Daniel J. 
Published: May 2018

Background:
Hospital readmission within 30 days of discharge (30-d readmission) is an undesirable outcome. Readmission of patients with diabetes is common and costly. Most of the studies that have examined readmission risk factors among diabetes patients did not include potentially important clinical data.

Objectives:
To provide a more comprehensive understanding of 30-day readmission risk factors among patients with diabetes based on predischarge and postdischarge data.

Research Design:
In this retrospective cohort study, 48 variables were evaluated for association with readmission by multivariable logistic regression.

Subjects:
In total, 17,284 adult diabetes patients with 44,203 hospital discharges from an urban academic medical center between January 1, 2004 and December 1, 2012.

Measures:
The outcome was all-cause 30-day readmission. Model performance was assessed by c-statistic.

Results:
The 30-day readmission rate was 20.4%, and the median time to readmission was 11 days. A total of 27 factors were statistically significant and independently associated with 30-day readmission (P<0.05). The c-statistic was 0.82. The strongest risk factors were lack of a postdischarge outpatient visit within 30 days, hospital length-of-stay, prior discharge within 90 days, discharge against medical advice, sociodemographics, comorbidities, and admission laboratory values. A diagnosis of hypertension, preadmission sulfonylurea use, admission to an intensive care unit, sex, and age were not associated with readmission in univariate analysis.

Conclusions:
There are numerous risk factors for 30-day readmission among patients with diabetes. Postdischarge factors add to the predictive accuracy achieved by predischarge factors. A better understanding of readmission risk may ultimately lead to lowering that risk.
Update on complications in cleft orthognathic surgery
Authors: Ohrmann Dörte , Hoyte-Williams Paa Ekow , Chen Philip Kuo-Ting 
Published: May 2018

Purpose of review
To give an update on recent publications and tendencies concerning complications in cleft orthognathic surgery.

Recent findings
Cleft-specific changes after orthognathic surgery and their impact on surgical outcomes are discussed. Focus lays on the causes and mechanisms of cleft-related surgical complications and strategies to prevent or minimize these complications. Bimaxillary surgery is seen as a safe procedure for cleft patients. Maxillary distraction, total or segmental, is pointed out as an alternative method to improve outcomes. Different techniques for osteotomies and maxillary mobilization could decrease adverse events.

Summary
Cleft patients are more susceptible to the occurrence of complications because of peculiar presurgical conditions. Different surgical approaches and techniques are presented to overcome these difficulties, to achieve better results and to increase patient safety. The importance of communication between patient, family and cleft team members is emphasized.
Modern postoperative monitoring of free flaps
Authors: Kääriäinen Minna , Halme Elina , Laranne Jussi 
Published: May 2018

Purpose of review
Flap failure in microvascular reconstruction is a costly complication with total flap loss being the worst-case scenario. With the aim to rapidly identify a postoperative circulatory problem, some susceptible flaps can be saved by careful clinical monitoring or by various technical monitoring methods. In head and neck surgery, where the flaps are often buried and difficult to monitor clinically, a reliable technical monitoring method would be useful. A broad range of different techniques are in use varying according to practical and personal preferences among clinics and surgeons. However, no evidence for any particular technique being superb has emerged. We review reports of some frequently used and modern free flap monitoring techniques.

Recent findings
Clinical monitoring is still the gold standard to which other techniques are compared to. Laser Doppler flowmetry and near-infrared spectroscopy have been reported to identify early circulatory problems, but both techniques are not well suited for buried flaps. Implantable Doppler, flow coupler, partial tissue oxygen pressure and microdialysis are invasive monitoring methods suitable for buried flaps.

Summary
More research with practical and clinically relevant parameters, that is flap salvage rate, false positive rate and cost-efficiency are needed before objective comparisons between different monitoring techniques can be made.
Human leukocyte antigen matching in organ transplantation: what we know and how can we make it better (Revisiting the past, improving the future)
Authors: Tambur Anat R. 
Published: May 2018

Purpose of review
A renaissance for human leukocyte antigen (HLA) testing emerged with the understanding that donor-specific HLA antibodies play a significant role in long-term allograft survival. This renewed focus on donor/recipient histocompatibility led to a recent quest to decipher antibody responses or, as introduced into the transplantation lexicon, ‘HLA-epitope matching’.

Recent findings
Whether matching is at the antigen or the epitope level, in-depth understanding of how histo-incompatibility leads to activation of an immune response is required. HLA-DQ donor-specific antibody (DSA) has the highest association with poor graft survival. However, HLA-DQ antigens and antibodies are understudied and significant gaps still exist in understanding the function of HLA-DQ in immune activation. Much of our knowledge about HLA class-II molecules is derived from studies performed on HLA-DR, whether it is crystallography, antigen processing and presentation analysis, or activation of T-cell signal-transduction pathways. Indeed, HLA-DQ molecules are less amenable for laboratory testing, but the limited studies that were performed indicate that HLA-DQ might have, at least to some extent, a different role compared with HLA-DR.

Summary
This review highlights qualities of HLA-DQ that may be associated with different pathways of activating an immune response. Understanding the consequences of such differences may lead to better appreciation and significance of HLA-DQ for matching purposes.
Comorbidities in Childhood Celiac Disease
Authors: Prinzbach Ariana , Moosavinasab Soheil , Rust Steve , Boyle Brendan , Barnard John A. , Huang Yungui , Lin Simon 
Published: May 2018

ABSTRACTObjectives:Celiac disease (CD) is associated with a variety of extraintestinal autoimmune and inflammatory findings that manifest clinically as symptoms and comorbidities. Understanding these comorbidities may improve identification of the disease and prevent sequelae. In this study, we use an unbiased electronic health record (EHR)‐based Phenome Wide Association Study (PheWAS) method to confirm known comorbidities, discover novel associations and enhance characterization of the clinical presentation of CD in children.Methods:Data were extracted from the Nationwide Children's Hospital EHR. Confirmed CD cases (n = 433) were matched with 4330 randomly selected controls. Utilizing an EHR‐based PheWAS method to analyze associations of phenotypes with CD, we conducted an unbiased screening of all International Classification of Diseases, 10th revision diagnostic codes and examined significance by performing Fisher's Exact tests. We further tested for the association between CD and 14 previously identified comorbidities in an a priori fashion.Results:We found 45 International Classification of Diseases, 10th revision codes significantly associated with CD. Thirteen are known comorbidities and nine are expected symptoms of CD, thus validating our study methods. Further investigation found symptoms that characterized CD clinically and discovered a significant association between eosinophilic disorders of the esophagus and CD. Of 14 previously identified comorbidities, 8 were significantly associated with CD.Conclusions:An EHR‐based PheWAS method is a powerful, efficient, and cost‐effective method to screen for possible CD comorbidities and validate associations at the population level. Ours is the first PheWAS of CD to confirm a significant association of eosinophilic disorders of the esophagus with CD in a controlled study.
Nutritional Considerations in Pediatric Pancreatitis
Authors: Abu‐El‐Haija Maisam , Uc Aliye , Werlin Steven L. , Freeman Alvin Jay , Georgieva Miglena , Jojkić‐Pavkov Danijela , Kalnins Daina , Kochavi Brigitte , Koot Bart G.P. , Van Biervliet Stephanie , Walkowiak Jaroslaw , Wilschanski Michael , Morinville Veronique D. 
Published: May 2018

ABSTRACTObjectives:Wide variations exist in how physicians manage the nutritional aspects of children affected by acute pancreatitis (AP), acute recurrent pancreatitis (ARP), and chronic (CP) pancreatitis. Better consensus for optimal management is needed.Methods:This consensus statement on nutrition in pediatric pancreatic diseases was developed through a joint ESPGHAN‐NASPGHAN working group that performed an evidence‐based search of the literature on nutrition in AP, ARP, and CP with a focus on pediatrics. The literature was summarized, quality of evidence reviewed, and expert recommendations developed. The authorship met to discuss the evidence and statements. Voting on recommendations occurred over 2 rounds based on feedback. A consensus of at least 75% was required to approve a recommendation. Areas requiring further research were identified.Results and Discussion:The literature on nutrition in pediatric pancreatitis is limited. Children with mild AP benefit from starting an early nutritional regimen in the course of the attack. Early nutrition should be attempted in severe AP when possible; enteral nutrition is preferred over parenteral nutrition. Children with ARP are likely to tolerate and benefit from a regular diet. Children with CP need ongoing assessment for growth and nutritional deficiencies, exocrine and endocrine insufficiencies.Conclusions:This document presents the first authoritative recommendations on nutritional considerations in pediatric pancreatitis. Future research should address the gaps in knowledge particularly relating to optimal nutrition for AP in children, role of diet or dietary supplements on recurrent attacks of pancreatitis and pain episodes, monitoring practices to detect early growth and nutritional deficiencies in CP and identifying risk factors that predispose children to these deficiencies.
Reducing RN Vacancy Rate
Authors: Hisgen Stephanie A. , Page Nancy E. , Thornlow Deirdre K. , Merwin Elizabeth I. 
Published: May 2018

OBJECTIVE
The aim of this study was to reduce the RN vacancy rate at an academic medical center by improving the hiring process in the Nursing Recruitment Office.

BACKGROUND
Inability to fill RN positions can lead to higher vacancy rates and negatively impact staff and patient satisfaction, quality outcomes, and the organization's bottom line.

METHODS
The Model for Improvement was used to design and implement a process improvement project to improve the hiring process from time of interview through the position being filled.

RESULTS
Number of days to interview and check references decreased significantly, but no change in overall time to hire and time to fill positions was noted. RN vacancy rate also decreased significantly. Nurse manager satisfaction with the hiring process increased significantly.

CONCLUSION
Redesigning the recruitment process supported operational efficiencies of the organization related to RN recruitment.
Laxative-Induced Contact Dermatitis
Authors: Melvin Jennifer E. , Hickey Robert W. 
Published: May 2018

Abstract
A 5-year-old female with Charcot-Marie-Tooth neuropathy and a history of constipation presented to the emergency department with a new blistering buttocks rash, which was initially concerning for nonaccidental burn. Upon further investigation, it was found that Ex-Lax had been given to the patient for constipation. This had resulted in a bowel movement, which led to an irritant dermatitis. The patient was eventually diagnosed with senna-induced erosive diaper dermatitis. This case report highlights the importance of a thorough history and physical examination to prevent an unnecessary child abuse work-up.
Infusion of cytotoxic T lymphocytes for the treatment of viral infections in hematopoetic stem cell transplant patients
Authors: Baugh Katherine A. , Tzannou Ifigeneia , Leen Ann M. 
Published: May 2018

Purpose of review
Allogeneic hematopoietic stem cell transplantation has proven curative for a range of malignant and nonmalignant disorders. However, the clinical success of this therapy is marred by the morbidity associated with viral infections, which are frequent (cytomegalovirus 15.6–28%, adenovirus 3–21%, BK virus 18.5–20.7%) post-transplant. These infections occur as a consequence of transplant conditioning regimens designed to eliminate not only malignant cells but also host immune cells that might interfere with stem cell engraftment. The result is a transient period of immune compromise when hematopoietic stem cell transplant recipients are at risk of infectious complications associated with both latent (cytomegalovirus, Epstein–Barr virus, BK virus, human herpes virus 6, herpes simplex virus, varicella-zoster virus) and community-acquired viruses including adenovirus, respiratory syncytial virus, and parainfluenza virus.

Recent findings
Current standard of care for many of these infections involves pharmacologic agents, which are often ineffective and associated with side effects including nephrotoxicity and hepatotoxicity. Ultimately, because these agents do not address the underlying immune compromise, viral rebound often occurs. Thus, a number of groups have explored the clinical potential of adoptively transferred virus-specific T cells (VSTs) as an approach to prevent/treat virus-associated complications.

Summary
The current review will highlight recent publications showcasing VST manufacturing technologies and clinical experience with such cells.
Detection of Cerebrospinal Fluid Dissemination of Recurrent Glioblastoma Using TSPO-PET With 18F-GE-180
Authors: Unterrainer Marcus , Fleischmann Daniel F. , Lindner Simon , Brendel Matthias , Rupprecht Rainer , Tonn Joerg C. , Belka Claus , Bartenstein Peter , Niyazi Maximilian , Albert Nathalie L. 
Published: May 2018

Abstract
PET targeting the translocator protein (TSPO) represents an interesting approach for glioma visualization, as TSPO is highly expressed in tumor cells. We present a 32-year-old man with recurrent glioblastoma after multimodal treatment. PET with the novel TSPO ligand 18F-GE-180 was performed after reirradiation. Here, the previously reirradiated tumor showed a remaining circular TSPO expression. Moreover, cerebrospinal fluid dissemination was detected by a high focal uptake at the right lateral and at the fourth ventricle, whereas only a faint contrast enhancement was present in MRI. This case demonstrated the diagnostic potential of TSPO-PET for glioma imaging by visualizing even minimal disease burden.
Impressive Response to Tandem Treatment With [90Y]DOTATOC and [177Lu]DOTATOC in Grade 3 Pancreatic Neuroendocrine Carcinoma
Authors: Lorenzoni Alice , Capozza Antonella , Artale Salvatore , Maccauro Marco , Seregni Ettore Cesare 
Published: May 2018

Abstract
Peptide receptor radionuclide therapy is an effective, well-tolerated, treatment for well-differentiated neuroendocrine tumors, resulting in a significant survival benefit and improvement of quality of life. Very few data are available on peptide receptor radionuclide therapy effectiveness in grade 3 neuroendocrine carcinomas with high somatostatin receptor expression. We report the case of a 70-year-old woman with metastatic pancreatic grade 3 neuroendocrine carcinoma who underwent 6 cycles of tandem treatment with investigational radiopharmaceuticals 90Y-DOTATOC and 177Lu-DOTATOC achieving an impressive response.
Do Sepsis-3 Criteria Facilitate Earlier Recognition of Sepsis and Septic Shock? A Retrospective Cohort Study
Authors: Scheer Christian S. , Kuhn Sven-Olaf , Fuchs Christian , Vollmer Marcus , Modler Arnd , Brunkhorst Frank , Shankar-Hari Manu , Hahnenkamp Klaus , Gründling Matthias , Rehberg Sebastian 
Published: May 2018

ABSTRACT

Background:
New Sepsis-3 criteria are supposed to “facilitate earlier recognition … of patients with sepsis.” To test this, we performed novel and direct comparisons of Sepsis-1 vs. Sepsis-3 criteria with respect to time differences of sepsis onset.

Methods:
In a cohort of intensive care unit (ICU) patients prospectively diagnosed with severe sepsis or septic shock according to Sepsis-1 criteria between 01/2010 and 12/2015, the time differences between meeting Sepsis-1 vs. Sepsis-3 criteria as time of sepsis onset and the corresponding differences in illness severity were tested. Similar comparisons were performed for septic shock subset meeting different Sepsis-1 vs. Sepsis-3 criteria. Patients with non-ICU-acquired sepsis and patients with sepsis onset more than 48 h postadmission (ICU-acquired sepsis) were analyzed separately to account for differences in availability of routinely collected organ dysfunction data.

Results:
A total of 10,905 ICU patients were screened; 862 patients met Sepsis-1 criteria, of whom 834 (97%) also met Sepsis-3 criteria. In patients, admitted to the ICU with sepsis, Sepsis-3 criteria compared with Sepsis-1 criteria were more frequently fulfilled within the first 3 h (84% vs. 75%, P < 0.001).
In patients with ICU-acquired sepsis, sepsis onset was in 50% at least 1 day earlier after application of Sepsis-3 (P = 0.011). These patients were systemic inflammatory response syndrome negative at the earlier sepsis onset, but suffered already from organ dysfunction. Sepsis-3 criteria were timely in 86% and 1 day delayed in 7%. Only 7% (8 patients) did not meet Sepsis-3 criteria in this group. These patients had already an increased SOFA score and did develop neither a further increase nor the new septic shock criteria. Classification according to Sepsis-3 reduced the proportion of septic shock (51% vs. 75%, P < 0.001).
Twenty-eight-day mortality was 38% for new septic shock compared with 33% of Sepsis-1 septic shock (P > 0.05). Patients not detected by Sepsis-3 had a 28-day mortality of 11%.

Conclusions:
Sepsis-3 criteria facilitate an earlier and more predictive recognition of sepsis and septic shock in patients with non-ICU and ICU-acquired sepsis primarily diagnosed by Sepsis-1 criteria. These results require further validation with prospectively collected data.