bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative Patient Expectations of Postoperative Pain Are Associated with Moderate to Severe Acute Pain After VATS
Authors: Bayman Emine Ozgur , Parekh Kalpaj R , Keech John , Larson Nyle , Vander Weg Mark , Brennan Timothy J 
Published: April 2018

Abstract

Objective
The goal of this post hoc analysis of subjects from a prospective observational study was to identify the predictors of patients developing moderate to severe acute pain (mean numerical rating scale [NRS] ≥4, 0–10) during the first three days after video-assisted thoracoscopic surgery (VATS) from a comprehensive evaluation of demographic, psychosocial, and surgical factors.

Methods
Results from 82 patients who were enrolled one week before VATS and evaluated during the first three postoperative days are presented. The primary outcome variable of the current study was the presence of moderate to severe acute pain after VATS.

Results
Fifty-nine percent (95% confidence interval, 47–69%) of study subjects developed moderate to severe acute pain after VATS. Factors univariately associated with the presence of moderate to severe acute pain were greater average expected postoperative pain, greater pain to a suprathreshold cold stimulus, and longer durations of surgery and hospital stay (P < 0.05). When considered in the multiple logistic regression models, the patients’ preoperative average intensity of expected postoperative pain (NRS, 0–10) was the only measure associated with the moderate to severe acute pain. Average intensity of postoperative pain expected by patients when questioned preoperatively mediated the effect of reported intensity of pain to the suprathreshold cold stimulus for moderate to severe acute pain levels. Preoperative patient expectations had greater predictive value than other assessed variables including psychosocial factors such as catastrophizing or anxiety assessed one week before surgery.

Conclusions
None of the preoperative psychosocial measures were associated with the moderate to severe acute pain after VATS. Average expected postoperative pain was the only measure associated with the development of moderate to severe acute pain after VATS.
Benchmarking the Physical Therapist Academic Environment to Understand the Student Experience
Authors: Shields Richard K , Dudley-Javoroski Shauna , Sass Kelly J , Becker Marcie 
Published: April 2018

Abstract

Background
Identifying excellence in physical therapist academic environments is complicated by the lack of nationally available benchmarking data.

Objective
The objective of this study was to compare a physical therapist academic environment to another health care profession (medicine) academic environment using the Association of American Medical Colleges Graduation Questionnaire (GQ) survey.

Design
The design consisted of longitudinal benchmarking.

Methods
Between 2009 and 2017, the GQ was administered to graduates of a physical therapist education program (Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa [PTRS]). Their ratings of the educational environment were compared to nationwide data for a peer health care profession (medicine) educational environment. Benchmarking to the GQ capitalizes on a large, psychometrically validated database of academic domains that may be broadly applicable to health care education. The GQ captures critical information about the student experience (eg, faculty professionalism, burnout, student mistreatment) that can be used to characterize the educational environment. This study hypothesized that the ratings provided by 9 consecutive cohorts of PTRS students (n = 316) would reveal educational environment differences from academic medical education.

Results
PTRS students reported significantly higher ratings of the educational emotional climate and student-faculty interactions than medical students. PTRS and medical students did not differ on ratings of empathy and tolerance for ambiguity. PTRS students reported significantly lower ratings of burnout than medical students. PTRS students descriptively reported observing greater faculty professionalism and experiencing less mistreatment than medical students.

Limitations
The generalizability of these findings to other physical therapist education environments has not been established.

Conclusions
Selected elements of the GQ survey revealed differences in the educational environments experienced by physical therapist students and medical students. All physical therapist academic programs should adopt a universal method to benchmark the educational environment to understand the student experience.
Open Reduction and Internal Fixation Versus Nonsurgical Treatment in Displaced Midshaft Clavicle Fractures: A Meta-Analysis
Authors: Ahmed Abdulaziz F. , Salameh Motasem , AlKhatib Nedal , Elmhiregh Aissam , Ahmed Ghalib O. 
Published: April 2018

Objectives:
To compare open reduction and internal fixation (ORIF) and nonsurgical treatment outcomes in displaced midshaft clavicle fractures.

Data Sources:
PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Library, and ClinicalTrials.gov were searched in September 2017.

Study Selection:
Inclusion criteria were randomized controlled trials reporting nonunion, shoulder functional outcomes, and subsequent surgery rates or pain scores. We excluded studies with patients younger than 16 years, maximum follow-up less than 9 months, and inaccessible full text.

Data Extraction:
Extracted data included the first author, publication year, number of patients, number of nonunions, Constant scores, disabilities of the arm, shoulder, and hand (DASH) scores, number of subsequent surgeries, and pain measured using the visual analog scale.

Data Synthesis:
The risk ratio of nonunion was 0.15 [95% confidence interval (CI), 0.08–0.31] in ORIF compared with that of nonsurgical treatment. Constant and DASH scores were significantly better in ORIF up to 6 months. The mean difference (MD) in DASH scores at 12 months was statistically insignificant in both treatments (MD, −4.19; 95% CI, −9.34 to 0.96). Constant scores remained significant in ORIF (MD, 4.39; 95% CI, 1.03–7.75). Subsequent surgeries and pain scores were similar in both treatments.

Conclusions:
Significant reduction in nonunions and favorable early functional outcomes are associated with ORIF. Nevertheless, late functional outcomes, subsequent surgeries, and pain scores are similar to those of nonsurgical treatment. Although patients treated with ORIF mainly had subsequent elective plate removals, nonsurgically treated patients had more surgical fixations for nonunions. As a result, there remains inconsistent evidence regarding the best treatment for displaced midshaft clavicle fractures.

Level of Evidence:
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Cutaneous Metastasis of Adenocarcinoma of the Ampulla of Vater
Authors: Fernandez-Flores Angel , Cassarino David S. 
Published: April 2018

Abstract:
Cutaneous metastases from an adenocarcinoma of the Ampulla of Vater are very rare, with only a few cases previously reported. We present here an additional case in a 57-year-old woman who complained of a painful growth on her frontal scalp that she had noticed 4 months earlier. Her medical history included an ampullary adenocarcinoma, which was diagnosed 4 years ago, excised through a Whipple procedure, and treated using chemotherapy and radiotherapy. The scalp biopsy showed a dermal and epidermotropic well-differentiated glandular neoplasm with abundant neutrophils within the luminae of the tumoral glands. The tumor failed to express p63 and cytokeratin 5/6, whereas it was intensively positive for CK7 and E-cadherin. CDX2 expression was weak and focal. The immunohistochemical expression of DNA mismatch-repair proteins (MSH2, MSH6, MLH1, and PMS2) was preserved. Despite oncological treatment, the patient developed multiple cutaneous metastases during the ensuing several months, and eventually died 6 years after her initial diagnosis with widespread metastases.
Role of Direct Immunofluorescence in Cutaneous Small-Vessel Vasculitis: Experience From a Tertiary Center
Authors: Lath Khushboo , Chatterjee Debajyoti , Saikia Uma Nahar , Saikia Biman , Minz Ranjana , De Dipankar , Handa Sanjeev , Radotra Bishan 
Published: April 2018

Abstract:
Skin is commonly affected by vasculitic process and often subjected to biopsy. Cutaneous vasculitis can be either primary or part of a systemic vasculitic process. This study was conducted to evaluate the diagnostic utility of direct immunofluorescence (DIF) in determination of etiology of cutaneous vasculitis. All histologically proven cases of cutaneous vasculitis over the past two and half years were retrospectively analyzed along with their clinical and DIF findings (IgG, IgA, IgM, and C3). Within this study period, a total of 198 cases of small-vessel vasculitis were diagnosed based on skin biopsy and DIF findings. The mean age of patients was 31.2 years (range 1–84 years) with slight male dominance (M:F ratio 1.06:1). Henoch–Schonlein purpura/IgA vasculitis was the commonest clinical diagnosis (31%), followed by urticarial vasculitis (11%) and others. Idiopathic vasculitis was suspected in 33% cases. Overall, DIF was positive in 60% (119/198) cases, with vascular deposition of IgA being commonest, followed by C3. The clinical diagnosis of Henoch–Schonlein purpura could be confirmed in 61.5% (40/65) cases by DIF, whereas another 20 unsuspected cases were picked up as IgA vasculitis based on DIF findings. DIF findings confirmed lupus vasculitis in 50% cases. Other cases showed variable nonspecific deposition of C3 and IgM in 42% cases. DIF can be highly useful to classify cutaneous vasculitis, with maximum efficacy for diagnosis of IgA vasculitis and lupus vasculitis. It can aid in the accurate diagnosis even when the histological changes are minimal. All cases of suspected cutaneous vasculitis should be subjected to DIF.
Replacement of the 6-Min Walk Test With Glittre ADL Test and Scores From the PFSDQ-M and HAP Questionnaires in the BODE Index
Authors: Moreira Fabiana B. R. , de Fuccio Marcelo B. , Ribeiro-Samora Giane Amorim , Velloso Marcelo 
Published: April 2018

Purpose:
Chronic obstructive pulmonary disease reduces functional capacity, which is strongly correlated with the morbidity and mortality of patients. The BODE index considers the multifactorial nature of the disease, including the functional capacity measured by the 6-min walk test (6MWT), and this index predicts the mortality in patients with chronic obstructive pulmonary disease. Our aim was to assess whether association exists between the original BODE index and the modified BODE index by replacing the 6MWT with the scores from the Pulmonary Functional Status and Dyspnea Questionnaire—Modified version (PFSDQ-M), Human Activity Profile (HAP) questionnaire, and the results of the Glittre ADL Test (TGlittre).

Methods:
Twenty-eight subjects diagnosed with chronic obstructive pulmonary disease underwent the 6MWT and TGlittre and responded to the PFSDQ-M and HAP questionnaires. Four BODE index scores were obtained: 1 calculated by using the original method (ie, using the 6MWT) and 3 others calculated by using the results obtained from the TGlittre, PFSDQ-M, and HAP (the modified BODE index scores).

Results:
High levels of association were observed between the original BODE index and the BODE TGlittre (R
2 = 0.824, P ≤ .0001), BODE PFSDQ-M (R
2 = 0.803, P ≤ .0001), and BODE HAP (R
2 = 0.500, P ≤ .0001).

Conclusion:
The BODE TGlittre, and BODE PFSDQ-M may be used as alternatives to the 6MWT when physical space is not available to perform the 6MWT or when the condition of a patient does not allow performance of the 6MWT.
Cortical astrocytes prime the induction of spine plasticity and mirror image pain
Authors: Ishikawa Tatsuya , Eto Kei , Kim Sun Kwang , Wake Hiroaki , Takeda Ikuko , Horiuchi Hiroshi , Moorhouse Andrew J. , Ishibashi Hitoshi , Nabekura Junichi 
Published: April 2018

Abstract
Peripheral nerve injury causes maladaptive plasticity in the central nervous system and induces chronic pain. In addition to the injured limb, abnormal pain sensation can appear in the limb contralateral to the injury, called mirror image pain. Because synaptic remodeling in the primary somatosensory cortex (S1) has critical roles in the induction of chronic pain, cortical reorganization in the S1 ipsilateral to the injured limb may also accompany mirror image pain. To elucidate this, we conducted in vivo 2-photon calcium imaging of neuron and astrocyte activity in the ipsilateral S1 after a peripheral nerve injury. We found that cross-callosal inputs enhanced the activity of both S1 astrocytes and inhibitory neurons, whereas activity of excitatory neurons decreased. When local inhibitory circuits were blocked, astrocyte-dependent spine plasticity and allodynia were revealed. Thus, we propose that cortical astrocytes prime the induction of spine plasticity and mirror image pain after peripheral nerve injury. Moreover, this result suggests that cortical synaptic rewiring could be sufficient to cause allodynia on the uninjured periphery.
Risk of Fractures in Inflammatory Bowel Diseases
Authors: Komaki Yuga , Komaki Fukiko , Micic Dejan , Ido Akio , Sakuraba Atsushi 
Published: April 2018

Background:
Studies assessing the risk of fractures in inflammatory bowel diseases (IBD) have shown controversial results.

Goals:
We performed a systematic review and meta-analysis to assess the risk of fractures in IBD.

Study:
Electronic databases were searched for cohort studies assessing the risk of fractures in IBD. The outcomes were the risk of overall fractures and at specific sites, and the association between the risk of fractures and the proportion of patients with corticosteroid use or osteoporosis.

Results:
Ten studies including 470,541 patients were identified. The risk of overall fractures in IBD patients was similar to controls [odds ratio (OR), 1.08; P=0.70; 95% confidence interval (CI), 0.72-1.62) with moderate heterogeneity (I
2=74.4%) which appeared to be due to the variable power and outcomes among the studies. The OR of fractures at the spine was significantly elevated at 2.21 (P<0.0001; 95% CI, 1.39-3.50) with low heterogeneity (I
2=26.1%). Meta-regression showed a correlation with the proportion of patients with steroid use. Risks of fractures at other sites (hip, rib, and wrist) were not elevated. Patients with fractures were more commonly on steroids compared with those without fractures (OR, 1.47; P=0.057; 95% CI, 0.99-2.20; I

2
<0.0001%), but there was no correlation with osteoporosis.

Conclusions:
IBD patients had no increased risk of overall fractures, but were at significantly increased risk of fractures at the spine, which was associated with steroid use. Strict surveillance and prevention of spine fractures are indicated in patients with IBD.
Refugee Children's Participation in the Women, Infants, and Children Supplemental Nutrition (WIC) Program in Massachusetts, 1998-2010
Authors: Smock Laura , Nguyen Thinh , Metallinos-Katsaras Elizabeth , Magge Hema , Cochran Jennifer , Geltman Paul L. 
Published: April 2018

Objectives:
To (1) describe prevalence of growth abnormalities and anemia in refugee children; (2) describe the proportion of age-eligible refugee children enrolled in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and (3) identify risk factors for lack of enrollment in WIC.

Design:
Data were collected from 1731 health screenings for refugee children younger than 5 years in Massachusetts in 1998-2010 and matched to WIC program records. Risk factors for lack of WIC enrollment were analyzed in SAS using multivariate logistic regression.

Setting:
Massachusetts.

Participants:
Refugee children under age 5 years.

Main Outcome Measures:
(1) prevalence of growth abnormalities and anemia in refugee children, (2) proportion of age-eligible refugee children enrolled in WIC, and (3) association of risk factors with lack of WIC enrollment.

Results:
Overall, 33% of refugee children under age 5 in Massachusetts had at least 1 growth and nutrition problem, including anemia (31%), stunting (10%), wasting (8%), and low weight for age (10%). WIC enrollment among refugee children under 5 years of age was only 62%, lower than that of all eligible children under 5 in Massachusetts (86%). Risk factors for lack of WIC enrollment among refugee children included age, world region of origin, and arrival cohort.

Conclusions:
Although many refugee children under age 5 experience growth or nutrition problems, one-third of refugee children in Massachusetts were not enrolled in WIC for nutrition assistance, representing a failure of the system. Agencies providing services at the local level should be supported to facilitate enrollment and participation for shared clients.
Evaluating Quality Metrics and Cost After Discharge
Authors: de Mestral Charles , Salata Konrad , Hussain Mohamad A. , Kayssi Ahmed , Al-Omran Mohammed , Roche-Nagle Graham 
Published: April 2018

Background:
Early readmission to hospital after surgery is an omnipresent quality metric across surgical fields. We sought to understand the relative importance of hospital readmission among all health services received after hospital discharge.

Objective:
The aim of this study was to characterize 30-day postdischarge cost and risk of an emergency department (ED) visit, readmission, or death after hospitalization for elective major vascular surgery.

Methods:
This is a population-based retrospective cohort study of patients who underwent elective major vascular surgery - carotid endarterectomy, EVAR, open AAA repair, bypass for lower extremity peripheral arterial disease - in Ontario, Canada, between 2004 and 2015. The outcomes of interest included quality metrics - ED visit, readmission, death - and cost to the Ministry of Health, within 30 days of discharge. Costs after discharge included those attributable to hospital readmission, ED visits, rehab, physician billing, outpatient nursing and allied health care, medications, interventions, and tests. Multivariable regression models characterized the association of pre-discharge characteristics with the above-mentioned postdischarge quality metrics and cost.

Results:
A total of 30,752 patients were identified. Within 30 days of discharge, 2588 (8.4%) patients were readmitted to hospital and 13 patients died (0.04%). Another 4145 (13.5%) patients visited an ED without requiring admission. Across all patients, over half of 30-day postdischarge costs were attributable to outpatient care. Patients at an increased risk of an ED visit, readmission, or death within 30 days of discharge differed from those patients with relatively higher 30-day costs.

Conclusion:
Events occurring outside the hospital setting should be integral to the evaluation of quality of care and cost after hospitalization for major vascular surgery.
Association of Hospital Network Participation With Surgical Outcomes and Medicare Expenditures
Authors: Sheetz Kyle H. , Ryan Andrew M. , Ibrahim Andrew M. , Dimick Justin B. 
Published: April 2018

Objective:
The aim of this study was to evaluate whether hospital network participation is associated with improvement in surgical outcomes and spending compared to control hospitals not participating in a network.

Summary Background Date:
Hospitals face significant financial and organizational pressures to integrate into networks. It remains unclear whether these business arrangements impact clinical quality or healthcare expenditures.

Methods:
We conducted a longitudinal, quasi-experimental study of 1,981,095 national Medicare beneficiaries (2007–2014) undergoing general, vascular, cardiac, or orthopedic surgery at a network (n = 1868) or non-network (n = 2734) hospital. We tested whether joining a network was associated with improvement in the study outcomes after accounting for overall trends toward better outcomes. We used hierarchical multivariable logistical and linear regression to adjust for patient factors, procedural characteristics, type of admission, and hospital factors.

Results:
After accounting for patient factors and existing trends toward better outcomes, there was no association between network participation and surgical outcomes. For example, the rates of serious complications were similar between network [11.4%, 95% confidence interval (CI) 11.1%–11.5%] and non-network hospitals (11.2%; 95% CI 11.0%–11.3%; odds ratio 1.00, 95% CI 0.97–1.03, P = 0.92). There was no association between time-in-network and improvement in rates of serious complications during the 8-year study period. For example, after 7 years of network participation, the rate of serious complications in 2014 was 9.6% (95% CI 8.8%–10.4%) in network hospitals versus 9.2% (95% CI 8.5%–9.9%, P = 0.11) in non-network hospitals.

Conclusions:
Hospital network participation was not associated with improvements in patient outcomes or lower episode payments among Medicare beneficiaries undergoing inpatient surgery.
Clinical Outcomes of Single-port Surgery for Colon Cancer in Octogenarians
Authors: Tei Mitsuyoshi , Otsuka Masahisa , Suzuki Yozo , Kishi Kentaro , Tanemura Masahiro , Akamatsu Hiroki 
Published: April 2018

Aim:
The aim of this study was to evaluate the clinical outcomes of single-port surgery for colon cancer in octogenarians.

Materials and Methods:
A retrospective cohort study was performed on patients who underwent single-port surgery for colon cancer from 2010 to 2014 at a single institution. Patients were categorized into the following 3 groups according to age: ≤69 years (n=196), 70 to 79 years (n=143), and ≥80 years (n=86). Short-term and long-term outcomes were assessed among 3 groups.

Results:
The rate of overall postoperative complications in the octogenarian group did not differ significantly, compared with the other groups (20.9% in the octogenarians group vs. 14.3% in the ≤69 y group and 15.4% in the 70 to 79 y group, P=0.363). The 3-year relapse-free survival rates were similar among groups (83.9% in the octogenarians group vs. 87.8% in the ≤69 y group and 87.5% in the 70 to 79 y group, P=0.754). The 5-year overall survival rates were 79.8% in the octogenarians group, 89.9% in the ≤69 years group, and 81.7% in the 70 to 79 years group (P=0.063).

Conclusion:
Single-port surgery is safe, feasible, and can provide satisfactory oncological outcomes in octogenarians with colon cancer.