bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality of British and American Nationwide Quality of Care and Patient Safety Benchmarking Programs: Case Neurosurgery
Authors: Reponen Elina , Tuominen Hanna , Korja Miikka 
Published: July 2018

Abstract

BACKGROUND
Multiple nationwide outcome registries are utilized for quality benchmarking between institutions and individual surgeons.

OBJECTIVE
To evaluate whether nationwide quality of care programs in the United Kingdom and United States can measure differences in neurosurgical quality.

METHODS
This prospective observational study comprised 418 consecutive adult patients undergoing elective craniotomy at Helsinki University Hospital between December 7, 2011 and December 31, 2012.We recorded outcome event rates and categorized them according to British Neurosurgical National Audit Programme (NNAP), American National Surgical Quality Improvement Program (NSQIP), and American National Neurosurgery Quality and Outcomes Database (N2QOD) to assess the applicability of these programs for quality benchmarking and estimated sample sizes required for reliable quality comparisons.

RESULTS
The rate of in-hospital major and minor morbidity was 18.7% and 38.0%, respectively, and 30-d mortality rate was 2.4%. The NSQIP criteria identified 96.2% of major but only 38.4% of minor complications. N2QOD performed better, but almost one-fourth (23.2%) of all patients with adverse outcomes, mostly minor, went unnoticed. For NNAP, a sample size of over 4200 patients per surgeon is required to detect a 50.0% increase in mortality rates between surgeons. The sample size required for reliable comparisons between the rates of complications exceeds 600 patients per center per year.

CONCLUSION
The implemented benchmarking programs in the United Kingdom and United States fail to identify a considerable number of complications in a high-volume center. Health care policy makers should be cautious as outcome comparisons between most centers and individual surgeons are questionable if based on the programs.
A Review of the Global Burden, New Diagnostics, and Current Therapeutics for Amebiasis
Authors: Shirley Debbie-Ann T , Farr Laura , Watanabe Koji , Moonah Shannon 
Published: July 2018

AbstractAmebiasis, due to the pathogenic parasite Entamoeba histolytica, is a leading cause of diarrhea globally. Largely an infection of impoverished communities in developing countries, amebiasis has emerged as an important infection among returning travelers, immigrants, and men who have sex with men residing in developed countries. Severe cases can be associated with high case fatality. Polymerase chain reaction–based diagnosis is increasingly available but remains underutilized. Nitroimidazoles are currently recommended for treatment, but new drug development to treat parasitic agents is a high priority. Amebiasis should be considered before corticosteroid therapy to decrease complications. There is no effective vaccine, so prevention focuses on sanitation and access to clean water. Further understanding of parasite biology and pathogenesis will advance future targeted therapeutic and preventative strategies.
Complement Factor H Levels Associate With Plasmodium falciparum Malaria Susceptibility and Severity
Authors: van Beek Anna E , Sarr Isatou , Correa Simon , Nwakanma Davis , Brouwer Mieke C , Wouters Diana , Secka Fatou , Anderson Suzanne T B , Conway David J , Walther Michael , Levin Michael , Kuijpers Taco W , Cunnington Aubrey J 
Published: July 2018

Abstract

Background
Plasmodium falciparum may evade complement-mediated host defense by hijacking complement Factor H (FH), a negative regulator of the alternative complement pathway. Plasma levels of FH vary between individuals and may therefore influence malaria susceptibility and severity.

Methods
We measured convalescent FH plasma levels in 149 Gambian children who had recovered from uncomplicated or severe P. falciparum malaria and in 173 healthy control children. We compared FH plasma levels between children with malaria and healthy controls, and between children with severe (n = 82) and uncomplicated malaria (n = 67). We determined associations between FH plasma levels and laboratory features of severity and used multivariate analyses to examine associations with FH when accounting for other determinants of severity.

Results
FH plasma levels differed significantly between controls, uncomplicated malaria cases, and severe malaria cases (mean [95% confidence interval], 257 [250 to 264], 288 [268 to 309], and 328 [313 to 344] µg/mL, respectively; analysis of variance P &lt; .0001). FH plasma levels correlated with severity biomarkers, including lactate, parasitemia, and parasite density, but did not correlate with levels of PfHRP2, which represent the total body parasite load. Associations with severity and lactate remained significant when adjusting for age and parasite load.

Conclusions
Natural variation in FH plasma levels is associated with malaria susceptibility and severity. A prospective study will be needed to strengthen evidence for causation, but our findings suggest that interfering with FH binding by P. falciparum might be useful for malaria prevention or treatment.
Prevalence and Transmission Dynamics of HIV-1 Transmitted Drug Resistance in a Southeastern Cohort
Authors: Levintow Sara N , Okeke Nwora Lance , Hué Stephane , Mkumba Laura , Virkud Arti , Napravnik Sonia , Sebastian Joseph , Miller William C , Eron Joseph J , Dennis Ann M 
Published: July 2018

Abstract

Background
Transmitted drug resistance (TDR) compromises clinical management and outcomes. Transmitted drug resistance surveillance and identification of growing transmission clusters are needed in the Southeast, the epicenter of the US HIV epidemic. Our study investigated prevalence and transmission dynamics in North Carolina.

Methods
We analyzed surveillance drug resistance mutations (SDRMs) using partial pol sequences from patients presenting to 2 large HIV outpatient clinics from 1997 to 2014. Transmitted drug resistance prevalence was defined as ≥1 SDRMs among antiretroviral therapy (ART)–naïve patients. Binomial regression was used to characterize prevalence by calendar year, drug class, and demographic and clinical factors. We assessed the transmission networks of patients with TDR with maximum likelihood trees and Bayesian methods including background pol sequences (n = 15 246).

Results
Among 1658 patients with pretherapy resistance testing, ≥1 SDRMs was identified in 199 patients, with an aggregate TDR prevalence of 12% (95% confidence interval, 10% to 14%) increasing over time (P = .02). Resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs; 8%) was common, followed by nucleoside reverse transcriptase inhibitors (4%) and protease inhibitors (2%). Factors associated with TDR were being a man reporting sex with men, white race, young age, higher CD4 cell count, and being a member of a transmission cluster. Transmitted drug resistance was identified in 106 clusters ranging from 2 to 26 members. Cluster resistance was primarily NNRTI and dominated by ART-naïve patients or those with unknown ART initiation.

Conclusions
Moderate TDR prevalence persists in North Carolina, predominantly driven by NNRTI resistance. Most TDR cases were identified in transmission clusters, signifying multiple local transmission networks and TDR circulation among ART-naïve persons. Transmitted drug resistance surveillance can detect transmission networks and identify patients for enhanced services to promote early treatment.
Asymmetric expansion of the Fe ejecta in Kepler’s supernova remnant
Authors: Kasuga Tomoaki , Sato Toshiki , Mori Koji , Yamaguchi Hiroya , Bamba Aya 
Published: July 2018

Abstract
The ejecta kinematics of supernova remnants (SNRs) is one of the crucial clues to understanding the explosion mechanism of type Ia supernovae (SNe). In particular, the kinematic asymmetry of iron-peak elements provides the key to understanding the physical processes taking place in the core of the exploding white dwarfs (WDs), although it has been poorly understood by observations. In this paper, we show for the first time the asymmetric expansion structure in the line-of-sight direction of Fe ejecta in Kepler’s SNR revealed by spectral and imaging analysis using the Chandra archival data. We found that the Kα line centroid energy and line width is relatively lower (&lt;6.4 keV) and narrower (∼80 eV) around the center of the remnant, which implies that the majority of the Fe ejecta in the central region is redshifted. At the outer regions, we identify bright blueshifted structures as have been ejected as high-velocity dense clumps. Taking into account the broad population of the Fe charge states, we estimate the redshifted velocity of ∼2000 km s−1 and the blueshifted velocity of ∼3000 km s−1 for each velocity structure. We also present the possibility that a portion of the Fe ejecta near the center are interacting with the dense circumstellar medium (CSM) on the near side of the remnant. For the origin of the asymmetric motion of the Fe ejecta, we suggest three scenarios; (1) the asymmetric distribution of the CSM, (2) the “shadow” in Fe cast by the companion star, and (3) the asymmetric explosion.
Propofol-based Total Intravenous Anesthesia Is Associated with Better Survival Than Desflurane Anesthesia in Colon Cancer Surgery
Authors: Wu Zhi-Fu , Lee Meei-Shyuan , Wong Chih-Shung , Lu Chueng-He , Huang Yuan-Shiou , Lin Kuen-Tze , Lou Yu-Sheng , Lin Chin , Chang Yue-Cune , Lai Hou-Chuan 
Published: July 2018

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Previous research has shown different effects of anesthetics on cancer cell growth. Here, the authors investigated the association between type of anesthetic and patient survival after elective colon cancer surgery.

Methods
A retrospective cohort study included patients who received elective colon cancer surgery between January 2005 and December 2014. Patients were grouped according to anesthesia received: propofol or desflurane. After exclusion of those who received combined propofol anesthesia with inhalation anesthesia or epidural anesthesia, survival curves were constructed from the date of surgery to death. After propensity matching, univariable and multivariable Cox regression models were used to compare hazard ratios for death. Subgroup analyses were performed for tumor–node–metastasis staging and postoperative metastasis.

Results
A total of 706 patients (307 deaths, 43.5%) with desflurane anesthesia and 657 (88 deaths, 13.4%) with propofol anesthesia were eligible for analysis. After propensity matching, 579 patients remained in each group (189 deaths, 32.6%, in the desflurane group vs. 87, 15.0%, in the propofol group). In the matched analyses, the propofol-treated group had a better survival, irrespective of lower tumor–node–metastasis stage (hazard ratio, 0.22; 95% CI, 0.11 to 0.42; P < 0.001) or higher tumor–node–metastasis stage (hazard ratio, 0.42; 95% CI, 0.32 to 0.55; P < 0.001) and presence of metastases (hazard ratio, 0.67; 95% CI, 0.51 to 0.86; P = 0.002) or absence of metastases (hazard ratio, 0.08; 95% CI, 0.01 to 0.62; P = 0.016). Simple propensity score adjustment produced similar findings.

Conclusions
Propofol anesthesia for colon cancer surgery is associated with better survival irrespective of tumor–node–metastasis stage.
Use of Dipeptidyl Peptidase-4 Inhibitors and New-onset Rheumatoid Arthritis in Patients with Type 2 Diabetes
Authors: Douros Antonios , Abrahami Devin , Yin Hui , Yu Oriana Hoi Yun , Renoux Christel , Hudson Marie , Azoulay Laurent 
Published: July 2018

Background:
Case reports have suggested a link between dipeptidyl peptidase-4 (DPP-4) inhibitors, antidiabetic drugs used as second- to third-line treatments, and incidence of rheumatoid arthritis. Because the DPP-4 enzyme is involved in several immunologic processes and possibly in the pathophysiology of rheumatoid arthritis, further research is warranted. This population-based study aimed to determine whether use of DPP-4 inhibitors is associated with incidence of rheumatoid arthritis.

Methods:
Using the United Kingdom Clinical Practice Research Datalink, we conducted a cohort study among 144,603 patients with type 2 diabetes initiating antidiabetic drugs between 2007 and 2016. We estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for incident rheumatoid arthritis using time-dependent Cox proportional hazards models, comparing use of DPP-4 inhibitors with use of other antidiabetic drugs. We imposed a 6-month exposure lag period for latency and diagnostic delays. Secondary analyses included assessment of the duration–response relation and comparison with other second-line antidiabetic drugs, among others.

Results:
During 567,169 person-years of follow-up, 464 patients were newly diagnosed with rheumatoid arthritis (crude incidence rate: 82 per 100,000/year). Compared with use of other antidiabetic drugs, use of DPP-4 inhibitors was not associated with an increased risk of rheumatoid arthritis (82 vs. 79 per 100,000/year; HR = 1.0; 95% CI = 0.8, 1.3), with no evidence of duration–response relation. The results did not change after using second-line antidiabetic drugs as the comparator group.

Conclusions:
In this large population-based study, use of DPP-4 inhibitors was not associated with an increased risk of incident rheumatoid arthritis.
DISAPPEARING CHOROIDAL MELANOMA ON OPTOS: THE NOSE ARTIFACT
Authors: Onishi Spencer M. , Crabtree Gordon S. , Marks Steven J. , Wilson Thomas , Shields Carol L. 
Published: July 2018

Purpose:
To illustrate a potentially concerning artifact on Optos wide-angle imaging.

Methods:
Case report.

Results:
A healthy 11-year-old girl, with no medical history, was found to have a lightly pigmented superotemporal choroidal tumor, suspicious for melanoma, which was detected on Optos wide-angle imaging by her optometrist. On referral to the retinal specialist, the mass was not visible on funduscopy. B-scan ultrasonography depicted flat retina and no visible mass. Review of the Optos image revealed that the pseudomelanoma represented the patient's nose.

Conclusion:
Optos wide-angle imaging provides broad retinal imaging; however, artifacts from patient positioning can lead to the nose artifact.
Validation of the Korean Version of the MacNew Heart Disease Health-Related Quality of Life Questionnaire
Authors: KANG Kyoungrim , GHOLIZADEH Leila , INGLIS Sally C. , HAN Hae-Ra 
Published: July 2018

ABSTRACT

Background:
Health-related quality of life (HRQoL) is an important concept in patients with cardiac diseases, including myocardial infarction (MI). Disease-specific tools offer valuable insights into the impact of a disease on various aspects of a patient’s life.

Purpose:
The aim of this study was to assess the psychometric properties of the Korean version of the MacNew Heart Disease HRQoL Questionnaire (Korean MacNew).

Methods:
One hundred thirty-six patients who had experienced MI about 3 months earlier were recruited from two tertiary hospitalsin South Korea. The internal consistency and various types of validity of the Korean MacNew were assessed. Exploratory factor analysis with varimax rotation was performed to identify a better structure for this instrument.

Results:
The internal consistency of the Korean MacNew was established with Cronbach’s alpha coefficients ranging from .88 to .93. Face validity and construct validity (both discriminant and concurrent) of the Korean MacNew were established. Strong positive correlations were found between the total Korean MacNew and the single-item global QoL scale (r = .73, p < .001). As expected, the total Korean MacNew also had strong negative correlations with the Depression Anxiety and Stress Scale 21 (r = −.81, p < .001) and the single-item fatigue scale (r = −.51, p < .001). The outcomes of exploratory factor analysis showed a better result with the five-factor structure in the Korean MacNew.

Conclusions:
The Korean MacNew showed consistently acceptable psychometric properties of reliability and validity in patients with MI. Therefore, this instrument may be recommended for assessing the HRQoL of patients with MI in Korea. However, caution should be taken in using the subscale scores.
Liver Biopsy Can Be Safely Performed in Pediatric Acute Liver Failure to Aid in Diagnosis and Management
Authors: Chapin Catherine A. , Mohammad Saeed , Bass Lee M. , Taylor Sarah A. , Kelly Susan , Alonso Estella M. 
Published: July 2018

ABSTRACTObjectives:Liver biopsy can be a valuable tool to help determine the etiology of pediatric acute liver failure (PALF), but is often not performed due to safety concerns. The primary aim was to describe the incidence of major complications after liver biopsy performed in the setting of PALF.Methods:Medical records from 2006 to 2016 were reviewed. Patients age 0 to 17 years, who met criteria for PALF, and had a liver biopsy performed while their international normalized ratio (INR) was ≥1.5 were included.Results:A total of 26 cases of liver biopsy in the setting of PALF were identified. The majority (n = 22, 85%) of patients had primary liver disease. Most biopsies (n = 17, 65%) were performed by the transjugular route, with 5 (19%) performed percutaneously under ultrasound guidance and 4 (15%) during a surgical procedure. Median INR before biopsy was 2.1 (IQR = 1.73–2.9). Blood products were given before or during the procedure in 23 (88%) cases. One patient (3.8%) had a major complication of biopsy‐associated bleeding requiring a blood transfusion. An additional 3 patients had a hemoglobin decrease of 2.1 to 2.9 g/dL post‐biopsy that was attributed to the procedure but no interventions were necessary. Biopsy results contributed to establishing a diagnosis in 62% (n = 16) of cases, and influenced treatment decisions in 9 of those cases.Conclusions:Liver biopsy is safe in the majority of patients with PALF and associated with infrequent major complications. Clinicians should consider performing liver biopsy in this setting, especially when the transjugular approach is feasible, since findings may guide diagnosis and therapy.
Handover of Patients From Prehospital Emergency Services to Emergency Departments
Authors: Sanjuan-Quiles Ángela , Hernández-Ramón María del Pilar , Juliá-Sanchis Rocío , García-Aracil Noelia , Castejón-de la Encina Mª Elena , Perpiñá-Galvañ Juana 
Published: July 2018

Background:During the transfer of patients, both ambulance and hospital emergency service professionals need to exchange necessary, precise, and complete information for an effective handover. Some factors threaten a quality handover such as excessive caseload, patients with multiple comorbidities, limited past medical history, and frequent interruptions.Purpose:To explore the viewpoint of nurses on their experience of patient handovers, describing the essential aspects of the process and areas for improvement, and establishing standardized elements for an effective handover.Methods:A qualitative research method was used.Results:Nurses identified the need to standardize the patient transfer process by a written record to support the verbal handover and to transmit patient information adequately, in a timely manner, and in a space free of interruptions, in order to increase patient safety.Conclusions:An organized method does not exist. The quality of handovers could be enhanced by improvements in communication and standardizing the process.
Pilsicainide Poisoning
Authors: Fukasawa Maki , Ninomiya Kenji , Kawakami Yuka , Fuke Chiaki , Miyazaki Tetsuji 
Published: July 2018

Abstract
We describe an autopsy case of fatal poisoning due to accidental overdose of pilsicainide, which is a Vaughan Williams class IC antiarrhythmic drug (a pure sodium channel blocker). A man in his 50s was found dead in his home at approximately noon. He had ischemic heart disease and insomnia, and had previously demonstrated improper prescription drug adherence. The autopsy revealed old coronary artery bypass grafting and mild fibrosis of myocardium, but no acute myocardial infarction was found in microscopic examination. Toxicological analysis also identified a high blood concentration of pilsicainide (femoral vein blood, 14.9 μg/mL), more than 15 times higher than reported therapeutic levels. The blood concentrations of other drugs were at therapeutic levels, and no alcohol was detected. We concluded that the cause of death was pilsicainide poisoning, based on the results of the autopsy and the toxicological examination. This is the first autopsy report of fatal poisoning due to pilsicainide as a single agent.
Integrating Public Health and Health Care Strategies to Address the Opioid Epidemic: The Oregon Health Authority's Opioid Initiative
Authors: Hedberg Katrina , Bui Lisa T. , Livingston Catherine , Shields Lisa M. , Van Otterloo Joshua 
Published: July 2018

Context:
Oregon is experiencing an opioid overdose epidemic, similar to the United States as a whole. To address this crisis, the Oregon Health Authority (OHA) implemented a strategic Opioid Initiative, convening stakeholders and integrating public health and health care system activities across sectors. Recent data indicate progress: from 2015 to 2016, Oregon had the sharpest decline in prescription opioid overdose deaths of any state.

Program:
The Opioid Initiative, launched in 2015, focuses on integrating efforts to improve patient care and safety, and population health, by increasing access to nonopioid pain treatment, supporting medication-assisted treatment and naloxone access for people taking opioids, decreasing opioid prescribing, and using data to inform policies and interventions.

Implementation:
Four OHA projects highlight the integration: (1) a Medicaid Coordinated Care Organization Performance Improvement Project focused on decreasing risky opioid prescribing; (2) Health Evidence Review Commission guidelines that set coverage standards for opioid and nonopioid back pain treatments for Medicaid recipients; (3) statewide opioid prescribing guidelines; and (4) an opioid data dashboard. Each project involves a partnership between governmental public health, public and private health care systems, and external stakeholders.

Progress:
From 2015 to 2017, the number of Oregonians on 90 or more Morphine Equivalent Doses (MEDs) decreased by 37%, from 11.1 per 1000 residents quarterly to 7.0 per 1000 residents quarterly. Prescription opioid overdose deaths decreased 20% from 4.5 per 100 000 in 2015 to 3.6 per 100 000 in 2016. Within the Medicaid population, the percentage of clients on 120 or more MEDs for 30 consecutive days decreased 27%, from 2.3% in December 2015 to 1.6% in September 2017.

Discussion:
Oregon's integrated approach to address the opioid crisis spans public health and health care systems, engages key stakeholders, and uses data and evidence to inform policies. The progress to date is promising and may assist other states seeking to identify effective strategies to decrease opioid prescribing, misuse, and overdose.