bluuebunny/crossref_metadata_2025_split huggingface dataset:
Promoting Shared Decision-Making Behaviors During Inpatient Rounds: A Multimodal Educational Intervention
Authors: Harman Stephanie M. , Blankenburg Rebecca , Satterfield Jason M. , Monash Brad , Rennke Stephanie , Yuan Patrick , Sakai Debbie S. , Huynh Eric , Chua Ian , Hilton Joan F. 
Published: March 2019

Purpose
To estimate the effectiveness of a multimodal educational intervention to increase use of shared decision-making (SDM) behaviors by inpatient pediatric and internal medicine hospitalists and trainees at teaching hospitals at Stanford University and the University of California, San Francisco.

Method
The 8-week Patient Engagement Project Study intervention, delivered at four services between November 2014 and January 2015, included workshops, campaign messaging, report cards, and coaching. For 12-week pre- and postintervention periods, clinician peers used the nine-point Rochester Participatory Decision-Making Scale (RPAD) to evaluate rounding teams’ SDM behaviors with patients during ward rounds. Eligible teams included a hospitalist and at least one trainee (resident, intern, medical student), in addition to nonphysicians. Random-effects models were used to estimate intervention effects based on RPAD scores that sum points on nine SDM behaviors per patient encounter.

Results
In total, 527 patient encounters were scored during 175 rounds led by 49 hospitalists. Patient and team characteristics were similar across pre- and postintervention periods. Improvement was observed on all nine SDM behaviors. Adjusted for the hierarchical study design and covariates, the mean RPAD score improvement was 1.68 points (95% CI, 1.33–2.03; P < .001; Cohen d = 0.82), with intervention effects ranging from 0.7 to 2.5 points per service. Improvements were associated with longer patient encounters and a higher percentage of trainees per team.

Conclusions
The intervention increased behaviors supporting SDM during ward rounds on four independent services. The findings recommend use of clinician-focused interventions to promote SDM adoption in the inpatient setting.
Cannabis Use Based on Urine Drug Screens in Pregnancy and Its Association With Infant Birth Weight
Authors: Howard D. Scott , Dhanraj David N. , Devaiah C. Ganga , Lambers Donna S. 
Published: March 2019

Objectives:
This study aims to clarify any association between infant birth weight and cannabis use in pregnancy based on urine drug screens.

Methods:
A retrospective medical record review of singleton births from August 2013 through December 2014 with available urine drug screens (UDS) at initiation of prenatal care and delivery was conducted at a large tertiary academic referral center. Patients who used drugs other than cannabis were excluded.

Results:
The prevalence of cannabis use in pregnancies not complicated by use of other drugs as evidenced by tetrahydrocannabinol in the urine of 2173 patients was 22.6%. Infants born to mothers who tested positive for only tetrahydrocannabinol in urine at both presentation for prenatal care and delivery were of lower median birth weight compared with those who tested negative [2925 g (IQR 2522–3265) vs 3235 g (IQR 2900–3591), P = <0.001]. There was no clinically relevant difference in gestational age at birth [39.0 weeks (IQR 37.1–40.0) vs 39.3 weeks (IQR 38.3–40.0), P = 0.012] between those positive for tetrahydrocannabinol (THC) and those who tested negative. Concomitant tobacco use during pregnancy was not noted to impact infant birth weight using the analysis of covariance. Higher perinatal mortality was observed among those who used cannabis with an adjusted odds ratio of 4.2 (95% CI, 1.53–11.49).

Conclusions:
Cannabis use is negatively correlated with fetal birth weight (up to 450 g less) in patients who tested positive for THC when compared with those who did not as documented in the urine drug screens. On the basis of these findings, additional patient education and cessation interventions should be explored with regard to cannabis use in pregnancy.
The Impact of Female Chronic Pelvic Pain Questionnaire (IF-CPPQ)
Authors: Al-Abbadey Miznah , Liossi Christina , Graham Cynthia A. 
Published: March 2019

Objectives:
The aim of this study was to assess the validity, reliability, and factor structure of the Impact of Female Chronic Pelvic Pain Questionnaire (IF-CPPQ).

Materials and Methods:
This was a cross-sectional questionnaire study that was administered online. To be eligible to participate, women had to have experienced chronic pelvic pain for a minimum of 6 months and be at least 18 years of age. A total of 969 women (mean age: 35.4 y, SD=12.0) took part. The main outcome measure was the IF-CPPQ. Additional validated measures that assessed related constructs were also administered. Principal axis factor analysis was used to assess the factor structure of the IF-CPPQ. Internal consistency was assessed using Cronbach α. Convergent and discriminant validity was assessed using Pearson correlations between factor scores on the IF-CPPQ and measures of related constructs. The consistency and model fit of the resulting factor structure was assessed using confirmatory factor analysis.

Results:
The final 26-item questionnaire comprised 5 factors (Psychological Impact, Sexual Impact, Relationship Impact, Occupational Impact, and Emotional Impact). Findings suggested good convergent and discriminant validity and internal consistency.

Discussion:
The findings indicate that the IF-CPPQ is a reliable and valid measure of the impact of chronic pelvic pain on women. While the IF-CPPQ has the potential for multiple uses within research and clinical practice, further research is needed to determine the questionnaire’s ability to detect clinically meaningful changes with treatment.
Impact of Sickle Cell Anemia on Inpatient Morbidity After Spinal Fusion
Authors: Lu Young , Lin Charles C. , Doermann Alex , Patel Nilay , Bhatia Nitin N. , Kiester Phillip Douglas , Rosen Charles D. , Lee Yu-Po 
Published: March 2019

Study Design:
A retrospective study.

Objective:
To determine the impact of sickle cell anemia on perioperative outcomes and resource utilization in elective spinal fusion surgery.

Summary of Background Data:
Sickle cell anemia has been identified as an important surgical risk factor in otolaryngology, cardiothoracic surgery, general surgery, and total joint arthroplasty. However, the impact of sickle cell anemia on elective spine surgery is unknown.

Methods:
Hospitalizations for elective spinal fusion surgery between the years of 2001–2014 from the US National Inpatient Sample were identified using ICD-9-CM codes and patients were grouped into those with and without sickle cell anemia. The main outcome measures were in-hospital neurological, respiratory, cardiac, gastrointestinal, renal and urinary, pulmonary embolism, and wound-related complications and mortality. Length of stay and inpatient costs were also collected. Multivariable logistic regressions were conducted to compare the in-hospital outcomes of patients undergoing elective spinal fusion with or without sickle cell anemia.

Results:
From a total of 4,542,719 patients undergoing elective spinal fusions from 2001 to 2014, 456 sickle cell disease patients were identified. Sickle cell anemia is a significant independent predictor for pulmonary embolism [odds ratio (OR)=7.37; confidence interval (CI), 4.27–12.71; P<0.001], respiratory complications (OR=2.36; CI, 1.63–3.42; P<0.001), wound complications (OR=3.84; CI, 2.72–5.44; P<0.001), and overall inpatient complications (OR=2.58; CI, 2.05–3.25; P<0.001). Sickle cell anemia patients also have significantly longer length of stay (7.0 vs. 3.8 d; P<0.001) and higher inpatient costs ($20,794 vs. $17,608 P<0.05).

Conclusions:
Sickle cell anemia is associated with increased risk of perioperative complications and greater health care resource utilization. Sickle cell anemia patients undergoing spinal fusion surgeries should be counseled on these increased risks. Moreover, current strategies for perioperative management of sickle cell anemia patients undergoing spinal fusion surgery need to be improved.
Patient and Family Engagement During Treatment Decisions in an ICU: A Discourse Analysis of the Electronic Health Record*
Authors: Kruser Jacqueline M. , Benjamin Brian T. , Gordon Elisa J. , Michelson Kelly N. , Wunderink Richard G. , Holl Jane L. , Schwarze Margaret L. 
Published: March 2019

Objectives:
Shared decision-making is recommended for critically ill adults who face major, preference-sensitive treatment decisions. Yet, little is known about when and how patients and families are engaged in treatment decision-making over the longitudinal course of a critical illness. We sought to characterize patterns of treatment decision-making by evaluating clinician discourse in the electronic health record of critically ill adults who develop chronic critical illness or die in an ICU.

Design, Setting, and Patients:
We conducted qualitative content analysis of the electronic health record of 52 adult patients, admitted to a medical ICU in a tertiary medical center from January 1, 2016, to December 31, 2016. We included patients who met a consensus definition of chronic critical illness (26 patients) and a matched sample who died or transitioned to hospice care in the ICU before developing chronic critical illness (26 patients).

Interventions:
None.

Measurements and Main Results:
Characterization of clinician decision-making discourse documented during the course of an ICU stay. Clinician decision-making discourse in the electronic health record followed a single, consistent pattern across both groups. Initial decisions about admission to the ICU focused on specific interventions that can only be provided in an ICU environment (intervention-focused decisions). Following admission, the documented rationale for additional treatments was guided by physiologic abnormalities (physiology-centered decisions). Clinician discourse transitioned to documented engagement of patients and families in decision-making when treatments failed to achieve specified physiologic goals. The phrase “goals of care” is common in the electronic health record and is used to indicate poor prognosis, to describe conflict with families, and to provide rationale for treatment limitations.

Conclusions:
Clinician discourse in the electronic health record reveals that patient physiology strongly guides treatment decision-making throughout the longitudinal course of critical illness. Documentation of patient and family engagement in treatment decision-making is limited until available medical treatments fail to achieve physiologic goals.
Necessity of Genetic Evaluation of Metachronous Metastases of Colorectal Cancer: Quantitative Analysis of Genetic Discordance Between Metachronous Metastases and Radically Resected Primary Colorectal Cancers Using Next-Generation Sequencing
Authors: Lee Kyung Ha , Kim Jin Soo , Kim Ji Yeon 
Published: March 2019

BACKGROUND:
Mutation analyses provide the basis of selecting an appropriate target agent for the treatment of metastatic colorectal cancer. However, metachronous metastases developed after the treatment of primary tumor could create significant opportunities for different genetic profiles relative to the primary tumors.

OBJECTIVE:
The purpose of this study was to assess the necessity of genetic evaluation of metachronous metastases; we performed a quantitative analysis of genetic discordance between metachronous metastases and radically resected primary colorectal cancers using next-generation sequencing.

DESIGN:
This was a retrospective study.

SETTINGS:
Patients from a single-institution tertiary care center were studied.

PATIENTS:
We enrolled 33 patients who underwent resection of metachronous metastases between January 2014 and December 2016, ≥6 months after radical resection of primary colorectal cancer and whose tissue was available for analysis.

MAIN OUTCOME MEASURES:
Tumor samples were analyzed by next-generation sequencing. The mutant allele frequency was analyzed to evaluate the proportion of mutations in the tumor tissue.

RESULTS:
The mutant allele frequency of KRAS in metachronous metastases was higher in 6 cases (mean difference =% 25.5% (range, 9.5%–58.0%)) and lower in 3 cases (mean difference = 9.3% (range, 8.0–10.0%) compared with each of their primary tumors. In 1 case, the KRAS mutant-type (mutant allele frequency = 22.6%) metachronous metastasis had developed from the KRAS wild-type primary tumor.

LIMITATIONS:
Tumor sample may not represent perfectly the whole tumor of the patient because of heterogeneity.

CONCLUSIONS:
Genetic discordance can exist between metachronous metastases and radically resected primary colorectal cancers. For appropriate target therapy, genetic evaluation of metachronous metastases needs to be considered when possible. See Video Abstract at http://links.lww.com/DCR/A932.
A Systematic Review of Patient-Reported Outcomes for Cosmetic Indications of Botulinum Toxin Treatment
Authors: Wang Jenny , Rieder Evan A. 
Published: March 2019

BACKGROUND
Botulinum toxin (BTX) injection is the most popular cosmetic procedure in the United States. Although facial rejuvenation is considered cosmetic, physical appearance has meaningful impact on quality of life (QOL), best measured by patient-reported outcomes (PROs). Patient-reported outcomes are now often required for Food and Drug Administration approval of new pharmaceuticals.

OBJECTIVE
This review summarizes the PRO instruments and outcomes in evaluating patient QOL after aesthetic BTX administration.

METHODS
PubMed, MEDLINE, Embase, Cochrane Library, CINAHL Plus, and PsycINFO databases were searched for prospective studies using PRO instruments to directly evaluate the success of cosmetic BTX intervention.

RESULTS
Five psychometrically validated, facial rhytid-specific PRO tools are currently used in clinical research. Most studies addressing PROs after cosmetic BTX treatment use 1-item Likert scales evaluating overall satisfaction. BTX treatment generally resulted in improved satisfaction and QOL metrics, such as perception of youthfulness, attractiveness, restedness, affect, mood, and self-confidence. Combination treatments, whether of multiple facial areas or with multiple treatment modalities, may improve PROs even further.

CONCLUSION
Validated, specific PRO instruments can be used to better understand patient expectations in regards to cosmetic treatment, thus helping aesthetic dermatologists maximize patient satisfaction and retention.
Ten-Year and Beyond Follow-up After Treatment With Highly Purified Liquid-Injectable Silicone for HIV-Associated Facial Lipoatrophy: A Report of 164 Patients
Authors: Jones Derek H. , Carruthers Alastair , Brody Harold J. , Black Jeanette M. , Humphrey Shannon , Carruthers Jean , Wesley Naissan O. , Minokadeh Ardalan 
Published: March 2019

BACKGROUND
Highly purified liquid-injectable silicone (LIS) has been established as a permanent agent for off-label correction of HIV-associated facial lipoatrophy (HIV-FLA). However, controversy exists about long-term safety.

OBJECTIVE
To establish the safety and efficacy at 10 years or greater of LIS for HIV-FLA.

METHODS
Patients from 3 practices with 10-year or greater in-person office follow-up were analyzed to determine the number of LIS treatments and total volume required to achieve optimal correction. The nature of any treated adverse events was noted.

RESULTS
One hundred sixty-four patients had 10-year or greater in-office follow-up. All subjects maintained long-term correction with an average of 9 treatments, average of 1.56 mL per treatment, and an average total of 14.1 mL. Two patients had severe adverse events manifesting as temporary facial edema. Four patients experienced mild-to-moderate excess fibroplasia presenting as perceived overcorrection, and 6 patients had nondisfiguring subcutaneous firmness. All adverse events were successfully treatable, mostly with intralesional 5-fluorouracil and triamcinolone.

CONCLUSION
Liquid-injectable silicone is an effective long-term treatment option for HIV-FLA. When injected in small quantities with the microdroplet serial puncture technique at monthly or greater intervals, optimal correction appears durable for more than 10 years. Adverse events consisted mostly of excess fibroplasia and were treatable.
Efficacy and Safety of a Sublative Bipolar Fractional Radiofrequency System Combined With Topical Tretinoin in Treating Striae Gravidarum: A Randomized Pilot Study
Authors: Tian Tian , Luo Yao-Jia , Wang Hua , Chen Hong-Duo , Li Yuan-Hong 
Published: March 2019

BACKGROUND
Striae gravidarum is a common skin condition resulting after pregnancy, caused by fibroblast dysfunction. Although not considered a disease, it may be considered cosmetically unpleasant to sufferers and remains as a therapeutic challenge to date.

OBJECTIVE
To evaluate the efficacy and safety of a sublative bipolar fractional radiofrequency (FRF) system, associated with 0.1% topical tretinoin, in treating striae gravidarum.

MATERIALS AND METHODS
Eighteen Chinese women with striae gravidarum on the abdomen were enrolled in the study. The target area of each patient was divided into 4 sites randomly: control, tretinoin, FRF, and tretinoin and FRF. Fractional RF was used 3 times, with 3-month intervals. Changes to striae gravidarum were evaluated through subjective scaling and objective measures, using both high-frequency ultrasound and histological study.

RESULTS
Both subjective assessment and skin thickness differences demonstrated significant improvement in the combination site (p < .001). Average optical density and density percentage of neocollagen and elastic fibers were also markedly increased in the combination site (p < .05). The adverse effects of FRF were limited to mild pain and transient erythema, edema, and microcrusts.

CONCLUSION
The combined therapy of FRF and topical tretinoin may be a potential method in treating striae gravidarum, with satisfactory efficacy and limited side effects.
How does stress, depression and anxiety affect patients undergoing treatment?
Authors: Boivin Jacky 
Published: March 2019

Purpose of review
To review latest findings about the impact of fertility care on emotional distress and effect of distress on treatment outcome.

Recent findings
Treatment failure and long agonist protocols are associated with increased emotional distress during treatment. Screening tools can be used to identify men and women at risk of emotional maladjustment at the start of fertility treatment and people unlikely to need emotional support during or after treatment. There are inconclusive results about the association between emotional distress and outcome of fertility treatment. Systematic review of studies evaluating the effect of psychological and educational interventions on anxiety, depression and live birth (or ongoing pregnancy) are uninformative because of clinical heterogeneity and risk of bias.

Summary
ART is emotionally demanding, patients that adapt more poorly can be identified in advance. Fertility staff should follow good practice guidelines to provide patients with support during treatment.
Enhancement of Viable Adipose-Derived Stem Cells in Lipoaspirate by Buffering Tumescent with Sodium Bicarbonate
Authors: Francis Ashish , Wang Wei Z. , Goldman Joshua J. , Fang Xin-Hua , Williams Shelley J. , Baynosa Richard C. 
Published: March 2019

Background:Fat grafting is a growing field within plastic surgery. Adipose-derived stem cells (ASCs) and stromal vascular fracture (SVF) may have a role in fat graft survival. Our group previously demonstrated a detrimental effect on ASC survival by the lidocaine used in tumescent solution. Sodium bicarbonate (SB) buffers the acidity of lidocaine. The purpose of this study was to determine whether SB buffering is a practical method to reduce ASC and SVF apoptosis and necrosis seen with common lidocaine-containing tumescent solution.Methods:Human patients undergoing bilateral liposuction for any indication were included in this study. An internally controlled, split-body design was utilized. Tumescent liposuction on one side of the body was conducted with tumescent containing lidocaine. On the opposite side, liposuction was conducted by adding SB to the tumescent. Tumescent solution and lipoaspirate pH were measured. Lipoaspirate from each side was processed for SVF isolation and ASC culture. The number of viable ASCs was counted and SVF apoptosis/necrosis was examined.Results:The pH of the SB-buffered tumescent was significantly higher than that of the standard tumescent, an effect also seen in the lipoaspirate. Adipose-derived stem cell survival in the SB-buffered lipoaspirate was approximately 53% higher. However, there was no significant difference in SVF apoptosis and necrosis between the groups.Conclusions:The acidic standard tumescent solution commonly used in liposuction diminishes ASC viability from lipoaspirates. Sodium bicarbonate buffering tumescent solution can enhance ASC viability, but does not affect SVF apoptosis and necrosis. We recommend buffering tumescent with SB to potentially improve fat graft take. Our findings advocate for further research investigating mechanisms and optimal harvest techniques that maximize SVF/ASC survival and the clinical effect on overall fat graft viability.
Classification of Subtypes of Apert Syndrome, Based on the Type of Vault Suture Synostosis
Authors: Lu Xiaona , Sawh-Martinez Rajendra , Jorge Forte Antonio , Wu Robin , Cabrejo Raysa , Wilson Alexander , Steinbacher Derek M. , Alperovich Michael , Alonso Nivaldo , Persing John A. 
Published: March 2019

Background:
Apert syndrome patients are different in clinical pathology, including obstructive sleep apnea, cleft palate, and mental deficiency. These functional deficiencies may be due to anatomic deformities, which may be caused by different forms of associated suture fusion. Therefore, a classification system of Apert syndrome based on the type of craniosynostosis pattern might be helpful in determining treatment choices.

Methods:
CT scans of 31 unoperated Apert syndrome and 51 controls were included and subgrouped as: class I. Bilateral coronal synostosis; class II. Pansynostosis; and class III. Perpendicular combination synostosis: a. unilateral coronal and metopic synostosis; b. sagittal with bilateral/unilateral lambdoid synostosis; and c. others.

Results:
Class I is the most common (55%) subtype. The cranial base angulation of class I was normal; however, the cranial base angulation on the cranium side of the skull in class II increased 12.16 degrees (P = 0.006), whereas the facial side cranial base angle of class IIIa decreased 4.31 degrees (P = 0.035) over time. The external cranial base linear measurements of class I showed more evident reduction in anterior craniofacial structures than posterior, whereas other subtypes developed more severe shortening in the posterior aspects.

Conclusions:
Bicoronal synostosis is the most common subtype of Apert syndrome with the normalized cranial base angulation. Combined pansynostosis patients have flatter cranial base, whereas the combined unilateral coronal synostosis have a kyphotic cranial base. Class I has more significant nasopharyngeal airway compromise in a vertical direction, whereas classes II and III have more limited oropharyngeal space.