bluuebunny/crossref_metadata_2025_split huggingface dataset:
A practical self-made device in parathyroid autotransplantation for patients with secondary hyperparathyroidism
Authors: Du Lei , Zhang Xiwei , Yan Liang , Zhang Hao , Tang Xuefeng , Kong Xiancheng , Liu Gang , Huang Jianping 
Published: September 2018

Objective Secondary hyperparathyroidism (sHPT) is one of the most serious complications in patients on long-term hemodialysis. These patients may suffer from metabolic bone diseases, severe atherosclerosis, and undesirable cardiovascular events. Endoscopic parathyroidectomy with autotransplantation is a treatment option for those who do not respond to clinical management. This study aimed to investigate practical use of a self-made device in parathyroid autotransplantation for patients with sHPT, and to compare this device with ordinary surgical scissors. Methods A total of 15 patients with sHPT were treated with endoscopic parathyroidectomy and autotransplantation. Pieces of parathyroid tissue were squeezed in our self-made device and injected into the brachioradialis muscle. Sixteen patients with sHPT who were treated with traditional parathyroid transplantation served as controls. Serum levels of parathyroid hormone, alkaline phosphatase, calcium, phosphorus and intact parathyroid hormone were measured before and after surgery. Results Preoperative symptoms were alleviated, and serum parathyroid hormone and alkaline phosphatase levels, hyperphosphatemia, and hypercalcemia were improved or normalized in all of the patients in both groups. Pathological examinations showed that parathyroid cells remained active. Conclusion Application of our squeezing device is an economic, effective, and safe method in endoscopic parathyroidectomy and autotransplantation for patients with sHPT.
Enhanced recovery after surgery protocol for prostate cancer patients undergoing laparoscopic radical prostatectomy
Authors: Lin Chunhua , Wan Fengchun , Lu Youyi , Li Guojun , Yu Luxin , Wang Meng 
Published: September 2018

Objective To determine the value of an enhanced recovery after surgery (ERAS) protocol for prostate cancer patients undergoing laparoscopic radical prostatectomy (LRP). Methods We conducted a retrospective cohort study using clinical data for 288 patients who underwent LRP in our hospital from June 2010 to December 2016. A total of 124 patients underwent ERAS (ERAS group) and the remaining 164 patients were allocated to the control group. ERAS comprised prehabilitation exercise, carbohydrate fluid loading, targeted intraoperative fluid resuscitation and keeping the body warm, avoiding drain use, early mobilization, and early postoperative drinking and eating. Results The times from LRP to first water intake, first ambulation, first anal exhaust, first defecation, pelvic drainage-tube removal, and length of hospital stay (LOS) were all significantly shorter, and hospitalization costs and the incidence of postoperative complications were significantly lower in the ERAS group compared with the control group. No deaths or reoperations occurred in either group, and there were no readmissions in the ERAS group, within 90 days after surgery. Conclusion ERAS protocols may effectively accelerate patient rehabilitation and reduce LOS and hospitalization costs in patients undergoing LRP.
Enhancing Clinical Learning Through an Innovative Instructor Application for ECMO Patient Simulators
Authors: Alsalemi Abdullah , Disi Mohammed Al , Alhomsi Yahya , Bensaali Fayçal , Amira Abbes , Alinier Guillaume 
Published: September 2018

Background.Simulation-based learning (SBL) employs the synergy between technology and people to immerse learners in highly-realistic situations in order to achieve quality clinical education. Due to the ever-increasing popularity of extracorporeal membrane oxygenation (ECMO) SBL, there is a pressing need for a proper technological infrastructure that enables high-fidelity simulation to better train ECMO specialists to deal with related emergencies. In this article, we tackle the control aspect of the infrastructure by presenting and evaluating an innovative cloud-based instructor, simulator controller, and simulation operations specialist application that enables real-time remote control of full-scale immersive ECMO simulation experiences for ECMO specialists as well as creating custom simulation scenarios for standardized training of individual healthcare professionals or clinical teams. Aim. This article evaluates the intuitiveness, responsiveness, and convenience of the ECMO instructor application as a viable ECMO simulator control interface. Method. A questionnaire-based usability study was conducted following institutional ethical approval. Nineteen ECMO practitioners were given a live demonstration of the instructor application in the context of an ECMO simulator demonstration during which they also had the opportunity to interact with it. Participants then filled in a questionnaire to evaluate the ECMO instructor application as per intuitiveness, responsiveness, and convenience. Results. The collected feedback data confirmed that the presented application has an intuitive, responsive, and convenient ECMO simulator control interface. Conclusion. The present study provided evidence signifying that the ECMO instructor application is a viable ECMO simulator control interface. Next steps will comprise a pilot study evaluating the educational efficacy of the instructor application in the clinical context with further technical enhancements as per participants’ feedback.
Stability and visual outcomes yielded by three intraocular trifocal lenses with same optical zone design but differing material or toricity
Authors: Poyales Francisco , Garzón Nuria , Pizarro Daniel , Cobreces Santiago , Hernández Adolfo 
Published: September 2018

Purpose:To compare rotational stability, centration and visual outcomes provided by three trifocal lens models that have the same optical zone design but different material, composition, and/or toricity.Methods:The study included 78 patients with symmetric bilateral intraocular lens implantation. The lenses under evaluation were trifocal intraocular lenses made of hydrophilic acrylic material: a spherical lens 26% hydrophilic acrylic (POD FineVision), a similar lens but having a toric design (POD Toric FineVision), and a trifocal lens 25% hydrophilic acrylic material (FineVision/MicroF). Moreover, the lenses share the same optical zone design. The lenses’ rotational stability and centration were measured by means of the PIOLET software, which relies on recording and image processing techniques to determine lens rotation and centration based on slit-lamp images. We also assessed patients’ visual quality by means of 25, 40, and 80 cm VA tests.Results:The best centration results were achieved with the POD Toric FineVision model, although the differences were not statistically significant. As for lens rotation, it was below 5° in all cases under study. Regarding VA, all subjects attained at least 0.3 logMAR for far distance uncorrected VA, at 80 cm VA was about 0.2 logMAR, at 40 cm it was above 0.15 logMAR, and at 25 cm it was about 0.3 logMAR for both lens types.Conclusion:All three intraocular lens models yield excellent visual results at far, near as well as intermediate distances. The POD FineVision and POD Toric FineVision models, with double C-loop design, yielded the best results centration-wise and rotation-wise. Differences had no clinical relevance.
Decreased Expression of ZWINT is Associated With Poor Prognosis in Patients With HCC After Surgery
Authors: Yang Xiao-Yu , Wu Bin , Ma Sen-Lin , Yin Lei , Wu Meng-Chao , Li Ai-Jun 
Published: September 2018

Background: ZW10 interactor was recently reported to correlate with human cancers. However, the prognostic value of ZW10 interactor in hepatocellular carcinoma was not reported. Methods: The expression level of ZW10 interactor was evaluated by Western blot and immunohistochemistry using tissue microarray. In the present study, we used 5 pairs of hepatocellular carcinoma and peritumoral frozen tissues for Western blot, and 70 paired paraffin-embedded hepatocellular carcinoma and peritumoral tissues as expression pattern cohort (cohort 1), and 280 paraffin-embedded hepatocellular carcinoma tissues were used as prognostic cohort (cohort 2). The integral optic density representing the expression level of ZW10 interactor in each tissue sample, was calculated using Image-Pro Plus. The integral optic density was added to the X-tile software for calculating the outcome-based cut point. Kaplan-Meier and Cox regression were used to evaluate the prognostic values. Results: The expression level ZW10 interactor was decreased in hepatocellular carcinoma tissues in 85.7% (60/70) of the cases compared to the corresponding peritumoral tissues evaluated by immunohistochemistry. Similar result was obtained by Western blot analysis using frozen tissue. Expression of ZW10 interactor was closely correlated with age ( P = .0001) and liver cirrhosis in cohort 1 and tumor node metastasis ( P = .018), tumor size ( P = .005), and vascular invasion ( P = .022) in cohort 2 based on χ2 analyses. Survival analyses indicated that patients with hepatocellular carcinoma having low ZW10 interactor expression had a shorter overall survival time and time to recurrence compared to cases with high ZW10 interactor expression in the prognostic cohort ( P < .0001 for both overall survival and time to recurrence ). Univariate and multivariate Cox analyses indicated that ZW10 interactor was an independent prognostic factor for overall survival ( P = .033). Conclusions: The present study clearly showed that ZW10 interactor was frequently decreased in hepatocellular carcinoma compared to nontumoral liver tissues, and ZW10 interactor could serve as a potential prognostic marker in patients with hepatocellular carcinoma after surgery.
Twitter Analysis of #OpenAPS DIY Artificial Pancreas Technology Use Suggests Improved A1C and Quality of Life
Authors: Litchman Michelle L. , Lewis Dana , Kelly Lesly A. , Gee Perry M. 
Published: September 2018

Background: Patient-driven innovation in diabetes management has resulted in a group of people with type 1 diabetes who choose to build and share knowledge around a do-it-yourself (DIY) open source artificial pancreas systems (OpenAPS). The purpose of this study was to examine Twitter data to understand how patients, caregivers, and care partners perceive OpenAPS, the personal and emotional ramifications of using OpenAPS, and the influence of OpenAPS on daily life. Methods: Qualitative netnography was used to analyze #OpenAPS on Twitter over a two-year period. Results: There were 328 patients, caregivers, and care partners who generated 3347 tweets. One overarching theme, OpenAPS changes lives, and five subthemes emerged from the data: (1) OpenAPS use suggests self-reported A1C and glucose variability improvement, (2) OpenAPS improves sense of diabetes burden and quality of life, (3) OpenAPS is perceived as safe, (4) patient/caregiver–provider interaction related to OpenAPS, and (5) technology adaptation for user needs. Conclusions: As users of a patient-driven technology, OpenAPS users are self-reporting improved A1C, day-to-day glucose levels, and quality of life. Safety features important to individuals with diabetes are perceived to be embedded into OpenAPS technology. Twitter analysis provides insight on a patient population driving an innovative solution to improve their quality of diabetes care.
Development and Implementation of a Subcutaneous Insulin Clinical Decision Support Tool for Hospitalized Patients
Authors: Mathioudakis Nestoras , Jeun Rebecca , Godwin Gerald , Perschke Annette , Yalamanchi Swaytha , Everett Estelle , Greene Peter , Knight Amy , Yuan Christina , Hill Golden Sherita 
Published: September 2018

Background: Insulin is one of the highest risk medications used in hospitalized patients. Multiple complex factors must be considered in determining a safe and effective insulin regimen. We sought to develop a computerized clinical decision support (CDS) tool to assist hospital-based clinicians in insulin management. Methods: Adapting existing clinical practice guidelines for inpatient glucose management, a design team selected, configured, and implemented a CDS tool to guide subcutaneous insulin dosing in non–critically ill hospitalized patients at two academic medical centers that use the EpicCare® electronic medical record (EMR). The Agency for Healthcare Research and Quality (AHRQ) best practices in CDS design and implementation were followed. Results: A CDS tool was developed in the form of an EpicCare SmartForm, which generates an insulin regimen by integrating information about the patient’s body weight, diabetes type, home and hospital insulin requirements, and nutritional status. Total daily recommended insulin doses are distributed into respective basal and nutritional doses with a tailored correctional insulin scale. Preimplementation, several approaches were used to communicate this new tool to clinicians, including emails, lectures, and videos. Postimplementation, a support team was available to address user technical issues. Feedback from stakeholders has been used to continuously refine the tool. Inclusion of the programming in the EMR vendor’s community library has allowed dissemination of the tool outside our institution. Conclusions: We have developed an EMR-based tool to guide SQ insulin dosing in non–critically ill hospitalized patients. Further studies are needed to evaluate adoption and clinical effectiveness of this intervention.
Influence of Color in a Lactation Room on Users’ Affective Impressions and Preferences
Authors: López-Tarruella Juan , Llinares Millán Carmen , Serra Lluch Juan , Iñarra Abad Susana , Wijk Helle 
Published: September 2018

Objective: The present study aims to examine the influence of environmental color hue in a lactation room at a health center on users’ affective response and preference. Background: Hospital design plays an important role in the emotional experience of patients. In this regard, many studies have attempted to find relationships between design variables and healthcare facilities users’ response. Color has been frequently examined because it is always present in the environment and can be easily changed. However, most of the studies dealing with color–emotion relationships acquire users’ affective response by questionnaires developed by experts which could lead to inaccurate results since nonexperts may misunderstand concepts set by experts and use nonimmersive images to simulate the environments to assess. Methods: To overcome these limitations, a Kansei Engineering–based approach was proposed. In the first phase, users’ specific affective factors for lactation rooms were determined using Semantic Differential. In the second phase, the influence of nine different color hues on users’ affective factors was obtained. An immersive display system was used to visualize the room altering hues in an isolated and controlled way. Results: (1) Six user’s affective factors connected to the lactation rooms were discovered: safety, elegance, coziness, spaciousness, simplicity, and luminosity, of which coziness has the most impact on the assessment of the room. (2) Warm colors like orange and yellow tend to score highly for coziness which puts them in leading positions when users’ assess lactation rooms. Conclusions: Results provide recommendations for designers and show the advantages of using semantic differential and immersive displays to analyze user’s affective response to environments.
A Retrospective Analysis of Prolonged Empiric Antibiotic Therapy for Pneumonia Among Adult Neurocritical Care Patients
Authors: Patzke Ciera L. , Armahizer Michael J. , Badjatia Neeraj , Motta Melissa 
Published: September 2018

Background and Purpose: Current literature reports that half of critically ill patients are continued on broad-spectrum antibiotics beyond 72 hours despite no confirmed infection. The purpose of this retrospective study was to identify the incidence of and risk factors for prolonged empiric antimicrobial therapy (PEAT) in adult neurocritical care (NCC) patients treated for pneumonia, hypothesizing that NCC patients will have a higher incidence of PEAT. Methods: This is a retrospective chart review of adult NCC patients treated for pneumonia. Antibiotic therapy was classified as restrictive, definitive, or PEAT based on culture results and timing of discontinuation or de-escalation. Results: A total of 95 patients (median age: 57 years; 28.4% female; admission diagnosis: 73.7% cerebrovascular, 10.5% neuromuscular, and 15.8% seizure-related) were included in this study. Overall, 59% of antibiotic regimens were considered PEAT, with vancomycin and piperacillin/tazobactam being most commonly prescribed. Median duration of therapy was 6.8 days, with shorter duration in patients with negative culture results compared to those with positive culture results (6.1 days [interquartile range, IQR 4.0-8.3] vs 7.2 days [IQR 5.8-10.3], P < .05). On multivariable analysis, elevated baseline white blood cell count, meeting Centers for Disease Control criteria for pneumonia, and negative bacterial culture were significantly associated with PEAT. Conclusion: The incidence of prolonged empiric antibiotic use was high in the NCC population. Patients are at particular risk for PEAT if they have negative cultures. All but one patient did not meet criteria for central fever, highlighting the challenges in identifying fever etiology in the NCC population.
Chronic pain: a consequence of dysregulated protective action
Authors: Hill Patrick 
Published: September 2018

Introduction: Pain is considered to be one of a number of idiosyncratic, context-dependent ‘protective actions’ projected into the conscious domain by the central nervous system (CNS), as a result of a series of complex interactions in response to perceived threat. A model is described which proposes chronic pain and a variety of long-term, systemic functional neurological conditions to be a consequence of significant dysregulation of these protection systems. The Model: Previous research has demonstrated that a cognitive–behavioural model, first described in 1995 by Surawy et al., for chronic fatigue has been successful in predicting the transition from acute to chronic states in a number of conditions. This model includes predisposing, precipitating and perpetuating biopsychosocial factors. This article discusses the potential role of these factors in affecting descending inhibition in the CNS, significantly altering its ability to modulate the threat detection system. The development of ‘central sensitisation’ is considered in this context. Conclusion: This model proposes that chronic pain, chronic fatigue and other so-called functional neurological phenomena can, perhaps, be more helpfully seen as the actions of a dysregulated neurological protection system, rather than symptoms of an untreatable and deteriorating medical condition. Recommendations are made for the development of appropriate therapeutic interventions indicated by this model.
Maximizing Benefit and Minimizing Risk in Medical Imaging Use: An Educational Primer for Health Care Professions Students
Authors: Armao Diane , Hartman Terry S , Shea Christopher M , Katz Laurence , Thurnes Tracey , Smith J Keith 
Published: September 2018

“I am not young enough to know everything.” Oscar Wilde Background: There is insufficient knowledge among providers and patients/caregivers of ionizing radiation exposure from medical imaging examinations. This study used a brief, interactive educational intervention targeting the topics of best imaging practices and radiation safety early in health professions students’ training. The authors hypothesized that public health, medical, and physician assistant students who receive early education for imaging appropriateness and radiation safety will undergo a change in attitude and have increased awareness and knowledge of these topics. Materials and methods: The authors conducted a 1.5-hour interactive educational intervention focusing on medical imaging utilization and radiation safety. Students were presented with a pre/postquestionnaire and data were analyzed using t tests and multivariate analysis of variance. Results: A total of 301 students were enrolled in the study. There was 58% ( P < .01) and 85% ( P < .01) improvement in attitude and knowledge regarding appropriateness of imaging, respectively. The authors also found an 8% increase ( P < .01) in students who thought informed consent should be obtained prior to pediatric computed tomographic imaging. Physical assistant students were more likely than medical students to prefer obtaining informed consent at baseline ( P = .03). Conclusions: A brief educational session provided to health professions students early in their education showed an increased awareness and knowledge of the utility, limitations, and risks associated with medical imaging. Incorporation of a best imagining practice educational session early during medical education may promote more thoughtful imaging decisions for future medical providers.
Single-cell heterogeneity in Sézary syndrome
Authors: Buus Terkild Brink , Willerslev-Olsen Andreas , Fredholm Simon , Blümel Edda , Nastasi Claudia , Gluud Maria , Hu Tengpeng , Lindahl Lise M. , Iversen Lars , Fogh Hanne , Gniadecki Robert , Litvinov Ivan V. , Persson Jenny L. , Bonefeld Charlotte Menné , Geisler Carsten , Christensen Jan Pravsgaard , Krejsgaard Thorbjørn , Litman Thomas , Woetmann Anders , Ødum Niels 
Published: September 2018

Key Points
Individual patients with Sézary syndrome contain several distinct malignant subpopulations and show marked single-cell heterogeneity. Malignant subpopulations exhibit differences in their sensitivity to treatment warranting precision therapy.
Patient Factors Associated With Delays in Obtaining Cancer Care in Botswana
Authors: Bhatia Rohini K. , Rayne Sarah , Rate William , Bakwenabatsile Lame , Monare Barati , Anakwenze Chidinma , Dhillon Preet , Narasimhamurthy Mohan , Dryden-Peterson Scott , Grover Surbhi 
Published: September 2018

Purpose Delays in diagnosis and treatment of cancers can lead to poor survival. These delays represent a multifaceted problem attributable to patient, provider, and systemic factors. We aim to quantify intervals from symptom onset to treatment start among patients with cancer in Botswana and to understand potential risk factors for delay. Patients and Methods From December 2015 to January 2017, we surveyed patients seen in an oncology clinic in Botswana. We calculated proportions of patients who experienced delays in appraisal (between detecting symptoms and perceiving a reason to discuss them with provider, defined as > 1 month), help seeking (between discussing symptoms and first consultation with provider, defined as > 1 month), diagnosis (between first consultation and receiving a diagnosis, defined as > 3 months), and treatment (between diagnosis and starting treatment, defined as > 3 months). Results Among 214 patients with cancer who completed the survey, median age at diagnosis was 46 years, and the most common cancer was cancer of the cervix (42.2%). Eighty-one percent of patients were women, 60.7% were HIV infected, and 56.6% presented with advanced cancer (stage III or IV). Twenty-six percent of patients experienced delays in appraisal, 35.5% experienced delays help seeking, 63.1% experienced delays in diagnosis, and 50.4% experienced delays in treatment. Patient income, education, and age were not associated with delays. In univariable analysis, patients living with larger families were less likely to experience a help-seeking delay (odds ratio [OR], 0.31; P = .03), women and patients with perceived very serious symptoms were less likely to experience an appraisal delay (OR, 0.45; P = .032 and OR, 0.14; P = .02, respectively). Conclusion Nearly all patients surveyed experienced a delay in obtaining cancer care. In a setting where care is provided without charge, cancer type and male sex were more important predictors of delays than socioeconomic factors.